History favors law in shootings - Asheville Citizen-Times

Recent incidents a reminder that WNC officers not charged in past gunfire deaths

by Jordan Schrader, JSCHRADE@CITIZEN-TIMES.COM

published July 31, 2006 12:15 am

ASHEVILLE - A series of deadly shootings by law enforcement this month has left some family members eager for the prosecution of officers who killed their loved ones.

If recent history is any guide, that's unlikely to happen.

Over the past five years the State Bureau of Investigation has looked into the deaths of 12 men killed by Western North Carolina officers, most recently Gregory Keith Hensley, Terry Jackson Evans and Lacy Pickens III. No officer has been charged in any of those cases.

That's not to say the shootings will spur no action. The deaths, including those of a man family said was mentally ill and of a teen who had threatened suicide, have encouraged some educators and mental health care providers to seek more training for officers on dealing with special needs.

District Attorney Jerry Wilson attributed the lack of charges to officers' good judgment. He said he found no evidence of overreaction in any shooting he has examined, including deaths in Watauga and Yancey counties.

Families often feel differently.

Evans' mother Tammy Revis now regrets alerting authorities to her fears that her son might commit suicide, a call that ended in the 17-year-old's death not by his own hand but by Buncombe County sheriff's deputy Tim Bradley.

Some Buncombe County residents wonder whether a call to 911 puts them in less danger or more.

Evans' mother said of people who attended his funeral: “You wouldn't believe how many parents told me that they would never call for help, never.”

What a public with the benefit of hindsight doesn't always understand, Buncombe County sheriff's Lt. James A. Grant said, is that officers threatened with deadly force have little time to consider their choices.

Grant shot and wounded a man in the leg Oct. 25 after the man he was trying to arrest fired at him and missed, the Sheriff's Department said then.

“Once you have your life in danger,” Grant said, “then you make that momentary decision to do what you did.”

Awaiting justice

An officer's decision to pull the trigger may take a split second.

But a family's wait to learn the truth can take much longer, if it ever comes.

SBI agents have spent at least five months, and as long as 17 months, probing fatal shootings by their fellow law enforcement officers in WNC over the past few years.

“The SBI works cases as quickly and as thoroughly as possible,” said William McKinney, spokesman for Attorney General Roy Cooper. “Oftentimes, in fatal shooting investigations, we're also working with the medical examiner's office and awaiting the results of an autopsy.”

The SBI has investigated at least 75 fatal shootings by officers throughout the state since 2001.

Agents present a final report to the local district attorney, who decides whether to file charges.

Like other criminal investigation reports, those documents remain closed to the public after a case is shut in North Carolina.

District attorneys have defended the secrecy, saying that the release of reports would reveal sensitive information that could expose informants.

“We deserve to know what they find out,” Terry Evans' uncle Henry Ward said. “… That's the least they can do. Because I don't think they'll charge anybody, because they all take care of their own.”

The Sheriff's Department said Evans pointed a shotgun at Bradley, a deputy since 1995, while scuffling with his mother over the gun outside their home in Leicester. But his mother said she had tackled him, pinned him to the ground and taken control of the gun. She said Bradley stomped on Evans before shooting him.

Bradley is on paid administrative leave awaiting the SBI's report, officials said. So are sheriff's Sgt. Caton McBride and Asheville police officer Chad Bridges, two officers involved in the most recent shootings.

Asheville police defended Bridges' shooting of Pickens, 27, of Asheville, during a traffic stop in West Asheville to serve a warrant. They said he shot into a car that had knocked his partner to the ground. Family members and the local NAACP questioned the police version of events and the need for deadly force.

McBride, the Sheriff's Department said, shot and killed Hensley at a home near Weaverville after Hensley threatened deputies with a gun.

Family members said Hensley, 44, of Lawrenceville, Ga., was mentally unstable and that they did not hold deputies responsible.

Training changes sought

Buncombe County deputies receive lessons every year in dealing with special populations such as the mentally ill, training coordinator Lt. Anthony Case said.

But some educators and mental health service providers want officers trained to specialize in such interactions, said Western Highlands Network CEO Arthur Carder and Asheville-Buncombe Technical Community College law enforcement academy director Scott Bissinger.

They have broadened the scope of their goals in recent weeks, Bissinger said, in part because of recent officer confrontations in WNC and beyond.

More than just teams of specialized officers, they are pushing for ways police can seek help from caregivers and for places where they can take potentially dangerous mental health patients.

Officials see precedent for a community-wide plan in the work of the Crisis Intervention Team at the Memphis Police Department.

In a widely copied model, Memphis police have about 225 officers trained to respond immediately to mental health-related calls. They work closely and regularly with mental health care providers and patients.

A-B Tech officials said they plan to have a conference call Tuesday with Memphis police and University of Memphis faculty to discuss how they can help WNC agencies learn such techniques.

Still, Bissinger said, considerations of mental well being become secondary when someone threatens to use a deadly weapon.

“It's kind of that double-edged sword,” he said. “On the one hand, they're mentally ill and they're not really aware of what they're doing. On the other hand, they can be deadly, too.”

Contact Jordan Schrader via e-mail at jschrade@gannett.com.



Deadly officer shootings

Fatal shootings, 2001-06, and how long the SBI took to investigate. None led to charges against an officer.

o July 13, 2006: A Buncombe County sheriff's deputy kills Gregory Keith Hensley. Ongoing SBI investigation.

o July 13, 2006: A Buncombe County sheriff's deputy kills Terry Jackson Evans. Ongoing SBI investigation.

o July 6, 2006: An Asheville police officer kills Lacy Pickens III. Ongoing SBI investigation.

o Nov. 15, 2005: A Jackson County sheriff's deputy kills Dewann Christopher McCollum. Ongoing SBI investigation.

o Jan. 2, 2005: An Asheville police officer kills Antoine Scott Peterson. SBI closes investigation after 17 months.

o March 5, 2004: Henderson County sheriff's deputies kill Saul Perez Ortiz. SBI closes investigation after five months.

o April 17, 2003: The Watauga County Sheriff's Department and the Boone Police Department are involved in the fatal shooting of Christian Leshawn Griggs. SBI closes investigation after eight months.

o August 25, 2002: Buncombe County Sheriff's deputies kill Ronald Surrett. SBI closes investigation after 13 months.

o August 3, 2002: Tino Coppotelli is killed during a gunfight with State Highway Patrol troopers and Henderson County sheriff's deputies. SBI closes investigation after nine months.

o March 16, 2002: Tryon police officers kill John Reagan in Polk County. SBI closes investigation after six months.

o Nov. 13, 2001: A Yancey County sheriff's deputy kills Bobby Phillips. SBI closes investigation after nine months.

o July 15, 2001: Asheville police officers kill Christopher James Ingle. SBI closes investigation after nine months.

Sources: State Bureau of Investigation; sheriff's and police departments; offices of district attorneys Ron Moore, Jeff Hunt and Jerry Wilson; Citizen-Times archive.
Read more!

Rotenberg Center: Treatment or Torment? - Quincy, Mass, Patriot Ledger

Weblink to article

TREATMENT or TORMENT? A Canton center’s therapy for mental illness - shocks and food deprivation - is staunchly defended and bitterly attacked

By TOM BENNER
The Patriot Ledger

CANTON - For desperate parents, it’s the treatment of last resort, and it works. For critics, it’s a torment bordering on torture. The Judge Rotenberg Education Center in Canton is the only special needs school in the country that uses skin shocks to condition students, and those critics are working through legal and legislative channels to shut it down.

For 35 years, the center has used ‘‘aversive therapy’’ to treat young people with the most severe mental illnesses, people who at times will mutilate themselves or injure others. Nearly 75 percent of the center’s 234 residents are subject to jolts of electricity to the skin or ‘‘food deprivation’’ if they act inappropriately.

The school’s use of skin shock prompted a legislative effort this year to ban aversive therapy in Massachusetts, and an ongoing investigation by education officials in New York state, which sends a large number of youngsters to the school.

Those efforts have done nothing to diminish the commitment of the center’s professional staff, who argue that aversive therapy has no permanent impact and is a much better idea than doping people up with powerful antipsychotic drugs.

‘‘The therapy saves lives and turns lives around, but it generates this controversy,’’ said Dr. Matthew Israel, 72, who founded the school after training at Harvard with psychologist B.F. Skinner. ‘‘But how can you stop using something that is so helpful to parents and to children?’’ said Israel, who remains the dominant figure at the school.

Some facts about the Rotenberg Center:

—The center’s two buildings are on 15 acres off Route 138 in Canton, and they are brightly decorated with cheerful and colorful art. The students live in 46 residential homes in Randolph, Holbrook, Canton, Stoughton and communities south to Attleboro. They are bused to the school each day.

—While the goal is to integrate residents back into regular schools in their communities, some of the clients don’t make that step and stay at the center for extended periods of time.


— About 75 percent of the current residents are under the age of 21. The residents are predominantly - 70 percent - male.

—Tuition at the nonprofit year-round school is steep - $210,000 a year for each resident, which is generally covered by the school districts from which they hail or by a variety of social service agencies for older residents. New York sends 151 people to the school, at an annual cost of about $31 million a year.

—Some 1,000 employees work at the school and its residential homes. They have 680 video cameras and 50 digital video recorders to monitor what is going on at the school and homes.

Israel started the school in 1971 in Providence, eventually moving to Canton and renaming it after a Bristol County judge who approved a settlement under which the state of Massachusetts paid $580,000 after unsuccessfully trying to close the school. That state effort came after the death in 1985 of a 22-year-old who suffered a seizure while restrained and forced to listen to static noise.

Three Massachusetts agencies - the Department of Mental Retardation, the Department of Education and the Department of Early Education and Care - now license the school for educational and residential programs.

The school adheres to a system of rewards for good behavior and punishments for bad behavior, a philosophy that stems from Skinner’s behaviorist theories. The rewards are tangible - CDs, access to game rooms, special foods and the like. But rewards alone sometimes are not enough to change the behavior of people with severe mental illnesses or profound retardation, and that’s where aversive therapy comes into play for about 80 percent of the center’s residents.

Roughly 65 percent of the students are subject to skin shocks and they wear backpacks or fanny-packs carrying the electronic shock equipment. Wires run under their clothes to their arms, legs or torso, where sensors emit a two-second shock every time a student is caught doing something wrong.

The shocks are measured in milliamps - a thousandth of an ampere. Three milliamps, the low end of the range used at the center, is a fraction of 1 percent of the shock delivered by a Taser pistol. If you go to a doctor’s office and get electric stimulation to relieve muscle or joint pain, you’re getting 1 milliamp.

The high end of the range used at the center is 45 milliamps, slightly less than 5 percent of the jolt delivered by a Taser. Only a handful of students get that sort of shock.

School officials acknowledge that the shocks hurt. They liken it to a bee sting, or getting a tattoo, or touching a hot stove.

They also admit it’s an unusual treatment, but they don’t think it’s cruel. Students at the school are weaned off medications, which school officials consider far more harmful than skin shocks.

‘‘Stop and think about the medications that these kids were on before they came to us, and how aversive that is for them,’’ said Dr. Patricia Rivera of Stoughton, the school’s assistant director of clinical services.

‘‘A lot of these kids are drooling, they can't even stay awake during the day to work on their academics, they're still hurting themselves or others, but that’s not aversive to a lot of people,’’ Rivera said. ‘‘I don't understand that, how some people think that’s not aversive.’’

The center is generally the last stop for students after a desperate regimen of medications, other special needs programs or psychiatric hospitalization. Students are mostly teenagers, but the center’s population ranges from 8 to 46. Some students suffer from autism or mental retardation, while others from emotional or behavior problems.

‘‘Some students bang their heads to the point of brain damage, they poke their eyes, they eat their own fingers, they break their bones,’’ Israel said in an interview this past week. ‘‘We had one student who had detached retinas and was blinding herself and punching her face. We had a student who bit off the end of his tongue and bit a hole in his cheek. We’re the only place that’s available to treat those students.’’

‘‘Food deprivation’’ is the term used at the center for another negative response to uncontrolled behavior. It involves denying ‘‘preferred foods’’ to misbehaving students, instead giving them a ‘‘nonpreferred’’ meal of bland food sprinkled with liver powder to make it look less appetizing. In some cases, even that ‘‘nonpreferred’’ meal is denied.

‘‘Skinner’s original work used food as a reward; all the work with the animals was done with food rewards,’’ Israel said. ‘‘Food is one of the best rewards of all, and in order to make it work, you have to have a little bit of deprivation.’’

Skin shocks weren’t used at the school until 1990. Before that, aversive therapies included spanking, pinching, muscle squeezing, the use of a water squirt or vapor spray gun and aromatic ammonia.

But the invention in 1989 of remote skin shock equipment led Israel to conclude that skin shocks are less harmful and intrusive than inflicting direct pain such as spanking.

Israel felt the skin shock device invented in 1989 wasn’t powerful enough to have an effect on students. So he designed a stronger model called the ‘‘GED,’’ or graduated electronic decelerator.

Two large sculptured dogs with lighted collars watch over the entrance to the school’s main administration building, and upon entering visitors are greeted by stars hanging from a high glass-atrium ceiling and colorful paintings, sculptures and flowers.

‘‘We made it a point to really try to make the environment attractive, colorful and upbeat,’’ said Israel, a fine arts major as a college undergraduate. ‘‘That’s also one of the most enjoyable parts of running the program.’’

Students arriving at the Rotenberg Center are not initially exposed to skin shocks, but they are told that misbehavior may lead to wearing a backpack and skin shocks. Multiple devices are used for students who try to disconnect them.

In every case, the school must get approval from a guardian and a probate court before administering the shocks.

‘‘If they don’t respond well to (positive reinforcement) and continue to hurt themselves or hurt other people, we go forward with the court process, which includes getting the guardian’s permission and getting the court’s permission,’’ Rivera, the assistant director of clinical services, said.

When students show signs of improved behavior, they may eventually be ‘‘faded’’ - first to wearing a smaller fanny pack equipped with a GED, and then to not receiving skin shocks at all.

Rewards for good behavior include sitting in massage chairs, favorite snacks or other foods, picking out CDs, DVDs or other prizes at a reward ‘‘store,’’ or playing in an arcade-like lounge with pool tables, video games and a popcorn machine.

‘‘We’re constantly being criticized for the use of aversives,’’ Israel said. ‘‘It’s really the responsible approach to make as powerful a reward program as you can, and then bring in the aversives when the rewards themselves are insufficient.’’




