Senate almost unanimous in investing less - NC Policy Watch

Fitzsimon File: Chris Fitzsimon
May 30th, 2007

The Senate gave tentative approval to its budget Wednesday afternoon that spends less on education, children’s health care, and other human service programs than the House spending plan, as Senators chose tax cuts over making larger investments in the state’s future.

With one notable exception, the floor debate was more backslapping and self-congratulations than meaningful policy discussion. All but two Republicans joined with the Senate’s 31 Democrats in supporting the budget and listening to the debate made you wonder if the chamber would break out in a verse of Kumbaya before the day was over.

Democrats and Republicans even voted together to remove the most progressive proposal in the budget, a plan by Senator Martin Nesbitt to allow three needle exchange pilot programs to reduce the spread of HIV/AIDS.

Nesbitt pointed out that the National Institutes of Health issued a consensus opinion that needle exchange programs not only reduce the HIV infection rate, they also increase the number of people in drug treatment because addicts establish relationships with the professionals in the exchange programs. The HIV/AIDS infection rate in North Carolina is increasing 20 percent a year and many of the new infections can be traced back to IV drug use.

No matter. Senate Majority Leader Tony Rand rose to endorse an amendment by Senator Steve Goss to remove the needle exchange programs from the budget and then Senator Jim Forrester, a doctor who should know better, told his colleagues that the programs “send the wrong message” and encourage risky behavior. Better to just tell drug addicts to stop using drugs than help them protect themselves and their unknowing sexual partners.

The needle exchange provision was taken out of the budget on a 39-10 vote with Republican Stan Bingham and Democratic Senators Atwater, Cowell, Dannelly, Foriest, Graham, Jones, Kinnaird, and McKissick showing the political courage to join Nesbitt in putting people’s lives ahead of political considerations.

The Senate budget does make some important investments in education, economic development and the state’s infrastructure. It provides a 5 percent raise for teachers, a 4 percent pay hike for state employees. Need based financial aid at UNC campuses gets a big boost, as does the Clean Water Management Trust Fund.

But when you compare the Senate budget to the House plan in how they treat people who are struggling in the state, the Senate comes up short almost every time. The House expands children’s health care, the Senate authorizes a study.

The Senate finds $10 million for the Disadvantaged School Supplemental Fund, the House budget has $20 million.

The Senate spends $2.1 million for 42 school nurses, the House has $4 million for 80 new nurses. The Senate allocates $14 million next year for the Housing Trust Fund, the House $15.5 million.

The Senate spends $8 million less on mental health services than the House. (Tuesday’s Fitzsimon File mistakenly said the Senate budget increased mental health funding more than the House.)

That was the theme of the day, Senators hailing the progress for the state made by a budget that invests less than the House plan in almost every important area. All so Senators could cut taxes and produce what Republican Senator and 2008 gubernatorial candidate Fred Smith said was the best budget he has seen since he came to the General Assembly.

Smith hailed the tax cuts in particular and said they made the state more competitive and improved the business climate, a view shared by Senate Democratic leaders. The Senate’s choice of tax cuts over children’s health care comes on the heels of a poll of 300 manufacturing companies by the North Carolina Chamber that found 73 percent of them thought the cost of doing business in North Carolina was either the same or better than in other states.

But what do business leaders know about the cost of doing business? Facts are sometimes not part of legislative budget debates and in one case Wednesday, neither was reality.

Budget Co-Chair Kay Hagan responded to criticisms that the Senate budget process was closed and secret, shutting out most Senators, much less the media and the public. Hagan said the corner room in which a handful of Senate leaders wrote the budget was “open morning, noon and night and on weekends and we didn’t see a lot of people.”

Hagan must think that a meeting doesn’t have to be announced or listed on any calendar to be considered open. You just have to find it. Imagine the money that can be saved as we eliminate all legislative calendars, emails, websites, and other schedules of meetings.

Maybe the savings can help fill some of the holes in the Senate budget, and pay for some of the services not provided to children, families, and the mentally ill. Read more!

Highlights of NC Senate Budget Bill - AP

Mental Health spending is under the Health and Human Services listing.

RALEIGH, N.C. -- Highlights of the $20 billion 2007-08 state spending plan given tentative Senate approval Wednesday. The figures reflect increases or reductions to base budget expenses, some of them based on projected rises in recurring spending.

Salaries and benefits

-- Average 5 percent salary increase for public school teachers; 5 percent for community college and university faculty and judges; 4 percent for most state employees and non-faculty university workers: $496.7 million.

-- Two percent cost-of-living adjustments for state retirees: $29.6 million.

-- Fifth installment of retirement funds intercepted in 2001 to narrow budget shortfall: $10 million.

-- Cash influx to cover projected shortfall in state employee health plan: $120 million.

Public schools

-- Replace 170 fewer school buses next year: -$4.5 million.

-- Keep teacher assistant funding at 2006-07 level: -$10.9 million.

-- Implement plans to restructure seven high schools: $1.4 million.

-- Student performance bonuses for teachers: $70 million.

-- Maintain 18-1 student-teacher ratios in kindergarten-3rd grade: $37.5 million.

-- Provide more funding for low-wealth school districts and schools with at-risk students: $13.1 million.

-- Expand "Learn and Earn" high school initiative to nine more schools: $2.5 million.

-- Deliver college courses electronically to high school students through Gov. Mike Easley's Learn and Earn Online program: $6.5 million.

-- Upgrade public school broadband connectivity: $7 million.

-- Increase school district funding for instructional supplies and materials: $2.4 million.

-- Increase district funding for academically and intellectually gifted programs: $1.8 million.

-- Increase district funding for children with disabilities: $5 million.

-- Provide additional money to help small-county school districts: $2.1 million.

-- Hire 30 literacy coaches in schools with eighth grades: $1.7 million.

-- Supplement funding for elementary school cafeterias operating in a deficit: $800,000.

-- Create education reform pilot program in five school districts with after-school programs, teacher recruitment and retention bonuses, teacher mentoring and assistance in science and math curricula: $4.4 million.

-- Establish technology pilot program where computers will be provided to all teachers and students in five high schools: $3 million.

-- Department of Public Instruction computer system upgrades, data warehousing: $4 million.

-- Train mathematics and civics teachers in financial literacy: $1 million.

University of North Carolina system

-- Reductions of 23 positions, other spending cuts recommended by President's Advisory Committee on Efficiency and Effectiveness: -$4.1 million.

-- Reduce campus operating budgets based on future recommendations of advisory committee: -$11.3 million.

-- Restores funding for projected fall university enrollment: $6 million.

-- Provide tuition grants to 1,000 additional students attending private colleges in North Carolina, raise grant to $1,950: $4 million.

-- Provide need-based financial aid for more than 46,500 students at UNC campuses: $27.6 million.

-- Continue funding for UNC Online degree and certificate programs: $4.2 million.

-- Operating funds, equipment and faculty startup funds for UNC programs at North Carolina Research Campus in Kannapolis: $16.5 million.

-- Create joint graduate School of Nanoscience and Nanoengineering at N.C. A&T State University and UNC-Greensboro's Millennium campus: $1.4 million.

-- UNC-Chapel Hill law school operating funds: $2 million.

-- N.C. State University bioengineering program funds: $5 million.

-- Begin Education Access Rewards North Carolina Scholars program, which provides up to $4,000 grants to low-income college students: $50 million.

-- Math and science teacher recruitment efforts for N.C. State University initiative: $1 million.

-- Create research competitiveness fund to support interdisciplinary research for emerging industries in state: $8 million.

-- New tuition waivers for recruiting and retaining graduate students: $2 million.

-- Summer programs for incoming freshman at seven system schools: $1.2 million.

-- Matching funds for UNC system campus endowed professorships: $6 million.

-- Fund Wake Forest Institute for Regenerative Medicine at Wake Forest University to attract federal investment in field at Piedmont Triad Research Park: $8 million.

-- Expand initiatives at Center for Bioenergy Technologies at N.C. State University: $3 million.

Community colleges

-- Fund enrollment for additional 2,300 students: $3.3 million.

-- Increase community college tuition by 6.3 percent: -$7.5 million.

-- Additional funds for Allied Health programs: $5.6 million.

-- Improve community college broadband connectivity: $3.8 million.

-- Expand male minority mentoring program at 10 more campuses: $300,000.

-- Funds for community college efforts at North Carolina Research Campus in Kannapolis: $1.3 million.

-- North Carolina Motorsports Consortium funds: $500,000.

-- Advanced matching planning funds for campus capital projects: $10 million.

Health and Human Services

-- Various reductions in HHS Secretary's Office: -$8.5 million.

-- Sustain provider network that coordinate free care for low-income uninsured patients: $2.3 million.

-- Competitive grants for community health centers: $5 million.

-- remove 339 children from child-care subsidy waiting list, increase lagging subsidy rates: $8.4 million.

-- Fund 850 scholarships for child care providers studying early childhood education or child development: $1 million.

-- Extra Smart Start funding to neediest counties: $1.3 million.

-- State match to purchase 844,000 treatment courses of antivirals in case of pandemic flu and create climate-controlled storage space: $9.7 million.

-- Fund HIV prevention and activities, including counseling and testing: $2 million.

-- Hire 62 public school nurses: $2.1 million.

-- Help medical care program for uninsured cancer patients: $1 million.

-- Additional screening and diagnostic services for breast and cervical cancer: $2 million.

-- Eliminate Medicaid provider inflationary reimbursement increases, with some exceptions: -$55.8 million.

-- Reduces Medicaid pharmacy payments for certain prescription drugs: -$17.8 million.

-- Medicaid cost containment activities, including increased fraud and abuse detection: -$15.3 million.

-- Savings with required prior authorization for mental health and HIV-AIDS drugs and for personal care services: -$11.2 million.

-- Supplemental payments for critical access pharmacies: $2.3 million.

-- Two hundred additional slots for Community Alternatives Program: $3 million.

-- Expand Medicaid coverage for foster care adolescents age 18-20: $216,000.

-- Fully fund N.C. Health Choice program: $7.5 million.

-- Reduce funds for mental health, developmental disabilities and substance abuse services based on historical availability of funds: -$2.3 million.

-- Realign mental health, developmental disabilities and substance abuse services for other programs: -$24.7 million.

-- Fund mental health, crisis services, to be distributed to local management programs: $17.1 million.

-- Fund local crisis services to mentally ill and find employment for mentally ill, developmentally disabled and substance abusers: $2.5 million.

-- Reduce budget of Dorothea Dix Hospital in Raleigh to account for anticipated closure in the fall: -$31.8 million.

-- Reduce budget of John Umstead Hospital in Butner to account for anticipated closure in the fall: -$35.3 million.

-- Open and fund new central regional psychiatric hospital in Butner: $62.4 million.

-- Transfer half of forensic unit from Dorothea Dix Hospital and Broughton Hospital in Morganton: $4.7 million.

-- Operating cost subsidies for housing for the disabled: $2.5 million.

Natural and Economic Resources

-- Transfer Agriculture Department research stations to University of North Carolina system: -$9.2 million.

-- Hire two agricultural safety officers to conduct migrant housing inspections and train farmers: $125,000.

-- County grants to adopt local programs to enforce statewide private well construction standards: $300,000.

-- Eliminates 25 vacation positions in Department of Environment and Natural Resources: -$1.1 million.

-- Various Division of Forest Resources reductions: -$1.9 million.

-- Fund N.C. state aquariums to replace admission receipts: $2.5 million.

-- Matching funds for clean water, drinking water revolving funds: $9.4 million.

-- Promote N.C. viticulture industry, help Surry Community College viticulture program: $10 million.

-- Regional film commission funds: $300,000.

-- Promote International Home Furnishings Market in High Point: $1 million.

-- Create N.C. Green Business Fund, providing no-interest loans to small private business to encourage environmentally based economy: $1 million.

-- One North Carolina Fund for economic development: $14 million.

-- One North Carolina Small Business Fund for economic development: $5 million.

-- Help Johnson & Wales University in Charlotte: $2 million.

-- Fund N.C. Institute of Minority Economic Development: $200,000.

-- N.C. Community Development Initiative: $500,000.

-- N.C. Minority Support Center: $1 million.

-- Support Defense and Security Technology Accelerator, a business incubator to boost economic development in homeland security and defense industries: $2 million.

-- Create incentives for broadband in rural areas, distribute funds for cable access channels through e-NC authority: $4 million.

-- N.C. Biotechnology Center create three "regional centers of innovation": $3 million.

-- Expand N.C. Rural Economic Development Center Economic Infrastructure Fund and establish Rural Economic Transition Program: $19.5 million.

Justice and Public Safety

-- Modernize technology in court system: $8.6 million.

-- Create two new positions for Judicial Standards Commission: $193,000.

-- Hire 155 new prosecutors and support staff, including 60 assistant district attorneys and 15 district attorney investigators: $11 million.

-- Hire 300 new deputy clerks: $11.9 million.

-- Hire 42 new magistrates: $2 million.

-- Funds for 10 new District Court positions: $1.5 million.

-- Funds for three new special Superior Court judges: $285,000.

-- Expand family and drug treatment courts, hire about 19 new positions: $1.5 million.

-- Hire 15 new staff for Guardian ad Litem program: $1.1 million.

-- Raise hourly rate for privately assigned attorney for indigent defendants in non-capital cases: $4.1 million.

-- Eliminate 75 vacant positions in the Department of Juvenile Justice & Delinquency Prevention. -$2.5 million.

-- Staff and contractual service costs for flood plain mapping program: $3.7 million.

-- Gang prevention, intervention and suppression initiative grants from Gov.'s Crime Commission: $3 million.

-- Reduce backlog of victims' compensation unpaid claims: $1 million.

-- Hire more sworn agents, staffers and technicians at State Bureau of Investigation, startup cost for Triad regional crime laboratory: $1.8 million.

Transportation

-- Reduce Department of Transportation division administration funds to pay for Interstate 40 resurfacing project: -$11.8 million.

-- Security management equipment at 31 Division of Motor Vehicle locations: $2.5 million.

-- Purchase one aircraft to upgrade department fleet: $3.4 million.

-- Increase funds for DMV technology upgrade for commercial driver's licenses: $3 million.

-- Hire 40 additional ferry division personnel, pay for rescue boats and generator upgrades to meet Coast Guard regulations, as well as operation expenses: $6.5 million.

-- Reduce expenditures for Triangle Transit Authority's commuter rail project: -$23.4 million.

-- Streamline freight rail operations through relocating or building new tracks and interchanges: $3.9 million.

-- Replace obsolete State Highway Patrol helicopter and establish airborne unit to perform search and rescue operations during disasters: $3.6 million.

-- Create 24 positions to support advanced statewide emergency responder radio network: $2.3 million.

-- Reduces Highway Trust Fund money for urban loops, city streets and other roads: -$6.3 million.

-- Reduces available Trust Fund money with gasoline tax capped at 29.9 cents per gallon: -$8.1 million.

Other agencies and funds

-- Reduce utilities budget needs for Department of Administration: -$1 million.

-- Increase funding for rape crisis and sexual assault funds: $800,000.

-- Hire four additional State Capitol Police officers: $186,000.

-- House remains of Civil War Confederate ironclad CSS Neuse: $500,000.

-- International Civil Rights Museum: $500,000.

-- Expand Arts Council activities: $2 million.

-- Increase operational support for Queen Anne's Revenge archaeology project: $150,000.

-- State aid to local libraries: $475,000.

-- N.C. Housing Trust Fund, including money to build apartments for people with disabilities: $11 million.

-- Continue home foreclosure protection pilot program: $1.5 million.

-- Reduce by 2 percent Department of Revenue items related to temporary employees: -$1.8 million.

-- Redact personal information from Secretary of State business entity database: $813,000.

-- Reserve for morale, recreation and welfare fund distributed to military installation: $1 million.



Reserves and capital projects

-- Continue upgrade of state's human resources, payroll and financial systems: $30 million.

-- Eliminate all non-university position vacant for longer than six months: -$34.4 million.

-- Equipment for state secondary data center: $9 million.

-- State match for water resources development projects: $20 million.

-- Reserve to install fire sprinklers in dormitories across UNC system: $9 million.

-- Special indebtedness for state construction projects, most university buildings: about $1.2 billion.

-- Increase information technology services operations: $9.5 million.



Tax provisions

-- Increase judicial fees, dedicated to court system technology and staff upgrades: $36.8 million.

-- Reserves for future tax credits or adjustments: -$30 million.

END Read more!

Statehouse Spotlight -NAMI

NAMI's Statehouse Spotlight is a biweekly electronic public policy news resource containing recaps of recent media coverage from across the country.To follow up on any of the items featured in this publication, please contact Angela Kimball at angelak@nami.org

News from the States

Missouri Medicaid Reforms Clear Legislature

The Missouri state legislature has completed negotiations on the state's highly publicized Medicaid reform initiatives, and has sent a package to Governor Blunt. Key components of the agreed-to reforms include: permission for physicians to collect copayments from Medicaid beneficiaries; requirements that beneficiaries be assigned a primary care location and enrollment in a health-improvement plan; and restoration of benefits for 4,000 workers with disabilities and 6,000 children who lost coverage over the last ffew years. The reforms will be monitored by a newly created oversight panel and do not include earlier proposals that would have provided incentives for beneficiaries who live healthier lifestyles. (kaisernetwork.org, May 22, 2007)i

Deficit Threatens Funding for Michigan Hospitals

Michigan hospital administrators are bracing for a 6 percent cut to Medicaid reimbursement rates if the state legislature fails to identify another solution to eliminate a $700 million budget deficit. Opponents of the cuts believe the reduced rates will create barriers to services for people on Medicaid, as fewer providers would opt to participate in the program. The legislature has until June 1 to reach a budget agreement or Governor Jennifer Granholm will begin enforcing the cuts. (mlive.com, May 16, 2007)

Wisconsin Expected to Support New Mental Health Unit for Women Prisoners

The joint finance committee of the Wisconsin state legislature is expected to approve funding for a 45-bed, $11 million treatment center at the state's Winnebago Mental Health Institution. The state's building commission recommended the construction of the free-standing facility in response to a scathing report issued by the U.S. Justice Department on conditions at Wisconsin's Taycheedah Correctional Institution. The report cited examples of inmates being held in administrative segregation because their psychiatric conditions were so severe, there was no other place to put them. The state currently faces legal action from the ACLU and possible action by the Department of Justice over the mental health care within its correctional system. (madison.com, May 24, 2007)

Utah Set to Launch PDL; Access to Psychotropics to Be Preserved

Utah is set to implement a preferred drug list by August with hopes of saving the state $10 million a year in drug costs. The state plans to start with acid reflux and cholesterol drugs and then expand to other categories; however, state legislators are insistent that the list not address psychotropic medications. One of the provisions of the new PDL is that doctors can bypass the list by using "dispense as written" on the prescription. (kcpw.com, May 16, 2007)

Community Forums in Ohio Identify Constituent Concerns

NAMI-sponsored events highlighting concerns about the state's mental health care system have proven interesting to several Ohio legislators who attended the events. Common themes from the meetings included concerns that Medicaid HMO's (new to the state as part of ongoing Medicaid reforms) would use formularies to limit access to mental health medications, and new requirements of local governments to use county funds to match federal expenditures for the state's Medicaid program. Already, the increased use of local funds has compromised a program historically used to support non-Medicaid programs. (athensnews.com, May 10, 2007)

Wisconsin Legislators Seek to Address Mental Health Parity

Legislators in Wisconsin are going to the mat once again to change state law to provide better insurance benefits for persons with mental health conditions. Currently, state law only requires group insurers to cover up to $7,000 annually for mental health or substance abuse treatment. Debate on the subject has demonstrated the economic toll of mental illnesses when insurance coverage is not available, including one couple who has generated over $25,000 in bills related to mental health treatment in just three years. Wisconsin is one of nine states that does offer some form of mental health parity. (thenorthwestern.com, May 24, 2007)

Washington Quick Glance

Debate on Medicare Part D Continues

Conversation about the U.S. Medicare prescription drug benefit is a hot policy topic among presidential candidates of both parties. NAMI has asserted several key priorities related to Medicare Part D for the past two years and encourages NAMI members to use these policy objectives in conversations with federal candidates:

It is critical for Part D drug plans to meet their obligation for broad coverage of medications to treat mental illness-–specifically to cover "all or substantially all" of the medications in six classes, including antipsychotics, antidepressants, and anticonvulsants-–currently required by CMS. NAMI supports efforts to Congress to codify this requirement as part of the permanent Medicare law.
Congress should change Part D to waive cost-sharing for dual eligibles residing in board-and-care homes, psychiatric residential facilities,--and congregate living arrangements-–as is proposed in S 1107, legislation proposed by Senators Gordon Smith (R-OR) and Jeff Bingaman (D-NM).
Congress needs to amend Part D to allow for coverage of benzodiazepines, which are currently excluded from coverage.
Recently, the American Psychiatric Association released a report outlining the experiences of Medicare Part D participants in gaining access to medications used to treat mental illness. Information on the report and other resources is available by clicking here. Read more!

Recovery possible in mental illness - Milwaukee Sentinel-Journal

Posted: May 30, 2007

Until recently, most doctors didn't talk about recovering from a major mental illness. It was generally believed that conditions such as schizophrenia, bipolar disorder and major depression were lifelong, debilitating illnesses. Ronald Diamond, a psychiatrist from Madison, is hoping to turn that kind of thinking around. Diamond will be the keynote speaker at a conference Sunday in Milwaukee titled "Hope and Help: You Are Not Alone: A Jewish Community Program on Mental Illness." The program runs from 11:30 a.m. to 3:30 p.m. at Congregation Sinai, 8223 N. Port Washington Road, Fox Point. It is sponsored by the Jewish Community Mental Health Education Project, a collaborative program of Jewish Family Services. Admission is free. Diamond, medical director at the Mental Health Center of Dane County, professor of psychiatry at the University of Wisconsin and consultant to the Wisconsin Bureau of Mental Health and Substance Abuse Services, spoke recently with Journal Sentinel reporter Meg Kissinger.

Q. Why do we make distinctions in our culture between those with mental illness and other illnesses?

A. A lot of people are frightened by mental illness. We are afraid to admit that we might have more in common with people who are mentally ill. We worry, "Will I catch it?"

Q. How does the stigma of having mental illness contribute to people's recovery?

A. It is almost as difficult as recovering from the disease itself. Instead of John or Susan, they are seen as "That Guy with Schizophrenia" or "The Woman with Bipolar." It's very polarizing.

Q.What is your estimate of the number of people with schizophrenia who can manage well?

A. About one-third of those with schizophrenia do quite well. Another third are pretty stable but continue to have trouble. The last third have a persistently difficult course.

Q.Wisconsin is one of a handful of states that does not require parity for mental illness in insurance coverage. Is mental illness that much more expensive to treat than, say, heart disease or cancer?

A. It's a fantasy or fiction that mental health care is really expensive and that people will fake it. The reality is that the prevention is much less expensive than a cure. And, if anything, people are inclined to under-report their mental illness.

Q.How do you help people recover from mental illness?

A. Help engenders hope. Recovery does not mean cure. They live with the risk of recurrence, just as cancer patients do. We are not talking about schizophrenia being gone. We are talking about being able to live as complete a life as possible. We need to let go of expectations. Read more!

Mental Health Board contract draws questions - Lebanon (OH) Western Star

By Candice Brooks Higgins

FAIRFIELD — The Butler County Mental Health Board awarded two contracts — totaling $3.7 million — Wednesday night to turn over some existing services to new providers, but not without some controversy.

Forensic Mental Health Services in Hamilton for many years has been contracted to provide 24-hour crisis intervention services and monitoring for the severely mentally ill who have been court-ordered to undergo treatment or admitted to the state hospital, Summit Behavioral.

However, expenses for overuse of the state hospital were allowed to peak to the highest in the state in 2005 while crisis services were cut back to primarily life or death situations, Mental Health Board Executive Director Terry Royer said. In addition, Forensic's executive director and finance director resigned late last year.

Therefore, the board requested proposals for those services and Forensic opted not to bid, Royer said. The Community Counseling and Crisis Center was one of three bidders for the crisis services, but its proposal was rejected because a statement of fiscal accountability was mistakenly excluded. The Oxford agency's director, Amelia Orr, requested a second time Wednesday for her agency — which runs a crisis hotline — to be considered. She was denied.

"The board has to be consistent," Royer said.

Butler Behavioral Health Services instead won the near $600,000 contract for crisis intervention. Forensic was paid $171,000 for the services, but new levy funds were used to expand the contract.

"A crisis service is...our most visible service and it needs to be first rate," Royer said. "I think that what we have that in Butler Behavioral's proposal."

Community Behavioral Health was awarded a $3.1 million contract — about $150,000 more than Forensic's contract — for services to the severely mentally ill.

The board has also decided to allow competitive bidding on expanded services in Middletown, which a recent study showed was underserved.

The decision came after Middletown-based Comprehensive Mental Health Services objected May 16 to Royer's recommendation to give Butler Behavioral, a Hamilton-based agency, that $450,000 contract. Royer's proposal was part of a larger plan to address immediate needs with the first $1 million of the $7.5 million generated annually from the passage of a new 1-mill levy.

Competitive bidding is not required for mental health services, but board member and Butler County Common Pleas Court Judge Michael Sage said it makes providers who have historically enjoyed long-continuing contracts accountable for their services.

"I don't believe there should be a closed shop," Sage said. "A free enterprise system is all about providing the best service for the least expense in dollars to the taxpayers."

Sage said he envisions competitive bidding becoming a standard practice after the board's strategic plan — which could be drafted by June 20 — is adopted. With the chance to reinvent the system after a November levy passage, Sage said the board can define the service the community needs and expect providers to bid on that service, rather than providers dictating available services. Read more!

N.H. Supreme Court: Mental incompetence doesn't preclude owning a gun - AP

CONCORD, N.H. (AP) _ Someone found mentally incompetent to stand trial in New Hampshire still may be competent to own guns, the state Supreme Court ruled Wednesday.

The court overturned a Concord District Court ruling in which a man was denied his weapons after being found mentally incompetent to stand trial on theft, disorderly conduct and resisting arrest charges for an outburst at Division of Motor Vehicles headquarters in Concord three years ago.

Scott Buchanan took the issue to court after authorities refused to give two guns back.

The court ruled the criteria for being found incompetent to stand trial were different from the legal standard for being declared mentally defective under federal law _ the standard by which gun ownership can be denied.

The high court directed Concord District Court to have another hearing to reconsider whether Buchanan meets the "mental defective" criteria.

The court ruled that a competency determination focuses on whether a defendant has a "rational and factual" understanding of a case and can reasonably assist in a defense. The state competency law does not, however, address the federal "mental defective" standards of whether a person is dangerous or unable to manage personal affairs, the court said.

"Because it appears the trial court ruled as a matter of law that 'adjudicated as a mental defective' means the same thing as incompetent to stand trial, we hold that it erred," the court ruled.

Buchanan was arrested Nov. 24, 2004, after a confrontation with a highway safety officer at the state DMV office in Concord.

Police seized a gun from Buchanan's car, and Buchanan later surrendered a second firearm as a result of a bail order while the charges were pending against him, Senior Assistant Attorney General Ann Rice told The Telegraph of Nashua.

The charges were dismissed after Buchanan was found incompetent to stand trial because of his excessive and unusual paranoia about police and government, according to court records. Read more!

First Lady takes state's mental health pulse - Hope (AL) Star

By STEPHANIE HARRIS THOMAS
May 30, 2007

Arkansas First Lady Ginger Beebe was in Hope on Tuesday to visit a family with a child who suffers from mental illness. She met with the family, whose identity is protected, as part of Mental Health Awareness Month.

The first lady has made that a part of a statewide plan to help mentally ill children. It is also in connection with a commission that will be appointed by the governor in the next few months.

“Being a first lady, I support the governor. That is my number one goal,” Beebe said.

She said the motivation for working with these children and families came from information gathered when campaigning.

“This is one of the things that I heard from so many families; some times it was about lack of services. Sometimes, it was about services that were good and they wanted to share that in hopes the state would expand on it,” Beebe said.

Beebe said the some partnering agencies involved are the Arkansas Department of Health and Human Services, Arkansas Advocates for Children and Families, Federation for Families, and the National Alliance of Mental Health, as well as parents of mentally ill children.

Julie Munsell, of the Arkansas Department of Health and Human Services, said that advocate groups for this type of thing have been in place for a long time, but they have not seen many real changes.

Beebe and Munsell agree that visiting with individual families will help to provide the best information on helping children with mental illness.

“We hope to show the normalness of mental health - it is just like your physical health. If you break your arm, you do not get stuck into a category like you would if you have a mental health issue,” Munsell said.

“Or a behavioral issue; a lot of children have behavioral issues because of mental health. They need a little support,” she added.

Beebe said she explained mental illness to a child at a benefit walk for the National Alliance for Mental Health. She said she told the four year old, “The difference with a physical illness is that you can see it. With a mental illness you can't see it,” Beebe said.

“Physical and mental illnessess both bleed over on one another,” Munsell said. They hope to lessen the stigma associated with mental illness, Munsell said.

“It is an illness, such as diabetes,” she said.

Munsell said the commission to be appointed originated from an act passed by legislation that created the Children's Behavioral Health Commission.

People who were appointed to the commission were providers, or from associated agencies, and state department of education representatives.

“This is the first year we've had seats for parents,” Munsell said. She said they want to get feedback from parents to meet the needs of mentally ill children. Read more!

Ritter signs bills on mental health, services for elderly - Denver Post

05/30/2007

DENVER- Gov. Bill Ritter signed seven measures Wednesday aimed at increasing services for the elderly and improving mental health care, including one that will expand the conditions that health insurers must cover.

The new law adds such conditions as post-traumatic stress disorder, drug and alcohol disorders and anorexia to the list of covered problems. Biologically based mental illnesses including schizophrenia and major depressive disorder were already covered under the previous law.

The other new laws also coordinate mental health treatment for children, including those in the juvenile justice system.
Ritter signed four other bills later in the day expanding services mainly for the elderly.

They encourage the use of tracking devices to locate handicapped people who become lost, rebate more tax money to seniors and disabled people, increase funding for such senior services as Meals on Wheels, legal assistance and shopping shuttles, and promote long-term services for the elderly in communities.
Read more!

Mental Health: Why it's important - Brigthon (CO) Standard-Blade

By Staff Writer
05/30/2007

A couple tries to build two careers, care for two careers, care for two children and build a marriage all at once. They’re stressed. They live in a fast-paced, high striving culture where they try to do all the right things for their children, their employers and each other. They often neglect themselves in the process.

A woman who is successful in her career and seems to have everything she ever wanted in life finds herself crying all the time. She is puzzled by her intense feelings and has tried everything she knows to do to try to “snap out of it,” but to no avail.

A man notices that he is losing his temper with his children and is disturbed by the realization that he is acting as his father did. Anger was common in the family he grew up in, and he told himself he would never be that way but he can’t seem to control himself.

An adolescent who is a good student and has many friends does not get the college scholarship he wished for. He becomes hopeless and considers suicide.

These individuals struggle with depression, anxiety and experience a myriad of physical problems related to their situations. Any of these scenarios sound familiar?

Our personal mental health needs can be the easiest thing to push aside—especially when the consequences of doing so are often not immediately seen or felt.

Later, these needs may catch up with us causing some kind of disease, sleep disturbances, panic attacks, depressions, conflicts in relationships, decreased productivity of work, overeating and a wide range of physical symptoms.

The physical effects of stress--high blood pressure, heart conditions, ulcers, headaches, etc.--are well documented.

Mental health reduces negative physical reactions and improves our overall quality of life. Mental health helps people cope with stress, find balance between personal and professional demands, make good decisions and function responsibly and successfully. Mental health helps us maintain self-confidence, develop healthy relationships and enjoy life.

One barrier to getting mental health help is the common belief that needing help is a sign of weakness or inadequacy, rather than a sign of strength and effectiveness.

Mental health care not only addresses mental illness or substance abuse, but also can help us handle all of the various problems of living, great or small. The need for support, validation and assistance in solving problems in the present, or healing from the past, is a normal human need.

Our culture reinforces the notion of not needing others in its overemphasis on independence and autonomy. Needing others is different than being overly dependent. And equating the need for support or assistance with a lack of autonomy just adds to more stress and bad feelings.

All these negative associations with mental health care contribute to the lack of psychotherapy and the isolation and unhappiness that people then end up living with.

Fortunately we are beginning to see how mental health and physical health are intertwined and the stigma associated with receiving mental health care is lessening. The Mental Health Association of Colorado has declared the month of May as Mental Health Month. The Surgeon General released a report in December of 1999. In that report was the recognition that mental health is integral to physical health, helping to normalize the need for mental health care.

I hope that the stigma attached to psychotherapy, whether it’s sought for significant mental disorder or for a problem in daily living, continues to decrease. And that mental health care is recognized by society, our government and managed care programs as essential for promoting healthy productive lives.

For more information check the Mental Health Association of Colorado at www.mhacolorado.org.

Pennock Center for Counseling is a nonprofit counseling center and a program of the First Presbyterian Church in Brighton. We provide professional counseling to adults, couples, children, adolescents and families. Fees are based on a sliding fee scale according to income. Call the counseling center at 303-655-9065. Read more!

Mental defense rare in Maine - Lewiston (ME) Sun Journal

By Christopher Williams , Staff Writer
May 30, 2007

LEWISTON - The man accused of murdering three women and a man over Labor Day last year is expected to claim he was not criminally responsible for his actions because he was mentally ill at the time.

How likely Christian Nielsen is to succeed with that defense will depend on conclusions drawn by his and the state's psychologists, who have investigated his mental state during the slayings.

While the public may view an insanity plea as an attempt to skirt justice, experts say the opposite is true.

An insanity plea is rarely used in Maine because state law requires defendants to provide a preponderance of evidence that they were not criminally responsible.

If Nielsen succeeds in his effort, he would be committed to the state's psychiatric hospital in Augusta for an indefinite period. He might never leave.

Dating back to 1970, nearly 60 people who invoked the insanity defense are in state custody, 22 of them at Riverview Psychiatric Center in Augusta. The others are living in halfway houses or supervised apartments. A few are serving prison sentences. All but possibly one suffer from mental illness, says State Forensic Service Director Ann Leblanc, a clinical psychologist who oversees the state's mental health evaluations. That one person probably suffered from a personality disorder, she said.

