Creative Synergy: A portrait of New York City artist Martin Cohen -Schizophrenia Digest

Reprinted from Schizophrenia Digest, Summer 2007

By Sandy Naiman

Martin Cohen’s life changed forever one February night in 1981 when all of his favorite rock stars came flying out of the sky, led by Peter Gabriel as the Antichrist, and King Tut rose out of his bed. Terrified, the then 22-year-old Cohen began hurling soda-pop bottles and telephones, shattering a 30-foot wall of windows in his parents’ Long Island home, along with—or so he thought— his dreams of being an artist.

Cohen was alone in the house at the time while his parents were vacationing in Florida. Police were summoned to the residence after his destructive behavior set off a security alarm. Now 47, Cohen reluctantly recalled this experience recently at the Bombay Express, one of dozens of trendy restaurants on Ninth Avenue in Manhattan’s Hell’s Kitchen. The place is only a few blocks from the Fountain Gallery—which Cohen was instrumen­tal in founding in 2000, and where he is a prominent artist.

Early in the dinner hour on a balmy spring afternoon, the restaurant is empty. Cohen is tall, gentle, and soft-spoken, a teddy bear of a man with clear blue eyes and thick, wavy light brown hair tinged with grey that curls around the collar of his pale blue shirt. Initially, he seems tired after his shift as an internal messenger at Neuberger Berman, an East Side brokerage firm, but after ordering a mutually an appetizer platter, chicken biryani, and a Diet Coke, he unwinds and continues his story. “I was hospitalizedand I slept for days, but when I finally woke up and was discharged, they gave me no med­ication, no diagnosis, and no follow-up care. They just thought I was greater than a kid doing drugs.” Martin’s father, Isreal Cohen, recalls that a few weeks before his son’s psychotic break, Martin had attended an est (Erhard Seminars Training) transformation program in Manhattan on a friend’s recommendation. “Marty came home flying. All he talked about was this pro­gram,” Isreal says.

Est was a controversial self-help movement that burned through the United States during the 1970s and 1980s, promising to “strip people of the mental and emotional ‘trappings’ imposed on them by the outside world and to teach them to accept themselves and take responsibility for their lives, rather than blaming others for what they are,” according to a 1977 article by New York Times health writer Jane Brody. For many hours over a week­end, est trainees were forced to sit without eating, smoking, going to the bathroom, or leaving the room while an overbearing leader taunted them and battered their self-esteem. “Many were reduced to tears; others fainted or rolled on the floor; some vomited,” Brody reported.

Often the most vulnerable and fragile individuals were drawn in by the est promise. Rather than self-acceptance, however, many est alumni ended up emotionally damaged. A 1977 American Journal of Psychiatry study reported that a number of est partici­pants were devastated and developed permanent psychosis.

Isreal Cohen believes the night his son “almost destroyed the house,” shortly after returning from his est weekend, “was the start of all Marty’s problems.” Before that, he says, “he was one of the sweetest guys you could meet, with a great bunch of friends.”
Development of an artist

The eldest of three children, Martin Cohen was born in Flushing, Queens. Later, as his father’s health-care person­nel and equipment business prospered, the family moved to the more affluent village of Roslyn on Long Island.

“He had a pretty normal upbring­ing and was a well-rounded kid who excelled at sports, but art was always a big part of his life,” his father says. “He attended a school which championed artistic and creative children.”

Martin Cohen says he has always found a sense of peace creating his art. “I used to feel safe when I was drawing or painting,” he says. “Art was my escape, my sanctuary. It was something I needed to do, that needed to be expressed, that I had to explore. I even loved the smell and feel of the oil paint, the oil pastels—all the materials I used.”

Throughout junior high and high school, Cohen studied life drawing. He became a protégé of the late Viggo Holm Madsen, a nationally known printmaker and teacher who encouraged him to experiment with a variety of materials, techniques, and artistic styles.

Later, when Cohen was an under­graduate in the bachelor of fine arts program at the State University of New York (SUNY) at Purchase—despite his 1981 breakdown, he was able to return to college—art critic Irving Sandler introduced him to the work of the Abstract Expressionists, including Jack­son Pollock and Willem de Kooning, and encouraged him to delve into the abstract in his own painting.

For two years after graduating from Purchase in 1982, Cohen studied at The New York Studio School before enrolling in graduate school at the College of Fine Arts at Pittsburgh’s Carnegie Mellon University. There, the contemporary artist Sam Gilliam took him under his wing and fostered his serious forays into Abstract Expression­ism, now Cohen’s defining artistic style.

After completing his master of fine arts degree at Carnegie Mellon in 1986, he moved back to New York to pursue his life as an artist.
Brilliant and prolific

Cohen has meticulously catalogued every piece of art he has ever created, in dozens of large black art books stacked in his one-bedroom apartment-cum art studio: pen and ink reclining nudes he drew at the age of 10; vibrant, pulsating oil pastel landscapes he did at 12; and delicately shaded architec­tural studies of wooden structures in pencil, created at age 14.

Other books contain a seemingly endless collection of his sly, satirical, witty collages—photo-montages in which he juxtaposes cutouts of hun­dreds of heads of self-important politi­cal figures with the bodies of other famous personalities, or gargoyles, “so I can make fun of people who take themselves too seriously,” he quips.

Page after page, his progress, his artistic development, his playing with style, his prodigious output, are bril­liantly evident and dizzying.

His more recent paintings are intri­cately detailed, dynamic, splintered and shard-like mixed-media images on huge canvases. These Abstract Expres­sionist works include a series of 30 “Doors of Expression” painted on six-and-a-half-foot-tall wooden doors he began working on in 1988. Several hang crowded together among his smaller canvases on every wall of his apartment, even in the windows, block­ing almost all the natural light.

Cohen’s representational works include stunning portraits of his favorite pop musicians—Jim Morrison, Neil Young, Keith Richards and Mick Jagger, Madonna, George Harrison, Paul McCartney and John Lennon, Frank Zappa, and others.
Synergy of art and illness

After 9/11, Cohen began trying to depict the horror of that day on nine door panels to create one sweeping 30-foot-long panorama called “Ground Zero.” He grew so upset and intense, so involved in this ambitious project, that he “got himself into trouble and had a psychotic break,” his psychia­trist, Ralph Aquila, MD, says (after receiving permission from Cohen to discuss his history). “He’s had one or two subsequent ones since, and usu­ally around his artwork, but we’ve been able to prevent a lot.”

Cohen says he works most passion­ately when his illness is at its worst. He listens to jazz, rock, or classical music while “acting out” on paper and canvas instead of in real life. His mood swings and hallucinations and his art can be singularly synergistic—he feels that in combination, they can enhance his creativity and his work.

Despite the shock of his first psy­chotic episode while he was a student at SUNY Purchase, his artistic future was far from shattered. Admittedly a “mood-oriented artist,” he says the deaths of his mother and grand­mother, as well as the suicide of a close high school friend, have influ­enced his art.

“My illness has informed my work and made me more willing to experi­ment. It was also therapeutic because it allowed me to express my suffering artistically.”

While Cohen regularly takes his medication now, there are times when he becomes so wrapped up in his painting, so involved, that he can for­get, says Aquila. “And because he’s very sensitive, in a couple of days he can get into trouble. But he’s never intention­ally not taken his meds.”

