N.C. health officials outline plan to improve mental-health system - Winston-Salem News Journal

Wednesday, May 31, 2006

Agenda calls for more pay for psychiatrists, money for training

By David Ingram

JOURNAL RALEIGH BUREAU

RALEIGH

Faced with a shortage of psychiatrists across North Carolina, health officials said yesterday that they want to pay psychiatrists 33 percent more for some treatments for patients eligible for Medicaid.

The change would affect about 300 psychiatrists and cost the state between $1.5 million and $3 million, officials said. They said they see the money as an investment, possibly resulting in fewer visits to emergency rooms and savings in other areas.

Officials also said they plan to redirect mo-ney to encourage training more psychiatrists.

"We simply don't have enough psychiatrists, especially child psychiatrists, to meet our needs," said Dr. Allen Dobson, the assistant secretary for healthy policy and medical assistance in the N.C. Department of Health and Hu-man Services.

The changes were part of a five-page "Action Agenda" released yesterday by Carmen Hooker Odom, the secretary of health and human services, and her staff. The agenda outlines plans for improving the state's mental-health system, which began moving toward privatized, local care in 2001.

A survey by the N.C. Psychiatric Association, a trade organization, found a 13.5 percent drop from 2003 to 2005 in the number of full-time-equi-valent psychiatrists working for the state mental-health system.

Robin Huffman, the executive director of the group, said that a higher Medicaid reimbursement rate might help bring psychiatrists back to the system.

Huffman said, however, that many psychiatrists have other objections about how the system is run.

"We want to make sure the mo-ney goes to making sure patients are being taken care of, and that it's not going to administration," she said.

Among the other recommendations in the Action Agenda are increased access to prescription medication for the poor, increased monitoring of medical providers' accreditation and the possible consolidation of some mental-health services into few-er buildings.

Odom and the Department of Health and Human Services have been heavily criticized for their roles in the transition of the mental-health system.

A legislative oversight committee has recommended chang-es of its own, and they are winding their way through the General Assembly along with about $104 million in proposed new spending for next year. Mental-health advocates have asked for at least $156 million.

Rep. Verla Insko, D-Orange, a co-chairwoman of the oversight committee, said she welcomes Odom's proposed agenda.

"This is consistent with what the oversight committee has been working for," Insko said. "We would prefer that the executive branch take the lead."

o David Ingram can be reached in Raleigh at (919) 833-9916 or at dingram@wsjournal-.com

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Mental health gets budget help - Winston-Salem Journal

$104 million not enough, some say

By David Ingram

JOURNAL RALEIGH BUREAU

Advocates for the mentally ill were cautiously optimistic yesterday after budget-writers in the N.C. Senate proposed $104 million in new spending for mental health.

The money would go toward day-to-day services, crisis services, housing and other resources for the mentally ill. It's about $15 million more than what Gov. Mike Easley recommended two weeks ago but about $52 million less than what advocates say the system needs.

"It's in general a good step, a good step in the right direction," said David Richard, the executive director of the Arc of North Carolina, an advocacy group for mentally ill people.

"This will be the biggest one-time recommendation ever for mental health, but knowing the needs ... we have to fight the perception that it's enough," Richard added. "It's not going to fix the system at the level that we need it fixed."

The spending is intended to help repair a mental-health system that has received heavy criticism since 2001, when the state began to privatize many mental-health services and to emphasize local care.

A series of articles in the Winston-Salem Journal in December explored how efforts to transform the system have faltered because of poor planning and a lack of money.

Senators have scheduled votes on their budget plan for today and Thursday, after which the House is expected to recommend its own plan. A final budget for state government's next fiscal year is expected to emerge in late June.

Senate leader Marc Basnight, D-Dare, said he would like to see more money for the mental-health system. But, he said, it was competing with many other priorities for the $2.2 billion available for new spending and for tax cuts next year.

A mental-health oversight panel has recommended $156 million in new spending.

"Every study committee recommends more money," Basnight said yesterday. "Every city will ask for more money. Every county will ask for more money. Every university will ask for more money.

"But I think we did pretty good for mental health."

Carmen Hooker Odom, the secretary of health and human services, said that the Senate's recommendations are reasonable.

"It follows along very closely with what the governor proposed," Odom said.

Unlike Easley's plan, the Senate budget recommends earmarking 5 percent of the state's alcohol tax for the Mental Health Trust Fund, which has been raided in recent years when the state faced billion-dollar budget deficits. The earmark would be the first dedicated revenue stream for the trust fund.

"The Mental Health Trust Fund is something that has great potential to build infrastructure throughout the state, and it hasn't been used to its potential," Richard said.

The Senate also recommended the replacement of two of the state's mental hospitals using certificates of participation, a type of bond that does not require voter approval. The plan would authorize $145.5 million to replace Cherry Hospital, followed in two years by $162.8 million to replace Broughton Hospital in Morganton.

State officials say that the hospitals are outdated, but Easley did not recommend replacing them. The new hospitals are the most expensive building projects in the Senate's recommendations.

Among the items that the Senate did not fully finance is money for crisis or emergency services.

The mental-health oversight committee recommended $10.5 million in startup money, but Senate budget-writers included only half of that. They did include full funding, at $9 million, for on-going emergency services.

People near Winston-Salem have limited options during a mental-health emergency, said Betty Taylor, the chief executive of CenterPoint Human Services, the mental-health program that covers Davie, Forsyth and Stokes counties.

CenterPoint's treatment center on Highland Avenue is open only during the day, so patients must go to a hospital emergency room after hours.

"Which of course puts increased pressure on our hospitals," Taylor said, "and it means that people do not always get the services that they need."

Rep. Verla Insko, D-Orange, is a co-chairwoman of the mental-health oversight committee. She said yesterday that she hopes to increase spending on mental health during House negotiations.

"The goal of reform was to service people in the community," Insko said, "and it looks like we're going in the exact opposite direction."

David Ingram can be reached in Raleigh at (919) 833-9916 or at dingram@wsjournal.com Read more!

Where do kids fit in this equation? - Greensboro News-Record

By Lorraine Ahearn:

It would have been nice.

At the Guilford Center on North Eugene, one of the county's full-service mental health centers, they've put in new carpet, bright pastel walls, and a kids' play area in the Child and Family Services waiting room. The long-planned work is almost done.

But as if to show how abruptly the state's mental health “reform” is about to pull the rug out from under the most vulnerable children -- this time almost literally -- parents who watched the progress of the spring renovations were already on notice that most of the services offered inside are being discontinued.

With the center being ordered, along with others across the state, to gut its staff by June 30 in favor of “divestiture” to HMO-type providers, thousands of families are scrambling to find new psychiatrists, therapists and caseworkers for children suffering from mental illness.

School bus driver Rudy Kennedy, for example, received a letter March 3 giving him two weeks to find new services for his daughter. The 14-year-old is bipolar, and her violent, psychotic episodes finally forced the family to place her in a group home. When Kennedy last met with a casework manager at the Bellemeade building and saw workmen pulling up the old carpet, it was a cruel joke.

“Why don't we fix up the ship before we sink it?” said Kennedy, who moved here in 2004 after Hurricane Charley destroyed his Florida home.

“We finally had everything in place for my daughter. Our caseworker has been absolutely wonderful. She pulled rabbits out of hats for us. And now she's being fired. That's stupid.”

At a chapter meeting Monday night of the National Alliance on Mental Illness, veteran child psychiatrist Barbara Smith was peppered with questions from parents confused by the virtual dismantling of the public mental health system. Other than to offer medication management and crisis services, the Guilford Center, like other regional centers statewide, will no longer exist after next month.

“I was stunned. I just cannot believe it,” Smith, a staff psychiatrist at Moses Cone Hospital, said of the changes, which the state announced in March would take effect June 30, six months sooner than planned. “Where are all these people going? They can't just close mental health without an alternative.”

In a March letter to families, Guilford Center officials said they were “excited” about the change: “We believe this new service is more flexible and that it should meet your child's needs better” than before.

The center's director of nursing, Paula Snipes, said her agency would still be a “safety net,” and that clinicians would help what she called “consumers” to find new providers.

But families and doctors said this week it is difficult to find therapists, caseworkers and psychiatrists who take the kind of insurance many children carry: Medicaid.

Advocates say it's no accident that business-school words such as “divestiture” and “consumer” have crept into conversation about public health.

“It's all boiling down to dollars and cents,” said Jean Allen, who founded the outreach program Tristan's Quest, named for her son who died while being restrained at Charter Hospital in 1998. “Where does that leave kids? Sometimes I think they've been left out of the equation.”

For Smith, who grew up bipolar in the '50s before the therapeutic knowledge available today, it's a painful predicament: An age of possibility for the mentally ill -- if they have money.

How, then, to calculate the cost of not treating children early on for disorders such as bipolar disorder, post-traumatic stress or depression? Should someone have taken an adding machine and totaled up all the misery before scrapping our mental health centers?

It would have been nice.

Next week: A gathering storm.

Contact Lorraine Ahearn at 373-7334 or lahearn@news-record.com
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New crisis stabilization center will open next year

by Leslie Boyd, LBOYD@CITIZEN-TIMES.COM

published May 22, 2006 12:15 am


ASHEVILLE - The last time Jamey Wallace had a mental health crisis, he spent hours in the emergency room before being transported to Broughton in Morganton, the closest state psychiatric hospital.

By early next year, Wallace and others who need emergency psychiatric care should have a place to go for stabilization in Asheville, a 16-bed unit where patients can stay from 23 hours to 15 days.

“Jamey's doing well right now,” said his mother, Kathy Wallace. “But there are no guarantees, and it would be wonderful to have a place where he can go that's close to home.”

Buncombe County will open the crisis stabilization center using money from the sale of buildings formerly used by Blue Ridge AreaProgram. Under mental health reform, Blue Ridge divested all its services and real estate, and the money went to the counties to be used for mental health services.

The new center will be on Biltmore Avenue, where the Neil Dobbins Center now provides substance abuse detoxification beds. Those beds will move to Black Mountain. It will be operated by ARP Phoenix, a division of Sisters of Mercy.

“It's important for the community that these beds be there,” said Don Reeves, vice president of Sisters of Mercy. “Having to take somebody to Broughton is a waste of community resources if it can be prevented.”

Reeves said the first two crisis care beds should open in the next month.

Crisis stabilization is an important part of mental health care, but has been lacking in this region since Charter Health closed in 2000. Patients who start to lose control can avoid hospitalization with the proper intervention. Some can be helped with a mobile crisis unit, but if counselors can't bring a situation under control, they need a place to take patients, said Dan Zorn, whose company, Families

Together, provides mobile crisis care for children and is adding adult mobile crisis care in the coming months.

“Without crisis care, people get worse,” said Diane Bauknight, whose daughter has been institutionalized for two years.

She blames the severity of her daughter's illness on the lack of crisis care.

Wallace agrees that transport to a crisis care center in town is far less traumatic than being handcuffed and taken to Morganton by police - the usual method of transport.

Mandy Stone, director of the Buncombe County Department of Social Services and a member of the board of Western Highlands Network, said the new center will cost between $500,000 and $750,000 to build and will operate at a loss of about $400,000 a year because it will have to treat people who have no insurance coverage.

The center also will connect patients to medical care, Stone said.

“You can't provide mental health care and ignore people's other health care needs,” she said. “We're working to link it all together.”

Contact Leslie Boyd at 828-232-2922 or via e-mail at lboyd@ashevill.gannett.com.
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County notes: Commissioners back mental health consolidation talks - Greenville Daily Reflector

By Amanda Karr, The Daily Reflector
Saturday, May 20, 2006

Pitt County's mental health agency might disband and become part of a regional organization.

Pitt County commissioners Thursday signed a resolution supporting the county joining eight other counties in a single agency.

The larger agency would organize and monitor mental health, developmental disability and substance abuse services. Local private providers would continue to provide the individual services.

There has been a statewide push for mental health agencies to regionalize since the agencies began transitioning several years ago from providing services to an administrative role. Many counties did partnerships that met the state's recommendation of organizations serving 200,000 people and five counties. Others, like Pitt, did not.

Impending funding cuts, however, are prompting agencies to reconsider.
Officials with Roanoke-Chowan Human Services Center and Neuse Center have met informally with Pitt County officials to discuss combining forces. With the nod from county commissioners and last month's approval by the Pitt Mental Health Advisory Board, those discussions will now become more formal, Pitt County Manager Scott Elliott said.

The Roanoke-Chowan agency serves Bertie, Gates, Hertford and Northampton counties. The Neuse Center serves Craven, Jones and Pamlico counties. Including those living in Pitt County, about 370,000 people would be served by such a regional entity.

Commissioners voted 8-1, with Mark Owens dissenting, to look into creating the entity before July 2007.

Meanwhile, Pitt Mental Health is scheduled to cut about half of the department's positions in the coming fiscal year.

Existing employees also are continuing to work on solidifying the agency's financial situation.

The county's mental health budget deficit has dropped from $3.6 million to $1 million because the state has reimbursed the county for payments to private service providers.

Melonie Bryan, deputy county manager for finance, said the chance the agency will make it back into the black looks much more positive. In earlier interviews, Bryan said she was worried the agency could still be down at the end of the fiscal year. Read more!

Prison officials seek long-awaited funding for new hospital - Associated Press

By MIKE BAKER,, Associated Press Writer

Karan Dillow's patients may be criminals, but the director of nursing at the state's Central Prison hospital believes they deserve respect in death like anyone else.

And so, when a prison storage room was too humid to hold a body three years ago, she kept the remains of a dead inmate in her air-conditioned office, patiently working at her desk while waiting for a transport team to arrive and take the body to the morgue.

“I had to do what was necessary,” Dillow said. “They still deserve dignity.”

Today, she longingly glances at plans drawn up eight years ago for a new Central Prison hospital - one with a morgue. Lawmakers knew then the facility that opened in 1965 was in need of repair and renovation. But nothing has happened since, and the hospital ward at the aging prison has devolved into what Dillow considers “third-world” conditions.

“We can't bury our heads in the sand any longer,” she said.

This year, the Department of Correction is seeking money - $152 million - to build a new hospital at Central Prison, which opened in 1884 and houses the state's death row and execution chamber. The current 86-bed hospital and 144-cell mental health wing serves the needs of 30,000 prisoners statewide.

The new hospital would have 120 beds, an operating room, a morgue and the ammenities of a community hospital, along with 200 cells for inmates with mental health needs.

But not long removed from a budget crunch, lawmakers face a backlog of requests and a new hospital prison is just one project in Gov. Mike Easley's proposal to spend $764 million on construction.

Easley wants to pay for the largest projects - the prison hospital and a $101 million replacement of the state's public health laboratory - with a kind of public debt that doesn't require voter approval. The cost of both projects is enough to make a few legislators wary.

“We need to be cautious, to be good stewards of our money,” said Sen. Linda Garrou, D-Forsyth, co-chair of the Senate Appropriations Committee.

Rep. Joe Kiser, R-Lincoln, who sponsored a bill passed Tuesday to funnel $15 million to the Department of Correction to shore up its health care budget, said a full makeover of the hospital would “save the state a tremendous amount of money” in the long run.

The problems at the hospital are numerous. There is no central heat or air conditioning. A leaking roof compounds a problem on the third floor, where bathtubs drip into a second floor patient care room. The building's elevator, used to transport sick and injured inmates, works sporadically. The now-defunct operating room has been replaced with a $1 million-per-year mobile trailer, where general surgeries are performed.

“It is really more of an infirmary than a hospital,” said Dr. Paula Smith, the state prison system's chief of health services.

For more pressing medical issues, about 30 prisoners leave the prison each day for hospitals in the Raleigh area, trips that officials said are a big part of why prison medical costs have jumped from $143 million in 2004 to a projected $192 million this year.

Inmates know how to take advantage of the hospital's problems. In the past, prisoners have shoved batteries or bed springs down their throats. One forced wired headphones into his rectum, while another threaded a mangled wire through his urethra to his bladder.

Each bodily gamble paid off with a trip to an outside hospital - a new venue with fresh faces and good food. And another chance to escape.

“It's dangerous,” said Gerald Branker, the prison's deputy warden. “Any time you move an inmate outside the confines of the prison, you don't know what you're getting in to.”

Correction Department officials fear it will take an escape or a hostage situation to force lawmakers to act. They also fret about facing a lawsuit challenging the hospital's decrepit conditions.

“I hate to say it, but we almost look forward to a lawsuit,” Dillow said. “Maybe something would finally happen.”

Revisions to criminal laws, such as one pending before lawmakers that would impose harsher penalties on sex offenders, have landed more inmates behind bars for longer sentences. In the next eight years, the state's prison population served by the hospital is expected to rise 20 percent, putting additional pressure on the aging facility.

As those inmates age, they turn “parts of our prison facilities into rest homes,” said Boyd Bennett, the state's prisons director.

Meanwhile, few nurses have applied to work at the hospital. A facility with a 20-year-old discontinued X-ray machine and a dialysis room the size of two parking spaces, stuffed with eight patients and their respective machines, isn't much of an attraction.

“The people that we do have are doing an excellent job with the resources that they have,” Smith said. “But it would benefit the entire state if we just had the basic standards that you'd find in a community level hospital.”
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Addressing the psychiatric health of U.S. Presidents - Pittsburgh Post-Gazette

May 18, 2006 08:02 PM EST

James Madison, John Quincy Adams and Franklin Pierce all suffered from major depressive disorders. Theodore Roosevelt was bipolar. So, too, was Lyndon Johnson. Woodrow Wilson suffered from a generalized anxiety disorder. If only we knew then what we think we know now.

It turns out that about half the presidents between George Washington and Richard M. Nixon suffered from some sort of psychiatric disorder. This is different from saying that you have to have a mental disorder to be president, which is an amateur's irreverent observation, though perhaps open to clinical testing. The cases mentioned above were diagnosed by three members of the Department of Psychiatry at the Duke University Medical Center in North Carolina, and they're not being playful. They've conducted the first psychiatric inventory of the presidency, and it's a serious study.

The sheer volume of psychiatric disorders resident in the historical presidency is, at first blush, staggering. Most of us have given very little thought to the mental health of, say, Rutherford B. Hayes (major depressive disorder) or James Garfield (depression, again). But to realize that 10 presidents suffered from depression is to concentrate the mind on why it often seems so difficult for presidents to concentrate the mind.

In truth, there is a very important message in the three psychiatrists' report, published this winter in the Journal of Nervous and Mental Disease. This study tells us that presidents are more vulnerable and less perfect than we sometimes think. It tells us that people with mental illness can be highly functional and highly successful. And, because the presidents suffer rates of mental illness roughly comparable to the general public, it reminds us that mental illness, especially depression, is more widespread than we sometimes acknowledge.

“These are ordinary people in some ways,” says Marvin S. Swartz, one of the Duke psychiatrists. “They are not immune to mental illness.”

This report may become irresistible fodder for political scientists of the Jay Leno and Jon Stewart schools, but if interpreted soberly it may be one of the most potent political tools the mental-health lobby has ever acquired. That lobby can now enlist Thomas Jefferson (social phobia, non-generalized), Abraham Lincoln (major depressive disorder, recurrent, with psychotic features) and Dwight D. Eisenhower (major depressive disorder) among those who suffered from mental illness. (Winston Churchill was an honorary American -- a status conferred by Congress in 1963, the first time such a designation was made -- and he, too, suffered from depression.)

Activists advocating programs for alcoholics can take heart, too. Ulysses S. Grant is probably the most famous alcoholic in American history, but not the only alcoholic president. Franklin Pierce suffered from alcohol dependence, and Nixon from alcohol abuse.

