U.S. Asian Immigrants at Lower Mental Health Risk - Forbes

THURSDAY, Nov. 30 (HealthDay News) -- Asian immigrants in the United States have lower rates of mental health problems than people, including those of Asian descent, who were born in the country, a new study finds.

For example, the study found that American-born women are twice as likely to have a depressive disorder as Asian-born women living in the United States.

The researchers interviewed nearly 2,100 native-born or immigrant Asian Americans, 18 and older, about their history of a number of mental health problems: depression, anxiety, phobias, eating disorders, substance and alcohol abuse, and post traumatic stress disorder.

"Roughly 48 percent of Americans will have some kind of lifetime disorder. In our study, less than one in four Asian-American immigrants will have a disorder. However, that won't necessarily be the case for their children and grandchildren. If trends continue, rates for them will go up, and that suggests that more investment is needed for prevention programs," study lead author David Takeuchi, a sociologist and social work professor at the University of Washington, said in a prepared statement.

Other findings from the study:

* There were no significant differences among the main Asian immigrant groups in the United States -- Chinese, Filipinos and Vietnamese.
* Among Asian men, those born elsewhere are less likely to have a substance abuse problem than those born in the United States.
* Asian immigrants who arrived in the United States as elementary school-age children have an easier time learning English than older children but are more likely to develop a substance abuse problem.

Takeuchi said this study raised issues that warrant further investigation. For example, he'd like to compare the mental health circumstances of immigrants who voluntarily migrate and those who are refugees.

"Someone who is a voluntary immigrant doesn't typically suffer the severe trauma that a refugee who is fleeing persecution or war does," Takeuchi said.

He also wants to investigate how discrimination impacts the mental health of Asian Americans.
Read more!

Smith backs mental-health changes - Statesman Journal

Senator meets with state officials during summit

PETER WONG
Statesman Journal

November 30, 2006

U.S. Sen. Gordon Smith pledged Wednesday that Oregon will not get the short end in congressional discussions about mental-health insurance benefits and a federal investigation of conditions at Oregon State Hospital.

The Oregon Republican spoke at an hourlong meeting with state lawmakers, officials and advocates in the Capitol.

"He seems to want to help in any way he can for this state and nation," said Peter Courtney, a Salem Democrat who is the Oregon Senate president -- a job Smith held in 1995-96. "It requires a total team effort. We are so far behind that anything we can do is better than what we have done."

Oregon joined the ranks of states that require insurance for mental-health services and addiction treatment on a par with coverage for illnesses and injuries. The 2005 law will take effect on Jan. 1, but pending federal legislation threatened to undercut state requirements.

But Smith said he is part of a bipartisan group in the Senate trying to broker a compromise.

"We are close to a deal that the House may accept and that is helpful to Oregon's parity," he said. "We are not subverting what they are doing; we may be adding to it."

U.S. Department of Justice investigators are studying conditions at Oregon State Hospital. A joint legislative committee has recommended a plan that will lead to its eventual replacement, including a 620-bed hospital in the northern Willamette Valley, and more community-based care.

Smith said both moves will help.

"If there are problems, they will find them, but in finding them, we are identifying a better path to the future," he said. "This is not the federal government against the state; this is about how we, the American people, can do better in dealing with mental health."

The 2003 suicide of Smith's son Garrett Lee Smith prompted Smith to sponsor and win approval for a 2004 law that makes federal grants available to states, tribes and colleges for suicide prevention and intervention programs.

"I would never have passed the act without it being personalized by a family tragedy," Smith said.

He said Americans, regardless of party, can unite to support an improved response to mental illness.

"Very few families are not touched by these issues," he said. "They know no partisan bounds."

pwong@StatesmanJournal.com or (503) 399-6745
Read more!

Families rip mental health reforms - Greensboro News-Record

For a more complete understanding of this issue, click here to read a copy of the MH/DD/SAS Division Memo clarifying family members as paid providers.

By Joe Killian, Staff Writer

JAMESTOWN — More than a hundred people crowded a small auditorium at GTCC on Wednesday night for a town hall meeting with state mental health officials. Many came to vent their anger over planned changes in the system.

The issue upsetting most: a change in policy that could require some parents to give up their guardianship if they want to be paid as their child’s caregiver. State officials said that the concern is a conflict of interest that isn’t good for children or their caregivers.

"When the person who has to say that appropriate service is being provided — the guardian — is the same person who is actually providing the service, there can be a conflict," said Leza Wainwright, deputy director of the state health division handling the change. "When it’s the same person there’s the chance that distance, that critical eye, is not there."

Wainwright said the state doesn’t want to strip parents of their guardianship — they want to be sure parents aren’t working more than 40 hours a week caring for their children.

Wainwright said in many cases the government would pay for 40 hours of family caregiving, but after that family members should cede some responsibility to professional caregivers to rest and retain perspective.

Many in the crowd said they couldn’t hold a job and care for family members with special needs.

"I didn’t ask for this job, it just sort of fell in my lap," said Margaret Hiatt, a Surry County mother of three special-needs adults.

She was greeted with loud applause from the crowd.

"I don’t see how there’s a conflict if my service is good and I follow the guidelines we go by," Hiatt said. "If my service isn’t good, the case worker will take care of it."

Many in the crowd echoed Hiatt’s sentiments, saying the state mental health care reforms are proceeding without a key ingredient — participation from those being served.

Officials listened to the crowd’s concerns but reminded them that, in many cases, their hands are tied by government guidelines and Medicaid.

"It isn’t that we don’t hear you if a decision is made further up the food chain than us," Wainwright said. "We lose arguments, just like you do. Medicaid is the 3,000-pound gorilla."

Contact Joe Killian at 373-7023 or jkillian@news-record.com Read more!

Ahearn: Cheesed off by state’s 'reform’ - Greensboro News-Record

For a more complete understanding of this issue, click here to read a copy of the MH/DD/SAS Division Memo clarifying family members as paid providers.

Published Nov. 29,2006

By Lorraine Ahearn, Staff Writer

There's a town meeting tonight at GTCC about mental health reform, and state officials hosting the event have a list of "talking points."

The topic of the list is the latest wrinkle — "Implementation Update #19," which prohibits parents of severely disabled children from being reimbursed by Medicaid for care, unless they give up legal guardianship.

"The policy has been reviewed by stakeholders," says one of the talking points compiled by state officials. "Prior to writing the policy it was discussed with a national consultant who works with other states throughout the country" on such policy questions.

State officials aren't saying which "stakeholders" they consulted on the rule change. Advocates estimate it could affect as many as 5,000 profoundly disabled North Carolinians — adults whose families care for them at home, without putting them in nursing homes or hiring home health care workers at state expense.

But after a visit in this space Sunday with Gibsonville resident Amy Massengill, who left a job as college administrator to care for her severely handicapped daughter, it's clear that families affected weren't informed until the change had been approved.

And if e-mails and phone calls in response to Massengill's story are an indication, the public is in no mood for "talking points." That includes people who aren't even "stakeholders," such as reader Maria Rossi.

"Not only has Amy Massengill sacrificed a career, now she will have to sacrifice her guardian rights if she intends on maintaining the financial support she needs. Does the state realize that they will be spending more of their own money and resources to help her and the many others, than what they do now?" Rossi wrote.

"Is it too late or is it possible that we may be able to change the minds of those that think they know best?"

Mary Johnson believes it is too late: "The fat cats get fatter as they make bad decision after bad decision. Billions have been wasted. Those of us on the front lines get pummeled/ridiculed, and patients get the short end of the stick. The taxpayer foots the bill. Now you beat the drum?"

Wrote Tom Sizemore: "I do not understand the 'experts' position ... that a parent will not give better care than someone only paid to be a caregiver. The people being cared for by their own families are truly in their own homes in their own communities."

Charlie Hammonds, who left his job as a painter to care for an adult daughter with cerebral palsy, can attest to concerns about the quality of care. As he was leaving for work one morning, his daughter had a seizure. The home health care worker, not knowing what to do, called Hammonds to help. The father gave CPR.

"When the paramedics came, they said, 'It's a good thing you were here,'" Hammonds recalled. "When you're giving your own child a breath of life, and then you remember those words (of the paramedic) ... Enough was enough."

Finally, a few words from Massengill, who takes care of her daughter Emily, diagnosed with cerebral palsy, diabetes and profound mental retardation. Asked what Emily gives in return, the mother answered in an e-mail Thanksgiving morning. She said Emily taught her courage, and also about simple pleasures — smelling a flower, enjoying a melody, lingering over a meal or a warm bath.

"I truly believe that we are all supposed to learn from each other," the mother wrote. "Maybe the people who have the greatest difficulty in learning in this life are the people who also have the most to teach."

Contact Lorraine Ahearn at 373-7334 or lahearn@news-record.com Read more!

Mental health reforms urged - St. Louis Post-Dispatch

JEFFERSON CITY — Calling the protection of mentally disabled residents one of
Missouri's priorities, a task force released a plan Wednesday to toughen
penalties for abusers, increase pay and training for caregivers, and limit the
secrecy of internal investigations.

"It is right there at the top of the priority list" for legislators, the
governor and other top state officials, said Lt. Gov. Peter Kinder, who chairs
the Mental Health Task Force. "They have promised they are going to fast-track
this."

The 25 recommendations were welcome news to advocates and family members,
including Martha Washington. Her nephew George Holmes died as a result of
worker neglect at the Bellefontaine Habilitation Center in Bellefontaine
Neighbors in 2004.

"It's wonderful — wonderful. I see that somebody was listening, and I thank God
for that," Washington said.

Kinder said he expects state officials to study more reforms after nine
residents and a worker died in a fire Monday at a southwest Missouri group home
for mentally ill and mentally retarded people. The current reforms focus on
reducing mistreatment by caregivers, not on improving building safety.

Gov. Matt Blunt created the task force in June after a Post-Dispatch
investigation found 21 deaths, 323 injuries and nearly 2,000 other incidents
tied to abuse or neglect by caregivers from 2000 through 2005.

The newspaper also found that the Department of Mental Health, which oversees
the care of mentally retarded and mentally ill residents, failed to follow its
own policies and state laws on how to investigate incidents and when to notify
police. The department also failed to adequately monitor the privately run
facilities that house the majority of residents overseen by the state.

The task force confirmed many of the newspaper's findings.

Kinder blamed, in part, the "deep budget cuts" the state department absorbed in
past years — making it harder to fund programs and keep or hire workers. He
said state leaders would "make sure there is funding."

The extra money would be used to boost pay and training of caregivers, boost
the ranks and training of internal investigators, and improve oversight of
state-run and privately run facilities.

Among the 25 recommendations, the task force wants a new law in the criminal
code that specifically penalizes those who mistreat residents.

The task force has called for private facilities to face more inspections and
stiffer fines for failing to report mistreatment or failing to correct
problems. And the report recommends that both state-run and private facilities
pursue national accreditation testing to ensure they meet high standards.

Beyond tougher oversight, the task force wants all deaths to be investigated by
a newly created panel of outside experts. Other investigations would continue
to be done internally, with more focus on serious allegations, quicker
interviews and thorough analysis of the root causes of mistreatment.

The plan also calls for the elimination of much of the secrecy in abuse and
neglect cases.

"When you throw a cloak of secrecy around it, it is an invitation for abuse,"
Kinder said.

The task force also wants to close a loophole that allows abusive employees to
quit their jobs and be hired by another facility before internal investigators
have completed their reviews. Under the plan, facilities would be forced to
ensure new hires aren't the subject of current investigations.

The task force report doesn't specifically address a thorny issue — whether to
close a state-run center in Bellefontaine Neighbors. The governor has pushed to
close it while parents' groups have fought to keep it open. But the task force
said, in general, that no state-run centers should be closed so long as they're
needed.

Interim Director Ron Dittemore said the department has already begun making
changes, including lowering the backlog of internal investigations from 418 to
32 in the past five months.

He said the department must ensure the vigilance for reform doesn't "drop from
the radar screen again." The ultimate goal, he said, is to ensure residents
feel safe, happy and secure.
Read more!

Ohio GOP lawmakers close to deal on mandatory mental health insurance - Akon Beacon-Journal

Associated Press

COLUMBUS, Ohio - Insurance plans would have to offer the same coverage for mental illness as for physical ailments under a bill that Republican lawmakers may approve after years of opposing such a requirement.

Top GOP legislative leaders said Tuesday they're ready to pass the legislation despite continuing concerns about the effect on businesses.

Whether Gov. Bob Taft would approve the bill is another question. Taft, a Republican leaving office early next year, has long opposed such a requirement. Spokesman Mark Rickel said Wednesday he's not aware that business groups have changed their minds about the bill's effect on their bottom line.

Gov.-elect Ted Strickland, a former prison psychologist, supports the measure.

Proponents are encouraged by the apparent change of heart among Republican lawmakers.

"The fact that leadership is supporting the issue now says we have moved past the tipping point," said Rep. Jon Peterson, a Delaware Republican and sponsor of the bill in the House.

Supporters argue that it's unfair and discriminatory for many health-insurance plans to offer less coverage for a mental illness such as schizophrenia than a physical ailment such as Parkinson's disease.

But small-business owners argue that another insurance mandate would drive up already high health care costs. They also say the proposal is unfair because it does not apply to all companies.

The National Federation of Independent Businesses/Ohio estimates the bill would affect coverage offered to about one-third of Ohio workers.

"This unconscionable bill targets the small-business community when health insurance has been the No. 1 concern since 1986," said Ty Pine, NFIB state director.

Republican Sen. Steve Stivers, chairman of the Senate Insurance Committee, said that while he's not a fan of the bill, there are enough votes to pass it out of committee. Senate President Bill Harris said he expects a vote by the full Senate.

Harris said he now supports the bill but still doesn't like that it fails to affect larger, self-insured employers who, under federal law, are exempt from state insurance mandates. He also worries that cost increases could force some small businesses to drop health insurance, though the bill provides an opt-out provision if costs increase more than 1 percent.

House Speaker Jon Husted, who voted against a similar bill two years ago, said advocates spent time explaining the financial effect of the bill.

"I've had several conversations on this and I felt that we had been able to allay some concerns and some of the business objections to this," he said. Read more!

Overusing Ritalin - Raleigh News & Observer (Letter)

Letter to the editor:

Regarding the Nov. 27 article "Medication may help younger ADHD patients, study shows":

Before we open the floodgates and have untold numbers of preschoolers on psychostimulants, we should examine whether those advocating medications are correct about what Attention Deficit Hyperactivity Disorder actually is.

Lucy Daniels Center clinicians are among the many mental health professionals who believe that 8 percent of American children have AD/HD because psychiatry has arbitrarily chosen to set a definitional criteria that sets the bar at 8 percent or so; in other countries, the bar is set differently, and the incidence of AD/HD is fractionally what it is in the U.S.

Furthermore, we should understand that AD/HD is simply a description of behaviors; there are many reasons that a child develops inattention, impulsivity and overactivity. It takes time and effort from families and professionals, and humility rather than rapid certainty, to decipher these reasons, and achieve true growth within children and families.

There is an occasional place for medications like Ritalin, usually on a pragmatic basis to achieve some symptomatic relief, but in the vast majority of situations Ritalin just covers up the basic problem like aspirin effectively covers up a fever.

Donald L. Rosenblitt, M.D.

Medical Director, Lucy Daniels Center for Early Childhood

Cary Read more!

State task force makes mental health recommendations- News Leader -Springfield MO

Tracy Swartz
© 2006, Springfield News-Leader

The state should establish a board to review the deaths of adults in state mental health facilities, a taskforce recommended Wednesday in a report that made no mention of improving fire safety.

The report comes days after a fatal fire at the privately run Anderson Guest House, a residential care facility licensed by the state Department of Mental Health.

The taskforce focused many of its 25 recommendations on improving the procedures for reporting abuse and neglect in state-operated facilities after a newspaper series detailed abuse problems in these facilities.

The eight-member panel crafted its recommendations upon gathering public testimony at hearings across the state, including one in Springfield this summer.
“We never heard one word from any of the 271 witnesses about fire safety,” said Lt. Gov. Peter Kinder, taskforce chairman.

The panel calls on the Department of Mental Health to:

• Pursue accreditation of its six habilitation centers and community providers that serve persons with developmental disabilities

• Ensure staff are trained on identifying and reporting abuse and neglect

• Increase penalties for failure to report abuse and neglect

• Establish a mental health fatality review board

• Allow access to non-confidential information in substantiated abuse and neglect investigations

Gov. Matt Blunt formed the taskforce in June. In August, the panel heard southwest Missourians voice concerns about the safety of family members in state mental health centers.

"These recommendations represent what Missourians told us they wanted for the state's mental health system," Ron Dittemore, interim director of the Department of Mental Health and taskforce co-chairman, said in a statement.

Earlier this year, the St. Louis Post-Dispatch reported 21 deaths were linked to abuse and neglect at state-affiliated centers. The series revealed a flawed system of reporting and oversight.

In a handful of state audits, U.S. Sen.-elect Claire McCaskill has called for more oversight for these facilities.

Though the Anderson Guest House holds a Department of Mental Health license, the state Department of Health and Social Services performs routine inspections.

That agency is supposed to inspect twice a year but budget cuts have allowed for only annual reviews, a spokeswoman said.

Kinder said he expects the legislature will review the department’s budget in the upcoming legislative session to restore funding for inspections.

A review of the Anderson Guest House in March 2006 and December 2004 revealed no deficiencies in fire safety. The nonprofit Joplin River of Life Ministries operates the center.

“This facility as far as we know was compliant with existing fire safety regulations,” Kinder said. “We along with everyone else in state government … will be looking and looking again at measures to improve fire safety.”

One measure that took effect in August mandates an automatic sprinkler system for assisted living facilities. As a residential care facility, the Anderson Guest House does not fall under these regulations.

Advocacy groups have called for sprinklers to be installed in long-term care facilities. The one-story home had a fire alarm system but no sprinklers, which was not required by the state.

“The costs are enormous to install sprinklers in older buildings,” Kinder said. “I’m not saying I’m against it. That’s why it has not been done to date. As we learn more about the cause of this fire and how it spread, we can all review.”
Read more!

Group seeks reform of child mental care - Boston Globe

By Carey Goldberg, Globe Staff

A coalition of leading local psychiatrists and advocates called yesterday for a sweeping overhaul of the state's system for helping mentally ill children and said its members would wage a political campaign to transform its proposals into reality.

"The time is now and the time is right, and it's time to carry through and act on the recommendations in this policy paper," said Dr. David DeMaso, psychiatrist in chief at Children's Hospital Boston.

The coalition described the current state system as fractured and underfunded. It estimated that among the nearly 150,000 Massachusetts children who need mental health services each year, more than 100,000 do not get the care they need.

At a crowded news conference at the State House yesterday, the coalition issued five sets of recommendations that included requiring insurers to cover mental healthcare at a level comparable to physical healthcare and making the mental health system more integrated, so that the correct care is provided. (The full report is available at childrenshospital.org/newsroom.)

Health Care for All, which advocates universal healthcare in Massachusetts and is a coalition member, is turning the proposals into a package of bills that can be brought to the Legislature by mid-January, DeMaso said.

Many previous reports have found similar problems in the mental health system, he said, but this time is different, because of the push for legislation.

"We've had enough with talk and good intentions," Marylou Sudders, president of the Massachusetts Society for the Prevention of Cruelty to Children, said in a statement.

She is one of the coalition's leaders and cochairs a transition committee charged with helping shape Governor-elect Deval L. Patrick's human services policy.

The change of State House administration is one reason the time is ripe for improving the children's mental health system, DeMaso said.

Asked whether the Patrick administration is likely to be better on children's mental health than Governor Mitt Romney's, DeMaso said: "It has to be better. It can't be any worse."

Carey Goldberg can be reached at goldberg@globe.com. Read more!

Mental illness led to a death - Raleigh News & Observer

Published Nov. 28
Mandy Locke, Staff Writer

SMITHFIELD - Schizophrenia robbed Kenneth Euell of a normal life, and Monday, he took the blame for the maelstrom that led to the death of his 11-year-old nephew.
Euell, 50, pleaded guilty to second-degree murder and assault with a deadly weapon inflicting serious injury for crashing his sister's van, killing one nephew and seriously injuring another, in August 2005. For that, he'll spend at least seven more years in prison. A judge ordered him to undergo psychiatric help and substance abuse counseling in prison.

Euell has been in custody since the incident.

It's a convoluted story how life went so badly wrong for Euell's family that day.

Euell had battled mental illness most of his life, said his attorney, Antoan Whidbee. When his mother wasn't making sure he took his medicine, Euell would end up in some mental hospital or on the streets. Because his mother's health was failing that August, the family sent Euell to Florida so his sister, Kim Roper, could look after him.

But Euell wasn't behaving there, prosecutor Susan Doyle told the judge Monday. He wasn't taking his pills, and Roper suspected he was dabbling with crack cocaine, Doyle said.

So, Roper loaded Euell and her three sons into the family van and headed north to Washington, where she planned to return Euell to their mother, Whidbee said.

It was just supposed to be a pit stop at the Sunoco station off Interstate 95 in Smithfield. Euell pumped gas into the minivan. Roper and one son went into the store to use the restroom.

About that time, a local family pulled into the gas station. They drove an identical dark blue van.

When Euell saw the other family load into their van, he snapped, thinking it was his sister's van. He crawled inside to try to stop them from stealing his sister's van, police said at the time.

The other family yanked him out of their van. Euell was combative; he got into a shoving match with the other men.

Roper rushed into the parking lot and tried to clear up the confusion, Doyle said. Euell pushed her aside and fled in Roper's van, fearing that the strangers would try to kill him, Doyle said. His two nephews were strapped inside.

Euell led Smithfield police on a chase through the town's center. He flew through town at more than 100 mph; the speed limit on the main drag is only 25 mph.

As Euell headed west to Raleigh on U.S. 70 business, he tried to pass a tractor-trailer on the shoulder. He lost control, and the van flipped several times before crashing into a line of horse trailers. Craig Antonio Euell -- Euell's 11-year-old nephew, who suffered from brittle bone disease -- died instantly. He was thrown from a wheelchair bolted into the van. Another nephew, 6-year-old Robert Roper, was seriously injured.

At the hospital, doctors found cocaine in Euell's bloodstream.

Staff writer Mandy Locke can be reached at 829-8927 or mandy.locke@newsobserver.com. Read more!

Children's mental health maze - Boston Globe

Editorial

Children's mental-health care in Massachusetts has been fragmented and incomplete for years. Now it's time to act.

Some 111,700 children will experience a "serious emotional disturbance" during the 2005 to 2007 fiscal years, according to an estimate from the state Department of Mental Health. But getting mental-health care for children can be like walking through a maze of doors. Parents knock, but they're told to go to another door. Or worse, no one knocks, and untreated mental illnesses fester.

Some of these issues are being addressed by the Rosie D. lawsuit. In January, federal district court Judge Michael Ponsor ruled that Massachusetts had violated Medicaid laws by failing to provide home-based care for 15,000 children with psychiatric disabilities. This will lead to reforms for children covered by Medicaid. But the state needs sweeping change for all children.

"The time has come for bold vision and systemic change," a new report says. All children should get timely, first-class care. Anything less is unacceptable. Written by officials from the Massachusetts Society for the Prevention of Cruelty to Children and Children's Hospital Boston, the report calls for an interagency council that would have the governor's ear and that could enact sweeping change across agencies statewide. It's compelling work for Governor-elect Deval Patrick and the Legislature. The report sets the stage for a bill to be filed in January.

The bill would give responsibility for these issues to the Department of Mental Health, putting it in charge of setting statewide standards for care. The bill would increase staff and step up prevention. As with community policing, the strategy is to shift from a largely reactive system to one that can anticipate needs and meet them quickly.

With this new focus, the department could promote promising programs. One example is a Medicaid-funded program that lets pediatricians make phone calls to get psychiatric consultations about patients. Children's Hospital runs a similar call-for-help program in 15 schools that's popular with teachers. It's a resource that all the state's schools should have. The department could also better ensure quality across the board, so that children in foster care, those detained by the Department of Youth Services, and those with private insurance would all get good care.

The challenge is to reach children and families wherever they are: schools and doctors' offices, but also in their communities. It's a way to increase access and ease the stigma that keeps people from seeking help.

If there is no progress on children's mental-health care promptly, Massachusetts will have failed, and children will lose. Read more!

Making a crime of mental illness - Brandeton (FL) Herald Today

Editorial

Out of sight, out of mind will no longer suffice as Florida's solution for its growing population of mentally ill persons - especially if the preferred hiding place is the county jail.

The Department of Children and Families faces a long-overdue challenge of its practice of stashing people with serious mental issues in county jails and then ignoring them. The challenge is being made by circuit judges in several state jurisdictions who consider DCF's non-response to the problem an act of contempt of the court. One judge, Crockett Farnell of Pinellas County, last week issued DCF Secretary Lucy Hadi seven counts of criminal contempt for ignoring his orders to clear the Pinellas County Jail of mentally ill inmates who have exceeded the 15-day maximum provided by state law for mental assessment.

Asked if he would have Hadi jailed, the judge responded, "Oh, I'd love to. I'll do whatever I have to do to get somebody's attention."

A challenge for Crist

Having a major department head arrested certainly would be a symbolic gesture to highlight Florida's failure to provide for a growing mentally-ill population. Hopefully, it will be a wake-up call to Gov.-elect Charlie Crist to repair the damage created under the administration of Jeb Bush.

For Florida has through neglect and misguided policy decisions criminalized mental illness. Its jails teem with mentally-ill inmates who need specialized treatment that jailors are not equipped or required to supply. Their offenses range from hallucinations that disturb the peace to murder. By law, the state has 15 days to decide if an inmate is competent to stand trial; if not, DCF is required to move that inmate to a secure facility for treatment and, if feasible, eventual return to the judicial system to answer for his or her offenses.

But the state is forcing counties to keep such inmates in jail for an average of around three months - six times what the law says it should. That's what has judges like Farnell in St. Petersburg fuming - and threatening to jail the DCF secretary and to court-order inmates into private facilities at a cost of $800 per day.

DCF officials say they have no choice, given the state's shortage of secure psychiatric beds. Following the state's restructuring of mental health care in 2000, there are just 1,400 such beds in three state institutions statewide, while some 1,483 inmates were declared incompetent in 2005 alone. Obviously, the inflow of new patients overwhelms the existing facilities.

No wonder the National Alliance for the Mentally Ill rates Florida an F in its state-by-state report card on mental health services. Florida ranks 48th among the 50 states in mental health funding.

Patient services cut back

DCF officials claim to be mystified by the sharp increase in the number of inmates ruled incompetent in the last few years. They shouldn't be. Policies by the governor and Legislature have had a direct impact on the spike in mentally ill people being arrested. A big contributor was the state's Medicaid reform effort of 2005. In changing the criteria for who is eligible to get mental health care and related services, the state simply lopped off nearly 5,900 mostly elderly patients who had been getting assistance. By definition among the poorest of the poor, these people were left with few treatment or medication resources.

The Medicare Part D prescription drug plan that went into effect this year also hit the mentally ill population. By requiring those eligible for Medicaid to choose Part D, it exposed them to the "doughnut hole" of no drug coverage when they hit the coverage ceiling. With a single prescription costing as much as $600, and some mental patients needing more than one drug to overcome their illness, many were simply forced off the medications that gave them a chance at a normal life.

Too slow to act

And, knowing the jails are full of mental patients in violation of the 15-day treatment window, why didn't DCF act to create more beds in a secure facility? When Judge Farnell threatened to have her arrested last week, the DCF's Hadi suddenly "found" $5 million in an administrative fund that could be used to relieve the situation in Pinellas County. But what about the other 66 counties? Local mental health experts estimate that at any given time Manatee County Jail has from 100 to 150 inmates with mental problems. Judges in south Florida also are challenging DCF's failure to take responsibility for mentally ill inmates there. In the Panhandle two inmates have died in the Escambia County jail in encounters with guards not trained to deal with mentally ill inmates.

Florida isn't alone in ignoring the needs of the mentally ill; advocates say it's a national crisis, with the number of beds in psychiatric hospitals down 40 percent in the last decade. But that's no excuse for Florida to continue this neglect of the mentally ill whose untreated illness may be the reason they're in jail in the first place. It's often been said that a society is judged by the way it treats its weakest members. Florida does not earn a high mark for its treatment of the mentally ill.

Should the head of the Department of Children and Families be jailed for failing to provide care for jail inmates judged incompetent to stand trial? Share your views at Bradenton.com.
TEXT Read more!

Follow Law On Mental Illness - Lakeland (FL) Ledger

Editorial

Florida law requires that jail inmates found incompetent to stand trial must be turned over to the state's Department of Children & Families and placed in treatment within 15 days. That's the law. But there are about 220 inmates in county jails in excess of the 15-day limit still awaiting placement by the DCF.

At mid-month, 10 of those inmates were housed in the Polk County Jail. Last spring, a survey by The Ledger found some mentally ill inmates in the Polk County Jail who had been judged incompetent to stand trial had been waiting for months without a transfer.

Who pays the bill that the state should be paying? Polk County taxpayers and their counterparts in 66 other counties - nearly all of which are in the same situation. No wonder it's so easy for legislators in Tallahassee to embrace the tax cuts proposed by Gov. Jeb Bush.

Last week, Pinellas County Circuit Court Judge Crockett Farnell decided he'd heard enough of it. He ordered DCF Secretary Lucy Hadi to appear in court in mid-December to explain why she shouldn't be held in contempt of court for failing to uphold the law and he issued seven counts of indirect criminal contempt for failing to get inmates out of the Pinellas County Jail as previously directed.

The case involved part of the backlog of 30 defendants in the Pinellas Jail who have been waiting for treatment placement. "The department's own documents reflect them not asking [the Florida Legislature] for the bed space they knew to be needed," Farnell noted in that hearing.

Farnell isn't the first judge who has been frustrated by the DCF's repeated failure to comply with court orders. Hillsborough County Circuit Judge Debra Behnke has been dealing with the problem with the DCF for more than a decade. "If they can't be held accountable," she told The Tampa Tribune, "why should Joe Citizen be held accountable?"

While the backlog has been ongoing, Farnell is the first judge who has called for a contempt hearing, thus raising the issue's visibility on both the public radar screen and that of the DCF.

It evidently had a desired effect: Later on the same day Farnell's order was issued, the DCF announced it was earmarking an additional $5 million for more treatment beds.

The department evidently plans to do that by robbing its other programs. Hadi told the Orlando Sentinel last week that she would be transferring some of the money saved by "administrative reductions." But more money would have to wait until December when the Legislative Budget Commission meets to approve account transfers.

"I do not think we will have sufficient dollars this year to address the entire waiting list. We will be able to reduce it," Hadi told a reporter.

Reduce it? The law says 15 days. Unlike the cold numbers the DCF recites, these are 220 humans accused of wrongdoing but unable to stand trial because of their mental condition. Yet they remain in jail far beyond the 15-day limit: an average of 10 weeks for women and 13 weeks for men, according to the DCF's own figures.

While DCF officials cite a lack of funding as the cause of their problems, legislators point a finger back at the DCF. "If this had been brought to our attention in the budgetary process [last year], we would have adequately funded it," state Sen. Victor Crist, R-Tampa, told a Tribune reporter recently. "But this is a new one to me."

It's been a long-running problem, one that has continued to worsen as the state has closed state mental hospitals without offering commensurate increases in budgets for community facilities helping the mentally ill.

Thus the state finds its DCF secretary facing seven counts of indirect criminal contempt.

"If the secretary were put in handcuffs or put behind bars, it would not create more beds," said DCF spokesman Al Zimmerman after Farnell's order for the contempt hearing was issued. "But I can tell you that if it would create more beds … she would do it in a heartbeat."

When a reporter for the St. Petersburg Times passed that comment to the judge, Farnell said: "Well, good. Let's let her try that, because that would certainly get the governor's attention."

And the attention of state legislators as well. Read more!

MENTAL ILLNESS: Create a foundation - Jacksonville (FL) Times Union

Editorial

The face of mental illness is visible throughout Jacksonville.

It's in the teen suicide rate, it's in a segment of the homeless population and it's in tragic daily events like the recent shooting of a Shands Jacksonville pharmacy manager.

That's why many of the city's Adult Mental Health Task Force findings are not surprising:

62,000 persons in Jacksonville have a severe mental illness.

171,000 have a diagnosable mental illness.

Only 11,000 people receive treatment yearly.

The mental health system is severely underfunded.
The group's two years of work also revealed a root cause of the mental health system's failures: no uniform data collection.

This means there is no information on how many inmates receive psychological services in Duval County jails; no data from mental health care providers funded by the Department of Children and Families; and no detailed statistics to base requests for more state money.

It's no wonder the report describes gathering the data as "very tedious and time consuming."

Fortunately, these mental health and nonprofit professionals pushed forward.

The result is the foundation for reorganizing a fragmented system to focus on clients and their recovery.

This overdue change must begin with a commitment from local organizations, the city and state to work together on a management information system.

Other recommendations should be implemented, including creating a mental health authority, gaining public funding for prevention efforts and increasing housing for the severely mentally ill.

It shouldn't have taken a report to document what the community already knew.

But since it did, the leadership to begin fixing the mental health care system in Jacksonville must remain steady.

Only then can the needless deterioration of lives be stopped. Read more!

Mental-health insurance bill advances - New Jersey Star-Ledger

Tuesday, November 28, 2006

BY TOM HESTER
Star-Ledger Staff

A bill that would bolster insurance coverage for mental health care and substance abuse treatment cleared a key state Senate committee yesterday despite pleas from business that it would increase the cost of health insurance.


The measure, which moves to the full Senate, would apply to the 12 state regulated health insurance companies and the plans that cover state and local government employees. At least 2.5 million New Jerseyans are covered by the health insurance companies.

"It's only right that mental health problems and alcohol and drug addictions be covered in the same manner as other diseases," said Sen. Joseph Vitale (D-Middlesex), a co-sponsor of the bill. "Early diagnosis and treatment ... will help prevent greater health care costs in the long run."

Vitale said people with such illnesses usually face a limited number of days for in-patient and out-patient care, while a person with a heart ailment or broken leg is covered for all the care necessary.

Sen. Barbara Buono (D-Middlesex), a co-sponsor, said one provision in the measure would expand the definition of alcohol and substance abuse to include inpatient and outpatient care, detoxification, screening, and non-hospital residential treatment.

The bill (S-807) was approved 12-2 by the Budget and Appropriations Committee. Sens. William L. Gormley (R-Atlantic) and Shirley Turner (D-Mercer), who cast the dissenting votes, said lawmakers shouldn't be increasing health care costs for government workers while the Legislature and Gov. Jon Corzine are attempting to cut government spending and reduce property taxes.

Cost estimates project the increased benefits would cost state and local government $4.5 million in the budget year that begins next June, and $4.9 million the following year.

"This flies in the face of reforms," Gormley said. "This calls for $4.5 million in increased costs to state and local government. It is a noble goal, but where is the money going to come from? We are in the midst of a debate about benefits and we are adding another benefit."

Christine A. Sterns, a lobbyist with the New Jersey Business and Industry Association, and Ward Sanders, a lobbyist with the New Jersey Association of Health Plans, warned the legislation would make health insurance for small businesses more expensive and that increased costs could be passed to employees.

