For years there were constant voices in Raymond Stuart Reed's head that led him to believe he was the target of a sinister plot, pushing him to abuse alcohol and crack cocaine.
"I really needed something to calm almost a beast inside of me," said Reed, 45, an Ellicott City native 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, constantly trying to remain one step ahead of homelessness and one step ahead of the addictions that his attempts to cope with his illness have caused.
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, just across the Baltimore County line from Elkridge in Relay. 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 is making 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.
According to one 2010 national study, Columbia is the least affordable rental market 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 Howard County General Hospital and other regional hospitals, years-long waiting lists at local residential rehabilitation programs and homelessness within the community, they said.
"We have a housing system that needs to be revamped," said Donna Wells, head of the county's Core Service Agency, which is the local authority responsible for mental health services.
"The housing issue is huge," agreed Andrea Ingram, executive director of Grassroots Crisis Intervention Center in Columbia, which operates a shelter where Reed once stayed.
"We have got to create some housing on our own, because it's not just going to pop up," Ingram said. "We've just got to do that. We have to have a broader range of housing in Howard County."
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 to the community has contributed over multiple decades to both 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.
Still, there 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.
In Howard County, there are more than 50 people waiting for one of the county's 108 RRP spots, some of whom are likely to wait for years before receiving a placement, Wells said.
That's especially true for those who are currently living in the community but seeking an elevated level of care, as they are last in a priority system that places patients from state institutions, general hospital units and homeless shelters before them, regardless of time spent on the waiting list.