Presidents may not rule from the grave, but psychiatrists can still give rulings on men in the grave. In this case, the Duke investigators examined biographies, histories, medical studies and journals to find suggestions of psychiatric disorders. Then they applied this information against a strict rubric to evaluate whether they could reasonably conclude that an individual president suffered from mental problems.

Some presidents emerged perfectly healthy, mentally speaking, although as political analysts and not practitioners of psychiatric analysis we can say with confidence that there was nothing rational about how one of them, James Buchanan, let the country slip into civil war, or how another, John F. Kennedy, let himself slip into bed and compromising relationships with dozens of women while he was presiding over tense Cold War years.

On the other hand, Andrew Jackson was fiercely, almost maniacally, competitive, but completely healthy. I have long wondered whether William McKinley suffered from mental disorders, but his behavior might best be described as abiding devotion to a wife who herself suffered from debilitating headaches and seizures. He gets a clean bill of health from the Duke psychiatrists.

Some of the presidents, to be sure, came to office with a proclivity to mental disorder, only to find that the stress of office pushed them into illness. But some -- Calvin Coolidge, Franklin Pierce -- developed mental disorders after their sons died tragically, Coolidge's from a bizarre toe infection after a blister developed during a tennis game, Pierce's from a terrible train accident. “Neither president was able to commit himself effectively to the task of leadership following such tragic loss,” the psychiatrists write. “(T)raumatic bereavement may have left each one poorly equipped to discharge the demanding responsibilities of office.”

In many cases, presidents overcame mental disorders or mined their strengths of character to emerge as national leaders despite mental problems. “To contemporaries well acquainted with Madison, Hayes, Grant and Wilson,” the psychiatrists write, “it must have appeared that, as young men, these individuals were doing very little with their lives, with Grant, in particular, unable to hold down even the most simple employment on account of alcohol problems.”

The Duke team did not examine the presidents after Nixon, but it is reasonable to guess that they would have found that Gerald R. Ford and George H.W. Bush were exceedingly healthy psychologically. We know that Ronald Reagan suffered from Alzheimer's late in life and perhaps even in the White House. George W. Bush has admitted freely that he abused alcohol in the years leading up to his 40th birthday. Bill Clinton exhibited colorful personal behavior before and during his presidency, but let's leave it to the next study for a professional diagnosis.

All this is intriguing, but perhaps only as presidential prurience. But it is important information for two reasons quite apart from the tantalizing notion that William Howard Taft had a breathing-related sleep disorder or that Coolidge suffered from social phobia. (In the latter case, one reading of the man's biography should be sufficient to convince even the most casual observer.)

The important implications of this study: There is no evidence that mental illness led to national catastrophe. (Indeed, it was a man with severe mental disorders who saved the nation during its gravest challenge, the Civil War.) And the prominence of mental illness in our most prominent citizens can only serve to diminish the stigma of psychological problems. In that regard, some of our presidents are serving their country long after having left office.


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An unhealthy lack of psychiatrists - Fayetteville News

By Rochelle Williams

Staff writer
Anna Finch refused to give her autistic son, Nicholas, antidepressants when he was a young boy.

But when he turned 11, in 2000, his inability to cope with changes to his routine — where his toys were arranged in his bedroom, what foods he was willing to eat — triggered anxiety attacks and bouts of violent anger that scared Finch and drained her entire family.

At the same time, new research indicated that autism was most likely caused by a chemical imbalance that could be neutralized with drugs.

Finch and her husband decided to consult a child psychiatrist. It took them a year and a half to find one who was accepting new clients.

Lack of access to psychiatrists is becoming an all too common problem in Fayetteville, in North Carolina and around the country.

The state’s supply of psychiatrists shrinks each year as need for the services grows, according to a recent report released by The Cecil G. Sheps Center for Health Services Research at the University of North Carolina at Chapel Hill, the Department of Psychiatry and Behavioral Sciences at the Duke University School of Medicine, and the N.C. Area Health Education Centers.

About one in three adults experiences a mental disorder each year, and 15 percent of children have behavioral disorders such as attention deficit problems, anxiety or depression. However, the number of psychiatrists has not increased in the past 10 years to meet population growth. North Carolina has 1.05 psychiatrists for every 10,000 people and ranks 20th in the nation.

The need for child psychiatrists is even greater and has reached a critical stage, according to the report. The number of child psychiatrists in the state has declined 24 percent in the past decade.

In Fayetteville, there are four child psychiatrists compared with thousands of children who need help, said Dr. Pinckney McIlwain, medical director of psychiatric services at Cape Fear Valley Health System.

McIlwain said shrinking reimbursements from private and federal insurance programs is one of the biggest reasons for the decline in the number of psychiatrists who graduate each year. He said psychiatrists are the second lowest paid medical specialists. Pediatricians get paid the least.

The shortage means more work for county mental-health center employees, emergency-department doctors, and general practitioners.

And while psychologists, social workers and other therapists can counsel people, only psychiatrists and other medical doctors can prescribe medication.

On Wednesday, six mentally ill teenagers showed up at the Cape Fear Valley Medical Center emergency department.

McIlwain said one of them was a young girl in distress, who was brought in by her parents.

“They have been trying to get her an appointment with a psychiatrist,” McIlwain said. The earliest anyone can see her is January 2007.”

Dr. John Lesica, a child psychiatrist at the county mental health center, said the shortage of psychiatrists is one of the biggest problems facing the health care industry today.

About a third of the patients treated for mental illness at the county center are children. The center treated 1,397 mentally ill children In 2005, said the center’s spokeswoman Sharon Yates.

Finch, who is the president of the Autism Society of Cumberland County, eventually found a child psychiatrist in Chapel Hill. She says her family lucked out.

After a few months of trial and error, her son’s psychiatrist found an anti-depressant that has alleviated many of Nicholas’s behavioral problems.

“When you are dealing with this type of issue you want to work with a psychiatrist who has a lot of experience under their belt, someone who is familiar with the medications, Finch said.”

But most people have to settle for whoever they can get. If they can get anyone at all.”

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Benefit bump could cost disabled people Medicaid - Raleigh News & Observer

Thomas Goldsmith, Staff Writer

It's not just older North Carolinians who stand to lose thousands in Medicaid benefits because of a small increase in Social Security payments.

Children and adults with disabilities who get help from Medicaid could lose services or pay annual deductibles of nearly $7,000 -- because their Social Security checks rose less than $400 a year.

"In the case of my daughter -- and probably many other developmentally disabled -- it will mean a drastic cut in support services," said Virginia Jones, 80, a Durham resident. Jones' daughter, Janet, 39, qualifies for the federal insurance program because she has mental retardation.

This year, the government gave the largest Social Security cost-of-living increase in 15 years. But that extra income pushed hundreds and perhaps thousands of seniors and people with disabilities over the Medicaid eligibility limit.

Exactly how many is not known. Marjorie Morris, chief of the state's Medicaid Eligibility Unit, said the state does not track the number of people who lose Medicaid coverage because of a Social Security cost-of-living adjustment.

Asked what people were advised to do when faced with the cutoff, she said she didn't know.

"I think that's up to each individual situation," Morris said.

More uninsured

U.S. Rep. Brad Miller of Raleigh predicted that people who lose Medicaid coverage will put more financial pressure on health-care providers.

"Many people can't afford the deductibles, and they will be adding to the rolls of the uninsured," Miller said. People will use emergency rooms and hospitals that are already stressed, he said.

Miller said Tuesday that he was trying to find a solution. After hearing from constituents, he said, he is contacting the Atlanta office of the federal Centers for Medicare and Medicaid Services, which runs the programs.

Donna Cross, technical director of the Division of Medicaid and Children's Health in Atlanta, did not return messages left at her office Tuesday.

In Janet Jones' case, the loss of Medicaid means she could be bumped from her group home and lose her slot at Life Experiences Inc. in Cary, where she works weekdays. The agency helps people with disabilities gain independence by teaching job and social skills.

"She's very appropriate for this type of setting," said Mary Madenspacher, executive director of Life Experiences. "She needs prompting, supervision and monitoring to stay on task, but with that support and help, she is capable of doing the task she is assigned."

Virginia Jones said she kept Janet at home as long as she could but arranged for the group home after her husband died and she was diagnosed with cancer.

"The world is looking pretty grim from every angle," said Jones, who this week tried to reach state and local officials about her daughter's situation.

Attorney Doug Sea of Charlotte-based Legal Services of the Southern Piedmont said his health-rights advocacy group asked state health and human services officials to do something about the impending cutoffs in March.

In an e-mail response to Sea, Mark Benson, chief operating officer of the Division of Medical Assistance, wrote that leaving the Social Security increase out of the picture when deciding people's eligibility for Medicaid "would only serve to manipulate/circumvent the income thresholds established by the General Assembly."

"We've actually heard from clients in our area and other parts of the state," Sea said. "Next, we'll be talking to legislators. [State officials] certainly knew about it."

'Off the cliff'

But a solution is uncertain in a year when legislators have a large budget surplus but face many demands for money.

State Sen. Bill Purcell, co-chairman of the committee on appropriations on health and human services, said he's aware of the situation and would like to see money for it included in the state budget during the current legislative session.

However, he said, the committee, with $165 million to work with, already has received "legitimate" requests for more than $560 million in funding.

That's an unwelcome prospect for parents of children with developmental disabilities such as autism or mental retardation. Medicaid support pays for the Community Alternatives Program, which often allows children to stay at home instead of at an institution.

The loss of Medicaid could mean that some families will be liable for a $581 monthly deductible -- nearly $7,000 annually.

"That's a perennial problem for programs with these sharp cutoffs that assist people with health care or child care," said Adam Searing, director of the N.C. Health Access Coalition. "If you have a strict income level, people fall off the cliff." Read more!

An unhealthy lack of psychiatrists - Fayetteville News

By Rochelle Williams

Staff writer
Anna Finch refused to give her autistic son, Nicholas, antidepressants when he was a young boy.

But when he turned 11, in 2000, his inability to cope with changes to his routine — where his toys were arranged in his bedroom, what foods he was willing to eat — triggered anxiety attacks and bouts of violent anger that scared Finch and drained her entire family.

At the same time, new research indicated that autism was most likely caused by a chemical imbalance that could be neutralized with drugs.

Finch and her husband decided to consult a child psychiatrist. It took them a year and a half to find one who was accepting new clients.��

Lack of access to psychiatrists is becoming an all too common problem in Fayetteville, in North Carolina and around the country.

The state’s supply of psychiatrists shrinks each year as need for the services grows, according to a recent report released by The Cecil G. Sheps Center for Health Services Research at the University of North Carolina at Chapel Hill, the Department of Psychiatry and Behavioral Sciences at the Duke University School of Medicine, and the N.C. Area Health Education Centers.

About one in three adults experiences a mental disorder each year, and 15 percent of children have behavioral disorders such as attention deficit problems, anxiety or depression. However, the number of psychiatrists has not increased in the past 10 years to meet population growth. North Carolina has 1.05 psychiatrists for every 10,000 people and ranks 20th in the nation.

The need for child psychiatrists is even greater and has reached a critical stage, according to the report. The number of child psychiatrists in the state has declined 24 percent in the past decade.

In Fayetteville, there are four child psychiatrists compared with thousands of children who need help, said Dr. Pinckney McIlwain, medical director of psychiatric services at Cape Fear Valley Health System.

McIlwain said shrinking reimbursements from private and federal insurance programs is one of the biggest reasons for the decline in the number of psychiatrists who graduate each year. He said psychiatrists are the second lowest paid medical specialists. Pediatricians get paid the least.

The shortage means more work for county mental-health center employees, emergency-department doctors, and general practitioners.

And while psychologists, social workers and other therapists can counsel people, only psychiatrists and other medical doctors can prescribe medication.

On Wednesday, six mentally ill teenagers showed up at the Cape Fear Valley Medical Center emergency department.

McIlwain said one of them was a young girl in distress, who was brought in by her parents.

“They have been trying to get her an appointment with a psychiatrist,” McIlwain said. The earliest anyone can see her is January 2007.”

Dr. John Lesica, a child psychiatrist at the county mental health center, said the shortage of psychiatrists is one of the biggest problems facing the health care industry today.

About a third of the patients treated for mental illness at the county center are children. The center treated 1,397 mentally ill children In 2005, said the center’s spokeswoman Sharon Yates.

Finch, who is the president of the Autism Society of Cumberland County, eventually found a child psychiatrist in Chapel Hill. She says her family lucked out.

After a few months of trial and error, her son’s psychiatrist found an anti-depressant that has alleviated many of Nicholas’s behavioral problems.

“When you are dealing with this type of issue you want to work with a psychiatrist who has a lot of experience under their belt, someone who is familiar with the medications, Finch said.”

But most people have to settle for whoever they can get. If they can get anyone at all.” Read more!

Troubled state of mind - Raleigh News and Observer

If you look past the facts, the figures and the endless torrents of jargon and acronyms, mental health reform in North Carolina boils down, very simply, to people.


Consider the case of Ann-Marie Dooley, a Greensboro mother whose 10-year-old autistic son has received treatment at the Guilford Center since he was 3.

"I trust them," Dooley says of the staff at the center, which offers centralized counseling and treatment for 16,000 clients a year. "They are an excellent provider."

Now that relationship is about to end. Dooley, who also is vice chairwoman of the Guilford Center's Consumer and Family Advisory Committee, is not sure what the future holds.

Five years ago, North Carolina decided to reinvent its mental health system, shifting the emphasis from state institutions to community-based programs. In theory, the new model will recast local treatment agencies such as the Guilford Center as HMO-like entities that instead will administer patient care through private providers. But in practice, the drastic makeover has prematurely snatched the government safety net from thousands of patients without providing an adequate replacement.

There is nowhere for many patients to live once they're turned out of state facilities. There are bureaucratic tangles. There are not enough private practitioners to handle the local demand for treatment, especially Medicare, Medicaid and indigent patients.

And there clearly is not enough money.

In Guilford County, the existing services are being removed much faster than they are being replaced. By December, the Guilford Center must lay off 135 employees, or nearly half of its work force.

Fortunately, the Joint Legislative Oversight Committee on Mental Health, Developmental Disabilities and Substance Abuse is proposing $155 million in funding to help fill the gaps in local treatment. Meanwhile, Gov. Mike Easley has included in his proposed budget $89 million for mental health reform.

Dr. Martha K. Sharpless, chairwoman of the nonprofit Greensboro Mental Health Association, says she prefers the Oversight Committee's spending plan, though even it may not be enough. Sharpless also has grave misgivings about the reform itself. "We should call a moratorium," she says. "We should screechingly halt and look at what we've done."

Sen. Kay Hagan, a Greensboro Democrat who supports at least $100 million in mental health reform funding, says a moratorium "for a short period of time" might be a good idea. For instance, what if, upon closer examination, the state decided all those Guilford Center staff cuts weren't necessary? she says.

At the very least, lawmakers need to provide adequate resources.

Overshadowed by the under-planned and, perhaps, overreaching reform initiative are continuing strides in treatment. More and more patients are able to lead productive lives -- when the system works.

Better late than never, that message may be getting through. Now lawmakers owe it to local communities, including Guilford County, to fix what the state has broken.
Read more!

State plans to build grandly - Raleigh News and Observer

Cherry, Broughton, Mental Health Hospital at Central Prison among projects considered

Published: May 13, 2006 12:30 AM
Modified: May 13, 2006 04:59 AM

J. Andrew Curliss, Staff Writer
State government is getting ready for a building boom, paid mostly with cash, on a scale not seen in two decades.

While the state has pumped millions of borrowed dollars into university buildings in recent years, budgets were tight elsewhere, and spending on new construction slowed.

But the state’s economic outlook has brightened, and leaders in Raleigh find themselves with a $2 billion budget surplus for the coming fiscal year.

Gov. Mike Easley this week proposed to spend much of that money on pay raises for teachers and state employees, education programs, mental health care and a small cut in the state sales tax.

Easley also said some of the money should be used for construction. The new plans are ambitious and stand to benefit Raleigh more than anywhere else.

There’s a $61 million engineering complex at N.C. State University and $10 million toward a new wing of the Museum of Natural Sciences downtown.

A $20 million parking deck would go up nearby.

In West Raleigh, the state would spend $40 million expanding the N.C. Museum of Art and $50 million toward a new office building for the Department of Environment and Natural Resources.

Easley wants to buy cranes for the state port at Wilmington and build a children’s center at the zoo in Asheboro. There’s money for a nursing school at UNC-Wilmington and a $2 million forestry office in the mountains.

Easley’s plan is just the beginning of the debate. Easley, House Speaker Jim Black and Senate leader Marc Basnight, all Demo-crats, indicated the building proposal will get plenty of attention before the legislature approves a final budget this summer.

“There’ll be a lot of debate on all of that -- it’s still very early,” Basnight said.

“Debate about it?” Black asked. “Oh, yes. Oh, yes.”

Some say the state should save at least some of the money.

“I just worry that we’re going to use it all up and not have anything left when the cycle turns downward,” said Sen. Phil Berger of Eden, the Senate Republican leader.

Easley has proposed using $324 million of the $2 billion surplus to replenish the state’s rainy-day account, which now stands at $313 million. He also wants $50 million set aside for emergencies. The governor would spend more than $300 million on building projects in the coming fiscal year.

He would also borrow for a few projects: a $101 million public health lab in West Raleigh and $152 million to pay for a 120-bed medical center and a 200-cell mental health center at Central Prison.

The prison facilities will help with security and save on costs such as putting inmates in medical facilities away from the prison, Easley said.

In addition, Easley would use $200 million for repairs and renovations, a 60 percent increase from a year ago.

Those figures are substantial by any measure, but more so when compared with what the state has spent on construction in recent years.

During a budget crisis in 2001-02 and 2002-03, the state spent about $30 million each year on capital projects, mostly for water systems and infrastructure. The state set aside nothing for repairs.

With little new construction, the needs kept piling up, state officials said.

“In the main, capital spending has been basically nonexistent since ‘01,” said Jim Lora, the assistant state budget officer for capital projects. “We’re only beginning to recover.”

The spending is possible because of increases in tax collections.

More suggestions

Already, legislators have heard from a number of interests that didn’t make the cut with Easley.

Some are pushing a plan to buy vacant land to preserve it from development. Others want the state to build affordable housing or water and sewer projects.

One item getting notice is a request from the Department of Health and Human Services to replace outdated state psychiatric hospitals in Morganton and Goldsboro.

DHHS Secretary Carmen Hooker Odom met with legislative leaders this week, pitching the need for money.

Some lawmakers have toured the hospitals and called the conditions terrible.

“It’s awful,” said Sen. John Kerr, a Democrat whose Wayne County district includes Cherry Hospital. He stretched his arms out. “You have four women in a room about this size. No one would want their relative in that,” he said. The price tag to replace both hospitals: $300 million.

“We believe our psychiatric hospitals are in a dire situation,” Hooker Odom said. Read more!

State plans to build grandly. Raleigh, others would get millions - Raleight News ‡ Observer

New hospitals for Central Prison, Broughton, Cherry mentioned

Published: May 13, 2006 12:30 AM
Modified: May 13, 2006 04:59 AM

J. Andrew Curliss, Staff Writer

State government is getting ready for a building boom, paid mostly with cash, on a scale not seen in two decades.

While the state has pumped millions of borrowed dollars into university buildings in recent years, budgets were tight elsewhere, and spending on new construction slowed.

But the state’s economic outlook has brightened, and leaders in Raleigh find themselves with a $2 billion budget surplus for the coming fiscal year.

Gov. Mike Easley this week proposed to spend much of that money on pay raises for teachers and state employees, education programs, mental health care and a small cut in the state sales tax.

