N.C. finds money to help some Medicaid recipients for now

N.C. finds money to help some Medicaid recipients for now

The Associated Press

Helping about 5,000 Medicaid recipients with mental or physical problems to remain independent would cost the state $30 million annually once the federal government drops payments for certain services in March, state officials say.

North Carolina residents with mental retardation, autism and cerebral palsy receive Medicaid assistance for meal preparation, shopping and daily scheduling so they can live in group homes, with family or on their own.

State officials told legislators Thursday they have assembled a plan to help the services continue for now by spending other unused state money. More than half of the affected people who receive the services would move to other Medicaid-financed programs, the officials said.

Legislators would have to set aside money in next year's budget for the state to keep offering the services. Rep. Edd Nye, D-Bladen, a chief budget-writer, said the state should keep the services going, but do so for less money.

"It'll be less than the $30 million they're presenting," Nye said.

Gov. Mike Easley's office said it's premature to comment on specifics of the proposal, but that "protecting the most vulnerable citizens will continue to be a high priority."

The state's plan to continue the services for now doesn't cover about 400 children who receive Medicaid services while at school. Local school districts would have to cover those costs, said Diann Irwin of the state Department of Public Instruction.

Rose Reaves, a Raleigh woman with cerebral palsy, said Thursday she's worried that she won't qualify for the alternative programs.

In a statement read by a neighbor, Reaves wrote her biggest fear "is that I will fall through the cracks." Read more!

Medicare Woes Take High Toll on Mentally Ill - New York Times

By ROBERT PEAR
Published: January 21, 2006

HILLIARD, Fla., Jan. 16 - On the seventh day of the new Medicare drug benefit, Stephen Starnes began hearing voices again, ominous voices, and he started to beg for the medications he had been taking for 10 years. But his pharmacy could not get approval from his Medicare drug plan, so Mr. Starnes was admitted to a hospital here for treatment of paranoid schizophrenia.

Mr. Starnes, 49, lives in Dayspring Village, a former motel that is licensed by the State of Florida as an assisted living center for people with mental illness. When he gets his medications, he is stable.

"Without them," he said, "I get aggravated at myself, I have terrible pain in my gut, I feel as if I am freezing one moment and burning up the next moment. I go haywire, and I want to hurt myself.""

Mix-ups in the first weeks of the Medicare drug benefit have vexed many beneficiaries and pharmacists. Dr. Steven S. Sharfstein, president of the American Psychiatric Association, said the transition from Medicaid to Medicare had had a particularly severe impact on low-income patients with serious, persistent mental illnesses.

"Relapse, rehospitalization and disruption of essential treatment are some of the consequences," Dr. Sharfstein said.

Dr. Jacqueline M. Feldman, a professor of psychiatry at the University of Alabama at Birmingham, said that two of her patients with schizophrenia had gone to a hospital emergency room because they could not get their medications. Dr. Feldman, who is also the director of a community mental health center, said "relapse is becoming more frequent" among her low-income Medicare patients.

Emma L. Hayes, director of emergency services at Ten Broeck Hospital, a psychiatric center in Jacksonville, said, "We have seen some increase in admissions, and anticipate a lot more," as people wrestle with the new drug benefit.

Medicare's free-standing prescription drug plans are not responsible for the costs of hospital care or doctors' services. "They have no business incentive to worry about those costs," said Dr. Joseph J. Parks, medical director of the Missouri Department of Mental Health, who reported that many of his Medicare patients had been unable to get medicines or had experienced delays.

At least 24 states have taken emergency action to pay for prescription drugs if people cannot obtain them by using the new Medicare drug benefit. Florida is not among those states.

In an interview, Alan M. Levine, secretary of the Florida Agency for Health Care Administration, said: "We've set up a phone line and an e-mail address for pharmacists. We try to solve these problems on a case-by-case basis. We have stepped in to get drug plans to pay for prescriptions, so people don't leave the pharmacy without their medications."

Federal officials said they were moving aggressively to fix problems with the drug benefit. About 250 federal employees have been enlisted as caseworkers to help individual patients. The government has told insurers to provide a temporary supply - typically 30 days - of any prescription that a person was previously taking. And Medicare has sent data files to insurers, supposedly listing all low-income people entitled to extra help with premiums and co-payments.

But in many cases, pharmacists say, they still cannot get the information needed to submit claims, to verify eligibility or to calculate the correct co-payments for low-income people. And often, they say, they must wait for hours when they try to reach insurers by telephone.

S. Kimberly Belshé, secretary of the California Health and Human Services Agency, said the actions taken by the federal government "have not been sufficient to address the problems that California residents continue to experience."

At Dayspring Village, in the northeast corner of Florida near Jacksonville, the 80 residents depend heavily on medications. They line up for their medicines three times a day. Members of the staff, standing at a counter, dispense the pills through a window that looks like the ticket booth at a movie theater.

Most of the residents are on Medicare, because they have disabilities, and Medicaid, because they have low incomes. Before Jan. 1, the state's Medicaid program covered their drugs at no charge. Since then, the residents have been covered by a private insurance company under contract to Medicare.

For the first time, residents of Dayspring Village found this month that they were being charged co-payments for their drugs, typically $3 for each prescription. The residents take an average of eight or nine drugs, so the co-payments can take a large share of their cash allowance, which is $54 a month.

Even after the insurer agreed to relax "prior authorization" requirements for a month, it was charging high co-payments for some drugs - $52 apiece for Abilify, an anti-psychotic medicine, and Depakote, a mood stabilizer used in treating bipolar disorder.

The patients take antipsychotic drugs for schizophrenia; more drugs to treat side effects of those drugs, like tremors and insomnia; and still other drugs to treat chronic conditions like diabetes and high blood pressure.

If I didn't have any of those medications, I would probably be institutionalized for the rest of my life," said Deborah Ann Katz, a 36-year-old Medicare beneficiary at Dayspring. "I'd be hallucinating, hearing voices."

Michael D. Ranne, president of the Jacksonville chapter of the National Alliance on Mental Illness, said the use of powerful psychiatric medications "virtually emptied out state mental hospitals" in the 1970's and early 80's. Ms. Katz said she had been "in and out of hospitals" since she was 13.

Sponsors of the 2003 Medicare law wanted to drive down costs by creating a competitive market for drug insurance. They focused on older Americans, not the disabled. They assumed that beneficiaries would sort through various drug plans to find the one that best met their needs. But that assumption appears unrealistic for people at Dayspring Village.

Heidi L. Fretheim, a case manager for Dayspring residents, said: "If I take them shopping at Wal-Mart, the experience is overwhelming for them. They get nervous. They think the clerks are plotting against them, or out to hurt them."

Residents of Dayspring Village see worms in their food. Some neglect personal hygiene because they hear voices in the shower. When nurses draw blood, some patients want the laboratory to return it so the blood can be put back in their veins.

Under the 2003 Medicare law, low-income people entitled to both Medicare and Medicaid are exempted from all co-payments if they live in a nursing home. But the exemption does not apply to people in assisted living centers like Dayspring Village.

Douglas D. Adkins, executive director of Dayspring Village, said: "Some of the pharmacists have been saying, 'No pills unless we get a co-payment.' Well, how are these people going to get the money for a co-payment? They don't have it."

Eunice Medina, a policy analyst at the Florida Department of Elder Affairs, said the state was trying to "find a solution" for people in assisted living centers.

"We are all aware that the next couple of months will be difficult for these clients, and that the possibility of a transition to a nursing home is their only option if prescriptions are not covered in assisted living facilities," Ms. Medina said in a memorandum to local social service agencies.

Luis E. Collazo, administrator of Palm Breeze, an assisted living center for the mentally ill in Hialeah, Fla., said many of his residents were forgoing their medications on account of the new co-payments.

"Because of their mental illness," Mr. Collazo said, "they don't have the insight to realize the consequences of not taking their medications. Without their medicines, they will definitely go into the hospital." Read more!

Report card points to numerous problems hampering reform effort - Carolina Journal

By Sam A. Hieb

January 18, 2006

GREENSBORO — So far, mental health reform in North Carolina has not gone smoothly. A report card recently issued by the North Carolina Psychiatric Association said that mental health reform “ran into a perfect storm’ of adverse events, among them budget problems, Medicaid shortfalls and increased populations of those needing treatment.

Other components of the “perfect storm” included more medically indigent (non-Medicaid) consumers needing care, less bridge funding than anticipated, community hospital capacity not increasing (and in fact hundreds of bed being closed over the past decade), and the loss of public sector clinicians (especially psychiatrists).”

In a recent two-part series, the Winston-Salem Journal painted an equally unflattering picture.

“The massive overhaul of the state’s $2.3 billion mental-health system began with the best intentions,” the Journal wrote. “But four years into the overhaul, there is little proof that treatment has improved, and there is growing evidence that the state’s complex system of care is worse than ever.”

In January 2001, state legislation was introduced to reform mental health care by returning its governance and operations to the counties. But the effort to streamline mental health care has only added another layer of bureaucracy.

Many observers think the entire legal, financial, and service structure of North Carolina’s mental-health system is being profoundly altered. Nonprofit agencies that offered mental health services to county residents have become local managing entities. Each agency must submit a local business plan to N.C. Department of Health and Human Services Division of Mental Health, Developmental Disabilities and Substance Abuse Services, after which the state recommends different divestiture offers.

Many of the state’s 30 local entities are in a state of confusion as they struggle to make sure it’s both economically and clinically feasible to divest themselves. Divestiture of clinical services at the entities is a complicated affair. The entities not only have to ensure private contractors are offering services to patients, but also must deal with matters such as asset transfer and annual leave for employees.

Local management entities were supposed to have received financial assistance to aid in the process as the state began closing beds in psychiatric hospitals, a move that would save about $50 million, according to the Journal. Hospitals are gradually trying to move away from primary care as more and advances in treatments and drugs are made. People with manic depression who would be hospitalized 20 years ago are now able to function in society.

