Va. Tech shooter had 'some interaction' with counseling center - The Associated Press

By KRISTEN GELINEAU

A mentally ill student who killed 32 people and himself during the April 16 shooting spree at Virginia Tech had 'some interaction' with the campus counseling center, the chairman of a governor's panel studying the killings said Saturday.

But it remains unclear whether Seung-Hui Cho actually received treatment at Virginia Tech's Cook Counseling Center, panel chairman Gerald Massengill said in a telephone interview Saturday.

'We know he had some interaction with the Cook center,' Massengill said. 'The records we got did not have the detail that would tell us the level of counseling _ if any _ so that's something yet to be determined. I think eventually we'll get there.'

Panel members obtained Cho's university mental health records in mid-June after weeks of negotiation with his family.

Cho was involuntarily sent to Carilion St. Albans Behavioral Center near Radford for an overnight stay and mental evaluation in December 2005, after police received a report that he was suicidal. A special justice found him to be a danger to himself, but not to others, and ordered him to receive outpatient treatment.

After a nearly 15-hour stay at St. Albans, Cho made an appointment with the Cook Counseling Center. But whether he underwent counseling at the center is still unclear.

Les Saltzberg, director of the New River Valley Community Services Board _ the agency that delivers mental health services in the Blacksburg area _ said Saturday that he knows Cho was referred to the Cook center, but that he had 'no direct knowledge' of whether Cho was treated there.

'I don't know if he went,' Saltzberg said.

Massengill said the records the panel has received do list when Cho interacted with the counseling center, but patient privacy laws prevent him from publicly releasing such information.

The review panel has one more public meeting scheduled for July 18 in Charlottesville. It is expected to produce a report in August.


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Bipolar LA inmate charged with cellmate death - The Associated Press

LOS ANGELES (AP) - A mentally ill prisoner accused of strangling a cellmate at the Los Angeles County jail was not placed in solitary even though he was facing trial over a similar slaying in state prison, officials said.

Mental health workers concluded that Kurt Karcher was fit to be in the general jail population instead of placing him in the wing for mentally ill inmates at the downtown Twin Towers jail, the Los Angeles Times reported Saturday.

He is accused of killing Jose Daniel Cruz at the jail on May 22.

Karcher, a convicted killer who has bipolar disorder, was transferred to the jail to face charges of strangling his previous cellmate at the state prison in Lancaster, officials said.

State prison officials acknowledged they did not provide county jailers with reports that Karcher allegedly had killed his former cellmate.

County mental health officials said they were prohibited by state and federal law from discussing their treatment of Karcher, but that diagnosing the mental health of any inmate is difficult because so many are dishonest during screening interviews

"Unfortunately, mental illness doesn't have a blood test," said Robert Fish, clinical manager for treatment at Twin Towers.

Karcher is now in a one-man cell and is awaiting trial on charges of killing two inmates.

Meanwhile, a county grand jury report released Friday recommended developing a program to better train mental health professionals who provide jail services. It also recommended that electronic medical records be made available within the jails.





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High court says Ark. man mistakenly released from mental hospital - The Associated Press

LITTLE ROCK (AP) - A St. Francis County man in the custody of the State Hospital for killing his father shouldn't have been released from the facility, the Arkansas Supreme Court said.

Carey Lewis Owens, 54, was released from the hospital by Pulaski County Circuit Court Judge Alice Gray in October. Owens was acquitted of killing his father by reason of mental disease in 1991. He was committed to the state facility.

Court files say that Owens stabbed his father in the neck with a meat cleaver before decapitating the 83-year-old, then setting the body on fire. When he was arrested, Owens told authorities that he thought his father was a robot.

Owens was transferred from the State Hospital to a treatment program in 1993 on an order of conditional release. He later returned to the hospital, but was conditionally released two more times. Those releases were later revoked.

Owens' attorney, Rusty Byrne, argued that the court's jurisdiction over his client's case ended in 1998, five years after his first conditional release. Gray agreed and approved a dismissal on Oct. 25.

Byrne said Friday he didn't know where his client was and that he hadn't seen Owens since October.

On Thursday, the Arkansas Supreme Court found the state law "cannot be interpreted to suggest that the court automatically loses jurisdiction over a case five years after an initial conditional-release order."

"Had the Legislature intended for the five years to run only from the initial order of conditional release, it could have easily said so by including such language in the statute," Justice Paul E. Danielson wrote in the decision.

The high court ruled that the five-year limit didn't apply because Owens' 1993 release was later revoked.

To hold that the state law limits a court's jurisdiction to five years from the first order of conditional release "could yield potentially devastating results in these types of cases," Danielson wrote.

"For example, it would potentially allow for the release of an individual who still poses a danger to themselves or others, and even the release of an individual who has been recommitted since the first order of conditional release so long as the five years had run," the ruling said.

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Mental health parity should be approved - Greensboro News Record

Opinion

The stigma of mental illness can prevent people who need psychiatric help from getting it. They're even less likely to seek treatment if their insurance doesn't pay for care or leaves them in a financial bind.

Legislation requiring equal treatment from insurance companies for mental and physical illness appears headed for approval in the General Assembly. This week, a committee passed on to the full Senate a parity bill. In May, the House, with only one dissenting vote, approved a somewhat different version.

Parity in coverage should encourage more North Carolinians to seek treatment for mental disorders. By getting the help they need, there's a better chance they can return to productive lives. And timely access to private care at home eases the costly drain on a faltering state mental health system.

It comes down to a matter of fairness. Mental health advocates argue convincingly that insurance providers should cover patients with major depression, for example, just as they do someone with heart disease.

The push to erase such inequities is gathering momentum. According to the National Conference of State Legislatures, 34 states already have passed such legislation. A similar bill awaits congressional debate. Not to be overlooked, N.C. state employee health plans already require equal coverage for mental and physical illness.

In the past, insurance companies warned that parity-related higher costs would curtail coverage. However, that hasn't occurred in states with equal treatment laws. Only a few companies dropped coverage, and cost increases were minimal.

With that in mind, insurers now are more open to covering mental health care. In fact, the state's largest private health insurer, Blue Cross and Blue Shield of North Carolina, suggested the version of the bill approved by the Senate committee.

Yet there are shortcomings. There's a glaring lack of coverage for treatment of alcoholism and drug abuse. That should be addressed because those conditions often are associated with mental disorders.

Also unresolved is whether businesses with fewer than 25 employees must comply. The fear is that expanded coverage would be too expensive for small businesses. But where there's parity, that hasn't happened. A stronger case can be made that employees shouldn't be penalized just because they work for smaller companies.

What has emerged isn't perfect, but it is a giant step toward more equitable insurance coverage. For many people, mental health care will become more affordable and accessible. Once it's on the books, there will be plenty of time to fine-tune progressive legislation.
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Smoking May Interfere With Alcoholics' Neurocognitive Recovery During Abstinence - Medical News Today

Alcoholics frequently smoke. Anywhere from 50 to 90 percent of individuals in North America who seek alcoholism treatment are also chronic smokers. New findings indicate that smoking may interfere with alcoholics' neurocognitive recovery during their first six to nine months of abstinence from alcohol.

Results are published in the July issue of Alcoholism: Clinical & Experimental Research.

"There are several possible explanations for the concurrent use of alcohol and tobacco products," said Timothy C. Durazzo, assistant adjunct professor in the department of radiology at the University of California San Francisco, and corresponding author for the study. "Nicotine and alcohol may enhance each other's rewarding properties; nicotine may decrease some of alcohol's negative effects on cognition and motor incoordination; paired use of nicotine and alcohol may produce a strong association between the two substances such that the use of one leads to cravings for the other; and there may exist a genetic vulnerability for concurrent active cigarette smoking and alcohol dependence."

Durazzo added that previous research had shown that chronically smoking alcoholics demonstrate poorer performance in multiple areas of cognitive functioning than non-smokers when they are still actively drinking or after a short period of sobriety. "However, it was unknown if non-smoking alcoholics and alcoholics who continued to smoke during abstinence would show comparable levels of recovery after a sustained period of sobriety," he said.

Study authors recruited three groups: 13 non-smoking recovering alcoholics (12 males, 1 female), 12 actively smoking recovering alcoholics (11 males, 1 female), and 22 non-smoking light-drinking 'controls' (20 males, 2 females). The researchers examined neurocognitive changes that occurred in the two recovering-alcoholic groups during six to nine months of abstinence from alcohol, comparing their neurocognitive performance with that of the controls.

"Non-smoking alcoholics showed a significantly greater level of recovery than smoking alcoholics in the areas of mental efficiency, higher-level reasoning and problem-solving, visual-spatial processing skills, and working or short-term memory," said Durazzo. "Although smoking alcoholics in the study improved significantly in auditory-verbal memory and processing speed over six to nine months of abstinence from alcohol, the level of their recovery was not greater than the non-smoking alcoholics. It is also of note that in the smoking alcohol group, those with greater nicotine dependence and longer smoking histories showed less recovery in several areas of functioning."

"In short, abstinent alcoholics without a history of cigarette smoking achieved better recovery of critical mental functions during the first six to nine months of sustained sobriety," said Sara Jo Nixon, a professor in the department of psychiatry at the University of Florida. "[These] differential outcomes demonstrate the importance of considering the behavioral impact of continued cigarette smoking among alcoholics on long-term recovery of function."

Durazzo concurred. "Previous research on neurobiological and cognitive recovery from chronic alcoholism has not considered the potential impact of cigarette smoking on recuperation," he said. "Furthermore, most research investigating the health consequences of chronic cigarette smoking has focused on increased risk for various forms of cancer and the cardiovascular, cerebrovascular, pulmonary ramifications. Given that the mortality associated with cigarette smoking is nearly four times greater than the mortality related to alcohol-induced diseases, and given our findings - perhaps chronic smokers entering treatment for substance abuse and alcoholism should consider concurrent participation in a smoking-cessation program."

"This study did not include a group of alcoholics who had quit smoking at the time of discontinuing alcohol use," noted Nixon, "but these data suggest this would be an important study. It is [also] important that the current study was almost exclusively male. Given the growing literature regarding female smokers, additional studies including women should be conducted. Finally, as the authors note, the observed differences are not likely associated with nicotine, per se. Rather, they are associated with exposure to the many toxins in smoke. This distinction is critical in considering individual options for nicotine cessation."

"Even though our results should be considered preliminary," said Durazzo, "they suggest that consideration of smoking status is relevant to the assessment of cognitive recovery. More generally, chronic smoking may impact neurocognition in other conditions where is it a prevalent behavior, such as schizophrenia-spectrum and mood disorders. Further research is imperative


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It can happen to anyone - Lowell Sun

Many people have a stereotypical view of drug addicts -- homeless, dirty criminals who deserve the desperate lives they are leading, who would never have amounted to much anyway.

In most cases, that perception couldn't be more wrong.

"Problems of addiction can happen to anyone -- and I mean it -- anyone," says Dr. Wayne Pasanen, vice president for Medical Affairs at Lowell General Hospital and president of the Massachusetts Society of Addictive Medicine.

He believes addiction is, and should be treated as, a social issue. We agree.

"My patients who are addicted are some of the most admirable, talented people I've ever met," says Dr. Edward J. Khantzian, associate chief of psychiatry at Tewksbury Hospital and a professor at Harvard Medical School.

Some people become addicted after suffering a severe injury or illness that requires the use of prescribed opiates. Others start using illegal drugs as a form of self-medication, to ease the pain of anxiety, depression or other mental-health problem.

There is also research that strongly suggests addiction can be a problem that starts at birth. Some people may be born with addictive personalities, genetic leanings that make it more likely they will become addicted to something -- marijuana, cocaine, food, exercise, opiates. For others it is a learned behavior, they grew up watching parents, siblings and friends use alcohol and drugs for comfort and recreation.

Addiction is not just a scourge of inner-cities. It crosses all socio-economic lines. In fact, heroin use -- and teenage heroin use, in particular -- is New England's dirty little secret, according to Dr. June Stansbury, special agent in charge of the U.S. Drug Enforcement Administration's New England Field Division.

At a recent conference on methamphetamine use at Middlesex Community College in Bedford, Stansbury said teens and young adults tend to view Oxycontin and opiates as clean and safe recreational drugs because they are prescription medicine and come as a pill that can be swallowed. Sadly, it doesn't take long for them to become addicted and to move on to even harsher drugs.

Oxycontin currently sells for between $40 and $80 a tablet on the streets. It's not unusual for an addict -- including teens -- to develop habits that require eight to 10 tablets a day. That's a hefty price-tag for anyone, so it's no surprise that most addicts soon turn to a much less expensive drug -- heroin -- which can be bought for $10 a bag.

"It takes an average of three weeks to go from using Oxycontin to mainlining heroin," says Stansbury.

It can take as little as a month for an honor-roll student to progress from drinking and smoking marijuana at an occasional party, to becoming a heroin addict. For some people, foolishly taking an opiate once or twice is all it takes to become hooked. They don't realize it at the time, of course.

Teens and young adults are particularly vulnerable, Stansbury says, because their brains don't process the risks as well as adult brains.

That is why it is crucial that parents, teachers, doctors, coaches, anyone who spends time with teens and young adults, pay close attention to any changes in behavior, grades, weight, health, friends and appearance. It may not be typical teen angst.

We must all work together to fight drug abuse before more youths fall victim to a deadly addiction.



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Appeals court backs dismissal of suit on mental-health system - Arkansas Democrat

BY LINDA SATTER

An 87-page ruling last summer dismissing a lawsuit accusing the state of discriminating against its mentally ill was “correct, thorough and well-reasoned,” a three-judge panel of the 8 th U. S. Circuit Court of Appeals said Friday.

In the ruling, U. S. District Judge G. Thomas Eisele stopped short of declaring the state’s mental-health system unconstitutional, but warned that lawmakers needed to address serious problems with the system before another legal challenge could crop up and lead to a costly court-order remedy.

In affirming the ruling that stoked some legislative changes earlier this year that affect the mentally ill, the appellate panel agreed that the state’s failures didn’t rise to the level of being unconstitutional.

The lawsuit was filed by Darin Winters, son of Donald Winters of Bella Vista. The elder man died on Jan. 1, 2003, in the Benton County jail, where he was being held until a bed became available for him at the State Hospital.

He had been arrested on Dec. 28, 2002, on a charge of criminal trespass, and his son had sought a mental-health commitment order, which was granted but could not be enforced until bed space became available in Little Rock.

The lawsuit took issue with the state’s failure to ensure that when mentally ill people pose a danger to themselves or the public, an appropriate place is immediately available to hold them until they can be properly treated or admitted on a more long-term basis to the State Hospital or another institution.

Donald Winters, who was 59, died of peritonitis, an inflammation in his abdomen, that a pathologist testified likely stemmed from an ulcer that perforated after his arrest. The ulcer had gone undetected by jailers who were not experienced in dealing with the mentally ill and could not communicate with Winters during his jail stay.

“Absent accurate information from the patient, the medical personnel [at the jail ] were denied information that might have aided in their ability to timely diagnose the perforated ulcer,” the appellate court said.

Winters also had head and trunk injuries, and fractured ribs, as a result of banging his head and upper body against a metal toilet in his holding cell, and struggling against restraints, although those injuries were found not to have contributed to his death.

The appellate court agreed with Eisele that the Benton County sheriff’s office had done everything it could to protect Winters and was not deliberately indifferent to his medical needs. The court also agreed that the state couldn’t be held liable under the Americans with Disabilities Act or the Rehabilitation Act because there was no evidence that Winters had been denied medical care.

The sheriff ’s office took Winters on more than one occasion to the local Bates Medical Center, but the hospital’s psychiatric ward refused to accept him because it wasn’t equipped to handle violent or aggressive patients.

So far, to address problems related to the mentally ill, the Legislature has directed the state Department of Behavioral Health to create a system of standard protocols statewide for dealing with jail inmates whose behavior indicates mental-health problems, and has authorized training for law-enforcement officials on the handling of people with mental illness.

Legislators also set aside about $ 3. 1 million for developing a new psychiatric unit in Northwest Arkansas, created the Children’s Behavioral Health Care Commission and added beds for juvenile sex offenders at the State Hospital


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Accused killer called fit to share jail cell - LA Times

By Stuart Pfeifer

A mentally disturbed state prison inmate being transferred into a Los Angeles County jail last month was examined by mental health workers, who declared him fit to be placed in the general jail population.

That finding caused Kurt Karcher, a convicted killer with a bipolar disorder, to be moved into a cell with inmate Jose Daniel Cruz.

Karcher is accused of strangling Cruz a few days later, while awaiting trial on charges that he had strangled his previous cellmate at the state prison in Lancaster.

The May 22 assault has sparked internal investigations and raised questions about how well state prison and county jail officials communicate when transferring prisoners, as they do thousands of times each year.

State prison officials acknowledge that they did not provide county jailers with reports that Karcher had killed his former cellmate when they placed him in the custody of Los Angeles County Sheriff's deputies so he could be closer to the downtown courthouse while awaiting trial.

Had Karcher been housed in the mental illness floor at the Twin Towers Correctional Facility, it's unlikely he would have been able to harm another inmate, said Melinda Bird, who monitors the county jails as a lawyer with the American Civil Liberties Union of Southern California.

"From what we understand, inmate Karcher did not receive adequate mental health care, and this is part of a larger pattern of inadequate treatment," Bird said. "In particular, this failure to coordinate with an inmate's previous treatment is absolutely widespread.

"I'm sick at heart that another inmate has died," she said, "but I'm not surprised."

County mental health officials said they were prohibited by state and federal law from discussing their treatment of Karcher. They said properly diagnosing the mental health of any inmate is difficult because so many are dishonest during screening interviews.

"The challenge for my staff is that some inmates who don't have mental illness will say they do. And some of our most severely disturbed inmates with mental illness deny they have problems and refuse treatment," said Robert Fish, a psychologist and clinical manager for treatment at the Twin Towers facility.

"Unfortunately, mental illness doesn't have a blood test that will definitively say this person has this or this person has that."

After his first cellmate was killed in Lancaster, Karcher was housed in a one-inmate cell and prescribed medication to control his mood, according to court records. However, according to several people familiar with the case, he did not receive medication at the county jail until after Cruz was attacked.

Karcher is now housed in a one-man cell and is awaiting trial on charges of killing two inmates, which could make him subject to a death sentence.

Bird said most complaints the ACLU receives from county jail inmates are about a lack of access to mental health care and medication for psychiatric conditions.

"We are very concerned about the persistent pattern of denial of psychiatric medication to inmates throughout the jail," Bird said. "We were actively pursuing this issue, even before we learned of this murder. We're pursuing it even more intensely now."

In addition to raising concerns about Karcher's mental health care in county jail, Cruz's death highlighted communication lapses between state prison and county jail officials. State prisons typically do not pass along inmates' disciplinary files — which would have included the allegation that Karcher killed a prison cellmate — to local jail officials.

Officials with the state Department of Corrections and Rehabilitation said prison officials will often tell jail officials orally if an inmate has been violent or is an escape risk. But they couldn't say whether that happened when Karcher was transferred to sheriff's custody.

Sheriff's personnel at the jail may not have been aware that Karcher was believed to have killed a cellmate even though sheriff's detectives conducted that homicide investigation, officials said.

State Sen. Gloria Romero (D-Los Angeles) said she believes the prisons should share information about dangerous inmates with county jails and is considering introducing legislation to require them to do so.

"It is the responsibility of the Department of Corrections to make sure that there is communication as to the risk and behavior that has occurred within the state system," said Romero, who oversees state prisons as chairwoman of the Senate Public Safety Committee.

"He was being transferred to jail because he committed something while incarcerated. That information has to be shared. To say 'we didn't need to tell you because you investigated it,' that's not good enough."

Sheriff's officials have declined to discuss details of their handling of Karcher because of an internal affairs investigation. Fifteen inmates have been slain in county jails since 2000. Sheriff Lee Baca said through a spokesman that he would support any effort to improve communication between state and local jail officials.

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Rehab in prison can cut costs, report says - LA Times

By Nancy Vogel

SACRAMENTO — Until California eases prison overcrowding, it can't slow the revolving prison doors that return roughly 70% of freed inmates within a year, national experts reported to the Legislature on Friday.

Their analysis of why California is among the worst in the nation at keeping ex-convicts out of prison concludes that jam-packed conditions prevent prison officials from offering drug and alcohol addiction treatment, anger management classes and job training — steps to help keep felons from committing more crimes.

The Legislature requested the report last year. It comes days after two federal judges blamed overcrowding for abysmal medical and mental healthcare in the state's prisons and indicated they were willing to move toward capping the inmate population.

The 16-member panel of rehabilitation experts faults California for giving prisoners and parolees little incentive to behave.

They recommend that wardens subtract time from the sentences of compliant inmates. They also suggest using nominal payments — such as the 8 cents to 95 cents an hour inmates can earn for working — to encourage people to complete classes, as well as offering expanded family visiting privileges, long-distance phone calls and vouchers at prison stores as rewards.

Parolees could get an early discharge for repaying victims, holding jobs or staying off drugs, they suggest.

"There are very few incentives, so inmates and parolees who participate in programs don't necessarily get out earlier or get off parole earlier, and that's unlike many other states," said panel co-chairperson Joan Petersilia, director of the Center for Evidence-Based Corrections at UC Irvine.

Harriet Salarno, president of Crime Victims United of California, agreed that prisoners should have rehabilitation programs. But she took umbrage at the notion of letting inmates out early for completing them.

"They still have to serve their time," she said. Otherwise, "you're allowing them to manipulate the system."

If California were to follow all of the report's recommendations, according to the authors, the state could eventually save between $561 million and $684 million a year on a reduced inmate population.

California Department of Corrections and Rehabilitation Director James Tilton embraced the report. He says that he doesn't have the money in his budget to do all it suggests but that he intends to launch pilot programs in a few prisons to prove that targeted rehabilitation programs work.

The public assumes, Tilton said, that "inmates go to prison, they sit on a bunk out in the desert somewhere and never come back."

"That's not the facts," he said. "People come back. Over 90% of these inmates come back to communities…. And we can do a better job."

The report's authors portray the state's $7-billion prison system as a lousy investment for taxpayers, with one of the highest rates of criminals returning to prison. They blame lawmakers and voters who for the last 30 years have passed laws that locked up more people for longer terms without helping criminals change their behavior.

They point to recent data showing that of the $43,287 that the state spends on each inmate each year, almost 50% is spent on security while 5% goes toward such efforts as teaching them to read or get a job.

According to the department, nearly half of all California prisoners released last year were not assigned to any rehabilitation programs or given jobs.

The authors of the report include current and former officials of prison systems in Ohio, Arizona, Pennsylvania and Washington state; James Gomez, who oversaw California prisons in the 1990s; Mark Carey, president of the American Probation and Parole Assn.; and several academic researchers. Marisela Montes, a chief deputy secretary with the prisons department, chaired the panel.

The report's top recommendation was to ease overcrowding. There are more than 170,000 inmates in California prisons designed for 100,000, with roughly 17,000 of them housed in classrooms, gyms and other spaces that could be used for rehabilitation efforts. Overcrowding also hinders education by triggering frequent lockdowns, in which prisoners are confined to their beds and classes are canceled.

At a news conference Friday, panel members said the quickest way to ease overcrowding would be to revamp parole policies that send thousands back to prison for brief stays for technical parole violations such as failing a drug test or missing an appointment with a parole officer.

"It's bad policy," said panel member Joseph Lehman, a retired director of prison systems in Maine, Washington state and Pennsylvania. It's better to see if there's a connection between a parole violation and past criminal behavior, he said, and decide whether an inmate should return to prison or get help finding housing or drug treatment.

Sen. Michael Machado (D-Linden) requested the analysis of California's rehabilitation programs last year as part of the state's annual spending bill. On Friday he said an independent analysis of sentencing laws was needed.

"Many states have done this and done it successfully without putting the public in danger," Machado said. "I think it's something we need to embrace posthaste
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Fraudulent Disabilities A Concern To NCAA - Washington Post

By Josh Barr

Recent rules passed by the NCAA to crack down on academic fraud by student-athletes allow significant latitude to students with diagnosed learning disabilities, and college administrators expect that some academically struggling athletes may seek to attain their athletic eligibility by obtaining fraudulent diagnoses.

In late April, the NCAA took aim at fraudulent prep schools, or "diploma mills," by ruling that, beginning with the high school senior class of 2008, incoming student-athletes must have completed 16 core courses, two more than previously required, at least 15 of which must be completed in their first four years after enrolling in high school. The rule ostensibly prohibits the practice of "fixing" an academically deficient high school transcript by fulfilling all missing requirements during a year in prep school.

However, students with diagnosed learning disabilities are allowed to take core coursework up until they enroll in college, with no time limitations -- essentially an exemption from the rule.

"There's no question it's out there," said Gary Roberts, the faculty athletic representative at Tulane and a member of the NCAA's Academics/Eligibility/Compliance Cabinet. "Anytime you have a program designed to give some sort of special accommodation for any class of people, there are going to be people who fraudulently try to become a member of that class so they can get benefits they're not entitled to."

Learning disabilities "will be the next area our committee will have to address," said Kim Callicoatte, chairman of an NCAA subcommittee on initial eligibility issues. "It's a floodgate where we're stopping up holes and there are always going to be additional holes some people will try to get through."

The first step toward receiving this accommodation is obtaining a diagnosis. According to NCAA spokesman Erik Christianson, the organization will accept a diagnosis from "a licensed or otherwise properly credentialed professional who has undergone appropriate and comprehensive training and has relevant experience."

"We receive LD diagnoses from psychiatrists, psychologists, pediatricians, neurologists and social workers," Christianson wrote in an e-mail.

The most common learning disorder in childhood is Attention Deficit Hyperactivity Disorder, which occurs in an estimated 3 to 5 percent of school-age children, according to the National Institute of Mental Health. ADHD usually becomes evident during childhood, and the median age for onset is 7, although ADHD can persist in later years and sometimes into adulthood, according to the NIMH.

Various forms of dyslexia and other disorders associated with reading comprehension also are common for those seeking to obtain the LD designation.

Before granting a student-athlete learning disabled consideration, the NCAA requires a signed copy of the most recent diagnosis, diagnostic test results and an individual education plan (IEP) designed by the school district for the student. For students attending private school, the IEP can be replaced by a statement of accommodations on school letterhead. The NCAA then notifies the Clearinghouse, which is responsible for certifying initial eligibility, that the student is learning disabled and allowed to receive the special considerations afforded to such students.

Said Bridget Niland, an assistant professor at Daemen College in Amherst, N.Y., and a former associate director of membership services for the NCAA: "There has always been a question about whether [diagnoses] have been legitimate or not. But when someone gives you a diagnosis, it's a diagnosis and you can't really refute that."

While obtaining a learning-disability diagnosis in the latter stages of high school might raise a red flag for some -- one local college athletic administrator dubbed the disorder "NBA DD" -- the diagnosis also could be legitimate, cautioned Diane Dickman, the NCAA's managing director of membership services. Dickman suggested that a student could be hindered by a undiagnosed learning disability throughout his or her schooling.

"Late diagnosis requires a clear explanation of why the diagnosis was not previously detected, which is a component of the clinical interview and reflected in the test summary by the clinician," Christianson said.

In recent years, the number of students receiving accommodations for a learning disability has remained relatively stagnant. There was a significant jump, from 203 to 338 students from the 2003-04 school year to 2004-05, with 335 cases in 2005-06 and 302 in 2006-07, according to the NCAA.

The Clearinghouse certifies 77,000 students for initial eligibility each year.

"The numbers wouldn't suggest that there is some mounting evidence of fraud," Dickman said. "We're going to monitor any kind of academic fraud. If, as we go forward, we see something that is of concern to us or leads us to believe there is something going on that relates to fraud, we certainly would [address] that."

High school and college coaches anticipate the NCAA will be busy. An assistant coach for a team that advanced to the round of 16 in this past season's NCAA men's basketball tournament said he was aware of one player who plans to try for an LD waiver. The coach spoke on the condition of anonymity because he did not want to identify the player or his potential disability in case the coach successfully recruits the player. "I don't think he's ever been tested before," the coach said, noting that he had seen the player's transcript and spoken with the player over the course of the past year. "There's definitely going to be some abuses, no question about that."

One area high school coach acknowledged that some may attach a stigma to being labeled LD, but didn't believe that would stop players from seeking such a diagnosis.

"Some of the kids [seeking an LD diagnosis], they don't have a learning disability. There is a moral dilemma there," the coach said, speaking on the condition of anonymity because of the sensitive nature of the topic. "Do you go to get something you know you're not and then you're labeled from that point on as a kid who is learning disabled?"

Roberts compared the situation to those who falsify documents to qualify for welfare or other governmentassistance.

"I'm sure there are some doctors out there who are big fans of college athletics or their local university and would be willing to bend their ethical standard," Roberts said. "When athletes run up against a brick wall, there are coaches and people out there helping them get over that wall."


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East Texas Woman Talks About Life With Mental Disorder - KLTV

Video of the story here.

It's an illness that affects one in every four Americans. Today, almost everyone knows someone suffering from a diagnosable mental disorder. One very brave East Texan knows the impact mental illness has on both a person and society. She is now sharing her life with Bipolar in a book, in hopes society will better understand the illness.

For more than 25 years, Melody Stroud of Chandler has been living with Bipolar Disorder.

"I was under a lot of stress at the time," said Stroud. "I began not to sleep. I had paranoia that people were watching me, following me. I had extreme energy, and then I became to where I had thoughts that were not real and basically lived out of reality." After admitting herself into a mental health facility, Melody learned she was bipolar, something that has taken her years to accept.

"For years I denied that I had a mental illness, so it's been a process up until the last two years where I have really come to terms with my illness and not ashamed to talk about it." Two years ago, Melody began writing a book about her life with Bipolar called In My Head, giving details that are not often talked about.

"The details of the thoughts, of your behavior, of the treatment that is available," said Stroud. "A lot of those thoughts like I said were so horrific, it's hard to even get it out of your mouth." Melody says she wants her book to be a resource for families because it was her family that has helped her live a more stable life.

"My family was so very supportive," said Stroud. "If it hadn't been for them, truly I wouldn't know where I would be." It's a success story, Melody says she hopes will encourage others suffering, or know someone suffering from the illness.

"There is hope," said Stroud. "There is hope." Melody says she hopes to have her book finished within the year.

Molly Reuter, Reporting. mreuter@kltv.com Read more!

Mental health services move to Rocky Mount -Wilson Daily Times

By Rochelle Moore
June 28, 2007

The Wilson-Greene Mental Health Center will close its doors Friday after operating from a building next to Wilson Medical Center for decades.

Public mental health centers operating in Wilson, Greene, Nash and Edgecombe counties will completely merge Sunday and become The Beacon Center. The administrative offices will be in Rocky Mount, located in the former Edgecombe-Nash Mental Health Center on the Nash General Hospital campus.

"People need to understand that even though the (local management entity) is moving to Rocky Mount, the people doing the services — the private providers — are still doing the services in Wilson," said Karen Salacki, director of the Beacon Center.

"Private providers that are in Wilson County will continue providing the services."

The closing of the mental health center in Wilson County is the final step of the four-county merger, which has been occurring in stages during the past several years. The change is a result of the state Mental Health Reform Act of 2001.

Prior to mental health reform, clients were able to receive mental health services onsite at the Wilson-Greene Mental Health Center.

But that role started changing and the mental health center started turning over services to the private sector.

The mental health center has become a manager of services and contracts with many area providers, some which receive state and local tax dollars for indigent care. Providers also receive payment through insurance, Medicaid and Medicare.

"I am not concerned about the closing of the Wilson-Greene Mental Health Center because most of the services have been divested to private providers," said Gail Boswell, a mental health advocate and consumer in Wilson. "The statistics show that more consumers are being served now than were being served by the Wilson-Greene Mental Health Center."

Wilson residents needing service, including emergency help, now have a toll-free number they can call for service referrals. Someone will be available to answer the call and assess the level of need by a caller. Immediate assistance will be given to people experiencing an emergency situation.

The number — 1-888-893-8640 — is open 24 hours, seven days a week, including holidays. Rocky Mount-area callers may also dial 407-2474 for the same service.

"If they have a question about services or they need a referral into services, they can call that number," Salacki said. "They don't have to go to Rocky Mount for services."

The remaining 10 staffers from the Wilson-Greene Mental Health Center will all move to The Beacon Center, except for some temporary office staff. Some of the agency staff have moved to Rocky Mount during the past 18 months.

The Beacon Center will have a board of 20 people, consisting of five from each of the four counties. Each county will need to have a county commissioner on the board. The four counties will also continue to provide money to the Beacon Center through county budgets.

Services provided through the Beacon Center will include telephone screening services, provider enrollment, quality assessment, quality assurance and utilization management, which assesses the type and level of services a client needs.

Jennifer Hancock, executive director of the Mental Health Association in Wilson County, expects to see an increase in calls into the nonprofit agency when the center closes.

"The phone for the center will automatically roll over to Rocky Mount for a while. However, our office anticipates we will field a lot of calls once there is no longer a number in the local phone book, other than ours, that says, 'mental health,'" she said.

The closing of the center will remove a sense of security from some consumers, Hancock said.

"It was like their safety net and possibly the only people they knew in their lives that they felt cared about how they are doing," she said.

rochelle@wilsontimes.com | 265-7818
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Speaker: Study mental health, too -Richmond (VA) Times-Dispatch

By CARLOS SANTOS
June 28, 2007

CHARLOTTESVILLE -- College mental-health advocate Alison Malmon, whose brother committed suicide while on leave from Columbia University, wants college students to look out for one another if mental illness strikes.

"Look at [Seung-Hui]Cho's roommates" in his senior year, said Malmon, speaking Monday at a forum at the Miller Center of Public Affairs at the University of Virginia.