Easley also said some of the money should be used for construction. The new plans are ambitious and stand to benefit Raleigh more than anywhere else.

There’s a $61 million engineering complex at N.C. State University and $10 million toward a new wing of the Museum of Natural Sciences downtown.

A $20 million parking deck would go up nearby.

In West Raleigh, the state would spend $40 million expanding the N.C. Museum of Art and $50 million toward a new office building for the Department of Environment and Natural Resources.

Easley wants to buy cranes for the state port at Wilmington and build a children’s center at the zoo in Asheboro. There’s money for a nursing school at UNC-Wilmington and a $2 million forestry office in the mountains.

Easley’s plan is just the beginning of the debate. Easley, House Speaker Jim Black and Senate leader Marc Basnight, all Demo-crats, indicated the building proposal will get plenty of attention before the legislature approves a final budget this summer.

“There’ll be a lot of debate on all of that -- it’s still very early,” Basnight said.

“Debate about it?” Black asked. “Oh, yes. Oh, yes.”

Some say the state should save at least some of the money.

“I just worry that we’re going to use it all up and not have anything left when the cycle turns downward,” said Sen. Phil Berger of Eden, the Senate Republican leader.

Easley has proposed using $324 million of the $2 billion surplus to replenish the state’s rainy-day account, which now stands at $313 million. He also wants $50 million set aside for emergencies. The governor would spend more than $300 million on building projects in the coming fiscal year.

He would also borrow for a few projects: a $101 million public health lab in West Raleigh and $152 million to pay for a 120-bed medical center and a 200-cell mental health center at Central Prison.

The prison facilities will help with security and save on costs such as putting inmates in medical facilities away from the prison, Easley said.

In addition, Easley would use $200 million for repairs and renovations, a 60 percent increase from a year ago.

Those figures are substantial by any measure, but more so when compared with what the state has spent on construction in recent years.

During a budget crisis in 2001-02 and 2002-03, the state spent about $30 million each year on capital projects, mostly for water systems and infrastructure. The state set aside nothing for repairs.

With little new construction, the needs kept piling up, state officials said.

“In the main, capital spending has been basically nonexistent since ‘01,” said Jim Lora, the assistant state budget officer for capital projects. “We’re only beginning to recover.”

The spending is possible because of increases in tax collections.

More suggestions

Already, legislators have heard from a number of interests that didn’t make the cut with Easley.

Some are pushing a plan to buy vacant land to preserve it from development. Others want the state to build affordable housing or water and sewer projects.

One item getting notice is a request from the Department of Health and Human Services to replace outdated state psychiatric hospitals in Morganton and Goldsboro.

DHHS Secretary Carmen Hooker Odom met with legislative leaders this week, pitching the need for money.

Some lawmakers have toured the hospitals and called the conditions terrible.

“It’s awful,” said Sen. John Kerr, a Democrat whose Wayne County district includes Cherry Hospital. He stretched his arms out. “You have four women in a room about this size. No one would want their relative in that,” he said. The price tag to replace both hospitals: $300 million.

“We believe our psychiatric hospitals are in a dire situation,” Hooker Odom said.�� Read more!

State plans to build grandly; Raleigh, others would get millions - Raleigh News & Observer

200-cell mental health center at Central Prison, new hospital in Morganton, Goldsboro considered

Published: May 13, 2006 12:30 AM
Modified: May 13, 2006 04:59 AM
J. Andrew Curliss, Staff Writer

State government is getting ready for a building boom, paid mostly with cash, on a scale not seen in two decades.��

While the state has pumped millions of borrowed dollars into university buildings in recent years, budgets were tight elsewhere, and spending on new construction slowed.

But the state’s economic outlook has brightened, and leaders in Raleigh find themselves with a $2 billion budget surplus for the coming fiscal year.

Gov. Mike Easley this week proposed to spend much of that money on pay raises for teachers and state employees, education programs, mental health care and a small cut in the state sales tax.

Easley also said some of the money should be used for construction. The new plans are ambitious and stand to benefit Raleigh more than anywhere else.

There’s a $61 million engineering complex at N.C. State University and $10 million toward a new wing of the Museum of Natural Sciences downtown.

A $20 million parking deck would go up nearby.

In West Raleigh, the state would spend $40 million expanding the N.C. Museum of Art and $50 million toward a new office building for the Department of Environment and Natural Resources.

Easley wants to buy cranes for the state port at Wilmington and build a children’s center at the zoo in Asheboro. There’s money for a nursing school at UNC-Wilmington and a $2 million forestry office in the mountains.

Easley’s plan is just the beginning of the debate. Easley, House Speaker Jim Black and Senate leader Marc Basnight, all Demo-crats, indicated the building proposal will get plenty of attention before the legislature approves a final budget this summer.

“There’ll be a lot of debate on all of that -- it’s still very early,” Basnight said.

“Debate about it?” Black asked. “Oh, yes. Oh, yes.”

Some say the state should save at least some of the money.

“I just worry that we’re going to use it all up and not have anything left when the cycle turns downward,” said Sen. Phil Berger of Eden, the Senate Republican leader.

Easley has proposed using $324 million of the $2 billion surplus to replenish the state’s rainy-day account, which now stands at $313 million. He also wants $50 million set aside for emergencies. The governor would spend more than $300 million on building projects in the coming fiscal year.

He would also borrow for a few projects: a $101 million public health lab in West Raleigh and $152 million to pay for a 120-bed medical center and a 200-cell mental health center at Central Prison.

The prison facilities will help with security and save on costs such as putting inmates in medical facilities away from the prison, Easley said.

In addition, Easley would use $200 million for repairs and renovations, a 60 percent increase from a year ago.

Those figures are substantial by any measure, but more so when compared with what the state has spent on construction in recent years.

During a budget crisis in 2001-02 and 2002-03, the state spent about $30 million each year on capital projects, mostly for water systems and infrastructure. The state set aside nothing for repairs.

With little new construction, the needs kept piling up, state officials said.

“In the main, capital spending has been basically nonexistent since ‘01,” said Jim Lora, the assistant state budget officer for capital projects. “We’re only beginning to recover.”

The spending is possible because of increases in tax collections.

More suggestions

Already, legislators have heard from a number of interests that didn’t make the cut with Easley.

Some are pushing a plan to buy vacant land to preserve it from development. Others want the state to build affordable housing or water and sewer projects.

One item getting notice is a request from the Department of Health and Human Services to replace outdated state psychiatric hospitals in Morganton and Goldsboro.

DHHS Secretary Carmen Hooker Odom met with legislative leaders this week, pitching the need for money.

Some lawmakers have toured the hospitals and called the conditions terrible.

“It’s awful,” said Sen. John Kerr, a Democrat whose Wayne County district includes Cherry Hospital. He stretched his arms out. “You have four women in a room about this size. No one would want their relative in that,” he said. The price tag to replace both hospitals: $300 million.

“We believe our psychiatric hospitals are in a dire situation,” Hooker Odom said. Read more!

Paxil Raises Suicide Risk For Young Adults - Medical News Today

GlaxoSmithkline, the makers of the antidepressant, Paxil, have warned that the drug may raise the risk of suicide attempts in people under 30. Glaxo has sent a letter to doctors stating this.

According to a clinical trial, of 3,455 people taking Paxil 11 tried to kill themselves. Among the placebo group of 1,978 people, 1 tried to commit suicide. The majority of suicide attempts were made by patients under 30. One of the Paxil patients who attempted suicide succeeded.

Mary Anne Rhyne, who works for Glaxo, said the company is advising doctors to monitor all patients to make sure their symptoms don't worsen while they are taking Paxil.

The FDA says doctors and patients should follow current advice. The agency is still analysing the results of the trial.

A spokesman for the FDA said it is important that patients on Paxil do not suddenly stop taking their medication without first consulting with their doctors.

Written by: Christian Nordqvist
Editor: Medical News Today Read more!

Antidepressant May Raise Suicide Risk – The New York Times

By BENEDICT CAREY and GARDINER HARRIS
Published: May 12, 2006

After analyzing data from clinical trials, GlaxoSmithKline has sent letters to doctors warning that its antidepressant drug Paxil appears to increase the risk of suicide attempts in some young adults.

The company said it had changed the labeling on the drug to reflect the finding of the study, which analyzed clinical trial data involving some 15,000 people. The study found that reported suicide attempts were rare but significantly more common in adults who took the drug for depression than in those who received placebo pills.

The Glaxo researchers reported only one suicide in the trials, a number so small it says nothing about the drug's risk, experts said.

In October 2004, the Food and Drug Administration ordered drug companies to place a strong warning on antidepressant labels after studies suggested that some drugs increased suicidal thinking or behavior in children and adolescents. But the Glaxo study — the first by a drug company to find a link between antidepressants and suicidal behavior in adults, experts say — is likely to persuade some skeptics that the risk is real and not confined to minors.

The studies of children and adolescents found mainly evidence of suicidal thinking and agitation. There were no completed suicides reported.

In a statement issued this week, the F.D.A. said that though it was still evaluating the data, "we are recommending that consumers and prescribers follow current advice to carefully observe adults being treated with antidepressants for worsening of depression and for increased suicidal thinking and behavior." The statement said, "It is essential that patients taking Paxil do not suddenly stop taking their medication."

Last year, the agency asked psychiatric drug makers to review all their data on side effects in adults after a prolonged international debate over whether antidepressant drugs increase the risk of suicide in some children. Other companies have not yet reported their findings.

"This is the first analysis to show a relationship between suicide attempts and one of the antidepressants" since the F.D.A. required the warning label for children and adolescents, said Kelly Posner, an assistant professor in the department of child psychiatry at Columbia, who has helped the agency interpret bad reactions to antidepressants.

Dr. Posner said the Glaxo findings should be treated with caution, because the antidepressant trials done to date were not designed to evaluate suicide risk.

"It's not clear that the drug caused the behavior," she said.

Glaxo sent out the warnings voluntarily, and its data still show that the drug's benefits outweigh the risks for people with depression, said Mary Anne Rhyne, a company spokeswoman.

"We are now advising doctors to monitor all patients to make sure their symptoms don't worsen" in the full course of treatment, Ms. Rhyne said.

Previous research has suggested that the risk of suicidal thinking or behavior was highest in the first few weeks of treatment, or when people went off the medication. One large review of antidepressant trials, published last year in BMJ, a British medical journal, found that people taking Paxil and similar drugs like Prozac reported suicide attempts more often.

But experts have debated the interpretation and value of these findings. In the Glaxo analysis, the researchers analyzed trials that included 8,958 people who took Paxil and 5,953 who received placebo pills. The study participants ranged in age from 18 to 64 years old and were taking the medication for depression or other disorders, like panic attacks and obsessive compulsive disorder.

The analysis found that 11 of 3,455 people who were taking Paxil for depression reported an attempted suicide, compared with 1 in 1,978 taking placebo in the trials. Most were among adults ages 18 to 30, the company said.

Over all, the analysis found no increased risk of suicidal behavior in adults over 30.

"The new findings are not going to change my practice a lot, but I say, yes, they provide a reason to do even more careful monitoring of people on the medication," said Dr. George Simpson, a professor in psychiatry and behavioral sciences at the Keck School of Medicine at the University of Southern California.

Dr. Simpson said the warning underscored the need for more careful tracking of side effects once drugs went on the market.

"The current system of postmarketing surveillance is lousy," he said. Read more!

State leaves few options for helping mentally ill - Wilminton Star-News

By S.I. Cantrell

I’d rather stay here with all the madmen,
Than perish with the sad men roaming free.
– David Bowie, 1972

These days, the rock singer’s mental patient no longer has the option of staying in a mental institution, even if he feels unready for life outside the walls.

Most patients enter in a period of crisis and are released in a few days, when they no longer pose a danger to themselves or others.

Local homeless shelter operators have been grumbling about Goldsboro’s Cherry Hospital sending people to Wilmington with little more than pills and a list of shelter addresses.

Tuesday morning, Janet Johnson, director of the state mental facility’s social work program, and Doug Dexter, social work supervisor of the adult admission unit, spoke to the Tri-County Homeless Interagency Council.

Their message? Shelters are pretty much it, but Cherry will try to work more closely with them.

“When the time for discharge comes, people want to go home,” Dexter said. Trouble is, if their family won’t take them, home means a homeless shelter.

Of 133 patients Cherry discharged to New Hanover County from January to April, they said, 24 went to homeless shelters, 78 to private residences like family homes, 12 into rest homes or nursing homes, seven into group homes and six into “halfway homes,” which included First Fruit Ministries’ transitional housing for homeless women. The rest went to hotels or other destinations.

Shelter operators say they aren’t prepared to offer services to the mentally ill.
Dexter said Cherry communicates with the destination shelters before release.

Shelter operators have told me that doesn’t always happen. Of the 41 people discharged in January to New Hanover, all but three were from this county, Johnson said. Two were from Brunswick County and one from Duplin.

Mental health reform was supposed to mean money for new facilities in communities like ours. We’ve seen some open, but not enough.

This year, Southeastern won permission to use some of the 12 beds in its detoxification unit for overnight crisis services. People can stay up to 15 days.

Southeastern’s Tammy Knight suggested the new unit could take some of the more severely affected patients discharged from Cherry, a sort of “step-down” level. But there aren’t enough beds to take everyone Cherry releases.

The National Alliance on Mental Illness in North Carolina held its annual breakfast for legislators on Wednesday. As usual, no legislators showed up.

While there, I talked to Southeastern’s director, Art Constantini. He said he’d like to see small group homes created to take Cherry’s discharged patients. They could offer relatively normal settings augmented with supportive services.

Such solutions take money and time. NAMI says much of the savings from closing two state mental hospitals is going to pay for the one that will replace them. That’s unacceptable.

The lawmakers who launched this reform need to repair it.

Film & a forum: I’ll be among the panelists discussing tonight’s showing of Out of the Shadow, Susan Smiley’s film about her mother’s schizophrenia. I saw an advance copy. It’s a powerful movie.

We see what it’s like to grow up in a home where Mom’s behavior swings erratically from suburban-normal to hostile and dangerous, how she’s shuffled from place to place and the toll it’s taken on her two daughters.

The film and forum are at 7 p.m. tonight in the Warwick Center Ballroom at the University of North Carolina Wilmington. It’s presented by NAMI Wilmington, the Cape Fear Chapter of the Mental Health Association of North Carolina, and Jannsen, a pharmaceutical company specializing in mental health.

It’s free and you’re invited.

Contact Si Cantwell at 343-2364 or si.cantwell@StarNewsOnline.com. Read more!

Easely Budget: $90 Million For Mental Health - Associated Press

By GARY D. ROBERTSON
Associated Press Writer

The General Assembly opened its session Tuesday ready to spend up to $2 billion in extra money and determined to better monitor the ethics and campaign contributions of lobbyists and legislators.

Legislative leaders and Gov. Mike Easley already have plenty of ideas about how to use the additional cash, proposing larger raises for state employees and teachers, improved mental health services and repairing aging government buildings. Lawmakers are also considering cutting taxes.

The House and Senate each convened about noon with the bang of gavels. Although both chambers adjourned within an hour, lawmakers said they were going to get as much done as possible during the so-called “short session.”

“We’re going to deal with a lot of issues,” House Speaker Jim Black, D-Mecklenburg, said while backed by dozens of Democratic colleagues at a news conference before the session started. “We’re going to hit the ground running today. We’re not going to have time for folks to throw bombs and deal with things that are not productive for the people of North Carolina.”

Republicans, the minority in both the House and Senate, want to eliminate a temporary half-cent sales tax increase that has been on the books since 2001. Anti-gas-tax forces scheduled a rally near Easley’s office and the Legislative Building for Tuesday afternoon.

Before the session started, Easley unveiled his proposed changes to the $17.4 billion budget the General Assembly approved last summer for the fiscal year beginning July 1. The $18.9 billion proposal suggests giving teachers 8 percent raises, cutting the sales tax by a quarter-penny and setting aside $90 million to accelerate mental health reform.

Budget-writers had to regroup last week after learning that April tax revenues surged thanks to real estate sales, a strong job market and continued robust sales tax growth. The projected surplus of nearly $1.1 billion is the highest recorded since lawmakers began adjusting state budgets annually in the early 1970s.

More money is expected to be returned from state agencies that didn’t spend their allotted money this year and tax revenues are expected to exceed expectations in the coming year, pushing the total expected surplus to about $2 billion.

The House and Senate also are expected to use this session weighing whether to change lobbying, ethics and campaign finance rules.

Part of their interest stems from a series of legal troubles that have surrounded Black since the General Assembly ended its last session in October.

The State Board of Elections has asked local prosecutors to consider filing misdemeanor charges against Black or his campaign for the handling of incomplete contribution checks from Black’s fellow optometrists. Separate state and federal investigations of possible lobbying and campaign finance wrongdoing tied to the speaker’s campaign are also ongoing.

A House committee formed by Black has recommended several bills, including one that would prohibit lobbyists from making campaign contributions to legislators and statewide elected leaders.

Legislators also are expected to consider this year whether to raise the minimum wage from $5.15 an hour and alter eminent domain laws. In his budget proposal, Easley recommended increasing the minimum wage to $6.

Bills filed in the House on Monday would raise all teacher and state employee salaries by 7 percent; another would set a statewide referendum November on whether to borrow $1 billion with water and sewer bonds. Easley’s proposal would give state employees other than teachers only a 4 percent raise.

The Senate was to meet Tuesday for the first time in its newly renovated chambers - the first overhaul since the Legislative Building was completed in 1963. The $2 million renovation covered the familiar masonry blocks and metal shadow screen behind the dais with drywall. There are also new cherry desks, leather chairs, carpeting and a new Senate seal.

Three new lawmakers - Rep. Tim Spear, D-Washington, and Sens. Pete Bland, D-Craven; and William Miller, R-Forsyth - took their seats for the first time Tuesday. Read more!

Los Angeles County OKs Mental Health Reform Plan

County supports $186 million plan

BY TROY ANDERSON, Staff Writer

In its first plan for how to spend revenue from a voter-approved state income tax on millionaires, the Board of Supervisors on Tuesday approved a $186 million plan to overhaul Los Angeles County’s mental health system.

More than 18,000 adults and children are expected to receive expanded mental health services beginning this fiscal year, and officials say the extra money will help get thousands of mentally ill transients off the streets. ��

“This is very huge,” said Marvin Southard, director of the county’s Department of Mental Health. “This is really revolutionary.

“This is the first step in what will be a major change in the way the mental health system operates. It will be a first step in making it more customer-friendly, providing what people need rather than narrow mental health services.”

The plan helps restore some of the services cut since the early 1990s, when budget woes forced the state to close psychiatric hospitals and the county to close several of its mental-health clinics.

The newly approved plan calls for hiring 260 mental health workers and building a psychiatric urgent-care facility at Olive View-UCLA Medical Center in Sylmar.

“What we are trying to do is create a psychiatric urgent care facility where people who are in a psychiatric crisis, but probably won’t get admitted to the emergency room, can go to get stabilized,” Southard said.

“Rather than have them wait in the ER, which isn’t necessarily a good place to be if they are in a mental health crisis, (this would) create an alternative place for them.”

Money for the plan comes from Proposition 63, passed by voters statewide in 2004 to help fund services for people with severe mental illness through a 1 percent tax on incomes of more than $1 million.

Southard said the initial round of funding will go to agencies that help the homeless on Skid Row and throughout the county, and includes $11.6 million for a trust fund to develop permanent housing for people with psychiatric disabilities.

