Mental-health money for kids reduced - Raleigh News & Observer

Lynn Bonner, Staff Writer

Weeks after setting aside more money than ever to care for North Carolina's mentally ill, the state is cutting $6 million used to help emotionally disturbed children so it can pay local administrative costs.

The money provides short-term care that keeps children out of group homes and helps parents who need advice on getting cooperation among social workers, school officials and other government agencies, said Connie Hawkins, executive director of the Exceptional Children's Assistance Center, based in Mecklenburg County.

"These kinds of silent cuts are just eroding the ability to do what we need to do," she said.

Legislators this summer approved an additional $80 million to treat mentally ill people and drug addicts, pay for housing for the disabled and expand community mental health services. It was the largest single-year increase for mental health programs since the state started overhauling the mental health system in 2001.

But the $6 million increase that was to go to severely emotionally disturbed children not eligible for Medicaid will be diverted. The state will spend $24.5 million instead of $30.5 million.

Community groups statewide are struggling to scale back plans to fit budgets that are suddenly smaller.

"It makes no sense," said Mark Sullivan, executive director of the Mental Health Association in Orange County. He said that the state knew it had to pay these administrative bills and should have devised a way to do it other than cutting money that was intended to help children.

Sullivan works with other agencies to develop programs for adolescent drug abusers, summer activities for emotionally disturbed children and other projects. Those plans are in question because of the cut.

"It's really frustrating for us who are working in the field," he said.

In Cleveland County, a planned support group for parents could be in jeopardy. Lori Oates, who works with the Cleveland community group, said she was surprised to learn of the budget cut so soon after cheering historic increases in the state's mental health budget.

"Where the heck did it go," Oates asked. "Why are we being cut?"

Beth Nelson, who heads children's mental health services in Wake County, said she had not heard about the cut.

State officials say they needed to find $18.9 million for local mental health offices because legislators ordered them to preserve certain services. Leza Wainwright, deputy director of the state Division of Mental Health, Developmental Disabilities and Substance Abuse Services, described the money being used to pay the offices as coming from "emergency reserves" and said no service will get less money than last year.

Offices, agency at odds

The budget cut is rooted in a dispute between local mental health offices and the state agency about how much should be spent on administrative work, such as coordinating who gets care where after business hours.

The state tried last year to cut local administrative expenses, but counties and local offices resisted. For the past two years, state officials used money from the Medicaid office to help cover the local administrative bill but could not take Medicaid money this year because of cuts in the Medicaid budget, Wainwright said. Legislators understood that the department would have to look for money in other accounts if it came up short, she said.

Rep. Verla Insko, a Chapel Hill Democrat who helped write the state mental health budget, said she didn't know that money for services would be cut.

"I was shocked," she said.

Legislators did not know, she said, that the division had money in accounts that it did not plan to spend.

"I didn't know they had money over there to pad their budget," Insko said.

The division expects administrative costs to drop as more local offices merge and as the state continues to rewrite its plans for mental health, Wainwright said. Local offices' administrative costs are based on the jobs they were doing in 2003 and 2004, she said, and their roles have changed. Money now being used for administration can go back to mental health services if office costs go down, she said.

"We hope this is not a recurring need," Wainwright said.

Staff writer Lynn Bonner can be reached at 829-4821 or lbonner@newsobserver.com.
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Coming out of the closet (or medicine cabinet) - Portland State Vanguard

Coming out of the medicine cabinet

Celebate Mental Health Awarness Week by eliminating the stigma
By Sean Cunnison Scott
September 29, 2006

I remember the day, several years ago, when a co-worker I didn't know very well told me that Zoloft saved her life. It came as a shock. I thought that she was, well, crazy, that she must have been way off the deep end to have needed that kind of help, let alone to bring it up in conversation like that.

Attitudes like this are fostered by a society that until recently just didn't talk about such things unless to ridicule or pity the freaks afflicted with such problems. Even I, as an educated and compassionate person, shared in such thinking to some degree. Is it any wonder, then, that when I started taking antidepressants I was loath to tell anyone? What would people think? Would it ruin my chances of getting a job?

The gay community has long had the "closet" as a metaphor of secrecy and shame. In recent years, more and more people have had the courage to "come out of the closet." I propose a parallel metaphor for another group that has too long, and too often, felt the need for secrecy and shame. Yes, folks, it's time to come out of the medicine cabinet.

Part of me is hesitant to draw an analogy between the stigma of homosexuality and the stigma of mental illness. After all, within my lifetime, homosexuality was still officially classified as a mental illness by the psychiatric profession. I would never say that gayness is a disease, and I'm disgusted by the "ex-gay" movement that seeks to cure sodomites of their sinful ways. That said, there are relevant parallels. Both sexuality and mental health can color and pervade all facets of our lives, and in both cases, little good can come of people denying the truth about themselves or the people they love. Both issues need to be dealt with honestly and openly for people to have healthy emotional lives and positive relationships.

Another big topic also shows the power of openness. "Cancer" used to be a word that many people were afraid to speak aloud. If anything, it was to be whispered, or cut to "C," as though the disease were a dog or child who knew words but didn't know how to spell, and would spin out of control unless one discreetly referred to C-A-N-D-Y or a W-A-L-K. People responded to the "C word" with a mixture of shame and magical thinking, as if merely to talk about the disease would encourage its spread, or even its transmission to others. Cancer was like Beetlejuice — say it too many times and it would appear in your life, with no way to get rid of it. Cancer is still scary, and still takes too many lives, but thanks to advances in medical technology — and, unfortunately, the appearance of deadlier diseases — cancer is now a problem to be dealt with, attacked, talked about, and even laughed at.

Because topics like homosexuality and cancer were not openly discussed, there was an emphasis on the negative consequences and the exceptional nature of those affected. You often didn't know that someone had cancer until it killed them, and people often weren't known to be gay unless they died of AIDS or their sexuality was revealed as part of a legal scandal. Even the few public figures who flaunted their sexuality, merely underlined the exceptionality and otherness of people with the disease. As more people came out of the closet, it started a virtuous, as opposed to a vicious, cycle. The more people came out, the less stigma there was, and as the stigma receded, more people worked up the courage to come out. Of course, gays are still the victims of discrimination and ignorance, but now gays and the people who love them can openly engage the critics and bigots rather than fearing guilt by association. As a society, we have come to see that gays and lesbians are not just flamboyant societal outsiders or tragic figures wasting away on deathbeds as a result of their own behavior. They are friends, loved ones, teachers, family members, professionals, working men and women. Hell, some of them are even downright boring! Because some people were brave enough to speak openly about their sexual identities, it has become easier for everyone to understand each other and live honestly.

The time is right for people suffering from depression, anxiety, obsessive-compulsive disorder, bipolar disorder, attention-deficit disorder and other mental health issues to come out of the medicine cabinet. In the last 10 years, very successful movies, memoirs, television shows and even children's books have treated mental illness openly, respectfully, compassionately, and even hilariously. Jack Nicholson's poignant and funny performance in As Good as it Gets, for example, raised awareness of OCD and even inspired many people to seek treatment so they could take control of a condition that had so long controlled them.

It has been said that fresh air and sunlight are the best disinfectants. In 1990, Congress designated the first week in October as Mental Illness Awareness Week. People struggling with mental illness have the opportunity to share the truth of their lives rather than live in fear. Those who know people affected by mental illness — i.e., all of us — have the opportunity to learn more about mental health issues. For more information on Mental Illness Awareness Week, visit http://www.nami.org/miaw. You have nothing to lose but your stigma. Read more!

State drafting plan to house mentally ill-(AP)

Friday, September 29, 2006
State drafting plan to house mentally ill
They need somewhere besides rest homes for the elderly, experts say

THE ASSOCIATED PRESS

CHARLOTTE

Responding to problems in the state's adult-care homes, North Carolina health officials have announced a plan to house aggressive mentally ill patients in a place separate from rest homes designed for senior citizens.

Plans for the new type of care center are being drafted, Health and Human Services Secretary Carmen Hooker Odom announced Wednesday. The move comes after a series of high-profile cases involving adult-care residents who wandered away from their centers. One resident died.

The practice of placing the mentally ill in rest homes has long been criticized. Critics say that the rules endanger frail geriatric residents and place mentally ill people where staff cannot properly care for them.

Rest homes have been a convenient place to house mentally ill patients when they move out of large mental hospitals under a state mental-health reform plan.

In the past two months, two residents have wandered away from the Unique Living home in Cleveland County. The first resident, who had dementia, was found dead in nearby woods. The second, who has schizophrenia, was found alive but hungry 100 miles away in Maggie Valley.

Hooker Odom has made finding a solution a priority, said Jackie Sheppard, the assistant Health and Human Services Secretary.

"Given the critical nature of this issue, and what we see day after day about people (wandering) and other issues, she decided it was too important not to take on," Sheppard said during a meeting of the N.C. Study Commission on Aging in Raleigh.

Sheppard said that the state health department has "cobbled together" the $600,000 expected to be the minimum needed for a long-range study on housing for mentally ill patients, including those who have a high potential for aggression.

Health-department officials also told commissioners that they have made progress toward improving screening of patients who are entering rest homes.

Legislators on the study commission said that they were pleased with the effort but noted that it has been 10 years since the General Assembly, the health department and rest-home industry officials started debating how to help mental-health patients who need long-term care.

Rep. Jennifer Weiss, D-Wake, asked why the state has been moving people out of mental hospitals with no plan on where to put them.

"I'm kind of distressed, shocked and appalled that now, in 2006, we're being told we need a study to figure out where we need to put these folks," Weiss said.

Sheppard agreed. "We share your frustration, and (we) don't take this issue lightly. People's lives are at stake," she said.

Serving the mentally ill requires larger staffs and specialized training for those who handle patients' drugs and outbursts, experts say. A state study finished two years ago estimated that as much as $198 million more in public dollars would be needed to train and staff care homes to meet the needs of all state residents.
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VA shortchanging mental health programs, report says - McClathcy Newspapers

By David Goldstein
McClatchy Newspapers
(MCT)

WASHINGTON - The Department of Veterans Affairs failed to fully spend a promised $300 million since 2005 to fill critical gaps in mental health services for returning troops and others, congressional investigators said.

The money was supposed to be used to improve awareness of the VA's mental health programs and provide better access to them for troops who served in Iraq and Afghanistan, women and other veterans suffering from serious mental illnesses.

But a Government Accountability Office report released Thursday found that the agency underspent the money and that not all of what it did spend went to those programs.

"Veterans expect that wounds suffered in service, be they to mind or body, will be cared for by the nation they served," Rep. Henry Brown Jr., R-S.C., said during a hearing he chaired Thursday on mental health issues. "We will exercise greater oversight on this issue now to determine what VA is spending and how it is being spent, to ensure that funds allocated by the American people are used as intended."

The VA didn't respond to requests for comment on the report.

The hearing was before the health subcommittee of the House Veterans Affairs Committee. The GAO's findings became yet another broadside at the VA and the Bush administration, which veterans groups have criticized for cutting benefits and not anticipating how the Iraq war would stretch the capacity of programs to treat the wounded.

The Kansas City Star reported in May that the VA had dramatically underestimated the number of troops that would return from Iraq this year suffering from post-traumatic stress disorder. The GAO reached a similar conclusion in a separate report last week.

In Thursday's GAO report, investigators found that the VA spent only $53 million of the $100 million it planned to use in fiscal 2005 on gaps in care under a mental health strategic plan. It sent $35 million of the $100 million to a VA general fund, where the money could be spent on a variety of programs.

"It is likely that some of these funds were not used" as intended, the GAO said.

Investigators also said that the VA didn't tell its hospital and health care officials that the $35 million was available and they "were unaware that any specific portion of their general allocation was to be used for mental health strategic plan initiatives."

Some of the money was used to pay for routine mental health programs, the GAO said.

Meanwhile, the $12 million remaining from the $100 million allocation went unspent, the GAO said, because VA officials said the fiscal year was running out.

Similarly, the GAO said that in fiscal 2006, which ends Saturday, the VA budgeted $200 million for the strategic plan, but $42 million remains unspent.

"Gaps in mental health services remain," said Rep. Michael Michaud of Maine, the ranking Democrat on the health subcommittee. "The mental health strategic plan is good. However, without a real commitment to funding, the plan will not become a reality."

Besides the GAO report, the hearing dealt with the rising number of post-traumatic stress disorder cases and traumatic brain injuries among troops.

Rep. Bill Pascrell Jr., D-N.J., said the Walter Reed Army Medical Center in Washington has so far treated more than 650 troops from Iraq and Afghanistan for traumatic brain injuries - 40 percent of all the troops from those combat zones the hospital has seen.

Col. Charles Hoge, director of psychiatry and neuroscience at the Walter Reed Army Institute of Research, said 15 percent to 17 percent of troops who served in combat have screened positive for post-traumatic stress disorder.

``Please don't hide behind statistics and bureaucrat-ese," Rep. Bob Filner, D-Calif., told Hoge and other medical experts at the hearing. "Let us know you have some passion for solving this issue."

Dr. Gerald Cross, a top VA health official, replied, "I can assure you we do have passion, and we have the passion for caring for our veterans." Read more!

Mental health agency selling buildings - Hendersonville Times-News

Scott Parrott
Times-News Staff Writer
scott.parrott@hendersonvillenews.com

Facing a looming shutdown amid financial woes, the region's largest mental health care provider will sell nine buildings in Henderson and Transylvania counties to make ends meet in the next month.

When Hendersonville-based Mountain Laurel and Asheville-based New Vistas merged in July 2005, each carried something the other needed, the head of the combined agency said. Mountain Laurel owned buildings. New Vistas helped more patients.

But now that the combined agency plans to shut down by Oct. 31, the buildings will be sold and the patients helped by new mental health care providers.

"We're in the process of having (the buildings) appraised and getting buyers for them, primarily with the focus of generating enough cash to meet our obligations to staff and to certain vendors and financial institutions," said New Vistas-Mountain Laurel Chief Executive Officer Will Callison.

Callison said the agency owes about $2.3 million to banks, and must also cover bills in the next month, from utilities to liability insurance.

New Vistas-Mountain Laurel also is trying to cover the ongoing payroll and employees' accrued paid time off, he said. The agency has 700 employees and an annual payroll of $24 million, an average of $2 million a month. Western Highlands, which manages mental health care in the eight-county region, is working to bring new mental health care providers to pick up the agency's caseload of 10,000-plus patients.

When asked whether the sale would impact the new providers expected to take on the agency's cases, Callison said, "That's really going to be an issue that Western Highlands is going to need to deal with. And in some cases, the potential purchaser may be able to not only use the building themselves for mental health services, but also may be able to sublease it to other providers."

"Another thing to remember, with new service definitions the emphasis is on community-based services, taking services out to the client," Callison said. "With that new model, I think that having a brick and mortar location where clients come for services is going to become less and less important."

Legislators discuss crisis

Meanwhile, a mountain legislator said Thursday the state should ensure mental health care providers divvy up profitable and taxing caseloads so no lone agency shoulders the financial burden.

That's one recommendation that came out of a legislative caucus held in Asheville on Wednesday, when seven mountain legislators discussed concerns about the looming closure of the region's largest mental health care provider. Western Highlands CEO Arthur Carder updated lawmakers on the response to the news that New Vistas-Mountain Laurel would shut down by Oct. 31.

Lawmakers said the Wednesday session was closed to the public because it was a legislative caucus, an exception to state open meeting laws.

Patients, case workers, county leaders, police officers and homeless shelters fear the short timeframe for the massive transition will translate into the mentally ill falling through the cracks.

Mountain lawmakers say they want to ensure such a massive shutdown never happens again. Rep. Carolyn Justus, R-Dana, says one way to do that is by ensuring no lone provider carries the burden of caring for patients who rely on the state's help to pay medical bills. Callison says one reason the agency went under is it shouldered the burden alone, losing money each time a state-funded patient saw a therapist.

"We need to share that around," Justus said.

Lawmakers said they came out of the meeting with Carder more optimistic than before. Sen. Martin Nesbitt, D-Asheville, hoped "at the end of the day we'll have an even stronger system than what we had to start with, if we can just get from here to there."

"Everyone is concerned that we have some 10,000 consumers out there that get their service from New Vistas that have to be taken care of. We want to make sure that is being done," Nesbitt said. "It will probably be a bumpy road. I don't know how you make a transition with that many people without having bumps in the road."

Sen. Tom Apodaca, R-Hendersonville, said one of his main concerns revolved around whether patients would have difficulty finding medication.

"One major concern -- are we going to have the necessary services for those who need it the most," Apodaca said. "I'm really concerned about the ones who have to have medication handed out on a regular basis. (Western Highlands) had already prepared for that and had prescriptions issued for four to six weeks so we could make sure these folks have their medications available to them."

Overall, Apodaca said, "It sounded to me like there are some positive things happening, and I just hope we can make it by the end of October. (Carder) seems to think we can."

Justus and Apodaca said the meeting was closed to the public because it was a legislative caucus.

The state's open meetings law allows General Assembly members to hold caucuses behind closed doors so long as they do not meet in a caucus called to subvert or evade the open meetings law. Nesbitt said the public could have attended the meeting. Read more!

Split possible in adult homes-The Charlotte Observer

Split possible in adult homes
State health official says plans in the works to place aggressive mentally ill patients in new housing
ERIC FRAZIER
efrazier@charlotteobserver.com

RALEIGH - With problems mounting in N.C. adult-care homes, the state's top health and human services official announced plans Wednesday to create new housing for some of the centers' most physically aggressive residents.

N.C. Health and Human Services Secretary Carmen Hooker Odom's office is drafting plans for a new type of facility that would take in aggressive mentally ill people now housed in rest homes designed for the aged.

Concerns over mixing the mentally ill with the elderly have intensified in recent months because of high-profile cases involving adult-care residents who went missing from centers.

Critics for years have said the homes often lack proper staffing or training to care for the mentally ill, and that the mixture endangers frail geriatric residents.

But since state rules allow mentally ill people to be placed in rest homes, the centers have emerged as a convenient place to put those being moved out of large mental hospitals under the state's mental health reform plan.

Ten days ago, a second resident in two months wandered off from one troubled Cleveland County home. The first resident, a dementia sufferer, was found dead in nearby woods. The second, who has schizophrenia, was found alive but hungry in Maggie Valley, 100 miles away.

News of Hooker Odom's plans emerged Wednesday as a state legislative research group, the N.C. Study Commission on Aging, discussed the problem. One of Hooker Odom's deputies told them she had decided to step up the search for solutions.

"Given the critical nature of this issue and what we see day after day about people (wandering) and other issues, she decided it was too important not to take on," said Jackie Sheppard, an assistant secretary for DHHS.

Sheppard said the agency has begun drawing up specifications for new housing that would meet the needs of mentally ill people with high potential for aggression. In addition, DHHS will order a long-range study to map out a full array of housing options for the mentally ill.

Such a study, estimated to cost at least $600,000, had been recommended to lawmakers in 2005. The General Assembly didn't fund it. DHHS has "cobbled together" money to finance it, Sheppard said.

Lawmakers on the study commission applauded the effort, but also expressed frustration. The General Assembly, DHHS and rest home industry officials have been debating for a decade or more about how best to meet the mental health needs of people in long-term care facilities.

One lawmaker asked why the state for years has been pushing people out of its mental hospitals if no one knows where they should stay. The state's mental health reform plan calls for moving mentally ill people out of hospitals and into the community.

"I'm kind of distressed, shocked and appalled that now, in 2006, we're being told we need a study to figure out where we need to put these folks," said Rep. Jennifer Weiss, D-Wake.

Sheppard responded: "We share your frustration, and (we) don't take this issue lightly. People's lives are at stake."

Cost likely daunting

DHHS is investigating the case of Kenneth Charles, a 45-year-old man who signed himself out of the Unique Living center in Cleveland County on Sept. 18. Charles, who suffers from schizophrenia, was going for a walk, but turned up in Maggie Valley a day later.More than 24 hours elapsed before the home alerted police and social services officials. Cleveland County DSS officials say that was too long. Unique Living officials have said Charles had the right to sign himself out, and that they didn't wait too long to give notice.

Charles is the second Unique Living resident in two months to wander away. Kelly "Buck" Whitesides, a 59-year-old former mill worker with dementia and diabetes, walked away July 30 and was found dead six days later in woods near the facility.

Those familiar with the problems of mentally ill people in rest homes say the solutions cost so much that authorities shy away from bold action. Serving the mentally ill requires larger staffs, as well as specialized training in handling residents' psychotropic drugs and possible emotional outbursts.

One 2004 state study looked at how much it would cost to fully train and staff the homes to meet the needs of all residents, mentally ill or not. The bottom line: As much as $198 million in additional local, state and federal dollars.

"We have been asking for (solutions) for 12 years," said Rep. Debbie Clary, R-Cleveland. "The problem with it is the money."

Fixes in the works

The state has been addressing some problems, though. DHHS officials told the study commission Wednesday about a three-year, $4.3 million contract they recently signed for production of a Web-based screening system for potential rest home clients.

It will give authorities more information on residents' problems and needs, helping them make wiser choices about which home a resident should stay in.

They also noted they are spending $1.4 million annually to add 20 staffers to special geriatric mental health teams that travel the state, training rest-home workers how to properly deal with mentally ill residents.

"We're not going to drag our feet on this issue," Sheppard said. "It's going to take a collective effort from the (rest home) providers and the state."
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Another resident wanders from rest home - Charlotte Observer

Man has schizophrenia, is found 100 miles away

ERIC FRAZIER AND KYTJA WEIR
efrazier@charlotteobserver.comkweir@charlotteobserver.com

Less than two months after a resident with dementia wandered away from a Cleveland County rest home and was found dead in the woods, investigators are looking into another disappearance at the same center.

Now the county's social services board wants the state to either change how it licenses Unique Living or shut it down.

Kenneth Charles, 45, signed himself out of the center near Fallston on Sept. 18 to go for a walk. He was found a day later in Maggie Valley, 100 miles away, dazed and hungry. The home didn't report him missing for more than 24 hours.

Charles suffers from schizophrenia and paranoia, DSS officials said.

"It just seems like a very dangerous situation when you have people checking themselves out and wandering all over the state, especially people with these diagnoses," said Steve Padgett, the DSS board's chairman.

State and local officials were already looking into problems at Unique Living. Now, they are investigating Charles' case, too.

"We are quite concerned," said Teala McSwain, program manager with Cleveland County DSS. "He was not in good shape when he was found."

The home said in a statement Tuesday it has created new policies restricting residents with "limited ability" from signing out. Charles, the home said, didn't fit that description.

"The resident in question is a competent individual who is capable of making decisions," wrote two of the home's owners, Dana Head and Shawn Kuhl.

Now all residents must get permission to leave, they said.

McSwain said Charles' doctor considered him well enough to sign himself out. Still, she said, the home is responsible for keeping him safe.

Charles left about 1:45 p.m., McSwain said, and the home didn't report him missing until about 5 p.m. the next day.

About 9 that night, he turned up at a closed restaurant near Maggie Valley and asked the staff to call police. DSS officials believe he had hitched a ride there.

Maggie Valley police Officer Jeff Mackey told the Observer he took the man to the police station. Charles told him he was starving and cold. It was clear to Mackey that the man couldn't take care of himself.

Charles ate a sandwich and drank some milk, then curled up on the floor with a blanket as police tried to find him help. A computer check revealed he had been reported as an "endangered" missing person out of Cleveland County.

Charles is back at Unique Living now.

This wasn't the first time he had disappeared. In May, he signed out and was arrested in Georgia for disorderly conduct, said Tom Ensley, Cleveland DSS adult services supervisor.

DSS officials said the home shouldn't have waited so long to notify authorities last week. They pointed to state rules requiring rest homes to immediately notify police and DSS if the person's safety is a concern and his whereabouts aren't known.

"If someone's walking and it's getting dark and they haven't called in, it would certainly be reasonable to start getting concerned," McSwain said.

But Unique Living's owners pointed to a different state rule that says if a person wanders away but doesn't require treatment for injuries, the home has as much as 48 hours to notify the resident's "responsible person."

However, that rule makes no reference to the timeframe for notifying police or DSS.

DSS officials have complained for years about problems involving mentally ill residents at Unique Living and Yelton's Health Care, a rest home that previously operated at the site. Two residents died there while it was Yelton's, and a convicted sex offender raped a fellow resident.

Scrutiny intensified after Kelly "Buck" Whitesides walked away from the center July 30. The 59-year-old former mill worker, who had dementia and diabetes, had a history of wandering. He was found dead six days later in woods near the facility.

DSS officials expect next month to ask the state for the maximum fine of $20,000 against the center in connection with Whitesides' death.

Several weeks ago, McSwain said, the state barred Unique Living from admitting new residents because the rest home hadn't submitted a budget report.

Ensley said DSS questions whether Unique Living has enough staff and training to care for so many mentally ill residents. An annual census this month found 96 percent of the home's 73 residents had been diagnosed with mental illnesses. The average age was 48.

In North Carolina, rest homes are designed primarily for the elderly. Experts say the licensing rules don't require enough training or staffing to meet the needs of the mentally ill, yet more and more mentally ill residents have flowed into them in recent years.

The Cleveland County DSS Board voted Monday to ask the state to either close Unique Living or relicense it as a mental health facility, which could upgrade training and staffing.

"The situation out there is unacceptable to the board and I would hope it's unacceptable to the people of Cleveland County," Padgett said.

Lawmakers are also looking into how such homes across the state treat the mentally ill. Today in Raleigh, the N.C. Study Commission on Aging plans to discuss possible solutions.

Read more!

Harkin pushes on for parity - American Chronicle

WASHINGTON D.C. -- As part of his effort to honor the legacy of his friend and colleague Senator Paul Wellstone, Senator Tom Harkin (D-IA) yesterday pressed for a resolution commemorating Wellstone’s tireless work on social issues and urging lawmakers to make mental health parity a priority for the 110th Congress.

“Paul was a champion of America’s underserved and fought hard for mental health parity,” Harkin said. “He fought for ordinary people, and always listened to the quiet voices that too often go unheard in Washington and across the country. It is long past do that we here in Congress rethink our priorities and continue the mission that Paul began.”

It is estimated that nearly 50 million Americans suffer from some sort of mental heath-related condition. But only one-third of those afflicted receive adequate treatment. Too many forgo medical treatment due to the high out-of-pocket cost of treatment, since private health insurance plans typically provide lower levels of coverage for treating mental illness than for treating other illnesses.

According to the Substance Abuse and Mental Health Services Administration, under-treated and untreated mental disorders cost the nation in excess of $200 billion annually – hurting the economy, the profitability of business, and government budgets.

“The good news is that millions of people with mental illness can recover and reclaim their lives, if provided treatment and support,” Harkin said. “To that end, it is time to do away with the discriminatory practice of treating mental and physical illness as two different things under insurance. I am proud to continue Paul’s fight and carry on this important work.”

In 1996, Congress passed the Mental Health Parity Act, which eliminated annual and lifetime dollar limits for mental healthcare for companies with more than 50 employees. This law was designed to be in effect for six years and it fell short of full parity. It also focused only on catastrophic benefits.

In 2001, with the end of this six year period approaching, The Mental Health Equitable Treatment Act was introduced for the first time by Senators Wellstone and Pete Domenici. In 2003 the legislation was reintroduced and renamed the Paul Wellstone Mental Health Equitable Treatment Act. The legislation that Harkin and others are urging Congress to consider next year would provide full parity, equalizing all treatment limitations and financial requirements for all physical and mental illnesses. Harkin has co-sponsored the same legislation for the past three sessions of Congress. Read more!

Mental health still a stigma in the locker room - The Philadelhia Inquirer

By Dawn Fallik and Alfred Lubrano

The Philadelphia Inquirer

(MCT)

PHILADELPHIA - As questions swirl around Terrell Owens' alleged suicide attempt, sports psychologists say stress that athletes need to pay as much attention to their mental health as they do their physical routines.

Professional sports teams typically employ doctors to care for everything from concussions to broken toes. But mental health is an issue often kept far behind locker room doors.

"The sports world is backwards and not very progressive regarding mental health," said Steven Berkowitz, a sports psychologist and former syndicated sports columnist for Copley News Service.

