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.

Angela Carter can be reached at 789-5614 or acarter@nhregister.com Read more!

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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Mental Health Court set - Tulsa (OK) World

By BILL BRAUN World Staff Writer

Tulsa County court officials are developing a Mental Health Court to address the treatment and supervision needs of mentally ill criminal defendants.

The specialized court will focus on people whose "criminal behavior is a byproduct of the mental illness," District Judge Rebecca Nightingale said.

A docket is projected to start in January or February on a one-day-a-week basis, with funding resources available to handle 50 people at this time, officials said.

Special District Judge Kirsten Pace is expected to handle the docket.

"There are far in excess of 50 people who qualify and have a need," said Nightingale, who will supervise the court's progress for the district judges.

District Judge Deborah Shallcross noted that "a significant number of people in jail have a serious mental illness."

The intent is to divert nonviolent offenders with significant mental ailments into treatment programs in the community, rather than keep them locked up in jail.

While the Tulsa County court system regularly handles civil proceedings related to mental health commitments, it has had no specialized approach to address the problems of criminal defendants with mental illnesses.

Participation is voluntary. Defendants must be competent for court purposes but also must be diagnosed with a serious mental illness, such as schizophrenia.

The expectation is that defendants who want to take advantage of treatment opportunities will not dispute the merits of their criminal charges, although program participants will be represented by public defenders or private attorneys to make sure their rights are protected.

Tulsa County prosecutors will have the authority to approve or deny an offender's participation in the therapeutic court.

"We will try to be a very fair and conservative gatekeeper," First Assistant District Attorney Doug Drummond said.

"Our position is that we are going to approach it similarly to how we approach Drug Court and be extremely careful in doing reviews on a case-by-case basis," Drummond said.

"With overcrowded prisons and jails, everyone in the criminal justice system is looking for other options that will still protect public safety," he said.

Defendants who are charged with one of many offenses -- including murder, manslaughter, robbery and rape -- will not be eligible for the court.

One crime that won't automatically exclude a defendant is assault and battery on a law enforcement officer -- a charge that often is indicative of a mentally ill person's behavior.

However, an aggravated assault and battery on a law enforcement officer will disqualify a defendant from consideration.

Letting a defendant who assaults and batters an officer, without inflicting serious injury, into this program "is an issue open for discussion," Drummond said. "We are mindful that our police officers are out there every day protecting us."

As proposed, mentally ill defendants will appear before a judge -- likely on a weekly basis -- and will face requirements related to counseling, medication, drug testing and supervision.

"This is a program of small bites," Nightingale said. "The idea is to help people get the right services so they can work their way through the criminal justice system."

The intent is "to try to treat people on an outpatient basis," said Rose Ewing, senior coordinator for local Drug and DUI Courts who is working on this project for the Community Service Council of Greater Tulsa.

Oklahoma County and a small number of other counties already have mental health courts.

State Sen. Brian Crain, R-Tulsa, said $120,000 in state money was allocated for administrative costs related to this Tulsa County program, with another $150,000 designated for anticipated treatment expenses.

"It is a true waste of money to take someone who is mentally ill or who has a drug addiction and to incarcerate them" if "we can regulate their conduct through treatment," said Crain, a former prosecutor.

Shallcross has said she can argue in favor of such "problem-solving courts" from either a "money standpoint or a human being standpoint."

"Problem-solving courts are being asked to deal with issues that the court system was never designed to deal with," she said.


Bill Braun 581-8455
bill.braun@tulsaworld.com




Mental Health Court has several goals

To achieve a better use of criminal justice resources by reducing the jail population and reducing repeated contacts between law enforcement and mentally ill people.

To increase public safety by reducing high recidivism rates and to reduce expenses by treating offenders in the community.

To provide a better quality of life for people with mental illnesses.

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N.Y. mental illness insurance coverage law signed - The Ithica Journal

By Dan Wiessner
Albany Bureau

ALBANY — Gov. George Pataki signed into law Friday a measure known as “Timothy's Law” that requires insurance companies to cover most mental illnesses as well as physical ailments.

“Timothy's Law is an important step to ensure that mental-health services are accessible to all individuals and families, so that they can receive beneficial assistance and treatment for mental illnesses,” Pataki said.

Opponents of the law are concerned that it will drive up insurance premiums and hurt small businesses.

The law provides insurance policies to cover a minimum of 20 outpatient and 30 inpatient visits per year for the treatment of mental illness. The state will cover the cost of insurance for companies with 50 or fewer employees, but larger companies will have to pay for additional coverage for illnesses such as schizophrenia, depression, and attention-deficit disorder.
The legislation is named after Timothy O'Clair, a 12-year-old Schenectady boy afflicted with mental illness who took his own life in 2001. His family had limited health coverage and had to give up custody of Timothy so he could qualify for state-funded treatment.

“To lose a life because we couldn't get treatment to an individual is more than motivation” for the law, said Assemblyman Paul Tonko, D-Amsterdam, who sponsored the bill. Tonko said he knew Timothy before he died.

Tom O'Clair, Timothy's father, has been pushing the measure for years and has been a fixture in the Capitol when the Legislature is in session. For the last week he has been holding a vigil outside the Capuitol urging Pataki to sign the bill.

“Anybody who knew Timothy knew how huge his heart was, and this law is a fitting tribute,” O'Clair said. “As Timothy was a gift to us, Timothy's Law is a gift to New York.”

Timothy's Law will take effect January 1 and last for three years. The Legislature will make a decision about continuing the law in 2009.

Some-business groups are disappointed that Pataki signed the bill, citing increased premiums and a vague explanation of how the state will fund the program.

“The bill fails on three counts,” said Chris Koetzle of Support Services Alliance, a small-business group. “It doesn't define the true cost of parity. It doesn't clearly tell us who is going to pay this unknown cost. It doesn't tell us how it's going to get paid.”

The state Business Council had been opposed to earlier drafts of the bill, but declined to take a position when the Legislature reached a compromise.

The cost of the law has been the main point of contention between supporters and opponents. No one is sure how big the increase in premiums will be, and estimates have ranged from a few million dollars to as much as $60 million.

Pataki said Friday that the cost is “superfluous” because most insurance companies already have mental-health options in their plans. The law, he said, just makes it a requirement.

And the cost of not having a mental-health-parity law is greater, said Shelly Nortz of the New York Coalition for the Homeless.

“Employers lose millions of dollars a year to a loss of productivity” resulting from mental illness, she said. The law will “help people attend work instead of being absent and help people complete treatment instead of interrupting it.”

Mental-health experts also widely support the bill.

“Timothy's Law represents the single most important piece of public health legislation ever passed in New York to address the problem of inadequate access to care for the treatment of mental illness,” said Seth Stein, executive director of the New York State Psychiatric Association. He added that people who once had to turn to the public health system for treatment would now have coverage, easing the burden on taxpayers.

The Assembly unanimously passed the bill, known as Timothy's Law, on Dec. 13. They had passed a more expansive version of it earlier this year, but it died in the Senate over concerns that it would drive up premiums and hurt small businesses. After a June compromise, the Senate unanimously passed it in September.

Pataki expressed concern Friday that because the law takes effect so soon, insurance companies may not be prepared to implement it. He said that Gov.-elect Eliot Spitzer and the Legislature must analyze the amount of time it will take. Read more!

Difficult challenges for mental health care of kids - Kansas City Star

Tammy Ljungblad | The Kansas City Star

A series of articles this week by Kansas City Star reporter Eric Adler chronicled the complicated challenges when a child has severe emotional or mental health needs.

The stories, focusing on a 6-year-old named Marcus, illustrated the many talented and caring people who perform this most necessary work.


Experts believe about 5 percent of children have severe mental or emotional disturbances, about the same percentage as for adults.

But children, unlike adults, crisscross through many entities —schools, juvenile courts, foster care, hospitals, clinics, private care centers.

Simply getting a proper diagnosis for a growing child, especially one who is not yet verbal, can be daunting for parents and other caregivers.

Factor in changes in what the federal government will pay for through Medicaid, and helping the child becomes even more difficult.

“A million moving parts,” is a term commonly used by advocates.

Both Missouri and Kansas are working toward aligning options so that children receive the best possible care.

Missouri, in 2005, passed legislation to form The Office of Comprehensive Child Mental Health, charging the multiyear project with this most important task.

A common complaint is that funding streams are still largely organized for the old model: state-run, in-patient care. Yet, today, society understands that children do best with a variety of programming, and if possible, without being separated from their families.

As one local expert said, “We know what we need to do ...”

Coordinating care and funding is a daunting challenge. Yet the most effective motivator is this simple fact: With excellent care, the children can improve.

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Parenting as Therapy for Child's Mental Disorders - NY Times

By BENEDICT CAREY

In school he was as floppy and good-natured as a puppy, a boy who bear-hugged his friends, who was always in motion, who could fall off his chair repeatedly, as if he had no idea how to use one.

But at home, after run-ins with his parents, his exuberance could turn feral. From the exile of his room, Peter Popczynski would throw anything that could be launched -- books, pencils, lamps, clothes, toys -- scarring the walls of the family's brick bungalow, and leaving some items to rattle down the hallway, like flotsam from a storm.

The Popczynskis soon received a diagnosis for their son, attention-deficit hyperactivity disorder, or A.D.H.D., and were told that they could turn to a stimulant medication like Ritalin. Doctors have ample evidence that stimulants not only calm children physically but may also improve their school performance, at least for as long as they are on medication.

But like most other parents, the couple preferred to avoid drug treatment, if possible. Instead, with the guidance of psychologists at the University of Buffalo, they altered the way they interacted with Peter and his younger brother, Scott. And over the course of a difficult year, they brought about a transformation in their son. He still has days when he gets into trouble, like any other 10-year-old, but he no longer exhibits the level of restless distractibility that earned him a psychiatric diagnosis.

''People are so stressed out, and it's so much easier to say, 'Here, take this pill and go to your room; leave me alone,' '' Lisa Popczynski said on a recent Monday after work. Peter sat on the couch, hunched over his homework, while her husband, Roman, occupied Scott, 8.

''But what I would say is that if you are willing to take on the responsibility of extra parenting, you can make a big difference,'' said Ms. Popczynski, an interior designer. ''I compare parenting to driving. We all learn pretty quickly how to drive a car. But if you have to drive a Mack truck, you're going to need some training.''

In recent decades, psychiatry has come to understand mental disorders as a matter of biology, of brain abnormalities rooted in genetic variation. This consensus helped discredit theories from the 1960s that blamed the parents -- usually the mother -- for problems like neurosis, schizophrenia and autism.

By defining mental disorders as primarily problems of brain chemicals, the emphasis on biology also led to an increasing dependence on psychiatric drugs, especially those that entered the market in the 1980s and 1990s.

But the science behind nondrug treatments is getting stronger. And now, some researchers and doctors are looking again at how inconsistent, overly permissive or uncertain child-rearing styles might worsen children's problems, and how certain therapies might help resolve those problems, in combination with drug therapy or without drugs.

The psychotherapy techniques intended for the improvement of interactions between parents and children have been used mostly for children who suffer from attention disorders or who exhibit aggressive or defiant behavior. But recently, mental health professionals have been studying their use for families whose children suffer from depression or other mood problems.

In a comprehensive review, the American Psychological Association urged in August that for childhood mental disorders, ''in most cases,'' nondrug treatment ''be considered first,'' including techniques that focus on parents' skills, as well as enlisting teachers' help.

And in its just-completed guidelines, even the American Academy of Child and Adolescent Psychiatry, an organization whose members strongly favor drug treatment, recommends that children receive some form of talk therapy before being given drugs for moderate depression, a very common complaint.

''We are at a point where families who bring in a child ought to get a Chinese menu of treatments that are backed by some evidence, including not only medication but psychosocial or family interventions,'' said Dr. John March, a child psychiatrist at Duke University. ''Not to do so when we know some of these therapies work is, in my opinion, simply unethical. Then let the family choose which one they want.''

The argument over which is better, medication or psychotherapy intended to change the behavior of parents and children, is irrelevant in many cases. A child paralyzed by feelings of severe despair or anxiety, for example, often cannot begin to engage in any type of therapy without a period on medication to break the disabling mood. And many studies suggest that the combination of medication and talk therapy is significantly more effective, and safer, than either alone.

Drugs, Therapy or Both?

''It's obvious that medication has been more effective than behavioral modification in treating the core symptoms of A.D.H.D., but behavioral treatments can produce real improvement, and for certain kids the combination of the two treatment appears to be best,'' said Dr. Oscar Bukstein, a child psychiatrist at the University of Pittsburgh School of Medicine who is helping the American Academy of Child and Adolescent Psychiatry write treatment guidelines. ''Children with other behavior problems in addition to A.D.H.D., for instance, seem to do best with both treatments.''

The Popczynskis found that a brand of family therapy by itself was sufficient to put Peter on track at school and at home. Their experience helps illustrate how a family can, in effect, treat a child's psychiatric disorder -- and for whom such an approach can be practical.

One thing the family had going for it was location. When Peter's mother began scouring the Internet for resources in the spring of 2003, she quickly learned that they lived only a few miles from the University of Buffalo, which runs one of the country's most comprehensive behavioral modification programs.

In a study involving 128 families, psychologists at the university had found that about a third of parents who completed the program saw enough improvement in their children that they had decided that medication was unnecessary. The other two-thirds put their children on stimulant medication at school but at doses significantly lower those typically prescribed, said William Pelham, a psychologist who is director of the Center for Children and Families at Buffalo and the senior author of the study. Eighty percent of the families who participated in the program, with follow-up parent training, decided that their children did not need medication at home.

''Most parents seeking help for a child with a psychiatric disorder never hear about programs like this,'' Dr. Pelham said. ''The only option they're given is medication. Now, it may be that the best treatment for that child is medication. But how do you know if you never try anything else?''

Behavior modification for A.D.H.D. and for related problems, like habitually disruptive or defiant behavior, is based on a straightforward system of rewards and consequences. Parents reward every good or cooperative act they see: small things, like simply paying attention for a few moments, earn an ''attaboy.'' Completing homework without complaint might earn time on a Gameboy. Parents remove privileges, like television and playtime, or impose a ''time out,'' in response to defiance and other misbehavior.

And they learn to ignore annoying but harmless attempts to win attention, like making weird noises, tapping or acting like a baby.

Tracking Behavior

These skills are hardly unknown to seasoned parents. But most also know that stress or anger, even when dealing with a child who has no serious problems, can sour the best instincts. That is why family-based programs insist that parents try to maintain a clear, neutral tone when instructing their children, or penalizing them.

Bluntness, for example, is a virtue. Saying to a child, ''Would you put your toys back in the box, please?'' turns a command into a question. Saying, ''Let's put your toys back in the box,'' implies collaboration. An unadorned ''Put your toys back in the box'' is clearer for everyone, psychologists say, especially so for a child who is highly distractible.

However it is dressed up, family therapy like this teaches parents to provide what many critics say children these days are missing -- discipline. But therapists make a careful distinction between corrective action and cruelty, between firmness and frostiness. Overly punitive parents increase the likelihood that a child will develop mood problems, some studies suggest. So parents learn not to become scolds, but to bring their children into line without demeaning them.

In some programs, parents play-act situations in front of their peers, who critique the performance for emotional tone and the clarity of parents' statements. As a result, the parents say, they become immediately more deliberate at home. ''You end up constantly saying things like, 'That's not an appropriate behavior,' using this unnatural language,'' said Ms. Popczynski. ''But the point is you don't get into it with them. The first thing I noticed was that I wasn't yelling all the time. The house got a lot quieter right away.''

Their instructions to Peter and Scott became more precise, as well. Saying ''Clean your room'' is too vague and covers a half-dozen tasks, Roman Popczynski, the boys' father, said. Peter might wonder where to start, or just decide it was too much to worry about, and give up, his father said. ''Put your laundry in the hamper'' is much more likely to get results, he said, and lead to the next clear step, like ''Put your toys where they belong.''

Multiple commands are also confounding: ''Put away your crayons, clear away the table, and organize your homework, please'' leaves a child wondering which to do first, and whether it is too much work to finish. ''It overloads a kid, and then he feels like he's failing, which only makes it worse,'' said Mr. Popczynski, who is a UPS driver.

Starting Slowly

Like most who try to use behavior modification techniques, the Popczynskis relied on a daily report card to keep a running tally of Peter's specific problem behaviors, like wandering attention, ignoring commands or defiance, and his efforts to correct them.

For instance, at the beginning, Peter, then 7, would get a check mark every time he ignored more than two commands to do his homework, put away his toys or brush his teeth, but he would earn immediate praise if he got started. He received check marks when he slid off his chair at dinner, and earned approval if he stayed seated.

At bedtime he accumulated marks if he pulled delay tactics. A tantrum resulted in instant punishment: a timeout of 5 to 10 minutes, shortened for good behavior. The report card was posted on the refrigerator.

The Popczynskis started slowly. They measured how many marks Peter recorded in a normal day, and at first rewarded him if he reduced the number by even one: with an extra 15 minutes on Game Cube, for example. If he had more good days than bad ones over the course of a week, he got to choose from a bag of toys from the $1 store.

Mr. and Ms. Popczynski continued to raise the standard, one checkmark at a time, until Peter hit zero consistently.

''You want them to be able to succeed,'' Mr. Popczynski said. ''If you make it too hard, they'll just give up, and so will you.''

The Buffalo program is more comprehensive than most: psychologists run a summer camp here, employing the same principles, and, during the school year, regularly visit the teachers of every child in the program. Those teachers who agree to cooperate -- most do -- keep daily behavior report cards for the child too, in effect providing full coverage for a child's every waking hour.

Even then, the therapy is far from a silver bullet or an automatic replacement for treatment with Ritalin or other drugs that are routinely prescribed for attention disorder based on many studies showing their effectiveness. The constant tallying and reminding is too exhausting for some parents, especially those raising children on their own and juggling outside jobs. The Popczynskis did well in part because Peter's difficulties were not severe, he was a capable student and his most disruptive behavior came out at home, Mr. Popczynski said. And the couple were able to share the many duties.

Yet most parents in the program have found that their children do best with a combination of the medication and family treatment, albeit with significantly lower doses of the drugs than typically prescribed.

Dawn Van de Wal, a single mother of three in Buffalo, said that over the last six months she has learned to contain and redirect the behavior of her exuberant 9-year-old, TJ, who has received a diagnosis of attention-deficit disorder. TJ can still become extremely frustrated when required to sit for long periods and concentrate on schoolwork, in the absence of his mother.

''I still give him medication for school, because the fact is that right now he needs it to get through the day, but it's a low dose,'' Ms. Van de Wal said while TJ practiced headstands on the couch. ''He doesn't take it at home, though, and I plan to reduce the dosage in time as much as I can.''

She added, ''I don't want him to look back and think the successes he's had are all due to a drug.''

In surveys and in dozens of interviews, most parents of children with psychiatric diagnoses say that they prefer to avoid using medications, if possible. It is not so easy to do. Insurers as a rule do not fully cover behavior modification therapies because they cost substantially more than drugs.

The therapies require an enormous commitment from already overloaded parents, and some children are too severely troubled to respond. Many clinics do not even offer the programs.

Psychiatrists, pediatricians and family doctors also tend to be more comfortable writing prescriptions for psychological reasons.

Shifting Perceptions

''It's a tremendous relief for the physician to prescribe something, because these kids are very tough, and it feels horrible to sit there and not be able to help,'' said Dr. Jennifer Mary Harris, a child psychiatrist practicing in Arlington, Mass., who has argued for more caution in using medication. At every level, she said, the mental health system strongly favors drug treatment.

Yet the increasing number of studies that support family-based behavioral treatment is shifting perceptions. The largest study comparing medication with behavioral modification therapy for attention deficit problems, released in 1999, found that drugs were more effective in improving children's ability to focus and keep still. But more than three-fourths of those treated without medication did well enough that their parents were able to keep them off drugs. And behavior therapy significantly improved children's reading performance and their relations with parents and teachers when combined with medication, the study found.

Researchers have also studied a different approach to behavior treatment, called cognitive behavior therapy. This approach engages children directly, and signs up parents as helpers. The children meet in groups to speak with a therapist, and learn elementary ways to identify and manage their anger, frustration and hopelessness. The parents learn in sessions how to reinforce those lessons at home.

Studies find that up to three quarters of children who suffer from depression, anxiety or obsessive-compulsive disorder find relief of their symptoms with the help of this kind of therapy, which usually involves once-a-week sessions for a few months or so.

Alicia Brzycki, a freelance editor who lives in Lawrenceville, N.J., said she noticed several years ago that her son was struggling more than usual with Tourette's syndrome, a neurological disorder that causes involuntary facial tics and limb movements.

The condition did not stop him from making friends or doing well in school, Ms. Brzycki said, ''but I think it was first grade, I realized that he was stifling the tics at school, and it created this boomerang effect, and they came out like mad at home.''

At the urging of a doctor, she took the boy, by then 9, to a program at Temple University in Philadelphia that specializes in treating childhood anxiety, which can exacerbate Tourette's. Therapists teach children to identify the thoughts that amplify their worries, and then defuse or moderate them. Ms. Brzycki and her husband attended sessions, too, and Ms. Brzycki learned she was unwittingly contributing to her son's anxiety. ''The main thing that came out for me was that I was being overprotective,'' she said.

She added: ''As a parent you want to protect a child from stressful situations, but by doing that you're creating an avoidance mechanism that can turn a minuscule anxiety into the big, bad wolf. I had to loosen my grip'' and let him face his fears.

Now in fourth grade, her son has helped make a DVD about Tourette's syndrome that he has shown to classmates. He has a close circle of friends, his mother said, and his tics seem to have diminished lately. But he sometimes still feels self-conscious and will talk himself through it, with his parents' help if needed.

Family-based therapy for a difficult childhood disorder is in almost all cases a way of life, not a weeks-long or months-long cure. If parents are serious about finding alternatives to drug treatments, experts say, they have to be willing to make difficult, and long lasting, changes to their behavior and the home environment, and to allow the child to progress at his or her own pace.

''You can't let your foot off the accelerator with something like behavioral modification for A.D.H.D., for example,'' said Dr. Gabrielle Carlson, director of child and adolescent psychiatry at Stony Brook University School of Medicine, who used the treatment for her own son. ''It's like making changes in diet and exercise to lose weight: you don't lose 20 pounds and then you're home free and can eat ice cream and cake again. No, it's a complete lifestyle change, and when you have a child with any of these psychiatric difficulties you have to stay on the program, for as long as it takes.''

Troubled Children

This is the last in a series of articles about the increasing number of children whose problems are diagnosed as serious mental disorders. The earlier articles examined one family's experience, the uncertainty of diagnosis, the use of combinations of psychiatric drugs and the transition to adulthood.

Resources and previous articles are online at nytimes.com/children

Correction: December 23, 2006, Saturday A front-page article yesterday about parents' influence in helping their children overcome psychiatric disorders misstated the age of TJ Van de Wal, whose attention problems have improved in response to parental techniques. He is 7, not 9. Read more!

DC mental-health chief to fix Medicare billing woes - Washington Times

By Gary Emerling
THE WASHINGTON TIMES

The director of the D.C. Department of Mental Health yesterday said the agency is working to correct its failure to obtain federal reimbursements for Medicaid services -- a breakdown that has been blamed in part for a projected $300 million shortfall in the District's budget over the next two years.

"Historically, a lot of money got left on the table," department director Stephen T. Baron said. "We're going back as far as we can go to really improve our performance in that area."

The Department of Mental Health and the Mental Retardation and Developmental Disabilities Administration received the majority of blame after D.C. Chief Financial Officer Natwar M. Gandhi said last month that the District was already $87 million over budget for fiscal 2007.

Mr. Gandhi also predicted that the city could be more than $215 million over budget for fiscal 2008.

The reasons cited for the overruns include that the two agencies often do not submit documents to receive federal reimbursements for Medicaid and Medicare services.

The District can receive a 70 percent match from the federal government for payments made for Medicaid services. Mr. Baron said his agency has submitted claims for the funds but has been largely unsuccessful at revisiting claims that are denied reimbursement.

"It's not that we're ignoring it," he said. "The initial claim goes in, but if it somehow gets rejected by Medicaid, we didn't have a structure to rework and resubmit the claim."

Mr. Baron said the agency is working to resubmit some claims filed in the past 27 months. There are roughly $10 million in rejected reimbursements the agency could potentially recoup, some officials say.

The department is planning to contract with accounting firm KPMG to help oversee the revenue collection, and the D.C. Council recently approved $1.5 million that will primarily go toward helping the agency improve its billing and claims processes.

Mr. Baron, the former president of Baltimore Mental Health Systems Inc., was nominated to lead the mental health department by Mayor Anthony A. Williams this year and officially took over in July.

He said he has met with Mayor-elect Adrian M. Fenty but does not know whether he will be retained in Mr. Fenty's administration.

"I very much would like to stay," Mr. Baron said. "We've begun moving the system forward. There's tremendous potential here."

Mr. Baron said the agency has made a number of improvements in the past six months. For example, the department broke ground Tuesday on a new St. Elizabeths Hospital in Southeast.

The $140 million building will house 292 patients -- about 130 fewer patients than the current hospital on the same site -- and will take 30 months to build, officials said.

The patients also will have their own rooms in the building. Some of the downsized population will be shifted to other hospitals, while others will be shepherded back into society with the oversight of wrap-around community services.