That money will augment $100 million the supervisors recently designated and




the $50 million Los Angeles Mayor Antonio Villaraigosa has promised to help house the homeless.

Southard also said some of the $2.8 billion targeted for housing in a $37 billion state bond package set to appear on the November ballot could be used for homeless housing.

“The most important thing, from our perspective, is creating avenues for people to get off the streets,” said Orlando Ward, spokesman for the Midnight Mission on Skid Row.

“We know from the physical exposure of people on the streets, particularly those suffering from untreated mental illness, we know their situation will not get better unless we find treatment for them.”

The funds will also be used to start and expand programs for people with schizophrenia, bipolar disorder, major depression and other serious conditions.

County programs are expected to include around-the-clock counseling and support, rent subsidies, resources for finding permanent, affordable housing, treatment for alcohol and drug problems, and drop-in centers.

It also will include counseling for teens leaving foster care, counseling for families with children who have severe emotional disorders, and transitional support for formerly homeless people.

The funds will also be used to set up more than a dozen transitional resource centers throughout the county, including in North Hills, Pasadena and Long Beach.

The facilities will help foster youth who have run away from the system or who have been emancipated at age 18 get housing, education and mental health services.
Read more!

Los Angeles County Mental Health Reform Gets OK -

County supports $186 million plan

BY TROY ANDERSON, Staff Writer

In its first plan for how to spend revenue from a voter-approved state income tax on millionaires, the Board of Supervisors on Tuesday approved a $186 million plan to overhaul Los Angeles County’s mental health system.

More than 18,000 adults and children are expected to receive expanded mental health services beginning this fiscal year, and officials say the extra money will help get thousands of mentally ill transients off the streets. ��

“This is very huge,” said Marvin Southard, director of the county’s Department of Mental Health. “This is really revolutionary.

“This is the first step in what will be a major change in the way the mental health system operates. It will be a first step in making it more customer-friendly, providing what people need rather than narrow mental health services.”

The plan helps restore some of the services cut since the early 1990s, when budget woes forced the state to close psychiatric hospitals and the county to close several of its mental-health clinics.

The newly approved plan calls for hiring 260 mental health workers and building a psychiatric urgent-care facility at Olive View-UCLA Medical Center in Sylmar.

“What we are trying to do is create a psychiatric urgent care facility where people who are in a psychiatric crisis, but probably won’t get admitted to the emergency room, can go to get stabilized,” Southard said.

“Rather than have them wait in the ER, which isn’t necessarily a good place to be if they are in a mental health crisis, (this would) create an alternative place for them.”

Money for the plan comes from Proposition 63, passed by voters statewide in 2004 to help fund services for people with severe mental illness through a 1 percent tax on incomes of more than $1 million.

Southard said the initial round of funding will go to agencies that help the homeless on Skid Row and throughout the county, and includes $11.6 million for a trust fund to develop permanent housing for people with psychiatric disabilities.

That money will augment $100 million the supervisors recently designated and




the $50 million Los Angeles Mayor Antonio Villaraigosa has promised to help house the homeless.

Southard also said some of the $2.8 billion targeted for housing in a $37 billion state bond package set to appear on the November ballot could be used for homeless housing.

“The most important thing, from our perspective, is creating avenues for people to get off the streets,” said Orlando Ward, spokesman for the Midnight Mission on Skid Row.

“We know from the physical exposure of people on the streets, particularly those suffering from untreated mental illness, we know their situation will not get better unless we find treatment for them.”

The funds will also be used to start and expand programs for people with schizophrenia, bipolar disorder, major depression and other serious conditions.

County programs are expected to include around-the-clock counseling and support, rent subsidies, resources for finding permanent, affordable housing, treatment for alcohol and drug problems, and drop-in centers.

It also will include counseling for teens leaving foster care, counseling for families with children who have severe emotional disorders, and transitional support for formerly homeless people.

The funds will also be used to set up more than a dozen transitional resource centers throughout the county, including in North Hills, Pasadena and Long Beach.

The facilities will help foster youth who have run away from the system or who have been emancipated at age 18 get housing, education and mental health services.
Read more!

Katrina’s young victims reminders of the need to take good care of all children - Asheville Citizen-Times

By Kerra L. Bolton
Pure Politics
May 9, 2006 12:15 am

Hakeem is one of the forgotten children of Hurricane Katrina.

Like many 6-year-olds, he loves to enact imaginary battles with action figures. He proudly recites the alphabet and can count to 110.

But the bright smile that illuminates his face disappears at times when he struggles with bedwetting and nosebleeds.

Hakeem’s story is one of many featured in the Children Defense Fund’s report: “Katrina’s Children: A Call to Conscience and Action.”

It highlights the illnesses experienced by thousands of children who are expected to develop post-traumatic stress disorder.

Marion Wright Edelman, president of the Children’s Defense Fund, traveled to New Orleans on Monday with a group of prominent Hollywood and New York women. The delegation included Reese Witherspoon, Jennifer Garner, Cicely Tyson, Regina King and Deborah Santana.

I was invited to cover the event but was unable to go.

“Over seven long months after children in our nation’s poorest states suffered horrifying flood devastation, tens of thousands of them have been left to wrestle with their profound losses without adequate mental health and health supports,” Edelman said.

About 27 percent of the first 1,000 children screened by the Louisiana State University Health Sciences Center displayed symptoms of trauma such as nightmares, flashbacks, heightened anxiety and bedwetting, CNN reported.

Hakeem, for example, constantly watches his grandmother, Valerie, for signs she will abandon him.

His mother deserted him during the storm. She relocated to another state and changed her phone number to an unlisted one when the family contacted her about reclaiming Hakeem, according to the Defense Fund’s report.

There are parallels between Hakeem’s story and those of countless children in North Carolina who go without adequate mental health services.

State lawmakers are considering earmarking $100 million this year to boost mental health services. But that isn’t enough. At least $172.5 million is needed to bring the current level of services to all who are eligible and seek help.

The state’s lack of psychiatric services has crested critical levels. North Carolina ranks 43rd in the nation in its per capita spending on mental health services, according to a report card issued by the National Alliance on Mental Illness.

Another report by the N.C. Psychiatric Association found it would cost an additional $285.5 million to bring the state’s per capita spending on mental services to 88.8 percent of the national average.

Legislative leaders will unveil today, the first day of the short session, a list of priorities that will include increasing teacher pay, ethics and government reform, and possibly tax cuts. But when children like Hakeem can’t count on adults to protect and provide for them, our priorities are as tattered as the trailer park shanty-town in which Hakeem lives.

This is the opinion of Kerra L. Bolton. She can be reached at (919) 821-4749 or kbolton@citizen-times.com.

Read more!

At last, good news on mental health - Asheville Citizen-Times Editorial

Some really good news on the mental health front came last week when a mobile mental health crisis services unit began operating in Buncombe County. It's about time for the unit - and for some good news about a system that's been in chaos for several years.

The mobile unit goes to patients who are having a mental health crisis and attempts to stabilize them. It already operates in Henderson and Transylvania counties and by the end of the summer it will operate in eight counties, according to Western Highlands Network, which oversees the local mental health network.

A $100,000 grant from the N.C. Division of Mental Health, Developmental Disabilities and Substance Abuse Services pays for the unit.

Those who have mental illness have been without adequate crisis intervention services since Charter Hospital closed in 2000. That's a long time, during which patients in crisis have found themselves in sometimes dangerous confrontations with law enforcement officers, dumped in hospital emergency rooms ill-equipped to care for them, and confined to residential facilities, sometimes far from their families. Mental health advocates in the region have lobbied for crisis intervention services since Charter closed. The mobile crisis services unit is part of the answer to their prayers. Besides operating around the clock, the unit is equipped to transport someone who cannot be stabilized at home to a facility, such as Broughton, prepared to handle mental health patients in crisis.

That should help free law enforcement officers to deal with criminals instead of spending hours escorting and transporting mentally ill patients. It should also reduce the times when they are placed in potentially dangerous situations they are trained to handle primarily through use of force, which could have a very bad outcome for the patient.

But the mobile unit is only part of the answer. Arthur Carder Jr., CEO of Western Highlands, called it a good first step.

The next critical step is a facility where patients whose crisis can't be resolved at home can be taken for a couple of days to be stabilized.

In many instances, patients placed in such a facility near their homes and loved ones can be stabilized and ready to return to their normal life within a few days. That ultimately saves the money required for longer stays in institutions far from home. And it permits family members to remain involved in their loved one's care and rehabilitation.

It is, as Diane Bauknight wrote in a letter to state lawmakers and other officials, a necessary component for a crisis care continuum. Bauknight is a member of the advocacy group WNC Families CAN and the mother of a child with a mental illness.

It's heartening to see that some progress toward better care for those who suffer from mental illness is being made. But many problems remain. Sen. Martin Nesbitt, D-Buncombe, is co-chairing an oversight committee looking for ways to fix a state mental health services system that crashed and burned as the result of a badly botched and severely under-funded reform. Nesbitt and his committee are expected to request more money for the system during the upcoming short session.

State lawmakers should move swiftly to approve the request in order to see that adequate funds are available to create the community-based services that were supposed to be part of the reform, but have been abysmally slow to materialize.


Read more!

Our View: Mental health reorganization isn’t ‘reform’ unless it works. - Fayetteville Observer

There is nothing wrong with appropriate community care for mental health patients. But Michael Watson, head of the eight-county Sandhills mental health unit, isn’t alone in wondering who’s going to provide and pay for all that care.

In fact, Cumberland County staff members voiced similar concerns at a meeting in March, reporting that only 30 providers had been signed.

By June 30, Watson reports, his organization will have moved 2,000 patients off its rolls. That Sandhills will be left with roughly twice that many still awaiting referrals is a serious problem.

If the first wave of 2,000 isn’t being moved to providers who are not merely in the mental-health business, but who can identify the particular needs of individual patients, that’s failure — with greater failure awaiting the second and third waves. If the providers are pros but lack the facilities to meet each patient’s needs, that’s failure, too. And it’s failure if a provider cherry-picks patients to avoid taking on problem patients who, in Watson’s words, “don’t pay for themselves.”

It’s failure if Medicaid, already under siege in Washington, is further squeezed by the state, prompting providers to turn their backs on suffering people.

Finally, it will be hard to declare reform a success if more patients than before end up “falling through the cracks in the system” — a phrase tossed about dismissively by those higher up the bureaucratic food chain, but used with bitter distaste by those who will be watching when the casualties fall.

The directors are not anti-reform. But they know that, in Watson’s words, “It’s an extraordinary amount of change happening very quickly.” They know that the state is burning bridges. (Sandhills’ budget will be cut in half next year.) And they know that their specific, rubber-meets-the-road concerns draw only broad assurances that everything’s going to work out fine (except, of course, for those who fall through the cracks in the system, tut-tut).

Dick Oliver, who evaluates local agencies, offered some good advice. If Watson thinks reform is coming too fast, he said, he should tell the state Division of Mental Health and plead for more time. His strong implication is that the state will grant any reasonable request. Maybe a procession of directors pleading for more time would shift the state’s focus from the gleaming superstructure to the unfinished foundation. Read more!

New service the first of many steps - Hendersonville Times-News

Mental illness doesn't keep regular office hours. Crises can happen at any time, day or night.

That's why getting mobile crisis intervention teams up and running is so important to the state's mental health care system. The teams are available 24 hours a day, seven days a week to respond to families experiencing a mental health or substance abuse crisis.

New Vistas-Mountain Laurel, which provides mental heath services in eight mountain counties, has launched mobile crisis teams in Henderson and Buncombe counties.

"That has not been something readily available in the past," said Barry Beavers, the director of Mountain Laurel Community Services. "In the past, a lot of community members, parents, clients have been upset that our help services ended at 5 p.m. even when Mountain Laurel extended office hours. Crises happen at three in the morning."

Money for the teams comes from a $100,000 state grant that Mountain Laurel received through Western Highlands, which manages mental health care for Henderson, Buncombe, Mitchell, Madison, Polk, Rutherford, Transylvania and Yancey counties. Western Highlands expects to have teams in the other six counties by mid-summer.

"Consumers, family members, advocates, board members and many others have consistently identified crisis services as a major gap in services," said Arthur D. Carder Jr., the Western Highlands CEO. "While this is not a solution to all the concerns, it is a step in the right direction."

Beavers said Mountain Laurel was selected to implement the service because it launched a similar program last year that has shown success.

The program was formed after a mental health reform mandated by the Legislature in 2001 caused the mentally ill to begin flooding local homeless shelters, overwhelming emergency rooms and burdening local law enforcement. Mountain Laurel launched a crisis assistance team in Henderson County to help ease the burden. The agency recently received a $71,000 grant to extend the program to Transylvania County.

The intervention team concept is a good one. A team of mental health professionals goes to the person's home or the location of the crisis. There the team evaluates the person's needs, defuses the situation if possible and figures out what the next step should be.

In some cases, if the person can't be helped on the spot, the crisis team may refer him or her to an out-of-home facility. In other cases, the team can refer people to a local provider for follow-up, which would allow them to remain at home.

Research shows that people have a better chance of long-term mental stability or sobriety if they are in familiar surroundings such as their home, school or work instead of being separated from family and friends at a facility far from home.

"Our goal is to enable consumers in crisis to remain at home whenever possible," said Don E. Herring, director of the Western Highlands Access and Emergency Services.

That's a good goal to shoot for and one that the mobile crisis intervention teams make more realistic.

But as important as the teams are, they are only one small step. More services are needed so that the mountains can offer comprehensive mental health care. For example, the mountains need a permanent facility where people in crisis can seek help and remain until they are stable.

What other services and facilities the mountains get will depend on how much money the Legislature makes available. The Legislative Oversight Committee on Mental Health, Developmental Disabilities and Substance Abuse Services is drafting a bill that would earmark an extra $160 million for solving the state's mental health care mess.

Mental health consumers, their families and the public ought to keep a close eye on this bill and insist that their legislators support it.

Getting the crisis teams going is progress, but the Legislature still has a long way to go before it fixes the system that it "reformed" five years ago. Read more!

Durham Center receives injunction - Durham Herald-Sun

BY GREGORY PHILLIPS
The Herald-Sun_gphillips@heraldsun.com
419-6636
May 3, 2006 : 7:34 pm ET

DURHAM -- A judge granted a preliminary injunction to the Durham Center that is the first court victory for local mental health providers against North Carolina's statewide reform plan to shift managed care to private companies.

The state Department of Health and Human Services announced in March that a private provider would start managing care for all Medicaid patients statewide as of June 1. On Tuesday, Administrative Law Judge Sammie Chess Jr. blocked that initiative from taking effect in Durham pending a full hearing the week of July 24.

The judge's ruling, the first of its kind in the ongoing dispute, also suspends the state's plan to have a neighboring authority handle all after-hours screening of Durham mental health cases beginning July 1.

The Durham Center is responsible for managing mental health, developmental disabilities and substance abuse services in the county. The state's directives would cost 15-20 of the center's 55 or so employees and $1.4 million in funding.

"This is the best news we've had in a long time," Durham Center Director Ellen Holliman said of the injunction. Durham's state legislators also told county commissioners Tuesday they'd fight to preserve funding for the Durham Center.

Private contractors don't save taxpayer money because they generally authorize more care than patients actually need, according to Durham Center officials. Losing that power to prescribe care and the ability to screen cases locally makes care less personal and not geared toward the patients' best interests.

During five years of mental health reform, local mental health authorities have moved toward service management rather than direct care, which is now handled mostly by private providers. The Durham Center embraced reform. For the most part it was labeled a model system by the state for its efforts to reduce local admissions at state hospitals.

But local officials got indignant when Health and Human Services announced in March that Value Options, a private provider, would handle authorization of all mental health care for Medicaid patients in the state starting June 1. Another blow was the simultaneous order that, beginning July 1, the neighboring Five Counties authority would handle all screening, triage and referral of mental health cases in Durham after 5 p.m. and on weekends.

A week after those announcements, County Attorney Chuck Kitchen filed a petition for a contested case hearing with the Office of Administrative Hearings to void the state's plan. The petition claims the state is violating its own statutes, breaching a contract with The Durham Center to oversee care and denying the center due process rights. That July hearing will result in a recommendation to Health and Human Services, which it can ignore. If the state ignores a ruling in The Durham Center's favor, the case can be appealed to Superior Court.

Health and Human Services spokesman Mark Van Sciver declined to comment on the specifics of the case, but said the state plans to have Value Options start authorizing care for other counties on schedule.

"We are not backing off," Van Sciver said. "Everything is proceeding."

Kitchen also declined to discuss how the state argued against the injunction in a closed hearing Tuesday.

"I don't want to comment on arguments because the case is still pending," Kitchen said.

A preliminary budget supplied to the Durham Center last month included a 28 percent budget cut from the state due to the impending removal of services. But Kitchen said the preliminary injunction also requires the state to continue funding The Durham Center to authorize care for Medicaid patients and conduct after-hours screening pending the hearing.

The center currently contracts with a private provider to screen cases. Holliman said bringing that service back in-house was one way the center might try to avoid losing staff if the state prevails.

The center's budget is up for discussion at a public meeting of its Board of Directors at 4 p.m. Thursday at 501 Willard St. downtown.


Read more!

Basnight urges more for reform - Winston-Salem Journal

JOURNAL STAFF AND WIRE REPORT
Wednesday, May 3, 2006

RALEIGH - N.C. Senate-leader Marc Basnight said yesterday that he wants the state to spend another $100 million a year to try to improve its mental-health system, plus another $280 million in bonds to replace two of the state's four mental hospitals.

"It's a huge issue that we have to apply some of our funds to, and it might be more than $100 million; I don't know," he said.

Basnight, D-Dare, made the comments to reporters in advance of the General Assembly's short session, which begins Tuesday. He is the highest-ranking state official to commit to so much money for the mental-health system.

He said he made up his mind after recent visits to Broughton Hospital in Morganton and Cherry Hospital in Goldsboro, which he said were in disrepair.

"I was just shocked," Basnight said. "I couldn't believe we did that to anybody."

A legislative committee has been considering a $160 million proposal." Read more!

So Tough It Hurts - USA Today

By Jim Thornton, May & June 2006

Doctors now know how to fix depression. Why do so many men still suffer in silence?


Henry T.'s life was never easy—he'd always had trouble getting close to people, and he depended on alcohol to take the edge off his loneliness. Throughout middle age, Henry endured bouts of the blues, though he always bounced back after a few months. Following retirement from his job as a graphic designer, however, Henry, now 68, experienced his worst depression ever. In the dead of one New York State winter, he stopped going out, stopped shaving, stopped washing. Many nights he couldn't sleep. His appetite vanished, and he shed 25 pounds.

By the summer of 2004, Henry's depression had become so deep that relatives in his hometown of Pittsburgh, fearing he might take his own life, convinced him to move back home. At the urging of a worried cousin, Henry reluctantly agreed to see Charles F. Reynolds III, M.D., director of the late-life mood-disorders center at the University of Pittsburgh Medical Center (UPMC).

With this decision Henry took the first—and most difficult—step toward reclaiming his life.

Though depression is a disease that afflicts both genders, a growing number of researchers believe men bear unique burdens that make it much harder for them to get treatment. For one thing, women suffering the disease tend to acknowledge their pain and seek help. Men—particularly older ones—don't.

The Road to Wellville

20: Percentage of men over 50 estimated to have depression or chronic low mood

30: Percentage of men with depression who seek treatment for their condition

90: Percentage of men treated for depression whose condition is significantly relieved

"It's not considered unwomanly to be emotional and vulnerable, but a real man would never be so 'weak' as to let his emotions get the best of him," laments therapist Terrence Real, best-selling author of I Don't Want to Talk About It: Overcoming the Secret Legacy of Male Depression (Scribner, 1997). "There's a lot of shame involved, and this sets up what I call compound depression—a man gets depressed about being depressed."

