Moreover, patients say BBH now requires them to pay about $150 or $200 a month in rent, meaning that BBH passes on most or all of the monthly rent to the patients.
- Stephen Brown says he was ill-equipped to be BBH patient-house manager
- Map: An unregulated housing network
- Marylanders pay clinic millions, but diagnoses questionable
- Pictures: Hooked on treatment
- Shirley Sturgill praises BBH for a strong system and helping her get clean
- Dr. Michael Fingerhood questions BBH's diagnosis in many cases
Advocates of affordable housing say BBH's system is one piece of a patchwork of residential options that have emerged in the 20 years since the state cut residential services for recovering addicts.
A lack of housing-based drug treatment is a major issue, said Greg Warren, president of Baltimore Substance Abuse Systems Inc., a quasi-public agency that distributes more than $50 million, mostly state grants, to city providers that treat addicts lacking insurance. (BBH has never applied for a grant from the agency.)
Jane Plapinger, president of Baltimore Mental Health Systems Inc., the city's mental health authority, called housing "a huge, huge, huge problem for people in this city who are mentally ill. The reality is, clients will go anywhere for housing because they're desperate."
For some who enroll at BBH, the prospect of a clean bed, rather than treatment, has long been a prime attraction, according to former patients and staff.
"You're homeless, nowhere else to go," said James Scriven, explaining why he went there after he got out of jail in 2004.
The motivation matters to Dr. Brian Hepburn, executive director of the Mental Hygiene Administration, which funds BBH through Medicaid, the state-federal program for the poor and disabled. He expressed concern that the housing might act as an "inducement" for some patients to seek treatment or to stay in treatment that they may not need.
Reports of drug use at the housing punctuate Hepburn's concern. "For some people," he said, "it sounds like what they're doing is using the program as a safe place to go to get shelter … and continue to use" illicit drugs.
Housing is critical for individuals in recovery, Hepburn agreed, "but we're paying for health care, not for shelter, a bed and a safe place."
Recently, Hepburn said BBH has assured the state that no one living in the houses is required to enroll there for treatment.
State officials acknowledge that they can't know whether BBH's rental houses constitute a "safe place," because the state has no regulatory oversight. That worries Nancy Grimm, director of the state Office of Health Care Quality.
"Not licensing those homes takes us out of the loop," Grimm said. "Maybe we should be licensing them."
The lack of oversight means BBH has wide latitude to operate the houses as it deems appropriate. That includes the freedom to put newly sober patients such as Stephen Brown into manager roles.
Others question the wisdom of that practice. Gaudenzia Inc., which offers mental health and addiction treatment services, would never delegate such responsibility to a recent drug user, said Gale Saler, director of its Chesapeake region.
"We wouldn't give someone with 60 days' sobriety access to someone else's medication," she said. At Gaudenzia, even entry-level staff must document a full year of sobriety. Two months is too soon, she said. Some patients are still "white-knuckled, holding on by the skin of their teeth. Recovery is hard."
"Certainly, 60 days seems short to me," said Warren of the city's drug and alcohol treatment agency. In July, the agency got authority from the state to begin using grant money to pay for housing, but Warren says he first wants clarity on quality standards. "I believe there needs to be oversight over supportive housing when and if public taxpayer dollars are being spent."
At present, the only government oversight of BBH rental houses, comes from Baltimore's housing agency and is limited to compliance with zoning and building codes. Occupancy levels in the homes fluctuate and range from under 10 to more than 20.
BBH has said it complies with all local requirements. City records show that, as of last summer, 16 of 21 houses identified as BBH houses were not registered by the owners, as is required for any non-owner-occupied house.