"The hope would be that St. Elizabeths would really reduce its acute care function," Mr. Baron said. "That would be shifted to the general hospital psych units, and St. Elizabeths would provide the intermediate and long-term care, and forensic care."

The department also hopes to roll out a program in the next two months that will create community liaisons for mentally ill inmates at the D.C. Jail.

The liaisons will be tied to five community-based service providers. They will aid prisoners while they are incarcerated and when they're released.

"I feel we have potential," Mr. Baron said of the program. "Everything takes a little while to work the kinks out, but I think we're laying the groundwork."
Read more!

News gatherers take vacation --- Will return 12/30/06

Read more!

Harris trial’s conclusion focuses on defendant’s mental condition - San Francisco Examiner

Adam Martin, The Examiner

SAN FRANCISCO - A mentally ill mother who threw her three children to their deaths off a San Francisco pier last October thought she was sending them to heaven, her attorney argued in closing statements Wednesday. But the prosecution said that whatever her motivation, the act was still murder.

Attorneys argued intent during closing arguments Wednesday at the trial of LaShuan Harris, 24, who pleaded not guilty by reason of insanity in the deaths of her children. Her attorney, Theresa Caffese, argued Wednesday that Harris, who has been diagnosed as schizophrenic, wanted to send the children to live in heaven, which she thinks of as a geographical place in which the children are still alive.

Prosecutor Linda Allen said that, even though Harris is mentally ill, she made a conscious decision to kill the children, knowing that death was a necessary step before they went to heaven. “She never said she thought they would be magically transported [to heaven]. She said they would drown,” Allen said.

Harris has not denied throwing Trayshawn Harris, 6, Taronta Greely, 2, and Joshua Greely, 16 months, over the railing of Pier 7 on Oct. 19, 2005. She faces three murder charges as well as three charges of assault on a child under 8 causing death.

During the trial, a cadre of psychologists and psychiatrists called by both the prosecution and defense testified that Harris is schizophrenic and prone to hallucinations. “She had been suffering from it before, during and after” the incident, said court-appointed psychologist Paul Good, whose statement that the schizophrenia caused Harris to kill her children was stricken from the record as conjecture.

“It doesn’t matter how we got here,” Allen said Wednesday. “When a mother intentionally kills her children, it’s murder.”

Earlier in the trial, the eight-man, four-woman jury saw a tape of Harris’ initial interview with police inspectors, in which she claims God asked her for a sacrifice, and she threw her children into the water instead of herself, knowing they would drown. “I guess it’s murder,” Harris said at the end of that interview.

The very same act that Allen referred to as murder, Caffese cited as evidence that Harris was delusional.

“The conduct confirms the delusion, because a mother doesn’t kill her kids unless she’s crazy, absent some other motivation,” Caffese said. Much of Caffese’s evidence over the course of the trial was meant to demonstrate that Harris was a devoted mother who would have no motivation to do her children harm.

The jury is expected to begin deliberating Harris’ guilt today. If she is found guilty, the trial will go into a second phase, in which the jury will determine whether she was mentally fit enough to take responsibility for her actions. Read more!

Schwarzenegger to study prison sentencing guidelines - AP

SACRAMENTO - Gov. Arnold Schwarzenegger said Thursday he will seek a review of California's prison sentencing guidelines, a politically risky undertaking that is part of a wide-ranging plan to address the state's burgeoning prison crisis.

The governor also is proposing an $11 billion building program to add space for thousands of additional inmates and changes to the state parole system.

Schwarzenegger characterized the state's prisons as in crisis and "in deep need of reform."

"My administration inherited a system that was dangerously overcrowded, poorly managed and out of control," he said during a Capitol news conference to release his plan. "Now we are at the point where if we don't clean up the mess, the federal court is going to do the job for us. As governor, I cannot let that happen."

His proposals come as pressure is mounting on the administration to fix a system widely seen as dysfunctional and dangerous to both inmates and guards.

Federal courts have taken authority over many aspects of prison operations, from inmate health care to treatment of the mentally ill. Judges have threatened to reach into the state treasury if lawmakers fail to fix the problems.

Last week, a federal judge gave the administration a June deadline to ease crowding that is aggravating violence, suicides and poor inmate health care. If it fails to meet it, the courts could order inmates to be released early or cap the prison population.

"Either we do it or the federal courts are going to step in and do it," said Sen. George Runner of Lancaster, the Senate's Republican Caucus chairman.

But he said many conservatives are concerned about Schwarzenegger's call to create a commission to review sentencing.

"We think the answer is incarceration for a longer term, not a shorter time," Runner said.

Schwarzenegger proposed a 17-member commission that would include four legislators, the attorney general, the corrections secretary, a judge and representatives of law enforcement and crime victims' groups. They would serve four-year terms.

Commissioners would spend their first year examining whether California's mandatory three-year parole period could be safely shortened for some ex-convicts.

Critics questioned whether the commission would be capable of proposing significant reform because it will not have authority to make changes in the law and its membership tilts heavily toward police, prosecutors and victims' relatives.

California has ignored previous sentencing reform reports and doesn't need another study group, said Rose Braz, a spokeswoman for Californians United for a Responsible Budget. The coalition of 40 prison reform groups sees Schwarzenegger's plan as nothing more than another "building extravaganza" that does nothing to ease crowding immediately, Braz said.

Senate Majority Leader Gloria Romero, D-Los Angeles, said sentencing and parole reform should be part of any prison construction package. If some inmates are allowed to leave prison earlier, sentences for other crimes could get lengthier, she said.

"This is where the debate does get tough," Romero told reporters.

Another pillar of Schwarzenegger's reform effort is creating more space for state prison inmates and those being housed in county jails.

The prison system is designed for about 100,000 inmates but houses 174,000. Many convicts are being held longer at county jails, overwhelming that system, as well.

Schwarzenegger already has implemented an emergency plan to transfer nearly 2,300 inmates to private prisons in other states. He now wants to add 28,000 beds at state prisons and 50,000 at the county level.

His proposal includes $4.4 billion for state prison construction and $4.4 billion in borrowing to help counties build jails and juvenile facilities. Counties would put up $1.1 billion in matching funds to add a projected 50,000 local beds.

Some inmates who currently go to state prisons would fill half the local cells.

Another $1 billion would go toward accommodating some 10,000 sick and mentally ill inmates, meeting the demand of a federal court-appointed receiver.

Schwarzenegger proposed $6 billion in new prison construction during a special legislative session last summer, but lawmakers adjourned without acting on his plan.

Responding to a reporter's question, Schwarzenegger said the money for the building program would come from a variety of sources, including the annual state budget and lease revenue bonds. Such bonds do not require voter approval and typically sell at higher interest rates than general obligation bonds.

He said it was better for the state to propose its own spending plan rather than waiting for the courts to impose reforms and take money from the general fund to implement them. That would take money from education and health care, Schwarzenegger said.

"That's not what we want," he said.

The budget the governor presents in January also will include hundreds of millions of dollars to track criminals on probation and sex offenders on parole.

During his re-election bid, Schwarzenegger supported the state's three-strikes law for repeat offenders and Proposition 83. The initiative, known as Jessica's Law, was approved overwhelmingly by voters and will increases sentences and parole terms for violent and habitual sex offenders.

On Thursday, Schwarzenegger said he would not favor a softening of the three-strikes law.

The governor announced his prison-reform plan a day after two former corrections secretaries testified in federal court. Both said they quit last spring because they felt pressure from top Schwarzenegger aides to trim reform plans as a way to curry favor with the prison guards union, the California Correctional Peace Officers Association.

Former acting Secretary Jeanne Woodford testified that she wanted to attempt sentencing reform then but was told it might affect the governor's re-election chances. Voters re-elected Schwarzenegger Nov. 7.

The union supports a sentencing commission and the governor's call for funding jail, medical and mental health beds, spokesman Lance Corcoran said Thursday. He called Schwarzenegger's earlier building plan "a Band-Aid approach to a long-term problem." Read more!

Free crisis psychiatric clinic hopes to help fill void - Hendersonville Times-News

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

When Mountain Laurel shut down Oct. 31, fear spread that the mental health patients most in need would fall through the cracks.

A new free crisis psychiatric clinic opened this month that hopes to fill the void.


The Free Clinics, based in Hendersonville, opened the psychiatric clinic inside the old emergency department at Pardee Hospital on Dec. 5. Each Tuesday, volunteer psychiatrists, nurses and social workers help Henderson County mental health patients handle crises. They also help the patients manage medication, free of charge. The clinic opens at 5 p.m.

The clinic represents the latest instance in which the community collaborated to tackle problems stemming from the state-mandated mental health reform of 2001. Another grassroots campaign saved the Sixth Avenue West Clubhouse, a staple in mental health care also threatened by the death of Mountain Laurel.

"The community has seen that there's a real need, and people have responded," said Susan Logan, a Pardee employee who volunteered as an intake nurse at the free psychiatric clinic.

When Mountain Laurel shut down, new agencies stepped forward to fill the void. But mental health care agencies can cherry pick clients, selecting those whose bills and medications would later be covered through insurance, Medicaid, Medicare or state reimbursement.

The chief executive officer of Mountain Laurel blamed cherry picking as one reason the agency died. Mountain Laurel served as the "provider of last resort," helping patients no other agency would treat. The Free Clinics feared the practice would continue, but with more dire consequences since Mountain Laurel would no longer be around to provide a safety net.

The Free Clinics estimated 300 to 400 mental health patients in Henderson County are uninsured, low-income and do not meet the state service definitions.

The week Henderson County received confirmation Mountain Laurel would be closing, community volunteers approached the Free Clinics about opening the new crisis psychiatric clinic to help bridge the gap for patients without access to care.

Pardee Hospital provided space. Also, six Pardee nurses and three psychiatrists are volunteering to provide mental health care through the free clinic.

Park Ridge Hospital in Fletcher and the Community Health Network are providing critical medication. A Park Ridge psychiatrist also volunteered for the clinic.

Pardee, Park Ridge and the Henderson County Board of Commissioners are helping pay for a new staff care management position, an employee who will assist at the clinic, follow up on patients and help patients apply for prescription assistance.

The psychiatric clinic accepts walk-in patients, but they should arrive about 5 p.m. It also accepts referrals from mental health care agencies and physicians.

More than 15,000 people in Henderson County lack health insurance and have low incomes. The Free Clinics treats patients with volunteers and then works to get them into the existing healthcare system.

The Free Clinics also holds a walk-in medical clinic, an adult dental extraction clinic, a diabetic life management clinic, an orthopedic clinic, an eye clinic and help with medications.

The free psychiatric clinic opened as a result of the Mountain Laurel closure. But it plans to stay open into the foreseeable future.

"As long as there's a need, we'll continue," said Pat Sells, a registered nurse and clinical services director for the Free Clinics. Read more!

Acute stress among soldiers tied to repeated tours of duty - LA Times

By Julian E. Barnes, Los Angeles Times

WASHINGTON - U.S. soldiers who serve repeated tours of duty in Iraq are more likely to suffer from acute stress in Iraq, according to a mental health survey released Tuesday by the Army.

Overall, 13.6 percent of soldiers reported suffering from acute stress in late 2005, when the survey was taken. Among soldiers serving their first tours, 12.5 percent reported suffering such stress. But among soldiers on their second tour of duty, the number reporting acute stress jumped to 18.4 percent.

``There is a sense that the yearlong deployments are challenging even if morale is good,'' said Lt. Gen. Kevin Kiley, the Army surgeon general. ``The normal things -- births, first steps, birthdays -- those are missed. When soldiers are on second or third tours, my sense is they feel that a bit more.''

The adverse effects of multiple, long deployments is a critical factor for military leaders as they consider increasing the number of soldiers in Iraq. If the White House orders a surge in troop numbers in a bid to control violence, the military probably would have to extend the tours of thousands of combat soldiers, keeping them in Iraq longer than a year.

In addition, the number of soldiers on their third tour is likely to increase next year, with the return of the Army's Third Infantry Division to Iraq, marking its third combat deployment.

Paul Rieckhoff, the founder of Iraq & Afghanistan Veterans of America, an advocacy group, said he expects to see the number of soldiers reporting acute stress increasing, especially if troop levels rise.

``It is a bad sign of things to come,'' Rieckhoff said of the report. ``There is a tremendous mental health toll to this war. That toll is only going to continue as we repeatedly ask the same people to sacrifice again and again. It is not just the equipment being run down; it is the people.''

Col. Edward O. Crandell, who helped oversee the survey, said it was too early to know why soldiers on second tours had higher stress levels. But he said the higher stress may be helpful -- a way to stay sharp in a dangerous situation.

``In some ways in the soldier's mind, it may be adaptive to maintain that heightened level of arousal,'' Crandell said. ``I have had numerous soldiers tell me: `I am going back. I need to be pumped. I need to be ready to do this.' ''

The survey did not examine the effect of extensions on mental health. But soldiers have reported in focus groups that stress rises near the end of their tours and that the long deployments are difficult, the Army researchers said.

Experts in military psychology said they believe the stress rates rise when tours are extended beyond a year.

``You are going to have all kinds of problems, discipline problems, all kinds of mistakes, misconduct,'' said Stephen N. Xenakis, a psychiatrist and retired brigadier general in the Army medical corps. ``Everyone feels things will go downhill by extending tours.''

The survey, known as the Mental Health Advisory Team report, is the third such survey the Army has released since the beginning of the war. The survey results are based on a year-old poll of soldiers, taken in October and November of 2005. Kiley said it took more than a year to analyze the survey data and then brief officials in Iraq and the Pentagon on the results.

He denied the results of the survey were held back until after the midterm elections. ``There was nothing nefarious in the delay,'' Kiley said.

Army officials have completed collecting 2006 survey data, but Kiley said there are no preliminary results from that poll yet.

The mental health report also found fluctuations in the rate of suicides among soldiers in Iraq. The rate in 2005 was 19.9 per 100,000, up from 10.5 per thousand in 2004. In 2003, the suicide rate was 18.8 per 100,000. The data is based on the actual number of suicides among soldiers in Iraq: 22 in 2005, 11 in 2004 and 25 in 2003.

``We consider one suicide to be too many,'' Kiley said.

Kiley added that the suicide rate in the Army has gone up and down over time and cautioned against reading anything into the swing in the number of suicides.

Kiley said the Army was concerned that soldiers on their second or third tours of duty in Iraq may be at an increased risk of post-traumatic stress disorder upon their return. But he said they have not found any link between multiple tours and suicide rates. Read more!

New Missouri director to lead makeover effort - AP

JEFFERSON CITY, Mo. - The Missouri Mental Health Commission returned to its past to pick a new director for an agency undergoing a makeover as a result of recent abuse and neglect allegations at mental health facilities.

Keith Schafer, 59, of Jefferson City, was announced Wednesday as director of the Missouri Department of Mental Health. He also served as director from 1986 to 1994.

If confirmed by the Senate, Schafer would take over Feb. 1 as the department implements recommendations from a pair of task forces.

Gov. Matt Blunt formed a task force in June after a St. Louis Post-Dispatch investigation found 21 deaths, 323 injuries and almost 2,000 other incidents tied to abuse or neglect by caregivers at mental health facilities from 2000 through 2005. The report also found the state didn't always follow its laws and policies in responding to the abuse and neglect cases.

The Missouri Mental Health Task Force released 25 recommendations last month, including tougher penalties for facilities, improved training to spot problems and less secrecy surrounding state investigations. The recommendations generally mirrored suggestions made by a separate panel appointed by the Mental Health Commission, which governs the department.

Schafer said he wants to ensure mental health patients receive "the best possible care in a safe environment," while giving them and their families a greater voice in the design of department programs and greater control over their services.

"The issue of consumer safety is just a fundamental expectation for any state agency serving vulnerable people, and particularly for the Department of Mental Health," Schafer said in a telephone interview. "We'll never be perfect, but we always have to strive to get better, and I frankly think that we can make some improvements."

Schafer said he was concerned that people receiving mental health services tend to die much younger than the general population. Their deaths are not necessarily linked to their mental health disorders but often to other medical conditions, Schafer said, adding that he wants to better coordinate patients' mental and physical health care.

Schafer said he also wants the department to make greater use of data in decision-making and to take a hard look at who is being served in state-run habilitation centers for the developmentally disabled and how well they are being served.

Blunt has proposed to close the Bellefountaine Habilitation Center in north St. Louis County, citing questions about patient mistreatment and excessive cost.

The Mental Health Commission said it chose Schafer largely because of his commitment to people with mental health disorders, developmental disabilities and substance abuse problems.

"Keith not only possesses the commitment, but also the administrative and technical skills that will help to make positive changes in the mental health system," said Mental Health Commission chairman John Constantino.

Schafer works for Comprehensive NeuroScience Inc., where he is director of program development and a senior account manager for its behavioral pharmacy management program and medical risk management program.

Department Director Dorn Schuffman resigned July 1. Since then, former longtime department employee and mental health commissioner Ron Dittemore has served as the interim director. Dittemore is expected to remain at the department until Feb. 1, said department spokesman Bob Bax. Read more!

Reform bid fades away amid hems and haws - LA Times

Steve Lopez

This will surprise no one who follows the Los Angeles County Board of Supervisors, whose history of inaction is the stuff of legend, but the biggest development at Tuesday's meeting was something that didn't happen.

The board failed to hire a national authority to help reform the county's juvenile justice system, which houses about 4,000 minors in nearly two dozen camps and juvenile halls. Many in the know call the system a mess, saying incarcerated kids are more likely to earn advanced degrees in crime than get attention for mental health issues, family dysfunction and other problems that got them into trouble in the first place.

So several county officials got together this fall and put out an SOS to Shay Bilchik, a former U.S. Justice Department official who audited the county Probation Department last year. They wanted him to create a master plan for reforming the system.

But the proposal, scheduled for review at Tuesday's meeting, was quietly pulled from the agenda. Bilchik had gotten a good look at the way the supervisors hem and haw about everything and asked to have his name withdrawn from consideration.

"I could see the infighting begin," said Bilchik, who runs the Child Welfare League of America in Washington, D.C.

Local reform advocates were steamed. They say the L.A. system is far too focused on warehousing kids in lockdown, and Bilchik was just what the county needed. He could have helped existing staff improve on education, prevention and crime-reduction in and out of the county's 22 juvenile halls and camps.

No one was more frustrated than Supervisor Zev Yaroslavsky. At the supes' Nov. 14 meeting, he urged his colleagues to approve an $860,000 contract immediately and get ahead of the curve for once, instead of allowing the juvenile probation problem to fester into another King/Drew-like fiasco that ends up costing millions of dollars.

"For the longest time, it's been patently evident to people who have monitored this area of probation that our system was failing," Yaroslavsky said. "This goes back a number of years, maybe seven or eight, that our system was just plain broken in every way, shape and form. And this county, in that period of time, was oblivious to it."

He warned that the county could face lawsuits directly related to a 2001 U.S. Department of Justice investigation of L.A. County's three juvenile halls. The feds found that conditions were so bad, minors "suffered harm or the risk of serious harm from the deficiencies in the facilities' medical and mental health care, sanitation, use of chemical spray, and insufficient protection from harm."

And then Yaroslavsky got personal, popping a quiz on his esteemed colleagues:

"Who said the following words, 'How could we have been so stupid for so long?' "

No one on the board answered. But in their defense, thousands of people might have asked how the board could have been so stupid for so long. Yaroslavsky thinned the herd by pointing to David Janssen, the county's chief administrative officer.

"Mr. Janssen said that — his panel. He also said, and I quote, 'The evidence is overwhelming. We are doing more harm than good,' referring to the kids under our jurisdiction. That's from our own CAO."

Yaroslavsky pointed out that Janssen, Probation Department boss Bob Taylor and Presiding Juvenile Court Judge Mike Nash were in agreement that Bilchik was the man to lead them out of the dark. Each of the three explained to the board why he had such unshakable confidence in Bilchik, but the supervisors were, in the words of one stunned reform advocate, "stuck on stupid."

Mike Antonovich wondered why there was such a rush to move on Bilchik "without a clear explanation of the problems," and he protested the idea of not considering other contractors — as if this were the first time.

Janssen politely referenced the well-documented nature of the crisis, explained that Bilchik was widely recognized as the go-to guy and said the county had diligently negotiated the contract down from roughly $1 million.

Dist. Atty. Steve Cooley may have influenced a few of the great minds on the board when he fired off a letter objecting to the Bilchik contract. Cooley told me he didn't appreciate being kept out of the loop, and he said he thinks the system is steadily improving and could be further improved without hiring an out-of-state consultant who might not be up to snuff on California law.

He admitted, as well, that he didn't like the looks of Bilchik's Child Welfare League website, which cites a report called "Get Tough Approaches Fail to Reduce Juvenile Crime." L.A. County would be better off, Cooley said, asking for help from the Countywide Criminal Justice Coordination Committee, which, as it happens, is heavily stocked with law enforcement officials.

"That's a joke," a reform advocate said of Cooley's viewpoint. "The CCJCC? That's what you do if you want to have nothing happen, because you don't have an independent review by someone familiar with reforms that are happening all over the country."

Despite Cooley's worries, the department heads who supported Bilchik have no interest in going soft on juvenile crime. They admit the system has some nasty kids who deserve to be punished. But their point is that if most of those kids are going to end up back on the street, everyone is better served by giving them alternatives to lives of crime.

"The inertia is against reform," said Yaroslavsky, who called juvenile facilities "the Harvard-Westlake" of criminal prep schools, sending many of their graduates on to Folsom and San Quentin.

It would have been useful for the supervisors to address the topic of differing rehab philosophies, but that would have been too much to ask. They were more concerned about whether the Bilchik contract might be extended to three years and cost closer to $3 million, and they did have some fair questions about other details.

Beyond that, there was much fulminating and little clarity. If you'd ever like to hear single sentences that contain more commas and semicolons than you'll find in all of "Moby Dick," a supervisors' meeting is the place for you. And you'll also hear nuggets like this one, from Supervisor Gloria Molina:

"Let's bring all the stakeholders and sing 'Kumbaya' about how to resolve the issues, but some of them are very troubling. They require — it's like a fire going on and you can't sit back and say, we'll be ready in December of 2007."

OK.

Supervisor Don Knabe was not to be outdone:

"Is there a reason why there hasn't been any conversations with the DOJ about, you know — I mean, because, right there, we know where we are, what we need to fix of the remaining items and yet you put before us a potential consultant to do some work that will be integrated into the solutions of what we need to finish because making the system better."

Taylor, the probation boss, made a valiant effort to paint a simple picture for supervisors.

"There are problems every which way. There is not one aspect of our system that is working on all cylinders, and the idea behind creating a blueprint, as I said, to get everybody together to create mutual expectations about what we expect everybody in the system to do…. And as far as Bilchik is concerned … this man's credentials certainly far exceed anybody else that you're going to find."

In the end, the supervisors delayed a decision at the Nov. 14 meeting, asking for more details on the contract. But it was too late. Bilchik has since had the good sense to run for the hills, and, as Yaroslavsky said, his withdrawal probably spared us six more months of incoherent rambling by the board.

So what now?

Yaroslavsky wants five county department heads to hammer out a Plan B, and Cooley intends to proceed with his call for the little-known Countywide Criminal Justice Coordination Committee to convene.

I'd like to be able to say this sounds promising, but something tells me we may be stuck on stupid a while longer.
Read more!

Court Orders Lawyer to Return Documents About an Eli Lilly Drug - NY Times

By JULIE CRESWELL

A federal court in Brooklyn overseeing product liability lawsuits against Eli Lilly’s best-selling drug Zyprexa has ordered the lawyer who provided company documents to The New York Times and other organizations and individuals to return the documents.

The internal Eli Lilly documents and e-mail messages detailed efforts by the drug maker to play down the health risks of Zyprexa, a medication to treat schizophrenia and bipolar disorder, as well as to encourage primary care physicians to use it in patients who did not have the disorder.

The documents, the basis for front-page articles on Sunday and Monday, were provided to a Times reporter and to organizations and individuals interested in mental health issues by James B. Gottstein. Mr. Gottstein, who is not involved in the Lilly lawsuits, is a lawyer representing mentally ill patients. He has sued the State of Alaska, accusing it of forcing patients to take psychiatric medicines against their will.

Lilly originally provided the documents, under court seal, to lawyers for plaintiffs who sued the company, contending that they developed diabetes from taking Zyprexa. Lilly agreed last year to pay $700 million to settle about 8,000 of the claims, but thousands more are pending.

Mr. Gottstein, who was not a party to the confidentiality agreement that covers the product liability suits, subpoenaed the documents in early December from another person involved in the suits, Dr. David Egilman, an expert witness for the plaintiffs, who was also named in the federal court’s order.

The order, issued yesterday by the United States District Court for the Eastern District of New York, requires Mr. Gottstein to return all of the documents provided to him by Dr. Egilman or any other source.

Mr. Gottstein was ordered to provide the court a list of people or organizations to which he gave the documents and to preserve all related voice mails and e-mail messages.

Mr. Gottstein said he was cooperating with the order and that he had asked the Times reporter, Alex Berenson, by e-mail and telephone, to return the documents.

George Freeman, a Times lawyer, declined to comment on the court order, other than to say, “Our customary practice is to retain documents which we legitimately required during our news gathering process and which are likely to be relevant to future reporting.”

The order did not name The Times or any other organizations or individuals who may have received the documents nor did it require them to turn over the documents.

