Throughout the former Crownsville Hospital cemetery in Anne Arundel County, leaves have piled up on tiny bricks inscribed with numbers that mark where former patients of the hospital are buried. There are no names on the markers.

The patients of the hospital, which treated African Americans transferred from correctional facilities and charitable residences, didn’t have relatives to bury them, so the hospital started its own anonymous mass grave.

For nearly two decades, Janice Hayes-Williams, an Anne Arundel County historian, has dedicated herself to identifying the former patients and bringing attention to their lives. Once called the “Hospital for the Negro Insane” in Maryland, it gained notoriety for its severe mishandling and mistreatment of patients.

Now others are joining Hayes-Williams in bringing attention to the hospital’s past. Anne Arundel County has been endeavoring to repurpose the land while simultaneously acknowledging its troubled history and commending the efforts of those dedicated to preserving this historical narrative.

Author Antonia Hylton’s book, “Madness: Race and Insanity in a Jim Crow Asylum,” which comes out next month, covers the dark and complex history of Crownsville Hospital.

The correspondent for NBC News and MSNBC highlighted neglect, unsanitary conditions, inadequate food and frequent occurrences of violence that patients experienced. She dedicated years to studying the history of Crownsville Hospital and delving into the circumstances that contributed to its establishment.

Long before Crownsville opened, white doctors and state leaders across the South speculated about mental illness among Black people, first during slavery, debating whether they thought it was real or not, Hylton found in her research. They noted rising cases of insanity and questioned why.

“You rarely see anyone pause to wonder the role that slavery might have played in Black people’s mental health challenges in that early period,” Hylton said.

Consequently, a number of states created segregated hospitals informed by white doctors who believed that Black and white people were different and needed to be treated separately, Hylton said. Thus Crownsville was built on a foundation of medical racism, she said.

The first three buildings for the hospital were built by 12 men who were brought to the forest to work. They were subjected to strenuous labor such as laying bricks, pouring concrete, clearing roads and moving railroad tracks. After the buildings were completed, they went on to become patients.

“It’s the only case I have been able to find in the United States of an asylum, a mental hospital where its own patients were forced to help build it from the ground up,” Hylton said.

As more patients came in, they were put to work as well. Patients were subjected to heavy farm labor and agricultural work and were rented out to nearby businesspeople who wanted free Black labor, Hylton said.

Not only were patients exploited for labor, but they also lived in substandard and overcrowded facilities and endured questionable therapy.

Patients received treatments such as hydrotherapy and electroshock therapy. Hydrotherapy entailed immersing the patient’s body, excluding the head, in either extremely cold or hot water within a tub, often for prolonged periods extending to hours or even days. Electroshock therapy involved administering an electric current through the patient’s brain.

“Shock was overused and very aggressive. People could leave electroshock with spinal fractures and damage to their bodies,” Hylton said.

Crownsville dealt with severe overcrowding. Patients sometimes slept on floors or on open porches or slept two to a bed. There were reports of patients being fed rotten food and consistently being beaten by employees, Hylton said.

The hospital, filled with a racist and troubled past, was integrated in 1963, according to Maryland State Archives. However, violence and questionable practices continued.

Former patient Guy Ferguson described his time there from 1976 to 1983 in the documentary “In the Crownsville: Lunacy to Legacy.”

“I thought I died and gone to hell,” Ferguson said.

The hospital closed in 2004 due to declining patient numbers, but its history lives on.

Hayes-Williams started the “Say My Name” ceremony to tell the story of marginalized people. The ceremony, in remembrance of the institutionalized patients buried at the hospital, involves a cleanup of the cemetery and speeches from community members. By using her connections in the community and tracking down old records, she has pent the past 19 years identifying patients of Crownsville who were buried at the cemetery in graves marked only by numbers.

“The government created mass burials,” she said. “The reason there is a Say My Name ceremony is because there is no name on their tombstones.”

Efforts across the nation have been made to memorialize Black gravesites that were neglected or unmarked. A National Geographic article, “The fight to save America’s historic Black cemeteries,” said the organization Friends of the East Cemetery revitalized a 16-acre site where an estimated 17,000 Richmond citizens were buried. Brooklyn cemetery in Athens, Georgia, was neglected for decades, but through volunteer work the cemetery was restored.

Hayes-Williams and volunteers have documented almost 1,700 names of patients. Sometime in the near future, a memorial will be placed in the cemetery to honor those who were buried.

State Sen. Dawn Gile, who serves District 33, which includes Crownsville, has participated in the “Say My Name” ceremony.

“That’s what’s so important about remembering the tragedy there, is that we can make it to have a sense of healing and to recognize and not forget that was what happened instead of just glossed over it. The community needs to be aware of what existed there,” Gile said.

Racism and the stigma surrounding mental health at the time fostered an environment where these atrocities occurred for years. Now, Anne Arundel County is not only acknowledging the painful history but is working to repurpose the hospital.

Anne Arundel County Executive Steuart Pittman has also made great strides in preserving Crownsville. In 2022, Pittman convinced the state to give ownership of Crownsville to the county to be used as a park and nonprofit center.

Pittman said at his December 5, 2022, inauguration speech: “Today, in this place, we launch Crownsville Hospital Memorial Park, and its campus for the community-based nonprofit organizations that so effectively deliver behavioral health services, food assistance, job training, and anything and everything that promotes the social determinants of good health.”

The Crownsville Advisory Committee is in the early stages of planning for a memorial park and how to best use the land. The committee has four subcommittees, including cultural history, health and wellness, infrastructure, and recreation and parks.

Gile, a member of the advisory committee, expressed intentions to acknowledge the deeply concerning historical aspects while aiming to use them as a foundation for healing and fostering hope.

“[We] have to really have a recognition of where we come from and what are we now, what are we going to do about it, and how can we honor that memory those there and not just glossed over it and make it a true faith healing,” Gile said.

Some vendors located at the former hospital site are the Anne Arundel County Food Bank; Gaudenzia, a substance use and co-occurring disorders treatment program; and Hope House, a nonprofit dual diagnosis treatment center.

Pittman acknowledges the significance of addressing not just the historical aspects of Crownsville but also correcting its history.

“That is part of the magic of the whole thing, is that people in this county, they understand what went on there and that’s what we have to heal from what’s going on there. Both the racism and the way the mental health is being treated, but also in the way America has handled mental health for everybody,” Pittman said.