Aversive therapy traces origin to Pavlov’s salivating dogs

It all started with Pavlov’s dogs. Russian psychologist Ivan Pavlov discovered through his experiments that by ringing a bell, he could condition his dogs to associate the bell’s sound with feeding time, and they would begin to salivate. The 1904 Nobel Prize winner opened up new branches of experimental psychology and the school of thought called behaviorism, or behavior modification.

B.F. Skinner became a major proponent of behavior modification in the United States, using aversive therapy - rewards to encourage desirable behavior, and negative reinforcement to punish undesirable behavior - in animals and human beings. The Harvard-trained psychologist’s famous Skinner box demonstrated that rats could be taught to press levers to obtain food.

Dr. Matthew Israel, who founded the Judge Rotenberg Education Center in 1971, did his doctoral thesis under Skinner at Harvard University. Strongly influenced by Skinner’s research into conditioned response, Israel maintains that skin-shock therapy has no lasting side effects, and is a proven method to teach positive behavior.

‘‘What we do is so much less intrusive than medications which can ruin your body for the rest of your life, or these time-wasting timeout procedures or emergency takedowns,’’ Israel said. ‘‘Sure it’s painful for two seconds, but there are no side effects to worry about.’’

Israel maintains that human beings by their nature learn from both positive and negative experiences.

‘‘People have such a strong dogmatic position about the use of punishment that they’re not willing to weigh the benefits against the risk,’’ he said.

Israel also feels that JRC - the shorthand way people at the Rotenberg center identify it - is an easy target for critics, including state Sen. Brian A. Joyce of Milton, who is pushing legislation to ban aversive therapy in Massachusetts.

‘‘The typical headline is ‘torture versus tough love.’ They love the word torture,’’ Israel said. ‘‘People like Sen. Joyce are repeating wild accusations and falsehoods that have no basis.’’

Israel calls the school’s critics ‘‘well-intentioned people who believe themselves to be advocates for the welfare of children, but they are unable to look at this in a scientific way, or come up with alternatives that are safe and less intrusive.’’

Skin shocks are administered for self-mutilating behaviors such as head-banging and eye-gouging, or aggression against others.

Israel maintains that the skin shocks have a high success rate, reducing problem behaviors in students by 95 percent, and substantially reducing the need for mind-altering medications.



More about the Judge Rotenberg Education Center

—Student population: 234, ranging in ages 8 to 46

—156 students receive skin shocks for misbehavior

—34 students are on food deprivation programs

—169 are school-age students and 65 are 22 or older

—163 are male, 71 are female

—Median stay: Two years

—Dress code for school: Collared shirts and ties for boys; no jeans and appropriate-length skirts for girls

—Tuition: $210,000 a year

—Revenues: $52.5 million

—Salary of school founder Dr. Matthew Israel: $334,000

—Location: Two buildings on 15-acre campus on Route 138 in Canton, monitored by 680 video cameras and 50 digital video recorders

—46 residential homes in Attleboro, Mansfield, Rehoboth, Norton, Randolph, Stoughton, Holbrook and Canton.

—School operates year-round

Tom Benner may be reached at tbenner@ledger.com.

Copyright 2006 The Patriot Ledger
Transmitted Saturday, July 29, 2006 Read more!

Rotenberg Center: Treatment or Torment? - Quincy, Mass, Patriot Ledger

Weblink to article

TREATMENT or TORMENT? A Canton center’s therapy for mental illness - shocks and food deprivation - is staunchly defended and bitterly attacked

By TOM BENNER
The Patriot Ledger

CANTON - For desperate parents, it’s the treatment of last resort, and it works. For critics, it’s a torment bordering on torture. The Judge Rotenberg Education Center in Canton is the only special needs school in the country that uses skin shocks to condition students, and those critics are working through legal and legislative channels to shut it down.

For 35 years, the center has used ‘‘aversive therapy’’ to treat young people with the most severe mental illnesses, people who at times will mutilate themselves or injure others. Nearly 75 percent of the center’s 234 residents are subject to jolts of electricity to the skin or ‘‘food deprivation’’ if they act inappropriately.

The school’s use of skin shock prompted a legislative effort this year to ban aversive therapy in Massachusetts, and an ongoing investigation by education officials in New York state, which sends a large number of youngsters to the school.

Those efforts have done nothing to diminish the commitment of the center’s professional staff, who argue that aversive therapy has no permanent impact and is a much better idea than doping people up with powerful antipsychotic drugs.

‘‘The therapy saves lives and turns lives around, but it generates this controversy,’’ said Dr. Matthew Israel, 72, who founded the school after training at Harvard with psychologist B.F. Skinner. ‘‘But how can you stop using something that is so helpful to parents and to children?’’ said Israel, who remains the dominant figure at the school.

Some facts about the Rotenberg Center:

—The center’s two buildings are on 15 acres off Route 138 in Canton, and they are brightly decorated with cheerful and colorful art. The students live in 46 residential homes in Randolph, Holbrook, Canton, Stoughton and communities south to Attleboro. They are bused to the school each day.

—While the goal is to integrate residents back into regular schools in their communities, some of the clients don’t make that step and stay at the center for extended periods of time.


— About 75 percent of the current residents are under the age of 21. The residents are predominantly - 70 percent - male.

—Tuition at the nonprofit year-round school is steep - $210,000 a year for each resident, which is generally covered by the school districts from which they hail or by a variety of social service agencies for older residents. New York sends 151 people to the school, at an annual cost of about $31 million a year.

—Some 1,000 employees work at the school and its residential homes. They have 680 video cameras and 50 digital video recorders to monitor what is going on at the school and homes.

Israel started the school in 1971 in Providence, eventually moving to Canton and renaming it after a Bristol County judge who approved a settlement under which the state of Massachusetts paid $580,000 after unsuccessfully trying to close the school. That state effort came after the death in 1985 of a 22-year-old who suffered a seizure while restrained and forced to listen to static noise.

Three Massachusetts agencies - the Department of Mental Retardation, the Department of Education and the Department of Early Education and Care - now license the school for educational and residential programs.

The school adheres to a system of rewards for good behavior and punishments for bad behavior, a philosophy that stems from Skinner’s behaviorist theories. The rewards are tangible - CDs, access to game rooms, special foods and the like. But rewards alone sometimes are not enough to change the behavior of people with severe mental illnesses or profound retardation, and that’s where aversive therapy comes into play for about 80 percent of the center’s residents.

Roughly 65 percent of the students are subject to skin shocks and they wear backpacks or fanny-packs carrying the electronic shock equipment. Wires run under their clothes to their arms, legs or torso, where sensors emit a two-second shock every time a student is caught doing something wrong.

The shocks are measured in milliamps - a thousandth of an ampere. Three milliamps, the low end of the range used at the center, is a fraction of 1 percent of the shock delivered by a Taser pistol. If you go to a doctor’s office and get electric stimulation to relieve muscle or joint pain, you’re getting 1 milliamp.

The high end of the range used at the center is 45 milliamps, slightly less than 5 percent of the jolt delivered by a Taser. Only a handful of students get that sort of shock.

School officials acknowledge that the shocks hurt. They liken it to a bee sting, or getting a tattoo, or touching a hot stove.

They also admit it’s an unusual treatment, but they don’t think it’s cruel. Students at the school are weaned off medications, which school officials consider far more harmful than skin shocks.

‘‘Stop and think about the medications that these kids were on before they came to us, and how aversive that is for them,’’ said Dr. Patricia Rivera of Stoughton, the school’s assistant director of clinical services.

‘‘A lot of these kids are drooling, they can't even stay awake during the day to work on their academics, they're still hurting themselves or others, but that’s not aversive to a lot of people,’’ Rivera said. ‘‘I don't understand that, how some people think that’s not aversive.’’

The center is generally the last stop for students after a desperate regimen of medications, other special needs programs or psychiatric hospitalization. Students are mostly teenagers, but the center’s population ranges from 8 to 46. Some students suffer from autism or mental retardation, while others from emotional or behavior problems.

‘‘Some students bang their heads to the point of brain damage, they poke their eyes, they eat their own fingers, they break their bones,’’ Israel said in an interview this past week. ‘‘We had one student who had detached retinas and was blinding herself and punching her face. We had a student who bit off the end of his tongue and bit a hole in his cheek. We’re the only place that’s available to treat those students.’’

‘‘Food deprivation’’ is the term used at the center for another negative response to uncontrolled behavior. It involves denying ‘‘preferred foods’’ to misbehaving students, instead giving them a ‘‘nonpreferred’’ meal of bland food sprinkled with liver powder to make it look less appetizing. In some cases, even that ‘‘nonpreferred’’ meal is denied.

‘‘Skinner’s original work used food as a reward; all the work with the animals was done with food rewards,’’ Israel said. ‘‘Food is one of the best rewards of all, and in order to make it work, you have to have a little bit of deprivation.’’

Skin shocks weren’t used at the school until 1990. Before that, aversive therapies included spanking, pinching, muscle squeezing, the use of a water squirt or vapor spray gun and aromatic ammonia.

But the invention in 1989 of remote skin shock equipment led Israel to conclude that skin shocks are less harmful and intrusive than inflicting direct pain such as spanking.

Israel felt the skin shock device invented in 1989 wasn’t powerful enough to have an effect on students. So he designed a stronger model called the ‘‘GED,’’ or graduated electronic decelerator.

Two large sculptured dogs with lighted collars watch over the entrance to the school’s main administration building, and upon entering visitors are greeted by stars hanging from a high glass-atrium ceiling and colorful paintings, sculptures and flowers.

‘‘We made it a point to really try to make the environment attractive, colorful and upbeat,’’ said Israel, a fine arts major as a college undergraduate. ‘‘That’s also one of the most enjoyable parts of running the program.’’

Students arriving at the Rotenberg Center are not initially exposed to skin shocks, but they are told that misbehavior may lead to wearing a backpack and skin shocks. Multiple devices are used for students who try to disconnect them.

In every case, the school must get approval from a guardian and a probate court before administering the shocks.

‘‘If they don’t respond well to (positive reinforcement) and continue to hurt themselves or hurt other people, we go forward with the court process, which includes getting the guardian’s permission and getting the court’s permission,’’ Rivera, the assistant director of clinical services, said.

When students show signs of improved behavior, they may eventually be ‘‘faded’’ - first to wearing a smaller fanny pack equipped with a GED, and then to not receiving skin shocks at all.

Rewards for good behavior include sitting in massage chairs, favorite snacks or other foods, picking out CDs, DVDs or other prizes at a reward ‘‘store,’’ or playing in an arcade-like lounge with pool tables, video games and a popcorn machine.

‘‘We’re constantly being criticized for the use of aversives,’’ Israel said. ‘‘It’s really the responsible approach to make as powerful a reward program as you can, and then bring in the aversives when the rewards themselves are insufficient.’’




Aversive therapy traces origin to Pavlov’s salivating dogs

It all started with Pavlov’s dogs. Russian psychologist Ivan Pavlov discovered through his experiments that by ringing a bell, he could condition his dogs to associate the bell’s sound with feeding time, and they would begin to salivate. The 1904 Nobel Prize winner opened up new branches of experimental psychology and the school of thought called behaviorism, or behavior modification.

B.F. Skinner became a major proponent of behavior modification in the United States, using aversive therapy - rewards to encourage desirable behavior, and negative reinforcement to punish undesirable behavior - in animals and human beings. The Harvard-trained psychologist’s famous Skinner box demonstrated that rats could be taught to press levers to obtain food.

Dr. Matthew Israel, who founded the Judge Rotenberg Education Center in 1971, did his doctoral thesis under Skinner at Harvard University. Strongly influenced by Skinner’s research into conditioned response, Israel maintains that skin-shock therapy has no lasting side effects, and is a proven method to teach positive behavior.

‘‘What we do is so much less intrusive than medications which can ruin your body for the rest of your life, or these time-wasting timeout procedures or emergency takedowns,’’ Israel said. ‘‘Sure it’s painful for two seconds, but there are no side effects to worry about.’’

Israel maintains that human beings by their nature learn from both positive and negative experiences.

‘‘People have such a strong dogmatic position about the use of punishment that they’re not willing to weigh the benefits against the risk,’’ he said.

Israel also feels that JRC - the shorthand way people at the Rotenberg center identify it - is an easy target for critics, including state Sen. Brian A. Joyce of Milton, who is pushing legislation to ban aversive therapy in Massachusetts.

‘‘The typical headline is ‘torture versus tough love.’ They love the word torture,’’ Israel said. ‘‘People like Sen. Joyce are repeating wild accusations and falsehoods that have no basis.’’

Israel calls the school’s critics ‘‘well-intentioned people who believe themselves to be advocates for the welfare of children, but they are unable to look at this in a scientific way, or come up with alternatives that are safe and less intrusive.’’

Skin shocks are administered for self-mutilating behaviors such as head-banging and eye-gouging, or aggression against others.

Israel maintains that the skin shocks have a high success rate, reducing problem behaviors in students by 95 percent, and substantially reducing the need for mind-altering medications.



More about the Judge Rotenberg Education Center

—Student population: 234, ranging in ages 8 to 46

—156 students receive skin shocks for misbehavior

—34 students are on food deprivation programs

—169 are school-age students and 65 are 22 or older

—163 are male, 71 are female

—Median stay: Two years

—Dress code for school: Collared shirts and ties for boys; no jeans and appropriate-length skirts for girls

—Tuition: $210,000 a year

—Revenues: $52.5 million

—Salary of school founder Dr. Matthew Israel: $334,000

—Location: Two buildings on 15-acre campus on Route 138 in Canton, monitored by 680 video cameras and 50 digital video recorders

—46 residential homes in Attleboro, Mansfield, Rehoboth, Norton, Randolph, Stoughton, Holbrook and Canton.

—School operates year-round

Tom Benner may be reached at tbenner@ledger.com.

Copyright 2006 The Patriot Ledger
Transmitted Saturday, July 29, 2006 Read more!

More Than Demons at Work in Mental Illness - Huffingtonpost.com

To visit the site: http://www.huffingtonpost.com/byron-williams/

By Bryon Williams

Recently I was engaged in the mundane activity of simply channel surfing. I was too tired to read and not interested in watching television, I was surfing for the pure sport of it. As I passed one of the local cable channels in Oakland, CA, I heard something that caused great concern.