Cohen’s father recalls that follow­ing his son’s first breakdown in 1981, the next 14 years “were very confusing and hard on Marty,” with different doctors diagnosing him variously with bipolar disorder or schizophrenia before eventually settling on schizoaf­fective disorder. Martin was repeatedly in and out of mental hospitals, where he was prescribed “heavy-duty chemi­cals” to ease his episodes of mania, depression, and psychosis. “He could-n’t handle the side effects, he’s so sen­sitive, and it was a very difficult time,” his father says.

But when he was well, Cohen’s energy was limitless. Between 1986 and 1992, he worked as a fine art installer for several art galleries and museums, while producing his own paintings and collages. In 1992, he acquired his own East Village gallery space and framing business—called Ten B.C.—through a friend of his father’s. There, living with his broth­er in an apartment above the gallery, he staged his first New York exhibi­tion and practically sold out. After several successful group and solo exhibitions, his complex, energetical­ly colorful mixed-media canvases and collages were starting to attract atten­tion in Manhattan’s mega-competitive art world.

Yet he was constantly struggling financially, and although he was seeing a psychotherapist, Cohen says, the therapy wasn’t helpful. “I got sick of therapy and I wanted to work.”

Enter Esther Montanez.
A life-changing meeting

It was 1995. Cohen needed to get a prescription filled, but the pharmacy wouldn’t process it, claiming some­thing was wrong with his Medicaid. He left and was walking down the street when a woman stopped him and said, “You look upset. Can I help you?”

“I told her what had happened,” Cohen says, “and she said, ‘Come with me.’”

Esther Montanez took Cohen’s arm and marched him right back into the pharmacy, where she said, “Hey, this is a good friend of mine. Give him his med­ication. He needs it.” And they did.

Montanez was the director of spe­cial projects at Fountain House, a 59-year-old pioneering community-based and multifaceted mental health serv­ice called a Clubhouse run by and for people with mental illnesses. Cohen became a member of Fountain House and Montanez became his close friend and ally.

At the same time, Cohen came under the care of his current psychia­trist, Ralph Aquila, MD, at The Store Front practice, located minutes away from Fountain House.

The Store Front is a one-stop shop for Fountain House members. Aquila, who directs the St. Luke’s Roosevelt Hospital Center’s Residential Commu­nity Services, specializes in treating peo­ple with serious and persistent mental illnesses, 60 percent of whom have been homeless. People in this popula­tion often have many more medical ill­nesses than the general population, so The Store Front emphasizes treating the whole person.

Aquila calls The Store Front’s multi-prong approach—which, in addition to psychotherapy, relies on such programs as A.A. and Weight Watchers, as well as caseworkers to communicate a message of hope and provide practical support—“the reha­bilitation alliance.”

“I try to see Marty every seven to 10 days just to make sure everything is okay. I work with his two key casework­ers so he doesn’t start to doubt him­self,” Aquila says.
Battling self-stigma

“One of Marty’s problems right now is self-stigma. Our main objective is to get him to do his art and work as a teacher, but the main obstacle to that is self-stigma. He doesn’t believe in himself and the fact that he can do it, so it’s a constant struggle around those issues. He’s a great guy, a great teacher, and he has a lot to share with a lot of people.”

Aquila and the Fountain House caseworkers meet with Cohen on a reg­ular basis to emphasize his strengths, communicate with each other, and try to stay on top of any potential prob­lems. As a team, they encourage him to be successful.

“During the time that I’ve been working with him, Marty’s become a much deeper and more perceptive artist,” says Aquila. “His capacity to do his artwork and teach, and the knowl­edge he brings to his art, have dramati­cally improved over the years.”

And according to Isreal Cohen, Aquila has done more for his son than anyone else ever has.

“He talks to him on his level and they’ve developed a friendship,” Cohen’s father says. “Also, he makes sure that Marty takes his meds. I know he loves my son.
More than a gallery. A movement.

Once settled into the Fountain House community, Martin Cohen embraced one of Montanez’s innovations—the Artist of the Month Club—and along with other Clubhouse members began displaying his art around the Club-house’s elegant Georgian Colonial headquarters on West 47th Street.

“Esther was a whirlwind, a power­house,” Cohen says. “One day she came to me with the idea of opening an art gallery at the Fountain House Thrift Shop (at the corner of 48th and Ninth Avenue), and she asked me to help.”

The initial idea came from Fountain House executive director Kenn Dudek, who regularly visits many of the more than 300 international Clubhouses that sprang from the Fountain House model. When he saw beautiful paintings by a member dis­played in a Scandinavian Clubhouse, he suggested that Fountain House open its own gallery.

A number of talented members, including Cohen, jumped at the chance to run a Manhattan gallery for Fountain House artists. Montanez, “with her usual flair,” Dudek recalls, engaged a large group of members, volunteers, and recruits she grabbed off the street. “She was famous for that,” he says.

Today, two of Cohen’s Abstract Expressionist works, called “Esther’s Wings,” hang at Fountain House oppo­site a striking portrait of Montanez that he and another Fountain Gallery artist painted. One of these “Wings” is in memory of Cohen’s grandmother, also named Esther, and the other honors Montanez, who championed him and his art. A driving force behind Fountain House for more than 40 years, Esther Montanez died in 2005 at age 70.

Fountain Gallery opened in June 2000 as a nonprofit co-operative run for and by Fountain House artists liv­ing with mental illnesses. Beginning with a coterie of six artists, today close to 40 painters, sculptors, and photog­raphers not only contribute to New York’s art scene but are challenging and changing common myths and mis­perceptions about people with mental illnesses, in keeping with the Fountain Gallery motto: “More than a gallery. A movement.”
Blooming recognition

Cohen’s work is included in several important corporate collections, among them that of the Estée Lauder Companies Inc., which is overseen by curator Elizabeth Szanzer Kujawski. Kujawski is also responsible for Ronald S. Lauder’s personal art collection, described by Glenn Lowry, director of the Museum of Modern Art, in a recent New Yorker article as “the finest collection of modern art assembled by an individual in the world today.”

“Marty is a very good artist in his use of color and application of materi­als,” Kujawski says. “His paintings are striking and very beautiful.”

Last fall, the Estée Lauder Compa­nies Inc. sponsored a solo show of Cohen’s art at Vivian Horan Fine Art on East 67th Street. It was a departure for Cohen, outside the nurturing fold of the Fountain Gallery, but the open­ing was packed and his paintings looked spectacular on the walls of the elegant second floor townhouse gallery. “It was a great evening and a great opportunity for me,” he says.

That was Cohen’s most recent solo exhibition; several of his pieces were part of a group show at the Fountain Gallery May 3 to June 30 called “Transitions.”

Right now, Cohen is actively look­ing for teaching opportunities, but he is also buying new materials, oil paints, and canvases, and conceptualizing the next phase of his creative vision.

Sandy Naiman, an award-winning mental health advocate and journalist for more than 30 years, lives in Toronto, Ontario, Canada.

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Health director's pay still too high - Charlotte Observer

$225,000 exceeds formula set by state

Mark Johnson, The Charlotte Observer

RALEIGH - State officials say the salary for an Eastern North Carolina mental-health director remains too high even after the director's board slashed his pay.

The Office of State Personnel has told officials at the Albemarle Mental Health Center that Executive Director Charlie Franklin's salary, reduced last month from $319,000 to $225,000, still exceeds a state formula for salary ranges. The state personnel office must approve pay plans for local agencies that are subject to the state personnel act.

Franklin, 65, did not return a telephone message Monday to his Elizabeth City office.