Mr. Gottstein said he believed that he had followed the orders established by the court in the Zyprexa lawsuit when he subpoenaed Dr. Egilman for the Lilly documents. Dr. Egilman declined to comment.

In a statement, Michael J. Harrington, Lilly’s deputy general counsel, said: “Lilly is concerned that this deliberate violation of a court order and the selective disclosure of incomplete information may cause unwarranted concern among patients that could cause them to stop taking their medication without consulting their physician. We are pleased with the seriousness with which the court addressed this matter and look forward to Mr. Gottstein’s swift compliance with the order." Read more!

Opinions of mental health clients heard - Lakeland, FL, Ledger

By Robin Williams Adams

LAKELAND - In the efforts to reform Florida's flawed and underfunded mental health system, the opinions of the people who have mental illnesses are often dismissed or ignored.

But in Polk County and around Florida, the people who rely on mental-health services are becoming more vocal about the weaknesses and needs of the system.

About 60 people, most of whom rely on mental-health services in some form, met Tuesday in Lakeland to make their voices heard. They are part of an emerging effort, encouraged by the Department of Children and Families, to transform the system. At the root of transformation is this key principle: Give mental-health consumers greater input in setting priorities for spending, goal setting and treatment.

Transforming Florida's mental-health system will come in a myriad of ways. Major changes are needed, such as making it possible for people living on disability checks to get affordable housing.

Smaller changes would be welcomed as well, such as more benches and covered shelters at bus stops.

Those suggestions and more were voiced at Tuesday's meeting, which focused on housing, transportation and the stigma faced by people with mental illnesses. The issues were identified by mental health consumers at a meeting this summer.

Employment is another area likely to get more attention, said Doris Nardelli, co-occurring systems coordinator with Human Services Associates Inc.

"We are extremely supportive of this transformation," Jack Kuharek, adult mental health supervisor in Department of Children and Families District 14, told those gathered at Tuesday's meeting. "We want to see changes but they have to come from you."

Some attending the meeting at Michael Holley Chevrolet listened but didn't voice their opinions. Others were vocal and determined.

"We need more housing for people coming out of the group homes," said Cathy Burroughs, a former pharmaceutical company employee who was diagnosed in her 30s with bipolar disorder. She chaired the housing subgroup.

Housing needs to be affordable and accessible, she said, reminding others attending that "You're usually using a bus to get there."

Housing alternatives need to be found for people who are homeless, she and others said, and for families trapped into paying high rent year after year because they can't afford down payments toward a house.

"I don't care if it's a rundown house, just someplace to put me and my kids in and our six dogs," said Yvonne Reynolds, who is in an outpatient program through Peace River Center. With $700 rent and electric bills that reach $400, she said, "I could already have eight houses on what I'm paying now."

Because she has a family, she can't live in a group home. And her husband can't work full time, she said, because he needs to be available if she or one of their children with mental disabilities has a crisis.

The transportation subgroup, headed by Clarence Carrington, focused on public transportation. The bulk of the concerns revolved around the city bus system, including a discount on passes, having better bus routes at night for those trying to hold a night job and having trash cans at the bus stops.

For helpful changes to occur, people using mental-health services can't continue to keep silent about their illnesses, the subcommittee tackling stigma said.

"We need volunteers who are willing to speak publicly," said Carl Reed, who became involved with mental-health lobbying after a son was diagnosed with a mental illness. "They need to be consumers primarily, if possible, and also family members."

To do that, he said, they need to arm themselves with factual information and ask for a greater voice among decision makers, such as urging Peace River Center to have a consumer advocate on its board.

"When I look around this room, I see a tremendous number of consumers," said Scott Gibson, who uses his experience in coping with mental illness as an asset in his part-time job with Peace River.

"When we acquire knowledge, we acquire power. We've got to dispel misconceptions." Read more!

Analysis: New mental health performance measures begin - UPI

By Olga Pierce
UPI Health Business Correspondent

Performance criteria have already been developed for doctors who treat patients with conditions like cardiac arrest and diabetes, but now, doctors who treat patients with mental disorders will be subject to the same scrutiny.

The National Quality Forum, a public-private partnership of employers, insurers and providers -- considered the gold standard for performance measures -- has unveiled criteria by which providers will be measured for mental health prevention and treatment.

Because the forum was convened by a presidential commission, the standards have a special legal status.

"The 49 consensus standards comprise the next step in (the forum's) ongoing, multi-year effort to endorse a standardized set of measures for gauging and publicly reporting the quality of ambulatory care, bringing to 86 the total number of voluntary consensus standards for ambulatory care to date," the forum said in a statement Tuesday.

Performance measures have been in the spotlight as a multitude of payers, including the Medicare program, have begun requiring doctors and hospitals to collect and report how they score.

Increasingly, physician and hospital payment is also based on how providers measure up. Many private insurers already make some portion of provider income performance-based bonuses. Medicare is also poised to include more pay for performance. Several pilot projects have been launched and if the pay-for-reporting is successful, all physicians will be included.

More than 33 million Americans use health services each year at a total cost of about $104 billion per year. But an estimated two-thirds of adults and a third of children needing mental healthcare do not receive it, according to the National Mental Health Association.

The guidelines, aimed primarily at screening and prevention could help ensure those who need it receive care.

Patients with major depression or symptoms of bipolar disorders should be screened, the measures say, and greater effort should be made to identify children with attention disorders.

Those who seem like they might be suicidal should also be assessed for their risk of self harm, according to the forum.

Another area of treatment that could be strengthened by the guidelines is substance-abuse care.

Nearly a quarter of a million Americans are estimated to need treatment for alcohol or substance abuse, but many do not receive it.

Because of the guidelines, doctors will also be graded based on whether they screen possible substance abusers and refer them to proper care.

The addition of the mental health performance measures is part of an expansion of measures to address care in a variety of areas.

Measures are developed through a sometimes lengthy consensus process that involves physician specialty organizations and others. Initially, measures were only available for a few physician specialties and conditions. However, the mental health measures were just a portion of 49 new standards for bone and joint conditions, diabetes, and prenatal care.

"The National Quality Forum plays a vital role in bringing stakeholders from a multitude of disciplines together to develop and endorse measures," Susan Pisano, a spokesperson for insurance industry group America's Health Insurance Plans, told United Press International.

That process "plays an important role in making sure measures are valid." Read more!

Mental illness, trauma play role in rootlessness - Eureka (CA) Times-Standard

Sara Watson Arthurs / The Times-Standard
Eureka Times Standard

Talk to a dozen homeless people and you may find a dozen different stories, said Dr. Mary Meengs. The reasons people become homeless are varied and complicated, but mental illness and trauma often play a role.

”There are still people who think that the homeless are all just lazy,” Meengs said. “Everyone has a story of how they ended up in that situation.”

Meengs is one of two doctors at Mobile Medical Office, a nonprofit health clinic whose patients include local homeless people. She noted that the clinic also provides care to a lot of non-homeless patients.

In essence, it's a lot like any other primary care medical practice -- she and her colleagues treat diabetes and hypertension. They give flu shots.

But the clinic receives grant money specifically to provide health care to the homeless. Meengs said the federal grant defines “homeless” broadly, including people who are living in temporary housing.

Reasons for being homeless include:

Mental illness: Chronic mental illness is common among homeless people, said Meengs. People with severe mental illness often receive disability checks, which are stretched thin when it comes to paying rent.

”It's kind of hard to live on $807 a month,” she said.

Meengs said she and Mobile Medical Office founder Dr. Wendy Ring are both trained as family practice physicians, but often have to do the job of psychiatrists.

”Wendy and I are forced to do a huge amount of mental health, more than we would like, because it is such a huge need that is unmet in this community,” she said.

Domestic violence: ”A lot of people are fleeing domestic violence,” she said. “They don't have anywhere else to go.”

These women and their children are invisible. They try to keep a low profile, afraid of being caught, and are thus unlikely to be counted when agencies conduct a homeless census.

Post-traumatic stress disorder: Domestic violence can cause mental health problems such as post-traumatic stress disorder, Meengs said. And middle-aged homeless men are often Vietnam veterans who have suffered post-traumatic stress disorder related to the war.

Trauma: “A huge number of people we talk to have been sexually abused.”

Substance abuse: Meengs said it's related to mental illness, as some people with mental illness turn to drugs for “self-medicating” their symptoms.

Chronic pain or traumatic brain injuries: Since brain injuries can affect memory, survivors of such injuries may move into housing only to find they can't remember their apartment number, she said.

And while some health issues can lead to homelessness, other health problems can result from it. Meengs said people who aren't mentally ill to start out with can suffer emotional and mental problems from the stress of being homeless.

Frostbite and hypothermia aren't as much of an issue in Humboldt County as in colder climates, she said, but Mobile Medical's homeless patients often have foot and knee problems related to walking many miles a day.

Skin infections are also common, as patients get scrapes or cuts that then get infected, Meengs said.

Pamlyn Millsap, homeless coordinator for the Humboldt County Mental Health Branch, said she believes substance abuse, more than mental illness, leads to homelessness. People who are using drugs often don't pay the rent, or their behavior is erratic, making it hard to find or keep housing.

”We have very few affordable substance abuse treatment options in Humboldt County,” she said.

But Millsap cautioned against stereotyping homeless people as drug addicts or mentally ill. Everyone has a different story.

One woman she works with had had drug problems in the past but has been sober for years -- only to again wind up homeless when someone bought the place she had been renting. She and her son are now living out of their car, Millsap said.

Millsap said landlords tend to be choosy, requiring the first and last month rent plus a deposit, and wanting to see a credit history.

”There just are not a lot of landlords that want to rent to somebody who is homeless,” she said.


Sara Watson Arthurs can be reached at 441-0514 or sarthurs@times-standard.com. Read more!

Kids and Mental Illness, Day 3 - The Kansas City Star

Children will always blame themselves.”

Joe Beck, Spofford’s director of therapy services

.2 to .8% of children have obsessive compulsive disorder

2% of adolescents have obsessive compulsive disorder.

1 to 4% of young people, ages 9 to 17, have conduct disorder.

20 to 40% of depressed adolescents eventually develop bipolar disorder.

66% of children with depression have another mental disorder.

For a complete listing of mental health offices and agencies go to Kansas

City.com and click on Mental Health.

Beginning in July, reporter Eric Adler and photographer Tammy Ljungblad followed the plights of five children inside Spofford Home, a nonprofit residential treatment center, which offered unprecedented access for this series. The Star chose the children based on their stories and parental cooperation. Parents, who wanted to raise awareness about children and mental illness, gave signed permission to peruse medical records, to record therapy sessions, and to conduct in-depth interviews with them, their children, therapists and others. Interviews with dozens of mental-health experts, and more than 3,000 pages of local, state and federal reports, were also used to prepare this series.

Adler, 47, has worked at The Star since 1985. His work has won numerous awards, including first place from the National Headliner Awards and the American Association of Sunday and Features Editors. He lives in Kansas City with his wife, Tamara, and 9-year-old son, Aidan.

Ljungblad, 43, has been at The Star for 17 years. Her photographs were part of The Star’s 1992 Pulitzer Prize winning series. She has also won awards from the National Press Photographers Association and the Missouri Press Association. She lives in Prairie Village with her husband, Brian, and 7-year-old son, Brett.

Bill Luening edited the series, Charles W. Gooch designed the pages and Don Munday edited the copy.

Marcus’ behavior deteriorates, but his therapist feels she’s found a breakthrough. Read more!

Mending Marcus is no child's play - Kansas City Star

Stories By ERIC ADLER, The Kansas City Star

In this, the third installment of a four-part series about a severely emotionally disturbed boy, Marcus’ mom joins a therapy session and, trying to teach him empathy, stuns everyone with her own brand of shock therapy.

Kym Barrera spots her son in the doorway of the play therapy room. He wears red shorts and T-shirt and an angry stare. She throws open her arms.

“Hey, baby!” she says, “can I have a hug?”

At Spofford, a residential treatment center for mentally ill children, the play therapy room is where it happens — a thin rectangular room with shelves of toys, a white rocking chair, a dollhouse and beige paint on the walls. Here parents and kids gather hoping for some small miracles that can help them manage their lives.

Marcus, the 6-year-old whose disturbed mind and behaviors have kept him inside Spofford for more than two months, glowers, crosses his arms and turns his back.

Family therapy this afternoon is to help him understand that his stay at Spofford is not punishment. It’s about control, his behavior and choices. It’s also about Kym and Marcus seeing the world through each other’s eyes.

“Do you wanna give mom a hug?” Sarah Thibault, the young Spofford therapist, asks.

Night after night, Miss Sarah has been reading texts and papers at home, searching for insights into Marcus’ condition and clues to help him. More than bipolar and attention deficit hyperactivity disorders, Marcus may also have PDD-NOS — Pervasive Developmental Disorder Not Otherwise Specified, a vague neurological disorder related to autism and Asperger’s syndrome. It may explain some of his behaviors, why he seems oblivious to danger and others’ feelings.

Marcus tightens his mouth, pouts and fixes his gaze on the gray carpet. He says nothing.

“Marcus, come here,” Kym finally says. Her tone is impatient.

Head lowered, Marcus walks and stands contrite in front of his mother.

“Baby, come on,” she says. “I think something’s bothering you. I’m thinking you’re a little bit mad at mama.”

She also thinks: “What am I doing to my boy?”

Marcus feels abandoned; Kym knows that. She knows he feels he’s here because he causes trouble.

It’s the way children think — even those, unlike Marcus, whose parents abuse or neglect them. “Children will always blame themselves,” said Joe Beck, Spofford’s director of therapy services.

But Kym blames herself every day.

A few nights from now, Marcus would call and plead with his mom to take him home. They both begin to cry and can’t stop. She has to tell him no.

“I knew it would set him back to see me so upset.”

By her own account, Kym is “a drill sergeant.” She is hard on Marcus, although she wonders if sometimes she’s too hard.

“I want him prepared for adulthood, for what he’ll face as an adult with handicaps. … No one is going to give him any concessions. No one is going to give him a break, especially not me,” she says.

Kym recounted for Sarah everything she still sees in Marcus when he comes home on weekend passes: kicking, hitting, punching, asking for medication “I’m not kidding, 30 times a day.” “It’s ‘Mama,mama,mama,mama,’ ” she says. “He’s grabbing you and chasing you and pushing you and he’ll scream in your face.”

Kym feels overwhelmed.

Her 5-year-old son, Ricky, suspected of being autistic, is getting worse week by week, losing control of his behavior and his ability to speak. He soils his bed. With all she has to deal with — Marcus, Ricky, doctors, therapists, two other children — Kym has had to leave her gas station job. Adrian, Marcus’ stepdad, a boyish Mexican immigrant with a mild voice and manner, works 12-hour days for a landscape company. When Kym works, he cares for the four kids. They’re running low on money. Rosalyn, the 6-month-old, now has a fever and is developing a soft mass under her armpit.

Inside the therapy room, Kym feels a migraine coming on.

“I was wondering,” Sarah says. “Marcus did such a good job the other day — remember how we played in the sand the other day, Marcus? — I want you guys to work on making pictures of your world.”

She points to two sand trays, one for Marcus and one for Kym, at the center of the room surrounded by bins of toys.

“You can use as many toys as you want,” Sarah says.

“What are you makin’, mama?” Marcus asks. He looks cheery, happy that his mother is here.

“You want to see what goes on in mama’s world every day, Marcus?” Kym says.

In her sand tray, Kym has created a Norman Rockwell family scene with dolls and trolls as people seated around a long table filled with food. At one end there is a treasure chest stacked with the money Kym says she is saving to buy the family its own home.

“Here’s Marcus,” Kym says. She points to one of the figures: an ugly, naked troll.

His smile drops. His eyes look hurt, then angry.

“I hate that,” Marcus says. “It looks stupid.” He storms to the other side of the room.

Sarah urges him to use his “coping skills”: Push on a wall; count to 10 …

Kym’s tone grows tense as she describes her life filled with doctors’ appointments, making dinner, rarely being alone with her husband. The phalanx of state case workers who are “good at giving advice, not really good at listening.”

They harp about her dirty house, tell her to cook better meals, to take showers when the kids are in bed, to watch them more, to bring them in the kitchen when she’s cooking.

“Last time I did that I got second-degree burns down my arms,” she had said.

Still, she feels blessed to have a roof over her head, food on the table and four children and a husband she loves. She’s grateful for the care her boys get and the way the state and feds pay for everything, mostly through Medicaid, even the care at Spofford, which runs about $200 a day.

But Marcus … little Marcus. Will he ever have a normal relationship with kids? Will he ever have a loving relationship with a woman? Will he ever have a normal adulthood?

In therapy, Kym points to the incongruent gray elephant she put at the scene’s center.

“You know what this elephant is? This is my world,” Kym says, her voice tinged with fatigue. “This elephant reminds you that there are always other people around, always little ears, always someone else. … There always seems to be an elephant in the room.”

For a moment, everyone is quiet.

“Do you have any questions, Marcus?” Sarah asks.

Marcus looks at the troll.

“I’m naked,” he says.

They move on to his world.

His bin contains a warthog, a blue cowboy, dolls, three dump trucks, a canoe, a motorcycle, an orange T-rex, a snake and a bulldozer.

“This is my dad,” he says, quiet, sweet and still sad.

Kym leans close.

“… and my brudder and sister …”

Gradually, his face softens, then lightens. He smiles again. As he does, Kym reaches into the sand tray and picks up his toys.

Marcus looks at her — quizzical, momentarily confused.

Kym holds the toys poised above the bin. Marcus stares at them.

In one swift move, Kym plunges and grinds them nose-first into the sand.

Sarah’s eyes widen.

Marcus looks at the toys crammed into the sand. His moaning begins quietly as if far away.

His face collapses, eyes half-shut, in anguish. The sound he makes is barely human, the eerie keening of an air-raid siren.

“Why’d you do thaaaat!”

“Because I wanted to,” Kym says. She is impassive. “Why?” she asks, “Did that make you angry?”

Marcus’ moan grows, but without tears. His face switches from pain to anger. He squeezes his hands into fists.

Sarah can’t believe it. For five minutes, Marcus sat quietly — a huge advancement — he sat quietly and listened as Kym described her world and her frustrations and, then, she literally turned his world upside down.

Sarah knew Kym was going to do something. Earlier Kym told her Marcus didn’t understand empathy, or how much he hurts others when he tips their worlds upside down. She, Kym, wanted him to feel it, to know, to understand how it feels.

Calm then chaos. The therapists at Spofford know Kym cares for and loves her kids, but also they wonder if, in her own way, she is drawn to drama and chaos, creating it, in order to fix it. Kym: prosecutor and savior.

Marcus’ keening grows louder.

“Marcus, Marcus, Marcus,” Sarah says. “Let’s work on saying our feelings. How do you feel right now?”

“Mama made me mad!”

“I’m sorry, Marcus,” Kym says. She is controlled, instructing. “That wasn’t nice of me at all. You know how you sat there and watched mama touch all your stuff and turned it upside down and tried to break ’em? You know how that made you feel angry? Sometimes at home, when you play with all of my stuff, it makes me angry, too.”

Questions race through Sarah’s mind: Was it right for Kym to do what she did just as they were working to understand each other’s worlds?

But this is Marcus’ world. Kym is right in that way. So much of therapy is aimed at teaching mentally and emotionally disturbed kids to find control, to somehow walk the razor’s edge without slipping and to deal with the worlds they are given.

Sarah urges Marcus to refocus, to use his coping skills. He takes deep breaths, but he does not explode. Sarah is proud. He focuses. Slowly, he calms. His fists relax. His breathing slows. Once again, he plops himself in front of his sand tray. Again, he begins. He points out his family: brothers, sisters, dad.

“Is anyone missing?” Sarah asks.

Marcus is silent.

“When you were talking earlier you were saying that you kind of felt like maybe mom and dad abandoned you here. Is that true?” Sarah asks.

Kym interjects.

“There is nothing more that mama wants than to have Marcus back at home,” she says, “and not ever to come back. That’s what I want more than anything.”

“You do?” Marcus says. He looks at his mom.

“Yes, I do. You’re the first baby I ever had.”

“So, Marcus, are you here because your mom and dad hate you?” Sarah asks.

“My mom and dad love me,” he says quietly.

“So much,” Kym says.

“Am I going on pass today?” meaning going home, Marcus asks faintly, hopeful eyes.

“No,” Sarah says. “Not today.”

He looks at the carpet.

As they leave the room, Kym turns to Sarah.

“I noticed he totally left me out of his world,” she says.


Read more!

County to pony up $222,720 - Hendersonville Times-News

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

Henderson County will pay $222,720 to cover liabilities left from the closure of Trend Mental Health Services, even as it continues to deal with other fallout from the state's botched mental health reform.

Commissioners voted 4-1 to pay that sum to the state after an audit by the N.C. Department of Health and Human Services determined the county was liable for the debt. Vice-Chairman Charlie Messer voted against it, saying "I think some questions need to be answered."

Commissioners had moments earlier voted to buy the Sixth Avenue West Clubhouse, which houses a program for the mentally ill, for $333,200. The county was compelled to buy the property from mental health service provider New Vistas/Mountain Laurel after it closed Oct. 31 due to financial insolvency.

New Vistas/Mountain Laurel replaced Trend as part of the state's 2001 health reform. Commissioners chaffed at having to pay liabilities for Trend, which closed in June 2005, even as they deal with the fallout from the closure of New Vistas/Mountain Laurel.

"It's extremely painful for the state to penalize us, take money that we could spend towards mental health back into their bureaucratic coffers, which I find a disgrace," Chairman Bill Moyer said.

The county had no choice but to pay the money because of an agreement it signed in April 2005 to dissolve Trend as part of the state reform, county attorney Russ Burrell said. Through 2003, the state funded Trend through advance monthly payments, but after that switched to paying the agency for services it provided.

Trend operated in Henderson and Transylvania counties, with Henderson providing 86.5 percent off its funding and Transylvania paying 13.5 percent, County Finance Director Carey McLelland said. Transylvania County and Western Highlands, the regional mental health management entity, have already paid their share of Trend's debt, McLelland said.

Messer said he understood that any money left in Trend's coffers when it closed went to Western Highlands. He questioned if Henderson County was being forced to pay more than its share.

Commissioner Chuck McGrady, an attorney, said he looked through the agreement commissioners signed to disband Trend and could find no way the county could get out of paying. He said commissioners were not made aware of Trend's liabilities when they signed the agreement disbanding the agency.

"If I had known what the liability was back then, we would have dealt with it then," he said.

Moyer said: "It's hard for me to imagine that Trend was so out of control they billed for $220,000 they didn't provide."

The county spends more than $500,000 per year on mental health care and has about $100,000 currently in escrow for that purpose, County Manager Steve Wyatt said. But under the state reform rules, the county can't use that money to pay off the Trend debt. By paying the money before year's end, the county avoided financial penalties.

"We didn't have any choice," Commissioner Larry Young said.

Read more!

Hendersonville Clubhouse won't be forced to move - Hendersonville Times-News

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

The Sixth Avenue West Clubhouse, which provides help and a sense of belonging to about 50 local residents suffering from mental illness, won't be forced to move.

The Henderson County Board of Commissioners voted unanimously Monday night to buy the building near the YMCA that the clubhouse has occupied for more than 20 years.

The county will pay $333,200 to buy the facility from New Vistas/Mountain Laurel, the mental health service provider that shut down Oct. 31 due to financial insolvency.

Counting the purchase price, repairs and safety improvements, the county expects to spend as much as $450,000, Chairman Bill Moyer said following the vote.

"We do need to do some repairs right away," he said.

County leaders hope N.C. Rep. Carolyn Justus, R-Dana, will be able to secure half the total price tag in state funding.

"Carolyn Justus has been tremendously helpful, both on the capital side and the operations side," Moyer said. "Thanks to Carolyn, it should be a minimum of $200,000 (state funding) for capital."

Moyer said he has also spoken with leaders of Sixth Avenue Psychiatric Rehabilitation Partners, the nonprofit formed to run the effort, about a community fund drive.

"They have agreed to go on a campaign," he said. "We'd like to retire the mortgage right away. They are going to need it for operational funds." The campaign has already started. Rosalie Hurst, a 91-year-old retired hardwood flooring dealer who helped found the program, in November offered to match up to $75,000 in community donations.

For more than two decades, the Sixth Avenue West Clubhouse has provided help and services to residents with serious mental illnesses. But the future of the effort was clouded when New Vistas/Mountain Laurel closed Oct. 31. Leaders of the former mental health service agency said it would have to sell the property, which had been valued at $700,000, to cover outstanding bills, payroll and employee benefits.

Since then, county officials have been negotiating to buy the property to prevent it from being sold out from under the program. County commissioners had a "vital interest" in preserving the clubhouse because of its importance to the community, Moyer said.

Moyer said he has worked with J.W. Davis of Carolina First Bank to set up financing for the county to buy the facility and lease it to the program until state and private funds come in. The Sixth Avenue Psychiatric Rehabilitation Partners will operate the facility. The county will use its staff to make safety and other improvements.

"Our goal is to use our people to get safety things done, then we will recover the costs and try to get out of it," he said. "We didn't want to get involved in the operational side. We just wanted to be sure it stayed in existence for the benefit of the people, and this seemed like the best way to do it."

Read more!

