Montgomery County is contributing more than any other place in Maryland to a worsening bottleneck of severely mentally ill criminal defendants waiting in jail for months on end.
The revelation came in a court hearing last week as a Baltimore County judge slapped the Maryland Department of Health with $608,000 in sanctions over continuing delays in creating enough bed space in its psychiatric hospitals.
The bed shortage — a long-standing problem that has reached record levels over the last year — means that people with severe mental illness are in jail long after judges order them into advanced psychiatric care. State law sets a 10-day deadline for such transfers, but often those defendants are languishing for months.
At the court hearing last week, a state health official under questioning by the district public defender said it was actually not Baltimore and Baltimore County that led the state in court orders to psychiatric care. Montgomery County, he said, has the “highest use,” in both raw and per capita numbers.
To address the problem, the official said, the state has been in talks with county executives about expanding “diversion” programs to reduce the number of people with mental illness from being funneled into the court system in the first place.
Last year, Montgomery County district court’s 174 psychiatric placements more than doubled Baltimore County’s 87 and Baltimore City’s 80, said Earl Stoddard, assistant chief administrative officer for Montgomery County. Stoddard is studying the issue and working with state officials to expand diversion options.
The spike in court placements of incarcerated people requiring psychiatric hospitalization can be attributed to several factors, and is not just a rebound in the criminal courts after a pandemic lull, Stoddard said. There is a new baseline. There were 1,126 court placements to psychiatric care across the state last year, compared to 537 in 2018.
“We’re definitely seeing an increase in mental health issues since the pandemic,” Stoddard said. “But there’s also been a change in the judiciary’s willingness to recognize mental health as a separate issue from criminality.”
In his view, judges in Montgomery County have become more tuned into a national conversation about the criminalization of behaviors that are driven more by mental health issues than by intention to break the law.
“I think the judiciary is largely saying, ‘If I can identify a mental health issue, let’s direct that person toward treatment, because incarceration is not the best option for that person,’” he said.
Yet the mental health system is not prepared to absorb all of the people who five or six years ago would have simply been incarcerated, Stoddard said.
In Montgomery County, people with sentences of 90 days or less make up about 20% of the waitlist to get into a psychiatric hospital from the detention center, Stoddard said.
Beds in state-run facilities can take as long as six months to open up, according to testimony in the court hearing last week, so many of those people are likely to serve out their entire terms in jail, despite the judges’ orders.
Many low-level cases involve nuisance crimes, such as trespassing, Stoddard said. When looking into the issue, he said he has found such cases typically follow repeated interactions between that individual and the police at the same location.
Stoddard said police officers feel they have no other choice but to make an arrest, even if they know that the person likely needs mental health treatment more than they require incarceration.
“They’re frustrated with the fact that they are left to deal with a problem that the rest of society has failed to do prior to that,” he said.
Increasingly, he said, Montgomery County is turning to building places other than jail cells to hold people who might be trespassing due to mental health issues.
The county has set up mobile crisis response teams to respond to calls instead of police. It currently has four and aims to eventually expand to seven.
Montgomery County officials also are building a state-supported diversion center set to open by the end of 2026. Until then, they are working with the state on establishing a smaller-scale diversion program of four or five beds.
Building up the human services side of a changing criminal legal system has been a challenge in Montgomery County, despite the fact that it is flush in resources that many other jurisdictions in the state don’t have. The county is the second-wealthiest in the state by per capita median household income, according to U.S. Census data.
Stoddard said that’s because mental health is a “highly competitive space,” with a lack of providers and staffing shortfalls. And like other parts of Maryland, Montgomery County has a shortage of correctional officers, which makes it harder to create isolated settings for people with mental health issues in the detention center, Stoddard said.
“It’s been one step forward, two steps back, in a lot of regards,” he said.