Epidemiologists estimate that up to 10 percent of the patients over 50 seen in primary care settings suffer major depression like Henry's. If you add in dysthymia—a less severe form of chronic low mood—this figure jumps to 20 percent. Though no one has an exact count, even the most conservative estimates hint at an epidemic. It's probable that 10 million or more older Americans are enduring this torment.

Even worse: their suffering is largely unnecessary. New treatments for late-life depression can restore hope and even joy to most patients. "Depression is one of psychiatry's great success stories, and study after study shows that 90 percent of men who receive help get significant relief," says Real. "Unfortunately, somewhere between 60 to 80 percent of depressed men never get the treatment they need. And that is a heartbreaker."


At 8:00 a.m. on a gray winter morning, Henry arrived at a psychiatric research lab on the campus of the UPMC. A technician led him to a gurney and inserted an IV line into a vein in his elbow crook. Within minutes a solution of radioactive sugar molecules was wending its way through Henry's circulatory system en route to his brain.

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The tech slid the gurney forward, centering Henry's head inside a PET scanner. Over the next hour the machine collected data on the metabolic activity of Henry's brain.

Later that afternoon a computer finished reconstructing Henry's data into a multicolored picture of a mind in agony. To a lay observer, the image looked like a metaphor for hell itself: flickering orange flames on his brain's convoluted fringes giving way to a singeing white heat in its dead center.

"This shows direct evidence of a sick brain," said Reynolds. "Henry's scan clearly indicates that the specific areas of his brain involved with mood have shifted into overdrive."

Such images support a radical change in the way doctors understand depression. As recently as the 1970s, many psychiatrists still considered the condition purely psychological, the consequence of faulty toilet training or similarly nonsensical causes.

Today, aided by state-of-the art scanning techniques and an explosion of insights into genetics, neurotransmitter systems, and synaptic wiring, the true picture of the disease has changed utterly. Depression is now understood as a physical illness of the brain.


Still, diagnosing the disease—especially in older men—can be tricky. Even if men are willing to discuss their feelings with a doctor, they may lack the vocabulary. "They'll just say they feel lousy—they're not sleeping well, food doesn't taste right, they're not having any fun, they can't concentrate," says Barry Lebowitz, Ph.D., deputy director of the Stein Institute for Research on Aging at the University of California, San Diego. "They end up endorsing every single symptom of depression except for one, which is sadness. In older guys, we now know depression often exists strictly in bodily perceptions."

This pattern is so common that it's even got an unofficial nickname among those who treat it: "depression without sadness." Experts in the phenomenon are not yet sure if victims truly don't feel sad—or if they simply lack the insight to articulate their feelings.

Therapist Real suspects that many afflicted men try to numb their pain with drinking, compulsive gambling, uncontrolled sexuality, or temper tantrums. "For such men, the experience of depression is not about feeling bad so much as about losing the capacity to feel at all," he says.

Real calls such behaviors "an addictive defense." Patrick McCathern knows the pattern all too well. A spokesperson for the National Institute of Mental Health (NIMH) Real Men/Real Depression Campaign, McCathern spent years attempting to distract himself from his own dark moods by relying on male stoicism, workaholism, and social withdrawal. When his wife finally divorced him, his mood spiraled so far out of control that he found himself turning to alcohol.

"Prior to that severe depression," McCathern says, "I barely ever drank. But when my depression set in, I found myself having a couple beers a day, and pretty soon it was six or eight followed by a bottle of Jägermeister."

McCathern says he understood that such self-medication was hurting him, yet he couldn't avoid being seduced by the short-lived relief he found in a bottle. "You don't want to drink, but it's a hard thing not to," he notes.

For men whose depression is complicated by substance abuse, the odds skyrocket for what is arguably the biggest difference between male and female versions of the disease: suicide completion rates. NIMH data suggest that women attempt suicide three times more often than men do, often as a cry for help, but men are four times more likely to finish the job. The single highest suicide completion rate for any demographic group in the United States is older white males. By age 85 men are more than ten times as likely as women to kill themselves.

McCathern, a retired Air Force sergeant, came within seconds of becoming just such a statistic. In a moment he now describes as the darkest of his life, he draped a noose over his bathroom door, placed his neck inside it, and slumped forward. "I was maybe 20 seconds away from passing out when one of my dogs walked in," says McCathern. "I was beyond caring what my friends or family might think. I felt so worthless and guilty, I didn't think I deserved to be consuming oxygen on the planet anymore.

"But when my dog looked up at me with his bright beagle eyes, it was like he was saying, 'What about us? We love you.' It occurred to me that if I died, who'd get my dogs water and feed them? I'd be ending my pain—but just starting the suffering for them."

McCathern removed the noose and dialed his only remaining friend. She drove him to the local ER—the first step in a long but ultimately successful journey back from the brink.


Though depression can strike at any time of life, it hits older men with a particular vengeance. "A lot of big stuff comes at men when they grow older," Reynolds explains.

Retirement Those who have derived their main sense of identity and self-esteem from careers can suddenly find themselves feeling purposeless.

Bereavement Losing a spouse is an important risk factor for depression, with roughly one in five of those widowed developing the disease in the first year. Men are especially vulnerable, because they tend to have fewer close friends to lean on than women do.

Disability Cardiovascular diseases, including heart attacks and strokes; chronic pain from osteoarthritis or lower-back injuries; insomnia; and other medical conditions common with age can all precipitate depression.

The exact mechanism has not yet been nailed down, Lebowitz says, but it looks likely that depression following sudden disability has both a psychological component (that is, it's depressing to lose the ability, say, to move or speak normally) and a neuroanatomical component (injury to specific brain regions can directly dampen mood).

Once disability triggers depression, the two conditions can feed off each other, though it doesn't have to be this way. A March 2005 study published in the Journal of the American Geriatrics Society showed that treating an older man's depression often translates into significant improvements in his physical health and functioning, as well.


The first step to getting a misfiring brain back in shape is a search for physical conditions that might be contributing to the problem. Certain medications—such as beta-blockers, used to treat high blood pressure—may send susceptible men into a serious slide. A simple change in medication can frequently eliminate the problem—as can monthly shots of vitamin B12 for patients whose blood tests low for this vital compound.

Usually, however, restoring long-term emotional well-being depends upon a more intensive, multipronged attack, particularly when the depression is complicated by addictions. "Part of my bread and butter these days," says Real, "is educating mental health professionals that traditional therapy by itself is often ineffective for male depression. You can't help a guy unless you first get him to attend to the fact that he's drinking a six-pack a day."

With a treatment plan in place for addictions and other conditions contributing to the depression, physicians can also work directly on lifting the mood itself. There are two main strategies for this, frequently applied in tandem: medicine and psychotherapy.

Medications Though many older men are dead set against antidepressant drugs such as Prozac or Wellbutrin—convinced that taking medicine means they're "crazy" or they'll get "hooked"—the truth is, modern medications have proven highly effective. Neither mind-altering nor addictive, they work over time to restore a normal chemical balance in the brain.

But drug treatment has its downsides. For one thing, the first drug tried usually works in only about 50 to 60 percent of cases. It also takes a minimum of four to six weeks before the drug's full effects kick in.

If the first drug doesn't work, there's no reason to despair. Often the second or third drug will do the trick. In the case of Tom Johnson, former CEO of CNN, it was not until his doctor tried a fifth medication that he finally found relief. "I know that what works for me does not necessarily work for another person," he says, "but I feel I owe my life to my doctor and the drug Effexor."

Another drawback, especially with older patients, is the potential for side effects, from sleep disturbance and nervousness to nausea and erectile difficulties. Not everyone gets these, and often they abate over time, but a change in drugs can resolve troublesome side effects.

Psychotherapy As effective as medication can be, there's another remarkably potent treatment: psychotherapy, a.k.a. the talking cure. And today's short-term, science-backed therapies have little in common with the lengthy, sometimes counterproductive Freudian probings of yore.

Three specific forms of therapy, in particular, are proven approaches that quickly give patients the tools to lift their moods. The treatments are cognitive-behavioral therapy, or CBT, which teaches how to recognize and successfully counter the negative thinking that fuels depression; interpersonal therapy, or IPT, which fosters better communication and conflict-resolution skills; and problem-solving therapy, which teaches ways of breaking down problems into manageable units that can be tackled one at a time.

All three approaches usually require 10 to 16 weekly sessions. Men receive practical advice and homework assignments to cement the skills. For many, this directive aspect has great appeal. "There are a lot of pluses to the traditional male role," says Real. "Men are not averse to hard work. Once you get the guy on board with these therapies, usually you've got a draft horse who is ready to pull and go the distance."

Future help For those few whose depression resists treatment, other therapies are on the way. One of the most promising is deep brain stimulation, or DBS, which is akin to placing a pacemaker in a key area of the brain. In a pilot study in the journal Neuron, researchers from Emory University in Atlanta and the University of Toronto reported that several patients spontaneously described, at the exact moment electrical stimulation was applied, a "sudden calmness" and a "disappearance of the void."


Following Henry's initial PET scan, Reynolds prescribed an antidepressant medication and a 16-week course of interpersonal therapy. Within several months Henry's symptoms lifted entirely, at which point he returned to the lab for a follow-up brain scan. This showed the improvement wasn't merely subjective.

"For two years," says Henry today, "I was so depressed and afraid that I could barely leave my house. Now, my true personality is back. I go out all the time, and I'm even considering starting a new career. My advice to other depressed men is to go to a doctor, explain your problem, and get on the right track to treatment. No matter how bad you think you have it, there is always reason for hope."

And, although seeking treatment may be difficult, Real says, fathers with depression have a special responsibility to do so. "Depression is like a fire in the woods passing from generation to generation to generation," he says. "This will keep going until one man in one generation turns around and faces that fire and does something about it. A man with the courage to bring spiritual peace to himself is also sparing the generations that come after him."

Jim Thornton wrote about Alzheimer's disease in the September-October 2005 issue of AARP The Magazine.







Read more!

Living with mental illness- USA Today

By Pete Earley
"Dad, how would you feel if someone you loved killed himself?"

My college-age son, Mike, has stopped taking medication for the mental illness that was diagnosed a year ago, and he is having a relapse. He and I are speeding to an emergency room. Hang on son, I think. The doctors will help you.

But after waiting four hours, a doctor appears and tells me it's illegal to treat Mike. He is not sick enough. He is not in "imminent danger," and because Mike now thinks "pills are poison," the doctor cannot forcibly medicate him under Virginia law. I'm told to bring him back if he tries to kill himself or someone else.

No parent should watch what I see next. Mike sinks further into a mental abyss. Forty-eight hours later, he breaks into a stranger's house to take a bubble bath. The homeowners are away, but Mike is arrested and charged with two felonies. I've been a journalist 30 years and thought I knew a lot about jails, courtrooms and mental illness. But I was always on the outside looking in.

I was so outraged about what happened to my son that I spent the next three years investigating America's mental health system.

I went to Florida, to separate myself from Mike's case, and spent time in the Miami-Dade County jail. I followed psychotic prisoners through the courts, rode with cops, interviewed judges, attorneys, psychiatrists, mental health advocates, parents and persons like my son.

System in disarray

I discovered our system is in a shambles. Jails and prisons have become our new asylums.

Deinstitutionalization — the haphazard closing of state mental hospitals and dumping of patients into the streets during the '70s and '80s — began the migration from hospital wards to jail cells.

In 1955, about 559,000 Americans were patients in state hospitals. If you took the patient-per-capita ratio then and extrapolated it out to today, you'd expect to find 930,000 patients in those facilities. But there are fewer than 60,000.

Where are the others? About 300,000 are in jails and prisons. An additional 500,000 are on probation. According to the Department of Justice, 16% of inmates in state correctional facilities say they have a mental condition or have spent a night in treatment. The largest public mental facility in the USA is the Los Angeles County jail.

Lawsuits filed to protect patients from abuse in horrific state hospitals created legal barriers that are now preventing parents and other loved ones from intervening until it is too late, just as they did in Mike's case. A shameful lack of community services, including treatment programs and housing, also are to blame.

In Miami, I saw homeless men with chronic schizophrenia arrested for trespassing, jailed, released untreated and arrested again days later. They are stuck in a vicious revolving door.

No one is immune

Mental illnesses are chemical imbalances that affect how nerve cells in the brain send and receive messages. They can strike anyone. Nothing in our family's history hinted that a debilitating disorder loomed ahead. And Mike did nothing to bring this sickness on himself.

Sadly, we are making jails a core part of our mental health care network. Jail officials are building separate facilities for psychotic prisoners. In effect, we are reconstructing the dreaded "warehouse" asylums from our past inside our jails.

Jails are not safe places for a person with a mental illness, and the sick shouldn't have to become criminals to get help. Most can get better. Treatment works in 80% of cases — if it is available.

Incredibly, we are continuing to shut down psychiatric wards in favor of jails. My state, Virginia, has lost 84% of its psychiatric hospital beds since 1955. Why are we choosing cells over beds? The cost of a psychiatric bed exceeds $500 per day. The cost of a Virginia jail is $89 per day.

My son is back on his medication. But now he faces the stigma of having a mental illness and a criminal record. That's wrong. Few of us worry we'll wake up with a mental illness. But what if the phone rings and it's someone telling you about your sister, your daughter, your mother — your son?

I've been on the inside looking out now. It is frightening.

Pete Earley's book, Crazy: A Father's Search Through America's Mental Health Madness, was published this month. Read more!

A rush to overprescribe?- USA Today

Rising numbers of U.S. children are taking a new generation of anti-psychotic drugs called atypicals.
Although the six drugs — Clozaril, Risperdal, Zyprexa, Seroquel, Abilify and Geodon — can be helpful in treating children with mental illness, critics say that the drugs are overprescribed and that many kids suffer serious side effects from drugs they never needed.

USA TODAY's Marilyn Elias talks to one mother who believes that's what happened to her son.

Evan Kitchens had problems from birth. He suffered from lack of oxygen during a difficult delivery. As a baby, he wouldn't nurse properly, didn't want to be held and screamed for hours.

"He hardly slept at all," says his mother, Mary Kitchens, a florist in Bandera, Texas.

At 18 months old, Evan was diagnosed with an autism spectrum disorder and prescribed Adderall, a drug to treat attention-deficit hyperactivity disorder.

But Evan just got more aggressive and hyperactive. When he was 2, he knocked out the front teeth of his younger brother with a flashlight. The family began a constant round of appointments with child psychiatrists and other doctors.

At 2½, Evan was diagnosed with obsessive-compulsive disorder. When he was 3, doctors put him on Risperdal, his first anti-psychotic. But in a "special needs" preschool, his aggressive behavior continued. He was out of control, racing out of the classroom, hitting other kids.

At 5 Evan was hospitalized for the first time. He was still on Risperdal and two other drugs, supposedly to stabilize his moods and curb hyperactivity. But nothing had worked well for long.

Kitchens says she tried doctor after doctor. She had insurance only on and off; her husband disappeared when twins were born 16 months after Evan, she says, so she became the family's sole support.

"Every drug created new symptoms, and then you had to treat those symptoms," she says. "We were constantly changing meds. I see now what we were really managing was symptoms of the drugs, not his underlying problem."

In April 2004, at age 8, Evan set fire to the bedroom carpet with a candle. Fortunately, 14-year-old Ethan, Evan's older brother, saw the fire before anyone was hurt.

Evan was hospitalized in San Antonio. The family drove three hours every day, Kitchens says, to bring Evan dinner and spend time with him. Now doctors said he might have bipolar disorder.

Evan had been on Risperdal and the mood stabilizer Lithium. Doctors added Seroquel to the mix. Within a month, he showed tremors, Kitchens says. "They got so bad, he was shaking all the time." Evan's eyes started to cross. Still, doctors thought it was important to keep him on the drugs. They added two more mood stabilizers. Soon Evan had a thyroid disorder and an abnormally low white blood cell count, Kitchens says.

In August, Evan was transferred to another center and weaned off everything but Seroquel and a drug for attention-deficit disorder. His alertness returned, but other symptoms lingered for months.

In January 2005, Evan came home. Kitchens gradually took him off Seroquel and says he's doing better than ever just taking medicine for ADD. He has had intensive behavior-management therapy; so has the whole family. His alarming symptoms are gone, but his eyes still cross occasionally if he's tired.

Many child psychiatrists are frustrated by the lack of drugs to treat kids with mental disorders, says Wayne Macfadden, U.S. medical director for Seroquel, which is made by AstraZeneca. But Seroquel isn't approved for children, he says. "Obviously, prescribers have to weigh the risks and benefits."

Evan made the honor roll in regular school his first semester home, Kitchens says. He sang in the school's Christmas choir, played basketball and is making friends.

His mother wishes she had gone the non-drug route earlier. "I didn't even know what was available ... I totally relied on the doctors."

Evan says his time of live-in care "is like a blur. I remember my stomach would hurt, and my head would hurt. I slept a whole lot. And then I started to see two of things. I was very scared." He says he's happy to be home: "Nothing hurts anymore."

If doctors recommend the drugs he took for other kids, Evan has some advice for their parents: "Sometimes it's good for them, sometimes it's bad for them. I would warn them about the bad things that can happen."

HOW TO BE AN ADVOCATE FOR A CHILD

If a doctor recommends antipsychotic drugs for a child, parents should ask some key questions and watch for "red flags" that might signal the need for another opinion, says David Fassler, a child psychiatrist and clinical professor at the University of Vermont.

"If you have any questions or concerns, you should always try to get a second opinion," he says. "Sometimes the chemistry just doesn't feel right with that doctor. Nobody has all the answers, and parents really need to be advocates for their children."

Questions to ask

• Why do you advise this medication? Have you treated others with it? Was it helpful?
• How will we know whether the medicine is helping? "Push for specific criteria," says Fassler. "Are we measuring frequency of tantrums, school attendance or what?"
• How long should it take to work? How long would my child need to be on this medicine if it is working?
• What are the common and uncommon side effects?
• What are the alternatives to this treatment? What are the risks and benefits of each?
• Where can I get more information on the drug and on other treatment options?
• Is this the lowest dose that might be effective?
• How will this medication interact with other drugs my child is taking?
• How can I contact you quickly if I have concerns?
• What will we do if it doesn't help? What is the next step?

Red flags

• The doctor hasn't done a full evaluation before prescribing the drug, including reviews of the child's developmental, medical and psychiatric history; family medical and psychiatric history; and the child's behavior at school, with friends and family.
• The doctor has no plan for regular follow-up.
• The doctor doesn't discuss any other options, such as counseling, to accompany the medication, or instead of it.

Helpful websites

• www.nimh.nih.gov
• www.ffcmh.org
• www.bpkids.org
• www.aacap.org/
• www.firstsigns.org
Read more!

For foster kids, oversight of prescriptions is scarce - USA TODAY

Foster children are of special concern to some experts who fear atypical anti-psychotics may be prescribed without the careful oversight usually provided by birth parents.

The vigilant medical monitoring that is needed by foster children on anti-psychotics "is still unusual, unfortunately" in the USA, says Moira Szilagyi, a Rochester, N.Y., pediatric endocrinologist who specializes in foster children.

There are no numbers collected nationally, but Paul Vincent of the Child Welfare Policy and Practice Group believes there has been an upswing in the use of atypicals by foster kids in the past few years. His Montgomery, Ala., firm consults for state child welfare agencies, reviewing many of their health services.

Some state data obtained by USA TODAY through Freedom of Information Act requests appear to support his observations.

