Government Estimates 754,000 Homeless People - AP

By STEPHEN OHLEMACHER

WASHINGTON — The nation has three-quarters of a million homeless people, filling emergency shelters through the year and spilling into special seasonal shelters in the coldest months, the government said Wednesday.

The Department of Housing and Urban Development estimated there were 754,000 homeless people in 2005, including those living in shelters, transitional housing and on the street. That's about 300,000 more people than available beds in shelters and transitional housing.

The report is the government's latest attempt to count people who are notoriously difficult to track. The estimate is similar to one by an advocacy group in January.

The 2000 Census pegged the number of homeless people at 170,700, but it was widely considered an undercount. In 1996, the Urban Institute used data collected by the Census Bureau to estimate there were between 640,000 and 840,000.

Housing officials hope the new report will serve as a starting point to more accurately measure changes in the homeless population.

"Understanding homelessness is a necessary step to ending it, especially for those persons living with a chronic condition such as mental illness, an addiction, or a physical disability," HUD Secretary Alphonso Jackson wrote in the report.

HUD developed the estimate using data collected by local agencies that serve the homeless. Agencies across the country tried to count the number of people living on the street one night in January 2005. The agencies also collected information about race, gender, and disability status from people staying in emergency shelters and transitional housing from February to April 2005.

Among the findings for people in shelters and transitional housing:

_Nearly half were single adult men.

_Nearly a quarter were minors.

_Less than 2 percent were older than 65.

_About 59 percent were members of minority groups.

_About 45 percent were black.

_About a quarter had a disability, though experts said the percentage is probably much higher.

The Urban Institute recently did a study on homeless people in Santa Monica, Calif., and found only 6 percent of those using services for the homeless did not have a mental illness or a substance abuse problem, said Martha Burt, a researcher at the institute.

Emergency shelters are more than 90 percent full on average nights, the report said. They would be over capacity if not for seasonal shelters.

By comparison, less than three-quarters of transitional housing units for families are occupied on an average night.

HUD has been shifting resources from emergency shelters to transitional and permanent housing for years. The number of emergency shelter beds dropped by 35 percent from 1996 to 2005, to 217,900.

Meanwhile, the number of transitional housing beds increased by 38 percent during the same period, to 220,400. The number of beds in permanent supported housing increased by 83 percent, to 208,700.

"We ought to be looking for ways to move people from shelters into permanent housing," said Nan Roman, president of the National Alliance to End Homelessness.

"Building shelter beds doesn't result in these people being housed," Roman said. "But clearly, short of housing, everybody should have a roof over their head. This points out that we are not there, either."

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On The Net:

Department of Housing and Urban Development: http://www.hud.gov/

National Alliance to End Homelessness: http://www.endhomelessness.org/

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Mental-health falls short, survey says - Winston-Salem Journal

By M. Paul Jackson

Less than half of the region's mental-health patients said that they are pleased with the state's mental-health system since it was overhauled in 2001, according to a report released yesterday.

The report was released by the Mental Health Association in Forsyth County Inc., a local advocacy group. The association held a meeting at Fellowship Hall at Highland Presbyterian Church in Winston-Salem to release the report.

The group surveyed about 220 mental-health patients and 80 mental-health providers from April to May of last year.

"We still have a ways to go, as far as satisfaction of services and consumers feeling that they're not getting what they need" said Andy Hagler, the association's executive director.

The survey was conducted to examine how the mental-health system has changed and how it has affected patients since it was overhauled.

The Winston-Salem Journal published a series of articles last year showing how the state's 2001 plan to shift care from mental hospitals to smaller community agencies was based on false assumptions about payments for mental-health services.

In addition, many smaller agencies were unable to provide adequate care and were forced to shut down, including HopeRidge Centers for Behavioral Health, a Winston-Salem agency that closed in 2005.

According to the association's report, about 48 percent of mental-health patients said that they were pleased with the changes to the state's system.

Mental-health providers, including staff members at agencies, were less satisfied with the system.

About 7 percent of the providers said that they were pleased with the state's changes. Many cited problems dealing with the government and planning for services for their disapproval.

The report also included statistics on the numbers of consumers who felt that they received all the care they believe they needed. For example, about 65 percent of the consumers surveyed said that they received enough mental-health services.

According to Liz Arnold, a board member for the association, about 90 percent of consumers should be satisfied with the amount of their care.

"I think that speaks to the level of turmoil in our system," she said.

The region's mental-health services are managed primarily by CenterPoint Human Services, a mental-health agency in Winston-Salem.

Association members said they planned to create support programs for mental-health providers under stress, as well as develop programs for the region's mentally ill homeless residents.

"It's an extremely underserved population in our community," Arnold said.

• M. Paul Jackson can be reached at 727-7473 or at mjackson@wsjournal.com. Read more!

The cost of reform - Raleigh News & Observer

Editorial:

State investigators are right to delve into the finances of a new Charlotte-area mental health program that serves more clients, by a relatively small percentage, than the program it replaced, but that costs $20 million more per month. The program understandably has raised the eyebrows of state Rep. Verla Insko of Orange County, who is one of the legislature's best informed members on the subject of mental health treatment.

The aim of Mecklenburg County's new program, run mostly by private firms, is to help clients toward self-sufficiency. That is an objective at the heart of what has been North Carolina's fits-and-starts attempt at mental health care reform. For nearly a decade, the state has been -- or was supposed to have been -- moving in the direction of getting the mentally ill out of long stints in big, centralized hospitals and into smaller programs closer to their communities.

The implicit goal, of course, is faster healing for hurting North Carolinians. They would be closer to supportive family and friends. Patients who get better sooner would be in a better position to get jobs and live independently.

But this change in treatment approach has proved neither easy nor cheap. Existing programs must be shut down and new local programs built, often from the ground up. They may have to go through periods of testing for effectiveness. State hospitals need to be reconfigured in keeping with their evolving mission.

The hoped-for payoff is that in the long run, money will be saved. Expensive hospital care, while it can't be eliminated, will give way to less costly local programming. Patients will be better off.

Critics of the Charlotte program say that companies are extending services -- personal aides who help clients build skills such as grocery shopping, house-hunting and searching for jobs -- to pad their invoices. The claims should be aggressively investigated. But state policy-makers should recognize that to make reform of the mental health system succeed, a large investment may need to be made in the short term to save money -- and help the mentally ill advance -- in years to come. Read more!

Easley wants HHS complex on part of Dix - WRAL Radio Raleigh

(Originally published Feb. 27)

Raleigh — There’s been plenty of debate, but no official decision on what to do with a prize piece of Raleigh real estate, the Dorothea Dix Hospital campus. The governor has made a move that speed up the process, however.

The 2008 budget that Gov. Mike Easley submitted last week includes $173 million in bond money to develop 25 of the 306 acres of the state property just outside downtown Raleigh. The city is hoping the state will sell it the land.

The 150-year-old state hospital is set to close late this year or in early 2008. What happens to that land will impact the capital city for generations, which led city officials to bring in planning advisers from the nationally known Urban Land Institute.

Easley wants to build a state-of-the-art, energy-efficient office complex for more than 3,400 Department of Health and Human Services employees.

“We need that. That is long overdue. We need that complex, and it will be the greenest building in the state,” North Carolina’s Democratic governor told WRAL.

The complex would be built on the edge of the Dix campus, along Lake Wheeler Road. DHHS employees who already work at Dix and thousands from downtown offices would fill the facility.

Politicians and planners have spent months talking about a putting a park, a mixed-used development or both on the site. A final decision hasn’t been made, which is why the budget item stunned some leaders.

“My reaction was a little bit surprised that it would be in this year's budget. It would have been great if everyone could have been on the same page,” Sen. Vernon Malone, D-Wake County, said. Malone co-chairs the committee studying the future of Dix.

The group hasn't yet found consensus, so, the senator and other lawmakers were surprised to learn the governor earmarked millions for the office complex.

“It is getting the cart before the horse in the governor's budget. What we need to do is determine what we're going to do with the Dix property first,” said Rep. Nelson Dollar, R-Wake County.

The governor says the jury is still out over what to do with Dix. He hopes the historic site can be preserved for public use.

Wake County leaders see the governor’s budget as an executive message.

“I know ultimately a decision has to be made on the Dix property. This may force us to move forward,” Malone told WRAL.

Easley’s chief economic adviser says that putting a new state building on the Dix campus makes sense.

“I believe this is the state's property first and foremost, and there's a lot of discussion that needs to take place on this,” said Dan Gerlach.

It now appears the governor is leading that discussion. The future of the Dix property will now become part of legislators’ budget negotiations. Read more!

Deadline to Meet Goals Extended as District Promises Better Foster Care - Washington Post

By Sue Anne Pressley Montes

The District's foster care system continues to shortchange children in its care by failing to provide full medical and mental health services and sufficient caseworker visits, a children's advocate said yesterday in U.S. District Court.

Officials from the new administration of Mayor Adrian M. Fenty, promising reform, negotiated an extension of a deadline for improving the child-welfare agency. The city has until Dec. 31, 2008, to make changes that should have been in place by the end of last year or earlier.

"It is troubling to us that, although the District has made progress, they are still as far off as they are," said Marcia Robinson Lowry, executive director of Children's Rights, a New York-based nonprofit advocacy group leading the long-running suit against the city. "The agency has still failed to address some significant problems affecting the well-being of these children."

The new timetable marks the latest development in the case now known as LaShawn A. v. Fenty. Filed in 1989, the federal class-action suit has outlasted several mayoral administrations and now represents about 2,400 D.C. children under the care of the Child and Family Services Agency. The suit was named for a 4-year-old who had been in emergency foster care for 2 1/2 years, significantly longer than the 90 days allowed by D.C. law.

Both sides in the case agreed to extend the deadline after lengthy negotiations. The District promised to improve investigations of alleged child abuse and neglect. The city also said it will seek better placement of children in family-like settings and provide more rigorous health and dental care.

Peter Nickles, general counsel for Fenty (D), told Chief U.S. District Judge Thomas F. Hogan that the new administration is "committed to the necessary funding."

"The issue is the quality of care, the outcomes for this vulnerable population," he said.

When the suit was filed, the District's child welfare system was described as chaotic. Hogan wrote about "the indifference" of the administration of then-Mayor Marion Barry (D) and "the resultant tragedies for District children relegated to entire childhoods spent in foster care drift." In 1995, the system was placed in court receivership because of the lack of progress, a condition that was lifted in 2001.

But improvements have come too slowly for child advocates involved in the case.

Lowry told the judge that the agency did not meet 60 of its 105 goals during the last three years. Among other problems, only 56 percent of children in foster care are receiving the prescribed twice-monthly visits by caseworkers, she said. Only 29 percent receive medical exams within 90 days of their placement in the system, although the District earlier had agreed to provide timely screenings for 90 percent of the children in its care by the end of 2005.

"Children are still being damaged on a day-to-day basis by this system," she said.

Richard S. Love, senior assistant D.C. attorney general, told the court that the agency has gone through "dramatic, measurable and, indeed, remarkable" reform. "But it is long recognized that there are things yet to be accomplished," he said.

Hogan acknowledged "the commitment of the new administration" and called the new deadline "logical and enforceable." He set a hearing for June 7 to gauge progress. Read more!

Please Check Mid-Afternoon for Further Updates

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Mental health building sold - Overland Park (KS) KC Community News

Miami County and Osawatomie officials concerned about how the loss of Family Services Center will affect delivery of care

By: Jennifer McDaniel, jmcdaniel@miconews.com

Despite the impending sale of the Miami County Family Services Center near Osawatomie, the county’s mental health provider is assuring local officials that mental health services designed for children still will be available.

But Osawatomie and county officials are working with Elizabeth Layton Center representatives to determine how to best solve the center’s dilemma of finding a new location without affecting services provided to children.

When it opened nearly seven years ago, the center served as a means for the former Miami County Mental Health Center to broaden its scope to help the county’s children struggling with severe behavioral disorders. Services originally were provided in the former Families First offices along Osawatomie’s Sixth Street. But with quarters so tight and a growing need to serve more Miami County families, officials began to look for an alternative site.

A little more than 12 acres of free state land just off U.S. Highway 169 near Osawatomie State Hospital would give officials a location, but it would take money to build the structure. Little by little, officials found the funding necessary to build the 6,700-square-foot structure where children could play, work on improving their own behavioral skills through therapy and seek help. Funding came from various sources, including a Community Development Block Grant, local charitable foundations, assistance from residents and utilities from the city of Osawatomie. In all, more than $1 million was donated.

But last year when Sunflower Centers, formerly Miami County Mental Health Center, experienced financial problems, the center was replaced in September by the Elizabeth Layton Center of Ottawa as the county’s mental health care provider. From the beginning, Diane Drake, executive director of the Franklin County clinic, said the center was informed the family services center building was for sale and was only available to rent on a monthly basis, a problem officials also struggled with as they worked through the initial transition.

“It was always the intentions of Sunflower to sell those buildings,” Drake said. “Since early September, they made it clear they would be selling. Through time, there had been a consistent message that their properties could be sold.”

On Nov. 29, she was told by a Sunflower employee that the group had an interested buyer and center officials had 30 days to vacate and find another location.

“That’s when we decided we had to get serious about looking for a place to relocate to,” she said.

Bob Nicholson, a Paola attorney representing Sunflower, confirmed Monday that officials have all four of its locations for sale, with contract negotiations nearly complete on three of the four buildings. Elizabeth Layton officials are close to working out agreements with potential owners of the East Street and Hospital Drive locations, but not the Osawatomie site, he said.

“Sunflower is having to sell off its assets to pay off debts,” Nicholson said.

Drake said the center does not have the resources to buy the building. Though she would not comment on the structure, Drake said the building has some inherent problems, including a lack of expandability and utilities that cost five times more than the center’s other facilities.

Despite the continuing negotiations between Sunflower, the building’s potential buyer and Elizabeth Layton representatives, both county and Osawatomie city officials thought they were in the dark. Both said they didn’t learn of the potential closing of the Osawatomie location until a Miami County Commission work session nearly two weeks ago, as Elizabeth Layton representatives and county officials worked to complete an agreement through the end of the year.

The county pays more than $200,000 to the center each year to subsidize cost of treatment for county residents. It also has involvement in the family services center. County officials offered $495,000 in certificates of participation to help construct the building. Though Sunflower has continued to make its payments, County Administrator Shane Krull said the county would have to cover the additional amount if Sunflower could no longer do so.

After learning of the issue, Commissioner George Pretz, Osawatomie Mayor Tom Speck and Norma Stephens, former Osawatomie State Hospital superintendent, scheduled a meeting with the center’s board of directors Thursday to convince officials not to close the location.

“We were caught by surprise,” Speck said. “We told them of our disappointment that they hadn’t come to us before, and why they waited until February.

“Obviously, we don’t want to lose those services, but now we understand their efficiency issues from a business standpoint,” he said. “We’re willing to work with them.”

Pretz said he thought the meeting was a positive first step.

“We had a chance to hear the other side of the story,” he said. “I think it was good. We made the whole board aware of the Osawatomie community’s concern, and by setting up this committee, I hope we can get down to the hard facts and see what we can accomplish.”

Drake said she doesn’t think the center itself delayed contacting city and county officials about the problems. She added that she did notify two individuals last fall, but said caring for clients had to be dealt with before facility issues.

“The first priority has always been client care,” she said. “Buildings are an issue, but No. 1, we want people to know those receiving care are not falling through the cracks. The same care is being provided.”

“We took on Sunflower without any resources given to us, meaning there wasn’t a stack of money,” she said. “We did it for the sake of client care, and that was the reason why we did it.”

Drake said the Family Services Center continues to operate and is planning for additional services and programs coming within the next year. The Layton Center has served nearly 860 clients in Miami County since Sept. 3, and 273 of those clients are children, she told commissioners earlier this month. The Family Services Center averages a quarterly caseload of about 62 children. Of those children, 20 live in Osawatomie.

As officials plan to meet in the coming week, Drake said she is more than willing to work with local officials and come up with a plan both can live with.

“We’re not wanting to make any rash decisions and will work cooperatively with the group named,” she said. “This isn’t an attempt to take away from Osawatomie; we don’t have control of building. It’s Sunflower’s choice to sell the building.

“It’s been a process ... I don’t know what we could’ve done better,” Drake said. “I feel our priorities were in the right place.” Read more!

Hearing focuses on mental health coverage - Deleware County (PA) Times

By PATTI MENGERS , pmengers@delcotimes.com

MIDDLETOWN -- In 1995, when U.S. Rep. Patrick Kennedy, D-R.I., was 27 years old and a new member of Congress, he became the major sponsor of a bill that would compel insurance companies to cover mental illnesses as fairly as they cover physical illnesses.

"I was the youngest member of Congress from the smallest state from the minority party sponsoring a bill with a large stigma against it," said Kennedy. "It was not popular."

Twelve years later, with Democrats in the majority and a promise of support from George W. Bush, the 39-year-old congressman is hoping to finally see his dream of mental health parity become a reality.

Next week, along with U.S. Rep. Jim Ramsted, R-Minn., Kennedy expects to introduce the Paul Wellstone Mental Health and Addiction Equity Act, named for the Minnesota Democrat who championed mental health parity in the U.S. Senate until his death in a plane crash in 2002.

To help fuel the cause, Kennedy, hosted by U.S. Rep. Joe Sestak, D-7, of Edgmont and the Mental Health Association of Southeastern Pennsylvania, conducted a forum Tuesday at the corporate headquarters of Elwyn, a nonprofit provider of services for special needs individuals including those suffering from mental illness and emotional and behavioral disorders.

"This is an issue of civil rights at its core," said Kennedy.

If enacted his bill would expand the Mental Health Parity Act of 1996 by requiring group health plans that offer benefits for mental health and addiction to do so on the same terms as other diseases. It would close loopholes that allow insurers to charge high co-payments, co-insurance, deductibles and maximum out-of-pocket limits and impose lower day and visit limits on mental health addiction care.

Kennedy, who told the audience he is a recovering alcoholic and addict with bipolar disorder, underwent treatment for cocaine addiction as a teenager and, last year, sought treatment for prescription pain medication addiction after an automobile accident on Capitol Hill. He said he has been criticized by members of the 12-step community for not maintaining anonymity in his recovery.

"People should be more wild and worked-up by the fact that 175,000 fellow alcoholics die because 300,000 insurance companies deny them treatment," said Kennedy.

The son of U.S. Sen. Edward "Ted" Kennedy and Joan Kennedy, who have both been connected with alcohol-related incidents,his cousin, David A. Kennedy, died of a drug overdose in 1984 at the age of 28.

"I faced it in my own family and in my own personal life. I lost a cousin to this illness. I’ve personally seen the effects of recovery in having access to the best treatment in the country as a member of Congress. What’s good enough for federal employees is good enough for the American people," Kennedy said after the hearing.

Elwyn President Sandra Cornelius testified one in five Americans suffer from mental illnesses but only one third receive treatment in part because of the constraints of health insurance coverage.

"Knowing that only a limited number of visits are covered, or that associated costs are prohibitive, forces patients to self-treat or minimize the effects of the illnesses. The impact of this can last a lifetime," said Cornelius.

She maintained the increased costs to employers and employees of mental health parity in insurance premiums would be outweighed by the increased productivity resulting from people obtaining the treatment they need.

Sestak estimated the indirect costs of untreated mental illness are three times what it would cost if Americans directly invested in mental health treatment.

According to the Mental Health Association of Southeastern Pennsylvania, equal coverage of mental illnesses with physical illnesses would ultimately save the nation about $2.2 billion because of the high success rates of proper treatment.

Pennsylvania Psychiatric Society President-Elect Kimberly Best testified research has shown an increasing number of mental illnesses to have genetic or biological bases.

A retired Navy admiral, Sestak noted of the approximately 17 percent of Iraqi war veterans who need care for such illnesses as anxiety, depression or post traumatic stress disorder, about 40 percent go untreated.

A Collingdale mother of three detailed how, while working two jobs, she was forced to drop her son from her private health insurance and enroll him in Medical Assistance to get him adequate care for manic-depression and behavioral disorders. During her quest for his care he became suicidal.

"I compare all of this with the fact that, if my son had been diagnosed with cancer, although this would have caused us enormous anguish, I would not have had to go through all the trauma of figuring out how we would pay for it and he would have had access to all the care he needed," she said.
Read more!

Mental health in new court - Crystal Lake (IL) Northwest Herald

Mental illness often is misunderstood in society.

It is not uncommon for employers, family members, and friends to fail to recognize that someone they care about needs help. One of the places where this failure to understand is magnified is the criminal justice system.

McHenry County is attempting to deal with this issue by creating a special court. The mental-health court will provide treatment resources for people with mental disorders, such as bipolar disorder or schizophrenia. The program will only be made available to those charged with minor crimes.

The National Institute of Mental Health estimates that about one in four Americans over the age of 18 suffer from a mental disorder. That translates to about 57.7 million people.

The court is recognition that it does no one any good to simply cycle those who suffer from mental illnesses through the criminal justice system. A better avenue is treatment. When it comes to minor, nonviolent crimes, one goal should be that offenders do not commit a crime again. The mental-health court could go a long way to help people to stay out of the criminal justice system.

“I think that mental-health issues are the most overlooked, ignored and misunderstood in our society,” McHenry County State’s Attorney Louis Bianchi said in a Saturday Northwest Herald story.

A program such as this one has the potential to be controversial. There is the fear among some of the public that someone will be able to cheat the system or avoid punishment by feigning mental illness. But, it is important to note that the court will not deal with violent crimes.

Also, cases will be funneled to the mental-health court through recommendations most likely made by police, attorneys or social workers. And victims will be consulted as to their opinion of the mental-health court option.

If the accused completes an intensive treatment program, criminal charges will be dropped.

It appears that McHenry County has gone about creating the court the right way. Hopefully, it will provide help to people who need it. Read more!

Facing Mental Health Issues: Looking Out for Each Other - Cornell Daily Sun

By David J. Skorton, Cornell University President

I am concerned about the level of stress and about mental health issues that affect our campus. We have many services available to students and also to faculty and staff members, but I want to be sure that everyone on campus knows what is available and how to access the help they may need. And I want to stress how important it is that we take better care of ourselves and also look out for each other as members of a campus community.

Mental health issues, including but not limited to the prevention of suicides, are receiving increased attention on college campuses — especially those like Cornell where many students report high levels of stress. Cornell has already established an extensive support network of mental health professionals and specially trained faculty, staff and students, but there is a growing recognition that we need to do more to watch out for each other and to support each other when cognitive and emotional challenges arise. This responsibility includes the entire Cornell community: faculty, students and staff.

There is debate regarding claims that mental health problems among college students are on the rise, but there is no question that the demand for mental health services has risen dramatically. The rate of referrals and self-referrals for mental health services at Cornell has risen briskly, with mental health visits to Gannett Health Services increasing 128 percent over the past eleven years. Such increases are due partly to advances in the treatment of mental illness in childhood and adolescence, which enable more individuals to function successfully, with appropriate support. Partly they are due to the decreasing stigma that our society attaches to mental illness.

Gannett Health Services has doubled its counseling staff over the last decade. In addition, the academic advising offices have become the first points of contact for many students in distress and also for faculty members who become aware of students in need of help. We also have a Dean of Students-based Alert Team for early intervention plus crisis managers and community support teams to provide organizational support for students in need.

Cornell’s Council on Mental Health and Welfare, which includes faculty, staff and students, guides our efforts to address mental health at the university, and we are continually evaluating our policies and practices to build a stronger safety net for students and provide a supportive environment. Our efforts have earned us recognition from the Jed Foundation as a leading campus in the area of student mental health.

We are part of a multi-campus project developing and evaluating best practices in mental health promotion and suicide prevention. Our staff and faculty are also conducting research to learn more about the sources of stress among our students and how their experiences compare with those from other colleges and universities.

We know, for example, that the rate of suicide among Cornell students is consistent with campuses nationwide. Of course, whatever the overall statistics, even one suicide on our campus is too many, and the steady rate of such problems requires our attention and action.

Gannett’s Counseling and Psychological Services offers extensive counseling services to students at the health center and at nine other locations around campus, as well as on-line depression screening and other resources and services. We’re also building a network of staff, faculty and students trained to recognize students in distress and reach out to them and who are also available to educate their colleagues about signs of distress and where they can steer students for help.

For Cornell faculty and staff and their dependents, the Employee Assistance Program offers free, confidential, professional counseling and consultation services by telephone or in person. EAP can help address personal and workplace difficulties ranging from stress-related emotional issues, to domestic violence, to interpersonal difficulties and financial concerns. I urge faculty and staff members to utilize its services when a problem is affecting their well-being, daily life or job performance.

We also need to preserve and enhance the physical environment of the campus so that people can find opportunities to reduce the stress in their lives, whether by taking a walk or a run through the Cornell Plantations, exercising at a fitness center, spending time in a practice room playing a musical instrument or curling up in a comfortable chair in the library. We must ensure that Cornell continues to provide a beautiful, nurturing environment that promotes good mental and physical health. And given such an environment, we need to discipline ourselves to slow down occasionally and take care of our own needs.

We have enormous leadership by professionals on our campus regarding mental health issues. However, we need to do more to support those of us who are struggling with mental health issues, but who have not yet received help. And we need to remember, as individuals, our role in identifying colleagues and friends under unusual stress.

• All of us must acknowledge our interdependence and share responsibility for our own and others’ health and well-being. The importance of such recognition and of an offer of help cannot be overemphasized. It is a sign of strength, not weakness.

• When we are aware of someone who is in distress, we demonstrate compassion when we extend ourselves to that person, rather than ignoring the need.

• And when we care for ourselves and allow others to help us when we are in trouble, we ease our own burdens and enable each other to express compassion.

Please join me in addressing the challenges of stress and good mental health at Cornell in a positive and supportive way.

David J. Skorton is the President of Cornell University. He can be reached at david.skorton@cornell.edu. From David will appear every month.
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The Ten Work-Happiness Secrets of People with Mental Retardation - Beverly Hills (CA) American Chronicle

More on the author, CSS Executive Director, is at the bottom of this article

Tom Swanston (originally published Feb. 27)

Is your workplace making you crazy? Do your co-workers get on your last nerve? There is no question that work can be a place that tests your patience by lifting you up, tearing you down or sometimes completely ignoring your contributions. It can be a place of passion and drive or a place of frustrated and burnt out clock-watchers. At Chesapeake Service Systems (CSS), hundreds of people with mental retardation and other severe disabilities have a refreshingly honest point of view about work and how attitudes on the job can greatly affect happiness and work satisfaction. We can all learn a lot from how they choose to see the world.

1. Be grateful that you have a job to go to every morning. 20.3 million people with severe developmental disabilities are unemployed in this country. People with severe disabilities who are out of work often suffer mentally, physically, and developmentally digress. Those who have a job, come into work with big smiles on their faces. They want to come to work on the weekends, holidays and even during inclement weather because they know how it dramatically affects their life for the better. Regardless of whom you are, having a job and a purpose in life is essential to self-esteem, independence, and overall well-being. It might be difficult to drag yourself out of bed on Monday morning, but without a job to go to; your quality of life would suffer immensely.

2. Every job (no matter how small it may appear) is important. Whether you have difficulty communicating, moving, hearing, seeing, or comprehending, every job for a person with a severe disability is important. To someone without a disability, putting a cable into a bag could seem monotonous and boring. It could appear to be just a very minute part of a larger contractual obligation with an outside company, but to that one individual performing the task; it is their one chance to be like everyone else. When they are on the job, they are not a person with mental retardation; they are a co-worker and an essential part of a team with a goals and objectives. Status and titles have no meaning here because everyone is an essential part of the companies’ success.

3. Greet your co-workers with a kind word or smile when you pass them in the hallway or when they enter your workspace. In a world that is increasingly cut off from people and emotions, simple gestures that display kindness and openness are harder and harder to find. Walking onto out work floor is an instant mood-lifter. Everyone who visits is welcomed with open arms and greeted in a positive manner, regardless of who you are or how much money you make. Everyone wants to know how your day is going, to shake your hand and to tell you how excited they are to be on the job. Think of how differently your day would go if you treated your co-workers in that manner.

4. Look for ways to encourage your co-workers to perform better on the job and you will all reap the rewards. It is not uncommon to see people on the work floor assisting others with their daily tasks or giving an encouraging word. No one is viewed as competition or as someone to fear, but rather as people who are all in the same boat, trying to make the best of some very challenging situations. When someone accomplishes a personal or professional goal, their achievements are championed by all. There is a deeper understanding that when one person wins, everyone wins.

5. Take breaks and have fun, even if it’s just for a few minutes. Understand the value of balance in your life. Due to physical, mental, and emotional limitations, breaks throughout the day are mandatory for our clients. Because of the unique circumstances, becoming stressed and overwhelmed not only affects one person, but can quickly permeate the entire work force and wreak havoc for everyone. Knowing when to stop, to give your mind and body a break, is essential to maintaining a happy and healthy work environment for people with and without disabilities.

6. Take pride in what you do, regardless of the pay or recognition. We all want to be known for being the best at what we do. It’s human nature to crave recognition and monetary compensation for hard work and dedication. Many of the jobs here are assembly-line, labor intensive or entry level positions that most people would dread. However, every single person is proud of the work they do and they are eager to tell everyone they know about it. The work is not glamorous. It’s not all that creative or dynamic. Unfortunately it will probably never be seen as something deserving of high wages or praise, but it serves a very important function in our society. These are jobs that give incredible meaning and value to countless lives.

7. Life is too short to gossip, back-stab or criticize. People, who have the most compelling reasons to complain about difficult life circumstances, choose not to. Life is challenging for everyone. We all deal with the daily frustrations of having to work with people who are different from us. Some people communicate differently, some are slower or faster than us, and some don’t share our same enthusiasm, but we all are required to work together. Conflicts arise on the work floor, but they never last long or become spiteful, catty, or mean. Being focused and grateful on the job leaves little time or energy for negative interactions with co-workers. Positive attitudes give-way to positive interactions.

8. Focus on what you have, instead of what you don’t have. It’s easy to get caught up in keeping up with the Jones’. In a society where it’s all about the nicest car, clothes, and house we miss out on enjoying what we have in the constant search for something bigger and better. Many of the clients with mental retardation, autism and other severe disabilities have very little in life. Almost all cannot drive, don’t own a home, and wear the same clothes year after year. However, that doesn’t change how happy and fulfilled they are in life. The one thing they want is to feel normal in the here and now. Working gives them that feeling and as long as they are provided that opportunity, they feel like millionaires.

9. Enjoy the little things in life. Some of the clients get paid $2.00 every two weeks, but to them, it’s like getting $2,000. It’s not about the monetary value of the check, but the paycheck alone that gives them pride in themselves and what they do. Going to the mall and buying something with their own hard-earned money is an indescribable joy that most people take for granted. The next time you buy something for yourself, remember how hard you worked to get it. It will make your purchase even more rewarding.

10. Get excited about going to work. Even if it’s raining outside, you are stuck in traffic or are running late, you were hired because of your unique abilities and talents. You were specifically chosen because someone was impressed by what only you can bring to the table. Someone had faith in you and believed in you. Celebrate and enjoy that fact!

So many people with severe developmental disabilities are never even considered for employment. They are all too often perceived as not being useful to society, much less on the job. Imagine how it would feel knowing you have a lot to contribute to the world, but no one will give you a chance. As a result you spend your entire life hoping that someone will come along who will see you for who you really are and give you that opportunity to shine.

People with mental retardation and other severe disabilities are elated to be at work. They are often the first to arrive and most days dread having to leave. Their work ethic is something beyond compare because they know how it feels to be isolated and segregated away from normal life. They appreciate the opportunities they are given and show their gratitude by excelling on the job.

Our motto is: “It’s not about the work they produce, but what the work produces in them.” That is true for all people in all work environments. In many ways your work defines who you are and brings to the surface your core values and character. It can make your life enjoyable or completely miserable. It’s all in how you choose look at it and how you choose to let it affect you. Take some time to see life from someone else’s perspective and learn the important lessons that they are trying to teach you. It is often in the most unexpected places where we find the greatest gifts.

----------------------------------------
Tom Swanston

As a successful Executive Director and a person with a severe disability (Meniere’s Disease), Tom Swanston brings insight, enthusiasm, and compassion to his work at Chesapeake Service Systems. Tom has a unique perspective in that he is an enthusiastic disability advocate, as well as experiencing a severe disability of his own.

With experience as a financial analyst, Tom has increasing CSS workshop sales from approximately $15,000.00 to over $4.8 million during the past twelve years. In 2004 Tom lead CSS into a capital campaign to expand client services with the goal to raise $3 million. Through superb grant writing techniques and marketing tactics Mr. Swanston single handedly raised over $1.3 million in less than 18 months.

