As Health Plan Falters, Maine Explores Changes - NY Times

By PAM BELLUCK

PORTLAND, Me. — When Maine became the first state in years to enact a law intended to provide universal health care, one of its goals was to cover the estimated 130,000 residents who had no insurance by 2009, starting with 31,000 of them by the end of 2005, the program’s first year.

So far, it has not come close to that goal. Only 18,800 people have signed up for the state’s coverage and many of them already had insurance.

“I think when we first started, in terms of making estimates, we really were kind of groping in the dark,” said Gov. John E. Baldacci, who this month proposed a host of adjustments.

The story of Maine’s health program — which tries to control hospital costs, improve the quality of health care and offer subsidized insurance to low-income people — harbors lessons for the country, as covering the uninsured takes center stage. States, including California, Massachusetts and Pennsylvania, have unveiled programs of their own, seeking to balance the needs and interests of individuals, employers, insurers and health care providers.

But as Maine tries to reform its reforms, it faces some particular challenges: It has large rural, poor and elderly populations with significant health needs. It has many mom-and-pop businesses and part-time or seasonal workers, and few employers large enough to voluntarily offer employees insurance. And most insurers here no longer find it profitable to sell individual coverage, leaving one carrier, Anthem Blue Cross Blue Shield, with a majority of the market, a landscape that some economists said could make it harder to provide broad choices and competitive prices.

Some parts of the state’s current program — named Dirigo after the state motto, which means “I lead” in Latin — are seen as promising. These include the creation of a state watchdog group to promote better health care, and an effort to control costs by asking hospitals to rein in price increases and spending, although experts and advocates said those cuts needed to be greater.

But a financing formula dependent on sizable payments from private insurers has angered businesses and is being challenged in court.

And while some people have benefited from the subsidized insurance, which provides unusually comprehensive coverage, others have found it too expensive. And premiums have increased, not become more affordable, because some of those who signed up needed significant medical care, and there are not enough enrollees, especially healthy people unlikely to use many benefits.

“It was broad-based reform that just never got off the ground,” said Laura Tobler, a health policy analyst with the National Conference of State Legislatures. “The way that they funded the program became controversial. And getting insurance was voluntary and it wasn’t that cheap.”

Governor Baldacci said in an interview that when the Legislature enacted the Dirigo Health Reform Act in 2003, it gave him less money and more compromises than he had wanted. He said his administration had now learned more about what works and what does not.

His new proposals include requiring people to have insurance and employers to offer it and penalizing them financially if they do not; making the subsidized insurance plan, DirigoChoice, more affordable for small businesses; creating a separate insurance pool for high-risk patients; instituting more Medicaid cost controls; and having the state administer DirigoChoice, which is now sold by Anthem Blue Cross.

“We’ve got a reform package that takes Dirigo to the next level,” Mr. Baldacci said. “It takes the training wheels off.”

The proposed overhaul seems to include something each of Maine’s constituencies can embrace and something each opposes, so there is no guarantee which changes will be adopted by the Legislature.

“It’s very hard politically to deal with the underlying costs of the system,” said Andrew Coburn, director of the Institute for Health Policy at the Muskie School of Public Service in Portland. “And Maine is just not wealthy enough to cobble together enough resources to fully cover the uninsured.”

The state’s current program, which has added 5,000 people to Medicaid and enrolled 13,800 people in DirigoChoice, has made progress. Even though the enrollment goal has not been met, the insurance plan has grown faster than any in Maine’s history, the governor said. And although about 60 percent of its enrollees were previously insured, some were paying what state officials deemed was too high a percentage of their income, said Trish Riley, director of the Governor’s Office of Health Policy and Finance.

The DirigoChoice benefits are impressive, said Hilary K. Schneider, policy director for Consumers for Affordable Health Care, a Maine advocacy group. The program completely covers preventive care, subsidizes premiums and deductibles, and unlike most insurance plans, covers treatment for mental illness and does not exclude people for pre-existing medical conditions.

Such coverage has caused critics to say DirigoChoice would be more affordable if it scaled back benefits.

“It’s a Cadillac policy, and we ought to be trying to fund a Ford Escort policy,” said Jim McGregor, executive vice president of the Maine Merchants Association.

One of DirigoChoice’s success stories, Jacquie Murphy, 63, of Westbrook, said, “It absolutely saved my life.” Ms. Murphy said she has fibromyalgia, chronic fatigue syndrome, back problems, an autoimmune disease and memory problems from a childhood brain injury. She said that a few years ago, when she left an abusive marriage and gave up her husband’s coverage, the fear of being unable to afford insurance that would accept someone with her illnesses “caused me to become clinically depressed.”

With DirigoChoice, which costs her just over $100 a month with the state paying a subsidy of about $250, she now has a walker, sees orthopedic surgeons for shoulder and ankle fractures, and takes medication for memory, cholesterol and thyroid problems. The relief of being insured lifted her depression, she said, and now, in her home with its Asian-themed pebbled backyard, she works as a career and life coach.

For others, like Leah Deragon, 34, DirigoChoice is too costly. Ms. Deragon, who runs a Portland nonprofit center that helps low-income families with new babies, said that although she and her husband, an engineering student, qualified for a subsidy, they could not afford the roughly $300 out-of-pocket cost each month. She remains uninsured, forgoing annual checkups and using student loan money when she needed dental work.

“For us it was very frustrating,” said Ms. Deragon, who shops at Goodwill and lives in her mother’s home in Gorham to save money. “We earned, I think, $16,000 last year. We can’t do $200 or $300 a month and still put gas in our car. Come the end of the month, we would be forced to hitchhike.”

And there is John Henderson, 42, of Auburn, who enrolled in DirigoChoice in 2006 for about $90 a month while working at an L. L. Bean warehouse, a job he kept to 20 hours a week so his income would qualify him for such a low rate.

But he dropped the plan this year when rates increased by 13.4 percent on average. Mr. Henderson, who has diabetes and is currently jobless, said he had stopped once-regular doctor’s appointments and some medications that “I have just no hope of affording.”

Ms. Schneider’s group is suing the state insurance commissioner for approving the rate increase.

An Anthem spokesman, Mark Ishkanian, said the increase was necessary because medical claims of DirigoChoice customers were “substantially higher” than anticipated, about double those of non-Dirigo plans. One reason for the higher expense was “pent-up demand” by enrollees who had been deferring visits to doctors while they were uninsured, Mr. Ishkanian said. Another was the richness of the coverage, which enrollees used for treating long-held conditions or mental illness, he said.

Ms. Riley said the state was surprised that more than half of DirigoChoice enrollees qualified for the highest subsidy, 80 percent, which meant the program has been more expensive for the state.

She said Maine also expected more small businesses to enroll in DirigoChoice. But many businesses found that the program requirements of enrolling 75 percent of a firm’s employees and paying 60 percent of the cost were too expensive.

“If they weren’t able to afford insurance before, they’re unlikely to be able to afford Dirigo,” said Kristine Ossenfort, senior governmental affairs specialist of the Maine State Chamber of Commerce.

Some health care advocates have accused Anthem of not marketing DirigoChoice enough to prospective customers, which Anthem denies.

Especially controversial was Maine’s financing formula for its program, which assumed that there would be savings because an increase in insured people would mean less charity care from hospitals, and that the cost-cutting measures would mean lower costs to insurers.

The state said it would charge insurers for those savings, rather than let insurers take the savings as profit. But when the state tried to charge insurers $43.7 million in 2005 and $34.3 million in 2006, the insurance industry and the chamber of commerce sued, saying the insurers owed much less.

A judge ruled for the state, but the case is being appealed. The governor’s new proposal would phase out this financing structure and impose lower-cost surcharges instead.

Among the state program’s biggest fans is Joan M. Donahue, 40, who was uninsured when she started a home care agency in Warren three years ago. She now has DirigoChoice for herself and her 17-year-old son, and three employees are enrolled. She also has two employees who cannot afford it and have not enrolled.

“I will absolutely stick with Dirigo,” said Ms. Donahue, who does not qualify for the subsidy. “This program needs healthy people who don’t get subsidized so it can prosper.”

The Dirigo program has already made one change that could attract people like Malvina Gregory, 31, a Spanish interpreter in Portland, who could not afford the subsidized insurance but may reconsider. Ms. Gregory was originally put off because it demanded full payment up front, and rebated the subsidy later; she went instead to a Portland program giving nearly free care, but is now afraid her income “will bump me over the limit” for that program.

DirigoChoice will now allow individuals to pay only their part up front. “The concept of Dirigo, I think, is phenomenal,” Ms. Gregory said. “I hope they are able to lower the premiums. There are a lot of folks like me that are in that bind.” Read more!

Disease Drove Sex Attack, Defense Says - NY Times

Published April 30
By ANEMONA HARTOCOLLIS

He was a media columnist for Women’s Wear Daily who built a reputation on his writing about the counterculture of the 1960s and ’70s. He got attention for his odd dress, a self-consciously nerdy, retro look that reminded some people of Austin Powers. His prose was dense, sarcastic, with intellectual overtones.

Now the writer, Peter Braunstein, 43, is about to go on trial, charged with a bizarre crime against a woman who worked in his own newsroom. Prosecutors say he dressed as a firefighter, staged a fire to get into her Chelsea apartment, tied her to a bed, drugged her with chloroform and sexually molested her for 13 hours.

As the trial opens today in State Supreme Court in Manhattan, jurors will be asked to decide whether he was a sadistic man preying on an unsuspecting woman or whether his actions were the result of mental illness.

The defense has conceded that he committed the crime, and is working on a risky defense that will combine traditional psychiatric testimony with the burgeoning field of “neurolaw,” which holds that there is a biological basis for behavior. Prosecutors have said that steps Mr. Braunstein took before the attack show his intent.

Mr. Braunstein’s lawyer, Robert Gottlieb, has said he would show color images of his client’s brain, called positron emission tomography, or PET, scans, that he said show that Mr. Braunstein had undiagnosed and, until his arrest, untreated paranoid schizophrenia that drove him to behave as he did.

During jury selection last week, and in his court papers, Mr. Gottlieb said he planned to argue that Mr. Braunstein was so psychologically impaired that he could not form the intent to commit a crime. He has hinted that Mr. Braunstein’s attack on the woman was part of an elaborate fantasy over which he had little conscious control.

In similar cases, lawyers have argued that their clients were in a dissociated state, much like sleepwalking. A version of this defense, said Rachel Barkow, a law professor at New York University, would be: “You know killing is wrong, but it turns out you think you’re in the middle of a video game. Because of a paranoid delusional state, you thought it was all a fantasy.”

A more classic lack of intention defense, said Stephen J. Morse, a professor of law and psychiatry at the University of Pennsylvania, would be that someone out hunting in the dark shot a person thinking he was shooting a tree.

Dr. Morse compared Mr. Braunstein’s argument to that in Clark v. Arizona, in which the defendant, a paranoid schizophrenic, was convicted of killing an Arizona police officer. There, too, intent was one of the issues, he said. The defendant claimed that he thought aliens — some impersonating government agents — were trying to kill him. “If he really believed that this was a space alien, he did not intend to kill a human being knowing it was a police officer,” Dr. Morse explained. (The United States Supreme Court affirmed the murder conviction in 2006.)

But the challenge of mounting such a defense, Dr. Morse said, is that “even abnormal brains produce intention.” Dr. Morse said that for a defendant to claim he was in an automatic state like sleepwalking for 13 hours would be unusual. “Virtually always, when people claim they committed a crime in an automatic state, that automatic state was relatively transient,” he said.

At first glance, Mr. Braunstein seems an unlikely candidate for a high profile trial. He had a fairly ordinary upbringing in Kew Gardens, Queens. The strangest part of his past, according to court papers, may be the family secret he unearthed when he was 27. He found out that his cousin was also his half-brother, the son of his father’s previous marriage to his aunt.

But because of his connection to New York’s fashion and media worlds, his story has been picked up not only by the crime-hungry tabloids, but by Vanity Fair and New York magazine.

As if working off a script, Mr. Braunstein staged the crime on Oct. 31, 2005, Halloween night, the prosecutors said. In an echo of a scene from his failed 2004 play, “Andy and Edie,” about Andy Warhol and Edie Sedgwick, it appeared he had videotaped his attack, although court papers say the tape was blank. He left a Manolo Blahnik shoe — the ultimate symbol of the fashion industry that had cast him out a few years before — on the bed, the police said.

Mr. Braunstein spent six weeks as a fugitive before being captured at the University of Memphis, where an employee recognized him from the television program “America’s Most Wanted.”

His downward spiral began in 2002, according to court papers filed by the defense, when he was fired from Women’s Wear Daily, in a dispute over free tickets to a Vogue event, and accelerated after he broke up with his girlfriend, Jane Larkworthy, the beauty editor at W magazine. “Without the stabilizing factor of a regular job, Mr. Braunstein rapidly began to unravel psychologically,” Barbara R. Kirwin, a clinical psychologist hired by the defense, said in a written report. He became suicidal and felt like a “person who exists with no social identity,” she said.

But the fashion press, Dr. Kirwin added, was the wrong job for Mr. Braunstein from the beginning.

“Working in the highly competitive, glitzy and sexually charged atmosphere of a celebrity-driven fashion periodical was an extremely toxic and unsuitable environment for a socially compromised and marginally compensated schizotype like Mr. Braunstein,” Dr. Kirwin wrote.

“It was,” she added, “in fact the proverbial recipe for disaster.”

The expert who conducted Mr. Braunstein’s PET scans, Monte S. Buchsbaum, a professor of psychiatry at Mount Sinai School of Medicine, has worked with other high-profile defendants, including Vincent Gigante, the Mafia leader. Mr. Gigante was known for wandering Greenwich Village in a bathrobe and slippers, and prosecutors accused him of faking mental illness to avoid prosecution. Dr. Buchsbaum testified in 1997 that brain images showed Mr. Gigante suffered from dementia.

In 2003, Mr. Gigante pleaded guilty to obstruction of justice, admitting he tried to outsmart the legal system by pretending he was mentally ill. Dr. Buchsbaum said in an interview last week that he stands by his diagnosis of Mr. Gigante, who died in 2005, and that he considered the guilty plea to be a legal maneuver.

In Mr. Braunstein’s case, while the defense is putting forward an insanity defense, prosecutors have a more prosaic theory of what happened. Maxine Rosenthal, the lead prosecutor, argued in pretrial hearings that Mr. Braunstein was bitter over his breakup with Ms. Larkworthy and enraged at the fashion world for rejecting him.

He could not attack Ms. Larkworthy, the prosecutor said, because she had taken out an order of protection against him, after accusing him of harassing and stalking her. So he lashed out at his co-worker, the prosecutor said, because she was an unwary surrogate for those who had betrayed and humiliated him.

The intentional element, the prosecutors said, can be seen in Mr. Braunstein’s ordering of the firefighter’s costume, chloroform and other supplies. He also called his probation officer in the stalking case to postpone an appointment scheduled for Oct. 31, the day of the attack.

In the end, said Stephen Gillers, a law professor at New York University, Mr. Braunstein will have to show why he should not be held accountable by society. “Gottlieb can point to his very pretty color photograph of Braunstein’s brain,” Mr. Gillers said. “But that’s not going to be enough. He’s got to satisfy the moral conscience of the jury, which is going to take this very seriously.” Read more!

New rate doesn't go far enough - Hendersonville Times-News

Editorial:

State officials made a step in the right direction when they backed off a 30 percent reduction in rates for a popular mental health care program.

Thursday the state announced it would roll back the cut to about 16 percent for community support services that keep people out of hospitals, on medications and at their jobs. We'll just have to wait and see whether the change is enough to keep an already shaky mental health care system from collapsing.

Originally, Department of Health and Human Services Secretary Carmen Hooker Odom had announced that the state was slashing the reimbursement rate for community support services from $60.96 an hour to $40 an hour. The cut was effective April 1, but later was made effective April 5. Now the rate will be set at $51.28, a reduction of $9.68 an hour.

While that's better than a reduction of almost $21 an hour, the 16 percent cut is still a heavy hit on a mental health care system that is still reeling from an ill-conceived and poorly executed reform that the Legislature mandated in 2001.

"We feel that this is a fair rate that covers the actual cost of the services," Hooker Odom said.

Complaints from providers that the 30 percent reduction would drive them out of business prompted the department to reconsider the cut. Providers such as Appalachian Counseling, which provides community support services to about 250 of its 5,500 clients in Henderson, Transylvania, Polk and Buncombe counties, reacted cautiously to the news.

"It is much better than the $40 rate," said Meg Foley, the chief operating officer for Appalachian Counseling. "I think some providers will have to restructure, but they may be able to continue services, which is a lot better than the alternative."

Hooker Odom said the original reduction was based on an audit of 167 providers who were billing for services provided by high school graduates. She said the rate was meant to pay for services provided by a mix of staff including professionals with master's degrees.

Jane Ferguson, the CEO of Appalachian Counseling, wrote in a guest column Thursday that the agencies that were billing incorrectly represented only about 16 percent of the state's more than 1,000 providers.

"Those providers could have been put on a corrective action plan or probation or both," she wrote, echoing exactly what we said in this space April 13.

Instead, the state chose to punish everybody for the sins of the few. Although this week's new rate may ease the pain some, it still punishes the entire system instead of just the wrong-doers.

As Ferguson said, community support services are the glue that holds the mental health care system together.

"Without it, many other services -- such as mobile crisis response, intensive in-home services, intensive outpatient services for substance abuse and psycho-social rehabilitation -- do not quite work," she said.

Hooker Odom said the new rate reflects the actual cost of providing the services. For the sake of the mental health care system and the people it is supposed to serve, we hope she got it right this time. Read more!

Dallas faced with 'mental health slums' - Dallas Morning News

By LEE HANCOCK / The Dallas Morning News
lhancock@dallasnews.com

Hundreds of boarding homes across Dallas warehouse the elderly, the disabled and the mentally ill in privatized bedlam. They are what the head of the region's mental health system flatly calls "mental health slums."

City officials believe at least 350 unlicensed, unregulated board and care homes house 2,500 people across Dallas – probably more.

"Pretty much, you can open up a boarding home anywhere you want to, stuff as many people in there as you can, keep them at 85 degrees or worse in the summer and 50 degrees in the winter. You can nearly feed them dog food and get away with it," said one veteran caseworker in North Texas' privatized mental health system.

"So many of the residents are clearly psychotic. We have clients who think they're God," the worker said. "Who's going to believe them when they say they're being mistreated or ripped off?"

Dallas' problems aren't unique, but official inaction here has made them worse.

The city and the state haven't closed troubled homes, and state regulators have shown little enthusiasm for pursuing unlicensed ones. County prosecutors have refused to take homes to court for violating state laws. The Social Security Administration has allowed home operators to control residents' disability checks, and that has led to abuse.

Dallas County pays hundreds of thousands of dollars a year to put people in some of these unlicensed facilities. And officials say it's all the county can afford as it tries to help the indigent and homeless.

There is little money for treatment – let alone housing programs – in a state ranked 49th in funding mental health programs, advocates say. So mentally ill people suffer and taxpayers get the tab for constant police and fire calls, jail stints and emergency treatment at Parkland and other hospitals.

Officials, mental health care providers and advocates acknowledge they've come to view the homes as a grim necessity. They share the belief that living in a bad one is better than living under a bridge.

That's akin to child-abuse investigators saying, "Oh, they only beat and starved the child but didn't kill it," said Texas A&M Regents professor Catherine Hawes, a national expert in long-term care regulation.

"It is a failure of government at every level – a failure of the mental health system that is so committed to moving people to 'the least restrictive environment' that it will tolerate them becoming homeless or living in conditions the Humane Society would not accept for a dog," she said.

"It is a failure of the regulatory system to ensure that all places housing vulnerable adults be licensed and meet minimum standards," she said. "It is a monumental failure of the judicial system not to protect these vulnerable adults. And it is a failure of our society that we allow this to occur."

The city formed a boarding home task force last fall. "The problem is a lot bigger than we first imagined. ... Every time we look, it seems to grow," said assistant city manager Charles Daniels, head of the task force.

The task force will brief the City Council on Wednesday on plans for better protecting neighborhoods and boarding home residents. "I know a lot of people do look at them as throwaway people. It is hard to get people to care," Mr. Daniels said. "But these are residents of the city of Dallas. The city has an obligation to protect them."


Troubled residents

The names of Dallas' board and care homes evoke hope and stability and family for people who have lost all of those things. Their residents are ex-cons, substance abusers, the chronically mentally ill, the mentally retarded and the elderly poor. Some are comfortable. Others are faded apartments, dilapidated nursing homes or flophouses indistinguishable from crack houses.

Some operators are good people trying to help the disadvantaged. But others are predators – as many as half of those in business, some officials and advocates say. Some drive luxury cars, while their residents trade $623 monthly Social Security disability checks for Dickensian squalor and a diet of bologna sandwiches, Ramen noodles and food-pantry handouts. Some have run unlicensed homes for years despite court orders and promises to quit.

Michelle Cotten may be a typical resident – 55, bipolar and unable to work or live on her own since her 20s. She said trying a care home seemed attractive when her mental health caseworker offered her a home list. Her mother, Ouida Banks, 92, said the caseworker didn't mention until later that the first home Ms. Cotten chose had long been known as a problem.

Ms. Cotten was in and out of three homes. The first was a place where she once went without heat in the winter and sometimes didn't eat until midnight – that's when someone brought food. No one ever told her or her mother that her second care home was being pursued by the state for operating illegally. Her last care home was a bug-ridden place where she fell asleep each night staring at a gaping hole in the ceiling. An air-conditioning duct had fallen through it, onto her bed's previous occupant, she said. "She had to go to the hospital," she said.

Another resident turned tricks when she wasn't feeling too ill from HIV, she said. The back stairs were so rickety that Ms. Cotten fell walking down them to smoke. She broke her back. "You might think you want my life," she said, "but you'd get tired of it."

"These group homes, they kind of dwell on mentally ill people," added her mother, a retired Dallas County court employee. "They can treat 'em any kind of way."


Nowhere else to turn

The dependence of so many mentally ill residents on boarding homes is rooted in changes in the mental health system. With new medications and deinstitutionalization in the 1970s, Texas began moving the severely mentally ill from state hospitals to outpatient care. Terrell State Hospital has since shrunk from more 2,500 beds to 316. The average stay is now about three weeks.

The region's mental health programs also have undergone a sea change since the '90s, shifting to a managed-care program. Although many advocates and officials say community treatment has improved, state funding hasn't kept up with demand. Funding for the few supportive housing programs for the chronically mentally ill has also been cut.

Caseworkers and advocates say profoundly disturbed, heavily medicated patients are often discharged from mental hospitals when they're barely stable. Many have no homes or families to return to. Caseworkers have to find someplace to put them and turn in desperation to unlicensed board and care homes.

"Everybody gets in a high-pressure situation," said Myrl Humphrey, a vice president at ABC Behavioral Health, a mental health care provider in the North Texas system. "We've got to get them out of there [the state hospital]. That's how they end up dumping them in those places."

The region's largest mental health care provider, Metrocare Services, maintains a boarding-house list with about 90 Dallas homes – only 12 of which are licensed.

Dr. James Baker, Metrocare's executive director, said his staffers aren't supposed to recommend unlicensed homes but know most clients can't afford any that are. So caseworkers hand the boarding-home list to clients and "follow them where they choose."

That's a sidestep around state law. Mental health care providers jeopardize state contracts and funding if they refer clients to illegal, unlicensed homes.

Dr. Baker said decent housing is crucial to treatment, and not spending money on that and other services for the mentally ill means more expensive emergency treatment and jail costs. "You get to the point that you decide you're going to do the best you can with what you've been given," he said. "And what we're given isn't adequate."

Mentally ill offenders in the justice system are also steered to unlicensed homes. "It's epidemic level," said Margaret Johnson, a court-appointed lawyer for special-needs offenders. She cited a recent case as typical: A bipolar client was paroled to a dingy, two-bedroom boarding home with eight other residents. He fled and ended up back in jail after being hit with a pipe for complaining about other residents smoking crack.

Regional mental health chief Ed Miles said mental health, justice and social agencies have pointed fingers and tried to shift costs instead of tackling the issue together. "You have agencies arguing about who is responsible and who can back it up with funding," he said. "There's been, really, a dramatic lack of coordination."


Disability checks

Making things worse is boarding-home residents' poverty. Many survive on $623 monthly Social Security disability checks. Even that pittance makes them targets for abuse.

"Boarding homes will go to homeless shelters and round people up," said Erroll Willis, a Veterans Affairs staffer who works with veterans who can't manage their own finances. "The boarding homes have people handing out cards, saying, 'If you need assistance getting your [disability check], we'll do it.' "

Social Security allows disability recipients who can't manage finances to have monthly checks sent to a person they designate as "representative payee." Boarding home operators often demand to be named residents' payee, and mental health advocates say that's not always unreasonable. Many residents will blow any money they get on drugs and alcohol.

Unlicensed Dallas homes that take the poorest, most troubled residents charge $500 to $600 a month, promising allowances from what's left from disability checks. In contrast, a recent survey found the average monthly charge for licensed assisted living in Dallas was about $2,500.

Some owners profit by crowding in disability recipients and feeding them poorly, advocates and officials say.

Ms. Banks, the retired Dallas County worker, said that happened to her daughter, Michelle Cotten.

One unlicensed Dallas home that Ms. Cotten chose from her mental-health provider's list hired teenagers and eventually quit buying food or utilities. They said the operator abandoned her daughter and others, and Ms. Banks called police. In a March 2005 report, Dallas police described finding Ms. Cotten and two other confused residents in a home emptied of furniture.

Ms. Banks said another home operator recruited her daughter and, as soon as she moved in, made her file papers replacing Ms. Banks as her daughter's representative payee. Ms. Banks said she got her daughter out, but spent months getting the boarding-home owner removed as payee. She said she never recovered several of her daughter's disability checks.

"I do try to screen places," Ms. Banks said. "There's a lot of things the state or somebody really needs to know about."

States are supposed to report substandard homes to the Social Security Administration, so they can be screened when disability recipients request payees. States also have had to certify annually since 1976 that no federal disability recipients are in substandard board and care homes. Critics have long said those requirements lack teeth.

Despite frequent complaints from disability recipients, Dallas officials and advocates say, they seldom hear of payees punished for mishandling money. Police also get reports but say they can do little.

"We get complaints all the time from the residents who are out panhandling. They say they're hungry. They talk about not being fed enough – that's constant," said Southwest patrol division Lt. Kimberly Stratman. "People in these homes are potential victims – not criminals."

Social Security's Dallas regional office referred questions to media representatives who did not return calls over more than a month.


Home inspections falling

Regulation of board and care homes in Dallas falls through city and state cracks. Texas law requires facilities to get assisted-living licenses if they help clients with bathing and eating or if they dispense medication and house four or more residents unrelated to the owner.

While the number of nursing homes in Texas – and the number of people in them – has fallen over the last nine years, the number of licensed assisted-living facilities has soared. For every state licensed home, regulators recently estimated, there may be two unlicensed ones.

As the industry has grown, Texas regulatory efforts have shrunk. State reports indicate that inspections of licensed assisted-living facilities and unlicensed homes have dropped 14 percent between fiscal 2002 and fiscal 2006. The state has rarely used its regulatory powers to close licensed homes or put in outside supervision. And policing of unlicensed homes has dipped since regulation moved in 2004 to the Department of Aging and Disability Services.

In Dallas County, DADS' unlicensed home inspections fell 30 percent between fiscal 2002 and 2006. In the fiscal year ending last September, DADS surveyors made 42 visits to 33 unlicensed assisted-living homes. They found in 18 of those visits that homes violated state law.

The Dallas County district attorney's office also has declined to take DADS case referrals for at least eight years, a district attorney's office spokesman said. In contrast, Harris County's district attorney regularly gets court orders fining or closing bad homes. Houston's DADS officials are also more likely to fine homes and go after unlicensed ones than their Dallas counterparts.

Cecilia Fedorov, a DADS spokeswoman, cautioned against comparisons between cities because regulatory decisions are made "case by case." She added that DADS inspectors have no legal authority to go looking for unlicensed homes unless they get complaints.

When investigators do go to unlicensed care homes, records indicate, they focus on whether the operators are doling out medications. When operators and staff say they don't, and there's no blatant evidence otherwise, cases are closed. If investigators do find violations, records indicate the agency often opts to send a warning letter.

When inspectors identify violators, licensed or unlicensed, the agency must consider "our jurisdiction, what we have the ability to do, and the circumstances surrounding each individual case," Ms. Fedorov said.

"While our role is enforcement, we must weigh the overall environment – to include a lack of affordable housing, limited resources for MHMR [mental health and mental retardation programs], the availability of appropriate licensed placements," she said.

The agency will close a facility only if it can find licensed homes that will accept the residents involved and charge what they can afford. Otherwise, she said, "we would be effectively putting those residents on the street or placing them in another facility which could be unlicensed."

A recent internal memo prepared by DADS on the issue of expanding state regulation of unlicensed homes was more blunt. Though DADS does have authority to close a home without court action if it is endangering residents, the December 2006 memo stated, it would then "be responsible for relocating the residents."

Dr. Hawes of Texas A&M said that, unlike Texas, most states pay supplements for Social Security disability recipients in licensed homes, "so vulnerable, disabled and poor residents will not face this choice of homelessness or housing in an unlicensed facility." Only licensed homes get the supplements, she said, giving homes incentive to get licensed.

She noted that a study she led in the mid-'90s for the federal government found Texas was among five states "with the weakest regulatory systems and the highest number of unlicensed homes." She said she still hears DADS officials voice concerns about the current regulatory system.


Criticism of DADS

People who keep an eye on care homes say DADS doesn't seem interested in getting a grip on unlicensed homes. Licensed industry representatives say that they regularly raise concerns about the homes to agency officials, only to be told they aren't a problem.

State Rep. Jose Menendez, D-San Antonio, said DADS officials have fought his bill requiring licensing and inspection of every facility providing meals, shopping, transportation or other services to three or more unrelated patients. Violators could face criminal fines of $1,000 for a first offense and $500 for additional ones, plus civil penalties. And the fines would go to regulatory efforts.

The state agency initially said the added regulation would cost $42 million in its first two years – a potential bill-killer for fiscal conservatives. Mr. Menendez thought DADS officials agreed that tinkering would drop the price. But DADS then upped its cost estimate to $50 million.

The agency's representatives have warned that DADS might have to regulate convents, motels and fraternity houses. Last week, DADS and Texas Adult Protective Services officials released an 18-point critique, warning that the bill could hurt group homes for the mentally retarded and lead to more elder abuse, neglect and exploitation. Among the downsides noted by the agencies: The bill would make local and state agencies stop referring people to unlicensed homes.

Dr. Hawes, the Texas A&M professor, said most states require licensing for any home housing two or more unrelated individuals – and don't have a problem with over-regulating other businesses.

Mr. Menendez said he is baffled by the agency's full-court press. "My level of frustration is through the roof," he said. "What's the potential cost to the state if we don't do something? What's the potential harm for people in these homes and the people living next to them if we don't try to get this under control?"

In El Paso, a probate judge saw the results of a lack of regulation. The judge, Max Higgs, said he was disturbed by mental-health agency referrals of vulnerable people to filthy, unlicensed homes that fed them rotten food and pocketed their Social Security. He appointed a lawyer to investigate. But the attorney general's office went to an appeals court, argued that the judge lacked jurisdiction and got the hearings halted.

Now retired, Mr. Higgs remains incredulous that the state's priority seems to be "stopping people from knowing how bad the situation really is."

In Dallas, officials with the Veterans Affairs have regularly warned DADS about problem homes and nothing happens, said Gloria Johnson, who oversees the VA's placement of veterans in licensed assisted-living homes. VA representatives visit the 43 North Texas homes in their program at least monthly to ensure all meet VA care requirements.

She recalled one state-licensed operator showing her a filthy Oak Cliff home with inadequate food and linens and a weedy yard last August. The operator was irate when rejected by the VA. Others applying to get VA contacts have admitted feeding residents only oatmeal, bologna and beans. One had a building so shoddy, she said, that VA staffers couldn't believe it passed state inspection.

"There are no consequences for bad care," said Mr. Willis, the VA field examiner who has visited homes all over Dallas since 2000. He said he has reported licensed homes for lack of food or heat and allowing residents to go so long without bathing that anyone walking in their facilities could smell them. All he can do, he said, is encourage veterans to move and refuse to pay homes that don't meet VA standards.

The severity of Dallas' boarding home problems appalled Dr. Miles, director of the North Texas Behavioral Health Authority. Last fall, he made an emotional presentation to his board. He also called DADS. "They read their policy to me," he said. "What it amounts to is there's nobody supervising these places."

He said he saw care-home issues as head of Florida's mental health system. But Florida counties and cities have more regulatory powers, he said. "At least you could call and complain and the problem would be looked at."

Dr. Miles said he'd like Dallas to do more but knows the city is "overwhelmed. It's crazy to me to expect the city to be able to regulate these places alone."


Ordinances not enforced

Dallas does have boarding home ordinances that the city hasn't enforced. The homes are required to get inspections and certificates of occupancy. But some don't bother. When caught, some operators have held off inspectors by claiming to be exempt from city oversight, records show.

City statutes confuse matters by terming the homes everything from group homes to boarding houses, rehab centers and residential hotels. The names determine how the city can restrict them. A U.S. Supreme Court ruling limits regulation of homes with eight or fewer disabled residents; restrictions on those homes must cover all property owners.

Records show homes sometimes go years without repairing violations. Mr. Daniels, the assistant city manager, said inaction has allowed the city's boarding home problem to spread. "It's like fire ants," he said.

The City Council passed a boarding home ordinance in 1998, prompted by state legislation on assisted living. The ordinance requires businesses providing personal care, room and board to four or more people to get state licenses and meet size and safety standards. Violators can face city fines and referrals to state regulators. If asked by state regulators, city attorneys can seek court injunctions and closure orders.

But none of that happened. "There's no valid reason why," said Mr. Daniels.

Complaints about board and care homes in Oak Cliff and East Dallas led to a city task force in 2003. The city's crisis management team gathered home operators, city staff and mental health experts in hopes of getting homes to meet standards voluntarily.