• In California, Med-Cal prescription claims for atypicals for kids in foster care increased 77% between 2001 and 2005, to 70,879. The actual number is probably higher because the state does not get complete data from managed-care providers, which cover the majority of foster children.

• In Illinois, the number of children covered under the state's public health care program — not just foster children — who had an atypical prescription went up 39% between fiscal years 2003 and 2005, to 17,746.

Kids as young as 4 are getting prescriptions for anti-psychotics, Vincent says, sometimes from unqualified counselors. "They aren't psychiatrists or even psychologists. I have considerable worry about the accuracy of these diagnoses."

The safety of these drugs is of most concern to Andrea Moore, a Coral Springs, Fla., attorney. Judges appointed her to represent foster kids a few years ago. Several children she represented started lactating after taking anti-psychotics, a recognized side effect of the drugs. A 12-year-old girl with a history of heart problems became short of breath on Geodon, an atypical that can cause arrhythmias. "The doctor prescribing it did not even have her medical history," Moore says.

Geodon has a proven "modest" effect on heart rhythms in adults, says Ilise Lombardo, medical director for the U.S. Geodon team at Pfizer Inc., maker of the drug. The clinical impact of this rhythm change is unknown but is being studied in adults, she says; safety and effectiveness studies in kids are underway, too. The drug's label says patients with certain heart problems shouldn't take it.

In February, Florida's health care agency ordered an independent investigation into why the number of Medicaid children taking anti-psychotics nearly doubled in the past five years. The numbers jumped from 9,500 to 17,900.

A new Florida law adds some protections for foster children, but it has loopholes, Moore says. "I'm still hearing about problems with overprescribing and under-monitoring." Read more!

Adult antipsychotics can worsen troubles - USA Today

By Marilyn Elias, USA TODAY
Evan Kitchens, a cheerful fourth-grader who loves basketball and idolizes his 16-year-old brother, had been hospitalized for mental illness by the time he was 8.

The boy from Bandera, Texas, was aggressive and hyperactive and had been diagnosed with a variety of other ailments, including obsessive-compulsive disorder and an autism spectrum disorder.

A couple of years ago, Evan was taking five psychiatric drugs, says his mother, Mary Kitchens. Two were so-called atypical antipsychotics, a group of relatively new drugs approved by the Food and Drug Administration for treating adults with schizophrenia or bipolar disorder.

"Evan was a walking zombie on all those drugs," Kitchens says. At the harrowing nadir two years ago, she wondered whether her son would survive, let alone live a normal life.

Evan shook with severe body tremors and hardly talked. He had crossed eyes, a dangerously low white blood cell count and a thyroid disorder, all symptoms that emerged after he started the atypical antipsychotic drugs, Kitchens says. Now, he has been weaned from the drugs and takes medicine only for attention-deficit disorder, she says. And he is mentally healthier than he has ever been.

These six new antipsychotic drugs — Clozaril, Risperdal, Zyprexa, Seroquel, Abilify and Geodon — are not approved for children, but doctors can prescribe them to kids "off label." And prescribing atypical anti-psychotics for aggressive children such as Evan is leading the field in a growing pediatric business, according to a new analysis of a federal survey by Vanderbilt Medical School researchers.

Outpatient prescriptions for children ages 2 to 18 jumped about fivefold — from just under half a million to about 2.5 million — from 1995 to 2002, the survey shows.

At the same time, reports of deaths and dangerous side effects potentially linked to the drugs are increasing. A USA TODAY analysis of Food and Drug Administration data shows at least 45 deaths of children from 2000 to 2004 where an atypical was considered the "primary suspect." More than 1,300 cases reported bad side effects, including some that can be life threatening, such as convulsions and a low white blood cell count.

Non-drug treatments

Treating children's disruptive behavior with pills is a complicated issue and the subject of debate among experts.

FOSTER CHILDREN: Oversight of prescriptions is scarce

"In my experience, and that of many psychiatrists, antipsychotics are often overused for aggression in young patients," says Ronald Pies, a clinical professor at Tufts University and author of Handbook of Essential Psychopharmacology.

That doesn't mean it's necessarily wrong to give the pills, he adds.

Nobody disputes that the lives of schizophrenic or severely manic children might be saved by antipsychotics. But many non-drug treatments can help to keep aggressive, disruptive children off the atypicals, says John March, chief of child and adolescent psychiatry at Duke University School of Medicine.

So much hinges on whether safer treatments can work for a child.

Kids who show up on antipsychotics for aggression often can be weaned off if there are family changes, says behavioral pediatrician Lawrence Diller of Walnut Creek, Calif. For instance, adolescents may lash out angrily if their parents are fighting or discipline is inconsistent, Diller says. In a divorce, the child sometimes ends up with the less effective parent.

Last year, Diller saw an 8-year-old boy on four psychiatric drugs, including an atypical. He lived with his mother, "a highly anxious, incompetent parent." When he went to live with his father, his symptoms virtually disappeared, and he didn't need any drugs, Diller says.

Child psychiatrist George Stewart says he has seen dozens of aggressive children weaned off the atypical antipsychotic drugs in his consulting work and as medical director of a residential treatment facility in Concord, Calif. Too often, he says, doctors give the drugs without considering family conditions or life experiences that cause aggressive behavior, which can be changed with intensive counseling. Three examples he offers:

• A boy younger than 3 was treated with two antipsychotics at a therapeutic preschool for kids with severe behavior problems. Stewart got a full family history, discovering his teen mother had a series of abusive boyfriends. "He was acting out due to that, but nobody took the time to find out what was going on at home," says Stewart, who worked with the mom to improve conditions. "She settled down."

The child was taken off atypicals and is doing fine.

• A 12-year-old boy with out-of-control rage — "we're talking smearing poop all over the 'quiet room' " — was treated at Stewart's center. Intensive therapy identified the sources of his rage and taught the boy how to cope. He returned home, off all meds.

• A teen girl seemed to be intractably violent. "She was trying to stab pencils in people's eyes," Stewart says. It turned out she had been raped and experienced other severe trauma. She was weaned off antipsychotics and counseled. Now in her late teens, she's living independently and doing well with no psychiatric drugs.

One of the most disturbing, potentially dangerous trends linked to atypicals is called "polypharmacy": routinely giving kids several psychiatric drugs, says child psychiatrist Joseph Penn of Bradley Hospital and Brown University School of Medicine in Providence. "We know very little about the interaction of these drugs, the effects they could be having on kids," he says.

The benefits of prescribing multiple drugs may outweigh risks in some cases, but Penn says he is appalled at how many times he has seen the mega-powerful atypicals prescribed to children suffering from insomnia when they're taking other medicines.

"I've seen hundreds of cases," he says, "and often parents don't seem to have been told about the many less risky prescription and non-prescription options out there."

Sometimes medical conditions or drugs for attention-deficit hyperactivity disorder cause the insomnia. Rather than attacking causes, doctors add an atypical to the mix, he says.

More research needed

There has been little carefully controlled, long-term research on children taking most psychiatric drugs, including the atypical antipsychotics. The FDA is trying to get more pediatric research on the atypicals, says Thomas Laughren, the agency's director of the psychiatry products division.

The FDA has asked five pharmaceutical companies that make the drugs to test them in children with schizophrenia and bipolar disorder, the uses they're approved for in adults. Under law, they can get a six-month extension on their patents for doing these studies.

Also, the drug companies are doing their own pediatric studies on children with disorders as diverse as ADHD, autism, conduct disorder and Tourette's syndrome.

Janssen LP has applied to the FDA for approval to use its atypical antipsychotic, Risperdal, in the treatment of symptoms of autism, says Ramy Mahmoud, vice president of medical affairs for Janssen.

The National Institute of Mental Health also is conducting pediatric studies, but the research is primarily funded and supervised by pharmaceutical companies.

Even if the companies win approval, it won't guarantee safety or effectiveness of the drugs in children, says David Graham of the FDA Office of Drug Safety, who emphasizes he doesn't speak for the agency. "You basically know the drug isn't cyanide. You don't know much else," says Graham, who was the whistle-blower in the 2004 Vioxx heart disease scandal. Industry-funded trials are four to five times more likely than independent studies to show effectiveness for a drug, he says.

According to a research review published in February, 90% of drug-company-funded studies come up with findings that support the company's drug.

In head-to-head research testing more than one atypical antipsychotic drug, the outcomes are contradictory, coming down on the side of whichever company is paying for the research. (The research included studies of Risperdal, Zyprexa, Clozaril and Geodon, but none on Seroquel or Abilify.)

"It appears that whichever company sponsors the trial produces the better antipsychotic drug," writes lead author Stephan Heres of the Technical University of Munich in the American Journal of Psychiatry.

And the short-term, smaller studies required of companies rarely detect any but the most glaring problems, Graham says.

"The American public is operating under the illusion that a drug is safe just because it's approved by the FDA," says Jeffrey Lieberman, chairman of psychiatry at the Columbia College of Physicians and Surgeons in New York. Studies lasting a few weeks to a few months, with a couple of thousand patients total, won't reveal all that's wrong with a drug, he says.

Laughren agrees that "it's very difficult to answer every question we'd like to answer with these studies, because obviously they're not huge. Sometimes bad things that happen are going to be discovered only when a drug is used more widely."

He says he, too, shares concern about the antipsychotics prescribed for children without proof of safety or effectiveness. Much more pediatric information on the atypicals will be available within five years, he says.

Recommended changes

Others favor fundamental changes to get the needed facts about drug safety. Lieberman thinks one solution would be for the FDA to be given a new legal authority: the right to require drug companies seeking to gain approval of a drug to contribute to a collective pool at the National Institutes of Health. The NIH could supervise larger safety and effectiveness studies of medicines after they're on the market.

A national electronic medical records database that would capture all bad side effects of drugs, and require ages and diagnoses, could do a lot to protect children from careless prescribing and reveal the effects of antipsychotics, Duke's March says.

"We know so little about what's happening to all the kids who are getting these powerful antipsychotics," he says.

March also thinks more private insurers ought to insist that aggressive children with short fuses try non-drug therapies proven to help before doctors jump in with antipsychotics. These pills can seem like an appealing "quick fix," he says, so they're popular.

For foster children with mental health problems, medication is a mainstay, says Ira Burnim, legal director at the Bazelon Center for Mental Health Law, an advocacy group for those with mental disabilities. There's proof that the most effective care is "wraparound," he says, meaning that caseworkers touch base regularly with a child's school, doctor, foster and perhaps birth families, in addition to ensuring therapy or medication as needed.

"Now they're medicating many kids instead of giving them the services they need. But there's very little time spent with psychiatrists and not much attention paid to side effects from these heavy drugs," Burnim says.

States vary in how much wraparound care they provide for foster kids, "but a typical pattern is patches here and there," Burnim says. "They rely heavily on medications like the antipsychotics. This costs more than wraparound in the long run, and it's less safe for the kids."

March considers the widespread use of antipsychotics on children without proof of safety or effectiveness "a very large experiment." Many kids are getting the short end of the stick, he says. "We're not even gathering good data on the outcome of the experiment. It's the worst of all possible worlds."

BEHAVIORAL OPTIONS ARE AVAILABLE

A number of behavioral treatment programs may help keep children off antipsychotic drugs. Among the options:

Webster-Stratton program: A five-month weekly program for parents and their severely defiant kids ages 3 to 8, it was developed by psychologist Carolyn Webster-Stratton more than 25 years ago. Children learn anger management, problem solving and social skills. Parents learn how to reinforce and teach positive behaviors to kids and how to reduce discipline problems by setting consequences for aggressive behavior. Parents also learn to manage their own anger and depression and how to work with teachers to set plans that encourage and reward positive behavior at school.

Webster-Stratton tracks graduates and says the method works for at least two-thirds of these very disturbed children. It's available at her home base, the University of Washington in Seattle, along with some areas of Delaware, Maine, California and Colorado. Costs vary. For more information, e-mail her at cws@u.washington.edu.

Multi-systemic therapy (MST): Developed by psychologist Scott Henggeler in the 1980s to treat juvenile delinquents, it's now also being used for aggressive, impulsive kids who aren't lawbreakers. It typically lasts four to six months and also involves the child's family, school and friendship groups. This intensive treatment is available in 32 states. Cost varies but averages $6,000. For information, visit www .MSTServices.com.

Parent management training: This program teaches parents how to shape and control the behavior of hostile or violent kids 2 to 14 years old. It's an hour a week for three months, and kids 8 to 14 attend their own groups. Hundred of studies over three decades show it works for most children, says Alan Kazdin, director of the Yale Child Study Center, who developed the treatment. It's also available in Oregon, Washington state and Florida. Costs vary. For more information, visit alan.kazdin@yale.edu.

Cognitive behavioral therapy: Parents and children can participate in a week-long or a more intensive several-week program at the University of Florida Medical School that helps kids with obsessive-compulsive disorder. It's cognitive behavioral therapy, a structured, goal-oriented treatment, says psychologist Eric Storch, who developed the specialized program. Research supports its effectiveness, he says. Cost averages $1,250 a week at Florida, varies by location. Other CBT programs are available in many states. For information: www.ufocd .org or www.ocfoundation.org.

Floortime: For children with autism or defiance disorders, Bethesda, Md., child psychiatrist Stanley Greenspan has created this program of intensive, structured exercises that promote communication and problem solving, he says. It's available in many states and described in Greenspan's new book, Engaging Autism. Costs vary. For information, visit www.floortime.org.

Read more!

Local management of mental health care gets push - Durham Herald-Sun

BY GREGORY PHILLIPS : The Herald-Sun

gphillips@heraldsun.com; 419-6636

May 2, 2006 : 11:20 pm ET

DURHAM -- Durham's state legislators told County Commissioners on Tuesday they'll support a funding package to keep the management of mental health care local, but how much of the proposal will remain intact will depend greatly on Gov. Mike Easley's budget proposal.

"When his numbers come in, we'll see where we are," Rep. Mickey Michaux said during a breakfast meeting with the County Commissioners to hash out local priorities in the short legislative session that begins this month. Impact fees and more district court judge positions were also high on the agenda.

A legislative oversight committee plans to propose a $155 million package, two-thirds of which would be recurring funds, to counter state cuts over the last four years of mental health reform. Legislators said they'd try to protect local interests as the budget process digests the proposal.

"We want to make sure the package doesn't hurt Durham," Rep. Paul Luebke said.

Those cuts have seen staff numbers at the Durham Center, the local mental health agency, drop from around 200 to about 55. The state Department of Health and Human Services has ruled a private provider will manage mental health care for all Medicaid patients after June 1, which would cost Durham 15 or so more staff members.

The Durham Center is suing the state to block that move, alleging breach of contract and violation of state statutes. County officials are hoping their legal action will stall the move until the Legislature can examine it.

Beth Melcher, The Durham Center's clinical director, told Rep. Michaux and his colleagues Paul Luebke, Winkie Wilkins and Sen. Bob Atwater that DHHS hasn't adhered to the Legislature's original plan for management of care to remain local.

"We're really struggling right now," she said.

The commissioners also back a push for a statewide law to give all counties the same revenue options. Some counties currently charge school impact fees to developers, have real estate transfer taxes, occupancy taxes and taxes on restaurant food.

Legislators said builders and realtors have been vocal in their opposition to impact fees in particular, adding that the N.C. Association of County Commissioners needs to make its arguments more loudly. County Commissioner Lewis Cheek suggested removing impact fees from the package if it could be fatal to its passage, but State Rep. Mickey Michaux shot that idea down, insisting that if developers are let off the hook, low-income families will bear the brunt of any tax increases.

"There's no way I'm going to vote for something like that," Michaux said. "It's the whole package or nothing."

Some counties have placed moratoriums on any development while they decide how to pay for increased educational needs. Durham County has a policy that would trigger discussion of a moratorium once the school system reaches 120 percent capacity, which officials say is about two years away.

"You've got to have the stomach to do that," Heron said. "We need to call a halt."

Durham is also hoping for relief from court overcrowding woes with some new court personnel, district court judges in particular. The county has already funded additional clerks, but only the state can create judge positions.

Durham's Trial Court Administrator Kathy Shuart said there'll be two alternative proposals for additional court staff before the General Assembly this year, one for $52 million and another for $40 million. Both include 10 new District Court judges, but how those positions will be distributed remains uncertain, she said.

"I don't know where we fall," Shuart said. "I don't know if we're in that 10 or not."

Read more!

Drug therapy caused some scary side effects - USA Today

By Marilyn Elias, USA TODAY
Erin Evans is one parent who wishes she had never heard of anti-psychotics.

As a military couple, she and her husband, Joe, moved around frequently. Their son, Rex, 13, was babied a lot. His mother now feels that he was not ready for school when he reached kindergarten age.

He had trouble focusing in the classroom and was diagnosed with attention-deficit disorder at age 6. He started on an ADHD medicine and began hallucinating about worms and bugs in his food.

Soon he was also on Prozac for anxiety, but the nervousness and paranoia persisted.

At age 8, Rex was given Risperdal by a Tennessee child psychiatrist in private practice who consulted for the military. He said the boy probably had obsessive-compulsive disorder, too, Evans says.

"(He) didn't tell us it had never been approved for children or warn us about any side effects," she says.

For the first few weeks, Risperdal helped a little; Rex became less anxious and hyper. "But then it wore right off, so the doctor kept increasing the dose," she says.

After one month on Risperdal, Rex started having tremors; within a few months, his hands shook so severely that he could barely write at school, "and I'd have to guide the cup of milk to his mouth in the morning," Evans says.

But the psychiatrist said the tremors weren't so bad, Evans says, and urged the family to continue the drug.

The psychiatrist didn't pressure them, she says, "but I'm from the generation where, when a doctor says something, you believe it."

Then, about a year after Rex started Risperdal, the Evanses found out that he might have schizoaffective disorder, a psychotic illness that children rarely get. A doctor's report said Rex probably would need to be institutionalized.

That year, when Rex was 9, the family moved to Colorado Springs. The parents started to learn more about Risperdal and, for the first time, they realized that Rex's symptoms could be side effects, so they started to wean him off the drug. In a few weeks they noticed his jaw was scrunching up and his facial expressions were becoming distorted. By then, Evans says, she had read up on tardive dyskinesia (TD), a neurological disorder that can be caused by anti-psychotics.

Rex became less anxious, but the TD worsened. "He had a horrible, ugly look on his face all the time," Evans says. Friends no longer came to play. Rex went from winning an award for best reader in the third grade to claiming he couldn't remember how to spell his own name in fourth grade.

Then in fifth grade, Rex slowly began to improve. A medical exam showed spasms in his thorax, perhaps linked to the upper body spasms, restricting the flow of oxygen to his brain.

He began oxygen therapy, and he quickly became more responsive to others and did better at school, Evans says. He also had behavioral therapies. At the end of elementary school, Rex had episodes only a few times a week.

But junior high has brought more stress and bullying, and the episodes have become more frequent. "His movement-disorder specialist said he expected Rex to have this for the rest of his life," Evans says.

Now she is bitter. "I trusted the doctors, I trusted the FDA ... and I feel betrayed by both," she says.

The Food and Drug Administration "does not regulate the practice of medicine," says Thomas Laughren, head of the division of psychiatry products. He adds that he's concerned about the use of such drugs in kids without systematic safety data.

Nobody knows how many children on atypicals get TD, says Ramy Mahmoud of Janssen LP, maker of Risperdal, but it's rare in adults. "Our drug isn't indicated for children," he says. "It's a strong drug. It has risks and benefits. Read more!

After nightmarish years, new dawn for 16-year-old - USA Today

By Marilyn Elias, USA TODAY
For Camille Houston, atypical anti-psychotic drugs have been a lifeline.

