State auditor to look into mental health system - Hendersonville Times-News

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

The Office of the State Auditor confirmed Monday it will launch an investigation into the demise of New Vistas-Mountain Laurel, the region's largest mental health care provider which closes today.

But the scope of the examination will extend beyond the mountains. State auditors also plan to examine the North Carolina mental health system on the whole, delving into the inner workings of a system shrouded in criticism since the state-mandated reform of 2001.

State auditors are making the move after Sen. Tom Apodaca, R-Hendersonville, Rep. Carolyn Justus, R-Dana, and the Henderson County Board of Commissioners requested an audit into New Vistas-Mountain Laurel.

"In light of that request and some other requests that we have received throughout the state, we believe that the timing is right to look into New Vistas-Mountain Laurel as well as to take a broad look into how mental health is being delivered in North Carolina," said Chris Mears, a spokesman for the Office of the State Auditor.

Mears said the statewide audit would delve into "pretty much all aspects." Everything's on the table." He could not say when it would begin.

Apodaca, Justus and the Board of Commissioners hoped the audit would shed more light on the closure of New Vistas-Mountain Laurel. The agency served 10,500 patients in eight counties, including Henderson.

"Since they are receiving state funds for services, it is imperative that we find out what caused this shut down," read the letter dated Oct. 24. "Hopefully this information will help us strengthen the mental health system so that we will not make the same mistakes in the future."

After the announcement Monday, Justus said, "I think that's probably good. This is not the first mental health provider that has folded under the new reorganization of mental health. Maybe this will give us insight into the real problems."

Commission Chairman Bill Moyer welcomed the news that the examination would extend statewide.

"I'm pleased that they're going to do the audit," Moyer said. "I think they need to look specifically into Mountain Laurel and see whether it was inherent faults of the system or certain things that Mountain Laurel did that contributed to this shutdown and bad situation.

"I'm glad they're looking into the overall state of mental health in North Carolina," he added. "I think we have a problem. As I've said before, I think we have a failed system. And I'll be very pleased to have them looking at it."

New Vistas-Mountain Laurel Chief Executive Officer Will Callison also welcomed the audit.

"I think that's great news," Callison said. "This has been so difficult for so many folks, starting with our clients that I think the only silver lining in the clouds would be for us to be able to learn from this situation and hopefully not have providers in the same place down the road.

"We're an open book and there seems to be a lot of information and assumptions that are not correct that are floating around," Callison added. "It's understandable in stressful times, but we see this as an opportunity for us to step back as a community and try to look at the facts and look where the gaps are and how we can make this system stronger for everyone."

The announcement of the audit came as employees helped clients and cleaned out their offices inside Mountain Laurel's Hendersonville office on Fleming Street. Employees phoned patients to ensure they had found new providers, so they could find mental health care once the Fleming Street office shuts down at 6 p.m. today.

"There are a lot of sad people walking around here today," said Larry M. Gerstenhaber, a Mountain Laurel psychologist who plans to work for Family Preservation Services starting Wednesday.

"There are people who worked 20, 30 years in the system in this area, and I think the way this is ending, nobody's talking about their dedication, nobody's talking about the fact that a lot of these people work for very little money compared to what they could be making (in other fields)," he said. "A lot of these people could have chosen at any point in the process to go look at something else. But there are a lot of people in this building who put their careers into this because they really saw themselves giving something back."

And most Henderson County Mountain Laurel employees, he said, plan to continue working in mental health under new providers.

At least six mental health agencies stepped up to provide services once New Vistas-Mountain Laurel closes today. By last count Thursday, 912 patients had yet to be assigned new providers in Henderson County.

Western Highlands, which manages mental health care in the region, hoped the number would be lower by today. Efforts to contact Western Highlands CEO Arthur Carder Monday were unsuccessful. The Western Highlands board of directors meets in special session at 9:30 a.m. today on the second floor of 356 Biltmore Ave., Asheville.

An effort by Henderson County leaders to ensure indigent patients have access to medication remains on schedule. PSC MedSupply LLC should open its doors at 8 a.m. Wednesday in the new Human Services building off Spartanburg Highway in Hendersonville.

"Basically, where they're nice is they connect indigent people, underinsured, uninsured folk with the most cost-effective solution for their drug needs," said County Manager Steve Wyatt.

PSC MedSupply also serves as the link between indigent patients and drug companies that offer free drug plans, Wyatt said. Medication can be mailed to patients who lack transportation, and PSC ensures the correct person receives the package.

"The average person doesn't know how to navigate that system," Wyatt said. "They navigate that system for you."

Moyer and New Vistas-Mountain Laurel continue negotiations over the Sixth Avenue West Clubhouse, which the dying agency plans to sell to cover payroll, employee benefits and outstanding bills. New Vistas-Mountain Laurel has a monthly payroll of $2 million, and Callison said the agency owes employees about $450,000 in accrued paid time off. An appraisal commissioned by New Vistas-Mountain Laurel put the property's value at $700,000.

"Very honestly, we think that's on the high side," Moyer said. "We've requested our own appraisal, and the representative of Mountain Laurel and I agreed that everything would just stay in place. The Clubhouse would continue to operate, we get our appraisal and then we sit down and try to hammer out an agreed upon purchase price."

Callison said the New Vistas-Mountain Laurel board of directors also voted to let the Clubhouse's new non-profit, Sixth Avenue Psychiatric Rehabilitation Partners, use the building into November free of rent.

"We still are trying to make this a win for the clients and the community as well as meet our obligations to staff," Callison said. Read more!

Deputies cleared in fatal shootings - Asheville Citizen-Times

By John Boyle

Two Buncombe County Sheriff’s Department deputies involved in separate fatal shootings the night of July 13 have been cleared of any wrongdoing.

“Obviously, both of these cases are very tragic, but in either case I don’t think there was anything the deputies could do,” said District Attorney Ron Moore, who reviewed State Bureau of Investigation reports in the cases and decided against pursuing charges against the officers. “You mix alcohol, psychological issues and loaded weapons …”

Officers in North Carolina are allowed to use deadly force when they feel their lives or the lives of others are in danger, Moore said, and that threshold was met in both shootings.

In fatal police shootings, SBI agents investigate and present a final report to the local district attorney, who decides whether to file charges.

Teen was suicidal
In the first shooting of that night, Deputy Tim Bradley responded to a call on Poor Man’s Hollow in Leicester concerning a suicidal 17-year-old, Terry Jackson Evans, who was wielding a .12-gauge shotgun and threatening to kill his mother, Tammy Revis, Moore said.

In the second shooting, deputies were trying to arrest Weaverville resident Gregory Keith Hensley, 44, when he reached for a handgun and was shot six times by Deputy Caton McBride.

Some members of Hensley’s family have said he was mentally unstable and that they don’t hold deputies responsible for his death.

But Evans’ mother said she had control of the shotgun her son had, and that the officer over-reacted.

“I know what I saw, and Ron Moore is trying to say it didn’t happen the way it happened,” Revis said. “I know the deputy said, he told Terry, ‘If you don’t stop, I’ll put six rounds in you.’”

In the Evans case, Bradley and a teenage Explorer deputy who was riding with the officer that night did not find Evans at his mother’s house and were preparing to leave when Evans came up the driveway.

“They were getting in their vehicle, and about that time they hear a shotgun blast go off behind their vehicle,” Moore said, citing the SBI report. “He has discharged the shotgun behind the vehicle. He had a shotgun in one hand and a case of beer in the other.”

Moore said an autopsy showed Evans had a blood alcohol content of 0.17 percent, more than twice the legal limit of intoxication. While witness reports varied, Moore said it was clear that Evans and his mother struggled over control of the shotgun.

“The deputy pulls his gun and tells (Evans) to put the gun down,” Moore said. “The mama’s yelling, ‘I got the gun, I got the gun,’ but there was nothing to indicate she had gotten control of the gun. Evans is telling the deputy, ‘It’ll take more than you to get me.’”

Moore said the SBI report indicated that the Explorer heard Evans threaten to kill his mother.

“The deputy feels he was gaining control of the weapon, so he shot him one time,” Moore said.

The single shot from the deputy’s 9-mm pistol entered Evans’ right side and exited his left, Moore said. After shooting Evans, Bradley stepped on the single-shot shotgun to keep control of it, and it discharged, indicating that Evans had reloaded it and cocked the hammer, Moore said.

Sheriff Bobby Medford said he was expecting his deputies to be cleared in both cases because lives were endangered and they responded appropriately. He noted that Bradley has 12 years’ experience and McBride “even more than that.”

“You have to be there,” Medford said. “The stage is set when we get there, and we have to act on how the stage is set.”

Hensley shot six times
In the second shooting, which occurred about 10 p.m. off Dula Springs Road in the Weaverville area, McBride and other deputies had responded to a call about a man with psychological issues who had a gun and was threatening people. With the homeowner’s permission, the deputies entered the house and found a man sleeping on the couch, who told them Hensley was in the basement.

McBride, who is part of the department’s emergency response team, led the way down the stairs, armed with an M-4 assault rifle. McBride encountered Hensley, who was partially hidden behind a curtain.

“He reached for a handgun, and (McBride) told him to lie down, which he didn’t do,” Moore said. “He was shot six times. He fired seven times and six hit him.”

No one else fired any shots. Moore said the SBI report stated that the officer fired multiple times because Hensley showed “no response, no look of surprise” when first shot.

“I think the officer was justified in his action,” Moore said. “He had reason to believe that Mr. Hensley was going to fire a gun in his direction.” Read more!

Regulators halt admissions at troubled rest home - AP

The Associated Press

A rest home being investigated for a series of problems won't be allowed to admit new residents, state regulators said.

Admissions at the Unique Living center near Fallston is suspended indefinitely, and the N.C. Division of Facility Services is considering requiring extra staff to supervise the residents.

"The documented violations indicate that conditions in the home are found to be detrimental to the health and safety of the residents," agency officials wrote in a letter.

Unique Living's owners did not return a call made by The Charlotte Observer on Monday evening.

Cleveland County social service officials had asked the state to fine, shut down or relicense the rest home after a patient wandered from the facility and died. In early August, Kelly "Buck" Whitesides, 59, was found dead in nearby woods, six days after he disappeared from the center.

In September, a man suffering from schizophrenia was found dazed and hungry about 100 miles away from the facility.

State and county social services officials in August and September started three separate investigations related to care at the center.

The Division of Facility Services "examined what we sent them and acted," said John Wasson, director of the Cleveland County Department of Social Services. Wasson said the state agency's decision is encouraging.

Experts say the home is not designed to care for mentally ill patients. More than 90 percent of the residents at Unique Living have been diagnosed with mental illnesses, according to state records. Read more!

Mental Health Education Program To Be Implemented In School Communities Nationwide-Medical News Today

The American Psychiatric Foundation today announced that it will collaborate with school communities around the country to implement its Typical or Troubled?(TM) School Mental Health Education Program. The program is designed to encourage and equip teachers, coaches and other adults who work closely with teens to notice the warning signs of mental health problems and refer students for help in addressing these issues

The Typical or Troubled?(TM) School Mental Health Education program will be implemented by 17 nonprofit organizations, schools and school districts in a total of 73 high schools during the 2006-2007 school year. More than 4,000 teachers and other school personnel are expected to participate in the program, which includes in-service training conducted by school mental health staff in collaboration with mental health professionals from their local communities. All 17 sites will utilize the Typical or Troubled?(TM) training module that was developed in 2004 by the foundation during a pilot phase in Colorado. Small grants were awarded to 16 of the sites to defer the cost of implementing the program.

"We are very pleased to offer this outstanding educational program to these school communities," said Altha J. Stewart, M.D., president of the American Psychiatric Foundation. "By training school personnel about the signs and symptoms of mental illnesses, we can encourage early recognition and help teenagers in need obtain appropriate treatment."

The organizations, schools and schools districts that received funding from the foundation to implement the Typical or Troubled?(TM) School Mental Health Education program include:

-- Chesterfield Mental Health Support Services, for implementation in ten high schools in the Chesterfield County School District, Chesterfield, Va.

-- Cleveland Heights High School, Cleveland Heights, Ohio

-- Freedom From Fear, for implementation in five high schools in Brooklyn, N.Y., and Staten Island, N.Y.

-- Houston Independent School District, Houston, Texas, to provide training in five high schools

-- Newark High School, Newark, Del.

-- New Canaan High School, New Canaan, Conn.

-- Mental Health Association of Columbia-Greene Counties, Inc., for implementation in twelve high schools in Columbia County and Greene County, N.Y.

-- Mental Health Association of Marion County, to provide training in two high schools in the Metropolitan School District of Lawrence Township, Indianapolis, Ind.

-- Mental Health Association of Sumter County, for implementation in three high schools in Sumter County, S.C.

-- Providence Alaska Medical Center, for implementation in seven high schools in the Anchorage School District in Anchorage, Ala.

-- Robbinsdale Armstrong Senior High School, Plymouth, Minn.

-- Sacramento City Unified School District, Sacramento, Calif., to provide training in five high schools.

-- The School District of Osceola County, for implementation in three high schools in Osceola County, Fla.

-- South Dakota Voices for Children, to provide training in two high schools in Wagner, S.D., and Sioux Falls, S.D.

-- South Shore Hospital, for implementation in three schools in Southeastern Massachusetts

-- York Community High School in Elmhurst, Ill.

In addition, the program will be implemented through self-funding in:

-- Albuquerque Public Schools in Albuquerque, N.M.

The American Psychiatric Foundation is the philanthropic and educational arm of the American Psychiatric Association. The mission of the foundation is to advance public understanding that mental illnesses are real and can be effectively treated. For more information, please visit the foundation's Web site at http://www.psychfoundation.org/.

American Psychiatric Foundation
http://www.psychfoundation.org/
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Three Oregon Counties Added To Mental Health Supported-Employment Initiative - Central Point News

By Joan Jones

A state initiative to help Oregonians with severe psychiatric disabilities get jobs has added Deschutes, Malheur and Marion counties, bringing to seven the number of participating counties.

The initiative seeks to reduce unemployment among Oregonians with severe mental illness, whose jobless rate was 82 percent in 2004 and mirrored national estimates of 80 percent to 90 percent.

"We know having a job helps people with mental illness not only increase their self-esteem but also get control of their symptoms," said Bob Nikkel, Oregon Department of Human Services assistant director for addictions and mental health. "And it's what people want -- they are clear that they want to work."

The three counties are being added to Josephine, Lane, Polk and Washington counties, which already have helped hundreds of people with mental illness go to work as custodians, cashiers, linemen, drywall installers, service-station attendants and in other occupations. Developing a diversity of jobs with numerous employers promotes mainstream occupational choices for people with severe mental illness, Nikkel said.

He said the state would invest a total of $41,000 during the next year from his division and from the DHS Office of Vocational Rehabilitation Services to pay for training and consultation to be delivered by Grants Pass-based Options for Southern Oregon and to help defray participating counties' start-up expenses.

Caseworkers provide a variety of employment-related services such as networking with potential employers, building up confidence among people who may never have worked, setting up interviews, helping new employees with work clothing, assisting with transportation arrangements and helping newly hired people to adjust daily personal schedules to include working. Individuals have a choice about how much assistance to receive, Nikkel said.

Supported employment is an evidence-based practice, meaning its effectiveness is supported by research. The Legislature told DHS and four other state agencies they must spend increasing shares of their budgets on such practices.

Since 2002, Oregon has sent quarterly outcomes data to Dartmouth Medical School to support its multi-state research into the effectiveness of supported-employment services. Sites participating in the Dartmouth project report more than 40 percent of individuals reached are engaged in competitive employment.

Over the past 18 months in Oregon, approximately 300 people participated each month with 55 percent to 60 percent reporting competitive employment.

Meanwhile, sites in Grants Pass and Portland also are participating in federal research into whether investing in supported-employment services ultimately reduces government expenditures for benefits to people with severe mental illness.

Contact: Jim Sellers 503-945-5738
Program contact: Mike Moore 503-947-5538
http://www.oregon.gov/DHS/index.shtml
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Good isn't good enough for mental-health care - Salem (OR) Statesman-Journal

Commentary

JEANINE STICE


It's clear what society has been doing since 1990 to follow and treat Kam Shing "Daniel" Chan: a good job.

Chan has been described as a model patient in a forensic psychiatric program at Oregon State Hospital, where he was sent after being judged guilty but insane in the death of his daughter.

After Chan's release, the Oregon Psychiatric Security Review Board continued to monitor him. The recidivism rate of people monitored by the board is 1.5 percent. Still, we have unsettling facts: a man can kill his daughter, six years later walk the streets, and a decade later be charged with attempted aggravated murder and arson in a fiery attack on a church congregation.

Despite our good efforts, we're living on miracles. Call it luck or a miracle, no one went up in flames at Peoples Church on Wednesday night.

News reports said Chan had been diagnosed with paranoid schizophrenia. That is a chronic disease that doesn't go away. It's unpredictable, difficult to manage and incurable. Isolation, stress and alcohol contribute to acute delusional episodes, which can be severe enough to end in schizophrenics harming themselves and others. When people are free on the streets, they have access to all those risk factors.

It can take four to eight weeks for patients to clear an acute attack, but it's extremely rare to keep them hospitalized for this extended period. If they are not treated and followed aggressively after discharge, they can place themselves and society at risk.

Schizophrenics are taught to seek care immediately if they have thoughts of suicide or homicide. In a case in South Carolina, a paranoid schizophrenic woman threw her infant off a bridge despite the fact that she had seen a psychiatrist within a week before the acute episode that ended her child's life. Like Chan, her psychiatrist described her as a model patient, compliant with her medications and treatment.

Although paranoid schizophrenia is a chronic disease, thoughts can change quickly and medications aren't perfect. Sue taught me this.

Her younger brother had nothing in common with Mr. Chan, or the woman who threw her infant from a bridge. He was a young Caucasian male from a middle-class family and had the same diagnosis: Paranoid schizophrenia. That was one of the reasons why Sue chose a residency in psychiatry.

She would work all day, come home from work, quickly eat dinner and go visit her brother in his "community setting" three to five times each week. She was always worried. Even on medication, his mood never was stable for very long. He had good days and bad days.

The aggressive follow-up she provided her brother was not the standard treatment provided by communities. She knew he needed more than the community would provide, and being a psychiatrist, she was capable of providing it.

Chan reportedly received appropriate care and met benchmarks for compliance, but today he faces horrendous accusations. Years ago, the night before he killed his daughter, he reportedly interpreted sirens as God's signal to kill his daughter. Did he have similar interpretations Tuesday night? We hope we'll find out after his mental-health evaluation is completed.

In Sunday's Statesman Journal, Mary Claire Buckley, the executive director of the PSRB, shared this comment, "No system is perfect, but the board has done what it can to be as effective as possible."

Oregon has not. Our state hospital is deplorable; our mental-health-care system is fragmented; reimbursement for psychiatric treatment is pathetically low compared with other health conditions.

The PSRB manages 710 cases. With a recidivism rate of 1.5 percent, Oregon can expect 10 or 11 more cases of mental breakdowns that could result in harm to the client or harm to others. Nearly half of the PSRB clients are managed in the community setting. Statistically speaking, communities might see five more incidents as severe as this attack.

Community-based outpatient treatment was not considered adequate for the brother of a woman training to become a psychiatrist. It did not prevent a woman from throwing her infant off a bridge. And it did not prevent Chan -- after killing his daughter years earlier -- of now being accused of setting fires at a church with the intent of killing everyone present.

Clearly, as good as they are, the Psychiatric Security Review Board and our community failed in the follow-up and treatment plan of this paranoid schizophrenic.

Is a good job good enough?

Jeanine Stice of Salem is the mother of three young sons, has a master's degree in public health and is a registered dietitian. Her column appears every other Monday. Send e-mail to nutritionetc@comcast.net. Read more!

Relatives Face a Gauntlet of Privacy Laws - Lakeland (FL) Ledger

Relatives out of touch for decades

By Robin Williams Adams
The Ledger

LAKELAND -- Billy wasn't the same after the Vietnam War.

He spent four years in the Marine Corps and did well, his mother said, but he came home as one of the walking wounded.

His wounds were inside. But his family and others in the small Pennsylvania town where he grew up saw what they did to him.

The handsome, smiling high school graduate became a remote, withdrawn stranger who felt he didn't belong.

'I just cannot readjust to life,' he wrote to his mother, Joyce McBride, who now lives in Lakeland. 'Hell, I never adjusted.'

Diagnosed with schizophrenia, he drifted around the United States, then disappeared.

His last visit with his mother was in fall 1985; his last telephone call in January 1986. Efforts to find him failed.

'I will never know what happened to him,' McBride said. 'I feel he is dead because I know if he were alive he would show up.'

McBride shares with millions of others nationwide the feelings of fear and helplessness that go with being a close relative of someone with a mental illness.
While relatives can, and often do, play a key role in helping their mentally ill children, siblings or parents, they are frustrated by laws and treatment practices that give them few rights and little support.

Families of people with mental illnesses routinely run into a brick wall of privacy laws, unwillingness on the part of many mental health care providers to actively include them in treatment and the refusal of insurance companies to pay for adequate care.

With 35,000 to 40,000 people in Polk, Highlands and Hardee counties having mental illnesses — and using a conservative estimate of three relatives per person — that's more than 100,000 here whose lives are affected.


What relatives fear

Not knowing whether someone you love is dead or in the hospital is the ultimate fear for many whose adult relatives have a mental illness.

Privacy laws are particularly stringent for people being treated for mental illnesses, and they often stand between concerned relatives — even those who are financially supporting the person who is ill — and access to medical information about their adult child, spouse or parent.

'With adults, the biggest problem parents have is the lack of influence they have,' said Cathy Hatch, executive director of the Polk County chapter of the National Alliance on Mental Illness (NAMI).

'All the privacy laws prevent them from knowing what's going on medically with their children unless there's a specific release of information. And very often, for whatever reason, the children won't sign those releases.'

That's one of many frustrations voiced by Polk families who have spent years trying to help a close relative who is ill. Others include:

The impact of that person's mental illness on the whole family, creating burnout, anger, fear, guilt and feelings of helplessness.

The inability to understand — or get others to understand — what someone with a mental illness is going through and how to help without causing harm.

Limits on what insurance pays for mental health treatment, which often is much less than for illnesses like diabetes or heart disease.

Overcrowded public-funded programs for those without insurance, which results in lengthy gaps between the time the mentally ill are released from short-term crisis stays and when they get into therapy.

Privacy, peace of mind conflict

A patient's right to privacy is paramount unless a relative has guardianship over them or the person with the mental illness agrees to release information.

Being someone's health-care surrogate isn't enough, said Dr. Sean Harvey, director of mental health programs at Lakeland Regional Medical Center.

'Without written permission, we can't even call and say your husband is here,' he said.

That doesn't change because the person lives at home, is on a relative's insurance or were diagnosed when they were young and it was the parent who doctors consulted about treatment.

Hatch cites the case of a local woman who spent months persuading her sister to seek treatment.

When the sister finally agreed the woman called a mental health provider to make an appointment, but was told she couldn't act on behalf of another adult. Only the prospective patient could make the appointment. Weeks later, the sister still hadn't sought treatment.

Representatives of Peace River Center and Winter Haven Hospital Behavioral Health — two key providers of mental-health treatment in Polk County — said they often encourage patients to let families get more involved.

But if the patients won't agree, they said, they can't force them.

Other than seeking guardianship or temporary hospitalization under the state's Baker Act, relatives have few legal options to force someone into treatment.

McBride experienced that frustration throughout Billy's illness, and she still faces it with another of her children, a daughter who is diagnosed with bipolar disorder.
In 1984, the tips of Billy's toes were black and his ankles and toes were cold to the touch. He had frostbite from living outside so much during his wandering.

Gangrene was setting in, according to a medical report, but he refused to agree to surgery. His family had to resort to legal action to force him to get the surgery.

In fall 1985, the last time McBride saw Billy, she had arranged for him to return to a Veterans Administration hospital. He stayed overnight with her, but the next morning told her to 'drop me off at the railroad.'

Then came an early morning, seemingly routine phone call, in January 1986. It was the last time McBride spoke to her son.

A few months later, an employee at the Pennsylvania plant where McBride worked reported seeing him.

But after that, nothing. There was no further word of Billy's whereabouts. Efforts by family members to find him failed.

McBride said she suspects Billy died in one of the many caves in the nearby mountains.

Waiting for a time bomb

McBride's daughter waited 20 years before telling her mother that she was diagnosed with bipolar disorder, and she doesn't share much information now, even though the two see each other frequently.

Her daughter had panic attacks and bouts of depression, starting as a teenager, followed by eating disorders. She held jobs for more than 20 years, McBride said, but can't work full time now.

'They're this sweet person you brought into the world and you never thought it would happen to you,' said McBride, 72.

Billy's last name and the daughter's are different than that of their mother. The name isn't used in this article to shield the identity of the daughter, who didn't want to be interviewed or have her name published.

At a support group in Lakeland, McBride described herself as being in a coping stage. She told other members of the group how important it is to cope a day at a time and to recognize when you may need therapy yourself to handle the stress.
'I'm trying to let one day go into the next and work on myself,' she said. 'This is a decades type thing. You don't sit around and wait for a time bomb, but you expect one to go off.'

Her relationship with her daughter is important to her, McBride said, and she tries to be careful about what she says.

But her years of being a worried parent have taken a toll. She now is being treated for depression herself.

That's not unusual.

The stress and frustrations of dealing with a loved one with a mental illness often exhaust family members' patience, money and health, experts say. It can strain other family relationships.

'I've jumped from one crisis to another and I'm beginning to feel like I've got the mental illness,' said another member of a NAMI group, who didn't want her name used.

A pervasive feeling of guilt filled the room at the support group and at a 12-week Family to Family training session.

Several who attended said they wished they had done more, recognized more quickly that a relative was ill or identified a situation, such as child abuse or other trauma, that caused a predisposition toward severe mental illness to blossom into outward manifestations.

'I keep looking back to when he was 18 and think, `Why didn't we do something then,'' said the mother of a man in his 20s who is diagnosed with both bipolar disorder and substance abuse.

Her son's bipolar disorder diagnosis didn't come until he had been in three treatment centers for substance abuse, she said, struggling to retain her composure as she described the impact on 'what I used to think was our Mayberry situation.'

Despite the widespread occurrences of mental illnesses, only a handful of family members attend the NAMI groups.

The organizers know that denial, lack of awareness and embarrassment are among the reasons more people don't come. They wish they would, however.
'This is the place where we come where we can open up and get the support we need from each other,' said Linda Kaley, secretary of Polk County's NAMI.

She leads groups in Lakeland. Others meet in Lake Wales.

McBride attends the support group and Family to Family class in Lakeland, drawn by a need to learn more and be with others who understand her feelings.

'People without experience of a loved one with any degree of mental health issue tend to treat it as a moral shortcoming, expect you to `get a grip' and help yourself,' she said.

'Unfortunately, that is not the way it works.'

Limited resources

If someone with mental illness is uninsured, options for extended mental-health care are limited unless the person or family members can afford to pay privately.
McBride's daughter had health insurance when she worked, but she is unemployed now and waiting to qualify for disability. Until then, she relies on Lakeland Volunteers in Medicine, a clinic for those without insurance.

If family members can afford it and want to help, they pay for doctor visits and medication as they try to get a loved one into community treatment programs run by Winter Haven Hospital Behavioral Health or Peace River, which receive state funds through the Department of Children and Families.

Peace River has a crisis intervention center where people can be taken for emergency commitment. But appointments to start ongoing therapy at Peace River or Winter Haven Hospital Behavioral Health can take weeks.

People with private insurance, although usually better off than those who lack it, can't be assured it will cover the cost of needed care. Mental-health coverage often is separate from plans that cover physical ailments and comes with more stringent limits imposed.

Advocates for the mentally ill have made it a priority to change that, but so far with limited success.

'There is no justification for health plans to impose discriminatory limits on treatment for schizophrenia, bipolar disorder and major depression (caps on inpatient days and outpatient visits, higher cost sharing) that ... do not apply to all other illnesses,' NAMI says on its Web site.

Polk County's Carl Reed is among many who have fought for years for 'parity' — equal coverage for all illnesses.

He became active in NAMI on behalf of his son, Paul, who has schizoaffective disorder, which has symptoms that are a cross between schizophrenia and bipolar disorder, both of which need ongoing treatment.

NAMI is urging people to lobby their U.S. representatives and senators to support House Resolution 1402 to achieve parity.

But supporters have had little success promoting the national legislation or a similar reform measure in Florida.

'The same thing has happened on the federal level as happened on the state level twice,' Carl Reed said. 'The legislative leadership won't let it out for a vote.'

Robin Williams Adams can be reached at robin.adams@theledger.com or 863-802-7558.
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Tougher Screenings Sought For Troops' Mental Health - Hartford (CT) Courant

October 26 2006

By LISA CHEDEKEL And MATTHEW KAUFFMAN
Courant Staff Writers

Policy reforms that have been signed into law by President Bush will enhance the mental health care of combat troops, but more improvements are needed as the pace of deployments accelerates, lawmakers and veterans' advocates say.

U.S. Sen. Barbara Boxer, D-Calif., a co-sponsor of the mental health reforms that were signed by the president last week, said she already has begun pushing a Defense Department task force to further tighten psychological screening and treatment of deployed troops.

"I'm glad we have a task force looking at these issues," Boxer said. "I hope they'll be the back-up" to restore some provisions that were stripped from the new legislation.

Boxer teamed with U.S. Sen. Joseph Lieberman, D-Conn., to sponsor a bill calling on the military to set clear mental-fitness guidelines for deployment, and to enhance mental health screenings of troops heading to war, which now consist of a question on a form. The legislation grew out of a May series in The Courant that found that the military was sending mentally troubled troops into Iraq and keeping them there, in some cases with fatal consequences.

"We drafted this amendment with the intent of sparing soldiers and their families from the tragedy that poor mental health care imparts," Lieberman said. He said the legislation was an important step toward improving care.

But while the final bill calls on the military to tighten procedures for screening and monitoring troubled troops, some provisions were dropped from the Senate version by a conference committee of House and Senate negotiators. The approved legislation requires the military to establish guidelines governing when deploying or returning troops should be referred for mental health evaluations, and expands pre-deployment screenings to include "an assessment of the current treatment of the member and any use of psychotropic medications."

The law also requires the military to develop a list of specific mental health conditions or treatments that would preclude deployment to a combat zone.

Dropped from the original version were requirements that any service member who indicated a mental health problem during the screening be referred to a specialist for evaluation, and that the screenings include "a mental health history" of each member.

Boxer said that while the new law makes important changes, she was disappointed that the original bill had been "weakened" in the conference committee. She met last week with members of the Defense Department's mental health task force and encouraged them to go further in recommending reforms.

"I told them how important their work is ... and I said I hoped they'd take a look at restoring some of [the original bill]," she said. With many troops now on second or third combat tours in Iraq, she added, "We want to make sure there's a clear set of requirements before you send someone out. Also, we want mental health professionals looking at those people" who indicate problems.

Dr. William Winkenwerder, assistant secretary of defense for health affairs, was "still in the process of reviewing the legislation" and would comment on it in the near future, said Cynthia Smith, a spokeswoman for his office.

The mental health task force, which will issue recommendations next May, is looking into a number of issues, including whether pre- and post-deployment screenings are adequate. At a meeting last month in Texas, the task force heard complaints from soldiers about the stigma associated with reporting psychological problems to superiors, and concerns from an Army psychiatrist about "burnout" among mental health providers serving in Iraq.

Army Surgeon General Kevin C. Kiley, the task force co-chairman, said during the meeting that the task force wants to find ways to encourage more troops to seek care.

"It certainly starts from the top, in terms of creating the atmosphere," Kiley said, according to a meeting transcript.

Veterans' advocates called the new law a good first step, but said the federal government is still unwilling to support comprehensive mental-health screening and treatment.

"It's not everything we wanted," said Stephen Robinson, director of government relations for Veterans for America. "In order for [the Defense Department] to meet what we believe is the same requirement that they would utilize for, let's say, a piece of equipment, we would have to increase the number of mental health care professionals in the Department of Defense. And that costs a lot of money."

Paul Rieckhoff, executive director of Iraq and Afghanistan Veterans of America, said that while more improvements are needed, he was surprised at the passage of any law that might reduce the number of troops that can be deployed.

"What we're also wrestling with here is the overextension of the military," Rieckhoff said

Contact Lisa Chedekel at lchedekel@courant.com.
Copyright 2006, Hartford Courant Read more!

Mental health experts: No Halloween psychos-MSNBC

Advocates, federal agencies work to rid Halloween of mental-illness themes

By Michael E. Ross
Reporter
MSNBC
Updated: 9:52 p.m. ET Oct 29, 2006

Mental health professionals and advocates are battling to take themes of mental-illness out of Halloween.

The National Alliance on Mental Illness says Halloween celebrations depicting psychoses and insane asylums victimize the mentally ill.

“Looking at it through the specific prism of Halloween, stigma is one of the main barriers topeople getting help when they need it,” said Bob Carolla, a spokesman for NAMI, a mental health advocacy organization based in Arlington, Va.

“The stigma is linked to the perception of violence, even though research indicates that people with mental illness are no more prone to violence than the rest of the population,” Carolla said.


The culprit? “It’s often a haunted house attraction dressed up with some kind of mental illness theme, usually presented as an insane asylum,” he said.

Haunting haunted houses
A NAMI project called StigmaBusters, meant to shift attitudes about mental illness in popular culture, has had some success making direct appeals to organizations that use insanity themes. If a film, program or event is seen as stigmatizing the mentally ill, StigmaBusters, and NAMI affiliates throughout the country, contact the producers through e-mail alerts. StigmaBusters has more than 20,000 e-mail subscribers, including hospitals, media outlets and universities.

A community haunted house, sponsored by the Wheaton, Ill., Jaycees, changed its “Insanitarium” theme this year, after objections made public by the project.

“We realize that mental illness is a serious problem that can have a great personal impact on many lives,” the organization said last week on its Web site announcing a change in the 2006 theme, and apologizing for the “Insanitarium” concept.