The City Council passed an ordinance requiring boarding homes to register annually and undergo regular inspections, along with multifamily properties such as apartments. Code enforcement began apartment registration and inspections but never got to boarding homes. Soon after, the task force folded.

That panel's chair, city crisis intervention manager Dave Hogan, said other priorities intervened and no one could answer a lingering conundrum: Would enforcement just add to Dallas' homeless problem?

So his staff continued social-work triage, moving residents when they discover horrific conditions and cajoling owners of better places to take people, Mr. Hogan said. "We sometimes find ourselves negotiating and looking the other way."


Another task force

Adam McGough, an assistant city attorney, began exploring the issue in early 2006, prompted by citizen complaints. He found boarding homes with sewage leaks, eight or 10 beds to a room, and beds in closets.

His findings, other complaints and mental-health community concerns prompted City Manager Mary Suhm to start a new task force last fall. The city named a boarding home code inspector in February, and county representatives have joined task force meetings.

The task force will brief the council next week about a new boarding house team including police, code and fire inspectors and social workers. They'll also discuss funding and housing solutions.

Mr. McGough notes that some boarding homes have already done repairs, moved or closed. He and others worry, though, about unintended consequences. After one flophouse hotel agreed late last year to quit housing permanent tenants, he notes, a mentally ill resident told to move set fire to her room.

Bottom line, Mr. Daniels said: The city needs help. "Is there going to be some sort of safety net, or are we going to be the ones having to provide care?" he said. "It's important that we get some additional assistance from the state and the federal government."

Mental health officials say they've seen too many past efforts to be too hopeful. "We're fearful of doing anything, the problem is so huge," said Melodie Shatzer, director of ABC Behavioral Health. "It's going to take money, and it's going to take the collective will of the community."

State commitment is a must, she said. "Until we make a decision that all of these facilities have got to be licensed, monitored regularly and adequately funded, we're going to continue to have this problem."

Read more!

Veterans combat anxiety - Wilmington Star-News

By Ken Little
ken.little@starnewsonline.com

Military service many years ago wounded the minds of Richard A. Wilson and Robert Bridges, even though the men fought very different types of battles.

Both remain in conflict against an internal enemy.

For Wilson and Bridges, the U.S. Department of Veterans Affairs Health Administration system is also sometimes the adversary. Both men suffer from post-traumatic stress disorder, a condition diagnosed in thousands of veterans trying to re-enter civilian life, including some returning from combat in Iraq and Afghanistan.

The VA says it is trying to accommodate the needs of all area vets and plans to move into a larger regional clinic in Wilmington by 2010, but for those like Wilson and Bridges who live in outlying areas, a trip to Wilmington or Fayetteville for specialized services can be a major undertaking.

In recent interviews, Wilson and Bridges discussed the life paths they took to get where they are today.

Richard A. Wilson

Wilson, now 68, lives in Bolton in Columbus County, his hometown. As a young man, he dreamed of a joining the military and did so in 1955, at age 17.

As a young black man in the recently integrated Army, Wilson said he encountered many overt acts of racism while training and serving on bases in South Carolina and Texas, and through interactions with civilians.

"I was a young country boy, being a long way from home. I was afraid when these things happened to me, and today those horrible acts still affect me. I have mental stress, headaches, diabetes, congestive heart failure and poor circulation. I didn't know anything about PTSD or anything else," Wilson wrote in an October 2006 letter to the VA.

Wilson was stationed in Hawaii with the 25th Infantry Division from 1956 to 1958. An event one night in June 1957 made a permanent impact.

The night began when Wilson and three friends went into Hilo to get some dinner. They began drinking. As they returned to base later on, the soldiers crossed a railroad bridge. One of them announced he was going for a swim and dived into the river below in full uniform. He quickly tired and went under. Wilson and the other two men did what they could to save their friend, but he drowned.

"Over the years, it traumatized me," Wilson said. "I knew something was wrong with me, but I didn't know where to seek help."

Wilson said he was put on "Kitchen Police" duty the day after his friend's death. He believes his Army days were numbered after the drowning incident. Wilson received an honorable discharge in November 1958, despite efforts to re-enlist. He served three more years in the New York National Guard.

"Over there, I tried to soldier as good as I could. I made rank and I had a lot of different jobs. My plan was to make a career out of the military," Wilson said.

After Army service, Wilson moved to New York City. He began drinking heavily. Troubled years followed. In the late 1970s, he sobered up for good.

"I wasn't able to keep a good job for 10 or 15 years. I couldn't cope with it," he said. "When I got sober, I qualified to manage some of the bigger supermarkets in the state of New York."

While successful in his new career, Wilson remained unsettled by his service experiences. He moved back to Columbus County about 10 years ago, still haunted by his past.

Deadly encounter

On the night of Nov. 28, 2004, Wilson was working as the assistant manager of the Hills Supermarket in Lake Waccamaw. It was closing time, and he and two teenage employees were getting ready to go home.

They were interrupted by an armed man who burst into the store. Pointing a 9 mm handgun at Wilson, the robber demanded that he accompany him into the office, ordering a young man sweeping the floor to join them.

A 17-year-old cash register clerk stood nearby, paralyzed with fear. When the robber, later identified as Kinny Bethea Jr., began to push the clerk in the direction of the office, Bethea became momentarily distracted. Wilson drew his own handgun and when Bethea turned a corner to enter the office, he was shot dead.

Wilson told police he believed he and his young co-workers were about to be killed. Authorities agreed the shooting was a clear case of self-defense.

Wilson worked about one more year. But he said the shooting vividly brought back many of the conflicts that plagued him since the Army.

"It blew it open. It opened it back up," he said of his post-traumatic stress disorder.

Wilson actively sought VA treatment and currently attends regular mental health counseling sessions at the Wilmington clinic. Persistent attempts to receive disability compensation have been denied. His most recent request to the VA to reconsider its findings about his PTSD was formally answered in January. The letter refers to an evaluation done at the Fayetteville VA Medical Center.

"While this additional treatment report reveals a diagnosis of PTSD was found, there is no verified in-service stressor linked to a diagnosis," it states. "The preponderance of the medical evidence links the diagnosis of PTSD to the involvement in the robbery in which you shot and killed an individual. Because of this, the previous denial of service connection is upheld."

VA officials declined to comment about Wilson's case on grounds of patient confidentiality.

Wilson, who has suffered two heart attacks and has other health conditions, receives medical treatment and assistance with prescription medicine from the VA. He and his wife Elizabeth make regular trips to Wilmington from Bolton, 30 miles away.

"They should have looked more into my case than what they did. I've had a problem for over 50 years," Wilson said. "They didn't deny I had post-traumatic stress. They are saying it didn't come from the Army. I've been through hell, and I've got all the information to prove it."

Robert Bridges

Robert Bridges, of Surf City, served in the Army from 1967 to 1970. He spent 19 months in Vietnam with an airborne infantry unit.

Bridges, now 59, said he was troubled by his Vietnam experiences from the time he returned home. He sought assistance from the VA, initially without success.

"When I got out of the service, I couldn't get any help there," Bridges said. "I just tried to work and get on the best I could."

Bridges said he was not immediately diagnosed with PTSD. He started drinking regularly, a practice that has persisted over the years.

"I drink to forget. I drink to numb myself. I drink because of my nerves," he said. "When a thunderstorm hits, I dive under the bed because I think it's bombs."

Bridges said he is on 100 percent disability but unable to get VA help for his drinking so he can be treated for his PTSD condition. He would like inpatient treatment but has had trouble getting placed because of lengthy waiting lists for detox center beds, Bridges said.

Bridges spent six days earlier this month in the Facility Based Crisis Center in New Hanover County, formerly known as the Tri-County Center, but was unable to find immediate follow-up placement in a VA hospital. Bridges has tentative arrangements to check into a VA facility in Salisbury, more than four hours away from his home, in mid-May. The treatment program there lasts 35 days, he said.

Frustration still remains for Bridges when he recalls the many times he sought help.

"They tried to send me outside the VA health system. What am I supposed to do?" he asked. "I'm tired of nightmares and I'm tired of flashbacks. You got to be clean and sober for six months, and I've been having a problem with that."

Bridges, who has a progressive eye disease, said it can be difficult making it from his Pender County home to the Wilmington VA clinic or to other VA locations for more specialized treatment. He is sometimes assisted by the Disabled American Veterans organization. He doesn't know how he will get to Salisbury.

"If they send you to Wilmington, you can't get done what needs to be done. Fayetteville is a 2 1/2-hour drive at your own expense," Bridges said. "I think they're doing the best they can. I think the problem is with the cutbacks. They have made everything outpatient. It's a hardship for a lot of veterans to get to where they have to go to get help."

Bridges sees a psychiatrist at the Wilmington VA clinic and said others there have tried to be helpful, but he added the services he really needs are not available locally.

"I fought for my country and my country let me down," Bridges said.

VA response

As with Wilson, VA officials would not discuss Bridges' case.

"Any veteran who thinks they have a need for mental health services, we're very confident we can be of help to veterans who are in need of that kind of support," said David Raney, communications officer for the VA Mid-Atlantic Health Care Network that includes North Carolina.

While the VA puts an emphasis on veterans returning from Iraq and other combat postings, "we certainly have not forgotten older veterans," he said. As of last year, an estimated 46,500 veterans lived in New Hanover, Brunswick and Pender counties.

The VA is "extremely proactive" in treating PTSD and substance abuse issues, Raney said.

Expansion plans are in place for the Wilmington clinic, even if it remains the responsibility of patients to get there.

"I get asked that a lot and I have to say we don't tell veterans where to live," Raney said. "Essentially, what we're trying to do with these new community-based outpatient clinics is we're trying to put these clinics typically in the center of where the veterans live. Typically, the idea is that they drive no more than an hour to get the services."

The VA plans to increase its ability to serve more veterans in the Wilmington area "with the construction of a larger clinic with expanded outpatient services," Raney said. The agency is currently looking for land. The new Wilmington clinic is scheduled to open by 2010.

In addition to primary and general mental health care, other services to be offered will include audiology and speech pathology, dental care, an eye clinic, prosthetics, radiology, rehabilitation medicine, a pharmacy and ambulatory surgery.

No outpatient clinic in Brunswick County is planned at least through 2012, Raney said.

Ken Little: 343-2389

ken.little@starnewsonline.com
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Mental illness necessitates focus, action -The Greenville Daily Reflector

Editorial:

America knows all too well the violent potential of some who suffer from mental illness. Less known are those who grapple with the disease in silence, without the medical help they desperately need to be participating and productive members of society.

Treating those with mental illness is not an easy or inexpensive task, and it requires a comprehensive effort utilizing many approaches. And it is vital that this community, state and nation take seriously that pressing need and act with due diligence to see that treatment options are available to all who need them.

Investigators report that 23-year-old student who shot 57 people at Virginia Tech on April 16 exhibited signs of mental illness long before his rampage. Seung-Hui Cho killed 32 students and professors that morning, two years after his interaction with two women led campus officials to have him undergo a psychological evaluation.

This community knows how difficult dealing with mental illness can be, as most recall the 2006 shooting death of a Greenville man who was shot by police following a dangerous high-speed chase. Officers were attempting to execute an involuntary commitment order to Kerry Turner when a stand-off led to the chase and, later, his death.

More often, however, the signs of mental illness are less noticeable and more unspectacular. From personality disorders to depression, signs of instability or imbalance may not be readily apparent to the person suffering or to those around them. It may take careful observation over time, and picking up on signs in order to notice someone in need of assistance. Substance abuse, as well, can be concealed, but requires attention and care.

Sadly, not all who need such help receive it. The Virginia Tech shooter was diagnosed as a danger to himself, but was treated as an outpatient and not required to be monitored. The results of that decision contributed to last week's carnage.

North Carolina launched a significant overhaul of its mental health services more than five years ago, seeking to reduce the number of agencies in the state and to make them more effective. The changes should reduce the overhead cost of administration and streamline bureaucracy. But it remains to be seen if services will suffer in counties that have worked to build strong mental health programs, like Pitt County, when the agency is asked to serve a greater population.

In the aftermath of the Virginia Tech murders, officials and psychiatric experts fear further ostracizing those with mental illness. Instead, Americans should dedicate their effort to making treatment more available and affordable. It should do better to educate the public about mental illness and help Americans recognize symptoms and warning signs, the best way to eliminate the sigma surrounding these disorders and draw more people who need it into treatment.

Last week's events were a terrible tragedy. And it would be shortsighted to avoid confronting this medical issue in the most productive manner in their aftermath. Read more!

Mental-health reform plan needs revisions -Rockford (IL) Register-Star

By Richard Kunnert
SPECIAL TO THE REGISTER STAR

Over the next several months the state Legislature will respond to proposed changes to the public mental-health system in Illinois by the administration

The core of Gov. Rod Blagojevich’s plan has nothing to do with care; it has to shift the cost of public mental-health care in the state to the federal government. Instead of using a preponderance of Illinois general revenue funds to buy service, the goal is to have Medicaid be the primary funder of service.

Some small amount of general revenue funds would be used to “fill in” where Medicaid services are lacking. This effort would shift from a grant-in-aid system to a fee-for-service system.

There are three fundamental service changes resulting from the governor’s plan to have Medicaid be the primary funder of mental health services in Illinois.

1) Medicaid is a fee-for-service format, 2) the service array is limited to what has been negotiated between state of Illinois and the U.S. Department of Health and Human Services and 3) only those eligible for Medicaid services can be served. Non-eligible people will have very limited access to service.

The consequence for Illinois residents is that fewer people have access to service, the range of services is not sufficiently broad to move people from treatment to recovery, and service delivery will be essentially office based and thus leaving many unserved.

In 1980, the National Institute of Mental Health published the Community Support Program. CSP was reinforced in 1999 when the surgeon general, Dr. David Satcher, released the first Surgeon General’s Report on Mental Illness. The CSP core services received additional research support as to their usefulness in assisting people suffering from mental illness. CSP has been an accepted model of care in Illinois since the ’80s. Now our governor chooses to pull away from a legitimate care model and introduce service instability into communities across the state.

A fee-for-service pay schedule, with few exceptions, only pays when the therapist is talking to a client. Many young people experiencing mental illness for the first time are unlikely to show up in an office. Going out to them has been found to be helpful and clinically productive.

Under Medicaid, time spent traveling out and waiting for people would be nonreimbursable, therefore, it won’t happen. (Grant money using Illinois general revenue funds had been used for case management monies.) The consequence will be more people wandering the city in a confused state. Psychosocial rehabilitation drop-in centers will receive a 90 percent reduction in funds.

Vocational programs are to be transitioned to a supported employment model which is not Medicaid compatible. Drop-in centers and vocational programs are not part of the Medicaid waiver.

The issue is not debating fee-for-service funding; the debate is the effect on the care system when a single funding methodology is used that does nothing to enhance care and is inadequate to support people.

There is another unintended consequence connected to Medicaid only funding. In a grant system, advanced payment to cover agency costs is an option while Medicaid payment is only retrospective. Also, the payment cycle can be anywhere from 60 to 90 days after the service provided.

A great many mental-health service agencies have cash reserves of 30 days or less. Lending agencies are not going to agree to constant indebtedness, therefore numerous bankruptcies are not beyond question. Smaller agencies, particularly those operating in rural communities will experience such a payment-cycle life threatening. Some local agencies could be effected.

Compromise could reduce the ill affects of the governor’s proposal. We ask you to:

Advocate for a continuance of a care model that has the capacity to take people from diagnosis to recovery.

Advocate for a funding system that is capable of producing an enhanced care system for residents.

Advocate for a timely payment mechanism that allows service providers to continue their role in the care system.

Please let the governor and our local legislators know your preferences, particularly Rep. Chuck Jefferson since he is member of the governor’s party.

Richard Kunnert is president of the Mental Health Association of the Rock River Valley.
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Virginia Tech stigma may prevent people from seeking help - Missoula (MT) Missoulian

By STEVE WOODRUFF of the Missoulian

Cliff was the first mentally ill person I ever met. I was a kid working in a produce market where Cliff was a sometimes laborer. Unkempt and unbelievably uncouth, he struck the teenage me as being hilariously outrageous. He was given to profane outbursts about enemies and the government, sentiments he shared freely with me and anyone else who didn't immediately retreat as he noisily approached. He bristled with knives and numchuks and ninja stars, which he'd brandish at the least provocation. I got to know him enough to talk with him a bit. Even as a kid, I could see he was more tragic than threatening.

My first roommate in college, a guy named Bob, was creepy. An upperclassman double-majoring in computer science and electrical engineering, he was brilliant but anti-social. He had a dark personality and seemed perpetually bitter about way too many things. He was especially unlucky in love, and rejection fed a near-pathological anger directed at women. He often mumbled about “getting even” once he was out of college, had a great job and was rolling in money - as if that were going to do the trick. I shared a room with him one very long semester, long enough to conclude he was full of bluster, lonely and rejected, without doubt doomed to unhappiness, but a menace to himself far more than to society.

I've encountered scores of people just like Cliff and Bob in the decades since. Well, not just like them but similar in that they're obviously sharing their heads with demons of one sort or another. A newspaper office, where I've plied my trade, can be a powerful magnet attracting the seriously mentally ill. Maybe that's not so surprising: Many people turn to the newspaper to air their grievances, and some of the unbalanced folks I've dealt with over the years have had an awful lot of grievances, real and imagined. It's a sad fact that a newspaper editor sometimes is the only person to whom a tortured soul can turn.

I've been thinking about all those folks in the wake of the April 16 massacre at Virginia Tech. I worry that mentally ill people everywhere may wind up suffering collateral damage from that awful bloodshed, becoming the focus of even greater suspicion and discrimination than they already are.

As the whole world now knows, 23-year-old Seung-Hui Cho was an angry loner known as a mental case by classmates and faculty at Virginia Tech well before the shooting rampage in which he killed 32 and wounded dozens before killing himself. We in the news business have an almost Pavlovian response to mass murder, which is to call into question America's gun laws. In this case, however, most of the attention focuses not on guns but on Cho's mental problems and the failures of the system that allowed such a psychopath to run loose. That's looking in the right direction, but I worry it will lead to the wrong answers.

Like crossing the street when you see someone who doesn't look or act “normal” on the sidewalk ahead. Or reporting the office introvert to human resources. Or branding depressives or neurotics or compulsives as psychos. Or calling the police to report abnormal people. Or, even more than ever, running not walking away from anyone and everyone who might now be imagined as the next mass murderer.

“We should be asking how weird and anti-social someone has to be before he's identified as a danger to himself and others,” Patty Fisher of the San Jose Mercury News wrote in a column published in the Missoulian last week.

Really? Should we really treat weird and anti-social people like criminals in waiting? Should we blur the lines between weird and dangerous, anti-social and psychotic?

Today I think about my first roommate, a troubled nerd born just a couple of decades before geeks became cool. Whatever his troubles, they could only have been made worse by the constant social rejection he suffered, including my own hasty abandonment of him. He never committed mayhem at college, but I wouldn't be surprised to hear he sometimes fantasized about it. I don't know what became of him. If he's found any happiness in life, it couldn't have been without obtaining mental health treatment.

Every college, almost every office and certainly every town has one or more people just like Bob. What's in store for them now? Will people engage them, befriend them, help them? Or will they avoid them, further isolate them and report them? What will happen to all the weird and antisocial people if we routinely identify them as dangers to themselves and others?

I think, too, about Cliff. If I were a little older, I might never have encountered someone like him in my younger years. That's because we used to “take care” of seriously mentally ill people by placing them in institutions, sometimes for treatment - which could include crude electroshock sessions and lobotomies - but more often just for warehousing. We put them out of sight and out of mind. That began changing in the 1950s and 1960s amid revelations about deplorable conditions in state hospitals. Ken Kesey's 1962 novel “One Flew Over the Cuckoo's Nest” had social as well as literary impact. The 1960s, '70s and '80s were all about “deinstitutionalizing” the mentally ill. Americans suddenly understood that people who hadn't committed any crime didn't belong behind bars.

But what obviously was less well understood is that the “illness” part of mental illness requires effective treatment, inside a hospital or out. Moving from institutionalized care to community-based care was the right thing to do, but doing so made provision of adequate treatment more challenging, not less so. Most communities, including our own, simply don't do enough to care for people suffering mental illnesses.

I suspect my old acquaintance Cliff had been spilled out of some hospital, set free to cope as best he could in an overwhelming world. He wasn't alone. From the mid-1950s to the mid-1990s, the number of people hospitalized for mental illness in America went from more than a half-million to a little more than 55,000, even as the overall population grew by nearly 100 million. Various studies show that close to half of the people with serious mental illness don't even seek treatment, much less get effective treatment.

“Untreated mental illness is America's No. 1 public health crisis, but it is a hidden crisis,” the National Alliance on Mental Illness says on its information-packed Web site. “Treatment works - we know what to do, but we simply have not invested adequately in this treatment.”

Perhaps Cho's shooting spree at Virginia Tech will raise mental health services on the nation's list of priorities. That would be good.

But I still worry about a backlash directed at the mentally ill. “Mental illness” is a broad and imprecise term applicable to about one of every seven people in any given year. The incidence of serious mental disorders is much smaller - affecting maybe one in 17 people. I worry that the stigma of mental illness is magnified by incidents like the Virginia Tech shooting and that the stigma will further isolate the mentally ill and perhaps even deter ill but harmless people from seeking help.

Easily lost in all the discussion of Cho and untreated mental illness these past couple of weeks is the fact that the vast majority of mentally ill people - even among the seriously ill - are not violent. Some are, of course, and the Montana Legislature has been arguing over how much it's worth to treat mentally ill criminals and how best to do it.

In general, though, “The overall contribution of mental disorders to the total level of violence in society is exceptionally small,” according to the U.S. Surgeon General's Report on Mental Health, issued in 1999.

Social-science research cited by the surgeon general shows the likelihood of violence caused by the mentally ill rises when people with serious disorders don't get or don't take prescribed medication. The greatest risk involves people with serious mental disorders who also have substance-abuse problems. The surgeon general's report persuasively argues for more and better treatment and better public understanding of mental illness to reduce the stigma that makes so many people avoid seeking help.

For all the good that does: A lot more people watch CNN and read newspapers than comb through 500-page tomes issued by the surgeon general. I worry the public may make Seung-Hui Cho the new poster child of mental illness. If we let that happen, the list of casualties will grow several orders of magnitude beyond the losses suffered April 16 in Blacksburg, Va.

Steve Woodruff is the Missoulian's opinion page editor Read more!

Don't ignore depression - Charlotte Observer

PRIMETIME | PAM IRISH

Spring is a time many people look forward to. It may be the flower and tree blossoms and the opportunity to enjoy sunny, warm days.

While spring means renewal and new life to most of us, others are experiencing depression.

Dawn Lillard has been a mental health professional in Union County for 25 years. Currently she is with the Geriatric/Adult Mental Health Specialty Team at Piedmont Behavioral Healthcare.

In this first part of a two-part interview, Lillard answers questions about depression and suicide in older adults.

Q. What are some statistics about suicide and older adults?

The age group with the highest suicide rate is white males 80 or older. Women attempt suicide more frequently than men. Men complete their attempt more often than women as they generally choose a more lethal means. Out of 100,000 people, 59 suicides are completed by the group 85 or older and for the general population there are 10.6 suicides per 100,000 people. In older adults, suicide is often a well-thought-out plan.

Q. What impact does depression have on the older adult population?

Of the 35 million adults 65 and older, it is estimated that 7 million are depressed but only 10 percent are being treated.

Q. Why is the percentage being treated so small?

Older adults do not often consider depression an illness. They may believe they are supposed to feel like they do. Even doctors sometimes believe that depression is normal for older adults. It is not normal and is not a part of the aging process. Many older adults may believe, "If I just pull up my boot straps, everything will be OK." Or they may feel a stigma about having a mental health illness and in seeking treatment.

Q. If I suspect an older loved one may be depressed, how may I best approach the subject?

Never ask an older adult "Are you depressed?"

The likely response will be "no." Often this is because there is a belief that depression is a sign of weakness, not an illness.

Symptoms to consider in older adults include a decrease in appetite and weight loss. They are also more likely to report somatic complaints such as back pain. They may complain about feeling "slowed down" and express worries about finances and health issues frequently. Rather than expressing feelings of sadness or hopelessness, the person is more likely to be irritable.

This may be misinterpreted as anger. Depression may become apparent after a major life change such as being widowed, divorced, job loss, substance abuse or failing health. Chronic illness symptoms and certain medications' side effects may mimic symptoms of depression.

The second part of this interview will look at seeking treatment and options available for depressed older adults. For more, call the Piedmont Behavioral Healthcare Access Call Center at 800-939-5911.

Primetime | Pam Irish Read more!

Glazier trying to close gun loophole - Fayetteville Observer

State Rep. Rick Glazier wants to close a loophole that could allow thousands of mentally ill North Carolina residents to buy handguns illegally.

The problem is this: It’s illegal under state and federal law for many mentally ill people to buy guns. But it’s also illegal under privacy laws for the state government to forward names of the mentally ill to a federal database, which law enforcement and gun dealers consult to confirm whether someone is allowed to have a gun.

It has become a significant issue following this month’s massacre at Virginia Tech University, where student Seung-Hui Cho fatally shot 32 people before killing himself.

Cho was able to buy two handguns for the attack despite a 2005 court declaration that he was a danger to himself. The ruling didn’t show up on the background check.

North Carolina judges issue similar mental health orders, but the court system can’t put that information into the federal database.

“We have no authority or directive to report this information to anybody,” said Dick Ellis, spokesman for the N.C. Administrative Office of the Courts, which oversees courthouse operations. “Unless we’re told directly to do so, we don’t give our records over to anybody.”

Glazier said Friday that he is researching the loophole and hopes to write a law to solve it.

If the law were changed, the court information would be stored in the National Instant Criminal Background Check System, which is run by the FBI. It relies on states to forward information such as court orders dealing with mental health.

North Carolina’s mental health filings to the FBI database now fall primarily in two categories, said John Aldridge, special deputy attorney general and leading authority on state firearms law. One is an open court ruling in a criminal case, such as being found not guilty by reason of insanity. The other is a record of being turned down by a sheriff for a pistol-purchase permit or concealed-carry permit.

North Carolina sheriffs are responsible for background checks on applicants for both permits. They can check commitment records on concealed carry permits because applicants waive privacy rights. While they aren’t allowed to check those records for pistol purchases, they might learn of such orders by other means and deny permits.

Sheriffs also decide whether to forward permit denials to the national database. North Carolina sheriffs have forwarded 319 mental-health-related denials since the database began in 1998, Aldridge told The News & Observer of Raleigh.

North Carolina is one of 22 states that report mental health information to the database, though it keeps involuntary commitments confidential.

Virginia has the most mental health-related entries in the database: about 80,000.

Ellis said North Carolina court clerks won’t provide the records unless the legislature grants them the authority to do so.

Virginia Tech
Glazier, a Fayetteville Democrat and former criminal defense lawyer, said he started researching the issue shortly after the Virginia Tech shootings.

“It’s pretty clear we’ve got reporting capacity issues,” Glazier said.

The issue may face a fight if it moves through the legislature.

F. Paul Valone, president of the gun rights organization Grass Roots North Carolina, said his group opposes removing confidentiality from involuntary commitment orders.

“The intention behind that legislation was to foment additional gun control in North Carolina, and we won’t tolerate that,” Valone said.

Mark Botts, an expert on mental health records and confidentiality at the University of North Carolina at Chapel Hill School of Government, said legislators have written exemptions into the law.

Sealed records relating to mental health treatment are also legally shared for child or elder-abuse investigations. They can be unsealed if considered in the public interest.

Botts said a similar exemption should be made for the gun database after the Virginia Tech shootings.

“I don’t think it has to be that polarizing,” he said.

Besides adjusting the reporting requirements, Glazier wants the legislature to give North Carolina’s 16-campus state university system more money for security.

The state House is preparing the state budget. For now, Glazier said, the system could get an extra $500,000. But he thinks that number will rise once the schools start reporting how they might use the money. Possible uses include police, security equipment and mental health services for the students, he said. Read more!

Caplan: Broken mental health system puts us all at risk -Waltham (MA) Daily News Tribune

By Arthur Caplan/Guest columnist

It is not just guns. In all my life I never thought I would write those words after a massacre involving a mass murder with a gun. But a week's worth of intense media coverage of the heinous murders of students and faculty at Virginia Tech and analyses focusing on guns by innumerable experts has left me furious.

I don't think the expert wisdom is even close to understanding what must be done to try and prevent this type of tragedy in the future. It is not just guns. We need to fix a broken, abandoned and pathetic system of mental-health care.

In the same month that Seung-Hui Cho killed and injured scores of people at Virginia Tech, a researcher at the University of Washington was shot to death in her office by a former boyfriend, who then killed himself. Rebecca Griego had gotten a restraining order against Jonathan Rowan. When he showed up at her office he fired five shots into Rebecca. A colleague at the university said it was a "psycho from her past."

In Mandeville, La., a man who had just had a restraining order issued against him by his estranged wife allegedly ambushed her and their three children. Police say James Magee chased his wife's gray Toyota Scion for several blocks, ramming it repeatedly until the car crashed into a tree. As Adrienne Magee tried to get out of the vehicle, James Magee allegedly stepped out of the truck and shot her in the head with a 12-gauge shotgun loaded with buckshot, killing her instantly. He then opened fire on his children as they tried to flee the vehicle, killing his 5-year-old son and striking his 7-year-old daughter in the chest, according to police.

Magee had never gotten any help for previous violent outbursts.

And in Queens, New York, a man killed his mother, a wheelchair-bound man and a home health-care worker before shooting himself dead - just minutes after the mother called 911 pleading for help.

The mother's surviving sister blamed police for failing to protect her sister from the "mentally ill" son. "My sister was scared!" Annetta Taylor screamed. "She thought this might happen!"

Cops outside the house tried to calm her, but she continued. "I blame you!" she said. "She called and nobody would respond!"

The murdered mother, Sonia Taylor, had called police twice Monday during fights with her son Wade Dawkins.
The police had been called to the home eight times since last May. During an incident this past October, Taylor told police her son, a drug abuser with no rap sheet, was throwing things around the house and acting violently.
The police brought him to a local hospital for an evaluation. He was quickly sent back to her house.

All of these killings involved not just guns, all involved killers who might have benefited from mental-health treatment. None got the help they needed.

The Virginia Tech murderer was - to be blunt - totally crazy. He fit the dreary profile all too familiar from the shootings at Columbine High School near Denver and the Nickel Mines School in Amish country near Lancaster, Pa. Cho was an angry outcast, preoccupied with thoughts of violence against those whom he saw as bullying, victimizing or just plain ignoring him.

From the tapes he made of himself, it is obvious that he was in the grip of paranoia. He had profound social withdrawal, suicidal thinking, destructive fantasies and was a known stalker. He scared people. But he fell through the cracks of university bureaucracy and a hodgepodge mental-health system.

Report after report over the past decade have warned that most public mental-health systems have, to quote one, "all but disintegrated." Such systems, whether local, state or federal, are badly fragmented and ill-equipped to address our nation's mental health in a comprehensive manner.

States have been balancing their budgets on the backs of the mentally ill for years. A recent example is North Carolina, where 33 percent cuts in the state budget have been proposed. Advocates for the mentally ill there say that if the cuts hold, it means that in many towns the mental-health system will simply "collapse."

But you don't really need to read the reports or look at the budgets. Look out your window. Most of the homeless people wandering around America's cities are mentally ill. Try to get help for your anorexic daughter, alcoholic brother-in-law, suicidal spouse and see what happens.

See what happens if someone threatens or harasses you repeatedly in terms of a coordinated police and mental-health response.

Serving in Iraq or Afghanistan with post-traumatic stress disorder or another mental illness? Good luck. The military's mental-health system is overwhelmed and understaffed. The services available to our soldiers' families are just as bad.

I don't buy the line that says "guns don't kill people, people kill people." I think there are too many guns with too much firepower that are too readily available. When the damaged and the deranged amongst us go undiagnosed and untreated in a world of guns, then fatalities result. The guns are not going anywhere. Politically, we lack the will to do anything about that problem.

But that is not the whole problem. It is time to start repairing a mental-health system that serves too few, costs too much, protects too little and cannot even find the means to help those who clearly are in desperate need. Maybe after Virginia Tech we can at least find the will to do that much.

Arthur Caplan, Ph.D., is director of the Center for Bioethics at the University of Pennsylvania. Read more!

Mental health issues baffle Va. - Richmond Times-Dispatch

By Bill McKelway and Michael Hardy

On Dec. 9, 2005, Leroy R. Hassell Sr., the chief justice of the state Supreme Court, hunkered down during a snowstorm in Richmond with 250 lawyers, mental-health advocates, state officials, sheriffs, caregivers and others to sort through problems with the state's strained mental-health system.

Hassell spoke of concerns he has about the treatment Virginia offers and challenged his listeners to transform the judicial process available "to those Virginians who are least able to care for and help themselves."

Four days later, a suicidal, morose student at Virginia Tech named Seung-Hui Cho became part of the very process that Hassell sought to change. Cho's 22nd birthday was just over a month away.

In a cheerless hearing room at a psychiatric hospital near Radford, Cho was ordered detained and the next day, Dec. 14, was released for outpatient treatment. The release came despite findings by a special justice that he was mentally ill and a danger to himself.

There is no public record of Cho ever receiving help. Nor do court records show whether he complied with unspecified terms of court-ordered treatment; a tape-recording of the hearing is sealed; Virginia Tech officials refuse to discuss whether Cho was referred to their counselors. There is no provision in state law that required a re-evaluation of Cho by the judge who released him.

On April 16, 16 months after Cho's release and Hassell's speech, a commission assembled by the chief justice was still struggling over how to bring more consistency and fairness to Virginia commitment laws and to its system of care for the mentally ill.

And on the Virginia Tech campus that day, Cho erupted from his reclusive shell to shoot to death 27 students and five teachers. He then killed himself, ending a shooting episode unparalleled in U.S. history.

Beyond the grief, the shootings have given a new importance to Hassell's, and now the governor's, promise to assess mental-health laws, even as some lawmakers express reservations about rushing to judgment based on one notorious rampage.

