Meanwhile, the state has reduced its number of state psychiatric beds since 2003, and the Department of Health and Mental Hygiene is in the process of procuring a study of short- and long-term patient capacity needs at its five remaining psychiatric hospitals, including Springfield in Sykesville.

The study won't result in additional capacity changes for years to come, said Betsy Barnard, director of the health department's office of capital planning, budgeting and engineering services.

But mental health advocates are worried. They agree the role of state institutions should decline, but said the state has a record of downsizing psychiatric capacity while keeping funding for community-based alternatives flat.

"The reason that the state wants to close the beds is to save money, and in a bad economic situation, there's always the risk and the reality that the state will have that money revert to the general fund," said Laura Cain, an attorney with the Maryland Disability Law Center.

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The state also issued in 2000 what amounted to a moratorium on new RRP beds in the state, despite the fact that providers would be eager to create more beds if allowed, Cromwell said.

Hepburn did not respond to requests for comment on that unofficial moratorium, but said cuts to state psychiatric beds since 2003 have resulted in more community-based housing options, including 12 new RRP positions opened with the closure of the Upper Shore Community Health Center in Chestertown last year. A total of 4,000 people received RRP services in Maryland in 2010, compared to 2,600 in 2003, he said.

Still, it's true that funding cuts at state institutions don't necessarily amount to dollar-for-dollar increases for community programs, he said.

Mixed grades for housing, care

In 2009, the National Alliance on Mental Illness, which has a Carroll County chapter in Westminster, compiled a report called "Grading the States," in which it evaluated mental health services across the country and gave each state a letter grade between "A" and "F."

No state received an "A," and the nation as a whole received a "D."

But Maryland was one of only six states to receive a "B," making the state one of the country's best in dealing with mental illness, according to the evaluation.

But when the affordability of housing for people with disabilities is considered alone, Maryland drops from the top of the class to the bottom, according to the national Priced Out in 2010 study conducted by the Technical Assistance Collaborative and the Consortium for Citizens with Disabilities Housing Task Force.

The study compares federal Supplemental Security Income payments — which are received by people with severe mental and physical disabilities and used for housing — to "fair market rents" for one-bedroom apartments in markets around the country, as calculated by the U.S. Department of Housing and Urban Development (HUD).

Only Hawaii and Washington, D.C., were less affordable than Maryland, where a one-bedroom apartment costs 164 percent of a person's $674 monthly SSI payment in 2010, the study found.

Among all HUD-defined rental markets in the country, only 30 had average rents for one-bedroom apartments that cost more than 150 percent of a person's monthly SSI payment.

In the market that includes Carroll County, the average rent was 156 percent of SSI.

Stability begins at home?

Advocates and mentally ill residents say that, overall, Maryland has a long way to go to shape a housing plan that meets the needs of the mentally ill population.

Namely, they say there's a need for independent living units that are subsidized in some way and which provide treatment and therapy services while allowing tenants to retain independence and privacy.

Mattox said his living situation with Prologue, in which he pays a $192 monthly rent out of his SSI, has been highly beneficial, helping him to control the mood swings that made him angry, and suicidal, in the past.

He recently got a job after a year-and-a-half search at the Walmart in Eldersburg, where Prologue plans to move him once it has completed renovations of a nine-unit apartment building that it recently purchased there with the help of federal funding.

"He had to overcome a lot of obstacles in his childhood, and he's really prevailed and done an excellent job," said Debbi Sauers, an Eldersburg resident who is one of Prologue's program directors who is close with Mattox.

With the help of Prologue's anger management classes and courses dealing with stress and other factors that trigger mood swings, Mattox is less explosive and quicker to apologize and to admit when he is wrong.

That was a struggle for him in the past, he said, but Prologue's support structure has helped.

"I know the staff's phone numbers, I know Ms. Debbi's number," Mattox said. "It's not like, 'You're in supportive housing, see ya, sayonara!' "