Bryan Johnson didn't know he had bipolar disorder until he ended up at the emergency room, where he assaulted a police officer.
His family had taken him to the University of Maryland Medical Center because he was acting strangely, staring into the distance and constantly pacing as he struggled with the death of his brother and the loss of his job. He was sent to Central Booking as soon as he was released from the hospital, and wound up with a five-year suspended sentence.
mental health institutions and not enough community programs.
Last month's massacre at a Connecticut elementary school has elevated a long-simmering debate over how to provide care for the mentally ill, as treatment continues to shift from a system of government-run institutions to one that aims to keep people in their communities. Though some who knew the alleged shooter, Adam Lanza, have speculated that he was mentally ill, authorities have not confirmed any diagnosis.
The General Assembly, which opens its 2012 session this week, is also set to consider such issues.
"If you want to have a real talk about multiple killings, we have to address how we make sure these people get the services they need," said Del. Michael Smigiel, an Eastern Shore Republican.
Advocates warn not to generalize about mentally ill people, pointing out that it's uncommon for them to be involved in violent incidents. But there is evidence that those with severe mental disorders such as schizophrenia and bipolar disorder may be slightly more prone to violent acts than the rest of the population.
Violence is one of many problems that become less likely with better treatment, experts say. A recent state report on guns and mental illness said that 5 percent to 7 percent of people with severe problems will harm others in a given year, compared with 2 percent to 3 percent of the general population. Violence becomes more likely when combined with substance abuse, the report said.
The transition from institution- to community-based care has not been smooth, and even supporters say the strategy hasn't worked perfectly. Critics argue that not enough community programs exist, resulting in long waiting lists and people not receiving care. Some people don't know where to get help. Others, like Johnson, don't realize they need it.
Now a mental health counselor, Johnson controls his condition through medication and works to help people deal with problems before they become emergencies like his own.
"We could always use more outreach," Johnson said. "The only question is, are people ready to take advantage of it?"
Mental health issues are likely to come up for debate during the coming General Assembly session, with more pressing consideration given to the issue because of the Connecticut school shootings, which killed 20 schoolchildren and seven adults. Lawmakers are planning bills that would further restrict the ability of people who have been in a mental hospital to own a gun.
A spokeswoman for Gov. Martin O'Malley said he would include mental health initiatives in his legislative package, which will be released in coming weeks. She declined to release details.
A state task force that considered access to guns by the mentally ill released recommendations last week that included seizing firearms from individuals deemed a credible threat to themselves or others. The panel also recommended requiring mental health professionals to report threats, more mental health training for police officers and more education on firearm laws for mental health providers.
"Because of another instance of mass killings by someone with possible mental illness issues … it is inevitable this subject will be legislated before the General Assembly this winter," said Del. Samuel I. "Sandy" Rosenberg, a Baltimore Democrat.
Others want to increase spending on mental health services.
Smigiel, who hopes to introduce legislation to increase psychiatric spending, said the state is moving in the wrong direction with closures of government-run mental health facilities, including one in his district, Upper Shore Mental Health Facility.
Nationally, government-funded mental health programs suffered severe downsizing in recent years even as demand for services increased. States cut nearly $4.4 billion from state mental health budgets from fiscal year 2009 to 2012, according to the National Association of State Mental Health Program Directors Research Institute.
Maryland increased its budget by less than 2 percent in that period, but advocates say it has still cut much-needed programs over the years. Much of the increase came because of increased federal funding.