This week, the first changes are expected to be announced by Virginia Gov. Timothy M. Kaine. He promised last week to close loopholes in Virginia weapons laws that allow gun sales to mentally ill people, such as Cho, who have been ruled dangerous but have not been committed to a mental facility. Federal law specifically bars gun sales to mentally ill people.

The loophole, first disclosed by The Times-Dispatch in the days following the shootings, has stunned even the most ardent backers of the Second Amendment. The National Rifle Association, for instance, emphasized it has opposed the sale of guns to the mentally ill for more than three decades.

Mental-health issues and challenges will dominate the proceedings of the independent eight-member commission of experts the governor appointed to review the Tech massacre.

Kaine predicted that its findings could jump-start legislative action to increase funding for mental-health services in Virginia. The state ranks low nationally in providing dollars, especially in community-based settings.

"We can do better on the mental-health side," the governor said.

. . .

An overhaul of Virginia's mental-health laws has been sought for decades, especially in response to the de-institutionalization movement that has shifted care of the mentally ill from sprawling state hospitals to communities.

Virginia, the first state to create a hospital exclusively for the mentally ill in 1769, has been among the slowest to empty them. Virginia still has a higher percentage of institutionalized mental patients than most other states. According to a national association of mental-health professionals, Virginia ranks ninth nationally on in-patient spending and 38th nationally on outpatient spending.

Even so, facilities offering care in local communities are strapped for money and staff, critical emergency care and hospital beds reserved for mental patients are lacking, and funds are focused on the most severely impaired. Virginia law reserves public care in most cases to mentally ill patients who must establish that they are a danger to themselves or others, a high threshold for care shared by only two other states, according to mental-health advocates in Virginia.

"You get help only when it's too late. You can wait weeks for even an appointment," said Hanover County resident Kathy Harkey, who lost her severely depressed adult son to suicide. She had gained access to care for him on some occasions only by lying that he had threatened her.

Mental-health advocates welcomed the focus on mental health in Richmond.

"A state as rich as Virginia needs to increase funding for community-based services," said Bill Farrington, president of the National Alliance on Mental Illness in Virginia.

He blamed the lack of interest on many lawmakers who pay attention to mental health only in times of crisis or scandal.

"In addition, some don't care and don't understand mental-health issues -- interest is low," Farrington said.

The organization gave the commonwealth a D in 2006 for its performance, pointing out that the state ranks 30th nationally in per-capita spending at $68.54. The District of Columbia spends $414 per capita.

The state Department of Mental Health, Mental Retardation and Substance Abuse Services has a budget of $849 million this year. Next year it is to jump to $870 million.

While praising the state's renewed focus, Farrington declared: "The negative is funding. We're always behind the curve." He agreed that there should be monitoring of court-ordered outpatient treatment. "There's no monitoring in the system now."

Del. Clarke N. Hogan, R-Halifax, a budget writer in the House, has been increasingly active in mental-health issues in recent years and is sympathetic to the needs of families and patients.

"There will be a huge push by some quarters saying double the funding," Hogan said. "But while there will be a huge push politically to do something now, it's unlikely that quick, reflexive moves will solve this problem."

It will require an extensive examination of the delivery of services, he said. Despite the demand for immediate action to protect public safety, it's not amenable to a quick fix.

"If you're not very careful, you won't solve the problems," Hogan said. "We'll be looking at the role of community service boards and how good a job community-based care is serving the public."

Hogan said he's pleased that there will be greater focus and debate about the mental-health system. "I think we have made some improvements, and it didn't take a crisis to do that," he said.

. . .

Any zeal for immediate reform must be tempered by court decisions protecting the legal rights of the mentally ill.

"Let's give the governor credit where credit is due for setting up the panel," said Del. William R. Janis, R-Henrico. "Its recommendation will carry a lot of weight."

"But there's a tension here between civil liberties and medical issues," he said. In other words: It requires a balancing of the public's right to security versus the constitutional rights, privacy and treatment needs of the mentally disabled, he said.

Speaking from her Blacksburg home last week, Terry Grimes, who has a mental illness, said the Virginia Tech shootings so close to her home could create further chaos.

"My fear is that there will be an overreaction, a belief that every mentally ill person represents a threat to become some sort of monster," she said. "The move to create new laws mandating treatment and medications could be a disaster. I can't help feeling like the government will be looking over my shoulder every minute, ready to act if I don't follow some court order."

Grimes, who once joked that a psychologist had determined she was "apparently recovered," is a member of the Hassell Commission studying mental-health reform.

She is determined to preserve the civil liberties of the mentally ill in the face of efforts to mandate care on an involuntary, outpatient basis.

"Services need to be people-driven, not rule- or law-driven or judicially ordered," she has written. "Most of all, the tremendous diversity, uniqueness, and potential of individuals with psychiatric challenges need to be recognized and fostered."

Court-ordered medications, for instance, can lead to sleeplessness, weight gains, a loss of sexual desire and a likelihood of diabetes, she said, noting that the patient's voice can be lost in systems of mandated care.

. . .

"Virginia needs to come to a decision about what sort of mental-health care system it wants to have and how to pay for it," said Mary Ann Bergeron, executive director of the Virginia Association of Community Service Boards, the regional agencies that provide most mental-health care in Virginia.

In legislative meetings last fall, Bergeron argued that passing laws increasing demands to provide broader community services to a broader slice of the mentally ill community must be backed with money; longtime mental-health advocate L. William Yelverton told legislators that "without vastly increased funding, outpatient commitment . . . is a charade."

Special justices involved in commitment proceedings said last week that Virginia's laws fail to address some elements of care and that outpatient treatment orders have little teeth.

One justice, who said his position precludes him from being identified, said that the shortage of available community services makes outpatient treatment orders impractical; and there are not sufficient laws on the books to force consumers to adhere to court-ordered outpatient treatment.

"What can I do with a person for violating my order?" he said. "If I can't find that the person is again an imminent threat, all I can do is send him to jail or fine him for contempt."

Such an outcome merely serves to force them into local jails, which are fast becoming the new warehouses for the mentally ill.

The thought was shared by Hassell in his speech calling for reform. He noted that 15 percent of Virginia's prisoners have some form of mental illness.

"The unintended consequence of de-institutionalization has left jail superintendents and sheriffs lamenting their newfound responsibility of housing the mentally ill," he said, "because sheriffs and jail superintendents lack the expertise and resources to do so effectively."

Contact staff writer Bill McKelway at bmckelway@timesdispatch.com or (804) 649-6601.

Contact staff writer Michael Hardy at mhardy@timesdispatch.com or (804) 649-6810.
Read more!

Blame at the top - Raleigh News & Observer

The untold part of mental health reform is that Secretary Carmen Hooker Odom of the Department of Health and Human Services, and officials in the department, continually ignored warnings that glaring problems would doom the system.

As early as 2005, advocates, providers and local mental health leaders identified serious concerns:

1) the possibility that unscrupulous providers would abuse the system by using unqualified individuals to deliver services;

2) the financial burden the new rates would have on North Carolina;

3) the fact that on March 20, 2006, there were not enough services and providers in the community as adequate time had not been given to train staff and properly develop and implement the new services.

Time and again, DHHS officials were encouraged to conduct pilot studies prior to full implementation in order to avoid catastrophic problems. Clearly, the major villains in this saga are Odom and other top-level officials. Cheating providers are minor actors by comparison.

I have requested that the governor assign a neutral third party to investigate the failure of the mental health system and hold those responsible for this failure accountable. Because consumers are losing services, time is of the essence

Frank H. Edwards

President, NAMI Wake County

Raleigh Read more!

The governor's role on mental health - Raleigh News & Observer

Letter:
Dr. Harold Carmel's April 25 Point of View piece "A dismal mark indeed," gives a misleading impression of North Carolina's commitment to the mentally ill.

Carmel first blames the state for apparent abuses among some providers of community support services. This is akin to blaming the banks for Jesse James. The department has taken steps to address these abuses, ensure that they do not recur and refer cases for criminal prosecution as necessary.

More shockingly, Carmel accuses the administration of failing to fund mental health adequately. He fails to note that the governor recommended, and the General Assembly enacted, substantial increases in the mental health budget for the current year. He fails to note that the state allocated the majority of this money in August for local management entities to spend on eligible clients.

However, a substantial amount of the money that has been sent to the LMEs -- approximately $93 million -- will not be spent this year. It would be fiscally irresponsible to allocate even more money when the LMEs apparently cannot spend what they have, given all of the needs facing the state that could use the money wisely and prudently right now.

Finally, Carmel fails to note that mental health reform was a legislative response to a 1999 federal court case and a state audit of the system. The changes in law were dramatic, and the administration suggested a more phased-in approach that assured clear accountability.

This administration has increased support for crucial mental health services through the Medicaid and mental health divisions by $250 million since 2001. Money is available but has not been spent by these local groups, which are not directly accountable to state government. These are serious challenges to vulnerable people. Unfounded accusations do not help these people in crisis at all.

Dan Gerlach

Senior Policy Adviser for Fiscal Affairs

Raleigh

(The length limit was waived to permit a fuller response to the article.) Read more!

After Fatal Clash, Questions About Police Tactics and a Suspect’s Mental State - NY Times

By MICHAEL WILSON and LISA W. FODERARO

It was dusk Wednesday when the roaring fire ended an extraordinary day of tragedy and the massing of police manpower, armor and technology in a quiet corner of the Catskill Mountains.

Cameras stuck on poles, cameras embedded in thrown balls and even a camera mounted on a stair-climbing robot were used to track a suspect in the killing of a state trooper who may have already been shot dead.

But when the smoke cleared yesterday morning, there was the skeleton of a farmhouse and an abundance of unanswered questions, and the troopers who had been side by side with their slain colleague had not yet been interviewed.

“We want to give the troopers a little bit of time to get their emotions under control,” said Maj. Kevin Molinari, commander of Troop C of the state police.

On Wednesday, Travis D. Trim, 23, confronted troopers searching for him, fatally shooting Trooper David C. Brinkerhoff, 29, and wounding Trooper Richard G. Mattson, the authorities said. The troopers returned fire, possibly striking Mr. Trim, before two officers fled with their two wounded comrades. That night, after troopers fired tear gas canisters into the farmhouse, a fire swept the almost century-old structure and ignited a cache of ammunition stored there by its owner, making the hills echo with explosions and keeping firefighters at bay.

Yesterday, a charred body found clutching a rifle inside the house set ablaze during the deadly standoff was identified by the police as Mr. Trim, a college dropout who had stolen a friend’s van days earlier.

Mr. Trim’s family and friends tried to reconcile the man they know — admittedly deeply troubled, using hallucinogenic drugs and seeming paranoid — with the man accused of killing a trooper.

“Travis was crazy, but he wasn’t the kind of guy who would shoot a cop,” said Jake Ritz, 18, a student at SUNY Canton, which Mr. Trim attended before dropping out last year.

An autopsy conducted yesterday at Albany Medical Center was expected to determine whether Mr. Trim died in the fire or was shot. The results were not immediately released.

In addition, Major Molinari said the state police would conduct an internal investigation into the events and tactical decisions that led to the standoff and its fiery end. He defended the troopers’ firing tear gas canisters into the home, one of which may have touched off the fire.

“The major issue is, we had a clear and detailed and well-thought-out and methodical plan in place yesterday as to what we needed to do to remove Travis Trim safely from that residence,” he said. “There does come a point in time when we realized that we are going to have to go in the house.”

Mr. Trim’s criminal career took its first violent turn on Tuesday, when a trooper, Matthew Gombosi, pulled over the van with a missing license plate outside a service station in Margaretville, a village on the edge of Catskill Park about 140 miles northwest of New York City, the police said.

Mr. Trim, appearing disoriented and without identification, they said, pulled out a pistol and shot Trooper Gombosi, whose body armor spared him from serious injury. Mr. Trim then fled, the police said.

Early Wednesday morning, the police responded to a burglar alarm at the nearby vacation home of Carole Chamberlain-Berman of Bergenfield, N.J. After finding a backpack and other belongings of Mr. Trim’s, the police called in a team of four troopers from the Mobile Response Team, an elite and heavily armored unit.

They encountered Mr. Trim on a second-story landing about 8:30 a.m. It remained unclear yesterday how many rounds were fired. Trooper Brinkerhoff was struck in the head, Trooper Mattson in the left arm.

Troopers converged on the home. There were about 140 troopers, along with 40 or 50 officers from local police departments and members of the F.B.I., Major Molinari said. The troopers fired tear gas into the house for hours and called the telephone in the home, but Mr. Trim did not pick up, the major said.

Eventually, Robert A. Chamberlain, Ms. Chamberlain-Berman’s son, arrived and drew a diagram of its interior so that the police could send a robotic camera into the house, where it examined every room downstairs and began climbing to the second floor before tumbling back down, the major said.

“Every logical step that we had laid out in an effort to safely remove him without use of force was completed,” Major Molinari said. “It just reached a time when we are going to execute the plan and go into the residence.”

Shortly before 6 p.m., troopers could be seen donning heavy camouflage vests and packs, readying themselves for entering the home. But first, more tear gas was fired.

“You have to remember, this is an individual who, within a span of 18 hours, had shot three police officers, killing one and injuring another,” Major Molinari said.

Late Wednesday night, the acting superintendent of the New York State Police, Preston L. Felton, said it was possible that the last gas canisters used had been pulled from a different batch, one that is hotter when fired.

“There may have been several rounds of hot tear gas shot into the building by one of the other units, and I’m having our internal affairs look into it,” the superintendent said. “It’s not something that we planned to do, but the use of tear gas has, on occasion, led to fires, and we’re aware of that, and that’s why we stationed firefighters in close proximity.”

Laura Drake contributed reporting. Read more!

Committee rejects cuts in mental-health services -Carson City (NV) Appeal

Geoff Dornan

Assembly Speaker Barbara Buckley, D-Las Vegas, led the charge Friday to restore staff in the Mental Health and Disabled Services budgets.

She said it makes no sense to be reducing support for Medication Clinics in southern and rural Nevada when the need for those services is growing.

The services' Administrator Carlos Brandenburg agreed the need is growing but described a kind of Catch-22 in which the budget is being reduced because the actual caseload, particularly in Southern Nevada, is below what was projected two years ago. He said the reason the caseload is down is because he can't find psychiatric nurses to provide the services to clients. The waiting list for services, he said, is growing.

The Medication Clinics budget provided for 7,548 clients this year. The proposed budget funds services for only 6,800 in each of the coming two years.

Buckley said that makes no sense.

"We have to readjust these numbers to fit reality," she said. "This is out of whack."

Subcommittee Chairwoman Sheila Leslie, D-Reno, joined Buckley saying the committee should restore the funding.

Brandenburg said he is confident he can hire to fill some of the vacancies.

"There is no doubt in my mind the need in Clark County is there," he said. "But if I don't have the staff, I'm not going to be able to serve the consumers."

He said if lawmakers provide the staff and he can hire psychiatrists, social workers and, hopefully, nurses, both of those programs will grow.

The joint Ways and Means/Senate Finance subcommittee voted to restore a total of $4.9 million to the Medication Clinics budget and consider adding even more money to reduce the waiting list for services.

"That's a big one, but I think we have to do it," Leslie said.

Leslie and Buckley said they want to take a look at other budgets in mental health services as well, including Psychiatric Ambulatory Services which is a 24 hour emergency walk-in center for people who need mental health treatment. Buckley said it makes no sense that budget is nearly doubling in Northern Nevada but static in the south. She said the need is growing at both ends of the state.

"You would think at some point, you adjust for reality," she said.

• Contact reporter Geoff Dornan at gdornan@nevadaappeal.com or 687-8750.
Read more!

Mental fitness checks ignored - Columbus (OH) Dispatch

By James Nash

Nearly 100,000 Ohioans have received permits to carry concealed firearms without being checked for mental competence as required by law, Attorney General Marc Dann said yesterday.

Only two, however, are having their licenses revoked after turning up on a list of mentally incompetent people.

The glitch went unnoticed for nearly three years because the databases of concealed-carry applicants and involuntarily institutionalized people were not programmed to communicate with each other, Dann said. The problem also kept the state from forwarding information on mentally incompetent people to a federal database used to screen gun purchases nationwide.

The state database of mentally incompetent people, created under the 2003 law that authorized Ohioans to carry hidden firearms, includes about 1,200 people referred by psychiatrists at mental institutions and by probate judges.

Dann said his office discovered that the mental-health checks were not being performed three days after a mentally unbalanced student fatally shot 32 people before killing himself at Virginia Tech.

"Somebody equally as disturbed could have received a (concealed-carry) permit in Ohio because of the previous administration's failure to perform these checks," Dann said, referring to former Attorney General Jim Petro.

"My office will not let this be left to luck or chance in the future."

Petro, a Republican, said he was unaware of the issue before Dann, a Democrat, called him Monday.

"I'm not sure it was an oversight," Petro said. "The technical aspects of it never came together as well as folks wanted it to."

The state law allowing concealed-carry permits requires sheriffs and the attorney general's office to screen applicants for criminal history and mental competence. Between 2004 and the end of last year, 86,832 Ohioans had received such permits.

Dann's office checked those names against the list of mentally incompetent people this week and found four names: one resident each of Summit and Lorain counties who had active permits and two residents of Lucas County whose permits had expired. The Summit and Lorain sheriffs have acted to revoke the permits, Dann said.

"What's frustrating to me is that we had the information and didn't share it," Dann said.

Toby Hoover, executive director of Ohioans Against Gun Violence and a critic of the concealed-carry law, said the failure to perform mental-health checks is less troubling than the easy availability of firearms through private sales without background checks. She noted that very few Ohio shootings involve people on the list of mentally incompetent people.

"This isn't who's shooting each other in this country," Hoover said. "The Virginia Tech incident was unusual."

Gun-rights groups took heart in the discovery that just two Ohioans deemed mentally incompetent were authorized to carry concealed firearms.

"The two people who slipped through the cracks are no reason to throw everything out the door," said Jeff Garvas, president of Ohioans for Concealed Carry. "Just because those people had a license doesn't mean they were empowered to do something they should not have done."

jnash@dispatch.com

"What's frustrating to me is that we had the information and didn't share it."

Marc Dann
Ohio attorney general Read more!

Mental health pilot program not being used-Charleston (WV) Daily Mail

Justin D. Anderson

After nearly a year, a pilot program that allows some mental hygiene commissioners and judges in the state to order people to take their medications is rarely used.

Linda Richmond Artimez, state director for mental hygiene services, said in implementing the program, which will expire in 2010, officials expected these kinds of orders to be issued in 40 to 50 cases during the first year.

"It hasn't been utilized as much as we would have expected," Artimez said. "That may be because people don't know it's there."

Artimez was unable to say how many times the orders have been issued. But the number is low enough that the state Supreme Court is bringing on a staffer whose job will be to visit the six participating judicial circuits and find out why the orders aren't being used, Artimez said.

Under the program, any person who's been hospitalized or who has committed violence because of untreated mental illness more than once over a two-year period can be ordered to take their medication or undergo other prescribed treatment for up to six months.

Commissioners and judges can extend the orders by another six months if they see a need. Forty-eight-hour detention orders and mandatory evaluations by mental health professionals can accompany the treatment orders if circumstances warrant.

A second part of the program, set to take effect next fiscal year, allows the chief judge in each of the six circuits to authorize mental health officials to certify mentally ill individuals and involuntarily commit and evaluate them. That commitment can last 48 hours.

This part of the program can be triggered by the same circumstances as the treatment orders. Court officials will begin learning about this method this summer, Artimez said.

The program was modeled after Kendra's Law, which New York lawmakers passed after a man with untreated schizophrenia pushed 32-year-old journalist Kendra Webdale in front of a New York City subway train in 1999.

Artimez said the provisions of Kendra's Law are used frequently in that state.

New York authorities have "found that it reduced arrests, reduced homelessness and reduced violence," said Tom Rodd, a lawyer with the West Virginia Supreme Court whose child has been diagnosed with schizophrenia.

Rodd and others were vital in pushing lawmakers to authorize the pilot program here in 2005.

He said it is essential for courts to be able to order people to take medications for mental illness.

"That's what it takes usually," he said.

"It takes an order and follow-up. And there's nothing like a court order to stimulate that follow-up."

If anything, Rodd said the program should be expanded in the state. He also suggested that the state's mental health court be expanded to deal with both civil and criminal commitments.

The mental health court program works to get non-violent mentally ill people into treatment programs after they're charged with crimes rather than having them sent to jail.

Advocates of such programs referred to last week's incident in Virginia, where a mentally ill student gunned down 32 people at Virginia Tech.

Compared to Virginia, West Virginia law makes it simpler to get someone involuntarily committed, Artimez said.

Virginia's laws say a person has to be an "imminent danger" to himself or others in order to be committed. West Virginia law requires only that they be found "likely to cause serious harm."

The difference, Artimez said, is that the "imminent danger" law means something bad is about to happen or is in the process of happening at the moment a mental health petition is filed.

In West Virginia, a person has to prove that something bad could happen in the future if an individuals doesn't get some help with mental illness.

"I think it's working for us well in West Virginia," said Roy Tunick, president of the West Virginia Psychological Association and a counselor at West Virginia University.

Contact writer Justin D. Anderson at 348-4843. Read more!

Patrick Kennedy finishes probation, drug treatmentfor Capitol car crash - AP

WASHINGTON -- Rep. Patrick Kennedy has completed the probation and court-ordered drug treatment for his middle-of-the-night car crash near the Capitol last May.

District of Columbia Superior Court Magistrate Judge Aida Melendez approved early termination of Kennedy's probation on April 10, more than two months before it was to end.

"He fulfilled his court-ordered requirements earlier than the date given," Kennedy spokesman Robin Costello said Friday.

Kennedy, D-R.I., met the terms of his probation, including weekly Alcoholics Anonymous meetings and counseling with his physician, Dr. Ronald Smith, according to a review of Kennedy's court records by The Associated Press.

"Mr. Kennedy is genuinely and honestly engaged in his recovery process," Smith wrote in a March 22 letter. "He has continued to attend daily AA meetings for the past year and is clean and sober. ... We remain very optimistic."

Kennedy, the son of Sen. Edward M. Kennedy, D-Mass., said in a recent TV interview that he had sought treatment for an addiction to the painkiller OxyContin months before wrecking his car.

The 39-year-old Kennedy, who won re-election to a seventh term last fall, has been open about his struggles with mental illness, including bipolar disorder, and his addictions to alcohol and various substances.

The congressman has battled addiction problems since high school, and he has been a passionate advocate on Capitol Hill for improved mental health care coverage.

He crashed his green 1997 Ford Mustang convertible into a security barrier about 3 a.m. on May 4, 2006.

As part of a plea deal last June, Kennedy was sentenced to drug treatment and probation.

In the hours before the wreck, Kennedy said, he returned home from work and took a sleeping pill, Ambien, and Phenergan, a prescription anti-nausea drug that can cause drowsiness. He said he did not consume alcohol.

One day after the crash, he entered the Mayo Clinic in Minnesota for treatment for addiction to pain drugs.

The following month, Kennedy agreed to plead guilty to a charge of driving under the influence of prescription drugs.

Two other charges against Kennedy -- reckless driving and failure to exhibit a driving permit -- were dismissed in the plea deal.

The congressman was given a 10-day jail sentence that was suspended, and he was ordered to serve 50 hours of community service. He agreed to pay $350 -- $250 of which would go to the Boys and Girls Club of Greater Washington, and $100 to a crime victims' fund.

He also was required to check in once a week with his AA sponsor, Rep. Jim Ramstad, R-Minn., and to submit to random urine screenings for drug abuse. Read more!

Guns, Mental Illness, Parity - Transcript from Democratic Presidential Candidate Debate

MR. WILLIAMS: Clinton, a question for you. Did the government -- did any role that government -- federal government plays fail those students at Virginia Tech?

SEN. CLINTON: Yes. You know, I remember very well when I accompanied Bill to Columbine after that massacre and met with the family members of those who had been killed and talked with the students, and feeling that we had to do more to try to keep guns out of the hands of the criminal and of the mentally unstable. And during the Clinton administration, that was a goal, not to in any way violate people's Second Amendment right but to try to limit access to people who should not have guns.

Unfortunately, we saw the tragedy unfold at Virginia Tech. We now know that the background check system didn't work, because certainly this shooter, as he's called, had been involuntarily committed as a threat to himself and others, and yet he could walk in and buy a gun.

MR. WILLIAMS: Governor Richardson, you are currently, if our research is correct, the NRA's favorite presidential candidate, declared, in either party, based on their ratings system. id anything about the massacre at Virginia Tech make you rethink any part of your position on guns?

GOV. RICHARDSON: The first point I'd want to make is my sincerest condolences to the families of those loved ones that perished. It was an unspeakable tragedy.

You're right, Brian. I'm a westerner. I'm a governor of New Mexico. The Second Amendment is precious in the West. But I want to just state for the record, a vast, vast majority of gun owners are law-abiding. This is an issue that deals with two fundamental problems in our system right now.

The first is mental illness. We should ensure that all federal and state initiatives deal with making sure that mental -- those with mental illnesses cannot get a gun.

Secondly, I was for instant background checks. We have to make sure that those background checks are state and local, states are properly funded to be able to detect those problems.

Lastly, in this country, mental health is not treated the same as other illnesses.

There should be mental health parity in this country, and we don't have it. And we should finally find ways to ensure that our schools get the help they need to detect these mentally ill patients.

MR. WILLIAMS: Thank you, Governor. We're over on time. And because our producers are learning about the consumption of time, we have our first show-of-hands question tonight. (Laughter.)

How many of you in your adult lifetime have had a gun in the house? One, Senator Gravel, Senator Biden, Senator Dodd, Governor Richardson, Congressman Kucinich.

Thank you very much.

Senator Biden, the kind of flip-side of the question I just asked Senator Clinton. What could the federal government have done to save those kids at Virginia Tech?

SEN. BIDEN: Shotgun, not pistol.

What they could have done is two things. One, I was the fellow who in the so-called Biden crime bill years ago to put a hundred thousand cops on the street, that the Clinton administration made work incredibly well. The first assault weapons ban was passed. I've worked with law enforcement for the past 30 years, deal with getting around with armor-piercing bullets, waiting periods, et cetera. But the one thing that's clear, we should not have let the assault weapons ban lapse.

Number two, we should close this so-called gun show loophole so you can't go in to a gun show and buy a gun that you couldn't buy walking into a gun shop.

Number three, I agree with everyone here; we have let the country down in the way in which we have not focused on mental illness. We should know that when you send a kid to college, you're going to be safe on college. My wife is a doctor of education, a teacher at a community college. If, in fact, she and other teachers determine that a child, by the way they're writing and what they're acting, that they're a danger, the school should be able to take them off the campus.

MR. WILLIAMS: Let's talk about health care, an issue that currently ranks a solid second in virtually every opinion poll in the United States.

Senator Edwards, you have said you would raise taxes to pay for a health care plan. The question is, which ones?

SEN. EDWARDS: I would get rid of George Bush's tax cuts for people who make over $200,000 a year. But I want to say, this is an example -- we've had a lot of discussion tonight, not a great deal of discussion so far about the substance of very specific ideas that each of us have on big issues.

I'm proud of the fact that I have a very specific universal health care plan, which I think is different than some others on the stage who are running for president. And I think we have a responsibility, if you want to be president of the United States, to tell the American people what it is you want to do. Rhetoric's not enough. Highfalutin language is not enough.

And my plan would require employers to cover all their employees or pay into a fund; covers the cracks in the health care system -- mental health parity, which others have spoken about; chronic care, preventative care, long-term care -- subsidizes health care costs; gives people a choice, including a government choice; no preexisting conditions, banned as a matter of a law. And the law actually requires that every single American be covered.

MR. WILLIAMS: Senator, thank you.

Senator Obama, how would you pay for your plan?

SEN. OBAMA: Well, first of all, let me tell you what I would do. Number one, I think we should have a national pool that people can buy into if they don't have health insurance, similar to the ones that most of us who are in Congress enjoy right now. It doesn't make sense to me that my bosses, the taxpayers, may not have health insurance that I enjoy. And we can provide subsidies for those who can't afford the group rates that are available.

The second thing, I think, that we're going to have to do is make sure that we control costs. We spend $2 trillion on health care in this country every year, 50 percent more than other industrialized nations. And yet we don't have, necessarily, better outcomes. This week we saw a story that showed that black infant mortality in this country is actually going up in some states, which is shameful and makes no sense. And if we make sure that we provide preventive care and medical technology that can eliminate bureaucracy and paperwork, that makes a big difference.

The third thing is catastrophic insurance to help businesses and families avoid the bankruptcies that we're experiencing all across the country and reduce premiums for families.

That's the kind of plan that I think we can accomplish as long as we build the movements to actually make that change happen.

Read more!

Officers trained for mental-health crises -Chapel Hill News

Stanley B. Chambers Jr., Staff Writer

About seven months ago, Durham Police Cpl. L.E. Sanders encountered a woman who was upset because her cat was missing.

Simple, right? But this woman suffered from bipolar disorder, and was so upset that she was unresponsive to her husband, who contacted police.

Instead of shouting questions at the woman, Sanders coaxed her with his calm demeanor and utilized other techniques he learned in a Crisis Intervention Team training program provided by the Wake County Sheriff's Office.

The woman eventually calmed down and was able to stay at home, Sanders said. Without CIT training, Sanders said he might have just taken her to the hospital.

"It feels wonderful any time you get a sense of a job well done," he said last week after five Durham County deputies and 17 Durham police officers graduated from the Durham Police Department's first CIT class. "I've learned a new way to do my job."

Durham's program is modeled after one established by police in Memphis, Tenn., in 1988 after officers killed a mentally ill man. Local police officials were approached by the Durham Center, which manages mental-health and substance-abuses services, about the program. After a trip to Memphis in February 2006, eight officers were sent to be trained in Wake County.

In the week-long class, officers learned about mental illness through role-playing and trips to mental-health agencies. They also had lessons about mental disorders and learned techniques for active listening.

In North Carolina, the concept started in 2005 with Wake County deputies, along with Raleigh and Cary officers. It has spread as far as Pitt County and Winston-Salem, said Robert Krutz, a program manager with the state Division of Mental Health who helped train the Durham officers.

Having such training has helped officers overcome a "fear factor" when dealing with mentally ill subjects, "which often was very cautiously," said Durham Police Chief Steve Chalmers.

"Now we've replaced that fear with education and understanding on how to efficiently interact and intervene with individuals," he said.

As the state struggles with mental-health reform efforts, it is often police rather than health professionals who respond first to a crisis. As a result, such situations often land a mentally ill person in jail rather than treatment.

About 64 percent of jail inmates, 56 percent of state prisoners and 45 percent of federal prisoners have some form of mental illness, according to a 2006 Department of Justice report. But only about 33 percent of state prisoners and 16 percent of jail inmates receive treatment while incarcerated.

Those behind bars with mental illness often have higher rates of criminal history, substance abuse, negative history such as sexual abuse, violating jail rules and getting into more fights than other inmates, the report said.

In Durham, about 17 percent of the approximately 600 inmates at the Durham County Jail are taking psychiatric medications, jail officials said.

The first interaction a police officer usually has with the mentally ill is when a family member dials 911 or someone is committed.

Between July 2004 and June 2005, Durham officers responded to 1,910 calls for service regarding mental cases.

The Durham Police Department has kept limited statistics on the number of mentally ill subjects that officers have faced, but it plans to implement a more detailed reporting system, Durham Police Maj. B.J. Council said.

The CIT training will help officers not only spot the signs of mental illness, but to have them think about treatment rather than incarceration, Council said.

"We don't need to utilize judicial time and taxpayer money to put them in the judicial system when they need to be in the mental-health system," she said.

There will be at least two CIT officers in the city's five police districts with the goal of eventually having every officer trained, Council said.

Though Officer M.J. Morais has a bachelor's degree in psychology and a master's in human resources development, he believes the CIT training will only further help him and others in crisis.

"It's the ultimate pro-policing program," he said.

Staff Writer Stanley B. Chambers Jr. can be reached at 956-2426 or at stan.chambers@newsobserver.com. Read more!

New center offers hope for mental health issues-Greenville Daily Reflector

By Amanda Karr

Hope is not just part of the name of a new support center being established in Pitt County, it's the basic principle for its success.

"When people find their hope they can do amazing things," Stephen Pocklington told a crowd of about 500 people gathered at a conference sponsored by Pitt Mental Health in partnership with East Carolina Behavioral Health. ECBH is the regional mental health management group Pitt County will be joining in July.

As part of the merger, Pitt County plans to open later this year a center that will be called Hope Station. It will give people with mental health issues, developmental disabilities or substance abuse problems a place to get support.

That support will focus on self-help and peer encouragement.

"This won't replace existing services," Pocklington said. "It will complement those. It's about tapping into each other as resources and finding a greater value in our neighbors, our families."

Pocklington is executive director of the Copeland Center for Wellness and Recovery in Arizona.

Speaking at the Greenville Convention Center, Pocklington shared his own story of mental illness and drug use. He also discussed the theory behind self-directed wellness and recovery plans.

"There is no one size fits all definition for recovery," he said. "For one person, it's being able to be stable for a long period of time. For others, it's being able to go without drugs and alcohol. For another, it's to become productive and gain self-esteem."

Giving people hope and empowering them to invest in their own improvement is the key, he said. He recognized not everybody is convinced the practice will work in all situations.

"Some of you say 'Hogwash, some diagnosis people are never going to recover from,' but I think denying hope is more dangerous than giving hope," he said.

Pocklington explained how to develop a wellness recovery action plan. Each plan is developed by having individuals identify the things that create stress and what helps them combat it. Once Hope Station opens in Greenville, locals can develop their own plans with staff assistance.

In creating their plan, people describe in writing how it feels to be well and the things they should do daily to continue feeling well. They also list what circumstances serve as triggers that make them feel out of control and their own early warning signs that they are not feeling well.

They then develop an action plan to relieve their early warning signs and what symptoms they display if those actions are insufficient.

They also develop a plan that can be implemented if they reach a crisis. The plan is a blueprint for how other people can tell an individual is in crisis and how to help. Included in the plan are a list of supporters that the person would like to help, a list of people they do not want around, what medications they feel work and don't work, what other treatments have helped or not helped in the past and where they would like to be hospitalized if it becomes necessary.