Mistaken memo stirs fear of stranding mentally ill - Charlotte Observer

CARRIE LEVINE
clevine@charlotteobserver.com

In a bid to tighten rules governing transportation for mentally ill Medicaid recipients, the state mistakenly told counties to stop taking patients to some medical appointments, sparking confusion and concern.

The state memo said Medicaid would no longer reimburse counties for the transportation, which has been in place for decades, according to local officials. State officials now say the memo -- sent out in late October -- was incorrect. They issued corrected information late Monday.

County officials say the incorrect memo and the prospect of changes have sparked concern among providers about leaving their patients stranded. They're waiting to see the impact of prospective changes on the program.

"Everybody's very upset," said Grayce Crockett, director of Mecklenburg's mental health agency.

The memo should have only ordered counties not to pay for transportation for some services, such as treatment that occurs in the patient's home, crisis services that can't be scheduled and residential treatment, said Leza Wainwright, deputy director of the N.C. Division of Mental Health.

"Unfortunately, it was one of those things where when you're trying to address one issue, some other things got added that shouldn't have been added without further study," Wainwright said.

Wainwright could not say how many people will be affected by the changes, and said those numbers are tracked by a different agency.

Mecklenburg officials said the program is one of several transportation programs they run, and they could not immediately say how many people use it or how much it costs annually.

Mecklenburg County General Manager Janice Allen Jackson hadn't yet received the corrected memo Monday. She said the county is waiting for the state to clarify the rules, and continues to take patients to appointments.

Patients use some programs, such as group therapy, daily and are not always well enough to drive themselves or take public transportation, program administrators said.

Laura Thomas, group vice president at Carolinas Medical Center-Randolph, said the measure appeared aimed at cost-cutting, but could force the hospital to charge the county more if it goes through.

"I'm not getting paid any more than I was three months ago before this regulation," she said. "There's limited resources, and only so much you can cover."

Thomas said the hospital has roughly 80 patients who come regularly. Children participate in a school program plus group therapy several times a day, she said.

Cheryl Nicholas, the director of InnerVision Clubhouse, a program for patients with chronic schizophrenia, said she doesn't have enough staff or money to pick up and drop off patients if the current transportation program is cut.

"We're very concerned about it," she said. "The potential is great for clients to not be able to access us." Read more!

Lilly denies 'off-label' dealings - McClatchy Tribune News Service

BOSTON - Eli Lilly vehemently defended itself on Monday against allegations raised in a New York Times story that said the drug maker had inappropriately promoted its anti-psychotic medication Zyprexa.

In a statement on Monday, Lilly maintained that it has not promoted Zyprexa, a treatment for schizophrenia and bipolar disorder, for "off-label" use, an industry term that means using a drug to treat a condition other than those for which it has been approved by the Food and Drug Administration.

Although off-label use of drugs is not only legal but commonly practiced in the medical community, federal law prohibits companies from promoting their drugs for purposes that have not been approved.

On Sunday, the Times said that leaked marketing documents showed that Lilly promoted Zyprexa to primary care physicians for such unapproved conditions as dementia in the elderly. Zyprexa carries a warning that it should not be used in older patients with dementia.

"At Lilly, we do not engage in off-label promotion -- as alleged in The Times article," Dr. Steven Paul, Lilly's executive vice president for science and technology, said in a statement. "Lilly is committed to the highest ethical standards and to promoting our medications only for approved uses."

Lilly also defended promoting the drug to nonspecialists, asserting that about half of patients suffering from serious mental illnesses either cannot or choose not to access psychiatric care, relying instead on their primary care physician.

The Times said the Lilly documents were provided by attorney James Gottstein, who represents patients with mental illnesses.

Lilly has been in embroiled in long-standing litigation with Zyprexa users who claim the drug can trigger obesity and diabetes. Gottstein had subpoenaed the documents from a party involved in that litigation.

On Monday, Lilly asserted that the documents were released "illegally" and that they did not accurately portray Lilly's marketing behavior.

In 2005, Lilly agreed to pay $750 million to settle suits filed by 8,000 former users of Zyprexa, with thousands of cases still pending, according to the Times.

Approved in 1996, Zyprexa is Lilly's best-selling drug, garnering 2005 sales of $4.2 billion. The drug has been used by almost 20 million people worldwide, according to Lilly. Read more!

Resources needed to care for caregivers - Raleigh News & Observer

Peggy Lim, Staff Writer

Craig Olive stood before Johnston County commissioners last month not to discuss the register of deeds office that he leads, but a more personal matter: Mom. Olive, 41, has taken care of his mother, Pearl, for the past 12 years. Looking after the 81-year-old as she has descended into the clutches of Alzheimer's disease has been an emotional and financial drain, Olive says. But his mother wanted never to be in a nursing home.

Olive wishes he had more help. In Johnston County, a private nonprofit operates senior centers. But they're not for people suffering ailments such as dementia, stroke or Parkinson's disease. Until last month, Johnston County didn't even have an informal support group for caregivers.

Caregiver advocates say the lack of such programs in many parts of the state means North Carolina is sorely unprepared as its estimated 2.2 million baby boomers begin to hit their 60s this year.

"It's a shame we don't have an adult day care here," Olive told the commissioners, who are beginning to explore such options.

Similar to children's day care, adult day programs serve adults who may need supervision, social interaction and help with activities such as eating, walking or going to the bathroom. Relatives or friends can work during the day, then look after the adults at night.

North Carolina has 104 such programs in 56 of its 100 counties -- including 11 in Wake, two in Orange and one in Durham. A recent study by the Robert Wood Johnson Foundation showed that North Carolina could support about 138 more adult day programs, serving about 5,500 more older people.

The programs provide care for "not only the client, but also the family," said Michael Boles, president of the N.C. Adult Day Services Association. "If the family's burned out from care giving, that's usually what leads to placement [in a 24-hour facility]."

At $40 to $55 a day, adult day care can be more affordable for families than in-home aides, who can cost about $19 an hour. But the greatest advantage of adult day programs, Boles said, is socialization. The facilities are generally equipped to deal with people with dementia and physical and mental disabilities. "Everybody needs peers ... with similar dislikes, likes, problems."

Boles calls adult day programs the "best-kept secret in long-term care."

Most adult day centers in Wake County are not at full capacity, Boles said. But in many counties, lack of money means no help for families. "There's no money in this," Boles said.

Medicaid and other state sources help pay for about two-thirds of the participants in adult day care centers, said Boles, who directs six centers for Resources for Seniors in Wake County. But the reimbursements do not cover the full cost. Fundraising and money from sources such as United Way are needed to make up the difference.

That can be a challenge, particularly in more rural counties. Several adult day care centers were attempted in Johnston County in the 1990s, for instance, but they quickly closed because they were losing money.

Even if a community is a long way from getting its own adult day care program, advocates say, other measures can make providing for older adults easier on families. Caregivers, they say, could benefit from more counseling, support groups or simple respite -- a weekend off or a few hours to celebrate a birthday.

Strength from a circle

Smithfield resident Blenda Braswell, 63, knows how invaluable support groups can be. A doctor with the Duke Memory Disorders Clinic diagnosed her husband, Perk, with dementia in 1995. It hit her then: "I can't handle this on my own."

Braswell started going with her husband to an Alzheimer's caregiver support group in Durham about 10 years ago. The group has sustained her through tough times. Recently, they gave her solace when her 70-year-old husband was temporarily committed to Dorothea Dix Hospital after becoming aggressive because of a urinary tract infection.

"I got so much emotional support that I could actually be at peace," said Braswell, a bruise still visible on her brow below her gray hair.

Braswell has been a driving force behind starting a similar caregiver support group in her own county. In November, a group began meeting at First Baptist Church in Smithfield. The meetings offer caregivers a time to learn, vent, cry or just get out of the house. A few doors down, certified nursing assistants look after the loved ones.

Melanie Bunn, a consultant for the Eastern N.C. Chapter of the Alzheimer's Association, says it's the first support group in the state she knows of where long-term care centers have volunteered to provide staff on a rotating basis. Bunn hopes the program can serve as a model for how the long-term care community, nonprofits and families can work together in other counties.

Olive, the youngest of eight children and seven step-children, has been relatively lucky to have other family members to help him as a caregiver. Besides hired in-home aides, Jerry, a brother with mental disability, helps at home looking after their mother. Four other siblings take turns on the weekends.

Still, being a caregiver hasn't been easy. Olive has had to take off work for his mother's doctor visits. He has lived with the sour-sweet smell of his mother's portable toilet in the family room.

But Olive says, "She sacrificed for me when I was coming up."

Pearl Olive worked through the years in a cotton mill, on the family's farm and as a nurse at WakeMed.

Now, near the end of her life, Olive is trying to ensure that his mother has someone to feed, sponge-bathe and lift her 75-pound frame into bed each night. He wants that someone to be her son.

Staff writer Peggy Lim can be reached at 836-5799 or plim@newsobserver.com. Read more!

Lack of group homes means sending loved ones far away - The Washington Post

By Chris L. Jenkins
Washington Post Staff Writer

It was a decision that Peggy Kube thought she would never have to make: Her brother, Terry Leatch, a 50-year-old with severe mental retardation, needed a new group home with more supervision. He wanted to stay near his sister because their parents, who doted on him for years, were dead.

But there was no place for him near her Spotsylvania County home -- not in Fairfax, not in Loudoun, not in Prince William. So she did the once unthinkable and had him moved 200 miles from his sister "Peg" to a group home outside Lynchburg, Va.

"I can't imagine that this is what my parents ever wanted for him . . . being so far away from family after we tried for so long to have him near us," said Kube, 61. "They were focused on family, keeping our family together the best way they could."

Like Kube, several dozen Northern Virginia families have sent mentally disabled relatives to facilities hundreds of miles away over the past few years because there is no space for them at the area's few homes. Escalating land, labor and other costs have prevented enough homes from opening at a time when the region's population and health-care needs are rising.

Virginia has long had a poor reputation for caring for the mentally disabled, and the problem is particularly acute in its suburbs outside Washington, local officials said.

Nearly 1,400 Northern Virginians with mental disabilities get a Medicaid-funded waiver to receive services -- largely group home beds -- in the community in lieu of being placed in institutions. But because of funding shortages, nearly as many are on years-long waiting lists to receive this community care, which is cheaper than placing the mentally disabled in the large facilities downstate.

A 2004 University of Colorado report found that Virginia was 47th in the nation in funding for the mentally disabled.

As a result, the rare instance of a new Northern Virginia group home opening often follows one closing, advocates and local officials said. In addition, several agencies have scaled back operations to cut costs and stay open.

Gov. Timothy M. Kaine (D) included money for 170 more group home beds throughout the state in the budget he proposed Friday. But he did not include a $5.5 million annual increase that Northern Virginia providers had sought to help defray the higher costs of doing business in the area.

For families, the lack of facilities creates heartbreaking decisions and strained relations as visits become less frequent.

To health-care advocates, the situation makes no sense. For years, they have tried to move the mentally disabled out of large, distant facilities into smaller, community-based ones near family.

"It's been like we've taken two steps forward and are now taking four steps back," said Nancy Mercer, executive director of the Arc of Northern Virginia, an advocacy group for the mentally disabled. "We're undercutting the ultimate point of our system, which is to provide community care for people to live in their communities."

Mercer and parents of the disabled said that it is crucial to keep vulnerable children nearby to provide better care and to keep them in the kind of familiar settings that can ease their lives.

"We've seen a screeching halt of new development for residential providers in terms of their ability to grow and expand because for years the [state reimbursement] rates haven't kept up with the cost of doing business," said Alan Wooten, director of mental retardation services for the Fairfax/Falls Church Community Services Board. "When you have a shift like this, it creates hardships on the families because they are no longer able to provide some natural supports and visitation."

At the same time that beds in Northern Virginia have been unable to keep pace with demand, a rising number of group homes have opened elsewhere in the state, including in the Appalachian southwest and Shenandoah Valley, where costs are far lower. For instance, this year, Northern Virginia received about 25 new slots for group homes, but that put only a small dent in the waiting list of more than 1,000 in the region, activists said.

State officials said they are generally aware of the decisions many Northern Virginias have to make about group home placements and acknowledged that they have not set up specific programs to address the issue. Several said that in some cases, living away from parents should be an option for the disabled just as it should be for those without disabilities.

"It's certainly a complex situation. But if the adult child wants to stay near their parents, and the parents want the child there, it would be good to do that," said Paul R. Gilding, director of community contracts for the state Department of Mental Health, Mental Retardation and Substance Abuse Services. "But unfortunately, sometimes that can't happen."

Advocates and state officials in Maryland said that, as in Virginia, there are waits of several years for similar services but that they aren't aware of families having to send relatives far away, partly because the state is smaller. Advocates in the District said they are not aware of disabled adults being placed in group homes elsewhere, either.

Activists in Northern Virginia estimate that 70 families have sent mentally disabled adult relatives elsewhere since 2001.

Edith Brinkley, 83, of Fairfax County sent her son Jay, now 53, to a Harrisonburg group home a few years ago because a small facility in the county was closed. The Shenandoah Valley group home was the only place that could meet his needs. She characterized the decision as a devil's bargain of sorts -- balancing the needs of keeping her family members close with the only options they had.

"Of course we want what's the best for my son, the best care," Brinkley said. "But it's important for him, for us to remain together. I thought that's what we've been fighting for all these years."

Jay has been gone for four years, she said, and she visits only once a month, when her daughter drives her the 120 miles.

"It just isn't the same," she said. Read more!

Playing Down the Risks of a Drug - NY Times

Editorial

It was bad enough when studies showed that the newest and most heavily promoted drugs for treating schizophrenia weren’t worth their high cost. Now the disturbing tale of their excessive use has taken a tawdry turn with revelations that Eli Lilly, a pharmaceutical giant, has consistently played down the risks of its best-selling antipsychotic drug, Zyprexa, and has promoted it for unapproved uses.

The details were spelled out in The Times this week by Alex Berenson, who drew on hundreds of internal Lilly documents that have surfaced in legal proceedings. Although Lilly says the documents present an inaccurate picture, they offer persuasive evidence that the company engaged in questionable behavior to prop up its best-selling drug, which creates almost 30 percent of Lilly’s revenue.

Zyprexa belongs to a class of drugs that were billed as a significant advance over the first generation of antipsychotic drugs but turned out to have serious flaws. Zyprexa, for example, has a tendency to raise blood sugar and to promote obesity, both of which are risk factors for diabetes. Some 30 percent of the patients taking Zyprexa gain 22 pounds or more after a year on the drug, with some gaining 100 pounds or more. Yet the documents show that Lilly encouraged its sales representatives to play down these adverse effects when talking to doctors.

The documents also show that Lilly encouraged primary care physicians — far less sophisticated than psychiatrists in treating mental illness — to prescribe the drug for older patients with symptoms of dementia even though it was approved only for schizophrenia and bipolar disorder. It is illegal for companies to promote drugs for unapproved uses, but nearly every major drug company is under civil or criminal investigation for alleged efforts to do so.

Lilly contends that it has never promoted Zyprexa for unapproved uses and has always shown its marketing materials to the Food and Drug Administration, as required by law. Both claims ought to be tested in Congressional hearings that should focus on how well the industry complies with existing laws and how effectively the F.D.A. regulates the industry’s marketing materials. Read more!

Elizabeth Smart kidnapper still mentally unfit - Deseret News

Deseret Morning News, Monday, December 18, 2006

A man accused of kidnapping Elizabeth Smart in 2002 again was declared mentally unfit to stand trial Monday after screaming at a judge to "forsake those robes and kneel in the dust."

Brian David Mitchell was removed from the courtroom after a loud stream of outbursts. Third District Judge Judith Atherton also reviewed a doctor's report that said he is not participating in therapy.

"I find the defendant continues to be incompetent to stand trial," Atherton said.

Mitchell and his estranged wife, Wanda Barzee, 61, are charged with kidnapping Smart from her home in June 2002. She was 14 at the time.

The hearing was delayed for more than two hours so Mitchell could be transported from the Utah State Hospital in Provo, where he had refused to leave.

The judge, who had not seen him for a year, demanded that Mitchell appear. Once inside the courtroom, however, his appearance was brief.

"Repent ye, repent ye. Forsake your idolatry," said Mitchell, his wrists restrained with a chain around his belly.

"How dare you sit in those filthy robes, those robes of false priesthood. Forsake those robes and kneel in the dust," he told the judge.

Mitchell, 53, had made similar outbursts at previous hearings.

He and Barzee so far have been found unfit to face charges tied to Smart's nine-month odyssey, from Salt Lake City to California and back to Utah, where they were discovered walking a suburban street in 2003.

In Barzee's case, her attorneys are asking the Utah Supreme Court to overturn Atherton's order forcing her to take medication to restore competency.

Doctors have been trying to treat Mitchell without drugs. But after the scene in court, prosecutor Kent Morgan said a similar request to forcibly administer drugs likely would follow.

"He's not competent. It's because he's not participating in any therapy," Morgan said.

Mitchell's attorney, Vernice Trease, disagreed that her client was incompetent simply because he wasn't participating in therapy. As she made her argument, Mitchell could be heard ranting in the holding area next to the courtroom.

The judge set a hearing for Jan. 12 to start the process toward determining if Mitchell fits the U.S. Supreme Court requirements for forced medication.

"I believe his behavior is somewhat controllable," Morgan said after the hearing.

Mitchell and Barzee are charged with aggravated burglary, aggravated kidnapping and aggravated sexual assault. They also are accused of attempted aggravated kidnapping, a charge linked to one of Smart's cousins.

No one from the Smart family attended the hearing.

© 2006 Deseret News Publishing Company Read more!

Schizophrenia compounded by other health woes - Indianapollis Star

By T.J. Banes
tj.banes@indystar.com

People with schizophrenia are more likely to suffer from chronic health conditions than those without mental illness, according to a new study funded by the National Institute of Mental Health.

This news is based on research published in the November issue of the Journal of General Internal Medicine.

The study, written by Caroline Carney Doebbeling, associate professor of psychiatry and medicine at the IU School of Medicine, reports that people with schizophrenia are more likely to have one or more of 46 chronic health conditions, including cardiovascular, pulmonary, neurological and endocrine diseases when compared to individuals without mental illness.

One-third of those with schizophrenia had three or more chronic conditions needing a doctor's care. Only 29 percent did not have an accompanying physical illness.
"This work is yet another piece in the larger puzzle of understanding the relationships between mental and physical health," Doebbeling said in a statement.

The study looked at insurance claims from more than 700,000 adults from the ages of 18 to 64. Doebbeling previously used data to study mental illness and cancer, mental illness and diabetes, and the likelihood of women with mental illness to undergo mammograms.

"This work highlights the need for integrated medical and psychiatric care, and the long-term deleterious effects on physical health of living with chronic mental illness," Doebbeling said. "Both physical and mental health practitioners should have a heightened awareness of the significant medical morbidity faced by persons with chronic mental illness."

Call Star reporter T.J. Banes at (317) 444-6815. Read more!

Mental illness, lack of treatment equal partners in gunshot death - The Missoula (MT) Missoulian

By MICHAEL JAMISON of the Missoulian

Kalispell - Trevor New never hurt a hair on anyone's head, yet was a registered violent offender.

He was remarkably intelligent, an accomplished communicator, yet communicated with shouts and curses and threats.

He was a kind and gentle man of conscience, yet chased people at knife-point, and aimed guns at police.

Trevor New was bipolar.

In his Jekyll and Hyde world, sometimes he was “good,” sometimes “bad.” But the truth is, those sorts of labels don't really apply very well.

Trevor New was simply sick - sick with a chemical imbalance that just as easily could have made him susceptible to random fits of kindness.

Instead, the 28-year-old's sickness marginalized him at every turn, finally criminalizing him.

“He is the rule, and not the exception,” said Dr. Gary Mihelish, president of the Montana chapter of the National Alliance on Mental Illness. “There are more people living with mental illness in Montana jails and prisons than there are in state mental health facilities.”

New had been one of those prisoners, would have been again, in fact, had he not been killed by Kalispell police in the early hours of Thanksgiving morning.

His death was, by all accounts, what is known as “police-assisted suicide.”

“Absolutely,” said his fiancée.

“Without a doubt,” agreed his mother.

“It's not surprising,” Mihelish said. “This sort of thing happens all the time. It's tragic, but it's not surprising.”

And that, perhaps, is most tragic of all, Mihelish said, especially considering society's response.

When news broke of the violent offender flying into a domestic rage and then pointing a shotgun at police, the letters started rolling in.

“Why do they let animals like this back out on the streets?”

“The gene pool is better now that he's gone.”

Laura Damon, Trevor's mother, quietly shook her head.

“You can't judge,” she said. “You don't know.”

Laura Damon remembers the school counselor who called her in because her 7-year-old son was “sad” and “unruly.”

She remembers the sixth-grader diagnosed with depression, the suicidal teenager hospitalized for weeks on end, the 18-year-old arrested for burglary. Homeless, Trevor New had broken into an apartment, eaten an apple and fallen asleep on a laundry-room floor.

So now he had a record.

There were the months when he thought he was the Messiah, she said, when he was irrational, paranoid, obsessed, in turns on top of the world or crushed by it. Fantasy and reality blurred.

Later, New himself would write of those times, saying the manic days were “very embarrassing.”

Unable to afford the help he needed, he self-medicated, she said, turning to drugs and later to alcohol.

He's not alone. Health providers figure about two-thirds of those with mental illness also have a substance abuse problem. Likewise, about two-thirds of those battling substance abuse also have an underlying mental illness.

Bernie Cassidy, top criminal prosecutor in Lincoln County, estimates that's the same percentage of Montana prisoners who have a mental illness.

“We just warehouse the mentally ill in jail,” Cassidy said, “because we don't have anywhere else to put them.”

Actually, there was a place to put Trevor New when he last encountered the criminal justice system, a few years back in South Dakota. In the haze of what fiancée Karstin Ray called a “psychotic break,” New got “mouthy” with a whole handful of guys. They jumped him, and he grabbed a knife, chasing them off.

No one was hurt, but “when he realized what had happened,” Ray said, “he crawled into the basement.”

There was a gun there, and New wanted to die. Problem is, he never had the will to do it himself. And there were no bullets.

So he waited. When police arrived, he pointed the empty gun at them, hoping they would do for him what he could not do for himself.

Instead, they waited for him to pass out - collapse often followed his fits - and then shuttled him by ambulance to the hospital.

The judge ruled him guilty, but mentally ill. Attorneys found him a bed at the state hospital.

But the judge chose jail. And so sat Trevor New for the next year, Ray said, with no access to his medication and no visits with psychiatrists.

New was now branded, a registered violent offender, despite the fact that he had never hurt anyone but himself.

“It broke his heart that he was on that list,” Ray said. “It absolutely broke his heart. He was absolutely not a violent person.”

He was terrified, though, that the label made it reality. In his world, fantasy and reality often became inseparable. So he created his own cell, a room at home with locks on the outside, just in case. Then he gave what he could - usually a couple dollars - to nonprofit groups such as Creative Non-Violence.

He was afraid of the label, Ray said, and afraid of returning to prison, where he believed treatment would all but cease.

He had good cause to worry, Mihelish said.

“We don't treat the mentally ill,” Mihelish said. “We warehouse them in prisons, hundreds of them, right here in Montana.”

All of that was on Ray's mind a few weeks back, when she made that early-morning call to 9-1-1.

She was, she knew, potentially sentencing her fiancé to prison again. But at that moment, she had few options. The options, she said, should have come long before Thanksgiving, but the system - society, really - had failed.

“Montana ranks at the very bottom for treatment of the mentally ill,” she said. “That's a choice we have made.

“These are the consequences.”

The consequences began for New and Ray several days before police were called. They began with a bout of the flu. Neither could keep anything down. Not food. Not water. Not meds.

“He hadn't had his medication for more than three days,” Ray said. “The disease was just shining.”

He wanted to go to the hospital, she said, to get an anti-nausea shot, or perhaps an injection of his medication. But he was mentally ill. He had a job, but not a steady job. He did not have insurance.

Too poor to afford the hospital care, not poor enough to qualify for public health benefits, New stayed home.

“I can't bankrupt us for the flu,” he told his fiancée.

He was still getting bills, after all, from that South Dakota ambulance ride.

“He knew he needed help but he couldn't get it,” Ray said.

And as the last of the meds slipped from his system, “his willpower disappeared,” Ray said.

That's how the disease works. Before she understood that, Laura Damon used to try to stir her son from the bed he would not leave for days on end.

“Just get up,” she'd say, “and you'll feel better.”

“Just try a little harder, and you'll get it together.”

“Pull yourself up, and don't be lazy.”

Those arguments are logical, of course, but to work they require the person to be logical as well. Reason fails when you're talking to a person who would empty all his pockets into a stranger's mailbox, and then later wonder, quite sincerely, why anyone would do such a thing.

“We expect people to be responsible for their actions, and that's the model for prison,” Mihelish said. “What we have to recognize is that's not always an option if your brain doesn't work right. Some people don't see the world the way the rest of us do. But we don't treat them or help them. We put them in jail.”

Trevor New was at Ray's home when the meds ran out. He got loud, she said, and disrespectful. She called his 15-year-old brother to pick him up and take him home.

Later, she called him there, hoping to keep him engaged until the mania wore him into sleep. But he'd just shout, then hang up.

Eventually, she said, he wouldn't answer the phone at all.

