Workgroups will look at mental health - The Democrat-Herald

A group of nursing professionals is advising the Oregon Department of Human Services on how to encourage more nursing students to prepare for psychiatric-nursing jobs at Oregon State Hospital, which is chronically short of nurses.

The workgroup is one of four that Bob Nikkel, DHS assistant director for addictions and mental health services, has named to help the state plan for a new state hospital and a strengthened community mental health system.

The other three groups are working on community services, services in Central and Eastern Oregon, and acute psychiatric care in local hospitals.

“This is the first time in Oregon’s history that we’ve taken a comprehensive look at mental health services, staffing and costs over the next 15 years,” Nikkel said. “This will improve state leaders’ ability to predict costs and deliver greater certainty to patients and families that adequate resources will be available when they need them.”

Prompting naming of the nurses’ workgroup is that more than 20 percent of the state hospital’s 165 nursing positions are usually vacant, Nikkel said, in part because fewer than 5 percent of nursing students choose psychiatric nursing as a career. The workgroup, comprising a dozen nursing professionals and DHS staff, is investigating ways to encourage more students to consider careers at the state hospital, which will need more nurses when new replacement hospitals open beginning in 2011.

The governor, meanwhile, is recommending increasing capacity in Oregon nursing education in his 2007-09 Hope and Opportunity Budget.

The state hospital, where nurses’ average age is 50, attracted 98 people to a Dec. 5 Salem job fair, at which three participants completed applications after receiving a hospital tour, viewing rarely seen hospital memorabilia and hearing from hospital officials.

The other three work groups:

• Community services: This group is analyzing early-assessment, community treatment, affordable housing and other services designed to assist people in their communities so they don’t need state hospital treatment. Members include legislative, county, advocacy, DHS and other representatives.

• Central and Eastern Oregon: This group is looking at services needed in rural parts of the state, including fast-growing Crook, Deschutes and Jefferson counties, which have the state’s least developed community resources supporting the state hospital. Members include legislative, consumer, community mental health, hospital, advocacy and DHS representatives.

• Acute-care policy: This group is investigating care, finances, policies and other issues affecting local hospitals that operate psychiatric wards. Members include hospital, community mental health, treatment, consumer and DHS representatives.

Nikkel said he wants the community services workgroup to report during the session of the 2007 Oregon Legislature, which is expected to make decisions that would begin construction by 2009 on the first of two replacement state hospitals.

Gov. Ted Kulongoski and legislators are considering a 620-bed state hospital in the Portland-Salem area, a 360-bed hospital south of Linn County, and at least two 16-bed facilities east of the Cascades.
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New insurance requirement for mental health coverage - AP

ALBANY, N.Y. A new law requiring insurers to provide more mental health coverage in New York takes effect in 2007.

Although most health insurers already provide care to varying degrees, Timothy's Law requires offering it to workers even in small businesses.

The state is to pay the premium increase for companies with 50 or fewer employees.

Because of delays in passing the bill, the law was signed by Governor Pataki just two weeks ago. He said the insurance industry may need more time to adjust to the new mandate, stalling implementation for a few months.

It requires insurance companies to cover 30 inpatient and 20 outpatient days of treatment for mental illness. Companies must fully cover "biologically based mental illnesses" including major depression, obsessive compulsive disorder, anorexia and binge eating.

It also requires coverage for children with attention deficit disorder, disruptive behavior disorders or disorders that include suicidal symptoms.
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NAMI Statehouse Spotlight 2006 Recap

Parity Bill on Ohio Governor's Desk

After twenty years of effort, mental health proponents in Ohio have succeeded in putting a mental health parity bill on the governor's desk. Once signed, the bill would require insurers to offer the same coverage for mental illness as for physical ailments. The bill is anticipated to directly affect 110,000 state citizens who are living with mental illness. (ohio.com, December 14, 2006)

Missouri Governor Behind State Medicaid Reform Efforts

Governor Matt Blunt gave his approval to the first of several recommendations to reform Missouri's Medicaid program by endorsing a requirement that all Medicaid participants have a primary care doctor, nurse, or clinic to improve coordination of care and use of preventative services. Known as a "medical home" model, the proposal originated from the state's Social Services, Health and Senior Services, and Mental Health departments. The governor will soon issue his own reform plan and will also consider other recommendations floated by a state-appointed Medicaid commission. (kansascity.com, December 15, 2006)

Healthcare Changes Brewing in Pennsylvania

On the eve of his second term, Pennsylvania Governor Ed Rendell has indicated he will back a major initiative to provide health insurance to an estimated 1 million uninsured people. The governor stopped short of following Massachusetts' lead, and instead is interested in following a comparable model to the state's CHIP program. Rendell has also announced plans to reign in health care costs for the state by broadening the scope of practice for nurse-practitioners, implementing measures for infection reductions, and altering emergency department configurations. While announcing the proposals, Rendell asked for bipartisan support, noting that his proposals would likely create "widespread squawking" as the plan would step on everyone's toes. (philly.com, December 12, 2006)

Congressional Action on Healthcare Important for States

Congress closed its lame-duck session by giving states a temporary reprieve from $2.1 billion in cuts proposed by the Bush administration that would have altered how states can fund state share of the federal-state Medicaid program. The administration had wanted to reduce the maximum provider tax rate from 6 percent to 3 percent, but Congress only allowed the rate to drop to 5.5 percent. The taxes are frequently used to recoup federal matching funds through Medicaid and then passed back to providers. The Congress also held steady in SCHIP funding but did amend the formulas used to determine how the dollars are distributed. (Stateline.org, December 12, 2006)


Top Statehouse Story Lines from 2006

Medicaid/Health Care Reform

Nationally, Medicaid accounts for an estimated 60 percent of spending for state directed mental health services. Of all topics receiving significant media play in '06, Medicaid was by far the most frequently covered and discussed. Congress passed, and President Bush signed, the Deficit Reduction Act of 2005 in early 2006, and this bill paved the way for states to enter into a flurry of reform efforts. NAMI state policy staff tracked developments in states as diverse as Idaho, Florida, Kentucky, West Virginia, and Maine as state policymakers wrestled with reigning in growth in Medicaid spending and advocates countered with efforts to preserve important services and supports. Then, in mid-year, Massachusetts upped the ante to leverage mandatory healthcare for all state citizens. As proposals surfaced, NAMI's network of affiliates was ready to answer the call and advocate effectively for persons experiencing mental illness who rely upon Medicaid for services.

Forensics and Mental Illness

Unfortunately, our nation's largest providers of mental health services continue to be operated by local sheriffs' and state corrections' agencies. 2006 saw greater interest in addressing this deficiency, but the year also saw continued abuses and shortcomings. Across the country, from Florida to Washington, California to New England, states struggled with shifting our system from one of incarceration to one of diversion and early intervention. Tensions were so high that multiple jurisdictions found mental health authority leaders in contempt of court for failing to address this tragic reality. For readers of Statehouse Spotlight, bi-weekly reminders of the ground yet to be covered was presented in media snapshots from all parts of our country.

Mental Health Parity

Throughout 2006, readers of the Statehouse Spotlight received regular updates on the progress of mental health parity legislation in two pivotal states: New York and Ohio. Great gains were made in these states towards enacting meaningful health coverage reform that would end the discrimination against mental illnesses in health plan design. NAMI staff and local organizations worked diligently on this important effort, not only in these states, but in others such as Idaho, where new gains were made by putting meaningful laws on the books. Buoyed by the success of state efforts to gain new parity standing and expand existing laws and a federal report validating the minimal fiscal impact of parity benefits, readers can expect even more attention to this issue in 2007 and beyond.

Elections & Politics

For state government, the election season of 2006 was one of intrigue and changing landscapes. Consistent with national trends, Democrats seized control after November electionsof both senate and house chambers in more states than any year since 1994. Readers of Statehouse Spotlight in 2006 were able to follow the ebb and flow of state-level elections and understand the impact of party change and how those changes affect healthcare policy.

NAMI Advocacy Tools & Resources

Over the last twelve months, NAMI national has provided readers of the Statehouse Spotlight with numerous tools and resources to impact state capitols across the country. Medicaid advocacy, criminal justice initiatives, child and adolescent services, and Grading the States--all of these important resources are cataloged on the NAMI website. Looking for materials to prepare your 2007 legislative plan of work? Visit the Policy Section of the NAMI website to review the numerous issue topics and related resources.

Washington Quick Glance

NAMI Participates in Important FDA Hearing

In the last issue of Statehouse Spotlight, readers were alerted to an upcoming hearing at the FDA on the topic of antidepressants and suicide risk. For a recap of this important meeting, click here. The link includes NAMI's testimony and press coverage from the meeting.

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Crisis in care; no excuse not to fix - Raleigh News & Observer

Editorial

The old line about everybody talking about the weather but nobody doing anything about it is sort of amusing, because it's pure, ironic whimsy. When it comes to mental health care in North Carolina, the same sort of observation might be made -- but there's nothing funny and everything outrageous about it.

The truth is, legislators and officials charged with supervising the mental health system have known for years that care was inadequate, options were confusing and expensive, and those suffering from mental illness, if they didn't have money (and many didn't), might even wind up in county jails.

So fast forward over those years, and some more years, and what do you find? Exactly the same problems. The state tweaked the system a few years ago by aiming to have more people obtain care in their communities rather than go to big state mental hospitals. A fine idea, except that counties are pressed to provide that kind of help because they face so many other demands. So people still go to the hospitals first. It's a big reason why the planned closure of Dorothea Dix Hospital in Raleigh has unsettled so many who have depended on it as a place where care was reliably available.

All in all, the situation is entirely unacceptable, and would that more lawmakers and Governor Easley were ready to address it like the serious crisis it is. A consultants' report found that the state still counts on large institutions for much care, and that North Carolina doesn't seem to have a coherent game plan or philosophy when it comes to treating the mentally ill.