"They knew he was off. They knew things were weird, but they left him alone. . . . Students see the changes in friends more than anybody. We can use what happened at Tech to open up the lines of communication.

"We need to educate students so they know who to go to," Malmon said. "We need to educate them so they know what to look for [in mental illness] in themselves and in others."

Cho, a mentally unbalanced Virginia Tech student, killed 32 students and faculty members at the school on April 16 before killing himself.

The forum was held to discuss mental-health issues on college campuses in the wake of the Tech killings.

Malmon founded Active Minds Inc. in 2001 to teach college students -- some 1,100 of whom kill themselves each year -- about mental health and its symptoms. The nonprofit group has spread to some 69 campuses.

Many college students face depression and other mental problems but are ashamed or afraid to seek help, Malmon said.

Her brother Brian, 22, was an extremely successful student with a 3.8 GPA and an active social life that included being head of a student a cappella group and sports editor of the newspaper. But Brian heard voices and fought depression.

"He did it all in secret. He was ashamed," Malmon said. "Students are living in this silence at campuses all over the country."

Unlike Cho, she said, most are much more likely to harm themselves than others.

Richard J. Bonnie, the director of the Institute of Law, Psychiatry and Public Policy at U.Va. and head of the Virginia Commission on Mental Health Law Reform, said one of the main issues is how to "redesign the system so people can get help quickly when they need it. . . . The goal is to provide timely access to high-quality care without stigma."

As for college students with mental-health issues, Bonnie said administrators are confused about what course of action to take.

"College and university administrators are uncertain and even ambiguous in assisting students with mental-health problems. How aggressive should they be?"
Contact Carlos Santos at (434) 295-9542 or csantos@timesdispatch.com.

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Coordination is important in addressing child mental health - Nashville Tennessean

Opinion: By CHARLOTTE BRYSON
June 28, 2007

Last month, more than 10,000 Tennesseans celebrated National Children's Mental Health Week to create awareness about children's mental health and to advocate for a coordinated system of care to meet the needs of children with mental health problems and their families.

Mental health problems seriously affect the thoughts, body, feelings and behavior of one out of 10 children, or about 140,000 children in Tennessee. Children and youth from low-income households are at increased risk for mental health problems. Mental health problems can be severe and lead to school failure, loss of friends, family problems and disruptions, out-of-home placements, and involvement in the juvenile justice system.

Youths with mental health problems are more likely to be absent from school, suspended or expelled, or drop out of school. In Tennessee, half the youths in custody and a vast majority in juvenile facilities have mental health problems; nearly half have substance abuse problems. Suicide is the third-leading cause of death ages 15-25. Two out of three children with serious mental health problems are not getting the services and supports needed to recover.

Tennessee's public service delivery system for children's mental health is fragmented, too often inaccessible and inadequate. The system especially fails young adults transitioning to the adult system.

Through the efforts of the state Department of Mental Health and Developmental Disabilities, Centerstone, Vanderbilt and Tennessee Voices for Children, system-of-care projects have shown that providing a comprehensive, coordinated system of care that is family-driven and youth-guided results in positive outcomes for children and families.

Culturally competent services provided include parent education and support, leadership training, parent support groups, in-home behavioral support, evaluations and assessments, interagency services for children, peer mentoring, child-care resources, special-education advocacy and respite care.

With this system, the goals of successfully keeping children with serious emotional disturbance in the homes, their communities and in their local schools have been met for hundreds of Tennessee kids. However, this represents only a fraction of children needing this interagency coordination, family support and individualized services.

Senate Joint Resolution 799, passed unanimously by the House and Senate and signed by the governor, directs the Select Committee on Children and Youth to study the children's mental health system and develop recommendations by April 1, 2008. Core partners include legislators, the state Mental Health Department, Tennessee Commission on Children and Youth, Governor's Office of Children's Care Coordination, state departments of Children's Services and Education, TVC, families, providers, advocates and the state Comptroller's Office.

Families are again hopeful we, as a state, will do the right thing and put in place a coordinated system for children with mental-health problems. Read more!

Mental health, on hold for 9 months? -Minneapolis-St Paul Star Tribune

For women with depression, the question of meds during pregnancy is complicated and personal.

By Maura Lerner, Star Tribune
June 28, 2007

Since she was a teenager, Linda had struggled with major depression. As a married woman in her 30s, she thought about having a baby, and on her obstetrician's advice, stopped her medication.

And she started spiralling down fast.

Within two months, she said, "I was so depressed that I didn't even want a baby anymore."

For many women like Linda, who asked that her last name not be used, the combination of depression and pregnancy can create a delicate balancing act. Many worry that taking antidepressants may harm their fetus. Yet untreated depression also can pose a danger to both mother and fetus.

So far, medical science has offered no clearcut answers. And two new studies being released today are unlikely to end the debate.

The studies, published in the New England Journal of Medicine, found that taking antidepressants during the first trimester of pregnancy may slightly increase the risk of some rare birth defects, including deformities of the skull and brain.

At the same time, the authors concluded that the risks were quite small, and might be explained by chance. Experts caution women against stopping treatment, because the risks of depression may outweigh those of the medication.

"If you do the math ... the absolute risk of even these rare defects is quite low," said Dr. Helen Kim, director of the Women's Mental Health Program at Hennepin County Medical Center in Minneapolis.

The two national studies were designed to find out if a class of drugs, known as SSRIs (selective serotonin-reuptake inhibitors) poses a risk to developing fetuses early in pregnancy. They were prompted, in part, by a 2005 study suggesting that one such drug, Paxil, increased the rate of heart defects from about 1 percent to 2 percent.

Researchers in Atlanta and Boston reviewed the records of thousands of infants, including those whose mothers took antidepressants early in pregnancy. They found no clear pattern of birth defects associated with SSRIs as a whole.

Yet one study found slight increases in three types of birth defects, affecting development of the skull, brain and intestines. The other study found a small rise in heart and intestinal problems with specific drugs. Both said more study is needed.

A fine balance

To some, the results were good news.

"I think this data is reassuring," said Dr. Katherine Moore, a psychiatrist at the Mayo Clinic in Rochester. She said Mayo's own studies have found no increase in heart defects among babies born to women on antidepressants.

But to some women, even small risks are unbearable. "The patients are always concerned about it," said Dr. Andrea Flom, an Edina obstetrician and vice chair of the state chapter of the American College of OBGYNs. "Some people won't even take Tylenol during pregnancy."

For doctors, too, what seems acceptable has shifted over time. At one point, they generally shied away from giving antidepressants to pregnant women, said Kim, a psychiatrist who specializes in treating depression during pregnancy. But in the last five years that's changed, she said, because of growing concerns that "depression itself carries risk during pregnancy."

Kim said about 10 to 15 percent of pregnant women experience depression, and many of those will go on to experience postpartum depression.

Experts say depressed women are less likely to take care of themselves, get prenatal care, sleep well or exercise; and more likely to engage in reckless behavior, such as illicit drug use. The mother's stress hormones can affect the developing fetus as well. And of course, there's the ultimate danger of suicide.

"The belief used to be 'We'll take them off meds, they'll be fine during pregnancy,' but in fact that's not true," said Deb Rich, a psychologist at Fairview Health Services in Minneapolis. "I have women who, a month into being off medications, are hardly functioning."

Flom, as an obstetrician, says she'd be reluctant to recommend stopping antidepressants, especially in a woman with a long history of depression. But if a woman has mild symptoms, and hasn't started on antidepressants, she said she might encourage alternatives such as psychotherapy. "I will probably try to hold them off if I can until the end of the first trimester," she said.

Sometimes, the women themselves insist on toughing it out until the baby is born.

Linda, who lives in a Twin Cities suburb, wasn't one of them.

After her depression returned, she decided to go back on antidepressants. And she switched to another doctor who supported her decision. Now she and her husband have a healthy son, born just over a year ago. And she has no regrets about taking the medication during her pregnancy.

"If you're so depressed that you're not taking care of yourself, then that's going to hurt the baby," she said. "And it's probably going to hurt the baby more than if you were on an SSRI."

Maura Lerner • 612-673-7384 • mlerner@startribune.com Read more!

Report details recommendation on children's health in Rockland -Westchester (NY) Journal News

By JANE LERNER
June 27, 2007

NEW CITY - Lack of services for children with psychiatric conditions is one of the most glaring gaps in health care for Rockland youngsters, according to a report by a local lawmaker yesterday.

"While the state of New York is a national leader in the delivery of services to children with mental retardation and developmental disabilities, it is ironic that services for children with depression, diagnosed psychoses, behavioral problems, addictions and other mental impairments are sorely lacking," the report said. "A significant contributing factor for this shortfall is the general lack of coordination between agencies in the state that provide mental health services for children."

The report, titled "A Vision for the Children of New York State," was done by Harriet Cornell, chairwoman of the Rockland Legislature.

Cornell held three public hearings last year during which she solicited opinions and information about issues related to the physical and mental health of children in Rockland. She also looked at services offered by state and local agencies to Rockland residents.

The hearings focused on such topics as prenatal and postnatal care, mental and behavioral health and nutrition and physical activity.

"The single most important conclusion of our report is that children are not small adults and face health-care issues that are unique and complex," Cornell said.

One of the most striking issues to come out of the hearings is the lack of mental-health services for children, Cornell said.

Many of the problems experienced by Rockland parents stem from lack of coordination of services.

New City resident Marlene Becker agreed.

She recalled spending years trying to get help for a child with mental illness.

"The most difficult thing at the time was that there was no single point of access," she recalled. "If you heard through word-of-mouth where to go, you were lucky. If not, you were left in the lurch."

Grass-roots organizations and parent support groups have made it easier to share information, but much more could be done to improve the quality of care that mentally ill children and their families receive, she said.

Many people who spoke at a meeting called by Cornell yesterday at the county office building said they agreed that more needed to be done to address mental health needs of children.

"Mental disorders in children are real and common and treatable," said Karen Oates, president of the Mental Health Association of Rockland.

Some services are available, but county and state agencies need to do a better job of working together, said Mary Ann Walsh-Tozer, Rockland County commissioner of mental health.

"There has to be a transformation in our system of care," she said. "We must put an end to the fragmented care of individuals."

Mary Jean Marsico, assistant superintendent for special student services at the Rockland Board of Cooperative Educational Services, said research into brain function was helping to improve treatment.

"Neuroscience has opened the door," she said.

The report highlights other areas where improvements to children's health could be made:

- Removing barriers for high-risk women who need prenatal care by making it easier for them to enroll in health insurance programs.

- Improving health-promotion and disease-prevention programs and using community education to promote better nutrition and more physical activity.

- Focusing on dental care for children. Rockland obstetricians and pediatricians should speak with families about dental health in children.

- Mandating better coordination among the offices of Mental Retardation and Developmental Disabilities; Mental Health; and Alcohol and Substance Abuse. The Inter-Office Coordinating Council should meet regularly.

Cornell presented a copy of the report to Lori Hall Armstrong, one of Gov. Eliot Spitzer's representatives. Armstrong said she would share the report with the governor.
Reach Jane Lerner at jlerner@lohud.com or 845-578-2458.
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Here's the truth about EMTs handling mental health patients -Barre Montpelier (VT) Times Argus

Letter: June 27, 2007

By Anne Donahue

The comments (letter of June 19) of the local EMT regarding emergency care of those with mental illness was a sad reflection of inadequate training. Fortunately, I know directly of many other emergency personnel who share in recognizing that mental illness in its acute phases is an illness that needs the expertise of medical personnel, including EMTs, and that individuals suffering from them should not be transported by sheriffs as though they were criminals unless it is necessary for safety.

The writer has his direct facts wrong.

He alleges that dangerous patients are now being dumped on local ambulance services without regard to safety of the EMTs, a subversive change from what he sees as appropriate shackling of ill persons.

Statutory changes were made in 2004, and refined in 2006, based upon recognition that some involuntary patients were not a safety risk to transport in a less traumatic ways than the use of leg irons, waist chains and handcuffs that traditional sheriff transport required.

Those changes, however, do not remotely resemble what the writer alleges.

First, the statute requires that while the transportation to inpatient settings use the least restrictive method of transportation that is necessary for the safety of the patient, it also requires that transportation protocols be "reasonable and appropriate measures consistent with public safety" (18 VSA 7511.) Patients at risk of injuring others, or themselves (by jumping out the ambulance door, the writer suggests, when strapped to a gurney and under the direct care of the treating EMT, as every type of patient already is?) are still always transported by sheriff.

In fact, the protocols established by the Department of Health in 2006 establish three options, depending on the level of safety needs: a) transport by a mental health staff person; b) transport by ambulance accompanied by a mental health specialist; or c) transport by sheriff. None of those options resemble the alleged "duping" of EMTs to have them unknowingly transport potentially violent ill patients. The protocols require an extensive assessment of any risk factors.

Statistics are maintained of all such transports. The fact is that last year, 100 percent of the nine transports from Central Vermont Medical Center to another hospital, and 25 of the 29 transports from the community to a hospital were done by a sheriff, a similar figure to 2004, when 32 persons from Washington County were transported by sheriff. The four other patients in 2006 are the total number that represent the "change from the past," and they include those transported by Washington County Mental Health staff; only one was by ambulance.

Interestingly, this is an area in which Washington County and most of Vermont is backward compared to many other states. Massachusetts uses ambulance only for all emergency mental health transportation; in Pennsylvania the law bans the use of metal restraints for such transports; in Florida, most transports are done by civilians with ambulance or law enforcement if needed as back-up; in New Hampshire, law enforcement is available as "back-up."

Most telling is what happens in Bennington County. Perhaps the air is different there.

All transports from the emergency room at Southwestern Medical Center (which has no psychiatric inpatient service) are by ambulance. All of them. One hundred percent. If security is an issue, a sheriff rides along.

The introductory training for ambulance service staff from the Office of Emergency Services is 120 hours. Three of those hours address mental health. A 2004 report from the Division of Mental Health noted a need to increase the mental health component. The slow move to a society that recognizes that mental health is a part of health requires more comprehensive training.

The numbers are similar in training of corrections staff and for law enforcement. Police officer training has traditionally included one day on mental health response out of six weeks of training, despite the fact that police are the most frequent "first responders" to such crises. There is now an excellent initiative through the law enforcement Training Council to enhance training opportunities.

It is often inadequate training that leads to comments such as those in the June 19 letter, or to debates such as in Montpelier, where police argue that Taser guns are necessary tools, often to de-escalate mental health crises that could be "talked through" with the right training. Tasers, a risky and painful alternative, is a "quick fix" substitute that reflects sadly on our social priorities.

In 2001, in an earlier phase of my recovery from my own mental illness, I was the subject of a 911 response in Barre, but took off on foot. Somewhere around 12:30 a.m., a local police officer spotted me. He took advantage of my confused and distraught condition to convince me that the only way he could help me make a phone call was to offer me a ride to Central Vermont Medical Center, which I accepted. Once there, I agreed to voluntary hospitalization. If hospitalization had been presented as the true reason for the ride, I would have refused it.

I am forever grateful to that officer's sensitivity and skill; without it, I, too, may have ended up temporarily committed against my will and therefore transported — as the June 19 letter writer would have preferred — by local sheriff in shackles. That outcome would not have been helpful either for my mental health, for the long-term costs to our medical system for my medical care and recovery, or for society as a whole.

Rep. Anne Donahue is a Republican who represents the town of Northfield.
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Mental health makes the switch - Morganton News Herald

By Heather Sanders
June 28, 2007

After today, Burke County will have officially switched from the Foothills Area Program to the Mental Health Services of Catawba County.

The switch has gone relatively smoothly, with no real obstacles beyond the amount of work going into it, said Catawba Area Director John Hardy.

“I feel very encouraged about the response from Burke County,” Hardy said.
He said the program has tried to anticipate issues, but fully expects unforeseen problems to come up in the switch.

The program has already made contact with the service providers in Burke County, many of whom people saw under Foothills.
“I really don’t see any change here at all,” Hardy said.
He said they are setting up a connection for emergency services with Grace Hospital and the 911 system.

For other issues, Hardy said the program will compromise between Catawba and Burke counties.

For instance, the Consumer Family Advisory board will meet in Valdese because it works as a midpoint between Morganton and Hickory, Hardy said.

County Commissioner Maynard Taylor will sit on Catawba’s board, along with two residents of Burke County, appointed by the commissioners.

Taylor said the county will be part of both Foothills and Catawba for a period of time during the switch before moving completely to Catawba.
He said Burke County residents shouldn’t worry about their services, and if they do have concerns, to contact him or the other commissioners.
“All the ones who need service in Burke County will be tended to,” Taylor said. “The reason (for the switch) was to offer better service. I wouldn’t have voted for it otherwise.”

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Mental health parity should be approved - Greensboro News-Record

The stigma of mental illness can prevent people who need psychiatric help from getting it. They're even less likely to seek treatment if their insurance doesn't pay for care or leaves them in a financial bind.

Legislation requiring equal treatment from insurance companies for mental and physical illness appears headed for approval in the General Assembly. This week, a committee passed on to the full Senate a parity bill. In May, the House, with only one dissenting vote, approved a somewhat different version.

Parity in coverage should encourage more North Carolinians to seek treatment for mental disorders. By getting the help they need, there's a better chance they can return to productive lives. And timely access to private care at home eases the costly drain on a faltering state mental health system.

It comes down to a matter of fairness. Mental health advocates argue convincingly that insurance providers should cover patients with major depression, for example, just as they do someone with heart disease.

The push to erase such inequities is gathering momentum. According to the National Conference of State Legislatures, 34 states already have passed such legislation. A similar bill awaits congressional debate. Not to be overlooked, N.C. state employee health plans already require equal coverage for mental and physical illness.

In the past, insurance companies warned that parity-related higher costs would curtail coverage. However, that hasn't occurred in states with equal treatment laws. Only a few companies dropped coverage, and cost increases were minimal.

With that in mind, insurers now are more open to covering mental health care. In fact, the state's largest private health insurer, Blue Cross and Blue Shield of North Carolina, suggested the version of the bill approved by the Senate committee.

Yet there are shortcomings. There's a glaring lack of coverage for treatment of alcoholism and drug abuse. That should be addressed because those conditions often are associated with mental disorders.

Also unresolved is whether businesses with fewer than 25 employees must comply. The fear is that expanded coverage would be too expensive for small businesses. But where there's parity, that hasn't happened. A stronger case can be made that employees shouldn't be penalized just because they work for smaller companies.

What has emerged isn't perfect, but it is a giant step toward more equitable insurance coverage. For many people, mental health care will become more affordable and accessible. Once it's on the books, there will be plenty of time to fine-tune progressive legislation.
Read more!

One More Snag - Winston-Salem Journal

June 28, 2007

Clients of a major provider of mental-health care in Winston-Salem got a break last week with the news that the provider, which had been planning to shut its doors, found a way to stay open. But the troubles with this state's mental-health system are far from over, and it's past time for North Carolina to get serious about fixing the system.

Disability Advocacy and Information Services (DAIS), which opened just five years ago, was planning to shut down until a Cumberland County mental-health agency said that it's buying DAIS. That ended several days of what must have been high anxiety for the clients of DAIS and for its employees. But that, unfortunately, is the topsy-turvy nature of this state's flawed mental-health system.

Many of the current problems were caused by the state's misguided overhaul of its mental-health system. The plan to move thousands of patients from state psychiatric hospitals to private community programs failed because the state didn't provide enough money for the switch and moved too fast in its reform efforts.

"One of the main problems you have in the system right now is a lack of providers," Sen. Martin Nesbitt of Buncombe County told the Journal's M. Paul Jackson. "We have run them off."

Indeed. And such agencies as DAIS are crucial. DAIS is a private company that provides community-support and other services to more than 400 patients. Its shutdown would have left families of those with mental-health problems scrambling to find help. DAIS's patients would have strained already overloaded social-service agencies.

And it would have been the second major mental-health care provider in the area to shut down in the last two years. HopeRidge Centers for Behavioral Health closed because of financial troubles in 2005.

Officials at CenterPoint Human Services, which oversees DAIS and other area mental-health agencies, told the Journal's M. Paul Jackson that "unpredictable mental-health system changes," delayed state reimbursements and a recent cut in Medicaid payments were behind the DAIS decision to close. The N.C. Department of Health and Human Services cut the Medicaid reimbursement rate to community-support services by 13 percent in April because some agencies over-billed.

DAIS, which was purchased by Mid-State Health Systems and will be renamed for that company, is spared, at least for now, as are its staff and patients. But DAIS, just as other mental-health-care providers, must continue to struggle with a flawed system as the state "reforms its reform."

It needs to move a lot faster at that job


Read more!

Psychiatrists Top List in Drug Maker Gifts The New York Times

By GARDINER HARRIS
June 27, 2007

As states begin to require that drug companies disclose their payments to doctors for lectures and other services, a pattern has emerged: psychiatrists earn more money from drug makers than doctors in any other specialty.

How this money may be influencing psychiatrists and other doctors has become one of the most contentious issues in health care. For instance, the more psychiatrists have earned from drug makers, the more they have prescribed a new class of powerful medicines known as atypical antipsychotics to children, for whom the drugs are especially risky and mostly unapproved.

Vermont officials disclosed Tuesday that drug company payments to psychiatrists in the state more than doubled last year, to an average of $45,692 each from $20,835 in 2005. Antipsychotic medicines are among the largest expenses for the state’s Medicaid program.

Over all last year, drug makers spent $2.25 million on marketing payments, fees and travel expenses to Vermont doctors, hospitals and universities, a 2.3 percent increase over the prior year, the state said.

The number most likely represents a small fraction of drug makers’ total marketing expenditures to doctors since it does not include the costs of free drug samples or the salaries of sales representatives and their staff members. According to their income statements, drug makers generally spend twice as much to market drugs as they do to research them.

“For the fourth year in a row, our analysis shows that there is a great deal of money being spent in our small state on marketing pharmaceutical products,” said William H. Sorrell, the Vermont attorney general.

Endocrinologists received the second largest amount, according to the Vermont analysis, earning an average of $33,730. Since the state identified the specialties of only the top 100 earners, these averages represent the money earned by only some of the state’s specialists. There were 11 psychiatrists and 5 endocrinologists in that top group of 100.

Still, a similar pattern was evident in a Minnesota database that was the subject of a series of articles in The New York Times this year. As in Vermont, psychiatrists earned on aggregate the most in Minnesota, with payments ranging from $51 to $689,000. The Times found that psychiatrists who took the most money from makers of antipsychotic drugs tended to prescribe the drugs to children the most often.

These and other stories have helped to fuel a growing interest among state and federal officials to document and restrict payments to doctors from drug makers. At a gathering last month at Columbia Law School in New York, state attorneys general from across the country discussed ways to get similar data for their states.

And today, the Senate Special Committee on Aging, which is led by Senator Herb Kohl, Democrat of Wisconsin, will hold the first of a series of hearings on the issue, which could lead to legislative proposals to restrict and require disclosure of payments and gifts to doctors from drug companies nationwide.

Several lawmakers on Capitol Hill have expressed interest in such legislation, including Senator Charles E. Grassley, Republican of Iowa. “A federal law requiring public disclosure of payments to doctors could be very effective if it was carefully monitored and consistently applied,” Mr. Grassley said.

Efforts to require disclosure of payments to doctors began almost by happenstance in 1993, when The Minnesota Legislature passed a law that restricts drug companies from giving doctors gifts valued at more than $100 in any given year. The legislation also required companies to report and make public any consulting fees paid to doctors.

Lee Greenfield, a former state representative in Minnesota and one of the law’s authors, said it passed with little fanfare or debate after legislators heard stories about doctors accepting gifts of great value from drug makers.

“Why do we want them bribing doctors to use what may not be the best or most cost-effective drug for the patient purely to get some hand-held TV, we all asked,” Mr. Greenfield said.

Still, compliance with the law has been spotty. Some companies never responded to the board’s requests for disclosures. Others did so fitfully. A few sent letters saying they did not collect that information and thus could not provide it.

Minnesota officials never cracked down. Such reports were put in file drawers and largely forgotten until this past year, said Cody Wiberg, executive director of the Minnesota Board of Pharmacy. Mr. Wiberg said he planned this year to pursue companies that fail to report.

Besides Vermont and Maine, more than a dozen other states have or are now considering similar legislation, said Sharon Anglin Treat, executive director of the National Legislative Association on Prescription Drug Prices.

Officials in Maine and Vermont said they would try to compare reports of payments to doctors with Medicaid records to explore how marketing practices might influence prescribing by doctors in ways that increased costs to taxpayers.

“What we want to be able to do is overlay the prescribing information that we have with the drug detailing information,” said Jude Walsh, special assistant to the governor of Maine, John E. Baldacci. “If we see that doctors in a certain southern county in the state are prescribing a lot of a drug and getting a lot of detailing for that drug, that could lead to some record reviews to see what’s happening.”

Read more!

New Survey Links Mental Health Issues in the Workplace to Higher Indirect Company Costs - PRweb.com

A new national survey is underscoring the growing concern over mental health issues in the workplace and the critical need for employee assistance programs, or EAPs, and other services that address mental health head-on. Based on a recent May 31st survey of more than 500 company representatives across the United States, mental health ranked as the number one health issue requiring the highest indirect costs among employers, beating the second-ranked concern of back problems by more than two to one.

Industry experts say the survey results, released by the Partnership for Workplace Mental Health and Employee Benefit News, reflect the growing awareness that unresolved mental health problems can sour working relations, dampen productivity and increase absenteeism among a company's most valuable resource - its employees.

"An unresolved mental health problem that affects an employee's job performance can quickly become everyone's problem and ultimately hurt a company's bottom line," said Dr. Robert Mines, CEO of the national employee assistance provider MINES and Associates (http://www.minesandassociates.com). Dr. Mines, a licensed psychologist, added, "Fortunately, more and more employers are now recognizing the importance of early and effective intervention and the long-term dividends of employee assistance programs and other on-the-job mental health services."

For industry leaders such as MINES and Associates, such intervention means an easily accessible EAP that features conflict resolution, short-term counseling or referral, crisis intervention, a 24-hour emergency service and after-care follow-up. In addition, MINES' managed mental health care service includes all assessments, referrals, authorizations and treatment monitoring, whereas its behavioral risk management can identify and address behavioral risks before they boil over and become disruptive physical or mental health problems.

With an extensive array of services available to employers and their employees, Dr. Mines stressed that education and sensitivity remain key parts of the equation. "Employees who are experiencing mental health problems need to know what their options are," he said. "Educating them and allaying their fears of being stigmatized or having their privacy invaded can do wonders for getting early and effective help to those who need it most." According to the survey results, for example, 80 percent of employers said they believe their workers don't seek help for mental health problems because of the associated shame and stigma of a diagnosis, while many cited privacy concerns and a lack of awareness about the seriousness of the issue or about treatment options as other deterrents.

When accessed, however, such services can dramatically lower the indirect costs of diminished employee productivity and increased absenteeism, a result in line with recent studies that suggest productivity rises as the stress levels and health problems of employees go down. Through an EAP, in fact, organizations can realize returns on their investments ranging from $8 to $20 for every dollar spent. Early intervention that helps solve employee or member problems reduces additional long-term costs by providing savings in the recruitment, training and retention of valued employees.

In February, MINES introduced telephonic coaching and consultation to its already extensive list of employee assistance programs and services, allowing employees and families belonging to any of MINES' client organizations to access EAP for confidential, one-on-one coaching sessions over the telephone. Trained professionals can help employees deal with topics ranging from conflict resolution and relationships to stress and even personal goals such as weight loss or smoking cessation. Together, the comprehensive array of tools focusing on the mental health and overall wellbeing of company employees can help people move forward with their lives, develop additional skills and enhance working relationships - positive steps for the continued health of any company.

The conclusions of this new survey suggests that as the list of success stories and new corporate strategies, such as EAP, continue to grow "companies large and small will recognize the value of investing in their employees' mental health." For more information on employee assistance programs and any of the other health and organizational psychology programs that MINES and Associates has to offer please log on to http://www.minesandassociates.com or contact Judy Braun at 1-800-873-7138 extension 4980.





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Coroner's Report: Jeni Was Mentally Ill - The Associated Press

LOS ANGELES (AP) -- Comedian Richard Jeni, who shot himself to death in March, had a history of mental illness and was hospitalized late last year for suicidal depression, according to a coroner's report obtained Thursday. Jeni, 49, died at a hospital after shooting himself in the head at his Hollywood home on March 10, authorities have said.

His girlfriend heard him talking to himself about a week earlier, saying '''just squeeze the trigger,''' according to a police report cited by the Los Angeles County coroner's office.

She was making breakfast downstairs when Jeni shot himself in the mouth with a .38-caliber Colt Detective Special handgun, according to the report.

Jeni, whose birth name was Richard John Colangelo, had not made any previous suicide attempts and left no note, the report said.

However, the report said Jeni was involuntarily hospitalized on Dec. 28 after he showed up in a hospital emergency room with suicidal depression and indicated he would jump off of a building.

Days after his death, Jeni's family disclosed the comic was mentally ill and said in a statement that he had been diagnosed earlier this year with ''severe clinical depression coupled with bouts of psychotic paranoia.''

According to the coroner's report, Jeni's girlfriend said he had problems with ''insomnia, paranoia and high blood pressure due to stresses of his work schedule.''

He also had a history of schizophrenia and had taken several antidepressants and a sleeping aid, the coroner's report said.


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Execution of Schizophrenic Killer Blocked By High Court - Washington Post

By Charles Lane

The Supreme Court yesterday blocked the execution of a schizophrenic Texas death-row inmate in a ruling that may allow more mentally ill condemned prisoners to contest their death sentences.

The court ruled in 1976 that it is unconstitutional to execute an insane prisoner, but since then no death-row inmate has succeeded in overturning a death sentence based on mental illness. Yesterday's ruling removed one obstacle to such claims: the fact that a prisoner's disorder might not become evident until after the deadline for raising constitutional appeals has passed.

By a vote of 5 to 4, the court said the law does not bar consideration of convicted murderer Scott Louis Panetti's claim that he is too delusional to understand the state's reasons for planning to put him to death, even though Panetti waited until his execution date was set in 2003 to raise it.

Requiring prisoners to meet the deadline would effectively require every inmate to lodge an "unripe" insanity claim just to preserve the option, Justice Anthony M. Kennedy wrote for the majority.

The court also held that the U.S. Court of Appeals for the 5th Circuit, the New Orleans-based federal court that regulates capital punishment in Texas, used an overly restrictive definition of mental incompetence when it rejected Panetti's claim. Panetti, who has a history of hospitalizations, says he knows that the state says it wants him to die for the 1992 murder of his mother-in-law and father-in-law. But he insists that the real reason is to prevent him from preaching the gospel.

The State of Texas suggested that Panetti met the requirement of the court's 1976 ruling, derived from then-Justice Lewis F. Powell's opinion that only those mentally sound enough to be "aware" of the reasons for their execution may be put to death.

But Kennedy ordered the case sent back to a federal district court to determine whether Panetti has no "rational understanding" of the connection between his acts and his execution

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Governor, show a little care for the mentally ill - The Los Angeles Times

By Steve Lopez

Hey, Gov. Schwarzenegger, it's been too long since our last cigar. You busy the next few days?

Yeah, I know. You're always busy in budget season.

But that's all the more reason for us to get together. If you can squeeze it in, I'd like to introduce you to a few people who have caught some tragically tough breaks in life and now face the possibility of another: a $55-million budget cut by you.

Sure, you've got a tough job and can't keep everybody happy, especially with your own party leaders yapping and barking for even deeper cuts. But the cut I'm talking about is heartless and idiotic, with all due respect. I'm talking about your proposed strangulation of the AB 2034 program, which provides 5,000 Californians with everything from lunch to counseling to housing.

Who are they?

They're castoffs who have lived under bridges and on sidewalks; people who have been beaten down, locked up and, finally, rescued. The thing they have in common is that they were struck down through no fault of their own. They're all mentally ill.

Before we light our smokes, I'll take you to meet Alan Guthrie, 48, who was once stabbed at 5th and San Pedro on skid row in L.A. Now he lives in supportive housing at the Lamp Community and says he has never had the combination of housing, counseling and other services he gets under AB 2034. He hopes he doesn't end up back out on the street because of a certain governor's knife work.

Then there's Charles Jordan, 51, another Lamp client whose AB 2034 benefits include an apartment at the Ballington on Wall Street. And by the way, governor, Jordan said he'd be happy to show you his apartment, share the story of all his hard knocks on the streets and tell you about the comfort he finally found when he was steered inside by Lamp outreach workers.

Yes, I know your argument for cutting the program. You say some of the same services are provided by Proposition 63, which was approved by voters in 2004 and taxes the wealthy to pay for mental health services.

But that's nonsense, and you know it. That money wasn't meant to give the state license to slash existing programs. It was for expanded services and for all the urgent needs unmet after decades of shameful under-funding, beginning with the shutdown of state hospitals.

"It would be plainly illegal" to eliminate AB 2034 funding because Prop. 63 is in place, says state Sen. Darrell Steinberg, who is fighting to keep the funding in the budget legislators hope to send to the governor any day now. Steinberg, of Sacramento, said a cut would subvert the will of the people who voted for Prop. 63, and he predicts legal challenges.

Do you want that, governor? Do you want to get sued for eliminating a program that has rescued so many lives and been imitated around the country?

Lamp Director Casey Horan calls AB 2034 "hands down the most effective" program for bringing people in off the streets and restoring their dignity. She says the program has led to huge reductions in incarceration and hospitalization. So AB 2034 reduces other expenses, and it also makes it possible to leverage private and nonprofit investment in more housing.

There's a great example of how it all works at a place called the Village, in Long Beach, which happens to be just a few blocks from the joint where you and I had our last cigar. Bring Maria too. I know she'll love what she sees. I'm happy to set up a tour, and this time the stogies are on me.