"Seeing a psychologist is still a taboo for some. And mental health is the last thing teams and athletes want to address."

When asked if the Eagles had a staff psychologist, spokesman Derek Boyko said he didn't know, adding that if something came up, a player would be referred to a professional.

On the other hand, the Philadelphia Flyers not only have a staff psychologist, he comes to practice every week.

"I'm just another part of the team to help them be the best they can be," said Joel H. Fish, director for the Center for Sports Psychology in Philadelphia.

"At the beginning of the season I'm introduced to the team, and I'm around informally on a regular basis so they know they have someone they can trust if they want to talk about their personal lives," said Fish, who works with the 76ers in the same way.

The American Psychological Association does not keep track of how many teams employ staff psychologists, but said many players work with a variety of mental health professionals, from "life coaches" to therapists to motivational specialists.

The same personality qualities that make athletes succeed on the field - high expectations, confidence, intensity - are the same ones that may make them more vulnerable to depression and substance abuse, said Eric Zillmer, a psychology professor and director of athletics at Drexel University.

"They don't talk things out, they act things out, that's why they're athletes," said Zillmer. "They tend to be a little more impulsive, and they take more risks, which is celebrated on the field but is maladaptive in their personal life."

Owens is going through an enormous amount of stress, psychologists pointed out. A new job and a new home are two of the top stressers, and would only exacerbate other problems.

Other football players have spoken openly about their struggles to cope.

In 2002, Owens' current teammate, Terry Glenn, sued the National Football League claiming it discriminated against him because he suffered from chronic depression. Glenn dropped the suit after he was traded to Green Bay.

And Terry Bradshaw, former star quarterback for the Pittsburgh Steelers, did not talk about his anxiety attacks and depression until well after his NFL career ended. Now he travels the country speaking out about how medication has helped him.

But although the stigma has lessened over the past two decades, many still believe in the macho dictate that anyone who needs a shrink is too weak to be playing the sport.

That may be more true of football than of other sports, said Deborah Graham, a Boerne, Texas, sports psychologist.

She said golfers probably seek help more than other athletes.

"I've worked with people from every sport, but golf is particularly difficult mentally," she said. "There's no guaranteed salary, there's too much time to think and it takes tremendous mental discipline to hit a ball that just sits there."

Jonathan Katz, director of sports psychology at Altheus, a Rye, N.Y., health and performance center for athletes, said Owens displayed "warning signs" that something might be wrong in his life.

"People who are confident in themselves don't feel a strong need to have to tell the world how great they are," as Owens has done, Katz said. "This is true if you're an athlete or a banker."

While everyone has problems, athletes face the additional indignity of being openly and, sometimes, roughly criticized. This can hurt even the most veteran performers.

"Criticism like Owens has endured wears down even the toughest athletes," said Berkowitz. "Being booed by 50,000 people all the time just doesn't work for anybody." Read more!

Israeli government to OK free mental health care - Israeli National News

(IsraelNN.com) At their weekly meeting in Jerusalem, Cabinet ministers are expected to approve broad reforms in the mental health services, including changes in National Insurance coverage.

As a result of the change, 200,000 Israelis in need of psychiatric care will now be able to do so within the framework of the services provided by the regular health funds.

Currently, mental health services are mainly provided by the private sector. This change is due to be implemented from the beginning of next year.

One of the last obstacles to the passing of the reform was removed yesterday, making psychiatric care free within the health funds. The reform is expected to shorten the waiting lists at psychiatric clinics and double the number of recipients of such services in Israel.
Read more!

Oregon tragedy spurs call for CIT - The Oregonian

Wednesday, September 27, 2006
The Oregonian

Heed Portland's police chief on mental health
The death of James Philip Chasse Jr. in police custody demands a public inquest, and a new preventative strategy

T o some, it may have sounded like an excuse. The recent death of James Philip Chasse Jr., a 42-year-old mentally ill Portlander, while in police custody put Police Chief Rosie Sizer on the defensive, after all. She's at another disadvantage, too: She's not yet able to share all the facts surrounding Chasse's death.

Still, the chief was right Monday to remind us about the larger context surrounding this death: our broken mental health care system. Constantly dealing with the mentally ill is part of the "burden . . . police officers carry with them each and every day . . . to an extent unprecedented in my 21-year tenure in the Police Bureau," Sizer said.

But that's not an excuse, and Sizer wasn't wielding it that way.

Sizer has promised to make the police investigation into Chasse's death public as soon as possible. That's good, but as we've argued for years, any death at police hands or in police custody also demands a public inquest. Both Chasse's death in custody and another recent death in the area -- the police shooting of Lukus Glenn, 18, of Tigard -- underscore why a public inquest is always essential.

For the public, both of these deaths instinctively fall into the category of: "This shouldn't have happened." Both Glenn's and Chasse's families deserve a full public airing of the facts. And only a public inquest can elucidate the circumstances sufficiently to rebuild a foundation of public trust and confidence in the law enforcement agencies involved.

But invaluable as public inquests would be in these cases, Oregon needs a more proactive strategy for dealing with the mentally ill (Chasse) and those in crisis (Glenn). These two recent deaths strongly suggest that it's time to consider mandating intensive training in crisis intervention and in dealing with the mentally ill for patrol officers.

True, some get a few hours of training now, and some agencies provide more intensive training on a voluntary basis. (With 188 officers certified in crisis intervention, Portland is one of the leaders in this field.) It's also important to emphasize that no training program can eliminate such tragic deaths. At times, events spin out of control and police must act to protect themselves and the public.

But teaching police smarter, safer, low-key approaches to dealing with the mentally ill and people in crisis could save lives. And police careers, too. "The officers were devastated" by Chasse's death, the chief said Tuesday. "This is not the outcome they desired or expected."

Although it would be expensive to train all officers intensively to intervene with the mentally ill, Portland and other police agencies need to start calculating the cost, making the pitch and pushing for such intensive training, not just for new officers, but for police bureau veterans, too.

Police shouldn't shoulder so much of the burden of dealing with the mentally ill and those in crisis, but, as Sizer acknowledged this week, they often do. As long as they make up the front line in dealing with people in these situations, it would be better for everyone -- the officers, and the community -- if police really knew what to do. Read more!

The mentally ill - armed and dangerous? - Fauquier Times-Democrat

Addressing the stigma of mental illness
09/26/2006 - Letter to the Editor

I had to bite my lip and cringe at my son's baseball game when I talked with another parent. He's a volunteer at a local rescue squad, and he proceeded to tell me about a call he received the night before.

He explained that they had responded to a late night call for some "mental guy who was off his medication." The man had fled the scene, and "he didn't want to go looking for him without a gun." I was floored. His sole rationale for needing a gun was that the man was mentally ill.


Mentally ill individuals do commit crimes. And they most often receive front-page, prime-time news coverage. But there is no evidence to support the case that mentally ill persons commit more crimes that the general public. The man was more likely to injure himself than the police or medical personnel.

Fortunately, most police officers receive training to deal with these situations and they can defuse them before they escalate to violence.

Unfortunately, this rescue squad volunteer's knee-jerk reaction is quite common and only accentuates the problem of stigma related to mental illnesses. Somewhere down the line, nobody educated this first responder about how to deal with this type of situation.

Many people still associate mental illness with the homeless or the institutionalized such as those seen in "One Flew Over the Cuckoo's Nest." In reality, many individuals with mental illness are part of our society and can go about their lives unnoticed.

And medications do remain an important piece of the medical treatment they receive. While it's true that individuals will sometimes go off their medication, it doesn't necessarily mean they will become a threat to society.

Mental illnesses are and will continue to be a part of the society in which we live. Reduced stigma and greater acceptance and understanding will only be reached through increased education.

Doug Harpole

Amissville
Read more!

Suicide Prevention: A New Dawn in Mental Healthcare - The Southern Illinoisian

In 1985, Steven Wikel, a senior in Carbondale Community High School, took his own life. He shot himself. He was only 18.

"It was one of those situations where it was a shock to everybody," recalls Judy Ashby, Steven's grieving mother, who is also a mental health counselor at Catholic Social Services, the executive director of LifeSavers Training Corporation and the chair of the community outreach workgroup at the Illinois Suicide Prevention Coalition.

"Part of me said, I'm a counselor, I should have known," says Ashby. "But parents are often the last to know in situations like these. It was a shock to everyone - to me, the school, the Church and the community. Of all people....not Steve Wikel, was the overwhelming reaction."

"It's a process to find a way through that kind of shock and grief; for our kids are our most important production. I will forever be haunted by the "If only...", "Why didn't I..." questions and how I failed as a mother," says Ashby. "To know that your own child, by his own hand, decided to stop living, changes your life irrevocably. This is just something you just cannot fix. You cannot bring your child back again."

"In retrospect, it was one of those situations where I could have gone crazy, slipped into depression, or followed him," says Ashby. "But I got busy. I wanted to desperately make sure this would never happen again."

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"In early 1987 maybe, I ran into a program featured at a conference in Springfield, IL. It was called LifeSavers. I thought to myself, gosh, this is what I'm looking for. I walked out into the lobby and connected with several people. Steven's teacher was there, trying to find answers too, just as I was."

Ashby ended up doing a lot of letter writing and connected with the department of mental health and disabilities. They gave her a $10,000 grant and she used the money to start a two day conference on suicide prevention, attended by cops, students and medical counselors.

With enough money left over from the grant to conduct the first ever suicide prevention training retreat in Carbondale, Ashby was soon approached by several schools, which had been affected by suicide. "They asked if we could train their students too," says Ashby.

Developing a suicide and crisis prevention training program specifically for high school kids, she started training students voluntarily from that point on. Not trained to be peer counselors, lifesavers are trained to be active listeners, who can responsibly help other students deal with the emotional crises of adolescence.

LifeSavers has now trained 26 other schools in Southern Illinois on suicide prevention. Close to 2,000 high school kids - sophomores, juniors, some mature freshmen form the first line of defense for high school communities.

Statistics show that suicidal incidents decreased by 50 percent in Southern Illinois schools that implemented the program and student referrals to counseling increased by 72 percent due to LifeSavers' awareness, interventions, and thoughtful referrals.

"We look for kids who are the carers; the listeners," says Ashby. "Whether they are preppies, jocks, nerds, geeks, Goths - doesn't matter. At the end of the training they each go back with a shifted attitude, to their own groups and help their friends and classmates."

"For example, they might see the weird kid in the corner who everyone's throwing dough at. In the past they would have avoided this kid. But after the training, they have a new perspective and realize the kid may be going through some issues like abuse at home or death of a parent," says Ashby.

"So the lifesaver then goes up to the kid and starts an authentic conversation. Hey man, you look like you're having a rough day. Wanna shoot some baskets? They find ways to talk to the kids and help them out."

Currently in the process of getting LifeSavers to college students now, Ashby says that what has worked at the High School level can be carried over and modified so that it works at the collegiate level. "We'll probably start at the dorms," she says.

A well respected public figure, Ashby is passionately working today to influence the government to provide more recognition, financial support and training for suicide prevention.

She says she's eternally grateful she went in this direction, for the death of her son, became a wakeup call for her and continues to be. "You slowly learn to laugh again. You learn to live again. But losing an adult child is a grieving experience you just cannot quite get over..."

Suicide: The Larger Picture

Often a last ditch effort to escape from unbearable stress and utter despair, suicide is recognized as a "chronic epidemic", with more than 30,000 deaths by suicide in the US alone, every year. The second leading cause of death among teens and children, nationally and statewide, experts say it is still vastly under reported.

Compared to the 18,000 who die from homicides and 17,000 from drunk driving every year, a person dies by suicide about every 18 minutes in the United States according to the American Association of Suicidology. Reliable estimates from the American Foundation for Suicide Prevention state that a suicide attempt is made about once every minute.

Multiple stressors - like marital and partner relationship difficulties, family issues, economic stress, adjustment disorders, anxiety disorders, schizophrenia and psychotic disorders, substance abuse, to name just a few - wear down the individual's inherent ability to cope on a psychological and physiological level resulting in depression and a feeling of utter hopelessness; which can trigger a suicide attempt.

"We see a lot of connections to the use of drugs and alcohol," says Laurie Schnider, director of mental health services, at Jefferson County Comprehensive Services (JCCS), in Mt. Vernon, Illinois. "Its not unusual for people who are under the influence to feel more distressed."

"There's also a link between domestic violence and suicide. More often than not the perpetrator kills himself or takes the poor victim with him. There are more deaths that are actually suicides than we can ever record. Many survive to tell the tale. Many don't. High risk behavior that leads to car accidents, driving off a bridge, driving into a tree - many of them are not really accidents, but intentional suicides."

"What worries us is when someone doesn't call and doesn't get the help they need," says Schnider. "If we don't know about it, we just can't help them out."

Contrary to popular belief, suicide attempts are generally not very high during the holiday season. "October and April tend to be the biggest months for suicidal attempts," says Schnider. "Seasonal changes, mid terms for students, tax time for families, whatever the reason; there are higher numbers around this time."

Statistics show that suicide rates are the highest among people aged 65 and older. Jim Novelli, adult crisis services manager at Southern Illinois Regional Social Services (SIRRS), in Carbondale, Illinois, says, "There's a misconception that anyone who is old is depressed. This is not true. The elderly can feel suicidal due to the loss of a loved one, innumerable medical problems, and the general feeling that life is just not what it used to be."

Being in school or college can be pretty traumatic too, with many attempting suicide over relationships gone bad. "You don't hear about it a lot," says Novelli. "But it happens all the time."

Prevention Services and Crisis Counseling

Managing a standalone crisis team of seven people who work together to provide crisis services to people 24/7, Novelli says they must have gone out to assess at least 500 adults-in-crisis, over the past year alone. "60 to 70 percent of those calls were suicidal or post a suicidal attempt that needed assessment," says Novelli.

While most people are uncomfortable talking about the subject, too often, victims are blamed and the surviving friends and family members are stigmatized states a brochure from the Centers for Disease Control and Prevention (CDC). Consequently, suicide is shrouded in secrecy.

Yet experts say that suicide is extremely preventable. In fact the American Foundation for Suicide Prevention reports that 75 percent of all people committing suicide give some warning of their intentions to a friend or family member. Hence all suicidal threats and attempts should be taken seriously.

"There is a national attempt to look at suicide prevention," reveals Schnider. "Within the last year there has been a federal move to look at suicide prevention in colleges. At present we're looking into how we can get the education out in places like Rend Lake College for example."

Harold Jones, assessment unit manager, Franklin-Williamson Human Services (FWHS), West Frankfort, Illinois says they have a prevention department that goes out into the community - usually targeting the school environment - and provides preventative services.

"We teach kids what to do if one of their friends approaches them with suicidal thoughts," says Jones. "We tell them they shouldn't leave their friend alone and to contact an authoritative person for help."

For adult consumers of the agency, FWHS has a psycho-social rehabilitation program.

Jones advises those in crisis to either call the National Suicide Hotline (1-800-273-TALK) or to go to the nearest emergency room or police station for help if it's late in the evening. "Our on-call crisis counselors will go there and see the individual," he says.

With services available in every community for the prevention, assessment and treatment of suicidal behaviors, experts verify that lives can be saved when suicidal behaviors are detected early.

Visiting jails, schools, nursing homes, emergency rooms and physician's offices, emergency crisis counselors play an important role in suicide prevention with the crisis intervention services they provide.

Novelli describes the evaluation process. "When we get a call from a person in crisis, it usually involves suicidal thoughts. We spend an hour or two evaluating the person. Do they have a suicidal plan in place? Can they manage with outpatient treatment? Do they need to be in the hospital?"

Counseling a lot of depressed, in-crisis individuals in rural areas, Shelly Wood, assertive community treatment (ACT) counselor, Egyptian Public and Mental Health Department, Eldorado, Illinois, says, "A lot of them have no jobs, no income, their families are falling apart."

Volunteering to carry the crisis beeper at night about 60 percent of the time, Wood determines what's going on when she meets an individual-in-crisis. "If they just need someone to talk to, we talk to them. If they are in danger to themselves or others, we evaluate them and make recommendations. In extreme cases, we work with officials to get them out of jail (if they are in jail) and move them to a hospital. But we try and handle most cases within the judicial system."

"We just listen with an open heart and open mind and allow them to tell their story from a safe place," says Ashby. "We provide education and gently nudge them along the way."

The executive director of Lifesavers Training Corporation (618-549-5578), Ashby says between 30 to 40 percent of teenagers think about suicide at some point. The Lifesavers program plays a vital role in suicide prevention, since it's a peer-supported, suicide and crisis-prevention training program for 9th through 12th graders.

The intense three-day training retreat teaches Southern Illinois high school students how to really listen with caring and respect to their troubled peers, how to recognize symptoms of an impending crisis, and when to seek professional help for their friend.

Student trainees gain a better understanding of the teenage concerns which can lead to a real crisis: alcohol and drug use, aggression and violence, sexuality and relationships, academic responsibilities, families, friends and peers, depression, stress, ineffective communication.

"Human beings can be incredibly resourceful," says Ashby. "With a lot of folks, if someone just listens to them with respect and caring, it helps them develop their own healing process. In most cases they have used up their entire repertoire of coping skills and just want the pain to stop. They don't really want to die."

Inpatient Facilities

Novelli says if someone is extremely suicidal and is certain to kill him/herself the minute they are left alone; the counselors do make every effort to help.

However if the individual cannot be trusted to be home alone or left on their own recognizance, since they are a danger to themselves, sometimes the only way out is to go through an emergency legal process where their civil rights are suspended and they are brought to a psychiatric unit for their own safety. "Others may choose to voluntarily enter an inpatient, lockdown facility on their own," says Novelli.

In-patient psychiatric facilities like the state operated Choate Mental Health and Developmental Center, in Anna and Chester Mental Health Center, in Chester; private in-patient psychiatric centers offered by Harrisburg Medical Center, Inc., in Harrisburg; St. Mary's Hospital, in Centralia; Richland Memorial Hospital, in Olney; and Lawrence County Memorial Hospital, in Lawrenceville; are just some of the facilities available in Southern Illinois.

"But the greater percentage of suicidal individuals are not hospitalized," clarifies Novelli. "We try to find the least restrictive options that will help them out immediately and in the long term."

How Can You Help a Suicidal Person?

"Unfortunately most people feel they shouldn't ask their friend or family member if they are feeling suicidal, since that may give them ideas," says Novelli, who recommends asking the person straight out if they feel like killing themselves. For if they are telling you they don't want to go on further, the thought of suicide has already entered their minds.

"Be there for the person," advices Novelli. "Be supportive. Listen to what their problems are in a non-judgmental fashion and then call a mental health professional for help. If it's an emergency, get them to the ER."

Sitting and listening attentively to the person and thinking of alternatives may open up new avenues for them, says Novelli. "People in crisis are not thinking straight. They are in such emotional pain that all they can think of is how to make the pain end and suicide seems like a solution."

"Hence parasuicidal attempts are really cries for help," says Novelli. Experts state that parasuicide, when defined broadly includes both suicide attempts and deliberate self-harm inflicted with no intent to die. The greatest predictor of eventual suicide, studies have consistently shown that females outnumber males in making parasuicidal attempts.

What the Future holds

Though more attention is being given to suicide prevention and treatment, those in the mental health field still face numerous problems and hurdles when dealing with suicidal patients.

"Plenty of substance abusers tend to be suicidal," says Wood. "But psychiatric hospitals won't take them in, since the individual has a substance abuse problem. Rehabilitation centers won't take them in since they are suicidal. It becomes a catch 22 situation."

"A lot of times we've had to keep them in intensive care units or special care units of hospitals, until the substance is out of their system and they can then go into a psychiatric facility," says Wood. "These are things that need to be looked at and worked out."

Currently working on developing a local coalition that will focus on problems unique to Southern Illinois, Wood says she has never seen a field like this that doesn't have the resources to deal with a problem on this scale.

At the Rural Suicide Causes and Prevention conference held recently in Southern Illinois, clinical psychologist, Michael R. Rosmann, from Harlan, Iowa spoke about youth being more likely to attempt suicide out of anger and in retaliation, whereas utter hopelessness seemed to be the trigger for adults.

Speaking from clinical experience Rosmann is the executive director of AgriWellness, Inc., a nonprofit corporation that promotes accessible behavioral health services for under-served and at-risk populations who are affected by rural crisis in agricultural communities.

According to Rossman, from the individual perspective, hope is of outmost importance in preventing suicide. "The courage that one receives from others who understand how desperate the suicidal individual feels, professional or pastoral counseling, support from friends, acceptance that a higher power is in charge and personal integrity will go a long way in suicide prevention."

The Role of Bilingual Counselors in Suicide Prevention

With a high rate of reported suicides in the Spanish speaking community, public and mental health agencies are beginning to realize the importance and need for bi-lingual counselors in helping those who are in crisis.

The US Bureau of Census reports that more than one in four Hispanics lives in a "linguistically isolated household" in the United States. This reality added to the extremely low availability of bilingual mental health providers, paints a bleak picture of how hard basic access to mental health care can be for Latinos.

Irma Villadiego, a bi-lingual family counselor at Catholic Social Services in Carbondale, Illinois, treats those in the Latino community who are unable to speak English. The only bi-lingual counselor in Southern Illinois, she started the service in 2003, and has single handedly undertaken more than 200 sessions with Latinos.

Also offering counseling services at the Shawnee Health Center in Murphysboro, Villadiego says word of mouth is the best publicity in driving more Latino in-crisis patients to her. While Cobden, Illinois has a large Latino community, with over 60 Spanish-speaking families who have settled there, Latinos from St. Louis, Murphysboro, Herrin, West Frankfort, Harrisburg, Carbondale and Cobden; have all made use of Villadiego's help in times of crisis.

Many of their suicidal thoughts stem from being culturally, linguistically, socially and emotionally isolated; dealing with American life and values which can be very different from that of their home countries; and assimilating their own culture with that of their adopted country.

Emotional situations arise and women are often the most affected, says Villadiego, since they typically stay at home while the man goes out to work. Isolated within the four walls of their home, they have no friends and can't speak the language to make any new friends.

Most families have only one car and the man normally takes it to work, says Villadiego. The women feel impotent and diminished, being unable to even buy a jug of milk. More often than not, they are too poor to afford English classes or get to the class, even if it's free. The women fall deeper and deeper into depression, until suicide begins to look attractive.

"When we come here, it is most hard for us," says Villadiego. "When we smile here, no one smiles back. Here our neighbor is not our friend. Whereas back home we would say to our neighbor, mi casa es tu casa (My house is your house)."

The feelings of isolation heightened by the language and cultural barrier, dealing with growing children who are imbibing American values, which clash with the more traditional values of Latino parents, increase the feelings of helplessness and depression, until the individual reaches a point of utter crisis.

Latino teenagers also feel pressured on all sides. The Centers for Disease Control and Prevention (CDC) Youth Risk Survey found a 10.7 percent attempted suicide rate among Latino youth, compared with a 7.3 percent rate among African American youth and a 6.3 percent rate for White, non-Latino youth.

Surprisingly enough, research on suicidal ideation found that foreign-born Mexican Americans are at significantly lower risk of suicide and depression than those born in the United States.

Currently preparing a conference presentation on how Latino parents need to understand American culture better, Villadiego suggests that people who are in crisis and in need of a bi-lingual counselor call 618-351-0743 ext. 15 and leave a message for her.

Training Law Enforcement Officers

A member of the Illinois Suicide Prevention Coalition, Shelly Wood, ACT counselor, Egyptian Public and Mental Health Department, Eldorado, Illinois cannot stress enough the importance of getting law enforcement officials trained in suicide prevention. "They are the first responders to most crisis calls. While there are specially trained Crisis Intervention Teams (CIT) in Northern Illinois and other parts of the country, there are none in Southern Illinois."

A CIT program consists of a team of sworn officers who receive intensive specialized training in dealing with individuals in the community who have a mental illness. Statistics indicate that even in Northern Illinois there are only 12 primarily multi-jurisdictional crisis teams operating in 73 law enforcement agencies, with 860 state certified CIT officers.

"The plan is to secure some grant money from the IL Suicide Prevention Coalition to get officers in Southern Illinois trained as CIT trainers themselves, so that they can train others in Southern Illinois," says Wood. The 40 hour, one week long, Illinois Law Enforcement Training and Standards Board (ILETSB) CIT program trains officers on mental illness recognition, substance abuse and dual diagnosis, child and adolescent disorders, psychotropic medications, developmental disabilities, risk assessment and crisis intervention skills.

A collaboration between the Egyptian Health Department and the Illinois Suicide Prevention Coalition the training will be held during National Prevention Week, volunteers Camille Harris, crisis coordinator, Egyptian Health Department.

National Prevention Week, sponsored by the American Association of Suicidology (AAS), takes place on September 10 through September 16. Promoting collaboration, integration, and understanding, the week is all about promoting suicide awareness.

Harris says that National Prevention Week coincides with World Suicide Prevention Day, which is hosted by the International Association for Suicide Prevention (IASP) in collaboration with the World Health Organization (WHO).
Read more!

Crisis intervention move is well-timed-Citizen-Times.com

Crisis intervention move is well-timed

published September 27, 2006 12:15 am

North Carolina’s move to treat mental health clients in community-based programs has hit a few well-publicized bumps in the road. One of the unfortunate byproducts of the move may be more of our mentally ill on our streets and in our jails.

Wake and a handful of other N.C. counties — including Buncombe — are to be congratulated for taking a pro-active step by training for law enforcement officers in mental health crisis intervention.

Two of the state’s largest psychiatric hospitals — Dorothea Dix Hospital in Raleigh and John Umstead Hospital in Butner — are closing as part of the reform. Crystal Farrow, director of Wake County’s Crisis and Assessment Center, said, “The streets of Raleigh will probably see a few more mentally ill than they do now.’

Streets from Asheville to Murphy probably will, too.

The 40-hour training program is designed to familiarize law officers with the symptoms of mental illness and teach them to handle situations before they become violent. Officers will undergo a course in psychiatric diagnoses, symptoms and medications; visit mental health facilities; and take part in role-playing sessions designed to teach them to defuse crises.

“It really extends the mental health services into the community and helps resolve the crisis earlier and with less struggle,’’ Farrow said.

Graduates of the training program receive Crisis Intervention Team pins, and the community has responded positively to the team. Some local families with family members in crisis call and ask for an intervention officer.

“They’re starting to recognize us and ask for us by name,’’ Wake County deputy Elliot Baker said. “It makes me feel better that we’re actually helping people.’’

The program is modeled on one that has worked in Memphis, Tenn., since 1988. Officials there credit the program with saving the agency time and money and leading to fewer officers injured on the job. Kudos to Wake for blazing the trail on this initiative, and we hope to see Buncombe County’s program up and running soon. Other counties would be wise to emulate them. The 40-hour training is a worthwhile investment of time and resources that will benefit law enforcement, the mentally ill and their families.
Read more!

Football star scorned over depression - Charlotte Observer

MARK WASHBURN
TV/Radio Writer

Score another one for the stigma of mental illness.

Football great Terry Bradshaw says going public about his struggles with depression brought him withering criticism from sports talk radio personalities and bloggers.

"People are mean, cruel and hateful," says the four-time Super Bowl quarterback scheduled to visit Charlotte for Sunday's game against New Orleans. "They love to take people who are successful and anything they can get on them, they like to wear them out."

Bradshaw went on a speaking tour in 2003, describing how he'd been plagued as an adult by anxiety attacks and persistent dark moods. He was paid as a spokesman for GlaxoSmithKline, maker of the antidepressant Paxil, which he was taking.

While many praised him for encouraging others to seek medical solutions for their depression, Bradshaw says some sports pundits used it as a way to heap scorn on him.

"I think the thing that hurt me the most was that people called me a phony and a liar," the Fox sports commentator said in a telephone interview with the Observer.

Bradshaw sought medical help while experiencing long-term anxiety after his third divorce in 1999. With therapy and Paxil (which he no longer takes because it interferes with another medication he takes for attention deficit disorder), he managed the symptoms.

Bradshaw, 58, is finished as an advocate for people with depression. "I got tired of people making fun of me. ... I decided I'm bringing this on myself and I don't need it."