Once committed, the former defendants can't leave state custody until they prove to a judge they no longer pose a threat to themselves or others.

Three were released last year from the custody of the commissioner at the Department of Health and Human Services; three were newly committed.

Rare in Maine
In Maine, the so-called insanity defense is rarely used. Leblanc says a "small percentage" of defendants evaluated by the state's psychologists actually proceed to trial asserting they are not criminally responsible because, as a result or mental disease or defect, they lacked substantial capacity to appreciate the wrongfulness of their criminal conduct. That wording is taken from state law.

Only a handful, up to a half-dozen, succeed each year, she said.

She doesn't track the number of cases that go to trial. National statistics are outdated and wouldn't necessarily be accurate because other states have different insanity laws, she said. Maine's has changed substantially over the years. Four states allow no insanity defense.

In nearly all insanity cases in Maine, the defendants were charged with serious felonies, such as homicide, kidnapping or arson, and were facing long prison sentences if convicted. Otherwise, the unknown length of stay they face if committed to Riverview is not an attractive alternative.

Related Info
RELATED STORY: State requests results of Nielsen examination
RELATED STORY: Nielsen amends plea in 4 deaths
RELATED STORY: Judge rules Nielsen can be force-fed
RELATED STORY: Expert: Motive can determine jail behavior
RELATED STORY: Competency test ordered for Nielsen
According to statute, only those who suffer "severely abnormal mental conditions that grossly and demonstrably impair a person's perception or understanding of reality" are eligible for an insanity defense.

Many have tried to fake it, but it's not easy to feign severe mental illness for more than a couple of days or even hours, Leblanc said.

"Most people can't do it long enough to be convincing," she said.

Those who try to deceive experts likely suffer from mental illness but attempt a more severe form or a different diagnosis from their own, she said.

'Very difficult' burden
And just because somebody is diagnosed with mental illness doesn't necessarily mean that person lacked the substantial capacity to appreciate the wrongfulness of their actions, said Charles Robinson, a consulting psychologist from Manchester who has testified in about a dozen insanity cases over two decades.

Not every evaluation results in a court appearance, he said. In fact, most don't.

"In the last three or four cases, I told the lawyers, 'OK, here's what I think.' There was no trial," he said.

If his conclusions match those of the state's experts, an agreement for commitment might result or the defense might not seek an insanity defense at all. That is happening more as the science of mental illness progresses, leaving less room for conflicting conclusions, he said.

Most defendants found not criminally responsible in the cases in which Robinson has been involved suffer from schizophrenia or bipolar disorder, he said.

Proving a defendant is not criminally responsible is a hard tack to take in court, the Manchester psychologist said.

"It's a very, very difficult burden to meet," he said.

At most criminal trials, the burden is on the state to prove guilt beyond a reasonable doubt. The insanity plea is called an affirmative defense because the defendant bears the burden of proving by a preponderance of evidence that he or she is not criminally responsible.

Robinson said he simply shares his findings and facts with the court when he takes the stand and doesn't try to persuade anyone to see things his way. Judges and juries would be able to see through that.

"It's not possible to be slick or to fool people," he said.

Melvyn Zarr, a law professor at Maine Law School in Portland, said the outcome of insanity cases hangs on the testimony provided by psychologists.

"Usually, the result is dictated by what the experts say," he said.

A sharp prosecutor will try to exclude the defense evidence supporting an insanity plea and ask the judge not to give the jury the option of finding the defendant not criminally responsible due to a lack of evidence.

Nielsen had no history
Nielsen's attorney has said his 32-year-old client had no history of violent behavior before the slayings. Since he has been in custody, however, he reportedly has attacked another jail inmate and slashed his own forehead with a razor.

Robinson said a person's history of mental illness and past actions are not always predictors of future behavior.

Some people are able to control their mental illness. Sometimes an illness progresses to a point where the person experiences a break and snaps into violent behavior.

In determining whether a person was not criminally responsible at the time of his or her actions, Robinson said he conducts an investigation that goes far beyond an interview with the defendant, which usually ranks near the bottom of his evaluation.

That investigation will include interviews with other people familiar with the defendant, medical and other personal records and videotapes of police interviews with the suspect. All elements are assigned different levels of importance, he said.

Most people who end up pleading not criminally responsible are quickly caught by police, Robinson said.

That was the case with Nielsen, who confessed to killing the four victims, according to a Maine State Police affidavit.

He said he shot James Whitehurst, 50, of Arkansas, in the back of the head on their way to Upton for some fishing. He started to dig a grave to bury Whitehurst's body, then attempted to burn it. He never told police why he killed Whitehurst.

At the Black Bear Bed and Breakfast in Newry, where he lived, Nielsen decided to shoot the inn's owner, Julie Bullard, 65, in the chest three times because she might suspect him of being responsible for Whitehurst's disappearance, he reportedly told police.

He shot Bullard's daughter, Selby Bullard, 30, and her friend, Cindy Beatson, 43, in the head after they surprised him at the bed and breakfast, according to police reports.

He took the bodies outside and dismembered them with a chain saw and a hacksaw, police said. Read more!

Troops in Iraq Fight Fear and Boredom - AP

Twenty percent of soldiers and 15 percent of Marines were found to have a mental health problem, defined as anxiety, depression or acute stress.

By PAULINE JELINEK

WASHINGTON — Life for U.S. troops in Iraq can be boring and commanders can sometimes seem petty.

Morale for each Army soldier and Marine in the war depends foremost on how much combat they have seen. But it also is about the trivial and mundane — a lack of privacy or a resented rule that dictates the color of T-shirts they must wear.

It's about the triumphs, too.

"It's up and down," said Spc. Christopher Hagen, assigned to Baqouba in the increasingly violent Diyala province north of Baghdad.

When troops score a success against militants, "morale goes through the roof," said Hagen. "But when you hear one of your friends gets hurt, it drops to an all-time low."

A recently released Pentagon mental health study of troops in Iraq found 45 percent of junior enlisted Army soldiers rated their unit's morale as low or very low. Twenty percent of soldiers and 15 percent of Marines were found to have a mental health problem, defined as anxiety, depression or acute stress.

Researchers found both depend partly on how long each person has been there, how many tours of duty they've served and what their personal experiences have been.

"We have it pretty good here," said Sgt. Jesus Cruz, who organizes helicopter flight logistics in Baghdad's Green Zone. The heavily fortified zone houses Iraqi government offices and is only sporadically hit by mortar. Assignment there means good dining hall food, regular work schedules and access to the U.S. Embassy swimming pool.

"A lot of guys out there have it a lot tougher," Cruz said.

About two-thirds of those surveyed said they knew someone who had been killed or injured. More than three-quarters of soldiers and Marines said they had been in situations where they could have been killed or seriously injured.

Events that made them feel "intense fear, helplessness or horror," were described by nearly 40 percent.

Reported anonymously in the publicly released version of the study, the events included:

_"My sergeant's leg getting blown off."

_"A huge ... bomb blew my friend's head off like 50 meters from me."

_"Doing raids on houses with bad intel."

_"Working to clean out body parts from a blown up tank."

_"Convoy stopped in dangerous areas due to incompetent commanders."

_"A Bradley (tank) blew up. We got two guys out, three were still inside. I was the medic."

The report, released May 4, was based on data collected from some 1,300 soldiers and nearly 450 Marines in Iraq last fall. When it was released, most attention focused on the study's first-ever survey of ethics among troops at the front.

The report also found:

_The ratings on morale and instances of mental health problems were at about the same levels as in the previous study, done in mid-2006.

_Fifty-six percent of soldiers were highly concerned about the long tours.

_Eleven percent of those deployed for the first time had a mental health problem, compared to 27 percent of those on repeat tours.

_ Lack of privacy was a major concern among 39 percent of soldiers, whose housing ranges from two-person trailers to 20-person tents.

_ Boring and repetitive work was a main concern for 39 percent of soldiers and 33 percent of Marines.

_Among soldiers exposed to a low level of combat, 11 percent had a mental health problem; it was 30 percent among those who saw a high level of combat.

_More than a third of soldiers and Marines reported being in threatening situations where they weren't allowed to use force. After Iraqis began throwing gasoline-filled bottles at them, for instance, troops were banned from responding with force for nearly a month until the rules of engagement were changed.

_Many resent senior leaders for what they say are harassing rules — like the one on the T-shirt rules.

When asked in focus group interviews specifically what affected morale, troops consistently mentioned two things: base rules they disliked and what they saw as an unfair system on morale-boosting programs, the study said.

In some places, soldiers were not allowed to wear tan Army T-shirts with black Army shorts — they could only wear gray T-shirts with the black shorts.

In one unit, it was ordered that when two or more soldiers were walking together, they had to be dressed alike.

Such rules can be aimed at maintaining order and discipline, but troops felt "they had no other practical purpose other than to harass" them, said the report.

Soldiers also said those who went off-base to do the most dangerous duty had to wait in long lines to use phones or e-mail, could rarely take the afternoon off to attend concerts or other events, and found it harder to take R&R because they are needed in the fight.

Those who rarely, if ever left base had unfettered access to those morale-boosting programs — not to mention got "first dibs" on new items coming into the post commissary.

"It is probably not any single" thing, but rather "the accumulation of all of them that tends to wear down the soldiers' and Marines' morale," the study said.

___

Associated Press Writer Todd Pitman contributed to this report from Baghdad. Read more!

Convicted killer gets life sentences - Greensboro News-Record

Doctors have diagnosed bipolar disorder and borderline personality disorder.

By Jonathan D. Jones

GREENSBORO — The killer sat silent throughout his trial.

Staring forward, avoiding eye contact, rarely speaking with his attorneys. At times it was easy to forget William James Schreiber was even in the room.

So it was no surprise that Schreiber showed little emotion when his sentence, the result of a hung jury, came in Tuesday night: two life sentences. One for murdering an 8-month-old baby. One for butchering her mother.

He was spared the death penalty.

Schreiber, 35, stabbed his girlfriend, Teri Marie Sokoloff, to death on Sept. 19, 2005. He then drowned her baby, Skye.

A Guilford County jury deliberated Schreiber’s fate for nine hours Friday and Tuesday. It found him guilty of two counts of first-degree murder last week.

But during the sentencing phase, the jury deadlocked

8-4 Tuesday in favor of a death sentence. That caused Superior Court Judge James Hardin to declare a mistrial in that phase, meaning the only sentence that could be imposed for each killing was life without parole.

Sokoloff’s father, John Land, said he was disappointed Schreiber wasn’t sentenced to die.

"If the vicious sneak attack on a 31-year-old sleeping female, stabbing her 14 times including in the neck, and the drowning of an infant doesn’t fit the parameters of the death penalty, then what kind of viciousness does?" Land said. "At the same time, I can understand that some people do not vision any situation under which the state should put someone to death."

None of the jurors contacted after the trial would comment.

Hardin gave Schreiber consecutive sentences at the state’s request. Prosecutor Bill Wood wanted to make sure Schreiber would stay in jail if the state ever considers granting early release to prisoners serving life sentences.

Schreiber remained mostly silent throughout the trial, opting not to take the stand in his own defense and not to speak during his sentencing.

Defense attorneys Wayne Baucino and William Causey were relieved that their client had been spared the death penalty. Causey called it a "miracle verdict."

They focused their defense of Schreiber on his mental illness and asked the jury to weigh that when considering the death penalty. At various times doctors have diagnosed bipolar disorder and borderline personality disorder in Schreiber.

His defense team conceded at the start of the trial that he was guilty of second-degree murder but argued that his mental illness prevented him from being able to formulate the intent needed for a first-degree murder conviction.

During his sentencing hearing Thursday morning, James Aiken, an expert on prisons, testified that there is a strong likelihood of Schreiber being victimized by other prisoners because he killed a child and that his life in prison will be particularly rough.

Land said he hopes Aiken’s assessment of life in prison for Schreiber is accurate.

"I hope (Schreiber) realizes that every day, when it comes to a close, no matter what kind of hell that day was, all it did was bring him one day closer to the final penalty," Land said. "And that will be for eternity." Read more!

Less investments, less debate mark Senate budget - NC Policy Watch

The Fitzsimon File: Chris Fitzsimon
May 29th, 2007

Democratic Senators had a surprise waiting for them when they arrived back at the General Assembly Tuesday morning after the Memorial Day Holiday, the Senate budget delivered to their offices at 8:30.

The Senate Democratic Caucus met at 9:00 to discuss the 272-page budget bill and the accompanying money report that runs close to 100 pages, documents that most Senators had not seen in their entirety until Tuesday morning.

After an hour and half meeting, Democrats adjourned to get ready for the budget subcommittees that met at 11:00.
Republican Senators got their first look at the $20 billion spending plan a few minutes before the 11:00 meetings, when it was delivered to their offices.

In many ways the details of the budget are as disturbing as the private and exclusionary process used to put it together. The Senate budget tracks the House budget fairly closely in terms of what is funded, but the amounts are different because of the decision Senate leaders made about taxes.


The Senate budget allows the 2001 temporary increases in the sales tax and income tax on the wealthy to expire, which means a loss of $300 million in state revenue. The House voted to keep the taxes on the books and still wasn’t able to meet many of the vital needs of the state, particularly in mental health.

The Senate budget cuts the taxes and provides less funding for the important programs that the House budget expands, health care for children, school nurses, teaching assistants, and affordable housing.

The House budget includes $4 million for Kid’s Care, a program to provide health coverage for children in families with incomes from 200 percent to 300 percent of the federal poverty level. The Senate declined to fund the program, instead calling for a study of expanding health care for children.

Advocates had urged the House to do more and allow parents who earn too much to qualify for the program buy into it by paying the full cost of the premium. The House balked at that logical expansion and the Senate decided to do even less, which is what happens when tax cuts are more of a priority than helping families with health care.

The Senate budget does spend slightly more on mental health services, but like the House, finds most of the money by reallocating it from other mental health programs. Advocates for the mentally ill think the Senate budget may actually be worse than the House proposal because of some of the restrictions put on the money in the Senate plan.

The one place the Senate did outspend the House was in borrowing money for university projects and state buildings, including $1.2 billion in certificates of participation, a type of bond that does require voter approval. The House budget was attacked for paying for $400 million worth of construction projects with those kinds of bonds.

The Senate budget cuts taxes, but does not include a Earned Income Tax Credit that the House voted to establish in the second year of the two-year budget cycle. It is an initiative that provides targeted tax relief for the working poor. (Look for more details about the plan in Wednesday’s Fitzsimon File.)

One important exception to the mediocrity that defines the Senate bill is the funding for three pilot needle exchange programs to help reduce the spread of HIV/AIDS. That’s a tribute to the persistence of Senator Martin Nesbitt.

The budget now goes to the Senate floor, but don’t expect much of a debate if Tuesday’s committee votes are any indication. After the budget committee heard the bill explained and discussed a few minor amendments, Senate Majority Leader Tony Rand said he had heard enough and cut off debate.

It was the Senate leadership flexing its muscle again, tolerating no more discussion, much less dissent about a plan that cuts taxes and spends less than the House on education, human services, and helping children.

It was the perfect ending to the Senate budget day. Read more!

Unjustified violence - Raleigh News & Observer

Letter to the editor:

In response to the May 25 article "Family: Stories differ on shooting," the family and the community await a more definitive and conclusive statement from investigators. Appropriately, this incident has encouraged continued discussion on speeding, police pursuit and the relationship between gun control and those who have mental illnesses.
According to your article, four officers fired between 10 and 39 shots at Stephen Gibson as he tried to exit the car while holding a gun. It seems that the victim was hit by two bullets.

In addition to an unacceptable shooting percentage by trained professionals, this seems to be an excess of force that concluded with the worst possible result.

While most people would strongly advocate for law enforcement officers to protect themselves and the public, I doubt that many citizens approve of this show of violence. It is disturbing to imagine that the Highway Patrol has policies, procedures or training that encourage officers to respond in this way.

The lack of public or editorial dissent in this tragic incident is equally disturbing. For the editorial staff at The News & Observer to call these actions "justified" in a May 25 editorial is insidious.

Jeff Rose

Fuquay-Varina

Editor's note: The editorial recounted Stephen Gibson's armed robbery of a store in Magnolia and the ensuing chase on I-40. It then said, "When it [the chase] ended in a crash, he is said to have held out a handgun while emerging from the car. The decision by law officers to use deadly force appears to have been justified, provided their initial version of events proves accurate. Read more!

UNC system delves into campus safety issues -Raleigh News & Observer

Excerpted from "Under the Dome" column

A UNC system campus safety task force on Tuesday started to hash out the difficult issues raised by the shooting rampage at Virginia Tech last month.

A group of chancellors, administrators, police chiefs, faculty and students began what is expected to be a six-month examination of safety on UNC campuses.

The panel will look at a variety of issues, such as how to identify and respond to threats, how to deal with students who have mental illnesses, and how to handle problems involving alcohol, drugs and weapons. Also on the table will be a look at technology that could improve emergency communications and make campus buildings more secure.

Another task force will look at safety on all campuses, including private colleges, community colleges and UNC campuses. That panel is likely to be appointed by the end of the week by Attorney General Roy Cooper, said Leslie Winner, the UNC system's vice president and general counsel.

A key question will be how and when campuses can notify parents or law enforcement if students pose a danger to themselves or others. Federal privacy laws and medical confidentiality rules often prevent counselors and others from communicating with relatives and sharing information with university officials who might be in a position to intervene. The issue will be be taken up by Congress.

Laws provide for notification in cases of imminent danger. Some suggested trying to lower that standard to include cases in which there is a reasonable likelihood of harm.

Another problem, say campus officials, is how to prevent students from buying guns. It is a felony to possess a handgun on a university campus in North Carolina, but that law does not keep it from happening, police chiefs say.

While improvements can be made, some cautioned that there is only so much universities can do to protect students.

"I don't think you can walk out of this task force telling parents that you can prevent Virginia Tech from happening again," said Phillip Dubois, chancellor of UNC-Charlotte. Read more!

Homeless shelter may lose its home -Charlotte Observer

FRED KELLY
frkelly@charlotteobserver.com

In a small strip mall in an area in northern Charlotte known for crime, evangelist Betty Smith is fighting back with food, shelter and preaching.

But the city wants to close her street mission for violating zoning rules. Some officials also say her efforts actually hurt a distressed neighborhood.

Smith, known widely as "Mother Betty," is upset because she deliberately opened a makeshift homeless shelter where she believes it's needed most.

She wonders why the city is trying to close her Deeper Life Mission but not the neighboring businesses, which include a topless bar and a pool hall.

"There are drugs everywhere around here, but they don't bother nobody but us," said Smith, 78.

Authorities acknowledge Smith's good intentions but disagree with her methods.

"Her heart's in the right place, but rules are in place for a reason," said Walter Abernethy, the city's code enforcement director.

Smith's effort is a personal crusade in the face of a larger problem. Her facility has housed up to 40 people a night, but Charlotte has an estimated 5,000 homeless people, with fewer than 2,000 available beds.

`We never close the door'

Smith said she grew up in Salisbury, an orphan raised by relatives and neighbors. She often relied on the generosity of others for food and necessities, she said.After moving around the country, she came to Charlotte in 1998. Since then, she has lived and conducted her ministry in the same neighborhood along Statesville Avenue north of uptown.

At one time, she used an amplifier and microphone to preach the gospel from the front porch of her home. Her Sunday sermons at a different storefront once played on public access cable television.

In December, she started renting a former barbershop for $500 a month, paid for with her own money. She cooks for the homeless, and some food is donated. The homeless sleep on chairs or on the floor and sometimes supervise the facility themselves.

Smith ministers at the storefront on a regular basis to some of the hardest cases on the street, drug addicts and those suffering from mental illness.

"I hate to see men going down like this," she said. "That's why we never close the door."

She has until June 11 to close or face fines. She says she may hire a lawyer to keep her mission open or find another location.

Three weeks ago, a city zoning inspector ordered Smith to close after police complained that she was running an unlicensed shelter.

The inspector, Derrick Caudell, said he issued a cease-and-desist order because the property is zoned for commercial business and a homeless shelter requires a 2-acre parcel. The strip mall property is less than one acre.

Smith also did not obtain proper licensing or seek rezoning, Caudell said.

Some tenants in Smith's building are suspects in a rash of break-ins and contribute to loitering and drug trafficking around the strip mall, said Officer Donnie Penix, who patrols the area.

For three years, he said, police targeted the strip mall, the site of shootings and drug trafficking.

Penix said police have unsuccessfully tried to shut down the pool hall. Some of the homeless men drink in the pool hall, which does not have a liquor license.

"It's a mess," Penix said. "Every day I pull into the parking lot and someone is drinking and loitering. It's a huge eyesore."

Smith denies that her clients have caused trouble. "Nothing goes on in here except the word of God," she said.

`This gave me hope'

If Smith's mission closes, many of the men say they will have no place to go. Some can't function in group settings, and others have been kicked out of shelters for breaking the rules.

Robert Jones, 48, said a stroke has left him physically unable to keep his construction job. He said he is blind in one eye and receives monthly Social Security checks, but it isn't enough to pay for rent.

He said Smith's counseling has helped him kick drugs for three months. "This gave me hope," he said.

Bobby Carter said he has slept at the mission since February. He said he is No. 1,540 on the Charlotte Housing Authority's waiting list for public housing, but that means he will likely have to wait at least two years for an opening.

Police: Good idea, bad place

Police were called to the area around the strip mall almost 600 times last year. Many reports were for assaults, prostitution and drugs.

On a recent night, police officers searched a laundromat while responding to a report that someone was using drugs there.

Police Maj. Eddie Levins said those kind of reports make Smith's operation a bad idea for that location. He said that Smith is trying to "do the right thing" but that it's detrimental to the homeless and the neighborhood.

For her part, Smith said she won't stop. She'll let the men go to her house if her mission is closed, she said.

Last week, she stood in the doorway of the building shouting "God loves you" repeatedly to a 16-year-old boy who was throwing a bottle near the shelter.

Smith called him over and spoke to him gently through a fence. She gave him a business card. Call anytime, she told him, and the boy agreed to stop throwing bottles.

"He's a sweetheart," Smith said. "He's angry. I asked him where his parents where, and he said they were out using drugs." Read more!

VA downplayed complaints -Hampton Roads (VA) Daily Press

By Stephanie Heinatz
May 29, 2007

HAMPTON, VA -- By admitting themselves to the psychiatric unit at the Hampton Veterans Affairs Medical Center, Floyd "Chip" Washabaugh and Glen Brennan were asking for help.

Washabaugh, a 63-year-old combat veteran wounded in Vietnam, was suffering from depression. He didn't want to commit suicide, he told physicians, but was convinced that he would soon die.

Brennan, a 35-year-old husband and new father, wanted to kick a drug addiction that he'd fought for several years.

Both men died at the VA hospital after frequent complaints of physical pains: Washabaugh was often short of breath, and Brennan had back pain - later determined to be from a fractured vertebra.

Their complaints were largely ignored by the staff, according to Washabaugh's medical record and a malpractice lawsuit filed by Brennan's widow.

Their deaths, a physician and three nurses familiar with the unit told the Daily Press, aren't anomalies. They are part of a pattern of mental health patients not receiving treatment - or receiving the wrong treatment - for physical problems.

"There is a callous disregard for medical issues of patients on the unit," said the doctor, who asked not to be named. "The unit is the most dangerous place to be at the VA."

When Washabaugh complained of trouble breathing, a doctor in the unit prescribed Washabaugh an anti-anxiety medication.

Washabaugh died in January of a blood clot in his lungs.

The unit's medical staff decided that Brennan's complaints of back pain were an attempt to get drugs, according to his widow's lawsuit. He died in 2001 of a drug overdose, which his family thinks was his way of self-medicating.

This year, the hospital paid $210,000 to settle the lawsuit and acknowledged that it was responsible for Brennan's death.

A spokeswoman for the hospital said there had been three deaths in the unit in the last 10 years. "That is very minimal in a 10-year span of time," said Wanda Mims, director of the Hampton medical center.

But that number doesn't include patients, such as Washabaugh, who got sick in the unit and then died after being transferred to the intensive care unit or the emergency room.

The Daily Press asked two weeks ago how many patients from the unit have died after being transferred to the ICU or the ER, but the hospital has yet to provide that information, saying it would require extensive research.

Mims said each death was taken seriously.

"We're all about providing quality care," she said. "Are we perfect? No. No institution is perfect. But we do have systems in place to identify (problems) to ensure we are addressing issues. We're here to provide great care to our patients."

The Joint Commission on Accreditation of Healthcare Organizations, which accredits the Hampton VA, requires hospitals to review any deaths considered unexpected, and its guidelines "encourage" hospitals to submit reports about those deaths.

Submitting the reports, the commission says, sends a "message to the public that (the organization) is doing everything possible to ensure that such an event will not happen again."

It also allows hospitals to learn from one another's experiences.

The VA hospital didn't report the deaths of Washabaugh and Brennan to the commission, though the information is available if the commission requests it.

Leigh Starr is the medical center's chief of quality management. She said that all deaths at the medical center were reviewed and that any deaths considered unexpected - such as Brennan's and Washabaugh's - received an immediate peer review to evaluate the medical care.

She said VA staff also conducted a "root-cause analysis" - a study of whether systems broke down to lead to a death.

In a letter to Virginia Sen. Jim Webb, Mims wrote, "A clinical review of the circumstances of the case of Mr. Washabaugh was conducted, and based on this assessment, we feel confident that the highest patient care was provided in a timely manner."

Some current and former psychiatric unit staff members - both nurses and doctors - say the Hampton VA has done little to ensure that patients' complaints about physical problems aren't merely dismissed.

Instead, the unit's policies and procedures perpetuate that culture, the staff members said.

It was only recently - after a Daily Press investigation led to pressure from Webb - that one such policy was rescinded.

Until last month, no patients in the unit were allowed to have visitors - a policy put in place in late 2004 that Dr. Priscilla Hankins, the hospital's chief of mental health services, said was a response to Brennan's death in 2001.

But the doctor with knowledge of the unit said, "Wives are the most valuable asset on picking up on medical problems. (Washabaugh) very well may have lived if he got prompt medical attention."

VA officials say medical attention for patients in the unit starts when they are admitted.

Patients must be physically examined and their medical histories recorded before they arrive in the unit, Hankins said.

The unit is authorized to hold 60 patients at a time and is divided into two wards: acute and sub-acute. Patients are admitted into the acute ward.

Hankins said most of the patients arriving in the acute ward are suicidal, severely psychotic, depressed, confused, combative or going through detoxification from drugs or alcohol.

After patients are stabilized and have completed an initial phase of treatment, they're transferred to the subacute ward.

Nurses and doctors in the entire unit are supposed to monitor patients' physical well-being, as well as their mental struggles.

Specialists can be called to the unit to meet patients with suspected problems, Hankins said, and patients can be transferred to the emergency room or intensive care unit if they get into any acute distress.

"That's just standard patient care," Mims said. "When a need arises to transfer a patient to a more acute setting, whether that be the ER or ICU, that's what we do. That's what the nurses are required to do. That's what the docs are required to do, as necessary."

In the meantime, patients' vital signs - temperature, blood pressure and pulse - should be taken at least daily, Hankins said. The medical center's protocol calls for vital signs to be recorded in each patient's medical record. A nurse who used to work on the unit - and who asked not to be named - said that didn't always happen.

"If a patient was sleeping, nurses won't take the vitals," the nurse said.

Based on the number of times that vital signs were recorded in Washabaugh's medical record - including on the morning he died and the physical exam done when he was admitted - medical staff took his vital signs five times. He was on the unit for 13 days.

During that two-week period, Washabaugh frequently complained of shortness of breath.

According to his medical records, it wasn't until the last few hours of his life that anyone measured the oxygen saturation level in his blood.

That measurement is done with a pulse oximeter - a small clip that goes on a finger and shines a laser into the nail bed.

"If somebody told me they were feverish, I would take their temperature," said Dr. John Perry, a pulmonary specialist with Peninsula Pulmonary Associates in Newport News. "If they tell me they're short of breath, I check their blood oxygen level."

Audrey Moore, the medical center's assistant director of patient care, said pulse oxygen readings were taken as needed. When a patient is having a hard time breathing or complains of shortness of breath, Moore said, a reading should be done.

There are several pulse oximeters in the unit, Hankins said.

According to his medical records, when Washabaugh complained that he was having trouble breathing, he was given Ativan, an anti-anxiety medication - even on the morning he died, when his difficulty breathing didn't subside for hours.

At 7:50 a.m. Jan. 24, according to a staff nurse's note, Washabaugh was "sitting in wheelchair, somewhat sweaty with rapid breathing. Patient appeared to have an anxiety attack."

Anxiety almost always accompanies pulmonary embolism, according to a nursing textbook. The textbook says it's crucial to frequently monitor the patient's blood oxygen level.

The nurse that morning gave Washabaugh a "paper bag to breathe in ... cold cloth to his forehead."

That was the wrong response. According to Perry, the paper bag technique - typically used for someone hyperventilating - further reduces the oxygen that someone breathes in.

About 20 minutes later, Washabaugh again complained that he was having trouble breathing.

A pulse oximeter reading - the first since he'd started complaining of shortness of breath - was 88. The normal range is between 95 and 100.

Perry said a reading as low as 88 was "never a normal number. Something certainly is causing it.

"Would you know it's a blood clot? Not necessarily. It could be heart failure, a collapsed lung. But it should prompt some kind of evaluation."

Washabaugh's nurse wrote that she referred him to the doctor and then the "patient (was) encouraged to relax."

At 8:55 a.m., Washabaugh was seen by a medical student who noted that "he denied chest pain ... but did feel anxious and somewhat short of breath. He was breathing more rapidly than normal."

Between 9:15 and 9:27 a.m., Washabaugh received a small dose of an anti-anxiety medication.

According to the doctor's notes, Washabaugh's "pulse ox at this time revealed a reading of 85."

A nurse wrote that she "wheeled patient to a quiet area and attempted to direct patient to breathe through his nose and out through his mouth. Patient was able to slow his breathing down a little but would start breathing fast again. His facial color was pale at first, then he regained color."

About 9:30 a.m., Washabaugh asked to be wheeled back to the nurses station. His pulse ox dropped to 59.

Washabaugh was taken to the intensive care unit and pronounced dead at 10:35 a.m. Cause of death: massive pulmonary embolism, or blood clot in his lungs.

His autopsy report revealed that in addition to the massive clot, there were several patches of dead tissue in his lungs.

"Usually - and 'usually' is the key word - that means he's had several smaller emboli (blood clots) and that those areas of (dead lung) were happening before the major clot that came," Perry said.

Essentially, each time when Washabaugh complained of shortness of breath in the days before his death could have been when those smaller blood clots were hitting the lung.

Pulmonary embolisms are the third-leading cause of death in hospitals.

Long periods of inactivity can lead to a blood clot.

It's why doctors encourage patients to get up and move around as soon as possible after surgery and why family physicians have long been telling patients to frequently get up and walk around during long plane rides.

Washabaugh's records are littered with reports that he was only "out of bed for dinner and a phone call" or "patient has been sitting in bed for long periods."

Before Washabaugh was transferred to Hampton from another VA hospital, his wife, Nancy, frequently visited him and made a point of getting him up and walking around.

The medical staff in Hampton wouldn't let her see her husband.

In the two weeks when Washabaugh was in the unit, Nancy was allowed to see him only once - for a treatment consultation - before she received a phone call from the hospital, telling her that her husband was dead.

Jan Garrity is a retired Navy commander who served as a combat-stress nurse. She described another problem in the unit:

Garrity used to teach a nursing course at a local university. She brought her students to the unit for clinical work and said she immediately noticed that if it weren't for her students and the hospital chaplains, the patients would have little to no interaction with the unit's staff.

"There wasn't any programming on that unit to get the patients up and moving or to help heal them holistically," Garrity said. There were group meetings in the morning and in the evening, but nothing in between, she said.

"I raised this concern several times," she said. "Nothing was done."

Staff researcher Tracy Sorensen contributed to this report. Read more!

Feds hit Georgia mental hospital -Atlanta Journal-Constitution

Patients in danger, warn regulators after fatal attack at Columbus facility. State is doubling nurses.

By Alan Judd, Andy Miller

Days after a patient died from a severe beating, federal regulators have ordered the state mental hospital in Columbus to quickly correct dangerous conditions that may have contributed to the assault.

Patients at West Central Georgia Regional Hospital, where Luis Marrero was severely beaten, are in "immediate jeopardy" of harm, regulators said Tuesday. If the facility doesn't reverse the situation shortly, it could lose its federal funding.

Late Tuesday, the state Department of Human Resources, which manages Georgia's seven mental hospitals, said it was doubling the number of nurses at West Central Georgia Regional from 18 to 36. DHR spokeswomen said staffing was a "key issue" in the regulators' complaint and a problem at all seven of the hospitals.

The action by the federal Centers for Medicare and Medicaid Services amounts to the latest indictment of Georgia's troubled psychiatric health care system. Already, the U.S. Justice Department is investigating whether conditions in the state hospitals violate patients' civil rights, auditors have issued blistering reports on the quality of care in two of the facilities, and a state commission is preparing to study ways to overhaul the entire system.

These inquiries came in response to a recent Atlanta Journal-Constitution series, "A Hidden Shame," that reported on deaths, patient neglect and abuse, overcrowding and understaffing in the state hospitals. The newspaper found that at least 115 patients died under suspicious circumstances from 2002 through 2006 and that more than 190 cases of patient abuse by hospital staff members had been substantiated during the same period.

The citation of the Columbus hospital came from a recent inspection shortly after Marrero, 53, died from injuries suffered in a beating in early May. Police charged another patient, Terry Cox, in connection with the attack.

The Marrero case is under investigation by both DHR and the Georgia Bureau of Investigation.

Marrero, a U.S. Army retiree, had been hospitalized with schizophrenia at West Central Georgia Regional in April after getting into an argument at the Columbus group home where he lived, relatives said. The fatal beating came about two weeks after he was admitted.

He had had violent episodes in his past, including a case that led to a manslaughter conviction in the late 1980s. His family attributes that incident to his mental illness.

Officials at the Columbus facility have begun responding to the federal citation, said Kenya Bello, a DHR spokeswoman. She said the hospital would hold a "hiring fair" in Columbus today in an effort to hire 18 more nurses by Friday.

"The key issue was staffing," Bello said. "That is being managed appropriately."

