State institutions used to serve as the de facto destination for thousands of patients. Today, there's broad consensus that state institutions are not the best option for most patients.

Rehabilitation and reintroduction of patients to the community has contributed 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.

Today, those numbers are reversed — but there still aren't nearly enough housing options available for the mentally ill, who, advocates say, shouldn't be institutionalized, but can't pay rent on their own.


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Once patients get into an RRP — a full-time, intensive treatment option — they are likely to stay longer than their condition requires because other housing options are so scant, and because some forms of disability support are cut off with departure.

That can lead to a bottleneck coming out of the programs, said Hawkins, whose office facilitates RRP placements.

"If you are housed in the community and you are waiting for a general level bed, you will be waiting for a very long time," she said. "It's always difficult to tell people who need housing that there's not much we can do, other than ... put your name on this list."

Hawkins' counterparts in Howard County, Baltimore County and Baltimore City reported similar backlogs of people waiting for placements, and said it's a statewide and nationwide issue.

Many programs offer treatment and therapy services without housing, but patients in those programs often start to regress because of housing instability, advocates said.

Advocates say that for those with mental illness, a lack of stable housing can undercut hard-won progress with their conditions, and creates obstacles to taking medicine on time and avoiding situations that trigger intense episodes of illness.

Corina Canon, associate director of housing services for Human Services Programs of Carroll County Inc., said about 30 percent of those served by her organization in its shelters in the county have some sort of mental illness.

"Struggling with a mental illness is a barrier to housing stability," Canon said.

"I think it's tough for a lot of folks to maintain their housing stability," she said. "And then to add a mental illness on top can make it hard."

Budget flat as population climbs

State funding for mental health services has been on the chopping block in recent years as legislators fight to control Maryland's deficit, prompting advocates to wage yearly lobbying efforts inAnnapolis.

They've had some successes.

In April, Gov. Martin O'Malley provided a supplemental appropriation to offset cuts to community mental health reimbursement rates for fiscal year 2012.

But Herbert Cromwell, executive director of the Community Behavioral Health Association of Maryland — a Catonsville-based group that represents community-based treatment and housing providers — said flat or even slightly higher levels of funding can't meet the needs of a mentally ill population that's growing at a much faster rate.

According to statistics provided by Cromwell, the state's public mental health system is projected to serve 139,000 people in fiscal year 2012, up from 99,000 people served in fiscal year 2008.

"The problem is that the demand for services, particularly community services, far exceeds budget capacity year after year," Cromwell said.