"The cost of health insurance has exploded in recent years, making it too expensive for some New Jersey companies," Sterns said. "As a consequence, the percentage of private sector employers providing health insurance coverage for their employees is beginning to fall."

Sterns said the average cost of a family health insurance plan in New Jersey jumped from $7,500 to $13,600 from 2000 to 2006.

Dawn Gemeinhardt, a clinical psychologist representing the New Jersey Psychological Association, supported the bill.

"Discrimination against mental health treatment within the totality of health care is unconscionable and inconceivable," she stated. "How can it be that we have long acknowledged the connection between the mind and the body yet parity between medical treatment and psychological treatment remains worlds apart?"

Vitale said he believes the bill will gain bipartisan approval in the Senate before the end of the year. Senate Minority Leader Leonard Lance (R-Hunterdon) voted in favor of the measure yesterday.
Read more!

LeGrande execution delayed for tests - AP

Associated Press 11.27.06, 1:51 PM ET

A judge ordered an execution delayed for 60 days Monday so psychiatrists can evaluate a man who wore a Superman T-shirt while representing himself at trial and pleaded with jurors to sentence him to death.

Guy Tobias LeGrande, 47, had been set to die Friday for the 1993 murder Ellen Munford, whose estranged husband offered to pay him $6,500 from a $50,000 life insurance policy.

The stay of execution granted Monday by Stanly Superior Judge William R. Bell includes 45 days for psychiatrists to submit their observations and evaluations to the court.

Death penalty opponents argue that LeGrande is one of the nation's most extreme examples of a mentally ill person who never should have been allowed to represent himself. Prosecutors suggest his courtroom antics were parts of an elaborate act.

Defense attorney James Coleman, a Duke University law professor, says a psychiatrist who recently examined LeGrande's records concluded that he is psychotic. The defense LeGrande believes the governor has already pardoned him and that he will receive billions of dollars from the state once freed.

Michael Parker, the current district attorney, said transcripts from LeGrande's 1996 trial show he appeared to know what he was doing much of the time. LeGrande's outbursts came at the end of the trial, when he didn't get the verdict he wanted, Parker said.

Beyond the issue of whether LeGrande should have been allowed to represent himself, his defenders question whether the state should execute an inmate they believe is mentally ill. Both the American Bar Association and American Psychiatric Association oppose executing defendants with severe mental disorders.

LeGrande's attorneys also are challenging the motivations of trial witnesses, saying they likely were paid for their testimony.
Read more!

Bedlam: Florida mental health care shameful - Tallahassee Democrat

Article published Nov 27, 2006

Back in the Middle Ages, an era lacking in enlightenment, a London hospital for the insane, whose name included "Bethlehem," became known in popular speech as "Bedlam."

The word evolved to its modern-day meaning: a place or condition of noise and confusion.

It's an apt description of Florida's at times dysfunctional treatment of mentally ill people who wind up behind bars as a result of their disease.

This month, the Department of Children & Families - which is part of the problem, but certainly not the source of it - has been on the receiving end of attorneys' and judges' anger because of this statewide inadequacy, which ultimately requires a legislative solution.

Under the gun, DCF last week agreed to spend an extra $5 million to comply with state law that requires mentally ill inmates who qualify for involuntary commitment to be placed in mental-health facilities within 15 days of a judge's order. More than 300 had been reported to be in jails across the state because the agency said it didn't have the money to find them beds.

In Hillsborough, Pinellas, Broward, Miami-Dade and possibly other counties, DCF faces legal problems because of its failure to comply. DCF Secretary Lucy Hadi was even slapped with an order to appear in a Pinellas courtroom next month to face possible contempt-of-court charges.

DCF has said the problem was due to an unanticipated increase in the number of mentally ill inmates, but a Miami-Dade judge placed the lion's share of responsibility on the Legislature.

"We have the most absurd system in the world," Associate Administrative Judge Steve Leitman told The Tampa Tribune. "Who's sicker, the mentally ill person trying to navigate the system or us? We devised a system you have to fail in" before getting help.

While few would argue that DCF doesn't deserve some of the blame, dumping all of it on the agency and its administrators is simply a cop-out. The real culprits here are lawmakers who've failed to address this issue sufficiently, leaving many of the most powerless, helpless citizens to languish in jail while their mental disease is inadequately treated.

Two years ago, Leon County Sheriff Larry Campbell told Tallahassee Democrat reporter Diane Hirth, "It shouldn't be against the law to be crazy, but right now they're treated as a law violator because they're unable to interact with society. They end up breaking the rules, and end up in my 'hotel.' ”

Sounds like bedlam to us. Read more!

Neighbors: Man fatally showas mentally ill - San Jose (CA) Mercury-News

By Leslie Griffy and John Woolfolk
Mercury News

Neighbors described the knife-wielding man shot and killed by two San Jose police officers Saturday afternoon as a sweet person who suffered from mental illness.

``I've known him since he was little,'' said a next-door neighbor who asked that her name not be used. ``He was so loving, but struggled.''

The 36-year-old man's name hasn't been released yet by police, and the neighbor declined to give it to a reporter.

Police said Sunday that the dead man had lunged at the two officers with two butcher knives outside of the single family home on the 6600 block of Cielito Way in the Santa Teresa area of San Jose.

A woman who answered the door at the home on Sunday declined to be interviewed.

Residents had summoned police to the quiet neighborhood of two-story stucco homes at 3:16 p.m. Saturday after hearing an escalating argument, Sgt. Nick Muyo said. Another neighbor phoned police at 3:25 p.m. and reported a man arguing with a woman and mentioning a knife.

Officers arrived to find the man locked outside the home and carrying the knives, Muyo said. At least one officer tried to subdue him with a Taser, Muyo said, but the stun gun failed to stop him.

``We don't know if it was a malfunction or if it missed,'' Muyo said. ``They did attempt to use less-lethal force.''

According to witnesses, the man then advanced toward the officers wielding the knives, and the officers shot him multiple times. He died soon afterward at a nearby hospital.

One neighbor said she heard five gunshots.

Muyo said the man had been arguing with a family member, but not a spouse.

The two officers, both 40 with 17 and 16 years on the force, were not injured and were placed on routine leave pending a review of the incident.

About three dozen police officers responded to the scene while a police helicopter hovered overhead. Read more!

Mental illness stretches jail stay - Seattle Times

By Keith Ervin
Seattle Times staff reporter

Someone booked into the King County Jail on a criminal charge or a conviction will likely stay there an average of nine to 35 days.

If the alleged offender is mentally ill, the stay will typically stretch to 158 days, more than five months.

Those numbers, recently presented by jail director Reed Holtgeerts to the Metropolitan King County Council, have helped galvanize an effort to get more mentally ill inmates out of jail and into treatment.

The council is studying whether to increase the sales tax by one-tenth of 1 percentage point to provide treatment and housing for people who are mentally ill or addicted to alcohol or drugs, and to expand therapeutic courts such as Drug Court and Mental Health Court. The tax would raise about $50 million a year.

"In terms of problems that exist and just are not acceptable, this one is at or near the top of the list," said County Councilman Bob Ferguson, D-Seattle. He called it "a moral wrong" to use the jail to "warehouse" people who are mentally ill.

If the council takes action, the sales tax, which will be 8.9 cents next year in most parts of the county, will go to 9 cents on a $1 purchase. The money would primarily help people who are homeless and are frequent inmates of the jail and frequent patients in the Harborview Medical Center emergency room.

Although council members generally support the idea of providing more housing and treatment, they also are concerned that raising the sales tax could hurt chances for voter approval of a regional-highway and transit-tax package next year.

The Legislature last year gave county governments the authority to raise the sales tax without a public vote to improve treatment services and expand therapeutic courts.

A report to the County Council this year cited a state Department of Social and Health Services finding that nearly all of the 125 King County residents who visited emergency rooms at least 21 times in one year were mentally ill or chemically dependent. Their hospital visits cost taxpayers more than $3.2 million in 2002.

The 158-day average jail stay for a mentally ill offender costs the county more than $15,000 — and for the most severely disabled far more than that — Holtgeerts said. Booking a typical inmate costs $180, and each day of incarceration costs $98 more.


Time spent in jail

Mentally ill inmates spend more time in jail because they tend to be homeless, have violated conditions of release and sometimes wait months for a competency evaluation.

On a visit to Mental Health Court, Holtgeerts said, he saw one suspect who was in jail for spitting on a bus and another for shoplifting. The mentally ill shoplifter had been locked up for 45 days because he was homeless and had no money for bail.

"Why are they in jail?" the jail director asked. "Look at what taxpayers are paying for these guys, and what have they done?"

County officials say the jail, with an estimated 274 seriously mentally ill inmates out of a jail population of about 2,550, has become the second-largest mental-health facility in the state, behind Western State Hospital.

After Holtgeerts, Sheriff Sue Rahr, judges, prosecutors and an advocate for the mentally ill told the County Council in June that putting schizophrenic and bipolar patients behind bars for minor criminal offenses was expensive — and in some cases worsened their mental condition — Ferguson introduced a motion to study the issue and consider raising the sales tax.

Ferguson's motion, which passed 9-0, asks Rahr, County Executive Ron Sims, Prosecuting Attorney Norm Maleng, judges and the public defenders to submit a plan by May for improving services for people with mental illness, alcoholics and drug addicts; reducing their numbers in the jail and emergency rooms; and reducing "chronic homelessness."

County Councilman Larry Gossett, D-Seattle, co-chairman of the Healthy Families and Communities Task Force, said raising the sales tax was "the centerpiece of our recommendations" on how to improve human services in King County.

Even with that tax, the task force found, the county will face a gap of $48 million in other social-service needs, such as supporting victims of sexual assault and domestic violence, helping troubled children and families, and providing health care to the uninsured.

That gap exists even with the $13 million-a-year Veterans and Human Services Levy approved by voters last year. That money is to be used primarily to reduce homelessness, jail stays and hospital visits by veterans, their families and others.


Decision in May

Only after the County Council receives the plan in May will it decide whether and when to raise the sales tax. It could put the issue up to a public advisory vote.

High on council members' minds is the rapidly growing local tax burden. County voters this month approved the Transit Now sales tax for bus service that will cost the typical household about $25 a year, and Seattle voters passed a separate streets levy, which next year will cost $36 per $100,000 assessed value, or $144 for a $400,000 house.

The County Council is considering a flood-management tax levy of up to $40 a year on a $400,000 home.

Sound Transit and the Regional Transportation Improvement District hope to put a package of sales- and property-tax increases on the November 2007 ballot that could raise the average family's tax burden by more than $250 a year.

"I believe that the potential for voter fatigue is out there," Gossett said.

"You can bet your bottom dollar that most of us as members are going to be thinking about what impact this is going to have on the voters of my district, even if we don't have to go out to them."

Councilwoman Kathy Lambert, R-Redmond, supports the concept of getting more mentally ill people out of jail and into housing and recovery programs.

But she wants to make sure the proposed sales-tax increase doesn't jeopardize funding of a regional highway tax. "We're trying to prioritize what is important," she said.

"We can't expect the citizens to be continually paying more and more taxes."


Keith Ervin: 206-464-2105 or kervin@seattletimes.com Read more!

Using drugs to alter kids behavior - NY Times

Editor's Note:
The following are six letters to the editor published in response to the NY Times recent article: Proof Is Scant on Psychiatric Drug Mix for Young

To the Editor:

Re “Proof Is Scant on Psychiatric Drug Mix for Young” (front page, Nov. 23):

As a practicing psychiatrist who has been on a medical school faculty for 28 years, I recognize the great benefit psychotropic medicines have provided for the psychiatrically ill. But I am alarmed at the trend of using multiple medications in the treatment of childhood disorders.

Medicines treat illnesses. It is misleading to think that medications can change behavior, but child psychiatrists are trying to do so nonetheless. Even more irrational is the trend of defining behaviors as illnesses to justify the use of medicines.


Child psychiatrists are moving toward a system that labels any child who has tantrums as “bipolar” and drugging that child into submission. In some instances, two drugs are used even though their actions are opposites.

Sir William Osler, the father of modern medicine, said that when there are many treatments for a single condition, it is because none of them work.

Gerald A. Shiener, M.D.
Birmingham, Mich., Nov. 24, 2006

•

To the Editor:

In all the articles that I see on psychiatric drug use in the young, the larger questions are never asked, or even acknowledged: Why are so many kids so depressed? Why are so many kids so hyper? Why can’t kids sleep?

Have we decided that the question of what causes these conditions is so hopeless we shouldn’t even ask it?

Scott Telek
New York, Nov. 23, 2006

•

To the Editor:

Your article rightly points out the complex issues behind the use of multiple psychiatric medications in children, especially the absence of any scientific proof as to their effectiveness and safety.

These children are quite unhappy. Their parents, teachers and doctors are desperate to help them. The bottom line, though, is that the children’s behavior is out of control.

Any sociologist or anthropologist looking at America’s child-rearing practices today will tell you that children’s compliance either will be learned by interacting with parents, teachers and peers or will be achieved chemically — no matter how many drugs or side effects it takes.

Lawrence Diller, M.D.
Walnut Creek, Calif., Nov. 24, 2006
The writer practices behavioral- developmental pediatrics.

•

To the Editor:

Anecdotal evidence about the high percentage of children treated with Ritalin and other prescription drugs suggests that we may be overmedicating.

But by affirming the backlash against the trend, you do a great disservice to those children — and adults — who do benefit from these drugs.

We have witnessed the joy with which these “miracle drugs” were received, and are now witnessing the backlash against their use.

I hope we will find a position of equilibrium before the progress we have made in sensitizing the public to mental-health problems has been erased.

Jessamyn Blau
New York, Nov. 23, 2006

•

To the Editor:

The problems of overmedication and undermedication are common in the contemporary treatment of psychiatric disorders. Some patients and families resist taking medication at all; others are too willing to take any and all medications prescribed.

The economics of mental health care does not support the thoughtful and unhurried assessment of the individual patient’s symptoms and problems by the most qualified and highly trained specialists.

There is evidence-based data available to guide clinical decision-making. Practitioners should resist external pressures from patients, families and schools to overprescribe and to promise more than can be delivered.

Michael Schwartz, M.D.
Stony Brook, N.Y., Nov. 23, 2006
The writer is an associate professor of clinical psychiatry at Stony Brook University School of Medicine.

•

To the Editor:

My goodness, have these parents not tried alternative approaches to changing the behavior of their children? Do they not see that Americans as a whole are overmedicated? Have they not considered other alternatives to psychotropic medications, such as family therapy or diet or exercise?

Why do parents continue to look outside of their family system to “fix” their children? The answer is not in pills. I applaud Andrew and Leslie Darr, who your article says weaned their children off their medications after Mrs. Darr herself felt what it was like to be medicated.

If more parents of these “sick” children could experience what it is that these children are going through, perhaps the pharmaceutical companies and the psychiatrists would find themselves with less profits in their pockets but there would be better-functioning families.

Donna Klein
Morristown, N.J., Nov. 24, 2006
The writer is a social worker.
Read more!

10 dead in Missouri Group Home Fire - AP

ANDERSON, Missouri (AP) -- A fire gutted a group home for the mentally ill in southwest Missouri early Monday, killing 10 people and injuring 24, authorities said.

Firefighters brought the blaze at the Anderson Guest House under control just before daylight, but blackened cinderblock walls were all that remained standing.

The home had 32 residents and two employees inside when the fire was reported around 1 a.m., Highway Patrol spokesman Kent Casey said.

The dead ranged in age from early 20s to the elderly, he said. Eighteen people were taken to area hospitals and six were treated at the scene, Casey said. Authorities initially thought another facility resident had escaped, but they learned the person was not at the home at the time.

Authorities were trying to determine if the fatal blaze was linked to a smaller fire at the facility Saturday morning, Assistant Fire Marshal Greg Carrell said.

He did not believe anyone was injured in the first fire, which was still under investigation when the second blaze began.

Two people were in serious condition at a Springdale, Arkansas, hospital. Freeman Hospital West in Joplin would not release the conditions of four people hurt in the blaze. All the other survivors who went to area hospitals were either in good condition or had been treated and released, officials said.

Those treated at the scene were at another facility operated by the home's owner, Joplin River of Life Ministries Inc., Casey said.

The cause was under investigation, and names of the victims had not been released.

A woman who answered the phone at Joplin River of Life Ministries on Monday morning said it was not releasing any information and hung up the phone.

Anderson, a town of about 2,000, is about 40 miles south of Joplin.

"I saw the front door blow open with fire," said neighbor Steven Spears, 47, who said he was up watching TV and saw the blaze erupt through security cameras he has outside his home. "I know most of them. I've talked to all of them at one time or another. It still hasn't hit me."

Inspectors from the Missouri Department of Health and Senior Services, which licenses the facility, found some deficiencies at the home in March but none related to fire safety, agency spokeswoman Nanci Gonder said.

"This is a devastating situation and we express our sympathy to the families of those who were killed or injured in the fire," Gonder said in a news release.

The facility also has a license from the Missouri Department of Mental Health that allowed mentally ill residents to live at the home and receive treatment elsewhere.

Mental Health spokesman Bob Bax said 17 of the facility's residents were receiving services from the department through the Ozark Center in Joplin.

Anderson is a former railroad town of about 1,800 people nestled in the Ozark mountains.

The town now has mostly small businesses and some manufacturing, though many residents commute roughly an hour south to jobs at Wal-Mart headquarters in northwest Arkansas or the businesses that have sprung up around the retailing giant. Read more!

In suicide by fire, an unheard protest - AP

Ashley M. Heher, The Associated Press

CHICAGO - Malachi Ritscher envisioned his death as one full of purpose.
He carefully planned the details, mailed a copy of his apartment key to a friend, created to-do lists for his family.

On his Web site, the 52-year-old experimental musician who had fought with depression even penned his obituary.

At 6:30 a.m. Nov. 3 -- four days before an election caused a seismic shift in Washington politics -- Ritscher, a frequent anti-war protester, stood by an off-ramp in downtown Chicago near a statue of a giant flame, set up a video camera, doused himself with gasoline and lit himself on fire.

Aglow for the crush of morning commuters, his flaming body was supposed to be a call to the nation, a symbol of his rage and discontent with the U.S. war in Iraq.

"Here is the statement I want to make: if I am required to pay for your barbaric war, I choose not to live in your world. I refuse to finance the mass murder of innocent civilians, who did nothing to threaten our country," he wrote in his suicide note. "If one death can atone for anything, in any small way, to say to the world: I apologize for what we have done to you, I am ashamed for the mayhem and turmoil caused by my country."

There was only one problem: No one was listening.

It took five days for the Cook County medical examiner to identify the charred-beyond-recognition corpse. Meanwhile, Ritscher's suicide went largely unnoticed. It wasn't until a reporter for an alternative weekly, the Chicago Reader, pieced the facts together that word began to spread.

Soon, tributes -- and questions -- poured in to the paper's blogs.

Was this a man consumed by mental illness? Or was Ritscher a martyr driven by rage over what he saw as an unjust war? Was he a convenient symbol for an anti-war movement? Or was there more to his message?

"This man killed himself in such a painful way, specifically to get our attention on these things," said Jennifer Diaz, a 28-year-old graduate student who never met him but has been researching his life. Now, she is organizing protests and vigils in his name. "I'm not going to sit by, and I can't sit by, and let this go unheard."

Family is divided

Mental health experts say virtually no suicides occur without some kind of a diagnosable mental illness. But Ritscher's family disagrees about whether he had severe mental problems.

In a statement, Ritscher's parents and siblings called him an intellectually gifted man who suffered from bouts of depression. They stopped short of saying he'd ever received a clinical diagnosis of mental illness.

"He believed in his actions, however extreme they were," his younger brother, Paul Ritscher, wrote online. "He believed they could help to open eyes, ears and hearts and to show everyone that a single man's actions, by taking such extreme personal responsibility, can perhaps affect change in the world."

His son, who shares the same name as his father, said his father was trying to cope with mental illness. Suicide seemed to be the next step, and the war was a way to give his death meaning.

"He was different people at different instances and so, so erratic. I loved him, no doubt, but he was a very lonely and tragic man," said Ritscher, 35, who is estranged from the rest of the family. "The idea of being a martyr I'm sure was attractive. He could literally go out in a blaze of glory."

Born in Dickinson, N.D., with the name Mark David, Ritscher dropped out of high school, married at 17 and divorced 10 years later. Eventually, he would change his name to match his son's and, coincidentally, a world-famous prophet's. At the end, he worked in building maintenance and was a fixture in Chicago's experimental music scene.

He described himself as a renaissance man who'd amassed a collection of more than 2,000 musical recordings from clubs in Chicago. He was a writer, philosopher and photographer. He was an alcoholic who collected fossils, glass eyes, light bulbs and snare drums. He paid $25 to become an ordained minister with the Missionaries of the New Truth and operated a handful of Web sites protesting the Iraq war.

A member of Mensa who claimed to be able to recite the infinite number Pi to more than 1,000 decimal places, he titled his obituary "Out of Time."

'I go now to God'

Friends, who seemed surprised about his death, found themselves searching for answers. Ritscher's death became even more enigmatic than his life.

In the end, only Ritscher knew the motivations for his suicide. There is little doubt, though, that he was satisfied with his choice.

"Without fear I go now to God," Ritscher wrote in the last sentence of his suicide note. "Your future is what you will choose today." Read more!

Too many questions unanswered as LeGrande faces execution - Charlotte Observer

Editorial

There's little doubt that Guy LeGrande is loony. His actions while representing himself in his murder trial demonstrated it. Whether his mental condition should prevent his execution Friday is but one of the questions the state must answer before his date with the executioner. A court hearing scheduled Monday in Stanly County is the first step in that process.

The process should involve Gov. Mike Easley as well as the judicial system, for at issue is not only Mr. LeGrande's fate but also North Carolina's commitment to justice.

Mr. LeGrande, who is black, was sentenced to death in 1996 for the 1993 murder of Ellen Munford in Stanly County. Authorities said Tommy Munford, who is white, plotted to kill his wife for insurance money and got Mr. LeGrande to do the job. Tommy Munford was allowed to plead guilty to second-degree murder in exchange for telling what happened. He's eligible for parole next year.

Mr. LeGrande was allowed to represent himself though, one lawyer said, he believed near the time of his trial that Oprah Winfrey and Dan Rather were speaking to him personally through TV sets. He sent the judge letters signed "Lucifer" and called the jurors "antichrists," court records say. An all-white jury convicted him.

Further questions arose after the trial when a judge ordered prosecutors to give his appellate lawyers the complete file on his case. Prosecutors argued they shouldn't have to, because he didn't properly request it before the postconviction deadline. But defense lawyer Jay Ferguson, appointed in October to examine competency issues in the case, argued that the deadline shouldn't apply because Guy LeGrande, who isn't a lawyer, didn't know to ask for the file.

A judge granted the request. The file showed some prosecution witnesses received payment for testifying and a share of a $5,000 reward -- facts the defense contends should have been made available to jurors but weren't.

At least three issues should be resolved satisfactorily if the state is to execute Guy LeGrande:

• Is he too mentally ill to be executed?

• Did race play a role in the decision to put him on trial for his life and let his white co-defendant plead guilty to a lesser charge?

• Did prosecutors improperly withhold information concerning payments and other benefits to witnesses -- information that might have made jurors skeptical about their testimony?

At this point the LeGrande case has more unanswered questions than a TV quiz show. The courts, and the governor, should get satisfactory answers before this case goes forward. Read more!

Living with mental illness in Florida - Daytona Beach News Journal

Shift to nonprofits causes concern

By DEBORAH CIRCELLI, Staff Writer

DAYTONA BEACH -- Three-year-old Allen Fuller picks a tiny white flower that fits perfectly between his fingers.

"Mommy, here's a flower for you," he says, running toward Monique Fuller.

"Thank you, Bubby." She leans down and gives him a kiss.

The 20-year-old steals as many tender moments as she can with her son. She only sees him on weekends because she's living in a facility for people with mental illnesses.

It had been more than a month since she left Act Corp.'s Pinegrove crisis center, where she was brought by police after thinking someone was trying to poison her. The medication she was taking for bipolar and schizoaffective disorders wasn't working properly, she said.

She's stable again, but worried about big changes ahead. Mental health care for Medicaid clients like Fuller is shifting to private, for-profit providers, and Fuller doesn't know whether her medication and other services will be covered.

Because of a 2004 legislative mandate, the state has begun phasing in managed care or what is called "prepaid mental health."

The change in Volusia and Flagler counties was to occur Dec. 1. That date has been pushed back until January or even February, as Magellan Behavioral Health of Florida, the for-profit company awarded the local contract, continues negotiating with local agencies that provide mental health services.

Instead of agencies such as Act Corp., the area's main mental heath provider, billing the state directly for services to Medicaid clients, the agencies will contract with Magellan.

Magellan, who is paid by the state to provide administrative-type services, acts as a middle-man between the state and the agencies in approving what services a client will receive.

The idea is to control skyrocketing Medicaid costs and fraudulent activity -- not to "put up a blockade to recipients," said Krista Moody, spokeswoman for the state Agency for Health Care Administration.

Under the current system with so many providers billing the state, Moody said it has been difficult for the state to check whether clients actually are receiving services. Agencies would bill the state after services were provided. The for-profit companies, with staff in the local areas, will have more accountability, state officials say, and ensure clients are receiving "high quality and medically necessary services."

But local mental health agencies and clients fear the change may mean fewer services.

"My biggest concern is that the clients are the ones who are going to suffer," said Gail Gregory, president of the Mental Health Association of Volusia County.

CHANGES DELAYED, AGAIN

Magellan was awarded the contract for Volusia, Flagler and St. Johns counties and in several other areas of the state this year after a statewide bidding process. It is a subsidiary of Magellan Behavioral Health and Magellan Health Services of Avon, Conn., which provides behavioral health needs nationwide. The company started operating in the Miami-Dade area in August and the Tallahassee area Oct. 1.

The change to managed care for Volusia and Flagler has been delayed numerous times. Negotiations are ongoing with officials at some area agencies who are reluctant to sign contracts because they say they are worried about how much and what types of services the company will approve for clients.

If local agencies don't contract with Magellan, the company will have to bring in other agencies to serve Medicaid clients.

In Volusia County, 56,061 people are on Medicaid, with 7,648 in Flagler, state officials say. The state estimates that 10 to 12 percent of Medicaid clients will need or use mental health services. Statewide, 2.2 million people are on Medicaid.

For Volusia, Flagler and St. Johns counties, the funding for prepaid mental health care is $4.6 million, about $300,000 less than in 2004/2005, according to state officials.

Some officials with agencies in other parts of the state, who have negotiated contracts with for-profit companies, said they've cut staff, and their clients face delays in getting services when prior approvals are needed.

Bob Sharpe, president of the Florida Council for Community Mental Health, said his members who have undergone the change have seen a 30 to 50 percent decline in Medicaid funding because less money is going to agencies to provide mental health services.

Sharpe, who previously oversaw the state's Medicaid program, said the state is taking an automatic 9 percent savings and managed care companies receive up to 20 percent for administrative costs, leaving even less Medicaid funding for the agencies.

"It clearly is a rationing of care and trying to avoid expensive care," Sharpe said.

Glenn Stanton, a senior vice president for Magellan, said his agency is taking less than 20 percent for administrative costs. He also said the "services currently being provided will continue to be provided" under the new plan.

He said agencies may need to get prior approval for some services, such as how long a person is hospitalized or how long a person may have a case manager. He also said Magellan's clinical staff will determine if services are "medically necessary" based on state guidelines. The length of time a client receives a service, he said, may also be shorter.

But prior approvals will not be needed, he said, for traditional counseling outpatient visits or visits with the psychiatrist regarding medication.

FEAR OF THE UNKNOWN

Local officials say there already are too few services available after case manager cuts this year at Act Corp., and the area can't afford any more cuts. Parents of Medicaid clients just want to know their children will get their medications, see their doctors and not end up in a crisis unit because of any delays.

Reggie Williams, local administrator for the state Department of Children & Families, said he also is concerned whether privatization "will result in fewer services." He said local staff will work with Magellan to ensure a smooth transition. State AHCA staff also will monitor Magellan to ensure enough services are being provided.

Shirley Holland, manager of Halifax Behavioral Services, which serves more than 3,000 local children, the majority on Medicaid, said despite the risk of fewer services, "we can't be so afraid of this transition that it paralyzes us." She said agencies have to be willing to negotiate the best contracts they can so clients can continue to have services.

Act officials originally said the agency wouldn't contract outpatient services with Magellan because they would lose money. But the agency is now trying to reach an agreement since Act wants to continue to provide services to its 1,700 adult Medicaid clients, officials there say.

The state will not switch to the new program until enough services are in place, officials said.

The House Next Door in DeLand, which provides counseling to families in several offices, is closing its Port Orange office Nov. 30 because it expects 25 percent less funding under the change, officials there said.

David Shern, the former dean of the University of South Florida Louis de la Parte Florida Mental Health Institute, who authored state reports analyzing managed care, said the proportion of people who could be receiving services is lower under managed care. Shern, who is president of the National Mental Health Association, also said only half of the time are clients getting the services recommended.

"We have a big concern regarding the quality of care that is provided," Shern said. "We have not yet found the magic bullet in terms of financing particularly with people with severe illnesses."

deborah.circelli@news-jrnl.com

A Silent Epidemic

NO. 1 Mental disorders are the leading cause of disability in the U.S. and Canada for ages 15 to 44.

26.2% estimated Americans ages 18 and older suffer from a diagnosable mental disorder in a given year, mental health experts say.

UP TO 9% of children in the United States have a serious emotional disturbance.

ABOUT 13% of kids between 9 and 17 have an anxiety disorder.

66% of boys in juvenile detention have a psychiatric disorder.

75% of girls in juvenile detention have a psychiatric disorder.

19 MILLION Americans have depression each year.

19 MILLION Americans live with anxiety disorders, such as phobias, obsessive-compulsive disorder and general anxiety disorders.

33% of Americans who need treatment for a mental health disorder receive it.

Definitions of Some Mental Illnesses

BIPOLAR DISORDER Also known as manic depression, is an illness involving one or more episodes of serious mania and depression. The illness causes a person's mood to swing from excessively high and/or irritable to sad and hopeless, with periods of a normal mood in between. More than 2 million Americans suffer from bipolar disorder.

SCHIZOPHRENIA A serious disorder that affects how a person thinks, feels and acts. Someone with schizophrenia may have difficulty distinguishing between what is real and what is imaginary; may be unresponsive or withdrawn, and may have difficulty expression normal emotions in social situations. They sometimes hear voices others don't hear, believe that others are broadcasting their thoughts to the world or become convinced that others are plotting to harm them. It affects about 1 percent of the world population. In the United States, one in 100 people, about 2.5 million, have this disease.

SCHIZOAFFECTIVE DISORDER A disorder that involves schizophrenia combined with a mood disorder, such as depression or bipolar disorder. The illness usually begins in early adulthood and is more common in women. People with affective disorders usually appear normal between episodes of illness. Seriously depressed and manic people often have hallucinations and delusions. An exact prevalence rate is not yet clear for this disorder, according to the National Mental Health Association, but it is estimated to range from two to five in every 1,000 people (i.e., 0.2 percent to 0.5 percent).

For more information, go to www.nmha.org and www.nimh.nih.gov Read more!

Funding cuts force choices for mental health centers - Longview (TX) News-Journal

By JIMMY ISAAC

Editor's note: This story on state funding for Mental Health and Mental Retardation Centers is the second in an occasional series about the challenges facing the state, Texans with mental health disabilities and their families. Next: The effect on Texas' criminal justice system.

Mark Blockus is entering his final week as executive director of the Northeast Texas Mental Health/Mental Retardation Center. About $1.5 million more, and he might have stayed a while longer.

That money wouldn't be for his salary. Blockus says the center has lost $1.5 million in state funding over the past decade, going from a budget of about $7 million in 1997 to $5.5 million in 2006. As a result, Blockus is voluntarily resigning from the center that has served Bowie and Red River counties since the 1970s. The Northeast Texas center will be consolidated into the Sabine Valley MHMR Center on Dec. 1.

"We're still viable and could have stayed as we were probably for several years. However, the continued cuts were going to have a more significant impact," Blockus said. "Truly, the Texas state (mental health) system is severely underfunded."

A spokeswoman for the Department of Aging and Disability Services disputes that funding to Northeast Texas MHMR for mental retardation services has not changed in recent years.

Blockus said, however, that his center's allocation for mental retardation allocation from DADS dropped by a third — more than $400,000 — between fiscal years 2003 and 2004 and that $39,000 was taken from Northeast Texas MHMR and redistributed to other centers.

A lack of money has forced mental health directors to make tough choices in the past few years. Sabine Valley serves six primary counties, but Bowie and Red River counties may not be the last to come into the fold. Inman Davis, Sabine Valley's executive director, says further expansions could be on the horizon.

Rather than hold its hand out to Austin, Sabine Valley is taking a proactive role. In October, it hosted past and present state lawmakers and mental health experts for an advocacy workshop aimed at showing area residents the how's and why's of taking their own personal messages to Texas legislators.

"About 10 percent of 9,000 bills will pass (each legislative session). Only 600 will be real substantive that will have an impact on people's lives," Arc of Texas Executive Director Mike Bright said to a group of patrons at the workshop. "We must ensure that bills are not harmful and will advance the cause of disabilities."

The center has aggressively pursued competitive, state-administered grants, tripling money from that source in the past six years, according to the center's budget documents.

Meanwhile, direct funding from local communities that get services from Sabine Valley have dropped by half in recent years, as have private insurance payments and non-profit donations, Davis said.

State revenues and mental health block grants have dropped 8.7 percent in six years.

Fiscal responsibility has remained at Sabine Valley's forefront, Davis says. Inside and outside auditors are at the center two out of every three days.

"If (auditors are) not in here that 70 percent of the time, we're in here making sure people's money is spent in the way it's supposed to be spent," Davis said.

State Rep. Tommy Merritt, R-Longview, says in his district of Gregg and northern Smith counties, 264 families are waiting for foster care placement or other disability services. He believes funding is an urban vs. rural issue, as many waiting families have moved to other parts of the state for faster help.

His solution is for fellow East Texas elected officials — Reps. Bryan Hughes, Chuck Hopson and Leo Berman and Sen. Kevin Eltife — to band together and help what he says are about 2,000 families throughout East Texas waiting for services.

"First of all, let me say many of the individuals at Sabine Valley who are affected by these cuts have been to Austin session after session talking about the weight lift," Merritt said. "I think Sabine Valley has done a good job of trying to get their clients to explain this issue to members of the Legislature, and we have to try to work together to help them."

The fight for increased funding faces an uphill battle. Gov. Rick Perry asked all state agencies to cut their budgets by 5 percent to make room for a lower cap on local school property taxes last year. In addition to budget cuts, other taxes were expanded or increased to allow the state to make up what school districts might lose because of the lower tax cap.

The Department of State Health Services' funding request for 2008-09 calls for a 15 percent cut for mental health services for adults and children. The Department of Aging and Disability Services is asking for 15.8 percent less money for home- and community-based services for fiscal year 2009 as compared to 2007.

Merritt says the state is expecting a more than $15 billion surplus in the next two-year budget cycle.