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High court spares mentally ill killer - The Los Angeles Times

By Henry Weinstein

The Supreme Court ruled Thursday that Texas could not execute a severely mentally ill man because he could not comprehend why he was going to be put to death.

The 5 to 4 ruling, written by Justice Anthony M. Kennedy, spared the life of Scott Louis Panetti, 49, who murdered his former in-laws in 1992 after battling mental health problems for years.

Panetti has been on death row in Texas since 1995 and has been diagnosed as schizophrenic.

Both Panetti's lawyers and attorneys for the state said he was mentally disturbed. The question was whether he was sufficiently mentally ill that his execution would violate the 8th Amendment's bar against cruel and unusual punishment.

Panetti was hospitalized for mental illness 14 times in the decade before using a shotgun to kill his former in-laws in the Texas hill country town of Fredericksburg, as his estranged wife Sonja and her child watched.

During Panetti's trial, he exhibited bizarre behavior, wearing a purple cowboy suit and 10-gallon hat and subpoenaing President Kennedy, Pope John Paul II and Jesus Christ as witnesses.

Panetti was ruled mentally competent to stand trial, mentally competent to represent himself and mentally competent to be executed. Before Thursday's decision, four courts, including the U.S. 5th Circuit Court of Appeals, rejected Panetti's lawyers' pleas to spare his life.

The Supreme Court sent the case back to a federal judge in Austin to reassess Panetti's mental health in light of the decision issued Thursday. Ted Cruz, the Texas solicitor general, said he would continue to press for Panetti's execution.

The case presented a particularly thorny question because evidence was introduced that Panetti was aware that he had killed Amanda and Joe Alvarado. But expert testimony was presented that Panetti, known as "the preacher" on Texas' death row, believed he was going to be executed because Texas was conspiring with the devil to block him from preaching the Gospel to fellow inmates — not because he murdered the Alvarados.

At an oral argument in April, Cruz asserted that Panetti was capable of understanding the connection between his crime and his punishment and was exaggerating his delusions.

But defense lawyer Gregory Wiercioch, of the Texas Defender Service, told the justices that Panetti did not rationally understand why he was to be executed. Consequently, Wiercioch said, killing Panetti would serve no legitimate retributive purpose.

That view eventually prevailed. The high court majority ruled that the 5th Circuit's standard for determining incompetence was too restrictive to provide Panetti the protections he was entitled to under the 8th Amendment.

Writing for the majority, Kennedy rejected the position taken by Cruz and the 5th Circuit, that Panetti's delusions were irrelevant as long as he was aware that Texas had made a link between his crime and the punishment.

"This test ignores the possibility that even if such awareness exists, gross delusions stemming from a severe mental disorder may put that awareness in a context so far removed from reality that the punishment can serve no purpose," Kennedy wrote.

Kennedy also found that execution would be inconsistent with a 1986 Supreme Court decision, Ford vs. Wainwright, which ruled that a person may not be put to death if he cannot perceive "the connection between his crime and his punishment."

Kennedy was joined by the court's moderate and liberal justices — John Paul Stevens, David H. Souter, Ruth Bader Ginsburg and Stephen G. Breyer.

Dissenting was Justice Clarence Thomas, joined by Chief Justice John G. Roberts Jr. and justices Antonin Scalia and Samuel A. Alito Jr.

Thomas' opinion illustrated the deep divide on the high court in death penalty cases. He said that the court should not even have considered the case because Panetti did not meet the standards set by a 1996 law to have his petition considered.

"Ignoring this clear statutory mandate, the court bends over backward to allow Panetti to bring" his mental illness claim "despite no evidence that his condition has worsened — or even changed — since 1995. Along the way, the court improperly refuses to defer" to a state court finding that Panetti was competent to be executed "even though Panetti had the opportunity to submit evidence and to respond to" a courtappointed experts' report on his condition.

Kennedy countered that the procedures the state court provided to Panetti "were so deficient that they cannot be reconciled with any reasonable interpretation of the Ford rule."

Still, Kennedy acknowledged that "a concept like rational understanding is difficult to define" and made it clear that not all condemned inmates with irrational thoughts would become the beneficiaries of the ruling.

"Someone who is condemned to death for an atrocious murder may be so callous as to be unrepentant; so self-centered and devoid of compassion as to lack all sense of guilt; so adept in transferring blame to others as to be considered … to be out of touch with reality," Kennedy wrote describing the types of individuals who could not utilize the decision.

The Supreme Court decision was hailed by the National Alliance on Mental Illness, which submitted a friend-of-the-court brief, along with the American Psychological Assn. and the American Psychiatric Assn.

"For once, law has caught up with medical science," said Ronald S. Honberg, NAMI's director of policy and legal affairs.

"The circumstances of this case are tragic, and no one minimizes the gravity of the crime or the suffering of the victims. However, execution of someone who is profoundly ill would only compound the original tragedy and represent a profound injustice for us all."


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Antidepressant-birth defect risk small - Associated Press

June 27, 2007

BOSTON, Massachusetts (AP) -- Newborns face little risk of birth defects from antidepressants taken by many women early in pregnancy, say the reassuring findings of the two biggest studies of this controversial link.

The research focuses on the class of drugs chosen most often for depression and anxiety, including the brands Prozac, Paxil and Zoloft.

Paxil carries a warning of possible heart defects in newborns, and experts don't expect the new research to change that. However, they find the new studies comforting for women struggling with depression.

The possibility of birth defects from antidepressants has put doctors and patients in a tricky quandary. Birth defects obviously hurt newborns, but depressed mothers who can't give proper care also endanger their babies.

Confusing matters, researchers have wondered whether the concern about birth defects should extend beyond Paxil to this entire class of drugs, known as selective serotonin-reuptake inhibitors, or SSRIs. The two latest studies, appearing Thursday in The New England Journal of Medicine, relieve some of that worry, say birth specialists.

"Yeah, there's a risk, but the risk overall is probably pretty small," said Dr. Susan Ramin, obstetrics chairman at the University of Texas Medical School in Houston, who was familiar with the findings.

The two studies -- one from the federal Centers for Disease Control and the other from Boston University -- use more cases of birth defects than previous research to consider links between the abnormalities and SSRIs. The Boston University study was funded partly by the National Institutes of Health and Paxil maker GlaxoSmithKline PLC.

Together, the two studies looked at 19,471 newborns with birth defects and 9,952 without them. Then they considered what SSRIs the mothers in both groups took during the first three months of pregnancy and mapped the patterns of birth defects.

Neither study was able to tie SSRIs as a group to either heart defects or most other defects. That reassurance is especially welcome because depressed women fret even more than other mothers about the health of their newborns, said Dr. Stephan Quentzel, a psychiatrist who treats pregnant women at Beth Israel Medical Center in New York City.

Also, a mother's untreated depression can lead to poor care or turmoil at home, a weaker maternal bond, and other problems for a newborn. "The fetus and the newborn are almost always worse off if the mom is depressed than if ... exposed to the vast majority of antidepressants," Quentzel said.

However, doctors and mothers have been very wary about medications and birth defects since Europe's thalidomide scandal of deformed babies in the 1960s. Defects from all causes are expected in about 3 percent of births, enough to make many mothers nervous.

The concern about SSRIs grew out of GlaxoSmithKline's own alert in 2005 about possible heart defects in newborns whose mothers took Paxil early in pregnancy. The U.S. Food and Drug Administration added its own warning. Last year, a separate study linked SSRIs taken late in pregnancy to a lung disorder in newborns.

The latest studies do not consider that disorder, known as persistent pulmonary hypertension. But they suggest that the risk of other defects from an SSRI -- even if confirmed -- would add only a fraction of 1 percent to the overall danger, researchers said.

Paxil did appear to triple the risk of a defect in blood flow from the heart, both studies found. But that additional danger would still be modest, experts said.

The studies further hinted at possible ties between other SSRIs and a handful of other defects, but researchers said the numbers of newborns with specific defects were too small to draw strong conclusions.

"Based on these studies, it's correct to say: no major risk," said Carol Louik, a public health expert who led the Boston study. "I wouldn't say, 'No risk."'

Researchers said women should talk over the potential risks and benefits with their doctors, preferably before pregnancy.



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Iraq Vet Seeks Out the War's Hidden Wounded - NPR.com

By Joseph Shapiro

Mike Colson refers to himself as the "dog catcher for trauma." His job is to get traumatized veterans into care before it's too late.

All Things Considered, June 27, 2007 · Many troops returning from Afghanistan and Iraq will struggle with depression and post-traumatic stress disorder. Some will drink too much and use drugs. They'll lose jobs. They'll drive away friends, family, spouses and children. Most of them won't ask for help.

Mike Colson is a mental health counselor for the Department of Veteran's Affairs in Washington state. He believes that with the right medications and counseling, these veterans can learn to live and function while dealing with the mental health problems common to war. His job is to get traumatized veterans into care before it's too late. He jokingly refers to himself as the "dog catcher for trauma."

Colson drives his government-issued car hundreds of miles a day, from military base to military base. He tells scores of men and women just how hard it's likely to be — mentally and emotionally — to go back to civilian life when they have just come from the brutal chaos of war.

At a Navy base near Seattle, 60 sailors and Marines wait inside an auditorium. Before leaving the military, they have to sit through three days of departure briefings filled with information. They're already slumped in their chairs when Colson enters the auditorium, walking with a shadow of a limp. A tough-looking guy, with a shaved head and a dark suit, Colson knows he has one chance to reach the young men and women in the room. He might even save somebody's life.

"To be a warrior, is to be exceptional," Colson tells the group. "But it can come at an emotional cost."

Colson knows there is a stigma attached to asking for help in the military. So he knows he can't use the words "mental illness" or "post-traumatic stress disorder" until he tells them something about himself: He has PTSD.

"Do I look like I have post-traumatic stress?" he says. "Just look at me. What do you think? Why am I able to talk to you? Medicine. That's right, I take it every day. Am I a better person because of it? Yeah. Will I be better next month? I don't know. But I'm better today."

War Experiences Come Home

The Navy sent Colson to Afghanistan twice and Iraq twice as a chaplain. He counseled soldiers who had seen friends die and who struggled with their own nightmares. Colson himself was severely injured in a helicopter crash several years ago. He broke his back and had eight surgeries. When he came home, he was anxious and distant. He put carpet down in his garage and slept there, alone, at night. He was slow to see that these were signs of his own PTSD.

One day, a Navy psychiatrist noticed Colson's "thousand-mile stare" — the distracted and distant gaze that marks those dealing with PTSD.

"He saw it in my face," Colson recalls. "He read trauma like a book… And he saved me. And he medicated me. He took the anger away, he got me to sleep for the first time in a few years."

Now, when he helps others, he is also helping himself heal. But Colson knows recovery is fragile, for himself or anyone with PTSD. And he knows that no matter how many thousands of troops hear him speak, no matter how many he gives his e-mail and phone number to, there will be some he won't reach in time. It has happened in his own family, to his nephew, a Marine who returned home from Fallujah.

His nephew lived far away. Colson called, wrote and even made therapy appointments, but they went ignored. His nephew drank and withdrew. One night, alone in his father's house, his nephew shot himself and died.

In some ways, Colson feels responsible for his death.

"I was a suicide-prevention officer for the Navy, for God's sake," he says. "Let's be honest. I didn't save him. I failed. And that failure will haunt me. When I talk to my sister, it's there. When I walk into a family gathering, it's there."

Stigma Can Cost Lives

He thinks the bravado of military service prevented his nephew from seeking help. He says that in the military, "Readjustment issues, and concerns, and PTSD and that horrible word, you know, mental illness, that's something you never tell anyone and that stigma can cost people their lives."

At another Navy base, Colson gives his speech again. He hopes he will shock more sailors and Marines into getting care. As he speaks, he scans the young faces in the room. He sees a woman with a girlish face in the third row who is blinking back tears. He watches two men who don't laugh at his jokes, but he sees that they're listening — closely. As Colson packs up, the woman in tears and the two men who didn't laugh seek him out privately. Colson will get them appointments at the Vet Center and hope they show up.

When Colson gets to his office the next day, there are four more e-mails from others. It's a handful. But for Mike Colson, it's a start.



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Execution of Mentally Ill Killer Blocked - The Associated Press

WASHINGTON (AP) -- A divided Supreme Court on Thursday blocked the execution of a Texas killer whose lawyers argued that he should not be put to death because he is mentally ill.

The court ruled 5-4 in the case of Scott Louis Panetti, who shot his in-laws to death 15 years ago in front of his wife and young daughter.

The convicted murderer says that he suffers from a severe documented illness that is the source of gross delusions. ''This argument, we hold, should have been considered,'' said Justice Anthony Kennedy, who wrote the majority opinion.

Panetti's lawyers wanted the court to determine that people who cannot understand the connection between their crime and punishment because of mental illness may not be executed.

The Eighth Amendment of the Constitution bars ''the execution of a person who is so lacking in rational understanding that he cannot comprehend that he is being put to death because of the crime he was convicted of committing,'' they said in court papers.

In dissent, Justice Clarence Thomas said that Panetti had petitioned the federal courts twice in his case, but that the law allows only one petition.

''The court bends over backwards to allow Panetti'' to bring his current claim, despite no evidence that his condition has worsened, or even changed, since 1995, Thomas wrote.

One of Panetti's lawyers, Scott Hampton of Austin, Texas, said he was relieved.

''Executing Scott Panetti would have been a mindless, meaningless, miserable spectacle,'' said Hampton.

Siding with Kennedy in the majority were Justices John Paul Stevens, David Souter, Ruth Bader Ginsburg and Stephen Breyer.

Joining Thomas in dissent were Chief Justice John Roberts and Justices Antonin Scalia and Samuel Alito.

Texas said the court should reject Panetti's appeal on procedural grounds. But it also argued that the court should set a tougher standard for mental illness exceptions to capital punishment. Only if a Death Row inmate ''lacks the capacity to recognize that his punishment both is the result of his being convicted of capital murder and will cause his death'' should his execution be halted, the state said. Panetti is competent on that basis, it said.

The killings took place in September 1992.

A former ranch hand and native of Hayward, Wis., Panetti had a history of mental problems before his conviction, recording 14 hospital stays over 11 years.

Four courts have said he was competent when he fired his trial lawyers. A jury and two courts rejected his defense of not guilty by reason of insanity. He personally argued that only an insane person could prove the insanity defense, dressing in cowboy clothing and submitting an initial witness list that included Jesus Christ and John F. Kennedy.

Then-Justice Lewis Powell said 20 years ago that a person may not be put to death if he cannot perceive ''the connection between his crime and his punishment.''

The case is Panetti v. Quarterman, 06-6407.


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Senate to tackle mental health bill - Raleigh News and Observer

Lynn Bonner, Staff Writer

A state Senate committee vote puts the legislature closer to improving insurance coverage, but the House's version differs

Workers in North Carolina are as close as they have ever been to benefitting from mental health insurance coverage required in most other states.
Insurance companies would treat people with major depression and other mental illnesses the same as they do patients with heart disease and other physical ailments under a proposal that cleared an important hurdle Wednesday in the state legislature. A Senate committee unanimously endorsed a bill that would require equal treatment from insurance companies for mental and physical illnesses. The bill now goes to the full Senate.

Legislators have talked for years about a law that would require equal insurance coverage for mental and physical illnesses. The Senate approved a version of the mental health insurance requirement 10 years ago, but the House all but ignored the issue until this year.

Insurance companies in the past have objected to expanding coverage because they said it would cost too much. But Blue Cross and Blue Shield of North Carolina, the state's largest private health insurer, worked on the measure this year and suggested the version of the bill that the Senate Health Care Committee approved.

Most of the arguments about increased costs now come from business lobbyists who say that expanded coverage would lead small businesses to drop health insurance plans.

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 1 percent of companies dropped coverage, and spending by Blue Cross and Blue Shield of Vermont increased 19 cents per month for each person enrolled.

Currently, few private insurance policies for North Carolina workers cover mental illnesses for more than short periods, and they often impose a lifetime cap that can be reached with just one hospitalization. Supporters say that expanding private insurance coverage would help working people and their families receive proper treatment.

The state ends up paying to treat or hospitalize workers with inadequate mental health insurance when they lose their jobs because of their illnesses or when their policies stop covering costs, say those who support expanded private coverage.

The talk of expanding private insurance comes as the public mental health system, which relies on private contractors to provide most treatment, is faltering.

The measure approved by the Senate committee is substantially different from the version the state House approved overwhelmingly in May. Neither proposal would cover drug or alcohol treatment, and under the House version, businesses with 25 or fewer employees would not have to comply.

The Senate committee took the recommendation of Blue Cross and Blue Shield of North Carolina and limited to nine the mental illnesses placed on equal footing with physical ailments. Insurers of patients with illnesses not among the nine would be required to pay only for 30 doctor visits and 30 days of hospital treatment each year. The House bill had no such restrictions.

Blue Cross lobbyist Kenneth Wright said that most of its customers hospitalized for mental illnesses have one of the nine specified ailments. "You take care of the bulk of the problem ... by using those nine," he said.

Advocates for the mentally ill said they prefer the Senate proposal. John Tote, executive director of the Mental Health Association in North Carolina, said the Senate proposal triples the number of people covered.

"For mental health, it moves us way down the road," he said.

The proposal has deficiencies, said Dr. Jack Naftel, director of child and adolescent psychiatry at the UNC School of Medicine. He warned that children would be shortchanged under the proposed limits because mental illnesses most often diagnosed in children such as Attention Deficit Hyperactivity Disorder, separation anxiety and disruptive behavior disorders are not included among the nine main mental disorders.

Lack of mental health treatment for children leads to lost work days for their parents and results in more children in foster homes, group homes and mental hospitals, he said.

"If we treat these children early, they move along an appropriate developmental track," Naftel said.

Dr. Don W. Bradley, chief medical officer for Blue Cross, said the company reviewed its records to see where people exhausted their benefits.

"That's where we need the most coverage," he said of the nine illnesses specified in the Senate bill.

For other illnesses, the 30-day and 30-visit limits are adequate, Bradley said. The Senate's insurance bill would lead to a $9.6 million increase in premiums for businesses with Blue Cross small group health insurance policies, company representatives said.

Large companies that are self-insured are covered under federal law and would not have to comply with the state law.

Some senators said they didn't like the limits but conceded that it was probably what most members would approve.

Democratic Sen. Bill Purcell, a retired pediatrician from Laurinburg, said he didn't like the limits on childhood illnesses but would accept them to get the law. "We need to get something on the books to get this thing started," he said.


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Mental health coverage bill changed - Asheville Citizen Times

By Jordan Schrader

RALEIGH — A plan to make employers’ health plans cover mental illness as they would physical ailments was overhauled Wednesday to include coverage for more workers.

The changes make it more palatable to both insurance companies and advocates for the mentally ill, who have feuded for more than a decade on the issue.

Although advocates want fully equal coverage for mental illness, some like the compromise version approved by the Senate Health Care Committee because it eliminates a provision added in the House by Rep. Charles Thomas, an Asheville Republican.

Thomas’ amendment would have exempted employers with 25 or fewer em-ployees.

That would have left just one in six workers covered under the bill, said John Tote, Mental Health Association in North Carolina executive director. The new version would apply to about half of the workers in the private sector, he said, excluding only those whose employers are self-insured and thus regulated by federal, not state, laws.

Longtime supporters of mental health “parity,” including the bill’s sponsor, Rep. Martha Alexander, preferred the latest version submitted by Sen. David Hoyle to the House-approved bill.

“This bill covers everybody that we can cover for every disease that’s out there,” said Sen. Martin Nesbitt, an Asheville Democrat. “So 99 percent of everything we’ve been fighting for 20 years, we just got.”

But the bill would not provide for complete equality between physical and mental health coverage.

To satisfy Blue Cross and Blue Shield of North Carolina, lawmakers agreed to require full coverage for just nine specific mental illnesses. The insurance company said those make up 82 percent of mental health patients.

Treatment for other mental illnesses would be limited to 30 doctor’s visits and 30 days in the hospital each year.

Dr. Jack Naftel, a specialist in child mental health at UNC-Chapel Hill, told the committee that limiting full mental health coverage to a few specific diseases would leave out treatment that is critical for children, including for autism, retardation and Tourette’s syndrome.

“If we treat these children early,” he said, “they move along an appropriate and normal developmental track.”

The limitations on treatment for most diseases mollified Thomas’ disappointment at his amendment being removed. He said the new version should actually cost small businesses less.

But he said it may also cost too much for the smallest employers, forcing them to drop insurance coverage altogether.


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Change gun bill discriminating against mentally ill - Des Moines Register

The National Rifle Association has joined "liberals" such as House Speaker Nancy Pelosi and U.S. Sen. Charles Schumer (who proclaimed to believe in the personal freedom of individuals) to bar all mentally ill people from buying guns ("House Toughens Gun Check Measure," June 14).

This is a tightening of a 1968 law prohibiting the mentally ill from buying firearms. This newly tightened law requires the listing of all persons who have a mental illness with the FBI's National Instant Criminal Background Check System.

This criminalizing of the mentally ill promotes denial and discourages the (diagnosed or undiagnosed) mentally ill from seeking treatment. Seung-Hui Cho, who killed 32 people at Virginia Tech before committing suicide two months ago, could perhaps today be a healthy college graduate if his instructors, fellow students and roommates had not shunned him and made him feel like he was a criminal with nothing to look forward to except unemployment.

Despite high-profile cases like Cho's, the untreated mentally ill are not significantly more violent than the nonmentally ill, and the treated, medically compliant mentally ill are much less violent than the nonmentally ill.

The 1968 law favored by so-called "liberals" makes no sense and should be changed to only bar certain mentally ill persons from buying a gun, and not to discriminate against the nonviolent who are the overwhelming majority of the mentally ill.

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Gaming junkies get no diagnosis - Los Angeles Times

By Alex Pham

Video-game buffs might feel hooked on their favorite titles, but they won't be officially addicted anytime soon.

Saying the issue needed more study, the American Medical Assn. on Wednesday scaled back a controversial proposal that sought to declare excessive video-game playing a mental disorder akin to pathological gambling.

The association also decided against urging parents to limit to two hours a day the amount of time their kids play video games, watch television and surf the Internet.

"While more study is needed on the addictive potential of video games, the AMA remains concerned about the behavioral, health and societal effects of video-game and Internet overuse," Dr. Ronald M. Davis, the association's president, said in a statement from its annual meeting in Chicago. "We urge parents to closely monitor their children's use of video games and the Internet."

The 250,000-member physician organization drew national headlines last week by pressing forward on a proposal to "strongly encourage" that video-game addiction be labeled a formal disorder. The proposal would have asked the American Psychiatric Assn. to consider including "video-game addiction as a formal diagnostic disorder" in the Diagnostic and Statistical Manual of Mental Disorders, considered by experts to be the authoritative handbook on mental illness.

Instead, the medical association Wednesday removed the word "addiction" and decided to simply forward its report expressing concerns about "video-game overuse" to the psychiatric group, which is revising its mental-health manual.

Maressa Hecht Orzack, director of the computer-addiction studies center at McLean Hospital in Belmont, Mass., said the word choice was irrelevant.

"The fact is, it's a behavior that's out of control," Orzack said, noting that some of her patients have trouble with school, work and their relationships because of their game-playing habits. "Whether you call it addiction, overuse or excessive use, it's the same thing. It's a condition that interferes with a person's mental health."

But some in the video-game industry, including the Entertainment Software Assn., were pleased with the toned-down language. The trade group for the $30-billion game industry "supports mental-health experts, the APA and others within the AMA who agree that it would be premature to conclude that video-game 'addiction' is a mental disorder," said Michael Gallagher, its president.

Industry executives were less happy with another recommendation in the report approved Wednesday: The physicians' organization plans to lobby the Federal Trade Commission to improve the current voluntary video-game rating system, which is now run by the industry-funded Entertainment Software Rating Board.

"We would like to see a ratings system that better alerts parents to the content of the video game and recommended age of the player, so they can decide whether or not their child should be playing it," the AMA's Davis said.

The board defended its system, which assigns ratings based on the level of violence or sexual innuendo in games.

The medical group's proposal to review the ratings system "seems to disregard the fact that the vast majority of parents are satisfied with the ESRB ratings and use them regularly to choose games for their children," ratings board President Patricia Vance said in a statement.
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Court: Suspect's family can tell all - Newark (NJ) Star Ledger

by Kate Coscarelli

In a unanimous ruling, the New Jersey Supreme Court today ruled state prosecutors seeking an indictment against a suspected criminal can question the person's family members about the mental state, drug use and sexual history of the accused.

The court found that before indictment, a grand jury can ask any questions it wants as long as they are relevant to the crime. However, once an indictment has been returned, prosecutor's can only use the grand jury to investigate new charges, not gather evidence about the existing charges, the court found.

"To carry out its investigatory role, the grand jury is entrusted with expansive powers. ... The standard to be applied to determine the proper scope of a grand jury's pre-indictment inquiry is whether the evidence sought is relevant to the grand jury's task," wrote Justice Roberto Rivera-Soto in the 6-0 decision.

The case involves the December 2002, knifepoint rape and murder of 32-year-old Elizabeth resident Majuly Collins and the suffocation of her 4-year-old son, Eduard Almazal, and 18-month-old daughter, Catherine Almazal.

Alturik Francis, of Elizabeth, is facing the death penalty in connection with the deaths, as well as the stabbing of Collins' cousin, Susan Vargas, who survived a knife attack.

In 2003, the Union County Prosecutor's Office ordered Francis' mother, stepfather, sister and brother-in-law before a grand jury after he was arrested, but before he was indicted. The assistant prosecutor, William Kolano, asked about Francis' past drug and alcohol use, his mental health, sexual abuse and prior instances of violence and behavior. Prosecutors said that the grand jury's role is to conduct a complete investigation.

The defense objected to the line of inquiry saying the prosecution was just trying to get information about what the family might say during the death penalty phase - should Francis be convicted.

Calls to the attorneys in the case, and the state Attorney General's Office which joined the case later, were not immediately returned


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Too Much Video Gaming Not Addiction, Yet - Chicago Tribune

By LINDSEY TANNER


June 27, 2007, 10:12 AM CDT

CHICAGO -- The American Medical Association on Wednesday backed off calling excessive video-game playing a formal psychiatric addiction, saying instead that more research is needed.

A report prepared for the AMA's annual policy meeting had sought to strongly encourage that video-game addiction be included in a widely used diagnostic manual of psychiatric illnesses.

AMA delegates instead adopted a watered-down measure declaring that while overuse of video games and online games can be a problem for children and adults, calling it a formal addiction would be premature.

"There's no science to support it," said Dr. Stuart Gitlow, an addiction medicine specialist.

Despite a lack of scientific proof, Jacob Schulist, 14, of Hales Corners, Wis., says he's certain he was addicted to video games -- and that the AMA's vote was misguided.

Until about two months ago, when he discovered a support group called On-Line Gamers Anonymous, Jacob said he played online fantasy video games for 10 hours straight some days.

He said his habit got so severe that he quit spending time with family and friends.

"My grades were horrible, I failed the entire first semester" this past school year because of excessive video-game playing, he said, adding, "It's like they're your life."

But delegates voted to have the AMA encourage more research on the issue, including seeking studies on what amount of video-game playing and other "screen time" is appropriate for children.

Under the new policy, the AMA also will send the revised video-game measure to the American Psychiatric Association, asking it to consider the full report in its diagnostic manual; the next edition is to be completed in 2012.

Dr. Louis Kraus, a psychiatric association spokesman, said the report will be a helpful resource.

The AMA's report says up to 90 percent of American youngsters play video games and that up to 15 percent of them -- more than 5 million kids -- might be addicted.

The report, prepared by the AMA's Council on Science and Public Health, also says "dependence-like behaviors are more likely in children who start playing video games at younger ages."

Internet role-playing games involving multiple players, which can suck kids into an online fantasy world, are the most problematic, the report says. That's the kind of game Jacob Schulist says hooked him.

Kraus, chief of child and adolescent psychiatry at Chicago's Rush Medical Center, said behavior that looks like addiction in video-game players may be a symptom of social anxiety, depression or another psychiatric problem.

He praised the AMA report for recommending more research.

"They're trying very hard not to make a premature diagnosis," Kraus said
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Regional effort to solve homelessness needs team players -San Diego City Beat

By Kelly Davis

When San Diego Mayor Jerry Sanders vetoed funding for the city's winter homeless shelter two weeks ago, he promised he'd find a way to pay for the 21-year-old program without dipping into the city's general operating fund.

Last Friday, Sanders announced his plan: He'd already allocated $201,000 from a citywide pot of federal grant money intended for social services and neighborhood improvement. The Center City Development Corp., the governing body that oversees downtown's redevelopment, plans to take over a $344,200 loan from the San Diego Housing Commission, freeing up that money for the Housing Commission to spend on the shelter. The United Way of San Diego County, one of the region's largest nonprofit social-services providers, chipped in the remaining $129,800. With that total, $675,000, some 200 homeless adults and 150 homeless veterans will have a place to sleep from at least Dec. 15 through March 15.

It's a one-year solution for a program that's never had a dedicated funding source. Most recently, the San Diego Housing Commission paid for the shelter with federal grant money, but last year the Department of Housing and Urban Development put restrictions on how that money could be used, forcing the Housing Commission to dip into its dangerously low emergency reserves to pay for the shelter. In October 2006, the Housing Commission told the mayor he'd have to find another funding source.

At a press conference the mayor held Friday, there was talk about the need for a long-term solution, like a permanent city-run homeless-services facility, as opposed to a temporary tent structure and its year-to-year piecemeal funding. United Way CEO Doug Sawyer talked about "shared responsibility and future collaborative efforts" on matters involving the homeless, and several of the city officials backing the mayor brought up the Plan to End Chronic Homelessness, a regionwide effort—and part of a national program—to address the needs of a sub-population of homeless individuals who've been living on the street for at least a year and who have a co-existing condition such as mental illness or a physical disability. Studies have found that it would cost far less to put those individuals in permanent housing with supportive services than to leave them on the street, which makes them vulnerable to ending up in jail or emergency rooms. The underlying goal of the plan is to increase the region's supportive-housing stock, in effect decreasing the burden of the chronically homeless on social-welfare programs. Of San Diego County's roughly 10,000 homeless individuals, 1,383 are considered chronically homeless.

Collaborative efforts, regional plans, shared responsibility. So where was the county of San Diego last Friday?

It's probably not a big deal that no one from county government was at the press conference. At press time, a city spokesperson was still looking into whether the county was even asked to help the cash-strapped city fund the shelter this year. If anything, the absence is symbolic, indicative of a less-than-collaborative relationship between city and county leaders when it comes to the issue of homelessness. The county, for instance, has yet to vote to support the chronic-homelessness plan—something the San Diego City Council did unanimously last October at a meeting devoted solely to homelessness issues.

CityBeat contacted each of the county supervisors to ask whether they consider it their responsibility to help fund the city's homeless shelter and also to find out when they'd be voting on the plan. Pam Slater-Price and Greg Cox didn't respond at all; Supervisor Dianne Jacob didn't respond to the question about the homeless plan but did say that operating shelters are "the discretion of each of the region's cities…. The county is already partnering with cities for program costs and cities need to do their part." (Indeed, the county Department of Health and Human Services sends counselors and a public-health nurse over to the city's winter shelter.)

A spokesperson for Supervisor Bill Horn told CityBeat to direct the question about the chronic-homelessness plan to Supervisor Ron Roberts, chair of the board. Roberts did not respond by press time, despite repeated calls to his office.

San Diego City Councilmember Toni Atkins, who's recently been in touch with Roberts (whose district includes downtown San Diego), said she's not sure why the supervisors haven't docketed the plan for consideration.

"I find it curious that the county has taken a pass on supporting the plan," she said in an e-mail. "This should be a countywide effort…. It only makes sense."

The Plan to End Chronic Homelessness will happen in phases, with some steps requiring approval from the region's governing bodies. Among an increase in supportive housing, the plan envisions a joint city/county homeless-services authority, similar to what's in place in L.A., where an independent government unit oversees funding and service contracts, monitors the effectiveness of those services, as well as keeps counts of the homeless population and provides outreach and crisis intervention, among other things.

Several people CityBeat interviewed for this story said such an authority was badly needed. It was difficult to get anyone to comment on the record about the need for a better working relationship between the county and its largest city when it comes to the homeless—many feared criticism would put the supervisors on the defensive. But one person who's familiar with the Plan to End Chronic Homelessness said the joint-powers authority might not be realized if the supervisors never vote to support the plan in the first place.

The county, according to its own policies, is legally obligated to provide "basic health and supportive services to the region's homeless"; cities throughout the county are expected to make "fair share" contributions to help out their own homeless residents. The county administers tens of millions of dollars in federal and state housing and social-services grants each year, allocating money to private providers for homeless-targeted services like transitional housing, job training, drug and alcohol treatment and mental-health services. The county does not operate its own homeless shelter (nor is there a county general hospital), but it does provide funding for a winter hotel-voucher program ($225,000) and, in 2005, spent $125,700 to shelter families with children.

According to the Regional Task Force on the Homeless, which puts together an annual report on public funding for homeless services, in 2005 (the most recent data available), the county spent 2 percent of its Community Development Block Grant money on homeless programs (discretionary federal dollars that are allocated to all city and county governments to assist low- and moderate-income residents). In 2005, the city of San Diego spent 4.3 percent of its CDBG money on homeless services.

There's long been a push for a better relationship between the city of San Diego, where roughly half of the region's homeless reside, and the county. In 2000, then-San Diego City Councilmember Valerie Stallings asked her fellow council members to pass a resolution asking the county to help fund a shelter program for homeless families with children and to "accept the responsibility of providing shelter for the homeless and take action." The council unanimously supported the resolution. Stallings, who's currently the governmental affairs coordinator for St. Vincent de Paul, said the lack of city/county collaboration that prompted the resolution seven years ago is still present today.