Mr. Swanston currently serves on the Endependence Center Board of Directors. He is a past Board Member of the Chesapeake Economic Development Board and has participated in fundraising activities with the Chesapeake Foundation for the Mentally Disabled.

Tom is a dedicated advocate with remarkable vision regarding the employment of people with severe disabilities and a conviction that all people with a disability can and should have a job.
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Family turns to petitions to keep son in mental hospital - Janesville (WI) Gazette

By Carla McCann (Originally published Feb. 27)

MILTON-Melly and Redgie Staskal want the community's help to keep their son, Mark, in a mental hospital, where he's lived since he murdered their daughter 22 years ago.

They are collecting signatures on petitions, asking people to sign in support of keeping Mark at Mendota Mental Health Institute.

"We're not against our son," Melly said. "Our concerns are about keeping the community safe so that other people don't become victims."

The Staskals also paid to have about 5,800 purple fliers showing their daughter Marcy's picture and asking people to "Help Us Keep Mark Staskal at The Mendota Mental Health Institute" inserted into The Janesville Gazette on Saturday.


A petitions to keep former Milton resident Mark Staskal in a mental institution sits near the cash register at Janesville's Kealy Pharmacy. Mark Staskal killed his sister, Marcy, in 1984 and has been confined to Mendota Mental Health Institute ever since. His parents are concerned that he is not cured and could kill again.
Bill Olmsted/Gazette Staff

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Mark has been confined to Mendota since the 1984 stabbing murder of his 16-year-old sister. He now wants to rejoin society and has petitioned for release from the hospital.

The Staskals are unsure how they will present the petitions to the court.

"God is leading us," Melly said. "We have a lawyer and may put the petitions in his hands."

She agreed that the petitions may not make a difference, but she said the issue is bigger than her son's case.

"We are giving the public the opportunity to say, 'We don't want people who are dangerous and violent free to hurt people,'" Melly said.

The Staskals have not counted signatures on the petitions, which they plan to collect March 6.

At Dave's Ace Hardware Store in Milton, Carla Herbst, a buyer, has heard customers express concern about signing the petition.

"Some are a little worried that if Mark does get out and has access to the petitions, he may come looking for them," Herbst said. "They would love to sign the petitions but are concerned about putting themselves and family in jeopardy."

Susan Frederick, customer service manager at Piggly Wiggly, said she's seen many people sign the petitions. She was unsure how many signatures the store has gathered, however, because some of the sheets were filled and removed.


Redgie Staskal


Melly Staskal
Although Mark has regularly asked for release without success, this time may be different.

At a hearing Jan. 5, Judge Michael Byron ordered the first step toward the 43-year-old being released to a halfway house by telling the Wisconsin Department of Health and Family Services to prepare a community-based treatment plan for the man.

The next court date is scheduled for Friday, March 9, but assistant district attorney Raymond Jablonski said it probably will be postponed. The state has requested more time to find a facility where Mark could live, Jablonski said.

Byron then would have to decide if it's an appropriate place, he said.

Mark suffers from paranoid schizophrenia, his parents said.

"The last I read, this disease has a very low cure rate," Melly said. "Mark is a victim of the disease."

The Staskals fear their son isn't well enough to live outside of the mental hospital's restrictive and structured environment. They believe Mark's unpredictable illness is smoldering beneath the surface and that he still is capable of murder. Read more!

Governor proposes two new state hospitals - Bend (OR) Weekly News

SALEM, Ore. – Today Governor Ted Kulongoski delivered to the Oregon Legislature recommendations for the location of two new state mental health facilities – a 620-bed hospital on the existing site in Salem and a 360-bed hospital in Junction City – to replace the outdated Oregon State Hospital and improve the lives of Oregonians with mental illness.

“This initiative represents the most significant opportunity in more than 120 years to improve the quality of mental health care Oregonians receive at our state hospitals,” said Governor Kulongoski. “As we move forward this critical initiative focused on construction of new state psychiatric hospitals, we must also remained focused on a vision of a truly transformed Oregon mental health system.”

In selecting the sites, the state used criteria developed by a 10-member committee named in June 2006 by the Governor, Senate President and Speaker of the House. Those criteria focused on three themes: 1) the opportunity to deliver high quality services to patients closest to their home communities; 2) the ability to retain and recruit the best professionals available to care for patients and deliver those high quality services; and 3) cost, focusing on estimated construction costs and the value of the investment to the state.

“I look forward to working with the Legislature to advance the recommendations in this report this session because this issue cannot wait another two years for action,” the Governor said. “Resolution on the location for these two new facilities before the legislature adjourns this summer is critical both to the state’s community mental health system planning efforts and, most importantly, to the state’s ability to better serve Oregonians with mental health needs in our state-owned hospital facilities.”

Construction of these facilities is critical to moving forward Phase III of a multi-phase process the Governor launched in 2004 to redesign Oregon’s mental health system, including a new State Hospital system.

That intensive planning process, detailed in the “Master Plan Phase I Report” and the “Oregon State Hospital Framework Master Plan Phase II Report” – was led by KMD Architects of San Francisco. The Phase I Report identified the structural and systemic challenges facing the Oregon State Hospital’s Salem Campus and concluded that Oregon should proceed with both the replacement of the Hospital facility and a redesign of the entire public mental health system.

Building on those findings, the Phase II Report recommended enhancing Oregon’s delivery of mental health care to its citizens at the community level and clarified the role that the Oregon State Hospital system should have within an improved and enhanced community-based system.

The Governor’s recommended budget takes significant steps to advance the mission of the next phase, namely, to create an integrated, culturally competent continuum of mental health treatment and support services designed to help individuals avoid disruptive and costly hospitalization in the first place, offer the highest quality community and state hospital-level services, and help individuals transition back into their communities when hospitalization is unavoidable.

Community services in the Governor’s budget include: improved access to phone counseling and “crisis” services; more out-patient and residential treatment; and more employment and housing supports for individuals with mental illness. The Governor’s budget also includes the necessary funding to perform a more detailed assessment (‘due diligence”) of both the Salem and Junction City properties, and to design and begin construction on the 620-bed hospital facility, with completion of that facility scheduled for 2011. The 360-bed facility would be completed by 2013.

The focus of today’s report is on the two larger facilities west of the Cascades recommended in the Phase II report. Separate efforts are underway to address the unique needs of central and eastern Oregon. Another separate effort detailing recommendations about community-based mental health service needs is also ongoing. Both of those efforts will produce additional reports at a later date.
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Stigmas of mental illness remain - Hackensack (NJ) Herald News

By TOM DAVIS
RECORD COLUMNIST

Five times he called her a "loon" or "lunatic." Each time, the peace activist reacted to Bill O'Reilly's name-calling with a shrug or smirk. But this encounter on "The O'Reilly Factor" raised the question: Who was more outrageous?

Was it O'Reilly for using words that some might interpret as slurs? Or was it the activist for not taking him to task?

For a long time, words and images that define mental illness have been used to describe a person who holds a differing opinion as out of line or evil.

Mental health professionals recoil when they hear such talk or see such pictures. Now they're speaking out to stop the use of words and images that stigmatize people who suffer from schizophrenia, bipolar disorder, obsessive- compulsive disorder and depression.

Stereotypes sell

Otto Wahl, a psychology professor at the University of Hartford, says that despite years of advances in mental health awareness, the media still rely on stereotypes to sell books, magazines, news-papers, movies and TV shows.

In his book, "Media Madness," Wahl displays movie posters that make light of mental illness.

One for "Crazy People," for instance, shows a cracked egg that appears to be sticking its tongue at people.

"The stereotypes of people with mental illnesses have just these qualities -- they are extremely dangerous, outstandingly different, and/or excessively ridiculous," Wahl writes in his book. "They are, in other words, entertaining and profitable."

The media have even created myths, Wahl and others say. The so-called "psycho killer," for example, has become a mystery-novel slasher-movie trademark. It even is the title of a hit song by the Talking Heads.

Not only does the term stigmatize people with mental illness, mental health professionals say the labeling is incorrect. They point to studies that show only 4 percent of people who commit murder are mentally ill.

But the media are making some progress, mental health professionals say.

Star power helps

Hollywood has achieved some measure of critical and commercial success by using likable or sympathetic characters to portray mental illness.

Gary Morris, a lecturer at the University of Leeds in the United Kingdom and author of the textbook "Mental Health Issues and the Media," cited Russell Crowe in "A Beautiful Mind" as an example of a box-office star taking on a sensitive role of a mentally ill professor.

Even Jack Nicholson's cranky Melvin Udall in "As Good as It Gets," Morris says, could be considered a favorable portrayal.

"It is helped to some degree because we, as an audience, largely admire the actor Jack Nicholson, and his character's warm side begins to emerge, enabling a more positive attraction to be formed," Morris writes.

The Coping column appears every other Tuesday. To suggest topics, write to Tom Davis, The Record, 150 River St., Hackensack, NJ 07601 or e-mail davist@northjersey.com. Please include your phone number with all correspondence. Read more!

The right reforms can lead to preventative care, cost controls - San Jose (CA) Mercury News

Mercury News Editorial

For decades the medical community has known that mental illnesses are biologically based brain disorders. Yet society, to its great detriment, still wrongly insists on attaching stigmas to those suffering from mental problems.

Mental health coverage must now be part of America's health care debate.

It's past time that we started treating the mentally ill as medically ill and began looking for ways to aggressively ramp up preventive treatment to bring down future costs.

Reps. Patrick Kennedy, D-R.I., and Jim Ramstad, D-Minn., plan in March to reintroduce legislation in Congress that would bring further parity to coverage of mental illness, requiring insurers to reimburse treatment for mental health problems as they would for other common medical problems, such as cancer or heart problems.

The logic is inescapable.

If a patient has a brain tumor, there are lots of resources. Many resources are covered by insurance and made available for long periods of time as alternatives are explored. But if a person has a chemical imbalance in the brain and is diagnosed as schizophrenic, they are commonly greeted with disdain or disgust, and hospital stays and treatments are limited. Many alternatives and long-term care are not fully covered by insurance.

The costs to society are staggering. Substance abuse. Homelessness. Disability. Incarceration. Estimates are that the impact is close to $100 billion every year. A stunning Department of Justice survey released in September revealed that the total number of prison inmates with mental health problems is two to three times greater than previously believed.

The study showed that 64 percent of local jail inmates, 56 percent of state prisoners and 45 percent of federal prisoners have symptoms of serious mental illnesses. It's an accepted medical fact that between 70 and 90 percent of people with serious mental illnesses can be treated so that the symptoms are severely reduced.

Opponents argue that health care costs are already escalating at an unsustainable rate, and that the nation cannot afford to add the costs of treatment for the mentally ill to an already over-burdened system.

But a study published in 2006 by the New England Journal of Medicine indicates that elimination of caps on mental health coverage might not lead to increased spending. The study of 20,000 federal employees who were given access to increased coverage failed to show an increase in spending, after inflation was taken into account.

Congress will want to take a prudent approach to the issue. But beyond the moral obligation to humanely treat the mentally ill's conditions as medical problems, attacking mental illness earlier and more aggressively could ultimately result in a reduction of costs to American taxpayers. Read more!

NJ child welfare reform finally on track, federal monitor says - AP

GEOFF MULVIHILL

New Jersey is finally taking the necessary steps to fix its long-troubled child welfare system, according a federal monitor assigned to track the system's progress.

A report released Monday by the Washington-based Center for the Study of Social Policy found that between July and December 2006, New Jersey accomplished everything it said it would to improve the protection of children. In several areas, it exceeded goals.

"New Jersey is finally on a positive path toward reforming the way it delivers child welfare services to children and families," the report's authors wrote.

Susan Lambiase, associate director of Children's Rights Inc., a New York-based advocacy group that sued New Jersey to force changes in the child-welfare system, said she's encouraged by the new report.

"This is the baby step. It is the first step in getting this fixed, but they're doing it so far," she said. "It's tremendous progress for a system who really couldn't get the job done in any area."

That sunny assessment reflects major changes in the Division of Youth and Family Services and changes in the way its progress is measured.

The state's child welfare system has been under federal monitors since 2003, when the New Jersey settled a lawsuit with Children's Rights, which claimed the system was placing children in peril.

Though critics said that the state had failed to protect the abused and neglected children in its care for years, the issue gained widespread public attention in 2003 when a boy was found dead in a Newark basement and then four severely malnourished boys were discovered in a Collingswood foster home.

The first monitor's reports found major problems in reform efforts. In 2005, Children's Rights asked a judge to intervene.

That request was dropped, though, when the state agreed to make big changes.

DYFS was taken out of the Department of Human Services and placed into a newly created Department of Children and Families, with former state child advocate Kevin Ryan put in charge.

After that, the state and Children's Rights reworked their settlement, giving the state more time to make changes.

The first steps would deal largely with improving the setup of the agency as well as meeting some other goals, such as stopping the practice of warehousing children who need mental health treatment in youth detention facilities and increasing the number of adoptions.

The state placed 1,387 children into adoptions in 2006 - far exceeding the goal of 1,100. In 2007, the agency is committed to place 1,400 children.

Under the new standards, the state is to be held eventually to other specific goals, such as reducing the number of children abused by foster families.

"We have a very long walk home," Ryan said. Read more!

Mentally ill make case for coverage - Bridgewater (NJ) Courier Post

By TOM BALDWIN
Gannett State Bureau

TRENTON -- A parade of witnesses telling stories of heartbreak and frustration appeared Monday before a congressional forum about insurance coverage for mental and emotional issues not routinely covered by insurers.

"There certainly is room for improvement. . . . We are at a critical point of both opportunity and challenge," said U.S. Rep. Frank Pallone, D-Long Branch.

Pallone and Rep. Patrick Kennedy, D-R.I., headed the subcommittee hearing that included state Sen. Joseph Vitale, D-Middlesex, chairman of the state Senate Committee on Health, Human Services and Senior Citizens.

"Mental-health and addiction-services parity has to happen," said Vitale. "Studies have long illustrated that mental health and substance-abuse are diseases."

Kennedy, who entered a treatment center after he had crashed a car near the U.S. Capitol and later blamed his incoherence on a mix of alcohol and medicines in 2006, told the room that people with mental disorders won't get what they seek "because we don't speak out enough," inspiring applause.

"When I get worse, or sick, my coverage gets worse, and when I am healthy, the coverage gets better," said Sekhar Subramani of Old Bridge of the Depression-Bipolar Support Alliance.

"We have been working on this, getting the coverage," said Bill Buther of Ocean Grove, speaking for the Care Center of Neptune City, which offers support for the mentally frail.

Asked how much the idea would cost, Pallone said, "If we have proper coverage, it means preventative care. It can save the state money."

"In this budget year?" asked a dubious Public Advocate Ronald Chen after he had testified for the need of such coverage. "I am thinking long-term." Read more!

Long waits, delays the norm for psychiatric patients - Newsday

Busy mental health centers are passing off patients to other institutions that face the same problems.

BY LAUREN E. TERRAZZANO
lauren.terrazzano@newsday.com

A Suffolk hospital that serves as a mental health hub to evaluate emergency psychiatric cases has been increasingly diverting patients to other centers as the demand far outweighs its resources, state and local health officials say. The Stony Brook University Medical Center was on "diversion" for nearly half of January, and for 12 days so far in February, according to records and interviews.

As a result of high patient loads, the mentally ill who are escorted by police for emergency care have been subject to long waits and delays in evaluation and treatment, or have been taken elsewhere, where they face similar waiting lags, officials say. And the county's already fragile mental health network has gotten increasingly backed up as people are delayed from entering long term treatment, local officials said.

"It's an issue we have to be very concerned about," said Thomas MacGilvray, the county's director of community mental hygiene. Those being diverted are specifically in the custody of Suffolk County police and sheriffs, MacGilvray said. The waits can be as long as seven or eight hours, and police are required to wait with them. As of Monday, the hospital was not on diversion, and was accepting patients to its 18 observation or extended-stay beds.

He said the problem has been exacerbated by the county's overall lack of hospital beds, the lack of community mental health day programs and the temporary closing of 25 beds at Bay Shore's Southside Hospital mental health unit because of renovations.

At Stony Brook, the Comprehensive Psychiatric Emergency Program serves mentally ill children, adolescents or adults. Officials there said they are working to make things better and reduce waiting time.

Calling it a statewide issue, Dr. Mark Sedler, Stony Brook's chairman of psychiatry, attributed the diversions to a decline in statewide psychiatric beds overall, "and are a symptom of the inadequacy of the whole system."

He said when the unit was designed in 1990, officials expected that it would need only four extended beds to observe patients. As Long Island's state-run psychiatric hospitals shut their doors and the number of outpatient programs didn't keep pace, the backups started to increase, he and others said.

"Our field office is working closely with the county mental health department to address the issue that is involved," said Jill Daniels, a spokeswoman for the state's Office of Mental Health.

Sedler said Stony Brook houses from seven to 18 unit patients. "We have a limited physical capacity. It's a locked unit, a very defined physical space," he said.

Part of the problem, he said, is that some patients are intoxicated and may require eight or more hours before evaluation, or the hospital may have trouble reaching a family member or getting medical test results. And some patients are homeless.

According to records, the state's Office of Mental Health last reviewed the unit in 2004, and found that 400 individuals waited at least six hours to see a physician. There are about 6,000 visits to the unit annually. It is due for another review in April, when it reapplies for its new operating certificate.

"For me, it's like waiting for the other shoe to drop," MacGilvray said. "People in need of acute psychiatric care aren't getting it, and I'm concerned about what happens while they're waiting."
Copyright 2007 Newsday Inc. Read more!

Rare No More - The Washington Post

With Research Up and Stigma Down, Autism Sheds More of Its Mystery

By Roy Richard Grinker
Special to The Washington Post

When my daughter Isabel's autism was diagnosed in 1994, when she was 2 1/2 , I knew little about the condition. Autism was a strange word to most people. "You mean like Dustin Hoffman in 'Rain Man'?" people would ask. "You mean she's artistic?"

Back then, autism was considered a rare disorder, occurring in only about three in every 10,000 live births.

Little more than a decade later, autism has become a "major public health concern," according to Marshalyn Yeargin-Allsopp, chief of the developmental disabilities branch of the Centers for Disease Control and Prevention. The results of a CDC survey released this month suggest that about one in every 150 children in the United States has some form of autism.

Those numbers don't reflect an epidemic, as some reports have suggested, or even mean that the incidence of autism has necessarily increased. Instead, we are defining autism and measuring its prevalence differently than we did in the past. Isabel's story illustrates that evolution.

The years since Isabel's diagnosis show a rapid change in our awareness of the disorder. In 1993, the state of Maryland (where we live) told the U.S. Department of Education that the state's public schools had provided special education services during the 1992-93 academic year to just 28 children between the ages of 6 and 21 with autism.

By the time Isabel was diagnosed, Maryland's public schools claimed to have served 300 people in the same age group with autism in 1993-94 (still a small number, but an enormous increase over the previous year).

And by 2003 there were more than 4,084 children ages 3 to 22 who had been given the official coding for autism in the Maryland public school systems, a rate of 1 in 183 children.

Isabel was no longer alone.

Shifting Definitions
Like most of the illnesses psychiatrists treat, you cannot see autism under a microscope or discover it through a lab test. The only evidence we have is the individual's behavior. And until 1980, when the criteria we're familiar with today were first standardized in the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders (DSM-III), there was little agreement about what was and was not autism. Even now, there is an element of subjectivity in each diagnosis.

What's more, many psychiatric diagnoses come and go -- and hence rates of diagnoses go up and down and change rapidly. Several million Americans have been diagnosed with depression, for example. But many of them would not have received that diagnosis just 50 years ago. The increase does not mean that depression is more common today than in the past, but only that our way of defining depression has changed. Half a century ago, the term was used to describe only debilitating depressions that required long-term hospitalization.

The shift in how we view autism is also part of a set of broader shifts taking place in society. The growth of child psychiatry after World War II, the rise of advocacy organizations, greater public sensitivity to children's educational problems and changes in public policies (the establishment, for example, of autism as a special-education code after the 1991 Individuals with Disabilities Education Act, or IDEA) have together changed the way autism is diagnosed and defined.

As a society, we have also become more aware of children's behavioral and learning differences at earlier and earlier ages and more comfortable with diagnosis, medication and psychiatric labels. Under the rubric of autism we now find a multitude of emotional and cognitive problems -- problems that used to be given other diagnostic labels or were even considered within the range of the normal.

And these days, researchers use reliable diagnostic tools to provide more accurate statistical counts of disease rates in a community, rather than basing their counts on reports of already known cases.

As a result, there are more people with a diagnosis of autism now than at any time in history.

And it's a better time than ever to be autistic.

More Awareness, Research
What was our school supposed to do in the early '90s with Isabel, who was just one of a few hundred kids in the whole state labeled with autism?

The key word here is "labeled," because there were certainly thousands of people in Maryland with autism at the time. So where were they? The answer is that many of the kids were in school; they just didn't have the label. That category had been introduced only in the 1991-92 academic year -- and then as an optional category.

A diagnostic label really does influence the way we view someone. If Isabel's condition had been diagnosed as schizophrenia, as might have happened in the 1950s and '60s, a psychologist might have recommended that she be sent to a mental institution or assigned her to a class or school for mentally disturbed children. If she had been diagnosed as mentally retarded, as so many autistic people were and still are, she would have been placed in classes for cognitively challenged kids.

Today, pediatricians, mental health-care practitioners, speech and occupational therapists and educators are providing therapy to children with autism at earlier ages than ever, and they are discovering how to use safe and effective medicines to ameliorate some of their symptoms.

Federal, state and local agencies have mobilized to manage the heavy public health burden of autism. Special-education programs are expanding; new money is pouring out of the National Institutes of Health into autism research; and donors are contributing millions of dollars to advocacy organizations, private schools and research foundations. Between 2003 and 2004, the number of grant applications to the National Alliance for Autism Research, which was then the leading private foundation for autism research, doubled.

The increased awareness, and the new, higher, more accurate rates, mean that a newly diagnosed child is no longer a mystery. And this is true no matter where you are -- in a suburb of Washington or in Seoul, Cape Town or New Delhi. Parents all over the world are beginning to break through the walls of stigma that had made them hide their children from public view. They are asking for the public assistance they deserve, and where it is absent they are demanding it.

Plenty of Progress
I trace the beginning of my knowledge about autism and Isabel's identity back to that beautiful spring day in 1994 when a short, slightly overweight, affable child psychiatrist at Johns Hopkins told my wife and me that "Isabel has enough features of autism to be called PDD-NOS, Pervasive Developmental Disorder Not Otherwise Specified. It means that she's not severely autistic." By that time we had already been worried about Isabel for more than six months. The discussion of her diagnosis was really just having someone we could trust tell us what we knew all along, even if we hadn't admitted it to ourselves.

Isabel was our first child, and so we didn't really have a standard for comparison. In her first two years, she had seemed like any other child, and at 12 months she had begun to make some of the sounds that seemed like the beginnings of words. We thought she was fine. But when I look at our home movies today, I see that she never tried to communicate with us; in none of the videos of Isabel between 18 and 24 months does she say a single word. At 25 months old, she made only fleeting eye contact.

She began flapping her hands and arms occasionally and didn't respond to her name consistently. She spoke little and couldn't even tell us if she was hungry. We were at a point where we demanded clarity from doctors. A valid diagnosis of what was wrong with Isabel was more satisfying than devastating. It gave us a framework for understanding Isabel and a road map for the future.

Today, my teenage daughter is mainstreamed into a high school classroom for part of the day. Numerous tests have shown that she has above-average intelligence. She plays cello in the school orchestra.

Just last week, I showed her two magazine articles about my new book on autism, in which I talk about how far she has come -- farther than my wife and I, or our doctors, ever expected. "What do these articles say?" I asked. "They say I'm doing great," Isabel replied. Indeed, she is. ·

Roy Richard Grinker, a professor of anthropology at George Washington University, is the author of "Unstrange Minds: Remapping the World of Autism" (Basic), from which this article is excerpted. Comments:health@washpost.com.
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Man kills disabled children, wife, self - AP

HARTFORD, Conn. (AP) -- An 81-year-old man killed his wife and disabled adult children before fatally shooting himself because he was ill and worried the family might become a burden to others, police said Monday.

Officers who discovered the bodies late Saturday in a condominium north of Hartford found a detailed note from Richard C. Brown, saying his wife's health was also failing and his children had experienced health problems throughout their lives.

''He said he didn't want the family to be a burden,'' Enfield Police Chief Carl Sferrazza said Monday. ''It wasn't something he wrote down in five minutes. It was a pretty detailed note, and not an impulsive act.''

Police found Brown's three-page letter on the dining room table when they discovered the bodies of Brown, his 80-year-old wife, Martha, and their children, 49-year-old Janice and 53-year-old Kenneth.

Brown called a family friend on Saturday night, and that person called 911, police said. Officers discovered that Brown killed himself after making that call.

Martha Brown had been shot in the head while reading on the living room couch, and the children -- both of whom were mentally retarded and had physical disabilities -- were killed in their beds in separate bedrooms, police said.

Brown's note was straightforward and gave directions on how to reach out-of-state family members to report the deaths, Sferrazza said. It gave no indication that his wife was aware of his plans.

Friends and associates said Brown was a strong advocate for people with mental retardation. He was recovering from recent back surgery. Read more!

Discussing Mental Illness On The Airwaves - Chester (PA) Daily

By Tracy Behringer

It took guts for John Aberlee to tell his story, but once he started talking, it seemed his courage had no bounds.

I first met this Chester County sales and marketing consultant, and former Air Force security specialist, almost two years ago. He visited my office at COAD, Mental Health Services, in Exton, after hearing our department head, Rachelle Weiss, on a radio program. She had been interviewed about her depression and bipolar disorder.

John felt moved to tell us about his own struggles with the same mental illnesses. But this 6-foot-3-inch tall bodybuilder is an imposing figure — and perhaps that‘s why his story is so compelling. When John tells you that depression kicked his butt, you realize that depression must be mighty powerful.

Fortunately, John has had few major depressive episodes; the first when he was an injured jock in his senior year of high school, and the most recent a couple years ago when his doctor made some medication changes.

While the first depression was awful, the last was even more difficult for the 37-year-old husband and father. John‘s family had never seen him so incapacitated. And his family depends on him.

Since that first meeting, John has stared down stigma and has volunteered to speak publicly about his illness. He‘s addressed high school health classes and was the keynote speaker at a local mental health event. But he has taken his natural public speaking talents and his passion for this subject even further. He‘s become a spokesman for the national Depression and Bipolar Support Alliance (DBSA), and has spoken at such places as Brown University.

Most recently, John was interviewed by Newsweek Magazine for a cover story on ”Men and Depression,“ and he has added ”radio talk show host“ to his resume.

In addition to a two-hour live sports show he has been hosting on WCOJ (1420 AM) every Saturday from 4 to 6 p.m., he is beginning a weekly Saturday morning radio program on mental health issues. John‘s Mental Health in Chester County will air the first segment at 8 a.m. on Saturday, March 3.

Rachelle and I have already taped the first show with John, and he plans on having guests from the local mental health community each week. If you want to hear a dynamic speaker, tune in!

If hanging out with ”radio celebrities“ wasn‘t enough excitement for someone who doesn‘t get out of Chester County much, I also had a phone call from Congressman Joe Sestak‘s (D-PA) office last week. Seems the congressman is holding a forum on one of my favorite subjects: mental health parity.

Mental health parity is the term used to describe a health insurance system that would cover mental illnesses in the same way it covers physical illnesses. I‘ve complained about the lack of mental health parity in this column, but it seems as though some people are listening. Congressman Sestak, along with Patrick Kennedy (D-RI) and Jim Ramstad (R-N) will be at the Elwyn Media Campus in Elwyn, Tuesday, Feb. 27 from 8:30 a.m. until 10:30 a.m. And we‘re all invited.

If you‘d like more information about this forum, call 610-594-9740.
Tracy Behringer is a Daily Local News columnist. She can be reached at tracy.behringer@gmail.com. Read more!

Ridding Mental Illness of Its Stigma - Washington Post

Letter to the editor:

The Feb. 18 Business article "Should You Tell?; For People With a Mental Illness, There's No Easy Answer" got it right on an issue that should be part of society's mainstream consciousness. Mental illness must not be stigmatized.

As the article noted, one in four people has depression or some other mental illness. Two other facets of mental illness are particularly profound:

First, suicide is the third-leading cause of death among people ages 15 to 24, with depression the leading cause of suicide.

Second, studies have shown that 50 percent of all cases of mental disorders begin by age 14, and three-quarters begin by 24.

Mental disorders impose enormous burdens and can have intergenerational consequences. They reduce the quality of children's lives and diminish their productivity later in life. But mental illnesses can occur at any stage of life. No community is unaffected, no school or workplace untouched.

Stigma is the most formidable obstacle to treatment and progress. New research tells us that the average delay between diagnosis and treatment is seven years. That is unacceptable.

When we think of a person with cancer, it evokes compassion and empathy. But when we think of a person with a mental illness, do we feel compassion and empathy? Or is it reproach, maybe even fear?

It's 2007. Let's resolve that no disease deserves to be stigmatized.

ALAN EZAGUI
Director, Potomac Ridge
Behavioral Health Foundation
Rockville Read more!

Groups send open letter to advertising community

WASHINGTON, Feb. 26 /PRNewswire-USNewswire/ -- The following is an open
letter from mental health groups to advertisers and a list of signatories:

In the last several weeks, television advertisements from two major
automotive companies have made light of suicide to sell consumers their
products. These ads were both insensitive and potentially dangerous. In
response to outrage expressed by our organizations and others, these
corporations reevaluated their new ads, determined them inappropriate and
pulled them off the air.

We thank General Motors and Volkswagen for this show of sensitivity and
responsibility. We urge other corporations and advertisers to follow their
leadership and avoid exploiting mental illness and/or suicide in their
advertisements.

Each year, suicide claims the life of more than 30,000 people in the
United States. That is twice as many people lost to homicide. Ninety
percent of suicides are attributable to untreated or mistreated mental
health conditions.

Mental illnesses can happen to anyone. In fact, over 60 million
Americans live with these illnesses each year -- with more than half going
without the treatment and care they need. We know that without treatment,
these people are at risk of many other serious problems -- including
suicide.

We feel that the children, adults and families living with a mental
illness in this country deserve compassion. They deserve to live a life
without shame. They deserve access to treatment and support. Without these,
we cannot begin to prevent the 30,000 tragic suicides each year, and we
cannot ensure people more productive, healthier lives.

Suicide and mental illnesses are no laughing matters. As our nation's
leading mental health organizations dedicated to reducing the stigma and
shame associated with mental illnesses and preventing suicide, we challenge
advertisers to appreciate the seriousness of mental illnesses and treat
them as you would any other major illness.

We ask you for sensitivity and compassion and we welcome the
opportunity to work with advertisers toward this goal.

American Foundation for Suicide Prevention -- http://www.afsp.org
American Psychiatric Association -- http://www.psych.org
Mental Health America -- http://www.mentalhealthamerica.net
National Alliance on Mental Illness -- http://www.nami.org

Contact: Heather Cobb, Mental Health America, 703-797-2588
Wylie Tene, AFSP, 888-333-AFSP Ext. 24
Jessica Mikulski, APA, 703-907-8640
Alexis O'Brien, NAMI, 703-312-7893 Read more!

GM rewrites suicide ad - Brandweek

Genral Motors has re-write the Robot Suicide Ad. They have eliminated the suicide scene that drew protests from mental health and suicide prevention groups and put a happy ending.

The original ad portrayed a robot on the assembly line who was fired for dropping a bolt. The anguished robot toiled through a series of low-end jobs, including holding a sign hawking condo units before pondering a bridge jump. As he jumps he awakes from what was a bad dream.

The amended 30-second spot, premiered today during the Academy Awards, removes the jump and substitutes as a bad dream a shot of a car being compacted in a scrap yard, and shows the robot in additional menial jobs, including work as a shelf-stocker and holding the security gate in a parking ramp. Read more!

Unpopular, Painful Choices Await on Budget - Portland Press Herald

Mental Health Services for the Poor Are Important, but Something's Got to Give.

Editorial:

With all the attention lavished on Gov. Baldacci's plan to force consolidation on local school districts, scant attention has been given to his other big budget initiative: cutting social service costs.

The governor's two-year, $6.4 billion budget has slightly more money being spent through the massive Department of Health and Human Services over the next two fiscal years than during this biennium. But that increase masks an aggressive attempt to bring spending on social services under control.

Without program cuts, the DHHS budget, which includes the state/ federal Medicaid program for low- and moderate-income Mainers, would grow by $75 million more than the governor has budgeted.