Mental health authorities estimate that up to a quarter of the U.S. adult population will experience symptoms of serious depression sometime in their lives.

"There's just idiots out there who refuse to understand what it is -- it's a disease, you morons. You don't get it from bad food or a needle. It's the way I was made." Read more!

Wake Commissioner right to hesitate - Raleigh News & Observer

Wake County Commissioner Herb Council is right in his hesitation to go along with the only viable choice thus far presented to commissioners with regard to providing short-term care for mentally ill persons who are poor.

Council last week cautioned his fellow board members to make sure that advocates for those with mental illness had a chance to express all their views on a Tennessee company's proposal. The company, Psychiatric Solutions Inc., would provide the care by adding 44 beds to its Holly Hill facility and accommodating 16 patients in a nearby, county-built treatment center for those without insurance.

WakeMed has said it hasn't been able to figure a way to be a part of the effort, so the Psychiatric Solutions plan is the only one on the table. That's why some commissioners apparently want to go ahead with the deal.

Council, however, says he thinks pushing on would leave the impression that the commissioners rushed to a decision -- a decision made necessary by the planned closing of Dorothea Dix hospital in Raleigh late next year. Council is right. Oh, it's true there isn't a generous amount of time to figure out more alternatives, but there is some time. And there are definite differences of opinion in the community as to the best course to take.

There's no question that the county simply must provide some sort of center where those who are poor and having a psychiatric crisis can get help. To to that, commissioners say they need a private partner.

But providing this kind of care to people who can't afford it is a challenge for even the best hospitals and treatment centers. It may be that the proposal from Psychiatric Solutions will be the best, but it's too early for commissioners to foreclose all their options.
Read more!

A healthy development for the Triangle - Raleigh News & Observer

Training law enforcement officers in keeping the mentally ill out of jail is a healthy development for the Triangle

Unlike the case with other diseases, the symptoms of mental illness can land a person in jail. That's the community's fault, but one that is, at last, gaining recognition in North Carolina.

For too long, this state has nickel-and-dimed the treatment of the mentally ill. Worsening symptoms have led families, as a last resort, to call the police for help. Yet when police officers or sheriff's deputies are trained only to take crime suspects to jail, a family's desperate cry does next to nothing for the patient experiencing symptoms.

For the past year, as The N&O's Jean P. Fisher reports, Wake County has been training law enforcement officers a new way. Officers are taking a 40-hour crash course in psychiatric disorders, their symptoms and medications used to treat them. They are introduced to local facilities providing care for the mentally ill and given a chance to practice safe ways of resolving tense situations.

This is all to the good. The Wake Sheriff's Department can point to instances where deputies have put their new skills to good use, ending a threat and delivering a mentally ill person to the county's crisis center. After evaluation by specialists in psychiatric disorders, patients can be treated. Even those who still must answer criminal charges pose less risk to other prisoners or themselves following treatment.

In human terms, the cost of leaving psychiatric disorders untreated has been profound. In training, officers themselves are experiencing, through a "hallucination machine," the terror that an arrest can cause a patient with schizophrenia or other illness. Not only is that sort of experience unjust for the patient, the behavior leading up to it can be devastating for families -- over and over again.

It's high time North Carolina short-circuited the route that far too many sick people have taken to jail cells in favor of a route leading to treatment. Thanks to the advocacy of the National Alliance on Mental Illness, crisis intervention teams are lighting a new path in Wake County. In just one year, 150 officers have received the training, and many more eventually will.

Officers from other counties are learning crisis-intervention skills here and taking them home. What's more, officer training is beginning in other parts of the state, from Greenville in the east to Asheville in the west.

It would be a squandered opportunity if all this effort added up only to a temporary solution. The hope is that crisis intervention of the sort now finding favor in North Carolina will open doors to community care offering the mentally ill stability and independence. They deserve no less. Read more!

No Longer a Prisoner of Panic - Asbury Park Press

How teen broke free from shackles of social anxiety disorder

BY SHAWN RHEA
GANNETT NEW JERSEY

Kristen Silary was at a restaurant with her mother and grandmother the first time she became uncontrollably nervous about what other people might be thinking of her.

"When we got to the restaurant my stomach started hurting and I had to leave and go to the bathroom," Silary said.

Only 12 at the time, Silary, now 19, didn't realize she was having a panic attack.

"I had the whole racing heartbeat and I couldn't breathe and I was clinching my fists," said Silary, of Voorhees.

Even when the attack began to subside, Silary couldn't bring herself to leave the restroom. "I was fearful of what people were thinking about me and that everybody was looking at me," she said.

When Silary's mother learned of the episode, she wanted to take her daughter to the doctor. But she convinced her mom that it was a fluke occurrence.

However, the attacks worsened over the next four years and they were most intense when Silary found herself in social situations. "It got to the point where I couldn't leave the house," she said.

At her worst point, Silary found herself experiencing the attacks as often as twice daily. At school, she'd avoid being called on in class and had to sit next to the door in case she felt an attack coming on.

Finally, during her junior year of high school, Silary's mother insisted her daughter see a doctor. After running several tests that came back normal, Silary's pediatrician diagnosed the then 16-year-old with social anxiety disorder, a condition where individuals fear interacting with people due to an overwhelming feeling that they will be negatively scrutinized.

"They're terrified," said Rhona Brown, a Cherry Hill-based psychologist specializing in child and adolescent care. "In social situations they can experience heart palpitations, shakiness, blushing, nausea, headache and stomach-ache."

There are no definitive statistics on how many children and adolescents are living with social anxiety, but about 13 of every 100 youngsters ages 9 to 17 experience some type of anxiety disorder, according to the U.S. National Mental Health Information Center.

And, recent national surveys found about 5 percent of American children and teens have social anxiety disorder, according to the University of California, San Diego, Web site veryshy.org.

Young people with social anxiety are living with a real and debilitating condition that can be the root of a long list of problems, including poor school performance, isolation and depression, say experts.

For example, about 75 percent of children with social anxiety disorder have no or few friends, according to a paper written by Canadian pediatric psychiatrist Dr. Jim Chandler. Half of socially phobic children aren't involved in any after-school activities, half say they don't like school and 10 percent refuse to attend school, he reports.

"Social anxiety isn't shyness," explained Brown. "A shy kid is the one that's slow to warm up to a crowd, but once they get started, they may be the life of the party.

"Social anxiety is a marked condition. If you've got a kid who gets sick every time there's a birthday party or it's time for school and there's no (logical) reason for it, then that may be the child with social anxiety."

One of the baffling aspects of social anxiety is that it can appear to strike suddenly, say mental health experts. Kids who are perfectly comfortable and talkative around family and close friends may suddenly freeze and experience a host of physical ailments when placed in unfamiliar situations, such as eating at a restaurant or working on a group school project.

That's exactly what happened with Silary, who, before her first attack, hadn't experienced any direct fear associated with social situations. "I've always had the same group of friends from the neighborhood," she explained.

But, as her circle began to widen, so, too, did her anxiety about meeting new people or being put into the spotlight. "When friends would call and ask me to go out, I'd make excuses," she says.

When she turned 16, Silary finally began to get a grip on her fear with the help of medication. Her doctor prescribed a low dose of the anti-anxiety medication Lexapro, which Silary takes once daily. "I haven't experienced any side effects, which is lucky, because my doctor told me it usually takes people a long time to find a medication for something like this," she said.

The treatment has helped Silary take on a public job working as a waitress and assistant manager at an area International House of Pancakes. She also attends Camden County College and gives talks to teens about social anxiety.

"The funny thing with it, is I'm very much a people person," said Silary. "So, my mom and I were, like, how could I have social anxiety? But what I really focus on now is how I've changed, and that someone with a mental illness can have a successful life." Read more!

Police officer at her best saving inmate from injury - Winston-Salem Journal

By Scott Sexton
JOURNAL COLUMNIST
Tuesday, September 26, 2006

Winston-Salem police officer Sharon Smith didn't hesitate when she saw that an obviously mentally disturbed woman had set herself on fire while sitting in a holding cell early in the morning of May 22.

Smelling smoke and seeing fire, Smith ran to the cell and struggled to get it open. Once she did, Smith beat the flames out with her bare hands and saved the woman from horrific injuries.

"She was resisting the whole time," Smith said in Forsyth County District Court a few weeks back, when Kellie Peterson was found guilty of assaulting a government official. "I got burns on my arms and permanent scarring on the backs of my hands."

Beyond those few words uttered to District Judge Denise Hartsfield, Smith didn't have much to say about her act of bravery.

Becky Zogry, a magistrate judge who was on duty that night, had plenty to say. Peterson was combative, fighting ferociously with Smith and another officer who had arrested her on a misdemeanor breaking-and-entering charge.

"The thing that impressed me the most was that as aggravating and as insulting as that woman had been, (Smith) charged in there and put the fire out with her bare hands irregardless of the danger to herself," Zogry said. "I just thought Sharon deserves some recognition for going in there like that."

Commendation

Smith and Officer John Hocevar had a hard time even getting Peterson into the holding cell.

She cussed, kicked and fought as if her life hung in the balance. And somewhere on her person, she had hidden a lighter or a book of matches.

A few minutes after the cell door shut, flames became visible.

"You could see the smoke and actually see flames coming off the back of that lady," Zogry said. "And she was really slamming Sharon into that wall. You could tell she had some sort of mental problem."

Her attorney, Kelly Lee, didn't dispute that interpretation during the hearing Sept. 8.

"Clearly there was some sort of psychiatric incident that night," Lee said. "She is extremely bi-polar and had an incident with her medication.

"That said, I want to commend (Smith) for everything she did even though my client was not acting in the most graceful way."

Even though she didn't realize at the time what Smith was doing for her, Peterson eventually did come to grips with what had happened.

"I'm very sorry, so very sorry," she said, turning to face Smith before the judge gave her a 75-day suspended jail sentence and 12 months' probation and ordered her to write a letter of apology.

Zogry, a lawyer who has also worked in the Forsyth County Public Defender's Office and as a social worker at a state mental hospital, said she won't forget Smith's actions.

"I was just standing there dumbfounded," she said. "I'd never seen anything like that. I hope I never do again." Read more!

Overseeing the 'stepchild of the industry' - Winston Salem Journal

Lifetime of Caring: Judy Briggs knew as a teenager that she would be in health care

Keeping watch over a sick relative as a child helped Judy Briggs decide what she wanted to do with her life.

Briggs, the chief executive of the Carolina Behavioral Health Alliance in Winston-Salem, was told as an eighth-grader to monitor the hospital intravenous unit attached to her mother, who had severe asthma. Briggs remembers counting each drop of fluid that drained into the IV bag.

"I thought I was doing something to help my mother," said Briggs, who eventually went on to nursing school. "That's when I decided that's what I wanted to do for the rest of my life. I never changed my mind. I remember that moment, very distinctly."

That introduction was the first step in a long career in health care for Briggs. From stops as a registered nurse and teacher to her current role as an administrator, Briggs has learned to use her passion for health care to help others, she said.

But it hasn't always been easy. Briggs said that she often struggles to help patients under the state's mental-health care system.

The negative image of people with mental-health problems can make it difficult for advocates to effectively help patients, she said.

"It's a huge problem. It's the thing that probably disturbs me the most, is how we do stigmatize mental illness, in that we don't recognize it as truly an illness."

She added: "I often say mental health is the stepchild in the industry."

Briggs' employer, Carolina Behavioral Health Alliance, provides mental health services for health-insurance plans in North Carolina. It is owned by three medical schools: East Carolina University, the University of North Carolina at Chapel Hill and Wake Forest University Health Services, which oversees the Wake Forest University School of Medicine.

The alliance has a long history in the region's mental-health system.

In 1996, Wake Forest University Baptist Medical Center created Wake Forest Behavioral Health Services, an organization that managed mental-health services for QualChoice, the managed-care company that the medical center had opened two years earlier.

East Carolina University and UNC-CH joined the program in 1999, and it became the Carolina Behavioral Health Alliance.

The combination of the three medical schools allows the alliance, a limited-liability company, to provide much-needed services without worrying about financial issues that could hamper for-profit companies, Briggs said.

The schools "didn't get into this business to make money off of health care," she said. "They got into this business to make sure health-care dollars are spent on health care and not Wall Street. It's the best of both worlds."

Briggs said that she primarily spends her day helping clients develop mental health-care programs, including programs that emphasize prevention and wellness services. One of her biggest challenges is convincing employers that proper mental-health services can improve a company's financial bottom line.

Workers suffering from depression or other mental-health problems can experience drops in productivity and increased absences - factors that can weaken a company's financial strength, Briggs said.

"I call it the elephant in the living room," Briggs said. "It impacts not only employers hugely, but it impacts our society hugely. We're paying for it in many ways in our society."

Briggs did not fall into the mental-health care industry by accident. The suicide of a close, teenage nephew and the death of a cousin motivated her to move into the field years ago, she said.

"Knowing the effects that it has on the family, and on people who love people that have mental illness, I finally realized that this is where I need to be," Briggs said. "This is what I need to be doing."

"It's kind of become my mission," she added. "It's been my calling."

Briggs said that she plans to continue helping workers and their employers combat mental-health problems. More prevention and wellness programs can help people identify and treat mental-health problems earlier, she said.

Many people with mental-health problems are simply not receiving adequate care, she said. "What I would love to see in my lifetime, is parity in mental illness," Briggs said.

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

Missouri group will lobby governor, legislators - Kansas City Star

Mental health care needs more funding

It’s appropriate that mental health service providers chose Municipal Correctional Institution as the site to announce a unified push for more state funding.

The city jail is now the second-largest inpatient facility for the mentally ill in western Missouri. The largest: the Jackson County Jail.

About 40 mental health professionals, judges and politicians gathered last week to announce they were forming the Northwest Missouri Regional Partners in Crisis. It will be part of a statewide group called Missouri Partners in Crisis.

The group will call upon Gov. Matt Blunt and state lawmakers to start meeting their responsibility to ensure appropriate care for persons with mental illnesses.

The state cut funding for mental health by $110 million between 1999 and 2005. One result: the new Western Missouri Mental Health center, due to staffing shortages, operates at only two-thirds capacity. For similar reasons, state psychiatric hospitals are serving 40 percent fewer patients than in 2002.

Those who need inpatient care have ended up in shelters, on the street and in jail. Community-based clinics and other resources can’t keep up with the needs.

“The mental health system is all about choice these days — choosing who gets services and who doesn’t,” said Bill Kyles, executive director of Comprehensive Mental Health Services in Independence.

Besides pressing for state funds, Partners in Crisis will educate people about mental illness and encourage excellence in treatment.

Members of the group are busy people, taking time from the extensive problems of their clients to embark on a lobbying effort. Blunt and Missouri lawmakers need to heed their pleas. Read more!

Patty Duke opens up on mental illness - Wilmington Morning Star

By Si Cantwell

Baby boomers like me fondly remember Patty Duke from a show where she played two teenagers, "identical cousins in every way" except that they had opposite personalities.

What we didn't know as we watched that show, first televised from 1963 to 1966 and endlessly rerun afterward, is that the early stardom had a profound effect on Duke's own personality.

It wasn't until the girl born as Anna Marie Duke began speaking out years later that we learned that she'd been diagnosed with bipolar disorder, then called manic depression. Her autobiography, Call Me Anna, was published in 1987 and she co-wrote A Brilliant Madness: Living With Manic Depression Illness in 1993. She has become a spokeswoman for mental health causes.

She'll discuss "Living With a Brilliant Madness" at 6:30 p.m. Wednesday at the Holiday Inn SunSpree Resort in Wrightsville Beach, part of the annual conference of the Mental Health Association in North Carolina (www.mha-nc.org).

Young Anna Marie fell under the influence of child-actor managers John and Ethel Ross, who renamed her Patty and in 1959 got her the role of Helen Keller in the Broadway version of The Miracle Worker. She was 12. The 1962 movie made her the youngest person to win an Oscar. At 16, she had her own television show.

"They had all the best of intentions to begin with," Duke told me by telephone recently. But "unlike the child actress who was handling success in stride, it really messed them up."

The domineering Rosses became involved in heavy alcohol and drug use, and led Duke down that path.

While mental illnesses have physical causes, Duke said, often there's a trigger that activates the disorder. In her case, she said, it was the pills.

Being diagnosed with manic depression in 1982 actually came as a relief after "years of feeling like I was the only one who ever felt this way," she said.

She'd swing from extreme highs to lows that left her "absolutely unable to get out of bed, except to use the bathroom, for months at a time." She spent those long days and nights crying.

Diagnosis and lithium restored the balance. After using the drug for a few weeks, she noticed "the absence of the running motor that would help my mania," and she'd stop short of descending into the abyss.

It took courage for Duke to go public with her story, which first surfaced in a TV Guide interview, she said. Her concern was for those still undiagnosed.

"I had a passion to tell other people who might be going through something like what I went through," she said.

As she travels the nation speaking about mental health, she's encouraged by the greater awareness she encounters.

But she believes the old stigma persists, she said. "It is born of fear, and the fear continues to exist."

She makes appearances like this week's speech to reach out to the undiagnosed and their families.

"I used to be tagged the 'everywoman' in TV movies. I'm hitching my wagon to that," she said. "I'm the everywoman. I have children, I have a past. I have needs, I have goals and I have my own brand of spirituality.

"I guess what I try to do is the Golden Rule," she said, "and that's what's been most successful for me in this little crusade I have."

Reach Si Cantwell at 343-2364 or si.cantwell@starnews online.com. Read more!

Depression can reach into the workplace, taking hold of corporate executives-Citizen-Times.com

Depression can reach into the workplace, taking hold of corporate executives
by Andrea Kay, At Work Columnist
published September 26, 2006 12:15 am

The person I was talking to was not the confident, I-can-handle-anything, king-of-entrepreneurs I had known. His voice was cracking. He said he felt useless and empty inside. He was depressed.

It is hard to understand how those who seem to have it all can find life so empty. But “corporate executives, and especially entrepreneurs, may in fact be even more vulnerable to depression than others,” says Hara Estroff Marano in Psychology Today.

It’s not that times are suddenly tough for CEOs, who, as she says are at this moment enjoying “as much trust as a car salesman.” It’s a combination of forces from within and without that are particularly durable and deeply embedded in men.

“The very qualities that propel them to success can arise from an extremely dark place in the psyche,” Marano writes. “The tendency to build their identity on achievement makes a downturn unbearable.”

Calling the recent events of this man’s life “a downturn” is putting it mildly. He experienced four deaths in his immediate family, the closing of his business and loss of steady income. From the outside, he seemed to be coping.

This is partly what makes people like him such a distinguished species. They’re smart, charming and have extraordinary coping skills, says Marano.

“But the orientation to action that so distinguishes them can work spectacularly against them when problems arise, preventing them from getting help or even recognizing they need it, ultimately pulling them into a depression so subterranean it resists treatment.”

Other executives have come before him. In 2001, 59-year old entrepreneur Heinz Prechter, who struggled with depression for 30 years and sought treatment, committed suicide.

It’s a disease with a high level of treatment success, “if people only would recognize it and seek help,” said behavioral-health consultant Lynne DeGrande in Crain’s Detroit Business.

Executives are among the most difficult groups to reach, says the article. They’re used to being in control. They tend to think if they can’t solve their own problem, nobody else will. There’s also a stigma attached to admitting you have an emotional disorder, let alone any weakness.

I was relieved to find other executives who have depression talk openly about it — a key to getting better.

For resources in your community, contact the National Mental Health Association (www.nmha.org); the National Alliance on Mental Illness (www.nami.org) or the Depression Bipolar Support Alliance (DBSalliance.org).

This is the opinion of Andrea Kay. Send questions to her at 2692 Madison Road, No. 133, Cincinnati, Ohio 45208; www.andreakay.com. E-mail: andrea@andreakay.com.
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`Excited Delirium' Cited in Deaths-AP

`Excited Delirium' Cited in Deaths

By JULIA GLICK
Associated Press Writer


DALLAS (AP) -- Police found 23-year-old Jose Romero in his underwear, screaming gibberish and waving a large kitchen knife from his neighbor's porch.

Romero kept approaching with the knife, so officers shocked him repeatedly with a stun gun. Then he stopped breathing. His family blames police brutality for the death, but the Dallas County medical examiner attributed it to a disputed condition known as "excited delirium."

Excited delirium is defined as a condition in which the heart races wildly - often because of drug use or mental illness - and finally gives out.

Medical examiners nationwide are increasingly citing the condition when suspects die in police custody. But some doctors say the rare syndrome is being overdiagnosed, and some civil rights groups question whether it exists at all.



"For psychiatrists, this is a rare condition that occurs once in a blue moon," said Warren Spitz, a former chief medical examiner in Michigan. "Now suddenly you are seeing it all the time among medical examiners. And always, police and police restraint are involved."

Excited delirium came to doctors' attention in the 1980s as cocaine use soared, said Vincent DiMaio, chief medical examiner in Bexar County, Texas, and a proponent of the diagnosis. No reliable national figures exist on how many suspects die from excited delirium because county medical examiners make the ruling, and some use different terminology.

In Dallas, at least three in-custody deaths in the past five months have been linked to excited delirium. This prompted the police department to start offering mental health assessment training they say will stem the sudden deaths.

Other police departments, including San Diego, have done the same to try to prevent community protests and costly lawsuits. In Phoenix, a jury awarded $9 million in April to the parents of a suspect whose death was attributed to excited delirium.

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The condition, described as an overdose of adrenaline, largely affects men with histories of drug use or mental illness, DiMaio said. He said most cases are triggered by drugs such as cocaine and methamphetamine.

The drugs elevate blood pressure and heart rate, and the increase is pronounced if a person is experiencing paranoia, hallucinations and violent impulses, DiMaio said.

Police often respond to calls of sufferers stripping off clothes to cope with a soaring body temperature, breaking glass and threatening others. The officers and the suspect struggle, and the excitement stresses the suspect's heart until it fails, DiMaio said.

"You are gunning your motor more and more and more, and it is like you blow out your motor," said DiMaio, who estimates that the condition kills as many as 800 people nationwide each year. "You are just overexciting your heart from the drugs and from the struggle."

Medical examiners and emergency room doctors know the syndrome well, but psychiatrists seldom see it because sufferers almost always die before they can get mental help, DiMaio said.

The chief psychiatric reference book, The Diagnostic and Statistical Manual of Mental Disorders, does not specifically recognize "excited delirium" as a diagnosis. The International Association of Chiefs of Police says not enough is known about it.

"It is not a recognized medical or psychiatric condition," said spokeswoman Wendy Balazik. "That is why we don't use it and have not taken a position on it."

Dr. Matthew D. Sztajnkrycer, an emergency room doctor for 10 years and associate professor at the Mayo Clinic in Minnesota, said he has seen cases of excited delirium but has many questions about it.

"It is not like a heart attack where you can just get a blood test and know you have the right diagnosis," he said. "Part of the problem is that post-mortem there is a paucity of physical evidence."

He said more research is needed to understand excited delirium and how commonly it occurs. Then doctors can better diagnose it and police can learn how to handle it, he said.

Spitz and other critics say the condition is questionable because it almost never occurs without police restraint techniques.

"By explaining deaths with excited delirium, it takes the focus away from where it should be," said Dawn Edwards, director of PoliceWatch at the Ella Baker Center for Human Rights in Oakland, Calif. "What it comes down to is the policemen, at the time of the death, were using excessive force."

But even critics like Edwards praise the Dallas plan, which they say could also curb brutality.

It calls for an ambulance any time a suspect is behaving erratically, and mental-illness training for police, 911 operators and dispatchers.

Instructor and Senior Cpl. Herb Cotner said officers will learn to defuse encounters with mentally ill suspects by slowing things down, using suspects' first names and trying to avoid the use of force.

Cotner recalled a suspect years ago who appeared in the throes of excited delirium. The man scaled a six-foot wrought-iron fence, tore his leg open, raced on for several blocks and almost bit off a fireman's finger, Cotner said. He fought police who were trying to restrain him and provide medical care. Then his heart stopped, and he died in the street.

"Call it anything you want, it doesn't matter," Cotner said. "I know these people exist. I have handled these people."
Read more!

Officials seek ways to survive new crisis - Hendersonville Times-News

Harrison Metzger
Times-News Staff Writer
harrison.metzger@hendersonvillenews.com

Henderson County Sheriff's deputies noticed the problems a week before the area's main mental health agency threatened to abruptly shut down Sept. 15.

Deputies started responding to calls for more involuntary committals several days before New Vistas-Mountain Laurel averted closing at 5 p.m. that day, said Sheriff's Capt. Rick Davis.

Though the agency remains open for now, problems for the mentally ill are starting to multiply.

In the past week since New Vistas-Mountain Laurel decided to delay its closing until Oct. 31, homeless people have come to the Hendersonville Rescue Mission saying they have been turned away, Executive Director Anthony McMinn said.

"How can it be business as usual until Oct. 31 if there is no staff?" McMinn asked before a meeting of about 100 mental health care providers and public agencies Friday at county offices.

Vicki Ittel, chief clinical officer at New Vistas, responded that her agency has not had any staff resign yet, despite preparing to close by Halloween. But others who work with the mentally ill told her patients seeking help at Mountain Laurel had been turned away or sent to Pardee Hospital.

"I apologize. If this happened Monday or Tuesday, there was a lot of confusion," Ittel responded, adding, "Our doctors are still there."

Henderson County Manager Steve Wyatt called the meeting, for mental health care providers to meet with Arthur Carder, director of Western Highlands. The Asheville-based organization has been responsible for overseeing mental health in Henderson and seven other mountain counties since the state's 2001 reform of its mental health system.

That reform, which many regard as botched, continues to have repercussions as Mountain Laurel prepares to close over financial insolvency.

Wyatt and Board of Commissioners' Chairman Bill Moyer have repeatedly urged mental health care workers to focus on the future because there is little time to cast blame. Yet several times at Friday's meeting, leaders questioned why they didn't receive more notice that Mountain Laurel was in trouble.

"It just seems that somebody should have given us the heads up this was coming," said Davis, among law officers that also included Hendersonville Police Capt. John Nicholson, who attended.

County leaders called the meeting to devise a crisis plan. In this case, the word has two meanings -- to provide emergency care for mentally ill residents in crisis and to weather the crisis caused by Mountain Laurel's closing. Davis and others said the plan should plainly spell out who is responsible for providing certain services, with a committee responsible for oversight.

"I just can't see sitting back here in another year and a half and saying why the jail is full of people who need mental health services," he said.

Carder responded the goal of the groups is to "get through this crisis now and then figure out how we can make this system work well for the consumers and the providers."

Changes looming

Carder said Western Highlands is working to recruit private mental health providers to step in and help patients with a variety of services. The organization expects to make an announcement by Oct. 1 "that will alleviate some of the pressure on New Vistas" and allow them to start moving staff to new providers, he said. The intention is for them to take their current cases with them to new positions.

Western Highlands has contacted several private mental health care providers, Carder said. Some, such as RHA, Appalachian Counseling and Families Together, are already working in the area and may want to expand. Others such as Triumph LLC, which is in the Winston-Salem area, are considering moving into the mountains. The organization intends to post on its Web site, http://www.westernhighlands.org/, a chart next week showing which companies will be responsible for certain services.

"Our target is to have a plan or at least a sketch of a plan for each county by the middle of next week," he said.

Private providers are needed to provide mental health services including community support services, school-based services, liaisons to jails and rescue missions and for the ACT (Assertive Community Treatment) teams that provide care for adults with chronic or persistent mental health issues.

And Western Highlands is working to recruit a company that can do court-ordered mental evaluations and another to provide pharmacy services.

"Otherwise, that's going to be a big burden on our health departments," Carder said, adding "hopefully we'll have good news on that in a week or so."

A key issue in recruiting new providers will be making sure they have the business office functions to be able to bill for their services, he said. Western Highlands is seeking specific proposals from agencies outlining what services they will provide, how many people they expect to serve and outcome goals.

Carder cautioned that money is limited. Henderson County, for instance, has budgeted $528,000 for mental health services.

Susan Dorfman is owner of Families First, a company that provides mental health and developmental disabilities services to about 75 families in Henderson and Transylvania counties. She has been in business here five years, yet she said she has not been asked by Western Highlands to make a proposal.