A pop-culture staple
Images of the mentally ill have been a staple of movies and television for years. The 1978 film “Halloween” followed Michael Myers, an escapee from a mental institution, on a murderous Halloween-night rampage. The film, considered a pioneer of the slasher movie genre, has been re-released this month. “Halloween 9” is set for release in October 2007.

Amusement parks have also adopted psycho themes. Paramount’s Kings Island, a park near Cincinnati, Ohio, continues to advertise “The Asylum” and “PsychoPath,” two of its Halloween attractions for “Fearfest 2006,” despite NAMI's objections.

“We're really appealing to teens and young adults, and we're using the theatrics of thrillers they enjoy,” said Maureen Kaiser, spokeswoman for Kings Island, in defending the attractions.

Kaiser said that none of the park’s attractions “are intended to offend anyone or to make light of mental illness, adding that no park customers had complained.

But she said NAMI's objections would be considered in shaping the “future of the attraction.”

Perception rather than reality’
For Carolla, negative perceptions of mental illness in pop culture can be as much implied as shown.

“It’s perception rather than reality,” Carolla said. “Besides the Halloween movies, you've got the film ‘Psycho,’ and there've been others. Sometimes it’s violent movies. Sometimes it’s comedies where people with serious [mental] illness are presented as the butt of jokes.”

“It's pervasive throughout the popular culture, which is one of the reasons this is so difficult,” Carolla said. “You don’t necessarily find organizations outside the mental health community willing to take on the cause and contribute to anti-stigma efforts.”

Bigger than Halloween
That said, Carolla says progress has been made in cultural depictions of the mentally ill that extend beyond specific Halloween themes. Carolla said the USA Network drama “Monk,” whose main character is an obsessive-compulsive detective, has attracted positive response from the mental health community for its depiction of that disorder. (USA Network is a property of NBC Universal, parent of MSNBC.)

And he called the 2001 movie “A Beautiful Mind” “a tremendous breakthrough in terms of educating the public about schizophrenia.”

The Entertainment Industries Council, a group that focuses the entertainment industry on health and social issues, has just produced a guide for screenwriters to use as a reference on bipolar disorder.

And on Nov. 29, the U.S. Department of Health and Human Services, the Substance Abuse & Mental Health Services Administration and the U.S. Advertising Council will start a national anti-stigma campaign, with public service announcements, aimed at changing the public’s perception of mental illness.
Read more!

Team treatment program launched-The Daily Nonpareil

TIM JOHNSON, Staff Writer
10/29/2006

Heartland Family Service has implemented an Assertive Community Treatment program to improve local mental health services.

The method is considered a "best practice" by the National Alliance for Mental Illness and other advocacy organizations. The ACT program is funded by Medicaid but managed by Magellan Health Services.

Assertive Community Treatment uses an interdisciplinary team of mental health professionals to address various client needs, said Tracy Hinz, team leader. The Heartland team includes a psychiatrist, psychiatric nurse, substance abuse specialist, vocational specialist, rehabilitation specialist and therapist - all based in one building. Team members meet daily to share ideas on clients' treatment plans.

"It's kind of like a one-stop shop," said Suzanne Watson, central point of coordination administrator for Pottawattamie County Community Services. To be eligible, clients must be on Medicaid or have an application for disability pending, she said.

The team approach also makes the members more accessible, Hinz said.

"We've got somebody who works every day of the year," she said.

The Heartland program, launched in January, is designed to help people with severe and persistent mental illness move toward recovery in the community, Hinz said. It serves people who haven't responded well to the county case management program. Most have been diagnosed with schizophrenia or schizoaffective disorder. Many clients have a dual diagnosis of mental illness and substance abuse.

"We're running at 30 to 40 percent dual diagnosis," she said. "It's a huge issue. To find staff that is dually credentialed in mental health and substance abuse is difficult."

Nationwide, the average is 75 to 80 percent.

Hinz cross-trains her staff so there is always someone available who can help clients.

"I want that person to be able to call and talk to any staff member, not just the substance abuse counselor."

Clients tend to be people who have been in the mental health system for a long time, Hinz said. "Oftentimes, we work with people who lived in mental health institutes or residential correctional facilities for a very long time, and we're helping them move back into the community and learn how to live on their own and receive help for their mental illness," she said. "A typical ACT client might be one that is homeless or has a long history of evictions, has been in and out of the jail system and lots of in and out of hospitals - the folks that don't seem to be able to maximize their recovery with the traditional treatment tools. An ACT person is someone who doesn't show up for appointments."

That's one of the basic things staff members work on, Hinz said.

"We really try to hold clients accountable, too," she said.

Most clients see a staff person three times a week or more, Hinz said. Some are seen every day, and a staff person observes them taking their medication. Some have refused to take their medication in the past and have ended up in the hospital as a result.

"We know that these folks need frequent contacts, we know that these folks have really given up on themselves and don't really have any accomplishments - and we know that there's hope. We know that these people can stabilize and become independent and really do some decent things with their lives."

Typically, clients stay with an ACT program for seven to 10 years, Hinz said.

"We're in it for the long haul with these folks," she said. "We really try hard to get them to interact and buy into their own recovery."

Research shows that ACT produces better outcomes, Hinz said. While it is expensive, it saves money in the long run by reducing rehospitalizations, she said. It also gives clients a better quality of life and empowers them to be more productive and contribute to the community.

"In the time we've been operating, we've had two hospitalizations, both of which were short-term," she said.

Iowa is behind in recognizing and implementing ACT programs, Hinz said.

"Minnesota started ACT in 2005 and accepted it at the state level," she said. "Within the first year of having ACT programs, they had 25 programs. We've been existing in Iowa since 1996, and we only have five."


©Daily Nonpareil 2006
Read more!

Inpatient mental health care ends in county as Oaks closes-St. Petersburg Times

Seven Rivers officials say the hospital simply couldn't fill enough beds.

By ELENA LESLEY
Published October 29, 2006

CRYSTAL RIVER - A decision by Seven Rivers Regional Medical Center to shutter its mental health facility has left Citrus County with no inpatient psychiatric services.

"Everything has closed," said Mary Lee Cubbison, director of the Centers formerly Marion-Citrus Mental Health in Lecanto. "There isn't one inpatient bed in the entire county."

Representatives from Seven Rivers said the decision to convert 16 beds dedicated to psychiatric services - known as "the Oaks" - to acute care beds was based on community needs.

"Because of advancements in outpatient care and medication, people don't need inpatient care as much anymore," said Dorothy Pernu, spokeswoman for Seven Rivers

But mental health advocates say Florida faces a shortage of inpatient psychiatric beds. The state received the lowest score possible in terms of access to inpatient services, according to a recent study by the National Alliance on Mental Illness.

"There are about 3,000 more beds needed in the state," said Sue Homant, executive director for NAMI Florida. "My personal guess is the number is even higher than that."

While Seven Rivers maintains that the hospital simply couldn't fill the beds, mental health experts say the decision to abandon psychiatric services is often driven by finances.

"Psych services classically lose money," said Ken Duckworth, medical director for NAMI. "It's a silent crisis in America today."

Bed shortages weren't such a looming problem 15 to 20 years ago, said Mark Covall, executive director for the National Association of Psychiatric Health Systems.

"There was actually major growth in the late 1980s and early '90s," he said. "In some areas, there was even an oversupply."

He attributed the increase to two factors: excess capacity and the advantages of a cost-based Medicare reimbursement system.

But since that time, excess space at many hospitals has been swallowed up by population growth, and, in January 2005, Medicare changed its reimbursement system. Instead of reimbursing medical facilities based on actual costs, Medicare now offers a flat daily rate.

"The pendulum has swung in the other direction," Covall said.

The flat rate that any facility receives is based on an average for all of the mental health programs around the country. Though adjustments are made, Covall said the new system generally puts smaller psych programs at a disadvantage.

"Smaller units, because of economies of scale, are often paid less," he said. "Ten to 15 beds is hard to operate if you have a high Medicare population."

Not to mention that insurance coverage and reimbursement for psych services rarely measure up to those given for other medical conditions.

"As states have withdrawn their commitment to the mentally ill, private entities need to do it out of beneficence," Duckworth said. "But the reimbursement is poor."

For example, a hospital may get $4,000 a day for a cardiac patient and only $500 for a labor-intensive psych patient, he said.

Seven Rivers, a private hospital, launched the Oaks in 1991, during the boom in general hospital mental health units. Citrus Memorial Health System, the county's other hospital, has no beds reserved for psychiatric care.

"At that time, there was a definitive need for inpatient services," said Joyce Brancato, chief executive officer of Seven Rivers.

But because of advances in treatment, the hospital saw a gradual decline in the number of mentally ill patients needing hospitalization, she said.

Then, in 2000, Seven Rivers stopped accepting Baker Acted - involuntarily committed - patients.

The change affected both families of patients and the Citrus County Sheriff's Office. Patients who threaten suicide or homicide now have to be driven to the Centers in Ocala (the Lecanto office offers only outpatient services) or the Harbor Behavioral Health Care Institute in Spring Hill.

"It's definitely inconvenient," said sheriff's Lt. Buddy Grant. "We have to take them out of county and then stay out of county for at least an hour."

Even worse, Homant said, "you're driving around a person who is very sick. If someone was having a cardiac crisis, you wouldn't make them wait for treatment."

But Brancato said the hospital needed to stop accepting Baker Acted patients, no matter the downfalls, to improve the treatment environment.

"We were trying to combine both voluntary and involuntary patients," she said, "and it was difficult to care for both."

While Seven Rivers focused efforts on voluntary patients, the hospital saw the number of them dwindling, Brancato said.

At the same time, the demand for surgical beds went up.

"This was truly a decision made on the needs of the community," she said, pointing out that Seven Rivers provides several million dollars' worth of uncompensated care every year.

Cubbison said the Centers will likely pick up former Oaks patients - a service that she is sure the organization can provide, even if it's a bit of a struggle.

"The demands on our resources will be heavier," she said. "We're the last standing mental health facility."

Elena Lesley can be reached at 564-3627 or elesley@sptimes.com.
Read more!

Mental Health Reform, Please - Washington Post

Virginia's mental health laws are stuck in the past.
Sunday, October 29, 2006

VIRGINIA OFFICIALS are taking some encouraging steps aimed at fixing the state's broken mental health system, but this much-needed effort has come under attack. The assault is misplaced.

Increasing numbers of mentally ill people in Virginia end up on the streets, in court or in jail, instead of in treatment, where they belong. Chief Justice Leroy R. Hassell Sr. of the Virginia Supreme Court has launched a commission to revamp state mental health laws, including the state's outmoded criteria for civil commitment, which provide emergency treatment only when people are an "imminent danger" to themselves or others. Justice Hassell wants those laws examined, with the hope of presenting "reform legislation" to the 2008 General Assembly.

At a recent hearing, however, Sen. Kenneth W. Stolle (R-Virginia Beach) warned the court not to overstep its role by getting involved in policy. According to the Richmond Times-Dispatch, Mr. Stolle, chairman of the Senate Courts of Justice Committee, said he didn't think judges should "tell us how we should deal with mental health." Justice Hassell should be applauded instead of criticized. Judges see firsthand the impact of untreated people on the criminal justice system and the inadequacy of laws that deal with the problem. Their advice to lawmakers is invaluable.

There is a precedent, too. In the 1990s, family violence was spotlighted as an issue by then-Chief Justice Harry L. Carrico, and reform followed.

Coincidental with the state effort, Fairfax County, through its so-called Beeman Commission, is analyzing its own mental services during a time of increased need and dwindling resources. These two efforts highlight Virginia's desperate situation and the need for solutions. Read more!

Panel looks at mental health-The Daily Advertiser

Panel looks at mental health
Care, funds for housing examined
Marsha Sills
msills@theadvertiser.com

Changing the concept of long-term care for the chronically mental ill and funding for supportive housing for them when they’re out of crisis treatment are just a few of the things the state needs to fix in its behavioral health services, according to mental health professionals who met Thursday.

Thursday’s meeting held in Lafayette was one of several stakeholder meetings in the state to help the state reform its access and mental health services.


“The governor recognized even before the storms that we didn’t have adequate access to mental health services — if anything, it exacerbated the problem,” said Dr. Roxane Townsend, DHH deputy secretary. Townsend said the information gathered at the meetings — 11 held throughout the state — will be used to formulate the state’s plan for reform.
Nearly 50 professionals attended the meeting.

One problem that agencies and counselors face when trying to work with a client is knowing which services they’ve already received, said Willie Young, a licensed addiction counselor.

“There’s no cohesiveness in the system,” Young said. “That client has to go to place 5, 6 and then 7 before getting the services they need and then when he comes to me I have no way of knowing which services he’s received.”

An integrated database between the Offices of Addictive Disorders and Mental Health would help make that happen, said Steve Creadeur, program supervisor of UMC’s First Step Detox program.

Once patients are in care, many don’t have the means to stay on their medication, said Val Jones, a licensed clinical social worker.

“Even those on Medicare, some specific prescriptions may not be covered,” Jones said. “We also need to increase funding for supportive housing opportunities for the mentally ill. This is a dire problem we face in mental health. There’s no where for them to go. They can’t go home.”

The state should reinstate longer term care, said Todd Dugas, director of programs at Acadiana Outreach Center, which provides transitional housing to the homeless and those in recovery.
Read more!

Brains of depressed visibly different-The Charlotte Observer

Scans indicate mental response to positive, negative words altered
JAMIE TALAN
Newsday

Research on depression has focused on the depths of low mood and negative thoughts that have come to define this common, disabling condition.

Now, a team of New York scientists has found that clinically depressed people may have abnormalities in a region of the brain that regulates pleasure and reward, and the finding could lead to novel treatments.

Dr. David Silbersweig and his colleagues at Weill Cornell Medical Center brought 22 people into the laboratory to undergo brain scans while watching words come up on a monitor. Some words were positive, some negative and others neutral. The aim was to see whether the depressed brain looked different in the region that governs reward when reading these words.

The answer is yes. The scientists tested 10 depressed people who had not yet received treatment and 12 volunteers with no history of mental illness. One key characteristic of depression is that patients have a very hard time motivating themselves and enjoying things that once made them feel good.

The scientists found that the brains of nondepressed volunteers responded differently to positive and negative words, such as "rejoice" and "damaged."
Read more!

Breast milk linked to better mental health - UPI

A study has shown that brest milk from breastfeeding leads to better mental health.

The study tracked the growth and development of Western Australian children over the past 16 years. 2,500 children took part in the Perth-based study which showed the benefits of breast milk for infants breastfed longer than six months.

The study proved that they had significantly better mental health.

Researcher Wendy Oddy said that mothers should breastfeed and keep trying if they fail at first.

“Mothers need a lot of support for breastfeeding so I think it has become a community and a social issue that really mothers need to be encouraged and supported to breastfeed,” she said.

One of the mothers who participated in the study, Karen Gonsalves, says she is glad she chose to breastfeed all 3 of her children.

“I’ve certainly seen the benefits of the bonding and he definitely had less bugs and stuff as some of my friends who didn’t choose to breastfeed at that time. So I stuck with it and I’ve had three kids and loved every moment of it,” she said. Read more!

Tougher Screenings Sought For Troops' Mental Health - Hartford (CN) Courant

October 26 2006

By LISA CHEDEKEL And MATTHEW KAUFFMAN
Courant Staff Writers

Policy reforms that have been signed into law by President Bush will enhance the mental health care of combat troops, but more improvements are needed as the pace of deployments accelerates, lawmakers and veterans' advocates say.

U.S. Sen. Barbara Boxer, D-Calif., a co-sponsor of the mental health reforms that were signed by the president last week, said she already has begun pushing a Defense Department task force to further tighten psychological screening and treatment of deployed troops.

"I'm glad we have a task force looking at these issues," Boxer said. "I hope they'll be the back-up" to restore some provisions that were stripped from the new legislation.

Boxer teamed with U.S. Sen. Joseph Lieberman, D-Conn., to sponsor a bill calling on the military to set clear mental-fitness guidelines for deployment, and to enhance mental health screenings of troops heading to war, which now consist of a question on a form. The legislation grew out of a May series in The Courant that found that the military was sending mentally troubled troops into Iraq and keeping them there, in some cases with fatal consequences.

"We drafted this amendment with the intent of sparing soldiers and their families from the tragedy that poor mental health care imparts," Lieberman said. He said the legislation was an important step toward improving care.

But while the final bill calls on the military to tighten procedures for screening and monitoring troubled troops, some provisions were dropped from the Senate version by a conference committee of House and Senate negotiators. The approved legislation requires the military to establish guidelines governing when deploying or returning troops should be referred for mental health evaluations, and expands pre-deployment screenings to include "an assessment of the current treatment of the member and any use of psychotropic medications."

The law also requires the military to develop a list of specific mental health conditions or treatments that would preclude deployment to a combat zone.

Dropped from the original version were requirements that any service member who indicated a mental health problem during the screening be referred to a specialist for evaluation, and that the screenings include "a mental health history" of each member.

Boxer said that while the new law makes important changes, she was disappointed that the original bill had been "weakened" in the conference committee. She met last week with members of the Defense Department's mental health task force and encouraged them to go further in recommending reforms.

"I told them how important their work is ... and I said I hoped they'd take a look at restoring some of [the original bill]," she said. With many troops now on second or third combat tours in Iraq, she added, "We want to make sure there's a clear set of requirements before you send someone out. Also, we want mental health professionals looking at those people" who indicate problems.

Dr. William Winkenwerder, assistant secretary of defense for health affairs, was "still in the process of reviewing the legislation" and would comment on it in the near future, said Cynthia Smith, a spokeswoman for his office.

The mental health task force, which will issue recommendations next May, is looking into a number of issues, including whether pre- and post-deployment screenings are adequate. At a meeting last month in Texas, the task force heard complaints from soldiers about the stigma associated with reporting psychological problems to superiors, and concerns from an Army psychiatrist about "burnout" among mental health providers serving in Iraq.

Army Surgeon General Kevin C. Kiley, the task force co-chairman, said during the meeting that the task force wants to find ways to encourage more troops to seek care.

"It certainly starts from the top, in terms of creating the atmosphere," Kiley said, according to a meeting transcript.

Veterans' advocates called the new law a good first step, but said the federal government is still unwilling to support comprehensive mental-health screening and treatment.

"It's not everything we wanted," said Stephen Robinson, director of government relations for Veterans for America. "In order for [the Defense Department] to meet what we believe is the same requirement that they would utilize for, let's say, a piece of equipment, we would have to increase the number of mental health care professionals in the Department of Defense. And that costs a lot of money."

Paul Rieckhoff, executive director of Iraq and Afghanistan Veterans of America, said that while more improvements are needed, he was surprised at the passage of any law that might reduce the number of troops that can be deployed.

"What we're also wrestling with here is the overextension of the military," Rieckhoff said

Contact Lisa Chedekel at lchedekel@courant.com.
Copyright 2006, Hartford Courant Read more!

Panel: Mental health tests for students optional - Indianapolis Star

October 26, 2006

A state legislative study commission Wednesday opposed screening all Hoosier schoolchildren for mental health problems. Instead, the panel supported an Indiana Department of Education plan to addresses mental health in children but does not require schools to screen them.

State Rep. Cindy Noe, R-Indianapolis, chairwoman of the mental health commission, had wanted a stronger statement to delay the plan by a year so the legislature could make clear that screenings are optional and to tweak other parts of the law. Committee members rejected that proposal.

The committee's report to the legislature is nonbinding but carries weight as lawmakers consider further action.

Advocates say that screening children at school can provide early detection of treatable mental illnesses and prevent suicides; opponents call it an invasion of privacy and say that job is better left to parents.
Read more!

Missouri task force mulls ideas to protect mentally disabled - St. Louis Post-Dispatch

Originally posted Thursday, Oct. 26 2006

By Carolyn Tuft and Joe Mahr
ST. LOUIS POST-DISPATCH

JEFFERSON CITY — Four months after a Post-Dispatch investigation found failures
in how Missouri protects its mentally disabled residents, a state government
task force is poised to recommend stricter laws, more oversight and less
secrecy to ensure their safety.

The Missouri Mental Health Task Force — which includes top state officials,
industry executives, and advocates — on Wednesday released a draft report of 20
recommendations. It includes a controversial stance that could affect the fate
of Bellefontaine Habilitation Center in north St. Louis County.

The task force's chairman, Lt. Gov. Peter Kinder, said the final report — to be
voted on Nov. 6 — will include "a comprehensive list of needed reforms that
reflect the best practices in other states."

That final report will go to Gov. Matt Blunt, who formed the task force in June
in response to a Post-Dispatch investigation.

The newspaper's inquiry found failures at every level of a system that was
supposed to ensure proper investigations of suspected mistreatment of the
11,000 mentally retarded and mentally ill residents in full-time care overseen
by the state.

The newspaper's investigation

revealed 21 deaths, 323 injuries and almost 2,000 other incidents tied to abuse
or neglect by caregivers from 2000 through 2005.

The newspaper's investigation also found that the state failed to follow its
own policies and state law on how it investigated incidents and notified
police. Even when notified, police commonly failed to conduct investigations.

In June, the task force immediately ordered other state agencies to help the
Department of Mental Health do internal investigations, and it required the
department to notify the State Highway Patrol of any deaths or alleged assaults.

Since June, the Department of Mental Health hired more investigators to reduce
a backlog of 418 cases to 146, said the department's interim director, Ron
Dittemore.

"That's still 146 too many," said Dittemore, who also is a task force member.
"We're hoping the number is zero by December."

To reduce caseloads, the task force's draft report has called for internal
investigators to stop reviewing less serious allegations of worker neglect,
instead letting employees' supervisors determine guilt. But the investigators
should more quickly review serious allegations and seek more police involvement
in those cases, the draft report says.

The task force balked at some advocates' push to have a separate state agency
investigate all allegations of mistreatment. But the draft report recommends
that a separate state board be created to review deaths.

The draft report also calls for a toll-free phone number for reporting
suspected abuse, and for the public to have access to completed investigative
reports, so long as patients' biographical information is redacted.

State law now prohibits the public from seeing any information in the reports,
which angered the parents group at Bellefontaine's center. As part of a fight
to keep the state from closing Bellefontaine, the parents group tried to
research such reports on private facilities but weren't given them.

Bellefontaine's fate remains unknown. Blunt and some advocates have lobbied to
close it, but Blunt has said he would reconsider it if the task force said so.
Bellefontaine residents' family members, along with parents of residents at the
five other state-run centers, have protested at the Capitol, held news
conferences criticizing the governor and constituted many of those who spoke at
the task force hearing. The draft report doesn't specifically mention
Bellefontaine, but it does say the state should keep open centers for mentally
retarded residents so long as there's a need for them.

For such centers, the state should pursue outside accreditation, according to
the report.

As for privately run facilities — which house most residents needing full-time
care — the draft report calls for more reviews by state inspectors and tougher
sanctions for places violating the rules. State auditors have found that the
state hasn't properly logged abuse in group homes, and the Post-Dispatch
investigation found the state failed to adequately investigate, monitor or
punish privately run centers where mistreatment occurred.

To stop mistreatment, the draft report calls for better pay and training of
workers. The Post-Dispatch investigation found heavy turnover among workers,
who receive little training and can be forced to watch too many residents at
once.

Beyond its 20 recommendations, the draft report suggests that the Department of
Mental Health also follow 23 recommendations made by a separate state body —
the Mental Health Commission — two months ago.

Dittemore said the department supports the task force's findings.

"We need to improve our services every day," he said. "And we are working hard
to do that."



Among the task force recommendations:

— Tougher criminal penalties for abusers

— Fewer, but more focused, internal reviews

— Outside reviews of state-run centers

— Fines for poorly run private facilities

— More training and pay for caregivers Read more!

Gaps fill as agency prepares to close-Hendersonville News

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

More than 900 patients in Henderson County had yet to be assigned a new mental health care provider Thursday, five days before New Vistas-Mountain Laurel shuts down.

But the number should drop before Tuesday, after more than a half dozen mental health care providers confirmed they would take on the dying agency's cases.

The message to the new providers: "If they're not bringing clients with them on their caseload, then be prepared that in the next few days we're going to be assigning cases to make sure that the consumer has a clinical home," said Arthur Carder, the chief executive officer of Western Highlands, which manages mental health care in Henderson and seven other counties. "We're going to assign these consumers to new providers so they're all taken care of."

The largest new provider, Family Preservation Services, has hired most New Vistas-Mountain Laurel employees in Henderson County. When the employees move, so will their cases. Family Preservation Services expected a seamless transition for those children and adults who rely on mental health, substance abuse and community support services.

Also Thursday, Henderson County leaders moved to hash out a contract that would ensure indigent patients can find medication after Tuesday. Under the agreement, the county would give PSC MedSupply Inc. space in the Human Services Building on Spartanburg Highway for a pharmacy. The pharmacy would open at 8 a.m. next Wednesday, the day after New Vistas-Mountain Laurel plans to close because of money woes.

Western Highlands has found new providers to pick up most of the services that New Vistas-Mountain Laurel offered in Henderson County. At least one provider is still looking for space here, while others such as Family Preservation Services are scheduling appointments by calling 697-4187.

Western Highlands plans to release public service announcements through local media Monday telling patients the names, telephone numbers and locations of new providers. Notices also will be posted on New Vistas-Mountain Laurel locations.

"I think we're accomplishing most of our goals, and that is to have multiple providers in the area that are willing to pick up and respond to capacity," Carder said. "The trick's going to be how well that's going to work. It was confusing enough as we made the transition from the old model to the new model with the LME (local management entity, Western Highlands) and the safety net provider."

Multiple providers, he said, can be "a little less clear. That's one of the areas we're concerned about."

The Henderson County Board of Commissioners on Thursday divvied up $391,000 among the groups stepping up to fill the void left by the closure of the region's largest mental health care provider.

Commissioners set aside another $137,000 to see how well the new mental health care providers perform in the coming months. County leaders plan to put the remaining money toward the programs showing the most success.

The fate of the Sixth Avenue Clubhouse property remains in doubt. The building, worth $700,000, could still be sold by New Vistas-Mountain Laurel to pay lingering expenses. But the Clubhouse's new non-profit, the Sixth Avenue Psychiatric Rehabilitation Partners, received $100,000 in start-up money from county commissioners.

"If we don't get them going, we have a good chance that would not continue through November," Commission Chairman Bill Moyer said.
Read more!

Panel wants more oversight of state-run homes-Columbia Daily Tribune

Published Thursday, October 26, 2006

ST. LOUIS (AP) - A state government task force has released a draft report of 20 ways to better protect Missouri’s mentally disabled residents in state and private homes.

The Missouri Mental Health Task Force’s draft report yesterday recommends stricter laws, more oversight and less secrecy to ensure their safety.

The group’s chairman, Lt. Gov. Peter Kinder, said the final report will be voted on Nov. 6 and will include "a comprehensive list of needed reforms that reflect the best practices in other states.

The final report will go to Gov. Matt Blunt, who formed the task force in June in response to a St. Louis Post-Dispatch investigation that found failures in a system that was supposed to ensure proper investigations of suspected mistreatment of the 11,000 mentally retarded and mentally ill residents in full-time care overseen by the state.

The investigation revealed 21 deaths, 323 injuries and almost 2,000 other incidents tied to abuse or neglect by caregivers from 2000 through 2005. It also revealed that the state didn’t follow its policies and state law in response.

The task force immediately ordered state agencies to help the Department of Mental Health do internal investigations, and it required the department to notify the State Highway Patrol of any deaths or alleged assaults.

The state has hired more investigators to reduce a backlog of cases.

Among the task force recommendations:

● Tougher criminal penalties for abusers

● Fewer, but more focused, internal reviews

● Outside reviews of state-run centers

● Fines for poorly run private facilities

● More training and pay for caregivers

The draft report also calls for a toll-free phone number for reporting suspected abuse and for the public to have access to completed investigative reports as long as patients’ biographical information is not revealed.

The fate of Bellefontaine Habilitation Center in north St. Louis County remains unknown. Blunt has said he plans to close it, but he later said he would reconsider it if the task force said so.

The draft report doesn’t specifically mention Bellefontaine, but it does say the state should keep open centers for mentally retarded residents so long as there’s a need for them. The report said the state should pursue outside accreditation for such centers.

The draft report also calls for more reviews by state inspectors and tougher sanctions for privately run facilities that break the rules.

Private facilities house most residents needing full-time care. State auditors have found that the state hasn’t properly logged abuse in group homes.

The draft report also suggests the Department of Mental Health follow 23 recommendations made by a separate state body - the Mental Health Commission - two months ago.

"We need to improve our services every day," the department’s interim director, Ron Dittemore, told the Post-Dispatch.

"And we are working hard to do that."
Read more!

Mental health topic of public hearing-Pisgah Mountain News

By Melissa Stout
STAFF WRITER
published: October 26, 2006 12:15 am

HENDERSONVILLE — With New Vistas-Mountain Laurel closing in less than a week, Henderson County officials have been busy working with the Western Highlands Network to accommodate those who will be affected.

Commissioners will hold a public hearing today to review the county-allocated mental health funds, the status of the medication program and the Sixth Avenue Psychiatric Rehab Partners Clubhouse. The clubhouse has supported people as they integrated back into the community after receiving mental health care.

“We did not want to take any specific action with the MOE (county dollars known as Maintenance of Effort funds) until we knew where all the money would go and how the two situations would shake out,” Bill Moyer, chairman for the Henderson County Board of Commissioners, said referring to the medications program and Sixth Avenue Clubhouse.

Arthur Carder, CEO with Western Highlands Network, advised the county at the board’s Oct. 18 meeting how most of the $528,402 would be best used. But since the meeting other providers have been added to the list, and the commissioners may make a decision on the allocation of the county funds tonight.

Carder recommended $480,000 of the $528,402 would be best used if Horizon Recovery, Families Together, Community Health Network and Sixth Avenue Psychiatric Rehab Partners received the money.

Moyer said reimbursement by the state is low, and as a result, medical providers are willing to take people on Medicaid but not state-funded patients because they don’t get enough money from them.

“The county is looking to put their money into providers that are willing to take a higher percentage of state-paid (patients),” he said. “We want to put MOE funds that will help people that wouldn’t get services otherwise.”

In other business at last week’s meeting, commissioners approved a ban prohibiting sex offenders from county parks, schools, day care facilities and camps.
Read more!

Closure strains Pardee capacity-Hendersonville News

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

The looming closure of the region's largest mental health care provider has already sent more patients into the Pardee Hospital emergency room.

Since New Vistas-Mountain Laurel announced it would shut down next Tuesday because of money woes, Pardee Hospital's emergency room has seen about 30 more mental health patients than usual.

Bridget Barron, the Pardee nursing service director of psychiatry and medical detox, delivered the news to the board of directors on Wednesday.

"We are looking at an increase of 20 to 30 patients per month from the data that we have seen already, keeping in mind that New Vistas-Mountain Laurel has not closed their doors yet," Barron said.

The 21 beds in the Pardee psychiatric unit are full, she said. When needed, mental health patients are staying in the medical units until a psychiatric or detox bed opens.

The hospital is trying to hire more social workers for the emergency room. It also set aside triage space for mentally ill patients so emergency room flow will be maintained.

The scene mirrors a trend in the wake of the state-mandated mental health reform of 2001, which pushed the mentally ill into hospital emergency rooms because they knew no other place to turn for help.

"We are struggling with follow-up care for patients, due to the lack of options for the uninsured and under insured, which puts increased liability on our organization and physicians," Barron said.

Barron said a lack of medication and follow-up care could lead to increased substance abuse, suicide, crime rates, homelessness and fear in the public.

"The aftershocks from this crisis are likely to be felt for months," she said, adding that she saw no foreseeable end to the crisis for the uninsured and underinsured.

A community responds

Soon after Pardee learned about New Vistas-Mountain Laurel's closure through the media, the hospital joined Fletcher's Park Ridge Hospital and others to form a mental health coalition to prepare for a crisis.

The Hendersonville Free Clinic, Appalachian Counseling, the Community Health Network and the United Way of Henderson County rounded out the collaboration which has met each week.

Barron said Pardee Hospital and the Hendersonville Free Clinic plan to offer free psychiatric clinics on Tuesday nights beginning in mid-November. Pardee donated the space for the free clinic and several hospital nurses and psychiatrists volunteered to staff the clinic.

When drug company representatives visit Pardee, the psychiatric unit is asking them to deliver any sample medications and vouchers to the Hendersonville Family Health Center for the free clinic.

Park Ridge Hospital increased the number of staff members who conduct psychiatric evaluations in the emergency room. The Park Ridge pharmacy is donating medications to the free clinic. And Park Ridge nurses and psychiatrists also volunteered to help with the free psychiatric clinic.

The Hendersonville Family Health Center is seeking two grants totaling $222,000 for mental health care in Henderson County. It also is looking to add social workers and perhaps a psychiatrist to its staff.

The Health Department hired a social worker in conjunction with the Community Health Network to provide therapy.

The Henderson County Board of Commissioners meets tonight to determine how the county will spend $528,000 to help new providers pick up caseloads once New Vistas-Mountain Laurel closes Tuesday. Commissioners will hear plans from nine mental health care providers tonight.

The head of Western Highlands, which manages mental health care here, plans to update the Board of Commissioners on the response to the looming closure. The special session is at 7 p.m. at the county offices, 100 N. King St.
Read more!

Court ends oversight of mental health system - Honolulu Star-Bulletin

By Debra Barayuga
dbarayuga@starbulletin.com

State officials called it a "proud day" for Hawaii after a federal judge announced an end to the federal court's oversight of the state's mental health system.

U.S. District Judge David Ezra accepted a recommendation yesterday by court-appointed special master U.S. Magistrate Judge Kevin Chang that the case be closed Nov. 30 with no further hearings.

The finding ended 15 years of court oversight that began with an investigation in 1989, primarily involving the Hawaii State Hospital, which resulted in a Civil Rights for Institutionalized Persons Act lawsuit.

During the course of the lawsuit, Hawaii's mental health system was ranked by the National Alliance of Mentally Hill as last out of 51 states and the District of Columbia.

The organization used words like "dire and abysmal" and "disgraceful conditions" to describe the system of care for Hawaii's mentally ill.

"The system was an embarrassment and the worst in the nation and now I believe the people of Hawaii can have pride in the mental health system," said Dr. Tom Hester, chief of the Adult Mental Health Division.

