Mike Duncan, a 47-year-old Ellicott City resident, still remembers when his father died in his arms after a massive heart attack 12 years ago.
The death, Duncan said, sent him into the thralls of depression.
Duncan, who had suffered from fetal alcohol syndrome and learning disabilities, said he was also dealing with post-traumatic stress disorder stemming after serving as an EMT firefighter in Howard County for 29 years.
The difficulty of finding housing with a mental health condition further undermined his stability as for five weeks he bounced between several couches, a hotel room, a local shelter and the streets, including the lakefront and the Mall in Columbia, in search of a place to live, he said.
"I was more depressed than I ever was. Everything was out of reach. There was no place for me to go," he said.
Duncan's struggle to find housing in Howard County is the result of a chronic shortage of affordable housing in the county for people with psychiatric conditions where subsidies, housing vouchers and other supports are scant, mental health advocates say.
When some developers are less than thrilled by the Howard County's rules for dispersing affordable housing in new housing, Kelly Cimino delivers her trademark response: "Wouldn't it be great if the teachers who work at the schools you use to market your project could live in the county?"
Those with mental health conditions seeking support in Residential Rehabilitation Programs in Howard County, which provide supportive public housing and access to care and resources, have to wait between three to four years to secure a spot. Finding housing is integral to allowing people with mental health conditions to live a fully integrated life that can lead them to achieve their potential and preserve their dignity, said Janet Jones, the adult services coordinator for the Howard County Mental Health Authority.
"It's a serious problem," said Scott Rose, chief executive officer of Way Station Inc., which has Residential Rehabilitation Programs in the county.
Rose said people with mental illness are "not only struggling with the disability but also the limitations of poverty. It's a double burden."
Currently, around 80 people are on a Howard County Mental Health Authority waiting list for one of 106 Residential Rehabilitation Program spots in the county, according to county data. Despite growing demand for these programs, the state only increased the number of spots by two spots six years ago.
"We're working with incomes that don't sustain housing at all. If you get Supplemental Security Income, that's only $735 a month," said Jones. "You're not going to find any type of housing unit anywhere, especially in Howard County, unless you have a housing voucher, but those are few and far between."
Those who successfully complete the Residential Rehabilitation Program and are ready to transition to independent living in the county — the ultimate goal of the program — often remain because of the county's limited affordable housing. And with local demand for these programs growing, the bottleneck prevents people on the waiting list from taking the spot of people who no longer need services, advocates said.
One person has been waiting to find independent living in the county for 27 years, said Jesse Guercio, director of Humanim's behavior health services department. Humanim is a Columbia-based nonprofit organization that has 80 spots in its residential rehabilitation program.
The problem is born out of a country-wide de-institutionalization movement in the 1960s that moved people once housed in state mental health hospitals to community-based programs. The idea was to reintegrate people into community mental health care systems that provide services and shelter.
Instead, advocates say the movement overburdened local programs with supportive public housing — leaving people with mental health conditions and psychiatric conditions with few places to go.
People coming from state hospitals take priority on waiting lists, leaving residents looking for in-county services at the bottom of the list. Howard County's affordability market for rents and its reputation as one of the most affluent counties in the country further exacerbate the issue, advocates and officials said.
As a result, mental health service providers tell people seeking housing for themselves or a family member in a residential rehabilitation program to "find a plan B" if they need to find housing urgently, Guercio said.
"The first question I usually ask is: If you're already housed, what can we do to keep it? Is there anything we can do to keep them where they are right now in your house?" he said.
While other areas like Baltimore City can repurpose vacant housing for these individuals, Howard County's vacancy rates are low. Some landlords are often unwilling to rent to people with psychiatric conditions, Guercio said.
Providers also struggle with the risk of moving individuals to housing outside the county, which could remove critical emotional and social support systems that longtime residents need to avoid regression.
"We could empty out the RRP and send them to cheaper counties but their therapist, their physician, their friends, their job, their life is here ... and that's the same things that they need to be successful in the outside world," Guercio said. "You can't pluck them out and make them start over again."
Baltimore City and Prince George's and Montgomery counties have the highest concentration of RRP beds in the state and each have more than triple the number available in Howard, according to state data.
The cost per person for RRP services ranges from between $21,000 and $31,000, according to state data. The county has among the lowest number of housing — 197 beds — through a federal grant from the Department of Housing and Urban Development that aims to provide a continuum of care.
Allan Conover, a 67-year-old Columbia resident, said he found little to no trouble securing housing more than 20 years ago. But he cannot say the same for his friends who are searching for a place to go.
"I know people desperately need housing. They just don't get it. It just doesn't exist," Conover said. "A lot of people wind up out in the street. They're homeless and if they're homeless with a mental problem, they wind up in jail or in a hospital. And that's not doing anything to solve the problem. It's a cycle that continues."
Demand for Howard County General Hospital's inpatient psychiatric unit is increasing, according to a hospital spokesperson. A new psychiatric unit is part of the plans for a new two-story addition to the hospital, along with a larger expanded emergency unit and a new pediatric emergency unit.
The problem of finding housing is especially challenging for ex-offenders transitioning from the Howard County Detention Center in Jessup, where between 30 and 40 percent of inmates are on psychotropic medication, according to Jack Kavanagh, the detention center's director.
Baltimore is the least healthy jurisdiction in Maryland followed by several Eastern Shore counties, while wealthier suburban counties such as Montgomery and Howard were the healthiest, according to an annual ranking that has changed little over the past several years despite inroads in some of the worst city statistics
"It's not that we don't have funding [to pursue housing]. We do," said Mika Singer, who coordinates criminal justice treatment programs for the detention center. "Ultimately, we often times rely on family and friends and natural support for housing."
Duncan eventually found housing through Humanim. He began living in a two-bedroom condominium in Columbia in October.
"Having my own place means I had stability. I can take a shower. I have a bed to sleep in. I have a place. Those things are everything," he said.
But not everyone is as fortunate. Some slide into homeless shelters, the criminal justice system or the streets, advocates said.
For Judith Schneider's son Daniel, the shortage in RRP was one of several unmet needs that surfaced before he committed suicide in 2011.
Schneider applied for an RRP spot in October 2011 after Daniel was hospitalized for psychotic delusions of paralysis — an application a social worker who worked with Daniel supported, she said.
He applied for RRP spots in Howard, Frederick and Washington counties with no luck. Judith Schneider searched for a facility for her son as he was about to be released from Fayette Health and Rehabilitation Center in Baltimore City, where he received support for physical rehabilitation.
With no place to take Daniel, Schneider placed her 32-year-old son in an assisted-living home for the elderly in Columbia, a move she said that proved challenging for Daniel.
"Everyone told us there was no space for him," Judith said. "There were many unmet needs and other factors. But there is a great need for more programs, more openings and more services for people struggling with mental health issues … In the end, the families bear the burden," she said.
Locally, a Humanim subsidiary built two housing units in Jessup to meet what Guercio calls a "dry spell" of housing. The county is using $153,000 in federal grants to purchase two condos in Ellicott City that will house four individuals with developmental or psychiatric disabilities, according to Kelly Cimino, the county's new housing director.
A critical piece is insuring public transportation is available nearby — a missing link in many parts of the county, said Madeline Morey, director of the Howard County Mental Health Authority.
Local advocates and service providers hope to see more coordination between the county's transportation office, the police department and other service agencies to better streamline services, including changes that would allow agencies to move housing vouchers from people who are not yet ready to transition into independent living to those who are.
For more than two decades, Conover has called home one bedroom in a Columbia condominium. He hopes to venture out to other housing in the county where he has lived for decades, but the housing shortage stops him.