Mental health officials are currently looking for people to be trained as Hope Station staff. It will be located at 2407 S. Memorial Drive.

"The reason this is a community conference on wellness and recovery is no one should stand alone," Pocklington said.

Amanda Karr can be contacted at akarr@coxnc.com and 329-9574. Read more!

What Level Of Mental Illness Should Preclude Execution - Medical News Today

The American Psychological Association has teamed with the National Alliance on Mental Illness and the American Psychiatric Association to present a brief as Amici Curiae to the U.S. Supreme Court, providing expertise on appropriate standards for determining the level of mental illness that should preclude execution. Arguments on the case, Panetti v. Quarterman, will be heard by the court today.

Scott Panetti, the defendant in the case, was sentenced to death for the 1992 murder of the parents of his estranged wife. In 2003, Panetti petitioned the Texas state court to determine his competency for execution. The Texas state court ruled him competent. Panetti next petitioned the federal district court. The district court found fault with the earlier ruling and held an evidentiary hearing at which four mental health professionals (three psychologists and a psychiatrist) all agreed that Panetti suffered from some degree of mental illness, characterized by impaired cognitive process and delusions, and consistent with schizoaffective disorder. The district court nevertheless held that Panetti was competent to be executed because he understood the state intended to execute him.

On appeal to the Fifth Circuit, Panetti argued that the district court employed the wrong legal standard to evaluate his competence to be executed. Panetti argued that an earlier Supreme Court standard established in the seminal case of Ford v. Wainwright required that Panetti not only be aware of the fact of his impending execution but also have a rational understanding of why he was to be executed. Panetti believes he is to be executed because he preached the gospel, not because he murdered his in-laws.

The central question before the Court is whether a defendant must have a rational understanding of the reasons for his execution, beyond the mere fact that he will be executed, in order to be competent to be executed?

The APA brief provides guidance to the Court in developing a meaningful standard of competence for execution, including bringing scientific knowledge to the Court on such issues as the ability of a prisoner with serious mental illness to understand the reason for the execution.

"The law-psychology field has been attentive to the law's distinction between 'factual' and 'rational' understanding for many years, and across a variety of legal questions," according to Kirk Heilbrun, PhD, a forensic psychologist who served as one of three APA representatives to the American Bar Association's Task Force on Mental Disability and the Death Penalty. "Factual understanding is about information. Rational understanding allows us to place that information in a meaningful context, without gross interference caused by certain symptoms of severe mental illness, or very serious impairment of intellectual functioning."

The APA brief will seek to bring to the Court information about serious mental illness and how it can manifest in particular individuals - such as:

-- Individuals who, like Panetti, suffer from severe psychotic disorders frequently suffer from bizarre delusions that disrupt their understanding of reality.

-- Individuals with serious mental illness may be unable to connect events or understand cause and effect - for example the connection between criminal acts and punishment.

-- Mental health professionals can reliably assist the courts in identifying prisoners with mental illness who suffer delusions that preclude them from understanding the actual reasons for their punishment.

The foundation for the APA brief was work done by an interdisciplinary task force established in 2003 by the American Bar Association. The interdisciplinary group brought together experts from the Bar Association, the American Psychological Association, the American Psychiatric Association and the National Alliance on Mental Illness to craft a joint policy statement calling for the establishment of limits on the use of capital punishment for those with severe mental health disabilities.

The American Psychological Association (APA), in Washington, DC, is the largest scientific and professional organization representing psychology in the United States and is the world's largest association of psychologists. APA's membership includes more than 148,000 researchers, educators, clinicians, consultants and students. Through its divisions in 54 subfields of psychology and affiliations with 60 state, territorial and Canadian provincial associations, APA works to advance psychology as a science, as a profession and as a means of promoting health, education and human welfare.

http://www.apa.org Read more!

Grant will help mental health court formation -Cincinnati Post

By Luke E. Saladin

Northern Kentucky University is giving three university faculty members a $55,448 grant to help set up a mental health court in Northern Kentucky.

The grant, known as a University-Community Partnership Grant, was given to Amy Thistlethwaite and Julie Rains, both professors in the political science department, and Gregory Hatchett, a professor at NKU's Department of Counseling, Human Services and Social Work.

The three will team with the Campbell County Criminal Justice Advisory Commission, a group of public officials, judges, lawyers and other law enforcement officials, to develop a screening mechanism to determine whether a person who is arrested is a candidate for the Northern Kentucky Regional Mental Health Court.

The mental health court will work with prosecutors and local treatment agencies to help those whose crimes appear linked to mental illness, much in the same way drug courts across the state seek to treat defendants with addiction problems.

The idea of a regional mental health court in Northern Kentucky surfaced when the commission began looking at ways to keep jail populations down.

The group visited a mental health court in Jefferson County, the only one in Kentucky.

Campbell District Judge Karen Thomas, one of the main organizers of the local mental health court, has already received approval from Kentucky Chief Justice Joseph Lambert to start it as a pilot program.

Thomas said Boone County District Judge Charlie Moore has agreed to oversee the mental health court docket, starting with hearings every other week until the project gets off the ground.

The commission must secure money to pay for professional staff to treat the inmates, train the staff and present protocol for the court to Lambert for his approval. Transportation for the defendants in the program would also be required, since many of those who qualify are unable to drive.

Organizers are seeking grant funding for the approximately $300,000 they will need in startup funds, Thomas said. Local fiscal courts have indicated they're willing to supply the annual operating funds.

If the startup money is secured, it's possible the court could begin hearing cases in a year, she said.

She credited Campbell County Judge-Executive Steve Pendery with making the court happen.

"Not many people want to listen when you start talking about mental health," she said. "Or getting people out of jail."

Pendery called the court a unique collaboration to help the mentally ill in the area. "We are happy to forge this partnership with NKU and commend their efforts in regional stewardship in this regard."

NKU President James Votruba said he is excited about the partnership and the continued impact of the university's grant program.

"It has been a pleasure to see our faculty partner with community leaders to help address issues facing Northern Kentucky, " Votruba said. "This grant is just the latest example of how our region can accomplish all that it aspires to if we work together."

Read more!

What's to become of Coast mental health?-Biloxi Sun-Herald

By JOSHUA NORMAN

The smiling, blue-shirted volunteers from Project Recovery will stop wandering neighborhoods and FEMA trailer parks after today, marking a major milestone in the Coast's recovery from Hurricane Katrina.

The end of the outreach program is symbolic of the federal government's opinion that crisis counseling is no longer necessary; that Coastians are ready to rely on traditional mental-health programs and can figure out how to find them themselves.

The problem with that, say local mental-health professionals, is the existing mental-health support system already is strained, and public and private financial support for it is declining despite rising costs and need.

For the dozens of outreach workers from Project Recovery, many of whom had never counseled before, this is also a tough time.

"Most of them feel like they have really done a lot to help people in their community," said Kris Jones, the state disaster behavioral health coordinator for the Department of Mental Health. "Most of them felt like it was time for the communities to move forward. I know they've saved some lives along the way."

Jennie Hillman, director of Project Recovery, said there were long-term positive outcomes, as well.

"I really think there are a lot of people who changed their opinion about mental-health issues and seeking emotional-health services," Hillman said. "I think it maybe helped reduce the stigma of getting help for mental-health problems.

"The project really accomplished its goals, knocking on doors and talking to people and letting them talk through their experience. It is a vital part of the recovery process."

For all the good results of Project Recovery, Hillman said large challenges in terms of Coastians and their mental well-being remain.

"This catastrophe is going to affect the mental-health system for years," Hillman said. "There has to be more money for treatment."

Hillman and others said there is a good chance some of the $16 million allocated by FEMA for Project Recovery may be left over on May 15, when all operations officially end and the DMH is required to return any leftover money.

For Jeff Bennett, director of the Gulf Coast Mental Health Center, one of only two options for low-income people in need of mental-health services in Harrison County, watching this money and Project Recovery leave the state at the same time will be difficult.

"When they leave, the resources are limited, and we'll be the primary player again," said Bennett, adding he's short-staffed by about 60 employees and underfunded despite the workload surpassing pre-Katrina levels. "For crisis intervention they did a great job. That's not going to be available in the streets anymore."

Bennett said he believes the mental-health needs of Coastians will increase in the months and years to come.

"Depression, if it's untreated, can lead to all kinds of things - loss of jobs, domestic problems, substance abuse," Bennett said. "It's on the news every day. People are just worn out. That's what we're beginning to see, is this malaise. It's just (like we're all) sick and tired of being sick and tired."

On March 27, Edwin Legrand, director of the state Department of Mental Health, submitted a letter to Sen. Thad Cochran's office requesting assistance.

"As of Project Recovery's last quarterly report, we have spent approximately $13 million of our $19 million grant," Legrand wrote. "Following our 90-day closeout period, DMH will return any remaining funds to FEMA. I would like to respectfully request that all funds remaining at the end of the grant period be reallocated and awarded to Gulf Coast Mental Health Center to provide funding for emerging mental-health treatment needs stemming from Hurricane Katrina."

Adam Telle, a spokesman for Cochran, said they immediately copied and forwarded the letter to FEMA.

"Sen. Cochran is currently working with FEMA to try to make that request happen," Telle said. "It's certainly a good initiate. As we understand it, it's a possibility."

Some at Project Recovery expressed concern recently that getting the money to stay would take an act of Congress, specifically to change the Stafford Act, which governs the government's response to disaster.

FEMA has interpreted the Stafford Act's ruling on mental health to mean it can financially assist counseling but not treating people with mental-health issues, hence the reason Project Recovery was so limited in scope.

Eugene Brezany, FEMA spokesman, said in an e-mail, "The remaining funds cannot be used for treatment of mental-health disorders because (Project Recovery) is a short-term program designed to supplement existing state and local mental health resources.

"Treatment services for mental health disorders are long term in nature and require a more permanent fixture to provide adequate follow-up and clinical oversight for as long as the individual's needs dictate. In addition, (disaster) funding is not intended to supplant existing resources designed to address mental health treatment needs, such as the Social Services Block Grant or any special appropriations that may be requested from and determined as appropriate by Congress."

Where to get help now
Project Recovery is ending, but there are still plenty of ways to get counseling and the services they offered.
The directors of Project Recovery said they have spent the last few weeks leaving their resource lists with local community centers, churches and clinics.

There are still options for counseling and mental-health treatment on a sliding pay scale.

In Hancock, Harrison, Pearl River and Stone counties, contact the Gulf Coast Mental Health Center in Gulfport (863-1132) for information about crisis counseling and a treatment center near you. The center has specialists in teen, family and substance-abuse crisis counseling on call.

In Harrison County there is the Center for Community Resilience in Biloxi (385-1119) which offers coping strategies at affordable rates.

In Jackson County, contact Singing River Mental Services (497-0690) for assistance.

The Mississippi Department of Mental Health's toll-free helpline is 1-877-210-8513.

The National Suicide Prevention Line is toll-free, 1-800-273-TALK (8255).

Following the money

On March 27, Edwin Legrand, director of the state Department of Mental Health, submitted a letter to Sen. Thad Cochran's office requesting assistance.

"As of Project Recovery's last quarterly report, we have spent approximately $13 million of our $19 million grant," Legrand wrote. "Following our 90-day closeout period, DMH will return any remaining funds to FEMA. I would like to respectfully request that all funds remaining at the end of the grant period be reallocated and awarded to Gulf Coast Mental Health Center to provide funding for emerging mental-health treatment needs stemming from Hurricane Katrina."

Adam Telle, a spokesman for Cochran, said they immediately copied and forwarded the letter to FEMA.

"Sen. Cochran is currently working with FEMA to try to make that request happen," Telle said. "It's certainly a good initiate. As we understand it, it's a possibility."

Some at Project Recovery expressed concern recently that getting the money to stay would take an act of Congress, specifically to change the Stafford Act, which governs the government's response to disaster.

FEMA has interpreted the Stafford Act's ruling on mental health to mean it can financially assist counseling but not treating people with mental-health issues, hence the reason Project Recovery was so limited in scope.

Eugene Brezany, FEMA spokesman, said in an e-mail, "The remaining funds cannot be used for treatment of mental-health disorders because (Project Recovery) is a short-term program designed to supplement existing state and local mental health resources.

"Treatment services for mental health disorders are long term in nature and require a more permanent fixture to provide adequate follow-up and clinical oversight for as long as the individual's needs dictate. In addition, (disaster) funding is not intended to supplant existing resources designed to address mental health treatment needs, such as the Social Services Block Grant or any special appropriations that may be requested from and determined as appropriate by Congress."



© 2007 Sun Herald Read more!

Changing the Mental Health Conversation -Inside Higher Ed

There’s lots of talk in these post-Virginia Tech tragedy days of the need to better identify students who are disturbed, just as there are plenty of calls from politicians and others to find ways to quickly remove them from colleges. An advocacy group for people with mental illness thinks the talk has gone too far.

“It’s sad that in the wake of a tragedy like this, there’s the hunger for quick fixes and quick legislation,” said Robert Bernstein, executive director of the Bazelon Center for Mental Health Law, at a press conference Thursday.

Added Chris Koyanagi, the center’s policy director: “I’m disappointed that the conservation has been about what could have been done right before to prevent this [shooting spree]. What about earlier?”

Cho Seung-Hui, the Virginia Tech shooter, entered a mental health facility in late 2005. Several leaders of the Bazelon Center said the real story is that police didn’t know where to turn when alerted of Cho’s stalking and threat of suicide, and that professors who saw the student’s disturbing writing didn’t find the right resources in the public health system.

Center advocates say changes have to be made at colleges so that everyone is aware of protocol when dealing with a student who is deemed a threat. Leaders of the center are working on a best practices report that urges colleges to avoid blanket policies that limit a student’s likelihood of seeking help but that still allow officials to intervene when needed.

Bernstein said the larger issue is fixing what he calls large gaps in service availability. Too few counselors are available to students at many campuses, he said.

Many administrators worry about legal problems if their institutions violate the Family Educational Rights and Privacy Act of 1974 and the Health Insurance Portability and Accountability Act of 1996, meant to protect privacy of health information. At a Senate hearing this week, both lawmakers and college officials underscored the dilemma: Share personal student health records and face potential legal action. Do nothing and face the possibility of lawsuits for inaction. Sen. Joe Lieberman (I-Conn.) appeared open to amending the legislation to include liability protection for colleges that follow a set procedure in dealing with troubled students.

But Bernstein doesn’t understand the “damned if you do, damned if you don’t” argument, because he said the privacy laws have clear exemptions for releasing health information in emergency situations.

“Liability is a red herring,” added Karen Bower, senior staff attorney at the center. “To go down the road of saying there should be more liability protection is presuming that there is liability in these cases.” She said no court has found a college liable for failing to prevent violent outbursts.

Ira Burnim, the center’s legal director, said colleges sometimes have the misguided view that the less they know about their students, the better. “That puts them at the most risk,” he said.

The center made its case for student protection in a recent case involving George Washington University that settled in November. It helped represent Jordan Nott, a student who sued claiming that he was forced to leave the university after seeking help for depression at the university’s counseling center. George Washington officials defended the removal as necessary to protect both Nott and other students.

A year ago, the Massachusetts Institute of Technology announced a confidential agreement to resolve a lawsuit brought by the family of a student who lit herself on fire in her dorm room and died in 2000. Last summer, Hunter College agreed to pay $65,000 to settle a suit challenging the college’s policy governing students deemed to be at risk of suicide.

“We do have concerns that colleges continue to overreact and seek to place students on involuntary leave,” Bower said.

— Elia Powers

Comments

Red Herring?
Karen Bower says: ” no court has found a college liable for failing to prevent violent outbursts.”
Just because courts have not ruled thus does not take away the filing of lawsuits. That’s why specific outlines of what should be allowed should be established. Senator Lieberman is correct.
Craig C, political pundit at http://blogresponder.blogspot.com, at 7:45 am EDT on April 27, 2007
re look the issue of Changing the Mental Health Conversation’
In the VA Tech shooting, many students and many teachers gave reports of his odd acting behavior. Cho was caught stalking women. At one point Cho was ordered to attend or sent (depends what you read) to psychiatric care.
Within the existing system of privacy if all of those “incidents” could’ve connected to place, maybe there woul’ve been an alert.
I cannot for the life of me see someone court ordered to psychiatric and no court or school have some way of monitoring the results. This may be the biggest snag. the court should’ve ordered reports to the college’s counseling or the student judicial affairs (that handles conduct issues) to prove such court orders were met.
ANyway I bleieve the solution is not in changing the law butr in defining emergency, duty to warn, and protection issues.
Nothing in any law prevents an intervention and there were times those interventions could,ve happened.
College Counselor, at 9:35 am EDT on April 27, 2007
Changing the Mental Health Care conversation
Let’s take the conversation one step in the other direction — and not assume that Cho qualified as being mentally ill.
The facts we have tell us he acted in a socially unacceptable way around others. He can do that and retain his citizen rights.
The facts also tell us he broke the law — an important personal safety law — when he stalked 2 female college students.
He cannot do that and retain the right to be with others.
Discrimination laws protect our right to act in a way that “others” deem to be socially unacceptable. We have a nasty history of doing so -hence the need for a law that says no person, group, media personality, institution, or group of ‘do-gooders’ has the right to discriminate on the basis of what “they” want to call “normal”
THAT SAID
No one has the right to intimidate,scare, or hurt others in a civil society — ANYONE who violates the rights of another needs to be removed from that society.
No excuses — Violent behavior is not a sign of mental illness. It is violence.
We need to address the social madness affecting our moral compass... and ask ourselves-
What type of reasoning allows for fuzzy time periods where we fiddle around trying to be omnipotent under some silly premise of caring for (read “labeling for")someone’s supposed ‘mental health’ when that someone hurts or intends to hurt others.
To do so is what I call crazy.
Pamela, Graduate Student/Instructor at University of MO- STL, at 9:50 am EDT on April 27, 2007
question for Pamela
Pamela, Just so you know, people probably do have a right to “scare” other people. “Scaring” is a rather subjective act, and people often claim to be “scared” by rather innocuous (or constitutionally-protected) behavior. Literally, people claim to be “scared” by anti-war demonstrators. Are you saying that just because someone claims to be “scared” they don’t have a someone lacks a right to do what they are doing?
Please tell me you are not proposing a country wherein individuals can stifle debate or expression just because 1) people are different; or 2) people have different views.
Larry, at 1:00 pm EDT on April 27, 2007
The demarcation of our civil rights
I agree with you Larry, and needto be more specific. We have the right to not be afraid of bodily harm, which is what the two college women were afraid of when they wanted Cho to stop stalking them. Which is why he needed to be held accountable.
Yet,communities often write policies that limit lewdness, profanity, and hate propoganda said in public, and there are laws that limit my speech,such as yelling “fire” in a crowded theater. But that’s not what we’re talking about here. Sorta,
kinda.
but then maybe it is...
When we yell “mentally ill” over every communication media available,
well,... some social service professionals stampede easily and only calm down by spreading labels.
Makes me wonder what purpose is served to create mental illness posthumous?
Cho was mean. He was hateful. He became a criminal. He left uncountable victims, who need support. Cho doesn’t benefit from attempts at social understanding-he’s infamous. and the legend of his mental anguish benefits who?
Pamela, Graduate Student/Instructor at University of MO- STL, at 3:10 pm EDT on April 27, 2007
freedom from fear?
Pamela, I am not sure that individuals have a right not to be “afraid” of bodily harm. There are a lot of paranoid people out there that are afraid of many things. Let me be very blunt about this: many white people are “afraid” that minorities will injure them. This is a racist and disgusting fear, but it is a “fear” of bodily harm nevertheless.
Instead, Pamela, why don’t you look at your state’s criminal code. For example, I see that you are in Missouri. Mo. Rev. Stat. 565.070 defines “assault in the third degree” as including
“The person purposely places another person in apprehension of immediate physical injury;”
http://www.moga.mo.gov/statutes/C500-599/5650000070.HTM
While “apprehension” might require some clarification, “immediate physical injury” is fairly narrow. There is no “right” to be free from all apprehension at all points in the future. Moreover, the defendant must be shown to have purposely put the person in this fear. Merely being creepy or a minority isn’t enough.
LArry, at 3:20 pm EDT on April 27, 2007
good law/ wrong point
I appreciate the opportunity to weave more legal framework into the present discussion and believe you picked a perfect statute for our conversation.
First, I hear your point that one’s fear, in and of itself, does not make my case. To tell you I am afraid of someone’s intentions is to voice my apprehension — an act of calling attention to the situation that constitutes the first criteria: I must be afraid that I am in danger.
I believe the wording of Missouri. Mo. Rev. Stat. 565.070 clarifies the second criteria
“The person PURPOSELY places another person in apprehension of immediate physical injury;”
If I purposefully place a person in harm’s way, I’ve committed a crime. If I claim or reveal my intention-the case is closed.
If I do not admit my intention and my actions result in harm to others, was it on purpose?
Now our conversation returns to the accountable — unaccountable continuum we like to call mental health...and the first straw man argument in play ( the second being scared white people)
We cannot-despite our hubris to the contrary-pin down this jello concept called “intent” and that’s the problem w/ playing god.
We can say that if someone follows me around, takes pictures of me w/ their cell phone, and pays me undue attention- that I have a right to be afraid -black, white or green, those actions are violating my personal space and the person needs to be arrested and held accountable.
As far as scared white people go, you may have something- but your minority argument does not hold water. I can be afraid of anyone but I have to have “cause” for fear to make a case for third degree assault.
I think white fear is about holding people accountable — or maybe its about closing our faviorite escape hatch for criminal behavior?
Pamela, Graduate Student/Instructor at University of MO- STL, at 6:40 am EDT on April 28, 2007
No right to distant “personal space”
Pamela, Most people that are convicted of crimes don’t “admit” their intentions. Instead, courts are left to infer intentions from manifested conduct. This is a matter of proof for trial (even though most charges are resolved via dismissals or guilty pleas).
Someone following you around taking pictures of you is like not a crime. In fact, this behavior is encouraged when it is done by police, private detectives, and journalists. “Personal space” (except the immediate area around you) isn’t really recognized by the law. I have witnessed many people claiming to be in “fear” of black people, or college girls claiming to be “Scared” by people that acted different, but were merely just clumsy conversationalists. For this reason, assault is more than just a vague feeling of fear, but there must be, at a minimum, some inference that the person intended to place the person in “apprehension” of physical injury. Taking pictures just isn’t doing this.
A mentally ill person might lack one of the elements of assault, or their illness might constitute a defense. At some level, no penal interest would be served by punishing someone that was truly ill (within the meaning of the law), since it wouldn’t discourage anyone, society wouldn’t be protected, and they wouldn’t be deterred from doing it again.
Larry, at 11:50 am EDT on April 28, 2007 Read more!

Opinion: What's right and wrong in dealing with mental illness-Detroit News

Mental illness has been much in the news. Anthony LaCalamita, the alleged perpetrator of the office shooting in Troy, was reported to have a major mental illness. We've been repeatedly informed that the gunman in the Virginia Tech massacre had a mental health history.

Here are three other items from Michigan newspapers in mid-April:
"Accused killer called insane" (headline);
"An attack on a Muskegon County Jail corrections deputy by an inmate with mental health problems left two officers injured" (lead sentence);
A Brooklyn (Michigan) mother charged with murdering her infant had once "overdosed on antidepressants and talked of suicide."

What in heaven's name is transpiring, and what is the public to make of all this?

One thing is that mental illness is highly prevalent. At any given point, it affects one in five people, with about 7 percent of the population displaying symptoms of severe conditions. Large-scale national studies have shown that 33 to 50 percent of adults experience one or more diagnosable mental disorders in their lifetime.

In any list someone wants to concoct -- be it charity activists, pet owners, jaywalkers or felons-- individuals with mental illness are going to be included.

The onset of a major mental illness means that someone has experienced an alteration of his or her brain chemistry. It is not a matter of having less willpower, discipline or toughness than other people.

But what studies have reinforced is that the overwhelming majority of people with mental illness (including me) pose no threat to anyone. If an individual is in psychiatric crisis, or is among the small proportion with a chronically uncontrolled serious condition, there is an increased risk of someone being harmed. Even then, that harm is more likely to fall on the individual with mental illness as opposed to an outside person.

The real problem is that across the nation, there are not enough resources allocated to public mental health programs to meet the service demand that exists. In Michigan, the situation is exacerbated because we are one of only eight states not requiring private insurers to cover mental illness in a manner equal to the coverage given other medical conditions. You get what you pay for, and we have traded psychiatric hospitalization for less-costly justice system incarceration as the repository for some of our most troubled fellow citizens.

Such incarceration often ensues from relatively minor offenses, as was the case when Timothy Souders first came in contact with the justice system. Souders died last year in a Michigan prison under brutal circumstances.

For many people with mental illness, advances in psychotropic medication have been a godsend, playing a critical role in assisting the process of recovery. Yet some public officials continually explore ways to reduce access to those medications under the naïve assumption that less mental health drug spending translates into savings for society.

In 2004, Gov. Jennifer Granholm, citing a "broken" mental health system in Michigan, appointed a special Mental Health Commission. The commission presented her that year with 71 recommendations, some of which could play a role in preventing a future tragedy. The governor's administration has shown little enthusiasm for those recommendations, even the ones not carrying price tags, and mental health interests have had to go directly to the Legislature to seek meaningful follow-up.

To paraphrase the famous "Pogo" comic strip line, "We have met persons with mental illness, and they are us." We're talking about ourselves and our families, friends, neighbors and co-workers. I hope and pray we can all keep that in mind.

Mark Reinstein is president and chief executive of the Southfield-based Mental Health Association in Michigan. E-mail comments to letters@detnews.com. Read more!

State backs off big rate cut for mental health and substanceabuse services - Asheville Citizen-Times

by Leslie Boyd, LBOYD@CITIZEN-TIMES.COM

RALEIGH — For the last three weeks, Gordon Smith wondered whether the mental health agency he worked for would be able to stay in business.

He was able to breathe a sigh of relief Thursday as the N.C. Department of Health and Human Services announced it would pay a rate of $51.28 per hour for mental health and substance abuse services known as Community Support.

Those make up one of the basic sets of services in the mental health system.

The original rate was about $61 per hour, but DHHS Secretary Carmen Hooker Odom issued a memo April 5 changing the rate to $40 per hour.

The services include helping people with skills such as handling money, making appointments and performing other daily living tasks. Service providers said the low rate would drive them out of business.

The state Division of Medicaid Services worked with a number of providers to assess the true cost of providing the service, and announced the new rate Thursday afternoon. The rate is retroactive to April 5.

“That’s excellent news,” said Arthur Carder, CEO of Western Highlands Network, the mental health management agency for eight counties in Western North Carolina. “It’s a substantial improvement over the $40 rate.”

‘It makes us pretty lean’

Service providers said they were hoping the rate would be slightly higher, but they will be able to stay in business.

“It’s just going to make it more difficult for us to be innovative,” said Dan Zorn, CEO of Families Together. Zorn was one of about 20 providers who took part in the rate review process with the Division of Medicaid Services. “I figured as long as the rate was above $50, I would be able to stay in business, and I will. But it makes us pretty lean.”

Smith, who works for Appalachian Counseling, said his company will have to revisit its business plan and do some restructuring.

“It’s about break-even for us,” he said. “I think we’ll be able to make it, but I hope we’ll get some adjustments to other services.”

Zorn said the state will look at other services that are thought to be paid at too low a rate, but the Community Services rate is permanent.

“We feel that this is a fair rate that covers the actual cost of the services,” DHHS Secretary Carmen Hooker Odom said in a statement. “We wanted this to be a transparent process and have worked with providers to determine this rate.”

Those other changes include a new process for applying for services that was released Tuesday afternoon.

Reviews will be conducted for all Community Services recipients who get more than 12 hours of service a week. Findings that services have been provided improperly could result in legal action.

The claim of any recipient for an increase in Community Services will be flagged and reviewed.

The state has proposed other changes that still are out for a 45-day comment period. Those proposed changes include:

All Community Support services will have to be approved before they are delivered, except for an initial eight-hour review by a qualified professional such as a psychologist.

For adults, the maximum amount that will be approved is 15 hours a week.

‘Really worried about this’

Currently, people applying for the service are allowed to get up to 28 hours of services a week for 30 days so they could be assessed.

“I’m really worried about this,” Smith said. “We’re waiting up to two months for approval on some of these cases now. I’m afraid this means people will wait for services for two months.”

Brad Deen, a spokesman for N.C. DHHS, said there is no formal process to expedite approval for people who need services right away, “but there are ways to get it done.”

The original rate of about $61 per hour was effective March 20, 2006, when Medicaid began to pay for community services. On April 5, Odom reduced the rate to $40 after auditing the 167 service providers in the state who billed for the most services and found some were overusing the service.

Your comment

To comment on the proposed changes in accessing Community Support services, visit www.ncdhhs.gov/dma/mp/proposedmp.htm. Read more!

Mental health system wasn’t broken and is not fixed - Asheville Citizen-Times

by Maggie Panther

I simply cannot believe the latest insane development in our state’s mental health debacle. If a state government had intentionally set out to destroy mental health services to its citizens it could not have done a better job.

I am a Masters-level professional who was laid off by our region’s largest private provider, just before it closed its doors on Oct. 31 because it could not survive in this designed-by-chimps system. That closure will be only the first of many unless we do something to stop this train wreck now. I am no longer working in the mental health field and will not consider doing so under this sorry excuse for a mental health system.

I am so sad and angry about this — our system was working just fine before our elected officials “reformed” it. Now they should take responsibility, admit we learned a tough lesson and get back to providing public mental health services to the citizens of this state whom they have sworn to serve.

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Maggie Panther, Waynesville Read more!

State eases severity of mental health cuts -Hendersonville Times-News

Scott Parrott

RALEIGH -- Mental health care providers breathed a sigh of relief Thursday upon learning the state's pay rate cut for a popular mental health care program is less drastic than previously expected.

The state announced Thursday the final Medicaid reimbursement rate for community support services would be $51.28 an hour. It is retroactively effective to April 5.

Local mental health care providers and administrators welcomed the news, though it was bittersweet.

The rate is a reduction, but less drastic than the 30 percent cut providers previously faced and feared would drive agencies out of business.

"I think more of our providers are feeling that that's a more workable rate than what it was," said Western Highlands CEO Arthur Carder. "It couldn't meet all our providers' cost, but some of them."

Western Highlands manages mental health care in eight mountain counties, including Henderson, Polk, Transylvania and Buncombe.

"We feel that this is a fair rate that covers the actual cost of the services," said N.C. Department of Health and Human Services Secretary Carmen Hooker Odom in a written statement. "We wanted this to be a transparent process and have worked with providers to determine this rate. We believe that this rate change, coupled with other changes, will make certain that the right people are receiving the right services at a cost that ensures that taxpayer dollars are well spent."

The final rate came three weeks after DHHS slashed the amount it pays for community support services from nearly $61 to $40 an hour.

DHHS revisited the reduction after mental health care providers said they would be driven out of business by the reduced pay.

"It is much better than the $40 rate," said Meg Foley, the chief operating officer for Appalachian Counseling. "I think some providers will have to restructure, but they may be able to continue services, which is a lot better than the alternative."

Appalachian Counseling serves about 5,500 clients in Henderson, Transylvania, Polk and Buncombe counties. About 250 of the clients receive community support.

Community support helps mentally ill clients and people addicted to drugs or alcohol with such skills as finding housing and jobs.

The original rate of $60.96 per hour took effect March 20, 2006, when Medicaid began to pay for community services. The $40 rate appeared April 5 after the state conducted an audit of 167 mental health care providers.

"That reduction was made based on the best available data we had at the time, which showed that those 167 providers were billing for services that were almost totally provided by people with high school degrees or less," Hooker Odom said.

"The original rate was set up with the idea that a quarter of the services would be provided by professional staff with master's degrees. Certainly, with those 167 providers, who represented 16 percent of the CS providers, that wasn't happening."

"But we had committed since 2006 to work with a group of providers who were chosen by their trade associations or local mental health agencies on determining real cost of service," Hooker Odom said. "We expedited that work, looking at 16 providers and found that the rate we decided on today reflects the actual cost of service provision."

Raleigh also tightened up the way use of community support will be reviewed. Western Highlands is trying to determine the impact these changes will carry for the management agency and local mental health care providers.

"The biggest issue now will be how the providers are going to be able to provide the benefit package, and what that's exactly going to be," Carder said.

The changes include:

• Post-payment reviews will be conducted for all community support recipients who receive more than 12 hours of service a week. Findings that services have been provided improperly could result in legal action.

• The claim of any recipient for an increase in community support will be flagged and reviewed for clinical appropriateness.

DHHS also proposed other changes, which are out for a 45-day comment period. Those proposed changes include:

• Prior approval will be required for all community support services, except for an initial eight-hour review by a qualified professional such as a psychologist to ensure that community support is the proper service.

• For adults, the maximum amount of community support that will be approved is no more than 15 hours a week.

"I think some people are still trying to figure out how to prepare for that," Foley said. "So this isn't over." Read more!

Service providers, state compromise - Winston-Salem Journal

By James Romose

State health officials and companies that provide mental-health care have reached a delicate compromise over the North Carolina’s payment rate for a group of services designed to help people with mental illnesses and substance-abuse problems.

The state announced yesterday a new Medicaid rate at which it will reimburse companies that provide what are known as “community-support” services. The announcement comes less than a month after the state cut the rate by a third and angered people who serve the mentally ill.

“I think that this is certainly an encouraging move, to move away from a rate that would have shattered our system even further,” said Debra Dihoff, the executive director of the North Carolina chapter of the National Alliance on Mental Illness.

The state, responding to what it says is widespread misuse of community-support services, also said yesterday that it is tightening the rules for how those services are provided and reviewed.

About 31,000 people in North Carolina get community- support services each month. Community-support workers assist clients with an array of tasks, such as managing medications and learning to live independently.

In March 2006, when Medicaid began to pay for community-support services, private companies and nonprofit organizations that provided the services were reimbursed by Medicaid at a rate of $61 an hour.