One of the budget-cutting targets is mental health services provided through the Medicaid program. For poor people who suffer severe mental illness, these services are vital. Many agencies serving this population use Medicaid reimbursements to provide mental health care to some of our most vulnerable citizens.

Those points were driven home by advocates for the mentally ill at a hearing last week. While supportive of better case management, providers were unhappy with plans to cap payments for some mental health services.

Chris Copeland, president of the Maine Association of Mental Health Services, complained that the "rate standardization" proposals in the budget were merely cuts. "Bringing down the maximum rate paid to providers without raising the minimum doesn't standardize rates," he said.

Actually, however, there's no reason why standardization can't mean capping rates only on the top end. It's that kind of standardization that's going to produce real savings. Cutting one rate while raising another may, in fact, increase overall payments, and it's reasonable to assume that is not the purpose of an exercise in budget-cutting.

This is not to say that the proposed rate cuts won't affect the level of service given to the state's mentally ill. But if Maine is to get state spending under control and lower its unreasonable tax burden, hard choices are going to have to be made. The trick is to provide the maximum level of service for the available dollars.

If reimbursement rates for mental health care appear to be too generous at the top end, that's a good place to start the budget- cutting discussion.

Social service advocates may not like it, but the state cannot make a budget by determining need first and then spending whatever is required to fill it. Needs are endless. Revenues are not.

(c) 2007 Portland Press Herald. Provided by ProQuest Information and Learning. All rights Reserved. Read more!

Man’s mental status keeps case in limbo - Fayetteville Observer

By Paul Woolverton

Nearly six years ago, deputies arrested Jamal Delvon Gurley and charged him with setting fire to his father and repeatedly stabbing his teenage cousin. Both died.

Gurley has been locked up for 2,161 days, longer than any other defendant awaiting trial for murder in Cumberland County. He is charged with two counts of first-degree murder and one count of first-degree arson.

Gurley, 27, may never get a trial, said Paul Herzog, one of his lawyers. “He’s severely mentally ill,” Herzog said, describing Gurley as delusional.

“It’s just one of these cases that’s in limbo because of the nature of the defendant,” he said.

The case began around 10:30 p.m. March 27, 2001, in the Gurley home at 1112 Hodhat Drive. The home is off Hoke Loop Road in western Cumberland County. Gurley lived there with his father, 53-year-old Bobby Glenn Gurley, and his cousin, 17-year-old Shakiya Taylor. Taylor had recently moved from Paterson, N.J., and wanted to get her high school diploma.

A neighbor saw Taylor run from the house. She wore only a shirt and a bra and was bleeding from stab wounds. She collapsed in the yard and died.

Inside the house, Bobby Gurley lay in his bed, set on fire with gasoline.

Jamal Gurley was arrested about two hours later at a convenience store at Cliffdale and Rim roads, according to deputies’ affidavits. He had blood on him and torn clothing, and he smelled of gasoline. A bloody knife was found in the trash can of the store’s restroom.

Gurley admitted to and described the killings, an affidavit says.

Gurley’s court file is fat with sealed records — it’s typical for a defendant’s mental health reports to be blocked from public view.

Suicide watch
The records that are public show that Gurley was put on suicide watch at the county jail soon after he was arrested. A few days later, he was sent to Central Prison in Raleigh, which has a mental health section, for safekeeping and evaluation.

In August 2004, Gurley was sent to Dorothea Dix mental hospital in Raleigh and found incompetent to stand trial. He was given treatment.

In June 2005, Gurley was found to be competent for trial. Doctors recommended keeping him at Dix to prevent him from deteriorating back to incompetence.

Further records show that Gurley moved back and forth between the Cumberland County Jail, Dix Hospital and Central Prison. At Dix, a court order says, he threatened the staff, tried to incite a riot to foster an escape and had to be kept in restraints.

In an affidavit dated Oct. 3, psychiatrist George Corvin said Gurley is a paranoid schizophrenic. He said Gurley believes he killed his cousin and father in self-defense and that his lawyers were conspiring against him. Further, Gurley did not believe he is mentally ill, Corvin said.

In fall 2006, Gurley attacked one of his lawyers, Herzog said. So those lawyers dropped out of his case. Herzog and Jim Parish were appointed in November to replace them.

They await a judge’s ruling on whether Gurley is incompetent to stand trial.

Gurley remains at Central Prison’s mental health facility, according to a letter he wrote on Feb. 8 to Cumberland County Superior Court.

In that letter, which starts, “Dear Judge,” Gurley complains that Herzog and Parish have not contacted him. He says he wants to see them before he is evaluated again because he doesn’t want an evaluation.

“I want you to try to speed things up so I can come back to the county and address my legal situation. Sincerely, Jamal Gurley.”

Staff writer Paul Woolverton can be reached at woolvertonp@fayobserver.com or 486-3512. Read more!

Agency that filled void is now gone - Wilmington Star-News

Generosity, integrity, dedication, community service - powerful words for a vital agency that had an impact on our community in remarkable and lasting ways. When a human service organization as important as Family Services of the Lower Cape Fear closes its doors after 60 years, it is worth noting.

Started in 1946 by visionary community leaders who documented the need for psychological and mental health services for families, Family Services assisted thousands of our citizens in times of trouble and has been a leader in developing new services as gaps in resources have been identified.

The loss of Family Services, which closed in December, is hard to measure. The legacy of role models like Alice Sisson endures, despite the agency's demise. Alice, whose memory is indelibly etched in this community, will always stand for self-sacrifice, grace, strength, and compassion.

These are tough times for mental health as the latest "reform" has been brutal in the cuts and closings of other human service agencies in the area.

Family Services served people from all socioeconomic backgrounds and operated on a sliding-scale fee system. Its closing creates a chasm where a large segment of people in our community needing mental health services and other resources will inevitably fall through the cracks.

As we grieve the losses, we must consider how much we value healthy families and communities and whether there are still visionaries willing to commit to strengthening all types of families, individuals, and communities as well as training future mental health professionals.

Making public mental health services available to everyone was the cornerstone on which Family Services' board of directors pushed forward with its mission. The agency engaged volunteers from organizations such as Junior League, men's service organizations, churches, synagogues. It accepted referrals from schools, public welfare and others serving families in need.

The United Way began providing funding for Family Services soon after it was established. The agency's staff and board believed in and supported the broad range of services needed for our community's citizens to get through times. It was truly a community agency.

Providing quality staff, offering student training, and developing new ways of dealing with family problems were hallmarks of this agency.

The agency developed many programs to meet community needs. Travelers Aid services, created in the 1960s, served hundreds of stranded and/or destitute travelers. In the 1970s, a neighborhood center was adopted as a special project (which eventually became the After School Enrichment Program) by student intern Alice Sisson. This program provided opportunities for engaging various groups of community and parent volunteers and students-in-training.

Consumer Credit Counseling, a service geared specifically to those needing help with debt or learning budget management, was developed in the 1970s. By the 1990s, it served large numbers of clients and was mainly supported by donations from the business community.

The Big Buddy program, also created in the 1970s, took its name from the decision by Family Services to serve both boys and girls rather than have the traditional Big Brother/Big Sister programs. Big Buddy matched countless children with mentors who believed in the resiliency of children and forged lasting bonds.

The core service of the agency - individual, couple, and family counseling - filled a gap left for those who could not afford the full cost of counseling. Family Counseling was staffed, for most of its history, by graduate-level clinical social workers.

It served as a rich and vital training ground for hundreds of students from various universities. Linking with these universities allowed Family Services to serve more clients while providing the kind of close supervision necessary for optimal learning experiences.

It is a tragedy to lose such a significant community institution. It is now our challenge to embrace a new vision to help bridge the gap in the wake of Family Services' closing.

Sid Bradsher is retired executive director of Family Services, and Melissa Bass is a former student intern and family therapist.
Read more!

Un-stalling parity - Raleigh News & Observer

Letter to the Editor

My fourth-grade math teacher always said that laziness, not hard work, is the mother of invention. To think that mental health advocates have been laboring, scraping and fighting over every dollar they can get for community-based mental health services!

As the mental health reform machine marches forward with the closing of Dorothea Dix Hospital, it is abundantly clear that without reimbursing mental health services at the same rate as other health care services (so called parity), few providers will step forward and our most vulnerable population will continue inappropriate, hard landings in our jails, rest-homes and our streets.

Who knew that the real solution was so quick, so easy, and so cheap? All we need is $29,000, a men's restroom and another corrupt legislator like Jim Black. Finally, real doctors might be reimbursed like other real doctors and chiropractors.

Our governor's silence on mental health reform leadership has been deafening. Here is his chance at redemption. During this difficult budget season, if Gov. Mike Easley is having trouble getting his hands on the cash, perhaps he could try his luck with the lottery. Do the math!

Seth E. Tabb, M.D.

Cary Read more!

After Iraq, soldier finds himself fighting Army - Washington Post

By Paula Span

THE SHADES IN RICHARD TWOHIG'S GARDEN APARTMENT ARE DRAWN TIGHT AGAINST THE SUMMER SUN. This is partly because it's 94 degrees in Knoxville, Tenn., this afternoon, but also because light can trigger one of his bad headaches, the kind that make his knees buckle. His kids have grown accustomed to dimmed surroundings.

They've been cavorting on the living room carpet, Lizzie with her fuzzy pink dog named Princess, her little brother, Damon, with his prized jeep. Their chirpy ebullience isn't unusual for a 6-year-old and a 3-year-old who haven't had much chance to romp outside today but noise can bring on Twohig's migraines, as well. "Why don't you go up and play a while?" he suggests mildly, and they troop upstairs to their shared bedroom.

The apartment, which the family moved into three weeks ago after a nomadic year, still feels a bit empty. There's a couch and a coffee table and a big TV in the living room, but the walls are bare. Twohig wishes he had a yard for the children and their real dog, a boisterous Great Pyrenees named Athena. Still, the place is clean and comfortable, and he can manage the $570 rent on the disability checks that the Department of Veterans Affairs sends each month.

"If I have a good day, I try to take them up to the park at the school," he says, knowing that the kids should probably be outdoors more. It's only a two-minute drive. But he doesn't have so many good days.

Since he was thrown from a moving armored vehicle in Baghdad in May 2003, and landed on his head, the former Army corporal says he has suffered from near-constant headaches. This afternoon's is the easier kind to take: He figures the throbbing registers a 6 or 7 on the 10-point scale that injured vets learn to use to quantify their pain. The more severe headaches come perhaps once a week now, he says, and even the heavy-duty drugs he takes can't really blunt them: "Before, I would pass out in the shower, things like that. You kind of learn when they're coming on. So when I feel lightheaded and my legs get weak, I crouch down" so he doesn't fall. Those are the sort he rates a 10.

The headaches are one of the disabling conditions Twohig incurred in the line of duty, the Army acknowledges, along with a "mood disorder with depressive features." He appears fit, in his patched jeans and T-shirt: 6-foot-2 and, now that the bloat from earlier drug regimens has dissipated, 180 pounds. Tattooed snakes and samurai, souvenirs of Fort Bragg, twine up his arms. With his blue eyes, cleft chin and crew cut, Twohig looks like the same paratrooper -- Bravo Company, 1st Battalion, 325th Airborne Infantry Regiment, 82nd Airborne Division -- who easily handled 25-mile marches wearing a 35-pound pack and carrying an M4 rifle.

But he isn't. He often forgets what his mother, retired Marine Corps Maj. Belinda Twohig, tells him on the phone moments after she has said it. He's lethargic; he can't concentrate. If he has to enter a mall, he calculates which entrance will let him come and go with the least amount of human contact. A guy who used to happily devour an entire sausage pizza and some cheese sticks for dinner, he now has scant appetite and, troubled by nightmares, sleeps perhaps three hours a night.

He can't imagine holding a job in this condition. "What can I actually do?" he asks. "Physical work gives me migraines. I vomit all the time . . . I'm on morphine; I'm addicted. I'm just a mess."

Ask him his age, and he takes a long, thoughtful pause before replying. "Twenty-five."

Despite the migraines, the tinnitus (ringing in his ears), the chronic shoulder dislocation and other documented physical problems, he works hard at caring for the children, doing their laundry, cooking them simple meals, supervising them with great patience. (Their mother, from whom he is separated, serves with the Navy in Virginia.)

"Damon, either sit up in your chair or go upstairs and play," he cautions calmly, when the kids grow restive watching the Cartoon Network. "Do not sit on your sister." He rarely raises his voice.

In fact, Twohig's response to most things is muted. He doesn't laugh much, doesn't seem to take much pleasure in Lizzie and Damon's exuberant antics. It might be the meds or the pain or the prospect of a life in which he may never work, but there's a flatness to his personality that his family finds new and troubling.

One subject prompts a more animated response, though, rousing him to noticeable anger: the U.S. Army.

Like any member of the armed forces injured in the line of duty and no longer able to serve, Twohig has been grappling with a complicated disability system that determines whether he merits military retirement. Thousands of other soldiers, sailors, airmen and Marines are dealing with the same process. With U.S. troops still in Afghanistan and the war in Iraq entering its fourth year, the annual caseload of troops injured severely enough to be considered for retirement has climbed nearly 53 percent since 2001, to about 23,000 a year. The great majority don't get it, which has made the disability system the object of confusion, apprehension and suspicion among injured veterans and their advocates.

In Twohig's case, an Army Physical Evaluation Board ruled in 2005 that he wasn't disabled enough to qualify, a decision that deprived his wife and children of health insurance through him. He and his family have been battling the finding since.

To Twohig, the fight is based not only on finances but also on principles. He enlisted; he trained; he followed every order "to a T," he says. He paid the price, and now it feels as though the Army is abandoning him.

"I have a son, and I wouldn't let him join the Army," Twohig announces, agitated. "They don't really care about soldiers. They got their mission, and if you're hurt, oh, well."

His voice tightens: "After we're no good to them, they just get rid of us."

RICHARD TWOHIG REMEMBERS LITTLE ABOUT HIS TIME IN IRAQ. His commanding officer, Capt. (now Maj.) Jeffrey Burgoyne, says that Bravo Company saw "a lot of firefights" in Fallujah and other towns as it made its way to Baghdad in late April 2003. But what Twohig can summon up from Iraq aren't battles but the heat and the odd quality of the sand ("it had been cooked so long that when you stepped on it, it broke into pieces") and the occasional K rations, "in big old metal things they heated up," that tasted better than meals-ready-to-eat.

Nor is much recorded about the accident that damaged Twohig -- not even the exact date it occurred. The Commander's Performance Statement, signed by Burgoyne, says Twohig was "on combat patrol" aboard a Bradley armored fighting vehicle, "going approximately 45 mph when it turned a corner in downtown Baghdad, causing Cpl. Twohig to be thrown from the vehicle. He fell on his head and lost consciousness."

Burgoyne now says that the vehicle wasn't a Bradley but a smaller, older M113 about to leave the unit's walled compound and thus going far more slowly. But Burgoyne was at a forward operating base five miles away and only heard of the accident by radio. In any event, "the guy fell off a moving truck; that's significant." And when the battalion learned that Twohig was being helicoptered to Germany, Burgoyne says, "that's when we realized it was more serious than we thought."

A neurology consultation at the Army hospital in Landstuhl, dated May 20, 2003, is the first record of Twohig's injuries, noting his head trauma, throbbing headaches and other symptoms, including memory loss. "I didn't remember my Social Security number or my unit or people I worked with," he says. He even, temporarily, forgot that his son had been born a few months earlier.

He was flown back to Fort Bragg a couple of weeks later. As he made the rounds of doctors at Womack Army Medical Center, Twohig says, his memory improved somewhat, but the headaches and psychiatric symptoms persisted. Belinda Twohig felt her hopes for a speedy recovery sink. She accompanied her son to a neurology appointment in which the doctor told them that when Richard's migraines struck, he should just take his meds and lie down in a quiet, dark room; there was no purpose in going to the emergency room, because nothing else could be done, no stronger medication prescribed. The prognosis was uncertain. After a concussion, the brain needs time to heal, the neurologist cautioned; it could take a year or two to see any improvement.

Meanwhile, Twohig's marriage was fraying under the strain. He says he was vomiting frequently, sleeping a lot and feeling depressed. He could no longer mow the lawn or help with errands; the house, despite his two young children, had to remain quiet. "It just changed the relationship," Twohig says. "She didn't understand and want to deal with my problems." His wife, Sang, did not respond to phone calls seeking comment. At times, he felt so lousy that he wouldn't even come to the phone when his mother called. "We had a close relationship; he always talked to me," Belinda says. "So the withdrawal was the first thing I noticed." When they did talk, she was aware of "confusion. I'd ask him something -- 'How was your day? Have you taken your meds?' 'Yeah, I think so' . . . Just a slow, lethargic answer. And this is not Richard."

Frightened as she was, she told herself that at least the Army would, in her words, "take care of him" and his family. After more than two decades in the service, she knew the outlines of the disability system, and she assumed he would be able to retire. For her son, though, this was uncharted territory.

The magic number, he quickly learned, is 30 percent -- the point at which a disability is considered to be severe enough to prevent someone from functioning normally in the workplace. Those with 30 percent or higher disability ratings can retire with benefits that include monthly checks for the rest of their lives, access to commissaries and post exchanges on military bases, travel on military aircraft and, most coveted, coverage by TriCare, the military's health insurance plan, for themselves and their dependents, present and future. Those rated below 30 percent usually receive a severance check from the military: two months' pay for each year's service, up to 12 years. They can then apply for benefits from Veterans Affairs, which also rates disabilities and provides monthly checks but doesn't offer the other advantages of retirement.

The practice of compensating injured soldiers dates to Colonial times, but the current system has its roots in World Wars I and II. Congress mandated the development of ratings for disabilities in 1917; the Career Compensation Act of 1949 then linked the amount of payments to the degree of disability, establishing the 30 percent threshold. "The thinking was, those rated less wouldn't be so handicapped as to warrant long-term disability pay," explains Rick Surratt, deputy legislative director of Disabled American Veterans. "A lump sum would hold them until they could get reestablished in the workplace."

Getting any rating at all can take many months, however. Once an injured service member is medically stable, he must wait for a military doctor to write a narrative summary of his condition. Then a board of physicians reviews the medical records -- often thick with test results, multiple diagnoses, lists of medications and addenda -- to decide whether he meets retention standards. If not, an informal Physical Evaluation Board assesses the severity of each disability that makes a service member unfit for duty and assigns it a numerical rating, based on detailed guidelines in the Veterans Affairs Schedule for Rating Disabilities.

"What we're attempting to do is approximate the average loss of earnings capacity," says Tom Pamperin, who oversees revisions to VA's guidelines, a nearly unceasing project. Amputation at the upper third of the thigh, for instance, merits an 80 percent disability rating. Amputation at the middle or lower third of the thigh: 60 percent. Mental disorder characterized by "occupational and social impairment, with deficiencies in most areas, such as work, school, family relations, judgment, thinking or mood . . .": 70 percent. Migraines "with characteristic prostrating attacks occurring on an average once a month over the last several months": 30 percent.

Twohig picked up the gist of the process at the Fort Bragg gym, where he worked with other soldiers too disabled for regular duty. He checked ID cards and handed out towels four hours a day -- and says he found even that difficult, because the clanging of free weights and the thunking of basketballs brought on migraines. Meanwhile, he and his buddies pondered the mysteries of disability retirement. There was ample time to compare notes; the pace at which cases proceed can be exasperatingly slow, in violation of the Pentagon's own guidelines.

Twohig waited 17 months to receive the medical evaluation board report that found him no longer fit to serve. Meanwhile, he watched as others received ratings too low to qualify for retirement. One guy with what Twohig describes as "titanium vertebrae" got a 10 percent rating. Another received no severance.

In fact, the majority of injured soldiers fall short of the magic number; the informal evaluation board rates them below 30 percent. The Defense Department reports that the Army, which handles more than half of the military's disability cases, put less than 4 percent of the 10,460 active duty soldiers and reservists it evaluated last year on the permanent disability retirement list and less than 15 percent on the temporary list. (Temporary retirees undergo periodic reassessments of their condition for as much as five years before a final decision.) By comparison, the Navy (including the Marine Corps) retired about 35 percent of its injured, temporarily or permanently, and the Air Force about 24 percent, the Defense Department says.

The difference, the Army's disability agency says, may reflect a higher proportion of musculoskeletal injuries that can interfere with soldiers' duties but have "mild" impact on civilian employability, resulting in severance pay rather than retirement. The Army also has "a unique policy" of not granting retirement for pain that has "no clear cause or objective findings." But, the agency concedes, "it is not possible to state with certainty what might account for the difference" between the Army's and the other branches' retirement rates.

At Fort Bragg, soldiers sometimes find it hard to understand why some people qualified for disability retirement and others didn't. "You don't really know too much about it until you start doing it," says Twohig's friend Jacob Biehn, a former specialist who suffered multiple gunshot wounds in Iraq and eventually received a 30 percent disability rating -- which allowed him to retire but struck his comrades as minimal, given his injuries. "When you go to find out what they decided," he says, "it could be a good day or a bad day."

For Twohig, it was a bad day. He called his mother from Fort Bragg on Nov. 2, 2004, sounding "shaken up," she recalls. "He said: 'Mom, it came back 20 percent . . . How am I going to survive? How can I take care of my family?' I said, 'Son, calm down. We're going to fight this.'"

TWOHIG HAD THE RIGHT TO CONTEST HIS DISABILITY RATING BEFORE A FORMAL PHYSICAL EVALUATION BOARD, and his mother stood ready to help him. A lifelong Marine and a congenital optimist, Belinda felt more determined than discouraged, convinced that the system had erred and would correct itself.

Each branch of the military provides opportunities for injured service members to challenge their ratings, but most of the injured simply pocket their severance checks and go home. Only 20 percent of soldiers ask for a formal hearing, at which an attorney can present evidence and call witnesses, the Army says. Then only half of those soldiers proceed with the hearing.

Perhaps that indicates most injured soldiers are satisfied with their ratings. But veterans groups say that more wounded service members would challenge their ratings if it weren't so complicated and time-consuming.

"It's probably one of the most convoluted workman's compensation systems in the world," says Steve Robinson, government affairs director at Veterans for America.

Most of those hurt in the line of duty are young, weary of fighting and anxious to return to their civilian lives, Robinson and others point out. A severance check for $10,000 or $12,000 (the latter was Twohig's severance after 49 months of service) can seem to be a lot of money. If a case has already dragged on for months, seeking a formal hearing -- even if that's in a service member's best interest -- can require still more time and frustration.

All of which tends to discourage the injured from taking on the system -- and some veterans advocates suspect that the Pentagon, openly worried about ballooning health-care costs, prefers it that way. Medical benefits are not discretionary; the Defense Department must pay the tab. "Increasingly, it's having a direct impact on the department's ability to meet its needs for equipment, replacement equipment, personnel," says William Winkenwerder, assistant secretary of defense for health affairs. "The costs of retirees, the health-care costs, are a great concern to us."

Nevertheless, the Defense Department says that each disability case "is evaluated on the basis of relevant clinical information," and the Army vehemently denies that its evaluation boards award lower ratings because of pressure, direct or indirect, to hold down costs.

"No one has discussed that financial burden with me at all," says Col. Carlton Buchanan, the new deputy commander of the Army's Physical Disability Agency, which oversees its evaluation system. "Nobody has said I have a particular requirement or a goal or a quota or a threshold that I can't surpass . . . I feel no pressure whatsoever to set limits on disability. We will do what's right."

Still, civilian attorneys who argue military disability cases see a pattern in the ratings.

"The informal board will tend to lowball," says Vaughan Taylor, who practices in Jacksonville, N.C., and has argued dozens of disability cases. Like many of the small fraternity of civilian lawyers who specialize in military cases, he is a former military lawyer, or judge advocate, himself. "It's almost as if the informal board exists to give out the standard 10 percent, and then see who squawks."

"The unwritten guidance seems to be: Push these people over to the VA, and let them pay for this," agrees Joseph W. Kastl, a former Air Force lawyer who now calls his Bethesda firm the Military Defender.

Sometimes, service members find the system works well for them. One of Taylor's clients, former Marine Sgt. Eric LeClair of Swansboro, N.C., was unhurt during the first wave of the Iraq invasion, only to take a bad landing during a martial arts test aboard the USS Iwo Jima in September 2003. His list of injuries was pages long: a traumatic brain injury, nerve palsy, bone spurs and degenerated discs. "I can't lift a half-gallon of milk above my waist, and it's been like that for two years," LeClair said this past summer.

The night before he was scheduled to learn his disability rating, he and his wife were too jittery to sleep. They had seen other seriously injured Marines "going through it and getting the shaft," in LeClair's opinion. Despite the pages of additional material and independent physicians' findings that his lawyer had amassed, LeClair expected the same result. But the next morning, to his surprise and his wife's enormous relief, he was placed on the temporary retirement list with a 60 percent rating -- no formal hearing needed.

Former Master Sgt. John Alden Millan of Newland, N.C., had to go a step further. An MP with the Army National Guard, he injured his neck jumping from a truck the day his unit arrived in Iraq. Despite surgery, he says, he still suffers from back pain and severe headaches. When he received a disability rating of 20 percent, he and his attorney, Jack Gately, asked for a formal evaluation board hearing. After Gately presented testimony and Millan answered questions, the board told Millan that his injuries warranted a 40 percent rating. "I said, 'I concur, sir,' signed my paperwork and left," Millan says.

But formal boards reject cases, too. Former Maj. Lionel Walton, who lives in Prince George's County, already had a 20 percent disability from past injuries but had chosen to remain in the Army Reserves ("I bleed green," he says), eventually serving 24 years. In Iraq, he says, he hurt his knee jumping from a truck and running from rockets and car bombs, and injured his back loading heavy cases. Now, at 46, "I can't walk 30 yards without having to sit down; I'm at level 8 pain every day," Walton says. He also struggles with post-traumatic stress disorder.

When his informal evaluation board found him 20 percent disabled -- the same rating he'd had before Iraq -- Walton hired Kastl. In September, the formal evaluation board at Walter Reed Army Medical Center declined to raise his rating. He was stunned: "My government, my country, should do better by me."

Refusing to back down, Walton appealed the formal board's decision to the Physical Disability Agency, and enlisted the help of Maryland Senator Barbara Mikulski's office. He's convinced that her involvement eventually helped raise his rating to 60 percent, and that infuriates him. "It's a shame," he says. "I fought to the end, but a lot of soldiers have given up because of this nonsense."

NORMALLY, THE TWOHIGS AREN'T THE SORT OF PEOPLE INCLINED TO TAKE ON THE MILITARY. Both Richard Twohig's parents were career Marines; his younger brother, Chris, has enlisted in the Marines and shipped off to Parris Island. This is a family that believes every young person should serve this country.

Belinda Twohig trusted so fully in the military's commitment to caring for its own that the idea of looking beyond an Army attorney to represent Richard didn't initially cross her mind. But when she called a friend who was a judge advocate, he warned, "Belinda, you don't fight the Army with the Army." What she needed, he said, was a civilian lawyer specializing in military cases. After a little research, he sent her a name: Mark Waple, a West Point graduate and former judge advocate who practices in Fayetteville, N.C.

Waple has argued perhaps 200 physical evaluation board cases, going back to the Vietnam War era. For most of that time, he says, the evaluation boards "tried very hard to be as fair as possible." Now he describes the system as "broken."

Wounded service members are supposed to be guided through the confusing thicket of disability regulations by physical evaluation board liaison officers, universally known as PEBLOs, whose job is to explain the process, advise service members of their rights and assemble their files. But service members complain that documents get lost, that files are incomplete; some report that the liaisons discourage appeals and the use of outside attorneys.

"Sometimes I feel half of what I do is explain what a PEBLO should have already explained," says Danny Soto, a national service officer for Disabled American Veterans, the only vets organization permitted an office at Walter Reed.

Liaison officers handle many cases; in the Army, for example, they counsel an average of 15 to 30 people a day, not including phone calls. Twohig only remembers meeting his liaison officer once: the day she told him he wouldn't be retired.

The Army has tried to keep up with the sharp rise in disability cases, expanding the Physical Disability Agency staff by 50 percent since 2003, and adding 40 percent more liaison officers and assistants. The Army's caseload, however, has soared by more than 80 percent since 2001.

At Walter Reed, where two part-time Army lawyers handled disability cases in 2003, three lawyers and a paralegal now work full time presenting cases to the formal evaluation board. These lawyers get high marks from their civilian counterparts and from vets groups for knowledge and competence, but low grades on having enough time to put together strong cases, which can involve preparing witnesses and gathering further medical documentation. Each lawyer at Walter Reed handles an average of 256 cases each year, and often doesn't meet a client until the day before the evaluation board hearing, when the attorney spends an hour or so preparing the soldier to testify.

"I don't know how you can prepare adequately for a hearing, a full and fair hearing, if you pick up the case file the day before, two days before," says civilian lawyer David Sheldon, who has a military practice in the District.

The Army disagrees. "Lengthy e-mail messages and in-depth phone calls from the paralegal and the attorney ensure that adequate contact is made in sufficient time before the hearing," says Lt. Col. Samuel Smith, Walter Reed's supervising staff judge advocate, via e-mail because the Army barred in-person interviews with any legal staff or with evaluation board members.

Few of the injured hire their own attorneys to contest findings, even though they have that right. A key barrier is money: A civilian lawyer specializing in military cases will likely charge $5,000 or more to prepare for a formal hearing, with no guarantee of success.

Waple was blunt about that when the Twohigs went to see him in early 2005. He thought Richard was clearly entitled to retirement. But migraines are hard to get rated for, because sufferers can rarely document how frequently they occur, something the physical evaluation board wants to know. Richard would have been better served, Waple said, if his neurologist had told him to go to the emergency room whenever he had an incapacitating headache, or even advised that he keep a diary. Waple, however, could call a witness -- Belinda -- who could explain why there was no record of how often Richard's headaches struck.

Richard's psychological symptoms presented a different problem. Waple knew the board might not give much credence to his mood disorder.

The way the military rates psychiatric injuries -- or doesn't -- is a sore subject among veterans groups and civilian lawyers who handle disability cases. The incidence of mental health problems among those returning from Iraq appears high. An Army research team, reviewing the records of more than 300,000 soldiers and Marines, reported last year that more than one-third of Iraq veterans had visited mental health clinics at least once in their first year at home; they were considerably more likely to show signs of psychological distress than those who had served in other overseas locations such as Afghanistan or Bosnia. Yet critics charge that evaluators are particularly skeptical about diagnoses of post-traumatic stress disorder and other psychological injuries.

"If they've been shot five times and need multiple surgeries, and it's very obvious to the doctors what's wrong, then it's a lot easier," says Charlotte Cluverius, a Washington attorney who represents service members at disability hearings. "The burden on the service member is much, much higher with psychological issues, even though those can be just as devastating and incapacitating."

Danny Soto agrees. At Walter Reed, where he counsels dozens of soldiers each week, he thinks that just 40 to 50 percent are being rated correctly for their injuries. When it comes to clear-cut physical problems, something as visible and inarguable as amputation, "they get that right," Soto says. "If you're talking traumatic brain injuries, psychiatric injuries, it drags on."

The Army rejects the notion that large numbers of injured soldiers aren't being rated correctly. Its Physical Disability Agency reviews 25 to 30 percent of informal and formal evaluation board decisions, and is satisfied with its work.

David Armitage, the agency's senior medical adviser, acknowledges that correctly evaluating post-traumatic stress syndrome and other mental disorders -- or any self-reported disability -- can be difficult. "It's a fact-finding matter," he says. "We look for supportive evidence." Otherwise, a condition such as migraine headaches "is too easily conjured up or exaggerated." But he adds, "that's true throughout the entire disability world, not just in the military . . . I think we're doing better every day."

Waple wasn't so sanguine. He told the Twohigs that he wasn't having much success with the Army and that the odds weren't high that the formal evaluation board would raise Richard's rating to 30 percent. Besides, Waple's services, including the fee for the independent forensic psychologist's evaluation he recommended, would cost about $6,000. Belinda, who had just paid lawyers' fees to divorce Richard's father, blanched. But they agreed to proceed, with each parent paying half the cost.

Richard's case would be heard at Walter Reed, where the evaluation board scheduled the hearing for a day when Waple had a court appearance elsewhere and then refused to grant a five-day delay. That meant Waple would prepare Twohig's case but that an Army lawyer would have to present it.

Still, the Twohigs felt hopeful. Once the board heard the full story, Belinda was sure, "they are going to realize that there was wrong done. They're going to see and say, 'Okay, Richard should be 30 percent.'"

BELINDA ACCOMPANIED RICHARD TO WASHINGTON FOR HIS HEARING IN MARCH 2005. For one thing, he was in no condition to drive, she says, "from the stress and all the meds he was on." In addition to the pain drug Dilaudid, he was taking medications for his migraines, for nausea and sleeplessness, and for depression. Belinda would also be a witness, able to testify about the changes in her son and about what his neurologist had advised.

