Albemarle Mental still short on answers - Outer-Banks Sentinel

BY VICTORIA BRAGUNIER | SENTINEL STAFF

The Dare County Board of Commissioners held a special meeting on March 28 to hear what representatives from Albemarle Mental Health had to say about the plan for which they were seeking commission approval.

This meeting resulted from a heated exchange between the two groups at the March 19 board meeting. At that meeting Albemarle requested that the board approve their three-year business plan and sign a letter supporting the building of a detox center in Martin County. Albemarle made the requests without giving the board specific documentation regarding funding or how the group would serve Dare County residents.

The purpose of the special meeting was so that Albemarle could present a detailed report outlining its budget and services provided to Dare County. The plan submitted for the special meeting was almost identical to the plan submitted at the earlier meeting. The primary difference with the newly-submitted documents was that additional attachments were included that described the administration and management of Albemarle Mental Health as a Local Management Entity (LME). It failed to address most of the issues the commissioners wanted addressed.

Before explaining the plan to the board, Sandra Jordan-Leigh, LME coordinator for Albemarle Mental Health, thanked the board for bringing to her attention that the 24-hour crisis line was not being answered.

"I checked on the phone issue and found that when the phone goes down, it resets itself but it does not connect back up to the 24-hour service," said Leigh.

"Our local business plan addresses the Local Management Entity. That is what we are required to submit to the Division Of Mental Health — it is more of an administrative management plan versus a directive of clinical care services. The only thing that you will see in the plan that addresses clinical services is the request that we [Albemarle Mental Health] will continue to provide services as a safety net to community," said Leigh.

Jack Shea was the first commissioner to question Albemarle's failure to address the issues.

"In reading it [the plan], I noticed it was written in what I call 'government-ease.' That format makes it hard to read and understand. Some of the areas in the plan need to be fleshed out more. One of the major issues has to do with providers and services. I saw nothing addressed in the plan about how you are going to recruit more providers of services to Dare County. Also, there was nothing in the plan about allocation of monies or how much money is being allocated for Dare County. Those are all very important issues that were not addressed," said Shea.

"In regard to the providers and services," said Leigh, "you will see in the plan the phrase 'that Albemarle LME is to remain an active force within the community, by serving as a safety net to provide all mental health services to the citizens of the community' and that is the catch all phrase that the LME can state to show that we are the provider of last resort and that is the most extensive that I can get into that," said Leigh.

She then went on to discuss recruitment issues.

"Additionally, we will continue to use recruitment efforts everytime someone calls and wants to get on our provider list," said Leigh.

"But what are you going to do to actively recruit providers?," said Shea.

"That is an area we are working on. As far as sending out requests to providers for proposals. One of the difficulties we encounter is the change to the service definition. There are specific services that providers are able to provide that are profitable, such as one-on-one therapy sessions. But if the services requires a large team approach, such as a whole psychiatric team, most providers can't afford to do that. Unfortunately, what we are finding is in rural areas, such as Dare County, we have found that providers are unable to afford to bring those resources together and therefore can't offer services. The other problem is the guarantee of consumers in this area. These consumers are more reactive to treatment than involved in preventative measures and so providers can not just open there doors and be profitable and stay in business. Therefore it makes it difficult to recruit and keep providers for this area," said Leigh.

Shea then asked if Albemarle had tried to use "circuit riders," where providers come out for a day or two a week to offer services.

"We have tried that, we had several large mental health providers — I will tell you their names, Life Incorporated, Pride in North Carolina, Health Services Personnel. At one time, they provided outpatient therapy services here and after providing those services for about 18 months, they realized it was not profitable to continue the offices down here and it became too much of an expense, so they closed the offices. We have tried that approach, but it was not successful," said Leigh.

Before Leigh could continue another Albemarle representative started to speak.

"If I could address that, all of this has to do with what is paid by the Medicaid rate and it is only affordable for the chronic population. So for providers coming in, they have to fit their services to the target population, which is a very narrow group of individuals and Medicaid does not pay a terrific rate. Additionally, the Medicaid regulations now require that providers have more than one staff person and that the client be treated two to three times a week. That makes it much more difficult for providers come in and be able to afford practicing," said Lee Walton, consultant to Albemarle.

Leigh then spoke up and addressed Shea's earlier question regarding how funds were to be allocated.

"The monies were not identified in the plan, that is because the business plan model that we have to submit to the State does not allow for that description," she said.

Walton interjected in the conversation stating that those figures would be provided in the budget that the commissioners will receive in the next few months.

"The biggest question I get from citizens is what services are being provided by Albemarle Mental Health?" said Max Dutton, commissioner.

Bonna Meadows, chief of clinical services answered Dutton's question.

"We have three offices in Dare County. They are located in Nags Head, Avon and Manteo. We do individual outpatient therapy, group therapy and medication management," said Meadows.

Dutton then asked what members of the public should do if they need to get someone into detox.

"If you are assisting someone into getting into detox, then you would bring them to our unit if it is in the daytime. Detox is different than other mental health treatment because detox admission requires that the patient see a physician. If we have a doctor at our unit, then the doctor would see them. Some of the detox facilities want lab work done prior to admission, so the patient may need to go to the hospital," said Meadows.

"Where would a person go for the detox treatment?" said Dutton.

"They would have to go to Greenville, Ahoskie and maybe even Wilmington," said Meadows.

Warren Judge asked Meadows what the hours the three Dare County offices are open.

"We are open eight to five, Monday thru Friday in Nags Head, and in Manteo it's eight to five Monday thru Friday, but I don't have a therapist on Thursday or Friday. The office in Avon is open Monday, Wednesday and Friday from eight to five," said Meadows.

Commissioner Virginia Tillett asked about why the detox facility was being built in Martin County and how the decision to build the facility there was made.

"What criteria did Martin have that Dare County did not?" asked Tillett.

"One of the issues that came up with building a detox facility in Martin, was that the hospital in Martin was willing to give space for the facility," said Leigh.

"Another factor was that Martin has a large staffing pool already located there. That staffing pool comes from a previous facility that has just recently shut down. Additionally,the Martin County Commissioners found the land, so the county was very willing and the hospital is very willing to help out, so those are some of the reasons," said Walton.

"How can we help you get more money to provide more services to Dare County?" asked Tillett.

"The best way to help us,is to approach your legislature and ask for changes to the statues," said Walton.

The board then discussed ways to help Albemarle and better assist the residents of Dare County. The board decided that Albemarle's business plan and letter of support were worthy of support. They voted unanimously to approve both measures.

victoria@obsentinel.com | 480-2234 Read more!

Crisis services lacking in Wilson, some say - Wilson Daily Times

By Rochelle Moore Daily Times Staff Writer

Kay Brannan considers herself lucky when it comes to finding adequate mental health services for her two adult daughters.

But years ago when the girls were teens, the services they received through the Wilson-Greene Mental Health Center were lacking, she said.

"Historically it's always been a problem getting services," she said. "Based on what I had and what my children experienced at the Wilson-Greene Mental Health Center, the services they received were poor."

Brannan, whose daughters now receive care through the private sector, knows many people haven't been so lucky. Statewide efforts to reform the mental health system have created problems and concerns for many seeking care. And many say that people, especially those in crisis, are falling through the cracks.

"I know what's going on and there's a huge gap in services," said Brannan, a member of the Mental Health Association board. "I think the biggest problem is for those individuals who do not have strong family support. There's nothing there for them, there's nowhere for them to turn.

"The need is great. I would say the general population doesn't know where to go if they need help."

The high number of Wilson County admissions into state psychiatric hospitals show that the lack of local crisis services is having its toll, said Jennifer Hancock, executive director of the Mental Health Association in Wilson.

Wilson, Greene, Nash and Edgecombe counties have the highest number of people per capita utilizing short-term service in state hospitals, according to a Community Systems Progress Indicators report filed with the state Division of Mental Health.

From July 1, 2005 to June 30, 2006, Edgecombe and Nash counties had the highest admission rate into the state psychiatric hospital system. Wilson and Greene counties follow with the second highest admission rate.

"Part of the reason we're over-utilizing the state hospital is because there are no crisis services available locally," Hancock said.

If services were provided to help people calm down after a short-term crisis, she said, the need may never exist for them to receive even more intensive services in a state psychiatric facility.

"Before someone is admitted into a state hospital, they have to be a danger to themselves or others," Hancock said. "There are levels of crisis before that and if we addressed that, (the admissions) wouldn't happen."

Mental health advocates blame state efforts to reform the mental health system as causing an increasing number of people to enter state psychiatric hospitals. State reports also show that more and more people are entering jails, emergency rooms and adult care homes.

Mental health reform in North Carolina started in 2001 with a restructuring of service delivery. The public mental health system has removed itself from providing services to managing services through the private sector.

"We've gone from a public system where if anyone walks through the door, they'd get services to a private system," Hancock said. "No private provider has to provide services to anyone."

The greatest problem for Wilson County residents is the lack of crisis services for people experiencing a mental breakdown or other short-term mental crisis, like depression, suicidal thoughts or overwhelming grief from the loss of a loved one, Hancock said.

"There is nowhere locally for these people to go," she said. "There's no service until you're a danger to yourself or others."

People who have a mental health crisis may enter the emergency room at Wilson Medical Center and receive an evaluation from hospital staff.

Following an evaluation, patients are given service referrals, they are placed in the hospital's psychiatric wing or they may be sent to another mental health facility by their own choice or through an involuntary commitment, said Connie Rhem, corporate communications manager at Wilson Medical Center.

Cherry Hospital in Goldsboro is one of the state's four psychiatric hospitals that admits patients if they are a danger to themselves or someone else.

Even though services can be found through the Wilson-Greene Mental Center or in the private sector, Hancock says that Wilson residents are not being adequately served when in crisis.

"From these limited services, there's nothing in between the state hospital and that," Hancock said. "There's just a big gap between people who can live in a community with limited support and someone who is a danger to themselves."

A 2007 report to the General Assembly by the Joint Legislative Oversight Committee on Mental Health, Developmental Disabilities and Substance Abuse Services also notes that local communities do not have needed crisis services.

The result is leading more and more people into hospital emergency rooms, jails and the state prison system. During the 2004-05 fiscal year, 64 percent of people newly admitted into North Carolina prisons were assessed to have substance dependency problems.

"Chemical dependency is a psychiatric illness," said Maj. J.H. Farmer, with the Wilson county Sheriff's Office. "It's like any other sickness or disease."

Wilson County has experienced an increase in people needing mental health services through involuntary commitments to psychiatric facilities. There has also been increased use of services through the New Foundations psychiatric unit at Wilson Medical Center.

In 2005, New Foundations staff completed mental assessments on 648 patients. In 2006, the number increased to 1,083. Also in 2006, Wilson Medical Center transferred 507 patients to private hospitals, detox centers or Cherry Hospital.

"There are a number of reasons those patients might be transferred," Rhem said. "They might choose to go to another hospital. They might require detox services, which we do not offer. Or, they might be involuntarily committed and we do not accept involuntarily committed patients."

Changes in the state's mental health system have led to the increased use of services through Wilson Medical Center, Rhem said.

Sheriff deputies are also seeing a rise in the number of people they transport for involuntary commitments. Involuntary commitments require approval by a magistrate and deputies handle the transfers to mental health facilities.

"It has been a steady increase," Farmer said. "The population is going up but so are the people who need evaluations and treatment. We're probably seeing a greater increase in chemical dependency on alcohol or drugs."

In 2002, the Wilson County Sheriff's Office involuntarily committed 407 people to mental health facilities across the state. Involuntary commitments increased to 502 people in 2006.

The Wilson County Jail has not experienced an increase in the number of people with mental health issues. Wilson police also say they have not seen an increase in the number of people being arrested and having a mental illness.

"I don't know if, at this point, we've seen any significant difference yet," said Wilson Police Chief Harry Tyson. "It's a consistent regular thing. We haven't seen the changes yet from mental health reform."

The state psychiatric hospital system has, since February, set in place limits on the number of people entering the system. Each of the state's four hospitals, including Cherry, will not admit patients if the facility is at 110 percent of its capacity.

State leaders have watched admissions increase and set the admissions caps in place for safety reasons.

"I would say over the past few years, we've had a significant increase in admissions," said Laura White, with the N.C. Division of Mental Health, Developmental Disabilities and Substance Abuse Services. "We're not staffed to handle that number of patients."

Even though admissions may be delayed, patients may go into one of the other state psychiatric hospitals or another mental health facility, White said.

White said it is difficult to determine whether increased admissions is a result of mental health reform efforts.

"The hospitals are part of the mental health system and, certainly, if people can't get what they need in the community, they may need hospitalization," White said.

Mental health advocates would like to see more local crisis services available and increased state funding to help people at the local level.

"What is most needed at this point in time is a local inpatient treatment facility where an individual in a crisis would have the crisis, immediate treatment they need," Hancock said. "In combination with these inpatient services, follow-up services need to exist that ensure the individual remains stable until they are connected with the community support services they need to avoid any regression or relapse.

"With this start we could address the issue of crisis services and decrease our dependence on the state hospitals."

rochelle@wilsontimes.com | 265-7818
© Read more!

Massachusetts Cell Suicides Hit 10 in 15 Months - AP

By THE ASSOCIATED PRESS

BOSTON (AP) -- An inmate undergoing a psychiatric evaluation hanged himself in a shower room, becoming the 10th inmate to commit suicide in the state prison system in the past 15 months, the Department of Correction said Saturday.

Jarred Aranda, 27, wrapped a shoelace around his neck at and tied it to the handle of the shower room door at Bridgewater State Hospital Friday night, DOC spokeswoman Diane Wiffin said.

It was the third suicide in Massachusetts state prisons this year, following seven in 2006. There was only one suicide in 2004 and four in 2005.

''You can't eliminate risk, you can only minimize it,'' Wiffin said Saturday.

A federal lawsuit filed this month claims inmates with mental illnesses get inadequate oversight, contributing to an increase in suicide attempts. It claims that one-quarter of the 11,000 inmates in the state prison system are mentally ill, and accuses the DOC of keeping hundreds of inmates in isolation for too long.

''We're long past the crisis stage,'' said Leslie Walker, executive director of the Massachusetts Correctional Legal Services, an inmate advocacy group that supports the lawsuit. ''It's especially disheartening that this occurred in state hospital, which is designed to protect and heal the mentally ill.''

The state's inmate suicide rate was about 27 per 100,000 inmates during the 10-year-period that ended in 2006, according to a state-commissioned report issued in February. That was nearly twice the rate nationally in 2002, the most recent figure available.

The report called for removing items inmates could use to harm themselves from cells, recommended hiring more staff to monitor troubled inmates and stressed a need for more and better training.

Aranda had begun serving a one-year sentence for larceny and assault in January. He was transferred from the Bristol County House of Correction to Bridgewater on March 13 for a 30-day psychiatric evaluation, Wiffin said.

He was one of 39 inmates assigned to a unit that was monitored by four correction officers, one above normal staffing, Wiffin said.

That unit, which has single rooms and multi-bed dorm-style rooms, has a shower room with observational windows for officers, Wiffin said. Only one inmate is allowed in the shower room at one time, she said.

© Read more!

High costs hinder care for mental health sufferers - Fredricksburg (VA) Free Lance Star

BY DONYA ARIAS

Across Virginia and nationwide, people are facing barriers to mental health care because of a lack of insurance, gaps in the insurance they do have or a fear of being labeled "crazy" if they seek help.

"The mental health system in this country is really broken," said Margaret Ann Holt, a member of the Rappahannock Chapter of the National Alliance on Mental Illness and the Virginia Interfaith Committee on Mental Illness Ministries.

Local advocates describe a Caroline County teenager who should be hospitalized for a life-threatening eating disorder. But her single mother cannot pay for the portion of care not covered by their insurance policy.

Then there's a Stafford County man whose pending divorce, after 20 years of marriage, has plunged him into depression. But he cannot afford mental health counseling because his insurance requires him to pay 50 percent of the cost, compared with a 15 percent co-pay for physical health care.

Two recent proposals in Congress aim to prevent such problems by requiring insurance companies to give the same level of coverage to mental health care as physical health care. But the bills already differ in scope and face opposition by groups concerned that the regulation could translate into a rise in premiums.

"In essence, big companies still restrict mental health benefits" because of cost concerns, said Lynn DelaMer, executive director of Mental Health America of Fredericksburg, a nonprofit that promotes mental health. "If you look at the impact on society of untreated mental health conditions, you can't put a price tag on it."

FALLING SHORT
The Mental Health Parity Act of 2007--if approved by Congress--would require insurance companies to treat mental illness on a par with physical illness.

The idea is to prevent group health plans from charging higher deductibles, co-payments or other out-of-pocket costs for mental health care, and to lift the tighter restrictions on how many days of covered care people can get in a hospital or as an outpatient.

If that promise sounds familiar, Virginia is one of the 41 states with so-called mental health parity laws already on the books.

Touted as a way to improve access for the millions who need mental health care, the laws have fallen short in the eyes of many.

For example, Virginia's mental health parity law, which took effect in 2000, requires that companies that provide health coverage to employees also provide mental health coverage. But the law, which exempts companies with 25 or fewer employees, requires only that mental health coverage be offered--not that it be on par with other benefits.

So, for instance, a policy may carry a $5,000 yearly limit on prescription drugs, but put a $500 yearly limit on antidepressants.

"There is no parity in mental health coverage," said longtime Virginia insurance agent Jim Lansburg.

He said he thinks true parity will never exist because it's impossible to compare a broken bone to a bout of depression when it comes to anticipating time and treatment needed for healing. Insurance companies demand such guidelines to help them manage costs.

STRUGGLING WITH LIMITS
David Vaughn, president of the Rappahannock Chapter of the National Alliance on Mental Illness, has a family member who waited a year for mental health coverage to kick in--even though the same waiting period did not apply to benefits for physical ailments.

Vaughn said a federal law would "be a positive thing" but wouldn't necessarily change mental health care or access in Virginia.

"Clearly, I think it's needed at the federal level if for no other reason than to ensure all states pick up some kind of parity laws," Vaughn said. "I think it sets a standard and sends a message from the highest levels that we are going to do what's right for people who have mental illness."

Mental health parity has been on the political radar for years. In 1996, Congress passed a parity law that prohibited insurance companies from setting lifetime limits on mental health coverage that were lower than for the rest of the policy. For example, before the law passed, it was common for policies to carry a $1 million lifetime limit for treatment of physical diseases such as cancer, but a $30,000 limit for mental health care.

GOING WITHOUT
Most agree access to affordable mental health care remains shaky at best.

The local Mental Health HelpLine fielded 1,600 calls last year from people who needed assistance finding treatment for themselves or loved ones.

Local advocates can cite countless examples of people needing care who couldn't afford it or were ashamed to ask for help.

Nationally, one of every two Americans who need mental health treatment goes without, according to the Campaign for Mental Health Reform. Access is even lower for racial and ethnic minorities.

"My hope is that this [parity effort] becomes reality, where people with mental health issues can get through the door and get the treatment they need," DelaMer said about the federal legislation. "I hope it's not just language."

Track the legislation at the Library of Congress site: thomas.gov Donya Arias is a freelance writer who lives in Stafford County. Once a daily newspaper reporter specializing in health and medical writing, she regularly contributes to many health-related publications, including the AARP Bulletin and the American Public Health Association's newspaper.

Copyright 2007 The Free Lance-Star Publishing Company Read more!

New bill would create a mental health database for police - Corvallis (OR) Gazette-Times

By Carrie Petersen

ALBANY — Mental health professionals and community members testified in Albany Thursday evening on a bill to create a database that would give police information about mentally ill people they come in contact with.

A public hearing was held at Albany City Hall during a special meeting of the House Committee on Human Services and Women’s Wellness.

Reps. Andy Olson, R-Albany, and Sara Gelser, D-Corvallis, are the two main sponsors of House Bill 3524.

The bill would create a mental health database within the Law Enforcement Data System. Those who choose to be included in the system would give written consent that would be witnessed by a physician or licensed psychologist. Consent would be revocable.

Information about the person would include name, birth date, last known address, physical description, description of illness, medications, safety alert for police if needed, and a contact person.

Olson, a former Oregon State Police trooper, explained that the bill would allow police and deputies to know when a person needs help rather than to be taken to jail.

Fourteen people spoke at the meeting. Some were in favor of the bill. Most were opposed or neutral.

Some of the concerns presented:

• More than just physicians and licensed psychologists should be able to help people get into the system.

• Police need more training in dealing with the mentally ill.

• There would be a limited number of people who would qualify for the system.

• People with mental illness would be singled out.

• There were questions as to how a person would get out of the system.

Linn County Sheriff Tim Mueller, who has been with the sheriff’s office for 23 years, said the county jail didn’t use to be the first place to take people with mental illnesses, but over the years that has changed.

In 2006, 14 inmates at the county jail were committed elsewhere because of mental health issues. Since January of this year, 26 inmates have been committed. Jail staff are also seeing mentally ill people that they haven’t seen before.

“We definitely have a problem in Linn County,” the sheriff said. “We need a vehicle in place where jail is not the first option.”

When people with mental illness are brought into the jail on misdemeanor charges of criminal trespass and disorderly conduct, they may be taken advantage of by other inmates, he said. The Marion County jail spends $20,000 each month on medications for mentally ill inmates.

Chris Hoy, the Marion County jail commander, said law enforcement officers have become first-responders for mental illness crises.

Hoy, who said he had no position on the bill, added that to continue on the same path would be “unconscionable and inhumane.”

Copyright © 2007 • Lee Enterprises Read more!

Mental illness: Facts and fiction - Ottumwa (IA) Courier

By MARK NEWMAN

OTTUMWA — People with mental illness may not be more violent than the average person — but they are more likely to be victims of violence.

That’s one of the facts Carol Porch said she wanted to share Friday in an effort to debunk the myths that seem to follow mental illness.

Porch, a representative for the Iowa chapter of the National Alliance for the Mentally Ill is not a psychiatrist, she said.

“But I feel like I’m ahead of the curve,” she said.

She is the mother of a son who was hospitalized for mental illness, and, due to 30 years of depression, has been a patient herself.

The discomfort about mental illness, she said, allows some to think it is fine to discriminate the mentally ill by bullying them, turning them out of apartment leases or not giving them a job.

Some of the myths that encourage these feelings are given life by the media with “crazy” movie villains, editorial cartoons and insensitive commercials.

“When you see this kind of stuff that perpetrates stigma, complain,” said Porch. “Object to it.”

She said there are two challenges in working with the mentally ill: Getting the public to understand that mental illness is a physical ailment, a brain disorder with a biological basis is one challenge. The other is treating mental illness itself.

And though a person with mental illness who is taking their medications is not likely to be violent, one statistic clearly saddened Porch: “More than 25 percent of severely mentally ill people will at some point pass through the criminal justice system.”

Mostly, she said, for non-violent crime. But the right resources can help.

“It costs a lot more to keep someone in jail than it does to treat their illness,” she said.

There are ways to avoid the victimization of those who suffer from a physical brain disorder or chemical imbalance resulting in mental illness.

“Teach diversity, [both] acceptance and understanding,” Porch said. “Help those who are bullied, homeless or in danger of going to jail by referring them to services.”

The Courier asked Porch what the most difficult part of the job was for NAMI advocates.

“To educate everybody to avoid the violence against the mentally ill perpetrated by stigma,” she said.
“When it comes to mental illness, there is treatment available but when it comes to the stigma we’re educating one person at a time.”

Reporter Mark Newman can be reached at 683-5358 or by e-mail at mgnewman@mchsi.com. For more information, go online at www.nami.org, or call 800-417-0417.

Copyright © 1999-2006 cnhi, inc. Read more!

New WA law expands equality of mental health insurance coverage - AP

OLYMPIA, Wash. (AP) -- Private health insurance policies for individuals and small companies in Washington will now be required to offer coverage for mental health treatment equal to their medical benefits.

"Washington now has the strongest and the best mental health parity requirements in our nation," Gov. Chris Gregoire said as she signed the bill into law Friday.

Still, about two-thirds of Washington residents aren't covered by the new rules, because they receive their health insurance through the federal government or employers who self-insure.

The measure expands a mental health parity law passed in 2005 that required all private health insurance policies for large groups to provide equal coverage for medical and mental health treatment. Under the new measure, that requirement expands to companies with fewer than 50 employees and to individual policies.

It means, for example, that if your health plan allows unlimited doctor visits for colds and sprains, there can't be a cap on therapy sessions.

"We know mental health services work and that mental illness is as treatable as a physical illness," Gregoire said. "Mental health parity reduces costs to society and is cost effective overall."

During House debate on the bill, some lawmakers argued the measure would be an unfair and costly mandate for small businesses.

But Rep. Shay Schual-Berke, D-Normandy Park, said at the bill signing that the law would save society money in the long run, because mental illness "costs us in the homeless, emergency room and in our jails."

"To continue this arbitrary, archaic distinction between mental health and physical health is to stay in medieval times," Schual-Berke said. "It's time to come into the sunshine of the 21st century."

Schual-Berke said about 540,000 more people would be covered under the new law. The 2005 law covered about 1.5 million people, including state employees and those on the state's Basic Health Plan.

With this law and the 2005 measure, mental health parity now covers about 2 million of the state's 6 million people, said Randy Revelle, senior vice president of the Washington State Hospital Association.

The remaining 4 million are people covered by federal programs, such as Medicare and Medicaid, work at self-insured companies, or have no insurance.

Some of those self-insured companies, such as Swedish Medical Center, Ben Bridge Jewelers, American Airlines, AT&T and General Motors, do voluntarily offer mental health parity to employees, Revelle said.

But only a federal law would require them to do so.

Revelle, a former King County executive who has suffered from bipolar disorder, has strongly pushed for the measure. He said the state has gone as far as it can, but he would now work to make sure any measures passed at the federal level do not trump state laws.

Mental health parity bills that Revelle described as "much weaker" than Washington's law are currently working their way through the U.S. Congress.

"The federal government can wipe out ten years of equity if they want to; they can pre-empt the states," he said, adding that he wants to make sure federal law would "allow Washington to have the law Washington passed."

---

The measure is House Bill 1460.

---

On the Net:

Legislature: http://www.leg.wa.gov

Washington State Hospital Association: http://www.wsha.org

© 2007 The Associated Press.

Read more!

Chiropractic vs. mental health parity - Raleigh News & Observer

Editorial:"Shouldn't that (mental health) parity be at least as important as parity for the patients of chiropractors?"

Should patients of chiropractors be entitled to the same level of co-payments - set by insurance companies - as patients of medical doctors? The answer to that is far from simple.

But it's not complicated at all that the legislature ought to repeal a law saying as much, now that it's been revealed in court that the law was passed as money changed hands. Jim Black, former speaker of the state House, pleaded guilty last month to taking $29,000 from three chiropractors during the time the chiropractic legislation was approved in 2005.

Black inserted the provision in the massive annual budget bill, and not surprisingly it passed with virtually no debate.

Laws that are passed under a cloud corrode public trust and shouldn't stand. The House this week overwhelmingly repealed Black's legislation. The Senate should follow suit.

Some legislators say that chiropractic patients understandably like the provision and want it kept. But there are questions involving overall costs and precedents. For example, parity for insurance coverage of mental health services has been talked about in the legislature for years without gaining approval. Shouldn't that parity be at least as important as parity for the patients of chiropractors?

That all goes to say that mandates involving health insurance coverage deserve vigorous debate and fully informed votes. Neither was the case when the provision to benefit chiropractic patients, and their doctors, was slipped into the books. Read more!

Disuse of System Is Cited in Gaps in Soldiers’ Care - NY Times

By IAN URBINA and RON NIXON

WASHINGTON, March 29 — Lapses in using a digital medical record system for tracking wounded soldiers have led to medical mistakes and delays in care, and have kept thousands of injured troops from getting benefits, according to former defense and military medical officials.

The Defense Department’s inability to get all hospitals to use the system has routinely forced thousands of wounded soldiers to endure long waits for treatment, the officials said, and exposed others to needless testing.

Several department officials said the problem may have played a role in the suicide of a soldier last year after he was taken to Fort Lewis in Washington State from Iraq. His intentions to kill himself were clearly documented in his digital medical record from overseas, but doctors at Fort Lewis did not consult the file and released him, according to department records and defense officials.

“The D.O.D.’s failure to share data and track patient records is truly a matter of life and death,” Senator Patty Murray, Democrat of Washington, said in a statement. “This isn’t an isolated case, but a system-wide failure.”

The system was designed to make seamless the transition of soldiers who were wounded in Iraq and Afghanistan as they moved to hospitals stateside. But only 13 of 70 military treatment centers in the United States use it even though it was mandated by the Pentagon more than two years ago, according to agency documents.

As a result, military doctors say they are less able to learn from mistakes since they cannot track the progress of wounded soldiers from one location to another. Others complain of costly and redundant testing.

“Patients are being unnecessarily exposed to radiation,” said Lt. Col. Gina Dorlac, medical director of the intensive care unit at a hospital in Landstuhl, Germany, where most severely wounded soldiers are taken from Iraq.

She said doctors from Walter Reed Army Medical Center and elsewhere regularly ordered CAT scans and M.R.I.’s even though the same tests had already been performed and the results were in the tracking system. “It’s a waste of time and money,” Colonel Dorlac said.

X-rays and CAT scans are generally considered safe, but doctors are wary of unnecessary tests because radiation can be harmful if it accumulates in a patient over time.

M.R.I.’s do not produce radiation.

Colonel Dorlac said that most doctors who used the system agreed that it worked well. But she said many doctors at United States military hospitals seemed reluctant to use it because doctors did not know they had access or were unwilling to learn how to use it.

Until he left the Defense Department in August, Tony DeNicola was responsible for ensuring that the digital system, known as the Joint Patient Tracking Application, was used throughout the military. In an interview, Mr. DeNicola said he ran into resistance: “We couldn’t get the services to use the system because they wanted to use their own. We also never got enough cooperation from the office in charge of electronic patient records.”

The application was developed in 2004 to allow doctors and military officials to track the medical care given to troops from the moment they arrive at field hospitals in Iraq or Afghanistan through their stay in military hospitals stateside.

The Internet-based system allows doctors or other personnel to enter or view clinical data and upload images from certain types of tests. Defense Department officials said the system was just one of several sources of information used in providing care for soldiers.

Tommy J. Morris, director of deployment health technologies and support programs, also said that the record system was being integrated into a larger defense system, which would particularly help in tracking patients moving into the Department of Veterans Affairs system.

Frustrations with the Pentagon’s tracking of medical data come at a time of growing concern on Capitol Hill about medical treatment and benefits for soldiers coming home wounded from Iraq and Afghanistan.

On Tuesday, defense officials testified before Congress that their department was improving data tracking and increasingly sharing medical information with Veterans Affairs. But Senator Murray raised concerns that the Joint Patient Tracking Application was not being used.

The Defense Department blocked Veterans Affairs access to the system entirely in January and as of this week only 12 of the 40 authorized V.A. officials and doctors had had their access restored, according to Defense Department records.

Representative Steve Buyer, Republican of Indiana, said he sought a meeting with Defense Department officials after visiting a V.A. hospital in Minneapolis where doctors lacked direct access to the patient tracking system and were still receiving faxed medical records from military hospitals.

He said he left that closed-door session on Wednesday after an hour and a half of discussion “not knowing the answer” to when the problems with data tracking would be resolved.

For wounded troops, the difficulties have complicated an already frustrating experience, according to veterans advocates and defense officials. At military hospitals that still depend on paper records, wounded soldiers endure long waits for appointments because their records cannot be found or were never transferred, advocates say. Soldiers also face delays in getting rehabilitation because defense officials do not use the system to assign specialists to centers with the biggest backlogs.

According to a congressional aide who attended the meeting on Wednesday, Defense Department officials said they were not familiar with the details of the Fort Lewis suicide.

According to other defense officials and department records, that soldier was evacuated from his unit in Mosul, Iraq, on Aug. 18, 2006, after telling doctors he had thoughts of suicide. After being evacuated to a military hospital in Germany, the soldier received psychological treatment and his condition was noted in the digital records system. On Aug. 24, he was sent to Madigan Hospital at Fort Lewis but was not admitted.

On Sept. 7, he killed himself. Defense records indicated that doctors at Fort Lewis did not check the soldier’s file in the digital system, where his suicidal tendencies were described, until a day after his death.

Sharon Ayala, spokeswoman for Madigan Hospital, said the hospital would not comment on the case because of privacy issues.

“Please be assured that the Army takes suicide and the risk of suicide very seriously,” Ms. Ayala said, adding that all troops returning from Iraq and requiring mental health evaluations are seen and evaluated by mental-health providers the day they arrive.

Soldiers may also not be receiving certain benefits, such as $430 a month for combat-related injury rehabilitation pay, because the office that provides those checks depends on data from the digital system to determine which soldiers qualify, according to Mr. DeNicola, the official who used to oversee the system.

Lt. Col. Mike Place, a physician at Blanchfield Army Community Hospital at Fort Campbell, Ky., said it was important for stateside doctors to use and update the digital records because doctors in Iraq and Afghanistan often access the files to check up on soldiers they cared for and to learn from the results.

Colonel Place said, for example, that many soldiers with blast wounds in Iraq experienced certain complications after returning to the United States, like muscle swelling that causes severe nerve damage. If battlefield doctors knew that, they could change how they treat soldiers immediately after they are wounded.

With the Joint Patient Tracking Application, Colonel Place said: “We don’t have to wait until the surgeon comes home to tell them. They can see the trend right away and start making changes.”

Steve Robinson, a veterans’ advocate, said virtually all military doctors agreed that the digital system was effective in tracking patients. But he added that he had participated in seven Congressional hearings, most recently last week, that focused on problems with how the defense and veterans departments track medical information.

“We don’t really have time to wait for another system to come online when we have one ready now that the D.O.D. approved,” Mr. Robinson said. “The tools are there, but we just keep having meetings about whether to use them.”