Inadequate staffing levels, according to another DHR spokeswoman, Dena Smith, "is a problem at the hospital and other hospitals."

West Central Georgia Regional has often been overcrowded and understaffed, according to patient advocate Sue Marlowe, president of the Columbus chapter of the National Alliance on Mental Illness.

"Full staffing levels at the hospital must be made a priority in order to maintain the safety of patients and staff," Marlowe said Tuesday.

Federal officials declined Tuesday to say whether regulators had cited the hospital because of the Marrero case. They also would not say specifically what the recent inspection found.

Lee Millman, a spokeswoman for the federal Medicare and Medicaid centers, would say only: "It is a crisis situation relating to the health and/or safety of patients."

However, DHR has declined to say how many patients were in the Columbus facility when Marrero was attacked or how many employees were on duty. Both issues, the department said, are part of an investigation into Marrero's death.

The Medicare and Medicaid centers gave the hospital until June 16 to draft a plan to correct its deficiencies. Regulators will conduct another unannounced inspection to see whether the plan is working satisfactorily.

A cutoff of federal funding is rare and could cripple operations of the Columbus facility. DHR could not say Tuesday how much federal money is at stake in Columbus. The case reflects the violence that regularly occurs in the state hospitals.

The Journal-Constitution reported in January that overcrowding in many hospital units, coupled with understaffing, contributes to an atmosphere where injuries are common.

Employees and inspection reports have cited frequent patient fighting, either against staff members or other patients. Hospital employees claim more injuries from altercations with patients than from all other causes combined, according to the Journal-Constitution's analysis of state workers' compensation data. Read more!

Aliens Part of Shooting Insanity Defense - AP

GEORGETOWN, Del. (AP) -- A man accused in a deadly two-state shooting rampage believed his victims were space aliens trying to abduct his daughter, his attorney said Tuesday at the start of his murder trial.

Allison Lamont Norman, 27, was in the middle of a psychotic episode and believed he was protecting his 5-year-old daughter during the time he is accused of killing two people and wounding four others in Maryland and Delaware in April 2005, defense attorney Brendan O'Neill told jurors.

''He thought there were aliens everywhere,'' O'Neill said.

Prosecutors are seeking the death penalty for Norman in the slaying of Jamell Weston, 24, in Laurel, Del.

Norman also is accused in the shooting death of DaVondale M. ''Pete'' Peters, 28, in Salisbury, Md., but that charge and others were dropped so the Delaware case could go forward. A Maryland prosecutor cited differences in the way the two states handle insanity pleas.

Both O'Neill and prosecutor Peggy Marshall told jurors that neither will dispute that Norman pulled the trigger.

''This case is not a whodunit. ... The issue in this case is what was Mr. Norman's mental condition, what was his state of mind, when he did these things,'' O'Neill said.

O'Neill told jurors they would hear seemingly far-fetched testimony that Norman stuck his head in a toilet, drank his own urine and ate his own feces after being arrested.

He was trying to ''prove his worthiness'' to get his family back, O'Neill said.

Marshall said Norman's state of mind would be the key issue and urged jurors to keep their own minds open.

The attacks began in Laurel, where Weston and another man were shot at an apartment complex, and a third man was shot at a nearby shopping center.

Investigators say Norman, wearing a bulletproof vest and carrying a handgun, then stole a car and drove about 13 miles to Salisbury, where he shot Peters, two other people and two dogs. One of the Salisbury victims was left paralyzed and Peters was killed.

The girl Norman believed was his daughter, Donesha Sturgis, took the stand to testify Tuesday. O'Neill said after court that Norman's girlfriend told him he was the girl's father, though there has never been scientific confirmation.

Sturgis, 7, told the court that the night before the shootings, Norman corralled her and her sisters in a corner of their apartment while her little brother was left alone in a hallway, screaming. According to O'Neill, Norman believed that the screams of the children helped keep the aliens at bay, and would pinch them to keep them yelling.

''He tore down the curtains in the kids' bedrooms so he could see the aliens at night,'' O'Neill said.

Also testifying Tuesday was Weston's cousin, Marcus Cannon, 20, who was wounded in the arm during the Carvel Gardens shooting. Cannon said that after seeing Norman shoot Weston, he ran for safety as Norman turned the gun on him.

Marshall asked Cannon what he was thinking as he sought safety.

''That I was going to die that day,'' Cannon replied.

Read more!

Mental health care helps students thrive in the community - Hillsboro (OR) Argus

By Jane Siguenza
Special to The Argus

Mental health concerns play an increasingly significant role in everyone's lives, but awareness of problems and treatment is still low. According to the Oregon Department of Human Services, nearly 13 percent of Oregon's children and adolescents experience moderate to severe mental health disorders. Public health agencies are able to serve only a third of them.

What are the consequences? DHS data shows that youth suicide is the second leading cause of death for youth ages 15-24 in Oregon. Children with mental health disorders are 50 percent more likely to drop out of school. Untreated youth mental health disorders affect child development, produce legal and financial consequences and can create even more problems in adulthood.

What helps? In other states, coordinated, community-based mental health care has been found to improve school attendance and grades, increase parents' ability to work and decrease arrests. Arrest rates for Oregon adolescents who receive mental health treatment are a third lower after treatment than before treatment.

In the Hillsboro School District, seven mental health care coordinators work with school counselors and staff, law enforcement and community agencies to help youth find the treatment they need. Their services are available to all the district's students and families.

"Success stories - I could write about many," states Shelley Corry, assistant principal at Century High School. "Two boys in our school are now finding the support of mental health agencies they have previously been unable to afford. Another student who is struggling with school phobia and anxiety (is learning) to cope with emotional issues that are keeping her from coming to school."

Corry added, "What makes this work is the camaraderie and single focus of all the participants - to get our students to school, keep them in school and focused on academic success. (Care coordination) has great value for us and our students (and) families."

Care coordinators not only act as the families' bridge to services, but they also review warning signs for at-risk behavior ranging from withdrawal, anger and disciplinary problems to severe rage, self-injury, property destruction or violence.

"Our data shows a significant drop in discipline issues this year as compared to last, and one of the major components of that change process has been integrating the care coordinator to our truancy and violence prevention plan," stated Greg Mitchell, assistant principal at Glencoe High School, in a service evaluation.

The care coordinators' partnership with schools also helps them keep tabs on trends in students' mental health concerns.

"We're seeing more mood disorders, teen depression and childhood anxiety," Care Coordinator Peter Knysak said. "There's pressure on kids and adults for success in school as well as a (negative) influence from a sensationalist media and environment."

Cultural and economic stresses also are major factors affecting youth and families. With increased awareness and access to treatment, more serious problems can be avoided.

May is National Mental Health Awareness Month. Be informed. Find help if you or a friend need it. Resources include school counselors, Washington County's mental health crisis line at 503-291-9111 and the federal site www.samhsa.gov.

- Jane Siguenza is a Communications Specialist for Hillsboro School District's Hillsboro Together, funded by a federal Safe Schools/Healthy Students grant. Read more!

Jeffs' Mental Evaluation Released - KUTV Salt Lake City

SALT LAKE CITY The jailed leader of a polygamous sect struggles with depression and anxiety and can go days without food or water.

Warren Jeffs has spent long hours motionless on his knees in prayer - so long, his knees developed ulcers, two mental health specialists reported in evaluations unsealed on Tuesday. Both found Jeffs mentally competent.

On Friday, 5th District Judge James Shumate declared Jeffs, 51, competent to stand trial. The judge at the same time ordered the release of edited versions of Jeffs' evaluations.

Click here to read the report.

The reports were posted Tuesday on a court Web site.

Shumate ordered Jeffs to stand trial in September on rape by accomplice charges surrounding the arranged marriage of a 14-year-old girl to her 19-year-old cousin in 2001.

"Mr. Jeffs is absolutely healthy, absolutely capable of going forward," the judge said Friday.

Jeffs' competency reports, however, portray a fragile religious leader who has been refusing to take psychoactive medication and can turn "catatonic" or "stuporous" from fasting.

The edited versions of the reports don't identify the medication or its purpose.

Jeffs' physical and emotional health came into question in January when he was taken from the Washington County jail to a St. George hospital for undisclosed treatment.

And at a March 27 court hearing - during a time of fasting, according to the mental health evaluations - Jeffs appeared ill, pale and skeletal. At one point, he nodded off and drooled on himself. His demeanor led to Shumate's sealed order for evaluations.

The reports found that Jeffs' practice of fasting can drop his lean body weight by six pounds to 130 pounds - he stands 6-foot-3 - and can affect his mental condition at court appearances.

Jeffs had improved by early April when he was interviewed, they said. In court Friday, Jeffs chatted with his lawyers; his face was no longer ashen, and he appeared to have gained weight.

"My religion is one of peace," Jeffs, president of the Fundamentalist Church of Jesus Christ of Latter Day Saints, told examiners, but he also denied having any spiritual powers. "I don't consider myself special."

The evaluators differed only on whether Jeffs suffered from "substantial" mental illness. Both agreed he was competent to stand trial.

The defense's examiner, Eric Nielsen, of Associated Behavior Consultants Inc. of the Salt Lake City suburb of Holladay, said Jeffs suffered from mental illness. In the edited version of Nielsen's report, no attribution or other references explaining the condition could be found.

"It is the examiner's opinion that this man is competent to proceed at this point," Nielsen wrote in his April 18 report. "However, he may suffer a relapse as he is not taking medication which would be prophylactic for him" - prophylactic means preventive.

In the prosecution report, Tim Kockler, director of Neuropsychology Services at Dixie Regional Medical Center, said Jeffs sometimes suffers from "depressive disorder."

His report didn't say whether the mild depression was brought on by Jeffs' stay since last August at the county jail, where he is kept in solitary confinement.

"Mr. Jeffs demonstrated a rational and factual understanding of the proceeding against him," Kockler concluded in another report filled April 23. "He has the ability to consult with counsel and to participate in the proceedings against him with a reasonable degree of rational understanding."

Jeffs was born in Sacramento, Calif., and grew up in the Salt Lake valley. He said his mother was still living but that his father had died, but refused to discuss his family or married life.

Jeffs said he regarded the two charges of rape as an accomplice as a serious threat to his liberty. "They are accusing me of influencing someone to commit these crimes," he told one examiner.

Both reports found Jeffs was cooperating with his lawyers and even discussing events surrounding the charges - a topic he refused to share with examiners. He refused to take a standard mental health test.

Jeffs presides over a community of about 10,000 members on the Utah-Arizona border that practices polygamy and arranged marriages.
Read more!

Speakers delve into the pain of mental illness with stories of own struggles - Wilmar (MN) West Central Tribune

West Central Tribune

WILLMAR — To look at him now, it’s hard to picture Minnesota’s former Senate majority leader standing on a bridge over Interstate 94, ready to jump to his death in a desperate attempt to flee a downward spiral of depression.
But that’s where John Hottinger said he was four year ago.

With his professional and personal life a mess, Hottinger — a Mankato lawyer who logged 16 years in the Minnesota Senate before retiring in 2005 — had decided to end his life.

That day on the bridge ended up being the best day of his life, he said, because it’s the day he finally sought treatment for his illness.

During the 16th annual Southwest Symposium on Mental Health last week in Willmar, Hottinger spoke frankly about his struggles.

He provided practical advice for professionals in the audience who have clients with mental illness and encouragement to family members who feared their loved ones suffer from mental illness.

He also provided an insider’s look at the four days he spent in a psychiatric hospital and the “incredible experience” of spending several months in group therapy with people that included successful professionals as well as homeless men and women. “No one is immune,” Hottinger said.

Therapy, proper medication to maintain his body’s chemical balance, a good insurance plan and support from family and friends has helped him stay healthy and gain the courage to speak publicly about mental illness.

“As an older white guy” with a very public professional career, Hottinger said it was easy to hide his depression behind a mask of public success. He’s since learned that it’s “OK to be fragile” and to talk about it.

Yet, Hottinger is still stung by the negative stigma the public has about mental illness.

“It’s an illness, not a character defect,” he said. Nobody tells people with cancer or heart disease to “buck up” or “get over it,” said Hottinger, yet that attitude and message is often what the public throws at individuals who have mental illness.

“There’s an enormous amount of stigma is our society,” he said. “That stigma is not fair.”

The mental health symposium, sponsored by a number of local health providers, Kandiyohi County law enforcement and human services departments, Ridgewater College, PACT 4 Families Collaborative, Lutheran Social Services, Atwater Block Nurse Program, Minnesota National Guard and Bethesda Homes, offered a variety of speakers and views on mental health.

Pete Feigal, a former Shakespearean actor, professional motorcycle racer and visual artist for Harley Davidson, now speaks full-time about mental illness. With a good dose of self-deprecating humor, Feigal said instead of hiding his “dirty laundry,” he “sells his.”

In 1971, when he was 15, Feigal was diagnosed with depression and locked in a Minnesota hospital for a year in a program so horrible it gained national attention. “I saw things there I’ll never forget,” he said.

When he was 21, he was diagnosed with bipolar disorder. The diagnosis for multiple sclerosis came just 10 days after he got married in 1987.

Today, he walks with a cane and is going blind. However, he said the physical devastation of having MS is minor compared to the pain of his mental illness and depression.

With depression, he said, “I feel ugly. I feel stupid. I feel unwanted. I feel unloved.”

MS is “destroying my body” but mental illness is “going after my soul.”

When he was diagnosed with MS, people brought hot dishes to the house and no one judged him for having the disease.

By contrast, people with mental illness are called lazy bums and told to get a job. Those words are like having a broken knife plunged into your heart, and twisted, said Feigal, who calls mental illness the “last evil bastion of prejudice” in this country. “You’re one of the damned and you don’t even know why.”

He said he’d rather live an entire life with MS than one more day of living with depression.

When Feigal was 16 and returned to his high school after spending a year in a hospital, his classmates were “nice” but most pulled back and never talked to him about his disease or absence, he said.

“To do nothing is the worst thing,” Feigal said. “No one can stand to be that lonely.”

Later, when he returned to a class reunion, he was embraced and welcomed and made to feel whole and loved by his classmates.

Feigal said he has survived mental illness because “people were kind to me.”

He said friends, family, teachers, classmates, co-workers and strangers all have the ability to help keep a person with mental illness alive with a kind word or a smile.

“You are the light of the world,” Feigal said, lifting his hands outward. “You are the face of God.”

Read more!

More western N.C. veterans seek trauma help -Asheville Citizen-Times

By NANCY BOMPEY
May 27, 2007

ASHEVILLE, N.C. - More local veterans are seeking help for post-traumatic stress disorder, and the numbers are expected to rise as more troops return home from Iraq and Afghanistan.

But, while the military is getting better at addressing mental illness, some doctors say that not enough veterans are seeking help. Psychologists say the stigma attached to mental health is one reason more veterans are not coming in for help, but the sooner they are treated for post-traumatic stress disorder, the better chance they have of overcoming it.

"Of course, there's no cure for memories, there's no cure for difficult experiences, but there are many things that can help," said Bruce Purvis, a psychologist at the VA Medical Center in Asheville.

Post-traumatic stress disorder, or PTSD, is an anxiety disorder that can occur following the experience of a traumatic event. While anyone who witnesses a traumatic event can suffer from PTSD, people who have been in combat are extremely susceptible to developing the disorder.

Andrew Clark, 24, began experiencing symptoms of the disorder about one month after he left the Air Force in 2005, following two deployments to Iraq. His symptoms included nightmares and becoming easily frustrated. After his unit was deployed back to Iraq and Clark was unable to go, he plunged into depression.

"Adapting back to civilian life is the hardest part of it," he said.

The National Center for PTSD estimates that about 30 percent of men and women who served in Vietnam experience PTSD and an additional 20 percent to 25 percent have had partial PTSD at some point in their lives. The center also estimates that between 6 percent and 11 percent of veterans from the war in Afghanistan and about 12 percent to 20 percent of military personnel who served in Iraq have been diagnosed with PTSD.

At the Asheville VA Medical Center, the number of patients being treated for PTSD has increased over the past 10 years.

Like most VA Medical Centers across the country, most of the PTSD claims at the Asheville VA are from Vietnam War veterans, but the number of veterans from recent wars who are being treated for the disorder in Asheville has more than doubled to 170 patients from October through April of this year from 58 patients during the 2006 fiscal year. This number does not reflect veterans who are also getting help at the Veterans Center and other mental health facilities.

Soldiers returning from World War I experienced shell shock, and veterans from World War II were said to suffer from combat fatigue. But a formal diagnosis for PTSD did not exist until the early 1980s.

According to the National Center for PTSD, people with the disorder have four major types of symptoms: They re-experience the event either while awake or asleep; they stay away from people, places and things that remind them of the trauma; they experience a loss of emotions; and they feel on guard, have trouble sleeping and are irritable.

To receive a formal diagnosis of PTSD, these symptoms must last for more than one month, cause significant distress and affect the persons ability to function normally.

The combat behaviors veterans learn in the military and the return to civilian life after being in a life and death situation can exacerbate some of these symptoms.

But, Purvis said these are normal responses to an abnormal situation.

"It's the way were put together," Purvis said. "It's the way we're wired."

Dr. Alan Krueger, a former psychiatrist at the Asheville VA Medical Center, said even if military personnel don't develop PTSD or other mental health issues, war has some effect on everyone who is involved in it.

"I don't think anybody who goes into combat comes out unscathed," Krueger said.

But doctors say newer veterans like Clark may have a better chance at recovery than some of the older veterans who fought in Vietnam.

"The symptoms are very much the same but the package is different," Purvis said.

Lonnie Darr, 60, was in Vietnam for three years. After he left the military in 1980, he couldn't hold down a job, his wife and kids left him, and he withdrew from the world.

One morning, he woke up in his car under a freeway in Los Angeles, homeless and alone, and decided to seek help.

"I never heard of PTSD until I went to the Vet Center," he said. "I knew something was horribly wrong, but I couldn't put my finger on it."

Although Darr is now getting help, he still struggles with many of the symptoms of PTSD on a daily basis. He is married for the third time, but he hasn't been able to work for the past three years because of severe anxiety and intrusive thoughts about Vietnam. Most days, Darr stays in his home office, which his wife has nicknamed "the bunker."

While the number of times he thinks about Vietnam has decreased, a few times a week, Darr will be back in a bunker staring into the face of a teenage North Vietnamese soldier or running through a firefight in Khe Sanh.

"In my day-to-day life, I see Vietnam all the time," Darr said. "This doesn't leave you."

Because PTSD was not formally diagnosed until the 1980s, many Vietnam veterans like Darr went without help for a long time, which made their symptoms worse and harder to overcome.

"When the Vietnam veterans came out we seemed to be pretty unaware of the psychological consequences of combat," Purvis said.

Krueger said because they are getting treatment at a younger age, veterans of Iraq and Afghanistan might have a better chance of overcoming PTSD than the veterans of previous wars.

Younger veterans have fewer additional health problems, and because they are being treated earlier for PTSD, fewer structural changes take place in the brain that compound the problems, Krueger said.

"The sooner we can intervene, the better," he said.

The military now also acknowledges the need for mental health services. Families and soldiers are educated about PTSD, and there are more support services both before and after soldiers go to war. The military screens soldiers for mental health problems during combat, and they have critical stress units on the ground in Iraq.

Krueger said doctors and the military today also realize that the methods of individual deployment and lack of time for adjustment back to civilian society during the Vietnam era affected soldiers mental health. Veterans of the Vietnam War also came home to an unwelcoming society and felt isolated and rejected, something that contributed to the development of PTSD.

Purvis said he thinks these differences may mean that younger veterans will have an easier time overcoming PTSD.

"I think we're trying to do a number of things to help the younger veterans because of the lessons learned from Vietnam," he said.

But, there is still a stigma associated with mental illness, both in the military and in civilian society, that prevents some veterans from getting help for mental health issues.

Both Clark and Darr said they tried to deny that they had a problem in the first place, a common response in veterans with PTSD, and both men said many of their friends claim there is nothing wrong with them even though they suffer from many of the symptoms of PTSD.

"They often think they're the only ones who are affected that way," Krueger said.

Clark said he realizes now that he isn't alone and the help he has received at the VA has helped him with his symptoms.

He is less irritable with other people and realizes he doesn't have to constantly be on alert, but Clark said he still suffers from occasional nightmares and anxiety.

"I don't know if it goes away or not," he said.

But, Purvis said that if veterans get help soon enough and they receive the proper care, they can overcome PTSD.

"I think you can put a great deal of it behind you," he said.

___ Read more!

Powerful Companies - Winston-Salem Journal

Editorial:

North Carolinians got a good look at the power of the state’s insurance companies, especially Blue Cross and Blue Shield of North Carolina, Wednesday. At the insistence of health-insurance companies, the state House watered down a health-insurance bill that should have gone through the General Assembly as originally written.

The bill would require that health-insurance policies provide benefits for the treatment of mental illnesses. It’s called mental-health parity.

Although the eventual cost to health insurers, and to those paying for policies, would be relatively small, the companies have long resisted this change. It’s required in most other states.

This year, momentum for mental-health parity was strong. But the companies first got a House committee to cut coverage for substance abuse and then the full House to limit parity to policies covering 26 or more people.

Given the slow pace of health-care reform in this state, maybe North Carolinians should be overjoyed that their legislators gave them anything that the big insurers oppose.

But for those families facing a mental-health crisis, it will be little consolation if they don’t get coverage. Read more!

Effective help is out of reach for most families -Winston-Salem Journal

Part two of a Journal series on autism programs. For related video, click here.
By Danielle Deaver

Parents of some autistic children are locked in a battle with the Winston-Salem/Forsyth County Schools over what type of care is appropriate for their children. In Part 2 of a series, the Winston-Salem Journal looks more closely at the public and private programs that serve children with autism.

The autism classroom at Cash Elementary School looks a little different than some other elementary rooms. Like most, it has brightly colored informational cards all over the walls that tell students about colors, numbers and money.

But the lesson cards on the wall offer information that is usually spread out over several grades. The play area of the room is sectioned off and has cartons of toys around it. There is a section for lunch and snacks.

And the room is quiet.

“The kids need it. A lot of times they’re super-sensitive to what’s going on,” said Rachelle Colditz, the classroom teacher.

At Cash, and in Konnoak and Jefferson elementary schools, students with autism are taught in the isolated rooms. They are usually among those students who are the most afflicted; students who are more functioning but still autistic are placed in mainstream classrooms when possible.

Many parents of the more severely afflicted students would prefer to see the school system offer their children therapy that follows the tenets of Applied Behavioral Analysis, which consists of intensive, one-on-one tutoring intended to draw autistic children out of their private worlds and teach them to communicate, play and learn.

Some send their children to a private center, ABC of NC, to receive that treatment, paying out of pocket for the care, which costs tens of thousands of dollars a year.

Colditz’s classroom has one teacher for every two students. The ratio allows children with autism to have a lot of one-on-one time.

Children who have improved during their time in elementary school, or who have a milder form of autism, go on to whichever middle school they want, and either take regular classes or enroll in special-education classes at those schools.

The children who are still severely afflicted can go to Lowrance Middle School. The same opportunities exist for students when they reach high school, where they can attend Carter Vocational High School if they are severely afflicted.

At Cash, Colditz works with two teaching assistants, and they spend a lot of time doing one-on-one work with the children.

Each child has folders that contain their schoolwork. They can pick them up and start working on them by themselves when they’re not interacting with one of their three teachers.

During their one-on-one time, students work on “manipulatives” - plugging pieces of information, like a piece of plastic with a day of the week on it, into the right place on a days-of-the-week board. They touch numbers while they count them. Everything has to be visual and kinetic for many of the children, Colditz said.

The children are also encouraged to play with each other, though most don’t want to. They aren’t forced to interact, Colditz said.

Autism literature is filled with recommendations for different methods - ABA or floor time. The school system also uses a method called TEACCH that was invented at UNC Chapel Hill. TEACCH helps create a structure for autistic children, with a regimented schedule and expectations for behavior and activities. Colditz said that she prefers to use different methods on every child.

“You kind of look at the student and see what they need,” she said. “You don’t teach just one way, because children learn all ways.”

Muhammad Paracha said that his son, Maaz, attended the autism classroom at Konnoak Elementary School for a year.

Maaz was 3 when he was found to have autism by James Mulick, a professor of pediatrics and psychology at Ohio State University. Maaz would spin plates for hours at a time. He would bang his head against walls until someone stopped him. And he would spend hours sitting alone in a dark closet. He could not communicate, so he would pull family members by the hand to show them what he wanted or needed.

When the family moved to Winston-Salem, the school system put Maaz into an autistic classroom.

“He would go there and they would basically go there and they would baby-sit him. He lost a whole year,” Paracha said.

School officials told the Parachas that Maaz was mentally retarded and would never speak, Muhammad Paracha said.

Frustrated, he called Mulick, who told the family that Maaz needed one-on-one ABA services. The school system disagreed. Paracha obtained a scholarship for his son to attend ABC of NC and took him out of the school system. He started two years ago, when he was 6.

Maaz now uses pictures to communicate and can say a few words. His incidents of injuring himself have decreased dramatically, and he seems happier, Muhammad Paracha said. Rather than pulling family members to what he needs, he points to a picture of the juice, food or activity he wants and they can get it for him.

“The school system is finding excuses not to provide what these kids need,” Paracha said. “What happens to these kids who (are) still attending these classrooms? They are going to end up in state institutions.”

Sam Dempsey, the director of exceptional children’s services for the Winston-Salem/Forsyth County Schools, declined to talk about ABA or ABC of NC because of a 2004 lawsuit filed against the school system by a family asking for the school system to pay for ABA therapy for their son. The lawsuit is pending.

A world for them

ABC of NC moved a few months ago to a one-story building on Old Vineyard Road, the former site of a Montessori school.

The classrooms have brightly colored posters about letters, the weather and the other things that children have to learn. There are low shelves filled with neatly labeled bins, filled mostly with toys. The rooms have stuffed animals and dollhouses, as well as computers. Every room has two small cubicles that have a table and chair.

The large multipurpose room, which serves as a cafeteria and a gymnasium, has a trampoline, seesaws and a large ball pit.

The program’s 18 children mostly move from classroom to classroom on their own, trailing tutors behind them. The children are encouraged to seek out the things that they want to do because the tutors want them to initiate play. The youngest child to attend was about 2 years old. Students can attend until they are 21, but must start by the time they are 12.

Everything was donated or purchased with grant money, said Selene Johnson, the executive director of the center.

Six-year-old Lexi Cota stood in the middle of the room last month, jumping up and down. She ran over to her tutor, who asked her if she wanted to swing, then waited patiently as Lexi picked a picture of a swing from a book. As soon as she chose the correct picture, Lexi was allowed to hop onto the swing. She began swaying back and forth, smiling.

She soon left that activity, and went to put on her shoes as her tutor asked, then followed her down the hallway to a classroom. There, she did some matching work in the small cubicle, then played with a small plastic toy that made noice reminiscent of a rainfall when it was shaken as a reward.

Then she hopped from one activity to another, playing with her tutor for just a few minutes each time before signaling “all done.”

ABA therapy focuses on building basic skills that the students will need every day of their lives, Johnson said. Something as simple as a trip to the grocery store involves matching; if you want to put back an item that you’ve decided you don’t want, you have to be able to figure out where it goes by matching it to the items around it, something that many autistic children can’t do. The tutors help them learn, by having students match a picture of a horse to a model of a horse, which they select from among a group of animals.

Autistic children, many of whom have trouble interpreting social cues, need to know how to imitate the people around them who are better at it. Imitating allows them to know when to stand up or when to sit down at group events, for example. It also helps them to learn more subtle social behaviors, such as standing at appropriate distances from other people.

Most of all, the therapy at ABC of NC works to correct something that to Johnson is the defining characteristic of autism: a social deficit. Much of the therapy might look like play, and it is, Johnson said. But it’s play with a greater purpose - to teach children such as Lexi that other people are fun, and it’s more fun to be around them than it is to withdraw into their own worlds.

The tutors and consultants at the center keep track of every aspect of each child’s progress. There are three-ring binders for each child, with a list of goals in the front. Each goal - things such as “tolerate frustration” or “desensitization to toothbrush.” An entire section of each notebook is devoted to each goal. The goals are broken down into smaller steps, and lack of progress, or progress on those steps, no matter how minute, is recorded constantly by the child’s tutors.

The goals are compiled during team meetings that take place every two weeks. Each meeting is attended by the child’s parents, as many as six teachers and one consultant. They typically last two hours. The teams figure out how the child has done during the previous two weeks and what needs to be done during the next two weeks, at home and at the center. They are similar to conferences that are held with the school system, but the school system typically has them only four times a year.

and will visit children’s homes to work on special issues such as toilet training. Parents said that children who have been unable to be toilet trained for years, even with the help of teachers with the school system, can accomplish the task within weeks or even days with help from ABC of NC.

But though the public school system’s program is free, ABC of NC is not.

It costs $62,400 a year to get one-on-one tutoring, six hours a day, five days a week for an autistic child. The center offers less-expensive options, either fewer hours or tutoring that takes place in group settings. Still, the price keeps some parents from even considering ABC of NC. Those parents who do send their child often have to take out second mortgages or cash out investments to afford it.

Medical insurers are not required to pay to help children with developmental delays, and so none do. County mental-health officials have to help with after-school care for some people, but are not responsible for providing therapy during the schoolday.

The ABC center has given out nearly $700,000 in scholarships with money that was raised from donations, but that has not been enough to help everyone, Johnson said.

Johnson knows that the cost is a barrier for many parents, but she also said that there’s no way to do the program more cheaply.

Johnson has seen so many success stories that she is convinced that early intervention can help just about any autistic child.

“I’ve never seen a child who has not benefited from this,” she said. “It’s not like rocket science. It’s not like this weird program.”

No easy solution

It’s difficult to say what will happen over time to children with autism. The numbers are increasing more quickly than experts expected. More children suffer from some degree of autism than juvenile diabetes and childhood cancer combined, according to the Centers for Disease Control and Prevention.

Winston-Salem/Forsyth County Schools offer acceptable services for students with autism, Superintendent Don Martin said.

“We evaluate the student and say, ‘This is what we can provide.’ The parents say there is xyz private school over here that does this thing or this consultant that does this thing. With that kind of discussion going on, the parent does not have the right to choose the program they want,” Martin said.

“They can say, ‘I like this program,’ and we can say ‘OK, we’ll look at that and see what’s going on.’ But ultimately we have to say, we believe this is the best way of serving your child in this school system and this is how we provide that.”

Parents of autistic children say that the school system’s best is not enough.

Kirby Moore was found to have autism in 1996 when he was 3. He is about to enter high school, but his parents aren’t sure which one he will attend.

He could go to Carter High School, the school system’s special-education high school.

He has been educated, off and on, by the Winston-Salem/Forsyth County school system since he was 3.

He also has received ABA tutoring at home, and has attended ABC of NC off and on.

For six years, he had a toilet goal in the plan that his parents developed with a team from the school system. He never met the goal.

After three days with home-based ABA, Bev and Alan Moore’s 9-year-old son learned how to use the toilet. He also learned how to tolerate a greater variety of food, and how to better control his behavior. His parents hope that the center and the technique can allow their son to live semi-independently and avoid being put into a state institution.

ABC officials have been talking with the N.C. Department of Instruction about the possibility of working together, but the talks are in the early stages, Johnson said.

ABC does have contracts with four public school systems - Watauga, Avery, Surry and Wilkes, Johnson said. The contracts are different for each system; for some, workers provide consultation services. The center provides full-time tutoring for a student from Surry County, Johnson said.

“It’s usually done on a child-by-child basis, which is unfortunate,” she said. “In some school systems, they willingly did this and in some they had to go to mediation.”

Winston-Salem/Forsyth County schools do not work with ABC of NC. Many parents say they wish the system could come to an arrangement with the center.

Dempsey, the director of the exception children’s program for the school system, declined to comment about ABC.

Still struggling

Lexi Cota has improved greatly after eight months at ABC, her parents said.

She used to be so frightened by a trip to the mall that she would be crawling into her parents’ arms, desperate to get away from the lights, the noise, the high ceilings - things that other children take for granted. ABC tutors started taking her out every week to the mall, to get her hair cut or to go to restaurants, and they worked with her at the center. Lexi has gradually become used to the sensations that used to overwhelm her, her parents say.

She’s also learned how to play, hesitantly, by herself and with other people.

But the Cotas worry about Lexi’s future.

They had to cut down on the amount of therapy that Lexi receives, from 30 hours a week to 20 hours a week, because they could no longer afford full-time therapy. They think that Lexi will need to stay at ABC for another two or three years; after that, they would like to send her to a private school with a one-on-one aide.

They have resigned themselves to the fact that Lexi will probably never get married or have children. And then there is the question that worries them the most, as it does for most parents of autistic children.

“The hardest thing to think about is what’s going to happen to her when we’re gone,” Chris Cota said.

Still, they said they are more hopeful since Lexi started ABC. They said they believe that ABC’s intense services will allow Lexi to live on her own with minimal assistance.

“You either do early intervention and you pay for it now, or you’ll have to pay for them for the rest of their lives,” Kelli Cota said. “ABC can get her to the mall, can get her to dinner. It opened up a whole new world for her.”

■ Danielle Deaver can be reached at 727-7279 or at ddeaver@wsjournal.com. Read more!

Give our loved ones the help they need -Hendersonville Times-News

Susan Hanley Lane : Life In The Middle

What do courts, guidance counselors, psychiatrists, police, social workers, hospitals, emergency rooms, prisons, psychiatric units, probation officers, bail bondsmen, judges, lawyers, doctors, nurses, prison guards and pastors all have in common?

Answer: Every one of them has to deal with the messy and painful aftermath of substance abuse.

For every alcoholic or hopelessly hooked drug addict you see, there are at least a dozen people who are directly affected by the addict's or the alcoholic's unquenchable need for the high that can never satisfy.

I know. I grew up surrounded by a whole family of them. Being one of the few sober ones in the crowd is not a pleasant experience, but it taught me something that most people would never guess. More than anyone else wants it for them, the addict herself, the alcoholic himself, want to put their poison down.

They just don't know how.

That's where treatment comes in. Studies have shown that every dollar spent on substance abuse treatment saves seven dollars that would have been spent cleaning up the aftermath of untreated substance abuse.