But according to NCPY, admission of adult patients increased by 23 percent since 1999 with a dramatic rise since March 2004. Admissions of child and adolescent patients increased dramatically in August 2003, nearly doubling between in three-month phases in both 2003 and 2004.

In a memo to local-entity directors around the state, J. Michael Hennike, the division of mental health’s interim chief of state operated services, let directors know that the spike in hospital admissions would have a profound effect on their budgets.

“We are hopeful that as those programs that have already been funded become operational, admissions to the State hospitals will decrease. As this occurs, we will reevaluate our ability to fund additional mental health community expansion proposals,” Hennike wrote.

There’s considerable doubt among many that the new 488,000 square-foot Central Region Psychiatric Hospital, scheduled to be completed in 2007, will have enough beds to satisfy demand.

In the meantime, local entities and their private spinoff companies are feeling the financial crunch.

In its series, the Winston-Salem Journal reported on the fate of HopeRidge Centers for Behavioral Health, the spinoff company of CenterPoint Human Services, the mental-health agency serving Forsyth County and surrounding areas.

In a letter outlining the contractual obligation with Hope Ridge, CenterPoint said it disagreed with legislation to reform the mental-health system because it would “alter the legal, financial and service structure of all area authorities as a reaction, in part, to the failure of some area authorities to meet established performance expectations.”

Still, CenterPoint pressed ahead with its local business plan to contract with Hope Ridge and finalized it in April 2005. In September, HopeRidge was bankrupt.

Another private contractor, Telecare, informed its client, Crossroads Behavioral Healthcare, that it would no longer be able to treat its patients, who live in Surry, Iredell, and Yadkin counties.

Officials at Telecare told the Journal it had lost $700,000 treating Crossroads’ clients.

“I guess we’re also hoping that the state and county will be patient with us, because we’re one of the largest providers that’s tried, and if we’re having difficulties perhaps the issue is the system needs to be adjusted,” Anne Bakar, Telecare’s chief executive, told the Journal.

On top of all this, the recent budgeting process was not kind to local entities. HHS was to adjust the number of local entities to 20, meaning treatment will be further regionalized. Until that goal is achieved, entity budgets will have to tighten to the tune of $28 million.

When advocacy groups such as the Mental Health Association in North Carolina voiced their opposition, the department backpedaled, saying it will find the $28 million somewhere else.

MHA/NC officials said that for true mental health-care reform to work, both hospitals and community programs still need adequate funding.

“Reform proponents have known from the start that both systems would need funding during the transition; the freeze on shifting funds is yet another barrier to having a mental health system that meets people’s needs in their community,” the association wrote in a recent public policy update.

Heib is a contributing editor at Carolina Journal.
Read more!

Mental health services providers needed – Asheville Citizen-Times

by Leslie Boyd, STAFF WRITER
published January 21, 2006 6:00 am

ASHEVILLE - Mental health services providers and management agencies are in a scramble to meet a tight deadline.

Advertisement
With the new Medicaid rules approved by the federal government last month comes the requirement that providers enroll in a network with the local management entity by March 10.

The LMEs are responsible for managing behavioral health systems in the state.

Each agency and each professional must meet certain requirements before they're authorized to provide services to Medicaid patients, Anne Doucette, director of provider and community network development for Western Highlands Network, said at a board of directors meeting Friday.

Doucette and her staff are responsible for getting the required paperwork and certifications completed before the deadline.

Western Highlands is the local mental heath care management agency for an eight-county area that stretches from Mitchell to Transylvania.

The requirement that someone from Western Highlands must visit each site where services will be provided means hundreds of visits across the area.

For some services - especially the new ones - the gap between the number of providers who have applied so far and the number that will be needed is large.

"I'll be honest with you, folks," Doucette said. "These numbers are very preliminary. Right now, they're just a best guess. But as the weeks go on, they'll get better."

Board member Ryan Whitson voiced concern about the ability of the network to meet the community's need.

"I'm worried about these numbers," he said. "For children's community support alone, we're still short 92 people."

Doucette said she believes the resources are there.

Many people who are performing services that will be discontinued will be moved into the vacancies for the new services.

As enrollment continues, she said, the number of vacancies will decrease, although there likely will be shortages in some fields.

Will Callison, CEO of New Vistas Behavioral Health Services, a nonprofit services provider, said that's what's happening at his agency.

"We will have to hire a number of paraprofessionals - people with a high school degree and a year of related experience - to provide community support services, but they will need supervision, so I don't see layoffs of qualified professionals," Callison said. "They will move into the new services positions."

Read more!

Police get help with mentally ill people - Cleveland Plain Dealer

Mark Puente
Plain Dealer Reporter

Panic reigned when Medina policeman Jim Stevens entered the house. Four screaming people held down a relative. The woman at the bottom - said to have nine personalities - appeared out of control.

The first thing Stevens did was order the others out of the room. Then he talked to the woman, calming her and bringing her back to reality. Moments later, she voluntarily walked to a waiting ambulance.

"It wasn't the old style, where you say 'you're going to the hospital,' and the fight is on," Stevens recalled of the 2001 encounter. "It's a matter of talking them down. It's a lot of patience."

Stevens was one of the first graduates of a program developed in 2000 by Akron police officer Michael Woody to help police deal with the mentally ill. The goal is to "de-escalate" situations before incidents turn unnecessarily into tragedy.

Since then, more than 1,500 Ohio officers have received the training, and the program is being copied across the country. Likewise, Ohio's court system is in the forefront in treating the mentally ill differently, through the use of a nation-leading 27 mental health courts.

Now retired from the police department, Woody works full time to train officers throughout the state. He developed the Crisis Intervention Team program because he believed officers often lacked special training in responding to numerous calls with the mentally ill.

He tweaked Ohio's model, based on a program developed in Memphis in 1988 after officers there killed a mentally ill patient. Officers receive 40 hours of specialized training under the guidance of mental health counselors, family advocates and mental health providers. They learn about common mental illnesses and their side effects.

Police ride along with case managers to see mentally ill people. Mental health patients also talk about their frustrations with police.

"It gives the officers a first-hand perspective," Woody said. "This is different from the movies."

Officers also learn to look for medications, which are a key indicator to see what type of disorder a person may have. The goal is to train 20 percent of Ohio's patrol officers.

Although 40 hours of training doesn't make officers experts on mental issues, Woody said, the constant exposure increases the likelihood of peaceful resolutions.

In part because of the program, the Ohio Peace Officers Training Council in January will lengthen the training time for such situations from two hours to 16.

Blair Young, spokesman for the Ohio chapter of the National Alliance on Mental Illness, said the public needs to understand the need for greater training by police.

"The appropriate response isn't to detain them," he said. "It only makes the problem worse. The goal is to get them in for voluntary treatment."

And in some courts, as well, the mentally ill are being treated in a different way - an effort to reduce the number of mentally ill people in prisons.

Many counties now have mental health courts. For cases to be shifted to the special courts, participants must be charged with a misdemeanor and have a diagnosis of a treatable disorder, such as schizophrenia or bipolar disorder.

An intense treatment plan is developed with counselors and probation officers. Mandatory visits to case managers are required. The plans must be approved by judges.

Ohio Supreme Court Justice Evelyn Lundberg Stratton, who in 2001 created a task force of law enforcement and mental health officials to develop solutions for the mentally ill, said such people are arrested numerous times for committing minor and nonviolent offenses.

"It's a huge, huge problem," she said. "Nobody is getting to the root of the problem."

The task force, the Supreme Court of Ohio Advisory Committee on Mentally Ill in the Courts, is encouraging counties to establish mental health courts to decrease the number of mentally ill inside jails.

If participants in the court programs quit attending sessions, they can be jailed.

"It's not a way for them to avoid their responsibilities," said Corey Schaal, Mental Health Court Program Manager for the Ohio Supreme Court. "It's a carrot-and-stick approach to justice. These people are already in the justice system."

The group organized a national conference last summer and expected 250 participants. However, more than 750 officials from around the country turned out to hear about both programs.

That's good news, Stratton said.

"Ohio has collaborated to a degree that others have not," Stratton said. "There's no turf battles."

To reach this Plain Dealer reporter:

mpuente@plaind.com, 440-934-0524 Read more!

Taming A Defiant Mind - Seattle Post-Intellingencer

SEATTLE POST-INTELLIGENCER, January 12, 2006

[Editor's Note: How profoundly can the symptoms of a mental illness engulf
a person's perceptions and rationality? - powerfully enough to make a mother
take the life of a beloved child. That point has been repeatedly reinforced
in a string of similar tragedies over the last few years, most notoriously
the deaths of Andrea Yates' five children.

By presenting Lori Farmer ten years after her horrific event, this piece
offers a viewpoint unavailable to us in examining those more recent
tragedies. She is understandably imbued with melancholy, but she is also
functional, stable and decidedly non-violent. Her recovery leaves little
doubt that her son's life was taken not by her but by the effects of her
illness.]


Lori Farmer's Recovery From Mental Illness Opens Window On Insanity Defense

By Tracy Johnson, Seattle Post-Intelligencer Reporter


Lori Farmer paces around with her guitar on open-mike night at the sandwich
shop, a colorful place filled with other eager performers who don't know
about her past.

The song she will sing mentions him, but not what happened. Not how.

She settles down at a table, sips her coffee and skims the topic, anyway.
Delving too deep, she still cries.

"I'm afraid people will persecute me. They'll say: 'Look at her. Do you know
what she did?' "

Her friend Brian Rogers tells her again. He tells her often:

"You're not the same person now."

Farmer says she knows. She was sick. The voices weren't real. God would
never urge her to hurt someone -- least of all her 4-year-old son, who loved
Batman and used to run around in a cape that his grandma made from an old
skirt.

Zane was buried in his pretend cape 10 years ago. Farmer killed him.

She believed, with a rigid certainty she can still barely express, that she
was saving him. She tried to die with him. Instead, a Pierce County judge
ruled her criminally insane.

She has struggled to get hold of a defiant mind and is trying to rebuild a
life.