Defense Department officials say they need more time — and an additional $30 million in the next fiscal year — to integrate the joint patient tracking system with the department’s larger system, an effort that has already cost more than $200 million. The Joint Patient Tracking Application cost an estimated $320,000 to develop and about $2 million a year to operate, according to Defense Department documents.

But last September the department certified that the tracking application had adequate security and privacy protections, according to documents from the office of the deputy assistant secretary of defense for force health protection and readiness. Read more!

Weiland's wife: Bipolar disorder caused meltdown - AP

LOS ANGELES, California (AP) -- Scott Weiland's wife said an imbalance of medications for bipolar disorder caused rowdy behavior that left hotel rooms trashed and led to her arrest for allegedly torching the Velvet Revolver rocker's clothes.

Burbank police said the couple argued Saturday afternoon at the luxury Graciela Hotel, leaving two rooms damaged. Mary Weiland was later arrested for allegedly burning her husband's clothes outside their Toluca Lake home, investigators said.

"The weekend's difficulties were brought on by a reaction to an imbalance in medications used to treat my bipolar disorder," she said in a statement released Tuesday by the couple's spokeswoman, Bryn Bridenthal.

"Reports that we were fighting at the Graciela Hotel are untrue," she said. "Scott was simply trying to help me calm down. I want to make it very clear that he did not hurt me in any way."

"For lack of a better expression, I was unstable and just lost it," she said.

Weiland, 31, was booked for investigation of felony arson vandalism after officers responding to a "female burning clothes" call Saturday night found a trash can full of smoldering clothes, Sgt. Mathew Ferguson said.

The 39-year-old rocker told police his wardrobe was worth $10,000.

"After nearly seven years of marriage I am truly grateful to have a loving husband, drug-free for 3 1/2 years now, who is able to care for me during this challenging time," Weiland said in her statement.

Prosecutors haven't filed arson vandalism charges, the district attorney's office said Wednesday. Police said it would be up to Graciela Hotel officials, who have declined comment, to press for a vandalism prosecution.

Mary Weiland said apologies and payment for damages had been made.

"Payment for the damages to the Graciela Hotel has already been made. The gracious staff and management have accepted our apologies and welcome us back in the future," she said.

Copyright 2007 The Associated Press. All rights reserved.This material may not be published, broadcast, rewritten, or redistributed. Read more!

Senators grill state official on deaths at institutions - Austin American-Statesman

By Corrie MacLaggan

In an emotional hearing Thursday, senators questioned a key state official about the deaths of 194 people in an 18-month period at the state's institutions for Texans with mental retardation.

"How did things get to that point?" Sen. Jane Nelson, R-Lewisville, asked Addie Horn, commissioner of the Department of Aging and Disability Services. "What could we have done?"

Horn said the death rate was in the range of that of facilities nationwide that serve similar populations. She also said many of the residents of state schools have a shorter life expectancy than the general population because of chronic health issues.

Lawmakers focused on a December 2006 federal report that described unsafe, unclean and unhealthy conditions at the Lubbock State School, where 17 residents died from June 2005 to November 2006. In one case, staff members found a woman unresponsive; they panicked, did not initiate cardiopulmonary resuscitation and delayed calling emergency medical services, the report said. The woman died.

Lawmakers said they fear that similar conditions exist at the 12 other state-run institutions for people with mental retardation, including the Austin State School. Almost 5,000 Texans live in the institutions, including more than 400 in Austin and about 300 in Lubbock.

"I never believe the problems exist in isolation," said Sen. Judith Zaffirini, D-Laredo. She has filed a bill that would provide information to people in institutions about how they can transition to living at home.

The U.S. Justice Department report about the Lubbock State School has drawn increased scrutiny in the wake of the sexual abuse scandal at the Texas Youth Commission, the agency that operates juvenile lockups.

But senators said a key difference between the two agencies is that there does not appear to be an official cover-up at the state schools for people with mental retardation.

"It distresses me greatly when people compare this with the TYC situation," said Nelson, chairwoman of the Senate Health and Human Services Committee. "This is not the same at all."

Horn told lawmakers that of the 194 people who died, 115 had do-not-resuscitate orders, and 122 died in hospitals. Twelve residents of the Austin State School died.

A shortage of nurses and problems with management were among the factors that contributed to the deaths in Lubbock, Horn said.

In response to findings that federal investigators shared with state officials months before issuing the report, the agency replaced managers in Lubbock, revamped staff training and closed an infirmary, Horn said. As a result, the health of residents improved, she said.

For example, the number of residents with pressure sores declined from 28 in 2005 to six in 2006. The number of residents with respiratory infections fell from 83 in May 2006 to 24 in January 2007.

Senators also wanted to know why the changes have taken place only in Lubbock. Zaffirini asked Horn whether she has a plan for implementing the changes at other institutions.

"As soon as I can," Horn said.

Horn fought back tears as she said that serving people with disabilities has been her life's work.

cmaclaggan@statesman.com; 445-3548 Read more!

Parent Center Navigates Mental Health System - Queens (NY) Chronicle

by Kim Brown , Chronicle Correspondent

When Lorraine Jacobs lost her husband to lung cancer in 1993 she was left with 10 children to support, including a bipolar daughter. The struggle to raise an emotionally disturbed child while supporting her family inspired Jacobs to help other parents navigate the mental health system.

Today, she is the supervisor of the Parent Resource Center of Queens, part of the Mental Health Association of New York City, a nonprofit advocacy and service organization. The center moved to new offices in Elmhurst on March 1.

“I still believe the best training and education is the training we had with our own children,” Jacobs said about her staff, all of whom have children with mental health issues. “When we start talking about our own children you can see the relief come over their faces.”

The Parent Resource Center of Queens, which first opened in the Queens Children’s Psychiatric Center last October, aims to empower parents, so they will know how to advocate for their children.

But Jacobs had to find resources for her daughter on her own.

After her husband died, she became a receptionist then won a scholarship and enrolled in college. While working and pursuing a degree, her daughter, now 17, was on and off medication, in and out of the hospital and back and forth within the mental health system.

Although Jacobs struggled to help her daughter on her own, she knew there were others going through the same things.

“I just didn’t have the support. I had to write letters and find my own resources,” she said. “I thought there had to be a lot of parents out there who were lost and confused.”

As supervisor of the Parent Resource Center, Jacobs relies on her own experience to create a welcoming haven for parents.

Parents who come to the center learn to navigate the education system, to ask doctors the right questions and to tap community resources for assistance.

“The key is we help them form the questions and we help them find the right answers,” said Luz Mercado, one of three parent advocates. Her 18-year-old son was diagnosed with paranoid schizophrenia. “No one can help them if they don’t know what they need.”

Like other staff members, Mercado didn’t know where to get help when her son was diagnosed with a mental illness. Because she knows what it is like to feel isolated and overwhelmed, Mercado has made it her mission to reach out to others.

“I can offer understanding,” she said. “Together we look at options and roll up our sleeves. I try to give parents a sense of hope.”

Mercado speaks Spanish and works with Latino parents who come to the center. Rena Au, whose 14-year-old son has attention deficit hyperactivity disorder, reaches out to Chinese families.

“A lot of parents feel ashamed. They feel like this child (with mental health issues) brings shame to the family,” she said, about the Chinese community. “By understanding, they have more patience to deal with this.”

The center is also looking to hire Urdu- and Korean-speaking advocates.

In addition to making referrals, teaching parenting skills and running support groups, the staff also offers parents a respite. Since having a child with mental health issues often leaves parents no time for themselves, the center offers programs like movie outings and trips to the park.

“We help the whole family,” said Denise Filmore, a parent advocate whose son was diagnosed with Tourette syndrome, attention deficit hyperactivity disorder and obsessive compulsive disorder. “If the family situation isn’t stable, the child can’t be stable.”

Like the others, Filmore knows first hand how difficult it is to raise a child with a mental health disorder.

“You just fall apart,” she said. “You feel as though there’s nothing you can do and no one’s there to help and you can’t get information.”

Often the parents who come to the center feel as lost as Filmore once did.

At the first session many cry, but by the time they leave there is a change.

One woman Filmore helped was bipolar and raising a daughter with depression.

“I finally feel there’s hope,” she said to Filmore at the end of their session, “and one day I’m going to call you and tell you I have a home, and I’m just calling to invite you to a barbecue.”

Like the other women who are part of the staff, Filmore is still coping with her own child and leaning on others. While their lives are not easy, they know they can make changes by sharing the knowledge and information they fought for themselves.

“Each day I thank God that my son is good for that day,” Mercado said. “I understand when parents come in and tell us their stories. I’ve been there.”

The Parent Resource Center is open Monday through Friday from 9 a.m. to 5 p.m. For more information call (718) 651-1960 or log on to www.mhaofnyc.org.

For counseling, addiction referral and information 24 hours a day, 7 days a week, call (800) LIFENET (543-3638), for Spanish speakers, (877) AYUDESE (298-3373), for Chinese and Korean speakers, (877) 990-8585, for the hearing impaired, (212) 982-5284, for other languages, (800) LIFENET and ask for an interpreter. Read more!

We need to treat, not arrest the mentally ill - Chapel Hill News

Opinion:


By Gary D. Gaddy
Before I really begin, let me make one personal recommendation to you: If you are going to get a disease -- choose your organ carefully -- because if you have heart failure, you can get a pacemaker; if you have pancreas failure, you can get an insulin pump; if you have kidney failure, you can get put on dialysis -- but if you have brain failure, you can get put in jail. And I mean today, in America; right here in good old Chapel Hill.

Only for the diseases of the brain called mental illness are people arrested for their symptoms.

Can you imagine your child suffering from a disease -- but it hasn't killed him yet -- then watching him being denied treatment because your insurance (and I quote) "only hospitalizes for matters of life and death"? Then after your child leaves the hospital, still with a deadly disease, you have to watch him get arrested for his symptoms.

I don't have to imagine, I've been there. My child had a brain disorder. And he was insured as a minor, and I had insurance coverage -- as a state employee.

With schizophrenia, bi-polar disorder or any other mental illness which manifests itself in psychosis, you can be arrested (and people are, every day) for manifesting its symptoms -- delusions, hallucinations, paranoia. Isn't it punishment enough to lose your job, your home and your family, as many do when they are hospitalized? Wouldn't treatment be better for us all?

A bill before the U.S. Congress now, informally called the Mental Health Parity Act, would help do that. It would require mental illness be treated like other diseases by insurance companies -- a bill the New York Times said "it looks as if Congress may be ready" to pass. Please note the word "may."

I have often said that I could convince anyone with either a heart or a brain that the government should do its part to insure that people with mental illness get early and effective treatment.

For those with a heart, I call for compassion to help those who cannot, by virtue of their diseases, help themselves. If government is to help anyone, it would be them.

For those with only a brain, I point out how much more expensive it is to support someone for a lifetime, than it is to treat the illness early, and how much more cost effective treatment centers are than jails and prisons, where many of those with severe mental illness are today -- simply because they did not get appropriate treatment. And we will all be better off if people disabled by brain disorders have safe and decent places to live rather than being left untreated and homeless with begging and petty theft as their only means of support.

Mental health insurance parity is one step towards getting treatment to those with mental illness.

People with mental illness, just like people with any other illness, need to be treated so that their diseases don't progress into lifetime disabilities. The health insurance system is one way we should do that. Currently, most health insurance policies do not cover mental illness like they do other illnesses. Because of what amounts to a system-wide insurance embargo on paying for treatment for mental illness, many episodes of mental illness go untreated until the individuals are so ill that they must be hospitalized -- usually at great public expense.

Only an estimated 20 percent of children and adolescents with mental illnesses currently receive treatment. Because of this many lives are unnecessarily destroyed by these diseases.

Fixing this gap in coverage would not be expensive, and in the long run will save our society money as permanent disabilities and revolving door hospitalizations are prevented. The Congressional Budget Office estimates requiring coverage for mental illness will increase the average premium about 1 percent the cost of the current average benefit.

Beyond the simple issue of fairness to those struck by mental illness, this would be modest investment in the health of people of our society.

E-mail or call 1-800-614-2803 to send a message to our senators, Richard Burr and Elizabeth Dole, and to our congressman, David Price, to express your views on mental health parity. Let them know you are a voter and leave your name, phone number and address, so there won't be any doubt. Your call or e-mail could make a difference.


Gary D. Gaddy lives in Orange County. (To see his past columns, go to GaryGaddy.com.) Read more!

When parents are the experts - Raleigh News & Observer

Donald J. Stedman

CHAPEL HILL - More than three decades have passed since parents of children with special needs took on the commonwealth of Pennsylvania to keep it from excluding their children from school.

Their lawsuit went all the way to the U.S. Supreme Court, the parents won and the court's decision guaranteed the right to a free and appropriate public education in the least restrictive setting for all children with special needs. It led also to federal and state laws under the Individuals with Disabilities Education Act we know today.

Now a new challenge is before the U.S. Supreme Court, this time from a suit by parents in Ohio against the public schools (the case is Winkelman vs. Parma City School District).It argues for the right of parents to defend their child in court when a lawyer cannot be found who is affordable or knowledgeable about children with special needs and their right to be included in educational programs in the public schools.

ONCE AGAIN PARENTS ARE SEEKING BETTER ACCESS FOR THEIR CHILDREN with special needs. Only this time it is some lawyers and some judges who appear to be the obstacles.

For more than 100 years, parents have come together to help find services for their special needs children. At first, they found help from churches -- counseling, support and space in the church basements for "special classes." As they grew and became more organized, parent organizations found politics an important strategy and identified legislators to draw attention and resources for their children.

Soon, senior leaders in the executive branch noted the value and opportunities available from well-organized parent groups seeking major aid and legislation to provide resources for health, education, vocational rehabilitation, social services and housing, particularly improved residential care. Initiatives with the executive branch reached their peak nationally in the 1960s, in North Carolina with Gov. Terry Sanford, a well-remembered advocate for families with children with mental retardation, and nationally with President Kennedy, whose sister Rosemary was a person with mental retardation.

It was only later, during the '70s and '80s, that the judiciary became an important route to change. Parents sought a "right to education" for their children as a civil right. And, as a result, parents gradually began to be viewed as adversaries by schools and other agencies.

NOW WE HAVE A NEW LEVEL OF DEBATE, PARENTS VS. THE COURTS.

Winkelman vs. Parma City School District is a case with significant implications for all children and their families. The Winkelmans, parents of a 9-year-old child with autism, were not satisfied with the school district's response to their need for special education. So they found a satisfactory program in a private school and want the Parma public schools to pay the tuition. Parma said no, and the suit was on. A series of appeals has landed the case in the Supreme Court largely because the appeals courts were ruling that parents could not pursue such suits without a lawyer.

An unusual feature now is the openness with which at least three of the justices -- Souter, Breyer and Scalia -- are discussing the merits of the case, Souter and Breyer supporting the rights of parents to represent their children with disabilities; Scalia saying it would "make a lot more work for federal district judges" (as quoted in The New York Times, Feb. 28). Justice Roberts, Ginsburg and Breyer have also shown a spirited interest in the case.

Parents of children with special needs have become very aware of the laws -- federal and state -- that provide for an education for their children. Some have become experts and, when unable to engage an equally knowledgeable attorney, or to afford one, they naturally seek to represent their own case. While the federal laws do provide people with the right to represent themselves in court, for some reason parents of children with disabilities appear to be an exception.

It is important to avoid frivolous suits, and children should be protected against the outcomes of overzealous representatives -- including their parents. But you can't fault parents for wanting to represent their children's rights if no one is around to help. They should have the right. And we certainly shouldn't create a new law to prevent them from trying.

(Don Stedman is a senior fellow at Action for Children-N.C. and dean emeritus of the School of Education at UNC-Chapel Hill.) Read more!

Helping jailed juveniles - Charlotte Observer

Opinion: Published March 28

With family treatment, overhaul would be vast improvement
From Warren Steinmuller, M.D., Child, Adolescent, and Adult Psychiatry and Psychotherapy, Charlotte, in response to "Critics call juvenile overhaul a gamble" (March 17 Observer):

As a former psychiatric consultant at a North Carolina training school in the late 1990's and early 2000's, I found the glaring errors in the "treatment" model were the inadequacy of the positive incentives that force children to make choices about their behaviors on a daily basis and the incarceration of these children far from their homes. The latter spelled doomed treatment, from the start, for many of the children whose only chance to maintain any gains they made was to return to a family that learned more effective skills.

While most (but not all) of the children argued that they wanted to go home throughout their incarceration, as that day neared the fear of returning to their former ways escalated as they knew in their own hearts nothing was going to be different in their home environment. There had been no focus on family treatment.

Family treatment was impossible under that system. Families were almost always poor and usually in distant locales. It would have been impossible for them to attend any useful treatment even if it were offered which it almost always was not despite documented need. The mental health staff was so miniscule as to be lost in the sea of children they were asked to see.

The details of the proposed overhaul are not clear. The justification of the expense and expected benefit impossible to evaluate based on the information in your article. But the smaller sized groups described and personal, intimate interaction and discussion with caring adults who set appropriate limits is something most of the kids I saw initially rejected but ultimately craved. Even more children need their own (or foster) families to learn these skills and implement them throughout the period of treatment.

If the proposed overhaul allows for this by locating treatment where family will (and it should be mandatory) attend, it would be a vast improvement and potentially avoid the automatic and guaranteed waste of millions of tax dollars incurred under the old system.

Feedback offers persons or groups criticized in Observer editorials, columns or news stories an opportunity to respond. Read more!

Living With Alzheimer’s Before a Window Closes - NY Times

The early stages of Alzheimer’s disease offer a short period of time to reason, communicate and go about regular life.

Mary Blake Carver gazes from the cover of a neurology magazine this month, under the headline “I’m Still Here!” She often feels like shouting the message to her friends, her children, her husband.

Ms. Carver, 55, is among the growing ranks of people in the early stages of Alzheimer’s disease, when short-term memory is patchy, organizational skills fail, attention wanders and initiative comes and goes. But there is still a window of opportunity — maybe one year, maybe five — to reason, communicate and go about her life with a bit of help from those around her.

Yet Ms. Carver is often lonely and bored. Her husband leaves her out of many dinner table conversations, both say, because she cannot keep up with the normal patter. He insists on buttoning her coat when she fumbles at the task. She was fired as a massage therapist because she lost track of time. So Ms. Carver fills her days by walking her neighborhood on the Upper West Side of Manhattan, always with her dog, so she looks like “an ordinary person,” she said, not someone with “nothing better to do.”

Five million people in the United States have Alzheimer’s disease, according to a study last week by the Alzheimer’s Association. About half, 2.5 million, are at the early stages of the disease, other studies have found, struggling to pass for normal.

They are impaired but not helpless or demented, and now a growing number are speaking out about how it feels to be them: Silenced prematurely or excluded from decision making. Bristling at well-meaning loved ones who boss them around. Seeking meaningful activities to fill their days.

Out of their individual frustrations, these patients are creating a grass-roots movement to improve services and change public perceptions. And they are making a mark.

Early stage patients like Ms. Carver, telling their own stories, have become popular speakers at national conferences and persuasive lobbyists with state and federal lawmakers. Closer to home, they are pushing for more patient support groups, creating social networks and taking part in couples counseling to restructure their marriages after diagnosis.

Rarely have ill spouses and well spouses participated in joint support groups because of the widespread belief that their fears and frustrations are very different and that Alzheimer’s patients were too far gone to benefit. Historically, social service agencies have focused on the needs of caregivers. But that, too, is changing. “We’ve given wide attention to the caregivers and ignored the psychological and relational aspects of the lives of people with the disease,” said Peter V. Rabins, a professor of psychiatry at the Johns Hopkins University and a co-author of “The 36-Hour Day,” a guidebook for caretakers. “So these are important steps toward redressing this imbalance.”

Ms. Carver’s husband, Stephen, an electrician at a Broadway theater, is mindful that spouses — fearful and overwhelmed — can be insensitive and impatient as their mates’ abilities decline.

“They can’t always follow what’s going on if there’s too much input,” Mr. Carver said. “Their brains have to work so much harder, which tires them out, and their logic isn’t always linear, so there’s a tendency to think they don’t comprehend. I’m not a patient person by nature, and Mary’s losing her mental capabilities. So I have to slow down and adapt. And I have to remind myself that she still has feelings and perceptions. She still has an emotional life.”

Absent a cure, or more effective drugs, Alzheimer’s disease is a march to oblivion. But the process can unfold over two decades. Patients at the front end, said Paulette Michaud, manager of early stage services at the New York City Alzheimer’s Association chapter, “lose the sense of independence and control much more quickly than they need to because everyone focuses on their deficits.”

“These are still viable people,” Ms. Michaud continued. “What are they supposed to do for the next three, four, five years of life?”

Some answers are emerging, as patients request and help design new programs at academic medical centers and social service agencies. Among them is a speakers’ bureau at the New York City chapter of the Alzheimer Association that grew out of complaints of boredom.

Ms. Carver is among the most popular speakers. She flushes with accomplishment when she is on the podium at a conference but recalls none of it moments after leaving the stage. Ms. Carver sobs at the extent of her short-term memory loss. Her support group friends comfort her, reminding her that their memories may be better, but their speech or concentration is worse.

At the Alzheimer’s clinic at Northwestern University Medical School, support group participants told Darby Morhardt, the facilitator, that they yearned to spend more time together. As a result, in partnership with the Council for the Jewish Elderly in Chicago, Ms. Morhardt’s support group takes regular bus trips to historical and cultural sites of their choosing like an African-American art museum, a glass blower’s studio and a Hindu temple.

Social groups are also springing up for couples. In San Anselmo, Calif., Peter and Judy Hebert regularly entertain new friends from Mr. Hebert’s two support groups, each with different deficits but all relatively high-functioning.

Mr. Hebert, once an official at the General Services Administration, is 67 and retains his short-term memory, but his speech and motor skills are deteriorating five years after diagnosis, and he cannot reassemble a sandwich should one piece of bread fall off. But he can maintain a busy schedule visiting assisted-living centers and nursing homes to exhibit his landscape photography, and sometimes his speech flows.

“It feels like I’m working,” Mr. Hebert said.

His wife accompanies him, struggling not to fill in the blanks in his halting sentences. “We all have that tendency to take over,” she said.

How much hovering is too much has been a common topic in couples counseling sessions at New York University that are part of a research study by Dr. Mary S. Mittelman.

The study, in which couples receive six counseling sessions together, was to have included 200 couples, but 16 have signed up, an indication, some of Dr. Mittelman’s colleagues said, that many couples still do not welcome frankness.

At the sessions, a counselor with expertise in Alzheimer’s disease can guide the conversation, slow everything down and offer enough encouragement so the ill spouse can participate. In reviewing early results, Dr. Mittelman said, the patients with dementia said they enjoyed being included, and their spouses said they learned ways to make that happen.

Months later, the patients remembered the counselor and were happy to be back, though the content of the sessions had disappeared from memory and they veered between confusion and understanding.

“What am I doing now?” asked John McCrosky, 75, directing the question at his wife, Corinne Samios.

The counselor intervened, asking, “Are you the same John as when I saw you last?”

“No, I’m not the same,” he said, slyly setting up the punch line to his own joke. “Now I can’t remember to flush.”

The second study involving couples, led by Carol J. Whitlatch of the Cleveland Institute, compared the expectations of the ill spouse and the caregiver spouse, with an eye toward planning for the future.

Both began the counseling assuming that all needs would be met by the well spouse but quickly saw that this was unfair and together sought areas where care could be delegated.

A result, Dr. Whitlock said, was that patients felt involved in the decision making and caregivers felt relieved at having more options than they had imagined, sometimes even the acknowledgment of the ill spouse that a nursing home might someday be necessary.

The groundwork for the current self-help movement is the 20-year-old work of Robyn Yale, a social worker in Northern California, who ran patient support groups when most Alzheimer’s agencies considered them incapable of benefiting. Ms. Yale is now organizing groups for early stage patients in assisted-living centers and nursing homes.

“It’s been a long process of changing stereotypes,” Ms. Yale said. “But we’re finally hearing their voices, and we need to respond to that.”

One frustration among innovators in the field is creating volunteer opportunities for people who are too forgetful or confused to do many jobs. An agency tried that in California, pairing a cognitively intact volunteer with a second volunteer with mild dementia, but, over time, the labor-intensive project could not be sustained.

Last year, the national office of the Alzheimer’s Association declared early stage services a priority. The association now has an advisory board made up of patients, most whom have a rare early onset form of the disease, which sometimes runs in families.

People struck with dementia of various sorts in the prime of life — 200,000 to 500,000, according to last week’s study — have been the most aggressive advocates, experts say. They have not settled into retirement or been slowed by other infirmities, and they also came of age in an era of activism.

“This younger group, we’re mouthy,” said Chuck Jackson, 53, one of the board members, a former outplacement counselor for loggers who left his job upon diagnosis, wanting to “enjoy daily life” as long as possible.

“I know where I’m going to end up,” Mr. Jackson said.

So do John Carpenter and Mary Carver, but they are not there yet.

Mr. Carpenter, who once performed in Broadway musicals, was determined to perform again after his illness was diagnosed recently at age 82. One of his “big hurts,” Mr. Carpenter said, “is not knowing what I’m going to do tomorrow or the next day or the day after that.” His wife, Milly, “doesn’t talk to me like she used to,” he said.

“And,” he added, “when people say, ‘Tell me what you did,’ it’s gone, just gone. I want to be who I was.”

So he petitioned the Alzheimer’s Association to let him star in a play about the disease. And he and Ms. Carver, a former singer, told Ms. Michaud, the group leader, that they would enjoy performing together. Could she help them find an adult day care center where they could entertain? She can, and she will.
Read more!

Commissioners: Pardee not for sale - Pisgah Mountai News (Asheville CT)

Hospital seeing some effects from the closing of New Vistas-Mountain Laurel

by Julie Ball

HENDERSONVILLE — While reviewing budget numbers from Pardee Hospital during a meeting last week, Henderson County commissioners tried to put to rest rumors that the county-owned hospital might be up for sale.

“That is absolutely not true,” Commission Chairman Bill Moyer said last week.
Moyer’s comments came during a county commission meeting. Moyer said three people had approached him in 10 days asking about a possible sale.

“There are no active discussions going on now with respect to the sale of the hospital,” he said.

Pardee had struggled financially over the last five years. In 2005, the hospital lost about $5 million.

But after three years of financial losses, the hospital’s bottom line — a number that represents revenue over expenses — was just more than $2 million for fiscal year 2006, according to Alan House, Pardee Hospital chief financial officer.

About $71,000 of that was income from hospital operations and the rest was money generated by investments or donations from the hospital’s foundation, according to House.

“We intend to be financially solvent. We intend to meet our budget as best we can. We do not intend to be a drain on the county,” interim hospital CEO Sally Davenport told commissioners.

Pardee officials made a push to reduce contract labor costs as well as contracted fees, House said.

As for 2007 projections, House said the hospital was “$800,000 ahead” of where it was as of Jan. 31 of last year.

“We think we will be close to budget by the time we are done,” House said.
The hospital is also seeing some effects from the closing of New Vistas-Mountain Laurel, a safety net mental health provider that was forced to close last fall, according to Davenport.

Since last October, the hospital has seen a 20 percent increase in the number of patients in the emergency department requiring a psychiatric evaluation compared to the average per month in 2006.

“We believe that we are serving, in some ways, as a safety net for the psychiatric patients through our emergency department,” Davenport said. Read more!

Sen. Nesbitt again showed he cares for people of WNC - Asheville Citizen-Times

Letter: by Arthur Carder

When confronted with challenges, many of us turn the other way, but some, like Sen. Martin Nesbitt, step up to the plate time and time again. He has helped lead the efforts to stabilize our mental health system and to keep the focus on local control. His focus on people and their needs is much appreciated by the general public.

The proposed “needle exchange” pilot program shows leadership and a willingness to help save lives and improve the quality of life for many of our citizens. Sen. Nesbitt has introduced this bill, which needs full support. This opportunity to increase access to services has the potential to reduce drug use and convey a message that we care about these individuals and want to provide alternatives. We must find more ways to help open doors to individuals in need; this is indeed another step in that direction.

Arthur Carder, Asheville
Carder is chief executive officer of Western Highlands Network (LME). Read more!

Talks scheduled on leasing old jail - Atlanta Journal-Constitution

By Kathy Jefcoats

Clayton County will negotiate with a Florida company to lease the former county jail in Lovejoy.

Cloid Shuler, vice president of business development for the Boca Raton, Fla.-based GEO Group Inc., said the 576-bed jail mainly will be used to house pretrial detainees for federal authorities.

"We feel there is a need for additional beds for the U.S. federal marshals office and Immigration and Customs Enforcement," Shuler said.

Clayton commissioners voted Tuesday night to allow county attorneys to negotiate with Shuler to work out the length and terms of the agreement. Once the contract is settled, Shuler said the facility will undergo an estimated $4 million renovation.

"We're hoping the negotiations will move along quickly," he said. "The renovation will take about eight months or less to complete."

The jail in Lovejoy was built in 1986 and evolved into a work-release facility in 2000 when a new criminal justice center was built in Jonesboro.

Citing "deplorable conditions," Clayton County officials closed the old Lovejoy jail about two years ago, moving all work-release inmates to the Jonesboro jail.

Commissioner Sonna Singleton said she was impressed by GEO Group's earlier presentation to county officials.

"Their presentation included employing people from the community, which I liked because of the high unemployment rate in Clayton County," she said. "They also said they are willing to participate in the community, to give back. Overall, they showed concern for the community."

GEO Group is the largest international provider of privatized corrections and mental health facilities, Shuler said. This will be the company's first venture in Georgia, he said. Read more!

Protesters attack governor's prison plans - LA Times

Activists seeking reforms say more penitentiaries aren't the answer to overcrowding crisis.

By Jenifer Warren

SACRAMENTO — Busloads of protesters fighting the construction of new penitentiaries swarmed the Capitol on Wednesday, while inside the statehouse, the simmering politics surrounding the prison overcrowding crisis boiled into full view.

The protesters attacked Gov. Arnold Schwarzenegger's plan to build 78,000 new prison and jail beds, saying that $11 billion worth of "bricks and mortar and debt" are no substitute for true reform.

Instead, the demonstrators — some dressed in orange prison jumpsuits and standing in makeshift cells — said lawmakers could quickly thin the inmate population by releasing geriatric and incapacitated convicts and by sanctioning thousands of parole violators in their communities rather than in state lockups.

Meanwhile, political fireworks were flying over a decision by Senate Democrats to place a moratorium on bills that would lengthen criminal sentences and thereby exacerbate prison crowding.

The maneuver infuriated Republicans, but Sen. Gloria Romero (D-Los Angeles), chairwoman of the Senate Public Safety Committee, said it could not be "a business-as-usual year" in Sacramento given the overcrowding emergency.

"The Legislature bears a share of the responsibility for the crisis, and we must accept that," Romero said. "We can't keep having bills fly out of committee like pancakes just because we want to appear tough on crime."

Supported by Senate President Pro Tem Don Perata, a Democrat from Oakland, Romero said she would hold in her committee until next year any bill that would intensify crowding. Three measures — two submitted by Democrats — have been stalled so far, including one that would add five years to the sentence of those impersonating a police officer during a kidnapping or sex offense.

The Senate's top Republican, Dick Ackerman of Tustin, called the move irresponsible: "Our No. 1 priority is public safety and protecting California's citizens from bad guys. This move is not the way to relieve crowded prisons."

Citing conditions of "extreme peril" for inmates and officers alike, Schwarzenegger in October declared a state of emergency in the state's adult prisons. Roughly 172,000 inmates occupy space for 100,000, and some 16,000 convicts are sleeping in "ugly beds" — those crammed into hallways, gyms, recreation rooms or other areas not designed for housing.

Corrections officials say they will be out of room for new inmates by the end of the year, raising the prospect that California's counties — 20 of which have court-imposed population caps on their jails — will have nowhere to send convicted felons.

With no relief in sight, lawyers for inmates with disabilities and medical and mental health problems have asked the courts to cap the prison population at a significantly lower level. Three federal judges are mulling those requests and will hold hearings in June. And one of the judges, Thelton Henderson of San Francisco, has given the Schwarzenegger administration until May 16 to present a plan to reduce the number of people behind bars.

Against that backdrop, the governor and legislative leaders have been negotiating a response to the crisis. Schwarzenegger said this week he hoped an agreement would be struck before the Legislature adjourned for spring break today.

Others close to the talks said progress had stalled, particularly over proposals seen as politically risky by lawmakers on both sides of the aisle.

Ackerman said he hoped the parties were nearing agreement on one small-scale relief valve — the movement of inmates to other states. Schwarzenegger already has ordered such transfers, and 360 prisoners have moved to private facilities in Arizona and Tennessee.

But a Superior Court judge last month halted the moves, ruling that the governor lacked the legal authority to authorize them.

Ackerman said lawmakers believe they could adopt language giving the governor temporary authority to arrange such transfers. Some Democrats, however, remain opposed.

Another controversial measure on the table is the diversion of thousands of parole violators now punished with short stays in prison. Some Democrats want those parolees whose violations are relatively minor to be sent to drug treatment centers or correctional facilities in their communities, rather than put in a state prison bed for three to five months. But Republicans and some moderate Democrats are leery.

"If some guy is 20 minutes late for his appointment with a parole agent, that's a true technical violation, and we will look at that," Ackerman said. "But it's my understanding that such cases are rare. Many of these parole violators are committing serious crimes and need to be sent back to prison."

As the talks continued, Assembly Republicans this week added a visual reminder of the crisis to the mix — a poster titled "Countdown to Community Chaos!" Taped to GOP lawmakers' office doors, the posters feature monthly calendars with the date May 16 — the federal judge's deadline — highlighted in red.

One protester outside the Capitol predicted the threat of court action would not motivate lawmakers to act.

"Everybody is just waiting for the federal court to take over the system, and they are all polishing their finger getting ready to point it at whoever they plan to blame," said John Lum, former chief probation officer for San Luis Obispo County and a coordinator of Wednesday's event.