Published reports in June about Franklin's pay stirred sharp criticism from legislators and Gov. Mike Easley. Franklin remains the highest-paid mental-health director in the state. Mecklenburg's director, for example, makes $142,000 to run a system with seven times as many clients as Albemarle. Easley makes $136,000.

The chairman of the center's board, former Chowan County Commissioner James "Pete" Dail, issued a statement Monday through a spokesman at a Raleigh public relations firm. He said the Albemarle board was adjusting Franklin's salary range to comply with the state formula.

The spokesman, Greer Beaty, did not say whether Franklin's salary would change, or the salary range for his job. Nor did Beaty make the new range available.

Helper earns $143,000

State Auditor Les Merritt also is investigating Franklin's salary. The General Assembly on Monday approved a state budget that requires mental-health agencies to follow a state-mandated pay scale for the director and restricts any pay increases to 10 percent above the salary range set by the State Personnel Committee. The legislation was generated by the controversy around Franklin.

Under the state personnel office formula, the bottom end of the salary range for Franklin's position cannot be more than 60 percent higher than the bottom end of the salary range for his highest-paid subordinate.

Franklin's pay range exceeds that difference. His top-paid subordinate, Linda Triplett, is his assistant who, with no college degree, earns $143,000 a year.

Albemarle officials asked for an exception for his salary.

"There isn't going to be an exception granted," said Drake Maynard, whose division at the state personnel office handles state universities and local agencies.

Also out of range

An additional problem with Albemarle's salary plan, though not with Franklin's pay, is that several other salaries exceed the pay range of comparable jobs in some of the 10 counties that Albemarle serves. All 10 are in northeastern North Carolina, and the group includes some of the poorest counties in the state.

Albemarle Mental Health Center's administrative functions are funded primarily with state tax dollars. The center, like other mental-health agencies, does not report to state officials in Raleigh but to a local board with members from each county covered.

Franklin retired in 2005 but continued doing the same job as an independent contractor for the same salary of $289,000. The board gave him a $30,000 raise last year. On top of his salary, he received $157,000 in pension payments before the state treasurer's office stopped those checks, arguing that Franklin never actually retired.

An administrative law judge in May agreed with the treasurer's office and ruled that Franklin's contract was void from the beginning.

In June, Albemarle's board cut Franklin's salary by nearly $100,000 and eliminated his $1,000-a-month automobile allowance, though the car money was about to be eliminated by the state budget language. One board member said the cuts came partly in response to Easley's criticism reported in The Charlotte Observer. "It influenced the decision of the board," said Cecil Perry, chair of the Pasquotank County commissioners and a member of Albemarle's board. Read more!

Father asks why police shocked son who jumped off Spokane bridge - AP

SPOKANE, Wash. (AP) -- The father of a man who jumped to his death off the Monroe Street Bridge is wondering why police shocked his son seconds before the fatal fall.

Josh Levy, 28, jumped to his death Friday afternoon after spending some 20 hours threatening to jump from the downtown bridge over the Spokane River.

Levy was shocked by a Taser right after police negotiators managed to talk him away from the bridge edge. But the Taser did not disable Levy, who then jumped over the railing and died when he hit the rocks below.

"I was assured all day that no violence would be taken toward my son," Dave Breidenbach told The Spokesman-Review on Saturday. "I don't believe that firing a Taser at a nonviolent potential suicide victim is a tactical maneuver."

Police Chief Anne Kirkpatrick said the Taser use was part of the hostage negotiations that led Levy to get off the bridge edge.

But only one probe of the Taser made contact with Levy, Kirkpatrick said.

"One of the success options that we give people in distress is, 'You make it look like we took you into custody,' and that was exactly what we were doing in talking with him," Kirkpatrick said. "Our tactical plan was to apply one application of the Taser to bring him to the ground so we could get him in that custody."

Levy climbed onto a bridge ledge on Thursday afternoon. The towering, four-lane bridge was closed for about 20 hours as officers tried to talk him down.

Breidenbach said his son had dealt with severe depression for years and had been diagnosed with paranoid schizophrenia and bipolar disorder. Earlier in the week, Breidenbach had picked up his son from Western State Hospital and brought to stay with him in Spokane. Levy grew up in Spokane and later, Bainbridge Island, where his mother still lives.

Levy had attempted suicide before and jumped from three bridges in Western Washington without suffering significant injuries, Breidenbach said. Levy also had been talked down on other occasions from Western Washington bridges.

Kirkpatrick said her negotiators were upset by the suicide

"The officers invested their hearts, their souls into helping him," Kirkpatrick said. "So for them to see that occur is truly devastating to them as well."

But Breidenbach compared the event to last year's death of Otto Zehm, a janitor who suffered from mental illness and died after he was falsely accused of a crime and Tasered and hogtied by police.

"We're going to give substantial time and effort to see that this never happens again to another person who is non-confrontational and non-aggressive," Breidenbach said. "I just want this not to happen again."

Read more!

Mother reaches out to autistic children -Avon (IL) Hendricks County Flyer

By Kiley Kellermeyer

Plainfield — Sharon Smith is a stay-at-home mother of three — two boys and a girl.

In some ways, her children are very much like other children. Quinn, 11, enjoys swimming and is fascinated with Transformers. Noah, 9, is very artisitc. Adriana, 7, enjoys listening to music.

But Quinn, Noah, and Adriana have all been diagnosed with some form of autism.

Autism is a brain disorder that begins in early childhood and persists throughout adulthood. It affects three crucial areas of development: communication, social interaction, and creative or imaginative play.

“It’s like having big 2-year olds,” Smith said. “They’re developmentally behind, but they’re a lot bigger and very strong and very determined, although the communication is not there.”

Smith said autistic children are generally diagnosed around 18 months of age, and are usually tested when they are not talking by that time.

With her family, though, her second born, Noah, was tested before her oldest, Quinn, and just after Adriana was born. After it was determined that Noah was autistic, the pieces all fell into place.

“Once we got the little two diagnosed, we ran across Asperger’s Syndrome,” Smith said, which is what Quinn was diagnosed with. Asperger’s is a pervasive developmental disorder that is similar to autism but without clinically significant language delay. The distinction between Asperger’s and autism is unclear.

The following years brought inevitable challenges to the Smith family in the form of tantrums, escape attempts, and communication barriers: pressure under which many families might crack.

Smith, however, chose to take what she had learned as a mother of three autistic children and share her knowledge with other families. She created a website, www.sharonsweb.com, and also ministers to special needs children.

“‘Jesus makes all the pieces fit’ is our theme (of the website),” she said.

And she is convinced that God has a plan for her unusual family.

“Sharonsweb.com is where I have information on Sharonsweb Autism Foundation,” Smith said. “It’s a non-profit ... people can donate ... money donated would go to our special needs ministry anywhere that it is needed.”

On the site, people can find “meet-up” groups, support groups with activities for autism spectrum children and their families.

Sharon also sells autism awareness items, with proceeds going to the foundation. They can also find information about fundraisers and post questions and ideas to Sharon and her helpers.



Mother reaches out to autistic children
By Kiley Kellermeyer

“It’s like an online support group,” Smith said. “[I want to accomplish] more awareness on autism, help other families.”

Smith said she started the site three or four years ago when she realized how difficult it was for middle-class families to get what they need for services and support from the government.

“We’re just kind of left out,” she said.

She also said there’s a niche in Hendricks County for her site.