Finding 'A Quality Life'

Farmer's story is a rare look at what happens to people who are found not
guilty by reason of insanity, sent to one of the state's two psychiatric
hospitals and, because of privacy laws, are often forgotten by the general
public.

Yet of the 27 people who killed someone in Washington and were found insane
between 1995 and May 2005, 13 have already earned some degree of freedom,
according to a Seattle P-I analysis of court records, mental-health
evaluations and interviews with prosecutors and defense lawyers across the
state.

Nine of them, including Farmer, have moved back into communities.

They include Bruce Rowan, a Port Angeles doctor found insane for killing his
wife with a baseball bat and an ax, and John Hallinan, who climbed into the
bathtub at a Federal Way motel six years ago and drowned his 3-year-old son.


In their cases, mental-health professionals generally found -- and judges
agreed -- that proper medication, treatment and a strong understanding of
their disorders make it unlikely they will commit another crime.

Most of the nine, like Farmer, who lives in a Lakewood group home, remain
under supervision and probably will for the rest of their lives.

Four more people, like Marc Gerson, who torched his family's Redmond home
six years ago because he thought demons told him to, have earned their way
to Western State's community program. The unlocked ward helps patients make
the transition to freedom.

The rest of the 27, like Dan Van Ho, who stabbed to death a retired Seattle
firefighter in a random attack outside the Kingdome in 1997, are still
considered unstable enough that they require 24-hour security.

Some, including Farmer, 42, may always hear voices or have delusions. The
goal of treatment, according to community program manager Dick Tomko, is to
help them find support outside the hospital's walls and "enjoy some form of
a quality life."


Early Signs Of Trouble

Years ago, Farmer's parents misread the early hints of mental illness as
signs of their daughter being a teenager.

She always thought people were looking at her and whispering behind her
back. She often seethed with anger. Her father, Deane Farmer, remembers how
she sometimes planted herself on the couch and glared at him, inexplicably
fuming.

Then one day, she began screaming that demons were coming out of the
bathroom mirror at her. She started seeing "shadow people" and feeling evil
spirits brushing against her skin, crawling lightly on her arms.

She began talking about things that didn't make sense to her family. That an
unseen camera had been clicking pictures of her every move. That Jon
Anderson, lead singer of the rock group Yes, was her father in a previous
life. That he had brought her to Earth in a spaceship.

She started drinking and smoking pot. She tried to hurt herself. Her mother,
Elva Farmer, recalls finding blood-soaked tissues and questioning her
daughter, who eventually admitted she'd made cuts across her wrists.

"If I tried to talk to her about it, she'd just pick a fight about something
else," Elva said.

They knew little about mental illness and recall that it was "pretty much
kicked under the carpet" back then, she said. They sometimes wondered if
Lori's odd behavior was a ploy; it often came when she didn't get what she
wanted.

Eventually, they helped her move into an apartment and supported her
financially.

"I have to confess," her mother recalled, "it was a lot easier to pay her
rent than to live with her."


Multiple Suicide Attempts

Farmer knew something was wrong. Other people didn't spend full days
sobbing. She would go to church but otherwise isolate herself in her Tacoma
apartment. She didn't have any friends. She'd sit alone and play her guitar.

Some days she felt almost normal. Some days she couldn't pull herself out of
bed.

"I felt like somebody hit my soul with a Mack truck," she recalled.

She heard angry voices, sometimes God, sometimes Satan, and started using
harder drugs such as methamphetamine. She was trying to get through the day
any way she could, thinking, "If I die, I die."

One night she cut her wrists so deeply that she almost did.

A doctor first prescribed an anti-depressant after one of her suicide
attempts, but she wouldn't always take it. She got counseling, too, but it
didn't help. Her parents say she had a way of "masquerading" -- pretending
she was fine.

They wanted her to get help but couldn't force an adult who didn't want it.
They weren't allowed to see her medical records, so she was able to keep
them in the dark.

Her father recalled simply, "We didn't know what to do."


Tough Defense To Prove

Many lawyers consider insanity a defense of last resort.

Juries seldom find people insane in murder cases. It appears to have
happened just once in the past decade in Washington, in the case of Rowan,
the Port Angeles doctor. And judges, as in Farmer's case, rarely do either.

At least 3,342 people were charged with homicide in Washington between
January 1994 and December 2004. Less than 1 percent of them were ruled
insane.

Proving someone is not guilty by reason of insanity is tough. It's not
enough that the person is mentally ill, hears strange voices or has a long,
documented psychiatric history.

Under state law, it means a mental "disease or defect" made the person
either unable to "perceive the nature and quality" of the crime or to
distinguish between right and wrong at that time.

The "not guilty" part can be a wrenching concept for victims' relatives to
accept: that legally, no one is responsible.

"I think most of the time it's met with great skepticism because murder is a
deliberate act of one human against another," said Jenny Wieland, director
of Families and Friends of Violent Crime Victims, a Washington-based
victims' advocacy group.

But mental health advocates say delusions can obliterate a person's
perception of what is real and what is right.

They say sending such people to prison -- blaming them for their disorder
instead of treating it -- doesn't bring justice for anyone.

"There's a legitimate public interest to make sure there's no recurrence,"
said Ron Honberg of the National Alliance on Mental Illness.

"Maximum-security prisons are environments that are pretty much guaranteed
to make symptoms of mental illness worse."


A Boy Called Bucky

Farmer keeps a small photo album full of pictures of Zane, who had shiny
brown hair and got a kick out of putting his hands over his eyes and
hollering, "Somebody turned out the lights!"

As she sat on a picnic bench on an outing with her Western State therapist,
Kris Harkness, her memories of Zane tumbled out. She smoked a menthol as she
talked about him with a proud smile and sad eyes.

She used to call him Bucky, and he could almost always sweet-talk her into
buying him a new toy. Once Farmer told him he had too many and should give
some to the Salvation Army. He thought about it and brought it up the next
day.

"Mom, don't give all my toys to the mations!" he told her, a bizarre word
that still makes her laugh.

His father was a man Farmer had met on the psychiatric ward at a Pierce
County hospital, where she ended up after a suicide attempt in 1989, but she
didn't stay with him for long.

Farmer acknowledges now that she often wasn't a good mom. She was sick, and
like many mentally ill people, was trying to feel well by using drugs. Some
mornings Zane found her too depressed to drag herself out of bed.

"He'd say, 'Take your medication, Momma,' " Farmer recalled. "He knew."

She had been prescribed several anti-depressant and anti-psychotic drugs
over the years, but they made her feel weak and anxious and gain weight.
She'd feel drained and ugly and quit taking them, then skid toward paranoia.

Once she saw construction workers outside her apartment and became convinced
that they were nailing boards over the doors to trap her inside.

She became preoccupied with the Antichrist, the Mark of the Beast at the
Apocalypse, concepts she'd learned about in church. She worried constantly
about kidnappers and sex predators, certain that one was going to snatch
Zane.

As she fought with her fears, her parents recalled, she tried to put
everything she had into taking care of Zane. That was clear to Elva Farmer
even as she cleaned out Lori's apartment after her grandson was gone.

"When I went to his little dresser, all his things were folded so neatly.
His socks were all rolled up," Elva recalled. "Everything of Lori's was just
a mess."


A Reeling Mind, A Gunshot

Farmer was expecting her parents for dinner on June 13, 1995.

Zane was playing outside while she stood at the stove, trying to make
spaghetti sauce. She couldn't concentrate. She recalls hearing the voice of
God: This is it, he told her. Suddenly, she had to get Zane.

Her mind was racing with all that was real to her: Jon Anderson, the
musician, the man who brought her to Earth in a spaceship in another life,
was now the Antichrist in this one. He was coming. The Apocalypse was at
hand.

Her neighbors were in on it. Zane would be given the Mark of the Beast, and
the Antichrist would take him away. She had to make sure she and Zane went
to heaven. Together.

The meat for the spaghetti sauce burned.

Farmer hurried outside and led Zane in by the hand. He was hungry. He headed
for the pantry and rummaged around for a snack. Farmer got the gun she'd
bought to protect them some earlier time when her mind had churned out
illusory reasons for alarm.

She remembers reaching one hand to her little boy's face.

"I said, 'Zane, I love you,' " she recalled, eyes filling with the tears
that nearly always come. "And I covered his eyes so he couldn't see."

She shot him in the chest. She remembers leaning his small body over gently
on the pantry floor.

"I thought I was saving him," she said. "I believed it with all my heart."

She sprawled next to him on the floor and curled the gun around, resting the
barrel against her own chest. Fired once. Tried again.

Wounded, bleeding, she fought with the weapon. It was jammed. She felt warm;
the pain wouldn't rush in until later.

The next hours collapsed into each other. Her parents came over, knocked
repeatedly and left. Night fell. Farmer fumbled around for some knives,
carved open her wrists and lay down on her bed.

Zane was on his way to heaven. She had to catch up.


No Dispute Of Her Insanity

Farmer was inconsolable, rocking, crying. Doctors at two other hospitals had
treated the bullet wound in her chest and her sliced arms after her parents
went to her apartment and discovered what she had done.

Now sitting at Western State Hospital, she was almost unrecognizable.

"When I first saw her, I never thought she'd get well again," her mother
said. "There wasn't much to say. We just sat and cried. She said, 'I tried
to save him.' I tried to tell her, 'Well, you're still here. The end of the
world hasn't happened.' "

Farmer was charged with murder. A psychologist asked by the court to
evaluate her concluded she was legally insane when she killed her son: that
while she understood what she was doing, she couldn't tell right from wrong.


Pierce County prosecutors knew it would be difficult to prove otherwise and,
in a rare decision, agreed Farmer should be found insane, according to Jerry
Costello, chief criminal deputy prosecutor.

For many months, Farmer would "sob for extended periods throughout the day"
and had "auditory and visual hallucinations, especially of angels and other
spiritual figures," according to a hospital report.

Her parents tried to learn what they could about Farmer's mental problems,
which they found, only after Zane's death, included schizoaffective disorder
-- essentially schizophrenia with shades of depression.