Hawaii has since improved in the rankings to 11 based on letter grades it received in March by the alliance. Hawaii was also nominated as most improved, Hester said.

But the end to court oversight doesn't end the state's commitment and the need to continually improve the mental health system, he said.

Verlin Deerinwater, Justice Department attorney, told the court that the state has come a long way but that there were aspects of Chang's 12th annual report that still need to be done and he expects to continue meeting with state attorneys until Nov. 30.

The litigation was one of two major cases involving active federal court oversight that state Attorney General Mark Bennett had made his priority to bring to an end. This case lasted longer than the landmark Jennifer Felix case that ended May 2005 after 12 years, bringing long-sought-after improvements to the state's special-education program.

"So it really is a proud day for Hawaii and the first time in two decades where we don't have a situation where the U.S. Department of Justice or the federal courts are actively supervising a major part of state government," Bennett said.

He credited the work of the Health Department -- from Health Director Chiyome Fukino to Dr. Tom Hester at the Hawaii State Hospital and Gov. Linda Lingle's commitment to improving mental health services in the state.

There has been a large increase in the number of mentally ill served in the past four years. Those receiving services in the community have grown from 4,500 to more than 12,000. And new services have been instituted in each of the four counties, including a 24-hour, seven-days-a-week access line that handles 90,000 incoming phone calls each year, Hester said.

Read more!

Future of patient records uncertain-Hendersonville News

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

With six days left before the region's largest mental health care provider shuts down, questions cropped up on whether new agencies will receive patient records in time for a smooth transition.

New Vistas-Mountain Laurel, which closes Oct. 31 because of money woes, served 10,500 patients in Henderson and seven other mountain counties. Now, the fate of those patient's records is in doubt.

Western Highlands, which manages mental health care in the region, wants to ensure the patient records are forwarded to the new providers that take on the dying agency's caseload after Halloween.

The records contain important information such as medications and treatments the patient received. The records would help new providers "start off running" by shedding light on treatment routes that worked and failed in the past, Western Highlands CEO Arthur Carder said. Otherwise, the provider starts from scratch.

"It really makes for a better continuity of care," Carder said.

But state and federal privacy laws forbid New Vistas-Mountain Laurel from simply passing on the patient records to the new providers. New Vistas CEO Will Callison said employees are working to secure releases from patients so the caseworkers can carry the records with them as they find jobs with new providers.

"As they go, they're securing a release to move the client information that we have over with them so that they can continue to utilize that information to take care of clients," Callison said.

Callison expected the transition of records would continue weeks after the agency closes.

"As Western Highlands works to secure providers, I think it's going to be an ongoing process," he said. "We will have sort of a close down team, a skeletal crew working beyond the 31st to ensure that medical records continue to be supplied."

But the transfer has hit a road bump, a problem the agencies are not sure how to handle.

New Vistas-Mountain Laurel is required to keep adult records 11 years, and children's records 11 years after the child turns 18. New Vistas-Mountain Laurel plans to pay a storage business $50,000 up front to hang onto the patient records.

But accessing and copying those records in the future would carry an extra cost. Who would pay, since New Vistas-Mountain Laurel is shutting down?

"We're trying to work through that, because we don't have a good answer for that," Callison said. "Really, the best thing for clients would be for Western Highlands to be able to have the authority to access those records and actually take possession of the records. I think that would far and away serve the clients best."

The N.C. Division of Mental Health, Developmental Disabilities and Substance Abuse Services told Western Highlands to not take on the burden, Carder said.

Western Highlands spends about $20,000 a year handling the records of the defunct Trend, Blue Ridge and Rutherford-Polk mental health agencies that closed after the state-mandated mental health reform of 2001. One Western Highlands administrator said the office would not have the manpower, time or money to handle the New Vistas patient records.

"Part is the ongoing cost and liability," Carder said. "The other is if the LME (local management entity, Western Highlands) isn't here, then it's the state's responsibility to perform these functions. The state doesn't want to assume any liability that could land on them at some point down the road either. It was part of the expectation when we negotiated with people to be providers that they assume these responsibilities."

The Western Highlands board of directors received an update on the challenges Friday. Carder proposed the LME set up a phone bank this week, so New Vistas-Mountain Laurel could call patients to secure record releases. The phone bank would focus on some 2,000 substance abuse clients, who fall under more strict federal and state confidentiality rules. Carder said Western Highlands set up the phone bank, but it has not been used.

Western Highlands and New Vistas-Mountain Laurel were scheduled to meet privately Tuesday to discuss the records situation.

"We're having problems getting New Vistas to assume their professional and ethical responsibilities around those clinical records," Carder said. "They're the provider agency, they have taken federal, state and county dollars to provide services, they're supposed to do certain things. One of those is to make those records available. They're resisting doing that at this point."
Read more!

Leaders organize mental health services-Hendersonville News

Jonathan Rich
Times-News Staff Writer
jonathan.rich@hendersonvillenews.com

BREVARD -- As the final day for mental health care services provided to people in eight mountain counties by New Vistas-Mountain Laurel Community Services gets closer, leaders in Transylvania County have made arrangements for continued care.

Approximately 500 people in Transylvania County were receiving mental health assistance at the Mountain Laurel Community Services building near Transylvania Community Hospital. But last month that organization announced it was shutting down Oct. 31 due to financial problems. Many people were left wondering where they would go for treatment.

Transylvania Community Hospital recently agreed to purchase the building on Hospital Drive in the Brevard Medical Park. The Transylvania County Board of Commissioners decided Monday night to provide rent and start-up costs for two Asheville-based organizations, Parkway Behavioral Health and Families Together Inc., at that location through May 2007.

"The county has agreed to subsidize $44,000 in start-up costs and fund six months of rent where Mountain Laurel was," said Transylvania County Manager Artie Wilson. "We wanted for that facility to be in the same place for our county's mental health needs so that residents won't have to look elsewhere."

Reform of North Carolina's mental health care system was originally designed to give patients more options for care. But after many private providers stopped accepting state-funded patients earlier this year, the demand created too much strain for New Vistas-Mountain Laurel.

Under the plan to replace that organization in Transylvania County, services will be provided by three organizations: Appalachian Counseling, Families Together and Parkway Behavioral Heath.

Appalachian Counseling will provide community support for adult patients, school-based therapy for children, diagnostic assessments and outpatient therapy. Parkway Behavioral will take care of daytime and after-hours emergency care. Families Together will provide psychiatric evaluations and mobile crisis services, as well as some diagnostic and community support services.

Those organizations will provide many of those same services in Henderson and Buncombe counties.

While almost all of the services provided by New Vistas-Mountain Laurel will be replicated by a combination of these three organizations in Transylvania County, the areas of substance abuse and providing for an assertive community treatment team have yet to be decided.

"Those gaps only mean we are not currently meeting the capacity of care," Wilson said. "I really think the new coverage plan is starting to come together. There will no doubt be some bumps in the road, but long-term we will be in better shape than we were before."
Read more!

Punishment/relassification sought for rest home - Charlotte Observer

KYTJA WEIR

Cleveland County social service officials are asking the state to fine a rest home $20,000 and suspend new admissions at the center whose missing patient was found dead in August.

Meanwhile, the county's Social Services Board has asked the state to either shut down the home or relicense it as a mental health facility, not an adult-care home.

The requests come at the end of three separate investigations into problems at the Unique Living center near Fallston, about 50 miles northwest of Charlotte.

Two men walked away from Unique Living in separate incidents in the past three months. One man with schizophrenia was found dazed and hungry about 100 miles away. The other, dementia sufferer Kelly "Buck" Whitesides, was found dead Aug. 5 in woods near the facility six days after he disappeared.

State and county regulators also looked into neighbors' complaints about the facility. The center's residents often wander around the area at all times of night, neighbors said, and one man routinely simulates sex acts on trees near the local church.

Experts say the troubles stem from having mentally ill residents in a setting designed to care primarily for the elderly. They say the homes lack sufficient staffing and training on mental health issues.

More than 90 percent of the residents at the 80-bed Unique Living facility have been diagnosed with mental illnesses, state records show. Additionally, another 30 or so mentally ill residents live in a dozen trailer units that surround the home.

Cleveland DSS asked the state on Friday to fine the home the maximum $20,000 in connection with Whitesides' death, said DSS program manager Teala McSwain. They also have asked to prohibit new admissions to the home until the state can evaluate staffing needs at the facility.

It's not clear when the N.C. Department of Health and Human Services will make a decision on the county's recommendations. But, in the meantime, the rest home has been able to continue admitting new residents and has hired a mental health expert to assess residents' needs, McSwain said. Read more!

Housing in the mix for Dix - Raleigh News & Observer

Theodore Kirousis and Janet Nelson

The latest development in the lengthy process to determine the disposition of the Dorothea Dix Hospital campus upon its scheduled closure in 2008 is the recruitment by a legislative task force of the Urban Land Institute. The Institute's experts on finance, urban planning and local government will begin to study proposed options this month, with the goal of making recommendations to the legislature in January.

The Institute's technical expertise and experience will certainly be a welcome infusion into the process. However, in order that the needs of the mentally ill are not lost in the shuffle of competing interests in the future use of the property, the concerns of the mental health constituency must be woven into the vision and the plans for the Dix campus.

The decision that will be made regarding the disposition and the permanent legacy of the Dix campus will inevitably serve as a highly visible indicator of the larger mental health reform effort that the state has undertaken in recent years. As the state moves toward a community-based mental health service delivery system, additional resources are critical to make this effort succeed. The asset of state land can be a valuable lever in providing support for the movement to the community.

One major and obvious possibility for assuring this benefit is to use the Dix campus as a means to achieve clear, permanent housing opportunities for mental health clients.

• • •

An example of this approach exists in Massachusetts, the home state of Dorothea Dix. The closure of Metropolitan State Hospital near Boston in 1992 afforded the opportunity for redevelopment of the campus to reflect both the housing and the land conservation goals supported by local communities.

A re-use planning committee was formed in 1994 under the auspices of the state agency responsible for land disposition. It included community representatives as well as members of the local mental health area citizen's board. For over two years this committee incorporated the views and developed a consensus among the various interests to feature housing development and land conservation as the two major goals of the land re-use. The agreement demonstrated that housing and park development are compatible goals.

Ultimately, most of the 300-acre suburban parcel was planned for conservation, with over 200 acres being transferred to the control of the state parks agency. However, much of the remainder of the land, particularly the 50-acre footprint of the former hospital buildings, was planned for private housing development.

The process was significant in that the plan was formalized into legislation in 1996. A key provision of the legislation required the creation of a substantial affordable housing component within the new housing development, and further required a specific percentage of apartment units to be set aside for people with mental illness.

As a result of this legislation, the state mental health agency will receive 39 units of affordable housing apartments, which will be priced at rental rates accessible to mental health clients. The final plan has come to fruition only in recent months, some 10 years after the legislation was passed. This illustrates the complexity of undertaking such a high-stakes public policy planning challenge, but also testifies to the tenacity of the commitment of the people involved in making their vision a reality.

• • •

The outcome has been an affirmation of the crucial principle of recognizing the social responsibility to provide housing for people recovering from mental illness. Housing is one of the primary needs facing this population. Adding to the affordable housing supply for these and other citizens of modest income should be a central consideration in planning for the re-use of public assets with a history of social purpose -- a feature conspicuously missing from all the proposals for the Dix property put forth so far.

In our example, upholding this crucial principle by affirming the legitimate advocacy, legacy and rights of people with mental illness -- and capturing this commitment in formal covenants -- has played a key role in upholding the dignity of citizens with mental health needs. Even more importantly, this approach has upheld the dignity and integrity of the wider community as it undertakes socially responsible development while leveraging the asset of significant public land.

Whatever the configuration of the Dix campus of the future, there is no doubt the outcome of redevelopment will be measured in part by how well the campus plan has addressed the needs of people with mental illness. Dorothea Dix, never one to mince her words, said, "I come to present the strong claims of suffering humanity." Her words serve as a powerful reminder, at this historic juncture of state mental health service reform, that the legacy of the reform will be reflected for better or worse in whether the re-use of the Dix campus has yielded tangible resources and outcomes for people with mental illness.

(Theodore Kirousis is area director for the Massachusetts Department of Mental Health and has worked directly on the re-use planning for Metropolitan State Hospital, Waltham, Mass. Janet Nelson is associate professor and head of the Department of Religion and Philosophy at Meredith College in Raleigh.)

Read more!

VA rebuts report on quality of care

David Goldstein, McClatchy Newspapers

WASHINGTON - The Department of Veterans Affairs has rejected the findings of a recent report warning that increased demands on its walk-in treatment centers could affect the quality of care.

"VA's Vet Center program is the world's leader in providing readjustment services to war veterans to help them reintegrate to a successful return to their communities," the agency said in a statement.

The VA was conducting its own survey of workload and quality of care at the Vet Centers.

The report last week from the Democratic staff of the House Veterans Affairs Committee said demand had risen for outreach and other services at nearly a third of the centers because of the conflicts in Iraq and Afghanistan.

The VA created the network of treatment centers staffed largely by former combat troops, where veterans could seek help immediately for mental health concerns and other problems, in 1979 after the Vietnam War.

The report says the number of Iraq and Afghanistan veterans who've sought treatment for post-traumatic stress disorder doubled from October 2005 to June.

When he was asked about the report last week during a speech in Wisconsin, VA Secretary James Nicholson said the agency had enough money and staff to treat veterans' mental health needs.

"We're dealing with it with great excellence" he said.

In its survey of 60 of the 207 Vet Centers, the report found that the centers needed more staff and that a quarter might have to cut services and create waiting lists.

The VA countered that "no vet center has a waiting list, and all veterans without appointments are welcomed and assessed within 30 minutes of their arrival."

The agency said it had authorized three new centers and had been expanding 11 others since the Iraq war began. It has also hired 100 more war veterans -- a 10 percent staff increase -- as "outreach specialists."

"Ninety-eight percent of all Vet Center clients have told us they are highly satisfied with our services and would refer a fellow veteran to a Vet Center if he or she needed help," the VA statement said.

John Rowan, the president of Vietnam Veterans of America, said that more staff and expanded centers were good steps, but "not enough in the face of the growing, well-documented needs of our veterans and their families." Read more!

Psychotherapist also Courtney Love's mom - Belleview (IL) News-Democrat

BY CHRIS COOPER
For the News-Democrat

Linda Carroll fell in love with her baby daughter at first sight.

"She was there, my daughter, eyes wide open and looking at me as though she had known me always. The room glowed with radiant light, as if it were filled with angels, and I wept at her beauty, my heart swelling with a deeper love than I had ever known," Carroll wrote in her memoir, "Her Mother's Daughter."

That daughter is rock star and actress Courtney Love, who has a history of drug abuse and who some health professionals think suffers from mental illness.

Carroll, now 62 and a psychotherapist, will be in Fairview Heights on Friday to conduct two workshops for the 4th annual conference "Piecing It All Together: How Children's Mental Heath & Mental Illness Affect Family, School, and Community."

She will discuss how her beautiful baby developed chronic crying fits, mood swings, self-inflicted violence and paranoia.

Like most mothers of emotionally challenged children, Carroll sought help from doctors, pediatricians, psychologists, psychiatrists, teachers, and caseworkers, but to no avail. They either could not identify what Courtney had, nor give a cure. Or, they said, it was her mother's fault.

"Courtney had come into the world with a biology that created internal torment," Carroll said in a telephone interview from her home in Corvallis, Ore. "Violent mood swings, troubles with attachment, terrible dreams and a sense of persecution had plagued her all her life, the flip side of her creativity, generosity and intelligence. I accepted that I had not created that temperament."

Carroll understands difficult childhoods.

She was raised in San Francisco by her distant adoptive parents and, as a result, became depressed and isolated. To escape, Carroll developed a pattern of pretending, which involved her fantasy lover or her "real" mother rescuing her.

By 35, Carroll had experienced the death of her adopted parents and her baby son Elki, an ectopic pregnancy. She went through her third divorce. And and the single mother of five children had no money.

Carroll, who was seeing her own therapist at the time, decided she needed an education to support her children. She began her studies in therapy, and later married Tim Barraud, her husband of 18 years.

After years of estrangement from her daughter, Carroll was surprised when Love called to inform her she was three months pregnant and had married the child's father, musician Kurt Cobain.

The next day, Carroll found herself at Puako Beach, Hawaii, sitting on the edge of a lava formation. She was watching the fish in the calm water and at that moment knew she had to find her own biological mother. Seven months later, she discovered her mother, writer Paula Fox.

"After I found my birth mother, I felt that the most significant part of my life had been completed and I thought about writing the story (of my life) again. When I was done with my last book ("Return to Essence," on women's spirituality) this one ("Her Mother's Daughter") seemed to begin itself, almost," Carroll said.

She began writing "Her Mother's Daughter" when Frances Bean Cobain, her first grandchild, was born. As she gazed at her grandbaby's face, she could see characteristics of Cobain and Love. Just for a moment, she thought of the 'curse of the firstborn daughter,' carried through generations of women -- Paula Fox, herself, Courtney Love and Frances Bean.

In May 1996, Carroll learned that the first generation of these women, Fox, had suffered a severe head injury. She immediately booked a flight to Israel to be by her side.

Even though she spent the majority of her time at the hospital, she managed to explore Jerusalem. She stopped at market stalls to look at their merchandise. Russian nesting dolls (dolls of various sizes that fit inside each other) caught her eye.

Carroll thought of each doll as a mother and a daughter connected by the generations of women before them and after them. She purchased two Russian nesting dolls -- one for herself and the other for her granddaughter, Frances Bean, who was 3 at the time.

"When she saw my identical set of seven, she said, 'Grandma, I have an idea. Why don't I give you my tiniest baby doll and you give me yours and we put each other's babies in our own mommy doll? Then we will always have a piece of each other,'" Carroll said.

At the conference in Fairview Heights on Friday, Carroll will speak of her first encounter with mental illness. While in high school in 1960, she discovered her classmate's brother was "hidden away" due to his mental illness. Now, she said, we are finally taking steps forward to solve this issue by simply recognizing that a child's mental illness is not the mother's fault.

Carroll will also speak of her own personal life as a daughter, wife, mother, therapist and writer.

One of Carroll's main objectives is to help those parents who have reached the point where there is nothing else they can do for their mentally ill child.

"I discuss how I help people in that state," Carroll said, "as well as my own personal education and tradition."

4th annual Piecing It All Together Conference

Topic: How Children's Mental Heath & Mental Illness Affect Family, School and Community.

When: 9 a.m.-4:15 p.m. Friday and Saturday

Where: Sheraton Hotel"s Four Fountains Conference Center, 319 Fountain Parkway, Fairview

Linda Carroll's talk: "From the Perspective of a Mother: The Myth of Closure," 1-2:30 p.m. Friday.

Information: e-mail NAMI-PIAT@hotmail.com or call 798-9788. Read more!

Choosing poverty to help a child - Cincinnate Enquirer

BY PEGGY O'FARRELL
Yvetta Collins stood on the edge of a roof, convinced that jumping to her death was the only way to get her mentally ill daughter the help she needed.

Dozens of hospital stays had exhausted insurance benefits for 11-year-old Linzi. Collins made too much money to qualify for public help. She owed thousands of dollars to doctors and hospitals. And she was sure she was about to lose her job with the University of Cincinnati Police Department because her daughter's illness took her away from work so often.

"I thought, 'If I take myself out, somebody will have to help Linzi,' " Collins says.

Collins didn't jump that night five years ago. She couldn't figure out how to ask God to forgive her. But the solution she reached was almost as drastic.

She quit her job and went on welfare so her daughter, who has bipolar disorder, would qualify for Medicaid. Now, the state pays for Linzi Collins' care - more than $22,000 since last year.

Linzi is one of an estimated 430,000 people in Greater Cincinnati and Northern Kentucky who have a mental illness. Many of them - and their families - are frustrated and scared by a U.S. health insurance system that pays less to treat people who suffer from mental illness than it does to treat patients with physical ailments like arthritis and diabetes. Now, the system may be squeezing them more.

Ohio lawmakers are considering a plan that would require employers to cover at least nominal mental health costs, but a loophole would let employers opt out of that.

Anthem, the region's largest health insurer, is cutting reimbursements to psychologists and some therapists, a move that may make it harder for people to get mental-care help.

All this is coming while patient loads are rising. Cincinnati Children's Hospital Medical Center treated children with mental health needs for a total 29,000 patient days in the year that ended June 30 - a 66 percent increase from just three years before. At the same time, the number of licensed psychiatrists in the region has dropped slightly, to 241 this year in Hamilton, Butler, Warren and Clermont counties.

Peter Mattson, 15, of Finneytown can swing from deep depression to irrational elation when his bipolar disorder is at its worst. His parents' health insurance covers the cost of 60 days in a hospital for Peter's mental illness - but that's the lifetime limit.

Peter exhausted that coverage when he was 9.

"If you have cancer, that's caused by a defect in your body. You can't help that. You can't stop that. You can't prevent it yet," Peter says. "If you have a mental illness, we think that's caused by a defect in your body. But insurance companies cover cancer. You can get thousands and millions and millions of dollars for help with cancer. But there's nothing for mental illness. You can't help cancer and you can't help mental illness, so what's the big difference?"

TOUGH CHOICES

Workers across the region are starting to pick among possible health plans for 2007, in the annual end-of-year exercise known as "open enrollment." Workers with family mental health issues are especially careful.

Thirty-eight states, including Kentucky, require insurers to provide at least some level of mental health coverage. But typically, plans limit payment for mental health care to a set number of therapy visits and hospital days. Insurance might pay for an individual to have 30 mental health therapy visits a year while giving unlimited coverage for visits to a cardiologist or diabetes specialist.

Ohio does not even require health plans in the state to cover mental health, although most do.

A proposal in the legislature would require employers who offer insurance to cover at least $550 worth of costs a year to treat mental illness or drug or alcohol abuse. But employers could opt out of that coverage if they can show it would increase their costs by 1 percent.

Families of mentally ill children are often hit hardest, says Mike Sherbun, a psychologist and senior clinical director for psychiatry patient services at Cincinnati Children's Hospital. Kids with bipolar disorder and schizophrenia, for example, often need more intensive services, including hospitalization, than adults, and can quickly exhaust mental health coverage under their parents' health insurance plans. It's not uncommon for one parent to quit working to care for a child.

"You have to accept that if you have a child with any kind of chronic illness in the mental health area that you're going to be impoverished," Sherbun says.

Families can choose, like Collins, to give up jobs and private insurance and go on state assistance, or to give up custody of their children and let the state take over their care, Sherbun says.

"That's a hell of a choice to have to make," he adds.

The National Institute on Mental Health estimates that one in five Americans has a diagnosable mental illness - which also is the No. 1 cause of disability.

A 1999 report from the U.S. Surgeon General found that a family needing $35,000 in medical costs to treat a physical illness would pay $1,500 and insurance would pick up the rest. A family with the same medical costs for mental health treatment would pay $12,000.

Mental health therapy can cost more than $100 an hour, hospitals can cost up to $1,000 a day, and prescriptions can run more than $100 a month.

Collins estimates that she owes $30,000 to $50,000 because of Linzi's illness, including a car loan she defaulted on because of medical bills.

ECONOMICAL COVERAGE?

Mental and physical health have been covered at different levels since managed care came into vogue in the 1980s. Insurers claim providers abused the system by submitting false bills. But advocates for the mentally ill maintain that too many people still see mental illness as a character or moral flaw, not a treatable illness.

In today's world, advocates say unequal coverage makes no sense.

"Mental illnesses are just as debilitating and just as treatable as any chronic illness," says Gary Goetz, vice president of operations for NorthKey Community Care, which serves 8,200 mentally ill people in Northern Kentucky. He says it's frustrating that people with chronic mental illness can't get the help they need because it's out of their financial reach.

Insurers and employers say requiring them to offer equal coverage is too expensive and could force some employers to drop insurance.

But studies show that equal coverage would increase most employers' costs by less than 4 percent, says Janice Bogner, a program officer for the Health Foundation of Greater Cincinnati.

Some employers would see increases of only 1 to 2 percent, says Sharron DiMario, president and executive director of the Employer Health Care Alliance, which represents employer health-care purchasers. That's a small increase, she says, but "it adds up to higher costs for employers, who already have been experiencing increases. And where do some of these increases end up? They get passed along to consumers."

Jim Mauro, executive director of NAMI of Ohio, an advocacy group for the mentally ill and their families, says consumers already pick up the tab for unreimbursed mental health treatment.

"The reality is we're paying for all of this anyway, with increasing costs for penal systems, ER visits, police intervention, all of those things that impact our entire society," Mauro says. "When you get people into treatment, you avoid all of these issues that we're going to pay for no matter what."

OUT OF REACH

Families affected by mental illness say they're limited, too, by the availability of care.

Anthem Blue Cross and Blue Shield, which covers 500,000 members in Greater Cincinnati and Northern Kentucky, is cutting its reimbursements to psychologists by 20 percent on Nov. 1. Reimbursements to other therapists, including licensed clinical social workers, also will be cut.

James Brush, a child psychologist in Monfort Heights, says the cuts will force him out of Anthem's network. That means his patients who are covered by Anthem will have to find new therapists if they want to stay "in network," where costs to them are cheapest.

But many therapists' offices already have long waiting lists.

Paul Beckman, vice president for health care management for Anthem Blue Cross Blue Shield for Southern Ohio, says the cuts will bring area reimbursements in line with those paid to therapists in the rest of Ohio, Indiana and Kentucky. The company now reimburses psychologists about $80 for a regular therapy session; that will drop to about $60.

For Collins, the issue of equal benefits is clear-cut. She had two other jobs after she left UC, but she had to leave each one to take care of Linzi. She also couldn't afford to keep working and pay for her daughter's treatment out-of-pocket.

Before she stopped working, she made about $40,000 a year.

To cover Linzi's care, Collins estimates she'd need to earn more than $5,000 a month, or $60,000 a year. Some months, when Linzi needs hospitalization, her income would have to be $10,000 a month.

Collins was desperate when she stood on that rooftop on the UC campus and considered suicide as her only option for helping her daughter. Now she credits her faith with giving her the strength to keep caring for her daughter.

She knows some people will criticize her decision to go on welfare. She and Linzi, now 16, live in a subsidized apartment in North Avondale. Their income is $900 a month, including $80 a month in food stamps.

The situation isn't great, she says, but "we have a roof over our head. There was a time when I thought we'd be homeless. I thought we'd be down in a shelter."

E-mail pofarrell@enquirer.com Read more!

Report criticizes VA on mental health spending - Escondido (CA) Times

By: JOE BECK - Staff Writer

Local mental health counselors said they are seeing a sharp increase in the demand for their services from those who served in Iraq and Afghanistan, part of a nationwide trend reported by the Department of Veterans Affairs earlier this year.

At the same time, a congressional investigation released late last month showed more than $50 million in mental health funds for veterans has gone unspent in the last two years. Veterans groups have responded by calling on the VA to spend more on mental health for veterans ---- and spend it more effectively.

"The VA must do a better job of spending those dollars that are allocated to it," said Paul Rieckhoff, an Iraq war veteran and founder of Iraq and Afghanistan Veterans of America.

In North County, the Vista Veterans Center reported a 71 percent increase in the number of visits by recent combat veterans seeking help for mental problems from fiscal year 2004 to fiscal year 2005, from 287 to 491. The VA Hospital in San Diego recorded a 58 percent increase, from 459 to 727 from fiscal years 2005 to 2006.

"I think it makes sense that more people would be coming in because the war has been going on for some time now and more and more veterans are being discharged," said Joe Costello, executive director of the Vista center.

Evidence of the trend is beginning to show up in statistics kept at VA hospitals and satellite clinics. More than one-third of Iraq and Afghanistan war veterans are seeking help for symptoms linked to post-combat stress or other disorders, a tenfold increase over the last 18 months, according to a study released by the VA earlier this year.

Jeffrey Matloff, program director for the San Diego VA hospital's post-traumatic stress syndrome team, said the number of Iraq and Afghanistan combat veterans seeking treatment for mental and health problems is now "running neck and neck" with the combined number of veterans from other wars.

"There's less stigma attached to coming in and getting help," Matloff said. "The diagnosis of PTSD is much more recognized now than in other wars."

Repeated deployments pushing up numbers

Advocates for veterans and mental health professionals say repeated deployments to combat areas make it more likely that service members will develop some or all of the symptoms of post-traumatic stress syndrome, even if they don't see combat.

"A year in the combat zone has changed them, whether you've been in an intense firefight or not," Costello said. "Sometimes, adjusting to those changes are stumbling blocks in civilian life."

Mental health professionals say that veterans who do not or cannot receive treatment for mental disorders are vulnerable to symptoms of post-traumatic stress syndrome ---- mood swings, anger, excessive anxieties, depression and high-risk behavior.

"There's a lot of substance abuse, particularly with younger folks driving down the road at 100 mph, drunk," Costello said.

The murky nature of combat in Iraq and Afghanistan, where the threat of ambush never disappears, is another factor cited by Matloff in the increased mental health caseload.

"You're involved in largely civilian areas, where you don't know where the danger may be coming from. All that uncertainty may make it more difficult as far as the rules of combat and stress on the people who have to be on the front lines, and there are no front lines," Matloff said.

Not all the reasons why more veterans are seeking mental health treatments are negative. Counselors praised the military for informing combat veterans of the availability of mental health services inside and outside the armed forces, a change from previous reluctance to venture into discussions about the psychological effects of combat.

Nevertheless, service members still perceive risks in discussing the subject, said Karen Schoenfeld-Smith, director of the San Diego Veterans Center.

"It's easier to keep quiet, particularly if you're interested in maintaining your career in the service," she said. "But the military has been very proactive, in its own way, trying to encourage people to go get treatment."

Despite the findings that money for mental health services is going unspent, three local counselors interviewed insist the part of the VA system serving San Diego County has the capacity to meet increased demands for counseling, at least for the near future.

But Rieckhoff says the VA, as a nationwide system, needs "dramatically increased" funding along with more efficiency to ensure it spends all the money it receives from Congress.

"The VA needs to get ahead of the curve and be proactive," Rieckhoff said. "We shouldn't have to wait until there's an increase in homelessness and martial problems."

Critics question mental health spending

The increase in cases, coupled with the congressional investigation showing that more than $50 million in mental health funds for veterans has gone unspent in the last two years, has prompted complaints from veterans groups. They question the government's spending practices ---- and overall commitment ---- to the mental health of veterans.

Ira Katz, chief of mental health services for the VA, said in a telephone interview with the North County Times that critics have misinterpreted the findings of the investigation, and that the administration held off on some spending to make sure money was being spent on the best programs.

"We want to make sure people know what works, what doesn't work and get doctors collaborating on plans," Katz said. "The department did not spend the full amount of mental enhancement dollars that were available to it over the last two years. As a result, some question the VA's commitment to mental health. That's just not the case."

The congressional investigation was conducted by the Government Accountability Office, an agency that works for Congress and studies ways to make government programs more efficient and less expensive.

The report on the VA said the agency failed to spend $54 million in fiscal years 2005 and 2006, money that was intended to pay for easier access to mental health counseling and for raising awareness of the service among veterans.

Fiscal years in the federal government run from Oct. 1 to Sept. 30. The $54 million was part of a total allocation of $300 million for new mental health initiatives offered by the VA over the last two fiscal years.

The Government Accountability Office report also concluded that an additional $35 million initially reserved for mental health was shifted to another fund where it could be used for other purposes.

"As a result, it is likely that some of these funds were not used" for mental health initiatives, the report said.

System needs streamlining, officials say

The report said VA officials interviewed by investigators said the money was not used because "there was not enough time in the fiscal year to do so" and it took too long to hire new staff members.

The report was written at the request of members of Congress and submitted to the Veterans Affairs subcommittee on health in the House of Representatives. The authors of the report said their agency was asked to show how the VA was spending money designated for new mental health initiatives in fiscal years 2005 and 2006.

Katz said training, new hiring, education and other changes in what he called the "culture" of the VA also led to delays in spending the mental health money. He said the administration is committed to improving the mental health of the country's veterans.

Katz gave the example of a veteran who might need treatment for three conditions ---- heart trouble, depression and alcoholism. Normally, such a patient would see three doctors working separately from each other in what Katz called "silos."

"This is really onerous," he said. "The existence of all these silos is all too often a barrier to people getting the care they need."

Creating more collaboration among doctors has taken some time, he said.

"Primary care and other doctors work side by side so a patient's cardiac condition, depression and drinking can be treated by his primary care doctor, not three doctors in three different systems," Katz said.

In 2004 and 2005, VA officials decided to add a total of $300 million for mental health initiatives to deal with expected increases in Iraq and Afghanistan veterans seeking counseling.

The VA's National Center for Post-Traumatic Stress Syndrome predicted in July that "the wars in Afghanistan and Iraq are the most sustained combat operations since the Vietnam War, and initial signs imply that these ongoing wars are likely to produce a new generation of veterans with chronic mental health problems associated with participation in combat."

Katz said he is well aware of the trend, and is working to make sure the VA is prepared to serve veterans who need help.

"Mental health is important and retiring veterans have great mental health needs," Katz said.

Contact staff writer Joe Beck at (760) 740-3516 or jbeck@nctimes.com. Read more!

Mental-health advocates hope to halt ‘horror cycle’ - Pueblo (CO) Chieftan

With the Halloween season under way, mental health advocates have a simple request:

Scare people with ghouls and goblins. Fill your haunted house with trapdoors and tombstones. But leave out the ‘‘psychiatric wards,’’ the ‘‘insane asylums’’ and the bloodthirsty killers in straitjackets.

Such themes, which have become as much a part of Halloween as pumpkins, reinforce negative stereotypes and a stigma that discourages people from seeking treatment, say activists who wage a yearly fight to remove the images from holiday events.

‘‘It’s our annual Halloween horror cycle,’’ said Bob Carolla, spokesman for the National Alliance on Mental Illness. ‘‘The cases vary by size and level of offensiveness, but for some reason, this year has been worse than most.’’

So far, word of about 10 particularly egregious attractions has reached the Arlington, Va.-based organization.

The group’s protests have had some effect. The Wheaton, Ill., Jaycees last week scrambled to change the theme of their haunted house from ‘‘Insanitarium’’ to something more generic. They retooled an ‘‘electroshock therapy’’ scene into an electric chair; posters and ads touting the theme were quickly pulled; apologies were issued.