The Rev. Dr. Lorenzo Carlisle speaking to his predominantly African American congregation and to the television audience stated that those who may be experiencing mental health issues know that such problems are not a sickness but rather a demonic spirit. He went on to further suggest that such problems could be alleviated almost immediately in "the name of Jesus!"

What about the poor soul whose mental health problems did not go away? Was it simply a lack of faith? Was the demonic spirit more powerful than their prayers? Or could it be that such analysis falls woefully short of the problem?

I have nothing against Dr. Carlisle personally. I am sure that he is an honorable man who believes in the power of his conviction, and he is not alone in his theological approach. In fact, this belief remains common in many churches and the result could very easily cause someone great harm.

Mental health, as an issue, permeates all sectors of society. The African American community, like other negative social/psychological forces, is disproportionately impacted. African Americans account for approximately 25 percent of the reported mental health needs in this country while only comprising 12 percent of the population.

Mental health challenges are compounded in the African American community by a justifiable and historical distrust of the dominant culture, along with social factors such as race, poverty, etc. I grew up in a house where it was widely believed that African Americans did not commit suicide. "The gun just went off unexpectedly in Uncle Smitty's hand," so the story goes.

Does Dr. Carlisle believe that those who may have been watching his televised service, suppressing years of mental and physical abuse, living in urban areas where violence and drugs are prevalent, or dealing with the daily pressures of life can turn it around so easily? This approach is not only shortsighted but can lead one further down the abyss of despair.

Those who may be suffering from mental health issues may find the church as being the only "safe" place in their life. Traditionally, the church has been the place of hope and healing, especially within the African American community. And the pastor holds a tremendous amount of trust within that community.

But too often, the church leadership fails to grant permission to its parishioners to seek help from professionals outside the church, forcing many parishioners to try to handle difficult, and sometimes insurmountable, problems on their own, which amounts to their suffering in silence.

Churches across the country has people sitting in the pews each Sunday, suffering from myriad mental health issues. They are trapped by the feeling of shame and inaction, which are reinforced by weekly homilies.

Pastoral good intentions notwithstanding, the feeling of worthlessness, a common symptom of depression, is only enhanced by the parishioners frustration from the failure of a God-inspired cure and the need to keep such information concealed from family and friends.

As a pastor, I believe that spirituality is a key ingredient to positive mental health, but that means the church should be working in tandem with mental health professionals and not offering simplistic remedies. More and more pastors must join forces with mental health professionals. This is particularly important for communities of color, who tend to have different attitudes about mental health from that of the dominant culture.

How might African American pastors work with mental health professionals to assist in helping parishioners and the community at-large to remove the stigma of mental health disease? The black church must assume a supportive rather than adversarial role if the portion of the African American community that lives with mental health disease is to liberate itself from the prison of hopelessness.  Read more!

Advocates have mixed feelings on Yates verdict

Advocates for people with mental illness felt gratified by a Houston jury's verdict of not guilty by reason of insanity in the Andrea Yates trial and said they were pleased she will get treatment.

However, some had reservations about the larger impact.

"We are relieved and happy that the jury recognized her severe mental illness," said Denise Brady, director of public policy for the Mental Health Association in Texas. "I'm not sure what tipped it this time. Maybe the defense attorneys did something different. It would be a very fortunate thing if the difference in the verdict from the first trial (in which Yates was found guilty) was because of a better understanding of mental illness on the part of the public and jurors."

"I have mixed feelings about it," said Ed Dickey, president of National Alliance on Mental Illness San Antonio, a grassroots advocacy group. "If the verdict helps emphasize the need and helps people to obtain the necessary services, that's good. But if the lawyers and the media were just after a sensational case, it doesn't change the way we treat people in a crisis. People with mental illness are not criminals. They are sick."

Brady noted that last year, legislative efforts to reform the state's insanity defense provisions failed to make any substantial change and did not expand the definition of insanity as only not knowing right from wrong.

In her first trial, lawyers argued that, because Yates called police after drowning her children, she knew right from wrong. People with mental illness may not be able to control their behavior, Brady said.

Yates's story is a tragedy for her children and her, Dickey concluded.
"But if we all sit around and wait for the next sensational case and don't get people the help they need," he said, "then that's a tragedy." Read more!

Mental health advocates worried - Goldsboro News-Argus

Mental health advocates in Wayne County said Thursday they are worried some people in need of help are being forgotten because of the state's new mental health reform laws.

"This is a pretty wild time with reforms," said Bobby Jones, president of the county's Mental Health Association. "We've got to take a stronger role in advocacy because people are falling through the cracks."

Jones made his comments Thursday during the association's monthly board of directors meeting. The association is made up of a group of local volunteers from both the business sector and mental health profession.

New state mental health laws are changing the treatment of disabled and mentally ill people by using more community-based resources and less institutionalized care.

State law requires local agencies to stop providing direct services by 2007.

Board member Jim Slowinski prompted Thursday's discussion, saying he had heard the changes weren't going well.

Gaspar Gonzalez agreed, saying he thought it was still "a little on the shaky side."

Mike Herring, a clinical social worker, said that the new laws are sometimes so specific that people who need help don't meet guidelines for inclusion.

"For example, a male substance abuser may not qualify for a program unless he has another disorder," Herring said.

Another problem that is surfacing is finding qualified private providers, association members said.

"For one thing, they're not used to the mountains of paperwork required by the government," Herring said. "There are only a few in the area that can handle this."

Jones said that there are serious challenges regarding how the money was dispersed.

The state refers to the various pots of money as 'silos,' Jones said.

"And there's a problem if the mental health condition falls outside the silo or if there are too many people going for the same money."

He said there is too little flexibility in how money is distributed.

"I know these measures were taken to fix the system, but I don't know if it's the right measures," Jones said.

A Supreme Court decision in 2001 ordered that disabled people be placed in community settings, rather than institutions, where possible.

After the ruling, President Bush formed the Freedom Commission to eliminate inequality for Americans with disabilities. From June 2002 to April 2003, the 22 commissioners met monthly to analyze the public and private mental health systems. The commission received comments and suggestions from nearly 2,500 people from all 50 states.

The commission then came up with a list of items that needed to be changed in the mental health and disability areas. They included: Integrating Americans with disabilities into the workforce, expanding telecommuting, implementing a 'ticket to work' program where disabled people can choose their own support services and maintain their health benefits when they return to work, providing innovative transportation solutions and promoting full access to community life.

The commission's report prompted the President to issue an executive order, which was passed on to the states. Any mental health funding from the federal government would be looked upon in relation to the Freedom Commission's report.

Those dictates prompted the North Carolina General Assembly to develop a plan for mental health system reform.

The programs should now become more "person centered," and programs will be developed to keep mentally ill or disabled people in their community.

"When they talk target populations, that means little to no money to me," Jones said. Moseley joins national board. Read more!

Law officers need training on use of deadly force - Asheville Citizen-Times

Commentary by Steve Towe

published July 26, 2006 12:15 am

There is a growing and alarming trend running rampant in America today, and it is best described as “death by cop.” Much like cartoon of the two guys in jail asking what the other is in for, and one says “I called it a pre-emptive strike, but the cops called it assault with a deadly weapon.”

Law enforcement officers are seldom held accountable for a citizen's death or wounding. There is a double standard that is inexcusable and should cause you to fear law enforcement officers in many situations. If they happen to feel threatened, your life is in grave danger.

Just in the past several weeks in WNC, we have had a sheriffs deputy kill a family pet when approaching the wrong house and the dog growled and moved toward him. Excuse? The officer felt threatened. The same thing happened during an unjustified stop last year in Tennessee. In another instance, a young 17-year-old was, according to his mother, subdued and disarmed when a sheriff's deputy kicked him repeatedly and shot him in the chest.

The mother had called worrying about her son's threat of suicide, and the officers removed that worry from her mind - they did the job for him. In another incident, a mentally impaired man suffering brain damage from an accident was killed in his home by another sheriff's deputy for allegedly pointing a gun when the officer was serving a warrant.

I know firsthand about how these things happen.

Three years ago in April, my rural community in Candler lost power for several hours while my son was home from college on spring break. The battery backup to the monitored alarm system was running low on charge, and triggered an alarm to the monitoring service. All my phones were out of order due to the power outage.

With power out to the entire community, two sheriff's deputies showed up and didn't even notice that fact. They didn't notice that all the cars in the driveway were registered to the owner - me. They hadn't been trained that over 95 percent of alarms are false alarms. They hadn't been taught that when the power is out, alarms can malfunction. Before their ill-conceived, Ramboesque fiasco was over, my son was lying on his back in my yard with two 45 caliber semi-autos pointed at his head cowering in fear. I was nearly shot when I tried (unarmed) to intervene to save him. His mistake was complying with the officers request to produce identification. When I ran to his aid, they pointed their weapons at me.

Had I done what most reasonable people in this county would have done when the power is out, it's dark, and your child is being assaulted by two unidentified men in the shadows screaming profanities with drawn weapons pointing at his head, people would have died.

When I drove to the magistrates office at 2 a.m. to file a complaint against the officers involved, requesting to charge them with assault with a deadly weapon against a homeowner on his own land without a warrant or just cause, I was told that I had to first speak with the sheriff.

When I called the sheriff, my call was transferred to the sergeant on duty, the very man who had nearly shot my son. When I complained, I was told, “I could have shot you when you first exited your house” (to check the grounds and turn on my generator). Hear that?

Upon further complaint to the sheriff's department, I was told that a mistake was made, most unfortunate, and they were sorry. Sorry?

My son was nearly killed, and had it not been for my wife pleading with the officers to holster their weapons, that we had lived here for 30 years, that they had her son on the ground, that I was her husband, God only knows what may have happened.

My point is this: You don't send in the Marines to weed your garden. The average home in Buncombe County has no less than four guns, according to the sheriff. Guns are a part of life here, and given the average police response times in the county, anyone who isn't prepared to defend themselves is courting disaster. The presence of a gun should not trigger an automatic response of deadly force.

Officers have a right to defend themselves with deadly force when their lives are genuinely threatened. They do not have a right to assassinate anyone who frightens them, who they cannot immediately control, or who presents a challenge to them.

Poor training often results in the loss of innocent life, and must be addressed. Police must be held accountable for their “pre-emptive strikes,” and must be supported when they react reasonably.

They have a tough job, and my heart goes out to them. There is no excuse for a lack of training, or a lack of discipline, that results in the loss of innocent life.

Steve Towe is a real estate broker and sixth-generation Buncombe County native. He lives in Upper Hominy. E-mail: stephentowe@ hotmail.com.
Read more!

Access to SBI reports essential for public trust - Asheville Citizen-Times

published July 25, 2006 12:15 am   Asheville Citizen Times editorial

Disparities in accounts of the recent shooting of two people by Buncombe County deputies on the same night, but in separate incidents, demonstrate yet again why SBI investigation reports should be made public.

Sheriff Bobby Medford said a shotgun had been pointed at a deputy when Terry Jackson Evans, 17, was fatally shot. But the boy’s mother, Tammy Revis, said the gun was in her control. She said her son was disarmed and on the ground when a deputy shot him in the chest.

In the other incident, the family of Gregory Keith Hensley doesn’t doubt that deputies shot the 44-year-old man, who was mentally unstable, in self-defense, but do disagree with the Sheriff’s Department about the number of bullets that were fired.

The citizens of Buncombe County, who employ the officers who work for the sheriff’s department, have no way of determining which account of what happened the night Evans was shot is accurate, and they will never know what an SBI investigation will reveal. That means they have no way of evaluating whether the action was appropriate.

It’s unfair to judge the officer’s actions without knowing what the evidence that will be collected by the SBI shows regarding what took place. But the differing accounts will cause many people to be concerned about whether the sheriff’s department acted appropriately and that undermines confidence in the department and public safety.

North Carolinians, in whose name SBI investigations are conducted and whose tax dollars pay for them, have a right to know what they reveal about matters of law enforcement conduct, once the investigations are completed and making them public would not compromise possible court cases or other pending action. Appropriate safeguards can be taken to protect the identity of innocent witnesses or other such sensitive matters.

The credibility of the criminal justice system is at stake, and that trumps any reason for keeping the public in the dark about what happened. There is no law that either prevents local district attorneys from releasing reports on SBI investigations or requires them to do so.
The North Carolina General Assembly ought to change that, requiring the release, with certain safeguards.

Otherwise, there will always be lingering doubts about what happened.
For that reason, it would be far better for the officer, the criminal justice system and the citizens whose confidence in that system is essential to keeping order, for the SBI reports to be made public. Read more!

Commentary by Ed Seavy

Recently Peggy Manning wrote an article on the complaints of private mental health service providers not receiving client referrals from the Smoky Mountain Center Local Management Entity (SMC-LME). Soon after, the current clinical operations director, Dr. Steve Puckett of the LME, wrote a guest editorial briefly explaining how mental health reform has left some service providers behind and how others advanced after reform mandated that SMC could no longer provide services, but rather, would manage services as an LME. Private providers would be state “endorsed” through the LME to provide services to clients.

Dr. Puckett said mental health, developmental disability, and substance abuse services reform changed what services the state is willing to pay for with public funds. The state has determined services known as evidence-based practices are more effective. That's when services go to the client instead of the client having to go to a place where the services are offered. The services that go to the client are “enhanced” services reserved for those clients with serious impairments that can escalate into a crisis situation. The Assertive Community Treatment Team where a team of specialists go to the client, is such an “enhanced” service that must be “endorsed” by the LME. This endorsement assures the state the provider has the qualifications and capacity to provide the service to be paid for with public funds. Traditional office-based services are effective for clients with less serious impairments/needs - the state is just not interested in paying for them.

Though some counselors who previously provided publicly funded services to SMC customers/clients no longer receive referrals from the LME, Dr. Puckett points out that other providers have affiliated into agencies and invested significant time and resources to hire and train staff to provide enhanced services. The problem is that many mh/dd/sas providers were disadvantaged by the unrealistic magnitude of reform that lacked adequate and sufficient guidance and resources. State legislators of the Legislative Oversight Committee (LOC) for MH/DD/SAS, has determined and reported that the NC Division of Health and Human Services (DHHS) has not provided adequate guidance, technical assistance, or standards in the implementation of reform as mandated by HB 381 in 2001. This created much turmoil throughout the state between LMEs and private providers, as well as for the consumer.