Hospital staff watched her carefully, wary that she might try again to kill
herself. She so urgently wanted to be with Zane.

"She said, 'I just want to die.' She said that for a good four or five
years,' " Elva Farmer recalled. "It was hideous. Just heartbreaking."


Treatment, Not Punishment

If she had been found guilty, Farmer might still be behind bars. A
second-degree murder conviction can mean 10 to 18 years in prison or longer.

To mental-health advocates, the time isn't the point. The goal isn't
punishment; it's helping people learn to manage their illness, which often
takes much longer than the sentence would have been.

"You're not sent to the state hospital to 'do time'; you're sent there to
get treatment," said Deborah Dorfman, director of legal advocacy for
Washington Protection and Advocacy System, which works to protect the rights
of people with disabilities including mental illness.

"It's not like they're discharging people right and left," she said.
"Getting a conditional release (from a psychiatric hospital) is not easy.
It's not taken lightly."

Still, some worry that the hospital staff members who recommend release --
or the judges who agree to it -- might make mistakes in deciding whether
someone still poses a risk.

Many victims' relatives want to see mentally ill offenders locked up for
more time simply "because they committed a crime, and there's got to be
accountability," said Wieland of the victims' advocacy group.

Zane's father, Tom Dickerson, said that although he's been diagnosed with
paranoid schizophrenia himself, his understanding of mental illness doesn't
calm his anger about what Farmer did.

"I think she should have went to prison," said Dickerson, 35, who is behind
bars in Idaho for failing to register as a sex offender after a 1990 rape
conviction. "She lost a son, and I know she really loved him, but he was all
I had."


Refusing Her Responsibility

As doctors searched for the right balance of anti-psychotic and
anti-depressant medications, Elva Farmer remembers, Lori became fidgety. In
the first year after the shooting, she talked more but would unconsciously
stamp her feet on the floor. She couldn't sleep.

And for a long time, Lori tried to blame others for Zane's death.

God shouldn't have let it happen, she'd tell people. The devil shouldn't
have tricked her. Her psychiatrists must have prescribed the wrong
medications. Her mother should have seen it coming.

"It was so much pain," Farmer recalled. "I had to have somewhere for it to
go."

Hospital staff were gently trying to help her understand that her own
actions, while she was psychotic, led to Zane's death.

"This is a very difficult process for any patient to come to grips with,"
they wrote in 1996, "as there is so much guilt."


Getting Better Was Worse

In their twice-yearly reports, hospital staff said Farmer was impulsive.

She broke rules. She traded food with a patient who was supposed to be on a
special diet. She got caught smoking in various places on the ward, lighting
cigarettes with a hairdryer.

Once, as patients were filing down a stairwell, she spontaneously yelled,
"Run, everybody, run!"

Every time she'd start to improve, earning a new level of responsibility
under the hospital's motivational system, she'd backslide.

"I think it was self-punishment," Elva Farmer said. "Her son was dead, and
she didn't think she deserved anything because of it."

Medications have a way of generating more anguish long before bringing hope.
They can expose reality.

Farmer remembers slowly realizing the Antichrist hadn't been coming for her
and Zane that day. Her mind had created this delusion. This lie. And still,
Zane was gone.

It tore at her all the time.

She hurt so many people. Her parents, who adored their grandson. His
playmates. Zane was their first friend who died and the reason they had to
learn, so young, what that meant.

"I had to face what I did," Farmer said. "It wasn't like I spilled a gallon
of milk. I mean, Zane died."

"There was a time, as she began to get better mentally, that the better she
got, the worse it was," her mother remembered. "She'd cry and cry."


'Guilty But Mentally Ill'

People have been found not guilty by reason of insanity for centuries,
though the idea has always brought controversy.

In 1982, when John Hinckley Jr. was found insane after shooting President
Reagan in an apparent attempt to impress actress Jodie Foster, many states
took steps to make it harder for mentally ill people to be acquitted.

Several states did away with the insanity defense altogether. Others gave
juries another option: a "guilty but insane" or "guilty but mentally ill"
verdict. The idea is that people will get treatment, then spend the rest of
their sentence behind bars.

Families and Friends of Violent Crime Victims plans to propose a similar law
in Washington state this year.

"The benefits would be for the victims, really," said Ida Ballasiotes, vice
chairwoman of the group's board and a former state representative. "At least
there's a little sense of closure."

The group's proposal will likely echo legislation once put forward by former
state lawmaker Jeri Costa, who now heads the state's Indeterminate Sentence
Review Board. It would let juries find people "guilty and mentally ill."

"Whether they knew what they were doing at the time or not, they killed
somebody," Costa said. "The No. 1 issue here is that there's no
accountability."

Mental-heath advocates argue that such an approach has a fundamental flaw:
It means locking up people for acts prompted by illnesses that aren't their
fault.

The National Alliance on Mental Illness opposes such laws because "they are
used to punish rather than treat persons with brain disorders who have
committed crimes as a consequence of their brain disorders."

Critics also contend it's just a regular guilty verdict in disguise -- with
a feel-good provision about treatment that people won't likely get because
there won't be resources to provide it.

"I think it's just something to mislead the jury," said Seattle lawyer David
Allen, who defended Rowan seven years ago. "And I don't think there's a
problem anyway, because very few juries ever acquit."


Accepting Her Illness

In her tiny room at the hospital, Farmer intermittently hung pictures of Jon
Anderson and Jesus, then ripped them down. Sometimes the images were
reassuring to see; sometimes she felt like they were saying bad things to
her.

Hospital staff said her spirits could soar or crash depending on whether she
believed, at any particular time, that she and Anderson would be together in
another life.

She went to daily group therapy, where patients talked about why they needed
to be hospitalized and how to prevent relapse. She attended sessions about
the importance of medications, the side effects and the need to steer clear
of street drugs.

By 2002, she began asking more questions about her illness and had "shown
desire to understand her behavior," according to a hospital report.

She admitted the voice of Jesus had been keeping her up at night. She
realized that hiding her symptoms hadn't persuaded anyone to free her and
wasn't helping her get better.

Staff saw signs that she was beginning to accept her illness and what it
would mean for her life. She talked about a future that involved making
supportive new friends, taking medication and probably never living alone.

In early 2004, hospital staff decided she was ready -- a Pierce County
Superior Court judge agreed -- to move to the community program.

There, she was gradually allowed to leave the hospital grounds -- at first
for an hour, eventually for weekend furloughs when she'd sometimes go
camping with her parents -- as she worked toward freedom.


Low Rate Of Reoffending

Some of the people who have committed crimes and live in Western State
Hospital's locked ward don't want help. They resent supervision. They don't
believe they are sick or try to pretend they aren't.

"Some people continue to blame other people or don't want to deal with the
seriousness of their crime," said Tomko, the community program manager.
"Those are the people who don't get out."

Yet patients don't have to show they are somehow "cured" to be released;
it's a matter of whether they are considered at risk of breaking the law
again. They must also show they can keep their symptoms in check.

Whether someone should move to the unlocked community program or into
society is up to the hospital's risk-review board, which also considers the
patient's attitude toward treatment, plan for the future and support outside
the hospital.

People who are treated at places such as Western State Hospital are much
less likely to commit another crime than those who land in prison, according
to Bruce Gage, supervising psychiatrist for the hospital's Center for
Forensic Services.

He said most people released from prison will break the law within three
years, while the recidivism rate for people found insane and treated at a
specialized psychiatric program is less than 5 percent.


Dealing With The Voices

Farmer now wants to understand as much as she can about the mental disorder
she used to pretend wasn't there. She wants to retain control of it.

"She's very genuine; very honest," said her therapist, Harkness, whom Farmer
calls her guardian angel. "She'll tell you when she has symptoms. She wants
help."

Despite her medication, the voices are still there occasionally. They don't
command her to do anything, which hospital staff would find more troubling.

She sometimes hears Jesus, God or even Anderson, whom she still believes was
her father in a previous life but now realizes isn't the Antichrist. They
say negative things, that they're going to punish her, make her fat, make
her hair fall out.

Jesus tells her, "Woe to you."

Sometimes she ignores the voices. Sometimes they grow too loud.

Then Farmer gets what she calls "a reality check" to help make sure these
hallucinations never again whirl out of control. She'll ask her mom,
Harkness or whoever is around: Could the voices be real?

Harkness sometimes tells Farmer to try to shut the voices out. They are her
illness. Her mom explains that God and Jesus are loving. They wouldn't want
to punish her.

Farmer said she thinks about it for a while, follows the logic, "and then I
start reasoning right."


Support Makes A Difference

At the end of August, Farmer moved off the campus of Western State and into
a group home, which has about 20 other residents and staff who work there
full time.

Harkness continues to see her at least weekly to talk about her symptoms,
budgeting her limited Social Security money -- most of it goes to the group
home -- or whatever else comes up.

At some point, Farmer plans to look for a job, maybe in a mailroom
somewhere, with very limited hours to curb potential stress.

Every Wednesday, she goes to a group session about substance abuse at
Greater Lakes Mental Healthcare, where she has a case manager and someone
who prescribes her medication.

She likes to relax at her parents' cheery rambler in Sumner. Her mom and dad
have given her constant support over the years, according to hospital
reports -- often a powerful part of a patient's recovery.

Her mother said she misses her grandson but has never felt like she couldn't
forgive her daughter.

"We lost one to this illness," she said. "There's no point in losing two."

Farmer often talks about how she'll always have to take medications and will
never again drink alcohol or do street drugs. If she does, or if her mental
illness otherwise grows worse, Western State staff can bring her right back
to the hospital.

A Pierce County judge also reviews hospital reports about Farmer, sent at
least twice a year, to consider how she's doing and whether there's any
reason she shouldn't remain free.

Farmer said she now wants to keep other mentally ill people from ending up
in her situation. To keep taking their medication. To realize that they
can't simply ignore what's going on in their heads.

She has seen her own illness at its worst and must live with the
consequences.