How can that be, you might ask? Think about it. Do alcoholics and drug addicts wind up in court? Ask a judge, or the police officers that get them there, or the bail bondsmen who bond them out, or the lawyers who represent them, or the prison guards who spend their days with them.

Do alcoholics need social services? Ask a guidance counselor trying to work with their hurt, rebellious children who can't understand why a can of beer means more to Dad than they do. Ask an addict's probation officer how often they do urine drug screens. Ask Women At Risk how many of their clients have been beaten up by drunk husbands or used by pimps who supplied them with drugs.

Do addicts wind up in the hospital? Talk to an ER nurse who has to divide his time between a person having a heart attack and an alcoholic who is violently drunk and abusive. Ask a chaplain what alcoholics regret on their death beds.

If all our dreams came true and the addicts and alcoholics among us actually put down the poisons that are killing them, we would be appalled at how many people would be out of a job.

Yet, unbelievably, the North Carolina General Assembly this week cut substance abuse treatment out of a bill it passed to give mental health care parity with other diseases that require serious medical treatment.

Parity is something we've needed for a long, long time. Put simply, parity requires "insurance companies to cover mental illness the same way they cover physical illnesses" (ncmentalhope.org).

Who was behind the push to eliminate substance abuse treatment from this badly needed legislation? Take a guess. Now open your wallet and take out your insurance card. Does it say Blue Cross Blue Shield on it? Mine does. And for the first time since I've had that card, I am no longer proud but am ashamed to be carrying it.

Powerful lobbyists for Blue Cross Blue Shield worked behind the scenes in the General Assembly to remove substance abuse treatment services from the mental health care parity bill.

What I'm dying to know is: How did they do that?

What can a Blue Cross Blue Shield lobbyist possibly have to say to an elected official that is more important than the needs of that representative's entire constituency? That it would cost insurance companies too much money? Despite the fact that Blue Cross Blue Shield is a "not-for-profit," last year it posted profits of almost $200 million. The cash reserve of Blue Cross Blue Shield is somewhere around a billion dollars.

For $27 million dollars, North Carolina Blue Cross Blue Shield customers could have had not only mental health care, but substance abuse treatment coverage as well. It would cost Blue Cross subscribers a mere $4 a month ($2 if split between employers and employees) more to have substance abuse services that are now costing our state (that's you and me, the lowly taxpayers) many, many more millions to clean up the aftermath of untreated substance abuse.

In real life terms, that means that alcoholics and drug addicts could finally begin to receive the help they so desperately need.

For those who do not understand the structure of medical reimbursements: When a service is not covered by insurance, it ceases to exist. Two decades ago, when substance abuse treatment was still covered by medical insurance, there were all kinds of services available to help addicts and alcoholics get the treatment they needed.

People who work in the substance abuse treatment field have families to feed, too. They have to be paid like anyone else. When insurance companies stopped paying for treatment, one by one the treatment facilities folded. Remember Charter and Appalachian Hall? These and countless other excellent programs across the country went under because of the selfish greed of insurance companies.

Now ask yourself a hard question: Do you know anyone who has a problem with alcohol or drugs (even prescription drugs)? If you don't, you're a member of a very small minority. Almost every one of us has a person we know and love who desperately needs the help that is now so very difficult to get.

Everyone, except insurance companies, pays for untreated substance abuse. Our taxes pay for those police, and judges, and prisons, and social workers. The $64,000 question is, why are our legislators more concerned with the well-being of Blue Cross Blue Shield than the health of the people who elected them? Or better yet -- the health of the state budget that absorbs so much of the costs of untreated substance abuse?

Poor legislative policy is poor fiscal policy in this instance. But the highest cost is the wrecked lives of people who don't know where to go for help. Because it isn't there anymore. We have let that happen by not paying attention to the "little foxes" that have forced their way in state legislative sessions at the expense of all the rest of us.

Please call your area representative (Trudi Walend (919) 715-4455 and Carolyn Justus (919) 733-5956) and thank them for their good work on the mental health care parity bill. Then beg, plead and demand that substance abuse treatment be put back into the bill.

If you need a good reason to do something that time consuming and bold, look around you at your friends and family. Which one of them needs this help that isn't available now?

Or possibly in the mirror. Is it you?

Susan Hanley Lane, a Times-News community columnist, lives in Naples. Read more!

Restrictive Medical Studies Exclude Blacks And Women -Medical News Today

Treatment studies that exclude the homeless, illicit drug users or people with mental problems disproportionately curb the number of African-Americans and/or women eligible to participate in medical research, according to a new study from investigators at Stanford University.

Lead researcher Keith Humphreys says the findings should encourage scientists who design studies to consider the unintended consequences of eligibility criteria.

"When you start to push on certain levers, you move some other variables you may not have anticipated, particularly how many women and African Americans end up in the study," Humphreys said. "I assume the best of my colleagues: I don't think they are racist or sexist, but I do think they underestimate the downside of restrictive study enrollment rules in terms of inclusion and fairness.

"Scientists share a basic social justice viewpoint that we all contribute to medical research when we pay our taxes, so the benefits of it and the burdens of it should be shared throughout society," said Humphreys, a professor of psychiatry at Stanford and the Veteran Affairs Health Care System in Palo Alto, Calif.

The National Institutes of Health, the largest public funding source for medical research, shares the same philosophy and has guidelines to promote diversity in NIH-supported medical trials.

In the June issue of Alcoholism: Clinical and Experimental Research, Humphreys and colleagues write, "In designing treatment studies with many eligibility criteria, researchers may therefore inadvertently be thwarting their own good-faith efforts to ensure that a range of vulnerable populations are able to participate in research."

The ACER investigation explores the effect of participant prohibitions in five alcohol treatment studies that enrolled more than 100,000 people.

Trials that disqualified patients with mental health problems such as depression or an anxiety disorder disproportionately whittled down the number of female participants, the study found. Studies that barred prospective patients based on social and residential instability or trials with drug-use prohibitions had the greatest effect on African-Americans.

Across a range of studies in different parts of the country, African-Americans had, on average, a 23 percent higher risk of being prohibited from alcohol treatment studies that excluded drug-using patients and 46 percent higher risk of exclusion from studies that disallowed participation by patients with unstable housing and employment situations.

"In other words, if you were an African-American showing up saying you wanted to be in the study, you'd be much more likely than a white person to have a treatment researcher say, 'Well, you can't,'" Humphreys explained.

Eligibility criteria are especially problematic because their consequences are so difficult to counter.

"If you have a criterion that disproportionately excludes people in some group blacks, women, whoever over-sampling will not correct the problem. If the women in the study are less representative of all women, then simply adding more, less-representative women doesn't fix the problem. You just end up with a bigger unrepresentative group," Humphreys said.

Some eligibility criteria are necessary to protect patient health. For instance, it would be unethical to enroll a patient in a medication trial if they had a medical condition that was a serious contraindication for the study. Nevertheless, Humphreys said study designers often include long prohibition lists out of habit and tradition rather than careful reflection. Other times, participant restrictions become a way to stack the deck and increase the chances for a positive result.

"At its best, science is the impartial search for truth, however, people have particular products or theories that they are invested in, so for financial or ego reasons, some studies are designed to make a particular program or theory look good by only testing it out on 'easy patients,'" Humphreys said.

People who are homeless or unemployed and patients with mental or physical problems might all be harder to retain in a study and more expensive to track down for follow-up.

Beyond fairness, there are practical reasons to encourage medical researchers to enroll a broad range of participants, says psychiatrist and Columbia University professor Paul Appelbaum.

"Researchers want clinicians to try the treatments they've tested. Doctors won't try a treatment if they see that the study population is nothing like patients they care for every day," said Appelbaum, director of Columbia's Division of Psychiatry, Law and Ethics.

Humphreys K, Weingardt KR, Harris AHS. The influence of subject eligibility criteria on compliance with National Institutes of Health guidelines for inclusion of women, minorities and children in treatment research. Alcoholism: Clinical and Experimental Research. 31(5), 2007.

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Article URL: http://www.medicalnewstoday.com/medicalnews.php?newsid=72335 Read more!

The high cost of easing troubled minds -East Brunswick (NJ) Home News Tribune

By MICHAEL L. DIAMOND
GANNETT NEW JERSEY

Paula Gallant has worked her way through the highs and lows of bipolar disorder, even having suicidal thoughts. And she's often wondered why health insurance doesn't treat mental illnesses with the same urgency that it treats physical health.

If it did, she said, people might get help sooner and prevent a spiral that can spin out of control.

As for the current system: "It's not enough time for someone to get well," said Gallant, a 56-year-old Berkeley resident who is an outreach worker for the Mental Health Association of New Jersey.

New Jersey may change that soon. A bill in the Legislature would require health insurers to cover mental health on par with physical health. A patient treated for alcohol abuse, for example, would have the same co-payment, deductible and number of doctor's visits as he would if he had cancer.

Supporters say the bill would help treat mental illnesses that are a drain on workplace productivity and society. But opponents say the bill would add to the cost of health insurance at a time when business owners can scarcely afford what they're paying already.

"In the past five years, premiums have gone up 80 percent," said Christine Stearns, vice president of health affairs for the New Jersey Business and Industry Association, a business lobbying group. "We just don't seem to be able to get legislators to focus on the need to make health insurance more affordable."

The bill takes aim at mental illnesses that aren't biologically based, such as bipolar disorder or major depression, but threaten someone's well-being nonetheless. They include alcohol abuse, drug addiction and eating disorders.

Joseph Califano, president of The National Center on Addiction and Substance Abuse at Columbia University, said the country has yet to figure out how to treat those disorders, and it is paying a steep price.

The number of illegal drug users, which dropped from a high of 25.4 million in 1979 to 12 million in 1992, has risen to 20 million in 2005. The number of Americans abusing prescription drugs jumped from 7.8 million in 1992 to 15.1 million in 2003. And there has been no significant improvement for decades in alcoholism, Califano said.

The cost to society: $1 trillion, when you factor in the crime and health-care expenses created by alcohol and drug abuse, he said.

"We have to recognize it's a disease, and we have to treat it like a disease," said Califano, author of "High Society: How Substance Abuse Ravages America and What to Do About it."

Mental-health advocates said part of the problem rests with a disparity that exists in insurance plans. For example, insurers typically restrict mental-health benefits by offering a limited number of days for treatment — along with co-pays and deductibles that are more expensive than insurance plans for physical illnesses.

It prevents workers and their family members from receiving enough treatment for their illness — unless they pay for it themselves, supporters said.

The Legislature appears ready to change that. A bill that would bring parity to mental-health coverage has passed the Senate and is awaiting a vote by the Assembly. The bill would affect 3.2 million people in New Jersey — mainly public employees and small business owners and their employees.

Employees of big corporations who operate their own insurance plans and residents who receive Medicare and Medicaid are covered by a federal law. That law doesn't require insurers to cover alcohol or substance abuse coverage. It also allows insurers to have different co-payments and deductibles for mental health.

"If we give people the opportunity to treat themselves, care for themselves, be more productive, to them it's life-changing," said Sen. Joseph Vitale, D-Middlesex, one of the bill's sponsors.

Gov. Corzine supports the idea of mental-health parity, but plans to study it to see what impact it would have on health insurance for public employees, Corzine spokesman Brendan Gilfillan said.

The bill doesn't come without a cost. A state commission that reviews legislation that would add services to health-insurance plans found the mental-health bill would raise average premiums 0.3 percent to 0.7 percent. That's high enough that as many as 5,000 people could lose their health insurance because their employers decide it is too expensive.

"Anything that's going to cost more money, I am dead against," said Drew Filoramo, owner of Drew's Market in Spring Lake Heights, who can't afford to offer employees health insurance. "It's hard enough to make ends meet as it is."

There are other concerns about the legislation. The medical profession, for example, hasn't found a cure for some of the mental-health problems that would be covered, which leads to the possibility of treatment with no end in sight.

"We're concerned the scope is overly broad and it's going to address disorders in which we haven't identified anything that is truly successful," said Ward Sanders, president of the New Jersey Association of Health Plans.

Paula Gallant, however, thinks it would be a good start to get a handle on a burgeoning problem. Gallant, who worked as a nurse, said she wasn't properly treated for her depression. As it grew worse, she had to quit working.

Gallant said she found the treatment she needed and now works with others struggling with mental illnesses.

"The impact on the workplace is people don't get well quickly enough," she said. "They don't really get the full treatment they need. Therefore, they are going back to work sicker. They are using sick days beyond what they have. It's a drain on the employer. It's discouraging for the people with the mental illness." Read more!

Needed: More sunlight on the inquiry into the Virginia Tech massacre - Washington Post

Editorial

IN LAYING out his vision for the panel he named to review last month's massacre at Virginia Tech, Gov. Timothy M. Kaine (D) said that he hoped its work would be "be conducted in as open and as public and as transparent a way as possible." Last Monday, in its second meeting, the panel ignored the governor's directive and booted out the media for two hours of testimony from law enforcement officials, then acceded to the university's request that journalists be barred from accompanying panel members when they toured the massacre sites. In doing so, the panel and its chairman, retired State Police Col. W. Gerald Massengill, raised doubts about their commitment to openness and accountability.

The Virginia Tech panel inquiry is expected to be long and complex. No doubt, panel members will wrestle with legitimate issues pertaining to privacy, confidentiality and the sensitivity of survivors. But for reasons that Mr. Kaine articulated well, there should be a bias in favor of openness -- for letting the media, and thereby the public, scrutinize as much information as possible about the horrifying events on April 16 and what preceded them. "The degree to which that [process] is open and transparent will create that sense of confidence about the recommendations," the governor said, and "will give that sense of comfort to families who are grieving."

The arguments offered for closing the doors last week were flimsy. In their public statements, police and other state officials have given no indication that Seung Hui Cho had any accomplice or that his crime was in any way part of a conspiracy. If that is the case -- if, in other words, Mr. Cho acted alone in killing 32 people -- then police are no longer seeking a suspect or facing any risk that divulging information will upset an ongoing criminal investigation. Rather, they are carrying out a detailed forensic reconstruction of the events leading up to and including the killings, which is a legitimate subject of public interest.

Some records, particularly those relating to Mr. Cho's mental health, may still be covered by privacy laws; the panel itself may have trouble gaining access to those documents. As a matter of common law, though, most privacy protections expire with a person's death. That, too, argues for leaving the great majority of the panel's proceedings open to the media and public.

Col. Massengill, who has a sterling reputation in law enforcement, reiterated to us that he is committed to the transparency that Mr. Kaine called for. "We are not going to have a closed session arbitrarily -- it'll be approached judiciously and thoughtfully," he said. Fine words. But if the panel he leads shuts the doors and draws the curtains whenever it is in the least doubt, it will undercut its own mission and the public's trust. The panel's guiding principle must be more access, not less. Read more!

Healing Warriors - Washington Post

Editorial: Almost a third of front-line soldiers suffer mental wounds.

ARECENTLY released Pentagon survey found that 30 percent of soldiers who have experienced heavy combat in Iraq also experienced mental health problems. The fraction is lower, but still high, for soldiers serving outside high combat areas -- 20 percent. Lengthy deployments and inadequate time for rest and relaxation magnify the intensity of the conflict. And those who serve multiple tours are yet more likely to suffer from post-traumatic stress disorder (PTSD) and other mental ailments. Yet soldiers who return from grinding combat in Iraq or Afghanistan with sometimes debilitating mental illnesses often have to contend with outdated rules and bureaucratic hassles to get the compensation and treatment that they deserve -- and sometimes do not get either.

Sens. Barack Obama (D-Ill.) and Pete V. Domenici (R-N.M.) offered one way to better the system last week. The legislators introduced a bill that would require the Department of Veterans Affairs to offer outreach and support to returned soldiers. To ensure that these services are widely available, the VA would contract with local health centers to provide services to veterans in areas far from VA facilities. It would also organize groups of veterans to conduct peer outreach to minimize the stigma some attach to mental health treatment.

More reforms are necessary. The Institute of Medicine, an advisory group that the VA asked to assess its treatment and benefits policies for PTSD, reports that the government's system for assessing disability benefits for those suffering from mental disorders is inconsistent and dated and may even discourage patients from getting the help they need. In particular, the institute stresses, the assessment of benefits for those suffering from PTSD is tied to whether a patient has a job. This probably discourages PTSD sufferers from seeking employment -- an important part of returning to normal life -- while preventing those who work from getting care they need.

The Pentagon should improve NCO training and mental health surveillance in the field. The VA's benefits adjudication system, meanwhile, must consider more than just a PTSD patient's fitness for work, hardly the only indicator of mental fitness, and gear the system to encourage veterans to get the help they need. Read more!

Too much sunshine can bring on the blues - LA Times

By Victoria Clayton
Special to The Times

SUNSHINE and warm weather aren't for everyone.

Take 30-year-old Saskia Smith, an illustrator who works part time in the billing department of a legal firm. She spent most of last summer's dog days prone in bed with the velvet drapes in her Mid-City apartment pulled tightly shut.

"Other times of year, I'm basically an upbeat person," Smith says. "But when summer hits, it's like I'm operating on a low battery. Last summer, I had no desire to eat, I lost 15 pounds, I had anxiety attacks and I stopped seeing any of my friends. Even going to the grocery store felt like an impossible task."

Smith, who grew up in Seattle and has lived in New York City and Germany (all areas with notably moody skies), is convinced she has seasonal affective disorder, or SAD. The condition first surfaced after she and her husband moved to Los Angeles almost three years ago. "It's the unrelenting sun day after day after day," she says. "I feel like I'm trapped and there's no relief from it. At my lowest point [last summer] I just wanted to die."

Although most people consider seasonal affective disorder to be a winter ailment brought on by waning sunlight, Smith and others say there's a summer version — and it packs a wallop as well.

Researchers estimate that about 1% of the population suffer from summer depression, compared with 5% for the winter variety. Although summer depression has been mentioned in ancient writings, as well as in scientific journals sporadically for the last 20 years, the relatively low prevalence in the U.S. has meant it hasn't gotten much serious consideration, says Dr. Thomas Wehr, a Bethesda, Md., psychiatrist and former National Institutes of Mental Health researcher.

"The closer you get to the equator — countries like India, China and Brazil — it turns out the condition is quite common. But here a lot of people with summer depression feel isolated," says Wehr, an expert on seasonal affective disorder.



Role of the thyroid

Wehr and NIMH colleagues first became aware of summer SAD when they were studying winter depression in the 1980s. "In the course of our research, we'd regularly get letters from people saying winter depression was interesting but they seemed to have the opposite problem. However, the symptoms were different."

People with winter depression tend to sleep more, have less energy, gain weight and have carbohydrate cravings. Summer depressives tend to be plagued with decreased sleep, weight loss and anxiety.

Researchers say that some people may be especially sensitive to heat, which could influence their production of various hormones. "We know thyroid hormone is suppressed by heat and growth hormone and prolactin are stimulated by heat," Wehr says.

Lack of thyroid hormone can cause energy drain, and too much growth hormone and prolactin can lead to lethargy and lack of libido. In addition, prolactin is known to repress the effects of dopamine, a brain chemical linked to feelings of enjoyment and pleasure. Light on the skin can also influence the production of hormones, but preliminary NIMH research points to heat more than light as the culprit in summer depression.

Typical to depression in general, researchers say, more women than men appear to suffer from summer SAD. The condition generally crops up in childbearing years and studies point to a genetic link; more than two-thirds of SAD patients have a first-degree relative with a mood disorder.

"The problem is that right now we just don't know enough about summer depression to say it gives us prognosis and treatment," says Dr. Daniel F. Kripke, professor of psychiatry at UC San Diego. "Until we do, it's not very useful."

Winter blues responds well to light therapy, and because researchers think the summer version is a condition of heat, reducing heat should work as a treatment for summer depressives.

That doesn't seem to be the case. A pilot study by Wehr and colleagues at NIMH found that manipulating temperature for a period of time was salutary but didn't have lasting effects on summer SAD patients.

"In our study, people would improve [with cooling] and then very quickly the symptoms would come back," Wehr says.



Antidepressants help

Some researchers take issue with associating winter depression with summer depression or labeling it "reverse SAD."

"Calling it 'reverse SAD' only confuses the issue," says Michael Terman, director of the Center for Light Treatment and Biological Rhythms at New York-Presbyterian Hospital. "It is not a light-related phenomenon and should not be considered the flip side of winter depression." Standard antidepressants are the only medical intervention that's been shown to be effective, he says.

Wehr agrees medication tends to work, but says the drugs may vary. "Some respond to Prozac-like drugs, some people respond to Wellbutrin. I've even had people respond to lithium and only lithium. They only take it during the summer," Wehr says.

Some people respond well to lifestyle changes, he says. Some of his patients take daily swims in cold lakes; one built a refrigerated room and several avoid summer daylight and heat. "One patient," he says, "was known to his friends and co-workers as 'the mole' because he literally never went outside in the summer daylight."

Smith doesn't want antidepressants, so she's working harder on the temporary fixes.

"Last year I ordered a Cape Cod rain-sounds CD," she says. "Whenever there was a heat wave, I would crank up my humidifier and air conditioner, close the blinds and meditate listening to the rain sounds. It really did the trick to put me, momentarily, in a different space."

This year she plans to paint the bedroom walls pale blue with faint undertones of gray and purple, a color called rainy day, and she's launched a website (www.seasonalsad.com) to reach out to others suffering from summer SAD.

In this perpetually sunny city, she says she hopes to form a support group for people who thrive in June gloom. If none of this works, she'll work on persuading her husband to move.

For now, however, she still has a sense of humor about it all.

"I realize this all has a slightly psychotic tone, but I'm not crazy, I'm not into goth and I don't want to be a vampire," she says. "I would actually like L.A. if it just didn't have so much sun."

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State mental hospital grapples with rise in patient violence - AP

LAKEWOOD, WA -- Over the last decade, mental hospitals across the country have been working under a federal mandate to phase out use of restraints and seclusion, tools psychiatric workers once relied on to prevent and control violence among patients.

At Western State Hospital, fewer patients are getting strapped to beds or locked in empty rooms than in the past, but incidences and severity of assaults on staff are on the rise.

Since 1999, the hospital has recorded a 19 percent increase in the number of patient attacks on workers, and the number of severe assaults -- those resulting in medical claims to the state -- has risen almost 80 percent, according to Department of Labor and Industries data.

To deal with rising patient violence, Western's staff is getting trained on techniques to slip away from enraged patients, duck blows and call for backup. Those maneuvers make restraints or seclusion a last resort.

Many at Western believe the increase in violence has more to do with inadequate training on how to calm overwrought patients.

Andy Phillips, Western's chief administrator since 2004, and his boss, Richard Kellogg, head of the state's Mental Health Division, told The News Tribune of Tacoma they aren't sure what's behind the increase in violence.

In November 1998, federal regulators cited the hospital for keeping patients in restraints and seclusion too long. That jeopardized Western's Medicare and other federal funding -- about 30 percent of its $156 million budget.

The threat of lost funding led to a quick, steep decline in restraints and seclusion in 1999.

Then, in 1999 and 2000, every other mental institution in the country was told to start eliminating most restraints and seclusion or risk losing federal funding. The order reflected a consensus among mental health experts that such techniques traumatize the mentally ill and make recovery more difficult.

Violence is also a source of friction between Western staff members and administrators, because of declines in assaults at other hospitals around the country.

Administrators say it will take a couple more years for the non-violence initiative to work, "but meanwhile we have to hear about people getting their jaws broken," said counselor Jim Sprague.

Sprague is president of the hospital's chapter of the Washington Federation of State Employees, a union that represents Western workers except nurses.

In an October report, the state Department of Labor and Industries called Western's organizational structure "dysfunctional" and characterized communication between staff and managers as hostile.

There were also lapses in worker safety, the report said, including electronic panic buttons workers carry to summon help that sometimes don't work properly.

Phillips acknowledged the findings.

Several workers said they've even given up filing unsafe-work-conditions petitions with supervisors because, they say, they're largely ignored.

Labor and Industries' report noted that Phillips, Kellogg and others in charge are "clearly committed to both worker and patient health and well-being, and they inherited many problems that have existed for years."

Phillips has implemented some of the changes recommended, including circulating training teams to teach workers how to handle patients more safely.

Kellogg suggested Western might be too big to run effectively.

With more than 1,700 total workers, about 900 involuntarily admitted patients on any given day and more than 2,000 inpatients treated per year, Western is larger than many of the country's state mental institutions.

Kellogg expects research on how things are done elsewhere to be completed soon, and hopes soon to have a plan to fix Western's problems.

© 1998-2007 Seattle Post-Intelligencer Read more!

Advocates question Houston police use of stun guns on mentally ill - AP

HOUSTON – Advocates for the mentally ill are questioning Houston police officers' use of stun guns on suspects with mental problems, many of whom were unarmed and then never charged with a crime.

Since officers started carrying Tasers in December 2004, nearly 130 people known or suspected to be mentally ill were shocked by officers responding to calls, according to a Houston Chronicle review of more than 1,000 incidents involving the stun gun.

The department also had its first Taser-related death recently that involved a mentally ill man, the newspaper reported Sunday.

Often, police knew they were responding to calls involving people with mental health issues but rarely called officers who are specially trained to deal with the mentally ill, according to police records.

“Using a Taser is easy,” said Arlene Kelly, who became an outspoken advocate for the mentally ill after her daughter was shot and killed by a Houston police officer in 1999. “There's no waiting. There's no need to be patient with someone who may not understand orders. The Taser has represented a step backward in how police deal with the mentally ill.”

Some of those stunned had committed violent crimes, threatened others or harmed themselves. But most were people who failed to follow officers' orders in the fog of their mental confusion, records show.

Police Chief Harold Hurtt said the use of Tasers has prevented dangerous situations from becoming deadly.

“Crisis-intervention training is a critical part of our approach to the mentally ill, and our officers are well aware of the necessity to use the minimum force necessary,” Hurtt said.

The newspaper found that most of the mentally ill people shocked by police were not armed and fewer than one in four were later convicted of a crime.

One case involved a 63-year-old man who needed a metal walker to move around. Another involved Carol Ann Vickery, a 49-year-old woman with a history of bipolar disorder who disrupted a local convenience store. When police arrived, she picked up a can of soda as if to throw it. Police responded with three 50,000-volt shocks from a Taser.

“She may have gotten excited, but two male officers should be able to defuse a situation with one woman without pulling out a Taser,” said Vickery's husband of 10 years, Tim Byus. “In this case, it's clear they did not try.”

Some dispatchers fail to identify people experiencing mental problems and send untrained officers to those calls, said Lt. Michael Lee, who is in charge of the department's crisis-intervention team that was developed in 1999 to train officers how to calm people with mental illness.

Other circumstances do not allow officers to wait for support, he said.

“Most officers are using Tasers to prevent a situation from escalating, and that can happen very quickly,” Lee said. “Sometimes de-escalation techniques just don't work.”

The crisis-intervention team had 600 patrol officers and more than 100 officers in other divisions, but the force has since been depleted by retirement, transfers and other strains. Its ranks have dropped to 410 officers, less than 20 percent of those on patrol.


Read more!

Mental health agency lays off workers - Chapel Hill News

By Lisa Hoppenjans, Staff Writer
May 27, 2007

HILLSBOROUGH -- A provider of mental health services has laid off more than 15 percent of its full-time workers in Orange County and is reducing services at its Hillsborough office in response to a statewide rate cut.

Caring Family Network, which serves about 1,000 Orange County residents, has let go seven full-time employees in the county, mostly administrative staff or community support workers. The agency also ended the contracts of a psychiatrist and therapist who worked with clients in the Hillsborough office.

The agency’s Orange County program director, Jim Martin, said the changes will affect about 100 clients who see the psychiatrist in the Hillsborough office. Some will have to travel to the agency’s offices in Chapel Hill or Roxboro.

Most of the roughly 55 people getting community support services in Hillsborough will be assigned to a different staff member, moved into a less intensive form of treatment or moved to another agency.

Community support can include counseling or such things as help finding medical care, housing or employment.

The office will continue to provide services five days a week, but will only be open two days with a receptionist and the ability to handle walk-ins who need immediate attention.

In April the state Department of Health and Human Services cut the rate for community support — a basic mental health service — from about $61 an hour to $51.28.

Sean Schreiber, development director for Carvaka, which provides management support and other services to Caring Family Network, said the $61-an-hour payment for community support services had been helping to offset losses for more expensive services being offered out of the Hillsborough office.

“After the rate cut, it just became impossible to sustain two separate offices with their own unique management and support,” Schreiber said. “We felt the only way to survive and be able to offer service to both areas was through a consolidation.”

Judy Truitt, area director of OPC Mental Health, the local governmental agency that oversees mental health, developmental disability, and substance abuse services in Orange, Person and Chatham counties, said her organization is working with Caring Family Network to manage the transition. She said any time there is a disruption in services, there’s the potential for an increased need for crisis services. She said the difficulties in Orange County reflect the larger reality of the state-funded mental health system.

“If a consumer does not have Medicaid and their treatment is funded by state dollars, I think the reality is that’s not an unlimited amount of money,” Truitt said. “I think it’s just one of the harsh realities of our system.”




Contact Lisa Hoppenjans at 932-2014 or lisa.hoppenjans@nando.com.
The Chapel Hill News Read more!

Obama: mandatory troop mental health screenings needed -AP

BY PHILIP ELLIOTT

CONWAY, N.H.---- Sen. Barack Obama on Sunday called for improved mental health services for veterans, a day ahead of a Memorial Day that other presidential campaigns also are using to talk about helping military families.

In remarks prepared for delivery on Sunday, the Illinois Democrat proposed changes to recruitment and deployment of military mental health providers. He called for the Pentagon to recruit more professionals to help identify and treat problems. And he sought mandatory mental health screenings of all troops.

''I believe strongly that there is a sacred trust between this country and those who serve it,'' Obama said in prepared remarks provided to The Associated Press. ''That trust begins the moment a service member signs on and lasts the duration of his or her life.

''We're falling far short in addressing the mental health care needs of these heroes, and that's inexcusable.''

Obama, spending two days in the first-in-the-nation primary state with his family, has made his opposition to the war in Iraq a central tenet of his campaign. His fervent opposition has help rally anti-war voters. Critics note Obama was serving in the Illinois state Senate when the U.S. Congress authorized the war in Iraq, and Obama didn't have a vote in the matter.

According to Obama's plan, scheduled to be released during a town hall-style meeting on Sunday, the military would require face-to-face mental health screenings for all service members. By making it mandatory, Obama said the military could reduce the stigma associated with mental health screening and treatment.

The plan also would institute early mental health screenings, so future psychological injuries could be more easily diagnosed and treated.

Obama aides said he also would propose increasing the Department of Veterans Affairs' budget. A hard dollar figure was not available, but aides say the proposed changes are expected to cost several hundred million dollars a year.

To pay for this, Obama is expected to propose a crackdown on unpaid taxes owed by defense contractors. Another source of funding could be to recover more money from third-party payers at Defense Department and VA hospitals.

Obama aides cite statistics they say show the military has failed to serve returning troops. Almost a third of the 631,000 veterans of Iraq and Afghanistan are showing symptoms of psychological or neurological injury. Meanwhile, the military has shrunk its corps of clinical psychologists by 22 percent.

And 4 out of 10 active duty clinical psychologist' slots in the Army and Navy are not filled, according to the campaign.

On Memorial Day, rival Democrat John Edwards is calling on a national day of action against the war in Iraq and in support of the troops. Edwards has said the best way to support the troops is to end the war.

On Friday, Sen. Hillary Rodham Clinton announced a group of veterans supporting her campaign. The event also highlighted Clinton's proposals to help military members and their families.

soldiers killed so far this month to at least 100 and putting May on pace to become the deadliest month for U.S. troops here in more than 2 1/2 years.

One of those killed, a Marine, died in combat in Anbar province in western Iraq on Saturday.

Three U.S. soldiers were killed in Salahuddin province, north of Baghdad, when an explosion hit their patrol; another died in a roadside bombing in south Baghdad.

Late Friday, a soldier was killed in an ambush near Taji, north of the capital, and two other soldiers were hit by a roadside bomb on Wednesday in eastern Baghdad, the military said. Copyright 2006 Associated Press. All rights reserved. This material may not be published, broadcast, rewritten, or redistributed.



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Families say poor mental health care fosters suicide among Iraq vets - AP

By: JENNIFER C. KERR - Associated Press

WASHINGTON -- In the three months after Marine Maj. John Ruocco returned from Iraq feeling numb and depressed, he couldn't sleep. He had lost weight. He had nightmares. He was distracted and withdrawn from his two young sons.

One night, he promised his wife, Kim, that he would get help. The next morning, he was dead. The 40-year-old Cobra helicopter pilot, based at Camp Pendleton, had hanged himself.

There are others. Army reservist Joshua Omvig. Army Capt. Michael Pelkey. Marines Jonathan Schulze and Jeffrey Lucey. Each came home from tours in Iraq and committed suicide.

Veterans groups and families who have lost loved ones say that the number of troops struggling with post-traumatic stress disorder or other mental health issues is on the increase and not enough help is being provided by the Pentagon and the Veterans Affairs Department.

For some, there are long waits for appointments at the VA or at military posts. For others, the stigma of a mental health disorder keeps them from seeking help.

Paul Rieckhoff, executive director and founder of Iraq and Afghanistan Veterans of America, says that although suicides among troops returning from the war is a significant problem, the scope is unknown.

"The problem that we face right now is that there's no method to track veterans coming home," said Rieckhoff, who served in Iraq as a platoon leader in the first year of the war. "There's no system. There's no national registry."

More than four years into the war, the government has little information on suicides among Iraq war veterans.

"We don't keep that data," said Karen Fedele, a VA spokeswoman in Washington. "I'm told that somebody here is going to do an analysis, but there just is nothing right now."

The Defense Department does track suicides, but only among troops in combat operations such as Iraq and Afghanistan and in surrounding areas. Since the war started four years ago, 107 suicides during Iraq operations have been recorded by the Defense Manpower Data Center, which collects data for the Pentagon. That number, however, usually does not include troops who return home from the war zone and then take their lives.

For service members returning from combat, post-deployment health assessments include a questionnaire with queries about mental health. This year, the Pentagon expanded health monitoring for war veterans to include another screening three to six months after combat.

"We're trying to reach out," said Maj. Gen. Gale Pollock, the Army's acting surgeon general. "Will we get to everyone on time? No, I wish we could."

