Mental illness survivors share stories - The Dartmouth

By Michael Coburn

Five Dartmouth students gathered at Tindle Lounge Tuesday to recount their stories about combating mental illness during an event sponsored by Active Minds, a campus organization dedicated to raising awareness of mental illness.

"In Dartmouth, mental illness is often swept under the rug," Heather Olson '07, the leader of the panel, said. "There are a lot of resources available, but often people don't take advantage of them because of the stigma."

The meeting was designed not just to share stories, but also to show where students currently suffering from mental illness could seek help. A therapist from Dick's House was available for consultation after the meeting.

Most panelists cited their family as the main source of their disorder. Bailey Massey '08, who suffered from an eating disorder said her problem did not originate from the media but rather from her mother.

"One day I asked my mom if I was fat," Massey said. "Instead of trying to comfort me, she responded with 'You could lose a few pounds.'"

Another panelist, Jessica Lane '09, suffered from self-mutilation. She believes that her problems were a direct result of a family conflict arising from her sister, who has been diagnosed with a wide range of mental disorders.

"One of my worst memories was that of my sister hitting my mom, and all my mom was doing was crying, not trying to stop her, but trying to give her a hug," Lane said.

Family conflict is one cause of mental illness, but family genetics are also important. Every panelist came from a family with a history of mental illness.

"I want to re-echo the genetic component," said Ben Jastrzembski '08, who suffered from severe depression. "Behavior matters, but genetics has an enormous impact in mental illness."

Many panelists felt trapped in their cycle of depression.

"I have few memories of high school that are not filled by darkness and despair," Eleanor Smith '09 said. "I felt as if I was in a dark tunnel in which there was no way out."

Despite the seriousness of their conditions, many of the panelists initially did not want to seek help. At the urging of their family and friends, however, they were able to get the counseling and medication they needed.

Combating mental illness and its aftermath is still a challenge for many. Amanda Wilson '08 suffered from depression, but still has yet to tell her father that she sought help, and some panelists such as Massey admit that they have suffered from occasional relapses.

Despite their difficulties, all the panelists were able to overcome their afflictions and get their lives back on track.

"The defining moment for me was during the 4th of July," Smith said. "My mom came up to me and said 'It's nice to have my daughter back.' I just looked at her and said, 'It's nice to be back.'"

In addition to recounting personal experiences, the panelists advised audience members.

"To all those suffering from a mental illness, one thing I want to say is that you are not alone," Smith said. "When I found the courage to open up, I realized that there were others just like me. When I tell people about my mental illness I get many responses, but I have never had a negative one." Read more!

Rally brings attention to mental-health system plans - Salem Statesman-Journal

PETER WONG

Mental-health advocates, fresh from legislative victories two years ago, mustered the support of Gov. Ted Kulongoski and key lawmakers Tuesday for their top goals.

Kulongoski and lawmakers from both parties spoke at a rally for the replacement of aging Oregon State Hospital and for an expansion of community mental-health services, particularly to children.

"Together we created the need to transform Oregon's mental-health system," Kulongoski told a couple of hundred people at the rally. "Now it is time to put that plan into action. We know what we need to do -- and we just need to do it."

His budget proposes $83 million to begin the replacement of the state hospital, $13 million to improve care at the hospital, $10 million to enhance community mental-health services, and $4 million to expand early intervention and treatment for children.

Shelley Joyce of Salem, the mother of an 18-year-old son with mental illness, said times have changed and state and federal policies are reflecting those changes.

"I think all of us are sick and tired of being left out, and of the mental-health stigma that has kept us down for so long," said Joyce, who was one of the hundreds of citizen lobbyists at the Capitol on Mental Health Day.

Four years ago, the Legislature ordered a revamping of mental-health services for children. Two years ago, after several tries, the Legislature put insurance benefits for mental health on a par with those for physical illnesses and injuries.

"Our time has come," said Jammie Farish of West Linn, mother of a mentally ill son and co-chairwoman of the state panel advising the children's mental health effort.

"It's time that we rewrite history and stop the exclusion of entire members of our community. It's not OK to institutionalize everyone, including an entire generation of children."

At the rally, Kulongoski and House Speaker Jeff Merkley, D-Portland, praised Senate President Peter Courtney, D-Salem, for sponsoring the mental-health parity law and putting the state hospital issue on the public agenda.

"When we talk about a solution for the state hospital, we must recognize that it has to fit within a broader framework for addressing mental-health issues in Oregon," Merkley said.

MacKenzie Farish, Jammie's daughter, said that framework must include support for the families with relatives in the state hospital and must provide for their care once they are released.

"It takes some work to organize all of this," she said. "If you don't have enough time, a lot of it is not going to get done."

Crucita White of Salem, the Oregon operations and training manager for the National Empowerment Center, said prominent people such as TV correspondent Mike Wallace have talked openly about coping with depression.

"Having people realize they can recover -- and function -- removes that stigma," White said.

Merkley said more than 160,000 adults in Oregon suffer from serious mental illnesses such as schizophrenia, depression or bipolar disorder, and more than 100,000 under age 18 have experienced a serious emotional disturbance.

"It's a recognition that everybody has mental health, not just physical health, and can experience all of these things," said Theresa Rice of Oregon City, the board president of the Oregon Family Support Network.

State Sen. Avel Gordly, an independent from Portland whose son has suffered from schizophrenia, joked about the shivering participants and audience on the Capitol steps.

"I'm not cold," she said. "I'm on fire for change. How about you?"

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

VPH Child Mental Health unit stabilizes and plans continuing care - Plattsburgh (NY) Press Republican

By: Jeff Meyers Staff Writer

PLATTSBURGH — Sometimes all a kid needs is a little hope; sometimes it's a lot more complicated than that.

Inpatient services at the Child and Adolescent Mental Health Unit at CVPH Medical Center offer support for children age 6 to 18 who are experiencing any of a wide range of mental illnesses.

"What we are trying to do is get the child stabilized," said Dr. Diane Zuniga, director and lead psychiatrist for the unit. "Our job is to get the (treatment) process started and then use our outpatient-referral system to ensure continued care."

Children typically enter the unit through the hospital's Emergency Department, though some also come with referrals from pediatricians or family doctors.

"The most common thing we see is when the child is suicidal or may have made an attempt at suicide," Zuniga said.

"Another is when a child is incredibly violent with siblings or parents. We're here to keep the child and the family members safe."

The typical length of stay is between seven and 10 days, depending on how the child responds to therapy while in the hospital.

But a child is never released unless the staff believes he or she is ready to return home and has follow-up care awaiting that return.

"A lot of times, we'll get kids who have been undiagnosed for a long period of time," Zuniga said. "Once an accurate diagnosis is made, managing the child on an outpatient basis can be much easier."

When a child is admitted to the 12-bed unit, Zuniga initiates care with full physical and neurological exams to pinpoint any physical problems that may be contributing to the mental condition.

Then she works with a treatment team — which can include parents, school officials, physicians, therapists and representatives from Social Services or Probation — to develop a treatment program for each patient.

"We look at different kinds of social issues, what's keeping them from getting the care they need. We'll talk about medications, about their outpatient needs, educational needs. We'll work with the kids, see if we can identify attention problems, whether they relate well with other kids."

A lot of attention focuses on the child's schoolwork. The staff tries to keep them on task so they aren't behind when they do get back to class, Zuniga noted.

"We'll deal with anger management, with social skills, behavioral management. We try to find a way to help them become more independent.

"And we'll help families figure what they need to do" when the child does return home.

Parents do play a large role in the process, she added. For instance, there's the responsibility for making sure the child receives the right medications at the right time.

Staff members work with children individually and in group settings. Typically, younger children spend their group sessions together in one area while teens are together in another.

LIMITED ROOM
Major areas of concern include depression, attention deficit/hyperactivity disorder, bipolar disorder and anxiety issues, though the gamut of mental illness is as complicated as the treatments for each specific kind of disorder.

The unit is filled much of the time, and patients often have to be referred to other facilities in Ogdensburg or Saratoga.

But since the family is such an important part of treatment, it is always the best option to keep a child closer to home, Zuniga said.

About one-third of patients admitted to the unit eventually come back a second time, she added.

"Some don't follow up (with outpatient care) as they should, and some have severe mental illness that is going to need several hospitalizations to treat, similar to a medical illness like diabetes.

"Mental illness is not cured; it's managed."

MIND MAZE

This is the fourth of a seven-part series on children's mental illness.

Tomorrow: The cost of treatment. Read more!

The inpatient experience - Plattsburgh (NY) Press Republican

By: Suzanne Moore Staff Writer

MALONE — Darren Fullum had let anger and his fists rule his actions one time too many.

Then, he heard a wake-up call — in a courtroom.

"The judge was saying if I don't straighten up, I'd be going somewhere I don't want to go," said the soft-spoken teen.

He chose the other path.

ADIRONDACK YOUTH LODGE
Darren, 14, has lived since the end of August at Adirondack Youth Lodge in Malone, a long-term residential treatment facility offering a form of mental-health intervention previously unavailable in Franklin, Clinton, Essex and St. Lawrence counties.

The Adirondack-style facility's community-based program is designed for boys and girls age 12 to 17 and includes medication and therapy, attendance at Malone Central School and family-style living, complete with chores, weekly allowance, recreational outings, such as swimming, and, most of all, consistency in rules and adult supervision.

"I consider the staff almost just like family," said Darren. "All the residents are just like brothers and sisters to me."

MUCH-NEEDED
He'll call the place home for a year, minimum, and maybe as long as 18 months.

The Constable teen has attention deficit hyperactivity disorder, which has plagued him since before he started school, and mild bipolar disorder.

Among the other diagnoses that bring teens to the lodge are depression and reactive detachment disorder, which manifests itself as an inability to form lasting relationships.

The need for the facility was unmistakable, said Susan Delehanty, Franklin County's director of community services, "because we had to send kids far away from their schools and families."

INSUFFICIENT BEDS
That's often the case when it comes to inpatient mental-health treatment, whether it's the residential style provided by the lodge or facilities designed for acute, emergency intervention.

CVPH Medical Center in Plattsburgh has the only inpatient unit in the region designed for children with mental illness. It's a short-term facility, aimed at stabilizing the patient before release to outpatient services.

And it has only a dozen beds.

So whether a child needs long-term intervention or mental illness erupts in crisis — when children become a danger to themselves or others — a facility far from home is often the only option.

Last year, about 24 children from Clinton, Essex and Franklin counties were admitted to St. Lawrence Psychiatric Center in Ogdensburg, a two-and-a-half-hour drive from Plattsburgh.

Twenty-one children found treatment at Four Winds Saratoga, in Saratoga Springs.

And those numbers don't tell the whole story, said Robert Greenbaum, PhD, chief executive officer and clinical director at Four Winds.

"The demand is enormous," he said of overall application for admission. "Last year, we probably turned away 500, 600 kids."

WHAT'S BEST?
Hospitalization brings its own trauma to children, and, according to Samuel Bastien, PhD, who heads St. Lawrence Psychiatric, that knowledge must be balanced against the potential good that can come of it.

Only occasionally does St. Lawrence accept youngsters of 4, 5 or 6, he said — when "there's no other way to create a safe environment for the child."

Medication, too, said Greenbaum, is prescribed with great caution.

"There have been some very substantial improvements in medication," he said. "Unfortunately, there are a lot of unknowns about the use of medications with kids.

"We're always stuck with that dilemma "¦ but if a kid is failing at everything in life, it's essential we intervene in some way."

St. Lawrence has three wards for children, including one with eight beds for patients under age 12, one with 10 beds for adolescent boys and another, the same size, for girls.

With certified teachers on site, the facility maintains a regular academic program with a student-teacher ratio of 6 to 1 or less.

"We find it very important to try to maintain children's academic progress," Bastien said.

The average stay varies, he said, with most children discharged after a very brief sojourn of just a few days. The median stay in late 2006 was 23 days.

Four Winds, with a separate unit for 5-to-9-year-olds, another for 10-to-13-year-olds and a third for patients 14 to 18, also has an academic program and, as does St. Lawrence, develops specific treatment plans for each child.

The average stay at Four Winds is about four weeks for the youngest children, three weeks for the intermediate group and 10 days to two or three weeks for the oldest patients.

FAMILY MATTERS
"I don't think we can ever underestimate how difficult it is for a family to place their child in a place like this," Greenbaum said.

Both Four Winds and St. Lawrence involve family in the treatment process as much as possible, and discharge planning — for treatment and services once the child is home — begins just after admission.

"Having the family here is a part of the healing," said Tracy LaVoie, treatment coordinator for Adirondack Youth Lodge, which operates under the umbrella of Franklin County's major mental-health provider, Citizens Advocates.

Not long ago, Darren whipped up a steak dinner for his mom and sister; he spent much of the Christmas break at home.

The teen, whose dream is to play major-league baseball, is an avid varsity wrestler who gets plenty of encouragement from staff and his lodge-mates, who often attend his matches.

His moods have leveled out, he said, in part because of medication adjustments and from taking them at the same time every day.

And his grades have improved.

"I'm able to do my homework in a quiet room," he said.

CONSISTENCY PAYS
Such consistency of atmosphere is a hallmark of treatment at the more-acute-care facilities, as well.

All employ a level system that rewards good behavior.

"It really looks at every interaction with the child being an opportunity to learn or improve certain skills," Bastien said.

"We try to teach them some independent living ... to be accountable for not going to school, for lying ...," said Heath Kuhn, Adirondack Youth Lodge treatment leader.

Each level there comes with certain privileges, like a five-day video rental or weekends home.

Darren approves of the system, both rules and rewards. Most promising for him has been the progress he's made keeping his temper in check.

"Before, I used to just blow up. Now I've learned to control and withstand things I never would have before."

Read more!

Voucher bill raises potential for special needs students - Atlanta Journal-Constitution

Under a proposal before the state Senate, taxpayer-funded vouchers would be provided to pay tuition for children with special needs, an approach that opponents fear could hurt public education in general in the long run.

While that danger is real, the proposal may help Amilio Mercado right now.

Amilio, 13, has cerebral palsy. His mother, Sammy Tate, says her son has regressed since the Tate family moved from Florida to Georgia four years ago and he started attending public schools, first in Cobb County and then in south Fulton County.

Sammy Tate wants to move her son to a private school in Fayette County that she believes is better able to accommodate children with cerebral palsy and sets higher aspirations for them.

"I am not going to live forever," Tate says. "I don't think I should have to put my child in a home. He has the right to feel that he fits in, that he is worth something, that he can do something. I just want to be able to give him that. I am desperate to do so. And this voucher would let me do it."

It's hard to argue with that, which is why the Legislature ought to pass a revised version of the Georgia Special Needs Scholarship Act sponsored by Senate President Pro Tem Eric Johnson (R-Savannah).

Under Johnson's bill, children who are physically, emotionally or developmentally disabled would be eligible for a voucher equal to the state funds now being spent on the child by the public school.

Based on Georgia's special education spending, the average annual voucher would be $9,000, which may not cover the entire cost of private education but would put a sizable dent in it.

"My son's teachers love him and they are very nice to him, but do they have the experience to help him progress?" asks Tate.

The proposed voucher could be used at a public school in another district or a private school that may or may not specialize in disabilities. It holds the greatest potential for children with mild learning disabilities and the least for kids with profound disabilities, such as mental retardation or autism.

Few private schools accept children with severe disabilities, although voucher proponents contend that more schools will open if a demand is developed.

However, the danger that a bill drafted and passed to help a certain well-defined population of children could be used to bolster a campaign to "privatize" education for all Georgia children is real, and is almost certainly part of its appeal for Johnson and others.

However, Georgia citizens do not support an abandonment of public education in favor of vouchers, and legislators must be careful to resist language in the bill that would broaden its scope.

The bill also needs a better means of holding private schools accountable if they accept public vouchers. After all, it is still taxpayers' money, and the government's responsibility to ensure that taxpayers' money is well spent does not magically disappear if the money is used for vouchers.

As written, the bill says the state Department of Education must approve recipient schools for academic and financial soundness and requires an annual assessment of the child, which has to be reported to parents and DOE. However, the bill sets no standards for students to meet on those assessments, unlike in public schools where specific benchmarks must be met.

Parents of special needs students who opt for private schools must also understand that they will forfeit their federal right to work with the school to create an individualized education plan for their child and to ask for an outside review in court if they feel that their child's plan is inadequate. However, many parents counter that those rights are illusive anyway.

"You do have rights," says Jasper County parent Debbie Cussen, "but you have to quit your job to get those rights because it becomes a full-time job to fight for your child. Those meetings with the schools turn into ambushes. You almost have to get a doctorate in special education to challenge what the schools tell you and most parents just throw up their arms and give up. "

Johnson's bill mirrors a program that has been in effect in Florida since 1999, when a pilot began with two students. Today, 17,200 children with special needs in Florida collect an average voucher of $6,927. However, those students represent only 4.25 percent of the 400,000 eligible students in the Sunshine State.

In Florida, it turns out that many parents prefer their child be in the most inclusive setting possible, and that's typically the public schools. That will probably be the case in Georgia as well.

For example, Kathy Everett, a special education teacher, sends her daughter Jennifer to Chattahoochee High School in Alpharetta and is pleased with her education.

"She is the first and regrettably still the only child with a significant disability there because that is where I believe she will learn how to live in society and how society will learn to live with her," says Everett.

Jennifer, who has Down syndrome, serves as team manager for the girls' varsity volleyball team and for the girls' junior varsity and varsity lacrosse squads. Earlier this month, when Jennifer participated in the Winter Special Olympic Games, her lacrosse teammates volunteered at the event and cheered Jennifer on in the bowling competitions.

"They did keep their eyes on Jennifer, coming over to congratulate her when she scored a spare or a strike. But they also got to know other children that were there," says Everett. "They enjoyed it so much that they want to help with the Summer Special Olympic Games, and they want to make this an annual tradition. How did this happen? It happened because Jennifer is at her neighborhood school and in regular classes, not segregated away from her peers at a special separate school."

For Everett's daughter, public education has turned out to be the right choice. Sammy Tate, however, believes her son would flourish in a private school setting.

For parents struggling to find the right place for their children, this bill honors both those choices.

— Maureen Downey, for the editorial board (mdowney@ajc.com) Read more!

Family says beheading suspect is mentally ill - Raleigh News & Observer

Mandy Locke, Staff Writer

CLAYTON - A decade before police charged John Patrick Violette with beheading his 4-year-old daughter, he began battling an illness that planted strange voices in his head, his family said.

Violette's loved ones are now replaying every scene they can remember from a stretch of months in the mid-1990s when doctors at a mental hospital in California first told Violette and his family that he suffered from paranoid schizophrenia, his sister Denise Violette said.

"I look back and I think, 'We should have never let him out of that place,'" said Denise Violette, John's older sister who helped care for him during this time.

Schizophrenia -- a brain disorder that often causes victims to lose sense of reality and to hear and see things that aren't there -- struck Violette in his mid-20s, long before he married Amber Marks and fathered Katlin. It's unclear whether his wife of eight years even knew of his mental illness; Amber's father Thomas Marks has said that John's outbreak caught them all off guard.

As far as Violette's family can tell, John Violette, 37, somehow managed to quiet the turmoil in his head for the better part of a decade. Schizophrenia is sometimes marked by long stretches of seeming dormancy, only to erupt in dramatic, occasionally violent, breaks with reality, mental health experts say.

Erratic behavior

Police won't discuss whether Violette's mental illness motivated Katlin's slaying. Violette's lawyer, Robert Denning, says his client is mentally ill and asked a judge to send him to Dorothea Dix Hospital last week so psychiatrists can determine whether he is competent to stand trial for his daughter's murder.

"He doesn't seem to grasp what's going on," Denning said.

Neighbors saw John Violette act erratically on Jan. 12, the afternoon Katlin's mother came home and found her decapitated in the hallway of their Clayton home. He sped down the narrow lane of their subdivision, whipping the car into their driveway. Neighbor Diana Narron said she saw him rant angrily as he rushed to the front door, "like somebody was talking to him in his head and he was talking back." When U.S. marshals found him holed up in a Washington hotel room early the next morning, he was shouting scripture from the Bible's Book of Revelation.

His family said no other explanation for John Violette's behavior makes sense.

As a kid, John was always the gentle, tenderhearted one of the siblings, his sister said. He and his sisters were military brats, moving from state to state and abroad as the Army shuffled their father between bases.

The family eventually settled in California, where John Violette's parents later split.

John Violette loved working with his hands and apprenticed as a carpenter after high school, his sister said. He crafted fine wooden furniture and gave it to relatives.

John Violette also messed with drugs, though his sister never knew for sure which kinds. Denise Violette later blamed her brother's mental breakdown on his drug habit.

"I thought it all had to do with the bad choices he made," Denise Violette said. His family suspected a drug high when John Violette first started to unravel 11 years ago.

When Denise Violette visited her brother at his new home in Hawaii then, John Violette confided in her that men were following him. Denise Violette said she believed he might be in danger and urged him to come home to California.

When John Violette came home, he was panicked. He ducked in and out of bathrooms, hiding from people he imagined might be after him, Denise Violette said.

His strange behavior didn't relent. Later, he tried jumping from his brother-in-law's moving car, Denise Violette said.

The family ended up putting him in a drug rehabilitation program, Denise Violette recalled. He fled there, only to end up belligerent in the emergency room of a hospital one night. Doctors found no drugs in his system, Denise Violette said.

Off medication

His family then committed him to a psychiatric hospital. A month later, doctors sent him home with pills and a diagnosis of paranoid schizophrenia, his sister recalled. He moved and talked more slowly, his sister said.

"He didn't seem like he was totally 100 percent," said Denise Violette.

At the time, Denise Violette doubted her brother had schizophrenia and didn't think he needed medicine. She urged him to stop taking the pills. He eventually did. As far as Denise Violette knows, that's the last time he took medicine to try to control his schizophrenia. It haunts her now that she encouraged him to quit.

Within a few months of his release from the mental hospital, John Violette headed east to North Carolina and settled with relatives in the Triangle. He eventually regained some semblance of a normal life, Denise Violette said. He picked up jobs, holding on to some longer than others, his sister said. The day before Katlin died, John Violette quit his job at Lowe's Home Improvement, a move he made to get back into carpentry, Denise Violette said.

In North Carolina, John Violette immersed himself in activities for singles at Colonial Baptist Church in Cary. That's where he met Amber Marks. The two married nearly eight years ago.

Katlin made the family three in 2002. By then, they'd set up home in a new subdivision in Clayton. They relished family time, making it a point to meet for lunch at the house each day. The three had slumber parties, setting up tents and sleeping bags in their living room.

John Violette's heart was so tender toward Katlin that he couldn't even spank her, Denise Violette said. He logged her journey with Christ in a journal; his other sister read from it at Katlin's funeral.

Denise Violette is still hoping she is having a nightmare, that some stranger broke into the house and killed Katlin instead of her brother.

"Even now, I think I will wake up and this will be someone else's family," Denise Violette said. "It is so beyond understanding." Read more!

Budget outlook neither great, grim, legislators say as negotiations begin - Winston-Salem Journal

By James Romoser, JOURNAL RALEIGH BUREAU

State legislators got their first collective look yesterday at the financial projections that will shape the next state budget as they began five months of number-crunching and negotiating.

The outlook is neither great nor grim, state officials said in a presentation to legislators. It is somewhere in the middle.

The economy is slowing down, causing the state to collect less tax revenue than it otherwise would, and requests for new spending will be up. Although the next budget cycle, which begins July 1, will be tight, nobody is expecting anything like the budget crises that rocked state government in years when the economy was in a recession.

The biggest factor that will affect the 2007-08 budget forecast is uncertainty surrounding the real-estate market in North Carolina, officials said.

"It's fair to say that the housing and real-estate slowdown have finally arrived," said Barry Boardman, an economist in the legislature's fiscal-research division.

Meanwhile, inflation and con-tinuing population growth in North Carolina will cause the costs of existing state programs to rise. Those unavoidable increases will be coupled with large requests for new spending in such areas as public education and mental-health care.

By the midway point of the current budget year, the state's revenue collection was ahead of expectations: The state collected $285 million more than the $8.7 billion that it had expected to collect by that point, state economists said.

They added, however, that the extra revenue is not likely to offset the state's so-called structural budget gap - a perennial failure of the state's annual revenue to cover operating costs. The structural deficit is often blamed on an outdated revenue system designed to fit a manufacturing-based economy rather than one based on services.

"We heard that, as always, there will not be enough money to spend as some people would like to spend," said Rep. Paul Stam, R-Wake, after the meeting. Stam is the House minority leader.

Members of both parties made general calls for a closer look at all areas of state government to find out what could be cut.

"When you have a $19 billion budget, there is room to make cuts," said Rep. Jim Harrell III, D-Surry, referring to the size of the current year's operating bud-get.

Some programs - including some very big ones - are difficult to cut.

Medicaid, for instance, is the state's second-largest spending commitment, after public education. Statistics presented yesterday showed that the state's Medicaid spending rises steadily every year, even in tight budget years when spending on other programs stays level or goes down.

That is because state legislators have very little discretion when it comes to Medicaid, a health-insurance program run by the federal government. Most state Medicaid spending is man-dated.

"It's a dilemma. What are we going to do?" asked Sen. Linda Garrou, D-Forsyth, who is one of the Senate's lead budget writers.

"There's no easy answer to Medicaid."

• James Romoser can be reached in Raleigh at 919-833-9056 or at jromoser@wsjournal-.com.

N.C. budget outlook
The three largest parts of the state budget are education, Medicaid and the N.C. Department of Correction. Total state spending has increased 63 percent in the past nine years:
State operating budget for 2006-07
Education $9.8 billion
Health and human services $4.2 billion
Justice and public safety $1.8 billion
Reserves $1.4 billion
Other $1.1 billion
Debt service $571 million
Total $18.66 billion

a) Changes in state spending
Spending area 1996-97 2005-06 % Increase
Medicaid $1.05 billion $2.9 billion 178.5
Education $6.2 billion $9.8 billion 60.1
Dept. of Correction $809 million $1.1 billion 33
Total state spending $10.3 billion $16.9 billion 63
Source: N.C. General Assembly Read more!

Disabled mired in backlog for aid - Charlotte Observer

N.C. joining federal effort to speed benefits to needy

FRED KELLY
frkelly@charlotteobserver.com

Ronald McKoy, homeless and HIV positive, applied for Social Security disability payments in October 2004 because he said he was too sick to work.

About a year later, social workers say, the 50-year-old McKoy barely weighed 100 pounds and went to a local hospital vomiting blood.

Yet, even when he died in February as a resident of the Uptown Men's Shelter, he was still awaiting a judge's ruling on whether he qualified for disability benefits.


"He was clearly disabled," said Lynn Bishop, McKoy's attorney. "I'm confident he would have won."

Bishop said the monthly payments -- $947 for the average recipient -- could have helped McKoy find a home and get food and medicine. McKoy had worked as a day laborer. Every American worker pays Social Security taxes, which fund the program.

Delays such as McKoy's have prompted efforts to fight the nation's ballooning backlog of disability cases.

Now, North Carolina is one of the latest states to join a federal program intended to help speed the process by aiding those most at risk.

Under the program, trainers started last week teaching social workers how to help the homeless fill out Social Security disability benefit paperwork. Proponents say the homeless often submit incomplete information to the government for approval.

The goal: to cut the wait for eligibility determinations from roughly three years to six months.

Federal estimates indicate the homeless are less likely than other applicants to get Social Security payments even when they would have qualified.

At the Salvation Army women's homeless shelter near uptown, nearly 1 in 5 clients is awaiting benefits, said Deronda Metz, director of social services for the agency.

"It's horrible," she said. "We have people who have been in here two years waiting. We have people in here with walkers."

607 days

Since 2002, the backlog of Social Security cases has ballooned from 468,000 to 730,000, said Thomas Richards, executive director of the Federal Managers Association, which lobbies for government administrators.Federal officials Tuesday could not provide the number of unresolved cases for Charlotte or the Carolinas.

But social workers and attorneys say hundreds of people in Charlotte become homeless every year because the application process takes so long.

Most initial requests are denied, for any number of reasons, from applications being filled out wrong to judgments about the person's disability. Backlogs start when applicants appeal their cases to an administrative law judge.

The Observer found:

• Applicants at Charlotte's disability hearing office wait an average of nearly four months longer than others across the nation, 607 days compared with 496 nationwide.

Officials at the office did not return messages this week seeking comment on its efficiency.

• Charlotte's two largest homeless shelters reported turning people away last year, even as clients inside awaited benefits that could have paid for them to live on their own.

• Raleigh attorney Charles Hall, former president of an advocacy group for applicants, said five or six of his clients die each year awaiting rulings.

The Social Security Administration, which oversees the program, acknowledges delays are "unacceptable" in a report released last year. Officials promise reforms, such as switching from paper to computerized record keeping and bolstering training for social workers who aid homeless applicants, will streamline the system.

"The new process will shorten decision time and pay benefits much earlier in the process for people who are clearly disabled," agency spokeswoman Patti Patterson said.

Sweating it out

On a recent day, Rob Weigle told a homeless support group he applauds the new federal program in North Carolina.

Weigle, an advocate for the homeless who was once homeless himself, has gathered information on the initiative for group members who meet weekly at the Urban Ministry Center uptown.

Once a computer programmer, Weigle suffers from epilepsy and anxiety attacks that prevent him from working. He lived in Boston in the mid-1990s when he said he was twice rejected for disability benefits.

He lived in a homeless shelter for one year until the decision was reversed in 2000.

The program gives the disabled hope "because you can sweat it out for six months," Weigle said. "Two years, however, you just don't know how you're going to do it."

At the Salvation Army women's homeless shelter near uptown, Margaret Thompson, 62, said she can't work. Arthritis, high blood pressure and the autoimmune disease lupus have taken a toll on her body.

Yet she said her application for Social Security disability payments has been rejected. Thompson has appealed her case and is awaiting a court date.

She worked as a library assistant until 2000 when she quit to care for her ailing father. When he died in 2005, her landlord allowed her to live rent-free until she started receiving disability payments. When the payments did not arrive by last summer, she was evicted.

"I'm just angry at the system," Thompson said. "I have been diagnosed by doctors. What are they waiting on? Money does me no good if I'm dead."

About the Benefits

People are eligible for Social Security disability benefits when a physical or mental impairment that is expected to last at least a year or result in death prevents them from working.7.5 million people nationwide receive Social Security Disability Insurance.

For complete information about Social Security: www.ssa.gov

Long Waits

Average waiting time in days for disability applicants awaiting rulings from administrative law judges.

Charlotte

607

Greensboro

595

Raleigh

484

Nationwide

496
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Turner's death still calls for reform - The Greenville Daily-Reflector

Editorial

Jan. 26 marked an unfortunate anniversary for this community, though it is one that passed without much notice. It marked one year since Kerry Turner, a 34-year-old Greenville resident with a history of mental illness, led city police on a dangerous high-speech chase before he was shot to death by officers.


In the time since, the officers involved in the shooting have been exonerated by internal and external investigations into the incident. But the community still has not made appreciable progress in training respondents to deal with those suffering from mental illness.

That incident put a city resident and police officers in harm's way, and the evidence suggests that could have been avoided. The public deserves greater assurance such an event will not be repeated, and that law enforcement, emergency workers and other critical personnel are receiving the training they need to address these types of incidents without injury or death.

Turner was shot several times in the head and chest by Greenville police at the corner of 14th Street and Greenville Boulevard. His death ended a high-speed chase, instigated by Turner, after police attempted to serve an involuntary commitment order obtained by his parents. Turner had a history of bipolar disorder and was yelling and throwing things at about 6 a.m., roughly four hours after he was transported by officers to Pitt County Memorial Hospital for similar behavior.

At several points in this process, those asked to handle Turner proved incapable of reasonably addressing the specifics of the situation. When taken to the hospital, Turner was released from PCMH without seeing a mental health professional. During the stand off that preceded the chase, police took a cell phone from his parents as they spoke to their son from outside the house. Police believed Turner was armed, though his parents insisted he was not.

Ultimately, Turner fled police, initiating a sequence that led to his death. But it seems clear from the mishaps and mistakes made, that officers lacked the training needed for this incident. And this community bears responsibility for that critical failure.

Earlier this month, Turner's parents filed suit against the city, claiming officers acted with negligence in provoking a dangerous situation at the Turner home that morning. Greenville City Attorney Dave Holec said the city will deny fault and liability, maintaining that officers acted appropriately throughout the episode. Residents should not expect the city to comment further on an on-going suit, but must question the handling of any outcome that puts officers in harm's way and results in the death of a city resident.

The death of Kerry Turner should tug at the conscience of this community. While it is true he acted in a dangerous and potentially lethal manner that morning, there is sufficient reason to believe the situation could have been avoided and even resolved without his death. That knowledge calls out with clarity and urgency for reform.
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Be ready with the mental health safety net - Minneapolis Star-Tribune

By Andrew Borene

The real tragedy in the wake of the suicide of Jonathan Schulze is that the young Marine asked for help but help was not forthcoming. We can respond proactively to this travesty, if we now prepare the state to help other veterans who may also be suffering.

Reading the story of this young Marine, I recognized that the same story might have been written about me. If I had not had the luxury of inpatient treatment and a supportive community when I needed it, I might have met the same fate.

I too may have been called "the life of the party," unaware that what lay beneath the disguise of thrill-seeking behavior was sadness and shame. Many were likely fooled by my unfulfilling search for happiness and escape from my own pain. I sought importance with an early run for the Minnesota Senate, even while attending law school and with two young boys at home. In the end, nothing I did in pursuit of excitement allowed me to outrun my shadow for long. Like Jonathan, my feelings of inferiority associated with believing I had not done enough and did not merit the nightmares and the overly intense reactions to daily events, may have created obstacles to seeking help.

I have now learned that, through no fault of our own, some of us may be predisposed to long-lasting psychological effects from the experience of war. It is well known that some human beings are simply predisposed to addiction, depression, anxiety or other disorders. For many the stigma of seeking help as a "mental health" patient is almost too much to bear in itself -- so when Jonathan Schulze showed the courage and responsibility to ask for help, it should have been available.

"Post-traumatic stress disorder" has been associated with a negative connotation for so long that the Department of Veterans Affairs has suggested clinicians refer to the same set of symptoms with terms like "adjustment" disorder and "transition" difficulties. Whatever the name, it is estimated that nearly a third of our combat veterans will need some assistance in readjusting to civilian life.