But earlier this month, the state lowered the reimbursement rate to $40 an hour. That cut shocked many service providers and advocates for the mentally ill. Companies across the state said they would have to eliminate services to cope with the loss of Medicaid revenue.

The state said that the original rate of $61 was too high. It found in an audit that many companies were abusing the program by billing for more hours than clients needed. It also said that many companies relied too heavily on “paraprofessional” workers - workers with high-school diplomas and minimal training - rather than highly qualified social workers and case managers.

After four weeks of intense discussion between state officials and service providers, the state settled on a new, and apparently final, reimbursement rate of about $52 an hour.

The state said that a review of companies’ financial data showed that the $52 rate reflects the actual cost of providing community-support services.

Bob Hedrick, the executive director of the N.C. Providers Council, said he thinks that the state did a good job in working with the groups who provide community support.

“We think the process was open and fair. We think that they accurately considered the factors in the cost,” Hedrick said.

But, he cautioned, actual costs vary from company to company. Even if the $52 rate is sufficient for some, it may not be sufficient for others - especially those who hire large numbers of well-educated, experienced workers with high salaries.

“It’s going to be up to each company to decide whether they can provide community support at this rate,” Hedrick said.

Some companies have already made cuts. Triumph LLC, a large provider of mental-health care, said on April 13 that it is shutting down services in Iredell, Surry and Yadkin counties.

Paul Caldwell, the chief operating officer of Triumph, did not return phone calls yesterday.

In addition to the change in the Medicaid rate, companies will face more intense reviews from the state when trying to get community-support services approved.

The state wants to limit the number of hours that adults can receive community-support services to 15 hours a week. That limit would reduce the amount of services currently being provided to many clients.

The 15-hour limit would not be hard-and-fast, said Brad Deen, a spokesman for the N.C. Department of Health and Human Services. The state would grant exceptions for people who show they need extensive services.

“But when you do go above the 15, that’s going to set off bells and whistles,” Deen said.

■ James Romoser can be reached in Raleigh at 919-833-9056 or at jromoser@wsjournal.com. Read more!

N.C. Medicaid panel reinstates part of cut mental health payment - AP

By GARY D. ROBERTSON, Associated Press Writer

RALEIGH, N.C. - Mental health treatment providers and their patients got back some of what they wanted Thursday when a state panel agreed that Medicaid will pay more for certain services scrutinized recently by regulators.

A rate review board agreed to raise the Medicaid reimbursement rate paid to providers of "community support" services from $40 per hour to $51.28. That's still nearly $10 less than the rate originally set last year by the Department of Health and Human Services.

"It's something that we can work with," said Milton Teague, president of Family Alternatives Inc. in Lumberton, which provides mental health services. "I have confidence that they have come up with something that's fair."

The department agency that runs Medicaid hastily reduced the old rate of nearly $61 per hour April 5 after its own review found that community support providers were billing for a surprising number of hours per patient.

The review also uncovered other misuses of programs, prompting department Secretary Carmen Hooker Odom to seek an official state audit and take legal action against what she called fraudulent or abusive billing.

The new rate was finalized after Medicaid officials met with a handful of providers who had reviewed cost data for the program. Medicaid has spent $700 million on about 45,000 patients since Medicaid began paying for community support last year.

"We believe that this rate change, coupled with other changes, will make certain that the right people are receiving the right services at a cost that ensures that taxpayer dollars are well spent," Odom said in a news release.

Mental health advocates, providers and their patients rallied two weeks ago outside the Legislative Building, asking lawmakers for help in reversing the one-third cut. Unless the old reimbursement rate was restored, they argued, providers could lay off workers or close their doors and the decade-old mental health reform movement in North Carolina would regress.

The higher rate will "keep community support active and it will take a lot of fear out of the system," said John Tote, executive director of the Mental Health Association in North Carolina.

Under community support, about 1,000 providers statewide examine patients' needs and help them get back on their feet while they await or leave intensive treatment. That could include social skills training or assistant to obtain housing or keep taking their medicine.

But the department audit found providers also were billing Medicaid to take children swimming or to the movies, or to help with homework, according to a memo Odom wrote last week to Gov. Mike Easley.

The state's review also found that most of the work was being performed by low-skilled workers that don't need to be paid as high as higher-skilled professionals.

Odom said the department will now require closer scrutiny of community support provider billings for a patient of more than 12 hours in a week. Any hourly increase for a patient also will be reviewed before approved.

While there may have been some abuses, leaders of the roughly 1,000 providers and patient groups argue most groups performed the work appropriately.

Others blame the Department of Health and Human Services for failing to detail properly what can or can't be billed. The extra hours of community support, in some cases, may be justified if it's improving health, said Debby Dihoff with the National Alliance on Mental Illness North Carolina.

"Our interest is having some stability in the system so that people get treatment and get better," Dihoff said.

Teague said state regulators have provided more assistance recently on community support billing. And Leza Wainwright, deputy director of the state division that oversees mental health services, said the criteria for community support services are clear. Read more!

Gun permit questions- Raleigh News & Observer

Excerpt from: Under The Dome

Legislation that would allow North Carolina sheriffs to keep track of handgun permit denials across the state was pulled from the House floor Thursday after one of the sponsors said he wanted to answer freshman lawmakers' questions.

Rep. Ronnie Sutton, a Pembroke Democrat, said some freshmen are feeling heat from gun rights advocates who oppose the bill, and so they want to hear more about the legislation.

A suicide in Guilford County prompted the bill. The sheriff there had denied a man a pistol permit because of mental health concerns raised by his family. But the man then went to Lenoir County, falsely claimed residency there and received a permit.

He used it to buy a handgun and then killed himself.

Sutton's bill would create a state database that sheriffs could use to keep track of pistol permit denials. The reason for the denial would not be recorded, though sheriffs could call that county and find out why. They would not necessarily be prevented from issuing a permit d Read more!

Mental health care gets new rate - Raleigh News & Observer

Lynn Bonner, Staff Writer

The State Department of Health and Human Services changed course Thursday on its rate cut for a basic mental health service.

After weeks of criticism for cutting the rate it paid companies from about $61 an hour to $40, state administrators decided on a price near the middle -- $51.28 a hour. And they decided to make the new rate retroactive. It will be as if the short-lived $40 an hour never happened.


"That was an arbitrary rate anyway," said Bob Hedrick, executive director of the N.C. Providers Council, a trade group.

Frustration with the state's struggling mental health system bubbled over when DHHS announced the $40 rate on April 5. Critics said the cut would put some companies out of business and force providers who were doing a good job to rely on less educated and less experienced workers.

Administrators said the cut was based on an audit of 167 companies that showed they were using less educated workers to provide the service, known as community support.

Hundreds of companies provide the service to children and adults who are mentally ill, drug addicts or alcoholics. The service can include counseling and help finding medical care or housing.

The state responded to the outcry by rushing to set another rate based on 16 companies' costs. That review resulted in the $51.28 announced Thursday. Hedrick said the participating companies thought the review was fair.

Connie Cochran, chief executive officer of Easter Seals UCP North Carolina, said it is reviewing cases of 1,300 of the 2,800 people in community support to see how much care they need and whether the nonprofit can afford to keep them. He said the agency can no longer afford to keep clients who need only case management, work that the most educated workers must do. Case managers are directors who make sure clients are getting the right amounts of the right kinds of care.

Clients who need about an hour of the professional service a month may have to go, Cochran said.

R. Jane Ferguson, CEO of Appalachian Counseling in Brevard, said the company's survival is no longer threatened, but workers will have to take on more clients.

"We're happy that they raised it from the $40," she said. "No one who had a professional agency could do it at that rate."


Staff writer Lynn Bonner can be reached at 829-4821 or at lynn.bonner@newsobserver.com.

© Copyright 2007, The News & Observer Publishing Company Read more!

Mental health system failed Virginia Tech -Gatehouse Media

By Daniel B. Kline

Law enforcement bears no blame for the massacre at Virginia Tech. The mental health system, however, must be at least questioned and we have to ask why we have no method of stopping people suspected of being capable of violent crimes from obtaining guns.

In some cases horrible crimes get committed by the people we least suspect. Perhaps they go through a mental breakdown or maybe they simply disguise their evil intentions, but in many cases we have no way of identifying a potential threat.

In the case of Virginia Tech madman Cho-Seung Hui that was simply not true. Fellow students, professors and university officials knew something was wrong and saw the potential for violence.

Seung-Hui never spoke to his roommate, had no friends and was accused of stalking women on multiple occasions. He also wrote amateurish incredibly violent plays for a creative writing class that scared other students so much they were afraid to comment on his work.

These actions got him sent to a psychiatric hospital where he was declared likely to be a danger to himself, but not to others. At no point did these suspicions of him being potentially violent — whether to himself or others — get reported to any authority that could prevent him from legally buying a gun.

Taken alone, things like not talking a lot and producing violent writing do not clearly mark anyone as someone who might commit a crime this awful. If we locked up everyone who wrote amateurish incredibly violent scripts, than Quentin Tarrantino would have been arrested after the “Grindhouse” premiere.

Taken together by a mental health professional, however, Cho should have been identified as a potential mass murderer. According to Northeastern University criminal justice professor James Alan Fox in an Associated Press article Cho in virtually every regard, Cho is prototypical of mass killers.

Fox goes on to say that “when criminologists and psychologists look at mass murders, Cho fits the themes they see repeatedly: a friendless figure, someone who has been bullied, someone who blames others and is bent on revenge, a careful planner, a male. And someone who saw warning signs in his strange behavior long in advance.”

Mental health professionals examined Cho and missed that he fit the prototype for serial killers. Meeting this prototype should raise red flags that put the person on whatever lists they need to be on so they can at least not easily, legally buy a gun. You can’t lock up people because they meet a profile, but you can restrict their access to deadly weapons
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This was not a shocking crime committed by your stereotypical neighbor who seemed nice. Everyone knew Cho had the potential for violence because he flaunted his mental illness. Nobody could imagine the extent of the massacre, Cho would pull off, but lots of people knew that he seemed likely to do something violent.

Forget metal detectors and additional police, we need to stop people who match the profile of being a mass murderer from buying guns when we become aware of them. If someone presents to a mental health professional with the profile of a potential killer, steps must be taken to minimize the threat.

It’s easy to pretend that we don’t know why the tragedy at Virginia Tech happened and hard to admit that perhaps it could have been stopped. We should not be so blind to potential future tragedies.

Swampscott native Daniel B. Kline’s book, “50 Things Every Guy Should Know How to Do,” is available in bookstores everywhere. He can be reached at dan@notastep.com. An archive of his columns can be found at www.notastep.com. Read more!

Lawmakers scrap name of state Dept. of Mental Retardation - AP

HARTFORD (AP) - The Connecticut House of Representatives voted unanimously Wednesday to scrap the name of the state Department of Mental Retardation.

The new name would be the Department of Developmental Services. It would take effect Oct. 1.

"This bill, in my judgment, is well overdue," said Rep. John Hetherington, R-New Canaan, who called the new name "more respectful language."

Some families, advocates and DMR clients have complained that the agency's name could be seen as stigmatizing and offensive to people with mental retardation. Last year, the legislature required DMR to come up with a new name.

The name change does not change the criteria for determining who is eligible for state services, such as having an IQ score of 69 or lower.

Rep. Linda Schofield, D-Simsbury, said that means the agency will not serve people with developmental disabilities other than mental retardation. Schofield said she hopes the agency will eventually change its mission and help more people.

The bill moves to the Senate for further action.
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Children Face Delays In Mental Health Care - Boston Globe

Carey Goldberg Globe Staff

Massachusetts' mental health system for children is clogged with some of its worst backups in years, leading to long emergency room waits and a record number of "stuck kids" who are deemed well enough to leave hospital units but have nowhere to go.

The logjam tends to worsen in late winter and spring, when mental illness often worsens. But it is particularly bad this year: in the latest count, state monitors found 156 stuck children at the end of February, some 50 percent more than the average number in recent years.

When the system backs up, patients can have long waits from start to end. They may have to wait in emergency rooms during full-blown psychiatric crises, because no hospital beds are available. They may end up as boarders, stuck for days or weeks in medical pediatric wards because they cannot get a bed in a psychiatric ward or hospital.

And then there are the classic stuck children, who are deemed well enough to leave psychiatric hospitals or units but cannot, for lack of outside treatment programs.

"There are more stuck kids in Massachusetts right now than there have ever been," said Lisa Lambert, interim director of the Parent/Professional Advocacy League, which advocates for children with mental illness.

Bottlenecks in psychiatric care for children have been a problem in Massachusetts and around the country for many years.

But the numbers and the concerns they evoked last peaked four or five years ago. The backups then abated, as state officials and care providers put programs into effect to keep the system flowing better and focused on the problem child by child.

But in recent weeks, the backups have "dramatically increased" again, said Dr. Joseph Gold of McLean Hospital, director of Community Child Psychiatry Services for Partners Healthcare.

The number of children needing psychiatric hospitalization has grown by 8 percent in the last two years, but that is not enough to explain the recent spike in stuck children, said Joan Mikula, assistant commissioner of child and adolescent services for the state Department of Mental Health.

State officials and care providers are trying hard to understand what is going wrong and how to fix it, she said.

"We're parsing data nine ways to Sunday, trying to really understand who these children are and what's happening," Mikula said.

Last week, the managed-care company that provides mental health care for the state's Medicaid population issued an alert to all its care providers that children's beds were getting exceedingly tight.

The company, the Massachusetts Behavioral Health Partnership, told them that its protocols for times of scarce beds were taking effect and asked them to consider bed-freeing measures such as moving older adolescents into adult wards when appropriate.

"For the past four or five years, we haven't needed to be in this mode of kicking in our protocols," said Anne Pelletier Parker, who oversees management of the Partnership's provider network. "We're doing everything we can to make sure it doesn't become a trend or a long-term situation."

To solve the problem, she said, children must be moved through the system more quickly after they are stabilized.

Children in state custody seem to constitute the core of the stuck children problem: Of the 156, 120 are under the auspices of the Department of Social Services, and 20 more are under the Department of Mental Health.

Oftentimes, Mikula said, the problem is that children who do not live with their families and must be discharged to intensive foster care, where they can be served well, face months of waiting for such homes.

This time, the backup seems especially bad in emergency rooms, said David Matteodo, executive director of the Massachusetts Association of Behavioral Health Systems, which represents private psychiatric hospitals.

The backup fluctuates, he said, but at times, "you can call all 15 hospitals" that can accommodate children with mental illness, "and nobody's got a bed - 'We're full. We're full."'

At Children's Hospital Boston, the backup does not seem nearly as bad as several years ago, in part because it is using new support techniques to help even suicidal patients go home from the emergency room, said Elizabeth Wharff, director of the hospital's emergency psychiatry service.

Last month, Mary Ann Tufts of Plymouth found herself facing such backups as she tried to help her 16-year-old daughter, who has bipolar disorder.

Her daughter started to unravel on a Saturday, and spent that afternoon through Monday afternoon on a gurney in a hallway of the Jordan Hospital emergency room, Tufts said.

A psychiatric bed was finally found in Waltham, she said; the only problem was that it was in an adult eating disorders unit, and her daughter does not have an eating disorder.

At week's end, the teenager was moved to an appropriate bed at McLean Hospital, thanks largely, Tufts believes, to high-placed contacts she made as parent coordinator of the Parent Information Network, which helps parents of children with mental illness.

It ended well, but the experience appalled her.

"I don't think children and adolescents, many of them traumatized, need to spend days in an emergency room where they're seeing blood and drunks and drug addicts," she said. "Is it a failure of the system? Absolutely."
Published April 26, 2007
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Parity for mental illness could solve many issues- Nasshau (NH) Telegraph

Letter:

Monday’s editorial on the mental health system posed some good questions and raised some issues that should be put on the table, but the first place you must start if you are to make any progress at all is parity.

Mental illness is a sickness just like any other sickness and must be treated as such. This starts with educating the public, so they are as knowledgeable about bipolar disorder as they are about diabetes.

If one in five people are likely to have a mental illness, why is it that the general public knows nothing or very little about it? In fact, what they perceive to be knowledge is usually myths and prejudices. The only time the public is exposed to it is when there is a media story to be told.

If it is so prevalent, why aren’t there adequate resources? Insurance companies have two sets of rules when it comes to providing coverage, a restrictive one for mental illness and a more generous one for all other illnesses. Why?

The U.S. government and Medicare benefits discriminate. Why?

Under Medicare, a patient in a psychiatric hospital is limited to 190 days in their lifetime, but if you have diabetes or heart trouble, your stay in a hospital over your lifetime can be many times 190 days.

Try counting the hospitals in New Hampshire providing long-term care for mental illness, and you can do it on one hand. Compare that to the number of hospitals offering care for your diabetic family member.

The lack of resources has a direct correlation on the difficulty in having a loved one admitted and, if admitted, kept till he or she is well enough to be discharged. The disparity in insurance coverage makes it difficult if not impossible to get treatment for your loved one.

Yes, this costs money, but if you want adequate treatment you have to pay for it. Penny-wise and pound-foolish results in saving money on coverage versus the price of pain and suffering, never mind the dollars spent to manage the situation. This pain and suffering also extends to the family of the person with the illness.

Ed Kirby
Nashua Read more!

Mental health should be a national priority-Zanesville (OH) Times Recorder

Letter:

Is there anyone alive that has not heard about the massacre at Virginia Tech? Is there anyone alive that has not heard of the mental condition of the perpetrator of this horrible deed? If this young man had received appropriate treatment, 33 people might still be alive today. Could NAMI on CAMPUS have helped this young man? President Bush's Freedom Commission on Mental Health called our system fractured. Is there anyone alive that disagrees?

If - Parents had to give up custody of their children for them to receive treatment for cancer

If - People with heart disease ended up on the streets or in the prisons because they couldn't get help

If - Businesses lost billions of dollars due to avian flu
If - 30,000 people died each year due to airplane accidents

This nation would demand action.

When it comes to mental health disorders, these scenarios are not "If's" - they are a reality. Loss of child custody, homelessness, incarceration, lost productivity and an epidemic of suicide as a result of mental health problems are sad realities in communities across the country. Research confirms that mental health is fundamental to overall health and demonstrates that mental illnesses are highly treatable. But individuals need access to appropriate services.

We call on Congress to embrace our vision for change and make mental health a national priority to ensure wellness for all Americans, from the Mental Health America Web site.

We are Tom and Margaret Quinn, officers of the National Alliance on Mental Illness (NAMI) Six County. May is mental health month. It seems a waste of time and effort after all that has taken place these last few days to remind ourselves that mental illness is out there. One in four persons, worldwide, will need mental health services at some point during their lives. Given this fact, it is difficult to understand why mental health services are so underfunded.

Treatment works - people recover.

Tom and Margaret Quinn
Zanesville

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Comments below

Inasmuch as I not only understand and sypathize with the point missingmeds makes there is that underlying truth we can't escape, some folks no matter the treatment, the meds, the doctrine of the society some folks will never get better. It is true in Cancer, you name it some folks won't respond.

I know what it is like to try to understand why someone drifts from happy to sad and why both are so extreme. I kknow what it is like to see someone you love in the depth of a depression so dark nearly no light penetrates it. I know what it is like to have to commit someone you love. I know the day to day struggle and the observation needed to watch for the next time.

All that being said, there should be family counseling but if you can't afford it, it is a non-starter. If you have to scrap and save to affrord the meds and office calls what is your choice? Six County and Dr. Fern Gave me my family member back by listening and giving her the right meds. I try my best to not hit the triggers but no matter how much you try you still hit one on those days where any amount of trying doesn't help.

If you look back in the life of my family memeber you would see the signs were there since she was small, but it not of her doing because it was clearly hereditary. I have a son in law to be i love to peices whose problems are even more pronounced but with the meds is a sweetheart and a half to be around. Yet when his tolerance to a medicine is reached he sinks back until it is adjusted and he is back. He goes to another facility and group of practitioners.

So as much as I agree with missingmeds on some of the points i don't agree with them all. I do agree with the orginal letter writer.
Sadly this administration has talked a much better game than it is played on woefully to many issues.

Posted: Thu Apr 26, 2007 3:37 pm
I have to agree with missingmeds on this one. Most of the time there are family issues driving the illness. You just can't treat a fraction, it must be the whole.

Posted: Thu Apr 26, 2007 3:31 pm
I would say that first of all the mental health professionals need to stand up and be accountable for what they do. They also need to realize that they can't treat just the patient, that they need to treat the whole family and sometimes that means calling a spade a spade.

Did the mental health and court system fail this young man? Yes, he was ordered institutionalized for observation and then ordered to follow up care with a counselor. Did either the mental health professionals or the court system follow up with him to make sure that he did what he was told? Apparently not.

Do I sound angry? I should, I deal with an ex husband that has now been in the mental health system for over 17 years and is still no better off than when he started. The one thing that I will say about the city police department is that they finally realized that he does what he does to keep from getting into trouble, and once he got out of Cambridge, they had him do a 3 day stint in the city jail. That stopped his so called suicide attempts.

But other than that nothing has changed with him.

Posted: Thu Apr 26, 2007 6:49 am
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State mismanaged situation - Hendersonville Times-News

Guest Opinion:

R. Jane Ferguson

Carmen Hooker Odom, the secretary of the Health and Human Services Department, has attempted to explain the rationale for the recent rate slash for community support services in the state's mental health care system.

Hooker Odom said that the 33 percent rate reduction was the only reasonable response for a government department charged with the fiduciary responsibility of managing state and federal Medicaid dollars.

She went on to say that recent audits of community support payments found that 98 percent of providers doing the service were paraprofessionals (high school grads) when the service was supposed to be provided by a mix of qualified professionals (master's level), associate professionals (bachelor's level) and paraprofessionals.

Her explanation was that because this was never the intent of the service definition, the state had to cut the rate to reflect the fact that most service providers were actually high school grads. Where did the state dig up this information?

The recent audit she cited was done on 167 providers that were picked for the audit because they billed far more per client than other agencies for this service. According to the state, community support is being overutilized and breaking the budget. Why didn't the state also exercise its responsibility to appropriately enforce conditional endorsement and utilization for this service?

The state contracted utilization management to Value Options in 2006, but apparently failed to keep track of its own budget to notice that the 167 agencies were billing a whole lot more services than the other 835 agencies that weren't! Once realizing this, and knowing there would be significant cost overruns, why didn't the Department of Health and Human Services and particularly the Division of Medical Assistance start asking questions a little sooner than the final quarter of fiscal year 2006-07?

Hooker Odom says state officials had always said they would have to revisit the rate and see if it was set appropriately. Way to go! Where was this said and when? At a cocktail party?

Instead of doing a solid cost analysis study, the Department of Health and Human Services retroactively notified stunned providers that their recent Medicaid checks would be 33 percent short of what was actually billed to the state.

A reasonable response by the state would be to enforce the service definitions and make sure that providers were following the intent of the definition. If they were not, because endorsement to do the service in the first place is presently conditional, those providers could have been put on a corrective action plan or probation or both.

The reasonable response is not to punish providers and consumers who depend on this service. It is not reasonable to drive providers quickly out of business by cutting fee reimbursement 33 percent.

Community support is the linchpin of mental health reform. Without it, many other services -- such as mobile crisis response, intensive in-home services, intensive outpatient services for substance abuse and psycho-social rehabilitation -- do not quite work.

Therefore, without adequate community support, reform will fail. Already within one week of this announcement, companies have started closing their doors, announcing closure and moving out of smaller counties.

Mental health reform is young and tenuous. Companies have spent millions of dollars aggregately in the past year to get fully staffed and trained. The state is acting irresponsibly.

I suggest Hooker Odom and Mike Moseley (director of Mental Health, Substance Abuse and Developmental Disabilities) resign and that Gov. Easley find other people who can come up with more reasonable solutions.

R. Jane Ferguson is the CEO of Appalachian Counseling, which provides mental health care services to about 5,500 clients in Henderson, Transylvania, Polk and Buncombe counties.

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The Missing Voice of Mental Illness - Washington Post

Opinion: April 24, 2007

By Pete Earley

Virginia Gov. Timothy M. Kaine has created an independent panel to review all aspects of last week's Virginia Tech massacre. He has recruited former homeland security secretary Tom Ridge, a retired state police superintendent and experts from education, law enforcement and psychiatry. What's missing is someone who has personal experience struggling with a mental disorder.

We may never know whether Seung Hui Cho had a mental illness such as bipolar disorder, schizophrenia or major depression, or whether his wrath was an episodic outburst committed by a sociopath. These psychiatric distinctions are important; the most prevalent mental illnesses are not caused by bad upbringings, bullying or immoral behavior but are considered by the National Institute of Mental Health to be brain "sicknesses" that can affect nearly anyone. Sadly, these differences will not matter to many Americans: Because of Cho's vengeful video rants, his has unfortunately become the de facto face of mental illness.



Messages at Robinson Secondary School in Fairfax honor those killed at Virginia Tech. (By Chip Somodevilla -- Getty Images)
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Cho, of course, is not representative of Americans who have had diagnoses of mental illness. Some more familiar faces include CBS journalist Mike Wallace, actress Patty Duke, Rep. Patrick J. Kennedy (D-R.I.), and writers such as William Styron and Kurt Vonnegut. Most Americans with mental health problems are simply ordinary people dealing with what can be extremely difficult and cruel disorders.

For many years, concerned parents, relatives, friends, psychiatrists and even government officials have tried to help people with mental disorders by finding ways to effectively treat their illnesses. They have learned that the best teachers are often those who have struggled personally with mental health problems and have found ways to recover.

In not appointing a panel member who has publicly struggled with a debilitating mental illness, Kaine has missed an opportunity to remind the nation that Cho and his actions do not accurately reflect the millions of Americans who have brain disorders. Naming such a person would help reduce fears about people with mental illnesses at a time when Cho's psychosis-fueled executions have increased stigma.

Just as important, someone who has experienced the isolation and self-loathing that often accompany depression and serious mental disorders would be in a better position than others to recognize, understand and explain why someone such as Cho may have avoided seeking and receiving help before it was too late.

Because the public tends to see a mentally ill person only when the person is clearly psychotic or has been abandoned on our streets, the suggestion of having a person with a mental illness on the investigative panel may strike some as odd. But that reaction reflects the stigma and prejudice that need to be squelched.

Kaine would be wise to invite onto the panel someone who understands firsthand what it is like to be tormented by a mental disorder. Kay Redfield Jamison, author of "An Unquiet Mind" and a professor of psychiatry at Johns Hopkins University, is regarded as one of the nation's leading experts on bipolar disorder -- an illness that she knows intimately because she has it. She or other experts would be familiar with what barriers persons who have mental disorders see when it comes to getting help and what helped them overcome their illnesses -- from their own perspective when they were racing along the edge of madness.

Pete Earley is the father of an adult son who has a mental illness. His book "Crazy: A Father's Search Through America's Mental Health Madness" was a finalist for the 2007 Pulitzer Prize in nonfiction

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System failed assailant - Raleigh News & Observer

Letter to the editor:

As one who has lost a child through a sad accident, my heart goes out to the slain students and parents in the Virginia Tech tragedy.

At the same time, I am dismayed by the apparent lack of understanding for the assailant who obviously was in deep pain from a lifetime of mental illness causing isolation and rejection.

Our anger should be directed at a system that failed to give him the help that he desperately needed and a culture that is ashamed to acknowledge mental illness.

We can pass all the gun control and security laws imaginable, but until we devote more research and develop better medical procedures for the mentally ill, we may just be spinning our wheels.

Joan Robinson

Cary
Read more!

Committed not on gun list - Raleigh News & Observer

Jim Nesbitt and Jessica Rocha, Staff Writers

Thousands of people involuntarily committed to psychiatric institutions by North Carolina courts aren't in a national database aimed at preventing gun sales to people with dangerous mental illnesses.

Although it is a felony to knowingly sell a gun to anyone so troubled, North Carolina court clerks keep commitment records under wraps because of privacy provisions in state mental health statutes. That means they don't show up in the FBI-run National Instant Criminal Background Check System that gun dealers and law enforcement use to determine whether a customer can legally purchase a firearm.

"We have no authority or directive to report this information to anybody," said Dick Ellis, spokesman for the N.C. Administrative Office of the Courts, which oversees courthouse operations. "Unless we're told directly to do so, we don't give our records over to anybody."

After last week's killing spree at Virginia Tech University by student Seung-Hui Cho, the availability on the NICS database of involuntary commitment orders and other court rulings related to mental health has become a major issue. Privacy concerns are pitted against public safety fears.

Despite a 2005 court declaration that Cho was a danger to himself, he was able to legally purchase two handguns he used to kill 32 people and himself at Virginia Tech. A Virginia judge ordered Cho to undergo a mental health evaluation, but the ruling didn't show up on the background check.

Federal law prohibits gun sales to people who fall into 10 categories, including felons, illegal immigrants, subjects of domestic violence restraining orders and anyone committed to a mental institution or ruled "mentally defective."

But the 10-year-old background check system depends on states to forward information, particularly court orders related to mental health. In the year ending last July, there were 56,124 confidential special proceedings in North Carolina courts. Those included involuntary and voluntary commitments to mental institutions but also hearings to suspend the licenses of attorneys, according to records with the N.C. Administrative Office of the Courts.

Experts say legislators have created exemptions to the mental health privacy provisions, including a requirement that courts report commitments for substance abuse to the Department of Motor Vehicles. Unless legislators provide a similar exemption for the database, court clerks won't give up those records, Ellis said.

Two ways to get in

As a result of this cloak of privacy, North Carolina mental health filings to the NICS database fall primarily under two categories, said John Aldridge, special deputy attorney general and leading authority on state firearms law. Both depend on the diligence of the local official in charge of the records.

One is an open court result in a criminal case, such as being found not guilty by reason of insanity. The other is a record of being turned down by a sheriff for a pistol-purchase permit or concealed-carry permit.

North Carolina sheriffs, who are responsible for background checks on applicants for both permits, can check commitment records on concealed carry permits because applicants waive their privacy rights. They aren't allowed to check commitment records for pistol purchases but may learn of such orders by other means and deny permits.

It's also up to sheriffs to decide whether to forward permit denials to the NICS database. So far, North Carolina sheriffs have forwarded 319 mental-health-related denials since the database was created in 1998, Aldridge said.

House ponders change

Today, the state House will consider a bill that would allow sheriffs to inform other sheriffs if they deny a pistol permit for mental health reasons.

Though it keeps involuntary commitments confidential, North Carolina is one of 22 states that report mental-health related information to the NICS, federal officials say.

But the number of North Carolina filings pales beside the 80,000 mental-health-related entries that Virginia has made in the NCIS database.

Since the Virginia Tech killings, there have been calls to make involuntary commitment orders an exception to medical privacy laws -- something both mental health advocates and gun rights adherents successfully opposed in 2002 when the measure was introduced in North Carolina.

"We need to lower the threshold so that all people who show signs of being a danger to themselves or others are reported," said Lisa Price, executive director of North Carolinians Against Gun Violence, a gun-control group that pushed the 2002 legislation as part of an anti-gun-trafficking package. "Keeping guns out of the wrong hands -- that's our goal."

F. Paul Valone, president of Grass Roots North Carolina, a gun rights organization, vows to fight any attempt to remove the confidentiality cloak from involuntary commitment orders.

"The intention behind that legislation was to foment additional gun control in North Carolina, and we won't tolerate that," Valone said.

Mark Botts, an expert on mental health records and confidentiality at the UNC-Chapel Hill School of Government, said legislators already have written several exemptions into the law, including the DMV measure. Sealed court records relating to mental health treatment are also legally shared for child or elder-abuse investigations and can be unsealed if the information is considered in the public interest.

In the wake of the Virginia Tech massacre, Botts said a similar exemption should be made for the gun database.

"I don't think it has to be that polarizing," he said.

Staff writer Jim Nesbitt can be reached at (919) 829-8955 or jim.nesbitt@newsobserver.com.

© Copyright 2007, The News & Observer Publishing Company Read more!

Home-health agency started small - Fayetteville Observer

By Melissa Willett

Two Lumberton sisters were named National Small Business Persons of the Year on Tuesday during the Small Business Administration’s conference in Washington.

Bobbie Jacobs-Ghaffar and Lesa Jacobs started their company — Native Angels Homecare and Hospice — in 2000 with only a cell phone between them, two patients and a certified nursing assistant.

Today, the company has more than 300 employees, sees more than 750 patients daily and earns more than $9 million annually.

The sisters were selected as the winners based on their record of stability, growth in employment and sales, financial condition, innovation, response to adversity and community service, according to the SBA.

“I think it’s great to be recognized among our peers,” said Jacobs-Ghaffar. “I really think it’s a tribute to the people that work for us. I would encourage anyone with a burning desire to start a business to do it. Small business owners are those who take risks.”

The sisters are doing just that. Growing up poor in Robeson County, the women were taught to love and care for people regardless of their financial status. So it’s no coincidence that they started a home-health business in their mid-30s.

Jacobs-Ghaffar had grown tired of writing grants and working different consulting jobs. Her sister, a registered nurse, was ready to be her own boss, as well.

“I was able to use my skills doing the administration part of the business and my sister, the R.N., could use her talents,” Jacobs-Ghaffar said.

Three years after starting their business, they added a mental-health division. In 2004, they started a hospice program.

Recently, they became licensed in South Carolina and Florida to practice home health.

Now they are in the process of building a new headquarters, Angel Exchange, which will be in Lumberton. It will allow the business to consolidate its operations and offer onsite healthcare services traditionally offered on an in-home basis, the SBA said.

The project, valued at $7.2million, is being funded in part through a Small Business Administration loan. It will create 105 jobs in a county where the unemployment rate is above average.

Sports

The building will include a full-service cafeteria, pharmacy, gift shop, spa, urgent care and chapel. The campus will include a 110,000-square-foot regional sports complex, which will host national competitive sports tournaments and professional meets. It will be run by the Angel Elite Sports Foundation, a nonprofit organization.

“Why sports?” Jacobs-Ghaffar asked. “Because it was something that made a difference in my life. I came from a low-income family and it taught me team concepts, how to overcome adversity, build self-esteem and how to react and interact socially.”

Growing up, Jacobs-Ghafar played softball at South Robeson County High School and at UNC-Pembroke.

As members of the Lumbee tribe, the women understand that starting a business can be especially tough for minority owners.