"I think the county still doesn't do what it should," she said. Social services "is supposed to be their job, not the city's. I would like to see the county become more of a partner in assuming the responsibility."

Shortly after that resolution, a joint city/county homeless task force was formed with the goal of "solutions through collaboration." The task force was to comprise two City Council members and two county supervisors. The task force met twice in 2000. Atkins, who was elected to the City Council that year, was appointed to the task force by Mayor Dick Murphy in 2001.

"When I was first appointed, I was excited [and] looking forward to meeting," she said. She asked her staff to find out when meetings were held—she was told infrequently—and so she waited. And waited.

"I've never been summoned to a meeting," she said.

But she sees a silver lining: At least such a task force exists. "I guess we have a vehicle in place to work with the county!"

Eric Wolff contributed reporting for this story.


Write to kellyd@sdcitybeat.com and editor@sdcitybeat.com. Read more!

Heroes in mental health - Boston Globe

By Jerrold F. Rosenbaum and Michael S. Jellinek

THE STORIES are heart-wrenching and painful. They come from tearful and desperate parents who describe children so intensely unstable in mood, so irritable, angry and violent, and so out of control that they are tormenting -- indeed, ripping apart -- themselves and their loved ones. Home is a living hell for these families.

Few truly understand the anguish they feel because, fortunately, most of us are spared from witnessing such suffering. Parents struggle to contain the chaos, trying to give their children some semblance of a normal life before precious childhood slips by. These parents search relentlessly for ways to stop their children from abusing drugs, starting fires and hurting themselves and others. They are frantic to protect their children from emerging into adulthood scarred by years of pain, rejection, and despair.

These are parents who reach out to Drs. Joseph Biederman and Janet Wozniak at Massachusetts General Hospital. These physicians are heroes to families of children with serious mental illness. Amid a firestorm of stinging and misdirected criticism, these physicians look to science to serve up hope. They use limited tools available to them -- medications, talk therapies, behavioral strategies -- to help children. Success stories -- and there are many -- are heartwarming and inspiring.

Emerging research shows that differences in brain structure and function as well as differences in genes underlie the vulnerability of these children to mental illness. Physicians who study and treat these patients know that very young children can have serious psychiatric issues, including bipolar disorder. Clearly, psychiatric disorders that afflict adults do not magically appear on the 18th birthday. Rather, susceptibility to mental illness can manifest early in life. For bipolar disorder, new findings from a study funded by the National Institute for Mental Health show that 60 percent of adults with bipolar disorder reported symptoms before age 18, and 28 percent before age 13.

Yet, many in the media and those without training and experience in child mental health have ignored science and fact to exploit a child's tragic death to promote a biased agenda. Four-year-old Rebecca Riley allegedly died of an overdose given to her by her parents, a tragedy that has little to do with any specific disorder. Rather, her death appears to be caused by the parents' misuse of medications. If a child with seizures or asthma were to be given a fatal overdose of medication, would a life-saving therapy and an entire medical discipline be attacked so viciously? It is appalling that Biederman's distinguished lifelong work caring for children has been dragged into this fray.

Biederman is the most widely cited child psychiatry researcher in the scientific literature. He has moved the field of child psychiatry forward carefully, deliberately. Unlike his critics, his meticulous research has withstood intense peer-review scrutiny, and his work is backed up with rigorous science. He does not use dramatic claims or horrific allegations directed at others. He is not a self-proclaimed expert with a book to sell. Rather, he has earned -- and continues to earn -- the respect and admiration of his professional peers through his critical academic work and his outstanding clinical practice.

Most important, he has the love and gratitude of those he has helped. Biederman's personal mission is to offer children and families hope where little has existed in the past. He is not a businessman or a politician. He is a dedicated physician, a medical pioneer. His passion is for the patients and families he works so hard to save, to restore.

Let's get the facts right. Joe Biederman had no involvement in the tragic death of Rebecca Riley. He had no knowledge of this child's diagnosis, no role in developing the treatment alleged to have been administered by the parents.

Despite the imbalanced and sensational media coverage, and despite the attempts of misguided critics, Biederman and others must -- and will -- persevere in this field because it is the right thing to do. No, it is not Biederman who suffers most from the preposterous allegations set forth. Sadly, the greatest losers are children with mental illness and families, who, as a result of the proliferation of misinformation and the deepening of a stigma, could feel too embarrassed and ashamed to seek the life-saving help they so desperately need.

Dr. Jerrold F. Rosenbaum is chief of psychiatry at the Massachusetts General Hospital. Dr. Michael S. Jellinek is the chief of child psychiatry at MGH.
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Mental health, criminal justice experts seek help for inmates -Hampton Roads Virginian-Pilot

By MATTHEW ROY, The Virginian-Pilot

VIRGINIA BEACH -- A conference that drew mental health and criminal justice professionals here Tuesday highlighted both the problem of sick inmates languishing behind bars, sometimes for petty offenses, as well as the promise of emerging programs to better cope with mentally ill people.

Long planned by the city's Department of Human Services, the conference comes as the Virginia Tech shootings have given new urgency to calls to reform the state's mental health system.

It drew more than 250 people, including mental health and law enforcement professionals and family members of people with mental illnesses.

James Morris, director of forensic services for state mental health, cited figures that said more than one in seven inmates in Virginia is mentally ill. That means more mentally ill people are behind bars than are in the state's mental hospitals.

Jail is not an ideal place for mentally ill people to be treated, said Annette Miller, a senior assistant public defender in Virginia Beach who has represented many mentally ill clients.

Their illness may be undetected or they may refuse treatment, she said.

Virginia's situation is not unique. Steven R. Williams, a Maryland warden, recounted how he came to be a firm believer in collaborating with the mental health system to provide treatment to inmates. Workshops also detail ed a program by police in Memphis, Tenn., that seeks to divert low-level offenders who are mentally ill to treatment rather than jail.

Much remains to be done, Miller said. She described a justice system in which some people with mental illnesses are arrested on minor offenses, such as trespassing, and then sit for months in jail awaiting a state hospital bed because they have been found to be incompetent to stand trial owing to their illness. The wait can be so long that it exceeds what a jail sentence would be, she said. The sickest may wind up in isolation.

Miller recounted how one of her clients smeared his waste in an isolation cell while he awaited a state hospital bed.

"Don't think that charging someone is a path to treatment," Miller said.

She also said, "Unless it's a safety concern, do not get the police... in the middle of a mental health situation."

Miller said more resources are needed to solve the problem and that one of the biggest barriers to getting mentally ill defendants out is a lack of housing.

"Until and unless we have placements for these folks," she said, "this isn't going to change much."

Matthew Roy, (757) 446-2540, matthew.roy@pilotonline.com
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Trinity to close behavioral unit - Ft. Dodge (IA) Messenger

Tibbitts blames shortage of psychiatrists

By TERRENCE DWYER, Messenger staff writer

The nationwide shortage of psychiatrists and an especially acute shortfall of physicians in this specialty in Iowa has finally caught up with Trinity Regional Medical Center.

The medical center’s board decided Tuesday to close TRMC’s 20-bed inpatient behaviorial health unit effective Friday. By then all patients now in that unit will have completed treatment programs and be ready for discharge to a home or outpatient setting or will have been transferred to another hospital, according to Deb Albrecht, the unit’s director. She said that in recent months the unit has typically had a census of 10 to 12 patients.

The unit, which treats patients with mental illness and substance abuse problems requiring hospitalization, has been part of the local health care system since January 1969. Its disappearance will mean that patients needing this type of specialized care will no longer have an inpatient treatment option in Fort Dodge or any other nearby community. The closest inpatient behavioral units to Fort Dodge are in Ames, Carroll, Spencer, Storm Lake, Mason City and Des Moines.

Tom Tibbitts, Trinity’s president and chief executive officer, said the decision to end this type of care locally was a difficult one. He said it came about because it has proved impossible for the hospital to recruit a psychiatrist to replace Dr. Lee Berryhill, who is retiring.

According to Tibbitts, the unit cannot provide an acceptable level of care without two psychiatrists on staff who are willing to manage the care of patients admitted to the hospital. With Berryhill’s retirement, Trinity was down to a single psychiatrist — Dr. Sang Lee.

‘‘We’re not going to run a unit,‘‘Tibbitts explained, ‘‘and hold ourselves out to be an inpatient psychiatric unit unless we have the kind of resources, i.e., psychiatrists, that are going to be able to provide the direction and oversight of midlevels or direct treatment of patients, as we’ve had in the past.’’

Tibbitts said the hospital has worked strenuously to recruit a replacement for Berryhill.

‘‘For five years we’ve not been able to locate a psychiatrist willing to do inpatient work,’’ he said, attributing the failure to do so to a national shortage of psychiatrists that is especially severe in Iowa.

‘‘There are not enough psychiatrists to go around, pure and simple’’ Tibbitts said, noting that Trinity would have preferred to keep the unit open, if that had been possible.

According to a fact sheet released Tuesday by Trinity, Iowa ranks 47th in the nation in terms of psychiatrists per capita. The document references a study by the Iowa Physician Task Force released in March 2006 that put the number of licensed psychiatrists in Iowa then at 221. The same study reported that at that time there were 60 full-time and 20 part-time open and unfilled positions statewide for psychiatrists.

Tibbitts said psychiatrists were choosing to practice in outpatient venues rather than treat hospital patients because government and insurance reimbursement policies increasingly are making the the hospital setting highly unattractive for them financially.



New outpatient emphasis

Tibbitts said Trinity recognizes the importance of having resources in Fort Dodge to address behavioral health needs. He said Trinity will develop expanded and upgraded outpatient programs to address these needs.

‘‘We’re just going to be transitioning and trying to figure out what is the right scope of services on an outpatient basis,’’ Tibbitts said. ‘‘One of the things we’re doing is talking very closely with the North Iowa Mental Health Center about how do we work together because they are strictly outpatient. ... How to partner and make the whole outpatient arena stronger, more comprehensive.’’

Tibbitts stressed that while inpatient care of this type will no longer be available in Fort Dodge, he hopes to create an outpatient behavioral health capability that will reduce the demand for that option.

‘‘We know that some of the patients are going to need inpatient care,’’ he said. ‘‘We’re going to have to minimize, hopefully, the need to always put people in the hospital by creating better and stronger outpatient programs. That’s our goal.’’

He was quick to acknowledge that the new approach is not ideal.

‘‘We can’t totally make up for the closure of the inpatient unit,’’ Tibbitts said. ‘‘But our goal is to go a long ways toward doing that.’’

Tibbitts speculated that it would prove less difficult to recruit psychiatrists for a program with an outpatient focus.

Albrecht said she and her team are enthusiastic about the opportunity to provide more extensive outpatient services.

‘‘We’re looking forward to providing comprehensive mental health and substance abuse outpatient services to the community,’’ she said.

‘‘We’re not getting out of the business,’’ Tibbitts emphasized. ‘‘It’s a transition to a different type. ... We’re going to continue to meet the needs. We just can’t do this inpatient unit and expect to keep the quality up there.’’

Partly due to this shift in emphasis, Tibbitts said he expects to find roles for the 35 employees currently assigned to the behavioral health unit in these new ventures or elsewhere in the medical center. He emphasized strongly Tuesday that layoffs are not contemplated.



Contact Terrence Dwyer at (515) 573-2141 or tdwyer@messengernews.net Read more!

Fayette commissioners mull plan for home -Uniontown (PA) Herald-Standard

By Amy Zalar, Herald-Standard

The Fayette County commissioners will vote Thursday on submitting an application for a housing proposal to open a Fairweather Lodge in Connellsville where eight individuals with mental health issues could live together.

Tammy Knouse of Fayette County Community Action Southwest said a building at 508 S. Pittsburgh St., Connellsville, has been purchased for the site. She said eight individuals would live in the home, and each would have their own bedroom, but would share rent and household chores and would start a joint business.

Knouse said a problem with people with mental health issues is paying rent, so it would be structured so only one-third of their income would go to rent. She said Erie has six Fairweather Lodges, and tenants have started businesses such as cleaning contracts.

Since the project has come to light, Connellsville entrepreneurs Michael Edwards and Dan Cocks, who own a bed and breakfast and art gallery near the site; Mayor Judy Reed; and Councilman David McIntire have voiced opposition to the group home.

During Tuesday's agenda meeting, the commissioners voted to place a motion on Thursday's agenda to consider approving the submission of a state Department of Community and Economic Development grant application in the amount of $267,000 by the Fayette County Redevelopment Authority for the Fairweather Lodge housing program for the Connellsville site.

Knouse said planning for the project began in November 2004 from the Fayette County Housing and Homeless Partnership. She said to date, $144,000 has been secured through the U.S. Department of Housing and Urban Development and $400,000 has been secured by the Fayette County Mental Health/Mental Retardation Agency.

The money will be used for property acquisition, operation of the home, rehabilitation and support services for three years.

According to Wikipedia, an Internet encyclopedia, the Fairweather Lodge Program is a psychosocial rehabilitation model combining congregate living with collaborative employment.

The Fairweather Lodge Program was developed by psychologist Dr. George Fairweather in California in 1963. Fairweather found that rehospitalization of patients with serious and persistent mental illness is less likely when the people live and work together as a group, rather than individually. A typical Fairweather Lodge is an affordable dwelling for four to eight people who share in running the home, including domestic chores and purchase and preparation of food.

The residents make their own house rules and manage their own activities. In addition, they run a small business chosen by consensus and jointly planned.

Such businesses may provide lawn care, custodial or laundry services, printing, furniture building, shoe repair, catering or other services.

The work is part time and organized so that one member can readily substitute for another whenever necessary. The role of staff provided by the sponsoring agency of a lodge is limited to mentoring, advising, mediating and helping in emergencies, although staff is continually on call.

Lodge members hire professional consultants such as accountants and lawyers to assist with the lodge business operation. The sponsoring agency sets eligibility criteria and recruits candidates for membership, but acceptance into a lodge requires a vote by existing residents.

Residents are charged for rent and operating expenses, but some costs (such as mortgage payments or transportation) may be covered by county and state programs, as well as by business profits.


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Report details recommendation on children's health in Rockland -Westchester (NY) Journal News

By JANE LERNER

NEW CITY - Lack of services for children with psychiatric conditions is one of the most glaring gaps in health care for Rockland youngsters, according to a report by a local lawmaker yesterday.

"While the state of New York is a national leader in the delivery of services to children with mental retardation and developmental disabilities, it is ironic that services for children with depression, diagnosed psychoses, behavioral problems, addictions and other mental impairments are sorely lacking," the report said. "A significant contributing factor for this shortfall is the general lack of coordination between agencies in the state that provide mental health services for children."

The report, titled "A Vision for the Children of New York State," was done by Harriet Cornell, chairwoman of the Rockland Legislature.

Cornell held three public hearings last year during which she solicited opinions and information about issues related to the physical and mental health of children in Rockland. She also looked at services offered by state and local agencies to Rockland residents.

The hearings focused on such topics as prenatal and postnatal care, mental and behavioral health and nutrition and physical activity.

"The single most important conclusion of our report is that children are not small adults and face health-care issues that are unique and complex," Cornell said.

One of the most striking issues to come out of the hearings is the lack of mental-health services for children, Cornell said.

Many of the problems experienced by Rockland parents stem from lack of coordination of services.

New City resident Marlene Becker agreed.

She recalled spending years trying to get help for a child with mental illness.

"The most difficult thing at the time was that there was no single point of access," she recalled. "If you heard through word-of-mouth where to go, you were lucky. If not, you were left in the lurch."

Grass-roots organizations and parent support groups have made it easier to share information, but much more could be done to improve the quality of care that mentally ill children and their families receive, she said.

Many people who spoke at a meeting called by Cornell yesterday at the county office building said they agreed that more needed to be done to address mental health needs of children.

"Mental disorders in children are real and common and treatable," said Karen Oates, president of the Mental Health Association of Rockland.

Some services are available, but county and state agencies need to do a better job of working together, said Mary Ann Walsh-Tozer, Rockland County commissioner of mental health.

"There has to be a transformation in our system of care," she said. "We must put an end to the fragmented care of individuals."

Mary Jean Marsico, assistant superintendent for special student services at the Rockland Board of Cooperative Educational Services, said research into brain function was helping to improve treatment.

"Neuroscience has opened the door," she said.

The report highlights other areas where improvements to children's health could be made:

- Removing barriers for high-risk women who need prenatal care by making it easier for them to enroll in health insurance programs.

- Improving health-promotion and disease-prevention programs and using community education to promote better nutrition and more physical activity.

- Focusing on dental care for children. Rockland obstetricians and pediatricians should speak with families about dental health in children.

- Mandating better coordination among the offices of Mental Retardation and Developmental Disabilities; Mental Health; and Alcohol and Substance Abuse. The Inter-Office Coordinating Council should meet regularly.

Cornell presented a copy of the report to Lori Hall Armstrong, one of Gov. Eliot Spitzer's representatives. Armstrong said she would share the report with the governor. Read more!

Mental patient shot by deputy - Birmingham (AL) Press-Register

By SUSAN DAKER
Staff Reporter

A 35-year-old man was shot twice Tuesday morning in Prichard as he tried to flee sheriff's deputies who were attempting to take him to a civil commitment hearing, authorities said.

Jeffrey Powe, who has a history of mental illness, was taken to University of South Alabama Medical Center and was expected to survive the gunshot wounds, said Mobile County Sheriff Sam Cochran.

Mobile County District Attorney John Tyson Jr. said he was confident that the shooting was justified.

Powe had been living behind his family's business on Craft Highway in Prichard when sheriff's deputies arrived about 7 a.m. Tuesday to take him to court, Cochran said.

Powe charged sheriff's deputies with a butcher knife, Cochran said.

A deputy fired two rounds at Powe but missed, and Powe ran away, Cochran said.

Less than an hour later, sheriff's deputies found Powe and shot him with a Taser, but the darts didn't stick, Cochran said.

"Tasers do not always work," the sheriff said. Tasers shoot two darts that lodge in a person's skin. An electrical charge is then sent through wires attached to the darts, temporarily disabling the person.

Both darts must be lodged for the charge to be delivered.

Deputies also used bean bags fired from a shotgun, but to no avail, the sheriff said.

On Meaher Street near the Wilson Avenue exit of Interstate 165, Cochran said, Powe ran at the deputies with the knife.

When the knife-wielding Powe came within 2½ feet of one of the deputies, Cochran said, another deputy fired shots, striking Powe twice.

Cochran said that Powe's family had wanted Powe to be committed and had warned deputies that he may have taken a knife from their home.

On Monday, officials at the Mobile Mental Health center requested that Powe be brought before Mobile County Probate Judge Don Davis to decide whether the man needed to return to 24-hour care, according to Carol Mann, a spokeswoman for the mental health facility.

"We recognized he was decompensating (deteriorating), and we believed he could be a danger to himself," Mann said.

Case managers and a therapist had tried to intervene and went looking for Powe last week, Mann said.

"We did everything we could," Mann said. "We express our sadness for the consumer (Lowe) and his family that he was injured."

About 7:30 p.m. Tuesday, Judge Davis convened a hearing at Baypointe Hospital on Powe's status.

At Baypointe, both adults and children are treated and observed so doctors can make recommendations on whether they need to be committed. Powe's guardian ad litem, James Patterson, requested that the hearing be closed except for Powe's family members and his mental health caseworker.

Under Alabama law, any party to the case can request that that the hearing be closed, and the judge has no choice but to grant the request, Davis said.

Before closing the hearing, several members of Powe's family, including his parents and a sister, were sworn in to testify.

About 12 to 30 people a week are picked up by sheriff's deputies and taken for probate hearings concerning their mental illness, according to the sheriff's department and Mobile Mental Health.

Cochran said Tuesday's shooting highlighted the dangers his deputies face when dealing with mentally ill patients.

"It puts our deputies in harm's way," Cochran said.

The shooting remains under investigation, Cochran said, but the preliminary results show that his deputies acted correctly. Tyson said the shooting was perfectly lawful and justified, though it was unfortunate that lethal force had to be used.

Cochran said that by either today or Thursday, he will release the names of the deputies involved.

In addition to his history of mental illness, Powe has been convicted of first-degree robbery and first-degree escape, according to court records and Cochran.

On Meaher Street on Tuesday, witnesses said they called 911 to report the shooting. "All I know is that he shot that man when he was down," said Tiffany Banks, 21, who said she watched the chase and shooting from her front porch.

As Banks described the scene while sitting on her porch, her mother paced frantically inside the house behind a glass door saying, "They did him dirty. Dirty." Read more!

Will mental illness save mom's killer? - Charlotte Observer

EMILY S. ACHENBAUM
eachenbaum@charlotteobserver.com

ALBEMARLE -- Standing between Guy LeGrande, sent to North Carolina's death row 11 years ago for murdering a young mother, and execution is a single question:

Is LeGrande, 48, competent enough to be killed?

That's what Superior Court Judge Robert Bell is considering now in Stanly County. Bell spent Monday and Tuesday listening to the testimony of three psychiatrists with opinions on the mental health and abilities of LeGrande, who had been scheduled to die Dec. 1, 2006. The execution was postponed due to concerns over LeGrande's mental health.

LeGrande's case has received widespread attention as lawmakers nationwide discuss bills that would ban the execution of the severely mentally ill. LeGrande's case is also unusual because he was allowed to represent himself during his trial, despite attempts from other attorneys to intervene. During his trial, LeGrande wore a Superman T-shirt to court and called the jurors Antichrists.

North Carolina allows the execution of the mentally ill. But to be executed, a defendant must be deemed competent. To be considered competent, a defendant must be able to understand what he or she is charged with, understand the punishment, and be able to offer assistance or direction to an attorney. It is possible to be mentally ill and meet the definition of competent.

There's little question LeGrande is mentally ill. The three psychiatrists who testified in the hearing this week think he is likely bipolar or psychotic, although none of them has interviewed LeGrande. LeGrande refuses to speak with them, so the doctors have been working from his prior medical records, evidence of his prior actions, and a judge-ordered taping of LeGrande in his prison cell this winter, where he was seen marching for up to three hours a day.

But one of the psychiatrists said that although LeGrande's statements may be odd, it doesn't mean he's incompetent. The other two psychiatrists disagreed.

Only two groups have emphatically said LeGrande isn't mentally ill at all: The family and friends of the victim, Ellen Munford, and LeGrande himself.

Munford's family and friends have said they believe LeGrande is smart enough to fake mental illness in order to dodge execution, and they say they're furious that LeGrande's health is receiving so much careful attention.

"He gets all the rights while we get none, Ellen gets none," said Dusti Hancock Smith, Munford's best friend.

LeGrande shot Munford in her home in 1993 after Munford's estranged husband, Tommy Munford, hired LeGrande to kill his wife. Although Tommy Munford was the mastermind of the plot -- he is now serving life in prison after testifying against LeGrande -- Munford's family believes LeGrande knew what he was doing.

LeGrande, talking to the judge in court, said he refuses to speak with psychiatrists and attorneys because he doesn't trust them.

"I'm not mentally ill and I'm not guilty," LeGrande said.

Jay Ferguson, a Durham attorney appointed to represent LeGrande during the competency claims (even though LeGrande says Ferguson is not his attorney and won't speak to him), told the judge that many mentally ill people often deny their illness, and LeGrande's opinion on his own mental health should not be believed.

Bell's decision on LeGrande's competency is expected within the next few weeks.
Emily S. Achenbaum: 704-289-6576 Read more!

Programs gives mentally ill a way to succeed -Marin (CA) Independent

Staff Report

FOR YEARS, James True of Fairfax lived on the street. Then he linked up with a network of homeless services and found stability - thanks to housing provided by nonprofit Buckelew Programs and a job at the San Anselmo Safeway.

True is mentally ill, a diagnosed schizophrenic.

Five hours a day, four days a week, he collects carts, bags groceries and sweeps the floor at the grocery store at Red Hill Shopping Center.

At the moment, his life is going "very well, very well," he says. If he gets a raise, he plans to move in with his girlfriend, another Buckelew client.

Buckelew Programs offers a continuum of services - housing, counseling, employment - for about 1,000 of Marin's chronically mentally ill.

Tall, blond, affable, True, 58, is one of 70 mentally ill residents who have obtained jobs at Safeway, Macy's, Sears, Longs and more than 40 other places across the county this year through Buckelew Employment Services.

"My objective is to place someone in every business in Marin," says Dan Daniels, who heads Buckelew Employment Services and beats the bushes every day on behalf of the jobless mentally ill who yearn for work.

The Buckelew program, says Daniels, is "about giving people hope."

His clients want the
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same things everyone else wants - someone to love them, a place to live, and a regular job.

He has 70 more clients he hopes to place. By the end of the year - as more people come to him requesting jobs - he expects to have served 300.

An upbeat man retired from a 20-year career as a counselor and parole officer with the state Department of Corrections, Daniels says placing clients in the community not only helps businesses but helps the mentally ill deal with their problems.

A study in 1998 by the Robert Wood Johnson Foundation found that employment was among factors that helped people recover from mental illness.

Daniels is a believer. "This job is so rewarding for me," he says. "I see the beauty of the work."

His clients range in age from 18 to 67. To be eligible for the jobs program, they must suffer from a severe and persistent mental illness.

The illnesses can range from bipolarism to schizophrenia to borderlne personality disorder. In the past, many have also had problems with drug abuse.

Some of the clients are attorneys. One is a nurse. Some, in mid-career, have suffered a psychotic breakdown.

True's illness sometimes makes him "see things that aren't there." Once he saw a woman driving a grocery cart through a telephone pole; sometimes he sees grocery carts that are non-existent.

But he says such moments are infrequent.

Most clients take medication to help, Daniels says.

Before clients are placed in jobs in the public, they undergo a skills assessment procedure, and also learn basic techniques for a job search: resume writing, how to fill out an application.

Once placed, they get on-the-job assistance from one of four job coaches.

Job coach Virginia Sandoval, 27, has worked with True since be began at Safeway more than seven months ago, and checks with him periodically. "He's doing excellent," she says.

Some clients do not require much coaching, and some get coached by phone or after-hours when they have questions they want answered.

True received training through a janitorial service run by Buckelew in Novato where he found his first work. Another facility, at 1000 Sir Francis Drake Blvd. in San Anselmo, runs a food preparation service where other clients get training.

When clients have shown they have good work habits and marketable skills, Daniels tries to place them.

"Doctors told me (True) would never find employment," Daniels says. "But now he's got a job. He's leading a pretty decent life."

Buckelew Employment Services is supported by the Department of Rehabilitation, Marin Community Mental Health and other sources.

A hefty portion of the office's annual budget comes from proceeds of MarinScapes, a sale of Marin landscape art that takes place this Saturday through July 4 at Escalle Winery in Larkspur.

Last year's event netted $110,000 for the program.

"We couldn't function without them," Daniels says.

Cara Chang, 31, is another client of the program.

Afflicted with depression for much of her life, Chang had almost no work experience before getting a job as a cashier at Staples in San Rafael, where she has been employed for more than a year.

Manager Sarkis Garabedian says he hesitated before hiring her, but "we are very, very happy with her performance. She gets a really good response from customers."

Chang, who grew up in Santa Venetia and attended Gallinas School and Terra Linda High, moved to a Buckelew group home when she was 16, and now lives in an independent living facility with her son Quanah, age 4. Buckelew helps with day care.

She got her first job training at the food service program in San Anselmo.

A Buckelew employment specialist, Amy Rogers, checks with her regularly.

Working has helped her self-confidence, says Chang, a serene-faced woman with dark eyes and long, dark hair. "I have more self-esteem."

True, a graduate of Redwood High School, comes from a family of high achievers: a brother is a judge in Alameda County and his late mother, Phoebe Searls True, was a founder of Buckelew Programs.

James True struggled with mental illness for years, living for a time in a tree house in Bolinas, playing guitar on the streets of Mendocino.

When he ended up in the Marin General Hospital Crisis Unit in 1998, he was diagnosed for the first time with schizophrenia.

Many good things come from having a job, True says. "At the end of the day, I feel great. I've worked hard and I feel in tip-top shape.

"Work elates me. It builds up my self-esteem."

Contact Beth Ashley via e-mail at Read more!

Proposed N.C. Law Change Causing Concern For Caregivers -WSOC-TV

Video Report Here.
June 26, 2007

CHARLOTTE, N.C. -- Some parents in Charlotte say a new proposal by the state of North Carolina will hurt their ability to care for their children.

Those parents are paid by the state to care for their adult children who have severe mental disabilities.

They are a people society often overlooks. Grown men and women shackled by autism and retardation and brain injury.

Now some parents feel they are in a battle for survival.

"These are people who, for forever and always, will be in the care of others. That's who we're talking about," Mary Short explained.

Short, and a room full of parents and their children are angry and frustrated about a proposal by North Carolina's Mental Health Division to drastically change a program that allows parents or relatives with proper training to be paid by the state to care for their adult children who can't care for themselves.

The state agrees Jennifer Grundmeyer needs more than 70 hours of skilled help each week. For years N.C. has paid her mother, Connie, to provide the care. But the state now wants to put a 50 hour cap on all payments to relatives, offering to pay for outside caregivers to cover everything else.

"If someone is working more than 50 hours week in and week out forever, that person is obviously going to be tired and not performing at their best," explains Leza Wainwright with the N.C. Division of Mental Health.

Wainright told Channel 9 that some families are abusing the system - seeking more hours simply to make more money.

But these families say they are not and in fact, it's their children who have been abused by the very kind of outside caregivers the state wants them to begin using.

Dee Dee Davidson said one nurse broke her son's hand in a door and another simply left him in the middle of the day.

"She just decided she didn't want to be there any more, so she left him by himself until I got home from work," Davidson agreed.

If the state cuts paid hours, these families said they won't be able to make ends meet, yet they're afraid to take second jobs and leave their children with others.

Copyright 2007 by WSOCTV.com. All rights reserved. This material may not be published, broadcast, rewritten or redistributed. Read more!

The roots of teen suicide - and how others may stop it -Hackensack (JNJ) Record

By RUTH PADAWER and COLLEEN DISKIN, The Record
June 26, 2007

HACKENSACK, N.J. - For every teenager who commits suicide, scores of others come close - and live.

They are people like Stacy Hollingsworth, who scoped out ravines and trees where she could crash a car once she got her driver's license. As a college freshman, she hoarded 110 pills and wound up in a student health center threatening to swallow them.

"I didn't want to die, but it was excruciating to live," Hollingsworth says.

After trying 15 prescriptions for depression, she found a combination that worked and is now in her last year at Rutgers. She's had an internship at NASA. Still, she says, the depression is always looming. She has a suicide plan should the darkest days return.

"To this day, I feel like I'm not going to live that long, so I try to make the best of it," says Hollingsworth, 23. "You have this sense you're on borrowed time."

In the 10 years ending in 2005, for example, 634 New Jersey residents aged 15 to 24 killed themselves. Far more tried - a chilling fact considering that teens who attempt suicide are three to 17 times more likely to try again. Many of those who survive are torn, sometimes daily, between hope that they'll make it and terror that they won't.

One 13-year-old in Paterson, N.J., has a list of things to remember if he ever again wants to end his life:

"I'll think about my family's feelings. I'll think how I wouldn't see my mother again. I'll think how I wouldn't go to my church again and how I wouldn't see the Holy Ghost. I'll think how I would never play ball with my little brother again, and I like playing with my little brother."

A 38-year-old accountant who, at 15, swigged a mix of paint thinner and vodka laced with Raid feels like Jimmy Stewart in "It's a Wonderful Life."

"Each year that goes by, I think about what I would have missed and what a gaping hole I would have left in people's lives," the Hackensack, N.J., resident says. "I'd have missed college and growing up and making friends and finding happiness. I'd have missed learning to ask for help and learning it's not a weakness and walking my grandparents down the aisle at my sisters' weddings. I'd have missed going to the beach and watching sunsets and growing into myself."

Need to intervene

Public health experts say no matter how small the numbers of people in a region who commit suicide, intervention is crucial. That's especially true for young people, who are more likely than any other age group to attempt suicide. They're also the least likely to die that way.

In that gap lies a crucial opportunity to save young lives.

"Many of the kids who attempt suicide don't intend it to be lethal," says Mark Hatton, a private psychologist in Ridgewood, N.J. "Kids who attempt are sending up a flare, and if you can pay attention to that flare, you will probably stop them from moving toward suicide."

In response to a plea by the surgeon general in 1999, suicide prevention programs have been beefed up across the nation. In New Jersey, teachers are being trained to look for troubled adolescents, while teens staff suicide hot lines in some counties. At Rutgers, Hollingsworth established a student chapter of the National Alliance for the Mentally Ill to reach others like her.

"We want to catch kids before they even begin thinking of killing themselves," says Donna Amundson, a social worker who coordinates teams of health professionals around the state to respond at schools after traumatic events.

But nationally and in New Jersey, child psychiatrists are in short supply. Many programs are at capacity. Insurance doesn't always pay for the care young people need.

More than three-quarters of those who try to kill themselves are believed to be mentally ill - but teens are widely under-diagnosed and under-treated. So much so that The New England Journal of Medicine recently concluded there is a "silent epidemic of mental illness among teenagers."

"Still too many kids are identified as having behavior problems, not mental illnesses," says Phil Lubitz, director of advocacy programs for the New Jersey chapter of the National Alliance for the Mentally Ill. "And the kids who don't misbehave - the kids who are just in the shadows - don't get identified."

So it was with Zach Toskovich, who threw himself off the roof of Glen Rock High School in February. The 17-year-old had seemed so well-adjusted and high-performing. It wasn't until his parents read his suicide note that they learned of his torment and that he had tried to end his life once before.