"I want to see me make it, and I'm going to," she said. "I don't want to
hurt anybody. I don't want to hurt myself. I want to have a peaceful,
successful life now."


Her Radiant Star

Farmer waits for her turn to sing at the Antique Sandwich Co. in Tacoma.
She's wearing a new outfit and an elaborate necklace jeweled with colored
stones.

She shows off the brown felt hat she's brought with her. Should she wear it
or not? She asks a few people. She puts it on. She takes it off. She
declares, "I'm not nervous at all."

On stage, she begins strumming her guitar, her thick silver rings flashing,
her short, sapphire-painted fingernails finding the chords. She's playing
"Radiant Star," a song she's written about Jesus being there during her
toughest times.

I got drunk at the bar; I slept in my car, she begins, her voice deep and
strong. But you were my radiant star.

She closes her eyes, moving to the music. My son died one day; in heaven he
plays. But you are my radiant star.

Sometimes she sings "Zane's Song." That one's harder.

Maybe she'll play it next time.
Read more!

N.C. panel approves reforms at group homes for children

Published: Jan 19, 2006 10:30 PM
Modified: Jan 19, 2006 10:30 PM

The Associated Press
A package of reforms designed to improve staffing and care at group homes for mentally ill children could become permanent later this year.

The reforms, approved Wednesday by the N.C. Mental Health Commission, could become permanent March 1 or in mid-June, depending on objections that might be filed.

The commission first passed the reforms last year, shortly after a series of stories in The Charlotte Observer revealed problems in the homes and lax oversight by the state.

The state hired new inspectors and checked on more than 1,000 group homes across the state. Gov. Mike Easley also ordered a moratorium on new licenses until tougher operating rules could be passed.

But group home operators then entered a formal protest process that kept the new rules from taking effect.

At the hearing Wednesday, group home operators said that of particular concern to them was a rule requiring one staff person to be on duty even when children aren't at home, and another rule requiring two staff members to be awake while children sleep.

Commissioners deleted the rule requiring a staffer on duty when no children are home. Instead, they will require a staffer to be able to reach the facility within 30 minutes in such situations.

Commissioners also revised the other rule to require at least one staffer be awake if there are with four or fewer children, and two awake with five to eight kids.

The commission then passed the reform package with no other major changes.

It's not clear what the group home operators will do next. They have retained an attorney, and they spoke to legislators earlier Wednesday about their concerns.

  Read more!

Care of mentally ill prisoners costly for jails - Cleveland Plain Dealer

Friday, January 20, 2006
Mark Puente
Plain Dealer Reporter

John paced feverishly, scratching his head and sipping coffee. His hollow eyes appeared to look beyond the white brick walls that confined him.

For a man with bipolar disorder and schizophrenia, the special-needs ward at the Lorain County Jail presents no boundaries. He can leave the jail, even if only in his mind.

For jail officials, though, it's John's body that is the problem.

Jails across Northeast Ohio say mentally ill inmates -- people once sent to psychiatric institutions -- are filling cells needed for more-traditional criminals.


Budgets balloon as the state and counties pay for more staff and more medication at a time when the region's jail population is at an all-time high.

As of October, Ohio was treating 8,371 mentally ill prisoners to the tune of about $67 million a year. The mentally ill represent 18 percent of all the people in state prisons.

Those numbers do not include mentally ill prisoners held in county jails, for which figures are not available.

For many, jail is the only place to get treatment.

"Their gateway to mental health care is through a jail," said Capt. James Drozdowski, the Lorain County Jail administrator. "A jail setting is no place for these people."

They used to have other alternatives.

In 1976, Ohio's psychiatric hospitals had about 15,000 beds. Today, that number stands at 1,200, but 700 are reserved for inmates who plead guilty to crimes by reason of insanity.

Institutions closed and patients were released as treatment philosophies began to suggest that people received better care in their communities than in institutions.

Terry Russell, executive director of the National Alliance on Mental Illness, said the local facilities needed to care for those patients were never built and many patients ended up homeless.

"Housing is our No. 1 priority," Russell said. "We cannot get anybody in state hospitals. They ultimately get in trouble."

County jails also pay the price.

Lorain County, for example, spends about 40 percent of its $1.2 million jail health-care budget on the mentally ill, who are housed in a 22-bed unit. "It's very taxing on the budget," Drozdowksi said.

The Cuyahoga County Jail spends about $2 million a year on its 96-bed psychiatric unit, said Warden Kevin McDonough. "It's a big, big issue," he said.

Jail administrators say the largest expense is psychotropic drugs, which can average $1,500 to $2,000 per inmate each month.

The drugs have a modifying effect on perception, emotion or behavior.

Also, under state law, inmates are given a two-week supply of prescriptions upon release.

But many mentally ill inmates commit crimes again after the medicine runs out or they stop taking it, officials say.

Capt. Frank Leonbruno, Lake County Jail administrator, said a jail allows mentally ill inmates to become stabilized and develop routines. He acknowledged that it's a delicate situation.

"What's bad is, we're a jail, not a mental hospital," Leonbruno said. "Once they leave, we can't maintain that routine."

Dr. David Muzina, director of Adult Inpatient Psychiatry and director of the Bipolar Disorders Research Unit of the Cleveland Clinic, said the region lacks adequate mental health services. But he said mentally ill people aren't more prone to commit crimes.

"It's a rap and a stigma on the mentally ill," he said.

It's a stigma that John, the Lorain County inmate, can't shake.

John, who asked that his last name not be used, has spent more than half of his 35 years in psychiatric units, both in hospitals and jails.

Pacing faster and faster around the jail, jumpy under his medication, he said he has grown accustomed to the lifestyle in confinement and commits crimes as soon as he is released.

"I don't believe anything is wrong with me, but I don't know what's going on out there," he said. "This is all I know. They don't have places for guys like me."

To reach this Plain Dealer reporter:

mpuente@plaind.com, 440-934-0524

Read more!

Mentally ill man on long road after 44 years in state hospital - Raleigh N&O

Ruth Sheehan, Staff Writer

Phil Wiggins' emergence from 44 years in a state psychiatric hospital has been a series of highs and lows, mirroring the promise -- and challenges -- of the mental health reform effort he personifies.

Over the last seven months, he has shown glimmers of great promise. Bursts of humor. A renewed interest in reading science texts.

He has also churned through five community-based social workers, the folks who stay with him all day. He has begun "cheeking" his medicine for schizophrenia and impulse control, refusing to swallow it.

And then of course, last fall, his sister, Louise Jordan of Raleigh, received notice that Wiggins was being evicted from his group home in Zebulon after trying to start a fire in the back yard with baking soda and cologne.

For two months, Jordan visited a grim selection of other homes. But the new year brought good news. With his sixth social worker, Wiggins seems to be making progress again -- so he's being allowed to stay at the group home.

I've followed Wiggins for nearly two years now in his journey back into the community. I've been struck by the beneficial effects of more freedom and interaction with the outside world. And I've been stunned at how quickly those advances can be lost when logistical obstacles arise -- a break between social workers or a delay in testing to make sure he's still swallowing his meds.

Keeping a patient as profoundly mentally ill as Wiggins on the right track requires a huge investment.

First of all, 56 hours per week of one-on-one care. Forty hours with one worker and 16 hours on the weekend with another.

That does not include the day program his social worker will soon begin attending with him, to help him learn to socialize.

Nor does it include the basic care he receives at the group home, from the psychiatric nurse who is on duty during daylight hours, and from the additional person the group-home owner has hired to be on hand overnight in case Wiggins wanders. Which he does.

On top of all that is Anita High, his uber-social worker, and the team that arranges for every necessity from clothing to psychiatric care.

But when things are going well, even a man as sick as Wiggins is capable of tremendous progress.

On a recent Wednesday, I met Wiggins and his new social worker, along with Jordan and High at a Ruby Tuesdays in North Raleigh.

The wait for our food seemed endless. Yet Wiggins sat quietly. He even commented on the restaurant's lively decor.

It was such a contrast from 21 months ago, when we first met. Then, Wiggins could not sit for five minutes in a meeting at a state psychiatric hospital in Goldsboro about his future. The meetings would barely begin and he'd shout, "Louise! How about we go to Hardees?"

He had no clue about his future, much less about the decor of any room he sat in.

So at Ruby Tuesdays, as we fought over the bill at the end of the meal, we all roared with laughter when Wiggins told his social worker to let Jordan pay.

"Save your money," he said, "and spend it on me."

A small victory? Yes. But in it lies some hope that mental health reform can succeed. Read more!

Community Child Protection Team - Washington DailyNews

By JONATHAN CLAYBORNE, News Editor
WILLIAMSTON — The Martin County Department of Social Services substantiated or provided services in 33 child abuse and/or neglect cases during state fiscal year 2004-2005, Susan Davenport, DSS director, informed the county commissioners Wednesday night.

Of the 33 cases, four were abuse cases, 26 were neglect cases, two were instances of abuse and neglect, and one was a dependency case, a DSS report reads. Dependency cases are those where a parent is unable or unwilling to care for a child.

Davenport shared the numbers during her annual presentation on the Martin County Community Child Protection Team, a group composed of representatives of the mental health, social services and law enforcement communities, among others. The team includes District Attorney Seth Edwards.

“Our job is to review cases of child abuse and neglect as defined by general statute,” Davenport told the board. “The main concern, and the main object here, is to identify any gaps in services, any gaps that we as a community can fill in.”

The team meets on a monthly basis to review cases, related Dusty Biggs, a team member and an investigator with the Martin County Sheriff’s Office.

“There may be services that can be offered through other agencies, not just law enforcement or social services,” Biggs related.

Davenport’s report provides a glimpse into the team’s role in child abuse cases and a small-picture look at part of the DSS caseload.

Representing DSS and the team, Davenport identified a gap in service Wednesday night, directing the board’s attention to a “lack of adequate mental health services.”

“With reform raging in the Mental Health field, services at the local level have suffered; our families have to travel to other counties to obtain them,” she wrote. “Thus, transportation ... becomes a barrier since many of our families do not have reliable means of getting to appointments. Mental illnesses and/or substance abuse issues are seen in many of the families we work with. The resolution of these issues is essential to having healthy families.”

