Police fatally shoot mentally ill Somali immigrant - AP

Police fatally shoot mentally ill Somali immigrant

Police say he lunged with knife; crowd shouts 'Cold-blooded killers!'

COLUMBUS, Ohio (AP) -- A deputy shot a mentally ill African immigrant to death when he allegedly lunged with a knife at officers who had come to take him to a psychiatric center, authorities said.

An angry crowd gathered in the northeast Columbus neighborhood after the shooting Wednesday of Nair Abdi, 23, an immigrant from Somalia. Four Franklin County deputies had been sent to his home because his family said he had stopped taking his medication and had become delusional.

Abdi refused to go and lunged at the deputies with a knife, said Lt. Brent Mull, Columbus police spokesman. When Mace didn't stop Abdi and he lunged again, one of the deputies shot him, police said.

"A knife is one of the most deadly weapons we come up against," Mull said.

Columbus police called to the scene were confronted by members of the crowd screaming, "Cold-blooded killers!" More officers had to be summoned to help disperse the crowd.

"They could have wounded him," said Liban Abdi, the victim's brother. "They could have shot him in the leg, in the arm, anything else."

The four deputies were placed on leave pending an investigation. Mull said it appeared they took the right steps in first attempting a peaceful surrender.

An order for Abdi to be taken to a psychiatric center had been issued Wednesday after a health-care worker said he was "a danger to himself or others," said William Reddington, chief magistrate of Franklin County Probate Court.

The family emigrated to the United States in 1999 and Abdi later started showing signs of mental illness, his brother said.

"He would say the television was made by the devil, cars were made by the devil," Liban Abdi said. The brother said he spent six months in the hospital earlier this year but had stopped taking medication after complaining that it made him feel weak and sleepy.

The shooting came two days after a knife-wielding New Orleans man, Anthony Hayes, was shot after a confrontation with officers that was partially videotaped by onlookers. Read more!

Mental health reform off to troubled start - Greensboro News-Record

Mental health reform was supposed to make it easier for state residents to get psychiatric help closer to home. Four years after the legislature rewrote the plan, the dream for many people has become a nightmare. While the state continues admitting more psychiatric patients than it can handle, local communities scramble to figure out how to provide care.

A recent two-part series in the Winston-Salem Journal concludes the state moved too rapidly in revamping the system without allocating adequate funding. Now, there's no turning back.

Unless state policies change again, the burden of finding answers falls mostly on local health care agencies.

Treating patients with mental-health problems at home rather than distant state institutions is a laudable goal. Little thought, however, apparently was given to who would do it and at what cost. Nor was there an adequate safety net in place to cover the inevitable glitches.

The plan was to get the state out of the psychiatric treatment business. But it takes more than simply downsizing state hospitals with hopes that the related cost savings will fund efforts back home.

In many cases, there's been too little planning or dialogue on how the private sector should deliver services at the local level.

In some counties, the lack of foresight has led to disastrous results. People who previously had been admitted promptly to the state system find themselves on the street, in jails, in emergency rooms or in long-term care facilities that serve the elderly.

When local programs lag behind, the state ends up filling the gap. So rather than declining, admissions at the state facilities have steadily risen just as funding was slashed in anticipation of more local control.

In retrospect, it would have been better to implement the changes incrementally instead of a massive overhaul. Pilot programs in selected areas could have averted much of the confusion and uncertainty, particularly when private hospitals statewide have cut back on the number of psychiatric beds.

Local private-sector providers have complained that confusing, contradictory state and federal Medicaid reimbursement rules interfere with billing. Without money coming in, they can't maintain operations. Compensation guidelines must be rewritten.

It should be noted that in 2001 the General Assembly made a good-faith effort to fund the transition process. However, Gov. Mike Easley raided the $47 million trust to balance the budget. Replacing that money would facilitate a smoother shift to a community mental-health delivery system.

An estimated 350,000 Tar Heels rely on the state for some form of psychiatric help. Despite the best of intentions, their interests aren't being served.

State and local agencies must work together to right that wrong. Read more!

N.C.’s mental health ‘reform’ is a train wreck right now- Winston-Salem Journal

published December 18, 2005 6:00 am

Nesbitt, D-Buncombe, said mental health reform is “the biggest mess in the state right now.” That may be, but that doesn’t mean it can’t get worse, and it certainly seems to be doing so.

While the senator and a joint legislative oversight committee try to figure out how to reform the reform, the system continues to spin out of control.

One of the most dramatic failures of the new state system occurred recently in Forsyth County, according to a report in the Winston-Salem Journal.

In 2004, CenterPoint Human Services, that area’s public mental-health agency, created a private agency called HopeRidge to care for about 5,000 patients with mental illness. A year later, in September, HopeRidge went out of business, leaving patients scrambling for care.

Other providers are also having trouble surviving under the state’s poorly developed and wholly inadequate reimbursement system as it attempts to privatize care.

Moreover, the state’s plan to provide community-based crisis intervention resources with money saved by downsizing the state mental hospitals never materialized because admissions did not drop as expected. Few communities, including the eight counties served by Western Highlands, based in Asheville, have adequate crisis intervention facilities.

“I think everyone in the state has fallen down in their leadership on this — the governor, the department, the General Assembly — because at this point we have a mess on our hands and there really isn’t a plan to resolve it,” Nesbitt, who co-chairs the joint legislative committee on mental health, told the Winston-Salem Journal.

Meanwhile, the federal government appears set on making things worse. It recently said that it will no longer cover community-based services for children with mental illness.