"It's a disgrace. The governor and Legislature keep stuffing people in the prisons but they refuse to take responsibility for the consequences."

jenifer.warren@latimes.com

Read more!

Antidepressants don't help bipolar patients, study finds - NY Times

Combined with a mood stabilizer, as many doctors prescribe, the drugs are found to have no effect on depressive symptoms.


By Denise Gellene

Antidepressants, which are widely prescribed with mood stabilizers to treat patients with bipolar disorder, do not work in relieving the depressive symptoms of the illness, a large federal study reported Wednesday.

The study in the New England Journal of Medicine narrows the already limited number of treatments for bipolar disorder, which affects 5.7 million adults in the U.S., experts said.

"A new generation of drugs is needed," said Dr. Thomas R. Insel, director of the National Institute of Mental Health. "It is clear from this data that antidepressants are not the answer."

Still, some doctors said antidepressants would continue to have a role because there were so few options, and the drugs seemed to alleviate other symptoms that often accompanied the complex disorder.

"Many people we see are refractory to a mood stabilizer alone, and adding an antidepressant markedly improves them," said Dr. Lori Altshuler, professor of psychiatry at UCLA, who was not involved in the study.

But Altshuler, who has consulted for companies that market drugs for psychological disorders, said the study clearly demonstrated that patients should first try a mood stabilizer, which could also have antidepressant effects.

People with bipolar disorder experience severe mood swings between depression and mania, a state marked by an excess of energy and restlessness. For most patients, depressive episodes are three times more common and longer-lasting than those of mania. Symptoms of the disorder can interfere with daily activities, and severe cases carry a risk of suicide.

Standard treatment consists of mood stabilizers such as lithium, valproate and carbamazepine. Antidepressants are often added to control severe depressive swings, despite concerns the drugs may trigger a switch to a manic episode.

Researchers estimated that 50% to 70% of people with bipolar disorder take antidepressants, although the Food and Drug Administration has approved none of the drugs as a treatment for the disorder.

The study, part of the institute's $27-million Systematic Treatment Enhancement Program for Bipolar Disorder, set out to determine whether the common antidepressants Wellbutrin and Paxil would enhance the benefits of mood-stabilizer drugs. The study was also designed to find out whether the antidepressants would trigger mania.

Previous studies provided mixed results on effectiveness. Wellbutrin and Paxil were chosen because earlier studies indicated they were less likely to trigger mania than other antidepressants.

In the study, 366 patients at 22 academic centers in the U.S. were randomly assigned to receive one of the two antidepressants or a placebo for 26 weeks, in addition to their mood stabilizers. Patients also received psychological and social therapy.

The study, designed to mimic real-world conditions, differed from a typical clinical trial in that many patients had complicating disorders, including anxiety, substance abuse or psychosis.

Of the 179 participants who received an antidepressant in addition to a mood stabilizer, 23.5% achieved a durable recovery, defined as an eight-week period marked by no more than two depressive or two manic symptoms.

In the placebo group, 27.3% of patients achieved a durable recovery.

The difference between the groups was not statistically significant, researchers said.

The criteria of durable recovery were stricter than in other trials, which used rating systems to measure overall improvements in patients' moods.

Researchers reported there was no sign that Wellbutrin or Paxil could trigger a manic episode. They said 10.1% of patients on antidepressants and 10.7% of those on placebo exhibited manic symptoms.

Lead author Dr. Gary Sachs, director of the bipolar clinic at Massachusetts General Hospital, said the study should guide the way new patients were treated, but there was no need for patients doing well on antidepressants to quit taking them.

"There is no benefit from standard antidepressant medication," he said. "But there is no risk to adding it, either."

In an editorial accompanying the report, Dr. Robert H. Belmaker of Ben Gurion University in Beersheba, Israel, said the study would not settle debates about the safety and efficacy of antidepressants in treatment of bipolar disorder.

Patients who had become manic in response to antidepressants in the past would not have enrolled in the trial, he said, casting doubt on whether the drugs are safe for all bipolar patients.

Belmaker noted that two European reviews of published studies found antidepressants to be effective, and that in his own practice he prescribed antidepressants to patients with severe depression but mild mania.

He said that bipolar disorder showed wide variability in symptoms, which argued for flexibility in treatment.

denise.gellene@latimes.com
Read more!

House Passes Bill to Improve Veterans’ Care - AP

WASHINGTON, March 28 (AP) — Reacting to shabby treatment of wounded service members at Walter Reed Army Medical Center, the House on Wednesday created a coterie of case managers, advocates and counselors for injured troops returning from Iraq and Afghanistan.

The Wounded Warrior Assistance Act, approved 426 to 0, also establishes a hot line for medical patients to report problems in their treatment and demands an end to the red tape that has frustrated disabled service members as they move from Pentagon care to care by the Veterans Affairs Department.

The bill would affect some of the more than 25,000 American service members wounded in hostile action since military operations began in Iraq and Afghanistan.

“We cannot allow those who have fought our foreign enemies in the defense of freedom to come home and fight the federal bureaucracy to get the health care they need,” said Representative Candice S. Miller, Republican of Michigan and a member of the Armed Services Committee.

The White House said in a statement that while those goals were commendable, the legislation was premature and suggested that Congress wait for a report from a presidential commission and a task force on the war-wounded created after the exposure of poor conditions and treatment at Walter Reed. Those findings are expected by the end of July.

The bill requires Senate action before it goes to the president.

Representative Duncan Hunter, Republican of California, whose support for a strong military is a cornerstone of his presidential aspirations, said he was particularly pleased with a provision that would improve personal care by limiting medical care case managers to 17 cases at a time. Mr. Hunter, the ranking Republican on the Armed Services Committee, said he also liked the legislation’s move toward more information sharing between the Defense Department and the V.A. and steps to ease the transition to veteran status.

Under the bill, the defense secretary would be required to provide disabled service members being separated or retired from active duty with a written plan for transition to V.A. programs.

Several amendments directed that more attention be paid to the mental health of returning combatants. Read more!

Mental health funding fractious - Fresno (CA) Bee

Published March 28
By Kerri Ginis / The Fresno Bee

Fresno County supervisors debated Tuesday whether to put additional money toward mental health services next year but delayed a decision after disagreeing about previous discussions they had on the issue.

Cuts are looming for county mental health services to address a $10 million budget gap in 2007-08. The board is trying to decide whether it wants to continue supplementing the budgets of the county's two mental health departments to help maintain existing services.

This year, the board gave about $5 million to the Behavioral Health and Children and Family Services departments. The money came out of the general fund, which pays for many services including law enforcement, roads and parks.

County Administrative Officer Bart Bohn said the 2007-08 draft budget doesn't provide any general fund money to those two departments.

But Supervisor Susan Anderson said the board never agreed to that.

"I don't believe our board ever said we wouldn't contribute general fund dollars," Anderson said. "The board has not voted on this, and I don't support doing that."

Supervisor Henry Perea disagreed. He said the board told Bohn several times not to give those departments general fund money next year. He said the board also adopted a three-year plan for reducing mental health costs that called for the general fund contribution to stop in 2007-08.

Now he wants the board to reconsider that decision.

"Good or bad, it was a board decision, and that's fine," he said. "I just want to understand the impacts of that."

The board will revisit the issue April 17. But it may be a difficult decision considering the other competing needs in the county, including public safety.

This year, behavioral health has $54 million budgeted for mental health services. Children and family services has about $22 million budgeted.

The departments already are planning to reduce services next year. Between the two, they are proposing to cut their staff by about 100 positions. They also need about $10 million to maintain current programs.

Several county residents pleaded with the board to continue the general fund contribution.

"Without the services of Fresno County, I would be in your jail, on your street homeless or in your morgue," said Curtis Q. Thornton, who was diagnosed with bipolar disorder and now has a degree in alcohol and drug counseling. "The services I have received have helped me, and they can help other people, too."

Billie Hughes, an advocate for those suffering from mental illnesses, said providing mental health services saves the county money.

"We would not like to be rehospitalized," she said. "We're trying to stay out and recover."

The reporter can be reached at kginis@fresnobee.com or (559) 441-6317. Read more!

Workers at Patton, other state mental hospitals demand pay raise - Riverside (CA) Press-Enterprise

By IMRAN GHORI

Employees at Patton State Hospital joined their colleagues around the state Wednesday in demanding higher pay at state mental hospitals.

Similar protests were planned at Metropolitan State Hospital and Atascadero State Hospital in advance of a meeting later Wednesday between union and state officials.

Court-ordered increases in recent months have led to large pay raises hikes for psychiatrists, psychologists and other staff members at state prisons. Employees at the state's five mental health hospitals fear that their pay is lagging behind and they will lose staff to the prison system.

"Right now there's an exodus of medical staff," said Mario Valenzuela, a union labor representative with Service Employees International Union, Local 1000, which represents about 900 nurses, food service workers, custodians, teachers and office personnel at Patton.

In an effort to recruit more qualified physicians, a federal receiver recently ordered the near doubling of salaries for prison doctors.

The move had the unintended consequence of luring physicians away from mental health institutions such as Patton and Atascadero State Hospital.

Facing lawsuits related to mental health care, both the Department of Corrections and the state hospital system separately risk having their systems taken over by a court-appointed federal receiver unless they make mandated improvements. Both systems are competing for the same doctors under the threat of receivership.

Holding signs saying "Equal pay for equal work," the group of mostly nurses at the protest said the loss of staff affects patient care and their safety. They said their work, dealing with criminally insane patients, is just as dangerous as those who work in prisons, if not more so.

"They have correctional guards behind them," said Sharon Simmons, a nurse at Patton.

"We don't have anyone. It's just us and the patients."

The disparity ranges from $2,551 per month for a pharmacy technician to up to $8,766 for a registered nurse, according to the union.

SEIU Local 1000 is pressuring the Department of Personnel Administration to include raises for its members in the state budget.

Cindy Barrett, a spokeswoman for Patton, said the hospital hasn't been affected by the loss of staff as much as other hospitals because the area has a large pool of employees to draw upon. But she said it is a concern.

"We agree the situation has to be looked at," Barrett said.

She noted that decisions on pay are made in Sacramento, not at the local level. Staff writer Paige Austin contributed to this report.

Reach Imran Ghori at 909-806-3061 or ighori@PE.com Read more!

Alzheimer's vaccine works on mice: Japan scientist - Reuters

By Isabel Reynolds

TOKYO (Reuters) - Japanese scientists have developed an oral vaccine for Alzheimer's disease that has proven effective and safe in mice, the director of a research institute behind the project said on Thursday.

The team is preparing to move to small-scale clinical trials in humans, possibly this year, said Takeshi Tabira, director of the National Institute for Longevity Sciences in Aichi, central Japan.

"We hope the Phase I trials go well," Tabira said. "Animals are able to recover their functions after developing symptoms, but humans are less able to do so. It may be that this only works in the early stages of the disease, when symptoms are light."

When administered to mice suffering from the disease, which causes dementia and is currently incurable, the vaccine reduced the amount of amyloid plaques in the brain and improved mental function.

Amyloid plaques are believed to be at the root of Alzheimer's -- a growing problem for aging populations around the world. The disease affects five million in the United States alone, the Alzheimer's Association said in a report last week.

The treatment did not cause inflammation or bleeding in the brains of the mice, Tabira said.

The vaccine is made by inserting amyloid-producing genes into a non-harmful virus. When taken orally, the virus stimulates the immune system to attack and break down the amyloid proteins in the brain, Tabira said.

The treatment was tested on 28 mice genetically modified to develop Alzheimer's disease. Half the animals were given a dose of the vaccine at the age of 10 months, while the control group were not treated.

Three months later, tests showed mental function in the treated mice had returned to levels close to those before they developed Alzheimer's symptoms.

U.S. drugmaker Wyeth and its Irish partner Elan Corp have an Alzheimer's vaccine called ACC-001 in early stage human trials.

The Japanese research, carried out in conjunction with scientists at Nagoya University and others, is to be published by the Federation of American Societies for Experimental Biology in July. Read more!

Mental health center to repay $556,687 - Boston Globe

By David Abel

A local social services provider has agreed to pay the state more than half a million dollars to settle allegations it billed the state Medicaid program and the Massachusetts Department of Mental Health for services it never rendered, officials said yesterday.

Tri-City Mental Health Center, a non profit organization with facilities in suburbs north of Boston, will pay the state $556,687 and enter into a compliance program negotiated by the state attorney general and the US attorney's office, according to a statement released by the attorney general's office.

Employee complaints in 2003 prompted Tri-City to review claims submitted by its service center in Malden, according to the attorney general's office.

The internal investigation led to the termination of at least one manager, an independent audit, and notification of state and federal officials.

An investigation by the attorney general's and US attorney's offices found that between February 2002 and November 2003, Tri-City submitted claims to the state Medicaid program for adult psychiatric day treatment services not supported by documentation or never provided.

From September 2001 to October 2003, the organization submitted claims to the Department of Mental Health for rehabilitation and other services that could not be substantiated by documentation or were never rendered, the attorney general's office said.

Officials from Tri-City did not return calls yesterday.

In its statement, the attorney general's office wrote that Tri-City Mental Health Center "neither admits nor denies the allegations as part of today's settlement and has cooperated fully with the investigation." Read more!

What 'Mental Retardation' Means, and Why the Term Is Acceptable - Washington Post

Opinion: By Jay Mathews

Dear Extra Credit:

In your March 22 response to my letter about the Montgomery County learning centers issue ["For Reporters, a Remedial Course in Learning Centers," Montgomery Extra], you said that my references to students or children with mental retardation were "old-fashioned, and, to some, offensive" and that I might want to trade in the term "mentally retarded" for "one of the terms now used by professionals in that field, such as learning disabled or developmentally disabled."

I'm using the term "mental retardation" because:

· That is the term that the Montgomery County public school system uses to describe students placed in the Learning for Independence and School-Community Based centers -- either students with mild to moderate mental retardation or students with moderate to severe mental retardation.

· Learning disabilities are not the same as mental retardation. By definition, someone with a learning disability has intelligence in the average or above-average range (above 70). Someone with mental retardation has intelligence in the below-average range. I don't think you want to imply that these two diagnoses are the same, unless you want parents of kids with learning disabilities jumping all over you.

· Developmental disabilities sometimes, but not always, include cognitive disabilities. For instance, a child with cerebral palsy has a developmental disability, but he may or may not have mental retardation. Tourette's syndrome is also a developmental disability, but people with that syndrome almost never have mental retardation. So, developmental disability is not synonymous with mental retardation. A developmental disability is simply a disorder that begins before 3, affects development and is expected to last for life.

I have a 13-year-old daughter with Down syndrome, and I am not happy with the term mental retardation. (My daughter is not happy with it either! I can't tell you how sad it made me the first time she came home from school and said: "Mom, what does retarded mean? Am I retarded?")

I am with the people who are pushing to have the term renamed something such as "cognitive disability" or "intellectual disability." Until that change is official, the only term you can use to be clear about the students you're referring to is "mental retardation."

Susan Stokes

Montgomery Village



Dear Extra Credit:


· Mental retardation is the term used in federal and state special education law.

· It is possible to have both mental retardation and a learning disability. The terms are not equivalent. If you have an individual with mental retardation with a specific, measured intellectual level, who cannot read or do math at that expected intellectual level, he/she may be diagnosed with a specific learning disability.

· "Developmental disability" is a broader term, encompassing conditions such as autism (which may or may not be co-morbid with mental retardation). Federal and state special education laws do use the term developmental delay, but I think it can only apply to children ages 3 through 9.

· In the field, some professionals instead use the term cognitive disability. So you get reports referring to individuals with a mild cognitive disability, a moderate cognitive disability or severe/profound cognitive disability.

I don't find the term "children with mental retardation" offensive. The "R" word (retard), however, is every bit as offensive to me as the "N" word, and it saddens me that school officials do not treat disability harassment with the same seriousness that they do racial harassment.

Lyda Astrove

Rockville


Thank you for your corrections and your nuanced explanations of the array of terminology. I have often confessed how little I know about special education, and how infrequently I write about it, mostly because it is so complicated and so difficult, at least for me, to turn into stories that readers will find interesting and comprehensible.

The nomenclature is changing. You seem to want to push it in the same direction I do. That awful use of the word "retard" is likely to bring an end soon to the term "mental retardation" in programs. The President's Committee on Mental Retardation has changed its name to the President's Committee for People with Intellectual Disabilities, and the former Association for Retarded Citizens now calls itself the Arc.

Please send your questions, along with your name, e-mail or postal address and telephone number, to Extra Credit, The Washington Post, 51 Monroe St., Suite 500, Rockville, Md. 20850. Or e-mailextracredit@washpost.com. Read more!

Missouri mental health system computer problems hinder billing - AP

Published March 28

ST. LOUIS - Many state mental health facilities for months have not been paid for care of patients covered by Medicare and Medicaid because of computer problems at the state Mental Health Department.

Since October, the St. Louis Post-Dispatch reported in Wednesday editions, most of the state's 17 mental health facilities have been unable to bill for clients under the government health care programs.

"We've been collecting the data, but we have not been processing the bills," said Tony Cuneo, chief operating officer of the Metropolitan St. Louis Psychiatric Center. "We're just holding them until we get the go-ahead that the system works."

The Mental Health Department also has delayed more than $26 million in payments to many alcohol and drug abuse treatment providers because of billing problems.

The department's new $13.7 million computer system - used to track patient admissions, discharges, transfers and assessments - is to blame.

State officials say internal software problems and a heavy volume of requested patient information caused the computer system failure. As a result, Medicare and Medicaid bills have gone unfiled and mental health provider payments have been delayed.

State mental health officials recently received one-time funding of $1.3 million to cover losses and additional expenses by mental health providers because of the computer bugs.

Alcohol and drug abuse treatment providers say they've faced extra costs and just recently saw the state relax business rules.

Department Director Keith Schafer said the agency set a July 1 deadline - the start of the new fiscal year - to get the system fully operational.

"By that time, all bills have to be up to date," Schafer said. "We have no choice."

The same troubled computer system is also responsible for reporting abuse complaints at state-run mental health centers.

"It's unfortunate that, because of all this, we're forgoing some reporting that is very important," Schafer said.

The state Senate gave initial approval Tuesday to legislation making a variety of changes in the mental health system, including making public final reports of substantiated abuse and neglect claims and requiring the department to inform law enforcement of credible complaints.

Some worry the new computer system's problems could threaten smaller, nonprofit mental health clinics.

"We've been terrified of it because of all the problems," said Francine Broderick, executive director of the St. Louis nonprofit mental health center Places for People.

In 2000, the Mental Health Department and the Office of Administration awarded a $3.75 million contract to Ohio software company Innovative Systems Inc. to replace the department's 20-year-old computer filing system. But the company missed deadlines and did not meet performance requirements, so the department instead hired Chesterfield-based Rose International.

But that company also did not meet contract requirements, and the state took over the project in 2004. A 2005 audit found the project was millions of dollars over budget and lacked adequate oversight. Read more!

Lack of resources mean police are default mental health system: B.C. expert - Canadian Press

By: SAUDAMINI RAINA

VANCOUVER (CP) - Police officers who joked with a 911 dispatcher after a man threatened suicide and eventually died will be investigated, but Chief Jamie Graham says black humour isn't the main problem in the case.

Instead, Graham says he's concerned the man's calls for help were given a low priority and for 20 minutes, no officer was dispatched to the man's apartment. Graham told a news conference Wednesday he wants an investigation to reassure people that their calls will be taken seriously, no matter what their background.

"Black humour, stupid things said on the telephone back and forth, I can deal with that. That does not happen very often and it may be explained in this case, I don't know. That's what we're going to find out but that's a secondary issue of individual personalities," Graham said.

"We go to try to help people. In this case, a man is dead. We owe it to his family, to you to find out if we could have done something better here."

Graham called the news conference a day after a coroner concluded Michael Sproule died 20 minutes after calling 911 for help and over an hour after his aunt called to say her nephew had threatened to kill himself.

The coroner found Sproule's aunt called just before 2 p.m. on Sept. 19, 2006, but her call was given a low priority and police units in the area were otherwise occupied.

Sproule called just before 3 p.m. the same day, saying he'd cut his wrists and that he was dying.

His call was transferred to the B.C. Ambulance Service but because he was also yelling and making confusing statements, the ambulance service contacted the police dispatcher to ask for officers to attend.

Though Sproule's call was bumped up in priority, it still wasn't ranked at the top and police weren't sent to his apartment until 20 minutes later, the coroner found.

Sproule was known to have had a history of mental illness and schizophrenia and depression.

Graham said Sproule had called 911 in the past threatening suicide and on the day Sproule died, police had received about a dozen such calls from other people.

When police finally arrived at Sproule's apartment, they couldn't get into his suite because he had barricaded the door with furniture. Officers had to climb over the balcony.

Once inside, they found Sproule on the floor in a pool of blood.

Coroner Mark Coleman concluded emergency dispatchers should have given Sproule's aunt's call top priority and that urgency should have been maintained when Sproule himself called.

The dispatcher responsible has been fired.

Coleman reviewed an internal investigation into how police are dispatched to 911 calls and did not find a systemic problem.

Bev Gutray, executive director of the B.C. division of the Canadian Mental Health Association, said that in general, police training to respond to the mentally ill has improved over the last few years.

"So I think they're on the right track," Gutray said, adding she couldn't comment on Sproule's case until the Vancouver police department completes its investigation.

She said police have a difficult job when it comes to dealing with people who are in crisis - whether it's domestic violence or mental health issues.

"There's over 500 people a year who take their life in B.C.," Gutray said, adding several coroners' inquests have identified police training as a critical issue.

"We have a mental health system for the most part, in this province, not unlike in every province in the country, that is stretched to its limit, that doesn't have enough resources and the police end up being the default mental health system."

Gutray's division has completed a pilot project with police departments across the province to train officers to respond when someone is in crisis.

Since the 1970s, Vancouver has had two emergency psychiatric response teams that include a nurse and a police officer to assess mental health crises.

But while the model is extremely effective, Gutray said there are only two such teams for the whole city - one for the day shift and the other for night.

"The most important thing, whether it's police or whether it's an ambulance driver or whether it's you or I, when somebody calls for help that means they need help. And we need to take cries for help seriously because otherwise they end up in tragic situations."

Graham said Sproule's case is an "isolated" one.

He wouldn't say what the joking remarks between the officers and dispatcher were, saying he wouldn't make them public until after an internal inquiry into the officers' conduct is finished, likely next month.

But Graham said the officers involved have been co-operating with the investigation.

Black humour "gets us through the day sometimes. But there are certain times when it's inappropriate and if that's one of these cases, we're going to find out and we're going to make sure the officers know the right way to conduct themselves.

"But these are experienced people. We'll get the facts very soon." Read more!

Child’s therapy room at the Oconee County Mental Health Center can ease troubled minds - Anderson (SC) Indpendent Mail

Published 3/29
By David Williams

Paintings of ballerinas and baseball players, kites flying high and swings hanging low decorate brightly colored walls, while toys and stuffed animals fill the corners and a small table with chairs sits off to one side.

It could be any child’s room anywhere. But it’s the child therapy room at the Oconee County Mental Health Center and it’s the first of its kind for the Anderson-Oconee-Pickens Community Mental Health Centers that are part of the South Carolina Department of Mental Health.

Judy Hassam, volunteer coordinator with the Anderson-Oconee-Pickens Mental Health Center, and volunteers with the National Alliance on Mental Illness saw a need for the special room.

“It’s truly what the community wanted and the project was wholeheartedly embraced by everyone,” Ms. Hassam said.

Family members who realized they must help each other in order to obtain mental health help for their family members started the national alliance.

The Anderson-Oconee-Pickens Community Mental Health Centers are funded through the South Carolina Department of Mental Health, insurance and grant funding. There are more than 3,200 people being assisted by the centers in the three counties, including 900 in Pickens County and 1,600 in Anderson County.

The Oconee center on Carter Park Drive is six years old and was designed to serve the mental health offices and services. About 700 people are helped at the Oconee Center including more than 150 children.

“We see some very frequently, others receive medication maintenance,” said Kevin Hoyle, the centers’ executive director. “Most of the patients are referred by family members, doctors, schools, but it has to be a parent’s choice.”

The new room in Oconee County has a one-way mirror with an observation area that also serves a second room used when evaluating teenagers and adults.

“The more comfortable you are, the more you talk about how you feel,” said Mary Campbell, who also works at the Oconee center.

Michelle Ready, with the National Alliance on Mental Illness and a board member of the Anderson-Oconee-Pickens centers, said the room could be a prototype for rooms in Anderson and Pickens counties that do not now have the one-way observation area.

Tab Hollwager, a child therapist, said parents should watch for extreme changes in their children’s behavior.

“What is special about the center is no appointment is needed for an assessment,” Ms. Campbell said. “If a mother wakes up frightened, it’s important they get the information they need when it’s needed. Parents have got to be involved. To treat the child, you treat the whole family. It’s like when couples get counseling, both have got to be actively engaged.”

Ms. Campbell said there is a stigma, a big mystery surrounding mental health and people need to overcome that shadow.

“It’s the same all over the country,” Ms. Campbell said. “When you’re in a room with 10 people, two have been directly impacted by mental health issues. Or one in five families.” Read more!

Fireworks both topic and tone of meeting - Outer Banks Sentinel

BY VICTORIA BRAGUNIER | SENTINEL STAFF

The March meeting of the Dare County Board of Commissioners was both
long and heated. One of the hottest topics of discussion began with
the presentation by Sandra Jordan-Leigh on behalf of the Albemarle
Mental Health Center.

Leigh presented to the board a local business plan that purports to
address the mental health, developmental disabilities and substance
abuse needs for the residents within a 10-county area. The counties
include Hyde, Tyrell, Washington, Martin, Camden, Chowan, Currituck,
Dare, Pasquotank and Perquimans counties.

The business plan is for a three-year period and is to be a blue print
for the North Carolina Division of Mental Health, Developmental
Disabilities and Substance Abuse Services (NCDMHDDSAS) about how
Albemarle Mental Health will manage and provide services to its
service area.

"We are asking the Dare County Board of Commissioners to approve our
business plan in order that Albemarle Mental Health can continue
serving Dare County. Additionally, we are asking that you sign a
letter of support in order for Albemarle Mental Health to build a
crisis/detox facility in Martin County," said Leigh.

The request was met with a mixture of scrutiny and outrage.

"What we have here is an executive plan that does not outline what
services Dare County is going to receive," said Allen Burrus,
commissioner.

Commissioner Richard Johnson who also serves on the Albemarle Mental
Health Commission shot back with a response to Burrus.

"Albemarle Mental Health is always getting a bum rap," he said.

"To be quite frank with you, you [Albemarle Mental Health] are
building a detox center for another county, which is something that
you haven't done here and you are asking for our help. It's quite a
slap in the face," said Burrus. "I suggest this board set this aside
and ask you [Albemarle Mental Health] to bring us your plan of exactly
what services you are going to provide this community."

The remarks by Burrus prompted other commissioners to join in the sentiment.

"We aren't rubber stamping anything anymore," said Virginia Tillet, commissioner

"I want to see a full business plan." said Max Dutton, commissioner.

With those statements, Warren Judge, commission chairman, requested
that a detailed plan be submitted to the board.

"We need your support today. We have to turn in the plan into the
State by March 30th and your board won't meet again until April," said
Leigh.

Leigh's remark prompted a whole new discussion.

"I have had many residents of Dare County come up and talk to me about
how disappointed they are in Albemarle Mental Health. They ask me why
they are not getting the needed services. I have heard that when
people call Albemarle's 24-hour crisis line that all they get is a
recording — so I called your 24-hour hotline and I got a recording. I
wonder what services are being offered, what is going on that no one
is answering the crisis line?" said Judge.

Leigh responded by denying that the hotline was not answered by a person.

"I am not sure what number you are calling, but I am sure you are not
calling the right number," said Leigh.

"The number I am calling is the number that has been passed out to the
schools and other agencies and one time out of four I got someone to
answer me. That one time they couldn't hear me and asked me to call
back and when I called back no one answered," said Burrus.

Leigh claimed ignorance and stated she couldn't understand what happened.

With that the board told Leigh that they would not sign off on the
plan without seeing a detailed report. Leigh again responded that the
board had to act then and without the board's approval, Dare County
may not continue to receive services.

"You've known that you needed us to approve this plan since December
21st and you waited until the last minute to present this plan. The
plan is without details and you expect us to approve it; that is
typical of how Albemarle Mental Health Center works. Now you're
threatening us with loss of services unless we approve your plan
today," said Burrus.

Judge again requested a full business plan be submitted. Albemarle
agreed to submit such a plan and the board will be holding a special
meeting on the matter March 28th.
Read more!

N.C. schools overrun with mental health options - AP

CHARLOTTE, N.C. (AP) -- Some school districts are taking steps to shield students from the mostly private, for-profit mental health companies that are lining up to send mental health aides into public schools.

The surge in private companies interested in serving students struggling emotionally and mentally began last year when North Carolina privatized the service. The move was an effort to reform the state's mental health system and give consumers more treatment options.

But officials in Mecklenburg County and elsewhere in the state worry that some companies are ill-qualified or more concerned with potential profits than serving students.

"We're being inundated with requests," said Carolyn Gaither, director of prevention and intervention services with Charlotte-Mecklenburg Schools, the largest school district in the state. "A lot of new agencies are popping up in the community."

The school system currently allows mental health experts to provide in-school services from only two organizations: Carolinas Medical Center or the nonprofit Family Center.

Over the past year, local mental health officials have cleared more than 70 businesses to work with Charlotte-Mecklenburg students. The school district has formed a committee to review the companies.

About 50 miles east of Charlotte, more than 200 mental health aides work in Anson County's 10 schools. School officials say some classrooms had up to five aides and they were distracting students who didn't need help.

In response, the county school board this week adopted rules that curb the companies' access to schools.

"I just think it's extremely profitable for the service providers," said Nat White, chairman of the Anson school board. "And it's not just a problem in Anson County. It's a problem all over the state."

In 2006, companies providing what the state calls "community support services" billed more than $433 million, mostly in Medicaid money. In February, state officials said they were auditing 167 firms with high per-client billings that might be misusing the program and keeping clients longer than necessary.

Critics suggest the surge in companies resulted from the state Department of Health and Human Services setting the pay rate too high, at $60 an hour, while setting standards too low.

"It's interesting that when the state introduces a new (pay) rate that's positive (for service providers), people come out of the woodwork," said Craig Bass, president of the nonprofit Alexander Youth Network in Charlotte.

The Family Center, which serves about 40 children within the Charlotte-Mecklenburg system, billed for about $51,000 last year under the community support services program, according to state figures. Figures from Carolinas Medical Center weren't available.

At Wadesboro schools in Anson County, R.E.A.D. Inc. serves about 60 students through the community support program. R.E.A.D, which started in 1998, billed Medicaid for more than $1 million last year.

Lawrence Elliott, who heads the company, said if he were only motivated by profits then he could easily have boosted his client list to more than 200.

"It's easy, quick money to enroll people," Elliott said. "There are companies who are trying to do the right thing. Unfortunately, we're overshadowed by companies that see (the program) as a quick revenue floodgate." Read more!

Autism can't bend subdivision rules - Raleigh News & Observer

Covenants anger parents who need fences to protect kids

Peggy Lim, Staff Writer

CLAYTON - Hunter Guyader, 2, shows signs of autism, and he is a climber. He broke out of his crib when he was 11 months old. He almost fell from an upstairs window while scaling a couch.

Michele and Rene Guyader hoped to build a 6-foot fence to keep their fast-growing boy from falling into a sewage drain hole at the back of their steeply sloping lot. The homeowners association of their Clayton subdivision turned them down.

Although a U.S. Centers for Disease Control and Prevention study released in February says that about 1 in 150 children born in the nation have autism or a related disorder, getting accommodations for such children can still be a struggle in private neighborhoods.

A privacy fence that tall "just creates a wall," said Rob Bailey of the architectural review committee. The Guyaders appealed the decision based on their son's special needs.

"It's not, 'Gee, I want a 6-foot fence because I don't like my neighbors,'" said Michele Guyader. "I like my neighbors, but I also like my son, and I want to see him safe."

North Carolina is one of only six states the federal government has certified for incorporating Americans With Disabilities Act accessibility guidelines in building codes. But such rules are geared toward public or commercial buildings or dwellings such as hotels, dormitories and nursing homes. They specify widths for wheelchair-accessible toilet stalls, heights for water fountains or the minimum percentage of units in apartment complexes that should be accessible. Backyard fences, though, aren't mentioned.

"ADA regulations only apply to public facilities," Theresa Cathey, president of TLC Management of Raleigh, told the Guyaders in an e-mail message after they appealed. A few days later, the Guyaders received a letter denying their initial request.

Telling a family with an autistic child they can't put up a fence is akin to telling someone in a wheelchair he can't have a ramp up to his front door, said lawyer Greg McGrew of Apex.

McGrew fought his Dogwood Ridge homeowners association in 2001 for permission to build a 5-foot-tall fence.

"My son at the time was an escape artist," McGrew said. "Turn your back, and he'd be gone."

Jacob, then 5, had already been diagnosed with autism. Even though autism is not a physical disorder, McGrew said, parents must often take physical measures to keep children with the disability safe, such as having an alarm system on their doors. Jacob had clambered over a 4-foot-tall fence at a previous home. McGrew and his wife were so desperate to put up a taller fence at their new residence, they went ahead and installed one without permission because the homeowners association was dragging its feet. The homeowners association in turn threatened to sue.

"By all means, let's go," McGrew said.

With help from Carolina Legal Assistance, a nonprofit agency that represents clients with mental disability, McGrew eventually got the association to back down. Four of five association board members resigned after the tiff, McGrew said. McGrew later became homeowners association president and president of the Carolina Legal Assistance board of directors.