Even at age 4, Camille marched to an unusual drummer. She would shift abruptly from giddy silliness to weeping for no apparent reason, says her mother, Sheri Houston.

Camille was hyperactive. Preschool teachers complained about her argumentative behavior and said she refused to stop doing things when told. On the plus side, "she was a very, very bright child," her mother says.

The girl was diagnosed with attention deficit hyperactivity disorder (ADHD) and depression at age 4, so doctors prescribed stimulants and an antidepressant. But Camille continued to struggle with mood swings and behavior problems.

When Camille was 6, a child psychiatrist diagnosed her with bipolar disorder. Doctors prescribed Depakote, a drug used in treating bipolar illness, and the antidepressant Prozac. Then she started to do terrifying, manic things. "She'd climb out on the roof, and (she) began to have hallucinations," Houston says. The girl was hospitalized at age 7 because she had become so manic that her parents feared for her safety.

Camille is the youngest of three children in a middle-income family in Layton, Utah. "We're happily married, she was never abused, and we're religious," Houston says. "We just couldn't figure out how this could be happening."

In the hospital, doctors gave Camille an atypical anti-psychotic drug, Risperdal. Her hallucinations went away. But she gained weight so quickly on the drug that she needed new clothes during the three-week stay in the hospital. Doctors took her off the Risperdal and put her on Zyprexa, another atypical anti-psychotic.

Still, Camille continued to fly into rages and to behave aggressively. After her brilliance in early childhood, "Camille's IQ was dropping," Houston says, because she couldn't function in school. At 11, she spun into a manic frenzy and again had frightening hallucinations. She had to be hospitalized.

Camille received a new diagnosis this time: schizoaffective disorder, a psychotic illness that rarely strikes children. Doctors increased Camille's Zyprexa dose, and "it worked wonderfully," Houston says. The hallucinations and manic behavior stopped.

Doctors added Abilify, another anti-psychotic, when Camille was 13, enabling them to curb the dose of Zyprexa, which is linked to major weight gain in children. "But we can't seem to get her off the Zyprexa without her becoming paranoid again," Houston says.

Now Camille, 16, takes an ADHD drug plus Depakote, the antidepressant Wellbutrin and the two anti-psychotics.

For three years she has been stable, though her IQ dropped 40 points from early childhood, her mother says.

"But I don't know that I would have done things differently," Houston says. "I don't know that she would have survived without the medicine."

Camille is making progress in her special-education classes, a private tutor is helping her with schoolwork and she is flourishing as an artist.

She does bold, abstract paintings in lime, hot pink and vivid blues. Classmates have asked her to do pictures and have offered to pay for them.

"At one time I felt like nobody cared about me," Camille says. "But I made two friends in junior high, and friends have stuck by me."

Camille's goal is to show her work in an art gallery or to be a fashion designer.

The medicine "has helped me in a lot of ways," she says. "I'm more happy. ... Sometimes I wake up and don't even remember that I have a disease."

Her feelings about people have changed, too: "I used to care a lot about what people think of me. They can call you fat or dumb or retarded or disabled. Now I just don't care.

"I know who I am."

HISTORY OF ANTI-PSYCHOTICS

The six atypical anti-psychotics Clozaril, Risperdal, Zyprexa, Seroquel, Abilify and Geodon were touted as wonder drugs when they gained FDA approval for treating adult schizophrenia and bipolar disorder from 1989 to 2002.

The drugs were seen as a major advance over first-generation anti-psychotics, such as Haldol, though they cost about 10 times as much (the drugs had about $10.5 billion in U.S. sales in 2005, according to IMS Health, a firm that tracks prescription sales). Studies in adults suggested they were less likely to cause tremors, painful muscle contractions and tardive dyskinesia, a potentially disabling neurological disorder.

But other serious problems surfaced. In 2003, the FDA ordered warning labels on all atypicals, saying there was an increased risk of high blood sugar and diabetes. In some cases, the blood sugar surges were associated with life-threatening medical conditions or death, the agency warned.

FDA added a "black box," the strongest safety warning, to the labels in 2005 because the drugs increased deaths in elderly patients with dementia. Read more!

New Antipsychotic Drugs Carry Risks for Children - USA Today

By Marilyn Elias, USA TODAY
Nancy Thomas remembers the bad old days when she had to wear long-sleeve clothes to church to cover bite marks all over her arms from her daughter Alexa's rages.

At age 8, Alexa was diagnosed with bipolar disorder. She was a violent child with sharp mood swings and meltdowns that drove her to tear up the house. Antidepressants and drugs for attention-deficit disorder had only made Alexa more aggressive, Thomas says.

A mix of medicines including so-called atypical antipsychotics — drugs approved only for adults — finally stabilized Alexa's moods. Now at 15, she is able to live a more normal life — as long as she takes the medication.

Even so, the Russellville, Mo., teen is paying a price: On one of the atypical antipsychotics, Alexa gained about 100 pounds in a year, putting her at risk for a host of health problems, including diabetes. It has taken her three years to lose a third of that extra weight; she is still struggling with the rest.

Atypicals are a new generation of antipsychotic drugs approved by the Food and Drug Administration for adult schizophrenia and bipolar disorder (manic depression). None of the six drugs — Clozaril, Risperdal, Zyprexa, Seroquel, Abilify and Geodon — is approved for kids, but doctors can prescribe them as "off-label" medications.

Psychiatrists say the drugs can be helpful for children with serious mental illnesses and have been known to save young lives. But diagnosis often is difficult, making appropriate prescribing tricky. And many experts, including behavioral pediatrician Lawrence Diller, author of Should I Medicate My Child?, say there is growing overuse of these powerful antipsychotics.

Schizophrenia is rare in children under 18: It strikes about 1 in 40,000, as opposed to 1 in 100 adults, according to the National Institute of Mental Health. Nobody knows exactly how many kids have bipolar disorder; psychiatrists don't even agree on criteria to diagnose the disease in childhood.

Research on how the drugs affect children is sparse, and experts increasingly are concerned that the drugs are being prescribed too often for children with behavior problems, such as attention-deficit disorder and aggression.

John March, chief of child and adolescent psychiatry at Duke University School of Medicine, prescribes the drugs to kids in some cases of serious illness when he thinks the benefits outweigh the risks. But he says prescribing them for behavior problems alone may be a mistake. "We have no evidence about the safety of these agents or their effectiveness in controlling aggression," he says. "Why are we doing this?"

At the same time, reports of deaths and dangerous side effects linked to the drugs are mounting. A USA TODAY study of FDA data collected from 2000 to 2004 shows at least 45 deaths of children in which an atypical antipsychotic was listed in the FDA database as the "primary suspect." There also were 1,328 reports of bad side effects, some of them life-threatening.

Drug companies are required to file any reports they have to the FDA, but consumers and doctors report such events on a voluntary basis. Studies suggest the FDA's Adverse Events Reporting System database captures only 1% to 10% of drug-induced side effects and deaths, "maybe even less than 1%," says clinical pharmacologist Alastair J.J. Wood, an associate dean at Vanderbilt Medical School in Nashville. So the real number of cases is almost certainly much higher.

"We're conducting a very large experiment on our children," March says.

Side effects that linger

Some parents tell stories of serious effects that linger long after their kids stop taking the drugs.

Rex Evans' parents are bitter about what happened to their son. They believe the 13-year-old Colorado Springs boy was harmed permanently by an atypical antipsychotic he took several years ago. Rex now has a serious case of tardive dyskinesia (TD), suffering daily episodes of involuntary jerking movements and facial grimacing, says Erin Evans, his mother.

Antipsychotics are known to cause TD, but it's thought to be a rare effect for the newer atypicals.

Despite such reports, outpatient prescriptions for kids ages 2 to 18 leaped fivefold — from just under half a million to about 2.5 million — from 1995 to 2002, according to a new analysis of a federal survey by Vanderbilt Medical School researchers. This doesn't include prescriptions at psychiatric hospitals or residential treatment centers.

And even though the drugs are approved only for adults, the rate of children treated with atypicals "is growing dramatically faster than the rate for adults," says Robert Epstein, chief medical officer for Medco Health Solutions, pharmacy benefit managers.

Medco did an analysis of outpatient prescriptions for USA TODAY and found that, in a sampling of about 2.5 million of Medco's 55 million members, the rate of children 19 and under with at least one atypical prescription jumped 80% from 2001 to 2005 — from 3.6 per 1,000 to 6.5 per 1,000. And that only represents kids who are privately insured, not those in foster care or others on Medicaid.

"We know these are very strong medicines," Epstein says. "You'd want to be absolutely sure the child needs it."

The more serious risks

Because of the nature of the FDA data, they don't prove that these drugs caused the deaths or the side effects. Many side effects for which an atypical is listed as the "primary suspect" occurred in the normal course of using the drug, but the database also includes cases involving drug abuse, overdoses, suicides and homicides. Entries are sometimes cryptic, and the FDA enters verbatim — misspellings and all — what's reported on the form.

Still, the data "can be a useful signaling device" suggesting problems with a drug that warrant conclusive studies, says Jerome Avorn, a pharmacology specialist at Harvard Medical School and author of the book Powerful Medicines.

One-fourth of the cases in the database studied by USA TODAY did not list the patient's age. But in cases that listed an age under 18:

• A condition called dystonia was most often cited as an "adverse event" suffered by someone taking one of the drugs, with 103 reports. Dystonia produces involuntary, often painful muscle contractions.

• Tremors, weight gain and sedation often were cited, along with neurological effects such as TD. Symptoms of TD can vary from slight twitching to full-blown jerking of the body.

• A condition called neuroleptic malignant syndrome, with 41 pediatric cases over the five years, was the most troubling effect listed, says child psychiatrist Joseph Penn of Bradley Hospital and Brown University School of Medicine. It is life-threatening and can kill within 24 hours of diagnosis. It's been linked to drugs that act on the brain's dopamine receptors, which would include the atypicals, Penn says.

The FDA office of drug safety checks the database, "and we haven't been alerted to any particular or unusual concern," says Thomas Laughren, director of the agency's division of psychiatry products. "The effects (in kids) are similar to what we're seeing in adults. We have not systematically looked at the data for children" because the drugs aren't approved for them, he says.

The 45 deaths

Among the 45 pediatric deaths in which atypicals were the primary suspect, at least six were related to diabetes — atypicals carry warnings that the drugs may increase the risk of high blood sugar and diabetes. Other causes of death ranged from heart and pulmonary problems to suicide, choking and liver failure.

An 8-year-old boy had cardiac arrest. A 15-year-old boy died of an overdose. A 13-year-old girl experienced diabetic ketoacidosis, a deficiency of insulin.

More than half of the kids who died were on at least one other psychiatric drug besides the atypical antipsychotic, and many were taking drugs for other ailments.

The youngest, a 4-year-old boy whose symptoms suggested diabetes complications, was taking 10 other drugs.

The reports don't tell the child's general state of health or other factors that could predispose him to trouble. Also, neither Clozaril, which is rarely used, nor Abilify, the newest atypical, was listed as a primary suspect in any deaths.

All the drugmakers emphasize that their products are not approved for children, and they say the drugs are safe and effective for adults with schizophrenia or bipolar disorder who are monitored for side effects. Still, "there are worrisome questions here," says Avorn. Large, longer-term database studies could provide answers, he says.

There's some evidence that the drugs can help young schizophrenics and may be helpful in treating bipolar disorder in children, says Robert Findling, a child psychiatrist at University Hospitals of Cleveland.

But the data from controlled studies "are too few to guide treatment decisions" on bipolar disorder, concluded Findling's research team in a summary of pediatric studies published in the Journal of Clinical Psychiatry.

These antipsychotics are the most widely used class of drugs to treat disruptive kids who attack others and defy adults, Findling says. Again, there's a paucity of proof that the drugs help.

There are only a handful of carefully controlled, sizable studies testing the drugs for any pediatric disorder, and they're mostly short-term, says Benedetto Vitiello, chief of child and adolescent psychiatry at the national mental health institute. The most serious, widespread problem found to be caused by the medicines is weight gain, he says. The effect varies by drug, but kids typically put on twice the pounds they should in their first six months on atypicals.

In the first three months on the drugs, children add about 2 to 3 inches to their waistlines, says research psychiatrist Christoph Correll of Zucker Hillside Hospital in Glen Oaks, N.Y. A lot of this is abdominal fat, which increases the risk of diabetes and heart disease. Obese children are twice as likely as normal-weight children to have diabetes, according to a new University of Michigan study.

"Some patients gain weight on Zyprexa and others do not," says Calvin Sumner, a medical adviser to Eli Lilly Research Laboratories. Lilly makes the drug, which has been associated with weight gains in adult studies. Sumner stresses that Zyprexa isn't approved for kids.

There's no proof atypicals cause diabetes, says Ramy Mahmoud of Janssen LP, maker of Risperdal. He says the FDA added a label warning of increased diabetes risk "to make people aware of the possibility."

One key question about atypicals is whether they will have long-term, unknown effects on the brains of children.

The brain system that the drugs work on develops through childhood and adolescence, says Cynthia Kuhn, a Duke University pharmacologist. "We really don't know the impact of chronically perturbing that system in childhood."

Why atypicals get prescribed

Given all the potential problems, why would doctors prescribe these drugs to children to begin with?

Nobody disputes that the lives of schizophrenic or severely manic children may be saved by antipsychotics. "I use them myself for patients," says March, the Duke psychiatrist. "I have a 9-year-old who threatened to jump out of a second-story window if her mom didn't give her the car keys to drive down to the 7-Eleven to get a Coke. If I took her off antipsychotics, she'd disintegrate."

But several factors can lead to misprescribing of antipsychotics.

It can be difficult to tell one behavioral disorder or illness from another in kids. For example, the aggression and irritability of bipolar disorder can mimic attention-deficit hyperactivity disorder or depression, the mental health institute says. Also, the environment can be a key cause of symptoms that may be mistakenly diagnosed as mental disorders, says Diller, the behavioral pediatrician. Some events in a child's life can trigger acting-out or other symptoms. Adults can explain what happened to them; children, especially the youngest, may be more reticent.

Doctors often face time pressures that prevent them from finding out what's going on in kids' lives, knowledge that might suggest alternative treatments, Penn says. For example, abuse of drugs such as methamphetamine, OxyContin and cocaine is fairly common among teens, he says. Kids begin acting strangely, hearing voices, becoming paranoid. The symptoms can mimic psychosis or behavioral disorders, and doctors can end up giving these children unneeded antipsychotic drugs, he says.

Insurance coverage rules may encourage the soaring use of antipsychotics for children, as well. "With some companies, the only thing they reimburse for is prescribing. There's little or no therapy," says Ronald Brown, editor of the Journal of Pediatric Psychology and a dean at Temple University.

Also, kids with serious mental health problems often have at least one hospitalization, but policies cover only a week or two.

It can take a couple of weeks just to get medical records and family histories, Penn says, but insurers often extend time if there's a new medicine started, which encourages drug dabbling for children who are not ready to go home.

In the end, some parents say their children have such severe behavior disorders or mental illness that the benefits outweigh risks.

Parents of children such as Alexa Thomas, who have bipolar disorder, say the atypicals often help. "We were very fortunate," says Alexa's mother, special-education director for the Russellville, Mo., school district. "The medication worked for my daughter. It doesn't work for everybody."

Misdiagnosis common

The Vanderbilt study of antipsychotic prescribing finds at least 13% of pediatric prescriptions are for bipolar disorder. But there is some concern about over-diagnosis and "jumping to this (bipolar) label too quickly," says psychiatrist Peter Jensen, head of the Center for the Advancement of Children's Mental Health at Columbia University.

Sandra Spencer's son, Stephen, was diagnosed as bipolar at age 6 and put on atypicals. He developed liver abnormalities and obesity, his mother says. "He's been on a smorgasbord of meds," she says. None worked well for very long.

By the time he was in sixth grade, doctors said they weren't sure Stephen was bipolar after all. Now 15, he is on low doses of an antidepressant and mood stabilizer. He's being weaned off both, says Spencer, executive director of the Federation of Families for Children's Mental Health, a support group.

She worries about how the drugs have affected Stephen, who is black: As little psychiatric drug research as there is on children, there's least of all on minority kids. Some drugs are known to affect black adults differently from whites. "He probably had ADHD all along," Spencer says. "Psychiatry is so not an exact science."

Child psychiatrist Barbara Geller, a bipolar expert at Washington University in St. Louis, agrees: "The science is nowhere near where it is in other branches of medicine."

So parents struggle to make the right decisions for very troubled kids. "There's a lot of fear among parents," Spencer says. "You don't know what the effects of these drugs are going to be. You're at the mercy of your doctor.

"I have had to make a lot of decisions, and they were fear-driven. You don't have enough information to make an intelligent decision."

To study the growing use of atypical anti-psychotic medications among children, as well as the symptoms associated with their use, USA TODAY analyzed data from several public and private sources.

For information on illnesses and deaths potentially related to atypicals, USA TODAY studied the Food and Drug Administration's Adverse Event Reporting System database.

The database collects mandatory reports from manufacturers and voluntary reports from health professionals and consumers describing adverse drug reactions.

It uses the information to look for potential safety problems worthy of investigation. It includes information on the patient's age and gender, medications, symptoms and outcome. The data cannot be used to prove that a particular drug caused an adverse event, but the agency does label which drugs were considered the "primary" or "secondary" suspects.

USA TODAY's analysis focused on 1,373 cases received by the FDA from 2000 to 2004 in which one of the six atypical anti-psychotic drugs was coded as the primary suspect. These cases were used to count symptoms, diagnoses and deaths.

To learn about patterns in atypical use, USA TODAY asked Medco Health Solutions, a prescription-drug benefit manufacturer, to query its member database.

The company provided sample data on rates for atypical and non-atypical anti-psychotic prescriptions and other topics.

Finally, USA TODAY obtained data on pediatric atypical prescriptions from California and Illinois under Freedom of Information requests.
Read more!

Crowd calls for police training - Greenville Daily Reflector

Rickert, The Daily Reflector
Tuesday, May 02, 2006

Curriculum for a program that would train law enforcement officers to better handle persons with mental illness was discussed in a meeting of the National Association on Mental Illness Monday night.

The meeting was prompted by the Jan. 26 shooting of Kerry Turner on Greenville Boulevard. The 34-year-old suffered from bipolar disorder and was shot multiple times by police during an episode.

In response to actions taken by police, NAMI of Pitt County, Pitt Community College and local law enforcement partnering in development of the training, which would call for officers to complete 40 hours of curriculum focusing on description of the disorders, medicines and suicide.

"I have recognized for sometime we need to be able to identify and respond to things more differently," Pitt County Sheriff Mac Manning said. "The program will offer information to help us better detect what the clues are ... we are very excited to be part of it."

The training will teach law enforcement to respond in a non-threatening manner by exploring not only how to speak with persons of mental illness during an episode but control body language so as not to offend.

None could comment Monday on when the training would be implemented.

Turner's family, who are members of NAMI Pitt County, were on hand Monday night as more than 100 people celebrated their son's life and the family's love for him.

Community members and officials wrote messages on blue balloons and paused for a moment of silence as they were released into the night sky as a memorial to Turner.

"We devoted this program to educating our community about mental illness," said Millie Hagler, one of the individuals who helped found NAMI Pitt County four years ago. "With knowledge, help and understanding a community can make a difference."

Hagler was one of several who knows first hand about what it means to have a family member suffering from a mental illness.

She and others shared portions of their stories Monday night. In honor of mental health awareness month, recognized in May, those attending were reminded to seek help from the organization created by families touched by mental illness.