Henderson County’s Kathryn Reiter’s 9-year-old adopted daughter, Elaine, who has bipolar disorder, is a poster child for a counter-intuitive system that seems bent on being unresponsive and outrageously and unnecessarily costly. Recently, Health Choice, the program funded with federal and state tax dollars that serves North Carolina children who don’t have health insurance, said that Elaine no longer needs case management or a community-based services (CBS) worker to help with her care. After that decision was made in September, Elaine’s behavior became increasingly out of control.

“They essentially said she was cured,” Reiter said. “Bipolar isn’t something that’s cured. It’s a lifelong thing. They say these things aren’t medically necessary, but her psychiatrist and her therapist both say they are.”

With no community-based services worker to help Reiter follow through on discipline, Elaine’s problems got worse and worse until, at wit’s end, Reiter wrote a letter to the Henderson County Department of Social Services, offering to give up custody of Elaine if that would enable her to get help.

But because Elaine wasn’t adopted through Henderson County DSS, the department told Reiter it could take custody only if Elaine was being abused or neglected.

Reiter also appealed the Health Choice decision and earlier this month the program agreed to pay for group home care for Elaine, but not a one-on-one worker.

Unfortunately for Reiter, who had reached a point of being unable to care for Elaine at home, she will be left to pay the $100-per-day cost for the group home for the three weeks Elaine was there before Health Choice agreed to pick up the tab.

“I don’t really understand it,” Reiter says. “The CBS worker is so much less expensive than residential care, and I thought mental health reform was all about keeping people at home, in the community. Elaine is in Greensboro.”

One real outrage here is the betrayal of Reiter and other North Carolina parents who adopted children with mental illness with the understanding that their children’s mental health needs would be provided by Medicaid until they are 18 years of age. Those parents must not only suffer the pain of watching a child they have come to love spin out of control without the resources to intervene, they face the endless frustration of fighting for needed resources and the financial burden of providing for them when the state won’t. That’s simply not right.

Reiter wants to keep her daughter at home and she insists that providing the services to keep her daughter at home would be less expensive than paying to provide care for her in a group home. What kind of sense does it make to pay more to do something that no one thinks is the best option?

As the legislative committee continues to meet and attempt to come up with a plan, there are several issues it needs to address:

• It must devise a system that provides adequate crisis intervention without burdening the state’s hospitals and jails with people who are mentally ill.

• It must clearly define the services for which it will reimburse and it must provide adequate funds for doing so to make it viable for private providers to stay in business.

• It must recognize that some services can’t be or won’t be provided by the private sector and will have to be provided by public agencies.

• Whatever restrictions the federal government places on Medicaid dollars, it must provide a system that offers adequate community-based care for children such as Elaine Reiter.

An estimated 22.1 percent of Americans suffer from a diagnosable mental disorder in a given year. And, as we have noted before, it isn’t just those people and their families who are impacted by mental illness. With adequate care, many people with mental illness can lead productive lives as contributing members of society. Without it, not only is there greater suffering for them and their families, they risk becoming homeless or becoming involved in criminal activity or dependent on social services because they are unable to hold a job.

That’s far more costly in tax dollars than providing adequate care up front. Read more!

Mental Illness Exacts Heavy Toll, Beginning in Youth - NIMH

Mental Illness Exacts Heavy Toll, Beginning in Youth

Researchers supported by the National Institute of Mental Health (NIMH) have found that half of all lifetime cases of mental illness begin by age 14, and that despite effective treatments, there are long delays - sometimes decades - between first onset of symptoms and when people seek and receive treatment. The study also reveals that an untreated mental disorder can lead to a more severe, more difficult to treat illness, and to the development of co-occurring mental illnesses.

The landmark study is described in four papers that document the prevalence and severity of specific mental disorders.

The papers provide significant new data on the impairment - such as days lost from work - caused by specific disorders, including mood, anxiety, and substance abuse disorders. These measures will allow researchers to determine the degree of disability and the economic burden caused by mental illness, as well as trends over time. The papers are reported in the June 6 issue of the Archives of General Psychiatry by Ronald Kessler, Ph.D., and colleagues. The study was a collaborative project between Harvard University, the University of Michigan, and the NIMH Intramural Research Program.

This study, called the National Comorbidity Survey Replication (NCS-R), is a household survey of 9,282 English-speaking respondents, age 18 and older. It is an expanded replication of the 1990 National Comorbidity Survey, which was the first to estimate the prevalence of mental disorders (using modern psychiatric standards) in a nationally representative sample. The expansion includes detailed measures that will significantly improve estimates of the severity and persistence of mental disorders, and the degree to which they impair individuals and families, and burden employers and the U.S. economy.

"These studies confirm a growing understanding about the nature of mental illness across the lifespan," says Thomas Insel, M.D., Director of the National Institute of Mental Health. "There are many important messages from this study, but perhaps none as important as the recognition that mental disorders are the chronic disorders of young people in the U.S."

Prevalence and Age-of-Onset of Mental Disorders Unlike most disabling physical diseases, mental illness begins very early in life. Half of all lifetime cases begin by age 14; three quarters have begun by age 24. Thus, mental disorders are really the chronic diseases of the young. For example, anxiety disorders often begin in late childhood, mood disorders in late adolescence, and substance abuse in the early 20's. Unlike heart disease or most cancers, young people with mental disorders suffer disability when they are in the prime of life, when they would normally be the most productive.

The risk of mental disorders is substantially lower among people who have matured out of the high-risk age range. Prevalence increases from the youngest group (age 18-29) to the next-oldest age group (age 30-44) and then declines, sometimes substantially, in the oldest group (age 60 +). Females have higher rates of mood and anxiety disorders. Males have higher rates of substance use disorders and impulse disorders.

