Debbi Sauers, a program director with Prologue Inc., listens as Joachim Mattox, a client at Prologue, discusses classes and other services that have helped him with anger management and other issues. Mattox says he has benefited from community-based housing options for mental health patients. (Staff Photo by Brian Krista / September 29, 2011)

For as long as he can remember, Joachim Mattox's mood has fluxuated between manic and depressed, a mental roller coaster made more difficult because of addiction issues and a lack of family support.

"They've made it very hard for me to open up, to trust," said Mattox, 34, of the swings brought on by his bipolar disorder, his attention deficit hyperactivity disorder, and the variety of other conditions he's been diagnosed with over the years.

"I sometimes put myself in positions where I don't make the best decisions," he said.

For more than two decades Mattox, who is from Eldersburg, has bounced in and out of hospital psychiatric units, treatment centers and other institutions, he said. Along the way, he's lost and regained family ties multiple times.

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Since December 2008, however, his life has turned with the help of Prologue Inc., an organization that serves people with mental illnesses in Carroll and Baltimore counties, he said.

After leaving Springfield Hospital Center in Sykesville, Mattox entered one of Prologue's residential rehabilitation programs (RRP), which provides him with an apartment in Reisterstown and daytime activity and treatment options in Prologue's Pikesville facility.

The independence that the program has given him has taken some getting used to, but living in the community has been a blessing, he said.

"I've been in and out of institutions ever since I was 8 years old," he said. "This is, amazingly, the longest I've stayed out of the hospital."

According to mental health advocates, independent-living options for people with conditions like Mattox's provide the right mix of treatment and independence, bringing dignity, purpose and community connections.

Unfortunately, they said, there are far too few of these options available.

Advocates and officials say that across the county, and throughout the 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 one 2010 national study, the Baltimore region, including Carroll County, 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 nonprofit support — are too few and far between, advocates said.

The shortage has contributed to crammed psychiatric units at hospitals throughout the state, years-long waiting lists for local RRP spots and homelessness within the community, they said.

"It's bleak," said Sendy Rommel, president and CEO of Prologue. "Everyone's backs are against the wall."

Housing is "absolutely" the largest problem facing local residents with mental illnesses, said Sarah Hawkins, head of the county's Core Service Agency, which is the local authority responsible for mental health services.

"It's the first question everyone asked when I came on," Hawkins said. " 'What are you going to do about housing?' "

Backlogs and homelessness

In Carroll County, there are more than 50 people waiting for one of the county's 66 RRP spots, some of whom are likely to wait for years before a placement, Hawkins said.

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.