"This state doesn't consider funding a mental health system a priority. Until it does, there will be problems."
Despite those problems, enforcement of assisted-living regulations has improved since the state redefined group homes and other facilities and began requiring licenses rather than permits in the late 1990s, Benner said.
"Two years ago, there was no enforcement," she said. "There's going to be a learning curve.
"Right now, we're focused on trying to get them in compliance and licensed and separate out those who don't want to be in compliance and those who do but don't know how.
"At some point, we'll have a handle on this and the need for constant enforcement should go down," she said.
Right now, though, health advocates are concerned about the violent incidents at group homes in Maryland, from the Owings Mills slaying to the Eastern Shore rapes.
In each case, officials found problems. There were too few staff members supervising the group homes, not enough training for caretakers, and inadequate screening of residents and staff for histories of violent or criminal behavior.
The number of hospital beds for the mentally ill has declined steadily as a result of recent cuts in state funding for mental health care and deinstitutionalization, a movement to transfer such patients from long-term institutions to community settings.
That, in turn, has increased the demand for assisted-living facilities, according to health officials.
In addition, as the numbers of mentally ill and elderly grow, more families want their relatives in residential settings that offer health care and supervision they can't provide in their own homes, advocates say.
Although incidents like the Owings Mills killing provide fodder for advocates lobbying for an overhaul of the state's health care system, Farinholt said, there's often negative public backlash against the group homes for existing at all.
"Every time one of these terrible incidents happens, it's one more time that a mentally ill person has become violent, when most of the time they're the victims," she said.
Call for shutdown
After the assault in Joppatowne, some residents initially wanted to shut down the group home on Joppa Farm Road run by REM Maryland Inc.
But Sen. Nancy C. Jacobs, a Harford County Republican, said after the first community meeting on the issue, residents were expressing concern for both the welfare of the neighborhood and of the staff and residents of the group home.
Jacobs said she and others were particularly worried about staff at the REM home, especially the 18-year-old female counselor who had been attacked by a resident with a knife who said he wanted to "operate" on her. She had less than 40 hours of training.
"We didn't want to go on a witch hunt trying to close all group homes down. Many people need to be in these settings. They have a real value," Jacobs said.
"But we want the companies that run them to be accountable for violations and we're looking for increased enforcement and oversight by the state."