Mental health crisis services provide a safety net that is crucial for many Minnesota families. According to the National Alliance on Mental Illness (NAMI) of Minnesota, suicide is the leading cause of death for 15- to 34-year-olds. But reimbursement rates for mental health are inadequate for private providers, and our public services are frequently overburdened or underprepared.

For some, like Jonathan, the only option might have been the VA medical center or other state services. But if Minnesota's hospitals are overwhelmed now, what will they do when approximately 3,000 Minnesota Guardsmen return after an unprecedented combat extension?

We need to act now. Advocates for mental health suggest that more efficient coordination of outpatient care would open beds for emergency admissions. Paying mental health crisis workers commensurate with other public safety officers might keep them available 24 hours a day. We should also support Rep. Jim Ramstad's mental health parity legislation, which would require private health insurers to provide reimbursement for mental health care comparable to that for physical health care.

Troops returning from the war will need the services that they were promised as part of their enlistment contracts. We need to honor an unwritten guarantee that Americans who stand up and risk their lives on behalf of their country deserve access to treatment upon returning home.

Emergency mental health services save lives, and treatment works. One young Marine made the right choice to ask for help but was let down. Minnesota now has a choice in our collective response to this wake-up call on veterans and mental health issues. Let us pray that we do the right thing and never let this happen again on our watch.

Andrew Borene, a law student at the University of Minnesota, was a U.S. Marine lieutenant in Iraq. He is an adviser to Iraq and Afghanistan Veterans of America, a veterans advocacy group. Read more!

AstraZeneca, NAMI partner for NAMICARE - PRNewswire

WILMINGTON, Del., Jan. 30 /PRNewswire-FirstCall/ -- AstraZeneca (NYSE: AZN - News) today announced its exclusive multi-year sponsorship of the National Alliance on Mental Illness (NAMI) in expanding NAMI-C.A.R.E. [Consumers Advocating Recovery through Empowerment], a peer-based, mutual support group program for people with mental illness. This partnership will allow the existing NAMI-C.A.R.E. program to expand to all 50 states and Puerto Rico by 2009.



NAMI-C.A.R.E. sponsors support groups whose purpose is to help overcome isolation and to promote recovery for people challenged by any severe and persistent mental illness. During weekly 90-minute meetings, individuals share experiences, learn coping strategies and offer mutual understanding and encouragement as they seek to move forward in their lives.

"Because patient health is at the foundation of everything we do, we are pleased to be part of a program that will have a dramatic impact on the health of people with mental illness," said Tony Zook, president and chief executive officer of AstraZeneca LP. "Our responsibility to people goes beyond making cutting-edge medicines. We are committed to helping people achieve wellness and this includes making available important supportive services, like NAMI- C.A.R.E."

NAMI-C.A.R.E. is a grassroots movement that began in a local NAMI affiliate in suburban Chicago, Illinois, to meet the needs of its consumer members. Since then, people with depression, bipolar disorder, schizophrenia, anxiety disorders and other mental illnesses have found a supportive place with NAMI-C.A.R.E. in various cities throughout the country. The expansion of this program aims to have a support group available in every major city across the country, in English and Spanish, all under a central leadership with consistent training and materials.

"We look forward to enhancing our already successful partnership with AstraZeneca through the expansion of NAMI-C.A.R.E., a program that is especially important because building a strong support system provides the foundation for recovery," said Suzanne Vogel-Scibilia, M.D., president of the NAMI national board. "Many people with mental illness feel isolated and try to recover alone, but a powerful healing process occurs when people find that they have peers who share their experiences."

"AstraZeneca is proud to be supporting NAMI and the work they continue to do with NAMI-C.A.R.E.," said Marianne Jackson, executive director, commercial operations at AstraZeneca. "Together, we can enhance the support available to Americans for their mental illnesses and help make their lives more meaningful and productive."

About NAMI

NAMI (the National Alliance on Mental Illness) is the nation's largest grassroots mental health organization dedicated to improving the lives of persons living with serious mental illness and their families. Founded in 1979, NAMI has over 1100 state and local affiliates across the country, engaged in research, education, support and advocacy.

About AstraZeneca

AstraZeneca is a major international health care business engaged in the research, development, manufacture and marketing of prescription pharmaceuticals and the supply of healthcare services. It is one of the world's leading pharmaceutical companies with healthcare sales of $23.95 billion and leading positions in sales of gastrointestinal, cardiovascular, neuroscience, respiratory, oncology and infection products. In the United States, AstraZeneca is a $10.77 billion healthcare business with more than 12,000 employees. AstraZeneca is listed in the Dow Jones Sustainability Index (Global) as well as the FTSE4Good Index.

For more information about AstraZeneca, please visit: http://www.astrazeneca-us.com.

This press release contains forward-looking statements with respect to AstraZeneca's business. By their nature, forward-looking statements and forecasts involve risks and uncertainties because they relate to events and depend on circumstances that will occur in the future. There are a number of factors that could cause actual results and developments to differ materially. For a discussion of those risks and uncertainties, please see the company's Annual Report/Form 20-F for 2005.

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First-time mental-health crisis terrifying - Plattsburgh (NY) Press Republican

This is the third of a seven-part series on children's mental illness.

By: Suzanne Moore, Staff Writer

PLATTSBURGH — Brenda Mousseau packed an overnight bag.

Her 7-year-old daughter, Tami, had smashed the walls of her bedroom with a dresser drawer, then tried to burn her hands on the kitchen stove.

Now she was a patient in the Children's Mental-Health Unit at CVPH Medical Center — and this mom would stay by her side, just as she had overnighted with Tami's brother, Dustin, following various surgeries.

"But we were only allowed to see her for an hour a day," said Tami's father, Larry. "They said they needed the other 23 hours for observation."


The locked-down ward and separation from her parents terrified Tami, who became hysterical when each visit ended.

She refused medication and her behavioral issues skyrocketed.

"I was beside myself," Mr. Mousseau said. "I didn't know what to do."

Very often, a family is catapulted into the maze of mental-health treatment by a crisis, by a first-time trip to the emergency room.

"They're just kind of thrown into it," said Lois Scoskie, family support coordinator for the Family Advocacy Program of National Alliance for Mental Illness: Champlain Valley. "Usually at that point, they're very confused; they don't really understand what's happening."

A mental-health issue can present itself less dramatically — a child or adolescent may show signs of depression or some other symptoms and, in fact, respond quickly to treatment.

There are both private psychiatrists (though only a few child-certified) and therapists available locally, and Clinton, Essex and Franklin counties all offer an array of services, from clinics for therapy and medication management to adventure-based counseling and mentoring.

The agencies in each county work together on committees designed specifically to see that children with emotional disorders get appropriate care.

"It makes the best use of our shared resources and minimizes duplication," said Essex County Community Services Director Nicole Bryant. "It's really been working incredibly well."

But there are almost always wait lists for any of those services, private or otherwise.

"It's not the fault of the providers," said Kelly Jarrard, a NAMI family advocate. "There really isn't the funding."

But treatment delays contribute to the tendency for that first mental-health experience to be of crisis proportions, she said.

And when that happens, she said from experience, "it's a major break. You are now in a whole new arena — your life is never the same."

FROM FEAR TO HOPE
The reality of their daughter's inpatient treatment left the Mousseaus stunned.

Mr. Mousseau got on the phone, calling one agency after another, searching for guidance.

"There was no compassion," he said. "It was like you against the world."

NAMI's Family Advocacy Program had not yet been formed, but at last someone referred the Mousseaus to Laurie Shutts, a mom who, with a emotionally ill child herself, knew the ropes of inpatient treatment.

Shutts and Jarrard teamed up to support the family.

"They had this horrid fear they shouldn't have brought (Tami) to the hospital," recalled Jarrard, who has lived a similar experience. "It was very frightening for them."

She and Shutts were able to make sense of the system for the couple, sit in on treatment meetings with them, offer constructive ideas to improve their daughter's situation.

They suggested offering Tami's pills in fat-free chocolate pudding, Mrs. Mousseau remembered.

It worked!

For the girl's parents, the light of hope began to dawn.

Tami is 12, now. Diagnosed with attention deficit hyperactivity disorder and obsessive compulsive disorder in addition to some already identified developmental issues, medication keeps her on a pretty even keel — under her parents' vigilant eye.

"We're learning to see what her triggers are," Mr. Mousseau said. "We're starting to see early warning signs right away."

Catching an episode at its inception allows redirection with such activities as drawing, painting or puzzles.

Tami has a collection of Matchbox cars that fills two 30-gallon bins, earned by good behavior in public, and she adores her cats, Smoky and Misty.

NEGOTIATING THE MAZE
Since Tami's hospitalization five years ago, the path has become more clear for those who need mental-health intervention for a child.

Area hospitals, schools and agencies often give NAMI's number to families in crisis.

Scoskie, Jarrard and others on NAMI's advocacy team help families negotiate the maze leading to appropriate treatment, which might include assistance, from coordinating services and joining in on parent-teacher conferences to giving support to those dealing with custody or juvenile-justice issues.

"We can assist the parents to understand better what's happening to their children," Scoskie said. "They know their children better than anyone, but we know the services out there."

In Essex County, hospitals give families the after-hours crisis number for the Mental Health Clinic; support organization Families First connects parents with various resources.

There's a distance to travel before there's enough networking for families, said Kathy Fadden, program director for Franklin County Mental Health Association.

Hospitals in her area don't clue parents in about the advocacy available to them, she said.

"We would love for that to change," she said.

But when the agency does get a call, she added, "any and all situations parents deal with — we're there."

A Clinton County guide called "Adolescent Community Mental Health and Substance Abuse Services Resource Book" is available from NAMI and Clinton County mental-health-care provider Behavioral Health Services North and will soon be found in pediatrician's offices.

And Essex and Franklin counties just put services up on a Web site easily accessible to the general population.

PROACTIVE PARENTS
But regardless of increased support services, the shock and fear that accompanies a family's early experiences with childhood mental illness can still leave them feeling lost, Mr. Mousseau said.

Educate yourself, he recommends, take advantage of supports such as NAMI.

And be proactive.

Preparing for his daughter's discharge, he undertook a complete renovation of Tami's bedroom, making it safe for her with plywood walls covered halfway up with carpeting and decorated with images of puppies, kittens and other animal babies.

"If she wants to pound on the walls, she won't get hurt," he said, standing in the pretty pink and mauve boudoir. "It's a safe environment for her."

Mr. Mousseau took a NAMI class called WRAP — Wellness Recovery Action Plan — to better understand his daughter's illness.

The Mousseaus work closely with Oak Street School, where Tami studies in a self-contained classroom with more individual attention.

"We're at every meeting," he said, emphasizing the need for consistency. "What they do at the school, we do at home."

Mr. Mousseau, 44, now serves on the NAMI Board of Directors. He trained as a lay advocate for schoolchildren with mental illness or other disabilities.

And he and Mrs. Mousseau, 41, host a support group — Larry's Basement Chats — in their home for parents of children with emotional disorders.

The give and take, just knowing they aren't the only family fighting the battle, gives them strength, Mrs. Mousseau said.

"It's given me great joy knowing somehow I'm able to help not just Tami but other children," Mr. Mousseau said. "There's always hope."

MIND MAZE

This is the third of a seven-part series on children's mental illness.

Tomorrow: Inpatient treatment.
Read more!

New funding to improve children's treatment - Plattsburgh (NY) Press Republican

By: Suzanne Moore, Staff Writer

PLATTSBURGH — Children's mental-health clinicians in Clinton, Essex and Franklin counties juggle as many as 50 cases at any given time.

And other children wait anywhere from a few weeks to six months for treatment to begin.

"We're strained beyond our capacity to handle what we are," said Sherrie Gillette, director of Clinton County Community Services. "We get these kids who are in need, who are damaged, and it is distressing to put them on a waiting list."

NEW STATE MONEY
But an infusion of new state funding, supporting a new approach to attacking the growing incidence of children's emotional disorders has Gillette and other providers throughout the region more hopeful about meeting the need.

The aim of the new Child and Family Clinic Plus is to identify and treat children earlier, before illnesses, said Gillette, "develop full-bore.

"Treatment works," she said. And especially if employed early on, "treatment is very effective."

But treatment must be preceded by diagnosis. All three counties will soon kick off screening projects to help identify children who may have such mental illnesses as depression, anxiety or conduct disorders.

Clinton County intends to screen elementary-school students, expanding an ongoing pilot project at Plattsburgh High School and augmenting a Health Department initiative soon to begin in pediatricians' offices.

In Essex County, said Community Services Director Nicole Bryant, emotional-wellness screens will start with fourth- through seventh-graders.

She hopes parents will see the value of checking their children's emotional wellness.

"Kids are subject to a multitude of screenings," she said, like dental checks and scoliosis exams.

"But never an emotional-wellness screen."

Franklin County is looking at checking in with second-graders and sixth-graders, while Akwesasne's St. Regis Mohawk Clinic, which works with Franklin and St. Lawrence counties to provide services, will start with sixth-graders, all the children in the Head Start program and any youngsters involved with Social Services, such as those in foster care.

Clinic Director Christine Venery, whose facility handles between 150 and 180 children's cases annually, thinks emotional disorders may be a bit more prevalent in the Mohawk community.

"Native Americans overall generally have a higher suicide rate," she said. "We've been trying to do more with suicide prevention."

The clinic, which has four therapists on staff who see between 30 and 40 children each, also operates school-based programs at St. Regis Mohawk School and Salmon River Central.

At the latter, services are available to non-native students, as well. While there's no wait presently to access clinic treatment; there is to see the psychiatrist, who gives one day a week to the job, Venery said.

Clinic Plus's in-community programs will raise awareness, she added, something she welcomes with open arms.

"We're trying to reduce the stigma of people trying to get mental-health counseling."

Clinicians from all three counties have already begun training in the evidence-based practices the state has determined should be employed by agencies participating in Clinic Plus.

Bryant hoped those treatments, including cognitive behavioral therapy and dialectical behavioral therapy, will prove themselves more effective. And since they follow specific time frames for treatment, she said, children should get better over a shorter period.

Several Franklin County therapists are already versed in evidence-based practices, Community Services Director Susan Delehanty said, but her clinic welcomes the opportunity to keep training up to date.

Already, the county's approach, she said, "is to wrap services around the child and family to meet their specific needs instead of trying to make them fit into a particular program mold. Families who have access to support, through case management, respite, skill building, support groups, etc., as well as clinical services, are more likely to achieve their goals and avoid costly, out-of-home and out-of-county services.

ADDING STAFF
Delehanty expected the wellness screens will increase need for services but felt existing staff can absorb that demand.

Additional clinicians will be brought on board if necessary, she said.

Franklin County, with Northstar Industries providing much of its mental-health care, has, a therapy staff of 11 serving children at three clinic locations and three school-based treatment centers.

Essex County will add one social worker to the present staff of three full-timers who, among them, share a caseload of about 75 kids.

And Clinton County will increase its present total of 4.5 full-time staff of clinicians by two. The county also hopes add a half-time psychiatrist to the four prescribers on board now, whose hours add up to 1.5 full-time staff.

"By adding the two staff, we'll be able to manage the wait list," Gillette said.

The Mental Health Clinic had 603 admissions in 2006. Gillette expects to add 136 cases to that "with enhanced reimbursement," she said, "to make it financially feasible."

The state doesn't guarantee continued funding, she said. But more staff and the streamlined treatment possible with evidence-based practices provide the opportunity to be self-sustaining, she said.

BHSN BUSY, TOO
In Clinton County, one of those other choices is Behavioral Health Services North, which offers a broad spectrum of treatment and support programs. The wait list there, where five full-time clinicians handle an average caseload of 50 children each, fluctuates between 30 and 50.

"If my wait list was as few as 25, I'd feel we were doing great," said Child and Family Clinic Director Henry Goldenberg.

Only one clinic in a county can join the new state program, so Behavioral Health Services North has to consider other ways to cut the wait down to size. An option under study, Goldenberg said, is to put a cap on services.

"It doesn't mean we abandon (clients)," he said. "We kind of transition them out responsibly, by regulation."

That policy could be open to argument from both sides, he said.

"If you're a parent, you want the kid in treatment as long as it's needed, but I'm not sure that's fair to the people on the waiting list who are getting no services."

SEEKING SOLUTIONS
Bryant's an optimist — about the prognosis of children with mental illness, about her clinic's ability to meet need. But that the state would devise such a program as Clinic Plus caught even her by surprise.

"All of these things coming at the same time — with money to support them — is something I never dreamed could happen," she said.

The changes can't come too soon for Gillette.

"You stretch and stretch and stretch to provide the services; it really causes us a lot of angst," she said. "Somehow, we have to find a solution to this."
Read more!

Adult home ratings debated - Raleigh News & Observer

Thomas Goldsmith, Staff Writer

If North Carolinians rely on a star-rating system to find the best child-care center, they should be able to access a similar rating for rest homes.

At least that's the position of some state officials and advocates who are pressing for legislation to set up a rating system. Others, including some legislators, argue that the proposal amounts to more burdensome regulation, especially for less expensive homes that depend on poor residents who receive government assistance.

"If you are tagged with one of these ratings, you are going to be stigmatized," Sen. Austin Allran, a Republican who represents Catawba and Iredell counties, said at a legislative study commission meeting last week. He predicted that more expensive assisted-living centers that house mostly private-pay residents will get the best ratings.

State Rep. Jennifer Weiss, a Cary Democrat, countered that the rating system would offer an incentive for all adult care homes to meet high standards.

"We are often criticized with being too heavy on the stick and not offering the carrot," Weiss said.

Draft legislation for the ratings system comes at a time when the state Department of Health and Human Services and the long-term care industry face increasing scrutiny over conditions in the state's rest homes. In 2006, the state started posting violations and penalties by homes on a Web site. However, even in cases in which a resident has died following a lapse in care, at least six months can pass before information is posted.

A rating system would be another source of information for consumers, proponents said.

A 2005 state law charged the Department of Health and Human Services with making plans for a star-rating system, but it didn't require the system to be used. The current proposal aims to get the system up and running.

Facilities could earn from one to five stars based on how well they met existing standards, sanctions for bad care and participation in plans to improve conditions for residents.

In opposing the ratings system, Lou Wilson, a rest home industry lobbyist, cited low levels of tax-funded staffing and lack of guidance for facilities in how to deal with a state-allowed mix of frail elderly residents with people who have mental illness.

In an interview, Wilson said the state was demanding a high level of performance from rest homes without being willing to pay for it.

North Carolina's child development division started issuing five-star ratings to day-care centers in 2000. A previous licensing system didn't give parents enough information about whether centers were doing more than meeting minimum standards, officials said.

Sen. Charlie Dannelly, co-chair of the study commission, said the ratings proposal for rest homes only requires them to meet minimum standards.

"I don't feel sorry for them," Dannelly said, if the homes can't meet the requirements.


Staff writer Thomas Goldsmith can be reached at 829-8929 or at tgold@newsobserver.com. Read more!

Teen pleads not guilty in shooting - Raleigh News & Observer

Father says teen has a history of mental illness, and unbeknownst to his family had stopped taking his medication a few months earlier.

Jessica Rocha, Staff Writer

HILLSBOROUGH - The teenager accused of holding a teacher and student hostage last spring at East Chapel Hill High School pleaded not guilty to kidnapping and other charges Monday.

William "Barrett" Foster, 17, pleaded both not guilty and not guilty by reason of insanity to multiple charges of second-degree kidnapping, discharging a firearm on educational property, carrying a gun on educational property and assault by pointing a weapon.

In April, Chapel Hill police say, Foster entered a classroom about the same time that student Chelsea Slegal went in to see civics teacher Lisa Kukla.

Foster has a history of mental illness, and unbeknownst to his family had stopped taking his medication a few months earlier, his father, William Z. Foster, said in October.

According to Kukla, Foster pulled a hunting knife, air pistol and shotgun out of a backpack, closed the blinds, locked the door and unplugged the phone.

Foster held the teacher and student against their will in the room for more than an hour, police say, while a soccer game and other after-school activity bustled around them.

Kukla said she and her student spoke with Foster during that time, trying to make a connection with him so he wouldn't shoot them.

After firing two shots through the window, Foster left the school and went home, police said. By that time, police had set up a perimeter to search for him, but he reached his family's nearby home before he could be arrested, and his mother then drove him to the hospital.

Neither Slegal nor Kukla was injured.

Friends and family of Slegal and Kukla attended Monday's hearing in Orange County Superior Court, as did David Thaden, East Chapel Hill High's principal.

The incident has been used to encourage improvements in school security and to advocate for tighter gun controls.

Foster is currently at Dorothea Dix hospital under $40,000 bail, though a bail hearing is expected to be scheduled in the coming weeks, Orange-Chatham District Attorney Jim Woodall said.

In October, Superior Court Judge Carl Fox denied a request by Foster's family to have their son come home for overnight visits. Fox said the visits would put the teenager too close to the school because the family lived within walking distance.

The Fosters have put their house at 104 Silver Glade Place up for sale. It was not clear Monday whether the home has been sold.

Staff writer Jessica Rocha can be reached at (919) 932-2008 or jessica.rocha@newsobserver.com. Read more!

More funding for youth rehab urged - Atlanta Journal-Constitution

By BILL HENDRICK

A composed and self-confident 17-year-old recovering drug addict from Suwanee faced a House Appropriations subcommittee Monday, urging legislators to boost funding for rehabilitation programs like the one she said had saved her life.

"I have been sober for more than one year," said Rachel Knobloch. "When I discovered that my second home, Katharos, was closing, I was devastated."

Rachel's mother, Candace, also spoke at a public hearing on Gov. Sonny Perdue's amended state budget for 2007. Speakers, including Rachel and her mother, argued against any cuts that they said could hurt what they described as much-needed social programs.

Candace Knobloch said she was among many people in Georgia "very concerned" that the Department of Human Resources might not keep programs like Katharos in place for financial reasons.

Rachel said she went to Katharos, a long-term alcohol and drug treatment center for girls in Griffin, at age 15 and sobered up.

She urged the subcommittee to provide funds because the Griffin center "saved my life.

"I am determined to keep Katharos open along with all the other drug treatment centers," she said.

Speaker after speaker said the Georgia Legislature isn't doing enough for young people with special needs or abused women and needs to act immediately.

Rachel was preceded at the podium by Allison Zito, a 27-year-old graduate student from Alpharetta who works with addicts, with whom she said she relates because she was one 13 years ago.

"At the age of 14, I had tried to kill myself, kill my mom, dropped out of school and had been living on the streets for a year and a half," she said. "I was using cocaine every day and had been using drugs intravenously."

She said she also got clean at Katharos after being sent there in late 1995.

The two were among a parade of advocates for better drug control facilities they said the Legislature must fund, but hasn't.

Rep. Mark Butler (R-Carrollton), chairman of the House Appropriations subcommittee on human resources issues, had few questions for the witnesses, but said Knobloch and Zito almost brought him to tears.

Normer Adams, executive director of the Georgia Association of Homes and Services for Children, said gaps exist in the state's public mental health service system, and need to be closed.

"It is estimated that there are over 160,000 children in Georgia with serious emotional disabilities who need mental health and behavioral services," Adams said. "With children in state care, over 3,000 in foster care and 3,500 children in the juvenile justice system need behavioral health services."

He said Georgia's ability to serve kids in need "is a fraction of what it needs to be."

"As Georgia's population grows, so does the number of children in need of mental health and behavioral health services," he said. "Funding over the past decade has not grown with the increased demand for community services."

He said that of 160,000 Georgia children with severe emotional problems, only 26 percent are receiving services. Read more!

Waits for Beds Exceed State's Legal Maximum - Washington Post

By Ernesto Londoño

Because of a shortage of beds at Maryland psychiatric hospitals, a growing number of patients, including many who are involuntarily committed, are spending days in emergency rooms, often in violation of a state law that mandates that they be placed at a comprehensive care facility within 30 hours of commitment, heath-care officials and patient advocates say.

In some cases, they say, this has forced doctors to release patients regardless of their mental state, sometimes only to have them involuntarily committed again with no guarantee that they will be placed promptly at a psychiatric facility.

The bottleneck of mental health patients in emergency rooms has been in the making for years, as the number of psychiatric beds in public and private hospitals has decreased. The long delays are worrisome to health care officials and patient advocates because they say the waits often worsen patients' conditions and overburden already-busy emergency departments.

"This is a national problem," said Patricia Petralia, vice president and chief operating officer at Potomac Ridge Behavioral Health Center in Rockville. "They're not receiving active treatment."

State officials acknowledge the problem, but they say cases of patients who are not referred to inpatient psychiatric facilities within 30 hours are not widespread. They say they are trying to address the issue by quickening the referral process and monitoring patients more closely to make sure they get access to the type of treatment they need.

"The number of beds available has not kept up with the demand," said Brian Hepburn, the executive director of the Maryland Mental Hygiene Administration. "Anytime you have someone released on a technicality means they're not getting their needs met."

Elsewhere in the region, Virginia has no time limit prescribed by state law, but also often faces problems placing involuntarily committed patients into facilities.

"We hear anecdotal complaints of people waiting in emergency rooms for extended periods of time," said James Reinhard, commissioner of the Virginia Department of Mental Health, Mental Retardation and Substance Abuse Services.

In contrast, the District's St. Elizabeths Hospital has 420 beds for psychiatric patients, more than enough to meet demand in the city. "We're not experiencing a crunch," said Linda Grant, spokeswoman for the D.C. Department of Mental Health. "Traditionally, we have not had a problem with placement."

The number of beds at Maryland state psychiatric hospitals declined by 72 percent between 1982 and 2005, according to a report released last month by the Maryland Health Care Commission. The drop from 4,390 to 1,235 beds during that period came as three hospitals closed and others downsized. The number of beds at private licensed psychiatric hospitals fell by 36 percent during that period, dropping from 830 to 519.

The number at state and private psychiatric hospitals in Virginia also has dropped sharply in the past 30 years. The reasons for the decreases, health experts say, include the deinstitutionalization of many patients and the difficulty of making psychiatric hospitals financially solvent.

Neither Maryland officials nor the patient advocates could provide specific numbers of people affected by the delays caused by the shortage of beds. But they agree they are increasing.

Lois Fisher, chief attorney for the mental health division of the state public defender's office, which represents most involuntarily committed patients, said cases of patients who waited in emergency rooms for more than 30 hours were rare a few years ago.

"We're seeing it more frequently," she said. "We're seeing it several times a week. We've all expressed concern about it."

Petralia, the Potomac Ridge official, said involuntarily detained patients who have spent more than 30 hours in emergency rooms are a near certainty on the weekly court docket.

Under state law, people in Maryland who are involuntarily committed by law enforcement officials or at the request of their relatives are taken to emergency departments for an initial evaluation. They must be evaluated by two physicians within six hours of their commitment. If the doctors feel the patients, if released, would pose a threat to themselves or others, hospital officials have 24 hours to get them to a psychiatric facility.

Once there, involuntarily committed patients go before a judge for an administrative hearing in which they can contest their hospitalization. A judge can release the patient if he has spent more than 30 hours in what some refer to as the "gray zone."

Public defenders often fight to get those patients released. Supreme Court cases and statutory law establish that people ought to be free if their commitment is unlawful, regardless of their mental state, they argue.

"We're talking about 48, 72 hours," Fisher said. "We're talking about major league delays in the ER."

Brian Drayton didn't have to wait quite that long. On Jan. 4 relatives obtained a court order to involuntarily hospitalize the 22-year-old Baltimore man.

"He imagines he's still in jail, very hostile and agitated," his mother wrote in an evaluation for an emergency petition. "He verbally threatens to defend his self. (ex. he says I'm gonna kill them before they get me.)"

He was evaluated at Greater Baltimore Medical Center, where officials signed off on the commitment order and tried to find him placement at a psychiatric hospital. He spent about two days there, far longer than 30 hours.

Uninsured patients such as Drayton are often trickier to place in psychiatric facilities because some private hospitals don't accept them, even if the state agrees to pay for their care, health care officials said.

Drayton was admitted to Potomac Ridge on Jan. 7. He authorized Potomac Ridge officials to allow a reporter to examine his medical record.

On Jan. 10, when a state judge made a weekly visit to Potomac Ridge to decide which involuntarily committed patients could leave, Drayton's condition had improved, but doctors said they felt that he was not ready to return home.

Shortly before his hearing was to start, Drayton signed a form agreeing to be hospitalized. Potomac Ridge officials said it was a huge relief, as they would have faced long odds had his case gone before the judge -- solely because it took more than 30 hours to get him to Potomac Ridge.

The crunch became a crisis at Shady Grove Adventist Hospital in Rockville about two years ago.

"It was not unusual to have patients in the [emergency department] for four days, even a week," said David G. Srour, the hospital's chief of emergency medicine. "It was like warehousing patients."

State and county officials last summer developed a pilot program at Shady Grove to streamline the referral of uninsured psychiatric patients. County crisis center mental health experts are now on call 24 hours a day to respond to Shady Grove to conduct evaluations and help find placement at a psychiatric facility when necessary.

Shady Grove officials say the pilot program has dramatically cut waiting times for referrals and allowed them to route patients to the right services.

Hepburn, the state official, said other jurisdictions across the state are taking similar steps.

But patient advocates say the long-term solution to the problem is simple: Make more beds available.

Fisher, the public defender, said she fears that the lack of prompt screening, referrals and comprehensive care will increase the likelihood that they will wind up getting in trouble with the law.

"There is no more expensive way to access the mental health system than through the court system," she said.

Staff writer Steve Vogel contributed to this report. Read more!

Former grad student remains in mental-health facility - Unv. of Texas Daily Texan

Joseph Boone

Former UT graduate student Jackson Ngai will remain in Kerrville State Hospital for at least one more year after District Judge Bob Perkins decided Monday that he was not fit for release.

In 2005 Ngai was found not guilty by reason of insanity for the 2004 murder of Danielle Martin, a UT piano professor.

During his trial, Ngai confessed to killing Martin, maintaining she was a robot trying to harm him. The two had a close relationship and were in Martin's home when Ngai stabbed her more than 200 times. He claimed she had a computer chip in her brain, as previously reported by The Daily Texan. Ngai, who was originally misdiagnosed with bipolar disorder, had stopped taking his medication in January 2004. He was taking lithium carbonate, which caused his hands to shake. This made it difficult for him to play the piano.

His father testified in 2005 that Ngai was studying to be a pianist.

He was found to be a paranoid schizophrenic and was confined to a mental-health facility where his condition is to be reevaluated each year, said Jim Erickson, who represents Ngai.

Ngai, who did not appear in court Monday, was recently moved from North Texas State Hospital to Kerrville State Hospital, Erickson said.

"Ngai has waived his right to a hearing," Erickson said. The court agreed to extend Ngai's confinement until another hearing takes place in a year's time, he said.

Because there are so many factors to consider, it is difficult for doctors to prescribe the right medications to patients such as Ngai, Erickson said. His medications are changing frequently, but Ngai has recently been "very stable," he said.

Before Ngai's arrest, there was no one responsible for monitoring him and making sure his medications were working, Erickson said. However, Kerrville State Hospital is able to monitor Ngai and his medications closely, making his recovery a possibility, he said. Read more!

Slain teen struggled with mental illness - Charlottesville (VA) Daily Progress

Boy killed by game warden was accused of threatening school

By Liesel Nowak

The 16-year-old boy who was fatally shot by a game warden last week struggled with mental illness in the past, his mother said, and was also accused of making threats at his former high school a week and a half before his death.

Four deputies came to Allen Michael Cochran’s house on Jan. 12 and took the teen to the University of Virginia Medical Center for a mental health evaluation, according to the teen’s mother, Danielle Cochran Ramirez.

The officers were acting on rumors that her son wanted to hurt himself and made threats directed toward William Monroe High School, Ramirez said. Those rumors were unfounded, she said, adding that the mental health check showed he was all right.

Twelve days later, during a roadside encounter with police, the teen was fatally shot by a game warden on U.S. 33 between Ruckersville and Stanardsville.

The sheriff’s office received a report that Cochran had kidnapped his girlfriend and threatened to kill her; a deputy and the game warden took the call.

Police have said that Game Warden Robert O. Ham III had tried to pull the girl from the car when Cochran used the vehicle he was driving to hit the officer. That’s when Ham fired on Cochran, police said.

The 15-year-old girlfriend was not injured.

Though the Jan. 12 mental health exam showed no cause for concern, according to Ramirez, Cochran had previously been diagnosed as having bipolar disorder and spent the last school year at the Ivy Creek alternative school in Albemarle County.

He returned to the Greene County school system in August for his ninth-grade year at William Monroe, his mother said, but was soon sent back to Ivy Creek after an altercation with a group of students.

About a month ago, Ramirez said she withdrew Cochran from Ivy Creek to teach him at home.

Superintendent Ray C. Dingledine III confirmed Monday that Cochran had never been

expelled from Greene County Public Schools.

The Virginia State Police, which has taken over the shooting investigation, remains tight-lipped about further evidence in the case. An agency spokesman said Monday that investigators are focusing their inquiry only into last week’s shooting, not past incidents between Cochran and law enforcement.

“We’re investigating the shooting part, and that’s what we’re taking care of,” said state police Sgt. David Cooper.

Greene County Sheriff Scott Haas said that to his knowledge, his office had only one prior encounter with Cochran before last week’s shooting. He declined to elaborate.

Ramirez said she believes the agency doesn’t respect her family.

Police would have handled things differently if a Cochran hadn’t been involved in last week’s reported kidnapping or the previous week’s alleged school threat, Ramirez said.

“They believe rumors before they actually believe the parents,” Ramirez said. “It’s so bad.”

The day of the alleged threat at William Monroe, sheriff’s officers surrounded the school in Stanardsville after receiving word that a former student had threatened to bring a gun to school.

A sheriff’s lieutenant said at the time that the threats were “just rumors” and a school board spokesman said deputies had “taken care of” the student.

A student who had overheard a former student on the previous afternoon talking about bringing a weapon to the high school reported the threat to the school’s principal.

According to Cochran’s MySpace page, which pays homage the slain rapper Tupac Shakur, the 16-year-old described himself as “a cool guy lookin for friends all tha time.”

His family buried the teen Monday afternoon at Holly Memorial Gardens.