Others have not been as receptive, including organizers of an asylum-theme house in Murfreesboro, Tenn., and Paramount’s Kings Island, a popular amusement park outside Cincinnati that is touting its ‘‘PsychoPath’’ - an outdoor trail of fright.

In Provo, Utah, a newspaper recently ran an impassioned editorial to ‘‘Bring Back Haunted Castle,’’ a seasonal fixture at a state hospital that used actual patients as performers before being shuttered almost a decade ago.

‘‘A far more evil force cast the monsters out - political correctness,’’ wrote the Daily Herald, noting that proceeds benefited the patients’ recreation fund.

Most readers who responded were in favor of resurrecting the attraction, despite a NAMI drive ‘‘to sway the vote,’’ according to editorial page editor Donald Meyers.

Some observers attribute the connection between the scary holiday and psychiatric disorders to the popularity of the 1978 movie ‘‘Halloween,’’ in which an escaped killer - institutionalized since childhood - goes on a violent rampage. Others say such imagery goes back centuries to medieval times.

Whatever the reason, the depictions are harmful, activists say. Criticizing such themes isn’t about semantics or being humor-impaired, they add, but about calling attention to a public health issue.

According to a U.S. Surgeon General report, stigma remains one of the greatest barriers to mental health care. Next month, several groups - including the Substance Abuse and Mental Health Services Administration - will launch a first-ever national campaign to stamp out stereotypes that rarely extend to other ailments.

‘‘It’s hard to imagine a cancer patient losing her wig as a source of amusement for patrons,’’ Carolla said.

NAMI regularly sends a ‘‘Stigmabusters’’ alert that flags hurtful representations of brain-based disorders to 20,000 subscribers. Many such instances arise out of ignorance, not maliciousness, NAMI says, and members hope to change attitudes by contacting the offenders.

Halloween may be the biggest nightmare for advocates, but deflecting jabs at the mentally ill requires year-round vigilance.

Targets of complaints have ranged from Nestle USA (for Tangy Taffy flavors such as ‘‘Psycho Sam’’) to the Vermont Teddy Bear Co. (makers of a straitjacketed ‘‘Crazy for You’’ cub for Valentine’s Day).

The headline a New Jersey newspaper put on a 2002 story about a fire in a psychiatric hospital - ‘‘Roasted Nuts’’ - was ‘‘particularly unfortunate,’’ Carolla said. But it also resulted in a series on mental health topics the following year. Read more!

Mental health advocates plan new tax pitch - Columbia (MO) Daily Tribune

Education seen as key after resounding defeat.

By JACOB LUECKE of the Tribune’s staff
Published Monday, October 23, 2006

Proponents of a local mental-health tax say if the oft-delayed measure is ever going to pass, Boone County residents must first understand why it’s needed.

The Boone County Mental Health Board has been back at the drawing board since 1994, when a resounding 72 percent of Boone County voters defeated the proposed tax. Several times the board has backed away from bringing the tax back for a second vote.

Board members’ current thinking is that local voters must understand the county’s mental health needs before they will approve a tax.

Helping people comprehend the depth of the county’s mental health-care deficit is the goal of a Boone County Mental Health Board forum at 6 tonight in the commission chambers of the county government center.

Children’s needs were cited as a substantial problem in a 2004 Boone County Mental Health Needs Assessment. The report estimated that 21 percent of Boone County children between age 9 and 17 experience a mental disorder such as substance abuse or emotional disturbance. More than half of those youths will experience an impairment that hampers their social, emotional or academic lives.

"We need to get that information out to the community," said board secretary Elaine Larson, a psychology resident at Fulton State Hospital.

At the forum tonight, Larson said, people involved with mental health care in Boone County will discuss the needs outlined in the 2004 assessment and how they have increased over the past two years.

"We’re going to be talking about current needs that have now come to the forefront because of budget cuts to the state," Larson said.

Since the General Assembly authorized counties to levy property taxes for mental-health needs in 1990, voters in 11 Missouri counties have given the tax a thumbs up, said Rita McElhany, community development manager for the Missouri Department of Mental Health.

She said the tax has a better chance of passing when people fully comprehend the needs in their community.

"In some counties it takes multiple attempts," McElhany said. "It really just depends on how well the community understands the need - whether they understand the need and whether they see the tax as a viable solution."

McElhany said mental illness is not a foreign concept for most people.

"Most people are impacted by mental illness in that they know someone with mental illness or they see someone struggling with mental illness in their workplace," she said. But people need to understand that mental-health needs spread beyond their single acquaintance, she said, as almost everyone knows a person dealing with mental illness. Read more!

Connecticut Holding Electronic Town Hall Meeting on Mental Health Initiative - Govtech.net

Connecticut Holding First Electronic Town Hall Meeting on Mental Health Initiative

Connecticut will use cyberspace this week to reach citizens across the state in a first-ever Electronic Town Hall Meeting on the quality and availability of mental health services.

The live, interactive, and web-based videoconference will be held Thursday October 26 to receive citizen input into the five-year, $13.7 million federal/state effort to transform the delivery of mental health services in the state. Citizens will be able to view the webcast, log onto the internet to ask a question, or attend a Town Hall meeting in person at any of seven locations across the state. Information is available the state Web site.

"The state is reaching out to help citizens speak up on the systems supporting the state's delivery of mental health services," Governor M. Jodi Rell said. "This is a unique opportunity to provide feedback and insight into this ongoing collaborative effort to improve the quality of care and services in Connecticut."

Connecticut is one of only seven states chosen for this grant, announced by Governor Rell in September 2005. Over the past year, seven workgroups with representatives from 14 state agencies and the Judicial Branch, consumers and family members, state and private providers and other key stakeholders have collaborated to develop 48 key areas of focus and have issued these key strategies for action over the next year:
Prevent suicide and increase mental health awareness through health education in schools
Give individuals and families a voice regarding mental health care services through a universal feedback tool
Identify and eliminate mental health disparities through standardized data collection
Expand access to prevention, screening, early intervention and treatment by maximizing state and federal dollars
Prevent youth from becoming involved in or having repeated involvement in the juvenile justice system through the use of evidence-based practices
Provide Connecticut citizens with a first of its kind comprehensive mental health Web site to improve access to mental health information and resources
Expand and enhance mental health training throughout Connecticut's workforce
Protect and enhance the rights of persons with mental illness.
Dr. Thomas Kirk, Commissioner of the state Department of Mental Health and Addiction Services, stated "Citizens can participate either onsite or online. We ask that citizens pre-register for the event, review materials online prior to the webcast, and present recommendations and responses either onsite or online on the 26th."

For those unable to participate, the webcast will be available online during the month of November.

The goal of the $13.7 million, five-year transformation initiative, awarded by the federal Substance Abuse and Mental Health Services Administration (SAMHSA), is to offer services and support. Read more!

A New Pathway To Mental Health - Eugene (OR) Register-Guard

By Andrea Damewood
The Register-Guard

As psychological health experts nationwide call for sweeping reform in the treatment of mental illness, one area program's workers think they have found the path to lead clients toward a successful recovery.

The Laurel Hill Center, which provides social services, employment and recreation for mentally ill adults, decided that after 34 years operating its flagship program, Harmony House, it was time for a change.

"The Harmony House just kind of ran out of gas," Laurel Hill Center Executive Director Mary Alice Brown said. "With changes in funding and new knowledge in the field, we wanted to try a new approach that really focused on people helping each other and on individual strengths."

So in July, the Harmony House closed its doors and Pathways, a new peer-directed program, began blazing a fresh trail.

The traditional top-down model of diagnosis and medication, with little in the way of self-improvement, serves to isolate adults with mental illness and may make symptoms worse, Brown said.

While the Harmony House was a great social outlet, patrons often would just sit alone on couches or play dice in small groups, she said.

Pathways, however, offers a daily schedule full of learning and wellness activities, all in a welcoming, window-lit room at the Laurel Hill Center, 2145 Centennial Loop.
"Harmony House was cutting edge 30 years ago," Pathways Coordinator Tina Larson said. "I think Pathways is now on the leading edge."

Classes include money management, beginning Spanish, and breathing and stretching. Many are led by members.

In that spirit, the staff was cut from nine positions to one full-time coordinator and one part-time assistant coordinator. Pathways is instead directed by a six-member advisory committee made up of clients that steers the program.

"I've done things on the Pathways committee that I never thought I'd do," committee member Randy Gudeika said. "We were asked to help in the hiring process. I found that was very empowering."

Pathways has served 236 clients since its inception in July. Pathways clients often hear about the program from other social services, doctors or by word of mouth, Larson said. The $40,955 it received this year from the United Way provides about 40 percent of its budget.

Peer support, coupled with the expectation that all members learn at their own pace, has completely changed the way some Pathways participants address their futures.
"This is a different approach that says, `Yeah, you have a mental illness, but it doesn't have to define your life,' " Brown said.

Paul Manion said that before he began to suffer symptoms at age 23 that were a combination of schizophrenia and bipolar disorder, he studied math and economics at the University of Oregon and the University of Texas. Then came a major breakdown, and he said he lost all confidence in his abilities.

"All of the people here had dreams and goals that they built their life on, and it was destroyed (by mental illness)," Manion said. "Many don't want to take the risk of having it destroyed again."

Pathways helps patrons see their illness as an interlude, rather than an ending, Brown said. Teaching them to recognize signs of oncoming episodes is a way to achieve stability.

Manion hosts a weekly group at the center called "Around the Water Cooler with Paul," where about seven other members join him to discuss current events. Now 54, he has gone back to Lane Community College and taken every math class except advanced calculus.

"I just went to my first public event in years. ... I'm even considering joining a men's group," said Manion, who has also discovered a love for poetry at Pathways. "The only problem with Pathways is that it encourages you to dream even bigger." Read more!

Changes needed in state's mental-health care system - Lincoln (NE) Journal Star

Local View: BY PATTY McGILL SMITH
Sunday, Oct 22, 2006 - 12:13:00 am CDT

I was saddened and surprised that the Nebraska state officials were “shocked” to learn of deficiencies in services to 370 residents at the Beatrice State Developmental Center (BSDC). This is home to 370 of Nebraska’s most vulnerable citizens.

Even though federal officials said immediate concerns had been addressed, the center is under grave threat by the federal government to lose $25 million in support for people if the state doesn’t improve its services. The state failed seven of eight requirements to operate. There were three instances of residents being in “immediate jeopardy.”

The report provides accounts of injuries to people being of “unknown origin” and no system to track or trend injuries of unknown origin. Verbal abuse, sexual assaults and lack of response to timely reporting are included in the report.

This is totally unacceptable! Where are the safeguards and supervision to provide for the safety, welfare, civil and human rights of people who live in this state-owned institution?

The officials are shocked. How must the parents and guardians of people with developmental disabilities who reside at BSDC have felt when they read the reports in the paper? To the best of my knowledge, no one was warned about the problems that existed and that this report was coming out.

For those of us involved in the support of people with developmental disabilities statewide, either as workers or advocates, we were dismayed and appalled.

Something has to change. Across the nation, so much has been done in working to solve the problems of failing institutions. From the Braddock Report of 2005, there were 139 completed and in-progress closures of state-operated institutions in 39 states. Seven states and the District of Columbia have closed all institutions under their purview. Another nine states are in the process of complete closure.

During the years while other states have been solving problems, Nebraska has kept the census of BSDC around 400. The budget for BSDC is more than $50 million, with an average of $130,000 per resident. At the same time, the costs keep spiraling upward, while the need for support in the community grows. Currently, there are 1,388 people waiting for services.

How can we best support people with developmental disabilities in a more cost-effective manner and in a way that provides a higher quality of life? Other states have responded by providing more options for supports and services. Those states are rebalancing their institutional care and community-based services while still providing the necessary and vital services for each individual. We need more options for types of supports and services.

The federal government has urged “rebalancing” of the funding for services. In order for that to happen, some very challenging decisions need to be made. Across the United States and around the world, the use of institutions has been reduced and in many places eliminated.

We all need to work together to help solve this very difficult problem. We need more independent oversight and greater accountability from our government. We need to make sure our citizens are safe and well cared for in the least restrictive environment.

Patty McGill Smith of Omaha is president of The Arc of Nebraska.
Read more!

Mental health advocates plan new tax pitch-Columbia Daily Tribune

Mental health advocates plan new tax pitch
Education seen as key after resounding defeat.

By JACOB LUECKE of the Tribune’s staff
Published Monday, October 23, 2006

Proponents of a local mental-health tax say if the oft-delayed measure is ever going to pass, Boone County residents must first understand why it’s needed.

The Boone County Mental Health Board has been back at the drawing board since 1994, when a resounding 72 percent of Boone County voters defeated the proposed tax. Several times the board has backed away from bringing the tax back for a second vote.

Board members’ current thinking is that local voters must understand the county’s mental health needs before they will approve a tax.

Helping people comprehend the depth of the county’s mental health-care deficit is the goal of a Boone County Mental Health Board forum at 6 tonight in the commission chambers of the county government center.

Children’s needs were cited as a substantial problem in a 2004 Boone County Mental Health Needs Assessment. The report estimated that 21 percent of Boone County children between age 9 and 17 experience a mental disorder such as substance abuse or emotional disturbance. More than half of those youths will experience an impairment that hampers their social, emotional or academic lives.

"We need to get that information out to the community," said board secretary Elaine Larson, a psychology resident at Fulton State Hospital.

At the forum tonight, Larson said, people involved with mental health care in Boone County will discuss the needs outlined in the 2004 assessment and how they have increased over the past two years.

"We’re going to be talking about current needs that have now come to the forefront because of budget cuts to the state," Larson said.

Since the General Assembly authorized counties to levy property taxes for mental-health needs in 1990, voters in 11 Missouri counties have given the tax a thumbs up, said Rita McElhany, community development manager for the Missouri Department of Mental Health.

She said the tax has a better chance of passing when people fully comprehend the needs in their community.

"In some counties it takes multiple attempts," McElhany said. "It really just depends on how well the community understands the need - whether they understand the need and whether they see the tax as a viable solution."

McElhany said mental illness is not a foreign concept for most people.

"Most people are impacted by mental illness in that they know someone with mental illness or they see someone struggling with mental illness in their workplace," she said. But people need to understand that mental-health needs spread beyond their single acquaintance, she said, as almost everyone knows a person dealing with mental illness.
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Connecticut Holding First Electronic Town Hall Meeting on Mental Health Initiative-Government Technology

Connecticut Holding First Electronic Town Hall Meeting on Mental Health Initiative

Oct 23, 2006 News Release

Connecticut will use cyberspace this week to reach citizens across the state in a first-ever Electronic Town Hall Meeting on the quality and availability of mental health services.

The live, interactive, and web-based videoconference will be held Thursday October 26 to receive citizen input into the five-year, $13.7 million federal/state effort to transform the delivery of mental health services in the state. Citizens will be able to view the webcast, log onto the internet to ask a question, or attend a Town Hall meeting in person at any of seven locations across the state. Information is available the state Web site.

"The state is reaching out to help citizens speak up on the systems supporting the state's delivery of mental health services," Governor M. Jodi Rell said. "This is a unique opportunity to provide feedback and insight into this ongoing collaborative effort to improve the quality of care and services in Connecticut."

Connecticut is one of only seven states chosen for this grant, announced by Governor Rell in September 2005. Over the past year, seven workgroups with representatives from 14 state agencies and the Judicial Branch, consumers and family members, state and private providers and other key stakeholders have collaborated to develop 48 key areas of focus and have issued these key strategies for action over the next year:

* Prevent suicide and increase mental health awareness through health education in schools
* Give individuals and families a voice regarding mental health care services through a universal feedback tool
* Identify and eliminate mental health disparities through standardized data collection
* Expand access to prevention, screening, early intervention and treatment by maximizing state and federal dollars
* Prevent youth from becoming involved in or having repeated involvement in the juvenile justice system through the use of evidence-based practices
* Provide Connecticut citizens with a first of its kind comprehensive mental health Web site to improve access to mental health information and resources
* Expand and enhance mental health training throughout Connecticut's workforce
* Protect and enhance the rights of persons with mental illness.

Dr. Thomas Kirk, Commissioner of the state Department of Mental Health and Addiction Services, stated "Citizens can participate either onsite or online. We ask that citizens pre-register for the event, review materials online prior to the webcast, and present recommendations and responses either onsite or online on the 26th."

For those unable to participate, the webcast will be available online during the month of November.

The goal of the $13.7 million, five-year transformation initiative, awarded by the federal Substance Abuse and Mental Health Services Administration (SAMHSA), is to offer services and supports that are culturally responsive, person and family-centered, and have as their primary aim the promotion of resilience, recovery and inclusion in community life for any Connecticut citizen and family impacted by mental illness.

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Living with a mentally ill child strains family's resources, sanity-The New York Times

Number of such kids has tripled since the early '90s, U.S. says
For story link, video and other contact, click here

By PAM BELLUCK

PLYMOUTH, Mass. — When Haley Abaspour started seeing things that were not there — bugs and mice crawling on her parents’ bed, imaginary friends sitting next to her on the couch, dead people at a church that housed her preschool — her parents were unsure what to think. After all, she was a little girl.

“I thought for a long time, ‘She’s just gifted,’ ” said her father, Bejan Abaspour. “ ‘This is good. Don’t worry about it.’ ”

But as Haley got older, things got worse. She developed tics — dolphin squeaks, throat-clearing, clenching her face and body as if moving her bowels. She heard voices, banging, cymbals in her head. She became anxiety-ridden over run-of-the-mill things: ambulance sirens, train rides. Her mood switched suddenly from excitedly chatty to inconsolably distraught.

“It’s like watching ‘The Sound of Music’ and ‘The Exorcist’ all at the same time,” Mr. Abaspour said.

For her family, life with Haley, now 10, has been a turbulent stream of symptoms, diagnoses, medications, unrealized expectations. Diagnosed as a combination of bipolar disorder with psychotic features, obsessive-compulsive disorder, generalized anxiety disorder and Tourette’s syndrome, her illness dominates every moment, every relationship, every decision.

Haley’s fears, moods and obsessions seep into her family’s most pedestrian routines — dinnertime, bedtime, getting ready for school. Excruciating worries permeate her parents’ sleep; unanswerable questions end in frustrated hopes.

“The first time we took Haley to the hospital, I guess I expected that they would put it all back together,” said her mother, Christine Abaspour. “But it’s never all back together.”

At least six million American children have difficulties that are diagnosed as serious mental disorders, according to government surveys — a number that has tripled since the early 1990’s. Most are treated with psychiatric medications and therapy. The children sometimes attend special schools.

But while these measures can help, they often do not help enough, and the families of such children are left on their own to sort through a cacophony of conflicting advice.

The illness, and sometimes the treatment, can strain marriages, jobs, finances. Parents must monitor medications, navigate therapy sessions, arrange special school services. Some families must switch neighborhoods or schools to escape unhealthy situations or to find support and services. Some keep friends and relatives away.

Parents can feel guilt, anger, helplessness. Siblings can feel neglected, resentful or pressure to be problem-free themselves.

“It kind of ricochets to other family members,” said Dr. Robert L. Hendren, president-elect of the American Academy of Child and Adolescent Psychiatry. “I see so many parents who just hurt badly for their children and then, in a sense, start hurting for themselves.”

Ms. Abaspour, 39, struggles to master the details of Haley’s illness, to answer her obsessive questions, to keep her occupied. Mr. Abaspour, 50, who long believed that “Haley was going to grow out of it,” has been gripped by anxious thoughts and intrusive images that rattle him to tears on the hourlong commute to his job as an anesthesia engineer at a Boston hospital. He imagines people being crushed by trucks, someone hurting Haley, his own death.

Haley’s sister, Megan, 13, has been so focused on Haley and determined not to add to her family’s burden that in June, after a quarrel with her parents, she tied a T-shirt around her neck in a suicidal gesture.

“I feel like she gets all the problems and I feel like I have to take some of that off of her,” Megan said. “It’s really difficult a lot to try to stay away from babying her and helping her. I try to stay still but it just hurts, it hurts inside.”

Haley, with her shy smile and obsidian eyes, is increasingly aware of her own problems, although she cannot always express exactly what is going on inside. “My mind says I need some help” is the way she explained it recently.

Her illness has caused great financial strain; although the Abaspours have health insurance, they have been forced to draw on their savings and lean heavily on their credit cards for living expenses. Still, they have bought a trailer in a New Hampshire campground because there Haley finds occasional solace, and relatives nearby understand the family’s ordeal.

The family wrestles with deciding whom to tell about Haley’s illness, and what to say. Her worst symptoms are most visible at home and less apparent at the public school and the state-financed therapeutic after-school program she attends. Her parents say she works hard to hold herself together during the day and then later, feeling more comfortable with her family, falls apart.

This disparity in behavior is not uncommon, said Dr. Joseph A. Jackson IV, Haley’s psychiatrist, and “parents often get the brunt.”

Because of the contrast in Haley’s public and private behavior, her parents are wary of telling people that she is mentally ill, as they might not notice.

“I don’t want anybody to pity her,” Mr. Abaspour said. But they also get frustrated when teachers or relatives play down the seriousness of Haley’s illness, or conclude that she is being manipulative or that another child-rearing approach would help.

In the middle of last year, for example, a teacher did not understand Haley’s need to leave the classroom to quiet the voices or relieve anxiety. Haley grew so frustrated that she “would sit there in her chair and cry,” her father said. The parents pressed school officials to switch her to another class.

“We’re sick and tired of trying to prove it to people,” Ms. Abaspour said.

Her husband added, “Everybody thinks they have the solution. When Joe Schmo comes over for a drink, he says, ‘Try this, this will work.’ No, it won’t.”

Visions and Voices

From birth, it was clear that “I was dealing with something different,” Ms. Abaspour said. Displaying a photo album with picture after picture of Megan all smiles and Haley “crying, crying, crying,” she added, “We just thought we had a very difficult child.”

Yet exactly what was wrong puzzled them for years, and even now, Ms. Abaspour said, “Every day it’s something new, I swear.”

While increasing awareness of childhood mental illness has helped many children and families, it can also create a misimpression that everything can be treated, said Dr. Glen R. Elliott, chief psychiatrist at the Children’s Health Council, a community mental health service in Palo Alto, Calif., and the author of “Medicating Young Minds: How to Know if Psychiatric Drugs Will Help or Hurt Your Child.” That can make families with complex cases feel “either genuine confusion or pretend certainty,” Dr. Elliott said.

The Abaspours decided to speak with a reporter about Haley’s illness and its impact on their family because they hoped it would help other families and make society more hospitable for children like their daughter. Talking about it was sometimes emotional, especially for Mr. Abaspour, whose eyes often clouded with tears. But they also said they found it useful to articulate their feelings.

When Haley was 3 or 4, a pediatrician blamed tonsillitis-induced sleep apnea, predicting that after her tonsils were removed, “ ‘you’ll see a totally different child,’ ” Ms. Abaspour recalled.

“We thought, ‘This is what is wrong with our child. This is our answer,’ ” she said. Preschool teachers suggested a learning disability. Later, Haley repeated first grade. The Abaspours consulted therapists about the visions of friends in the liner of the family’s pool and riding with Haley on her bike, and the voices criticizing her or telling her to touch a certain table. When a neurologist ruled out medical causes like Lyme disease, Ms. Abaspour recalled, her husband said, “I think we should just give her a placebo — it’s all in her head.”

They got a cat, “though we weren’t cat people,” Ms. Abaspour said. Then they got another because the first was “not the type of cat that Haley could throw over her shoulder and squeeze.”

New symptoms kept emerging. For a while, when she was about 7, the voices “were telling her she was a boy,” Ms. Abaspour said. “She had to constantly prove to them that she wasn’t.”

Haley became obsessed with penises, which she called “bums.” She claimed to see them though she was looking at fully clothed men and boys, her mother said. “Then she felt guilty. She would come up to me and whisper, ‘I saw his bum, I saw his bum.’ The bus driver or the little boy, anyone. It was constant.”

To halt the whispering, Ms. Abaspour suggested that they share a private signal: Haley could flash a thumbs-up after a sighting. Haley also seemed preoccupied with death, and on a highway would say that voices told her, “If that license plate didn’t say such and such, she was going to die,” her mother said.

Once, Mr. Abaspour recalled, Haley “kept yelling that she wants to start over.”

The Treatment Puzzle

When she was almost 8, Haley visited Dr. Jackson at his office at the Cambridge Health Alliance. He was struck by the results of a screening: Haley met full criteria for virtually every mental disorder listed.

“Her symptoms,” he said, “suggested anxiety, morbid thoughts, obsessions possibly of a sexual nature, frequent fluctuations in mood, periods of euphoria, giddiness, irritability, rapid speech, auditory and visual hallucinations, thought disorganization, vocal tics, distractibility, poor socialization in school, sensory integration issues, attention impulse disorder, manic behavior, sleep disturbance.”

Dr. Jackson wondered if the voices and the friends, which Haley told him were “nowhere but everywhere,” were schizophrenic-like hallucinations or milder thought distortions.

He also saw Haley’s mood swing from anxiety about a “disturbing dream in which her mother was killed” to euphoria, as she gleefully drew a large, brightly colored butterfly and a self-portrait with a too-big smile and a skirt that ballooned as if she were floating. The pictures, he said, “scream” manic sensibility, suggesting bipolar disorder.

Dr. Jackson prescribed an antipsychotic, Risperdal, one of a dozen drugs Haley would try. Some helped initially, but the voices returned or side effects developed.

Huge pills or bad-tasting liquid made Haley gag or throw fits.

“It was horrible, horrible, horrible,” her mother said, “and she’d pull us into it because we had to make her take it.”

Lithium caused weight gain: clothes that fit her one day no longer did the next.

When Haley was 81/2, Mr. Abaspour said, “Let’s drop all of these medications and see what happens.” He said, “I wanted to see her true self.”

The results chastened them. “You see her fine one day,” Mr. Abaspour said. “The second day comes and she’s fine and you say, ‘You see, honey, there’s nothing wrong with her.’ Then it’s the third day and she goes crazy and you feel like an idiot.”

Haley resumed taking Risperdal. Then, abruptly, her condition worsened.

“She couldn’t function, she couldn’t go to school,” said Ms. Abaspour, who took Haley to a hospital; she had to handle the crisis with her husband away in London.

In the emergency room, Haley was manic and hyperarticulate, Ms. Abaspour recalled. “I was a basket case.”

When Mr. Abaspour returned and saw Haley “like a zombie” in a hospital full of out-of-control children, his first reaction was, “She can’t be in here.”

But the eight-day hospital stay made him grasp the severity of her illness.

“You look at an X-ray and you say it’s a fracture,” he said. “But this thing. ... Before then, there wasn’t solid evidence.”

A year later, school halls “would get scary because the voices would get louder,” so Haley constantly visited the school’s nurse and psychologist, her mother said. “She was going out of her mind.”

Haley was hospitalized again, and another antipsychotic drug, Abilify, muffled the voices.

“I remember thinking, ‘Am I supposed to be happy about this?,’ ” Ms. Abaspour said. She was grateful that something helped but distressed at the suggestion that Haley was psychotic. The Abilify has not soothed Haley’s anxiety or stopped her outbursts. And despite increases in the dosage, back are the voices (four boys and a girl), the tics (eye squinting and hand clenching) and the “bums.”

Dr. Jackson, her psychiatrist, said Haley’s biggest asset was her “very caring family” that was “seeking ways to shore themselves up” to better help her.

Ms. Abaspour said: “We ask ourselves sometimes, ‘Why? Why did it happen to us?’ Other times we see a child bald, going through chemotherapy. That’s the thing about this — it’s on the inside, you can’t see it.”

Megan’s Heartache

I pretend no one is around me when my sister is there.

I feel a constant hurt inside.

I touch a rainbow of joyfulness in my mind when my sister and I are FINALLY having a fun laugh together.

I worry that when one day I die, I won’t be there to help my sister.

I cry to the stars, pleading them to take me away from this madness at mind.

Megan’s sixth-grade writing assignment was to write a poem called “I Am.”

Virtually every line was about Haley.

Megan wrote of love, frustration, obligation, pain, embarrassment. Eighteen months later, those feelings erupted.

Told to do dishes before calling a friend, Megan felt that the chore should be Haley’s and stormed to her room. When her father said it was Megan’s responsibility, “I really got mad and slammed the door,” she recalled. “He came and ripped my phone right out of the wall.”

That was unusual for Mr. Abaspour, usually gentle or quietly humorous.

“I tried not to say something that would hurt her,” he said. “And definitely not to touch her. So I took it out on the phone.”

Megan said her reaction was, “Why should I live?”

“I took a T-shirt and I put it around my neck,” she said. “Then I said, ‘No I shouldn’t do this. I want to live but I don’t know another way out.’ ”

Siblings of mentally ill children often have such feelings, experts said.

Ten days of treatment helped Megan understand that “I felt pretty much like I was another mom for Haley,” she said.

The Abaspours, who always gave Megan positive attention, were stunned. But Ms. Abaspour said she might have unconsciously been relieved that Megan could get Haley to laugh, or in other ways “take a little attention off me.”

For Megan, a doctor prescribed Prozac, but she became edgy and the suicidal thoughts continued.

“When I’m doing dishes and I see a knife there, my mind’s like, ‘Pick up the knife and kill yourself,’ ” Megan said. “I kind of just think, ‘Would things be easier without me?’ ”

Now she has stopped taking medication and is seeing a psychiatrist. Her parents are encouraging her to focus more on herself. She realizes, she said, “I’m important.”

Still, trying not to help Haley is hard. “I don’t really feel the pain that she feels,” Megan said, “but I feel that I should to make it even between us.”

Haley’s mother calls it “the ongoing search” — Haley’s obsessive quest for novelty and for objects to hold or to stroke over her touch-sensitive skin.

“I need something to calm me down so I can learn how to end my frustration,” Haley said. “I just get, like, sometimes, mad. I need to, like, hold it or hug it or just play with it.”

She and her family search through stores, scavenge through her crawlspace storage area and her bedroom full of Beanie Babies, toy cars, dolls. Megan said she sometimes offered her own belongings for Haley, thinking, “if I get excited about it she’ll decide it’s the right thing.”

But, Ms. Abaspour said, “she’s never satisfied.” Because her parents sometimes brush the hair on her arm with a surgical brush from Mr. Abaspour’s hospital, the family’s therapist recently suggested getting a soft lambskin.

Haley fixated on buying one, always asking as if it were a new thought: “Oh my God, you know what just came to mind? If I get that animal fur...”

Megan found her a faux shearling vest to stroke instead, but Haley exploded.

“I wanted Megan to find something like that animal fur,” she wailed, convulsing and weeping.

Anguished as he watched her, Mr. Abaspour said: “This is the point of no return. She’ll scream and cry and kick. If the neighbors could hear, they would think we were abusing the kid.”

Haley refuses to be consoled or touched, all the while saying, “Please help me, please make it stop, please make it go away,” her mother said. The Abaspours look on helplessly or send her to another room.

Haley’s eruptions, often 20 minutes long, occur almost daily, especially in the evenings. They often begin with Haley revved up.

Before the lambskin incident, for example, she marched around, chatting giddily about camp: “Today, today, today, we, um, instead of two periods of the game thingies, they call it sessions, periods, each session or whatever, we went to the picnic tables and we all went to the picnic tables and it was really fun.”

Haley’s parents struggled to track her unspooling sentences and scrambled thoughts.

“Did you follow the bouncing ball?” Ms. Abaspour asked her husband, who replied, “I don’t even see the ball, honey.”

Haley sighs, frowns and fidgets, eyes drooping before she falls apart. Sometimes she hyperventilates or crawls under a table. It always ends with crying, but sometimes she will start to laugh through her tears, becoming “all chipper again, like manic,” Mr. Abaspour said.

Adds Ms. Abaspour: Later, “she says, ‘I’m sorry, I’m sorry,’ apologizing for who she is.” Her father said: “It’s not like a hurt that you can kiss better. It comes from within, and she doesn’t know why, and you can’t do anything about it.”

A Mother’s Stoicism

Christine Abaspour, the youngest of four girls raised by a divorced mother, knew what she wanted early in life. At 19, she left Massachusetts, joined a sister in Florida and became a waitress. At 25, she met her husband-to-be, who was 11 years older. She was engaged in two weeks, married in nine months and a mother a year later.

“We both wanted to have children right away, like you wouldn’t believe,” she recalled.

Ms. Abaspour said that she had no regrets, and that Haley “was given to us for some reason, and I keep waiting for the day when I realize why.”

Still, the experience has tested her stamina, and she avoids capitulating to Haley’s whims and outbursts by imposing structure, consistency, even distance.

“I’m her mother,” Ms. Abaspour said. “I try to make it a better world for her, a more comfortable world. I stay very strong for her and very encouraging for her. If she comes out of a meltdown, I’ll say, ‘I knew that you could.’ I don’t make her feel totally hopeless. It doesn’t give me any satisfaction, though, because I still feel helpless. Unfortunately it just bites you in the face all day long.”

Ms. Abaspour’s stoic approach, which her husband appreciates but cannot always emulate, is “a good coping skill for parents,” Dr. Elliott, of the Children’s Health Council, said. “It’s what happens to a family system when you’ve got a source of chaos in the middle of it.”

After getting Haley ready for school, Ms. Abaspour feels she has already lived an entire day. In the afternoon, “Haley walks in the door and I just want to hold her and give her a big kiss like most kids,” Ms. Abaspour said. “Instead I get a frown and tears and ‘Ooh, I had such a stressful day.’ ”

She said that every evening, a distraught Haley will “say to me her same 12 questions: ‘What’s going to happen when I need to go to school and I can’t leave the classroom?’ or ‘What do I have to look forward to today?’ ”

By bedtime, Ms. Abaspour said, “your heart’s just breaking.”

To slake Haley’s thirst for “something to do,” Ms. Abaspour keeps her involved in activities outside of school. Otherwise, the family ends up stopping for ice cream or concocting other outings, because unstructured time allows Haley to focus on the voices and anxiety. “Staying home is not an option,” Ms. Abaspour said. “Honestly I could not keep her busy. Sometimes being around here on a Saturday or Sunday, it’s almost toxic. She has multiple episodes — it’s like living hell.”