Pollock said the Army is expanding a program started in January at Fort Bragg, N.C., which aims to lessen the stigma associated with post-traumatic stress disorder. It brings behavioral health staff directly into primary care clinics instead of making soldiers go to a separate mental health facility for help.

Earlier this month, a Pentagon task force warned that the military health care system is overburdened and not sufficient to meet the needs of troops suffering from PTSD and other psychological problems. The panel called for a fundamental shift in treatment to focus on screening and prevention instead of relying on troops to come forward on their own.

Shortcomings in mental health care were also identified in a recent report by the VA's inspector general. It found that several of the agency's hospitals and clinics lacked properly trained workers and had inadequate screening for mental health problems. It said this put Iraq veterans at increased risk of suicide.

Floyd "Shad" Meshad, president and founder of the California-based National Veterans Foundation, has no doubt that military suicides are a growing problem. He said he receives two to three calls each week from Iraq veterans contemplating suicide -- or from their families.

A Vietnam veteran who has counseled other vets for more than 30 years, Meshad runs a toll-free support line based in Los Angeles. He was asked recently to help train counselors at the Suicide Prevention Center in Los Angeles, where a spike in calls from veterans has been reported.

One of the biggest challenges for troubled vets is the stigma of a mental health disorder, Meshad said. "It's very, very hard for you to reach out and say, 'I'm hurting.' It's hard for men to do it, but particularly (for) a soldier who's endured life and death situations."

Kim Ruocco of Newbury, Mass., said her husband, John, was a role model for the young Marines he led in war. He worried about the ramifications of seeking help, personally and professionally.

"He felt like that was the end of everything for him," Kim Ruocco recalls. "He felt like his Marines would, you know, be let down."

John Ruocco ended his life in February 2005, a few weeks before he was to redeploy to Iraq.

Joshua Omvig, 22, a member of the Army Reserve from Grundy Center, Iowa, also took his own life. In December 2005, he shot himself in front of his mother after an 11-month tour in Iraq.

His parents, Ellen and Randy Omvig, say that Joshua wouldn't talk much about Iraq. They tried to get him help, but he worried that it would hurt his career if the Army found out, his father said.

Randy Omvig says that the military and VA need to offer better readjustment counseling. There should be teams of health professionals, he said, who come to the base to talk to the troops in a comfortable setting with their comrades.

"It's like you and I going out on that interstate and driving 65 miles an hour and then all of a sudden deciding to put it in first gear," Randy Omvig said. "What happens? Does the car handle it very well? Some will handle it, a lot of them are going to have problems."

The Senate Committee on Veterans' Affairs is considering a bill named for Joshua Omvig. It directs the VA to develop a suicide prevention program for veterans suffering from PTSD and other depression issues. It unanimously passed the House in March.

The VA declined to comment about the bill or its requirements.

For some troops returning from Iraq, the wait for care is too long.

Army Capt. Michael Pelkey, who suffered from night sweats, anxiety, headaches and exhaustion when he returned, sought help at Fort Sill, Okla. His wife, Stefanie, said the mental health facility there was understaffed and Michael was told that he would have to wait up to two months for an appointment.

He went off-base in November 2004 and a civilian counselor diagnosed him with post-traumatic stress disorder. His wife says that it came too late. He shot himself in the living room a week later.

Jonathan Schulze of New Prague, Minn., also tried to get help after he came home from Iraq. His parents say that he asked to be admitted to a VA hospital but was turned away twice. The VA disputes that. The Marine hanged himself in January at age 25.

For Marine Jeffrey Lucey, the return home from Iraq was followed by months of emotional and mental torment, said his father, Kevin Lucey. The 23-year-old killed himself in June 2004 at his parents' home in Belchertown, Mass. His father found him dead in the basement, hanging by a garden hose.

There are more. Robert Decouteaux, Douglas Barber, William Howell, Andre McDaniel, Jeremy Wilson, Robert Hunt, Chris Dana and David Guindon -- all men who served in the Iraq war and killed themselves after coming home.

Veterans groups worry that there will be more given the rise in cases of post-traumatic stress disorder.

PTSD disability claims to the VA increased almost 80 percent over five years -- from 120,265 in 1999 to 215,871 in 2004. Benefit payments jumped nearly 150 percent, from $1.72 billion to $4.28 billion in the same period, according to a report this month from a committee of the Institute of Medicine and the National Research Council.

Marine Cpl. Cloy Richards says he experienced symptoms of PTSD after two tours in Iraq. "I was depressed all the time. I just hated myself," he recalled.

He couldn't sleep. He didn't want to be around other people. One day, he said, he put a gun in his mouth and then decided to call his mom to say goodbye. She talked him down.

Richards, 23, said that he had trouble getting appointments at his local VA in Missouri, but eventually received counseling from a Vietnam veteran who taught him how to better cope with his anger and anxiety. Richards has become an outspoken critic of the war, joining Iraq Veterans Against the War.

He wants to be happy, he says, but still feels troubled.

"My counselor says that comes from guilt," Richards said. "I feel guilty about being happy since, you know, some of my friends died in Iraq and I'm alive."

Read more!

Disturbed son's death shows gaps in mental care -Raleigh News & Observer

By Michael Biesecker, Staff Writer

RALEIGH - The month before Stephen Ryan Gibson led state troopers on a 70-mile car chase that ended Tuesday in a fatal hail of bullets, his father went to a Wake County magistrate to ask that his son be involuntarily committed to a mental hospital.

Gibson's psychiatric files, released to his family after his death, raise questions about whether the troubled 23-year-old's downward spiral could have been prevented if the agencies charged with his care had treated him more aggressively.

Such concerns are shared by other families whose loved ones have struggled to negotiate North Carolina's strained mental health system, though individual outcomes rarely make headlines.

Uninsured and unable to afford private care, Gibson drifted through gaps that have long existed but have grown wider since legislators set out to reform mental health with a prescription for privatization.

Without treatment, Gibson's family says, his paranoia and anger deepened. He claimed to see ghosts in his home.

Tuesday morning, a young man with no criminal record stole a rental car, robbed a convenience store at gunpoint and lost his life while putting others at risk.

"What happened with this young man is symptomatic of a system crumbling apart," said Frank Edwards, president of the Wake County chapter of the National Alliance on Mental Illness. "It's tragic. People are falling through the cracks. But it seems to take either a fatality or a lawsuit for the powers that be to pay attention."

Family members say Gibson kept to himself and had few friends. Since he was s boy, he had absorbed knowledge like a sponge, voraciously consuming books on human anatomy, religion, survival skills and fast cars. He was about 6 feet tall, but so thin and frail an uncle said he looked as if a hug might might break a bone.

With his parents divorced, he lived with his mother in Charlotte, graduating from East Mecklenburg High School. He moved to Raleigh to live with his father and enroll at Wake Technical Community College, which offered health sciences classes that piqued his interest.

Albert Gibson says his son soon started having problems. He dropped out of college and went to work in a string of low-wage fast-food jobs.

On April 12, in the same week a mentally ill student at Virginia Tech killed 32 classmates and teachers before killing himself, Albert Gibson sought help after learning that his son had sought to buy a handgun. The father went to the magistrate's office with concerns that his son was going into rages, talking to himself and acting paranoid that his family was out to get him.

Assessed by county

The following morning, Raleigh police arrived at the Gibson home near downtown Raleigh and took Stephen Gibson for an evaluation at Wake's Crisis and Assessment Service, a county-run mental health facility on Falstaff Road, behind WakeMed hospital.

An emergency services clinician interviewed Gibson about 12:30 p.m. and determined he was probably suffering from a psychotic disorder, according to his evaluation report.

Psychotic disorders, such as schizophrenia, are treatable with antipsychotic drugs and psychotherapy.

Described as "very bright; has job skills," Gibson was observed talking to himself. During the interview he said he had no plan to commit suicide or murder, a key measure used to determine whether a patient should be committed against his will. And he denied having a gun, saying that he had only gotten pistol permits because he enjoyed collecting official documents and certificates.

But as the staff probed deeper during his long evaluation, the file says he seemed paranoid, claiming that his father owed him $1,200 for landscaping work and that family members had accused him of damaging his father's car, which he denied. He was agitated, making references to "hurting people" if he didn't get the money.

Delusions of persecution are a textbook symptom of psychosis.

The records show the clinician and a psychiatrist concluded that Gibson should be involuntarily committed.

"Patient expresses intense preoccupation with family frustrations," the doctor concluded. "He appears very entitled and bitter. Of concern, he has been making threatening phone calls to his parents and apparently recently purchased a gun. Patient has no prior history of psychiatric treatment but appears unpredictable. He is referred to hospital for further assessment and treatment."

If Gibson had health insurance, he would likely have been sent from the Wake crisis service to Holly Hill Hospital, a private psychiatric facility less than a block away. Wake County is seeking a contract so it can pay Holly Hill to add 44 patient beds to treat the uninsured, but that arrangement is not in place.

Since Duke Raleigh Hospital shut down its 19-bed psychiatric unit in early 2003, Wake County has had no general hospital capacity for people in psychiatric distress. Plans are just unfolding for Wake County to build a $21 million mental health facility where patients could stay overnight to stabilize.

Interview at Dix

For Gibson, that left Dorothea Dix, the 150-year-old state mental hospital in Raleigh set to close next year as part of the state's effort to move patients out of institutions and into community care. A few hours after Gibson's initial assessment, a Raleigh police officer drove him to Dix, where a form shows he arrived at 5:40 p.m.

He was soon interviewed by a staff psychiatrist, who agreed with the county assessment that Gibson was mentally ill but determined he was not an immediate danger and therefore not sick enough to stay.

"Patient very anxious not to leave job and willing to go to mental health clinic for outpatient evaluation," the hospital doctor wrote.

The doctor then checked a box that terminated the legal proceedings to have Gibson involuntarily committed. The paperwork shows he was discharged at 7:26 p.m., less than two hours after arriving at Dix.

There is no record indicating he was prescribed medication or given a follow-up appointment.

Wake County pays for a day-shift nurse at Dix to help with the transition back into the outpatient system. But it was Friday evening, and that worker was gone.

Gibson was released into the care of his sister for the weekend on the promise he would return to the county assessment and crisis facility the next week. It can sometimes take more than a month to get an appointment with a private psychiatrist through the county.

He never returned to seek treatment.

Gaps in the system

Dr. Tim Isley, chief of psychiatry for Wake County's Department of Human Services, says it is not unusual for doctors to interview the same patient and come to different conclusions about the extent of mental illness. If a mentally ill person refuses to voluntarily seek treatment, a family might have to seek a forcible commitment more than once before succeeding.

In 2001, state legislators set out to transform a network of local treatment centers and state hospitals criticized as too difficult to access and too expensive to maintain. Now, even those working inside the system question whether the switch to privatization and more patient choice has turned out worse than what it replaced, especially for the uninsured.

"Our system is an inch deep and a mile wide," said Crystal Farrow, the director of Wake County's mental health management agency. "Now, if someone needs more intensive services than what they're getting, if they could benefit from some kind of costly residential setting, a lot of one-to-one kind of direct intervention, ... we are not able to stretch our budget to fit those kinds of individual needs."

Dr. James Mayo, the clinical director at Dorothea Dix, said Friday that he could not discuss an individual patient's care. But the criteria for admission have not changed since the reform effort began, he said.

Gibson's father is left to agonize over whether his son would still be alive had he been admitted to the hospital and prescribed antipsychotic drugs. He thinks Stephen was terrified and irrational during the chase, trying to make it back home.

"He never had a chance," Albert Gibson said Thursday, shortly after learning that law officers fired at least 39 shots at his son, who was holding a handgun.

"I tried to get him help," the father said, "but he didn't get what he needed."


Staff writer Michael Biesecker can be reached at 829-4698 or michael.biesecker@newsobserver.com. Read more!

Changes debated in state laws on weapons, privacy - Raleigh News & Observer

Sheriffs can't get mental health files

Jim Nesbitt, Staff Writer

The shooting death of Stephen Ryan Gibson underscores the mental health loopholes in North Carolina gun laws, a product of the conflict between patient privacy rights and statutes aimed at keeping firearms out of the hands of people judged a danger to themselves and others.

Gibson, 23, was killed Tuesday as he climbed out of a stolen car with a pistol in his hand weeks after his father had asked that his son be involuntarily committed to a mental health facility.

Like last month's Virginia Tech massacre, where a mentally disturbed student fatally shot 32 classmates and professors, the Gibson case rekindles a debate over whether state and federal privacy laws make it easier for people with dangerous mental disorders to buy and keep firearms, in violation of federal and state gun laws.

Public safety, law enforcement officials, lawmakers and gun control advocates say privacy shouldn't trump public safety. They want North Carolina sheriffs to have access to sealed involuntary commitment orders while conducting background checks for pistol purchase permits.

"We put everyone at risk to protect one person's confidentiality, and that's not good public policy," said Wake County District Attorney Colon Willoughby.

But gun-rights supporters oppose what they view as an unwarranted encroachment on Second Amendment guarantees. They're joined by mental health advocates who say the people they speak for are unfairly tarred as potential mass killers.

"Just because someone has a mental illness doesn't mean they're a danger to themselves or others -- that's an important distinction," said Jennifer Mahan, policy director for the Mental Health Association in North Carolina.

Peter Morris, medical director of Wake County's Crisis and Assessment Services office, disagrees.

"There are often no restrictions on a person with severe and persistent mental illness from actually obtaining a weapon," said Morris. "The issue becomes what conditions under which that weapon can be revoked. ... Frankly, in the aftermath of Virginia Tech and the aftermath of this tragedy, I think all states ought to be reviewing their rules about the right to obtain and possess a firearm."

Morris heads the Wake facility where Gibson's father said Raleigh police officers took his son for a mental health evaluation in mid-April, less than a month after the Wake County Sheriff's Office issued him two pistol-purchase permits. Albert Gibson said a staff member at the facility told his ex-wife his son was showing signs of psychosis.

Records withheld

In North Carolina, the debate about privacy and gun laws focuses on a statute that cloaks mental health records and court proceedings such as involuntary commitments and mental competency hearings. Court clerks across the state keep such records sealed. They're neither forwarded to a statewide criminal database maintained by the SBI nor sent to a federal instant criminal background check database relied on by gun dealers and law enforcement nationwide to determine whether someone can legally purchase a handgun.

Under North Carolina law, people who want to buy a handgun must get a purchase permit from the sheriff of their county of residence. Before issuing the permit, which is valid for five years, the sheriff is required to conduct a background check using federal and state criminal records.

Sheriffs enjoy a degree of discretion in issuing pistol purchase permits. They can deny a permit under the "good cause" clause if they learn of an applicant's mental health problems through indirect means -- such as information from a deputy who transported someone ordered to be involuntarily committed, or by calling a cooperative official at a local mental health facility.

But Eddie Caldwell, executive vice president of the N.C. Sheriffs' Association, said sheriffs need direct access to court records of involuntary commitments.

"That's a huge missing component in the information a sheriff needs," said Caldwell. "Right now, they have limited information and sporadic information, but they don't have all the information that's out there."

Sheriffs don't need a person's entire mental health file, Caldwell said, just a summary of court records that show whether a person has been involuntarily committed for mental health reasons or judged mentally incompetent.

Caldwell's group also favors a bill that passed the state House last week that would create a statewide database of pistol purchase permit denials, including those rejected for felony convictions and mental health reasons.

Johnston County Sheriff Steve Bizzell favors the bill.

"I'm all for gun ownership, but if a person is denied a permit in Harnett County or Wake and they apply to purchase a pistol here, I'd like to have a database to find that out," Bizzell said.

Willoughby, the Wake County prosecutor, favors even broader access to mental health orders for background checks on applicants who want to be teachers, day-care workers, police officers and home health care workers.

"I understand the need for confidentiality," he said, "but when someone's being permitted to buy a gun or enter a profession like teaching or law enforcement, information about mental health is crucial."

(Staff writer Michael Biesecker contributed to this report.)


Staff writer Jim Nesbitt can be reached at 829-8955 or jim.nesbitt@newsobserver.com.
Staff writer Michael Biesecker contributed to this report Read more!

A costly search for help, answers - Winston-Salem Journal

Video and related links to this story can be found here.
Parents and schools are often at odds over a promising autism therapy

By Danielle Deaver

Lexi Cota has curly, red hair and soft hazel eyes. They only briefly look at a visitor as she smiles uncertainly and then looks away, drawing back into her mysterious world.

A world of autism.

It’s a world that Kelli and Chris Cota never thought they would be a part of. It’s a world in which Kelli Cota had to quit her job to take care of her little girl, and fight to find the services that she needed. It has changed the Cota’s plans for their family.

They have decided, at least for now, not to have a second child out of fear that he or she would also have the disorder, or would one day have to take care of Lexi, who is now 6. They have cashed in two 401(k) accounts to pay more than $90,000 for treatment for their daughter.

Autism poses challenges financially and academically to parents and educators, and frequently pits the two against each other.

Autism can present itself subtly - a child who stands too close to people or doesn’t get jokes. Or it can stand out - a child who cannot communicate, and strikes out in fits of bad behavior. About one child in every 150 is affected in some way. The cause of the disorder is still a mystery.

After years of therapy and education, some children are able to communicate by pointing to pictures, or even by talking, and parents discover how much their silent child has learned and has never been able to share. That breakthrough is the hope of every parent of an autistic child, and most would do anything in the world to make it happen.

Parents of some more severely afflicted autistic children in Forsyth County, including the Cotas, say that their children have made remarkable progress at the Applied Behavioral Center of North Carolina, a center based in Winston-Salem that is one of two in the state to offer a promising therapy in a group setting.

ABC of NC uses a version of Applied Behavior Analysis - intense, one-on-one therapy to draw children out of their silent world. It encourages them through a system of rewards, praise and affection to talk and play.

Parents tell stories of amazing successes - children who become potty-trained after years of diapers, who can tell parents what hurts and what they need.

But getting the help is difficult. A year at ABC of NC costs about $62,400, and most parents have to pay the full cost out-of-pocket. Parents say that it is worth it, that if children get intensive help when they are young, they will be able to overcome the disorder and go on to live relatively normal lives.

The Winston-Salem/Forsyth County school system, which by state and federal law must take responsibility for the therapy and education of disabled children when they turn 3, offers a home-based version of the Applied Behavioral Analysis therapy.

Parents who have worked with the school system say that the home-based system is deeply flawed and puts an almost impossible burden on parents. And no matter how much progress the children are making, the school system ends the therapy at age 5.

“I think the school system believes that there is no rehabilitation for these children,” said Greg Gordon of Winston-Salem. His son, Ross, 4, has autism and attends ABC of NC. “They think, ‘There is no hope for these kids, so let them go to the junkyard.’”

Superintendent Don Martin said he disagrees.

“In fact, we want to provide, we’re trying to provide, the appropriate environment for every child,” he said.

Their own world

A diagnosis of autism used to mean that a child would never be able to function in the world. Now, most experts agree that there is a broader disorder at work, one that has a spectrum of symptoms. Autism is diagnosed by a series of tests done by doctors when the child is as young as 18 months, but some parents know earlier that something is wrong.

The Gordons suspected that Ross had autism when he was 6 months old, said Kristi Gordon, his mother. He never responded to people or toys, and could spend hours spinning things.

The diagnosis was confirmed a year later.

“No matter how much we thought it, it still kind of crushed us,” she said.

Others, like the Cotas, watch their seemingly typical child change into someone they don’t recognize. When she was a year old, Lexi was a charming, typical toddler, one who loved to pop out from behind doorways and say “hi!” Then, when she was about 16 months old, she began to change. She became at turns silent and withdrawn or unruly, running around and flapping her arms wildly. She was diagnosed with autism a few weeks before her third birthday.

No matter when they get the diagnosis, the message that goes with it is the same: Get help now.

Many experts say that children who are placed into therapy as soon as possible have the best chance of eventually living a relatively independent life in which they will be able to have a job, even if their social mannerisms are unconventional.

“When you see them young, and 11/2, 2 and 3, you have no way of knowing which child will respond well to intervention and which won’t. The idea is you provide intervention and treatment when they’re young,” said Dr. Kurt Klinepeter, an associate professor of pediatrics at Wake Forest University Baptist Medical Center and the medical director of Amos Cottage. Amos Cottage is affiliated with Wake Forest and offers services for children with developmental problems.

It’s difficult to tell how many children have other conditions that co-exist with the autism. About 30 percent of autistic children will have IQ scores in the normal range. Those children will have the best chance at eventually living independently, with jobs and typical lives - not just because they score well, but also because they have to be on the higher-functioning end of the autism spectrum to be able to take an IQ test at all, Klinepeter said.

The other 70 percent aren’t necessarily mentally retarded, he said. They could be more affected by the communication and social aspects of the disorder, which would make it nearly impossible to correctly administer an IQ test.

Children who are suspected of having autism usually end up at the county’s early-intervention program, either through a referral from a doctor or day-care worker, or because the parent is concerned enough to want an evaluation.

If the child is autistic, the county is in charge of providing therapy until the child turns 3, through the Children’s Development Service Agencies. Children can receive a combination of speech, occupational and physical therapies. Some also receive therapy through the ABC of NC center. It is paid for by Children’s Development Service Agencies.

Many parents want their children to receive Applied Behavior Analysis. The National Institute of Mental Health, the leading federal agency for research on mental and behavioral disorders, said that ABA has “become widely accepted as an effective treatment” in its booklet about autism. ABA is the only treatment specifically mentioned in the booklet.

There were 165 children with autism in the Winston-Salem/Forsyth County school system, and 6,247 in all North Carolina schools with autism during the 2005-06 school year.

The Winston-Salem/Forsyth County school system offers home-based ABA therapy to some autistic students. The guidelines state that the children must be severely limited and have a diagnosis made through recognized tests for autism.

Children can only receive ABA services when they are 3 or 4 years old, and cannot start within one year of eligibility for kindergarten. The school system stops offering the therapy to all children when they turn 5 and refers them to one of the classrooms for autistic children that are set up in three elementary schools. Some parents pay privately to continue the ABA therapy.

The rule frustrated the Cotas, who received home-based ABA services from the school system until Lexi was 5.

The Cotas refused to put Lexi in one of the elementary- school classrooms for autistic children. A private assessment they paid for showed that the school system’s program would not help Lexi, her parents said, so in August 2006, they enrolled her in the ABC Center despite the financial burden.

Legal obligations

School systems work with limited amounts of money.

The Winston-Salem/Forsyth County system’s guidelines for home-based ABA services notes that state law “does not ensure students receive services to enable them to maximize their potential.’’

Rather, the system is obligated only to offer services that provide students with “some educational benefit” or “meaningful” educational benefits.

Federal law requires school systems to offer students a fair and appropriate education, and one that is given in the least-restrictive environment. School officials have said that they are uncomfortable with ABA because the one-on-one, home-based approach the system uses isolates such children from their peers.

Officials in each school system can determine how to educate the autistic children. Teams of teachers and other people in the special-education departments meet with parents once a year to draw up an Individualized Education Program for each student. The program lays out goals for the year and plans to meet them.

Students can be placed in regular classrooms and given extra assistance. Some students are put in classrooms with other special-needs children, but that is considered appropriate only for the children with more severe problems because it is isolating, said Tom Winton, a section chief in the Exceptional Children’s Division of the N.C. Department of Public Instruction.

“You only go to that if it’s absolutely necessary,” he said.

Across the state, school systems handle the education of autistic children differently.

ABA therapy has become a sensitive topic for the school system. A local couple, Debbie and Michael Wittenberg, filed a lawsuit that was first heard in 2004, claiming that the school system had denied their son, who is autistic, the services that he needed - specifically ABA.

The Wittenbergs claimed that school officials deliberately mislabeled their child to make sure that he wouldn’t qualify for ABA services. The school system denied the claims.

The lawsuit was first heard in the Office of Administrative Hearings in Raleigh, where an administrative law judge found in favor of the family. The judge wrote that the school system should have labeled the Wittenberg’s son as autistic instead of developmentally delayed, and given him home-based ABA therapy.

The school system appealed, and a state review officer found in its favor. The review officer wrote that the developmentally delayed label was appropriate, and that ABA services are not a necessary part of a free and appropriate public education.

The Wittenbergs, who declined to comment about the case, have since appealed to the U.S. District Court of the Middle District of North Carolina. The case is still pending.

Unbearable burdens

Parents who have used the ABA therapy offered by the school system say that the experience was unsettling at best.

Kelly Creasy’s son, Parker, was found to have autism when he was about 20 months old. The family lives in Winston-Salem but did not make enough money to consider enrolling him at ABC of NC.

“I worked 50, 55 hours at GMAC. We were a working family. We had two kids in day care,” Creasy said.

At first, Parker received services through the county. When he was 3, he started to attend the Special Children’s School, a private school where he was happy, but made no progress, Creasy said.

Creasy learned about ABA therapy from other parents, and decided to try it. The school system agreed in 2005 to pay for ABA therapy for Parker.

She quickly ran into problems.

The family spent hours each week making supplies for the tutors. They searched to find different pictures of the same object, such as a snowman, or different plastic models of animals, for matching activities. The Creasys had to find and hire the tutors and then had to do the paperwork, including tax forms, for the tutors. The school system also requires parents to pay the tutors, and then get reimbursed every six weeks.

“For some people, holding $1,200, $1,300 for six weeks wouldn’t be a big deal. We just didn’t have it,” she said.

As many as four or five tutors would come in during the day to work with Parker. They were scheduled to overlap slightly to make sure that he was always supervised. But four or five times a week, a tutor wouldn’t show up or would be late getting to the Creasys’s house. She would have to leave work and drive home to stay with Parker until another tutor arrived.

In the fall of 2005, Creasy was fired from her job as an insurance adjuster. Although GMAC said that it was for performance, Creasy said she can’t help but believe that all the time she missed to take care of her son affected her situation.

Martin said that people who can’t stay home during the day might want to forgo home-based ABA and consider one of the school system’s other programs.

“If the parent says ‘I have to work’ then you would have to choose the other non-home- based program,” he said. “We do have a program that could be served without being home-based. But I think it’s because of the preference to choose the home-based service ... I do know there are other ways other than the ABA methodologies for serving kids.”

Through all of the difficulties, Creasy said, she never thought about giving up, because the ABA was working.

“We saw the first changes with him as far as talking,” she said. “He steadily progressed. That’s what made us put up with the crap.”

The school system ended Parker’s ABA therapy when he turned 5 in July and assigned him to one of the three classrooms for autistic children for 2006-07. Creasy refused to put him there.

“You can’t take a child who can’t speak and have him model on other children who can’t speak,” she said.

So Creasy pulled together a patchwork of funding from the county, scholarships and fundraisers that have been held for Parker, and he is tutored at home by people she hires. Her family and her husband’s family help out as much as they can.

“He’s a puzzle,” she said of her blond-haired, blue-eyed boy. “It is a little heartbreaking because he’s trying to tell us something and we can’t figure out what it is.”

■ Danielle Deaver can be reached at 727-7279 or at

ddeaver@wsjournal.com. Read more!

One in four will need mental health care -Asheville Citizen-Times

By Tom Campbell

Statistically, we are told that one person in four will need mental health care sometime during his or her lifetime. The question is, where and from whom will you get that care. “Anytime people lose faith in a system, you have a crisis, and people have lost faith in our state’s mental health system,” moderator Chris Fitzsimon told a group of three hundred assembled for a “Crucial Conversations Luncheon” about the state of mental health in our state. The 2001 mental health reforms were “well intentioned,” but aren’t working well.

A panel that included an advocate, a legislator, a regulator, a family member, and a newspaper columnist assessed the problems. Our reforms were not just “tweaking,” but sweeping system changes. They were implemented without an adequate planning period and insufficient business plans. There was no pilot program initiated on a small scale to oversee and work out problems. Too many changes were implemented at one time and there was little consideration of the impact decisions would make on other parts of the system. Counties and regional health agencies did not step up and take the reins being handed them. Meanwhile many service providers, especially hospitals, eliminated beds for mental health at the same time the number of short-term hospital stays, owing largely to drug abuse, increased sharply.

The litany continued. Guidelines were inadequate and few were held accountable. Bureaucratic slowdowns and rigid decisions on the federal and state levels hampered flexibility and innovation. Because there were so many major changes made there were internal tensions inside the Department of Health and Human Services, between the department and the legislature, between the state and local/regional authorities, and even among local parties. Finally, there were few champions with sufficient clout to correct problems.

Is there any wonder we have a crisis? How do we fix it? First, we must find leaders who can and will be champions within the executive branch, the legislature, the department, and local/regional governments and agencies. We have not demonstrated we have the expertise to address this crisis and would benefit from consultants who do and are given the authority to right the ship. Several speakers said we need to stop making changes every other week and allow the system to stabilize enough to decide what is and isn’t working. Clearer guidelines with greater accountability are essential. Counties, local management entities, and local care providers need to step up. We need to prioritize and provide care to those with the most severe needs first, then implement a plan for others. Insurance parity, requiring health insurance carriers to provide mental health care, might help put more money into the system, even though it would likely increase premiums.

We cannot allow our prisons and our hospital emergency rooms to continue to end up with our mentally ill. If a society is judged by how well it treats those who cannot provide for themselves, North Carolina is currently found wanting. Too much is at stake and this is important. What we now have is shameful.

Tom Campbell is former assistant North Carolina State Treasurer and is creator/host of NC SPIN, a weekly statewide television discussion of NC issues airing Sundays at 6:00am on WLOS-TV. Contact him at www.ncspin.com Read more!

Coverage for Children's Mental Illness Reduces Out-of-Pocket Spending - Health Services Research

Providing equal insurance coverage for mental illness does not increase usage and reduces out-of-pocket expenditures for families who have children with mental illness, a Yale School of Public Health study reports in the journal Health Services Research.

"Prior research has left policymakers with the impression that state parity laws will neither break the bank nor confer much benefit," said Dr. Colleen Barry, assistant professor in the division of Health Policy and Administration (HPA) at the Yale School of Public Health and lead author of the study. "But our study indicates that these laws are providing important economic benefits to families of mentally ill children. This information may be important to policymakers considering enacting parity or expanding existing laws."

Dr. Barry and Dr. Susan Busch, associate professor in HPA, said health plans typically provide less insurance coverage for mental health compared with other medical care. Many states have passed mental health parity laws in an effort to improve equity in private insurance and reduce financial risk for those with mental illness.

At the federal level, Congress is currently considering two competing versions of comprehensive parity legislation. Research has demonstrated that mental health benefits can be offered on par with other medical services without significantly increasing health insurance premiums. Studies also indicate that state parity laws have had little effect on the use of mental health services.

Dr. Barry and Dr. Busch said little is known about how state policies affect the financial burden of seeking mental health treatment.

Using data from the Centers for Disease Control 2000 National Survey of Children with Special Health Care Needs, the researchers examined how state parity laws affect out-of-pocket health care spending and other measures of the financial burden of treatment costs on families. Results indicate that living in a parity state significantly reduced the financial burden on families of children with mental health care needs. Specifically, the authors detect significantly lower out-of-pocket health care spending among families with children needing mental health care living in parity states compared with those in states without parity laws. Forty percent fewer families in parity states report their child's health care has caused financial problems.

The project was supported by a grant from the Robert Wood Johnson Foundation through its Changes in Health Care Financing and Organization initiative, which supports research, demonstration and evaluation projects examining major changes in health care financing.

For more information contact Dr. Barry at colleen.barry@yale.edu. Read more!

Prisons punish, not treat, mental breakdowns -Allentown (PA) Morning Call

''Mentally ill inmates in Pennsylvania and elsewhere are often shunted to disciplinary confinement units because of their inability to cope with the rigors of prison life.''

Commentary by: MARY BETH PFEIFFER

Zachariah Brown was not among the 563 students in mortarboards who graduated along with my son on a sunny green at Muhlenberg College on May 20.

Brown had been charged on May 9 with making ''terroristic threats'' on a blog in which he expressed loathing for himself, his professors, his school and his life. In one, he pondered five options of public suicide or, alternatively, whether he should ''murder a certain professor and spend the rest of my life in jail.''

Brown's threatening expressions deserved to be taken seriously. Had administrators acted more aggressively at Virginia Tech, a troubled student might have been stopped from killing 32 people in April. As a parent, I was glad to know that my son, who at one point lived next door to Brown, was being protected.

But, I also wonder: In a world in which jails and prisons have replaced mental institutions, did college administrators and police go too far trying to protect society from Zach Brown -- and Zach Brown from himself? Has a young man's life been derailed in an overdone criminal-justice response to what essentially may be a mental health problem?

Years ago, someone like Brown, who apparently had no weapons and had limited his violence to the written word, would have been taken to a mental hospital. Instead, the 22-year-old theater major went to Lehigh County Prison on $250,000 bail, where an evaluation of his mental fitness was to be done.

Back in 1955, Pennsylvania had 40,900 beds in state mental hospitals, a figure that was whittled with the advent of thorazine and developing theories of community care to 13,000 by the 1960s. With a new round of bed closures since 2005, including at Harrisburg State Hospital, there are now about 1,200 beds in state-run hospitals for the mentally ill in Pennsylvania, a figure that spells trouble for anyone trying to get into long-term psychiatric care in the Keystone State.

In 2006, the National Alliance for the Mentally Ill gave Pennsylvania a grade of D-plus for its system of mental health care. That was just a smidgen better than the nation as a whole, which got a D. In many ways, Pennsylvania is typical of much of the rest of the country: When it closed its mental hospitals, it failed to replace them with a system of care that was up to the task of caring for thousands of people with mental illness.

According to NAMI's assessment of Pennsylvania, ''Advocates report that waiting lists are growing and access to services is reduced. Consumers languish in hospital beds at one level because there is a lack of available community services -- or they are sometimes discharged without appropriate provisions for community care.''

Zach Brown was taken to a correctional facility and not a hospital because that is where the beds are. While it was closing hospital beds en masse, Pennsylvania was replacing them with prisons. It built 17 state correctional institutions since 1987, including two on the grounds of former mental institutions.

If you doubt that cells have taken the place of hospitals, consider that there were more than 7,400 mentally ill people in Pennsylvania's prisons in 2004, about six-fold the figure in state hospitals. As troubling, the number grew by 17 percent from just two years earlier.

I do not advocate a return to the days when Harrisburg State Hospital had 3,400 beds and the landscape was dotted with massive institutions of its ilk.

