For years, constant voices in his head led him to believe he was the target of a sinister plot, and pushed him to abuse alcohol and crack cocaine.
"I really needed something to calm almost a beast inside of me," said Raymond Stuart Reed, 45, a Relay resident who has battled chronic paranoid schizophrenia and underlying depression since he was about 15 years old. "I'd be walking, almost running, to the liquor store on a daily basis."
In the three decades since he first began noticing the signs of his mental illness, which can distort his reality, Reed has bounced from one place to the next, trying to remain one step ahead of homelessness and one step ahead of the addictions caused by his attempts to cope with his illness.
There have been stints in hospital psychiatric units, in shelters and in a rental apartment that turned out to be a "crack den," he said.
There have been lots of couches, many left in the ashes of burned bridges with family members and friends.
For the past five years, Reed has mostly lived with his girlfriend, Mary Atwater, in her Relay home. He is now on a daily drug regimen — five drugs in all, including insulin for his Type I diabetes — that has allowed him to stabilize his condition and stop using drugs. He makes ends meet with monthly disability checks and money left to him by his father.
Still, Reed feels he has been "struggling and sinking for the longest time," he said, largely because of his difficulty finding long-term, affordable housing.
He's not alone.
Across the county, and throughout the Baltimore region, there is a severe shortage of affordable housing for those with psychiatric conditions, especially those with medical and psychosocial needs that can't be met in traditional living situations, according to mental health advocates and officials.
"It's bleak," said Sendy Rommel, president and CEO of Prologue Inc., an organization that provides housing support for people with mental illnesses in Baltimore and Carroll counties.
According to one 2010 national study, the Baltimore region is among the 30 least affordable rental markets in the country for those receiving disability support, and Maryland is one of the least affordable states. Alternative housing options — whether through government subsidies and vouchers or through non-profit support — are few and far between, advocates said.
The shortage has contributed to crammed psychiatric units at hospitals throughout the state, years-long waiting lists at local residential rehabilitation programs (RRP) and homelessness within the community, they said.
"One of the challenges for folks is the availability of housing alternatives," said Robert Blankfeld, head of the county's Core Service Agency, the local authority responsible for mental health services.
Backlogs and homelessness
A key factor in the housing shortage is the half-century evolution of thinking on treatment and housing that has led to a shift away from state psychiatric institutions.
Before that evolution, state institutions served as the de facto destination for thousands of patients, who were often sent to the institutions indefinitely.
Today, there is broad consensus that state institutions are not the best option for most patients, and an intense focus on rehabilitation and reintroduction of patients into the community has contributed over decades to a drastic decrease in the number of patients at state psychiatric hospitals and a proliferation of community-based treatment and housing alternatives.
Thirty years ago, about 70 percent of state mental health funding went to state institutions and 30 percent went to community programs, said Brian Hepburn, executive director of the Maryland Hygiene Administration, which oversees the state's public mental health system (PMHS).
Today, those numbers are reversed. Still, there aren't enough housing options available for the mentally ill, who, advocates say, shouldn't be institutionalized but can't pay rent on their own.
In Baltimore County, more than 220 people are waiting for one of the county's 321 filled RRP spots to open. Some of whom are likely to wait for a year or longer before receiving a placement, Blankfeld said.