But that didn’t deter them.

“You ask why Robeson County?” Jacobs-Ghaffar said. “That’s our home. The culture there, we understand it. There’s not a lot of questions about their (patients’) lives and their living conditions. We embrace them and care for them as they are.”

And that’s what they plan to do when they return home from Washington. Back to work, business as usual. Only now there will be a national award hanging on an office wall for all to see.

Staff writer Melissa Willett can be reached at willettm@fayobserver.com or 486-3574.
Photos: Bobbie Jacobs-Ghaffar; Lesa Jacobs Read more!

Lots of talk about money, but it’s people who matter -Asheville Citizen-Times

by Carol Wood
published April 26, 2007 12:15 am

Regarding recent news articles in the Citizen-Times about the 33 percent Medicaid rate cut for providing mental health services: Not enough is being reported about what this means for the humans who receive these services and those who deliver them.

Community Support, the mental health service being cut, is designed to provide enhanced benefits to mentally ill individuals, in large part to divert from costly hospitalization. When Community Support is no longer viable because the reimbursement is too low, clients who can no longer get this service are more vulnerable to crisis and an increased need of hospitalization. And as pay rates are lowered to reflect decreased reimbursements (which is currently happening), employees will be looking for work in other fields.

The state has asked providers to work increasingly hard for fewer dollars. There is a cost-benefit analysis that suggests no one in their right mind would continue to try to provide this needed but challenging service.

Meanwhile, those of us not yet in our right minds soldier on.

Carol Wood, Asheville

Wood is a licensed clinical social worker. Read more!

Mental health services change sought - Asheville Citizen-Times

Note: In light of the story being about developmental disabilities, the headline is interesting

by Leslie Boyd, LBOYD@CITIZEN-TIMES.COM

ASHEVILLE — The Arc of North Carolina brought its campaign to improve services for people with developmental disabilities to the area Wednesday evening with a forum at the YWCA.

The advocacy organization, which has some 5,000 members across the state, presented its “Roadmap for System Success” to a group of providers and advocates.

Dave Richard, the director of Arc of N.C., said the document came about because “the existing model of one-size-fits-all services for people with developmental disabilities, mental illnesses and substance abuse isn’t working and can’t work.”

Linda McDaniel of The Arc of Buncombe County said there’s a myth among legislators that developmental disabilities services are funded adequately, and she worries the budget could be cut.

The Arc document doesn’t suggest huge increases in the budget, but does recommend that the N.C. General Assembly:

• Find funding for the full number of Medicaid waiver “slots” — 660 — the state had hoped to fund, instead of the 200 slots in the current version of the budget. The waiver covers a wide range of services and the state pays only one-third of the tab. The cost to the state would be $10 million and the federal government would contribute about $20 million.

• Increase funding for respite services for families who don’t qualify for Medicaid or for state money.

• Fully fund First in Families, an initiative already available in 33 counties that helps families get services or equipment that’s not covered by Medicaid or insurance.

On the Net: To read a copy of “Life in the Community: A Roadmap for System Success,” which contains the full list of recommendations, visit www.arcnc.org/action_alert/Roadmap%204.17.07.pdf.

Contact Leslie Boyd at 828-232-2922, via e-mail at lboyd@ashevill.gannett.com Read more!

Bubba, Blacks and Guns - Black Press International

Apr 25, 2007
Commentary, William Reed, Posted:

Where racism has been expressed by a shooter, can slain victims be considered killed at random? While the nation mourns the Virginia Tech deaths, the 2003 shooting rampage in Meridian, Miss., has been all but forgotten -- if it was ever thought of at all.

One of the first students killed in the Virginia Tech shootings was Ryan Clark, a young African American student. The fatal shootings have thrust the issue of gun control back on the national political agenda and illustrate another gap in attitudes that separates blacks and whites. African Americans are more likely to support gun control and less likely to own a handgun than whites.

Bubba with the gun rack on his pickup truck remains a real and consistent threat for blacks in America. As white Americans in Congress and statehouses fret about 2nd Amendment rights after Virginia Tech, African American families involved in the nation’s most heinous racial hate crime committed with firearms have yet to have the issue addressed and resolved.

The dastardly deed occurred in 2003 at a Lockheed Martin assembly plant in Meridian, Miss., when a white factory worker went on a rampage, shooting five blacks and one white dead before killing himself. During the morning break, the gunman opened fire at the aircraft parts plant with a shotgun and a semi-automatic rifle.

The shooter, Doug Williams, was a 19-year company employee who didn't like blacks and had talked about wanting to kill people. Williams had previously exhibited racist behavior and undergone psychological evaluation as a result of a racially charged argument he’d had with a fellow worker less than two years before the rampage.

Erica and Jonathan Willis, children of shooting victim Thomas Willis, now allege that Milwaukee, Wis.-based NEAS Inc. and Meridian-based Psychology Associates caused the problem when their evaluation failed to address Williams’ racism and rage. Their attorney -- William F. Blair -- says the family is suing the companies "for damages and acknowledgment that this was a senseless racial murder."

Willis’ fatal contact with Williams came on July, 8, 2003 after Williams abruptly walked out of a mandatory diversity training class at the plant. Williams went to his vehicle and returned with a 12-gauge shotgun and a semiautomatic rifle. Mr. Willis, who had apparently complained to company officials about Williams' threats, was shot in the back as he tried to flee.

The national conscience will side with Virginia Tech victims, but proving the culpability of the Lockheed Martin contractors in Williams’ acts has been difficult for plaintiffs. Black plant workers say they’d complained for months that Williams threatened them, used racial slurs and even spoke of a coming "race war."

Lynette McCall, one of those murdered, had told her husband of several racist incidents involving Williams over years; such as: "Saying he was going to come in one day and kill up a bunch of niggers and then he was going to turn the gun on himself." When Williams overheard a black man complimenting a white woman on the factory floor, he stepped to the man, used a racial slur, angrily told him blacks had no business being with blond women, and threatened him. The night before the fatal shooting, Williams told his father he was angry that he would have to attend the annual ethics and sensitivity training course the next morning.

Brenda Dubose who suffered injuries in the attack is a party to the suit, but Psychology Associates officials “deny” they are liable in any regard. Blair says Williams had been referred to NEAS, then to its affiliate, Psychology Associates, in response to an argument with a black employee. He says Lockheed had told NEAS about Williams’ violent racial threats. NEAS employed Psychology Associates in Meridian to evaluate Williams but only told Psychology Associates that Williams had “communication problems”. Blair contends both companies failed to reasonably evaluate Doug Williams and claims they did little to defuse Williams' hostility and allowed him to return to work.

The nation’s attention will focus on mental illness in the Virginia Tech shootings, but societal inattentiveness to illnesses of racism continue to allow gun and workplace practices to the detriment of African Americans. In spite of Williams' violent attacks and history of racial taunting, local law enforcement says it isn’t clear the shootings were racially motivated. The Lauderdale County Sheriff claims it appears Williams “fired at random.”
Read more!

My Brother's Battle -- and Mine - Washington Post

By Asra Q. Nomani

MORGANTOWN, W.Va.

"I'll take a knife and cut up your uterus," said the voice on the other end of the line. I shuddered, but got off the phone gently, because the speaker was someone I love very much. My brother spoke those chilling words to me last October, but the recent suicide-massacre at Virginia Tech brought back the anguish of that day.

Like so many, I mourn for the victims and their families and friends. But strange as it may sound, I also connect with the killer and his immigrant family, and my sadness extends to them. Since the early 1980s, my brother has been bravely battling an incurable illness called schizoaffective disorder that hit him on the threshold of adulthood. It's a brain disease related to schizophrenia, characterized by mood swings, thought disorder, psychosis and bursts of violence. When he's being treated, my brother is kind, thoughtful, loving, a genius in world history and brilliant at soccer, a sport he had hoped to play professionally.

The day he threatened me last year, he had refused to go to the hospital for a regular dose of a new injectable antipsychotic drug his physicians were trying. I had urged him to take his medicine, prompting the outburst. In the preceding months, he had been "decompensating," psychiatric jargon for melting down, as the new medicine wasn't working well. We'd been there before. Over the years, my family had been on the firing line because of my brother's illness. Once, he punched me in the head. He has kicked, scratched, hit and spat on our parents. Earlier last year, he had broken down our mother's bedroom door and pummeled her. But we always knew it was his illness speaking, and we always loved him. And we knew that he was suffering.

This wasn't the American dream that our parents -- like the parents of the Virginia Tech killer -- were chasing. They had immigrated to the United States in the 1960s in search of better lives than our native India could offer. My brother and I joined them in 1969, when I was 4 and he was 6. Like Seung Hui Cho and his sister, who were born in South Korea, my brother and I are part of the "1.5 generation," who come to the United States as children.

Now psychiatrists are learning something about this generation. A study published in the Schizophrenia Bulletin last year found "compelling evidence" that immigrants have an elevated risk of developing schizophrenia and other types of psychotic disorders. A 2005 Journal of Psychiatry article reported that "social defeat," or the "chronic stressful experience of outsider status," can make migration an "important risk factor" for schizophrenia. While my brother deteriorated, I went out, like Cho's sister, and became the supposed immigrant success story, privately in anguish all the while.

Away from home in those early years of my brother's disease, before cellphones, I thought about getting a pager so my mother could reach me if my brother beat her up. I have lived in dread ever since that I'd get a phone call saying that my brother, who lived at home, had killed our parents. When he threatened me last fall, my family and I made a heart-wrenching decision for the sake of everyone's safety: We had him committed to a psychiatric hospital.

We were one of the lucky families. We live in a state where such an act is possible, because the legislature wrote new laws in recent years that allow mental health commissioners to examine medical histories, among other things, when judging whether people are likely to seriously harm themselves or others. Too many states do not allow the consideration of medical histories.

As someone who has spent 25 years painstakingly navigating mental health laws to protect my family, my brother and society from violence, I believe that future massacres like the one at Virginia Tech and others can be avoided. But it will take much-needed reform of outdated state laws based on the concept, dating to 1972, that people must be of "imminent danger" to themselves or others before a court can order them into treatment.

On the books, in part due to the lobbying of the Arlington, Va.-based Treatment Advocacy Center, most states have departed from the "imminent danger" standard. In recent years, 23 states have lowered the bar to include a "need for treatment" standard to determine whether someone should get court-ordered treatment, either outpatient or inpatient. New standards in North Dakota, for instance, consider whether there has been a "substantial deterioration in mental health."

But an attitude requiring dangerousness prevails, not allowing mental illnesses to be treated as the medical conditions they are. Pennsylvania requires a person to be of "clear and present danger," and Virginia has retained the "imminent danger" standard. That was what handcuffed Virginia Tech police when an English professor warned them about Cho's disturbing classroom behavior. Tragically, in January, the Virginia General Assembly passed up an opportunity to broaden the criteria, tabling proposed reforms in favor of waiting for a commission report -- due in 2009.

Every week, our national mental health crisis comes to life for me when I drive a little more than an hour on I-79 South to a place called Weston, W.Va. Heading through town, I pass a sprawling building of native blue sandstone that was opened in 1858 as the Trans-Allegheny Asylum for the Insane. It's closed now, replaced by a state mental hospital up the road from the Mystik Mountaineer Mart.

At the new hospital, behind the locked doors of the G-1 unit, my brother has been treated for the past six months, slowly getting better. It's not the institution of expos?s past. Last weekend, a nurse gave my 4-year-old son and me a tour of the rec room, the indoor swimming pool area, the neatly stocked library and the cafeteria.

But it's also not pretty. Not long ago, my brother was punched in the jaw by another patient. A male nurse dislocated two fingers while pulling them apart. As I visited my brother last week in a locked room for visitors, the assailant waved to me through the glass window, his earlier violence apparently forgotten.

My brother is due for a mental health commission hearing this week to determine whether he should be hospitalized for another six months. "I'm scared," he told my mother and me, and I knew he was getting better. It's rational to be afraid of being committed to a psychiatric unit.

Because of West Virginia's new legislation, he probably will be discharged soon for a six-month "temporary observation period" that orders him back to the hospital if he doesn't take his medicine. The bar will not be violence.

As a psychiatric nurse let me out of G-1, we stood for a moment at the door beside a sign that read, "Caution. Elopement Risk." "We wouldn't leave someone bleeding on the streets because they didn't want to go into the hospital after a hit-and-run," the nurse said to me. "Why abandon the mentally ill?"

As the nurse went back into G-1, I caught my brother's eye through the sliver-of-glass window on the door. My heart ached, but I knew that he wouldn't be a threat to others as he received the treatment he critically needs. Then the door clicked shut.

asra@asranomani.com

Asra Q. Nomani is the author of "Standing Alone: An American Woman's Struggle for the Soul of Islam." Read more!

California told to submit better hospital plan - LA Timew

Mental health officials are given until May 21 to figure out how to stem departure of clinicians.

April 24, 2007
By Lee Romney and Scott Gold, Times Staff Writers

SACRAMENTO — Saying he was unimpressed with a state plan to address a crippling staff shortage in California's mental hospitals, a U.S. district judge Monday gave the Department of Mental Health another month to submit a more comprehensive solution.

In February, Judge Lawrence K. Karlton ordered state mental health officials to produce a plan that would stem the flow of mental health clinicians to better-paying jobs with the California Department of Corrections and Rehabilitation. That exodus has left the state hospitals dangerously short of staff and jeopardized patient safety.

In response, Gov. Arnold Schwarzenegger and Department of Mental Health Director Stephen W. Mayberg last month authorized raises for existing staff through the end of June, and will seek to extend the increases through the next budget year.

But lawyers who are representing mentally ill prisoners in a class-action lawsuit before Karlton said those raises fell too short of corrections' salaries to prevent staff from leaving the hospitals for prison jobs.

When told that the Department of Mental Health would submit a better plan, Karlton voiced fears that there may not be enough qualified clinicians in California to solve the problem.

"It's not at all clear to me what can be done," he said. "I'm very discouraged."

Nevertheless, Karlton gave the state until May 21 to submit a more detailed plan, after Deputy Atty. Gen. Lisa Tillman explained that more money — for raises for recruits as well as existing staff — might be secured in the upcoming revisions to next year's budget.

"I want something concrete when you show up next time," Karlton told Tillman.

Karlton is overseeing changes in the prisons' mental health system, where he has deemed care so poor as to be unconstitutional. He has authority over state mental health facilities only because they treat some mentally ill prisoners. He signaled Monday that he was unlikely to order broad changes for that department.

"I am not in charge of the Department of Mental Health and I don't intend to be," he said.

After the hearing, state officials said they were optimistic that the problem could be addressed.

"We are absolutely dedicated to resolving the staffing issues at our hospitals and ensuring patient safety, public safety and staff safety," said Ann Boynton, undersecretary of the Health and Human Services Agency, which oversees the Department of Mental Health.

In the courtroom were employees of Atascadero, Napa and Patton state hospitals, who said they have been forced to work exhausting, mandatory overtimes. They said staff shortages also had meant that they were less able to defuse violent patient outbursts.

Paul Hannula, a psychiatric technician at Atascadero State Hospital for five years and vice president of the hospital's chapter of the California Assn. of Psychiatric Technicians, said the proposed raises add only about $77 a month to technicians' pay — not enough to keep them.

"We are losing our experienced staff," he said. "It is dwindling so fast."

Hannula applauded the judge. "He is taking this very, very seriously," he said.

But some workers were less impressed. Patton nurse Christina Villareal said that workers who left for more lucrative prison jobs were recruiting former colleagues. She said she wanted the judge to take more urgent action:

"I had hoped there would be more to it," she said of Monday's hearing.

lee.romney@latimes.com Read more!

ACLU urges action on jail conditions - LA Times

April 25, 2007
By Stuart Pfeifer, Times Staff Writer

The ACLU of Southern California asked a federal judge Tuesday to hold the Los Angeles County Sheriff's Department in contempt for failing to adhere to a court order to improve conditions at a jail where some prisoners spend days in overcrowded rooms without blankets or regular meals.

The request comes five months after U.S. District Judge Dean D. Pregerson ordered the department to hold inmates no longer than 24 hours at the Inmate Reception Center, the downtown hub through which they are processed into the nation's largest local jail system.

Conditions have grown worse since the department, acting on orders from the county Board of Supervisors, stopped using overtime to maintain jail staffing, according to a brief filed by the American Civil Liberties Union.

The average population in the reception center grew from 740 in January to 1,240 in March, with dozens of prisoners held longer than the one-day limit Pregerson set, according to the ACLU.

Inmates at the reception center are housed in large holding rooms without beds, blankets, toiletries or adequate toilet facilities, the ACLU alleged. Inmates say the rooms are so crowded that they don't have space to lie down, and they often fight over bags of sandwiches tossed to them by deputies.

The ACLU asked Pregerson to consider testimony from several former inmates who described conditions as intolerable. The vast majority of prisoners in Los Angeles County jails are awaiting trial and have not been convicted of crimes.

"Nothing — not even my experience with continued, extensive combat in Vietnam — could have prepared me for the negative experiences that I endured during that month in the appalling L.A. jails," former inmate John Finn said.

If Pregerson finds the Sheriff's Department in contempt, he can impose fines or order it to improve conditions. The ACLU requested that the judge order the county to hire consultants to review medical and mental health services in the jail, study services at the reception center, and monitor the sheriff's budget to make sure enough money is allocated to provide inmates with reasonable treatment.

A sheriff's spokesman said the department was taking steps to reduce the time inmates spend in holding rooms before they are assigned cells in other jail facilities.

"We as always share the concerns of the judge and the ACLU, and every day are working to make it better," sheriff's spokesman Steve Whitmore said. "As we bring on more deputies, more beds will be available."

ACLU attorney Melinda Bird said the organization acted after receiving a number of complaints from inmates.

"It breaks your heart to talk to these guys. We walk down the hallways … and there are men pounding on glass doors begging for food and saying 'I'm freezing cold!' And the deputies ignore them," Bird said.

Former inmate Albert Smith said he was in a holding cell with about 100 prisoners in March when deputies handed a bag of sandwiches and drinks to two inmates, rather than passing them out to people individually.

Two gang members distributed the sandwiches to their friends and let others go hungry, Smith said. An older inmate complained and was then beaten by the gang members, he said.

"Deputies did nothing to intervene or help him; they just let it escalate," Smith said in a declaration filed with the court.


stuart.pfeifer@latimes.com
Read more!

State seeks $7.4 billion for prisons - LA Times

By Jenifer Warren, Times Staff Writer

SACRAMENTO — Facing mounting pressure from the federal courts, legislative leaders and Gov. Arnold Schwarzenegger agreed Wednesday to spend $7.4 billion on new jail and prison beds while doing more to help inmates succeed once released.

The complex deal, reached after weeks of negotiations, represents an effort to ease overcrowding in California's sprawling correctional system, where 172,000 convicts are packed into space intended for about 100,000.

The crowding crisis has become so severe that federal judges, who already control large portions of the state system, are considering whether to cap the inmate population. Hearings on that issue are set for June.

The deal, which would create 53,000 beds at prisons, jails and new urban "reentry" centers, is set for a vote in the Legislature today. Contained in an urgency bill, it requires approval by two-thirds of the members in each house and would take effect immediately. The beds would be funded by lease revenue bonds, which do not require voters' approval.

The bill would also break new ground by giving the governor temporary authority to transfer up to 8,000 inmates to out-of-state facilities against their will. Schwarzenegger initiated such transfers in October to free up space and moved 350 inmates, all volunteers. But the transfers were stalled by the courts after unions challenged the governor's authority to order them.

Senate Democratic leader Don Perata (D-Oakland) praised the agreement as a balanced response to the prison crisis that would reduce the state's alarming recidivism rate.

"Every negotiation requires compromise, and this agreement provides both a big increase in prison beds as well as a strong commitment to rehabilitation programs and greater oversight of the Department of Corrections," Perata said.

In a statement, Schwarzenegger said that after ignoring the prison crisis for decades, California was on the verge of making history.

"This proposal will bring critical new rehabilitation programs and create desperately needed space to relieve overcrowding," the governor said, praising legislative leaders for joining him in addressing "this very real threat to public safety."

But critics called the plan disappointing, saying that it falls far short of what California needs to quickly ease the overcrowded conditions and reduce recidivism. About 70% of felons who are released are back in prison within a few years, a rate that leads the nation.

Several proposals that might have brought a more immediate drop in the population — but are considered politically risky — were omitted from the deal. They include keeping tens of thousands of parole violators out of state prison by using other sanctions to punish them — an approach used in numerous other states.

The agreement does not include the creation of a commission to review and change the state's sentencing laws, which scholars believe is essential to controlling the prison population. Perata said that controversial issue would be dealt with through separate legislation.

Lawyers for inmates in three class-action suits against the state were among those expressing dismay. They predicted that the package would not satisfy the judges considering a population cap.

"The deal is mostly a prison construction program, which is going to cost billions without any significant effect on crime," said Donald Specter, executive director of the nonprofit Prison Law Office. "It really ignores any meaningful short-term reforms and it assumes the department will provide quality rehabilitation programs, which is almost a flight of fancy."

A spokesman for the powerful prison guards' union also had harsh words for the deal and said the organization would work today to sway legislators against it.

"We are going to do everything we can to point out the dangers of this plan," said Lance Corcoran of the California Correctional Peace Officers Assn.

He said the union was particularly concerned about the mandatory out-of-state transfers authorized by the deal, noting that inmates who did not wish to move would create peril for officers.

"We're going to have to fight them out of their cells," he said, adding that putting in more beds at prisons that are already crowded would also endanger officers.

The agreement proposes adding beds in two phases, with the second round of construction authorized only if the Department of Corrections and Rehabilitation meets certain conditions. In addition, all new beds would be accompanied by increases in rehabilitation programs, including substance abuse counseling, academic and vocational training and mental health services. In the first year, $50 million would be allocated for such programs.

The first phase calls for spending $3.6 billion on 32,000 beds at jails, existing prisons and smaller community "reentry" facilities for convicts nearing the end of their terms. The total also would include 6,000 medical beds requested by the federal receiver in charge of inmate healthcare.

In order to obtain funding for the second phase, officials would have to meet about a dozen benchmarks tied to enhanced rehabilitation for inmates. Among those are the creation of 4,000 drug treatment slots; formation of a California rehabilitation oversight board to monitor the department's progress; individual inmate assessments to ensure that each receives suitable education or mental health treatment; and overall expansion of vocational and academic training behind bars.

If the goals were met, the department would receive $2.5 billion in bond money to build an additional 16,000 beds at state facilities; 5,000 beds would be added to county jails.

The state money would be matched in both phases by county funds totaling more than $1.2 billion.

Pressure for a deal has been building since last summer, when a special session on prisons called by Schwarzenegger failed to yield results. In October, the governor declared a state of emergency in the prisons, saying that extreme peril existed for staff and inmates.

In December, lawyers representing inmates in three class-action lawsuits — concerning medical and mental health care, as well as the treatment of disabled prisoners — filed motions seeking the population cap.

The lawyers argue that overcrowding has become so severe that it is preventing state officials from resolving problems they committed to fix as part of the litigation. They say that only a significantly lower population would enable the state to raise medical and mental health care to constitutionally adequate standards.

Two of the judges, Thelton E. Henderson of San Francisco and Lawrence K. Karlton of Sacramento, have already indicated that they may be inclined to move toward a population cap.

At a December hearing, Karlton gave the state six months to continue to show progress, and said that although he hopes to avoid what he called "a radical step," he would do it if pushed.

In a February order, Henderson indicated that he expects the state to reduce the population from its current level. He directed officials to report by May 15, "each concrete measure" they are taking to reduce the population by next March, and by March 2009.

jenifer.warren@latimes.com Read more!

High court overturns 3 death sentences in Texas - LA Times

David G. Savage, Times Staff Writer

WASHINGTON — The Supreme Court overturned the death sentences of three Texas murderers Wednesday, ruling that jurors were not given a fair chance to spare them given their mental difficulties and histories of childhood abuse.

In a series of 5-4 votes, the court pointed to the flaws in the Texas capital sentencing system before 1991. The rulings will probably lead to new sentencing hearings for a handful of Texas death row inmates who were given death sentences under the old system.

Until Texas was forced to revise its law in 1991, jurors were given only two questions when deciding whether a convicted killer would receive a sentence of death or life in prison. Was the murder deliberate, and did the killer represent a "continuing threat" to society? If the jury agreed on a "yes" answer to both, the defendant received a death sentence.

In the late 1970s, however, the Supreme Court had said jurors must be permitted to weigh any "mitigating factor" in a defendant's life or character as a reason to spare him from a death sentence. Nonetheless, the justices upheld the Texas system at the time, even though it left little or no room for jurors to weigh mitigating evidence.

For a time, Texas judges tried to get around the problem by telling jurors they could falsely answer "no" when they were asked whether the murderer presented a continuing threat to society, even though they thought the right answer to the question was yes.

Not surprisingly, the justices in the majority Wednesday described that approach as "fatally flawed" because it depended on jurors giving an answer they knew to be untrue.

Justices John Paul Stevens, Anthony M. Kennedy, David H. Souter, Ruth Bader Ginsburg and Stephen G. Breyer formed the majority in all three decisions.

The rulings reversed death sentences for Ted Cole, now known as Jalil Abdul-Kabir, who strangled and robbed a 68-year-old man in San Angelo; Brent Brewer, who stabbed and robbed a 66-year-old store owner in Amarillo; and LaRoyce Smith, who stabbed and killed a former co-worker at a Taco Bell in Dallas.

In a strong dissent, Chief Justice John G. Roberts Jr. said the fault in the handling of the cases lay with the Supreme Court, not the state and federal judges in Texas.

"Our precedents did not provide them with 'clearly established' law, but instead a dog's breakfast of divided, conflicting and ever-changing analyses," Roberts wrote.

He said the lower court judges were told to follow the law as it was then, but the majority at the Supreme Court shifted back and forth and failed "to follow a consistent path."

No wonder, he said, that the appellate judges in Texas were unsure whether they should affirm or reverse the Texas death sentences handed down before 1991.

Justices Antonin Scalia, Clarence Thomas and Samuel A. Alito Jr. joined Roberts in dissent.

david.savage@latimes.com
Read more!

New Rules for Confining the Mentally Ill -NY Times

April 25, 2007

By SARAH KERSHAW
New York State would more closely scrutinize its use of solitary confinement for mentally ill prison inmates under the proposed terms of a legal agreement scheduled for review by a federal judge on Friday.

New York is one of several states that have faced lawsuits over the means used to punish mentally ill prisoners, and, under a settlement reached last week, it has agreed to consider changes in how it uses solitary confinement as a disciplinary measure with the mentally ill.

Many advocates hail the agreement as a watershed in prison reform because of the effects long sentences in isolation have had on the most vulnerable prisoners, including suicide and self-mutilation.

Some mentally ill inmates serve months to years in punitive segregation, locked up for 23 hours a day and sometimes restricted to a diet of cabbage and a pasty flour loaf three times daily for up to 30 days for misbehaving.

Disability Advocates Inc. and the Legal Aid Society of New York sued the state over the practices five years ago, and the resulting agreement goes before Judge Gerard E. Lynch of the Southern District of New York on Friday for final review.

If the agreement is approved, as expected, the state will not be barred from the use of solitary confinement, or punitive segregation, to discipline mentally ill prisoners, but it would have to provide far more assessment and services for mentally ill inmates in solitary. In addition, the state would be required to review the reasons for and the length of proposed segregation sentences.

Many mental health advocates believe that the New York settlement will create pressure on other states to review their policies of confining mentally ill prisoners.

Others, including state lawmakers and advocates, said the agreement was only a small step toward stopping inhumane treatment of these prisoners. Many of those advocates were particularly disheartened last fall when Gov. George E. Pataki vetoed a bill that would have banned the use of solitary confinement for the mentally ill in New York.

“We see the settlement as a step in the right direction because it provides additional resources and services for treating the mentally ill in prison,” said Robert Gangi, executive director of the Correctional Association of New York, an advocacy group that is now lobbying the new administration in Albany to stop sending mentally ill prisoners into isolation. “But it falls far short of the policy changes that are needed to ensure humane and appropriate treatment for all the mentally ill people in prison.”

In New York, with one of the largest prison populations in the country, mental illness has been diagnosed in about 8,400 of the 63,000 inmates, according to the State Office of Mental Health. The number of inmates has decreased significantly in the last few years, but Mr. Gangi said the number of mentally ill prisoners was rising, possibly because the condition is being more accurately diagnosed.

Under the agreement, mentally ill prisoners sent to solitary confinement would be entitled to leave their cells for therapy and treatment for two to four hours daily. Their placement in solitary confinement would have to be preceded by extensive reviews, all prisoners entering the system would be screened for mental illness, and the state would be required to provide some mentally ill prisoners with alternative residential housing.

State officials said that because of both the agreement and their own budgetary priorities, they had set aside an additional $9 million in the 2007-8 fiscal year for programs within existing prisons and new or renovated facilities to accommodate mentally ill inmates, a total of $57.5 million dedicated to mentally ill inmates.

The agreement also stipulates that New York prisons, which local and national advocates say are unique in using restricted diets to punish prisoners already in segregation, cannot use the cabbage-and-loaf punishment for more than seven days with mentally ill prisoners without “exceptional circumstances.”

Lawyers who brought the suit and national prisoner rights advocates said the New York settlement was unique in covering all mentally ill prisoners, from the time they enter the system until they leave, whereas some states have merely stopped sending prisoners with major mental illnesses to prisons with especially harsh conditions.

“The proof of the pudding is in the eating,” said David C. Fathi, senior staff counsel with the American Civil Liberties Union’s national prison project, who has handled several cases around the country regarding the treatment of mentally ill inmates. “We will have to see how this is implemented. But on paper, it is very significant, a victory and a step forward.”

He added, “Now we can point to New York and say, if New York can do it, why can’t you do it?”

Copyright 2007 The New York Times Company Read more!

From Brother’s Death, a Crusade -The Washington Post

April 25, 2007
By TAMAR LEWIN

WASHINGTON — One Friday afternoon in March 2000, Alison Malmon, a freshman at the University of Pennsylvania, got word that her brother, Brian, a 22-year-old on leave from Columbia, had committed suicide.

Brian had been a kind of star on campus, with a 3.7 grade-point average, and a lively wit that shone through his roles as sports editor of the newspaper, president of an a cappella group and actor in the annual student-written musical.

The death of her only brother, and the discovery that he had hidden his struggles with mental illness from his friends and family for years after he began hearing voices, rocked Ms. Malmon’s world, and by her junior year led her to start the student group that evolved into Active Minds Inc., a nonprofit organization with student-run chapters on 65 campuses, devoted to increasing awareness of mental illness.

She started small. Very small. Only three people showed up for the first meeting at Penn of what she initially called Open Minds.

“I asked them to help me figure out what we should do, ” said Ms. Malmon, now 25. “There’s so much talk about sexual identity and racial relations on college campuses. It was ridiculous in my mind that mental health wasn’t right up there with them, since it’s an issue that touches so many people.”

The prevalence of mental illness on campus is stunning, she found when she began researching the topic: Suicide is the second leading cause among death for college students. Almost one in 10 college students has made a suicide plan. Nearly half of all students report having felt so depressed that they could not function in the previous year. Most people with schizophrenia develop the disease before they are 25.

And yet, Ms. Malmon said, mental illness like her brother’s is so stigmatized that it is often kept secret.

“Mental illness is such an isolating thing,” she said. “It’s not something that’s easy to tell your family and friends about. That is the impetus for this. I firmly believe that Brian took his life because he didn’t know how to live with mental illness. It’s terrifying, because there aren’t positive role models, there’s just the people you see on the streets.”

Now, with the Virginia Tech shootings, Ms. Malmon is concerned about a resurgence of the stigma against mental illness. “I worry that as a society we’re going to look toward everybody with mental illness as being violent, and that stigma will build right back up,” she said. “We want to emphasize the need for students to talk about what they’re going through, and share their experiences. ”

Active Minds is one place where students can do that. While each chapter is different, the membership blurs the lines between students with mental illness; students with friends or family members living with mental illness; and a smattering of psychology students, social workers and nurses.

“When we have panel discussions, some are about what you can do to help a friend you’re concerned about, that you should go and say, ‘I’m worried about you, is everything O.K.?’ and walk them over to the counseling center,” Ms. Malmon said. “Others are about how to live with mental illness, where people discuss their own experiences with anxiety disorder or depression. It may sound a little mushy, but all these things help get the word out,” whether it is showing ”A Beautiful Mind,” sponsoring a Stamp Out Stigma run or having a speaker.

When a college student develops a mental illness, she said, friends are often the only ones who notice. Active Minds seeks to ensure that everyone on campus knows what mental health services are available and when to use them. On each campus, Active Minds has tables offering materials on mental health — often the same materials available at the counseling center, Ms. Malmon said, but more visible. In some cases, a chapter has worked even more closely with the counseling center, providing student interviewers to sit in when candidates are interviewed for counseling jobs.

Ms. Malmon, a sunny and impressively composed young woman who was a gymnast as a child and a varsity cheerleader at Penn, grew up in Potomac, Md., with her mother, Joanne, a social worker, and her father, Stuart, a lawyer. They separated when she was 8 and divorced when she was 12. “That’s really when Brian and I bonded, traveling back and forth from one to the other,” she said. “It was very important having a brother with me.”

Ms. Malmon was always interested in psychology. As a freshman, she studied historical perspectives on mental illness, and abnormal psychology. Brian’s death focused her interests further. Her senior thesis was “Attitudes Toward Mental Illness Among Ivy League Undergraduates.”

In 2003, Ms. Malmon graduated Phi Beta Kappa from Penn, incorporated Active Minds, and became the youngest recipient of the Tipper Gore Remember the Children Award from the National Mental Health Association.

Now, financed by a combination of individual donations and foundation grants, Active Minds is her full-time job. She shares the headquarters, a crammed one-room office in Washington, with two other women who coordinate the campus chapters. And soon, she expects, they will need more space. Every week brings inquiries about starting chapters, most recently from students or staff members at Arizona State University, Luzerne County Community College in Pennsylvania, the University of Central Florida and Humboldt State University in California.