"The powers that be cannot say we don't have any money," former State Sen. Bill Ratliff told about 100 people at the Behind the Pines Advocacy Workshop. "They can say you're not going to get it, but they can not say they don't have it."

Ratliff advised would-be advocates to visit legislators and use their polite, non-threatening messages to combat special-interest lobbyists who have millions of dollars on their side.

"You have to bring a message so persuasive that you don't need a few million dollars," Ratliff said.

The business of helping patients will continue for employees in Texarkana who will now work for Sabine Valley, Blockus said.

Northeast Texas is the smallest center in the state, and state-set limits on administrative spending led to some hard decisions in the wake of funding cuts.

"As a governmental entity, we have regulatory responsibilities that have become more difficult to do with the reduction of funds," Blockus said. "It has to be considered to try to find some funds to put in (the mental health) system, because at this point, the costs are being shifted to hospital emergency rooms, jails, prisons, other counties and county indigent funds.

"One way or another, we're paying for it, and we're paying much higher costs to provide services to individuals than if we would put that money into community service."

Read more!

Sick kids come last - Charlotte Observer Editorial

EDITORIALS

North Carolina doesn't care about its mentally ill kids. That's the only logical conclusion to draw from the way the state Department of Health and Human Services handled the decision to outsource approval for treating sick children on Medicaid.

Mistakes were made, and kids have been hurt. Gov. Mike Easley should ask for a full accounting from HHS Secretary Carmen Hooker Odom. This isn't the first major HHS foul-up that has put vulnerable children at risk. If Ms. Hooker Odom can't fix the mess, and fix it now, Gov. Easley should replace her.

In March, Ms. Hooker Odom suddenly decided to pay a private company to review requests for treatment for the state's mentally ill Medicaid recipients. The idea behind that change was sound: to save taxpayers millions of dollars a year and get requests approved faster than local public health agencies could work.

Yet reforms began with children's services, and secretary's decision only gave the company two months to prepare. HHS ignored warnings that requests could balloon, and swamp the company.

The result? Thousands of treatment requests for mentally ill children flooded into the company. Long delays left children who needed help waiting and suffering, or getting worse.

Here a few of the things the Charlotte Observer's investigation uncovered.

• One mentally ill boy ran away while waiting for approval to go into a group home.

• A girl in Charlotte attempted suicide while waiting for her treatment to be approved.

• Kids charged with crimes waited in detention centers -- or getting into more trouble while they waited.

Gov. Easley should ask for an investigation of what went wrong. Of particular concern:

• Why did HHS move so quickly to implement a major reform?

• Why didn't mental health providers receive thorough training in how this change would work?

• Why did Ms. Hooker Odom not realize that a combination of new treatment services and new approval rules would produce as many requests as it did?

In 2001, another critical leadership failure at HHS put emotionally ill children in group homes at risk. Slack rules, lucrative reimbursements to private contractors and scant state oversight surfaced after a girl in a Charlotte group home suffocated while a worker without proper training restrained her.

Administering mental health services is complicated, but we'll say it again: The only logical conclusion is that the people in charge in North Carolina don't care about mentally ill kids, particular poor ones. That's not acceptable.

Government can't be expected do everything, but it can and should be an advocate for vulnerable children who cannot speak up for themselves. Read more!

Mental illness in black face - Julian Bond, Charlotte Observer

Published Nov. 24

Condemned man's trial tainted by racism, overzealous prosecutors

JULIAN BOND, Special to the Observer

Convinced he was receiving signals from Oprah Winfrey and Dan Rather through his television, Guy Tobias LeGrande fired his attorneys and, wearing a Superman T-shirt, represented himself in the trial for his life. The State of North Carolina plans to execute LeGrande Dec. 1.

It is now universally acknowledged that capital defendants are entitled to competent defense lawyers. Why did North Carolina allow this seriously mentally ill man to represent himself?

In the last few years, the U.S. Supreme Court has decided that some offenders -- juveniles and those with mental retardation -- are less morally culpable, and for that reason should not be subjected to the death penalty.

Last August, the American Bar Association, in concert with the American Psychiatric and Psychological Associations, formally recommended that people with serious mental illness should not be eligible for execution if the illness prevents them from "exercis[ing] rational judgment in relation to conduct." Under that standard, LeGrande should not be executed.

Unfair from the start

LeGrande's case is the appalling story of zealous prosecutors exploiting a mentally ill man. Although I have seen progress in race relations in my lifetime, it is an undeniable fact that racism continues to play an insidious role in our criminal justice system. LeGrande's exploitation was even more shameful because that same racism enveloped his case, creating an unfair climate from the start.LeGrande is black. The two men who planned every detail of the murder for which LeGrande faces execution are white. The central facts of the crime are not disputed. Tommy Munford harassed his wife for years and told even casual acquaintances that he wanted to "do [her] in." He tried to recruit at least three people to kill her, offering to pay them from the proceeds of an insurance policy he had on her life. He established an alibi for himself by taking his two small children to the beach while she was killed.

Munford told the white man with whom he had planned the murder and who provided the murder weapon that he had found a "n----- from Wadesboro" to kill his wife. As a result of decisions by the prosecutors, this "n----- from Wadesboro" was the only person to face the death penalty for the murder.

Prosecutors freely acknowledged that Munford was the mastermind and driving force behind the murder. Nevertheless, they offered Munford an extraordinary deal for his testimony fingering LeGrande as the triggerman: Munford pled guilty to charges that leave him eligible for parole. The other white accomplice and co-conspirator was not even charged.

Outrageous statements

LeGrande's trial was farcical. Before trial, a psychiatrist at a state mental facility interviewed LeGrande and found that he had "narcissistic, grandiose, and hypomanic traits" and prescribed anti-psychotic medication, which LeGrande refused to take. Fueled by his mental illness, LeGrande made outrageous statements to the prosecutor and others, claiming among other things that celebrities were sending him messages over the television, his case was receiving national attention (it wasn't), that he was innocent and entitled to a large sum of money from the state, and that the FBI was taking his calls.

LeGrande was prosecuted by a district attorney's office with a sordid history of race discrimination. The prosecutor gained notoriety for wearing in court a gold lapel pin shaped like a noose. In an effort to "boost morale," the prosecutor awarded nooses to assistant district attorneys who won death penalty cases. In LeGrande's case, the prosecutor used a rope metaphor throughout his opening statement, obviously referring to a noose. The prosecutor selected an all-white jury.

As the trial progressed, LeGrande became increasingly agitated. The judge suggested LeGrande try to calm himself. During the crucial penalty phase of the trial, LeGrande's incoherent ramblings reached a pinnacle when he goaded the all-white jury to "Pull the damn switch and shake that groove thing." The jury sentenced him to death after only 45 minutes of deliberation.

Commute sentence to life

The issues of mental illness and race that plague this case cannot be separated. The sad fact is that for many white Americans, mental illness is even scarier when it appears in black face. I am convinced that LeGrande was condemned to death in part because his all-white jury could not muster any empathy for this mentally ill black man who had killed a white woman in their community.

LeGrande should be punished for his role in the death of Ellen Munford. But human decency compels us to acknowledge the central role that his mental illness, entangled with racial prejudice and fear, played in both the crime and the punishment. Gov. Mike Easley has a tremendous opportunity to address an obvious injustice. He can right this wrong by commuting LeGrande's sentence to life in prison.

Julian Bond is board chairman of the NAACP, 4805 Mt. Hope Drive, Baltimore, MD 21215. Read more!

Proof Is Scant on Psychiatric Drug Mix for Young - NY Times

Published November 23, 2006

By GARDINER HARRIS

Their rooms are a mess, their trophies line the walls, and both have profiles on MySpace.com. Stephen and Jacob Meszaros seem like typical teenagers until their mother offers a glimpse into the family’s medicine cabinet.

Bottles of psychiatric medications fill the shelves. Stephen, 15, takes the antidepressants Zoloft and Desyrel for depression, the anticonvulsant Lamictal to moderate his moods and the stimulant Focalin XR to improve concentration. Jacob, 14, takes Focalin XR for concentration, the anticonvulsant Depakote to moderate his moods, the antipsychotic Risperdal to reduce anger and the antihypertensive Catapres to induce sleep.

Over the last three years, each boy has been prescribed 28 different psychiatric drugs.

“Sometimes, when you look at all the drugs they’ve taken, you wonder, ‘Wow, did I really do this to my kids?’ ” said their mother, Tricia Kehoe of Sharpsville, Pa. “But I’ve seen them without the meds, and there’s a major difference.”

There is little doubt that some psychiatric medicines, taken by themselves, work well in children. For example, dozens of studies have shown that stimulants improve attentiveness. A handful of other psychiatric drugs have proven effective against childhood obsessive compulsive disorder, among other problems.

But a growing number of children and teenagers in the United States are taking not just a single drug for discrete psychiatric difficulties but combinations of powerful and even life-threatening medications to treat a dizzying array of problems.

Last year in the United States, about 1.6 million children and teenagers — 280,000 of them under age 10 — were given at least two psychiatric drugs in combination, according to an analysis performed by Medco Health Solutions at the request of The New York Times. More than 500,000 were prescribed at least three psychiatric drugs. More than 160,000 got at least four medications together, the analysis found.

Many psychiatrists and parents believe that such drug combinations, often referred to as drug cocktails, help. But there is virtually no scientific evidence to justify this multiplication of pills, researchers say. A few studies have shown that a combination of two drugs can be helpful in adult patients, but the evidence in children is scant. And there is no evidence at all — “zero,” “zip,” “nil,” experts said — that combining three or more drugs is appropriate or even effective in children or adults.

“There are not any good scientific data to support the widespread use of these medicines in children, particularly in young children where the scientific data are even more scarce,” said Dr. Thomas R. Insel, director of the National Institute of Mental Health.

Psychiatrists who prescribe drug combinations say that the ability to mix and match medications improves their chances of being able to help children who are seriously, even desperately, ill.

Dr. Joseph Biederman, a professor of psychiatry at Harvard, said that doctors commonly used multiple medicines to treat heart disease, diabetes, cancer and AIDS. “Child psychiatry is not any different,” Dr. Biederman said. “These drugs have revolutionized how we treat severe psychopathology in children.”

The controversy leaves parents in a terrible bind. Desperate to help, many agonize over whether to medicate their children.

Mothers and fathers sometimes disagree, with the dispute straining or even ending marriages. Since some psychiatric drugs can cause worrisome physical effects, parents say that they must on occasion make a terrifying choice between their child’s physical health and his mental health.

The parents interviewed for this article told their stories, they said, in hopes of gaining greater acceptance for their children and themselves. Nearly all recalled being in a store when their child threw a tantrum and feeling that onlookers branded them as bad parents. They also said they hoped to help others negotiate what many said were unequal and often fraught relationships with psychiatrists.

“We struggled so much, made so many mistakes and felt so stigmatized, I hope our story can make it easier for others,” said Jacquie Erickson of Anchorage. Her daughter, Kaitlyn Johnston, 10, has taken psychiatric drugs since she turned 5 for diagnoses that include bipolar disorder.

On Shaky Ground

Stimulants like Ritalin are by far the most commonly prescribed psychiatric medicines in children. But doctors routinely pair stimulants with antidepressants, antipsychotics and anticonvulsants, even though some of these medications can cause serious side effects, have few proven pediatric psychiatric benefits and lack clear evidence about how they interact or influence mental and physical development.

Last year, the Food and Drug Administration required drug makers to warn on their labels that antidepressants can cause suicidal thoughts and behavior in some children. Anticonvulsant drugs carry warnings about liver and pancreas damage and fatal skin rashes. The side effects of antipsychotic medicines can include rapid weight gain, diabetes, irreversible tics and, in elderly patients with dementia, sudden death. When drugs are combined, these risks compound.

Ms. Kehoe, who receives government financial and child-care assistance because her children are considered mentally ill, said she knew that there were risks to the drug cocktails. Both her sons are short and underweight for their age — a common side effect of stimulants — and she fears that the drugs have affected their health and behavior in other ways.

“But I don’t think the insurance would pay for it if the F.D.A. didn’t decide that children should use it,” said Ms. Kehoe, who herself takes psychiatric medication.

In fact, the drug agency has specifically warned against the use of Lamictal, one of the drugs Stephen takes, in children who, like him, do not suffer from seizures because in 8 out of 1,000 children the drug causes life-threatening rashes.

Stephen and Jacob’s psychiatrist did not reply to telephone messages left with an office secretary on three different days. Ms. Kehoe said that she asked him to speak to this reporter but that he refused. The boys have had 11 psychiatrists over the last three years, according to prescription records, and many more before that, Ms. Kehoe said.

In interviews, Stephen and Jacob said they hated taking their drug cocktails.

“Everybody hates meds,” Jacob said.

Ms. Kehoe said her youngest son, Lucas Keck, was showing signs of attention deficit disorder and might soon need to start medication.

“I see the hyperness in him,” she said. “My pediatrician has said that he would venture to say that Lucas will be A.D.H.D.”

Stephen and Jacob were Lucas’s age — 6 — when they were given their first prescriptions.

The F.D.A. requires drug makers to prove that their drugs work safely before the agency will approve them for sale in the United States. But doctors can prescribe and combine approved medicines as they see fit. Such mixing is common in medicine but rarely studied by drug makers.

Psychiatrists started mixing psychiatric medications because the drugs were only moderately effective and often caused terrible side effects, said Dr. Steven E. Hyman, the provost of Harvard University and former director of the National Institute of Mental Health. “None of these drugs by themselves do an adequate job of controlling symptoms,” Dr. Hyman said.

If one drug failed, many psychiatrists assumed that two or more drugs used together might succeed. For decades, no one studied whether this was accurate. But in recent years, a trickle of studies have examined the question, with mixed results.

In studies in adults, some combinations of two drugs have been shown to work better than single medications to improve the symptoms of depression, obsessive-compulsive disorder and the mania associated with bipolar disorder. For example, a recent large government-financed study in adults, published in The New England Journal of Medicine, found that two antidepressants worked a bit better than one for adults who suffered from chronic, severe depression. But other studies have found no benefit from commonly prescribed drug combinations.

The use of two-medicine combinations in children is on much shakier ground. Even for single drugs, the effectiveness of some psychiatric medications in younger patients is questionable: most trials of antidepressants in depressed children, for instance, fail to show any beneficial effect. But hardly any studies have examined the safety or the effectiveness of medicine combinations in children. A 2003 review in The American Journal of Psychiatry found only six controlled trials of two-drug combinations. Four of the six failed to show any benefit; in a fifth, the improvement was offset by greater side effects.

“No one has been able to show that the benefits of these combinations outweigh the risks in children,” said Dr. Daniel J. Safer, an associate professor of psychiatry at Johns Hopkins University and an author of the 2003 review.

If the evidence for two-drug combinations is minimal, for three-drug combinations it is nonexistent, several top experts said.

“The data is zip,” Dr. Hyman said.

Many psychiatrists said that they turned to drug cocktails only in desperate circumstances. “If you’ve got a 15-year-old who is cutting up her arms, you’ve got a barn on fire and what are you supposed to do?” asked Dr. Alexander Lerman, a child and adolescent psychiatrist in New York, who said he rarely prescribed combinations.

Billy and Jackie Igafo-Te’o of Jackson, Mich., are among the desperate. In the last seven years, their 12-year-old son, Michael, “has been on just about everything you can put a child on,” Mrs. Igafo-Te’o said. He is now taking four medications: an antipsychotic, an anticonvulsant, an antidepressant and a sleep medicine.

Despite the medications, Michael’s behavior has grown increasingly disruptive. He has kicked and punched holes in almost every wall of the Igafo-Te’o home. He wrenched the sink off the wall in the upstairs bathroom and pulled two bedroom doors off their hinges, damaging the frames. The family no longer fixes the damage.

During a recent visit, Michael and Mr. Igafo-Te’o were sitting on the living-room floor. Michael wanted the phone. His father held it out of reach to prevent Michael from playing with it. Michael became increasingly desperate. He cried. He cursed.

“That’s it, you have a timeout,” Mr. Igafo-Te’o said.

“No, no, no,” Michael answered. “You pimp!”

He slapped his father in the face, hard. Mr. Igafo-Te’o hustled Michael into the kitchen and forced him to sit for 20 minutes.

“What’s the purpose of all this medication if I still have to do that?” Mr. Igafo-Te’o asked.

He said he wanted to end Michael’s drug therapy. Among other side effects, the drugs have made Michael obese, which has led to asthma.

Mrs. Igafo-Te’o quietly disagreed. “I’m afraid he wouldn’t be able to focus,” she said. “I’m afraid he would regress socially.”

“Regress socially? Look at him!” her husband responded, motioning to their son, crying uncontrollably on the kitchen floor.

“I have to believe in something,” his wife mumbled and walked out of the room.

Mr. Igafo-Te’o watched her go and then smiled apologetically.

“We always debate meds,” he said.

Divergent Views

Most experts agree that some children are so violent or suicidal that a combination of psychiatric drugs is worth trying. But recently, more psychiatrists have been asking whether in some cases drugs are being prescribed for children who do not need them, or for problems that fall within the spectrum of normal behavior. The doubters are especially concerned with the growing use of drug combinations for preschoolers.

Fate Riske, 3, of Fond du Lac, Wis., takes two antipsychotics and a sleeping medicine to control what her mother, Elizabeth Klein-Riske, said were hours-long tantrums, a desire to watch the same movies repeatedly and an insistence on eating the meat, cheese and bread in her sandwiches separately.

On a recent visit, Fate played sweetly for four hours as her parents, who both have trouble walking, sat in front of a television. Sucking on a pacifier, Fate showed off her pink dress and matching shoes.

Mrs. Klein-Riske credited the drugs for Fate’s cherubic behavior during the visit. But a few weeks on a different antipsychotic led Fate to become aggressive, talk rapidly and “run around wild, totally out of control,” said Mrs. Klein-Riske, who receives government financial and child-care assistance because her daughter is considered mentally ill.

Fate’s weight ballooned in five months to 48 pounds from 30.

Dr. Gary Sachs, director of the Bipolar Clinic and Research Program at Massachusetts General Hospital in Boston, estimated that half the children referred to his clinic for research in recent years — including many who took drug combinations — had the wrong diagnosis and often did well on fewer drugs. “Even among properly diagnosed bipolar patients, many come to our program already taking medicines that interfered with each other,” Dr. Sachs said.

But Dr. Judith Rapoport, a senior investigator in child psychiatry at the National Institute of Mental Health, said that in her experience, few children were overmedicated. Dr. Rapoport studies children with schizophrenia. Before entering her study, children must be drug-free for three weeks.

“We’ve had a handful of cases who are completely normal when they get off drugs,” Dr. Rapoport said. “But most of these kids become very, very sick and unmanageable without drugs.”

The first psychiatric problem diagnosed in most children is attention deficit disorder, treated with stimulants — drugs that improve attentiveness. But when children’s problems persist, parents’ relatively good experience with stimulants often convinces them to agree to try other medicines — in some cases drugs like the antipsychotic Risperdal or the anticonvulsant Depakote that have few proven benefits in children and greater dangers, said Dr. Ranga Krishnan, chairman of the department of psychiatry and behavioral science at Duke University.

“After you get them on one drug, parents don’t seem to mind the second,” said Dr. Krishnan, who said that he had grave doubts about the growing use of psychiatric drug cocktails in children.

Antidepressants are commonly paired with stimulants, but antidepressant use has declined over the last year after the F.D.A. warning about suicide risk. In their place, physicians are prescribing combinations that include antipsychotic and anticonvulsant drugs, according to Medco. From 2001 to 2005, the use of antipsychotic drugs in children and teenagers grew 73 percent, Medco found. Among girls, antipsychotic use more than doubled.

On Again, Off Again

Andrew Darr of Caldwell, Idaho, whose sons took medications, said that he was opposed to it from the start. “When you come home from work and instead of getting them clawing at your feet and yelling, ‘Daddy, Daddy,’ you get a lethargic grunt, it just kills you,” Mr. Darr said.

His wife, Leslie Darr, eventually agreed to stop the medicines, but only after a family tragedy.

The Darrs have four children, Nicholas, 16, Nathan, 15, Becky, 12, and Benjamin, 9. At 3, Nicholas suffered a mild brain injury when undiagnosed appendicitis led him to suffer weeks of high fever, Mrs. Darr said.

Mrs. Darr said that she was pressured by school officials to give Nicholas a stimulant at age 6. Nathan soon followed.

Three years later, the boys had a traumatic weekend away with relatives. A month after that, Mrs. Darr said, both were hospitalized for a week and given a diagnosis of bipolar disorder and prescriptions for antipsychotic, antidepressant and sleeping medicines.

Over the next three years, Nicholas’s weight ballooned to 140 pounds from 52. Nathan went to 115 pounds from 48. Neither boy got much taller, Mrs. Darr said. They did poorly in school.

Then Becky developed a brain tumor. A nurse practitioner gave Mrs. Darr free samples of an antipsychotic drug to help her cope. After starting it, she said, she could not sleep or think straight. She realized that she had been giving similar medicines to her sons for years and she decided to wean the boys off the pills.

Their behavior immediately worsened. At one point, Nicholas left the house during a blizzard wearing only boxer shorts, Mrs. Darr said. They found him in a tire swing saying, “Baaa.”

“There were several times that we almost gave up,” Mr. Darr said.

But after four months off medication, the boys’ behavior normalized, the Darrs said, and they were transferred out of special education and into regular classes. The Darrs recently allowed the boys to spend their first evening at a mall without supervision, and in July they gave both boys their first bicycles. “They’ve come a long way,” Mrs. Darr said.

In an interview, Nicholas said the drugs “were not cool.”

“You go to school and everybody thinks, ‘Look at that retard,’ ” he said.

Still, most of the parents interviewed for this article said their children’s behavior deteriorated rapidly without medication.

Joanne Johnson of Hillsborough, N.J., described a psychiatrist’s effort to wean her 17-year-old son, Brad, off of all five of his psychiatric medicines as “the biggest mistake of our lives.”

Brad, then 13, became suicidal and was hospitalized for weeks, Ms. Johnson said.

“He went into the hospital on five drugs and came out on five different ones, but he was unstable,” she said. “It took a little over two years to find the right match again.”

Brad is now taking lithium, an antipsychotic, an anticonvulsant, an antidepressant, a stimulant and a sleeping pill.

“He’ll probably be on these for the rest of his life,” Ms. Johnson said. Read more!

Mental-health training is vital - Salem (OR) Statesman-Journal

Guest Opinion, KRIS ANDERSON, November 25, 2006

I was pleased to see Portland Mayor Tom Potter's and Police Chief Rosie Sizer's dedication to providing crisis intervention team training to all Portland police officers. I dare to hope the 2007 Legislature will require the same of all officers.

My son has bipolar disorder and had his first handcuffed ride in a police car when he was 7 years old. He also received his first assault charges at that time. Police deal daily with mental-health issues in children such as my son, youths, adults, their families and victims. They need to have crisis intervention team training for these frequent encounters.

At least twice a month for the past six months, I have had my son's psychiatrist say, "You should call 911 when that happens." ("That" refers to threats against family, property or himself.) I remind the doctor, "I work with police and fire personnel. I know law enforcement won't be able to do anything unless there's physical harm/damage. I do call then."

Yes, I answer 911 calls from others desperate for help in a system with a dearth of services and supports. My co-workers and responding officers ask: "Why is she calling for this?" "What does he expect from us?" "How can we help?"

I answer, "She's calling because her therapist/ psychiatrist told her to. He expects understanding. We can help by educating ourselves about mental illness. We help when we show empathy, not pity or disgust. We can be more effective by using communication strategies that work when someone is in a mental-health crisis." Crisis intervention team training provides this education.

Last month, the Marion County Sheriff's Department hosted crisis intervention team training. I was privileged to be part of it. Unfortunately, I had to leave early. My son was slamming his head into the brick wall of his school. Crisis can happen anytime, anywhere.

I am quite pleased some of our local deputies and officers have this training; still, many do not. One of the reasons: Tight budgets make it difficult to cover the cost to keep patrols on the street and pay overtime to the officers attending the training.

Portland Mayor Potter is asking for $500,000 to provide crisis intervention team training to all officers. That's a lot of money. But it costs more to repeatedly send the mentally ill to the emergency room and to jail.

Consider the cost of a single incident: the Marion Street Bridge closing. And how do we measure the cost of a death? We will never know if the deaths of Lukas Glenn and James Chasse were unavoidable. But when, not if, the police are called about my son, I'd prefer a crisis intervention team officer responds.

Each of us, police officer or not, can help: by understanding what services do exist in our communities, finding out what has worked better in other communities, supporting and bringing these proven services to our communities and volunteering to mentor.

For other suggestions, contact your local National Alliance on Mental Illness affiliate, the Oregon Family Support Network or county mental-health department.

Kris Anderson of Salem is the Mid-Valley regional director for the Oregon Family Support Network, the president of NAMI Marion-Polk and a part-time 911 call taker. She can be reached at andersonkris@comcast.net. Read more!

Kentucky's elderly battle mental illness - Lexington Herald-Leader

LOUISVILLE, Ky. - Dudley Williams lost his wife in the fall of 2003. The next summer he was diagnosed with prostate cancer.

He began to eat and sleep less; he lost interest in his appearance; he stopped doing the things he loved like shooting pool and reading. "I found myself walking around the house asking why I was even living," the 68-year-old Williams said.

Williams' depression is part of a larger problem as the number of older Americans grows: mental illness is often undertreated among the aging.

And it's an issue of special concern in Kentucky, experts say, for two reasons:

_ The state has the nation's highest rate of mental distress in the elderly, defined as 14 or more days of poor mental health in the past 30 days, according to a 2001 report by the Centers for Disease Control and Prevention.

_ Kentucky currently ranks 28th in the nation for residents over 65, but will rank 14th in less than two decades, according to the Kentucky Cabinet for Health and Family Services.

"In general, the geriatric population is growing, and the amount of money allocated to health care and mental health care is shrinking," Dr. Manoochehr Manshadi, a psychiatrist with Seven Counties Services Inc., told The Courier-Journal.

Jim Dailey, executive director of the National Alliance of Mental Illness Kentucky, agreed, noting that two years ago, he seldom heard complaints about mental illness among the elderly.

Now they account for one of every three calls to his agency.

Mental health advocates point to some sobering national statistics:

_ While people 65 and older make up only 13 percent of the U.S. population, they accounted for 18 percent of all suicides in 2000, according to the most recent National Institute of Mental Health's study of the issue.

_ Nationally, less than 1.5 percent of all community-based mental health care goes to the elderly, according to the American Geriatrics Society's most recent figures.

"We do not have a good public system for mental health in the elderly," said Barbara Gordon, director of social services at Kentuckiana Regional Planning and Development Agency.

"Older adults suffer a lot of loss and grief issues, which are associated with depression," said Phyllis Parker, branch manager for adult services for the state division of Mental Health and Substance Abuse. But too often, she said, their depression remains "undetected, unrecognized and under treated."

"Kentucky is very rural, and the poverty rate is very high, and I think that the social isolation associated with these is linked with this high incidence of frequent mental distress."

Pip Gardner, a 69-year-old patient of Manshadi's said she has been depressed for a long time and has kept a close eye on it in recent years, knowing the loss, grief, bad health and limited income that often are associated with old age can exacerbate her condition.

"I get discouraged and aggravated I don't have much to show for my life," she told the psychiatrist.

"We're first in the number of people over 65 on disability, first in the number of people over 65 smoking, fifth in hypertension and 14th in obesity," said Mark Birdwhistell, secretary for the Kentucky Cabinet for Health and Family Services, who believes mental and physical health are related.

Gardner, who has had several bypass operations and suffers from arthritis, said that's been true for her.

"The chronic illness you have, that can make you depressed," she said. "You can't get out ... as often." Read more!

Block on new mental patients lifted, for now - Boston Herald

Published Thursday, November 23, 2006

By Kimberly Atkins

The state Department of Mental Health yesterday reversed its decision to block state mental health facilities from taking new patients, a move that drew cautious praise from hospital officials who worried the move might be short-lived.

After DMH Commissioner Elizabeth Childs announced Monday the inpatient facilities would turn away new patients across the state just before Thanksgiving, citing Gov. Mitt Romney’s budget cuts last week, hospital groups cried foul. They said the move would overcrowd hospital psychiatric units and leave the neediest patients without care.

Yesterday, DMH officials notified hospitals the facilities will remain open at least through the holiday weekend, despite about $7 million in budget cuts.

But yesterday, in a joint statement, Ronald Hollander, president of the Massachusetts Hospital Association, and David Matteodo, executive director of the Massachusetts Association of Behavioral Health Systems, said: “This is only a temporary reprieve, and we remain concerned.”
“We were just told the moratorium on new patients would be lifted through the weekend,” said MHA spokesman Paul Wingle.
State Health and Human Services spokeswoman Brigitte Walsh said the move was “indefinite.”

“DMH will not stop admissions until further notice, at least through the holiday weekend,” Walsh said. “We are still analyzing the impact of the cuts.”

When asked about the moratorium on admissions yesterday in response to his budget cuts, Romney said: “I’m not familiar with that particular circumstance.”

But he said the cuts were meant to force agencies to tighten their administrative costs, not affect services to Bay State residents.

“Of course there will be some agencies that say we can’t possibly cut any of our jobs or our positions, we must cut services to individuals,” Romney said. “We’ll look at those and see if it’s true or not.” Read more!

Mental health cases prey on frustrated judge - San Antonio Express-News

Originally published 11/22/2006

Elizabeth Allen, Express-News Staff Writer

Each Tuesday, one of Bexar County's two probate judges heads out to San Antonio State Hospital to decide if mental health patients need to stay in the facility for up to 90 days.

Except this week, when Travis County Probate Judge Guy Herman drove from Austin to do it, after Probate Court No. 2 Judge Tom Rickhoff decided he couldn't take it anymore.

"In an effort to reduce angst and conflict in my life, I need to step aside from the mental health docket now," Rickhoff wrote in a Nov. 14 letter to Probate Court No. 1 Judge Polly Jackson Spencer.

"I worry about it too much because I have lost faith in a system ..." he continued, describing the merry-go-round of treatment and release for Texas' mentally ill.

Rickhoff sent the letter one week after he was re-elected to a four-year term in a race in which his opponent made an issue of his work ethic. He said the timing was no accident.

"The last thing I wanted to do was trivialize something as important as a mental health docket in a political race," he said.

County Judge Nelson Wolff met with Rickhoff on Tuesday, and the two agreed that Rickhoff would keep working the docket for six months while officials seek a solution.

Wolff said Rickhoff's concerns were valid, but that he "was making a big mistake on the way he was approaching the issue."

"I asked him to stay six more months until we had a chance to see what should be done," Wolff said Wednesday.

That gives county officials time to figure out if they can create a mental health court, he said, and if they can get help from the Legislature, which meets in January.

Rickhoff suggested forming a group to examine mental health options and said retiring 225th District Judge John Specia was interested in helping. In a letter to Wolff after their meeting, he suggested starting a community shelter for people who don't need full-time hospital care.

Specia said Wednesday that he'd had a brief conversation with Rickhoff and was indeed interested, but that it was too soon to discuss options.

Rickhoff can hand his half of the mental docket to Spencer because by law her court handles it. However, two and sometimes three judges have shared those duties for years.

The probate judges routinely hear about 15 cases in which hospital doctors recommend that a patient should be committed to what's usually a 90-day stay. If hospital authorities believe a patient is ready for release, Spencer said, no hearing is required.

These are "civil commitments," as opposed to "forensic commitments," or mentally ill people accused of committing a crime. Those are handled through a separate system.

When Spencer got Rickhoff's letter, it came as no surprise — but not because the two judges, whose courtrooms are side by side, had discussed the issue.

"Somebody had reported to me that when he had done the hearings at the state hospital on the 14th, that he had told them that he wasn't coming back," she said. It also had made its way through the courthouse rumor mill.

In response, Spencer contacted Herman, the state's presiding statutory probate judge, and requested a visiting judge.

"It would be very difficult to absorb that docket," Spencer said. "We had scheduled the rotating plan for some months into the future."

But she agreed with Rickhoff that the system needs work.

"It is a terrible problem in terms of the treatment of the mentally ill on a nationwide basis, and to me indicates that a great deal more work needs to be done in this area," she said.

"This acute care is really the first piece of the puzzle, but a lot of the other pieces never get put into place."

According to a 2006 report by the National Alliance on Mental Illness, Texas ranked 47th among the states in per capita mental health spending.

While there are some public resources like Bexar County's Center for Health Care Services, many people slip through the cracks. They usually are committed in state hospitals that have seen their resources chipped away. They tend to rotate out, then back in if they don't stay on their medication — and they often don't.

"And because there is a steady stream of patients coming in the front door of mental hospitals, there is a lot of pressure to release them out the back," Spencer said.

Doug McBride, spokesman for the Department of State Health Services, said space crunch doesn't affect the decisions to release patients.

"The stock answer is, it shouldn't," McBride said. He said a patient can be transferred to another state hospital if the local one is full. "It's no secret that there is a capacity issue, and we've been, along with others, working with that for probably several years."

Dr. Terresa Stallworth, clinical director at San Antonio State Hospital, said keeping patients for short cycles has been a nationwide trend for 40 years, on the belief that community-based treatment is better.

"That began a trend toward downsizing state hospitals," many of which are at about one-tenth the capacity they had in the early 1960s, she said.

Rickhoff said he opposes the trend toward deinstitutionalizing the mentally ill, was frustrated with having no say over the system and was tired of worrying about what he couldn't control.

"Here's what it forces: It forces a serious consideration of having a mental health court," he added. "It's not just some little judicial feud or something." Read more!

Helping musicians change their tune-Houston Chronicle

CD sales fund mental health care for struggling Austin artists

By POLLY ROSS HUGHES
Copyright 2006 Houston Chronicle Austin Bureau

AUSTIN — Rick Broussard sips from a tall glass of iced tea at South Austin's Evangeline Cafe, recalling the day a worried friend summoned him to the Town Lake statue of Stevie Ray Vaughan.

It was 10 years ago, when standing in the shadow of the Texas blues legend, life began to change for Broussard, then the troubled frontman of the roots-rock band Two Hoots and a Holler.

Broussard had a long talk about his downward spiral and addictions — the booze, speed, cocaine and heroin — with Peyton Wimmer, the first director of Austin's SIMS Foundation, which offers low-cost mental health care for Austin musicians

"He was a big fan of my band. I told him I felt like I was putting my own fire out," said Broussard, who attained sobriety six years ago when his third try at rehab took. "Without that initial contact, the ball would have never been rolling."

Today marks Austin's day-after-Thanksgiving tradition of great music for a good cause: The 14th volume of KGSR radio's limited edition Broadcasts CD goes on sale to raise money for mental health needs of the city's famed musicians.

This year's collection features live radio performances by Death Cab for Cutie, Spoon, The Green Cards, The Blind Boys of Alabama, Billy Bragg, Patty Griffin, Nickel Creek, David Gray, Kris Kristofferson and more.

Proceeds from the all-volunteer effort benefit the SIMS Foundation, established in 1995 in memory of Sims Ellison, a beloved Austin songwriter, member of the hard-rock band Pariah and boyfriend for several years of actress Renee Zellweger. Ellison, who suffered from depression, committed suicide by shooting himself, just one year after Kurt Cobain met the same fate.