The same report says that the state needs to spent an additional $500 million a year for the next five years to fix the shortcomings. The state, of course, isn't going to do that. Lawmakers managed to put an additional $100 million into mental health services and housing this year, and you'd have thought they wanted the Nobel Peace Prize.

In fact, the state is quite likely hundreds of millions of dollars behind what it should be doing to provide these services, but money remains hard to come by. What can be done is to move ahead with some sensible reorganization of how the system works. That may mean seeking outside help as to how to make the system more efficient -- getting those in need of help to the right people in the right way, something that seems to be troublesome for the state at this point.

It's not that officialdom is insensitive to the needs of the mentally ill. Carmen Hooker Odom, state secretary of Health and Human Services, no doubt wants to do the right thing by people who depend on her department.

But lawmakers need to pony up some more money, and agencies that are involved in all aspects of care for the mentally ill need to work together more effectively to help each other. Toward that end, the General Assembly ought to view this latest report not as another hunk of paperwork, but as a five-alarm bell.

It's long since time the state, meaning politicians and the bureaucracy, faced up to North Carolina's problems with mental health care and -- here's a thought -- actually did something long-term about them. Read more!

A look back: changes stir up mental health care - Asheville Citizen-Times

By Leslie Boyd
LBOYD@CITIZEN-TIMES.COM

ASHEVILLE — The year 2006 offered little stability to a population that needs just that to function — people with mental illness, developmental disabilities and substance abuse problems.

In February, the federal government approved new Medicaid rules, after a wait of more than two years, and then gave the state less than two months to implement them.

“I’m not going to suggest I ever thought that transition would go smoothly,” said Michael Moseley, director of the N.C. Division of Mental Health, Developmental Disabilities and Substance Abuse Services. “It was a lot of change and that created some havoc.”

Then in September, New Vistas-Mountain Laurel, the agency that provided services for about 10,000 people in the eight-county area, announced it would close by the end of October.

In each case, the local management entity, Western Highlands Network, which covers Buncombe, Henderson, Transylvania, Madison, Yancey, Mitchell, Rutherford and Polk counties, had to scramble to respond to the crisis.

The new Medicaid rules didn’t include the one-on-one workers whom parents and schools had come to rely on for children with severe disabilities, so the state had to come up with a replacement on its own. The solution was to move everyone who needed the workers to another program that would pay for their use — the Community Access Program for Persons with Mental Retardation and Developmental Disorders.

David Arata of Candler was one of those who moved to CAP MR/DD, but soon afterward, the state ruled people in the program no longer were eligible for transportation to day programs.

“I have to interrupt my day in the morning and again in the afternoon,” said Sue Arata, David’s sister-in-law and caregiver. “He doesn’t get physical therapy anymore because he can get transportation there but not back to the day program. It’s been an incredibly frustrating year.”

‘A model system’
When New Vistas-Mountain Laurel announced it would fold, new service providers had to be found for about 10,000 people. Kathy Wallace feared her son, Jamey, might lose the team of professionals who manage his care. Jamey Wallace has a severe mental illness and depends on the team to help him get to appointments, assess his medications and keep him stable.

“I have to say, it went much better than I thought,” Wallace said. “He has the same team, and the transition went pretty smoothly.”

Western Highlands, officials from the eight counties and service providers who agreed to take on most of the people being served by New Vistas-Western Highlands, were praised by state officials recently for building an entirely new system in less than two months.

“We probably built a model system with a model (local management entity) and we’re way ahead of the rest of the state,” said state Sen. Martin Nesbitt, D-Buncombe, co-chair of the Legislative Oversight Committee for Mental Health, Developmental Disabilities and Substance Abuse Services.

The system still is short on psychiatrists, and there are other minor problems being ironed out, but the system is working well overall, said Arthur Carder, CEO of Western Highlands Network.

In the seven westernmost counties, Meridian Behavioral Health Services, the large provider spun off from Smoky Mountain Center after mental health reform took effect, underwent a makeover, cutting back its area and services and allowing new providers to fill in the gaps.

The importance of local control
In March, N.C. Department of Health and Human Services Secretary Carmen Hooker-Odom announced a decision to hand over review of Medicaid cases to the for-profit, Virginia-based Value Options, which has offices in Raleigh and has other contracts with the state, taking the task away from the 29 local mental health management agencies in the state. The department then took away up to one-third of the agencies’ funding, prompting layoffs of up to one-third of their staffs.

Hooker-Odom said when the move was made that it would be more efficient, but complaints about the length of time it takes to get approval from Value Options continue to come in nine months after the change.

“The Division of Medical Assistance oversees Value Options, and they’re working to resolve the problem,” Moseley said.

The move sparked the ire of Nesbitt and other legislators. In response, his committee wrote legislation defining the functions and responsibilities of the local management entities.

Tom McDevitt, CEO of Smoky Mountain, says local control is important for mental health care.

“The farther you get from the local level, the more likely you are to look at numbers instead of people,” he said.

The N.C. Legislature in its summer session increased funding for mental health by $100 million. A report from Hooker-Odom’s office last week concluded North Carolina’s mental health system will need $2.7 billion over the next five years.

Moseley said the division will hold several meetings in January with the legislative oversight committee to discuss the report and set priorities.

“We’re going through it now to determine what policy decisions we can make first,” Moseley said.

David Cornwell, director of N.C. Mental Hope, said he believes the state, which is among the bottom 10 in its per-capita funding for mental health, has to increase funding for things that help prevent mental health crises.

“These are not second-class citizens, not second-class illnesses,” he said. “And the costs of untreated and inadequately treated mental illness are among the highest from both fiscal and humane perspectives.”

People whose mental illness is not managed well tend to wind up in crisis.

The state is funding more crisis care, which will help keep people out of hospitals, Carder said.

“It’s only logical to pay for the full array of services people need in the community,” Carder said. “It’s a lot more expensive to pay for them in jails, emergency rooms or state hospitals.”

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Aetna Behavioral Health Introduces Industry-first Bipolar Disease Management Program -

Editor's Note: Although the following is a company press release and certainly created for its marketing value as much as anything else, it would still seem to be a significant step in the right direction by a major carrier.

HARTFORD, CONN. — Aetna (NYSE: ΑET)today launched an innovative disease management program to improve the care for members suffering from bipolar disorder, a disease that impacts two million adult Americans and costs U.S. employers an estimated $14.1 billion a year in lost productivity. Bipolar disorder carries a significant mortality risk, with an estimated 25 percent of people attempting suicide.

Aetna’s new program, created in conjunction with Astra Zeneca, seeks to help Aetna members who suffer from bipolar disorder achieve their optimal health by giving them information and care management support. For those who sign up for the voluntary program, care managers will provide the support necessary to increase member adherence to a physician-prescribed treatment plan.

By improving medication adherence and the care members receive after a hospitalization or other event, the Bipolar Disease Management program will help decrease relapses, increase quality of life, and reduce the overall health care costs associated with bipolar disorder.

"Studies about bipolar disorder show that it is the sixth leading cause of disability ahead of other long-term conditions such as HIV, diabetes and asthma," said Mary Fox, head of Aetna’s Behavioral Health and Pharmacy Management businesses. "Research, as well as Aetna’s own positive experience developing disease management programs for mental health conditions, spurred us to take a leadership position by developing a program that could have a significant impact on both our members and customers."

This Bipolar Disease Management Program will become part of Aetna’s suite of disease management programs, which includes Aetna Health ConnectionsSM. Aetna’s medical management products and services help members achieve and maintain their optimal health. Through these services, Aetna takes an innovative, personalized, holistic approach to supporting member health, providing useful information to help members make smarter decisions about their health and health care.

Initially, Aetna members enrolled in a fully insured HMO plan will have access to the Bipolar management program, with plans to expand the program further in 2007. Aetna members who fit the following criteria, are eligible for voluntary enrollment in the Bipolar Disease Management program:
At least 18 years of age or older;
Diagnosed with bipolar disorder;
Recently discharged or currently hospitalized for bipolar disorder.
Aetna members enrolled in the program are assigned a care manager who will partner with them to enhance disease and treatment awareness, facilitate coordination of care, and improve treatment adherence. Care managers will call members at least monthly, and may call more often depending on the level of severity of their disorder. Care managers also personally assist members with finding community-based resources that help people cope with the disorder, encourage family support for members and coordinate care between different health care providers. Program participants will receive educational mailings about bipolar disorder and treatment options. In addition, members have access to a customized website, providing 24 hour-a-day, 7 day-a-week educational information and resources for bipolar disorder.

Aetna is one of the nation’s leading diversified health care benefits companies, serving approximately 29.8 million people with information and resources to help them make better informed decisions about their health care. Aetna offers a broad range of traditional and consumer-directed health insurance products and related services, including medical, pharmacy, dental, behavioral health, group life, and disability plans, and medical management capabilities. Our customers include employer groups, individuals, college students, part-time and hourly workers, health plans and government-sponsored plans. www.aetna.com
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Crisis Teams a good start - Lehigh Valley (PA) Patriot-News

The fatal shooting by police of a West Shore man with mental health issues six years ago was one of those tragedies that may have ultimately resulted in a greater good.

A mobile crisis intervention team has been launched to aid police in such situations, and officers have received training in handling situations involving mentally unstable people.

Ryan Schorr, a 25-year-old Wormleysburg man, was shot and killed during a fracas with two West Shore Regional Police officers in November 2000. Police reports said an enraged Schorr began struggling with one of the officers for control of his pistol and managed to fire at least one shot, wounding the offi cer.

A Cumberland County grand jury determined the of ficers had little choice in returning fire and cleared them of wrong doing. But the cir cumstances sur rounding the case were troubling and cast a spotlight on incidents in which police have to deal with mentally ill individuals.

Earlier in the day of the fatal shooting, the officers had taken Schorr, who suffered from a bipolar disorder and had stopped taking his medicine, to Holy Spirit Hospital. Schorr escaped from the hospital and returned home, where the shooting occurred after officers returned to retrieve him.

The shooting spawned litigation and a debate that pitted family and friends of Schorr, who was described as easy going and pleasant when taking his medication, and defenders of police who sympathized with the difficult situation in which the two officers found themselves that day.