Bailey, the architectural review committee member in the Guyaders' neighborhood, said he was not fully aware of the son's condition until contacted by a reporter. He would consider a 4-foot-tall fence, topped with a see-through lattice.

The Guyaders aren't sure yet that will work. They argue an exception to the covenant is warranted because they didn't know of their son's condition before moving into Cobblestone subdivision about a year ago.

Early signs of autism

Hunter had been developmentally on track his first 12 months. But after the Guyaders' second child, Annabelle, was born, he started to regress. He won't get in to see a neurologist for an official diagnosis until May. But Hunter already shows signs of being on the spectrum for autism.

The 2-year old has regular meltdowns in the grocery store. To get him to nap, Michele Guyader must drive him around Clayton in the car for 20 to 30 minutes each afternoon.

On this day, after Hunter wakes up from a midday slumber, his mother scoops him up and carries him to the fridge.

"Mmmmmmmmm," Hunter says, hugging her neck then holding out his hands.

"You want milk?" she asks.

Hunter grabs the sippy cup. "Awaayway wawah," he says.

"Really?" Guyader says as if the babble makes perfect sense.

While most children at 18 months know about 40 words and are able to string together two- to three-word sentences, Hunter's vocabulary is limited to hand gestures for "more" and "please." He points his index fingers together, for instance, to say he wants more food.

Half the time, he seems deaf, Guyader says.

She and her husband must watch him closely when he plays in the front yard, pushing his Fisher Price lawnmower or loading rocks into a toy truck. He'll eat the rocks, his mother said. And he doesn't hear them calling his name, telling him not to run into the street.

That's why the Guyaders won't take him to parks without fences, and why they hope to find a safe enclosed space for him to play in their backyard.

-----------

CHALLENGING THE RULES
Many neighborhoods have covenant rules to protect property values. Arguing for an exception to the rules for a mental disability can be tough if it's not well-understood. Here are some tips advocates recommend:

* Submit letters from doctors, detailing a child's condition.

* Provide letters from neighbors, supporting the proposed change.

* Offer to remove a modified structure when it is no longer needed or when you are moving out of a subdivision.

Governor's Advocacy Council for Persons with Disabilities; Laurel Wright, N.C. Department of Insurance




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

Teen crisis center to be built - Waynesville Mountaineer

Published March 26
by Peggy Manning

CLYDE — Big changes are in store for the Teen Education and Crisis Hotline.

Plans are being finalized to build a nine-bed crisis center in Jackson County for youth 10 to 18 years old and to relocate the TEACH operations to a portion of that building. “We will keep our Parents Against Teen Suicide main office in Clyde, but the equipment for the hotline will be in Jackson County,” said Fred Davis, founder and director of both organizations.

The TEACH board of directors agreed last year to sell the TEACH headquarters in Clyde to Mountain Youth Resources to help offset operating costs.

Plans for the new crisis center are subject to final approval by the boards of TEACH and Mountain Youth Resources, Davis said. Mountain Youth Resources and Parents Against Teen Suicide will have offices on the main floor, with three apartments to be built upstairs in May. Three more apartments will be added later, Davis said.

The apartments will be offered to homeless and disabled clients of Mountain Youth Resources, said Keith Henry of Mountain Youth Resources.

“We have already built two buildings in the Windy Hill section of Clyde,” Henry said. One is a one-bedroom house and the other is a two-bedroom duplex.

The new intake center fills a need in the area, Henry said, after the Smoky Mountain Center for Mental Health closed its crisis center in the Balsam community.

“The center will stabilize youth in emergency shot-term situations. The average stay will be 30 days,” Henry said.

TEACH joined forces with Mountain Youth Resources in March 2006 to provide referrals and follow-up counseling services for the youth who call the suicide hotline.

TEACH dissolved its contract with the Smoky Mountain Center for Mental Health for those services because Smoky Mountain Center had stopped providing funding to TEACH to operate its crisis hotline.

“We lost $95,000 in funding, so we had to get rid of some of our overhead,” Davis said. At one point, the telephone bill for the hotline was $27,000 a year. It’s much less now that TEACH has stopped working the calls for Smoky Mountain Center, Davis said.

Because TEACH lost those funds, eight operators for the suicide hotline had to be laid off. Some stayed on as volunteers, but Davis ended up taking over many of the shifts.

“The hotline didn’t stop,” he said. “More than 290,000 calls have been worked since the TEACH hotline began operating in 1990 and we have records that show we have helped 80,000 people and have documented about 2,095 direct interventions.”

Davis said he is aware of only one person who proceeded to take his life after an intervention was made by TEACH.

Even though the success of the hotline is well documented, Davis has struggled through the years to keep the program funded and operating.

Of the $230,000 annual operating budget, the only funds these days that Davis can count on come from the United Way of Haywood County.

The agency typically provides $25,000 to TEACH. Davis is responsible for raising the rest.

A new Web site was launched for TEACH in January and has already received more than 15,000 hits, Davis said.

“We will probably open another PATS office in Cherokee,” he said.

The hotline number will remain the same, 1-800-367-7287. “We need more volunteers to train to work the hotline,” Davis said. Read more!

State wants data on addicts - Asheville Citizen-Times

By Jordan Schrader

ASHEVILLE — The lawmakers’ response wasn’t quite, “Help is on the way.”

Instead, they asked leaders pleading for help treating Buncombe County’s drug addicts to arm them with data, pick their top priorities and wait for lawmakers to get more money for what Sen. Martin Nesbitt called a “dysfunctional” state mental health system.

Treatment providers and local government officials on the Asheville-Buncombe Drug Commission set out their problems and potential solutions Monday to Nesbitt and three state representatives.

They asked that local agencies be reimbursed for long-term help for drug abusers after the most intensive treatment ends.

“It’s not the stopping that’s hard,” said Dr. Paul Martin, a physician specializing in addiction. “It’s the staying stopped.”

Among the other goals of the commission chaired by City Councilman Carl Mumpower:

• A 24-hour, one-stop shop to assess drug users in crisis.

• Case managers to track clients.

• A way agencies can share information online.

• A “wet shelter” to take in intoxicated homeless people whose present options are the emergency room and jail.

Nesbitt, D-Buncombe, said the local management entities that run mental health in their communities could use some of the $135 million his committee has proposed for them this year on such items from their wish list as a wet shelter.

But he cautioned that the state couldn’t do everything and that Buncombe County has room to spend more of its own money on mental health.

The commission, on a request from Rep. Charles Thomas, R-Buncombe, agreed to come up with its top priorities within a month.

Thomas showed interest when Martin told lawmakers that onerous state regulations limit patients’ choice of treatment providers.

“A private practicing physician cannot see these clients,” Martin said, “without belonging to some sort of agency.” Read more!

Violence and mental illness - High Plains (TX) Journal

The news media too often leads viewers and readers to believe that people with mental illness are dangerous, violent, and will "go crazy" with little or no provocation. When in fact, research and studies indicate the opposite; that people with major mental illness are more likely to be the victims of violence rather than the perpetrators.

A recent study from North Carolina State University and Duke University found that people who suffer from schizophrenia, bipolar disorder, or psychosis are more than twice as likely to be attacked, raped, or mugged than members of the general population. Homelessness and alienation from family and friends often contribute to their vulnerability. Other studies indicate that the majority of people who have a severe mental illness are no more violent than anyone else. Factors such as youth, gender (male), poverty, and a history of violent behavior are all stronger predictors of violence as compared to having a mental illness.

The general public wonders why a depressed woman like Andrea Yates would drown her five children, or why a man like John Hinckley Jr., became obsessed with the movie star Jody Foster, and also tried to assassinate a United States President. Crimes such as theirs are very rare in people with mental illness, but each is an example of how a psychotic disorder or thought disorder can result in extreme behavior. In contrast, many individuals who suffer from a severe mental illness such as schizophrenia, delusional disorder, or bipolar disorder, do experience a great deal of private torment, yet would never commit a violent act.

When violence does occur in a person with a mental illness, other factors should be taken into consideration. Individuals with major psychotic symptoms, such as paranoia, usually function better on psychiatric medications. If they quit using their medication, in spite of cautions from their therapist, physician, and family, their behavior will tend to become more unpredictable. Alcohol or drug abuse also increases the chance of violence. If their behavior does become threatening or violent, it is usually focused on family members, or someone they know well. Thus it is vital for friends and family who are aware, to know their own limitations when dealing with the person, and call for assistance from a mental health professional and/or law enforcement if any situation feels unsafe.

People who are burdened with a severe mental illness face challenges on a daily basis that are difficult for others to understand, or to imagine. But when it is assumed that everyone who has a mental illness is a potential criminal, waiting to explode, then their burden becomes even heavier.

Contributed by Ken Loos, MS, LMLP, LCP, Consultation and Education Department.

Mail questions to: High Plains Mental Health Center, PLAIN SENSE, Consultation and Education Department, 208 East 7th, Hays, KS 67601; or visit www.highplainsmentalhealth.com. Read more!

Senate panel considers dropping ‘mental retardation’ from agency name - Columbia (MO) Missourian

By KATHLEEN BUHRMANN

Several Boone County residents attended a Senate committee hearing Tuesday on whether the words “mental retardation” should be removed from the name of a state division that provides services for people with disabilities.

Sen. Kevin Engler, R-Farmington, presented Senate Bill 621 to the Seniors, Families and Public Health Committee at the Capitol. He wants the words stricken from the name of the Division of Mental Retardation and Developmental Disabilities, saying it’s offensive to people with mental disabilities.

“The word ‘retard’ is now a derogatory term used in society,” Engler said.

Several parents, group representatives and people with disabilities spoke in favor of the bill. Four members of Boone County’s People First attended.

People First member Greg Griffin of Columbia has supported the name change since it was first proposed in 1998. He handed the committee a letter singed by 17 fellow members. It said the name change is “long past due” and asked that the committee “please help Missouri get with the times and remove MR from MRDD.”

All but 13 states have removed the term from the names of their state agencies. Four of those, including Missouri, are considering bills to follow suit.

Lobbyist Jerry Ford, of Cape Girardeau, however, opposed the bill. He said he represents several groups that are fine with the term.

“The majority of people with MR are incapable of expressing their opinion,” Ford said. ”So I am speaking on their behalf.”

Bernie Simmons, director of the Division of Mental Retardation and Developmental Disabilities, spoke in support of the bill.

“Changing the name of the division,” he said, “would not change the mission of the division, those eligible for services or those receiving services from the division or contract providers.”

The committee is tentatively scheduled to decide next week whether to move the bill forward.

Several people from the hearing will be addressing other disabilities issues and concerns during Disability Rights Legislative Day 2007 today. They include Columbia residents Max Lewis, Bob Pund and Cathy Enfield, who will talk about accessibility, affordable health care and Medical Assistance for Workers with Disabilities. Sens. Wes Shoemyer, D-Clarence, and Chuck Graham, D-Columbia, and Reps. Jeff Harris, D-Columbia, and Charles Portwood, R-Ballwin, will also speak at the rally. Read more!

Governor's order would bolster mental-health services for children - Salem (OR) Statesman Journal

THELMA GUERRERO

Gov. Ted Kulongoski wants Oregon children to have better access to mental-health services.

To make that happen, the governor on Tuesday signed an executive order establishing the Children's Wraparound Steering Committee to oversee the development of an integrated care system for youths with mental illnesses and their families.

"The issue of mental-health care for Oregon children has been long overlooked," Kulongoski said. "The time has come to develop an integrated system of care for these children."

Kulongoski signed the order surrounded by young Oregonians and their families whose lives have been adversely affected by mental-health issues.

It is estimated that more than 43,000 children in Oregon have mental illnesses, according to census data.

During the roundtable discussion, Devin Mayner, 16, a sophomore at North Salem High School, shared his personal experience with mental illness.

"I had a lot of anger toward the world. I felt alone and helpless, felt I wasn't being heard," Mayner said. "I was doing and selling drugs, my grades dropped, my sports. Life was not good for me at the time."

He said he was able to turn his life around after he began to receive services from the Early Assessment and Support Team, a Mid-Valley behavioral care network that helps young people at risk of developing psychosis.

"I'm even looking to graduate a year early," Mayner said.

Kulongoski emphasized the importance of investing in early prevention and treatment programs to help deter youth with mental illnesses from behavioral and substance-abuse problems.

His budget proposes an investment of $4.3 million to expand the EAST program.

The governor also addressed the need to integrate and coordinate services that help address developmental and behavioral disorders in youths, saying they and their families often need services from multiple child-serving agencies.

The shared agenda is intended to break down communication and collaboration barriers that often occur between youths, families, mental-health providers and service agencies and schools.

The newly created steering committee is charged with developing strategies aimed at improving cross-agency service coordination at the state and local levels to help provide better care for children, youth and their families.

Under the executive order, the committee must submit its plan to the governor by October.

tguerrero@StatesmanJournal.com or (503) 399-6815 Read more!

Lawmakers to study privatization of mental hospital - Salt Lake City Tribune

By Matt Canham

Conservative lawmakers are continuing a push to hand over the operation of the state mental hospital to a private company.

Legislative leaders met Tuesday to create a subcommittee that will hold six hearings on the relationship between private industry and government.

Draper Republican Sen. Howard Stephenson requested the subcommittee and will lead the effort. He said the group of eight lawmakers will discuss proposals to privatize the state mental hospital and to create a privately run prison, among other issues of government competition.

"I am really curious why Utah has been very slow in examining the government interference in the private sector," Stephenson said.

Legislative leaders also requested an audit of the state hospital Tuesday. That audit, which will take months to conclude, will focus on the "quality and type of care" and "the need for additional bed space."

Senate Majority Leader Curt Bramble did not ask Auditor John Schaff to look into privatization.

"Before you can even think of privatization you have to look at the state of services," Bramble said. "Where are we at right now?"

Bramble and Rep. Rebecca Lockhart, R-Provo, were the sponsors of a bill this past legislative session that would have required the state to contract with a private business to run the hospital. They abandoned their efforts before the bill came up for a vote.

Bramble and Lockhart were members of a legislative delegation that visited a privately run mental hospital in Florida last December at the request of Rob Jolley, who is a lobbyist for Geo Care, an international company that runs hospitals and prisons.

House Democrats argued against the privatization subcommittee, complaining that it was given too much latitude.

mcanham@sltrib.com
Read more!

Georgia Senate OKs panel to probe state hospitals - Atlanta Journal-Constitution

By Alan Judd, Andy Miller

The state Senate voted Tuesday to create a commission that would study ways to improve care in Georgia's troubled state psychiatric hospitals.

The measure, Senate Resolution 363, passed unanimously without debate on "crossover day," the deadline for bills to have cleared at least one chamber to be considered for final passage during this legislative session.

Sen. Johnny Grant (R-Milledgeville) filed the resolution in response to a series of articles in The Atlanta Journal-Constitution, which revealed a pattern of neglect, abuse and poor medical care in the seven state hospitals that contributed to at least 115 suspicious deaths since 2002.

The resolution would create a legislative commission that would spent two years looking at the state hospitals' chronic overcrowding and understaffing, at diverting more patients to community-based services and at requiring insurance plans to provide the same coverage for mental health care as for other medical treatment.

The panel would consist of legislators, a judge and citizens representing hospital patients and law enforcement agencies.

Advocates for people with mental illness applauded the Senate's vote, which sends the measure to the House for consideration.

"I really do believe that if they do this commission the right way, they will actually see how disjointed the mental health system is," said Ellyn Jeager of the Georgia chapter of Mental Health America. "It's in serious need of fixing, and you can't fix it until you understand it."

The U.S. Justice Department is considering whether to investigate conditions in Georgia's state hospitals, as advocates requested after publication of the Journal-Constitution articles in January. Federal intervention in other states has forced improvements in care, hospital construction and renovations costing millions of dollars. Justice Department officials have said they are reviewing the request for an investigation.

Read more!

A cop's view from skid row - LA Times

The ACLU can gripe all it wants, but LAPD efforts are changing the area for the better.

Opinion: By Andrew Smith
ANDREW SMITH is a captain in the Los Angeles Police Department.
March 27, 2007

I AM THE CAPTAIN for the LAPD's Central Division, which encompasses downtown and all of skid row. Like the police officers who patrol skid row, I was sorely disappointed by Ramona Ripston's complete distortion — in a column on this page — of our efforts to stem the lawlessness, suffering and human misery that was commonplace on skid row just a few months ago.

I am outraged that Ripston, the executive director of the American Civil Liberties Union of Southern California, implied that our officers are violating the very Constitution they are sworn to uphold and protect. The officers in skid row, who all volunteer for the assignment, have one of the lowest rates for the use of force in the city. And I am even more appalled by her views because she walked skid row streets with our officers and rode around in a black-and-white last year and was shocked then at the horrific conditions under which our most vulnerable citizens survived. How quickly she forgot!

How quickly she forgot that convicted murderers, rapists, robbers, 3,800 parolees and 300-plus registered sex offenders called the 50 square blocks of skid row home. How quickly she forgot the dealers dangling narcotics in front of those trying to kick drugs. Many other predators were hiding among the street population, preying on the weak, addicted and mentally ill.

Fortunately, the terrible culture of lawlessness that was once the norm on skid row is quickly changing for the better.

Despite the efforts of the ACLU and other self-appointed champions of the homeless to thwart us, the Los Angeles Police Department is succeeding in protecting the vulnerable on skid row and in curbing the lawlessness: Fewer people are dying of drug overdoses; paramedic calls are down; crime has plummeted 36% so far this year, on top of an 18% reduction in 2006, and nobody who has wanted a bed and follows the rules has been left on the streets.

Moreover, missions report that more people are seeking beds and treatment, and our Streets or Services (SOS) program is diverting misdemeanor arrestees away from jail and into treatment and housing programs. The people living on the streets and the people living in the missions, hotels and apartments in the area report that they are feeling safer — because they are safer.

Ripston referred to several people on skid row who claimed that they were "harassed" for no reason. She decried the "jaywalking tickets" our officers write. We write traffic tickets to change behavior, not to harass the homeless. Consider that, in 2006, four out of six traffic deaths in the Central Division were caused by pedestrians in the roadway, as were all three traffic deaths so far this year.

Just a few months ago, skid row was where "anything goes" — an open-air drug bazaar with blatant outdoor acts of prostitution. Today, about 1,200 of those dealing (selling heroin or rock cocaine) are in jail. Hundreds of parole violators are back in prison.

Ripston asks: Where did all the homeless people go? I am sure some people have chosen to go to other communities where they can continue their criminal behavior. But many others who used to hang around skid row actually had a home; they just chose to stay on skid row because of the cheap and plentiful drugs, alcohol and prostitution.

Who would come to skid row just to hang out? How about Jason Johnson, a gang member who last year stabbed to death a homeless man in a dispute over a bicycle. Johnson had a home in Azusa but chose to hang out on skid row because he liked to smoke rock cocaine and because of the "party" atmosphere. He is now one of the people in prison, where he belongs.

Or Kristi, a woman from a prominent family who found herself addicted to drugs and living on the streets of skid row. Despite every effort by her family and outreach workers to get her back home or into an apartment, she chose to live on the sidewalk at 5th and San Julian streets, right next to an open shelter with empty beds. She was beaten to death last year on the sidewalk by a drug dealer.

What other kind of people are officers arresting on skid row?

How about Jimmy Lee Smith, who we caught in February hiding among the homeless. He was arrested on a parole violation. You may remember him as the "Onion Field" killer responsible for the murder of Officer Ian Campbell in the 1960s. Or how about Demond Little, an East Coast Crips gang member who was arrested by our Safer Cities Task Force, which is assigned specifically to skid row. Little, who was hiding out on skid row, was convicted of a home invasion, rape and murder.

Want to find out the truth about skid row? Want to see if our officers are trampling on the civil rights of homeless people? Come down and see for yourself. And don't take my word for how the homeless are being treated; ask them yourself. Or ask one of the 400 courageous men and women working Central Division about the human suffering they see every day.

We are proud of skid row police officers. We will continue to provide training in dealing with the troubled and troublesome population on skid row. Do we need more money for housing, for supportive services and mental health care? Of course. Yet, until such resources are available, it is the job of the police to make the skid row area safe for the most vulnerable members of our community, giving them the opportunity to recover from their addictions in a supportive environment.

And much credit also goes to Police Chief William J. Bratton, who has pushed forward the Safer Cities initiative and taken on the problems of skid row despite constant criticism from the ACLU and others. His addition of narcotics officers and foot patrol officers is making the community safer.

When I "walk the walk" with my officers on skid row, I like to remind them of the quote from President Theodore Roosevelt, "It's not the critic who counts." The reality is that the LAPD Central Division officers are the ones who count, and they make a difference to the community on skid row every day.

Read more!

Better care is sought for mental patients - LA Times

Five lawmakers urge a remedy for staffing shortages at state hospitals after some link the problem to a rise in suicidal acts.

By Scott Gold and Lee Romney

Five lawmakers with state mental hospitals in their districts called on the Legislature's budget chairs Tuesday to address an accelerating staffing shortage at the institutions, calling it "a crisis of meltdown proportions."

The urgently worded letter came in the wake of a Times report that two Atascadero State Hospital patients had killed themselves and four others had attempted suicide since early February — an alarming increase that some have tied directly to the staffing shortage.

The lawmakers' appeal also comes a week after Gov. Arnold Schwarzenegger and state Department of Mental Health Director Stephen W. Mayberg unveiled a plan to boost salaries at the facilities starting in April.

Mental health clinicians have been leaving the hospitals in droves since a federal judge last December ordered steep pay increases for comparable jobs in the state prison system.

The proposed pay increase crafted by the governor last week is the administration's first concrete attempt to stop the exodus, which has left Atascadero with an 87% vacancy rate for psychiatrists.

The raises will bring psychiatrists and senior psychologists to within 5% of the prison salaries, while other clinicians such as psychiatric technicians will still earn 18% less than their prison counterparts.

Schwarzenegger did not need legislative approval for the temporary salary increases, which will be in effect through June and cost the state $9.4 million.

But the Legislature will have to approve the governor's $37.6-million proposal to maintain them through the next budget year.

"It's a very good solid first step," said Assemblywoman Noreen Evans (D-Santa Rosa), one of the lawmakers who appealed for action. But "it isn't enough. In a perfect world we'd be paying these very highly dedicated and well-trained, professional staff everything we could."

The raises apply not only to the Department of Mental Health, but to the departments of Developmental Services and Veterans Affairs, which have also lost significant numbers of staff to the prisons.

Evans said there is a "very real possibility" that some of the state hospitals, developmental centers and veterans homes would have to curtail services or close altogether.

In their letter Tuesday, the lawmakers expressed "grave concerns" for the institutions. "Even if immediate action is taken to reverse the brain drain to prisons, it is conservatively estimated that it will take 2-3 years for treatment conditions to normalize to resemble adequate care," they wrote.

Other authors are Sens. Patricia Wiggins (D-Santa Rosa) and Abel Maldonado (R-Santa Maria) and Assembly members Sam Blakeslee (R-San Luis Obispo) and Lois Wolk (D-Davis).

Response to the governor's proposal has been mixed. Some psychiatrists believe the raises will stem further departures. But lower-paid technicians, whose pay raises won't put them anywhere near on par with their prison counterparts, immediately attacked the announcement.

Tony Myers, statewide president of the California Assn. of Psychiatric Technicians, likened it to someone yelling "Fire!" inside Atascadero — telling everyone to "get out of there."

At Atascadero, about a third of the psychiatric technician positions are vacant, he said, and that was before the governor's announcement caused widespread disillusionment.

"I talk to people every day who say: 'I don't want to leave.' But they aren't being given a choice."

scott.gold@latimes.com

lee.romney@latimes.com
Read more!

Couple Plead Not Guilty in Girl's Death - AP

BROCKTON, Mass. (AP) -- Parents accused of killing their 4-year-old daughter with an overdose of prescription drugs had concocted symptoms of mental illnesses to qualify the girl for government benefits, a prosecutor said Tuesday. Michael and Carolyn Riley pleaded not guilty to first-degree murder charges Tuesday and were ordered to remain in custody without bail.

The Rileys' applications for Supplemental Security Income for their daughter, Rebecca, were twice rejected after government doctors examined her and found no evidence to back the parents' claims of bipolar disorder and attention deficit hyperactivity disorder, or ADHD, Assistant District Attorney Frank Middleton said.

Rebecca was found dead on the floor of her parents' bedroom on Dec. 13. A medical examiner said she died of a lethal combination of prescription drugs, including a fatal dose of Clonidine, which she had been taking for ADHD.

The Rileys' attorneys blame the girl's death on her psychiatrist.

''The medicines that a totally irresponsible doctor gave her killed her -- not the parents,'' said John Darrell, Michael Riley's lawyer.

Rebecca's older siblings, now ages 11 and 6, already had gone to the psychiatrist, Dr. Kayoko Kifuji, and were diagnosed with the same disorders and were receiving Supplemental Security Income, the program administered by the Social Security Administration for disabled children.

Middleton said Carolyn Riley told Kifuji that Rebecca had ''mood swings'' and was ''driving me crazy.'' Kifuji diagnosed her with bipolar disorder at age 3.

Carolyn Riley ''continued to feed Dr. Kifuji fabricated symptoms,'' Middleton said. He said Rebecca's teachers, a school nurse, mental health therapist and neighbors and adults who lived with the Rileys all told a grand jury that ''Rebecca showed none of these behaviors.''

Prosecutors also say that in one year Carolyn Riley got over 200 more pills than should have been prescribed for Rebecca by claiming she either lost or ruined bottles of pills, and by telling a pharmacy she had run out.

According to a state police investigator's report, witnesses told police the Rileys gave their daughter large doses of powerful prescription drugs to keep her quiet and sleeping for long periods.

The couple's other two children had been diagnosed with the same illnesses and were on almost identical prescriptions.

Kifuji agreed to stop practicing medicine until the state Board of Registration in Medicine completes an investigation. Her attorney, J.W. Carney Jr., has said she did nothing wrong and did not overprescribe medication for Rebecca. He declined to comment Tuesday. Read more!

Groups angry about ad campaign for suicide film - Reuters

Originally published March 26

NEW YORK -- Suicide prevention groups are dead set against the proposed ad campaign for the comedy "Wristcutters: A Love Story," which plans to bill itself with posters showing people killing themselves.

The images will depict people jumping off a bridge, electrocuting and hanging themselves. The acclaimed film follows a group of people that have committed suicide (including stars Patrick Fugit and Shannyn Sossamon) as they take a road trip through purgatory.

"You don't see people making fun of other causes of death, but you see it with suicide and mental illness," Robert Gebbia, executive director of the American Foundation for Suicide Prevention (AFSP), wrote in a letter to the film's backers.

But Courtney Solomon, co-owner of After Dark Films, said the posters will be displayed as traffic-style stop or yield signs with a bar and circle over the illustrations, along with hearts to reference the film's romantic story line. He said the campaign may change before its mid-July rollout.

"The movie takes place in purgatory, and its message is that love is better than suicide," Solomon said, adding that the film may even help prevent suicide.

"Our job is to get people into the theater in a way that's accessible to them. There are many different ways to skin a cat. God forbid someone was considering committing suicide. This film may change their opinion."

It's just the latest controversy for After Dark, which last week removed billboards and taxi signage for the upcoming film "Captivity," after complaints over depictions of star Elisha Cuthbert being tortured and killed.

After reading earlier this month about the "Wristcutters" signage, the R-rated film's target audience of 17- to 30-year-olds, and Solomon's comment that he hopes the signs "don't cause too many accidents," the AFSP wrote a separate letter to Solomon, along with 14 other groups, contending that the marketing campaign was overkill.

Jerry Reed, executive director of Suicide Prevention Action Network USA, said Solomon has not yet responded.

Solomon said he has been busy reshooting more violent scenes for "Captivity" to appeal to the audience that turned "Saw" and "Hostel" into hits. He cited this additional workload as one factor in moving the "Wristcutters" campaign from April to mid-July before its August 31 release in New York, Los Angeles and possibly other major markets.

He intends to offer screenings or DVDs of the film to concerned organizations in the next few weeks, and then discuss the campaign with them and ask for their input.

Both Reed and Gebbia said they were not objecting to the film but to the proposed campaign. "We don't want to censor work," said an AFSP spokesperson.

While the "Wristcutters" campaign has come under fire, Goran Dukic's dark comedy-romance was one of three films nominated for a 2006 Humanitas Sundance feature screenwriting award. Dukic received a plaque noting his "extraordinary contribution (to) entertainment that also enriches, probes the meaning of life and motivates love within the human family."

Copyright 2007 Reuters. All rights reserved.This material may not be published, broadcast, rewritten, or redistributed.

Read more!

Meth addict who made documentary dies - AP

ST. LOUIS, Missouri (AP) -- A former trucker whose documentary chronicled an agonizing descent as methamphetamine ravaged his body has died, optimistic to the end that his story would keep others from the highly addictive stimulant.

"He was extremely satisfied, wanting to do more in getting the word out and showing kids what meth harm does. We didn't get to that point," his father, Jack Bridges, said shortly after the 35-year-old died Monday at a hospital in Cape Girardeau.

"He didn't want anyone to go through what he did," his father said.

Shawn Bridges drew global attention last year for "No More Sunsets," a 29-minute film shot by a former southern Illinois television videographer at Bridges' request.

By his family's account, Bridges already had died at least twice, his heart so damaged by years of using meth -- a concoction that can include toxic chemicals such as battery acid, drain cleaner and fertilizer -- that it stopped and had to be shocked back into beating.

The documentary shows Bridges mostly bedridden, his constant companions a catheter and feeding tube.

"I'd say he's got a 34-year-old body on the outside with a 70- to 80-year-old man on the inside," his father told The Associated Press last May.

Roughly 28,000 people sought treatment for meth addiction across the country in 1993, accounting for nearly 2 percent of admissions for drug-abuse care, according to the federal Substance Abuse and Mental Health Services Administration.

Just a decade later, the meth-related admissions numbered nearly 136,000 -- more than 7 percent of the national total for drug-abuse treatment.

Family members have said Bridges had been haunted by the dreary day in 1976 when his younger brother Jason, barely a year old, died in a car wreck. Bridges was 4 and nowhere near the accident but still blamed himself, wanting to trade places with his dead sibling, his father said.

A lenient upbringing set Bridges on the road to becoming "a little monster," his father said. "By 16, the kid was a high school dropout and partier."

At 26, Bridges had a heart attack that his father blamed on meth's ability to damage a chronic user's heart and other internal organs. Bridges learned he had congestive heart failure. Twice, he tried to kill himself, according to family members.

During his final months in a hospital bed, Bridges' words slurred to guttural sounds when he tried to talk. At times, he spit up blood, and his weight fell dangerously when he couldn't keep food down. His father said Monday that Bridges developed a urinary tract infection shortly before he died.

"I don't think people will forget what got him to this point," said Chip Rossetti, who filmed the documentary. "But what he did with his condition is really the amazing thing."

Rossetti said 500 to 600 copies of the documentary have been sold, some going as far as Australia. Bridges was also profiled on German television. Rossetti said Monday he plans a sequel, chronicling Bridge's final year and testimonials by people touched by his awareness effort.

"We wanted to keep him with us a lot longer, but we appreciate God's good grace," Jack Bridges said after his son's death. "We'll still be trying to drive home the point that these drugs are poison, and that people using them are heading the same place Shawn has gone." Read more!

Mental health services may elude some immigrants - Norwich (CT) Bulletin

By ERICA JACOBSON

NEW LONDON -- A black single mother from New Orleans relocated to Connecticut after Hurricane Katrina finds herself dealing with white culture for the first time.
A Hispanic child who doesn't recognize another Spanish-speaking country's word for not telling the truth.

A Middle Eastern patient who prizes privacy above everything else when it comes to seeking psychiatric help.

These were some of the examples of people, especially children, who easily could fail to get the help they need from southeastern Connecticut mental health agencies, according to panelists who addressed a gathering Tuesday night.

"As a system, we know that we're not serving minority populations," said Linda Fecteau, a private mental health consultant based out of East Lyme. "They're fearful of treatment. They're fearful of being involved in a system that doesn't necessarily value their culture."

Several dozen members of the Southeast Mental Health System of Care met at New London's Lighthouse Inn to discuss the culture, linguistic and philosophical barriers that stand between some of the region's newest residents and the mental health care they need.

"Hispanic clients come into the system on a mandate," said Maria Gallagher, Oakdale-based project outreach coordinator for the Northeast Regional Children's Advocacy Center. "They don't come in voluntarily."

Gallagher, one of four panelists who spoke during the presentation, used her own family as an example.

Her brother's drug addiction drove several members of her family to seek therapy as a way to help him and themselves, Gallagher said. Except for her mother.

Gallagher said the woman lied about the source of her son's problems.

"She was feeling that this was a family problem," Gallagher said. "If he's sick, it's because we're all sick. It was too much for her to bear and she was not going to go to therapy."

Jerry Fisher of the Jewish Federation of Southeastern Connecticut said part of dealing with those outside our cultures means respecting their needs and not imposing our values on their situation.

"We're not intruding into their lives beyond where they want us to go," said Fisher.

But a large part of the problem simply comes down to language. The region needs more competent translators who will deliver a patient's responses without judgment or filter, Gallagher said. Other panelists agreed.

"When you have somebody who speaks the language, that's 90 percent of the battle won," said Dr. Bassam Awwa, a New London psychologist fluent in Arabic and French. "When they start speaking your language, you start to trust them." Read more!

Mental Health's financial mess - St. Louis Post-Dispatch

By Derek Kravitz

JEFFERSON CITY — Computer problems at the Missouri Department of Mental Health
have made it impossible for the state to collect millions from the federal
government for the past six months, state officials say.

Since October, most of the state's 17 mental health facilities have been unable
to bill clients who are covered under Medicaid or Medicare, including most of
the patients who visit the state's three mental health clinics in St. Louis.

"We've been collecting the data, but we have not been processing the bills,"
said Tony Cuneo, chief operating officer of the Metropolitan St. Louis
Psychiatric Center. "We're just holding them until we get the go-ahead that the
system works."