"This CD helps us save lives. That's the bottom line," said Sandra Bruce, president and clinical director of the foundation with a board guided by Asleep at the Wheel leader Ray Benson.

'Most gratifying'
Today the foundation serves 500 musicians a year, with treatment for depression ranking high among needs. Its $395,000 annual budget, most of it from the CD sales, helps pay for counseling and other services from a network of local mental health experts who deeply discount their fees.

"It's all about SIMS," said Jody Denberg, KGSR program director and volunteer producer of the CDs. "It's the most gratifying thing I do in my life, to help fund this foundation. If I have mental health issues, I can get help, but my friends in the music industry can't afford it."

Creative individuals, such as artists and musicians, suffer disproportionately from mood disorders, the foundation notes, citing years of studies in the American Journal of Psychiatry.

Add to that the low pay of Austin's musicians, who report average incomes of $300 a week. That's no more and often less than they made 10 years ago, according to the foundation.

SIMS eligibility requirements include living in Austin at least a year, earning money as a musician (one hopes beyond tips) and a family income not exceeding 250 percent of the federal poverty level, or $24,500 for an individual. Musicians and their immediate family members qualify, and co-pays starting at $5 are determined on a sliding scale.

In its earliest years, the SIMS Foundation focused first on substance abuse and drug addictions, Bruce said, cases that now make up less than 10 percent of the clients.

Of today's clients, 77 percent call SIMS complaining of relationship problems, depression and anxiety, foundation research over the past three years shows.

"It seems for the past six months, we've had at least one if not two calls a week of people who are suicidal," Bruce said.

Right off the bat
Mo Stoycoff, the foundation's development director, remembers hectic preparations for her first SIMS board meeting coming to a sudden halt with the ring of a telephone.

As one staffer talked to the distraught musician by phone, another made calls looking for a provider available in the evening to see the client immediately.

"It really brought home to me what we were doing on my very first day," she said.

Increasingly, the mental health safety net of Austin's musicians is focusing on preventive services to ease the stress of performers and their families, according to Bruce.

"We're big believers in the systems theory," she said. "If something's not right on one part of the mobile and it's going to shake, then everything on the mobile is going to shake."

This holistic approach will include a research project in January asking musicians what they need most to bolster their sense of well-being, she said. Perhaps they'll need coping skills for managing good nutrition on the road, financial planning on low budgets or information on how to spot someone whose life is in danger from drugs or thoughts of suicide.

The mental health foundation has seen no shortage of Austin counselors, social workers, psychologists and psychiatrists eager to care for musicians at half the normal rate, Bruce said.

Partly the mental health profession feels an affinity for creative types, commenting that musicians are expressive, know how to be honest and are in touch with their feelings, she said.

With 11 years of growth have come inevitable changes, especially a greater reliance on the wonders of technology, foundation staffers say.

Gone are the poetic days when intake consisted of meeting at Austin's statue of Vaughan. Now, clients calling SIMS are screened by phone in a 15-minute interview, and a computer delivers a spreadsheet of the closest provider matches.

Along with a musician's specific emotional issues, the match could include a provider who best knows how to treat a South Austin musician with a disabled family member and a belief in Eastern religion, Bruce said.

One big myth remains a constant, she said. Too often musicians fear they'll lose their nerve, their edge, the wellspring of their creative energy.

Broussard, about to take the stage at the Cajun-infused Evangeline Cafe, remembers the first time he faced an audience sober.

"Yeah, it was terrifying. Things were uncomfortable at first. There's nothing to calm the nerves," he said, joking that all his favorite writers seemed to be "junkies or alcoholics."

Yet, he's proof that conquering one's demons is anything but a problem.

In his six sober years, Broussard's toured the United States and played in Europe three or four times. He's produced three albums, including Rick Broussard's Two Hoots and a Holler, a winner of the AMP Award for Austin's top 10 albums in 2005. His next album, produced jointly in Austin and London, is set for release next spring.

"Junkies don't do that," he said.

polly.hughes@chron.com
Read more!

A false sense of security in L.A. County jail- The Los Angeles Times

Thomas Lingenfelter's family thought he was safe in custody. His death highlights risks to the mentally ill behind bars.
By Stuart Pfeifer, Times Staff Writer
November 23, 2006

After watching him struggle for decades with mental illness and drug addiction, Thomas Lingenfelter's family felt he was safest when he was in jail. At least then he'd have food to eat and a place to sleep at night.

As it turned out, jail was no refuge.

Lingenfelter, 51, was beaten to death Nov. 8 in his cell at Twin Towers jail, just north of downtown Los Angeles. He died in a 96-cell wing reserved for inmates with mental health problems. His cellmate, a younger, stronger inmate who also had a long history of mental illness, was charged with Lingenfelter's killing.

Detectives believe Lingenfelter's cellmate beat, kicked and stomped him to death in their cell of about 100 square feet on the 5th floor of the county's newest jail. Deputies assigned to the facility said they didn't see or hear anything until another inmate shouted, "Man down!" and pointed to Lingenfelter's bloodied corpse on the concrete floor.

Sheriff's officials are investigating the decision to place Lingenfelter, homeless and frail from years of drug abuse, alone in a cell with Jay Selznick, a 27-year-old carjacking suspect and martial-arts enthusiast.

"We always felt he was safe in jail or the mental hospital. I can't imagine what he went through or what provoked this guy," said James Sterling, Lingenfelter's older brother, speaking from his home in West Virginia. "You go to jail and you're supposed to be in a safe environment. If he's right there within sight, where was the guard? What was going on?"

Selznick and Lingenfelter were among thousands of inmates with mental health issues who receive treatment each year in the Los Angeles County jails. Sheriff Lee Baca has said that caring for the mentally ill is among the most challenging aspects of operating the nation's largest jail system, which processes more than 200,000 inmates every year.

The paths that led the two inmates to Tower One, Pod 152-A, Cell No. 7 were typical of many mentally ill inmates in the Los Angeles County jails. Both had been in jail before and both had struggled to control mental illness.

Selznick was awaiting trial on carjacking and joyriding charges after allegedly assaulting his mother at her San Fernando Valley home and driving off in her car. He was arrested Sept. 26 by San Luis Obispo police officers who responded to a complaint that Selznick was loitering at a doughnut shop and learned he was wanted.

Lingenfelter was arrested Oct. 14 by Long Beach police for allegedly violating terms of his parole from a prior conviction on weapons charges. He and Selznick were assigned to bunk together Nov. 6, two days before Lingenfelter died on his cell floor.

Theirs was one of 96 cells with nearly 200 inmates that surrounded a glass-enclosed booth housing a sheriff's custody officer who has a partial view into the cells.

Two deputies also patrol the halls on that floor, looking into each cell at least once per hour to make sure the inmates are safe. The deputies last inspected Cell No. 7 about 10:39 p.m. and reported both Selznick and Lingenfelter alive and well.

Sometime after that, Selznick punched, kicked and stomped Lingenfelter to death, authorities said. By the time deputies arrived about 11:15, Selznick had washed his hands. His right foot was swollen, apparently from repeatedly kicking his cellmate, said Sheriff's Det. Charles Morales, who is investigating the death.

Paramedics pronounced Lingenfelter dead in his cell. He had been so badly beaten that his head appeared "lopsided," Morales said. An autopsy found skull fractures on the front and back of his head and severe brain trauma.

The death in Cell 7 followed decades of concern by Lingenfelter's family. The youngest of six children, Lingenfelter was raised in several Southern California cities, including San Pedro, Bellflower and Canoga Park. During high school, he began skipping school, hanging out with a bad crowd and fighting with his parents, relatives said.

One of Lingenfelter's older brothers once caught him pushing their mother. Ken Sterling said he beat his younger brother after that, sending him to a hospital. "I think the only thing he understood is when he got beat up."

James Sterling said his brother subsequently struggled with mental illness, although he did not know his diagnosis. He and his siblings occasionally sent Lingenfelter money over the years. But his adult life was a path from one arrest to the next, one jail cell to another. His rap sheet included convictions for drug and weapons possession and armed robbery. He spent time in a mental hospital.

His family eventually grew weary. "There's nothing really that can be done. We did what we could," James Sterling said. "I can't spend all my time chasing after Tommy,"

Jay Selznick's family was reluctant to speak about his past without talking to an attorney. But his father, Lew Selznick, said his son was struck with mental illness a decade ago when he was in his late teens.

"He and I were as close as a father and son could be. When this thing hit him at 16 or 17, he was not the same person as he was as a kid," Lew Selznick said.
Read more!

Better mental health services ordered for foster children- Los Angeles Times

A federal judge tells L.A. County it must improve care and move faster on previous reforms.
By Susannah Rosenblatt, Times Staff Writer
November 23, 2006

A federal judge has ordered Los Angeles County to improve mental health services for children in its foster care system and move faster to comply with reforms agreed upon in a past federal agreement.

The court finding, filed this week, validates the conclusions of an independent panel of experts that determined in August 2005 that the county wasn't offering adequate mental health services to foster children still living with their families and did not have a comprehensive plan to help them.

Panel members monitor the county's 2003 federal settlement to improve mental health services for foster children.

"It's an important case for the kids of Los Angeles County," said Kimberly Lewis, an attorney with the Western Center on Law and Poverty, who has been closely involved with the case. It is "not a small number of children that would be impacted by this."

The order this week will require county officials to screen all kids in the foster system, including those who still live at home; of the county's 40,000 foster children, 23,000 live in foster homes.

It's important to treat children with mental health problems at home or in a homelike environment to keep them out of the foster system, Lewis said.

The settlement sprang from a class-action lawsuit by representatives of five children who said they received substandard care.

County officials say they are making progress.

The major point of contention is "the speed with which it's reasonable to proceed in the expansion of the specialized services," said Marvin Southard, director of the mental health department.

"In general, I think we have agreed with the panel that foster care kids need a wide array of support," Southard said. "We've come a long way in developing a plan that actually delivers these services…. We're trying to go as fast as we can."

Over the last few years, "the department has worked with the department of mental health to further improve its mental health service to children," said Louise Grasmehr, spokeswoman for the county Department of Children and Family Services.

Grasmehr cited the establishment of close to 10 hubs throughout the county that medically and psychologically evaluate children entering foster care.
Read more!

A Growing Plea for Mercy for the Mentally Ill on Death Row - NY Times

RALPH BLUMENTHAL

LIVINGSTON, Tex. — Scott Louis Panetti says he was drowned and electrocuted as a child and that he was recently stabbed in the eye in his death row cell by the devil. Mr. Panetti says he has wounds that were inflicted by demons and healed by President John F. Kennedy.

“The devil has been trying to rub me out to keep me from preaching,” Mr. Panetti, explaining why he faces execution, said in an interview from behind thick glass in the Polunsky Unit here in East Texas, where condemned prisoners are held before transfer to the death house 45 miles west in Huntsville.

Despite Mr. Panetti’s obvious mental illness — he was a mental patient long before he gunned down his in-laws in 1992 — he served as his own lawyer at his murder trial, throwing the courtroom into chaos with frequent gibberish. Now the hyperactive and gangling Mr. Panetti, 48, has become an illustration of the growing quandary over the application of a 1986 Supreme Court decision barring execution of the insane.

The ruling appears to be limited to those without the capacity to understand that they are about to be put to death and why. Whether Mr. Panetti fits that definition is a matter of dispute.

In an appeal to the Supreme Court that could affect the cases of other mentally ill prisoners awaiting execution, Mr. Panetti’s lawyers argue that while he has a “factual awareness” of his execution, he has a “delusional belief” that it is unconnected to his crime, and that he should therefore be spared lethal injection.

The case of another mentally ill death row inmate, Guy T. LeGrande, who represented himself and is scheduled to die Dec. 1 in Raleigh, N.C., is going through its final state appeals, with his lawyers arguing that he, too, is delusional, and that he hastened his execution by abandoning his defense.

Charged in the contract killing of a woman whose husband pleaded guilty to plotting the murder and is serving life, Mr. LeGrande, 47, says he is innocent and was framed. He appeared in court in 1996 in a Superman T-shirt, cursed the jurors as “Antichrists” and taunted them, “Pull the switch and let the good times roll.” They took less than an hour to sentence him to death.

Experts and advocates in the field say the issue of executing the mentally ill is the next frontier in death penalty law.

“This is an emerging issue,” said Richard C. Dieter, executive director of the Death Penalty Information Center, a research institute in Washington that opposes capital punishment.

Mr. Dieter cited the Panetti and LeGrande cases as gray areas in which “the death penalty may be extreme punishment given their reduced culpability.”

Franklin E. Zimring, a professor of law at the University of California, Berkeley, and author of “The Contradictions of American Capital Punishment” (Oxford University Press, 2003), said there was something “indigestible” about these cases.

“We assume people don’t want to die,” Mr. Zimring said. “But these are defendants that call the legal system’s bluff.”

Concern over execution of the mentally disabled prompted the American Bar Association last August to join a widening chorus of professionals calling for a halt to death sentences and executions for defendants with severe mental disorders that “significantly impaired” their rational judgment or capacity to appreciate the wrongfulness of their conduct. The moratorium was endorsed earlier by the American Psychiatric Association, the American Psychological Association and the National Alliance on Mental Illness.

The groups also opposed death sentences for prisoners with mental disorders that impaired their ability to assist their lawyers and make rational decisions on their appeals. The Supreme Court has already barred execution for the mentally retarded and for juveniles.

“An increasing percentage of people executed are people giving up their appeals,” said Ronald J. Tabak, a lawyer at the firm Skadden, Arps, Slate, Meagher & Flom in Manhattan and a specialist in capital cases who led the bar association’s death penalty task force. “And of these, a significant percentage have serious mental illness.”

The Supreme Court’s 1986 ruling, on a Florida case, Ford v. Wainwright, left much unclear. Although no state permitted execution of the insane, the justices affirmed that the Eighth Amendment against cruel and unusual punishment prohibited it. But they did not provide a standard for determining when someone was competent enough to be executed.

In a concurring opinion later adopted as law by lower courts, Justice Lewis F. Powell Jr. said it was enough “if the defendant perceives the connection between his crime and the punishment.” Justice Powell also said that the Constitution “forbids the execution only of those who are unaware of the punishment they are about to suffer and why they are to suffer it.”

The United States Court of Appeals for the Fifth Circuit found that Mr. Panetti had the requisite legal awareness. And the Texas attorney general, Greg Abbott, has argued that the execution, as yet unscheduled after having been postponed in 2004, should proceed.

There is no dispute that Mr. Panetti is “profoundly mentally ill,” his lawyers Gregory W. Wiercioch, Keith S. Hampton and Michael C. Gross said in a petition seeking to overturn the Fifth Circuit ruling. In the decade before the murders, they said, he was hospitalized 14 times in six institutions for schizophrenia, manic depression, auditory hallucinations and delusions of persecution. Believing the devil was in his furniture, he buried it in the backyard, and thinking the devil was in the walls, he hallucinated that they were running with blood.

On Sept. 8, 1992, Mr. Panetti, dressed in military fatigues and carrying a sawed-off shotgun, a rifle and knives, invaded the Fredericksburg home where his estranged wife, Sonja Alvarado, had taken refuge with her parents, Joe and Amanda Alvarado. In front of his wife and their 3-year-old daughter, known as Birdie, he shot the Alvarados to death and took his wife and daughter captive before releasing them unharmed and surrendering.

In 1994, a first jury deadlocked on his mental competency, but a second found him able to stand trial.

Waiving legal counsel, Mr. Panetti represented himself, appearing in court in cowboy garb and seeking to subpoena Jesus before deciding “he doesn’t need a subpoena — he’s right here with me.” He attributed the killings to an alter ego named Sarge Ironhorse and, testifying in Sarge’s voice after calling himself as a witness, recounted the killings:

“Sarge is gone. No more Sarge. Sonja and Birdie. Birdie and Sonja. Joe, Amanda lying kitchen, here, there blood. No, leave. Scott, remember exactly what Sarge did. Shot the lock. Walked in the kitchen. Sonja, where’s Birdie? Sonja here. Joe, bayonet, door, Amanda. Boom, boom, blood, blood. Demons. Ha, ha, ha, ha, oh, lord, oh, you.”

When Judge Stephen B. Ables tried to cut him off, Mr. Panetti said, “You puppet.”

Mr. Panetti does appear to have moments of lucidity, and these disconcerted the juries at his competency hearing and trial, planting suspicions that he might have been faking.

“Not to make excuses,” he said in the death row interview, “but when someone’s insane, they’re insane.”

Psychiatrists testified that schizophrenic patients often spoke intelligently.

Asked in the interview if he understood he was on death row for crimes he committed, Mr. Panetti said: “Certainly not. They are in a strong delusionment. They’ll be undeceived by delusionment.”
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Mentally incompetent people languish in jail - South Florida Sun Sentinel

Editorial

Jail is for people who have been accused of crimes and are awaiting trial. It's also for people who have been convicted of certain kinds of offenses. It is not for people who have been accused but declared incompetent to stand trial.

State law recognizes this. It requires that people be moved out of jail and into a state forensic hospital within 15 days of being declared incompetent.

Yet 307 people are on a statewide waiting list for hospital admissions, including 71 in South Florida who have been sitting in jail for longer than 15 days since being declared incompetent -- 37 in Broward County, six in Palm Beach County and 28 in Miami-Dade.

The responsible agency, the Florida Department of Children & Families, is refusing to comply with the law, citing a shortage of hospital beds -- which, of course, results from a shortage of money. This is a travesty of justice and a blot on Florida's honor.

DCF should have seen this coming and insisted on more funding from the Legislature before it got to this point. This would have been a good year for it, when legislators had a substantial revenue surplus to work with during their annual session in the spring.

Whether the fault lies primarily with DCF Secretary Lucy Hadi or with Sally Cunningham, who oversees mental health and forensic programs, DCF simply must show more leadership on this issue. So must the Legislature. It shouldn't even take a request from DCF for legislators to be concerned that inadequate funding might cause a state agency to ignore a law they passed.

There should be no more waiting. Even if it takes an emergency appropriation, these people should be moved out of jail immediately.


BOTTOM LINE: State officials must follow the law and transfer them to hospitals, even if it requires emergency funding.
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Fla. Agency Head Threatened With Jail - AP

ST. PETERSBURG, Fla. (AP) -- A judge Tuesday threatened to jail the head of the state Department of Children & Families if the agency can't explain why it consistently has failed to get mentally ill jail inmates into psychiatric treatment.

Under Florida law, jail inmates found incompetent to stand trial must be turned over to the agency and placed into treatment within 15 days.

An assistant public defender in Miami, Carlos Martinez, said the average wait time had spiked to more than two months, and his office and public defenders in Broward and Hillsborough counties have filed court motions to force DCF to treat the inmates.

Circuit Judge Crockett Farnell found the agency in contempt last week and ordered fines. On Tuesday, he went father, ordering DCF Secretary Lucy Hadi to appear in court next month to answer why she shouldn't be held in contempt for failing to abide by the law. She could face more than two years in jail.

Hadi has acknowledged a problem but said it surfaced with a dramatic increase in mentally ill inmates, like a "tsunami," that the agency didn't have the bed space to handle.

"We don't control the pipeline," she told The Miami Herald last week.

A lawyer representing mentally ill prisoners said the agency and Hadi are breaking the law and should have to answer for it. Records show more than 300 defendants are still jailed and waiting to be moved to a hospital for treatment, the Herald reported.

"Regular citizens who ignore court orders go to jail," said Bob Dillinger, the Pinellas County public defender who represents several inmates waiting to be taken to a DCF-operated psychiatric hospital. "I don't think government people should be any different."

Agency spokesman Al Zimmerman said the agency was working aggressively to solve the bed space problem and would ask lawmakers to move $5 million from other agency services to pay for new beds at the three state hospitals that take those patients.

"The secretary being led off in handcuffs is not going to help add more beds that are desperately needed by these people," he said.

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Executive Summary, Governor's Veterans Summit

The Governor’s Summit on Providing Mental Health and Substance Abuse Services to Returning Combat Veterans and their Families - September 27, 2006, Summary Report


The Governor’s Summit on Returning Combat Veterans and their Families is the beginning of a partnership between State and Federal Government, community providers, and programs. It is also the beginning of an ongoing process in which mental health and substance abuse service needs of veterans of Operation Enduring Freedom (OEF) and Operation Iraqi Freedom (OIF) will be identified and addressed through specific recommendations and concrete plans and timelines. By exchanging information about their respective agencies’ assets and goals and identifying strategic partnerships, Summit attendees began the work of articulating an integrated continuum of care that emphasizes access, quality, effectiveness, efficiency, and compassion. Principles of resilience, prevention, and recovery were emphasized along with state-of-the-art clinical services as part of a balanced public health approach. The product envisioned is a referral network of informational, supportive, clinical, and administrative services that will comprise a system through which citizens of North Carolina will have access to post-deployment readjustment assistance for veterans and their families.

While content presentations were the focus of the morning, four discussion groups were conducted simultaneously in the afternoon. Each discussion group issued specific recommendations, which are outlined below:

Discussion Group #1: Identifying available resources for combat veterans and their families
• Train STR (Screening, Triage, and Referral) staff, CARE-LINE staff, and potential providers throughout the state.
• Develop a visual road map for each service system.
• Identify a named point-of-contact within each service system [e.g., Department of Veterans Administration (VA), Department of Health and Human Services (DHHS), Department of Labor (DOL), and Department of Public Instruction (DPI)] so that combat veterans and their families may easily access the system (concept of “no wrong door”).

Discussion Group #2: Ensuring engagement and support of combat veterans and their families
• Develop a seamless transition plan across agencies to enable service providers’ provision of the right information to the right person at the right time.
• Proactively conduct outreach, where simple, clear messages in multiple formats are provided to combat veterans and their families.
• Suggest Public Relations campaign to alert veterans to resources available in the system (e.g., billboards, posters).

Discussion Group #3: Enhancing resiliency and improving readjustment
• Request that the Governor write personalized letters to veterans and their family members expressing appreciation for their service to our country, identifying a select set of access information and charging them with a new mission in the service of the state and their local communities.
• Develop and disseminate informational pocket cards for veterans and their families and for health and behavioral health care providers.
• Effectively utilize care managers to work with service members and their families over time.


Discussion Group #4: Accessing formal mental health services
• Provide training at all levels coordinated with the best practice models identified by the Substance Abuse and Mental Health Services Administration (SAMHSA) and in the Department of Defense (DoD) and Department of Veterans Affairs (VA) systems. Use resources identified in the DoD and VA systems for training in the public system.
• Work with all stakeholders, connecting existing resources.
• Expand the Citizen-Soldier Support Program throughout the state.
• Work with the university system, Area Health Education Centers, and other partners to develop and disseminate products and educate primary care and behavioral health care personnel.
• Work with the University of North Carolina (UNC) Health Information (Medical Library Services) to disseminate relevant information to veterans and their families as well as to health and behavioral health providers.


Overview

On March 16-18, 2006, three members of the Planning Committee attended The Road Home: The National Behavioral Health Conference on Returning Veterans and Their Families in Washington, DC. Sponsored by the Substance Abuse and Mental Health Services Administration (SAMHSA) in partnership with the Therapeutic Communities of America, the purpose of the conference was to bring together community mental health and substance abuse treatment providers to discuss evidence-based strategies for restoring hope and building resiliency in OEF (Operation Enduring Freedom) and OIF (Operation Iraqi Freedom) veterans, active-duty service members, reservists, National Guard members, and their families. This conference served as a catalyst for the North Carolina Governor’s Summit, with the first planning meeting occurring shortly after the national conference.

After nearly six months of planning, Governor Michael Easley hosted the Governor’s Summit on Returning Combat Veterans and their Families in Research Triangle Park, North Carolina on September 27, 2006 (see Appendix A for a copy of the agenda and list of participants). Co-sponsors included the North Carolina Division of Mental Health, Developmental Disabilities, and Substance Abuse Services (DMH/DD/SAS), Department of Health and Human Services (DHHS); the Department of Veterans Affairs (VA); the Department of Defense (DoD); the Governor's Institute on Alcohol and Substance Abuse, Inc.; the Mid-Atlantic Addiction Technology Transfer Center; and SAMHSA. GlaxoSmithKline graciously offered their conference facilities and services for the meeting.

Co-chaired by Michael Lancaster, MD, Chief of Clinical Policy, Division of Mental Health, Developmental Disabilities, and Substance Abuse Services, North Carolina Department of Health and Human Services, and Harold Kudler, M.D., Acting Director, Post Deployment Mental Illness Research, Education and Clinical Center (MIRECC), Veterans Health Administration, Department of Veterans Affairs, the purpose of the Summit was to bring together key leaders of North Carolina State Government, the Department of Veterans Affairs, and the Department of Defense, with representatives of provider and consumer groups to share essential information and promote best practices in the service of returning veterans of military service in Afghanistan and Iraq and their families. Governor Easley and Secretary Carmen Hooker Odom emphasized the importance of creating a continuum of care for OEF and OIF veterans once they return to their home communities. Providing timely and effective mental health and substance abuse services was considered to be critical, with Governor Easley charging participants to develop new ideas that would help veterans succeed in returning to their families, their jobs, and their communities.

Presentations

Speakers laid the groundwork for what was discussed in the small groups during the afternoon session. A synopsis of each presentation is provided in the following paragraphs (see Appendix B for a copy of the PowerPoint presentations).

COL Edward O. Crandell, Ph.D., Chief, Department of Behavioral Health, Womack Army Medical Center, Soldier Behavioral Health and the Deployment Cycle. COL Crandell addressed the stages of the emotional cycle of deployment; pre-deployment, combat and non-combat deployment stressors; post-deployment adjustment; and Battlemind training and “resetting” soldiers. He discussed challenges that veterans and their families face prior to, during, and after deployment and described how Battlemind training can help military personnel transition to civilian life. He reported that a similar Battlemind training program is being developed for family members. COL Crandell also identified key resources for veterans and their families.

CAPT Monica Mellon, USMC and CAPT Richard Welton, USN, The Three-Legged Milk Stool Approach. CAPT Mellon discussed the Marine Operational Stress Surveillance and Training (MOSST) Program, which helps prepare service members and their families during pre-deployment, deployment, transition, and post-deployment. Education and support resources are available to address family readiness issues. CAPT Welton explained that the Navy provides health services to Marines and presented information on the Deployment, Return, Reunion Program (DRRP).

Harold Kudler, M.D., Post Deployment Mental Illness Research, Education and Clinical Center (MIRECC), Veterans Health Administration, Strategies in Service to New Combat Veterans and their Families. Dr. Kudler provided an overview of current approaches across the DoD/VA continuum of care. He emphasized a public health approach that provides outreach, education, and emotional support to all returning veterans and their family members. While triage to mental health services must be available when appropriate, Dr. Kudler noted that all veterans and their families deal with significant adjustment stress during and after deployment. He therefore recommended that population-based outreach should be made available to them, all with the aim of increasing resiliency rather than simply screening for new diagnoses.

Angeline Martin Woodson, Ph.D. and SFC Kurtis Cherry both spoke about their experiences as service members and the impact of their experiences on their personal lives. Dr. Woodson focused on post-deployment and how she, herself, coped with feelings of depression, loneliness, and alienation. SFC Cherry talked about experiences that Iraq veterans commonly have when they return home and how these experiences can affect their personal lives and their families. Even though they want normalcy in their daily lives, this can be very difficult to achieve. Tension can lead to arguments, domestic violence, alcohol and/or drug abuse, and separation or divorce. He requested that programs that help Reservists be continuously improved so that support can be extended and strengthened.

Mrs. Lil Ingram was the luncheon speaker. Even as a National Guard spouse, she recalled that she had not considered what it meant for her husband to be deployed until he was called up. She spoke movingly about her experiences and those of other Guard families she has known. In addition Mrs. Ingram talked about her interest and involvement in programs that help children of National Guard and other Reserve Component members. She identified three programs—the Kids on Guard developed by the Morrisville Family Assistance Center; the Prevention and Relationship Enhancement Program (PREP); and two-day institutes for teachers and counselors, developed by the Department of Public Instruction and the North Carolina Board of Education. She also mentioned that the Citizen-Soldier Support Program, a national demonstration hosted by the University of North Carolina at Chapel Hill, works with the National Guard and other Reserve Component family programs to mobilize local communities to support citizen-soldiers and their loved ones.


Discussion Groups

Four discussion groups were held simultaneously in the afternoon. A description of each group follows, with key points identified.

1. Identifying available resources for combat veterans and their families, with James A. Martin, Ph.D., BCD, Colonel, U.S. Army (Retired) and Director, Citizen-Soldier Support Program, as facilitator and Flo A. Stein, MPH, as recorder
Different participating groups and agencies each address the needs of returning veterans and their families, but they do not all address the same needs, and few, if any, address all their needs. This discussion group will work on identifying what services are available, where the natural interagency alliances are, what services need further development, and what needs are not currently being addressed..
The group’s discussion centered on four themes, all related to communication:
• Messages and the information that they contain about services and benefits may be overwhelming and may need to be simplified, repeated, and/or explained in multiple ways. Both the message and the method of conveying the message are important.
• Resources need to be coordinated so that they are disseminated throughout the state and across agencies and organizations. Partnerships need to be further developed and expanded between the military; Veterans Affairs; state, regional, and local agencies; private and public entities; educational institutions; and nonprofit organizations. Because resources are not evenly distributed across the state, procedures need to be in place to ensure that veterans and their families can identify, access, and obtain adequate mental health and substance abuse services regardless of location.
• A visual road map needs to be created so that it is easier for veterans and their families to understand what services exist and how to access them. The VA has already accomplished this task for its own agency and it may be possible to model statewide efforts on this VA model.
• Making the initial contact may be difficult. Emphasis is on “no wrong door” so many portals are possible. One portal is Military OneSource, which provides easy access to services for veterans and their families. Staff at Military OneSource would need to know what is being offered by agencies and organizations in North Carolina at all levels. Another portal is the CARE-LINE Information and Referral Services operated by the Office of Citizen Services under the aegis of the NC Department of Health and Human Services. This toll-free line (800/662-7030) provides consumers with information on, or referrals to, human service providers across the state. An additional resource is the NC Consumer Health Information Portal under development at UNC-Chapel Hill. This resource will have a specific North Carolina focus and provide easy-to-use health information for all North Carolinians. This portal could be developed further to contain a specific easy-to-use area for veterans and their families. In addition, with some modifications, NC Health Info/MedlinePlus, now operated by the Health Sciences Library at UNC-Chapel Hill, could provide in-depth and comprehensive coverage of topics and services for veterans and their families. This would benefit the public, as well as health and behavioral health professionals.
The group also identified resources:
• Governor’s Advisory Commission on Military Affairs
• Veteran Employment and Training Services (VETS), US Department of Labor
• Vet Employment Project, Employment Security Commission
• NC Division of Mental Health, Developmental Disabilities, and Substance Abuse Services, Department of Health and Human Services, including crisis centers and STR units
• VA Regional Office
• NC Division of Veterans Affairs, including 97 county veterans services officers
• Vet Centers
• Family Assistance Centers
• Service-specific programs [e.g., Marine Operational Stress Surveillance and Training (MOSST) Program and the Navy Deployment, Return, Reunion Program (DRRP)]
• National Guard Family Program
• NC National Guard youth program (i.e., Kids on Guard)
• Military OneSource
• Citizen-Soldier Support Program
• American Legion
• Order of the Purple Heart
• Disabled American Veterans
• Veterans of Foreign Wars
• North Carolina Medical Society
• Mental Health Association
• Project CARE (Community Action Readiness Effort), Onslow Chamber of Commerce
• NC University System and Community College System
• UNC Health Sciences Library
• Area Health Education Centers
Identified as missing are centralized services for the Army Reserve, Marine Reserve, and Air Force Reserve members and families. Also missing is the involvement of certain community organizations, civic associations, faith communities, and community health systems (e.g., primary care, behavioral health, and public health).
2. Ensuring engagement and support of combat veterans and their families, with Everett R. Jones, Jr., M.D., as facilitator and Kristy Straits-Tröster, Ph.D., ABPP, as recorder
While returning veterans and their families are entitled to a host of services and supports, competing demands on their time, limited awareness of what services and supports are available, confusion about how such supports can assist them, concerns about career, impact of service use, and stigma regarding mental health services can all limit engagement. This discussion group will develop strategic approaches to engaging returning veterans and their families.

The group focused on barriers and solutions. Barriers included the following:
• access (e.g., transportation, hours of service, unavailability of service in some rural locations)
• lack of information or too much information, agencies unaware of what other agencies offer, requirements for accessing services
• bureaucracy (e.g., paperwork, time, delays),
• stigma (e.g., fear of engagement of the system, fear of discrimination, concern about negative impact on promotion or security clearance )
• denial, guilt, selflessness
• poor perception of the VA
• absence of additional supports (e.g., child care)
• lack of an integrated plan
• dispersion of veterans, making follow-up difficult
What is needed is a seamless transition plan across agencies to enable service providers’ provision of the right information to the right person at the right time. VA care managers were identified as being in the position to assist veterans—to reach them wherever they are. Multiple formats (e.g., letters, pocket cards, text messaging, iPod streaming, blogs) of the same information are needed since individuals learn in different ways. Other solutions included outreach, a decision support tool (i.e., central depository available 24/7), public access, PDAs, cell phone advisories, peer counselors/buddies, and public relations. Possible “doors” were identified: Military OneSource, chaplains, Family Assistance Centers, doctors offices, state mental health, public health departments, primary care, social services, hospice, community action agencies, Employment Security Commission, schools, community colleges, universities, banks, grocery stores, barber shops, court houses, ABC stores, defensive driving and DUI classes, AA meetings, homeless shelters, jails, advertising (e.g., PSAs; ads on Super Bowl, NASCAR/RBC, bulletin boards, late night television, and buses and in phone books; stickers on beer coolers; and posters in recreational areas and fast food drive-in windows). What is needed to move forward is money, infrastructure, decision support tools, gender-specific services, sharing standardized tools, and cross training and a common language across all agencies.
3. Enhancing resiliency and improving readjustment, with Harold Kudler, MD, as facilitator, and L. Worth Bolton, MSW, as recorder
All returning veterans and their families face challenges in dealing with deployment and readjustment. Even when the veteran does not meet criteria for mental health diagnoses, they and their families may be threatened by dysfunction and disability. This discussion group will work on identifying practical (and often non-medical) interventions that effectively improve resiliency and function among individuals and families.
This group looked at how trauma affects the resiliency of individuals, their families, and their communities. Resiliency was defined as an ongoing, dynamic process and essential as individuals strive for “hope, meaning, and a defined role.”
The group identified barriers and assets for each level. At the individual level, perhaps the single greatest barrier to resiliency is the stigma which the veterans, themselves, associate with people who have readjustment problems. Other potential barriers included lack of strong family and/or community support systems, lack of phase-specific information about readjustment, the fact that information changes over time, lack of direction and focus during the many phases of transition after deployment, and the need for “surge capacity” within each system of care. Assets included Military OneSource, VA’s Seamless Transition and Returning Veterans Outreach, Education and Care (RVOEC) Programs, the Vet Centers, Vet Service Officers, the MIRECC, the Citizen-Soldier Support Program, the Division of MH/DD/SAS, information and referral services of the local management entities (LMEs), and case management and care coordination systems.
At the family level, potential barriers included the family’s lack of understanding or knowledge about the military and its culture (especially in the Reserve Component); lack of information on how to access services for the veteran and/or family; the stigma associated with seeking help; the realities of multiple deployments; the isolation of families; and gender role challenges (important in this war in which approximately 15% of those deployed are women). Assets included the Family Assistance Centers, faith communities, Citizen-Soldier Support Program, K-12 schools, and primary care physicians, including pediatricians.
At the community level, potential barriers included lack of knowledge and understanding among the public and professionals and a tendency to confuse political ideology about the war with concerns about the warriors. Assets included the many people in the community who care and want to help; the Marines for Life Program; the MIRECC, the Citizen-Soldier Support Program; and the Family Assistance Centers.