Haley’s fears of noises, crowded streets and surprises force the Abaspours to forgo amusement parks, apple picking or other traditional family activities. When relatives visit “and you think it’s going to be relaxing and we’ll watch movies and eat popcorn — that doesn’t happen in this family,” Ms. Abaspour said.

Instead, there are mood cycles, as when Haley marched around announcing, “I’m going to make a really great art project,” then fell apart, wailing, “I don’t know what to do.”

Ms. Abaspour stays unflustered. When Haley bawled, “I don’t have any markers,” her mother replied, “Oh, don’t tell me you don’t have.”

But she found Haley a T-shirt to cut up and draw on, saying, “If I can get her to do that kind of chop, chop, chop, mark, mark, mark, it kind of brings her back.”

Ms. Abaspour said she had watched “everyone else in the family rush over to her, and I won’t become a part of that. I make her be responsible for her own feelings because I can’t be responsible for those. You still have to be a regular parent. Honestly, she has to learn to soothe herself.”

But Ms. Abaspour doggedly monitors Haley’s progress. This summer, she visited Haley at day camp and was dismayed that the child frequently declined to participate, asking for the nurse.

Sitting out the swim period one day, Haley, wearing a “Keep It Cool” T-shirt, listed her feelings on a worksheet: “stressed, axxouis, sick, shacky.”

At lunch, she mostly licked salt off pretzels. Asked to choose a word-card matching her emotions, she picked “overwhelmed.”

Ms. Abaspour worries that as Haley becomes a teenager, her poor social skills might get her “mixed up with the wrong kids” or lead her to use illegal drugs. So she arranges play dates, but if friends are unavailable “it’s the end of the world,” she said. If they are available, she said, Haley anxiously asks, “What do I say, Mommy?”

Ms. Abaspour was recently laid off from a medical assistant’s job. Her former co-workers understood her need to interrupt work to deal with Haley’s needs, she said, and “didn’t look at me and say, ‘Her child’s crazy.’ ” Now she fears she will not find an employer who is as tolerant, though the family needs the income. Haley’s illness, the Abaspours were dismayed to discover, does not qualify for disability assistance.

In August, Ms. Abaspour arranged an elaborate 50th-birthday surprise party for her husband. They were “not always on the same page” about Haley at first, she said, but their strong marriage helps her handle the strain.

So do bright spots, she said, like the day Haley “really kissed me.”

Still, she can get overwhelmed.

Sometimes she bolts awake at night, but she declines medication.

“I can’t climb in a shell and stay there forever,” she said, “although it seems like some days where I’d want to be.”

A Father’s Anxiety

As a young man, Bejan Abaspour worried, especially about family.

Twenty years ago, for example, when his sister’s son was born, “I pictured my nephew getting Super Glue in his eyes and I was calling my sister saying, ‘Make sure you keep Super Glue away from him.’ ”

But the worries were not that intense — until Haley’s illness. After that, the intrusive thoughts and images got worse, horrific scenes in which he imagines himself as bystander or thwarted rescuer. “I’ll be driving next to a semi tractor-trailer truck and all of a sudden I will picture someone getting crushed by the wheel,” he said. “It’s usually an older lady or a kid. You get them out from under the truck, but it doesn’t stop. I’m in the emergency room, trying to help. I’m at the funeral. Then very easily, the tears come.”

Mr. Abaspour said he sometimes pictured Haley “getting lost somewhere, or someone’s going to hurt her. I’m involved and trying to get the guy who did it to stop. Sometimes I kill him. Sometimes it doesn’t get that far.”

Other times, he said, he imagines his death, seeing his family “at the funeral home and I’m laying there. I try to see what’s going on at home, how Meggie’s reacting to my death, how Haley’s reacting, what Christine is going through.”

He rehashes things Haley has said, like wanting to “start over” or her question: “When I get really old, can I come back home? Will you be there?”

He wonders if his worrying laid genetic groundwork for Haley’s illness, “if I’m the cause of what Haley’s going through.”

Until recently, Mr. Abaspour, who also has trouble sleeping, told no one about his agonizing thoughts, not even his wife.

“I didn’t want to burden her,” he said. “I can handle it. So what if I’m driving to work and I cry? So what if I only sleep for four hours?”

But last spring, the family’s therapist noticed “I had certain problems,” he recalled. She encouraged him to tell his wife whenever he had disturbing thoughts. Mr. Abaspour said he hoped that confronting his own anxiety would help “get to the bottom of what Haley’s going through.”

He added, “It doesn’t matter for me, but for Haley.”

Families once kept illnesses like Haley’s quiet, afraid of being shunned or disparaged.

Public acceptance has grown, but some misperceptions and prejudice remain, and families feel conflicted: they want people to understand so the child can get appropriate help, but they also fear that Haley will be mocked or ostracized.

“If they keep it a secret then they’re bad parents,” Dr. Elliott said. “If they start spewing diagnoses, they’re subject to criticism because they’re not taking responsibility, just laying it on the illness. Or they’re social pariahs because there are some people who think that mental illness is contagious.”

Like other families, the Abaspours sometimes hesitate to publicly label their daughter mentally ill. But they also want people to know, and they get frustrated if people do not fully accept or understand it, or see her symptoms “as a manipulative thing, or they feel like they can fix it themselves, maybe by distracting her,” Ms. Abaspour said.

Her own family now understands and is very supportive, but it took some convincing, she said.

“My mother would say, ‘She’ll be fine, she’ll be fine, there’s nothing wrong with her,’ ” Ms. Abaspour said. “My sister says, ‘Well, she didn’t act like that when she was over here.’ ”

Mr. Abaspour has not told most of his family, who live in England, because they might worry excessively or not understand.

He told his sister, but “she was like I was when I first encountered the situation — disbelief or denial,” he said. His sister, he said, has not told her husband or her 20-year-old son, which created an odd atmosphere when they visited the Abaspours in August. “When Haley did have one of her little episodes, they were all like, ‘oh, oh,’ and they wondered why we weren’t running over to her,” Ms. Abaspour said. “I would like to talk to them more about it. If she had diabetes, they’d know she had diabetes.”

When, after reading a book for children with bipolar disorder, Haley said, “I can’t wait to go to school and tell everybody I’m bipolar,” the Abaspours were torn.

They discouraged her from announcing the diagnosis. But Haley did tell her classmates, “ ‘I have a lot of noise going on in my head and sometimes I feel anxious and sometimes I have to take a walk.’ ”

Some day, the Abaspours hope, Haley will have more effective drugs and better coping skills, and society will be more tolerant, so she can lead an independent life. But they have no illusions.

“This is not going away,” Ms. Abaspour said. Not for Haley or her family. “The overflow of what Haley has is what has made all of us what we are today.
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Money frozen to save Clubhouse -Hendersonville Times-News

Scott Parrott
Times-News Staff Writer

The agency that manages mental health care here says it will give no more money to New Vistas-Mountain Laurel unless the Sixth Avenue West Clubhouse is saved.

On Friday, the Western Highlands Board of Directors froze the remainder of $1 million it had set aside to help New Vistas-Mountain Laurel make ends meet through Oct. 31.

The chief executive officer for the dying agency said it must sell the clubhouse building, worth $700,000, to cover payroll, employee benefits and other debts. New Vistas-Mountain Laurel is the region's largest mental health care provider, with 700 employees and more than 10,500 patients in eight counties.

"Does this decision immediately thrust us toward bankruptcy? No, it does not," said Will Callison, the New Vistas CEO. "But it certainly is not contributing to our stability as we move toward the 31st of October."

Some of the $1 million has been spent. New Vistas already received $350,000. Western Highlands earmarked another $360,000 for liability insurance to cover New Vistas employees in case they are sued after the agency closes.

That leaves about $290,000 at stake. Western Highlands CEO Arthur Carder said New Vistas would receive the money if it turns over the clubhouse. The Western Highlands Board of Directors scheduled a special session Oct. 31 for an update on the negotiations.

Some fear the move could open the door to bankruptcy for New Vistas-Mountain Laurel. Bankruptcy would mean the fate of the clubhouse and other New Vistas properties would be put into the hands of a judge. The Western Highlands Board of Directors said it would call an emergency meeting if needed before Oct. 31.

New Vistas-Mountain Laurel has a $2 million monthly payroll and owes employees $450,000 in accrued paid time off, Callison said.

The conditions of the $1 million allotment are under debate.

Western Highlands board members say they set aside the money on the condition that some assets, including the clubhouse, would be treated as security. Carder said he expected New Vistas to transfer the clubhouse to Western Highlands, which would have then turned the title over to Henderson County.

Callison said Western Highlands did not seek to place any conditions on the $1 million until after the allocation was approved. He said the agency has no choice but to sell the building. Callison said the buyer would be required to lease the property to the clubhouse for three years at $6,000 a month.

A community-wide push is underway in Henderson County to buy the building on Sixth Avenue West near the Henderson County YMCA. County Commission Chairman Bill Moyer is working to negotiate a sale and raise money.

The Community Foundation opened a donation fund for the clubhouse, which has set up a new non-profit dubbed Sixth Avenue Psychiatric Rehabilitation Partners. Read more!

Future of New Vistas records in doubt - Asheville Citizen-Times

by Leslie Boyd, LBOYD@CITIZEN-TIMES.COM

ASHEVILLE — As New Vistas-Mountain Laurel Behavioral Health Services nears its closing date, officials are trying to decide what will become of the records for the more than 10,000 people who have received care there.

Will Callison, CEO of New Vistas, asked the board of Western Highlands Network at its regular meeting on Friday to take custody of the records when New Vistas closes Oct. 31. The records will need to be kept for at least 11 years. The records of children need to be kept for 11 years after the child turns 18. Western Highlands then would be authorized to grant access to the records.

“We can contract for the records to be kept, but the cost of that is $50,000, and then there’s a fee every time they’re accessed,” Callison said.

Arthur Carder, CEO of Western Highlands, said state officials have advised him not to take the records.

“I’m not sure we even have the space for all these records,” Carder said. He suggested the state could take them.

But child psychiatrist Dr. Gerald Travis said the records could become inaccessible if arrangements aren’t made, and that could make treatment or requests for disability payments and other government services more difficult.

“I was here when Charter (a psychiatric services hospital) closed,” Travis said. “Those records are all in a warehouse someplace and nobody can get at them.”

Consumers can request their own records. Those who already have a new services provider should get New Vistas records through the new provider. People who don’t have a new services provider can get their records directly from New Vistas. Requests need to be made before Oct. 31. Read more!

New programs cater to ex-cons with serious mental illness - AP

By ANGELA DELLI SANTI
Associated Press Writer

October 21, 2006, 9:08 AM EDT

TRENTON, N.J. -- Larry Lamb has lived a half-century of failures: three stints in state prison, four psych ward confinements, drug and alcohol abuse dating back to adolescence, and more time in county lockups than he can count.

Then a year ago, things changed. He began racking up successes.

Lamb, 50, hasn't had a drug-tainted urine sample since he enrolled in a program for mentally ill inmates as he was being released from jail. He's taking antidepressants, keeping appointments with his therapist, working when he can find a job and paying off court-imposed fines from his prior life of crime and homelessness. He's about to move into his first apartment, is re-establishing a relationship with his teenage son and hoping, one day, to find a mate.

"I knew I needed help," said Lamb, who traces his troubled and isolated life back to the day when he was 7 and he saw his 9-year-old brother get run over and killed by a truck. "I was willing to do anything."

Lamb is among the ex-inmates participating in programs for parolees with serious mental illness. The programs offer comprehensive services _ housing and job assistance, medication management, counseling and education _ aimed at keeping this high-risk, high-maintenance population from returning to jail or causing trouble out on the streets.

Until this year, the state didn't offer any services for the mentally ill once they left state prison. Nine of the state's 21 counties have some mental health services for such inmates who are about to be freed from county jail, though the assistance varies in scope, duration and intensity.

"The dilemma was, 'where do I put a person like this?"' said Kevin McHugh, director of community programs and grant management for the state parole board. "We don't want to keep them in jail, and the likelihood for them to fail on the outside was high."

The two pilot programs for inmates emerging from state prisons are run by separate groups and funded by different sources. But their missions are similar: to provide the best possible chance for mentally ill ex-cons to become independent and productive rather than be re-incarcerated. County-based programs like the one Lamb is in are also relatively new and strive for similar outcomes.

Providing services to mentally ill inmates is now standard. To settle a prisoner-generated lawsuit over a lack of psychiatric services on the inside, the state developed mental health programs to replace the less informed approach of segregating inmates whose psychiatric disorders made them disruptive.

Those services typically cease when an inmate leaves state custody, however, and ex-prisoners often relapse.

"People who have a serious mental illness _ bipolar, major depression, schizophrenia _ they're three times more likely to end up in prison or jail than in a state hospital. That doesn't make any sense at all," said John Monahan, CEO of Greater Trenton Behavioral HealthCare, the nonprofit that runs one of the new programs.

"We have to see to it that people who have serious mental illness get the help that they need so they don't wind up incarcerated and they get help before problems happen for them," Monahan said.

McHugh estimated that a quarter or more of state prisoners have serious mental illnesses, and Monahan said the percentage in county jails was probably one-third to one-half.

Monahan co-chaired a mental health task force commissioned by former Gov. Richard Codey that led to one of the pilot projects, PROMISE, or Program for Returning Offenders with Mental Illness Safely and Effectively, funded by the state and run by Volunteers of America in Camden.

That program operates on a shoestring $400,000 budget, providing up to six months of post-incarceration services to paroled inmates who have a history of criminal behavior related to untreated mental illness. The program began in the spring, now has 16 parolees and can accommodate a maximum of 30. So far, five people have completed the program, and two committed parole violations and returned to prison.

Monahan's project, called Coming Home, relies on state, county and grant funding to provide outreach services to state and Mercer County inmates. Counselors begin working with inmates three months before discharge to develop a plan for living on the outside. They'll continue to work with parolees until they are self-sufficient.

A three-year, $300,000 grant from the Robert Wood Johnson Foundation funds the portion of the project dealing with state prisoners. The money will pay for services for 60 state prisoners and underwrites efforts to amend state policy so such services are widespread and permanent.

Lamb, who is among the ex-Mercer County Jail inmates in Greater Trenton Behavioral HealthCare's Corrections Project, says his bond with counselor Anthony Towns is the reason for his success. But Towns, his counselor and mentor, insists Lamb is being modest.

"I haven't done anything more for Larry than I've done for any other client," Towns said. "In any therapeutic relationship, the client and the counselor should have some type of bond. Larry came to me with motivation to succeed. It just so happens that Larry connected with me."

Said Lamb: "I'd never let anyone get close to me before. I trust that man with my life." Read more!

Prison Mental Health Crisis Continues to Grow - APA

The report "Mental Health Problems of Prisons and Jail Inmates" is posted athttp://www.ojp.usdoj.gov/bjs/abstract/mhppji.htm

From the American Psychiatric Association

Federal support is needed to reverse the increasing "criminalization" of mental illness and drug addiction, according to APA and federal health officials.

A growing body of evidence demonstrates that the criminal justice system has taken over from the public health system as the destination for many with mental illness and addictions. That was the message delivered to members of Congress and their staffs last month at the annual Mental Illness Awareness Week event sponsored by APA and the National Alliance on Mental Illness (NAMI).

"With the reduction of psychiatric beds in past years, there is only one place that can't say `no' when you need someone kept away from society: the criminal justice system," said Richard Nakamura, Ph.D., deputy director of the National Institute of Mental Health.

Nakamura and others cited statistics such as those from 1996 research by Linda Teplin, Ph.D., that found that 1 million, or 8 percent, of jail bookings annually involve persons with severe mental illness. A more recent study of the Chicago jail found that 6 percent of males and 12 percent of females entering the system had severe mental disorders, including schizophrenia, mania, and major depression. A 2005 study by H. Richard Lamb, M.D., and Linda Weinberger, Ph.D., concluded that as much as 24 percent of the prison population has a severe mental illness.

More recently, the Department of Justice's Bureau of Justice Statistics (BJs) reported that more than half of all prison and jail inmates have mental health problems (see page 6). Tom Hamilton, Ph.D., NAMI's liaison to APA's Committee on Jails and Prisons, said that the report was flawed, however, because it did not address the number of inmates suffering from severe and persistent mental illness.

"I suspect if most of us spent much time in these places, we would all develop mental health "problems,'" Hamilton said.

Generally, discrepancies in the number of inmates with mental illness identified by researchers are likely due to differences in the ways they define mental illness, he said. But despite the varying percentages of prisoners with mental illness, people with mental illness are more than twice as likely to be incarcerated.

The cause of the burgeoning number of prison inmates with mental illness in recent decades appears linked to the falling number of state psychiatric beds since the 1960s, Hamilton said. He presented data from Texas to illustrate "transinstitutionalization" of inmates from state psychiatric hospitals to the criminal justice system. Jail data from Harris County, Texas, which includes Houston, showed that 37 percent of inmates had a serious mental illness, based on a matching of jail and county public mental health records.

The nationwide deinstitutionalization of patients with mental illness, which led to the loss of 90 percent of state psychiatric beds over the last 50 years, was supposed to be replaced with a system of 2,000 community mental health centers. But most states viewed the closure of psychiatric hospitals as a chance to save money, Hamilton said, which resulted in the creation of fewer than 700 "underfunded" community-based mental health facilities.

Also contributing to the problem is the prevalence of substance abuse among people charged with or convicted of crimes. Nearly 6 in 10 mentally ill offenders reported they were under the influence of alcohol or drugs at the time of their latest offense, according to a 1999 BJS report. It also found that one-third of offenders identified as mentally ill were alcohol dependent.

"Just locking up addicts so they can't feed their addictions sounds good, but the problem is that it just doesn't work," said Wilson Compton, M.D., director of the Division of Epidemiology, Services, and Prevention Research at the National Institute on Drug Abuse, about the high recidivism rates research has found among inmates with untreated addictions.

Although the problems are severe, evidence is mounting that specific programs and approaches can reduce the number of inmates with mental illness and drug addictions, the speakers noted.

Research has found significant progress in reducing addiction rates among inmates when public-health efforts are combined with those of the criminal-justice system, Compton said. The combination takes advantage of the person's incarceration to provide consistent addiction treatment over several months, an approach likely to prevent drug relapses and recidivism. The efficacy of jail-based treatment was reported by a 2006 Maryland study that found that 69 percent of heroin-addicted inmates who received counseling and drug therapy in the months before their release continued treatment one month after leaving prison, and only 29 percent tested positive for heroin.

"This study and others have led to major changes, where treatment is at least being talked about as part of incarceration for those who need it," Compton said.

Nakamura pointed out that research has found jail-diversion programs for suspects with serious mental illness and co-occurring substance use conditions reduce the time they spend incarcerated without increasing the public-safety risk. Studies have also found that the costs for jail diversion are no higher than those for imprisonment of those with mental illness, who often languish in jail on minor charges because they lack the understanding or funds to fight their incarceration.

Other programs that deserve federal support are Crisis Intervention Training for police officers and postincarceration programs to eliminate recidivism, speakers pointed out.

Rep. Grace Napolitano (D-Calif.) told attendees that she supported their goals of reduced incarceration and improved care for those with mental illness, but that better national cost/benefit data are needed to convince Congress to support these programs.

"The Republican majority understands cost/benefit, so you have to show how these programs can save the government money," Napolitano said.

Until the nation develops a "safety net" to treat everyone with mental illness, she added, the criminalization of mental illness and drug addiction will continue to plague society.

Read more!

More State Money Sought to Aid the Disabled

Costs Higher in N.Va., Lawmakers Are Told

By Chris L. Jenkins
Washington Post Staff Writer

The General Assembly set aside an unprecedented amount of money two years ago for people with mental disabilities, enabling placements in group homes for those with cerebral palsy and other disorders and offering other services across the state. Many had been on waiting lists for years.

But in Fairfax County and elsewhere in Northern Virginia, one problem persists: The state consistently has underfunded many local agencies that provide the services, because the cost of doing business in the area is higher than in other parts of the state, resulting in providers' scaling back services.

Advocates for people with mental disabilities in Fairfax have started an aggressive push to increase state payments to the region, hoping to convince lawmakers during the 2007 legislative session that more money needs to be pumped to the Washington suburbs. Activists have appealed directly to Gov. Timothy M. Kaine (D) and to members of the General Assembly's committees that develop the state budget.

They also have invited Democrats and Republicans in Northern Virginia to meet individuals with disabilities as part of the ARC of Northern Virginia's A Life Like Yours program. Advocates hope that by spending time with those who have disabilities, public officials will better understand the needs of that community and be encouraged to take action.

In particular, advocates have reached out to Republican Fairfax Sens. Ken Cuccinelli II and James K. "Jay" O'Brien Jr. as well as Fairfax Dels. David B. Albo (R), Vincent F. Callahan Jr. (R) and James M. Scott (D).

"It's never been anyone's number one priority. . . . No one ever makes it their pet project," said Nancy Mercer, executive director for the Falls Church-based ARC, referring to the difficulty that advocates have had in the past. "We're doing everything we can this year to change that."

Currently, Virginia's Medicaid program reimburses agencies that work with people with mental disabilities in rural Virginia for the same amount that it reimburses those within Fairfax. But the cost of doing business is often more than 20 percent higher in Northern Virginia, according to state audits. For instance, the state reimburses agencies that run group homes about $17 an hour per client, according to state records. The actual cost hovers around $41 an hour, making it difficult for facilities to provide complete services for those entitled to them.

The economics of such services also discourage agencies from setting up in Northern Virginia, an outcome that limits the choices for those seeking providers.

Advocates said they need $5.5 million a year to at least partially bridge the gap between the money from the state and their actual costs. They have asked Kaine to include the increases in his changes to the state budget.

They also have asked several lawmakers to submit budget amendments that could provide the money.

That money would be used primarily for increasing the salaries paid to those who work with patients with disabilities every day. In many cases, workers can't afford Northern Virginia's cost of living and do not stay with the work very long, advocates said.

Efforts to secure the money in the past have been stymied largely because of regional hostilities that plague Virginia politics. Very often, rural and downstate lawmakers are unwilling to make special concessions for Northern Virginia.

"It's going to be a tough sell," said Albo, who said he was considering a budget amendment to secure the funds. He said such requests often get caught up in negotiations over other issues with lawmakers in other regions.

"It's like everything else that we deal with in Northern Virginia, whether it's transportation or education. Some of the downstate guys say, 'Well if you guys want that, then . . . how about this for us?' It just makes it hard." Read more!

New programs cater to ex-cons with serious mental illness-AP

New programs cater to ex-cons with serious mental illness
ANGELA DELLI SANTI
Associated Press

TRENTON, N.J. - Larry Lamb has lived a half-century of failures: three stints in state prison, four psych ward confinements, drug and alcohol abuse dating back to adolescence, and more time in county lockups than he can count.

Then a year ago, things changed. He began racking up successes.

Lamb, 50, hasn't had a drug-tainted urine sample since he enrolled in a program for mentally ill inmates as he was being released from jail. He's taking antidepressants, keeping appointments with his therapist, working when he can find a job and paying off court-imposed fines from his prior life of crime and homelessness. He's about to move into his first apartment, is re-establishing a relationship with his teenage son and hoping, one day, to find a mate.

"I knew I needed help," said Lamb, who traces his troubled and isolated life back to the day when he was 7 and he saw his 9-year-old brother get run over and killed by a truck. "I was willing to do anything."

Lamb is among the ex-inmates participating in programs for parolees with serious mental illness. The programs offer comprehensive services - housing and job assistance, medication management, counseling and education - aimed at keeping this high-risk, high-maintenance population from returning to jail or causing trouble out on the streets.

Until this year, the state didn't offer any services for the mentally ill once they left state prison. Nine of the state's 21 counties have some mental health services for such inmates who are about to be freed from county jail, though the assistance varies in scope, duration and intensity.

"The dilemma was, 'where do I put a person like this?'" said Kevin McHugh, director of community programs and grant management for the state parole board. "We don't want to keep them in jail, and the likelihood for them to fail on the outside was high."

The two pilot programs for inmates emerging from state prisons are run by separate groups and funded by different sources. But their missions are similar: to provide the best possible chance for mentally ill ex-cons to become independent and productive rather than be re-incarcerated. County-based programs like the one Lamb is in are also relatively new and strive for similar outcomes.

Providing services to mentally ill inmates is now standard. To settle a prisoner-generated lawsuit over a lack of psychiatric services on the inside, the state developed mental health programs to replace the less informed approach of segregating inmates whose psychiatric disorders made them disruptive.

Those services typically cease when an inmate leaves state custody, however, and ex-prisoners often relapse.

"People who have a serious mental illness - bipolar, major depression, schizophrenia - they're three times more likely to end up in prison or jail than in a state hospital. That doesn't make any sense at all," said John Monahan, CEO of Greater Trenton Behavioral HealthCare, the nonprofit that runs one of the new programs.

"We have to see to it that people who have serious mental illness get the help that they need so they don't wind up incarcerated and they get help before problems happen for them," Monahan said.

McHugh estimated that a quarter or more of state prisoners have serious mental illnesses, and Monahan said the percentage in county jails was probably one-third to one-half.

Monahan co-chaired a mental health task force commissioned by former Gov. Richard Codey that led to one of the pilot projects, PROMISE, or Program for Returning Offenders with Mental Illness Safely and Effectively, funded by the state and run by Volunteers of America in Camden.

That program operates on a shoestring $400,000 budget, providing up to six months of post-incarceration services to paroled inmates who have a history of criminal behavior related to untreated mental illness. The program began in the spring, now has 16 parolees and can accommodate a maximum of 30. So far, five people have completed the program, and two committed parole violations and returned to prison.

Monahan's project, called Coming Home, relies on state, county and grant funding to provide outreach services to state and Mercer County inmates. Counselors begin working with inmates three months before discharge to develop a plan for living on the outside. They'll continue to work with parolees until they are self-sufficient.

A three-year, $300,000 grant from the Robert Wood Johnson Foundation funds the portion of the project dealing with state prisoners. The money will pay for services for 60 state prisoners and underwrites efforts to amend state policy so such services are widespread and permanent.

Lamb, who is among the ex-Mercer County Jail inmates in Greater Trenton Behavioral HealthCare's Corrections Project, says his bond with counselor Anthony Towns is the reason for his success. But Towns, his counselor and mentor, insists Lamb is being modest.

"I haven't done anything more for Larry than I've done for any other client," Towns said. "In any therapeutic relationship, the client and the counselor should have some type of bond. Larry came to me with motivation to succeed. It just so happens that Larry connected with me."

Said Lamb: "I'd never let anyone get close to me before. I trust that man with my life."
Read more!

Study: Some Preschoolers Can Use Ritalin - AP

Published: October 20, 2006

CHICAGO (AP) -- The first long-term government study of preschoolers who take Ritalin, the popular attention deficit disorder drug, warns of side effects but also found benefits in children with severe problems.

The drug isn't approved for use in children under age 6, and the researchers said those youngsters need close monitoring. Preschoolers are more likely than older children to develop side effects, experts said.

The research was done because of concerns over reports that soaring numbers of very young children are being given psychiatric drugs, including Ritalin.

The study's message is, proceed with caution, said Dr. Thomas Insel, director of the National Institute of Mental Health.

''We're not talking about fidgety 3-year-olds,'' said Insel, whose agency funded the study.

The research involved children with severe cases of attention deficit hyperactivity disorder -- cases that included hanging from ceiling fans, jumping off slides or playing with fire. The researchers say the benefits of low-dose treatment outweigh the risks for these youngsters.

But critics disputed that.

''I hope publication of this does not lead to more overprescribing,'' said Dr. Sidney Wolfe of the watchdog group Public Citizen. ''The safety isn't adequately established, the efficacy even less.''

About 40 percent of children developed side effects and roughly 11 percent dropped out because of problems including irritability, weight loss, insomnia and slowed growth.

Preschoolers on methylphenidate, or generic Ritalin, grew about half an inch less and gained about 2 pounds less than expected during the 70-week study.

''This is a catastrophe. It just opens up the way for drugging the younger kids,'' said Dr. Peter Breggin, a New York psychiatrist and longtime critic of psychiatric drug use in children.

Breggin said the research is part of a marketing push by the drug industry to expand drug use to the youngest children.

The study appears in the November edition of the Journal of the American Academy of Child and Adolescent Psychiatry. Several of the researchers have financial ties to makers of ADHD drugs, including Ritalin.

Lead author Dr. Laurence Greenhill, a psychiatrist with Columbia University and New York State Psychiatric Institute, has been a paid speaker for most companies that make the drugs.

Roughly 8 percent of U.S. children have ADHD, including around 3 percent of preschoolers.

Previous research found that about 1 in 100 preschoolers had been prescribed Ritalin, which has only been approved for use in children aged 6 and older. Use in younger children is considered ''off-label'' but is not illegal.

Dr. David Fassler, a psychiatry professor at the University of Vermont, said the study does a good job of outlining pros and cons of Ritalin treatment in preschoolers.

''This is exactly the kind of information we need to help parents make informed decisions about treatment options for young children with ADHD,'' Fassler said.

The study included 10 weeks of behavioral treatment along with parent training and about one year of drug treatment. Nearly 300 families were enrolled, but many dropped out after the first phase, either because the behavior treatment worked or because they didn't want to put their children on drugs.

The drug phase started with 165 children, more than a dozen dropped out because of side effects.

Behavior improvements were seen in children taking 7.5 to 30 milligrams daily, but the optimal dose was 14 milligrams daily -- less than half the usual Ritalin dose for older children, Greenhill said.

------

On the Net:

Journal: http://www.jaacap.com
TEXT Read more!

Clubhouse future still in doubt - Hendersonville Times-News

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

The future of the Sixth Avenue West Clubhouse fell back into doubt Wednesday as the region's largest mental health care provider said it must sell the property to cover the bills.

New Vistas-Mountain Laurel says the $1 million it will receive from Western Highlands will not be enough to cover payroll, employee benefits and other debts before it closes Oct. 31.

Seven hundred employees work for New Vistas, which helps more than 10,500 patients. The agency reported a monthly payroll of $2 million, and its chief executive says it owes employees more than $500,000 in accrued paid time off.

The dying agency backed away from a deal that would have transferred the property to Western Highlands, a state-created regional body that manages mental health care in Henderson, Buncombe, Transylvania and five other mountain counties.

New Vistas-Mountain Laurel wants $700,000 for the property on Sixth Avenue West near the Henderson County YMCA.

"It's a very difficult balancing act that we're trying to achieve," said New Vistas Chief Executive Officer Will Callison. "We want to do the right thing for the staff and for the clients. In this particular situation, obviously the best thing for the clients would be to continue in that building and not have a disruption in service. We are very committed to trying to see that occur.

"On the other hand, we have obligations to our staff that we have to fulfill as well."

Since the 1980s, the Clubhouse has helped people who suffer chronic mental illness become independent. Members cook, clean and answer the phones. They help one another find, and hold down, jobs. Despite the self-sufficient operation, the Clubhouse does not own the roof over its head.

Callison said New Vistas will stipulate that the property buyer rent the building to the Sixth Avenue West Clubhouse for three years at $6,000 a month.

Quandary

The threat of the sale frustrated the Henderson County Board of Commissioners, which received the news Wednesday from Western Highlands CEO Arthur Carder.

Commissioners say the $6,000 a month rent would put an added financial strain on the Clubhouse, which serves 50 clients each month.

They also feared the Clubhouse would be left on the brink three years from now, its future uncertain. The Clubhouse launched a new nonprofit, dubbed Sixth Avenue Psychiatric Rehabilitation Partners, in preparation for the looming closure.

The issue could come to a head Friday when the Western Highlands Board of Commissioners meets in Asheville.

Western Highlands considered withholding the rest of the $1 million from New Vistas-Mountain Laurel if the Clubhouse property is put on the block. Western Highlands already earmarked $360,000 of the money for liability coverage for New Vistas-Mountain Laurel employees in case they are sued after the agency closes.

But Henderson County leaders and Western Highlands are in a quandary. Should the dying agency collapse into bankruptcy, the remaining assets would be seized. That would strip the county and Western Highlands of any sway in the fate of the building.

They have few options now.

Western Highlands "has no authority to take the property, to seize it or demand that they sign it over to us at this point other than to not provide these additional funds, which could precipitate an abrupt closure," Carder said.

Carder and commissioners questioned a $300,000 jump in the reported value of the Clubhouse property. Carder said New Vistas-Mountain Laurel originally reported that the property was worth $400,000. New Vistas-Mountain Laurel says the latest appraisal put the value at $700,000. Commissioners requested a hard copy of the appraisal, refusing to take the agency's word.

Callison said the $400,000 price figure was an early estimate before a recent appraisal.

A community push

After receiving the go-ahead from commissioners, Chairman Bill Moyer will continue negotiations to save the building, including fundraising. The Community Foundation of Henderson County on Tuesday delved into ways to help the Clubhouse, joined by the offices of U.S. Rep. Charles Taylor and U.S. Sen. Elizabeth Dole.

"They are going to use their resources as a 501C-3 (nonprofit) to try to raise money through the community to help buy that building and see if that's at all possible," Moyer said. "Certainly, I think the preferred option would be if the community would rally and the group could get a significant down payment."

Taylor said Wednesday he is aware of the mental health breakdown and the Clubhouse problem in particular and was hoping to help.

Callison said someone expressed interest in buying the property, but nothing definite is in place. He said the Oct. 31 closure would not be the deadline for the property sale. But the agency cannot hold off indefinitely, he said.

"Of course, the best option would be if the Sixth Avenue Psychiatric Rehabilitation Partners were able to purchase the facility for themselves," Callison said. "That would be our best outcome."

The question over the property comes as the Clubhouse plans to expand the services it offers under the newly formed Sixth Avenue Psychiatric Rehabilitation Partners. The non-profit hopes to fill in the gap Clubhouse members will encounter once New Vistas-Mountain Laurel closes. Four teams of mental health care providers would offer the services, which include diagnostic assessment, community support, assertive community treatment and psychosocial rehabilitation. The nonprofit says it needs $350,000 from the county, which is still working out how to spend $528,000 set aside for mental health care.