The survey found that in the U.S., mental disorders are quite common; 26 percent of the general population reported that they had symptoms sufficient for diagnosing a mental disorder during the past 12 months. However, many of these cases are mild or will resolve without formal interventions.

It is likely, however, that the prevalence rates in this paper are underestimated, because the sample was drawn from listings of households and did not include homeless and institutionalized (nursing homes, group homes) populations. In addition, the study did not assess some rare and clinically complex psychiatric disorders, such as schizophrenia and autism, because a household survey is not the most efficient study design to identify and evaluate those disorders.

Failure and Delay in Initial Treatment Contact The study documents the long delays between the onset of a mental disorder and the first treatment contact, as well as the accumulated burden and hazards of untreated mental disorders.

These pervasive delays in getting treatment tend to occur for nearly all mental disorders, though they vary according to specific diagnostic categories. The median delay across disorders is nearly a decade; the longest delays are 20-23 years, for social phobia and separation anxiety disorders. This is possibly due to the relatively early age of onset and fears of therapy that involve social interactions.

Shorter delays between onset of disorder and treatment seeking - still a protracted 6-8 years - are seen for mood disorders, and are likely attributable to public awareness campaigns, the marketing of newer therapies directly to consumers, and expanded insurance coverage.

While approximately 80 percent of all people in the U.S. with a mental disorder eventually seek treatment, there are public health implications from such long delays in treatment. Untreated psychiatric disorders can lead to more frequent and more severe episodes, and are more likely to become resistant to treatment. In addition, early-onset mental disorders that are left untreated are associated with school failure, teenage childbearing, unstable employment, early marriage, and marital instability and violence.

"The pattern appears to be that the earlier in life the disorder begins, the slower an individual is to seek therapy, and the more persistent the illness," said Dr. Kessler, a professor of health care policy at Harvard Medical School. "It's unfortunate that those who most need treatment are the least likely to get it."

Treating cases early could prevent enormous disability, before the illness becomes more severe, and before co-occurring mental illnesses develop, which only become more difficult to treat as they accumulate, according to the researchers.

Severity and Comorbidity of Mental Disorders The second paper reports that even though mental disorders are widespread throughout the population, the main burden of illness is concentrated in those with a severe disorder - about 6 percent. A "serious" disorder involves a substantial limitation in daily activities or work disability, or a suicide attempt with serious lethal intent, or psychosis. The serious group reported a mean of 88.3 days - nearly 3 months of the year - when they were unable to carry out their normal daily activities.

Unfortunately, say the researchers, individuals with one mental disorder are at a high risk for also having a second one (comorbidity). Nearly half (45 percent) of those with one mental disorder met criteria for two or more disorders, with severity strongly related to comorbidity. This finding supports the suggestion by a growing portion of researchers that the boundaries between some diagnostic categories may be less discrete than previously believed.

Use of Mental Health Services The study indicates that the U.S. mental health care system is not keeping up with the needs of consumers and that improvements are needed to speed initiation of treatment as well as enhance the quality and duration of treatment. For instance, over a 12-month period, 60 percent of those with a mental disorder got no treatment at all.

The good news is that the proportion of people who reported 12-month mental health service use is higher now - at 17 percent - than a decade ago in the baseline NCS survey, at 13 percent. The expansion was mainly in the general medical sector, with more primary care physicians providing psychiatric services.

People with mental or substance abuse disorders were more likely to get treatment from a primary care physician/nurse or other general medical doctor (22.8 percent), or from a non-psychiatrist mental health specialist (16 percent), such as a psychologist, social worker, or counselor, than from a psychiatrist (12 percent), though the survey did show that the adequacy of treatment - measured by number of visits - is best when provided by mental health practitioners. About 9.7 percent sought help from a counselor or spiritual advisor outside of a mental health setting; and 6.9 percent used a complementary-alternative source, such as a chiropractor or self-help group. This held true even for those with severe mood disorders. Traditionally underserved groups, such as the elderly, racial/ethnic minorities and those with low income or without insurance, had the greatest unmet need for treatment.

Future and Ongoing Efforts The NIMH epidemiological research portfolio contains several related projects that are focused on mental disorders among adolescents and ethnic subgroups. These include 1) an arm of the NCS-R that is studying 10,000 youths; 2) the National Study of African American Life, with 6,000 participants; and 3) the National Study of Latino and Asian Americans, with 5,000 participants. Each of these, like the NCS-R, will provide information on diagnosis, medications, disability/impairment, and service use, drawing from nationally based samples.

An international perspective on these findings is also becoming available, as the study is part of a global initiative on the epidemiology of mental disorders in 28 countries, coordinated through the World Health Organization. Read more!

Hospital beating raises questions - Citizen-Times

by John Boyle, and Angie Newsome, STAFF WRITERS
published December 14, 2005 6:00 am

The victim of a bizarre beating at Mission Hospitals remained in fair condition Tuesday in a case that raises questions about why police drove his assailant to the hospital and then left him unattended.

The case also points to a troubling lack of treatment resources for the mentally ill.

Johnny West, 57, suffered a fractured skull, broken nose and bruising of the brain in the attack, which happened in the emergency room waiting area of the St. Joseph campus of Mission. West works for United Parcel Service.

Rutherfordton resident Shawn Michael Pettie, 30, has been charged with assault inflicting serious injury and ethnic intimidation, according to the Asheville Police Department. He made an obscene gesture at West, who is African-American, before attacking him without provocation, according to witnesses.