Medicaid is a state and federal program that pays for doctor visits, nursing
home care and in-home services for more than 800,000 low-income Missourians,
many of them children. Medicare is a federal program that primarily covers the
elderly and the disabled.

Additionally, the Department of Mental Health, which oversees state
institutions and privately run centers, delayed more than $26 million in
reimbursements to many of the state's 300 alcohol and drug abuse treatment
providers because of billing problems.

At fault is the department's new $13.7 million computer system — called
Customer Information Management, Outcomes and Reporting, or CIMOR for short.
The system is used to track patient admissions, discharges, transfers and
assessments.

State officials say the computer system failed because of internal software
kinks and the heavy volume of requested patient information.

"It's just one more example of a mental health system that has large gaps in
providing services that we should be providing," said Rep. Margaret Donnelly,
D-St. Louis, who is a member of the state House's Health, Mental Health and
Social Services Appropriations Committee.

The result has been unfiled Medicare and Medicaid bills and delays in
reimbursing already-cash-strapped providers.

The same faulty computer system that is causing billing problems also is
responsible for the reporting of abuse complaints at state-run mental health
facilities.

The Department of Mental Health came under fire last year after an
investigation by the Post-Dispatch reported that 21 deaths, 323 injuries and
almost 2,000 other incidents were tied to abuse or neglect by caregivers of
mentally disabled residents from 2000 through 2005.

The newspaper reported that the department failed to follow its own policies
and state laws on investigating incidents and notifying police.

"It's unfortunate that, because of all this, we're forgoing some reporting that
is very important," said the department director, Keith Schafer.

State mental health officials recently requested and received a one-time $1.3
million supplemental appropriation from the state to cover losses and
additional expenses by mental health providers because of the computer bugs.

Schafer said the department has also set a July 1 deadline — the end of the
department's fiscal year — to get the system fully operational.

"By that time, all bills have to be up to date," Schafer said. "We have no
choice."

Alcohol and drug abuse treatment providers say they've incurred additional
costs and that they have only recently seen any relief, in the form of relaxed
business rules from the state.

"The system is still a little buggy," said Brenda Fraser, executive director of
Bridgeway Counseling Services in St. Charles. "We have had to hire a few more
staff and get some additional training to comply. Hopefully, the system will
continue to improve."

Other service providers say the new computer system's problems could threaten
smaller, nonprofit mental health clinics.

"We've been terrified of it because of all the problems," said Francine
Broderick, executive director of the nonprofit mental health center Places for
People, in St. Louis.

In 2000, the Mental Health Department and the state's Office of Administration
awarded a $3.75 million contract to Innovative Systems Inc., a privately held
software company, to replace the department's antiquated 20-year-old computer
filing system.

During the next three years, deadlines were missed and performance requirements
were not met. The department canceled its contract with the Toledo, Ohio-based
company and signed a new contract with Chesterfield-based Rose International.

That company also failed to meet contract requirements, and the state took
control of the project itself in 2004.

A 2005 audit of the Department of Mental Health's Office of Administration
Systems reported that the project was millions over budget and lacked adequate
oversight.

dkravitz@post-dispatch.com | 573-635-6178 Read more!

Me and You and Mental Health - Cornell University (NY) Daily Sun

By Erin Geld

I’m finishing Cornell and after four years, I’ve done a lot. Eight straight semesters and decent grades. I’ve toughened up. If it’s not only the academic pressures, it’s also the laundry list of undergraduate traumas — homesickness, culture shock, isolation, inadequacy, tumultuous relationships, spots of depression and weight gain. Been there, done that. I actually managed them fairly well, with the help of family, old friends and school friends. Unfortunately, there were other times when I needed more support.

In my junior and senior year, I nearly lost loved ones to sudden and serious illnesses. I could not help but be very involved in both incidents, particularly the second one, which caused me to fall behind on a week’s work and miss important deadlines. Catching up and explaining myself, when the semester was in full steam, was a nightmare. In the following weeks, I had severe mood swings, was depressed and slept constantly. At this point, I decided to call CAPS (Counseling and Psychological Services). I was interviewed on the phone and later told that there were no appointments available for three weeks (they may have been particularly busy in early October), but they directed me towards a local “community health resource,” Family and Children’s Services. I visited a therapist for the first time in my life. Unfortunately, after a few sessions, I felt the visits were unnecessary and asked my mother to visit instead, which worked wonders and gave me the push I needed for the final weeks of school. Heavy stuff, huh?

Because of Cornell’s size and competitive academic culture, it is important that there is support available to students. However, because of Cornell’s size and competitive academic culture, students are not receiving support when they should. With a population of thousands, it is impossible to accommodate the needs of every student. The drive of the Cornell student makes them very, very reluctant to admit to “weakness” and get the help they might need. It’s a big, bad vicious cycle.

Despite stepping to the plate and asking for help, I did not really get the support I needed from Cornell or CAPS. Perhaps, I was unlucky and didn’t click with my counselor. Perhaps, I should have tried harder, been a little more patient. Perhaps, I shouldn’t have been insistent on a short-term solution and accepted the principle of therapy, which needs time in order to be effective. I do not know.

I am sure that CAPS has helped many people, but there is more to be done.

I understand that accommodating the Cornell community is a momentous task and I can hardly offer suggestions in terms of CAPS’ makeup and structure, but I do know there is an information gap. Not only was I surprised to discover on the website that they had counselors that specialized in all sorts of areas, but they had walk-in services all over campus. Beyond that, many people do not know what it means to be mentally unhealthy. This ranges from students in crisis to students who are simply stressed. The dated pamphlets are only available at Gannett. I only discovered the website a few days ago, when researching for the column. Most of my knowledge on mental health comes from quizzes in cheery, gung-ho women’s magazines.

It may be because I live in Collegetown, where there are no Residential Advisors or posters on every door advertising mental health services. Other than the flu visit to Gannett, a cursory glance at the advertisement in my planner, my fuzzy memory of posters and flyers from freshman year were the only way I knew about CAPS. There are thousands of Cornell students living in Collegetown that should have this information on hand. Not only information about the where and what of CAPS, but about basic mental health issues, enabling all students to identify any problems more readily.

There is one simple suggestion I can offer — a mailing list. Pamphlets in our dilapidated off-campus mailboxes will give us something to stash in our desk. E-mail is better, though: students live through it, checking it any moment they can. We already receive a monthly one from the Career Services Center (stressful!), why not a mental health awareness bulletin? With some CAPS-approved reading, perhaps a little mini-test or two. It needn’t be alarmist or overlong, but brief and friendly. It would increase a sense of involvement, accessibility and also bolster students’ grasp of their own mental wellbeing. Most importantly, it would give these issues more visibility, reduce stigma and encourage compassion, which President Skorton has been admirably vouching for in recent speeches and writing, especially concerning mental health.

All in all, there is no doubt that ours is a demanding school. Some people can handle it fine, others cannot. Sometimes shit happens. Remember that little quip you read in college ranking literature? “Cornell is the easiest Ivy to get into, but the hardest to graduate from.” It’s true. However, life after school is also demanding. Only when you underperform, the consequences are a little more drastic. It’s important to incorporate a mindful, empathetic posture towards mental health at Cornell, so we may be successful in many more ways than one.

Erin Geld is a senior in the College of Arts and Sciences. She can be reached at esg24@cornell.edu. The Sampling appears alternate Wednesdays.
Read more!

Virtual hallucination machine gives user mental illness lesson - Florida Times Union (Jacksonville)

By CHRISTINA ABEL

Barbara Gentry, a nurse with the St. Johns County Department of Mental Health, plans to use her recent training with a virtual hallucination machine that simulates schizophrenia to better understand and sympathize with her patients.<

County Sheriff David Shoar said he's planning on using the virtual machine to train his officers for a crisis intervention training program that he'll start next month. The program will train law enforcement officials to deal with people with mental illnesses.

The virtual hallucination simulator, which is one of two in the country, was brought to the county's mental health department Thursday to help show staff and community officials what it's like to experience schizophrenia.

Gentry, who tried the simulation Thursday, called it "frighteningly realistic."

She's been in the health field for most of her career and got into the mental health arena about three years ago. She said that she'd never been through training like Thursday's and that it gave her a better perspective of what her patients experience daily.

"It helps me to deal with our clients and know what they're going through," Gentry said. Patients with schizophrenia often come in to the office acting rude or distracted; the simulation put all of that into perspective, she said.

During the simulation, participants experienced what a schizophrenic person would see and hear as they walked through a Publix grocery store and tried to get their medication refilled at the pharmacy. Outfitted with earphones and goggles, participants had to make it through the aisles, crowded with people, all the while dealing with an onslaught of visual and auditory hallucinations. Male and female voices shouted "loser" and the pharmacist, who disappeared and reappeared frequently, whispered about poisoning the medication.

Mental Health Department research shows 70 percent to 75 percent of people with schizophrenia experience auditory hallucinations and 15 percent experience visual illusions or distortions.

The department defines schizophrenia as a psychotic illness in which an individual may have hallucinations, delusions, abnormal emotions, impaired thinking and behavioral changes.

The most consistent symptom is greatly reduced emotional responsiveness.

Shoar said Thursday's experience was so realistic and illuminating that he wants to use it in his crisis intervention training.

"We are dealing with more and more people who are suffering from mental health issues, whether that be bipolar disorder or schizophrenia" Shoar said. "We have to start educating the people in our field about these mental illnesses and how to handle people who have them."

Studies by the Memphis Police Department, which developed the training back in the late '80s, show the "programs are designed to educate and prepare police officers who come into contact with people with severe mental illnesses to recognize the signs and symptoms of these illnesses, and to respond effectively and appropriately to people who are experiencing a psychiatric crisis."

christina.abel@jacksonville.com, (904) 249-4947, ext. 6319

This story can be found on Jacksonville.com at http://www.jacksonville.com/tu-online/stories/032807/nep_8805437.shtml.
/span> Read more!

Counselors just need $40 and a background check - Olympian (Olympia WA)

By Adam Wilson

People who advise others — but don’t treat them for mental illness — railed against a proposal to eliminate Washington’s low bar for registration as a counselor.

Anyone who has $40 and clears a background check can be a registered counselor in this state.

That doesn’t mean they’re qualified to act as mental health professionals, argue proponents of a bill that would eliminate the “registered counselor” profession.

Only people with specific degrees could register as mental health advisers under the bill. Others who work with regulated social service groups could be registered as agency- affiliated counselors.

“If I were to walk out on my clients tomorrow and say, ‘Sorry, I’m not a counselor anymore,’ that would be unprofessional and unethical,” said Miriam Dyak of the Washington Professional Counselors Association.

The group formed this year, she said, to represent the 7,200 people who are working as registered counselors.

They often have advanced degrees, but not always in the fields of social work, mental health or psychology, as the proposed law would require, she said.

Unlike other therapists, they don’t treat people for mental disorders and charge their health insurance, she said. They often are paid out-of-pocket for personal help and advice.

“People don’t need to be diagnosed ill in order to find the help and support they want,” said Richard Berger, a Seattle resident who said he has turned to registered counselors for help.

Supporters of the measure, however, say people assume that counselors registered with the state are trained professionals.

“In too many cases registered counselors are simply not qualified to do mental health counseling,” said Rep. Don Barlow, D-Spokane.

A practicing mental health counselor, Barlow is sponsoring the bill. It passed the House unanimously and was supported before the Senate health care committee by the state associations for clinical social work, marriage and family therapists, psychiatrists and psychologists.

The state Department of Health also supports the proposal, House Bill 1993. Department representative Laurie Jenkins said it would clarify that state-recognized mental health counselors are professionally trained.

People who act as personal coaches, advisers or wellness counselors could still do business, but could not call themselves registered counselors, she said. Read more!

Mental Health Firms: Schools cautious with aides for students - Charlotte Observer

Mental health companies in North Carolina are eyeing a lucrative crop
of prospective new clients -- thousands of children in public schools.

But school officials in Mecklenburg and other counties are reacting
cautiously or even blocking the mostly private, for-profit companies,
fearing the firms are either ill-qualified or motivated more by
potential profits than public service.

The educators join a growing list of critics who suggest the state is
seeing many poorly qualified mental health startup firms because the
N.C. Department of Health and Human Services set the pay rate too high
-- $60 an hour -- and standards too low.

Firms offering a program the state calls community support services
billed more than $433 million last year, mostly in Medicaid money.

The companies want to send mental health aides to school to help
emotionally and mentally disturbed students, including those
challenged by problems such as attention deficit disorder and chronic
misbehavior.

They say they can provide specialized help for teachers at a time when
schools are struggling with hard-to-handle children and families
battered by substance abuse, poverty and violent crime.

But school officials aren't sure what to make of the firms.
Charlotte-Mecklenburg Schools currently allows mental health experts
from only two groups -- Carolinas Medical Center and the nonprofit
Family Center -- to provide such in-school services.

About 70 other groups have been cleared by local mental health
officials to provide the service in the past year. CMS has formed a
committee to figure out how to screen the businesses.

'We're being inundated with requests,' said Carolyn Gaither, director
of prevention and intervention services with CMS. 'A lot of new
agencies are popping up in the community.'

Gaither said there isn't a timetable, but putting a screening policy
in place is a priority for Superintendent Peter Gorman.

The Family Center serves about 40 CMS children; state figures show the
agency billed for about $51,000 last year under the community support
services program. Carolinas Medical Center's numbers weren't
immediately available Tuesday.

Craig Bass, president of the nonprofit Alexander Youth Network in
Charlotte, said school officials will have a tough time deciding which
of the new companies are reputable.

The state's application process for firms wanting to get into the
business 'is a pretty low bar to get across, and it's all paperwork,'
Bass said. 'It's interesting that when the state introduces a new
(pay) rate that's positive (for service providers), people come out of
the woodwork.'

In Wadesboro, about 50 miles east of Charlotte, so many have sprouted
that the Anson County school board on Monday passed rules curbing
their access to schools. More than 200 mental health aides are working
in the county's 10 schools.

Officials said some classrooms had up to five aides and that their
presence sometimes distracted students they weren't helping.

Anson school leaders said many of the firms cropped up about a year
ago after state mental health officials privatized the service.

State and federal officials believed consumers would enjoy more
treatment options if private firms could compete over a service once
dominated by local public mental health agencies.

But now the competition is causing disruption in classrooms.

'I just think it's extremely profitable for the service providers,'
said Nat White, chairman of the Anson school board. 'And it's not just
a problem in Anson County. It's a problem all over the state.'

Some misuse suspected

State health and human services officials recognize they have problems
with community support services, one of the cornerstones of their
effort to reform the state's mental health system.The state announced
in February that it would audit 167 firms that have racked up high
per-client billings through the program. State officials suspect some
firms are misusing the program and keeping clients longer than
necessary.

Officials at several firms operating in Wadesboro said they did well
on their audits, but added that they'd heard of abuses. Lawrence
Elliott, head of R.E.A.D. Inc., told of how more than a dozen parents,
apparently seeking jobs for relatives or friends, offered to let him
sign up their children -- if he'd hire their relative or friend as the
child's aide.

Elliott said he turned them down. His firm, which has about 90
employees, serves about 60 students through the community support
program.

R.E.A.D. billed Medicaid for more than $1 million last year, but
Elliott said he easily could have boosted his client list to more than
200 if profits were his only motive.

'It's easy, quick money to enroll people,' said Elliott, whose firm
has been operating since 1998. 'There are companies who are trying to
do the right thing. Unfortunately, we're overshadowed by companies
that see (the program) as a quick revenue floodgate.'

Behavior, provider problems

Richard Trent Hill is executive director of Hilltop Comprehensive
Care, a Charlotte-based firm that billed for more than $105,000 in
community support last year. He said he hasn't been trying to get into
the schools, but his work as a mentor at West Charlotte High School
tells him educators need help.

'The teachers are spending all of their time just dealing with
behaviors,' he said.

Alexander Youth Network's Bass agreed. He said many of those problems
have roots in mental health issues. The community support program
isn't the problem, he said; bad service providers are.

He urged school officials to work with reputable providers and mental
health regulators.

'We don't want to throw out the (program),' he said. 'We just want to
make sure it's being used effectively.'

Community Support Services at a Glance

WHAT IT IS

The year-old community support program serves about 31,000 people each
month and ranks as perhaps the state's most important service for
mentally ill people and substance abusers. It was intended as a
short-term service to guide people toward independent living. Aides
teach adults basic tasks such as grocery shopping, job searches or
finding stable housing. They help children monitor and manage their
symptoms, and help them adapt at home, school and in the community.
Case managers monitor their progress.

HOW IT WORKS

For a child to receive help through the program, a service order must
be completed by a physician, licensed psychologist, physician's
assistant or nurse practitioner. The consumer picks a service provider
from a list of companies endorsed by the local mental health
regulatory agency. But many local regulators say they aren't able to
adequately oversee the firms because so many have sprouted and they
lack key billing data showing what firms are doing for individual
clients.

Copyright (c) 2007 The Charlotte Observer, All Rights Reserved.
Read more!

Mental health parity at last? - Raleigh News & Observer

Opinion:
By Johnny Whitfield, Managing Editor

North Carolina legislators have an opportunity to right a longstanding injustice. Among the bills under consideration in the House of Representatives is a proposal to require mental health insurance parity.

For years, people with mental health have been treated like second-class citizens by the insurance industry.

Insurers have been allowed to provide less coverage for mental health care than they provided for other healthcare needs.

Co-sponsored by eastern Wake County’s own Representative Linda Coleman, this bill would require insurers to cover mental illness just like any other illness – say a heart attack or cancer.

No more could an insurance provider place unreasonable limits on the amount of care it will pay to a client with, say, schizophrenia.

Of course, similar bills have been introduced before and always beaten back by the powerful insurance lobby.

But with mental health care among the top five or six issues facing the General Assembly this year, proponents of mental health insurance parity have better than average reason to hope this will be the year they break through the insurance industry’s iron curtain.

We do too.

Legislators need only spend a small amount of time with people who suffer from mental illness or with doctors who treat the mentally ill to learn the maladies they struggle with are every bit as real as a broken leg.

For those who argue that parity would be too costly, we simply point out that the savings in work place productivity would far outweigh the expense of providing mental health insurance that’s on equal footing with other health care insurance offerings. A Surgeon General’s report from 1999 placed the cost of lost productivity due to mental illness at

$70 billion nationally.

We’re glad Linda Coleman is on the right side of this debate. We urge the rest of her colleagues in the General Assembly to join her.


Contact Managing Editor Johnny Whitfield at 269-6101 or johnny.whitfield@nando.com. Read more!

Burke approves merger with Catawba - Morganton News-Herald

Matt Collins (The News Herald)

Morganton - Burke County Commissioners voted 4-1 Monday to join Catawba County in creating a new mental health governing body.

The decision sets the groundwork for Burke County to eventually fully-merge with Catawba and leave the Foothills Area Program, the current manager of mental health services for Burke, Caldwell, Alexander and McDowell counties.

A stipulation of the decision to merge with Catawba County is that Foothills employees in Burke County will have full consideration for jobs in the new management program. Burke County Manager Ron Lewis says this means that “We’re going to be advocates for the employees.”

John Hardy, CEO and area director for mental health services in Catawba County, says that for jobs that exist in Burke County, Foothills employees “certainly would be given serious consideration if the fit is there.”

The decision to merge doesn’t sever all ties with Foothills. An inter-local agreement will be created between Catawba and Burke counties starting July 1 and the full merger will proceed on June 30, 2008, the start of the 2008-09 fiscal year, says Lewis.

This means that Burke County will be a part of the new governing body as well as Foothills for one year, an idea brought up when commissioners traveled to Raleigh and met with state mental health officials earlier this month.

“My idea is to form an LME (local management entity) with Catawba but not pull out of Foothills and then if things go well, then in 2008, pull out,” says Dan Kuehnert, county attorney.

Dick Oliver, an LME team leader with the state division of mental health in Raleigh, says that “Burke and the other counties may have to decide some fund balance and property matters during the transitional year.”

Oliver says he understands that some people question whether a county can belong to two LMEs at the same time. Counties can, he says, and a recent example was when Carteret County joined the Onslow County LME in 2004.

During the 2007-08 fiscal year, Lewis says he hopes for a smooth transition and that Foothills clients in Burke County will continue to go through Foothills until July 1.
“No one will be without service,” he says. “We will work out all the details. I don’t see any issue that can’t be worked out between now and June 30 (2008).”

The decision to withdraw Burke County from Foothills comes after a loud protest from Foothills clients and volunteers earlier in the month and passionate public comments about the merger.

Chairman Wayne Abele says that he doesn’t take things like this lightly.
“This subject is weighing heavily on our minds,” he says.
He also says that this decision is the hardest he has had to make since becoming a commissioner.

Abele is now in his fifth year on the board.

Don Pagett, CEO of Foothills, says that he is satisfied that commissioners have made a decision they feel is in the best interest of Burke County.

“Foothills will continue so no citizen who has needs will be left out,” he says.
A committee will be formed to oversee the merger.

Abele says that he would like to see a seven-, eight- or 10-member committee, with one or two commissioners, a service provider and some other mental health professionals serving.

“I’d like to see some of the people who were against us (merging with Catawba County and pulling out of Foothills) on the committee,” Abele says.

Robert Cox, a former client and now volunteer with Foothills, is against the merger.
“I still think it’s not a good decision,” he says. Read more!

Anxiety Rising on U.S. College Campuses - Washington Post

By Amanda Gardner

U.S. colleges and universities are experiencing a surge in the number of students seeking mental health services, a new report finds.

And while most schools do have some mental health services, they don't offer programs specifically geared to treat anxiety disorders, the most frequently diagnosed mental illness in children and teens. They also don't have the staff to meet this rising need, researchers say.

"Not surprisingly, the nation's top schools are reporting that there's an increase in students needing and accessing mental health services," confirmed Jerilyn Ross, president and CEO of the Anxiety Disorders Association of America (ADAA), which today released a survey documenting these trends.

"Nearly all of the national university and liberal arts colleges responding reported an increased usage of student mental health through the past three years," Ross said in a press briefing on Tuesday. "We're also seeing a growing number of students coming to college with a history of mental illness, with an increase after 9/11. There is also increased awareness around mental illness."

Anxiety disorders refer to a spectrum of illnesses characterized by anxiety, worry and fear, which include obsessive-compulsive disorder (OCD), panic disorder, post-traumatic stress disorder (PTSD) as well as specific phobias.

According to the ADAA, more than 40 million adult Americans are diagnosed annually with an anxiety disorder, making this the most common mental health diagnosis. Anxiety disorders are also the most common mental disorders to occur during childhood and adolescence.

The novelty of heading off to college can present special difficulties, experts say. It's also a time of life when mental health problems tend to emerge.

"The classic issue for many people starting out in college is separation from family. They're free at last, but it's a double-edged sword," said Alec L. Miller, chief of child and adolescent psychology at Montefiore Medical Center/Albert Einstein College of Medicine, in New York City.

"There are a lot of benefits but also risks and trouble spots," Miller said. "A lot of kids are not well prepared with adequate internal resources to withstand stress. Some kids don't monitor eating and sleeping properly, and all these things create vulnerability for anxiety and other psychiatric disorders."

The report,Anxiety Disorders on Campus: The Growing Need for College Mental Health Services, was released as part of ADAA's annual conference, in St. Louis. It involves surveys with 83 schools selected fromU.S. News & World Report's2007 guide to the nation's top national universities and liberal arts colleges.

The survey found that most schools do offer crisis intervention, individual counseling and referrals, but few programs are tailored to the specific needs of students.

Among the report's other findings:

Almost all respondents reported an increased usage of mental health services over the past three years. Liberal arts colleges reported a higher overall usage rate (an average of 23 percent of students) compared with national universities (13 percent). More than one-fifth of schools reported an increase in the number of students seeking treatment at college counseling centers who were already taking psychiatric medications. "This is a problem that I don't think we've ever had on these campuses," Ross said. Less than half of responding schools knew how many of their students were seeking treatment for anxiety disorders. Among those that did know, national universities reported about 35 percent requesting treatment for this type of condition vs. 23 percent of liberal arts colleges.

The ADAA believes that availability of mental health services should be a factor when deciding which institution a child is going to attend. "This report will give students and parents additional information to consider when selecting a school," Ross said.

"Our call to action is that it is critical for students to have access to counseling and other mental health services to diagnose and treat anxiety disorders," Ross added. "Many people don't know they have a disease that can be treated. Instead, they suffer silently and don't know where they can get help."

More information

For more on anxiety disorders, visit the Anxiety Disorders Association of America.

SOURCES: March 27, 2007, telebriefing with Jerilyn Ross, president and CEO, Anxiety Disorders Association of America; Alec L. Miller, Psy.D, chief, child and adolescent psychology and associate professor of psychiatry and behavioral sciences, Montefiore Medical Center/Albert Einstein College of Medicine, New York City; Anxiety Disorders Association of America report,Anxiety Disorders on Campus: The Growing Need for College Mental Health Services Read more!

Army Officer: Long - Term Morale a Concern - AP

WASHINGTON (AP) -- The Army's new acting surgeon general said Tuesday she is concerned about long-term morale because the military lacks money to hire enough nurses and mental health specialists to treat thousands of troops coming home from Iraq and Afghanistan.

''When the original plans were made, we did not take into consideration we could be in a long war,'' said Maj. Gen. Gale Pollock. She became surgeon general earlier this month after Kevin Kiley was forced to resign in a scandal over poor treatment of war-wounded at Walter Reed Army Medical Center.

''We have not been able to do the hiring,'' Pollock told a House Armed Services subcommittee.

She testified at the first of two congressional hearings Tuesday on veterans care during which lawmakers expressed impatience with the Bush administration's efforts. They said years of communication gaps between the Defense and Veterans Affairs departments have yet to be fixed.

Testimony from officials from the two departments highlighted the difficulties that lie ahead for the Bush administration in fixing problems following reports of shoddy outpatient treatment and bureaucratic delays at Walter Reed, one of the Army's premier facilities for treating the injured.

Since the disclosures last month, three high-level Pentagon officials have been forced to step down. Some Democrats also have questioned whether VA Secretary Jim Nicholson, a former Republican National Committee chairman, is up to the job of revitalizing the veterans care system.

Bush has appointed a presidential commission to study the problems and a slew of reviews are under way by the Pentagon, VA and several congressional committees. But troops and veterans say many of the issues are well known and have long been in need of response.

Among the complaints are the difficulties troops and veterans have in navigating the health care system, including moving from military hospitals to the VA's vast network of 1,400 clinics and treatment facilities, which provide supplementary care and rehabilitation to 5.8 million veterans.

Speaking before a Senate panel, Michael Kussman, executive-in-charge of the Veterans Health Administration and Ellen Embrey, deputy assistant secretary of defense for health affairs, defended their efforts to improve coordination that would speed health care to injured troops and veterans.

Embrey said the departments had taken steps to strengthen joint committees and place each other's personnel in Pentagon and VA-run facilities.

That drew an angry response from Sen. Richard Burr, R-N.C., who noted that the Government Accountability Office earlier this month reported the two departments still fail to share health records electronically despite years of warnings and recommendations.

''We're now in the fifth year of this armed conflict,'' said Burr, a member of the Senate Veterans Affairs Committee. ''At what point do we actually look at what's going on and implement changes? How many real-life experiences do we have to listen to?''

Acknowledging that the VA and Pentagon have the technology to share records but don't always do so, Embrey responded, ''That's a good question.''

She added that the departments have since begun looking at finding ways to share inpatient records. ''I think we have the institutional structures in place, but at the individual level, some things don't happen.''

Sen. Patty Murray, D-Wash., said a first step is to provide the VA and Pentagon the money they need to treat problems such as post-traumatic stress disorder and traumatic brain injury. A Senate bill that provides $122 billion to fund the wars in Iraq and Afghanistan includes millions to build polytrauma centers and hire new claims processors.

''I've just about had it with administration officials who assure us everything is being taken care of,'' Murray said. ''I know you work hard, but we are going to judge you by the results you get for our veterans, and we're going to hold you accountable.''

But Sen. Larry Craig, the Senate panel's top Republican, argued that overall the military health system works well and noted that the VA system typically outranks the private sector in customer satisfaction.

''I am hopeful that the president's new interagency task force on returning global war on terror heroes will help us determine what changes -- legislative or otherwise -- need to be made,'' he said.

That task force, headed by Nicholson and made up of Cabinet secretaries from Defense, Labor, Health and Human Services and other agencies, is expected to report by late April.

Separately, a nine-member presidential commission chaired by former Sen. Bob Dole, R-Kan., and former Health and Human Services Secretary Donna Shalala, a Democrat, to improve veterans care is scheduled to begin work in earnest next month and has a June 30 deadline. Read more!

Family services agency gets new 'home' office - Asheville Citizen-Times

By Jordan Schrader,

ASHEVILLE - The Families Together agency shores up what might otherwise become broken homes.

So when CEO Dan Zorn looked for a new office, he found a house that could use a bit of literal repair.

The agency plans, within the next three months, to move into 723 Fairview Road, turning two dilapidated buildings in the heart of the Oakley neighborhood into a home base for a program that provides case management for families trying to keep their children out of foster care and adults trying to stay independent.

Families seeking services would rather come to a house than an office building, Zorn said.

"It's consistent with what we want to project, which is a home environment," he said.

The agency will maintain its downtown office on Grove Street and others around the seven Western North Carolina counties it serves.

The new building will help to house a staff that has expanded from 80 to 140 to accommodate the needs of people stranded by the closing of New Vistas-Mountain Laurel, the region's largest mental health provider.

Renovations will start next month, Zorn said, after delays due to the work accompanying the New Vistas closure.

The repairs will bring the structures built in the 1920s and 1950 back to their original character, he said. Workers will replace roofs, windows, doors, electrical wiring and insulation and work on cleaning and landscaping, but they won't alter the façade.

Before he bought the property, Zorn consulted the Oakley neighborhood association, whose board voted unanimously last year to approve his renovation project.

Residents were glad he sought their input, said Kathy Littlejohn, the association's secretary and treasurer.

As retail booms in the area around Wal-Mart and River Ridge shopping center, she said, neighbors are glad to be able to guide some development.

"We support what he does," Littlejohn said, "and with what is happening with mental health anyway, it's kind of good to see someone who's keeping their head above water." Read more!

Barling Man Battles Mental Illness Daily - Ft. Smith (AR) Times Record

The routine of one man coping with paranoid schizophrenia

By Amy Sherrill

Ryan Shields, 33, listens to National Public Radio while lying in his bed at a retirement home in Barling.

After about 30 minutes, he will get up from his bed and go to the smoke room at the facility, Sebastian County Retirement Center Phase II.

He smokes one or two cigarettes, then returns to his room. His favorite kind of cigarette is a menthol, but he’ll smoke any brand.

Shields will alternate about every 30 minutes as the day goes on between listening to NPR or music on the radio and smoking cigarettes until 8 p.m. when he gets his nightly medications. Then he goes to bed.

The routine is one way he copes with his mental illness — paranoid schizophrenia.

While the prevalence of smoking in the U.S. population is about 25 percent to 30 percent, the prevalence among people with schizophrenia is about three times as high, according to www.schizophrenia.com, a Web site of a nonprofit community providing in-depth information related to the disease.

The radio stays on and tuned into Cool 104.7 all night long. Luckily, Shields’ roommate, who has obsessive compulsive disorder, doesn’t seem to mind.

“It’s kind of interesting to watch him do all his obsessive compulsive disorder kind of stuff,” Shields said.

Shields moved into the Barling facility in late August and his Social Security and supplemental Social Security income checks are delivered to the retirement center so he doesn’t have to worry about maintaining a budget.

The $30 left over from his checks each month he spends on soda and candy bars.

His maternal grandparents, Stacy and Chloe Lamon, buy his cigarettes each month, for which Shields said he is extremely grateful.

Born Tommy Ryan Shields to Tom and Dana Shields, he has two younger brothers. His parents divorced when he was really young, said his grandmother, Chloe Lamon.

When Shields was 12, Shields’ mother died of a shotgun blast to the head while standing at a sink in her Lavaca residence where she lived with her husband of one week, Britt Owen.

Owen was arrested for the crime that occurred July 10, 1985, and held at the Sebastian County Adult Detention Center on suspicion of the homicide, but later was released when charges were dropped against him, according to arrest records.

“He was never brought to trial, which has bothered all of us,” Chloe Lamon said.

Lamon said Shields’ two younger brothers went to counseling after their mother’s death, but Ryan said he didn’t need it.

Shields’ father, Tom Shields Jr., died in 2006.

Ryan Shields graduated from Northside High School in 1991. He took classes at Westark Community College but stopping taking classes just short of earning an associate degree.

Chloe Lamon, 80, describes a younger Ryan as “extremely precocious and bright.”

“He always worked, but he didn’t stay with jobs,” Lamon said. “I think that was maybe the beginning.”

Isolation

Shields lived in a small residence behind his grandparents’ home on the north side for several years during his 20s. He partied all the time.

“He had friends over,” Lamon said. “They were not unruly. We had no problems.”

As Shields’ disease began to evolve, he became more and more isolated.

One day, Shields’ grandmother saw a sign on his door, “Stay out. This means you.”

His friends stopped visiting.

Eventually, he shut his two brothers out of his life.

Shields did it to protect himself as he became increasingly more paranoid, thinking constantly people were out to get him.

“If I wasn’t around them, I couldn’t count them as scheming against me,” Shields said.

Voices began to talk to Shields as his disease progressed unmedicated. He quashed them by self-medicating with alcohol. He would ask his grandmother for $5, which he would take to a local liquor store and buy a pint of whiskey. Shields would return to his room, turn on his television to a Christian network and drink whiskey until he passed out.

“That’s how I coped with it for a long time,” Shields recalls. “The voices were getting to me so bad, and if you got stone drunk you didn’t hear no voices. You just laid on the bed numb.”

Lamon said she and her husband never knew because Shields would cover up his sickness.