The Community Foundation set up a fund that can accept charitable donations from people interested in supporting the Sixth Avenue group until it receives nonprofit status from the Internal Revenue Service. Read more!

Henderson County battling "failed system" - Hendersonville Times-News

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

Henderson County commissioners are trying to figure out how they will spend $528,000 to help local mental health care providers shoulder the burden once New Vistas-Mountain Laurel shuts down Oct. 31.

Commissioners say the county is picking up the pieces of a state-mandated reform doomed from the beginning.

"We watched this for four years," said Bill Moyer, the chair of the Board of Commissioners. "I think we're battling a failed system. If we do not change this failed system, there's no guarantee we're not going to be right back here in six to nine months."

New Vistas-Mountain Laurel served more than 10,500 clients in eight counties, the largest mental health care provider in the mountains. Financial problems sparked the agency's looming shut down, money woes caused in part by low reimbursement rates from the state.

Henderson County and Western Highlands, which manages mental health care, are trying to come up with a plan to make sure the mentally ill don't fall through the cracks.

Seven mental health care providers stepped up to the plate so far, saying they could expand services to pick up the slack. They pitched plans to Western Highlands, which reported the results to the Board of Commissioners on Wednesday.

The kicker: All together, the requests carry a $1.3 million price tag. The Henderson County coffers would cover less than half -- $528,000.

"The fact of the matter is we're going to take $528,000 and spread it out to where we can afford to do as much as we can, and then we might have to come back at a later date and look and put some more in other places," said Commissioner Charlie Messer.

Commissioners invited the seven providers to "make the case" for the money they requested. The special meeting will be at 7 p.m. next Thursday at the county offices, 100 N. King St.

County commissioners and Western Highlands are trying to avoid another big shutdown, where an agency's closure would translate into another crisis.

So they plan to divvy out the services. No agency will shoulder a service alone. And they want to avoid too much overlap, so the full range of services will be available and money will be well spent.

That's not the only way they plan to watch the pocketbook. Providers will get half the money up front, and the rest once they prove at least 30 percent of their patients rely on state money for mental health care.

Will Callison, the CEO of New Vistas, says low state reimbursement rates contributed to the agency's downfall. The agency alone shouldered the burden of caring for indigent clients who relied on state help, he said. Callison says other mental health care providers made money because they avoided these patients, cherry picking clients covered by private health insurance or Medicaid. New Vistas-Mountain Laurel earned the name "provider of last resort."

Henderson County also will make the new providers prove they are earning the county money, requiring them to sign performance contracts.

"I will say to you, all of our performance contracts will be audited more than once a year, at least every six months, by our internal auditor," said County Manager Steve Wyatt. "For the compliance with the expenditure of funds, but also for the performance measurements, the number of clients seen, to make sure that those targets are being made."

Western Highlands CEO Arthur Carder said changes are needed statewide to ensure another major shutdown does not occur. The transition so far has come across roadbumps, including complaints that patients are having trouble finding help through New Vistas even though the closing date is two weeks away. Western Highlands wants 12 doctors to help cover caseloads in the eight county region. Five signed on so far. Carder said some new providers remain unsure whether they can pick up services because they don't know whether they will have the employees. Some New Vistas-Mountain Laurel employees are playing the field, waiting to see which new provider will offer the best compensation.

Carder said mental health care management agencies need access to the financial records of private providers.

"That's something we need to look into to be able to monitor where is their financial condition really based on what they're telling us versus what their books are showing," Carder said. "And we've got to make sure the books are done right in order to know that."

Second, he said no lone mental health care provider should carry the burden of caring for state patients.

"We think that's wrong, and it shouldn't be allowed," Carder said.

Commissioners say the state created the problem with the mental health reform of 2001, but cannot be relied on to fix it.

"We're very hopeful that they can do something, but I think the bottom line is we're going to have to work our way through this problem, and we're not going to be able to rely on any help from the state," Moyer said. Read more!

Demands rising at Vet Centers - Charlotte Observer

DAVID GOLDSTEIN
McClatchy Newspapers

WASHINGTON - A network of community-based walk-in veterans' treatment centers is under increasing pressure as more and more former troops who served in Iraq and Afghanistan have come looking for help.

A report to be issued today from the House Veterans Affairs Committee's Democratic staff says that nearly a third of all Vet Centers have seen the demand rise for outreach and other services.

The report found that the number of Iraq and Afghanistan veterans who have sought help for post-traumatic stress disorder (PTSD) doubled -- from nearly 4,500 to more than 9,000 -- from October 2005 through June 2006.

The number of veterans with other types of possible mental health and readjustment problems also doubled, and in some cases tripled, the report said.

Half of the Vet Centers sampled reported that their expanding caseloads have affected their ability to treat their current clientele.

"The administration's failure to increase staffing and other resources for Vet Centers has put their capacity to meet the needs of veterans and their families at risk," the report said.

The centers, part of the VA's Readjustment Counseling Service, were created in 1979 under then-VA Administrator Max Cleland, a triple-amputee Vietnam veteran. He later served one term as a senator from Georgia.

The centers were designed to be accessible, storefront clinics where veterans could be seen almost immediately by a staff largely composed of combat veterans.

Their core mission is to help veterans suffering from mental and emotional concerns. PTSD, which wasn't even recognized as a medical condition when the centers were founded, is the most widespread mental health problem experienced by soldiers in combat.

PTSD can cause nightmares, flashbacks, depression, survivor's guilt and other types of anxiety.

The VA vastly underestimated the number of PTSD cases it expected to see this year, predicting it would see 2,900 cases.

As of June 2006, it has seen more than 34,000 Iraq and Afghanistan veterans for PTSD.

A recent VA report shows that more than 1 in 3 Iraq and Afghanistan veterans who've gone to the agency for medical help report that they're under stress or have mental problems.

Vets' Needs

Other findings in the report:

• 30 percent of vet centers said they need more staff.

• 20 percent said they have either limited or no capability to provide counseling or therapy for families dealing with veterans suffering from PTSD or other mental health problems.

• 40 percent of the centers have sent veterans with readjustment issues who should be receiving individualized therapy into group therapy.

The report is the result of a confidential survey of Vet Center staffs. The House Veterans Affairs Committee's Democratic staff contacted a sample of 64 centers in all 50 states, the District of Columbia, Guam, Puerto Rico and the U.S. Virgin Islands. Sixty centers responded. Read more!

Candidate would cut substance abuse to fund mental health - Winston-Salem Journal

By Patrick Wilson
JOURNAL REPORTER
Thursday, October 19, 2006

The term "power of incumbency" is an understatement when it comes to U.S. Rep. Mel Watt.

He has held his seat in North Carolina's predominantly Democratic 12th District for 14 years, and he is the chairman of the Congressional Black Caucus.

He won 67 percent of the vote two years ago against Republican Ada Fisher. She is challenging him again in the Nov. 7 election.

"The issues haven't changed," said Fisher, a retired doctor. "There's a fundamental difference of opinion in how Mr. Watt approaches things and how I approach things."

As he has in previous elections, Watt is promoting his years in the House.

"Experience has some value," he said. "I think it has value because during that 14 years, I've positioned myself on committees that have importance to this congressional district."

Watt is on the House Financial Services Committee and the House Judiciary Committee.

"That's been a valuable part of my campaign - to remind people that they have an experienced representative and they can keep an experienced representative if they go to the polls and vote on Nov. 7," he said.

Watt opposes the resolution authorizing war in Iraq.

"I have aggressively taken the position that the president has lost the majority support for this war in the United States," he said. "It's time for us to set a timetable for us to start withdrawing our troops, and that timetable needs to be started immediately and concluded within the next 12 months."

He said he determines his positions based on what his constituents want.

"My platform generally is whatever people are talking about," he said. Watt was elected in 1992 after the long, winding district was created to ensure minority representation in Congress from North Carolina. The district runs through 10 cities, including Charlotte, Winston-Salem, Salisbury and Greensboro.

Fisher is presenting herself as a different choice.

"Experience matters, and I have experience that matters," she said.

Fisher is a former school-board member in Rowan County, a former medical director for Amoco Oil Co., and the former chief of occupational health services at the Veterans Affairs Medical Center in Salisbury.

She said that her priorities are cracking down on illegal immigration, cutting taxes to create jobs, and providing access to affordable health care.

Although many candidates advocate programs with no way to pay for them, Fisher has cuts in mind - the failed "war on drugs," she said.

She said she would reduce money for substance-abuse programs to instead help pay for mental-heath programs and better health care for veterans.

That position comes in part, she said, from her experience as the detox director at John Umstead Hospital in Butner, where the substance-abuse program for people with mental illnesses didn't work, she said.

"I know that these programs don't work. So why do we keep funding things that don't work?" said Fisher, who hands out pens that read, "Get a doctor in the House."

She said that what she lacks in political experience she has made up for in real-life experiences.

"If you've been on a school board, you can do anything in the world," she said.

The candidates' fundraising in this year's race has been comparable.

Watt had raised $389,418 and spent $302,952 as of Sept. 30, according to the Center for Responsive Politics. Fisher had raised $335,901 and spent all of it. Unlike previous campaigns, this year she did a direct-mail fundraiser to raise money.

• Patrick Wilson can be reached at 727-7286 or at pwilson@wsjournal.com. Read more!

National non-profit organization could be new mental health provider for Polk-Tryon Daily Bulletin

National non-profit organization could be new mental health provider for Polk
Leah Justice
October 19, 2006

Residents who use mental health services in Polk County may not need to worry about a lapse in service, despite the imminent closing of New Vistas, the current provider.
Western Highlands, the state mental health entity that includes Polk County, is currently negotiating with a nationwide non-profit organization to provide the services, according to Polk County Manager Michael Talbert.

Talbert announced during a board of commissioners meeting Monday that Western Highlands is speaking with Providence, a non-profit organization located in 34 states and parts of North Carolina.
Western Highlands was alerted recently that its provider, New Vistas, is closing its doors Oct. 31. Since that announcement, several meetings have been held regarding the effort to find new providers quickly so that services will not be interrupted. New Vistas is also still providing services to its current patients until the end of the month. Service after hours is currently provided by Phoenix Inc. while Western Highlands finds a new provider.
New Vistas decided to close after suffering a financial deficit due to all services not being reimbursed. It appears that if Providence does agree to provide services for Western Highlands, it will not provide services that are ineligible for reimbursement.
Talbert said negotiations with Providence are not final yet but look promising. He said the non-profit has a larger funding pool than New Vistas and should not suffer the same problems as the local organization that started more recently.
“If negotiations work out, (Providence) will hire a majority of the New Vistas staff,” Talbert said.
The county is still considering other options for long-term mental health service. The discussions on Monday were part of a requested budget amendment for Polk County to turn over $313,997 to Western Highlands.
These funds, currently in Polk’s fund balance, were Polk County’s share of funding left after the dissolution of the Rutherford-Polk Mental Health Authority, the county’s previous mental health care organization.
Polk County has discovered it must turn the funds over to Western Highlands unless it has a specific plan for spending the funding for mental health services. Talbert said the county will have to turn over the funds, because it could take a year to develop a mental health plan for Polk County.
The board decided to wait to turn over the funds until its next meeting to give commissioners more time to consider other possible uses for the money.
One such possible use might be to set up a joint regional mental health program. Because of Polk County’s small size, setting up its own non-profit to provide services may not make sense, Talbert said, but joining a three-county region program could.
Talbert was scheduled to meet yesterday with Transylvania and Henderson counties to discuss the possibility of setting up such a regional program.
Another option might be to give that money to help Buncombe County build a planned mental health crisis center that will also serve Polk residents. Talbert said Buncombe County, also part of Western Highlands, was recently allowed to keep $1 million of its mental health funding to build a 15- or 18-bed crisis center that will be available for all other counties in the Western Highlands network. He said the crisis center should be completed in nine months to a year.
Commissioners seemed interested in the possibility of giving some or all of its mental health funding to expand that crisis center, instead of turning the funds over to Western Highlands.
Read more!

County unveils new mental health institute - Essex County (NJ) Eagle

By Lauren DeFilippo, Staff Writer

ESSEX COUNTY, NJ - Essex County is now home to the state’s first Institute for Mental Health Policy, Research and Treatment. The institute will be housed in the new Essex County Hospital Center currently being built in Cedar Grove.

The newly established institute is a partnership between county, state and federal governments, health care and academia and will create centers of expertise in several areas.

The institute will be funded through the Essex County Hospital Center’s existing operating budget which is approximately $28 million.

Regina Palo, who lobbied the county for more than two decades for a new hospital center, could not have been happier with the partnership, or the new, state-of-the-art hospital center under construction that will house it.

“To realize this type of hospital ... is way beyond the dreams we expected 25 years ago,” she said.

The new institute will work toward bridging the gap, if one exists, between the science and the art of caring for people who have mental illnesses, County Administrator Joyce Wilson Harley said.

The focus of the centers include: mood disorders, such as depression and bipolar disorder; schizophrenia and psychotic disorders, which will focus on treatment and rehabilitative strategies to promote wellness and recovery; medical and metabolic disorders, which will focus on reducing major health problems of patients through promoting healthy lifestyles and appropriate medical intervention; workforce development to provide adequate training and education to other care providers and professionals; technology integration to promote access to information to foster a continuous caring relationship between consumers and providers through a Web-based plan of care; and mental health policy which will focus on helping the consumers and their families with their health-care providers.

This center will also make policy and budget recommendations to county and state agencies.

County officials were joined at the unveiling in Cedar Grove by Gov. Jon Corzine, Cedar Grove officials and health-care professionals in announcing the initiative.

“It’s a huge issue,” the governor said of mental illness, noting that one in four adults suffer from some diagnosed mental illness at one point in their lives.

That statistic, he said, equates to 200,000 people affected by mental illness in Essex County, and more than 2 million affected statewide.

“There’s a huge, huge need for us to have an integrates and thoughtful approach to mental illness,” Corzine said.

Dr. Robert L. Johnson, dean of medicine at the University of Medicine and Dentistry of New Jersey - New Jersey Medical School, said that not enough time is spent on mental-health illness.

“You can’t treat everything with pills,” he said.

Though the health-care industry has realized, by and large, that mental illness is a cause for concern, little time is still spent finding appropriate or innovate treatments, and even less time disseminating information about and implementing approaches that work, he said.

Changing that is a goal, he said, noting that “it is a venture like this that will get us closer to that point.”

Going a step further, Clark Bruno, acting commissioner of the state Department of Human Services, said that the institute would help create a coherent, coordinated and responsive system addressing mental illness throughout the state, the foundation for which would be built around wellness and recovery.

“This will be a significant improvement to the mental health system in Essex County,” he said.

Dr. Natarajan Elangovan, medical director of the county’s hospital center, said that when he first brought the idea of the institute to DiVincenzo’s attention, the only question he asked was if creating it was the right thing to do.

With Elangovan answering in the affirmative, the ball started rolling.

“Nothing can help without the support of the political leadership,” he said.

“Today, I couldn’t be more proud,” DiVincenzo said, noting that much of what the county has accomplished with regard to mental illness has been with the help of residents such as Palo, John Gaitkowski, Bob Davison and other advocates and family members.

“This is what you call shared services,” he said jokingly to Corzine, who was seated in the front row.

The Institute has established Clinical Academic partnerships with the University of Medicine and Dentistry New Jersey Medical School, Robert Wood Johnson Medical School and School of Nursing; Farliegh Dickinson School of Nursing; Felician College School of Nursing; Bayonne School of Nursing; and Essex County College.

Lauren DeFilippo can be reached at 908-686-7700, ext. 119, or essexcou ntyb@thelocalsource.com. Read more!

Transition to new mental health providers bumpy-PisgahMountainNews

Transition to new mental health providers bumpy
By Melissa Stout
STAFF WRITER
published: October 19, 2006 12:15 am
Contact Melissa Stout at 828-232-5967, via e-mail at mstout@CITIZEN-TIMES.com

HENDERSONVILLE — Big tears rolled down Belinda Firpi’s cheeks as she talked about not being able to receive treatment from one of her therapists after New Vistas-Mountain Laurel closes on Oct. 31.

“It’s hard to find somebody that cares,” she said. “I’m trying to get my life back to the way I used to have it . . . I don’t know what happened to me.”

For the past few months, Firpi, 45, has been receiving services from New Vistas-Mountain Laurel in Hendersonville. But her help from the nonprofit facility that provides services in the areas of mental health, substance abuse and developmental disabilities to more than 10,000 people in eight Western North Carolina counties is coming to a halt in 12 days.

When the facility near Pardee Hospital closes, 2,200 people in Henderson County could possibly be left without a place to turn.

“It’s horrible no one can take care of us. No one cares. They treat us like crap because we’re on Medicaid” Firpi said. “As rich as this town is, and they can’t help us.”

Firpi will continue to receive services from one of her therapists, who found a job at another area provider, but not everyone will be so lucky.

Officials with Western Highlands Network, a Local Management Entity that provides a network of community services and support for facilities like New Vistas-Mountain Laurel, say providers are stepping up to take some of the uninsured or underinsured after the facilities close in Henderson County.

“Our provider network is extremely large,” said Arthur Carder, CEO with Western Highlands Network. “We’re looking to have providers expand that are currently in the system. Some may pick up three new cases. Some may pick up 300 or 500.”

Carder said the search for providers has been going well.

Desperate plea

“What we have is a mess,” said Steve Wyatt, Henderson County manager. “Unfortunately, people’s lives are going to be negatively affected by the events of the last couple months.”

Wyatt said the county is urging service providers to work with Western Highlands to soften the impact of New Vistas closing.

He said the county is also working with Western Highlands on how the county can best use the $528,402, the amount of money the county was required to budget and the amount they were spending on mental health before the state reorganized mental health.

Carder was expected to present a list of providers and recommendations for the county money at this week’s county commissioners meeting.

New Vistas-Mountain Laurel, funded through public money, was to act as a safety net that cared for clients other private, mental health care facilities would not take.

It served clients in Buncombe, Henderson, Madison, Mitchell, Polk, Rutherford, Transylvania and Yancey counties.

Five years ago, a mental health system was created in North Carolina with the goal of moving people with mental illness out of state hospitals and back into their communities when possible.

But many of the nonprofits that took over services during the reform could not afford to include psychiatric serves for people with severe mental illness.

New Vistas-Mountain Laurel was born out of the reform.

The problem with this model is the state expected companies to take on critical services that were under funded, said Will Callison, CEO of New Vistas-Mountain Laurel. The main under-funded services included psychiatric services, medication management by a physician or psychiatrist and walk-in crisis services.

“It was a system set up for failure from the beginning,” Callison said.

Callison said there are several basic things that need to be addressed. First, funding for psychiatric services has to increase significantly. And second, the state needs to increase funding for services for clients who cannot pay for services, he said.

Diane Bauknight knows firsthand what it could mean to be left without hope.

Bauknight adopted her daughter, Angie, 17, 12 years ago. She then has since been an advocate for mental health in North Carolina.

Over the past 12 years Bauknight has seen systems set up for mental health care come and go, but with none of them ever fully addressing the problem.

“I haven’t seen anything positive that’s lasted,” the soon-to-be Fletcher resident said.

So it didn’t come as a surprise to her when she heard New Vistas-Mountain Laurel was closing.

“New Vistas closing is another symptom of the mental health system imploding,” Bauknight said. “It’s a series of many tragedies that occurred. Just when you think it can’t get any worse . . .”

Bauknight can sympathize with people possibly losing their mental health care when New Vistas-Mountain Laurel closes.

“We’re going to see a lot of people with serious mental illness and no means to pay and have no place to go,” she said. “They’re going to end up in jails, in the shelters and on the street, dead. I have a lot of concerns for those people.”

Where to turn?

While Western Highlands is working on gathering providers for the thousands of patients that will be left without a place to turn on Oct. 31, other area agencies are also preparing for the increase in numbers they may experience.

Rev. Anthony S. McMinn, executive director and CEO of the Hendersonville Rescue Mission, considers himself outspoken on the subject of mental health.

“It will affect us quite a bit,” McMinn said. “I’m just so tired of dealing with it. The reform they’ve tried hasn’t worked.”

He said having to help more people at the rescue mission takes away from crisis intervention and from following up with people with mental health needs.

Capt. Rick Davis with the Henderson County Sheriff’s Department said that anytime there is a disruption in the mental health area, law enforcement always sees a spike in involuntary commitments, arrests and overtime for employees.

“We always notice through overtime that officers are tied up with involuntary commitments and arresting more people,” Davis said. “We do adjust accordingly whenever we’re expecting some type of disruption.”

McMinn currently has about 40 men a night staying at the rescue mission and 18 women and children. He said he’s already seen an increase in people coming through the doors for help.

The mission provides shelter to the homeless, food to the hungry, recovery to the addicted and medical assistance to the homeless and poor of the community, according to its Web site.

New Vistas-Mountain Laurel “has already lost services,” McMinn said. “When it comes to crisis we’re going to first see it here.”

Tim Jones, director of operations at the Hendersonville Rescue Mission, said that the New Vistas-Mountain Laurel telephone consultation, walk-in referral system and crisis intervention are already gone.

“We’re in a new territory with no resources,” he said. “We have a lot of folks that eat here, but don’t stay here. They’re just above the water with the system we’ve got now. If that goes away, it won’t be long before those people are out on the street.”

Three out of four women that receive assistance from the rescue mission have a clinical diagnosis of a mental illness, McMinn said. Half the men who receive services from the mission have known substance abuse issues such as drugs and alcohol. One out of 10 women at the mission battle with substance abuse issues, Jones said.

“When the system breaks down, everyone on the front lines struggles,” McMinn said. “We struggle tremendously.”

Callison said he expects a large burden to be placed on hospital emergency departments because of inadequate crisis services.

“There will be fewer places other than the hospital emergency department to go if a client is in crisis and needs to be seen immediately,” he said.

Jon Schurmeier, CEO of Pardee Hospital in Hendersonville, said the closing of New Vistas will have a tremendous impact on the hospital.

“My perspective is it’s going to be very difficult. If people are in need of medication, they will turn to us,” he said. “I don’t see how it’s going to go any other way.”

Schurmeier said the hospital will not be handling patients any different than it does now, but the difference is going to be if there’s no reimbursement to cover the cost of the increase in the uninsured needing emergency care.

“We can’t be the answer to this crisis,” he said, “we just can’t be.”

The employees

New Vistas employs 700 people.

Carder said Western Highlands held a job fair for the New Vistas-Mountain Laurel employees, and many of the new providers have interviewed them. Some employees have found new jobs.

Kathy Farquhar, lead community support worker with New Vistas-Mountain Laurel, is one employee who does have a job lined up after the Oct. 31 closing date.

She will transition to LifeSpan and continue to serve clients in Henderson County.

When asked if she had a job lined up, Debbie Hudson, compliance officer with New Vistas-Mountain Laurel, said she isn’t worried as much about her job as she is about patients’ futures.

“To me it’s much more than the job,” she said. “I worry about those clients that don’t have funds to go other places. Those without income or Medicaid will go unserved.”

In turn, Farquhar said the clients are more worried about the employees than about themselves.

“One of the biggest challenges is (clients) will no longer have one facility to come to,” she said.

Firpi, who has Medicaid, will get to continue services with one of her two therapists at the end of the month, but she is still sad to see New Vistas-Mountain Laurel close.

“I’ve never been to a place where you actually get respect. They don’t look down on you,” Firpi said. “These people give you respect. You don’t get that from a regular doctor. These people truly care.”

Since 1982, when a mental health facility first opened at the New Vistas-Mountain Laurel location in Hendersonville, people that needed mental health services could just walk through the door.

About 60 percent of her caseload is state-funded clients, Farquhar said.

“There’s a limited pool available for clients, and it’s shrinking. I’m afraid we’re going to hit the wall,” she said of the overall mental health system, not just what New Vistas-Mountain Laurel is going through.

But losing client services and their jobs are not the only things employees are worried about.

“I’m upset it got to the point we had to sell off assets,” Hudson said.

Callison said four of the five group homes in Henderson and Transylvania counties were sold for $1.1 million. The Hill Park Avenue facility in Hendersonville is the only one that has not been sold.

“We’re in a situation where we’re having to sell assets to meet our obligations to staff, vendors and the folks who are holding debt,” Callison said. “So that’s a difficult part of having to close the organization, but it’s necessary.”

He said the facilities they had to sell, in a sense, have extended the life of a flawed system and essentially paid for services for a period of time. But that way of doing business just couldn’t be sustained.

A fix

Carder said Western Highlands’ focus is getting a new system in place, and in the next several months, Western Highlands will look to make sure this doesn’t happen again in the future.

Local officials are urging concerned citizens to call state lawmakers to voice their opinions.

“The General Assembly needs to revisit this issue of mental health service delivery in North Carolina,” Wyatt said. “We’re not the only region struggling. This is not a county government function, but we’re concerned about our citizens, some of whom have crucial mental health issues. Our rescue mission, domestic violence (agencies), school system, social services, public health are all affected by mental health services or the lack of. So this is a crucial issue, and it is a crisis.”

Sen. Tom Apodaca said it is the state’s responsibility to provide these services.

But McMinn said money is a critical issue to keeping a program up and running, and he wants to see a permanent fix to the problem.

“If (the state) is really going to address it, and they’re serious about it, they need to put major dollars in the program,” McMinn said. “We don’t need another Band-Aid to heal mental health. They continue to make it worse by putting a Band-Aid on a huge wound. (The state) needs to fix it for good this time.”

Apodaca agrees that the issue needs to be permanently fixed.

“It’s gotta be fixed. This is like a train wreck. Every time we get it back on track, something comes back and knocks us off again,” Apodaca said. “Hopefully we can get to where people are being looked after the way it needs to be.”

Contact Stout at 232-5967 or mstout@PISGAHMOUNTAINNEWS.com.





Read more!

Children deserve mental health help before a crisis - Rockford (IL) Register Star

Editorial

In most cases, by the time kids get to Janet Wattles Center for mental health services, there’s already been a crisis. It’s a “casualty-based system,” says Wattles’ executive director Frank Ware.

What if children received prevention and early-intervention services at the first signs they needed care? What if they got counseling and medication in time to enjoy a smoother journey through adolescence into adulthood? What if we didn’t wait for them to become full-fledged casualties?

That is the philosophy behind the new Mildred Berry Center, which is being built just off East State Street near Northern Illinois University’s building. Wattles launched a public fundraising campaign this week to help pay for the new building. When it is finished, it will house all of Wattles’ children’s programs, which currently are being offered downtown at 526 W. State St.

Typically, children get mental health services 12 years after their problems begin, Ware said, and only when the problems can’t be ignored any longer. Treatment usually comes on the heels of one of three crises.

• The child has been thrown out of school for anti-social behavior.

• The child has done something to lead to arrest and incarceration.

• The child has experienced family trauma that results in Department of Children and Family Services intervention.

Prevention and early intervention do not mean labeling children as mentally ill, Ware said. They mean identifying and responding early to behavioral issues and to traumatic situations that put children at risk for emotional disorders.

The move to a new building was motivated by several factors. The downtown building where most of Wattles services are offered is crowded. The center has 4,000 clients, and 1,500 of them are children.

Children’s services are relegated to the basement to separate them from adult services, but the quarters are dark and cramped. The tunnel that’s being built from the new jail on the west to the courthouse on the east of Wattles’ building will go though the children’s service area.

Ware said some families hesitate to bring their children downtown for treatment, as the center is located so close to the jail and courthouse, the city’s largest homeless center and the bus depot. Parking is a problem, too.

The new building will be child-friendly and welcoming to families, Ware promised.

In addition, Janet Wattles is charged with serving Boone County, as well as Winnebago County, and the new building will be better situated to serve those clients.

The new center will cost $5.2 million. Most of the money will be financed, and $1.1 million already has been raised from private sources. Janet Wattles needs an additional $400,000 to make the numbers work. Most of the center’s funds come from the state or from donations. Fees, charged on a sliding scale, produce some revenue.

Neither Winnebago nor Boone county has a 708 tax, as most Illinois counties do, to help pay for mental health services. And so, this capital campaign is the community’s opportunity to step up.

We hope Janet Wattles’ executives will monitor services closely to make sure that the new location and the drive time to get there don’t prove deterrents to clients who live near downtown Rockford or on the city’s west side. It shouldn’t be a significant issue, as about half Wattles’ services to children are delivered in their homes or schools.

Just as the move makes sense for a variety of reasons, so does the shift from the casualty model to the prevention and early intervention model. As a society, we vaccinate to keep people from getting everything from polio to the flu.

Yet, we ignore early predictors of mental illness and wait until people act out with symptoms of serious problems. About half the people in American prisons have a diagnosable mental illness, Ware said.

“You shouldn’t have to go to jail to get mental health services,” he said.

You should act early.
Read more!

Va. Chief Justice scolded for reform effort - Richmond Times-Dispatch

BY BILL MCKELWAY
TIMES-DISPATCH STAFF WRITER
Wednesday, October 18, 2006

A prominent state senator yesterday scolded the chief justice of the Virginia Supreme Court for overstepping his authority in seeking to reform the state's mental-health laws.

The comments from state Sen. Kenneth W. Stolle, R-Virginia Beach, seemed to stun the high court's chief staff attorney, Greg Lucyk, who moments earlier had finished describing the chief justice's effort to a Senate subcommittee that Stolle was heading.

Stolle wondered aloud if the Supreme Court has become an activist body. He warned Lucyk that the high court's role is one of administering the courts and deciding the law, not legislative priorities and spending recommendations.

"The more you talk, the more concerned I become," Stolle said when Lucyk gently tried to rebuff any suggestion that the mental-health-reform commission intends to overstep the legislature's role.

The unusual flare-up came just days after Chief Justice Leroy R. Hassell Sr. told several dozen people involved in mental-health issues to work over the coming year to revamp mental-health laws in Virginia.

"I am truly honored that you have agreed to participate in our mental-health initiative," Hassell said in remarks at the opening session of the commission in Williamsburg last week.

Hassell has been working to get the effort under way for at least a year.

Hassell and University of Virginia law professor Richard J. Bonnie have said they expect legislative proposals to be ready for the 2008 General Assembly session.

Yesterday, Lucyk said the high court's role in the effort has been to convene major stakeholders, not to push spending or legislative priorities to the detriment of other programs.

And in an e-mail response, Bonnie said the commission will "focus exclusively on the way in which mental-health problems affect the courts." He said any recommendations would be developed in partnership with the executive branch and the General Assembly.

Stolle, chairman of the Senate Courts of Justice Committee, said, "I don't think it's appropriate if judges don't like what we are doing with mental health, to tell us how we should deal with mental health.

"I think they ought to inform us on how mental-health issues impact the courts. And not to tell us how to do our job."

Stolle drew the support of at least two other senators, but state Sen. Janet D. Howell, D-Fairfax, who sits on the commission task force with a handful of Republican and Democratic legislators, urged support for the Hassell effort.

"I think the judges are re-activist," she said, rejecting Stolle's activist label. "They have been put in the situation where at every level and at every court, the people with mental illness are confronting the judges. And they don't have the tools for confronting these people.

"I think [the judges] are acting responsibly and reacting to our actions and lack of actions."

Howell said Virginia is in a crisis in which overcrowded jails have become warehouses for the mentally ill. State laws and funds are lacking to properly care for them or to provide community-based care, she said.

Stolle said the reform effort will come down to money and that is the bailiwick of the legislature, not the courts.


Contact staff writer Bill McKelway bmckelway@timesdispatch.com or (804) 649-6601. Read more!

Privacy issue can nullify gun laws - Raleigh News & Observer

Jessica Rocha, Staff Writer

HILLSBOROUGH - Orange County sheriff's deputies responded to a 911 call this spring from the parents of a young man threatening to kill himself.

Deputies found the suicidal teenager, confiscated his shotgun and a journal, and took him to UNC Hospitals for treatment.

After he got out of the hospital, the teen bought a shotgun and a rifle. That summer, he cut down the shotgun's barrel. He built pipe bombs, acquired bags of ammunition, smoke bombs and firecrackers in an apparent plan to execute a Columbine-style attack.

Now Alvaro Castillo, 19, is in jail, accused of shooting his father to death before opening fire on his former high school.

It shouldn't have gotten this far, family acquaintances say.

Despite alarming behavior known to law enforcement, mental health professionals and the courts, Castillo twice walked into a Mebane gun shop and -- legally -- made purchases.

"It's just a shame that someone in that mental condition could get a gun," said Lisa Price, executive director of North Carolinians Against Gun Violence.

Federal law bans certain mentally ill people from owning guns. Since 1968, it has been illegal to knowingly sell guns to a person who has been involuntarily committed to a mental institution or otherwise been found by a judge to be mentally ill.

Castillo was on his way to becoming such a person when law enforcement took him to a magistrate April 20 and started the commitment process.

"[He] stated to his father and family that he was going to kill himself. A shotgun was taken from him, and he left the house," an Orange County deputy wrote in an affidavit and petition for involuntary commitment.

The magistrate agreed Castillo met the criteria for involuntary commitment -- that he was mentally ill and a danger to himself or others.

The sheriff's officers drove him to UNC Hospitals, where a physician found Castillo was psychotic and needed inpatient stabilization. All that remained was an evaluation by a second doctor and a trip to District Court.

But those steps never happened. Instead, Castillo consented to treatment and the state dropped the case. That's where his court record ended.

Getting around law

North Carolina law encourages authorities to persuade people to consent to treatment, even if they are considered dangerous and eligible for involuntary treatment.

But when consent is given, the state loses control over making sure a person is complying with treatment "because you can voluntarily discharge yourself," said Mark Botts, a law professor at the UNC-Chapel Hill School of Government with expertise in issues of confidentiality of mental health records.

The difference between those who get involuntary and voluntary treatment often is small, Botts said. Nevertheless, it has potentially big consequences.

Once Castillo admitted himself to treatment, he preserved his right to buy a gun.

On June 2, he passed a federal background check before buying a Hi-Point 9 mm rifle at the Mebane shop, according to Orange County Sheriff Lindy Pendergrass, and on July 7, he bought a Mossberg 12-gauge shotgun, after passing another background check.

Even if he had been involuntarily committed, however, it's unlikely the federal ban on gun sales to such patients would have kept him from buying the guns.

That's because in North Carolina, it's illegal to share mental health records, including when a District Court judge orders a person to get treatment -- involuntary commitment. So that information isn't entered into the National Instant Criminal Background Check System, an FBI-run database used to screen gun buyers.