The group identified the following overarching principles:
• Providers are not always well informed about potential resources.
• Education and personal contact provide the first links in a strong response process. These may best be provided by an identified case manager who is responsive to the veteran and the family’s specific needs and who helps them navigate the system over time.
• There is a real need to define a clear role for veterans within society and a clear path for their next steps.
The group recommended that the Governor send personal thank you letters to each service member accompanied by a select list of resources with direct contact information, perhaps using a pocket card format. A separate letter to family members of the service member was also recommended. As a key step towards enhancing resilience, the Governor would conclude his letter by charging veterans and their families with a new mission in service to the state and their local communities.
4. Accessing formal mental health services, with Michael Lancaster, MD, as facilitator, and Wei Li Fang, Ph.D., as recorder
A subset of returning veterans and/or their families may develop the need for more substantive, “traditional” mental health services to address depression, anxiety disorders, PTSD, and substance abuse. Psychiatric conditions may arise in the veterans themselves, their spouses, or their children. The parents and other loved ones are also greatly impacted by these stressors and their needs should be recognized as well. This discussion group will begin to identify a means to assess and track service needs, the resources currently available by location and natural hand-off points and procedures.
The group discussed issues related to the identification of veterans and family members for mental health and substance abuse services and strategies for engaging them in the system. It was thought that having demographic information would be helpful in better serving service personnel including veterans and those who are still serving in the Guard and Reserve but who are no longer on active duty. Demographics of service personnel in North Carolina are not readily available although the Department of Defense has mailing addresses. The Department also sends a list of potential discharges by zip code, and this may aid VA case managers in discharge planning and follow-up.

Training at all levels is needed, from the veteran’s spouse and/or parent(s) to school personnel, primary care physicians, community providers, librarians, benefits officers at community colleges, and faith communities. Improved communication is critical in order to connect existing resources, both in the military and in the community, and to increase awareness of stakeholders of what services exist and how to access them. For example, MIRECC is developing educational best practice models and tools (e.g., pocket cards) based on a recovery orientation for medical personnel, and these materials could be used in the broader health services community. Information on issues related to normal readjustment as well as Battlemind should be disseminated. Partnering with the university and community college systems and Area Health Education Centers across the state and academic detailing were also suggested.

MIRECC disseminates information and issues educational grant initiatives to train community members. Greater mobilization of existing resources is needed, with a statewide expansion of the Citizen-Soldier Support Program. To assist in community education, partnerships could form so that churches could provide the facility and child care while various agencies or organizations could provide education. A public relations campaign, utilizing billboards and newspaper inserts, was also suggested to increase awareness of OEF and OIF veterans and their families as well as the general public.

Of note is the fact that this war is very different from previous wars in that it has relied heavily on the National Guard and Reservists, and repeated deployments are common. Because the existing support system is geared toward military installations and is not necessarily a strong presence where the service members live, it has meant that health and other support personnel need to be more proactive in their outreach and education. GWOT (Global War on Terror) Coordinators at the five Vet Centers and staff in the various services that provide family readiness assistance are available to provide advocacy, education, outreach, and referral services. Counties vary in the breadth and scope of services offered.

Benefits are a concern, with local providers perceiving poor reimbursement rates through TriCare. Perhaps specific funds to support community-based services for veterans and their families could be requested from the General Assembly. To track service needs of this population, the North Carolina Treatment Outcome and Program Performance System (NC TOPPS) could be utilized.

Common themes across the four groups were that there should be “no wrong door” to which veterans and their families can come for help; the need to meet the veterans where they live; the need to better utilize and integrate existing resources through increased communication and collaboration; and the need to connect the dots for veterans and their families so that they may access and receive timely and effective mental health and substance abuse services.

Prepared by members of the Veterans Summit Planning Committee:

Wei Li Fang, Ph.D.
Denisse Marion-Landais Ambler, M.D.
Worth Bolton, M.S.W.
Debbie Crane
Joe Donovan
Fred Johnson
Everett Jones, M.D.
Harold Kudler, M.D.
Michael Lancaster, M.D.
James Martin, Ph.D.
Anthony McLeod
Charlie Smith
Flo Stein, M.P.H.
Kristy Straits-Tröster, Ph.D., A.B.P.P.

November 16, 2006


Co-sponsored by the Governor’s Office of North Carolina; the North Carolina Division of Mental Health, Developmental Disabilities, and Substance Abuse Services (DMH/DD/SAS), Department of Health and Human Services (DHHS); the Department of Veterans Affairs (VA); the Department of Defense (DoD); the Governor's Institute on Alcohol and Substance Abuse, Inc.; the Mid-Atlantic Addiction Technology Transfer Center; Substance Abuse and Mental Health Services Administration (SAMHSA); and GlaxoSmithKline.


Planning Committee Co-chairs:

Michael Lancaster, MD, Chief of Clinical Policy, NC DMH/DD/SAS, NC Department of Health and Human Services, Raleigh, NC 27699, 919/733-7011, 919/508-0951 (fax), Michael.Lancaster@ncmail.net
Harold Kudler, MD, Co-Director, Clinical Core, VISN 6 Mental Illness Research, Education and Clinical Center (MIRECC) and VISN 6 Mental Health Coordinator,, 508 Fulton Street (V6-MIRECC), Durham, NC 27705, 919/286-0411, ext. 7021, Harold.Kudler@va.gov

Planning Committee Members:

Denisse Marion-Landais Ambler, MD, Assistant Professor, Department of Psychiatry, UNC School of Medicine, 256 Medical School Wing D, CB # 7160, Chapel Hill, NC 27599-7160, Denisse_Marion-Landais@med.unc.edu
Worth Bolton, MSW, School of Social Work, University of North Carolina at Chapel Hill, CB #3550, Chapel Hill, NC 27599-3550, 919/962-4371, lwbolton@email.unc.edu
Debbie Crane, Public Affairs Director, Department of Health and Human Services, Debbie.Crane@ncmail.net
Joe Donovan, NAMI North Carolina, P.O. Box 985, Raleigh, NC, 27602, 919/931-1453, jdonovan@nami.org
Wei Li Fang, PhD, Director for Research and Evaluation, Governor's Institute on Alcohol and Substance Abuse, Inc., P.O. Box 13374, Research Triangle Park, NC 27709, 919/990-9559, 919/990-9518 (fax), Wei.Li.Fang@governorsinstitute.org
Fred Johnson, Information & Referral Specialist, Alliance of Disability Advocates, Center for Independent Living, P.O. Box 12988, Raleigh, NC 27605-2988, 919/833-1117; 919/833-1171 (fax); alliance@alliancecil.org, Fred.Johnson@alliancecil.org
Everett R Jones, Jr., MD, Senior Consultant, Clinical Core, VISN 6 Mental Illness Research, Education, and Clinical Center (MIRECC), 508 Fulton Street (V6-MIRECC), Durham, NC 27705, 919/286-0411, ext. 6112, Everett.Jones@va.gov
Anthony McLeod, Director of Operations, Governor's Institute on Alcohol and Substance Abuse, P.O. Box 13374, Research Triangle Park, NC 27709, 919/990-9559, 919/990-9518 (fax), amcleod@mindspring.com
Charlie Smith, Assistant Secretary for Veteran Affairs, Department of Veterans Affairs, Director, NC Division of Veterans Affairs, 1315 Mail Service Center, Raleigh, NC 27699-1315, 919/733-3851, Charlie.Smith@ncmail.net
Flo Stein, Chief of Community Policy, NC DMH/DD/SAS, NC Department of Health and Human Services, 3007 Mail Service Center, Raleigh, NC, 27699-3007, 919/733-4670, Flo.Stein@ncmail.net
Kristy Straits-Tröster, PhD ABPP, Assistant Co-Director, Clinical Core, VISN 6 Mental Illness Research, Education, and Clinical Center (MIRECC), 508 Fulton Street (V6-MIRECC), Durham, NC 27705, 919/286-0411, ext. 6032, straitstroster@biac.duke.edu or Kristy.Straits-Troster2@va.gov

Read more!

State: Veterans need transition help - Greensboro News-Record

Note: The report from the Sept. 27 summit referred to in this post is the next post down.

By Lex Alexander, Staff Writer

When a veteran of Iraq or Afghanistan seeks help for mental problems or addiction, there must be "no wrong door" for him to knock on in North Carolina, a state report released Tuesday says.

The report from the N.C. Department of Health and Human Services calls on government and private agencies in North Carolina to create a seamless net of resources, information and referral for such veterans and their families.

And it calls on the state to meet veterans — especially National Guard and Reserve personnel not living on military bases — where they live, making services and referral widely available and publicizing them.

The effort seeks to make the transition to civilian life easier for veterans and their families and to ensure that any veteran with mental health or substance-abuse issues is referred quickly to places where he can receive such services. The effort is key in North Carolina because more service people are discharged here than in most other states.

Returning veterans typically have two years after discharge to sign up for government benefits related to their military service. But post-traumatic stress disorder, the most common type of formally diagnosed mental problem, and related problems often do not appear until many years after the veteran has been discharged, said Wei Li Fang, director for research and evaluation at the Governor's Institute on Alcohol and Substance Abuse and one of the report's contributors.

The report is an outgrowth of a summit on veterans' mental health and substance-abuse needs convened Sept. 27 by Gov. Mike Easley.

In addition to ways to help veterans with problems, that discussion covered ways to help veterans and their families increase their "resiliency" — their ability to cope with the stresses associated with overseas deployment — rather than simply screening for mental-health disorders.

Meanwhile, all returning Army units, whether regular Army, Army Reserve or National Guard, are being briefed on services available through the Department of Veterans Affairs, said Maurice Murphy, a team leader at Greensboro's vet center, a regional counseling and outreach center operated by the department.

Those briefings are repeated at the returning units' first drill after their return, typically about 90 days later, Murphy said. He declined to comment on the state report.

Contact Lex Alexander at 373-7088 or lalexander@news-record.com Read more!

Officials poised to freeze hospital admissions - Boston Globe

Originally published Tuesday, November 21, 2006

By Carey Goldberg, GLOBE STAFF

The Department of Mental Health appears poised to go ahead with its plan to freeze admissions to state psychiatric hospitals Wednesday in response to recent budget cuts, despite intensive meetings with Romney administration officials who want the agency to find less painful ways to reduce spending.

The department has notified private hospitals that "admissions are shut down starting tomorrow until further notice, and we haven’t gotten any further notice," David Matteodo, executive director of the Massachusetts Association of Behavioral Health Systems, said Tuesday.

Governor Mitt Romney’s spokesman said administration budget staffers have been in talks with the Department of Mental Health since Monday and have proposed alternative cuts, including $700,000 that the agency has budgeted for management consultants and $1.7 million that would have paid for 64 additional employees.

The agency has been told to cut about $7 million from a total budget of $640 million, but advocates for the mentally ill said that because the cuts come at mid-year, their impact is actually double, adding up to $14 million on an annual basis.

Romney cut $425 million from the state budget on Nov. 10, blaming the Legislature for putting the state into a spending crisis by transferring money from the rainy day fund. Romney vetoed the transfer, and lawmakers did not override it, leaving a deficit.

In response, Mental Health Commissioner Elizabeth Childs plans to reduce spending on hospital staffing by $1.9 million, meaning some of the 850 or so beds in the hospitals would have to be left empty. The agency also plans to cut services to the mentally ill in the community. Advocates for the mentally ill on Monday circulated an analysis estimating that 170 agency jobs would have to be eliminated.

Asked Tuesday whether state hospital admissions would indeed cease on Wednesday, Romney spokesman Eric Fehrnstrom said, "That was in a proposed plan submitted by the Department of Mental Health and it has not been finalized.

"We’re working with them on a more realistic set of budget cuts," he said. "And while we’re insistent on the 1 percent cut, we’re flexible on where they can take it from their budget, and I think it can be done in ways that don’t result in major program reductions."

Carey Goldberg can be reached at goldberg@globe.com.

Posted by the Boston Globe City & Region Desk at 09:55 P Read more!

Sex offenders wrongly jailed in psychiatric facilities - AP

ALBANY, N.Y. (AP) -- New York's highest court ruled Tuesday that the state -- acting under an order from Gov. George Pataki -- wrongly confined convicted sex offenders in psychiatric facilities after their prison sentences ended.

In a 7-0 decision, the Court of Appeals reversed a midlevel court decision allowing 12 men to be held without hearings as psychiatric patients and ordered their cases back to a lower court for more hearings. The men are still confined.

Pataki ordered the convicts held because he was frustrated by the state Legislature's failure to enact a law preventing them from returning to communities where they could repeat their crimes.

In November 2005, a state Supreme Court justice found the inmates -- whose crimes included sodomizing and raping children -- were held illegally when they were involuntarily sent to mental hospitals through a process known as "civil commitment."

The judge said the inmates, called John Does 1-12 in the suit filed by the advocacy group Mental Hygiene Legal Service, were denied due process because the state violated rules for transferring prison inmates to psychiatric facilities.

But the Appellate Division said that because the sex offenders had been released from prison, the lower court judge was wrong when she relied on provisions of the state's Correction Law, which governs psychiatric confinement of prison inmates. The court said she should have used the Mental Health Law, which deals with the hospitalization of civilians.

The Court of Appeals disagreed and ordered immediate hearings for the men to determine if they pose a danger to the public.

"We understand how, in an attempt to protect the community from violent sexual predators, the state proceeded under the Mental Hygiene Law," Judge Carmen Beauchamp Ciparick wrote in her opinion. "We do not propose that these petitioners be released, nor do we propose to trump the interests of public safety. Rather, we recognize that a need for continued hospitalization may well exist." Read more!

Autopsy shows inmate died of hyperthermia, dehydration - AP

DETROIT (AP) -- A 21-year-old mentally ill inmate who spent four days naked and shackled in a hot, isolated cell died of hyperthermia -- an increase in body temperature -- and dehydration, according to an autopsy.

The autopsy, results of which were received by the state Friday, found that Timothy Joe Souders' death was an accident, but the Michigan Department of Corrections said its internal investigation found evidence that a nurse who attended to Souders and a physician's assistant who treated him violated work protocols.

The case prompted a federal judge to order Michigan to stop using restraints like those used on Souders and to reopen federal monitoring of mental health care of the state's inmates.

Souders had been sentenced to up to four years in prison for resisting arrest, assault and destroying police property.

He spent most of his last four days naked inside an isolation cell at the Southern Michigan Correctional Facility in Jackson, his arms and legs bound in shackles, sometimes lying in his own urine. He died Aug. 6, two hours after his restraints were removed.

The nurse, Charles Boltjes, was suspended last month and could face punishment ranging from a written reprimand to firing, department spokesman Russ Marlan said, while the physician's assistant, Ray Mooney, wasn't suspended.

Marlan said the internal investigation has concluded. State police are still reviewing the death.

The department found that Boltjes failed to send Souders to the hospital the day of his death, Marlan said. It also found evidence of inhumane treatment of prisoners and dereliction of duty.

Boltjes, contacted by phone Monday, declined to comment on the investigation.

The department found that physician's assistant Ray Mooney failed to chart some information, Marlan said.

Messages left Monday night seeking comment at listings for Mooney were not immediately returned. Read more!

Admissions to halt at state mental hospitals- The Boston Globe

By Carey Goldberg, Globe Staff | November 21, 2006

State psychiatric hospitals will stop admitting new patients tomorrow , and 170 Department of Mental Health staff positions will be eliminated in response to Governor Mitt Romney's emergency budget cuts announced earlier this month, according to private hospital groups briefed by state officials.

In addition to the freeze on hospital admissions, the cuts would do away with 37 percent of the staffers who provide care to hundreds of emotionally disturbed children and teens in their communities; cut dozens of inpatient jobs for nurses, aides, and psychiatrists; and reduce funding for medical school research, according to an overview circulated by the Massachusetts Hospital Association.

The mental health agency began sending out notifications on Friday that its hospitals, which have about 850 adult inpatient beds, would stop accepting psychiatric patients who would normally have transferred to them for longer-term care.

It aims to re open admissions when the patient population has dwindled enough to be cared for by a smaller staff.

"This is just a horrible Thanksgiving for people in the state who have mental illness," said Toby Fisher, executive director of the Massachusetts branch of the National Association on Mental Illness. "This will block up the entire mental health system."

Romney's spokesman, Eric Fehrnstrom, defended the cuts, and accused Department of Mental Health officials of resorting to a "Washington Monument" strategy to try to get out of reducing the budget: "You take something highly visible and shut it down, so the public will complain and funding will be restored," he said .

The agency should be able to absorb its 1.1 percent cut without reducing services, Fehrnstrom said.

"We think any good manager should be able to absorb a 1.1 percent cut through payroll and administration," he said, and budget specialists will work with the department "to put forward a more realistic plan."

Mental Health Commissioner Elizabeth Childs declined to comment, referring the Globe to the governor's office.

But mental health care providers and advocates for the mentally ill warned that the cuts would worsen waits and bottlenecks in a system that is already chronically strained.

There is a constant backup of 25 or 30 patients waiting to get into state hospitals as it is, said David Matteodo, executive director of the Massachusetts Association of Behavioral Health Systems, which represents private psychiatric hospitals and units within general hospitals.

Most of those would probably have managed to get beds in the near future, he said, but "because of this policy, they're not going to get in."

When access to state hospitals is blocked, psychiatric patients back up at all levels of care, he said.

Many remain in private acute-care hospitals meant for stays of only a few days, and that means more also get stuck in emergency rooms, unable to get a bed on a ward.

The patients at state hospitals tend to be the most chronically mentally ill, people whose illness has ebbs and flows, such as schizophrenia, treatment-resistant depression, or substance abuse. When the illness worsens, they need acute care, but then they tend to need longer-term placement for continuing care at a facility like a state hospital. In a final step, they get out, and often need further care in the community or in a residential facility.

Romney cut a total of $425 million from the state budget on Nov. 10, accusing the Legislature of casting the state into a spending crisis by irresponsibly tapping the rainy day fund.

Romney vetoed the rainy-day fund transfer, and the Legislature did not override his veto, leaving a deficit.

Fehrnstrom said the governor's cuts amounted to 1.4 percent of the state budget overall, while the cuts to the Department of Mental Health totaled only 1.1 percent, or about $7 million of a total budget of $640 million. Even after the cuts, he said, its budget would still end up growing by about $10 million compared with the previous year.

"We'll probably start with their plans to increase staffing by 107 people," he said. "At the end of the day, they probably won't be able to increase by that many people."

Advocates for the mentally ill and hospitals said that the department could ill tolerate even minor cuts, and that because the cuts come at mid-year, their impact is actually double, so they amount to annual cuts of $14 million.

"When you look at the growth of agency budgets over the years, the Department of Mental Health has been the stepchild in this administration," said Marylou Sudders, a former commissioner of the department herself.

"Those of us in the mental health community feel that for the first time, here's a budget that is very modest, but addresses some of the issues that we have been advocating for, for a number of years, all of which was undone and slashed," she said.

The cuts would also affect home services for people with mental illness so that they can live independently; and inpatient hospital staffing, including staff nurses and 16 psychiatrists on contracts.

That cut in psychiatrists translates into 267 hospital beds without the required level of physician staffing, the overview says, adding to the need to stop admissions to the hospitals until the number of patients drops.

In a statement, the Massachusetts Hospital Association warned yesterday that "patients could pose a danger to themselves or to others if they cannot be discharged to an appropriate setting."

Matteodo, of the private mental hospital group, said that Commissioner Childs had called on Friday afternoon to say all admissions to state facilities would be halted as of Wednesday, and, he said, she acknowledged that this was "very bad news."

"I obviously agreed with her, and said, 'You know, we were having a problem before this,' and she said, 'I understand, but I have to do my job.' "

The state Department of Public Health has been told to cut 1 percent from its budget -- about $5 million.

A spokeswoman for the agency, Public Health Commissioner Paul Cote, said last night that no final decision has been made on what programs will face reductions.

Stephen Smith of the Globe staff contributed to this report. Carey Goldberg can be reached at goldberg@globe.com.
© Copyright 2006 Globe Newspaper Company.
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Psychological problems often ignored in black community - Milwaukee Journal Sentinel

By GEORGIA PABST
gpabst@journalsentinel.com

Brenda Wesley said it wasn't until her son got in trouble with the law that his mental health problems finally were diagnosed by Wisconsin Community Services.

"Too often, it's difficult for families to recognize mental illness because of a 'don't ask, don't tell' mentality and because of the embarrassment" in the African-American community, said Wesley, of Milwaukee.

Wesley was speaking at a recent meeting of a task force formed by the Black Health Coalition of Wisconsin, which became alarmed by undiagnosed and untreated mental health problems in the black community that can wreak havoc.

When an 11-year-old girl is raped by a group of men and boys, and a mentally ill man is beaten to death on the street by a mob, something is wrong, said Patricia McManus, executive director of the Black Health Coalition.

"You can't just say they are terrible people with no morals or values. We know it's a larger issue among all the issues of joblessness, homelessness and not being able to make ends meet," she said.

Too often, mental illness remains a taboo in the black community, she said.

"Historically, you're told you're supposed to suck it up and take it," McManus said. "Black women are told you just have the blues or that what you're suffering is just a test of your faith and to pray."

Even if someone recognizes a mental health problem, there's a good chance he or she won't have health insurance to pay for treatment, McManus said.

Culturally appropriate resources also are lacking, said a number of participants at recent meetings to start the task force.

Michael Bell, director of behavioral health at Milwaukee Health Services, said only three or four African-American psychiatrists work in the Milwaukee area and about six total in Wisconsin.

Bell came to Milwaukee in 2004 as a member of the National Health Service Corps, a federal program that helps find physicians for underserved areas.

"Historically, community health centers have been the last line of defense when everyone else rejects a patient for a variety of reasons, including the lack of health insurance," he said. "Unfortunately, health centers have few people to care for a lot of people, and at some point, I think, quality starts to suffer."

Bell said there should be parity among insurance providers for mental health and services such as high blood pressure screening, adding that this also has been recommended by the American Psychological Association.

Although he deals with adults, Bell said, mental illness in a family has a profound effect on children and how they adapt to the world and deal with problems.

Gwen Jackson of the Red Cross said schools must do more to address mental health issues and not just label children.

"We need to make sure we get what we need," she said.

Bell said he sees mental health problems getting worse here and around the country. "But in America, prison is the new asylum," he said. He called the Los Angeles County Jail "the largest inpatient mental health hospital in the country."

Working with inmates

For eight years, McManus and the Black Health Coalition have been working with pregnant women in the Milwaukee County Jail.

"We've served more than 200 women a year, and a good 60 percent of women in jail have some mental health issue," she said. With a federal grant, the coalition can bring in mental health services and alcohol and drug counseling services, she said.

Brenda Wesley's son is now in his late 20s and incarcerated for selling drugs. Even after his diagnosis, there were times he went off his medications and had problems finding the right combination of drugs, she said.

Working with the National Alliance on Mental Illness, Wesley makes it her mission to speak out about her son's mental illness, her efforts to help him and the need for increased awareness and services.

"I want to put a face on mental illness," she said. "He's sick. I want to let families know they didn't ask for it. Mental illness should be treated like illnesses of cancer or diabetes." Read more!

Vet stress disorders concern the state - Greensboro News-Record

By Lex Alexander, Staff Writer

GREENSBORO — When Johnny and Janie come marching home from Iraq and Afghanistan, there’s a fair chance they’ll be bringing service-related mental disorders home with them.

That fact has federal and state officials and mental-health professionals scrambling to provide the care that the country has explicitly promised its troops since the time of George Washington.

Because more people are discharged from the service in North Carolina than in almost any other state, the state has particular reason to be concerned about veterans’ well-being.

Whatever problems are coming may not be apparent soon. Charles S. Smith, the director of the N.C. Division of Veterans Affairs, estimates that no more than 15 percent of veterans who need mental-health services now are seeking them.

"There’s a stigma associated with mental illness," Smith said. "These folks are real young — 18 to 25, the majority of them — and a lot of times they don’t feel like there’s anything wrong with them."

A report on how to address that issue, stemming from a September summit on the subject convened by Gov. Mike Easley, is due Monday on the desk of Carmen Hooker Odom, the state’s secretary of health and human services.

The report comes at a time of rapid increase in mental disorders among veterans.

Many combat veterans may experience hypervigilance or trouble sleeping, or they could have nightmares. Most get over those symptoms within a few weeks or months without any help and readjust to civilian life. But some develop more serious mental disorders.

The number of Iraq and Afghanistan veterans being treated at veterans hospitals and clinics for post-traumatic stress disorder (PTSD) or "battle fatigue," the most common mental-health disorder affecting returning veterans, nearly doubled during a recent nine-month period, from 20,394 in September 2005 to 38,144 patients in June.

The numbers are likely to grow; at least 150,000 men and women left the service between mid-2005 and mid-2006. At least 15 percent of them, and possibly many more, are likely to develop PTSD, government officials estimate.

By comparison, about 31 percent of men and 27 percent of women who served in or near Vietnam during that war developed PTSD, the Department of Veterans Affairs says.

The high percentage of National Guard and Reserve units among those seeing combat creates greater vulnerability, as well: 15 percent of members of such units were found to be at risk for PTSD three to six months after returning home, compared with 9 percent of active-duty personnel.

The nature of this war — where there is no identifiable front line, units sometimes must kill up close in house-to-house combat, deadly roadside bombs can be anywhere and it’s sometimes impossible to tell friend from foe — is particularly conducive to PTSD.

The nation’s 157 veterans hospitals and 207 outpatient clinics, called vet centers, are bracing for more patients. So too are state agencies and mental-health professionals who frequently work with veterans.
But the feds are doing so with uncertain, and perhaps even inadequate, resources.

A September 2004 report by the Government Accountability Office found that the VA could not even determine how many people it was then treating, let alone whether it could serve an increase in cases of post-traumatic stress disorder.

A survey of 60 of the nation’s 207 vet centers earlier this year by the Democratic staff of the House Committee on Veterans Affairs found that:

*All have seen significant increases in services to Iraq and Afghanistan veterans.

*Half say that increased demand has hurt their ability to serve their existing case load.

*40 percent have directed veterans to group therapy who nevertheless needed more intensive individual therapy.

*20 percent could provide services only for veterans, not their families. Experts say family plays a key role in helping veterans overcome PTSD and readjust to civilian life.

The capabilities of the vet centers are particularly important because they do outreach to veterans and also serve veterans’ families. Medical centers generally do not.

Requests for comment from mental-health professionals at the Durham and Salisbury VA hospitals were referred to the Department of Veterans Affairs, which did not respond. Phone messages left for counselors at the Greensboro vet center were not returned.

The time lag between veterans returning home and beginning to seek treatment for PTSD was one of the subjects discussed at the Sept. 27 summit in Research Triangle Park, along with ways to reach out to veterans who might need help.

"Once a person leaves the military, he or she has two years to sign up for benefits related to service," said Wei Li Fang of the N.C. Division of Mental Health. "The problem is that PTSD doesn’t always show up right away. That’s what we’re kind of trying to prepare for, to make sure there’s things in place in the community for people who all of a sudden find themselves having problems."

Fang said the state is working with vet centers in the state to ensure that veterans who contact any state agency can be directed to the services they might need, regardless of which agency they first contact. The state also has set up a toll-free CareLine number for veterans to call.

PTSD also is a major concern for the active-duty military. It and related mental-health concerns are the leading cause of hospitalization among servicemen and second to pregnancy among servicewomen, according to a 2005 article in the American Journal of Psychiatry. And of those hospitalized, 50 percent are likely to leave the service within six months, compared with no more than 12 percent for any of 15 other major disease groups.

Accordingly, the military has stationed more than 200 counselors in Iraq to work with troops there. And it assesses the mental health of troops before they deploy overseas, shortly before or immediately after they return, and then again 90 to 180 days after they return, to have a better chance of flagging possible mental-health problems, said Cynthia Vaughan of the Surgeon General’s Office.

The Army also has developed Battlemind training, a program that helps soldiers and their families draw parallels between behavior that is essential in a war zone and related behavior that is inappropriate, or even dangerous, elsewhere.

Every effort is essential, Fang said.

"I saw a figure the other day, and it was really high the number of divorces that have resulted from this war," she said. "It has done a lot of damage."


Contact Lex Alexander at 373-7088 or lalexander@news-record.com Read more!

Suicides most common by older white men - Greensboro News-Record

By Eric J.S. Townsend
Staff Writer

Bob Alley loved jazz music almost as much as he loved his two grown daughters. The Carolina sports fan enjoyed traveling and, by all accounts, appeared ready to enjoy retirement in the company of his longtime girlfriend.

Then one summer morning, with Barbara Walker waiting on the back patio, Alley, 76, retrieved a revolver and entered their Cottage Place bathroom. Though she heard a "crack," Walker thought little of it until she noticed he hadn't returned.

She found him several minutes later and called police.

"It's indelibly impressed on my mind," Walker said. "I can see it now as if it was today."

The "typical" suicide in the United States, if there is such a thing, would not be of a despondent teenager craving attention. The act is taken more often by older adults, whose depression can go unrecognized by family and physicians.

Statistics show that about every hour and a half, an American older than 65 takes his or her life. Victims are almost always white men. Firearms tend to be their method.

As one expert told national lawmakers in September, compared with average citizens, men older than 85 are five times more likely to kill themselves.

And unlike suicide attempts by the young, death occurs more often when the elderly try to end their lives. One of every 200 suicide attempts by youths ends in death , according to the California-based Institute on Aging. For seniors, one out of every four attempts is fatal.

Still, not all recent statistics spell gloom.

The elderly suicide rate has declined since its peak in 1987, when it neared 22 suicides for every 100,000 senior citizens. A strong economy in the 1990s, plus medical advances that improved quality of life for older people, fostered the decline.

While the total number of suicides among senior citizens fell likewise, lawmakers and health experts are giving the issue a fresh look as the elderly population grows and baby boomers reach retirement.

Why they do it

Elderly suicide patterns in Guilford County mirror national trends. Since the turn of the century, 42 people older than 65 were pronounced dead from suicide — or about one of every five people in the county who ended their lives.

It often happened with a gun. All but six were men. Each victim was white.

In one instance five years ago, a man lost his wife to cancer on a fall morning. He drove home from the funeral parlor, climbed into the attic and shot himself, leaving his children to bury both their parents.

Another man opened his financial statement in August 2002, less than a year after the Sept. 11 attacks shook the stock market. His wife returned from a massage to find him dead from a shotgun wound.

A third man drowned himself in a pond near the Randolph County line.
Authorities found his car parked at a nearby convenience store with his wallet and keys inside, leading to the suicide ruling.

"It's become a classic scenario that the wife comes home and can't find her husband or a neighbor hears a shot," said Dr. Jan Hessling, the Guilford County medical examiner. "And they find him behind a shed or in the woods."

The reasons for suicide vary, though depression is almost always associated with the act. When neither depression nor alcohol plays a role, medical examiners and physicians attribute the act to impulsiveness, a decision made without weighing the options.

Researchers cite two reasons for the higher rate of death among seniors versus young adults who attempt suicide. The elderly resort to firearms more often than younger adults, who also employ hanging or cut wrists, methods more easily treated if discovered quickly.

Young adults also are able to recover more easily from the injury if an attempt does not prove fatal.

A handful of local suicides involved elderly residents dying from illnesses. For example, a Liberty woman fighting Lou Gehrig's disease used a shotgun. And a man battling lung cancer used a gun on the porch of his Greensboro home.

"The first thing that comes to many families' minds is 'why?'" said Christopher Colenda, the president of the American Association of Geriatric Psychiatry. "'Why did they do that? Did we miss something? Could we have helped them?'

"The second thing that is evident is guilt and remorse."

Alley's family felt that guilt. A car wreck months earlier, combined with a prostate cancer diagnosis, propelled the retired salesman into a deep depression — one that even his family never fully understood.

It wasn't that Walker, his girlfriend, failed to realize how he felt. She encouraged Alley to seek help. And upon the recommendation of his physician, Alley visited a psychiatrist.

"Bob was the kind of person who always wanted to be in control of his life," Walker said. "But things began to build up. He had pneumonia. ... Then he discovered he had prostate cancer. Bob was always a macho person, and the discovery was not exactly macho."

Problems with the system

Experts in geriatric mental health and now some lawmakers agree that daunting obstacles to treatment must be addressed before a significant drop occurs in both the rate and overall number of elderly suicides.

Under Medicare, seniors pay half the cost of mental health services, as opposed to only 10 percent for primary care visits. A high out-of-pocket expense might keep older Americans on fixed incomes from visiting psychiatric specialists.

Another problem is finding expert help. Few doctors enter the field of geriatric psychiatry because few seniors pay that cost, experts said, and because other specialties offer more money.

Seniors who seek help often turn first to their family doctors, physicians who generally receive little training in psychiatry, let alone geriatric psychiatry. Specialists who spoke in September before the U.S. Senate Special Committee on Aging said family physicians can overlook depression for that reason.

"An older adult is more likely to go talk to someone about a physical problem," said Art Walaszek, a geriatric psychiatrist at the University of Wisconsin School of Medicine and Public Health. "Because of stigma or their own beliefs, they may not be as likely to talk about an emotional problem unless a physician brings it up."

Of more than a dozen local families contacted by the News & Record for this article, only Alley's loved ones agreed to talk about his death.

Alley's brother Charles said he may have missed signs of a pending suicide attempt when he last visited Bob Alley days before his death. Charles Alley said his brother mentioned in a "jovial" manner that a psychiatrist he visited saw no precursors to suicide.

Even mentioning suicide in the conversation, Charles Alley said, was a possible warning.

"I don't like the word 'healing,'" he said Thursday. "I don't think you can heal. As far as my brother is concerned, I'll always miss him.

"Bob's outlook was always so bright. There was a lot of laughter in our relationship."

What lies ahead

Experts who follow the trend of elderly suicides express cautious hope for continued declines as a new generation of Americans nears retirement. Baby boomers, they say, more readily accept depression as a treatable condition and are less inclined to attach a negative stigma to it.

"The good news is that with better awareness and availability of broad-spectrum drugs to treat depression, we've started to see suicide rates decline," said David Shern, the president and chief executive officer of the National Mental Health Association. "They're declining in all age groups.

"Elders still lead the pack, but those numbers are headed south."