Six years later, police in Cumberland and Perry counties now have a mobile crisis intervention team -- similar units are already in place in Dauphin and York counties -- to accompany officers to calls involving the mentally ill. Holy Spirit is providing the services of the two-person team under a contract with the two counties, which have collaborate mental health services.

In addition to providing police professional assistance at the scene, mobile crisis workers are meeting with police, clergy and community organizations to discuss early warning signs that someone may be headed toward crisis. As such, altercations with police may be headed off in advance or, if summoned, officers will have a better grasp of the person's condition.

The mobile team also comes on the heels of increased training of police in Cumberland and Perry counties in ways of handling the mentally ill and of available professional services.

A lot of this comes at the impetus of Schorr's mother, Susan Schorr, who in settling a civil lawsuit with police in 2003 insisted on improved police training and resources as one of the terms.

None of this is going to bring back Ryan Schorr or undo what must be horrible memories for these two police officers. But the increased training and implementation of the mobile team will hopefully prevent similar cases in the future.

As Susan Schorr has suggested, this is training that would be prudent for all police officers in Pennsylvania. Read more!

Four-year struggle continues for psychiatric care in Northwest Arkansas - Springdale (AR) Morning News

By Don Dailey

Maybe St. Mary's will provide beds for psychiatric patients when its new hospital opens in 2007 or 2008.

Maybe the University of Arkansas for Medical Sciences will open a Northwest Arkansas campus and include a psychiatric rotation.

Maybe the Legislature will fund a satellite center of the State Hospital here.

Then perhaps a schizophrenic like Chad Skaggs won't be sent to an intensive care unit, and someone like Donald Winters won't die in a jail cell; and a mother like Joilet Salomo will get treatment before she shoots herself in the head.

The Legislature meets again later this month, renewing hope the state will address the lack of beds for people with acute psychiatric needs. There's a new task force and some new plans.

And the same old hope.

Patchwork system

Getting treatment for acute mental illnesses is difficult in Northwest Arkansas, particularly if you are poor or accused of a crime.

"Right now it's hit or miss statewide and in Northwest Arkansas it's more miss than hit," said David Williams, president and CEO of Ozark Guidance, the primary mental health care provider for the indigent in Northwest Arkansas.

Highland Hall, the psychiatric unit at Northwest Medical Center-Springdale, closed four years ago and left Northwest Arkansas without a unit to provide acute care to the mentally ill who are on Medicaid or are without insurance.

Medicaid rules stipulate only general hospitals may bill Medicaid for acute psychiatric care, but local hospitals believe there are more profitable uses for the resources a psychiatric unit would need.

Jails, along with emergency rooms and intensive care units, are now the front lines in mental health care, a situation many in law enforcement and health care find unacceptable.

"The reality is on a given day, we can't find enough beds because the State Hospital is generally full," said Williams, who is a leader in the effort to replace the service lost when Northwest's psychiatric unit closed.

And even when beds are available in the State Hospital, patients have to be taken 200 miles away to Little Rock.

A prominent example of the worst the system offers is Donald Winters, a 60-year-old Bella Vista man who died in 2003 in the throes of a mental health crisis while in the Benton County Jail.

Winters' family sued the state Department of Health and Human Services and Benton County Sheriff Keith Ferguson claiming the county and state failed to take care of Winters properly. U.S. District Judge G. Thomas Eisele ruled in June against Winters' family but said the Legislature should take notice of the case and do something to provide for the mentally ill.

Spurred partly by the judge's ruling, the Legislature has taken an interest, making many hopeful an overhaul of the state's hospital system is imminent.

The Joint Interim Committee on Public Health, Welfare and Labor impaneled a task force of sorts last month to suggest to the Legislature ways to solve the acute-care problem.

Benton, Washington, Madison and Carroll counties combined need about 40 acute-care beds per month on average, said Williams, who is on the task force. There are 17; none of those are in a general hospital.

Many with mental illness in Northwest Arkansas who need acute care go to Tulsa, Okla., or Dallas or Little Rock to be treated, or they simply go without treatment.

Williams said in the last year that Highland Hall operated there were 856 people hospitalized in Northwest Arkansas for mental illness compared with the just more than 400 hospitalized in 2005.

"We have a lot of paying folks who refer out of town, out of state," Williams said.

Those in jail who need treatment wait for a court order sending them to the State Hospital and then they wait for a spot to open.

"The demand far exceeds Arkansas State Hospital beds," Williams said.

On Friday, seven people committed to the State Hospital out of the criminal-court system statewide and one civil commitment waited to be admitted for treatment in the State Hospital, said Julie Munsell, spokeswoman for the Department of Health and Human Services.

Munsell said a waiting list of seven people on any given day is typical.

The Department of Health and Human Services follows a triage program for pretrial inmates designed to allow the most acute cases of mental illness to be treated first. The system was implemented as part of a court settlement in 2002, Munsell said.

Focus on criminal

Diane Mackey, a Little Rock attorney and spokeswoman for the Center for Public Health Law, a joint venture of the University of Arkansas at Little Rock law school and the University of Arkansas for Medical Sciences, was chosen to lead the task force. She invited mental health and law enforcement professionals from across the state to participate.

The group agreed to concentrate on the intersection of law enforcement and the mentally ill, Mackey said.

"If we can take care of one part of the system then we can move on to the next," she said. "If we can pull this off, maybe we can do something broader."

The group hopes to have a bill ready for the Legislature to consider by the end of January. Mackey would not discuss possible sponsors.

The centerpiece of the group's proposed legislation is a plan to create four satellites of the Arkansas State Hospital so that every part of the state is within a reasonable drive of psychiatric treatment. Crisis centers would be included at each satellite to stabilize patients experiencing acute symptoms.

Mackey's group will ask for 64 total additional beds to be divided evenly among the four corners of the state. That would mean 16 additional beds to serve western and northwestern Arkansas.

Whether those 16 new beds would be reserved for people in the court system hasn't been discussed, Mackey said.

The group will not ask for new buildings to house the satellite facilities in order to keep the price tag down.

"We're intensely practical," Mackey said.

That means existing hospitals will have to be convinced to help out by providing space and other resources.

Mackey said other components expected to be in the proposed bill include:

* Requirements for accountability and standardized reporting.

* Making training available for law enforcement in every county.

* Creating a jail diversion program that could include a mental health court similar to drug courts that would keep the mentally ill out of jail.

Support will be forthcoming for the lawmakers if the task force can come up with a good model, Williams said.

The task force hasn't come up with a cost estimate. Money set aside in 2005 to help pay for a psychiatric acute care unit in Northwest Arkansas wasn't spent, and legislators and local mental health activists and professionals hope to keep it.

Hopes soared in summer 2005 when lawmakers pledged more than $500,000 to help pay for a 16-bed unit in the former Washington Regional Medical Center building in Fayetteville.

Those hopes landed with a thud when the hospital pulled out of the plan. Hospital officials said they were concerned jails and other hospitals would dump patients in the unit.

Sen. Sue Madison, D-Fayetteville, said her plan for the 2007 legislative session is "to try and make sure the general improvement money from last time can be redirected and not expire."

Susan Barrett, president and CEO of Mercy Health System, said last summer there's a possibility the St. Mary's Hospital building in downtown Rogers could be used as a psychiatric unit when the hospital moves to a new location on Interstate 540 in 2007 or 2008.

St. Mary's, Northwest Health System and Washington Regional Medical Center did not respond to interview requests by The Morning News for this report.

Williams and others also are intrigued by the possibility of the University of Arkansas for Medical Sciences in Little Rock opening a satellite campus in Northwest Arkansas. The medical school's chancellor, I. Dodd Wilson, announced that possibility last summer.

Such a campus would likely include a psychiatric rotation that would include an outpatient and inpatient component.

"I see that as very helpful if it comes to be," Williams said.

Mental illness stigma

How can a metropolitan area of more than 300,000 people find itself without a major health care service?

Libby Wheeler, past president Mental Health Association of Northwest Arkansas, believes people generally prefer to ignore the mentally ill.

"I think the basic problem is stigma, that our society doesn't accept mental illnesses like they accept physical illnesses," she said.

People with mental illnesses often make for difficult patients, and treating them also carries a stigma, Wheeler believes.

"What really bothers me is that we have all these glitzy new hospitals all up this I-540 corridor all vying for patients: 'Come to my cardiac unit. It's the best,' and we have a medically needy population that nobody wants to serve," Wheeler said.

Williams didn't think it would take this long to replace the services of Highland Hall.

"I really thought when we got such strong legislative support in 2005 that by now we'd have at least one (acute care) unit in Northwest Arkansas," he said.

Mental health advocates see the Winters lawsuit as similar to the Lakeview lawsuit that declared the state's education system unconstitutional. Although the judge in the Winters case didn't go that far, perhaps a judge in some other case will, Wheeler said.

Jerri Skaggs, president of the Arkansas chapter of the National Alliance on Mental Health, felt her optimism for the system flagging last fall, but recent news accounts of Mackey's task force boosted her spirits.

"I do feel good about what I'm seeing going on to keep awareness alive," said Skaggs, whose son, Chad, suffers from schizophrenia. "I think there's always hope." Read more!

Mental Illness: Time for Parity - Grand Rapids (MI) Press

Editorial

Depression can be just as devastating as cancer or Parkinson's disease. So, for that matter, can any illness of the mind.

Treating mental illness on a par with bodily illness is a matter of good medical sense, not to mention equity. Thirty-nine states mandate in some form that insurance companies offer comparable coverage. Michigan is not among them. The Legislature should pass that reform. Gov. Jennifer Granholm, who supports parity, could advance the cause by showcasing it in her upcoming State of the State address.

Legislative inaction indicates continued misunderstanding about mental illness, as well as legitimate concerns about the cost parity would place on the mental health system. Both need to be addressed.

Too often, stigma has shadowed the mentally ill. Some, especially those who have not encountered these afflictions in their own lives, suspect that mental illness is less real or crippling than physical disease.