“There’s not really much in Hendricks County, so [I want to] make it convenient, try to help families like ourselves that aren’t close to anything,” she said.

Smith and a friend from her church, Center Community Church, provide a Veggie Tales ministry for autistic children who are nonverbal, or who cannot yet form their own words.

“My two little ones repeat Veggie Tales songs,” Smith said. “We use that as part of the ministry.”

With that particular ministry, Smith explained, the ideas and messages in the videos get through to the very visual learners.

Smith also tries to integrate her autistic students into activities with the other children, which, she said, takes understanding on behalf of the congregation members.

Overall, Smith said, autism is misunderstood.

“If people don’t understand autism, my children may look like they’re not behaved,” she said. “It looks like they’re having a tantrum when they jut can’t verbalize what they want.”

That is the main challenge of autism — communication.

And Smith is trying to overcome that obstacle, at least, she hopes to break down communication barriers between families that she feel should be sticking together.

“[Visiting Sharonsweb.com] would help with the support,” Smith said. “They’d be able talk to other families.”
Read more!

What Virginia owes the families of Tech victims -Newport News (VA) Daily Press

Opinion:

A disconnect seems to be developing between the state's response to the shootings at Virginia Tech and the response of some of the victims' families.

The state's response is measured, weighty with procedure — and seemingly self-protective. Witness a recent observation by Gerald Massengill, chairman of the panel formed by Gov. Tim Kaine to investigate the shootings. Massengill said he doesn't think university officials or police could have done anything differently that morning — an interval that includes the first shootings in a dorm and the massacre two hours later in a classroom building — that absolutely would have saved lives.

That is preposterous. There are no absolutes, and hindsight is 20/20, but two decisions that might have saved lives come immediately to mind: One, to order a stay-put-and-lock-the-door order after the first incident. Two, not to spend so much time pursuing the wrong suspect. That isn't to blame the people who made the decisions, only to acknowledge that different decisions might have produced a different outcome.

Massengill's words — and the university's insistence that "it did everything it possibly could" that day — hint that there will be no mea culpa on the state's part, at least when it comes to the response once the shooting began. We'll have to wait for the panel's final report to see how well it sorts out responsibility for decisions made before that day.

Here, too, different choices might have made April 16 an ordinary day on campus. On the university's part, to respond more effectively to a student many people knew was seriously troubled. And on the state's part, to fund and organize local mental health services to intervene once he was declared mentally ill.

An impartial critique, a clear accounting of responsibility, official acknowledgment of any failures by agencies of the state, seems to be what the families are crying out for.

It looks as though the panel will focus on what can be improved to prevent a recurrence. That's essential, but we must forgive families if the issue that consumes them isn't how another child or husband or wife can be protected, but why theirs died.

Also understandable is some families' insistence on compensation. Money can't fill the hole left by a death. But it can help with the bills it leaves, and can bring comfort in the form of acknowledgment-by-checkbook of responsibility for their loss.

The compensation already proposed will come from donors who contributed $7 million to the Hokie Spirit Memorial Fund: $150,000 each would go to families of those killed, with smaller amounts to those wounded.

But some families seem to want compensation from the state, and in much larger amounts. That demand may not be just about money, but about a yearning to make the state pay for what happened to a person they entrusted to its care.

A lawyer who says he represents 22 families has talked of at least $2 million each, a figure pulled — inappropriately — from the average payout from a fund set up by Congress for victims of the Sept. 11, 2001, terrorist attacks. The idea is that the additional compensation would come from a fund set up by the state, with taxpayers making up any shortfall if donors don't send in enough. The implied threat that accompanies that talk — that a lawsuit could be forthcoming if that compensation isn't — may be another manifestation of some families' anger over the state's actions that day, and frustration with its handling of the matter since then.

What Virginia really owes the victims and their families is an honest and complete accounting of why they were victims. Of whose decisions and indecision, actions and inaction — the shooter's, the university's, the mental health system's — contributed to the terrible denouement of a situation that could have turned out differently. The question of whether it legally owes them money may be one for the courts, but the question of whether it owes them the truth, and apologies, is one any human heart can answer.
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Let's close Florida's revolving jail door -Pensacola (FL) News Journal

Commentary: By Gary Bembry

Recently, Florida Department of Corrections Secretary James R. McDonough announced a significant change to the agency's mission statement. To those concerned with the safety of our communities, it is an important change of direction.

The revision, according to Secretary McDonough, places a "renewed emphasis on the preparation of inmates for reentry into society as part of our mission. This is an anti-crime measure of the utmost importance to our state."

We commend the secretary's vision and understanding of the problem. But this is not a battle any one person can win. He will need the help of our Legislature, other state agencies and Florida's communities.

Too many ex-offenders leave prison unprepared for life on the outside and eventually return. In April there were nearly 92,000 inmates in Florida's prisons; more than 44 percent had been there before.

Recidivism is especially troublesome for those with a mental illness. It is estimated that 20 percent of the prison population has a serious mental illness and nearly three-fourths of inmates with a mental illness also have a substance-abuse disorder.

Mentally ill offenders have a higher-than-average rate of recidivism, cycling in and out of criminal justice settings with alarming regularity.

It is easy to see why this is such a problem. In prison, those with mental illness often experience rapidly declining physical and mental health, which makes a life of homelessness, poverty and a pattern of recurring crime, arrest and re-incarceration all the more likely.

So what happens to them? The sad truth is that unless they are arrested again, we often have no idea. We do know, however, that we are setting them up to return.

As Secretary McDonough moves forward, we hope he focuses on issues such as having transitional housing for ex-offenders with a mental illness. If we don't, then we are placing them directly into homelessness, for which they can be sent back to jail.

If we are trying to avoid seeing repeat offenders, this is an odd way to go about it.

Those with a known mental illness should be connected to local mental health and substance abuse counseling services prior to release. We need some sort of tracking that may include a period of parole and a way to know if they are treated in a hospital emergency room or have an encounter with police.

We need to work directly with law enforcement to explore additional means of intervention other than re-incarceration.

Establishing this tracking system is crucial, as the highest risk of recidivism of mentally ill ex-offenders is in the first six months after release from prison.

In addition to public safety concerns, our lack of success in keeping ex-offenders from re-entering prison costs taxpayers millions each year. With 20 percent of the 10,000 ex-offenders released every year having a significant mental illness, we are paying $120 million annually for their reentry into the prison system.

That is more than our state spends on all children's mental health services in a year.

Investing in community-based transitional centers and support staff is the key to tracking, counseling and guiding ex-offenders with mental illness toward safe and healthy actions and away from our prison gates.

It's what is best for them and our communities.

Gary Bembry is chair of the Florida Council for Community Mental Health. He is CEO of the Lakeview Center in Pensacola. Contact him (850) 469-3702, or gbembry@bhcpns.org. Read more!

Yolo cuts a lifeline for its mentally ill -Sacramento (CA) Bee

Clients and staff alike are saddened by the closure of three longtime county resource centers.

By Lakiesha McGhee - Bee Staff Writer

They have gathered each year to congratulate each other on the year's accomplishments.

Friends have swapped stories about a new apartment or job that was found, a milestone reached in their lives or a hurdle overcome.

The annual picnic for staff and clients of Yolo Community Care Continuum always has been a time to celebrate the nonprofit for providing mental health services to Yolo County residents.

Last week, the picnic also was a time to say goodbye to longtime mental health resource centers in Davis, Woodland and West Sacramento.