It was a stressful time. Belinda, who had been teaching ROTC at Florida A&M University, was newly divorced and about to retire from the Marines after 28 years, forgoing an expected promotion to lieutenant colonel. She planned to sell her house in Tallahassee and look for a job in Tennessee, where she would be near Richard and her grandchildren.

"My children have sacrificed a lot for my career," Belinda says. "There were deployments; there were a lot of long hours." She can still tick off her absences: the 10 weeks her two boys stayed with her sister while she was at Officer Candidates School, the six months' further training at Quantico when she got home every other weekend, a stint at Guantanamo . . . "I wasn't always there for them, I feel."

Now, she intended to be. So while Richard lay in the back seat of her '94 Mustang, she drove north, stopping at a highway rest area when a headache nauseated him and he needed to vomit.

This wasn't the son she had raised. Growing up mostly in Jacksonville, N.C., he was the kind of kid who was happiest outdoors, a deer and duck hunter, a year-round surfer at nearby beaches, a halfback on a traveling soccer team. "Richard always had friends; Richard used to joke a lot," she remembers. She wasn't pleased, when she and her husband went off one weekend, to learn that Richard had invited his soccer buddies over for a beer bash that drew the police. But the incident does remind her that back then, "he liked to be around people. He was always dragging someone home."

He went off to North Carolina A&T to study business management, and, toward the end of freshman year, met a young woman in a club. He and Sang, the daughter of Cambodian immigrants, went out for a while, had Lizzie when they were both 19, then married. Twohig left school and took jobs flushing radiators at Jiffy Lube and loading United Parcel Service trucks, but he had trouble earning enough for a family, and none of his employers supplied benefits. The military would. It might be "the best option to get my degree and help the family," he thought. "My mom did it that way, went in the Marine Corps, got her education. So did my dad." And the Army was offering $20,000 signing bonuses. He walked into the recruiting station in Jacksonville and enlisted in early 2001. When he graduated from boot camp, his mother swore him in, an officer's prerogative and an act she now sometimes regrets.

Twohig was sure after September 11 that he'd be sent to Afghanistan. But his unit remained at Fort Bragg until Iraq, a war whose political dimensions he gave little thought to. "I looked on it more as a job," he explains. "You're supposed to do it. Your feelings don't really matter."

He had been a good soldier, his mother thought, and he was a good man. She had faith, and not solely in the military.

In the months since his accident, Belinda, a churchgoing Catholic, prayed the rosary as she walked around the track at Florida A&M each morning. She was praying again as they rounded the Beltway and headed for a hotel in Silver Spring.

THAT AFTERNOON, THE TWOHIGS MET WITH ASSIGNED MILITARY COUNSEL DAVID WHITE, who, using Mark Waple's brief and materials, would represent Richard at the hearing next day. White explained the procedure and, as Belinda remembers it, said Richard stood a decent chance of having his 20 percent rating raised.

Richard hardly slept that night. When they reported to Building 7 at Walter Reed the next morning, both in uniform, he felt ill and vomited a little in a hallway water fountain; Belinda fished some tissues from her briefcase and cleaned up the mess. To ward off an approaching migraine, he took his anti-nausea pills and Dilaudid, which tended to undermine his already-diminished ability to concentrate. "He looked like a zombie," his mother says.

The Physical Evaluation Board at Walter Reed is one of three meeting around the country for the Army; the others are at Fort Lewis in Washington state and Fort Sam Houston in Texas, sometimes supplemented by a mobile board. (The Navy and Air Force have their own physical evaluation boards.) A typical board has three members, one of whom is a physician. But that doesn't mean anyone on the board has had previous experience in evaluating disabilities; the physician hearing about brain injuries could be a dermatologist or an obstetrician. Members of the Army board take a five-day classroom course before they start adjudicating cases; the rest of their training comes on the job.

Inadequate training is among the problems that investigators have repeatedly cited in calling for improvements to the disability system. For nearly two decades, studies by both military and civilian teams -- the Army Audit Agency, the Defense Department's Inspector General, the Rand Corp. -- have criticized the system's inconsistencies, its delays, its lack of oversight and quality control. The latest report, issued by the Government Accountability Office last year, sounded many of the same themes, and the Defense Department didn't disagree. The Pentagon says a number of improvement efforts are now underway, including the long-planned computerization of all health records.

The Army, however, insists that it is already doing a good job. Armitage, who helped develop the Army's five-day training course, defends the members of the evaluation boards and their preparation. "These are people who know what soldiering is all about; they know the stresses that soldiers undergo; they know what the requirements are for soldiers to perform," he says. "They've been there."

The evaluation board that met to consider Twohig's case included a longtime infantry officer as president (he has since retired), a retired Navy psychiatrist as the medical member and a personnel management officer who had served in Iraq. They met in Room 235, a small space hung with Army insignia and posters of the human spine. Each of the three members and the soldier had a microphone on the table before him so that the hearing could be recorded on a CD.

It's supposed to be a non-adversarial proceeding. Some soldiers find it intimidating, nonetheless. For Twohig, it mostly seemed perplexing. The transcript shows that several times, as the attorney had him describe his injuries or board members chimed in with questions, he sounded muddled, not quite able to grasp what was being asked.

Physical Evaluation Board president Col. James Babbitt (after Twohig testified that he had trouble concentrating): If the 1st Sergeant tells you, "Go to 1st Platoon and find the Platoon Sergeant and tell him I want to see him at 2 o'clock," can you do that?

Twohig: Yes.

Babbitt: If he says, "Go find the 1st Platoon Sergeant, tell him I want to see him at 2 o'clock, find the 1st Squad Leader and tell him I need to see him right now, and tell the 2nd Squad Leader I'll see him tomorrow," would you have any problem delivering those messages?

Twohig: What?

Belinda Twohig also testified, speaking at length about the changes she had seen in her son since his accident, his isolation and memory problems, his physical incapacity. "There is depression, because he feels he is incapable or cannot achieve any dreams that he had before," she said. "I think that the depression is coming because he doesn't know how to get better, and, you know, I don't either . . ."

But Babbitt prevented her from testifying about what the neurologist had said about not needing to seek further medical attention when the migraines hit. "We've brought that out already," he said. "That's not necessary. That's just duplicious."

After nearly two hours, the board recessed briefly. Then Babbitt read its decision: that Richard was physically unfit to perform his duties, that he had "post-concussive syndrome associated with headaches, dizziness, bilateral tinnitus, nausea, decreased concentration and forgetfulness" that "limit his activities of daily living." That he took "a narcotic substance, mood stabilizing and antidepressant medications." That he further had "mood disorder with depressive features manifest by chronic irritable mood, insomnia, decreased appetite, social withdrawal and low self-worth."

It sounded to the Twohigs as though the board saw things their way. Then Babbitt read Richard's rating: 10 percent.

After thanking Richard for his service, the board adjourned; the recording equipment was turned off.

Belinda Twohig remembers erupting in shock. "I don't believe this!"

"Mom, what happened? What are they saying?" Richard didn't understand.

"I gave the Army a perfectly capable young man, and what you give me is somebody incapable of working, and you tell me that's only worth 10 percent?" Belinda exclaimed.

The board president said he understood her distress.

"I don't believe we are not taking care of him," she said.

"That's what the VA is for," she remembers Babbitt saying.

One board member, Lt. Col. Nick Gnemi, disagreed with the finding and announced he would submit a minority report, a rare occurrence. As the Twohigs waited in the anteroom while Gnemi wrote it, Richard was anxiously wondering how he could take care of Sang and the kids. They would have to sell the house they had bought just two years earlier. "He was just ripping inside," Belinda says.

Sounding stronger than she felt, she told him not to worry, that they would get through this. She didn't want Richard to see her in tears, and she didn't want to show emotion before the other officers, "especially that president." So she found a corner downstairs, wept briefly, dried her face.

Gnemi handed them a copy of his two-page minority report, explaining his disagreements with the rating and concluding, "This combat veteran needs to be given the benefit of the doubt and be placed on TDRL [temporary disability retirement list] to continue additional rehabilitation and medical care." He told the Twohigs he hoped it would help.

Enervated, they left Walter Reed and started the long trip home. Richard was feeling sick.

"Do you want to stop?" Belinda asked.

"No, I just want to get the hell out of here."

So she paused just long enough for him to open the car door at a stop sign, lean out and vomit. Then she drove on.

RICHARD TWOHIG IS VERY QUIET on the 40-mile drive out to his mother's farm in Sweetwater, Tenn. It's the first time he has left the apartment in a couple of days.

Smoking Newports, he steers his SUV off the interstate, along a two-lane blacktop that climbs past fields of Queen Anne's lace and dairy cows in fenced pastures. Belinda first visited this area during a vacation in the Smokies, and bought her tract of fields, creeks and woodland six years ago. She hadn't expected to move here this soon, but now that seems the best solution for everyone.

Her plan is to raise, breed and sell alpacas. She already owns eight, currently boarded in Georgia while she prepares paddocks and barns. Richard, always an animal lover, has spent time learning to care for them. Alpacas are one of the few subjects for which he can, sometimes, summon real enthusiasm -- talking about how "they're real skittish" until you've worked with them for a while, how "they love kids," how their fleece comes in lots of colors, "gray, silver, black, white."

So Belinda's great hope is that he and the kids will move into a log cabin she's building on the property, where she can help raise her grandchildren while her son helps raise her flock.

"Daddy! Daddy!" Lizzie and Damon, who have spent the night with Belinda ("Grammy") and her fiance, Robert Rhyne, come dashing over as Twohig pulls into the drive. "Did you bring our water guns?"

"I didn't think of it," he says. He has a headache, one of the milder ones, but he sits on the front porch of the cabin -- Belinda and Robert are hanging kitchen cabinets inside -- and plays several rounds of tic-tac-toe with Lizzie. "No more," he says, after a few minutes. He watches Damon run his battery-powered truck up the pile of dirt next door to the cabin.

He and the children bounced around a good deal after his hearing and separation from the Army. The Veterans Affairs office in Winston-Salem, N.C., processed his benefits application at near-record speed -- probably helped along by an article in the Fayetteville Observer about his plight. The VA often assigns higher ratings; it uses the same guidelines as the military but applies them according to its own regulations and practices. It found Twohig 100 percent disabled, including a 50 percent rating for his headaches and 70 percent for his cognitive and mood disorder, with lower ratings for several other physical problems. "It is clear," its report says, "that you are unable to acquire and/or maintain substantially gainful employment in either a physical or sedentary setting . . ."

But while the VA began paying him $2,700 a month, it also -- by regulation -- deducted the Army's severance payment from his checks until the entire $12,000 was repaid. Unable to maintain a household on so little income, Richard sold the family's brick ranch in Fayetteville, and he and the kids lived for a while with his mother in Florida, then with his father in Tennessee and with Sang in Virginia. When he and Sang separated this past summer, they agreed that Richard should take the children because he wasn't working and could be at home.

He wouldn't get higher monthly income as a retiree than he currently gets from the VA. But TriCare insurance would let him see local civilian doctors; he would not have to drive nearly two hours to the VA hospital in Johnson City, Tenn. And it would cover Lizzie and Damon. Providing them with health insurance is the reason his estranged wife enlisted, so they're okay for now, but Sang has said she isn't loving the Navy. What happens if she leaves?

An appeal filed with the Physical Disability Agency was denied in April 2005, but Waple said he was willing to take Twohig's case to the ultimate level, the Army Board for the Correction of Military Records.

Even after Waple reduced his normal fee ("These people have been through hell," he explains), the appeal would cost another $2,500. "Mom, don't waste your money," Twohig urged. But Belinda considered that a reasonable investment if it brought her grandchildren health insurance until adulthood. "If I don't do this for the kids' sake, for their medical benefits, I'll regret it for the rest of my life," she decided.

So in July, Waple filed a petition arguing that the physical evaluation board failed to award the appropriate disability percentage, based on the regulations and the evidence presented. A decision could still be months away.

Belinda remains optimistic. "If I was sitting on that board and this was not my son, and I looked at everything," she says, "I would give him that 30 percent."

Meanwhile, the farm is taking shape. Belinda teaches ROTC in a Knoxville high school, and on weekends she and Robert, a jovial former contractor, do as much of the construction work themselves as they can. The main house, a dormered colonial of clapboard and fieldstone, is going up just across the meadow from the cabin. It will have three bedrooms upstairs and one on the main floor for Belinda's mother.

The cabin, where soon everyone is eating sandwiches and sitting on lawn chairs and upended spackle buckets on the porch, is just 400 square feet. Belinda can use it for meetings with prospective buyers and seminars on alpaca-raising. But it has a kitchen and a bathroom and could easily be expanded, which is her not-very-secret plan.

She's treading carefully, trying not to pressure Richard; she knows he needs to make his own decisions. She's mindful of the time she offered to ferry Lizzie to and from school each day -- the elementary school is near the high school where she's teaching -- and her son objected, "Mom, I have to have a purpose in life." Sometimes, beset by pain and depression, he says caring for his children is all that keeps him going. So Belinda hasn't pushed for a decision.

"I'm just in transition," Twohig says. "I don't know what I'm doing." In the coming months, as he turns 26, he'll move out to a rented house near the farm -- but not onto it.

Nevertheless, when Belinda stands on the porch and looks out at her property, a quiet haven without another house in sight, she envisions building a couple of bedrooms onto the cabin for Richard and the kids and the dog. He could help with the alpacas, with feeding and watering, shearing, trimming toenails. And when he had a bad day, Belinda and her mother would be just a few hundred feet away, ready to care for the kids until he recovered.

He'd never have to contend with crowds or noise or pressure or bosses. He could raise children and alpacas, and she'd have his back. He could, perhaps, be happy.

Paula Span, a contributing writer to the Magazine, can be reached at spanp@comcast.net. She will be fielding questions and comments about this article Monday at noon.

Read more!

Patient dumping may be criminal but ... - LA Times

By Richard Winton, Times Staff Writer

Despite the public outrage over the dumping of homeless patients on Los Angeles' skid row, there is growing debate about whether criminalizing the practice would solve the problem.

As the number of suspected dumping cases reached 55 last week, a state senator announced legislation that would make it a misdemeanor for hospitals to transport patients and leave them on the streets against their will.

But some legal experts question whether the law could be effective without a parallel effort to provide more shelter and services for chronically ill homeless patients who are well enough to leave the hospital but have no place for continuing medical services.

There are only about 40 "recuperative beds" available in L.A. for homeless people who need medical attention after being discharged from hospitals, officials said, and there is general agreement that's not enough. The proposed law, legal experts say, might be vulnerable, because it seems to make hospitals alone responsible for finding care for these patients.

"It is more complicated than it first appears," said Russ Korobkin, a UCLA law professor who teaches health law. "Requiring hospitals to be responsible for the patients and not leave them in the gutter is a first step. But you've got to have a second step of providing some government-funded beds for recovery."

Otherwise, he and others said, the law essentially creates an "unfunded mandate" — which could be challenged in court — that hospitals must not only treat the sick but also find housing for them upon their release.

Another expert on health law, USC law professor Alex Capron, said the proposed legislation could leave a hospital on the hook for services that go well beyond how it provides treatment for homeless people.

"If someone lives in a one-room flophouse alone, would that even be an appropriate discharge under this law and to what extent would a hospital be responsible?" he asked.

The proposed legislation, by state Sen. Gil Cedillo (D-Los Angeles), would make it a misdemeanor for a hospital facility or worker to transport patients anywhere other than their residences without their informed consent. Individual offenders could be punished by up to two years in county jail and a fine of up to $1,000. Healthcare facilities could be fined up to $10,000.

Cedillo and others said the law would give city prosecutors better tools to prosecute hospitals for dumping. City Atty. Rocky Delgadillo has filed criminal charges against just one hospital, Kaiser Permanente, saying the dumping of a homeless woman on skid row in 2006 amounted to false imprisonment. That legal strategy, however, hasn't been tested in court.

"We had great faith in hospitals' commitment to their patients," Delgadillo said. "We have great faith in the Hippocratic oath. We had great faith in people's adherence to common decency. We hoped hospitals would adhere to those ideals. But it doesn't appear so.

"These dumping incidents aren't aberrations, and they certainly make it necessary for us to make a clear and powerful statement about what is appropriate behavior for the health community and anyone dealing with fellow members of society," he added. But some question whether it makes sense to focus only on hospitals when they are just one piece of the puzzle.

Homeless services officials said there is not enough money for long-term housing of homeless people, especially those with medical conditions or mental problems.

L.A. civil rights attorney Carol Sobel questions the validity of a law that would make hospitals liable for how they treat the homeless while not extending that liability to other groups.

"This is the last person in a chain that has failed these indigent patients," she said. "Where's the county social worker? Where are the nursing homes? Where are the missions? Where's the rest of the system that is supposed to care for these people? Why don't the police criminally charge the mission that turns somebody away?"

Hospital officials argue that they are being singled out even though medical centers in Los Angeles County provide care for 18,000 homeless patients each year. They say it's difficult to find places to send those who are well enough to leave the hospital but have no place to go where they can receive care.

But Delgadillo and others say that although hospitals often face a dilemma, there is no excuse for leaving patients on skid row if they have nowhere else to go. Earlier this month, a 54-year-old man in a soiled hospital gown, his colostomy bag still attached, was found crawling in the gutter after being dropped off outside a skid row park, far from homeless services.

Police say that as onlookers demanded help for the man, the driver of the van for Hollywood Presbyterian Medical Center applied makeup and perfume before driving off. The hospital said it is investigating but acknowledged that it didn't follow its own release policies.

The Kaiser case involved a 63-year-old patient who was discharged early last year from Kaiser Permanente's Bellflower medical center. A short time later, video at a downtown mission captured her stepping out of a taxi in a gown and socks and then wandering aimlessly down San Pedro Street. Kaiser has denied any wrongdoing, saying the woman was discharged by mistake. The hospital said it has revamped its release policies.

Delgadillo said that about 10 of the 55 dumping cases have the potential to lead to further action. He said dumping isn't unique to skid row, adding, "We suspect it is happening in other parts of the city." Read more!

Drug keeps addicts in powerful grip - Raleigh News & Observer

Treating meth addicts has challenged substance abuse counselors in North Carolina.

For one thing, it's hard to get them into a program, and they often turn up in local emergency rooms in the throes of a psychotic breakdown. They are then committed to state mental hospitals and soon released without dealing with their addiction. Because there is no systematic way to force imprisoned addicts into treatment once they are freed, they often pick up the habit again.

Staff writer Mandy Locke recently discussed the issue with Jim Thornton, director of a pilot program in Watauga and Ashe counties designed to treat meth addicts and their families. The federally funded program works with law enforcement and social services to also attempt to deal with the child welfare and job placement struggles that often accompany meth addiction. Here are edited excerpts of that interview:

Q: Are you still having a problem with meth addiction in the western part of North Carolina?

A: There's still a lot of meth here. We have not seen any drop in the meth families being referred to us. That said, over the last few months we haven't seen an increase yet either. The cooks are the hardest to get into treatment.

Each quarter, we might work with about 200 people, 60 or so of those being adult addicts.

Q: Meth addicts tend to be particularly paranoid. Does that make them difficult to treat?

A: They are delusional, more delusional than paranoid. They are paranoid once they get rounded up . Once they stop using, they can present fairly normally. But they never drop their belief in the delusions. That's the interesting part. Years later, meth addicts still believe they have things in their skin, or they believe their wives were extremely promiscuous with men who pop in and out of floorboards. You try to explain to them that delusion was part of their meth addiction, but they can't let it go.

Another challenge is that some people become runners, and it's hard to keep up with them. They flee. We've run down pregnant women on meth. They start using again, and they don't want consequences of testing positive.

Q: What else is different about meth addicts from other kinds of substance abuse addicts?

A: Well, when they are using, they get into periods of intense focus. They might pick their face in front of a mirror for 18 hours. If they are parents, they have no awareness of their children. Cocaine addicts do that, too, but only when they are high. With meth addicts, it's so long-acting, they might ignore their children for weeks.

Q: What's the silver bullet? What works for them?

A: If you are going to engage this population, you can't be a passive treatment center. You must go out and get them. You can't just give them an appointment time. We go out and throw a net over them. We show up at their house early. We set up a team around them. It gives us leverage. That team gets together and solves problems such as transportation. We rope them in pretty well. Our addicts live remotely. They live in chaos in these trailers with no window, no water. They have small children foraging around. It would be very difficult for them to participate otherwise.

Once you get the wrap around them, they do well, particularly the ones with children. But it's a drug that you get habituated to, and it will sneak up on you the rest of your life. We get them straight for good lengthy periods of time, though. Read more!

Panel: Military Mental Health System Fails - AP

(AP) Many Iraq war soldiers, veterans and their families are not getting needed psychological help because a stressed military's mental health system is overwhelmed and understaffed, a task force of psychologists found.

The panel's 67-page report calls for the immediate strengthening of the military mental health system. It cites a 40 percent vacancy rate in active duty psychologists in the Army and Navy, resources diverted from family counselors and a weak transition for veterans leaving the military.

The findings were released Sunday by the American Psychological Association.

More than three out of 10 soldiers met the criteria for a "mental disorder," but far less than half of those in need sought help, the report found. Sometimes that is because of the stigma of having mental health problems, other times the help simply was not available, according to the task force. And there are special difficulties in getting help to National Guard and Reserve troops, who have been used heavily in Iraq, the report said.

The special task force found no evidence of a "well-coordinated or well-disseminated approach to providing behavioral health care to service members and their families."

The psychology task force, chaired by an active military psychologist and comprised of psychologists working for the military or Veterans Administration, said "relatively few high-quality" mental health programs exist in the military now.

"There are tremendous needs; the system is stressed by these needs," said pediatric psychologist Jeanne Hoffman, a task force member and a civilian pediatric psychologist at Tripler Army Medical Center in Honolulu.

The Defense Department's mental health experts had not read the report. Pentagon spokeswoman Cynthia Smith said the military is proud of its mental health services record, including a new program this year that checks up on service members after they return home to their families.

"For the past four years, DOD has been aggressively reaching out to support our military personnel before and after deployments. This is unprecedented," Smith said in an e-mail to The Associated Press. "We have assessed the health, including the mental health of more than 1 million service members before and after deployments. We have worked with their families and others to address mental health concerns associated with deployments and with war."

One of the major problems is that four out of 10 "active duty licensed clinical psychologist" slots in the Army and Navy are not filled, a problem worsened by the dire need to send mental health experts into war zones, the report said.

That high vacancy rate has several side effects. One is that the psychologists left are overwhelmed, the report said. It found that one-third of Army mental health personnel reported "high burn out" and 27 percent reported "low motivation for their work."

Because of the shortage, there are even fewer stateside therapists to help families of those deployed and to help returning soldiers readjust, the report found.

Hoffman, the pediatric psychologist, said she's seen children regress on toilet training, have severe headaches, stomach pains, and suffer in school because of the stress of having a parent deployed.

And for soldiers and veterans returning home, only 10 to 20 percent of the military's mental health experts are trained to help those with post-traumatic stress disorder, the report found.

"I know guys that are waiting for appointments," said Russell Terry, chief executive officer of the Iraq War Veterans Organization. "I know guys who are dealing with doctors who have no concept of PTSD."

Terry was on the phone with an Iraq war veteran last year when the vet killed himself.

Report co-chair Michelle Sherman, a psychologist at the Veterans Administration Medical Center in Oklahoma City, said the military and VA are "working very hard to meet the needs" of those returning from Iraq.

At VA headquarters, Antonette Zeiss, deputy chief consultant in the agency's office of mental health services, said the report "misses the mark by quite a way." She said her agency didn't have "an opportunity to present data (to the panel) about what the VA is really doing."

Sherman said the panel did seek data from the VA, but when asked if the agency provided information to the psychologists' panel, she said: "I'm not supposed to answer that question."

Zeiss said the VA has been increasing spending on mental health services yearly, opening new centers and hiring more psychological professionals.

"We have the strongest mental health system in the country and we are making it stronger," she said.

But veterans groups disagree.

"The system as it exists today ignores the readjustment needs specific to Iraq and Afghanistan service members," Veterans for America President Bobby Muller said in a statement. "We have to stop throwing money at a problem that requires a complete overhaul. The system is broken." Read more!

Drug may treat mental symptoms of Down syndrome - Reuters

By Maggie Fox, Health and Science Editor

WASHINGTON (Reuters) - An old drug once used to study epilepsy can help improve learning in mice with a form of Down syndrome and also might help people, U.S. researchers said on Sunday.

The beneficial effects the drug, called pentylenetetrazole, or PTZ, continued for two weeks after treatment. This suggests the drug, like some other psychiatric drugs, can make long-term changes in the brain.

The finding, published in the journal Nature Neuroscience, also can help scientists understand what causes the mental retardation seen in Down syndrome patients.

"This treatment has remarkable potential," said Craig Garner, a professor of psychiatry and a director of the Down Syndrome Research Center at California's Stanford University.

"So many other drugs have been tried that had no effect at all," Garner said in a statement. "Our findings clearly open a new avenue for considering how cognitive dysfunction in individuals with Down syndrome might be treated."

Down syndrome is the most frequent genetic cause of mental retardation and occurs equally around the world, in about one in every 800 births. About 5,000 children born in the United States each year have Down syndrome.

It is caused by the presence of a third chromosome, known as chromosome 21. Most people have two copies of each chromosome and the additional activity of the genes on the third copy of chromosome 21 is believed to cause the symptoms of Down syndrome.

Symptoms range from moderate mental retardation to very mild disability. Many Down's patients also have health problems, especially heart trouble.

Fabian Fernandez, a student in Garner's lab, was exploring the possibility that the brains of Down's patients are too strongly affected by a chemical called GABA, a neurotransmitter, or message-carrying chemical, that stops brain cells from becoming too excited.

DAMPING DOWN LEARNING

"In general, learning involves neuronal excitation in certain parts of the brain," Garner said. "For example, caffeine, which is a stimulant, can make us more attentive and aware, and enhance learning."

Inhibiting this process can interfere with learning.

PTZ does this by causing more GABA to be available in the brain. Overdoing this process can cause seizures and PTZ was once used to study epilepsy. But it is no longer approved for use in people.

Fernandez gave daily doses of PTZ to mice specially bred to have many of the same genetic differences that cause Down syndrome.

"My idea was that it might be possible to harness this excitation effect ... to benefit people with Down syndrome," Fernandez said.

He gave the drug to the mice and then gave them a maze test. Normal mice tend to explore first one arm of a T-shaped maze and then the other, while the Down mice are more random in their exploration.

But after 17 days of treatment, the drug made the Down mice explore and learn more like normal mice.

"Somehow the drug treatment creates a new capacity for learning," Garner said.

More tests showed that daily doses were required for several days before any effect was seen, and the mice acted more normally for up to two months after the drug was stopped.

That may suggest the drug is changing brain structure, Garner said. His team may explore testing the drug or a similar compound in people as a possible treatment for Down syndrome.

© Reuters 2006. All rights reserved. Republication or redistribution of Reuters content, including by caching, framing or similar means, is expressly prohibited without the prior written consent of Reuters. Reuters and the Reuters sphere logo are registered trademarks and trademarks of the Reuters group of companies around the world.
Reuters journalists are subject to the Reuters Editorial Handbook which requires fair presentation and disclosure of relevant interests. Read more!

New ADHD drug wins U.S. approval - AP

WASHINGTON - A new amphetamine-based drug to treat attention deficit hyperactivity disorder won federal approval Friday. It's harder to abuse than older stimulants, the manufacturer says.

The Food and Drug Administration approved Vyvanse, also known as lisdexamfetamine, agency spokeswoman Susan Cruzan said. The drug is made by Shire.

Shire hopes the drug will extend its lucrative ADHD franchise once its top-selling Adderall XR begins facing competition from lower-priced generic versions in 2009. Shire hopes to move patients from the older to the newer drug at the time, company spokesman Matt Cabrey said this week.

Shire said it tried to limit the drug's potential for misuse. It tested the drug on adults with a history of abusing stimulants to assess its "likeability." Results suggest the drug delays the onset and limits the intensity of amphetamine-like effects, the company said.

Vyvanse works by gradually releasing its active ingredient, d-amphetamine, after the drug has been swallowed and comes into contact with enzymes in the digestive tract.

Unless it's swallowed, Vyvanse remains inactive. Shire believes that will curtail its potential for abuse by users who snort or inject crushed pills.

Despite those measures, the Drug Enforcement Administration has proposed making Vyvanse a Schedule II drug, a class that includes cocaine, methadone, methamphetamine and other drugs with a high potential for abuse.

Other ADHD medicines, including Adderall and Ritalin, also are Schedule II drugs.

Vyvanse's label will bear a "black-box" warning, the government's strongest, Cruzan said. Details were not immediately available.

FDA approval of Vyvanse came the same week that the agency asked all manufacturers of ADHD drugs to warn patients and their parents of mental and heart problems associated with use of the medicines. Read more!

Lawmakers weigh creating mental health 'department' - Bennington (VT) Banner

MIKE GLEASON, Staff Writer

BENNINGTON — The state Legislature is considering a measure to create a separate department for mental health issues.

The proposal, which passed the state House of Representatives this week, would once again separate Vermont's Division of Mental Health from the state Department of Health.

"Before the agency reorganization in July 2004, the Division of Mental Health was a separate department," said Charles Gingo, local field director with the Agency of Human Services. "I know there has been advocacy to have a separate commissioner of mental health again. I also know there has been the sentiment that it makes sense to keep the two together, because mental health is a part of health."

Robert Pini, communications director for Bennington's United Counseling Services, said his organization is in favor of re-establishing the office of commissioner of mental health.

"Since the commissioner's office was folded into the Department of Health, there's been a loss of focus, vision, planning and development for the future," Pini said. "When the department moved from Waterbury to Burlington, it lost a lot of expertise."

Pini said the Vermont State

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Hospital has likely suffered due to the combined department.
"For some time, there's been a struggle to improve the hospital because of a lack of leadership," Pini said. "Also, Vermont State Hospital future planning — to relocate, rebuild or renovate the hospital — has gone a lot slower than it should have."

Ken Libertoff, executive director of the Vermont Association for Mental Health, said he was pleased the separation is being considered.

"(The separation) has been our number one priority for advocacy this year," Libertoff said. "We feel, by creating a commissioner position, we will get more attention to mental health problems — deputy commissioners (which the mental health division has currently) are less independent than full commissioners."

The combination of the departments, said Libertoff, has been a bad move.

"It's unqualified that it's hurt attention to mental health issues," Libertoff said. "The problems Vermont is confronting in regards to mental health call for the leadership and competence that we can get from the commissioner post."

Libertoff also attributed the problems at the state hospital to the lack of a mental health commissioner.

"We have a state hospital that's lost its certification," Libertoff said. "It's not a good thing — the state has lost federal Medicaid reimbursement because of it."

Michael Hartman, the current deputy commissioner of mental health, said that if the Legislature felt the division was a good move, the department was willing to accept that decision.

"We have important collaborations that we've barely started," Hartman said. "Over the short term, though, having a (separate) commissioner may help to address the current state of affairs in mental health."

The idea that first led to combining the two, said Hartman, has not disappeared.

"We're looking into how to maintain some of our connections, as we look at an extended period of time as separate entities," Hartman said. "We want to retain the idea of public integration of health and mental health."

The bill will now be sent on to the Senate. Read more!

VA and mental health - Raleigh News & Observer

Letter to the Editor

The Department of Veterans Affairs Mid-Atlantic Health Care Network proudly operates eight medical centers and 10 outpatient clinics in North Carolina, Virginia and West Virginia serving approximately 300,000 veterans annually.

Recent articles have questioned VA's capacity to meet the mental health needs of veterans returning from Iraq and Afghanistan. Although these newest veterans comprise less than 5 percent of all those we serve, we assure them and all our other veterans that we are ready to meet their needs.

Each of our medical centers has a Post-Traumatic Stress Disorder (PTSD) outpatient program. Two facilities also have specialized PTSD inpatient programs, both ranked among the nation's best. All of our community-based clinics offer general mental health and primary care on site. We equip our clinics with telehealth technology to provide enhanced sub-specialty consultations -- a service rarely found outside VA.

Concerns also have been raised about VA's assessment of new veterans for pressing problems and suicide risk. Every new combat veteran coming to our facilities is screened for PTSD, depression and substance abuse. VA is also providing Suicide Prevention and Homelessness specialists to assist veterans determined to be at risk.

Additionally, VA's Post-Deployment Mental Illness Research, Education and Clinical Center is headquartered in Durham. This leading-edge consortium of providers applies the best lessons learned in research to enhance our services across VA and to assist returning veterans and their families.