Rob Seal contributed to this report. Read more!

Mental Health Screening: New Liberal Tool for Child-Control - Human Events Online

Affiliated with National Conservative Weekly

by Phyllis Schlafly

Mental health screening of all children is the goal of legislation introduced into many state legislatures this year. Typical of these highly controversial bills is the Missouri bill that would require every Missouri school district, in collaboration with "the office of comprehensive child mental health," to develop "a policy of incorporating social and emotional development into the district's educational program."

The Missouri bill requires schools to "address teaching and assessing social and emotional skills and protocols for responding to children with social, emotional or mental health problems." The bill also requires the Missouri state board of education to set "social and emotional development standards."

One marvels at the arrogance of government officials who think they can set children's social and emotional standards. Where on the chart would they place a child crying because he fell and skinned his knee?

Cortland County, New York, has already announced a plan to annually screen every fifth-grader and ninth-grader for mental health problems. The purpose, according to the county director of youth services, is "to raise awareness that mental health issues are in essence no different than other physical issues, such as heart disease." Apparently, you are not "aware" if you think otherwise.

The screening process, which takes 15 minutes, involves getting the kids to answer a series of yes-or-no questions, on either computer or paper. It is claimed that parental permission will be necessary, but all children of any age in foster care will automatically be screened.

Mental health screening is based on the assumption that ten percent of children suffer from a mental disorder severe enough to cause impairment, and that five percent of children have emotional or behavior difficulties that interfere with learning, friendships and family life.

Cortland County plans to refer the ten percent to the county mental health clinic or other providers for further evaluation, and it is well known that referrals often result in orders for drug therapy. The clinic will be rewarded with $50 of taxpayers' money for every child sent to the clinic.

Parents are starting to wake up to this invasion of their authority over the care and upbringing of their own children. A bill that would prohibit school personnel from making mental health recommendations or requirements for children, including the use of psychotropic medications, just passed out of a committee of the Utah legislature.

This bill would also prohibit schools from requiring a student to take psychiatric medication in order to attend school and prohibit the state from removing a child from parental custody based on a parent's refusal to consent to the administration of psychotropic medication.

A bill introduced into the Connecticut legislature is more specific. It would require that all parents who are requested by the school to have their child evaluated be first provided with a statement that the government does not recommend any particular checklist, assessment or evaluation for psychiatric or psychological disorders, plus a copy of the Protection of Pupil Rights Amendment (the federal law that requires prior written parental consent before schools can require students to submit to psychological or psychiatric testing or treatment).

Last year, Alaska enacted a law forbidding schools from conducting psychiatric or behavioral health evaluations and from requiring that a child take a psychotropic drug as a condition for attending a public school. Also last year, Arizona passed a law requiring that schools obtain written parental consent before conducting any mental health screening on any pupil and must make the actual survey questions available for inspection by parents.

Someone should notify state legislators and school districts that are contemplating mental health screening requirements that the American Psychological Association recently urged that "in most cases" of childhood mental disorders, non-drug treatment should "be considered first." This should include techniques that focus on parenting skills as well as help from teachers.

Even the American Academy of Child and Adolescent Psychiatry, an organization whose members strongly favor drug treatment, just completed new guidelines recommending that children receive talk therapy before being given drugs for the common complaint of moderate depression.

Parents should take on the responsibility of being parents, and they should beware of the psychotropic drugs that have unfortunate or even tragic side effects. Parents should help to pass pro-parent legislation before those who think the "village" should raise all children use mental health screening to label their child as nuts. Read more!

Military creates mental health hotline - AP

By KIMBERLY HEFLING

WASHINGTON -- U.S. troops who have been reluctant to seek help for mental health problems may soon be able to find it with a phone call.

A new automated phone-in assessment program is the latest effort by the military to reach out to soldiers and family members who might not otherwise seek help for post-traumatic stress or other psychological issues.

The program is similar to an anonymous mental health screening effort begun online last year. About 40,000 troops or their family members - roughly 7 percent of them in Iraq - have participated.

There's much concern among those in the military that seeking help will affect someone's career, so it's good to have more anonymous options, said Dr. Jay Weiss, a former Air Force psychiatrist in private practice in Louisiana who has treated Iraq veterans.

While seeking help via telephone and Internet is not ideal, it's "certainly better than nothing," he said.

The new efforts are extensions of counseling programs the military has implemented in recent years. Defense officials are hoping that the phone screening will attract National Guard and Reserve troops and families who are far from a military base and may not have easy access to in-person counseling or to the Internet.

The phone-in program was introduced Monday at the Military Health System annual conference in Washington. It is expected to begin taking calls by Feb. 12. The calls will be conducted in English and Spanish and will operate 24 hours a day.

"People respond in different ways. Some people will go to the Internet. Some will talk on the phone. Some people, they need someone ... who is in the same situation, the chaplain. Some people respond to religion, some will not," said Lt. Col. Bruce Farrell, full-time support chaplain for the Pennsylvania National Guard.

Participants in telephone screening are transferred to a counselor if they indicate they might be suicidal or if they wish to speak to a live person. Callers are given an immediate result from their assessment and phone numbers for treatment or educational resources.

The military already has phone-in counseling resources available, but the new program is the military's first to have automated interactive mental health screening.

Army Surgeon General Kevin Kiley testified recently on Capitol Hill that an estimated 17 percent of troops return from Iraq with post-traumatic stress disorder, severe anxiety or depression. Symptoms of PTSD include hypervigilance, irritability and nightmares.

Since the 2003 invasion of Iraq, 96 troops have committed suicide in Iraq, according to the Department of Defense. Another 15 committed suicide in Afghanistan.

Those who have participated in the assessments online in the last year have primarily filled out questionnaires on depression and alcohol abuse, said Col. Joyce Adkins, program director for the Defense Department's combat and operational stress control program. Those who participate online can print out their assessment and take it with them to see a counselor.

Although troops who have not deployed are encouraged to participate, about 60 percent who have participated in the online program have indicated they or a family member has been deployed to combat.

Like the Internet program, the phone-in system is focused on educating people about issues such as depression, alcohol abuse and post-traumatic stress disorder, Adkins said. She said the programs aim to get the word out that problems like post-traumatic stress disorder are "not a life sentence."

"PTSD and other mental health concerns are treatable," Adkins said. "You can get treatment and recover fully."

---

The toll-free number for the Telephone Self-Assessment will be (877) 877-3647.

On the Net:

Mental Health Assessment Program: https://http://www.militarymentalhealth.org/welcome.asp

Pennsylvania Dept. of Military and Veterans Affairs: http://sites.state.pa.us/PA-Exec/Military-Affairs/DMVA/ Read more!

Are Prisons Driving Prisoners Mad? - Time Magazine

Published: Friday, Jan. 26, 2007

By Jeffery Kluger

There's no such thing as a good day for a prisoner at the highest level of security within the Ohio State Penitentiary, a 504-bed supermax prison in Youngstown, Ohio. Every inmate lives alone in a 7-ft. by 14-ft. cell that resembles nothing so much as a large, concrete closet, equipped with a sink, a toilet, a desk and a molded stool and sleep platform covered by a thin mattress. The solid metal door is outfitted with strips around the sides and bottom, muffling conversation with inmates in adjacent cells. Three times a day, a tray of food is delivered and is eaten alone. The prisoner may spend 23 hours a day in lockdown, emerging to exercise once a day. The lights in the cell never go off, although they may be dimmed a bit at night.

If there's not much to like about the conditions in Youngstown, there's not much to like about the people confined there either. These are the men corrections folks like to call "the worst of the worst," the kind of felons who dealt drugs or led gangs or killed on the outside and continued to do so in prison. For them, maximum security would not be enough--only supermax would do. And say what you will about the draconian environment, it keeps them under control.

But that level of control may be counterproductive. It's possible that the very steps we're taking to keep society safe and such prisoners in check are achieving just the opposite. The U.S. holds about 2 million people under lock and key, and 20,000 of them are confined in the 31 supermaxes operated by the states and the Federal Government. That may represent only 1% of the inmate population, but it's a volatile 1%. Push any punishment too far and mental breakdown--or at least a claim of mental breakdown--is sure to follow. When that happens, a constitutional challenge can't be far behind.

In December, officials in Texas and California conceded that the suicide rates in their prisons are on the rise, with the majority occurring among inmates in solitary. This prompted an outcry against both systems. Lawyers for accused terrorist facilitator Jose Padilla challenged his fitness last month to stand trial, arguing that his 3½ years in solitary lockdown at a South Carolina military brig have rendered him unable to assist in his own defense. Around the same time, convicted bomber Eric Rudolph began corresponding with a reporter for a Colorado newspaper, describing his days in his 7-ft. by 12-ft. cell as a form of confinement "designed to inflict as much misery and pain as constitutionally permissible."

But is it constitutionally permissible? And even if it is, is this the kind of open-ended mental-health experiment the government should be running? "We have to ask ourselves why we're doing this," says psychiatrist Stuart Grassian, a former faculty member at the Harvard Medical School and a consultant in criminal cases. "These aren't a bunch of cold, controlled James Cagneys. We're taking criminals who are already unstable and driving them crazy."

The origin of solitary confinement in the U.S. is actually benign. It was the Philadelphia Quakers of the 19th century who dreamed up the idea, establishing a program at the city's Walnut Street prison under which inmates were housed in isolation in the hope of providing them with an opportunity for quiet contemplation during which they would develop insight into their crimes. That's not what has happened.

By the 1830s, evidence began to accumulate that the extended solitude was leading to emotional disintegration, certainly in higher numbers than in communal prisons. In 1890 the U.S. Supreme Court weighed in, deploring solitary confinement for the "semi-fatuous condition" in which it left prisoners. The case was narrow enough that its effect was merely to overturn a single law in a single state, but the court's distaste for the idea of solitary was clear. "The justices saw it as a form of what some people now call no-touch torture," says Alfred W. McCoy, a professor of history at the University of Wisconsin at Madison and author of the book A Question of Torture. "It sends prisoners in one of two directions: catatonia or rage."

Modern science has confirmed this, with electroencephalograms showing that after a few days in solitary, prisoners' brain waves shift toward a pattern characteristic of stupor and delirium. When sensory deprivation is added--as when Padilla was seen being led from his cell wearing a blindfold and sound-deadening earphones--the breakdown is even worse. As long ago as 1952, studies at Montreal's McGill University showed that when researchers eliminate sight, sound and, with the use of padded gloves, tactile stimulation, subjects can descend into a hallucinatory state in as little as 48 hours.

All of this is providing legal traction for constitutional lawyers. The most obvious point of attack is the Eighth Amendment's ban on cruel and unusual punishment. One suit involving prisoners in a Wisconsin supermax has led to rulings requiring that mentally ill inmates be kept out of such facilities. The state is challenging the decisions, and arguments will be heard in February, but at least six other states have fought similar suits, and all of them have failed. "So far, the prisoners are batting a thousand on the issue of mentally ill inmates," says David Fathi, a senior staff counsel with the A.C.L.U.

Another approach--one that's a bit of a constitutional bank shot--is to rely on the 14th Amendment's requirement of a due-process hearing before the state denies an inmate a "liberty interest," something courts define as a reasonable expectation of a freedom or right. People confined to prison have few liberty interests left and thus have little ground to challenge assignment to a strict level of security. Confinement to supermax, however, may be so qualitatively different that it does require a hearing. That's the argument Ohio inmates made in 2005, and that's the argument a unanimous Supreme Court bought, with Justice Anthony Kennedy writing that supermax isolation imposes such an "atypical and significant hardship" that prisoners must have a formal opportunity to make their case against the assignment before prison officials decide.

The eventual ruling on Padilla's fitness could liberalize things further, and similar suits are sure to follow. Even so, no one thinks the supermax system is going away soon. For all the debate the prisons generate, it may not take much to make them more palatable to civil libertarians. TVs or radios, reading material and clocks, as well as a bit of natural lighting--which provides critical time-of-day orientation--would help stabilize inmates. So would human contact with guards or other prisoners.

"Just how sterile do you have to make that cell?" asks retired prison expert Chase Riveland, who spent his career as an official in the Colorado, Wisconsin and Washington prison systems.

What's more, inmates aren't the only ones hurt by extreme incarceration. People like Padilla or the Guantánamo Bay detainees are, in theory, resources for information about the extremist groups with which they are putatively associated. "To an overwhelming degree, such people are not threats behind bars. They're opportunities," says Grassian. "We hurt ourselves by destroying their sanity." Closer to home, prisoners serving sentences for more mundane crimes do sometimes get released. Demolish their psyches while they're in prison, and nobody's safer when they get out.

Part of the reason we build prisons at all has always been the retributive urge. Those who do very bad things while they walk among us should lead very hard lives after they have been removed. That makes a lot of emotional sense. Whether it always makes practical sense is something else entirely. Read more!

Pennsylvania hospital losing mental patients - The Intelligencer (PA)

By JENNA PORTNOY

HATFIELD - As Linda Drakas looked around her Hatfield apartment, still decorated for Christmas, she rattled off things she never expected to have: a job as a prep cook at T.G.I.Fridays, a Walkman blasting her favorite INXS tunes, and most of all, freedom.

Six years ago she lived at the state psychiatric hospital in Norristown where someone else made all her decisions.

“People who live in institutions like I did don't want a life like that,” the 36-year-old said. “They want to go out and do something with their lives.”

That people like Drakas are better off living independently with support is not a matter of debate.

But with the last remaining state hospital serving the five-county region set to phase out 70 percent of its patients over the next four years, counties fear the state will not provide enough funding to care for mentally ill patients living in the community.

In Bucks, which has historically ranked among counties receiving the lowest amount of mental health dollars, the situation could tax the courts, burden an already overcrowded jail and lead to more homelessness.

“It could disrupt the whole system,” said Phil Fenster, who runs Bucks' mental health and mental retardation division.

Phasing longtime mentally ill patients out of institutions and into the community is not a new idea. As early as the 1960s, federal and state governments recognized what advocates already knew: “Sharing a room with 40 people is not a dream for most adults,” said Nancy Wieman, deputy administrator for mental health services in Montgomery County.

Then came a 1999 Supreme Court ruling that said under the Americans with Disabilities Act public agencies must provide services “in the most integrated setting appropriate to the needs of qualified individuals with disabilities.”

State hospitals were slowly replaced with community services, such as group homes, semi-independent residences and outpatient programs.

Although the five southeastern Pennsylvania counties closed 634 beds between 1993 and 2006, advocates argued the state was not moving fast enough to set up community programs and therefore in violation of the ADA's “integration mandate.”

Enter Robert Meek, an attorney with the Disabilities Law Project of Philadelphia. In 2000, he filed a class-action suit on behalf of patients at Norristown State Hospital.

Six years and many appeals later, a settlement was reached in which Norristown State Hospital agreed to phase out patients living at the hospital for more than two years. That works out to about 210 of 304 individuals, most diagnosed with schizophrenia, in the civil section over four years. The forensic section, for people accused of crimes, will be unaffected.

According to the September 2006 agreement, all five counties must present to the state a plan to provide community services for 30 people in each of the first and second years, 60 in the third year and 90 in the fourth year.

“It's hard to do a huge number in one fell swoop,” Meek said. “This is a fairly modest number. It gives the counties time to create the infrastructure they need.”

The first step is deciding which patients need what services.

Aiden Altenor, director of hospital operations for the state Department of Public Welfare, said doctors, families and advocates will put together plans for all mentally ill individuals depending on their goals and abilities.


“I'm trying to dispel the myth that people have to get ready,” Altenor said. “They are as ready as they'll ever be.”

The state will funnel funds formerly used to house patients at the hospital to counties, which will in turn pay community providers for support services. Once outside the hospital, most will also be eligible for Medicaid.

“Their recovery is enhanced and facilitated in the community where people can go to the movies, live in a decent place, go to school, go to work, have a date on the weekends,” Altenor said. “The kinds of things you and I enjoy.”

Weiman, of Montgomery County, which had 86 patients at the hospital as of last week, is confident the state will provide the money to care for people in the community.

“We're going to have the funds to grow the service,” she said.

Bucks' Fenster is less certain.

“For us the issue really is just getting the money to close "x' number of beds down,” he said, “but that's not going to help our total situation because our infrastructure is so poor.”

Inadequate public funding for Bucks' mental health needs dates back to the 1970s when poorer communities in the lower section of the county may have been lumped together with Philadelphia, giving the city a portion of Bucks' share, Fenster said.

State lawmakers took aim at the problem by commissioning a study that found Bucks received the fifth lowest allocation of mental health dollars — about $13 million — in fiscal year 2005, he said.

Bucks Commissioners Charley Martin and Sandy Miller said they will lobby Harrisburg for more equitable funding, especially in light of developments at the state hospital.

Harris Gubernick, director of the Bucks County Department of Corrections, is worried individuals living outside the hospital could come into contact with police.

“There is a concern as with generally mentally ill people,” he said, “where they are no longer compliant with treatment, they could end up acting out and end up in prison.”

At bail-reduction hearings, Bucks County President Judge David Heckler routinely encounters people in need of mental health services, yet there can be long waiting periods for treatment.

“The dumbest way to deal with these people is to have them in the criminal justice system,” he said.

Even with all the problems closing beds at state hospital causes, advocates insist it's the right thing to do.

Carol Caruso, executive director of the Montgomery County chapter of the National Alliance on Mental Illness, emphasized the need for alternative residential care services, but remained positive.

“It's a great opportunity to return people to the community so they can lead full lives just like anyone else,” she said.

Still, the most powerful argument for de-institutionalization combined with services is people like Drakas, who was diagnosed with a form of schizophrenia.

When she first left Norristown, a counselor visited her often to help with dishes, laundry and other aspects of self-sufficiency. But nowadays, Drakas sees her therapist on an outpatient basis once a month.

“Medicine helps,” she said, “but you have to give the person a chance. Someone reached out and I grabbed it and took off.”

Jenna Portnoy can be reached at (215) 345-3060 or jportnoy@phillyBurbs.com. Read more!

Abolish mental institutions - Atlanta Journal-Constitution

Tragedies show it's time to use other methods

By Tom Seegmueller, Eric E. Jacobson
For the Journal-Constitution

Why would an 11 year-old with an initial diagnosis of autism be placed in an institution? Why did young Sarah's family feel institutionalization was their only choice?

The story of Sarah Crider, the first in an occasional series of articles by AJC reporters Alan Judd and Andy Miller, combined with the impact of several subsequent investigative reports about conditions in state hospitals, revealed extremes of unhealthy neglect, misdiagnosis, criminal acts and lethal outcomes that characterize a system that places Georgia in the bottom ranks of state mental health services.


Study after study proves people living in communities have better quality of life than those placed in institutions. Yet when families feel desperate, and alternatives for community supports and services are virtually nonexistent, they are too often forced to give in to the only option they have, to subject loved ones to the hazardous reality of an antiquated state hospital system. These facilities are centers of segregation, isolation and neglect.

All people, especially our most vulnerable children and adults, need and deserve places to belong, stable homes, loving families and communities where people can thrive. Institutions are not substitutes for safe places. Sarah's is a classic example of what goes wrong when children are separated from the caring, watchful eyes of loved ones. She never should have been living in Georgia Regional Hospital in the first place.

The reporters revealed problems that have continued for many years.

Simply, people should not live in institutions. The United States Supreme Court ruled against the state of Georgia in 1999 and said that the Americans with Disabilities Act gave individuals the right to leave institutions and live in the community. Ten states have already closed their state-run institutions, and Georgia should follow their lead.

While Judd and Miller uncover disturbing, even frightening conditions, the Governor's Council on Developmental Disabilities cautions lawmakers not to merely react by throwing money at the problem by allocating more funds for state hospitals. We need to focus on building and improving the community—-based infrastructure and ensuring that direct support professionals in the community are paid a livable wage and receive the necessary training and support.

Community-based services not only save the state money, they save lives and go a very long way in preventing the abuses enumerated in the AJC reports.

GCDD and members of the Children's Freedom Initiative, a coalition of advocacy organizations, agency representatives and children's advocates, are working to move children out of state hospitals. The Children's Freedom Initiative promotes increased resources for families to care for loved ones at home. Such resources could have made all the difference in young Sarah's life.

We support DHR Commissioner B.J. Walker's focus on building and balancing "a whole system of care." A balanced system of care would prevent children from living in institutions. It would bring children and adults with developmental disabilities home to care that is appropriate for them; buoyed with support based on properly diagnosed needs and monitored by professionals, family and friends.

When Georgia's citizens and their elected officials are given the facts and truly understand that there are responsible alternatives to institutions —- indeed healthy, secure and cost-effective alternatives —- positive, lifesaving change can occur. The media help when they shed light on the benefits of fully funded community-based services and supports that provide resources for individuals to stay in their communities and make it possible for families to stay together.

We fear there are far too many Sarah Criders in Georgia. We —- Georgia citizens, legislators, family advocates and the media —- must make it clear we want to move all individuals with developmental disabilities out and keep them out of institutions entirely.

Tom Seegmueller (left) is the chairman and Eric E. Jacobson is the executive director of the Governor's Council on Developmental Disabilities.

Read more!

The stigma of childhood mental illness - Plattsburgh (NY) Press Republican

By: Jeff Meyers

PLATTSBURGH — The noise and lights in Kmart set off Tami Mousseau's symptoms.

The 4-year-old fought and struggled in the seat of the shopping cart in the checkout line, so her mother, Brenda, hurried on ahead of her husband, Larry, to get Tami out of the store.

Their daughter, now 12, suffers from mental illnesses including attention-deficit/hyperactivity and obsessive-compulsive disorders.

But other shoppers only saw a child having a temper tantrum.

"'Oh, my God,'" Larry remembered hearing one woman say, "'that lady can't even control her child.'

"This is the stigma that's behind mental illness," the Plattsburgh man said in a recent interview.

STIGMA HURTS
The 2001 U.S. Surgeon General's National Action Agenda on Children's Mental Health blames stigma in great degree for the fact that only 1 in 5 children with mental illness get appropriate treatment and that health-insurance coverage for brain disorders has fallen far short of that provided for physical ailments.

Stigma, in large part, is the reason there is no system by which to track suicides in the North Country. Shame and embarrassment prevent open acknowledgement that a loved one's mental illness proved fatal. Death certificates often report the physical cause of death, not that it was suicide, and available numbers, officials say, under report its incidence.

"We have to know what we're dealing with," said Clinton County Community Services Director Sherrie Gillette, who intends creating a system to collect that data. "We need a really good plan."

A PHYSICAL COMPONENT
Education is the key to reducing the stigma surrounding mental illness, experts believe.

"Until we can start talking about mental health on the same level as heart disease and blood pressure, there will be a stigma associated with mental illness," said Bonnie Black of Behavioral Health North.

Her agency works regularly with children through education and outreach projects to strengthen the understanding of emotional disorders.

General perspective says "it's not like having the measles or having kidney problems," said Harry Cook, director of Behavioral Health Services North. "If you happen to have behavioral or mental-health problems, there is still some negative social views of those conditions."

Think about how people use the simple phrase "Are you nuts?" to emphasize disbelief, he said.

"But the more we understand of mental-health problems, the more we recognize that there is a very physical component to mental health. Both mental and physical issues need to be addressed together."

VIOLENCE NOT THE NORM
Another area where officials hope to make improvements is in the media and how people with mental illness are portrayed in movies and on television, in fiction and on the daily news.

"If you look at the high-profile cases, it is often a mental illness that is put at the forefront," said Ilene LeShinsky, clinic coordinator for the Clinton County Mental Health Clinic.

"But the view that people with mental illness are always violent is so misguided. The majority of people (with mental illness) are not violent at all. But they are often lost behind the media reports."

Perhaps it's because the general population does not realize how prevalent mental illness is in today's world. The Clinton County clinic, for instance, has more than 600 admissions a year and works with between 200 and 500 open cases at any time.

Most of those clients lead otherwise normal lives, some with the support of medications, others relying on therapy to help them through difficult times.

EXTRA LAYER OF BLAME
But for many — children, in particular — the stigma of brain disorders weighs heavily on their daily activities.

"They often feel failed, somehow, like they're weak and should be stronger," Gillette said. "If they're not able to cope with this, then it can put an added burden on their recovery."

Many of the disorders that professionals work with are biologically based, though society often looks at the person's actions or behaviors as a reason for the mental illness.

"That adds an extra layer (of blame), not only on the child but on the parent, who looks at his own 'self' as the cause of the illness," LeShinsky said.

Kelly Jarrard of Saranac recalls how shocked she was when, reading her daughter's mental-health records, she came across a doctor's notation saying he thought the girl's mother was misreading her symptoms.

The mother, he wrote, seemed to be very outgoing and perhaps what she thought was depression was actually a child who was more introverted.

"That shouldn't be there," said Jarrard. "First of all, he was wrong.

"Second, (because of such attitudes) parents in general don't get help soon enough.

"They doubt themselves, ask, 'What have I done wrong?'"

IMPROVING VIEW
While officials are concerned with the frequent news reports of violence by a person with mental illness — disproportionate, they say, to the far greater majority of individuals who lead perfectly normal lives — they do rely on the media to generate awareness with a more educational slant.

"I think there has been great improvement (along those lines)," LeShinsky said. "The Press (Republican) has done a wonderful job representing mental illness. That's helped people come forward, helped lessen stigma in the community."

And that helps influence people to come forward for treatment.

"When there's greater awareness, there's more acceptance," Gillette said. "More and more people are seeking services, and in that respect we are making progress."

The bottom line, experts believe, is that people need to change their perspective of what mental illness truly is. With a stronger understanding, the stigma that disrupts the daily activities of those people trying to live normal lives can be limited.

Mousseau heartily agrees.

When, in Kmart, he overheard the comment that blamed parenting for Tami's behavior, he didn't stay silent.

"She's a special-needs child," he told the woman.

"You're almost crusaders," he said of the role he and Brenda have taken on ever since. "You have to help change the system and help educate people."

"We've got to change the way we perceive things," Black said. "When you say something like, 'You're crazy,' think about what that really means to somebody who is struggling with the stigma of mental illness every day."

— Staff Writer Suzanne Moore contributed to this story.

MIND MAZE

This is the second of a seven-part series on children's mental illness.

Tomorrow: Navigating the treatment maze. Read more!

UM training focuses on addictions, mental illness - Missoula (MT) Missoulian

By TRISTAN SCOTT of the Missoulian

The University of Montana has unveiled its first batch of online training courses for state probation and parole officers who work with chemically dependent and mentally ill offenders.

Timothy Conley, the assistant professor of social work who designed the program, said the online training will fuse an academic understanding of addiction and mental illness with the daily, real-life interactions a probation officer experiences.

“Knowledge is power, and to increase a person's knowledge is to increase their power,” Conley said. “The power to do what? To change the lives of people who are on parole and probation, the majority of whom are addicted or mentally ill.”

In order to meet the demands of a population of offenders increasingly defined by mental illness and substance abuse - Conley said 48 percent of offenders in Montana's prerelease centers have mental illness, while 93 percent struggle with substance abuse - the state Department of Corrections hired UM to engineer an online training program to assist its officers in dealing with such complex cases.

“We need to bridge the gap between the research tanks and the probation and parole officers on the street,” Conley said. “They should know more about the drugs than the people abusing them.”

On Monday, at least 80 probation and parole officers across Montana will log on to a four-hour Web-based training module that addresses chemical dependency.

“We're going live,” Conley said. “We're still a little nervous. This is kind of cutting edge.”

Conley, a leading addiction specialist in Montana, said hundreds of millions of dollars are spent researching addiction and mental illness at an academic level.

“But in that final step, where you're translating the contemporary knowledge and getting it to the people who work in the field every day, that's where it most often breaks down,” Conley said.

The training consists of 16 related one-hour modules, and is designed so officers can participate one hour per day, four days per week, for four consecutive weeks. The final course sections will address diversity and sexually violent offenders.

The new curriculum will cost the state between $102,000 and $118,000, Conley said, depending on how many employees ultimately log on to the courses.

The training is offered through UM's Continuing Education Department, which offers a variety of online courses.

Conley said he expects the project will save taxpayer dollars because officers won't have to travel to distant cities and stay in hotels for training, as they did previously.

“I'm not trying to train parole and probation officers to be counselors and therapists,” he said. “I'm simply trying to get them to understand the language of counselors and therapists.”

Reporter Tristan Scott can be reached at 523-5264 or at tscott@missoulian.com Read more!

Ground broken for addition to Colorado hospital for criminally insane - AP

BY THE ASSOCIATED PRESS

PUEBLO - Ground was broken for a new $50 million high-security complex for the criminally insane at the Colorado Mental Health Institute.

The 200-bed Institute for Forensic Psychiatry has been in the work for years. Construction is scheduled to start soon and should be completed next winter.

"The weather isn't the best, but I'll tell you, it's one of the most beautiful days in Pueblo," Bob Jackson, chairman of the hospital's community advisory group, said during a groundbreaking ceremony Saturday.

State Sen. Abel Tapia, D-Pueblo, told the crowd that construction of the building has been a long time coming.

"This the fourth iteration to get this building financed," Tapia said.

He said the 2005 voter-approved relaxation of state spending and taxing limits helped the cause.

The project has had false starts in the past. At one time, construction was set to start in 2001.

H.W. Houston Construction Co. of Pueblo won the contract to build the new forensic unit.

Plans for the new unit got under way after an advocacy group sued in 1999 over the suicides of four patients in the existing maximum-security forensic unit, where the most violent and aggressive patients are housed.

The hospital ran into legal troubles last month. The Legislature's Joint Budget Committee approved $1.6 million in emergency funding for more staff after special prosecutors threatened to seek a contempt citation against the hospital's director and the head of the state Department of Human Services, saying they ignored court orders to admit mentally ill inmates.

Hospital officials said they were under court orders to reduce the number of patients.
Read more!

Mental health needs weighed - Fayetteville Observer

By John Fuquay, Staff writer

RALEIGH — A recent mental health report says North Carolina is so woefully inadequate at providing services that it cannot catch up under its current format and needs more than $500million yearly for the next five years.

“It shows what a lousy job we’re doing,” state Rep. Rick Glazier, a Fayetteville Democrat, said of the 172-page report.

North Carolina ranks 43rd in per capita spending on mental health, and state House and Senate leaders have said the issue will be a funding priority in the 2007 session, which opened last week.

But will lawmakers commit $500 million for the next five years?

“That’s a lot of money,” said Senate Majority Leader Tony Rand. “There are a lot of competing interests.”

The long-range plan for the state Division of Mental Health, Developmental Disabilities and Substance Abuse Services was released last month and paints a grim picture. A $2.7 billion increase is recommended over the next five years to meet the needs of the children and adults who need the division’s services.

The hefty sum accounts for population growth and inflation. The report suggests the state could reduce the figure by more aggressively pursuing Medicaid entitlements and charging non-Medicaid clients on an ability-to-pay fee schedule.

But the report concludes that such changes are unlikely.

PUBLIC FORUM

The Cumberland County Mental Health Center and the county affiliate of the National Alliance on Mental Illness will hold a public forum on mental health services from 6 to 7:30 p.m. Monday, Jan. 29 at the Child and Family Mental Health Services Building in Fayetteville, 711 Executive Place. For more information, call (910) 222-6108.
“The N.C. (mental health) system does not currently have a culture nor has it the capacity that lends itself to maximization of resources and services to assure the most benefit is provided for eligible persons,” the report states.

It criticizes the mental health system for lacking consistent and coherent service plans, inadequate coordination of care and benefits, too great a reliance on costly hospital and institutional care, and inadequate screening and monitoring, among other deficiencies.

“Mental health is a train wreck waiting to happen,” Glazier said. “We are even past the point where we’re Band-Aiding. Our approach has been ill-timed, poorly managed, disjointed, and our resources have been fragmented.”

Cumberland problems
Bob Arnold, president of the Fayetteville affiliate of the National Alliance on Mental Illness, said he has seen examples of disjointed service in Cumberland County, which lags behind the state average in per capita funding for mental health. He said jails often house mentally disabled inmates and don’t take steps to alert mental health authorities.

“The Mental Health Center and the Sheriff’s Office, they’re all county employees,” he said. “If somebody comes in the jail, and they’re schizophrenic, they’re not eating or they’re crying, you obviously don’t need a medical degree to see something’s wrong. That’s a problem. They need better communication.”

North Carolina spends $50.26 on annual per capita mental health services, compared with an average of $91.12 for all 50 states and the District of Columbia.

State spending includes county, state, Medicaid and miscellaneous funding totaling about $2 billion. The state pays about $657 million, and Medicaid pays most of the rest.

About 337,000 residents across the state use mental health, developmental disabilities and substance abuse services.


Of the state funding, the Cumberland County Mental Health Center — one of 30 such centers around the state — received $29.03 per person last year, which was below the state average of $37.20 per person. The county will get more money this year, but the population is growing.

“Cumberland County has always been low,” said state Rep. Margaret Dickson, a Fayetteville Democrat.

Part of the reason is a decades-old decision by county leaders to minimize local spending for mental health. The local money was used in a formula to determine how much the county would get from the state.

“It has stayed low, and that hurts us especially,” Dickson said. “When our military service people are deployed, that has an impact on their families and their children.”

Budget surplus
Lawmakers have a budget surplus of almost $300 million but have been hit with spending requests of more than $12 billion. Obviously, the majority of requests will go unfunded.

“We’re just now getting into that,” Rand said. “We’re talking about mental health reform and how we’re going to go about it.”

Glazier and other lawmakers from Cumberland County plan to meet Monday with Health and Human Services Secretary Carmen Hooker Odom to discuss a new funding formula. However, a new formula likely won’t be devised this session.

Staff writer John Fuquay can be reached at fuquayj@fayobserver.com or (919) 828-7641. Read more!

Dix Hill land rush is on - Fayetteville Observer

Editorial: Originally published on Friday, January 26, 2007

Our View: Mentally ill may be lost in the stampede to develop Dix Hill.

For some in Raleigh, mental health reform has already served its purpose — by committing the state to liberating more than 300 acres of prime real estate atop Dix Hill.

Dorothea Dix would not be among the celebrants. Nor would the Fayetteville lawmaker without whom her dream of providing institutional care for the severely mentally ill in North Carolina would not have been realized.

Today, the debate is a familiar one that pits developers, who want no more green space than their site plans require, against preservationists demanding more than a postage-stamp park to break the structural monotony.