For the afflicted, however, nothing could be more real than the mind and soul crimped by chemical imbalance, past trauma or bedeviling addiction. Depression, schizophrenia, bipolar disorder and anxiety can be debilitating, even deadly. Scientific advances of the last few decades have created sophisticated therapies for these illnesses, especially more effective drugs, making them all the more treatable and offering new hope.

But disparity persists in the way insurers cover such diseases. When it comes to mental illness, some impose higher co-pays and deductibles, mandate shorter hospital stays and put stricter limitations on lifetime coverage amounts. Too many patients have to draw down their bank accounts to receive the help they need, and too many go without any help at all.

Putting mental illness on a par with physical illness could raise insurance premiums, though by how much is a matter of debate. Estimates range from very little to 3.4 percent. One plan studied in Vermont actually saw over-all addiction and mental health costs decrease after a parity law passed.

Offsetting the coverage cost, however, would be increased productivity and well-being for the currently under-insured. Mental illness takes a toll not only on lives but on the bottom line, especially in absenteeism and poor performance at work.

In addition, there would be a savings to the public health system, which bears the load when private insurance fails. When lawmakers consider the expenses -- and they must -- they need to consider all of them.

Earlier this month, legislators debated a parity bill in the final hours of the lame duck session. Nothing passed, which is just as well. This kind of important new law should not be rushed through in a snowstorm of others. However, lawmakers ought to waste no time getting it done when they reconvene in January.

Michigan has lagged behind other states in caring for those with mental illness. The question of how to insure them dates back many years. The mentally ill and their families have waited long enough for relief.

Read more!

Taft signs mental-health parity bill - The Columbus Dispatch

Controversial measure ‘disappointing blow’ to small businesses, critics say
Saturday, December 30, 2006
James Nash
THE COLUMBUS DISPATCH

Over the objections of some small businesses, Gov. Bob Taft yesterday signed a bill requiring health plans to offer the same treatment for mental illnesses as they do for physical ailments.

The bill was among the more controversial pieces of legislation passed this month, many of which still await the outgoing governor’s signature or veto. Taft has not weighed in on bills dealing with the minimum wage, predatory lending, red-light cameras and liability for cleaning up lead paint.

Taft, who leaves office Jan. 8, must sign or veto a glut of legislation that moved through the General Assembly before it adjourned Dec. 20.

In addition to the mentalhealth measure, Taft yesterday also signed 17 noncontroversial bills dealing with civil-service regulations, preventing bullying and harassment in schools and prohibiting parole officers from using private cars on the job, among other topics.

The mental-health parity bill was the most controversial of the measures Taft signed into law. Taft had resisted similar legislation two years ago, bowing to concerns from businesses that complained it would saddle them with additional costs.

Taft said yesterday that he expects such costs to be "minimal" and outweighed by the benefits of providing mentalhealth treatment to people who might otherwise end up homeless, hungry or imprisoned.

Some businesses "shifted their position to realizing that this could be an overall cost savings to society," Taft said.

Still, the National Federation of Independent Business/Ohio yesterday expressed disappointment that Taft would sign an "unfair mandate."

"He has dealt a disappointing blow to small-business owners who are already struggling to provide any level of coverage and who will now face yet another hurdle in their efforts to provide basic health-care benefits to their employees," the federation’s Ohio leader, Ty Pine, said in a statement after the signing.

Mental-health advocates noted that thousands of Ohioans are missing out on needed treatment because it was not covered by their insurance plans.

"That’s what this bill is about: It gives people who may be depressed the ability to laugh," said Rep. Robert F. Spada, R-North Royalton, its sponsor. "It gives the ability to have good days with proper care and treatment."
Read more!

Top stories of '06 No. 3: Mental health care crisis - Hendersonville Times-News

Scott Parrott
scott.parrott@hendersonvillenews.com

The blow came quick. On Sept. 18, Henderson and seven other mountain counties learned the region's largest mental health care provider would shut down in one month because of money woes.

The news frightened many mental health patients, still confused by the state-mandated reform of 2001.

They weren't alone. Homeless shelters, police officers, hospitals and government leaders feared the worst when New Vistas-Mountain Laurel announced it would close Oct. 31.

But the community responded just as fast, and Henderson County diverted a crisis.

Western Highlands, which manages mental health care in the region, found providers who could help the mentally ill once Mountain Laurel closed.

The Free Clinics launched a free psychiatric clinic in December to help the people most in need, those who lack health insurance, Medicaid, Medicare and state reimbursements.

The Henderson County Board of Commissioners saved the Sixth Avenue West Clubhouse from being sold, voting to buy the clubhouse for $333,200.

Rosalie Hurst, a 91-year-old retired hardwood flooring dealer, offered to match up to $75,000 in community donations to the clubhouse.

Henderson County diverted a crisis, for now.

The statewide outlook remains bleak.

A recent study reported North Carolina needs to spend $2.7 billion over five years to correct the mental health system. Legislators doubt $500 million a year will be possible. Read more!

Mental health initiatives deserve wide support - Great Falls (MT) Tribune

Editorial
Gary Mihelish probably feels like a broken record.

The Helena dentist has been cajoling, sweet-talking and arguing for years in the name of the National Alliance on Mental Illness.

Progress has come erratically — two steps forward and one step back, he'd probably say.


Mihelish and fellow advocates for the mentally ill are approaching the upcoming session of the Montana Legislature with more than the usual amount of hope, for two reasons:

The state's cash flow is well into the black — the surplus is approaching a billion dollars; The sitting governor has indicated support for at least some of their causes.

In fact, Gov. Brian Schweitzer has $5.8 million in his budget to renovate the Xanthopoulos Building at Warm Springs, converting the old forensic unit into a secure, 120-bed psychiatric unit for court-ordered mentally ill offenders.

He also has money in the budget to staff the new facility.

Warns Mihelish: "It will not be successful unless the people who are released from that facility receive appropriate follow-up care."

That's the broken-record part of Mihelish's message. He and others have been trying for years to get beefed-up community services for the mentally ill.

In one of the sadder episodes in the history of how Montana treats the mentally ill, the state made a big push to "deinstitutionalize" patients, spreading across the state, usually in their home communities. The problem was that support for those patients has never been sufficient.

An upshot has been the "F" grade given by NAMI to Montana's mental health care system.

The state has few crisis beds for psychiatric emergencies, and the state ranks second in the nation in per capita suicides, which often result from untreated or improperly treated mental illnesses.

But there may be hope on that front, as well.

The head of the Department of Public Health and Human Services' addictive and mental disorders division said the administration wants very much to provide exactly the kind of community-based help that Mihelish seeks for the mentally ill.

"It's a big, aggressive budget to really better develop the community services," said Joyce DeCunzo. "This administration is keenly interested in mental health. That's a positive thing."

We couldn't agree more. The Legislature, too, should support these mental health care initiatives.
Read more!

Backers of parity hopeful - AP

The Associated Press

WASHINGTON -- After years of trying, advocates think they have a good chance of getting Congress to pass legislation next year that would require equal health insurance coverage for mental and physical illnesses, if their policies include both.

The legislation, named for the late Senator Paul Wellstone, a Democrat who championed the cause, has strong support in Congress but has run into Republican roadblocks. In the last congressional session, 231 House members — more than half of the chamber — signed on as co-sponsors. The Republican leadership, which in the past had expressed concern that the proposal would drive up health insurance premiums, would not bring it up for a vote.

In 2003, Senate Democrats tried to win passage of the bill as a tribute to Wellstone, who died in a plane crash the previous year. Republicans blocked an attempt to pass it by unanimous consent.

"I'm very optimistic that 2007 will finally be the year that our health care system recognizes that the brain is, in fact, a part of the body," said Congressman Patrick Kennedy, a Democrat who sponsored the bill in the last Congress. "We've had majority support for this legislation six years in a row, and now we have a chance to bring it to the floor and pass it."

Kennedy has worked to erase the stigma of depression and other mental health problems. He has been candid about his own mental health, including being diagnosed with bipolar disorder, and he has won praise for speaking publicly about suffering from depression since his teenage years, taking antidepressant medication and regularly seeing a psychiatrist. He has also acknowledged being in recovery for alcoholism and substance abuse.

Kennedy's lead co-sponsor, Republican Jim Ramstad, said a "silver lining" to the Democrats winning both houses of Congress is the increased chances of passing the bill, known as mental health parity.

"The Republican leadership would not give us a vote," said Ramstad, a recovering alcoholic who has pushed for improved treatment for those with alcohol and drug dependency.

Ramstad said that incoming House Speaker Nancy Pelosi has told him the bill will come up for a vote on the House floor, which Pelosi spokesman Brendan Daly confirmed.

"We need to deal as a nation with America's No. 1 health problem," Ramstad said. "It's not only the right thing to do, but the cost-effective thing do."

Prospects have also improved in the Senate. Incoming Majority Leader Harry Reid is a big backer of mental health parity, as is Kennedy's father, Democrat Edward M. Kennedy, who will chair the Health, Education, Labor and Pensions Committee next year.

A 1996 law already prohibits health plans that offer mental health coverage from setting lower annual and lifetime spending limits for mental treatments than for physical ailments. But backers want to see that expanded to things like co-payments, deductibles and limits on doctor visits. Read more!

New Research Strives To Understand How Antidepressants May Be Associated With Suicidality - Science Daily

Science Daily — The National Institute of Mental Health (NIMH), part of the National Institutes of Health, is funding five new research projects that will shed light on antidepressant medications, notably selective serotonin reuptake inhibitors (SSRIs), and their association with suicidal thoughts and actions (suicidality).

Studies have shown that most individuals suffering from moderate and severe depression, even those with suicidal thoughts, can substantially benefit from antidepressant medication treatment. However, use of SSRIs in children and adolescents has become controversial. In 2005, the U.S. Food and Drug Administration (FDA) adopted a "black box" warning--the most serious type of warning in prescription drug labeling--for all SSRIs. The notice alerts doctors and patients of the potential for SSRIs to prompt suicidal thinking in children and adolescents, and urges diligent clinical monitoring of individuals of all ages taking the medications. This can be particularly challenging because it is difficult for patients, their family members and practitioners to determine whether suicidal thoughts may be related to the depression, the medication, or both.