The county Department of Alcohol, Drug and Mental Health Services cut funding to the Community Care Continuum because of a projected $5.2 million budget shortfall. The cut resulted in the closure of the resource centers July 1.

For people trying to cope with depression, schizophrenia and other mental illnesses, the centers were a lifeline. For the staff, they were a way to reach out and form bonds in the community.

"I'm going to miss you," said Kate Hutchinson, who is resigning as executive director of Yolo Community Care Continuum after 13 years. She hugged Deborah Koebel inside the Farmhouse in Davis, one of the agency's long-term mental health treatment residences and picnic site.

Koebel had been a client at Haven House Resource Center in Woodland since 1994. When the center closed, she had to give up her regular case manager and get help for bipolar disorder from a county office, she said.

"Remember, we have a lunch date when you get back from vacation," Koebel said.

"I love you," Hutchinson said.

Yolo's mental health services department is in the midst of a financial crisis. It is expected to end the year with an operating budget shortfall of $5.2 million, according to a county report.

About half the deficit is due to a high number of people being treated in 24-hour residential care facilities and hospitals, mostly outside Yolo County, said Richard DeLiberty, the department's interim director.

Mental health services are being reorganized, and the department is seeking more ways to keep people out of expensive long-term facilities.

"I can't stress enough that Yolo County is not unique in our current fiscal bind," DeLiberty said, adding that Fresno County cut more than $10 million in mental health programs and Santa Cruz County cut 36 positions and about $800,000 in community contracts.

Rural counties seem to be having the most difficulty. Shasta and Glenn counties recently considered no longer providing mental health services to Medi-Cal patients and returning the program to state control, DeLiberty said.

Money woes date back several years for Yolo mental health services. However, recent problems are attributed partly to $325,000 in unplanned expenses associated with moving to a new building last year. Department staff was moved to the site on North Cottonwood Street in Woodland from various county offices that were old and had structural problems, DeLiberty said.

The county also lost $668,000 in Medi-Cal and Medicare revenue, and a state audit is requiring a $2.1 million payback. The large payback is attributed to disallowed claims that resulted from changes in county mental health practices, according to a county report. The audit is currently under appeal.

The mental health community in Yolo County is struggling with the changes and uncertainty.

"The first priority is to not have to lay off county workers, and that's why some of these difficult decisions are being made," said Marilyn Moyle, chairwoman of the Yolo County Local Mental Health Board.

The county analyzed its mental health services and programs and found that the YCCC resource centers were not providing the level of services needed, officials said. About $360,000 in funding to YCCC was directed to mental health programs instead.

Outpatient offices in Davis, West Sacramento and Woodland will replace the resource centers. A clinical supervisor has been established at each office, and a new division is being created to oversee case management, discharge planning and crisis services.

After speaking with several clients, clinicians and visiting sites, Moyle said that things appear to be going well. She said YCCC has an opportunity to bring forth a proposal to restore programs at a lower cost.

"It's heartbreaking when we have to cut funding to such a strong organization," Moyle said. "We are all really concerned about the clients, and we are watching to make sure they get what they need."

For Koebel, 44, any change is difficult. At the Farmhouse, surrounded by a spread of hamburgers and hot dogs, she talked about coping with bipolar disorder and social anxiety since childhood. Staff members at the Woodland resource center were like family, Koebel said.

In addition to counseling, they helped Koebel with her budget, grocery shopping, doctor appointments and moving into a new apartment shared with two cats.

When she learned that the resource center would close, she said, "I felt like I was going to fall back into my depression."

Hutchinson said the resource centers provided comfort in a home-like environment. They served 137 clients in Yolo County, and most staff members worked with their clients an average of eight years.

The county continues to fund 90 percent of YCCC's $1.2 million annual budget, which includes operating the Farmhouse in Davis and Safe Harbor House in Woodland, Hutchinson said.
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State care, minus the institution - Portland (OR) Oregonian

Oregon changes how -- and where -- it treats mentally ill kids, favoring home over a facility

SUZANNE PARDINGTON

At age 7, Zachary Hogan took his first psychiatric medication and spent his first of many nights away from his family in residential care.

Now 14, he's living at home, learning to cope with his mental illness in everyday life and working toward another first: attending regular public high school.

That goal would have seemed impossible two years ago, before a radical shift in the way Oregon pays for and allocates mental health services for 37,500 low-income children.

Following a nationwide trend, the state now aims to treat its most severely disturbed children primarily in their homes and communities instead of institutions. The change is part of a larger push from the state mental health, education, social service and juvenile crime authorities to work together to provide "wraparound" services to children.

The state's new mantra is every child should be "at home, in school and out of trouble."

The mental health system based its changes on evidence that children do better over the long run if they receive coordinated services and support in their regular environment. Their school attendance and performance improves. They are less likely to be arrested and spend time in juvenile detention. And they have fewer emotional and behavioral problems. That's according to the federal Substance Abuse and Mental Health Services Administration.

Keeping those children at home requires a web of care and support that typically costs about $3,000 to $5,000 a month in Multnomah County, less than the $8,500 a month for residential care. But the price of community-based care varies widely depending on each child's needs, and Bill Bouska, manager of the state's Child and Adolescent Mental Health Services, expects the new system to cost about the same overall as the old one.

For Zachary, that means a battery of therapists and trainers from the Albertina Kerr Centers drives to his family's mobile home in Welches several times a week to work with him, his mother and twin sister. If there's ever an issue the family can't handle alone, they can call a 24-hour crisis line.

"They've enveloped us as a family," Pam Hogan, Zachary's mother, said. "They're not just treating Zachary, they're treating the family."

Zachary can tell the difference, too.

"It's the first place that has really committed to helping me and hasn't given up," he said. "They are there through thick and thin."

Less time in facilities

Under the old system, Oregon contracted with residential psychiatric care providers and paid them directly for each child served.

There was often no alternative to residential care for children needing intense services, and there was only a limited system of monitoring cases locally to determine whether the placement was really needed, how long the child should stay or what happened after the child left.

Now the money is routed through one of nine mental health organizations, which manage each child's case and determine the best services for the child. With a team of local people monitoring treatment, more children are avoiding residential care or staying there no longer than necessary.

Since the change took effect in 2005, the average length of a child's stay in residential psychiatric facilities in Multnomah County has gone from 205 days to 115 days. Statewide, it decreased from 175 to 136 days.

Judge Nan Waller, chief family law judge in Multnomah County, said residential care still has a place. "It is needed sometimes, to stabilize. But I think everyone would agree that's not where we want to put our highest priority for kids. We want to keep them in as normalized a situation as possible."

"They just want to be regular kids," she added. "For some kids what I really see is that we are providing them with some hope."

Struggle since birth

Zachary and his twin sister, Zoe, were born about three months prematurely, each weighing about 21/2 pounds. Doctors thought they would die, and life has been a battle for Zachary ever since.

Pam Hogan's first indication that something wasn't right with Zachary was at age 4, when he would claw himself and pull his hair out if he didn't get his way. No one seemed to have any answers.

He was kicked out of his first preschool in Hawaii, where the family lived at the time, because the staff had to spend too much time chasing him. In his second preschool, he urinated on everything and everyone around him during nap time, prompting his first full psychological evaluation.

Over the years, he has been diagnosed with depression, anxiety, attention deficit/hyperactivity disorder and oppositional defiant disorder, according to Hogan. She said he also has post-traumatic stress disorder caused by how his father treated him.

