An Anne Arundel County judge has ripped the Maryland Department of Health for its presentation of what he described as a woefully inadequate plan to address the state’s psychiatric bed crisis.

Responding to a mandate from Circuit Judge Ronald A. Silkworth, health department officials on Thursday testified about their proposed solutions to a long-standing crisis in which defendants deemed too mentally ill to be prosecuted languish in jail rather than getting treated at state psychiatric hospitals.

Maryland law requires the health department to accept defendants who judges deemed dangerous and incompetent to stand trial to hospitals within 10 days of a court order. But with the health department’s 1,056 psychiatric beds perpetually full, that almost never happens.

According to the health department, there are an average of 235 people waiting in jail for hospital beds at any given time. It takes the department an average of 57 days to admit a defendant to one of its four regional mental hospitals and roughly six months for its maximum-security psychiatric facility, which is reserved for people accused or convicted of violent felony crimes.

Amelia Tibbett, director of the health department unit that oversees court-ordered hospital placements, outlined efforts such as a “waitlist challenge,” which focuses on enhanced coordination between the health department and its hospitals. The goal is to discharge and admit 15 patients weekly.

She credited the plan with reducing the number of people waiting for beds from a record of 240 in February to 225 Thursday.

But Ellen Goodman Duffy, a deputy district public defender for Anne Arundel County, questioned Tibbett about the long-term prospects of her plan.

“This seems like we’re trying to hold the line, but how are we going to get under the number we are at now?” Duffy asked.

The challenge led to better communication, Tibbett said. “Each hospital is taking this challenge seriously,” she said.

Silkworth interjected, “This is not a waitlist issue. This is a constitutional crisis.”

“This has been a decades-long problem. … This is about real change," the judge said.

Silkworth is among the judges around Maryland who have imposed fines totaling millions of dollars against the health department for failing to follow the 10-day law, with many expressing frustration about a lack of progress despite weighty court sanctions.

In 2017, a Baltimore Circuit Court judge held the state health secretary in contempt of court for failing mentally ill defendants. The following year, the General Assembly passed a law establishing the 10-day deadline, with lawmakers describing it as a long-standing “serious public safety risk and a violation of the United States Constitution.”

Since 2019, the health department has added 63 psychiatric beds, according to its report. It also recently hired an immigration attorney to help with the discharge of patients lacking documentation, an increasing problem that health officials said was slowing the patient turnover rate in hospitals.

State budget constraints are holding up plans to add approximately 150 beds across three hospitals, including 60 at the maximum-security Clifton T. Perkins Hospital Center, Tibbett testified.

More pressing, she said, was the risk of losing all 289 beds at Perkins because regulators recently discovered HVAC and plumbing problems. Regulators gave the health department three weeks to fix the problem, or risk losing the hospital’s accreditation. Emergency funds were immediately released to fix the problem, Tibbett added.

“If we do not meet their standards, they’ll shut us down,” she said.

Adding bed capacity is a small part of the health department’s plan.

It also calls for diverting people before they enter the criminal justice system; increasing opportunities for patients to transition out of inpatient care; moving eligible patients from Perkins to lower-security facilities; allowing defendants accused of certain misdemeanor crimes to go to residential rehab; and bolstering clinical staff across the hospital system.

“I think they have enough staff to be operational,” Tibbett said of the hospital system. “I think they need more staff, clinical staff, to move people through quicker.”

Silkworth said he was disappointed that the plan lacked specifics, questioning whether it “has any meat to it” and doubting it would lead to significant change.

“I’m not looking for a piece-of-paper plan,” the judge said. “I’m looking for a real action plan.”

Like health officials before her, Tibbett expressed dismay about an increasing number of court orders requiring the health department to admit mentally ill defendants. She said the department receives about 25 such orders a week. Courts ordered that defendants be committed to the department 865 times in 2022, 1,126 times in 2023 and 1,014 times in 2024.

The senior judge suggested that growing awareness in the criminal justice system about mental illness could be contributing to those figures.

Defendants are deemed incompetent to stand trial when they cannot, because of a mental condition, understand the charges against them or the roles of those in the court system. Judges also have to determine whether they are dangerous — that is, whether they would present a danger to themselves or others if released. Only if found to be dangerous are defendants committed.

A disability rights group in January sued the health department in federal court, alleging that it was violating the U.S. Constitution, the Maryland Declaration of Rights, and the Americans with Disabilities Act by leaving mentally ill people to languish in jail. The complaint noted that health department clinicians conduct the evaluations that judges rely on to decide whether to commit someone.

In a recent court filing, Disability Rights Maryland said health department evaluators were “over-designating” defendants as dangerous, citing a report that found 97% of defendants deemed incompetent to stand trial in Maryland are also found to be dangerous and committed.

In court, Tibbett said the department didn’t have control over court orders. She said she didn’t have power over the state’s finances or the health department’s. She said the plan still needed to be approved by Meena Seshamani, the new state health secretary.

Tibbett said she believed officials would reduce the waitlist significantly, but doubted whether they would ever be able to comply with the 10-day law.

Duffy encouraged Silkworth to require the health secretary to testify. The judge said he would invite, but not require Seshamani to appear.

Pushing back on a health department lawyer’s suggestion that the plan showed progress, Silkworth said many of the things that Tibbett, who is almost two years into her role, was uncovering “should’ve been institutionalized” long ago.

“We cannot let this go. The issue is too important,” Silkworth said, adding that the plan needs more specifics. “This is not just about managing a chart and numbers, this is about people.”