So Ray headed for bed, but along the way she spotted New's medication there in her cabinet. He'd need that first thing, she figured, if the nausea had passed by morning.

So she drove to his house. Then he didn't want her to go. She insisted.

“He snapped,” she said. “In that instant, in his mind, I think I went from being a person to being a possession he didn't want to let go of.”

Everything moved so quickly after that. He pulled her into the house. She broke away to call

9-1-1. New's brother told her to just leave. The 9-1-1 operator said to stay on the line. New pulled the phone from the wall.

When two Kalispell police officers arrived, not long after midnight on Thanksgiving Day, Ray was locked in her car, her keys lost in the chaos. Trevor New was inside the house.

His brother, knowing New had talked about police-assisted suicide, was on the porch, but ran inside when officers arrived. He knew Trevor had a gun, knew it wasn't loaded, and intended to save his brother's life.

“Trevor knew by then he was going back to jail,” Ray said. “To him, that was unacceptable. That was the bottom, a fate worse than death.”

The brothers wrestled for the weapon, and when New came up with the empty gun he aimed it at police.

They hit him with a Taser, but the connectors missed.

And so one officer fired twice, the other three times.

Everything slowed again. They cradled the injured New until medical help arrived.

Ray watched from outside, saw the muzzle flashes through the window.

“None of us feel the police did anything other than what they had to do in that situation,” she said. “We totally support the police and their actions.”

What concerns her, however, are the years and months that led up to Thanksgiving.

“The system failed,” she said.

To fix the system - and make no mistake, that is exactly what Karstin Ray intends to do - you must begin at the beginning.

Schools need to do a better job of recognizing mental health problems in young people, she said. Society needs to do a better job of acceping the needs of the mentally ill. The justice system needs to have better sentencing alternatives, and jails need to have better treatment programs.

Private prisons, she said, are an enormous, market-driven part of the problem, profiting from the “revolving door” while viewing treatment as a burdensome cost.

“We've made the prison system a private profiteering enterprise,” Ray said, “and they have every incentive to lock more people up. It's just not in their financial interest to spend a dime on treatment for mental illness.”

Ray wants better support systems for families, more access to answers. There also needs to be more mental-health follow-through for those back in society, she said, and more access to much-needed health care.

Every detail needs to be examined, she said.

An example: Trevor New's parole officer had arranged access to anything New told his drug and alcohol counselor.

“So he couldn't be honest with his counselor,” Ray said, for fear of going back to jail. An admission of falling off the wagon was a ticket to prison, she said.

But New wanted help, knew honesty was a lynchpin to getting that help, knew jail was not the place to seek help. So he spent his own money on another drug and alcohol counselor, one he saw on the sly, one with whom he could be honest about his dependency.

“That's exactly the kind of thing that has to change,” Ray said. “The system is stacked against treatment.”

With that violent offender label, Ray said, no group home would take New. Yet he could not care for himself.

Where else, then, but jail?

According to Mihelish, “the Department of Corrections is already one of the largest treatment providers for individuals living with mental illness.”

He, like Ray, wants more crisis beds for psychiatric emergencies, because those patients do not belong in a cell. He wants more safe houses, more hospital beds, more money for prevention, more alternatives for those who, like New, are guilty but mentally ill.

Sure, it will cost money, he said, but the state already is spending the money - just not wisely.

“Law enforcement agencies,” he said, “should not be required to be interim mental health facilities.”

The solutions sought by Ray, Mihelish and many others are the same solutions being sought by Deb Matteucci. She works half-time for the state's Addictive and Mental Disorders Division and half-time for the prison system, as Montana's “behavioral health program officer.”

Indeed, the fact that her brand-new job even exists represents a recent acknowledgment that the problem is a big one. Matteucci, too, wants more resources to bring to that place where mental health meets jurisprudence, and for now she's optimistic.

Despite the fact that, nationally, the number of “safe beds” for the mentally ill is on the decline while the number of prison beds is on the rise, Matteucci says “Montana is becoming very active on this topic.”

Trevor New's story did not surprise her, but it's less likely to be repeated today than even a year ago, she said. Matteucci's been compiling data, trying to get a handle on how big the problem really is. And she's been fine-tuning the system so those with mental illness get more attention when they land in prison, and more attention when they leave.

She's exploring treatment options, sentencing alternatives, finding out how public health and corrections compare. She's talking to private physicians, advocates like Mihelish, and she wants to know: “How does something like this happen? How does someone who clearly has a mental illness wind up in the custody of the Department of Corrections?”

Mihelish thinks he already has the answer to that one. “These are the invisible, disposable people,” he said. “We don't like to think about them. The jails and prisons have become the insane asylums of our time, and that's tremendously sad.”

Frank Garner is the chief of police in Kalispell, and it was under his watch that Trevor New died.

It was, Garner said, the very first fatal shooting in the history of the Kalispell police department.

Those left behind, he said, are paying a high price. Garner says professional estimates show more than 40 percent of police shootings are, in fact, police-assisted suicides, “and many, many of those people are bipolar.”

Just like Trevor New.

“The last thing we want to do,” Garner said, “is to pull that trigger.”

That's why Garner sent two of his officers off to special training a while back, coursework designed to teach them exactly how to deal with people such as New. It's a commitment he makes a top priority, but, he said, it is no guarantee come midnight when guns are flashing.

And while hopeful - helpful, even - the officer training does nothing, Garner said, to address the larger issues.

“We don't have the necessary mental health facilities available,” he said. “We as a state don't put enough money toward mental health resources. I have to deal with this on a daily basis. It's just continual.”

The mentally ill, he said, are largely a forgotten population, except for folk in his line of work. “They have no lobby, no champion.”

What would it have cost, he wonders, to pay for New's anti-nausea shot?

And what will it cost now for the investigations and inquests into his death, the autopsies and the officers' paid leave?

“This is exactly what you don't want,” Garner said. “But when you start to talk to people, guess what the big hang-up has been? Money. Funding.”

It is, Garner said, a bit of a pay-me-now-or-pay-me-later situation, and he for one believes later is always more expensive.

“The state is working on it,” he said. “Things are getting better. And yet, what do you do in Kalispell tomorrow night if someone's in a mental health crisis? Where do you put them? What do you do?”

It is a very important question.

Because Trevor New was bipolar, an inherited condition, and he has a sister.

She's bipolar, too.

“It is,” said mother Laura Damon, “a very helpless feeling.

“It's like we knew this day was coming. Now, we have to change the future for others.”

For New's sister, Elizabeth, who calls him “the coolest brother.”

“No one,” Elizabeth said, “should ever experience as much pain as Trevor struggled with in his life.”

Reporter Michael Jamison can be reached at 1-800-366-7186 or at mjamison@missoulian.com Read more!

Looking for the best solution in school - Kansas City Star

By ERIC ADLER, The Kansas City Star

Mrs. O’Neal?

Yes?

Holly’s school, Underwood Elementary in Lee’s Summit, is on the line with an idea.

Meet-the-Teacher night is Monday. Given Holly’s emotional difficulties, how about instead of bringing Holly to Meet-the-Teacher night, Holly’s new second-grade teacher would love to have some one-on-one time at their home, say, on Tuesday?

Time was when Kim O’Neal might have considered the offer thoughtful. But at 37, having helped raise at least 16 foster kids and adopted five, she keeps her suspicion meter well-tuned.

“I guess they don’t want my kid there,” she said after the call. “Probably afraid Holly’ll throw a desk and scare the parents.”

Tuesday arrives, Aug. 22, one day before school starts. She’s watching Mrs. Sauve, an affable middle-aged teacher as light and thin as a spindle, sit on her carpet and read “Alice the Fairy” with a 7-year-old who, Kim’s convinced, “could knock her on her butt in a heartbeat.”

Debbie Sauve has no clue Kim’s annoyed. She just wants Holly to feel comfortable, to get to know her new teacher before the year starts.

One thought keeps coursing through Kim’s head:

Lady, you have no idea what you’re getting into.

•••

Educating children with severe emotional disturbances is a national problem, vexing teachers, districts and parents.

In 1975, Congress enacted a law that would eventually become IDEA, the Individuals with Disabilities Education Act, requiring states to provide disabled students with “free appropriate public education” in the “least restrictive environment.”

The law has been a boon. Six million disabled students each year are given IEPs (Individualized Education Programs) that qualify them for special services, education classes, programs, technologies, social workers, even personal paraprofessional helpers.

But conflict in the mental-health world centers on those not helped.

The U.S. Department of Education says 1 percent of children in school, about 800,000, are severely disturbed emotionally or mentally. But the U.S. surgeon general and repeated epidemiological studies say 5 percent, or 4 million children, is a conservative estimate, leaving 3.2 million unaccounted.

“Where are the rest of them? They are in regular classes in school, not getting the help they need, and causing a lot of difficulties,” said James M. Kauffman, professor emeritus of education at the University of Virginia and a leading authority on education and mental illness.

“The typical kid in special ed has been known to be emotionally disturbed for years,” he said, “maybe five or six years. Most are not caught early. Schools are loath to identify mental illness. Part of it is cost. Serving four to five times the number of kids we serve now means you would have to spend four to five times more money, and hire four to five times as many special ed teachers.”

That’s money most cash-strapped school districts can ill afford. Nor are they kids schools want, experts say.

“It’s not like we have people standing in line to have these kids in their classrooms,” said Rich Simpson, a researcher and professor of special education at the University of Kansas. “These are kids who spit and kick and cuss. They are the most neglected and the most poorly looked-after in the school system. They have the fewest advocates.”

Their educational fate, he said, is often bleak. “Unfortunately, they either drop out or are incarcerated or they sort of vanish,” he said.

Kim doesn’t want that for Holly. For months, she has struggled to convince school officials that putting Holly in an all-day regular classroom with 19 kids would be disastrous for everyone. She wants Holly to be taught in a special class with her own IEP.

But IDEA calls for disabled children to be taught in the “least restrictive environment” for numerous reasons. One is the belief that kids do better when taught alongside their peers and treated like everyone else.

Also: “We want to make sure we’re not putting kids into special classrooms that don’t need to be there,” said Jerry Keimig, the Lee’s Summit School District’s director of special services. “ED (emotionally disturbed) is a powerful label to put on a kid.”

Money, he said, is not a factor in deciding the best way to teach emotionally disturbed children. In the last decade, the district — like others locally and many nationally — has expanded services in response to a problem that is deepening more than it is growing, he said.

“The numbers aren’t the issue as much as the severity,” Keimig said. “They are much more severe. They have multiple diagnoses. Families are not becoming more functional, families and communities are becoming less functional. They bring all those issues to school.”

In response, each of the district’s 1,200 teachers is now required to go through Behavioral Intervention Support Team (BIST) training to learn how to calm kids before and when they fly out of control. Besides its special education classes, the district also has less restrictive alternatives: “buddy rooms” for overwrought kids to take a breather; “focus rooms” where kids can spend much or most of the day with specially trained teachers before returning to their regular classes.

The result, he said, is that fewer students, from 158 in 2000 to 110 now, are deemed emotionally disturbed. Nor are they put in special education classes which Keimig said should be “a last resort.”

Other districts are similar, hiring social workers and behavioral specialists, running individual and group counseling sessions. Earlier this year, the Hickman Mills School District teamed with Spofford to help identify kids with mental and emotional issues long before they erupt and to work with families to help keep their kids on track. The Kansas City, Kan., School District joined with the Wyandot Center for Community Behavioral Healthcare and began the Wyandot Academy, a school just for children with severe emotional disorders.

•••

Kim is worried. With Mrs. Sauve on the floor, Holly is happy. Everything about her, her smile, her eyes, her bushy hair, her energy, seems exaggerated, electric.

“You know, Holly,” Mrs. Sauve says, “if you read books, you can go anywhere you want.”

Kim holds her tongue.

“Mrs. Sauve is in denial,” she’d say later. “They think if they give them TLC and love in the classroom, it will be OK. This is a mental-health issue.”

Holly’s IQ is barely 90. Her math and reading are at pre-kindergarten levels. “She can recognize about half of her kindergarten sight words,” Kim says. “After that, it’s guessing.”

She is bipolar and, because of it, takes lithium and Risperdal. She has a reactive attachment disorder, born of severe neglect as an infant.

In a healthy attachment cycle, infants discover, for example, that if they cry out of hunger or discomfort their needs are taken care of. They attach to other humans with a sense of trust and safety. But, the theory goes, if those needs go unmet or answered with blows, infants can view the world as unsafe. Instead of trust, they develop rage. They fight for their survival.

“She slapped a teacher last year,” Kim says of Holly. “She’s thrown desks. She swings her backpack and hits people, punches people. Any slight thing can send her into a tantrum — getting ready for school, brushing her hair.”

Just days ago, Holly returned home after three-months at Spofford, where doctors altered her medications and she was taught control.

It helped. When she entered Spofford in May, she erupted daily and often, as she did the day a dorm-mate got a new hairdo. Holly flung herself to the floor, pounded her hands and feet on the carpet, screaming, “I’m ugly!” because, she said, the other girl looked prettier.

Her fits have reduced. Spofford therapists now treat Holly at home. But Kim and her husband, Rick, are still worried.

Their experience with severely emotionally disturbed kids runs deep.

The couple (Kim works for the Midwest Foster Care and Adoption Association; Rick is a carpet layer) took in their first foster child, Mark, when their own kids, Kimmy, now 18, and Ricky, 16, were still in grade school.

After Mark, whom they eventually adopted, came 15 other kids, many emotionally disturbed.

The O’Neals got Holly in 2000 at 15 months old and officially adopted her two years later, along with her sisters, Brittney, now age 6, and Jamie, 14. Brittney has a mood disorder. Jamie, who suffered the longest and most abuse, has been living in residential treatment centers for the last four years.

“I want to prevent that as much as possible for Holly,” Kim says.

She’s not saying that getting Holly into a special class is going to solve all her daughter’s problems, or even the tiniest fraction. But for her the lessons are more fundamental: following directions, understanding consequences, controlling her behavior enough to stay in school.

Holly may seem fine in this moment with Mrs. Sauve, with all the attention trained on her. But Kim has little doubt what will happen in a class of 19.

“I give it one week before Holly does something big,” Kim says after Mrs. Sauve leaves.

But Kim is wrong.

It takes two weeks.

Holly O’Neal is now in a special class. Read more!

A new teacher, a new hope - Kansas City Star

Young and nervous, a therapist prays for guidance, then turns to play to enter a disturbed young mind.

Stories By ERIC ADLER, The Kansas City Star

Today is the second installment in a four-part series of stories tracking Marcus, a severely emotionally disturbed 6-year-old, as therapists try to map the landscape of his troubled mind.

Therapist Sarah Thibault strides down Spofford’s cinderblock hallways, her soft-soled loafers silent on the tile.

From outside, the building — low-slung, wood, set on a green expanse in south Kansas City — looks like a ski lodge.

But at any one time, the nonprofit residential treatment center is home to four dozen children age 4 to 12 years whose mental and emotional problems are so severe that “when they end up here,” says Joe Beck, director of therapy services, “it means all the other traditional stuff has failed.”

Average stay: 5½ months in one of five dorms including “Kiva,” reserved for the youngest children, most in kindergarten, none older than 7.

At 25, Miss Sarah, as the colleagues and kids call her, is prim and congenial. She wears wire-rimmed glasses and is guided by a spiritual duty so deep that, in college, she worked with Romanian orphans. When she returned home, materialism so disgusted her she gave away her clothes except what fit in a single suitcase. She made her own wedding dress, buys no more than $50 in clothes a year and drives a faded ’87 Oldsmobile Cutlass whose passenger door sloshes with water when it rains. Her husband, Gil, helps the poor at the Kansas City Rescue Mission.

“I feel like I’m doing what I’m called to be doing,” she would say.

She has a recent degree in social work but she’s also young, nervous and barely tested. With 10 children in her caseload, she prays at night for wisdom.

“All the time I feel like I don’t know what I’m doing. I feel so very less experienced than the other therapists.”

She approaches Kiva’s entryway, a heavy metal door with a single square window. Through the window she can see a common room with speckled industrial carpeting, chairs and tables. Here the kids draw and watch TV, scream and act out.

Around the room’s periphery are five cinderblock bedrooms for 10 children. Single beds, plain dresser, vinyl mattresses with cotton sheets printed with Superman, Mickey Mouse, Dora the Explorer.

Some of the children have never had a room. A few have never slept in a bed or been taught to wash or brush their teeth. All are disturbed: attention deficits, attachment disorders, self-mutilation, anger, violence.

For two months, one profoundly difficult 6-year-old has been living inside Kiva making little progress. Now, new to the case, it’s Miss Sarah’s turn. She steps through the door.

“Marcus, Miss Sarah’s here!” a dorm worker calls out.

Marcus looks up and sees her smiling at the far end of the dorm. He puts down his Legos and shuffles toward her along the carpet. His eyes look tired, but his face is emotionless, inscrutable.

He walks past his Kiva dorm-mates:

A 6-year-old boy who once tried to strangle his sister, leaped from a moving car and watched his mother stab his heroin-addicted father in the chest. The first-grader has been on 13 psychiatric medications.

A 5-year-old brother and sister, abandoned by their drug addict mother. Their tantrums can last two hours. The girl makes herself vomit. She wets her bed. The boy threatens to kill himself.

The girl with the wide eyes and frizzy hair screaming “I’m ugly!” is Holly O’Neal, 7, bipolar, oppositional defiant and struggling to feel a true emotional connection. Kyler Lair, 6, is obsessed with guns and shows no remorse when he hurts other children.

One first-grader scratches until he bleeds. His father had sex with him on videotape.

Then there is the smallest child, brutally abused.

When the police raided his home, a methamphetamine lab, they discovered him and his brother so purple with bruises they rushed them to the hospital. The boy punches himself and once pulled out a chunk of his hair. For discipline, he begs to be beaten. He is in preschool.

The therapists have no illusions. They can’t cure these children. But maybe they can save them by giving them a chance. Maybe they can find the right combination of medicine and insight and family therapy to help them cope, moment to moment.

The task this afternoon, like gentle exploratory surgery, is to dig as deep but as carefully into Marcus’ thoughts and emotions to find the fear or pain or anger that possesses him. Once found and identified, maybe then Sarah can treat it.

“Are you ready, Marcus?” she says.

Miss Sarah clasps Marcus’ hand in hers and walks down Spofford’s hallway to the play therapy room.

•••

The room is tiny but homey — a narrow rectangle, carpeted, with a rocking chair at one end, bookshelves filled with bins of toys lining the length of one wall, and a one-way mirror for observation. Miss Sarah sits in the rocking chair. Marcus sits in a mini-chair at her knees looking up at her.

At Spofford Marcus may have as many as five therapy sessions a week: individual, family (some parents participate, some don’t) and any number of groups — anger management, peer relations, sexual encounters.

Psychiatrists check and re-check his and all the children’s medicines, and during the school year, children attend class at Spofford, taught by Hickman Mills School District teachers.

The foundation for most of the treatment is cognitive behavioral therapy, an approach that, in essence, holds that life is perception, that thinking makes it so. If children can change the way they perceive their lives and problems (cognition) they can change the way they react to it (behavior).

“A lot of children feel the way they feel because of their life circumstances,” said Lori Meyer, Spofford’s then-vice president of clinical services. “They can feel any way they want to feel, but it’s the way they choose to act that matters. They need to find that connection between their feelings and how they act on those feelings.”

When the children are not in therapy, Spofford reinforces “coping skills” to teach children to deal with the chaos of their own homes or emotions. They punch a pillow, press on a wall, count to 10, talk to staff, take a deep breath, go to a “safe place.”

Twice a day, dorm staff evaluate the kids’ behaviors and, next to their names on a white board in each dorm, they are given an evaluation of a “red,” “yellow” or “green” as both an incentive and a guide. Red means danger, green means go, progress.

When behavior goes bad, when they threaten or carry out violence toward themselves or others, they are put “on safety.” Staffers take their sneakers to keep them from using their shoes or laces as weapons, from hurting themselves, or from running too far. They are watched.

Marcus is getting reds and yellows.

•••

“I thought we could start by reading a book today. Does that sound good?” Miss Sarah says.

One of the most arduous aspects of dealing with mentally ill children is delving into their true emotions. But what kids might not be able to express in words, they often express in play or through art.

“This is a book called The Way I Feel,” Miss Sarah says

Each page is a different emotion. She flips to the first, “Silly,” and the picture of a girl with a goofy face.

“What do you think she’s feeling there?” she asks.

“Mad,” Marcus says

“Mad?” Sarah says. She reads the text:

Silly is the way I feel when I make a funny face and wear a goofy, poofy hat that takes up lots of space.

Next is “Scared.”

I’m shaking because I’m scared, all alone in the dark at night…

“Tell me something you’re scared of.”

“Nothing,” Marcus says flatly.

“Nothing?” But Sarah knows he is afraid of something. “Spiders?”

Marcus is still.

“I like to smash them,” Marcus says, no anger, just explaining. “I’ll take a hammer and smash them in the head.”

“I’m scared of spiders,” Sarah says.

“You gotta get a hammer and smash them,” he advises. Sarah laughs.

“How was your pass this weekend?” Sarah says.

“My mom left me,” Marcus says, his voice gone flat and emotionless. He looks down at the carpet. “My brudder left me. They left me all by myself. I was all by myself crying.”

“Your mom told me it wasn’t good. What was that about?”

He refuses to talk.

She flips the page.

Happy, she reads.

“So when is there a time when you feel happy?" she asks.

“When my mom and sister was here, and my brudder,” Marcus says.

Sometimes I feel so very sad, Sarah reads.

Marcus interrupts. He is abrupt and cool.

“I don’t want to do that one.”

She tries again.

“No,” he says. Sarah changes her tack.

“What makes you angry?”

“When my brudder and sister hit me. When they kick me and punch me in the nose.”

“Anything that makes you angry here at Spofford?”

“Nope.”

“How about when someone says something mean about you? Like, ‘Marcus, you’re so stupid!’ That wouldn’t make you angry?”

“That would make me hit them,” he says.

Minutes later, Sarah leads Marcus to the “sand tray,” a clear plastic bin of clean sand, surrounded by bins of plastic toys.

She asks him to use the toys to create a picture in the sand of the emotions from the book.

They start with angry. Marcus grabs a walrus and sets him in the center of the sand.

“What is the walrus angry about?” Sarah asks.

“His mom and dad are gone,” he says. “They went to the zoo without him.”

“Why?”

“Because he was bad,” Marcus says. He was “hitting people” because he was angry.

“Let me do happy,” he says.

He picks up a yellow rubber duck and places it in the sand.

“Why is Ducky so happy?” Sarah asks.

“ ’Cause his mom is with him,” Marcus says. Then he reaches into a bin, grasps a rubber snake, and slowly grinds him into a hole.

“How come he’s going in that hole?” she asks.

“He’s sad,” Marcus says. “ ’Cause his mom and dad ain’t comin’.”

Sarah and Marcus look down at the snake, its head crammed beneath the sand. Even after one session she senses the boy’s troubled depths, wondering if, over the months ahead, she can rescue what he has buried. Read more!

Children: What's at stake and who's at risk - Kansas City Star

The diagnosis

Thirty years ago, researchers didn’t believe that children possessed the ego structure to become depressed. Now they know that children at 3 or even younger can exhibit the same mental and emotional problems as adults. The most common or severe childhood mental disorders include:

Attention-Deficit/Hyperactivity Disorder (ADHD): One of the most common mental disorders among children. Symptoms include inattention, hyperactivity and impulsivity over a period of time.

Bipolar disorder: Formerly called manic-depressive illness, characterized by cycles of mood changes: severe highs followed by severe lows.

Conduct disorder: Persistent misbehavior, such as frequent temper tantrums and lying, violating the rights of others, being actively aggressive toward people and/or animals, amorality.

Depression (major affective disorder): a combination of symptoms that interfere with the ability to work, study, sleep, eat and enjoy once-pleasurable activities.

Generalized Anxiety Disorder: constant, worrisome thoughts, unwarranted and exaggerated tension about routine life.

Obsessive-Compulsive Disorder (OCD): Patterns of repetitive thoughts and behaviors that are distressing but extremely difficult to overcome.

Oppositional Defiant Disorder (ODD): Extreme levels of argumentativeness, disobedience, stubbornness, negativity and provocation of others that persist over months or years and occur across many situations.

Post-traumatic Stress Disorder (PTSD): Persistent symptoms that occur after a traumatic event such as nightmares, flashbacks, emotional numbness, depression, anger, irritability, distractedness and being easily startled.

Reactive Attachment Disorder: A disorder related to gross deprivation of care or successive multiple caregivers, leading to a lack of attachment.

Schizophrenia: A chronic, severe brain disease. Youths with schizophrenia often suffer terrifying symptoms such as hearing internal voices, or believing that other people are controlling their thoughts, or plotting to harm them.

Separation anxiety: Unreasonable fears about leaving home and parents. Serious education or social problems can develop if away from school and friends for an extended time.

Children at risk

How do children enter the mental-health system?

Typically by one of four routes:

Overwhelmed loved ones contact their own doctors, psychologists or a community mental-health center.

Juvenile justice system : refer troubled kids..

Schools: identify kids acting out.

Child welfare agencies look into cases of child abuse and neglect.

What does childhood mental health cost the nation?

Between $5 billion and $50 billion a year, although it could be much more. No one knows for sure because parsing the numbers has proved nearly impossible.