"I already have people (mental health care workers) calling wanting to come to our agency," she said.

Carder responded that mental health consumers will have ultimate choice about where they receive services. He urged her to submit a proposal for expanding her company's services to Western Highlands.

Expect problems

Paul Caldwell, CEO of Triumph, said he expects to decide within a few days whether to expand services to the mountains from the Winston-Salem area where his company is based.

"It's not a decision we can wait three or four weeks on, it's a decision we've got to make in the next few days," he said.

When Carder responded that Mountain Laurel is continuing to provide services, an exclamation of disagreement went up among many people in the room. Ittel, the chief clinical officer for New Vistas-Mountain Laurel, said that the agency's walk-in clinic in Henderson County remains open.

The clinic is accepting patients with "urgent or emergent" needs, but not ones with routine needs, such as those needing appointments in three or four weeks, she said.

McMinn of the rescue mission responded that the mentally ill homeless people he deals with cannot wait weeks for an appointment.

Carder responded: "This is not the best case scenario. What we are trying to do is get things as stable as we can for 30 days until we can get more providers to respond."

Caldwell's company has experience in other communities where public mental health providers have closed. He said there is no way to avoid some problems as workers leave existing agencies and seek jobs with private providers.

"If someone uses the term "seamless transition" with me I'm going to jump across the table and strangle them," he said. "There will not be a seamless transition here."

Tonya Blackford, director of Mainstay, a Hendersonville domestic violence shelter, urged county leaders to take a fresh look at the problems caused by the state reform when making plans for the future.

"There is so much that has happened in the last two years that has not worked, that has been horrible," she said. "The problem is the consumer can't manage the system and we're asking them to manage the system."

Moyer, chairman of the Board of Commissioners, responded that the state imposed the reform on counties four years ago. Every time local officials go to Raleigh to discuss problems, "we get heads nodding and no action," he said. Some state leaders have told county officials "if your people were more efficient you could make this work," he said, prompting sighs and groans.

"We have been trying and we will continue to try (to get state leaders' attention)," he said, "but we are required right now to follow state law."

Not reassured

Despite attempts to plan for meeting the emergency needs of mental health patients, McMinn of the Rescue Mission left Friday's meeting feeling discouraged.

"Even today they didn't have a realistic viewpoint of how they are going to deal with this crisis," he said.

McMinn said the crisis staff Mountain Laurel had posted at the rescue mission was let go on Sept. 11 or 12. But he does not blame the workers who have been trying to provide services to the mentally ill through Mountain Laurel.

"We had the best services under Mountain Laurel in my 13 years as director of the rescue mission," he said. "I can say with full confidence (New Vistas CEO) Will Callison did the best he could do to make sure there were crisis services for the rescue mission, Mainstay and the jail, and it made our job a job a lot easier."

But now, with private providers taking over, the state needs to provide money beyond the $528,000 Henderson County has pledged, or the $1 million Western Highlands has for the effort, McMinn said. Yet even if all that money went to Henderson County, it would not cover mental health costs estimated at $4 million here, he said.

"The state is going to have to really get involved. The county doesn't have the type of money to support these programs," he said. "It just tears me up." Read more!

New Vistas raises old fears-Citizen Times.com

New Vistas raises old fears-Citizen Times.com

Businesses say closure has 'social' fallout
by By Joel Burgess, JBURGESS@CITIZEN-TIMES.COM
published September 22, 2006 12:15 am

ASHEVILLE- News of the closing of the region's largest mental health care provider continued to send ripples through the community Thursday as leading downtown activists warned the shutdown of New Vistas-Mountain Laurel is the biggest issue facing Asheville's central area.

Asheville Downtown Association President Dwight Butner addressed more than 70 business owners, residents and others at the annual State of Downtown meeting at the Civic Center. Butner, who owns Vincenzo's restaurant, first spoke about a sea of change in downtown development, from renovation to new construction.

But he later said that issue was secondary.

"In my humble opinion, I thought that future development in downtown was the key issue facing us. The closing of New Vistas ... has made me rearrange that position. We have had a challenge with how we are going to deal with the consequences of social issues in downtown," he said.


New Vistas serves 10,500 clients, some severely mentally ill. The nonprofit will close Oct. 31 after suffering a $1.5 million deficit. Some have expressed fears that clients will swell the ranks of homeless and overburden hospitals, jails and shelters.

Butner urged association members to unite around the issues of mental illness and homelessness and to "stop approaching problems from a diverse and confrontational way. It is absolutely essential that we do the same things that we did 25 years ago - come together as a community which respects the truth in other people's positions and fashion solutions to problems. There is no political party, there is no person that has an exclusive right to the truth."

In the past, the association has supported rules against panhandling and Butner supported moving a mobile soup kitchen that business owners said was crowding out Pritchard Park.

Kelso Advertising and Design President Marilyn Ball said she has seen increased numbers of homeless gathering near the corner of Walnut Street and Lexington Avenue.

"It's almost become a residential neighborhood in itself, with them leaving their garbage, dog waste, needles, whatever," she said.

Other issues addressed at the luncheon included the encouragement of dense downtown development, parking and a possible bond referendum to fund major projects, such as greenways. The latter two issues were raised by City Councilman Jan Davis and Mayor Terry Bellamy.
Read more!

Study Finds Repeat DUI Offenders Have High Mental Illness Rates-Medical News Today

Study Finds Repeat DUI Offenders Have High Mental Illness Rates-Medical News Today


A new study shows that alcohol may not be the only problem for repeat drunk drivers. More than half of DUI offenders also suffer from at least one mental illness in addition to a drug or alcohol-use disorder. The study found almost 60 percent of those with two or more DUI convictions reported experiencing major depression, bipolar disorder, obsessive-compulsive disorder or posttraumatic stress disorder over their lifetime.

The study consisted of people convicted of at least two DUI offenses in the past 10 years, and 40 percent had three or more DUI arrests. The majority of both men and women reported having at least one psychiatric disorder, as well as alcohol- or drug-abuse or dependence. Women had higher rates of depression than men and were more likely to suffer PTSD.

"People who deal with drug and alcohol abusers need to understand there are often other disorders that need to be dealt with as well," said Sandra Lapham, M.D., M.P.H., principal investigator of the study. "That's why we need to screen repeat offenders for multiple disorders. The offender should be viewed as a unique person with a unique set of issues. If they include psychiatric problems, these should be treated along with drug and alcohol issues."

Lapham is director of the PIRE Behavioral Health Research Center of the Southwest in Albuquerque, New Mexico. She says the data suggests DUI evaluations by the courts and treatment programs should include psychiatric screening and assessments.

The study participants were part of a three-year program called Driving Under the Influence of Intoxicants Intensive Supervision Program (DISP) developed by Multnomah County Circuit Court in Portland, Oregon. The volunteer program requires intensive probation, close monitoring and built-in punishments and rewards, in exchange for reduced jail time.

"The results of this study should encourage the courts to develop a more comprehensive approach to dealing with the hard-to-treat drinking driver," says Multnomah County Circuit Court Judge Eric J. Bloch.

"Assessing the mental health of a DUI offender will help us choose the program that will reduce the chance of a re-offense."

The study published in the September edition of Journal of Studies on Alcohol was funded by the National Institute on Alcohol Abuse and Alcoholism.

PIRE, or Pacific Institute for Research and Evaluation, is a national nonprofit public health research institute, funded mostly by federal science grants and contracts, with centers in eight U.S. cities. PIRE's website, http://www.PIRE.org, offers original content about PIRE research and programs. To stay informed about the latest research on public health problems, go to http://www.PIRE.org/subscribe to receive monthly updates on the vital work produced by PIRE.

Pacific Institute for Research and Evaluation
http://www.PIRE.org
Read more!

Local activist warns of mental health care crisis-Citizen-Times.com

Local activist warns of mental health care crisis
by Joel Burgess, STAFF WRITER
published September 21, 2006 3:07 pm

ASHEVILLE – News of the closing of the region's largest mental health care provider is continuing to send ripples into the community as Thursday a leading downtown activist warned that the shutdown of New Vistas is the biggest issue facing Asheville's central district.
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Asheville Downtown Association President Dwight Butner addressed more than 70 business owners, residents of downtown and others at the annual State of Downtown meeting at the Civic Center. He first spoke about the beginning of a new phase in downtown development, from renovation to new construction. Later though, Butner said the construction of new buildings is secondary.

Asheville Downtown Association President Dwight Butner addressed more than 70 business owners, residents of downtown and others at the annual State of Downtown meeting at the Civic Center. He first spoke about the beginning of a new phase in downtown development, from renovation to new construction. Later though, Butner said the construction of new buildings is secondary.

"In my humble opinion I thought that future development in downtown was the key issue facing us. The closing of New Vistas...has made me rearrange that position. We have had a challenge with how we are going to deal with the consequences of social issues in downtown.

New Vistas serves 10,500 clients, some severely mentally ill. The non-profit said it will close Oct. 31 after suffering a $1.5 million deficit. Many have expressed fears that clients will swell the ranks of homeless and overburden hospitals and jails.

Butner urged association members to unite around the issues of mental illness and homelessness "stop approaching problems from a diverse and confrontational way. It is absolutely essential that we do the same things that we did 25 years ago – come together as a community which respects the truth in other people's positions and fashion solutions to problems. There is no political party, there is no person that has exclusive right to the truth."

Other issues addressed at the luncheon by downtown activists and Asheville elected officials included new development rules, parking and a possible bond referendum.
Contact Joel Burgess at 828-232-5960 or via e-mail at jburgess@citizen-times.com.
Read more!

Another 'reform' disaster - Hendersonville Times-News

Editorials

September 20. 2006 12:00AM

The announcement Monday that the primary mental health provider for our area is going out of business marks the logical extension of the Legislature's 2001 reorganization.

It has "reformed" mental health care right out of existence.

The closing of New Vistas-Mountain Laurel achieves the opposite of what legislators intended. The aim was to get the state out of the business of providing the care directly, reduce institutional care at state mental hospitals and shift services to communities through private providers.

It was a fine idea, horribly executed.

Now financial problems have forced the largest primary provider in the area to close, shifting mental health care back to the Western Highlands Local Management Entity, which coordinates care for eight mountain counties.

Effective Oct. 31, New Vistas-Mountain Laurel will close 17 clinics in Henderson, Buncombe, Polk, Transylvania, Mitchell, Madison, Rutherford and Yancey counties. New Vistas-Mountain Laurel has 700 employees and a $24 million payroll.

Roughly 18,000 clients are served by those offices -- many of them vulnerable residents already whipsawed by radical changes in care delivery. Now they are again left wondering where to go for help.

Officials at Western Highlands say they plan to make the change as seamless as possible. They are going to work with other providers to take on New Vistas' clients and hire their workers.

That would help preserve the relationship between patients and providers, but it won't solve the basic problem. New Vistas officials said having to provide crisis and emergency services combined with a low Medicaid reimbursement rate for psychiatric services left the agency $1.5 million in the hole.

"And that's the flaw in the system," said Will Callison, New Vistas' chief executive officer. "All of the services really can't stand on their own financially and therefore some are more or less attractive for private providers to pick up."

Henderson County Assistant Manager Justin Hembree, a Western Highlands board member, said New Vistas' closing fulfills predictions made five years ago.

"The profitable services would be cherry picked and some agency, whether LME or counties or non-profits, would be saddled with the burden of services that are not as profitable," Hembree said.

Don't look now but the state's unwanted baby is landing on Henderson County's doorstep today. Commissioners are expected to discuss the most urgent needs today.

Although emergency crisis care is not supposed to be the county's responsibility "by law we can't let the people go without some kind of services," Chairman Bill Moyer said.

State mental health officials and legislators need to understand that low Medicaid reimbursements for emergency and crisis services makes the hoped for market-based response impossible.

Local providers have been telling state officials that for months. The Times-News and other newspapers have documented the many flaws in the mental health reform system.

The private provider's economic collapse was predictable, indeed widely predicted. All the more reason the state should step in to help.
Read more!

Seeking options in wake of New Vistas closing - Hendersonville Times-News

Harrison Metzger
Times-News Staff Writers
harrison.metzger@hendersonvillenews.com

Lisa Crosby heard the news on the radio Tuesday morning, one day after New Vistas-Mountain Laurel announced it would close Oct. 31. She was taken aback.

Crosby sat on the front porch of her home in Hendersonville, wondering whether she and her 5-year-old daughter, Charity, would be able to find mental health care once November rolls around.

Crosby says she relied on Mountain Laurel since 1989, when it still went by the name Trend, back before the state-mandated mental health reform of 2001.

"If it wasn't for these people and the medication, I'd probably end up in jail or dead," said Crosby, who suffers five mental health disorders.

She now fears for her future, the future of other clients and the future of the agency's 700 employees.

She is not alone.

The announcement the area's largest mental health care provider will close provoked reaction Tuesday from advocates to state lawmakers.

A General Assembly committee, born to tackle the problems of the state-mandated reform of 2001, will delve into the closing, Sen. Tom Apodaca, R-Hendersonville, said Tuesday.

"Mainly, we want to see where the shortfalls came from to see if we can fix it so it won't happen again, and get the coverage where we need it," Apodaca said.

Government leaders in Henderson County met Tuesday and discussed a crisis plan to get county residents care until the mental health delivery system is stabilized.

Western Highlands, which manages mental health care in the eight-county region, continued working against the clock to recruit mental health care providers to cover the New Vistas-Mountain Laurel caseload.

Western Highlands and New Vistas-Mountain Laurel scheduled a press conference today to further discuss the closing and looming changes. The conference is at 3 p.m. in the New Vistas-Mountain Laurel offices on Biltmore Avenue in Asheville.

And the Four Seasons chapter of the National Alliance on Mental Illness called an emergency meeting so the advocacy group could figure out what steps to take to help make sure the mentally ill continue to receive care.

"Ominous is a word that has been used," said NAMI Four Seasons President Sandy Goble, describing the phone calls and e-mails that buffeted the 60-member group that serves Henderson, Polk and Transylvania counties.

Calling the six-week period "very short," Western Highlands Chief Executive Officer Arthur Carder said he would have preferred a four to six month period for the transition.

Because of the short time frame, Western Highlands is working with existing mental health care providers to expand services in the region before the deadline. In the longer term, providers headquartered in other parts of the state could open new locations in the eight-county region to further help the caseloads.

"I'm optimistic we're going to respond to the needs of these consumers," Carder said. "We've got to get things stable and supported and then the system can go from there."

The North Carolina Division of Mental Health contributed $200,000 toward Western Highlands hiring up to 12 psychiatrists to ease the caseloads in the eight-county region on an as-needed basis. The money will help, Carder said, but it is not enough to cover the full tab for hiring one psychiatrist. The Western Highlands Board of Directors dedicated $1 million toward the transition to new service providers.

More than 10,500 people sought help through New Vistas-Mountain Laurel this year in Henderson, Polk, Transylvania, Buncombe, Rutherford, Madison, Mitchell and Yancey counties.

Seven hundred employees are now looking for jobs, which the agency's leadership hopes they will find with the new mental health care providers that will pick up the New Vistas-Mountain Laurel caseload.

Henderson County Manager Steve Wyatt estimated about 1,500 to 1,600 county residents receive mental health services. Of that number, about half do not receive Medicaid or have issues with coverage or reimbursement for service providers, he said.

"Those are the folks who are really in danger of falling through the cracks, so we're putting together an action plan to make sure those people are protected and served," he said Tuesday.

County Commission Chairman Bill Moyer said county leaders believe Western Highlands, the local management group that includes eight western counties, is responsible for making sure these residents have access to mental health providers.

Nevertheless, Wyatt has been meeting with local health care providers, law enforcement agencies and others to make sure these residents can get help once Mountain Laurel closes. Both Moyer and Wyatt said they would not be surprised if that happens before Oct. 31.

"Not only will we be affected, but you'll be affected," Wyatt told municipal leaders during a meeting of the Local Government Committee for Cooperative Action on Tuesday. "Your police departments, God bless them, deal with these people every day."

When the state passed the law reforming its mental health system, Henderson County was contributing $528,000 per year to mental health care, one of the highest amounts per capita in the state, Moyer said. The county has by law continued to contribute that amount, "and we're insisting it be used in Henderson County on services," Moyer said.

Moyer described the crisis plan as an interim step to get county residents care until the mental health delivery system is stabilized. He said if the state cannot fix the problems that came out of its reform effort, it should return that responsibility to counties. Henderson and Transylvania counties were served by a local agency, Trend Mental Health Services, before the reform.

"We've said to the state, 'look, you've caused this gosh darn problem, step in and help," he said. "We haven't seen help yet." Read more!

For some, New Vistas-Mountain Laurel closing no surprise - Citizen-Times

By Leslie Boyd
LBOYD@CITIZEN-TIMES.COM

ASHEVILLE — The announcement Monday that New Vistas-Mountain Laurel will close on Oct. 31 didn’t surprise Janet Price-Ferrell, a member of the Western Highlands area Consumer and Family Advisory Council.

“This pending disaster has been on my radar screen for a year,” she said. “We saw HopeRidge close and knew this could be coming for us, too.”


New Vistas was the “safety net” mental health services provider for about 10,000 people in Buncombe, Henderson, Transylvania, Polk, Rutherford, Yancey, Madison and Mitchell counties. It was one of four providers in the state that were spun off almost intact from area programs during mental health reform.

All of the state’s 29 area programs were required to stop providing services between July 1, 2003, and July 1, 2004. Some held onto some of the more expensive and hard to replace services such as psychiatric care.

Most of the larger providers have folded or have had to reinvent themselves, said Leza Wainwright of the N.C. Division of Mental Health, Developmental Disabilities and Substance Abuse Services.

In Winston-Salem, the provider, HopeRidge, closed a year ago. Betty Taylor, the director of CenterPoint Human Services, said the transition was bumpy, but the system in place now is more diverse and offers more choices to consumers.

Carder has said Western Highlands Network is negotiating with a number of companies that likely will provide services and hire the majority of New Vistas’ 700 employees. He also is consulting with Taylor to find out how CenterPoint built a new system.

Another of the large providers, Daymark, in the Piedmont area, is thriving. But it operates under different conditions than New Vistas or any of the others. Instead of having to abide by strict Medicaid definitions for reimbursements, the agency uses a block grant that offers it more flexibility in its spending.

“They came to us and offered to do this as a pilot program,” Wainwright said. “We’re still evaluating it.”

The fourth large spin-off provider, Meridian Behavioral Health Services, which served the seven westernmost counties in the state, had to undergo “radical surgery” to survive.

“We realized that if we were going to survive, we had to stop trying to be all things to all people,” said Joe Ferrara, director of Meridian. “We couldn’t be a seven-county agency and provide all the services.”

In the last few months, Meridian has cut its services, reducing its caseload from 4,000 to 3,ooo, cutting its number of employees from 220 to 110 and centering its services in Haywood, Jackson, Cherokee and Swain counties.

“The jury is still out,” Ferrara said. “We still don’t know if we’ll be OK.”

Tom McDevitt, director of Smoky Mountain Center in Sylva, said his agency has developed a network of “mini Meridians” in Graham, Clay and Macon counties.

“We took our eggs out of one basket,” he said. “That way if one agency goes out of business, it isn’t the disaster it could be.”

Western Highlands also will move to a number of smaller providers, said Anne Doucette, director of provider and community network development.

“We’re looking to expand some of the providers already in the network and to bring in a couple of larger providers who already are familiar with situations like this,” she said.

Doucette predicted the transition will have some rough spots and it likely will take six months to iron everything out, but it will be a more diverse network and consumers will have a wider array of services.

“I think the end result will be much better than what we had, but it’s going to be a bumpy ride to get there,” Price-Ferrell said.


Read more!

Mental health care is vexing - Raleigh News & Observer

Wake divided on plan to go private
i
Ryan Teague Beckwith, Staff Writer

Wake County commissioners are divided on a Tennessee company's proposal to provide short-term psychiatric care for the poor.

In two meetings Monday, they split over how seriously to take the concerns from mental health advocates about a proposal from Psychiatric Solutions Inc.

Some commissioners said it's the county's only option. Others said they did not want to rush the decision.

The county needs a private partner to run a crisis center for patients who currently are treated at the Dorothea Dix state hospital after the facility closes in late 2007.

Psychiatric Solutions, which owns the private Holly Hill Hospital in Raleigh, turned in the only proposal. But county staff and mental health advocates had hoped WakeMed or another local hospital would step forward.

Those alternatives no longer seem likely.

Judy O'Neal, vice president for governmental affairs at WakeMed, told commissioners that after studying the issue thoroughly for a year and a half, the hospital was not interested.

"We have come up with no perfect solution, and there probably is not one," she said.

That left commissioners Betty Lou Ward, Phil Jeffreys and Kenn Gardner arguing that the only choice the county has is to seriously consider the proposal from Psychiatric Solutions.

"We need a solution, and so far we haven't had one," said Ward.

But Commissioner Herb Council said that he did not want to rush into a contract without considering the objections of mental health advocates and county staff, who have argued that the proposal is inefficient.

"The perception is that we're making this hurry-up decision," he said.

Under the proposal, Psychiatric Solutions would spend several million dollars to add 44 beds to Holly Hill. On nearby land, they also would run a county-built 16-bed treatment center for adults who do not have insurance.

The proposal was designed to get around federal regulations that restrict psychiatric hospitals from charging Medicaid for the care of those patients.

County staff will meet with Psychiatric Solutions to go into more detail about how the treatment center would work. At the same time, the county's human services board will debate whether to endorse the proposal.

A half-dozen mental health advocates spoke out against the proposal at a commissioners' meeting Monday afternoon.

Representatives of the National Alliance on Mental Illness, a consumers' group, wore matching red shirts and had drawn up protest signs that read: "Don't railroad the mentally ill." But they kept the signs under their seats and mostly limited their remarks to encouraging commissioners to look more closely at how the proposal would affect people with mental illnesses.

"My plea to you today is to take very careful consideration of what we're doing," said Adele Foschia, interim executive director of the NAMI statewide chapter. "We're getting ready to make some very big decisions."

Staff writer Ryan Teague Beckwith can be reached at 836-4944 or rbeckwit@newsobserver.com. Read more!

Milwaukee looks at housing mentally ill - AP

Associated Press

MILWAUKEE - Milwaukee Mayor Tom Barrett and County Executive Scott Walker have agreed to work together in an effort to establish an agency that would develop permanent housing for people with chronic mental illness.

The two said Tuesday they were looking at the Community Housing Network in Columbus, Ohio, as a possible model for the effort here.

"We need to get together and talk about this and make sure we are not stepping on each other's toes," Walker said.

A meeting has been tentatively scheduled for Oct. 3. The two pledged to include civic leaders and state and federal officials at the gathering, saying they want to maximize the amount of funds available.

Both said they were dismayed to learn recently that millions of federal dollars had been left unspent in Milwaukee during the last several years.

"We should not be leaving federal money on the table," Barrett said.

"We can't and shouldn't do it alone."

The Milwaukee Journal Sentinel reported in March that hundreds of people in the care of county psychiatric case managers were living in squalid places, including rooming houses and apartments with no heat, no running water, broken toilets, rats, roaches, broken smoke detectors and faulty wiring. Read more!

Psychiatrist Is Slain, and a Sad Debate Deepens - New York Times

By BENEDICT CAREY
New York Times

In the hour before he was killed, on Sunday, Sept. 3, Dr. Wayne S. Fenton, a prominent schizophrenia specialist, was helping his wife clear the gutters of their suburban Washington house. He was steadying the ladder, asking her to please stop showering debris on his clean shirt; he had just made an appointment to see a patient and wanted to look presentable. She said she would be happy to go along, to help control the patient.

It was a running joke between them. For in this part of the country, Dr. Fenton was the therapist of last resort, the one who could settle down and get through to the most severely psychotic, resistant patients, seemingly by sheer force of sympathy and good will. An associate director at the National Institute of Mental Health, he met with patients on weekends, sometimes late at night, at all hours.

Absolutely the most nonthreatening person you ever, ever met, his wife, Nancy Fenton, said in an interview last week.

At 4:52 p.m. that Sunday, the Montgomery County police found the 53-year-old psychiatrist dead in his small office, a few minutes drive from his house. They soon tracked down the patient he had agreed to meet that afternoon, Vitali A. Davydov, 19, of North Potomac, who admitted he had beaten the doctor with his fists, according to charging documents. When the young man left the office, Dr. Fenton was on the ground, bleeding from the face, the documents said.

Dr. Fenton had known that the patient presented some risk: he was young, male, severely psychotic and struggling with a mental state that was frightening and unfamiliar. The psychiatrist was trying to persuade his patient to continue taking medication, Mrs. Fenton said.

The killing, besides devastating the two families involved, has deeply shaken mental health workers around the country. In the days since, many have wondered about their own safety and about the dangers of allowing patients with severe psychosis to go without medication.

Dr. Fentons death is not likely to change psychiatric practice, experts said, but it may become a touchstone for one of the most contentious debates in psychiatry: whether people suffering from psychosis should be compelled to accept treatment to reduce the risk of violent outbursts.

We have been thinking about all these things in the past week, thats for sure, said Dr. Thomas H. McGlashan, a psychiatrist at Yale and a close friend of Dr. Fentons, who worked with him decades ago at Chestnut Lodge, a renowned psychiatric hospital that closed in 2001. Yes, there is a risk of violence with some patients, and no, its not black-and-white, like some would want you to see it. Its not just that Wayne is dead, but that the kids life is ruined too.

Violence is less common among those with mental illnesses than is sometimes assumed. Many people with schizophrenia are withdrawn, more likely to be targets of an assault than to commit one, said Bruce Link, a professor of epidemiology at Columbia.

But studies suggest that those with untreated psychosis often characterized by intense paranoia and imaginary voices issuing commands are at least two to three times as likely as people without mental disorders to get into physical altercations, including fights using weapons, Dr. Link said.

An analysis published last month in The American Journal of Psychiatry found that people with severe mental illness committed about 5 percent of the violent crimes in Sweden, though they made up a small fraction of the population. The United States, which has higher crime rates, has a much smaller proportion of crime attributable to the mentally ill than Sweden, experts said.

Yet the risk is real, if remote, for those who meet one on one with severely psychotic patients and try to negotiate difficult issues like medication. So-called antipsychotic drugs effectively blunt symptoms of psychosis and tend to reduce the risk of violent outbursts, psychiatrists say. But the medications are mentally dulling and often cause weight gain, among other side effects, and many patients either stop taking them or refuse them altogether.

In part to forestall violent episodes, several states, including New York and California, have tightened their treatment laws to compel some mental health patients to accept treatment, even if they have not committed a crime. The issue is divisive among former psychiatric patients, researchers and practicing psychiatrists.

This is an extremely important issue for psychiatry, and there are two sides of this story, said Dr. William T. Carpenter Jr., the director of the Psychiatric Research Center at the University of Maryland and the editor of the journal Schizophrenia Bulletin. As doctors, we think patients ought to do what we think they should do, and if someone needs to be on medication its difficult not to wish there was some way to do that.

On the other side, Dr. Carpenter said, you have a significant civil rights argument.

In the wake of Dr. Fentons killing, some patient advocates cautioned against exploiting the tragedy to promote forced treatment.

The main concern is that we not let fear and stereotypes based on this case drive public policy in support of forced commitment and drug treatment, said Will Hall, a mental health advocate in Northampton, Mass., who was hospitalized as a young man and treated with antipsychotic drugs for about four months after a suicide attempt. A better way to prevent violence, Mr. Hall said, is to offer patients who refuse medication on any ground a much wider range of options, including psychosocial treatments.

Yet alternatives to drug treatment are not yet widely available. And with the news of Dr. Fentons killing in their thoughts, some psychiatrists said they were thinking carefully about the precautions they take every day.

When a patient is revving up and paranoid, Dr. McGlashan said, instead of becoming imperious or dogmatic or rigid I might admit that Im kind of nervous too. If youre scared, you let the patient know that. Because a lot of their behavior is coming from their perception of being threatened. If you let them know that you are feeling threatened, vulnerable and not interested in controlling them, that can help defuse the situation.