Rural areas such as ours lacks a pool of private providers with the capacity to meet the coming state expectations. For many years, the agencies which are now LMEs, monopolized services. SMC, under the pressures of reform, nurtured a non-profit that would address the needs of clients through the privatization of services in reform. It does take a lot of resources and commitment to provide enhanced services, much of which derived from SMC into the creation of a non-profit service provider which is endorsed by SMC. Much of the administrative staff has made the transition from SMC to the non-profit. Some competing private providers consider the SMC to SMC nonprofit transition to be an unfair advantage. Decisions that were being made by SMC staff that would affect competing private providers were being developed by SMC staff that were transitioning to employment with the SMC non-profit, which could be perceived as a conflict of interest.

Though SMC/LME did conduct the mandated stakeholders forums with competing private providers, some felt as if they were not being heard or that the information that they needed to be part of the process was not being shared by those making the decisions. As a consumer advocate and former member of the SMC Consumer and Family Advisory Committee and through networking with other advocates throughout the state, I found information to be guarded. Then again, with the lack of guidance from the state, as indicated by the LOC, in many cases there was no information.

Dr. Puckett points out that there are 13 competing private providers endorsed by the LME in Haywood County. A cornerstone of reform was for the client to be able to make an informed decision in the process of being referred to a service provider. It was supposed to be the responsibility of the LME and CFAC to provide informed choice. However, with the SMC-LME so closely sharing staff, facilities and phone services with the non-profit (Meridian Behavioral Health Services) in the privatization transition, the process became further muddled and confusing. Every service eligible client should automatically receive a current directory of choice with input from the private providers.

An independent private provider peer network should also be able to review all LME referrals on a regular basis, after records have been sanitized for client confidentiality. This will maximize the potential for a diverse private provider network as reform progresses and population increases in our region.

Ed Seavey lives in Waynesville and is a former member of the SMC Consumer and Family Advisory Committee.
Read more!

Training key for police facing crisis situations - Asheville Citizen-Times

Editorial

It was a an incident not unlike the recent shootings of two people with mental problems by Buncombe County Sheriff’s deputies that led to the formation of a Crisis Intervention Team at the Memphis Police Department.

The department developed a model in 1987 that’s been emulated by law enforcement agencies around the country, including some in North Carolina, and its time law enforcement agencies here adopted it as well.

But as Maj. Sam Cochran, who has coordinated the Memphis Crisis Intervention Team since 1988, emphasizes, law enforcement reflects the community and changing the way officers respond to people with mental illness in crisis is about more than training.

“With regard to mental illness, one of the issues, probably the most significant issue underlying… what is appropriate is the stigma of mental illness,” Cochran said. “Mentally ill people are viewed as dangerous. This is something our country has to come to terms with — the lack of services in place and understanding of what mental illness is.”

The Buncombe County shootings occurred on the same night but in separate incidents. In one incident Gregory Keith Hensley, who relatives said had been mentally unstable since a motorcycle accident more than 20 years ago left him with brain damage, had a gun pointed at deputies when he was fatally shot inside his uncle’s home, according to Sheriff Bobby Medford. Deputies were trying to serve a warrant on Hensley stemming from charges he pulled a gun on his uncle’s stepson earlier in the day.

The second shooting occurred after deputies responded to a call from the mother of a teenager who was threatening suicide. Medford said a deputy shot Terry Jackson Evans after the teen struggled with his mother over control of a shotgun Evans had. The mother later said her son was disarmed and laying on the ground when a deputy shot him in the chest.

In the Memphis case that led to the creation of the police department’s Crisis Intervention Team, police were called to the home of a mentally ill man who was cutting himself and threatening his family with a knife, Cochran said. In the confrontation that followed, police shot and killed the man.

The year before the incident occurred, members of the local chapter of the National Alliance for the Mentally Ill had “expressed emphatically” to the Memphis Police Department that in their view officers were not trained to deal with crisis situations involving people who were mentally ill and that in many cases the officers made matters worse.

But it was the outcry following the shooting that led the mayor of Memphis to appoint a community task force, which included members of NAMI and the mental health profession. The task force studied other communities and found that little was being done. Some communities had a person on call, but there was often a significant delay in getting that person to the scene of a crisis event.

Memphis rejected that path and chose instead to create a crisis intervention team.

The team currently includes 250 out of about 1,000 uniformed officers on the force.

They are distributed throughout the different shifts and stations, Cochran said. CIT officers are selected based on natural ability, skills and interest. They respond to regular dispatch calls just like other officers, but when a call comes involving a mentally ill person, dispatch will find the nearest CIP officer and send him to the scene. Other officers will also respond, but the CIT officer will be the lead officer.

“That brings clarity and accountability to the event,” Cochran said.

CIT officers receive an extra 40 hours of training in understanding mental illness and are very skilled in verbal de-escalation, Cochran said.

It’s hard to measure outcome because there’s no way to calculate what didn’t happen, but based on figures from before and after the CIT was established, the number of police injuries when responding to calls involving people with mental illness decreased six-fold, Cochran said.

Another measure of success is that the department receives more calls from people with mental illness themselves, who wouldn’t call police before because they were afraid. The CIT has also decreased instances where people with mental illness are unnecessarily put into the criminal justice system.

“It’s been a win/win for the entire community,” he said.

The Memphis program has been so successful, his department has helped set up CIT teams for law enforcement agencies from Houston to Albuquerque to Raleigh.

But, Cochran stresses that the problem goes beyond law enforcement.

“Many people are unnecessarily going into the criminal justice system because services are not there,” he said. “With lack of services, law enforcement is the first responder sent to correct the problem…. These things we’re talking about are community concerns, not law enforcement concerns. The community needs to come together and work through these complex issues.”

It’s clear that the advantages of creating a crisis intervention team go beyond the hope that fewer mentally ill people will be injured when they’re in crisis.

Based on the Memphis study, officer safety is enhanced and the overcrowded court system is spared dealing with a number of people who should be in treatment, not in jail.

The sheriff’s department and every other law enforcement agency in Western North Carolina should be working toward establishing such a team. Diagnosable mental illness is a very common condition. NAMI estimates about one in four U.S. adults suffer from a diagnosable condition in a given year.

Everyone — families, taxpayers, mentally ill individuals, law enforcement officers, the entire community — will benefit from officers trained to handle crisis situations with as little force as is necessary.
Read more!

Mother: Suicidal teen not armed - Asheville Citizen-Times

Note: It is unknown at this point if this case involves chronic depression or other illness.

By Adam Behsudi

ABEHSUDI@CITIZEN-TIMES.COM
July 16, 2006 12:15 am

LEICESTER — The mother of a Leicester teen killed Thursday night by a Buncombe County Sheriff’s deputy says her son was disarmed and laying on the ground when the deputy shot him in the chest.

Sheriff Bobby Medford said Friday a shotgun had been pointed at the deputy when Terry Jackson Evans, 17, was shot. But Tammy Revis, the teen’s mother, said the gun was in her control.

Revis said her son, armed with a shotgun, showed up at her house on Poor Man’s Hollow off Dix Creek Road, while she was waiting with two deputies who had arrived in an unmarked, white SUV.

She said Evans fired the gun into the air while standing at the end of her driveway and told the officers to leave.

The deputies were responding to a 911 call Revis made after Evans threatened suicide earlier that day.

After Evans fired the gun, Revis said she tackled him to the ground.
“I was on top of Terry, and I had the gun,” she said Saturday. “Half of my body was on top of Terry.”

As Revis lay on her son, she said the deputy came over, stomped on the teenager’s chest five times and then shot him.

“If Terry had pointed the gun at them and shot, why didn’t they shoot him then?” she said.

On Friday, Medford said a deputy was in the driveway in his car when he heard the shot behind him. He said there was a struggle between Revis and her son over control of the shotgun when it was pointed at the officer. Medford could not be reached for comment Saturday evening.

Revis said neither deputy checked Evans’ status after he was shot.

Henry Ward, Evans’ uncle, said Saturday the shotgun was a single-shot and the round had already been fired by the time the officer shot him.

Betty Ward, Evans’ grandmother, said the experience of seeing her grandson dead on the ground made her reconsider the trust she had in local law enforcement.
“From what I’d seen the other night, and (if) I had an emergency, I wouldn’t call 911,” she said.

Evans was one of two people shot and killed by Sheriff’s deputies Thursday. Officers shot Gregory Keith Hensley while they were serving him with a warrant near Weaverville.

A release from the Sheriff’s office said the State Bureau of Investigation is investigating both incidents. The two officers involved were placed on administrative leave, a standard response when officers use deadly force.
Read more!

Children first to walk the plank of state 'reform' - Greensboro News-Record

By Louise Ahearn

Article published Jul 16, 2006

The bill for $150 from the Guilford County Sheriff's Office for "transportation" was, you might say, the icing on the cake. Or the last nail in the coffin.

It came in Rudy Kennedy's afternoon mail two weeks ago, a postscript to the withering, futile battle the Greensboro man waged on behalf of his mentally ill daughter Miranda.

She turned 15 Friday, but there was no party. After her Guilford Center caseworker was laid off this spring in the first phase of a statewide "reform" of the mental health system, a tenuous safety net beneath the severely bipolar, schizophrenic teen quickly unraveled.

First came her violent, uncontrolled attack on the staff at a group home in Sophia where the teen was placed. From Wesley Long's ER, she was sent to a holding facility at the Guilford Center's crisis unit, one of the few public mental health services being kept intact. For now, anyway.

Guilford workers tried to find a mental hospital to admit the teen, but there was none. Wake Forest University Baptist Medical Center took her for 10 days, but finding no "medical" (read, "reimbursable") reason to keep her, sent her back to the group home.

There, the whole cycle repeated itself, this time landing Miranda in juvenile detention and then court. In the end, a judge released the aggressive, out-of-control teen to -- guess who? -- her father. He works 50 hours a week driving a dump truck and has three other adolescents at home, one of whom is autistic.

"It was a complete, systemwide breakdown. They just bailed out on us," said Kennedy, who meanwhile had contacted 10 private agencies looking for a new caseworker with no success. "I burned up the phone lines, burned up the e-mails. Nobody would take our case. I am so done."

Well, now that you've heard the bad news about mental health reform -- the cost-cutting blunderbuss that was locked and loaded last week with Gov. Mike Easley's signing of the budget -- are you ready for the worse news?

That is, Guilford County is one of the best places in the state for the mentally ill. Compared with rural areas -- which make up most of North Carolina's square miles -- there are more options in Greensboro, where public services for mentally ill children were phased out June 30. Adult services are to follow by the end of December.

"The more rural you get, the more abysmal it gets, and children are being put way on the back burner," said Diane Bauknight, a western North Carolina advocate who is suing the state for failing to provide services for her adopted daughter. "There literally is no place to go. But in the Orwellian doublespeak of the state, the services are being 'enhanced.' When in reality, they're being gutted."

The whole reform push came after state auditors reported in 2000 that the system was fragmented and needed a massive overhaul. Toward that end, legislators began dedicating a trust fund to consolidate services and replace such outdated institutions as Dorothea Dix and John Umstead.

What happened next, in a nutshell, was that the economy went south in 2001, the trust fund went to balance the budget, and hospital beds continued to be cut with little to replace them. Hence, the "doublespeak."

"The reform effort was put out there; then it was essentially starved to death," said Greensboro resident Eileen Silber, a past national board member for the National Alliance on Mental Illness. "The most frustrating part is that we now have so much knowledge about what works -- which therapies, which medications. We can't seem to put it together."

With once-public casework and treatment services now being farmed out to HMO-type companies such as ValueOptions of Norfolk, Va., local mental health agencies will play an administrative, bean-counting role.

In areas such as Alamance, Caswell and Rockingham counties, which on July 1 formed a new, joint mental health administration, the big uncertainty is where private therapists, psychiatrists and social workers will be found to pick up the patients.

For children in crisis situations, the state is pledging "mobile response teams." But advocates across the state, noting that there is no mandate as far as child crisis care, ask where children go from there.

"If a mobile crisis team responds, what then?" said Buncombe County advocate David Cornwell, director of Mental Hope. "They get a change of scenery for a few hours and the crisis is magically over? Most crises are just not that way."

For Diane Bauknight, whose lawsuit against the state is pending, the answer was allowing her suicidal teenage daughter to be hospitalized in Georgia at a cost of $360 per day. She is, at least, alive -- unlike the group home resident who died in Charlotte in 2004 after being improperly restrained.

"I used to say, 'Somebody's going to have to die before they realize this has to change,' " Bauknight said. "Then somebody did die, and it didn't change. Not only did it not change, but there was no public outcry."

As for Kennedy, the Greensboro dump truck driver whose raging, bipolar, schizophrenic daughter was released to him by a judge? With no place that would take Miranda and no way for her to stay at home -- not with three siblings and a father working 50 hours a week -- there was only one choice left.

At Miranda's urging, Kennedy let her go live with an out-of-state relative -- an unstable arrangement the father knew to be unhealthy for the child. Two weeks after putting her on a plane, Kennedy walked to his mailbox and found the bill from Guilford County Revenue Collections.

"It was a statement with my 'balance due' for law enforcement transportation," Kennedy said, reading the bill for Miranda's ride in a squad car from the Guilford Center to Baptist. "And '$20 will be charged for returned checks.' "

Now, let's multiply the Kennedys' case by thousands across the state. Let's tally up the sorrow and misery when sick children go without treatment, without medicine, without a stable home where people love them. And let's ask ourselves.

Who gets to pay that bill?
Contact Lorraine Ahearn at 336-373-7334 or lahearn@news-record.com

Copyright © 2006
The News & Record
and Landmark Communications, Inc. Read more!

$100M dose for mental health - Asheville Citizen-Times

Amount one-third short of request

by Leslie Boyd, LBOYD@CITIZEN-TIMES.COM


published July 16, 2006 12:15 am

North Carolina’s faltering mental health system will be infused with nearly $100 million more in state funds in the coming fiscal year.

The Legislative Oversight Committee for Mental Health had requested about $150 million in additional money.

The way I see it, getting two-thirds of what you asked for in budget negotiations isn’t too bad,” said Allison Breedlove, interim director of the Governor’s Advocacy Council for Persons with Disabilities in Raleigh. “What remains to be seen is whether it’s effective.”

The state added $12.2 million for crisis services, plus $29 million more to pay for services for people with developmental disabilities that the federal government stopped paying for this year. The state also will pay an additional $7.2 million each for mental health and substance abuse services.

Arthur Carder, CEO of Western Highlands Network, was pleased at the news.