Although the stigma of depression may be diminishing, recent surveys show a greater percentage of boomers report suffering from the condition. Researchers cannot fully explain why: Is it from more self-reporting, or do external factors today make people in their 50s and 60s more susceptible to depression?

Answering those questions is one part of tackling the issue. It surprised state Sen. Stan Bingham in September when, during a hearing on aging in Raleigh, health officials discussed elderly suicides.

"I was always under the impression it was young, male teenagers who because of a romantic interest, they take their lives," Bingham said.

He said he plans to ask General Assembly researchers in 2007 to study how other states work to prevent elderly suicides.

"There's an opportunity," Bingham said. "Hopefully it's something the legislature can do without being a dramatic expense to anybody."

In one regard, North Carolina already is taking action. Twenty geriatric mental health specialty teams work within the state. The teams, which will expand from two to three workers next year, train caregivers to recognize mental health illnesses, among other duties.

Hessling, the medical examiner, offered one final observation on elderly suicides and why the rates appear likely to continue their decline: companionship. The large boomer population should make it more difficult for older Americans to remain socially isolated.

"As long as they can get up and out," Hessling said. "Some of these (victims) didn't have any (signs of depression). It's the thought of needing care that is going to drive them."

Walker said she thinks that may have been what motivated Alley to take his life. He was twice widowed after his wives died of cancer. As the caregiver in their final months, he saw firsthand what impact it could have on his family.

Six years after Alley's death, Walker and Charles Alley offer advice to families with an elderly loved one.

"Be careful to look for the little things," Charles Alley said. "The mention of suicide should have been a trigger for me."

Said Walker: "Pay attention to the person you are close to. Realize when that person is in some sort of mental turmoil and love the hell out of them."

News researcher Diane Lamb contributed to this story.
Contact Eric J.S. Townsend at 373-7008 or etownsend@news-record.com Read more!

Oregon's mental care a tarnished model - The Oregonian

Budget gap - Once a national beacon, the system leaves the ill with little help and strains emergency services

MICHELLE ROBERT

Over the past three years, thousands of Oregonians have lost access to drop-in centers, counselors and other services created to treat people with mental illnesses before they become a serious danger to themselves or others.

The changes result from the lingering effects of budget cuts by the Legislature and the growing expense of closing the dilapidated Oregon State Hospital. But the consequences can be seen daily on the streets of Portland and other communities, where police increasingly encounter the mentally ill and more of them end up in jails.

Mental health officials say Oregon has taken an about-face, turning a system once praised as a national model for preventive care into one of triage, with police, crisis workers and emergency rooms feeling the brunt.

"We're spending a lot of resources to build new projects for people as they leave the state hospital," said Bob Nikkel, administrator of the state's Office of Mental Health and Addiction Services. "That's well and good, but they're expensive projects. . . . We haven't invested enough in the front end to keep people well."

In response, Nikkel's agency is proposing a 32 percent increase in state mental health spending over the next two years, with the bulk of the new money focused on community programs that have been squeezed.

The death last month of a 42-year-old man with schizophrenia who was fatally injured by Portland police during a street arrest has again placed the condition of Oregon's mentally ill population in the public eye.

James P. Chasse Jr. lived in subsidized downtown housing and had access to medication and professional help. As such, he was better off than many low-income Oregonians who are not so ill as to require hospitalization but instead depend on the web of state-funded mental health services provided in local communities.

The shrinkage in the system dates to 2003, when Oregon lawmakers moved to plug a recession-racked budget. They made it harder to qualify for medical insurance under the Oregon Health Plan, cutting 80,000 low-income residents from the rolls, including an estimated 13,000 who regularly used mental health services.

Separate cuts left some 2,000 mental health workers and drug and alcohol counselors without jobs. And lawmakers eliminated monthly stipends for the poor that many mentally ill people used to buy medicine or pay rent.

In the years since, lawmakers have poured millions back into mental health. But it has not offset all the reductions. Much has been eaten up by the cost of moving patients out of the state hospital, where conditions had become bad enough to prompt a civil rights lawsuit and an ongoing U.S. Justice Department investigation.

By the end of 2009, officials hope to cut the hospital's population of nearly 800 in half by placing patients in community facilities such as group homes or medium-security centers. Now, there are not enough such places to go around.

Troubled in Portland

In Portland, it's unusual to walk through some downtown areas without seeing people with untreated mental illnesses -- often complicated by alcohol or drug addiction -- slumped in doorways or mumbling at bus stops.

Police encounters with the mentally ill are on the rise, averaging about 40 a week last year in Portland. Calls to Project Respond, which provides mental health specialists to assist officers, are up 40 percent this year, according to Cascadia Behavioral Healthcare, the largest provider of mental health services in Multnomah County.

Recent budget restraints forced Cascadia to close four community drop-in centers for people with severe and chronic mental illnesses. Before the closures, the centers on a typical day served up to 300 people debilitated by brain disorders such as schizophrenia or bipolar disorder.

"A lot of the guys now are just walking around downtown," says John Shatokin, 58, a mental health client who attended the drop-in center in Southeast Portland until it closed. "They're not getting pills or going to classes. They're just wandering around and getting sicker."

Jerry Wiseman, 48, is a frequent visitor to the city's last remaining drop-in center at the Royal Palm Hotel in Northwest Portland. He said it's one of the few places he can avoid being hassled by police.

"It's very difficult because it seems like society doesn't want us anywhere else," Wiseman said. "They'd rather not see us and our problems."

Cascadia's medical director, Dr. Maggie Bennington-Davis, said the situation shows the system's fragility.

"When you stop paying for things, you put pressure on every other part of the system -- hospital emergency rooms, jails, police, alcohol and drug, homeless shelters," Bennington-Davis said.

The situation can be desperate for those who need help and those trying to provide it.

Recently, a man in his 50s with schizophrenia showed up at a downtown Cascadia clinic asking for medication and a place to sleep, according to agency officials. Two emergency rooms had turned him away, the man said. When told there was nothing to offer him, he stabbed a caseworker in the chest with a pen.

Police arrested him for felony assault, and he ended up in jail -- a common outcome.

A recent state report determined that up to 20 percent of all jail and prison inmates in Oregon are mentally ill. That is higher than a national estimate cited in a May publication by the Justice Department, which said 10 percent to 15 percent of people who are jailed have a severe mental illness.

Once a "shining example"

No one believes jails are the place to treat the mentally ill, especially in a state that 10 years ago had established itself as a leader in treating people with brain disorders in community settings.

"Most of us saw Oregon as a shining example in the country for community mental health," said Dr. John Talbott, a professor of psychiatry at the University of Maryland at Baltimore and a nationally recognized expert. "Then we saw you get the stuffing kicked out of you."

Talbott recently delivered a largely critical speech in Portland about Oregon's mental health system, saying the state relies too heavily on long-term hospitalization to treat difficult cases of mental illness.

Community mental health took a cut of $30 million, or 18 percent, three years ago. The effects were widespread. Some mental health clients lost access to medication. Others were evicted from group homes.

Although lawmakers put money back into the system in the current budget, not everything was restored.

The General Assistance Program, which provides stipends for disabled and low-income people who are unable to work, was eliminated. The benefit was only $314 a month, yet it allowed caseworkers to access treatment and housing programs that require mentally ill Oregonians to pay a percentage of their income to remain eligible.

General assistance also helped plug another gap in the system. The chronically mentally ill may apply for and receive federal disability benefits under Social Security. The benefits, usually at least $800 a month, are a lifeline. But qualifying can take as long as three years in Oregon because of a large case backlog.

Mentally ill people depended on the general assistance money to make co-payments and pay rent until federal benefits began. "Now they have nothing," said Leslie Ford, Cascadia's executive director.

Alcohol and drug services for those who work but earn too much to qualify for Medicaid were reduced $3 million at the end of 2003. That put more than 1,000 drug and alcohol counselors out of work and eliminated nearly 10 percent of the state's treatment beds, state officials said.

Experts say that up to half those with mental health problems also are substance abusers. The alcohol and drug services haven't been restored.

The community mental health cuts forced agencies across the state to lay off another 1,000 people who worked directly with mentally ill people. Caseworkers who once managed 30 or 40 clients now handle more than 100.

Also eliminated was the state's Medically Needy Program, which covered more than 9,000 Oregonians who had unusually high medication expenses but didn't qualify for Medicaid. "Several thousand people who lost that program had mental illnesses," said Madeline Olson, a deputy state mental health administrator.

The Oregon Health Plan was designed as a way to expand eligibility for health coverage under Medicaid to the working poor. But the 2003 cuts limited enrollment to 20,000, down from 100,000, and stricter rules make it harder for patients who do qualify to stay on the plan, Ford said.

"If they make one mistake, like missing a premium payment, they're off it," she said.

The collective result of all the cuts, Ford and others say, is that thousands of people with mental illnesses can't get help until they are so sick that a judge commits them to a hospital for their own safety. But with the Oregon State Hospital slated for closure, and alternatives still works in progress, that creates new pressures.

State hospital overcrowded

The Oregon State Hospital houses nearly 700 patients and has long struggled with inadequate staffing, poor physical conditions, overcrowding and violence.

Most residents are forensic patients -- those who have been found guilty of crimes except for insanity. Empty beds for civil commitment patients are virtually nonexistent, which leads to crowding in acute care hospitals and emergency rooms.

Eleven months ago, the Oregon Advocacy Center, a federally financed watchdog group for people with disabilities, sued the state to force a staffing increase and improve safety and quality of care at the hospital.

The Legislature acted quickly. Meeting in emergency session last spring, lawmakers approved $9.2 million from reserves for staff and community placements for patients who could be helped in less-restrictive facilities.

The lawsuit was settled, but scrutiny remains intense. The Justice Department alerted Gov. Ted Kulongoski in June that it would investigate whether patients' constitutional rights were violated at the hospital. Department investigators visited the hospital last week.

Improving conditions at the hospital will help patients. But state officials say they must also create new inpatient and community-based alternatives for current hospital residents and future patients.

The state hired a San Francisco architectural firm last year to assess what to do with the hospital. That led to a bipartisan plan to replace the hospital with four new facilities at a cost of up to $334 million. Decisions about the location, design and financing for the facilities are on the 2007 Legislature's agenda.

Oregon spends large sums on mental health and addiction -- $352 million in the current two-year budget, not counting federal dollars. The biggest share, $174 million, goes to community mental health.

The latter sum includes a $40 million increase from the prior budget, but officials say about 40 percent of that is being absorbed by the state hospital transition.

Nikkel's office is asking for a huge increase -- $113 million -- in the 2007-09 budget submitted to Kulongoski. The bulk of that increase is targeted at community services.

"We can't turn away from the hospital's problems," Nikkel said. "But it's become clear that until we invest state general fund dollars in front-end services, we'll never get ahead of this process."

In 2004, the Governor's Mental Health Task Force issued a "Blueprint for Action" calling for improvements in care for mentally ill Oregonians of all ages. But only two of its 10 proposals have been enacted. One is a parity law, effective next year, which requires private health insurers to provide equal coverage of both mental and physical illness. The other provision suspends rather than terminates Medicaid benefits when someone is jailed.

Parity helps Oregonians with private insurance but does not increase access to care for the poor.

"We need to be directing our resources into the development of community systems that keep people out of hospitals," said Bennington-Davis. "We ought to be paying attention to what works nationwide -- everything we know that does has been cut in the last year or so. We're going in the wrong direction."

Kulongoski declined an interview request. But Oregon Senate President Peter Courtney, D-Salem, who sponsored parity legislation in 2005, said he will push for mental health reforms in the upcoming Legislature.

"The whole system is in need of repair and has been for years," he said. "Parity gave us a foundation and now we've got to build on it. I'm going to predict we're going to make more progress in the next 10 years than we have in the past 75."

Michelle Roberts: 503-294-5041; michelleroberts@news.oregonian.com Read more!

Parity, Universal Coverage for Children on Kennedy Agenda - Kaiser Capital Watch

Originally published Nov. 17

Sen. Edward Kennedy (D-Mass.) on Thursday outlined his health care agenda as incoming chair of the Senate Health, Education, Labor and Pensions Committee, the Washington Times reports. Kennedy said he would focus on moving toward universal coverage, with expansion of SCHIP the first step toward that goal. Another major agenda item for Kennedy is a proposal called "Medicare for All," which would gradually expand Medicare coverage to U.S. residents younger than age 65.

In the first phase, Medicare eligibility would be expanded to include 55- to 64-year-olds. In the next phase, coverage would be offered to individuals younger than age 20. The proposal, which is co-sponsored by Rep. John Dingell (D-Mich.), would provide access to total Medicare coverage, including prescription drug benefits. According to a summary from Kennedy's office, the proposal is projected to cost $600 billion annually and to generate savings of $380 billion annually. The cost would be funded by payroll taxes and general revenues (Fagan, Washington Times, 11/17).

Other Measures
Kennedy's health care agenda also includes passing legislation that would give the HHS secretary the authority to negotiate with pharmaceutical companies to lower drug prices under the Medicare prescription drug benefit. He said the HELP committee would work with the Senate Finance Committee to make the drug benefit "affordable and eliminate the 'doughnut hole' and other inefficiencies."

Kennedy said he would examine distribution of federal funding for the drug benefit, particularly subsidies for managed care plans. He said, "There's a lot of money that's rattling around out there and the question is who's going to get it, and we're going to try to help those who should have it." Kennedy also said he would work to pass legislation that would lift current restrictions on federal funding for embryonic stem cell research. President Bush vetoed similar legislation in July. "We will be back again and again next year until we succeed in overturning the restrictions on stem cell research that hinder the search for new cures," he said.

In addition, Kennedy said he is "hopeful" that Congress will pass "mental health parity" legislation that would require insurers to offer the same coverage for mental illness as for physical conditions (Carey, CQ HealthBeat, 11/16). Kennedy said he would work with outgoing HELP Chair Mike Enzi (R-Wyo.), adding, " The gavel may change hands, but our partnership will not" (Lee, CongressDaily, 11/17). Read more!

Casualty of war: Mental health - Palm Beach Post

By Anne Usher
Palm Beach Post-Cox News Service

WASHINGTON — Multiple and extended tours of duty in Iraq and Afghanistan are resulting in rates of post-traumatic stress disorder among soldiers that will likely match or exceed those for Vietnam veterans diagnosed with the chronic condition, government officials and veterans groups say.

The unique circumstances in Iraq, where soldiers face an insurgency without a front line, have left many particularly vulnerable to combat stress and are driving the abuse of drugs and alcohol, military health experts say.

Yet many veterans and active-duty troops are not getting the treatment they need.

About one in six of the 589,000 veterans who have served in Iraq and Afghanistan has been diagnosed with post-traumatic stress disorder, or PTSD, according to the Department of Veterans Affairs. The rate is expected to climb because it can take months and sometimes years for the condition to become manifest. Symptoms include anxiety, sleeplessness, flashbacks and extreme wariness, a recipe that often strains personal relationships and makes it hard to get and keep jobs.

Jesus Bocanegra, a 24-year-old former Army sergeant, said he is haunted by the countless shots he fired at Iraqis while serving as an infantry scout in Tikrit in 2003 and 2004. The McAllen, Texas, native said he lost track of how many innocent civilians he killed.

"How the hell was I capable of that?" he said.

Back home and plagued with anxiety attacks, he tried to close himself off from the world by drinking to the point of passing out, he said. He progressed to marijuana and then cocaine.

"The only way to sustain yourself day to day is to keep yourself drugged up," he said. But "it made it worse."

Eventually, he stopped taking drugs. But it took nearly two years for him to get an appointment at the closest veterans hospital, a four-hour drive away, because it was overbooked, he said. He was diagnosed with post-traumatic stress disorder and given pills, but with no VA therapists in the area, he sought help from a group called Vets for Vets.

"It's good to have someone to talk to," he said. "It's the only thing that keeps me going."

Between 15 and 29 percent of soldiers returning from Iraq and Afghanistan will suffer from PTSD, according to an estimate by Col. Charles Engel, a clinician at the Walter Reed Army Medical Center in Washington. As of August, 63,767 discharged soldiers had been diagnosed by the VA with a mental disorder, and 34,380 with PTSD, data show.

Experts say the PTSD rate among Iraq veterans could well eclipse the 30 percent lifetime rate found in a 1990 national study of Vietnam veterans because soldiers still on active duty are being deployed longer and more often to Iraq and more doctors are aware of the disorder and will properly diagnose it.

But a study released in May by the Government Accountability Office, the investigative arm of Congress, found that nearly four in five service members returning from Iraq and Afghanistan who may have been at risk for PTSD were not referred for further mental health evaluation. The Pentagon was unable to explain to the GAO why some were not referred for care.

Medical experts say mental health and substance abuse problems are intertwined. And drugs ranging from marijuana to prescription antidepressants are easily accessible in Iraq, according to interviews with more than a dozen soldiers who served there.

Soldiers said they used banned substances as a way to mentally escape the violence around them. Others said pills were handed out by medics in the field.

John Crawford, a 28-year-old former Florida National Guardsman who served with the Army's 101st Airborne Division, said soldiers in his unit drank alcohol, some took steroids, "pretty much everyone took Valium" and "some did all three."

Crawford said he bought 200 to 300 pills of Valium on the street in Baghdad for $2 as a way to catch some sleep between patrols. After eight months, he built up a tolerance and was taking seven or eight at a time.

The extent of alcohol and drug abuse among combat veterans is difficult to quantify. Announced drug tests are usually done just once a year.

Army Maj. James Weeden, who directed a team of 200 mental health specialists dealing with combat stress in Iraq until he left there in September, said senior officers recognize the strain their troops are under and have begun assigning some mental health specialists to remote forward operating bases.

But seeking treatment in a combat environment is difficult because any travel risks exposure to enemy attacks and roadside bombs. And asking for help is still seen as a sign of weakness.

Weeden and other medical specialists say they can only treat the symptoms of combat stress - with antidepressant drugs and rest, for example - and that soldiers are sent out of Iraq only when they have clearly disabling cases of PTSD. Commanders naturally want to keep soldiers in the field, and most soldiers say that they don't want to abandon their units.

"We strengthen (combat readiness) because we get them back," Weeden said.

Joyce Raezer, director of government relations at the National Military Family Association, said soldiers - some now on their fourth or fifth tour - are bringing "all the baggage from the last deployment into the next."

"The stress is cumulative," she said. Families are alarmed by military statistics showing that 80 percent of soldiers who have been flagged with "mild" symptoms of post-traumatic stress disorder have been sent back to Iraq and Afghanistan, many with antidepressants to enable them to still fight.

When the roughly 160,000 soldiers now serving in Iraq and Afghanistan eventually return home, the Department of Veterans Affairs has the resources to offer all of them treatment for PTSD and substance abuse, said Dr. Ira R. Katz, the department's deputy chief patient care officer for mental health. He noted that there are 200 "readjustment" centers for veterans nationwide and that "telemental" health counseling is available over the Internet.

But many soldiers seeking treatment for combat stress when they return say they face steep hurdles getting help from the government.

The Government Accountability Office said the VA has not spent millions of dollars at its disposal to treat returning soldiers, many of whom say their problems were also ignored after being flagged in post-deployment tests aimed at catching early signs of PTSD.

Maj. Gen. Paul Mock, commander of the 63rd Regional Readiness Command for the Army Reserve, told an Army convention last month that he doesn't think the infrastructure is in place to treat all returning troops who need mental health care, especially in rural areas.

Adam Reuter, a 23-year-old former Army specialist from Atlanta who was stationed near the Syrian border with the 3rd Squadron, 3rd Armored Company, said a medic simply handed him a plastic bag filled with pills with no instructions after he was tossed out of a Humvee in an accident. The bag contained Percocet, Vicodin, Tylenol with codeine, a muscle relaxant, Motrin and naproxen.

He said he went back for more and developed a dependency he is still trying to shake.

The military maintains a zero-tolerance policy for drug use on all but prescription medications. Some soldiers have lost their military benefits - regardless of their combat citations - after they have been found to have used banned substances. But many commanders offer leeway in such cases, choosing nonjudicial punishment such as demotion to keep soldiers on duty, said Army Col. Bill Buckner, a public affairs officer at Fort Bragg in North Carolina. Read more!

Aid to Poor Improving, but Caseloads Still High - Washington Post

By Bill Turque
Washington Post Staff Writer

The Fairfax County agency that operates mental health programs says it has eliminated a waiting list of low-income adults seeking treatment, but warns that the improvement could be short-lived if heavy therapist caseloads are not reduced.

The Fairfax-Falls Church Community Services Board reported this year that as of June 1, 314 people faced waits of up to six months for initial mental health screenings -- nearly double the 173 awaiting service March 1.

In an Oct. 31 memo to County Executive Anthony H. Griffin, the Community Services Board's executive director, James A. Thur, said recently filled staff vacancies, several newly created positions and rehiring of retirees enabled the agency to wipe out the backlog.

According to the memo, adults and children with psychiatric emergencies can now expect immediate responses from clinicians. Those with non-emergency conditions will be seen within 16 days -- higher than the nationally accepted standard of two to 10 days, but an improvement from last June.

"Excellent progress has been made on the wait for services compared with June 2006," Thur wrote.

Supervisor Penelope A. Gross (D-Mason), vice chair of the Board of Supervisor's human services committee, said the Community Services Board's report was "a step in the right direction," but that she wants to be assured that recent progress is more than a temporary gain.

"My skeptical side says we need to see more of a sustained effort," Gross said.

Thur said the recent gains are at risk if clinical caseloads are not reduced. Community Services Board clinicians each carry 40 to 58 patients, far above the national standard of 25.

"Caseloads are growing to unacceptable levels, and this must be addressed in order to maintain the progress that has been made," Thur said.

The agency plans to ask for more money to hire additional clinicians next year.

Heavy caseloads are one of several vexing issues facing the board. The Washington Post reported last week that 19 severely mentally ill people whose families sought treatment were released from involuntary confinement because there were not enough independent psychologists to perform examinations. When the Community Services Board began using its own psychologists and social workers for the evaluations, a panel of Fairfax justices ruled that the organization was not sufficiently independent, because they could ultimately be involved in the patients' future treatment. The justices ordered the patients released.

The agency's difficulties prompted supervisors this year to empanel a commission to investigate mental health services in the county. The Josiah H. Beeman Commission, named after the late Community Services Board chairman, is expected to deliver an interim report in the middle of next year.

Mental health, mental retardation and substance abuse treatment in Virginia is provided through a network of community boards. Fairfax County underwrites about 55 percent of the Community Services Board's $137 million annual budget, with Medicaid and the state providing the rest.

The county's growing population and changes in the health-care industry have strained the Community Services Board's ability to serve those in need. More than 83 percent of the 11,000 Fairfax residents who received mental health care in 2005 had household incomes below $25,000 a year. Most were uninsured or underinsured.

Because most nonprofit mental health service providers don't provide medication and don't accept Medicaid patients, Thur said, demand for the Community Services Board's assistance will continue to grow.

"The [board] is finding itself as the default provider of mental health and substance abuse services for a growing number of uninsured and underinsured persons," he said. Read more!

Palin targets development of Mental Health Trust lands - Alaska Journal of Commerce

Governor-elect tells miners' convention that the trust must expedite process of responding to developers

By Tim Bradner
Alaska Journal of Commerce

Governor-elect Sarah Palin said the Mental Health Trust must be more proactive in developing its lands.

In her first official appearance as Alaska's governor-elect, Sarah Palin told Alaska miners she plans to shake up the state's Mental Health Land Trust administration to make it more friendly to developers.

Palin addressed the Alaska Miners Association's annual convention in Anchorage Nov. 9.

"The Mental Health Land Trust needs to be more proactive in development of lands they control. They need to expedite their process of responding to individuals and companies wishing to do business with them," Palin told the miners.

"If they do not possess the knowledge they need to expedite this process, we must hire people who have the experience and ability to make resource development decisions. The trust needs to not be a stumbling block, but a partner in safe, sound development opportunities," she said.

Palin was apparently referring to problems mining companies and other potential developers have had with the state Mental Health Land Trust, although she was not specific about what the problems were. Attempts to contact Palin for elaboration on her statements were unsuccessful.

Palin may find she has limited ability to influence management of the land trust, however. Under current law, land management policies are actually set by the board of trustees of the Mental Health Authority, not the state administration.

The trust manages about 1 million acres of land around the state on behalf of the Alaska Mental Health Authority, which funds programs that serve mentally ill and disabled Alaskans. Trust lands are leased for oil and gas and mineral development as well as real estate and other commercial activities. Because the land trust is intended to generate revenues to support mental health programs in the state, the lands are intended to be managed more for development than for other uses, such as recreation or wildlife habitat. In contrast, the Department of Natural Resources is charged with managing other state lands for multiple uses. Lands were set aside in a trust to support the mentally ill when Alaska was a territory, but when the Alaska became a state, the trust lands were combined with other state lands and administered by the Department of Natural Resources. A settlement of litigation in 1994 led to the recreation of the land trust as a separate entity. The lands designated for the trust are managed by a separate group within the resources department that are funded from trust revenues and report to the trustees of the Mental Health Authority, rather than the commissioner of Natural Resources. A memorandum of understanding between the trust authority and DNR spells out the relationship between the entities. The executive director of the lands trust, currently Marty Rutherford, is hired by the trustees, not the DNR commissioner.

"Trust lands are managed pursuant to the court settlement and statutes passed by the Legislature. The lands cannot be managed as general state lands," Rutherford said. The board must also abide by general trust law as it has evolved over the years, she said.

Palin supports state control of wastewater permits

In a second policy statement, Palin said she supports Alaska assuming administrative control of wastewater discharge permits from the federal government, a process that was started in Gov. Frank Murkowski's administration.

The U.S. Environmental Protection Agency now administers National Pollution Discharge Elimination System discharge permits under the federal Clean Water Act, although the state plays a role by certifying that the permits meet Alaska standards for clean water.

Many states also administer the permits under guidelines of the Clean Water Act, and Alaska is on a track to do the same. Palin said she supports this.

Palin also said she will push to take formal title to state-selected land on a more aggressive schedule and will make infrastructure projects, on which mining companies depend, a priority.

Palin was received warmly by the miners. "I've been a commercial fisherman and a politician. I haven't been a miner, but I'm willing to listen and learn," she told listeners in a jammed-packed Howard Rock Ballroom at the Anchorage Sheraton Hotel.

"We admire Sarah Palin's streak of independence and her willingness to take long-shot risks. Those are qualities miners share," said John Reeves, a Fairbanks businessman who introduced her to the convention.

During her campaign, Palin sent a strong signal that she was receptive to mining when she said she was at least open to letting Northern Dynasty Mines Inc. submit applications for its controversial Pebble copper-gold mine. If developed, the mine would be located at the headwaters on rivers that flow into Bristol Bay. Palin said she would allow the public review process to work, although with her Bristol Bay commercial fishing background, she is still concerned about the mine. In contrast, her Democratic opponent, Tony Knowles, said he flatly opposed the Pebble project even before the company has finished its proposed mine plan. Knowles also took frequent campaign flights on a jet owned by Anchorage businessman Bob Gillam, an opponent of the mine. Tim Bradner can be reached at tim.bradner@alaskajournal.com. Read more!

Surviving suicide: Father turned tragedy into personal campaign - Raleigh News & Observer

By Orr Shtuhl, Correspondent

PITTSBORO -- After his son Stephen killed himself in 1999, Phil Morse was devastated. But in the years that followed, he did more than learn how to cope; he created an ally for those affected by suicide in the Triangle.

When Morse, 64, retired from his professorship at the State University of New York at Fredonia and moved to Pittsboro in 2002, he founded the Triangle Consortium for Suicide Prevention (TCSP), a group that brings together bereavement centers, hotlines, research foundations and other organizations to collaborate on prevention methods. On Nov. 5, the group held its Walk to Save a Life, one of the events it organizes to increase awareness.

But although Morse's work is fulfilling, the pain hasn't vanished.

"I think about him every day," he said. "The slightest thing can bring you to tears, still, and this is seven years later. You just try not to get too sad."

Every year, more than 30,000 Americans commit suicide, and 90 percent of them suffered from a mental disorder -- in more than half the cases, depression. In addition to raising awareness, the Triangle Consortium organizes survivors of suicide, or SOS, a weekly support group for family and friends of suicide victims.

"There are a lot of things that haunt you as a survivor -- he did this under your watch," Morse said. "It's like the ultimate thing you didn't do for your kid. It just feels like you really failed. And obviously it's not, and you've got to get over that."

Survivors often are left asking themselves what they could have done to prevent the tragedy, a question that usually doesn't have an answer.

Stephen Morse's death was one such case. In high school, he earned excellent grades, was a class officer and won a championship with the soccer team. He graduated from SUNY-Fredonia with a bachelor of fine arts and in 1997 moved to Pittsburgh for graduate school, where his straight As continued.

"He was probably one of the most well-adjusted kids I've ever met," Morse said. "He was exceptionally well grounded. He never had any of those teen rebellious streaks."

After receiving a master's in higher education administration at the University of Pittsburgh, he took a job in the city at a small school called Chatham College. But the job was too demanding; Stephen would work long hours, seemingly doing the work of two or three people. During that time, he also broke up with a longtime girlfriend, and in January 1999, his father, sensing something wrong, encouraged him to take time off and come home to Fredonia for treatment for a growing depression.

Stephen, who was 31 at the time, went through depression treatment. He also took a family trip to Hawaii with his parents and sister and spent some more time at home afterward. But in his time off, he began to feel like his friends were moving on, while he remained static, stuck at home.

On Oct. 9, 1999, Stephen woke up in his parents' house tired, upset after a disappointing job interview the day before. A few hours later, as Morse was leaving for his office, he saw his son stepping outside to check the mail. Morse waved him off from the end of the driveway -- it hadn't arrived yet -- and Stephen turned on his heels as his dad left for the office. That was the last time he saw his son alive.

His sister soon found him in the garage, where he had hanged himself, leaving no note.

For the next two years, the family didn't celebrate Christmas. Holidays were difficult -- imagine the glare of an empty seat at the table. Instead, they would vacation in Florida, avoiding yearly traditions.

"The problem with a tree is you have to decorate it, and when you decorate it, all these little things bring back memories," Morse said. "These little things are devastating."

Morse later divorced his first wife and remarried after moving to Pittsboro, a common scenario: Eighty percent of couples that endure a suicide in their nuclear family eventually divorce, he said.

He stays active with the coalition, attending SOS meetings, conferences and working on national-level collaboration for the Consortium. And come the holidays, his house will have a tree.

"It's one of those things where you really don't have much choice -- you have to deal with it. You can either say, 'I'm not going to get over it,' or 'I'm going to do something to help people.'" Read more!

ValueOptions under fire - The Charlotte Observer

PAM KELLEY AND CARRIE LEVINE
pkelley@charlotteobserver.com
clevine@charlotteobserver.com

When North Carolina recently outsourced the task of approving treatment for mentally ill people on Medicaid, the change was supposed to improve efficiency. Instead, it triggered a statewide crisis.

ValueOptions, the private company that took on the job in June, didn't have enough workers and became buried under more treatment requests than expected. Its backlog grew into the thousands.

As a result, some mentally ill children couldn't get critical treatment. Some charged with crimes languished in juvenile detention centers. In Mecklenburg County, one boy ran away from his foster home while waiting for ValueOptions to OK a spot in a group home. A girl in Charlotte attempted suicide while waiting more than a month for in-home treatment.

In July, N.C. Providers Council Executive Director Bob Hedrick e-mailed state officials about a boy who'd been waiting nearly a month for treatment. "The therapist called today stating that the child brought knives with him to his bedroom and slept with them under his pillow. ... He needs services ASAP!"

Dozens of e-mails sent to state officials and obtained by the Observer describe a situation verging on chaos: Companies that provide mental health services couldn't collect Medicaid money without authorizations, so they threatened to stop serving clients. Some therapists hadn't been paid for weeks. A ValueOptions official asked how to respond to providers who showed up in her company's lobby, demanding to be seen.

More than five months after the outsourcing, providers and state officials say the crisis is abating. ValueOptions was originally predicted to save the state millions of dollars a year. Now, state officials don't know what the contract will cost.

N.C. Department of Health and Human Services Secretary Carmen Hooker Odom said she expected some problems with the change, but regrets the chaos. "We're going to get it right," she said.

But critics say the state failed to heed warnings that a tidal wave of authorization requests would swamp the company. The outsourcing coincided with other major mental health system changes, and ValueOptions officials had told the state they didn't know if they could hire new staff fast enough.

"It was like going from zero to 60 in five seconds," said John Tote, head of the Mental Health Association in North Carolina.

"They make these sweeping changes without building any of the infrastructure," said Brett Loftis, executive director of Charlotte's Council for Children's Rights. "And the kids suffer every time."

Effort to standardize

Before N.C. Medicaid recipients can obtain mental health treatments, many must be reviewed and approved by a clinician. The process is similar to reviews that health insurance companies use to decide whether to cover treatments.Until recently, the state's local mental health agencies did most of these reviews for more than 300,000 people on Medicaid.

But in March, Hooker Odom decided that ValueOptions would take over most reviews. The transition would begin in June with children's mental health. To make the change easier, the company would take over approvals for other services on a staggered schedule through the summer.

The state chose the private Virginia-based company because it would use the same rules when reviewing all requests. Federal rules require such standardization, but the state's 30 local mental health agencies, which all operate differently, hadn't achieved it.

Companies that provide mental health services liked the idea, which let them submit treatment requests to a single office.

But the secretary's decision gave ValueOptions only about two months to prepare. When thousands of treatment approval requests for mentally ill children landed in ValueOptions' Durham offices in June, the company was overwhelmed.

"We have submitted dozens of requests, (ValueOptions) loses them, requests resending, does not respond," wrote Charles Davis, N.C. director of The Mentor Network, in an e-mail to state officials in late June. "Whole picture is that they have insufficient staff to handle volume, are stacking things on desks and on floors, and are in gridlock due to everyone in state calling them to follow up on work they cannot do."

Without written approval, providers couldn't start new treatments. In Charlotte, the non-profit Council for Children's Rights heard from callers desperate to get help for mentally ill children. Brett Loftis learned of the boy who ran away from his foster home and the girl who tried to commit suicide from Charlotte's Family Preservation Services. The provider was trying to get their treatments approved.

N.C. District Judge Lou Trosch, who presides over juvenile cases, also began seeing a pattern of treatment delays that left mentally ill children sitting in detention facilities or getting into more trouble while they waited.

When treatment for one defendant wasn't forthcoming, Trosch went to the top to find out why: He subpoenaed Hooker Odom. Because the defendant is a juvenile, Trosch can't discuss the case. But others familiar with the incident say Trosch relented on the subpoena after officials from the state and ValueOptions agreed to meet with providers and advocates for the mentally ill in Charlotte.

By early September, ValueOptions had a backlog of at least 8,000 treatment requests.

As of early November, the company had received more than 150,000 requests -- about 60 percent more than expected, company spokesman Tom Warburton said. A backlog remains, but officials can't say how big it is, because they're weeding out duplicate requests. The company aims to be caught up before year's end, he said.

N.C. officials are now suspending some rules to speed payments. And many providers say they're getting treatment approvals in days or weeks instead of months.

"It's not perfect, but it's getting better," said The Mentor Network's Charles Davis, who e-mailed state officials with complaints in June.