All of which, of course, Dr. Fenton understood.

But the need was urgent, Mrs. Fenton said. The need was urgent, the family was desperate, and that was enough for her husband, as long as she had known him. Someone wanted his help, so Wayne would go. Read more!

Depression, substance abuse, ups suicide - UPI

WASHINGTON, Sept. 19 (UPI) -- Those who die from suicide are a fraction of those who consider or attempt suicide, says the U.S. Substance Abuse and Mental Health Services Administration.

However, for those with a major depressive episode who also engaged in alcohol or drug abuse, the likelihood of suicide attempts or suicidal thoughts were even greater, according to the SAMHSA report Suicidal Thoughts, Suicide Attempts, Major Depressive Episode and Substance Use Among Adults.

The report says 10.4 percent, or 1.7 million people, of adults ages 18 or older who experienced a major depressive episode made a suicide attempt; while 14.5 percent, or 2.4 million people, made a suicide plan; 40.3 percent, or 6.6 million people, thought about committing suicide; and 56.3 percent, or 9.2 million people, thought that it would be better if they were dead.

"Almost everyone is touched by the tragedy of suicide in their lifetime," said Assistant Surgeon General Eric Broderick, acting deputy administrator of SAMHSA. "These new findings show the scope of the problem and underscore the importance of suicide prevention efforts. For people in crisis the National Suicide Prevention Lifeline at 1-800-273-TALK offers immediate assistance." Read more!

Kendra's law passes amid protests - Albuquerque Tribune

Albuquerque – Kendra's Law has passed the City Council, but one supporter says she'll push for a statewide version of the law allowing court-ordered treatment of the mentally ill.

Just before the City Council voted 8-1 to pass the ordinance Monday, Carol Oleksak left the meeting room with an air of cautious satisfaction, still waiting to see how Act 2 might turn out.

"You have to start somewhere," she said.

Oleksak, a sergeant in the Albuquerque Police Department, draws on firsthand experience in her support of Kendra's Law: In 2003, a mentally ill homeless man shot her in the face, an incident she barely survived and doesn't actually remember.

"I should be an invalid," she said.

Since then, Oleksak has been pushing for the law - which would allow courts to force potentially dangerous mentally ill people into treatment programs in some limited circumstances - on the state and local level.

Earlier this year, the first effort died in the Legislature, but Oleksak and at least one city councilor want that to change in the next session.

"I would hope New Mexico is the 43rd state in the nation to pass Kendra's Law," said Councilor Ken Sanchez.

Supporters for the bill have pointed to the five fatal shootings in August 2005 - including two police officers - that police have blamed on a single mentally ill man, John Hyde. However, members of Hyde's family have said he would not have fit the criteria for court-ordered treatment.

At Monday's council meeting, opponents of the bill made heartfelt pleas against it.

Michael Wirts, who serves on the board of the National Alliance for the Mentally Ill Valencia County chapter, called the ordinance "blatant racism" and said it would only serve to stigmatize people.

"I don't want to be ashamed of being a mentally ill American," he said.

Others said a more effective strategy would be to address an inadequate mental health care system.

"Until you remove this stigma, prioritize mental health services and prevention, see us as worthy, as your constituents and listen to us . . . this law won't matter because we will still be here, seeking services that don't exist," said Sarah Couch, who works with two groups active in mental health issues.

In the end, the opposing arguments inspired only one opposing vote, from Councilor Debbie O'Malley.

"I think it unfairly penalizes the mentally ill," she said.

As during the run-up to passage of the bill, the shortcomings of the mental health care system remained a talking point Monday. Council President Martin Heinrich estimated that some 75 people could fall under Kendra's Law, but tens of thousands of other mentally ill people would not.

"This is not a bill that helps people with their mental health issues," added Councilor Sally Mayer. "This can't be the last thing we do." Read more!

Some worried they won’t receive care after closure-Citizen-Times.com

Some worried they won’t receive care after closure

by Leslie Boyd, LBOYD@CITIZEN-TIMES.COM
published September 19, 2006 12:15 am


ASHEVILLE — Stannita Mason tries to be optimistic about what will happen to her mental health services when New Vistas-Mountain Laurel closes.

“I have bipolar disorder and I depend on New Vistas,” she said. “To be honest, I’m kind of scared.”

Mason moved from Atlanta to live with her sister four years ago and waited three months to get an appointment at Blue Ridge Center, the area program that provided mental health services and management. When state-mandated mental health reform forced Blue Ridge to divest its services in 2004, the services arm was spun off to create the nonprofit New Vistas, and the management arm became Western Highlands Network.

“Really, all that changed was the name,” Mason said. “I usually have to wait two or three weeks for my medications.”

Even with the problems, Mason says, she has been helped by New Vistas. With the agency set to close by Oct. 31, Mason and others worry that they’ll receive no care.

Even with the problems, Mason says, she has been helped by New Vistas. With the agency set to close by Oct. 31, Mason and others worry that they’ll receive no care.

Western Highlands CEO Arthur Carder said Monday the agency has been negotiating with providers for some time.

“We’ve been trying to expand our capacity,” Carder said. “We have a number of providers ready to step up to the plate.”

The negotiations now are about maintaining capacity, he said.

The transition is likely to be rough, said Betty Taylor, area director of CenterPoint Human Services in Winston-Salem. CenterPoint’s spin-off services provider, HopeRidge, closed last September.

“I’d place it somewhere between total disaster and a smooth transition,” she said. “We were incredibly fortunate that we had new providers who were able to come in, but the transition was a very rough time for all concerned.”

Everyone knew there was no way to tie up every loose end, Taylor said, and some people either lost services or experienced delays.

“We expect to see delays here,” Carder said. “But we hope to make the transition smooth.”
New Vistas' services

Crisis/emergency services: Around the clock, every day, for people in psychiatric crisis.

• Services for children, adolescents, and families: Individual, group, and family counseling; case management and outreach; in-home services; school and community-based services; adolescent substance abuse treatment; medication evaluation, education, and monitoring; consultation to schools, the courts, community agencies and health care providers.

• Early childhood intervention: Specialized instruction, speech/language therapy, occupational therapy, feeding therapy, parent education, help with problem behavior, family counseling, child mental health counseling, childcare consultations and evaluations.

• General outpatient program: Services for adults with issues ranging from emotional distress to serious mental illness including individual, family, and group counseling, medication evaluation, education, and monitoring; case management and outreach; ACTT Services; rehabilitation services including pre-vocational, transitional, supportive employment, psychosocial rehabilitation, club houses, and support for independent living; and family support groups.

• Substance abuse services: Substance abuse evaluations and individual, group, and family treatment; DWI assessments and treatment; case management; Intensive Outpatient Treatment; family counseling; and consultation, education, and referral services.

• Psychological evaluation services: For individuals, the courts, employers, and community agencies; specialized forensic services for children who are adjudicated as sex offenders as well as adults with mental retardation/developmental disabilities who exhibit sexually inappropriate behaviors or who are adjudicated as sex offenders.

• Developmental disability services: Specialized evaluations; case management; program consultation; and referral to community providers.

Consultation, education, and prevention services: Presentations on specific topics of interest; consultation on issues related to mental health, developmental disabilities and substance abuse services; and targeted prevention services directed toward a particular focus of concern in these areas. Consultation, Education and Prevention Services are offered on a fee-for-service basis or as New Vistas-Mountain Laurel Inc. funding allows.
Contact Leslie Boyd at 828-232-2922 or via e-mail at lboyd@ashevill.gannett.com.

Citizen-Times.com

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European Mental Health Groups Unite To Issue Call To Action On Metabolics In Mental Health-(Medical News Today)

European Mental Health Groups Unite To Issue Call To Action On Metabolics In Mental Health

Article Date: 18 Sep 2006 - 8:00am (PDT)

GAMIAN-Europe and EUFAMI today issued a call for action to address a growing crisis for people with mental illness - the relentless increase in CHD risk in this population. The statement followed presentation of the results of one of the largest ever global patient and carer surveys in psychiatry1. It was echoed by demands for the clinical community to urgently address the physical health of their patients, by leading international clinicians who dubbed the results ‘staggering'.

The UNITE (Understanding patients' Needs, Interactions, Treatment & Expectations) Survey, which was supported by Pfizer Inc., revealed that almost three quarters of people with schizophrenia or bipolar disorder surveyed reported significant weight gain since being diagnosed with their mental illness. This causes major health complications, significantly raising the risk of cardiovascular disease (CVD), diabetes and death2.


These increased risks have been acknowledged for some time and there is growing evidence that they are exacerbated by treatment with some antipsychotic drugs3 - the mainstay of symptom control in these conditions. These risks are addressed in several guidelines for treatment, but the survey revealed that, despite scientific awareness, daily practice remains vastly different. Only a minority of respondents received adequate physical health checks. Less than a third of people with schizophrenia or bipolar disorder in Europe reported having their blood pressure checked and only one in four of them reported being regularly weighed.

Roger S. McIntyre, MD, Associate Professor of Psychiatry and Pharmacology at the University of Toronto commented: “This is a significant survey that shows a staggering rate of metabolic related co-morbidities. These are young people, very much in the prime of their lives, being exposed to decades more physical illness than those without schizophrenia and bipolar.

“It should also be highlighted that these medical conditions not only occur more frequently in these patients, but also disproportionately account for the excess mortality. This should be a wake up call to physicians to consider both psychiatric and medical aspects of the patients that they manage.”

The UNITE Survey was specifically designed to gain an understanding of the perceptions of people with schizophrenia and bipolar and their carers about the nature of and level of satisfaction with their current medical care. It found that obesity, diabetes and high blood pressure are the most frequently diagnosed co-existing conditions for people with schizophrenia or bipolar disorder. Around three out of four people with schizophrenia or bipolar reported gaining weight in the duration of their disease. In addition around one in two people with either condition reported that this weight gain had led to additional health complications, citing increased cholesterol, diabetes and high blood pressure most frequently.

Rodney Elgie, past President of Global Alliance of Mental Illness Advocacy Networks-Europe (GAMIAN-Europe) said “The physical health of people with severe mental illness has long been a cause for concern for GAMIAN. This is the first time that the patient voice has been heard with regard to this issue. We hope that the survey will raise awareness among physicians of the importance of treating the patient holistically. It is no longer acceptable to maintain an artificial division of above and below the neck when considering the treatment of a patient with a severe mental illness.”

Kevin Jones, Secretary General of the European Federation of Associations of Families of People with Mental Illness (EUFAMI) added “People with schizophrenia and bipolar are already extremely vulnerable from their condition. As such, they and their families and carers have to place a huge trust in doctors to ensure they receive the best possible level of overall care. If they are not receiving this care then something needs to be done urgently.”

Forty per cent of people with schizophrenia and 30 per cent of those with bipolar disorder reported gaining more weight than they deem acceptable to stay on their treatment. This is also corroborated in the responses of their carers, who report more weight gain than is acceptable to the point where their concordance with medication is questionable.

Dr Marc de Hert, clinical psychiatrist and psychotherapist working at the University Psychiatric Centre Katholieke Universiteit, Kortenberg, Belgium stated “The research to support the increase in metabolic complications in these populations has been there for years. There is an increased prevalence of obesity, dislipidaemia and glucose abnormalities in people with severe mental illness and this results in a greatly increased risk of cardiovascular disease.”

In those with mental illness, the prevalence of traditional risk factors for CVD is already high4. The proportion of those who smoke is greater and there is a greater tendency for physical inactivity and poor diets5.

Second generation antipsychotics play an important role in the management of schizophrenia and bipolar disorder and lifelong use of them in these populations is widespread. However, certain antipsychotics have been associated with an increase in the prevalence of obesity, dislipidaemia and diabetes. Recent recommendations from the American Diabetes Association and American Psychiatric Association6, have not yet been matched by broad European guidance. However, a statement from the Belgian Consensus Group regarding initiating and maintaining therapy with second generation antipsychotics was issued recently7. The recommendations state that a greater degree of monitoring of metabolic factors should take place and treatment decisions, where there is equal efficacy, should be made on the basis of metabolic risk factors of the patient and the risk profile of the antipsychotic agent.

Dr de Hert, one of the members of the Belgian consensus group added “Our recommendations are that many simple measures can be undertaken to ensure that physical health as well as mental health is managed successfully. If there are any modifiable factors that the clinical community can change to lessen this burden then it is time they did something to address them.”

About GAMIAN-Europe

The Global Alliance of Mental Illness Advocacy Networks is a pan-European patient driven organisation assisting people affected by mental illness, either as a sufferer or as a carer. The objectives of GAMIAN-Europe are to raise the profile and importance of mental illnesses among members of the European Parliament and the European Commission, to provide advice, information and support to enable member organisations to provide and improve upon the services that they offer to their own members, and to develop working relationships with health professionals within the mental health field.
www.gamian-europe-history.org

About EUFAMI Founded in 1992, EUFAMI is the European Federation of Associations of Families of People with Mental Illness. It is the representative body for family run voluntary organisations across Europe, which promotes the interests and well being of all people affected by severe mental illness. It is registered in Belgium as an international non-profit organisation.
www.eufami.org/index.pl/en


GAMIAN-Europe
EUFAMI

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Tenn. company's offer for services worries advocates - Raleigh News & Observer

Ryan Teague Beckwith, Staff Writer

Wake County is giving a surprise second look to a Tennessee company's proposal to provide short-term psychiatric care for the poor.

The renewed interest set off shock waves among mental health advocates, who have long expected that WakeMed or another local hospital would offer the treatment.

They argue that the proposal from Psychiatric Solutions Inc. is expensive, inefficient and narrowly focused. "It's a patchwork, Band-Aid solution, when we need something visionary," said Ann Akland, president of the Wake chapter of the National Alliance on Mental Illness.

Psychiatric Solutions has proposed expanding its private Holly Hill Hospital in Raleigh and running a separate, smaller treatment center just for patients without insurance.

The county had hoped that WakeMed or another hospital would run a larger treatment center for all patients, but negotiations had made little progress.

Several county commissioners said the county was simply running out of time. The county needs to open a new treatment center by the time the Dorothea Dix state hospital in Raleigh closes in late 2007.

"I think it's time to move ahead," Commissioner Betty Lou Ward said.

She will meet with commissioners Phil Jeffreys and Kenn Gardner today to consider the proposal from Psychiatric Solutions, which owns Holly Hill. They plan to make a recommendation to the rest of the board in a few weeks.

Their decision to reconsider the proposal may have cut off talks with WakeMed prematurely.

At a mental health care summit held by commissioners in early 2005, WakeMed President Bill Atkinson said the hospital would run the treatment center if it did not lose money. Since then, the county and the hospital management had met several times.

Commissioner Tony Gurley, who heads the board, said the two groups were close to an agreement.

"We're very close to having a resolution, though I don't know what that would be," he said. "All of the research into what would be necessary to make a decision had been done."

But Deb Laughery, vice president of public relations for WakeMed, said that there were no formal negotiations and that the hospital was nowhere near a resolution on the treatment center.

"I am pretty sure that the discussions never ever got anywhere close to that kind of finality," she said.

Despite Atkinson's pledge, neither WakeMed nor the other hospitals ever officially agreed to provide treatment. When the county asked for proposals last year, only Psychiatric Solutions participated.

The three hospitals even signed a letter to the county saying they supported that plan.

But county staff found serious flaws in the original Psychiatric Solutions proposal. Since then, the company has revised the proposal twice, though it still has the same basic problem.

At issue is how to pay for mental health patients who don't have insurance.

Because it is a private company, Psychiatric Solutions cannot bill the federal Medicaid program for the cost of caring for those adults. Under federal rules, only hospitals like WakeMed can bill Medicaid for psychiatric care.

The company found a loophole typically used by rural areas that allows treatment centers with fewer than 16 beds to bill Medicaid.

Under its most recent version of the proposal, Psychiatric Solutions would add 44 new beds at its own expense to Holly Hill. Across the street, the county would build a 16-bed facility that the company would run separately.

If patients who do not have insurance come into Holly Hill, staff would send them across the street, and Medicaid would help foot the bill. But if that building was full, Holly Hill would treat them, and the county would pay the entire cost of care.

County staff say that makes Psychiatric Solutions' proposal more expensive than a comparable plan from a hospital.

But mental health advocates say there are other problems. They argue that splitting up treatment will make it harder to check records, keep patients with the same doctors and coordinate treatment for physical ailments.

"We need a more integrated system of care," Akland said.

Staff writer Ryan Teague Beckwith can be reached at 836-4944 or rbeckwit@newsobserver.com. Read more!

Just because you're mentally ill doesn't mean you're criminally inclined - Edmunton Star

The recent high-profile case of a Grande Prairie nurse with bipolar disorder who drugged her co-workers has the unfortunate potential to stigmatize the mentally ill.

Combine a crime that terrorized hospital staff with a mental ailment that isn't well understood, and you risk undermining efforts to educate the public about mental illness.

So let's be crystal clear right off the bat: there is no systematic cause-and-effect relationship between mental illness and crime. All kinds of people commit offences, including those with mental problems.

But just because you're mentally ill doesn't mean you're criminally inclined.

Unfortunately, Sarah Bowes committed a series of bizarre and disturbing crimes while she was suffering from then-undiagnosed bipolar disorder.

Mental illness sometimes leads to aberrant behaviour. When such activity is criminal, however, it gets media coverage and becomes fodder for conversation around the water cooler.

And experts worry that the Bowes case will fuel myths about mental illness.

"We work with hundreds of people who are dealing with bipolar and they are not doing this crime," says Jan Neumann, supervisor of the outreach program of the Edmonton branch of the Canadian Mental Health Association.

"This (incident) does have some potential to cause that stigma," she adds.

Over the course of about a year, between 2004 and 2005, Bowes' behaviour at the Queen Elizabeth II Hospital escalated from practical jokes - sending food and flowers to co-workers with anonymous notes - to the theft of ID used to obtain credit cards to spiking colleagues' food with a tranquillizer.

The 28-year-old licensed practical nurse was arrested in March and pleaded guilty a week ago to 12 charges, including four of administering a noxious substance.

She was given a two-year conditional sentence and three years' probation.
The sentence was immediately denounced by some of Bowes' co-workers. Readers, too, vented about the case.

"I'm very disappointed in the justice system," said one of Bowes' colleagues. "She showed no mental illness to me." But mental illness isn't necessarily glaringly obvious.

One Sun reader wrote a letter to the editor saying she was "bewildered and appalled" at the conditional sentence.

"This verdict has set our cause of education and removing the stigma back about 20 years," wrote the woman, who says she has bipolar disorder.

Bowes should have gotten help for her mental illness instead of using it as an excuse for her crimes, the woman suggested.

"I live with (depression), knowing that I am always responsible for my own feelings and actions. As should Sarah Bowes," she wrote.

While she's right to point out that the mentally ill are no more prone to criminal activity than anyone else, she mistakenly assumed that Bowes knew she had bipolar disorder.

In fact, Bowes wasn't diagnosed until after her arrest. And, as her lawyer D'Arcy Depoe points out, it can be terribly difficult to get the mentally ill to acknowledge they're sick.

"Mentally ill people engage in strange behaviours," says Depoe. "Some of them happen to be criminal but that doesn't stigmatize everybody who has mental illness."

Bowes began exhibiting symptoms of bipolar disorder - alternating periods of depression and hyper behaviour - at age 21 and started taking a sedative, benzodiazepine, to control her mood swings. She eventually became addicted to the medication.

While she wasn't completely unaware of the nature of her actions, her mental state affected her judgment, according to the forensic psychologist who assessed her.

Bowes is now off the benzodiazepine and has been stabilized under the care of a psychiatrist - precisely the right outcome.

Jail would have derailed her.
- mjacobs@edmsun.com Read more!

Mental health remains a funding afterthought - Centre Daily, PA

Opinion
by Mark Milliron

Where were you 10 years ago today?

On Sept. 17, 1996, I was one of the many people who found themselves on the HUB lawn on the Penn State campus that dreary morning, although my purpose for being there was different from most of the others.

I am the emergency medical technician on the left in a photograph that is often used to summarize the events of that tragic day.

As I look back over the past 10 years, I have asked the question, where are we now?

Ten years ago, Melanie Spalla was killed and Nicholas Mensah was seriously wounded by then-19-year-old Jillian Robbins. According to official reports, Robbins had a history of mental illness and Spalla's parents have sought damages based on that.

What has changed in the past decade?

A 27-year-old man who shot three people in Altoona last year was recently found guilty of homicide. His defense attorney claimed the accused assailant was off his medications for a panic disorder at the time. He asked the jury to consider a "mental element."

Another recent Associated Press story reported that colleges and universities across the country are struggling to deal with an estimated 1,100 suicides a year.

And just last week, a gunman opened fire on another campus, Dawson College in Montreal, Canada, killing one and wounding 20. According to the AP, the man posted Internet photos of himself with a rifle before the attack and said he felt "crazy" and "postal."

As a board member of Centre Volunteers in Medicine, I have not been surprised to find that depression and anxiety are among the top five diagnoses of patients seen there, and that one of our biggest difficulties is finding funds for the medications that people need.

I have worked in the mental-health system and with programs funded by public mental-health and mental-retardation dollars. In the past 10 years and beyond, we considered our programs fortunate if they received a 2 percent increase in funding from year to year -- fortunate, because even though 2 percent is below the general inflation rate and well below the medical care inflation rate, it was better than the years the programs received no increase at all.

There is no such thing as a merit raise for employees in the mental-health field, and they are lucky to get raises that approach the inflation rate. Employees are often hired as hourly wage-earners on a part-time basis with no health-care or other benefits.

On any given day, you can find newspaper employment ads for part-time, no-benefits, mental-health workers who have a four-year baccalaureate degree and will be paid $11 per hour.

Even if they can get 40 hours a week, that only comes out to $22,880 annually (assuming they never take a vacation or sick day). That easily meets Centre Volunteers in Medicine's low-income requirements for free medical care for a family of two.

When I worked in mental-health care throughout central and south-central Pennsylvania, I found the same issue facing all of the school districts with which I dealt. Children had to wait three, four or even six months before they could get a needed psychiatric evaluation to start treatment.

I found that most psychiatrists and psychologists are reluctant to participate in our public mental-health programs because the reimbursement rates are so low.

The organization for which I worked eventually ended up closing its adolescent residential treatment facility because the state refused to consider raising the reimbursement rate to one that was adequate to fund it.

A few months ago, I asked Estelle Richman, Department of Public Welfare secretary, why. Her answer was essentially throwing up her hands and saying the public will not politically support these public-health programs. Legislators do not get re-elected by putting resources into them.

Where are we 10 years later? I think we are worse off.

Public-health programs are grossly underfunded, some have closed and many, if not most, struggle to exist. Neither state nor federal legislators are interested in making serious reform.

Even private foundations and some charitable donors seem interested in only "new and innovative" projects that get them good publicity rather than funding known successful programs.

What can we do?

It's hard to compete for attention from legislators with the Political Action Committees, such the pharmaceutical industry, which makes the medications and emphasizes high profits rather than good care.

A good start would be simply to support the local United Way during its fundraising campaign and the other local organizations that are struggling to keep up with the need to provide care in our community.

Mark Milliron is an instructor in health policy and administration at Penn State University. Readers can respond to him by e-mail at mem9@psu.edu.
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Mental Health Care Out-of-pocket Costs Continue To Outpace Those For Other Medical Care, USA-Medical News Today

Mental Health Care Out-of-pocket Costs Continue To Outpace Those For Other Medical Care, USA

Article Date: 17 Sep 2006 - 4:00am (PDT)

Privately insured consumers seeking treatment for mental health and substance abuse problems still have to pay more out-of-pocket than do patients receiving other medical services care patients, despite state laws mandating equal coverage for both types of care, according to a new study by HHS' Agency for Healthcare Research and Quality.

AHRQ's researchers compared what consumers paid out-of-pocket for psychotherapy, behavioral counseling, medication management and other outpatient mental health services with what they paid for medical care between 1996 and 2003. They found that while consumers' out-of-pocket shares for both types of visits declined during the period from 39 percent to 35 percent and from 31 percent to 21 percent, respectively, by the end of the study period mental health consumers still paid a larger portion of their bills than those using medical care services.

The researchers also found that as the number of visits rose, out-of-pocket payments for mental health services progressively increased while those for medical care decreased. For example, while consumers paid about the same for the first few mental health or medical visits, their average cost for the 20th mental health visit was $35 in comparison to $20 for their 20th medical visit.

According to AHRQ's Samuel H. Zuvekas, Ph.D., and Chad D. Meyerhoefer, Ph.D., the higher out-of-pocket amounts for mental health services likely resulted from the persistence of less generous coverage for mental health treatment. They note that state mental health parity laws cover only a fraction of privately insured patients and relatively few employers voluntarily moved to full parity. Managed care restrictions may have also led consumers to seek treatment from more costly out-of-network providers or pay for their care entirely by themselves.

"Coverage for Mental Health Treatment: Do the Gaps Still Persist?" was published in the September 2006 issue of the Journal of Mental Health Policy and Economics

For further information please contact:
Bob Isquith, Agency for Healthcare Research and Quality (AHRQ),
U.S. Department of Health and Human Services
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The summer I ceased to exist - Houston Chronicle

Darkness of mental illness eclipsed my life

By CLARE ALLAN

LONDON — It was June 1997, Wimbledon time. The sun was shining; the strawberries were ripe. New Labor had been in power for six weeks and in six more Diana, Princess of Wales, would die in a crash in a Paris tunnel. I say this merely to locate you in time; it has no relevance to the story — or maybe it has a little.

The place was London. North London. Highbury, to be exact. Most famous for the Arsenal football club, a few hundred yards down the road. On match days you couldn't step outside the door because of the crowds that pressed along the street, an unstoppable red and white flood with one ambition. But that has no relevance either; it wasn't a match day. The single salient fact is this: I was about to be committed.

It wasn't the future I'd envisaged for myself when, in 1990, I'd first come to London straight from university. During those early years in the city, I lived behind the confident outer edifice that had served me so well as a student. But inside, the walls were crumbling; dry rot had set into the brickwork. It was only a matter of time before the whole thing collapsed.

As friends moved into relationships and their careers began to take shape, I struggled to maintain the facade, writing by night to the sound of plaster crashing down from the walls, writing stories I knew I would never dare show anyone. By day, I worked in sandwich bars, mixing great basins of curried chicken, and I was soothed by the precision of the recipes, the neat list of instructions for me to follow.

Summers were always the worst time, the long, exposing days, the relentless sunlight revealing the cracks, invading the darkest corners. Each autumn, as children appeared on the streets in their slightly too-large school uniforms, as the nights began to eat into the days, my lungs would fill with the damp air of relief.

People often ask me when I first became ill, a question I find impossible to answer. There was no single moment like breaking an arm; no malarial mosquito. Mental illness, in my experience, has no beginning as such, but a gnawing inevitability eating through the very foundations of one's existence — or that's how it feels.

Each summer seemed more precarious, each autumn a more miraculous survival. I changed jobs regularly, moved to a new flat every few months, constantly shifting, like one on the run, anxious to avoid detection.

Then, as the last stones of the edifice crumbled, I stopped working completely and took to walking the streets. Mile upon mile of mechanical walking — one step then the next, then the next, then the next, day and night, walking, mile after mile, no aim, no direction, just walking and walking, not thinking, just walking, come rain or shine walking and walking and walking and walking.

And rain it did — the wettest June for more than a century, and the first time since 1909 that Wimbledon was completely rained out for two days in succession. I felt the rain dissolving my skin, eroding my bones, washing me into the gutter. When the sun returned, brutal and unforgiving, I hid in doorways where moments before others had sheltered themselves from the rain.

And then, as the last of me dissolved, I ceased to exist altogether, a terrifying state of affairs, and one I felt compelled to keep on testing. I would step without warning into the road to see if the cars would stop, pour boiling water over my arms to see if I could feel anything. It wasn't long before such tests began to attract attention.

And so it was that I found myself an involuntary guest on the Samuel Taylor Coleridge ward of the Waterlow Unit on Highgate Hill in North London.