Veterans of the Global War on Terror are urged to call the Seamless Transition Case Manager at the nearest VA medical center for assistance. On behalf of the more than 10,000 dedicated employees in our network, we can assure our veterans that we have the resources, the expertise and above all the commitment to provide them with the compassionate care they so rightfully deserve.

David L. Raney, Ph.D.

Col., U.S. Army Reserve (Ret.)

Communications Officer, VA Mid-Atlantic Health Care Network

Durham Read more!

Police keep tabs on teen suspect - Raleigh News & Observer

Leah Friedman, Staff Writer

HILLSBOROUGH - The teenager accused of holding a teacher and student hostage last spring at East Chapel Hill High School was released into his parents' custody Friday on $40,000 bail.

But police will still be watching William "Barrett" Foster, who turned 18 Wednesday.

Under the conditions of his release, Foster must wear a device around his ankle that tracks his movements by satellite.

Except for medical appointments and visits with his lawyer, he may not leave the Raleigh apartment complex where his family recently moved.

The device has two parts -- a small box that Foster must keep with him and an ankle bracelet about the size of a wristwatch, said Capt. Charles Blackwood of the Orange County Sheriff's Office.

"He will not be able to remove it without us knowing," Blackwood told Superior Court Judge Carl Fox.

If Foster tries to remove the bracelet, the police will know immediately and arrest him, Blackwood said.

Teacher Lisa Kukla and student Chelsea Slegal agreed to Foster's release with the tracking device, District Attorney Jim Woodall told Fox. And East Chapel Hill High has been informed of his release, he said.

Fox had denied the family's request to have Foster come home for overnight visits in the fall because the visits would have put the teenager too close to the school.

On Friday, Foster's parents, William and Vicki Foster, sat behind their son and his attorneys, Kirk Osborn and Sam Coleman.

Foster held his hands in front of him and told the judge he understood the terms of his release.

"You're the only person that can make this decision go haywire," Fox told him. "Do not mess with this GPS device. How are you doing otherwise?"

"Fine," Foster said faintly.

In January, Foster, 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.

Foster has a history of mental illness and, unbeknownst to his family, had stopped taking his medication a few months before the April 24 incident, his father said last fall.

Foster held Kukla and Slegal at gunpoint in a classroom for more than an hour, police say. He has been staying at Dorothea Dix hospital and was previously hospitalized in 2005.

Attorneys for both sides said they expect to reach an agreement by March 5 before going to trial.

After the hearing, sheriff's deputies placed the bracelet on Foster's ankle.

When asked how they felt to have their son back, William and Vicki Foster smiled but would not comment.

Foster then climbed into the back seat of a white Volvo, and the family drove off.



Staff writer Leah Friedman can be reached at 932-2002 or leah.friedman@newsobserver.com. Read more!

Homeless, mentally ill man jailed 17 months for alleged theft of soda - AP

CROWN POINT, Ind. — Officials are at a loss to explain how they allowed a homeless, mentally ill man accused of stealing a soda to languish in jail for 17 months.

Edward Perez's attorney, his court-appointed psychiatrist, the judge in his case and Lake County jail officials all apparently believed he had been released a year ago.

The mistake wasn't discovered until this month, after a new warden ordered a review of all inmates' files, Sheriff Roy Dominguez told the Post-Tribune of Merrillville for a story Friday.

"This is very unfortunate," Judge Sheila Moss said. "This is a guy who apparently needed services, and he should have been somewhere where he could get that, rather than sitting in our county jail, which is already overcrowded."

The jail released Perez, 22, and transferred him to a mental health clinic Feb. 7, Dominguez said.

Perez had stayed in the jail's medical wing since July 2, 2005, after allegedly stealing a bottle of Pepsi from a Wal-Mart in Schererville, Dominguez said.

A police report that referred to the man as "Edward Hammer-Perez" said that before stealing the soda, he said he had just gotten out of jail and wanted to go back. He listed the state psychiatric hospital in Logansport as his address.

In February 2006, the psychiatrist went to the jail to evaluate Perez only to be told he already had been released, Moss said. The judge said that after the psychiatrist informed her, she deferred to defense attorney Fred Flores, who agreed that his client was not behind bars.

Moss, noting that Perez appeared in some records as "Edward Hammer-Perez," speculated he might have been jailed under a different name than appeared on his court file.

The jail kept Perez in custody because it never received a release order, said Mike Higgins, a sheriff's spokesman. Moss said she had seen no need to issue such an order because Perez was "by all accounts, already free."

A telephone message left by The Associated Press seeking comment from Flores was not immediately returned Friday. An employee at the clinic where Perez was taken said officials authorized to comment were unavailable until Monday. Read more!

Candidate upfront about his mental illness - St. Petersburgh (FL) Times

By LISA BUIE

ZEPHYRHILLS - Richard Kaeberlein is up front about his mental illness. He also insists that it wouldn't affect his ability to govern if he wins a spot on the City Council.

"I still have problems, but I'm better equipped to deal with them now," the 34-year-old Tampa Tribune contract carrier said this week after acknowledging three misdemeanor battery arrests and a bankruptcy.

He said the arrests, which happened in 1996, 1998 and 2002, were the result of his schizoaffective disorder. According to a Web site for a support group for families, the disorder is similar to schizophrenia. It can affect work, relationships and hygiene. The disorder carries a variety of symptoms including possible hallucinations and delusions. Patients sometimes need hospitalization and can find it difficult to distinguish between fantasy and reality.

Kaeberlein is trying to unseat Daniel Burgess, a University of South Florida student who won the seat two years ago at age 18.

Burgess said he won't dwell on his opponent's problems.

"I'm going to focus on me, what's positive, what's right," he said. "I don't want things to get dirty; I don't want things to get negative."

State records show Kaeberlein first was arrested in Hillsborough County in 1996 on a domestic battery charge and obtaining property with a worthless check. He pleaded no contest to the battery charge; a judge withheld a formal finding of guilt. The check charge was turned over to another agency.

The second arrest, also domestic battery, happened in Hillsborough in 1998; Kaeberlein was acquitted. He was arrested again in 2002 in Zephyrhills, but that battery charge was dismissed.

Kaeberlein and his wife, Wendy, say that in all of the cases he was a danger only to himself, though he said he does not fully recall the details. However, Hillsborough sheriff's spokeswoman Debbie Carter said an incident report shows Kaeberlein was accused of hitting his wife in 1998.

Also, an incident report in the 2002 case says Zephyrhills police arrived at the Kaeberleins' house to find the spare bedroom in a state of disarray and a dent on a closet door. Kaeberlein and his wife each told the officer the other was the attacker. However, officers noticed what looked like a bite mark on Mrs. Kaeberlein's neck and arrested her husband. Mrs. Kaeberlein then refused to be a witness, and the charge was dismissed. During the incident, Kaeberlein told the officer he was on prescription medicines for mental illness.

Kaeberlein said this week that he entered the no contest plea to the 1996 charge only because he "didn't know what was going on."

He said he was only 22 when he filed for personal bankruptcy due to debt caused by medical problems. If he had known more, he would have opted for another solution, he said.

He said he realizes his illness won't help in his campaign.

"Some people see it as a personal flaw and it's not," said Kaeberlein, who contends he has recovered with medication and counseling. "It won't affect my serving as a council member. I'm ready for this."

Kaeberlein is not the only Pasco candidate recently to battle mental illness.

In October, Donovan Brown also said he had schizoaffective disorder when he was held at a mental health facility under the state's Baker Act while running for the state House District 61 seat being vacated by Ken Littlefield.

Will Weatherford won the seat.

Advocates for the mentally ill say candidates with those illnesses should be viewed the same as candidates with hypertension, diabetes or cancer.

Ginny Van Nattan, a Hernando representative for the National Alliance for the Mentally Ill, said she has never met Kaeberlein, but "if he has nothing to hide, if he's honest and stays on his medication, I'd say he's okay."

Unfortunately, she said, society does not always agree.

"It's going to come back and bite you sometimes," she said. Read more!

Insanity verdict finds grandmother not guilty in killing - Denver Post

By Kieran Nicholson

Centennial - A woman who killed her toddler granddaughter by stabbing her 62 times with a butcher knife was ruled not guilty by reason of insanity Friday after the grandmother's family vented their fury at her in court.

"Look at me! Look at me, you (expletive)," Nicholas Pappas, the slain girl's father, screamed at his mother, Carol Lynn Pappas, before the judge's ruling. She kept her head down, refusing to look her son in the eyes.

Nicholas Pappas, still screaming, was rushed by sheriff's deputies and a police officer. Subdued and handcuffed, he was taken from the courtroom.

Nicholas Pappas and other family members addressed District Court Judge Charles Pratt before his ruling on what was to have been the first day of Carol Pappas' trial on a first-degree murder charge.

They called her a killer and pathological liar who was using an insanity plea to keep out of prison.

"She murdered an innocent, little baby," Melissa Pappas, Carol's daughter and the dead girl's aunt, told the court.

Pratt, however, found Carol Pappas to be insane at the time she killed her 21-month-old granddaughter, Madison Pappas, based on evidence presented by prosecutors, defense attorneys and state doctors. Pappas has been diagnosed as manic-depressive and bipolar.

The judge ordered her to be held at the Colorado Mental Health Institute in Pueblo for treatment until she is deemed sane.

Just two months before killing Madison, Carol Pappas was released from the Pueblo mental facility after a three-month stay.

Carol Pappas, 53, was living with Nicholas, his wife, Jessica, and their daughter, Madison, in an Aurora home when she telephoned police on Oct. 29, 2005. When officers arrived, they found Carol Pappas alone with Madison, her hands covered with the girl's blood, court records show.

Melissa Pappas told the court she's had to deal with her mother's mental health problems throughout her adult life.

"Doctors just wash their hands of it and say, 'I guess she wasn't sane,'" she said.

She said her two young children live in constant fear about "monsters in their closet" because of Madison's gruesome death.

Carol Pappas has received intensive overnight psychiatric care at least six times over the past 15 years, but her family was never warned by doctors that she could be dangerous, according to court testimony.

Pratt told family members he was sympathetic with their frustrations, but his insanity ruling - not uncommon in Colorado courts - was in accordance with the law.

The judge suggested they take up complaints about the state's mental health system with state legislators.

Defense attorney James O'Connor said the case is a "tragedy" and that Carol Pappas "will be haunted by this the rest of her life."

O'Connor said his client suffers from "mental disease" and was "not responsible" for Madison's death.

After Carol Pappas was led from the courtroom, Pratt summoned Nicholas Pappas back into court and instructed deputies to remove handcuffs he'd been placed in after his outburst.

Pratt offered his condolences to Nicholas Pappas and excused him.

"It's not the court's intent to make you the victim in this case," Pratt told him. "The court understands their are times in our lives where our emotions get the best of us."

Staff writer Kieran Nicholson can be reached at 303-954-1822 or knicholson@denverpost.com. Read more!

Payment for mental health care discussed by group - Fort Dodge (IO) Messenger

By BILL SHEA, Messenger staff writer

Mental health professionals saddled with too much paperwork and a shortage of money took their case to some Webster County lawmakers Friday.

State Sen. Daryl Beall, D-Fort Dodge, and Rep. David Tjepkes, R-Gowrie, said there is a proposal to invest an additional $23 million of state money into the mental health system. Tjepkes added that he hopes the money is approved.

But when it comes to the paperwork, the lawmakers repeated what the mental health professionals already knew: The federal government is the source of that and there’s little the legislature can do.

Beall and Tjepkes met with about 20 people at the Webster County Disabilities Alliance Legislative Forum at the Webster County Courthouse.

Paying for mental health care was a recurrent theme of the session. That cost is now split between the state and the 99 counties.

Beall said he believes the state needs to pick up a bigger share of that tab.

Tjepkes cautioned that pumping more state money into the system could result in more state interference in the delivery of mental health care.

Some local providers are already worried about that happening, according to Jim Buhr, director of the North Central Iowa Mental Health Center in Fort Dodge.

‘‘I don’t think that’s the fix,’’ he said. ‘‘I think it will be a disaster if the Department of Human Services runs the system from the top down.’’

Beall said he’s opposed to that kind of setup, but added that there appear to be some people in state bureaucracy talking about it.

‘‘I see some evidence that that specter may be out there,’’ he said.

Tjepkes said Iowa now provides more mental health services than other states that have a centralized system.

In the Senate, Beall has introduced two bills on mental health issues. One would expand the current mental health parity law to include requiring insurance coverage for treatment of eating disorders.

However, he said he’ll probably support another senator’s bill that expands mental health parity with a broader definition of conditions to be covered.

His second bill would test a concept he calls ‘‘mental health courts.’’ He said many criminals break the law, at least in part, because of mental conditions that they suffer. A mental health court, he said, would address that underlying cause of criminal behavior by ordering some form of treatment. But those courts would not erase the charges pending against a suspect even when ordering them into treatment, he added.

The bill calls for a pilot project of three mental health courts in three different counties across the state.

Mental health courts weren’t the only criminal justice issue to emerge during the session. Tjepkes said lawmakers are studying the rule that bars convicted sex offenders from living within 2,000 feet of a school.

‘‘I think it’s safe to say there’s a general realization that the 2,000 foot rule is not as effective as we would like it to be,’’ he said.

An alternative, he said, would be to create safe zones that a registered sex offender could not enter without prior permission.

Tjepkes said such a change could eventually be aided by new and more accurate assessments of a sex offender’s likelihood of committing another sex crime. Assessments being used now, he said, appear to be more effective than ones used five years ago.

Contact Bill Shea at (515) 573-2141 or bshea@messengernews.net
Read more!

Schools Restructuring Mental Health Services - Berkeley (CA) Daily Californian

BY Jacqueline Johnston

Berkeley teachers and administrators say they are developing a new, culturally sensitive approach to supporting the mental health needs of students that addresses their social and emotional well-being.

The Berkeley Schools Mental Health Partnership Strategic Plan, presented to the Berkeley Unified School District school board Wednesday, outlines a prevention-focused program in development since 2005 by a team of district educators, city officials and UC Berkeley staff members.

The program seeks to “develop the needs of the whole child” by addressing issues such as self-esteem, race and gender identity and problems in the home, said Lisa Warhuus, district manager of school-linked programs and an author of the plan.

District officials are seeking $2.5 million in annual funding through federal and state grants and private donation to implement the plan, which will take effect piece by piece as funding becomes available. The cost of developing the program is being covered by a grant from the federal government, officials said.

School board member Shirley Issel lauded the plan, which she estimates will be fully realized in three to five years, as a way to coordinate and supplement existing district mental health programs.

“The current mental health service programs are fragmented,” Issel said. “There is no coherent school-based early intervention strategy.”

The program will create prevention and problem-solving strategies that coordinate existing resources such as counseling, medical and social services, and connect them with teams of students and staff members, Issel said.

Prevention strat(a)egies implemented by the program could cut the costs of services on a long-term basis because potential problems will be addressed early, Issel said.

More case workers and coordinators will be hired under the new plan to flesh out existing district mental health programs and connect programs at different school sites.

Student success teams, groups of district staff members involved in a student’s life that meet to discuss his or her progress, will create an “integrated system of response,” Issel said.

Planners will assess public and private support resources available to students and how to best utilize the services to meet student needs. Currently, there is no comprehensive list of all resources and services available to students in Berkeley, Issel said.

Students will be given specialized support based on their social circumstances, like race, gender, sexual orientation and religion, said Superintendent Michele Lawrence.

Students will be referred to mental health services based on their individualized needs under the new program, officials said.

Under the current referral system, students with behavioral problems and minor learning disabilities are frequently placed in special education programs when they could be served by supplemental health services, Lawrence said.

“The current cycle almost forces identification of special education needs,” she said.

Lawrence said this method of treating students is counterproductive.

“The longer they stay in special education, the poorer their achievement becomes. It’s not the answer,” she said.

The plan is based on the Comprehensive Systemic Intervention Framework designed by Howard Adelman and Linda Taylor at the UCLA Center for Mental Health in Schools.

Contact Jacqueline Johnston at jjohnston@dailycal.org. Read more!

Lack of mental care can yield high costs later - Dalles (WA) Chronicle

By ED COX

Wasco and neighboring counties could likely save hundreds of thousands of dollars in prison costs — and much more in general social costs — if they had the capacity to treat people with mental health and addiction problems sooner, rather than later.

That was one of the messages brought to the Wasco County Court in an annual report by Sharon Guidera, executive director of the Mid-Columbia Center for Living, which offers mental health, developmental disability and substance abuse services for Wasco, Hood River, Sherman and Gilliam counties.

A recent state report revealed that for every dollar spent on substance abuse, 96 cents goes to “shoveling up the wreckage of impairment,” while only 4 cents is spent on prevention and treatment.

With alcohol or substance abuse complications accounting for between 20-40 percent of all general hospital admissions, alcoholism causing 500 million lost work days per year, and one in five people suffering from mental health issues, the cost to society of unaddressed needs in these areas are “huge,” Guidera said.

As goes the state, so go the counties. “We’re no different,” she said, “but the need is still large.“

She reported to the court that during the past fiscal year the Center for Living was able to meet only about half of what is estimated to be the four-county need for its services — including the same percentage of Wasco County’s need.

Meanwhile, she said, many of those who fall through the cracks of the system end up at the Northern Oregon Regional Correctional Facilities (NORCOR), where the cost of their treatment is much higher.

“I think the general public is unaware of just how profound the costs shifts are,” Guidera said. She estimated that maintaining and treating a mentally ill inmate at NORCOR costs $9 for every $1 that might have been spent on the same individual with early-intervention treatment.

According to NORCOR’s Captain Larry Lindhorst, Wasco County, with a current prison population of 50, spends $2,666 monthly on prescripton drugs to treat mentally ill inmates. That’s in addition to a per-day, per-prisoner cost to the county of between $60 and $70 — for a current total of about 100,000 per month.

Guidera said that according to a study by the Wasco County Local Public Safety Coordinating Council, 70 percent of repeat offenders housed at NORCOR had mental health and/or addiction problems.


She estimated that 20-30 percent of the general prison population, mostly charged with misdemeanors, could be diverted to treatment facilities if there were a full-fledged treatment/jail diversion program.

If that were indeed the case, a rough calculation based on current prison numbers would see Wasco County saving at least $200,000 a year on incarceration costs alone.

While Guidera said “several more things would have to be considered” before a precise estimate of potential savings could be arrived at, it seems unlikely that the county would have to foot all or much of the bill for increased mental health services.

The four counties served by Center for Living supported less than 2 percent of its budget in the last fiscal year. In contrast, 48 percent of its funding came from the state with another 20 percent from the Oregon Health Plan and an equal amount from federal grants.

Given the tight fiscal situation of the counties, any significant increase in support for early treatment would probably have to come from the state. Major cuts in 2003 cost Center for Living 20 percent of its funding, but Guidera is “cautiously optimistic” for this year’s legislative session.

“This may be the session where we have a window of opportunity,” she told the court.

Guidera said three funding bills have been proposed, all involving some combination of taxes on beer, wine or malt liquor. She has placed her hopes on House Bill 2535, sponsored by Rep. Jackie Dingfelder and Sen. Bill Morissette, as the “most comprehensive” for restoring and enhancing addiction treatment and prevention services.

That proposal would impose a cost recovery fee on malt beverages and distribute monies to cities and counties for alcohol and drug abuse and mental health prevention, early intervention and treatment services, among others. Law enforcement and public health would also be funded to address addiction issues in the population.

According to the text of the bill, which is currently in committee, revenues could also be spent on drug-free housing efforts and to fund drug court programs.
Wasco County has developed a drug court with no funding which has served 31 people. It’s a highly successful program, Guidera said, but lack of money has limited participation.

“It’s an evidence-based process, the judges love it, but the funding has to follow,” she said.

Drug-free housing — together with supported housing for the mentally ill — was one of four needs identified for the current bienium (2007-2009) at a community forum the Center for Living held last year.

Besides supported housing, the needs identified at the forum were for senior counseling, services for “transition-age” (18-25) youth, and residential treatment services.

In elaborating on the need for the last, she noted that there are no residential addictions treatment or detox programs in the four counties. Locally, NORCOR serves as the default detox facility.

According to Guidera, Wasco County residents generally account for over half of the numbers her organization serves, a reflection in part, she said, of population and demographics that place the county “at the higher end of the risk factors.” Most of the specialty services such as the psychiatric residential program and consumer drop-in center are located in Wasco County.

Guidera described the problem of unaddressed addictions and mental health problems as a “runaway” train. “The cost to society is huge,” she said.

She recalled for the court a conversation at a recent meeting of the Local Public Safety Coordinating Council where various law enforcement officials were actually questioning the need for more prisons and promoting more treatment facilities instead.

“When you hear law enforcement making that strong a statement,” she said, “you know this issue has just gone over the top.” Read more!

County mental health agency trims services - Flint (MI) Journal

By Shantell M. Kirkendoll

GENESEE COUNTY - Getting help from county Community Mental Health will get harder as it streamlines its services to the poorest and sickest patients.

The agency's board approved cuts Thursday that create waiting lists of non-Medicaid clients and, effective March 1, CMH will steer the uninsured elsewhere for therapy visits and medications.

Most of the changes affect the one-third of CMH's 11,100 clients who are not eligible for Medicaid but have received county help with mental health services.

"We can't say no to anyone with Medicaid," said Teesha Deeghan, CMH's chief operating officer. "But it's possible others will have to wait."

Mental health officials are streamlining spending to the severely mentally ill patients at risk of hospitalization as they make up a $5-million budget deficit.

Other cuts approved Thursday include eliminating two contract psychiatrists, shifting to generic medicines for non-Medicaid clients and reducing one ACT team, a group of workers who make home visits to about 60 mentally ill patients living on their own.

"This is the least disruptive way to achieve what we need to achieve," said CMH Chief Executive Officer Danis Russell.

But Ramona Deese, president of the Genesee County chapter of the National Alliance of Mental Illness, said the working poor will be left without a safety net, and it puts thousands of mentally ill people at risk of losing their stability.

"These people make heroic efforts to work and, without treatment, they may digress, lose jobs or end up in jail," Deese said. "The best way to reduce the burden on the public is to get people well."

Financial trouble for the agency has loomed while it saw about 11 percent more clients in 2006 than in 2005, Danis said. The rise resulted from increase unemployment and more people living without insurance, he said.

Until now, CMH has offset the increase by using its rainy day fund.

CMH recently gave a grant to the Genesee Health Plan to provide therapy and medicines for the working uninsured enrolled in GHP.

Still, board member Pete Saddington said he was against creating waiting lists for some clients.

"We're taking away from people who are already disenfranchised," he said. "We have some internal problems with this agency that need to be addressed - union problems, insurance issues. It's easier to take away from others and harder to take away from ourselves."

Russell said other cuts can be looked at, but savings need to be realized now. Read more!

Missouri chosen for mental illness initiative - Springfield (MO) News Leader

JEFFERSON CITY – The Council of State Governments Justice Center announced Thursday that Missouri is one of seven states selected to participate in the Chief Justices’ Criminal Justice/Mental Health Leadership Initiative, a national project designed to help state supreme court chief justices guide efforts in their states to respond better to people with mental illnesses in the criminal justice system.

Missouri Chief Justice Michael A. Wolff will lead the statewide task force, according to a state news release.

“There are thousands of persons with mental illnesses incarcerated in our state prisons, and there are thousands more on probation and parole who need mental health treatment,” Wolff said.

“We believe this initiative will enhance Missouri’s efforts to reverse the worsening effects of mental illness by enabling the state’s three branches of government to formalize a strategic plan to help offenders deal with their illnesses and become more productive members of society.”

The Missouri Department of Corrections reports that 15.5 percent of the people incarcerated in the state have a mental illness. Five years ago, that number was 11.2 percent.

“The increasing number of persons with mental illness appearing in criminal courts, and the frequency with which they cycle through our prisons and jails, has significant implications for the administration of justice as well as public safety and government spending generally,” said Larry Crawford, director of corrections in Missouri.

According to a 2006 report by the U.S. Bureau of Justice Statistics, nearly a quarter of both state prisoners and jail inmates who reported they had a mental health problem had served three or more prior sentences.

This makes them familiar faces in our nation’s courtrooms.

In Missouri, offenders with a mental illness are 4 percent more likely to return to prison within two years of release than other offenders.

“Improving outcomes for people with mental illness involved in the criminal justice system requires extensive collaboration among leaders in the judiciary, the legislature, and the administrators of multiple state agencies,” said Mass. Rep. Mike Festa, chairman of the Justice Center Board of Directors.

“We established this initiative because in many states, a state supreme court’s chief justice is uniquely positioned to convene and lead a multi-branch discussion on this issue that leads to real, meaningful action.”

The CSG Justice Center solicited applications from chief justices across the country interested in establishing a statewide task force on criminal justice/mental health issues.

Twenty-three states submitted applications for the initiative, from which seven were selected. As part of the initiative, the task forces will receive technical assistance, access to leading national experts and a small amount of funding support.

The Justice Center also will convene a two-day national policy forum this spring for the seven states.

Evelyn Stratton, associate justice of the Ohio State Supreme Court and co-chair of the advisory board that reviewed the applications, congratulated leaders in Missouri: “The application process was very competitive. The states selected had to demonstrate that they had engaged legislative and executive branch leaders and that their task force had the potential to yield a viable, comprehensive plan. Missouri clearly demonstrated the broad base of leadership necessary to make the plan successful, and we look forward to working with the state in the upcoming year.”

The Council of State Governments Justice Center is a national nonprofit organization that serves policymakers at the local, state and federal levels from all branches of government.

The Justice Center provides practical, nonpartisan advice and consensus-driven strategies, informed by available evidence, to increase public safety and strengthen communities.

This project is coordinated through the Judges’ Criminal Justice/Mental Health Leadership Initiative, managed by the Justice Center in partnership with the National GAINS Center.

The support to the state task forces is made possible through grants awarded from the JEHT Foundation and the Conrad N. Hilton Foundation. Funding support for the planning phases of this project was provided by the U.S. Justice Department’s Bureau of Justice Assistance, and the U.S. Department of Health and Human Services’ Substance Abuse and Mental Health System Administration.

For more information about the Judges’ Criminal Justice/Mental Health Leadership Initiative, visit http://consensusproject.org/JLI. Read more!

Stanly County 'a guinea pig' for reforms? - Stanly News & Press

By Kim Kinnecom, Staff Writer

Thursday, February 22, 2007 — Mental health professionals in North Carolina have recently found themselves in the hot seat.

Field consultants and analysts recently criticized North Carolina’s mental health and substance abuse services, saying the state needs billions of dollars in upgrades to bring the state up to an acceptable national level.

A special consultant’s report served as a report card of sorts for a 2001 reform that began after irregularities loomed within many community mental health programs.

Christina Thompson, of Heart of the Matter Consulting, reported to the North Carolina General Assembly that the state does not reach enough people who need services and does not provide continuity of care for those being treated.

Thompson’s report highlighted the haphazard growth in the community-based mental health systems and said improper planning has created regional inequities, leaving some residents needing services in the dust.

A heavy reliance on state hospitals and large institutions - despite the five-year-old reform to decentralize services - was also criticized.

The 2001 plan called for the number of beds at the traditional state hospitals to decrease as patients relocated to the local treatment programs.

Many local programs have had a hard time contracting with providers, some that have since closed, and the goal - bed reductions - has not been acheived.

Since reform was initiated, the state has seen an 11 percent increase in the number of people seeking treatment with state programs.

“You’re basically serving more people as a state but you’re not providing an adequate dose of care,” Thompson said in her report to the General Assembly.

Local mental health professionals respond to the criticisms, explain where Stanly County fits into the picture.

“In line with the tenets of reform, Piedmont Behavioral Health (PBH) is a local manager (LME) of services,” Billy West, executive director of Daymark Recovery Services, said.

PBH is the local manager for Stanly, Union, Cabarrus, Davidson and Rowan counties.

Unlike other LMEs, PBH can manage both state and federal dollars available to provide care for persons with mental health and substance abuse problems and developmental disabilities.

West said Stanly County falls under the PBH medicaid waiver where state and federal funding can be leveraged.

“The advantage of having local control over both state and federal dollars is that PBH can plan and manage their provider network to prioritize needs and services. Whereas non-waiver counties often have too many providers for some services that tend to be profitable and not enough for those with lower profit margins,” he said.

Daymark Recovery Services Clinical Operations Director Dr. Lisa Brandyberry said she’s watched the mental health reform change a complex system into a diverse system with more options for medicaid patients.

“The reform allows choice - where before reform you didn’t have choice. Unfortunately, the money isn’t behind it,” she said.

State consultants were correct in saying that with added choice must come the ability to pay for unused capacity, Brandyberry said.

She said while the state has control over the provider network, the LME can establish rates and determine how much choice is available, depending on community needs.

West and Brandyberry agreed the state tried to “privatize a public sector” while increasing regulatory requirements.

“As long a we are intent on writing War and Peace for every patient and killing a couple of trees, then we need whatever the consultant said,” West said.

The system does not pay rates high enough to operate like the “private sector” while keeping all of the “public sector” regulatory requirements, West said.

“I am sure most of the requirements are mandated out of legislation. I cannot imagine anyone really believes that paperwork equals a quality service,” he said.

Brandyberry said pre-reform mental health meant waiting about five weeks for service if the patient wasn’t suicidal.

“Now, we get them in within seven days and some people even chose to use our walk-in ‘advanced access clinic’ for same day service. We see more people more frequently.”

One of the post-reform major downsides is fragmented care.

“Patients can’t get the services under one roof anymore and with HIPPA we can’t just pick up the phone and talk to the other care providers about the patients’ needs,” she said.

Daniel Brown, director of Foundations Behavioral Services which like Daymark serves Stanly County clients, said the county is ahead of the game.

“We’re further advanced than the rest of the state as far as reform goes because Piedmont has a Medicaid waiver that allows us to do things a little differently than the rest of the state. To a large extent. Stanly County has benefited.

“The waiver allows PBH to control the number of service providers, they can drive up quality and I think that has happened,” he said.

Brown said the funding has not been behind the development of community-based programs, but said more services are now available.

Fragmentation of services is also exaggerated, he said.

“There is competition now where there wasn’t before. The system changes quickly and frequently and all in all Stanly County has more scope and breadth of service than we’ve ever had in the past. It is pretty empowering to say ‘I have a choice now,’” he said.

Mona Johnson-Gibson, director of Behavioral Health Development at Stanly Regional Medical Center, said the county has been “a guinea pig” since reform.

“In some respects, Stanly County is better since the reform. But it still doesn’t have all the programs. We are very deficient in child and adolescent inpatient services and inpatient substance abuse programs. We have to refer to other counties.

“Also, the reform focused on ‘severe and chronic’ patients so there are not many resources for the day-to-day type patients, which are the larger population,” she said.

Gibson said Piedmont is a pilot program that was given more control in decision making and was more planned than most state programs.

“PBH had more hold on decisions and planning. That has made our growth less haphazard than what the consultant has reported.

“It is a very complicated area to understand, and people within the system don’t completely understand what’s going on. The state as a whole is in a baffled situation.

“When your own industry is confused, it is hard to communicate to the general population what is happening,” she said.

Gibson said not knowing who is slipping through the service cracks and understanding why the funding isn’t on the “front line” are two major concerns mental health providers are consistently facing.

“I think everyone in the industry is concerned that people aren’t getting service and where to go from here to rectify it; that is a big question.” Read more!

Bonds would benefit campuses, inmates - Raleigh News & Observer

Ryan Teague Beckwith and Jane Stancill, Staff Writers

RALEIGH - Here's a rough guide to Gov. Mike Easley's proposal for a $1.4 billion state bond referendum this November:

If you're in it, you're happy.

If you're not in it, you want to be.

The governor's proposal calls for voter-approved debt to be spent on new college buildings, expansions at state prisons and pet projects such as a new visitors center in Raleigh.

Advocates for conservation and public schools are upset they were left out.

The bonds would be the first issued by North Carolina since voters passed a record $3.1 billion in bonds for public universities and community colleges in 2000.

STATE UNIVERSITIES: The governor's proposal includes $487 million for university projects, a third of the overall package. The dozen university projects are spread across the state and include $120 million for a genomic sciences building at UNC-Chapel Hill, $87 million for a dental school at East Carolina University and $45 million for a classroom building at UNC-Greensboro.

"We're very excited about it," said Greg Chadwick, associate vice chancellor for oral health at East Carolina.

PRISONS: The proposal includes $237 million for state prisons, including 400 new beds for acute care mental health patients and major expansions at corrections centers in Alexander and Scotland counties.

WHAT ABOUT SCHOOLS? Leanne Winner, director of governmental relations for the N.C. School Boards Association, said that the governor should have included more money to help struggling local school districts.