When Zachary first went into residential care at age 7 in Hawaii, "it was like he was swallowed up by darkness," his mother said. "It was horrible. When I did see him, he was so miserable."

Hogan moved Zachary and Zoe to the Portland area from Hawaii five years ago to make a fresh start.

The family lives on Hogan's financial aid from Eastern Oregon University, where she plans to take online classes in the fall, and federal disability benefits for the children. Zoe, who attends Sandy High, has a mild form of cerebral palsy in her legs and has received special education services.

When Zachary was upset, he sometimes became violent, hurt himself and threatened or attacked others. His mother often had to place him in a physical hold to keep him safe. When she couldn't handle him at home, he stayed in residential care, sometimes for months at a time.

Zachary, who is intellectually bright, made major behavioral strides after Oregon created its system to keep children like him out of institutional settings whenever possible.

He attends Kerr's day treatment program in east Portland. When he gets too worked up, he can take a break in respite care at a residential facility for a few days, instead of a month or longer.

Pam Hogan now feels that she has a larger role in decisions about her son's care and enough support from Kerr to keep him at home.

"It's really working," she said. "The people who knew us in Hawaii would be shocked to see him now."

A paid role model

One morning at the beginning of July, Zachary built a shed outside the family's mobile home in Welches with Ian Mouser, who teaches music at Kerr's day treatment program and spends several hours a week with Zachary.

The lanky 28-year-old with shaggy hair is Zachary's skills trainer. Playing the role of a mentor and older brother, he shows Zachary positive ways to deal with his emotions and interact socially.

He helps provide stability for Zachary in other ways, too. When he heard that the family would be kicked out of the mobile home park if they didn't paint and fix up their home, he arranged for Home Depot volunteers to do it for free.

Without help, "we would have lost our home," Hogan said. Kerr is "the first to understand that part of the process is everyone feeling safe and secure and that we'll be there for a while."

That morning, Mouser and Zachary sat cross-legged in the shade to read the shed directions.

"What do you think is the likelihood of our building this the first time perfect?" Mouser asked.

"Not very likely," Zachary replied.

Mouser showed him how to measure and saw the wood into 3-foot pieces. That was just the first step in a complicated project, and Zachary soon grew annoyed with the slow progress.

"This is frustrating and boring," he said, before retreating inside the mobile home to complain to his mother. He sat on the floor, laid his head on his knee and rubbed his cat.

Mouser and Hogan spoke quietly to him, trying to calm him. Zachary soon curled up on a futon next to his mother with his back to Mouser and announced he wanted to take a nap.

What's key is what didn't happen, his mother said later. Zachary didn't fly into a rage. He didn't try to hurt himself or his mom. She didn't have to put him into a hold to keep him safe. She hasn't had to do that for about two years, since his last stay in residential care. She now gives him hugs instead.

"Something as simple as saying 'no' could set off a domino-type event that before might have ended up in some kind of crisis situation," Hogan said. "Now we're able to talk about feelings and reasons why."

Zachary hopes to attend Sandy High School in about a year. His mother said he's smart enough to do well there. But the social and behavioral expectations of a large public high school pose a major challenge for him. For now, he's still working on managing his fear and anger.

"I just want him to get along in the world," his mom said.

Suzanne Pardington: 503-294-5927; spardington@news.oregonian.com Read more!

Handicapped can't work at Uptown Cafe -Lake County (IL) Sun-Times

By LOMG HWA-SHU
Hlong@scn1.com

WAUKEGAN -- For years, Diane Verratti, president of Waukegan Main Street, would stop at Uptown Cafe to have breakfast with her husband every Monday. But now the eatery has shut down.

"We really missed it. It was a nice addition to downtown," she lamented Monday. "The food was very good and the people were so nice."

After nearly six years, the cafe at the corner of Grand Avenue and County Street was forced to close because of the new Rule 132 from the Mental Health Division of the Illinois Department of Human Services.

In a nutshell, under the rule the cafe, which was funded in part with a state grant, may not employ the mentally handicapped even though it can try to find jobs for them, according to Brendan Kennedy, a mental health worker from Thresholds, a non-profit mental health rehabilitation organization based in Chicago. The group had been running the cafe, known by the lunchtime crowd for its overstuffed sandwiches, including the Jack Benny Sandwich -- a triple-decker turkey pastrami and Swiss cheese with Russian dressing on toasted white bread.

Officials at the state agency could not be reached for comment.

Ironically, Kennedy said the cafe has been converted into a service center for the mentally ill by Thresholds since closing June 29.

"It is very much alive, but we can't serve any food," he said, adding, "We had to terminate the six people who worked there and found them jobs elsewhere."

"We're disappointed, heart-broken, so are a lot of other people." Kennedy stressed.

The cafe, originally run by the non-profit Lake County Enterprises, was meant to help the severely mentally ill with jobs to enable them "to gain confidence and self-esteem." It was later taken over by Thresholds, known as the largest and oldest psychiatric rehabilitation organization with 30 service centers and 75 housing locations in the state.

The cafe which also provided catering never made money. It was run under a $250,000 annual budget including a $75,000 grant from the state. Most of funds came from Thresholds, according to Michael Pollock, Thresholds vice president for external affairs. Other funding came from money raised by Lake County Enterprises and donations. One reason the cafe did not make money is that it was out of the way, away from the traffic flow, according to Kennedy.

"The irony is that we can't employ people within the same organization trying to serve them," he said.

The Waukegan center, as the other centers, is trying to open doors of opportunity for those in need. One good thing about Rule 132 is that it has enabled Thresholds "to help more people," said Pollock.

Equipped with computers and staffed with six professionals from Thresholds, the center attempts to find jobs, housing and medical services for those in need.

Thresholds officials say that 80 to 85 percent of those participating in its rehabilitation program successfully integrated into the community for an entire year without psychiatric hospitalization.
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Bibliotherapy: Reading Your Way To Mental Health - Wall Street Journal

By KEVIN HELLIKER

A growing number of therapists are recommending something surprising for depressed and anxious patients: Read a book.

The treatment is called bibliotherapy, and it is gaining force from a spate of research showing that some self-help books can measurably improve mental health. In May alone, the journal Behaviour Research and Therapy published two studies demonstrating the effectiveness of bibliotherapy in patients with depression or other mood disorders. The national health system in Britain this year is prescribing self-help books for tens of thousands of people seeking medical attention for mood disorders.

Decades after the emergence of the self-help book, it remains one of publishing's hottest categories. This year, U.S. revenue for the category will exceed $600 million, a single-digit jump from 2006, says Simba Information, a market research firm in Stamford, Conn.

Yet this category is reminiscent of the market for elixirs, oils and pills before the advent of federal regulation. Despite the growth in research, fewer than 5% of the tens of thousands of self-help books on the market have been subjected to randomized clinical trials. And authors with no scientific credentials are just as likely to hit the jackpot as are renowned physicians. "When the book cover announces that it's a bestseller, that means nothing," says John Norcross, a University of Scranton professor of psychology and researcher on the effectiveness of self-help books.

Now, mental-health professionals in the U.K., the U.S. and elsewhere are determined to distinguish the most proven offerings. The aim is to recommend books that have been shown to be successful in published trials conducted by reputable, independent researchers. Trials are conducted much the way drug research is done, comparing patients' depressive symptoms before and after treatment, compared with patients who didn't undergo the treatment. For instance numerous clinical trials have shown that "Feeling Good: The New Mood Therapy," a 1980 tome by Stanford University psychiatrist David Burns, reduces depressive symptoms in large numbers of readers.