“This is the largest increase mental health has gotten in a long time,” he said. “It’s good news for consumers and families. I’m pleased to see the money for crisis care. We know what we need to do there — we’ve been planning and consulting for a long time. Now we just need to get it up and running.”

Some of the Legislative Oversight Committee recommendations weren’t funded at all, including a proposal to spend $1.2 million to create a consumer advocacy committee.

“If you have a system that is supposed to be consumer-driven you should fund consumer advocacy,” Breedlove said. “It’s about oversight and accountability, and that’s something fundamental that’s lacking in this state.”

The committee also proposed a 5 percent tax on liquor that would put money into the state’s mental health trust fund, but it wasn’t adopted.

“That leaves us without a designated revenue stream for the trust fund,” said David Cornwell of North Carolina Mental Hope, an advocacy group.

The trust fund is supposed to help with community-based program start-up costs and other issues related to mental health reform.
The state has put $14 million into the trust fund, but Cornwell believes it shouldn’t be funded year-to-year as it has been.

“Advocates need to look at this year’s budget as a good start and continue to work toward the $285.5 million recommended earlier this year by the N.C. Psychiatric Association, money to be spent exclusively for mental health funding,” he said.

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

TEXT Read more!

Mental health overhaul worries many - Greensboro News-Record

Sunday, July 16, 2006

By Nate DeGraff
Staff Writer

GREENSBORO - Gavin Hoover, a big, bespectacled middle schooler, should have been home playing video games or teasing his sister. Instead, he was back in the hospital.

Gavin has bipolar disorder, a condition that causes dangerous mood swings. Last fall, he became so angry and prone to outbursts that his mother had to check him into the hospital. He needed 24/7 attention; she needed help.

Then, in a stroke of good fortune, Nichole Pulliam found the Guilford Center, the county's mental health agency. A caseworker started arranging her son's appointments with the schools and a therapist, relieving her of those weighty responsibilities.

"She hooked us up with everything that we've got now," Pulliam said. "She did it all. I mean, none of it's anything that I went after myself. ... She was an amazing, amazing lady."

But that happy relationship ended this spring because North Carolina is changing the way it cares for mentally ill people. The idea is to treat people in their communities, surrounded by family and friends, rather than at large state institutions.

As a result, the Guilford Center is slashing jobs and shuffling families off to outside groups. Pulliam was told that she'd have to find somebody else to help Gavin.

Once again, Mom is doing more.

Like many of the 16,000 people who receive mental health care through the Guilford Center or the groups it contracts with, Gavin faces an uncertain future. Under the state's multiyear play for mental health reform, the agency is cutting a hefty chunk of its programs, eventually leaving sick people and their families to fend for themselves in the labyrinthine world of private mental health care.

Gone will be the Guilford Center's case management programs for mentally ill adults and children, along with special services for people with crippling developmental disabilities. Private groups are supposed to provide the services.

"Some of these families, they literally live and die on these services," said John Ansbro, executive director of Arc of Greensboro, a group that helps people with mental retardation and expects to add 20 to 30 families to already full case rolls.

"This is going to be a disaster waiting to happen," he said.

Mental health advocates got good news last week when state officials put an extra $95 million for mental health care in the new budget. But advocates worry that the money might not be enough and that local nonprofits already full of patients won't be able to handle the extra workload. Advocates say that could overburden police, emergency rooms, homeless shelters and jails with mentally ill people.

"You take someone that doesn't have enough sense to come out of the rain and you tell them to go to this agency or another one, what do you think are the chances of them going?" Guilford County Sheriff BJ Barnes asked.

"Some of these folks are going to end up in our jail," he said.

"It is a devastating cycle," the Mental Health Association in Greensboro wrote in a statement released this year. "When you cut mental health services, problems erupt elsewhere."

Much of the fallout will occur over the next several months, when the Guilford Center continues cutting 135 jobs from its payroll. Fewer than 180 positions will remain.

Many of the affected employees are caseworkers, the sorts of people who navigate the technical, acronym-filled world of mental health so parents don't have to. As county employees, they've been able to take advantage of the state's pension system, and their salaries are generally higher than what people make in the private sector.

Ansbro says someone making $40,000 at the Guilford Center would earn only about $35,000 with his group, and the retirement benefits aren't nearly as good.

Some employees who were working in the Guilford Center's child unit, which was shut down last month, are headed to the county's Department of Social Services. Others are going to ValueOptions, the Virginia company that the state has charged with doling out Medicaid payments to the private groups, taking over those responsibilities from public agencies such as the Guilford Center. Many others haven't found jobs yet, said Paul Evans, the agency's provider services director.

So in the end, fewer people could be caring for mentally ill young people in Guilford County.
Finding help
Most of the time, Gavin is a lot like other 13-year-olds. He plays basketball and baseball. He's a worldbeater at his football video game. He joshes around with his 6-year-old sister, Emileigh.

But Gavin is different. At age 3, doctors diagnosed an attention deficit hyperactivity disorder. The bipolar diagnosis was added later.

Gavin is what doctors call an "ultra-rapid cycler," meaning that his moods can swing from good to bad several times in the same day. And with an IQ below 70, he has mild mental retardation. Throw in the ups and downs that accompany adolescence, and his mom has her hands full.

When Gavin's up, he's laughing and giggling a lot. But then he starts losing sleep. He gets agitated. When that happens, his mother says, it starts getting ugly.

When Gavin's down, he's way down. It's hard to get him out of bed.

According to people who know him, Gavin wasn't getting the care he needed for most of his life. Because he was mentally disabled as well as bipolar, his mother said, some medical centers refused to treat him. And when he was hospitalized last fall, his mom felt that the psychiatrist who had been seeing him was overbooked and didn't have enough time for Gavin, who was in the middle of a manic episode that wouldn't go away.

But at Brenner Children's Hospital in Winston-Salem, the family caught a break. A social worker recognized that the family needed help and called the Guilford Center.

Enter caseworker Leola Avery. She stepped into a tough situation.

"(Gavin) seemed to lash out for no reason at all," Avery recalled. "He would threaten you. He was harmful to himself, as well as to other people."

Avery looked after all aspects of Gavin's mental health care. She dealt with his special learning plan at school. She set up psychiatric appointments. She made sure his medications were lined up. And when Mom needed time off, as parents of mentally ill children often do, Avery would arrange for someone else to look after Gavin.

Things got better. For the first time, Pulliam didn't have to set up everything for her son. The stay-at-home mom even thought about going back to work so her husband, Gavin's stepfather, wouldn't have to shoulder the family's financial burden by himself.

And Gavin was improving, too. With Avery's help, Gavin was seeing the right people, getting the right medications.

His mom said: "When his meds are right and he's stabilized, he's just as normal as you and I."

Marveling at all this was Gavin's godmother, Shanon Armfield, who had watched for years as Pulliam and Gavin kept struggling to find Gavin the right care.

"They're the first place that really did him any good," Armfield said of the Guilford Center.

By spring, Avery said, Gavin had "more better days than bad days."
Moving on
But the experience was short-lived.

Earlier this year, when cuts at the Guilford Center were starting to unfold, Pulliam got word that Avery wasn't going to be watching over Gavin anymore.

The family still uses the psychiatrist and other services that Avery found for them, but Pulliam worries about what will happen when Gavin becomes manic again. And she worries about wading through the inch-and-a-half-thick list of mental health groups to find the right people who can help her son.

And she has abandoned plans to get a job anytime soon.

Now, Gavin has a therapist, Monica Williams, who does some of the things that Avery used to do, but it's not the same as a professional case manager immersed in the system.

"They made friends," Pulliam said. "They know people everywhere. They can do recommendations. And now ... it's like an interview process. You just have to try so many until you find one that you know will fit."

Pulliam and her son have lost something else, too: comfort.

"It feels like the minute you finally get something that you can rely on," Pulliam said, "it's gone."
Contact Nate DeGraff at 373-7024 or ndegraff@news-record.com
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Facilities' violations going public - Raleigh News & Observer

Facilities' violations going public

The state will post case information on nursing homes and adult care homes online

THOMAS GOLDSMITH, Staff Writer

Beginning in October, serious violations and fines levied against North Carolina nursing homes and assisted living facilities will be posted online.

A state Department of Health and Human Services spokesman said Wednesday that the department will post the information for nursing homes and adult care homes, including in cases in which a resident has died or been put in danger of serious injury. The information will include fines, which can reach as much as $20,000.

The department's decision to publish the information came as a proposed state law mandating the postings had apparently stalled.

Opposition and questions from the long-term care industry had mounted against the bill, which was held up in the Senate Health Care Committee after passing the House unanimously in June, said committee co-chairman Sen. Bill Purcell. Organizations advocating for older North Carolinians were still rallying support for the bill early Wednesday.

"If we go through the process of finding a severe issue and levying a fine, you ought to be able to find that information out, and it shouldn't be difficult to do," said Bill Lamb, of the Institute on Aging at UNC-Chapel Hill.

Roger Bone, a lobbyist representing N.C. Association of Long-Term Care Facilities, said his industry opposed the bill as a matter of fairness.

"They pick out assisted living and rest homes, and they do not cover other providers," such as in-home care and group homes, Bone said.

In addition, he said, the state is adding additional ombudsmen and inspectors for long-term care while failing to pay adequate rates to the facilities to ensure good care.

Bill Wilson, a lobbyist for AARP, called the state's decision to post violations "a good consumer move."

Fines against nursing homes and assisted living facilities, or rest homes, are assessed after a lengthy process involving reports by county and state investigators, deliberation by the Division of Facility Services and opportunities for response by facility owners at several steps along the way. People who want information about violations now have to go to county social services departments or to the Division of Facility Services to sift through records in person.

"This is something we can do whether this bill passes or not -- it's in the plan for us to do it," said Jim Jones, spokesman for DHHS. "They are targeting having it up and running at approximately the same time that the bill calls for."

State Rep. Jennifer Weiss, a Cary Democrat and co-sponsor of the legislation, noted that the bill followed a recommendation by the state's Study Commission on Aging.

"I think it's very important information that should be easily accessible to the public," Weiss said.

In Wake County, the Division of Senior and Adult Services maintains a comprehensive listing of assisted living facilities, including any past violations. The site is visited 4,000 to 5,000 times a month, said Gail Holden, division director.

"If a penalty is assessed, that is as far as we go," Holden said. "What we don't have information on is, what was the end of the negotiation process? Sometimes the facilities pay in full; sometimes it's a few hundred here and a few hundred there."

Staff writer Thomas Goldsmith can be reached at 829-8929 or tgold@newsobserver.com.

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Buncombe deputies kill 2 men - Asheville Citizen-Times

By Clarke Morrison

CMORRISON@CITIZEN-TIMES.COM

July 15, 2006 12:15 a.m

ASHEVILLE — In two separate, fatal shootings Thursday night, Buncombe County deputies believed
their lives were in danger and were justified in using deadly force, Sheriff Bobby Medford said Friday.��

Medford said the suspects in both cases pointed guns toward deputies.

His department’s policy calls for deputies to use deadly force when, “The officer’s life or
the life of someone else (is) in danger,” he said.

Deputies get instruction on when to fire at a suspect during twice yearly firearms training,Medford said.

In one of the shootings, a deputy trying to serve a warrant shot and killed a man inside a home near Weaverville after the suspect pointed a gun at him, the sheriff said.

In the other, a deputy who responded to a call about a 17-year-old contemplating suicide shot the teen when the suspect aimed a shotgun at the officer outside his Leicester home.

Medford said both deputies were placed on administrative leave, standard procedure in such cases, and the State Bureau of Investigation is investigating both cases.

A local SBI official referred questions to an SBI spokeswoman who could not be reached Friday

Those cases followed, by just more than a week, the fatal shooting of a man in his car by an Asheville Police officer in the parking lot of the Cracker Barrel restaurant on Smoky Park Highway. Authorities said the suspect tried to run over officers with his car.


The Bureau of Justice Statistics and the FBI do not keep figures on the use of deadly force by officers, spokespeople for the agencies said Friday.

But Medford and others said the use of deadly force is extremely rare, given the number of contacts that officers have with suspects.

“Usually, you may have one every two or three years or something like that,” the sheriff said

Asheville Police Chief Bill Hogan called it a “strange fluke” to have deadly force used three times in the span of eight days in the area.

“It just shows that these kinds of circumstances can happen anytime, anywhere and anyplace,” he said. “And officers have to be prepared to respond in a split second to defend themselves or innocent people.”

Read more!

Study finds single women predominate in caring for disabled kids - Associated Press

The Associated Press

RALEIGH, N.C.
Children with disabilities are more likely to live with a single woman - whether a mother, grandmother or a female foster parent - than other children, according to a new study.

The researchers at the University of North Carolina at Chapel Hill also found that single mothers are five times more likely than single fathers to care for a child with disabilities.

The findings indicate that organizations aimed at helping disabled children must also consider the particular problems faced by the single women who often care for them, said Philip Cohen, an associate professor of sociology at the university.

“In the patchwork of arrangements to care for children with disabilities, we have to realize that the system is also dealing with issues of gender equity,” Cohen said.

“I don’t want to portray the care for children with disabilities as simply a burden, because this is a labor of love for many people. But if we’re trying to help families, we have to consider the special challenges they face.”

The study, conducted by Cohen and his former student Miruna Petrescu-Prahova, now a doctoral student at the University of California, Irvine, was published Friday in the quarterly Journal of Marriage and Family.

The study examined 2000 Census data on 2.3 million children ages 5 to 15. More than 130,000 were reported to have mental and/or physical disabilities.

It found that while 62 percent of children without disabilities live with a married, biological parent in a two-parent home, the same can be said for fewer than half - 46 percent - of disabled children.

Single mothers care for 17 percent of children without disabilities, but for 24.5 percent of those who are disabled. Fewer than 5 percent of disabled children live with a single father, about the same percentage of non-disabled children living with fathers.

In homes where no biological parent is present, Cohen said disabled children were more than twice as likely to be cared for by a single woman than were children without a disability.

The findings are not particularly surprising, but offer a different perspective the challenges faced by single, female caregivers, said Avis Jones-DeWeever, director of poverty, education, and social justice programs at the Institute for Women’s Policy Research in Washington, D.C.

The institute’s own research has shown an inordinate number of women getting government aid are either themselves disabled or taking care of a disabled child, Jones-DeWeever said.

Single mothers often have multiple challenges causing them to fall through the cracks of existing assistance programs, she said. She agreed with Cohen that his data show “perhaps we need to think more concretely about what kinds of policy supports these families need.”