Shields began to spend a lot of time reading. He believed he was getting messages in the books. He assumed the messages were from God.

He was isolated in a room with books as he deciphered the messages. He left his room only to eat, but he would wait to do that when his grandparents were asleep.

The voices told Shields not to tell anybody about them because he would be locked up forever if he admitted to seeing and hearing things.

“I did finally tell someone,” Shields said.

When Shields realized he needed medical help, he didn’t have any insurance and he was too old to be carried on his grandparents’ plan.

Shields got on Medicaid and eventually started receiving Social Security benefits. He’s glad he has the benefits; otherwise his monthly medication — at least five prescriptions — would cost him several hundred dollars.

‘I Thought I Was Gifted’

Like most families, it was hard for Shields and his grandparents to admit that he had a mental illness.

In Lamon’s generation, people just didn’t talk about mental illness — there was a stigma attached to it.

“I didn’t want to admit there was anything wrong,” Lamon said. “In my mind, he was just Ryan and he was just young and he’d get over it. And also there used to be a stigma attached to mental illness. Now there isn’t, but we still prefer to think that there’s nothing wrong. We don’t want to face it.”

Shields didn’t want to believe it, either.

“I didn’t think there was anything wrong with me,” Shields said. “I thought I was gifted. I thought I had been touched by God. It took a long time for the pills to kick in where I could tell the truth, reality from just my delusions. I didn’t accept it for a long time.”

He depended on his grandparents for shelter and food.

“I needed time to heal and they provided me a place to do that,” Shields said. “If you don’t have any family or any resources, you’re going to be out on the street.”

Lamon started telling her friends because she believed there was nothing to be ashamed of about Shields’ sickness.

Almost every person she talked to told her they knew someone with a mental illness.

Even after Shields came to the realization that he was a paranoid schizophrenic, he quit taking his medications several times.

His behavior would become so violent it was obvious he had gone off his medication.

Shields has been picked up by the police a couple of times for wandering the streets. Another time was for aggravated assault.

While in the Sebastian County Adult Detention Center, Shields said, he was placed in a padded room. He said sometimes another inmate would be in there with him. Whether this is true or what Shields believed was true is hard to determine.

He believed that jailers were putting people in the room and he was supposed to fight them.

Other times when he stopped taking his medication, Shields believe his grandparents were Adolph Hitler and Eva Braun and that they were evil.

Voices Speak To Shields

Bob Needham, an intervention specialist at Western Arkansas Counseling and Guidance, said one reason paranoid schizophrenics stop taking their medication is so they can feel the “high” that the disease gives them of feeling as if they have magical powers or a conviction that God has ordained them and they are better than other people.

Shields agrees. He said he starts having feelings that he can be a God on earth and can use magic to manipulate people when he stops taking his medication.

At 33, Shields believes he has a handle on his disease and he will stay on his medication, but the voices never completely disappear.

The difference with medication is that the voices now don’t tell him to do harmful things such as get a gun and kill himself.

They just talk about people now.

He sees a counselor, a psychiatrist and a case worker each month. His main concern now as his grandparents’ age is having a place to live and food to eat.

In the past, he dated often, but knows now if he had a wife and children that he would have lost them by now with the ups and downs he’s had since discovering he is a paranoid schizophrenic.

Shields describes himself as being a loner most of his life and he likes it that way for now.

He’s never lonely, though.

“I never feel lonely anymore because I have someone to have a conversation with in my head at all times,” Shields said. “So like I’m never lonely anymore. I haven’t felt loneliness in years. It’s because I have the voices with me. “

Sometimes when Shields visits, the Lamons notice him talking to the voices.

“We have learned to accept it,” Chloe Lamon said. “That’s just part of it, you know.” Read more!

State accused of denying mental help to inmates - San Luis Obispo (CA) Tribune

By Stephen Curran

Closing Atascadero State Hospital — and the state’s other mental hospitals — to new admissions unfairly denies much-needed treatment to prison inmates, lawyers claim.


Attorney Michael Bien accused the state Department of Mental Health in a motion Friday of failing to address record-high staff vacancies that in January prompted ASH administrators to close the facility to new admissions.

That unprecedented action, he said, created a domino effect that undermines a complex arrangement requiring ASH officials to set aside 256 of its 1,239 beds for treatment of mentally ill prisoners in custody of the state Department of Corrections and Rehabilitation.

Bien and 11 other attorneys are asking Sacramento District Court Judge Lawrence K. Karlton to order the Mental Health Department to take immediate action to hire enough new staff to reopen all 256 beds to mentally ill prisoners within 30 days.

According to the lawsuit, the hospital in February was only treating 110 corrections department patients.

Karlton is scheduled to hold a hearing on the claim April 23.

The motion is the latest move in more than a year of lengthy discussions among union leaders, legislators and state administrators. The vacancy rates, up to 80 percent for psychiatrists, were aggravated by a recent court order creating 500 new jobs and mandating across-the-board wage hikes for prison clinicians.

Statistics provided by the hospital last week show that, since January, two patients have killed themselves, the first successful suicides since 2005. The spike has not been directly tied to the staff shortages.

"There’s a crisis that needs to be addressed," Bien said. "The reason we brought the motion now is that we think there’s an emergency. The place is collapsing."

Mental health officials on Monday declined to comment on the pending motion.

The legal action came less than a week after mental health Director Stephen Mayberg announced a plan that could drastically increase salaries for some of its workers.

Under the proposal, effective April 1 through June 30, the Department of Mental Health would set aside $9.4 million in unused funds to more closely align salaries with those at Department of Corrections-run prisons. The governor is expected to request an additional $34 million from the Legislature to maintain the salary increases.

The proposed "retention bonus" would be most significant for psychiatrists and senior psychologists, whose salaries would still be about 5 percent less than prison doctors. Other employees, including psychiatric technicians, would still earn about 18 percent less than they would at a state prison.

Randall Hagar, government affairs director for the California Psychiatric Association, said the state needed to act more quickly to correct the shortages.

"The meltdown is compounding, day by day, and I think what you’re seeing is a realization that they need to act in a much more quick timeframe," Hagar said.

However, Bien said, the long-term damage done to the state hospital system could take much longer to reverse.

"It may only have taken a month or two to destroy these hospitals," Bien said. "It’s going to take a lot longer to build them back."

Read more!

Fee-for-service won't heal ailing mental-health system - Macon (GA) Telegraph

Opinion:

The April 1 implementation of new state mental-health rules could easily turn into April Fool's Day. The Georgia Department of Human Resources is in charge of the shift of services from various agencies to include private entities and the implementation of a fee-for-service model, but the outcome may do little to provide more effective treatment for those with mental-health issues. Mental health professionals have little faith that the DHR can effectively pull off the changes, and if this effort is unsuccessful, treatment of the mentally ill will land squarely on the shoulders of local municipalities. Even state officials say it will be painful in the short-term.

Already the Phoenix Center in Warner Robins has had to lay off 41 people due to funding formula changes. Three programs for adults have been shuttered and its Crawford County office closed. Laurens County will close a facility next month designed for young men with drug issues, and Bibb County has had to cut its methadone clinic and its 14-day unit for addicts.

Georgia is ranked 44th out of 50 states by the National Alliance on Mental Health, and while the jury has yet to rule on the latest efforts to improve care, there are already gaps in service that have yet to be filled on the eve of implementation.

There are some changes that show promise. One is a toll-free number where those in need can reach a trained clinician 24 hours a day. The old call-in system was not as comprehensive and featured 25 different numbers.
However the other nuts and bolts of mental-health services could easily fall between the cracks, only to be picked up by county jails. Just because hospitals, clinics and programs shut down doesn't mean the problems cease to exist. The patient population ends up on the street. They are our homeless population and our panhandlers, and they make up the majority of our jail population.

The mental health alliance estimates that 64 percent of local jail inmates are suffering from some type of mental illness. Bibb County has had to begin its own court to handle those who might be caught between mental illness and crime. Instead of jail, they get a caseworker and, with luck, treatment. Bibb Sheriff Jerry Modena said, "There's a group of these people who have absolutely no business being in jail." Bibb County spent $572,889 last year on mental-health services and psychotropic drugs to treat 2,465 inmates.

While the system is broken, the state's effort may not be what the doctor ordered. It is already apparent that the new system is going to have bumps and fatal flaws for some. Unfortunately, those with mental-health issues are accustomed to being forgotten. Read more!

Mental health: Lawmakers, invest wisely - Tallahassee (FL) Democrat

Opinion: By Bob Sharpe

Unanticipated revenue shortfalls are casting a shadow on the budgeting process in the Legislature this session. The clear message is that money is tight, and legislators are looking for ways to refine their lists of priorities.

Words like “investment” are being tossed around as the concept of getting something in return for dollars spent is always more palatable than money spent with no meaningful accountability.

While the goal of the state budget is obviously to make good spending decisions with our limited dollars, it can be argued that a significant investment will be made by default on certain issues whether even one dollar of additional funding is appropriated.

Such is the case with community mental health services.

Last year, the issue of underfunded mental-health concerns received considerable media attention. Many Floridians heard the term “forensic beds” for the first time in reference to the system's inability to move jailed inmates with mental illness to a state hospital until they were capable of facing charges against them.

The law requires that they be moved within 15 days of incarceration, but a waiting list that topped 300 created a logjam that will require nearly $50 million annually to fix.

That issue is merely the tip of the iceberg. Florida ranks 48th in the country in per-capita spending for mental-health services, 47th in Medicaid spending for child beneficiaries and 43rd in Medicaid spending for adult beneficiaries.

Florida also ranks second in the number of homeless, first in the number of substantiated reports of child abuse and neglect, second in the number of children in juvenile detention facilities and third in the number of prison inmates.

A significant portion of these problems can be traced to the lack of mental-health care. It is an embarrassing and unfortunate statement about our lack of commitment to care for those with mental illness. We aren't adequately funding proven and cost-effective local mental-health programs, though their success proves time after time that treatment and community supports work. We know that access to local mental-health care is the key to providing patients with much-needed help at a reasonable cost to taxpayers.

While Florida is nowhere close to acceptable funding levels for community mental-health services, some lawmakers appear to be willing to push this issue out of public view for yet another year.

If this is so, and without funding community-based services, the Legislature will by default be investing in hospital inpatient services, emergency-room care, shelters, foster care, juvenile detention facilities, jails and prisons.

In 2005, the U.S. Department of Justice estimated that more than half of all prison and jail inmates in the U.S. had a mental-health or substance-abuse problem. It also has been estimated that approximately 72 percent of jail inmates have a mental or substance-use disorder.

A legacy of inaction also can be seen in our city's streets and parks as the estimated homeless population in Florida on any night was nearly 86,000 in 2006. It is estimated that 24 percent of those are mentally ill and 37 percent have alcohol and/or drug problems.

The problem is not going away, but with diminishing funding of community mental-health programs, it certainly can get worse. Between now and the closing of the 2007 session, an investment will be made in the mental-health system. The question is whether a good return on that investment will be realized or if another opportunity to use our limited resources wisely will be squandered.

We cannot afford to ignore funding community mental-health services for yet another year. The cost would simply be too great. Read more!

NASA Sets Team to Review Astronaut Mental Healthcare - Space News

By Jeanna Bryner

Prompted by the arrest of now ex-astronaut Lisa Nowak, NASA has announced the committee members who will review the mental and other health services available to astronauts.

The committee, announced Monday, will review NASA’s current healthcare systems and medical policies, standards and certifications for astronauts. In April, committee members are scheduled to travel to the Johnson Space Center (JSC) in Houston to review documents and interview personnel, including astronauts, involved in the agency’s spaceflight program, NASA said.

Chairing the group of external experts will be Air Force Col. Richard E. Bachmann, who studies aerospace medicine and has provided medical support to people who work in extreme environments like that in space.

Nowak, a 43-year-old mother of three, was arrested on Feb. 5 after allegedly driving 900 miles from Houston to the Orlando airport, where police say she confronted and pepper-sprayed Air Force Capt. Colleen Shipman, girlfriend of space shuttle pilot William Oefelein, whom she viewed as a romantic rival for the astronaut’s affections.

Immediately following the incident, Nowak was charged with attempted first-degree murder, attempted kidnapping and three other criminal acts. The charges were later downgraded and Florida prosecutors have entered charges for kidnapping. Nowak’s lawyers have formally entered a not guilty plea and the trial is expected to begin on July 30.

Meanwhile, the space agency removed Nowak’s flight status and in collaboration with the U.S. Navy, they ousted her from NASA’s astronaut corps. The seeming “breakdown” of an astronaut also spurred the space agency to look into how they screen astronauts for both mental and physical health as well as services available to astronauts during their careers.

The other external members of the newly-formed committee include:

Air Force Col. Timothy Sowin, a neuropsychiatrist
James R. Fraser, an expert in aerospace medicine from the Federal Aviation Administration (FAA)
Retired Navy Capt. Sandra Yerkes, a clinical psychiatrist
Mark Bauer, a clinical psychiatrist from the Veteran's Administration
Elizabeth Holmes, a clinical psychologist from the U.S. Naval Academy
James Bagian, a former NASA astronaut physician and an expert in aerospace medicine and patient safety from the Veteran's Administration
Navy Capt. Paul M. DeLaney, an expert in medical legal matters and medical privacy legislation
Ellen Baker, a current NASA astronaut physician, will serve as a consultant to the team. Also, serving as “ex officio” members will be James M. Duncan, the NASA chief of Space Medicine at JSC, and Wayne Frazier of NASA's Office of Safety and Mission Assurance.

In June, the committee is expected to report their findings to Richard S. Williams, NASA’s chief health and medical officer, who will look over the review and report the findings to NASA Administrator Michael Griffin. Read more!

Oklahoma congressional hearing planned on mental health - AP

TULSA, Okla. (AP) - A congressional hearing is planned for Friday as lawmakers consider legislation that would require insurers to provide equal coverage for mental health and physical illness.

Most insurance policies limit coverage regarding mental health and substance abuse disorders. A federal report issued in 2003 says Oklahoma has the highest rate of serious mental illness among adults.

The hearing will be overseen by U.S. Reps. John Sullivan, R-Tulsa, and Patrick J. Kennedy, D-R.I. Eight people are scheduled to testify, including people affected by the policies; Oklahoma Insurance Commissioner Kim Holland; and Terri White, who is to be the next commissioner of the Oklahoma Department of Mental Health and Substance Abuse.

John Hair, who owns a company with about five employees, plans to testify.

When a family member received a diagnosis of schizophrenia a few years ago, Hair was surprised to find that the coverage had limits on mental illness services.

"I'm a business owner and when I buy insurance for my employees, I expect it to cover their health-care needs," he said. "People need health care. And for the insurance industry to sell a policy and not cover what is needed, that is not right.

"They shouldn't collect a premium if they are not going to cover what we need."

Insurance policies often have higher copayments for mental health coverage, limited number of days for hospitalization and limited number of office visits, mental health advocates say.

The hosts of the hearing are the Tulsa Mental Health Association and the National Alliance on Mental Illness.

Mike Brose, the executive director of the Tulsa Mental Health Association, said 256 members of Congress had signed on to support the legislation, including Sullivan. Kennedy is one of the bill's sponsors.

"We want people to understand that if they have not had to use their mental health coverage, for those who have coverage, they may not be aware the coverage level is much lower than other health care coverage," Brose said.

"We want to educate the public and build a groundswell of support to end the discrimination for people needing mental health benefits." Read more!

Many mental health needs go unmet - Psychiatric Services Magazine

Mental health in general population

Psychiatrists' first large-scale assessment of the general population shows nearly 30 percent need mental health care and about one-third of them get it.

The study focused on Baltimore, where a team of psychiatrists interviewed 816 people between 1993 and 1999.

They found the greatest need was treatment of alcohol dependence, nearly 14 percent, and major depression, nearly 11 percent.

"There are a lot of people who need psychiatric care who aren't getting any," says Dr. Erick Messias, psychiatrist at the Medical College of Georgia and lead author on the study in the March issue of Psychiatric Services. "There is a constellation of factors keeping people away from that care. This translates into people suffering for years, when there is a solution."

He notes that many people don't even seek help, some because they believe they will get better on their own. A perceived lack of efficacy of treatment, societal pressures, stigma and a lack of comprehensive insurance coverage for mental health also are factors. Insufficient numbers of mental health professionals also impede access.

In his own practice, Dr. Messias sees people who have struggled for years before they finally seek help. While he acknowledges that seeking help won't always cure the problem, he believes it can decrease most people's pain.

The study looked at the most common mental health problems, social phobia, panic disorder and agoraphobia – in addition to depression and alcohol dependence. These problems may not require medication but could benefit from treatment, from psychotherapy to programs such as Alcoholics Anonymous, he says.

Interestingly those with severe mental illness, such as schizophrenia, are more likely to get help. "However, from a public health perspective these conditions, albeit causing great pain and suffering, compared to prevalent mental disorders, affect a smaller proportion of the population" Dr. Messias says.

"Prevalence of mental disorders is only an approximation of the need for treatment," he and co-authors write. "There is a substantial need for mental health services in the general population."

Dr. Messias suggests that Baltimore's population reflects the prevalence and unmet needs of most larger cities, such as New York, Chicago and Atlanta. Studies are needed to see how midsize and small cities fare, he says.

What is clear is more mental health professionals are needed across the spectrum, including psychiatrists, psychologists, social workers and occupational therapists, and those professionals need to work as teams to maximize impact, he says.

He estimates that within his own practice, a psychologist working with him would enable him to double his patient load.

Acknowledging that it can be difficult for individuals to decide they need any level of mental health care, Dr. Messias says there are some key indicators. "I always ask patients how they sleep, because the way you sleep tells me a lot about how well you are," he says. "If you are so tired you are sleeping all the time or you can't sleep, that's a sign that something on your mind is not letting you relax." Work and personal relationships are two other good indicators. "If you can love and work, you probably will do fine." Read more!

AMHC seeks support for $2 million detox/crisis center - Elizabeth City Daily Advance

By BRENDA KLEMAN
Correspondent

CURRITUCK — Albemarle Mental Health Center officials are asking local governments to endorse its legislative request to build a $2 million crisis/detox center in Martin County. AMHC representatives made their requests at the Currituck and Camden boards of commissioners meetings Monday night.

Both boards agreed to sign a prewritten letter to Sen. Marc Basnight, D-Dare, stating "full agreement and support of this need (a detox center)."

Camden Commissioner Carolyn Riggs cast the only dissenting vote.

Riggs asked why the facility was being built in Martin County rather than in the Albemarle.

"I think we should look for some place closer," she said.

AMHC currently serves six counties: Camden, Chowan, Currituck, Dare, Pasquotank and Perquimans. Sandra Jordan-Leigh, representing AMHC, told the Currituck commissioners that the agency is in the process of merging with Tideland Mental Health.

If the merger is successful, AMHC will incorporate four counties — Hyde, Tyrrell, Washington and Martin — currently served by Tideland Mental Health. The merger would expand AMHC's service area to 10 counties.

Consultant Lee Walton, who was hired by AMHC to help with its three-year business plan, said the new crisis/detox center will provide nine beds for the ten counties. The detox center would be used to stabilize patients for up to seven days until they can be hospitalized or receive outpatient care.

"The need is great for crisis/detox services in the region," Walton said.

AMHC plans to send a funding request to the state that includes a one-time construction expense of $2 million. The agency also hopes to hire one psychiatrist, 10 nurses and nine counselors and estimates that it would cost $1.6 million annually to cover expenses at the center.

Walton told the commissioners that he and Jordan-Leigh weren't asking them for financial support, only that they sign the letter addressed to Basnight endorsing AMHC's request for the state to provide funding for the detox center.

AMHC officials hope that the letters of support from local governments will help persuade the legislators to grant the request.

Staff writer David McCaulay contributed to this story. Read more!

Mental illness poses challenge for colleges - San Jose Mercury News

By Patty Fisher

When classes started at the University of California-Santa Cruz last fall, campus counselors thought returning students would be upset about the suicide of Chancellor Denise Denton over the summer and would want to share their feelings.

Jean Marie Scott, acting vice chancellor of student affairs, offered to arrange discussion groups so the community could talk about Denton's death, and heal together.

As it turned out, she misjudged her audience. Nobody was clamoring to meet with a bunch of teachers and counselors.

"There is a growing divide between young adults, the ways they connect, and the ways of connecting within a college community," Scott said. "It's hard to know what they are thinking."

Reaching out

Scott spoke at a community forum at De Anza College on Friday about a growing problem on campuses across the country: suicide and mental illness. School officials, counselors and elected officials from throughout the South Bay spent the morning sharing ways to use their shrinking resources to reach out to an increasingly stressed-out - and tuned-out - student body.

Today's high school and college campuses can be mental-illness factories. Kids feel pressured to get into college. Once they get there, they're juggling jobs and classes, worrying about graduate schools and careers, and coping with life away from family and friends.

Stress can exacerbate depression, and the results can be tragic. Each year 1,100 college students take their own lives in this country. Thousands more attempt suicide. On University of California campuses, there were 40 suicides in five years.

Research shows that 90 percent of students who commit suicide have diagnosable mental illnesses, yet most don't seek treatment.

So how do the faculty and staff at high schools, colleges and universities identify students who are in trouble and reach out to them before it's too late? How do they get the kids to turn off the iPods and talk to professionals who can help?

Wiggsy Sivertsen, director of counseling services at San Jose State University, urged teachers and staff members not to wait for kids to ask for help. Is a student suddenly quiet, withdrawn? Writing or saying disturbing things? Take the initiative, she said.

"Go up to that student and say, `Gee, I'm worried about you. Is there something I can do?'"

Those few words could save a life.

Forum's inspiration

Another panelist was Vic Ojakian, former mayor of Palo Alto. Actually, he wasn't just another panelist. He was the inspiration for the forum.

In 2004, Ojakian's son, Adam, a senior at the University of California-Davis, committed suicide.

I've often wondered how parents survive the loss of a child. The Ojakians have survived by channeling their grief into campaigning for better mental health services. They've spoken with state leaders and testified before a congressional committee. They've talked to school administrators, teachers, parents and kids.

It's important to keep talking, Ojakian said, until people stop being ashamed of having a mental illness and see that it's like any other illness and can be treated.

"We're trying to overcome several hundred years of not talking about it," he said.

Perhaps it's also time to talk about changing the campus culture.

"We need to look at the degree to which we are, ourselves, the problem," said De Anza College President Brian Murphy. "We're not the best models of living the balanced life."

I left the forum thinking about all the young people out there who are depressed but afraid to talk about it. Too many of them think the only way to ask for help is to hurt themselves.

If only someone would go up to them and say, "Gee, I'm worried about you. Is there something I can do?" Read more!

Cruel and sadly usual: Prisons shouldn’t be mental wards - Boston Herald

Opinion: By Jamie Fellner

Twelve years ago a federal judge ruled unconstitutional California’s practice of putting mentally ill prisoners in solitary confinement. It is, he said, the equivalent of putting an “asthmatic in a room with no air.” Since then, inmates have won settlements or court orders in 12 states to keep prisoners with serious mental illness out of “solitary” or what corrections officials prefer to call segregation.

In Massachusetts, there will likely be a similar victory in the lawsuit filed last week against the Department of Corrections. The evidence is overwhelming that it is cruel and a violation of basic human dignity to force prisoners with serious mental illness to spend years confined round the clock in claustrophobic cells, with nothing to do, and no one with whom to have a normal conversation. The cruelty is compounded because mental health services for segregated prisoners typically consist of nothing more than medication and brief periodic cell-front checks-ins.

Prisoners with serious mental illness need structured days and interaction with others. They need group therapy, individual counseling, training in daily living, education about their illness, supervised recreation and other forms of psychiatric rehabilitation as well as medication. Yet as is often the case in prison, security and punishment trump mental health needs.

Why are there mentally ill prisoners in segregation? Because prisons have become the nation’s mental health facilities.

Untreated or undertreated, the mentally ill in segregation may deteriorate. They may rant and rave, babble incoherently or huddle silently. They may talk to invisible friends and live in worlds constructed of hallucinations. They may beat their heads against walls, yell endlessly, cover themselves with feces and self-mutilate until their bodies are riddled with scars. Many try suicide; some succeed.

Prisons now house three times more people with serious mental illness such as schizophrenia, bipolar disorder and major depression than mental health hospitals. The federal Bureau of Justice Statistics says half of state prisoners nationwide have a mental health problem.

They end up in prison because the community mental health systems are in shambles - fragmented, underfunded and unable to serve the poor, the homeless and those who are substance-addicted as well as mentally ill.

Nationwide, half of the state inmates with mental health problems were convicted of nonviolent offenses, primarily low-level drug and property offenses. Alternatives to incarceration may have been appropriate, but the court’s hands are tied by mandatory sentencing laws.

Once behind bars, the mentally ill find themselves ill-equipped to handle the stresses and rules - formal and informal - of prison life. They are more likely to be victimized and more likely to be injured in a fight than other inmates. They are more likely to break the rules. They are more likely to behave in ways that annoy, disgust and even enrage security staff who have scant training in how to recognize, much less cope with, symptoms of mental illness.

Moreover, prison mental health services across the country are woefully deficient, crippled by understaffing, insufficient facilities and limited programs, and swamped by the sheer number of prisoners who need them. Lacking resources and options, prison officials put problem prisoners, including the mentally ill, in segregation, where by virtue of being locked up around the clock they cause less trouble.

States can institute policies to keep mentally ill inmates out of segregation or wait for litigation to force them to do so. They can improve the quantity and quality of mental health services they provide. But even those necessary steps fail to confront the larger question - should prisons be de facto mental institutions? If not, then the country must reduce the number of mentally ill people who are incarcerated.

The starting point is to reform needlessly harsh and counter-productive sentencing laws. States must also increase the scope and effectiveness of community mental health systems. The mentally ill do not have to end up in prison, but first elected officials must show far more compassion and common sense than they have to date.
Read more!

County seeks proactive approach to mental health care - Yakima (WA) Herald-Republic

Published March 25
By DAVID LESTER

One out of four people booked into the Yakima County jail receive help for mental health problems.

Officials believe that statistic, taken from the year ending in June, is one reason for a revolving door at the county jail where inmates are arrested multiple times.

Hoping to slow that trend, Yakima County is considering a new program to deal with mental illness and its all-too-often companion of substance abuse. The program would intercept minor offenders who appear to be mentally unstable either before or soon after they are booked into jail and get them into treatment.

A major dividend is lowering costs for operating the jail.

The county's Department of Cor-rections does not track specifically how many of its inmates are repeat
offenders, but the jail officials sense the number is high.

A Washington State Sentencing Guidelines Commission report, however, concluded repeat offenders made up 61 percent of those sentenced for felony crimes in the state in 2004.

"It's pretty clear the current methods aren't solving the problem," said county Commissioner Mike Leita.

A growing number of cities and counties around the country are coming to the same realization, said Rick Weaver, chief executive officer for Central Washington Comprehensive Mental Health.

"All counties are grappling with this. It is happening in Tri-Cities and Olympia and elsewhere. Everyone is having this same kind of discussion," he said. "We are way ahead of them."

Intervening with inmates who exhibit mental problems would build on a program that has taken hold in police departments around the country.

The program is called crisis intervention team training, giving patrol officers help in identifying mental health issues among people they encounter.

Chris Devilleneuve, coordinator of the Crisis Intervention Team program for Central Washington Comprehensive Mental Health, said 64 police officers from Kittitas and Yakima counties have received the training.

Yakima police officers also went through one-day classes on how to defuse a crisis situation involving the mentally ill.

The county has been using a federal grant to divert to treatment those in custody for minor crimes. That grant, however, ends this month.

It's at the front end, the first encounter with people displaying mental disorders, where authorities are struggling to stem the tide.

"There's a whole layer of people out there who commit a nuisance offense or are panhandling," Weaver said. "They are mentally ill. Everyone knows it but the legal wraps around involuntary treatment don't qualify them."

That has been the experience of Yakima police Chief Sam Granato. When his patrol officers encounter a person with mental instability, they have no choice but to take the person to jail.

"If we had a program that gives us an option other than jail and help reduce the jail population, that is a big draw," he said.

Steve Hill, director of community services for Yakima County, whose office would coordinate a treatment program at the county level, said it's too early to say whether the program would be pre- or post-arrest.

Diverting individuals to treatment following their arrest does raise issues of due process and self-incrimination among defense lawyers.

"We need to figure out what works for us. The intent is to get people who shouldn't be locked up into treatment as soon as possible," he said.

Hill said the county wants to involve current service providers in a network to deal with both mental illness and drug problems.

A Yakima County delegation will visit a jail diversion program in the county that includes San Antonio next month that uses a post-arrest model.

Populous Bexar County launched its program with a three-year federal grant in 2003. Now, officials there say cities, the county and area hospitals have assumed financial support for the program that has seen more than 600 people per month since September 2005 diverted from jail into some form of treatment. The program, is saving the county and cities millions of dollars in reduced criminal-justice costs, officials said.

Bexar County has a population of about 1.4 million people, more than six times that of Yakima County.

Allen Castro, a policy and program development manager for the county, said the program began out of desperation. Declining funding for treatment left more people with mental health problems on the streets and in contact with the cop on the beat.

"The jail became the mental health hospital," he said.

Gilbert Gonzales, director of the Jail Diversion Program for Bexar County, said the various players got together and decided they needed a different approach.

The result is a locally funded program to get people out of the jail and into treatment.

"The reality is we are all touching the same people. We have worked diligently to identify where we have duplication of spending and effort, where we can coordinate and consolidate and make it better both fiscally and clinically," he said.

Leita said should Yakima County launch such a program, the issue of long-term funding needs to be addressed.

The state Legislature in 2005 authorized the counties to collect a 0.1-cent sales tax for chemical dependency or mental health treatment.

Leita said the county wants to review all options and determine whether funds could be freed up through further efficiencies before there would be any discussion of taxation. A sales tax increase would generate more than $1 million per year.

He said the county needs to do something to slow the pace of repeat offenders that add to the jail population.

"We are looking for innovative ways to break the cycle and gain value for the community," he said.


* David Lester can be reached at 577-7674 or dlester@yakimaherald.com. Read more!

Mental health needs greatest at Taycheedah - Appleton (WI) Post Crescent

Two-thirds of inmates at women's prison have mental illnesses

Published March 25
By Wendy Harris

With a history of mental illness and suicidal behavior, 18-year-old inmate Angela Enoch was placed in an isolation cell for "observation" at Taycheedah Correctional Institution near Fond du Lac, a lawsuit alleges.

Five days later, the troubled teen used ripped seams from her pillow to strangle herself.

The June 2005 suicide illustrates the grossly inadequate mental health care at Taycheedah, according to a pending lawsuit by the American Civil Liberties Union. Similarly, a U.S. Department of Justice investigation also documents a severe shortage of mental health staff at Taycheedah, as well as the alleged misuse of isolation cells to punish mentally ill inmates.

Wisconsin is among several states facing lawsuits demanding improvements in the treatment of mentally ill inmates.

The ACLU suit notes that the suicide rate in segregated units is 10 times the rate in the general population units in Wisconsin prisons. Taycheedah, the state's largest prison for women, meanwhile, has the highest ratio of mentally ill offenders of all Wisconsin's 19 correctional institutions, state Department of Corrections officials say. Two-thirds of its inmates have mental health needs.

Corrections officials say they have been working to improve mental health care at the prison and now give a closer review of inmates considered for segregation.

In 2002, Taycheedah opened a new, 64-bed unit to treat mentally ill inmates. And in 2003, the state formed a segregation work group to develop recommendations to better treat the mental health needs of inmates in segregation, said corrections spokesman John Dipko.

In the past year, Taycheedah has added two additional part-time psychiatrists for a total of four part-time psychiatry staff, he said. Additionally, the prison has implemented a new policy that requires input from psychology staff when a mentally ill inmate is being considered for segregation.

"We are doing more frequent reviews of offenders who have behavioral types of problems, to determine whether mental illness had any part in their behavior," said Ana Boatwright, warden of Wisconsin's women's correctional system.

In segregation, inmates typically spend 23 hours of each day alone in a cell, and are given about one hour outside of it to exercise.

Former inmate Merica Erato, who was at Taycheedah when Enoch died, said she also experienced time in segregation.

"I was having a panic attack and they thought I was being disobedient," said Erato, who served 15 months for a car accident that caused the death of her 5-year-old son.

"When I yelled back at the guards, wanting them to take me seriously, they punished me," said Erato, who now lives in Neenah with her husband and children. "I was three months pregnant."

Erato said she was going through medication withdrawal at the time, which triggered her panic attack. She said she had been on prescription drugs to treat anxiety and depression. But her drugs were abruptly stopped when she entered Taycheedah, she said, despite her pleas to guards and medical staff to give them to her.

"I've been on meds since I was 18 and I needed them," she said, adding that she was eventually given back her prescriptions.

"It's like you are in hell, listening to everyone cry and scream," said Erato, recalling her time in segregation. Read more!

Broken promises: State mental-health reform a cruel sham - Asheville Mountain Xpress

Published March 21

by Diane Bauknight

In reading your recent roundtable on state mental-health reform ("Slouching Towards Bedlam,” Jan. 17 Xpress), I was struck by the enthusiasm Curtis Venable of Pisgah Legal Services has for our present mental-health-care system. Clearly, Curtis and I live in different worlds.

Through no fault of her own, my daughter has severe mental illness. I was promised that Medicaid would provide and pay for all psychiatric care for her as an adopted, special-needs child. Initially, Charter was able to provide the intensive outpatient-and-crisis services she required, and she made great progress. But Charter closed in 2001 (the year “reform” began), and most of the services we lost then have never been restored.

When we called the local program during a psychiatric crisis after Charter had closed, we were told to call the police, who would handcuff my 11-year-old and drive her to John Umstead, a state mental hospital five hours away. I was instructed to wait until my daughter was actually hurting herself so she would qualify for admission. And when Copestone, the local hospital, opened an adolescent unit, we would sometimes wait 12 hours or more in the emergency room only to be told that she would not be admitted.

