Laurie Menino, who oversees five state forensic hospitals, told a Baltimore County Mental Health Coordinating Council meeting that a combination of legal constraints, bed shortages and administrative delays is slowing admissions and discharges of court-ordered patients.

Menino, invited as a special guest, said court orders come through Maryland’s electronic case management systems (MDEC/OSEP), are triaged by acuity and routed by charge level — with high-felony patients going to Perkins — which puts pressure on limited secure beds. "We have the Hawkes case at the back end saying they must be safe when they come back into the community," she said, describing appellate guidance that discharge plans must mitigate risk before release.

The most immediate operational constraints are capacity at secure units and parallel legal and clinical tracks for each patient. Menino described the legal track (regular court reviews and competency evaluations) running at the same time as a clinical track (diagnosis, medication stabilization and substance-clearance). She said: "90 percent of the folks who walk through our front door are incompetent to stand trial and dangerous" and explained that placement decisions are constrained both by criminal charges and by which facility has the appropriate security level.

Administrative barriers also slow discharges. Menino said benefit enrollment and identity documentation are frequent obstacles: Social Security and other benefit determinations can take months, and the hospital often must obtain or replace IDs and immigration paperwork before community providers will accept a patient. "Gotta be honest, we're the fourth worst state in the country right now," she said of SSI processing delays during the meeting. Providers are reluctant to accept new referrals when payment and eligibility remain uncertain, she added.

Menino gave placement statistics showing the scale of transfers and discharges: she reported 843 discharges from Perkins in the past calendar year and named other receiving hospitals (Eastern Shore, Spring Grove, Springfield and Tom Speed Finance Center); she said Baltimore County accounted for 418 discharges in the same period. She also said about 20 county patients returned home with wraparound services, while smaller numbers were remanded back to detention, moved to assisted living, placed in shelters after refusing services, or went to substance-use treatment.

Committee members pressed for solutions. A detention-center representative asked whether the delays stem from a lack of beds or from downstream services; Menino said both are factors, and that the number of arrests identifying mental-health needs has risen since COVID. She recommended earlier document transfer (IDs, school records, medical histories) so hospitals can begin benefits applications before or immediately upon admission.

The committee did not vote on policy changes during the meeting; members agreed to continue coordinating intake summaries and to explore improved information sharing to reduce downstream delays. The council's next meeting is scheduled for Dec. 9, when members said they would follow up on possible process improvements.