Davenport indicated she’s confident the issues she tied to mental health care changes will be resolved after the conclusion of system reform. The reform to which she referred is a state mandate that, in part, requires divestiture of in-house government services and a move toward facilitating more private-sector involvement in mental health care, professionals in the field have reported.

Despite the problems highlighted in Davenport’s account, it appeared Martin County remained free of deaths stemming from child abuse in 2004, the last year for which numbers were immediately available.

The state reported 31 children died because of abuse in 2004, but none of those children were from Martin or surrounding counties. Martin County DSS found 117 abuse and/or neglect reports were unsubstantiated, Davenport shared.

The state report, contained in a packet Davenport had handed to the commissioners, lists the children’s ages, sexes, first names and counties of residence. None of the young victims were old enough to vote or obtain a learner’s permit. They ranged in age from 1 month to 14 years.

None of the deceased children resided in Hyde, Beaufort or Washington counties. Two of the cases took place in Tyrrell County. The list was embargoed until Sept. 29, 2005.

The accounts of child fatalities caught the attention of commissioners’ Vice Chairman Tommy Bowen.

“It’s unbelievable,” Bowen said.

Speaking as a team member and a sheriff’s investigator, Biggs said substance abuse is fairly common in households were child abuse occurs, but added that’s not true in every case. And child abuse isn’t confined to low-income residences, he advised.

“Abuse is not set to one social standard,” Biggs said. Read more!

Durham's Better Idea - Raleigh News and Observer

Published: Jan 18, 2006 12:30 AM
Modified: Jan 18, 2006 07:44 AM

Durham's better idea

Paying counties not to send mentally ill patients to state hospitals is no boondoggle. Such payments may be just the sort of incentive some North Carolina counties, such as Wake, have needed to build community services that can take the place of state hospitals -- a goal of mental health reforms that have been in the works since 2001.

As The N&O's Lynn Bonner reports, Durham's mental health office came up with the payment idea as a way of reducing a deficit that its crisis center is running. The deficit is due, in part, to the fact that the Medicaid program reimburses less for those services than for hospital care. But another key factor is that many more patients are receiving short-term treatment at the hometown crisis center instead of hospitalization.

A woman named Angela McCuiston is a prime example of how a system built on community services is supposed to work. McCuiston told The N&O she had been in and out of Umstead State Hospital for years, only to return to alcohol and heroin use. Last year was different. A Durham-based team of doctors and counselors saw her admitted into a rehab clinic, found housing for her and came to the rescue when she relapsed. Though she has been in the Durham crisis center for four short periods, McCuiston sounds hopeful that she is finally receiving effective treatment.

Now Durham, which used to be one of the state's largest users of state mental hospitals, reports one of the lowest utilization rates among all North Carolina counties. That track record earned the county an affirmative answer for its proposal to reduce utilization further still, in return for the money saved.

It's particularly encouraging that the state mental health director, Michael Moseley, is willing to extend similar deals to other counties. The money could prove to be the incentive needed to stimulate more alternatives to hospital care.

Wake County, for one, may be able to alter its alcoholism treatment center enough to serve alcoholics who also have been diagnosed with mental illness, according to the county's medical director, Dr. Peter Morris. That would be one way to reduce Wake's admissions to Dorothea Dix Hospital in Raleigh -- and would be welcome news for all considered.

Read more!

Reform rips mental health ‘safety net’

Paperwork, finances challenge emerging area providers
by Leslie Boyd, STAFF WRITER

Two years ago, Bernice Penn wanted to die. Out of work and disabled, she was on the verge of being evicted because she couldn’t pay her rent.

“I’m one of those aging baby boomers who fell down and couldn’t keep one paycheck ahead of it all,” said Penn, 56. “I was so close to the edge, so tired of crying all the time.”

She turned to New Vistas Behavioral Health Services, the nonprofit that took over many of the services of the old Blue Ridge Center Area Program under the state’s mental health reform.

Counselors there treated her severe depression and referred her to the help she needed to get into public housing and onto the food stamps program.

As reform took place across the state beginning in July 2003, the old area programs became local management agencies, or LMEs, and stopped offering mental health services. Several of the LMEs, including the two that serve the counties of Western North Carolina, helped set up nonprofit service providers in their areas.

But these “safety net” providers are in financial trouble. One agency, Hope Ridge in Winston-Salem, has closed, and others, including New Vistas, are struggling.

On Jan. 1, New Vistas merged with Mountain Laurel Community Services, which provides services to Henderson and Transylvania counties. The agency will continue to operate both entities under their current names.

“I think there are some real serious problems,” said Will Callison, CEO of New Vistas/Mountain Laurel. “But I still believe we can work them through.”

Among the problems are mounds of paperwork providers must do, Callison said — more than double the load the area programs had before mental health reform.

One example is a survey that must be completed in an hour-long, face-to-face interview with a clinician for each person. Before reform, the survey was given to a sampling of substance-abuse patients; now it is mandated for everyone.

“It might not be so arduous for a smaller provider, but we have 10,500 open cases right now,” Callison said.

The process for Medicaid approval also has been made more complicated, Callison said, and it no longer is computer-based.

“It used to be electronic, but now it’s all on paper,” he said.

Finally, the safety-net providers don’t turn anyone away, and their patients tend to be sicker and need more intensive — and more expensive — care, said Vicki Ittle, clinical director of New Vistas.

Joe Ferrara, CEO of Meridian Behavioral Health Services in Sylva, said his agency is struggling as much as all the others.

“We attempted to offer a full continuum of services for our region,” Ferrara said. “Unfortunately, there are services that are financially viable and those that are not, and we try to provide them all.”

Ferrara said Meridian might have to look at cutting some of its services to stay afloat.

“It’s a pretty fragile system right now,” Ferrara said. “I think that’s really the bottom line.”

Carol Duncan Clayton, director of the N.C. Council of Community Programs in Raleigh, said most providers are experiencing cash-flow problems.

“The system is so bureaucratic it keeps dollars in the pipeline so long that people go under before they get paid,” she said. “I don’t think the spin-offs are in any better or worse shape than the provider network as a whole. There’s a fragility of the entire network.”

Michael Moseley, director of the N.C. Division of Mental Health, Developmental Disabilities and Substance Abuse Services, acknowledges there are problems, especially with cash flow.

“One of the biggest issues is that some of these service providers geared up to provide these new services and then had to wait months and months for reimbursement,” he said. “The revenue stream will move more quickly now, and it will be a sustainable revenue stream.”

Providers no longer will have to bill through the LME but can bill Medicaid directly, cutting out one step in the process.

Moseley also said the state is working on an action plan to help providers stay in business.

“We’re asking how we can get cash into the hands of these providers more quickly,” Moseley said. “We should have that plan ready later this month. … If there are policy issues that we control that will pave the way for these providers to stay in business, we certainly will address that.”

Allison Breedlove, interim director of the Governor’s Advocacy Council for Persons with Disabilities, fears what will happen if providers can’t stay afloat.

“If these nonprofits and other providers fail, we’re going to see huge gaps in services,” Breedlove said. “The services just aren’t going to be there and people are going to end up on the streets, in hospital emergency rooms and in jail.”

Penn believes her fate would have been even worse.

“I’m pretty sure if New Vistas hadn’t been there, I’d be dead,” she said. “I’m still waiting for disability, so I’m still in limbo as far as that goes, but now I believe I’ll be OK. … Therapy helped me realize I can change the channel in my head and advocate for myself.”

Contact Boyd at 232-2922 or lboyd@CITIZEN-TIMES.com. Read more!

Commitment process takes toll on rural areas

Wilkes officers want to find better way to deal with staff issues

By Monte Mitchell
JOURNAL REPORTER
NORTH WILKESBORO

A few days ago, a 25-year-old man who said he was going to stab himself in the heart was at Wilkes Regional Medical Center.

A North Wilkesboro police officer waited with him while health-care workers determined that the man was dangerous to himself and to others and had abused such drugs as OxyContin, crack cocaine, marijuana and painkillers.

Police stayed with the man for the five hours involved in the involuntary mental commitment process, then took him to detox and returned to patrol.

Handling involuntary commitments is a job faced by police and sheriff's departments across North Carolina, but in a rural place such as Wilkes County it is a process that authorities say often leaves their jurisdictions without adequate police protection.

North Wilkesboro typically may have two or three police officers available on a given shift.

If they're down to two officers when an involuntary-commitment call comes, one of the officers must wait with the patient at the hospital. "I don't feel like we're giving the people of the town of North Wilkesboro the police coverage they deserve," said Chief Randy Rhodes of the North Wilkesboro police department.

"It's a lonely feeling, even in a small town, to be the one officer," he said, adding that Sheriff Dane Mastin of Wilkes County and Police Chief Gary Parsons of Wilkesboro experience similar problems with staffing because of involuntary commitments.

"It's even worse for us because our police officer is outside their jurisdiction" at the hospital, Parsons said. "It leaves one officer in town."

"It's a big issue with all of us," Mastin said.

North Wilkesboro government is organizing a meeting to include all three law-enforcement agencies, as well as health-care workers, to see what can be done to better manage the involuntary-commitment process.

None of the agencies have a written departmental policy on handling involuntary commitments, a step that is among recommendations from the N.C. Department of Justice.

All three department leaders in Wilkes County speak well of each other. Their officers often cooperate on cases.

The lack of a clear understanding of who should handle a particular case for involuntary commitments has led to disputes, even among rank-and-file officers, as they tried to figure out who should sit with a patient and who should be free to return to patrol in the early-morning hours.

The three agencies each have unique challenges.

Because the hospital is in North Wilkesboro, police there respond to a level of involuntary commitments out of proportion to the town's population of 4,100.

During 2005, North Wilkesboro police handled 115 involuntary commitments, but only about a quarter of them were people who live in North Wilkesboro. The longest case took 24 hours, or two entire police shifts.