Mission listed West in fair condition Tuesday, which means his vital signs are stable and within normal limits but he is acutely ill.

“He is conscious, and he has spoken to me,” said West’s wife, Sharon West, adding that her husband remained in Mission’s neuro-trauma intensive care unit. “We know what happened, we just don’t know why. It’s awkward, and it’s bizarre.”

Sharon West, a registered nurse who works at Mission Hospitals, also writes a column for the Citizen-Times. She said she hasn’t had a chance to think about police or hospital policies and protocols.

Officer drove Pettie to hospital

Asheville Police Chief Bill Hogan said the officer who took Pettie to the hospital, Rosa Perez-Schupp, was doing what officers do routinely. She responded to a call on North Lexington Avenue downtown early Monday, and a witness told her Pettie had been assaulted.

Pettie did not appear to be injured, so Perez-Schupp called in and got permission from a supervisor to transport the man to Mission.

“We give officers a reasonable level of discretion in dealing with these kinds of situations,” Hogan said. “If it’s not a serious injury or illness, it’s not unusual for us to transport someone to the hospital. We are a full-service department.”

Hogan said officers don’t want to become “a taxi service,” but they do give rides daily to people in need — those stranded by a car accident or a homeless person in need of a ride to a shelter on a cold night, for example.

Hogan said officers had dealt with Pettie before and noted in a subject file he had exhibited signs of mental illness, but Perez-Schupp didn’t find that out until after the assault. Pettie was convicted in 1998 of being intoxicated and disruptive and resisting a public officer, both misdemeanors, but he has no other criminal record.

Perez-Schupp dropped Pettie off at St. Joseph’s Emergency Room waiting area and was standing outside when the assault took place. She and Mission security guards subdued Pettie quickly.

Hogan said the officer did not accompany Pettie inside the emergency room or alert hospital staff because he had not shown any signs of aggression or instability.

‘Not in a right state of mind’

The Rev. Dedrick Clark, who was with the Wests that night in the emergency room, said Pettie seemed highly agitated. The Wests had come to the hospital to visit a young woman who was being treated, and Pettie, without provocation, made an obscene gesture at them, Clark said.

“He appeared to me to be some kind of nervous or mad,” Clark said. “He was definitely not in a right state of mind, I can tell you that.”

Pettie ran toward West, kicked him in the face and started punching him, Clark said. After Clark yelled at him, Pettie “froze in his tracks and backed up with his hands up,” Clark said. “And the police got him.”

Law enforcement procedures expert William T. Gaut of Naples, Fla., questions the decision to take civilians to the hospital. A former police officer and detective division commander who testifies as an expert in police matters in state and federal court, Gaut says the Asheville Police Department may have deviated from typical police procedures.

“The deviation from the norm is putting a person in the police car and taking them to the hospital,” Gaut said. “Generally speaking, what the officer is trained to do is call for medical support.”

Someone could be more seriously ill or injured than it appears and could die or suffer a permanent injury, Gaut said. Also, paramedics are trained to evaluate injuries and mental health.

“You don’t just grab him up, put him in a police car and drop him off at the hospital,” Gaut said.

Mental illness care lacking

Merrell Gregory, a spokeswoman for 716-bed Mission Hospitals, said the hospital’s security guards responded quickly to the assault. Mission has 52 security officers on staff, four team leaders and one supervisor.

They receive training in the use of pepper foam, expandable batons, handcuffs and unarmed self-defense, but they do not carry firearms.

Gregory said hospital officials “feel terrible this happened,” but she also noted the assault highlights the lack of care available for the mentally ill.

Allison Breedlove, interim executive director of the Governor’s Advocacy Council for Persons with Disabilities in Raleigh, said the statewide mental health reform enacted four years ago simply is not working. The idea was to privatize much of the care and make it more community based, she said, but essentially it has left many people in need of mental health care without treatment.

“We feel very strongly that mental health reform is not working — it’s broken,” Breedlove said.

The number of inmates in need of mental health care has grown significantly in recent years, according to Capt. Glen Matayabas, the facility administrator of the Buncombe County Detention Facility, which is run by the Sheriff’s Department.

In November, the jail averaged a daily population of 422 inmates, and about half of those needed some sort of mental health services. From October 2004 to March 2005, the jail and its social worker did initial mental health assessments for 109 inmates. For the six-month period running from April through September of this year, the number jumped to 238, he said.

“We’re trying to do the best we can to deal with it, but it’s a monumental increase,” Matayabas said.

Contact John Boyle at 828-232-5847 or via e-mail at jboyle@ashevill.gannett.com. Read more!

Post details: Man Severely Beaten in Hospital ER

ASHEVILLE — A hospital emergency room visitor suffered a brutal beating early Monday from a man with a history of mental illness, authorities said.

Johnny West, 57, was at the St. Joseph’s campus of Mission Hospitals with his wife, Sharon, to visit the daughter of a friend when he was attacked about 12:25 a.m.

West was hospitalized in the neuro-trauma intensive care unit with a fractured skull, broken nose and bruising of the brain. He was listed in serious condition.

Shawn Michael Pettie, 30, of Rutherfordton, was jailed on charges of assault inflicting serious injury and ethnic intimidation.

Pettie was taken to the hospital by Asheville police after he told an officer he had been in a fight on Lexington Avenue and needed medical attention, said Capt. Tim Splain of the Asheville Police Department. The attack occurred soon after Officer Rosa Perez-Schupp dropped Pettie off at the hospital, witnesses and police said.

The Rev. Dedrick Clark was sitting with the Wests when he saw the suspect make an obscene hand gesture at Sharon West.