"These new, multi-year projects will clarify the connection between SSRI use and suicidality," said NIMH Director Thomas Insel, M.D. "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," he added.

The projects are listed below.

* Kelly Kelleher, M.D., of Columbus Children's Hospital and the Ohio State University, and Joel Greenhouse, PhD, of Carnegie Mellon University, will build on data initially collected by the FDA to analyze antidepressant medication use and suicidal behavior among youth, adults and older adults. Dr. Kelleher will use new and more sensitive statistical approaches to integrate data from numerous other studies--both randomized and non-experimental--to paint a more complete picture of the relationship between antidepressant medication use and suicidal thoughts or actions.
* Marcia Valenstein, M.D., of the University of Michigan, will examine the records of 994,000 individuals from the U.S. Department of Veterans Affairs National Registry for Depression, Medicare records and the National Death Index to determine what relationships exist between the use of antidepressants and suicide attempts and/or deaths, and use of any concurrent medications or treatments. The study will help determine the relative effectiveness of different depression treatments in reducing suicidal thoughts and actions.
* Wayne Goodman, M.D., of the University of Florida, will investigate if and how SSRIs may induce in some young people an "activation syndrome"--a set of symptoms such as irritability, agitation and mood swings that may lead to suicidal thoughts or actions. He will study this potential syndrome among pediatric patients diagnosed with obsessive compulsive disorder. By focusing on patients with a disorder that is less likely to be associated with suicidality, he will be able to better assess whether SSRIs are related to an actual activation syndrome, and whether suicidality is a component of the syndrome. The study will improve recognition and understanding of the syndrome, and help identify interventions that will reduce the risk of suicide.
* Sebastian Schneeweiss, M.D., of Brigham and Women's Hospital, will assess critical issues surrounding the safety of antidepressant medication use by comparing several large datasets of SSRI users. He will measure rates of suicidality; identify social and demographic factors that may be associated with SSRI use and suicidality; and examine the impact of FDA actions on use of SSRIs. The study aims to develop and better target prescribing and risk management strategies.
* Prudence Winslow Fisher, PhD., of the New York State Psychiatric Institute, will develop better and more reliable ways of monitoring for adverse reactions to the use of antidepressant medication. The study's long-term goal is to construct a standardized computer tool for adolescents and parents that could be used to screen for suicidality associated with the use of antidepressant medications.

In addition to these new projects, NIMH is currently funding other studies that aim to find the best treatments for individuals suffering from depression, and reduce or prevent suicidal behavior. Studies focused on youth depression and suicidal behavior include the Treatment for Adolescents with Depression study, the Treatment of SSRI-Resistant Depression in Adolescents, and the Treatment of Adolescent Suicide Attempters.

The National Institute of Mental Health (NIMH) mission is to reduce the burden of mental and behavioral disorders through research on mind, brain, and behavior. More information is available at the NIMH website, http://www.nimh.nih.gov. The National Institutes of Health (NIH) - The Nation's Medical Research Agency - includes 27 Institutes and Centers and is a component of the U. S. Department of Health and Human Services. It is the primary federal agency for conducting and supporting basic, clinical, and translational medical research, and it investigates the causes, treatments, and cures for both common and rare diseases. For more information about NIH and its programs, visit http://www.nih.gov.

Note: This story has been adapted from a news release issued by NIH/National Institute of Mental Health.
Read more!

Community is doing what it can - Hendersonville Times-News

If there was anybody in Raleigh who doubted that the state's mental health care system is broken, a report on the system released 10 days ago removed all doubt.

Consultants from Michigan and Florida who worked on the report fault North Carolina for failing to have a consistent, coherent philosophy, for failing to spend enough money and for continuing practices that led to continued reliance on large facilities while the state was saying it wanted more community-based treatment.

The report said many rural jails have become way stations for the mentally ill because rural communities don't have the agencies to provide treatment or medication.

As Gomer Pyle might say, "Surprise, surprise!" The Times-News has been saying the same things since we published a series back in February 2005 on how the mental health care reform ordered by Legislature in 2001 has created a mess.

To fix the problems, the report says the state would have to increase the money it spends on mental health care and substance abuse by $2.7 billion over the next five years.

That's hardly likely. Even with all the debate over fixing the system in the last Legislature, lawmakers succeeded in adding only $100 million for mental health services. That money might have helped New Vistas-Mountain Laurel, the mountains' main mental health care provider, avoid bankruptcy and stay in operation. But New Vistas officials say they never saw a dime of the money.

Thank goodness for the Henderson County Board of Commissioners and the local medical community. They have stepped forward to see that the most vulnerable among us can still get help.

The commissioners have pledged money from the half-million dollars a year they earmark for mental health care to ensure the continuity of services as people served by New Vistas switch to new care providers. They also agreed to buy the Sixth Avenue West Clubhouse for $333,000 and spend up to $117,000 on improvements and repairs. Without the commissioners, many people who need care would have ended up in local hospital emergency rooms, jails or homeless shelters.

Now the state has the gall to insist that commissioners pay the state nearly $223,000 to cover liabilities left when Trend Mental Health, the predecessor to New Vistas, closed its doors. Imagine that. The agency that has created the mess through miscommunication and mismanagement is taking money away from the one county in the mountains that has done the most to see that mental health care is available to those who need it. What a joke.

Recently, psychiatrists, nurses and the county's two hospitals joined to set up a free psychiatric clinic under the umbrella of the Free Clinics. The clinic will provide mental health care and critical medication to people who are uninsured or low income and do not meet state service definitions.

These efforts are hardly what the state meant when it said it wanted care to be community-based. But until the bureaucrats in Raleigh can get their act straight and provide the Legislature with some clear answers on how to fix the system, local officials and the local medical community will have to continue taking matters into their own hands.

Read more!

Agencies look to begin mental-health court program - Clayton (GA) News-Daily

By Daniel Silliman

dsilliman@news-daily.com

Seven agencies are seeking a $50,000 grant to start a mental-health, jail-diversion program in Clayton County, which would put misdemeanor and non-violent offenders, with mental-health problems, into court-monitored treatment instead of prison.Agencies look to begin mental-health court program

“This gets them out of the jail and in the position where they can really address their issues,” said Chief Magistrate Judge Daphne Walker, who has led the effort to start the Mental Health Jail Diversion Court. “This will keep them on the magistrate level and put them on a mental-health treatment plan.”

Walker estimates that about 10 percent of the people in the courts and in jail in Clayton County are suffering from some sort of mental illness. About eight percent of the more than 1,550 inmates in the county jail have been identified as having mental-health problems.

Some people with mental illness become repeat offenders because they’re not treated, she said, returning to jail on non-violent charges only a few days after they are released. The proposed jail-diversion program is focused on reducing that recidivism.

“The real measure of our success in the program will come when the accused does not re-offend, but instead completes his or her course of treatment, finds stable employment and housing,” Walker said.

The non-violent offenses Walker commonly sees, resulting from mental-health problems, include criminal trespassing, theft, shoplifting and drug charges.

“A lot of times they hear hallucinations, saying, ‘You need to take this,’” she said. “A lot of times the drug, in fact, induces some type of mental illness.”

The seven agencies – the Magistrate Court, the District Attorney’s office, the Solicitor General’s Office, the Public Defender’s office, the Sheriff’s Office, the Clayton County Police and the Clayton Center – signed a memorandum of understanding this month, outlining the need for a mental-health corps in the county, and agreeing to work together on the program.

Walker said Clayton County has more people with mental-health problems in its courts and jail than most other counties, because of Hartsfield-Jackson International Airport. The airport attracts homeless people with mental-health problems, she said, because it’s always open and warm.

“They just take trains or buses to the airport and they hang out in the terminals,” Walker said. “Because all the concourses are in Clayton County, we get all those arrests.”

District Attorney Jewel Scott said prosecutors see a lot of cases in which mental illness is an issue and they have to figure out different ways of approaching those cases.

Scott, who worked with mental-health cases before she moved to Clayton County and ran for district attorney, said the program would help her office prosecute cases appropriately.

“In crimes, you look at intent. With mental-health issues, they’re not in control. You can’t necessarily punish that person and send them to jail,” she said. “You put someone like that in jail, you have full blown psychosis and they don’t get treated. Our criminal justice system should be fair and that’s where this comes in.”

The new program will speed up assessments of mental-health problems, hopefully getting them done in 14 days. It currently takes two to three months to receive an evaluation.

Corrections officers, police officers, defense attorneys and other officials will be able to refer a defendant, who appears to be mentally ill to the program. The treatment will be monitored by the magistrate court “to make sure they’re on their medication, that they’re on their treatment, that they’re not committing additional offenses,” Walker said.

The seven agencies are seeking a grant from the Bureau of Justice Assistance to help fund the program. The BJA will review the application and make a decision sometime late next year.

“It’s something that’s badly needed. It’ll be a great day in Clayton County,” said Clayton County Sheriff Victor Hill. “The majority of the people in my jail, the charges might be aggravated assault, they might be fraud, or whatever, but nine times out of 10 the underlying problem is drugs or some type of mental-health problem.”

Mental-health assessments of defendants and inmates are important, even when they don’t change a person’s culpability in a crime, said Steve Frey, president of the county’s bar association.

“The symptoms are often confused with irritability, crankiness,” Frey said. “They’re cast aside as trouble makers. This [program] can more appropriately address their needs and society’s needs.”

A person is only criminally insane when they cannot tell the difference between right and wrong. Someone can have the ability to tell right from wrong – and be held responsible for the crime – but still need treatment, or can benefit more from medication rather than punishment, Frey said.

The program is slated for implementation in November 2007, Walker said. Even if it does not receive the grant money, the agencies will still attempt to get it up and running, using existing personnel. Read more!