In 1848, it was also about money — public funds to get the mentally ill out of the jails and out of the ranks of the homeless who wandered the streets. It was about an appealing coincidence of cost-effectiveness and compassion.

Dix’s bill, sponsored by Rep. John Ellis of Rowan County, had languished in the General Assembly and was thought to be a lost cause until Dix befriended the ailing wife of Fayetteville’s James Cochran Dobbin. Her deathbed plea sent her husband back to the House floor to make an impassioned case for what is now Dorothea Dix Hospital.

Then, as now, the legislature first fielded a commission to give it advice.

In 1848, lawmakers knew what to do but couldn’t seem to find the money until Dobbin went to work.

Today’s commission has presented some interesting ideas regarding recreation as well as revenue, but is awaiting a champion to step forward and offer the bill that explains how it can be done.

The landscape of 21st-century Dix Hill remains unsettled, although cynics will already have awarded this contest to the contestants with the deepest pockets.

Either way, the hospital will be gone.

That in itself may be no great tragedy, although it is misleading to imply that all of the structures on Dix Hill date to the mid-19th century. If, however, the end result of all this reform is that agencies at the local level are overwhelmed and sick people go back to the streets and jails while more fortunate North Carolinians quibble over the division of spoils, the state will have done more than rob Dobbin and Dix of their dream. It will have sacrificed on the altar of profit something that has worked, imperfectly but reliably, for generations of patients and taxpayers. Read more!

WNC lawmakers set priorities as session begins - Asheville Citizen-Times

Mental health reform one challenges faced

Sen. Martin Nesbitt, D-Buncombe, and Sen. John Snow, D-Cherokee, barely got back to Raleigh before they filed a bill to change how school construction money generated from lottery revenues is distributed. It’s Senate Bill No. 2.


The change would remedy a funding scheme that deprives every county in Western North Carolina of its fair portion of the revenue generated by the lottery. Under the formula for sharing lottery profits earmarked for education, 40 percent are allocated for school construction. But the money is not handed out evenly among the state’s school districts.

Of the money for construction, 65 percent is allocated based on the number of students in the district. The rest goes to counties where residents pay higher-than-average property taxes. No county in the Western region meets the higher-than-average property taxes criteria.

Local lawmakers have vowed to do all they can to change the formula, and Nesbitt and Snow didn’t waste any time making their intentions clear. Good for them..

Challenges ahead

State lawmakers who returned to Raleigh last week face a host of critical decisions about how to allocate revenues among competing priorities, including school construction.

School construction needs are estimated to be about $9.7 billion. Lawmakers sold the lottery as a way of funding school construction costs, but unfortunately, there’s a $75 million difference between projected lottery proceeds and the actual amount generated. Whatever amount the lottery raises, every county should get its fair share.

Possible shortfall

The challenge lawmakers confront may be made more difficult by a $500 million to $1 billion budget shortfall projected by government watchdog agencies. A healthy surplus is expected at the end of the current fiscal year, but two taxes scheduled to sunset may produce a shortfall in 2007-2008.

A one-fourth cent sales tax added in 2001 to see the state through a budget crisis will sunset on July 1 unless it is renewed, and an additional tax on the state’s highest earners is set to end at the beginning of January 2008.

Given the number of needs facing North Carolina, this may not be the time to sunset those taxes.

One thing is certain, it’s critical that lawmakers not simply use this year’s surplus to plug needs that require a recurring source of revenue. But the temptation will be great. Here’s a partial list of the challenges they face:

* Counties want the state to remove from them the requirement of paying 5.5 percent of Medicaid costs. Asking counties to help fund Medicaid is unfair, as they have no control over what Medicaid programs the state offers. For some poor counties, the costs overwhelm their budget. The cost to the state would be about half a billion dollars a year. One option would be for the state to take back Medicaid costs and also take back one-half cent of sales tax revenue that now goes to counties.

* Counties also want more money for school construction. By relieving counties of paying Medicaid costs, a substantial amount of county money would be freed, some of which could be devoted to school construction.

* A consultant told a legislative oversight committee that the mental health care system needs $2.7 billion over the next five years, though lawmakers have already signaled they view that amount as beyond the state’s means. That may be, but the need for crisis intervention centers and other services is critical and lawmakers must do something to remedy the system’s inadequacies.

* Land for Tomorrow, a statewide partnership of conservationists, farmers, business leaders, local governments, health professionals and community groups, hopes to persuade the General Assembly to provide $1 billion over five years to protect the state’s land, water, and special places before they are lost to rapid growth. One way of funding the land conservation effort would be through a statewide bond issue.

* Other prospective bond proposals include roads and water and sewer.

A statement of values

While some savings may be found in the budget, it would seem that lawmakers face three options – raise taxes or retain those about to sunset, incur bonded indebtedness or refuse to fund some or all of these needs. The challenge will be finding the right mix.

As they weigh the consequences and benefits of various requests, it will be important for lawmakers to keep in mind that the budget they ultimately craft will be a statement about what North Carolina truly values and how far-sighted its leaders are.
Read more!

Asheville shifts funds to transit, housing, mental health - Asheville Citizen-Times

by By Joel Burgess, JBURGESS@CITIZEN-TIMES.COM

ASHEVILLE - The city has reallocated $446,000 in federal funds to four projects tied to affordable housing, mental health and public transit.

The money, composed of a Community Development Block Grant, comes from affordable housing projects that were being done by Neighborhood Housing Services. The local nonprofit recently quit the business of home building and restructured to concentrate on loans to low-income homebuyers.

The new projects approved by Asheville City Council are:

$200,000 to NHS for loans to low-income home buyers.
Up to $120,000 to the Affordable Housing Coalition to aid families evicted from the McCormick Heights housing complex.
$86,000 to Buncombe County for a mental health crisis stabilization center at 277 Biltmore Ave.
$40,000 to install benches at about 30 city bus stops.
Asheville City Council voted 5-1 this week to reallocate the CDBG funds.

Voting yes were Vice Mayor Holly Jones and council members Brownie Newman, Bryan Freeborn, Jan Davis and Robin Cape. Councilman Carl Mumpower voted no.

Mayor Terry Bellamy did not vote because Mountain Housing Opportunities, the nonprofit for which she works as marketing director, may be involved in some of the projects.

NHS said government regulations and rising land and construction costs made its program of building affordable homes nearly impossible. Since then, the city has adjusted its affordable home building loan program, raising the allowed selling prices on houses and apartments.

The projects NHS were doing included scattered site housing and developments on Bradley Street and Brotherton Avenue. Read more!

Youth suicides soar in wake of Ecuador's exodus - LA Times

The emigration of residents seeking better pay has left children lacking one or both parents -- and prone to killing themselves.

By Chris Kraul,Times Staff Writer

GIRON, ECUADOR — His seventh-grade teacher was discussing family values last month when Jaime Castillo startled his classmates by bursting into tears. They knew that the 13-year-old hadn't seen his father since he left for the United States three years ago and that he was depressed about it, but he wasn't the kind of child to cry in public.

The next day, his friends' surprise turned to shock when they learned he had gone home and swallowed a packet of rat poison. Only quick action by his mother and doctors at a clinic saved his life.


"His mother takes good care of him, but his father is in another part of the world," said friend Jose Abel Avila, 14, who also lives in this town surrounded by lush, steep mountains that bring to mind Switzerland in the summertime. "He sends money, but it can't take the place of affection."

The southern province of Azuay has sent more emigrants to the United States and Europe than any other region in Ecuador. The exodus of young fathers, and lately mothers, has had devastating consequences for the youths they leave behind.



Profit and loss

A sharp increase in adolescent suicides as well as teenage pregnancies, alcoholism, car wrecks and declining school performance represent the dark side of Ecuador's migration phenomenon. Although the flight of as many as 20% of its citizens over the last few decades has created an economic windfall totaling $2 billion a year in remittances, the social costs have been high.

"Fifteen years ago, youth suicides were unheard of," said Guido Pinos, a psychiatry professor at the university in Cuenca, the provincial capital. "Now they have become a kind of fashion, or what we in psychiatry term a 'model,' to follow to escape from conflict, from being uncared for or feeling abandoned."

Pinos said that in 2006, youth suicides in Azuay rose 20% from the previous year, and he estimated that the province's overall suicide rate was at least twice the world average of about 12 per 100,000. In towns such as Giron and neighboring Santa Isabel, which have seen an exodus of men, the rate is eight times the global norm as calculated by the World Health Organization, health officials say.

"Sixty percent of adult males have left this municipality. As a result, families fall apart," said Claudia Romero, a social worker in Santa Isabel. Suicides in her town last year included those of a 10-year-old boy and a 9-year-old girl, she said.

Miguel Penafiel, director of Vicente Corral Moscoso Hospital in Cuenca, said that although other countries with a pattern of emigration to the United States and Europe also see suicides, he thinks Ecuador's rate is higher because social disintegration is more pronounced here.

"There are many destroyed families here, as many as 20% in some towns, by which I mean you have children living without either parent," Penafiel said.

Elizabeth Jimenez, a psychologist with the Waaponi Foundation of Cuenca, a youth counseling group, said suicides might be high because Ecuador is one of the world's "saddest countries."

"When people get depressed in the country, they listen to sad music and consume alcohol. It's a lamentable social characteristic," she said.

The suicides cut across class lines, affecting children who receive significant amounts of money from their absent parents and those who do not. Affluence is evident here in Azuay, which receives an estimated $800 million a year in remittances from its native sons and daughters and has a profusion of nice cars and two-story houses.

"Despite the resources they may be getting from their parents, the youths are missing someone and something," said Jose Manuel Usca, a Roman Catholic priest in Giron. "They don't think it makes sense to fight for their future and … they don't value what they have. Going where their parents are is all that matters."



'A lack of values'

School officials such as Maria Villa Sanchez, principal of the town's National Technical High School, are struggling to cope. Over the last year, she said, three of her 407 students, all 15-year-old boys, attempted suicide. She acknowledges she is at a loss.

"What you see in the kids is a lack of values. They talk to teachers with an aggressivity you never heard before," Villa Sanchez said, adding that 60% of her students have one or both parents living abroad. "I have asked for a team of psychologists, for more teacher training. The problem is that the parents are far away, and those who are left behind have to deal with the consequences."

The surge in suicides coincides with an explosion in Ecuadorean emigration that began more than seven years ago after a financial crisis caused bank failures, widespread unemployment and poverty. Although Ecuadoreans have left the country in a steady stream since World War II, the 1999 crisis pushed unprecedented numbers to seek better lives abroad.

The crisis and its aftermath have also sent an increasing number of mothers abroad, so more children are being left with grandparents, aunts or neighbors who often offer little emotional support, discipline or understanding, said Maria Caridad Pena, a psychologist with the Esquel Foundation of Quito, which is developing programs to help troubled youths.

"Sometimes the caretakers are doing it for the money the parents pay them, not for the children. So the youths are confused and suffer low self-esteem for the lack of attention and of being listened to," Pena said. "This is what leads to suicide, the lack of a family connection that permits emotional support."

Doris Valdivieso was a popular 16-year-old in Santa Isabel when her mother left in the middle of the night for the United States, leaving her with her alcoholic father. She swallowed a fungicide and died in 2005, one of 17 adolescent suicides in the town of 17,000 people that year.

"She left a note saying that she felt abandoned," said her friend Maura Mendietta. "She took a poison that acts very fast, so there was nothing anyone could do."

It is not uncommon for children to lose all contact with their parents, either because the adults start new lives and families or because they die during the often perilous journey.



Seeking solutions

Local governments and school officials are coming to grips with the severity of the problem. The University of Cuenca is developing a program, already partially implemented, to better monitor youths at risk, train teachers to recognize depression, and make psychological help available at schools, said Lorena Escudero, a sociologist at the university.

But the real key may simply lie in getting through to youths who have been shunted from caretaker to caretaker, to tell them that they and their emotions matter, said Eugenio Cordoba, director of a town-sponsored program called Our Roots in Santa Isabel. Under the program, he and two other teachers drove to a dozen remote hamlets each week to give nearly 500 Santa Isabel youths lessons in dance and music. The outreach program was suspended in September for lack of funds.

"The lessons worked. At least none of our kids attempted suicide," Cordoba said. "It's all about helping these kids occupy their time and in some cases keeping them healthy. We are also seeing cases of malnutrition among children left with caretakers who abuse the money the parents send them."

A Cuenca public schools program encourages children to express their feelings about emigration through essays and murals they paint on school walls. A creation at Jose Rafael Arizaga elementary school illustrates the fear and anger that emigration instills in the children: One panel shows skulls and dollar bills against a black background. Another depicts a shark devouring migrants lost at sea.

"It means migration is no good because they go for money but they find death instead," sixth-grader Silvia Guartembel said.

With tens of thousands of Ecuadoreans migrating each year, few people expect the root causes of the problems facing youths here to be solved any time soon.

"Social programs are being developed, but it won't get better overnight," said Romero, the Santa Isabel social worker. "The phenomenon of migration continues to be a necessity for some people, so the consequences aren't going to go away."

chris.kraul@latimes.com
Read more!

Childhood mental illness: Not a phase - Plattsburgh (NY) Press Rebulican

EDITOR'S NOTE: This is the first of a seven-part series on children's mental illness.
Tomorrow: The stifling effect of stigma.

By: Suzanne Moore, Staff Writer

PLATTSBURGH — Gabrielle Palmer stopped talking to her parents, became withdrawn, morose.

"At first, we passed it off as a phase," said the teen's mother, Amy. "We thought it was normal 13-, 14-year-old stuff."

It wasn't.

SUFFERING IN SILENCE
"We were fighting a lot," Gabrielle said of her parents. "I kinda hated them."

And an uncle had died.

She was deeply depressed. For a while, off and on, she had been self-injuring. Now, that behavior became her coping mechanism. She would cut her arms with a razor then hide the wounds under long sleeves.

The physical pain, for the moment anyhow, helped her deal with her emotions.

"You need to be able to feel something in order to learn something and get past it," said Gabrielle, who's 14 now.

A friend's mother alerted the Palmers to the situation.

"She was blunt enough to say, 'You'd better do something,'" Amy said.

YOUNGER, MORE ILL
That's an awareness, on a grander scale, that has come also to Clinton, Essex and Franklin counties.

"More and more, it seems like families are in crisis," said Kathy Fadden, program director for Franklin County Mental Health Association.

Studies show a higher incidence of emotional disorders, self-inflicted injury and suicides among North Country youths than elsewhere in New York state.

"And for every suicide (it's estimated) there are 25 attempts," said Marguerite Adelman, executive director of National Alliance on Mental Illness: Champlain Valley (NAMI).

The statistics that she finds among the most telling come from the 2004 Eastern Adirondack Health Care Network Youth at Risk Survey, which queried 1,060 Clinton County high-school students.

Among them, 20.2 percent said, over the previous 12 months, they had seriously considered suicide; 15.9 percent had formulated a plan to do so.

A total 5.5 percent had tried suicide once during the past year; some of those had done so many more times.

"If people aren't shocked by that," Adelman said, "they should be."

In Clinton, Essex and Franklin counties, according to 2000 U.S. Census data, almost 21 percent of children ages 10 to 17 suffer some kind of mental-health disorder.

Most prevalent, at 15 percent, are youths with anxiety issues; another 10.3 percent exhibit disruptive behavior. Mood disorders, including depression and bipolar disorder, come in at 6.2 percent, or more than 1,200 cases.

And those numbers don't include children under age 10.

"Definitely, there's been an increase overall in children coming to us at an early age," said Nicole Bryant, Essex County director of Community Services. "We have had kids as young as 3 — probably 20 years ago that would have been mostly unheard of."

MANY FACTORS
Why have numbers risen?

"The mental-health field is getting better at identifying the behaviors as they relate to their underlying causes," offered Susan Delehanty, director of Franklin County Community Services.

At one time, a teen suffering from post-traumatic stress who got caught stealing, for example, could have very well missed out on diagnosis, she said.

"We ... are also learning how to engage parents and families as part of the treatment team and including them in identifying their major strengths and needs."

"We do identify kids more readily," said Sherrie Gillette, Clinton County Community Services director. As well, she said, "we are seeing more people, and they are more disturbed."

At the root of that trend, said Bryant, are endless possibilities.

Prenatal care, chemicals in the environment — those are two, she said.

"Just as the population grows, the incidence would be proportionately growing."

Then there are societal influences.

"There's no doubt the media's having a major influence on children's development," Bryant avowed. "The ultra-thin super models — I'm glad to hear lately more attention focused on that."

"An 8-year-old can turn on the TV set and see sexualized behaviors, behaviors associated with the drug culture," said Henry Goldenberg, director of Behavioral Health Services North's Child and Family Clinic, which serves Clinton County.

"Kids are getting into more harmful syndromes of behavior because (at those younger ages), they lack the judgment to know how to make good choices."

Some behaviors have attained an "almost trendy aspect," he continued.

Teens show off self-inflicted injuries almost like a ticket into a certain clique, he's observed.

"The same with eating disorders."

Mental illness can have a genetic genesis — it strikes across all social and economic lines.

It can also result from situational causes, like emotional or sexual abuse.

"I am struck by the percentage of children here that have been exposed to some sort of trauma," Goldenberg said.

WAITING LISTS
Every county clinic that treats children's emotional disorders has a waiting list, and the gap between statistics and identified cases demonstrates a crisis in treatment availability, says a study conducted by the tri-county initiative MAPP (Mobilizing for Action Through Planning and Partnership).

Beyond that are the young people who go untreated.

According to the Surgeon General's National Action Agenda on Children's Mental Health, released in 2001, in any given year, one in 10 children has at least some functional impairment due to mental illness, but fewer than one in five gets specialty mental-health services.

That's something all three counties hope to address soon with early mental-health screenings and education, both pieces of a new state initiative called Child and Family Clinic Plus.

"I think a large part of it is education," Gillette said. "When is a problem a problem?

"A lot of times, parents struggle to figure out when a kid is just being a kid."

And they fear being blamed, she added.

"We don't look to cast blame."

STIGMA HURTS
When Gabrielle was first hospitalized for her self-injury last March, Amy and her husband, Paul, suffered through the guilt parents often feel when a child is diagnosed with a mental illness.

"It's like a dirty little secret when you're first going through it," Amy said. "I hid it from my family, what Gabby was going through.

"And I tried being June Cleaver — it didn't work."

Then the reality of the crisis grew far beyond who should know or not know.

"We got a call from the same person as the first time, saying something was really wrong."

Gabrielle was suicidal.

It was after that second hospitalization that she was diagnosed with bipolar disorder (also known as manic depression), an illness that causes dramatic mood swings between depression and mania that's thought to be a genetic disorder involving an imbalance of brain chemicals.

It was scary learning she'd be taking medication for the rest of her life, Gabrielle said. But acceptance somehow became easier after her mom finally shared the diagnosis and found other family members have bipolar, too.

"It's part of me," Gabrielle said. "It's part of my family."

PLAIN SPEAKING
Amy and Gabrielle readily talk about her diagnosis and experiences, hoping to help others.

"The biggest thing I see with parents with children who have this is they think, if I have to get help for them, I'm a bad parent," Amy said.

"That's the last thing it means. This is a mental illness — no one's to blame.

"Any other physical ailment, you'd seek treatment for."

Medication and therapy, along with participation in NAMI's support group Club Teen Scene, have put Gabrielle's life back on track.

She actually initiates family outings now; she's outgoing and talkative again.

And her grades are better.

"I'm getting help in school," she said.

Gabrielle faced some tough life issues in recent weeks. She had to give up her dog and, more traumatizing, an aunt died.

Either would have been enough to put her in the hospital not many months ago.

"But I'm dealing with things now," she said. "I think I'm going to get better."

As for her parents, the experience has given them an education they wish they had sooner.

"Not realizing she was ill, we couldn't help her," Amy said.

"Hindsight is your best teacher."

SIGNS OF TROUBLE

By identifying possible problems early, a child can be more easily treated.

The following signs can help determine whether a child needs help from a mental-health professional:

• Decline in school performance.

• Poor grades despite strong efforts.

• Constant worry or anxiety.

• Repeated refusal to go to school or to take part in normal activities.

• Hyperactivity or fidgeting.

• Persistent nightmares.

• Continuous or frequent aggression or "acting out."

• Continuous or frequent rebellion and/or temper tantrums.

• Depression, sadness or irritability.

If you are concerned about your child's mental health, consult with his or her teachers, guidance counselor or other adults who may have information about his or her behavior.

If you think there is a problem, make an appointment with your child's doctor or school psychologist.



Source: The National Mental Health Association. Read more!

First-time mental-health screening identifies need - Plattsburgh (NY) Press Republican

By: Suzanne Moore, Staff Writer


PLATTSBURGH — The first local teen mental-health screening resulted in almost half the participants — 20 out of 46 — being referred for intervention of some kind.

Only seven of those Plattsburgh High School sophomores had seen professionals for the issues the screening revealed, said Mary Anne Cox, who coordinated the Columbia TeenScreen project for National Alliance on Mental Illness: Champlain Valley (NAMI).

"What that's telling me," she said, "is there are kids who are anxious and depressed, (and) no one was aware that they were having problems."

STIGMA REVEALED
Among them, Cox said, was one suicide attempt that had never been reported to anyone — the student hadn't had any mental-health intervention.

Five others had also tried to end their lives by suicide, she reported.

A growing incidence of childhood mental illness, along with an increased number of suicides by teens and young adults over the past few years, prompted the pilot screening, which is mostly funded by Eastern Adirondack Health Care Network and is a project of NAMI and many other agencies.

These first results, while not a large sampling, confirm the need for widespread evaluation, Adelman said. As well, she said emphatically, they reveal the barrier that stigma puts up between a potentially fatal disease and the treatment that can save a child's life.

"We never realized how big the wall was until we did the screening," she said.

Parents of 185 sophomores returned only 92 consent forms, even though Cox distributed them both in school and mailed second copies to those families who did not return the first ones.

More significant, she and Adelman said, was that of the 92 that did come in, 47 parents chose not to give consent.

They had expected participation from about half the class.

ISSUES IDENTIFIED
The primary goal of the screening, designed by Columbia University and widely used throughout the country, was to identify indicators of anxiety, depression and possible suicide.

Among the 45 participants, seven tested positive for generalized anxiety, with the same number doing so for depression.

Seven students admitted to thoughts of suicide.

Other results revealed students afflicted with social phobias and others with panic or obsessive/compulsive issues.

Some students tested positive for more than one indicator, Cox said.

IMMEDIATE EVALUATION
Students who did test positive for any issue included in the computer screening were immediately evaluated further by Cox, who is a licensed clinical social worker, or another mental-health professional.

A few problems had quick resolution.

One student's depression was related to bullying by other students, a situation the school was able to address.

Another teen had been on the verge of tangling with the law due to behaviors the screening identified as related to emotional problems. Now, he would get help, Cox said.

Three tests turned out to be false positives.

AND THEN ...
Except for the students already in treatment, all the others received referrals for further evaluation.

Among them, it was suggested six teens see in-school counselors and at least four others seek a higher level of treatment.

Parents of one teen didn't want to follow up, Cox said. And some adopted an attitude of "wait and see."

She encourages otherwise.

"If you don't take your child (for evaluation) and there is a problem, you're running a risk of things getting much worse and it getting more difficult to treat," she said. "You have nothing to lose by getting your kid evaluated."

JUST A START
The screening just taps at the door of mental-health awareness regarding young people, Cox said, especially with the low participation rate.

Columbia TeenScreen doesn't cover all the bases, she emphasized.

"It doesn't ask specifically about bulimia, anorexia, self-mutilation."

ANOTHER ROUND
In the spring, PHS eighth-graders will have the opportunity to take part, with the pilot program continuing next school year with the same two populations.

NAMI hoped to expand to other schools for 2007-08 but has found the screening is more labor intensive than anticipated and needs to iron out funding for that extra work.

Cox hopes the results of the sophomore screening and the education that went with it will increase participation in the next round.

A productive outcome of the first session is increased awareness by school staff, she said.

And the students themselves, for the most part, found the screening no big deal.

A few felt the personal questions were a bit uncomfortable, Cox said.

"Mostly it was positive, ranging from OK to good to thought provoking."

One student wrote, "It was something that made me feel a little better because I was thinking of what has been going on and was able to express myself and my feelings without getting in trouble."

CHECKING IN
"I would say the results suggest that we really have to pay attention to kids' emotional well-being as well as their physical well-being," Cox said, "and ask them from time to time about it."

That's how she left it with the students.

"If you're having problems, we want to make sure you know help is available to you," she told them. "You don't have to be alone."

common disorders

A child who experiences excessive fear, worry, or uneasiness may have an anxiety disorder. These include:

Generalized anxiety disorder: pattern of excessive, unrealistic worry that cannot be attributed to any recent experience.

Phobias: unrealistic and overwhelming fears of objects or situations.

Panic disorder: terrifying panic attacks with physical symptoms, such as rapid heartbeat and dizziness.

Obsessive-compulsive disorder: pattern of repeated thoughts and behaviors, such as counting or hand washing.

Post-traumatic stress disorder: flashbacks and other symptoms. Occurs in children who have experienced a psychologically distressing event, such as abuse.

Severe depression: Child often feels sad or worthless, loses interest in playing or schoolwork. Appetite and sleeping patterns may change; child may have vague physical complaints, believe he or she is ugly or have general hopelessness. Possible risk of suicide.

Bipolar disorder in adolescents: Teen has exaggerated mood swings with moderate mood in between. During extreme highs (excited or manic phases), person may talk nonstop, need little sleep and show poor judgment. At the low end of the mood swing is severe depression.

Early onset bipolar disorder in children: Children usually have an ongoing, continuous mood disturbance that is a mix of mania and depression. Cycling between moods produces chronic irritability and few clear periods of wellness between episodes. Behaviors may include rapidly changing moods; explosive, lengthy and often destructive rages; separation anxiety; defiance of authority; hyperactivity; little or too much sleep; bed wetting; night terrors; impulsivity; racing thoughts; dare-devil behaviors; delusions and hallucinations. (From Child & Adolescent Bipolar Foundation)

Attention-deficit/hyperactivity disorder: Child is unable to focus attention, is often impulsive and easily distracted. Most have difficulty remaining still, taking turns and keeping quiet. Symptoms must be evident in at least two settings.

Conduct disorder: Child has little concern for others and repeatedly violates the rules of society. Offenses, such as lying, theft, aggression, arson, vandalism, often grow more serious over time.

Reactive attachment disorder (RAD): Child has great difficulty forming lasting, loving relationships due to neglect, or other abuse. Symptoms include a severe need to control everything and everyone; frequent tantrums or rage, often over trivial issues; demanding or clingy, often at inappropriate times; trouble understanding cause and effect; lacks morals, values, and spiritual faith; little or no empathy. (From RADKid.org)

Anorexia nervosa: difficulty maintaining a minimum healthy body weight.

Bulimia nervosa: child binges (eat huge amounts of food in one sitting) then rids body of the food by vomiting, abusing laxatives, taking enemas or exercising obsessively.

Schizophrenia: Includes psychotic periods that may involve hallucinations, withdrawal from others and loss of contact with reality. Delusional or disordered thoughts, inability to experience pleasure.


Source: U.S. Dept. of Health and Human Services, unless otherwise noted. Read more!

Mental health system needs some radical fixes - Athens Banner Herald

Opinion: Melissa Hanna

In the recesses of her mind, I know some of the memories still haunt her.

The "her" is my mother. The "memories" are of experiences she picked up while spending most of her working years in the mental health field.

She knew years ago the system was broken. It's very apparent and obvious to those directly exposed to the crisis.

And finally, it seems the people who can do something about it might be paying attention. Prompted by a series of recent articles by The Atlanta Journal-Constitution uncovering abuse and death in Georgia's mental hospitals, the state legislature might finally have noticed.

The numbers are staggering. According to the series, over the past five years, 115 patients died under suspicious circumstances and there were more than 190 substantiated cases of physical and sexual assaults of patients.

For many, these numbers aren't surprising. But others have reacted like ostriches with their heads buried in the sand. After state legislators met last week with mental health advocates hoping for some major reform, House Appropriations Chairman Ben Harbin, R-Evans, was quoted as saying, "What we have to determine is: Is the system broken, or are the people who run the system broken?"

Now that's a man who sounds a little surprised. And it's a bit sickening, really, because the system is so far beyond broken it was in a million pieces years ago. Even more sickening is that the people who run the system include Harbin and his fellow lawmakers.

Mental health care has been a victim of budget slashes reaching back years. The responsibility of caring for the mentally ill has been shifted from the federal government to state governments, and more and more, local governments are having to confront the issue.

Nobody really wants to fully bear that burden, because it's a losing battle.

The mentally ill aren't the only victims. People who dedicate their lives to working in this field, like my mother, who served as a registered nurse, sacrifice a lot to do their jobs. Many of the workers are underpaid and overworked, and as a result, many who work at such facilities aren't necessarily people you would handpick to care for people in such need.

And with the growing burden on communities, that makes it our problem. Yours and mine.

The mental health fallout is evident in Athens. Although it's difficult to find solid numbers, it is thought that around 475 people currently are homeless in the Athens area, according to county statistics. According to state statistics, at least 30 percent of those folks are homeless because they are mentally ill. Some statistics estimate a number much higher than that.

So what part can we play in all of this? We are faced with a unique situation in Athens, with the closure of the Navy Supply Corps School and the land's pending redevelopment.

Many nonprofit social service groups have submitted proposals for use of the property or some of its buildings. Almost all of those services would help the homeless. Scattered here and there in the proposals are some mental health services.

But what's been suggested so far is just not enough. The number of homeless people in Athens suggests the mentally ill need a permanent facility, one that truly can cater to their needs and do so adequately.

So is there a solution here? The University of Georgia probably will end up taking the entire site for a potential medical school. But the law requires that the closing of a military base must benefit the homeless, whether through free facilities, a land swap or cash grants.

Is it possible to have a medical facility that does both? Could UGA dedicate some of its mission to offering a place to aid the mentally ill in a way that will serve as more than just a temporary fix? Could part of the medical school proposal be dedicated to mental health, serving as a learning experience for students as well as a real fix to a large population in need?

Maybe one of our own, state Rep. Doug McKillip, D-Athens, is one step ahead of us. He was the only lawmaker to attend a news conference with the Georgia Mental Health Services Coalition last week. Maybe he will be the one to step up and sponsor legislation to help the mentally ill and the Athens problem along the way.

My mother finally has retired and left the madness behind. But I know some of the children and adults she wasn't able to help still haunt her dreams.

None of us can afford to hide our heads in the sand anymore. A complete overhaul in mental health in this state is necessary and it is necessary today, for the sake of the patients, the caretakers, nurses and doctors. Years of neglect have broken the budgets of the facilities and the spirits of those expected to care.

• Melissa Hanna is the assistant news editor of the Athens Banner-Herald. She can be reached at melissa.hanna@onlineathens.com.


Published in the Athens Banner-Herald on 012807 Read more!

Man accused of killing brother suffers from mental problems - San Francisco Chronicle

Henry K. Lee, Chronicle Staff Writer
Saturday, January 27, 2007

A Danville man arrested on suspicion of fatally stabbing his younger brother had been suffering from mental problems that worsened as a result of their mother's death to cancer and their father's suicide, another brother said today.


Joshua Lemke, 28, is expected to be formally charged Tuesday in Contra Costa County Superior Court in the slaying of Jonathan Lemke, 26, at their home on St. David Drive in Danville.

The suspect called Danville police at about midnight Thursday to say that his brother, a musician, had been stabbed, authorities said. A motive for the slaying hasn't been established, police said.

Joshua Lemke had been "struggling with all sorts of stuff for a long time," his brother, Justin Lemke, 24, told The Chronicle today. "I know that Josh has always been slightly off."

The siblings, including the eldest brother, Jeremiah Palmer, 30, were devastated by the July 2003 death of their mother, Carol Palmer Lemke, 56, as a result of breast cancer.

On Aug. 27, their father, Gary Lemke, shot himself to death at the age of 60 after being diagnosed with an inoperable brain tumor. The couple had been married for 24 years.

Gary Lemke didn't want to put the family through another ordeal, Justin Lemke said.

Joshua Lemke found his father's body, and Jonathan Lemke was also home at the time, Justin Lemke said.

Joshua and Jonathan Lemke didn't fight, but "were bombarded with so much," Justin Lemke said. "My brother Jonathan loved my brother Josh like no other, and vice versa."

After their father died, Jonathan Lemke removed Joshua Lemke from a group home where he had been living so that the two could live together, said Justin Lemke, who followed his father into the U.S. Navy.

Jonathan Lemke played the bass guitar for a band called Watersigns, and Palmer, known as "Miah," plays the drums for another band.

As two of his brothers pursued their music careers, Joshua Lemke tried his best to fit into society and be a social person, Justin Lemke said. "He's always been depressed, just not a very social person -- not antisocial or psychotic or anything or sociopathic in any way, not anything like that," Justin Lemke said.

Joshua Lemke was arrested early Friday on suspicion of murder and is being held in lieu of $1 million bail at Contra Costa Jail in Martinez, where he declined an interview request by The Chronicle on Friday.

Justin Lemke said he and Palmer planned to visit their brother in jail to "try to find out and understand what happened."

E-mail Henry K. Lee at hlee@sfchronicle.com.
Read more!

Mental health court planned - The Kentucky Post

By Luke E. Saladin
Post staff reporter

In an effort to help ease overcrowding and keep criminals from making return trips to local jails, officials in Campbell County are looking to create a mental health court that would serve all of Northern Kentucky

Such a court would work with prosecutors and local treatment agencies to help those whose crimes appear linked to mental illness, much in the same way drug courts across the state seek to treat inmates with addiction problems.

A mental health court judge, for example, might allow a person convicted of a crime the option of participating in counseling or receiving medication rather than serving jail time.

"We have inadequate mental health care in Kentucky. It's as simple as that," said Campbell District Judge Karen Thomas, one of those attempting to organize the mental health court. "Incarcerating these folks is simply not the way to deal with them. The entire community suffers when these people can't receive the treatment they need. It's tragic."

The idea of a regional mental health court in Northern Kentucky surfaced when the Campbell County Criminal Justice Advisory Committee - a group of public officials, judges, lawyers and other law enforcement officials - began looking at ways to keep jail populations down.