These hospitals kept people too long and under often abusive conditions. But how much have things improved when people who were once patients are instead inmates? When men and women who were hospitalized with the goal of becoming well are instead jailed with the goal of punishment?

Zach Brown's future is bleak if he goes to prison; of that there is little doubt. Mentally ill inmates in Pennsylvania and elsewhere are often shunted to disciplinary confinement units because of their inability to cope with the rigors of prison life. There, their conditions deteriorate, and they self-mutilate and attempt suicide. On average, mentally ill inmates serve 15 months longer nationally. Besides this, felony convictions often make it impossible to get jobs on release, assuring a high rate of recidivism.

Pennsylvania prisons spent $32,000 on each inmate incarcerated in 2001, and the cost is far higher for inmates who require mental health care. Zach Brown may soon be one of them. And like the vast majority of inmates, he will someday be released. The question is whether he -- and the rest of us -- will be better off because he was punished for his mental breakdown rather than treated for it.

Mary Beth Pfeiffer of upstate New York, is author of ''Crazy in America: The Hidden Tragedy of Our Criminalized Mentally Ill'' (Carroll & Graf, 2007). Her e-mail address is marybethpf@aol.com. Read more!

Putnam social agencies face budget ax - Putnam (NY) Journal News

By SUSAN ELAN

CARMEL - Legislator Vincent Tamagna, a former champion of county funding for libraries, museums and mental health organizations, now says cash-strapped Putnam can't afford to help finance those agencies and many others in 2008.

"The money we take from taxpayers has reached an end," said Tamagna, R-Philipstown, who wants county officials to warn the groups to start looking elsewhere for funding. "People expect Putnam County to do what it has done in the past. It can't do it because of its financial shape."

Legislature Chairman Dan Birmingham, R-Brewster, said Tamagna's proposal will be discussed at the Tuesday Budget and Finance Committee meeting at the County Office Building in Carmel.

The heads of organizations that received some of the $1.9 million Putnam gave to outside agencies this year have already reacted with alarm. Funding cuts would curtail or seriously hinder their ability to provide services to Putnam residents, they say.

"We worked so hard to increase our services to meet the needs of the children, adults and seniors of Putnam County," said Edythe Schwartz, executive director of Putnam Family and Community Services, which provides mental health care. "We got rid of our waiting list. Whatever cut there is would mean a reduction in services." Cuts would also mean the loss of matching state grants, Schwartz said.

The agency, which has a $5 million budget, received $485,744 from Putnam in 2007. The organization gets the rest of its money from the federal and state governments, foundations, private donors and patient fees.

To wean the agencies off county funding, Putnam should help them become more proficient in obtaining corporate donations and federal and state grants, Tamagna said.

"If the county is in a fiscal crisis, we don't want to create a fiscal crisis for the outside agencies in September or October," he said.

Tamagna said his initiative follows budget projections by County Executive Robert Bondi indicating a potential tax increase of 66 percent in 2008. The increase would be about 40 percent if the state Legislature renews a half-percent sales tax it granted Putnam in 2005.

This year's $121.3 million budget was bolstered by an 18.65 percent property tax increase.

Patricia Seger of Mahopac said she pays too much in taxes and has little to show for it. She wants her tax dollars to finance services for residents, particularly those for seniors like herself and her husband.

"What are they spending this money on?" Seger said. "We pay for water, septic, garbage, everything out of our own pockets."

Bondi, who proposed cutting county funding to outside agencies by 30 percent when preparing the 2006 budget, opposes Tamagna's plan. An infusion of $575,000 in state funding, secured by state Sen. Vincent Leibell, R-Patterson, staved off the cuts in the final days of the budget process.

Bondi said a survey conducted by his administration in preparation for this year's budget convinced him of residents' willingness to pay to keep quality-of-life services such as libraries, the Humane Society and arts organizations.

"There is very strong support for services even if it means steep tax increases," he said. "We feel at this time that all the services Putnam County pays for are important for the welfare of the people."

Legislator Tony Hay, R-Southeast, a fiscal conservative, and Legislator Sam Oliverio, D-Putnam Valley, said they also would not support Tamagna.

"There's no way we're going to cut the funding 100 percent or even 10 or 15 percent," Hay said.

"We haven't given these institutions a raise in three years," Oliverio said. "To threaten them with cuts is unacceptable."

To stabilize the county's financial situation in 2008, Bondi has called for an increase in Putnam's sales tax rate to 8.375 percent. The county Legislature backs the move. But Assemblyman Greg Ball, R-Carmel, has requested that the state Legislature extend the existing half percent without adding an additional half percent. Ball has said he is not convinced Putnam has cut enough of its spending.

Kathleen Delamere, head of the Putnam County Historic Preservation Advisory Commission, said the organization would fold without the $10,000 a year it gets from the county.

Patti Haar, Patterson's library director and head of the Putnam County Librarians Association, said $352,116 in county money this year is paying for literacy programs, high-speed Internet service and on-line database access. The services would not be available without the county money, Haar said.

Reach Susan Elan at selan@lohud.com or 845-228-2277. Read more!

Mental health care parity is matter of principle -Appleton (WI) Post-Crescent

Editorial:

Mental health care should be covered by insurance in the same ways as other health care. It's an injustice that it isn't. And it appears it can only be corrected by a law.

Wisconsin is one of nine states that has no version of a mental health parity law. But Sen. Dave Hansen, D-Green Bay, who has tried in the past to get a bill passed, said he'll try again in this legislative session. There are also several bills in Congress that would set nationwide standards.

Any legislation has to have some teeth in it to close the loopholes that have left other states' laws ineffective. In Connecticut, insurance companies can get around a state law by denying coverage they deem unnecessary. They also can provide such low reimbursement rates and require so much paperwork of mental health providers that many providers won't take private insurance.

Estimates of how much parity would cost differ, depending on who's giving the estimate. Some studies have said it raises insurance costs less than 1 percent — or even lowers them. Others, connected with business, have said the increase is as high as 5 percent.

That's significant, but this is more an issue of principle than anything else. It's wrong to treat mental illness as less important than other physical illness.

But looking at cost, the cost of untreated mental illness has to be considered, too. That can be steep, not just for the ill but for all who have to deal with the effects — and that's all of us.

Mental health coverage by insurance companies shouldn't be optional, or second-rate. Our society deserves better. Read more!

The mental health crisis that isn't - LA Times

Commentary:
Statistics don't support fears of a psychological emergency on our college campuses.

Mike Males, MIKE MALES, former sociology instructor at UC Santa Cruz, is senior researcher for the online information site YouthFacts.org.

IN RECENTLY RAISING a fee that pays for student services, University of California officials cited "the serious and urgent need for enhanced mental health services" on the system's 10 campuses. Students today suffer "so much stress," Elizabeth Downing, head of the UC Santa Barbara health center, told The Times last week, and the UC Student Mental Health Committee reported that "students are presenting mental health issues with greater frequency and complexity." About 43% of the revenue generated by the higher fee will go to treating such problems.

These concerns are not confined to California. College counselors across the nation face "an entirely new scale of difficulty" as "the number of students with depression has doubled, the number of suicidal students has tripled and sexual assaults have gone up fourfold," the American Federation of Teachers reported in its monthly On Campus magazine.

Jean Twenge, San Diego State psychologist and author of the much-quoted "Generation Me," goes further: Today's students are more miserable, lonely, narcissistic, self-centered and materialistic largely because school curriculums artificially inject young people with unmerited "self-esteem" at the expense of demanding real achievement.

But our most reliable long-term surveys and public health measures show that students today are no more plagued with mental problems that their predecessors and that claims of a "campus mental health crisis" may be overblown.

Since 1966, UCLA's Higher Education Research Institute has annually surveyed hundreds of thousands of first-year college students, publishing its findings in the American Freshman. According to the institute's surveys, the percentage of college freshmen who described themselves as "frequently depressed" has fallen substantially over the last two decades, from a peak of 11% in 1988 to lows of 7% in 2005 and 2006. The percentages of students who felt overwhelmed by academic obligations rose through the late 1990s but have since declined. Campus counseling center statistics are inconsistent and limited, but those available show that the percentages of students using them to be fairly stable.

More generally, public health and law enforcement statistics reveal that rates of suicide have fallen by 50%, and rates of other self-destructive deaths (drugs, poisons and hangings, accidental deaths from guns and deaths of undetermined intent) by more than 60% among California teenagers and young adults over the last 35 years. Students seem particularly safe from lethal dangers. The 2003 Big Ten study of 12 Midwestern campuses found annual suicide rates — 7.5 per 100,000 students age 18 to 24 — were half the national rate for that age group.

The findings of my study of the eight UC campuses — Berkeley, Davis, Irvine, Santa Barbara, Riverside, Santa Cruz, Los Angeles and San Diego — and their surrounding communities were similar. Students 18 to 24 years old rarely died violently, and the rates of such deaths were declining dramatically.

Today, 18- to 24-year-olds make up about 40% of the adult populations surrounding the eight UCs but account for just 12% of suicides, 15% of violent deaths, 21% of gun deaths, 27% of traffic deaths and 5% of drug overdose deaths. My research found that older students and college personnel were much more at risk than undergraduates.

Monitoring the Future, a survey of 12,000 high school seniors annually conducted by the Institute for Social Research at the University of Michigan, contradicts Twenge's claim that students suffer more pathologies because of undeserved self-esteem. According to the surveys, today's high school seniors actually have lower self-images than those of 30 years ago. For instance, in 1976, 82% of the students said, "I take a positive attitude toward myself," and 86% agreed that "I am a person of worth." In 2005, the percentages were 73% and 77%, respectively.

However, considerably higher percentages of these students than their predecessors say they are "very happy," are having fun, enjoy the fast pace of modern life, view the future optimistically and feel it's important to make a contribution to society. Many fewer report feeling lonely, left out and "no good at all" compared to their counterparts of the 1970s.

Nor do Monitoring the Future surveys support Twenge's contention that today's youth are stressed by rising materialism. Compared to their counterparts of 20 to 30 years ago, current high school seniors are substantially less likely to value owning the latest fashions or to feel their status is enhanced by driving a nice car or coming from the right family. And while the percentages of them saying they wanted to have "lots of money" rose from 1976 (46%) to 1985 (61%), they have not significantly risen since then.

Students today also appear less psychiatrically medicated, according to the Monitoring surveys. About 7% of high school seniors report taking doctor-prescribed sedatives, tranquilizers or amphetamines versus 15% in the 1970s.

Likewise, illicit pharmaceutical drug use is only half as common today as back then. Use of prescription narcotics like codeine or Vicodin has remained flat over time.

How then to explain the increasing impression that younger college students are more mentally disturbed, suicidal, dangerous and endangered?

There is no question that burgeoning college enrollment has pushed the caseloads of campus mental health personnel and psychologists beyond professional guidelines. For instance, UC enrollments have increased by 50,000 in the last decade as funding for many student health services has been cut. As a result, UC has about one psychologist for every 2,300 students, which is far below the guideline of the International Assn. of Counseling Services of one psychologist for every 1,000 to 1,500 students.

But rather than peg their case for more mental health funding to these legitimate concerns, campus officials have played the "troubled youth" fear card. For a century, mental health practitioners have regularly ascribed more depression, anxiety, violence and other mental troubles to young people.

In 1913, psychologist Lewis Terman proclaimed that skyrocketing teenage stress was driving an "epidemic of child suicide." In 1935, the American Council on Education's American Youth Commission reported that 75% of young men suffered physical debilitation induced by mental anxiety, while a national study a year later found youth in a "melancholic … state rapidly approaching a psychosis." In the 1980s, the National Assn. of Private Psychiatric Hospitals and other lobbies trumpeted an "epidemic of teen suicide" that later congressional testimony and an American Psychological Assn. investigation concluded was an attempt to fill beds in overbuilt psychiatric hospitals.

Judging by the best evidence we have, today's high school and college students are no more troubled — indeed are probably less so — than those of 15, 25, or 35 years ago. That higher tuitions raise student anxiety — a new UC-funded poll found 16- to 22-year-olds citing "school and money as their top sources of personal stress" — is just one more compelling reason to base mental health funding on professional criteria rather than "suicidal student" scare campaigns.

Read more!

Housing for mentally ill gets final OK in Folsom -Sacramento (CA) Bee

By Walter Yost -
May 25, 2007

A proposed 19-unit apartment complex for people with mental illnesses cleared its final hurdle and was approved by the Folsom City Council this week.

The council Tuesday night unanimously approved a planned development permit for the Folsom Oaks Apartments as well as a request for $200,000 from the city's housing trust fund to help build the complex.

The sum is considerably less than the $2.2 million originally requested by the project applicant - Transitional Living and Community Support Inc. - but council members said the $200,000 is consistent with the approximately $10,000 per unit the city has provided for other affordable housing projects.

Under the proposal approved Tuesday, the city will enter into an agreement for release of the $200,000 once the applicant demonstrates that full funding for the project is in place.

Paul Powell, associate director of Transitional Living and Community Support Inc., said getting the necessary entitlements from the city will enable his agency to apply for state funding.

Although the apartment complex on the border of the city's Historic District initially drew opposition from many residents, no one spoke against it at Tuesday's meeting.

Council members have said the applicant had a right to build multifamily housing on the site and the city couldn't reject the project based upon who would live in the apartments. Read more!

Tech Killer Deserves No Protection -Richmond Times-Dispatch

By Ray McAllister

The Virginia Tech shootings revealed troubling issues with the state's mental-health system, its treatment of severely disturbed people, and maybe even police and administrative responses.

But one issue doesn't seem to take a brain surgeon:

Why are mental-health-related records of the shooter being kept private?

He's dead.

Cho not only killed 32 innocent people on April 16, he killed himself.

So why are we still trying to protect HIS privacy?

Investigators on a gubernatorial review panel are looking into whether the massacre could have been prevented -- or more important, whether others can be.

But they're stymied, at least temporarily.

In 2005, the killer-to-be was ordered to undergo outpatient treatment by a special justice who found him to be suicidal. But it's unclear whether he sought the treatment -- or whether anyone in the system cared one way or the other.

Something's broken there.

But Virginia Tech says -- rightly, apparently -- that it is forbidden even from disclosing whether Cho ever sought mental treatment there, let alone turning over to citizen panels any files that may exist.

W. Gerald Massengill, head of the panel, says the group will go to court if it needs to.

It shouldn't need to.

The U.S. Department of Education says don't blame it.

"As a college student, Seung Hui Cho's [Family Educational Rights and Privacy Act] rights expired upon his death," Education Department spokeswoman Katherine McLane said. She said his education or treatment records could be released at "the discretion of the institution."

FERPA rights expire at death, but it seems HIPAA rights -- Health Insurance Portability and Accountability Act rights -- live on in the afterlife.

HIPAA's privacy rule, according to a U.S. Department of Health and Human Services Web site, "is balanced to protect an individual's privacy while allowing important law-enforcement functions to continue." Information can be disclosed but usually only to law-enforcement entities under specific circumstances.

That's too tough a standard, when a gubernatorial commission has to labor -- and have its important work delayed -- simply to get information about a dead man.

Paula Price, executive director of Mental Health America of Virginia, a citizens organization that promotes mental-health issues, cautioned yesterday against a rush to overhaul privacy laws, though.

They possibly make the nation less dangerous, not more, she said. Without them, fewer would seek help. "The stigma against people with mental issues is the culprit that keeps them from getting treatment."

Fair enough.

But again, the shooter is dead. What's the stigma now?

Price said it's possible some would be less likely to seek help if they thought their illness would be revealed after death. That might shame their families.

Price urged lawmakers to be cautious if they consider changing privacy laws, as many people think could happen at the federal and state levels. "This is an extraordinary case," she said, "and any time laws are made for a particular case, they're generally not good laws."

Point made.

But there simply has to be an exception made in cases like this.

Cho did horrific harm before finally turning that gun on himself.

He shouldn't be allowed to continue.

Contact staff writer Ray McAllister at rmcallister@timesdispatch.com or (804) 649-6333. His column runs Tuesday, Thursday and Saturday, and is online at www.inRich.com, keyword "columnists." Responses may be printed from time to time. Read more!

War wives at greater risk of postpartum depression - LA Times

By Denise Gellene

Women with spouses on military deployment during their pregnancies face a nearly threefold higher risk for postpartum depression in initial screening tests, researchers reported this week.

The findings mean that military wives should be informed of the risk and aggressively screened for depression during their postpartum medical exams, said lead author Dr. Jeffrey Millegan of the Naval Medical Center in San Diego.

Postpartum depression is marked by feelings of guilt or hopelessness, and in some cases, suicidal thoughts or behaviors. Other symptoms include feelings of inadequacy about motherhood and nagging worries about the infant's safety.

Postpartum depression is believed to affect 10% to 15% of new mothers and can occur up to three months after childbirth. Antidepressants or psychotherapy are effective treatments.

The study, presented Monday at a American Psychiatric Assn. meeting in San Diego, looked at 415 women who received preliminary screening tests for the condition approximately six weeks after their children were born.

One-quarter of the 90 women whose husbands were deployed at any point during their pregnancy screened positive, according to the study, compared with 11% of the women whose husbands were not deployed.

Researchers found that women whose husbands were deployed during their pregnancies had 2.7 times the risk of screening positive.

The women who screened positive were referred for further mental health services. The study did not follow those women to learn whether they were ultimately diagnosed with postpartum depression.

Still, Dr. Vivien Burt, director of the Women's Life Center at the UCLA Resnick Neuropsychiatric Hospital, said the results underscored the need for action because previous studies had shown that a mother's depression could leave lasting scars.

"The impact is dramatic and has a ripple effect on other family members," she said.

denise.gellene@latimes.com
Read more!

Delegates eye mental health care - Roanoke (VA) Times

By Michael Sluss

RICHMOND -- A House of Delegates committee plans a series of public hearings to get a better grasp of the shortcomings in Virginia's mental health system, responding to critical questions that emerged from the April shootings at Virginia Tech.

The work of the House Health, Welfare and Institutions Committee could lay the foundation for legislation to reform a system that many consider overburdened and underfunded.

The panel plans the first of four public hearings on the issue June 18 at the General Assembly Building in Richmond.

The committee's chairman, Del. Phil Hamilton, R-Newport News, said he expects "a plethora" of mental health-related bills to come before the General Assembly in its 2008 session.

"This is to kind of educate the committee," said Hamilton, who is well-versed in the complexities of mental health funding and regulation.

Hamilton expects lawmakers to delve deeply into issues raised by the handling of Seung-Hui Cho, the troubled Tech student whose April 16 shooting rampage ended when he took his own life.

Cho was found to be mentally ill in December 2005, after a roommate reported that he might be suicidal. A Montgomery County special justice concluded that Cho represented a danger to himself and ordered him to receive outpatient treatment. It is unclear whether Cho got that treatment.

State law requires that regional community services boards or behavioral health authorities "recommend a specific course of treatment" for such outpatient orders. But New River Valley Community Services, which coordinates a variety of mental health programs in Montgomery County, had no one present at Cho's hearing. The board's executive director said this week that the agency assumed no treatment would be ordered because a standard independent psychological evaluation found Cho did not meet Virginia's "imminent danger" threshold. But the special justice who heard the case disagreed.

Hamilton said his committee's hearings will try to identify gaps in the system and help lawmakers develop fixes for them. The June 18 meeting will include briefings from the attorney general's office, the Department of Mental Health, Mental Retardation and Substance Abuse Services, and representatives of regional community services boards, he said.

Among other things, the committee will examine privacy laws, the criteria for voluntary and involuntary hospital commitments, and the criteria for inpatient and outpatient treatment orders, Hamilton said.

Del. Dave Nutter, R-Christiansburg, called the hearings "a positive development to look at the broader policy questions."

Nutter said the committee's efforts will complement the work of Gov. Tim Kaine's Virginia Tech Incident Review Panel and a mental health law review panel created by Leroy Hassell, the chief justice of the Virginia Supreme Court.

Nutter, a member of the committee, said the committee also will address funding issues. The two-year state budget includes $1.1 billion for mental health and mental retardation services, but the state still struggles to meet growing demands for community-based care.

"Ultimately, these are all money questions," Nutter said.

Staff writer Mike Gangloff contributed to this report. Read more!

More consequences await if we ignore mental health system - Terre Haute (IN) Tribune Star

May 25, 2007
By Galen Goode
CEO, Hamilton Center, Inc

Our nation is still reeling from the tragedy at Virginia Tech. As the shock wears off, the natural inclination is to find fault. We search for the “black box” — the evidence of what went wrong. While there are undoubtedly many factors that might have changed the outcome of April 16, there is an underlying issue that can’t be ignored.

Mental illness affects almost 60 million Americans. That’s an estimated one in every four adults and one in every five children. Mental illness is more common than cancer, diabetes or heart disease, making it the leading cause of disability in the United States.

As Americans, we are so frightened by mental illness, or the stigma associated with it, that we do a fairly good job of ignoring it. So does our government.

Despite advances in medicine and therapy that make it possible to treat and prevent lifelong disability from mental illnesses with increasingly greater success, the systems that do so are woefully under funded at all levels. Even Medicare discriminates against mental health treatment, as do private health insurance companies. Almost 90 percent of private health plans place on mental health care limits that they don’t place on medical/surgical care.

The cost to all of us is horrific. Senseless tragedies. Wasted lives. Broken families. Increased crime. Lost productivity.

How many more tragedies must occur before our national and state leaders get serious about making mental health care a priority?

There are more than 2,000 community mental health organizations across the country, that have brought quality treatment to millions in need of mental health care — including those with serious mental illnesses, the uninsured, the homeless and children in foster care.

Chronically under funded, most of these organizations have, in recent years, wrestled with managed care, diminishing resources, and growing needs. Some have been forced to merge or go away entirely, leaving large geographic areas without accessible care. For the most seriously mentally ill, case management services and community supports are being cut back. And services to adults and children with depression, anxiety or disruptive behaviors, who with treatment could lead highly productive lives, have been all but eliminated. There are too few dollars to support experienced professional staff capable of doing so much more.

We know now that Seung Hui Cho, the gunman at Virginia Tech, was diagnosed with a mental illness and ordered to get treatment. He spent some time at a psychiatric hospital. But it wasn’t enough. He fell through the cracks. Our nation’s funding priorities did not allow for a comprehensive system of early intervention, assessment, monitoring, treatment and authority to keep him from being a danger to himself or others.

There are solutions, but the problem is of such magnitude that it will take a dramatic shift in our thinking and government action, recognizing the prevalence of mental illness and recognizing that treatment is indeed worth our time and money.

Perhaps the tragedy at Virginia Tech will help focus our national, state and local leaders on the need for seamless, ongoing care for those with mental illness. We can continue our patchwork approach to public mental health services and suffer the consequences. Or we can move toward a more cohesive national mental health system that better meets the needs of those with mental illness and their families and communities.

. Read more!

Video of Mental Heatlh Panel Discussion - NC Policy Watch

For those of you who missed Monday's panel discussion on mental health in North Carolina, WRAL, Raleigh, taped it in four segments. Here are the links:

http://www.wral.com/news/local/video/1433475/
http://www.wral.com/news/local/video/1433485/
http://www.wral.com/news/local/video/1433487/
http://www.wral.com/news/local/video/1433490/ Read more!

Mixed news from crossover chaos - NC Policy Watch

" ... headline of the week so far is the House passage of parity legislation."

Fitzsimon File: By Chris Fitzsimon
May 24th, 2007

The crossover deadline is now just hours away and House and Senate members continue to scramble to make sure their bills stay alive for the session. The Senate convened Thursday morning and then recessed to let committees meet to consider more bills.

The House stayed in session Wednesday night until after 11:00, though the fate of the most controversial bills may be not decided until the end of the day Thursday.

It has been an unpredictable week with good news about migrant labor laws, more fairness in the capital punishment system and tentative approval of a plan to crack down on bullying in school, though an amendment to remove consideration of sexual orientation from the bill failed by a single vote and offensive rhetoric continued to mark the debate.

The House also defeated a proposal to bring North Carolina into the 21st century by banning corporal punishment in schools after several lawmakers looked fondly back at the spankings they received and claimed that hitting children is an effective form of discipline.

But the headline of the week so far is the House passage of parity legislation to finally end discrimination against some people with mental illness in North Carolina. It is an important victory and a tribute to the tireless efforts of Rep. Martha Alexander, though diminished by an amendment added in the House that exempts businesses with less than 25 employees from the requirement to provide mental health coverage for their employees.

Advocates for the mentally ill say the exemption may affect as many as half of the employees covered by the original bill. That means that arbitrary discrimination can continue against some people with mental illness based on where they work.

It also comes on the heels of the decision by the House Insurance Committee to remove substance abuse from the proposal, leaving people with chemical dependency on their own to battle their disease.

The House floor debate was filled with now familiar claims by opponents of comprehensive parity that it would increase the cost on insurance to the point that some businesses would stop providing insurance for their employees.

The claims continue despite evidence showing that hasn’t happened in states that already have parity laws, but facts don’t seem to get in the way of lawmakers’ allegiance to the lobbyists for the insurance industry and business groups.

The National Federation for Independent Business hadn’t weighed in much on the parity debate in the last few weeks, but circulated a flyer to lawmakers Wednesday afternoon saying that “most” small businesses would be forced to drop all health insurance for their employees unless the bill was changed.

That’s absurd even by the low standards of the rhetoric used by parity opponents. But it worked, reinforcing the milder, but still misleading claims some lawmakers had already heard from industry lobbyists, and the amendment by Rep. Charles Thomas to exempt businesses with less than 25 employees passed 60-56.

Thomas must be proud that he can go home to Asheville and tell people with mental illness who work in companies with 24 employees that they will not get help for their mental illness, but the folks at the company across the street with 30 workers will be covered. Quite a day’s work.

After the Thomas amendment, the bill passed with only one dissenting vote and is now on its way to the Senate, where lawmakers have another chance to end discrimination against everyone with mental illness, not just the people who work at businesses of a certain size.

They ought to consider adding substance abuse back to the bill too. Twenty-six states include it in their parity law and there have been no reports of widespread bankruptcy or businesses rushing to drop insurance for everybody.

Taking the bill back to its original form and covering everyone with mental illness and chemical dependency would require Senators to rely on facts, not unsupported claims of economic ruin on last-minute flyers.

It would also mean they would have to confront the powerful insurance industry lobbyists who prefer to call the shots from behind the scenes rather than say publicly they don’t want people to get help for a mental illness or an addiction.
Standing up for vulnerable people who don’t have well-connected lobbyists and don’t write campaign checks defines political courage. We’ll know soon whether or not the majority of the Senate has any.

Read more!

Grant will help disabled live at home - Raleigh News & Observer

Thomas Goldsmith, Staff Writer

An estimated 550 older and disabled North Carolinians will be able to live at home instead of in nursing homes or psychiatric hospitals, thanks to a $16.9 million federal grant, state officials said.

The money, part of a $1.75 billion, five-year federal project called Money Follows the Person, will pay for caregivers to provide personal services, hygiene, cooking and other activities in an older person's home.

It's a start on meeting the desire of a large majority of older people to live at home as they age; the federal money could help those moved from institutions with everything from housing deposits to hot meals in their new homes. Another goal is to save money, keeping people out of high-dollar, high-maintenance settings such as nursing homes.

Consumer costs for a nursing home easily run $50,000 a year. Medicaid is likely to save more than two-thirds of the $1.75 billion it's spending on the project by keeping patients out of nursing homes, the Congressional Budget Office estimates. But Medicaid rules have typically made it easier to get care in a nursing home or other institution than at home.

"We know that a lot of people would not wind up in care facilities if they had the option of someone helping them at home," said Alice Watkins, executive director of the Alzheimer's Association, Eastern North Carolina branch.

In addition to personal care, the grant money will pay for help with transportation, counseling and even home modifications, said Dr. William Lawrence Jr., deputy director of the state Division of Medical Assistance. It could also pay for respite care, paying for someone to fill in occasionally for a family member who normally handles the care.

"We are going to target elderly and disabled people in nursing homes who have been there for at least six months," Lawrence said. "It will be those who are now stabilized and clearly in a situation where they could benefit from moving back to a least restrictive environment."

No older patients have yet been served by the project. It's being designed and should benefit people next year.

"It's a very different thing to live in one's home than in a group home," said Dave Richard, executive director of the ARC of North Carolina, a nonprofit group that advocates for people with mental retardation and other disabilities. "Just imagine if you lived in a house with five people unrelated to you, with whom you had nothing in common but an intellectual disability."

State officials said the program for older nursing home residents will look much like the program that has helped people with disabilities such as Lee Tillery, who briefly considered living in a nursing home more than 10 years ago, but concluded it wasn't for her.

Tillery, 42, suffered a spinal cord injury at birth, but she was in her early 30s when her aging parents realized that they couldn't look after her at home indefinitely.

"I said, 'Nursing home, no; group home, no,'" Tillery said, shaking her head Tuesday as she recalled the search. "I'd rather be here than in a group home."

"Here" is an apartment that Tillery shares with a roommate near the Raleigh-Cary town limits. It's made possible through Medicaid funding, which pays for Tillery and her roommate to get in-home care from workers to help with hygiene, cooking and other activities.

North Carolina's Community Alternatives Program, or CAP, is allowed under a waiver of some Medicaid rules and brings helpers such as Mary Hinnant into Tillery's home.

"We help her with bathing and hygiene," said Hinnant, an employee of Easter Seals UCP. "If they are going to have coffee, we help them to get cups and everything."


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

Mental health movement - Raleigh News & Observer

Editorial:

North Carolina may have taken a definitive step forward regarding treatment of the mentally ill with the passage this week of an insurance coverage parity bill in the state House. The Senate has to concur, but the outlook for progress in this area is hopeful. Certainly tragic events in the news of late have helped illustrate what can be at stake when it comes to adequate care for people with mental problems.

Fear of being stigmatized may lead mental illness sufferers to avoid treatment, and reducing any stigma is an aim of the House-passed bill. Someone is even less likely to seek help if his or her insurance doesn't pay for care, or if the coverage is so limited that treatment is financially draining. A number of states have parity, requiring insurance companies to offer the same depth of coverage for mental ailments as for physical ones.

Parity legislation has been introduced routinely since 1992, thanks to Rep. Martha Alexander of Charlotte. But the bill has stalled each time, and it hasn't been unscathed this year. Companies with fewer than 25 workers would not be required to provide coverage with parity (if they offer health insurance coverage at all). That would affect many North Carolinians and their families.

The good news is that in the time since several states have adopted parity laws, few companies have stopped offering health insurance to employees and premiums haven't skyrocketed.

North Carolina happens to be is in the midst of a broad but troubled effort to make changes in its mental health care delivery system. That effort now is in line for new leadership, with Governor Easley's announcement that veteran public administrator Dempsey Benton will head the Department of Health and Human Services, replacing Secretary Carmen Hooker Odom when she leaves office to go to work for a New York-based foundation. Benton is a former long-time Raleigh city manager who has been serving as the state's chief deputy environment secretary.

Benton is known for making government work. Improving mental health care shapes up as his most urgent challenge.


All rights reserved. This copyrighted material may not be published, broadcast or redistributed in any manner. Read more!

Family: Stories differ on shooting - Raleigh News & Observer

Agents say driver shot at 39 times

Michael Biesecker and Thomasi McDonald, Staff Writers

The family of a mentally ill man killed by law officers in a hail of bullets on Interstate 40 on Tuesday said they are so concerned about inconsistencies in accounts of the shooting that they have postponed cremating his body for fear of destroying evidence of precisely how he died.

A pair of SBI agents met with relatives of Stephen Ryan Gibson for about two hours Thursday at the family home. According to the deceased man's father and uncle, the agents gave the family an account of Gibson's death that differs from the version released by the state Highway Patrol earlier in the week.

According to father Albert Gibson, the agents said that at least 39 shots were fired at his son, hitting him twice -- once in the head and once in the leg.

The agents said that officers opened fire after Stephen Gibson cracked open the rear driver's side door of the wrecked Chrysler 300, sticking out his right arm and pointing a gun at the approaching officers, according to the family. Gibson never fired his weapon, the family said they were told.

In an interview with The News & Observer after the shooting Tuesday, Highway Patrol 1st Sgt. Steve Greene said that Gibson was shot while trying to climb out a window on the passenger side of the car and that four troopers and a Wake sheriff's deputy fired after observing a gun in his hand. It was not alleged in the earlier statement that Gibson pointed his gun at the officers before they fired.

Gibson later died at WakeMed Raleigh campus.

Family members said they are concerned that the two accounts could be so different.

"We were planning to cremate his body [Friday]," said John Gibson, who was Stephen Gibson's uncle. "Because of the fact that it's totally the opposite of everything we've been hearing, I told them, 'It doesn't make any sense cremating the body because what if everything is wrong and we destroyed whatever the evidence there is on it.' "

The SBI launched an investigation Tuesday, standard procedure in a shooting involving law enforcement officers.

Reached for comment late Thursday, a spokeswoman for the state Highway Patrol said she could not address the differences in the information released Tuesday and what the family said they were later told by the SBI.

"We've not heard anything back from the SBI and as far as we know the investigation is still ongoing," said Julia Jarema, spokeswoman for the state Department of Crime Control and Public Safety. "We don't have anything else at this point. We are still awaiting the rest of the investigation."

An accident report made public by the state Highway Patrol on Thursday said the stolen rental car Gibson used to flee police was traveling about 115 mph when it crashed into a Chevy Tahoe on I-40 in southeast Raleigh.

The collision ended a more than 70-mile chase that spanned four counties.

The officers who fired at Gibson have been placed on administrative duty pending the conclusion of the SBI investigation, as is routine.

Greene said in an interview earlier Thursday he was not sure how long the SBI would take to complete its investigation.

"If the troopers are cleared of any wrongdoing, that will be made public," Greene said. "If the officers are found to be at fault, then the investigation will be turned over to the district attorney's office."

Authorities think Gibson, 23, of 1410 Governor's Court in Raleigh, stole the Chrysler early Tuesday morning from Triangle Rent A Car on Spring Forest Road. He then drove to Duplin County, where they think he robbed a convenience store in Magnolia, a small town near I-40.

Albert Gibson said that his son was mentally unstable and that he had sought psychiatric treatment for him the same week a Virginia Tech student shot himself after killing 32 classmates and professors. Albert Gibson also said he tried without success to have the Wake County Sheriff's Office revoke two permits to buy pistols issued to his son in late March.