“We were trying to ignore him, hoping he would go away, because he seemed very unstable,” Clark said. “Mr. West didn’t even see him.

“(The man) runs down the aisle and kicked (West) in the face. The guy jumped on him and started beating the daylights out of him with his fists.”

As Sharon West was attempting to help her husband, Clark screamed at the attacker and got his attention, he said.

“When he looked up at me he got off that guy like he was scared to death,” Clark said. “I don’t know who he thought I was.”

He said Perez-Schupp and hospital security guards quickly subdued and handcuffed the suspect.

“I thought they responded as quick as they could,” Clark said. “I don’t see how you could have reacted any faster. (The attack) happened in a matter of a few seconds. He didn’t do a thing to provoke this guy.”

Splain said there was no reason for the officer to remain with Pettie in the emergency room waiting area because he had not been charged with a crime and there were no outstanding warrants against him.

Pettie has a history of mental illness, Splain said. The suspect’s subject file available to officers states that he has mental health issues, he said.

Splain said Pettie was charged with ethnic intimidation because he made statements to officers that “he had some kind of issues with somebody who’s African-American.” Pettie is white, and West, who works for United Parcel Service, is African-American.

“We’re just dazed. We’re very traumatized by what happened,” said Sharon West, declining further comment.

Mission Hospitals spokeswoman Merrell Gregory said the hospital has security officers on duty at its emergency rooms 24 hours a day. The officers were close by when the attack occurred, she said.

“We feel terrible this happened,” she said. “Certainly our officers responded immediately.

“Anytime you have an incident like this you go back over it and see if anything can be learned from it and if any changes need to be made in policy and practice.” Read more!

Local family struggles with mental health care for child - Citizen-Times

by Leslie Boyd, STAFF WRITER
published December 12, 2005 6:00 am

FLETCHER — As Kathryn Reiter watched her 9-year-old daughter deteriorate, her frustration grew.

“She is out of control,” Reiter said. “I can’t keep her (at home) anymore because I can’t get the services she needs.”

For years, Reiter has had to fight for mental health and other services for her three adopted children.

Right now, the crisis is with Elaine, who has bipolar disorder. Health Choice, the program that serves North Carolina children who don’t have health insurance, has said Elaine no longer needs case-management or a community-based services, or CBS, worker to help with her care.

Since the decision was made in September, Reiter says, her daughter’s behavior became increasingly out of control.

“They essentially said she was cured,” Reiter said. “Bipolar isn’t something that’s cured. It’s a lifelong thing. They say these things aren’t medically necessary, but her psychiatrist and her therapist both say they are.”

Reiter’s experience is likely to be repeated across the state once the federal government approves the new rules for what services Medicaid will cover.

One thing the federal government has said is that it will not cover community-based services workers for children with mental illness and developmental disabilities. Instead, children with mental illness will receive “community support,” a modified service that combines case management and skills development, said Lisa Wainright of the state Division of Mental Health, Developmental Disabilities and Substance Abuse Services.

Reiter appealed her decision, and last week Health Choice agreed to pay for group home care for Elaine but not a one-on-one worker. For three weeks, though, when Reiter was unable to care for Elaine at home, the child was in a group home in Greensboro, and Reiter was left to pay the $100-per-day cost.

“I don’t really understand it,” Reiter says. “The CBS worker is so much less expensive than residential care, and I thought mental health reform was all about keeping people at home, in the community. Elaine is in Greensboro.”

Attorney Sarah Somers with the National Health Law Program in Chapel Hill agrees that it’s “penny-wise and pound-foolish” to approve the more expensive group home care and not a worker.

“Five years ago, CBS workers were approved by (federal) Medicaid, but now they say it’s not rehabilitative and will not be covered,” Somers said.

Children with mental illness will get community support, but home-based services will be reduced in the long run, said Curtis Venable, an attorney with Pisgah Legal Services who specializes in health issues. For many children with mental illness, the federal government’s decision will mean fewer hours of services.

“There will be some home-based services, but they will be reduced as a person’s condition improves,” he said. “In the end, there will be fewer hours of that for children with mental illness.”

“That’s not going to work for someone like Elaine,” Reiter says.

Reiter says that soon after Health Choice issued its decision in September, Elaine’s behavior started to deteriorate. With no community-based services worker to help Reiter follow through on discipline, Elaine’s problems worsened.

At wits’ end recently, Reiter wrote a letter to the Henderson County Department of Social Services, offering to give up custody of Elaine if that would enable her to get help.

“I am forced to write and ask that you facilitate a voluntary placement agreement (VPA) for Elaine to go into foster care in order to get the medically necessary services that her psychiatrist and therapist have identified — even though it is against the law to force that course of action,” Reiter wrote. “Elaine will need an experienced therapeutic foster family that can work with her complex behaviors: manipulative and controlling (“Cluster B” personality traits); aggressive, moody and explosive (reflective of the bipolar disorder, for which she takes a number of medications); thumb sucking and bed wetting; picking wounds and smearing the blood; noncompliant with medication, chores or homework.”

Elaine wasn’t adopted through Henderson County DSS, though, so the department informed Reiter it can’t take custody unless Elaine is abused or neglected.

“Western Highlands has been able to get me some respite days paid for, but it won’t cover all of this,” said Reiter, a teacher’s assistant for special needs students.

Vince Newton, director of community services and consumer relations at Western Highlands Network, the regional agency that oversees mental health care for the state, said he couldn’t discuss Reiter’s case specifically, but decisions on Health Choice are made by Value Options, a Norfolk, Va., company that contracts with the N.C. Division of Medical Assistance.