As the years passed with crisis services still not available, my daughter’s condition deteriorated. Eventually she was admitted to Broughton state hospital, where children sometimes had to sleep in the hallways because the state had closed other wings of the facility under the banner of reform. When my child was ready for discharge, there were no services for step-down care. The Whitaker School, another state facility, had a two-year waiting list because reform had reduced the number of beds they had. As a result, we were forced to seek treatment out of state, and my child spent two years institutionalized in Georgia and South Carolina. Despite all the lofty promises made, North Carolina did not provide the services my child needed, which could have kept her at home and out of expensive—and traumatic—institutional care. Pardon me if I am not impressed by the so-called mental-health reform.

Those of us living the reform nightmare are told to be patient while change is taking place. Meanwhile, my child lost her teen years to institutionalization, and I have too many friends who’ve seen their children default to institutional care, group homes or juvenile justice because critical services no longer exist. I know too many people who wonder if their adult child is freezing to death under a bridge or will end up in jail—the state’s largest mental-health institution—because the housing and other needed supports just aren’t there. No one with a physical condition such as heart or kidney disease would even dream of having to endure such a situation. Yet people with brain disorders and their families are expected to accept that suffering, institutionalization, jail, homelessness, suicide, broken lives and destroyed families are merely part of the landscape of a floundering mental-health system. This is our world.

To assert that the reform is working so well that we have no ER or jail problem ignores the facts. Nationwide, 64 percent of jail inmates are people with mental illness; North Carolina’s average is 70 percent. In Buncombe County, 400 inmates with serious mental illness were treated in our local jail in 2004. The following year, that many inmates had been treated by October.

Our private and state hospitals are usually at or near 100 percent occupancy, yet the state moves ahead with plans to close more beds. Who does it serve to pretend that our “reformed” mental-health-care system is working? Granted, many wonderful local people are doing a great job of providing the lower-intensity services that are still funded, but those services may not be enough to stabilize a person with severe mental illness. Where are the outpatient crisis facilities and step-down services promised by reform? And why does it continue to be OK that such serious gaps in care persist?

To be sure, there were many problems with the pre-reform mental-health-care system, especially in the area of children’s care. So when we were told that the new system would provide a full continuum of community-based services, I desperately wanted to believe those promises. Dr. Tom Smith, a retired psychiatrist and patient advocate, was usually holding a placard or speaking out in public meetings, warning us that the reform was a sham. It turns out that Dr. Smith was right.

This so-called reform has not been about improving care for people with mental illness. It has been about big business, money, power—and a thinly veiled attempt to save state Medicaid dollars by squeezing some of our most vulnerable citizens. Shame on the state of North Carolina for inflicting this travesty on us.

[Diane Bauknight, whose adopted child has mental illness, is a founder of WNC Families CAN, a support group. In 2002, she received the Nancy Susan Reynolds Award for advocacy.] Read more!

Back to Square One - Raleigh News & Observer

Letter to the editor: Gerry Akland

The writer of the March 22 letter titled "A community focus" makes a convincing case that most people with mental illness can live successfully in the community with the right kind of treatment and supports.

The cruel joke is that these services were promised to thousands of people with mental illnesses and their families in 2002 when the N.C. Department of Health and Human Services started emptying beds and downsizing our state psychiatric hospitals.

The reality is that North Carolina did not fund these wonderful new services. The state agency tasked with designing and implementing a system of community care proved incapable of getting the rudimentary business practices in place, leaving our local government agencies impotent to either provide care or find care for thousands of the most vulnerable people in our state.

We need to go back to 2002 and open those hospital beds that were closed to rebuild the safety net. Then, develop a mental health reform plan that will work over the next 10 years. Close beds as community supports are really in place. Otherwise, we will be warehousing very mentally ill people in our prison system and on the streets.

Gerry Akland

Knightdale Read more!

Stolen lightbulb casts only darkness - LA Times

Columnist: Steve Lopez, Points West

Having met Mark Smith in Los Angeles County Jail, I can tell you it's a relief to know we're safe from the likes of him.

Smith, 51, might not look very menacing, with pale skin and trembling hands. But he's been behind bars for six months after committing a heinous crime.

He stole a lightbulb from a Rite Aid in Van Nuys.

There's no telling what kind of mayhem Smith would be up to on the outside, even if he does have Parkinson's, emphysema, heart disease and dementia. Oh, and he is HIV-positive and recovering from throat cancer.

All right, so there's a little more to the story than that. Smith has a dark past, as they say, and his lightbulb caper constituted a parole violation. But in a state with a critical overcrowding problem in its prisons and jails, Smith is a poster boy for the insanity of prosecutorial zealotry.

If the name sounds familiar, it's because Smith was in the news five years ago in a showdown with then-Gov. Gray Davis. Smith, a punk and thief as a young San Fernando Valley man, served 17 years for a second-degree murder conviction stemming from his presence at a Topanga Canyon drug dispute that turned deadly.

The Board of Prison Terms ruled Smith suitable for release in 2000, and even Smith's trial judge supported that finding, calling him less culpable than the other man convicted in the 1985 murder.

But Gov. Davis, who played to the peanut gallery with his no-parole policy for murderers, refused to go along. Davis called Smith "a person with little regard for human life" who had committed a "violent act against another." Did the bloodless governor not realize Smith was an accomplice rather than the killer?

Davis blocked the release, but Smith prevailed in 2003 when the state Supreme Court rebuked the governor. Smith was turned loose after nearly 20 years in prison and moved in with his family in Sun Valley, not far from Bob Hope Airport in Burbank.

His mother, Dolores Padilla, tried to help nurse him back to health. But Smith, who had had two heart attacks while locked up, remained seriously ill and on disability. When he was able, he toured the state speaking out about sentencing and parole reform.

"Because the media knew me, I was sort of drafted into putting a face on inmates and lifers," says Smith. "I thought it was my duty to do my part to make the world a better place and … bring fairness to the system."

Last August, Smith was the opening speaker at a Sacramento hearing on prison overcrowding and the disastrous shortage of rehabilitation and mental health programs. He then went to San Francisco for a television interview on the subject and was mugged after leaving the studio.

"I was attacked on the streets by a group of four or five guys and knocked unconscious," said Smith, who began seeing a psychiatrist for help with memory loss and confusion.

Two months later, he was arrested after leaving the Van Nuys drugstore. Although he had paid for his other items and still had about $180 in his wallet, a security guard saw him walk out with a lightbulb in his pocket.

"I just forgot it," said Smith.

I'm not sure I believe that, especially since the guard claimed Smith had used a knife to cut open a lightbulb pack before sticking one of the bulbs in his pocket.

It's possible that with AIDS-related dementia, along with any damage caused by the mugging, Smith stole the lightbulb because he wasn't right in the head. But let's say for the sake of argument that he knew full well what he was doing.

Was a stolen lightbulb a significant enough parole violation to send him back into the slammer?

At his probation revocation hearing in December, Smith's mother argued that her son's health had stabilized since his release from prison because he had better care and easier access to the dozens of medications prescribed for him. She said he drew and painted, got interested in computers and eventually moved into his own apartment.

"I don't think he belongs back in prison, that's for sure," she said.

At the December hearing, Smith's attorney presented medical reports on his "terminal illness," saying his "dementia is progressive" and his attention and short-term memory impaired. His parole officer recommended that Smith be released, citing his compliance with the terms of his parole. Although Smith acknowledged having a drink or two, which would appear to have violated the terms of his release, his parole officer said he had given him permission.

William Crisologo, deputy commissioner of the state Board of Parole Hearings, wasn't sold. He called Smith's "lifestyle" a matter "of personal choice," saying he saw "some denial on your part with respect to theft and alcohol."

Smith, his heart sinking, was confused. What did alcohol have to do with the lightbulb incident?

"I understand your circumstances," Crisologo went on, "the positive things you've done … but today Mr. Smith I regret … to tell you I will have to revoke your parole…. You make choices, I don't."

What this means is that Smith, who later pleaded no contest on the lightbulb charge, is back to being a lifer. He's entitled to a parole hearing by December, and it could happen much sooner. But he might also be transferred from County Jail back to state prison and could conceivably be denied parole each time he comes up for review.

"He's so sick," Smith's nerve-rattled mother told me in the living room of her Sun Valley home. "I don't know how long he's going to last in there."

Don Specter of the Prison Law Office called the lightbulb case Mickey Mouse but typical. He said "tens of thousands" of parole revocations are issued each year because of minor crimes, calling that "a major source of overcrowding" in prisons, along with countless cases of nonviolent third-strike violations.

The question for California legislators, and a governor who claims it's time to get serious about overcrowding, is whether people like Mark Smith ought to be locked up indefinitely.

Then again, it was a high-definition lightbulb worth nearly $10.
Read more!

Can You Live With the Voices in Your Head? - NY Times

Adapted from “Muses, Madmen and Prophets: Rethinking the History, Science and Meaning of Auditory Hallucination”

By DANIEL B. SMITH

Angelo, a London-born scientist in his early 30s with sandy brown hair, round wire-frame glasses and a slight, unobtrusive stammer, vividly recalls the day he began to hear voices. It was Jan. 7, 2001, and he had recently passed his Ph.D. oral exams in chemistry at an American university, where, for the previous four and a half years, he conducted research into infrared electromagnetism. Angelo was walking home from the laboratory when, all of a sudden, he heard two voices in his head. “It was like hearing thoughts in my mind that were not mine,” he explained recently. “They identified themselves as Andrew and Oliver, two angels. In my mind’s eye, I could see an image of a bald, middle-aged man dressed in white against a white background. This, I was told, was Oliver.” What the angels said, to Angelo’s horror, was that in the coming days, he would die of a brain hemorrhage. Terrified, Angelo hurried home and locked himself into his apartment. For three long days he waited out his fate, at which time his supervisor drove him to a local hospital, where Angelo was admitted to the psychiatric ward. It was his first time under psychiatric care. He had never heard voices before. His diagnosis was schizophrenia with depressive overtones.

Angelo remembers his time at the hospital as the deepening of a nightmare. On top of his natural confusion and fear over the shattering of his psychological stability, Angelo did not react well to the antipsychotic he’d been prescribed, risperidone, which is meant to alleviate the symptoms of schizophrenia by reducing the level of dopamine in the brain. In Angelo’s case, the pills had a predominantly negative effect. His voices remained strong and disturbing — an unshakable presence, quiet only in sleep — while he grew sluggish and enervated. “If you think of the mind as a flowing river of thoughts,” he told me in an e-mail message, “the drug made my mind feel like a slow-moving river of treacle.” Several days into his stay, Angelo’s parents flew to the United States from London and took him back home.

More than six years later, Angelo still lives at his parents’ house. He currently takes a cocktail of antidepressants and antipsychotics, with tolerable side effects, and sees a psychologist every two months to monitor his medication. The pills help Angelo to manage his voices, but they have not been able to eradicate them. Shortly after his return to London, he made an attempt to resume his career, accepting a research position at the university where he had received his undergraduate degree. He lasted eight months (his neighbors heard him screaming at his voices and called the police), checked himself into the hospital for six weeks and returned home. Despite these setbacks, Angelo has maintained his optimism. He is eager to discover new ways to combat his voices. Not long ago, he found one. In November, his psychologist informed him of a local support group for people who hear voices, from which he thought Angelo might benefit. Angelo began to attend the group late last year.

I first met Angelo at a meeting of the group in mid-January. (I was given permission to sit in on the condition that I not divulge the participants’ last names.) The meeting took place in the bright, cheerfully decorated back room of a community mental-health center in North Finchley, an affluent, grassy suburb in the northern reaches of London. The gathering was small but eclectic. In addition to the group’s facilitators — Jo Kutchinsky, an occupational therapist, and Liana Kaiser, a social-work student — five men and women assembled in a circle of bulky wool-knit chairs around a worn coffee table. Besides Angelo, there was Stewart, a young, working-class Londoner with a shaved head and a hoop earring; Jenny, an affable woman in her 50s who spoke of her fondness for arts and crafts; Michelle, a heavyset woman who dominated the session with her forceful opinions; and David, a 60-something man with a thick gray beard and a pageboy haircut who slumped in his seat and dozed throughout much of the meeting.

Angelo was the newest member of this group — it was his third visit — and he did not seem inclined to participate fully. When Kutchinsky opened the meeting by asking each member to discuss the previous week’s experience hearing voices, he softly mentioned that his voices made it difficult to read, then quickly ceded the floor. What followed was sometimes painful. Stewart in particular was visibly agitated. His hallucinatory life, as he described it, was chaotic and irrepressible. He heard voices pleading to him for help; he heard the voices of strangers; he heard the voice of his father. Sometimes he heard the voices of military commandos, who offered to defend him against this confusion. “I haven’t been well for a long time,” he said glumly. Yet most of the members spoke of their voices in the way that comedians speak of mothers-in-law: burdensome and irritating, but an inescapable part of life that you might as well learn to deal with. When David’s name was called, he lifted his head and discussed his struggle to accept his voices as part of his consciousness. “I’ve learned over time that my voices can’t be rejected,” he said. “No matter what I do, they won’t go away. I have to find a way to live with them.” Jenny discussed how keeping busy quieted her voices; she seemed to have taken a remarkable number of adult-education courses. Michelle expressed her belief that her voices were nothing more exotic than powerfully negative thoughts. “Negative thoughts are universal,” she said. “Everyone has them. Everyone. What matters is how you cope with them: that’s what counts.”

I had trouble gauging Angelo’s reaction throughout these testimonies, so afterward I pulled him aside and asked him what he thought. “It’s interesting to hear people’s stories,” he said. “Before I started coming, I hadn’t realized just how long some people have suffered. I’ve heard voices for six years. Some people have heard them for 15 or 20. It’s amazing.” I asked him if this knowledge reassured or frightened him. “It’s a bit scary, in a way. I think, I could be this way for a long time.” Still, he appeared to appreciate the camaraderie. For years, he had been socially isolated. He spends most of his time with his parents and a sympathetic older sister. His neighbors know only that he is “off work.” It was comforting, he said, to speak at last with people who understood.

The meeting that I attended in London is one of dozens like it affiliated with a small but influential grass-roots organization known as Hearing Voices Network. Based in Manchester, Hearing Voices Network (H.V.N.) has since its inception, in 1991, developed a range of services related to the phenomenon known as auditory hallucination: a hot line for people who suffer from the experience, a series of educational workshops for mental-health professionals and 170 support groups across Britain, with more in development. H.V.N., which openly challenges the standard psychiatric relationship of expert physician and psychotic patient, might be said to take the consumer movement in mental health care to its logical endpoint. Although H.V.N. groups meet in a variety of settings — from psychiatric wards to churches to the organization’s headquarters — all must be run by, or there must be active plans for them to be run by, voice-hearers themselves. What’s more, H.V.N. groups must accept all interpretations of auditory hallucinations as equally valid. If an individual comes to a group claiming that he is hearing the voice of the queen of England, and he finds this belief useful, no attempt is made to divest him of it, but rather to figure out what it means to him.

H.V.N.’s ecumenical approach makes it a difficult organization to pin down. I have met members who believed that their voices were a result of a biochemical glitch, requiring all the tools modern pharmacology has to offer; I have met those who believed their voices were signs from the spirit realm — a cherished gift. Yet the organization’s clearest rhetorical note is oppositional and antipsychiatric.

For more than a half-century, auditory hallucinations have primarily been studied and discussed in terms of severe mental illness, most notably schizophrenia, and linked to bizarre delusions, disordered thought and emotional dissociation. Approximately 75 percent of patients diagnosed with schizophrenia hear voices, and for the majority the experience is overwhelmingly negative. Those voices may issue commands, comment sarcastically on everyday actions or berate, curse and insult the hearer. As many as one-third of people with schizophrenia attempt suicide; as many as one-fifth hear voices that command them to do so. H.V.N. does not dispute that auditory hallucinations are frequently painful: many of the organization’s leading members have endured harrowing voices themselves and, at one time or another, sought psychiatric help.

What H.V.N. does dispute is that the psychological anguish caused by hearing voices is indicative of an overarching mental illness. This argument, disseminated through a quarterly newsletter, numerous pamphlets and speeches and alternative mental-health journals, are as voluminous and diverse as its membership. But H.V.N.’s brief against psychiatry can be boiled down to two core positions. The first is that many more people hear voices, and hear many more kinds of voices, than is usually assumed. The second is that auditory hallucination — or “voice-hearing,” H.V.N.’s more neutral preference — should be thought of not as a pathological phenomenon in need of eradication but as a meaningful, interpretable experience, intimately linked to a hearer’s life story and, more commonly than not, to unresolved personal traumas. In 2005, Louise Pembroke, a prominent member of H.V.N., proposed a World Hearing Voices Day (held the next year) that would “challenge negative attitudes toward people who hear voices on the incorrect assumption that this is in itself a sign of illness, an assumption made about them that is not based on their own experiences, is stigmatizing, isolating and makes people ill.”

H.V.N.’s insistence that it is not just the psychotic who hear voices does not, in fact, contradict psychiatric orthodoxy. According to the Diagnostic and Statistical Manual of Mental Disorders, the so-called bible of psychiatry, auditory hallucinations are only a potential symptom of mental illness — they must appear with other symptoms, persist for a specified length of time and impede day-to-day functioning in order to become part of a diagnosable syndrome. In a 2001 debate on whether voices are by definition pathological, Tony David, a neuropsychiatrist at the Institute of Psychiatry in London, noted that a “voice-hearer who is not in any distress, who lives a fruitful and productive life according to commonsense criteria, would never enter the arena in which the possibility of mental illness was up for discussion.” Nor does psychiatry insist that the syndrome in question when a voice-hearer is in distress is invariably schizophrenia. Approximately 20 percent of patients suffering from mania and 10 percent of patients suffering from depression hear voices. Auditory hallucinations can also be caused by “organic” conditions, like Parkinson’s, Alzheimer’s, temporal-lobe epilepsy, hyperthyroidism and migraine headaches, and have long been known to occur in the twilight consciousness between wakefulness and sleep.

That said, H.V.N.’s insistence that voice-hearers should attend carefully to what their hallucinations say is far from traditional. Prolonged exposure to untreated psychosis is held by many experts to be damaging to an individual’s ability to hold down a job or to maintain a meaningful relationship and by others to be damaging to brain function — what clinicians refer to as “psychosocial toxicity” and “neurotoxicity,” respectively. And though psychiatrists acknowledge that almost anyone is capable of hallucinating a voice under certain circumstances, they maintain that the hallucinations that occur with psychoses are qualitatively different. “One shouldn’t place too much emphasis on the content of hallucinations,” says Jeffrey Lieberman, chairman of the psychiatry department at Columbia University. “When establishing a correct diagnosis, it’s important to focus on the signs or symptoms” of a particular disorder. That is, it’s crucial to determine how the voices manifest themselves. Voices that speak in the third person, echo a patient’s thoughts or provide a running commentary on his actions are considered classically indicative of schizophrenia.

Interpreting voices in relation to a patient’s past has a checkered history in the treatment of psychosis. Though Freud discouraged the application of psychoanalysis to psychotic patients, it nonetheless became, for 25 years after World War II, a widespread treatment for schizophrenia in the English-speaking world. This episode in psychiatry is now widely acknowledged to have been a medical and moral disaster; crippling psychoses were routinely blamed on insufficiently nurturing and “schizophrenogenic” mothers. “The psychoanalytic approach to psychosis was toxic,” says Peter Weiden, a professor of psychiatry at SUNY Downstate Medical Center in Brooklyn. “Clinicians of that time were often highly antagonistic toward family members. They blamed the parents, left them out of the treatment process and isolated the patient from his family.” Over the past 30 years, the biomedical model displaced the psychoanalytic one, bolstered by advances in pharmacology, modern genetic and neurological research and the completion of large-scale empirical studies that concluded that psychoanalysis was useless at best and actively destructive at worst. Today, medication is typically prescribed to extinguish, or at least mitigate, voices (about 80 percent of patients experience a reduction in voices, Weiden says, from medication alone, though this does not always translate into an equal improvement in day-to-day functioning); psychotherapy is usually admitted as an adjunct, to deal with issues of social functioning and stigma.

There are signs, however, that psychotherapy is again encroaching on the biomedical paradigm in the treatment of psychoses. Since the 1990s, a growing number of researchers and clinicians, predominantly based in England, have been comparing voice-hearing in psychotic patients with voice-hearing in nonpatients, measuring the incidence of hallucinations in the general population, and using cognitive behavioral therapy (C.B.T.), a popular, short-term treatment for depression and anxiety, to help them manage their responses to the voices they continue to hear. C.B.T. typically asks patients to scrutinize how they interpret their symptoms rather than focusing on an illness as an underlying cause. “The matter of whether it’s effective, and to what extent,” Lieberman says, is still being investigated. So far, the use of C.B.T. in the treatment of psychoses is much more prevalent in the U.K. than in the U.S. In large part, Lieberman says, this is because “the motivation to research the treatment has mostly come from investigators in England.” But, he added, “you could also read into the situation the influence of a strong antipsychiatry or antimedication movement in England — there’s more of an interest in getting nonmedication treatments into clinical use.”

In England, this new cognitive approach to psychosis and the efforts of Hearing Voices Network are independent of each other, and are sometimes at odds. H.V.N.’s leading members, for instance, frequently criticize even sympathetic academic researchers for being insufficiently political. Yet both approaches share a similar purpose in seeking to place voice-hearing within the continuum of normal human experience — one, in order to better treat patients, the other, out of a firm conviction that hearing voices need not interfere with leading an otherwise “normal” life. Over the years, they have forged something of an alliance; psychologists, though they may not embrace H.V.N.’s more polemical views, frequently refer their patients to H.V.N. groups, while H.V.N. frequently cites the research of psychologists. And both H.V.N. and the cognitive approach to psychosis can be traced, to varying degrees, to the same radical figure.

When H.V.N. is accused of being hostile to psychiatry, its members sometimes point out that the organization was, in effect, founded by a psychiatrist — albeit a singularly unorthodox one. In 1986, Marius Romme, a professor of psychiatry at Maastricht University in the Netherlands, was referred a patient, Patsy Hage, who suffered from chronic auditory hallucinations and fell into a deep, suicidal depression. Hage took comfort only from reading “The Origin of Consciousness in the Breakdown of the Bicameral Mind,” an eccentric book, published in 1976, by Julian Jaynes, a Princeton psychologist, in which he argues that before around 2,000 B.C., all humans were guided by hallucinated verbal commands caused by a physical split between the right and left hemispheres of the brain.

Romme wondered whether Hage might benefit from communicating this theory with other voice-hearers and arranged to appear with his patient on a popular Dutch television program. They invited people who heard voices to contact them: 450 people called in, one-third of whom claimed they were able to live alongside their voices without much difficulty. It struck Romme that this smaller group, the existence of which surprised him, might serve as a therapeutic resource. He asked 20 men and women who had learned to manage their voices to serve as speakers at a conference for voice-hearers. The governing principle of the meeting was that all interpretations of voice-hearing, no matter how unusual, would be accepted.

Today, H.V.N.’s members speak of that first conference as the birthplace of their organization — and, indeed, of a worldwide Hearing Voices movement. There are currently self-help organizations for people who hear voices in more than 15 countries, including Germany, Japan and Australia. (The group has only recently begun to make inroads in the U.S.) Meanwhile, Romme has emerged as a spirited leader-activist, increasingly speaking of psychiatry in terms of cultural and personal oppression. People who hear voices, he has declared, “are like homosexuals in the 1950s — in need of liberation, not cure.” H.V.N. often echoes this protesting stance. Its annual conferences, held in Manchester, project an antiestablishment tenor. Ron Coleman, a prominent member, sports a tattoo that reads “Psychotic and Proud” and looks forward to a day when he can “walk the streets talking to his voices and not be denied his freedom.”

In its publicly disseminated material, however, H.V.N. tends to focus less on Romme’s rhetoric than on his research. In an article published with a group of colleagues in The Journal of Nervous and Mental Disease in 1998, Romme reported on the hallucinations of three groups: patients with schizophrenia, patients with dissociative disorder and nonpatients. All three groups heard a mixture of positive and negative voices (though the patients heard more negative voices than nonpatients), reported traumatic experiences in their past and heard both external and internal voices. What for Romme distinguished the voices of the patients most from those of the nonpatients was that the latter felt that they had control over their voices; they rarely sought to eradicate or ignore them and devised ways of coping with and understanding them. “Helping the patient to accept the voices and actively developing effective coping strategies with the patient,” Romme had noted earlier, “may well prove an effective adjunct to psychiatric rehabilitation.”

The concept of “coping” is central to H.V.N., based on its belief that people feel better not when their voices are extinguished but when the person hearing voices learns to listen to his hallucinations without anguish. Jacqui Dillon, the national chairwoman of H.V.N., embraces this credo based on personal experience. Dillon, a mother of two, has heard voices for more than 30 years and has never taken medication for them. Mostly, she says, her voices are supportive and even witty, though occasionally they are cruel — they swear and tell her to harm herself. But she no longer heeds their commands or allows them to bother her. Instead, she takes them as symbols of her unconscious thoughts. “Sometimes voices carry messages that you don’t want to hear,” she told me. “Nevertheless, you don’t shoot the messenger. You listen to him.”

When Romme’s gospel of hallucinatory “acceptance” emerged in the early 1990s, it sparked a notably sharp rebuke in the mainstream British Medical Journal. Reviewing “Accepting Voices” (1993) — a hodgepodge of research findings, coping strategies and firsthand testimonies edited by Romme and his wife and colleague, Sandra Escher — Raymond Cochrane, a professor of psychology at the University of Birmingham, wrote, “Anything that may encourage people to accept the reality of delusional beliefs, and even attribute to these beliefs some mystical supernatural power, can only prolong the existence of these beliefs and make recovery from schizophrenia more protracted and more uncertain.”

But Romme’s work influenced a number of researchers and clinicians, even those not inclined to agitate for the liberation of voice-hearers. “By the late 1980s, hearing voices had become such a stigmatized experience, people had forgotten that it is not just the insane who hear voices,” says Douglas Turkington, a psychiatrist at the Royal Victoria Infirmary, in Newcastle. “The standard line was: ‘Don’t talk to patients about the experience. It’ll only make it worse.’ ” Romme’s report that there existed numerous people living in the community who heard voices and were not distressed, Turkington says, provided ballast for a psychotherapeutic approach to schizophrenia that he and a colleague, David Kingdon, a professor of psychiatry at the University of Southampton, had already embarked on. Adapting the techniques of cognitive behavior therapy, they started in the late 1980s to lead patients, through Socratic-style questioning, toward an understanding of their hallucinations as coming from their own minds. The therapy included mitigating patients’ fears of madness by pointing out that even “normal” people can hear voices. Turkington and Kingdon’s efforts are now widely credited with helping to reopen the door to psychotherapeutic approaches to psychotic symptoms.

Richard Bentall, a professor of psychology at the University of Manchester, embraced not only the clinical implications of Romme’s research but also some of his political activism. Over the past 15 years, Bentall has garnered a reputation as an opponent of traditional psychiatric diagnostics and as an enthusiastic supporter of consumer-based therapies. In the early 1990s, as a professor at the University of Liverpool, Bentall supported the first H.V.N. group in that city, and last August he joined Romme and H.V.N. at a news conference held to announce the Campaign for the Abolition of the Schizophrenia Label, which they billed as “the last great civil rights movement.”

For Bentall, schizophrenia is the diagnostic equivalent of a circus tent, sheltering a heterogeneous crowd of experiences and serving to stigmatize patients. Clinicians, he maintains, should be treating individual symptoms, not syndromes. He is not merely indulging in the kind of rhetoric favored by the antipsychiatrists of the 1960s and 1970s, with whom he is sometimes compared. Questioning the validity of schizophrenia as a label is not new — even the architects of the DSM acknowledge that it is useful only insofar as it guides research and treatment. And while Bentall’s argument that specific psychotic symptoms should be studied in relation to the psychological mechanisms that give rise to them places him outside the mainstream, he publishes frequently in leading peer-reviewed journals and is often cited by psychologists (who are more inclined than their psychiatric counterparts to place auditory hallucinations on a continuum of everyday experience). He has also received support from the British government for his clinical work, most recently a $2.9 million grant from the U.K. Medical Research Council to investigate whether C.B.T. can prevent people who exhibit early signs of psychosis from developing a full-blown disorder.

In his 2003 book, “Madness Explained,” Bentall draws on the theory that auditory hallucinations may have their roots in what psychologists call “inner speech.” All of us, every day, produce a steady stream of silent, inward-directed speech: plans, thoughts, quotations, memories. People hear voices, Bentall argues, when they make faulty judgments about whether this inner speech is the product of their own consciousness or of something alien to their consciousness. Lapses in what researchers call “source monitoring” may occur for a number of reasons — because an individual is primed to expect a perception to occur, because the level of background noise makes it difficult to separate what is internal from what is external, because he or she is in a state of emotional arousal. But whatever the cause, Bentall writes, there is evidence to suggest that hallucinating “can be explained in terms of the same kinds of mental processes that affect normal perceptual judgments.”

This theory raises the critical question of why making source-monitoring errors results in psychosis: why, when people mistake their private speech for someone else’s, does it cause them to grow so distressed that they seek professional help? The answer Bentall gives echoes Romme’s observation that a fundamental difference between voice-hearers in the community and voice-hearers under psychiatric care is that the latter think negatively about their experience. According to Bentall, how patients perceive auditory hallucinations can have a significant impact on how those hallucinations are experienced. Bentall cites a landmark 1994 study by Max Birchwood, at the University of Birmingham, and Paul Chadwick, of the Royal South Hants Hospital in Southampton, to support this view. Published in The British Journal of Psychiatry, it proposes that the anguish experienced by patients who hear voices is directly related to their beliefs in the malevolence and power of the voices. A more recent study, published in 2004 and led by Anthony Morrison, a colleague of Bentall’s at the University of Manchester, also found that negative beliefs about voices are associated with an increase in the distress of the experience, and often these negative beliefs are reinforced by both mental-health services and the media.

According to Louise Johns, a psychologist at the Institute of Psychiatry in London, cognitive models of psychosis have had a significant impact on mental-health practice in Britain. Few psychologists trumpet C.B.T. as a panacea; it is considered an adjunct to, not a replacement for, standard medical intervention, most frequently in cases where patients do not respond well to medication or are chronically ill. Since the early 1990s, more than 20 randomized clinical trials have been conducted with C.B.T. for psychosis, showing that C.B.T. can be useful in helping patients cope with psychotic symptoms, increasing insight into psychosis and promoting compliance with medication. Based on the findings of these studies, the National Institute for Health and Clinical Excellence — the advisory body of the British National Health Service — in 2002 announced that all “individuals with schizophrenia who are experiencing persistent psychotic symptoms should be offered C.B.T.”

Members of H.V.N. express a wary appreciation of these developments. Many are glad that the mental-health professions are taking a psychological approach to psychosis seriously (their literature even notes the increasing availability of cognitive behavioral therapy), but they worry that the organization’s more radical, populist message is being obscured. As always, said Jacqui Dillon, the chairwoman of Hearing Voices Network, the mainstream is attending to what scientists have to say about how to treat voice-hearing rather than what nonscientists like her have to say about how to accept the phenomenon.

It was just before noon on a mild Friday in January when the North Finchley hearing-voices group reconvened after a 15-minute coffee break. A sixth participant had joined the group: Chris, light-haired, overweight and audibly short of breath, who has been a member for four years. He seemed completely at ease.

Earlier in the day, Kutchinsky and Kaiser printed out a list of coping strategies that another group’s members had found useful, cutting each description into thin rectangles, which they now spread across the table, facedown. The participants were asked to choose one and discuss. Angelo picked first: “Hobbies.” He cleared his throat, and in a gentle, measured voice, began: “Collecting, day or evening classes, visiting a library, computer skills, reading and sport. All these activities are not only fun and relaxing; they can fill voids in our lives and help to occupy us during the day or evening. They can improve concentration and reduce isolation. They can also boost our morale and confidence and give us a feel-good factor.” Finished, Angelo lifted his head from the paper and looked around.

“Well, do you have any hobbies, Angelo?” Kutchinsky asked.

“I like to play chess,” he said. “And, as I’ve said, I like to read. But it’s difficult. I can really only handle something light or humorous. Like Dave Barry.”

“I see. Does reading help to block the voices at all?”

Angelo’s eyes seemed to darken. “No. I’m afraid nothing at all blocks the voices. Even if I play music really loud, it doesn’t help at all.”

The coping strategies that followed were within the same vein as the first — commonsensical lifestyle suggestions geared toward improving one’s frame of mind, or sanding down the edges of the experience’s effects. Liana chose “Exercise”; Jenny chose “Religious Activities”; David chose “Pamper Yourself” (“Put nice music on in the next room, put some scented candles around the room. You could even have a bath with your partner!”). The most novel strategy, and the only one that seemed to cause the group’s members to perk up, came under the heading of “Mobile Phones.” If you have the temptation to yell at your voices in public, one suggestion went, you should do so with a phone to your ear. That way you can feel free to let loose, and no one who sees you will think you’re crazy. Chris in particular seemed to cozy to the suggestion. “I sometimes talk to my voices in public,” he said matter-of-factly. “It’s very upsetting. I have to bite my knuckles to suppress the urge.”

Participants in H.V.N.’s self-help groups take comfort from strategies like these not least because they approach voices as you would approach any other painful but normal experience, like anxiety or stress. Many of the members of the North Finchley group, however, pursue pharmaceutical treatment in addition to coping strategies: they talk at the same time that they are on pills. Indeed, as Kutchinsky told me, they sometimes talk about their pills. They talk about the best dosage and about how to deal with the anxiety and sluggishness and impotence that pills sometimes cause. There is, of course, nothing wrong with this combination. It might even be ideal: who better to talk to about medication than people who are actually on it? And if you were struggling from an experience as complicated as hearing voices, why wouldn’t you use every means at your disposal to deal with it?