Police are frustrated over how long it sometimes takes to find a psychiatric hospital willing to accept a patient. They also want to figure out why there are so many cases.

By comparison, Winston-Salem police handled 311 involuntary commitments in 2005. On a per-capita basis, North Wilkesboro police handled 17 times as many cases.

Wilkesboro police handled 40 or so cases in 2005, Parsons said, and 75 percent of them were for people who don't live in Wilkesboro but were picked up there because the magistrates' office is in the courthouse in Wilkesboro.

"If we get an officer tied up for 17 hours on a commitment, that's 17 hours taken away from the taxpayers of Wilkesboro," Parsons said. "And we don't get anything back for it."

The Wilkes County Sheriff's Office handled 285 involuntary-commitment cases in 2005. Because state law requires a sheriff's office to transport patients out of the county, many of those cases included ones handed off from Wilkesboro or North Wilkesboro police so deputies could take the patients to psychiatric hospitals in Hickory, Winston-Salem or other places.

The sheriff estimates that his officers spend 8 to12 hours on average for each involuntary-commitment call.

Mastin, Rhodes and Parsons all say they don't understand why the involuntary-commitment process takes so long. Most of the patients aren't violent, they said. Most are cordial.

All three said they have seen abuses of the system. Some calls are for bedridden or nursing-home patients. They say they've seen elderly people being involuntarily committed because they wouldn't take their medication.

"That's the frustration we're seeing in law enforcement is we're not seeing the imminent threat," Mastin said. "I think there's some solutions out there, but it's going to take everybody involved coming to the table and taking responsibility, which would include family members or legal custodians."

• Monte Mitchell can be reached in Wilkesboro at (336) 667-5691 or at mmitchell@wsjournal.com Read more!

N.C. mental health funding picture brightens — somewhat - Citizen-Times

In October, state Sen. Martin Nesbitt, D-Buncombe, told members of the local chapter of the National Alliance on Mental Illness that one of his greatest frustrations as co-chair of a committee overseeing state mental health reform results from the state’s decision to redefine the mental health treatments it will pay for under Medicaid while changing the way it delivers services.

Nesbitt said he’d been trying for a year and a half to get the new Medicaid definitions. It’s very difficult, he said, for the local management entities set up to oversee delivery of mental health services to find private providers when they don’t know what treatments will be reimbursed or at what rates. Nesbitt said he was very concerned that some services would be eliminated that should not be.

“I want something approved,” Nesbitt said. “Then, if it’s not appropriate, we can change it. Now, I’m fighting a ghost. Meanwhile, some providers are going out of business.”

Last week, Sen. Nesbitt got his wish. The federal Centers for Medicare and Medicaid Services approved some new service definitions requested by the state and refused others. It appears the senator was right to worry that some services would be eliminated that should not have been, but there was good news in the new service definitions, as well.

The federal government agreed to cover 62 percent of the cost of care for Medicaid-eligible patients in several new areas. It will subsidize the medical supervision of addicts trying to become sober and will pay for some residential treatment programs. Medicaid will pay for mobile teams to go to patients in psychiatric crisis and stay with them until the crisis is resolved or the person has been moved into treatment.

It will also pay for teams consisting of 10 to 11 practitioners, including psychiatrists, nurses, therapists and substance abuse experts to monitor patients rather than wait for patients to visit a clinic. For teens, Medicaid will reimburse the cost of teams that offer age-appropriate treatments to address serious antisocial behavior, behavioral problems and substance abuse.

The new definitions fall into a category state Mental Health Director Mike Moseley calls “community support services,” which he says are more comprehensive and more flexible than services previously provided. Knowing that Medicaid will reimburse for these services should help local management entities recruit private providers to make the services available.

“What has happened is that we’ve had providers sitting on the sidelines,” Moseley said in a telephone interview Tuesday. Understandably, he said, they have been either unable or unwilling to gear up to provide the needed services when they have no idea what services the state will reimburse them for.

But, while some requested services were approved, others were not. Medicaid will provide less coverage than is currently available for people with autism, mental retardation and other developmental disabilities.

The state Division of Mental Health is working this week, Moseley said, to find ways to provide coverage for the affected children and adults under other programs. But that may be difficult in an already badly underfunded system. The legislature has asked the Division of Mental Health to determine service gaps and reliable estimates of what it would cost to treat everyone who qualifies for assistance over the next five years. That report is due in March.

“We have a woefully underfunded system and folks should not be misled to believe that receiving approval for the new Medicaid-funded services will be a panacea,” Moseley said. “There will be a need moving forward for additional state dollars to be appropriated into our system.”

While the new service definitions are not all that could be hoped for, they do provide a desperately needed answer to the question of what services Medicaid will reimburse. Hopefully, that will bring new providers into the field. It also gives a clearer picture of what services the state will need to provide without Medicaid support.

It’s a step forward, but much more needs to be done before Sen. Nesbitt’s committee can present the legislature with a comprehensive plan to get mental health reform back on track. Read more!

Paying for care- Raleigh N&O Editorial

Federal subsidies for community mental health services are welcome despite gaps. The state is obligated to fill those

North Carolina redesigned its system of caring for the mentally ill in 2001, emphasizing private services instead of state-run hospitals and clinics. For too long after that decision was made, state health administrators managed the progress of reform without much leadership from Governor Easley and the legislature. Worse, when budgets got tight, they took money intended for transitional mental health care and spent it on other things.

Many private groups have come forward to provide communities with help for families of the mentally ill and other services, but the response has been uneven. Some needed to know that government health programs would reimburse them for the care of indigent patients, and how much, before they could fully commit their own resources. Unfortunately, it took the better part of 2005 for the federal Centers for Medicare and Medicaid to make that call.

Now, federal subsidies for those providing community-based mental health care have been announced, and that amounts to good news for North Carolina's mental health reform. If all the needed services become accessible, many patients won't have to be confined to state mental hospitals, and reform will be a well-deserved victory for these patients and their families. But it's a big "if."

As hospital beds have been phased out, there have been glaring gaps in services. Sadly, patients have been discharged to homeless shelters in some areas. In Mecklenburg and Cumberland counties, the state wasn't prepared to keep tabs on all the group homes that opened for business, and some were sorely lacking in trained staff. More inspectors weren't mobilized until the death of a 12-year-old patient in a Charlotte group home made the papers.Soon Medicaid will be covering 62 percent of the cost of key services, including drug and alcohol abuse treatment and emergency psychiatric care. Particularly significant is the government's decision to pay for teams of professionals who will keep up with patients and steer them to preventive care. Research has shown that the team approach works to keep most people with mental illness out of hospitals and in their communities.

While expanding the services that Medicaid will cover, federal administrators have drawn the line at others, some of which North Carolinians may not deem discretionary. Last month, Medicaid officials told North Carolina the program would no longer cover the cost of trained workers who help some patients with autism or mental retardation function outside of institutions.

To keep patients from falling between state programs and losing this help, the legislature needs to put more money in the state budget. In fact, the state ought to take more responsibility for the mentally ill in general. As the reform proceeds, state leaders must expect progress, closely monitor developments and quickly act to plug gaps in services that patients need.

Even with the federal subsidies, gaps in services could persist in parts of the state. That ought to be unacceptable to the governor and legislative leaders who are elected to serve all North Carolinians.

Read more!

New mental health CEO optimistic

by Leslie Boyd , STAFF WRITER
published January 8, 2006 6:00 am

ASHEVILLE — Although some people believe the state’s reform of its mental health care system is a disaster, Arthur D. Carder Jr. believes there are positive aspects to it.

Carder, the new CEO of Western Highlands Network, the local mental health management entity, says there’s plenty about the system that can work.

We do have some challenges,” said Carder, who most recently was regional services administrator for a 23-county area for the Georgia Department of Human Resources. “But that’s one of the things that’s exciting about this job. … There’s a tendency to say, ‘Oh, this is not working, let’s change it,’ but we need to find out what about it is working before we change it.”
Carder, 57, is a native of Virginia. He arrived at Western Highlands the end of October and has been working with former CEO Larry Thompson, who retired Dec. 31. He oversees the management of mental health services for the eight-county area covered by Western Highlands — Buncombe, Henderson, Transylvania, Madison, Polk, Rutherford, Yancey and Madison.

Carder believes the Consumer and Family Advisory Council and the mandate to involve mental health services consumers more in their own care are two of the most important aspects of the new system.

“We can no longer have a group of people sitting around a table and deciding what’s best for someone without their input,” said Carder, who is the former director of a community-based behavioral health program in Iowa.

Consumers and their families live in the real world, outside the realm of theory, and they know what works for them, he said. They know whether a certain medication’s side effects are too much for someone, or what supports a person needs to live productively in the community.

“We have operated from a position traditionally where we say we know what’s best for a person,” he said.

Health care moved away from that model decades ago, and mental health care must do the same, he said.

Susan Hendrick, chair of the Western Highlands board of directors, said Carder stood out from the other applicants because of his experience in the mental health field and his eagerness to face the challenges of reform.

“Things change from day to day and we felt he could work with that,” she said.

An estimated 22.1 percent of Americans suffer from a diagnosable mental disorder in a given year. With adequate care, many people with mental illness can lead productive lives. However, without care, many risk becoming homeless, getting involved in criminal activity or being dependent on social services because they can’t hold a job.

Mandy Stone, director of the Buncombe County Department of Social Services and a member of the Western Highlands board, said she was impressed with the breadth of his experience — in both the public and private sectors of mental health and his training in social work.

“The other thing was that of all the applicants, he was the one who understood the best that this new system needs to be consumer-driven,” Stone said.

Carder also wants to work to increase cooperation between mental health and other health professionals.

“Mental health has a huge impact on physical health,” he said. “And medications for mental illness have an impact on a person’s physical condition. You can’t separate mental health from physical health.”

Carder sees the gaps in crisis services for people with mental illnesses as one of the biggest challenges Western Highlands faces.