"We'd never even known," says his mother, Jane. "He wrote about all this terrible pain and how he couldn't live with it anymore, but if you don't let anybody know, how can they help you? My husband and I keep saying, `Zach, why didn't you tell us? Why couldn't you tell us?' We never even had a chance to help."

Suicide factors

Experts believe there are genetic, neurological, psychological, social and cultural factors that influence who will attempt suicide.

Imaging studies and autopsies show that the region of the brain involved in regulating emotions and behavior is different in people who attempt or commit suicide than in those who don't. That may contribute to difficulties in solving problems.

To many suicidal people, dying is the only solution. That short-sightedness is particularly common among teens.

"Because of the lack of frontal lobe development, adolescents are old enough to comprehend problems on a deeper level but they don't yet have the coping skills to deal with them, and they haven't been on the planet long enough to practice those skills," said Andy Yeager, a school psychologist for Park Ridge. "Adolescence is a double whammy because they can't foresee consequences, like that `dead' means forever. Add impulsivity and substance abuse and you have a recipe for disaster."

That was the recipe that nearly destroyed one man, who realized in horror at age 13 that he was gay. Though he denied it to his junior high classmates, he was taunted and ridiculed.

One evening, at age 15, he slipped behind the junior high where his troubles had begun. He mixed his cocktail of Raid and paint thinner and drank.

"I decided it would be better for my parents to think I'd died of my own hand rather than from gay sex," says the man, now a Hackensack accountant, who winces at the myopia of his youth. He waited to die.

"Suddenly, a feeling washed over me of intense fear, because as bad as things were here, I didn't know what was waiting for me on the other side," he says.

He stumbled into a Burger King. "Help," he sobbed. "Help me! I need help!"

What followed were years of fumbled efforts to deal with both his mental illness and his sexuality. The teen spent time in a psych ward and was diagnosed with manic depression, but even on antidepressants, his pain persisted because he refused to tell anyone why he was so miserable.

His life improved when he took his cousin's advice to open up to his therapist. He was placed in an alternative high school, where he finally made friends. But when his psychiatrist decided he was doing so well that he no longer needed medication, his condition deteriorated. In college, he relied on drugs and alcohol to quiet his manic depression.

At age 25, he came out to his family. "I was tired of hiding," he says. It took a while, but his folks came around. He feels closer to them now that they know who he really is and still love him.

Now 38, he continues with therapy and medication. He still thinks about suicide sometimes, but he always decides against it.

"I have too much good in my life, with my family and friends," he says. "I couldn't imagine hurting them that way. And if the feeling ever gets intense, I know to talk about it with my friends and my therapist."

Why do some people survive the struggle? What does it take to keep going?

"So much depends on the person's intent when they attempted suicide, their motivation, the underlying psychiatric disorder, whether they get effective treatment, and what support systems are in place," says Lanny Berman, executive director of the American Association of Suicidology.

Keys to survival

Though the nationwide suicide rate dropped 26 percent among 15- to 19-year-olds from 1990 to 2004 - likely due to increased use of antidepressants and stricter firearm laws - the portion of high school students reporting attempts has remained relatively stable.

In 2005, 8 percent of high school students reported in a national Centers for Disease Control and Prevention survey that they attempted suicide in the previous year. Most experts believe those are wild exaggerations. Interpretations vary greatly about what behavior reflects a true intent to die. Does swallowing four aspirins? Does scratching one's wrists till they bleed?

In teens and young adults, a suicide attempt is frequently preceded by conflicts with parents, problems with a romance, bullying, academic difficulties or the death of a parent.

The key to survival is getting young people to talk about their problems and their thoughts of suicide. "If you can talk about it, that already significantly reduces the chance of it happening," says Hatton, the Ridgewood psychologist.

In the last few years, New Jersey has organized Traumatic Loss Coalitions in each county to spring into action at schools after deaths, accidents or suicides to help students and staff cope. The groups also train counselors, pediatricians and police officers to spot early signs of mental illness in children and teens.

Last year, the state began requiring suicide prevention units - on social problem-solving skills and how to seek help and manage emotions - in elementary, middle and high schools. Legislators also mandated that teachers get two hours of suicide-awareness training, which some say is already paying off.

"Teachers are sending me more middle school students than before for evaluation," said Randie Fielder, a student assistant counselor for the River Dell regional school district, which serves River Edge and Oradell. "There's a lot of drama in sixth, seventh and eighth grade, but I think teachers are starting to listen to that drama more carefully. They know what to look for now. They realize that adolescence is a training ground for adulthood, and that mental health problems, if untreated, can become very serious later in life."

One Paterson, N.J., boy was just 12 when he told his school counselor he wanted to die.

The seventh-grader ended up in a hospital for 10 days, then was sent to an after-school program for young people struggling with suicidal thoughts, depression and other mental illnesses.

After nearly a year of intensive group and individual therapy four days a week, he has learned not to get overwhelmed by his feelings. He recently graduated from the program.

"I know I might be depressed sometimes and maybe have suicide feelings," he says. "But I know I'll know how to handle it if I do."

"He's so much more assertive and he's learned to ignore things he wouldn't have been able to before," such as teasing by fellow students, says Jennifer Hayes, the program's director.

The same weekend that counselors took him out for Chinese food to celebrate his progress, 2,000 people gathered in Manhattan for a 20-mile overnight walk organized by the American Foundation for Suicide Prevention.

Some wore white beads, signifying the loss of a child to suicide. As dawn approached, the exhausted participants gathered by the East River and scrawled notes of remembrance:

"In loving memory of my little brother, Mike. R.I.P. Sweet Angel."

"Jesse, gone too soon and too young, but we'll watch your little girl."

"Brian - I do this for you. Miss you day after day, hour after hour. Love, Mom."

Jane Toskovich sobbed for her son, Zach. She was embraced by another North Jersey mother, whose shoulders shook with grief, and dread.

The woman's 16-year-old son has been depressed since he was 8. Twice in the last 18 months, he has tried to kill himself by overdosing. She will always remember the thud she heard when her son collapsed.

"Every time I hear a loud noise, my heart stops," she says.

"I worry every day when I wake him up, when he goes off to school, when he's due back at home, when he's upstairs," she says. "I know what it's like to live in fear."

Above her, the night sky was fading slowly. Clouds blocked the sun. Clearly, it wasn't going to be a bright day, but at least the darkness had begun to lift. Read more!

County is reclaiming Oakleigh building - Durham Herald-Sun

By Carolyn Rickard : The Herald-Sun
June 26, 2007

DURHAM -- Durham County is reclaiming a building from the Durham Regional Campus as a home for a mental health clinic.

The Durham Center Access, currently in an office park on North Duke Street, will move to the Oakleigh building, which had been leased to Duke University Health System as part of the hospital. The access center, which provides 24-hour crisis services to mental health patients, will be able to grow, since the new space is twice the size of the old one, said Ellen Reckhow, chairwoman of the county commissioners.

"This is truly a win-win," she said Monday night. "This is something we've been working on for months."

The Board of County Commissioners approved a plan Monday night by which, in exchange for the building, Duke would have its rent reduced and has agreed to pay half the amount of that reduction to Durham County for mental health and substance abuse services.

The Oakleigh building had been a substance abuse program until 2001. However, in recent years it has just been used for storage.

County officials plan to use part of the building's lot to construct a building for the City of Medicine Academy, a program where high school students can prepare for medical careers. The program is currently housed in Southern High School.

In other business Monday night, board members:

-- Approved raises for four county employees who report to them directly. County Attorney Chuck Kitchen's salary was raised to $160,000 from $149,000. Sheriff Worth Hill's annual pay was raised from $110,000 to $116,000. Tax Administrator Kenneth Joyner's was set at $109,000, up from $101,000, and Willie Covington, the register of deeds, will make $103,000, up from $98,000.

-- Residents of Southview Road asked the board to press the Department of Transportation to pave in their neighborhood. The street, they said, has been on the department's schedule for a few years, but has yet to see work.

"I've fought busted windshields, a flat tire," said Tom Freeman. "We're desperately looking to get that road paved." Read more!

First Lady's tour focuses on mental health of children -Forest City (AR) Times-Herald

June 26, 2007

David Nichol, T-H Staff Writer

Arkansas First Lady Ginger Beebe was in Forrest City today, talking to the families of children who have behavioral or mental health problems.

She met with the families at East Arkansas Community College.

“This is part of a mental health tour that I’ve been doing,” Beebe said.

“This is a listening tour I’m doing around the state, listening to families talk about their children, the services they have that are working and the services that they need. All of this is going to be put together in a report to the governor, who is appointing a commission, we hope at the end of July.”

Act 1593 of 2007, calls for the creation of the Children’s Behavioral Health Care Commission (CBHCC). Ten to 20 governor-appointed members will serve as advocates for children, families, and representatives of a variety of behavioral health care agencies, disciplines and providers. The CBHCC is charged with identifying and implementing changes to the current system.

Pam Marshall, executive director of the Association of Arkansas Families, is traveling with Beebe, along with several other people.

Beebe said more needs to be done for children who have problems.

“One thing I’ve learned is that in certain areas there are no services provided for these children,” she said. “They don’t have physicians. Schools are not adequately staffed.”

Marshall added that children in some areas receive good care, but she said it is a patchwork. “Some have them and some don’t…So we need to get uniformity.” She also said that sometimes state agencies don’t talk to each other enough.

Beebe said the problems she heard in Forrest City were similar to what she has heard in other places.

“We hear the same thing everywhere we go,” she said. “Parents don’t get the information they need, they don’t get access to the kinds of support they need.”

She also said that early detection is needed for children, and stated that mental illness is something that can be treated.

“But the earlier you can diagnose some things the earlier you can help. We need earlier diagnosis we need more physicians trained,” Beebe said.

She also said that sometimes at the meetings being conducted across the state, parents meet each other and get the opportunity to exchange information and help each other.

“Last week, there was a family who had been asked to leave the church because their child had a behavior problem, and another family invited them to come to their church on Sunday,” she said.

The commission which is to be created will be charged with several things, including:

•Identifying up to $2 million per year to meet extraordinary, non-Medicaid reimbursable needs of children, youth, and their families.

•Revising state Medicaid rules and regulations to increase quality, accountability, and appropriateness of Medicaid-reimbursed behavioral health care services.

•Creating additional capacity within the Arkansas Department of Health and Human Services, Division of Behavioral Health Services, to develop, support, and oversee the new system of care Read more!

Mental retardation, autism treated in mice -United Press International

CAMBRIDGE, Mass., June 26 (UPI) -- U.S. medical scientists have reversed symptoms of mental retardation and autism in mice.

Researchers at the Picower Institute for Learning and Memory at the Massachusetts Institute of Technology said the mice were genetically manipulated to model Fragile X Syndrome, the leading inherited cause of mental retardation and the most common genetic cause of autism. The condition causes mild learning disabilities to severe autism, with no effective treatment yet developed.

"Our study suggests that inhibiting a certain enzyme in the brain could be an effective therapy for countering the debilitating symptoms of FXS in children and possibly in autistic kids as well," said co-author Mansuo Hayashi, a former Picower postdoctoral fellow currently at Merck Research Laboratories in Boston.

The research is reported in the online early edition of the Proceedings of the National Academy of Sciences. Read more!

Polk addresses growing child protection needs -Tryon Daily Bulletin

By Leah Justice
June 25, 2007

County leaders say they were tired of seeing the need for child protection services grow in the county and nothing done about it. Each year the Department of Social Services (DSS) provided a report highlighting the need, and then DSS came back a year later with a nearly identical report.

Last month commissioners heard virtually the same report again, but this time decided to take action.

Commissioners agreed on Monday to create a new position at DSS, and they directed county manager Ryan Whitson to meet with child protection team officials to come up with a plan to address child protection needs.

The child protection team list for 2006 included needs in the areas of substance abuse by parents, mental health services, parenting education, juvenile court services and summer program/day care.

Polk County Department of Social Services Director Sue Rhodes says the county has already been working to address its mental health and substance abuse needs, which top the list every year. Being able to hire a community social service assistant will allow more one-on-one time with children and families, according to Rhodes.

“I am really pleased by the commissioners’ response,” Rhodes said. “I feel they have taken seriously the gaps we see in services. They were willing to step up and ask how they can help and I give them a lot of credit for wanting to address those needs.

“The more people we can have working together to address issues, the better it will be,” Rhodes added.

Polk County DSS foster care services have grown tremendously over the past several years. Between 2005 and 2006 the department saw a 29 percent increase in foster care, according to the child protection team report.

Annual foster care costs per child are estimated at $4,303.

During 2006 at least 71 children were in the legal custody or responsibility of the agency with a monthly average of 42 in DSS care. Polk County DSS maintained an average of 23 licensed foster homes during 2006. In 2006, permanent plans were achieved for 22 foster children, including nine who were reunified with parents, five who were adopted, three who live with guardian relatives, two who are in the custody of relatives and three who aged out of foster care.

Since 2000/2001, 146 children have come into foster care in Polk County, with only 8 of those re-entering the foster care system after leaving foster care.

During this period 34 children have been reunited with family, 34 have been adopted, 12 have left foster care through guardianship, 9 were placed in custody of another source, 9 aged out of the system, 2 had petitions dismissed and 2 were transferred to another county.

Adoption costs also continue to rise each year as children are placed in permanent homes when they cannot be returned to family.

“Child abuse and neglect continue to dramatically impact the lives of children and families in Polk County,” stated the child protection team annual report. “During 2006, the average monthly Child Protective Services assessments/investigations increased seven percent from 2005, from 27 to 29.”

During 2006, more than 100 Polk County children were served through child protective services each month, according to the report.

Substance abuse by parents continues to be identified as the number one factor that most often was the cause of children being unsafe in their own homes. Mental health issues were second in 2006.

Rhodes says the county’s work on addressing local substance abuse and mental health needs since the state reform has already helped some of the top two issues.

The county plans to fill the new community social service assistant soon. The new position is included in the budget for the 2007-08 fiscal year, which begins July 1.

The county is also looking into providing office and conference room space for a juvenile court counselor who would be in Polk County full-time instead of the current two days per week. The child protection team report identifed a need for a full-time juvenile court counselor. Read more!

Group-home death in van stuns mom - Miami Herald

BY ELINOR J. BRECHER

At 4:45 p.m. on May 23, Denis Manuel Maltez called his mother, Martha Quesada, from the group home where he lived.
''I love you, Mommy,'' was the last thing he said.

Then the autistic 12-year-old and seven other Rainbow Ranch residents boarded a van headed to a flea-market barbershop.

Four hours later, Martha Quesada tore into Hialeah Hospital's emergency room, hysterical. Something had happened in the Rainbow Ranch van. After an employee restrained him, Denis had stopped breathing.

Neither the staffer who tried CPR in the Flea Market USA parking lot nor paramedics could save him. Now the dark-haired, dark-eyed boy she called mi negrito lay under a white sheet.

''Mommy's here! Mommy's here!'' Quesada screamed, convinced by the breathing tube helping preserve his organs that he was still alive.

Then she fainted.

On June 1, Rainbow Ranch's three group homes lost their licenses. Operators David and Therese Glatt had to shut them down. Denis' death wasn't the only reason.

State regulators presented a juvenile court judge with an emergency order portraying the home where he lived, 310 Northwest Dr., as a den of neglect where disabled children were over-medicated, sexually abused each other and sometimes went hungry.

DOING WELL

Quesada was surprised to hear it. Denis -- so violent by the age of 8 that he could no longer live with his family -- had done well there.

Except for infected bug bites and bruises he told her he got fighting other children, Denis seemed happy and healthy.

He'd been on medication since a doctor prescribed Ritalin when he was 3 ½, after it had become obvious for a year that something was wrong.

''He was not talking,'' said Quesada, 29, who emigrated from Venezuela at 12. She has two younger children with her longtime companion, Adalberto Ros. 'He just said a few words: `Mama.' 'Leche.' ''

At this point in a recent conversation, she broke down sobbing. It was less than a month since Denis' death and she still had no answers: What really happened in the van? Who was with him? Why did he stop breathing?

She said a caregiver ``told me he was kicking the [van] window and that was the reason they had to sit him down and put his arms behind his back to restrain him so he'll calm down in the van.''

The emergency order, which doesn't name staffers, says at the flea market, three staff and four kids went inside, ``leaving one staff person alone with the remaining children in the van. The driver states that when he came back, [Denis] began yelling, screaming and kicking, so he asked the other staff person if she needed help. Reportedly, she declined it.''

The report says the driver heard Denis talking and thought he was all right, ``then suddenly noticed that D.M. was silent and nonresponsive. They took him out of the van and attempted to revive him and called 911.''

The staffer left in the van ''reported that she laid D.M. down on the seat and restrained his legs,'' the report says, then ``turned him over on his back and noticed he was not breathing. . . . She denied using excessive force.''

Autopsy results, pending toxicology tests, are months away. County police homicide detectives are investigating.

FIRST GROUP HOME

Quesada can't forget the day in 2003 when she took Denis to his first group home, in Cutler Ridge. She thought she wasn't a good mother because she couldn't control his outbursts.

He had a habit of pretending to vomit when he got upset. He hit and bit, pinched his mother's arms and face hard enough to leave bruises, threw and broke things, and pulled sister Dayana's hair.

When he tried to choke Dayana, now 10, Quesada agreed to place him. She forfeited no parental rights.

''It was hard'' to leave him at the group home, she said. ``Every time I go see him and have to leave him, I cry.''

After another boy punched him in the face in April 2005, she moved him out. An administrator from the Agency for Persons with Disabilities strongly recommended the newly opened Rainbow Ranch.

She was delighted.

''It's a big house with a pool, and I think it's going to be better. It looked like your own home. It was clean. . . . '' At the time, only one child lived there.

Quesada visited her son often. She'd sometimes see the kids lunching on rice and beans, chicken or vegetables, but Denis liked going out to Burger King.

''He never mentioned he was hungry,'' she said.

He also loved visiting Dayana and their younger brother at the Hialeah house that Quesada and Ros are remodeling.

One of Quesada's concerns was about how sleepy her son often seemed.

After his death, she learned from the emergency order that his drugs had been putting him to sleep at school, Ruth Owens Kruse Educational Center, and that school personnel had told Rainbow Ranch about it.

Kendall psychiatrist Dr. Steven L. Kaplan prescribed Denis' drugs. He saw him twice: May 27, 2006, and two days before Denis died.

Denis had been diagnosed with autism, schizophrenia, mild mental retardation, psychosis and depression, and was already taking the ''major tranquilizers'' Seroquel and Zyprexa and the anti-seizure drug Depakote when he met him, Kaplan said.

If Denis hadn't taken his medications at the right times, ''it's possible'' he'd be sleepy at school, ''but I never saw him dopey or sleepy,'' Kaplan said. ``He was all over the place, a tough little guy to handle but very likable.''

The call came at 7:12 p.m. from Jessica Coronel, Denis' favorite Rainbow Ranch employee. She told Quesada that Denis ``was taken to the hospital . . . because he was not breathing well.''

When Quesada and Ros reached the hospital, they found Therese Glatt and her mother-in-law, Gloria Auston, in tears.

''David [Glatt] was not there,'' Quesada said. ``They said he was so devastated.''

She next saw Glatt was at the funeral. He'd sent flowers, then gave her a check for funeral expenses: about $10,000.

The next -- and last -- time she saw Glatt was after reading about Rainbow Ranch's license revocation in the June 2 Miami Herald.

`IT WAS A LIE'

'I went to the group home. . . . I said, `David, I need to you explain me this article.' He said all of it was a lie.''

When hospital officials initially asked Martha Quesada about organ donation, she refused. But as the night wore on, she reconsidered, then agreed.

''Maybe another mother can be happy,'' she thought.

A few weeks later, after Denis had been tucked into a niche at Dade Memorial Park, someone called from the University of Miami. Would Quesada consider donating some of her son's autopsied brain tissue for autism research?

This time, Quesada didn't hesitate: ``I say yes.''
Read more!

NC regulators find trouble with mental health provider - The Associated Press

GREENSBORO, N.C. - State regulators allege that a Durham-based nonprofit that provides mental health treatment used unqualified or underqualified service providers to care for patients.

Dominion Healthcare has been the subject of at least three investigations by the state's mental health division since 2006. State reviews this year listed 63 state regulations that Dominion has violated, including failing to check criminal histories or qualification of staff members who deal with patients, the News & Record of Greensboro reported Sunday.

The company is permitted to diagnose patient illnesses and offer "community support services," designed to help patients get back on their feet while they await treatment. That could include social skills training and assistance to obtain housing or keep taking medicine.

"If you're in a crisis, if you have an emergency, that's the person you call," said John Tote, with the Mental Health Association in North Carolina. "You can't be dealing with someone who isn't qualified or is learning on the fly."

According to state reports, Dominion was ordered to repay $44,613 in April 2006 after a state Medicaid audit found one of the company's Raleigh offices failed to document treatments properly. In February, an investigation found the company's Charlotte office had failed to conduct proper personnel registry checks and didn't make clear to clients that Dominion provided mental health services.

And a complaint last month showed some staff members had not received proper health care registry or criminal history checks. Records of Dominion's professional staff showed several didn't meet experience requirements to be considered for what's called a "qualified professional position."

Dominion president Joel Hopkins didn't return repeated phone calls last week by the News & Record seeking comment. A phone number listed for Dominion in Durham was disconnected Monday. An attorney representing the company also didn't return a phone call.

Jim Jarrard, who heads a team within the state mental health division that investigates complaints, said the problems at Dominion could be simple paperwork errors. The only way the state can ensure that a client received proper clinical treatment is by reviewing the paperwork.

"You're either in compliance or you're out of compliance," Jarrard said.


Read more!

SARS May Have Left Mental Scars - Washington Post

MONDAY, June 25 (HealthDay News) -- While most Canadian patients who survived the 2003 SARS outbreak in Toronto had good physical recovery, many reported a decline in their mental health the following year, a new study finds.

Researchers evaluated 117 SARS (severe acute respiratory syndrome) survivors three, six and 12 months after they were discharged from hospital. Each evaluation included a physical examination, a six-minute walk test, a lung function test, a chest X-ray and quality-of-life measures. They were also asked how often they saw a doctor.

At one year, all but one patient had normal/pre-SARS chest X-ray results. At three months, 31 percent of the patients had a reduced six-minute walk distance. That decreased to 18 percent of patients by 12 months. Most patients had normal lung function by three months.

However, one year after discharge from hospital, the patients' general health, vitality and social functioning remained below the normal range, according to the study, which is published in the June 25 issue ofArchives of Internal Medicine. The patients also made frequent use of health care services in the year after being discharged from hospital, the researchers found.

Many patients returned to work part-time and gradually increased their workload, while 23 patients returned to work full-time with no need for a modified schedule. One year after being discharged from hospital, 17 percent of patients had not returned to work and nine percent had not returned to their pre-SARS level of work.

"We have shown that most SARS survivors have pulmonary and functional recovery from their acute illness. However, one year after discharge from hospital, health-related quality of life remained lower than in the general population, and patients reported important decrements in mental health. These findings are reflected in the notable utilization of psychiatric and psychological services in the one-year follow-up period," the study authors wrote.

Family and friends who acted as caregivers for the patients also experienced declines in mental health, the researchers found.

"These data may help to highlight the needs of patients and caregivers during and after an epidemic, the potential benefit of a family-centered approach to follow-up care, and the importance of exploring strategies to minimize the psychological burden of an epidemic illness as part of future pandemic planning initiatives," the authors concluded


Read more!

Leaders target crisis care - Asheville Citizen-Times

by Jordan Schrader, JSCHRADE@CITIZEN-TIMES.COM

RALEIGH — The streetwise, 18-year-old Angie Bauknight who returned to Buncombe County this year, her mother said, is very different from the innocent child who left.

North Carolina taxpayers paid for three years of institutionalization in three states, Diane Bauknight said. It exposed her daughter to the wrong sort of girls, ones mixed up in gangs and prostitution.

“The whole time,” she said, “we said we would like her to come home. Please just let her come home.”

Local care for patients like Angie Bauknight has been rare in Western North Carolina.

Care for patients in crisis — who may be suicidal or violent — would expand under plans the state House and Senate may approve.

But mental health advocates say they need more than the $20 million to $24 million increase lawmakers are considering if they are to address the state’s problems.

“When what you need is a long, steady, soaking rain, it’s hard to get too excited about a sprinkle,” said David Cornwell, a native of Fletcher and executive director of N.C. Mental Hope.

Sen. Martin Nesbitt, the principal author of the Senate plan for mental health, defended the amount of money it provides, saying it is all a chaotic system can bear.

He cautioned it is not a cure-all. Earlier this year, a committee he co-chairs recommended a $135 million increase in money for mental health.

But Nesbitt said the Senate plan addresses the No. 1 need of the state mental health system by putting $14 million toward crisis care.

Local agencies could use the money to build facilities or pay health workers for mobile crisis teams.
Crisis care

A person suffering from mental illness needs specialized care but often winds up in an emergency room or jail.

Safety concerns led the state to limit admissions to its four psychiatric hospitals, including Broughton Hospital in Morganton, the closest crisis care for those in Buncombe and surrounding counties.

When Broughton is full, people must seek help in Raleigh or Goldsboro or at overbooked community hospitals closer to home. Mental health patients might wait hours or a full day for treatment at Mission Hospitals, if they’re admitted.

“These are the very citizens who are in many cases not able to continue work, who are much more likely to ... show up at Pritchard Park, creating a nuisance, much more likely to show up in the county detention center because they’re disturbing the peace,” said James Pitts, co-president of the National Alliance on Mental Illness’ WNC chapter.

For law enforcement officers, the time spent committing patients could have been used to curb crime.

A sheriff’s deputy might spend a day or more picking up a patient, driving to a hospital as far away as the coast, waiting for an assessment and filling out paperwork.

Neil Dobbins Detox Center in Asheville is scheduled to start crisis care treatment this fall, providing room for five to 16 patients at a time.

But advocates said that program could fill up and leave outlying counties short.
Local control

An experiment in funding more local treatment is included in both versions of the state budget. Nesbitt hopes the plan will be tried in Buncombe County.

The program would put the local workers that oversee mental health in charge of their areas’ psychiatric hospital admissions, giving them extra money to reduce those admissions.

“One of the glaring errors we’ve made along the way in reform is we didn’t empower the locals enough,” Nesbitt said.

Senators want to pay for crisis care with money taken from other mental health services.

Local agencies are returning about $38 million of the $509 million they received this year to the state. That shows the mental health system isn’t ready for a large amount of new funding, Nesbitt said.

Advocates complain there are too many rules on how the money can be spent.

Nesbitt and other lawmakers have proposed expanding a program that lets some agencies spend their money on clients without regard to which category they fall in.

Western Highlands, which covers Buncombe and seven other mountain counties, hopes to be one of the areas allowed greater flexibility.

It “would be a great benefit to the citizens of North Carolina,” Western Highlands CEO Arthur Carder said. Read more!

Good care knows no ideology - Boston Globe

GLOBE EDITORIAL

June 25, 2007

"THE ONLY good institution is a closed institution" -- that's a common belief among many people working in the disability field. This single-minded commitment to deinstitutionalization is well-intentioned, but it is has developed into a barrier both to reliable care for retarded residents of Massachusetts and creative reuse of vast tracts of state-owned land from Baldwinville to Waltham.


The 977 retarded men and women still living in six state-run institutions are known in Department of Mental Retardation circles as "stayers." The "movers" are the roughly 8,500 DMR clients living in privately-operated group homes that often accommodate four to six residents. Another roughly 1,000 men and women with intellectual disabilities live in DMR group homes operated by state workers. All too often, policy disagreements between these groups are resolved not through consensus, but litigation.

The Fernald Development Center in Waltham is the current legal battleground between the "stayers" and the "movers." Many of the 186 people living there also have serious medical complications requiring ventilators, feeding tubes, and other devices. Their relatives and guardians praise the quality and continuity of care at Fernald, where many elderly residents have lived for decades. DMR, however, wants to move people out of the facility. The Patrick administration is even challenging the standing of federal Judge Joseph Tauro, the longtime monitor of the institution who humanely proposes that residents be allowed to remain.


Patrick's priorities emerge
The Patrick administration has stopped short of former governor Romney's call for the outright closure of these six state campuses. But the administration's views are starting to emerge, and they don't favor the future of the six institutions. "Why perpetuate that model," asks Dr. JudyAnn Bigby, the state's secretary of human services, "when people can be successfully moved and placed in smaller, community settings?"

Those will sound like fighting words to the Coalition of Families and Advocates for the Retarded, whose members argue persuasively that care is often more consistent at the state institutions, where higher salaries and better benefits result in less frequent staff turnover. For COFAR, the presence of on-site physicians and 24-hour nursing care at Fernald and other state facilities easily trumps the group home with a picket fence.

But Bigby's message is sure to be music to the ears of Massachusetts Arc (formerly the Association of Retarded Citizens) a powerful advocacy group for retarded residents in the state. It enjoys the support of the private vendors who operate roughly 2,000 group homes under contract with DMR. The director of Arc, Leo Sarkissian , argues that equal or better treatment is available in private group homes for even the most medically fragile residents. Arc estimates that keeping the six state institutions open would require $210 million in capital expenditures alone over the next 20 years, money better spent on community care.

Finding the right balance between institutional and community-based care now falls to DMR's new commissioner, Elin Howe. She refused last week to comment on the future role of the institutions or any other DMR business until she arrives here next month. Howe, the former commissioner of the New York state office of retardation, will need superior diplomatic skills. Outgoing commissioner Gerald Morrissey enjoyed the respect of both COFAR and Arc, and not even he was able to craft a compromise at Fernald agreeable to both sides.


Ample room for compromise
One thing is certain: There is plenty of land on which to accommodate the state's retarded residents. US Attorney Michael Sullivan, the court-appointed monitor in the ongoing litigation over the right of residents to remain at Fernald, surveyed the six institutions during his year long analysis of the services offered by DMR. He expressed surprise at the "vast acreage surrounding the state institutions" in a March report: 123 acres at Glavin in Shrewsbury; 54 acres at Hogan in Danvers; 400 acres at Wrentham; 588 acres at Monson in Palmer; 186 acres at Fernald; and 2,600 acres at Templeton in Baldwinville.

One good approach would be to solicit bids for the land from private housing developers, provided they agree to build group homes for the retarded on the periphery of the campuses or set aside units in their developments. These could serve the roughly 200 new DMR clients who arrive each year in need of residential services. Respite care could be offered on the grounds for use by the thousands of families who now receive only limited home-based services for their retarded relatives, or none at all. Campuses in key locations could still provide the intensive medical care needed for the most medically complicated cases.

Creative solutions would first require Arc and its supporters to stop the provocative campaign to close all of the institutions. In turn, COFAR and its supporters would need to agree on a long-range consolidation plan that leaves some campuses in place with a full array of intensive medical services while planning for the closing of others. As long as the two groups are squabbling, there is no real incentive for DMR officials and state redevelopment experts to come to the table.

Most town officials know better than to discriminate against people with disabilities. But selectmen and other elected officials are likely to resist any new housing developments on state properties. They argue that such growth places too many demands on local services, especially schools. Legislators do the bidding of local officials on such homegrown issues. But a true coalition of advocates for the retarded could counter that trend. The Patrick administration could also pitch in by appointing members who favor compromise to the lapsed Governor's Commission on Mental Retardation.

All disabilities are not created equal. The state needs both group homes that offer maximum independence and medically-intensive facilities that offer round-the-clock nursing care. The physical space is there if the Patrick administration and the advocates for the retarded can summon the will.




Read more!

'Housing is health’ for many people with mental illness -University of Alabama Dateline

Pairing a home with treatment is best but not easily done

By Sarah Bruyn Jones

NORTHPORT -- Inside, the apartment was dark, but it was a roof over Maddox’s head and had running water and enough wall space to hang countless framed family photographs.

Maddox’s living room was filled with oversized furniture. An armchair was in one corner with a matching couch against the opposite wall. A wooden media center sat in another corner housing the television, which was on -- a constant companion and the only source of light.

Maddox’s home is a big step up from her sister’s floor or a friend’s couch. But her path to suitable housing has been filled with potholes caused directly and indirectly by her mental illnesses. Stress ignites some of her difficulties with depression and schizophrenia, but she attends therapy sessions with Indian Rivers Mental Health Center and stays in touch with her caseworker. She recently had to spend a few days in the hospital after trying to commit suicide.

“I’m under a lot of stress," the 33-year-old Tuscaloosa native said during a recent interview at her home. “I got to worrying about my family, and I had a meltdown. I’m just carrying other people’s burdens when I should be thinking about my own."

She said after the short stint at North Harbor, it was nice to know she had a home to return to.

“In the beginning, it used to be that I couldn’t see my way, I didn’t know if I was coming or going. But at least now I know I have a bed, a roof, a home," she said.

Maddox, who asked to be identified by her last name out of fear of stigma because of her mental illness, was diagnosed with schizophrenia and depression in 2002. She hasn’t worked since the diagnosis, and instead lives on her disability payments of $648 a month.

Still, she acknowledges she is one of the lucky ones, even if she does have a few complaints. She said she would like to move to a different apartment and didn’t understand that paperwork she signed a while ago had renewed her lease. But mostly, she is content. After all, she has a home.

Maddox is one of a handful of people to receive a rent stipend through the federal government program Shelter Plus Care. It’s a program that has the support of nearly all involved. Patients like it because they get stable housing and consistent contact with a social worker, and the social workers maintain it prevents people like Maddox from getting lost in the system.

Other programs that offer support and a roof are also being touted, but funding and locating adequate housing has proven difficult.

“We want to be able to provide good continuous housing and be able to wrap services around the person," said Okon Dale, the health care for homeless veterans coordinator at the Tuscaloosa Veterans Affairs Medical Center.