“We just got a $100,000 three-year grant to do outreach,” Ms. Malmon said. “The goal is a chapter on every campus, but more realistic is that we’ll have about 300 chapters in the next three years. Mental illness is such an important issue. I expect to grow, not stay a little nothing nonprofit.”

Next Article in Education (4 of 11) » Read more!

Changes Urged for Student Privacy Law - AP

WASHINGTON (AP) -- A lawmaker who also is a child psychologist wants Congress to better define when a university can release students' mental health information to their parents.

Last week's massacre at Virginia Tech shows the need for such legislation, said Rep. Tim Murphy, R-Pa.

Virginia Tech student Seung-Hui Cho, 23, went on a shooting spree in a dormitory and classroom building on campus, killing 32 people and himself. It is unclear what, if any, contact the university had with Cho's parents -- even after a professor removed him from class for violent writing and disruptive behavior.

Murphy said he would introduce a bill that would allow a university to notify a student's parents without fear of violating privacy laws if that student is deemed to be at risk of committing suicide, homicide or physical assault.

The Federal Educational Rights and Privacy Act of 1974 allows access to records in case of an emergency or to protect the health of a student. Parents also can be notified if the student consents.

But the law is written too vaguely, Murphy said in a letter to House colleagues.

''There are many examples where information was not released to parents or guardians regarding a student's mental health, which led to miscommunications and withholding of vital information that would have prevented suicides, assaults and other crimes,'' Murphy said.

A magistrate ordered Cho in December 2005 to have an evaluation at a private psychiatric hospital after two women complained about annoying calls from him, and an acquaintance reported he might be suicidal. An initial evaluation found probable cause that Cho was a danger to himself or others as a result of mental illness.

David Shern, president of Mental Health America, an advocacy group for people with mental illness, said Murphy's plan sounds reasonable, but he would like to see the specifics.


Copyright 2007 The Associated Press Read more!

Failure to act before shooting indicts system -Maryland (Annapolis) Gazette

Editorial: April 25, 2007

By all accounts, Cho Seung Hui was a time bomb waiting to detonate. The murderer of 32 students and teachers at Virginia Tech was a social misfit showing signs of violence and depression.

He hinted at suicide and was temporarily committed to a psychiatric hospital. Police had visited him and students dropped out of his classes for fear of their lives. Even teachers pleaded with university officials to intervene after they recognized disturbing behavior.

So with signs this obvious, why couldn't anyone over the past two years stop this mentally troubled student from committing such a heinous act?

There is cause for all of us to ask this question - of ourselves, mental health experts and legislators. We can see the symptoms of people likely to harm themselves or others - we just can't seem to prevent it from happening.

People tried to get help for Cho. When he dropped hints of suicide to campus police in 2005, he was sent to a psychiatrist who determined he was mentally ill - but not a danger to himself or others. Because he made no threat to others, police and campus authorities weren't able to remove him from class or force him into counseling.

The laws that were created to spare mildly ill people from being warehoused in mental institutions have gone too far if this is the result. University officials and others fear lawsuits if they violate the rights of an individual. They aren't even allowed to notify parents of their child's illness. Does that make any sense?

Fearing retaliation in a litigious society, the alternative is to do nothing. Say a prayer, keep your distance and hope that a person's despondent behavior will be cured by divine intervention. We give more attention to people who fail to buckle their seat belts than to people broadcasting signs of mental instability.

Even tougher gun laws haven't been able to stop the mentally ill from buying weapons. Cho didn't admit to his mental illness on his gun registration form - did the authors of this law really expect honesty from anyone with criminal intent?

Even without his admission, Cho's mandatory background check failed to uncover his mental evaluation and temporary confinement. Regrettably, states aren't always providing mental-illness adjudication records to the federal government's National Instant Criminal Background Check. The financial burden is apparently too great - the reason the bill has died twice in the U.S. Senate. We hope this incident encourages senators to reconsider.

But laws alone aren't going to stop determined people like Cho from committing violence of this enormity. That will require continued vigilance by us - and liberalized laws that allow for more intervention.



School lockdown

Given what has just happened at Virginia Tech, you can't blame the county school system for reacting aggressively to a recent intrusion by an uninvited visitor.

Schools should be security-conscious every day, and right now there is good reason for them to be on heightened alert.

The incident started when a man, dressed in what appeared to be women's clothes, attempted to see a female student at North County High School. When the student said she wasn't expecting to be picked up, an alert school official put out the alarm.

Police were alerted and North County High and nine other area schools were locked down for several hours, meaning that no one was allowed to enter or leave.

The man, identified as Antonio Brown, was not found, but police arrested him a few days later. He was wanted in connection with a suspected homicide.

Students and parents may have been annoyed by this disruption, but a suspicious school visit by a man who may be a suspect in a murder is nothing to take lightly. School officials should be thanked for their vigilance.
Published 04/25/07, Copyright © 2007 Maryland Gazette Read more!

Our Broken Mental Health System - Pacific News Service

Apr 25, 2007
Opinion: Barbara Ehrenreich

Leaving aside the issue of WMM (Weapons of Mass Murder, aka guns), the massacre at Virginia Tech has something to teach us about the American mental health system. It's farcically easy for an American to be diagnosed as mentally ill: All you have to do is squirm in your fourth grade seat and you're likely to be hit with the label of A.D.D. and a prescription for Ritalin. But when a genuine whack-job comes along--the kind of guy who calls himself "Question Mark" and turns in essays on bloodbaths--there's apparently nothing to be done.

While Cho Seung-Hui quietly - very quietly - pursued his studies, millions of ordinary, non-violent, folks were being subjected to heavy-duty labels ripped from the DSM-IV. An estimated 20 percent of American children and teenagers are diagnosed as mentally ill in the course of a year, and adults need not feel left out of the labeling spree: Watch enough commercials and you'll learn that you suffer from social phobia, depression, stress, or some form of sexual indifference (at least I find it hard to believe that all this "E.D." is purely physical in origin.)

Consider the essay "Manufacturing Depression" in the May issue of Harper's. Hoping to qualify for a study on "Minor Depression" at the Massachusetts General Hospital, the author, Gary Greenberg, presents himself with a list of problems including "the stalled writing projects and the weedy garden, the dwindling bank accounts and the difficulties of parenthood," in other words, "the typical plaint and worry and disappointment of a middle-aged, middle-class American life..."


Alas, it turns out he does not qualify for the Minor Depression study. "What you have," the doctor tells him, "is Major Depression."

In the early sixties, the renegade psychiatrist Thomas Szasz argued, in The Myth of Mental Illness, that the real business of the mental health system was social control. Normal, physically active, nine-year-olds have to learn to sit still. Adults facing "dwindling bank accounts" have to be drugged or disciplined into accepting their fate. What therapy aimed to achieve was not "health," but compliance to social norms.

Szasz still rings true every time I've been confronted with a "personality test" which reads like a police interrogation: How much have you stolen from previous employers? Do you have any objections to selling cocaine? Is it "easier to work when you're a little bit high"?

Then there is the ubiquitous Myers-Briggs test, which seems obsessed with weeding out loners. Presumably, someone in the HR department can use your test results to determine whether you're a good "fit" - a concept the libertarian Szasz must cackle over. (And incidentally, Myers-Briggs possesses no category, and no means of detecting, the person who might show up at work one day with an automatic weapon.)

But for all the attention to "personality" and garden-variety neurosis, we are left with the problem of the afore-mentioned whack-jobs, and the painful question today is: If Cho Seung-Hui's oddities had been noted earlier - say, when he was still under 18 - could he have been successfully diagnosed and treated? Journalist Paul Raeburn's 2004 book, Acquainted with the Night: A Parent's Quest to Understand Depression and Bipolar Disorder in His Children suggests that the answer is a resounding no.

When his own children started acting up, Raeburn found that there are scores of therapists listed in the Yellow Pages, as well as quite a few inpatient facilities for the flamboyantly symptomatic. But nothing links these various elements of potential care into anything that could be called a "system." The therapists, who all march to their own theoretical and pharmaceutical drummers, have no reliable connections to the hospitals, nor do the hospitals have any means of providing follow-up care for patients after they are discharged. Then there is the matter of payment. Between 1988 and 1998, Raeburn reports, managed-care plans cut their spending on psychiatric treatment by 55 percent, putting mental health services almost out of the reach of the middle-class, never mind the poor. Hence, no doubt, the fact that three-quarters of children and teenagers who receive a diagnosis of mental illness get no care for it at all.

If we have no working mental health system, and no means of detecting or treating the murderously disturbed, then there's only one thing left to do: Limit access to the tools of murder, i.e., end the casual sale of handguns.

Our Broken Mental Health System

Barbara Ehrenreich

Barbara Ehrenreich is the author of thirteen books, including the bestselling Nickel and Dimed. This article was originally published in her blog. Read more!

Mental illness—too much stigma, not enough funding -West Branch (IA) Times

April 25, 2007
by Kandi Baylor

For the families of those struggling with mental illness, there is often a sense of helplessness.

In the wake of the tragic shootings that left 33 dead on the campus of Virginia Tech, Virginia Gov. Tim Kaine has named an independent panel to review the events, including the mental health of the shooter, Cho Seung-Hui. Kaine said the panel will examine several key questions, with the hope of learning more about the killer.

Those questions include: What was Cho’s interaction with the mental health system? What kind of treatment did he receive or not receive? What warning signs did Cho exhibit? Who was warned and what was done?

Mary Kay Townsend of Families Inc. in West Branch believes there are serious problems with the mental health system, but she also believes that the stigma of receiving help dissuades many from seeking it. “Many are hesitant to access services or ask for help when they need it,” said Townsend.

Families Inc. is a local counseling service. Most of their services are done in-home. Townsend believes the services available in West Branch are underutilized — a stark contrast to most communities. One reason may be because many aren’t aware that services are available.

Another may be that people are embarrassed. But embarrassment about mental illness is a hurdle that society must overcome. “It’s so important to realize that it is OK to seek help,” said Townsend.

Even when someone who is experiencing significant problems does reach out for help, it is very difficult to get it. “Lots of insurance policies don’t cover services. Affordable places are hard to get into. If you call and find you have six weeks to wait, it’s discouraging. Many just give up,” said Townsend.

People who saw the coverage of the Virginia Tech shootings look at the shooter and see the face of mental illness. But there are many other faces in our society who are struggling with mental disorders, ranging from mild depression to schizophrenia.

What has happened in our country that there are so many needing help and so few getting it?

Pete Earley, a reporter for the Washington Post and author, recently released the book, “Crazy: A Father’s Search Through America’s Mental Health Madness.” Earley’s son begins suffering with mental illness his senior year in college, forcing his father to deal with the same mental health system that will be scrutinized in the Virginia Tech investigation. Reviews call it “a remarkable piece of investigative journalism” and “a wake-up call — a portrait that could serve as a snapshot of any community in America.”

According to Earley’s research, a mental health revolution has occurred in the United States. In 1955, some 560,000 Americans were patients in state mental hospitals. Between 1955 and 2000, our nation’s population increased from 166 million to 276 million. If you took the patient-per-capita ratio in 1955 and extrapolated it today, you’d expect to find 930,000 patients in mental hospitals. But there are fewer than 55,000. Where are the others?

More than 300,000 are in jails or prisons. Another half-million are on court-ordered probation. The largest public facilities for the mentally ill are jails and prisons. They have become our new asylums.

Mike Quinlan, former mayor of West Branch and a member of the Mid-Eastern Iowa Community Mental Health Center board of directors, agrees that Virginia Tech is a tragic symptom of a much larger issue. “There are a lot of people with mental illness struggling out there,” said Quinlan.

Iowa’s public mental health and disability service system serves more than 70,000 people. “Many of those people get sucked into the criminal justice system — not because they are criminals, but because they can’t get proper treatment and end up doing criminal acts,” Quinlan said.

Townsend agrees that people who are frustrated with the lack of support or who are just intimidated by the system will end up with other problems. “Many will try self-medication for mental health issues. Some will drink or resort to substance abuse instead of seeking services,” she said.

Psychiatrists, psychotherapists and social workers are overworked and underpaid. “There are a lack of psychiatrists and psychotherapists in Iowa in general. Although in this area we are fortunate, the University of Iowa is a tremendous resource,” said Quinlan.

Even with such resources, the university itself isn’t immune to the consequences of mental illness. In November 1991, the campus was terrorized by a student, Gang Lu, who shot six people, fatally wounding four and killing himself. This killer also left messages behind that have never been disclosed.

University officials said the student believed his doctoral dissertation should have earned a prestigious academic award. J. Patrick White, then the Johnson County attorney, said that the man’s “perceived grievances” were more wide-ranging. White painted a portrait of a darkly disturbed man.

While some may believe that events like the ones at Virginia Tech, Columbine or the University of Iowa are isolated and won’t be replicated if they aren’t widely discussed, those who work in the mental health industry put the focus on dealing with mental health issues, not ignoring them.

“Unless you can get help for mental health issues, things can spiral out of control,” said Quinlan. “You would like to think mental health services would be available, but you have to have resources and everyone wants the same tax dollar.”

For the families of those struggling with mental illness, there is often a sense of helplessness. “Many times in families, there is a denial about what might be wrong,” said Townsend. “If it were cancer, you would seek medical help. Often times the mental illness is treatable.”

As painful and upsetting as these tragic events are, one result may be more attention on improving mental health in the United States. “Mental health funding needs to be better. If we don’t do something, the results will be poor and things like Virginia Tech will continue to happen,” said Quinlan.

According to the surgeon general’s report on mental health, in the United States, mental disorders collectively account for more than 15 percent of the overall burden of disease and slightly more than the burden associated with all forms of cancer. These data underscore the importance and urgency of treating and preventing mental disorders and of promoting mental health in our society.

With such staggering statistics and overwhelming obstacles, how do we begin to make a change?

“Sometimes it only takes one person in your life, a teacher, anyone, just someone to love you enough to seek help,” said Townsend. “It can make all the difference in the world.” Read more!

Bill would require at least two military mentalhealth cetners - San Diego Union-Tribune

April 25, 2007
By Rick Rogers

Hundreds of thousands of service members nationwide, including thousands stationed in San Diego County, could benefit from medical centers dedicated to treating war-spawned mental illness and brain injuries, two U.S. senators said yesterday in introducing a bill to create such facilities.

The Pentagon has no specialized centers to lead research on those conditions, develop treatment standards for them or train health professionals nationwide on how to administer the most up-to-date care.

“Our troops are risking their lives for this country, and we owe them nothing less than the best care in return,” said Sen. Barbara Boxer, D-Calif., who is co-sponsoring the legislation with Sen. Joe Lieberman, D-Conn.

If passed into law, “The Mental Health Care for Our Wounded Warriors Act of 2007” would direct the Pentagon to establish at least two centers. They would likely be part of existing military hospitals in regions with many service members. Those facilities might include the San Diego Naval Medical Center, also known as Balboa naval hospital.

The Pentagon would have up to six months from the legislation's enactment to designate the sites, tell Congress how much money they need and specify other details for the system.

The bill also would require Pentagon officials to inform Congress about what they're doing to reduce a shortage of mental-health specialists at military hospitals. In recent months, various surveys have documented the understaffing and highlighted widespread burnout among remaining psychologists, psychiatrists and other related workers.

“I think the biggest point of this legislation is the acknowledgment that 'Houston, we have a problem.' The Defense Department . . . underestimated both the physical and mental trauma caused by this war,” said John Pike, director of the military think tank GlobalSecurity.org.

About 1.5 million service members have fought in the Iraq or Afghanistan wars. Numerous studies have estimated that 17 percent to 33 percent of them suffer mental health problems such as post-traumatic stress disorder, and that one in 10 have experienced a traumatic brain injury. Both conditions can require years of expensive and highly specialized treatment.

Pike gave the bill a “pretty good chance” of becoming law.

“I consider this the down payment on what it is eventually going to cost to take care of injured veterans,” he said.

Joe Violante, national legislative director for Disabled American Veterans, praised Boxer and Lieberman for trying to improve care for troops while they're still on active duty.

“The centers would be a way to develop experts,” said Violante, who estimated that it would cost hundreds of millions of dollars to start such facilities. “Eventually, you hope they will address issues at places like Camp Pendleton and Fort Bragg.”

Camp Pendleton's units have gone through two major rounds of deployment to Iraq, and some of them have served four tours of war duty in recent years. Their most recent wave, which largely ended last month, involved more than 25,000 Marines and sailors.

Once service members leave the military, they usually receive two years of free care from the Veterans Affairs system. The concept of creating specialized centers for certain medical conditions also has been discussed in the VA system.

There's a great need to not only train more people in the best ways to treat mental disorders such as PTSD, but also for research to find better therapies, said Jeffrey L. Matloff, former program director of the PTSD team at the San Diego VA Healthcare System in La Jolla.

“The ideal is to have education and dissemination of information so that we're all up to speed on the latest interventions and techniques, so people at Balboa naval hospital are practicing the same state-of-the-art care” as clinicians at the VA hospital, he said.

Staff writer Cheryl Clark contributed to this report.

Rick Rogers: (760) 476-8212; rick.rogers@uniontrib.com Read more!

Suspect in murder-suicide had history of mental illness - Houston Chronicle

Note: At the end of this story is the response from a number of Houston readers, most of which (after the first couple) portray a likable man who was well thought of.

By ROBERT CROWE

A man who fatally shot his apartment manager, wounded the husband of an Israeli diplomat then killed himself Monday had a history of mental illness, police said.

David Howard Thurm, 48, was supposed to vacate his apartment Saturday after being evicted for harassing management, quarreling with the family of Deputy Israeli Consul General Belaynesh Zevadia and protesting outside The Post Oak at Woodway.

Thurm shot through the door of Zevadia's apartment, wounding her husband inside, then walked to the leasing office where he killed manager Laura Schoellmann, 62, as she was preparing documents to evict him. Then he killed himself.

"During a criminal act ... the husband of the deputy consul general of Israel was shot," Asher Yarden, consul general of Israel to the Southwest, said in a statement Tuesday. He is in good condition at a local hospital.

Thurm had become increasingly hostile toward Schoellmann and the Zevadias since March 13, when he filed the first of two noise complaints against the family, said Sgt. Brian Harris of the Houston Police Department Homicide Division. The Zevadias and their 5-year-old daughter live above Thurm's apartment.

"It was the type of noise for a normally active household, usually from the hours of 6 to 9 p.m.," Harris said.

Thurm, an independent photographer, moved to the apartment in December after selling a home in Fort Bend County following a separation from his wife. His depression and mental illness contributed to a recent divorce, Harris said.

Investigators think Thurm's mental illness took a serious turn in 2005, when his therapist, concerned for her safety, filed a police report about his unstable state.

Schoellmann filed a complaint with HPD on April 14.

He was evicted Thursday and ordered to move out by Saturday, the same day his cat died.

Reporter Peggy O'Hare contributed to this report.

robert.crowe@chron.com


VOICES OF HOUSTON


jackiepierce wrote:
Tragedies will happen, and most can't be prevented because life isn't a straight forward "do x, do y, and result will be favorable".
Anyway, I wonder what the cat died of. Hopefully natural causes. Sometimes people kill their pets, and their wife/husband and children, because they don't want the pets/people they left behind to suffer, that the survivors can't make it without them.
4/25/2007 1:47:15 PM
Recommend

Jazz wrote:
The gunman at NASA was not given an "impossible performance program and had one month before being fired" by pjpowell. He declined to make any changes to his tasks. Because of his own decisions, his company had no choice but to offer him a transfer. He was assurred that he would not be losing his job. While there is no doubt that both men suffered mental problems in these two very separate and unrelated events, it is pointless to lay blame and resolve to making excuses for their heinous acts.
4/25/2007 2:40:19 PM
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Mash1978 wrote:
I can't say I know Dave very well, but I bought the house from Dave and Darlene last December. From the few email exchanges I had with Dave, he seems to be a wonderful person. I am just shocked to hear Dave is involved in this tragedy. I think Christina's use of the word "idiot" really saddens me because people who knew Dave would feel otherwise. We ALL had experienced extreme anger one time or another....and for that split second, we stop thinking rationally and take extreme actions without thinking about their consequences. Unfortunately for Dave, he crossed that thin line. This is just very sad and my heart goes out to the victims’ family as well as Dave's family. It also serves as a reminder that we should lend out a helping hand when we see someone's down and we just "MIGHT" save a few lives.
4/25/2007 3:18:08 PM
Recommend (2)

Stephen424 wrote:
There is absolutely no way the VT killer's videos and pictures that ran for two days on every station on TV have anything to do with inspiring this rash of murder-suicides.

:sarcasm:
4/25/2007 3:34:02 PM
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pjpowell wrote:
Re Jazz's comments - According to whom was the man at NASA 'NOT' given an impossible task? - the person who wrote the review requirements? The person who wanted to transfer him out of their group? (prehaps for a younger, conceivably faster, less costly replacement employee? Was someone already lined up for that position? Has anyone looked into that? What is the hiring, relocation, demotion rate for 40-65 year olds at the company for whom the NASA gentleman contracted, compared to the rate for under 38 year olds?

The above comments and statements made by me were not "excuses" for anything or anyone. They are, however, real issues that can break a human spirit. I would like for an OBJECTIVE third party to do some REAL, STATISTICAL homework on this. I'm not seeing highly skilled 35 year olds being pushed out into the hopelessness of a workplace dominated by those convinced that age means useless, not experienced. No one is superhuman. No one should be mercilessly thrown away after years of stewardship and loyalty.

As a family-member-survivor of TWO random murders separated by TWO years, I assure you that I understand the difference in what instigates random acts of sociopathic violence, and desperate acts of idiocy.

All are heinous. Some, however, have reasons which drove them mad, and some are simply sociopathic. These men were not sociopaths. We need to look at the reasons, even if some would like to encourage us to close our eyes.
4/25/2007 3:37:49 PM
Recommend (2)

JAXXX wrote:
"Suspect in murder-suicide had history of mental illness" YOU THINK!!!!
4/25/2007 3:51:16 PM
Recommend (1)

tovtov wrote:
I am shocked by all of you people who are saying "I knew good ol Dave. Poor guy, so sad that he would do that etc etc etc". You should be ashamed of yourselves. That man is a murderer and will hopefully pay the price for being a murderer. Unlike all of you, my prayers are most definitely NOT with him. And no matter how well you knew him, nor should yours. I don't care what a "wonderful" guy you remember him as, no matter how depressed/suicidal/down and out you are there is no excuse for killing an innocent person! If there is a hell, lets hope he lands up there.
4/25/2007 8:44:19 PM
Recommend (3)

OnLineName wrote:
Tovtov - I am not ashamed to say that Dave was a good guy.

He was a good guy. He was also a murderer for the last five minutes of his life and had he somehow survived his suicide, I would have been first in-line to make sure he was convicted and removed from society.

No one who knew Dave is excusing him, we're just saying we can't comprehend his actions. His mental illness in no way excuses his taking someone's life, but it does help to explain it.
4/25/2007 10:38:32 PM
Recommend (1)

aphroditta wrote:
This is directed to tovtov. here you speak that we should be ashamed to speak of Dave as a good man. Whether you like it or not that is the truth. I knew Dave for the past 5 years and he was a very respectable person. Like OnLineName wrote, he was a murderer for only the last five minutes of his life, so what about the other 48 years and the good things that he did in his life? The fact that he loved his family, his wife, his pets, and his friends. The fact that he was a hardworker. Are we to discard all of that? I am not saying what he did was right, but then again. who am I to judge? My question to you is... are you a perfect human being? What gives you the right to judge anyone? What gives you to judge Dave? And what gives you the right to judge us the ones who knew him? We should concentrate on the positive things in life and let go of all that negativity that we are fed thru the media day after day because I can guarantee you that you will never get the truth anyway.

And to you Dave, I am so sorry for the sorrow that you felt. It must have been intolerable for you to do what you did. I will always remember you as my friend that I had for the past 5 years and not for what you became the last 5 minutes...you will be in my prayers.

To the victims family, I am truly sorry for your loss and I am sure Dave would have been too if he were still with us. My prayers are with you too. It is unfortunate that these tragedies happen. May time and prayer bring you peace...
4/25/2007 11:35:11 PM Read more!

Walk a mile in the shoes of those with,mental illness - hilton Head Island Packet

Editorial:

Deb Morris' team in Saturday's NAMI Walk at Coligny Beach will be called the "Barrier Busters."

As board chairperson of the Beaufort County chapter of NAMI (National Alliance on Mental Illnesses), Deb will join hundreds of others walking to raise money for education, advocacy and support.

But they're doing something even more important. The walkers will also bring mental health into the sunshine where it belongs, especially as the nation reels from the Virginia Tech shootings.

I do not know the medical situation of the shooter who killed 32 students last week before killing himself.

However, I'm told it's inaccurate to link violence with mental illness.

"The U.S. Surgeon General has reported that the likelihood of violence by people with mental illness is low," NAMI posted on its national Web site last week (www.nami.org).

"In fact, 'the overall contribution of mental disorders to the total level of violence in society is exceptionally small.' More often, people living with mental illness are the victims of violence.

"Severe mental illnesses are medical illnesses. They are different from episodic conditions. They are different from sociopathic disorders.

"Acts of violence are exceptional."

While others research the shooter's diagnoses, how he was treated, how the follow up was handled -- and how all of that meshes with prickly medical privacy and civil rights issues -- I think we can all resolve to do something simpler.

We can be "Barrier Busters."

We can help reduce the stigma attached to mental illness. That stigma prevents many from reaching out for help. That stigma keeps loved ones from speaking out for equity in medical care.

Mental illness is like a broken arm. It's a medical problem that needs attention, and can be cured. It is not a family failure. It is not an ethnic or gender failing. It is not shameful. It is not a character flaw.

One thing it is for sure is widespread. Forgive me for being trite, but if you think there are no bats in your belfry, you haven't rung the bell lately.

So why are we hiding it?

NAMI has been fighting this stigma in our community for 15 years. That is why the beach walk is such a big deal.

Lots of worthy organizations hold walks. It was a high-water mark last spring when NAMI joined them. For the first time, mental illness was mainstream. Political leaders stepped out in broad daylight to show support -- right along with parents who struggled for years to get their now-adult children diagnosed and treated.

We can all reach out to hug Virginia Tech. The anguish it is going through could have landed anywhere. We can appreciate the signs of forgiveness showing up on its beautiful campus.

But we can do more. We can bring this new national discussion of mental illness home. And we can do more than discuss it. We can step out and become a "Barrier Buster."


Copyright © The Island Packet, 2007. Read more!

Immigrants seek mental health outreach - AP

April 25, 2007, 2:17AM
By JEAN H. LEE Associated Press Writer

ANNANDALE, Va. — The video manifesto Seung-Hui Cho mailed midway through his rampage at Virginia Tech revealed a bitter, vengeful and violent young man — and raised questions about why he hadn't received counseling or treatment that might have averted the massacre that left 32 students and teachers dead last week.

But church officials in Cho's hometown in northern Virginia say the 23-year-old gunman's family tried for years to get him counseling. And experts say his parents, emigres from South Korea, may have been unsure what to make of Cho's disquieting isolation and held back by the stigma mental illness carries in their culture.

Cho, 8 when his family emigrated to the U.S., was already showing signs that worried his family in Korea: He was unresponsive, nearly mute and distant, relatives say. Cho struggled to fit in, but "we never could have envisioned that he was capable of so much violence," his sister said in a statement Friday.

Gov. Timothy M. Kaine met Tuesday with Korean Americans and promised to reevaluate mental health outreach to immigrants after community leaders pleaded with him for more funding and resources.

Although mental health problems still carry a stigma in many cultures, they can be especially hard to identify in immigrant populations where people may not know if problems are internal or related to the stresses of adjusting to a new country.

Theodore Kim, of the Korean American Association of Greater Washington, said Korean Americans were rendered "completely speechless" by news that the gunman was from their community.

"Unfortunately, our diligence and helping hand failed to reach Seung-Hui Cho," he said tearfully. "How could this happen?"

In the video sent to NBC, Cho exhibits clear signs of a serious mental disorder, said Dr. Damian Kim, a New York City psychiatrist and psychoanalyst. "The main culprit here is mental disease — schizophrenia, the paranoid type," he said.

Kim, who specializes in mental health among immigrants, acknowledged that there is no way to know Cho's true condition without having evaluated him. But he said Cho's sense of persecution and reports he had imaginary friends suggest schizophrenia.

"When it becomes chronic, they have a knack for hiding their pathology," he said, "so the family may not have thought there was anything seriously wrong."

The Rev. Dihan Lee of the Open Door Presbyterian Church in Herndon says many parents are unsure when their children are merely adjusting to U.S. life — or need outside help.

"If you come to this country and your child has to deal with learning the language, fitting into the culture, and they show behavior problems or are socially awkward, you chalk it up to just trying to fit in," he said.

Even if the parents suspect a serious problem, they may hesitate to seek help, said Kim. "Saving face" is paramount to Koreans, who are fiercely proud and protective of their family name and reputation. The shame of one is shared by all, he said.

Church is the backbone of many Korean communities in the U.S., serving not only as a place of worship but also as a community center. But mental health is rarely addressed there.

"Koreans wouldn't want people to know their child is mentally unstable. Who would want that stigma to follow him?" said Henry Pak, 32, of Rockville, Md.

One pastor said Cho's mother went from church to church looking for someone to counsel her troubled son.

"They went around seeking help for their son ever since he stopped talking 10 years ago," said Bong-han Kim, an assistant pastor at the One Mind Church of Washington in Springfield.

News that the gunman was Korean set off a torrent of discussion — and reflection — among Korean Americans, who debated whether pressures within the community may have contributed to Cho's isolation.

For many, the burden of fulfilling the "American dream" can be immense, said Josephine Kim, a Harvard lecturer who specializes in mental health issues among Asian Americans.

She cited a study showing that 76 percent of Asian Americans treated in emergency rooms for attempted suicide cite intergenerational conflicts with their parents.

"The pressure is unreal. Korean parents view their children as extensions of themselves, so if the children fail, they fail," she said.

John Lee, 22, a senior at George Mason University, said many of his Korean-American friends chafe under the pressure their parents place on them to get into a top-tier college.

"It's noble that they came all the way over here for our sake, and I really do appreciate it, but sometimes I wish they understood better that it's a different world — and we have different sets of values and goals," he said.

It's hard to see any similarity between Lee — outgoing, articulate and ambitious — and Cho, a loner with few friends.

But John's father, Jonathan Lee, recalls a time when his son wasn't so well-adjusted. He was distant during middle school, and his grades dropped.

A psychologist assured him his son was fine — and was only being teased at school. They eventually turned to a pastor for counseling.

Lee said he could've turned out angry like Cho, so he launched his own rampage, a "love rampage."

"I made sure I gave everybody around me an extra dose of goodness," he said. "There is too much hate in this world... and I wanted to spread a message of peace and love."

___

On the Net:

Open Door Presbyterian Church, http://www.opendoorpc.org

Korean American Family Counseling Center, http://www.kafcc.org

Korean Community Service Center of Greater Washington, http://www.kcscgw.org Read more!

Mental health system's gaps pose threat to us all -St. Petersburgh (FL) Times

Published April 25, 2007
By DR. MARC J. YACHT

Mental health treatment represents one of the largest holes in our health care system. Health coverage eludes 47-million U.S. residents, but millions more have inadequate mental health coverage. Surveys suggest that about 15 percent of the U.S. population seek mental health services each year. Half that number have significant mental health problems and one in three of that group receives services. That translates to 15-million people with serious mental disorders with little or no care.

The history of mental health services in the United States began with the asylums that evolved to mental hospitals and finally community mental health centers. The advent of the centers in 1955 marked the era of deinstitutionalization and what was touted as a more humane approach to mental illness.

The states and federal government bought into deinstitutionalization and the community mental health network hook, line and sinker. After all, look at the savings; and if the experts are sold on the idea that the state hospitals are inhumane and archaic, who are we to argue. If the experts believe that a community mental health network can offer treatment and a normal life to many who might spend their life institutionalized - it's a win-win; it's the right thing to do!

Unfortunately, the mass exodus from the state mental hospitals left many very ill people without care or their medications, and a very large population of these folks never stepped foot in a community mental health center.

Although the experts pointed to populations that were mainstreamed, little attention was given to the rising numbers of homeless, one-third of whom were mentally ill and often from the state hospital system.

Even today, psychologists and psychiatrists will argue that mainstreaming this population was the correct and humane thing to do; they will also admit that the community mental health system was never funded or able to capture the full population of mentally ill that were released.

Law enforcement has its own problems with the mentally ill who don't receive treatment. The extra burden on law enforcement officers has been overwhelming.

But more important, disturbed people are placed in the prison population without adequate evaluation and treatment. Often, particularly in the dangerously psychotic, that treatment requires isolation and lockdown. Rarely is a jail equipped adequately for that inmate.

However, treatment modalities are superb in treating an array of serious psychiatric disorders. Many, who prior to 1955 might be permanently housed in state hospitals, could, with the treatment regimens available today, live long and productive lives within their communities.

The problem is, as it is throughout our health care system, too many mentally ill cannot access the services and medications they need.

How many tales have we heard of mothers with seriously disturbed children who cannot get the treatment or medication needed for their loved one?

How many walk our streets with bipolar illness and other significant mental disorders without treatment?

How many violent crimes are traced to mentally ill individuals who cannot get or refuse the treatment they require?

Efforts to mainstream the mentally ill must be viewed as progressive and humane. However, that should not interfere with the need to properly isolate and treat the dangerously sick. The state reception centers had the ability to make such identification and house and treat those in a hospital environment. Careful professional determinations would be made for their ultimate release - if ever - into society.

Allowing the discharge of the seriously mentally ill from prison and allowing the untreated to walk the streets without access to medication or services leads to the all-too-frequent headline about preventable death and injury to innocent people. The emotional price on all of us cannot be overestimated.

The opening of the community mental health centers should not have emptied our state mental hospitals and allowed so many untreated mentally ill to roam the streets. That is what happened regardless of the intent of the growth of the community mental health care system. We continue to pay daily as a society for not addressing this problem.

The reception centers should be reopened and the seriously mentally ill isolated from the community with adequate treatment and housing.

Tragedies will continue to strike us within our own communities without the proper attention and resources provided for mental health services.