As for Angelo, his concern is not to choose one option over another — but only to recover. “I have found the group interesting,” Angelo wrote via e-mail three weeks after we met. “It has made me realize that many voice-hearers have had the problem for many years, and that many never stop hearing the voices, though some are successful in that regard. One lady has recently quit the group as she no longer hears voices. I also see that some hearers are quite high-functioning and are able to hold down a job despite the voices. I hope to do this myself. Perhaps the right combination of drugs will make this possible.”

Daniel B. Smith is the author of “Muses, Madmen and Prophets: Rethinking the History, Science and Meaning of Auditory Hallucination,” just published by the Penguin Press and from which this article is in part adapted. Read more!

The Homeless Maze - NY Times

Opinion:

Mayor Michael Bloomberg set a very ambitious goal when he said he would reduce the number of homeless by one third in five years. Halfway through the program, though, the ranks of the homeless have gone up considerably, with the number of families reaching a new high.

Many factors can be blamed, but some of the problems resulted from miscalculations by the city, which clearly underestimated the challenge and set unreasonable requirements for people seeking rent subsidies.

It is reassuring that Mr. Bloomberg and his homeless czar, Robert Hess, are vowing to try again. According to a study by the Coalition for the Homeless, the number of homeless families reached 9,250 this month, the most since the city began keeping track in 1982. Mr. Bloomberg, voicing his disappointment, warned the situation could worsen if the economy slows.

That makes it all the more imperative that New York pursue a change of course that addresses the real reasons why people can’t find anywhere to live except the streets and the shelters.

An analysis by the Pratt Center for Community Development tells the story. In the 10 neighborhoods where the majority of the city’s homeless families come from, the number of families paying more than 50 percent of their income for rent grew by more than 30 percent, to nearly 114,000, between 2002 and 2005. Brad Lander, the center’s director, says the big surprise is that there aren’t even more families in the shelter system.

A turnaround won’t be easy, but the city can begin by addressing what most experts agree are serious shortcomings in the program called Housing Stability Plus, which was supposed to replace Section 8, the federal housing voucher program. The city made a mistake when it said that that only homeless people on welfare would qualify to get housing assistance. Welfare is often not a steady proposition. As many as 65 percent of families saw a disruption in welfare benefits, which cost them rental support. That in turn angered landlords who went unpaid during the disruptions.

The unintended consequences of this policy were considerable. To keep roofs over the heads, families were motivated to stay on welfare, instead of finding work. The already depleted supply of housing available for subsidies, meanwhile, was diminished further — by some 14 percent last year — with many landlords wanting nothing further to do with the city program.

One sensible alternative would be to use an income-based formula that calculates assistance as a percentage of earnings, without setting deadlines that send those still needing help back to the streets. The city might also consider providing at least some of the families with Section 8 vouchers, a policy it abandoned even though it helped bring down numbers in 2004.

Housing Stability Plus failed to acknowledge a fundamental fact — that thousands of working families, not only those on welfare, often face untenable pressures to keep a roof over their heads.

While the cause of much homelessness among individuals is rooted in substance abuse or mental illness, for many families homelessness often comes down to simple dollars and cents. Most of these families are stable and intact, but do not earn enough to provide both housing and food for their children.

No family should have to make that choice. The city needs to do better by them, finding a way to get them support for as long as necessary. Read more!

Changing minds about mental-health care - Billings (MT) Gazette

Prison is the worst place to start psychiatric treatment.

When a mentally ill person only begins to get treatment as an inmate, the system has failed. Tragically, these failures abound. Montana State Prison in Deer Lodge holds more people who are taking psychiatric medications than does the state psychiatric hospital at Warm Springs. All across America, prisons and jails have become the largest mental-health care facilities in their communities. The burgeoning number of mentally ill inmates must be reduced with effective treatment.

That imperative prompted a new collaboration in Montana between the Department of Corrections and the Department of Public Health and Human Services. The directors of those departments explain their proposal for the Secure Treatment and Examination Program in a guest opinion elsewhere on this page. It's commendable that the two departments are working closely to improve government services. The program proposed in the governor's budget would return the Xanthopoulos Building at Warm Springs to the purpose for which it was built: high-security psychiatric treatment. It would also remove criminals from the building that houses civilly committed patients.

The concern that many Montana mental health advocates have about STEP is that the mental health services outside prison where treatment should start are severely lacking. Even if the state provides more effective treatment to inmates, there won't be sufficient community services to keep them well and out of trouble with the law - unless the state significantly improves its support for counseling, medication assistance, crisis intervention and other community care.

Bipartisan effort
The bipartisan joint subcommittee on Health and Human Services recognized the need for making mental health care more accessible in our communities. The subcommittee, chaired by Rep. Edith Clark, listened to testimony from people from all over this state, and then made careful decisions to add about $13 million more than Gov. Schweitzer's biennial budget proposed for improving community care. It was standing room only when the subcommittee heard the mental health proposals, according to Yellowstone County Commissioner Bill Kennedy.

How much better is it to get care in one's hometown? How many of us central and Eastern Montanans would chose to be transported to a hospital in Warm Springs for care of a heart attack or a broken leg?

How much cheaper and less painful is it to go to the local walk-in clinic for treatment of a deep cut than to wait until the wound is infected and the infection has spread throughout the body? Yet that wait-till-it's-worse philosophy permeates the public mental-health system. There aren't enough psychiatrists to see indigent patients quickly at walk-in clinics, but if a person attempts suicide, he will be seen in the emergency room. The state doesn't yet fund treatment courts, but it pays $25,000 a year to lock up offenders.

On right track
The Schweitzer administration is on the right track by recognizing that chemical addictions and mental illnesses are contributing hugely to the state's growing prison population. But the governor must put the same priority on community programs as on state-run programs. Community care is essential to maintain individuals released from the state hospital or a prison hospital and - most importantly - to intervene with care before people deteriorate to the point of needing hospitalization or committing a crime that they would not have done if they were in effective treatment.

Before this Legislature finally adjourns, forward-thinking lawmakers should reinstate the bipartisan subcommittee's recommendations on community mental health services. Chairwoman Clark, Vice Chairman Sen. Dan Weinberg, Sens. John Cobb and Greg Lind; and Reps. Joey Jayne and Penny Morgan did a commendable job of balancing needs for institutional and community services.

Their fellow legislators should adopt their recommendations and so should Schweitzer. Read more!

Help Wanted: Psychiatrists - Brownsville (TX) Herald

Published March 24

By LAURA B. MARTINEZ — The Brownsville Herald

He tries not to cry, bows his head and remembers all the tears he’s shed because he’s unable to help his beloved wife, “Sarita.”

“I don’t know what else to do,” the 81-year-old Vicars said at his Brownsville office. “I don’t know how many times I’ve sat here and cried my eyes out.”

Sarah Vicars, 79, suffers from severe depression. With no psychiatrist working in this city and only one in private practice in Cameron County, Margal Vicars fears she won’t get the help she needs.

Margal Vicars was once a Brownsville mayor. Sarah was the city’s first lady.

He remembers her as a vibrant woman who was greatly involved in the community, serving on boards and active in the annual Charro Days festivities.

She changed when the couple’s only daughter died seven years ago.

Sarah Vicars was able to cope with her daughter’s death at first, then fell into a “deep depression” and sought out a psychiatrist, her husband said.

She was slowly recovering when her psychiatrist moved from the area and referred her to another doctor.

Dr. Clay Ross worked with Sarah for three months, then announced he was retiring.

Ross’ departure left one psychiatrist in private practice for Cameron County. That doctor, Robert Collier, has offices in Harlingen, just 30 miles away but too far for Sarah to travel. Other health complications make it hard for her to leave home.

“She has fought so hard,” Margal Vicars said.

Collier could not be reached for comment for this article.

According to the National Alliance on Mental Illness, major depression, the leading cause of disability in the United States, affects more than 9 million adults each year.

Nearly twice as many women (6.7 million) as men (3.2 million) are affected by a major depressive disorder each year.

Stephanie Contreras, president of the South Texas chapter of the National Alliance on Mental Illness, said the Rio Grande Valley is in crisis because of the psychiatrist shortage, especially Cameron County.

“I hurt for the people in Brownsville. I get a lot of calls” from there seeking assistance, Contreras said. “In the private practice, to not have even one psychiatrist in a town the size of Brownsville is truly ridiculous.”

She has heard that area doctors have unsuccessfully tried to lobby new psychiatrists to relocate here.

They are drawn to the climate and nearby beaches, but most doctors are lured to practice in larger, more metropolitan cities, she said.

“The bottom line is: Until we can figure out a way to draw people down from other parts of the nation, the incentives must be there,” Contreras said. “We need those millions of dollars that are coming down for our medical education to include psychiatric care, not just psychologists and sociologists, but in-depth psychiatric care.”

What’s the difference between a psychologist and a psychiatrist? A psychologist treats a patient through counseling and therapy. A psychiatrist treats a patient through not only psychotherapy but prescribes medication as well.

There are about a half dozen psychologists and psychotherapists in Cameron County.

Cameron County offers one psychiatrist for an estimated population of 378,000. This is difficult for Margal Vicars to comprehend or explain. Hidalgo County is home to more than a dozen psychiatrists.

“It’s a critical crisis in Cameron County,” he said. “Why are the doctors shying away from Cameron County?”

The Texas Department of State Health Services records show Cameron County is designated as a mental health professional shortage area since 2003. Hidalgo, Starr and Willacy counties also have this designation.

Hope surfaced in December after Cameron County Commissioners Court agreed to meet with Margal Vicars and 80 residents who care for individuals with psychiatric needs.

After listening to the stories and the grim statistics, the group was told on Dec. 11 that a Mental Health Task Force committee would be formed to address the issue. Some three months later, Margal Vicars is still waiting for the group’s first meeting.

“It just kills me to sit here and can’t see anybody giving us any support,” he said. “If it was their family, what would they be doing? I’m hear speaking out for all the families that have no one to speak for them.”

The Mental Health Task Force committee will likely meet for the first time next month, said Cameron County Precinct 2 Commissioner John Wood, who is charged with developing the task force.

Wood’s wife teaches psychology at the local university. He said he recognizes the need for more psychiatrists in Cameron County but said the problem is getting them to relocate to the area.

Because of the county’s demographics, a psychiatrist would also need to be bilingual to serve the population, which is largely Hispanic and Spanish-speaking.

Wood tried to persuade a Matamoros doctor to open a practice in Brownsville, but the physician declined, saying it would be too much of a caseload.

He hopes that when the task force meets, they can offer a solution to address the problem. No meeting date has been set.

One option is having patients meet with psychiatrists electronically, communicating through a computer.

The trend, more commonly known as telemedicine, would link a patient with a doctor at the University of Texas Medical Branch at Galveston, said Maribel Martinez, with UTMB-Galveston.

The patient would communicate to the physician face-to-face with a Web camera link. Planning and funding is needed to establish links here.

Part of the city’s legislative agenda includes soliciting funds from the Texas Legislature for local education programs that provide teaching and training for students interested in psychiatry.

“We need to get some training here so we can get some qualified people,” City Manager Charlie Cabler said. “We need to come up with incentives to get people here.”

Margal Vicars is also seeking solutions.

“I’m not going to stop until somehow we get a doctor here,” he said.

“As long as I have breath, I won’t quit until we have help in this county. I’m not going to take ‘no’ from the county judge, commissioners or whatever.” Read more!

Treatment, not fear - North County Times (Escondido, CA)

By: RUTH MARVIN WEBSTER

Ann Cummings of Vista started her adult life with hopes and dreams. A freshman on a scholarship to Stanford University, she was smart, talented and hardworking. On the outside, she seemed to have everything.

But with her mental breakdown the first year, all those hopes and dreams came to an abrupt end.

Cummings is among the one in four of all Americans over 18 who suffer from mental illness, according to the National Institute of Mental Health. But unlike many who go through their lives undiagnosed and without treatment, Cummings has regained control of her life with the right combination of medication and support.

Many mental disorders manifest in the early 20s or earlier, in adolescence. In fact, half of all lifetime cases of mental illness begin by age 14, according to the National Institute of Mental Health.

Particularly for young adults, it may be difficult to recognize the symptoms, know the language to describe them, or seek help.

"That's why parents who start children on antidepressants need to be really on top of it," said Cummings. "They need to pay extra attention, take courses and have therapy to help kids express their feelings without self-medicating with drugs and alcohol."

Cummings is chairwoman of consumer programs for the National Alliance on Mental Illness, which is hosting a 5K Walk for the Mind of America on April 21 in Balboa Park (see sidebar). She speaks often to civic groups to encourage people to step out from under the shame of mental illness and find treatment for their disease, which experts now consider a biological brain disorder ---- an illness, just like diabetes or heart disease.

'It took me decades'

When Cummings sought help at the student health clinic back in the '70s, tranquilizers were prescribed. "I thought I was lazy, inept, stupid," she said. "It took me decades to be diagnosed, to be treated and to face up to it."

Cummings believes severe and persistent depression runs in her family. Her grandfather committed suicide by jumping off a 14-story building in Seattle. Her father did the same by leaving the Veterans Hospital in La Jolla and lying down behind a big rig, where he was crushed to death. And her 13-year-old son hanged himself on a tree in their front yard.

These days, Cummings keeps a large plastic box of prescription pill bottles in the back of her car. Some are antidepressants and anti-anxiety drugs; other drugs minimize their side effects. She swallows one handful of pills when she wakes up. Another handful at midmorning. Another at lunchtime. More in midafternoon, in the evening and at bedtime. Every day, 365 days a year, she must take the correct mixture of medications to live a full and productive life.

"I hate the idea of taking medication my entire life," she admitted, "but they help me to become who I should have been.

"I hadn't laughed since I was 15, and there I was in a room ---- laughing. I had not experienced that joy for so many years. I have finally found myself. I can pay my bills and go shopping. I can go to a football game, which used to be too stimulating. And although I don't have those hopes and dreams I had before, I am creating new ones."

'A lot of shame'

Today, Cummings supervises a number of support programs for the mentally ill and their families through the National Alliance for the Mentally Ill chapter in North County. Called consumer programs, they serve people with severe and persistent mental illness and their families.

She's particularly proud of the Peer to Peer Recovery Education course and In Your Own Voice, which encourages people to speak about their own experiences with mental illness. By sharing experiences, journeys and stories, participants hope to open minds and change public attitudes. Eradicating the stigma surrounding mental illness is the hope.

"You don't feel like you're a bad person if you have high blood pressure or a thyroid condition," said Dr. Alvin Mirow, medical director of Tri-City Medical Center's Outpatient Behavioral Health Services and Cummings' psychiatrist. "But with mental health disorders, they threaten the core of who we are. It goes to identity, and there is a lot of shame for what others can think of as a lack of control.

"Mental illness has been seen as a kind of character deficiency, so I'm not that surprised by the stigma, but it has been improving," said Mirow. "There is more sophistication on the part of the general population, and it has been accepted in many quarters now. You see celebrities admit they have some sort of mental health issue.

"Yes, the stigma is still a huge problem, no question. But it is getting better slowly."

Many are affected

Much of the public recognizes schizophrenia, bipolar disorder and severe depression as mental illnesses. But other conditions, including anorexia and bulimia, autism, post-traumatic stress disorder, Alzheimer's and phobias are also mental illnesses, according to the Diagnostic and Statistical Manual of Mental Disorders, 4th Edition.

According to the National Alliance for the Mentally Ill, the most serious mental conditions affect 5 million to 10 million adults (2.5 to 5.4 percent) and 3 million to 5 million children ages 5 to 17 (5 to 9 percent) in the United States. But many people have conditions in varying degrees along the continuum.

"I would not hesitate to say that every family deals with mental illness on one level or another," said Aaron Byzak, assistant public affairs officer for Tri-City Medical Center. "It's not just the stereotypical view of people with mental illness, but people with obsessive compulsive disorder, panic attacks and others."

"Every family" includes that of Debbie Divis of Vista. As she grew up, she said, her upper-middle-class family appeared unexceptional. Divis, however, has suffered from bipolar 2 disorder for most of her life and left a wake of chaos until she began treatment. Able to work full time now, she is also a presenter in the In Our Own Voices program. She said it wasn't until her brother was killed by a drunken UC Santa Barbara student in 2001 that she started to come to terms with her mental illness.

"The news networks came to our house and put a microphone in my face," she recalled after her brother's death. "Everyone at my job knew I was depressed. I had to go behind the racks and cry all of the time."

It was not until she tried to commit suicide in Hawaii years later that she sought medication and therapy, and she had to face down her fears to do it. "I saw 'One Flew Over the Cuckoo's Nest,'" she said, referring to its negative depiction of mental hospitals.

Divis' father was diagnosed late in life as bipolar also. An alcoholic, he died in his aunt's guesthouse at age 57. His body wasn't discovered for five months ---- too late to determine the cause of death, though Divis believes it was probably suicide.

Delaying treatment

Though public attitudes have improved, many people are still reluctant to reveal they have a mental illness. The U.S. National Institute of Mental Health has found there are often delays --- sometimes decades long --- between the onset of symptoms and when people seek treatment.

"One of the problems I often run across is that people don't make the distinction between drugs of abuse and medication for a disorder," said Mirow. "'I don't want to be on drugs,' they say ---- as if they are going on (drugs) for the purpose of getting high instead of for the purpose of getting well."

Many of today's medications for serious mental illness are highly effective. According to the National Alliance for the Mentally Ill, between 70 percent and 90 percent of individuals have significantly reduced symptoms and improved quality of life from medicine and therapy.

Still, the mentally ill as well as their families often deny the illness. It's all in their head, they say.

According to a recent survey by the National Mental Health Association, 55 percent of those who have never been diagnosed with depression know that depression is a disease and not something people should "snap out of." In a 1991 survey, only 38 percent saw depression as a disease.

"My husband used to tell me to 'Buck up,'" remembered Dawn Sizemore, 40, a divorced mother of two sets of twins from Carlsbad, who said she suffers from bipolar disorder. Diagnosed at age 23, she went off her medication for a time and suffered psychotic episodes almost immediately. Sizemore said she was even jailed overnight when her husband called the police during one episode.

Today, she said, it is somewhat of a relief to come to terms with her illness, said Sizemore, who said she used to own her own business and work in retail management, and now cleans houses for a living. The psychotic episodes, though she doesn't remember all of them clearly, woke her up.

"I know now I have to do this ---- medications, therapy. And group (therapy) has helped. I suppressed my anger and my feelings for so long, growing up. Now I'm just happy to be able to do the little things ---- get out of bed, iron and be there for my kids."

Public understanding

With education and awareness, the public is increasing its understanding of mental illness.

Joyce Kistler, a registered nurse and health and psychology teacher at Carlsbad High School, has taught a unit on mental health for many years. She said that she used to bring health professionals in to talk to the students, but she also has had students and family members come in to discuss their experiences with mental illness.

"We have parents come in and share," she said. "I think they realize the stigma and in their own small way, are more open and accepting ... a lot of them have been in therapy, and that used to be such a stigma too, but they realize they're not crazy and that it helped them."

Kistler is also in charge of a peer advocate program on campus where students go through a long interview process and more than 200 hours of training before speaking with other students suffering with mental health issues.

"I see them come in to talk with their peers because the room is right next to mine," she said. "I see these kids with their shoulders slumped, their hoods on and dressed all in black, and they come out with a smile. It is working. They have security that it is other kids they are speaking to, and everything is confidential. We don't give advice, but we refer them to help."

Charlene Moore, community liaison coordinator for Tri-City Medical Center's outpatient behavioral health services, said the hospital has been working toward adding services for the community, including a walk-in mental health assessment center for adults that would operate 24/7; adding crisis beds; and expanding Psychiatric Emergency Response Teams, which train police to recognize those suffering from mental illness and assess the level of care they need.

"I don't think we need more institutions," she said, "just more support and help so people can take care of themselves. I think everyone wants to do that. They don't want to be taken care of ---- some just need help to live an independent lifestyle."

Contact staff writer Ruth Marvin Webster at (760) 740-3527 or rwebster@nctimes.com.

Info Box:

The National Alliance on Mental Illness is a nonprofit, self-help, support and advocacy organization for those with severe mental illness such as schizophrenia, major depression, and bipolar, obsessive-compulsive and anxiety disorders, and their families and friends.

The group is sponsoring the NAMI San Diego County Walk for the Mind of America 5K Walk on April 21 in Balboa Park at 6th and Laurel streets. Call (619) 584-5564 to register, visit www.namiwalksandiego.org or e-mail to shannonjaccard@namisd.org.

Local chapters:

NAMI North Coastal, PO Box 2235, Carlsbad CA 92018; (760) 722-3754

www.nami-northcoastal.org

NAMI North Inland, PO Box 300386, Escondido CA 92030; (760) 745-8381

Tri-City Medical Center, Behavioral Health Outpatient Services, 510 W. Vista Way, Vista CA 92083; (760) 940-5050

Palomar Outpatient Behavioral Health Services, 125 Vallecitos de Oro, Suite A, San Marcos CA 92069; (760) 510-8585 Read more!

Care providers fearful of mental health changes - Macon (GA) Telegraph

By Travis Fain

ATLANTA - A culture of change in state-run mental health care hits a major milestone April 1 in a shift that care providers across the state fear will prove disastrous for an already struggling system.

State officials behind the shift say they're bringing order to the system by adding more competition and accountability.

Instead of getting a set amount of monthly funding from the state, mental health and drug treatment providers will have to document who they've treated to earn reimbursements from the Georgia Department of Human Resources. They'll also face new competition from the private sector, where more than 160 entities are bidding for a slice of the millions that state taxpayers spend each year on mental health care and drug treatment.

Department officials say the changes may be difficult in the short term, but long term they'll shift resources to the people who need them and force providers to seek out needy patients.

"This has been a broken system," said Gwen Skinner, the department's director of mental health, disabilities and addictive diseases. "We're not going to throw money at mental health anymore."

But longtime advocates are crying out, complaining of funding cuts already taken and predicting disaster as the state tries to privatize mental health care and drug abuse treatment.

"It's gonna be a huge mess," said Nora Haynes, president of the Georgia chapter of the National Alliance on Mental Illness. "I hope I'm wrong. I hope they're ready. But if history repeats itself, they're not going to be ready. ... DHR has not been ready thus far with anything."

THE CONSEQUENCES OF CHANGE

Like a large ship, the state has been turning the department's mental health and drug treatment system for several years.

Within the past year, cuts have hit Middle Georgia community service boards hard. Those boards are the groups that provide the bulk of government-funded mental care and drug treatment in the midstate.

Houston County's community service board, The Phoenix Center, laid off 41 people in fiscal 2006. It also closed its Crawford County office and shut down three treatment programs for adults, director Joyce Jackson said.

In Laurens County, a 16-bed home for young men with drug problems will close at the end of this month, said Dr. Patsy Thomas, CEO of the Middle Georgia Community Service Board in Dublin. A five-day stabilization home for the mentally ill will close, too. The buildings, built by Laurens County taxpayers, will sit empty, Thomas said.

Bibb County's community service board, River Edge Behavioral Center, has shut down its methadone clinic, which provided prescription drugs to addicts. Bibb also closed two group homes, where about a dozen long-term people found not guilty of various crimes by reason of insanity had been living.

They live in area apartments now, and River Edge staff members check on them, said Frank Fields, River Edge's director.

Bibb's 14-day unit, where addicts lived and readjusted after detoxification, closed last year, too.

"And nobody cared," Fields said. "I thought the community would really rise up over that."

The effects of these closures are visible, if subtle. Providers fear they will become more obvious.

"You are seeing more homeless people in Dublin, Georgia," Thomas said. "You are seeing more petty crimes."

DHR officials insist that these types of closures are part of shifting resources. Money is being spread throughout the state to realign spending with needs, the department says. In some cases it's simply being shifted to a new provider in the same community.

"Just because a (community service board) lost money does not mean the money has been removed from that community," Skinner said.

Indeed, total DHR spending in the mental health division is up every year since fiscal 2004, and River Edge's annual budget hasn't been cut. But instead of handling mental health and drug treatment for a four-county area, it expanded to seven, Fields said.

In response to repeated requests by The Telegraph to provide a list of new services started in Bibb County over the past two years, the department said two new in-home mental therapy programs for families are scheduled to start soon.

Various drug treatment services - again focused on out-patient care in people's homes as opposed to "deep-end/intensive services" - are also on the way, department spokeswoman Kenya Bello said.

"In the past, we were not purchasing the right services," Bello said. "These are the corrections that we're making."

JAIL INMATES, HOMELESS PART OF EQUATION

Many therapists, administrators, activists, bureaucrats and elected officials are calling Georgia's mental health situation a crisis.

The National Alliance on Mental Illness gave Georgia a D for its mental health system and ranked it 44th of 50 states in 2006.

The Atlanta Journal-Constitution reported earlier this year on 115 suspicious deaths at state mental hospitals from the past five years.

Studies vary, but all agree that a high percentage of jail inmates and homeless people have a mental illness or addiction. Most people with a mental illness or drug problem want to get better, and they can live regular lives, Fields and members of his staff said.

"But there are those that are dangerous," Fields said. "You don't just dump them out on the streets."

Fields keeps a box full of knives and sharpened implements as a reminder. They're items security has taken from people seeking treatment at his facility.

Bibb County Sheriff Jerry Modena said he has seen mentally ill people at the county jail who seem fine - as long as they're on their medication. But when they get out of jail, away from the jail's treatment program and daily supervision, they stop taking that medication.

They come back, arrested again, and "in wretched shape," Modena said.

On March 5, a man allegedly snatched a 2-year-old child in front of the child's mother, then left the child at an empty house less than a block away. When he was caught, the man told police he had no recollection of the event or anything else over a two-day span.

Police suspect drugs contributed heavily.

Also this month, a man walked into the Dublin mental health center to see a doctor. While the doctor was filling out paperwork to send him to Central State Hospital in Milledgeville, the man went outside, attached his coat to a sign out front and tried to hang himself, said Thomas, the center's CEO.

"I'm telling you, the private sector does not want that," she said.

Asked if she worries that someone who shouldn't be on the street will hurt someone, Thomas said she fears it "every day."

'HEADED FOR A TOTAL BREAKDOWN'

The playbook for change at DHR headquarters in Atlanta is a report from Gov. Sonny Perdue's private-business-based reform initiative: Commission for a New Georgia.

Appointees on the commission sought private-sector answers to long-standing problems in the state's mental health system.

"We do nothing outside of that," DHR spokeswoman Bello said of their report.

The task force included business people but also mental health advocates and doctors. They suggested an increase in competition, and that the state shift some care out of its seven mental health hospitals, including Central State Hospital, in favor of out-patient services.

But one of the biggest changes in day-to-day operations will be the April 1 shift to "fee-for-service," the moniker for the new way providers will be paid. They won't have a set budget, per se, but will have to justify funding by documenting treatment provided.

Contracts are also being re-bid, and longtime providers may not get renewed.

"Naturally they would be upset," Bello said.

"I understand the stress that causes," Skinner said. "This is a major overhaul of Georgia's mental health system."

Some community service boards will survive, others will not, said Ken Whiddon, who has worked in several community service boards across the state and now runs a private treatment provider, AmericanWork.

"Historically the funding, how well it was spent and how efficiently it was spent, was dependent on the local situations," Whiddon said. "Now it's sort of like ... the marketplace dictates it. If you don't provide the service, you don't get paid for it."

Bello and Skinner said providers will have to seek out the sickest and poorest in the state and treat them to make money. Fields and Thomas, along with other providers and advocates, fear private companies will "cherry pick" the easiest clients to treat.

Whiddon disagreed, saying there will always be state money for the sickest patients, and private companies will go after that funding.

Fields said he sees the safety net of community service boards eroding. And Thomas said the system is in "chaos."

"I've been with the mental health system in Georgia since '72," Thomas said. "Never seen it this bad. ... I feel like we are headed for a total breakdown."

STATE LEGISLATIVE PANEL TO LOOK AT SYSTEM

The National Alliance on Mental Illness has asked the U.S. Department of Justice to investigate the system in light of deaths at state hospitals. State legislators are considering a potentially lengthy look at the entire system themselves, through a legislative commission.

Senate Resolution 363, sponsored by state Sen. Johnny Grant, R-Milledgeville, would create the commission. A separate measure, House Bill 535, would create a mental health ombudsman - an independent investigator who would look into specific complaints about the system.

Both pieces of legislation have passed committee and await debate in the full House and Senate.

"I generally tend to be a free-market type of person," Grant said of the move to privatization. "But there are some areas that do not seem to apply. And I think that a lot of what we deal with in the mental health arena is some of that.

"It seems like our agencies are starving our (community service boards) by cutting back the funding for them," Grant said. "I'm just fearful that many of the things that we're doing to change our mental health system are not going to be working."

Haynes, the president of NAMI Georgia, said she'd like to see a freeze on fee-for-service and other privatization initiatives, until the state Legislature can take a hard look at the system.

Grant said "that would be nice" but would probably take an act from the governor.

A Perdue spokesman said the governor is working hard to improve the system. He said the administration is moving forward with fee-for-service, a move DHR officials note has been planned for some time now and has worked in other states.

"The fee-for-service will ensure that resources get to the right places and are distributed equitably," Perdue's office said in a statement. "The current system disproportionately funds certain programs over others. Fee-for-service ensures the best care for individuals."

To contact Travis Fain, call (404) 659-8735 or e-mail tfain@macontel.com.

***

Mental illness in Bibb County's jail
In 2006:
* Bibb County spent $334,700 for River Edge Behavioral Health Center to provide services to mentally ill and drug addicted inmates.
* The county spent an additional $238,189 on psychotropic medications to treat inmates.
* 2,465 inmates were seen by the jail's in-house therapist.

SOURCE: Bibb County jail and River Edge Behavioral Health Center

Who suffers from a serious mental illness?
* 6.7 percent of Georgians (estimated)
* 25 percent to 35 percent of the homeless population
* 56 percent of state prisoners
* 45 percent of federal prisoners
* 64 percent of local jail inmates Read more!

Mental illness claimed talented performer - Richmond Review (British Columbia)

Published March 24.

By Martin van den Hemel

As she prepared a late-night tea for him, Shameine Ali recalls sensing something wasn’t quite right with her 25-year-old son Zeyn.

“He looked a little uneasy, a little uncomfortable. I asked him if everything was OK...I made him his cup of tea, I hugged him and I went to bed.”

It would prove to be a tragic early Jan. 16 morning for the talented Richmond-raised actor and singer, who died of a fall from the downtown Vancouver highrise apartment he shared with his brother Zaven and mother.

Shameine contacted The Richmond Review this week to share her son’s heartbreaking story in the hope that Zeyn’s recent struggle with mental illness will help raise public awareness about the condition which affects so many.

Zeyn wasn’t in a hit-and-run accident—as first reported by the Vancouver Police. He’d actually stepped out of the window of his 16th floor bedroom.

“It was the monster of mental illness that took my son’s life,” she said.

Zeyn suffered from psychosis, or mental conditions characterized by a loss of contact with reality, that can take the form of paranoia, delusions hallucinations or disorganized thoughts.

He was first hospitalized in the summer of 2004, and Shameine believes the trigger for his first psychotic episode was the cumulative emotional impact of the deaths of four people very close to him over a short period of time.

Most researchers believe that the cause of psychosis, which first strike young adults between 15 and 25 years of age, is rooted in both genetic and environmental factors, including stress. Also implicated by a growing number of scientific studies is drug use.

Zeyn’s grandmother, with whom he shared a very close bond, died in August 2004, just six months after leukemia claimed Zeyn’s acting mentor and friend Carl Anderson, who portrayed Judas Iscariot in the touring rock opera Jesus Christ Superstar in which Zeyn played an apostle. Zeyn’s father died of a brain aneurysm in 2002 and he’d also recently lost his grandfather.

“In all these cases he wasn’t able to connect, to go back home for the funerals because he was always on stage. When you’re on stage, you can’t leave a show,” Shameine said this week.

Two months after the end of the national tour of Jesus Christ Superstar in the summer of 2004, Shameine noticed her son became very introspective, immersing himself in quiet work on the computer.

“I thought that this is the ups and downs of an actor. You’re on a high, you get a job, you come back home for a whole summer break not knowing when your next job is. He seemed to be depressed. That’s the only indication I had.”

While at her mother’s funeral in Trinidad, Zeyn began to behave unusually in August 2004. He sent a cousin an e-mail that made no sense, moved his mattress into his brother’s room because he didn’t want to be alone, and then made some curious visits to friends, who couldn’t understand what he was talking about.

“I think people have to know these signs of mental illness.”

Eventually, after scaling the fence of the Buddhist Temple on Steveston Highway, Zeyn was admitted to the psychiatric ward at Richmond Hospital.

But Zeyn made solid progress in his treatment in the months following his hospitalization. Last year, he was selected to go to Toronto, making it into the top 100 in the Canadian Idol singing competition. He’d secured a gig as principal singer on a major cruise ship, which was set to start one month after his death.

“It’s like another mind was directing his body. This is not any Zeyn we know. This is not the Zeyn who lived life to the fullest, who loved people, who loved his life, who had a beautiful spirit.”

Dr. Mellisa Fahy, a consulting psychiatrist with the Vancouver/Richmond Early Psychosis Intervention Program, said in young adults already vulnerable to psychosis, drugs like marijuana can trigger the psychosis. In those who have it, these drugs will exacerbate the symptoms and even cause a relapse.

“Early intervention is the key,” she said, adding that treatment includes anti-psychotic medication, psycho-social rehabilitation and education.

She said a lack of funding means there aren’t enough resources available to those who need help.

Shameine and her family intend to establish the Zeyn Ali Foundation, and will soon embark on a fundraising campaign with the goal of providing scholarships for aspiring entertainers. As well, she’d also like to raise enough money to create transitional housing for people suffering from psychosis.

Efforts are being made to release Zeyn’s debut CD later this year, with