Shelter Plus Care

Twenty people are on Shelter Plus Care grants. Eleven of them are veterans and are managed through the Tuscaloosa Veterans Affairs Medical Center. One is a West Alabama AIDS Outreach client, and the rest are clients of Indian Rivers Mental Health Center.

The Shelter Plus Care program is authorized under the McKinney-Vento Homeless Assistance Act and has been awarding grants to state and local governments since 1992. Tuscaloosa, however, received its first Shelter Plus Care grant in 2005 for 10 people.

Since the dollar amount is based on fair market rent prices for the year, the amounts differ from year to year. In total, Tuscaloosa has received $506,400 for the program.

This year, Tuscaloosa is requesting $141,300 to support five more people.

The program was built on the premise that housing and services need to be connected to ensure the stability of housing for those with a chronic illness, addiction or mental illness. For every dollar that the grant helps supplement in rent, the local service providers must provide a dollar’s -worth of care.

“Right now, Shelter Plus Care is our best solution," said Debbie Williams, Salvation Army social service coordinator and a member of the CHALENG committee, which secures government grant funding for all housing programs in Tuscaloosa County and Tuscaloosa city.

“Housing is health. People need a stable place to live. Otherwise, everything else becomes in jeopardy."

Federal grant application guidelines require that communities form continuum of care committees. The name of the combined Tuscaloosa County and Tuscaloosa city continuum is CHALENG.

Because each continuum is awarded funding based on population, CHALENG cannot simply ask for a large amount of money to fund all the Shelter Plus Care people its membership believes are needed, which some suggest to be as high as 100. Instead, the group has been forced by the funding guidelines to request support for about five new people with each annual funding cycle.

Shelter Plus Care is one of 39 programs funded through the Department of Housing and Urban Development’s SuperNOFA grant process. For 2006 applications, $2.2 billion was available nationwide for SuperNOFA programs. Of that, Tuscaloosa could apply for $207,139. That’s a number that is based on census data, Williams said, noting that Birmingham can apply for up to $2.3 million through the same grant process.

The local continuum, which must vote to prioritize its programs, is asking to use the bulk of the money for five additional Shelter Plus Care people.

The search for housing

Because under the program the maximum rent allowed is $340 a month for a one bedroom, the selection of apartments is limited. That cap on rent differs depending on cost of living and housing in various parts of the country. But in Tuscaloosa, it can pose a problem.

“It’s really difficult to find an apartment for that little," said Shelia Calhoun, the homelessness case manager at Indian Rivers. “And many of the low income places are in bad neighborhoods. The last thing our clients need is to be in a bad neighborhood, because they are so easily susceptible to the negative influence."

That negative influence can and does lead to criminal activity and, at times, arrests. Calhoun said the last place someone with a mental illness needs to be is in jail.

Sill Calhoun said she could use more Shelter Plus Care subsidies to help secure stable housing for more clients.

“Money is the biggest challenge for most of the people I work with," she said, noting that even if their monthly incomes can pay rent and utilities, they often don’t have enough for security deposits, and their credit histories are poor.

Shelter Plus Care falls under the umbrella of supportive housing, which has become the vogue solution for housing mental health patients without returning to an institutionalized protocol.

Lately, the Department of Mental Health and Mental Retardation has pushed for more supportive housing options. In April, a department committee released a report estimating that the state needs 8,782 supportive housing units. Among those estimates, Indian Rivers needs 427 units and West Alabama Mental Health Center could use 207.

And it’s not just the state shouting for more beds. The VA, parents of the mentally ill and advocates are all pushing for more options.

“There could always be more beds," said Scott Martin, the director of residential treatment programs at the Tuscaloosa VA. “We especially need those beds that allow a person to be independent in the community but have some structured support."

Supportive housing is touted as a growing trend across the nation. Proponents say it is increasingly clear that people with serious mental illness have better treatment outcomes if they live in a stable, supportive housing environment. Statistics such as 80 percent of supportive housing tenants maintain housing for at least a year are cited to support the need for more such programs.

The main purpose is to promote independence, while trying to avoid people slipping through the cracks and having to be re-hospitalized. And considering the average disability check is about $630 a month, most programs include financial assistance.

People who have worked with Roderick Sims say his journey through Indian Rivers shows the success of supportive housing.

Roderick Sims’ story

Roderick Sims used to be a wanderer. He would walk all over Tuscaloosa. It’s unclear if he had a stable home, but he couldn’t hold a job.

He was ultimately diagnosed with paranoid schizophrenia.

When asked about his past, he started by describing his trip to Indian Rivers.

“I went there and they helped me get here," he said.

Since his diagnosis, he has worked his way through various steps of treatment and housing.

He spent time in the hospital and later lived in a group home.

Then he moved to Pinefield Apartments, which are owned by the Department of Housing but run by Indian Rivers. Onsite care is available 24 hours a day, but the residents live independently.

Since moving to Pinefield, Sims has held a steady job. He still walks a lot, but instead of walking without a destination, he hikes the quarter mile to the store for milk or the bus stop.

He has also completed his application for Section Eight housing, a government subsidized voucher for low-income individuals. He said he’s ready to be on his own.

“They’ve got rules here," he said. “No visitors at night, and I have a curfew. It’s a good place to be, but I’m trying to be on my own."

And that’s exactly what those at Indian Rivers said they would like to see. But with a waiting list for Section Eight and few other options, Sims will stay were he is for the time being.

Taking on new jobs

The need for independent housing that has some sort of treatment connection is so strong that Indian Rivers has started to get involved in property management.

Indian Rivers’ executive director, Jim Moore, said he doesn’t want to be a property manager but in order to do his job of treating the mentally ill he might have to take on the role of apartment building landlord.

“I’m not sure I want to be the biggest landlord in town, but that could easily happen," Moore said. “Being a landlord allows us to do more of what we need to do for our clients. But it also forces us to branch out and do more of what we aren’t meant to do."

Despite his concerns, Moore has purchased several properties within the last year. The most recent purchase was a group home in Bibb County.

Even the properties operated by Indian Rivers aren’t ideal. Most are in remote areas where access to public transportation is not available. Moore said he worries that by creating communities on the outskirts of town, and therefore not integrated with the general population, the system may just be instigating another form of institutionalization or segregation from the general population.

“We’re supposed to be integrating our folks in the community," he said. “But when you stick them in these other places, it’s a concern that we are just building another institution."

Reach Sarah Bruyn Jones at sarah.jones@tuscaloosanews.com or 205-722-0209. Read more!

Mental-health care faces language, cultural barriers -Richmond Times-Dispatch

By Juan Antonio Lizama
Times-Dispatch Staff Writer

Zoila Arteaga had trouble communicating with her 8-year-old son and feared he had a brain injury.

The Richmond school system instead attributed her difficulties to a language barrier. The Richmond family speaks Spanish at home, but Arteaga's son prefers English.

It turns out that he may only have a learning disability.

Arteaga learned this after consulting with Carla M. Shaffer, a graduate student therapist at Virginia Commonwealth University's Latino Mental Health Clinic. Shaffer helped Arteaga to work with the school system, and she expects a full evaluation of her child this fall.

Arteaga's story is an example of how a resource-challenged mental-health system is reaching out to immigrant communities in the Richmond area. Arteaga, who is from Mexico, was fortunate to find a mental-health therapist who speaks Spanish. She speaks English, but is more comfortable with Spanish. Shaffer could communicate effectively with her and her son.

"As the various groups of immigrants increase .¤.¤. it really challenges the health system to find ways to reach out to people that need our services," said Michael O'Connor, executive director of Henrico County Mental Health and Retardation Services.

It's difficult to find Hispanic and Asians and other minorities in the mental-health field. "There is a lot of competition for minorities who have those credentials," he said.

The demand is especially pronounced for Spanish-speaking immigrants, O'Connor said. His agency educates immigrant population through churches and other community organizations, he said.

"I think that when you have people who form part of a culture and speak the language, you find that people seek services much more readily."

The Latino Mental Health Clinic, housed within VCU's Center for Psychological Services and Development, opened this year to offer services in Spanish and other foreign languages. Three graduate students are offering counseling in Spanish.

In a recent needs assessment of the Richmond-area Latino community, a study led by clinic director Dr. Rosalie Corona, people rated mental-health services high on the list.

Though the clinic is new, it already has a waiting list, which is the case in most mental-health agencies, Corona said. The list is growing as schools and other organizations refer clients. The waiting period at the clinic is at least a month.

"Our waiting list further reinforces the findings of the needs assessment that bilingual mental health services are urgently needed," she said.

Peter V. Nguyen, assistant professor at VCU School of Social Work who specializes in acculturation dynamics and mental-health access and services for immigrants, said the Virginia Tech shooting should alert the public at large and state lawmakers that there are serious existing mental-health issues in the immigrant population.

Korean immigrant Seung-Hui Cho shot 32 people and himself at Virginia Tech in April. Nguyen said the tragedy should result in a large-scale initiative or serious discussions exploring effective outreach strategies and use of mental-health resources that would address the needs of the immigrant population.

"The problems are brewing and they're there," he said. "I think it needs to become a priority in our legislature." Dr. Asha S. Mishra, medical director of the Chesterfield Community Services Board and a professor of psychiatry at VCU, said her agency tries county employees as interpreters and translators.

Relatives, church and family members and in some cases children are used as interpreters in emergency situations, she said.

Henrico County also does the same. CJW Medical Center and VCU Medical Center also provide interpretation.

"It is not preferable, but sometimes is the only option you have," Mishra said about family and children interpreters. "You have to make do with what you've got.

"It is hard to provide psychiatric services when it's somebody's child or somebody who has nothing to do with health care serving as the interpreter. What you really need is a culture broker."

Read more!

Addiction experts say video games not an addiction - Reuters

By Julie Steenhuysen
June 24, 2007

CHICAGO - Doctors backed away on Sunday from a controversial proposal to designate video game addiction as a mental disorder akin to alcoholism, saying psychiatrists should study the issue more.

Addiction experts also strongly opposed the idea at a debate at the American Medical Association's annual meeting.

They said more study is needed before excessive use of video and online games -- a problem that affects about 10 percent of players -- could be considered a mental illness.

"There is nothing here to suggest that this is a complex physiological disease state akin to alcoholism or other substance abuse disorders, and it doesn't get to have the word addiction attached to it," said Dr. Stuart Gitlow of the American Society of Addiction Medicine and Mt. Sinai School of Medicine in New York.

A committee of the influential physicians' group had proposed video game addiction be listed as a mental disorder in the American Diagnostic and Statistic Manual of Mental Disorders, a guide used by the American Psychiatric Association in diagnosing mental illness.

Such a move would ease the path for insurance coverage of video game addiction.

Even before debate on the subject began, the committee that made the proposal backed away from its position, and instead recommended that the American Psychiatric Association consider the change when it revises its next diagnostic manual in 5 years.

The psychiatrist group has said if the science warrants, it could be considered for inclusion in the next diagnostic manual, which will be published in 2012.

While occasional use of video games is harmless and may even help with some disorders like autism, doctors said in extreme cases it can interfere with day-to-day necessities like working, showering or even eating.

"Working with this problem is no different than working with alcoholic patients. The same denial, the same rationalization, the same inability to give it up," Dr. Thomas Allen of the Osler Medical Center in Towson, Maryland.

Dr. Louis Kraus of the American Academy of Child and Adolescent Psychiatry and a psychiatrist at Rush University Medical Center, said it is not yet clear whether video games are addictive.

"It's not necessarily a cause-and-effect type issue. There may be certain kids who have a compulsive component to what they are doing," he said in an interview.

But addictive or not, too much time spent playing video games takes away from other important activities.

"The more time kids spend on video games, the less time they will have socializing, the less time they will have with their families, the less time they will have exercising," Kraus said.

"They can make up academic deficits, but they can't make up the social ones," he said.

The AMA committee will consider the testimony and make its final recommendation to the AMA's 555 voting delegates, who will vote on the matter later this week.

The Entertainment Software Association, which represents the $30 billion global video game industry, said more research is needed before video game addiction should be categorized as a mental disorder.

(Additional reporting by Scott Hillis in San Francisco)
© 2007 Reuters Read more!

Internet site offers resources on mental health -Columbia (MO) Daily Tribune

By SARA SEMELKA
June 24, 2007

After the mass murder in April of 32 people at Virginia Tech University and the disclosure that the gunman suffered from mental illness, Faisal Ahmed wanted to provide Mid-Missourians access to information about mental health.

This image shows the “Mizzou” page on the healingarts-online.com Web site, which was launched by Faisal Ahmed, a recent psychiatry graduate of the University of Missouri-Columbia.

Using the concerns of his patients as a guide, Ahmed, a recent psychiatry graduate of the University of Missouri-Columbia, designed and launched a Web site to act as an informative guide for mental health crisis management, prescription drugs and local mental health resources.

"The philosophy is for it to be the one portal of care options in Mid-Missouri and Columbia," Ahmed said yesterday.

One feature of the site is a step-by-step guide for individuals who feel a close friend or relative is in need of professional mental health services.

"The main resistance for people seeking help is that they wonder, ‘What’s going to happen to my wife or husband if I take them in?’ " Ahmed said. "With a click of a mouse, now you can find out exactly what will happen."

Ahmed said that it is often hard for people to decide to bring a loved one to the hospital because of a psychiatric problem but most patients are grateful after they receive the treatment.

"It’s painful to hear voices, it’s painful to be depressed," he said. "They are thankful."

Under the "Topics" section of the home page, a visitor to the Web site can find descriptions of causes, warning signs, treatment options and facts about the most common psychiatric disorders such as depression, post-traumatic stress disorder, bipolar disorder and attention-deficit hyperactivity disorder.

Web site users can also take online self-assessment tests for information about alcohol abuse and anxiety disorders. A subsection of the Web site deals specifically with women’s mental health issues such as postpartum depression and rape trauma.

The site also features a discussion board where people can register anonymously and have their questions answered by a team of psychiatric residents.

Links to hospitals, care centers, hot lines, support groups and instructions for reporting abuse are a crucial part of the site, Ahmed said.

Ahmed said that since he spoke with Columbia Mayor Darwin Hindman about the site, a link to his Web site is now available on the city’s Web site. Ahmed said he wants to get in touch with Columbia Public Schools officials and hopes to make presentations in high schools this year.

"We wanted to provide authentic, researched information and videos that are properly presented," Ahmed said, adding that before the launch two months ago, several MU professionals edited the site.

In the future, Ahmed said he plans to add features such as teleconferencing with psychiatrists and free online mental health screenings.

Nancy Howard of the Boone County Mental Health board of trustees said there is a need for a Web site such as Ahmed’s.

"I’m glad. I think the idea is wonderful," Howard said. "Somebody’s doing something to get the information out there, and I want to commend him for taking the time."

Howard said she hopes Ahmed will make more community presentations to spread the word, including one to the board.

"I want to ask him to come visit and talk to us about it because it’s a great resource," Howard said.

Reach Sara Semelka at (573) 815-1717 or ssemelka@tribmail.co Read more!

Mental health provider broke rules, state says -Greensboro News-Record

By Mark Binker
June 24, 2007

GREENSBORO — A company that provides key mental health services for agencies in Charlotte, Greensboro and Raleigh has used unqualified providers to treat patients, according to recent state investigations of the company.

Dominion Healthcare, a Durham-based nonprofit, has been the subject of no fewer than three state Division of Mental Health complaint investigations since 2006.

North Carolina has increasingly relied on companies such as Dominion since 2000, when the state pursued what is commonly called mental health reform. In its current incarnation, reform shifts the focus of publicly provided mental health care away from large, central mental hospitals to private providers in patients' communities.

Dominion was incorporated in 2001, as were many similar providers who sought to take advantage of the increasing workload — and potentially lucrative payments — offered by the state.

Reports from two 2007 state reviews listed 63 state regulations that Dominion had violated. Those breaches included failure to check staff members' criminal histories and failure to ensure staff members had proper qualifications to deal with patients.

The News & Record has made repeated calls to Dominion's offices during the past week seeking comment from the company's president, Joel Hopkins. Hopkins has not returned calls. Nor has anyone from the company responded to a message given to Larry Hall, a Durham lawyer who does work for the company.

Dominion first obtained permission to provide publicly funded health care in Guilford County on March 26. The Guilford Center, the local public mental health agency, gave the group permission to operate locations on Freeman Mill Road and South Elm Street.

The company is allowed to diagnose illness in clients and provide "community support services," a linchpin in the evolving state mental health system.

Support services include everything from making sure a person has a place to live and can find a job, to making sure clients take medication and are getting to appointments with more specialized health care providers. Dominion is one of many such providers used by Guilford County.

"If you're in a crisis, if you have an emergency, that's the person you call," said John Tote, executive director of the N.C. Mental Health Association. "You can't be dealing with someone who isn't qualified or is learning on the fly."

Community support providers have become important in North Carolina because of a push to reduce the number of patients in big institutions, such as Raleigh's Dorothea Dix hospital. Since 2000, the state has placed greater emphasis on moving mental health clients back to their communities.

While support providers play a key role in doing that, they were also at the center of controversy earlier this year when the state cut the amount it would pay to those providers. That move was based on figures that showed the state was paying three times what it anticipated the program should cost.

Tote and other mental health experts say most providers give good service to the patient, but there are some that are not up to the task.

A series of reports by state and local agencies raise questions about Dominion specifically:

l The company was ordered to repay $44,613.12 in April 2006 after an audit by the state's Medicaid program. The audit found one of the company's Raleigh branches had failed to document treatments properly.

l A Feb. 5 complaint investigation report said that the company's Charlotte branch had failed in some cases to conduct proper personnel registry checks, had not made clear to some clients or their guardians that Dominion was providing mental health services, and failed in some instances to document treatment properly.

l A May 3 complaint investigation report showed that some staff members had not received proper health care registry or criminal history checks. As part of the same report, investigators checked the records on 25 of Dominion's professional staff and found that 15 "did not meet the experience requirements for a Qualified Professional position" and that 17 "did not meet the experience with population served requirements for a Qualified Professional position."

Asked if the findings show that Dominion was allowing unqualified or underqualified people to treat patients, Jim Jarrard of the state's Mental Health Division said, "Yes, that is exactly what it means."

Jarrard heads the accountability team at the division that investigates complaints against mental health providers.

As part of their May 3 report, investigators wrote that they gave Dominion no advance warning of their visit because the company had been accused of falsifying or backdating records during prior reviews. The report did not provide specifics of that accusation.

Jarrard said investigators also gave Dominion limited time to respond to information requests made in association with the May 3 report.

He said some of the findings could point to simple paperwork errors. But, he said, the only way the state has to confirm whether a mental health provider has given a client proper treatment is if its paperwork is in order.

"You're either in compliance or you're out of compliance," Jarrard said.

Jarrard said Dominion is one of the larger providers in the state and as such has been the subject of more complaint investigations than a small, more local provider would endure.

"We get a lot of complaints about them, but those which we have substantiated are those you see before you," Jarrard said.

In a May 3 memo from Guilford County's Provider Quality Improvement Committee to Jarrard, Guilford Center officials reported that staff members at the new Greensboro Dominion branches had made "questionable" referrals of patients for services.

To protect patient confidentiality, Guilford Center officials removed some information from the copies released to the News & Record. However, it appears Dominion may have been asking to provide mental health services for clients with little or no history of mental illness.

Alexis Underwood, mental health service coordinator at the Guilford Center, said his agency referred those cases to the state.

He said some of those inappropriate referrals may have been the result of "inexperience" on the part of the provider.

And Underwood said the Guilford Center would not "overstep" the state's authority.

However, if Wake County, where Dominion was first authorized to operate, were to rescind its "endorsement" allowing Dominion to operate there, Guilford County would follow suit.



Contact Mark Binker at (919) 832-5549 or mbinker@news-record.com Read more!

McNabb Center to toss LifeLine to those in mental-health gap -Knoxville News Sentinel

By KRISTI L. NELSON

An "array of good services" in the Knoxville area makes up the mental-health safety net, said Clif Tennison, Helen Ross McNabb Center vice president and chief clinical officer.

Examples, he said, include sliding-scale programs such as Interfaith Health Clinic and the community collaboration Knoxville Area Project Access, as well as free-care clinics operated by doctors and organizations, and indigent-care programs through the county health department and businesses such as Cherokee Health.

But even as various groups try to cover every instance in which an uninsured person might need mental-health services, there's still one gap in the net: eligibility criteria. Every organization has some sort of eligibility criteria, Tennison said, and there are a few people who just don't fit anywhere.

McNabb Center hopes to sew up that gap with a new program, LifeLine, that is set to run three years. Starting in fall, LifeLine will care for about 200 uninsured adults annually by providing comprehensive psychiatric assessments, treatment and intensive follow-up and outreach, including medication management and therapy when needed.

Though "we won't turn anybody away," Tennison said, the program is designed to help people who have "severe and persistent mental illness" of the type that a primary-care clinic that treats sore throats, ear infections and chronic health problems just isn't staffed or equipped to treat on an ongoing basis.

"It would be really hard to treat, for example, chronic schizophrenia in a free (primary-care) clinic like that," Tennison said, because the nature of the illness requires constant management and outreach to keep the patient from ending up hospitalized, homeless or in jail. "You can't do that in a private office, even if your heart's huge and you're giving away free care."

All mental-health agencies locally provide some care for free, he said, but without reimbursement they don't always have the resources to provide the quantity or quality of care each client really needs. Too often, agencies end up referring clients to another agency - but without follow-up, there's no guarantee they'll even make it to help.

LifeLine, ultimately, would help with that transition. Designed as a short-term program, it's modeled on the success of ChildNET, a program that McNabb Center began in 2002 to help uninsured children with mental, emotional or behavioral problems. In the course of that program, after the children were stabilized, about half qualified for TennCare or another program, Tennison said, which opened up those ChildNET slots for other children.

LifeLine, it is hoped, would eventually treat more than 200 people a year.

The McNabb Foundation started a campaign, headed by board members Dale Keasling and Bo Shafer, at the beginning of June to raise the estimated $775,000 that will be needed to start the program and fund it for three years. The campaign will continue through the summer.

Less than a month into the campaign, the foundation has already raised almost $380,000.

"This really tugs at the heartstrings," Tennison said, and sometimes attracts a different group of donors than those who give money for bricks-and-mortar building campaigns. "There's no infrastructure involved. There's no building; there's no vans. It's just to hire a psychiatrist and a nurse and a social worker to treat people who have nothing and no insurance."

Tennison said a lot of the funding so far has come from McNabb staff "because they see the people and the need. (Situations where) we know what to do but don't have the resources to do it is one of the most painful things that happens in our line of work."

With LifeLine, McNabb Center "won't miss a beat" when it does crisis intervention for people who have lost insurance (or never had it) before experiencing an episode of mental illness. Instead of providing "patchwork" coverage or referring clients elsewhere, McNabb Center can do a comprehensive assessment that includes psychosocial history, a psychiatric evaluation and a nursing assessment, and then follow up by helping clients access and manage medication and even find solutions to primary-care, housing or employment problems.

"The way I like to think about it is, 'Stand up and do it anyway' " Tennison said. "In other words, we can sit around and cry and whine and gnash our teeth and pull our hair and boo-hoo about how, oh, the federal block grants are less, and TennCare cuts, and Gov. Bredesen's disenrollment, and private grants don't give as much as they used to because they have other priorities now, and all these things are falling through the cracks, and we can't do what we know how to do.

"Or you can just say, 'By God, we know what to do. We know how to do it. All we need are the resources. So we're just going to ask the citizenry of the town to see if they'll give the money to develop the resources and do what needs to be done


Read more!

Dorothea Dix's value is in the eye of the beholder -Raleigh News and Observer

By David Bracken and Michael Biesecker

Earlier this month, Raleigh Mayor Charles Meeker pegged Dorothea Dix's worth as parkland at $10.5 million, a figure that was immediately derided by several state lawmakers who think the 306-acre site is worth much more.

While haggling over Dix's value is nothing new, the response to Raleigh's offer shows just how wide the gap remains more than three years after the state announced it would close the 150-year-old psychiatric hospital on a hill overlooking the city's central business district.

"I think there's folks who may be unrealistically low on the outside, but I also think there's folks here [at the legislature] who are unrealistically thinking they're going to get all this money, you know, $100 million, out of a market value," said Sen. Janet Cowell, D-Wake.

If a deal is to be struck between the city and the General Assembly, which must approve the sale of Dix, Cowell said it could involve a long-term payment scheme.

"I think the most likely scenario is some sort of lease-to-own setup," Cowell said. "That's certainly not a given, but that to me is the path I can see through."

Sen. Neil Hunt, R-Wake, who showed up at last week's Raleigh City Council meeting to voice his support for turning Dix into a park, also said leasing the property is a viable option.

"I think the city needs to be in a position to pay what the land's worth," said Hunt, who estimated its value at $40 million.

A price tag of $40 million to $50 million could make a long-term lease more likely, as that amount would make it hard for the city to purchase the property at one time.

It would also greatly affect the city's long-term financial plans to develop Dix.

Meeker and others behind the city's offer want to turn it into a "destination park." Such a project would require investing tens of millions of dollars over many years.

Dix Visionaries, a park advocacy group, has promised to raise more than $7 million from private donors, but much more will be needed.

Last week, Meeker sent a letter to Gov. Mike Easley reasserting the city's desire to buy Dix and offering to help in the selection of an appraiser. The governor's office said Easley was focused on the budget now and would further discuss the Dix matter at the appropriate time.

How an appraisal of Dix is conducted will be important.

Park advocates insist the property should be appraised as parkland -- not as land that could be sold to the highest bidder.

"It's very important that a distinction is made between [the campus being] sold to be commercially developed or to a public-private partnership that plans to invest millions in it," said Greg Poole Jr., president of Dix Visionaries.

Poole said he is open to the idea of having a public-private partnership lease the property.

"We could work with that," he said.

Parkland-based offer

While Raleigh's $34,000-an-acre offer has been widely panned, Meeker continues to insist it is realistic. As proof, he points to the average price-per-acre the city has paid for other tracts of parkland in recent years, which comes to about $23,000 an acre.

Given Dix's prime downtown location and its legacy as a mental health facility, few lawmakers are viewing a potential transaction as just another land sale. Some legislators have recommended that proceeds from Dix's sale go toward the Mental Health Trust Fund; that idea may tempt lawmakers to support a higher valuation.

Meeker and other park advocates say it is unrealistic to think money from the sale of Dix will significantly address the state's mental health needs.

"The mental health needs of the state will not be solved by any amount of revenue from the Dix hill property," Meeker said.

In the end, park advocates are hoping that the General Assembly's Wake County delegation can convince other lawmakers that Raleigh's offer for Dix makes the most sense, even if it's not the most lucrative.

"I'm sure they might get some huge amount," Cowell said. "But I don't get the sense that's what the people of North Carolina want, just some sort of developer free-for-all over there. There's still a sense of sacredness to the place."

Read more!

AMA may identify excessive video game play as addiction -Chicago Tribune

CHICAGO — An American Medical Assn. committee meeting in Chicago to consider its future public health agenda asked its policymaking body Sunday to determine whether to support adding video game addiction to a key handbook on mental illness.

Testimony at the AMA annual meeting seemed to favor deferring to the American Psychiatric Assn., which will make the final call as it writes a new edition of a diagnostic manual for mental health professionals.

Sunday's debate at the AMA centered on whether enough science was available to classify excessive video game playing as an addiction and whether the organization should advocate an outright classification as an addiction or push for limits on game playing such as one to two hours of "total daily screen time."

The psychiatric group will decide the issue over the next five years. It could determine whether doctors determine medications or treatments for excessive gaming and whether employers or insurers pay for coverage as they might for alcohol or drug dependency.

Other groups urged the AMA to back down from declaring excessive video game playing an addiction, saying such activity is problematic but more a societal issue than a medical problem.

"If you are not putting time into hobbies and interests, [life] would be pretty boring," said Dr. Stuart Gitlow, an AMA delegate representing the American Society of Addiction Medicine. "If it wasn't an addiction with baseball, model trains and cars, then it isn't with video games."

Other doctors told the AMA there may even be health advantages to gaming, citing studies showing benefits for children with autism. Benefits for Alzheimer's disease patients are also being studied.

The message board at the website for On-Line Gamers Anonymous is filled with stories about people whose lives have been changed by games.

"I don't want to admit that I messed up my first 2 years of college with games, I mean, I passed," one poster wrote. "But what if those C's and B's were A's?"

Liz Woolley founded On-Line Gamers Anonymous after her son killed himself because of his obsession with the fantasy role-playing game "EverQuest." Her priority is "to educate parents that these games are addictive." Parents, she said, should know that their child could be getting up in the middle of the night to play, without them knowing. Read more!

Psychiatrist for aged prefers house calls -Raleigh News & Observer

Thomas Goldsmith, Staff Writer

WINSTON-SALEM - Dr. Burton Reifler sees the White House welcoming sports heroes and thinks it's time to honor another kind of champion -- the family caregiver.

"I wish the president would find somebody who had stayed up all night taking care of her elderly mother, then got the kids ready to go off to school," said Reifler, a geriatric psychiatrist. "I think he ought to call that person and give her a pat on the back."

As a specialist in aging and mental health, Reifler has been a front-runner in the effort to help older people with mental illness and those who care for them.

Reifler started his efforts long before the current rush to prepare society for the "tsunami" of aging baby boomers.

The doctor has been recognized nationally and internationally for his work and was recently honored with a named professorship at Wake Forest University.

Reifler, the chairman emeritus of Wake Forest's psychiatry department, is back where he started 30 years ago, going out to visit older patients with mental illness.

"There would be instances where a community agency would think the person needed to go into a nursing home right away," said Reifler, 62, at his office at Wake Forest University Baptist Medical Center.

But if Reifler and his team found that the person had fresh food in the refrigerator, a clean place to live and bills paid, they suggested that the person could stay home -- with a little help.

In the decades since he started, the idea that people with various kinds of disabilities can stay at home under the right circumstances has moved to the forefront of a national discussion on the treatment of aging and disabled Americans.

Chicago-born and Georgia-raised, Reifler has lived for 20 years in Winston-Salem, where he now heads Geriatric Outreach, or GO, a program at the medical center that treats older people with mental illness in their homes. He works with a social worker and case manager in an arrangement designed to be a model for other efforts across the country.

The GO program exists because of large financial gifts from Arnold Snider, a North Carolina native and investments figure. Wake Forest helped out when Snider's mother, Kate Mills Snider, needed help.

"A psychiatrist on our staff, Dr. Deirdre Johnston, said she'd be glad to go see his mother," Reifler said.

Johnston was able to alleviate some of Mrs. Snider's symptoms. The resulting donations -- Snider doesn't want the amount known -- mean that the GO program has unusual stability for an effort of this kind. This spring, Reifler was named the Snider professor, the holder of an endowed professorship.

On a recent spring day, Reifler drove out to a patient's home in Winston-Salem with one goal in mind -- to enable an older person with mental illness to live at home, instead of in an institution.

Recliner-side manner

Reaching the patient's home, Reifler greeted him and his daughter and asked how his spirits were, whether he felt depressed.

Capt. Charles A. Dancy, retired from the Navy, didn't hesitate.

"Sure, I'm depressed," said Dancy, 92, who has dementia. "I'm discouraged about the fact that I was a Naval officer. I'm depressed that the world has gone atilt."

The frank exchange between psychiatrist and older patient was unusual mostly because of where it happened -- in Dancy's living room. Medicare doesn't pay extra for psychiatric house calls, so they rarely happen. For thousands of older North Carolinians with mental illness, the alternative is to be housed in a state mental hospital or in long-term care.

Reifler said that's a shame.

"People are much more comfortable being talked to in their own homes," he said. "The nature of the illnesses themselves often interferes with people seeking care. People who have depression have no energy to get help. With cognitive dementia, there's a lack of awareness that they have a problem. With paranoia, it's the belief that the problem is not with them, it's with somebody else."

Dancy's daughter, Cathy, 55, said she and her dad consider Reifler "more like a friend" than a doctor. During the home visit, Reifler sat next to Dancy's recliner as he asked questions that tested orientation and memory.

The antidepressant Dancy has started won't improve his memory, but could keep him better able to function, easier to deal with and more likely to stay out of long-term care. Cathy Dancy, a former employee of the medical center, said loss of memory has been tough on her dad, a former crossword whiz who had to start playing Jumbles word games instead.

"When he was in the Navy, he was used to giving orders, so when he would come home, we'd run around trying to get things right," she said.

The family says the program is working well for Dancy overall.

An intern's fascination

Reifler grew up in Macon, Ga., where his father, a dermatologist, treated all patients alike, regardless of background or ability to pay. He followed his father into medicine. During his internship in an inner-city Atlanta hospital, Reifler grew fascinated by the many older people he treated. Despite often grim situations, they tended to greet life with optimistic, generous attitudes, he said.

"I remember a man who was devotedly taking care of his wife, who had Alzheimer's disease," he said. "He told me, 'All I want to do is just outlive her by one day.' He did not see caregiving as a burden."

Reifler's fondness for older patients pushed him into his field at a time when Alzheimer's disease was a relatively new diagnosis.

Reifler and his wife, Frances, enjoy Wake Forest sports and spending time with their two grown children, but he doesn't appear close to retirement. The demand for his services in geriatric psychiatry, an underserved field, keeps calling him back.

Dr. Dan Blazer, a Duke psychiatrist and an old friend of Reifler's, said Reifler is an unusually positive person for a mental health physician.

"Many psychiatrists tend to throw up their hands. He's always looking for new ways to do things," he said.

Looking forward, Reifler hopes the next Snider professor will be young, energetic and ready to take on the demographic bulge of baby boomers and the mental health problems that will inevitably come.