Dr. Marc J. Yacht is the retired director of the Pasco Health Department.

© 2007 Read more!

County budget cuts loom - KPIX-TV San Francisco

04/24/07

Mental health workers, patients and supporters filled the Santa Clara Board of Supervisor chamber and an overflow auditorium today as they made one of the most impressive shows against upcoming budget cuts yet.

One by one, a seemingly infinite number of speakers addressed the board, asking them not to cut mental health services, as sign-waving, yellow-clad supporters applauded each speaker despite pleas from Supervisor Don Gage for silence.

"It's not right to balance the budget by taking something so valuable away from people who have so little and who suffer so much,'' David Krenek said, whose son suffers from severe bi-polar disorder and depends heavily on the mental health services provided by the county.

The proposed budget cuts would close four mental health clinics in Santa Clara County and would leave an estimated 8,000 clients without care, according to James Kurtz, a psychiatric social worker for Central Mental Health Clinic.

"We wouldn't do this for diabetes or heart disease. There needs to be equal coverage,'' Kurtz said.

Several speakers addressed the shootings at Virginia Tech as the result of a young man slipping through the cracks of mental health.

"This is not an easy decision to make. It's nothing personal,'' Gage said, concluding the opening comment period.

This is the third major rally against county budget cuts by groups dependent on county funding in the last two months.

The Board of Supervisors faces a $238 million dollar budget cut and the question for the board isn't a matter of whether groups should be funded or not but rather which groups can be funded.

The fiscal year 2008 budget will be publicly available May 7 and will be finalized June 15, according to Deputy County Executive Leslie Crowell. Read more!

Taking aim at mental health records-Newsweek/MSNBC.com

By Michael Isikoff
April 24, 2007 - In his first public comments since last week’s massacre, the National Rifle Association’s top lobbyist said today that the group backs proposed new legislation designed to ensure that mentally unstable killers like Cho Seung-Hui do not gain access to firearms.

Wayne LaPierre, the group’s executive vice president, told NEWSWEEK that Cho, the Virginia Tech killer, “absolutely” should have been barred from buying a gun under current federal laws. But Lapierre nonetheless says the group is now working with longtime ally Rep. John Dingell, Democrat of Michigan, on a bill to ensure that mental-health records—such as the December 2005 court order directing Cho to receive a psychiatric evaluation—are entered into a FBI database that is used for background checks of gun buyers. Federal law does bar sales of guns to those who have been found to be mentally “defective,” but most states have a shoddy track record of reporting mental-health records to the feds.


“Our position on this is crystal clear: If you are adjudicated by a court to be mentally defective, suicidal, a danger to yourself or to others, you should be prohibited from buying a firearm,” said LaPierre, who oversees the powerful gun lobby’s political operations. “The federal law is pretty clear on this. He [Cho] should have been in the [FBI] data base.”

Immediately following the shootings last week, the NRA put out a brief statement saying that “out of the respect for the families” of the victims, it would forswear any public comments about the political implications of the tragedy. But since then, there has been a sharpening debate about whether enforcement of the gun laws should be tightened to prevent mentally unstable individuals like Cho from acquiring weapons.

The NRA’s position puts the group at odds with The Gun Owners of America, which has already launched a public campaign to block the legislation that the NRA supports, warning that the proposal could “block millions of additional, honest gun owners from buying firearms.” (The NRA boasts more than 3.5 million members; the Gun Owners group has only 300,000, but maintains clout in the Capitol disproportionate to its numbers.)

“Your Gun Rights Could Soon Hang in The Balance,” the Gun Owners group proclaimed in an “alert” message posted on its Web site this week. The alert warned that even military veterans who were found to have suffered from “post-traumatic stress” disorders could have their names entered into the database and be denied their gun rights.

The debate grew hotter still today when an official of the American Psychiatric Association denounced the proposed bill sponsored by Dingell and Rep. Carolyn McCarthy, Democrat of New York. The measure would provide $1.1 billion in funding to the states and local courts systems over the next three years to computerize records of mental-health orders and commitments so they can be entered into the FBI’s National Instant Criminal Background Check System, a database that is used for background checks of prospective gun buyers. (Currently, only 22 states provide mental-health records to the FBI; many of those that do, such as Virginia, don’t provide complete records of all mental-health commitments and detentions.)

“This looks like an enormously expensive, extremely intrusive, extremely stigmatizing approach to a tragic situation,” Dr. Nada Stotland, vice president of the psychiatric association, the largest group representing the nation’s psychiatrists, said of the McCarthy bill. “It is unconscionable to restrict people’s civil rights because they have a medical illness.”

In his interview with NEWSWEEK, LaPierre brushed aside suggestions that measures such as the McCarthy bill constituted a new form of “gun control” as the Gun Owners of America have charged. He said the NRA, which has long been a powerful opponent of gun control, has always supported denying gun rights to those who are mentally “defective”—one of the categories of individuals who are banned from owning firearms under the 1968 Gun Control Act. (Others include felons, fugitives, and drug users.) “We’ve been there for decades on this,” said LaPierre. “We just don’t think it’s really gun control to try to keep guns out of the hands of criminals and the mentally defective.”

McCarthy told NEWSWEEK that she was pleasantly surprised to hear of the NRA’s public position, noting that an executive of the Gun Owners of America had met with House Republicans this week to gin up opposition to her measure. “I have a feeling that this is their [the NRA’s} way of showing they can be moderate,” she said. (A McCarthy aide said that when the congresswoman's staff members met with NRA lobbyists last January about her proposed measure, the NRA officials said they would not publicly support it unless language was added that would eliminate the existing ban on interstate purchases of firearms. No such language has been added, the aide said.)

Still, McCarthy said today she thought LaPierre’s public statement would buck up House Democratic leaders who have been extremely averse to any measure that might be labeled as gun control. “Their knees are shaking constantly,” McCarthy said about her party’s leaders in the House. “They are scared of anything that might be controversial on gun issues.”

McCarthy, whose husband was killed by a deranged gunman aboard the Long Island Railroad in 1993, also said that the concerns raised by the American Psychiatric Association were overstated. The NICS database controlled by the FBI is not public information—so there is little risk that mentally ill people whose names were entered into it would be “stigmatized” through public disclosure, McCarthy maintains. Moreover, she said, citizens who had been found mentally ill (and were therefore denied the right to own a gun) could also appeal the denial and present evidence that their mental health had improved. “My bottom line,” says McCarthy, “I’m sorry, is if you’re mentally ill, you should not be able to buy a gun.”

URL: http://www.msnbc.msn.com/id/18298126/site/newsweek/

© 2007 MSNBC.com Read more!

More updates later today

TEXT Read more!

A dismal mark indeed - Raleigh News & Observer

A dismal mark indeed - Raleigh News & Observer

Harold Carmel

CHAPEL HILL - Recent revelations of cheating by North Carolina mental health providers come as no surprise. What we are seeing is the state announcing its inability to manage the "transformed" privatized mental health system it has created. This failure endangers the health and safety of North Carolinians.

Recall that mental health "reform" started in 2001 with the premise that the public mental health system was "broken" -- there weren't enough community services, Area Programs were "monopolies," state hospitals were overused and no new money would be needed because so much was being wasted.

Now, six years later, it seems that what we meant to say was that Area Programs were "safety nets," not "monopolies." The "broken" mental health system had aspects we now sorely miss, that are unlikely to be restored for some time. And so many North Carolinians will continue needlessly to suffer.

WHAT WOULD A FAILED MENTAL HEALTH SYSTEM in North Carolina look like?

*It would have skyrocketing state hospital admissions.

*It would have a governor whose budget contains a surprisingly small funding increase for mental health, and who is shocked -- shocked! -- that managing a privatized mental health system is beyond the capabilities of the Department of Health and Human Services.

*It would have had failures of important "safety net" clinical organizations (adding insult to injury, the Division of Mental Health, Developmental Disabilities and Substance Abuse Services would accuse them of financial irresponsibility -- because they served indigent, unfunded patients, precisely those who are most in need of a safety net).

*It would have investigations into privatized entities that might have skimmed millions from the state.

*It would have ongoing losses of community psychiatrists. (The supply fell 16 percent per capita between 2003 and 2005, and these losses have continued.)

*It would have a Division of Mental Health, Developmental Disabilities and Substance Abuse Services that has spent just $39,000 of a $4.5 million appropriation to ensure access to community psychiatry (by devising a process that few agencies could master).

ALL THIS HAS HAPPENED, AND MORE. Welcome to the "reformed" North Carolina public mental health system.

Can it get any worse? Probably. No doubt, there will be more developments and revelations.

You might ask, where do we go from here?

Let's face it: The Easley administration probably cannot make the changes needed to revive public mental health in North Carolina. The legislature cannot take over the administration's responsibilities. We will have to wait for the next governor, the next Department of Health and Human Services secretary, the next director of the mental health division.

North Carolina needs a competent mental health policy organization to provide the next administration with the guidance it will need to lead us out of this mess. Normally, mental health policy is crafted by experts within state government who have the knowledge, experience and perspective to judge what the state needs to do. Given the mental health division's condition, that capability will need to be built anew. It will probably need to be housed outside the division, in a public-service-oriented organization such as the N.C. Institute of Medicine or one of the universities.

The legislature may try to help. It may well want to spend more money on mental health than the governor proposes (it would be hard to spend less). We will hear about the details of various proposals in the months to come.

Yet we must recognize a remarkable accomplishment. Clearly, in 2001 the Easley administration wanted to leave an unforgettable mark on North Carolina public mental health.

It wasn't easy. It took lots of hard work. But there can be no doubt it has left its mark, one that will be hard to forget.

(Harold Carmel, M.D., is associate consulting professor of psychiatry at Duke University, president-elect of the N.C. Psychiatric Association and a veteran of 22 years in public-sector psychiatry.) Read more!

Parental alienation: A devastating problem -Hendersonville Times-News

For more information, visit www.therachelfoundation.com and www.parental-alienation-awareness.com

Lindsay Lancaster
lindsay.lancaster@hendersonvillenews.com

Four kids, 12 and under, no longer want to see their mother, despite a close relationship. Their reasoning? She's a lying, pill-popping, mental case involved in a religious cult. To top it off, she divorced their father.

Truth is, she isn't a druggy, she's sane and she doesn't belong to a cult. She's a loving, lonely mom, alienated from her children by her ex-husband who has brainwashed them to reject her.

As awful as that scenario sounds, situations like these are occurring across the country, in North Carolina and even here in Henderson County. It's called Parental Alienation Syndrome.

Pamela Hoch, 55, is the parent described above. She helped start the nonprofit Rachel Foundation seven years ago to help other parents suffering through parental alienation and to educate the public about this heart-wrenching problem.

Parental alienation, as defined by a support group, is the systematic brainwashing and manipulation of children to destroy a loving and warm relationship they once shared with a parent. Now, after years of lurking in the shadows, parental alienation is beginning to garner state and national attention. In fact, today, April 25, is Parental Alienation Awareness Day in Iowa, Maine, Nebraska, Kentucky and Nevada, thanks to proclamations by the state's governors.

Here in North Carolina, Gov. Mike Easley signed a proclamation declaring April as Child Abuse Prevention month. Parental alienation is considered a form of child abuse.

In her work at the Rachel Foundation, Hoch has seen children cry themselves to sleep every night, coping with a world of fear and hatred.

It has to be taught

She recalls what the judge in her legal case had to say about parental alienation: "Hatred is not an emotion that comes naturally to a child," said Superior Court Judge John Gomery in the Montreal district. "It has to be taught."

Until it happens to you, psychologists say, it's almost impossible to fathom how it feels to think your children hate you.

"Teaching a child to hate, to me, is the most unspeakable crime," Hoch says.

The former teacher is working on her master's degree in community counseling at the University of Texas at San Antonio. She has received numerous awards for her work in parental alienation. She was named Canadian "Woman of the Heart" in 1992 and received an Award of Merit from the National Center for Missing and Exploited Children for "Outstanding Commitment to the Protection of Children and International Child Abduction Issues" in 1999, to name a few. She's married to Bob Hoch, with whom she shares 10 children and two grandchildren.

Hoch and other parents who are struggling with parental alienation issues want the public to understand their severe struggles to regain contact with their brainwashed children.

"Any parent that alienates the other parent shows that they hate the other parent more than they love the child," Hoch says.

How it happens

One parent alienates a separated or divorced couple's child or children from the other parent via a series of tactics. Among them: Repeatedly making untrue statements about the other parent, denying visits with the other parent, acting hurt if the children enjoy being with the other parent and telling the children that the alienated parent never loved them or had abandoned them.

Another tactic, Hoch and others say, is to take a grain of the truth and twist it into something untrue. For example, when Hoch was going through severe parental alienation, she would take Tylenol for her frequent stress-induced headaches. Her ex-husband told the children, who had seen their mother taking the Tylenol, that she was addicted to bad drugs.

"Children are very easy to influence and very malleable," Hoch says. "Children are like hostages -- they're scared."

The term Parental Alienation Syndrome was coined by the late psychiatrist Richard Gardner in the mid-1980s. Either a father or a mother can be the culprit, say psychologists, family counselors and lawyers who have worked on such cases. Parental alienation most often occurs with parents who are divorcing or separating.

Yet, despite increasing recognition of the condition, parental alienation is a controversial and complex subject. Some professionals say it exists, and some say it doesn't.

"For the parents that are going through it -- it hurts, it exists and there's no doubt that it's real," Hoch says.

Mental health professionals are deeply divided over how to handle these cases.

"A child needs a healthy relationship with both parents if possible," Hoch says.

Some counselors say let's talk this out so both parents can have a relationship with their child. But counseling doesn't work when the parent manipulating the children against the other parent actually has a diagnosable mental disorder.

"It's a waste of money," Hoch says. Especially when the psychological problems are not curable.

Characteristics of alienating parents tend to include high levels of narcissism and/or paranoia, a rigid personality -- where they feel threatened by life changes like divorce; and a high incidence of borderline personality disorder -- a disorder where the person doesn't have a sense of boundaries to the point that he or she thinks of the child as a part of him or herself.

"Borderline personalities are virtually incurable," Hoch says.

Dr. Lynne Parsons, a clinical psychologist at Hendersonville Family Practice, has worked with parents and children going through parental alienation.

Malicious acts towards the target parent extend way beyond damaging the alienated parent -- the children also suffer immensely.

"They're being programmed, and so it deprives them of the emotional support that they need to grow up to be a competent adult," says Dr. Parsons. "Emotionally, it's like starving them inside."

Results of a study published in Cultic Studies Review in 2005 show that alienating parents often use the same manipulation and persuasion techniques cult leaders use to increase dependency on them. That manipulation can give the attacking parent the same excessive control of children as cult leaders. The effect on children: Low self-esteem, guilt, depression and lack of trust.

"Children all have the need to be seen as their individual self," Dr. Parsons says. When their emotions are not respected and appreciated, a child can lose that ability.

Cases of parental alienation, Dr. Parsons explains, can range from an ignorant parent who is repeating a family pattern he or she endured as a child to the extreme cases of psychopaths or sociopaths.

Other effects of parental alienation on children can be eating disorders, split personalities, anger, depression, aggression, anxiety, post-traumatic stress syndrome and even suicidal tendencies.

Every time Hoch gives a lecture on parental alienation, audience members tell her about their own traumatic experiences. The majority say they're still hurting. One man in his 70s came to her with tears in his eyes.

"Their emotional growth is stunted," Hoch says. "It is extremely, extremely harmful."

Meanwhile, the alienated parent suffers immeasurably, too. Initially an alienated parent may feel defective and blame her or himself, but as time goes on many realize they are not causing the syndrome.

"Kids are our most precious life experience," Parsons says, "so it's profoundly devastating."

A burden to society

About 51 percent of marriages end in divorce. Hoch estimates that 1 to 5 percent of all divorce cases include some degree of alienation. The most serious typed is deliberate alienation. Based on the number of inquiries the Rachel Foundation sees, Hoch thinks at least 1 to 2 percent of all divorces experience some kind of severe alienation.

Divorce lawyers and those specializing in domestic violence can attest to the problems caused by parental alienation.

"I constantly see accusations that either or both parents are making disparaging comments or remarks about the other parent," says Katie Fisher, a domestic violence attorney with Pisgah Legal Services, a private non-profit law firm that serves low-income clients in Western North Carolina. One parent, she says, will often say that the other parent is poisoning their children's minds.

Sometimes problems like these do burden the court system, especially when parents can't get past how much they hate each other to put the child's best interests first.

"The courts take parental alienation very seriously," Fisher says. "If any parent is seen as adversely affecting the minor child, they're going to have to answer for it."

These types of cases consume a family court judge's time, Hoch says.

But judges don't always learn the truth. When an alienated parent can't afford an attorney or is fearful a spouse will harm them or the children if they take action, the problems continue.

Unfortunately, Hoch doesn't foresee many alienating parents trying to change.

"In my 12 years of work, I have found no shred of clinical or anecdotal evidence that supports the thesis that severely alienating parents ever change," Hoch says. "Their hatred of the other parent remains undiminished or even more entrenched 12, 15, even 20 years later. To expect them to change is highly unrealistic. Change is very rare," Hoch says.

Some key factors can increase an alienated parents chances of reuniting with their estranged children, she says.

If the alienated parent has had a strong, healthy relationship with their children up to age 11, judges have a better chance of imposing meaningful contact through court-ordered visits.

If the alienated parent can withstand the grief, rejection, pain, loneliness and sense of guilt associated with parental alienation, and not become consumed with anger and bitterness, chances of reconciliation are also better, Hoch says.

Like other types of abuse and addictions, "these things tend to run in families," Hoch says. "It's best to look for it before you ever get married in the first place."

Growing awareness

Some states mandate pre-divorce classes that cover the consequences of parental alienation.

Although North Carolina does not mandate pre-divorce cases, judges often order some parents to take parenting classes through their county's social services, Fisher says.

These courses help prevent many of the more mild to moderate cases of parental alienation, but there's no evidence that they help in a severe case of alienation, Hoch says.

"The trend I'm observing now is that judges are growing more confident in their ability to rule in these cases and to enforce their orders," Hoch says.

Promoting education and awareness of parental alienation is another key part of preventing it.

"To my knowledge, there is no university syllabus developed on the issue," Hoch says. "I see this as a tremendous growth area for mental health."

The help, the public can donate directly to the Rachel Foundation, where no one is turned away based on inability to pay.

"We depend entirely on donations from individuals and program fees," Hoch says.

The Rachel Foundation offers an online support group that is available to parental alienation victims 24-7, 365 days a year. The support offered is based on a 12-step program developed by the Rachel Foundation to help suffering parents.

"It's a simple, safe emotional haven for parents."

Family, friends and faith have helped Hoch through her horrible parental alienation ordeal.

"Focus on loving your children every day," she says. "Keep that hope in your heart and a ray of sunshine in yourself."

Read more!

The state of the county's health - Hendersonville Times-News

Linda Charping
Public Health

Are people in our community receiving the care they need to manage dental health problems, asthma, diabetes or mental health issues? How many school nurses are there and are more needed? What's being done to prepare for health related emergencies like pandemic flu or communicable disease outbreaks?

These are just a few of the questions that are being addressed by the health department and the Henderson County Partnership for Health (PFH) as a part of the community health assessment process. Every four years, the health department and PFH lead a group of representatives from community organizations in reviewing data from surveys, focus groups and statistical resources to establish health priorities to address. In the interim years, the health department conducts a review and publishes a State of the County's Health Report, which is a progress report on the health priorities being addressed.

In the last Community Health Assessment, conducted in 2003, seven health priorities were identified: dental health, asthma, mental health, obesity, colorectal cancer, lack of school nurses and tobacco use. The latest State of the County's Health Report identified progress in most areas.

In 2005-06, 18 percent of kindergarteners had untreated dental decay. This has declined steadily since 2000-01 when the untreated dental decay rate was 23 percent.

Several factors have contributed to this decline: Smart Start funding has provided treatment costs to dentists who have seen many children who have no insurance or source of payment for dental care; Smart Start has also supported a program that teaches proper dental care to children in pre-school; city water has been fluoridated since May 1997; and access to care has improved for Medicaid eligible children.

Low-income families with Medicaid and Health Choice still have few options locally for dental treatment. Some receive treatment at the Stokes Dental Clinic at Blue Ridge Community Health Services, which is the only dental clinic in the county accepting Medicaid. Several private dentists see Medicaid patients; however, most patients have to travel out-of-county for care. Finding dental care for adults is even more of a challenge.

The Free Clinics operates an extraction clinic at the Stokes Dental Clinic using volunteer dentists; however, they are not able to meet the demand for care from low-income and uninsured residents.

The Partnership for Health received a Healthy Communities Access Program grant in 2004 to coordinate care for the uninsured. Focus areas of this grant are asthma, diabetes and depression.

Through this program the Community Health Network was formed to help uninsured patients obtain medical care and medication assistance. Care coordinators provide services to patients with asthma, diabetes and depression, helping them to get the care they need. As of the end of 2006, the Community Health Network had enrolled nearly 600 patients with asthma and/or depression.

There are currently six school nurses working in Henderson County Public Schools. The current ratio for the 2006-07 school year is 1:2115 or one nurse for every 2,115 students. Henderson County is one of the worst in the state. The state average is 1:1576 and the recommended ratio is 1:750. There are only four counties in the state with higher ratios than Henderson County.

In the wake of 9-11 there has been much emphasis on bioterrorism and preparedness planning and the role that public health would play in an emergency. The Department of Public Health staff has attended Incident Command System training and has been working on preparedness and emergency plans. In the fall each year, they use the flu clinic to practice a mass vaccination model by working with the local hospitals to offer flu and pneumonia vaccines.

The 2006 State of the County's Health Report and the 2004-07 Community Health Assessment provide additional information about the health priorities and progress made. They are available on the health department's Web site at www.hendersoncountync.org/health or by calling 694-6063.

Charping is the health education director at the Department of Public Health and can be reached at charping@hendersoncountync.org. Read more!

Mental health mess will be Easley’s legacy, unless …Asheville Citizen-Times

by Raymond Turpin

When are Secretary of DHHS Carmen Hooker Odom and the state of North Carolina going to accept any responsibility for this mental health reform mess? Reform has been mismanaged with a series of staggeringly bad decisions, poor planning, cryptic, convoluted and contradictory communications and a leadership that is completely out of touch with the everyday realities of mental health service delivery.

I’m sure these are smart people, but they have no idea how their ivory tower decisions play out in rural North Carolina. We need new leadership before the whole system crumbles. How bad does it have to get before Easley does something about this mess he helped to create?

Perhaps the legacy of the Easley administration will be the thorough and wholly unnecessary dismantling of the North Carolina mental health system.

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Raymond Turpin, Waynesville Read more!

Mental patient accused in 1988 murder working full time - AP

RALEIGH, N.C. - A mental patient who killed four people in a Forsyth County shooting spree is working 50 hours a week at a convenience store, upsetting the parents of one of the victims.

Michael Hayes, 43, was acquitted by reason of insanity in the 1988 shooting that killed Thomas Nicholson and three others. He has lived at Dorothea Dix mental hospital in Raleigh since then, having been deemed too ill or dangerous to be released.

While the victims' families weren't able to access information about Hayes, R.B. "Nick" and Doris Nicholson used a $2 million judgment they won against Hayes in 1990 to make him answer their questions two weeks ago in court.

They had found out about Hayes' job in Wake County from a friend who saw him going to work.

"It's the most horrible thing there is. He has no business out working," Doris Nicholson said.

Hospital officials wouldn't confirm that Hayes is a patient because of privacy laws, but they acknowledged that six of 31 patients who were found not guilty by reason of insanity are in the off-campus work program.

"Our goal in the hospital is to help people return to the community when it's appropriate," said Dr. Jim Osberg, the hospital's director.

Hayes' attorney, Karl Knudsen of Raleigh, said he understands why the Nicholsons would want to know about his client. But he questioned the couple's motives, saying they have no legal right to know everything.

"It is, in my opinion, a vehicle to obtain information that otherwise would not be obtainable and as a way to exact whatever retribution is available to them," he said.

The Nicholsons have collected only $600 from Hayes in 17 years, and Nick Nicholson acknowledged that they probably won't ever get the millions.

"That's the way we have put the civil judgment to good use," he said.

After the judgment expires in three years, the Nicholsons could only get information if Hayes requests a hearing to argue for his release from the hospital.

Hayes had said he thought he was killing demons in human bodies when Thomas Nicholson and the others were killed at a rural crossroads.

Knudsen said Hayes has not taken psychiatric medications since 1988, and Hayes' hallucinations stopped shortly after the killings. Hayes has suffered by living the past 19 years in a mental institution, Knudsen said.

"He has been a sane man living in an insane asylum for years and years and years," he said. "That is punishment."

Information from: The News & Observer, http://www.newsobserver.com

© Copyright 2007, The News & Observer Publishing Company
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Virginia Governor Seeks to Include Mental Health Reports in Gun Background Checks - AP

Tuesday, April 24, 2007

RICHMOND, Va. — Virginia's governor said Tuesday he may be able to close the loophole that allowed a mentally disturbed Virginia Tech student to acquire the guns he used to kill 32 classmates and faculty last week.

Gov. Timothy M. Kaine said in a radio interview that changes in the reporting of people a court has ruled have mental problems into a background check database might be possible with an executive order.

Seung-Hui Cho had been ordered by a court to undergo psychiatric counseling after he was ruled to present a danger to himself.

But because Cho was treated as an outpatient and never committed to a mental health hospital, the court finding never made it into the database that federal law requires gun dealers to check before selling a firearm.

The law prohibits selling firearms to people judged to have mental disabilities.

Kaine said federal regulations on what must be reported about mental commitments by courts are vague, and their interpretations differ among states.

"Less than half of the states currently share information about mental health adjudication with the national database," Kaine said during an hourlong discussion of the Virginia Tech shooting on WTOP radio in Washington.

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Though Virginia is among the most aggressive nationally in reporting such information, a civil order for Cho to undergo psychiatric evaluation was not entered into the database.

"We have been doing it, but in this case because he was not committed to an institution, that information was not given to the database, and that's one of the things that we're looking at very immediately," Kaine said.

An eight-member panel Kaine appointed to review last week's massacre will consider the issue over the next three months, he said. But Kaine said he is not inclined to wait that long.

"I don't know what the original thought was that we would report based on involuntary commitments ... but we wouldn't report based on orders to receive outpatient services. This is a very important issue and we're talking about it today and we're talking about it with the attorney general's office. Hopefully, we can administratively adjust that," he said.

Attorney General Bob McDonnell said lawyers are examining whether there's a way to address the disparity between the state and federal laws on background checks. But he's cautioned against a response by Congress that could infringe on Second Amendment gun ownership rights.

In response to follow-up questions after the broadcast, Kaine's spokesman, Kevin Hall, said the issue hinges on whether state or federal law compels a certain type of mental health finding to be incorporated in the database from which Virginia does its instant background checks for gun purchases.

If it does and Virginia has not been including it, the governor could, by an executive order, "explicitly instruct the State Police to comply with the law."

Administration officials, however, said it has not been determined whether the change can be made with a governor's decree or legislative action. The General Assembly does not reconvene in regular session again until January.

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California told to submit better hospital plan - LA Times

Mental health officials are given until May 21 to figure out how to stem departure of clinicians.

By Lee Romney and Scott Gold

SACRAMENTO — Saying he was unimpressed with a state plan to address a crippling staff shortage in California's mental hospitals, a U.S. district judge Monday gave the Department of Mental Health another month to submit a more comprehensive solution.

In February, Judge Lawrence K. Karlton ordered state mental health officials to produce a plan that would stem the flow of mental health clinicians to better-paying jobs with the California Department of Corrections and Rehabilitation. That exodus has left the state hospitals dangerously short of staff and jeopardized patient safety.

In response, Gov. Arnold Schwarzenegger and Department of Mental Health Director Stephen W. Mayberg last month authorized raises for existing staff through the end of June, and will seek to extend the increases through the next budget year.

But lawyers who are representing mentally ill prisoners in a class-action lawsuit before Karlton said those raises fell too short of corrections' salaries to prevent staff from leaving the hospitals for prison jobs.

When told that the Department of Mental Health would submit a better plan, Karlton voiced fears that there may not be enough qualified clinicians in California to solve the problem.

"It's not at all clear to me what can be done," he said. "I'm very discouraged."

Nevertheless, Karlton gave the state until May 21 to submit a more detailed plan, after Deputy Atty. Gen. Lisa Tillman explained that more money — for raises for recruits as well as existing staff — might be secured in the upcoming revisions to next year's budget.

"I want something concrete when you show up next time," Karlton told Tillman.

Karlton is overseeing changes in the prisons' mental health system, where he has deemed care so poor as to be unconstitutional. He has authority over state mental health facilities only because they treat some mentally ill prisoners. He signaled Monday that he was unlikely to order broad changes for that department.

"I am not in charge of the Department of Mental Health and I don't intend to be," he said.

After the hearing, state officials said they were optimistic that the problem could be addressed.

"We are absolutely dedicated to resolving the staffing issues at our hospitals and ensuring patient safety, public safety and staff safety," said Ann Boynton, undersecretary of the Health and Human Services Agency, which oversees the Department of Mental Health.

In the courtroom were employees of Atascadero, Napa and Patton state hospitals, who said they have been forced to work exhausting, mandatory overtimes. They said staff shortages also had meant that they were less able to defuse violent patient outbursts.

Paul Hannula, a psychiatric technician at Atascadero State Hospital for five years and vice president of the hospital's chapter of the California Assn. of Psychiatric Technicians, said the proposed raises add only about $77 a month to technicians' pay — not enough to keep them.

"We are losing our experienced staff," he said. "It is dwindling so fast."

Hannula applauded the judge. "He is taking this very, very seriously," he said.

But some workers were less impressed. Patton nurse Christina Villareal said that workers who left for more lucrative prison jobs were recruiting former colleagues. She said she wanted the judge to take more urgent action:

"I had hoped there would be more to it," she said of Monday's hearing.

lee.romney@latimes.com

scott.gold@latimes.com
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Incident points out need for mental health funding -Asheville Citizen-Times

Letter to the editor:

by Ted Hughes

I have been watching coverage of the tragedy at Virginia Tech. Many have identified failures of the mental health and legal systems. I have seen little mention of the crisis in funding for these systems that is being experienced all over the country. Legislatures see these budgets as easy targets, and we will all suffer as a result.


Several days before the Virginia Tech incident, I was having a conversation with a friend of mine who works as a mental health social worker. She was worried about job security because of recent funding cuts in the mental health system here in North Carolina. I told her that if she wants job security, she should consider getting a job in the prison system or at an emergency room because that is where the mentally ill will end up when the mental health system is no longer able to deal with them. I think the situation at Virgina Tech illustrates this point well.

Everyone needs to demand proper funding of the mental health systems. Adequate funding will save many dollars and many lives. You pay now, or you pay later.

Ted Hughes, Asheville Read more!

Funding Cuts May Affect Services for Autistic Children - Fox8 News Winston-Salem

April 23, 2007

By BRENT CAMPBELL

WINSTON-SALEM, N.C. (WGHP) -- Between 1992 and 2002, the number of diagnosed cases of autism in the United States increased 10-fold, from 16,000 to over 160,000. And although that number continues to rise, the North Carolina Department of Health and Human Services is reducing funding by 33 percent to some community programs that support families with autistic children and others with mental illnesses.

The cuts specifically affect community support services, where private companies use therapists or tutors to help those with mental illness and substance abuse problems.

A recent state audit showed some of the companies were overbilling or abusing the money, but many who depend on the services say the cuts unfairly punish everyone.

"We are concerned that this is just one more blow in a system that is already not as stable as we would like it to be," said Ronda Outlaw, who works with autistic children at CenterPoint Human Services in Winston-Salem, N.C.

Last year, Medicaid paid $700 million toward community services for 45,000 people using the services. Stat officials say they simply cannot afford the abuse any longer.

The cuts, when announced, produced a public outcry that precipitated a complete state audit. Later this week, the state review panel will announce the results and what changes it recommends. Read more!

Don't stigmatize the mentally ill, local officials say - The Greenville Daily Reflector

By Amanda Karr

The recent shootings by a student at Virginia Tech who showed signs of mental illness illustrate the importance of recognizing and supporting the mentally ill, local mental health officials said Monday. The tragedy is not a reason to stigmatize individuals who may need help, they stressed.

Officials with Pitt Mental Health and East Carolina Behavioral Health, the nine-county agency Pitt County will join July 1, discussed the local mental health system Monday in the wake of the college tragedy.

"When these things happen in a community, it causes a lot of reaction," said ECBH Clinical Director Cindy Ehlers. We want to be proactive rather than reactive."

Community education is important, she said, as she promoted a conference on Thursday at the Greenville Convention Center. The conference — which is free and open to the public — will discuss community support and developing wellness and recovery plans for those with mental illness, substance abuse problems and developmental disabilities.

Pitt County will open a center later this year where people in crisis or simply needing support can go to talk with peers, Ehlers said.

"A lot of people out there with mental health issues are isolated, and when something happens they don't have anyone to go to or vent to," she said. "In this center everyone will be treated like a friend."

Ehlers also expressed concern that the community does not judge those with a mental illness based on the shooter at Virginia Tech.

"It's really important as a community we don't overreact and assume everyone with mental health issues is going to go and do something like this," she said.

Society can particularly stigmatize those with mental illness and substance abuse problems, and that can sometimes keep them from getting help, she said.

"People don't want to be known as crazy, so they don't get the help they need," she said.

She stressed the individual nature of each person and his or her own challenges. There is no one definition of someone who is suffering from a mental health problem, she said.

"Everyone is different and is going to manifest their signs and symptoms uniquely," she said.

Many people experience at some point in their lives a mental health problem, she said. The survivors of the shootings at Virginia Tech could be among them: They may face post-traumatic stress disorder to depression to more severe illnesses such as schizophrenia, she added.

"No one is immune to mental illness," Ehlers said. "At anytime someone could have it happen to them or someone they know, so they need to know how to get support."

For more information on Thursday's conference, call 902-2100 or visit www.pittcounty nc.gov/depts/mentalhealth for a registration form.

Amanda Karr can be contacted at akarr@coxnc.com and 329-9574. Read more!