A bad state to be sick in - Wilmington Star-News

Editorial

Here's what North Carolina does about mentally ill people: It throws reports at them.

The latest, from out-of-state experts, concludes that North Carolinians with mental illness or drug problems don't always get good continuous care.

We are mighty grateful for that unexpected insight. We had no idea.

These experts, like the tiresome parade of their predecessors, observed that the state's grand plan to move patients from hospitals into private mental health services closer to home has not been a spectacular success.

The state's dreamy optimists didn't make realistic plans and the state's windy legislators didn't provide realistic financial support.
Private providers have proven less than enthusiastic about taking on some of the most difficult patients, many of them without the wherewithal to pay. And in many places, particularly rural areas, there aren't enough private providers in the first place.

Of course, the mentally ill get care of a sort. In emergency rooms, homeless shelters, under bridges and in jails.

The latest report says it would cost $2.7 billion over five years to fix what's wrong. But the Honorables, even the ones who profess to care mightily about the mentally ill, quickly explained that such a sum was not remotely possible.

Earlier this year, the National Alliance on Mental Illness gave North Carolina's efforts a D-plus. South Carolina, not usually viewed as a beacon of enlightened humanitarianism, got a B.

Nothing much is likely to change in our state, however.

Reports are cheaper than help. Planning "reform" is easier than paying for it. Read more!

Texas Legislature should re-examine parity - Houston Chronicle

Employer-provided insurance for the treatment of mental illness helps companies and families.

Editorial

The Texas Legislature has declined to pass a law requiring insurance companies to provide equal coverage for mental illness. However, a mass of data should persuade lawmakers that insurance coverage for mental illness helps employees, families and businesses.

Only a handful of companies in the Houston area — the Houston Chronicle is one — offer equal health coverage for mental illness. Jim Hackett of Anadarko, a chief executive who has introduced mental health coverage at three companies, says the benefit added no more than 1.5 percent to company insurance costs. The Chronicle and other Houston companies that voluntarily provided mental health coverage paid about 1 percent more.

Meanwhile, as Hackett and others who have observed the phenomenon point out, at companies with mental health coverage, absenteeism and accidents drop as productivity rises. The increased efficiencies cover the slight insurance cost many times over.

The benefit to business and industry alone would justify equal coverage for mental health treatment. However, humanitarian concerns provide a moral imperative. About one in 10 workers and executives suffers from depression. Successful and inexpensive treatment would return most of these people, and their families, to reasonably happy, constructive lives.

Texas has long shortchanged the mentally ill, providing inadequate beds and clinics to treat all those who need it and cannot afford to pay the full cost. When private insurers don't provide mental health coverage, thousands of workers needlessly suffer the symptoms of mental illness, often leading to substance abuse problems and antisocial behavior that ruins the lives of everyone near.

Legislators eager for bipartisan accomplishment that advances the public interest need look no further than legislation to require equal coverage for mental health treatment. At a slight cost quickly repaid, everyone benefits regardless of party or ideology. Read more!

Courts try to address mental ills - Cleveland Plain-Dealer

Emphasis on treatment tempers punishment

John P. Coyne
Plain Dealer Reporter

Cleveland Municipal Judge Kathleen Keough keeps a foot-high pile of folders near her desk containing the records of hundreds of defendants who come through her court.

What's different about these lawbreakers is they are ill. Their health problems are not readily apparent to most people. But in most cases, the health problems are what got them into trouble.

All have been diagnosed as mentally ill.

In the past, defendants showing signs of mental illnesses, ranging from depression to schizophrenia, would linger in jail two to three times longer than other inmates while officials determined if they were competent to stand trial. Because the inmates need close supervision and daily medications, the cost of keeping them locked up was double that for others.

Today, judges and others in the justice system are trying a different tack. They see mentally ill defendants less as criminals and more as sick people who need help.

The change is prompting court officials to team with community mental health agencies to move these offenders through the justice system quicker.

In Cuyahoga County and a score of other Ohio communities, officials have established mental health courts. The program in Cuyahoga County derives from a Mental Health Initiative established three years ago to make recommendations on how to handle cases involving mentally ill defendants.

"One out of every 10 calls that police respond to involves mental illness," said Shaker Heights Municipal Judge K.J. Montgomery, who heads the initiative. "The goal is to have a place where police can bring someone who needs evaluation or stabilization so they don't languish in jail."

Rather than holding traditional adversarial proceedings, which can result in punishment or sanctions, judges in mental health courts try to place defendants with psychological problems into court-supervised treatment programs.

"We're not dealing with a high population of people with really good, secure home lives," Keough said. "We get people whose life has been in upheaval for years and who don't know any of their rights. No stability. Nobody really to count on."

Often, these people have burned the relationships they had with family, friends and employers.

Recent studies indicate that mental disorders affect one of every four adults in the United States. Yet, a recent U.S. Department of Justice study found that more than half the inmates in the nation's prisons and jails have mental health problems.

So why do so many mentally ill people end up in prison?

Part of that problem can be traced to the de-institutionalization of psychiatric hospitals, said Dr. Philip J. Resnick, director of forensic psychiatry at Case Western Reserve University.

In 1960, more than 550,000 people were in psychiatric hospitals throughout the country, Resnick said. With the closing of many of the hospitals, that number has dropped to about 70,000.

"The major factors [in the decline] were the development of anti-psychotic medications -- which permitted people to live in the community -- and the cost savings," Resnick said. "It's a lot cheaper to keep people in the community with mental health outpatient services than in hospitals."

But while many people anticipated that the money saved by closing state hospitals would be used to treat the mentally ill, it did not happen. Only about 10 percent of the savings went into treatment, said Dan Peterca, manager of pretrial services for Cuyahoga County Common Pleas Court. In many cases, care for the mentally ill became the responsibility of their families or by the individuals themselves.

That was the case earlier this year when a 27-year-old man barricaded himself in his house on Cleveland's East Side, holding his wife and children hostage. Negotiators from a police SWAT team tried to talk the man out of the house, but, according to the police report, "the male was highly aggressive, belligerent and paranoid."

The man, who was receiving disability payments because of his mental condition, felt police and the establishment were out to get him, the police report said. Finally, after a 10-hour standoff, police used a Taser to subdue the man. He ended up on the seventh floor of County Jail, a floor reserved for the mentally ill.

Peterca said some people with psychiatric illnesses stop taking their medicine because of unpleasant side effects. That results in mood swings and other unpredictable behavior. If the behavior becomes threatening or abusive, police make an arrest, putting a mentally ill person back into the custody of the state -- a situation that some people describe as the criminalization of the mentally ill.

Mental health officials believe that about 300,000 psychiatric patients -- the most-serious cases -- now fill the nation's prisons and jails.

"No one is suggesting that you go back to warehousing, but one of the consequences of pushing everyone possible out [of state mental hospitals] is that some become homeless," commit crimes and end up in prison, Resnick said. "In prison, the mentally ill are more likely to be victimized and not get adequate treatment compared to hospitals."

In the last two years, local courts have identified more than 1,000 defendants with some form of mental illness.

Peterca said the Mental Health Initiative already is helping law enforcement officials do a better job of screening and identifying those who need help and linking them to community agencies.

While under court supervision, these defendants know they must take their medications, pay their court costs and continue to interact with the judicial system.

Cuyahoga County Common Pleas Judge Mary Jane Boyle, one of five county judges overseeing cases with mentally ill defendants, said most crimes committed by the mentally ill happen when the individual is off his or her medications. "That is why it is so important for family members to make sure the person is getting his medications," she said.

Corey Miller, a coordinator for Recovery Resources, a nonprofit group that provides mental health programs and services throughout Northeast Ohio, said many of the inmates tell him they got into trouble either because they cannot afford to pay for their medications or they find it easier "to cope with the voices in their head" by turning to drugs or alcohol.

"A lot of the homeless have a mental illness but lack the services to deal with the problem," Miller said.

Keough, one of the five Cleveland Municipal judges to keep track of defendants with psychiatric illnesses, said the mental health docket gives these defendants the chance to receive the help they need to become more productive.

"Sometimes the best thing to happen to them," she said, "is when they get into court."

To reach this Plain Dealer reporter:

jcoyne@plaind.com, 216-999-4845 Read more!

Panel on deadly force eyes mental illness - New Haven (CT) Register

Angela Carter, Register Staff

NEW HAVEN — The city’s task force on the use of deadly force is considering an additional recommendation on policy and training tools to curtail police officer-involved shootings, specifically with regard to people with mental illness.

The 13-member group approved eight suggestions last month, but a ninth has been proposed by East Rock Alderman Edward Mattison, D-10, a task force member.

The Board of Aldermen formed the task force after four police officer-involved shootings in late 2004 and spring 2005 left three city residents dead and 10 officers on administrative duty. All but one of the officers since have returned to their regular assignments.

Mattison wants city administrators, Police and Fire department officials, professionals from the Connecticut Mental Health Center and emergency room staff members from Yale-New Haven Hospital and the Hospital of Saint Raphael to call a meeting on how to minimize criminal justice intervention when a mentally ill client has a crisis.

The recommendations will be submitted to the Board of Aldermen for review and any further action, once task force members decide whether to include Mattison’s idea.

He could not be reached for comment.

Dwight/West River Alderman Yusuf Shah, D-23, chairman of the task force, said he supports the proposal "wholeheartedly" because it has the potential to save lives when someone is a danger to himself, herself and to others.

"It’s critical for everyone to understand what’s going on, and to know the potential outcomes if you call the police," Shah said. "There is a disconnect in the consistency and continuity on how communication happens. If I didn’t learn anything in this task force, I learned there has to be a uniform way of communicating between the mental health community and the police."

Other recommendations already agreed upon include calling on Police Chief Francisco Ortiz Jr. to draft a general order outlining criteria for police crisis intervention teams and mental health clinicians to be called to an incident; retooling the Civilian Review Board; enhancing crisis- intervention training for police; and seeking state funding for mental health professionals who would respond to scenes around the clock.