My first day, my first week, I lay on my plastic mattress and stared at the ceiling, like a jet-lagged traveler suspended between two disconnected worlds. A nurse came and read me my rights under Section 2 of the Mental Health Act in an accent so truly execrable (I was tempted to read it for her) that I still have not the faintest idea as to what my entitlements were.

What I got was time, endless hours of time. Psychiatric wards are unchanging places, curiously remote from the outside world with its temporal markers — national, cultural, personal — turning the seasons. They are remote from the weather outside as well; thick panes of reinforced safety glass — thick enough to withstand a chair — contain the constant, slightly stuffy, climate of mental ill health.

Wards run to their own internal rhythm: mealtimes and medication. You smoke and sleep your way from one to the next.

There was something soothing in this simple tempo, like the beating of a heart in the womb. There was something calming in being hidden from the summer as Covent Garden blared with buskers and Oxford Street sweated and heaved. It was as though I'd been taken out of time, plucked up off my feet as the planet spun beneath me.

My fellow patients gradually turned into people, significant, cigarette-trading people, more real by far than the curious phantoms who drifted in at visiting time, expressing their various degrees of alarm and concern. As patients we had our own, more immediate concerns. We squabbled over what channel to watch, who got to eat halal. A teenage boy tried to hang himself but survived when the curtain rail collapsed. An Irish patient taught us to jig, and jig we did, with pajama-clad exuberance, until our teacher got injected for, as the syringe-wielding nurse described it, "undue elation."

I remember little more of that summer. Meds muffle the past as they do the present. Weeks, months, seasons, even years dissolve like a dream on waking. Beyond the windows the world moved on; Wimbledon was lost and won, the annual holidays came and went, the weather was cursed, as it always is, and barbecues were canceled.

Inside, we queued for meals and meds, swapped cigarettes and waited. I'm not sure what we were waiting for, but I do know that when I finally emerged, as pale as a fresh-peeled apple, Diana was dead and autumn was in the air.

Allan is the author of "Poppy Shakespeare." Read more!

Pataki Casts Doubt on Fate of Mental Health Measure Passed by the Senate-(AP)

Pataki Casts Doubt on Fate of Mental Health Measure
Passed by the Senate

By RICHARD PÉREZ-PEÑA
Published: September 16, 2006

After one of the more intensive grass-roots campaigns that Albany has seen in years, the State Senate voted yesterday to require that health insurance plans cover treatment for mental illness.

The Assembly is also expected to pass the bill, but yesterday, Gov. George E. Pataki cast some doubt on its chances of becoming law.

The Senate majority leader, Joseph L. Bruno, a Republican, said at a news conference, “I’ve talked to the governor about this, and the governor has indicated to me, this governor, that he would sign the bill when it gets there.”

But minutes later, at another news conference, Mr. Pataki, a Republican, said only that he would look at the bill, which is expected to raise the cost of some health insurance policies. Asked about Senator Bruno’s claim that he had promised to sign the bill, Mr. Pataki said, “I don’t recall that conversation.”

Advocates for the mentally ill have campaigned for such laws since the 1980’s. Last year, 44 states and the District of Columbia required some kind of mental health coverage, according to the Blue Cross and Blue Shield Association, a national group.

In New York, the Democratic majority in the Assembly had long favored the idea. It was opposed by business groups, health insurers and many of the Republicans who control the Senate. But in 2004 and 2005, a deal seemed imminent, but then talks broke down.

This year, people who have mental illness in their families and organizations for the mentally ill stepped up the pressure, demonstrating noisily outside lawmakers’ offices, the Senate chambers and even at a nearby baseball stadium where Mr. Bruno was throwing out the ceremonial first pitch at a game.

Most prominent among them has been Tom O’Clair, whose 12-year-old son, Timothy, committed suicide in 2001. He drew widespread attention with his plainspoken persistence, often staying at the Capitol past midnight. The bill was dubbed Timothy’s Law, and Mr. O’Clair stood beside Mr. Bruno yesterday as he announced the Senate vote.

“We know how many people suffer from mental illness, and how few are able to come to grips with it, get treatment for it or even admit to themselves,” Mr. O’Clair said. “Timothy’s Law will address the stigma, will help in eliminating it.”

Mr. Bruno mentioned his own granddaughter, who was recently the subject of a statewide hunt when she went missing. He said that she suffers from anorexia.

Several times in the last 10 years, New York lawmakers have told private-sector insurers that they must cover certain services — infertility treatment and minimum hospital stays after mastectomies, for example. Business groups and insurers oppose the requirements, arguing that they raise the price of insurance and discourage people and businesses from buying it.

Such state laws apply to about seven million of New York’s 19 million people, according to the Conference of Blue Cross and Blue Shield Plans. Millions more belong to employer or union plans that are governed by federal law and are exempt from state laws. And in both groups, many policies already cover some degree of mental health treatment.

The bill would not apply to the more than six million New Yorkers on government plans like Medicaid and Medicare — which also provide some mental health benefits — or to the three million with no insurance.

Estimates of the cost of a mental health mandate vary widely, but “some plans have estimated about a 11/2 percent impact on premiums,” said Mark Amodeo, a spokesman for the statewide Conference of Blue Cross and Blue Shield Plans.

Earlier Assembly proposals would have required much more than the current bill, including coverage of drug- and alcohol-abuse treatment, but they were whittled down in talks with the Senate, until a verbal deal was struck in June.

The final version does not cover substance-abuse treatment. Also, it requires fewer services for adults than for children, while forcing the state to pay the resulting costs for businesses with 50 employees or fewer. The law would expire after two years, requiring legislators to reconsider the issue in 2008.

This year’s regular legislative session ended in June, but the Senate convened for a few hours yesterday, and passed the bill, 55-0. Assembly members said they expect to convene briefly after the November election.

For adults, the bill would require coverage of a number of specific conditions, including major depression, bipolar disorder, schizophrenia and eating disorders, and up to 30 days a year of hospitalization and 20 days of outpatient treatment.

For people under age 18, other conditions are added, like attention deficit disorder, and the bill is much more broadly worded, requiring, for example, coverage for treatment of emotional disturbances that pose a risk of injury or significant property damage.

Michael Cooper contributed reporting from Albany.
Read more!

Eastern NC agencies outline plan to merge - New Bern Sun-Journal

SUE BOOK
SUN JOURNAL STAFF

GREEVNILLE — The shape of the agency coordinating area behavioral health assistance was outlined here Thursday night for board members of three agencies merging to accomplish the mission.

That they have similar definitions of that mission is the primary bond between the partner agencies including Neuse Center, Pitt, and Ahoskie-Chowan groups now serving eight eastern North Carolina counties including Craven, Pamlico and Jones.

The new local management entity for administering mental health, developmental disabilities, and substance abuse services expects to form July 1, 2007, and will be called East Carolina Behavioral Health.

It expects to coordinate services and state and federal payment for services provided by private agencies as required by state mental health reform underway for about five years.

“We feel like the way it’s being done, we won’t lose,” said Paul Delamar, a Pamlico County Commissioner and Neuse Center board chairman. “We are all concerned about protecting the consumer whether in a big county or a small county.”

Delamar said he was initially a “reluctant endorser” of the proposed group, which also includes Pitt, Bertie, Gates, Hertford and Northampton counties.

“It just makes sense,” said Arey Grady, New Bern attorney and Neuse Board member. “It is really fortunate we line up geographically. We couldn’t have asked for it to come together better.”

Along with many of those present Thursday, Ann Holton, a board member and Pamlico commissioner, attended a state meeting for LME’s in Winston-Salem last week and said she senses “a lot of excitement.”

State money will pay for the administration to be done by the new agency, she said. County money helps pay for services in each county.

If an LME does not form an agency to serve more than 200,000 and cover at least six counties, it will be penalized 10 percent a year under reform mandate.

Those numbers are what pushed Pitt County, which initially reorganized in the reform process as a county department, into the larger group that is expecting to serve 337,000, said Steve Elliott, Pitt County Manager.

Roy Wilson, who has headed Neuse Center since 1987, is expected to head the new LME.

The new agency is expected to have offices in Ahoskie, Greenville and New Bern.

Sue Book can be reached at 635-5666 or sbook@freedomenc.com. Read more!

WNC mental health agency calls emergency meeting - Asheville Citizen-Times

Fate of area-wide service provider apparently topic of meeting

By Jon Ostendorff
Jostendorff@citizen-times.com

ASHEVILLE — The agency that oversees mental health care in eight Western North Carolina counties will meet in an emergency session Monday.

The reason for the special meeting of the Western Highlands Network Board of Directors was not available Friday, said Beverly Atkins, executive secretary to CEO Arthur D. Carder Jr.

Atkins said Carder asked her to notify board members, the agency’s legal staff and the news media of the meeting on Friday afternoon.

The call for the meeting came hours after county managers from eight counties met with Will Callison, chief executive officer of New Vistas Behavior Health Services. New Vistas serves about 10,000 people in Buncombe, Henderson, Madison, Mitchell, Polk, Rutherford, Transylvania and Yancey counties.

Buncombe County Manager Wanda Greene was at the meeting, saying it focused on the mental health needs in each county and how they can be paid for. She referred questions about New Vistas’ finances to New Vistas officials.

Callison said he couldn’t comment on details of the meeting with county managers.

The meeting on Friday and the one planned for Monday come on the heels of reports this year that said North Carolina’s mental health rates were driving doctors away and creating fewer care options.

Sen. Martin Nesbitt, D-Buncombe, co-chair of the state’s Legislative Oversight Committee for Mental Health, said in March that New Vistas was losing money. He could not be reached Friday.

North Carolina created a new mental health system in 2001. Read more!

NY Senate approves mental health parity - The Business Review, Albany

The Business Review (Albany) - 4:56 PM EDT Friday
by Joel Stashenko

The Business Review
State senators Friday approved a bill 55-0 which they had long resisted to require health care policies in New York state to cover treatment for mental and emotional illnesses.

The state Senate's Republican majority dropped its opposition to the so-called mental health "parity" bill under an agreement reached in June, just before the Legislature concluded its regular 2006 session. The deal called for mandatory coverage for alcohol and drug treatment to be dropped from the legislation, and for the state to provide $50 million to $60 million to offset insurance cost increases for due to the parity bill for companies with 50 or fewer employees.

The bill's chief Senate sponsor, Thomas Libous (R-Binghamton), said the bill is "long overdue." He said he hoped it would help more people overcome the "horrible stigma of mental illness and give people hope."

State Sen. John DeFrancisco (R-Syracuse) said he did not think there was anyone in the Senate chamber Friday who hasn't suffered from mental illness or have a loved one who has.

"It's a great day for those mental health advocates and those suffering from mental illnesses," DeFrancisco said.

Sen. Thomas Duane (D-Manhattan) said in the next few years, the state Legislature should revisit the health insurance mandate and include alcohol and drug addiction treatment in the coverage requirement.

The state Insurance Department will work out how the smaller companies will be reimbursed for additional coverage costs.

The legislation requires policies to cover 30 days of inpatient treatment and 20 days of outpatient treatment for mental illnesses. They include schizophrenia, major depression, bipolar disorder, panic disorder, bulimia, anorexia and binge eating. The bill also requires policies to cover the children of workers under age 18 who need treatment for severe emotional problems.

The legislation approved by the Senate Friday would take effect Jan. 1, 2007, and will run for two years. A study will be performed at the same time into the effectiveness and costs of the bill to help guide the Legislature in whether to extend or alter the mandate in two years.

The state Assembly has yet to schedule a return to Albany to approve the bill and deal with other legislative issues facing that chamber.

State Senate Majority Leader Joseph Bruno said Friday it was his understanding that Gov. George Pataki will sign the bill if it reaches his desk. But Pataki on Friday only promised to "take a look" at the bill if it gets that far.

Of a promise to sign the bill that Bruno said Pataki made, the governor said, "I don't recall that conversation." Read more!

Judge says he’ll rule in ‘stuck kids’ suit - Worcester, MA, Telegram

Case centers on several thousand Medicaid-eligible children in Massachusetts now confined in institutions that need to be released and provided with home-based treatment.

By Richard Nangle TELEGRAM & GAZETTE STAFF
rnangle@telegram.com

A federal judge who ordered the state to reach a settlement with eight Massachusetts families in a class-action mental health lawsuit said this week he will render a decision after hearing from both sides Dec. 12 at U.S. District Court in Springfield.

Judge Michael Ponsor’s decision means that by the time the Rosie D. v. Romney lawsuit is settled, the defendant in the case, Gov. Mitt Romney, is likely to be out of office. When Mr. Romney was inaugurated, the case was about a year old.

The plaintiffs’ lawyer, Steven J. Schwartz, of the Northampton-based Center for Public Representation, said Mr. Romney has been of little help.

“It would take at least a month for the judge to release a formal opinion, and probably another governor will be inaugurated by the time of the decision,” Mr. Schwartz said. “That may be a good idea and helpful because Gov. Romney was not particularly sympathetic to the kids and not particularly instructive in trying to formulate any solution even when the judge found the state was not in compliance with the law. A different governor might be more responsive to the needs of children and to orders of the court.”

The case has been argued by a lawyer from the office of Attorney General Thomas F. Reilly. A spokesman for that office referred inquiries to the Executive Office for Health and Human Services. Richard Powers, a spokesman for that office, said he had not been apprised of the events in Springfield yesterday. “Quite naturally, each side thinks its proposal is reasonable,” he said.

That the two sides are far apart is not news. It has been that way ever since Judge Ponsor’s January decision on the so-called “stuck kids” suit.

He ruled at the time that several thousand Medicaid-eligible children in Massachusetts now confined in institutions need to be released and provided with home-based treatment.

Advocates hailed the ruling as definitive and far-reaching and predicted the state would have to completely rework its service delivery system to young people.

In June, the plaintiffs’ law firm wrote to the court, “Almost five years after the filing of this lawsuit, children with serious emotional disturbance still have not received any new programs, services or treatments that would allow them to remain in their homes and home communities.”

The state, also filing June 12, characterized negotiations this way: “The parties are working well together and the remedy negotiation meetings have been productive,” wrote Deirdre Roney, the assistant state attorney general handling the case.

The two sides filed briefs with the court in preparation for yesterday’s court hearing. For the December hearing, Judge Ponsor asked each side for detailed analyses of what they do not like about the other’s remedy.

The plaintiffs in the case alleged that most of the roughly 15,000 children with extreme functional disabilities who participate in Medicaid receive adequate services only when placed in psychiatric hospitals; but there, they often become “stuck kids” who cannot exercise a home-care option because it doesn’t exist.

In July 2005, the Governor’s Commission on Mental Health issued a report calling for children’s mental health services to be fully incorporated into the state’s health care equation, with routine screenings.

Contact Richard Nangle by e-mail at rnangle@telegram.com. Read more!

"Mental Health: A Public Health Crisis"-Senate Briefing-NAMI

The Senate Caucus on Mental Health Reform will hold a briefing entitled "Mental Health: A Public Health Crisis" on Wednesday, September 20th, 2006, featuring Dr. David Satcher, former Surgeon General of the United States.

The Senate Caucus on Mental Health Reform was created by Senators Domenici, Kennedy, Smith, and Harkin. Senators Dewine and Reed have recently joined.

We urge you to contact your senators to urge them to participate in this important briefing and to thank your senators if they are already members of the Caucus.

The National Alliance on Mental Illness
Read more!

Experts Urge Lawmakers to Help EaseExperts Urge Lawmakers to Help Ease Growing Mental Health Crisis in Seniors- LA Times

Experts Urge Lawmakers to Help Ease Growing
Mental Health Crisis in Seniors

By Moises Mendoza, Times Staff Writer
September 15, 2006

WASHINGTON — Senior citizens have high rates of mental illness and the country's highest suicide rate when compared with other age groups, a panel of mental health experts told a congressional committee Thursday.

Appearing before the Senate Special Committee on Aging, the experts said poor access to mental health care, inadequate training for primary care physicians and even apathy among seniors was contributing to a growing mental health crisis among those older than 65.


Seniors account for a fifth of all suicides — many by firearms; nearly 40% show signs of depression, but only about 3% seek psychological help, the experts testified.

"I think you could probably characterize the situation as a national embarrassment," said psychologist David Shern, president and chief executive of the National Mental Health Assn., an advocacy group in Alexandria, Va.

Fewer than half of all adults with symptoms of depression are screened accurately by their primary care physicians, he said, urging changes in clinical and training practices.

He also called for more research funding to study suicide risks among the elderly — a view that all of the panel's experts endorsed.

Dr. David C. Steffens, a geriatric psychiatrist at Duke University Medical Center, said that when money gets tight, some seniors stop taking antidepressants rather than give up medications to treat physical ailments.

But, he added, several projects looking into innovative approaches to seniors' mental health care showed promise.

In one study conducted in New York, Philadelphia and Pittsburgh, depression care managers — usually nurses or social workers — worked with physicians to identify patients who showed signs of depression and follow up on their care.

Steffens said participants in this program were less likely to think about suicide than people in a control group.

In another study, covering five states, clinical specialists in depression worked with patients in a primary care clinic, reducing their depression symptoms by as much as half when compared with patients who did not receive specialist care, Steffens said.

As the hearing ended, Sen. Gordon H. Smith (R-Ore.), the committee chairman, said that improving mental health services for seniors should be a top priority.

"There really should be no higher issue for us in Congress than to fix this," he said.

moises.mendoza@latimes.com


The LA Times Read more!

Story triggers debate about how to help mentally ill man - Des Moines Register

Published September 15, 2006

By JARED STRONG
REGISTER STAFF WRITER

A statewide discussion about mental illness is under way after a story about a West Des Moines neighborhood's struggle with a man who has a bipolar disorder appeared in Thursday's Des Moines Register.

Joe Martens, 29, has suffered from bipolar disorder for about six years. Martens has severe mood swings when he doesn't take his medicine. During those bouts, Martens' neighbors feel captive in their homes because of his alleged actions, such as throwing rocks, cursing and vandalism. Martens' neighbors have met with police in an attempt to oust him from the neighborhood.

Martens, too, says he feels victimized. He says that his neighbors are always watching him.

The controversy has sparked lively chatter on Internet discussion boards and talk radio. Callers discussed the topic Thursday afternoon on a Des Moines radio talk show, Mac's World. Also, more than 100 posts have appeared on DesMoinesRegister.com.

Bipolar disorder is marked by dramatic mood swings, from extreme excitement to deep depression. There are varying degrees of the illness and not everyone with the disorder is affected as severely as Martens.

Some Internet posts were critical of Martens' parents.

"If you can't handle him - commit him - before he really hurts some innocent person," wrote someone identified as "former Iowan."

But Des Moines resident Susie Severino, who has a son with schizophrenia who lives in a group home in Boone, said she sympathizes with Martens' parents.

"We have no control. We had no cooperation because they are adults, according to the law," Severino said. "We can't force them to take the medication."

Several people who identified themselves as Martens' neighbors posted online throughout the day.

"The meeting was not to vote Joe off the island," wrote someone identified as "caring neighbor." "The neighbors want to be part of the solution. We want to be proactive and helpful."

Others blamed the neighbors.

"I believe that the neighbors need to educate themselves on the illness and make an effort to get to know Joe Martens," wrote someone identified as "Des Moines Woman," who claimed to know Martens.

Others who suffer from bipolar disorder called the Register to share their stories.

"People think we're crazy, but we're not," said Des Moines resident Heather Main, who was diagnosed with bipolar disorder 12 years ago. "We live in our own personal hell, and we each deal with it in our own way."

*****

Reporter Jared Strong can be reached at (515) 284-8075 or jstrong@dmreg.com.

Click here to read more of the comments and to join the discussion.

Read more!

Mental-health work are high-risk jobs - The Seattle-Times

By Kyung M. Song
Seattle Times staff reporter

Marty Smith, of Bremerton, died last November working in one of the most dangerous occupations around: mental-health worker.

Smith, 46, was stabbed to death in the dining room of Larry Clark, a child rapist whose mother had summoned help, saying Clark was schizophrenic and off his medications.

Deaths such as Smith's need not be inevitable dangers for mental-health professionals, according to a report released Thursday about workplace violence in the state's community mental-health services. The report was commissioned after Smith's death by Service Employees International Union 1199NW, which represents 2,000 mental-health workers in Washington.

The union supports the "Marty Smith" bill, which would require mental-health workers to work in pairs when making high-risk home visits. The bill died in the Senate this year but will be reintroduced when the Legislature convenes in January.

Among the study's recommendations are putting more money into community mental-health services to help reduce workers' caseloads, mandating that an extra person accompany mental-health workers on high-risk home visits and training workers in how to cope with violence.

The state's Department of Social and Health Services (DSHS) will address safety concerns of mental-health workers at two conferences next week, DSHS spokesman Jim Stevenson said.

These "brainstorm sessions" will draw on workers' experiences to develop improved protocols to help mental-health workers avoid unnecessary danger and prepare for dangerous situations that can't be avoided.

DSHS "safety summits"


The Mental Health Division of the Department of Social and Health Services is sponsoring two full-day "safety summits" to discuss safety concerns among mental-health workers.

In Western Washington, the meeting will be 8 a.m. to 4 p.m. Monday at Western State Hospital in Tacoma. To register for the free event, e-mail thadela@dshs.wa.gov.

Speakers include Leslie Gamble, of Vancouver, B.C., an ergonomics specialist as it relates to safety in the social services field, and state Rep. Tami Green, who has introduced legislation addressing mental-health-worker safety.

Kathleen McPhaul, assistant professor with the University of Maryland's Department of Family and Community Health who interviewed mental-health professionals and other experts for the field report, said caseworkers have the power to prevent violence in people with mental illness.

"It's the face time with the worker that keeps the patients stable," McPhaul said. "Violence is not necessarily a symptom of being mentally ill."

Violent acts by the mentally ill are "ultimately preventable. It's not random," she said.

Based on Washington workers' compensation claims between 1995 and 2000, workers at psychiatric hospitals experienced by far the highest rates of workplace violence.

They suffer 2 1⁄2 times more violence-related injuries than the next-highest group, residential-care workers, and nearly eight times the rate of police officers.

Psychiatric work "is not thought to be a risky job, but it's highly dangerous," said Michael Foley, a senior economist with the state Department of Labor and Industries.

Social services and health services have the highest rates of assaults and violence among major industries, Foley said. In July, Maritza Dowe, a clerk at a public-health clinic in downtown Seattle, was blinded after a former mental-hospital patient attacked her with a knife.

Rep. Tami Green, D-Lakewood, who sponsored the "Marty Smith" bill and will speak at the DSHS conference next week, said she is more hopeful that it will pass next year.

Smith's widow, Yolanda Smith, said she blames the system perhaps more than Clark for her husband's death.

After the attack, Clark was initially deemed mentally incompetent to face a first-degree murder charge. After receiving treatment at Western State Hospital, he was declared competent and awaits trial in Kitsap County Jail.

Seattle Times staff reporter Carol Ostrom contributed to this report.

Kyung Song: 206-464-2423 or ksong@seattletimes.com Read more!

Eastern mental health leaders meet - The Daily Reflector

By By Amanda Karr
The Daily Reflector

Friday, September 15, 2006

Officials from Pitt County and two nearby mental health agencies met for the first time Thursday as plans to combine the three entities into one continue to progress.

Pitt County commissioners, mental health advisory board members and officials with Roanoke-Chowan Human Services and Neuse Center held a dinner meeting at the Pitt County Agriculture Center. The event was designed so the leadership could meet each other. They shared optimism over the regionalization plan, which is scheduled to formally take effect July 1.

"I'm excited. We've been hearing about and talking about a merger for four years, and, finally, we can see the light at the end of the tunnel," said Johnnie Farmer, Hertford County commissioner and chairman of the Roanoke-Chowan board of directors.

The combined entity will be known as East Carolina Behavioral Health. Representatives from each agency have met monthly for several months to plan the merger.

Currently, Pitt Mental Health operates as a single-county entity as a county department, a decision made by county commissioners when a state law was passed in 2001 requiring all mental health agencies to switch from service providers to service managers.

Pitt County commissioners voted in May to move forward in combining the three entities starting next fiscal year. The boards of directors of the other two agencies have also passed similar resolutions, as has the Pitt County Mental Health Advisory Board.

The decision to consolidate was prompted by increased state pressure for all local management entities to serve at least six counties or 200,000 people. The prospect of a state funding cut created a real incentive for Pitt County, County Manager Scott Elliott said.

The regional entity will serve eight counties — Bertie, Craven, Gates, Hertford, Jones, Northampton, Pamlico and Pitt — with a combined population of about 337,000.

Staff of the combined mental health local management entity will work out of Ahoskie, Greenville and New Bern according to the current plan, said Jeanne Supin, a consultant working with representatives of the three agencies during regionalization talks.

Residents in need of mental health services would continue to be referred to service providers in their area.

Ensuring those in need of services continue to receive them is the primary concern, officials from all three entities said.

"We had a concern when this process started that we'd lose our identity and the consumer would not be protected because of such a large entity. ... I was reluctant, but as we've gone along I feel much better," said Paul Delamar, chairman of the Neuse board of directors, adding that those he met at the meeting seemed very consumer-driven.

Elliott echoed the sentiment.

"We're very committed to the services we deliver and to regionalization because we see it as the best thing for the consumer and the citizens overall," he said.

Before the regionalization plan can move forward, county commissioners in each county must sign an agreement, a regional Consumer Family Advisory Committee must be formed and a new board established.

Pitt Mental Health has been without a director since February. Other employees have also either left the agency in the past year or had their positions eliminated as the agency downsized as a result of changes mandated by the state, leaving a staff of about 20.

Amanda Karr can be contacted at akarr@coxnc.com and 329-9574 Read more!

Mental health crisis among aging grows - The Baltimore Sun

Experts tell Congress rates of illness and suicide are high in U.S.

By Moises Mendoza

September 15, 2006

WASHINGTON -- Senior citizens have high rates of mental illness and the highest U.S. suicide rate compared with other age groups, a panel of mental health experts told a congressional committee yesterday.

Appearing before the Senate Special Committee on Aging, the panelists said poor access to mental health care, inadequate training of primary care physicians and apathy among seniors contribute to a growing mental health crisis among those over 65.

Seniors account for a fifth of all suicides - many by firearms - and nearly 40 percent show signs of depression, but only 3 percent seek psychological help, the experts testified.

"I think you could probably characterize the situation as a national embarrassment," said psychologist David Shern, president and chief executive officer of the National Mental Health Association, an advocacy group in Alexandria, Va.

Fewer than half of all adults with symptoms of depression are screened accurately by their primary care physicians, he said, urging changes in clinical and training practices.

He also called for more research funding to study suicide risks among the elderly - a view that all the panelists endorsed.

Dr. David C. Steffens, a geriatric psychiatrist at Duke University Medical Center, said that when money gets tight, some seniors choose to stop taking anti-depressants rather than give up medications to treat physical ailments.

But, he said, several projects looking into innovative approaches to seniors' mental health care show promise.

In one study conducted in New York, Philadelphia and Pittsburgh, depression care managers - usually nurses or social workers - worked with physicians to identify patients who showed signs of depression and follow up on their care. Participants in this program showed lower suicide ideation rates than people in a control group, Steffens said.

In another study covering five states, clinical specialists in depression worked with patients in a primary care clinic, reducing their depressive symptoms by up to half when compared with patients who did not receive specialist care, Steffens said.

As the hearing ended, Sen. Gordon Smith, a New Hampshire Republican who is the committee chairman, said:

"There really should be no higher issue for us in Congress than to fix this."

Moises Mendoza writes for the Los Angeles Times. Read more!

Slain man had record, but 'not a threat'-Charlotte Observer

Slain man had record, but 'not a threat'
Union resident shot him after van break-in
EMILY S. ACHENBAUM
eachenbaum@charlotteobserver.com

The victim of a fatal shooting in Union County was a mentally disabled man who'd had brushes with the law, but wasn't violent or dangerous, friends and neighbors said.

John David Mobley, known around Waxhaw as "Ronie," died Monday after being shot by Lonnie Kirkley, according to the Union County Sheriff's Office.

Deputies said Mobley was outside Kirkley's home just after midnight, and inside Kirkley's truck.

Kirkley's wife had seen someone inside her van moments before, deputies said, and alerted her husband, who went outside with his gun.