The group visited a mental health court in Jefferson County, the only one in Kentucky.

"We're not suggesting that somebody who is violent or truly a criminal be released to do more harm," said Campbell County Judge-Executive Steve Pendery.

"What we're trying to do is weed out those who, but for their mental illness, would not be in jail or in the court system."

Thomas said she has already received approval from Kentucky Chief Justice Joseph Lambert to start the court as a pilot program.

Thomas said Boone County District Judge Charlie Moore has agreed to oversee the mental health court docket, which Thomas said would probably be heard once every other week until the project gets off the ground.

What remains is to secure money to pay for professional staff to treat the inmates, train the staff and present protocol for the court to Lambert for his approval. Thomas said transportation for the inmates in the program would also be required, since many of those who qualify are unable to drive.

Thomas said there is more than $450,000 in federal grants available to help get the initiative up and running.

"If everything goes smoothly, I'd like to have us hearing cases in about a year," she said.

"Eventually, I'd like us to hold the court once a week in a centralized location."

Kenton County Commonwealth Attorney Rob Sanders said although some details might needed to be worked out, he supports the idea of pursuing a mental health court in Northern Kentucky.

"We hear hundreds of cases every week, and there are always a few of these cases that would qualify," Sanders said.

"Anything we can do to keep people from going to jail is a worthwhile cause in my book."

Kenton County Jailer Terry Carl, who in the past few years has implemented several programs to help deal with mental illness in his jail population, agreed.

"I think it's a great idea," Carl said. "Any time you can deal with mental health issues on the front end, it's going to save you twice as much on the back end, and you help people stay out of jail. It would definitely be a great thing to have."
Read more!

15 Years of ADA - Filled with Setbacks - and Victories - AAPD

From the American Association of People with Disabilities

Guest Commentary by Mike Ervin
January 26, 2007

Today, Jan. 26, is the 15th anniversary of the day the Americans
with Disabilities Act went into effect. Since then, a barrage of
legal challenges has rendered the ADA much weaker than envisioned.

Title I, which prohibits employment discrimination, has especially
taken a hit over the years. Employers from both the public and
private sectors have frequently challenged the ADA's definition of
disability and have narrowed the scope of who qualifies for
protection under the law. It is now at the point where people with
such conditions as diabetes, heart disease, cancer and significant
vision loss have had their cases dismissed because judges
determined they don't qualify as disabilities.

Employment discrimination suits brought under the ADA are rarely
successful in courts. Every year since 1992, the American Bar
Association has surveyed Title I cases, and each year the survey
reveals that employers have prevailed in more than 90 percent of
the decisions.

President Bush has helped undermine the law his father proudly
signed by appointing active opponents of the ADA to the federal
bench.

In the infamous University of Alabama v. Garrett case in 2001,
William Pryor, who was then attorney general of that state, hired
Jeffrey Sutton to argue before the U.S. Supreme Court that state
governments should be immune from Title I lawsuits brought forth
by state employees. Sutton and Pryor won. Bush subsequently placed
both men on the federal bench.

In spite of the setbacks, America is vastly more accessible than
it was 15 years ago. We have the ADA to thank for that. What made
this law revolutionary was that it extended the obligation not to
discriminate to the private sector. As a result, sometimes the
mere threat of legal action has brought about positive change for
people with disabilities.

One of the most monumental court victories brought about by the
ADA was the 1999 case of Olmstead v. L.C. and E.W. The Supreme
Court ruled the state of Georgia violated the ADA by arbitrarily
warehousing two women with disabilities in a state institution
against their will. As a result, many states have rightly shifted
spending priorities away from institutionalization and into
community living programs.

In 2006, the U.S. Department of Justice reached an out-of-court
agreement with NPC International that will make nearly all the 800
Pizza Hut restaurants the company operates more uniformly
accessible to people with mobility disabilities by the end of
2009.

The ADA also requires all new buses, trains and stations to be
wheelchair accessible. As a result, public transit access has
improved dramatically in the last 15 years.

These victories still make the ADA well worth celebrating.

Mike Ervin is a disability-rights activist with ADAPT
(www.adapt.org). He wrote this commentary for Progressive
Media Project. Read more!

Dix park supporters file to incorporate - Raleigh News & Observer

Ryan Teague Beckwith, Staff Writer

The Dix Visionaries have gone legit.

The advocates for a major urban park on Dix Hill have been strictly informal since retired executive Greg Poole pulled them together last year.

But this month they filed paperwork with the state to become a charitable organization for "the support of acquisition, development, conservation, maintenance and operation of public parkland in Wake County."

Despite their unofficial status, the group has already accomplished a lot. They raised $150,000 to hire a planner from St. Louis and an attorney from Chicago to draw up a proposal for the park.

They also paid for a DVD with interviews of Raleigh philanthropist Assad Meymandi, Wachovia President Ken Thompson and Duke Energy executive Ruth Shaw.

And they've hired LargeMouth Communications, based in Research Triangle Park, to do public relations. (The Friends of Dorothea Dix Park, meantime, has hired French West Vaughan of Raleigh.)

If the Dorothea Dix mental hospital campus becomes a major urban park, Poole hopes the Dix Visionaries will end up playing a role much like the Central Park Conservancy, managing and developing the land for public use. Read more!

If the state wants to assist care homes - Raleigh News & Observer

Letter to the editor

Regarding your Jan. 23 editorial "Problems at home," you are right. It is sad that residents are wandering from adult care homes and being harmed. It is even sadder that members of the General Assembly, Gov. Mike Easley and top officials in the Department of Health and Human Services can't figure out that they bear responsibility, as well as the care home owner.

Sadly, these types of incidents will continue to occur until the state makes drastic changes in how it does business. No sane person could believe that one staff person could adequately care for 20 people who need help and supervision with almost every activity of daily living. Yet that is exactly the staff-to-resident ratio the state is willing to pay for the Medicaid population residing in the homes. The ratio has not changed in over 20 years!

Officials have tried for decades to fix this with more laws and rules than you can count, more penalties, more regulators and more negative actions against the homes. The General Assembly plans to fix it this year by ignoring the people in the homes who need mental health services and putting in place a Star Rating System to grade how a facility stays in compliance with the many rules and laws.

Let us hope that Health and Human Services officials will soon look at their own reports regarding the $200 million that it would take to staff the facilities for a safe level of care. Let us hope they will take seriously the fact that the federal government has said they are not compliant with federal law in their treatment of people who live in adult care homes as it relates to allowable services.

And we could dream that the state would even take some of those Medicaid savings they like to talk about and purchase tracking bracelets and other devices to help keep people safe.

If we really want to dream big, we could even hope that law enforcement officers would not wait six days to search for a missing resident, as they did last summer in the disappearance of the resident from Unique Living Center in Cleveland County.

Lou B. Wilson

Executive Director, N.C. Association, Long Term Care Facilities

Raleigh Read more!

Don't close Dix - Raleigh News & Observer

Letter to the editor:

The Triangle area has had an advantage most of the rest of the state has not enjoyed. When it comes to mental health services, you live in a different world than us.
With your university hospitals, the Whitaker School in Butner and the Dix and Umstead hospitals, you have had little concern over what happens if community-based services fail or are simply not available should a person in a psychiatric crisis need help.
In the face of all evidence that our mental health system is in shambles and the community-based services we were promised have not materialized, the state plows ahead to close Dix and reduce or eliminate other state facilities and services.

If you want a park, use some of the land around Dix as a park, but don't close one of the only facilities that admits and treats patients private providers may deem "too difficult." If you do, you'll be sorry.

Diane Bauknight

Fletcher Read more!

Homeless people need beds, and then they need treatment - Fayetteville Observer

Editorial

The homeless problem in Fayetteville is getting worse. On any given night, 250 to 300 people are looking for a warm place to sleep. There are about 50 beds available to them.

If local officials are serious about ending the homeless problem in 10 years, the first order of business should be to build more shelters.

The local effort is part of a national partnership of communities working toward similar goals. Last February, city leaders formed a committee to develop the 10-year plan.

The size of the homeless population here is not unique. Fayetteville police officer Stacy Swinton says the number of people living on the streets is similar to other cities in the state. But Fayetteville has dedicated fewer resources to address the problem.

Unlike some cities, Fayetteville does not operate a shelter run on government grants earmarked for the homeless. Churches and nonprofit organizations run the few facilities in the area. But Victor Sharpe, the city’s community development director, says building a city-run shelter isn’t a goal. It should be.

The problem isn’t limited to Fayetteville. Advocates estimate that the number of homeless people in Cumberland County has grown to as many as 1,000. In the meantime, shelter space is shrinking.

Last year, the Hope Center, operated by the Coalition on Services to the Homeless, shut down its shelter of 21 beds. A closed-in-patio that homeless people slept in at St. Joseph’s Episcopal Church on Ramsey Street burned down.

City and county officials shouldn’t just build short-term shelter space. They should provide homeless people with transitional and long-term housing as well as treatment for mental illness and addiction.

Government needs to create a “one-stop shop” resource center where homeless people can get all the help that they need in one place. Swinton says other cities around the state are running similar centers successfully.

Earlier this year, city and county officials hired the consulting firm J-Quad Associates of Dallas to help come up with ways to end homelessness in Cumberland County. It’s good that they are studying the problem, but some solutions are already obvious. Homeless people need places to sleep, they need counseling and they need health care. It’s time to invest in resources to provide it. Read more!

Officers graudate from Pitt CIT program - Greenville Daily-Reflector

By Erin Rickert

Just completed crisis intervention training is expected to help local police and deputies handle people suffering from illnesses such as bipolar disorder, dementia, autism and mental retardation without resorting to violence or deadly force.

Through lessons and role playing in Pitt Community College's Greenville Center, 25 officers with the Greenville and Ayden police departments and the Pitt County Sheriff's Office learned to shed their commanding voices, approach in a non-threatening manner and maintain eye contact.

Graduates were pinned Friday after completing three exercises using the skills they learned during the week-long training, which began Monday.

Officials heading the program said the efforts were the first step in better handling those in crisis.

Bonnie Currie, Pitt County Mental Health Local Management Entity community outreach coordinator, said she was already working to coordinate future continuing education classes. Implementation of CIT training has been in the works since October 2005, Currie said.

The collaboration of Pitt County Memorial Hospital, Pitt Mental Health, East Carolina University, PCC, the National Alliance on Mental Illness, the Consumer & Family Advocacy Committee, the Pitt County Mental Health Local Management Entity and local law enforcement finally made efforts a reality, Currie said. CIT certified officers from Wake and Vance counties also volunteered their time to teach classes.

In addition to eight hours of visitation at local mental health facilities, the program touched on topics such as medication management, autism, mental commitment, substance abuse, suicide risk and homelessness.

The training comes just a year after Greenville police fatally shot Kerry Turner — who was suffering from an episode of bipolar disorder — on Greenville Boulevard near 14th Street following a car chase Jan. 26, 2006.

Currie and others said the training was not prompted by Turner's death.

Sgt. Ted Sauls, training coordinator for the Greenville Police Department, said the reason nearly 10 officers with his department volunteered for the training was so officers "have a better understanding of what a developing crisis is."

"It's more of a proactive approach than a reactive approach," Sauls added, noting the department already does periodic crisis training.

Erin Rickert can be contacted at erickert@coxnc.com and 329-9566.

Read more!

Georgia mental hospitals under review - Atlanta Journal-Constitution

By Andy Miller, Alan Judd

State officials told legislators Thursday that they are reviewing mental hospital procedures in the wake of an Atlanta Journal-Constitution investigation on deaths, abuse and neglect in those facilities.

The response was disclosed as a House Appropriations subcommittee questioned the commissioner of Department of Human Resources, which runs the seven state hospitals, about the newspaper's articles at a legislative hearing on the agency's budget for fiscal 2007.

The Journal-Constitution identified at least 115 patients who died under suspicious circumstances and found more than 190 substantiated cases of physical and sexual abuse of patients during the past five years.

B.J. Walker, the agency commissioner, said the newspaper's conclusions on patient deaths were inaccurate. "I would not agree we've had 115 suspicious deaths," she told the panel. But she said the newspaper articles provided "an opportunity" for the agency to examine its processes, she said.

The agency said it has brought in Medical College of Georgia experts to scrutinize hospitals' medical and psychiatric care.

Walker said the newspaper failed to point out that the number of hospital deaths has been dropping.

She told the panel that most of the death and abuse cases highlighted by the newspaper occurred in 2002 and 2003. She became DHR commissioner in 2004.

She did acknowledge hospital failure in the 2006 death of Sarah Crider, 14, which was detail by the newspaper. A doctor who treated her has been terminated, Walker said.

The Journal-Constitution's investigation shows a decline in overall deaths in the seven hospitals, from 83 in 2002 to 48 in 2006. The newspaper's findings for suspicious deaths show 15 in 2002; 29 in 2003; 29 in 2004; 22 in 2005; and 20 in 2006.

Ellyn Jeager of Mental Health America of Georgia, a consumer group, criticized state officials' response to lawmakers after the Thursday hearing.

"I'm waiting for the state to acknowledge that people died unnecessarily. It doesn't matter how many. They must accept responsibility for the deaths."

The newspaper used several sources to compile its list: a database of state vital records, death certificates, autopsy reports, claims filed against the state, and DHR documents. Reporters also consulted psychiatrists and patient advocates, who agreed the deaths were suspicious.

The suspicious deaths included 36 people who died from choking on food, vomit or foreign objects, or by aspirating those substances into their lungs. A similar number died for lack of emergency treatment or from questionable medical care. Twelve committed suicide.

Besides people with mental illness, including forensic patients sent by the courts, the hospitals also serve the developmentally disabled.

After the hearing, chairman of the subcommittee, Rep. Mark Butler (R-Carrollton), said, "We need to take more steps. We're looking at a few items ... some additional oversight." It would probably come in legislation, Butler said. Earlier this week, he and other lawmakers said they intend to examine conditions in the hospitals.

On Tuesday, advocates for the mentally ill cited the newspaper series in calling for Georgia lawmakers to create a statutory commission to recommend reforms to the system. The advocates also sought funding for an independent state ombudsman to investigate reports of abuse and neglect in state hospitals.

One group, the National Alliance on Mental Illness, has called for a U.S. Department of Justice investigation of Georgia's mental hospitals, citing the newspaper's series. A Justice spokeswoman said the agency is reviewing the group's request.

DHR officials told the legislative panel Thursday that they have scrutinized how they review hospital problems, including how they report incidents to the Georgia Bureau of Investigation. GBI officials have said the hospitals do not systematically notify them of deaths or of other serious incidents. Last year, it took six days before Georgia Regional Hospital/Atlanta notified either the Department of Human Resources headquarters or the GBI that an employee allegedly raped a patient.

Agency officials, through a budget proposal, also are looking at raising the pay of nurses in hospitals, as well as that of other workers who care for patients.

Gwen Skinner, who heads the mental health division of the Department of Human Resources, said the state has been forced to reduce medications for patients, along with therapy services within the hospitals, because of a deficit in funding. The agency is requesting an additional $9 million for the current fiscal year. But Walker said the additional funding requested was not directly linked to care problems cited by the newspaper.

Walker said the average occupancy rate in adult mental health units was 109 percent. She has said the state has created additional community services to prevent hospitalization.

But Butler and other lawmakers sharply questioned Human Resources officials on the availability of community services, citing a reduction in facility treatment beds for adolescents with substance abuse problems. Read more!

State prisons in 'tailspin,' panel says - LA Times

By Jenifer Warren, Times Staff Writer

SACRAMENTO — Three decades of tough-on-crime lawmaking has sent California's prison system into a "tailspin," creating the most pressing crisis facing the state, the government's own watchdog panel declared Thursday.

In a blistering 84-page report, the nonpartisan Little Hoover Commission linked the problems plaguing the correctional system to political cowardice among governors and lawmakers fearful of being labeled soft on crime.

If policymakers are unwilling to make bold changes, the commission said, they should appoint an independent entity — modeled after the federal Base Closure and Realignment Commission — with the power to do it for them.

"For decades, governors and lawmakers fearful of appearing soft on crime have failed to muster the political will to address the looming crisis," the commission said.

"And now their time has run out."

The 13-member commission is an independent agency composed of Republicans and Democrats appointed by the governor and legislative leaders. Since its inception in 1962, the commission has worked to improve the efficiency and effectiveness of state programs.

The report, delivered directly to the governor and the Legislature, included suggestions for sentencing reform and other changes, many of them previously offered by the commission and other critics. It broke new ground, however, by bluntly stating that when it comes to corrections in California, political posturing has trumped sound lawmaking.

The state's 33 prisons are packed to twice their intended capacity, with more than 16,000 inmates bunking in hallways, classrooms and other areas not designed as housing. Prison leaders say they will be out of room for new inmates by summer, and concern about riots is extremely high.

A federal judge, meanwhile, has given the state until June to relieve the crowding or face a possible cap on the inmate population, now about 172,000.

Though Gov. Arnold Schwarzenegger has unveiled an ambitious $10.9-billion prison building and reform plan, its fate in the Legislature is uncertain, and most of the proposed solutions would take years to enact.

The governor has a short-term program to ease crowding — transferring inmates to other states — but it is faltering because few convicts are volunteering to go.

In October, the commission noted, the governor declared a state of emergency in the prisons: "But even that didn't bring action, only more reports to federal judges that underscore the fact that the state's corrections policy is politically bankrupt."

In an interview, Commissioner Dan Hancock said the report's unusually harsh tone was designed to highlight the desperate state of affairs, which he said extends beyond crowding to medical and mental health care and a criminal sentencing system the commission called a "haphazard jumble."

Hancock said the crisis had been caused largely by a ceaseless game of one-upmanship by politicians seeking to burnish their reputations as crime-fighters.

"Each has tried to outdo the other on who could be toughest on crime, but nobody was thinking clearly about what the ramifications would be for the state," he said. The result is an incoherent penal code dominated by what experts call "drive-by sentencing laws," often enacted by politicians responding to a single high-profile crime.

The report comes just days after Schwarzenegger and the top Democrat in the Assembly publicly lamented the lack of political will to tackle the problem.

In an interview with The Times last week, Schwarzenegger said prisons had not been a priority because they were not a "sexy" topic that affects the lives of voters — and thus had attracted little interest from lawmakers.

"You talk about prisons, people feel like, 'OK, go out and get the criminal and you send him somewhere, but wherever that is, I don't want to look there, I don't want to know,' " the governor said.

"When the people are not excited about it, how do you make the legislators excited about it?"

Assembly Speaker Fabian Nuñez (D-Los Angeles) was more pointed in his comments, blaming legislators for a short-sighted "lock up everybody" mentality that has wrought painful consequences.

"It's good politically, because you can champion it as you're tough on crime," Nuñez told a news conference Monday. "But in the end, the prisons are overcrowded, we don't do enough rehabilitation, the prisoners get out of jail and go back and commit more crimes, we have the highest recidivism rate of any state in the nation.

"It's a shameful part of the California body politic. We've got to change that."

Whether the rhetoric — or the commission's report — will have any substantial effect on lawmakers is unclear.

Analysts say the political fear of being tagged as a friend of felons runs deep. And voters enthusiastically embrace ballot initiatives seeking to toughen penalties, such as the "three strikes" law of 1994 and the crackdown on sex offenders passed last year.

"We're always ever so nice to furry animals and very, very mean to criminals," said Shaun Bowler, a professor of political science at UC Riverside. "It's almost reflexive, the voters' desire to be tough. If the prisons are a cross between a sewer and the Roman Colosseum, their answer seems to be, 'Good.' "

But some criminologists say the public has been misled about just what sort of policies make the streets safer. At UC Irvine, Joan Petersilia said the "cookie-cutter" approach has put a lot of people in prison but failed to deliver much in the way of public safety.

"I don't think the public really understands that all this money we're spending isn't yielding much in return," Petersilia said. California, she noted, may spend more than $8 billion a year on corrections — a 52% increase over the last five years — but roughly 70% of inmates released by the state wind up back behind bars.

"Everyone agrees we've got a crisis, but no one is willing to put forth an agenda and lead," Petersilia said.

"That's the key ingredient that's been missing."

The Little Hoover report is available at http://www.lhc.ca.gov/lhc.html .
Read more!

Death row inmate to get new trial because of antipsychotic drugs - LA Times

Federal judge cites drugs administered at jail as reason James Melton was not involved in his defense at 1982 trial.

By H.G. Reza

A man convicted 24 years ago in the murder of an elderly man in Newport Beach has been granted a new trial by a federal judge who said he was unable to participate in his own defense because of drugs the jail staff administered.

James Andrew Melton, who has been on death row for almost a quarter of a century, will be returned to Orange County for retrial unless the state attorney general asks U.S. District Judge Robert M. Takasugi to reconsider his ruling or appeals the case. Officials at the attorney general's office declined to comment Friday.

Melton cried when informed of Takasugi's 79-page ruling, said his attorney, Robert F. Kane.

"This ruling gives him the trial he never had," Kane said.

Melton was 29 when he answered an ad placed in a gay newspaper by Anthony DeSousa, 77, a retired hairdresser who had advertised for a lover.

His battered nude body was found with an electrical cord tied around its neck.

Police found Melton in possession of DeSousa's car and arrested him. He was convicted Dec. 1, 1982, and sentenced to death March 18, 1983.

According to Takasugi's ruling, issued last week, during his trial Melton was given daily doses of 750 milligrams of Mellaril, an antipsychotic medicine, and 100 milligrams of Phenergan, which can act as a sedative.

"These medications had a profound affect on Melton's physical and mental functioning…. It is impossible to determine whether he understood the evidence against him," said Takasugi, citing medical experts who testified during the appeal.

Takasugi also criticized Orange County Superior Court Judge Robert R. Fitzgerald, who presided over Melton's trial, for failing to note that he was not involved in his defense.

Takasugi said Fitzgerald admitted having "pro-prosecution leanings" but said he was fair to Melton, whom Fitzgerald said "was at the top of the list of deserving souls for execution."

Fitzgerald testified at the appeals hearing that Melton appeared competent at trial, a conclusion he reached by observing him at the defense table. But Takasugi said "Fitzgerald's testimony establishes only that Melton remained awake and was compliant and non-disruptive."

Fitzgerald could not be reached for comment.

Takasugi also said Richard Bonner, Melton's trial attorney, was ineffective and criticized him for not paying closer attention to the medication given his client.

"Competent defense counsel would have at least attempted to find out why their client required such powerful antipsychotic medications," Takasugi said.

Bonner is no longer a practicing attorney. He could not be reached for comment.

Kane filed Melton's first appeal in 1989, and the California Supreme Court denied it four months later. He filed another appeal in federal court in Los Angeles the same year.

It took more than 17 years for the court to conduct an evidentiary hearing and issue the ruling.
Read more!

Mental illness can lead to earlier death - Cincinnati Enquirer

BY LAWSON WULSIN

Avoiding heart disease could save us 13-18 years, according to the Healthy People 2000 initiative. Avoiding smoking saves us about 14 years.

If we could avoid having a major mental illness, how many years would that save us? Do mental illnesses, including depression, schizophrenia and bipolar disorder, cause early death?

For quite a while I've been teaching that the burden of mental illness on society comes mostly from the prolonged disability that mental illness causes, not from early death. By contrast, the burden of heart disease comes mostly from early death.

But it's time to change our thinking. Recent studies estimate that major mental illness is associated with 15-32 years of potential life lost, almost twice the years lost to heart disease or smoking.

In six states studied in 1999, the average age at death for public mental health clients was between 49 and 59, representing a range of 26-32 years of potential life lost because of major mental illness.

Even people with less severe mental illnesses die much younger than people with no mental illness at all.

Accidents and suicides account for some of the early deaths, but most people with mental illness die of heart disease, cancer, diabetes and stroke. The mentally ill develop these chronic conditions earlier, get less treatment, and die younger than the non-mentally ill.

If we can appreciate how the ravages of the mind ravage the body in a slow burn toward lethal chronic physical illness, then the prevention and primary care for these physical illnesses in the mentally ill become life-saving priorities for all of us. Read more!

The voters giveth and the governor taketh away - Stockton (CA) Record

The voters giveth and the governor taketh away.

That's the worry of California mental health officials who are seeing larger-than-expected Proposition 63 revenues while hearing warnings of offsetting budgetary cutbacks to mental health programs.

The net impact is unknown, but there's legitimate concern the intent of Proposition 63 - to further supplement funding for mental health programs in the state - will be circumvented by a budget proposal calling for a $55 million reduction to the Integrated Services for Homeless Adults and Serious Mental Illness Program.

Gov. Arnold Schwarzenegger is trying hard to balance California's budget and avoid tax increases. One way is to look for acceptable cutbacks.

Proposition 63, passed by nearly 54 percent of the voters in December 2004, was written to expand mental health services.

The initiative called for a 1 percent tax on taxable personal income for those earning $1 million or more per year. The funds can't be used on existing programs.

Members of Schwarzenegger's budget staff need to make sure that cuts they're considering don't violate Proposition 63.

We're also concerned with how the new infusion of cash would be monitored and measured for success.

Too often, when unexpected money appears, it's misused, ineffective and casually applied.

Bruce Hopperstad, San Joaquin County's mental health director, has an obligation to taxpayers to make sure Proposition 63 funds are used wisely. The revenue flow won't be the same each year. That knowledge needs to be part of Hopperstad's planning.

There needs to be a practical application of the $7.8 million the county is expected to receive in the next fiscal year. There also needs to be accountability. Read more!

Police officer with bipolar settles suit - Furiousseasons.com

Editor's Note: The following was taken from the furiousseasons.blog, a blog largely devoted to oversight of the pharmaceutical industry and it's marketing of psych meds. Links to the articles mentioned can be followed by visiting the original article posted January 23, 2007, on that site.

Angela Holland settled her lawsuit with the King County Sheriff's Office yesterday, 18 months after suing her former employer for discrimination and wrongful termination. Holland, for those of you new to this story, was a veteran KCSO deputy who, in June 2004, revealed she had bipolar disorder. She'd done nothing wrong on the job and, in fact, was considered a good cop and had numerous commendations (that speaks well to how bipolars can adapt and do damn near anything they choose). She outed herself because she'd had some meds go south on her, needed to make a switch, and had to have time off to make it work. For this, she was fired four months later--a very fast turnaround for firing a cop.

Meanwhile, the same department didn't fire and, as it turns out, hardly disciplined a veritable rogue's gallery of other KCSO deputies who did some very bad things on and off-duty. Think I am making that up? Read this series by the Seattle Post-Intelligencer. If you want to read about the whole Holland story, read this article, which I wrote in 2005.

Holland's case is, to the best of my knowledge, unprecedented. When I was reporting on her situation two years ago, I talked to lots of disability and mental health lawyers and not one could think of a case where someone with bipolar disorder or schizophrenia had won a court case against a discriminating employer or had walked away with money in a settlement. I looked at a legal database and the academic journals. I talked with the Equal Employment Opportunity Commission, which administers the ADA. The outcome was the same. Bipolars never win discrimination claims. (Let me know if you know of cases where they have.)

Holland, three weeks before her case was scheduled to go to trial, walked out with money, an agreement by the Sheriff to reclassify her firing from "medical termination" to "medical retirement," and an agreement by the Sheriff to provide Holland with a letter of recommendation. She won. The Sheriff lost. Holland's attorney, Jeff Herman, won. King County Deputy Prosecuting Attorney Don Porter, defending the Sheriff, lost. The people who doubted the story I wrote about Holland, or felt it was too activist-ish, have been proven wrong. They can go fuck off now.

Straight-up, Holland made history yesterday. And although there is lots of mental health news the last few days about states investigating Eli Lilly, Pfizer melting down and another examination of some of the Zyprexa documents (not a very revealing examination, in my mind) in the Times of London, this is truly the only story that matters. I'll get back to that other shit another day.

Holland's story has broader implications. It's a story of treatments that don't work well, bad doctors (and a good doctor, too, in the end), medication side effects, social discrimination, employment discrimination and so on. It establishes just how far we haven't come since 1993 when, pardon the self-referential crap for a moment, I was fired from a job after revealing that I was bipolar. The same dynamic was at work as with Holland. I could do my job well, had had meds go south on me and, once the bureaucracy caught on, all of America's unfounded assumptions about the mentally ill came crashing down upon me. Same deal with Holland, except almost 15 years later she came out with a better, but not enough better, result. Perhaps 15 years from now, things will work out much better for the next bipolar who gets jammed up by a moronic employer and their paranoid bureaucratic fantasies.

One other common thread is that Holland and I got screwed by the legal system. In my case, i didn't even have access. In hers, the Prosecuting Attorney's Office pushed its defense so aggressively that it was clear to Holland that going to trial on this case would be a huge roll of the dice. They were going to paint her with every bad thing any bipolar had ever done in history. Enough members of a jury would likely believe DPA Porter's fear-mongering to make a trial unwinnable for Holland. She had to settle. Someday, I will share some of the details from Holland's deposition in this case, in which Porter crossed so many ethical boundaries in his questioning and said so many ugly and false things that he must be held to account.

And he will be. As will others. Stay tuned.

Posted by Philip Dawdy at 02:23 AM | Comments (9) Read more!

Mental Health Center acts on new findings - Blairsville (GA) Union-Sentinel

Raising kids is more complicated than June and Ward Cleaver let on.

Family life isn't always as upbeat as the Brady Bunch acted either.

For many of us, the reality is that our family is living paycheck to paycheck. We're too busy and too stressed. We're worried. We're tired. We often snap at each other and our children. We want our kids to do well in school and to grow up right. But, let's face it, we're doing the best we can … And, we're only human.

Welcome to modern-day families. Where parenting can be challenging and growing up can be difficult. Growing up can be lonesome. And, growing up can be scary … especially if your child has a mental health need that isn't being met.

Studies show that is often the case. One out of every five children and adolescents has a mental disorder. One in 10 has a serious emotional disturbance. Nearly one in 10 teenagers experienced major depression in 2005 and fewer than half were treated, according to a study released from the Substance Abuse & Mental Health Services Administration.

These new findings should serve as a wake-up call. Like adults, both children and

adolescents can have mental disorders that interfere with the way they think, feel and act. But prevention and early intervention of mental health disorders can minimize consequences for children and their families, as well as costs to society.

"I have seen first hand how the lives of troubled youth can be turned around with the appropriate help," said Carol Poole, a licensed clinical social worker at Union County Mental Health at 41 Hospital Street. "And, I've seen too many times what can happen to the distraught child or adolescent who doesn't receive help - sometimes school failure, drug abuse, family problems and a host of other issues."

Trained clinicians at the mental health center provide treatment for children, adolescents and families affected by a mental illness, severe emotional disorder or substance abuse.

Poole and her coworkers who serve youth throughout Towns and Union - Jennifer Schlienger, Janie McConnell, Margie Winkler and Linda Garver - are passionate about supporting area youth and families.

They provide on-site services in various local public schools and also Crossroads alternative school and Head Start. They seek ways to help children and adolescents in their normal daily settings.

Staff run a Family Empowerment Group two times a month to provide support and communication tools to families in which both the parents and children use the mental health center's services.

Also, in the works: an innovative after-school program for youth dealing with drug or alcohol abuse.

The center's mental health services include diagnostic assessment; individual, family and group counseling; brief therapy; psychiatric and nursing care; and referrals to other services.

"Here, we look at the whole person," said Poole. "We have a range of staff expertise - from licensed professional counselors to paraprofessionals to a psychiatrist to a physician's assistant - available to treat a variety of needs related to addiction or mental illness."

The funding for those public services comes from fees paid by clients and family members, private insurance policies, Medicaid, Medicare, PeachCare and other federal, state and county funds.

Some individuals who do not have any coverage may qualify for a reduced rate by supplying information such as pay stubs to substantiate their financial situation.

Based on an individual's household gross income and family size, some clients may pay only a percentage of their fee - sometimes ranging anywhere from $5 to $20. (Funds from the Georgia Department of Human Resources cover the remaining amount.)

The center is the local branch of Georgia Mountains Community Services, a public organization serving 13 area counties.

"If we can just help one person - help a youth find his way out of depression, help a child deal with seemingly uncontrollable behavior, help a family stay together - then it's all worth it," said Carol Perkins, the Services Director for Georgia Mountains. "That is what we're here for."

For more information, call the Union County Mental Health Center at 745-5911.

Quick Facts for adjacent box, if needed:

Mental illnesses can affect persons of any age, race, religion, or income. They are not the result of personal weakness, lack of character, or poor upbringing.

The most serious and disabling mental disorders affect five to ten million adults and three to five million children in the United States, according to the National Alliance for the Mentally Ill.

Addictive diseases are progressive illnesses, prone to relapse, that can affect every aspect of a person's life. Read more!

A bridge to mental health - Hackensack (NJ) Herald News

Thursday, January 25, 2007

By SACHI FUJIMORI
HERALD NEWS

When Rose Hardy was ordained a minister in the Unity Fellowship Church a few years ago, she hoped to hide her collar at her day job.

As coordinator for outpatient mental health care at Barnert Hospital in Paterson, she feared that the two worlds didn't mix. "I was clinically trained not to go there, to stay away from religion," she said.

And likewise, on Sundays, attending her Newark church was a time to refuel spiritually, to leave her workweek at the door.

But one afternoon in 2000, while volunteering at her church's drop-in center, she overheard a conversation she could not ignore. A man walked in speaking in rapid-fire sentences. Recently fired from his job, he believed his employers discriminated against him because he was black and that they were coming to his home to attack him. With 25 years experience working in mental health, Hardy immediately saw the signs of paranoia. But the deacon to whom the man was telling the story didn't detect the illness, and sent him on his way with information on how to contact the state Department of Labor.

Seeing the need to talk about mental illness in her community, Hardy began to educate her fellow congregants at Newark's Liberty in Truth Unity Fellowship Church, a church rooted in the social justice principles of the Catholic Liberation Theology movement. She encouraged her pastor to talk about the issue on the pulpit. She advised deacons on how to detect the signs of mental illness. She taught the ushers how to gently approach a church member having a psychotic episode.

And last year while attending a mental health conference, she learned of a New Jersey pilot program that would help her combine her faith background with her mental health work at Barnert.

In the black community, mental illness is often stigmatized and undiagnosed. Church members, Hardy noticed, are comfortable standing up in services to talk about their afflictions, like HIV, and drug or alcohol addiction, but mental illness remains a hushed topic.

