Incompetent to Stand Trial Policies in Maryland are Incompetent Themselves
Research on effective policies
and fiscal efficacy ignored

WASHINGTON, D.C. — When it comes to the length of treatment for people deemed incompetent to stand trial (IST), Maryland’s policies and practices are not in line with national standards, cost too much, and disproportionately impact African Americans, according to a new report released today by the Justice Policy Institute (JPI). People who are charged with a crime must be able to understand the court proceedings and charges against them, and be able to assist counsel, otherwise they are deemed “incompetent to stand trial” and receive treatment to attempt to restore competency so that they may be tried for the offense. Twenty states have statutes limiting the length of competency treatment to a year or less, but Maryland instead chooses to link time in compulsory treatment to the sentence of the alleged offense. Tying maximum treatment lengths to potential sentences before adjudication goes against research: whether competency can be restored can usually be determined within six months to a year in treatment, regardless of the offense. The report found that most people held at Spring Grove Hospital Center on incompetency status in the Baltimore City District Court are never convicted of the offense, and if they are, they do not receive sentences of incarceration; they are in effect being forced to “serve time” in a state mental hospital long past when it is clear whether competency can be restored. This has the effect, if not the intent, of “punishing” people outside the judicial system.

At a time when Maryland is investigating its need for psychiatric beds, When Treatment is Punishment: The effects of Maryland’s incompetency to stand trial policies and practices, delves into how an increase in the number of people on incompetency status in mental hospitals in Maryland—and increasing lengths of stay for this group—has led to greater costs, both in terms of people’s lives and taxpayer dollars. Baltimore City District Court, in particular, has seen an increase in people being sent to mental hospitals for incompetency treatment for longer periods of time, even though few if any of them will ever be convicted of the charged offense. In fact, in the first six months of 2011, none of the 24 people from Baltimore City whose IST cases were resolved were sentenced to spend any time behind bars, even after spending over a year on average in Spring Grove.

While some U.S. jurisdictions have adopted evidence-based maximum treatment periods and have shifted to greater use of outpatient treatment to attempt to restore competency, others, including Maryland, require costly inpatient treatment for too many people and allow those people to remain confined for long periods of time.

“Mental health treatment is a crucial government service that communities depend on, but abusing incompetency standards to hold people for years at a time against their will and without due process is unfair and unethical,” said Nastassia Walsh, principal author of When Treatment is Punishment. “Maryland’s incompetency to stand trial policies and practices need to be changed to reflect research on effective practices, and to ensure scarce mental health dollars are being put to best use.”

It costs Maryland taxpayers $512 per person, per day to hold someone in Spring Grove Hospital Center, where the majority of people charged in Baltimore City District Court are placed. People in Spring Grove on IST status spend an average of 414 days in the hospital while attempting to restore competency, at the average cost of $211,968 per person. If people who ultimately are found “unrestorable” were held even a year instead of the current average of 579 days, the state of Maryland could save over $100,000 per person. As treatment in communities can be as effective and significantly less expensive, treatment in state hospitals should be a last resort.

“We question court takeover of mental health services for persons who have not committed serious violent crimes, who are being served by the mental health system and who will continue to be served by that system and not in jails or prisons,” said Laura Cain, managing attorney for the Maryland Disability Law Center, the protection and advocacy agency for Maryland. “Judicial approval of mental health plans for persons who ultimately will not be processed through the criminal justice system intrudes on the purview of the executive branch of government and skews critical resources of the Department of Health & Mental Hygiene.”

Walsh, who is also the research manager for JPI, noted, “People are being involuntary confined to a mental hospital without being found guilty of any offense. In essence, they are left in ‘competency limbo’ waiting for court and mental health stakeholders to come to a conclusion that will mean the closing of their case. Research shows that if people are going to be restored to competency, it will happen, on average, within 180 days. The average stay for those who are restored to competency at Spring Grove is nearly twice that rate—314 days. We all want people to receive the treatment that they need, but current practices of holding people longer than necessary under criminal justice status is ineffective policy.”

When Treatment is Punishment includes a number of recommendations for cost-effective criminal justice policies that will reduce the number of people unnecessarily held in state mental hospitals:

  • Develop training for all court personnel and treatment providers on effective practices and standards for treatment to restore competency, including out-patient treatment and appropriate limits on treatment periods.
  • Establish policies and practices in DHMH facilities to ensure that people are found “not dangerous”, restored to competency or determined unrestorable more quickly and consistent with research.
  • Develop processes for streamlining competency evaluations for people confined while awaiting evaluations—especially those being held in jails.
  • Develop policies and practices for people with TBI or other ABI, including valid and reliable measures for screening, training for court personnel and treatment providers, and appropriate community-based programs.
  • Ensure that community-based mental health resources are available and properly utilized.
  • Invest in quality, affordable and supportive housing for people who need it.
  • Eliminate quality of life policing sweeps that bring more people with mental illness and other mental disabilities into the justice system.
  • Establish a special police team based on Memphis’ Crisis Intervention Teams model to respond to mental health or behavioral crises without the use of arrest.
  • Ensure that studies on future state hospital bed needs and redevelopment plans take into account findings that people are unnecessarily confined for treatment to restore competency and for too long.

Tracy Velázquez, executive director of the Justice Policy Institute, said the organization took on this report because “it was an issue that has received scant attention, although it has a large impact on people’s lives and state budgets. We believe people should be treated fairly at all points in the justice system, including when they are being held and treated for competency to stand trial issues.”

To read When Treatment is Punishment, CLICK HERE. For additional information, please contact Zerline Hughes at (202) 558-7974 x308 or [email protected]. For more JPI reports on the criminal justice system, please visit our website at

The Justice Policy Institute, based in Washington, DC, is working to reduce the use of incarceration and the justice system and promote policies that improve the well-being of all people and communities. For more information, please visit