Waiting for treatment

March 05, 2007

Karen Williams, convicted of prostitution and parole violation last year, has used drugs for 21 years. But she also suffers from a bipolar disorder, and the combination has put her at a distinct disadvantage. When offenders have mental health and substance abuse issues, a judge can order them into treatment under Maryland law. But as more of these cases have been identified, it's shamefully clear that Maryland has far too few appropriate treatment slots to help them. The result is that Ms. Williams and similar offenders sit in jail, often for months at a time, not getting help for their mental health issues or their substance abuse problems.

The state's inability to secure prompt treatment for five such offenders prompted a district judge to hold the Maryland Alcohol and Drug Abuse Administration in contempt recently. Gov. Martin O'Malley's administration needs to pay more attention to the issue and work with judges and state legislators to solve it.

Judges have the option under state law to order specific defendants into residential treatment programs that are generally funded under contracts with ADAA. It's also generally accepted as good practice that people with so-called co-occurring substance abuse and serious mental health issues - such as schizophrenia, bipolar disorder and severe depression - should receive simultaneous and not separate treatment.

That's frustrating for judges, who consistently try, often in vain, to get an accurate timetable for when treatment beds will be available. The frustration was one reason why District Judge Jack Lesser held ADAA in contempt last month for failing to promptly provide appropriate beds for the five offenders with co-occurring illnesses. Although the state offers some general treatment options, with contracts for about 150 long-term residential substance abuse beds and about 50 beds for people with co-occurring disorders, that's woefully inadequate. In just one of Baltimore's three district courthouses last year, 166 people were sentenced to court-ordered drug treatment and 55 had mental health and substance abuse issues.

More money needs to be provided for long-term residential treatment programs, and standards need to be developed to ensure quality programs, particularly those for drug users with mental illnesses.

Since the contempt order, beds have suddenly opened up and most of the offenders are much closer to being treated. But there are still too many people like Karen Williams walking around. She recently stated at a court hearing, "I just need the program. ... I'm tired of starting and stopping with myself." But after a five-month stay in jail waiting to get into a program, she was sentenced to time served and released. As far as anyone knows, she is not in treatment.

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