State troopers knew nothing of Gibson or his mental condition during the chase. Greene, the patrol spokesman, said it would probably have made little difference if they had.

"I don't know how we would have handled it if we had known," Greene said. "If there's a threat to Highway Patrol officers or civilians, our officers are instructed to use whatever force is necessary to get the situation under control."

Before the accident, the patrol reported, Stephen Gibson was driving 130 mph as he hit the I-40 merge with the Raleigh Beltline on the southeast side of town. His car ran over some "stop sticks," the patrol reported, and then struck the Tahoe.

The impact spun the Tahoe out of the westbound lanes of the interstate and into the path of traffic merging from the Beltline, where it slammed into a Dodge passenger car, the patrol reported.

When asked why was it so important to stop the Chrysler, Greene said troopers followed proper procedure. State Highway Patrol policy allows a trooper to continue pursuit when the need to catch a criminal suspect is greater than the danger the chase may pose to the public, the trooper or the suspect.

"It's just unfortunate that it ended with a tragic loss of life," Greene said.

An autopsy was performed on Gibson this week by the state Medical Examiner's Office in Chapel Hill, prior to the body's release to the family.

John Gibson said the family may now seek an outside examination of his nephew's remains.


Staff writer Michael Biesecker can be reached at 829-4698 or mbieseck@newsobserver.com. Read more!

Lawmakers’ deadline passes - Asheville Citizen-Timees

Buncombe legislator's amendment limits the number of the mentally ill covered by a proposal to expand their insurance coverage.

By Jordan Schrader
JSCHRADE@CITIZEN-TIMES.COM

RALEIGH — They have worked since January, but lawmakers, like most of us, tend to procrastinate right up to a deadline.

So their last week to pass much of their legislation through either the state House or Senate was marked by marathon sessions — and when Thursday’s deadline passed, not everything had made the cut.

A constitutional amendment to limit eminent domain powers survived. So did caps on certain medical-malpractice awards and a crackdown on school bullying.

But other proposals may be dead until 2009, including banning cell phone use while driving, preventing public officials from signing confidentiality agreements like the one that brought Google to Caldwell County, giving police more rights to challenge discipline, curbing junk mail and keeping teachers from spanking students.

Lawmakers still could come up with creative ways to resurrect issues, whether by adding a fee to turn their plan into a budget bill that’s not subject to the deadline or by putting the idea in another bill.

Then, too, legislative leaders could choose to be strict or loose in deciding what is subject to the deadline, said Rep. Charles Thomas, a freshman Republican.

Thomas came out of the chaotic final week a winner, passing an amendment in the House to limit the number of the mentally ill covered by a proposal to expand their insurance coverage.

The bill would require businesses to cover mental illness as they do other health problems. But it wouldn’t apply to the largest businesses, which are self-insured and not regulated by the state, and under Thomas’s amendment it wouldn’t apply to the smallest businesses with 25 employees or fewer.

Opponents said it gutted the effort to end discriminatory insurance policies for the mentally ill. Thomas argued that small businesses faced with mounting costs would simply drop insurance altogether.

“The very smallest businesses,” he said, “by forcing that upon them, not only would it be an unfunded government mandate, but it also might increase the number of uninsured people.”

Restricting eminent domain, if it goes on to success in the Senate, could be one of the most significant moves of the 2007 session.

The constitutional amendment, which would go to state voters for approval, would prevent governments from seizing people’s property for purposes of economic development. A 2005 U.S. Supreme Court case that upheld such seizures sparked the effort in North Carolina.

It overwhelmingly passed the House on Thursday after surviving intact numerous attempts to amend it with less restrictive language.

Reps. Susan Fisher of Buncombe County and Phil Haire of Jackson County were among the 15 who voted against the bill.

With the change, “We’re going to end rural economic development in North Carolina,” said Rep. Pryor Gibson, another opponent.

Fisher sponsored some legislation that survived this week and some that is likely dead.

Her bill requiring school districts to adopt policies to end bullying moved on, despite opposition to its list of the children most likely to be bullied, including those of different sexual orientation and gender identity.

“Teachers want clear guidance,” Fisher said. “Students want to feel safe.”

Less successful was a proposal by lawmakers including Fisher to ban corporal punishment in schools. One third of the state’s school districts will continue to allow officials to strike children in some circumstances.

Rep. Joe Kiser summed up his opposition to both the spanking and bullying proposals: “What we need to do is let the professionals in the school system manage (it).”

Fisher said her proposal to let people limit junk mail, similar to a do-not-call list, would likely be turned into a request for study. But she said she’ll find a way to keep alive her bill to move the sexual education curriculum away from abstinence-only lessons.

One proposal that survived was authored by Rep. Ray Rapp of Madison County to send medical malpractice lawsuits to mediation, if neither side objects, and to cap the money awarded at $1 million.

Another winner was Haire’s proposal to teach high-school students that they can legally give a child younger than a week old to any adult, aimed at keeping them from abandoning newborns to die.

A move by Sen. Martin Nesbitt of Buncombe County was perhaps the clearest sign of this week’s importance to lawmakers’ plans.

The Democrat successfully moved a bill through the Senate that he said he has no intention of becoming law. It concerns the Asheville Housing Authority, but he intends to replace it with any new legislation that becomes necessary if Asheville and Buncombe County reach agreement over the city’s water system. Such legislation couldn’t be introduced in a new bill after Thursday. Read more!

Judge Nixes Organ Donor Body Parts Suit - AP

Bain was used as a "normal control" in a study on schizophrenia.

SEATTLE -- A judge has dismissed a lawsuit over the use of organ donor body parts for research and purposes other than transplantation, and officials say they plan to revise the state's consent procedure as a result.

King County Superior Court Judge Joan E. DuBuque rejected a case brought by Nancy Adams and her husband, Matthew, against the county medical examiner's office after they learned that organs from her son, Jesse Smith, 21, were sent to a research company without the family's knowledge.

Smith died of a heart attack on May 21, 2003, less than two months after marking the organ donor consent form while renewing his driver's license. Within hours his mother was told that her son's organs were unsuitable for live transplant.

She said it was only after a KIRO Television investigation into the medical examiner's office's dealings in body parts in 2005 that she discovered his brain, liver and spleen had been sent to the Stanley Medical Research Institute in Baltimore, where his brain was used as a "normal control" in a study on schizophrenia.

"Our son's organs were taken without his permission and without our permission and sent to a medical research institute back in Maryland who we had never heard of," she told KIRO-TV for a broadcast Wednesday.

The Adamses' lawyer, Stephen L. Bulzomi of Tacoma, told the station Smith never expressed any interest in donating his body for medical research.

"He expressed a very firm conviction that he wanted it to be used for transplantation, to help living persons," Bulzomi said. "He had no contemplation of his donation being used to advance the study of mental illness."

The ruling means that the choice offered by the state Licensing Department, which signs up the vast majority of Washington's organ donors, is now between allowing the use of body parts for research as well as for transplants and refusing to donate organs for either purpose, spokesman Bradley A. Benfield said.

"All of us here at DOL were shocked to discover this ruling and how it effects potential organ donors," Benfield said.

At LifeCenter Northwest, which keeps the state's organ donor registry list, chief executive Diana L. Clark said the ruling could discourage potential donors.

Within a few months, LifeCenter Northwest and the state agency will institute a "kickback" letter campaign so that anyone who enrolls as an organ donor will receive a follow-up letter listing options such as transplant only, research only or both, officials said.

Current enrollees can choose from the same options by contacting the Living Legacy Registry.

Links related to this article:
Living Legacy Registry: www.livinglegacyregistry.org/ Read more!

Defense now takes stage in Boggess retrial -Durham Herald-Sun

The death penalty is not being sought for Boggess this time around.

By John Stevenson,

Durham | The prosecution rested its case Thursday in the homicide retrial of Todd Charles Boggess, with jurors left pondering a tape-recorded confession in which Boggess said he should be executed for the fatal beating of a Laney High School honor student in the woods of northern Durham 12 years ago.

The defense now is presenting evidence that Boggess suffered from automatism, a mental condition that can cause people to do things automatically without remembering how they did them, or even if they did them.

Defense attorneys contend the condition was spawned by a sordid childhood that included fatherly sexual abuse.

Court officials expect the trial to end next week.

Boggess faces an automatic sentence of life in prison without parole if found guilty, as charged, of first-degree murder.

He already was convicted once, in 1997, and sentenced to die. However, the state Supreme Court subsequently granted him a new trial because of a judicial error.

The death penalty is not being sought this time around.

Among the most dramatic evidence in both trials was a tape-recorded confession, in which the suspect said he had a problem with his conscience when he kidnapped Danny Pence from Wrightsville Beach in 1995, stole his car and then beat him to death with a board, a rock and his fists at an abandoned, crumbling house on Terry Road. The site is near northern Guess Road.

"I just sometimes don't go by it, you know," Boggess said in the confession, referring to his conscience. "It's like, why bother?"

A homeless drifter at the time, Boggess claimed he did not intend to kill Pence, but merely wanted to knock him out and make off with his Ford Mustang

He said he learned a psychological coping mechanism from frequent parental sexual abuse that began at an early age.

"I shut myself down," he explained. "I don't want to think anything. I don't want to believe anything. I don't want to hear anything, see anything. I just basically shut myself down, blocked everything out. ... It's so much inside me. I can't handle it. I feel like I am going to snap, start screaming, yelling and hitting myself."

It was that kind of mental state, according to defense evidence, that allowed Boggess to kill Pence without realizing what he was doing.

In his confession, Boggess admitted he attacked the Wilmington student without provocation, saying he was sorry.

"I could have gotten away," he told a detective. "But I wouldn't have been able to live with that. I can't live with it now. I don't want to live with it on my conscience, and I don't want to think about it. I don't want to go to sleep because I have to dream about it."

A co-defendant in the case, Melanie Gray, who was only 14 when the crimes occurred, pleaded guilty to a reduced charge and served nearly 10 years in prison.

She was Boggess' girlfriend and accompanied him during the Pence murder. She did not testify in either of his trials, however.
Read more!

Polk to create mental health crisis response team - Tryon Daily Bulletin

Leah Justice
May 24, 2007

Polk County is planning to create a mental health crisis response team using $234,000 left over after the former mental health authority was dissolved.

Polk commissioners on Monday agreed to use the funds to serve mental health and substance abuse patients in Polk County for a minimum of four years.

The Polk County Mental Health and Substance Abuse Initiative presented Monday a three-phase plan to commissioners to fill gaps in mental health services in the county.

The crisis response team would handle evaluation/assessment of mental health and substance abuse crisis clients at St. Luke’s Hospital, placement of those clients in treatment facilities in or out of Polk County and other necessary services.

Representatives of the Polk initiative said Monday that their desire is to create a new non-profit organization to manage the delivery of mental health and substance abuse services to the general public of the county. They said they want to be able to use any and all available health care professionals to do the job and to eventually operate out of a walk-in clinic. The clinic would be developed through a strategic planning process that would determine optimum location, size, funding sources and affiliations.

Until the nonprofit organization is formed and operative, Polk County is planning to contract with an endorsed provider to staff and manage the crisis response team.

Polk County Manager Ryan Whitson said the county has received several letters from the state telling the county to return its dissolution funds over to Western Highlands Network, an organization overseeing mental health services in an eight-county area that includes Polk County.

Whitson said the county will turn over approximately $313,000 to Western Highlands and then will ask that the $234,000 be used in Polk County for a minimum of four years for the crisis response team.

Jim VanHecke presented the plan to commissioners on Monday, saying that the initiative group determined that the best use of the funding will be for a crisis center. He also said the group feels that they can get four years of service out of the $232,000.

Dr. Gordon Schneider, Polk County Mental Health Advisory Board chairman, as well as other members endorsed the plan and agreed that the plan is needed for the community.

A few months ago Polk County agreed to use $80,000 of the dissolution money to fund a mental health trained sheriff’s deputy to help in transporting mental health patients to facilities. The mental health advisory board objected to the use of these funds and asked the county to wait until its master plan for filling gaps in services is complete.
The county obtained permission from Western Highlands to use the funds. Read more!

Man convicted of killing woman, baby - Durham Herald-Sun

Doctors diagnosed Schreiber with borderline personality disorder and bipolar disorder

GREENSBORO, N.C. -- Jurors were expected to begin deliberating Friday on a sentence for a man they found guilty of killing a woman and her baby.

William James Schreiber, 35, was convicted of two counts of first-degree murder in the deaths of Teri Sokoloff, 31, and her 8-month-old daughter, Skye. The two were found in September 2005 in a Greensboro town house Sokoloff sometimes shared with Schreiber.

During the trial, defense attorneys said doctors diagnosed Schreiber with borderline personality disorder and bipolar disorder. A forensic psychologist called by the defense said Schreiber would need special care as a prisoner because of his mental illness.

Schreiber could face the death penalty or spend the rest of his life in jail.

Using the forensic psychologist's testimony, defense attorneys said during the trial that Schreiber was guilty only of second-degree murder because his mental illness prevented him from being able to formulate intent -- a key part of first-degree murder.

Sokoloff's father, John Land, said he was pleased with the murder conviction.

"I feel like, at this point, justice and right have prevailed regardless of what the final sentence is," he said. Read more!

Va. House to Review Psychiatric Care Gaps - Washington Post

Hearings, Spurred by Massacre, Presage a Tide of Reform Efforts, Lawmakers Say

By Tim Craig and Chris L. Jenkins

RICHMOND, May 24 -- The Virginia House of Delegates will hold hearings this summer to consider solutions to problems in the mental health system exposed after Seung Hui Cho's shooting rampage at Virginia Tech.

The hearings in the Health, Welfare and Institutions Committee are the first step in what lawmakers say will be a flurry of potential legislative reforms to the mental health system after Cho killed 32 students and faculty members and then himself April 16.

Del. Phillip A. Hamilton (R-Newport News), the committee's chairman, said legislators want to review state funding of mental health services and the laws governing privacy, emergency custody orders and involuntary and voluntary commitments. The committee also plans to hear from private providers of mental health services and solicit suggestions from the public.

"We have to get a plan to make sure the system and processes don't break down again, so similar circumstances don't occur," Hamilton said.

He said the hearings, the first of which will be held June 18, will lay the groundwork for what could be a contentious debate in the General Assembly next year on mental health treatment and funding.

Although he has commissioned a separate investigation, Gov. Timothy M. Kaine (D) said Thursday he welcomes the legislative review.

"We are working toward the same goal," said Delacey Skinner, Kaine's communications director. "We all want to make sure we address any flaws or loopholes in the system that need to be addressed."

Cho's case underscores some of those flaws, officials have said. He was referred to the New River Valley Community Services Board in 2005 after Virginia Tech police said he had harassed two female students.

The board, the government mental health agency that serves Blacksburg, determined that Cho was "mentally ill and in need of hospitalization," according to court papers.

A day later, on Dec. 14, 2005, Paul M. Barnett, a special judge hearing Cho's case, decided that Cho was an imminent danger to himself as a result of mental illness and ordered him into involuntary outpatient treatment.

But three law enforcement sources familiar with Cho's medical records have said that Cho never received treatment. There was no follow-up from the community services board or the courts.

State law says that community services boards are responsible for setting up a treatment plan for mentally ill people released into the community for outpatient care. But Les Saltzberg, executive director of the New River Valley Community Services Board, said his agency did not create a treatment plan for Cho because the special justice did not tell the board of his order.

Saltzberg, who took over at New River last year, said a board representative used to be present for commitment hearings to help with treatment plans, but a lack of funding and resources stopped the practice several years ago.

Joe Painter, who said he presided over 15,000 mental health commitment hearings while serving as a special justice in Blacksburg from 1989 to 2000, dismissed as "naive" Saltzberg's contention that the board didn't know about Cho.

"The law requires them to set up the specific course of treatment," Painter said. "I want to know when and why they unlearned the law."

At a meeting today, Saltzberg said he and Barnett will seek to improve communication between the court and the agency.

"We're going to work with the special justice to figure out what the best way is to do this," Saltzberg said in an interview Thursday. "Based on our mutual cooperation, we'll figure out a way to make sure that nobody gets lost."

Hamilton said the legislative hearings will focus heavily on the role of community services boards.

But because the committee doesn't have subpoena power, Hamilton said it won't delve too deeply into the case of Cho, whose records are protected under privacy laws.

He said he will leave specific questions about Cho to the eight-member Tech Review Panel, which Kaine created to study the shooting and the state's response.

That review has been hampered by state and federal privacy laws that prevent Virginia Tech and providers of mental health services from releasing Cho's medical and academic records.

Cho's parents, as the executors of his estate, might be able to authorize the release of some records, but officials say they are out of the country.

Retired State Police superintendent W. Gerald Massengill, chairman of the review panel, said the committee might have to seek a court order to get the information.

"We will do whatever we have to do to get those records, and if that means a court order, subpoena, whatever, then certainly we have to look at that," Massengill said.

Massengill said panel members are debating how far into Cho's past they need to go to get a better understanding of his illness.

"At the very least, we have to know what happened since his issues were identified at Virginia Tech in 2005," Massengill said.

"I would think to really get at these root causes, we may want to go back much farther than that."

Staff writer Brigid Schulte contributed to this report. Jenkins and Schulte reported from Washington. Read more!

More raises ordered at state hospitals

Judge's order covers not just psychiatrists but all clinicians treating mentally ill prisoners. Implementation remains a question.

By Lee Romney and Scott Gold

The federal judge overseeing reforms in mental healthcare for California prisoners has ordered the Department of Mental Health to significantly raise salaries of all clinicians at state mental hospitals who treat the sick prisoners.

U.S. District Judge Lawrence Karlton had indicated at a Sacramento hearing Monday that he might require pay raises only for psychiatrists. But his written order, released late Wednesday, is far more sweeping — applying also to psychologists, licensed clinical social workers and the psychiatric technicians on the front lines of day-to-day care.

Still, it remained far from clear Thursday when or how the raises would be implemented and whether the majority of hospital workers would even receive them.

The move came after Karlton's December order to sharply raise pay for prison clinicians inadvertently helped trigger an exodus of staff from the state hospitals — which treat some of the same prisoners whom Karlton's court aims to protect. Although all five state hospitals have been affected, Atascadero State Hospital on the Central Coast has seen the largest staff exodus and treats the greatest proportion of sick prisoners.

The shortages at Atascadero are so acute and detrimental to patient and staff safety that the facility effectively has been closed to new admissions since January, contributing to a growing waiting list of severely mentally ill patients in prisons and elsewhere.

"It is apparent to this court that steps must be taken immediately to remedy the staffing shortage," Karlton wrote in his six-page order, which instructs the department to file a plan within three weeks laying out raises equal to those that prison clinicians received.

Karlton is overseeing the reforms in response to a class-action lawsuit on behalf of mentally ill prisoners, whose care he deemed unconstitutionally poor. He has no jurisdiction over Department of Mental Health treatment of non-prisoners, who include sex offenders who have already served their prison time, parolees too violent to be released, jail inmates too ill to stand trial or not guilty by reason of insanity, and a dwindling number of patients committed to the facilities through the civil courts.

Although Atascadero, Coalinga, Patton, Napa and Metropolitan state hospitals all house mentally ill prisoners, Napa and Metropolitan have only five beds apiece for such patients.

The state could avoid some of the mandated raises by moving mentally ill patients out of some hospitals and grouping them at fewer facilities. It could also raise salaries only for those clinicians who treat the patients under the court's jurisdiction. But that would create a two-tiered system and might prompt state hospital workers to flood toward the jobs with better pay.

"It requires some analysis," Department of Mental Health Director Stephen Mayberg said Thursday. "Who's included? Who's not included? … There are a lot of big questions that have to be answered."

Karlton's order already raised the alarm for mental health clinicians at developmental centers across the state, which have lost staff to the prisons and could lose more if additional employees left for higher-paying hospital jobs.

Mayberg and Gov. Arnold Schwarzenegger have pushed for a plan that would centralize mental health recruiting for numerous agencies, including the departments of Developmental Services and Veterans Affairs. But their proposal for a million-dollar-a-year headhunter has been criticized as inadequate to solve the immediate crisis. They are also seeking enhanced funding from the Legislature to hire 750 more people in the coming year at enhanced salaries that would nevertheless fall significantly short of the pay parity Karlton is ordering.

Mayberg said he would forge ahead with that strategy while analyzing Karlton's order. "We are committed to addressing all of the concerns that the judge has raised," he said.

At Atascadero, psychiatric technicians reacted jubilantly to the order. Paul Hannula, the facility's California Assn. of Psychiatric Technicians representative, said he had fielded dozens of calls since Wednesday night, some from staffers who had left for prison jobs and wanted to return to the hospital and others from those who had planned to leave but now wished to stay.

"This decision is the only way to save California's forensic mental health system," Hannula said. "This will be the turning point of us being able to maintain staff and recruit staff, and at the same time it increases safety."

The mood was less ebullient at Metropolitan State Hospital in Norwalk, which has lost psychologists, social workers and other staffers in a steady stream in recent months.

Social worker Osbaldo Gutierrez, 27, said both psychologists had recently left his unit — which treats 57 patients routed through the criminal justice system — and he too is laying the groundwork to abandon the hospital for a correctional facility where he can make more money in a safer environment with a lighter caseload.

The strains on remaining staff have left patients increasingly antsy and aggressive, he said, because scheduled therapy and educational sessions are often canceled.

"As the clinicians leave, the patients don't have anyone to talk to," he said. "They're agitated. It impacts the progress they've made," and their condition worsens. As that happens, "It becomes a safety issue. There are more assaults."

lee.romney@latimes.com

scott.gold@latimes.com
Read more!

Wounded vets panel told more must be done -San Diego Union Tribune

Commission formed by Bush meets in S.D.

By Rick Rogers

SAN DIEGO – Combat veterans – especially reservists and those living in rural areas – lack proper mental-health care because there are too few treatment specialists, a flood of patients and a lingering stigma among troops about seeking help.

That was the gist of what medical experts and private citizens told the President's Commission on Care for America's Returning Wounded Warriors during its hearing yesterday in San Diego.

President Bush established the panel in March to gauge the needs of injured service members after he learned about shoddy patient care at Walter Reed Army Medical Center in Washington, D.C. The commission is led by Bob Dole, former U.S. senator and Republican presidential candidate, and Donna Shalala, former U.S. secretary of health and human services.

“We are trying to find a solution,” Dole said. “We are not on a witch hunt or a white-wash.”

It didn't take long for the commission to hear what became a recurring message: more needs to be done.

“The military system does not have enough resources, funding or personnel to adequately support the psychiatric health of service members and their families – in peace and during conflict,” said Richard McCormick, a professor at the Case Western Reserve School of Medicine in Cleveland. “This creates a perfect storm of barriers to receiving care.”

Few of the roughly 50 people who attended the meeting were combat veterans. The commissioners plan to visit Camp Pendleton today to meet Marines and their loved ones.

Oceanside resident Miguel Delgado was the lone veteran who spoke during yesterday's session.

Delgado, a retired Navy senior chief and corpsman and a two-tour veteran of the Iraq war, said he kept rationalizing his drinking, anger and flashbacks until he awoke one day to find himself choking his girlfriend.

He blasted the treatment he has received for post-traumatic stress disorder since leaving the military in November.

“I am not convinced there is a system in place for veterans who return with PTSD,” said Delgado, 45, who did praise other medical services provided by the Veterans Affairs system.

He stopped going to group counseling because he didn't feel comfortable sitting next to heroin addicts and the homeless. Delgado fears he could meet the same fate if better PTSD treatments, including more specialized counseling services, aren't made available.

“I'm afraid I am going to wind up in the street with a sign,” Delgado said.

He is “100 percent certain” that many Camp Pendleton-based Marines are suffering from PTSD because of their combat duty in Iraq. Delgado also said Marines routinely lie on mental-health assessments so they can deploy with their units and avoid the stigma of being seen as weak.

“Stigma is still an issue for us,” said Col. Elspeth Cameron Ritchie, an Army psychiatrist and a consultant to the Army's surgeon general. She said 20 percent of the soldiers in Iraq show signs of mental-health problems.

“We are concerned about the number of suicides,” Ritchie said.

Last year, the Army saw its suicide rate spike from the annual average of 10 to 12 soldiers per 100,000 to just over 17, according to a recently released Pentagon report on troops' mental health and ethics.

McCormick, the Case Western professor, is part of a Defense Department task force on mental health. He visited Camp Pendleton and other military installations nationwide to help prepare the task force's report, which will be released next month.

The military's mental-health services are uneven, McCormick said, but active-duty troops who live in remote areas and National Guardsmen and reservists might be the most vulnerable. They have less access to specialized medical care or belong to branches with a poor health-care infrastructure.

“The reservists are a special challenge,” McCormick said.


Rick Rogers: (760) 476-8212; rick.rogers@uniontrib.com Read more!

Program that helps S.J.'s homeless battle mental illness could lose funds - Stockton (CA) Record

By Greg Kane

STOCKTON - Maryann Mendez has a home after spending 10 years on the street addicted to methamphetamine and alcohol. So does Norma Brown, who lost her house after a nervous breakdown following her son's departure to the war in Iraq, and Monica Madrigal, whose heroin addiction led family members to stop taking her in.

They are among hundreds of San Joaquin County residents battling mental illness who were helped since 2000 by the county's Homeless Engagement and Response Team, which is in danger of losing its nearly $1 million in funding this summer. The money is among $55 million in mental health funding left out of Gov. Arnold Schwarzenegger's revised 2007-08 budget released last week.

The so-called HERT program - pronounced "heart" - shelters, diagnoses and counsels people suffering from schizophrenia, bipolar disorder and other mental illnesses who were living on the street, said program director Lynn Thomas. Participants are treated, placed in housing and assigned case workers who monitor their recovery and progress.

Mendez, 41, who believes she abused drugs and alcohol to treat four disorders with which she has since been diagnosed, said HERT provided the stability she did not receive in previous experiences with the county's Mental Health agency.

"It brought me life," she said.

State officials have suggested that counties continue to fund HERT and similar programs with money from Proposition 63, a millionaire tax expected to generate more than $1 billion in the coming year for mental health programs. San Joaquin County is in line to receive $8 million from the tax in 2007-08.

But critics say using Proposition 63 dollars to supplement existing programs violates the promise behind which voters approved the tax in 2004. State Sen. Darrell Steinberg, D-Sacramento, authored both Proposition 63 and Assembly Bill 2034 - which created the now-threatened funding in 1999 - and said Wednesday that Proposition 63 was intended to create new programs, not support those already in existence.

"We told the voters of California that if they passed Proposition 63, we would increase mental health services," Steinberg said. "The precedent here is very significant."

Steinberg said there is a push in the state Legislature to replace the $55 million, although its absence from the budget "remains a major threat."

No decisions have been made on what will happen to the HERT program if the cuts remain, said county Mental Health Services Director Bruce Hopperstad.

The HERT program received $920,000 this year - enough to handle 126 cases at a time, Hopperstad said. Clients are referred to the agency by everything from shelters and clinics to law enforcement agencies and courts.

Once diagnosed, patients receive medication and are placed in temporary housing until they can find jobs or begin receiving Social Security or other federal assistance. They also meet with counselors and fellow patients in weekly therapy sessions and often receive treatment for addictions that had helped put them on the street, Thomas said.

Hopperstad said patients who go through the HERT program are more likely to hold onto jobs and less likely to become homeless again than those in other programs. "It would be a tremendous loss," he said. "It really is one of the most effective programs we have."

Walter Clay was a recovering crack addict and recent parolee when he found the program after spending some time homeless. He is now clean and working as a mentor for others with mental illness, and he attributes his success to the help he received from the program.

Without continued funding, he said, such success stories may disappear.

"There are a lot of people that are going to go astray," said Clay, 47. "What's going to happen to those people that don't come back?"

Contact reporter Greg Kane at (209) 546-8276 or gkane@recordnet.com. Read more!

Fix the fractured mental health system - Roanoke (VA) Times

Editorial:

A tremendous breach in Virginia's mental health system came to light in the aftermath of the Virginia Tech shootings, and state leaders immediately must do all within their power to correct the deficiency.

The New River Valley Community Services Board learned it might have been responsible for ensuring Seung-Hui Cho received mandatory outpatient treatment 16 months after a special justice ordered it. By then, Cho had already carried out his deadly rampage.

The community services board stopped staffing competency hearings years before because it just couldn't afford the expense. Nor was an order sent to the agency.

Because his medical records have not been released, it is not known yet whether Cho received private care. No conclusion can be drawn about whether the system failed Cho and his many victims. What can be said for certain is that Virginia's mental health system is a sieve that allows ill people to slip away.

The New River Valley board is reviewing ways to plug the holes so that no one else is sucked into the void. A meeting scheduled for today is aimed at finding ways to improve communication, which could mean physically staffing every commitment hearing.

This is encouraging, but it comes with two cautions.

First, any shifting of staff to cover hearings without additional funds to add more people could shortchange other services. That could create another set of tragic consequences.

Second, changes made locally will do little to correct deficiencies statewide.

Mark Bodner, who heads the commitment task force on the state Commission on Mental Health Law Reform, said his group has yet to look at all aspects of the commitment process, but "great variations" exist.

Before the Tech shootings, Virginia policymakers and lawmakers were already at work defining the many flaws of the mental health system. The earliest that action could be expected is next year.

That's too long to wait to fix this glaring deficiency, especially if other mentally ill people are not receiving much-needed treatment. For starters, state Department of Mental Health officials immediately should develop a unified procedure and then train each community services board. Read more!

Kids, teens with mental illness to find help at new center -San Francisco Chronicle

Erin Allday, Chronicle Staff Writer
Thursday, May 24, 2007

Thousands of San Francisco children and teenagers with undiagnosed mental illnesses are the focus of a new mental health center that will combine resources from UCSF and San Francisco General Hospital, public health officials announced Wednesday.

The Pritzker Center is set to open in March, funded by a $25 million donation from the Lisa and John Pritzker Family Fund. The center will provide services for children -- especially children from low-income families -- who now are bounced among departments and doctors split between UCSF and San Francisco General.

"This facility will be a place that will stress early diagnosis of childhood and adolescent emotional illness in an effort to save young lives and offer a healthy future," said Lisa Pritzker, a San Francisco resident who volunteers at San Francisco General in child and adolescent psychiatric services. "These kids and families really deserve to be well taken care of."

Public health officials say there are roughly 6,000 children and teens in San Francisco with undiagnosed mental health problems, such as depression and post-traumatic stress disorder. Many come from low-income families and have limited access to health care, and psychiatric care in particular, said Miriam Martinez, a psychiatrist with UCSF and San Francisco General who will be executive director for clinical services and programs at the new center.

The public mental health system in San Francisco is now divided between UCSF's Langley Porter Psychiatric Institute and San Francisco General. That division can be frustrating for families seeking a diagnosis and can lead to delays in treatment, Martinez said.

For example, a child who is having trouble at school may first visit a specialist in attention deficit disorder at UCSF, then be referred to a psychiatrist at San Francisco General when it turns out he's suffering symptoms of post-traumatic stress. The new center will keep both departments in one building.

"There's been a fragmented system, and this is going to really pull things together under one roof, in a place that's really built for children and adolescents," Martinez said.

Access to childhood mental health care is a growing concern in the United States. Ten million young Americans suffer from a treatable mental illness, according to the National Institute of Mental Health.

But few parts of the country have the resources to keep up with demand. Northern California needs 1,000 additional child psychologists to meet mental health needs, according to the American Academy of Child and Adolescent Psychiatrists.

Developers of the Pritzker Center said they hope it will draw top mental health care providers and start an expansion of services in the Bay Area.

"A century ago, the challenge was to eliminate childhood diseases such as smallpox, measles and polio," Lisa Pritzker said. "Today, all too many young people face significant emotional afflictions. Too many children who need mental health care are being overlooked."

E-mail Erin Allday at eallday@sfchronicle.com. Read more!

In Other Words: Fixing the inequity of mental health coverage - Portsmouth (NH) Herald-News

By Herb Perry
May 24, 2007

We got a new health insurance plan at work Jan. 1, and, like so many people with mental health issues, I discovered the insurance policy did not reimburse psychiatric and psychological expenses the same as it did other medical conditions.

Historically, insurance benefits for mental health treatment have not been comparable with medical and surgical benefits. However, two bills dedicated to helping people with mental illness are winding their way through Congress — the Mental Health Parity Act of 2007 (S. 558) in the Senate and the Paul Wellstone Mental Health and Addiction Equity Act of 2007 (H.R. 1424) in the House of Representatives.

From what I understand, not only will insurance reimbursements become equitable, but people heretofore unable to have mental health treatment covered by health insurance will now get that coverage.

The bills and their sponsors deserve our support.

Now, don't get me wrong. I am very happy to have the insurance well, I couldn't work without it and I think that, as far as insurance goes these days, it's a good plan. But the policy's fine print doesn't favor people with mental illness.

For example, when I go to a chiropractor, a massage therapist gives me a (painful) sports massage for 45 minutes and then my chiropractor manipulates my back into its proper alignment. I shell out a $20 co-pay.

On the other hand, I go to my psychiatrist for barely 15 minutes, pay a $20 co-pay and still owe him another $29.15. My doctor charges $80 for the visit and the insurance company covers only 58.30 of the cost.

It's worse for my therapist. He charges me $125 for a 50-minute session, the insurance company covers $79.20 of that cost, and I pay $39.60 beyond the $20 co-pay I make at the office.

In February, Democratic Massachusetts Sen. Edward Kennedy and Sens. Pete Domenici, R-N.M., and Mike Enzi, R-Wyo., introduced the Mental Health Parity Act, which mandated employers and health plans cover mental health treatment as they would any other illness.

The bill would improve on the 1996 Mental Health Parity Act by expanding federal law and, as the National Alliance on Mental Illness puts it, "prohibit employers and health plans from imposing durational treatment limits and financial limitations on coverage for mental illness that do not apply to all other medical conditions."

The House bill co-sponsored by congressman, U.S. Rep. Tom Allen, D-Maine, is also making its way through the legislative process.

According to Susan Lexer, Allen's senior legislative assistant, "The bill would prohibit treatment limits or the imposition of financial requirements on mental health and substance-related disorder benefits in group health plans if plans do not include treatment limits on substantially all medical and surgical benefits classified in the same category or services.