The U.S. Department of Health and Human Services estimated that state mental-health departments alone spend $30 billion a year on mental health — $5 billion a year to children. But these numbers do not include the billions spent by other local, state and federal organizations such as school districts, juvenile justice programs, non-profits, insurers, private individuals and child welfare agencies.

Although children make up 30 percent of the population, children generally get significantly less in mental-health money. The most generous states, such as Vermont, Alaska and Montana, spent between 40 and 49 percent of their state mental-health money on children. Most spend between 15 and 25 percent.

In 2006, the Missouri Department of Mental Health will spend about 16 percent of its $366 million on children’s services. In 2006, Kansas will have spent 32 percent of its $216 million. Read more!

Kids and Mental Illness: About the Series, Upcoming - Kansas City Star

About the series: Finding help coming tomorrow

If you look at prison, most prisoners have a mental-health diagnosis … We’re trying to make sure that doesn’t happen. We’re trying to make sure that the person living next to us is not one day chopping up bodies …You know, that sounds crass, but that’s real.” - Joe Beck, Spofford’s director of therapy services

1 where anxiety ranks as a mental illness among children.

20 to 50% of depressed children and adolescents have a family history of depression.

25 to 50% of anti-social children become anti-social adults.

50% of children with a mental illness drop out of high school.

70% of children in the juvenile justice system have a diagnosable mental illness.

For a complete listing of mental-health offices and agencies go to Kansas City.com and click on Mental Health.

Beginning in July, reporter Eric Adler and photographer Tammy Ljungblad followed the plights of five children inside Spofford Home, which offered unprecedented access for this series. The Star chose the children based on their stories and parental cooperation. Parents, who wanted to raise awareness about children and mental illness, gave signed permission to peruse medical records, to record therapy sessions, and to conduct in-depth interviews with them, their children, therapists and others. Interviews with dozens of mental health experts, and more than 3,000 pages of local, state and federal reports, were also used to prepare this series.

Adler, 47, has worked at The Star since 1985. His work has won numerous awards, including first place from the National Headliner Awards and the American Association of Sunday and Features Editors. He lives in Kansas City with his wife, Tamara, and 9-year-old son, Aidan.

Ljungblad, 43, has been at The Star for 17 years. Her photographs were part of The Star’s 1992 Pulitzer Prize-winning series. She has also won awards from the National Press Photographers Association and the Missouri Press Association. She lives in Prairie Village with her husband, Brian, and 7-year-old son, Brett.

Bill Luening edited the series, Charles W. Gooch designed the pages and Don Munday edited the copy.

During family therapy, Marcus’ mom provides a shock of her own.

Sources: President’s New Freedom Commission Report on Mental Health 2003, American Academy of Child & Adolescent Psychiatry, Missouri Department of Mental Health, Kansas Department of Health and Environment, Substance Abuse & Mental Health Services Administration, National Mental Health Association, National Alliance for Mental Illness, U.S. Surgeon General, Centers for Disease Control and Prevention. Read more!

Many of the 'ADD generation' say no to meds - LA Times

Newly minted grown-ups are carrying out a massive natural experiment by choosing to do without the drugs that profoundly affected their experience of childhood.

By Melissa Healy
Times Staff Writer

For Devin Barclay, life with attention-deficit disorder has been a winding road. And seven years after he quit taking medication for the condition, "it's still winding," he says with a laugh.

But as the 23-year-old navigates his way into adulthood, he's managed to pay the roadside distractions a little less attention. And he's learned a thing or two about getting himself from one destination to the next without taking major detours.

In 1990, when Barclay was 7, he was diagnosed with ADD and began taking Ritalin — a stimulant medication that he and his parents referred to as "the thinking pill" — to help him sit still and pay attention in class. Over the next decade, almost 2 million American boys and girls were similarly diagnosed, an unprecedented growth of a medical condition that, before 1990, had been so rarely recognized that the national Centers for Disease Control and Prevention did not even track it.

Today, the children on the leading edge of a wave dubbed by some "the ADD generation" have reached the cusp of adulthood. And as they take on jobs or college, care for themselves away from home, enter into adult relationships and become parents, these newly minted grown-ups are carrying out a massive natural experiment.

It seems like only yesterday they were fidgeting in their seats, sprinting around their classrooms and daydreaming their way through addition and subtraction. Most, just like Barclay, struggled through elementary and middle school on Ritalin as the practice of medicating attention problems in children took off steeply in the United States: Between 1990 and 2005, production of the two stimulant compounds most used to treat ADD — methylphenidate and amphetamine — increased seventeenfold and thirtyfold, respectively.

Now many are choosing to do without the drugs that profoundly affected their experience of childhood and school and, in many cases, made it possible for them to learn alongside other kids in mainstream classrooms.

It is one of the first decisions of their adult lives. Mostly, it was parents who dictated whether and when they would start medications to sharpen their focus. But the decision to stay on or go off these drugs is one that these teens and young adults have made for themselves — with little research to guide them.

Whether the results will be momentous or slight will be more than a personal test for each of them; it is uncharted terrain, also, to researchers in the field of attention problems who are watching intently for answers — and hoping for better guidance for future generations of ADD sufferers.

American society remains deeply ambivalent about the diagnosis of ADD, a catch-all term used more commonly in the past that includes today's more well-known attention-deficit hyperactivity disorder. (Children diagnosed with ADD typically have difficulty focusing and paying attention. Those with ADHD are physically frenetic as well.)

Almost three decades after the psychiatric profession first detailed the condition in its diagnostic manual, nagging questions remain: Does medicating a child with ADD help that child's well-being in the long term? Are there any negative consequences? And must it be a life-long prescription?

Although most mental health professionals believe that about 2 in 3 children with ADD will continue to contend with the condition as adults, the truth is that "we have very few firm numbers," says Dr. Xavier Castellanos, a leading ADD researcher at New York University.

In short, "There are more questions that are unanswered than are answered," says Lisa L. Weyandt, a psychologist at Central Washington University who studies college-bound kids with ADD. Nobody, she says, knows how these fledglings will fare away from home and neighborhood schools, and whether the medications that appeared to help them in grade school will continue to be of use to them as adults. "They are," Weyandt says, "in uncharted territory."

Schooling in adulthood

One reason that the terrain is unfamiliar is that this is the first generation of ADD kids for whom effective medication and accommodations for those with learning disabilities have made college a widespread possibility. "They're here and they're here in increasing numbers," Weyandt says. Barclay, now a freshman at Ohio State University, is typical of such youths in many respects.

When he was little, he says, his energy was so prodigious that his father had to sit at his bedside at night and hold his eyelids shut to help him fall asleep. "I was always going at 100 miles per hour … and I was making bad decisions on a regular basis," Barclay says. "I just didn't think of the consequences. I just charged ahead."

Looking back, he acknowledges that Ritalin did help him academically. But he also felt that it blunted his natural sociability, made it "hard to feel passionate about anything." And the same intensity of focus that helped him in class, he believes, impaired his instincts on the soccer field — a troublesome side effect for a rising soccer star.

He quit Ritalin as a freshman in high school. Off the drug, he says: "I felt more like a happier person. I just felt more like myself," voicing an observation heard again and again among young adults who abandoned their ADD medication.

He has no interest in going back. And he doesn't believe that he needs to. The symptoms that first prompted his parents to put him on Ritalin when he was 7 — the nonstop physical drive, the impulsiveness, the inability to focus in school — have abated with age, he says. A stubborn restlessness of mind remains, but the ADD has changed, and so has he. Adult life has a wider range of choices than grade school offered. He hopes that if he makes the right ones, he can make it all work.

Barclay has got plenty of company, according to Mariellen Fischer, a professor of neurology at the Medical College of Wisconsin. Among the roughly 150 children she has tracked well into their 20s, "discontinuation of the medication [has been] by far the vast norm," she says. Of those diagnosed and medicated for ADD as children, she estimates, about 9 in 10 are off those medications by the time they reach 21.

By high school, she adds, the most glaring of ADD symptoms — the inability to sit still — has typically eased. And, just like their peers without ADD, these young patients are driven to question the judgment of the people that have been in charge of their lives.

Those challenges are naturally focused on the parents, teachers, physicians and therapists who played roles in labeling them different and putting them on medication that is a daily reminder of that judgment.

They want, overwhelmingly, to feel normal, Fischer says — to be like other kids who can make it through a school day without being chided for daydreaming or sent to the nurse for a midday pill. Many, she says, are keen to try life without the medications to prove something: "to feel that your success, your accomplishments, your failures are truly your own and not the product of medication."

For parents, this moment of awakening can be a frightening challenge. But experts warn that it's better to brace for change and have a plan than to dig in or — worse — be taken by surprise.

"You can tell a 7- or 8- or 9-year-old to take his medication and he will. By 12 it starts to get tricky, by 14 it's difficult, and by 16, it's impossible," Castellanos says. "You get into issues of autonomy and [charges like] 'You're just trying to drug me.' "

Castellanos says that a child often first questions his or her medication during the middle school years. When that happens, the child's parents and a counselor or physician should propose a "controlled break" of several weeks from medication, he recommends. During the break, the parents and counselor can nudge an adolescent to answer questions to determine whether there were benefits from the medication: Are classes less interesting than they were on medication? Does homework get done as readily? Is the child more forgetful about school assignments or appointments, and do friends and family notice a difference in personal interactions?

"When they're on treatment for a period of time, they may forget what it's like being off treatment," says Sharon Wigal, a psychologist with UC Irvine School of Medicine whose research and clinical work focuses on adolescents and adults with ADD. Unless they're asked to cue in on the symptoms, she says, many adolescents are quick to believe that age has cured them of the disorder that has set them apart from peers and made life difficult.

Yet there is reason to believe that adulthood is no cure for ADD, Wigal adds. In recent years, ADD diagnoses among adults have grown sharply, while the proportion of children diagnosed has held steady between 6% to 7% of the population. Though the numbers are uncertain, many ADD experts estimate that as many as 3.5% of adults could have the disorder.

A lingering issue

What few studies there are suggest that ADD often still causes problems after kids grow up. For 13 years, Fischer and her colleague Dr. Russell A. Barkley tracked 147 children who had been diagnosed with ADD by age 7. They compared them with a set of kids from the same neighborhoods without ADD.

In 2005, they reported that the young adults with a childhood ADD diagnosis were more likely to have dropped out of high school and to have been fired from jobs. They were more likely to have had sex earlier and became parents at a younger age than their non-ADD peers. They had higher credit card debt and fewer savings, and were far less likely to attend college.

Young adults with ADD also appear to have more motor vehicle collisions and traffic citations and are more likely to experiment with illegal drugs. But the data suggest that ADD sufferers who took prescribed medication were less likely than those who did not to use illegal drugs.

Beyond that, the story is fuzzy because children that Fischer and Barkley tracked did not sort themselves into neat research categories. Some of the children diagnosed with ADD did not take medication. Others took medication steadily. Most took them for a while and then, at various ages, quit.

And that leaves researchers in the dark. They don't know whether taking medication for some stretch of time, or during some critical period, will offer protection against these later, adult ills — even if, as adults, people decide not to medicate themselves any longer.

In that sense, Devin Barclay's peers are writing the textbook on ADD as they go along.

"We are the first generation of Ritalin kids," says 31-year-old David Cole who, as an undergraduate with ADD at Brown University, co-wrote "Learning Outside the Lines," a book about navigating college with a learning disability. (He's now an up-and-coming artist based in Rhode Island.) Certainly, such medication has made success in life a possibility for kids like himself, he adds — but once school is out, "it's whatever works for you," he shrugs.

At 23, Devin Barclay has begun to learn how to harness his attention on tasks that he needs to accomplish. He wouldn't dream of bringing his laptop to a busy coffee shop to do homework, or to have the television on while reading. He plans to do his school work in short spurts of no more than an hour, and is careful to sequence his obligations — term papers, bill paying, soccer coaching duties — so they don't scramble his attention.

And he recognizes the signs of a mind gone astray during a task. That's when he ties on his sneakers and takes a long run "to re-center" himself, as he puts it.

In a nod to his ADD, Barclay says he accomplishes many of his grown-up tasks in pinball fashion, bouncing haphazardly from paying a bill to tending the home he owns to walking his dog.

"I get things accomplished. It's probably not as efficiently or as quickly as other people, but it happens in my own way," he says.

There have been detours. In 2000, one year after he quit taking Ritalin, Devin left high school after his sophomore year, intent on playing soccer professionally. At 18, he signed on with Major League Soccer and spent the next four years playing forward for teams in Tampa Bay, Fla.; San Jose; Washington, D.C.; and Columbus, Ohio. By 2005, he had earned his high school equivalency degree and also reached the end of his soccer career.

Now he's a freshman at Ohio State University and older than most of his classmates — but much wiser, he says, for the winding road that has led him there.

Dr. Lawrence Diller, a San Francisco psychiatrist and author of the 1998 book "Running on Ritalin," says that for children with ADD, the path into adulthood is seldom a straight line. In 25 years in practice, Diller has prescribed ADD medication to hundreds of kids. But in a new book, "The Last Normal Child," he raises concerns about the effect on society and children when parents, schools and the medical establishment reach too easily for such medication.

Diller calls it "unduly pessimistic" to believe that two-thirds of kids with ADD will continue to suffer symptoms negative enough to require medication as adults. By a young adult's mid-20s or so, he believes that many who were diagnosed with ADD as children have developed strategies, as Devin Barclay has, to work around their weaknesses. And they are better equipped to answer the question — to medicate or not? — with a clear sense of their adult selves.

Diller feels that those diagnosed with ADD — as well as their parents and counselors — should revisit "the bargain" that many made with Ritalin and other such drugs as children as they meander through their early adult years. In return for the often-reported side effects of the medication — sleep difficulties, appetite suppression, a "not quite me" feeling — children and their parents expected ADD medication to help them succeed in school at a time when sitting still and compliance with rules was highly valued.

But in the adult world, young people with ADD have far wider choices, and they should make them with an awareness of their strengths and their weaknesses, Diller says — not what others expect of them.

Using medication "to take octagonal kids and fit them into square holes" may be acceptable in grade school, he says. But "they will be patients for the rest of their lives," he adds, if they pursue fields that require enormous attention to detail or intense concentration on matters that do not fire their interest.

It is a lesson that Barclay understands well by now. He is gravitating toward hospitality management or maybe psychology — both social fields that play to his outgoing nature.

"The whole idea of doing what you love and finding what you enjoy doing is really important," he says. "But sometimes, there's pressure coming from your parents or thinking you need to make a lot of money."

Those expectations, he says, can tempt someone with ADD to pursue a career or course of study that highlights weaknesses rather than playing to strengths that often come with the condition — such as creativity, gregariousness and quick response time.

It can be a formula for disaster, he says.

"If you have ADD, eventually that's going to really take hold. If you're doing something you don't enjoy, you're screwed."

melissa.healy@latimes.com

*

Find out more

For more information on attention-deficit disorder and its treatment, consult these resources:

• The National Institute of Mental Health. http://www.nimh.nih.gov/publicat/adhd.cfm and http://www.nimh.nih.gpv/healthinformation/adhdmenu.cfm .

• "Taking Charge of ADHD: The Complete Authoritative Guide for Parents," by Russell A. Barkley (1995, Guilford Press).

• "Driven to Distraction: Recognizing and Coping with Attention Deficit Disorder from Childhood Through Adulthood," by Edward M. Hallowell with John J. Ratey (1995, Touchstone Press). Also by Hallowell: "Delivered From Distraction: Getting the Most Out of Life with Attention Deficit Disorder" (with Ratey, 2005, Ballantine Books) and "Positively ADD: Real Success Stories to Inspire Your Dreams" (with Catherine A. Corman, 2006, Walker & Co.).

• Children & Adults with Attention Deficit/Hyperactivity Disorder (CHADD) is the leading nonprofit patient group, providing support groups through local chapters, advocacy and research dissemination, conferences and a magazine. http://www.chadd.org .

— Melissa Healy Read more!

New psychiatric facility is welcome - Wilmington Star-News

By Cheryl Welch, Staff Writer
cheryl.welch@starnewsonline.com

Mental health advocate Stan Oathout recognizes that psychiatric services don't stand a chance in a popularity contest when up against other hospital ventures.

They don't make money and aren't exactly on the hospital tour. In fact, many hospitals nationwide have dropped psychiatric services in recent years, and hardly any are expanding their programs.

That's why Oathout, president of the local chapter of the National Alliance for the Mentally Ill, is so thrilled with New Hanover Regional Medical Center's $11.2 million investment in a new Oaks Behavioral Health Hospital. Not only that, but hospital administrators are planning to develop outpatient services for adolescents, something they have never offered before.

"It's a real commitment, and I'm pleased that New Hanover made that decision," Oathout said.

The architect's plan for the new 62-bed Oaks, set to open April 2008, calls for private rooms, additional family visiting areas, wings based on diagnosis and a separate outpatient center.

Adolescents - who have long traveled one to three hours for psychiatric care - will be able to stay close to home and in their schools thanks to services the hospital plans to offer.

"We have a tremendous need here," said Nancy Woolwine, director of emergency and ambulatory services. "It is the right thing for this medical center to do. It is a service our community relies on."

Mary Ellen Bonczek, New Hanover Regional's chief nurse executive, said the new building will have lots of open space, natural lighting and access to nature. All of these have been shown to elevate the spirit and promote healing.

"They feed off their environment, which is why the environment has to be healthy," Bonczek said.

While advocates said the amenities at the facility will certainly be nice, they're most excited about services for adolescents.

Every year, more than 200 area children and teenagers are referred elsewhere for mental health treatment.

"It's crucial to have behavioral health services close to home," said Jennifer Mahan, director of policy at the Mental Health Association in North Carolina. "Especially with adolescents, you want to have the family, if at all possible, involved in the treatment. It's absolutely critical for them to recover."

Cheryl Welch: 343-2315

cheryl.welch@starnewsonline.com
Read more!

Suicide rates down for psychiatric patients - Journal of Clinical Psychiatry

J Clin Psychiatry 2006; 67: 1936–1941

Investigators have found a substantial reduction in the rate of suicide among psychiatric patients who have been discharged from hospital for more than 1 year, particularly among middle-aged and older patients.uicide risk has declined for patients with psychiatric illness

"Recent improvement in psychiatric care and treatment and promotion of new generation antidepressants may contribute to these changes," say Ping Qin (University of Aarhus, Denmark) and colleagues.

The researchers retrieved data from Danish longitudinal registers for the 21,169 suicides that occurred in Denmark between 1981 and 1997 and for 423,128 controls.

The results showed a continuous decline in suicide rate during this period of time. The reduction was generally faster among the 9316 (44%) individuals with a history of admission to a psychiatric hospital.

The researchers note that the decline in suicide rate among these participants was largely accounted for by a faster reduction among patients who had been discharged from psychiatric hospitals for more than 1 year compared with those who had been discharged within 1 year.

Among the latter group, the reduction was similar to that for the general population, whereas the reduction was slower for those hospitalized for treatment at the time of suicide.

Further analyses stratified by age showed that the association between a faster decline in suicide rate and a history of hospitalization for psychiatric illness was present for patients of all ages, but it was more pronounced in patients aged 36 years and older.

The slower decline in suicide rate seen among patients hospitalized at the time of suicide was largely confined to older patients.

Qin et al note in the Journal of Clinical Psychiatry that the decline in suicide rate among patients with psychiatric illness in Denmark has occurred simultaneously with substantial changes in mental health services, including a reduction in the number of psychiatric beds in hospitals and an increase in the number of people employed in psychiatric services.

These changes provided possibilities for "closer observation and support during inpatient stay," says the team.

"We also believe that improved treatment of psychiatric illness, both for inpatients and outpatients, contributes to our findings." Read more!

Hard year almost over at Guilford Center - Greensboro News & Record

Published Dec. 17, 2006

By Ryan Seals, Staff Writer

Guilford Center Director Billie M. Pierce says she is hoping for stability in 2007.

She is hoping for a year in which her staff can put total focus on their jobs and continue serving patients in the best manner possible.

Her wish comes on the heels of a year filled with vast transition for the Guilford Center, the county’s mental health care agency.

The center has spent the past four years planning and implementing changes brought on by state mental health care reform.

Like other state government-operated mental health facilities, the center has been forced to hand over its case-management services to private providers.

The Guilford Center will continue to offer psychiatric medical services for children and adults, including psychiatric assessments, prescribing and dispensing medications, and providing 24-hour crisis and emergency services in both Greensboro and High Point.

The center will also continue to operate its 24-hour toll-free access service for screening, triage and referrals, in addition to providing treatments for the deaf and hearing-impaired, and for youth sexual offenders.

The center has shifted from providing case management to managing state-designated private providers.

Among the changes this year has been the task of reassigning 685 consumers to private community providers and cutting 125 positions — mostly caseworkers — from the center’s payroll, all by Dec. 31.

"This has been a tremendous amount of work," Pierce said. "Our clinical staff has really worked very, very hard to find providers. ... They’ve done it extraordinary well — I’m proud of the way they’ve handled that."

With the state-mandated deadline two weeks away, Pierce said Tuesday all but seven customers have found treatment among 699 providers in the region.

"I think the hardest thing is when a consumer says 'My choice is the Guilford Center, I want the Guilford Center,’ and that’s not possible," Pierce said.

"When it comes down to it, many of these consumers have been under our care for a long time, and changing that relationship and changing that bond has been difficult."

The state mandates that if the remaining customers haven’t found providers by the end of the year, center employees must assign them elsewhere.

Pierce said most caseworkers have found jobs elsewhere.

About 70 caseworkers are expected to remain until Dec. 31, she said.

Pierce said the Guilford Center will oversee and guide services for private providers, including training, technical service and monitoring.

It will operate a Consumer Affairs office that informs clients of their rights and handles provider complaints and will offer quality-management services.

Pierce said the center is busy working on its second local business plan, which outlines management strategies for the upcoming fiscal year.

The document must be approved by the center’s board of directors and by county commissioners before being submitted in March.

"Next year will be a transition year," Pierce said. "I think we will have to be very focused on operating the most efficient med clinics and crisis programs we can run. I would (also) like for my staff to have some time where they aren’t constantly facing super-change.

"This has been a year of change at the most accelerated pace imaginable."

Contact Ryan Seals at 373-7157 or rseals@ guilfordrecord.com
Read more!

Patient deaths lead to health center policy changes - Milwaukee Journal-Sentinel

By SCOTT WILLIAMS
swilliams@journalsentinel.com

Waukesha - Lisa Hansen smiled in gratitude upon hearing that her brother was sleeping comfortably while he recovered from an overdose of methadone.

"Thank you, thank you," she repeatedly told employees at the Waukesha County Mental Health Center.

A few hours later, her 41-year-old brother, Cary Borkin, was dead.

Jill Carriveau worried that her son Brandon was not getting proper care or supervision at the Mental Health Center as he struggled with depression and signs of alcoholism.

A telephone call at work brought her devastating news: Brandon Carriveau, 21, had committed suicide by hanging himself at the county facility.

In both instances in 2004, state inspectors determined that Mental Health Center staffers had failed to provide adequate supervision of the patients.

County officials say they have since retooled their procedures to prevent such tragedies from happening again.

But the families of both Borkin and Carriveau remain tormented by questions about how their loved ones could befall such misfortune while under the care of medical professionals trained to handle troublesome patients.

"I actually thought he was in good hands," Hansen said of her brother. "It just never should have happened."

Jill Carriveau said she blames the county for operating the Mental Health Center in a way that allowed her son to commit suicide.

"He was supposed to be in a safe place," she said. "How could this possibly happen?"

Similar questions have been directed in recent months at the Milwaukee County Mental Health Complex, where a 33-year-old woman died after becoming malnourished and dehydrated. The Journal Sentinel has chronicled such problems in recent stories.

The newspaper recently uncovered details of the two suburban patient deaths, both of which occurred in late 2004.

Waukesha County officials say they had not previously experienced a patient death at the Mental Health Center since at least 1993, when the 28-bed facility opened at its current location near the Waukesha County Courthouse.

Peter Schuler, the county's director of health and human services, said he does not believe his staff committed any mistakes in caring for Borkin or Carriveau. He said no patient can be guaranteed safety 100% of the time without round-the-clock supervision, which he characterized as impractical.

"You just can't do that with everyone," he said. "You'd have to have an army" of employees.

The Mental Health Center maintains a staff of 45 employees on a budget of about $5 million a year.

But the county has changed its procedures to reclassify all patients as high-level suicide risks - requiring that staff check each patient every 15 minutes, unless a doctor determines that a patient can be downgraded to a lesser classification requiring less supervision. Previously, a patient was not regarded as a high-level risk unless labeled by a doctor.

"We made changes, and we made them quickly," Schuler said.

State inspectors have since approved of the county's changes under federal standards for such public health facilities.

Finding fault

According to state inspection reports obtained under open records laws, inspectors harshly criticized Waukesha County's handling of the two deaths, noting that the county had "failed to ensure that the facility maintains an ongoing program for patient safety."

Even several months after the deaths, inspectors found fault with the county's response. In August 2005, an inspector wrote that Borkin's death still had not been formally reviewed, because a coroner's finding on the cause of death was still pending.

"It has been over eight months and the facility has not put anything in place to prevent a similar incident from occurring," the inspector wrote.