"We're having explosive growth in a lot of places around the state," she said. "We've got areas that just can't afford the construction, and their kids are in schools that are 50 or 60 years old."

And Kate Dixon, director of Land for Tomorrow, a statewide partnership of conservation groups, said that the proposal did not include enough new money to preserve open space.

In 2005, the group called for $1 billion to be spent on land conservation over five years. The governor's proposal includes just $100 million, paid for with existing tax revenue.

"There's a much larger need than that," Dixon said.

(Staff writer Lynn Bonner contributed to this report.) Read more!

Menntal-health series takes two top awards - Winston-Salem Journal

Other newspapers receiving awards for mental health coverage will be listed as information is received or when a full-list of winners becomes available.

A Winston-Salem Journal series about privatization of mental-health care in North Carolina won two awards in an annual competition sponsored by the N.C. Press Association.

The Journal won eight awards, including four first-place awards, in the press association's 2006 news, editorial and photojournalism competition.

The awards ceremony was held yesterday at the association's Winter Institute meeting in Raleigh.

The series "Breakdown: A Crisis in Mental Health Care" by M. Paul Jackson, Phoebe Zerwick and staff won first place in Investigative Reporting and third place in Public Service Reporting.

First place in the Green/Rossiter Duke University Award for Distinguished Newspaper Work in Higher Education went to the series "Public Schools, Private Dollar" by former Journal reporter Kevin Begos and Laura Giovanelli, the Journal's higher-education reporter.

Jeremy Boyd's illustration, "Watch Your Back," which accompanied a story about the dangers of MySpace.com, won first place in the Illustration category.

The Journal's arts and entertainment reporters swept the Criticism category. Ed Bumgardner won first place in Criticism for his review of a Rod Stewart CD, a column on Keith Richards and an obituary story on local musician Charles Greene.

Michael Hewlett won second place in Criticism for reviews of CDs by Mary J. Blige, Ghostface Killah and Van Hunt.

Former arts reporter Mark Burger took third place in Criticism for reviews of the movies Domino, Slither and The Descent.

Tom Fluharty won second place in Headline Writing for three headlines: "Bawl Control," about the wisdom of allowing babies to cry themselves to sleep; "Probation? Done. Now it's time to run," about a sheriff's candidate in Ashe County; and "See Spot, See spot for Spot. See Spot run," about an off-leash dog park.

The N.C. Associated Press also announced its awards for writing, editing and support of open government yesterday.

The Journal's Jennifer Young received honorable mention in the Carl Bell award for excellence in editing competition.

James Romoser, of the Journal's Raleigh bureau, received honorable mention in the Walter Spearman award for young writers competition.

The award is named for a longtime journalism professor at the University of North Carolina at Chapel Hill.

The NCPA also honored Journal publisher John Witherspoon for 43 years of service to journalism. Witherspoon, a former president of the NCPA, will retire May 31.

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Highlights of Easley's 2007-08 N.C. budget

RALEIGH, N.C. — Highlights of Gov. Mike Easley's $20.1 billion budget released Thursday for the 2006-07 fiscal year. For tax changes, figures are for the amount of revenue generated or lost. For spending changes, figures are for amount spent or saved:

Tax or reserve changes

_ keeping on the books an additional 0.25 percent of the sales tax and the 8 percent individual income tax rate for the state's highest wage earners, both set to expire this year: $300 million.

_ eliminate income tax or cut from 6 percent to 3 percent the income tax rate for the poorest tax filers: -$28 million.

_ increase tax deductible expenses for small business: -$35.8 million.

_ deduct college tuition: -$13.9 million.

_ deposit $238 million in the rainy day reserve fund.

_ adoption tax credit: -$3 million.

Spending changes

_ supplemental funding for low-wealth schools: $18.9 million.

_ hire 100 additional middle-school literacy coaches: $5.7 million.

_ expand broadband Internet to public schools: $12 million.

_ hire school resource police officers for all middle schools: $4.4 million.

_ expand brick-and-mortar sites for Learn and Earn program and provide online courses at other high schools: $20.3 million.

_ new "Education Access Rewards North Carolina" college grant program for needy students: $50 million.

_ additional money for current need-based financial aid program: $29 million.

_ State Board of Elections training, office space and voting machine maintenance: $1.2 million.

_ build Department of Revenue's new tax administration system: $10 million.

_ operating support for State Energy Office: $1.3 million.

_ expand Cultural Caring and Sharing pilot program for the arts: $1.25 million.

_ add $5 million to N.C. Housing Trust Fund.

_ create N.C. Kids Care program for affordable health insurance for 12,000 children in working families: $4.7 million.

_ add 2,000 slots for subsidized child care: $8.4 million.

_ continue open enrollment in N.C. Health Choice health insurance program for kids: $7.5 million.

_ reserve for antiviral medications for influenza pandemic: $9.7 million.

_ increase community services funding for mental health, substance abuse and crisis services: $3.5 million.

_ complete statewide automated fingerprint system: $2.7 million.

_ expand statewide interoperable voice radio network: $11.3 million.

_ equip state Highway Patrol with equipment to perform aerial rescue operations: $3.6 million.

_ continue mapping of state to identify potential areas for natural disaster: $5.3 million.

_ expand prison bed capacity: $13.6 million.

_ increase number of judges, prosecutors and court support staff: $7.5 million.

_ expand National Guard Family Assistance Centers: $1.5 million.

_ state match for federal clean water funds: $8.1 million.

_ One North Carolina Fund for business recruitment: $15 million.

_ highway system improvements and maintenance: $2.41 million.

_ North Carolina ferry operations: $3.6 million.

Capital improvements

_ debt for 11 university projects, subject to statewide referendum: $487.3 million.

_ debt for expanding prisons at 12 locations, subject to statewide referendum: $310 million.

_ debt for several state government buildings, subject to statewide referendum: $200 million.

_ debt for local water and wastewater projects, subject to statewide referendum: $250 million.

Salaries, retirement

_ average 5 percent raises for public school teachers: $208 million.

_ 2.5 percent raises for rank-and-file state employees: $167 million.

_ average 5 percent raises for community college faculty: $19.5 million.

_ 2 percent cost-of-living increase for retired state employees: $27.2 million.

_ state's portion of health insurance plan for current and retired employees: $111 million.

_ retirement system payback of money intercepted by Gov. Mike Easley earlier this decade: $45 million. Read more!

Bill censors offenders' letters to the media - Witchita (KS) Eagle

BY DION LEFLER

A month after a Wichita Eagle report revealed inhumane conditions at a state-run mental hospital, the Kansas House of Representatives approved a bill that would prevent sex offenders there from being able to send uncensored mail to the news media.

The House Judiciary Committee had recommended news outlets be included in a list of entities that could get mail from patients in the sexual predator treatment program at Larned State Hospital without it being opened, read and possibly blocked by hospital officials.

On the floor of the House Thursday, Rep. Jason Watkins, R-Wichita, made an amendment to exclude reporters from a bill to rewrite the rules for housing mentally ill sex offenders.

Watkins said he was concerned that self-proclaimed journalists could obtain sexually inappropriate sketches or writings and post them on the Internet.

Rep. Candy Ruff, D-Leavenworth, argued against Watkins' amendment.

She said the sex offenders are among the few patients at Larned with the mental acuity to report instances of abuse throughout the facility, which also houses severely disabled psychiatric patients and mentally ill juveniles.

"They can see, they can walk around, they can look and they can express themselves, and they can oftentimes bear witness to some of the things that are going on in this institution," she said.

"Restricting access to the media is something that should be done very carefully -- and not at all, frankly."

As the bill stands now, patients in the sex offender unit would be allowed to send sealed mail to their lawyers, doctors, courts, the hospital superintendent, the secretary of SRS and the Disability Rights Center.

Any other mail could be opened and blocked "if the superintendent or his designee has reason to believe that the mail could pose a threat to security at the facility or seriously interfere with the treatment, rights or safety of the patients or others."

Watkins said he trusts the facility's superintendent not to divert complaints about conditions at the hospital.

"I would imagine that he will not allow information to go out that will be the pictures and the drawings and the written sexual fantasies of these deviants," Watkins said. "I think he would allow information about inhumane conditions to go out."

On Jan. 21, The Eagle published a story based on a report by the Kansas Department of Health and Environment, which cited Larned for numerous violations of state and federal laws.

According to the KDHE survey, problems included filthy conditions, cold showers, violations of patient privacy and inattention that led to the choking death of a female patient who had a swallowing disorder.

The Eagle learned of the survey's existence through a tip from a patient in the sexual predator program.

The KDHE report had not been provided to legislators and most learned of the problems at Larned from The Eagle's reporting.

As originally filed, House Bill 2001 would have revoked virtually all the rights sexual predators now have as mental patients in state custody.

Its author, Rep. Mitch Holmes, R-St. John, represents the Larned area.

He said the bill was based on a list of ideas he got after asking Larned officials in 2005 for ways to improve the facility and make their jobs easier.

He said communications should be curtailed because some sex offenders had abused phone and mail privileges to contact their victims or to harass state officials.

The original bill was substantially amended by the Judiciary Committee, where some members were concerned that it could be used to justify mistreatment and silence whistleblowers.

The amended bill allows sexual predators to retain some of the rights they now have, including the right to refuse medication, psychosurgery or shock treatments.

The amended bill also establishes rules for restraining or isolating patients.

"We really cleaned it up a lot," said Rep. Jim Ward, D-Wichita, a member of the committee. Read more!

Stepping up inmate care - Denver Post

State agrees to timely access to court-ordered mental health services

By Howard Pankratz

Colorado inmates who need court-ordered mental health services will get them within four weeks under a deal announced Thursday, resolving a crisis in which many troubled prisoners were left languishing in local jail cells for months.

The agreement comes after a judge threatened state officials with contempt charges.
Under a settlement between state officials and two court-appointed special prosecutors, the state agreed that usually it will treat inmates within 24 days of receiving a judge's order, or within 28 days in extraordinary cases.

Denver District Judge Martin Egelhoff, who pushed the state to treat inmates more quickly, was elated Thursday at a hearing where the settlement was announced.

"What was accomplished was nothing short of extraordinary," Egelhoff said. "It became apparent to me how significant the problem was and that the problem was intolerable."
Egelhoff praised special prosecutors Iris Eytan and Marcus Lock and assistant attorney general Beverly Fulton, who helped work out the deal.

Egelhoff had threatened to hold state officials in contempt because the state hospital in Pueblo was failing to treat inmates who he thought needed mental- competency evaluations or to restore inmates to competency for trial.

At the time of Egelhoff's threat, there were 81 criminal defendants throughout Colorado who hadn't been admitted to the hospital as ordered by judges. Some had been in jails for six months.

Egelhoff appointed Eytan and Lock to look into the situation.

Eytan said Thursday that the health of inmates was affected by the delays. "Their mental illness was exacerbated and compromised," she said. "They were given meds here and there at the local jails. But lack of immediate help takes them back months and years in their treatment."

She added that the hospital staff cares about helping the mentally ill but hadn't received enough money.

"They are rich in the heart but poor in the pocket," Eytan said.

Gov. Bill Ritter's transition team was involved in the settlement conferences.
"Under this settlement, detainees will get the services they need in a reasonable time frame, the jails can manage their populations better, and the state can meet its obligations," Ritter said.

The agreement will run until a new 200-bed high-security unit at the state hospital is opened in the summer of 2009. It should easily accommodate criminal defendants who need mental health treatment, officials say.

If the state hospital and the Colorado Department of Human Services fail to meet the 24- and 28-day deadlines, they face hefty penalties, including fines of $1,000 per quarter, per patient.

All 81 of the inmates in question are now being treated because of a $1.7 million emergency appropriation Dec. 15 by the state legislature's Joint Budget Committee, which allowed the state to open a 20-bed unit at the hospital, officials said.
The special prosecutors say they are confident that the JBC will authorize continued funding in future years.

Only if there is a major, unexpected influx of mentally ill defendants into the state's criminal justice system will the state hospital have trouble meeting the deadlines, Eytan said.

Liz McDonough, Human Services spokeswoman, said the department is requesting $3.5 million for the fiscal year beginning July 1 to fund the settlement. She expects a similar request in fiscal year 2008-09.

McDonough said that because the state hospital was able to get the 20-bed unit running within a brief time, "we feel they (the JBC) will likely approve continued funding."

Staff writer Howard Pankratz can be reached at 303-954-1939 or hpankratz@denverpost.com.
Read more!

Georgia state hospitals: progress made, more will follow - Atlanta Journal-Constitution

By B.J. Walker, Gwen Skinner

Although mental illness in some form affects almost every family in Georgia, for too long it has been the "elephant in the room." Everyone sees it, but no one talks about it. The AJC's recent series on mental health care has helped spur more conversation. Unfortunately, it just doesn't tell the whole story.

As the agency responsible for helping the state's mentally ill and developmentally disabled, our deepest regret is that we can't always prevent bad outcomes regarding persons in our care. We know that each patient is someone's parent or child, sibling or spouse, neighbor or friend. We also know that every tragic incident deserves scrutiny and a plan of action that, as much as possible, will help prevent similar occurrences.

Today, that scrutiny begins almost immediately. Each serious incident including death or injury sets in motion a series of events designed to uncover the facts and determine a proper corrective course. This investigative process itself is subject to continuous assessment and improvement in our effort to enhance safety in our facilities.

In the case of 14-year-old Sara Crider, whose case the AJC highlighted, we immediately asked a team of independent doctors to investigate. Based on their recommendations, we fired her doctor and disciplined the resident working with him. The Office of State Administrative Hearings recently upheld our termination decision.

We value the safety and security of patients and our staff. In fact, Georgia's state hospitals equal or do better than the rest of the nation on key measures. We, for example, rely on seclusion and restraint far less than other state hospitals. We have, on average, fewer runaways. While medication error rates are going up nationally, Georgia's are going down. And the rate of client injuries, while once high, has been substantially reduced.

Safer state mental hospitals, however, are only part of the solution. Too many Georgians who need community based mental health services go untreated until their mental health problems reach crisis requiring hospitalization. We've relied too long on state operated hospitals as the strength of our response to mental Illness.

We need now, as some other states have, to develop a strong system of community mental health services. Fortunately, this work has begun as we now spend in Georgia more on community mental health services than on state-operated hospitals.

We are now making slow but steady progress toward a more balanced system. We've increased the number of short-term crisis stabilization beds for adults by 30 percent and we're building similar services for children. We're working with the National Alliance for the Mentally Ill to train 20 percent of all law enforcement officers to safely assist someone with signs of mental illness and direct them to treatment, rather than to jail. We recently engaged the Medical College of Georgia to help us identify changes that need to be made in training and staffing.

Since almost half of our state-operated beds are serving people with developmental disabilities who may have the desire and the ability to live in the community, we have added an unprecedented number of new Medicaid waivers to give these individuals the necessary supports to live quality lives in the community. That's undeniable progress.

As we continue to improve, we expect and welcome oversight. It's an essential and customary part of doing this important public work. In fact, our hospitals currently receive oversight from:

> the Centers for Medicare and Medicaid Services, which monitors our compliance with federal rules and guidelines;

> the Georgia Advocacy Organization, which investigates possible abuse and neglect on behalf of patients;

> the Joint Commission on Accreditation of Healthcare Organizations, which reviews and inspects our facilities every three years to ensure their quality and safety; and

> the Office of Regulatory Services, which makes sure we are implementing the laws, rules, and regulations of Georgia and investigates deaths and acts of violence.

Even with vigilant oversight and the many improvements, challenges remain. We are ever aware that consumers and their loved ones rely upon us to provide high quality, accessible and safe care. We are committed to doing so.

> B.J. Walker is commissioner of the Georgia Department of Human Resources.

Gwen Skinner is director of the Division of Mental Health, Developmental Disabilities, and Addictive Diseases. Read more!

Anti-dumping bill ignores root problem - LA Times

Editorial: Yes, discharging homeless patients to skid row can be cruel, but hospitals don't have many good choices.

THE IMAGE OF A hospital van abandoning a paraplegic man in a skid row gutter is so revolting that it was just a matter of time before elected officials tried to crack down on dumping the homeless. City Atty. Rocky Delgadillo and state Sen. Gil Cedillo (D-Los Angeles) struck first, unveiling a bill this week that would bar hospitals from transporting discharged patients without their written consent anywhere but to their home or another health facility.

The bill would make it easier for local prosecutors to go after hospitals and staff involved in headline-grabbing cases. But the root problem this bill won't fix is that many discharged patients have nowhere to go. Except maybe for skid row.

Today, hospitals are obligated to treat anyone who comes in with a medical emergency, regardless of their ability to pay. Once a patient's condition has been stabilized, however, the only obligation is to provide a plan for follow-up care and to make a good-faith effort to suggest an appropriate provider. Hospitals are not required to make sure the patient receives this care, nor do they have to give patients a ride home — or anywhere else.

Homeless patients put hospitals in an awkward situation at discharge time. Patients can be simply walked out the door and left there, even if they're still dressed in a hospital gown and fitted with a colostomy bag (as was the paraplegic man dumped on skid row). Because that's inhumane, a hospital might put a homeless patient in a van or a taxi bound for a homeless shelter that can provide some mental health or drug treatment services. Such facilities are concentrated on skid row. But there isn't enough room for all the people who need that kind of help, and when a shelter turns the patient away, he or she may wind up dumped on the street nearby.

That's happening with alarming frequency. Delgadillo's office is investigating more than 50 cases of alleged dumping. Still, the bill that he and Cedillo are pursuing wouldn't put a dent in the underlying problem, which is the shortage of shelters, treatment centers and other badly needed facilities for the tens of thousands of homeless in Los Angeles County, and the lack of an organized plan about what to do with homeless people freshly discharged from hospitals. Instead, it's more likely to prod hospitals to leave their discharged patients at the nearest bus stop or curb.

A more helpful step would be to create a system connecting hospitals to homeless service facilities able to handle follow-up care. But the needs in this area are much greater than the county's capacity to deliver. Until every community can meet the needs of its homeless residents, the region will continue to send them on costly trips to hospital emergency rooms. And when they're discharged, many will still wind up wandering around skid row. Read more!

Insanity vs. Malice as Motives of Rampage - NY Times

By ANEMONA HARTOCOLLIS

When Steven Johnson, an unemployed barber who has AIDS, stormed an East Village bar in 2002 armed with a samurai sword, three pistols and kerosene, by most accounts he was propelled by one thought: He would die in a fusillade of police bullets, and his family would then be able to sell his prophetic words and use the proceeds to start a new life.


Only it did not happen that way. He did not die. He did not kill anyone. His family did not sell his story. And now he is on trial — for a second time — on charges of hate crimes, assault and the attempted murder of a police officer. As for the fame he sought, that seems nonexistent as well: aside from an initial burst of attention, his trial has taken place in an all but empty courtroom.

In the early hours of June 16, 2002, Mr. Johnson took the subway from his housing project in Brooklyn to the East Village, looking for “happy people” and seeking to avenge the oppression of black people like him, according to a statement he later gave to the police.

He shot and wounded three people and sprayed several patrons with kerosene at Bar Veloce on Second Avenue, threatening to set them on fire. He was eventually tackled by two women in the bar, then shot and wounded by the police.

To the prosecution, this is a case of attempted “suicide by cop” by a man with a record of weapons and drug arrests going back two decades. He may have been antisocial, the prosecutor said, but he was not mentally ill; he rationally, calculatingly, set out to harm others and gain fame for himself and fortune for his family.

To the defense, these were the acts of a madman, who is so delusional that he cannot be held legally responsible for what he did.

Prosecutors have given the jury a copy of a long suicide note that Mr. Johnson left behind for his 10-year-old son, telling him, “Trust me, you will be famest and a star just cause of me, and cause I follow Gods word.”

During the closing argument yesterday in State Supreme Court in Manhattan, the prosecutor, Peter Hinckley, played a tape of Mr. Johnson giving himself a kind of pep talk as he prepared to take his journey to the East Village.

Mr. Johnson could be heard talking in a slow, quiet, hypnotic voice, telling himself that he had God on his side, and urging himself on by saying, “Pull your guns on these crackers, son.” In the background, the incongruous sound of a child’s happy, playful voice was heard as Mr. Johnson carried on his monologue.

Mr. Johnson’s lawyer, Michelle Gelernt, of the Legal Aid Society, told the jury in her closing argument that Mr. Johnson’s words in the suicide note and on the tape were clear evidence that he was delusional.

“Somehow, his taking those white people hostage and burning them alive and having police kill him would cause a revolution,” she said, while anybody in his right mind, she argued, would expect no such thing.

But to Mr. Hinckley, the prosecutor, Mr. Johnson’s words were evidence not of mental illness but of a widespread phenomenon familiar to anyone who watches “American Idol” on television.

Mr. Johnson was simply media-crazed, and determined to get his 15 minutes of fame, the prosecutor said.

“The defendant didn’t have any command hallucinations,” or orders from God telling him to kill white people, Mr. Hinckley said. Rather, “he knew he would create media attention” by shooting up a bar, and he wanted his family to profit from his 15 minutes of “notoriety.”

Mr. Hinckley rattled off a long list of other people he said were similarly obsessed by fame, perhaps criminal in some cases but not insane. The list included Mel Gibson, Osama bin Laden, Timothy McVeigh, abortion clinic bombers, Palestinian and Iraqi suicide bombers, members of the Aryan Nations, and any number of amateur singers competing on “American Idol.”

“They are clearly grandiose and have strongly and passionately held beliefs,” he said, but they were not delusional in the clinical sense.

Mr. Hinckley was scheduled to end his closing argument today, before the case goes to a jury for the second time. Mr. Johnson’s first trial ended in a mistrial in November 2004, when the jury deadlocked after two and a half weeks of deliberations.

Yesterday, Ms. Gelernt said Mr. Johnson, who is 39, had told a psychologist that he had a “sixth sense” and that he believed that people were “scheming on him.” She urged the jury to interpret that sixth sense as something spiritual, a connection to God, while the prosecution’s psychiatric expert dismissed the phrase as a synonym for “street sense.”

Ms. Gelernt described part of Mr. Johnson’s past that could have been a chapter from “The Fortress of Solitude,” the acclaimed novel about a black boy and a white boy growing up in Brooklyn who fancy themselves superheroes. She said that Mr. Johnson’s mother had taught him to sew when he was a teenager, and that he sewed costumes of Spider-Man and Superman for himself. It was not clear, she said, whether he actually wore those costumes on the street, but certainly he had fantasized about being a superhero.

She quoted Mr. Johnson, who is black, telling psychologists, “There’s no war in the ghetto, but there’s a war in my mind,” and that he was “throwing rocks of words” as a way of educating people to the oppression of black people by white people.

Mr. Hinckley, however, argued that if Mr. Johnson was trying to get revenge on white people, he would not have been cooperative with the white staff at the hospital and jail where he was held, or with his white defense lawyers.

He said that while Mr. Johnson had a history of what he called “conduct disorders,” like fighting with other children and breaking things in childhood, he had not been hospitalized for psychiatric problems as an adult.

Mr. Johnson’s actions were criminal and antisocial, he said, but not driven by mental illness. They were, he said, “the actions of a sane, manipulative man, fully aware of what he did.”
Read more!

Mental health courts might allow better use of resources - Battle Creek (MI) Enquirer

EDITORIAL

It is a sad fact that too many people suffering from mental illness end up in jail or prison instead of getting the treatment they need. The issue received national attention recently with the death of an inmate at a state corrections facility in Jackson who critics say should have been in a health-care facility, not prison.

Last week, legislation was introduced in the Michigan Senate to encourage the creation of mental health courts. The legislation would allow courts to hold hearings to determine whether someone charged with a crime was suffering from mental illness, emotional disturbance or had a mental disability. If that was determined to be the case, the person could be diverted into a mental health court which would order the appropriate treatment, rather than prosecution.

The idea is similar to drug courts, which in recent years have shown promise in Calhoun County and elsewhere in Michigan of helping nonviolent offenders with substance abuse problems to rebuild their lives instead of being incarcerated.

As with drug courts, individuals coming before a mental health court would be required to agree to a treatment program, and would be monitored to ensure they adhered to that program. If not, they then could be subject to criminal prosecution.

Over the past decade and a half, Michigan has closed 15 of its 21 mental hospitals. In many instances, former patients have been able to forge new, more independent lives with the assistance and support of a variety of community resources and programs. But for those who have not, deinstitutionalization sometimes has led to homelessness, crime and imprisonment.

Ensuring that people with mental illness get proper treatment instead of being tossed in jail not only is the humane thing to do, it also is the fiscally responsible thing to do. At a time when prison populations are burgeoning, jail space must be available for those who pose the greatest threat to society. It makes more sense to provide mentally ill nonviolent offenders with the treatment they need than to lock them away behind bars.

There would be costs involved in developing a mental health court system and supporting the necessary community resources to provide treatment, but in the long run those costs would be less than the $30,000-plus per year it costs to keep an individual in prison.

We recognize that now is a tough time for the state to consider spending money on any new programs. But there also is much talk about the need to revamp government so it operates more efficiently and better utilizes scarce resources. Mental health courts may be one way of doing that.

Read more!

NAMI: Only marginal improvements in Maine - Kennebec (ME) Journal

AUGUSTA -- During the past six years, Maine has made only marginal improvements helping mentally ill people caught in the criminal justice system, a nationally recognized advocate concludes in a new report.

"I think there has been a very small amount of progress on the low-hanging fruit," said Carol Carothers, executive director of the Maine chapter of the National Alliance on Mental Illness.

Carothers received a prestigious national award from the Robert Wood Johnson Community Leadership Program in 2004 for her work on behalf of mentally ill prisoners. She issued her first report in 2000.

Carothers said Thursday she renewed her study after seeing funds cut for mental health services and more deaths behind bars.

"Six years into this journey, 19 jail inmates died from suicide or drug- or alcohol-related illness and there have been four suicides in the prison," Carothers wrote in her latest report.

"In some ways, things are worse," Carothers continued. "I say this despite what I know are significant and ongoing efforts."

But even those efforts, Carothers said, are endangered because many of them are run by volunteers or funded with one-time grant money.

"I had certainly hoped in six years there'd be fewer (mentally ill) people in our jails and more of the recommendations generated actually implemented," she said.

Criminal lockups are not able to provide adequate mental health services, she said. Yet programs to keep mentally ill prisoners from ending up behind bars are inadequate, leaving county jails especially to provide treatment, something they are not designed to do.

"They shouldn't be in there, and if mental health treatment was adequate, they wouldn't be," Carothers said. "We know what to do. We know what works. We just haven't found the will to do it."

Associate Corrections Commissioner Denise Lord said the state is making progress, but much of the effort to head off more serious criminal behavior by mentally ill offenders must come at the local level, and that system must be available statewide. "I respect Carol greatly," Lord said. "She certainly brings attention to a very important issue and she's an able advocate for change. Some of the changes we're working on may not be happening as quickly as some people would like."

Lord said state prison officials have changed the ways they handle inmates with mental illnesses and mental health, psychiatric and pharmacy services.

Most of the inmates who end up sentenced to the state's prisons already have committed serious crimes and are unlikely to be eligible for diversion programs, Lord said.

But if better diversion programs were available earlier, fewer mentally ill people might end up behind prison bars later on.

"There's a misperception that everybody in jail is a bad person, a violent criminal, and deserves what they get when they get there," Carothers said. "The truth is, 50 percent of those people in there were not in their right mind when they got in some wrangle.

"Studies all over the country show when you cut mental health services and you make access to mental health services more difficult, people end up in jail," Carothers said. "It costs more in jail and it's not effective. My message is: We need to change what we're doing." Read more!

Bill creates review panel for mental hospitals - Atlanta Journal-Constitution

By ANDY MILLER, ALAN JUDD

Legislation introduced this week in the state House would create a patient advocacy board to review abuse, neglect and deaths in state-run mental hospitals.

Rep. Mark Butler (R-Carrollton), sponsor of House Bill 535, said the seven psychiatric hospitals need oversight that's independent of the state agency that runs them.


"The fox doesn't need to be guarding the henhouse,'' Butler said Thursday.

Consumer advocacy groups recently called for independent review of hospital deaths and an ombudsman office to investigate reports of abuse and neglect, citing an Atlanta Journal-Constitution investigation that found at least 115 suspicious deaths in the state hospitals since 2002.

The newspaper's series, "A Hidden Shame," also identified more than 190 substantiated cases of physical and sexual abuse of hospital patients during the past five years.

A separate bill, House Bill 461, would require a pilot privatization of at least one state mental hospital.

A third bill, House Bill 514, also sponsored by Butler and recently introduced, would set up a commission to consider restructuring the agency that runs the mental hospitals, the Department of Human Resources, along with the Department of Community Health, which runs the Medicaid and PeachCare for Kids health insurance programs.

The Journal-Constitution found in its investigation that unlike a handful of states, no independent agency routinely investigates or analyzes Georgia mental hospital deaths.

The patient board under HB 535 would be housed in the Department of Community Health. The panel would have an administrator and consist of medical professionals who would review hospital records, make recommendations to the state, and also refer cases to the Georgia Bureau of Investigation.

GBI officials have said the hospitals do not systematically notify them of deaths or of other serious incidents.

A consumer group representing people with mental illness said it would support the hospital review bill. "I think it's a good beginning,'' said Ellyn Jeager of Mental Health America of Georgia. "I think Rep. Butler is trying to get a better look at what's happening in mental hospitals.''

But Jeager added that she preferred the added oversight be extended to deaths of patients in jails, prisons and the community.

In an interview late last year, agency officials defended their internal investigations as thorough and unbiased.

At a legislative hearing Thursday chaired by Butler, B.J. Walker, commissioner of Human Resources, said the Journal-Constitution's articles provided "an opportunity to take a look at ourselves.''

Walker said other outside organizations provide external evaluation of state hospitals. But one that she cited, the Georgia Advocacy Office, told legislators recently it is investigating 27 patient deaths. The group's director of legal advocacy, Josh Norris, criticized the state's system of oversight. A second organization Walker cited, the Centers for Medicare and Medicaid Services, has written scathing reports about Georgia hospital conditions.

"I'm never one to say that you can have too much external [evaluation],'' Walker told lawmakers.

Patient advocates and some legislators say the General Assembly has momentum to add a new layer of oversight. But the legislative session is more than halfway over, so there's not much time to pass new bills.

Besides people with mental illness, including forensic patients sent by the courts, the hospitals also serve the developmentally disabled.

The hospital privatization bill, HB 461, reprises an idea that came up in the last General Assembly. "We need to look outside the box,'' said Rep. Donna Sheldon (R-Dacula), lead sponsor. The mental health system needs improvement, she added.

The National Alliance on Mental Illness, an advocacy group, said Thursday that Florida's privatization of a problem-plagued mental hospital has largely been successful. The key factors in privatization, said NAMI legal director Ron Honberg, are whether a state puts adequate funds into the hospital, and whether the state retains oversight and responsibility for patient care.

A Human Resources spokeswoman, Dena Smith, said, "I worry that requiring privatization of government services may not lead to the best price.''

The possible reorganization of Human Resources and Community Health in HB 514 could put all state health services under one roof, rather than having them in separate agencies.
Read more!

Caregivers Call New Mental Health Center A Breakthrough - Omaha (NE) KETV

OMAHA, Neb. -- Health officials and mental-health volunteers said the announcement of a new facility in Omaha is a "huge step" in mental health.

Last Hope Recovery Center will offer 24-hour crisis support and long-term recovery, plus outpatient care, at the old Richard Young Center building in downtown Omaha. Public and private entities joined to bring the center to fruition.

At Community Alliance, volunteers and managers said Last Hope will put under one roof what many patients currently must seek from numerous places. Mental health professional Carole Boye said patients may bounce between emergency rooms, hospitals and outpatient centers trying to find a good fit.

"When someone is in acute illness, to be moving from place to place within a three- or four-week period of time, that's not a good continuum of care," Boye said.
Rhonda Hawks’ own story helped her find the players who needed to work together to make Last Hope a reality.

"My father was diagnosed with schizophrenia is his early 20s," Hawks said.
Hawks said her vision is to help patients pass through the continuum of care and successfully reenter the community.

Alegent Health and the Nebraska Medical Center have each pledged $5 million to cover any unexpected operating costs. That's in addition to the money already donated.
Alegent will operate the center.

The partnership estimates annual operating costs to be about $15 million, with $10 million coming from Medicare, Medicaid and insurance payments.

The 64-bed facility will offer behavioral health services to residents of Cass, Dodge, Douglas, Sarpy and Washington counties -- the area known as Region 6.

Boye said that Lasting Hope will be one place people can go to gradually progress through a treatment program. She said nonprofit groups, such as Community Alliance, will partner with the new facility to provide additional services.