The group supported a pilot program the Police Department is planning that would introduce Taser stun guns, if funding were approved by the Board of Aldermen. At $800 apiece, the Police Department wants to deploy 50 Tasers initially, with about 100 officers trained to use them.

Each device electronically records when it is taken out of a holster, the number of darts fired, time span between shots and other data that Ortiz said he would monitor daily and release publicly if not related to a pending investigation.

Angela Carter can be reached at 789-5614 or acarter@nhregister.com .12/26/2006
Panel on deadly force eyes mental illness
Angela Carter , Register Staff

-NEW HAVEN — The city’s task force on the use of deadly force is considering an additional recommendation on policy and training tools to curtail police officer-involved shootings, specifically with regard to people with mental illness.
The 13-member group approved eight suggestions last month, but a ninth has been proposed by East Rock Alderman Edward Mattison, D-10, a task force member.

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The Board of Aldermen formed the task force after four police officer-involved shootings in late 2004 and spring 2005 left three city residents dead and 10 officers on administrative duty. All but one of the officers since have returned to their regular assignments.

Mattison wants city administrators, Police and Fire department officials, professionals from the Connecticut Mental Health Center and emergency room staff members from Yale-New Haven Hospital and the Hospital of Saint Raphael to call a meeting on how to minimize criminal justice intervention when a mentally ill client has a crisis.

The recommendations will be submitted to the Board of Aldermen for review and any further action, once task force members decide whether to include Mattison’s idea.

He could not be reached for comment.

Dwight/West River Alderman Yusuf Shah, D-23, chairman of the task force, said he supports the proposal "wholeheartedly" because it has the potential to save lives when someone is a danger to himself, herself and to others.

"It’s critical for everyone to understand what’s going on, and to know the potential outcomes if you call the police," Shah said. "There is a disconnect in the consistency and continuity on how communication happens. If I didn’t learn anything in this task force, I learned there has to be a uniform way of communicating between the mental health community and the police."

Other recommendations already agreed upon include calling on Police Chief Francisco Ortiz Jr. to draft a general order outlining criteria for police crisis intervention teams and mental health clinicians to be called to an incident; retooling the Civilian Review Board; enhancing crisis- intervention training for police; and seeking state funding for mental health professionals who would respond to scenes around the clock.

The group supported a pilot program the Police Department is planning that would introduce Taser stun guns, if funding were approved by the Board of Aldermen. At $800 apiece, the Police Department wants to deploy 50 Tasers initially, with about 100 officers trained to use them.

Each device electronically records when it is taken out of a holster, the number of darts fired, time span between shots and other data that Ortiz said he would monitor daily and release publicly if not related to a pending investigation.

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Cyclical mental health care effects costly in Lee County - Ft. Myers (FL) News-Press

Turnstile approach leads many to prison

By Bob Janes
Chairman of the Lee County Board of County Commissioners

People in need of mental health care in Lee County have been facing a crisis for quite some time. Years, in fact. Years of neglect and cyclical care that's just not working.

People in need of mental health and substance abuse care continue to enter and exit a turnstile that one time may lead to a short-term care facility and the next time may lead into the state or federal prison system or even a juvenile justice facility.

Most times there is very little hope of breaking this cycle as there are too few beds available for long-term care. This ineffective pattern is costly to taxpayers because people in need are continuously in and out of our courts and criminal justice facilities. This is not the right venue for them and truthfully, the cycle is just plain cruel to people who truly are in need.

We need to realize that it is not a crime to need mental health care. But it is a crime to treat people with a mental illness as though they are criminals.

To exacerbate this issue, when a person with a mental illness is placed in a jail or justice facility, they may be given contradictory or less effective medications than they have been originally prescribed, causing physical and emotional reactions and unneeded stress on the individual. Controlling medical care in the criminal justice system is mostly a fiscal issue, not a best-medical care practice, and could provide a contradictory purpose to the person needing mental health treatment. For example, earlier this year in a Pinellas jail, an inmate plucked out his eye in frustration while waiting for treatment.

JAIL CRISIS

Once released from the jail or prison system, people in need begin living under short-term state care or in private facilities. When they are released from these temporary shelters, they often begin living on the street and then can end up without medication and back in the justice system. This is a broad example of the broken circle.

According to the Florida Department of Children & Families, more than 309 adults in crisis are currently being held in jails and prisons while waiting for one of the paltry 1,329 available state beds. For juveniles, there only are 158 beds available and half a dozen youth are awaiting care. Despite ever-increasing spending on correction facilities for both juveniles and adults, Florida's jail and prison populations are growing faster than we can build them.

On a national level, up to 700,000 people or about 6 percent of the 11.4 million adults booked into U.S. jails each year have active symptoms of serious mental illness. In Florida about 20 percent of the adult inmates are people with a mental illness.

Florida is not alone in this crisis but perhaps we can set a good example for what is needed. Turning our backs on this issue and pretending it does not exist is not the solution. Instead, the solution is a public-private team approach that will provide a smooth transition from a crisis situation to long-term private care.

STATUS QUO UNACCEPTABLE

The Florida Substance Abuse and Mental Health Corp., created by the Legislature last spring, of which I am an ex-officio member, will advise the governor on this very issue in 2007. The corporation has put together a Committee on Criminal Justice to examine this dilemma and to help develop a comprehensive mental health and substance abuse care plan for juveniles and adults. The committee is concentrating on developing a plan that includes diversion tactics to place people with mental health or substance abuse needs who commit minor infractions in alternative facilities rather than jails and prisons. The committee also will focus on in-care and after care services for both age groups.

The committee and larger corporations do recognize already-in-place local and state agencies and facilities that can provide the base network for people in need. It is looking to strengthen these with legislation, guidance and enhanced diversion and long-term services which means increasing expenditures for these services. Earlier this month, the Department of Children & Families developed a 13-point list of Forensic Waitlist Actions to help focus attention on the need for additional and diversionary care.

I want to bring these solutions into Lee County and help our existing facilities and programs fill in the gaps. This will take social and financial support. The Smart Growth Committee recently held a workshop where members discussed supporting this initiative. However, additional input and discussions are needed to make this partnership work.

Status quo won't do. The goal is to provide relief to our community by helping to thin out the jail population, keep people off of the streets and save money by taking people in need out of the court system and providing them with preventative care.
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New USC Department Chair Looks to the Future of Psychiatry - LA Downtown News

Imagine a world where the "bench" in the psychiatrist's office has no leather - and all the chairs are actually stools lined up along a metal lab table.

While there will always be a need for the traditional psychiatric clinician, the future of psychiatry involves a significant amount of bench research, noted Carlos Pato, chair of the Department of Psychiatry at the USC Keck School of Medicine.

Research into psychiatric neuroscience presents the tantalizing possibility that medications could stave off many crippling conditions that are only treated symptomatically now, he said. With the two-part game plan Pato has for the department, much of that research will come from USC.

"The USC Department of Psychiatry has traditionally had a very strong educational focus, training excellent clinicians to treat those with serious mental illness," said Pato, who came to USC from the Veteran's Administration in Washington, D.C., a year ago. "That mission is absolutely critical to advance. But in becoming one of the leading private research universities, USC is moving quite naturally into psychiatric neuroscience as well."

Pato defines genomic psychiatry "quite broadly," to be the study of genetic risk, gene expression, its functional impact and the interaction of those risks with environmental risks that lead to illness. "The promise of genomic psychiatry is actually developing a major way that medicine will be practiced, with the potential of defining the risks so you can intervene before people become ill."

Genomic psychiatry is a natural progression for "those of us who were looking at research opportunities in the 1980s and benefited from the beginning of the era of molecular genetics," he said. "Those tools really allowed us to open a new window on these tremendously disabling illnesses."

For centuries, he added, "We've suspected, or known, that many of these illnesses were familial. For example, if you have a sibling who's ill with bipolar, there's a 10% to 15% risk that you will have it. If you're an identical twin, the risk rises to 75%. Multiple studies show a genetically transmitted risk that's very important in whether or not you become ill."

At the same time, he added, "There are also environmental factors, such as an infection, nutritional status, anything in both external and internal environment. The trigger may be an in utero event. So these are complex disorders with a tremendous amount of genetic liability as part of the pathophysiology."

One of the projects already providing tantalizing prospects is a study looking at gene expression profiling from leukocytes in schizophrenia.

"It's the beginning of what might end up being a diagnostic blood test," Pato said. "It's one of a number of potential avenues that are still some time in the future."

USC is uniquely poised to take advantage of the new era of genomic psychiatry, he said, given that it has a number of researchers who are studying epigenetics, the heritable changes in genome function that occur without a change in DNA sequence. For decades, the sequence of DNA was considered to be the sole determinant of heritable information, but recent discoveries have drastically changed this view. So-called "epigenetic" modifications - changes to the chemical "switches" that turn specific genes on and off - affect hereditary information without the genetic code being modified.

The department is also recruiting new genomic research talent, said Pato, noting that recent recruit Jim Knowles, a professor of psychiatry, came to USC from Columbia University with a background in genetic psychiatry. More recruits will be coming, he said.

The traditional training role of the department will benefit from the "translational" aspect of the bench research, Pato added. "The interface between the science and the direct care of patients will improve care significantly. We're very cognizant of the need to work with things we can do today to improve the care delivered to our patients in Los Angeles."

In fact, said Pato, "We are equally committed to improvement in the traditional strengths of this department, in bringing together absolutely the best people who want to work with each other and improve the clinical and training missions. We are looking at how we can work with the state and federal government and community networks of providers to better the lives of our patients, to improve their care and to achieve the highest level of recovery in our patients."

Evolving the department to take advantage of both the latest science and improved clinical practice will take some time, said Pato, but is within realistic expectations. "We're looking for the synergy achieved by ideas that complement each other and produce new directions," he said. "I'm very optimistic."

Article courtesy USC HSC Weekly.
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Wisconsin declares hospital patients in danger - AP

MILWAUKEE - State inspectors declared patients at the Milwaukee County Mental Health Complex in immediate jeopardy last month after discovering a second patient had starved there.