"Believe me you are not the only one," said Larry Hagler, treasurer of NAMI North Carolina and Millie Hagler's husband. "NAMI has been a godsend to our family and many others."

Erin Rickert can be contacted at erickert@coxnc.com and at 252-329-9566.




Read more!

Officers cleared in fatal shooting of man with bipolar - Greenville Daily Reflector

By Erin Rickert

Tuesday, May 02, 2006

The three Greenville Police officers involved in the January shooting-death of Kerry Turner on Greenville Boulevard returned to regular duty Monday after a two-month internal investigation determined the men violated none of the department's policies or procedures.

The investigation looked into whether everyone involved in the Jan. 26 shooting of the 34-year-old Turner acted within department guidelines, Greenville Police Maj. Kevin Smeltzer said at a news conference Monday.

"The internal affairs investigation determined that there were no violations of the Greenville Police Department policies and procedures," Smeltzer said of the investigation, completed late last week. "Specifically, the internal affairs investigation determined the actions of the officers involved were consistent with the policies and procedures relating to the use of deadly force."

Officers shot Turner multiple times in the head and chest after he crashed his car into several vehicles during a high-speed car chase along Greenville Boulevard.

Shortly before the chase, Turner allegedly had pointed a weapon at officers outside his home, although police later reported that Turner had no gun with him at the time he was shot.

Smeltzer said the vehicle Turner was driving "...was the deadly weapon used by Mr. Kerry Turner that resulted in the use of deadly force by the officers."

Kerry Turner's parents, Barbara and Karl Turner, declined to comment on the investigations findings Monday night.

Sgt. D.C. Johnson, officer K.L. Knox and officer C.E. Adkins returned to regular duty Monday after being placed on desk duty April 18 following a decision by Pitt County District Attorney Clark Everett not to file criminal charges against the men. Everett's decision was made after reviewing an investigation completed in late March by the State Bureau of Investigation.

In a letter to the police department dated April 15, Everett wrote, "... I have determined that although the death of Kerry Turner was the result of gunshot wounds inflicted by members of the Greenville Police Department, based on the circumstances existing at the time of the shooting, the shooting was legally justified and therefore not the result of any criminal conduct on the part of the officers involved."

Prior to April 18, the officers were on administrative leave with pay.

At 2 a.m. on the morning of Jan. 26, officers were called to the Turner home after his mother expressed concern over a dispute her son, who suffered from bipolar disorder, was having with his girlfriend.

Smeltzer said Barbara Turner told police her son was verbally abusive and had been drinking and taking a lot of medication. Officers transported Turner to the hospital after convincing him to admit himself to the hospital, he said.

A few hours later, Kerry Turner left the hospital grounds without being seen by a mental health professional. With the help of police, the Turner family obtained an involuntary commitment order for Turner from a magistrate.

About 6 a.m., the Turners' contacted police, claiming their son was outside the home yelling and throwing things, Smeltzer said.

When officers attempted to stop Turner, he yelled obscenities and ran into the Crestwood Drive home and locked the door, Smeltzer said.

A short time later, after more officers arrived, Turner came out of the home and aimed a long gun at law enforcement, Smeltzer said.

Kerry Turner's parents did have contact with their son at least once when he called their cell phone. In an earlier interview with The Daily Reflector, his parents said they disagreed with a police decision to take their phone to prevent further calls.

The Turners' said their son hated police, and they believed he could have been calmed down if they had been able to talk with him using the phone.

Smeltzer said telephone conversations between the on-scene commander and Turner revealed threats to kill his parents.

"Mr. Kerry Turner said he was not coming out of the house. He stated he was not going to jail, he further stated that he wanted to know why his mother had not come to the hospital to pick him up and that he had to walk all the way home," a news release put out by the department Monday stated. "He also said he was going to kill the pigs if they tried to come into the house and repeatedly said he hated his parents and was going to kill them."

Smeltzer said the decision to take the phone was a judgment call made with the information the officers had at the time.

Shortly afterward, Smeltzer said, Kerry Turner attempted to run over several members of the department's Emergency Response Team.

Officer Adkins shot at the tires in an attempt to disable the vehicle, hitting one tire, he said.

A chase ensued during which Turner's vehicle struck several vehicles then ended at the intersection of 14th Street and Greenville Boulevard as he attempted to make a U-turn.

An officer began to approach Kerry Turner's vehicle, and Turner aimed and accelerated his vehicle toward him, Smeltzer said.

Kerry Turner struck the vehicle of a nearby motorist, and attempted to run over an officer as he exited his vehicle, he said. Shots were fired in response to these actions, Smeltzer said.

"Officers did what they needed to do to stop that threat," Smeltzer said. "The policies and procedures of the Greenville Police Department provide that deadly force may be used when an officer reasonably believes that the action is in the defense of human life, including the officer's own, or in defense of any person ... in immediate, imminent danger of serious bodily injury."

He said once Kerry Turner began to endanger lives, the fact he suffered from a mental illness was not the issue.

An 18-inch bayonet was recovered from the floorboard of Turner's vehicle and a rifle police believe Turner pointed at them earlier was recovered from the home, Smeltzer said.

The Turners disputed reports that their son was armed with a gun in earlier interviews, stating the long weapon police saw was actually a long wooden stick.

"Can we forget this? No," Smeltzer said. "... Could it have been done better? Yes. But everything done at the scene was a judgment call."

Erin Rickert can be contacted at erickert@coxnc.com and at 252-329-9566.

Read more!

Mental Health Cuts Vex Edgecombe - Rocky Mountain Telegram

By John Ramsey
Rocky Mount Telegram
Tuesday, May 02, 2006

TARBORO – Mental health reform has Edgecombe County commissioners banging their heads against a wall.

The N.C. Division of Mental Health proposed a massive funding cut in the Edgecombe-Nash Mental Health, Developmental Disabilities and Substance Abuse Department.

The proposed cut comes despite the department's rejection of the long-planned merger with Wilson-Greene Area Mental Health that would have caused the reduced funding.

"It makes no sense what they're trying to do," said Charlie Harrell, chairman of the Edgecombe County Board of Commissioners. "They need to be challenged."

The merger had been planned for more than two years to comply with a bill requiring mental health centers serve either five counties or a minimum population of 200,000. Edgecombe-Nash Mental Health serves a population of 145,637.

The board voted to have County Attorney Mahlon DeLoatch investigate any legal action the county may be able to take.

Edgecombe-Nash Mental Health receives more than $2 per person per month in the current fiscal year. The proposed 2006-07 funding level drops to $1.28 per person per month.

Although the commissioners rejected the merger because of the financial disincentive, the Division of Mental Health decided to consider the Edgecombe-Nash department merged with Wilson-Greene anyway, according to an e-mail from Area Mental Health Director Karen Salacki.

"I just think it's a tragedy what they're trying to do," Harrell said. "There's no way we can operate on that funding level."

Salacki's e-mail said the Division of Mental Health acknowledged that the funding level was insufficient; officials from the division suggested dipping into the fund balance for the remaining costs of operation.

The board questioned how the Division of Mental Health could choose to consider the departments merged when the commissioners clearly rejected the merger.

And another source of controversy was the proposed funding for similarly sized county mental health departments. Pitt's proposed rate is $1.81 per person; Johnston's is $1.79.

"There's no equity in the funding," County Manager Lorenzo Carmon said. "There's no rhyme nor reason to how they arrived at these dollar figures." Read more!

Mixed Result in Treating Schizophrenia Pre-Diagnosis - New York Times

May 01. 2006 12:00AM


By BENEDICT CAREY
New York Times

In recent years, psychiatric researchers have been experimenting with a bold and controversial treatment strategy: they are prescribing drugs to young people at risk for schizophrenia who have not yet developed the full-blown disorder.

The hope is that while exposing some to drugs unnecessarily, preemptive treatment may help others ward off or even prevent psychosis, sparing them the agonizing flights of paranoia and confusion that torment the three million American who suffer schizophrenia.

Yet the findings from the first long-term trial of early drug treatment, appearing today in The American Journal of Psychiatry, suggest that this preventive approach is more difficult to put into effect and more treacherous than scientists had hoped.

Daily doses of the antipsychotic drug Zyprexa, from Eli Lilly, blunted symptoms in many patients and lowered their risk of experiencing a psychotic episode in the first year of treatment, the study found. But the drug also caused significant weight gain, and so many participants dropped out of the study that investigators could not draw firm conclusions about drug benefits, if any.

The long-awaited study, which was financed by Eli Lilly and the National Institute of Mental Health, raised more questions than it answered, experts said.

"The positive result was only marginally significant, and the negative result was clear," said Dr. Thomas McGlashan, a professor of psychiatry at Yale and the study's lead author. "This might discourage people, and legitimately so, from using this drug for prevention because of the weight gain, but hopefully it won't discourage study" of other drugs.

Critics have charged that treating people for a disorder that has not yet been diagnosed is not only premature but stigmatizing, especially for adolescents. The new study was intended in part to clarify the trade-off between the risks and the potential benefits of preemptive treatment.

"Unfortunately, the study's numbers are so small that it cannot be decisive on the key issue, which is whether it's prudent to treat people early when there are uncertainties about the diagnosis and given the effect of stigma and adverse effects," said Dr. William Carpenter, director of the Psychiatric Research Center at the University of Maryland, who was not involved in the study.

The study was plagued by recruitment problems from the beginning, in 1997. Mild, psychosis-like symptoms are rare in adolescents, and families often wait until symptoms are pronounced before seeking treatment, Dr. McGlashan said. Good candidates trickled in slowly; and the researchers added several recruitment sites along the way to increase the numbers of people in the study.

They eventually enrolled 60 people, most of them adolescents, who scored highly on a scale that assesses risk for psychosis. The scale rates severity of more than a dozen symptoms, including suspiciousness, grandiosity and bizarre thoughts. From 20 to 45 percent of people who score high on the scale go on to develop full-blown psychosis, in which these symptoms become extreme, researchers have found.

The researchers split the participants into two groups, one that received drug treatment and one that took placebo pills. In the first year of a two-year trial, 5 of the 31 of those on medication developed full-blown psychosis, compared with 11 of 29 of those who were taking dummy pills.

But by then, more than two-thirds of the young people in both groups had dropped out, making it difficult to interpret differences between them. Some left the study without explaining why; others moved; and 10 of those on medication quit the study because they felt the drug was not working, could not make the appointments or did not like the side effects, among other reasons.

Those on medication gained an average of 20 pounds during the study. Weight gain is a common side effect of Zyprexa.

"It's a pessimistic trade-off, the weight gain and other side effects for what looks like a modest delay in the acute psychotic episode," said Dr. Steven Hyman, a professor of neurobiology at Harvard. "It's clear we need more efficacious drugs with milder side effects." Read more!

ACLU alleges inadequate care for women prisoners at Taycheedah - Milwaukee (AP)

Associated Press

MILWAUKEE - The medical, mental and dental care at Taycheedah Correctional Institution is grossly deficient and has caused its female prisoners great physical and mental suffering, according to a class-action lawsuit filed Monday.

The lawsuit was filed in U.S. District Court on behalf of all inmates at Taycheedah Correctional Institution near Fond du Lac, the largest women's prison in the state. It houses 700 maximum and medium security prisoners.

The American Civil Liberties Union filed the 49-page lawsuit, which names top state officials as defendants, including Gov. Jim Doyle, Department of Corrections Secretary Matthew J. Frank and various medical professionals who work in the prison system.

The insufficient medical care constitutes "cruel and unusual punishment in violation of the Eighth and Fourteenth Amendments of the United States Constitution," according to the lawsuit.

It also alleges the prison failed to provide mental health services comparable to those for male prisoners in Wisconsin.

The suit is filed on behalf of four current Taycheedah inmates: Kristine Flynn, 48, Lenda Flournoy, 54, Vernessia Parker, 37, Debbie Ann Ramos, 43.

According to the lawsuit:

_Flynn suffers from bipolar mood disorder and social anxiety syndrome. She had been prescribed eight psychotropic medications over a year and then was abruptly taken off, and six days later she attempted suicide. Taken to a hospital, she took someone hostage and assaulted a security guard and she was severely beaten, resulting in four years being added to her sentence. She never received individual or group therapy, the suit said. A psychiatrist testified at her trial that the medication interruption triggered her aggressive behavior.

Also, doctors failed to remove a lump in her right thigh for nearly a year until it grew to the size of a golf ball, resulting in cut nerves and tendons when it was removed, leaving her with little feeling in the leg.

_Flournoy suffers from scoliosis, chronic rhinitis and degenerative joint disease. She had surgery to remove a metal wire from her toe, but she was not given pain medication for eight days, the suit says, and no one checked the toe for alignment so she had to have another surgery when it healed improperly. She now needs crutches to walk and cannot work. She had also been taking medications for anxiety, depression and schizophrenia and had to wait a month to see a crisis intervention worker after requesting one.

Before being incarcerated, doctors found abnormal breast tissue and told her to be vigilant in getting it checked, but she was granted only two screenings over eight years in prison, the suit says.

_Parker suffers from bipolar mood disorder and major depression, among other things, but has only had a few sessions with psychologists, and only when she was in crisis, the suit said. She was diagnosed with systemic lupus erythematosus in early 1999 but didn't see a doctor until December 2000.

_Ramos, who has endometriosis, hadn't seen a gynecologist for her first seven years at the prison, even though her vaginal bleeding worsened every year. She was forced to have a hysterectomy in 2000 and has never seen a gynecologist again, the suit said. She was diagnosed with asthma in 2002 but never received medication or an inhaler for two years, the suit said.

John Dipko, a spokesman for the state Department of Corrections, said he couldn't comment on the allegations but said the department plans to make improvements in prison health care over the next six years.

He said officials are working to get the facilities accredited by the National Commission on Correctional Health Care. Taycheedah will become accredited in the next two years, he said.

"That demonstrates our commitment to improving the quality of health care throughout our system," he said.

He said he couldn't comment on the specific improvements because he wasn't at his office.

Seeking accreditation had been considered by previous secretaries but Frank is the "first to make it a priority," Dipko said.

Doyle's spokesman Dan Leistikow couldn't comment on the complaint because he had not seen it but said the governor take the issue seriously.

The suit quotes a 2002 study done by the national commission of 14 of the 15 Wisconsin prisons operating at the time.

It found severe understaffing throughout the prison system, reliance on untrained corrections officers to distribute most controlled medications, poor mental health services, reluctance to refer prisoners for offsite consultation and a backlog of requests for routine and emergency dental care, among other things.

Taycheedah's supervising physician, Steven Meress, who is named in the suit, is only at the facility one day a week for part of the day. There is only one part-time dentist, and mental health staff levels fall short of recommendations of the American Psychiatric Association and the American Association of Correctional Psychologists, the suit said.

Women at the prison don't have adequate specialized women's health care services, like pap smears, mammograms and appropriate prenatal, obstetrical and postpartum care, the suit said.

Women about to give birth are taken to St. Agnes Hospital in Fond du Lac, where department security policy requires the women to be shackled for most of the labor and re-shackled right after birth.

Messages left for ACLU-Wisconsin Executive Director Chris Ahmuty and Legal Director Laurence Dupuis at their offices were also not immediately returned. No home listings could be found when The Associated Press tried to reach them Monday night.

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Health changes cause worry - Fayetteville Observer

By Andrew C. Martel

Staff writer

CARTHAGE - The state mental health system's reorganization might be moving too quickly and leaving some patients without services, according to the director of a mental health agency.

Michael Watson, the director of the Sandhills Center, said he expects to lose 2,000 patients by June 30. That represents about 30 percent of his agency's clients, which come from an eight-county region consisting of Moore, Hoke, Harnett, Lee, Anson, Randolph, Montgomery and Richmond counties.

The center is responsible for steering the 2,000 patients to private organizations that will help them with mental health, substance abuse or developmental disability needs. The private organizations will be able to bill the state for Medicaid reimbursements.

Last week, Watson told the Moore County commissioners that some patients would inevitably get lost in the transition.

Watson worries especially about the patients who have rare or expensive needs.

“The problem is you get down to things that don't pay for themselves,” he said.

Staff at the Cumberland County Mental Health Center voiced similar concerns at a meeting in Fayetteville last month.

The state Division of Mental Health is requiring the Sandhills Center and other local management agencies to stop providing one-on-one services and to focus on case management and oversight of private care. The requirement is part of a plan approved by the legislature in 2001 to overhaul the mental health system.

Private agencies will give patients more choices and eliminate government bureaucracy, said Michael Mosely, the director of the Division of Mental Health.

Mosely said that the Division of Mental Health is building its list of private agencies to meet the new demand.

Watson said he agrees with the intent of the changes, but it needs to be flexible.

“It's an extraordinary amount of change happening very quickly,” he said.

Watson added that he is losing staff to some of these private agencies. He expects the state to cut the Sandhills Center's $60 million budget in half next year.

But if Watson is concerned about the pace of changes, he could go back to the state officials and tell them that he needs more time to find providers for some patients. Other local agencies have done that, said Dick Oliver, the leader of a team that evaluates the performance of local agencies, for the Division of Mental Health.

Watson has some understandable worries, but it is his responsibility to set up these private provider networks for the community, Oliver said.

“We recognize there are gaps in services,” Oliver said. “But there were gaps in service before reform as well.”

Staff writer Andrew C. Martel can be reached at martela@fayettevillenc.com or 323-4848, ext. 372.


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Mental health unit now mobile - Asheville Citizen-Times

by Leslie Boyd, LBOYD@CITIZEN-TIMES.COM

ASHEVILLE — A mobile mental health crisis services unit will begin operating in Buncombe County today and by the end of the summer will operate in eight counties, according to Western Highlands Network, which oversees the local mental health network.

The unit, already operating in Henderson and Transylvania counties, goes to the patient and stabilizes people who are having a mental health crisis. It operates around the clock.

"This is a start,” said Florence Rowe, a longtime member of the local affiliate of the National Alliance for Mental Illness (NAMI). “I think it’s a good start, but more is needed.”
The money for the unit comes from a $100,000 grant from the N.C. Division of Mental Health, Developmental Disabilities and Substance Abuse Services.

Mental health advocates in the region have lobbied for crisis services since Charter Hospital closed in 2000.

Since then, many adults and children in crisis have been handcuffed by police and transported to emergency rooms or to Broughton State Hospital in Morganton. A mobile crisis unit is equipped to transport someone who cannot be stabilized at home.

Arthur Carder Jr., CEO of Western Highlands, called the mobile crisis unit a good first step.
“We have a long way to go,” he said. “A crisis services unit has to be next.”
Western Highlands is assembling a crisis services task force that will help steer the development of more crisis services.

Diane Bauknight of the advocacy group WNC Families CAN and the mother of a child with mental illness has pushed hard for “the full continuum” of crisis services. She said the mobile unit will work for some people, but others need hospitalization to be stabilized and Mission Hospitals’ Copestone Unit doesn’t take all patients.

“Necessary components of a crisis continuum require mobile teams and a crisis facility to take people to when the person cannot be stabilized in the community,” Bauknight wrote in a letter to legislators and state officials. “… Now even more providers will get to experience what families have struggled with for years when a loved one is in crisis and cannot be stabilized at home: There is no place to go.”

Contact Leslie Boyd at 828-232-2922 or via e-mail at lboyd@ashevill.gannett.com.
 
Want to know more?
Mobile Crisis Management services will be available to all residents. Consumers who receive therapy or other direct services from providers in Western Highlands Network should call their providers. Consumers not receiving services on a regular basis from Western Highlands should call 225-2800 weekdays and (800) 951-3792 after hours and weekends.
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