Both said the largest unanswered question in all the research is why women end up dominating such caretaker roles. Most probably, it’s simply “the cultural norms and a combination of what we as women tend to do,” Jones-Deweever said.

“Frankly I just believe one trait that women have - that we have a right to be proud of- is that we roll up the sleeves and get the job done.” Read more!

Serving of warrants has fatal ending in Weaverville - Asheville Citizen-Times

CITIZEN-TIMES.com

By Andre A. Rodriguez
ARODRIGUEZ@CITIZEN-TIMES.COM

July 15, 2006 12:15 am

WEAVERVILLE - Gregory Keith Hensley had a gun pointed at two deputies when he was fatally shot during a confrontation inside his uncle's Weaverville home, Buncombe County Sheriff Bobby Medford said Friday.

Medford, in releasing some details of the Thursday night shooting for the first time, said Hensley was moving toward the deputies in a hallway when a deputy fired a single shot.

The sheriff's account differs from that of family members in the number of shots fired, though family at the home said they place no blame for the killing on deputies.

Jerry Weese said he was inside his Dula Springs Road house when deputies tried to serve a warrant against Hensley that stemmed from charges he pulled a gun on Weese's stepson earlier that day.

Weese said he heard three shots fired about 9:30 p.m. Three bullet holes in a wall near where Hensley was killed bear similar testimony.

Medford could not be reached for comment on the discrepancy.

Family members described Hensley, who they said was 44 and from Lawrenceville, Ga., as a good man but mentally unstable since a motorcycle accident more than 20 years ago left him with brain damage.

Unemployed, Hensley lived with his parents and helped to care for his mother, who is disabled from polio.

"He's not mentally all there, but he's still a good person," Christina Tackett said of her cousin. "He's gotten worse over the years."

Weese said Hensley was "slow," but also a gentleman.

Tackett said he had trouble with short-term memory, often forgetting somebody he just met.

She said she thinks the officers acted in self-defense. Family members said it was common for Hensley to be carrying a weapon.

Weese said he found a loaded .44 Magnum among his nephew's possessions Friday morning, and Tackett said they had also found a .22-caliber pistol.

Hensley had been staying with the Weeses for two days before the shooting and was making plans to move to Weaverville from Lawrenceville with his parents.

"He was good-hearted," Weese said. "This to me is not Greg. I don't know what happened."
TEXT Read more!

Mental-health storm approaches - The Advocate, Baton Rouge, LA

Agencies brace for 'anniversary reaction' among Katrina victims

By EMILY KERN_Advocate staff writer _Published: Jul 15, 2006

As the one-year anniversary of Hurricane Katrina approaches next month, mental health experts are preparing hurricane victims to deal with a surge of emotions expected around the day they experienced the trauma.

Psychological literature refers to this as anniversary reaction.

Clinical and neuropsychologist Dr. Darlyne Nemeth has teamed up with several groups to offer hurricane anniversary wellness workshops for adults beginning today.

The workshops will be held at the Bishop Robert E. Tracy Center, 1800 S. Acadian Thruway.

Later workshops will be held July 22 and July 29. The workshops, which are free and include lunch, are from 9:30 a.m. until 4:30 p.m.

According to the National Mental Health Information Center, “as the anniversary of a disaster or traumatic event approaches, many survivors report a return of restlessness and fear.”

Anniversary reaction is defined as a person's response to unresolved grief resulting from losses.

It can involve several days or even weeks of anxiety, anger, nightmares, flashbacks, depression, or fear.

Nemeth, of The Neuropsychology Center of Louisiana in Baton Rouge, said people are having significant anniversary reactions to hurricanes Katrina and Rita. Katrina struck the Gulf Coast on Aug. 29, while Rita hit southwest Louisiana and Texas on Sept. 24.

“People are getting nervous about it,” Nemeth said. “They're upset.”

Nemeth pointed to the closeness of many New Orleans neighborhoods and the fact that many evacuees now are isolated in FEMA trailer parks.

“What I do know about New Orleans - the neighborhood was everything,” Nemeth said.

People met at the corner grocery store and talked with neighbors on their front porches.

“They don't have that at the FEMA trailer parks,” she said.

Gilda Butler, herself a hurricane evacuee and the chief social worker for Louisiana Spirit, participated in a session last month to evaluate the workshop.

Louisiana Spirit is a grant program for crisis counseling paid for by the Federal Emergency Management Agency.

Butler, who lived in New Orleans before Katrina, spent several months living on the grounds of East Louisiana State Hospital in Jackson with other state mental health workers.

The group was serving patients evacuated from the Mandeville and New Orleans areas.

Two months ago, Butler said, she found an apartment in Baton Rouge. Her husband is living in a trailer in New Orleans.

“Those who have gone through it, of course, are having some anxiety,” Butler said.

Even those not affected personally watched the aftermath on television or read about it in the newspapers, she said.

Now, people are worried about the current hurricane season and still trying to restore their homes and move back, she added.

Butler said she found several parts of the workshop helpful.

“The experiences that people have will be different for each person,” she said.

Louisiana Spirit crisis counselors will be at the workshop as group facilitators, Butler said. And local mental health authorities also were notified so they can follow-up with people as the anniversary approaches.

The workshops will allow adults to recognize their feelings and what may happen as the anniversary gets closer, Nemeth said.

The workshop will not be a lecture, she said. Rather, people will be doing something - performing exercises and talking and interacting within their groups.
Read more!

Buncombe Deputies Kill 2 - Asheville Citizen-Times

By Clarke Morrison

CMORRISON@CITIZEN-TIMES.COM

July 15, 2006 12:15 a.m

ASHEVILLE — In two separate, fatal shootings Thursday night, Buncombe County deputies believed
their lives were in danger and were justified in using deadly force, Sheriff Bobby Medford said Friday.��

Medford said the suspects in both cases pointed guns toward deputies.

His department’s policy calls for deputies to use deadly force when, “The officer’s life or
the life of someone else (is) in danger,” he said.

Deputies get instruction on when to fire at a suspect during twice yearly firearms training,Medford said.

In one of the shootings, a deputy trying to serve a warrant shot and killed a man inside a home near Weaverville after the suspect pointed a gun at him, the sheriff said.

In the other, a deputy who responded to a call about a 17-year-old contemplating suicide shot the teen when the suspect aimed a shotgun at the officer outside his Leicester home.

Medford said both deputies were placed on administrative leave, standard procedure in such cases, and the State Bureau of Investigation is investigating both cases.

A local SBI official referred questions to an SBI spokeswoman who could not be reached Friday

Those cases followed, by just more than a week, the fatal shooting of a man in his car by an Asheville Police officer in the parking lot of the Cracker Barrel restaurant on Smoky Park Highway. Authorities said the suspect tried to run over officers with his car.

The Bureau of Justice Statistics and the FBI do not keep figures on the use of deadly force by officers, spokespeople for the agencies said Friday.

But Medford and others said the use of deadly force is extremely rare, given the number of contacts that officers have with suspects.

“Usually, you may have one every two or three years or something like that,” the sheriff said

Asheville Police Chief Bill Hogan called it a “strange fluke” to have deadly force used three times in the span of eight days in the area.

“It just shows that these kinds of circumstances can happen anytime, anywhere and anyplace,” he said. “And officers have to be prepared to respond in a split second to defend themselves or innocent people.”

Read more!

Mental health providers can be successfully located with pediatricians

Note from advocate Diane Bauknight:  This article says children can receive up to 26 therapy visits per year. Medically necessary therapy for children who are Medicaid eligible CAN NOT be limited without violating federal EPSDT law. Go to www.healthlaw.org for more information.
 
Contact: Robert Conn
rconn@wfubmc.edu
336-716-4587

Wake Forest University Baptist Medical Center

Mental health providers can be successfully located with pediatricians

WINSTON-SALEM, N.C. – Mental health providers can be successfully located with or in pediatric practices, according to researchers at Wake Forest University Baptist Medical Center and the N.C. Chapter of the American Academy of Pediatrics.

Writing in the journal Clinical Pediatrics, the researchers said, "With the increased need for identification, diagnosis and treatment of mental health disorders in primary health care settings, location of mental health providers in primary care practices is a concept whose time has come." The article is being published online today. Jane Williams, Ph.D., the lead author, and colleagues describe three practice models, all of which were financially sustainable.

"Across all three models, enhanced communication between medical and mental health providers was consistently perceived as improving quality of care for patients, increasing comfort in diagnosis and treatment of behavioral health disorders by physicians and providing educational opportunities between disciplines," Williams said. "Pediatricians perceived themselves to be more efficient in their practices."

In one model, a practitioner who was employed by a community Mental Health Center was stationed in a large pediatric practice, Aegis Winston East. Williams said the model "provided more convenience for patients, less stigma and better communications with primary care physicians."

In the second model, a master's degree-level, licensed psychological associate was directly employed by a private pediatric practice in Washington, N.C., that assumed all responsibility for expenses and reimbursement. The practice chose that type of practitioner because of a contract with the local school system to provide psychological testing services.

Other services included diagnostic interviews, individual and family therapy and informal consultation with the physicians in the practice, Washington Pediatrics.

In the third model, a self-employed psychologist practiced in the same suite of offices with a rural pediatric practice in Sylva. High demand for mental health services resulted in the addition of a second psychologist, a clinical social worker and a psychological associate.
Patients said that having the two offices together "contributed to a high level of satisfaction and trust," Williams said. "Pediatricians indicated increased confidence in prescribing psychotropic medications due to exposure to the mental health group as well as increased skills in caring for children who had been hospitalized for mental health disorders."

While some practices have had mental health professionals working directly with them for years, reimbursements came only from private insurers. Until recently, children with mental health diagnoses who 1qwere on Medicaid could be treated only in public clinics.

A number of changes in N.C. Medicaid policy allowed mental health providers to serve a mix of Medicaid and privately insured children. Up to 26 visits annually per child are now permitted, which can be billed to Medicaid either by a primary care provider or a mental health professional.

###
Coauthors were Jane Meschan Foy, M.D., of the Department of Pediatrics and Steven E. Shore, M.S.W., of the N.C. Chapter of the American Academy of Pediatrics.
Media Contacts: Robert Conn, rconn@wfubmc.edu, Shannon Koontz, shkoontz@wfubmc.edu, or Karen Richardson, krchrdsn@wfubmc.edu, at (336) 716-4587.
Wake Forest University Baptist Medical Center is an academic health system comprised of North Carolina Baptist Hospital and Wake Forest University Health Sciences, which operates the university's School of Medicine. The system comprises 1,187 acute care, psychiatric, rehabilitation and long-term care beds and is consistently ranked as one of "America's Best Hospitals" by U.S. News & World Report. Read more!

Helping Children In Earliest Years Is Most Cost-effective Use Of Public Funds, Authors Say - Stanford University

Laying out the scientific basis for why helping all kids have the best early experiences is good economic policy.
--------------------------------------

With flashy toys, expensive classes and music compilations all promising to make your child smarter, it's hard to sort out the best way to help your child's brain thrive. A new policy paper helps put those worries to rest. The gist of the paper is this: what kids need is a secure relationship with adults who adore them.

"It's all about playing with your child," said Eric Knudsen, PhD, the Edward C. and Amy H. Sewall Professor in the Stanford University School of Medicine, succinctly summing up a paper coming out in the June 27 advance online issue of the Proceedings of the National Academy of Sciences. A child's eventual ability to learn calculus or a second language, he explained, starts with the neurons that are shaped by positive interactions with nurturing adults.

The piece, written by Knudsen and three other members of the National Scientific Council on the Developing Child including Nobel Prize-winning economist James Heckman, PhD, doesn't just ease parents' toy-buying decisions - it lays out the scientific basis for why helping all kids have the best early experiences is good economic policy.

Their argument is based on work from the diverse fields of economics, neurobiology, developmental psychology and public policy. Working independently, the four authors each came to the conclusion that the earliest years of life forever shape an adult's ability to learn. Although much research has been published on the value of positive early experiences, this paper pulls those strands together into an integrated message that the group hopes will help guide public policy in the future. They've already influenced legislation in Washington state and Nebraska and have begun working with lawmakers around the country with a nonpartisan partner, the National Conference of State Legislatures.

BUILDING A BETTER BRAIN

Jack P. Shonkoff, MD, chair of the National Scientific Council on the Developing Child and an author on the paper, said that as more and more unskilled jobs move overseas, the United States needs a well-educated work force to stay economically strong. Getting that work force means making sure more kids are able to benefit from their education; that means making sure their brains are well-prepared to learn.

"This paper addresses the debate about how we invest in human capital and puts a strong scientific stake in the ground," said Shonkoff, a former dean of the Heller School for Social Policy and Management at Brandeis University who is moving to Harvard University as founding director of the newly established Harvard Center on Children. "With all the attention currently focused on K-12 education reform and job training for adults with limited skills, this paper says that the biggest bang for the buck will come from investing in the earliest years of life, well before the kids start school."

Californians encountered this argument earlier in June when they voted down a proposition to support preschool for all kids in the state. However, the paper goes beyond the debate over preschool for 4-year-olds and emphasizes the importance of early experiences on the development of basic brain architecture from birth.

The paper, written under the auspices of the National Scientific Council, aims to help guide policy-makers struggling to write legislation that will have the most benefit for kids and make the best use of tax-payers' money.

Evidence for their argument comes in part from Knudsen's research on the brains of young owls, where he has shown that the earliest experiences change the types of connections that are made between neurons in the brain. Those brain connections last throughout the life of the animal and result in adults with differing abilities to learn new skills.

Knudsen's findings about how experiences shape the brain's architecture help explain findings in both rats and monkeys, where early experiences translate directly to how the adults behave and learn. Co-author Judy Cameron, PhD, professor of psychiatry at the Oregon National Primate Research Center, has found that monkeys prevented from forming a strong bond with their mothers as infants go on to be less social, less likely to investigate new situations and more prone to anxiety as adults.

Shonkoff said the animal work has an important parallel in human development. For example, kids who are abused or neglected, whose parents are compromised by drugs, alcohol or depression, who are shuttled among relatives and foster-care placements or who spend long hours in poor-quality child-care programs don't develop the same brain power as kids with happier, more nurturing and stable childhoods. Those kids have less chance of securing skilled jobs when they grow up. They are also more likely to need expensive remedial help in school or-even more costly-rely on public assistance or serve jail time as adults.

"What we're pointing out in this paper is that the earlier you spend money on disadvantaged people the more cost-effective it is," Knudsen said. In contrast, programs that spend money on school-age kids or on adults rarely have the same return in terms of future productivity.