Inspectors visited the hospital after the Milwaukee Journal Sentinel investigated the starvation death of Cindy Anczak, 33. When they arrived at the Wauwatosa complex, they learned a second patient had been hospitalized after losing 44 pounds in three months and becoming dehydrated. He also was overmedicated.

A report obtained Friday by the Journal Sentinel says the hospital faces 11 federal safety and health violations, and a spokeswoman for the state Department of Health and Family Services said it expects to issue an equal number of citations.

The state has stepped back from its declaration of immediate jeopardy - it's highest alert - after county officials agreed to make changes at the facility.

"We know that we have a lot of work to do, and we will do it," said Jim Hill, administrator of the county's Behavioral Health Division.

The hospital must submit a correctional plan to the state by Wednesday, and a follow up inspection is scheduled for Jan. 4, Hill said.

Jean Anczak, Cindy Anczak's mother, cried when the newspaper told her of the state's report. She said she was glad to learn the county is making improvements.

"Sometimes I think that God wanted Cindy to die so that others wouldn't have to," Anczak said. "Still, I wish like anything that I would have taken her out of there."

The state has cited the facility for improperly monitoring patients' eating in the case of Cindy Anczak and a 65-year-old man who has been transferred to an acute care hospital. It also said the hospital failed to protect two patients who were on suicide watch.

Scott O'Brien, 31, overdosed on the pain medication fentanyl in July 2005. Four months later, Debra James, 40, overdosed on morphine.

This is the hospital's second citation this year for failing to protect patients on suicide watch. State inspectors issued the first violation in August, after Anczak's death prompted a review of the hospital.

Inspectors did not address patients' nutritional care then.

But the November report looks in detail at how Anczak, who weighed 182 pounds when she entered the hospital on July 10, died. The 33-year-old woman suffered a heart attack and pulmonary embolism on Aug. 16. She had not had proper food or water for four weeks, her medical records showed.

Anczak's doctor told inspectors that staff members were supposed to monitor Anczak for dehydration, and she relies on workers to tell her when "something is amiss."

"I cannot possibly follow up on that many patients, being a consultant on the units," the doctor said in the report.

Inspectors and hospital officials told the Journal Sentinel that problems identified in Anczak's records after her death were not immediately corrected to ensure no other patients would suffer.

The Anczaks have filed notice of intent to sue the county for their daughter's death. In court documents, they say county officials know the hospital is understaffed and have been deliberately indifferent to problems there.

Information from: Milwaukee Journal Sentinel, http://www.jsonline.com
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Kentucky jail suicides declining - Louisville Courier-Journal

Crisis Network in Kentucky is saving lives at little cost

By Jim Adams
jadams@courier-journal.com

Suicides in county jails in Kentucky -- viewed as alarmingly high just five years ago -- now appear to be significantly declining, and numerous officials credit an innovative mental-health program set up by state lawmakers in 2004.

During a 30-month stretch in 2004-2006, the nine suicides in Kentucky's 83 county jails occurred at roughly half the rate as they did during a comparable period in 1999-2001, when there were 17 suicides, state records reviewed by The Courier-Journal show.

In addition, among just the 74 jails that now use the innovative program called the Kentucky Jail Mental Health Crisis Network, inmate suicides have been running at one-fifth the earlier rate -- a drop that, if sustained, would amount to a wholesale turnaround from 1999-2001.

"I know it's saved some lives," said Woodford County jailer Gary Gilkison, president of the Kentucky Jailers' Association, whose members were initially skeptical of the program.

The Crisis Network's designers and other experts believe the program offers a unique approach to a problem that has long bedeviled jails nationwide: It provides a round-the-clock telephone "triage" line, which a jail may call for advice from mental-health professionals about troubled inmates.

In the most serious cases, the Crisis Network can dispatch a specialist from a community mental-health agency to evaluate an inmate within three hours -- even in the middle of the night, in the far reaches of the state.

The program puts a great deal of attention on each inmate's mental condition just after arrest, a period of high risk for suicide. By providing face-to-face emergency evaluations, the program also fills a gap that once left many inmates in peril, particularly in rural counties.

And it all costs the jails nothing. The $2.1 million per year used to run the program is raised through a $5 increase in court costs paid by criminal defendants in circuit and district courts statewide.

Lindsay M. Hayes of Mansfield, Mass., a longtime jail researcher and a leading authority on suicides in jails, said evidence suggests that suicide rates have fallen nationally over the last two decades as awareness and prevention measures have increased.

He said he believes more time probably is needed to assess connections between the new Kentucky program and the suicide decline -- but "those numbers sound very encouraging."

Kentucky's program already has drawn considerable national attention.

Three mental-health officials flew to Phoenix a few weeks ago to accept an "Innovations Award" from the Council of State Governments. And more than 10 states have asked for briefings on the program from its architects, Ray Sabbatine, former director of the jail in Lexington, and Connie Milligan, who oversees the Crisis Network as director of intake and emergency services for the Bluegrass Regional Mental Health-Mental Retardation Board in Lexington.

The Bluegrass agency provides the service under a contract with the state.

Milligan describes the work of the jails, the triage line and the local mental-health agencies as being "like a relay race. A baton keeps getting passed to the next person to do the next phase of work."

No suicides for six months
The Crisis Network's effectiveness may have been seen from its very beginning. After the full program was launched in October 2004, Kentucky's county jails, which have 16,387 beds, did not have a suicide for 10 months, state records show. And there has not been a suicide in any Kentucky jail since June 15, more than six months ago.

"Any time the suicides are decreasing, it sounds like something is working," said Judy Devine of Danville -- whose 52-year-old brother, Edgar Martin "Junie" Strevels, hanged himself on July 4, 2000, in the Marion County Detention Center, where he had been held for nearly four months on a sentence for fourth-offense drunken driving.

But Devine also said she believes more still could be done, including closer checks on inmates put in cells by themselves.

And not everyone has embraced the program.

In Bowling Green, for example, city police and other officers decline to answer screening questions that jail officers pose about prisoners' behavior prior to arrival at the jail. That's because of liability fears from judgments officers might be making, according to city attorney Eugene Harmon -- fears Sabbatine say are misplaced.

Milligan and Sabbatine also say that some jails are not calling the triage line as often as they should.

And some jailers and mental-health workers worry that Kentucky still has no hospital beds for many jail inmates with serious mental illnesses, mainly those charged with violent crimes.

Nevertheless, state mental-health officials are elated over the Crisis Network's results.

Rita Ruggles, a program administrator for the state Department for Mental Health and Mental Retardation Services, said she believes the current, lower level of inmate suicide can be maintained.

"The real key is the partnership between the jails and the mental-health provider," she said -- a partnership that was nonexistent in some jails before 2004.

The program begins
The Courier-Journal published a series of articles in early 2002 titled "Locked in Suffering," reporting that 17 inmates killed themselves in 14 county jails between Jan. 1, 1999, and June 30, 2001.

That was roughly one suicide every 53 days. Many of the 17 inmates had drug and alcohol problems and were in jail for nonviolent or minor offenses.

The 2002 General Assembly reacted by setting up a $550,000 program to train jail officers in identifying suicidal tendencies. The state also began requiring that jails report suicides and serious attempts to the state Department of Corrections.

The 2004 General Assembly went further, adopting Sabbatine's idea for the Crisis Network and a related "Telephonic Triage." It also provided funding through the court cost increase.

Under the system, a participating jail can call the triage line to discuss an inmate's condition with a mental-health professional. Sometimes, the mental-health specialist will speak directly with the inmate.

The mental-health worker will then designate a level of risk for the inmate -- critical, high, moderate or low. That will guide the jail in how to place and monitor the inmate.

For example, inmates deemed at "critical" risk are typically put on either frequent or constant observation by jail staff, and might be strapped into a confining device called a restraint chair. At the same time, the triage line will arrange for the state-supported mental-health agency serving that jail's community to send a worker to evaluate the inmate.

By the end of 2005, the network had signed up 65 jails. By next month, the number will top 75 -- leaving only a handful of jails not participating.

Initially, the program provided annual payments to each mental-health agency equaling $121 for each bed in each participating jail in its region. This year, however, the payment dropped to $86 per jail bed, because income from the $5 court cost fee has been running about $500,000 a year less than projected.

In the state's largest jails, in Louisville and Lexington -- which have their own mental-health staffs under contract -- the network money is being used to expand mental-health services. In Louisville, for example, the jail and Seven Counties Services are developing a pilot project to increase services to mentally ill inmates once they leave the jail.

What the numbers show
In a review of state records this month, The Courier-Journal found that Kentucky jails reported nine suicides from Jan. 1, 2004, to June 30, 2006. That is one suicide every 101 days -- nearly 50 percent lower than the 17 during a comparable period in 1999-2001.

The numbers are even more dramatic when reviewing the jails participating in the Crisis Network.

Those jails have seen only three suicides in the almost 27 months the phone line has been operating statewide. That's one suicide every 271 days.

And Milligan and Sabbatine said that only one of those three jails called the line for help with the inmate who later committed suicide.

In other words, of more than 15,000 calls the line has taken from jails in the past 27 months, only one inmate who was "triaged" and evaluated went on to commit suicide. That inmate was in Daviess County, in Owensboro.

Milligan said the program has provided valuable insights into jail suicide. For example, of the 10,135 triage line calls in the year ending Oct. 31:

Just over one-third of the inmates triaged had been in a psychiatric hospital in the previous six months -- confirming that many inmates simply rotate between the justice and treatment systems.

One-third of the inmates reported a substance abuse problem -- confirming the frequent co-existence of alcohol and drug abuse with mental illness.

Two-fifths of inmates were deemed to be at high or critical risk for suicide.

Milligan said the program also has found that an inmate's stress or shame over the charge he is facing is "one of the most critical … variables" in assessing suicide risk.

"And that had not been in the literature," she said.

Reporter Jim Adams can be reached at (502) 582-4199.
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