Kirkley found Mobley exiting his truck and shot him, deputies said. No charges have been filed in the shooting, though the case is being reviewed by the Union County district attorney.

People who grew up knowing Mobley, 39, say he was born with a mental disability. They said he was a petty thief, though not a threat.

His arrest record shows he was convicted twice for breaking and entering into cars.

For a while, he panhandled in downtown Waxhaw, police said.

Mobley trusted people, and some took advantage of him, neighbors said -- taking his small amounts of money, or telling him to go break something or pull someone's hair in return for a treat such as some change or candy.

"People would dare him to do something because he would -- hit someone, take something. He didn't understand he was doing something wrong," said Melanie Haile, who grew up near Mobley. Haile said Mobley had special needs, but he "was not a thug."

Mobley may have received some public money but otherwise was destitute, neighbors said, so they gave him money for small handyman projects.

"He did little chores for me," said neighbor Lawrence Crockett. Crockett said Mobley was paid to hold tools during a plumbing project, or help with his lawn. "That's how he survived," Crockett said. "People knew him, people would help him out."

Often given probation -- revoked when he committed crimes again -- Mobley was ordered to have mental health evaluations, arrest records show.

It's not clear whether he received treatment, and he went in and out of prison. On other occasions, Mobley was given probation on the grounds that he stop panhandling, or stop calling 911 in nonemergency situations.

"He didn't mean anything by it, but he was a nuisance, and he caused trouble," said Waxhaw Police Chief Mike Eiss.

Haile said she doesn't necessarily fault the man who shot Mobley, because the shooter likely "didn't know who he was dealing with. ... (Mobley) was not a threat."

Kirkley could not be reached for comment.

A funeral for Mobley will be at 11 a.m. Saturday at Blessed Hope Baptist Church in Mineral Springs.
Charlotte Observer
Read more!

CDC: Among disabled, Southerners less healthy - Charlotte Observer (AP)

MIKE STOBBE
Associated Press
-
ATLANTA - Southerners with disabilities are in worse health than are people with disabilities in other parts of the country, according to a federal report released Tuesday.

The report also showed that smoking, obesity and physical inactivity rates were consistently higher among people with disabilities than the able-bodied.

Question: Were most of the surveyed people disabled and then developed unhealthy behaviors, or did they become disabled after - or perhaps as a result of - engaging in unhealthy behaviors?

That's a chicken-and-egg puzzle that has not yet been solved, said John Crews, lead scientist with the CDC's disability health team. "There's a lot that we don't know about this population," he said.

But the study shows the need to start targeting smoking cessation and other public health messages to people who are disabled, including using photographs of disabled people in outreach, he said.

West Virginia and Kentucky had the highest rates of adults with disabilities, each with about 25 percent of the population saying in a survey they have functional limitations such as decreased mobility or a loss of vision or hearing.

Only about 11 percent of adults in Hawaii report being disabled, making that the least disabled state. North Dakota and Illinois were next lowest, both at 16 percent.

Nationally, about 20 percent of non-institutionalized adults are disabled, according to federal health officials.

All of those rates have been reported in the past. What's new is measurements of the health behaviors of disabled and non-disabled people in each state, Crews said.

Kentucky had the highest U.S. rate of smoking among people with disabilities. In that state, 40 percent of disabled people identified themselves as smokers, while 29 percent of non-disabled people did.

Tennessee ranked second, with 38 percent of disabled people smoking, while 22 percent of non-disabled smoked. Louisiana was third, with smoking rates of 37 percent and 24 percent, respectively.

Mississippi had the highest rate of obesity among people with disabilities, at about 37 percent. The obesity rate for Mississipians without disabilities was 24 percent.

Indiana ranked second, with obesity rates of 36 percent and 22 percent, respectively. North Carolina was third, with rates of 36 percent and 21 percent.

The data were collected from a national health survey done in 2001 and 2003 that involved more than 200,000 telephone interviews in each of the years.

People were considered to have a disability if they answer "yes" to one or both of the following questions: Are you limited in any way in any activities because of physical, mental, or emotional problems? Do you now have any health problem that requires you to use special equipment, such as a cane, a wheelchair, a special bed, or a special telephone?

The report was released Tuesday at the CDC's National Health Promotion Conference, held in Atlanta.

In all states, higher percentages of disabled people said they did not exercise or engage in other physical activity. While that may not be surprising, it shouldn't be assumed that a disabled person cannot exercise or enjoy good general health, Crews said.

"We don't want to equate the notion of disability with poor health," Crews said.

"Health behaviors are modifiable. That's the positive message in all of this," he added. Read more!

VA Study Doubts Gulf War Syndrome-Associated Press

Sep 12, 2:51 PM EDT

VA Study Doubts Gulf War Syndrome

By ANDREW BRIDGES
Associated Press Writer

WASHINGTON (AP) -- The unexplained symptoms that afflict thousands of Gulf War veterans don't constitute a single illness, a federally funded study concludes.

Even though U.S. and foreign veterans of the 1991 war report more symptoms of illness than do soldiers who didn't serve in the Persian Gulf, there is no such thing as Gulf War syndrome, according to the Veterans Affairs-sponsored report released Tuesday.

Nearly 30 percent of all those who served in the brief war have reported problems.

"There's no unique pattern of symptoms. Every pattern identified in Gulf War veterans also seems to exist in other veterans, though it is important to note the symptom rate is higher, and it is a serious issue," said Dr. Lynn Goldman, of Johns Hopkins University, who headed the Institute of Medicine committee that prepared the report.

The report did find evidence of an elevated risk of the rare nerve disease amyotrophic lateral sclerosis, also called Lou Gehrig's disease, among Gulf War veterans. They also face an increased risk of anxiety disorders, depression and substance abuse, it said.


The VA contracted with the Institute of Medicine, part of the National Academy of Sciences, to review scientific studies and probe the issue at the direction of Congress. Department of Veterans Affairs spokesman Phil Budahn said the VA would not comment until it had a chance to study the report.

Tuesday's report is the latest in the important series, which the VA will rely on to determine whether Gulf War veterans are eligible for special disability benefits if they are found to suffer from illnesses that can be linked to their service.

Veterans can now claim those benefits only by making an undiagnosed illness claim, said Steve Robinson, a Gulf War Army veteran and government relations director for Veterans for America.

"They keep saying it over and over, every year. We know that - we know that there is no single thing that made veterans sick. We know this thing is likely a combination of various exposures," Robinson said in pushing for new studies he hopes will find what ails tens of thousands of his fellow vets.

However, the report's confirmation that Gulf War veterans are sicker may actually help them secure government benefits, said Shannon Middleton, assistant director of health policy for the American Legion.

A member of the Research Advisory Committee on Gulf War Veterans' Illnesses, also chartered by Congress, called the report the "first step" in cataloging the studies done on veterans of the conflict.

"But the most prevalent problems in Gulf War veterans are the multisymptom illness/Gulf War syndrome-type problems that still affect a sizable proportion of those who served in the war. I am disappointed that the IOM report does little to analyze what these studies collectively tell us about the nature and causes of these conditions," said Lea Steele, a Kansas State University epidemiologist who is the committee's scientific director.

Soldiers who served in the Persian Gulf following the Iraqi invasion of neighboring Kuwait in August 1990 have reported symptoms that include fatigue, memory loss, muscle and joint pain, rashes and difficulty sleeping. The variety of symptoms has complicated efforts to pinpoint their cause, according to the report.

Nearly 700,000 U.S. soldiers, along with troops from 34 other countries, took part in the Gulf War. Once in the region, those soldiers were exposed to a wide array of toxins and other potential health hazards, including smoke from hundreds of oil well fires, pesticides, depleted uranium ammunition and possibly the nerve agent sarin, released during the demolition of a munitions dump.

Inadequate screening of soldiers before deployment in the Gulf War, coupled with a lack of environmental monitoring during the conflict, have hindered efforts to determine whether exposure to those contaminants is linked to any illness, the report also notes.

For years, the government denied the mysterious illnesses were linked to the war. It now acknowledges that at least some were due to wartime service. The government is no longer pointing to stress as the likely reason, as some federally funded studies had suggested.
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Mental health authority, sheriff's office partner to deliver services - Henderson Dispatch

Two local agencies are partnering to better address calls to law enforcement that are generated by incidents involving people suffering from mental illness.

The partnership between the Vance County Sheriff's Department and the Five County Mental Health Authority, which has been developing over the past year, has culminated in the designation of Deputy Todd Flowers as a Crisis Intervention Team (CIT) coordinator.

In that capacity, Flowers is helping guide the sheriff's office in diverting mentally ill people into appropriate services.

Gina Dement, public information officer for Five County Mental Health, was excited about the spirit of the two agencies working together.

“The success of this new program will be measured by its ability to divert the mentally ill away from jail and to appropriate services,” she said.

Flowers was trained in crisis intervention with officers from Wake County where the North Carolina initiative was first implemented. As the first “CIT Certified” law enforcement officer in rural North Carolina, he brings his experience and skills to create the first rural version of the CIT effort, Dement said.

Surrounding counties have recognized the need to increase the knowledge and the skill sets of officers on accessing individuals in a mental crisis. The Vance County Sheriff's Office and Five County Mental Health are offering a Crisis Intervention Training program at VGCC this month for law enforcement officers in Franklin, Granville, Halifax, Vance and Warren counties.

Officers who enroll in the Crisis Intervention Officer Program will receive 40 hours of training that will enhance their skills to quickly assess situations involving individuals in a state of mental crisis, Dement noted.

The training will be held Sept. 18-22 on the college's main campus. Graduates will be certified as CIT officers at a graduation to be held on Sept. 22, at 3 p.m. at VGCC.

The CIT officer will work directly with the sheriff and other deputies as a resource in the management of incidents that entail a mental health related issue.

“The CIT program provides an avenue for the development of community partnerships and the collaboration of working together for community interest of service and care,” Dement said. “CIT is about doing the right thing for the right reasons. The more direct channel of communication and cooperation between the sheriff's office and the mental health system is expected to improve service offered by both agencies.”

Estimates are that up to three quarters of inmates of jails and correctional facilities may have a substance abuse or mental health problem that contributed to their incarceration.

“Without a program such as the one in Vance County, they often do not get the help they need to stay out of the criminal justice system,” Dement added.

Recent changes in the organizational structure of mental health services have been brought about due to the mental health reform. This new environment facilitates better cooperation among agencies trying to help people with mental health problems get directed toward appropriate assistance, Dement said.

“By getting mental health consumers diverted back into an appropriate channel of care, law enforcement can better focus on criminal and public safety issues,” she added.

For more information on the CIT class, interested persons should contact Flowers at (252) 738-2236.

Send comments to news@hendersondispatch.com. Read more!

Members of merging mental health agencies to meet - New Bern Sun Journal

SUE BOOK
SUN JOURNAL STAFF

Neuse Center CEO: ‘We are excited about this partnership’

Members of the boards of directors of three area mental health agencies planning to merge in July 2007 will sit down to talk for the first time in Greenville Thursday.

The organizations — Neuse Center serving Craven, Pamlico and Jones counties, Ahoskie-Chowan, and Pitt — have agreed to merge as part of North Carolina’s restructuring of mental health, developmental disabilities and substance abuse services.

About 50 people are expected at the 6:30 p.m. dinner at Pitt County Agriculture Building in Greenville, said Roy Wilson, Neuse Center CEO, who is expected to head East Carolina Behavioral Health.

“We are excited about this partnership in order to better manage the quality of services provided to our citizens and take advantage of economies of scale,” said Wilson.

The new regional organization will meet state requirements that public local management entities, or LME’s, serve at least six counties or 200,000 people. The eight counties — Craven, Pamlico, Jones, Bertie, Gates, Hertford, Northampton and Pitt counties — total 337,000 people.

“Our effort will draw from the strengths and expertise of each of three partners, building the best possible regional organization,” said Scott Elliott, county manager for Pitt County, the only program previously operating as a county department.

“All three partners want to maintain a strong local presence in each community and work with local providers to make sure consumers and families get the services they need close to home,” said Joy Futrell, Roanoke-Chowan Human Services CEO.

Local agencies not complying with the state mandate would be penalized 10 percent of state funds annually.

East Carolina Behavioral Health’s board is expected to have one member of the county board of commissioners in each participating county and one other individual from that county.

The new, regional approach comes as the three agencies set to merge complete three years of sweeping change, including passing care management to private providers while the agencies manage eligibility and payment accounting and referrals.

Offices are planned for New Bern, Greenville and Ahoskie with efforts made to keep participants close to home for services, Wilson said.

“We have all been in this business a long time, and we see this as an opportunity to maximize our strengths for the benefit of our consumers and our communities,” he said.

While no formal business will be conducted Thursday, Wilson said the meeting will offer an overview of the plans for East Carolina Behavioral Health and open dialog between the partners.

Sue Book can be reached at 635-5666 or sbook@freedomenc.com. Read more!

The Nose Knows-Philadelphia Inquirer

Olfactory neurons, local scientists have found, can reveal a lot about live brain cells and mental illness. And they're easy to study.
By Tom Avril
Inquirer Staff Writer

For the millions of Americans who take drugs to treat mental illness, about the only way psychiatrists can tell whether the medications are working is through observation and asking patients how they feel. And even when doctors do find the right drugs, they can't explain exactly why the meds are effective.

It's the glaring void at the heart of mental health treatment. No one, from the scientists developing drugs to those who prescribe them, is able to examine the diseased tissue: the cells of the human brain.



Enter Nancy Rawson, a cell biologist at Monell Chemical Senses Center in Philadelphia. She does it through the nose.

Working with colleagues at the University of Pennsylvania and Thomas Jefferson University, Rawson takes advantage of a scientific curiosity: The sensory cells in the nose, unlike those elsewhere in the body, are very similar to neurons in the brain, Rawson says. And they can be easily plucked out for study, a few hundred at a time, because they grow back.

In recent years, researchers have developed several methods to probe the mind, from analysis of spinal fluid to imaging methods such as MRIs and PET scans. But looking at olfactory neurons - located high in the nose, directly connected to the brain through a porous plate in the skull - is the only way to examine living neurons short of surgery.

The goal: better diagnoses and better medicines.

Robert Freedman, editor of the American Journal of Psychiatry, published a paper last year by Rawson and Chang-Gyu Hahn, a Penn psychiatrist and neurobiologist.

"In other fields of medicine, we know we can directly examine the cells," Freedman said. "The problem we have in mental illnesses is that the brain itself is obviously something that's out of bounds for biopsies."

Until now. Though still at an early stage, the work already has shown significant differences in how nose cells function in those with mental illness.

Previous studies have found that people with Alzheimer's disease and schizophrenia can have an impaired sense of smell. But the work in Philadelphia takes things down to the microscopic level. Rawson and Hahn measure fluctuations in calcium - the mineral that helps carry electrical signals through the body's cells.

It is not clear whether nose cells may be related to the underlying causes of mental illness, or if they merely reflect the symptoms.

"How representative are these neurons of neurons that might be dysfunctional in other parts of the brain?" asked William T. Carpenter, a University of Maryland schizophrenia expert.

Yet the olfactory bulb, which processes odor information, is among the oldest and most primitive parts of the brain, evolutionarily speaking - as is the nearby limbic system, which handles emotions. So it's possible that the olfactory system could be tied in with emotional disorders.

At the very least, Rawson and her colleagues have opened a new tunnel into the mysteries of the mind.

Painless procedure

Removing a clump of neurons from the nose is a delicate business, but in the hands of Edmund Pribitkin, it's swift and painless.

The otolaryngology professor at Jefferson has done hundreds of the biopsies. Last month, Pribitkin demonstrated on Jerome Lennon, a healthy volunteer whose cells will be compared with those of sick people.

Using lidocaine to numb the nose and a thin pair of forceps, Pribitkin extracted bits of tissue from high up in Lennon's nose.

Minutes later, Rawson packed the samples into a blue insulated bag and carried it across town to her basement lab, passing by Monell's landmark golden statue of a mouth and nose on her way in.

There, researchers placed one sample in an incubator to grow more neurons from the stemlike cells expected to be in Lennon's tissue. In addition to the mental health research, they are studying this ability to regrow neurons, which might someday be used to treat stroke or brain injury.

As Rawson watched, research associate Jiang Xu prepared the other sample and placed it under a microscope.

There, on an adjacent computer screen, were living neurons from Jerome Lennon.

Xu bathed them first in one mixture of odors, consisting of citrus, menthol and cloves, followed by another mix that included fish, roses and vanilla.

Rawson and Xu monitored calcium levels in the neurons to see how they responded to each combination of smells. Either an increase or a decrease in calcium would mean a cell had sensed an odor, and was trying to send a message to the brain.

The researchers used a dye that caused cells with lots of calcium to glow brighter. In response to odors, some cells absorbed calcium from the surrounding fluid. Inside the nose, cells absorb calcium from mucus.

In the paper the team published last year, calcium levels in the neurons of patients with bipolar disorder dropped in response to various odors. Yet calcium levels rose in the nose cells of healthy people. In addition, the cells of untreated bipolar patients responded differently from those treated with a mood-stabilizer drug.

Other research is under way on cells from people with depression and schizophrenia.

The process involves a lot of luck. There's no telling which of the hundreds of types of olfactory neurons will be in each piece of tissue, or if there will be any neurons at all.

The biopsies must be done again and again to achieve a large enough sample size for the various types of cells. The work will take years.

Medicines 'by accident'

Without the ability to examine the living brain, the history of developing psychotherapeutic drugs has been something of a guessing game.

"Most of the drugs we have currently either were discovered by accident or are copies of drugs that were discovered by accident," journal editor Freedman said.

And scientists do not fully understand why they work, though for some, such as the class of antidepressants that includes Prozac, they have a pretty good idea.

Penn's Hahn estimated that 30 percent of people with depression gain no relief from treatment.

For schizophrenia, medicines can alleviate psychotic symptoms such as hearing voices, but they do not address cognitive and emotional problems.

Researchers test drugs on human cells from elsewhere in the body, and on the brains of mice and other lab animals. But creating a mouse with a human illness is tough, Hahn said.

"Say somebody believes the FBI is following them around," Hahn said. "It'd be hard to model that in a mouse."

Besides leading to new drugs, the researchers hope their work will allow a better understanding of the very definitions of mental illness. Depression and schizophrenia, for example, are likely not single diseases, but clusters of diseases.

Rawson, a quiet woman who chooses her words carefully, was drawn to the research by the potential to regrow neurons, having watched a grandmother succumb to dementia.

She did her doctoral dissertation on the liver at Penn. As part of that work, she came to Monell to learn how to dye cells to monitor calcium levels.

Upon learning more about the unusual properties of neurons in the nose, she was hooked.

"I never made it out of the nose back to the liver," she quipped.

Finding the right treatment

Robin Cunningham, a member of the board of directors for the National Alliance on Mental Illness of New Jersey, said that if the research is successful, it would be a "tremendous boon." It often takes years for patients to hit on the right diagnosis and the appropriate medicine, a painful process during which friends become distant and lives are wrecked, he said.

"They're going from one drug to the hospital to another drug to the hospital. It is a horrendous, harrowing experience," he said.

A new study from Harvard Medical School estimates that bipolar disorder accounts for $14.1 billion in lost productivity each year, major depression for $36.6 billion.

Cunningham has schizophrenia, and went through 10 drugs over a decade before finding one that controlled the symptoms, which included his belief that others were putting thoughts into his head.

Some scientists remain cautious. Freedman, the journal editor, predicted the nose biopsies would be most valuable in developing new drugs, but doubts they would be used for everyday diagnosis anytime soon.

Rawson and Hahn are more optimistic; Hahn called the work a "stepping stone" to personalized medicine.

Most of today's medicines are receptor blockers, meaning they inhibit processes external to the cell, he said. He predicts that will change within 10 years.

Peering into the very insides of neurons, he said, will help drugs cross a threshold.

"We'll be seeing medications that target what happens inside the cell," Hahn said, "not just knocking on the doors."

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Battle Lines in Treating Depression-New York Times

Battle Lines in Treating Depression

Article Tools Sponsored By
By BARNABY J. FEDER
Published: September 10, 2006

TAMARA KNIGHT remembers little of the summer of 2004 beyond a numbing despair that resisted 16 different antidepressant drugs. She dreaded a return to electroshock therapy, which she had tried periodically for years, because it brightened her mood for only a few weeks, at best, while progressively destroying her memory.

“She was in as dark and low a place as you can ever imagine a person living,” said Don Knight, her husband. So Ms. Knight drove to a drugstore in her hometown of Columbus, Ga., bought two large bottles of extra-strength Excedrin and two boxes of sleeping pills. She said she swallowed as many of the pills as she could before she passed out.

Katherine V. Coram, another depression sufferer with a history of attempted suicide, was in relatively better shape that same summer. She had managed to cling to a job at the National Archives in Washington, where an understanding boss gave her a light workload. But Ms. Coram felt defeated. Her three years in a clinical trial to see if an implanted nerve stimulator could control her illness had ended with hellish results.

“I was hospitalized three times in the year after I got it for anxiety, panic and other problems — after having gone 15 years without hospitalization,” said Ms. Coram, who lives alone in Silver Spring, Md. “Once I even hit a stranger in a restaurant after I got mad. It was totally out of character for me.”

The summer of 2004 was also trying for Cyberonics, a small Houston company that made Ms. Coram’s stimulator, and Robert P. Cummins, known as Skip, the company’s combative chief executive. A Food and Drug Administration panel recommended in June that the agency approve the device — a pocket-watch-sized generator implanted in the chest that transmits electronic pulses to a major nerve pathway in the neck — for treating the most intractable forms of depression. But about two months later, the F.D.A. ignored its own panel’s recommendation and decided to withhold approval after weighing criticisms from groups opposed to the controversial treatment.

Since 2004, Ms. Knight and Ms. Coram have continued their struggles with depression, their fates intersecting with Cyberonics’ own battles with the F.D.A. and insurers, as well as medical skeptics and public interest groups who argue that the company is peddling false hopes built on a still unproved technology.

The struggle over the future of the $15,000 device, which costs another $10,000 or more to implant, is being played out against that most tender of landscapes: the human psyche and the unpredictable and poorly mapped fault lines that cause depression and separate people from themselves and the world around them.

IT is a very promising avenue of research, and the long-term data they are pushing are encouraging,” said Dr. Christopher Gorton, chief medical officer of APS Healthcare, a consulting firm that was hired by the state of South Carolina to review Cyberonics’ research results. “But people have a legitimate need to be cautious. Even the sponsors admit they don’t know exactly how it works. The psychiatric literature is full of people clutching at straws.”

Some 21 million American adults suffer from depression, according to the National Institute of Mental Health, a federal research agency. While doctors as far back as the Renaissance speculated that mood disorders had medical roots, it was not until the end of the 19th century that such views were widely accepted. Since then, mental health care has seen innovations in talk therapy, electroshock, surgical procedures, drugs and, most recently, implanted devices.

Along the way, there have been notorious examples of misplaced medical enthusiasm, including adoption of lobotomies to treat depression. Currently, critics complain about frequent misuse of electroshock therapy and the virtually unregulated mixing of potent antidepression and antipsychotic drugs.

Cyberonics, which finally secured F.D.A. approval to market its implant last year, has ventured into the most difficult corner of depression treatment. It says its stimulator can provide relief for many of the four million or so people who suffer from “treatment resistant depression,” or T.R.D., a form so severe that patients fail to respond to drugs and traditional shock therapy. No other product has ever been designed for — and tested exclusively on — such a severely depressed population.

During the last month, some 1,300 doctors, patients and Cyberonics employees have written to the Centers for Medicare and Medicaid Services, asking that the agency grant Cyberonics’ recent petition for Medicare coverage. Public Citizen, a consumer advocacy group in Washington, filed a competing request on Wednesday, asking the agency to deny coverage. The group contends that Cyberonics has relied on misleading advertising and clinical trial write-ups, among other tactics, to secure federal approvals.

See the full story at
New York Times
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Mental illness doesn't have to be disabling - Hendersonville Times-News

Sandy Goble
Be Our Guest

The costs of untreated mental illnesses are extremely high.

The economic burden to the United States alone is more than $100 billion each year. The consequences are staggering -- unnecessary disability, unemployment, substance abuse, homelessness, inappropriate incarceration and suicide.

What are the advantages of early identification and treatment? During the latter part of the 20th century, huge strides have been made in the development of new and more effective therapies. The work goes on.

Today the best treatments for serious mental illnesses are highly effective. Between 70 and 90 percent of individuals appropriately treated experience significant reduction of symptoms. Effective pharmacological and psychosocial supports can bring huge payoffs for consumers of mental health services and their families.

Oct. 1 through 7 is "National Mental Illness Awareness Week." Established in 1990 by Congress, its purpose is to raise the public awareness of the fact that mental illnesses are disorders of the brain that can often profoundly disrupt a person's thinking, feeling, mood and ability to relate to others.

In addition, "Bipolar Disorder Awareness Day" is held each year on the Thursday of Mental Illness Awareness Week (Oct. 5) to encourage further understanding and promote early intervention and treatment for this mental illness.

The National Alliance on Mental Illness (NAMI) is an organization that provides support for consumers of mental health services as well as for family members and loved ones touched by mental illnesses. NAMI, a grassroots organization, also provides community education and works to eradicate ignorance, fear and stigma, which unfortunately still exist in the 21st century.

Here are some important facts about mental illness:

People anywhere on the age continuum can have a mental illness. However, the old and young are especially vulnerable.

Often mental illnesses strike in the prime of life. Many times when individuals are adolescents or young adults.

Children are not immune. Twenty-one percent of our nation's children ages 9 to 17 have a diagnosable mental or addictive disorder that causes at least minimal impairment.

Suicide is the third leading cause of death in youths aged 15 to 24, more than cancer, heart disease, AIDS, birth defects, stroke, pneumonia, influenza and chronic lung disease combined.

In addition, youths with unidentified and untreated mental disorders tragically end up in jails and prisons.

Mental illnesses can occur in all levels of severity. Among U.S. adults, the most serious and disabling conditions affect between 5 and 10 million people (2.6 to 5.4 percent). Three to 5 million children ages 9 to 17 (9 to 13 percent) are also affected.

Mental disorders are the leading cause of disability (lost years of productive life) in North America, Europe and, increasingly, in the rest of the world. However, by the year 2020, major depressive illness will be the leading cause of disability in the world for women and children.

Approximately 2.3 million Americans are presently diagnosed with bipolar disorder (manic-depression). This condition can cause extreme shifts in mood, energy and functioning. However, bipolar disorder is a highly treatable condition and persons receiving appropriate treatment can lead full and productive lives.

NAMI Four Seasons meets at 10 a.m. the third Saturday of each month at Pardee Education Center in the Blue Ridge Mall in Hendersonville. The general meetings are followed by an education program at 11:30 a.m. For more information, call the NAMI Four Seasons information line at 693-0907. Please leave a message, and someone will return your call.

Sandy Goble is a registered nurse and president of the NAMI Four Seasons chapter. She lives in Brevard.
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Critical Gaps in Evidence For Current Treatment of Children - APA

Download full report here

A lack of empirical evidence for some treatments, limited access to care and the burgeoning problem of mental illness in children all need immediate attention according to the report

WASHINGTON, DC – Limited access to services for children and adolescents with behavioral problems or mental illness often leads to inadequate care and treatment based on insufficient scientific evidence of safety and effectiveness, concludes a report by the American Psychological Association (APA) released today.

According to the report, a product of the APA Working Group on Psychotropic Medications for Children and Adolescents, gaps in the scientific knowledge concerning which treatments work best for specific diagnoses and patients, a dearth of clinicians specifically trained to work with children, cuts in Medicaid funding, and poor reimbursement for mental health services leads to many children being treated with medication despite limited efficacy and safety for their use particularly with children.

Research published earlier this year showed a five-fold increase in the use of antipsychotic drugs to treat behavioral and emotional problems in children and adolescents from 1993 to 2002.

"This entire state of affairs is in part related to our health care system's failure to provide sufficiently for children, particularly in the area of pediatric mental health care," states Ronald T. Brown, PhD, chair of the APA Working Group and Professor of Public Health and Dean at Temple University. "As a result, much of the care provided to children for mental health issues has been limited to medication even though many psychosocial treatments have been found to be effective and some with better risk profiles. Psychosocial treatments, however, can be more labor intensive and more expensive."

