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!