Brandon Carriveau, who lived in Hartland, was admitted to the Mental Health Center on Nov. 29, 2004, after making suicidal threats to police officers who had arrested him for drunken driving. It was his fourth admission to the county facility, in what his family describes as a recurring bout with depression and drinking.

Although county procedures at the time called for such patients to be checked every 30 minutes, inspectors wrote that Carriveau was left unmonitored for four hours. Staffers then overheard his shower running about 10:30 a.m. and found him hanged by the neck with bed sheets inside the bathroom about 20 minutes later.

County officials declined to comment specifically on Carriveau or Borkin's medical care, citing patient confidentiality.

But in written responses to the state, officials wrote that both patients had been placed on 30-minute checks and that the problems were in recordkeeping rather than patient care.

Borkin, who lived in Milwaukee, was admitted to the Mental Health Center on Dec. 18, 2004, after being treated at a Menomonee Falls hospital for an overdose of methadone, commonly used to treat recovering heroin addicts.

His sister says Borkin was not a heroin addict, but that he abused other drugs and went to a Milwaukee methadone clinic because he wanted to try that particular narcotic.

Police booked him on an unrelated warrant and took him to the mental health facility, citing suspicions that he had tried suicide before. He was found unconscious in his bed the next day and pronounced dead at Waukesha Memorial Hospital.

An autopsy turned up a lethal dose of methadone, and his death was ruled an accidental overdose. The coroner's report makes no precise determination about when and how he obtained more methadone.

Hansen believes her brother persuaded county staffers to give him more methadone. County officials could not or would not help her pursue that theory, she said.

In an autopsy report, Medical Examiner Lynda Biedrzycki seemed to support Hansen's theory, although she also wrote that Borkin was still suffering lingering effects from his previous overdose.

In addition to updated operational procedures, county officials say they have invested thousands of dollars to correct physical shortcomings in the Mental Health Center cited by state inspectors. Among the changes: replacing the type of ceiling grate Carriveau used to hang himself with bed sheets.






From the Dec. 18, 2006 editions of the Milwaukee Journal Sentinel
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Some with mental illness may get homes - San Antonio Tribune-News

By Sarah Arnquist
sarnquist@thetribunenews.com

San Luis Obispo County is expanding housing for adults with serious mental illnesses in the North County by partially funding the purchase of an Atascadero housing complex.

The county contributed $350,000 to help Transitions Mental Health Association and the San Luis Obispo Housing Authority buy a $1.2 million nine-unit apartment building. In exchange, six two-bedroom units will be dedicated for 20 years to house adults participating in the county’s mental-health programs.

"This program will take people who already live in North County and provide them with a safe place to live," said Jill Bolster-White, executive director of Transitions Mental Health Association.

The people who qualify for the housing have serious and persistent mental illnesses and may have been living with aging parents or on the streets because they cannot afford housing,

Bolster-White said. Residents will pay a portion of their rent, depending on income, she said.

The Mental Health Services Act was created in 2004 when California voters approved an extra 1 percent tax on the state’s millionaires to fund programs for mental health.

The act requires mental health departments to focus services on people with severe mental illnesses and underserved populations. It also requires them to provide intense "whatever it takes" services to keep people in stable living conditions and out of institutional care.

Each county underwent a lengthy planning process to find the underserved populations and identify the community’s greatest unmet needs. In San Luis Obispo County, housing was the No. 1 unmet need for adults with mental illness, followed by substance-abuse services, employment opportunities and crisis services.

"The biggest feature of the Mental Health Services Act is that we really had a conversation with the people who were getting services," Bolster-White said. "We finally asked people what they needed."

Housing is a critical step in recovery for these individuals, said Karen Baylor, director of the county’s Behavioral Health Department, which includes mental health and drug and alcohol services.

"If you don’t have a place to live, nothing else really matters," she said.

Housing is only one way the county is spending Mental Health Services Act money. Many other programs are now up and running, Baylor said. Other programs include family advocates to help people navigate the system, a supportive employment program that provides vocational training and helps people find jobs, and education programs through the National Alliance for the Mentally Ill.

The county also expanded its mobile crisis teams that respond 24 hours a day to people in crisis and added Latino outreach programs. The bulk of the new money funds teams of therapists, social workers and others that wrap mentally ill clients in services. These service partnerships should begin in January, Baylor said.

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Kids and mental illness by the numbers - Kansas City Star

Curing mental illness, with all its variables, makes curing Alzheimer’s look like a walk in the park.”

Laurence Hirshberg, Brown University professor and director of the Neurodevelopment Center, Providence, R. I.

1% of children in public schools receive special classes (about 8,200 in Missouri, 4,500 in Kansas) because they are severely emotionally disturbed

5% of America’s 80 million children (about 4 million children) have a mental or emotional illness considered “severe.”

11% of

America’s 80 million children (about 9

million) have a mental or emotional illness

considered “significant.”

20% of America’s 80 million children (about 16 million) have a

diagnosable mental disorder from mild to severe.

50%

of children with mental and emotional problems receive adequate treatment.

Beginning in July, reporter Eric Adler and photographer Tammy Ljungblad followed the plights of five children inside Spofford Home, a nonprofit residential treatment center, which offered unprecedented access for this series. The Star chose the children based on their stories and parental cooperation. Parents, who wanted to raise awareness about children and mental illness, gave signed permission to peruse medical records, to record therapy sessions, and to conduct in-depth interviews with them, their children, therapists and others. Interviews with dozens of mental-health experts, and more than 3,000 pages of local, state and federal reports, were also used to prepare this series.

Adler, 47, has worked at The Star since 1985. His work has won numerous awards including first place from the National Headliner Awards and the American Association of Sunday and Features Editors. He lives in Kansas City with his wife, Tamara, and 9-year-old son, Aidan.

Ljungblad, 43, has been at The Star for 17 years. Her photographs were part of The Star’s 1992 Pulitzer Prize-winning series. She has also won awards from the National Press Photographers Association and the Missouri Press Association. She lives in Prairie Village with her husband, Brian, and 7-year-old son, Brett.

Bill Luening edited the series, Charles W. Gooch designed the printed pages and Don Munday edited the copy.

Marcus’ tangled mind proves daunting to his new therapist.

DAY 1
Suicide, often a consequence of severe mental illness, is the leading cause of violent death worldwide.

Suicide: 49. 1 percent

Homicide: 31.3 percent

War deaths: 18.6 percent

Source: — World Health Organization
Read more!

In jail and in danger - LA Times

Mentally ill inmates among most vunerable

By Stuart Pfeifer and Robin Fields
Times Staff Writers

On a Tuesday in October 2003, Ki Hong entered Men's Central Jail in downtown Los Angeles to serve a five-day sentence for soliciting a prostitute.

He didn't survive two hours.

Three members of a Korean gang instantly spotted Hong, 34, who authorities allege was a member of a rival gang. The trio had broad freedom to roam the jail because sheriff's deputies had given them jobs as inmate workers — jobs for which they, awaiting trial on murder charges, should have been ineligible.

They let themselves into Hong's dormitory using a guard's control button. Then they stabbed Hong repeatedly, strangled him with bed linen and hid his body in a trash bin.

Since 2000, 14 inmates have been slain in jails run by the Los Angeles County Sheriff's Department, including four this year. Hundreds more have been injured in jail violence.

Taxpayers, who pay more than $500 million a year to operate the jails, paid an additional $6 million since 2004 to compensate inmates and their survivors for errors, negligence and brutality. In addition, a tentative $2.8-million settlement is awaiting county approval.

A Times review found that:

• The Sheriff's Department has failed to protect vulnerable inmates from predators, despite repeated calls for action by jail experts. Last year, deputies placed Chadwick Cochran, a low-level offender with a long history of mental illness, in an unsupervised holding cell with violent gang members. They punched and stomped him to death.

• The department has had increasing difficulty maintaining order at its eight jail facilities. More than 30 major disturbances involving large numbers of inmates erupted this year. Riots left two dead and at least 100 injured. After widespread rioting in 2000, the violence subsided briefly. But the number of disturbances has risen from 47 in 2001 to 112 this year, records show.

• Disciplinary action against sheriff's employees whose lapses contributed to inmate deaths or injuries is often softened or rescinded on appeal. In one case in 2003, a deputy was suspended five days for failing to notice that two inmates, drunk on jail-brewed alcohol, had beaten their mentally ill cellmate to death. A supervisor overturned the suspension over the objections of the department's internal affairs monitor.

The Hong case cost the county $800,000 in legal claims and prompted sanctions against a dozen jail employees. Yet similar failures played a role in at least seven inmate deaths over the next two years.

In the most notorious case, an inmate wandered unescorted through Men's Central Jail for several hours, finally finding a witness who had testified against him in a murder case and strangling him in his cell.

Sheriff Lee Baca says his department has done its best to contain an ever-more-explosive inmate population.

"It's remarkable there's not more violence in the context of the county jail demographics," he said in an interview. "It could be 10 to 100 times worse if it wasn't for the managers and deputies in the Los Angeles County Jail. We'll never be singled out for the murders we have prevented."

Baca said his department has taken steps to reduce jail violence in recent months. A centralized team now screens arriving inmates to separate the vulnerable from the violent. Many Latino gang members are held apart from the general population to avoid clashes with outnumbered black inmates.

The sheriff also said his department has inadequate resources to staff the jails properly and renovate unsafe facilities.

Civil rights attorney Hermez Moreno, who represented the family of the slain witness, 20-year-old Raul Tinajero, said the department's shortcomings came down to management, not money.

Tinajero's killer was allowed out of his cell by pretending to have a court appearance. The deputy responsible for checking his ID number against the list of inmates with court appearances apparently did not do so.

The $1.25 million paid earlier this year to settle a lawsuit filed by Tinajero's relatives was the second-largest payout for an inmate death in county history.

"How much money would it have taken for one guy to look at the wristband of the guy who killed Tinajero?" Moreno said. "The answer is no amount of money. The answer is accountability and appropriate training."



Comparing jails

In the Los Angeles County Jail system — the nation's largest — about 3,300 uniformed employees watch over an inmate population that averages more than 18,000.

The New York City Department of Correction, which oversees about 5,000 fewer inmates, has three times as many uniformed guards.

At least one in five Los Angeles County inmates is a gang member. Nearly 90% are awaiting trial on felony charges.

Almost two-thirds of the jail killings since 2000 have taken place in Men's Central Jail, an aging 4,800-bed behemoth just north of Union Station.

Dilapidated, understaffed and chronically overcrowded, the cellblocks at "CJ" are a nightmare of poor sightlines and dark corners. During an internal affairs review, sheriff's personnel conceded that they rarely entered the bunk-lined dormitory where Hong was murdered. Instead, they monitored inmates by peeking through its sole small window.

Inmates routinely walk CJ's halls unaccompanied by staffers. Pairs of deputies guard lines of 100 inmates or more as they shuffle through the jail.

Assessing the conditions in February as part of ongoing civil rights litigation, former Virginia prison Warden Toni V. Bair wrote that "in every instance where there was a mass inmate movement I did not observe anything close to adequate supervision…. Inmates, frequently numbering 100 or more, could have created a disturbance, rioted and taken hostages."

Jail management experts such as Bair acknowledge the sheriff's challenges but say his agency has not done enough to safeguard the most likely targets of violence.

The Sheriff's Department is well aware of who the most vulnerable are: informants, child molesters, the mentally ill, the elderly and African Americans, who are outnumbered by Latino inmates. Yet time and again, these inmates have been victimized.

In May 2003, sheriff's deputies placed a defendant in a courthouse holding cell with Martin Davis, a witness in his criminal trial, even though the men's security classifications mandated that they be kept apart.

Spotting Davis sleeping on the floor, the defendant, Joseph Allen, kicked him repeatedly until a deputy intervened. Davis emerged from a coma after more than a week and sued the county, receiving a $375,000 settlement.

Seven months after the Davis assault, Jose Beas, an accused child molester, was placed with 80 other inmates in a dorm at Men's Central Jail even though a special order had been entered into the jail system's computer to segregate him for his protection. Beas, 41, was beaten severely.

The Board of Supervisors is scheduled to vote Tuesday on a settlement paying his family $2.8 million for his lifelong care.

In a November 2004 report to the supervisors, Merrick Bobb, who monitors the sheriff for the board, urged the Sheriff's Department not to house the most dangerous inmates — given security ratings of 8 or 9 — with lower-risk inmates. He based his recommendation on the circumstances surrounding five jail homicides between October 2003 and April 2004.

The department did not follow Bobb's advice until early this year. By then, there had been three more slayings. In two of them, assailants classified as higher-level risks killed lower-level offenders.

Sean Anthony Thompson, 38, was killed in his cell at Men's Central Jail in February, 2 1/2 months after Undersheriff Larry Waldie assured the supervisors that plans were underway to separate level 8 and 9 inmates from others. Thompson was a Level 6. Three of his four attackers were Level 8.

Marc Klugman, chief of the sheriff's correctional services division, said the agency moved as quickly as possible. "It was a pretty massive sea change. It was not something we could just do overnight," he said.

Within weeks of Thompson's slaying, the Sheriff's Department was putting all Level 9 inmates in one-man cells and segregating Level 8s from the rest of the jail population.

The department moved more swiftly on recommendations to tighten policies on inmate workers, who handle such tasks as distributing meals and cleaning cells and common areas.

Deputies used to choose the workers informally. One of Hong's attackers kept his job — and, thus, access to Hong — even after deputies received a tip that he was dealing drugs inside the jail.

After Hong's killing, the Sheriff's Department required supervisors to approve all inmate workers.

Yet in practice, the selection process has remained casual. Inmates sometimes pass deputies makeshift resumes through their cell bars, listing as "references" other officers for whom they have worked.

Baca rejected the notion that if his agency followed its own rules better, it could avert at least some attacks.

"The problems in the jails, in my opinion, are 100% bred by the prisoners," Baca said. "They're going to commit crimes in the jails. They just find a new victim population."

They did not have to look far to find Stephen Prendergast.

On Dec. 6, 2003, two of Prendergast's cellmates at Men's Central Jail attacked him, apparently angry that he was acting strangely and talking to himself.

Prendergast, 33, awaiting trial on an arson charge, had spent several months in a state mental hospital before being sent to the Los Angeles County jails.

He was transferred into the general population at Men's Central Jail after refusing to take medication for schizophrenia at Twin Towers' mental health unit.

Prendergast's cellmates started assaulting him at 6 p.m. and continued for several hours, a sheriff's investigation found.

Two hours into it, a deputy came around to check on the cell. He did not notice that Prendergast had been beaten or that his cellmates were drinking a homemade jail brew called pruno. The assault continued. When Prendergast cried out, other inmates on the row yelled to cover up the sound.

It wasn't until almost 8 a.m. the following day that another deputy realized Prendergast was injured. He was taken to the hospital, where he died from severe brain trauma. The county paid his family $262,500 to settle their wrongful death lawsuit.



Little punishment

Anthony Fernandez lives in the garage of his mother's Pico Rivera home. He struggles with his balance. His speech is halting and sometimes slurred. In April 2004, while Fernandez was serving a six-month sentence for carrying a concealed weapon, four inmates who thought he stole from them dragged him to the back of his dormitory at Pitchess Detention Center's North Facility and beat him senseless.

Fernandez, 21, suffered extensive neurological damage and may never be able to live independently. His assailants had 20 minutes to attack him undetected because the deputy assigned to watch his dorm left her post unattended, assuming her replacement was on his way.

It was a costly error. The county agreed to pay $750,000 to settle a lawsuit by Fernandez's family.

The Sheriff's Department handed down a stiff penalty too, demoting the deputy to custody assistant, a lower-paying civilian position. But after the deputy objected, she was reinstated and given a 30-day suspension instead.

The agency has followed a similar pattern in dozens of other instances in which employees' lapses played a role in inmate deaths and injuries, records show. Department officials initially took disciplinary action against eight deputies, two custody assistants and two sergeants for mistakes and inattention in the Tinajero killing, doling out a combined 72 days of suspensions.

But their supervisors reduced the punishments imposed on nine of the 12, dropping suspensions to written reprimands in three cases. A five-day suspension for the deputy who apparently failed to check the ID of Tinajero's killer was dropped entirely after he appealed.

Department executives slashed the discipline imposed in the Hong case by two-thirds. Just one employee served a suspension longer than five days.

Correctional Services Chief Klugman said punishments are often eased after deputies promise to learn from their mistakes.

Jail experts and attorneys said the department lacks the will to hold employees accountable. The pattern of imposing, then rescinding, punishments sends a message that negligent or abusive officers have little to fear, they contend.

"They know nothing is going to happen," said Moreno, the civil rights attorney.

Michael Gennaco, chief attorney for the sheriff's Office of Independent Review, acknowledged that disciplinary action is sometimes watered down without justification. But he said misconduct by deputies is investigated more thoroughly and punished more harshly than under previous sheriffs.

Jail employees' use of significant force rose 60% between 2000 and 2005, department records show. Incidents resulting in hospitalization or verifiable injury to inmates almost doubled in that time, from 186 to 339.

Gennaco said many uses of force are appropriate reactions to inmate behavior. Still, he acknowledged, the Sheriff's Department has a reputation for parking problem officers in the jails. Some incidents stem not from problem deputies but from questionable practices passed down over the years.

On Nov. 16, 2005, Chadwick Cochran was placed in an unmonitored television room in Men's Central Jail with about 30 other offenders.

Two gang members apparently mistook him for a police informant and pummeled him with their hands and feet as well as plastic dinner trays. As Cochran lay motionless on the floor, the pair took turns jumping off steel benches and stomping on his head.

The officers who left Cochran unsupervised were not disciplined. What they had done was so common at the jail that internal investigators decided it wouldn't be fair to punish them.

"The informal practice of placing inmates in television rooms was well-established, if misguided," a report released by Gennaco's office concluded. "This made it difficult to hold people accountable for following it."

Despite strides made by the Sheriff's Department this year, violence is commonplace in the L.A. County jails. In the last six weeks, two more inmates have been slain. A 51-year-old mentally ill man was killed in his cell by a younger, stronger cellmate, and an inmate was beaten to death by gang members.

Baca said his department continues searching for ways to bring the violence under control.

"I'm certainly of the belief that we can always do better," he said. "I don't think any death in the jail is acceptable."

stuart.pfeifer@latimes.com

robin.fields@latimes.com

*

(INFOBOX BELOW)

530

Inmate disturbances in jails run by the Los Angeles County Sheriff's Department since 2000.

$6 million

Money Los Angeles County has spent to compensate inmates and their survivors for negligence, errors and violence since 2004.

18,000 +

Average number of inmates held daily in jails operated by the Los Angeles County Sheriff's Department.

*

(INFOBOX BELOW)

Jail violence

Inmate disturbances in Los Angeles County jails are up sharply this year. Major disturbances are described as involving a majority of inmates in affected areas and may lead to serious injuries; minor disturbances involve smaller groups and may result in minor or no injuries; riots are classified as violent disruptions that put the safety of the staff and inmates in serious jeopardy.

Incident
type 2000 2001 2002 2003 2004 2005 2006*
Riot 1 0 0 0 0 0 3
Major 78 19 26 31 26 28 34
Minor 35 28 48 28 31 39 75
Total 114 47 74 59 57 67 112


*Through Dec. 6.

Source: Los Angeles County Sheriff's Department

Read more!

Eli Lilly Trying To Play Down Risk of Top Pill? - NY Times

By ALEX BERENSON

The drug maker Eli Lilly has engaged in a decade-long effort to play down the health risks of Zyprexa, its best-selling medication for schizophrenia, according to hundreds of internal Lilly documents and e-mail messages among top company managers.

The documents, given to The Times by a lawyer representing mentally ill patients, show that Lilly executives kept important information from doctors about Zyprexa’s links to obesity and its tendency to raise blood sugar — both known risk factors for diabetes.

Lilly’s own published data, which it told its sales representatives to play down in conversations with doctors, has shown that 30 percent of patients taking Zyprexa gain 22 pounds or more after a year on the drug, and some patients have reported gaining 100 pounds or more. But Lilly was concerned that Zyprexa’s sales would be hurt if the company was more forthright about the fact that the drug might cause unmanageable weight gain or diabetes, according to the documents, which cover the period 1995 to 2004.

Zyprexa has become by far Lilly’s best-selling product, with sales of $4.2 billion last year, when about two million people worldwide took the drug.

Critics, including the American Diabetes Association, have argued that Zyprexa, introduced in 1996, is more likely to cause diabetes than other widely used schizophrenia drugs. Lilly has consistently denied such a link, and did so again on Friday in a written response to questions about the documents. The company defended Zyprexa’s safety, and said the documents had been taken out of context.

But as early as 1999, the documents show that Lilly worried that side effects from Zyprexa, whose chemical name is olanzapine, would hurt sales.

“Olanzapine-associated weight gain and possible hyperglycemia is a major threat to the long-term success of this critically important molecule,” Dr. Alan Breier wrote in a November 1999 e-mail message to two-dozen Lilly employees that announced the formation of an “executive steering committee for olanzapine-associated weight changes and hyperglycemia.” Hyperglycemia is high blood sugar.

At the time Dr. Breier, who is now Lilly’s chief medical officer, was the chief scientist on the Zyprexa program.

In 2000, a group of diabetes doctors that Lilly had retained to consider potential links between Zyprexa and diabetes warned the company that “unless we come clean on this, it could get much more serious than we might anticipate,” according to an e-mail message from one Lilly manager to another.

And in that year and 2001, the documents show, Lilly’s own marketing research found that psychiatrists were consistently saying that many more of their patients developed high blood sugar or diabetes while taking Zyprexa than other antipsychotic drugs.

The documents were collected as part of lawsuits on behalf of mentally ill patients against the company. Last year, Lilly agreed to pay $750 million to settle suits by 8,000 people who claimed they developed diabetes or other medical problems after taking Zyprexa. Thousands more suits against the company are pending.

On Friday, in its written response, Lilly said that it believed that Zyprexa remained an important treatment for patients with schizophrenia and bipolar disorder. The company said it had given the Food and Drug Administration all its data from clinical trials and reports of adverse events, as it is legally required to do. Lilly also said it shared data from literature reviews and large studies of Zyprexa’s real-world use.

“In summary, there is no scientific evidence establishing that Zyprexa causes diabetes,” the company said.

Lilly also said the documents should not have been made public because they might “cause unwarranted fear among patients that will cause them to stop taking their medication.”

As did similar documents disclosed by the drug maker Merck last year in response to lawsuits over its painkiller Vioxx, the Lilly documents offer an inside look at how a company marketed a drug while seeking to play down its side effects. Lilly, based in Indianapolis, is the sixth-largest American drug maker, with $14 billion in revenue last year.

The documents — which include e-mail, marketing material, sales projections and scientific reports — are replete with references to Zyprexa’s importance to Lilly’s future and the need to keep concerns about diabetes and obesity from hurting sales. But that effort became increasingly difficult as doctors saw Zyprexa’s side effects, the documents show.

In 2002, for example, Lilly rejected plans to give psychiatrists guidance about how to treat diabetes, worrying that doing so would tarnish Zyprexa’s reputation. “Although M.D.’s like objective, educational materials, having our reps provide some with diabetes would further build its association to Zyprexa,” a Lilly manager wrote in a March 2002 e-mail message.

But Lilly did expand its marketing to primary care physicians, who its internal studies showed were less aware of Zyprexa’s side effects. Lilly sales material encouraged representatives to promote Zyprexa as a “safe, gentle psychotropic” suitable for people with mild mental illness.

Some top psychiatrists say that Zyprexa will continue to be widely used despite its side effects, because it works better than most other antipsychotic medicines in severely ill patients. But others say that Zyprexa appears no more effective overall than other medicines.

And some doctors who specialize in diabetes care dispute Lilly’s assertion that Zyprexa does not cause more cases of diabetes than other psychiatric drugs. “When somebody gains weight, they need more insulin, they become more insulin resistant,” Dr. Joel Zonszein, the director of the clinical diabetes center at Montefiore Medical Center in the Bronx, said when asked about the drug.

In 2003, after reviewing data provided by Lilly and other drug makers, the F.D.A. said that the current class of antipsychotic drugs may cause high blood sugar. It did not specifically single out Zyprexa, nor did it say that the drugs had been proven to cause diabetes.

The drugs are known as atypical antipsychotics and include Johnson & Johnson’s Risperdal and AstraZeneca’s Seroquel. When they were introduced in the mid-1990s, psychiatrists hoped they would relieve mental illness without the tremors and facial twitches associated with older drugs. But the new drugs have not proven significantly better and have their own side effects, said Dr. Jeffrey Lieberman, the lead investigator on a federally sponsored clinical trial that compared Zyprexa and other new drugs with one older one.

The Zyprexa documents were provided to the Times by James B. Gottstein, a lawyer who represents mentally ill patients and has sued the state of Alaska over its efforts to force patients to take psychiatric medicines against their will. Mr. Gottstein said the information in the documents raised public health issues.

“Patients should be told the truth about drugs like Zyprexa,” Mr. Gottstein said.

Lilly originally provided the documents, under seal, to plaintiffs lawyers who sued the company claiming their clients developed diabetes from taking Zyprexa. Mr. Gottstein, who is not subject to the confidentiality agreement that covers the product liability suits, subpoenaed the documents in early December from a person involved in the suits.

In its statement, Lilly called the release of the documents “illegal.” The company said it could not comment on specific documents because of the continuing product liability suits.