The Promoting Emotional Wellness and Spirituality (PEWS) program seeks to build bridges between black churches and mental health awareness programs. Sponsored by the Mental Health Association in New Jersey (MHANJ), the program includes a 30-minute video, "Anything But Crazy," and a Power Point presentation geared to both clergy and mental health care providers.

Recognizing that churches are important social centers in the black community, the program speaks to the faithful through them. Advertisements for the PEWS program are printed on sturdy paper fans, traditional items found in black churches, used to cool off during services.

Launched in spring 2005 by Laverne Williams, an MHANJ community outreach coordinator, the program has forged partnerships with 10 churches throughout the state, most of them in Essex County, where Williams has connections as a deaconess at Montclair's Union Baptist Church. With a $70,000 annual budget, funded by the state and private donations, the program is just getting off the ground.

The idea grew out of Williams' own experience. In the mid-1980s, when her older sister was dying from cancer, she began to suffer panic attacks. While driving, her hands would shake uncontrollably and drip with sweat, she said. With no one to turn to, she grabbed the phone book and looked up a therapist with her same last name, grasping for familiarity. Before the first session, the therapist told her she was white and asked if that was OK. "At that point, it didn't matter. I needed help," she said. After eight weeks of therapy her panic subsided. Later when she shared her story with family and church members, they began approaching her with their own stories of mental illness. "All it takes is one person to bring it out," she said.

Some family members asked her, "What does it feel like talking to a stranger?"

A goal of the outreach is to dispel the myth in the black community that mental illness is solely a "white man's middle-class disease," said Williams. During tough times, keeping a stiff upper lip is the way to muddle through, and telling your problems to an outsider is not culturally acceptable, she said. Blacks' distrust of the mental health care system is also fueled by the lack of service providers who look like them. Nationwide only 2 percent of psychiatrists and psychologists are black, according to the National Alliance on Mental Illness.

Another stigma among the faithful is that mental illness is a punishment from God for past sins, or a result of weak faith. In one biblical story, Jesus cures a man possessed by demons -- which today would be an indication of mental illness. Living alone in the tombs, he cries out night and day and cuts himself with stones, behavior that today would be interpreted as mental illness. Jesus visits him one day and the man bows before him in prayer. In an instant, Jesus calls the demons out of him, casting them into a herd of swine.

Hardy witnessed this belief last year in a spirituality group she runs at Barnert. A woman suffering from schizophrenia shared the fact that her former pastor told her to stop taking her medications, that prayer was sufficient. She had suffered from schizophrenia since the age of 13, and her church told her she wasn't praying enough. The woman said she was forced to stop attending church, because she knew if she stopped taking her medications she would end up at Greystone, a state psychiatric hospital.

"It disturbed me," said Hardy.

Humility is key to being a good therapist, she said. She harbors no agenda to push her beliefs on others. But for patients who do believe in a higher power, engaging them in their spirituality is a powerful part of healing, empowering them to draw on their inner resources to get better, she said.

There is no magic pill in treatment, Hardy said. But for many people faith is one part of their identity, and should not be ignored.

In the coming months, Hardy will bring the PEWS presentation to share with co-workers. Next, she hopes to reach out to Paterson churches. The area has a plethora of mental illness-related addiction problems and depression, she said. Speaking to churches is one way to reach those in need.

Several church leaders have recognized the need for mental health care, and debunked the myth that prayer alone is sufficient.

"We are not practicing physicians," said the Rev. Douglas Maven of the First AME Zion Church in Paterson. "For some issues we need to know when to refer out and not to feel guilty about that."

Working the network

The Rev. David Thornton of the United Presbyterian Church in Paterson said that when referring members of his congregation for help, he dips into his church network to find a psychologist with a faith foundation.

One concern, he said, is when someone comes to rely too much on a therapist. He wonders about the effectiveness of treatment for those who spend their lives in therapy. "A life relationship with God is indispensable," said Thornton.

Hardy is excited about the receptiveness of Paterson churches to the PEWS program. The next step will be to get brochures into churches and furnish leaders with a resource guide on where best to refer members.

Other mental health professionals based in Passaic County also see the benefits of reaching out to churches. "I don't see any conflict," said Laura Coniglio, executive director of the Family Support Organization of Passaic County, based in North Haledon. "I don't care how they get through the door. Anytime someone gets the help they need, that's a positive."

Reach Sachi Fujimori at 973-569-7154 or fujimori@northjersey.com.
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Mental health and criminal justice: Not a good mix for some - Petoskey News

By Steve Zucker News-Review staff writer
Friday, January 26, 2007 11:45 AM EST

When Beverly Gille took her then-15 year-old son Brad to the doctor eight years ago, she never dreamed that she and her son would be walking away with a life sentence.

Gille's sentence: A lifetime of worry, struggle and frustration with a son diagnosed with paranoid schizophrenia - a serious mental illness.

For Brad, now 23, the sentence has been more than just living with the ups and downs of the illness. Over the past several years the illness has led him to receive actual criminal sentences for crimes his mother says are a direct result of his illness.

Gille's son has been on a revolving door in and out of the Emmet County jail in recent years for a variety of misdemeanor offenses - from shoplifting to disorderly person and other charges.

“He's fine when he's on his medication,” Gille, a Levering resident, said. “The problem is, his illness tells him that he is fine and doesn't need to take his medication. He's also been through the (mental health) evaluations so many times that he knows how to answer their questions.”

Gille said the illness also makes her son vulnerable to unscrupulous friends taking advantage of him.

Round and round

And so, Gille says, the cycle goes like this: Brad goes off his prescribed medicine regimen, his behavior becomes unstable (such as yelling to himself as he walks along the street in the middle of the night), he gets in trouble, winds up in jail where court officials, jailers and mental health workers get him back on track with his medications and then as soon as he is released or off probation, he goes back off his medications.

It's a cycle that is all too familiar to Emmet County Sheriff Pete Wallin as his corrections officers see several dozen people over the course of a year that are riding the same merry-go-round.

“I've been (working for the sheriff's department) for the past 25 years and some of the people I dealt with when I was on road patrol, my people are still dealing with,” Wallin said.

“Jail really isn't the place for some of these people,” Wallin said. “We don't really have the facilities and our staff isn't really trained for it.”

“We don't exactly have a mental health wing, so these people are mixed in with the general population, which isn't the best situation, either,” Wallin said.

A blessing and a curse

Gille said that while she agrees that jail is not the place for her son, she also acknowledged that his condition has been controlled the best in recent years when he's been in jail or on probation.

Gille doesn't fault the people in the local criminal justice system for her son's plight. In fact, she offers high praise for them. Gille said everyone from police to probation officers, jailers and judges have made many efforts to help her son.

She counts herself as blessed to live in a community where law officials are willing to go the extra mile.

“I don't know what would happen if we lived in an area where there weren't such caring people,” she said.

Gille points to one occasion where she received a call from Petoskey police when her son had made repeated nuisance calls to 9-1-1 on the previous night. When police checked on her son at his apartment, they found out he was fine, but that he made the 9-1-1 calls “because he was lonely” and his “friends” had used up all the time on his pre-paid cell phone and 9-1-1 was the only call that would go through.

Even as recently as this week, Emmet County sheriff's deputies - who, like many police officers in the area, know her son and his condition very well - stopped her son while driving, and after writing him a citation for no proof of insurance, dropped him off at Gille's home.

No simple answers

When a person with a diagnosed or suspected mental illness winds up in jail, he or she typically is referred to North County Community Mental Health, the public mental health agency that serves a six-county region of Northern Michigan including Charlevoix and Emmet counties.

The agency's director, Alexis Kaczynski, said her agency offers a vast array of services - from evaluations to counseling and jail diversion and follow-up programs - for people with mental illness, often with successful results.

But, she said, situations such as Gille's are common, too - mainly because of several factors that work against her agency's efforts.

Most noteworthy, Kaczynski said, is the fact that most of the time treatment - or at least long-term treatment - is voluntary. Even if a person's criminal sentence requires him or her to participate in mental health treatment and take all of his or her prescribed medications, once that time has elapsed, it's up to the patient to continue with the treatment.

“We may be in total agreement with the patient's family, but we can never force someone to take medication,” Kaczynski said.

Short of a court order, the law provides no means of “forcing” a person into mental health treatment.

And those court orders aren't easy to get.

In short, for a person to be committed to mental health treatment a judge must find that the person is an immediate danger to himself or others.

Kaczynski said this is a high threshold, but said that's for a good reason.

“It's a balancing act between ensuring the safety and well-being of a person and the community and protecting a person's civil rights,” Kaczynski said. “When you are talking about taking away somebody's freedom, that's not something we should take lightly.”

Privacy laws are another stumbling block for both family members and mental health workers.

Kaczynski acknowledges that supportive friends and family members in patients' lives offer some of the best chances of long-term recovery. But health care privacy laws can seriously restrict the information available to friends and family - particularly if the patient does not agree to allow the information to be given to those people.

That's exactly what happened to Beverly Gille recently when her son was moved from the jail to a treatment facility and had temporarily rescinded permission to release information to his mother. Gille said she spent the better part of two days worried and scared about her son's whereabouts and condition.

Hoping for help

Beverly Gille said she's talking to whomever will listen about her son's situation because she's hoping that her story will spur public discussion and perhaps lead to action in the legislature.

What she is hoping for is some means of probation-like oversight of cases such as her son's that doesn't involve the criminal justice system or a full-blown commitment order.

In 2004, the legislature took a small step in that direction when they passed and the governor signed “Kevin's Law.”

The law amends the mental health code to allow for court-ordered outpatient treatment for certain mentally ill people who are not complying with their recommended mental health treatment.

Kaczynski said the new law still has its limitations, because it still requires a time-limited court order with the same or similar high “danger to himself or others” threshold. She said so far in the agency she oversees the law has seldom, if ever, been used.

Gille said her son is “doing OK” for the moment, but she is concerned that status could change as his probation expires and the responsibility for managing his condition falls back to him.

“My plea for help is real,” Gille wrote in a recent letter. “People ask me ‘What are you going to do?' I say ‘All that I can in my power and then some until my very last breath. Never, ever will I give up.'”
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News from the states - NAMI

News from the States

To follow up on any of the items featured in this publication, please contact Steven Buck at sbuck@nami.org

Governors Propose Health Reforms

Governors from three states–-California, Oregon, and Pennsylvania-–have joined other state CEO's in elevating healthcare reform to the top of the 2007 public policy agenda.

In California, Governor Schwarzenegger announced a proposal requiring all state residents to obtain health insurance. Analysts predict that if the Governor's proposal is successful, an additional 30 states would copy California's plan. Criticism of the proposal centers on the plan's complexity and some fee assessments that are part of the program design. (kaisernetwork.org, January 16, 2007)

Meanwhile, in Pennsylvania, Governor Rendell has proposed sweeping reforms that would extend health coverage to the state's 760,000 uninsured residents, cut billions in health care costs and ban smoking in restaurants, bars, and workplaces. The package, if enacted in full, would require changes to 47 state laws and regulations. To fund the reforms, Rendell proposes a ten-cent per pack increase on the state's cigarette tax and fees on businesses that do not offer health insurance to employees. (nytimes.com, January 20, 2007)

Oregon's former governor (and emergency department physician) John Kitzhaber has announced the introduction of the Oregon Better Health Act, a far-reaching proposal that was the product of eight months of civic engagement including a diverse planning group. The reforms would focus on redefining health "benefits" and increasing efficiency in the healthcare delivery system. If passed, the reforms would require Congressional approval to reallocate public dollars spent on healthcare. (KTVZ.com, January 17, 2007)

Idaho Medicaid's Fiscal Situation Improving

The Idaho Medicaid program is returning $12 million to the state this year due to a stronger than expected economy. These savings were generated by the Medicare drug benefit and from Medicaid reform efforts. Anticipating some growth in FY2008, Governor Butch Otter plans to ask the legislature for a 5.1 percent increase for the program, a growth rate about one-third of recent requests for funding. (KTVB.com, January 18, 2007)

Expansion of Medicaid Managed Care on Blunt's Agenda

Governor Matt Blunt of Missouri is considering expansion of Medicaid managed care as a strategy for including primary care for state Medicaid recipients and for reigning-in state expenditures on the federal-state program. Using a "health care home" approach, the plan would likely rely on federally qualified health centers to serve as the coordinating clinics. As part of an ongoing study, the state is considering expanding the number of qualified health centers into 21 counties beyond the Kansas City and St. Louis areas. (Kansascity.com, January 18, 2007)

Consultant Projects a $2.5 Billion Need for North Carolina's Mental Health System

A recent study by the Joint Legislative Oversight Committee on Mental Health, Developmental Disabilities, and Substance Abuse Services have identified 17 specific problem areas in the state's struggling mental health care system. The study wraps up one month after a consultant reported a multi-billion dollar investment would be required to bring the state's system up to par. As part of the review process, advocates point to a lack of crisis services and concerns about the number of persons experiencing mental illness who are entangled in the criminal justice system. (citizens-times.com, January 20, 2007)

New Jersey Legislature Pushes for Constitutional Amendments to Remove Stigmatizing Language

Senate President Richard Codey has introduced a resolution that would remove archaic language from the state's constitution related to mental illness. The resolution seeks to remove outdated terms such as "idiots" and "insane," which were inserted in the constitution in 1844. The resolution must be passed by both legislative chambers and then receive the approval of state voters in the November election. (delawareonline.com, January 9, 2007)

West Virginia Legislature Seek Involvement in Medicaid Reforms

As West Virginia begins a sweeping reform that will change the way 384,000 West Virginians get their healthcare, lawmakers are seeking to change state law and require the Medicaid agency to inform the legislature and public about alterations to the $2.1 billion program. Legislators are particularly concerned about the lack of communication involving the recent reforms ordered by Governor Manchin's administration. (sundaygazettemail.com, January 21, 2007)

NAMI Advocacy Tools & Resources

Deciding to redirect advocacy to federal oversight agencies is one of the difficult decisions faced by NAMI leaders.

In recent weeks, NAMI and NAMI Georgia jointly made a decision that Georgia's failing system of state hospitals merited such an important step.

Following disclosure of the history of neglect at Georgia state hospitals through a newspaper series, NAMI called for an investigation by the US Department of Justice. In a letter to U.S. Attorney General Alberto Gonzales, NAMI Executive Director Michael Fitzpatrick advised that "Federal action is not only appropriate, but imperative" under the civil rights law that protects institutionalized persons.

Related to NAMI's technical assistance to state and affiliate organizations, NAMI is pleased to announce the appointment of Angela Kimball to serve as director of state advocacy. To contact Angela, please email her at angelak@nami.org.

Washington Quick Glance

House Clears Stem Cell Legislation

As discussed in the January 10th Statehouse Spotlight, the House of Representatives was poised to take action on HR 3, a vote to clear restrictions on stem cell research. On Jan. 11, the House cleared the Stem Cell Research Enhancement Act of 2007 by a vote of 253-174.

The bill now moves to the Senate where support is strong. However, President Bush has renewed his pledge to veto the legislation. To review NAMI's letter in support of HR 3, click here. Updates on the progress of this legislation, and other important measures, will be published regularly in Statehouse Spotlight and other periodic NAMI communications.

Campaign for the Mind of AmericaNAMI Statehouse Spotlight is an electronic newsletter provided free of charge as a public service. With more than 1,100 state and local affiliates, NAMI is the nation's largest grassroots organization dedicated to improving the lives of people with severe mental illnesses. Contributions to support our work can be made online.
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Mental health one of many issues Legislature must address - Hendersonville Times-News

Originally published Januayr 24
Editorial

When the General Assembly starts work today, issues that affect the wallets and quality of life for mountain residents and all North Carolinians should take priority: Medicaid and mental health reform, education and preservation of open lands.

The state must find a way to relieve counties of paying a share of Medicaid, the federal medical insurance program for the poor and disabled. Eliminating that burden, which North Carolina alone among 50 states lays on its counties, would free up almost half a billion dollars counties could put toward building new schools.

The Legislature should have taken care of this problem last year when the state had a $2.4 billion surplus. Though extreme fiscal discipline is needed to fix it now, that effort ought to go forward in the interest of fairness and property tax relief at the local level.

North Carolina's counties face almost $10 billion in school construction needs, according to the N.C. Association of County Commissioners. Henderson County is looking at an estimated $300 million in county building needs, mostly for schools, through 2020.

Medicaid costs in 2005-06 totaled $4,485,689 for Henderson County, $1,507,466 for Transylvania and $912,634 for Polk. Altogether, North Carolina's 100 counties shouldered a staggering $427 million in Medicaid costs that year.

With billions in needs for new schools statewide, counties also want other help, in the form of a $2 billion statewide school bond referendum or alternative revenue sources, such as a .5 percent tax on real estate transfers or a half penny sales tax. Any movement to help counties build new schools is desperately needed.

The crisis in mental health care has not gone away since the General Assembly and state bureaucrats first bungled reforming the system six years ago. A couple of different reports in the past month have estimated it would cost $500 million to $5 billion to fix the system.

State Sen. Tom Apodaca, R-Hendersonville, is right when he says the General Assembly can't afford to fund the system at those levels. The Legislature ought to be looking at making sure state reimbursements to mental health providers cover their costs as it moves toward the goal of privatizing care. And we hope the local delegation is successful in its effort to send home $200,000 to repay Henderson County for buying the Sixth Avenue West Clubhouse, a psycho-social rehabilitation program that's served residents for more than 20 years.

Mountain legislators are pushing other initiatives of statewide and regional importance. Apodaca's school testing reform proposal to scrap numerous exams in favor of one standardized national test deserves serious consideration.

Rep. Carolyn Justus, R-Dana, using the important work of the study committee she chaired, will file a bill to increase penalties for destroying graves, clear up confusing state laws and initiate citizen programs to preserve historic cemeteries. The issue won statewide recognition based in part on the ongoing coverage of Times-News reporter Jennie Jones Giles of obliterated, lost and threatened historic graveyards in this area.

Another item of huge importance to the state and mountains is finding a way to buy Chimney Rock Park as part of the future Hickory Nut Gorge State Park. The Land and Water Conservation Commission has backed away from a proposed $1 billion state bond referendum to buy land for parks, but says the state still needs to spend that much on conservation over the next five years.

The Times-News will take a closer look at several of these priorities over the next couple of days, but suffice it to say legislators have got their hands full. Issues such as school construction, reform of the mental health "reform" and the need for more parks and open space won't go away, but will become more pressing as our state and region continue to rapidly grow.
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Vision added to Orange County homeless plan - Raleigh News & Observer

Cheryl Johnston Sadgrove, Staff Writer

CHAPEL HILL - The committee charged with crafting a 10-year plan to end homelessness in Orange County decided Wednesday the plan isn't ready to meet public approval.

Members of the steering committee decided to add a vision statement, success stories from other places and some cost estimates to help win support from local governments and other potential financial partners.

The 10-year plan is part of a federal initiative to have communities come up with effective ways to address homelessness. Durham and Wake counties are already implementing their plans.

Orange County's plan proposes creating an outreach team to build relationships with homeless people on the streets, building 40 housing units to provide permanent housing for individuals caught in a cycle of homelessness, and providing more substance abuse and mental health treatment and other services. It embraces a federal initiative called Housing First, which emphasizes providing housing before an individual commits to a treatment plan or other programs.

The plan estimates the housing units will cost about $3 million to $4 million to build.

For the public to be willing to spend a lot, the plan has to provide a vision that convinces people that the plan will improve the community,

"Let's give people the vision that if we do this, we're going to improve quality of life around here, not just for those who are homeless, but for everyone," said Mark Zimmerman, chairman of the board of directors of the Chapel Hill-Carrboro Chamber of Commerce.

Finding money to build the units might not be that difficult, said Jefferson Parker, finance director for the Chrysalis Foundation for Mental Health Inc. Grants are available for capital projects, but it may be harder to find money for the Assertive Community Treatment Teams that will bring services to homeless individuals, he said.

Jacquelyn Gist, a member of the Carrboro Board of Aldermen, said the public and local governments will be confused about how this plan meshes with the mission of the Inter-Faith Council for Social Service, a Carrboro-based nonprofit that provides meals, groceries and emergency shelter for people in Orange County.

"The IFC is getting ready to start looking for some more money, and a new place for the homeless shelter and the kitchen," Gist said. "So, as we get closer, those two initiatives are going to have to work really close together, or one is going to get short-changed."

No one representing the IFC attended the meeting. Chris Moran, IFC executive director, told the Chapel Hill News on Tuesday that he is concerned that the plan is too focused on the chronically homeless.

The committee will meet again Feb. 28 to go over the revised draft plan. Read more!

State's Prop. 63 funds help get mentally ill off the streets - Sacramento Bee

By Judy Lin - Bee Capitol Bureau

State officials today are rolling out an ambitious plan to create 10,000 new housing units for homeless people who suffer from mental illness.

The Department of Mental Health and the California Housing Finance Agency plan to spend up to $75 million a year in Proposition 63 funding on the brick-and-mortar stage of establishing permanent, supportive housing for the mentally ill.

An additional $40 million will be used to subsidize rental units, bringing the investment to $115 million a year for addressing one of the state's ongoing social challenges.

"It's our first major initiative under the Mental Health Services Act," said Sen. Darrell Steinberg, author of Proposition 63, which voters passed in 2004 to tax individuals who make more than $1 million for expanding mental health services in California.

"We promised to voters that we would deliver big impacts, and this will be one of the big impacts to address homelessness."

The $115 million, Steinberg said, will be available every year for the next 20 years due to higher-than-expected revenue projections from Proposition 63. Combined with new housing bond money passed under Proposition 1C and existing federal funding, Steinberg said the state could generate up to $6 billion in the fight against homelessness.

While mental health advocates hailed the housing initiative as a critical element for helping people get off the streets, it comes at the same time that Gov. Arnold Schwarzenegger is proposing to cut the precursor program to Proposition 63, also written by Steinberg under Assembly Bill 2034.

Mental health advocates say AB 2034 has helped an estimated 4,500 people transition off the streets into permanent housing where they can regularly receive medical and psychiatric treatment, and even start working.

"If the money was to go away today, we'd have to stop all operations and support for the people we're working with," said John Buck, executive director of Turning Point in Sacramento, one of three nonprofit mental health service agencies currently receiving AB 2034 money to run a homeless intervention program. "That's a big concern."

Buck said the program has proven to be cost effective simply by reducing the number of days people suffering from mental illness spend in hospitals or in jail.

One of Turning Point's success stories is 47-year-old Mildred Littlejohn, a formerly homeless mother who has been living independently in a one-bedroom apartment nestled in a sprawling, gated North Highlands complex for the past three years.

After 12 years of drifting from Connecticut to California, Littlejohn, who suffers from schizophrenia, cherishes having her own bedroom, which she describes as her "sanctuary."

"I never knew I didn't have to be on the street," said Littlejohn, whose son is now 26 and drops by for visits.

In her bedroom decorated only with a black dresser, matching nightstand and a bed she purchased on a layaway plan, Littlejohn deliberately keeps the white walls bare so she's not distracted from sleep at night. A white shopping cart is collapsed leaning against one wall. She takes it out when she rides the bus to Sam's Club for groceries.

"I'm like a pit bull," she said. "I found my niche, and I don't want to share it with anybody."

Department of Finance spokesman H.D. Palmer said Proposition 63 revenues are coming in higher than anticipated, from $1.6 billion this fiscal year to $1.8 billion in 2007-08.

"The budget proposes to eliminate this program," Palmer said. "You have similar services to what is being provided under Proposition 63."

Steinberg said he wants the Legislature to reinstate $55 million in annual funding for AB 2034.

"We're going to fight that cut. Even though the projections for the Mental Health Services Act are very positive, when it comes to the years of neglect, no one can argue that there's too much money going to mental health illness." Read more!

Closing the revolving door - NY Times

Editor's Note: The editorial mentions 1 of 6 inmates with a mental illness, far below the U.S. Department of Justice estimate of 45% of federal prisoners. It is unknown where the Times figure comes from.

The United States is paying a heavy price for the mandatory sentencing fad that swept the country 30 years ago. After a tenfold increase in the nation’s prison population — and a corrections price tag that exceeds $60 billion a year — the states have often been forced to choose between building new prisons or new schools. Worse still, the country has created a growing felon caste, now more than 16 million strong, of felons and ex-felons, who are often driven back to prison by policies that make it impossible for them to find jobs, housing or education.

Congress could begin to address this problem by passing the Second Chance Act, which would offer support services for people who are leaving prison. But it would take more than one new law to undo 30 years of damage:

¶Researchers have shown that inmates who earn college degrees tend to find jobs and stay out of jail once released. Congress needs to revoke laws that bar inmates from receiving Pell grants and that bar some students with drug convictions from getting other support. Following Washington’s lead, the states have destroyed prison education programs that had long since proved their worth.

¶People who leave prison without jobs or places to live are unlikely to stay out of jail. Congress should repeal the lifetime ban on providing temporary welfare benefits to people with felony drug convictions. The federal government should strengthen tax credit and bonding programs that encourage employers to hire people with criminal records. States need to stop barring ex-offenders from jobs because of unrelated crimes — or arrests in the distant past that never led to convictions.

¶Congress should deny a request from the F.B.I. to begin including juvenile arrests that never led to convictions (and offenses like drunkenness or vagrancy) in the millions of rap sheets sent to employers. That would transform single indiscretions into lifetime stigmas.

¶Curbing recidivism will also require doing a lot more to provide help and medication for the one out of every six inmates who suffer mental illness.

The only real way to reduce the inmate population — and the felon class — is to ensure that imprisonment is a method of last resort. That means abandoning the mandatory sentencing laws that have filled prisons to bursting with nonviolent offenders who are doomed to remain trapped at the very margins of society.
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Drive is on to create mental health care safety net - Great Falls (MT) Tribune

By PAULA WILMOT

Psychiatrists are scarce in Montana.

So scarce that a person in crisis often faces a wait of several weeks or months to see one, according to Michael Mason, director of adult and family services at the Center for Mental Health in Great Falls.

Montana isn't alone with the dilemma either. Mason said psychiatrists are short everywhere, not just in rural states.

Not only are there fewer practicing psychiatrists in the country, but the doctors are getting older, according to a nationwide survey for LocumTenens.com in 2005. More than 60 percent of psychiatrists have been out of school more than 21 years. Only 32 percent of psychiatrists are under 45.

Adding to the problem, experts figure 30 percent of the population will need to see a psychiatrist sometime in their lives. So, states and communities are finding alternative ways to provide mental health care.

Formerly called Golden Triangle Community Mental Health Center, the Center for Mental Health is a big piece of the safety net for the mentally ill in the Great Falls area, serving 4,200 clients in 13 counties.

Help also is available from private professional therapists, personal care physicians and in the emergency room and the behavioral health unit at Benefis Healthcare in Great Falls.

The Great Falls yellow pages list five psychiatrists, one child psychiatrist and 14 psychologists.

An estimated 70 percent of the work that goes on at the main location of the Center for Mental Health is with children and families. Adults also find help in the former Largent School building, 915 1st Ave. S.

The New Directions Center, 621 1st Ave. S., deals with more serious cases involving emotionally disturbed and disabled adults, such as those suffering from schizophrenia.

If a child runs into trouble at school, school officials usually meet with the parents. If they conclude the child needs help, he's often referred to the center.

"We like to get them in within 72 hours to start the intervention," Mason said. "Sometimes, the family needs an intervention, too."

If local programs don't work for a child, residential treatment is often recommended, he added. Referrals also are made to child psychiatrists in Missoula or Billings.

"We like to start with the least invasive service," he said. A case worker might get a child into therapy, the whole family, too, if it's advised. "We like working with the kids in their school setting," he added.

Attention deficit hyperactivity disorder and defiant oppositional disorder are common childhood conditions seen at the Center for Mental Health. ADHD is associated with learning disability.

Oppositional defiant disorder occurs when parent-child relationships break down. Left to fend for themselves, kids become angry, resentful and act out, Mason said.

Adults who are treated at the center are often connected to the children's cases. In addition, the center contracts with the Veterans Administration to see veterans in Great Falls instead of sending them to Helena.

Post traumatic stress disorder associated with service in Iraq hasn't shown up much yet, Mason said. "With estimates that 20 percent of Iraq veterans suffer from it, we expect it will create a huge need for services," he added.

A psychologist as well as an administrator, Mason also does clinical work at the center.

Patients at the center are billed on a sliding scale, based on their ability to pay. Those with insurance can go to the center for help, too, although many go to their personal physicians for medications and referrals to therapists.

Therapy work is difficult, and the professional burnout rate is significant, Mason said.

Montana has the second highest rate of suicide in the nation, so it's no surprise that some patients enter the mental health system because of a suicide threat. The statewide crisis line, based in Great Falls, takes more than 1,600 suicide calls a year, about 25 percent of the total calls, which average 6,500. In 2005, the last year for which the state has statistics, 205 suicide deaths were recorded statewide.

Cascade County recorded 18 suicides in 2005, including 15 males and three females. Over the last 10 years, the number of suicides in the county ranged from a low of 13 in 2004 to a high of 21 in 2002 for a total of 172. Men were more than four times as likely to kill themselves as women.

Not all suicide attempts end up in the vital statistics report. Last year, 267 patients were seen in the Benefis emergency room after failed suicide attempts.

Voices of Hope, the organization that fields the crisis calls, has a system for follow-up.

"We assess where they are in the crisis," said Kristy Evans, executive director. "Sometimes, we refer them to the hospital emergency room. Sometimes, police perform a welfare check on them," she said.

Crisis-line calls are taken 24/7 by 20 trained volunteers and four staff members. "We're not a counseling service. We're there to listen and give referrals," Evans said. "They want us to tell them what to do, but we can't. They need to develop their own plan."

The "plan" includes a promise not to attempt suicide until they have talked to their counselors, she explained. If they can't afford a counselor, the City-County Health Department has counselors who take pro bono cases, and a suicidal person might be referred to one of them.

Suicide prevention is a joint effort of Voices of Hope and the health department.

A recent $30,000 grant from the State Department of Public Health and Human Services to the local City-County Health Department will help finance a number of activities.

Teen Screen is a free, optional computerized mental-health screening that helps determine whether a student may be at risk because of drug or alcohol use, family, money or peer problems.

QPR training is given by Voices of Hope throughout the community by request. QPR, which stands for question, persuade and refer, is part of the training completed by the crisis line volunteers.

"It gives you tools on what to do if you know someone is suicidal," said Carol Keaster of the local health department.

Depression screening is planned at the University of Great Falls and College of Technology, too, according to Keaster.

The post-holiday season commonly seeks a spike in depression, an underlying condition that can lead to suicide, Mason said.

Depressive disorders affect some 18.8 million American adults, or about 9.5 percent of the adult population. About 80 percent of sufferers receive no treatment. Many are too embarassed to seek help or believe it is a weakness, not an illness. Some don't know where to turn for help.

For some people, the holidays are a set-up for a crash, according to Mason. The expense, the stress, the demands, the expectations are too much, he said.

"If a person has an underlying depression from an emotional loss, such as a death in the family or a divorce, it can be a bigger crash," he said. The combination of post-holiday depression and seasonal affective disorder, caused by winter's darkness, make January and February a busy time for mental-health professionals.

"A person with moderate depression might recover without professional help," Mason said. "Talking it out with a network of friends can help. Exercise and eating right are important, too."

Major depression is a different story.

A person who loses motivation, sleeps too much, feels hopeless, and has low energy and difficulty making decisions might have a major depression.

"If you suspect someone is in trouble with depression, reach out and talk. Say 'You haven't been yourself lately. Do you want to talk about it?' If they're in over their head, try to refer them for help," Mason said.

Often a personal physician is a step in the right direction. The doctor can prescribe anti-depression medications or refer the person to a therapist. Religion can help too, or pastoral counseling.


Reach Tribune Staff Writer Paula Wilmot at 791-6594, 800-438-6600 or pwilmot@greatfallstribune.com.

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Nevada's rural mental health centers may see staff cuts - Las Vegas Sun

CARSON CITY, Nev. (AP) - Mental health officials said Wednesday they'll eliminate 29 vacant positions in rural Nevada clinics because they didn't get funding from Gov. Jim Gibbons' new budget to recruit and retain skilled staff.

"It's a work force crisis we've been talking to the legislators about for many years," said Carlos Brandenburg, administrator of the Division of Mental Health and Developmental Services. "Not everyone with a degree can adapt to conditions in the rural frontier."

While Gibbons recommended a big increase in funding for the Department of Health and Human Services, which oversees the mental health division, he wouldn't endorse incentives to bring more qualified mental health staffers into the rural areas.

The incentives included a $2,400 signing bonus, a 5 percent pay differential for rural area workers and accelerated retirement that would offer six years of retirement for five years of service.

The incentives, which have a pricetag of $2 million over two years for all rural mental health workers, are based on similar programs offered to police and teachers in rural areas.

"There are no new concepts here," said HHS Director Michael Willden.

The rural clinic positions - mainly nurses, counselors, psychologists and social workers - were approved by the Legislature four years ago but were never filled. The positions amount to 15 percent of all mental health staffers for rural areas.

Ray Kendall, agency director for the rural clinics, said waiting lists at some of the 21 clinic locations in rural Nevada are three to four months long. Access to a psychologist who can write prescriptions only happens once a month in Ely and Battle Mountain, for example.

Suicide rates in rural Nevada average two to three times the national average and are consistently higher than the state average, according to Misty Allen, suicide prevention coordinator at HHS.

Even with programs to help repay school loans and reimburse moving expenses, recruiting trained staff for rural Nevada remains extremely difficult, Kendall said, adding that thousands of recruitment letters each year to prospects around the country usually produce nothing.

"There is a shortage of social workers nationally," Kendall said. "It would make a huge difference if we could get those three incentives that were proposed."

Assemblyman Morse Arberry, D-Las Vegas, asked Brandenburg to repeat himself during his briefing to a joint Senate-Assembly budget subcommittee on Wednesday. Arberry is vice chairman of the subcommittee.

"Did I hear you are eliminating staff?" Arberry asked. "Will you help transition them somewhere else?"

Brandenburg clarified that the 29 positions are vacant and nearly impossible to fill under current circumstances. Leaving the positions open also dilutes caseload statistics and makes it harder to justify staff funding, Kendall said.