In the U.K., where the wait for professional treatment can stretch six months, the national health system has embraced bibliotherapy as the first line of treatment for non-emergency cases. The program varies but in most parts of the country, health officials have approved a list of about 35 books that have been stocked at local libraries. Seekers of non-emergency mental-health services receive a prescription enabling them to check out a book without a library card and for 12 weeks, four times longer than other books.

In a small but significant percentage of cases, bibliotherapy reduces symptoms sufficiently that the sufferers no longer seek additional treatment, says Neil Frude, a Cardiff University psychology professor who helped develop the U.K. program.

In the U.S., no official list of bibliotherapy treatments exists. But thousands of mental-health professionals have contributed to a self-help manual that Dr. Norcross -- co-author himself of a self-help book, "Changing For Good" -- has been updating since 2000. "The Authoritative Guide To Self-Help Resources in Mental Health," available from many commercial booksellers, ranks more than 1,000 self-help books according to their effectiveness, based on clinical trials and on the clinical experience of professionals.

Bibliotherapy works best on mild to moderate symptoms, and isn't regarded as a replacement for conventional treatments. A 2003 article in the Journal of Clinical Psychology reviewed the published research on bibliotherapy and concluded that it could successfully treat depression, mild alcohol abuse and anxiety disorders, but was less effective with smoking addiction and severe alcohol abuse.

Most research suggests that bibliotherapy is most effective when used in conjunction with conventional therapy or while waiting for conventional therapy to begin.
• Email healthjournal@wsj.com. Tara Parker-Pope is on vacation.
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Mom's slayer sent to state hospital - Salt Lake City Tribune

Will undergo mental evaluation for 18 months before his final sentence is determined

By Stephen Hunt
The Salt Lake Tribune

A mentally ill Kearns man who two years ago killed his 72-year-old mother will undergo up to 18 months of treatment at the Utah State Hospital before his final sentence is decided, a judge said Monday.

Matthew Alex Kirkham earlier this year pleaded guilty and mentally ill to second-degree felony manslaughter for the June 4, 2005, slaying of Joeann Kirkham, whom he hit in the head with a rock and then smothered in a plastic bag filled with paint fumes.

After her death, Kirkham fractured 15 of her ribs and severed her spinal column, according to an autopsy.

At a Monday sentencing hearing, attorneys said Kirkham, now 37, believed his mother was "another entity," emanating voices that threatened to make his head explode.

Kirkham was initially charged with first-degree felony murder, but prosecutors offered a plea deal after mental health experts reported he lacked the ability to form the intent to kill.

Prosecutor Alicia Cook said Kirkham had been on medication for schizophrenia and had been stable for five years before the murder. But Kirkham's attorney, Michael Peterson, said the medication was discontinued just prior to the homicide by a counselor at Valley Mental Health, who decided Kirkham had been misdiagnosed.

Soon after, when Kirkham and his mother began arguing - apparently about her plans to kick her son out of her house - his schizophrenia was "simply raging," Peterson said.

Kirkham's guilty and mentally ill plea gave 3rd District Judge Randall Skanchy sentencing options ranging from probation to a prison term of one to 15 years. The judge compromised by imposing the prison term, but ordering Kirkham sent to the state hospital.

Kirkham will be treated there for up to 18 months, or until he has received the maximum medical benefit. Skanchy said he would review Kirkham's progress on Feb. 11.

Once the hospitalization is completed, Peterson said Kirkham should be sent to a halfway house.

But Cook argued that prison is the only place secure enough to keep Kirkham from harming others. "This is not someone we can release to the community," she said.

Cook noted that, according to family members, Kirkham had occasionally stopped taking his medications. She also said that Kirkham is unable to provide himself with "the basic necessities of life."

Kirkham told the judge his mother believed she was "a terrible mom." But Kirkham noted she had taken him to therapy sessions for five years running.

"When this happened, she was still trying to help me," Kirkham said. "I wish I could tell her she was not the worst mother in the world."

shunt@sltrib.com Read more!

House passes mental health bill, 3 others - Associated Press

By Jim Abrams

The House took steps Monday to improve counseling and care for the tens of thousands of military personnel returning from Iraq and Afghanistan with brain injuries and post-traumatic stress disorder.

The bill, one of four veterans bills passed by the House, requires the Veterans Affairs Department to provide outreach and mental health services to veterans of the two campaigns. The VA secretary is also directed to contract with community mental health centers in areas not adequately served by the VA.

The VA in April reported that one-third of veterans of the two wars have sought VA health care since fiscal 2002, and that mental disorders comprised 37 percent of possible diagnoses among recent battlefield veterans.

It said that of 84,000 patients that received a diagnosis of possible mental disorder, almost half were provisionally diagnosed with PTSD.

That number could be low, said Veterans’ Affairs Committee Chairman Bob Filner, D-Calif.

The bill, sponsored by Rep. Michael Michaud, D-Maine, also allows the VA secretary to make grants to conduct therapeutic workshop programs in such areas as music and the arts.

The bill provides grants for rural veterans service organizations to help transport veterans in remote areas, makes permanent a program to treat participants in Defense Department chemical and biological testing, expands counseling services for veterans emerging from prison who are at risk of homelessness, and provides housing assistance to very low-income veterans.

A second bill waives co-payment for veterans receiving hospice care at home or at acute-care facilities, and another assures that disabled veterans living temporarily with a family member are eligible for adaptive housing assistance.

The fourth bill extends pension benefits to World War II veterans of the U.S. Merchant Marine who were deprived of the benefits given most veterans after the war.

Merchant Marine veterans were ineligible for the GI Bill and other housing and health benefits, and it wasn’t until 1988 that they received veterans status. The bill authorizes $485 million over five years to pay $1,000 a month to Merchant Marine veterans and surviving spouses.

According to one VA estimate, about 13,000 surviving mariners and 6,000 spouses would qualify for the benefit.

All four bills passed by voice vote and now go to the Senate.


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Who’s Minding the Mind? - New York Times

By BENEDICT CAREY

In a recent experiment, psychologists at Yale altered people’s judgments of a stranger by handing them a cup of coffee.

The study participants, college students, had no idea that their social instincts were being deliberately manipulated. On the way to the laboratory, they had bumped into a laboratory assistant, who was holding textbooks, a clipboard, papers and a cup of hot or iced coffee — and asked for a hand with the cup.

That was all it took: The students who held a cup of iced coffee rated a hypothetical person they later read about as being much colder, less social and more selfish than did their fellow students, who had momentarily held a cup of hot java.

Findings like this one, as improbable as they seem, have poured forth in psychological research over the last few years. New studies have found that people tidy up more thoroughly when there’s a faint tang of cleaning liquid in the air; they become more competitive if there’s a briefcase in sight, or more cooperative if they glimpse words like “dependable” and “support” — all without being aware of the change, or what prompted it.

Psychologists say that “priming” people in this way is not some form of hypnotism, or even subliminal seduction; rather, it’s a demonstration of how everyday sights, smells and sounds can selectively activate goals or motives that people already have.

More fundamentally, the new studies reveal a subconscious brain that is far more active, purposeful and independent than previously known. Goals, whether to eat, mate or devour an iced latte, are like neural software programs that can only be run one at a time, and the unconscious is perfectly capable of running the program it chooses.