In some ways, the Zyprexa documents are reminiscent of those produced in litigation over Vioxx, which Merck stopped selling in 2004 after a clinical trial proved it caused heart problems. They treat very different conditions, but Zyprexa and Vioxx are not entirely dissimilar. Both were thought to be safer than older and cheaper drugs, becoming bestsellers as a result, but turned out to have serious side effects.

After being pressed by doctors and regulators, Merck eventually did test Vioxx’s cardiovascular risks and withdrew the drug after finding that Vioxx increased heart attacks and strokes.

Lilly has never conducted a clinical trial to determine exactly how much Zyprexa raises patients’ diabetes risks. But scientists say conducting such a study would be exceedingly difficult, because diabetes takes years to develop, and it can be hard to keep mentally ill patients enrolled in a clinical trial.

When it was introduced, Zyprexa was the third and most heralded of the atypical antipsychotics. With psychiatrists eager for new treatments for schizophrenia, bipolar disorder, and dementia, Zyprexa’s sales soared.

But as sales grew, reports rolled in to Lilly and drug regulators that the medicine caused massive weight gain in many patients and was associated with diabetes. For example, a California doctor reported that 8 of his 35 patients on Zyprexa had developed high blood sugar, including two who required hospitalization.

The documents show that Lilly encouraged its sales representatives to play down those effects when talking to doctors. In one 1998 presentation, for example, Lilly said its salespeople should be told, “Don’t introduce the issue!!!” Meanwhile, the company researched combinations of Zyprexa with several other drugs, hoping to alleviate the weight gain. But the combinations failed.

To reassure doctors, Lilly also publicly said that when it followed up with patients who had taken Zyprexa in a clinical trial for three years, it found that weight gain appeared to plateau after about nine months. But the company did not discuss a far less reassuring finding in early 1999, disclosed in the documents, that blood sugar levels in the patients increased steadily for three years.

In 2000 and 2001, more warning signs emerged, the documents show. In four surveys conducted by Lilly’s marketing department, the company found that 70 percent of psychiatrists polled had seen at least one of their patients develop high blood sugar or diabetes while taking Zyprexa, compared with about 20 percent for Risperdal or Seroquel. Lilly never disclosed those findings.

By mid-2003, Lilly began to change its stance somewhat, publicly acknowledging that Zyprexa can cause severe obesity. Marketing documents make clear that by then Lilly believed it had no choice. On June 23, 2003, an internal committee reported that Zyprexa sales were “below plan” and that doctors were “switching/avoiding Zyprexa.”

Since then, Lilly has acknowledged Zyprexa’s effect on weight but has argued that it does not necessarily correlate to diabetes. But Zyprexa’s share of antipsychotic drug prescriptions is falling, and some psychiatrists say they no longer believe the information Lilly offers.

“From my personal experience, at first my concerns about weight gain with this drug were very significantly downplayed by their field representatives,” said Dr. James Phelps, a psychiatrist in Corvallis, Or. ‘Their continued efforts to downplay that, I think in retrospect, was an embarrassment to the company.”

Dr. Phelps says that he tries to avoid Zyprexa because of its side effects but sometimes still prescribes it, especially when patients are acutely psychotic and considering suicide, because it works faster than other medicines.

“I wind up using it as an emergency medicine, where it’s superb,” he said. “But I’m trying to get my patients off of Zyprexa, not put them on.” Read more!

Mental health network lauded - Asheville Citizen-Times

ASHEVILLE — Western Highlands Network is being praised for its handling of the closing of the region’s largest mental health provider.

Western Highlands manages the private network of mental health, developmental disabilities and substance abuse services in eight counties in Western North Carolina. At the end of August, the largest services provider, New Vistas/Mountain Laurel Behavioral Health Services, announced it would close within 60 days.

“Western Highlands is being looked at as a shining star in this state for the way it dealt with this crisis,” Bill Bullington, the state liaison from the Division of Mental Health, Developmental Disabilities and Substance Abuse Services, told the Western Highlands board of directors Friday.

Western Highlands Network personnel worked with county leaders and local agencies to find services providers for about 10,000 clients, said CEO Arthur Carder. In less than 60 days, nearly all the people who had worked for New Vistas were hired by providers who were willing to expand their services, and clients chose or were assigned to new agencies for their care.

“We are still getting more urgent calls than normal, but we have 314 providers now, and every adult mental health consumer whose case was open with New Vistas has been assigned a provider,” Carder said.

The eight WNC counties covered by the Western Highlands Network are Buncombe, Henderson, Madison, Mitchell, Polk, Rutherford, Transylvania, and Yancey.

Sen. Martin Nesbitt (D-Buncombe), co-chair of the legislative committee that oversees mental health issues, called the work by Western Highlands, leaders from the eight counties and local providers incredible.

“We probably built a model system with a model local management agency, and we’re way ahead of the rest of the state,” he said.

Read more!

Triad researchers take aim at Alzheimer's - Winston-Salem Journal

By M. Paul Jackson

In laboratories locally and across the country, pharmaceutical companies are attempting to build a better mousetrap. That mousetrap is a new treatment for Alzheimer's disease, a debilitating illness that gradually robs patients of their ability to think, walk and reason.

In Winston-Salem, Targacept Inc. is developing a drug targeting receptors in the brain, hoping to reduce the disease's symptoms, for example. In High Point, TransTech Pharma is developing a treatment targeting the buildup of a specific protein to possibly prevent the illness.

Their research is part of an accelerating race to find a better way to treat Alzheimer's patients. Existing treatments can often be inadequate or fail to treat symptoms for very long. Companies trying to develop better medications could be treading into unfamiliar - but possibly lucrative - waters, health-care experts said.

"There's no such thing as a cheaper, generic treatment to prevent memory loss or reverse memory loss," said Dr. Jeff Williamson, the director of the Kulynych Center for Memory and Cognition at Wake Forest University Baptist Medical Center.

"A company that could find a drug in this area really would have no competition."

Alzheimer's disease is a progressive brain disorder that gradually destroys a patient's memory, cognitive function and communication skills. It has no cure and can cause death. Elderly people are the most vulnerable to the disease.

For caregivers of Alzheimer's patients, the disease can also be devastating. Patients can exhibit mood swings, extreme changes in personality, loss of motor function and decreased judgment. Those with advanced Alzheimer's usually need round-the-clock care. Nearly 5 million Americans have the disease, or some form of it.

Kathy Hatfield of Pfafftown knows firsthand about the effects of Alzheimer's. Hatfield's 78-year old father, Lyman, was found to have the illness about two years ago. He suffers from huge holes in his memory and can no longer remember things occurring just moments ago.

When her father was first diagnosed, "Originally, it was a death sentence for me," she said. "I was thinking 'How am I ever going to be able to stand this?'"

For Hatfield, dealing with her father is a delicate negotiation. She has learned not to anger him, to try to stimulate his thinking and to encourage his daily routine.

She has disconnected the battery of her father's car to prevent him from driving, she said.

"The main, important thing with a person with Alzheimer's, in my opinion, is to continue to encourage their dignity," she said.

Such companies as Targacept and TransTech Pharma are trying to develop drugs for patients like Hatfield's father.

The companies have both reached advanced, phase-two clinical trials of their most promising Alzheimer's drugs. Most drugs go through three phases of clinical testing before the Food and Drug Administration decides whether the drug will be approved for the market. The FDA also monitors the process at each phase of a drug's development.

The market to create a better Alzheimer's drug is wide open, largely because current drugs treat only ease the disease's symptoms, and many can have side effects.

Pharmaceutical companies that are developing Alzheimer's treatments are also aiming for a piece of a large financial pie. About $100 billion is spent in the United States on Alzheimer's care annually. Even a small slice of that pie is substantial.

Kathy Hatfield's father takes Aricept and a drug called Namenda.

But creating a better treatment is not easy.

Doctors are still uncertain as to what causes the illness. To build a better treatment, doctors will have to attack the degeneration of cells thought responsible for the disease, experts said.

"The exciting thing right now is that there's a lot of technology out there," said Dr. Kevin Schulman, the director of the center for clinical and genetic economics at Duke University Medical Center.

Despite the challenges, the area's two biotechnology companies seem to be in the forefront of developing a treatment.

Targacept, which went public last April, and TransTech Pharma, a private company, have each joined with pharmaceutical giants to develop treatments for the disease.

Targacept entered a $300 million collaboration with AstraZeneca PLC last year, and TransTech Pharma signed a $155 million collaboration with Pfizer, Inc., in September to develop an Alzheimer's treatment.

Now, they need to successfully bring those treatments to market, experts said. "It's important to look over your shoulder and see how other people are doing, but it's equally important to go with your product," Schulman said.

Treating the disease

Physicians and scientists have not determined the exact cause of the disease, but they widely believe that Alzheimer's is caused by the build up of certain proteins in the brain. The proteins, called beta amyloid proteins, can damage nerve cells that are responsible for transmitting signals throughout the brain.

The damage to the brain's nerve cells has serious side effects. In many cases, the cells are unable to produce enough of a much-needed chemical called acetylcholine, which plays a key role in memory and judgment. Acetylcholine helps transmit information to other cells.

Most Alzheimer's research involves inhibiting the breakdown of acetylcholine, allowing the brain to transmit information.

The race to develop a better treatment for Alzheimer's disease took off about 10 years ago, just after the country's most widely used Alzheimer's treatment hit the market.

In 1996, the federal government approved the use of Aricept to treat the disease. Aricept is made by Pfizer and works by inhibiting the breakdown of acetylcholine.

Other Alzheimer's treatments perform similar functions - but no drug is able to repair or prevent the basic cell degeneration believed responsible for the disease. In addition, Aricept and similar drugs can have side effects including nausea, vomiting, fatigue and even anorexia.

Now, 10 years later, that earlier research has set off a wider search to develop a better drug.

Targacept, for example, is developing a drug with the working name of TC-1734. The drug works by triggering certain receptor cells in the brain to release more acetylcholine, the chemical that helps transmit information. The drug would reduce the cognitive- impairment symptoms of the illness. It also seems to have fewer side effects than medications like Aricept, according to the company's studies.

Targacept, based in the Piedmont Triad Research Park, has about 75 employees. It is developing drugs based on nicotine research to treat diseases of the central nervous system, which also include schizophrenia and cognitive impairment.

The company entered the public market in April. Its Nasdaq stock price debuted at $9 a share but has since ranged from $5.26 to $9 a share, reflecting the volatile biotechnology industry.

Targacept officials are betting that their particular drug will deliver positive benefits.

"The problem right now is there's a huge unmet need," in helpful Alzheimer's treatments, said Alan Musso, Targacept's chief financial officer. "It's just an area, right now, where the current therapeutics that are available aren't very effective."

The pharmaceutical industry is taking keen interest in the small company's research. AstraZeneca, Targacept's partner in the Alzheimer's research, makes the popular acid-reflux medications Prilosec and Nexium, for example.

Generally in developing drugs for the disease, "the failure rate is going to be high, but the reward is going to be higher," said Don deBethizy, Targacept's chief executive.

TransTech Pharma is taking a different route.

The company, which has about 80 employees, is using specific molecules to try to prevent Alzheimer's in patients, rather than treat the symptoms of the disease.

The company is developing molecules that could help prevent the buildup of the beta amyloid proteins believed responsible for the illness, TransTech Pharma officials said. Beta amyloid proteins can eventually kill healthy nerve cells in the brain, causing the debilitating symptoms common to Alzheimer's.

A steadily aging population has made the need for drugs treating Alzheimer's disease and age-associated memory illnesses more vital, experts said.

"There's a demographic tsunami coming our way, in terms of Alzheimer's disease," said Dr. Anton Porsteinsson, an assistant professor of psychiatry at the University of Rochester School of Medicine in New York. "It's a big problem today, and it's going to be a huge problem."

TransTech Pharma officials agreed. "The company that comes up with a drug that really does treat this is going to be viewed as a real savior out there," said Stephen Holcombe, the company's chief financial officer. "It's certainly a popular illness to go after."

A local industry

The focus on Alzheimer's treatment is one of the clearest examples of the region's attempt to transition into a new industry, economic-development officials said. An increasing focus on biotechnology and health care is one way to shift this area's economy away from its tobacco and manufacturing past, they said.

Winston-Salem has worked to lure doctors and scientists from such places as Harvard University, for example.

Targacept and TransTech Pharma aren't the only two North Carolina companies that are developing Alzheimer's treatments.

Voyager Pharmaceutical Co. in Research Triangle Park and Merz Pharmaceuticals, a German company with an office in Greensboro, are also developing Alzheimer's drugs.

Within the health-care industry, there's a sense that some of the major work on Alzheimer's is being performed locally. Many of the other possible treatments for the illness are still in early testing stages, for example.

But designing complicated new medical treatments for the elderly is far from easy.

Most small biotechnology companies fail, particularly when their products are tested in humans. The pressure will be on for companies to produce positive results for their investors, said Schulman, the Duke professor.

Still, Schulman said that the time is right for companies to explore new treatments for age-old illnesses.

"Biotechnology is the industry of huge risk," Schulman said. But "the exciting thing right now is that there's a lot of technology. There's at least the promise that we have new approaches to things that haven't been reachable before."

Where is Alzheimer's research headed? Some experts say they think that companies will follow TransTech Pharma and attempt to develop drugs that will prevent the disease.

Alzheimer's "is probably kind of settling in and taking hold of your brain for possibly decades before you develop clinical symptoms," said Porteinsson, the University of Rochester doctor. "We do believe that, in the long run, the treatment of Alzheimer's disease will have to be preventative."

Such drugs as Targacept's medications could provide stronger treatments for the symptoms of Alzheimer's, as well as help treat other disorders of the central nervous system, but "basically, the targeting of the underpinning of the disease is, in my mind, the future," Porteinsson said.

• M. Paul Jackson can be reached at 727-7473 or at mjackson@wsjournal.com.
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Walk in a Dix Park - Raleigh News & Observer

Editorial, Published Dec. 16

North Carolina and the City of Raleigh have asked for, or have been offered, a number of plans for how the Dorothea Dix campus should be used once the mental hospital closes in 2008. Whichever proposal or combination thereof is ultimately chosen, the result should look and feel like a destination park for Raleigh-area residents and for North Carolinians visiting the state capital.

Debate is welcome over what fringe development ought to be allowed on the campus, and over a proposed swap with N.C. State University of some nearby land. But the core aim ought to be a bucolic retreat in the rapidly developing city. A parallel goal should be to establish a revenue stream that would be used to fund programs for the mentally ill.

The land swap with N.C. State was suggested by the Urban Land Institute in a study financed by the state. A large, open Dix field would be traded for a slice of the northern portion of Centennial Campus, creating a 215-acre park out of what is now the 306-acre Dix property.

Raleigh offers the state a hefty $40 million for the Dix tract, an attractive way to preserve large portions of it and also to generate money that the state could use to augment mental health services.

The Dix campus is in a desirable spot near downtown and thus is valuable to developers. The sale of a small part could mean significant proceeds to put back into mental health funding. But minimal development of some out-of-the-way portions wouldn't, and shouldn't, rule out the Raleigh-sized version of a big-city amenity such as Central Park in New York City or Fairmont Park in Philadelphia. Read more!

Tenn. Mayor Takes Homeless to Movie - AP

CHATTANOOGA, Tenn. (AP) -- Inspired by his father, who was homeless for a time as a teenager, Chattanooga Mayor Ron Littlefield tried to raise the hopes of a group of homeless people by taking them to see a new movie that tells a rags-to-riches story.

"The Pursuit of Happyness," a movie starring Will Smith as a man who gets evicted along with his young son and becomes homeless for a while, is based on the true story of Chris Gardner, now a millionaire business executive.

"This is not going to drastically change anyone's life," the mayor acknowledged as about 15 homeless movie guests were given large soft drinks and buckets of popcorn, concessions provided by an anonymous donor.

But he said his aides came up with the movie idea as a "good way to illustrate that homelessness is not permanent."

Critics call it patronizing that the mayor is counting on a movie to inspire Chattanooga's homeless, many of whom are mentally ill and have substance abuse problems, but the film's real-life subject hopes it does exactly that.

Gardner told The Associated Press in a statement that he wants the Chattanooga group to "take one thing away from those two hours: Chris Gardner isn't doing anything I can't do."

"This movie, and my story, is really the story of all the people out there who don't quit on their dreams for a better life and don't give up on their children," he said.

Littlefield arranged for a city bus to pick up the moviegoers and take them to the downtown theater. The bus system paid for the $6 movie tickets.

Several people left the theater crying and wiping away tears. Tammy "Blondy" Ledford, a 32-year-old woman who has been homeless for nearly eight years, said the movie reminded her of her own life.

"It was sad," she said. "I remembered how it was whenever me and my three kids got thrown out of my apartment. ... Everybody ought to come watch this movie, especially all the homeless people."

Lou Dandoy, 46, who said he has been homeless for only a few weeks, called it "one hell of a good movie."

"It inspires me to go back to school and get off the streets," he said.

The moviegoers, who volunteered at several agencies that deal with the homeless to see the film, also watched a short video on the mayor's proposal to build a campus for the homeless that consolidates public services in one spot. Littlefield this year got the city to buy a piece of land for $775,000 to develop the project.

Similar campuses have been started in some other cities, including Seattle; Phoenix; Jacksonville, Fla.; and South Bend, Ind.

Littlefield says his concern for the homeless was inspired by his father, who left home during the Great Depression to ride the rails because his family couldn't feed all seven children.

Michael Stoops, acting executive director for the National Coalition for the Homeless in Washington, agrees with the mayor's push to consolidate homeless services, but he doubts a movie can encourage people to work themselves out of poverty.

"Homeless people already know what it is like to be homeless," Stoops said. "They don't need an uplifting story."

Merri Mai Williamson, a spokeswoman for Citizens for Real Homeless Solutions in Chattanooga, a group that opposes the mayor's proposed homeless campus, described the movie outing as "manipulation at its finest," designed to build public support for the project.

But Kimberly Kyriakidis George, a spokeswoman for the Chattanooga-Hamilton County Salvation Army chapter, described the movie outing as a nice escape from reality.

"All of us enjoy entertainment. It helps us escape a little bit of our own reality," she said. "I think in that aspect it would be enjoyable and beneficial to them."

© 2006 The Associated Press. All rights reserved. This material may not be published, broadcast, rewritten or redistributed. Learn more about our Privacy Policy. Read more!

Report recommends NC needs $2.7 billion - Raleigh News & Observer

Lynn Bonner, Staff Writer

A sweeping report on the state mental health system faults North Carolina for failing to provide mentally ill people and drug abusers with consistent and continuous care.

The state would need to spend an additional $2.7 billion over five years to get things right, according to a report by consultants that was released Friday.

But even legislators sympathetic to the needs for improved mental health services say the state won't be able to add $500 million a year over the next five years to the mental health budget.

"It is going to be a terribly depressing year where those kinds of services are concerned, to know what the needs are and what people will be hurt as a result of that and not be able to do anything about it," said Sen. Vernon Malone, a Raleigh Democrat.

The legislature pumped an additional $100 million into mental health services and housing this year. Politicians were responding to criticism that changes they made in 2001 failed to achieve the promise of providing care close to patients' homes rather than in state institutions.

Though the shake-up in the mental health system five years ago had a goal of increasing community treatment, state hospitals are still a first stop rather than a last resort for many, the report says.

Increasingly, rural jails are turning into way stations for the mentally ill, county sheriffs say, because local communities don't have enough agencies to treat those who need doctors or medication.

Consultants in Michigan and Florida who worked on the report fault North Carolina's mental health system for lacking a consistent, coherent philosophy, and for practices that lead to continued reliance on large institutions.

The state Department of Health and Human Services tends to promote people from within the state mental health division who don't have experience in other states or in the field, said state Rep. Verla Insko, a Chapel Hill Democrat who leads the legislative committee that asked for the report.

"I think the people who are there need training, or we need different people," she said.

Mental health services would be lucky to get an additional $100 million a year, Insko said. But she said the state is pursuing, or could pursue, changes that would lead to improvements at little cost.

Insko wants more local mental health offices to be able to manage services by setting up networks of private agencies and directing Medicaid patients to them. Such a system would require federal approval. As it stands, any agency that meets federal standards can treat patients and charge Medicaid for services.

The consultants' report describes community mental health services as fragmented and growing in a way that will "ultimately result in failed provider systems and providers who refuse to treat the indigent population."

The state mental health office is putting its muscle behind helping areas fill their gaps, said Leza Wainwright, deputy director of the state mental health office. Any widespread change allowing more local offices to set up networks would need more study by the department and the legislature, she said.

Looking to change

In a letter introducing the report, Carmen Hooker Odom, the state secretary of health and human services, said the department is already considering suggestions for improvements.

The state division is looking at working with local mental health offices on cutting back use of state psychiatric hospitals.

The division also wants to be able to set statewide guidelines that would have people who are not eligible for Medicaid pay for at least part of their bill. The department would need legislative approval to set a statewide payment schedule. Local offices set their own guidelines, and they vary widely. The state also lacks rules that require agencies to seek payment from private insurance before government pays the bill.

The report describes problems that legislators have heard about, anecdotally, for years.

Rural residents get the least service. Mental health and drug treatment for children and adults is insufficient and leads to unnecessary hospital and group home admissions. North Carolina spends less than most states on community services and more on state institutions.

Insko said the report reinforces that the state was right to change the mental health system but that it didn't make changes the right way.

"It has some features that are recognized across the nation as being good features," she said. "We probably didn't plan well enough for implementing it."

Staff writer Lynn Bonner can be reached at 829-4821 or lbonner@newsobserver.com. Read more!

After Self-Destructive Descent, a Man Finds a Rung to Grasp: Therapy - NY Times

By ANTHONY RAMIREZ

Jan Jarvis is 6 feet 4 inches tall and weighs 230 pounds. At first, he seems sullen and imposing, especially dressed in a dark-blue security guard uniform.

But coaxing a smile out of Mr. Jarvis is not difficult, a remarkable achievement after a life of sexual abuse, unfocused rage and homelessness. With counseling and several hospitalizations for clinical depression, he has turned his life around.

Still, Mr. Jarvis has surprised even himself with how close he has come to falling back to self-destructive habits.

In August, Mr. Jarvis recalled, he took a stack of MetroCards from a secretary’s desk at the Brooklyn center where he receives therapy. After a night of remorse, he returned them.

“By the grace of God, I didn’t steal and I didn’t go to jail, and I did do the right thing,” Mr. Jarvis said. He said that he had just celebrated a birthday in August and, reflecting on his life, had started feeling low.

“I wanted to get high — to escape,” he said. “But I realized I don’t want to be using and 34.”

The Brooklyn Bureau of Community Service, one of seven agencies supported by The New York Times Neediest Cases Fund, provided Mr. Jarvis with $200 for fees and a refresher course to regain his security guard’s license (he had worked as a guard in 1998). Now, he works as a guard at a carpet-cleaning company and hopes someday to be a physical therapist for the elderly.

In 1993, military doctors gave Mr. Jarvis a diagnosis of bipolar disorder, a mental illness of extreme mood swings that can be accompanied by hallucinations.

After graduating from Samuel J. Tilden High School in East Flatbush, Brooklyn, Mr. Jarvis joined the Army Reserve, working as a forklift operator in Fort Totten, in Queens, and, he said, developing a heavy alcohol, cocaine and marijuana habit.

While visiting Fort Lee in Virginia for routine training, Mr. Jarvis flew into an inexplicable rage after a sleepless night and a bout of drinking. He hurled a television set down the stairs in a recreation room and pushed a filing cabinet out a window.

“I thought the TV set was talking to me,” Mr. Jarvis said. “It was telling me to calm down, how to live my life.” Mr. Jarvis was hospitalized at Walter Reed Army Medical Center in Washington. He was 21.

“When I was feeling good,” Mr. Jarvis said, referring to his bipolar disorder, “I was a troublemaker, I thought I was invincible, I was stronger than 20 people.”

But when he was feeling bad, he said, he felt suicidal, almost homicidal. He tried to pick fights with other men, but no one would challenge him because of his hulking size.

Mr. Jarvis said he was raped when he was 5. “It changed me,” he said, taking a deep breath.

The decade or so after serving in the Army Reserve was a downward spiral for Mr. Jarvis, who slept on relatives’ couches, stealing petty cash from friends and family members to buy drugs.

“I was living in a tunnel with no light in it,” he said.

At last, he exhausted the patience of friends and family and, in April, became homeless when no one he knew would take him in. He wound up at a shelter operated by Bellevue Hospital Center, surrounded by patients who could not control themselves, who sometimes howled in the night.

Finally, Mr. Jarvis sought help. For years, he had been prescribed drugs like lithium for bipolar disorder and Ativan for anxiety, but he never took them, he said, because "I told myself I wasn’t crazy.”

Now he is enrolled in therapeutic programs, including Project Moving On, a daily full-day program sponsored by the Brooklyn Bureau of Community Service, which provides therapeutic and social support services for adults with mental illnesses.

“Day by day, I’m changing my life around,” said Mr. Jarvis, who recalls his close call with taking the MetroCards.

Mr. Jarvis hopes to go to Hunter College for physical therapy classes to help the elderly.

“When I was at Walter Reed,” he said, “I had to learn how to walk again and talk. Because of my mental disease, it hurt to talk. I was a baby all over again.

“There were young people there who helped me. I want to return the favor.”
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