Assemblywoman Sheila Leslie, D-Reno, said she does not want to give up on rural Nevada, saying, "We absolutely have to find a way to provide those (mental health) services."

Gibbon's proposed budget for all human services programs amounts to $2.01 billion, which accounts for 29.4 percent of the total general fund budget. If approved, human services funding will increase by 22.6 percent over the 2005-2007 budget years, compared with an 18 percent increase in general fund revenue.

Federal dollars for human services are decreasing in Nevada because funding equations take into account the increasing wealth of the state. Gibbon's budget replaces $5.3 million in lost federal funds for substance abuse treatment and prevention programs. Mental illnesses and substance abuse often go hand in hand, Brandenburg said.

Also, the governor's budget allots $11 million for a 6 percent pay raise to state clinical workers to bring salaries in line with those of other Western states. Read more!

Violence Against Mental Health Professionals - Psychiatric Time

By Richard A. Sherer, Psychiatric Times

Once his colleagues began to recover from the shock, the death of Dr Wayne S. Fenton triggered a discussion in the professional and lay press about the risks of violence to mental health professionals posed by mentally ill patients. Fenton was found unconscious and bleeding in his office in Bethesda, Md, on Sunday, September 3, 2006. He had been beaten severely around the head and died at the scene.

A 19-year-old man, Vitali A. Davydov—his name was published following his arrest—was found nearby with blood on his hands and clothing. Fenton had met with Davydov for the first time the day before, on a referral from a colleague. On Sunday morning, Davydov's father asked Fenton to meet with his son again because the young man was refusing to take his medications.

According to news accounts, the charging document presented in court says that Davydov "elected to make a statement of admission to the crime" after being informed of his rights. Davydov was indicted for the killing on October 26. The charging document also says that Davydov was being treated for schizophrenia and bipolar disorder.

Fenton was director of the Division of Adult Translational Research and associate director for clinical affairs at the National Institute of Mental Health. According to a statement from NIMH, he "authored textbook chapters and more than 50 scientific papers on [the] diagnosis, treatment, outcome, and service delivery for schizophrenia. He also served as Deputy Editor of Schizophrenia Bulletin and served as a consultant to the Department of Justice, Civil Rights Division. He was active in the National Alliance for the Mentally Ill, serving on the Scientific Council of this advocacy organization."

In addition, he was NIMH's liaison to the American Psychiatric Association (APA) and the World Psychiatric Association and was involved in the development of the agenda for the forthcoming DSM-V. Fenton also maintained a private practice in Bethesda and had a reputation for working with extremely difficult patients.

Two days after Fenton's death, the Washington Post headlined a story, "Devotion to Most Severe Cases Raises Risk of Personal Danger." The article began, "Wayne Fenton knew better than most about the risk of treating people with severe mental illness," which drew an immediate response from Liz Spikol, managing editor of the Philadelphia Weekly, who writes a blog about mental illness.

"This is entirely predictable spin, but it's misleading. The fact is, the vast majority of violent crimes are NOT committed by a person with mental illness," she wrote, citing a passage in an August 2005 commentary by Leon Eisenberg, MD, published in Archives of General Psychiatry: "In the public mind, violence is associated with mental illness. Yes, there is a strong association, but . . . persons who are seriously mentally ill are far more likely to be the victims of violence than its initiators." The Post article, quoting Fuller Torrey, MD, said that "each year, people with serious mental illness commit about 750 murders, or five percent of the homicides, in the United States."

But the risks of treating the mentally ill are measurably greater than the risks facing other physicians or the American workforce as a whole. Times Online, a Web site combining reports from The Times and Sunday Times of London, reported that "the rate of [being a victim of] non-fatal, job-related violent crime is put at 12.6 per 1000 workers across all occupations in a survey by the US Department of Justice. Among doctors, the rate is 16.2 per 1000. For psychiatrists and mental health professionals, the rate is 68.2 per 1000."

Commenting on the Fenton case, the writer added, "Dr Fenton, 53, clearly had not foreseen that he was at serious risk. And if he couldn't predict it, who can?"

Paul Jay Fink, MD, past president of the APA and a consultant on youth violence and youth murder working with the city of Philadelphia, echoed the same thought in an interview with Psychiatric Times. "Can we actually determine who's going to be violent? We know that patients with untreated schizophrenia have more of a tendency toward violence, especially if they have been using alcohol. We know there are parameters to determine the possible level of dangerousness. Can we ever be 100% accurate? The answer is no."

Fink believes that a psychiatrist, especially one working with unstable patients, has an obligation to learn something about referrals if he or she can.

"When you have somebody who is dangerous and you don't know them and they don't know you, you need to be careful," he said. "Any little insult can fire up a paranoid patient, and that's a danger. The first thing a psychiatrist should learn is that he should get some information when he does the consultation, so he can get some sense of the presence of danger. You can get a message on your answering machine with no information and end up walking into a patient's gun, so to speak.

"Patients are impulsive," Fink added. "They can react negatively to a remark that you didn't think was terrible."

Inexperience—not a factor in the Fenton case—often leads physicians into difficulty, especially in dealing with mentally ill patients. Fink recalled an example from his own past.

"The uninitiated sometimes make big mistakes and say things they shouldn't say. I did once, 50 years ago, when I was a resident: I was in the residents' area and heard a noise in the day room. I went in and saw a patient of mine screaming and acting very psychotic. He was surrounded by 30 or 40 staff and other patients who were making things worse.

"I walked into the circle, took the patient by the hand, walked him across a lawn and up 2 flights of stairs. I got him into the locked men's ward, and I said 'I'm going to have to take away your ground privileges.' He picked up a water fountain—pulled out the pipes—and threw it through the nurses' station window. I thought, 'That was stupid. It could have been me.'"

Fink's personal experience reflects the findings of researchers of violence against physicians. David Fink, MD, surveyed psychiatric residents at several institutions in Pennsylvania and found that 41% said they had been assaulted and 48% had been threatened during their training. In an essay included in the APA's clinical practice publication Patient Violence and the Clinician, he noted that "Available studies confirm that a substantial percentage, approximately 40 percent, of psychiatric residents will be assaulted at least once during the course of a 4-year residence. . . . Violence against residents cannot be considered as an occasional and acceptable risk of training."1

Citing an earlier study, David Fink quoted S. I. Hallack as pointing out a possible reason for the increased risks during residencies: "Psychiatric training programs traditionally place their least experienced doctors in the most difficult treatment situations."

The effort to predict which patients may present a threat is still in its infancy. A study reported in BMC Psychiatry by Abderhalden and colleagues2 noted that the BrØset Violence Checklist has been effective when used with patients in the hospital: "The [checklist] assesses the presence of six observable patient behaviors namely whether the patient is confused, irritable, boisterous, verbally threatening, physically threatening, and attacking objects. The reported discriminatory ability is good with a correct prediction rate around 85%."

Paul Jay Fink suggested that practitioners dealing with unstable or unknown patients might improve their safety by redesigning their offices. "Place your chair closest to the door so you don't paint yourself into a corner. . . . There are times when you may . . . have to leave the door of the office open so that you have vocal access to somebody who will hear you. But that's when you know a patient is threatening.

"Most offices are not organized in the way I'm talking about," he added. "I don't have a single schizophrenia patient in my practice. I'm an analyst; I see patients on the couch. If I had Fenton's practice, which was almost all schizophrenia, I might have a panic button. If I thought a patient was extremely dangerous, I might ask a family member or a colleague to sit in with me. But you can't do that frequently. You've got to know the customer."

References
1. Eichelman BS, Hartwig AC, eds. Patient Violence and the Clinician. Washington, DC: American Psychiatric Press; 1995.
2. Abderhalden C, Needham I, Dassen T, et al. Predicting inpatient violence using an extended version of the Brøset-Violence-Checklist: instrument development and clinical application. BMC Psychiatry. 2006;6:17.
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Teen Screening Inspires Controversy - Scientific American

If mental illness is epidemic among teenagers, why isn't screening for it routine?

By Charles Q. Choi

When Laurie Flynn's 17-year-old daughter Shannon attempted suicide, it came without warning. "I would have sworn on a stack of Bibles until the attempt that there was nothing wrong with her. I had no clue," Flynn recalls.

The story is disturbingly familiar to many parents. Suicide is currently the third leading killer of teenagers, after accidents and homicide. Each year roughly one in 10 teens ages 15 to 19 attempt suicide at least once, with more than 600,000 injuring themselves badly enough after their attempts to require medical attention.

Past studies have revealed that parents do not know of suicide attempts 90 percent of the time. In fact, roughly one third to two thirds of suicidal teens do not reveal past attempts to anyone.

Teens with mental disorders are at even greater risk—roughly 90 percent of teens who died by suicide had a psychiatric illness at the time of their deaths, according to research by child psychologist David Shaffer at Columbia University. Nearly two thirds of youth who die by suicide exhibit psychiatric symptoms for more than a year beforehand, which makes this time a significant window for potential intervention.

Flynn is now executive director of TeenScreen, a national mental health and suicide risk screening program based on Shaffer's research. In 2005 the program screened more than 55,000 teens at 460 sites in 42 states and they hope to have exceeded 500 sites by the end of 2006. "The idea is to identify risks early to prevent tragedies," Flynn says. "It's amazing when kids who are really struggling and don't know why then learn what's going on and that there are things that can help."

The program not only helps detect teens at risk for suicide, but also tackles the silent epidemic of mental illness among young people.

"There are people who say, 'Suicide is rare, so why devote such energy to it?' And they're right," Shaffer comments. "The rationale for going ahead is that the disorders predisposing to suicide are very common and extremely disabling. If they can get help, their school attendance can go up, social relationships can improve, grades can get better, and they can feel happier."

Teenage mental illness also has consequences later in life—research from sociologist Ronald Kessler at Harvard Medical School has revealed that more than half of all cases of adult mental illness begin during the teenage years. "Five out of 10 of the leading causes of disability worldwide are significant mental illnesses, and the number one overall cause of disability in the United States is depression," notes Eric Caine, co-director of the Center for the Study of Prevention of Suicide at the University of Rochester, who is not associated with TeenScreen. "If you start to look at their economic impact, the World Bank, which is not exactly a soft-hearted group, found major mental disorders have a huge impact far exceeding infectious diseases and a number of cancers, but there's an inordinate lack of attention toward them."

"The hope is to take away some of the stigma around mental health disorders with the idea of a mental health checkup, as routine and widely available as any other checkup," Flynn explains.

TeenScreen employs a screening process divided into two stages: In the first, teens answer questionnaires with roughly 15 to 50 questions dealing with the most important signs of teen suicide. "For the most part that's depression in girls. Boys are more complicated—often depression with substance or alcohol abuse, or anxiety disorders," Shaffer says.

All teens then go on to a second stage that includes face-to-face discussions. Those that had tested positive by answering yes to a certain number of questions about their mental health meet with clinicians to determine if they are truly at risk. Those teenagers that are deemed so are then offered a referral for a complete mental health evaluation. with negative test results meet with program staff for the chance to ask for help with any problems not covered in the screening. Read more!

1500 rally for mentl health housing in Albany - Empire News Service

ALBANY, NY -- (01/23/2007) The New York State Campaign for Mental Health Housing (www.campaign4housing.org) brought over 1,500 people from across the state to the Capitol in Albany Tuesday to call on the Governor and Legislature to include $100 million in the state budget to preserve, reform, and develop supportive housing for people with mental illnesses.

Steve Coe, Campaign Chair and Executive Director of Community Access, said that after 10 years of the band-aid approach to the growing shortage of supportive housing for people with mental illnesses, it's time for the state to invest wisely in solutions that will make a real difference.

"As we can see by the amazing turnout here today -- mental health issues touch many, many lives," said Coe. "It's not just the 200,000 people in New York who live with mental illnesses, but lives of their friends and family are often thrown into turmoil as well." Coe said that the lack of appropriate housing is a roadblock to recovery, leads to homelessness, and overburdens overcrowded hospitals and jails. "There are over 10,000 people with mental illness living on our streets," Coe said. "Over 1,500 youth transition out of foster care and become homeless each year, and thousands of people with mental illnesses await discharge from hospitals and jails with nowhere to go."

"In the meantime," said Coe, "we're throwing away upwards of $250,000 per person with mental illness per year to shuffle them from emergency services to hospitals to shelters to homelessness. A decent home that allows people to live productive lives is as little as $8,000. We can't afford not to re-invest wisely in supportive mental health housing."

Toni Lasicki, a member of the Campaign's Executive Committee and Executive Director of the Association for Community Living said that by preserving services in 30,000 units, reforming existing programs to meet client needs, and developing at least 35,000 units over the next 10 years, we can provide the decent, affordable housing that everyone deserves. "The Campaign's goal is to make the housing and services we have better able to handle the complex needs of the clients, and to develop more housing to keep up with the growing demand. One of the main residential models of care is over 20 years old and in great need of reform" said Lasicki. "People with mental illnesses are capable of living productive lives in their communities if they have an appropriate stable home from which they can organize their recovery."

"I wouldn't be where I am today -- speaking to all of you, healthy, in recovery, and strong -- without the housing I received," said David Newton, a consumer from New York City who spoke at the event. "Today, there are tens of thousands of people waiting for housing. They are not getting treatment, they are not becoming stable, and they do not feel safe. These are people just like me -- with a story to share, and an important life to live."

Roy Neville of Schenectady said that as the father of two adult children living with schizophrenia, he wants what every parent wants for their children: a home, friends, and an opportunity to participate in community life. "As family members, we have done everything possible to provide these simple necessities, often at great personal sacrifice. We are prepared to do even more, and ask only for the government to participate with us as partners to plan for the needs of our family members so they might enjoy independent and productive lives in the future."

For more information on the New York State Campaign for Mental Health Housing, go to www.campaign4housing.org Read more!

Inspection finds problems at mental health agency - Baker City (OR) Herald

For those interested, the list of 16 deficiencies and an explanation is listed in the second half of this story

By MIKE FERGUSON
mferguson@bakercityherald.com

State mental health regulators found 16 ways for Mountain Valley Mental Health to correct identified deficiencies in its program, corrections the agency's board chair and executive director said have for the most part already been made.

At the request of the Baker County Board of Commissioners and following months of criticism of the county's mental health provider by an ad-hoc citizens group called the Healthy Mental Health committee, four members of the state's Addictions and Mental Health Division paid a site visit to MVMH Dec. 5-7.

The team interviewed MVMH employees and administrators, county commissioners and the citizens committee. It also examined the agency's records, policies and procedures.

Among the state team's findings:

o Confidentiality of MVMH clients had been breached because clinical records had been left outside the locked and secure clinical offices.

o The agency had failed to perform criminal background checks and check credentials and infectious disease vaccinations of some employees. "Employees were interviewed and repeatedly responded that they were unclear who was responsible for their supervision and unclear of their specific job duties and responsibilities," the draft report indicates.

o MVMH had no formal policy or procedure for identifying and reporting "critical incidents" among clients, such as suicidal gestures or medication errors.

o The agency's practice of requiring clients to attend "problem solving groups" before seeing an individual therapist "has been negatively affecting access to service for some consumers who are reluctant to participate in a group with other peers, for reasons such as their confidentiality would be compromised."

o None of the individual treatment plans for adult clients that were reviewed by the team met state minimum requirements.

County commissioners received a draft version of the state team's findings last week. To download a PDF copy of the team's entire draft report, visit www.bakercityherald.com.

The final version of the state's findings is due Feb. 1, said Dr. Larry Levinger, MVMH board chair. The deadline for the agency to correct all the identified deficiencies is 30 days later, March 3.

Most of those fixes have already been implemented, Levinger said.

He said the MVMH board has discussed the report extensively and that the agency was working hard to address and change procedures identified by state regulators as deficiencies.

"Most of them are paperwork issues," Levinger said. "We've corrected two-thirds of them at this point, and we plan to correct the rest in the next two weeks."

Levinger said the state's findings — and Mountain Valley Mental Health's efforts to correct the identified deficiencies — won't interrupt the agency's service to clients.

"When they give you a report like this, the state has the option to shut you down," Levinger said. "Mountain Valley Mental Health is up and running and giving good client care. The board gives a lot of credit to (MVMH executive director) Vicki Long, who's been working 80-hour weeks for months, and to our good staff."

Long said the draft report "said nothing about how far we've come to make corrections." She said she's eager for the team of state regulators to revisit her agency. A member of the site review team, Keith Breswick, the quality improvement coordinator for the state Addictions and Mental Health Division, plans to offer the MVMH staff training between Jan. 31 and Feb. 2.

The training will be designed to help employees correct some of the deficiencies outlined in the draft report, she said.

"We're excited for the technical assistance" that Breswick can offer the staff, Long said. "Everything they have to say is helpful to us. It adds clarity."

County Commission Chair Fred Warner Jr. said the draft report "gives us a plan to do what I and the (other two) commissioners want to get our mental health services on track."

He said commissioners are hoping for another site review six to nine months from now — "or at least a clean bill of health before then," Warner said.

Mickey Edwards, chair of the county's newly-formed Advisory Committee for Mental Health and Developmental Disabilities, said her committee will meet with county commissioners Feb. 20 to discuss the state's findings. The draft report clarifies the advisory committee's role, she said.

"Our role is specific in terms of monitoring," Edwards said. The draft report "said we don't even exist, but we had just been formed. They met with some of our members."

"This is something we need to digest to see what it means," she said. "Then we'll do some follow-up to make sure our advisory group is in compliance."

Len Ray, the Addictions and Mental Health Division's community development, quality improvement and certification manager, said that while it's difficult to compare Mountain Valley Mental Health to other mental health providers around Oregon, "each (provider) has a unique set of strengths and weaknesses. What we're looking to do is support local (county) commissioners and the board of directors to make sure that mental health services are as strong as they can be in Baker County."

Ray said that all his team's findings can be corrected by Mountain Valley Mental Health "with appropriate support from the board and commissioners and our own technical assistance, to make sure they can comply with our requirements."

That technical assistance is available when the site visit team thinks it would be beneficial, or when it's requested by the local mental health provider. In this case, it was both, Ray said.

"Vicki Long asked for it, and we found it's something we want to provide, given the conditions we found," he said.
Here are the 16 deficiencies identified by the state's site review team, and brief descriptions of how the deficiencies must be addressed:

1. The Mental Health and Developmental Disability Advisory Committee had not existed for four years up until it was formed by Baker County Commissioners in November 2006. As a result, the committee had not performed its duties as required by Oregon Administrative Rules, the rules state agencies use to implement state statutes.

Required Action: The committee must meet at least quarterly to advise commissioners and service providers on community needs and priorities, as well as to plan, review and evaluate services.

2. MVMH's clinical records must be locked and accessible only to authorized staff.

Required Action: By March 3, MVMH must notify the state which consumers were affected by the insecure storage of records, and document the fact that records are being stored in a secure way.

3. MVMH has no quality management plan, quality assurance committee, or policies and procedures for performing quality improvement, as required by state statute and OARs. Several consumers interviewed by state regulators had been "diagnosed with severe and persistent mental illness, yet none of them were currently receiving case management services as would seem appropriate for meeting their needs and circumstances," the draft report indicated.

Required Action: The agency has 90 days to create and implement a Quality Management Plan.

4. There's a lack of coordination of care between the crisis services provided to clients after hours and their primary clinician. Some staff provides crisis intervention without required clinical supervision, while staff qualified to provide services are not assigned these duties.

Required Action: MVMH has 30 days from receipt of the final report to prove that qualified mental health professionals are providing crisis and assessment services

5. The agency's "General Procedures for Complaints" policy dues not meet OAR requirements. Consumers and family members contacted the Addictions and Mental Health Division, but none of their complaints were identified in the consumer's charts or responded to as required by OAR.

Required Action: MVMH has until March 3 to send a draft procedure for accepting, processing and responding to complaints and grievances.

6. Personnel records for MVMH employees, contractors, personal care assistants and volunteers were incomplete and inadequate and should include a criminal background check, infectious disease vaccinations, credentials of education and experience, position description and date of hire.

Required Action: MVMH has 30 days from receipt of the final report to "determine additional documentation and actions necessary to bring personnel records into compliance with administrative rules requirements."

7. Only one report from the agency had been filed with the state's Office of Investigations and Training during the past three years, despite numerous indications of other critical incidents or consumer reports of abuse and neglect.

Required Action: By March 3, MVMH must conduct training for all staff on the requirements of mandatory abuse reporting.

8. In addition to reporting abuse, MVMH must identify, report and respond to critical incidents, such as breach of confidentiality, suicidal gestures of enrolled consumers or medication errors. There's no policy that identifies critical incidents or a procedure for responding to and reporting these incidents.

Required Action: The agency can use sample policies and procedures available through the state to create its own policies and procedures

9. MVMH has no "authorized designee" to make fitness determinations of employees which, in one case, allowed an individual who was initially denied approval to remain employed and provide clinical services in direct conflict with state administrative regulations.

Required Action: By March 3, the agency must appoint an authorized designee and will, up until that person is in place, rely on the Oregon's Criminal Records Unit to determine fitness for employment.

10. While MVMH's board of directors recently revised the agency's Personnel Policy Manual, the policies don't meet OAR requirements.

Required Action: By early May, the board must send a copy of the Table of Contents page of the newly revised manual to state regulators.

11. MVMH requires clients to attend group classes for three sessions before they can see a therapist, case manager or psychiatrist.

Required Action: MVMH must cease requiring clients to attend the problem solving groups before they can receive services.

12. MVMH's contractors who are currently providing supervision, after-hours crisis services and medical services do not have contractual agreements that meet OAR requirements.

Required Action: MVMH must review and revise all its personal services contracts; contractors will be subject to all conditions of supervision, credentialing, criminal background checks and training as required by Oregon Administrative Rules.

13. Two-thirds of the clinical records reviewed by the site review team didn't contain a current notification of client rights signed by the client and did not include required information, such as the primary care physician's address and telephone number

Required Action: The forms must be revised and sent to state regulators by May 3.

14. Of the nine clinical records reviewed, none of the adult assessments met standards for identifying important biological, cultural, psychological and social factors that are a priority for intervention. The records also lacked consumer or family expectations for recovery and a justification for treatment services and prognosis.

Required Action: The agency must complete a clinical record audit of the mental health assessments in a sample of charts by early May.

15. Adult treatment plans reviewed by the team did not meet key treatment plan standards.

Required Action: A plan of correction is required by March 3.

16. "Progress notes" related to treatment plans were included in, at most, one-third of the clinical records reviewed.

Required Action: A plan of correction is required by March 3. Read more!

Changes sought at children's psychiatric hospital - NY Times

January 24, 2007

By JENNIFER MEDINA

MIDDLETOWN, Conn., Jan 23 — For months, Connecticut’s psychiatric hospital for children has been buffeted by criticism. Employees say it is unsafe and complain that their opinions are dismissed, and others worry that the children remain in custody far too long.

Then last month a report concluded that there were major gaps in communication among management and the psychiatrists, pediatricians and nurses who work at the facility, Riverview Hospital.

On Tuesday, a group of state legislators added to the chorus of dissatisfaction, saying they were eager to see improvements more quickly at Riverview, the only publicly run facility in the state for children with severe mental problems.

“We come out of this knowing that things are not where they should be, but there is improvement,” said State Senator Edward Meyer, the chairman of the committee that held the hearing.

After a stream of complaints from the staff and others, the superintendent stepped down in October. So far, state officials have made little progress finding a permanent replacement.

The commissioner of the Department of Children and Families, Darlene Dunbar — who herself is expected to be replaced by Gov. M. Jodi Rell — said at the hearing that the only viable candidate recently withdrew. And the department, which oversees Riverview and several other facilities, has had several problems in recent years: There have been reports of violence at some places, and other sites that have cared for troubled children have shut down.

“How can you have accountability when you don’t know who should be held accountable?” Mr. Meyer asked. Many critics at Tuesday’s hearing said the problems had deepened in recent years because of friction between management and staff.

“There is no vision and nobody making it clear what the hospital is meant to do,” said Jeanne Milstein, the state’s child advocate.

Ms. Milstein pointed to some children staying in the hospital for more than a year, without plans for their release to a less restrictive setting.

While the number of violent episodes reported by administrators at Riverview had declined in recent months, the report issued last month said that there were “splits at all levels” that made it difficult to make changes at the hospital.

While several leaders, including Ms. Dunbar, have advocated using fewer physical restraints, in part to limit violent outbursts, the report found that there has been resistance among some staff members.

Richard Liburdi, a children’s service worker at the hospital and one of several staff members at Tuesday’s hearing, said many of his colleagues felt their professional opinions were being disregarded. He described one case in which a teenage girl was moved against the advice of a psychiatrist who had worked with her for several months.

Later, Mr. Liburdi said, the girl lashed out at some staff members and had to be restrained.

Despite the criticisms, Ms. Dunbar said that she was confident that the latest report had provided the management and staff with a “road map” for what to do next.

“Will this be overnight? No,” she told the group of lawmakers. “But it is not as if you are coming to us and we don’t know what to do. We do have a plan.” Read more!

Groups urge mental health reform - Macon Telegraph

Advocates call for program to monitor state's health system
By Travis Fain
TELEGRAPH STAFF WRITER

ATLANTA - Mental health advocates Tuesday renewed their push to establish an ombudsman system to watch over the state's mental health system and to investigate accusations of abuse and neglect.

Saying Georgia's mental health system is in a crisis, representatives from four advocacy groups stood on the Capitol steps and demanded a new focus on the mentally ill - particularly in light of a recent Atlanta newspaper report on the suspicious deaths of 115 mentally ill patients under state care.

Legislation creating the ombudsman system has passed the General Assembly before but has never been funded, advocates said. They'd like to see a pilot program funded during this year's session.

Ellyn Jeager, interim director of the Georgia chapter of Mental Health America, pegged the program's startup cost at $500,000, but said she didn't have an estimate to take it statewide.

Jeager and other advocates said they've won interest from state legislators but don't have a sponsor for their ombudsman bill.

Tuesday's news conference didn't come with a display of much support: Of the General Assembly's 236 representatives and senators, only one, freshman state Rep. Doug McKillip, attended.

And the news conference was held in the cold just outside the Capitol, partly because organizers didn't request space inside until the day before. It's also partly because no senator would agree to stand with the group during the conference, a requirement to use the Senate's briefing room.

"They said there's no place for you to go," said a shivering Nora Haynes, president of the National Alliance on Mental Illness' Georgia chapter. "Is this not symbolic?"

The lack of support likely was because NAMI's national office has asked the U.S. Department of Justice to investigate the state's mental health system in the wake of the Atlanta Journal-Constitution's investigation and report, said state Sen. Johnny Grant, R-Milledgeville.

Grant's district includes Central State Hospital, where many of the state's mentally ill are treated. He said the ombudsman proposal has "a lot of merit." He also said Georgia faces serious challenges when it comes to mental health, but they're state problems and need a state fix - not federal mandates.

"I cannot support (the call for a federal investigation)," Grant said Tuesday. "That's absolutely why support shied away (this morning)."

A Department of Justice spokeswoman said NAMI's request is being reviewed, but she didn't have a timetable for that review Tuesday.

"It was so egregious," national NAMI spokeswoman Katrina Gay said of the reported deaths of mentally ill patients in state care. "If even a fraction of them (are true), then how could you not call for an investigation?"

Haynes said she and other advocates will continue to push for the ombudsman program and for other proposals aimed at keeping the mentally ill in treatment programs and out of jail.

One of those proposals is being prepared by state Rep. Pat Gardner, D-Atlanta. Gardner said she will file a bill creating an advanced directive system - an idea embraced at Tuesday's news conference.

Basically the bill, which failed to pass the General Assembly last year, would allow mentally ill patients to sign contract with an agent - typically a family member - who could force the patient to take medication when the patient is not lucid, Gardner said
Read more!

State legislature will be faced with same time-worn problems - Winston-Salem Journal

By James Romoser
JOURNAL RALEIGH BUREAU

RALEIGH - Wednesday is back-to-work day for North Carolina's 170 state legislators. At the stroke of noon, they will get back to work on a laundry list of statewide problems that never seem to go away.

Medicaid. School construction. Road building. Mental-health reform.

Not to mention balancing the budget.

As the 2007 session of the N.C. General Assembly opens, legislators are looking ahead to a session that are likely to be defined not by any new, sexy issues but by lots of old, sticky ones.

"The big issues, as always, will be the budget, education, lack of funds in the highway system," said Rep. Bill McGee, who represents southwest Forsyth County and is the new Republican whip in the N.C. House of Representatives.

Some change, of course, is coming to the legislature this year. Rep. Jim Black, D-Mecklenburg, who has been tarnished by continuing ethics investigations, will no longer be the speaker of the House.

The man expected to replace him, Rep. Joe Hackney, D-Orange, is likely to run the House in a more open manner and could redouble his push for a moratorium on the death penalty.

This year will also be the first year that legislators and lobbyists face stricter ethics rules aimed at preventing lobbyists from giving gifts - such as fancy dinners or golf trips - to legislators. The new, wide-ranging ethics law was passed last year in reaction to the scandals surrounding Black, and now that it has taken effect, many legislators say they are still sorting through the law, trying to figure out what's allowed and what isn't.

Notwithstanding those changes, the 2007 legislative session will resemble many other recent years because the state will struggle to find a way to pay its bills.

The projections for the next two-year budget cycle, which will begin July 1, can change in the next five months, but some sort of budget shortfall is expected. It won't be as big as the crippling shortfalls from earlier this decade, but it also won't be anything like last year's surprising surplus, either.

Essentially, that means that the state's expected revenues over the next two years are less than its expenses. The situation is perhaps most dire in three key areas: overcrowded schools, inadequate financing for transportation, and the need for more community-based care in the mental-health-care system.

Rather than try to appropriate new money in the budget for these and other needs, the state is likely to try to borrow money through bonds. That can become a vicious cycle, said the leader of the N.C. Senate, Marc Basnight.

"Bond ideas surface because you haven't been funding the projects. You've been sort of derelict in your responsibilities," said Basnight, D-Dare.

Still, various legislators and special interests are pushing to have bond proposals put before voters in November of this year. The ideas for bonds include school construction, road construction, land conservation and water and sewer improvements.

Rep. Jim Harrell III, D-Surry, wants the state to issue bonds to pay for more affordable housing.

"I feel like the one that has the best chance will be the housing bond," he said.

"I strongly believe that to stabilize a family, you have to be certain of your housing situation."

Among all of these bond ideas, legislators will have to pick and choose, because the state's borrowing capacity is limited.

Another issue on legislators' agendas will be figuring out a way for the state to absorb Medicaid costs that are currently being paid by counties. Both parties say they are committed to ending what everyone describes as an unfair burden on county governments.

But no one has proposed a solution that has satisfied both the state and the majority of the counties, who want to rid themselves of Medicaid expenses but also are reluctant to give up any local revenue.

The Medicaid problem and the problem of frequent budget shortfalls are two symptoms of what legislators agree is an outdated revenue system that needs big changes to the tax code.

For instance, some believe it would make sense to expand the sales tax (so it would apply to the purchase of services) while lowering the overall sales tax rate.

A legislative committee is studying this and other tax issues, but any major change this year is unlikely, because no matter what, some people would perceive it as a tax increase, said Ran Coble, the executive director of the N.C. Center for Public Policy Research, a nonpartisan group.

"That kind of issue takes a champion, somebody who could step out front and give the legislators cover," he said.

At least in 2007, Coble doesn't see that happening.

• James Romoser can be reached in Raleigh at 919-833-9056 or at jromoser@wsjournal.com.


ON THE TOPIC
Five Big Issues for the Legislative Season

1. Balancing the budget.
State officials anticipate a revenue shortfall of $500 million for 2007-08, and some predict a shortfall of as much as $1 billion.

2. Tax reform.
Reforms could include an expansion of the sales tax to include such services as haircuts, home repairs or legal services and an overall reduction in the sales-tax rate.

3. Medicaid costs.
North Carolina is the only state that requires counties to pay a share of Medicaid insurance costs, about $470 million a year. Counties want out from under the burden.

4. Bond issues.
Legislators will consider asking voters to approve billions of dollars of bonds to pay for public-school improvements, land conservation, roads, water- and sewer system repairs.

5. Mental-health reforms.
The five-year cost to overhaul mental health services is estimated to be as much as $2.7 billion. Read more!

NC legislative panel recommends park, commercial use for Dix site - AP

The Associated Press

RALEIGH, N.C. - A legislative panel looking at the future of the 315-acre campus of the Dorothea Dix state mental hospital made recommendations Monday that could allow for both recreational and other uses when the hospital closes.

The Dorothea Dix Hospital Property Study Commission urged state lawmakers to consider building a park on the property along with commercial, residential or state office space that would make the location attractive.

Money from the property's redevelopment also should be earmarked for improvement of the state's mental health programs, the commission's report said.

The commission didn't come up with specific legislation, which the full General Assembly must approve for the changes to occur. Rather, the panel asked the leaders of the commission to work with their fellow lawmakers to develop a bill that fits the parameters laid out by the panel.

The full General Assembly reconvenes this week. The commission has been meeting for years to come up with a plan for the campus where the hospital is slated to close in 2008.

"What we've got to do is get something (created) that can get passed," said Sen. Vernon Malone, D-Wake. "There are some pretty strong feelings on this whole thing."

Outside groups have differing ideas on what to do with the land.

The Urban Land Institute suggested in October that the state sell the campus just south of downtown Raleigh for $40 million. The plan called for several groups to manage the site and to build a 215-acre park, and develop housing, retail and government space.

"A big park would be nice, but you've got to have something that's practical, that really makes sense," Raleigh Mayor Charles Meeker said. "And to me, the (institute's) plan is much more realistic for the state than what's being proposed otherwise."

The panel chose not to back a plan by a group called Dix Visionaries that would allow development on the borders of the property and a park in the middle. The development would not include houses or condominiums.

"We have a larger vision. They have a more narrow vision," said Greg Poole, a group representative. "They are more happy with a smaller neighborhood park, if you will."

Joseph Huberman with Friends of Dorothea Dix Park and a commission member, said the parameters created by the panel still "are fully compatible" with creating a 300-plus acre park. Read more!