"We will be working with their staff to say, 'OK, what can be put into place? What can we do to avoid that next hospitalization and help them restore their quality of life?'" Boye said.

The center was envisioned as part of the state's mental health reform plan passed in 2004. Gov. Dave Heineman said it could serve as a model for other communities.
The partnership is composed of government entities, local health care providers and community leaders, among others. Read more!

Mental Illness Among Maine Inmates Is Growing - Portland (ME) WCHS-TV

Web Editor: Rhonda Erskine, Online Content Producer

A new report by the Maine chapter of the National Alliance on Mental Illness, or NAMI, concludes that despite ongoing efforts, jails continue to be hospitals for the mentally ill. The group says that has the cost to taxpayers soaring.

Late Thursday afternoon, a Cumberland County Jail inmate slashed her arms with what guards believe was a razor blade. When she was returned to the jail on suicide watch, she ripped out the stitches with her teeth.

Sheriff Mark Dion says it's just another example of an ongoing problem.

NAMI Maine says more than half of the inmates in county jails in the state have some form of mental illness and that corrections officers are still the largest providers of mental health services in the state.

Advocates say when the state's mental health facilities were downsized, the promise was that more community based treatment would be put in place. But that promise was never fulfilled. NAMI says that's why more people are ending up in jail who shouldn't be there.

"I think there's a misunderstanding that everybody in jail is a violent criminal who needs to be in there and they deserve what they get. And the truth is at least 51% of the people in jail, on average, in Maine are people who have mental illness, who couldn't get treatment in the community, who got into some kind of a small scuffle and end up in jail and then they get sicker when they're in there," said Carol Carothers from NAMI Maine.

There have been 19 suicides in Maine jails over the past six years. Penobscot Country Sheriff Glenn Ross says the stress for his corrections officers in trying to deal with a mentally ill population continues to climb. Read more!

African Americans with mental illness make contributions to communities - ABC7 Chicago

By Karen Meyer

This month, ABC7 is honoring the accomplishments made by African Americans. Three Chicago area African Americans who struggle with mental illness are making significant contributions to their communities.

Being African American with mental illness is not easy. However, Sharon, Shelly and George have found ways to succeed.

"It took me 15 years to get my bachelor's degree in liberal arts and science and I specialized in communication and theater in particular speech," said Sharon.

"I applied to Chicago State a while ago and that's been my goal for past three years to get there with the assistance of community scholars with Thresholds," said Shelly.

"I majored in psychology and I got my degree in May 19, 2006. I walked across that stage with my degree and it was just amazing," said George.

Sharon, Debrah Williams, Shelly Williams and George Jones are members of Thresholds, Chicago's largest mental health agency. Their goal is to help people with mental illness.

Sharon is a former military officer. She had a difficult time getting through college because of her psychiatric conditions.

"I was told that I needed to be on time, I wasn't able to approach a professor for the time for studies when I had a uncle passed away, I felt intimidated but previous to that I was in and out of school for several years, I would say my first five years because of not being stable on lithium," said Sharon.

Sharon currently works at Thresholds running a group for consumers.

Shelly came to Thresholds two years ago. She struggles with depression and anxiety.

"A traumatic experience brought me to Thresholds for their services. South residential has been a big part in my recovery," said Shelly.

Shelly is still at Chicago State majoring in social work and working as a case aide.

George has come a long way.

"I had been at Chicago Read and I was really down and I was determined after that after I got out of Chicago Read to get my degree and when I walked across that stage it was just amazing. A lot of people didn't know I had two severe mental impairments," said George.

After graduation, George started working at Thresholds.

"I sit down with clients and listen to exactly what they want. I put it in their records exactly what they want," said George.

When asked about the struggles faced by African Americans with mental illness, Shelly says, "There are challenges in itself with that and when you add a disability it's constant struggle to maintain that stability and it's a challenge but it has a price and it also has some, you know, not advantages but rewards I guess you could say."

Sharon, Shelly and George are planning to go to graduate school. They are role models for other African Americans with disabilities -- especially those with mental illness.

For more information visit www.thresholds.org. Read more!

Raising the bar for mental health parity - Oakland (CA) Tribune

By Suzanne Bohan, STAFF WRITER

REDWOOD CITY — Three members of Congress listened raptly Wednesday to testimony that ranged from tragic to inspiring on the toll of mental health illness on residents and the lack of support for treating these conditions.

Reps. Patrick Kennedy, D-R.I., Jim Ramstad, R-Minn., and Anna Eshoo, D-Atherton, held a congressional field hearing here midway through a 13-city tour to drum up support for legislation that Kennedy and Ramstad plan to reintroduce in March that would require insurers to reimburse treatment for mental health conditions on par with that of physical conditions such as heart disease or diabetes.

Nine people stood before the politicians and an audience of about 50 in the San Mateo County Board of Supervisors chamber, describing how mental illnesses drove themselves or their relatives to despair, and the struggles they faced receiving treatment.

The illnesses also left their families burdened with crushing bills, as their insurance coverage, if they had any, didn't cover mental health treatment, or did so only marginally.

John Kevin Hines described to an attentive audience the day in September 2002 when he heard voices urging him to kill himself. He walked onto the Golden Gate Bridge, he said, leapt over the railing and fell to the water below. "By the graceof God, I survived," Hines said.

Hines, who sits on the Mental Health Board for the City of San Francisco and is getting married in June, said his father incurred "heavy costs" for his subsequent treatment and urged the politicians to continue their efforts to get their legislation, the Mental Health Parity Act, to President Bush's desk.

"From the bottom of my heart, this means the world to me," Hines told the three congressional representatives.

Theresa Bassett, who now works for a San Mateo County mental health program, struggled for years to cope with bipolar disease. She said she found marginal treatment programs, which led her to "self-medicate" with alcohol and drugs.

She then began cycling in and out of incarceration. "The last time I went into jail, I just wanted to die. Just get it over with," Bassett said.

Bassett, however, found a lasting solution with a now-defunct mental health program in San Mateo County that treated her "as a whole person," she said. "I had a psychiatrist, a therapist and a case manager. I got on medicine that kept me on an even keel," she said.

"That program saved my life, literally," Bassett said, as she lauded the work of Kennedy, Ramstad and Eshoo to pass legislation expand coverage for mental health services.

Mental illness is rife among Americans, emphasized Kennedy, who noted that in a recent year, three members of Congress lost members of their family to suicide.

"This is an epidemic that knows no bounds," Kennedy said. Some 54 million Americans, Ramstad added, will suffer to some degree from a mental illness.

Both congressmen have battled against addiction themselves. After crashing his car into a police barrier shortly after 2 a.m. one night last year, explaining that he needed to get to Congress to cast a vote, Kennedy revealed that for years he's fought against drug addiction and bipolar disorder. Ramstad, an alcoholic, reached out to Kennedy after that incident, and the two men have formed a bipartisan alliance to get the mental health insurance legislation to the president's desk.

Previous versions of the bill, twice introduced when Republicans had control of the House, were backed by strong bipartisan support. A majority in Congress supported it, and President Bush, who swore off drinking at age 40, promised to sign the legislation. But it languished in a Republican-led committee, Ramstad said.

"Our leadership would not give us a hearing, let alone a vote," Ramstad added.

The chief objection against a government mandate to require that insurers cover treatment for mental illness and addictions at a level comparable to that for physical conditions is that it would drive up health care costs at a time when employers are grappling with double-digit annual increases in health care premiums.

The U.S. Chamber of Commerce adamantly opposes the mental health parity laws for those reasons, said David Felipe, a spokesman for the chamber.

"Imposing new coverage mandates, no matter how popular or well-intentioned, will increase those costs," the chamber stated in a prepared release.

However, the National Federation of Independent Business is cautiously supportive of a Senate version of the legislation that is awaiting a vote.

"We're very pleased that an exemption for small business was included in the Senate version," said Mike Donohue, a spokesman for the federation.

The Senate bill, like the current version of the House bill, limits the mental health parity mandate to businesses with

50 or more employees.

Numerous supporters of parity, however, stress that studies show that mental health coverage has negligible effect on premium costs. An "exhaustive study" by the Department of Health and Human Services found that a 2001 implementation of mental health parity in coverage for federal employees resulted in "little or no increase in total mental health/substance abuse spending," according to a congressional statement.

In fact, several speakers at the Wednesday hearing asserted that rising health care costs could be directly attributed to undertreatment of mental health diseases.

"If you provide treatment at the right time, there's no question it saves costs," Kennedy said.

Unlike the House bill, however, the Senate bill allows health plans to determine what mental illnesses are severe enough to warrant coverage, said Ramstad, a provision that he opposes. He also objects to the federal pre-emption clause in the Senate version, which prohibits states from forcing insurers to follow more stringent mental health parity mandates than that required by federal law.

Kennedy said he expects the House bill to be introduced to Congress in March, where it has the support of House leadership. If it passes as he expects, the next step will be crafting a version that melds the House and Senate versions.

"My hope is that the Senate bill, which is somewhat limited, will be improved as the process goes along," said Saul Feldman, a former executive with the National Institute of Mental Health and commissioner of California's Proposition 63, which funds mental health services by imposing a 1 percent tax on those with annual incomes above $1 million.

Feldman also thought it likely that an expanded mental health parity bill would reach the president's desk for a signature.

"There is an appetite for this that is much greater than it was in the past," Feldman said. If this latest incarnation of the law takes effect, it would mark a major milestone in the attitudes toward mental illness, he said.

"It will be a message to the American people that in fact, discrimination against mental health is over."


Contact Suzanne Bohan at (650) 348-4324 or sbohan@angnewspapers.com. Read more!

Lung disease linked to mental health problems - Reuters

Feb 21, 2007 — NEW YORK (Reuters Health) - Lung disease is associated with an increased risk of mental health problems, according to findings published in the American Journal of Epidemiology.

Dr. Renee D. Goodwin, of Columbia University, New York, and colleagues examined data from a representative sample of U.S. adults between the ages of 25 and 74 years. The subjects were enrolled in the First National Health and Nutrition Examination Survey, from 1971 to 1975.

Measurements of lung function were performed and patients received a preliminary diagnosis of restrictive lung disease or obstructive lung disease. Evaluations of mental health were also conducted.

The study included 642 subjects with restrictive lung disease, characterized by a decrease in exhaled airflow, such as asthma, emphysema or bronchitis; 68 with obstructive lung disease, a decrease in total volume of air that the lungs can hold, which can result from loss of elasticity of the lung or problems with the expansion of the chest wall during inhalation; and 4,776 with normal lung function.

Compared with individuals with normal lung function, those with obstructive or restrictive lung function were significantly more likely to have mental health problems.

Specifically, obstructive lung function was associated with significantly lower feeling of overall well-being. Restrictive lung function was associated with lower scores on feelings of overall well-being, general health, vitality and self-control, and higher depression scores.

The reason for the association between lung function and mental health problems is unclear, Goodwin's team notes. They suggest that impaired lung function may lead to a decreased sense of well-being as a result of physical limitations associated with physical disease.

Even patients who do not have functional limitations may experience distress over poor physical health, the researchers add, and this may lead to depression and worry.

SOURCE: American Journal of Epidemiology, February 2007.

Read more!

The state of Texas' mental health care: It's criminal - Navasota (TX) Examiner

By STEVE SNYDER

Aaron George sits in the Grimes County Jail, deteriorating every day, becoming less and less functional, less and less himself, less and less "human" as a human being, all while leaving the sheriff and jail staff frustrated and helpless.

Sheriff Donald Sowell, through no fault of his own, is in an unenviable position. District Attorney Tuck McLain is left to potentially prosecute a case he'd rather not, even as the wheels of the judicial system grind so slowly George's case has not even gone before the grand jury yet for possible indictment.

It's criminal.

Whether Aaron George is a criminal now, or was in 1992, it's criminal that a bipolar schizophrenic sits in a county jail cell rather than a state mental hospital.

It's criminal that he sits there without proper medication, literally beating himself against the walls because voices and compulsions tell him to do so.

It's criminal that Donald Sowell, a small-county sheriff has to deal with cases like George's because jails like his become dumping grounds for mentally ill people who may commit crimes because of inadequate treatment.

It's criminal that the state mental health system leaves them stuck there, sometimes for a year or more.

It's criminal that mental illness, besides any actual crimes committed by a mentally ill person, still has a quasi-criminal taint to it, whether in Grimes County or anywhere else in the state.

It's criminal that many people may still think mental illness issues can just be swept under the rug.

It's criminal that state officials believe this enough that the prison system faces another serious lawsuit, this one from advocates for mentally ill inmates.

It's criminal that the Mental Health Mental Retardation budget gets slashed year after year.

It's criminal that MHMR doesn't have more state hospitals and beds, along with halfway houses or group homes.

It's criminal that more and more of the functions of Child Protective Services get privatized to untrained people by Gov. Rick Perry and the Texas Legislature.

Literally criminal, as in the case of a young girl in south suburban Dallas, where I used to work, who died while under the oversight of a privatized foster care oversight agency.

It's criminal that addiction and rehabilitation services were similarly privatized due to ideology, again to private agencies often lacking adequate training, by our previous governor and previous legislatures.

It's criminal that more people don't know about how bad these problems are.

It's criminal that some may not even care.

It's criminal that the mentally ill, the drug and alcohol addicted, and the children who come from homes filled with sexual or physical abuse, aren't reached before they start becoming criminals.

Even looking at this from a purely financial angle, residents of Grimes County who think they are saving so much in state tax dollars by sitting idly by, or worse, while current politicians continue to slash MHMR, privatize CPS and otherwise pass the buck on mental health care and child protection, AREN'T.

Stretching Sheriff's Office manpower, and budget, for the special caretaking of mentally ill prisoners, refutes that right there.

Don Sowell's work as sheriff gets affected the thinner and thinner he gets stretched. Ask him. He'll tell you.

District Attorney Tuck McLain, even if he disagrees with Beverly George on what happened at Aaron's house in 1992, doesn't like prosecuting a case like this. His staff gets stretched thinner, and more county-level budget spent on it, because voters are penny-wise and pound-foolish in supporting governors and legislators that won't adequately fund mental health care and the other two legs of state care.

It's criminal, when McLain says the state could use at least four times as many mental health beds, to continue to cut funding for state mental health services.

It's criminal when George has to wait three months or more for his case to go to a grand jury due to the county having just one-third of a district court in two different court jurisdictions.

Even if you don't personally know someone with a history of mental illness - or a child abuse victim, or a drug or alcohol past or present history - you are still affected by how these people impact our society.

And, they are people, not statistics. And, they are people, not less than human.

It's criminal for society to see them, and treat them, otherwise.

This isn't a "conservative" or a "liberal" issue; it's a humanity issue, as any religious or philosophical beliefs you hold will tell you. Period.

It's not just criminal, it's inhumanitarian and immoral.

Contact Steve Snyder at editor@navasotaexaminer.com.

For more information on mental health and illness issues, go to the National Alliance For Mental Illness Web site at www.nami.org≈ Read more!

Experts: Padilla Unable to Stand Trial - AP

MIAMI (AP) -- Accused al-Qaida operative Jose Padilla suffers from intense stress and anxiety stemming from his isolated years in military custody and cannot adequately help his lawyers prepare for trial, two defense mental experts testified Thursday.

Defense lawyers hope to delve more deeply into Padilla's treatment at a Navy brig in Charleston, S.C., later in the federal hearing, when they are allowed to question brig officials directly involved in his custody. Those officials have never spoken publicly about the case, and the hearing will continue Monday.

''He is immobilized by his anxiety,'' said Patricia Zapf, a forensic psychologist who administered tests on Padilla last October. ''He believes he will go back to the brig and he will die there.''

The hearing before U.S. District Judge Marcia Cooke on Padilla's competency is crucial in deciding whether he and two co-defendants will stand trial in April.

Padilla, a 36-year-old U.S. citizen, is charged with being part of a North American terror support cell that provided money, recruits and supplies to Islamic extremists around the world. All three have pleaded not guilty and face possible life imprisonment.

The Bush administration initially claimed that Padilla was on an al-Qaida mission to detonate a radioactive ''dirty bomb'' in a major U.S. city when he was arrested in May 2002 at Chicago's O'Hare International Airport.

He was designated an ''enemy combatant'' and was imprisoned by the military without criminal charges. But the dirty-bomb allegations are not part of the Miami case.

Padilla has claimed in court filings that he was tortured at the brig, which U.S. officials have denied. Prosecutors say he is competent for trial.

''It has always been our policy to treat all detainees humanely,'' Cmdr. Jeffrey Gordon, a Defense Department spokesman, said Thursday. ''The government in the strongest terms denies Padilla's allegations of torture, allegations made without support and without citing a shred of record evidence.''

Dr. Angela Hegarty, a forensic neuropsychiatrist, said she concluded after examining and testing Padilla for more than 22 hours last fall that he is mentally incompetent for trial because he has post-traumatic stress disorder. Zapf reached the same diagnosis and recommended that Padilla receive treatment.

Padilla's symptoms are most acute when he is asked to talk about his 3 1/2 years in the brig, including interrogations techniques used on him, or to review evidence in his criminal case, including transcripts of intercepted telephone conversations, Hegarty said.

''He doesn't want to because it hurts so much, and because it hurts so much he shuts down,'' Hegarty said.

When Padilla his asked about his case or the brig, Zapf said, he becomes noticeably tense, begins to sweat, tries to change the subject and rocks back and forth while hunched over. She said he was adamant that he did not want to testify in his own defense.

''He said he can't relive it, he can't go through it again, and he can't name names,'' Zapf said.

During cross-examination, prosecutor John Shipley pointed to a test administered by Hegarty in which Padilla scored zero on the portions indicating post-traumatic stress disorder. Those segments involved questions about flashbacks, nightmares, depression and other symptoms.

''Nothing in this test supports your diagnosis at all, isn't that correct?'' Shipley asked.

''No,'' Hegarty replied, noting that the test answers were only one component of her decision. Read more!

An Rx to thin California prison population - LA Times

By Steve Lopez

In the ongoing flap over prison overcrowding in California and what to do about it, little consideration has been given to inmates such as Stephan Lilly.

I wrote about the Los Angeles man late last year, when his conviction on charges stemming from a scuffle with a security guard were counted as a third strike. Despite a years-long battle with schizophrenia, and the fact that one of the three strikes was a threat that involved no physical contact, Lilly got 25 to life.

California's prisons are jammed with thousands of mentally ill inmates who didn't get help before their incarceration and aren't likely to get much while locked up. Not only is that like a chapter out of the Dark Ages, but the high rate of repeat crimes among parolees is costing taxpayers a fortune.

Tomorrow, state Sen. Darrell Steinberg, a Democrat from Sacramento, will introduce a bill that calls for a complete overhaul of mental health care behind bars, with the goal of putting a big dent in both the overcrowding problem and the high recidivism rates.

"I would argue very strongly that it's the missing element of corrections reform," Steinberg said. How can you talk about getting a handle on overcrowding, he asks, without doing something about the fact that an estimated 20%-25% of the state's 170,000 inmates are bipolar, schizophrenic, clinically depressed or otherwise afflicted?

Steinberg expects a vigorous debate over the details of his legislation, especially on funding and staffing, areas on which he is a little vague. But the basic idea is to establish mental health courts that can divert worthy defendants into treatment instead of prison, to bolster services behind prison walls, and to prepare inmates for a return to community-based programs once they've served their time.

"California has the highest recidivism rate in the country," said Adam Mendelsohn, a spokesman for Gov. Schwarzenegger. He said his boss wants a comprehensive overhaul of prisons, and "the governor would welcome a discussion about the mental health aspect."

Steinberg brings real credibility to the subject and has worked previously with the governor on mental health. He was the godfather of Prop. 63 in 2004, which taxed the state's highest income earners to fund new mental health services across California, based on a model that includes housing, treatment, job training and a raft of additional support services.

Steinberg still hopes that Prop. 63's yearly infusions of roughly $1.6 billion will go a long way toward reducing skid row populations that began growing when the state shut mental hospitals under then-Gov. Ronald Reagan and reneged on a promise to build community clinics.

One thing he won't stand for, Steinberg said, is stealing money from Prop. 63 to pay for his new plan. If the governor can find $10.9 billion for his prison reform plan, the senator argued, the state should be able to shift funds or find additional revenue to pay for a mental health overhaul that could deliver long-term savings.

Steinberg pointed to a program that was a precursor to Prop. 63, in which formerly homeless clients with mental illness had a 56% reduction in hospitalization and a 72% reduction in incarceration. That program cost roughly one-third as much per person as it costs to lock someone up in prison for a year.

Stephan Lilly might not be facing life in prison, his attorney Donna Tryfman told me, if Steinberg's legislation were already in place.

steve.lopez@latimes.com

Read more!

Five officers on leave following shooting - Charlotte Observer

MARCIE YOUNG
myoung@charlotteobserver.com

Five law enforcement officers involved in a Tuesday shooting that killed a man have been placed on administrative leave, authorities said.

The State Bureau of Investigation is looking into the shooting that killed Marty Dale Rogers, 32, in a field near his home north of Conover and about 70 miles northwest of Charlotte.

Catawba County Sheriff David Huffman said Rogers, who was dressed in camouflage and hiding in the field's thick brush with an automatic rifle, was a threat to the officers surrounding him and that authorities had no choice but to fire.

The Catawba County Sheriff's Office has put four members of the STAR team -- the county's version of a SWAT team -- on administrative leave through Friday, Huffman said. The team is made up of officers from several police agencies in the county.

Huffman would not name all of the deputies placed on leave but did say that Maj. Coy Reid, the team's leader, was one.

The Hickory Police Department also put one officer on administrative leave, according to a news release. He is expected to return to work after the SBI completes its investigation.

SBI agent David Call would not comment on the investigation.

Deputies from the Catawba County's Sheriff Office were trying to serve Rogers with mental health commitment papers Tuesday when he jumped into his pickup and fled.

The chase ended in a field near the intersection of Three D Ranch Road and Springs Road, where Rogers got out of the truck with the rifle, ran several hundred yards and then hid in a brushy area.

Rogers was shot and killed by a law enforcement officer's bullet after he ignored commands to put down his weapon and unlocked the gun's safety clip, Huffman said. Read more!

Spike in care cost triggers inquiry - Charlotte Observer

Editor's Note: Once again, no differentiation is made between Community Support for adults and for children, where CS is often the only service available.

ERIC FRAZIER
efrazier@charlotteobserver.com

A new N.C. program designed to teach mentally ill people and substance abusers how to live without government help is costing taxpayers nearly twice as much as the service it replaced.

The program, called community support services, serves only 2 percent more people each month. However, it costs about $20 million more each month than the program it replaced.

Officials at the N.C. Department of Health and Human Services say that kind of glaring imbalance spurred them two weeks ago to announce a statewide audit of mostly private firms in the nearly year-old program.

Officials launched the audits after the Observer requested a cost comparison for the old and new programs.

Advocates charge that the companies are supposed to be helping people become self-sufficient but instead are running up the bill to taxpayers by extending services too long.

"Right now, people are getting more (service) than they need, and the taxpayers are paying for it," said Rep. Verla Insko, D-Orange, co-chair of the legislature's top mental health oversight committee.

The new program serves 31,000 people a month -- only 700 more per month than the old one.

It supplies personal aides who help people master skills for everything from job searches to grocery shopping to securing housing. The program also supplies a case manager to make sure the person is getting the right help.

State officials have said they switched to the new program last March because they felt the old system was too open-ended. They feared people were becoming too dependent on aides in the old system, and staying on the service too long.

Some families who preferred the old service have called the new one a clever way for the state to reduce costs. But statistics show costs instead have risen dramatically.

The new program is on track to cost the state and Medicaid $577 million in its first year-- or about $48 million a month. The old program, which focused more on offering help than teaching independence, cost about $300 million a year, or $27 million a month.

Those numbers helped prompt the audit, said Leza Wainwright, assistant director of the N.C. Division of Mental Health.

State Health and Human Services officials suggested the results of the audit, expected to take a month, could trigger a reduction in the $60 per hour reimbursement rate the state gives providers.

The head of the N.C. Providers Council, a trade group representing about 70 mental health and substance abuse firms, said companies are not bilking the system.

"These are new and changing services," said Bob Hedrick, executive director of the council. "It's more an issue of training and maturation of these services rather than a systemwide misuse. It's just going to take some time to get this worked out."

How the System Works

The community support services program forms the core of the state's treatment system for the mentally ill and substance abusers. Here's how it works:

• The consumer receives a diagnosis from a doctor or other professional, then picks a service provider from a list of companies endorsed by the local mental health regulatory agency. ValueOptions, a private company working for the state, gives the go-ahead for service and payment.

• The firm provides a case manager to guide the consumer's recovery and help access other services. An aide visits regularly, helping the consumer gain daily living or coping skills. The state pays the firms $60 per hour, often using federal Medicaid dollars. Read more!

Kennedy, Ramstad discuss stigma, illness - Stanford University Daily

By Kaylin Pennington

Congressmen Patrick Kennedy (D-RI) and Jim Ramstad (R-MN) discussed mental health and the stigma associated with mental illness with a small group of students and community members gathered in Tresidder Union’s Cypress Room South yesterday afternoon.


Kennedy spoke frankly about his personal experience with alcohol addiction in order to illustrate how society might eliminate the social stigma attached to mental health issues.

In 2006 Kennedy was implicated in a drunk driving accident which prompted criticism from political opponents and made him a punch line on late night talk shows. But he noted that the ensuing media storm, which thrust his personal problems into the limelight and sent him into rehab, helped initiate dialogue among his constituents about mental health and addiction.

“The American people are way ahead of where we think they are,” Kennedy said, citing the fact that he won reelection in his congressional district after the 2006 incident with 69 percent of the popular vote. It was the largest margin of his 12-year career in the House of Representatives.

Ramstad and Kennedy, who stopped by Stanford after a public hearing in Redwood City as part of a nationwide tour to gain support for mental health legislation, say they firmly believe that health insurers should cover mental illness at the same level as they cover physical illness.

Both congressmen spoke frankly about their own struggles with alcohol and drug addiction, and how they both believe they were able to get the necessary treatment because of the exhaustive health insurance provided to members of Congress. They are concerned, though, that most insurance companies ignore issues of parity when it comes to mental illness.

According to Ramstad, who is Kennedy’s Alcoholics Anonymous sponsor, 54 million Americans suffer from mental illness and many are unwilling or unable to seek help because insurance companies set lower reimbursement, co-payments and deductibles for mental illnesses, in addition to limiting visits to physicians.


Calling mental illness “our largest public health problem,” Ramstad said that a mental health parity bill would “increase [insurance] premiums by 78 cents per month in the worst case scenario.”

Kennedy, the son of Sen. Edward Kennedy (D-MA) and the nephew of former President John F. Kennedy, added that the National Institutes of Health (NIH) “spends only $5 out of every $100 on brain research, even though [the brain] affects everything else.”

Both men said they believe their bill is the “floor, not the ceiling” of any healthcare policy that addresses mental illness.

“The public needs to know that recovery is possible,” said Ramstad.

“This bill is about civil rights more than public health,” Kennedy added.

Alejandro De Los Angeles ‘07, was one of only a handful of students in the audience. President of Stanford Peace of Mind, a student group that strives to spread awareness about mental health issues on campus, De Los Angeles agreed with Kennedy’s categorization of the parity issue as primarily a civil rights question.

“It is great that there are high-profile politicians that will enact legislation that will hopefully result in a reduction of the existing mental health stigma,” he said.

De Los Angeles said he was surprised at the low turnout given that the public officials focused on the “stigma attached to mental illness” and “in light of things that have recently happened on campus.”
Read more!

Florida state hospitals could go private - Jacksonville Times-Union

By J. TAYLOR RUSHING

TALLAHASSEE - State legislators are considering privatizing three Florida mental health hospitals, a move some say could be devastating to rural areas such as Baker County.

The House Committee on Health Innovation began exploring the idea this week, with several representatives claiming the work could be done better and cheaper if outsourced.

Three of Florida's six mental health hospitals already are outsourced - two near Miami and one near Pensacola - accounting for 628 of the state's 1,827 beds. The remaining three hospitals include Northeast Florida State Hospital in Macclenny, which employs 1,190 people and has a budget of $67.9 million.

"It's a huge expense and in recent years the privately run hospitals have been able to offer better services," said Rep. Rene Garcia, R-Hialeah, the committee's chairman.

The impact of outsourcing operations of the Macclenny hospital worries Jeanette Wynn, president of the American Federation of State, County and Municipal Employees, which represents 64,000 state workers.

"It would be devastating," Wynn said. "It employs 12 percent of the people in Baker County."

The prospect also concerns Rep. Aaron Bean, R-Fernandina Beach, and chairman of the House Healthcare Council, which oversees the health innovation panel.

"I'm in an excellent position to block this, and I can tell you that I absolutely will," Bean said Wednesday.

Baker County Manager Joe Cone said discussions about privatizing Northeast Florida State Hospital are nothing new.

"Every couple of years, this issue seems to surface," Cone said. "Of course, we'd rather see it not privatized unless there is some kind of assurance that the employees there could retain their jobs at their current salary level. There's no question that it's critical to the economic vitality of this area."

But Garcia said the hospital isn't necessarily going to be privatized and that if it is, he would offer such assurance to the employees.

jt.rushing@jacksonville.com, (850) 224-7515


Read more!

Many offenders need mental care, not prison - Detroit Free Press

Michigan's county jails and state prisons hold thousands -- perhaps tens of thousands -- of mentally ill offenders who should be in community programs. Locking up people who commit minor crimes because they need treatment for mental problems is ineffective, expensive and wrong.

Bills by state Sen. Liz Brater, D-Ann Arbor, would help fix the problem by establishing mental health courts modeled after Michigan's successful drug courts. The bills would authorize judges to order mental health treatment, if appropriate, instead of jail or prison time for minor offenders with illnesses like schizophrenia and bipolar disorder. Brater will also propose that the state shift some money from the Department of Corrections to the Department of Community Health to pay for increased community mental health services. In the main, that makes sense. Incarceration, treatment and health care costs for mentally ill prisoners can cost Michigan taxpayers at least $50,000 a year per inmate. By contrast, community mental health care costs roughly $10,000 a year, some of which is picked up by private insurance or Medicaid.

One in four of Michigan's more than 50,000 inmates have a history of mental illness. But state prisons, where security is top priority, are not equipped to treat them. Brater's bill would target offenders like Timothy Joe Souders, the 21-year-old mentally ill inmate who died Aug. 6 after spending most of his last four days strapped down in a hot isolation cell in Jackson. Souders, serving a one-year sentence for petty theft and resisting arrest, didn't belong in prison.

Brater's plan comes too late for him, but it would divert hundreds of others who need treatment instead of costly prison stays. Read more!

Social service agencies outline funding needs - Dayton (OH) Daily News

By Lynn Hulsey

DAYTON — The need for social services continues to outpace the money available to pay for them, the Human Services Levy Council was told Tuesday.

The council heard from representatives of area social services agencies as well as the county's juvenile court and Stillwater Center. It's the second of several meetings in the process of determining how much money may be needed to meet human services needs in Montgomery County through 2012.

The county's human services levy is expected to be on the November ballot for renewal, and very possibly will include a request for additional money, county officials said.

Tuesday, members of the Alliance for Executives spoke for social services groups. Patti Schwarztrauber, executive director of the Artemis Center for Alternatives for Domestic Violence, said groups struggle each year to get grants, which often won't pay for operations and sometimes are not renewable beyond a couple of years.

Those agencies are coping with high health care costs, the need for technology, the cost of collecting data required by funders and a broader pool competing for United Way dollars, said Bonnie Parish, executive director of the Family Service Association.

Most of all there is poverty, the community's most critical issue, she said. Most recently, the agencies are seeing an increase in people new to poverty and "not knowing how to be poor, not knowing how to access resources," Parish said.

The council also heard requests from juvenile court, which projects needing $2.7 million in levy money in 2009, a 3.3 percent increase over 2008. The additional money would help improve intervention programs that help youth and their families with addiction, mental health, discipline problems and other family dysfunction, Court Administrator James Cole said.

Stillwater Center is requesting more than $3.9 million in levy funding for 2009, a 68.3 percent increase over funding anticipated in 2008. The center, home to 98 severely mentally disabled people, is coping with a long decline in federal funding and an increased need for respite care and nursing services, Director Carolyn Borden-Collins said.

On Feb. 12, the council heard presentations from the top four major recipients of levy funding. Those projected needs for additional money in 2009 included:

• Montgomery County Children Services, which needs about $23.9 million, a 3.5 percent increase, in 2009. Among the challenges: difficulty placing children with behavior problems and the lack of a local residential treatment center for youth.