FROM SCIENCE TO POLICY

The PNAS paper is the latest publication from the Scientific Council. The group has published four working papers on different topics relating to childhood health and development. In each case, the council digests the most current science into a form that lawmakers can use.

State Representative Ruth Kagi (D-Wash.) finds these summaries invaluable. "Law-makers don't have the time to do the reading that we want to do on a wide range of subjects. They translate the science into brief summaries that we have time to read," she said.

Kagi has worked with Shonkoff to develop policies in Washington state to support young children. She said that in politics most arguments revolve around philosophical differences. Should the government get involved in children's lives? Which is a better use of the government's money, home visits or after school programs? "This information gives us a scientific argument for changing policies not just a philosophical one," she said.

Kagi, who is the chair of the Washington House of Representatives Children & Family Services Committee, led legislation to form the Council for Early Learning in Washington. The bill had support from the Bill & Melinda Gates Foundation, Wells Fargo, Boeing and others in private industry. Kagi said that the Gates Foundation and Boeing have been long-time advocates for improving K-12 education. "They've all come to the conclusion that we are starting too late," she said.

Legislators in both Nebraska and Arizona are also working with Shonkoff and other members of the council to write policies of their own. He added that there are many different ways of implementing good policy, which vary with local politics. Kagi's is one, but anything that takes into account the need for kids to have strong, stable relationships with their parents or other caretakers passes muster.

"The key issue is the nature of kids' relationships with the important people in their lives. It's not about the toys, it's about the human connection," Shonkoff said.
Read more!

Brief CBT improves schizophrenia outcomes - British Journal Pscyhiatry

Brief CBT improves schizophrenia outcomes
05 July 2006
Br J Psych 2006; 189: 36-40

Brief cognitive–behavioral therapy (CBT) administered by psychiatric nurses can improve medium-term outcomes in patients with schizophrenia, UK physicians say.

Their claim is based on a randomized study that assessed the durability of brief CBT in relation to recovery, symptom burden, and readmission to hospital. The short-term effectiveness of the intervention has been reported previously.
Study participants were 336 adults with an ICD-10 diagnosis of schizophrenia at six sites in the United Kingdom, 211 of whom received brief CBT while the remainder received usual care.

The CBT intervention comprised six weekly sessions administered by trained mental health nurses and aimed to improve patients' understanding, develop their coping skills, and help them take more control over their illness.

"This brief intervention is technique-based and should not be confused with formulation-based and schema-focused CBT for treatment resistance," note Douglas Turkington (University of Newcastle-upon-Tyne) and fellow researchers in the British Journal of Psychiatry.

At 1-year follow-up, participants who received CBT showed a range of significant benefits that were not experienced by those assigned to usual care.

For instance, they had significantly more insight, fewer negative symptoms, less time spent in hospital, and a delayed time to admission, compared with patients who received usual care. However, brief CBT did not improve psychotic symptoms or occupational recovery, and did not have a lasting effect on overall symptoms or depression at follow-up.

Turkington and coauthors conclude: "Brief CBT offered to patients with schizophrenia and their carers appears to have beneficial effects, which should encourage training providers to support the development of more training courses with continuing supervision from experienced therapists."
TEXT Read more!

Comorbid BPD, bipolar disorder under scrutiny - American Journal of Psychiatry

05 July 2006
Journal Abstract: Am J Psych 2006; 163: 1173-1178

Borderline personality disorder (BPD) and bipolar disorder often coexist but do not necessarily herald a worse prognosis, results of a prospective study indicate.

John Gunderson (Brown University, Providence, Rhode Island) and coworkers tested whether BPD is a variant of bipolar disorder by examining rates of co-occurrence in a longitudinal course.

In all, 196 patients with BPD and 433 patients with other personality disorders (eg, schizotypal, avoidant, or obsessive-compulsive) were assessed at baseline, 6, 12, 24, 36, and 48 months.

As reported in the American Journal of Psychiatry, both prevalent and incident bipolar disorder were significantly more frequent among BPD patients than in those with other personality disorders.

At baseline, 19.4% of patients with BPD also had bipolar I or II disorder, versus just 7.9% of those with other personality disorders.

During follow-up, 8.2% of BPD patients were newly diagnosed with bipolar I or II disorder, compared with 3.1% of other individuals.

Interestingly, however, the co-occurrence of bipolar disorder did not seem to influence the course of BPD, with similar proportions of patients achieving remission by the end of follow-up. Bipolar disorder also did not affect global assessment of functioning scores, hospitalizations, or use of antidepressants, neuroleptics, or anticonvulsants.

Gunderson et al note that it is unusual for BPD patients not to have been diagnosed with bipolar disorder, despite the absence of a strong association suggested in this study.

"Clinicians are frequently reluctant to give patients a diagnosis of BPD because it is viewed negatively and is treated most effectively when specialized services… are used," they write.

"In fact, however, a diagnosis of BPD offers patients a reasonable hope for a future that will not require ongoing mental health intervention."
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Budget plan highlights

The Associated Press

Highlights of the $18.87 billion final spending plan for the 2006-07 fiscal year approved Thursday by the House and Senate. The monetary figures reflect adjustments to the two-year budget the legislature approved last year.
Salaries and benefits

- average 8 percent salary increase for public school teachers and 6 percent raise for community college and university faculty, with 2 percent one-time bonus for community college faculty and professional staff; 5.5 percent raise for most state workers: $664.1 million.

- additional 30-year salary step for public school teachers: $10.8 million.

- University of North Carolina system faculty recruitment and retention salary fund: $5 million.

- raise salaries of public school janitors, service workers and other non-certified employees to at least $20,112: $8.6 million.

- 3 percent cost-of-living raise for state retirees: $27.1 million.

- fourth installment of five-year retirement system payback: $30 million.

Public schools

- meet projected increased enrollment of 18,363 students: $77 million.

- use lottery money to pay for class-size reduction efforts: -$127.9 million.

- compensate for lower than expected civil fines and forfeiture collections: $30 million.

- restore money to local school districts for previously ordered spending reductions: $44.3 million.

- expand funding to all school districts to help students most at risk of academic failure: $27 million.

- provide full funding for low-wealth school districts: $41.9 million.

- evaluate Disadvantaged Student Supplemental Fund and low-wealth district funding: $500,000.

- increases funding for exceptional children from $2,966.65 per student to $2,972.52: $1 million.

- fund ABCs of Public Education teacher bonuses: $90 million.

- expand “Learn and Earn” high school initiative from 15 schools to 34, with planning money for 20 more: $9.7 million.

- expand number of small specialty high schools from 11 to 32 and provide planning money for 10 more: $4.5 million.

- fund North Carolina Virtual Public Schools initiative: $2.8 million.

- upgrade public school broadband connectivity: $6 million.

- hire 100 literacy coaches at schools with eighth graders: $4.8 million.

- begins pilot program in three school districts to each provide salary supplements to 10 new math and science teachers: $515,000.

- support short-term contracts for long-delayed NCWISE computer grade book: $1.9 million.

- Kids Voting NC Funds: $250,000. University of North Carolina system

- hire professors, staff and pay for other items to meet projected enrollment increase of 7,110 students: $79 million.

- increase need-based financial aid for additional 1,730 students this fall and cover higher prices for other students: $21.6 million.

- create graduate nursing scholarship loan program: $1.2 million.

- expand Area Health Education Centers, educate psychiatrists to serve rural areas: $1.4 million.

- expand “Translational Medicine” program at UNC-Chapel Hill medical school: $2.5 million.

- first-year cost of UNC's share of North Carolina Research Campus in Kannapolis: $6 million.

- operating support for biotechnology initiatives at N.C. Central University and N.C. State University: $4.5 million.

- construct Family House at UNC Hospitals, a 40-bedroom facility to provide housing to patients and family members visiting the hospital: $1 million.

- additional focused growth, special needs campus funds (10 campuses): $2 million.

- increase research at N.C. Progress Board: $200,000.

- scholarships and grants to schools attending N.C. private colleges: $7.8 million.

- continue UNC-community college systems' 2+2 E-Learning Initiative: $1 million.

- expand prospective teacher scholarship loan program: $1 million.

- expand Future Teacher of North Carolina Scholarship Loan Program: $325,000.

Community colleges

- meet projected increased enrollment of 2,277 students: $7.1 million.

- multicampus college enrollment growth: $601,000.

- provide one position for administration of financial aid program at each college: $3.6 million.

- purchase of instructional equipment: $10 million.

- creates competitive grant program for campuses for facility and equipment needs and for allied health projects: $20 million.

- improve nursing programs: $1 million.

- fund Rowan-Cabarrus Community College Biotechnology Training Center and Greenhouse at new North Carolina Research Campus in Kannapolis: $2.2 million.

- operation of N.C. Military Business Center: $1 million.

- mobile video conferencing equipment at eight colleges: $120,000.

Health and Human Services

- revise Medicaid program expense forecast: -$150 million

- inflation reimbursement rate increases for Medicaid providers: $12 million.

- 200 additional slots for Community Alternatives Program: $3 million.

- adjust reimbursement rates for skilled nursing facilities: $1.5 million.

- inflation rate increase for home health and personal care services providers: $1.5 million.

- cap counties' share of Medicaid at 2005-06 levels: $27.4 million.

- reduce funding for Governor's Vision Care Program: -$1.5 million.

- expand early intervention program for children up to age 3 in Division of Public Health, hire 141 workers: $7.1 million.

- expand coverage of influenza, pertussis vaccines: $5.5 million.

- permanent funds for 65 school nurses: $3.3 million.

- fund grants for Community Focused Eliminating Health Disparities Initiative: $2 million.

- provide state match for antiviral medication for first responders: $400,000.

- test anticipated additional private well water samples due to increase enforcement of well construction standards: $226,000.

- dental preventive services for children at high risk of tooth decay: $390,000.

- more funding for 93 new positions, operations with expansion of two alcohol and drug abuse treatment centers: $4 million.

- replace federal funds for services to developmentally disabled: $26 million.

- funds for community-based mental health and substance abuse services: $14.4 million.

- mental health trust fund one-time funding: $14.4 million.

- apartment housing for people with disabilities: $11.3 million.

- startup and operating funds to community-based mental health management centers for patient crisis services: $12.3 million.

- maintain caseload and reduce waiting list for child-care subsidies: $14.1 million.

- expand Smart Start childhood initiative: $13.5 million.

- reduces Work First cash assistance payments: -$2.3 million.

- cover increased costs of foster care, adoption assistance programs: $12.2 million.

- increase State/County Special Assistance rate adjustment for residents in rest homes: $2.4 million.

- increase daily rates for adult day care and adult care health care programs: $1 million.

- replace voice response unit, upgrade telephone system at Martin County child support enforcement call center: $2 million.

- use lottery money to pay for More at Four program, which is being transferred to the Department of Public Instruction: -$66.7 million.

- improve public patient access to psychiatrists: $4.5 million.

- community health center grants: $3 million.

- rural hospital funding: $3 million.

Natural and Economic Resources

- emergency preparedness within Agriculture Department: $2.1 million.

- four new coastal habitat protection compliance positions: $277,000.

- five new positions, technical support for private well water safety program: $1.1 million.

- new emergency drinking water fund: $300,000.

- state aquarium operating funds: $2.5 million.

- implement new coastal recreational fishing license program: $375,000.

- matching funds for clean water, drinking water revolving funds: $6.1 million.

- monitor and cleanup Texfi site contamination: $100,000.

- One North Carolina Small Business Fund for economic development: $5 million.

- One North Carolina Fund for economic development: $15 million.

- economic development reserve fund: $10 million.

- replace Industrial Commission's electronic document system: $1.5 million.

- promote North Carolina as business destination: $1 million.

- advertise International Home Furnishings Market in High Point: $1.75 million.

- promote N.C. motor sports: $100,000.

- promote N.C. film industry: $250,000.

- proposed Advanced Vehicle Research Center in Northampton County: $3.75 million.

- provide funds to Minority Support Center to support Generations Credit Union and Latino Community Credit Union: $1.5 million.

- increase funds for N.C. Biotechnology Center and regional offices: $2.5

Justice and Public Safety

- legal services programs: $1 million.

- staff for Innocence Claim Review Commission if panel becomes law: $211,000.

- ongoing Justice Building renovations: $512,000.

- improve electronic filings in court system, automated evidence tracking system for open discovery: $8.5 million.

- 90 new assistant district attorneys and nine victim witness legal assistants: $4.2 million.

- replace, upgrade technology and office equipment in court system: $5.9 million.

- 75 new deputy clerks of court: $1.4 million.

- funding for 17 new District Court judges: $1.3 million.

- six new magistrates: $266,000.

- hire 13 new Guardian ad Litem staff: $780,000.

- expansion of family, drug treatment and business courts: $1.1 million.

- increase juror fees: $500,000.- cover unpaid attorney fee applications for indigent defendants: $4.5 million.

- raise hourly rate for private assigned counsel in capital cases from $85 per hour to $95 per hour: $1.6 million.

- hire 12 new State Bureau of Investigation agents and scientists: $808,000.

- replace state and local equipment for automated fingerprint identification system: $2 million.

- upgrade N.C. sex offender registry program to include consumer access to map of offenders' homes and e-mail notification: $200,000.

- increase rate for Eckerd Wilderness Camps for at-risk youths: $2.2 million.

- operating reserve for startup of new youth development centers for juvenile offenders: $690,000.

- implement electronic, satellite monitoring of up to 300 most serious convicted sex offenders: $1.3 million.

- reserve for Department of Correction energy costs: $9.6 million.

- increase prison capacity by 468 beds over six prisons: $2.1 million.

- provide partial funding for increasing prisoner medical care expenses: $16.2 million.

- 38 medical records clerk and practical nurses in prison system: $1.4 million.

- train and equip urban search and rescue and swift water rescue teams: $440,000.

- increase maximum monthly pension payment for N.C. National Guard members from $150 to $160: $965,000.

- Governor's Crime Commission grant money for gang violence prevention: $1.5 million.

- assistance for N.C. National Guard families: $500,000.

- reduce crime victims compensation claims: $1 million.

Transportation

- reduce Department of Transportation administration budget: -$2.5 million.

- expand assistance for capital projects at rural airports: $2 million.

- recall old license plates that need to be replaced: $1.2 million.

- close 13 local drivers license offices by December: -$82,000.