To see the problems that are ahead, Reifler said, "all we've got to do is look in the mirror."

Staff writer Thomas Goldsmith can be reached at 829-8929 or thomas.goldsmith@newsobserver.com.
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Mental health care may rise - Raleigh News & Observer

Samiha Khanna, Staff Writer
June 23, 2007

DURHAM - More help will be on the way for Durham residents with mental health and drug abuse treatment needs if county leaders vote Monday to expand Durham Center Access, a county-managed treatment facility.

A favorable vote also would assure $1.5 million in contributions from the Duke University Health System.

If county commissioners approve the multiparty agreement, it would allow the county to use a 20,000-square-foot space in the Oakleigh Building at Durham Regional Hospital.

The extra space -- nearly double the current size -- would allow 16 beds for patients instead of a dozen, and would allow for more substance abuse services, including meetings for 12-step programs, said Rob Robinson, deputy director of The Durham Center, which manages Durham Center Access.

The space also would allow people who are involuntarily committed to stay in Durham. Right now, they can be sent to state hospitals as far away as Butner, Robinson said.

County officials have been considering the move for several months, knowing that the Durham Center Access lease on a cramped space at 2609 N. Duke St. will expire.

Oakleigh, which was a substance abuse treatment center until 2001, has always been the top option. Since then, it has been used for storage and as a mock-operation room, County Manager Mike Ruffin said.

"The layout is pretty close to what we need," Robinson said. "The proximity to Duke [Hospital] is key."

The county owns the hospital off North Roxboro Road but leased it to Duke University Health System eight years ago. On Monday, county commissioners would finalize their plan by approving an amendment to that lease and take back the space in Oakleigh.

Excluding Oakleigh from the rent will save Duke University Health System $300,000, Ruffin said.

But Duke will give some of those savings back, contributing $500,000 immediately, and $100,000 a year for the next decade. The total $1.5 million will go to renovation costs and operations.

Renovations by next spring are expected to cost about $2.7 million, based on initial estimates, Ruffin said.

"We've got to get this facility ready and ready quickly," he said.

If everything goes as planned, a lot right next to the Oakleigh building will be the new site of City of Medicine Academy, a nursing and pre-med program for Durham high schoolers.

Since students work at hospitals as part of the curriculum, Durham school officials have long sought after a similar site, but previous plans have fallen through.

School leaders hope voters will approve a $210 million bond package in the fall that includes $7.1 million set aside to house the medical high school.

Staff writer Samiha Khanna can be reached at 956-2468 or samiha.khanna@newsobserver.com.
Read more!

Ex Atlanta official dies homeless on the street -Atlanta Journal-Constitution

By BILL TORPY

The homeless man's head rested on his backpack, his yellow prescription glasses still on his face.

To the railroad detective, who spotted the rag-tag man loitering in the tree-shaded lot by the tracks the day before, it looked like he was taking a nap.

But the man wasn't sleeping. He was dead, covered in ants. Investigators found pennies and denture adhesive in the pockets, insulin and syringes in his backpack and a MARTA card and a Six Flags Over Georgia contract employee ID in his wallet.

Fulton County Medical Examiner's case 07-0989 appeared to be open and shut: Life expectancy is not good for 63-year-old alcoholic diabetics on the street.

But the life and death of the former Atlanta city official, who worked for Mayor Andrew Young in the 1980s and was known by two other future mayors, was anything but simple.

Robert F. Sumbry apparently never recovered from a hard, notorious fall that sent him to federal prison and forever altered his life.

Sumbry's nine siblings had not heard from him in at least 15 years, a sister in Florida said. He just faded away after being released from prison.

When family members learned of his death on June 8, they were surprised he was still in Atlanta.

"The phone call ... telling us of his death was finally a sad closure," said Evelyn Henderson of Tampa. "How sad that families must go through this. You could never guess what lives these street people previously lived."

Those who knew Sumbry on the streets usually saw a reserved man with a quiet, sad dignity who existed in the margins, trying to slip by unnoticed. That is, unless he was blithering drunk.

"He really didn't have any friends out on the street," said David Baird, a former homeless man who is a guidance counselor at Safehouse Outreach in downtown Atlanta. "He said he used to have a great job but things happened and he ended up on the street. He kept to himself. He didn't want to cause any trouble."

Juanita Ford, another of Sumbry's sisters, said he got an economics degree from Florida A&M University in the late 1960s. The proud young man was set to seize the opportunity. He moved to New York, then Baltimore — where he married — working with the Federal National Mortgage Association before coming to Atlanta.

"He was a go-getter; he had a lot of energy," she said. "He always wanted to be a millionaire by the time he was 40."

In 1985, Mayor Young appointed the dedicated man in a crisp business suit to run the city's agency that provided housing for the poor. In 1987, Young reappointed him, saying, "Mr. Sumbry has done an outstanding job during his brief tenure with the city."

Another boss said he surpassed the agency's yearly goal, making more than 1,500 units habitable for poor families.

But Sumbry had another side. He bought his own houses to rent out to poor people and threatened to evict them if they didn't pay more than Section 8 stipulated. Mary Bennett, an epileptic who could not read, was one such tenant. Her family complained to Atlanta Legal Aid. Dennis Goldstein, a lawyer who took the case, figured Sumbry was doing the same thing to other tenants.

Sumbry's victims were working mothers, the elderly, the sick. Most were too scared to talk to legal aid lawyers.

"I remember him as arrogant," said Goldstein. "He struck me as a guy who tried to hide his lies through bluster. But then we ground him down."

The legal aid case led to a federal investigation. An ambitious U.S. Attorney named Bob Barr, who later became a congressman, took up the case. An equally ambitious city councilman named Bill Campbell publicly tore into Sumbry and the Young administration.

Young's chief administrative officer, Shirley Franklin, initially defended Sumbry, saying removing him from office would slow the momentum in housing improvements he had made.

The sympathetic victims made the case dramatic and put it on the top of the evening news. One victim had her heat cut off and huddled with her children by the fireplace. "When [she] refused to pay any more, he gave her 10 days to get out of her house and threw her furniture after her," Thomas D. Bever, the prosecutor assigned to the case, told the judge as Sumbry was being sentenced after pleading guilty to three fraud counts.

Sumbry, then 44, got five years.

Juanita Ford last talked to her older brother during his prison stint. He said he'd go back to landlording. "He said he'd get in touch when he got out," she said. "But he never did."

The family tried a computer search of their brother, to no avail. "We felt he was alive but embarrassed," Ford said. "We were hoping he was rebuilding his life."

Instead, his life was coming apart.

At least five times after he left prison, he or his wife filed for bankruptcy. One judge called the filings "an abuse of the system." He returned to prison twice after his December 1990 release — in '92 and '96 on parole violations. In 1996, he tried unsuccessfully to appeal his conviction.

His brothers and sisters never heard what Sumbry did, or tried to do, to make it in the world after his release. Another sister heard that her brother drove a cab for a small Atlanta taxi company in 1992 but he didn't stay there long. His former wife declined to say much, other than she hadn't seen him in years. She filed for divorce against her absentee spouse in 2004.

Police reports show he had bottomed out by then. He was arrested for public urination, intoxication and fare evasion at MARTA.

He had been out on the streets for at least four years before his death, street people and homeless advocates say.

Delores Young knew one of Sumbry's tenants who complained in the 1980s. Bonnie Owens, a nearly blind woman, was threatened with eviction for coming forward, she said.

"I feel bad," said Owens' friend, Delores Young, about how Sumbry had died. "But when you do people wrong in life, bad things happen to you."

Tim Sewell, a homeless man standing by the forbidding brick shelter at Peachtree and Pine streets last week on a hot, sunny afternoon, immediately identified Sumbry from a 20-year-old photo.

"That's Bob," he said.

"He was a supervisor for the city, or something. He said he knew Andy Young personally. And Shirley Franklin. Nobody believed him.

"He talked about the opportunities he had and was proud of that. He wanted his life back. It was eating at him every day."

He sometimes drank cheap liquor, causing him to forget his insulin and go into diabetic shock, Sewell said.

The two men hung out at downtown parks or made the rounds to a half-dozen or so missions and shelters around downtown, hearing religious services to get a free meal.

Sometimes, Sumbry went to the library downtown to peruse the Internet. He liked to keep up with politics, keeping an eye on Franklin's rise to mayor and Campbell's fall from mayor to convicted tax cheat and federal prisoner.

Reminiscing was a temporary respite from a grim reality. Street life is a test even for a young man. Sumbry sometimes slept at shelters like the one Peachtree and Pine, which can accommodate 500 men. But he preferred not to.

"He'd end up outside in the park or under a bridge," said Baird. "If it's nice weather, most guys like to stay outside because when you get a bunch of guys in a building all together, it's not a healthy atmosphere. You're dealing with so many situations. People are drunk, bipolar. The hotter it gets, the worse it gets."

But outside, "you get extremely wore out because you're always in the elements," said Baird.

"You want to rest, to become invisible. But it's hard to do."

And likely, that's what Sumbry was trying to do when he laid down in the shady, secluded lot that offered a panoramic view of Atlanta, the city he came to years ago to make his mark. Read more!

Two who lived — and two who died - Atlanta Journal-Constitution

By ALAN JUDD, ANDY MILLER

Profiles of four psychiatric patients and how they fared:

14-year-old boy: Family forced to fight for treatment

The boy's first stay at the hospital lasted three weeks, but didn't seem to work.

He had arrived in March at Georgia Regional/Atlanta after expressing suicidal thoughts. Almost from the start, though, his family had questions about his care. The boy, 14, diagnosed with bipolar disorder, went days without bathing, his clothes unwashed, until his parents complained.

He got into fights, and was sedated several times at the hospital, said his father, Shon Harp of Canton, who requested his son's name be withheld because of the stigma surrounding mental illness.

On April 6, a hospital worker abruptly told the family to pick up the boy that evening. The hospital arranged no discharge meeting with the family, and provided no paperwork about the boy's treatment, Harp says.

When picked up, the boy didn't know he was leaving. "He didn't have a clue," Harp says.

It soon became clear to the family that the boy's condition had not improved.

Less than a week after the hospital discharge, the boy told other kids that he was going to blow up his house and his school. He then denied saying it, Harp says.

But on April 16 — the same morning as the shootings that left 33 dead on the Virginia Tech campus — the boy was arrested at school with a lighter, an aerosol spray can, and blasting powder from his model rocket kit.

"He told kids that he knew where the propane tank was, and that he was going to blow it up," Harp says.

That landed the boy back at Georgia Regional.

But after just three days at the hospital, a social worker called Harp to say his son would be released the next day.

Harp was told the boy was no longer a threat to himself or others.

The news of the sudden release astonished his father and stepmother. They feared for their safety — the safety of their 5-year-old daughter. How could he have gone from threatening to kill others to being OK after just three days?

A hospital doctor said the boy needed long-term residential treatment, according to Harp. But the paperwork would take a long time, the doctor said, and the boy would have to go home first.

The doctor said that if the family didn't pick up the boy, they could be charged with child abandonment, Harp said.

The boy's mother, Trish Frazier, began calling state officials, pleading for the boy to remain in the hospital or under state care. She told the officials she would go to the media with the story.

The barrage of calls had an impact. An official told Harp that the boy would remain at Georgia Regional until a residential placement was found. In late May, the boy was transferred to a private residential treatment center, partly paid for by the state.

"If their hand wasn't forced," Harp said, "they would have released him and put him in DFCS custody."

Bronnie Jackson Watson III: 'He was torn to pieces'

Bronnie Jackson Watson III, 63, spent six months at Georgia Regional in Atlanta. Then, without consulting his family, his mother said, the hospital transferred him in 2005 to a nursing home in Metter, almost 200 miles away in Middle Georgia.

"I got him on the phone," said Watson's mother, Emily Smith, 89, of Lawrenceville. "My son didn't want to talk. He was crying. I was crying. He was torn to pieces."

Two days later, Watson was dead.

An internal report at Georgia Regional later concluded that the hospital's staff erred in not making sure the nursing home could properly care for Watson. In explaining deaths like Watson's, experts in long-term care use the term "transfer trauma." His death certificate says Watson died from heart disease, cardiac arrest and an alcohol-related psychotic disorder.

Watson died not knowing that his mother was looking for a place for him in the Atlanta area, closer to her home.

"I tried, with the social worker, to bring him back," Smith said. "I never had a chance to tell him that I was bringing him back."

Peyman Farzaneh: Wound up in a shelter

After he lost his apartment in Atlanta, Peyman Farzaneh tried to kill himself. He also needed help for drug abuse. But in 32 days at Georgia Regional in Atlanta, Farzaneh said, he received little treatment.

Instead, he said, with his unit woefully understaffed, another patient attacked him. The assault left Farzaneh, 46, with two broken bones in his nose and one in an eye socket. It also severed a nerve in his cheek; he described the lingering effect as like being on Novocain all the time.

Farzaneh had asked to leave the hospital before the attack. But staff members said they could find no openings in community programs. "They said, 'You could go to a shelter,' " he recalled.

When he complained that he was being harassed by another patient, the one who later assaulted him, Farzaneh said, a nurse offered this advice: "You need to bust his head up. He'll leave you alone."

After the attack, hospital workers found two possible placements for Farzaneh. Neither, however, was suitable, he said. Finally, on Feb. 22, he agreed to move into a homeless shelter in Atlanta.

"They give you two MARTA tokens," said Farzaneh, now a waiter at an Atlanta restaurant. "I got on the bus to Baptist Rescue Mission."

Lamar Hunt: No group home available, so he lived in his van

When Lamar Hunt entered Georgia Regional Hospital/Atlanta in October 2005, he had a history of alcoholism, drug abuse and suicide attempts. His home, he told hospital workers, was an old Chevrolet van parked in Atlanta's West End.

Hunt, 39, spent 11 days at Georgia Regional. Hospital records show he went from despondency — he "does not see what everyone else sees in him," as a social worker wrote early in his stay — to expressing optimism about his future.

Hunt told therapists he wanted to move into a group home for people with mental illness. There, he reasoned, he could receive treatment while looking for a job.

But the hospital could find no group home that would take him. Staff members told him he should instead move into a homeless shelter.

"You promised me a place," Hunt angrily told his activity therapist, according to the report from a later state investigation.

The therapist told an investigator he suggested that Hunt could still follow his "coping plan," even in a shelter.

"It may be a little harder," the therapist said. "It's just a matter of where he spends his nights. ... Sometimes being in a shelter will motivate you to reach goals."

Hunt's response, according to the therapist: "I better not see you outside."

As he prepared to leave the hospital a few days later, records show, he told his psychiatrist he had no intention of taking his prescribed anti-psychotic medications.

And he said he would not attend his appointments at a Fulton County mental health clinic.

"He just wants to hit the streets," the psychiatrist wrote in Hunt's file, and then he let him go.

Hunt returned to his inoperable van, parked by the curb in front of the decaying brick houses that line Holderness Street, just off Ralph David Abernathy Boulevard. He slept on a rollaway sofa bed in the van's cargo area.

Several days later, on Nov. 6, 2005, a friend realized he had not seen Hunt for a time. When he checked the van, the friend found Hunt's body lying in bloody vomit on the sofa bed, according to a medical examiner's report. A belt fashioned from a shoelace held up Hunt's Levi's. The pockets contained 41 cents.

An autopsy found Hunt died of meningitis. A state investigation found that Georgia Regional employees "followed their policies and procedures." Read more!

Psychiatric patients are vulnerable when state shunts them to inns, shelters, streets - Atlanta Journal-Constitution

Sixth in an occasional series: A Hidden Shame: Danger and Death in Georgia's Mental Hospitals

By ALAN JUDD, ANDY MILLER

Drendell Willis was burning alive.

Delirious with fever, he staggered through the streets of Albany, Ga., on a hot spring day. He found a doctor's office, but collapsed outside. At a nearby emergency room, a nurse recorded Willis' body temperature: 108 degrees, as high as the digital thermometer would register.

Minutes later, a doctor pronounced Willis dead. It was April 20, 2006.

Forty-eight hours earlier, Willis, 38, had checked out of a state psychiatric hospital, smiling and thanking doctors for getting his psychosis under control.

In five stays at Southwestern State Hospital in Thomasville, Willis had been nothing but trouble. He tried to hang another patient with a sheet. He toppled a piano. He exposed himself to patients and hospital workers.

He was so violent and so disruptive that doctors tried to transfer him to another state hospital for electroconvulsive therapy. That hospital refused to take him.

At one point, Willis' doctor prescribed an injection of an anti-psychotic medication "every time patient opens mouth."

Each hospital admission followed a pattern: Willis would act violently, doctors would subdue him with medications, and then, while he was still placid, they would discharge him.

Willis' death, too, followed a pattern, an investigation by The Atlanta Journal-Constitution shows.

Since 2002, at least 10 patients from Georgia's state mental hospitals have died after inadequate discharge planning, the Journal-Constitution found by reviewing medical files, court records, police reports, autopsies and other documents.

These deaths underscore twin failings of Georgia's mental health system: The seven state hospitals are chronically overcrowded and understaffed, forcing patients out into the surrounding community to seek treatment. But services in communities are hard to come by, and many patients — particularly those like Willis, with mental illnesses that seem beyond control — end up with no care at all or back in the hospitals again and again.

The way Georgia's state hospitals plan for patients' care after their discharge is among the topics on which the U.S. Justice Department will focus as it investigates possible civil rights violations in the facilities. The inquiry, announced in late April, began after the Journal-Constitution reported that at least 115 state hospital patients had died under suspicious circumstances from 2002 through 2006.

Few experienced as spectacular a collapse as Willis.

From an early age, trouble

By the time he was 14, Drendell Willis already was taking lithium, one of the earliest drugs used to treat manic depression. It didn't really help.

"He's been a mental patient as far back as I can remember," said his aunt, Frances Judge, of Albany.

Willis first got into trouble as a teenager; he later told a psychiatrist he had been sent to a juvenile detention center for "breaking dishes." From an early age, Willis' medical records say, he had "an extensive history" of substance abuse: alcohol, marijuana, crack cocaine.

When Willis was 26, a jury in Wilkes County in eastern Georgia convicted him of burglary, shoplifting and other crimes. Willis entered Georgia State Prison, the maximum-security facility in Reidsville, on Valentine's Day 1994.

Willis later told a doctor that another inmate had sexually assaulted him. So he spent much of the next eight years there in solitary confinement, by choice.

"He was afraid of the other inmates," his aunt said. "He would just do something to get them to put him in isolation."

Rather than release him when his sentence expired in 2002, prison officials sent Willis to the state psychiatric hospital in Augusta, East Central Regional. A review of his medical records indicates that the first of what would become repeated admissions to state hospitals did little to slow Willis' downward spiral.

In January 2004, shortly after he moved to Albany to be near his aunt, Willis entered a mental health crisis center in Albany. When he tore a sink off the wall and flushed keys down a toilet, the center's staff had him involuntarily committed to the nearest state hospital.

Southwestern State kept Willis for about five weeks. When he left on Feb. 23, 2004, a doctor assessed his prognosis: "fair."

Between hospital stays, Willis usually lived in a boardinghouse in Albany. There, owner Kenneth Price said, Willis was responsible for managing his own illness. Willis had barely lived on his own as an adult, and had shown little ability to cope with routine responsibilities. But whether he made appointments to see his doctors was up to him. So was whether he took his medicine as prescribed.

'Very shaky condition'

Southwestern and the other state hospitals routinely discharge patients like Willis to places where their chances for recovery — or even survival — are slim, at best.

A Journal-Constitution analysis of state records shows that about 5,000 times between 2002 and 2006, the hospitals released patients to homeless shelters, bus stations, motels, even streets and abandoned buildings.

Many leave the hospitals with no more than a week's worth of medicine and no more than a vague plan for continued treatment. They may have follow-up appointments with psychiatrists, but not until as long as two or three weeks later — after their medication runs out. At Georgia Regional Hospital/Atlanta, for instance, departing patients may get little more than the address of a homeless shelter and a ride on MARTA.

"People tend to get released in very shaky condition," said Janet Grayson, a former staff attorney at the Atlanta hospital. She now represents patients who have been involuntarily committed.

The hospitals are supposed to hold any patients deemed to be a threat to themselves or others or who cannot care for themselves. But when the hospitals are crowded, Grayson said, "the pressure to get rid of patients leads them to lower the bar on that standard."

Often in such situations, she said, "the person is pretty much alone in the world."

These patients frequently return to the hospital within a matter of days or weeks, records show.

The readmission rate to Georgia psychiatric hospitals is more than 50 percent higher than the national average, according to a state-sponsored study from 2005. State records and lawyers and advocates for people with mental illness describe patients who have come and gone from state hospitals 40, 50, even 70 times, with little or no improvement in their conditions.

'Bizarre' behavior

Indeed, Willis was back at Southwestern State not even three months after his first discharge.

He stayed four days, until medications calmed his outbursts. Then he moved into the boardinghouse, using his monthly disability check to pay the rent. After exposing himself to other residents of the boardinghouse during a psychotic episode, he returned to Southwestern State on March 31, 2005.

In Willis' medical file, doctors reduced his behavior this stay to a single word: "bizarre."

He drank soap. He sometimes dropped to his knees to simulate sex acts.

And he turned violent. He struck a sleeping patient in the head with a chair; the man needed 11 staples to close his wound.

Willis' outbursts exasperated the hospital staff. About a week into his stay, one of Willis' psychiatrists, Dr. Pamela Carter, issued a standing order to give him a shot "every time patient opens mouth" or "exhibits sexually inappropriate behavior" — as many as 10 injections a day. Those injections of an anti-psychotic medication formerly known by the brand name Thorazine would total 500 milligrams, triple the average daily dosage for patients with severe schizophrenia.

After Willis overturned a piano, doctors further increased his medication. The higher dosages sedated Willis enough to control his behavior; doctors said they no longer considered him a danger to himself or others, the key standards for involuntary commitment.

They discharged Willis on May 18, 2005. This time the doctors downgraded his prognosis to "guarded," and a hospital van carried him back to the boardinghouse.

Not 'optimum placement'

Every two weeks or so, a white van pulls into the parking lot at MUST Ministries of Marietta, which operates the only emergency shelter for homeless people in Atlanta's northwest suburbs. Usually, one or two passengers, clutching a few papers and a plastic baggie containing several pills, stumble out before the van drives off.

This, according to MUST officials, is how the state hospital in Rome, Northwest Georgia Regional, discharges patients who have no home or no other place to go — with little or no notice to the shelter and, apparently, with little or no plan for how the patients will cope with their illness on their own.

Like most others, the Marietta shelter has no mental health professionals on its staff, and barely enough workers and volunteers to manage the daily chaos of caring for nearly four dozen homeless people.

"It is an issue of being able to support them appropriately," said Stephanie McKay, MUST's housing director. "We just are not able to do that."

Officials at the Georgia Department of Human Resources, which operates the state hospitals, said patients leaving in stable condition make their own decisions about where they go. Rather than telling former patients where they should live, "our job is to have services and resources in place to help them get better," Dena Smith, a spokeswoman for the department, said Friday.

In an interview last November, Gwen Skinner, director of the agency's mental health division, said: "Do we think that a discharge to a homeless shelter would be an optimum placement? The answer to that is no."

Experts in psychiatric care say discharging patients into homelessness is an especially troubling practice.

"I can't conceive that a homeless shelter is a place where I could discharge a patient to," said Dr. Sidney Weissman, a psychiatrist who teaches at Northwestern University's medical school in Chicago. "It's a place to sleep. ... These are hard people to treat with everything in place. So when you don't have everything in place, it's much harder."

Weissman and others say patients should remain in mental hospitals until their conditions are stable. Discharge plans, experts say, should revolve around strong community-based services that make sure patients take their medicines and that assist them with housing, medical care and therapy, among other needs. In Georgia, though, budget cuts have made such follow-up services scarce.

In an April report on the state hospital in Atlanta, Virginia-based behavioral health consultant Diane Grieder wrote that its "discharge plans are not real, relevant or clinically or personally useful."

Off his medication

When Willis returned to Southwestern State on Sept. 10, 2005, he said he had been off his medication four or five months — in essence, since his last discharge.

He was actively hallucinating, doctors noted. Willis told them he heard voices saying, "Behold, the Great Knight." He called himself "Black Lord" and announced, without prompting, that he did not "rape anybody."

This stay was his rockiest yet.

Sept. 14: With no provocation, Willis kicked and struck what a doctor described as a "vulnerable" patient. Hospital workers placed him in restraints.

Sept. 16: Willis trapped a staff member in a bedroom. Workers placed him in restraints again.

Sept. 19: After he injured two more patients "significantly," medical records say, doctors tried to transfer Willis to Central State Hospital in Milledgeville for electroconvulsive therapy. Central State said it had no room for him.

Oct. 14: Willis ripped a pipe out of bathroom plumbing and used it to strike another patient.

Oct. 24: Willis threatened to incite a riot on his hospital unit. He calmed down after talking to a therapist about his childhood — then, unprovoked, punched a young mentally retarded patient.

Nov. 14: Willis became aggressive again after doctors reduced the dosage of his anti-psychotic medication.

Nevertheless, they prepared to discharge him.

By then, a physician wrote in Willis' file, "he would threaten staff only when his demands were not immediately gratified. Likewise, he argued with peers over snacks and cigarettes but not over delusions. ... He had reached maximum hospital benefit."

His prognosis: "guarded because of his anti-social behavior."

Escalating violence

Willis returned to his boardinghouse in Albany, with predictable results.

He got into a dispute with the owner over his disability check. They scuffled in the street, the police came, Willis struggled with the officers, and he wound up in the Dougherty County Jail. Thirteendays later, he was back at Southwestern State.

In his medical file, doctors described Willis as "difficult to stabilize" and "extremely psychotic." If anything, his violent behavior had escalated since his last admission.

Two days after he entered the hospital, he tried to hang another patient with a sheet. About a week later, he bloodied a technician's lip. He struck a patient in the head with a deodorant can. Then he punched a technician, breaking the man's nose.

"From that point on," said Judge, his aunt, "it was just a downhill slide."

Willis' father, Ralph, who lives near Chicago, said a hospital social worker told him that because of the attack on the technician, she would no longer get within 20 feet of his son.

The doctors, meanwhile, again increased Willis' medication. The effect, records show, was to sedate him so heavily that his blood pressure dropped to 114/50, and his pulse rate soared to 142.

Hospital employees stimulated and hydrated Willis, and his vital signs improved.

"It sounded like they had doped him up and wanted to get him out while he was under the influence," Willis' father said.

Two of the physicians who treated Willis, Drs. Pamela Carter and Gary Carter, a married couple who both practice at Southwestern State, declined to comment.

By mid-April, doctors had decided Willis was responding well to therapy. No psychosis was evident, they wrote in his medical chart.

They discharged him on April 18, but with a warning, records show: Two of the medicines they had prescribed would make him unusually sensitive to sun and heat.

Willis smiled, the doctors wrote. He told them, "Thank you for all you've done."

A hot spring day

April 20, 2006, was hot for a spring day. Albany recorded a temperature of 89 degrees, the highest yet of the year.

Willis had been back at his boardinghouse for two days. Already, a doctor from a community mental health provider had prescribed new medications for him, state records say. It isn't clear, however, whether he actually had begun taking them.

Shortly after lunch on April 20, wearing a plaid short-sleeve shirt and long green pants, Willis left the boardinghouse on foot. No one knows where he was headed. But he apparently wandered for at least three hours in the hot sun — exactly the kind of activity his doctors say they had warned him against.

Late in the afternoon, his temperature spiking, Willis collapsed on a ramp outside a doctor's office. At the emergency room, nurses packed him in ice. He died anyway.

An autopsy determined that Willis died from neuroleptic malignant syndrome: a heatstroke induced by his anti-psychotic drugs.

The medicine that was supposed to control his behavior ended up killing him.

At Southwestern State, Drs. Gary and Pamela Carter signed a report summarizing Willis' last hospital stay. The report detailed their decision to discharge him despite their doubts about his potential for success on his own.

Willis, they noted, had a "history of noncompliance" with medication orders and a "history of polysubstance dependence." They described his prognosis as "guarded."

By then, he had been dead five days.
— This article is based on a review of Drendell Willis' voluminous medical chart from Southwestern State Hospital, which was obtained by attorneys for his family; state reports on his death; an autopsy report; and interviews with family members. Read more!

Mental-health push in jail - Denver Post

By Christopher N. Osher

Efforts are underway to find ways to keep the mentally ill from stacking up in Denver's jails, and the reverberations could affect surrounding communities as well.

The initiatives range from hiring treatment specialists to help the mentally ill in the jails to the creation of a specialized mental health docket at Denver's courthouse.

Another effort to create crisis centers in Denver and surrounding suburbs that would intervene and stabilize the mentally ill before they commit a crime has attracted the support of Colorado's first lady Jeannie Ritter, the wife of Gov. Bill Ritter.

Nearly 17 percent of inmates at Denver's jails, or 350 people, have serious mental health problems, ranging from schizophrenia to manic depression, according to the calculations of jail officials.

"And there are others with less serious mental illnesses who are able to function in the jail and receive treatment, but in all cases, once they're released from the jail, they hit this cliff," said Bill Lovingier, Denver's director of corrections.

Three months ago, the jail hired two mental-health case managers to help address the needs of that population.

Lovingier said the new employees are supposed to help find ways to help ease the mentally ill into services once they leave the jail, in the hope they will be less likely to reoffend.

A disabled veteran might not realize he could qualify for assistance under the U.S. Department of Veterans Affairs, Lovingier explained. The new case manager's job will be to ensure that an inmate gets handed off to the proper authorities once he is released from the jail and has the proper insurance in place to pay for treatment.

Denver also is creating a specialized court docket in which a specific judge will oversee those with mental health problems, Lovingier said. He said the program will function like the reinstituted drug court, which emphasizes treatment for minor drug offenders over incarceration.

Meanwhile, another group is working at creating three crisis centers in Denver and surrounding suburbs that would strive to keep some mentally ill from ever going to jail in the first place.

The Mental Health Association of Colorado has been studying the concept over the past year and has one big backer: Jeannie Ritter. She is a member of the steering committee trying to bring such centers to the Denver area.

The 16-bed crisis centers would become the place that law-enforcement authorities could take the mentally ill when they reach a crisis. The centers would have the capacity to provide treatment for up to three days, and they would specialize in ensuring those needing treatment are handed off to outside professionals once they are released.

"They can intervene before the behaviors rise to the level where a crime might be committed," said Lovingier, who also is a member of the steering committee. "The crisis centers are a front- end service that will prevent people from coming to jail."

Three hospitals - Centura Health, Health One and Exempla Healthcare - contributed $75,000 each to study the concept in the summer of 2006. The Colorado Health Foundation added an additional $250,000.

Heather Cameron, the crisis center project director for the Mental Health Association of Colorado, said preliminary estimates suggest it would cost about $3.35 million annually to run each center.

Cameron said crisis centers already are up and running in cities like San Antonio, Phoenix and Tucson. One center she studied provides recliners that allow those in a crisis state to calm down while mental health professionals assess their needs, she said.

The concept is being studied by Colorado's Legislative Committee for the Treatment of Persons with Mental Illness in the Justice System.

"I'm committed to finding smart solutions, not relying on the status quo," said state Rep. Judy Solano, a Democrat from Thornton and vice chairman of the legislative committee, in a prepared statement. "It would be better to use taxpayer's money on mental health crisis centers, not incarceration."

Another supporter, Golden Police Chief Bill Kilpatrick, said part of the challenge will be finding ways to finance such centers across multiple jurisdictions that could include Denver as well as Arapahoe and Adams counties.

"This cannot and should not be just for Denver," he said. "They must be relatively close and provide easy access for all law enforcement."

Currently, 236 inpatient psychiatric beds exist in the metro Denver area, and police have few choices when confronted with a suicidal, potentially homicidal, person experiencing a mental health crisis, Kilpatrick said.

He said many police officers end up relying on the emergency departments of hospitals. With no safety net in place, jail cells end up becoming the place of last resort for many mentally ill, Kilpatrick said.

A survey of 19 hospitals in the Denver area conducted by the Mental Health Association of Colorado found that 11 reported receiving 16,612 behavioral health patients in a year.

The steering committee is studying a mix of funding solutions for the crisis centers, ranging from public funds to assistance from foundations and local hospitals.

Some are lobbying for a tax on those in Colorado earning more than $1 million annually to pay for mental health programs. A group called M.I.N.D.S., or Mental Illness Needs and Deserves Success, has hired a pollster to study whether such a tax, similar to one instituted in California, could win the support of Colorado voters in 2008.

The group has held discussions with the governor's office, but Ritter has not committed to backing the concept.

Staff writer Christopher N. Osher can be reached at 303-954-1747 or cosher@denverpost.com. Read more!

Psychiatric center probe goes to DA - Albany (NY) Times Union

By JAMES M. ODATO

ALBANY -- State Inspector General Kristine Hamann will hand over her investigation of Jesse Nixon's leadership of the Capital District Psychiatric Center to the Albany County district attorney's office on Monday, state officials said Saturday.

The referral comes after Hamann reported findings last week of a three-year review of Nixon's handling of the state facility. She concluded he ran the center as a personal fiefdom and misused state money and resources.

The investigators said he declared having "absolute power" and found he funneled $3 million in public funds to people and contractors improperly. The inspector general's report said he steered jobs to favored people, took $30,000 from Albany Medical College to augment his $129,555 salary, expensed personal trips and doled out bonuses without any apparent authorization from superiors.

Steve Del Giacco, a spokesman for Hamann, said Nixon's conduct warrants review by a prosecutor.

"It's been under consideration to provide our findings to a prosecutor, and on Monday we are going to be contacting the Albany district attorney's office and providing him a copy of our report," he said.

Neither Nixon nor his lawyer could be reached for comment Saturday.