Tom Warburton, vice president of marketing and communications for Value Options, said his company’s decisions are based on medical necessity.

“Medical necessity is determined by state guidelines, provider organizations and Value Options clinical executives,” he said. “Does the letter come from Value Options? Yes. Did Value Options make that decision? Not necessarily.”

Newton said if a child is turned down for Health Choice, he or she isn’t allowed to receive any services through Medicaid either because that also is based on medical necessity.

“If something has been deemed not medically necessary by one, it won’t be picked up by the other,” he said. “We can’t change the determination; our hands are tied.”

Last summer, Reiter prevailed in a lawsuit against Western Highlands and the N.C. Department of Health and Human Services Division of Mental Health, Developmental Disabilities and Substance Abuse Services to get crisis services for her 17-year-old son, Thomas. She has been able to receive mobile in-home crisis services, but out-of-home crisis-stabilization services are not yet available to Thomas.

“I think they think I’ll get tired of fighting and give up and go away,” Reiter said. “They don’t know me.” Read more!

State may have may have taken on “too much” in mental health reform plan - Citizen-Times

ASHEVILLE - In 2001, the N.C. General Assembly mandated a complete restructuring of the state’s mental health delivery system. The idea was to move people from hospitals back into the community, where an array of private services would offer them choices in their treatment.

So far, the network of services has been much less robust than was predicted, and admissions to state-run psychiatric hospitals have increased. Several community-based programs have gone out of business, and the number of people with mental illness on the streets and in jails has increased, said Allison Breedlove, interim executive director of the Governor’s Advocacy Council for Persons with Disabilities.

“We don’t have an accurate number of how many people with a mental illness are in our jails,” Breedlove said. “We’re in the process of doing a study to find out.”

At the same time the state is going through mental health reform, it also is redefining what services will be covered by Medicaid. The federal government’s Center for Medicaid Services, known as CMS, must approve the new definitions before they can take effect, and that process has been pending for months.

N.C. State Sen. Martin Nesbitt believes the state tried to do too much at one time, which has caused a great deal of disarray as people try to move from the old system to the new without knowing exactly what the new rules will be.

“This is the failure of reform: We’ve left everyone hanging,” Nesbitt told members of WNC-NAMI, an advocacy organization.
Recently, the N.C. Division of Mental Health, Developmental Disabilities and Substance Abuse Services sent a letter to the local management entities, which manage the network of private service providers. The letter said CMA has ordered community-based services workers removed as soon as the new definitions are in place.

That means many children and adults with mental illness and developmental disabilities will lose the one-on-one workers they have come to rely on. People with mental illness will be offered “community support,” a modified version of CBS; no substitute is yet determined for people with developmental disabilities who are not in the Medicaid waiver program, CAP-MR/DD.

“That’s just not going to work for everyone,” said Sarah Somers, an attorney with the National Health Law Program in Chapel Hill. “It does seem rather short-sighted to deny these services to children – and to adults for that matter.”
Contact Boyd at 232-2922 or lboyd@CITIZEN-TIMES.com. Read more!

"Dream" scenario for mental health - Virginia

BY MICHAEL HARDY
TIMES-DISPATCH STAFF WRITER
Dec 7, 2005

Gov. Mark R. Warner wants to spend about $460 million to replace four
outdated state mental-health institutions and upgrade community
mental-health services.

The four are Eastern State Hospital in Williamsburg, Western State Hospital
in Staunton, Central Virginia Training Center in Lynchburg and Southeastern
Virginia Training Center in Chesapeake.

New state-of-the art hospitals and training centers for the mentally
retarded, costing $290 million, will be built at or near the existing
facilities over the next four years, the governor said. Employees now on the
job will not lose their positions, he said.

In his final budget, the Democratic governor also wants to use almost $170
million, most of it state cash produced by a booming economy, to upgrade
Virginia's deficient community services for the mentally disabled.

Warner assured that those with severe conditions will be treated in
institutions and that the state will substantially expand local services.

"We believe that everyone who needs a bed in a state facility will have one,
but whenever possible, we will serve people in the community as our first
option," the governor said.

"I believe this is a historic step forward for Virginia today -- a
record-setting investment in the commonwealth's mental-health and
mental-retardation systems, " he said.

About 90 legislators, mental-health advocates and officials attended
Warner's announcement yesterday in the executive office building near
Capitol Square.

Warner leaves office Jan. 14, and his mental-health proposals will be left
for the legislature to decide during its winter session. Initial reaction
was highly positive yesterday from politicians and activists, two groups
that have been at war over the issue for decades.

"The situation in Virginia for years has been shameful, and we were not
living up to our obligations," said Sen. Janet D. Howell, D-Fairfax.

"You're really going out with a bang for a lot of us," said Sen. Benjamin J.
Lambert III, D-Richmond.

"It fulfills what is a dream for many," said Del. Phillip A. Hamilton,
R-Newport News, a health-care leader in the General Assembly.

Nita Grignol, president of the ARC of Virginia, which champions services for
the retarded, said, "I'm happy as long as the state is moving toward"
emphasis on local services.

Mary Ann Bergeron, executive director of the Virginia Association of
Community Service Boards, described herself as "extremely delighted and
gratified."

"There has to be an adequate array of community services if we are to do
anything with" state institutions.

Heidi Lawyer, director of the Virginia Board for People with Disabilities,
said most are awaiting details of the program.

"We're certainly delighted at the infusion of money in communities," she
said.

Although Warner will not be in office to push for the initiative, Gov.-elect
Timothy M. Kaine supports its broad outlines.

