Every day, hundreds of mentally ill people languish in Maryland's jails, awaiting trial or serving sentences for crimes often committed as a result of their illnesses.
Most have committed petty offenses but are jailed anyway because law enforcement officials have few other options.
Take the case of Marc K. King. A Glen Burnie native, he has been jailed at least six times for trespassing, breaking and entering, malicious destruction of property. He once started a fire to keep warm in an abandoned house.
"They treated me like a dog in jail," he said, describing his incarceration in Anne Arundel County. "I had no medication, no treatment. They threw water on me. They called me names. Then they released me to the street."
The justice system sees Mr. King as a criminal who needs to be behind bars. Mental health advocates say he is a paranoid schizophrenic who needs treatment and a place to live.
"His crimes are logical things to do, really, considering his circumstances," said Lois Miller, executive director of Omni House, a community-based program where Mr. King lives. "If it's cold, he breaks in somewhere to get warm. If he's hungry, he steals something to eat.
"Obviously something's got to be done. But putting someone like Marc in jail is not the answer."
The state's answer is a series of pilot programs the Mental Hygiene Administration started in four counties two years ago. The goal is to help the mentally ill before they are jailed, during incarceration and after they are released.
The program receives $200,000 a year. The state will add $160,000 July 1.
Advocates say the program is an important first step for Maryland, which a 1992 study ranked 42nd in terms of helping mentally ill jail inmates after their release.
Fewer than 17 percent of the state's mentally ill inmates get help after their release, said the report, conducted by The National Alliance for the Mentally Ill and Ralph Nader's Public Citizen's Health Research Group.
Jail superintendents estimate that 5 percent to 10 percent of the state's 7,500 jail inmates suffer from serious, chronic mental illness. Mental health professionals say the number could be as high as 20 percent, because many inmates are not diagnosed.
Though the state is trying to deal with the problem, critics say the efforts are not likely to make much of a difference.
"There's a serious level of denial about the magnitude of the problem," said Patricia Sollock, who runs a unit for mentally ill inmates at the Montgomery County jail. "It's like an ostrich. If you bury your head in the sand and don't see the problem, you don't have to do anything about it. And that's pathetic."
One of the program's biggest shortcomings is that it does not sufficiently address the housing problem, said Ms. Sollock. Without safe housing, the mentally ill are less likely to follow treatment plans, stay on medication and out of jail.
"I agree with what the pilot program is trying to do," said Carolyn Knight, president of the Montgomery County chapter of the Alliance for the Mentally Ill. "But [the grant] is not even enough to get started in most counties. So, many think, 'Why bother?' "
Eldon C. Watts, director of the state's Jail Mental Health Program, said resources are inadequate.
"Obviously, there's not enough resources. But it's a very good start," he said.
Dr. Stuart Silver, director of the Mental Hygiene Administration, agreed. "Let's look at what we can do with what we do have," he said. "You just can't say, 'I don't have a million dollars, so I'm not going to do anything.' "
The number of mentally ill in Maryland jails has grown steadily since the "deinstitutionalization" movement of the early 1970s emptied psychiatric hospitals.
Thousands of people who might have spent their lives hospitalized are now spending them in and out of jails, said advocates.
"All we've done is trans-institutionalized the problem," Ms. Sollock said.
Yet health professionals and jail officials have been slow to accept responsibility, pointing fingers at each other. Meanwhile, little is done to help mentally ill inmates.
Ethel Nemcek of Hagerstown believes her son, Charles S. Cross, might be alive if he had received better treatment for his mental illness two years ago. Mr. Cross committed suicide in the Anne Arundel jail in 1992.
He had been in and out of special schools, psychiatric hospitals and juvenile detention centers since he was 8, said his mother. In 1991, after turning 18, he was placed in Crownsville Hospital Center in Anne Arundel County. Soon he was in jail, charged with felony escape.
More than once, he called home crying, his mother said.
"He said, 'Bugs are crawling all over me,' " Mrs. Nemcek recalled. "This is a boy who had been on Thorazine for 10 years. And they let him go off it cold turkey?"
Not until she threatened to call the news media did the jail resume his medication, she said. His condition continued to worsen. He was released, then jailed again after losing control at a court hearing.