Heather Orth, a spokeswoman for Albany County District Attorney David Soares, said the prosecutor had no comment at this time.

Nixon ran the 160-bed center, one of 27 hospitals operated by the state Office of Mental Health, from 1981 until 2004. During that span, he misused state cars, telephones and other resources and directed $2.8 million in rental fees that should have gone to the state but instead went to salaries and contracts for people selected by Nixon, the report says.

The rental money, from the Albany Citizens Council on Alcoholism and Other Chemical Dependencies, supported "rent people" -- people chosen to benefit from the arrangement by Nixon, the inspector general said.

"You have to wonder with the history of questions raised here how this could have gone on as long as it did," said Harvey Rosenthal, executive director of the New York State Association of Psychiatric Rehabilitation Services. He worked at the psychiatric center 25 years ago, briefly under the direction of Nixon.

The inspector general's report found that the state Office of Mental Health failed to oversee Nixon.

Investigators said that from 2000 until October 2004, Nixon approved expenditures exceeding $420,000 from an account he controlled. The money went to:

Salary supplements to CDPC staff, $230,175;

Employee travel expenses $68,363;

Costs for out-of-town visitors to CDPC, $40,382;

Nixon's own travel expenses, $25,888;

Prestige catering services, $20,834;

Meals and cocktails at Carmine's restaurant in Albany, $14,584;

A jazz concert by Al Jarreau, which was sponsored by the Friends of CDPC, $11,817;

Floral arrangements, $2,750;

Various miscellaneous expenses, such as lottery tickets, pins bearing CDPC's logo and other meals, $5,943.

Most of Nixon's out-of-state travel, which was not approved by "responsible state officials," the report says, exceeded $20,000. Destinations were either his hometown of Milwaukee, or Chicago, where his son and his family reside. Nixon claimed business purposes for the trips, but Hamann's investigators found nothing to back up the assertion. M. Odato can be reached at 454-5083 or by e-mail at jodato@timesunion.com. Read more!

Our health system must do better job - Hendersonville Times-News

Letter To The Editor:

Ike (not his real name) hanged himself last week.

He was worn out from the voices and the struggle to establish the kind of life he deserved.

Although highly educated and intellectually brilliant, he was not able work at a well-paying job or get the help he needed for the voices of schizophrenia.

The cocaine kept coming back into his life, and the cracks of the mental health system stayed wide open.

I corresponded with Ike while he was still in prison. My anguish at the pain and isolation he described in his writings were overwhelming.

Now that pain resonates acutely today just after learning of the news of his suicide.

Why couldn't Ike have made it?

One in five of us has a diagnosable mental illness over the course of a year.

Suicides are increasing. Why can't the mental health system be effective in preventing more of these?

I miss my friend.

Sandy Goble

Brevard
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New program could ease jail crowding, get treatment for addicts and mental health patients - Greely (CO) Tribune

Rebecca Boyle, (Bio) rboyle@greeleytribune.com

If Weld County criminal justice officials are successful, scofflaws with mental health or drug problems might soon have a place to go instead of jail.

Proponents say the county's pilot program will help inmates who might need more aid than punishment, and it will ease some of the crowding at the overpopulated jail.

Starting this month, accused criminals who meet specific criteria will be considered for the In-Custody Alternative Placement Program, called ICAPP, which involves prosecutors, defense attorneys, probation, law enforcement, North Range Behavioral Health, Island Grove Treatment Center and Avalon, which runs the Villa halfway house.

Weld District Attorney Ken Buck said he hopes the program is running in the next few weeks.

"We'll have maybe 100 folks a year that are not sitting in the jail and are getting treated," he said.

The Colorado Legislature is looking at similar options statewide, and state Sen. Scott Renfroe, R-Greeley, is on a legislative oversight committee that is reviewing them.

The committee oversees a panel tasked with examining treatment of inmates with mental health problems.

"There are numerous people that are in our prisons that probably don't belong there; they should be in more of a mental facility and getting help that way," Renfroe said. "And it's unfortunate -- they've showed us the different costs you have in treating someone at the different places."

In Weld, however, money won't be a problem, Buck said. Grants and redirected money have made funding the program relatively easy.

The Weld program's genesis was a combination of factors, the largest being the crowded jail. Additionally, attorneys in the DA's office and the Colorado Public Defender's Office noticed high recidivism -- re-offending -- among people with drug or mental health problems.

Officials thought if they could capture those people early and get them into treatment, they might have a better chance of rehabilitating rather than re-offending.

Then everyone had to figure out how to do it.

During the past seven months, Buck, public defender's representatives and sheriff's officials have met with North Range and Island Grove leaders to hammer out the details. On Thursday, Buck and Rick Dill, commander of the jail, told a group of Weld judges and leaders about their preliminary plans.

The program is loosely modeled on a successful one from Boulder called Partnership for Active Community Engagement, or PACE. PACE officials met with Weld officials, who adapted it for a Weld-specific clientele.

Renfroe's committee met Thursday also and heard several options for future treatment at the state level. He said he's looking forward to seeing what Weld officials came up with.

To be eligible for the program, a person must be in the jail accused of a crime that was caused by an underlying mental health or substance abuse problem. Offenders are ineligible if they are in jail for any violent crimes or have been convicted of any violent crimes in the past.

Once the person is chosen, an intake coordinator will determine his or her eligibility and assess his or her needs. A screening committee will then review the case, and each party has veto power. That way, if everyone agrees a person needs mental health treatment but North Range can't accept the person, North Range isn't forced to take the patient.

Inmates who make it through the selection process will be sent to one of several options: intensive pre-trial supervision, an adult diversion program or a sentencing alternative program.

The first option would funnel the inmates to North Range or Island Grove for residential treatment of mental health or substance abuse.

If inmates follow all guidelines, they could face less strict sentences when their criminal cases are resolved.

At Thursday's meeting, Weld District Judge Marcelo Kopcow asked Buck how that would work.

"People won't go to prison who might have otherwise because of their proven success?" he said.

That's one potential incentive, Buck said.

There is a drawback, however, said Dana Nichols, a public defender who has been helping develop the program.

"They can also prove that they can't comply," she said. "There is a downfall, from the defendant's point of view."

But, she added, success in the program could help the inmate avoid prison and future crime by treating its underlying causes. And that means one less crime, one less court process and one less jail inmate.
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Include mental-health support in 2007 farm bill'ssafety net - Des Moines Register

Guest commentary:

Ron Swanson,
director, AgriWellness board,

The 2007 farm bill creates an opportunity to develop a safety net to protect Iowa people engaged in the production of food, fiber and renewable energy. After all, it is the farmers who are the most important asset to agriculture.Here are essential ingredients for inclusion in the 2007 farm bill:

The bill should provide a national farm and ranch stress assistance network (FRSAN) that helps agricultural producers obtain information and education and connects the farm population with the necessary resources to solve problems.

Iowa has a good start on such a network in the Sowing Seeds of Hope Project. This project is coordinated by AgriWellness Inc., a nonprofit organization headquartered in Harlan. The existing FRSAN includes seven upper Midwestern states, all of which operate crisis hotlines such as Iowa Concern Hotline. Funds to maintain farm-crisis services on an ongoing basis have been difficult to obtain. A national FRSAN would adequately fund behavioral health supports for stressed farm families on a pilot basis in the seven upper Midwestern states, including Iowa, and if successful, could be expanded to other agricultural areas of the country.

A Center for Agricultural Behavioral Health should be created to conduct research and train professional providers of agricultural mental-health services. Iowa's major state universities are ideally positioned to serve as the home for such a center.

The 2007 farm bill should include a provision that automatically triggers crisis counseling assistance whenever an agricultural disaster is declared by the president.

Crisis counseling assistance after floods, tornadoes and other natural disasters is an accepted evidence-based recovery practice. Let's expand it to cover all agricultural disasters.

These steps will not entail significant expenditures but they will go a long ways toward the health and well-being of Iowa's 92,000 farms, which produce over 6 percent of the total value of U.S. agricultural goods.

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Finding trained staff for mental health facilities is a challenge - Victorville (CA) Daily Press

By KATHERINE ROSENBERG

Even though a new mental health hospital was recently built and opened in Coalinga, only 500 of the facility’s 1,500 beds are currently being used, because there aren’t enough trained professionals to staff it at capacity.

“They planned it years ago as a means to take the relief off of us, but that hasn’t happened,” said Cindy Bennett, assistant to the executive director of Patton State Mental Hospital.

Patton also has in excess of 1,500 beds, and is almost always at capacity, forcing mentally ill individuals who have been deemed unfit to stand trial to be housed in county jails.

The same is true of state hospitals for the developmentally challenged, said Evonne Gibson, assistant to the executive director at Porterville State Hospital.

“We do have a 96-bed expansion currently in the works which should be completed by the middle of 2008. At that time we will be hiring 140 new staff members before it’s opened,” Gibson said.

Easier said than done.

A national epidemic could be to blame for the overcrowding in state run hospitals and, as a result, in county jails. Some mental health care professionals feel that despite efforts to create more space, a lack of experienced medical professionals is the source of the problem.

“They are having trouble finding people to staff (Coalinga), and yes, generally there is a shortage of trained professionals nationally,” said Rusty Selix, the Executive Director for the Mental Health Association in California, based in Sacramento. “There just don’t appear to be any options at this time.”

Selix said that in recent years hundreds of millions of dollars have been thrown at the issue in order to get more mental health care professionals trained, but he acknowledged that there is no way to see results overnight.

“We do need more trained professionals, and that’s going to take a long time,” Selix said.

He said that the state is looking at programs such as early, or conditional, release programs to make more room in state run hospitals.

While sheriff’s officials such as Deputy Chief Glen Pratt who is in charge of corrections, say that some of these mentally ill patients are considered a danger and early release programs may not be the way to go, keeping them housed in the jails has been a Band-Aid causing more trouble than solutions.

“It’s like the same road block exists in both of these state run institutions,” said Kathy Wild, health care administrator for the Sheriff’s Department’s corrections system. “But the point is that people who need mental health treatment simply aren’t getting it.”

Katherine Rosenberg can be reached at 951-6276 or by e-mail at krosenberg@vvdailypress.com. Read more!

Is our mental health at risk? - Indianapolis (IN) Star

Editorial

Experts are concerned because people in need of services are going untreated

'Our nation's mental health system is drastically under-funded and fails on nearly every level to provide Americans living with mental illnesses with the effective community-based programs they need," said David Shern, President and CEO of Mental Health of America. MHA is the country's leading nonprofit mental health organization, with 320 affiliates nationwide.

Shern's comment followed a recent federal report on the Virginia Tech shooting that failed to address the mental illness of the man who killed 32 people and wounded 25 others.

"If we are serious about averting such tragedies," Shern said, "the federal government must fund programs to get people those needed services."

Carson Soule, executive director of Mental Health America of Greater Indianapolis, points to a lack of funding for a pilot program at the Gallahue Community Mental Health Center for young adults (18-25) who've been diagnosed with serious mental illnesses.

"Rather than helping them at the onset of their disease, they must be hospitalized, arrested multiple times, or homeless before they are deemed appropriate for treatment," she said.

Mental illness is a significant issue in Indiana.

About 51,000 Hoosiers were treated for a serious mental illness in 2006. About 29,700 children were treated for "serious mental disturbances."

Community mental health clinics served 92 percent of the state's mental health clients. Yet only 40 percent of state funding of mental health programs goes to those clinics.

Because the topic is so complex and far-ranging, today's conversation should be seen as the beginning of a longer, more in-depth look at this topic.

Today's contributors include Vickie Trout, who has worked in mental health for more han 30 years, and Joseph Vanable, who heads the board of a mental health agency. Dan Carpenter's column on Page 3 is also relevant.
We encourage you to send your comments, ideas and suggestions to jim.herman@indystar.com and we'll share selected comments in next Sunday's Voices section. Read more!

Mental health care a priority - Mankato (MN) Free Press

Editorial:

Mental health is often overlooked in the realm of critical medical care. Government reimbursement for psychiatrists is so low there is a shortage of available professionals. A shortage of psychiatric beds often follows.

That was the case in Mankato a few months ago when Immanuel St. Joseph’s hospital had to discontinue its mental health unit, citing the inability of psychiatrists having the time to keep the behavioral health unit running.

Fortunately, ISJ, the Mankato Clinic and other local mental health professionals teamed up to reinstitute the program and initially provide six beds at the hospital for psychiatric patients. The new model they have come up with takes a more collaborative approach. It involves psychiatrists but also other professionals including social workers and mental health nurses. The new approach spreads out the responsibility of mental health caseloads and clients among the different professionals trained to handle certain aspects of mental health case management.

Eventually, the hospital hopes to expand the number of beds to 15. As a regional medical center, Mankato clearly needs local behavioral health services. But even 15 beds may not be enough. As more and more veterans come back from tours of duty in Iraq and Afghanistan, there will very likely be more need for mental health services.

In fact, shortly after the hospital announced the regaining of psychiatric services, it was announced Minnesota’s National Guard unit stationed in Iraq will be soon returning. There is little doubt that dozens of soldiers and veterans will need mental health assistance after what they have been through.

Numerous reports have shown the Veterans Administration hospitals and other providers will not be able to provide mental health services in a timely manner to the thousands of service members coming home.

On a broader scale, the availability of mental health services will be as critical a need as emergency services. For someone with severe mental health problems, every day is an emergency. The federal government and Congress need to seriously consider raising reimbursement rates. These cases will be even more costly when psychiatric patients have to be driven to Owatonna or elsewhere. Some may end up in the very expensive emergency room.
Solving mental health problems first often prevents other serious physical health problems. Read more!

Changing the stigma of mental illness -Rio Rancho (NM) Observer

According to the Substance Abuse and Mental Health Services Administration (SAMHSA), nearly one in five young adults in New Mexico lives with a mental health problem.

This coming week, you'll likely see television commercials designed to decrease the negative attitudes that surround mental illness and encourage young adults in New Mexico to support friends with mental health problems.

Mental illnesses, including depression, anxiety, bipolar disorder and schizophrenia, are widespread in the U.S. According to SAMHSA, in 2005 there were an estimated 21.4 million adults aged 18 or older living with serious psychological distress, an indicator highly correlated with serious mental illness.

Among 18-25 year olds, the prevalence of serious psychological distress is almost double that of the general population, yet this age group shows the lowest rate of seeking help. These young people are also more likely to minimize future disability if social acceptance is broadened and they receive the right support and services early on.

New Mexico has a high rate of serious psychological distress among young adults. According to the 2004 and 2005 National Survey on Drug Use and Health (NSDUH), nearly one in five (19 percent) of 18 to 25 year olds in New Mexico lives with serious psychological distress.

For far too long, individuals with mental illness and their families have borne the brunt of stigma and discrimination. The negative attitudes and misunderstandings about mental illness often prevent people from seeking the care that they need.

Perhaps some of that will change through this progressive awareness campaign.

More people need to understand that personal and social networks can help in the treatment and recovery process.

A resource guide, "Developing a Stigma Reduction Initiative," is also a part of the campaign and is based on the evaluation and lessons learned from the Elimination of Barriers Initiative. The guide provides information on how to mount a statewide anti-stigma campaign, examples of outreach materials, reports on the best practices for stigma reduction, and lists important resources for technical assistance. Copies of the guide can be obtained by calling SAMHSA's National Mental Health Information Clearinghouse at 1-800-789-2647.

To view the ads, visit www.whatadifference.samhsa.gov. The PSAs will air in advertising time that will be entirely donated by the media.

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Drugged-out homeless mental patient gets 30 years in abduction, sex assaults - Ft. Lauderdale (FL) Sun-Sentinel

NCMH News Editor's Note: When possible, I try to run headlines and stories as they are found in their respective news outlets. Headlines are sometimes edited for clarity and extraneous material cut from articles. While this headline and the article that accompanies it are somewhat sensationalized compared to today's mainstream journalism, the article does show what can be the more tragic consequences of mental illness on many lives. Certainly, as you'll read, issues other than mental illness played a role in the tragedy as well. -- DC

By Missy Diaz
June 22, 2007

WEST PALM BEACH -- Duane Vanduyl plied himself with alcohol, marijuana and crack cocaine before the mentally ill homeless man abducted three July Fourth revelers last year and forced them at gunpoint to perform sex acts and withdraw money from an ATM.

For his crimes, Vanduyl on Friday was sentenced to 30 years in prison, followed by 10 years of probation. Circuit Judge Krista Marx designated Vanduyl, who is 40, a sexual predator, meaning he faces involuntary civil commitment at the completion of his prison term.

Two of his three victims, two young women and a man, came to court on Friday and asked the judge to throw the book at Vanduyl. The state and defense had already struck a plea deal that would keep Vanduyl incarcerated between 25 and 40 years. The judge would hear from both sides before deciding on the sentence.

The women recounted the profound terror that greeted them as they walked to their car from the popular downtown West Palm Beach night spot E.R. Bradley's Saloon. Vanduyl appeared out of bushes with a gun and ordered them into their van, where he took the driver's seat and had them take turns performing sex acts on him while he cruised around downtown. They felt the cold metal of the gun on their skin throughout the ordeal. Vanduyl taunted them, periodically announcing they were about to die.

"My sexual purity, which I treasured, is no longer with me," one of the women told the judge. The South Florida Sun-Sentinel does not identify sexual assault victims.

The other female victim, a single mother, said thoughts of her 7-year-old son being motherless plagued her as she was held hostage by a "psychotic, unstable, crazed maniac."

"We were tortured ... held as prisoners in fear for our lives," she wrote in a letter that Assistant State Attorney Michelle Marken read on the woman's behalf as she stood beside her. "We never knew if his joy ride was going to end."

Vanduyl, bound with feet shackles, waist chains and flanked by a half-dozen deputies, stared somberly at the floor for much of Friday's testimony, which included a forensic psychologist and his older sister Vicki Vanduyl of Maryland. Before learning his fate, he stood and apologized to the victims.

"I hope one day they'll forgive me," he said quietly.

He has a long documented history of mental illness dating to his childhood in Fairfax, Va., according to psychologist Christopher Fichera. Substance abuse compounded his mental problems.

The youngest of four children, he was born with an underdeveloped lung and suffers a form of bi-polar disorder as well as congenital brain damage and major depression and mood disorders. He has an IQ of 74, which borders on mental retardation, and was ridiculed mercilessly as a child because of his poor speech and low intellect. When his father, who was his best and only friend, died of a heart attack when Vanduyl was 15, he fell into a deep depression, for which his mother placed him in a long-term psychiatric facility. He began taking a plethora of medications including anti-psychotics, anti-anxieties and mood stabilizers. He improved a bit, records show, though doctors told his mother that her only son would likely never be able to live outside a supervised hospital setting.

Though he has had periods of sobriety has thrived best in in-patient care, Vanduyl was homeless for years at a time. Law enforcement came to know him well, through arrests for things like trespassing and affray. He was involuntarily committed numerous times to short-term mental facilities, but always relapsed after being released.

Payton Bruns, who came to know Vanduyl through Alcoholics Anonymous meetings over the past eight years, said Friday that Vanduyl was friendless and "pretty beaten down at times" when he sporadically attended the meetings. Vanduyl recently wrote a letter to the group expressing remorse for his actions and thanking them for their unconditional kindness.

Pastor Olga Smith, who runs a homeless ministry, recalled helping Vanduyl enroll in a faith-based Tennessee rehab facility a few months before the attacks, but was surprised to encounter him on the streets a couple months later.

A "disheveled" Vanduyl was out of touch with reality and didn't recognize Smith. She never saw him again until he appeared in the news after the attacks.

Assistant Public Defender Antony Ryan asked the judge to forego the maximum 40-year prison term so that Vanduyl might one day have another shot at freedom. Vanduyl will be a senior citizen should he ever get released.

"I'd argue the last fraction of his life doesn't have to be spent in prison," Ryan said. "He won't be the same person 25 years from now."

While Marx attributed Vanduyl's station in life to his mental problems, she also told him that he's a danger to the community and needs to be punished for his "terrible, terrible crimes."

"It's really too late for rehabilitation," she said, before announcing the 30-year sentence, explaining that 40 years would amount to a life sentence.

Missy Diaz can be reached at mdiaz@sun-sentinel.com or 561-228-5505.

Copyright © 2007, South Florida Sun-Sentinel
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Artist brings message on mental health -Milwaukee Journal-Sentinel

New York-based artist Susan Weinreich has won widespread praise for her paintings, which have been presented in solo exhibitions in New York and California. Formerly diagnosed with paranoid schizophrenia, Weinreich appeared last week at a benefit for Milwaukee's Grand Avenue Club, a community that provides support and assists in job placements for people with mental illnesses. She spoke with Journal Sentinel reporter Belinda Yu.

Q.How did you get involved with the Grand Avenue Club?

A. I had met the director of the Grand Avenue Club (Rachel Forman) in Indianapolis. (The Club) wanted me to present my work to the Milwaukee community. The concept is to break the stigma of mental illness and to get people talking about their mental health. I myself have had a long recovery from paranoid schizophrenia. At the age of 19, when I was a student at the Rhode Island School of Design, I became very, very sick and ended up spending 10 years in psychiatric hospitals. Back then, there was nothing in the community to support people that were suffering from mental illness.

Q.The New York Times has described your drawings as "messy, dark, and strange . . . totally unencumbered by conscious thought or feeling." Is this a fair assessment?

A. Oh, absolutely. When I approach my drawing or painting, it's extremely heartfelt. It's not analytical. My process is spontaneous. I try not to hold back in any way. When I start a painting, I have absolutely no idea where it's going to take me until it's all over. It's always a surprise. Sometimes it's a shock.

Q.Much speculation has been made about a possible link between mental illness and creativity. Do you believe a relationship exists?

A. I grew up in a world where it was taught that to be an artist, you have to suffer. And I think that's absolutely insane. There's no question that art can come from a sense of angst that we all have. But I think good art mostly comes from a sense of commitment, perseverance and investment in what we do. I think an artist can be anyone.

Q.You've painted a portrait of Samuel C. Klagsbrun, a psychiatrist who has written about bereavement, and world-renowned cellist Leonard Rose. How did these paintings come about?

A. Doctor Klagsbrun was my former psychiatrist who turned my prognosis around. My family was told for many years I would be institutionalized for the rest of my life. Although he only treated me as a psychiatrist for three years, we continued to stay in contact all this time. Leonard Rose was actually married to one of my latter therapists. (Klagsbrun) referred me to a woman named Xenia Rose.

Q.What's your favorite color?

A. Ah, let's see. I'd have to say cadmium orange.
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Critics of 'The Secret' Bemoan Claims - AP

By TARA BURGHART
Associated Press Writer

CHICAGO — The woman with long, dark hair looks yearningly at the gold necklace in the window of a jewelry store. She fixates on the bling. There's some kind of disruption in the atmosphere. And then, the necklace is draped around her neck.

The scenes unfold in "The Secret," a 90-minute-long DVD advocating the power of positive thinking that has sold 2 million copies. More than 5.2 million copies of the book of the same name are in print.

While "The Secret" has become a pop culture phenomenon, it also has drawn critics who are not quiet about labeling the movement a fad, embarrassingly materialistic or the latest example of an American propensity of wanting something for nothing.

Some medical professionals suggest it could even lead to a blame-the-victim mentality and actually be dangerous to those suffering from serious illness or mental disorders.

"It's a triumph of marketing and magic," said John Norcross, a psychologist and professor at the University of Scranton in Pennsylvania who conducts research on self-help books. He believes some are very useful when backed by science and focused on specific problems, such as depression.

"'The Secret' has earned my antipathy for its outrageous, unproven assertions that I believe go beyond the ordinary overpromises of most self-help books into a danger realm," he said.

"The Secret" is the work of Rhonda Byrne, an Australian television and film producer. Her central claim is that the "law of attraction" governs our universe.

"The law of attraction says that like attracts like, and when you think and feel what you want to attract on the inside, the law will use people, circumstances and events to magnetize what you want to you, and magnetize you to it," Byrne said in an e-mail in response to several questions posed by The Associated Press.

She said she was struggling personally and professionally several years ago when she was given a nearly 100-year-old book called "The Science of Getting Rich," by Wallace D. Wattles. In it, readers are guaranteed to become wealthy if they learn and follow "certain laws which govern the process of acquiring riches."

Inspired to do further research, Byrne said, she resolved to create a film to spread the word about what she felt she had learned about the "law of attraction."

The DVD, also available as a Web-based, pay-per-view video, was released in March 2006. It resembles a videotaped seminar, featuring commentators with titles such as "quantum physicist," "philosopher" and "visionary" — many of whom had already written their own books. Its trailer has cloak-and-dagger images, yellowed scrolls and mystical music evoking another massive publishing hit, "The Da Vinci Code."

The book, which followed last November, features images of wax seals and paper that mimics parchment. It's currently the No. 1 nonfiction book on lists of best sellers, including Publishers Weekly, The Wall Street Journal and USA Today, and is No. 1 on The New York Times' hardcover advice list.

As with many publishing hits, the "Oprah Effect" played a role. Winfrey devoted two shows in February to "The Secret," and Larry King and Ellen DeGeneres also featured it on their shows. It was spoofed on "Saturday Night Live" when a man portraying a refugee in the Darfur region of Sudan was blamed for having negative thoughts.

However, the fear that "The Secret" will lead to a blame-the-victim mentality is a serious claim of critics.

For example, the book dismisses conditions such as a genetic predisposition to being overweight or a slow thyroid as "disguises for thinking 'fat thoughts.'" And during times in which massive number of lives were lost, the book says, the "frequency of their thoughts matched the frequency of the event."

Psychotherapist and lifestyle coach Stacy Kaiser said that after reading "The Secret," several patients have worried that it was their fault they were abused, or laid off from their jobs. Others seem to expect everything in their lives to change overnight, she said.

The Los Angeles-based Kaiser joined several other therapists who praised the positive thinking espoused in "The Secret," but who question its failure to discuss action.

"People start to think that they don't have to use their free will, that they don't have to have power anymore, that they don't have to make choices," Kaiser said. "They don't realize they have to do the work. And that's the conversation I keep having to have with people."

Dr. Gail Saltz, an author and psychiatrist at New York-Presbyterian Hospital/Weill Cornell Medical Center, pointed out that cognitive behavioral therapy seeks to modify harmful thoughts as a way to improve patients' feelings.

She said that among people who are ill, those who remain hopeful and have a positive attitude tend to do better. But she was especially upset about a portion of Byrne's DVD in which a woman claims her breast cancer was cured without radiation or chemotherapy; the woman watched funny movies and had faith that she had already been healed.

Saltz received hundreds of angry e-mails after she talked about her concerns on the "Today" show. She thinks that some fans of "The Secret" take it figuratively — they don't think they'll get a necklace just by thinking about it, but feel improving their thoughts improves their life. But from the e-mails she received, she said some people do believe it is based in scientific reality.

"Living is difficult. ... People want ... a solution and an answer. If it were an easy one, like 'think it' — that would be even better, right?" she said. "I understand. It's a wish fulfillment. I really do understand that."

Dr. Maria Padro, a psychiatrist at St. Vincent's Hospital Manhattan in New York City, believes that Americans turn to self-help books because contemporary society is stressful and there is still sometimes a stigma connected to visiting a therapist.

She read "The Secret" to see what the "jibber jabber" was about. She jokes that she keeps the book in her bedroom, out of the view of visitors. Still, she sees value in its positive outlook.

"I think the secret is that everyone has their own secret, and everyone has their own dream," she said. "And the book is one of the tools we can use to get it, but I don't think that it's a little magic wand."

Even one of the participants in "The Secret" DVD and book laments the lack of action. James Arthur Ray is billed as "a philosopher," although he says in a telephone interview that he is five hours shy of a college degree in behavioral science.

He speaks to groups on his own philosophy of success, and he maintains that the "law of attraction" is just one of seven "laws" people must use to improve their lives. He felt "The Secret" was "a good way to introduce people to a new way of philosophical thinking and looking at their world." But Ray said during the creation of the DVD, much of his talk about taking action ended up on the cutting room floor.

"You can watch 'The Secret' and come away with the illusion that you can sit around in your living room and visualize your millions dumping into your lap, and that's just not going to happen," he said.

Byrne counters that the type of action her critics discuss isn't required by the "law of attraction."

"It is impersonal, exact and precise. Become that which you want on the inside, and you shall receive it in the outside world," she said in her e-mail. "The most important action to take is the work within you. When that is done, you will be moved in the outside world to receive what you asked for."

As for the woman with breast cancer, Byrne said "The Secret" fully supports all forms of healing, and feels "enormous gratitude" for what traditional medicine has accomplished.

"The Secret" owes its life as a book to an Oregon dinner party where the president and publisher of Portland-based Beyond Words Publishing met one of the DVD's commentators, who prompted them to watch "The Secret." Atria Books, an imprint of Simon & Schuster, has a co-publishing agreement with Beyond Words. Judith Curr, Atria's executive vice president, said when she watched the movie, she immediately envisioned a book.

She was especially confident because of the success of the "teachers" featured on the DVD. The contributors, including Jack Canfield of the "Chicken Soup" series, had sold roughly 400 million copies of their own books, she estimated.

"I told everybody here when I still just had a DVD that we were going to sell a million copies," she said. "They all, of course, thought I was smoking something."

Now "The Secret" is being published in 35 foreign languages and is the fastest-selling self-help book in Simon & Schuster history.

"It's great to be involved in something that can help change people's lives in a positive way," Curr said.

Amanda Jacobellis, 25, believes her life has changed for the better since she watched "The Secret."

Earlier this year, she was trying to turn a building in West Hollywood, Calif., into a makeup salon specializing in eyelash extensions and evoking the glamour of Old Hollywood. Her renovation was only half done, her credit card bills were coming due and her banker couldn't explain why the money for a $50,000 approved loan hadn't arrived in her account.

Sensing her despair, a friend suggested she watch Winfrey's upcoming show on "The Secret." Jacobellis did, and bought the DVD as well.

She spent a night diagramming what she wanted in her life, using a piece of paper and a Sharpie pen: happiness, security, freedom; good relationships with her friends and family; fitness and health goals; less stress — and in one corner, she wrote that she wanted her $50,000 loan by the next day at 3 p.m. She made a call to her banker the next morning: no news. But by 3 o'clock, the mail arrived, containing a letter saying she could call to get the funds transferred into her account.

Jacobellis now sells the DVD in her Makeup Mandy salon.

"I think where people are mistaken when they watch it is they think all they have to do is wish and it's going to happen," she said. "That wasn't exactly the case. This is something I had put a lot of energy and time into.

"What I take from it is not that you just have to wish or hope or think something's going to happen. ... There's a way it's going to happen. ... When you're more positive, I think new ideas come to you and you're able to kind of get through hurdles or over obstacles."

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Parental rights can sometimes be dwarfed by parental wrongs -Durham News

Guest Commentary:

By John Schwade

Last month the North Carolina Court of Appeals affirmed the order of Durham District Court Judge James Hill terminating the parental rights of a mother in the case of a boy identified only as C.O.A.

Such actions are rare because two rigorous standards must be met. The first is a finding, by "clear and convincing evidence," that the child was abandoned, neglected or abused as defined by the law.

Judge Hill found that the mother had "willfully left the child in foster care" for more than two years after the filing of the motion to terminate parental rights "without showing ... that reasonable progress under the circumstances has been made in correcting those conditions which led to the removal of the child."

In fact, she moved to Washington, D.C., and did not avail herself of return trips to Durham offered by the Department of Social Services. Further, the mother's "needs prevented her from being able to provide appropriate care" for the child, and she didn't cooperate with mental health treatment.

Termination of parental rights must be "in the best interests of the child," the second standard. In practical terms, this means a better home environment must be available. In the case of C.O.A., his foster family had a loving relationship with him and the special qualifications to provide for his care.

Nevertheless, termination of parental rights provokes emotional reactions from all directions. Conservatives may object to government interference with parental prerogatives or religious beliefs; those on the left may claim such decisions reflect sexism or racism. The legal loss of a child is often characterized as sad or even tragic for the parent.

All such reactions have one thing in common: Precedence is given to the parent over the child whose abandonment, abuse, or neglect constituted "those conditions which led to the removal of the child."

For the past 23 years I've worked as a psychologist in an institution for mentally retarded adults, a juvenile training school, and now a prison. I've seen the other side of the story -- the effects of "those conditions" on children whose parents never lost either their legal rights or their perceived right to mistreat their children. Among the most disturbing memories are:

* A man whose parents locked him in an attic throughout his childhood, stifling development in all areas.

* A mother who, having abandoned her son at birth, declared herself "redeemed by the Lord" and re-entered his life after he was locked up for raping and cutting a woman. Her contribution to her son's development was to declare his innocence to those attempting sex-offender treatment, despite DNA evidence and the victim's scars. Her son subsequently developed into an adult predator.

* A boy whose father, recognizing the opportunity afforded by the mother's crack addiction, took custody of his son a decade after abandoning him. When the father received notice that his child support obligation had ended, he abandoned his son again -- to the streets, and ultimately prison.

* The many boys who misbehaved in training school to ensure that they would not be released before their 18th birthdays, to the parents who had exploited them to commit crimes (some were pimped), or abused them so cruelly they were sentenced to prison.

Published reports can be read outside the presence of young men sobbing with grief, or disfigured by neglect of their medical care. Reports are not studied under the gaze of men who, unable to connect with other humans, look at you as if you were a vending machine, useless if not dispensing. ("Got a cigarette?")

That's the awful reality of childhood maltreatment -- and it does not stop with the victim. As adults, those abandoned, neglected or abused as children are most likely to mistreat their own progeny.

Breaking the cycle sometimes requires terminating parental rights in the best interests of the child, and children of future generations.
Durham resident John Schwade is a psychologist at a state prison. Read more!