“We need a range of services, from someone who can go to the person and try to defuse the situation to crisis care beds,” he said. “Sometimes we oversell a single solution. We can’t measure services by saying we have a certain number of beds. We do need beds, but we definitely need more resources across the board for children and adults for crisis supports.”

Carder also would like to see law enforcement officers receive training in crisis intervention so they can avoid jailing someone when what’s needed is treatment for a mental illness. An officer with crisis training is better able to defuse a mental health crisis before it becomes violent, he said.


Contact Leslie Boyd at 828-232-2922 or via e-mail at lboyd@ashevill.gannett.com. Read more!

Need Medicaid? Show Your Passport - NY Times

By BOB HERBERT
Published: New York Times, January 5, 2006

Buried in the nearly 800-page federal budget bill is a nasty little provision, ostensibly aimed at immigrants, that will make it difficult for many poverty-stricken U.S. citizens to get the health care they are entitled to under Medicaid.

Advocates believe that the provision, which will require Medicaid applicants to document their U.S. citizenship (which means producing a passport or birth certificate), may be especially harmful to poor blacks, most of whom do not have passports and many of whom do not have birth certificates.

There are no exceptions to this onerous provision, not even for people with serious physical or mental impairments, including Alzheimer's disease.

The budget bill is scheduled for a final vote in the House on Feb. 1. The Medicaid provision seems to have originated with a pair of Republican congressmen from Georgia - Nathan Deal and Charlie Norwood. The idea, Congressman Deal told me, is to create a barrier against illegal immigrants who might slip into the Medicaid program by falsely claiming they are citizens.

You haven't heard much about this latest threat to the republic because there is no evidence it is much of a problem. As the Center on Budget and Policy Priorities has reported, an extensive study by the inspector general's office of the Department of Health and Human Services "found no substantial evidence that such false applications are actually occurring and [the inspector general's office], accordingly, did not recommend making the change that is included in the [budget] agreement."

The problem will come when poor people who are ill get sucked into a nightmare of documentation when their focus should be on their illness. The center noted: "Many individuals who require Medicaid coverage - such as people affected by emergencies like Hurricane Katrina, homeless people or those with mental illness - may be unable to get Medicaid promptly when they need it because they do not have such documents in their possession."

Many poor people live far from the cities or towns where they were born and do not have ready access to their birth certificates. And, as the center said, a large number of African-American women, especially in the South, were unable to give birth in hospitals because of racial discrimination. Many of them never received birth certificates for their babies.

A spokesman for the Senate majority leader, Bill Frist, who is a physician, said the Senate went along with the House proposal because the "members did not feel it was an unreasonable provision." He said applicants in serious need of care would receive it, and that Medicaid officials could accept the documentation of citizenship later.

I wondered what would happen to individuals who were bedridden, destitute, disoriented, enfeebled. They might receive care in theory. But would they really? Stepping on their care seems a heavy price to pay to address an issue that very few people view as a serious problem.

I asked Abel Ortiz, who advises Gov. Sonny Perdue of Georgia on health care issues, if he was aware of any studies that showed whether significant numbers of illegal immigrants in his state were getting Medicaid benefits. He said no, although he added, "We have some cases that have happened."

The Congressional Budget Office has estimated that the new provision would save more than $700 million over the next decade. But if illegal immigrants crashing the Medicaid program is not a big problem, where will the savings come from? How about from the reduction in enrollment of sick or otherwise troubled U.S. citizens who are poor and less than savvy about the arbitrary workings of the bureaucracy?

The budget bill is a good example of how the insiders and special interests get what they want in Washington, while ordinary people, who are supposed to be represented by the members of the House and Senate, get bludgeoned.

Some members of Congress wanted health care savings - if there were going to be any - to be achieved by such measures as negotiating better rates with large drug companies and managed-care facilities. But that's not the sort of thing that flies in this day and age. So the savings will be drawn like blood from the sick and the poor.

Someday the pendulum will swing back, and the government of the United States will become more representative and more humane. Meanwhile, as Lily Tomlin said, "We're all in this alone." Read more!

Durham called model in mental health reform

BY GREGORY PHILLIPS : The Herald-Sun
gphillips@heraldsun.com
Jan 5, 2006 : 9:03 pm ET

DURHAM -- Durham has been a model for other counties in its approach to mental health reform, the county's mental health director said Thursday night.

Ellen Holliman, director of The Durham Center -- the county's mental health, developmental disabilities and substance abuse authority -- said the center is ahead of the curve in North Carolina's reform effort. It's exceeding state requirements for reducing state hospital admissions and providing mental health services to patients in their own communities, according to a report Holliman shared with the center's board.

The Durham Center, which serves around 7,000 people each year and has an annual budget of $43 million, cut the bed-days used by Durham County patients at John Umstead Hospital in Butner by 50 percent in two years, landing the county an additional $1.7 million in funding, Holliman said.

The number of Umstead admissions from Durham dropped from 19,541 to 9,690 between fiscal years 2002-03 and 2004-05, 9 percentage points ahead of the goal.

"They have gone up in other areas, where ours have absolutely decreased," Holliman said. "People are not showing up [at hospitals], which means people are getting their services close to home."

The reform plans include a provision to redirect money saved from hospital bed closings to community programs. That hasn't happened everywhere, but Durham has been more fortunate than most, Holliman said.

"We have actually gotten our money," she said. "Statewide, that hasn't been the case."

The amount of hospital closure funds transferred to The Durham Center has grown ahead of the planned curve, and stands at $1.68 million for the current fiscal year, over $64,000 more than projected.

Board Chairman Doug Wright said the redirected funds have allowed The Durham Center to better target care where it's needed.

"What's happening is we're taking basically the same dollars, providing the proper services and able to provide more of it," he said.

However, he did express concern that while Durham has received hospital closing funds, state hospital budgets haven't yet decreased, leading him to wonder whether "the well will dry up."

Holliman said Durham's program has been getting state money in part because a unique agreement among counties for the state to tie performance-based funds to Durham based on meeting admission reduction goals.

"If we don't perform, we don't get the money," she said. "No one else came to them to do that."

Reform also requires counties to privatize services. Durham maintains 135 contracts with 84 agencies to provide services ranging from transportation to outpatient counseling to methadone services. Holliman said a concentration on individual case management in particular has been the lynchpin of reducing hospital admissions.

"It's going to be case management that gets people connected, gets them services and keeps them out of the hospitals," she said. Read more!

COLUMN: County jail an unsettling place even to visit - LaCrosse Tribune

By RICHARD MIAL | La Crosse Tribune Opinon page editor

Let me get a couple things off my chest first, and then I’ll tell you about my visit to the La Crosse County Jail.

I wrote an editorial for Tuesday’s Tribune titled “La Crosse County Jail needs better mental health services.”

The headline is dead-on accurate. But Sheriff Mike Weissenberger had complaints about much of the rest of it.

I think he’s right on two points: The editorial made it sound as if all the investigations into the suicide death of 17-year-old Kirk Gunderson are complete. They are not. While the sheriff’s department has concluded a review of how specific procedures were followed the night of Gunderson’s death, other aspects of the investigation — including visits by outside agencies — remain active.

The other point is that the editorial made it sound as if absolutely nothing is being done to deal with mental illness in the jail. And that’s not the case.

Again, I think the headline is more accurate: The county does need to do more. In the same way, we need to do more as a community.

I spent about two hours in the county jail Thursday with Weissenberger, jail Captain Doris Daggett and Tribune editor John Smalley. We also met earlier with Steve Josephson, a clinical therapist with the County Human Services Department, and Tribune publisher Rusty Cunningham.

Josephson spends about half of his work week in the jail. His job is to track the inmates who are suicide risks or have other critical mental health issues.

There is plenty of work to do. Last year there were 175 separate instances of inmates either threatening suicide, attempting suicide or showing other severe symptoms of problems.

Josephson said, “We do have a lot of people who have mental health issues.”

That may be an understatement. And the realities of county budgets means there is not a lot of care available.

Josephson does not have time to conduct individual or group therapy sessions with inmates unless he had already been seeing them in his human services practice before they went into the jail.

When inmates are booked into the jail, an extensive mul-ti-page medical history form is filled out, including questions about mental health issues.

If you’ve never been there, seeing life in the county jail close-up is a shock. As you enter the housing unit — which has room for 172 inmates in several cell blocks of varying security levels — the first thing you see is a large, slightly elevated room in the center of the structure, with large windows and a console where a jailer works, observing the many monitors.

From that control room, one jailer can open and close all the doors in the housing unit. There are multiple cameras in all the cell blocks (but not in the cells) and intercoms throughout the facility, including in the cells.

Surrounding the control room is a dimly lit hallway. Along the outer walls are the cell blocks. Most have a two-story bank of cells along the outer wall of the building, and a small day room, with stainless steel tables and stools bolted to the floor.

Here, the inmates spend the entire day. They are locked out of their cells for 10 hours a day and have to spend that time in the day room. Some of them read paperback books or magazines from the jail library. Inmates might play cards or other games. But mostly they sit, lay on the floor or wander around the small day room, with 20 or 30 inmates sharing the common space.

Some dayrooms have small televisions, some do not. None have cable access, so the channel selection is limited. Jail windows allow in some natural light, but inmates can’t see out the windows, either to the outside or to the hallway.

The large windows that allow the jail staff to look in to the cell blocks appear as mirrors to the inmates. Two “roving” jailers on each shift go in-to every cell block on an irregular once-an-hour schedule.

There is an unheated recreation area, with a lone basketball hoop on the wall. There also is a small classroom, where high school equivalency classes are held.

The jail ministry also uses it for programming. It also coordinates volunteers and supervises inmates in the recreation area. Weissenberger says he does not have the staff to allow for such supervision. Once a week, the jail ministry conducts religious services.

There’s not much to do in the jail. Weissenberger said serving a one-year sentence in the county jail would be “hard time,” worse than being in a state prison, where at least there is an opportunity to work, some movement between buildings and opportunities to get outside.

The jail is a difficult place to work. It’s an unsettling place even to tour.

Imagine living there.

And then imagine living there with a mental illness. Read more!