The new emphasis, backed by cash, on providing services in localities for
mental patients may in part make a virtue out of necessity.

Virginia's poor record on local treatment and services could invite legal
challenges in the wake of a 1999 U.S. Supreme Court decision. It required
that states must release institutional patients who could be treated in
local communities.

Often, Virginia has responded to calls for improving mental-health services
only when threatened with lawsuits or action by the U.S. Department of
Justice.

Without his proposed investments, Warner predicted, "it might be another
decade before we have a chance to do what we are proposing today."

His plan will provide more services and placements in localities for the
handicapped, he said.

The upgrades will cut the number of beds at the four hospitals by one-third
and nudge the state toward its goal of treating two patients in their home
communities for every one patient in an institution.

The extra dollars -- about $116 million in state funds and an additional $52
million in federal Medicaid dollars -- will result in higher reimbursement
rates for service providers. The cash will shorten the waiting lists for
people seeking services.

In Virginia, 16 public hospitals serve about 3,000 mental-health and
mentally retarded patients.

Rebuilt Eastern State will have a population of about 300, down from 486,
and Western State will have 260 beds, down from 270. Central Virginia will
be reduced from 544 beds to 300, and Southeastern Virginia will be cut from
200 to 100 beds.

Contact staff writer Michael Hardy at (804) 649-681 Read more!

Winston-Salem Journal calls for overhaul

Winston/Salem Journal calls for immediate filling of gaps in care, including
24/7 crisis care across the state and more accountability to the area
programs (LME), while over-hauling the so-called "reform".

Thursday, December 8, 2005

State officials could spend months trying to figure out how their 4-year-old
plan to move thousands of patients from state psychiatric hospitals to
private community programs went so wrong. But they should instead focus on
quickly fixing the many holes in the overhaul - holes that now threaten the
health and safety of the patients and, at times, of the general public.

Last May in a family-care home in rural Alamance County, an 88-year-old
resident was stabbed and later died of her injuries.

A 25-year-old psychiatric patient who lived in a room down the hall from her has been
charged with murder in her case. That's an extreme example, but it grimly
underscores what can happen as private agencies take over much of the
residential care for the mentally ill that had been done by the state. More
numerous are examples of patients who've lost access to their health care
because they couldn't negotiate the bureaucratic maze created with
privatization, as a Journal series this week by M. Paul Jackson and Phoebe
Zerwick made clear.
Many of those patients, unable to afford care outside the public system, are
flooding emergency rooms at local hospitals. Some are ending up on the
street and in jails because they are not monitored and are not taking their
medicine.

Privatization was meant to save the state money while improving care for
those with mental illness, developmental disabilities and substance-abuse
problems. Through the plan enacted by the state legislature, the state pays
private agencies to provide much of that care for the needy.

But the overhaul has so far generally failed at improving that care - and,
in some cases, at even providing that care. The biggest failure has been the
HopeRidge Centers for Behavioral Health in Winston-Salem, which was supposed
to be a model for reform in the state's $2.3 billion mental-health system.
But one year after its creation, HopeRidge went bankrupt amid angry
recriminations between its leaders and officials at CenterPoint Human
Services, which started it.

Other agencies have had to absorb its clients. Some of those clients,
frustrated by red tape, aren't getting any help.

The failure of this mental-health-system overhaul is a complex problem that
demands comprehensive solutions. Among other things, there needs to be
greater use of Medicaid for psychiatric services, more 24-hour crisis
services in communities statewide, more accountability on the part of
community agencies and a heck of a lot more communication between state
officials and these agencies. The first goal should be making sure that
patients don't get lost in the maze.

Reform of the privatization overhaul will be neither cheap nor easy - but it
is crucial. The state is failing one of its most vulnerable populations, a
population ill-equipped to help itself. Read more!

Man killed after bomb claim at airport - CNN

MIAMI, Florida (CNN) -- A 44-year-old U.S. citizen who claimed to have a bomb was shot and killed when air marshals opened fire on a boarding bridge at the Miami airport, several sources told CNN. No bomb was found.

American Airlines Flight 924 was in Miami on a stopover during a flight from Medellin, Colombia, to Orlando, Florida, when the man, identified as Rigoberto Alpizar, said there was a bomb in his carry-on backpack, a Department of Homeland Security official said.

Alpizar was confronted by a team of federal air marshals, who followed him down the boarding bridge and ordered him to get on the ground, the official said. ( Watch the aftermath of the shooting -- 1:36)

When Alpizar appeared to reach into his backpack, he was shot and wounded, the official said, adding that the marshals' actions were consistent with their training. Officials said later that the man died of his injuries. ( Watch an air marshal talk about his extensive training -- 5:03)

Upon investigation, there was no evidence that Alpizar had a bomb, an official said.

Alpizar was traveling with a woman and had arrived in Miami on a plane from Quito, Ecuador, federal officials said. He and the woman began arguing before getting off the plane in Miami, two officials said.

A passenger, Mary Gardner, told WTVJ in Miami that the man ran frantically down the aisle from the rear of the plane, arms flailing, and that the woman accompanying him said that her husband was bipolar and had not taken his medication, according to The Associated Press.

After he got off the plane in Miami and went through customs, he got on the Orlando-bound plane and said he had a bomb, Air Marshal Service spokesman Dave Adams said. (Read about air marshals being taught to avoid risk)

Air marshals asked him to get off the plane, which he did, but when they asked him to put his bag down, he refused, Adams said. Alpizar then approached the marshals in an aggressive manner, at which point two or three shots were fired, he said.