- two new drivers license mobile units: $460,000.

- additional ferry maintenance: $1 million.

- improved automated roadside weigh stations: $12.8 million.

- Highway Fund maintenance, contract resurfacing projects: $167 million.

- public transportation grants: $4 million.

- cover operational costs of Carolinian and Piedmont passenger trains: $1.2 million.

- small construction projects for economic development, safety and transportation improvements: $38 million.

- expand, provide maintenance for statewide emergency radio network: $10.2 million.

- reduce annual transfer from Highway Trust Fund to general fund: - $195 million.

- increase funds for intrastate system, urban loops: $141.1 million.

- secondary road construction: $9.3 million.

Other agencies and funds

- grants for domestic violence prevention programs: $350,000.

- Cultural Sharing and Caring Program within Division of Archive and History in part to provide opera and ballet within public schools: $750,000.

- Queen Anne's Revenge archaeology project: $247,000.

- venue fee for Egyptian Art and expenses for Monet exhibits at N.C. Museum of Art: $225,000.

- Grass roots Arts Council grants: $1 million.

- state aid to local libraries: $830,000.

- continue home foreclosure protection pilot program: $1.5 million.

- reallocate four positions within Secretary of State's Office to meet new lobbying registration requirements: $136,000.

- create eight permanent and three temporary campaign finance reporting positions within State Board of Elections: $787,000.

Capital projects, reserves

- revised debt service payments: -$50 million.

- state employee payroll system: $41.8 million.

- establish state emergency response account: $20 million.

- heating and cooling assistance to needy families: $10 million.

- reserve for legal expenses for state Attorney General's Office: $1.1 million.

- design, build two 100-bed veterans nursing homes: $8.8 million.

- purchase four container cranes for Port of Wilmington: $7.5 million.

- new state emergency operations center in Raleigh: $8.5 million.

- planning funds to design History Education Center at Tryon Palace: $1.5 million.

- acquire land and make improvements for planned 2,000-acre expansion at Hickory Nut Gorge State Park: $15 million.

- water resources development projects: $20 million.

- Appalachian State University capital planning for proposed College of Education Living Learning Academic Building: $1.8 million.

- Fayetteville State University capital planning for proposed science and technology complex: $1 million.

- N.C. Agricultural & Technical State University capital planning for general classroom facility: $1 million.

- N.C. School of the Arts capital planning for proposed library: $1 million.

- N.C. State University engineering school relocation to Centennial Campus: $61 million.

- UNC-Chapel Hill capital planning and site preparation for Genomics Science Building: $28.4 million.

- UNC Hospitals capital funds for master plan for hospital and UNC medical school: $3 million.

- UNC-Greensboro capital planning for proposed general classroom and office building: $2.3 million.

- UNC-Pembroke capital planning for proposed residence hall: $1 million.

- UNC-Wilmington nursing school design and construction: $27 million.

- Western Carolina University capital planning for School of Health and Gerontology Building: $2.4 million.

- Winston-Salem State University capital planning for proposed student activities center: $768,000.

- planning funds for UNC-Chapel Hill dental school expansion and for establishment of East Carolina University dental school: $7 million. Tax provisions

- reduce state portion of sales tax from 4.5 percent to 4.25 percent starting Dec. 1: -$140.1 million.

- reduce individual income tax rate for top wage earners from 8.25 percent to 8 percent starting Jan. 1, 2007: -$28.6 million.

- cap gasoline tax rate at 29.9 cents per gallon for a year.

- $250 per employee small business health insurance tax credit: -$7.2 million.

Read more!

UNC Hospitals to focus on women's mood disorders

THE ASSOCIATED PRESS

CHAPEL HILL, N.C.
A new psychiatric clinic at UNC Hospitals will focus on women's mood disorders, including postpartum depression and severe premenstrual syndrome.

The care of these conditions had been done by gynecologists and general practitioners, but it has been moved to the Department of Psychiatry in part because symptoms often are not recognized or aggressively treated, officials said.

Dr. David Rubinow, who took over as chairman of the psychiatry department in January, established the University of North Carolina clinic.

Rubinow worked for nearly three decades at the National Institute of Mental Health, which is part of the federal government's National Institutes of Health.
There, he studied how fluctuating levels of women's reproductive hormones such as estrogen can trigger anxiety, irritability and depression.

"It's an area of medicine I really helped to create," Rubinow said.
Postpartum depression is a leading cause of death in new mothers.

Dr. Diana Dell, a Duke specialist who treats women's mood disorders, considers postpartum depression the most under-diagnosed obstetrical problem in America.
"Anything that draws attention to these legitimate, treatable problems is just super," Dell said of the new UNC center in Chapel Hill.

Rubinow and others who treat hormone-linked mood disorders say the conditions remain under-recognized and undertreated, which can lead to potentially devastating effects.

That, they said, is despite broader awareness among both patients and physicians.
Some patients and doctors consider menopause a natural process that should not require medical treatment. Such disorders are often trivialized or not recognized as severe, Rubinow said.

"I think it does an enormous disservice to women to say that those who become depressed ... should simply learn to live with it," he said. "It's a barbaric notion to suggest that people should not get treatment. It's unconscionably stupid." Read more!

Mental illness should be treated, not punished - Charlotte Observer

Posted on Sat, Jul. 01, 2006

Too many still consider it a failure of character, not a biological disorder

KAY MCSPADDEN

Special to the Observer

Even as U.S. Rep. Sue Myrick and the House Committee on Energy and Commerce were holding hearings on mental health this week, Andrea Yates was standing trial again in Texas.

Yates was convicted four years ago of drowning her children in a bathtub. Her defense attorneys argued that she was not guilty because she suffered from postpartum psychosis, a rare complication of childbirth that affects one or two women in 1,000. Yates had five children, attempted suicide twice, and was hospitalized several times in psychiatric units. She was delusional and paranoid, believing that characters on the TV could see her, that invisible cameras in the ceiling were monitoring her, and that her children were doomed to Hell because she could not raise them properly. When she was treated with anti-psychotic medications, she improved dramatically. When she stopped taking them, she killed her children.

Yet the prosecution argued for the death penalty and scoffed at the insanity plea.

"I believe in the insanity defense, in which someone can commit a crime and not be held criminally responsible. I do not see that in this case," prosecutor Kaylynn Williford said.

Public better educated?

During the trial the jury heard testimony from Yates' doctors and from her family, who had watched her deterioration over the years, but they also heard testimony from Dr. Park Dietz, a psychiatrist who said that an episode of "Law and Order," a show Yates often watched, had depicted a case where a mother drowned her children and was acquitted by reason of insanity. Prosecutors suggested that Yates believed that she could also escape punishment after getting the idea from the show. However, no such show ever aired, and an appeals court in Houston last year overturned the conviction.Prosecutors and defense lawyers are using the same strategies they used in the first trial. By Texas law, Yates can be found guilty if she knew that what she did was wrong, and prosecutors argue that she planned the murders and carried them out willfully. The defense hopes that in the four years since the original conviction, the public has become better educated about the nature of mental illness and will recognize that Andrea Yates needs treatment in a psychiatric facility, not life in prison.

After the jury convicted Yates of murder in 2002, at least three other Texas juries in similar high-profile murder cases found mothers who had killed or seriously injured their children not guilty by reason of insanity. Mental health advocates and groups such as Postpartum Support International are hopeful that the publicity generated by these cases will lead to improvements in mental health care.

Screenings, research needed

Already there is some evidence of increased interest. In April, New Jersey's governor Jon Corzine signed into law a bill requiring postpartum screenings for perinatal mood disorders, and Sens. Robert Menendez of New Jersey and Dick Durbin of Illinois recently proposed federal legislation for similar screenings.

Kay Redfield Jamison, a professor of psychiatry at Johns Hopkins School of Medicine and a scheduled witness at the hearing called by Rep. Myrick, wrote this week in the Washington Post about mental health improvements needed in this country.

"Like the tens of millions of Americans who suffer from mental illness, I hope the hearings have the kind of influence that they should," Jamison, who suffers from bipolar disorder, wrote. "Scientists have made extraordinary advances in understanding the brain and its disorders. We know far more about the genetics, neurobiology, and psychology of depression and bipolar illness than we did just five years ago. But research funding needs to keep pace with the promise of the field."

I would argue that educating the public is as important as research. Too many people fail to understand that our minds are not disembodied entities but are the cognitive activity of our brains. Brains that are diseased or damaged produce minds that are dysfunctional.

Ill people blamed for symptoms

We would never take a nearsighted person's glasses away and tell him to "try harder" to see, nor would we tell someone with a broken back that he could walk if he really applied himself -- yet we hold people with mental illnesses to a different standard of conduct, blaming them for being willful or calculating when they exhibit the symptoms of their disease.

I do it despite knowing better -- which reflects badly on my own willfulness. When my 17-year-old son recently missed three doses of the medication he takes to control his obsessive-compulsive disorder, I became alarmed with his swift descent into depression and then impatient when he couldn't just snap out of it.

As a classroom teacher, how many times have I spoken harshly to a student whose attention-deficit disorder made him appear lazy or restless? Or dismissed an anxious student with a stupid platitude?

As we expand our understanding of how the brain works -- and sometimes doesn't work -- we will treat mental illnesses the same way we treat other disorders, as defects of the body and not failures of character. Until then, we will continue to believe -- wrongly -- that mental illness is a cause for shame and punishment.
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Group wants to start mental-crisis service - Winston-Salem Journal

Saturday, July 1, 2006

CenterPoint study to find out region's needs

By M. Paul Jackson
JOURNAL REPORTER

CenterPoint Human Services is trying to create a 24-hour crisis-management program for this region - a program critical to shoring up the holes in the state's mental-health system, officials said yesterday.

But creating the program could be expensive, and agency officials are still trying to nail down the price tag.


"This is a great idea, but we need to know what it's going to cost in black and white," said Carl Ekstrom, CenterPoint's director of government and community relations.

The proposed "crisis-response network" includes an around-the-clock crisis-stabilization program, suicide-prevention services and a volunteer chaplain program for Forsyth, Davie and Stokes counties. The response network would also offer a small inpatient-bed unit that would serve all three counties.

The agency hired the Human Services Resource Institute, a Massachusetts company, in June to perform an analysis of the mental-health needs of the region, Ekstrom said.

The company is scheduled to present its findings to CenterPoint later this summer, which will help the agency in the creation of its proposed crisis program.

CenterPoint officials estimated earlier this year that the crisis-response program could cost about $3.8 million a year, but Ekstrom said that it could cost as much as $5 million a year.

Establishing the needs of the community could help CenterPoint in its bid to raise public and private financial support for the program. CenterPoint's budget for this fiscal year is about $7.8 million, and itcannot afford to pay for the program by itself.

"Everyone knows that this is a need," Ekstrom said. "A lot of this is going to scientifically verify what we already know."

CenterPoint's efforts to develop a regional, full-time crisis program comes asthe state's mental-health industry worksto right itself after years of financial turmoil.

The Winston-Salem Journal recently published a series of articles showing how the state's 2001 plan to shift care fromits state mental hospitals to community agencies was based on faulty assump-tions about government payments for mental-health services, as well as theability of smaller, local agencies to provide care.

As a result, private mental-health agencies have found it difficult to provide care for patients, and admissions to mental hospitals have grown.

The Charter Behavioral Health System of Winston-Salem, a psychiatric hospital, closed in 2000, making it harder for patients in crisis to receive immediate, 24-hour care.

State officials have promised more money for mental-health care.

The General Assembly agrees but has not yet approved a new state budget, which includes more than $100 million for mental-health services, advocates said.

"I'm optimistic that there is going to be more of an increase," said Andy Hagler, the executive director of the Mental Health Association of Forsyth County, a mental-health advocacy group.

"I'm hoping that the worst of the crisis is over and also that healing can start beginning."

o M. Paul Jackson can be reached at 727-7473 or at mjackson@wsjournal.com.

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APA Applauds Introduction Of Healthcare Truth And Transparency Act

‘Patients Shouldn't Have To Play Roulette,' Says APA's Robinowitz
30 Jun 2006   

Today the American Psychiatric Association (APA), as part of the Coalition for Health Care Accountability, Responsibility and Transparency (CHART), announced its strong support for the Healthcare Truth and Transparency Act, which would help patients make informed choices and protect their safety.

Representative John Sullivan (R-Okla.) and Representative Gene Green (D-Texas) introduced bipartisan legislation to help safeguard patients from misleading claims by healthcare providers about qualifications and training. Representatives Sullivan and Green were joined by Representatives Michael Burgess (R-Texas), Joe Schwarz (R-Mich.), Charles Bass (R-N.H.), Michael Bilirakis (R-Fla.), and Pete Sessions (R-Texas) as original cosponsors.

A recent survey conducted for CHART found that the vast majority of respondents (90 percent) appear to be concerned about their providers' qualifications and 86 percent support federal legislation that would make it easier for them to understand the qualifications of the health care professionals that treat them and their families.

“Patients shouldn't have to play roulette with their health care,” said APA President-elect Carolyn Robinowitz, M.D. “Now is the time for truth and transparency in health care. Information is power - the power to make better choices, to protect you and your family's safety, and to keep costs in check by getting you the care you need the first time.”

Within the field of mental health alone, there are numerous examples of non-physician providers who have failed to help settle patients' confusion over which providers offer which services. Among the most egregious cases, in Louisiana, psychologists, who are not physicians, sought and won the right to prescribe psychoactive medications - not by virtue of securing a medical degree, but by convincing the legislature to grant them that right and even call them “medical psychologists.” Worse, the law does not vest oversight of “medical psychologists” with the state medical board, but with the Louisiana State Board of Examiners of Psychologists, a regulatory board whose members are not trained in the practice of medicine and cannot judge medical competency.

“The term ‘medical psychologist' encourages a patient to believe he or she is being seen by a medical doctor when they're really being seen by someone without a medical degree. To me, that is deceptive,” said Dr. Robinowitz. “Psychologists can help with a broken heart, too, but neither would that make them cardiologists. It is fundamentally wrong to subject people in need to substandard - and perhaps even dangerous - care by misleading them. We urge Congress to pass the Healthcare Truth and Transparency Act now.”

Members of CHART are leading professional associations representing diverse physician specialties, including the American Psychiatric Association, the American Academy of Ophthalmology, the American Academy of Otolaryngology - Head and Neck Surgery, the American College of Surgeons, the American Medical Association and the American Society of Anesthesiologists.

About the American Psychiatric Association


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