Still, Trosch said he's concerned some children aren't getting treatment they need, especially kids who don't have a judge on their side.

Unexpected volume

ValueOptions wasn't new to North Carolina. The company has contracted with the state since 2001 to authorize Medicaid-funded services, such as psychiatric hospitalization or group home placement. The self-described industry leader in managing the nation's public behavioral health programs, ValueOptions has contracts with governments in 11 states.

But in North Carolina, ValueOptions got an unpleasant surprise: A combination of new treatment services and new approval rules produced more requests than the state expected.

To make matters worse, some mental health providers hadn't attended training on request procedures. Countless requests with errors couldn't be processed.

With hindsight, the state would have moved more slowly and spent more time training mental health providers, said Tara Larson of the Division of Medical Assistance.

ValueOptions will eventually have 200 employees working on N.C. cases, 50 more than first planned. It's still short about 35.

Initially, state officials predicted the ValueOptions three-year contract, estimated at $8.5 million annually, would save between $13 million and $29 million a year.

But because authorization volume is much higher than predicted, costs will be higher. For now, state officials can't say how much higher. Still, they predict the service will cost less than it did when local mental health agencies approved treatments.

State falls short

Even the state's worst critics concede that transforming North Carolina's mental health system is incredibly complex. Currently, 44 states are tackling some sort of mental health reform, and some are having more problems than North Carolina, says Tote, of the nonprofit Mental Health Association of North Carolina.But advocates for the mentally ill say state officials should have anticipated serious problems. "They didn't plan ahead," said Frank Edwards, president-elect of Wake County's National Alliance on Mental Illness.

Said Mecklenburg Consumer and Family Advisory Committee Chair Sandy DuPuy: "They absolutely wouldn't slow down. We just kept saying, please, please. Can you wait a little bit?"

N.C. Rep. Verla Insko, from Orange County, co-chair of the legislative committee that oversees mental health reform, is also frustrated. She realizes now, she said, that neither state mental health officials nor her committee members asked the right questions to head off problems.

"I think the (mental health) division and the oversight committee both fell short," she said.

Said Tote: "The state of North Carolina can do better."

Pam Kelley: 704-358-5271; Carrie Levine: 704-358-5071.

Observer Exclusive


Fixing a Broken System

Five years ago, the N.C. legislature approved a mental health reform plan to fix a system widely seen as broken. The plan called for more community-based services, so people didn't have to stay in institutions. To encourage competition and create choices, private companies would offer services.

Public mental health agencies would mostly get out of the service-providing business and instead manage services. They'd monitor providers and ensure that people with mental illness, developmental disabilities or addictions got needed treatments. The agencies would also approve those treatments.

By 2006, plans were shifting. State officials saw that some public mental health agencies were doing a lousy job of approving treatments.

In March, state officials concluded that no agency met the standards needed to review treatments. In early April, Hooker Odom told ValueOptions that it would be the state's single vendor.

The decision took nearly everyone, including ValueOptions, by surprise.

Grayce Crockett, director of Mecklenburg's mental health agency, called the decision "an abrupt change in strategy." N.C. Rep. Verla Insko, co-chair of the legislative committee that oversees mental health, described it as "a huge shock."

Some mental health agency directors dispute the state's findings. Mecklenburg could have done a good job on treatment approvals, Crockett said.

She and other mental health advocates argue that by outsourcing treatment review, the state is setting up area mental health agencies for failure: Agencies can't effectively manage the system if they aren't reviewing treatments.
Pam Kelley

Read more!

Leaders hopeful crisis averted- Hendersonville News

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

They feared the worst, after the region's largest mental health care provider shut down Oct. 31, a demise triggered by money woes.

Henderson County leaders -- not to mention hospitals, homeless shelters, sheriff's deputies and others -- worried patients would once again fall through the cracks. They envisioned the aftermath of the state-mandated mental health reform of 2001, when a massive restructuring triggered a flood of patients to homeless shelters and hospital emergency rooms because they knew no other place to go.

But two weeks after New Vistas-Mountain Laurel closed, county leaders say the outcome has not been nearly as dire as they expected. And people on the front lines say they remain cautiously optimistic, as new providers set up and take on the dead agency's caseload.

They are hesitant to say the community is in the clear. Pardee Hospital says its emergency room is seeing more mental health patients, and an official with the Hendersonville Rescue Mission says the shelter has encountered problems tracking down after-hours emergency care.

But most agree that the community's swift action, from new providers broadening the scope of the services they offer to private citizens donating cash toward causes, helped Henderson County avert a crisis.

"At this point, I think it's going better than expected," said Steve Wyatt, the Henderson County manager and a board member for Western Highlands, which manages mental health care in the region. "I'm not saying there are not holes, but I'm really impressed by the way everybody stepped up to the plate and worked for the common good."

Plugging holes

Some issues remain unresolved.

A question mark looms over the Sixth Avenue West Clubhouse property, which New Vistas-Mountain Laurel plans to sell to cover lingering bills. The Office of the State Auditor has yet to launch its investigation into the closure. Some patients have yet to be assigned new providers. And, as the Hendersonville Rescue Mission has seen, there is no around-the-clock emergency crisis intervention.

But these holes are closer to being plugged.

The Henderson County Board of Commissioners completed an appraisal on the Clubhouse property and continues negotiations to buy the building on Sixth Avenue West near the Henderson County YMCA.

And the Board of Commissioners -- with a new addition, Republican Mark Williams -- could decide in December whether to dedicate seed money to help Parkway Behavioral Health take on emergency mental health care, daytime triage and walk-in clinic services in Henderson County.

"Overall, I've been very pleased with the way the providers and the community have stepped up across the board," said Commission Chairman Bill Moyer. "I think we are at a better point now than honestly I could have hoped. My concern, though, is that there's still inherent problems in the system."

Among those problems, Moyer says: a low state reimbursement rate for patients who have no medical insurance, whether Medicaid or private. The head of New Vistas-Mountain Laurel says low reimbursement rates and the agency's role as the so-called "safety net provider" are prime reasons the agency fell apart.

Problems encountered

The state-mandated reform five years ago sought to offer patients more choice in where they can receive mental health care. Instead of turning to one countywide provider, patients now choose from a list. Moyer finds that problematic.

"I personally have thought and still think that's an awful lot to ask of people that are in crisis," explained Moyer, who says adjustments should be made to make the system more efficient for patients and cost-effective for providers.

"Unless we address some of the inherent problems in the system, I'm very afraid that we could be back in this situation again," he said.

Western Highlands released an updated list of new providers who are picking up cases in the eight-county region Thursday.

"I think level heads, good planning and developing a strategic plan, which is what we did, pays off in terms of being able to move forward," said Arthur Carder, the Western Highlands chief executive officer.

Tim Jones, the operations director for the Hendersonville Rescue Mission, says the shelter has encountered problems finding mental health care for some guests in the past two weeks.

"We've had, I say, a handful of pretty severe cases that there just wasn't help for them, where with the resources we had before there would have been," Jones said. "It's kind of what we expected, but I'm encouraged by the fact that there are at least structures out there in place."

Among those structures is a free psychiatric clinic operated by the Hendersonville Free Clinic that will soon open in the old emergency department at Pardee Hospital.

The clinic plans to open on Dec. 5, from 5 to 9 p.m. It will be staffed by volunteers from Appalachian Counseling, the Hendersonville Free Clinic and Pardee and Park Ridge nurses, psychiatrists and social workers. From then on, the free psychiatric clinic will be open each Tuesday night.

"That's a good cause for hope for us," Jones said. "I think the county really stepped up and tried to be proactive with what they saw coming this time.

"It's discouraging," Jones said, talking about the problems the shelter has encountered. "But it's not like it was before where no one seemed to be listening. I think we'll see some positive things on the horizon."
Read more!

Jed Foundation and mtvU launch national campaign to debunk mental health stigmas-Indiana Daily Student

By Jacqueline Faine | Indiana Daily Student | Friday, November 17, 2006

It's hard to fight statistics that say suicide is the No. 2 killer of college students.

But in an effort to raise awareness and combat the stigmas of stress, depression and suicide, mtvU and the Jed Foundation have partnered up to launch a program called "Half of Us" to reduce student suicide rates, fight mental health misconceptions on college campuses and connect students and their friends to the help they need. The program's name, "Half of Us," comes from research indicating that nearly half of all college students have said they have felt so depressed at some point they could not function.

The Jed Foundation is a nonprofit organization founded by Phil and Donna Satow after their son, Jed, killed himself during his sophomore year of college. His death shocked family and friends who were not fully aware that Jed's life was in imminent danger. The Jed Foundation works to educate college campuses about the importance of suicide prevention and reprioritizing mental health.

Jason Rzepka, mtvU communications manager, said the issues of suicide prevention and stress critically affect lots of colleges, and the negative connotations associated with mental instability prevent students from seeking help.

"I'm happy that mtvU is being used as a platform for social change and a connection to resources," Rzepka said. "Every instance of someone committing suicide touches people across the range, and I'm personally proud to participate. 'Half of Us' addresses one of the first steps for friends and families -- to reach out."

MtvU opened halfofus.com to serve as a safe space for students to discuss their feelings or seek help for a friend. The Web site offers school-specific and national resources and an anonymous screening tool for emotional disorders. The TV station is airing public service announcements that profile students who have contemplated suicide.

Nancy Stockton, director of Counseling and Psychological Services at the IU Health Center, said students need to inform themselves about the signs of depression and suicidal risk in the same way they would for an imminent heart attack or stroke.

Left untreated, Stockton said, depression robs students of their abilities to interact with their social and academic environments, to be productive and to enjoy themselves. Research has demonstrated that a combination of medicine and psychotherapy is the best treatment for depression of moderate and greater severity, she said. Milder forms of depression usually respond to either counseling or medicine alone.

Stockton said the best way to stay informed is to learn how to respond to people who might be giving subtle or not-so-subtle indications that they are contemplating suicide. When appropriate help is available and students know about it, she said, most students learn other coping strategies. The quickest way to solve unnecessary suffering is to take steps to solve it early and she said students can do that on campus at Counseling and Psychological Services.
Read more!

Our Great Depresssion - NY Times

Op-Ed Contributor

By ANDREW SOLOMON
DEPRESSION is the leading cause of disability worldwide, according to the World Health Organization. It costs more in treatment and lost productivity than anything but heart disease. Suicide is the 11th most common cause of death in the United States, claiming 30,000 lives each year.

Despite medical advances in the last 20 years that have greatly improved our ability to help those who suffer from depression, we lack an effective system for administering care. Only a very small percentage of depressives who seek help receive appropriate treatment for their condition. Research often stalls short of being translated into useful medicine. Depressives continue to be stigmatized, which makes their lives even more difficult and lonely. Finally, many sufferers are left to spiral, unsupported, into despair because their insurance companies refuse to pay for treatment.

These problems are similar to those cancer patients once faced, and the best way to address them might be similar as well. We need a network of depression centers, much like the cancer centers established in the 1970s.

Through the National Cancer Institute, federal funds were dispersed to interdisciplinary centers like Memorial-Sloan Kettering in New York and M.D. Anderson in Houston. The idea was to make sure that 80 percent of the American population lived within 200 miles of such a center.

As this network of institutions took root, the quality of cancer treatment advanced dramatically. The centers brought researchers and clinicians under one roof, ensuring that basic science was applied to achieve medical results. Scientists communicated both within and between centers, so that everyone could make use of everyone else’s work to accelerate progress.

Following this model, the National Institute of Mental Health should coordinate and subsidize a national network of depression centers, ideally based at research universities with good hospitals and departments devoted to the subject.

The University of Michigan, host to the country’s first national depression center, which opened its doors last month, has been a pioneer in this regard. More than 135 experts on depression and bipolar disorder will collaborate there, about half of them psychiatrists. The center has a large clinical treatment program and a genetic database that will house samples from tens of thousands of depressed and bipolar patients. It is sponsoring social and biological research and pressing for policy initiatives related to mental illness.

Among the thousands of depressed people I have met with, the majority have sought treatment but feel that they are not getting good care. Many of them have been prescribed antidepressants by family doctors who lack training in psychiatry and have conducted only cursory interviews before rendering their diagnoses. Antidepressants vary in their chemistry and effects; and human brains vary as much as human minds. To treat the most complicated organ in the body appropriately demands considerable expertise.

The question I am asked most frequently is how to get better care, and it can be devilishly hard to answer. Depression centers that could deliver a high standard of comprehensive care would be a dream come true — not only for millions of depressives, but also for the research community.

Last winter, the Library of Congress organized a conference where theoreticians met with mental-health consumer advocates and clinicians. The combination was unusual and wonderful. Everyone left with fresh ideas. We need formal bodies to sustain such fruitful intimacy.

Research related to a major disease should not unfold in a purely intellectual context, nor should consumer advocacy exist solely in a lobbying context, nor clinical practice exclusively under the shadow of profit-driven pharmaceutical research. (Full disclosure: my father is the chief executive of a pharmaceutical company that manufactures antidepressants.)

Before the cancer centers came around, cancer was as taboo as depression is now. But as antibiotics and vaccines for other illnesses lengthened life expectancy, cancer became more pervasive and less shameful. Depression, too, is becoming more widespread and more frequently diagnosed. Depression and bipolar illness will affect some 20 percent of Americans during their lives, and yet the stigma endures. People often come up to me after lectures to whisper about their affliction, as though everyone else in the room weren’t grappling with precisely the same thing.

It is neither wise nor feasible for a large proportion of the population to be trying to keep a secret. A national network that helped to medicalize depression in the public imagination would reduce sufferers’ shame. The very waiting rooms of depression centers would provide incontrovertible proof of the ubiquity of the illness and ease the isolation of sufferers. Within the centers, patients would find themselves the focus of an elite community of insight and support.

Alleviating stigma will also make it harder for insurance companies to deny treatment. As it is established that these mental illnesses are not character defects, but instead can be characterized in terms of brain symptoms, the false distinctions between them and cancer or heart disease will become impossible to sustain. The fiscal irresponsibility of leaving untreated an illness that causes enormous loss of productive work years would be clearly demonstrated.

We’ve made stellar progress in treating mental illness since the Prozac revolution but there is a catastrophic divide between research and practice. We must come up with a seamless way to support scientific progress and to administer the treatments we have, in order ultimately to alleviate as much suffering as possible.

Andrew Solomon, the author of “The Noonday Demon: An Atlas of Depression,” is on the national advisory board of the University of Michigan Comprehensive Depression Center. Read more!

U.S. military changes guidelines that linked homosexuality with mental disorders - AP

The Associated Press

Defense Department guidelines that classified homosexuality as a mental disorder have been changed and now put it among a list of conditions or "circumstances" that range from bed-wetting to fear of flying.

The new rules are related to the military's retirement practices. They do not affect its "don't ask, don't tell" policy that prohibits officials from inquiring about the sex lives of service members and requires discharges of those who acknowledge being gay.

The revision was made in response to criticism this year that the guidelines listed homosexuality alongside mental retardation and personality disorders. Mental health professionals said Thursday they still were not satisfied that the change accurately characterizes the matter.

"We appreciate your good-faith effort to address our concern that the document was not medically accurate," said James H. Scully, head of the American Psychiatric Association, in a letter to David Chu, undersecretary of Defense for personnel and readiness. "But we remain concerned because we believe that the revised document lacks the clarity necessary to resolve the issue."

The Pentagon guidelines outline retirement or other discharge policies for service members with physical disabilities. And it includes sections at the end that describe other specific conditions, circumstances and defects that also could lead to retirement but are not physical disabilities.

Among the conditions are stammering or stuttering, dyslexia, sleepwalking, motion sickness, obesity, insect venom allergies and homosexuality.

"More than 30 years after the mental health community declassified homosexuality as a mental disorder, it is disappointing that the Pentagon still continues to mischaracterize it as a 'defect,' said Democratic Rep. Marty Meehan, a member of the House Armed Services Committee.

Pentagon spokeswoman Cynthia Smith said Thursday that "homosexuality should not have been characterized as a mental disorder. A clarification has been issued."

The APA declassified homosexuality as a mental disorder in 1973. Questions about the Pentagon's guidelines were raised in June by what is now known as the Michael D. Palm Center, a research institute at the University of California at Santa Barbara.

There were 726 military members discharged under the "don't ask, don't tell" policy during the budget year that ended Sept. 30. Read more!

Patty Duke shares story of abuse and mental illness - Post Cresent (WI)

Famed actress visits Appleton, describes her role as treatment advocate

By Wendy Harris
Post-Crescent staff writer November 16, 2006

APPLETON — Patty Duke is known by millions for her Oscar-winning role as Helen Keller in “The Miracle Worker” and her decades-long career as a beloved television and film star.

On Thursday, Duke visited Appleton to share another part of her life: the dark world of child abuse and the ravages of untreated mental illness.

“This was so ugly and deep and dark and I felt so guilty that I didn’t even remember this as the years went on,” said Duke, referring to the abuse she endured by her managers. “When I was playing Helen Keller, the sexual abuse began, along with the plying of this child of 12 with alcohol.”

Duke was the featured speaker at the Children’s Hospital of Wisconsin-Fox Valley’s annual luncheon at the Radisson Paper Valley Hotel. The event raised funds for the hospital’s two-year-old Child Advocacy Center, as well as awareness about children in the Fox Valley who suffer from mental illnesses, abuse and neglect.

Since opening, the Child Advocacy Center has served nearly 600 local victims of child abuse. The center provides support and care for suspected victims in an effort to minimize the additional trauma that can occur as their cases move through the legal system.

“I am very humbled to be among all of you who are actually doing it … not just the idea of hope, but the practical application,” Duke told the crowd of 300. “Today’s luncheon demonstrates the grace with which you treat our children, all of them, but especially the abused and the neglected.”

Duke told of her struggle to survive abuse both at home and in Hollywood, and her descent into manic-depressive illness at the height of her success.

During one manic episode in her early 20s, she married a stranger and appeared on the Dick Cavett show, where she announced she “was going to build an ark in the desert between Barstow and Bakersfield.”

The marriage was annulled 13 days later, and people close to her tried to get her to seek professional help.

“My fear of the label, my fear that I would never work as an actress again, was too great that I chose to spend 15 more years before I went and got a diagnosis and treatment,” said Duke, whose autobiography, “Call Me Anna,” was published in 1997. She also co-authored the book “A Brilliant Madness: Living with Manic-Depressive Illness.”

Stigma and insurance discrimination remain the two biggest barriers that people face when struggling with mental illness, Duke said after her talk.

“We are making progress, but we need to triple time it because science and medicine are moving so quickly that that only thing standing in the way of successful treatment is stigma,” she said.

Mental illness does not receive equal insurance coverage as physical illness in many states, including Wisconsin.

“I am very much involved with the advocates, activists and politicians who are working on the insurance parity issue,” she said.

She said she expects progress on that issue soon. “If not, I believe we will have a revolution.”

Sherwood residents Mike and Sharon Williams, who attended Thursday’s luncheon, said they were pleased to see so many area residents join together for such a good cause and discuss mental illness, a taboo subject for many.

“So many people with mental illness don’t want to go public with it for fear of losing their jobs,” said Mike Williams.

“The public is very unaware,” said Sharon Williams. “Mental illness is almost like cancer was in the ’60s. Many families have this and don’t realize it.”

The couple leads a support group for family members who are dealing with mental illness through the Appleton-based National Alliance on Mental Illness-Fox Valley. Read more!

Provisional ballots could topple mental health levy passage - Middletown (OH) Journal

Provisional ballots could topple mental health levy passage

By Candice Brooks Higgins
Staff Writer

The Butler County Mental Health Board is cautiously optimistic as it waits in suspense to see how 5,149 provisional ballots will determine its funding fate.

Election Day voters approved the board's 1-mill mental health services levy by 1.5 percentage points — 56,291 for and 54,710 against — according to unofficial results from the Butler County Board of Elections. It marked the first time in 21 years and seven ballot attempts that county voters approved a tax increase to support mental health services.

However, the outcome is uncertain. Final election results including the provisional ballots will be released Nov. 28, said Terry Royer, executive director of the mental health board. And, if the final tally is less than one-half of a percentage point, it would require a recount. Those results would not be known until Dec. 8, he said.

"The fact that we are ahead, I couldn't be happier," Royer said. "I'd rather be in this situation than be where we have been so many times in the past."

Board President Laura Amiott said board members are remaining hopeful because the alternative is so bleak.

"The 'Real Needs, Right Now' campaign was really not just a slogan," Amiott said. "It was an accurate representation of the budget situation."

The board, which has slashed services, is faced with a $1.8 million deficit in the current budget. However, the levy would generate $7.5 million annually, compared with $2.2 million annually from the existing 0.5-mill levy.

If the levy passes, the board plans to hire a consultant to evaluate where the money could best be spent, Royer said.
Read more!

L.A. hospital charged with dumping patients - LA Times

By Richard Winton and Cara Mia DiMassa
Times Staff Writers

November 16, 2006

The Los Angeles city attorney's office filed false-imprisonment and dependent-care-endangerment charges against hospital giant Kaiser Permanente on Wednesday, the first criminal prosecution of a medical center accused of "dumping" patients on skid row.

The charges stem from an incident earlier this year when a 63-year-old patient from Kaiser Permanente's Bellflower hospital was videotaped as she left a taxi in gown and socks, and then wandered skid row streets.

In addition to the criminal charges, the city attorney filed a civil lawsuit against Kaiser, using a state law on unfair business practices that city prosecutors usually implement against unscrupulous slumlords to force them to clean up their buildings. The suit seeks a judge's order to forbid all Kaiser medical facilities from dumping homeless patients on skid row or impose financial sanctions if it violates the order.

Kaiser is one of 10 area hospitals under investigation by city prosecutors for allegedly discharging patients to the 50-block area of downtown that is known for missions and homeless encampments. City Atty. Rocky Delgadillo said Wednesday that the Kaiser case was a first step in holding hospitals accountable for dumping.

"We seek to end the inhumane and illegal practice," Delgadillo said. "We believe this is the right action to take and it speaks to this region's values. We are in the right place at the right time to hold Kaiser accountable."

A Kaiser spokeswoman on Wednesday said she was "very surprised" by the charges.

"I can't understand how these charges would be levied based on what I know of the incident," said Diana Bonta, vice president of public affairs for Kaiser Southern California.

She said Kaiser had changed some of its practices since the March incident to better serve discharged homeless patients.

"As soon as we heard about it, we said this is not how we do business," she said. "And we apologized. Since then, we have been talking not only with the city attorney's office, but we've worked with the agencies that service the homeless."

The indictment marks a turning point in the city's yearlong effort to halt the practice by hospitals, as well as some outside law enforcement agencies, of dumping patients and criminals on downtown's troubled skid row.

The push comes as city leaders are trying to crack down on crime and blight in the district, which has the largest concentration of homeless people in the western United States.

The LAPD recently began more aggressive police patrols, and Mayor Antonio Villaraigosa has vowed to find more housing to get transients off the street. In Sacramento, lawmakers earlier this year passed legislation designed to reduce dumping homeless people by requiring all municipalities to devise plans to help their homeless populations.

Legal experts said the Kaiser lawsuit was novel but did have some legal precedent.

"This may be a bit of creative lawyering, but when they first used these kind of tactics against slumlords, it raised eyebrows but worked," said Laurie Levenson, a law professor at Loyola Law School.

"Corporations can be charged with crimes," she said. "In many ways it is better to go after the corporate entity as a prosecutor when it is a matter of policy and practice."

Unfamiliar with skid row

Prosecutors said they decided to file the Kaiser case first in part because they had strong evidence and a compelling victim. Reyes, who was homeless and lived mostly in a public park in Gardena, had never lived on skid row and was unfamiliar with the area, they said.

City officials have been in contact with Reyes since the March incident, when a "dumping cam" at the Union Rescue Mission, installed last year after Los Angeles police began accusing hospitals and police agencies elsewhere of dumping people on skid row, captured Reyes' arrival in the downtown zone. She wandered for about three minutes on busy San Pedro Street and then on the sidewalk before workers at the mission brought her inside.

Reyes, who was interviewed after the incident, said she could not remember what happened after she left the hospital or how she got to skid row.

According to the 20-page court filing, Reyes was brought by ambulance to the Bellflower hospital on March 17. At the time, she was suffering from dementia, living in the park and "regularly collecting and recycling cans and bottles as a way to generate income for herself," court documents said.

Reyes spent three days at the hospital for treatment of facial wounds. The day she was discharged, March 20, hospital staff members wrote on her chart that she was "non-talkative," "forgetful" and "disoriented," according to court documents.

"Despite these findings," prosecutors said, "the Kaiser Bellflower staff made no other efforts to assess or treat her medical condition."

Instead, the documents say, hospital staff "summoned a taxicab and directed the taxi driver to transport Ms. Reyes to skid row, approximately 16 miles away…. [She] was literally rushed out of the hospital and into the taxi even though the hospital staff could not locate her clothes…. [T]hey escorted her to the taxi without any pants, even though Ms. Reyes expressed concern about her clothes."

Court documents allege that Reyes was not told that she was being taken to skid row.

After Reyes arrived at skid row, Union Rescue Mission staff members worked out a special arrangement so that she could remain in the facility during the day rather than check out the next morning and re-apply for a bed later in the day. But three days after her discharge from Bellflower, according to the documents, Reyes "lost consciousness in the bathroom of URM, falling and suffering head trauma."

Jeff Isaacs, head of the city attorney's criminal division, said Reyes was subsequently hospitalized at Los Angeles County-USC Medical Center, where she was diagnosed with pneumonia, anemia and dementia, a progressive brain dysfunction, and remained in the hospital for at least 45 days. A guardian has been appointed to protect her interests, Isaacs said.

Reyes also is being represented by the American Civil Liberties Union of Southern California and Public Counsel. Representatives from both organizations said Wednesday that they planned to file a second lawsuit on Reyes' behalf soon.

"This is the first case in the nation where there is a joint effort by government and civil rights groups to halt the practice of hospital dumping," said Mark Rosenbaum, the ACLU's legal director.

Rosenbaum said that meetings with Kaiser and hospitals failed to yield reform — and that was part of the reason for the court filings. "It is like they lit a match to the Hippocratic oath," he said.

Dan Grunfeld, president and chief executive officer of Public Counsel, the largest pro-bono legal firm in the nation, echoed that sentiment. "This is as stark a case as you are likely to find," he said. "You have a relatively older woman in adult diapers and gown dumped on a skid row sidewalk. That is a pretty profound statement. Ms Reyes is not alone. There are a lot of Ms. Reyes' out there. We hope to achieve a systemic change."

Several hospitals accused

The LAPD has accused several hospitals of dumping patients on skid row over the last year and a half, including Kaiser's West Los Angeles hospital, Martin Luther King Jr./Drew Medical Center and Los Angeles Metropolitan Medical Center. Officials at those hospitals have denied dumping patients, though some have said they had taken homeless patients to skid row service providers.

City prosecutors said they spent months examining more than 40 allegations that hospitals had dropped patients on skid row after discharge, often against the patient's wishes. The investigation yielded 15 potential cases, they said.

The cases included a man with a foot wound who was dropped on skid row by a taxi after being discharged from a Covina area hospital and a man left outside the Union Rescue Mission last year with a head gash.

If convicted, Kaiser Permanente would be placed on probation that would limit its behavior and contain potential penalties. Any criminal finding could influence a medical facility's bonding and its ratings by medical organizations.

Kaiser's Bonta said the hospital group was committed to treating homeless patients with respect and care. After the Reyes case, Kaiser stopped using taxis to transport patients to skid row. It now uses a van service. Hospital officials are instructed to notify skid row providers in advance if they are sending a discharged patient there. Moreover, the van driver is supposed to escort the patient inside the facility and ensure that a handoff occurs, she said.

"These issues with the homeless are difficult and complex," Bonta said. "It takes all of us working together to find the best way to ensure that care is rendered through this process."
Read more!

Speaker promotes idea of mental health extension network--The News-Gazette (IL)

By Debra Pressey
Thursday, November 16, 2006 7:37 AM CST

CHAMPAIGN – Psychologist Dale Johnson has seen how American agriculture has benefited from a network of extension agents who teach farmers how to do a better job growing crops and raising livestock.

So why not try the same approach to help fix the nation's ailing mental health system, he proposes.

In other words, train a core group of people to go out and train community mental health staffs, based on the agricultural extension model.

"I'd like to have mental health agents go out and do the same thing," he added.

Johnson, a retired professor of psychology at the University of Houston and former president of the National Alliance on Mental Illness, spoke to the Champaign County Mental Health Board on Wednesday.

In an interview earlier, he said the nation's mental health system is fragmented and, in most places, ineffective.

In fact, the National Alliance on Mental Illness – a support organization for people with serious mental illness such as bipolar disorder and schizophrenia – gave Illinois a failing grade for its public mental health system when it issued state report cards earlier this year.

"One reason it's not working is there simply are not enough facilities to handle all the needs," Johnson said. "We find that about one-third of people who are homeless have some kind of psychiatric disorder, and that number is probably low if you include alcoholism and drug abuse."

Another factor is budget cuts that deprive treatment facilities of staff trained to work with people with serious mental illnesses, Johnson said.

Johnson proposes four reforms, among them creating a federally funded, state-administered cooperative extension system for mental health training.

He also proposed establishing a system of sheltered workshops to create occupations for people with serious mental illnesses.

"I'm appalled by the number of people with schizophrenia who spend all day doing nothing," he said. "They sit all day in facilities. They're not bored by the nature of the illness. If you talk to people, they'd rather be doing something."

Johnson said he has observed people with serious mental illnesses working productively in Japan and, he proposes, "the same thing could work here."

Still another reform he suggests would take a cue from the United Kingdom, where community mental health centers assess family caretakers of people with serious mental illnesses and offer them help through training centers, Johnson said.

Families in the United States have "close to zero" preparation and training in communication, stress management, problem solving and other factors related to caring for a mentally ill person, he said.

Johnson also advocates the use of evidence-based practices – those that have been tested and proven effective – in the treatment of serious mental illnesses.

Evidence-based practices are commonly used on patients with physical illnesses, such as breast cancer or prostate cancer, he said, but the mental health field has been slow to adopt this approach, "maybe because so much mental health treatment has been developed apart from science."

Peter Tracy, executive director of the Champaign County Mental Health Board, said Johnson was invited to a board study session as an educational opportunity for board members.

The local board's primary emphasis has been on services for children and those with less serious mental health impairments, while serious and persistent mental illnesses have been handled by the state. But the local board is looking at possibilities to augment what the state provides for those with more serious mental illnesses, he said.
Read more!

Execution would be a stain on NC justice - Raleigh News & Observer

Cruel treatment (Editorial)

Guy LeGrande committed a horrible crime 13 years ago when he agreed to kill another man's wife. Strong evidence exists that the murder was a symptom of LeGrande's psychosis. There is evidence, too, that North Carolina's justice system gave him the rope it is using, figuratively speaking, to hang him.

Instead of receiving treatment for his illness, LeGrande is scheduled to die by lethal injection on Dec. 1 at Central Prison in Raleigh.

This execution would leave a stain on North Carolina justice, a stain that Governor Easley can still prevent. He should use his power of clemency to commute LeGrande's sentence to life in prison and order the psychiatric treatment he needs.

Here are the pertinent facts of LeGrande's case: In 1993, LeGrande was working at a restaurant in the town of Albemarle, east of Charlotte.

A co-worker named Tommy Munford recruited LeGrande to kill his estranged wife, Ellen, and not only provided the gun but gave his recruit a ride to the crime scene.

Then Munford left town to create an alibi. After waiting several hours, LeGrande went inside and shot Ellen Munford twice in the back.

It was a tragedy that left two children without a mother and, after the plot was discovered, a father as well. Munford turned state's evidence and entered a guilty plea that sent him to prison for life.

Consistent with his history of delusions, LeGrande insisted on being his own lawyer. He persisted despite a state psychiatrist's diagnosis of personality disorder and prescription for lithium, which he refused.

Nevertheless, the court accepted the recommendation of a state psychologist, finding LeGrande competent to stand trial and represent himself. How a restaurant worker could protect his own interests in a capital murder case defies imagination.

In reality, LeGrande taunted jurors in outrageous outbursts and essentially became a witness for the prosecution. When the jury sentenced him to die, to the surprise of few, it was clear the system had failed LeGrande.

As The N&O's Andrea Weigl reported, LeGrande's case is part of a national quandary about applying capital punishment to people with serious mental illnesses. Meanwhile, the death penalty is being applied to the mentally ill leniently in one state, strictly in another.

Unabomber Ted Kaczynski, for example, behaved in court as obnoxiously as LeGrande did, calling psychiatrists who diagnosed his schizophrenia "the enemy" and demanding to represent himself.

When the judge rejected Kaczynski's demand, he entered a guilty plea. That way, Kaczynski avoided the death penalty even though he was responsible for three deaths and many serious injuries during his 17-year terror spree.

The Unabomber's choice also spared California the hideous spectacle of executing a mentally ill man. In Guy LeGrande's case, it's up to Governor Easley to choose mercy on behalf of all North Carolinians. Until the courts outlaw capital punishment for the mentally ill, mercy is the best choice. Read more!

Mother of murder victim: Condemned man seemed competent at trial - Raleigh News & Observer

By ESTES THOMPSON,, Associated Press Writer

The mother of a woman murdered 13 years ago said Tuesday her daughter's killer was "a pro" and shouldn't be spared from execution because of defense claims he was mentally incompetent to defend himself in court.

"I was at the whole trial," said Gayzelle Simpson of Albemarle, Ellen Munford's mother. "I think he's totally competent."

Simpson was in Raleigh on Tuesday to meet with aides for Gov. Mike Easley while Easley discussed the case of 47-year-old Guy T. LeGrande with defense lawyers and prosecutors. LeGrande is scheduled to be executed at 2 a.m. Dec. 1 at Central Prison in Raleigh. His lawyers have asked Easley to reduce his sentence to life in prison.

Prosecutors say LeGrande shot Munford twice in the back July 23, 1993, expecting to get $6,500 in insurance money from her estranged husband. He was sentenced to death in 1996 after rejecting help from his court-appointed lawyers and deciding to represent himself.

"He knew exactly what he was doing when he killed her and he took a part of my heart when he killed her that nobody will ever replace," Simpson said with a trembling voice. "He is a pro."

Defense attorneys said they plan to challenge LeGrande's competence in Stanly County Superior Court based on a new mental health review that they say shows he is psychotic.

LeGrande has met briefly with one of his defense lawyers and psychiatrists have been limited to his medical record and court transcripts to analyze his behavior. During a recent hearing, LeGrande wouldn't talk to his court-appointed defense attorney.

District Attorney Michael Parker, who didn't handle the murder trial but has been in court with LeGrande, said the defendant appeared to understand what was going on during a discovery hearing where prosecutors shared files with the defense.

"He didn't act out of the way. He looked at documents that were given to him and he acted like any normal individual," Parker said after meeting with Easley. "Guy LeGrande is a manipulator. He plays to the audience that is listening."

Parker said a psychiatrist found LeGrande was anti-social and narcissistic, yet competent.

Parker said LeGrande waited in woods near the victim's house for the right time to kill her, but could have walked away.

Defense lawyer Jim Coleman, a law professor at Duke University, said the defense revolves around racism and mental illness.