"There can be a debate about what kind of mental commitment records should be entered, but right now, the problem is that basically none of them are," said Zach Ragbourn, spokesman for the Brady Center to Prevent Gun Violence, a Washington-based advocacy group.

In North Carolina, the only mental health records that can be shared are open court records: if a person is found guilty of a crime by reason of insanity, for example, or if a judge finds a person mentally incompetent.

As of Aug. 31, North Carolina had contributed 253 mental health records to the federal database -- out of a national total of 290,447 mental health records, according to the FBI's Criminal Justice Information Services Division.

UNC's Botts doesn't think lawmakers intended confidentiality rules to stop records from being used to protect public safety, "but just to prevent [them] from being available to the general public."

The legislature has made exceptions, including for investigations into child abuse or neglect. If they choose, legislators could amend the law to include an exception allowing involuntary commitment records to be added to the federal database, he said.

Data hidden

In 2002, a bill was introduced that would have created that exception. Language contained in a gun-trafficking bill would have allowed involuntary commitment data to be added to the NICS database, and included language to keep the records confidential so only an "accepted" or "denied" would come up in the search.

The bill never came to a vote.

Mental health and gun-rights advocates opposed it, said state Sen. Ellie Kinnaird, D-Chapel Hill, a supporter of the bill and chairwoman of the Mental Health and Youth Services Committee.

Mark Sullivan, executive director of the Mental Health Association in Orange County, said the group supports gun restrictions case by case. But a law barring all people who have been involuntarily committed from possessing guns was "based on a poor understanding of mental illnesses," he said. As a group, he said, the mentally ill are no more likely to be violent than the rest of the population.

Sheriff Pendergrass also questioned using mental health records to prohibit gun ownership. People go through rough patches and then pull through them, he said.

"That's none of your business; that's none of my business," he said. "Time moves along."

Kinnaird acknowledged that it was a complex issue but said she would like to see the state's involuntary commitment records added to the federal database.

"I don't know how many incidents it takes," she said. "The mentally ill person who kills someone is just as much a victim as who they kill or injure."

A sick mind

On the morning of Aug. 30, Castillo's father, Rafael Huezo Castillo, was shot seven times, probably as he was sitting in his shorts on the living room couch, according to the autopsy.

In a videotape and letter Castillo is thought to have made leading up to the school shooting, which he mailed to the Chapel Hill News, Castillo tries to explain how sick he is.

"I want the world to look into the mind of a depressed and traumatized individual," he wrote.

After saying he just shot his father, Castillo speaks into the camera, saying he feels no remorse. In the letter he writes:

"I will die. I have wanted to die for years. I'm sorry."
Read more!

Court master OKs Maine compliance plan - AP

By Associated Press

AUGUSTA, Maine -- The state on Monday began implementing a newly approved plan to deliver mental health services in the state, bringing it closer to full compliance with a court decree, Maine human services Commissioner Brenda Harvey said.

The 101-page plan was approved Friday by former Maine Chief Justice Daniel Wathen, who is now court master overseeing the state's compliance with a decree that sets guidelines for services for the mentally ill.

The 1990 consent decree resulted from a class action suit claiming that Maine had failed to provide adequate care for patients at Maine's former state mental hospital, the Augusta Mental Health Institute. AMHI has been replaced by the Riverview Psychiatric Center, also in Augusta.

The newly approved plan, which has been in the works since 2003, establishes a new structure for mental health service delivery in Maine. It focuses on community service networks, performance requirements, flexible services and housing, and consumer councils and peer services.

Harvey said it also includes something that's been missing in the past: a process or checklist to make sure the state complies with its service delivery plan.

"It doesn't get us out of the consent decree, because we still have to demonstrate compliance," said Harvey, who heads the Department of Health and Human Services.

Harvey said it also marks the first time the state, the attorney for plaintiffs, mental health consumers and service providers have all agreed on a comprehensive service delivery plan.

The new plan includes "a lot of enhancements of things we already do," said Harvey. She described the timetable for implementation as "aggressive."

"But people are so eager to implement it, there's a sense of energy around both the plan and the opportunity to make it happen," said Harvey. "It's time to put away the pens and pencils, to roll up our sleeves and get to work."

Read more!

Mental health transition rocky - Asheville Citizen-Times

By Leslie Boyd
LBOYD@CITIZEN-TIMES.COM
October 16, 2006

ASHEVILLE — As the closing date for New Vistas-Mountain Laurel Behavioral Health Services nears, county officials and the local mental health management entity are scrambling to maintain continuity of services for 10,000 people in eight counties.

Meanwhile, service providers are struggling to gear up for all the people who need services.

“Some employees are looking for the best deal,” said Arthur Carder, CEO of Western Highlands, the management entity for the eight counties served by New Vistas. “Most of them are most concerned with the consumers, but there are those who are holding out for the best deal.”

At Horizon Recovery Inc. in West Asheville, about a dozen employees walked off the job last week without notice.

Paul Kessler, director of Horizons, said he had a disagreement with the leaders of his two assertive community treatment teams and suspended them for a day.

“They never came back and neither did the members of their teams,” Kessler said. “They served 80 clients, and I have to replace them fast.”

Kessler believes the chaos created by the closing of New Vistas allowed the two teams to walk out because they knew they would be able to find jobs quickly.

“Unfortunately, this is what we’re seeing in some places,” Carder said. “Agencies are taking employees from other agencies and it just adds to the instability.”

Carder and others say they do not expect New Vistas to be able to provide services until Oct. 31, so they are working to have new providers in place immediately.

“New Vistas-Mountain Laurel can’t do what it has to do already,” Carder said. “There was an incident in Transylvania County where someone was suicidal and they were referred to New Vistas-Mountain Laurel and when they got there, no one was there.”

For months now, patients have had to wait eight weeks for an appointment with a psychiatrist.

Carder said anyone with an emergency can still call the emergency number and be referred to services.

Some of those providers recruited to replace the services of New Vistas feel pressured to take on more than they wanted.

At Mainstay, the domestic violence agency in Hendersonville, director Tanya Blackford said her agency will take on a piece of it. Mainstay will offer a couple of specialized beds at its shelter and contract out for mental health services.

“I’d really be happier withdrawing my application to provide mental health services,” she said. “It’s not our mission, but somebody has to do it or people will go without. I don’t want the money we asked for, but I have to do it because I have to make sure our people are safe.”

Carlos Gomez, director of WNC Community Health Services, believes his clinics will see 500 to 700 new patients for mental health care in the next year.

“We’re picking up some of the pieces,” he said. “It is a burden. We’re having to stretch a lot in a very short time. … We’ve had to make decisions about how much of a load we take on so we don’t buckle under the load.” Read more!

Texas advocates: illegal group homes on rise - AP

AUSTIN -- Mental health advocates say the number of cheap and usually illegal group homes for the poor and mentally ill are on the rise in Texas.

"They wouldn't be there unless people were making money," Jeff Garrison-Tate, a policy services manager at Advocacy Inc., said in a story in Sunday's El Paso Times. The organization is an advocate for Texans with disabilities. "I don't think that many people would do it out of the goodness of their hearts."

There's no clear figure on how many unlicensed group homes exist in the state or how many people live in them because no single agency oversees those types of homes, the newspaper reported. Some experts have estimated there are at least 4,000 such unlicensed homes with as many as 60,000 residents.

The Texas Department of Aging and Disability Services, which is responsible for licensing assisted-living facilities and investigating unlicensed facilities, says it is enforcing laws and there isn't a problem with unlicensed facilities in the state. It says there are fewer than 300 problem homes statewide.

Dallas police Lt. Kimberly Stratman estimated there are at least a dozen unlicensed homes in the Oak Cliff area, some with as many as 15 residents.

The home operators "just shove them in a filthy dirty room. Their belongings aren't protected. They're not protected and they just wander," she said.

Stratman said her officers, who work from 3 p.m. to midnight, either respond to a call from one of the unlicensed homes or come in contact with a resident about 35 times a week.

"It's low-level crime, but it still requires response from us," she said.
Sixteen schizophrenic men allegedly lived in less than 500 square feet of space with one bathroom at an El Paso home, according to testimony at a public hearing. And San Antonio officials found at least six unlicensed homes within blocks of each other, the newspaper reported.

Mental health advocates say unscrupulous owners of unlicensed homes often become the payees for their clients' Social Security and Veterans Affairs payments. Most of the money goes for rent and little is left for food, clothing or medicine.

"The question always comes back to what's worse," Garrison-Tate said. "And we shouldn't be arguing about what's worse; we should be talking about ways to make it better."

"We're finding a large number of boarding homes in which they are pretty nasty," said Ron Cowart, who supervises programs for the city of Dallas that help the homeless. "They are so bad that even a person taking medication becomes so despondent they go back out in the streets."

A task force is developing recommendations for regulating the unlicensed group homes.
Cowart said one problem is determining which agency oversees the homes.

The state Department of Aging and Disability Services can only get involved with private boarding homes if the operator is found administering medicines and therefore falls under the state's assisted-living regulations.

Cowart said not all unlicensed homes are terrible. He said the good ones are a valuable housing resource. He said he hopes to create a list of good homes where people needing safe shelter can be referred by crisis intervention teams, homeless shelter operators and mental-health workers.

"Those people who are not compliant would stick out like a sore thumb, and we'll be able to close them down," he said. Read more!

Postpartum psychosis and mental illness in Appalachia - The Buffalo News

By KAREN BRADY
News Book Reviewer

Adrienne Martini goes where many writers would fear to tread in "Hillbilly Gothic: A Memoir of Madness and Motherhood."

While bravely reliving her own experience with postpartum psychosis, she steps into even more-forbidden territory, tracing a tendency toward mental imbalance in her own family and, by extension, parts of Appalachia.

"Isolation has long been the hallmark of Appalachia," she writes. "Before the era of reliable transportation, entire generations could be born, live, and die without ever clapping eyes on a stranger's face. . . "Deliverance' does not exist in a vacuum."

Her mother's family "springs from this setting," Martini says:

"The isolation and suspicion that inform the region also inform generations. It is coded in our genes like brown hair. For decades, outside help was never sought. Nor was it even imagined to be needed. My family tree kept growing inward . . . "

It is a grim chain of illness that Martini seeks to break here, and she goes about it with astonishing candor, courage - and wit.

"My family has a grand tradition," she notes at the book's start. "After a woman gives birth, she goes mad."

Martini - happily married and working on a weekly newspaper when we meet her - has her inadequacies and her quirks but had assumed she would be the family member to escape the postpartum "blues."

"How tricky can a baby be?" she asks herself as she and her husband leave a Knoxville, Tenn., hospital with their firstborn.

Darn tricky, she discovers, but Martini doesn't realize that she is in deep trouble with it till days later when she attends a wedding and finds it "hard not to grab people I know by the shoulders and scream at them to help me."

She leaves the wedding "tired from holding up my damn mask, the one that makes it look like I'm OK," soon after checking herself into "Tower 4, a local psych ward."

"During my colorful confinement, in a conversation with a social worker, I described the hillbilly Gothic patchwork of suicides, manic depression and bipolar disorders that is my mother's family and (a) notable suicide attempt on my father's side," she recalls.

Moreover, Martini says, "I wasn't the first of my generation to log some time in the loony bin" - which she calls "my family's version of summering in the Hamptons."

Blunt, irreverent and probably offensive to legions, Martini always makes her point. Here, it is simply that, as she finds out, most new mothers "are responsible, reasonable adults who need to be less ashamed to admit that we struggle sometimes."

In asking for help, she sees that she did the mature thing - thereby stopping a runaway train, bringing some order out of chaos and realizing that, with treatment, there are "unseen benefits of losing your mind."

What is striking here is Martini's level of candor, sparing no secrets, her own or her family's or Appalachia's, and all the while maintaining a certain dignity for everyone concerned.

She is particularly fine at portraying the microcosm that is a psychiatric unit, housing a cross-section of society and some of the world's most unusual people.

She calls the first doctor she sees "Spalding Gray's doppelganger" and notes that "he and the nurse must have gone to deadpan school together."

But in only a few days, she is less aware of appearances and behaviors of the staff and patients in this "nut hatch" than of the individuals behind these human curtains.

"People are interesting, even when you're not at your best," she notes.

She also learns that her illness is "a disorder of mood rather than a disorder of thought," and that her "feelings are real and not just something I can get over with a Protestant backbone and stiff upper lip."

Martini begins to get her bearings and sees other people doing the same.

"While I did not believe it at the time, Tower 4 was exactly where I needed to be," she says. "Everyone, mentally or no, could benefit from spending some time up there."

Knoxville's Chamber of Commerce may never give Martini an award for this book, but it takes place primarily in the Knoxville area. The picture she paints of the city's "point of playing up its hillbilly character" of today is riveting:

"Just down the road from the city is the region's true spiritual center, where Dolly Parton's theme park and tacky-ass Gatlinburg meet in an unholy amalgam of shops, Thomas Kincaid paintings, tattoo parlors and "family entertainment' . . .

"The Aunt Granny's eatery is a must-visit on the park's grounds, where you can get fried chicken, greens and biscuits while pondering what shape a family's tree must be in to have an Aunt Granny."

Martini's mother's family objects to her book's title, she says, its members telling her, "We're "mountaineers.' Not "hillbillies.' "

But to Martini, "Hillbilly is a perfectly fine word, one that captures the resourceful, gritty people who settled in the southern Appalachians and made unforgiving landscapes thrive while providing for the rest of the country."

Martini clearly loves the mountains - which she describes at one point as never changing, "cutting across the landscape like rugs bunched up on hardwood floors."

The mountains "will always keep you safe," she says at the book's end. "They are constant and true, like a loyal dog. You just have to learn to meet them on your own terms."

Just as Martini learns to meet her illness, and as her book like the mountains is much larger than one woman's story.


Karen Brady is a former News columnist.
Read more!

Florida Agency Told to Aid Mentally Ill Inmates - AP

ST. PETERSBURG, Fla. (AP) -- A judge threatened the state Department of Children and Families with thousands of dollars a day in fines if it does not begin taking in mentally ill jail inmates, as required by law.

Florida law requires the agency to move county jail inmates found incompetent to stand trial to treatment facilities within 15 days. But law enforcement officials and inmate lawyers across the state say the agency's inaction has left many languishing in jail for months.

In one of the toughest rulings on the issue, Pinellas-Pasco Circuit Judge Crockett Farnell said Friday that he will fine the agency $1,000 a day for each mentally ill inmate who remains in the Pinellas jail longer than 15 days. He may also require placement in more expensive private treatment facilities.

"This type of arrogant activity cannot be tolerated in an orderly society," Farnell wrote in a ruling in favor of public defenders representing several inmates.

Farnell set a Nov. 16 hearing to check on the agency's progress. There are now about 30 mentally ill inmates in the Pinellas jail who should have been moved to state mental health facilities weeks or months ago.

The Department of Children and Families said it will appeal the decision. The agency said the 1,300 beds available in its current budget are inadequate to meet the demand.

"It's a matter of trying to catch up and trying to work with the legal system to try to find a way to at least find a temporary solution to this problem," agency spokesman Al Zimmerman said. "We are very eager to work with the judicial system to solve this problem."

Officials around Florida are becoming impatient. In the Panhandle, for example, a judge threatened to have a mentally ill inmate dropped off at department Secretary Lucy D. Hadi's office if the agency couldn't find a hospital bed.

Read more!

Henderson County to discuss mental health options-PisgahMountainViews

Henderson County to discuss mental health options
Melissa Stout
published: October 16, 2006 11:53 am
Contact Melissa Stout at 828-232-5967 or via e-mail at mstout@CITIZEN-TIMES.com.

HENDERSONVILLE - Arthur Carder, CEO for Western Highlands Local Management Entity, will make a presentation about the latest on mental health providers to accommodate for New Vistas-Mountain Laurel closing at Wednesday's Henderson County Board of Commissioners meeting.

The commissioners meet at 9 a.m. in the Commissioner’s Meeting Room, 100 N. King Street, Hendersonville.

Henderson County Manager Steve Wyatt said the county is also working with Western Highlands on how the county can best use the $528,402, the amount of money the county was required to budget Maintenance of Effort Funds and the amount the county was spending on mental health before the state reorganized mental health.

Carder is also expected to make recommendations for the county money at the meeting.

New Vistas-Mountain Laurel, a private non-profit mental health safety net provider for eight Western North Carolina counties, is closing Oct. 31.

PisgahMountainViews Read more!

Stereotypes mean older men less likely to seek help - University of California, Davis

A man's stereotypical self-image as the “strong, silent type” and the stigma of depression are major reasons why older men are less likely than women to be referred to studies of depression, to seek treatment for depression, and to recognize and express symptoms of depression, according to clinicians and recruiters interviewed for a new study from the UC Davis Department of Psychiatry and Behavioral Sciences.

The study provides some of the strongest evidence to date that depressed older men are less likely than women to receive treatment for their depression, underscoring the importance of these barriers.

Among some older men, the study found, traditional views of masculinity and the stigma associated with mental illness lead to a tendency to reject a diagnosis of depression, and to conceal or mask symptoms of the condition. Authored by UC Davis associate professor of psychiatry professor Ladson Hinton, the study appears in the October 2006 edition of the American Journal of Geriatric Psychiatry. The study contributes further evidence to gender disparities in depression care documented in previous studies, and identifies reasons for these disparities.

The findings are important in the arena of public health because of depression's association with suicide in older adults. Older men have higher rates of completed suicide: 31.8 per 100,000 in men age 65 and older, compared with 4.1 per 100,000 in older women. The reasons for gender disparities in depression care among older adults are poorly understood, the study states.

Among the reasons found in prior research are more negative attitudes among men toward seeking help for mental health problems, lower disclosure rates of depressive symptoms, lower rates of health service use, and more “atypical” presentations of depression. However, the problem of under-treatment in older men has received little focused attention.

For their study, Hinton and his research team examined the data from a large, multisite study of a disease management program for late-life depression in primary care, called IMPACT (Improving Mood: Providing Access to Collaborative Treatment for Depression). The IMPACT participants were 1,800 adults 60 and older with major depression or dysthymic disorder from 18 primary care clinics, affiliated with eight health-care organizations in the United States.

The UC Davis researchers analyzed gender differences in history of depression treatment, as well as referral rates and symptoms. To better understand lower rates of depression treatment and referral to IMPACT of older men, the researchers also conducted qualitative interviews with 30 key individuals connected to IMPACT, including referring physicians, depression care managers and study recruiters, to learn about the challenges in recruiting and treating depressed older men.

Hinton and his team found that, compared with older women, older men were much less likely to be referred to IMPACT, to recognize and describe symptoms of depression, and to have received prior treatment for depression. The interviews identified factors that were important contributors to the gender disparities: the manner in which men experience and express their depression, traditional masculine values, and the stigma of depression.

The IMPACT interviewees reported that older men experience and express their depression in ways that do not fit well with diagnostic criteria, making a diagnosis more difficult. Some of the IMPACT principals speculated that older men “might have more difficulty accessing and recognizing their feelings,” while others believed men were “actively trying to conceal or mask their depression.” For example, one primary care provider, when asked if men present their depression differently from women, said, “They try to hide it, basically, whereas women are more open and they come and talk … because it is their nature for some reason.”

“Because older men tend not to endorse depressed mood or sadness, they were often felt to be more reluctant to accept the diagnosis of depression and the treatment recommendations,” stated the UC Davis study.

Older men often described as “old school” or the “John Wayne type” were considered difficult to diagnose and treat “because they perceived the cultural meaning of depression to be in conflict with their own view of themselves as men,” the study says. It noted that “clinicians made a direct connection between more traditional views of masculinity and difficulties with diagnosis and referral to specialty mental health.”

One of the IMPACT clinicians said that in her view, “'giving up' these core masculine views … was an important step in the treatment process.” Another physician reported that some older men “just do not think that tough guys go talk to psychologists or psychiatrists, and fool around with that type of monkey business.”

The association of depression with severe mental illness, or “craziness,” was another barrier to care, although it was cited less frequently than the other obstacles. One depression care manager cited stigma to explain the greater tendency of men to express their depression in physical rather than emotional terms. The manager said, “They will not say, ‘I feel sad' or ‘I feel depressed.' They'll say, ‘I have a stomach ache.'” A primary care physician described a depressed and psychotic older man who was expressing suicidal thoughts, but nevertheless was unwilling to see a psychiatrist because he feared it would “mark him as crazy.”

Hinton and his team state that their findings suggest future avenues for education and intervention for older men with depression. When dealing with more traditional older depressed men, clinicians may need to tailor standard educational approaches to directly address the attitudinal barriers identified in the UC Davis study. One such initial approach might be to de-emphasize professional labels and place more emphasis on symptoms and sources of stress. Health-care providers interviewed by the UC Davis researchers suggested other strategies, such as using an open-ended interview style, using less direct or clinical (i.e., threatening) language to discuss depression, and involving family in all phases of treatment.

The researchers acknowledge that their study “should be considered as exploratory and hypothesis-generating because of the modest number of interviews conducted.” An expanded study “with a more representative sample of clinicians and patients would be likely to deepen our understanding” of the themes identified in the study, and to identify other important factors.

“The public health importance of improving care for depression among older men is clear,” the study states. “Older men experience higher rates of completed suicide than any other age and gender group. Because depression is one of the most important suicide risk factors, elucidating gender-specific aspects of depression care has the potential to reduce this disparity, close the gender gap in depression treatment, and lessen the enormous burden of suffering for older adults and their families.”

The second author on the study was Mark Zweifach, a psychiatrist from Kaiser Permanente, Southern California. Other collaborators on the study were Sabine Oishi and Lingqui Tang, both from UCLA; and Jurgen Unutzer, from the University of Washington. The study was funded by the John A. Hartford Foundation and the National Institute on Aging.

The American Journal of Geriatric Psychiatry, published monthly, is the official journal of the American Association for Geriatric Psychiatry and can be found online at http://www.AJGPonline.org.

University of California, Davis, Health System
4900 Broadway, Ste. 1200
Sacramento, CA 95820
United States
http://ucdmc.ucdavis.edu Read more!

Auto Pioneer's Suicide Inspires Research On Bipolar Disorder - University of Michigan

One morning five years ago, the automotive industry was shocked by the suicide of one of its brightest stars, Heinz Prechter. He killed himself despite seeming to have it all: a successful company he had built from nothing after coming to America, a beautiful and intelligent wife, growing children, and dozens of friends.

But in fact, Mr. Prechter had something else, which almost no one else knew about: the mental illness called bipolar disorder, formerly known as manic depression. His moods would swing from extreme happiness and boundless energy to deep, dark, depressed lows. During one of those lows, he took his life.

In other words, bipolar disorder killed Heinz Prechter.

Today, the tragedy of his death is driving scientists at the University of Michigan Health System and elsewhere to perform research that should give hope to the 5.7 million Americans who have bipolar disorder, and to their loved ones.

Because bipolar disorder runs in families, the scientists are focusing on studying genes. By collecting DNA samples from thousands of people with the disease, and comparing it with DNA from people who don't, they hope to find out what puts someone at risk of bipolar disorder, and how to improve diagnosis and treatment.

Hundreds of bipolar patients and healthy comparison volunteers are still needed in order to make those discoveries possible. Each volunteer gives a small blood sample and agrees to be interviewed each year.

The scientists are getting help from Mr. Prechter's wife, Waltraud, known as Wally. She has given substantial money and effort to build the DNA “bank,” called the Prechter Genetic Repository, and to fund research projects and raise awareness.

Out of her family's sorrow, she hopes, will come real advances in identifying the combination of genes that make someone susceptible to the disease that took her husband. And with those discoveries, she hopes, the stigma and secrecy that surround bipolar disorder will evaporate.

“I had lived with Heinz for 24 years, and experienced what he went through. I had an idea what other people with bipolar disorder are going through, because if you're not in those shoes, you don't know,” she says. “And I wanted to do something about it. I wanted to change the way we look at that illness and help change the way we treat people who have it, bring it to the forefront and help fix it, once and for all.”

One of the leaders of the bipolar research effort is Melvin McInnis, M.D., a U-M psychiatrist and geneticist, and member of the U-M Depression Center. He holds the Nancy Upjohn Woodworth Professor of Bipolar Disorder and Depression chair at the U-M Medical School.

“The genetics of bipolar disorder is something we've known about for almost a hundred years, because in essence it appears to run in families. But what we really do not know is what exactly is inherited, how it is inherited, and the mode of transmission between generations,” he says.

The Prechter DNA project is trying to identify specific differences within genes that might work together to make a person more likely to develop bipolar disorder - or more likely to have frequent or severe “manic” and depressed episodes over the course of their life. The scientists also are looking for genes that might make someone with bipolar disorder more likely to have lifelong depression at the same time.

This, in turn, could help lead to tests that could tell doctors which medications might work best for each patient, and keep them balanced and well over the long term. It may also lead to blood tests to help identify which members of a family are most at risk of developing bipolar.

“We have a number of treatments for bipolar disorder, and for many patients, these treatments are very effective,” including drugs like lithium, says McInnis. “Unfortunately, there are a large number of patients for whom these treatments are not effective. Probably 30 to 50 percent have a very difficult time with their treatments,” whether it's because they don't do enough to ease the bipolar episodes, or because they cause side effects.

That lack of effective treatment is a big reason for the high risk of suicide or suicide attempts among people with bipolar disorder, McInnis says. Like Heinz Prechter, anywhere from 5 to 15 percent of bipolar patients will attempt or commit suicide sometime in their life.

Many people with the disease also suffer horrible social consequences during their manic and depressed phases. Half of people with bipolar disorder have some sort of alcohol or drug abuse problem, and many have trouble with relationships, including a high rate of divorce. During manic periods, patients may take financial risks or make extremely large purchases that they can't afford, leading to economic troubles down the road.

But the manic episodes also can have their upsides, especially in people such as Heinz Prechter who have the “hypomania” variety of bipolar disorder. Such patients don't experience quite as “high” a mania as others, and may appear to others as just especially energetic and driven.

“Heinz was very imaginative, he had great business vision, and could think out things that other people could not imagine. He was very blessed with a lot of gifts,” says Mrs. Prechter. “ When I first met him, I remember him being extremely exuberant and happy, and very, very optimistic, to the point that I thought, ‘Wow, I've never met anyone like that.'”

But when depression struck, as it did shortly after Mrs. Prechter became pregnant with the couple's twins, it was deep. “It affected his whole being, his thinking, acting, behavior, to the point that he would stay home and just sit in a chair and look out at the river, or want to stay in bed all day.”

That memory of her brilliant husband reduced to such a low, and unable to tell anyone what he was going through, is part of what drives her today, she says. “It think it's very important to come forward and talk about it, just like we talk about other illnesses. Let's come up with solutions to help people have a better quality of life, like anyone else who has any other physical illness, like cancer, diabetes or heart disease. Bipolar disorder deserves the same urgency as all these other illnesses.”

She adds, “My husband wanted to make a difference in his life, and if I can leave that for him in his legacy, I think that's important.”

Facts about the Prechter Genetic Repository and the Heinz B. Prechter Bipolar Research Fund at the University of Michigan Depression Center:

-- In addition to U-M researchers, the fund has supported research at Stanford University and Cornell University.

-- The repository has expanded with the addition of genetic samples and data from 1,500 patients collected by Johns Hopkins University researchers, who will now work with the other Prechter-funded researchers. The repository can be used by other scientists, too.

-- Many more DNA samples are needed, both from people who have bipolar disorder and from people without the disorder, no matter whether they have loved ones with bipolar.

-- Giving a DNA sample involves allowing the research team to take a small sample of blood. Volunteers are interviewed at the start of the study, and annually after that, about their health, mental well-being and other issues.

Facts about bipolar disorder:

-- Bipolar disorder was once called manic depression, but the term “bipolar disorder” is more accurate and more commonly used today.

-- The main characteristic of bipolar disorder is major swings in mood, which can occur off and on throughout life. These can alternate between manic “up” or “high” periods, and depressed “down” or “low” periods.

-- During “up” swings, people with bipolar disorder experience increased energy and restlessness, extreme irritability, racing thoughts, distractibility, little need for sleep, poor judgment, spending sprees, and denial that anything is wrong.

-- During “down” swings, they will often experience lasting sad, anxious or empty moods; feelings of hopelessness or pessimism; feelings of guit or worthlessness; loss of interest or pleasure in activities they once enjoyed; decreased energy; insomnia or need for a lot of sleep; chronic pain not caused by illness or injury; and thoughts of death or suicide.

-- More than 5.7 million Americans, or 2.6 percent of the population, are estimated to have some form of bipolar disorder. Some experience the form called bipolar I, in which episodes of mania and depression alternate; many more have bipolar II, which features less-intense manic episodes called hypomanias. People who experience four or more episodes in a year are said to have “rapid cycling” bipolar disorder.

-- Bipolar disorder runs in families, and children whose parents have it are at an increased risk of developing it themselves. This is why scientists are looking for genes that might be handed down from generation to generation, and play a role in putting a person at risk.

-- The drugs lithium and valproate are the most common treatments for bipolar disorder, but mood-stabilizing medicines, antidepressant medications, anti-psychotic medications and talk therapy also help. Once a person finds a treatment that works for him or her, it's important to take that treatment regularly, even when symptoms aren't present. Regular sleep habits, exercise, meditation and other lifestyle steps can also reduce the impact.

-- Suicide, or suicide attempts, are unfortunately a common occurrence among people with bipolar disorder. People who talk about wanting to die, feeling like nothing will ever change or get better, feeling that nothing they can do will make any difference, feeling like a burden to others, or who abuse alcohol or drugs, give away possessions, or put themselves in dangerous situations, are likely experiencing suicidal feelings and need immediate help.

University of Michigan Health System
2901 Hubbard St., Ste. 2400
Ann Arbor, MI 48109-2435
United States
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Faith in mental health system is misplaced - Concord (NH) Monitor

Accurate assessment may have saved my son's life

By KAREN CZAJKOWSKI
For the Monitor

My heart goes out to the Gauntt family on the loss of their loved one.
I can sympathize with the frustration they feel over the ability to get Bruce psychiatric help, and completely agree with Kelly Gauntt's statement that mental health professionals "need to take another look at what does meet criteria."

Six years ago next month, we took our 18-year-old son to the emergency room of Concord Hospital because he was suicidal. The Riverbend mental health worker who saw him insisted Matt could not be hospitalized because, in his opinion, Matt presented no danger to himself or others.

This, despite the fact that our son had been in the emergency room only four days before after ingesting rat poison, had threatened to use his paycheck to go out and buy a gun, had not been eating or sleeping for days, was in the demographic most at risk for suicide (teenage males) and had been brought to the emergency room at the recommendation of two police officers.

When the Riverbend counselor told us Matt presented no danger to himself, I asked him repeatedly to explain the criteria he was using to reach that conclusion. He refused to answer me.

---ADVERTISEMENT---

Three days later, our son took his own life.
After Matt's death, I requested Riverbend's records. I was then able to read the "lethality assessment" forms that the counselors filled out.

These forms were used to determine the risk level involved by checking off various conditions that might apply under low, medium or high risk.

An overall rating was then made, determined by the number of checks under each column.

The first time we took Matt to the emergency room, the counselor didn't bother to fill out the lethality assessment.

On the second visit, four days later, the counselor checked two conditions as "high risk" (multiple previous attempts and a recent significant loss), two as medium risk and four as low.

The low-risk category won out numerically, but three of the four conditions checked were that (1) he didn't have a "suicide plan," (2) a "where" or (3) a "when." In addition to the lethality assessment, the form contained a "mental status" check.

The two forms combined had our son as being agitated and angry, impulsive, depressed, prone to anxiety and panic, and experiencing sleep disturbances and impaired judgment.

Yet, according to Riverbend, he posed no danger to himself.

After reading these records, I filed a complaint with the Mental Health Board asking, among other things, for someone to look into how Riverbend trains its staff and what qualifications the counselors have who attend the emergency room.

Ironically, on the very day I sat down to write this letter, I finally received the board's answer, 5½ years later. While the board is very sorry about the loss of my son, it found no reason to pursue my complaint any further.

Louis Josephson, the CEO of Riverbend, wishes "we had more resources to throw at people" and concedes that "There are some gaps out there."

Considering that these "gaps" result in death, perhaps it is time for local mental health professionals to do an assessment of their own.

(Karen Czajkowski lives in Webster.)



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Community mental care 'lacking'-BBC News

Mental health patients face inadequate community services, extremely long waiting times and some may never get specialist care, a report has claimed.

This is because too much money has been spent on long term hospital stays and compulsory treatment, the think tank Reform says in its report.

It is calling for choice and competition to cut waiting times dramatically for the "vast majority".

NHS managers said shortages of expert staff was a big barrier to this.

Similar concerns were raised by the Healthcare Commission in September. Its review of 174 mental health teams in England found gaps in out-of-hours care, talking therapies and access to information.

The latest report, by Nick Bosanquet, Professor of Health Policy at Imperial College London and others, says choice and competition will allow an efficient redeployment of resources and enable patients to regain independence.

Reform also said that the prescribing of modern drugs was insufficient.

Between 1999-00 and 2003-04, spending on inpatient, outpatient and day patient services rose by £1.1bn.

This compared to an increase of only £400m for community mental health and illness nursing, says the report.

Choice agenda

Researchers believe that the modern model of mental health care, which involves early intervention, community support, reduced admission and help finding jobs, can be delivered through choice.

Reform claims the postponement of the introduction of payment by results for mental health services has been a major setback.

It recommends making much more use of direct payments for patients who are reaching the point of discharge, and rehabilitation and for those needing therapy in the community.

Prof Bosanquet said: "Mental health services have been left out of the mainstream of NHS policy for too long. Modern thinking has not been applied to a key illness of modern society.

"The application of the health reform principles will bring benefits to some of the most vulnerable of NHS patients. Unless mental health services use the reform incentives funding pressures will see community services further undermined."

Nigel Edwards, director of policy at the NHS Confederation, said: "We would welcome more choice in mental health.

"However, one of the biggest barriers to creating choice in this sector is the shortage of specialist staff."