The Working Group’s report identifies and calls attention to several “notable gaps” in the knowledge base upon which psychotropics are currently being prescribed, including anti-depressants and anti-psychotics. The report furthermore notes that existing evidence for both psychosocial and psychopharmacologcial treatments are “uneven across disorders, age groups, and other defining characteristics of race, ethnicity, and socioeconomic status”.

“Furthermore,” the report states, “data are lacking concerning the long-term effects of the majority of treatments, both psychosocial and psychopharmacological, as well as their effects on functional outcomes” such as academic achievement and peer relationships.

Finally, the report notes that the lack of availability of all pharmaceutical data on psychotropics and their effects prevents the news media and the public from a full understanding of which treatments work, which do not, and the possible adverse side effects of some medications.

Among its recommendations, the report calls for:

Longitudinal studies of treatment efficacy and effectiveness for specific disorders (childhood depression, preschool and adolescent ADHD, adolescent autism, etc.) in terms of targeted symptoms, functional impairments, adaptive functioning and quality of life across gender, age, racial and ethnic groups, and for children with comorbid disorders.
Research to determine the optimal sequencing of treatment components as well as optimal doses and combinations of psychosocial and psychopharmacological treatments.
Research on the role of families, school, and primary care providers in the development and delivery of mental health services for children, the moderators and mediators of treatment effects, and the factors that are associated with treatment adherence.
Increased collaboration across federal funding agencies involved in child treatment research, including National Institutes of Mental Health, National Institute of Child Health and Human Development, National Institutes of Natural Sciences, the Agency for Healthcare Research and Quality, the Centers for Disease Control and Prevention, the Substance Abuse and Mental Health Services Administration and Institute for Education Science.
Public disclosure of all efficacy and safety data emanating from both psychosocial and psychopharmacological treatment research on child and adolescent disorders.
An emphasis on evidence-based child treatments, including psychosocial and psychopharmacological interventions in the training and continuing education of all mental health providers.
“Systematic reimbursement for evidence-based psychosocial and psychopharmacological treatments must be established,” the report concludes. “Current funding and administrative mechanisms often encourage the use of medication or non-evidence based psychosocial treatments over empirically based psychosocial treatments. Finally, mental health services for youth are provided across a number of different service sectors, either simultaneously or sequentially, and collaborative care is often hampered by cost, discipline, and administrative barriers.”

Best treatment depends on diagnosis and balances risks
and benefits

In addition to the aforementioned global needs for an evidence base, appropriately trained providers and good access to care, the Working Group looked at the evidentiary base for numerous treatments currently in use for children and adolescents with behavioral and mental health problems.

The report recommends that decisions about first line of treatment options should be guided by the need to balance the anticipated benefits of the treatment with its possible harms, including the absence of treatment. Safer treatments with demonstrated efficacy should be considered first before any use of other treatments with less favorable risk profiles.

This diagnosis-by-diagnosis review of the literature reached a general conclusion that much more research is needed, as well as a few specific conclusions - pending further research - about current treatment practices for each illness:

Attention Deficit Hyperactivity Disorder -- Behavioral treatments, psychopharmacological treatments, and a combination of the two all have solid evidence for acute efficacy. Behavioral treatments have the most favorable risk:benefit ratio, suggesting they be first line interventions. Combining behaviorally based treatments with medication can yield better short-term outcomes than either treatment alone and the combination enables lower doses of medication to be used.

Oppositional Defiant Disorder and Conduct Disorder – Based on evidence showing better results with psychosocial interventions, such interventions should be the first line treatment and tried before psychotropic medications.

Tourettes and Tic Disorders – Drug treatment should be used cautiously due to safety and tolerability issues. If medications are used, keep doses low to decrease the risks of adverse side effects and use in combination with behavioral treatments such as habit reversal training (HRT).

Obsessive Compulsive Disorder -- Evidence supports the use of cognitive behavioral therapy as the first line treatment. Medication should be added only if necessary.

Anxiety Disorders – There is strong evidence to support cognitive behavioral therapy (CBT) as a first line treatment and CBT does not pose the risks that some medication treatments do. However, treatment with SSRI medication is also a viable choice for children who are unable to engage in CBT or do not show improvement during such treatment.

Depression/Suicidailty – A treatment strategy designed to minimize risks would involve sequential use of psychosocial interventions and close monitoring, followed by medication (fluoxetine is the only medication approved by the FDA for treating depression in children) for those children and adolescents who do not respond to psychosocial treatments. If a child is to be treated with medication, his or her parents must be fully informed of the potential risks and benefits.

Bipolar Disorder – Both psychosocial and psychopharmacologic treatments for bipolar disorder require more study. The limited research suggests psychosocial treatments are beneficial and do not present adverse side-effects. Short- and long-term medication trials are needed to clarify the risk:benefit ratio for all medications used to treat bipolar disorder.

Schizophrenia Spectrum Disorders – These disorders are rare in children and adolescents; empirical evidence of how best to treat these disorders in young people is also very limited. However, based on the little research that does exist, psychosocial interventions that are psychoeducational, family-based, and cognitive-behavioral are suggested. Newer pharmacologic agents hold promise but also carry the risk of adverse side-effects.

Anorexia Nervosa and Bulimia Nervosa – For anorexia nervosa, there is a general lack of evidence of effectiveness for both the psychosocial interventions as well as the pharmacologic interventions currently in use. For bulimia nervosa, psychosocial interventions, particularly CBT, appear to have more scientific support and a more favorable risk:benefit ratio compared with medications. Future research needs to be done to determine the effectiveness of specific forms of treatments or treatment combinations.

Elimination Disorders - The efficacy of behavioral treatments, such as the use of a urine alarm, is well documented in the research literature. There is little or no evidence of the effectiveness of drug treatments for elimination disorders; there is concern about the safety of such medication based treatments. Because elimination disorders often have some kind of physiological foundation, mental health practitioners should partner with a pediatrician when assessing and managing enuresis and encopresis.

Full text of the article is available from the APA Public Affairs Office or at http://www.apa.org/releases/PsychotropicMedicationsReport.pdf

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Initiative for homeless worth a try - Charlotte Observer

IN MY OPINION / JOE DEPRIEST

JOE DEPRIEST

The weather-beaten woman I saw walking along Franklin Boulevard one morning this week might have had a home.

But I doubt it. She had the look. The worn face and empty stare of someone who lives on the streets. The kind of person most folks would rather put at arm's length and not think about.

I didn't think about her again until a day later at a meeting of Gastonia's Task Force on Homelessness at St. Mark's Episcopal Church.

The woman's face came back to me as representatives of local service and law enforcement agencies talked about how to refocus a group started six years ago by Gastonia Mayor Jennie Stultz. It began as a public awareness organization, but now is taking on a role as an advocate in the community.

Discussion centered on whether Gastonia wants to join a national initiative called Project Homeless Connect. Thirty U.S. cities have adopted the program. In North Carolina, Durham is exploring the program, and Winston-Salem has tried a limited version, focusing on medical issues.

In a nutshell, that's a one-stop-shopping approach that brings together all resources for helping the homeless. Social services, child care, medical and dental care, Medicaid -- it's all offered in one place instead of scattered all over town.

Community volunteers would give one-on-one help to the homeless. Stultz told task force members that San Francisco was the first city to start the program and now "it's happening all over the country."

I learned that a lot is going on already to help the homeless in Gastonia. Churches have projects that offer all sorts of services. But Stultz kept pointing out that when groups are out there doing their own thing, energy is wasted.

The collaborative one-stop method is more efficient. One thing I learned at the task force is that homelessness is more than a human issue; it's also about economics.

According to the task force, Gaston County had 238 chronically homeless people as of January. The chronically homeless are usually people with serious mental illness, substance addiction, an unstable job background and a history of being in and out of jails and hospitals.

The task force calculated the annual tab taxpayers pick up for looking after each homeless person. The conservative estimate is nearly $10,000 each, or about $2.2 million a year for all 238 people.

The task force hopes to break the cycle and get homeless people back on their feet and into housing of their own.

I sat next to James Biddix Jr., community ministries director at the Gastonia Salvation Army, and he reminded me some people like living on the streets.

He mentioned a man who shows up at the Salvation Army's shelter every six months or so, spends the night and then leaves.

"He said he'd rather sleep under the stars," Biddix told me. "He'd rather stay outside and live by his own rules."

This wayfarer is content with his lifestyle. But other homeless people want help.

The task force decided to try the Project Homeless Connect in a one-day pilot program in early March. An invitation will go out to churches, shelters, medical providers, housing experts and transportation specialists. If enough providers are sold on the idea, the group will try to offer the program more often and track people who show up to receive services.

The task force will meet again Sept. 20 to work out details. At that time they'll hear from a group of experts: homeless people, coming to explain exactly what services they need.

I hope the talk phase of these planning sessions will wind up soon. I agree with comments from the homeless population quoted by a task force member this week: We're tired of talking, they said. Let's do something.

Want to Help?

For more information about Gastonia's Task Force on Homelessness and Project Homeless Connect, call Mary McCreight, the city's coordinator of homeless issues, at 704-866-6766. Read more!

Big voice will join Dix land debate - Raleigh News & Observer

Urban Land Institute hired

Ryan Teague Beckwith, Staff Writer

RALEIGH - It's no disaster zone, but Dix Hill will soon get advice from the same experts who told New Orleans and Lower Manhattan how to rebuild.

A legislative task force decided Thursday to hire the prestigious Urban Land Institute to study the 315-acre property just west of downtown Raleigh.

During a three-day visit in late October, a panel of nationally recognized experts will recommend what to do with the site when the Dorothea Dix state mental hospital closes in 2008.

Similar panels gave advice on rebuilding New Orleans after Hurricane Katrina and Lower Manhattan after the Sept. 11, 2001, attacks, as well as reusing arenas in Atlanta after the 1996 Olympics.

The future of Dix Hill has vexed lawmakers for five years. Various plans have called for pricey condominiums, state offices, restaurants and shops, a hotel, a botanical garden and a major city park.

But until now, no one has explained how to turn any of those ideas into reality.

The four-member Urban Land Institute panel will include experts on finance, urban planning and local government from around the country. They will give advice on details such as how to run a park or pay for restoration of historic buildings.

The experts will be working professionals who volunteer their time for the Washington, D.C.-based nonprofit group. Their services, estimated to be worth as much as $250,000, will cost the state only about $60,000.

The nonprofit group has not yet chosen the panel members. But Urban Land Institute trustee Trish Healy of Raleigh said that the Dix property would attract volunteers because it is a compelling problem.

"This is 300 acres in the capital of a state, adjacent to downtown and public uses," she told the task force. "This is very interesting intellectual work. We have people standing in line wanting to do this."

It will not be the first time that Dix Hill has been studied.

Last year, the city and the state paid $122,600 to Charlotte-based LandDesign. The urban planning firm came up with proposals for an urban neighborhood and a city park that were not well-received at public hearings.

Four other proposals then came from Raleigh and Wake County planners, park advocates, a group of botanical gardeners and a coalition of historic preservationists.

For now, the state task force hasn't locked onto a specific plan. Several members said they would prefer a major urban park, but they also say that they have to persuade other legislators to foot the bill.

"The less it costs the state, the easier it will be to get through the General Assembly," said Rep. Deborah Ross, a Raleigh Democrat.

The Urban Land Institute's advice will come at a critical time for the future of the Dix campus.

Over the next three months, the 11-member task force of lawmakers and Raleigh residents will study the proposals and draw up a plan for the site. They hope to give it to the General Assembly by January, in time for a vote during the next session.

The Urban Land Institute panel will be asked to look at how to organize and finance different options. They could give narrow technical advice, or they could make a bolder statement on what should be done.

Their potential influence makes some observers nervous.

Janis Ramquist, director of the nonprofit Friends of Dorothea Dix Park, has argued that the entire site should be preserved as open space. She questioned whether the experts have experience in designing major city parks.

"The success of it depends on the quality of the panel," she said.

But civic activist Barbara Goodmon, who sits on the legislative task force, said that the panel would be a valuable counterpoint to the developers, state officials and park advocates already arguing over the property.

"Other than that, it's the people with the most money or the biggest mouths who get all the attention," she said.
Staff writer Ryan Teague Beckwith can be reached at 836-4944 or rbeckwit@newsobserver.com. Read more!

Centerpoint gets additional state money - Winston-Salem Journal

Thursday, September 7, 2006

$600,000 targeted for developmental therapy program

By M. Paul Jackson
JOURNAL REPORTER

CenterPoint Human Services has received additional money from the state that could help shore up its developmental-therapy program - a program that seemed in jeopardy last month.

CenterPoint, a mental-health agency, was given an additional one-time allocation for $600,000 from the N.C. Department of Health and Human Services to manage developmental-therapy services for customers, Betty Taylor, CenterPoint's chief executive, said yesterday. The money is allocated for the program through June.

CenterPoint, based in Winston-Salem, oversees mental-health services in Forsyth, Davie and Stokes counties. The agency got word of the allocation late last week, Taylor said.

The therapy program provides training for people with such developmental disabilities as autism. About 100 children and adults use the services.

The program had been in financial straits. CenterPoint got about $1.2 million from the state this fiscal year. But the agency had already authorized about $637,000 worth of developmental-therapy services for customers and was in danger of running out of money to pay for the program.

CenterPoint's fiscal year will end next summer.

The additional $600,000 raises CenterPoint's budget for the program to about $1.8 million annually.

"It's a true increase," Taylor said. "So this is an area that I don't foresee that we're going to have a problem with."

According to state health officials, the additional money was allocated to CenterPoint because demand for the developmental-therapy program has increased.

Receiving services for customers with behavioral-health problems is key, mental-health advocates said. Kim Jones, a Winston-Salem parent of a child with autism, said she has had problems navigating the county's mental-health system and now plans to move out of Forsyth County.

"Basically, I feel like I've been chasing my tail for the two years I've been in Forsyth County," Jones said.

Taylor said that additional money could allow the agency to increase the number of hours that its customers receive the therapy program's services. The program provides training for customers for a maximum of about four hours a day.

"We're going to see if we can't raise the ceiling on that," she said.

CenterPoint also has established criteria to determine which customers are eligible for the program, Taylor said.

Mental-health advocates said they are keeping a watchful eye on the developmental-therapy program. The additional $600,000 might not be enough to effectively run the program, one advocate said.

"I hate to say I'm skeptical, but I'm skeptical," said Beth Bowman, the president of the Winston-Salem Mayor's Council for Persons with Disabilities, an advocacy group.

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

Kicked out for suicide attempt - Associated Press

Some colleges face legal challenges for evicting suicidal students

DAVID B. CARUSO
Associated Press

NEW YORK - A depressed Hunter College student who swallowed handfuls of Tylenol, then saved her own life by calling 911, was in for a surprise when she returned to her dorm room after the ordeal.

The lock had been changed.

She was being expelled from the dorm, the school informed her, because she violated her housing contract by attempting suicide. The 19-year-old was allowed to retrieve her belongings as a security guard stood watch.

Policies barring potentially suicidal students from dorms have popped up across the country in recent years as colleges have struggled to deal with an estimated 1,100 suicides a year. But some of those rules have come under legal attack.

Hunter College announced last month that it was abandoning its 3-year-old suicide policy as part of a settlement with the student. The student, who was allowed to continue attending class, claimed in a lawsuit that her 2004 ouster from the dorms violated federal law protecting disabled people from discrimination.

The school, part of the City University of New York system, also agreed to pay her $65,000.

Hunter spokeswoman Meredith Halpern said the college may still consider temporarily removing troubled students from its residence halls, but such evictions will no longer be automatic.

College officials say such expulsions are not punitive; Halpern said Hunter's policy was aimed at protecting students' privacy and shielding them from schoolmates' prying eyes. At George Washington University, in the nation's capital, spokeswoman Tracy Schario said the idea is to give suicidal students a break from the stresses of university life and encourage them to seek help.

But some activists suspect such evictions are an attempt by colleges to avoid legal liability if someone commits suicide in the dorms.

Up until recently, the prevailing legal theory had long been that adult students were responsible for their own behavior, and that colleges could not be held liable.

But that philosophy was undermined by a pair of court rulings involving the Massachusetts Institute of Technology and Ferrum College in Virginia.

In both cases, judges ruled prior to out-of-court settlements that colleges might have a duty to prevent a suicide if the risk was foreseeable. The cases prompted some schools to be more aggressive about sending troubled students home.

Karen Bower, an attorney with the Bazelon Center for Mental Health Law, which helped litigate the Hunter College case, said she hopes the settlement will prompt other schools to rethink their policies.

"The real danger of these policies is that they discourage students from getting the help that they really need," Bower said. Students might be scared from speaking out about suicidal thoughts if they believe it would mean eviction, she said.

The chances that a student might be expelled from a dorm simply for talking about suicide with a counselor are considered slim. Conversations with mental health professionals are generally confidential and protected by privacy laws.

But universities can hear about a student's troubles and take action if he has been talking with friends or classmates, or does something that leads to a middle-of-the-night hospitalization, which might involve campus security or a housing official.

Joanna Locke of the Jed Foundation, a program aimed at preventing college suicides, said schools should have flexibility. "There is no right answer, except that (the decision) should be made carefully, and the decision should be made kindly," she said. Read more!

N.C. to look at mental illness, elder care

Legislators will again study the mixing of 2 populations in homes

ERIC FRAZIER
efrazier@charlotteobserver.com

Key N.C. legislators on Wednesday announced the formation of a special subcommittee to look into the state's much-criticized custom of placing young mentally ill people in adult-care homes that traditionally house the elderly.

The idea for a new subcommittee won backing Wednesday in Raleigh from the General Assembly's main research panel on mental health issues. Next week, the proposal will go before the assembly's main fact-finding panel on issues affecting the elderly.

The panel will study how to best provide mental health services to residents, how to separate the mentally ill and the frail elderly, and how much money it would take to solve those problems.

"We're going to look at this and we want to get it right," said Rep. Beverly Earle, D-Mecklenburg. "What everybody wants is appropriate housing for the mentally ill and for the elderly."

She said state officials made the decision out of long-standing concerns over the problems and because of recent reports in the Observer and other media outlets. Earle said she wants the group to put bills forward during the next legislative session, which begins in January.

Advocates for those living in the homes responded with cautious optimism.

The state has repeatedly formed study groups, then failed to act on those groups' recommendations, said Chris Ivy, president of Friends of Residents in Long Term Care, a Raleigh advocacy group.

"We don't need another study to say what we would do if we had the money," he said. "We need a financial commitment."

Others applauded the legislators' action.

"To go from an idea to a law takes forever, but (the problem) is not being ignored," said Debi Lee, ombudsman for the Charlotte-based Centralina Area Agency on Aging.

N.C. officials have been debating for a decade or more how best to serve the mental health needs of residents in long-term care facilities. A state-sponsored report in 2004 found that more than 40 percent of those in adult-care homes carried an active mental illness diagnosis.

But the staff in most of the state's 1,300 adult-care homes -- also called rest homes -- aren't trained or equipped to handle the special needs of the mentally ill. They offer help with basic daily needs such as bathing and feeding. Mental health training isn't mandated.

State officials, advocates for the elderly and rest-home industry officials say the situation can leave the elderly in physical danger from younger, stronger residents, and can leave the mentally ill without needed treatment and programs.

Authorities say about a quarter of all adult-care home residents are under 65; more than 60 percent of those under 65 have a mental health diagnosis.

At least two state-backed studies have recommended wide-ranging reforms. The report issued in 2004 recommended spending $188 million to upgrade the state's adult-care homes. Another, presented to the General Assembly early this year, recommended spending $2.4 million a year on trainers to teach rest-home staffers how to handle mentally ill residents.

Lawmakers have acted on some of the recommendations, but the problem, they say, defies easy answers.

"We need to look at what the long-term housing needs are for people with mental illness and what the short-term situation should be," said Rep. Verla Insko, a Chapel Hill Democrat.

Earle expressed frustration, noting that the state is spending more than $100 million this budget year on mental health services. Critics, noting millions in budget cuts that preceded it in previous years, still call it insufficient.

"We're trying to do better," she said. "But to say we'll get (the problem solved) next year, I can't say that."

Eric Frazier: (704) 358-5145
Read more!

Mental illness high among inmates - Raleigh News & Observer

Jenifer Warren, Los Angeles Times

More than half of the nation's jail and prison inmates suffer from mental health problems, according to a report released Wednesday.

The study, by the research arm of the U.S. Department of Justice, confirms what wardens, convicts and correctional officers already know -- that large numbers of inmates routinely display symptoms of depression, mania or psychotic disorders.

Based on a representative survey of more than 25,000 prisoners nationwide, the report found that mental health problems were associated with an inmate's violence and prior convictions. Those state prisoners with mental problems were more likely to have at least three prior incarcerations and to have broken prison rules.

Mentally ill inmates also were twice as likely as other convicts to have been injured in a prison fight and substantially more likely to have been abused as a child and homeless in the year before their arrest. Three out of four were dependent on drugs and alcohol, with 37 percent saying they used drugs at the time of their crime.

Mental health experts called the study disturbing. They said it illustrates a direct relationship between gaps in community mental health care and the large numbers of mentally ill people winding up in the criminal justice system.

"If one out of three people incarcerated in this country are receiving mental health treatment, it shows that there is something very wrong with the way services are delivered in the community," said Bill Emmet of the Washington-based Campaign for Mental Health Reform, a coalition of advocacy groups. "People need services before they do something that might result in their incarceration."

The study also found:

* Female inmates had higher rates of mental illness than males -- with 73 percent of females in state prisons reporting symptoms, compared with 55 percent of males.

* The prevalence of mental illness varied by race, with 62 percent of white inmates suffering from problems, compared with 55 percent of blacks and 46 percent of Hispanics.

* More than half of mentally ill inmates had a family member who was incarcerated.
All rights reserved. This copyrighted material may not be published, broadcast or redistributed in any manner. Read more!

A deadly formula: Make reforms, but don't fund them - Charlotte Observer

Editorial

Here's the truth about North Carolina's commitment to the mentally ill: It is not a priority.

If it were, people like Kelly "Buck" Whitesides would not wander off from places where rules don't require specially trained staff, and die. Nor would the state legislature, year after year, turn its back on funding costly, strategic reforms.

That neglect must end. Vulnerable citizens shouldn't suffer because North Carolina's politicians balance the budget at the expense of a fundamental public need.

Mr. Whitesides, a dementia sufferer, was found dead after he wandered away from Unique Living, an adult care home in Cleveland County in July. An Observer investigation found that home to be among 100 statewide that admit high numbers of mentally ill residents, but do not necessarily make provisions for them.

It's hard to believe, but state rules for adult-care homes require no additional staffing, training or supervision for the mentally ill. That means elderly residents with minimal health-care needs live alongside those with illnesses like schizophrenia.

How did that happen? North Carolina, like many states, has moved mentally ill patients out of hospitals and institutions. Reforms reflect a belief that mentally ill people fare better being treated in a community network of care.

Yet at the same time, politicians in Raleigh have consistently failed to fund alternatives promised to take the place of state-run hospitals.

Adult-care homes turned out to be a convenient -- but dangerous -- solution.

Here's what we mean. People with mental illness need staff that know how to monitor their behavior, medication and treatment plans. Homes that admit them need a crisis intervention plan and staff trained to administer it.

The state's rules do not require adult-care homes to do those things. That's inviting a tragedy like Mr. Whitesides' death.

Consider the record at Yelton's Health Care, now operated as Unique Living.

• Documents show one developmentally delayed woman who had problems eating too fast died after choking on a Spam sandwich.

• A convicted sex offender was accused of of raping a mentally disabled woman on the woman's first day as a resident.

Public money funds many adult-care residents' bills. At the very least, those dollars should pay for a safe environment and basic treatment.

Here's what needs to happen:

1. North Carolina needs to toughen its rules. Staff in adult-care homes accepting residents with mental illness ought to be trained in their care, and supervision ought to be increased.

2. Politicians in Raleigh ought to own up to their responsibility by fully funding community-based mental health reforms. When hard times hit in 2001, lawmakers sharply cut back on human service funding that would have boosted those programs. That's wrong.

Government can't do everything, but it can and should provide sufficient basic care for the mentally ill. It's time North Carolina made that a priority. Read more!

Autistic children linked to older fathers - LA Times

Study in Israel affirms research finding that autism rates go up dramatically with father's age

Thomas H. Maugh II, Los Angeles Times

Men over 40 are nearly six times as likely to father an autistic child as those under the age of 30, according to a new study that provides support for the role of genetics in the development of the disabling mental disorder.

At least two previous small studies have hinted at such a link, said epidemiologist Abraham Reichenberg who led the new study, reported Monday in the Archives of General Psychiatry. He called his results "the first convincing evidence" that advancing paternal age is an important risk factor for development of the disorder.

THE STUDY: The team studied more than 318,000 Israelis during six consecutive years in the 1980s. They linked birth records to those of the Israeli draft board, which assesses mental and physical health of Israelis at age 17.

THE RESULTS: Those whose fathers were between ages 30 and 39 at birth were 64 percent more likely to be autistic than those whose fathers were 29 or younger. Those whose fathers were 40 to 49 were 5.65 times as likely to be autistic.

WHY? The team considered several possible explanations for the findings, including spontaneous mutations in sperm-producing cells and alterations in genetic "imprinting," which controls the genes that are activated during development.

WHAT IS AUTISM? Autism is a severe developmental disorder in which children seem isolated from the world around them. There is a broad spectrum of symptoms, marked by poor language skills and an inability to handle social relations. No cure exists, but many problems can be alleviated with intensive behavioral therapy.

WHO HAS IT? A recent government study found that the disorder now strikes about 1 in every 175 children.

WHAT'S NEXT: Reichenberg said the team is now beginning trials to look for such gene changes in older men and their offspring. They are also replicating the study in other populations.
Read more!

Adjunct medications may be unnecessary in chronic schizophrenia patients - Journal of Clinical Psychiatry

Researchers have found that for most stabilized chronic patients with schizophrenia, tapering adjunctive medications, such as psychotropic drugs, does not change outcomes.

This finding has led the team to question the efficacy of some concomitant classes of medications in patients with chronic schizophrenia who are already receiving adequate antipsychotic therapy.

"There are virtually no controlled data suggesting that concomitant psychotropic medications improve outcome in schizophrenia after the acute phase," note Ira Glick (Stanford University School of Medicine, California) and colleagues.

"Despite that, concomitant psychotropic medications are almost universally utilized by clinicians (for a variety of reasons), and polypharmacy (with all its disadvantages) is far more common than monotherapy."

The researchers carried out a naturalistic, systematic study involving 35 stabilized patients with schizophrenia from one clinical practice setting.

They tested the clinical strategy of concomitant psychotropic medication use with antipsychotic treatment, by gradually tapering all such adjunctive medications, except for anti-anxiety agents.

Outcome over a period of at least 3 months and up to 18 months was measured using the Clinical Global Impressions-Improvement scale, before and after taper.

In 21 patients undergoing 22 antidepressant tapers, no change was noted for 18 tapers, while improvement was observed in three and worsening of symptoms in one.

For the 12 patients receiving concomitant treatment with mood stabilizers, taper led to no change in 10 of 13 discontinuations, while a mild worsening of symptoms was seen in three patients.

One patient was receiving both modafinil and trazadone and reported no change in symptoms after tapering of each medication in separate discontinuation trials. Another three patients who were taking sleeping medications also experienced no change in symptoms after discontinuation.

"With rare exceptions, antidepressants or mood stabilizers did not add much to outcome," the researchers write in the Journal of Clinical Psychiatry.

They note that many of the concomitant psychotropic medications may have been appropriate and useful when they were started during acute illness, but their long-term benefit had not been established.

"The data should encourage clinicians who have chronic, relatively stabilized patients on treatment with multiple medications to carefully attempt to withdraw the adjunctive medications while monitoring clinical status," say Glick and co-workers

"Of course, if patients worsen when their concomitant psychotropic medications are withdrawn, treatment can be promptly restarted." Read more!