The prosecutor at the time, former District Attorney Ken Honeycutt, wore noose-shaped lapel pins, said Coleman, pointing to the racist undertone of lynching associated with the display.

There were no black jury members and the state chapter of the National Association for the Advancement of Colored People has protested the death sentence.

The North Carolina State Bar has filed claims to reinstate a misconduct case against Honeycutt and an assistant, contending they hid deals with a witness in another murder case. The prosecutors denied the claims, but the defendant received a new trial.

Coleman said LeGrande's case is well-suited for clemency.

"We're not saying the governor shouldn't execute him because he is mentally ill," Coleman said. "His mental illness caused him to prevent the court from examining the issue. The Supreme Court has made it clear you can't execute a person who is incompetent."

The defense presentation to the governor included sections from a letter LeGrande sent the prosecutors, which he signed "Lucifer."

"Try the case yourself if you dare. In the courtroom, sir, before a jury I will bring you to your knees and make you proclaim me Lord and Master." Read more!

Care of disabled adults in Alabama often left in parents' hands - Birmingham News

MARIE LEECH

BIRMINGHAM, Ala. - Sheila Vardaman is facing a decision she thinks no mother should have to make. Her daughter, Casey O'Brien, turns 21 next year. For most parents, that milestone means their children are approaching independence - they can have a legal drink for the first time, finish college or move out of the house.

For Vardaman, it may mean sending away a daughter who can never be independent. O'Brien attends the Linda Nolen Learning Center in Alabaster, a school for students with severe mental disabilities. Federal law requires public school systems to care for disabled students until they're 21. Then, the state is supposed to provide services under the Medicaid Act.

But fewer than one-third of the people in Alabama who need the services are actually getting them, said Karen Stokes, executive director of the Shelby County ARC.

"They're just kind of dropped after 21, and nobody else picks them up," Vardaman said. "My options are to look at the possibility of a private residential facility, but I don't want to do that. I feel as a parent I should have more options."

So do almost 1,600 people on the waiting list for services with the Alabama Department of Mental Health-Mental Retardation. Federal law requires the state to provide residential services, or group homes, day services and in-home support services for those who need them. Some have been on the waiting list so long that they filed a lawsuit in the U.S. District Court against the state department and the governor's office, arguing that the state is violating the Medicaid Act by not having enough services available.

The lawsuit started with five people in Jefferson County and has since grown to 30 plaintiffs, said James Tucker, a lawyer with the Alabama Disabilities Advocacy Program.

The lawsuit was filed in 2000 and tentatively settled, but the settlement was rejected by Gov. Bob Riley and Attorney General Troy King, who contended that the residents had no legal standing to sue the state for services.

Two years ago the suit was reassigned to a new judge, who rejected that argument and promised to move rapidly on the case, Tucker said.

"Six years is a long time in the eyes of these families," he said. "It's appalling." Vardaman put her daughter's name on the state's waiting list two years ago and has little hope the lawsuit will be settled before O'Brien graduates next May. The thought horrifies her.

Vardaman can't afford to quit her job as a special education teacher at the Linda Nolen Learning Center to stay home with O'Brien, she said.

On the other hand, she doesn't want to see her go into an assisted living facility, either.

"I love Casey, and I've had her for 20 years now. It would be hard to let her go," Vardaman said. "But I have bills to pay. If I quit my job, Casey and I would live in poverty."

O'Brien lacks all basic functions and skills needed in life. She can't eat on her own and all foods must be pureed - she wears a diaper, can't stand or walk and must be bathed.

"It's a full-time job, and it's mentally and physically exhausting," Vardaman said. "The best thing for Casey would be for someone to come to our house and watch her. She needs a day program."

Fordyce Mitchel is director of mental retardation community programs for the Alabama Department of Mental Health and Mental Retardation, which is a defendant in the lawsuit.

Mitchel said he understands the families' frustration.

"There's a huge unmet need in this state," he said. "We served 42 people last month, but on average, we have 30 to 40 applications a month."

As a result, the list doesn't get any shorter, he said.

"We're delighted when we can serve somebody, but we have to have the resources to do that," Mitchel said.

Stokes said fewer than 6,000 people in the state are receiving services, while more than 12,000 are eligible but are not receiving them.

"Some people just give up and don't even bother getting on the waiting list," she said. "The waiting list is based on criticality, so if a family situation is stable, they may never move up on the waiting list, and that's frustrating for a lot of parents."

Medicaid provides money to furnish services for the mentally disabled when they leave public school, Stokes said.

"It's a lack of matching dollars from the state that's missing," she said. "People get services when there's a federal lawsuit; the state seems to find money when that happens."

Since the lawsuit has been reassigned to a new judge, Stokes and others remain hopeful.

"For a lot of years, it's been frustrating," she said. "There are limited options, and it's very sad sometimes."

What happens in most cases is the disabled child graduates from school and is then forced to stay at home with parents or other family members, most of whom aren't trained to teach him any skills, said Bill Hoehle, executive director of Jefferson County ARC.

"They basically come out of school, where they learn all these skills, and then lose them because they are no longer being taught," he said.

Grace Smith, 62, of Adamsville had her sister on the state's list for almost a year before receiving services - after her sister's case became critical. Her sister has Down syndrome, and Smith has taken care of her for 30 years.

But when her sister was diagnosed with Alzheimer's disease, it got too much for a 62-year-old to handle, she said.

"Most people are on the list much longer," Smith said. "A lot of people don't move up until a parent dies because the state doesn't consider them critical enough. But I couldn't get her into a bathtub anymore. She couldn't go to the bathroom. It was just getting too much for me to handle."

Smith's sister is now in an assisted living home in Blount County.

"There's simply not enough services out there," she said. "I just wish the state would get off their duffs and settle this lawsuit." Read more!

Officials clash over mentally ill in Florida jails - NY Times

By ABBY GOODNOUGH

MIAMI, Nov. 14 — For years, circuit judges here have ordered state officials to obey Florida law and promptly transfer severely mentally ill inmates from jails to state hospitals. But with few hospital beds available, Gov. Jeb Bush’s administration began flouting those court orders in August.

Now, in a growing standoff between the government of Florida and its judges, the state is being threatened with steep daily fines if it does not comply. And at least one judge has raised the possibility that the secretary of the Florida Department of Children and Families could go to jail for contempt of court.

“This type of arrogant activity cannot be tolerated in an orderly society,” Judge Crockett Farnell of Pinellas-Pasco Circuit Court wrote in an Oct. 11 ruling.

State law requires that inmates found incompetent to stand trial be moved from county jails to psychiatric hospitals within 15 days of the state’s receiving the commitment orders. Florida has broken that law for years, provoking some public defenders to seek court orders forcing swift compliance.

With the state now rebuffing even those orders, a rising number of mentally ill inmates, now more than 300, have been left without treatment in crowded jails because the state’s 1,416 psychiatric beds are full.

Two mentally ill inmates in the Escambia County Jail in Pensacola died over the last year and a half after being subdued by guards, according to news reports. And in the Pinellas County Jail in Clearwater, a schizophrenic inmate gouged out his eye after waiting weeks for a hospital bed, his lawyer said.

Public defenders in Miami-Dade County describe psychotic clients who have hallucinated, mutilated themselves and attempted suicide while awaiting transfer to hospitals. The state says that shortages of beds and financing have made compliance impossible, and that court orders forcing the transfer of certain inmates are unfair to those who have waited longer.

Most judges have responded skeptically, asking why the Department of Children and Families has not sought more state money as the number of committed inmates has soared. The agency cut its budget by $53 million this year, which public defenders say makes no sense given the inmate crisis and the state’s $8 billion budget surplus.

In one of the toughest rulings to date on the subject, Judge Farnell said last month that he would start fining the department $1,000 a day for each mentally ill inmate who stayed in the Pinellas County Jail longer than 15 days. The judge, based in Clearwater, expressed outrage about the agency’s “conscious decision” to ignore court orders.

Judges in Broward, Hillsborough and Miami-Dade Counties are also weighing motions to force the department to comply with the law or to hold it in contempt for letting the mentally ill pile up in unsuitable jails. The department appealed after three state judges in Miami ordered it to take custody of several inmates last month, but a panel of the Third District Court of Appeal indicated last week that it might rule against the department and its secretary, Lucy D. Hadi.

“It strikes me that ultimately you’ve got contempt issues,” Judge Frank A. Shepherd said during oral arguments, “and Ms. Hadi may be going to jail.”

The problem is not unique to Florida, although it is especially severe in Miami-Dade County, which has one of the nation’s largest percentages of mentally ill residents, according to the National Alliance for the Mentally Ill, an advocacy group.

A Justice Department study released in September found that 64 percent of inmates in county jails around the nation reported mental health problems within the last year. Many are arrested for petty crimes, advocates say, yet remain in jail an inordinately long time because there is nowhere else for them to go.

Only 40,000 beds remain in state psychiatric hospitals around the nation, down from 69,000 in 1995. Advocates for the mentally ill say that community-based treatment programs, which were supposed to replace psychiatric hospitals after the deinstitutionalization movement of the ’60s and ’70s, have not begun to make up for the loss.

Long waits for beds are especially common in the nation’s urban areas. Last week, 307 mentally ill inmates were waiting for one of Florida’s 1,416 psychiatric beds, and 72 percent had waited longer than 15 days. The state has three psychiatric hospitals with secure beds.

“This is a national problem, and it’s a direct reflection of the lack of adequate beds and coordination between the criminal justice and mental health systems,” said Ronald S. Honberg, legal director of the National Alliance for the Mentally Ill.

In Miami, an average of 25 to 40 acutely psychotic people live in a unit of the main county jail that a lawyer for Human Rights Watch, Jennifer Daskal, described as squalid after visiting last month. Seventeen such inmates are currently waiting for state hospital beds, said Valerie Jonas, a county public defender, adding that the number has been as high as 30 in recent weeks.

Ms. Daskal said that some of the unit’s 14 “suicide cells” — dim, bare and designed for one inmate — were holding two or three at a time, and that the inmates were kept in their cells 24 hours a day except to shower. None of the mentally ill inmates receive group or individual therapy, she said in an affidavit.

Officials with the Department of Children and Families have argued that the agency cannot be held in contempt when it simply has no more beds, and that it could not have anticipated this year’s sharp rise in commitments. In June 2005, they said, only 125 inmates were waiting for hospital beds, of which 38 percent had waited longer than 15 days.

“We are at the moment on a daily basis trying to find a short-term solution to the bed shortage,” said Al Zimmerman, a spokesman for the department. “We are trying to find ways to pay for additional space, pay for additional beds.”

The department requested and received money for about two dozen new secure beds this year, and it has asked for 38 next year. Each bed costs $100,000 a year, Mr. Zimmerman said.

Ms. Jonas, the public defender, said it was unconscionable that the department would not ask for more. “Given they’ve got a wait list of over 300 and they’re running all over the state claiming inability to comply,” she said, “where do they get off requesting only 38 new beds?”

Yet Mr. Honberg said that putting more mentally ill inmates in state hospitals should not be the ultimate goal. The treatment they get there often skims the surface, he said, and many end up deteriorating when they return to jail, only to end up on the wait list for a hospital bed again.

“You have large numbers of people sent to state hospitals not for therapeutic purposes, but for purposes of making them competent to proceed to trial,” Mr. Honberg said. “We’re not going to solve these problems until we invest adequate resources into services that work for people before they get to jail.” Read more!

Judge Says Inmate Death Was ‘Torture’ - NY Times

By LIBBY SANDER
Published: November 15, 2006

CHICAGO, Nov. 14 — Shackled to a concrete slab, Timothy Joe Souders spent the final days of his life naked and lying in his own urine, sweating through temperatures over 100 degrees in an isolated prison cell.

Mr. Souders, a 21-year-old with a history of severe mental illness, died Aug. 6 after spending four days in a segregation cell at the Southern Michigan Correctional Facility in Jackson. His death prompted state prison officials to revise their restraint policies for unruly prisoners, limiting the use of “top of the bed” restraints to a maximum of six hours.

But this week, a federal judge in Kalamazoo said those revisions were not sufficient. Scolding corrections officials for failing to provide adequate treatment to mentally ill inmates, the judge said on Monday that the conditions leading to Mr. Souders’s death constituted “torture.”

“You are not coat racks who collect government paychecks while your work is taken to the sexton for burial,” wrote Richard A. Enslen, a senior federal district judge. “If a patient does not receive necessary medical or psychological services, including medicines and specialty care, it is not his problem, it is your problem.”

Medical experts cited in Monday’s ruling have speculated that Mr. Souders died of dehydration, though an autopsy report has not been completed.

Judge Enslen ordered an immediate ban on punitive restraints in three Jackson prison facilities holding roughly 4,500 inmates. The court has been monitoring those facilities as part of a 1985 consent decree.

Russell L. Marlan, a spokesman for the Michigan Department of Corrections, said the department disagreed with the ruling and planned to appeal. Top of the bed restraints, he said, are “nationally accepted, effective practices in correctional populations. We think the changes we’ve made in regard to these restraints are what is necessary.”

Mr. Souders, who suffered from depression and psychosis and had previously tried to hang himself at a county jail, was serving a sentence for shoplifting, said Paul W. Broschay, who is representing Mr. Souders’s estate in a federal wrongful death lawsuit against the Department of Corrections. At the time of his death, he was taking at least six medications for mental disorders.

On July 31, Mr. Souders was transferred to the segregated cell for disobeying orders. Three days later, after slipping out of soft restraints, Mr. Souders was restrained atop the concrete bed slab. Though Mr. Souders had been scheduled for a transfer to a mental health facility after a social worker found him “floridly psychotic,” the transfer never happened, and on Aug. 6, he was pronounced dead. A court-appointed doctor visiting the prison on Aug. 7 learned of Mr. Souders’s death. The doctor, Robert L. Cohen, wrote in an Aug. 14 letter to Judge Enslen: “No psychiatrist was consulted. No emergency psychiatric evaluation was obtained.” He concluded that Mr. Souders’s death “was predictable and preventable.”

Monday’s ruling is believed to be the first ban on punitive restraints in state prisons, said Elizabeth Alexander, director of the National Prison Project of the American Civil Liberties Union.

“This really is a precedent-setting decision,” Ms. Alexander said. Read more!

New look at anti-depressant/suicide risk

By AARON RUPAR
UPI Correspondent

WASHINGTON, Nov. 14 (UPI) -- The National Institute of Mental Health is funding a variety of new research projects that hope to shed light on the possible link between a particular type of anti-depressant medication and suicidality.

"This study is really a combination of studies looking at kids, adults and the elderly. It would be very helpful if we could learn more about the sets of subgroups that are at risk for this problem," said Dr. Jane Pearson, acting deputy director of the Division of Services and Intervention Research at the NIMH.

The particular anti-depressants the research will focus on are known as selective serotonin reuptake inhibitors (SSRIs). Common SSRI medications include Paxil, Luvox, Zoloft, Serzone and Prozac.

The Food and Drug Administration adopted a "black box" warning -- the most serious type of warning in prescription-drug labeling -- for all SSRIs last year. The notice alerts doctors and patients of the potential for SSRIs to prompt suicidal thinking in children and adolescents, and urges diligent monitoring of individuals of all ages taking the medication.

However, monitoring those who are prescribed anti-depressants for suicidality is confounded by uncertainty as to whether suicidal symptoms are due to the depression, the medication, or both.

"These new, multi-year projects will clarify the connection between SSRI use and suicidality," said NIMH Director Dr. Thomas Insel. "They will help determine why and how SSRIs may trigger suicidal thinking and behavior in some people but not others, and may lead to new tools that will help us screen for those who are most vulnerable."

Despite the FDA's black-box warning, there is considerable uncertainty as to whether or not SSRIs or any other anti-depressants actually increase the risk of suicidality. For instance, a 2003 study concluded that "findings fail to support either an overall difference in suicide risk between antidepressant and placebo treated depressed subjects in controlled trials or a difference between SSRIs and either other types of antidepressants or placebo."

Conversely, a 2004 data review by an FDA medical reviewer found that children who took anti-depressants had 1.78 times the risk of making a suicide attempt or "making preparatory actions towards imminent suicidal behavior." In addition, in 2005 the FDA released a Public Health Advisory that warned that "several recent scientific publications suggest the possibility of an increased risk for suicidal behavior in adults who are being treated with antidepressant medications."

Dr. Kelly Kelleher, who is authoring one of the five new studies being funded by the NIMH, traces the uncertainty about the possible link between SSRIs and suicidality to the limited knowledge about how exactly SSRIs work. "The actual mechanism is poorly understood -- if we knew the mechanism, we would know how it causes these side-effects," he said. "Brain research on young children in particular needs to be conducted."

According to Kelleher, the FDA's black-box warning has had a profound effect on how doctors prescribe anti-depressants. "During the '90s, antidepressants became a staple of many pediatric practices. The black box warning hit pediatricians and family physicians right in the gut," he said.

"Use of antidepressants had skyrocketed until the black-box warning came out. Since then, the prescription growth rate has gone down."

Kelleher noted that "there are many competing hypotheses" that attempt to explain why SSRIs might increase suicidality. One possibility is that particular drugs may simply induce agitation. Another possibility is that there is an inherent link between the beginning of treatment for depression and an increase in suicidal thoughts and actions. In any case, understanding the possible connection "will require many different types of studies being combined together," Kelleher said.

Also unclear is why the possible link between suicidality and anti-depressants is more prominent in children. "These associations (between anti-depressants and suicidality) might change over the lifespan," Kelleher said. "There are people who have drawn associations from randomized trials that show that children might have increased suicidality when they take certain antidepressants. But which children, which drugs, and what disorders might they have?"

While the difference between reactions to anti-depressants in children and adults may ultimately be traced to differences in the brain, it is also possible that the difference is simply maturational. "We often act as if children are little adults but they are different -- they are more impulsive and more likely to verbalize things than adults," Kelleher said. If children have suicidal thoughts they might be more willing to verbalize them than adults. Read more!

Comedic Postscripts From the Edge - NY Times

An ironic look at the life of Carrie Fisher, including her travels through addiction and struggle with mental illness.

By SHARON WAXMAN
BEVERLY HILLS, Calif., Nov. 14 — There is a canvas sign hanging over Princess Leia’s parking lot that reads, “May the Life Force Be With You.”

Carrie Fisher’s house gets only more curious from there. To the left of the lot, up a long driveway, a small bungalow is home to Ms. Fisher’s mother, Debbie Reynolds. Steps lead to the main house, a low-slung ranch where Bette Davis once lived. Now it belongs to Ms. Fisher, at 50 a Hollywood survivor and, as ever, a witty chronicler of its many pitfalls.

Inside is Ms. Fisher, clutching an ever-present Coke and a pack of American Spirit cigarettes. She strides past the stuffed moose head in her living room and the stained-glass panel of her daughter, Billie, 14, out to the terrace, which is filled with more collectibles. (A Howdy Doody head in a gilt display case, for example.)

It is not yet two years since Ms. Fisher found the body of her friend R. Gregory Stevens, a 42-year-old Republican operative, in her bedroom, an event that shook her to the core. His death was declared an overdose, but Ms. Fisher attributes it to sleep apnea and a surfeit of sleeping pills.

For Ms. Fisher, who has long struggled with drug addiction and a bipolar disorder, the sudden death at close range sent her into a post-traumatic spiral of shock and renewed drug use. Her hair turned white. Nothing was funny for months. But she finally climbed back toward stability, and work. Now, many years after her mother urged her to go onstage, Dear, and sing, she is finally doing so, in “Wishful Drinking,” a one-woman show that opens on Wednesday and runs through Dec. 23 at the Geffen Playhouse in Los Angeles.

This ironic look at her life gives no more than a nod to her friend’s recent death, but includes a survey of her often bizarre childhood as the daughter of Ms. Reynolds and the singer Eddie Fisher, details about her brief marriage to Paul Simon and her travels through addiction and struggle with mental illness. There’s some juicy stuff about making out with the actor Harrison Ford and her relationship with a man who later declared himself gay (Billie’s father, the agent Bryan Lourd).

In the show she sums all this up in the painfully deadpan observation: “If my life weren’t funny, it would just be true. And that would be unacceptable.”

Of course, Ms. Fisher has long been a gifted observer of her own life, which many already know well from her roman à clef, “Postcards From the Edge.” She followed that by writing a hilarious movie based on the book, with Meryl Streep as the Fisher character and Shirley MacLaine as the mother.

Now, a day after one of her previews, Ms. Fisher is dressed in black pants, black T-shirt, black jacket, black shoes and, lounging in a rattan armchair, already imagining the critical response. “I know I’m going to get reviews saying, ‘Someone tell her to shut up about her stuff,’ ” she said, her voice deep with cigarettes. “Not only do you know everything about me — it’s like, ‘Enough already’ too.”

Ms. Fisher got the idea for the play after seeing a number of other solo comic monologues — like ones by Julia Sweeney and John Leguizamo — and realizing she had a wealth of good material from countless gigs she had introducing the “Star Wars” creator George Lucas for a never-ending parade of awards.

“I’d host the evening, and end up roasting George: ‘Now I’m going to introduce someone who knows George better than anyone, except for a couple of hookers from Hong Kong. But they couldn’t be here because they’re busy at another benefit, for Mel Gibson,’ ” she recalled. But since those gigs never paid, she thought she might try to put together her patter in a show. “I’d never done anything like this, and I was raised to do a nightclub act,” she continued.

As a naturally rebellious child, she refused anything of the kind, until now. She said she hoped this show would be something on the model of a Spalding Gray monologue.

She has an unusual ability to regard her privileged youth and Hollywood fame with a writer’s detachment and a native skepticism. Her life certainly provides plenty of material. With time, her perspective has shifted to a more forgiving tone toward herself and the entertainment ecosystem she knows so well.

“I learned early on that it was a unique position to be in, one that I hadn’t earned,” she said, explaining her often caustic attitude. “It was an accident of birth.” She recalled being surprised by a video of herself, assembled this year for her 50th birthday, which showed her silent and perplexed-looking as a young child, very unlike the overexuberant teenager she became after puberty struck.

“I’m literally doing a show based on being an outsider looking in,” she said. “I’m a spy in the house of me.”

The times weren’t so jolly. When she was 2, her father left her mother for Elizabeth Taylor. Her mother married a shoe magnate, Harry Karl, who lost his fortune, and then his wife’s.

“By the time I was 15, all the money was gone; I’ve never had the sense that money stays,” Ms. Fisher said. “And I always had a sense of shame. I grew up on the back side of show business. So I had no desire to go into it. It had beat up my mother. I had a front-and-center view of how that hurt her. I understood that when they were done with you, they were done.”

While still a teenager, Ms. Fisher had a fleeting role in “Shampoo,” and then, after auditioning as a lark, landed the part that has permanently knit her into the cultural fabric: Princess Leia in “Star Wars.” In her new show she mocks her inability to separate from that role of nearly 30 years ago, and closes with familiar dialogue that she can’t seem to shake.

Now single, rearing a teenager, Ms. Fisher can admit that contentment is less elusive than it once was. “I was born into everything; I had everything,” she said. “But I could never feel my life. So much of it is good, and I can’t feel it. It’s over there.”

Does she still feel that way? “Not all the time,” she said. “I’m still transfixed at looking at how things are, and not how they ought to be.”

“I am happy,” she adds. “Among other things.”

Read more!

More mental health money?-Winston-Salem Journal

Officials present suggestions on ways to add $500 million

By M. Paul Jackson
JOURNAL REPORTER

State legislators are examining ways to add more than $500 million to mental-health services in North Carolina - including asking some counties to pay more for those services.

Officials from the N.C. Department of Health presented a preliminary report on how to pay for the additional services to the Joint Legislative Oversight Committee on Mental Health, Developmental Disabilities and Substance Abuse Services in Raleigh yesterday.

State officials and mental-health advocates are trying to find ways to properly allocate money to the state's troubled mental-health system.

State health officials submitted a report to the committee last month recommending that the state add more than $500 million over the next five years to improve mental-health services.

"For a variety of reasons, our money is not allocated in a way that makes much intuitive sense," said Leza Wainwright, the deputy director of the N.C. Division of Mental Health, Developmental Disabilities and Substance Abuse Services.

The General Assembly allocated about $80 million in additional money for mental health earlier this year.

Mental-health advocates, legislators, residents and officials, including Mike Moseley, the director of the N.C. Division of Mental Health, attended the committee meeting.

According to the plan - which has not been completed - the additional money could come from Medicaid, block grants from the state, and payments from county governments.

Many counties allocate money to the local agency that oversees that county's mental-health services.

The money is used to provide services, but there is no required minimum financing level for each county.

Forsyth County allocates more than $7 million annually to CenterPoint Human Services in Winston-Salem for mental-health services, for example.

The proposed plan would not mandate minimum financing levels for each county, but would instead be based on a county's ability to pay for those services, Wainwright said.

North Carolina is still struggling to repair its fragile mental-health system.

The Winston-Salem Journal published a series of articles last year showing how the state's 2001 plan to shift care from mental hospitals to local agencies was based on incorrect assumptions about government payments for mental-health services.

Since the 2001 overhaul, some community agencies have been unable to effectively provide care.

HopeRidge Centers for Behavioral Health, a mental-health agency in Winston-Salem, shut down last year, and New Vistas-Mountain Laurel, a mental-health agency in Asheville, announced in September that it would stop operations because it could no longer afford to provide services.

That agency stopped operating in October.

State consultants and health officials will present the legislative oversight committee with a completed report on how to pay for the additional services at the committee's meeting next month.

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

County requests audit of $464,000 compensation - The Daily Advance

By BOB MONTGOMERY
Staff Writer
Published November 11, 2006

State Auditor Leslie Merritt will consider Pasquotank County's request for a performance audit of Albemarle Mental Health Center's business operations as part of his investigation into how mental health care is being delivered throughout North Carolina, a spokesman said Thursday.

But, spokesman Chris Mears said Merritt could deliver no assurances that a specific audit would be performed on AMHC.

Pasquotank's request seeks to determine why AMHC's program director, Charles Franklin, is earning a total compensation package of up to $474,000 a year.

"This really does fold into our examination of the way that mental health is delivered in North Carolina," Mears said. "That (a performance audit of AMHC) will figure into it if it's necessary. We want to let the facts define the scope of the audit and what we focus on."

Pasquotank County Commissioners voted 4-3 three weeks ago to request a performance audit to answer "questions ... about the business practices of Albemarle Mental Health Center," according to a letter sent to Merritt Tuesday by County Manager Randy Keaton.

Specifically, Pasquotank wants Merritt to examine "the amount of salaries paid to (AMHC) employees, the re-employment of former employees as contractors, the use of rental income, and the expenses of board conferences," Keaton's letter states.

Commissioners who voted for a performance audit were Hank Krebs, Lloyd Griffin, Bill Trueblood and Marshall Stevenson.

Voting against it were Jeff Dixon, Matt Wood and Cecil Perry, the board's representative on the AMHC board of directors.

The key issue is over Franklin's compensation package of between $318,000 and $474,000 a year.

Another focus is spending by AMHC board members for "retreats," as Krebs and Griffin described, to places like Southern Pines and Myrtle Beach.

But at Perry's request, Keaton's letter changed the word "retreats" to "conferences."

Commissioners also want to know why Franklin was getting more than $12,000 a month in retirement benefits while still performing the same job — even if he was hired after retiring through his own consulting firm.

The State Treasurer's Office in July ordered Franklin to repay the state $157,000 in retirement benefits. Franklin has since appealed, according to John Morrison, the AMHC board's attorney.

Morrison said the AMHC board welcomes a state performance audit and pledges full support.

"Salaries are high by design, by board policy," Morrison said. "It cuts down on training, which is a great expense, and can be therapeutically disadvantageous to patients. We have the lowest turnover rate of any mental health care provider in the state."

He also defended board members attending conferences that are also attended by other mental health care providers.

"I don't know of any retreats," Morrison said. "I know the board members routinely attend statewide conferences" to receive "information on finances of mental health" and "staff educational programs."

Merritt's investigation stems from two performance audit requests received in the past three weeks — one from Pasquotank County Commissioners, and one from state Sen. Tom Apodaca, R-Hendersonville, who wants to know what forced the recent closing of western Carolina's largest mental health care provider, New Vistas-Mountain Laurel. Read more!

Public beliefs on schizophrenia and depression causes differ - Psychiatry Research Journal

The general public believes that psychosocial causes are the most important factors for depression whereas biological causes underlie schizophrenia, study findings show.

"Knowing about the lay public's causal beliefs about mental diseases is a prerequisite for providing adequate information and education to both patients and the public," observe Georg Schomerus and colleagues from Leipzig University in Germany.

To investigate what the general population perceives to be the underlying causes of depression and schizophrenia, the team interviewed 5025 people. During the interview, the participants were presented with a vignette containing a diagnostically unlabeled psychiatric case history, which described either schizophrenia or major depressive disorder.

Individuals were asked to indicate how they would label the psychiatric problem and to identify the causes from 18 possibilities. Finally, the participants had to rate the perceived relevance of the causes.

For schizophrenia, brain disease was the most frequently named principal cause. When hereditary links were added, more than 40% of respondents said that a biological cause was primarily responsible for the type of behavior described.

In contrast, life events and other psychosocial causes dominated the factors given for depression.

The researchers note in the journal Psychiatry Research that if the vignette was described as a mental illness, the likelihood that brain disease would be chosen increased. The specific mention of schizophrenia or psychosis enhanced the likelihood, whereas mentioning depression reduced it.

Looking at the combinations of the most and second most important causes, the researchers found that brain disease and hereditary factors were the most frequent combination for schizophrenia, at 12.3%, followed-by brain disease and drug abuse, cited by 6.9%. A combination of brain disease and life events came third, at 5.2%.

For depression, the causal beliefs were more consistent, with the most common combination of life event and stress in partnership or family suggested by 6.0% of participants, followed by life event and stress at work by 5.3%, and stress in partnership or family and stress at work cited by 4.8%.

"Our study endorses the earlier found preponderance of psychosocial causal beliefs among the public concerning depression," Schomerus et al conclude.

"Asking respondents to prioritize their perception of causes for schizophrenia produced biological causes, however, as more popular than the literature would suggest." Read more!

FDA urges new Tamiflu warning - UPI

WASHINGTON, Nov. 13 (UPI) -- The U.S. Food and Drug Administration Monday urged adding a new warning for the flu drug Tamiflu amid reports of psychiatric problems in patients who take it.

"It is still unclear whether these neuropsychiatric events are drug-related only, disease manifestation alone, or a combination of drug-disease expression," said an FDA staff summary posted on the agency's Web site.

The FDA reviewers said they evaluated 103 reports of hallucinations, suicidal behavior and other mental problems -- mostly among children -- from August 2005 to July 2006. Three deaths were from falls.

Nearly all the cases, 95 out of 103, came from Japan, the FDA staff said.

Tamiflu was prescribed 24.5 million times in Japan between 2001 and 2005, compared with 6.5 million times in the United States, which has more than twice the population, the FDA Web site said.

Tamiflu is made by the Swiss pharmaceutical company Roche Holding AG, which has discussed label changes with the FDA, a company spokesman said. Read more!

How mental health affects everyone - The Oregon Daily Emerald

Will Brundage, Guest Opinion

The Net. You can find all sorts of things tucked away in those nooks and crannies, hosted on some distant server on a college campus somewhere. One treasure I found on Liquid Generation (Liquidgeneration.com) involved a series of games, including one titled appropriately, "Homeless or Jesus?" Simple and easy, it takes two minutes to play and you cannot lose.

It doesn't face the truth of the matter. People are losing to mental illness all day long. One of my friends had his first bipolar episode and alternated between being Jesus and John the Apostle. While he didn't turn into the scruffy figures depicted in the game, it was frightening to see that he had lost control and was valiantly trying to get it back. Once he was hospitalized and given lithium, things got better.

The frustrating thing was that he failed to recognize he had a problem. Partly due to his illness and partly due to the fact that he was completely unknowledgable about mental heath. Indeed, most of the people in the world couldn't really tell you the difference between bipolar disorder, manic depression and schizophrenia, much less the 12-pack of personality disorders. It doesn't take long to start learning about mental illness and how it can impact everyone's life, not just the homeless fellow asking for change outside of Espresso Roma. Keep in mind that 1 out of 4 families deal with mental illness directly. It is a given that unless you're a recluse, only emerging to buy groceries and socks, you know someone who is confronting mental illness.

So here's a rundown of the common mental illnesses. No, I won't be going into vodou possession states or shamanic trances. That is something else entirely. All the quotes are drawn from the National Alliance on Mental Illness' pamphlet "Mental Illness: An Illness Like Any Other".

Schizophrenia: "People living with schizophrenia have hallucinations and delusions." That sums it up in a nutshell. The brain is constructed differently, and thus the brain misfires in a random pattern.

Someone with schizophrenia does not have multiple-personality disorder. An important distinction, as MPD is entirely different. A whole different bag of candy.

Bipolar Disorder: This, also known as manic depression, affects over 2 million Americans. "Extreme shifts in mood, energy, and functioning" occur. Alternating periods of mania and depression are common, with mixed states in between. Bipolar disorder is a chronic condition, even though symptoms might disappear between episodes.

Major Depression: "Much more than feeling sad or blue," depression causes sleep, mood, and appetite disorder. Approximately 15 million Americans are affected by major depression (that's 7 percent of the population). It can occur at any age and in any socioeconomic category. People often appear OK on the outside, but inside they're miserable. Suicide is a common factor with depression.

So there it is. The first steps towards a complete education about mental health in about a minute. There is always more to learn and always more to explore. Disability Services and NAMI have a vast repertoire of literature to peruse. Go give it a look!

For more information, NAMI of Lane County, a non-profit organization that assists those living with mental illness, is having a presentation Nov. 13 at the EMU's Umpqua Room at 7 p.m.

Will Brundage is a University student and NAMI intern Read more!

Creating a holiday "wellness toolbox" - Daily Journal (Murfreesboro, TN)

By COLLEEN CREAMER
ccreamer@dnj.com

Social anxiety, a sudden jolt of dysfunctional family time, feelings of alienation — a constellation of holiday stressors can worsen an already tenuous mental health condition. Given that 23 percent of adults in North America will have a brush with mental illness in a given year, according to the National Alliance on Mental Illness (NAMI), the holidays are a time those at risk should shore up.

This Wednesday, Ed Rothstein, director of Our Place Peer Support Center in Murfreesboro, will speak at the Linebaugh Public Library on the center's WRAP (Wellness Recovery Action Plan) program. WRAP is based on work by Mary Ellen Copeland, a mental health expert and author who deals in strategies for emotional health.

"Wellness, recovery, action and planning is an objective way to self-monitor and self appraise how you are doing, not only during the holidays, not only with a mental illness, but with whatever goal you might have for your wellness," Rothstein said.

Planning responses, Rothstein said, can reduce or even eliminate symptoms. He said one of the program's components is a "wellness toolbox," which includes support measures that have worked in the past.

"These are things that you can do to help yourself feel better when you are getting down," Rothstein continued. "You use these tools to develop your own WRAP plan in order to stay well."

A few of those measures include talking to a health professional or a friend who has been helpful in the past, writing, eating better, exercising, doing some form of art or exercising.