Content warning: sexual, emotional, medical, physical abuse of mentally ill people in jails
In October 2017, The Baltimore Sun wrote a scathing op-ed highlighting how the state of Maryland fails people with mental illnesses. A month before the article was published, Judge Gale Rasin had found that the acting state health secretary and four other top officials had “willfully disregarded orders to increase the number of psychiatric hospital beds available for criminal defendants, some of whom had been languishing in jail for weeks waiting for treatment.”
The Sun reported that Maryland criminalizes mental illness instead of treating it as a necessary part of healthcare; the number of treatment beds available is consistently far fewer than the number of people in need of treatment. This pattern of criminalization has continued in the years since the Sun published its op-ed and is visible in Courtwatch data. From January to October 2022, our volunteers observed 117 hearings in which defense attorneys proffered that their clients had mental health conditions. In 58.1 percent of these hearings, judges ordered the defendant held without bond.
In one of those hearings, in September 2022, Assistant State’s Attorney Justin Greer argued for a mentally ill person, who had been shot by the police, to be held without bond, based on the grounds that mental health should be provided by the state, not in a person’s house. Judge Jeannie Hong granted the order, forcing the person not just to stay in jail awaiting an evaluation, but to be placed on suicide watch.
Suicide watch is state sanctioned sexual, physical, medical, and emotional abuse. People held in this unit are not necessarily suicidal — judges can use their discretion as to whether to put a person in the Inpatient Mental Health Unit (IMHU), where people on suicide watch are housed. While in the IMHU, a person is in solitary confinement, locked in a cage for 23 hours a day, and only let out for a few hours each week. Everyone in this unit is forcibly stripped naked, and there is no privacy. This horror is not only directed towards mentally ill adults; often trans people, children, and people with cognitive disabilities endure the worst of the dehumanization. The ACLU published a letter in October 2022 after visiting Baltimore Central Booking and Intake Center, stating that “people in the IMHU are held in the harshest and most deprived conditions we have ever encountered in any prison or jail in the United States, including in death row and ‘supermax’ units.”
Out of the 117 hearings we observed involving people with mental health concerns, 34 were for children being prosecuted as adults. Of these 34 hearings, 76.5 percent ended with the child being held without bond. In other words, more often than not, children with mental illnesses are punished by the criminal legal system instead of given care. When looking at the adults in the 117 hearings, adults with mental health concerns are held without bond 50.6 percent of the time. Clearly, children with mental health concerns are held without bond at a much higher rate than their adult counterparts.
Jail is a site of daily retraumatization for people with mental illnesses. At almost every docket we observe, we hear defense attorneys tell judges that their clients’ mental health is rapidly deteriorating in jail — especially when people are held without a trial date in sight. This causes people to miss appointments, evaluations, competency hearings, and any type of treatment or therapy. Often, medications a person was previously taking are not administered in jail.
In addition to losing access to medical care, people’s basic needs, such as housing, can be taken away while they are incarcerated. Our observers heard cases where people with mental health concerns were evicted after being arrested, or had their homes foreclosed on while in jail. According to the National Low Income Housing Coalition, evictions are associated with depression and poorer mental health. In February 2022, Hong heard a case where the defendant would lose their housing if they were not released. She ordered them held without bond. In March 2022, Judge Cynthia Jones held a child without bond who became homeless after not having a treatment bed available.
In some bail review hearings, defense attorneys present a treatment plan to the court, asking for their client to be admitted into a mental health program, with the condition of either release on recognizance or electronic monitoring. These plans include treatment facilities, medication management, therapies, rehabilitation, and other services that address the individual’s needs and the root causes of their circumstances. Far too often, judges rule that they are better off in jail, sometimes over a concern as comparatively trivial as a treatment program’s inability to transport people from jail to the new facility.
Judges have the power of discretion to determine whether or not to release someone to a treatment program. We have witnessed judges justify refusal to allow someone to receive mental health treatment in many ways — sometimes it is dissatisfaction with a specific location, the security level of a certain facility, the amount of time a program takes, or the types of services offered. In other cases we have heard judges express disbelief that a person needs treatment at all for their illness. Mental health care should be available for everyone, not just those deemed worthy by a judge.
In a just world, everyone is able to access mental health care: people with mental illness could be in charge of their own treatment plan, and anyone could access opportunities for community care and resources for healing. People with mental health concerns should have the right to housing, to consensual medical care, and to take care of themselves and their families. Instead, Baltimore’s jails eat up resources that might make that world possible and offer the exact opposite, inflicting and compounding trauma and exacerbating mental illness, and the judges and prosecutors who are confronted every day with this reality nonetheless choose to feed vulnerable people into them.