Legislators free to mold Dix Hill - Raleigh News & Observer

The task force votes for guidelines that don't commit to a major park

Ryan Teague Beckwith, Staff Writer

Two Wake County legislators will have wide latitude to shape the future of Dix Hill.
A task force on the Dorothea Dix hospital campus gave co-chairs Rep. Jennifer Weiss and Sen. Vernon Malone vague guidelines for drawing up a final plan.

That upset advocates who wanted the task force to endorse creating a major urban park on the 300-acre property just west of downtown Raleigh.

The guidelines call for the legislature to consider accommodating 3,000 state workers, reusing historic buildings, creating a park and allowing new commercial and residential uses with minimal state funding. But they do not provide specific details on how any of that would be done. The only specific recommendation is that money from the sale go to the state's Mental Health Trust Fund.

The task force, which met for the last time Monday, is considering what to do with the site of the state mental hospital when it closes in 2008. Last year, it hired the nonprofit Urban Land Institute to draw up a specific proposal for the property.

The guidelines mostly line up with that proposal, which called for Raleigh to create a new nonprofit to buy the land for $40 million. But they are broad enough to cover seven other plans put forward by advocates, city planners and a Charlotte design firm.

Two members argued against giving Weiss and Malone such wide leeway as they write legislation, saying the task force should take a stronger stance in favor of a major urban park.

Barbara Goodmon, president of the A.J. Fletcher Foundation, said she didn't know if the two legislators would be able to stop "wheeler-dealers" in the General Assembly from selling valuable real estate on Dix Hill to private developers.

"I feel OK about everybody in here," she said. "I don't feel OK about everybody else."

But the other six voting members of the task force at the meeting said that Weiss and Malone need room to negotiate with their colleagues in the legislature, who will make the final decision on the site.

"We have to get 61 votes in the House and 26 votes in the Senate," Weiss said. "We need flexibility."

Greg Poole, leader of the pro-park Dix Visionaries, said that the guidelines would end up creating a much smaller park on the unusable parts of the property along the Rocky Branch Creek and on top of an old city landfill.

"All they would give us as a park is wetlands and a landfill," he said.

Rep. Deborah Ross said several recommendations in the guidelines essentially call for a major park. She noted that they include making the property "a destination" and creating "active and passive recreation."

"I can't imagine in my wildest dreams that there will not be a large park up there," she said.

But task force member Joseph Huberman, who belongs to the nonprofit Friends of Dorothea Dix Park, said that the guidelines also call for considering commercial and residential uses that would undermine a park.

"This is property that belongs to the state of North Carolina, and it shouldn't be given over to private use," he said. "It certainly shouldn't be turned into a strip mall or a subdivision."

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

Consumer groups call for reform commission - Atlanta Journal-Constitution

To read the series, go to www.ajc.com/hiddenshame

Consumer groups seek state mental health reforms
Pattern of neglect, abuse and poor medical care cited

By ALAN JUDD, ANDY MILLER

A coalition of consumer advocacy groups Tuesday called for a statutory legislative commission to reform Georgia's mental health system.

Speaking at a Capitol press conference, the groups, who advocate for people with mental illness and their families, also urged the Legislature to create an independent state ombudsman's office to investigate reports of neglect and abuse in the state's mental hospitals.

The groups cited an Atlanta Journal-Constitution investigation that found a pattern of neglect, abuse and poor medical care in Georgia's seven psychiatric hospitals. The newspaper series earlier this month reported at least 115 suspicious deaths of patients and more than 190 substantiated cases of physical or sexual abuse by hospital employees since 2002.

''Georgia has a mental health crisis," said Anna McLaughlin, past chair of the Georgia Mental Health Services Coalition. Noting that lawmakers took quick action when 35 teenagers died in traffic accidents, she said a similar response is needed now. "We have 115 suspicious deaths [in mental hospitals],'' McLaughlin said. "We need some leadership."

The Department of Human Resources, which operates the hospitals, said in a recent statement about the hospital deaths that 82 patients identified by the Journal-Constitution had underlying medical problems "that were appropriately treated."

In an additional 24 cases, the agency said, "we agree the hospital system should make improvements."

Officials say they have been working to improve mental health care by shifting resources and patients, especially those with developmental disabilities, to community-based services.

In an interview after the press conference, McLaughlin said some legislators are "very supportive" of mental health issues, but none has indicated a willingness to sponsor bills this year. "We're hoping they'll hear the real cry."

The coalition groups include Mental Health America; the National Alliance on Mental Illness; the Georgia Mental Health Consumer Network; and the Georgia Parent Support Network. The coalition also includes the Carter Center Mental Health Program.

NAMI last week asked the U.S. Justice Department to investigate what it called "unacceptable and intolerable" conditions in Georgia's seven state mental hospitals.

The advocacy groups also called for more community services for people with mental illness.

"You cannot single out the hospitals and say herein lies the problem,'' said Ellyn Jeager, interim executive director of Mental Health America of Georgia. "The problem is much broader." She called for lawmakers to fund the mental health ombudsman's position.

"How many of these lives would have been saved ... had this mental health ombudsman been funded?"

To read the series, go to www.ajc.com/hiddenshame Read more!

Father Pleads Guilty After Attack on Disabled Son - Washington Post

Police Say Man Was Tired Of Seeing Teenager Suffer

By Theresa Vargas
Washington Post Staff Writer

No one can know if Eric Paredes realized it was his father, sitting several feet away from him in a Prince William County courtroom yesterday, on trial for trying to kill them both.

The severely disabled teenager, who cannot talk, placed his head against his mother's shoulder and folded his body into her as his father, Oscar Paredes, sat a few rows in front of him in the defendant's chair. It was the first time the teenager had seen his father since both were found in February lying in a blood-soaked bed together, their throats slashed and chests pierced.

Both relatives and police believe Oscar Paredes, who was his son's primary caretaker, had plummeted into depression.

"He said the pain was too much for him, and he wanted both to die," Detective Brian Oxendine testified yesterday in Circuit Court. "He said he took care of Eric every day, and he was just tired of seeing Eric suffering, seeing Eric in pain."

Paredes, 54, had spent his days and nights taking care of his son, then 16, who is described as having the mental capability of a toddler. While everyone else in the family struggled to make a living, Oscar Paredes bathed his son, fed him, watched Sesame Street with him. The two even shared a bed for 10 years because of Eric's seizures.

Paredes family members said that he wrote a note before the incident on Feb. 6 saying: "My life is miserable. I'm nothing in this life." When his wife, Ana, came home that day, she found the two in the bed, apparently dying.

Oxendine testified yesterday that Oscar Paredes had bound his son's hands with plastic wire ties before slitting his throat with a box cutter. When Eric Paredes didn't die fast enough, Oxendine said, his father bound his neck with the plastic ties. Paredes also stabbed his son in the chest before inflicting the same injuries on himself, Oxendine said.

He wanted his wounds and his son's to be identical, Oxendine said.

Paredes pleaded guilty yesterday to abduction and aggravated malicious wounding. The latter charge carries a sentence of 20 years to life. He is scheduled for sentencing May 3 and will undergo a mental evaluation before then.

Michael A. Pignone, the attorney for Paredes, said he hopes the court sends his client to a mental hospital rather than prison.

"He is clearly suffering from a mental defect or disease," Pignone said.

Ana Paredes said her husband is a shell of what he once was. He has lost weight, dropping from about 150 pounds to 115, and a stroke in the summer has made it difficult for him to walk or talk, she said. Ana Paredes said he needs the type of rehabilitation only a hospital can provide. "In jail, he is not going to get better," she said. His mental state is also visibly fragile, she said.

"Something is wrong with him," she said, alternating between Spanish and English. "I didn't even see him watching Eric. I didn't see him say: 'Oh, Eric is there. Oh, I saw him. I saw my son.' "

Before the incident, Oscar Paredes was extremely protective of Eric and didn't trust anyone else to take care of him, family members said. Even though the Muriel Humphrey Center, a nonprofit that helps the disabled community, was located right across the street from the family's home, Paredes never went there for help, they said.

Eric Paredes now spends several hours there each day after school in a room with seven other teenage boys.

"He should have been coming here a long time ago," said Kate Brackney, the center's day-care program director. "As far as his disability, I could see now how it could put a strain on the family."

Throughout the court proceedings, Ana Paredes caressed Eric's back, but she said she doesn't believe he was aware of what was going on around him. His sister, Claudia Garcia, is also doubtful.

"He doesn't know if he was there. He doesn't know if his dad is still sick," Garcia said, her eyes watering.

Since the incident, Garcia has developed a closeness with her father she never had when he was home. She has visited him in jail several times.

"He knows what he did was wrong, but he knows life goes on," she said.

"Now that we started a new year, when it came to be January, the first thing I wished was that my father could be in a better place this year," she said.

After he was found guilty yesterday, Oscar Paredes told the judge that he needed to see a doctor because he was in a lot of pain. Before being led out of the courtroom, he turned to his family, looked at no one in particular and said in Spanish, "Everything went bad." Read more!

Outsider to His Kin, but a Ghost No More - NY Times

By KATHRYN SHATTUCK

Their flight from Los Angeles had arrived nearly three hours late, but travel fatigue couldn’t keep Maria Ramirez-Miller, her six daughters and a granddaughter from scampering out of their Manhattan hotel rooms and onto West 53rd Street on Friday around midnight.

There it was — trumpeted by banners hanging from street lamps and on coffee cups and catalogs stacked in the window of the American Folk Art Museum gift shop — the name Martín Ramírez. For more than 70 years, this self-taught 20th-century outsider artist had been little more than a ghost to his family.

“A friend of mine said, ‘You’re just 20 steps from the museum,’ and we went squealing down the street,” said Josie Alonso de Levy, one of the daughters, who took her own 12-year-old, Cynthia, on the excursion. The next morning the women, laughing and chattering in Spanish and English, entered the museum, where they saw the 97 drawings, many for the first time, that make up “Martín Ramírez.” The retrospective of his art, made while he was confined in a mental institution, opens today.

Suddenly there was silence, and then tears. The daughters huddled around their mother, Mr. Ramírez’s oldest grandchild, as she gazed at the work before her: the obsessive, hypnotic renderings of horses and riders, trains and tunnels, Madonnas and the landscape of the Jalisco region of Mexico. In 1925 Mr. Ramírez had left his small ranch there, seeking work in the United States to support his wife and children.

By 1931 he had all but disappeared into the California mental health system, with diagnoses of manic-depression and later catatonic schizophrenia. Over time, he ceased to talk and was classified, erroneously, as deaf and mute. After 1948 he lived out his years at the DeWitt State Hospital in Auburn, Calif., spending his time drawing.

Hospital workers apparently sent Mr. Ramírez’s family a few of his artworks, along with a letter, sometime in the 1940s. The family members decorated their patio with the colorful images but then burned the drawings when they were told that Mr. Ramírez had tuberculosis.

The artist’s larger works can now fetch more than $100,000 at auction. His family, however, has been left without any tangible connection to Mr. Ramírez, except for a shared surname and a newfound sense of pride. Few of the art historians or collectors who helped burnish his reputation over the last two decades made any attempts to contact the Ramírez family.

Brooke Davis Anderson, the director and curator of the folk art museum’s Contemporary Center, corresponded with members of the Ramírez family as she planned the retrospective, and she guided the family through the show. Before a chronology of the life of Mr. Ramírez (1895-1963), Ms. Ramirez-Miller stood next to the name of her mother, Teofíla, Mr. Ramírez’s second daughter, for a photograph.

Ms. Ramirez-Miller began to cry as she viewed “Untitled (Rosenquist Scroll),” in which a man stands either in a hole or on a mount, depending on perspective, with a rope tied around his waist. Above, a collaged magazine image of a smiling woman, with arms added on by the artist, holds the rope in one hand and a scythe in the other, perhaps ready to make a cut.

Some critics interpret the image as depicting Mr. Ramírez’s wife, who saved his brother from hanging during the 1920s Cristero Rebellion in Mexico by pretending to be his wife. But Ms. Ramirez-Miller, 66, saw it differently.

“I see it as my grandfather in a well, and he is waiting for his wife, my grandmother, to come and pull him out,” she said.

The extended Ramírez family — a surviving daughter, nieces, nephews and grandchildren, great-grandchildren and great-great-grandchildren — stretches from Guadalajara, Mexico, to California. (Three relatives arrived from Mexico to attend the opening party last night.) Until the last decade, only a few family members had been aware of Mr. Ramírez’s rising status in the ranks of outsider artists.

“When this exhibition was started, we had no idea it could be something like this,” said Elia Diaz, Ms. Ramirez-Miller’s oldest daughter. “It’s amazing after all this time to find out where your background comes from.”

Ms. Ramirez-Miller’s life also speaks to the immigrant story — of hardships in Mexico and the United States, loneliness, language barriers, displacement and depression. The oldest of 16 children, she was sent as a young child to live with her grandmother, Mr. Ramírez’s wife, whom she called Mom. By 9, she was designing patterns and embroidering them on garments as a contract worker; by 12, she worked full time as a seamstress.

She recalls when the family received a letter and photographs from DeWitt State Hospital telling them that Mr. Ramírez was doing well and asking his wife if she wanted to retrieve him. She declined, Ms. Ramirez-Miller said, partly because she could not provide his medical care and perhaps because she had felt abandoned 25 years earlier.

“Still, I think she thought she had a very good married life,” Ms. Ramirez-Miller said. “She once said that had she known she would have been married only for those eight years, she never would have married.”

Like her grandfather, Ms. Ramirez-Miller emigrated to California, where she worked as a seamstress to support her seven children after discovering that her husband had another family.

“She lived a very hard, isolated life,” said her daughter Martha Bell, “but always she was a pillar of strength.”

Speaking about her great-grandfather, Ms. Diaz said: “Do I think he was mentally ill? I think it’s more the fact that he was away from his family, he was homeless without a job, he couldn’t speak the language and he was depressed, just walking around, frustrated that nobody was listening to him. And he felt he had nothing to go home to.”

In 2000 Ms. Ramirez-Miller and her daughters found Mr. Ramírez’s pauper’s plot at a California state cemetery in Stockton and, with a priest, laid a tombstone on his grave. The women are now talking of forming a family trust perhaps to buy a work by Mr. Ramírez and promote his legacy.

“My mother and her family grew up with shame, but now I feel pride for my mother,” Ms. Diaz said. “She has suffered a lot in her life, and now it’s like she’s coming full circle. There’s a sort of fulfillment from this. It has given her a lot of sense of self-worth connected with her heritage. She grew up really poor, but now she feels rich.”

Her sister Elba Ortega added: “It’s such an accomplishment for him. Maybe he thought all those years that he had left his family nothing. But he left us this.” Read more!

Fighting Depression Since 12, She Has a Tailor-Made Job - NY Times

Another in the paper's "Neediest Cases" series

By KARI HASKELL

The pain weighs heavily on her. It always has. “I was depressed from very, very young,” said Heather Eicholz, a case manager at a social service agency on Long Island.

At 29, she is the closest she has ever been to happiness since receiving a diagnosis of severe depression at 12. “Content” is how she puts it. “If I didn’t have this job,” she said, “I don’t mean to be dramatic, but I probably would have given up.”

A year ago, Ms. Eicholz was hired by Federation Employment and Guidance Service, a beneficiary of the UJA-Federation of New York, one the seven charities supported by The New York Times Neediest Cases Fund.

As a case manager, she helps clients with mental disabilities find the resources to cope with their illness. The connection with people who understand their illnesses gives a person hope, she said.

Her own demons still torment her, but they have gradually diminished, she said. She is in therapy and takes only one medication; at one point, she was taking five.

The forearm scars from cutting herself are fading with use of a steroid cream. The evenings are still difficult, Ms. Eicholz said, because she is alone.

“During the day, at work, it is better,” she said. “I never got up for anything in my life that I actually looked forward to. You are not labeled. You are not your diagnosis.”

“If I am identified here, if anything, it is as a good case manager,” she said of her work environment.

For Ms. Eicholz, the less desirable labels “a problem,” “crazy” and “special” began almost at birth. Her biological parents met in a psychiatric hospital on Long Island. Her mother died shortly after Ms. Eicholz was born. At 13 months, she and her older sister were placed in foster care, and both were later adopted by Johanna and Donald Eicholz of Hicksville, on Long Island.

“Nothing made me happy or excited,” she said of her childhood.

Sent to Catholic school, she defied the nuns or fell asleep in class. She was placed in special education classes until the sixth grade, and then transferred to Fork Lane School, a public school in Hicksville.

At the age of 12, she said, she found a feeling of euphoria by cutting herself with a broken piece of glass. She was near the school playground at the time. “It was impulsive,” she said. “There really is no pain associated with it. It was like, ‘Ahh,’ and emotional release.”

A year later she tried to commit suicide by overdosing on 100 Tylenol tablets, she said. Her actions created a deep rift between her and her parents. Following a doctor’s suggestion, they sent her to High Point Hospital, a psychiatric institution in Westchester County, where she lived for three years, starting at 14.

“I can’t describe to you what happened there,” she said. Her complaints to her parents about her life at the hospital, which closed in 1995, fell on deaf ears, Ms. Eicholz said. “I was sick, so no matter what I said — it didn’t matter. They were in denial.”

At 17, she left High Point and enrolled for half a year in Harmony Heights, a residential school for girls in Oyster Bay, on Long Island. After graduation, she moved into an apartment that she paid for through disability assistance and a small inheritance from her mother’s sister. “I could afford it then; rents weren’t so high as they are now,” she said.

After Ms. Eicholz turned 18, she said, she attempted suicide again. “I was in the hospital most of the time,” she said of the five years after leaving High Point. “When I didn’t know how to deal with something, the cutting got really bad,” she said.

On good days, she attended classes. She enrolled in various community colleges on Long Island but rarely finished. “I couldn’t function,” she said. “I didn’t have the skills.”

At 24 she entered an outpatient treatment program at North Shore University Hospital. “It gave me structure,” she said. There, her skills in advocacy developed, and then she learned that there was a job available at Federation Employment and Guidance Service.

The job was developed around her interests, and it has ended a destructive cycle, Ms. Eicholz said. “It was a life saver,” she said. The $600-a-month salary enables her to afford a $210 a month subsidized one-bedroom apartment in Old Bethpage, on Long Island, $150 for car insurance, and monthly payments to her parents for her white ’96 Chrysler Sebring.

She calls the car a godsend because it gets her to work, which she loves. But when its water pump sprang a leak last year, it was out of commission.

“I lost it psychologically,” Ms. Eicholz said. Losing the freedom that the car gave her, she said, brought up feelings she experienced while she was hospitalized. “I felt trapped and powerless,” she said. She confided in Holly Beck, her work supervisor, who drew $765.05 from the Neediest Cases Fund to have the car repaired.

“I was relieved,” Ms. Eicholz said. “Without having a financial foundation, there is always a sense of fear, like you don’t know what is going to happen.” Read more!

SMHART provides care to the underserved - Jackson (MS) Clarion Ledger

By Robin Street

Bad things can happen even in small towns. An African-American woman in a rural area of Leake County made an alarming discovery when her 7-year-old granddaughter visited.

"When I was giving her a bath, I noticed blood in her panties," said the grandmother. "I asked her (if she had been sexually abused), and then she told me (she had). I did not know what to do, so I carried her to the doctor." The family's names are kept confidential because The Clarion-Ledger does not identify victims of sexual abuse.

The doctor at the Dr. Arenia C. Mallory Community Health Center, a federally funded clinic that provides health care to low-income families, treated the child, then referred the family for counseling. Because of the Southern Institute for Mental Health Advocacy, Research and Training - SMHART - finding an affordable counselor was not a problem.

SMHART'S MISSION

SMHART's mission is to improve mental health service for low-income, rural and African-American Mississippians and other underrepresented populations in the state.

This includes:

Holding an annual conference on mental health

Providing mental health counseling

Developing community advocacy projects for mental health

Training community leaders and service providers on the importance of mental health

Working to reduce the stigma of receiving mental health services

Working with state government leaders to influence mental health policy.

Source: SMHART brochure and Dr. Safiya Omari, SMHART director

The counselor was just down the hall in the clinic of SMHART, a Jackson State University program that provides counselors to work at no charge at the Mallory clinics in Lexington, Tchula and Canton.

Counselor Kira Johnson, a policy analyst and advocacy specialist with SMHART, has spent months counseling the child and the grandmother, who sought temporary custody of the child.

"She (Johnson) was an angel and a blessing to our life," said the grandmother.

SMHART started in 2004 as a way to do research, training and advocacy to reduce the stigma of receiving mental health services and to address the mental health needs of low-income, rural and African-American populations. It is funded by the U.S. Office of Rural Health Policy.

"When we sat down to develop SMHART, we were looking for ways through which we could use our mental-health knowledge base and skills to effectively improve the quality of people's lives and reduce the rate of mental health disparities in underserved populations," said Dr. Safiya R. Omari, SMHART director and associate professor of social work and public health at JSU.

Omari notes the thinking about mental health has changed in the past 25-30 years.

"Mental health used to refer only to mental illnesses, and mental illnesses were so shameful and stigmatized that people didn't talk about them or seek services. Today, much has changed," Omari said.

"Mental wellness means that a person can reach enhanced levels of mental health, even if they do not have any diagnosable mental illness. This definition of mental health highlights emotional well-being, the capacity to live a full and creative life and the flexibility to deal with life's inevitable challenges, and this definition is reflective of SMHART's perspective on mental health," Omari said.

SMHART counselors understand that rural, low-income or African-American community members may not know how, or be too embarrassed, to seek counseling, Omari said. They also may lack funds to pay for treatment or transportation to get there.

SMHART invited area ministers to a seminar, co-sponsored by the National Association for Mental Health, to help them learn more about mental health services.

"What we find a lot of times, especially in the African-American community, is people (with problems) first go to the church," Johnson says. "So if we could build this alliance with preachers, then we could possibly get more people into care and get them to the appropriate services that they really need. If the preachers endorse it and say it's OK to go and get these services, then a lot of times the members of their congregation will be more open to it."

Seeing patients in the health clinic makes a difference, Johnson says.

Providing mental health services in a nontraditional setting helps reduce the stigma, "and people are more likely to come back because you don't know what they're going back there for - to get a shot or a check-up or to see a mental health therapist," Johnson said.

The nontraditional setting even includes occasional home visits to clients who have no transportation.

"If they can't come to services, what we're finding is that stopping by and making a home visit and talking with someone really does make a difference because a lot of the people are just so isolated because of economic or social reasons," Johnson said.

The language Johnson uses with clients is also non-traditional. "I change the language a little bit and talk about emotional health because it's OK to talk about your emotions. It's OK to talk about 'am I sad?' 'am I angry?' things like that."

That approach is producing positive results. "We really feel like we're making substantive strides into decreasing the stigma associated with seeking mental health service," Omari said.

Johnson's clients, the grandmother and granddaughter, are getting some of those positive results. The child, still in counseling and now living with her grandmother, is healing emotionally. "She tells me I love you every few minutes and tells Ms. Johnson she loves her, too," the grandmother says.

Where would they have turned if SMHART had not been around? "To tell you the truth, I don't know," the grandmother said. "If I had to pay for this, me working at this age and getting ready for retirement, I don't know where I would get the money from."

That response shows Johnson just why SMHART is needed.

"Some days I'll say, 'Well, I know why I went into this field,'" Johnson said. "I know why I'm doing the work I'm doing because I can see the changes in people's lives and see them feeling better and sometimes dealing better. That helps me, so I know I'm actually providing a service. I know the work I'm doing is worthwhile."


AMERICANS AND MENTAL HEALTH

About 20 percent of adults in the United States suffer from a diagnosable mental illness annually.

33 percent of Americans mistakenly think emotional or personal weakness is a major cause of mental illnesses. Research shows mental illnesses are caused by genetic and environmental factors, traumatic events and other physical illnesses and injuries that have psychiatric side effects.

44 percent of American adults report knowing only "a little" or "almost nothing at all" about mental illnesses.

A recent study by the National Institute of Mental Health found the rate of successful treatment for depression to be 70-80 percent, compared to the rate for other chronic illnesses, such as heart disease (45-50 percent).

Source: American Psychiatric Association. Healthyminds.org. Read more!

Dilemma may set murder suspect free- Durham Herald-Sun

Originally published Jan. 21

By John Stevenson : The Herald-Sun

DURHAM -- A mentally ill first-degree murder suspect soon could be walking the streets unless Durham's senior judge can solve a novel dilemma that arose last week.,

Psychiatrists have concluded that the suspect, Carl Lee Brown Jr., is incapable of standing trial because he doesn't understand the charge against him and doesn't have the mental capacity to assist his attorney.

That means Brown cannot be prosecuted or held under the $75,000 bond that has kept him in jail for months.

But according to some reports, psychiatrists also declared at one point that Brown was not a danger to himself or others.

Under the law, he cannot be detained in a mental hospital against his will unless it is believed he might harm someone.

"The bottom line is, we might have to let him go," said Superior Court Judge Orlando F. Hudson.

Hudson took the issue under consideration last week and will address it again soon. Additional psychiatric information is being sought in the interim.

Brown is charged with fatally shooting and robbing Marshall Rivers in June 2000. The 72-year-old victim's body was found along a wooded footpath near N.C. 55 and Riddle Road, where he had been riding his bicycle when slain.

Brown wasn't arrested and charged until four years after the crimes.

Defense lawyer John Fitzpatrick said in court last week that Brown was declared mentally incompetent at Dorothea Dix Hospital in Raleigh, then transferred to John Umstead Hospital in Butner for treatment. But Umstead sent him to the county jail after exhausting its treatment options, according to Fitzpatrick.

Brown has remained behind bars since October.

"If he's not dangerous and he's incompetent, he's going to have to be released," the judge declared. "He's going to walk around like me and you. Being incompetent doesn't mean he can't walk around and go down to Burger King like the rest of us.

"We need to find out what his status is," Hudson said. "I'm not guessing at it. We need to find out if his rights are being violated. There are only two answers: yes or no."

Fitzpatrick complained in an interview that Brown had been "sitting in jail since October without anybody paying any attention to him."

"Without a specific finding that he is a danger to himself or others, they've got to release him," said Fitzpatrick. "It's just not fair. John Umstead [Hospital] would not have released him if he was a danger. Beyond that, the facts of this case do not support a murder conviction against him. For him to sit in jail is tantamount to punishment without conviction."

Prosecutor Tracey Cline argued last week, however, that the question didn't belong in Durham County Criminal Superior Court.

"If he's still incompetent, this is not the proper court to decide whether [Brown] should be released," she said.

Rather, the issue should be addressed in a civil forum, according to Cline. Read more!

Event series aims to de-stigmatize mental health issues - UC Davis California Aggie

Kelly Chen

When pharmacology and toxicology graduate student Hung-Chieh Chai took his life Nov. 1, 2006, senior African American and African studies and sociology double major Devon Lee knew something needed to be done.

Lee, a campus climate and community intern at the Cross Cultural Center, along with Counseling and Psychological Services psychology fellows Kensa Gunter and Sharon Zygowicz, organized "Respect My Mind," a mental-health awareness program that will take place this week.

The programs aim to break down the stigma that comes with counseling and to make students aware of available resources.

"There is a stigma associated with going to CAPS and even just stepping into North Hall," Lee said, referencing CAPS' location. "People want to take care of their own problems."

According to the CAPS website, "Most students face normal developmental concerns and academic pressures while at UCD and may feel anxiety, anger, sadness or depression."

"Mental health is an issue on campus," Lee said. UC Davis, which has the highest student-suicide rate of all the University of California campuses, has had over 11 suicides since 2000. The administration has done little about it, Lee said.

UC Davis also has the highest number of students staying for fifth and sixth years UC-wide. With the university's minimum progress requirements, Lee said a lot of students are leaving because of stress, which can lead to mental health problems.

While the "Respect My Mind" program addresses particular issues concerning students from underrepresented and underprivileged backgrounds, Lee said the events are for everyone, including undergraduate and graduate students, faculty and staff.

"Mental health affects us all," Lee said, referencing a Purdue University study that found 44 percent of all college students have considered suicide.

"Respect My Mind" will consist of a benefit concert, a community discussion and a movie showing and response. The events are free and are co-sponsored by the Student Recruitment and Retention Center, the Office of Campus and Community Relations, the Native American studies department, the Chicano/a studies department and others. For more information, see the sidebar.

KELLY CHEN can be reached at campus@californiaaggie.com.
Read more!

Discussing mental health can cause indigestion - Fayetteville Observer

From Inside Politics column

The topic was mental health reform, and state Sen. Tony Rand summed up last week what most people in the room were thinking: “I’ve really enjoyed my breakfast, but you have ruined my appetite.”

Rand, a Democrat from Fayetteville and the Senate majority leader, joined other legislators, county commissioners and members of the Cumberland County Mental Health Board on Jan. 16 to discuss legislative goals.

The General Assembly convenes Wednesday.

Many at the meeting lamented about mental health reform, which the legislature passed in 2001 to help shift the mentally ill from institutions to private, local settings.

What particularly irked Rand was learning that Cumberland County Mental Health needs between $2 million and $3million more each year to be at the median funding level for North Carolina counties.

“We’ve been getting screwed since the start, and that really upsets me,” Rand said.

The local Mental Health agency’s budget this fiscal year is about $14.5 million.

The funding disparity is mostly because of past political decisions, said Hank Debnam, the Mental Health director. In the 1970s, the county commissioners refused to accept some state grants for mental health programs. They feared the state money would dry up and leave local taxpayers footing the bill.

Mental Health officials also want more flexibility in how they spend their state money. Most of it now is spent by category; unspent money has to be returned to the state, even though some programs in other categories have unmet needs.

Debnam said the biggest needs are among children with mental problems and adults addicted to alcohol and drugs.

Another problem, Debnam said, is Value Options, a company under state contract to review and approve Medicaid reimbursements to private providers. Value Options has been swamped and late reimbursing providers, who in turn face the possibility of cutting off treatment to clients.

Other local legislators who attended the breakfast session were Margaret Dickson, Rick Glazier, Marvin Lucas and Mary McAllister. All are Democrats.

Rand voted for the 2001 reforms. He said he didn’t regret his vote, but that reform has not lived up to expectations.

Who does he blame? “I’m sure there is plenty of blame to go around. I can’t give you a name.” Read more!

3 WNC politicos seek key roles - Asheville Citizen-Times

Includes info on Sen. Nesbitt's role as co-chair of theLOC

by Kerra L. Bolton, KBOLTON@CITIZEN-TIMES.COM

RALEIGH — Western North Carolina lawmakers could play key roles in the upcoming session, which starts on Wednesday.

The beginning of a biennial session often brings shifts in power.

Veteran lawmakers in the majority party solidify their power. Newcomers look to stamp their unique imprint on the office. Some lawmakers become power players within their area of expertise.

That’s the case for Buncombe County lawmakers Reps. Bruce Goforth and Charles Thomas and Sen. Martin Nesbitt. Here’s why they are the ones to watch this year.

Bruce Goforth

With the retirement last year of former Rep. Wilma Sherrill, R-Buncombe, there’s a gap in mountain leadership on the Appropriations Committee, which writes the state budget.

Goforth says he hopes to get the coveted spot in the upcoming session.

“I’ve already talked to (presumptive Speaker) Joe Hackney about the concerns I have,” Goforth said. “I want to be sure that Western North Carolina is recognized like the rest of the state. I think we get shortchanged so much.”

Elected in 2002, Goforth has built a political career taking on tough, headline-grabbing issues that are popular with constituents.

Last year Goforth helped tighten regulations for convicted sex offenders, restricted the authority of local governments to use eminent domain powers and strengthened identity theft protections.

Once an ally of former House Speaker Jim Black, Goforth was able to get many of his bills heard even though he was not the chairman of major committees such as appropriations and finance. His effectiveness ranking among lobbyists and political observers leap-frogged 41 spots from 80th in the 2003-04 class to 39th in the 2005-06 class.

The annual survey is conducted by the N.C. Center for Public Policy Research, a nonpartisan, nonprofit organization.

Martin Nesbitt

Martin Nesbitt inherited more than just a Senate seat in 2004 when he was appointed to finish the unexpired term of then Sen. Steve Metcalf.

Nesbitt served 11 terms in the House before moving to the Senate, where he was chosen to assume Metcalf’s place as chairman of a legislative panel that oversees mental health reform. He soon found himself in the middle of an unwieldy transition that generated many questions and fewer answers.

A blueprint for reform appeared nearly three years later in the form of an independent consultant’s report that the state would need $2.7 billion to address all of the gaps in the mental health, developmental disabilities and substance abuse services.

Nesbitt says much of the work can be done for $500 million spread out over the next several years.

Much of the initial money would go to expand the number of crisis services offered throughout the state, and to constructing independent housing for clients. This is in addition to the $15 million and $5.25 million lawmakers earmarked respectively for crisis services and independent housing.

The study commission Nesbitt leads will develop a list of recommendations in February and bundle that into legislation to be introduced in the General Assembly.

Nesbitt’s committee has to wait until March for reports from local mental health agencies about how they plan to spend seed money to build or renovate facilities to house crisis services.

“You have a situation where by any measurement the state is under-funding the areas of mental health and substance abuse,” Nesbitt said. “I don’t think we can fix all that right now. But what we can do is fix some of these hot spots.”

Charles Thomas

Charles Thomas, an Asheville Republican, is the newest delegation member.

He narrowly defeated Democrat Doug Jones in November to capture the seat held by former Rep. Wilma Sherrill for six terms. Sherrill announced her retirement nearly a year ago after being diagnosed with breast cancer.

At 34, Thomas is one of the youngest members of the 2007 freshmen class. Newcomers rarely win positions of power during their first term. But Thomas will be watched to see how his style compares to Sherrill’s. She was considered an icon in the General Assembly for her determination to get resources to Western North Carolina.

“I hope to continue to champion the issues Wilma worked on, particularly in the area of women and children,” Thomas said.

But Thomas says he has his own ideas about how things should be done, including creative financing for the renovation of the Asheville Civic Center.

“I’m hoping people will be open and receptive to these new ideas and listen to them all the way through before rendering a decision,” Thomas said.

He also plans to work on property tax restructuring, medical liability reform, tightening up the issuance of driver’s licenses, equalizing lottery proceeds for public school construction, and stopping involuntary annexation.

“That’s a process that really runs counter to the way most of us feel government should work,” Thomas said. “You should have some representation if you are going to be taxed. Of course, people who are forcibly an