He said developing a system of payment by results for mental health was a big challenge.
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Mental illness ‘costs Scotland £8bn a year’-SundayHerald

Mental illness ‘costs Scotland £8bn a year’


By Judith Duffy, Health Correspondent


THE social and economic cost of mental health problems in Scotland amounts to around £8.6 billion annually – equivalent to nearly the entire NHS budget this year.

A new study, which is due to be published next month, will reveal for the first time a comprehensive assessment of the burden of mental illness north of the Border. Researchers took into account not only the costs associated with care and lost working days, but also the human cost of a reduced quality of life.

The staggering figure has prompted renewed calls from experts and politicians for more resources to be targeted at services, both to improve the lives of sufferers and to prevent Scots from developing mental illness in the first place.

SNP health spokeswoman Shona Robison said: “Mental health is supposed to be one of the key clinical priorities, but it is still very much the Cinderella service.”

The study, commissioned by the Scottish Association for Mental Health (SAMH), was carried out by the Sainsbury Centre for Mental Health. Shona Neil, chief executive of SAMH, told MSPs on the Scottish Parliament’s health committee earlier this month that the initial findings indicated the social and economic cost of mental health problems in Scotland was around £8.6 billion during 2004-5.

Expenditure on health and social services accounted for just under 18% of the total, with other costs including those of lost work and welfare benefits. The report also calculated a monetary value for the reduced quality of life experienced by people with mental health problems to show the human costs of pain, disability and distress.

Dr Alison Blair, chair of the public affairs committee of the Scottish division of the Royal College of Psychiatrists, said the results were unsurprising.

“If you look at a patient going on a journey of care with a significant illness, it has an impact on their family, it can involve police, emergency services, primary care services and secondary care services,” she said.

“I think we grossly underestimate the impact. People have a certain amount of denial about the reality of mental illness.”

Blair said that the level of investment in services was a major concern, citing the example of conditions in hospital wards for mentally ill patients.

“The conditions of acute inpatient units we feel are certainly not on a par with a physical illness acute inpatient unit,” she said.

The Mental Health Act, which came into force last year, aimed to improve care and services for people with mental illness, with the expectation that they should be helped to live as full a life as possible in the community.

But Isabella Goldie, head of Scotland for the Mental Health Foundation, questioned whether extra cash to support the new legislation was enough. She said: “Health boards have had a pot of money, but it is not recurrent, so whether it is going to be sufficient is a major concern.”

Goldie also warned that far more effort had to be invested in preventing people from developing severe mental illness in the first place.

“We are only just starting to think the cost and the burden of these illnesses is major and that we need to think about preventing people from becoming unwell in the first place,” she said.

A spokeswoman for SAMH said the latest report would be launched at the Scottish parliament in November and that they were unable to comment further on the findings until then.

The Scottish Executive is due to publish a national mental health delivery plan by the end of this year, which will set a timetable for change of Scotland’s mental health services.

Health minister Andy Kerr said: “Improving mental health services in Scotland remains a top priority for us and we are investing more resources than ever before in the NHS to do this.”

15 October 2006
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Mental illness is hell. Don't diminish it-The Sunday Times

Mental illness is hell. Don't diminish it
Minette Marrin

Last Tuesday was World Mental Health Day and in this country a couple of attention-seeking politicians have been holding forth about mental illness, which is what the phrase mental health now means.

David Blunkett, in his self-pitying diaries, confessed that while a cabinet minister he had been “clinically depressed” during his deluded affair with a society minx. Alastair Campbell shared with the nation his experiences of a psychotic breakdown in the 1980s, when he was arrested for driving the wrong way round and round a roundabout and sent to hospital, and also his deep depression in Downing Street at the time of Dr David Kelly’s famous suicide.

This only confirms one’s worst fears that new Labour has for a long time been in the grip of a collection of unstable chancers. One only has to think of the neurotically disabling mutual loathing of Tony Blair and Gordon Brown

I had not realised that Campbell was subject to periods of depression, still less that he had suffered a psychotic collapse. I had only known he was an alcoholic. But his revelations do a great deal to explain his alarming behaviour when in power. Reports of his conduct constantly suggested extreme aggression, paranoia, ill-controlled anger and an eccentric attitude to truth, which one might expect of someone prone to mental disorder. The deep depression he described at the death of Dr Kelly can only, for someone in Campbell’s awkward position, be seen as normal. Otherwise one can all too easily appreciate that he may suffer intermittently from mental illness.

Blunkett’s claim to “clinical depression” is less easy to accept. It is hardly surprising, in a painful intrigue with a married woman, involving a disputed baby or two and a huge threat to one’s political ambitions, that a man might feel a bit low. That would be normal. But this phrase “clinical depression” is thrown around too vaguely, and indeed its meaning is rather vague.

The truth is that anything more than mild to moderate depression is seriously debilitating. It would involve, among other things, a sense of futility and self-loathing, impaired judgment, impaired relationships with other people, mild paranoia, a loss of drive and energy, indecisiveness and chronic fatigue, precisely what one would not want in a cabinet minister, or a surgeon or head teacher for that matter.

Perhaps Blunkett did not feel quite as bad as all that. After all, he says he refused the offer of antidepressant pills. But if he was more than mildly depressed, he should certainly have resigned or have been told to stand down, and so should Campbell. People in the grip of mental illness can’t function properly. They should most certainly not be doing extremely responsible and demanding jobs.

Yet both Blunkett and Campbell have praised Blair for being so understanding about their mental problems and enabling them to go on working. Indeed, in Blunkett’s account Blair seemed to think that being a cabinet minister might be good occupational therapy for his old friend — not perhaps the best use of one the great ministries of state. Blunkett and Campbell, like Stephen Fry in his television series on mental illness, have said they have spoken out because they want to help remove the stigma of mental illness; that is after all the point of World Mental Health Day.

Ironically, the efforts of Campbell and Blunkett confirm my sad belief that the stigma is useful. It warns us, however crudely, of the dangers mentally ill people often present to themselves and others. What Blunkett, Campbell, Fry and others are expressing is the current orthodoxy: people with mental illnesses must not be subject to any kind of discrimination, least of all at work.

I cannot agree. Of course unfair or undue discrimination is wrong; and of course it is true that until very recently people’s attitudes to mental illness were brutal and ignorant. The lunatic asylums of my childhood were often places of horror and there was a tendency to assume that everyone who was a bit “mental” could turn into a homicidal loony. Even now people can be very cruel. But that is no reason to go into denial, covering up painful realities with soothing euphemism.

These days you hardly ever hear the phrase mental illness, at least not in public sector and right-on circles. People almost always talk instead of “issues around mental health”. Illness bad, issues okay. This is quite absurd; it is as if an alcoholic were to talk of “issues around sobriety”. There are no issues about sobriety. The issue is alcoholism, or mental illness.

Campbell pointed out that six out of 10 employers say they wouldn’t take on someone with mental health problems, as if that were self-evidently unfair.

Baroness Neuberger wrote to The Times saying: “There is no reason why having a mental health diagnosis (sic) should stop a person working, at any level. With the right support and good management, people with mental health problems can work as well as anyone.” Yet, she continued, myths abound, “making employers wary of keeping, let alone hiring, those with mental health conditions (sic)”.

No doubt myths do abound, but one of them is that mentally ill people are all just as employable as everyone else. They aren’t.

Those with mild, intermittent problems may be able to hold down certain, but not all jobs, with help and understanding. They may not present much of a problem to their employers, or they may choose self-employment to keep their problems to themselves. But people suffering from anything worse are clearly a liability to themselves and others.

Anyone who has known people with bipolar disease, chronic acute anxiety or severe obsessive compulsive disorder, to pick just three common “conditions”, will know that these people’s lives are a constant struggle. I have nothing but sympathy for them. There is plenty of mental illness in my family and among my friends and I have personal knowledge of what it can mean. But I have been forced to understand that mouthing euphemisms and talking of rights is worse than useless.

It’s based on an unwillingness to face reality and creates false expectations and false obligations. It’s crazy, really.
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Family, mental health group looks for answers to suicide problem-The Kansas City Star

Family, mental health group looks for answers to suicide problem

PHYLLIS J. ZORN
Hays Daily News

WaKEENEY, Kan. - Sean Reeder's family saw the signs and did all the right things to prevent him from committing suicide. But ultimately, their efforts were not enough.

John and Lisa Reeder, Sean's father and stepmother, remember Feb. 26 starting out as a fairly normal day. By day's end, their lives were changed forever. The 17-year-old shot himself in the head that day.

While his parents were away, Sean made three phone calls to his girlfriend. Things weren't going as well between the pair as Sean wanted. During the third call to her on that Sunday, Sean shot himself.

The previous November, Sean had made a suicide threat. What preceded that threat was the death of his beloved pet and then, two days later, the girlfriend saying she wanted to break up. On that day, Sean told his father on the phone that he wanted to kill himself.

Lisa Reeder went looking for Sean and found him south of WaKeeney. John Reeder went to Sean and talked him out of the gun. Sean spent five days at an in-patient psychiatric facility. While there, Sean drew up a safety plan of things to do if he felt suicidal again.

"It obviously didn't work the day he committed suicide," John Reeder said.

Nationwide, more people take their own lives than are murdered, said Karen Schueler, a consultant for High Plains Mental Health in Hays. About 30,000 per year commit suicide compared to 18,000 per year who are the victims of homicide, she said. Schueler points to other statistics that show that men ages 25 to 45 have the fastest-increasing suicide rates, and that people 80 and over have the highest rate of suicide.

In a five-part series, The Hays Daily News found Kansas' suicide rate of 12.7 per 100,000 population exceeds the national average of 10.8. Law enforcement officials in northwest Kansas report 11 suicides and 27 suicide attempts in the first nine months of 2006 and the emergency department at Hays Medical Center has treated 58 patients for 63 suicide-related incidents in that same time frame.

The problem of rising suicide rates has been the focus of recent educational outreach efforts by High Plains Mental Health, the community mental health agency for the region.

"Sometimes people think that if people talk about it, we'll put the idea in their head," Schueler said. "What we've come to learn is, it's already there. If we talk about it, people can learn there are options."

"I know there is a myth that if you ask someone about suicide, they will think about it," said psychiatrist Dr. Virginia Patriarca, who practices in Hays. "The more you don't talk about it, the more dead people."

Suicidal people are trying to solve a problem, said High Plains Mental Health consultant Ken Loos. They consider suicide whether or not they suffer from major depression.

"They have that sense of hopelessness," Loos said. "If you feel hopeless, tomorrow is not going to be brighter day."

"When people are under a lot of stress, that is the main cause why people commit suicide," Patriarca said.

Loos said that if you can appeal to the part of the person's mind that is healthy, you might be able to make a difference.

Schueler said that while counseling can be an effective tool in preventing suicide, it won't always work. No matter how much help they get, how many people love them, how much medication they take, some will commit suicide anyway. Out of 100 people High Plains deals with, five still will commit suicide.

"What's difficult to understand is when a young person takes their life," Schueler said. "There's been a rise in adolescent suicide."

Kevin Struss' son, Kurt, was 19 when he shot himself in the head six years ago. Like Sean Reeder, Kurt Struss had been in a troubled relationship with a girlfriend. For his family, Kurt's death came as an unexpected, heart-stopping blow.

"There are some days you think you've got it in the back of your mind and something reminds you, and it just hits you like a brick," Struss said.

Hindsight has a way of bringing things into focus that hadn't seemed important before. Looking back, the family realizes that things they hadn't really thought about at the time actually were warnings.

"Open up your eyes," Struss said. "Look around. Go to classes. Learn what the signs are."

Patriarca pointed to loss of health, loss of spouse, job loss, financial problems, anxiety disorders, psychiatric disease and substance abuse as risk factors for suicide. Recognizing risk factors is important, because you might intervene if you recognize it early enough, Patriarca said.

Patriarca said she asks clients if they have a suicide plan, and how close they are to carrying out the plan.

"Most people will tell you," she said.

The Reeder and Struss families belong to the same church. Their pastor, Randy Gibbs, has seen firsthand the ordeals families go through in the aftermath of suicide.

"I think it's helpful to know that suicide is a decision by the person who does it and they don't consult their family in that way, so their family sometimes doesn't have any input," Gibbs said. "Most of the time I'd say they don't. The person who commits suicide is responsible."

Gibbs said the unanswered questions of a suicide leave survivors with a deep sense of guilt.

"As for speculating on what you might have done, guilt is a gruesome thing at that point, and as a spiritual thing, it's the kind of guilt that will eat the soul," Gibbs said.

Gibbs said that for most of us, having something to grasp onto helps us know there are other options. But those who commit suicide aren't able to grasp that.

Watch for signs that someone is suicidal, do your best to help people who are in situations where suicide might happen, Gibbs said.

"Keep your eyes and ears open, work with them and get them help, but if they do commit suicide, don't blame yourself," Gibbs said. "Just understand that they did it for their reasons - reasons that we probably won't understand. It may be necessary to forgive them for our grief. And in the end to lay our loved one squarely in the hands and grace of God - and lay ourselves there as well."

"After the loss, you're in shock and you're just dealing with it minute by minute and hour by hour," Reeder said.

Reeder believes teens need more education on dealing with relationships, so they have better tools to deal with the ending of those relationships and the emotions they will feel when that happens.

Reeder wants teens to know they have other options. He'd like to see a statewide program started to educate teens about that, and he said he'd be glad to accept the invitation to speak to teens about suicide.

For Sean, it was a momentary decision that is impacting us forever," Reeder said. "It can't be taken back and can never be changed. And I miss him horribly."
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State can do better on mental-health issues - Salem (OR) Statesman Journal

Guest Opinion

KRISTEN ANDERSON
October 14, 2006

How aware are you of mental illness? According to the president's New Freedom Commission on Mental Illness, mental illness is the leading cause of disability in the United States.

Did you know that more than 50 percent of jail and prison inmates have a mental illness? And 20 percent of Americans have a mental illness? Or that 90 percent of people who commit suicide suffer from a mental illness? And that suicide is the No. 2 cause of death for people 15 to 25 years of age? Also, 66 percent of adults with a serious mental illness are unemployed, but with supported employment, 60 percent to 80 percent of these individuals are able to maintain employment.

Mental illness doesn't discriminate. There are people of all colors, religions, political affiliations, intelligence levels, sexual preferences, ages and socioeconomic groups with mental illness. One would think with the numbers of people on disability assistance, in jails, on overcrowded court dockets, out of work or waiting at emergency rooms that there would be a high priority for providing adequate treatment and support. It is difficult to understand how this year's survey of state mental-health-care systems could have produced a national average grade of D.

Oregon is in the top 10. It's good we're in the top 10. We are making progress. There are incredible things happening around our state. There has been an increase in developing community-based services to support both children and adults at home. There is a cultural change taking place within Oregon's mental-health-care system. We are one of the first states to take legislative action supporting the transition to a statewide system driven by individualized, strength-based treatment coordinating the various services and agencies involved in each person's care.

The National Alliance on Mental Illness of Marion and Polk Counties is celebrating one of our local successes: Mental Health Court. Another change worth celebrating is mental-health-insurance parity. This was passed with overwhelming bipartisan support in the last legislative session.

As we head into elections and another legislative session, there are some things you may want to ask candidates. Such as, what will you do to improve access to mental-health care? What plans do you have to support recovery for those who live with mental illness? What steps will you take to reduce the number of these individuals in the criminal-justice system? How will you address the needs of children to ensure they have the help they need to become healthy, productive adults?

So, what was our score? Oregon received a C+. I don't think that's good enough. Together we can do better.

Kristen Anderson of Salem is the president of NAMI Marion-Polk. The mother of an 11-year-old boy with bipolar disorder, she is working to change the children's mental-health system. Contact her at andersonkris@comcast.net. Read more!

Caramore: Work key to recovery - Chapel Hill News

By Meiling Arounnarath, Staff Writer

CHAPEL HILL -- Though her son had schizophrenia, writer Lee Smith said work gave him back his life.

Smith's son, Josh, died in 2003 from the collapse of his enlarged heart. By then, he was living in his own apartment and had held a job at least seven years, she said.

On Thursday evening, Smith read her essay "The Working Man: How Caramore Helped My Son" to an audience full of clients of Caramore and their families at its annual client celebration.

Caramore is a vocational rehabilitation program in Carrboro for people with mental illness. It's run out of a building that looks like a house that sits on Smith Level Road near Rock Haven Road.

"The whole experience was pivotal for him," Smith said in an interview Friday. "They take it slow, but they really do show each person that he has something real to contribute -- that he can work, that he has a real job he can do."

Josh's mental illness had taken away a lot of the skills he had, she said. Caramore helped bring them back, she said.

"He was learning skills that a parent really can't impart. These are people who are really, really good at what they do," Smith said. "The parent is too eager, too willing to do things for people who are sick. We tend to not make them do things for themselves."

"I'm not here tonight to mourn him, but to celebrate his life -- a life made possible by Caramore," Smith said Thursday night.

Josh had been at Dorothea Dix for a little while. But Smith, her husband, writer Hal Crowther, and her father were looking at other programs in the area that could help Josh with his mental illness.

"My daddy weighed in. 'Listen, a boy's got to be trained in something,' " Smith said. " 'A man's gotta have a job,' he said."

Soon after Josh joined Caramore, Smith noticed a dramatic change.

"He became more animated ... more talkative," Smith said. "Now, he was filled with stories ... The main thing was: his sense of humor had come back."

Caramore serves about 56 clients, said budgeting counselor David Cooley, who helps clients organize their money, benefits and health care.

"We don't preach that you'll get better, necessarily, but we talk about managing [behavior]," Cooley added, explaining how the program is realistic.

Work is the focus.

"We think it reduces symptoms," he said. "It's something to do every day. It's something to get up for."

Brenda Cobbs received a client recognition award Thursday for steadily holding her job in the Marshall's department store's fitting room. Diagnosed with bipolar and schizo-affective disorders, she said she had been a cocaine addict for about 31 years before coming to Caramore.

"When I came to Caramore, I was homeless, and I didn't know how to do anything," Cobbs said. "I didn't have any strength."

Angela Pickett has been with Caramore since June.

"They tell us the truth, and they don't baby us," she told the crowd Thursday. "They help us grow up."

Smith believes the same thing.

"It was through Caramore that [Josh] became a real working man," she said.


Contact staff writer Meiling Arounnarath at 932-2004 or at marounna@nando.com. Read more!

Telemedicine Being Used More Frequently For Mental Health Services-Medical News Today

Telemedicine Being Used More Frequently For Mental Health Services
Article Date: 13 Oct 2006 - 14:00pm (PDT)


Telemedicine increasingly is being used by psychiatrists to treat patients in rural regions of the U.S. "where specialists are in short supply," AP/USA Today reports. Telemedicine treatment, which includes appointments by video screen or telephone, enables therapists to reach patients who otherwise might not have access to care. Experts maintain that telemedicine works "especially well" with mental health patients, AP/USA Today reports. There are no figures on the number of doctors using the method, but Jonathan Linkous, an American Telemedicine Association spokesperson, said the practice has been growing annually. Terry Rabinowitz, medical director of telemedicine at University of Vermont College of Medicine, said, "I think that it has virtually unlimited potential," adding, "Not only can we help folks in underserved areas in the United States, but with little -- comparatively speaking -- investment, we can do consultations worldwide." However, Gerald Koocher, president of the American Psychological Association, said therapists must feel assured that they can deliver quality care and ensure that emergency help is available if a patient needs it. He added, "I wouldn't recommend treating someone suicidal remotely." Myron Weiner of the University of Texas Southwestern Medical Center in Dallas said it also is difficult to assess an individual's mood through a video screen, and facial expressions and gestures might not be clearly communicated (Stengle, AP/USA Today,10/9).
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Popular drugs help few with Alzheimer's - Associated Press

Thursday, October 12, 200

THE ASSOCIATED PRESS

Widely prescribed anti-psychotic drugs do not help most Alzheimer's patients with delusions and aggression and are not worth the risk of sudden death and other side effects, the first major study on sufferers outside nursing homes concludes.

The finding could increase the burden on families struggling to care for relatives with the mind-robbing disease at home.

"These medications are not the answer," said Dr. Thomas Insel, the director of the National Institute of Mental Health, which paid for the study. He said that better medications are at least several years away.

Three-fourths of the 4.5 million Americans with Alzheimer's disease develop aggression, hallucinations or delusions, which can lead them to lash out at caregivers or harm themselves. This behavior is the most common reason families put people with Alzheimer's in a nursing home.

The study tested Zyprexa, Risperdal and Seroquel - newer drugs developed for schizophrenia. Doctors are free to prescribe them for any use. However, the drugs carry a warning that they increase the risk of death for elderly people with dementia-related psychotic symptoms, mainly because of heart problems and pneumonia, and that they are not approved for such patients.

Yet about one-quarter of nursing-home patients are on these drugs, and at least that many patients at home have used them, mainly because there are no good alternatives and there was some evidence that they might help a little, experts say.

The study tested the drugs on 421 patients at 42 medical centers who needed considerable care but were living in their own home, a relative's or an assisted-living center. The findings were reported in today's New England Journal of Medicine.

Symptoms did improve in about 30 percent of patients taking the drugs, as well as in 21 percent of those on dummy pills, partly because symptoms can naturally wax and wane.

Some patients who stopped taking one pill were switched to another treatment for the study's second phase, results of which will be reported next spring.

Dr. Jason Karlawish of the University of Pennsylvania's Alzheimer's Disease Center wrote in an editorial that the drugs did help a small group of patients who had little or no side effects. He said that Zyprexa and Risperdal were both better than Seroquel or the placebo in treating behavioral problems. Read more!

Broken Silence: Couple share years of clinical depression - Winston-Salem Journal

Thursday, October 12, 2006

By Janice Gaston
JOURNAL REPORTER

Jene Horne knows well the signs that lead to the abyss. She starts wondering why she was born, why she was placed on earth. When those feelings surface, she knows that she must go immediately to her husband, her family, her doctor.

She knows that she needs help. Without it, she could fall into a dark well of depression.

Horne and her husband, Chris Horne, will talk about "Depression in the Marriage" next Thursday at the annual meeting of The Mental Health Association in Forsyth County. The Hornes, who have dealt with her mental illness throughout their marriage, will give the talk on their 10th wedding anniversary.

"We wouldn't be anywhere else," she said. "This is so important to us. I've got a wonderful husband. He's been to hell and back with me."

Horne hopes that his familiar name - he spent nine years as a news anchor on WXII-TV Channel 12 - will help bring better public awareness that mental illness can affect anyone's family.

Jene Horne, 44, first started showing signs of clinical depression when she was in college in West Virginia. She spent days huddled in her dorm room. Knocks on her door went unanswered because she couldn't bear to face the world.

She left school after two years and went to work. She became a receptionist, then a representative for a wall-covering distributor. She traveled through West Virginia, Ohio and Pennsylvania. She kept up a front. She remembers laughing and joking with a customer, while darkness swirled inside her head.

"I was looking at him thinking, 'If he only knew I wanted to die right now.'" She could usually keep herself together at work, but when she went home, she often took to her bed. If things got too bad, she called in sick.

In 1994, she met Chris Horne at a charity bachelor auction in Wheeling, W. Va. She wasn't bidding; she was an officer for the charity. They clicked. Two months later, he took a job in Jacksonville, Fla. , and they continued their relationship long-distance. During their courtship, she was feeling OK, she said. She showed no signs of depression. They married in 1996.

Later that year, she began to slide. Her depression became so deep that she decided to commit suicide by taking sleeping pills.

Her mother, Judith Krall, has worked with mental-health organizations for years. She is now the president of the Moore County Chapter of the National Alliance on Mental Illness. She noticed signs of depression in her daughter, and she steered her toward help. She also helped her son-in-law understand what he was up against.

"My brothers have mental illness, too," Jene Horne said. "We talk about mental illness in our family like people talk about the common cold."

Depression runs in families, said Dr. Hal Elliott, a psychiatrist at Wake Forest University Baptist Medical Center. When doctors interview people who show signs of clinical depression, one of their standard questions is "Who in the family has been depressed?"

According to the National Mental Health Association, more than 19 million Americans suffer from clinical depression each year. Fewer than half seek treatment.

Jene Horne is technically bipolar, she said, which means she suffers from both depression and mania, characterized by exaggerated feelings of well-being, excessive activity and abnormal excitability. She has gone through manic periods when she didn't sleep, her mind raced, and she acted irrationally.

'You have to do things now," she said. She remembers buying a tree and planting it at 10 p.m., using the light of flashlights and her porch light.

To qualify for being technically bipolar, Elliott said, a patient has to have had at least one manic episode. "A lot of people are primarily depressed," he said. The patient might have just one or two manic episodes throughout a lifetime. But once they have had one, they are classified as being bipolar, he said.

Jene Horne's illness far more often manifests itself in depression. She has fallen into that dark well many times. A few times, she barely managed to pull herself out. Few people knew.

"Jene is adept at putting on the happy face, giving everyone the impression that nothing is wrong" her husband said.

Elliott said that people who are depressed can hold themselves together in front of co-workers and strangers throughout a day. "Nobody can really tell," he said. "That doesn't mean that they're not depressed, that they don't have periods of being really down. They can just cover it."

"When I am at my lowest, you will not see me," Jene Horne said. "If I can't put on the mask, you won't see me."

In March of 2003, Horne went through another particularly low spell. She composed a suicide note in which she wrote about hating her life and of trying to swim but being unable to hold her head up.

That time, she realized that her thinking was distorted, and she told her husband. When she thinks about the note now, she realizes that she is no longer the person who wrote it.

The note still remains on her computer, a morbid but valuable reminder of how low she can go if she doesn't get help when she needs it.

Throughout their marriage, Chris Horne has dealt with his wife's ups and downs.

"She's spent entire weekends in bed, even weeks sometime," he said. He fought his frustration at dealing with a problem that was so elusive and intangible.

People can see a broken leg on an X-ray, he said. But a mental illness is invisible.

"You're dealing with a ghost," he said.

Together they fought the invisible enemy.

He cooked, cleaned and cared for the couple's cats while she struggled to overcome her demons. He learned to separate the person from the illness, to realize when he was dealing with his wife's personality and when he was dealing with her depression. Now, when he sees signs that she is headed for trouble, he tells her.

She listens.

"I can't be defensive about it," she said. "I don't want to go to that deep, dark pit. If people see signs, they need to go back to the doctor. They need to increase or change their medication. I've done that. And I've gone from planning my suicide to (feeling that) life is good."

Chris Horne said, "Regardless of how well I've coped with it, nothing compares to what Jene's done."

She learned to be an aggressive patient, to seek out the right doctor and the right medication. She has gone through several doctors in various cities and tried 10 or 11 antidepressants.

No drug works instantly. She would take one for four to six weeks, only to find that it didn't work. Then it was on to the next trial, and another four to six weeks. Sometimes she would find a drug that would work for a while, then stop. The routine is typical of people trying to find the right drug.

People with mental illnesses, like those with physical illnesses, sometimes have to try different drugs to find relief, Elliott said. "Sometimes the illness will break through."

People sometimes take drugs for high blood pressure that bring the blood pressure down, he said. Then for some reason, the illness breaks through the medicine, and the doctor has to adjust the patient's dose or change drugs. The same is true with mental illnesses.

When Jene Horne first went to her current doctor, she told him that she wanted to go off all her medicines. He asked her, "Why would you want to do that?"

She explained that she had been on so many drugs that she no longer knew who she was. She wanted to clean out her system and start over. He agreed.

"Unfortunately, most people are not as aggressive as I am," she said. The drugs she is on now keep her on as even a keel as possible, her husband said. She works in real estate and as a pet sitter. Her husband is also studying to get his real-estate license.

One of the Hornes' main goals is to see mental illness treated just like physical illness. In North Carolina, many insurance plans limit visits to mental-health providers, and people with mental illnesses often have to pay higher co-pays for their treatments than people with physical problems do.

"The brain is the same as any other organ in the body," Jene Horne said.

The stigma that accompanies mental illness is slowly lessening, the Hornes said. Television commercials for antidepressants run constantly, and public figures speak freely about their bouts with mental problems. But it hasn't disappeared. It won't until people routinely look at mental illness just as they would diabetes or cancer.

And too many people still think that curing mental illness is simply a matter of willing it away, Jene Horne said. "People tell you to snap out of it. You cannot snap out of it. It's a chemical imbalance."

In their zeal to stamp out the shroud of silence that often surrounds mental illness, the Hornes speak about their experiences for free, to any group that invites them - even if it's on their anniversary.

Jene Horne explained why.

"We really want to get the stigma gone," she said. "It's time."
The symptoms
Here are the symptoms of major depression, a mental illness:
• Persistent sadness or an irritable mood.
• Pronounced changes in sleep, appetite and energy.
• Difficulty thinking, concentrating and remembering.
• Physical slowing down or agitation.
• Lack of interest in or pleasure from activities that were once enjoyed.
• Feelings of guilt, worthlessness, hopelessness and emptiness.
• Recurrent thoughts of death or suicide.
• Persistent physical symptoms that do not respond to treatment, such as headaches, digestive disorders and chronic pain.

Seek professional help if you suffer from several of these symptoms at the same time, if they last longer than two weeks, and they interfere with daily life. See your doctor for a thorough physical to rule out other illnesses and then, based upon your doctor's recommendation, see a licensed mental-health professional for a diagnosis and treatment plan.

Sources: National Alliance on Mental Illness and The Mental Health Association in Forsyth County.

Tips for coping
If you live with someone who suffers from depression, here are some tips for coping:
• Understand the illness.
• Keep in mind that he or she can't "snap out of it".
• Ask about his or her childhood feelings and experiences.
• Admit that you have no power over the illness.
• Do not try to rescue your loved one.
• Don't make excuses for your partner.
• Encourage him to get help.
• Look at your own background and habits.
• Tell your partner what you need.

Source: Dr. Bob Murray, the author of several books on depression, including Creating Optimism: A Proven Seven-Step Program for Overcoming Depression.

• Janice Gaston can be reached at 727-7364 or atjgaston@wsjournal.com.

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NC lawmakers debate mental illness, adult care - Raleigh News & Observer

Thomas Goldsmith, Staff Writer

Roughly 5,000 people whose chief diagnosis is mental illness live in North Carolina rest homes, sometimes presenting a danger to other frail, elderly residents, state human services officials told legislators Wednesday.

Such a mix of populations -- with different medical issues, staffing needs and treatment plans -- could be eased with the development of a hybrid facility, where up to 12 people with mental illness could receive the care and attention their conditions require, members of a state legislative subcommittee learned.

"I think this committee must consider special-care units for people with mental illness," co-chairwoman Rep. Verla Insko, a Chapel Hill Democrat, said after the presentation. Members of both the House and Senate serve on the committee, which met for the first time Wednesday to address long-standing concerns.

A 12-bed home could be specifically developed and financed as a place for people with mental health problems -- anxiety, phobia, depression and schizophrenia among others, a Division of Medical Assistance staffer told the group.

The state would not build homes under the program -- for which no cost estimate was available -- but would pay providers for care, Insko said. The state has been struggling to change the way it provides care for people with mental illness, moving treatment from institutions to care in communities. After years of allocations that mental health advocates called inadequate, legislators this year approved an additional $74 million for mental health services.

Separately, the state pays a portion of the bills for many patients in long-term care.

"Are [adult care homes] set up to deal with that kind of thing, and if not, how are they dealing with it?" asked Rep. Debbie Clary, a Cherryville Republican.

Complex details

The mixing of rest home residents and people with mental illness presents many troublesome issues, state and industry representatives said. Aides at rest homes aren't trained to deal with younger residents who suffer from mental problems, and facilities often are asked to admit residents without being given full information about their conditions.

When residents with mental illness do create problems for themselves or others, it's often difficult to discharge them, because there are few alternatives.

"Where's the person going to go?" asked Barbara Ryan, chief of the division of adult licensure.

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

Virginia to begin review of mental-health laws - Richmond Times-Dispatch

This week, in the opening session of what will be a yearlong effort, the chief justice of Virginia's Supreme Court will set in motion the broadest review of the state's mental-health laws in three decades.


BY BILL MCKELWAY
TIMES-DISPATCH STAFF WRITER

In an apartment off Parham Road in Henrico County, Nancy Walden sometimes sits on the floor sifting through her brother's notes and memos.

They track his decline into what she described as a psychotic nightmare.

On Aug. 12, in an act of violence his family had feared for years, police say Jared C. Walden slashed his stepfather to death in a rage. Walden, 25 at the time, was under the supervision of a program of intense outpatient care for mentally ill people.

But his record is peppered with protective orders sought by his family, failed drug tests, repeated court appearances, and caseworker notes saying he failed to show up for counseling sessions.

This week, in the opening session of what will be a yearlong effort, the chief justice of Virginia's Supreme Court will set in motion the broadest review of the state's mental-health laws in three decades.

A key objective: addressing behaviors and treatment options that too often are failing the public and troubled people such as Jared Walden.

The review has been months in the planning and is years overdue, according to participants from fields as diverse as law enforcement and medicine. Twenty-five frontline players in the mental-health field will pick apart state laws and policies that have blocked access to care, transformed jails and prisons into warehouses for the mentally ill, and that further bind a system strapped for money and space.

Chief Justice Leroy R. Hassell Sr. set the wheels in motion late last year, describing in a speech Virginia's frayed system of care for mentally ill patients that ranks 30th in the country in per capita spending on mental health.

Hassell spoke of a court system swamped by nearly 50,000 involuntary mental-commitment hearings a year, jails and prisons teeming with mentally ill prisoners who are barred from getting treatment, and a community-based system of care that has struggled to bear the load of handling 90 percent of the state's once-institutionalized mentally ill people.

Hassell and Richard J. Bonnie, a longtime law professor at the University of Virginia, will oversee the Chief Justice's Commission on Mental Health Reform.

It gets under way tomorrow in Williamsburg and will produce an omnibus mental-health reform package that will be ready for the 2008 General Assembly.

During legislative committee meetings this summer, the complexity of reforming Virginia law was evident. It is also evident that the Hassell Commission is likely to spark some of the stiffest resistance from the very people it most seeks to help: the mentally ill.

Standing before a Senate subcommittee last month, longtime Northern Virginia mental-health advocate Diane Engster methodically aligned across a lectern 18 bottles of medication she takes daily to control her mental problems.

Asked afterward what would happen to her without her