H.R. 1424 is now before the House Energy and Commerce Committee, on which Allen serves, and the House Education and Labor Committee and the House Ways and Means Committee.

"The bill has gained broad bipartisan support and currently has 267 sponsors," Lexer said.

If both pass, a conference committee composed of legislators from both houses will negotiate a compromise that will become law.

It's about time.

Herb Perry is a copy editor and page designer for Seacoast Media Group. He can be reached at hperry@seacoastonline.com. Read an archive of his In Other Words columns, and his personal story of battling schizoaffective disorder, at http://archive.seacoastonline.com/news/10012006/nhnews-a-o1-schiz-intro.html. Read more!

Medical bills mount for mental health patients -Oshkosh (WI) Northwestern

Northwestern staff and wire services
May 24, 2007

Karen and Jay Schiller owe more than $25,000 in medical bills, a number that grows each month as they struggle to pay for Karen's care.

The Menasha couple has private health insurance, but coverage for Karen's condition is abysmal. She has bipolar disorder, which set in shortly after the birth of her son three years ago.

Once middle class, the Schillers have since joined the ranks of the working poor. They live paycheck to paycheck, spending up to $1,000 per month for Karen's medications and appointments.

"When you have so much medical debt, some of your dreams go out the window, like buying a house, a car, or saving for college," says Karen, 28.

Wisconsin is one of nine states that don't offer some form of insurance parity when it comes to mental illnesses. Group health insurers in Wisconsin are required to provide $7,000 annually for mental illness and substance abuse treatment — a number that hasn't budged since it was mandated in 1985.

Sen. Carol Roessler, R-Oshkosh, said $7,000 a year is by no means enough.

Roessler has co-sponsored numerous mental health bills through the years, none of which have passed because of the concerns over the impact changes in the law would have on the cost of health insurance.

"It's a physical disease, the same as diabetes or heart disease," Roessler said. "It ought to be treated as any other disease."

Mental health advocates say, the current system isn't just hurting patients financially. Many people suffer without care because they can't afford it. And when they get desperate, taxpayers foot the bill.

"It's legalized discrimination against people with mental illness," said state Sen. David Hansen, D-Green Bay, who has worked for 12 years to get a parity law on the books in Wisconsin. "Mental illness is a medical condition and should be dealt with like any other medical problem."

Hansen plans to introduce yet another bill in the coming months.

Herb Clark, a local advocate with the National Alliance on Mental Illness, said the situation is a disaster for those who suffer from mental illness.

"It's unfair," Clark said. "They've got medications, which are not cheap. Psychiatrists, psychologists, hospital stays. Many of them are flat broke. Some decide their medications are too expensive and just give up on them."

Wisconsin's lack of mental health insurance parity isn't just hurting people, it's killing them, argues James Siepmann, 47, a former Oshkosh physician, who developed severe depression over a decade ago and had to quit practicing medicine.

"We have a high suicide rate compared to the rest of the country," said James Siepmann, who believes that illnesses of the brain deserve equal insurance coverage as illnesses of the heart, lungs or kidneys. "You can't help but to think it's due to the lack of parity in this state."

Suicide is the 10th most common cause of death in Wisconsin. The state's suicide rate — 11.5 deaths per 100,000 people — exceeds the national rate of 10.6.

People with mental health problems in Wisconsin suffer because of the system, said Siepmann, speaking from experience both as a doctor and a patient.

Under the care of her psychiatrist, Schiller has been taking different combinations of drugs, with the goal of counteracting her disease. But the stress caused by her family's growing debt weighs heavily on her.

"I am both angry and frustrated," Schiller said. "If it wasn't for medication and treatment, I wouldn't be here today."

Krista B. Ledbetter contributed to this report. She can be reached at (920) 426-6656 or kledbetter@thenorthwestern.com Read more!

Merger nears for local mental health services -Wilson Daily Times

By Rochelle Moore Daily Times Staff Writer
May 23, 2007

On July 1, the Wilson-Greene and Nash-Edgecombe mental health centers will merge into the Beacon Center. And even though the merger has been planned for years, many still have unanswered questions.

Leaders of the Beacon Center, a publicly funded mental health agency in Rocky Mount, talked about some of the changes coming with mental health reform and the upcoming merger of the Wilson, Greene, Nash and Edgecombe mental health systems.

"This event is meant to educate consumers, families, providers and community stake holders on how to access services," said Karen Salacki, future director of the Beacon Center.

On July 1, people needing mental health services will have a new way of accessing services. Instead of walking into the mental health center, they will need to call an access line at 1-888-893-8640. People living in the Rocky Mount area can call the Beacon Center directly on the access line at 407-2474. The calls are answered by professionals working in the Beacon Center.

Each caller will be screened and a determination will be made about the level of service needed. Immediate crisis situations, like a nervous breakdown, will likely be handled by police or the hospital emergency room.

"A year ago, people who would want to access mental health services would call the mental health center," said Gina Lane, director of access and utilization management at the Beacon Center.

That will all change July 1 with the merger and addition of the access line, Lane said.

In 2001, the state legislature approved a broad-sweeping mental health reform plan that has led to the reduction of mental health services provided in local communities. Mental health centers, funded through state and local tax dollars, were tasked to dismantle their role as service providers. The centers now manage services, and many county agencies across the state have merged as part of the statewide plan.

The Beacon Center will serve as the main office for mental health, developmental disabilities and substance abuse services in Rocky Mount. Clients will be assessed and directed to appropriate service providers.

The center will replace the Wilson-Greene Mental Health Center and the Nash-Edgecombe Mental Health Center.

Tuesday's event helped professionals and advocates understand how the upcoming changes will impact the local community and the services they provide.

"It's a great opportunity for the community to learn about this system," said Jennifer Hancock, executive director of the Mental Health Association in Wilson. "Plus, it's good to have different players together. With the changes, we have to get everybody together. Everybody has to start working together to help the consumers."

Veronica Creech, director of the Wilson Human Relations Office, said she was empowered by the information presented Tuesday in a Wilson Medical Center meeting room.

"I can't stress how exciting this group is that we have here," Creech said to the 35 or more people in attendance. "We need everyone in every corner of our world to take care of this."

The Community Mental Health Forum was held in connection with the May observance of Mental Health Month, under the theme, "Mind Your Health."

The forum included information about the role of the hospital's New Foundations psychiatric unit, the emergency room, the Wilson Police Department and the Wilson Committee for Persons with Disabilities.

The event was sponsored by the Wilson Committee for Persons with Disabilities, Mental Health Association, National Alliance on Mental Illness, Wilson Police Department and the Wilson Human Relations Office.

rochelle@wilsontimes.com | 265-7818

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Mentally ill could get more help - Raleigh News & Observer

The State House OKs a bill that would require insurance companies to make coverage of mental and physical illness similar

Lynn Bonner, Staff Writer

North Carolina took an initial step Wednesday toward joining a majority of other states that require insurance companies to cover treatment for mental illnesses the way they do physical ailments.

But before passing the measure, members of the state House decided in a close vote to limit the number of people who may receive the expanded benefits.

Supporters see the measure as an important step in reducing the stigma surrounding mental illness and helping people stay employed. The overall measure passed 116-1, and must now go to the Senate for consideration. Rep. George Holmes, a Republican from Yadkin County, provided the lone "no" vote.

"If we can get people the help they need, many times they're able to go back to work and become taxpaying citizens," Rep. Martha Alexander said in an interview before the vote. Alexander, a Charlotte Democrat, has tried since 1992 to get the House to approve the insurance law.

Until this year, Alexander's colleagues have shown limited interest in requiring insurance companies to cover depression or bipolar disorder as they do diabetes and heart disease. Currently, few private insurance policies cover mental illness or substance abuse treatment for more than short periods, and they often impose a lifetime cap that can be reached with just one hospitalization. For years, insurance companies and business groups protested that expanded coverage would drive up costs and force some employers to drop health insurance.

Other states have found that few companies drop coverage and that cost increases are minimal. For example, a 2003 study of the mental heath coverage law in Vermont found that less than one percent of companies dropped coverage, and spending by Blue Cross Blue Shield of Vermont increased 19 cents per month for each person enrolled.

But concerns about costs to small businesses were raised Wednesday by Rep. Charles Thomas, an Asheville Republican, who proposed excluding businesses with 25 employees or fewer from the requirement.

Surrounding states impose such limits, he said, and if legislators find later that it isn't needed, they can remove it.

Rep. Bill Daughtridge, a Nash County Republican, said setting the limit would spare the state's small businesses from rising costs and protect employees from the possibility that they could lose all coverage.

"Premiums go up," Daughtridge said. "Businesses have to drop insurance" or exclude some workers so they can afford to cover the rest.

The change, which was approved 60-56, significantly limits the companies that would have to comply with the law. Large companies -- most of those with 100 employees or more -- are self-insured and exempt from state mandates. With the amendment, the proposal would apply to only about one-sixth of the state's insurance market.

Those who want more people insured said mental health coverage shouldn't be denied based on the size of a worker's office.

Rep. Jennifer Weiss, a Cary Democrat, said she knew a mentally ill woman who worked for a small business that offered limited mental health coverage. She was discharged from a hospital when her coverage ran out, Weiss said, and was dead 24 hours later.

"She committed suicide," Weiss said. "We have the opportunity today to prevent that kind of thing. I don't think we should be picking and choosing which people get it and which people don't."

According to the National Conference of State Legislatures, 34 states have what is known as "mental health parity," though definitions vary. Some states limit mental health coverage to major illnesses such as bipolar disorder and schizophrenia. North Carolina's state employee health plan requires equal coverage for mental and physical illness.

The proposal to require more private insurance coverage picked up momentum this year when legislators decided to exclude treatment for drug and alcohol addiction from the mandate.

Discussions in the past few years about the public mental health system, and the massacre at Virginia Tech in April, helped focus legislators on ways to get treatment for more people, Alexander said.

"People are beginning to understand we needed to do something for our citizens," she said.

The Senate is interested in expanding private mental health coverage, said Senate leader Marc Basnight, a Manteo Democrat.

"Anything that would be an improvement in that world would certainly be beneficial," he said.


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

Father: I tried to save my son - Raleigh News & Observer

He wanted a gun taken from Stephen Gibson, the man shot on I-40. No one could help him

Thomasi McDonald, Staff Writer

RALEIGH - On March 27, the Wake County Sheriff's Office granted Stephen Ryan Gibson two permits to purchase handguns.

Less than a month later, during the same week that an unstable Virginia Tech student shot and killed 32 classmates and professors, Gibson's father asked police to have his son committed to a mental health facility. Albert Gibson said his son was hallucinating and told him he saw ghosts in their home.

Stephen Gibson was released the same day. In the weeks that followed, Albert Gibson tried without success to convince local law enforcement and mental health authorities that his son should not own a firearm.

On Tuesday, Stephen Gibson died after four state troopers and a Wake County sheriff's deputy opened fire on him. Authorities say he had robbed a convenience store in Duplin County and led officers on a more than 70-mile car chase that ended on the Raleigh Beltline. According to the Highway Patrol, the officers shot at Gibson when they saw him holding a handgun as he emerged from the car.

The officers have been placed on administrative duty while the State Bureau of Investigation looks into the shooting, a standard procedure.

The day after his son's death, Albert Gibson stood outside his Raleigh townhouse and talked about how federal confidentiality laws prevented him from proving to the Wake County Sheriff's Office that his son's mental condition made him a threat to himself and others.

"I'm not angry with the Wake County Sheriff's Office," he said. "Their hands were tied."

Albert Gibson initially said early Wednesday that his son had been diagnosed as mentally ill and admitted overnight at WakeMed's Raleigh campus. A WakeMed spokeswoman said Wednesday that the hospital has no record of treating Stephen Gibson.

Albert Gibson clarified his statement later in the day, saying that a Raleigh police officer showed up at the family home at his request to take his son to be evaluated at Wake County's Crisis and Assessment Services office, just behind WakeMed on Falstaff Road. Gibson said a staff member at the facility told his former wife that Stephen Gibson was showing signs of psychosis.

Gibson said his son was then taken to Dorothea Dix Hospital, where he was released the same day.

Officials with both Wake County and the state Department of Health and Human Services said Wednesday that federal patient privacy laws prevent them from confirming that they had seen or treated Gibson.

Dr. Peter Morris, the medical director for the county crisis assessment service, said that generally his office sends patients to Dix if they pose an immediate danger to themselves or others. But to be admitted, a second psychologist or psychiatrist at the state hospital must agree with the initial assessment.

Albert Gibson said he had learned about his son's pistol permits from a relative in Atlanta. He contacted the sheriff's office to see whether he could have the permits revoked due to his son's mental condition.

Once a sheriff issues a pistol purchase permit, it can't be easily taken away, even if the sheriff learns the permit holder has been involuntarily committed for mental health reasons, said John Aldridge, special deputy attorney general and leading expert on North Carolina gun laws.

That's because state law does not include a revocation provision for pistol purchase permits. This gives a sheriff two options -- ask the person to voluntarily relinquish the permit or ask a judge to order it done. Aldridge said he has never heard of a North Carolina sheriff doing either.

Wake County Sheriff Donnie Harrison said his office tried to help Albert Gibson. Harrison said his office needed proof that Stephen Gibson was mentally incompetent, which Harrison said the father was trying to provide.

When Albert Gibson went back to the county offices on Falstaff Road to obtain paperwork about his son's evaluation, he was told that because his 23-year-old son was an adult the information was confidential.

"They said the only way they could give it to me was if he signed a consent form," Albert Gibson said. "I knew he wasn't going to do that because he was mad I had him committed, and he knew that would stop his permit."

Bright but drifting

Stephen Gibson was one of seven children. Born in the Bronx, he spent recent years living between his parents' homes in Raleigh and Charlotte. He graduated from Charlotte's East Mecklenburg High School and moved to Raleigh about two years ago to attend Wake Tech. His father said he stopped attending classes after less than a year.

Along with working odd jobs, Albert Gibson said his son purchased large quantities of odd items such as oil filters and cat food and was "addicted to information." He loved watching the news on television and often bought boxes of books during visits to area thrift stores.

John Gibson, Stephen's uncle, opened one of the boxes he had stowed in the trunk of his car. The books included a medical volume about internal medicine, several interpretations of the Bible, books about mammals and a dictionary.

"He was unbelievably smart," his father said. "He read that dictionary like it was a regular book."

(Staff writers Michael Biesecker and Jim Nesbitt contributed to this report.)


Staff writer Thomasi McDonald can be reached at 829-4533 or thomasi.mcdonald @newsobserver.com.
Staff writers Michael Biesecker and Jim Nesbitt contributed to this report. Read more!

DA won't pursue death for Castillo - Durham Herald-Sun

BY BETH VELLIQUETTE : The Herald-Sun
bvelliquette@heraldsun.com

HILLSBOROUGH -- Orange-Chatham District Attorney Jim Woodall won't seek the death penalty against Alvaro Castillo, who allegedly shot and killed his father and then drove to Orange High School and fired shots at students eating lunch on an outside patio.

Castillo, 20, who appeared for a Rule 24 -- or death penalty -- hearing in Orange County Criminal Superior Court Wednesday morning, is charged with the first-degree murder of his father, Rafael Huezo Castillo, and for firing at and injuring students at Orange High on Aug. 30, 2006. An Orange County sheriff's deputy, who worked as the school resource officer, and a retired N.C. Highway Patrol officer confronted Castillo while he was shooting at the school and were able to get him to lay down his weapons before anyone was seriously injured.

Woodall gave several reasons for not seeking the death penalty against Castillo.

One reason, he said, is because Orange-Chatham Public Defender James Williams turned over information to Woodall about the medical treatment Castillo received four months before the school shooting after he had made suicide threats, Woodall said.

After Castillo allegedly said during a traffic stop four months before the shootings that he wanted to commit suicide, he was committed to a mental hospital. Woodall would not go into detail but said a major issue during the trial, especially if it was a death penalty case, would be "the issues surrounding his treatment and what occurred whenever he was committed back in April."

Another factor is that the wife of Rafael Huezo Castillo does not want the state to seek the death penalty. She is also the mother of Alvaro Castillo.

"She was very opposed," Woodall said. "That's not a defining factor. It's just one thing to consider."

The third issue is the death penalty itself. In North Carolina, there is currently a de facto moratorium on death sentences because of questions concerning physicians' role in administration of the penalty. That makes it difficult for prosecutors to ask for a death sentence and difficult for juries to give the penalty, Woodall said.

Woodall said he wishes the N.C. General Assembly would decide whether it wants a death penalty rather than leaving prosecutors in limbo.

"Everyone should know whether they want to have it or not," he said.
Read more!

UNC starts online screening program - Durham Herald-Sun

BY CARA MCDONOUGH
chh@heraldsun.com

CHAPEL HILL -- The university has started an online mental health screening program which has yielded impressive results, the vice chancellor for student affairs told the Board of Trustees on Wednesday.

Peggy Jablonski reported to the trustees' University Affairs Committee about efforts to change the campus culture and focused on three issues she said the Student Affairs Department has been concerned about -- fraternity and sorority life, alcohol and substance abuse, and mental health on campus.

Mental health initiatives, she said, have come to the forefront in light of the recent shootings at Virginia Tech.

"Now we have faculty's attention on this issue," Jablonski said.

She said that the university's online mental health screening program was offered to juniors and seniors this year and will be expanded to include the entire student body next year.

The survey was offered through an e-mail, and resulted in 152 students contacting mental health services and 87 students seeking treatment for mental health issues -- an "exceedingly effective" result, said Jablonski.

Allen Hamrick O'Barr, the associate director for clinical services at UNC Counseling and Wellness Services, pointed out that the surveying technique is effective because it is anonymous, and also because it will be offered repeatedly.

"What we're aiming for is having it go to every student, every year to make sure it picks up everyone," he said.

A student who had ignored the survey the previous year may since have experienced a crisis and welcome the opportunity to get help.

Committee Chair Rusty Carter asked if the screening could help the school avoid events like the one at Virginia Tech.

"Do you have a sense that we might have a significantly greater chance of identifying someone like the person who was admitted to Virginia Tech?" Carter asked.

Jablonski said while she couldn't definitively answer the question, the screenings were certainly valuable.

She also spoke about increased efforts to improve Greek life on campus and reviewed a new "Standards of Excellence Program" that will be implemented this fall.

The program includes policies aimed at ensuring all Greek chapters maintain academic integrity, foster relationships with the faculty and commit to community service and campus involvement.

Concerning alcohol and substance abuse, Jablonski said some fraternities and sororities have developed their own policies, and that the campus as a whole continues to offer alternatives to drinking as a social outlet, including programs like "Carolina After Dark," that coordinate poetry readings, holiday parties and other events.

Read more!

Mental health center awaits Crist’s OK for expansion - Naples (FL) Daily News

By Liz Freeman

The third time was the charm for the David Lawrence Mental Health Center for a state legislative allocation to add more crisis beds for adults at its Golden Gate Parkway campus.

At least that’s the way things are heading as David Lawrence officials wait for Gov. Charlie Crist to sign off Thursday on the final 2008 budget that includes $300,000 for the center. The money would be used to do some remodeling and add two more adult-crisis stabilization beds, to bring the total to 16 beds, said David Schimmel, executive director of David Lawrence.

“I think this is the third year we have asked for this,” he said.

The center originally was seeking $1 million in operating dollars to add seven or eight more crisis beds and another $1 million in construction dollars to help toward a $4 million expansion. Instead, the center will have to be diligent in its fundraising and return to the state Legislature in subsequent years seeking funding, Schimmel said.

The money was a special appropriation initiated by state Sen. Burt Saunders, R-Naples, and backed by Rep. Mike Davis, R-Naples, and Sen. David Aronberg, D-Greenacres, whose district includes part of Lee County.

Schimmel said the center will seek additional operating dollars during next year’s legislative session.

“We have plans to go to 24 beds,” he said.

The crisis stabilization unit that also serves as a receiving center for individuals retained involuntarily under the state’s Baker Act law for a mental health evaluation runs beyond capacity frequently.

“Seventy percent of the time we have more people than beds,” he said. “We bring out the roll-away beds. We can go over census by 10 percent — if not more than 48 hours.”

Schimmel said the hope is that Crist won’t veto the funding.

“We’ve been told he respects and understands our legislators don’t ask for frivolous things. It’s essential we increase the size of this (unit). There’s just way too few beds for Collier County’s population. That’s why we’ve been asking for help for three years.”

Saunders said the $300,000 is one-time funding and not-recurring in future years as hoped by the center.

“It is always non-recurring. It is always a battle,” Saunders said. “They need more beds than that. It certainly is a help, but not a total solution — yet this was a tight budget year.”

Saunders is optimistic Crist won’t veto the allocation.

“I would hope this would not be vetoed,” Saunders said. “There is tremendous support for the David Lawrence Center.”

© 2007 Naples Daily News and NDN Productions. Published in Naples, Florida, USA by the E.W. Scripps Co. Read more!

Health-plan bill clears committee - WBRZ Baton Rouge (LA)

By MARK BALLARD

A Senate committee approved legislation Wednesday that would require an employee’s health insurance cover treatments for mental illness and substance abuse.

“Help these people get the care that they need,” said Sen. Ben Nevers, D-Bogalusa, in trying to persuade the Senate Insurance Committee to forward his Senate Bill 93. The panel approved the bill without dissent.

SB93 would require that all group policies cover treatments for mental illness, alcoholism and drug dependency. It would go into effect in January 2008.

Nevers said 38 other states require health plans to cover mental illness and substance abuse treatments.

Jennifer N. Jantz, executive director, of National Alliance on Mental Illness Louisiana in Baton Rouge, recalled for the senators how her daughter had problems with her breathing. When it was considered asthma, then her insurance covered the treatments, she said.

But when an emergency room clinic performed a battery of tests and declared the cause was a stress attack, Jantz said, she was facing hundreds of dollars in medical bills because her health insurance provider considered stress a mental illness, not covered under the policy.

“How do I tell the difference between asthma and a panic attack,” Jantz said.

Nevers presented statistics that showed 47 percent of all work-related injuries involved substance abuse.

Gil Dupre of Louisiana Association of Health Plans, said he agreed with Nevers that substance abuse caused problems in the workplace and needed to be addressed on wide scale.

“The question before you today is whether small employers and their employees are going to be called upon to solve this social problem,” Dupre told the committee.

Derrell Cohoon, executive director of Louisiana Associated General Contractors, Inc., opposed the legislation arguing that adding mental health and substance abuse coverage would drive up the cost of insurance for small employers. “We’re very much concerned about the impact of the bill,” Cohoon said.

Nevers said adding these maladies to the list the state already requires to be covered would increase costs 1.3 percent to 4 percent. He said that translates to about $5.42 to $11.04 more.

But those costs could be less since most people are insured through their employers’ and have to contribute towards their health-care coverage costs, he said.

SB93 now goes to the full Senate for consideration.

Read more!

Tracking an Online Trend, and a Route to Suicide - NY Times

May 23, 2007

SEOUL, South Korea — From their nondescript sixth-floor office, Kim Hee-joo and five other social workers troll the Internet to combat a disturbing trend in South Korea: people using the Web to trade tips about suicide and, in some cases, to form suicide pacts.

“There are so many of them,” said Mr. Kim, secretary general of the Korea Association for Suicide Prevention, a private counseling group working to decrease the number of suicides, which nearly doubled from 6,440 in 2000 to 12,047 in 2005, the last year for which government figures are available.

One of the recent Internet suicide pacts involved two women who died of carbon monoxide poisoning in a one-room apartment south of Seoul.

In another, five young men and women who made a pact over the Internet and had failed in two previous suicide attempts drove to a seaside motel to discuss more effective methods. There, one member of the group had a change of heart and slipped out to call the police.

Figures released by the Organization for Economic Cooperation and Development show that South Korea’s suicide rate stood at 18.7 per 100,000 people in 2002 — up from 10.2 in 1985. In 2002, Japan’s rate was the same as South Korea’s, but the rate in the United States was 10.2 per 100,000.

Experts attribute the increase to the stresses of rapid modernization and the degradation of rural life, but they are also concerned that the Internet is contributing to the jump. South Korea has one of the world’s highest rates of broadband access and, as in Japan in recent years, the Internet has become a lethally efficient means of bringing together people with suicide on their minds.

In hardly more than a generation, South Korea has transformed itself from an agrarian society into an extremely competitive, technologically advanced economy where the pressure to succeed at school and work is intense.

Meanwhile, the traditional support base, the family, is under pressure: divorce rates are at a record high. And guarantees of lifetime employment evaporated with the Asian financial crisis in the 1990s.

In 2005, in the first rally of its kind, hundreds of high school students demonstrated in central Seoul, shouting, “We aren’t study machines!” They gathered to mourn 15 students from around the country who had killed themselves, apparently because of the intense pressure to succeed.

The government does not compile figures on how many suicides may have been inspired or aided by the Internet. But in an analysis of 191 group suicides reported in the news media from June 1998 to May 2006, Kim Jung-jin, a sociologist at Korea Nazarene University, found that nearly a third of the cases involved people who had formed suicide pacts through Internet chat sites.

In Korea, the Internet has been implicated not only for helping people get together to die, but also for widely sharing individuals’ suicidal thoughts.

One well-known actress, Jeong Da-bin, 27, posted her thoughts on her Web site a day before killing herself on Feb. 10.

Under the title “The End,” she wrote: “For no reason at all, I am going crazy with anger. Then, as if lightening had struck, all becomes quiet.

“Then the Lord comes to me. The Lord says I will be O.K. YES, I WILL BE O.K.”

Counseling centers in Seoul said calls for help jumped in the days after her death.

Notes like Ms. Jeong’s — or ones that call for help in dying — are not difficult to find on Internet bulletin boards in Korea.

“I really want to kill myself,” said a Yahoo Korea Web posting in April by an anonymous teenager who complained of bullying at school and his parents’ pressure to improve his grades. “I only have 30,000 won,” or about $32, he wrote, adding: “Can anyone sell me a suicide drug? I don’t want a painful death like jumping from a high place.”

In March a 28-year-old man who ran a suicide-related blog called “Trip to Heaven” was arrested on a charge of selling potassium cyanide to a 15-year-old boy he met via the Internet. The boy used the poison to kill himself.

Since 2005, Web portals, acting under pressure from civic groups, have banned words like suicide and death from the names of blogs. If a user keys in “suicide,” search engines display links to counseling centers at the top of their search results.

Also in 2005, the Korea Internet Safety Commission, a government watchdog on cyberspace, ordered the removal of 566 blogs, chat groups and Web postings that encouraged suicide, up sharply from 93 cases a year earlier. The figure declined to 147 in 2006 and rose again to 161 in the first four months of this year.

The government is taking or discussing other measures to impede suicide as well. Since nearly 40 percent of South Koreans who kill themselves do so by drinking pesticides or jumping, the government is considering making pesticides less toxic and is installing more barriers on rooftops and bridges.

The Seoul subway system began erecting glass walls on platforms after 95 people, some wearing black plastic bags over their heads, threw themselves in front of subway trains in 2003, according to transit officials. Doors in the glass wall open only when trains pull into the station.

Kim Hee-joo’s counseling group discovers an average of 100 suicide-related Web sites each month and asks portals to delete them. A few are serious enough that the staff alerts the police to possible violations of laws against assisting suicide or trading in hazardous substances.

“People used to use blog names like ‘Let’s Die Together,’ ” said Mr. Kim. “Now they’re more careful. Once they’ve met each other they shut down the site and switch to e-mail and cellphones. You need a lot of searching and hunches and luck to track down these people.”

Recently Mr. Kim’s team discovered a blog called “Life Is Tough,” described by its creator as a meeting place for people contemplating suicide. The site attracted several people who left their cellphone numbers and e-mail addresses to link up with others who wanted to “take the trip together.”

The police are now searching for the blog’s creator, who could face charges of aiding suicide, a crime punishable by up to 10 years in prison on conviction.

“People are social animals,” said Jason Lee, director of the Metropolitan Mental Health Center in Seoul. “Some apparently want a companion even when committing suicide.”
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Writer Is Convicted in Sex Attack on Former Colleague - NY Times

By ANEMONA HARTOCOLLIS

Peter Braunstein, a former fashion writer with a bitter grudge against the industry, was convicted yesterday of kidnapping and sexually abusing a woman he barely knew after posing as a firefighter to gain entrance to her Chelsea apartment and tying her to her bed.

The jury in State Supreme Court in Manhattan rejected the defense argument that Mr. Braunstein was delusional and so mentally ill that he lacked the intent to commit a crime.

He was convicted of 10 counts of kidnapping, burglary, robbery and sexual abuse — every charge against him except arson. He faces 25 years to life in prison on the most serious charge, kidnapping, at his sentencing, set for next month.

The verdict, which came after the jury had deliberated for barely four hours, was an uncommonly swift finish to a three-week trial. The jury began considering the charges about 12:30 p.m. and sent a note announcing its verdict to Justice Thomas Farber at 4:23 p.m.

Mr. Braunstein, 43, a former writer at Women’s Wear Daily, had sat through much of the trial in an apparent stupor, and showed little expression as the verdict was announced. But he did turn and scrutinize the jurors as they were polled individually to confirm the verdict.

“I’m devastated,” Mr. Braunstein’s father, Alberto, said afterward, looking shaken. But he added that he was not surprised by the guilty verdict.

“As I said all along, mental illness has never been recognized” in this country, he said.

Prosecutors said Mr. Braunstein dressed as a firefighter, his face hidden behind a helmet and visor, and set off a smoke bomb to trick the woman, a former colleague, into letting him into her apartment on Oct. 31, 2005.

The 36-year-old victim testified that once inside, Mr. Braunstein knocked her out by putting a chloroform-soaked rag over her mouth, stripped her, tied her to her bed with a green parachute cord and sexually molested her over a period of 13 hours. She said he took a pair of Manolo Blahnik sandals out of her closet and put them on her feet while touching her.

She said she tried to keep him engaged in small talk because she was afraid that he might kill or rape her. He told her, she said, that he was an Aquarius, and left a message written in makeup on her bathroom mirror: “Bye — Hope things turn around for U soon.”

The jury also heard her terrorized 911 call, in which she at first refused to let police officers inside her apartment because she thought they were Mr. Braunstein returning in another disguise.

Mr. Braunstein’s trial drew attention because of the bizarre nature of the crime, because of his ties to the fashion industry and because the testimony included readings of long, rambling passages from a diary and manifesto in which he compared himself to the victims of Hurricane Katrina, expressed admiration for serial killers and threatened to kill Anna Wintour, the editor of Vogue.

“I’m going to kill Anna Wintour — because I feel like it,” Mr. Braunstein wrote in his “personal manifesto, a k a the making of a menace.” Just shooting her would be too “impersonal,” he added. He wrote that he considered blowing up Ms. Wintour’s town house, then dashing inside the ruins dressed as a firefighter and killing her.

He also wrote that Ms. Wintour would be “escorted by eunuchs to a place in hell run entirely by large rats.”

But the trial was also notable as a test case for a rare type of psychiatric defense. His lawyers, Robert Gottlieb and Celia Gordon, contended that Mr. Braunstein had an organic brain disorder associated with paranoid schizophrenia. His mental illness, they argued, prevented him from forming the intent that the law says is needed to convict someone of the crimes with which he was charged.

“You certainly have gotten a Ph.D. in psychology faster than any doctor in the history of the world,” Mr. Gottlieb told the jurors jokingly during his closing argument.

But they were not convinced. Dolph Klainberg, an alternate juror who stayed to the end of the trial but did not participate in the deliberations, said he would have arrived at the same verdict. “It was a no-brainer, actually,” Mr. Klainberg, a retired manager for city agencies, said in a telephone interview.

Outside the courthouse, Mr. Gottlieb said the guilty verdict showed how inept the legal system is at dealing with the mentally ill. The prosecutors agreed that Mr. Braunstein was mentally ill, but their experts contended that he was not psychotic or delusional and that he was perfectly able to form intent. He did not take the stand.

Mr. Gottlieb said the state prison where Mr. Braunstein will serve his sentence would not be set up to provide him with appropriate psychiatric treatment. “The reality is, our prisons do not have those types of facilities,” he said.

Defendants who are mentally ill, Mr. Gottlieb said, “are treated just like lepers.”

His “lack of intent” defense was not a conventional insanity defense, in which, under New York law, a defendant can be found “not responsible by reason of mental disease or defect” and committed to a mental institution. Mr. Gottlieb said he had rejected the classic insanity defense because it was “an impossible standard to meet.”

Mr. Klainberg said Mr. Braunstein might have had a better chance with a traditional insanity defense.

“It really was an indefensible defense,” Mr. Klainberg said. “All the actions, the record, his writings, his interviews were very clear. All the events leading up to it, the preparation for the crime, the actual execution of the crime, his getaway. It was a really conscious effort on his part to commit this crime.”

But the acquittal on the arson charge indicated that the jury considered intent carefully, he said. On that charge, Mr. Klainberg said, Mr. Braunstein lacked intent not because he was mentally ill, but because he set off the smoke bomb as a diversion, not with the intent of damaging the building by starting a fire.

Mr. Braunstein’s victim was a former editor at W magazine, who had worked in the same newsroom. But they knew each other only in passing.

Prosecutors said he attacked her because he was bent on revenge against Women’s Wear Daily, which fired him in 2002, and against a former girlfriend, Jane Larkworthy, the beauty editor for W magazine, who broke up with him in 2003. The victim became a surrogate for everyone who had ever humiliated him, said the prosecutors, Maxine Rosenthal and Shanda Strain.

“The best witness was the victim,” Mr. Klainberg said, because she was able to describe exactly what Mr. Braunstein did and his demeanor as he did it. “That was the crucial part of all the testimony. He wasn’t acting like a raving maniac with her. In fact, he was conversing with her.”

Ms. Larkworthy testified in detail about the violent unraveling of their relationship. Mr. Braunstein broke wine bottles, taped her to a chair and menaced her with a knife, she said. The relationship ended in November 2003, she said, when Mr. Braunstein threatened to cut himself and make it look as if she had cut him. She went to the police, who took Mr. Braunstein to a psychiatric hospital.

When he was released, she said, he began a campaign of harassment. Using false names, he sent e-mail messages to her employers and others saying that she was mentally ill and directing them to nude pictures of her, taken when they were a couple, that he had posted online.

Colin Moynihan contributed reporting. Read more!