• Montgomery County Board of Mental Retardation and Developmental Disabilities, which asked for $31.1 million, an 18.9 percent increase over 2008. Problems include Medicaid funding changes, the need for early intervention and expanded adult day care, and the challenge of an aging population of family caregivers for MRDD clients.

• Montgomery County Board of Alcohol, Drug Addiction and Mental Health Services, which anticipates needing $31.1 million, nearly 3.6 percent more than the 2008 projected allocation. The agency serves a fraction of the estimated 235,200 people needing addiction or mental health services and is unable to provide inflationary increases to its providers.

• The Combined Health District of Montgomery County, which requested a 9 percent increase in levy funding for 2009, for a total of $18.3 million. Among the concerns raised by district officials is that the need to care for vulnerable populations will grow without more preventive and intervention measures.

Contact this reporter at (937) 225-7455 or lhulsey@DaytonDailyNews.com.

Read more!

ADHD drugs to carry warning labels - AP

WASHINGTON — Drugs prescribed to treat attention-deficit (hyperactivity) disorder will include guides to alert patients and parents to the risks of mental and heart problems, including sudden death.

The Food and Drug Administration said Wednesday that it directed the manufacturers of Ritalin, Adderall, Strattera and all other ADHD drugs to develop the guides. In May, the agency told manufacturers to revise the labels on the drugs to reflect concerns about the cardiovascular and psychiatric problems.

Draft versions of the guides posted on the FDA Web site include discussion of reports of increased blood pressure and heart rate in ADHD patients, as well as cases of sudden death in some who have heart problems and heart defects. In adult patients, the reported problems also include stroke and heart attack.

The alerts also cover psychiatric problems, such as hearing voices and manic behavior, of which there is a slightly increased risk in patients who take the drugs, the FDA said. The guides tell patients and their parents of precautions they can take to guard against the risks.

The announcement came roughly a year after two panels of FDA advisers recommended that the drugs include such patient medication guides. The announcement covers 15 drugs. Read more!

Panel asks Texas Legislature for new mental health facility - Cox News Service

By DAVOD RAUF

AUSTIN — A panel from East Texas asked state lawmakers on Wednesday to spend part of an $83 million request by the Department of State Health Services to build a mental health facility in the eastern part of the state.

Members of the panel — which was comprised Angelina County Judge Wes Suitor, Nacogdoches County Sheriff Thomas Kerss, and two medical administrators, Nacogdoches Memorial Hospital Administrator Tim Hayward and Burke Center director of operations David Cozzad — discussed treating patients at the local level for mental health problems as a way to help eliminate unnecessary transportation costs and ease the burden on local law enforcement and emergency rooms that are not equipped to deal with mental health patients.

A lack of funding and proper resources for mental health patients has left entire regions across the state, including Angelina and Nacogdoches counties, without the ability to provide proper mental health care, Tim Hayward, administrator of Nacogdoches Memorial Hospital, said.

"It takes resources away from what they are designed to do," Hayward said. "If the mental health issue continues to be unaddressed and continues to be not appropriately funded, then we do have to start switching more resources, and that threatens the existence of our social fabric."

Officials from the Department of State Health Services made the $83 million-request to help pay for mental health needs across the entire state.

The panel discussion regarding mental health concerns across East Texas was only one session that was part of the Nacogdoches-Lufkin-SFA Day in Austin, which began Wednesday afternoon and continues today. Today, Lufkin-Nacogdoches-SFA Day patarticipants will attend meetings in House and Senate chambers.

But regarding the mental health issues that are affect rural texas counties, Texas is currently 47th of all states in terms of funding for mental health services, according to Department of State Health Services. Reductions in recent years to state funding for mental health has left the department able to serve only 28 percent of the estimated 450,000 adults statewide that have the greatest mental health needs, according to Department of State Health Services.

Since there is a finite amount of money available to help people with mental illnesses, only the most serious cases get attention from the state, Cozzad said.

He added, "But that leaves a lot of other people without the help."

Read more!

University to staff area clinic - Springdale (AR) Morning News

A 36-bed mental-health unit staffed by University of Arkansas Medical Sciences and supported by Ozark Guidance Center could be housed in Northwest Medical Center in Springdale, if funding for renovation and operation can be secured.

David Williams, CEO of Ozark Guidance, said today that the Little Rock-based medical school, the Springdale hospital and the local mental-health center have reached substantial agreement on the plan and will submit requests for funding to the Arkansas Legislature.

“All parties are working on it,” he said, emphasizing that the agreement is “not 100 percent yet.” But they’ve agreed to announce their plans and ask lawmakers to file the necessary funding bills this week.

The project would answer a long-term need in Northwest Arkansas for in-patient mental health care, allowing more than 400 hospital admissions per year, Williams said.

The figure compares to about 150 admissions Ozark Guidance has been able to get for charitable care in recent years.

The proposed unit would be large enough and sufficiently staffed to provide more efficient care and shorter stays for patients who need to be hospitalized, Williams said.

Projected cost to renovate space in Northwest Medical Center for a 36-bed unit is $1.6 million, which Williams said could come from General Improvement money, if lawmakers agree.

He said Ozark Guidance would also need additional charitable-care funding in its regular appropriation and would be requesting $325,000 in the first year of the biennium and $600,000 in the second.

Under the agreement, Northwest will host the psychiatric unit in its Springdale hospital. UAMS Department of Psychiatry will provide the medical staff and clinical leadership to manage the unit and will have residents doing in-patient and out-patient treatment. Out-patient treatment will be coordinated with Ozark Guidance, which will provide continuity of care for patients moving in and out of the hospital and provide a single-point of entry into the state medical system.

Williams estimated it would take six to seven months for the facility to open, assuming work begins in July. Most of the rooms in the psychiatric unit would be single rooms, although a few may be double-occupancy. Read more!

Iowa county's mental health costs 'in good shape' - Council Bluffs (IO) Daily Nonpareil

TIM ROHWER, Staff Writer
02/21/2007
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While a number of Iowa counties are struggling with mental health costs, that's not the case in Pottawattamie County, three local officials said.

In fact, one official said, the county's mental health fund is operating "totally in the black."

"My understanding is that we have been able to maintain enough county money to run a viable system right now," said County Supervisor Roger Williams. "We're doing OK for the time being. We're not one of those counties scrapping at the bottom of the barrel."

Every county's mental health program receives operating funds from the county itself and from the state, which includes what's called supplemental funding. The state also picks up 82 percent of the cost of case management programs in which a caseworker helps determine the needs of the individual.

This year, the state contributed $142.6 million to counties for mental health and disability services. Since 1997, however, state lawmakers have placed limits on the amount of tax money counties can collect for those services, while cutting millions of its own dollars intended for county budgets.

Williams and supervisor Melvyn Houser, were among several from southwest Iowa who traveled to Des Moines Feb. 14 to discuss various issues with lawmakers. The issue was brought up in the discussion, Williams said.

He was led to believe there are a large number of counties around the state struggling with the issue, Williams said, though it's less problematic for the higher-populated ones.

"I got the impression it is tougher in rural areas," he said.

There was talk during the discussion about county-to-county inequities in mental health funding, Williams said.

"A lot of the discussion was like, 'Is that fair?'" he said, but added, "I heard nothing from the legislators about lifting the cap. I heard nothing about changing the cap."

"Pottawattamie County is very fortunate in that the revenues we have received from the state to supplement our tax dollars has been sufficient," county Auditor Marilyn Jo Drake said. "And, we have been able to keep at least 10 percent cash carryover at the end of each fiscal year. At this point in time, Pottawattamie County's mental health fund operates totally in the black. Between the state supplement and our tax dollars levied each year in the mental health fund, it is sufficient to pay all the expenditures to provide all of people their needed services."

The county's mental health department will have a $2 million carryover for fiscal year 2008 that begins July 1, and a similar carryover the following year, Drake said.

Suzanne Watson, who oversees the county's mental health program, said a lot of counties have levied the full amount allowed, but as costs continue to rise they haven't been able to get additional money.

"We are levying 70 percent of what we can levy," she said. "Pottawattamie County is sitting as one of the best, as far as our ability to provide services."

Approximately 1,083 residents use the county's mental health services, Watson said, and 360 people are in its case management program.

The county board spent part of Tuesday discussing Watson's fiscal year 2008 budget.

Watson has proposed spending $8,836,884, while the county is going to levy for $3,233,599 of that amount, according to Drake.

Williams had high praise for Watson's work.

"Suzanne runs a tight program and accounts for every dollar and spends it very wisely," he said. "We're still in good shape." Read more!

Critics of Maine mental health budget cuts turn out in black - AP

AUGUSTA, Maine --As anticipated one day earlier by Health and Human Services Commissioner Brenda Harvey in her opening presentation, a Baldacci administration plan to pay less to mental health service providers came under sharp attack Wednesday as legislative budget hearings continued and audience participation increased.

"What is being proposed is not rate standardization but simply a rate cut," said Chris Copeland, president of the Maine Association of Mental Health Services. "Bringing down the maximum rate paid to providers without raising the minimum doesn't standardize rates."

Copeland, the executive director of Tri-County Mental Health Services in western Maine whose association claims more than 40 providers, was one of numerous witness speaking before an overflow crowd and the Legislature's Appropriations and Health and Human Services committees.

Some in the audience wore black clothing to signal their unhappiness with proposed budget cuts.

Baldacci administration officials told the committees Tuesday that care management initiatives for mental health system clients could generate about $54 million in savings over two years, while standardizing Medicaid payment rates and lowering the highest provider-specific rates could net another $20 million.

The savings have been proposed within Baldacci's $6.4 billion budget package for the two years beginning July 1.

Copeland testified Wednesday that his association favors contracting with an experienced company -- an administrative services organization -- for management and rate-setting.

However, he added, taking renewed aim at the administration budget plan, "attempting to reduce overall costs with managed care and (simultaneously) attempting the rate reductions proposed will push a beleaguered system closer to collapse."

The president of the board at Community Counseling Center in Portland, Lisa Toner, told lawmakers they should consider "a more rational approach to savings than the harsh budget cuts recommended in this budget."

Urging more thought, Toner added, "Just saying that Maine's providers are paid too much and funding should be cut ignores the complex and delicate reality of providing these safety net services to low-income, isolated and often very ill people."

Not all the critics focused on reimbursement rate changes.

"As I understand the two policy changes anticipated in this budget -- more utilization review, more prior authorizations, more gatekeepers in managing who is eligible for services under Medicaid and also reducing the Medicaid payments to providers at mental health centers, I sense this will only exacerbate an already inadequate system of health care delivery to those in such desperate need," said an Episcopal Church priest active in the Maine chapter of the National Alliance on Mental Illness, the Rev. James Gill of Winthrop.

The budget hearings have been the primary focus at the State House this week with the Senate and House of Representatives scheduled for no floor sessions and most other committees idle or operating with light agendas.

The Appropriations Committee's concentration on human services programs in the Baldacci budget package, with the Health and Human Services Committee sitting in, runs through the week.

Other major elements of the package include a tobacco tax increase that would produce about $66 million a year and bring the tax per-pack of cigarettes in Maine to $3 -- the nation's highest among the states.

The governor also hopes to shrink 152 school district administrations around the state to 26 units known as regional centers. Administration officials have booked $36.5 million in savings from such a consolidation for fiscal 2009. Read more!

Tough times for mentally ill, jailers in small town Texas - Navasota (TX) Examiner

By STEVE SNYDER Examiner editor

For many years, Aaron George has all too often been trapped by prisons of his own mind.

Unfortunately, when George is mentally incarcerated due to the effects of schizophrenia and bipolar disorder, plus post-traumatic stress disorder and anxiety disorder - and, for the last year, a brain cyst - he often winds up also being physically confined in a jail cell.

His current residence, since Thanksgiving Day, is the Grimes County Jail.

Sheriff Donald Sowell has the unpleasant, and often frustrating, duty of being his jailer.

He, too, is incarcerated, in a sense. He is "locked up" by a small county's small jail budget, which includes not only a relative lack of manpower but no special facilities and no special training to give full care to people like George, who is the worst but not the only casualty of the state's, and nation's, mental health system to end up in his custody.

Sowell said he has been combative, and has even had to be restrained. He keeps in touch as much as possible with George's mother, Beverly.

Beverly holds no animus toward Sowell or the jail. She, too, recognizes the limitations Sowell has.

"They have been absolutely helpful," she said. "I'm upset, but not with the people there."

With a state Mental Health Mental Retardation department limited in what it can do as far as outpatient care, not to mention limited by an ever-shrinking, ever-more-lopped budget, and a state mental hospital system, at Vernon or elsewhere, either lacking bed space or unwilling to take George on until he has been "processed" through the criminal justice system, he remains in Sowell's care, and on his hands.

Beverly said MHMR has sent a caseworker, but nobody with more specialized training. Other than that, he has not had a psychiatrist visit him, his mother said.

Beverly recognizes this is an ongoing burden for Sowell, too.

"He earlier had a patient similar to Aaron, and it took a him a year to get him out of there and to Vernon," she said.

In Houston, MHMR opened a 40-bed hospital for the mentally ill in the late 1990s. But Sowell doesn't have that option, even if George had a lesser criminal charge staring him in the face, or a lesser criminal history behind it.

The charge that got George arrested - this time - is aggravated assault. That offense, being a felony, is the sticking point, even though his mother and stepfather, Alfred Istre, don't want to press charges any more.

"They said it was aggravated because he had steel-toed boots. I said that, but I was mistaken," she said. "Yes, he was LifeFlighted, but his injuries were not serious."

She added that she had called for the authorities in part because she was concerned about her son's safety. In fact, Beverly George said that she and his stepfather filed an affidavit to dismiss charges just a week after the arrest.

But, Sowell's efforts aside, Beverly George is still a worried mother.

"My son is in danger," she said.

Complicating the aggravated assault charge is that George remains on parole from a 1996 conviction years ago for allegedly killing his 6-week-old son, Alexander Daaron, in 1992. Beverly, Alfred and the rest of his advocates contend then and today the infant died because of an aneurysm. But, in part because Aaron had told detectives he had shaken the baby, he was convicted.

Treated since he was a child by Dr. Gary Miller, who served as commissioner of the Texas Department of Mental Health and Mental Retardation from 1982 to 1988, he was taken off the medications Miller had prescribed for him.

After that, he was placed in the general prison population.

His mother says he has not been the same since.

The post-traumatic stress disorder comes from rape and beatings Beverly said he suffered while in prison.

Before that time, he had not been problematic, she said. He took his medications and she made sure to take him to his psychiatrist, she said.

District Attorney Tuck McLain disagrees on George's past criminal history and the likelihood he is a current threat not only to himself but the rest of society. That said, he too is frustrated, and even "incarcerated," by the state's inadequate and also Byzantine system of mental health care.

"I'm incredibly frustrated," he said. "I read somewhere the state has 795 mental health beds. They could quadruple that and it wouldn't be enough."

But, as the district attorney, he sees George as having committed a serious felony, having a previous felony record, and therefore someone who should not be in public.

"Do we let a killer go on the streets of Grimes County or do we leave him in jail," he rhetorically asked. "My concern is that he has already killed one person. Sometimes you have to make those choices."

However, George may not have to go through the entire criminal process, at least not at this time.

One reprieve for now could be granted at a competency hearing, which is set for March 9, according to his mother.

McLain explained how a hearing on a suspect's competency to stand trial works, including noting carefully that this is an entirely different issue from insanity as a criminal defense within a trial.

A competency hearing is based on the judgment of an independent, court-ordered mental health expert. Based on that person's findings, the court can find the suspect competent to stand trial, currently competent with a likelihood of recovery, and currently incompetent with no likelihood of recovery.

Especially in cases of incompetency with likelihood of recovery, but in general, McLain said his office doesn't usually appeal a court ruling.

What would then happen is that George would be sent to the state mental hospital in Vernon.

As for George doing that, then having to go through the entire criminal process before getting help, McLain has his opinion on that, too.

"Quite frankly, it's useless," he said.

He said that often, Vernon's medication regime can include tranquilizers, not just antipsychotic medication. A mental patient is calmed down enough to regurgitate basic facts and statements, then declared competent and sent back for trial.

The other thing is to get him found to have violated his parole and sent back to the Texas Department of Criminal Justice, where he would likely and hopefully go to its Skyview mental health unit. McLain said his assistant has already done the first step in that process by getting a "blue warrant" issued against George.

Contact Steve Snyder at editor@navasotaexaminer.com. Read more!

Mental health services 'fragile' - Durham Herald-Sun

By Emily Coakley, The Herald-Sun

CHAPEL HILL -- Orange Person Chatham Mental Health has finished part of its mental health reform goals but challenges remain, the agency's executive director told the Orange County Commissioners on Tuesday night.

Judy Truitt said the different services the agency provided have been turned over to independent organizations.

"The providers that we divested and services we moved into the private market are reasonably stable, but our system remains fragile," Truitt said.

All over the state, organizations such as OPC, which is a government entity, have had to get out of the business of being managers and providers and just be managers. The state Legislature mandated the change, and the idea was to increase a client's choices when seeking a provider.

OPC served more than 5,100 people in the three counties during 2006, and nearly half the people served were Orange County residents, she said. Clients include people seeking help for mental illnesses, developmental disabilities and substance abuse issues.

About this time last year, OPC had trouble making ends meet while adjusting to state reforms. By June, the state's Department of Mental Health gave the agency access to $2 million, which helped relieve the crunch.

"We are pulling out of the financial crisis that we were in last year," Truitt told the board.

Some problems remain. When the state allocated money for this fiscal year, OPC received about $243,000 less in funds for children's services than it received the previous fiscal year. The reason, Truitt said, was OPC didn't spend that amount of money in the previous year.

Truitt said OPC tried to have that money transferred to be spent on other services, but that request wasn't processed in time.

For the same reason, OPC received less money to serve people with developmental disabilities and substance abuse issues. With the children's services, that lost money totaled about $400,000, she said.

But the General Assembly put millions of dollars of new money into mental health for this fiscal year, and OPC's allocation was about $543,000.

Mike Nelson, a commissioner, asked Truitt about gaps in local services.

A major gap, she said, is in substance abuse treatment, adding that there are not enough licensed and credentialed people available statewide to work with those who need help.

"I think that appropriate housing and job opportunities for consumers are significant issues across the state and certainly here in the three-county area," Truitt said. "Residential treatment options for children are also an issue."

Children who need treatment in a residential setting have to go to the Charlotte area or Asheville, instead of staying in the community.

OPC is working on ways to help people access mental health services in different areas, including through Orange County Schools and the Department of Aging, Truitt said.

The agency is also working on a new three-year business plan, and a top priority is increasing public service ads to let people know help is available. Read more!

S.C. Supreme Court rules hospital proceeds must go to mental health - Columbia State

COLUMBIA -- The S.C. Supreme Court has ruled the state can sell the 178-acre State Hospital campus on Bull Street in Columbia, but the State Department of Mental Health will keep the money.

The ruling paves the way for a future developer to build thousands of homes, offices and stores according to an innovative "new urbanist" plan that focuses on high density and a variety of prices.

Mayor Bob Coble and downtown boosters say the new neighborhood will reshape the city's core.

"This is a red-letter day for Columbia," the mayor said. "Bull Street and (USC's) Innovista (research campus) together can transform our economy."

The sprawling campus is the largest single tract of property to come available in downtown Columbia in decades.

Because of the complexities of zoning and marketing the massive tract, the sale could take up to a year, backers say. But a spokesman for the Mental Health Department said it could take up to three years and tens of millions of dollars to move the remnants of its operation to other locations.

There are 60 children housed on the site, and an additional 140 patients are going to be moved there temporarily because of roof problems at another facility, spokesman John Hutto said.

"It's a big piece of property," he said. "We would hope the marketing and selling could get under way while we're still in our corner taking care of business."

Advocates for mental health care hailed the ruling as a "major victory."

"When South Carolina started closing long-term hospital care for patients, we were promised the (savings) would be reinvested in mental health services," said Dave Almeida, executive director of the S.C. Chapter of the National Alliance on Mental Illness. "This is the last chance for the state to make good on that promise."

The S.C. State Budget and Control Board -- the governor, treasurer, comptroller general, House Ways and Means Committee chairman and Senate Finance Committee chairman -- will handle the mechanics of the sale.

'Much work to be done'

Board spokesman Mike Sponhour said "there is much work to be done" before a sale can take place.

"This issue has been dormant for a year pending the (court) decision, so it's difficult to say how it will go forward," he said.

A committee appointed by Coble and Gov. Mark Sanford chose New Urbanism guru Andres Duany and his Miami-based Duany Plater-Zyberk & Co. to develop a plan for the property.

The plan calls for 1,257 residential units -- from apartments to lofts to single-family homes -- 179,000 square feet of retail space and 638,000 square feet of office space.

A central park would wind around a lake. And about a dozen historic buildings, including the Babcock Building with its signature cupola, would be reused.

Estimates on the property's value have varied widely over the years, with pundits predicting a sales price of anywhere from $12 million to $30 million.

"That's what the free market is all about," said Columbia financier Don Tomlin, a businessman who has been the driving force behind the property's conversion.

Tomlin, who developed Lake Carolina among other projects, has vowed not to make money off Bull Street, but to shepherd the process for the good of the city.

The biggest of a litany of decisions the five members of the budget board have to make is whether to adopt Duany's plan and present it to the Columbia Planning Commission.

Sanford spokesman Joel Sawyer said the governor could not speak for the full board, "but we like what we've seen so far." Read more!

Armed man killed as papers served - Charlotte Observer

MARCIE YOUNG
myoung@charlotteobserver.com

A Catawba County man who was being served with mental health commitment papers was shot to death during a standoff with authorities Tuesday.

Marty Dale Rogers, 32, was killed shortly after noon in a field near his home north of Conover, about 70 miles northwest of Charlotte, authorities said.

Catawba County Sheriff David Huffman said Rogers, who was dressed in camouflage and hiding in the field's thick brush with an automatic rifle, was a threat to the officers surrounding him.

"We didn't have a choice," Huffman said. "If we had not shot, he could have taken out four or five officers." Huffman was not sure who shot Rogers or who fired first, he said.

The State Bureau of Investigation was investigating.

Rogers' family would not comment, but neighbors remembered him as a loving father to his 9-year-old son.

"He was an excellent dad," said neighbor and lifelong friend Donna Sipe. "They did everything together. They went hunting together, four-wheeling together, you name it."

On Tuesday morning, Huffman said, Catawba County sheriff's deputies went to his house to serve papers that would allow them to take Rogers to a hospital for a mental health evaluation.

Mental health officials told the Sheriff's Office that Rogers had made threats, and deputies received reports that he was armed, Huffman said. Huffman said he did not know details of Rogers' mental problems.

As deputies tried to serve the papers, Rogers jumped into a pickup and led them on a 15-minute chase around the area, Huffman said.

The chase ended less than a mile from Rogers' house, after he stopped the truck behind another home.

Rogers' neighbor and longtime family friend, Jerry Sigmon, said he was working on his car next door and tried to approach the truck. Rogers raised a gun, he said, but lowered it when he recognized Sigmon.

An officer yelled at Sigmon to go into his house, and Sigmon complied, he said.

Shortly after that, about 50 officers arrived, Sigmon said.

Rogers got out of his truck with a weapon, which Huffman said was an automatic rifle, ran several hundred yards and then hid in a brushy area.

Members of the STAR team -- Catawba County's version of a SWAT team -- surrounded Rogers and saw him raise the gun, Huffman said.

Officers told Rogers to put the gun down several times, and he twice complied.

He raised the gun a third time, unlocked the safety clip, and officers fired several shots, Huffman said. Rogers was struck and killed.

"When someone raises a weapon and takes the clip off, he's ready to shoot," Huffman said. "You have to make a snap decision very, very quickly." Read more!

Dallas Jail Settles Mistreatment Lawsuit - AP

By MATT CURRY

DALLAS — County officials approved a nearly $1 million settlement Tuesday with the families of three mentally ill inmates who were denied medication while in the country's seventh-largest detention complex.

Just over half of the award went to James Mims, a Dallas County jail inmate whose psychiatric medications were withheld for two months in 2004, his attorney David Finn said. Mims also nearly died when water was shut off in his cell for two weeks.

"They could just not afford to have this case go before a jury," Finn said.

Commissioners approved the $950,000 agreement without discussion.

The federal civil rights lawsuit was filed in December 2004 on behalf of inmates Mims, Kennedy Nickerson and Clarence Lee Grant Jr., who died in custody.

Grant, who had paranoid schizophrenia, was found dead in his cell after not receiving medicine for five days in 2003, according to court records. An autopsy showed he died from complications of diabetes, pneumonia and other ailments.

Nickerson, who also has paranoid schizophrenia, was released from jail in 2003 without medication. A few days later he was found on the street dehydrated, suffering from fever and seizures, court records show.

The U.S. Department of Justice told the county in December that the jail violates inmates' rights by failing to provide adequate medical and mental health care, and warned that a lawsuit could be filed if the problems weren't fixed. Read more!

Call may have thwarted tragedy - Wilmington Star-News

By Myron B. Pitts

Let me be the first and maybe the only person to give Deyon Branch a little credit.

Branch is the mother who Fayetteville police say pulled a gun on her children about 9 a.m. Thursday. Reports say that Branch was angry that the children, ages 9, 10 and 12, would not clean their rooms.

Branch, 29, of the 6400 block of Rockford Drive, has been charged with felony child abuse and other offenses. Bail is set at $2,500, and she will not be allowed to be alone with her children.

What I credit Branch for is her decision to call her husband, Michael. She may have saved her children’s lives.

She called to tell her husband, who was at work, that she would kill the children unless he stepped in, police reports said.

What led her to make that call? I’m feeling spiritual enough these days to suggest that something moved her from on high.

Even if her savior was merely a momentary touch of clarity or a pure lucky turn, it seems that something caused whatever switch that snapped on Thursday to snap back off, at least for several crucial seconds.

After reading about Branch, my mind could not help but wander to Andrea Yates. I wish Yates’ clouded mind could have cleared long enough for her to call her husband.

You may recall that she is the Houston mother who, in 2001, drowned her five children one by one. She had suffered from severe postpartum depression.

Something else the Branch case brought to my mind is how many women have no husband to call. Single mothers must find their own ways to pull back from the breaking point with their children.

Calling someone at the critical time can be key, says Charnett Muhammed, a case manager and substance abuse counselor at Family Alternatives, a community family counseling service.

She says a mother she knew had hit her daughter in the hand with a telephone and immediately called the Department of Social Services. Social Services is one option, Muhammed says, because it can steer parents toward addressing underlying problems, such as mental health or substance abuse issues.

“You need support,” she says. “You need somebody to help you through the situation.”

Missing child

Branch has been in the news before in a drama involving one of her children.

In 2003, she arrived at Cliffdale Elementary School to find her then-kindergartner, Michael Jr., missing.

“I had a panic attack,” she said at the time. “How could you let a 5-year-old get away?”

Then, too, she called Michael Sr. He went to the school and worked with deputies to search nearby neighborhoods. The boy was found that afternoon at a friend’s house.

Branch’s timely phone call Thursday does not erase the seriousness of the charges she faces. There is no telling the emotional long-term effect on the children.

One can only hope that, whichever turn her case takes, she will eventually wind up in some kind of counseling.

Columnist Myron B. Pitts can be reached at pittsm@fayobserver.com or 486-3559. Read more!

State needs to fix mental health reform - Hendersonville Times-News

Letter to the editor

To The Editor: Mental health care, here and nationally, is in a scandalous state today in spite of publicity coming from some sources to make us think otherwise.

An indicator is our state government's continuing failure to accept the monumental crisis in mental health reform. Examples include capping of hospital beds, mentioned in a recent Times-News article, while at the same time cutting Medicaid benefits for mental health care in the community.

I hope this "sticking their heads in the sand" syndrome is only because the North Carolina legislators move ever so slowly.

Another local advocate, Diane Bauknight, points out, "The reason that state hospitals are overflowing is because the service definitions stink, the Medicaid reimbursement rates are too low, there's very poor support for private providers, the full continuum of 'community based services' the reform promised never materialized, and private hospitals pick and chose who they will serve (and they often will not accept our sickest people).

"People are in state facilities because the intensive community based services needed to treat the so-called target population the reform was supposed to serve are inadequate, at best, and in some parts of the state do not exist at all."

Robert H. Andersen
Laurel Park
Read more!

$1.4 billion awarded to help the homeless - AP

WASHINGTON -- The federal government awarded nearly $1.4 billion in grants to support local homeless programs yesterday, a slight increase from the year-ago amount.

North Carolina's share was $18.6 million, an increase of 13.9 percent from last years' $16.3 million.

Local agencies compete for most of the grants, which support more than 5,300 programs across the nation. The grants pay for a range of programs, from emergency and transitional housing to job training and substance-abuse counseling.

The goal is to get people off the street and provide them with the services they need to keep them from returning.

"Whether it's a single man living with a mental illness or a family struggling to give their children a roof over their heads, this funding is quite literally saving lives," said Alphonso Jackson, the secretary of Housing and Urban Development.

Local programs for the homeless use the federal grants to obtain more money from state and local governments and private donors, said Nan Roman, the president of the National Alliance to End Homelessness.

Roman called the grants "essential," but said that they are inadequate.

"As important as this is, it's remedial," Roman said. "It helps people after they have fallen over the cliff. We need to keep them from falling over the cliff."

Roman's group recently used HUD data to estimate that the United States had 744,000 homeless people in 2005. A little more than half were living in shelters, and about 40 percent were living on the street.

"It's really the lack of affordable housing," Roman said. "We have a huge affordable-housing crisis in this country."

Read more!

Jail project seeks to relieve crowding - Charlotte Observer

Focus on alternatives for mentally ill

CARRIE LEVINE
clevine@charlotteobserver.com

Mecklenburg County will renovate some temporary jail facilities in the north part of the county to ease inmate overcrowding, County Manager Harry Jones said Tuesday.

But proposals for a permanent new facility are unlikely to come this year.

Jones said early estimates for the temporary project are between $5 million and $6 million, and he expects it to take about six months.

Sheriff Jim Pendergraph asked county commissioners for relief in October, saying the crowding was "reaching a boiling point." On Tuesday, Jones said the county has hired consultants Kimme & Associates to study the need for jail space and how best to meet it, and the study is likely to take eight months. That means it's unlikely that the county will ask voters to approve borrowing money for a new jail in November, Jones said.

Jones said he also backs creating programs to treat inmates with mental health and substance abuse problems. In a presentation to county commissioners Tuesday night, Mecklenburg Area Mental Health Director Grayce Crockett said offering offenders appropriate mental health care when they are arrested could cut recidivism and save taxpayers money.

Many inmates are mentally ill and have substance abuse problems, Crockett said.

She said her staff had researched a possible model for such programs that would include training police officers to respond to situations involving mentally ill people, creating a crisis center that would assess and stabilize them and creating residential treatment options.

Crockett said she plans to visit a crisis intervention program in Wake County next month, and also will study the costs of the program so county commissioners can consider including it in next year's budget. Read more!

New director facing challenge - Eastern Wake News

Originally published Feb. 20
By Johnny Whitfield, Managing Editor

As Ramon Rojano prepares to take over as the leader of Wake County’s Human Services Department, he faces many challenges. In a state where much of the burden for paying for Medicaid costs rests with the counties and not the state, Rajano will have to exercise considerable fiscal restraint while at the same time advocating for adequate resources to serve the needs of those who call on the Department of Human Services.
Perhaps more importantly, Rojano will have to figure out how to serve the needs of Wake County’s mentally ill.

Reform has been the operative buzzword in the mental health community for the past five years or so.

But the bottom line in all the changes regarding mental health has been the sheer incompetence of people leading the way at the state level.

The theory behind the reform was to provide less hospital care and more care in the communities where patients live.

That service, reformers said, was to come from the private sector, which the state believed would step to the fore when it was needed.

That hasn’t happened as readily as state officials had hoped and other parts of the reform plan have continued on unabated, including plans to close Dorothea Dix Hospital and John Umstead Hospital in Butner. In their place, the state plans to build a hospital smaller than either one of those institutions to care for the mentally ill in both service areas.

Enter Rojano who must figure out how to navigate the perils of mental health reform in North Carolina while providing quality services to a largely forgotten segment of our society.

We wish him well and we caution him to keep a bulldog’s mentality when it comes to advocating for this group of constituents who so desperately need more champions. Read more!

Missing Mental Health - Raleigh News & Observer

Letter to the editor:

Gov. Mike Easley used his State of the State speech on Feb. 19 to give himself a big pat on the back and talk about tax cuts and education, two of the safest topics for any politician. But it's what he did not say that speaks the loudest. The governor missed a golden opportunity to show an interest in the state's failed mental health system, which has completely unraveled since he came to office.
Easley's silence says it all.

Mark Sullivan

Carrboro Read more!