Karlina Griffith, translating for her grandmother, witness Miriam Delgado, told WFOR television that Delgado heard three gunshots before people started running and "going crazy." ( Watch a witness account -- :40)

Officials could not confirm if Alpizar suffered from mental illness. His mother-in-law told WKMG television in Orlando that he suffered from bipolar disorder, but his brother-in-law, Steven Buechner, told CNN he was unaware of any mental problems.

Alpizar moved to the United States from Costa Rica in 1986 and worked for Home Depot, Buechner said. He and his wife had been in South America since the day after Thanksgiving to help her uncle, a volunteer dentist, Buechner said.

Alpizar and his wife lived in Maitland, Florida, just a few miles north of Orlando, and they had no children, Buechner said.

The killing marks the first time a federal air marshal has fired a weapon at an individual since the program was bolstered after the September 11, 2001, terrorist attacks.

Footage from the scene showed armed SWAT team members carrying rifles outside the aircraft, along with more than a dozen police vehicles. Paramedics were standing on the stairway to the aircraft.

Investigators took the backpack and two other pieces of Alpizar's luggage onto the tarmac, and an explosives team blew the bag open by firing a bottle full of water at it. The water is used to effectively defuse any explosive device by separating its components.

The Boeing 757, which can hold about 180 passengers, was due to take off for Orlando at 2:18 p.m. ET. It had arrived in Miami at 12:16 p.m. ET, according to the airline's Web site. No other flights at Miami International were disrupted Wednesday, an airport official said. Read more!

In Case of Emergency: Forsyth short of 24-hour help and beds – Winston-Salem Journal

By M. Paul Jackson and Phoebe Zerwick
JOURNAL REPORTERS

The crisis in mental health began here in Forsyth County five years ago just
as the state was beginning its reform program, officials said.

In 2000, CenterPoint Human Services, the local public mental-health agency,
closed its 12-bed psychiatric ward on Highland Avenue, in what was then the
Reynolds Health Center, for lack of money.

Advocates warned at the time that without local beds for psychiatric care,
admissions to the John Umstead Hospital in Butner, the state psychiatric
hospital for this region, would rise.

That's exactly what happened.

According to figures provided by the state, admissions from this region have
nearly doubled since 2001, from 578 to 1,056 last year.

"I miss the old Reynolds Health Center. They cut that out because of budget
cuts and now we're finding, by golly it's necessary," said Ken Farrington, a
board member with the local branch of the National Alliance on Mental
Illness. "The hospitals have not taken up the slack."

In fact, three months after CenterPoint shut its psychiatric ward, Charter
Behavioral Health System of Winston-Salem, a private psychiatric hospital
with 111 beds for adults and children, closed because its parent company was
bankrupt.

"Our plan was to contract as much as possible with local hospitals to pick
up the slack and literally within weeks of our announcement Charter closed
and the community lost all the services Charter provided, including a large
number of adult beds," said Ron Morton, the former director of CenterPoint.

The state plan for reform of its $2.3 billion mental-health system did not
provide for 24-hour crisis care here or elsewhere to replace local hospital
beds.

"It was either a gross oversight on the part of the state or the state
assumed communities would pick up the slack, which has not been the case,"
said Farrington, whose adult son was admitted to Umstead after the local
public psychiatric unit closed.

With reform under attack, state and local mental-health officials now say
that the most important thing they can do to keep people out of the state
psychiatric hospitals is provide 24-hour crisis care in communities across
the state. The details have not been worked out, but round-the-clock care
could include a crisis center, similar to the one CenterPoint ran, or
outreach workers and specially trained police squads.

State officials say they will work on improving payment for such services.
Carmen Hooker Odom, the secretary of the N.C. Department of Health and Human
Services, said she also hopes to help local hospitals keep their psychiatric
wards open by negotiating with federal-health officials for an increase in
the payments from Medicaid for psychiatric care. A request is pending with
federal-health officials, she said.

In the meantime, emergency rooms at local hospitals are struggling to keep
up with patients who need crisis care.

Forsyth Medical Center, with 43 psychiatric beds, is negotiating a new
contract with CenterPoint to admit some of CenterPoint's uninsured clients,
said Kevin Beauchamp, CenterPoint's chief financial officer.

Despite this region's extensive medical community, hospital officials said
they should not bear the financial burden of creating a 24-hour crisis
center locally.

"Our responsibility is adult, acute-care management" and not mental-health
services, said Jo Haubenreiser, the executive director of post-acute
services for Forsyth Medical Center. "I truly believe the community isn't
looking for hospitals to do it."

Officials at Wake Forest University Baptist Medical Center agreed.

Vaughn McCall, the chairman of the medical center's department of
Psychiatric and Behavioral Medicine, said that both hospitals have some role
in creating round-the-clock care, but psychiatric care is not the hospital's
top priority. Baptist has 44 psychiatric beds.

"I think hospitals may have responsibility in being part of a communitywide
program," McCall said. But "it would simply be impossible for Wake Forest
University to single-handedly rescue what is a bad situation."

So what is the solution? Some mental-health advocates said that the federal
government needs to increase reimbursement for mental-health care, which
could encourage hospitals to add more beds for those patients.

Mental illness is "just another disorder, like diabetes or heart disease,"
said Benjamin Staples, the executive director of the state branch of the
National Alliance on Mental Illness in Raleigh. "How you can have a hospital
and not have a psychiatric unit is disturbing."

. Phoebe Zerwick can be reached at 727-7291 or at zerwick@wsjournal.com

. M. Paul Jackson can be reached at 727-7473 or at jackson@wsjournal.com Read more!