The give and take between these unconscious choices and our rational, conscious aims can help explain some of the more mystifying realities of behavior, like how we can be generous one moment and petty the next, or act rudely at a dinner party when convinced we are emanating charm.

“When it comes to our behavior from moment to moment, the big question is, ‘What to do next?’ ” said John A. Bargh, a professor of psychology at Yale and a co-author, with Lawrence Williams, of the coffee study, which was presented at a recent psychology conference. “Well, we’re finding that we have these unconscious behavioral guidance systems that are continually furnishing suggestions through the day about what to do next, and the brain is considering and often acting on those, all before conscious awareness.”

Dr. Bargh added: “Sometimes those goals are in line with our conscious intentions and purposes, and sometimes they’re not.”

Priming the Unconscious

The idea of subliminal influence has a mixed reputation among scientists because of a history of advertising hype and apparent fraud. In 1957, an ad man named James Vicary claimed to have increased sales of Coca-Cola and popcorn at a movie theater in Fort Lee, N.J., by secretly flashing the words “Eat popcorn” and “Drink Coke” during the film, too quickly to be consciously noticed. But advertisers and regulators doubted his story from the beginning, and in a 1962 interview, Mr. Vicary acknowledged that he had trumped up the findings to gain attention for his business.

Later studies of products promising subliminal improvement, for things like memory and self-esteem, found no effect.

Some scientists also caution against overstating the implications of the latest research on priming unconscious goals. The new research “doesn’t prove that consciousness never does anything,” wrote Roy Baumeister, a professor of psychology at Florida State University, in an e-mail message. “It’s rather like showing you can hot-wire a car to start the ignition without keys. That’s important and potentially useful information, but it doesn’t prove that keys don’t exist or that keys are useless.”

Yet he and most in the field now agree that the evidence for psychological hot-wiring has become overwhelming. In one 2004 experiment, psychologists led by Aaron Kay, then at Stanford University and now at the University of Waterloo, had students take part in a one-on-one investment game with another, unseen player.

Half the students played while sitting at a large table, at the other end of which was a briefcase and a black leather portfolio. These students were far stingier with their money than the others, who played in an identical room, but with a backpack on the table instead.

The mere presence of the briefcase, noticed but not consciously registered, generated business-related associations and expectations, the authors argue, leading the brain to run the most appropriate goal program: compete. The students had no sense of whether they had acted selfishly or generously.

In another experiment, published in 2005, Dutch psychologists had undergraduates sit in a cubicle and fill out a questionnaire. Hidden in the room was a bucket of water with a splash of citrus-scented cleaning fluid, giving off a faint odor. After completing the questionnaire, the young men and women had a snack, a crumbly biscuit provided by laboratory staff members.

The researchers covertly filmed the snack time and found that these students cleared away crumbs three times more often than a comparison group, who had taken the same questionnaire in a room with no cleaning scent. “That is a very big effect, and they really had no idea they were doing it,” said Henk Aarts, a psychologist at Utrecht University and the senior author of the study.

The Same Brain Circuits

The real-world evidence for these unconscious effects is clear to anyone who has ever run out to the car to avoid the rain and ended up driving too fast, or rushed off to pick up dry cleaning and returned with wine and cigarettes — but no pressed slacks.

The brain appears to use the very same neural circuits to execute an unconscious act as it does a conscious one. In a study that appeared in the journal Science in May, a team of English and French neuroscientists performed brain imaging on 18 men and women who were playing a computer game for money. The players held a handgrip and were told that the tighter they squeezed when an image of money flashed on the screen, the more of the loot they could keep.

As expected, the players squeezed harder when the image of a British pound flashed by than when the image of a penny did — regardless of whether they consciously perceived the pictures, many of which flew by subliminally. But the circuits activated in their brains were similar as well: an area called the ventral pallidum was particularly active whenever the participants responded.

“This area is located in what used to be called the reptilian brain, well below the conscious areas of the brain,” said the study’s senior author, Chris Frith, a professor in neuropsychology at University College London who wrote the book “Making Up The Mind: How the Brain Creates our Mental World.”

The results suggest a “bottom-up” decision-making process, in which the ventral pallidum is part of a circuit that first weighs the reward and decides, then interacts with the higher-level, conscious regions later, if at all, Dr. Frith said.

Scientists have spent years trying to pinpoint the exact neural regions that support conscious awareness, so far in vain. But there’s little doubt it involves the prefrontal cortex, the thin outer layer of brain tissue behind the forehead, and experiments like this one show that it can be one of the last neural areas to know when a decision is made.

This bottom-up order makes sense from an evolutionary perspective. The subcortical areas of the brain evolved first and would have had to help individuals fight, flee and scavenge well before conscious, distinctly human layers were added later in evolutionary history. In this sense, Dr. Bargh argues, unconscious goals can be seen as open-ended, adaptive agents acting on behalf of the broad, genetically encoded aims — automatic survival systems.

In several studies, researchers have also shown that, once covertly activated, an unconscious goal persists with the same determination that is evident in our conscious pursuits. Study participants primed to be cooperative are assiduous in their teamwork, for instance, helping others and sharing resources in games that last 20 minutes or longer. Ditto for those set up to be aggressive.

This may help explain how someone can show up at a party in good spirits and then for some unknown reason — the host’s loafers? the family portrait on the wall? some political comment? — turn a little sour, without realizing the change until later, when a friend remarks on it. “I was rude? Really? When?”

Mark Schaller, a psychologist at the University of British Columbia, in Vancouver, has done research showing that when self-protective instincts are primed — simply by turning down the lights in a room, for instance — white people who are normally tolerant become unconsciously more likely to detect hostility in the faces of black men with neutral expressions.

“Sometimes nonconscious effects can be bigger in sheer magnitude than conscious ones,” Dr. Schaller said, “because we can’t moderate stuff we don’t have conscious access to, and the goal stays active.”

Until it is satisfied, that is, when the program is subsequently suppressed, research suggests. In one 2006 study, for instance, researchers had Northwestern University undergraduates recall an unethical deed from their past, like betraying a friend, or a virtuous one, like returning lost property. Afterward, the students had their choice of a gift, an antiseptic wipe or a pencil; and those who had recalled bad behavior were twice as likely as the others to take the wipe. They had been primed to psychologically “cleanse” their consciences.

Once their hands were wiped, the students became less likely to agree to volunteer their time to help with a graduate school project. Their hands were clean: the unconscious goal had been satisfied and now was being suppressed, the findings suggest.

What You Don’t Know

Using subtle cues for self-improvement is something like trying to tickle yourself, Dr. Bargh said: priming doesn’t work if you’re aware of it. Manipulating others, while possible, is dicey. “We know that as soon as people feel they’re being manipulated, they do the opposite; it backfires,” he said.

And researchers do not yet know how or when, exactly, unconscious drives may suddenly become conscious; or under which circumstances people are able to override hidden urges by force of will. Millions have quit smoking, for instance, and uncounted numbers have resisted darker urges to misbehave that they don’t even fully understand.

Yet the new research on priming makes it clear that we are not alone in our own consciousness. We have company, an invisible partner who has strong reactions about the world that don’t always agree with our own, but whose instincts, these studies clearly show, are at least as likely to be helpful, and attentive to others, as they are to be disruptive.



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Activist sent to mental clinic: Russian opposition - Reuters

By Olesya Dmitracova

MOSCOW (Reuters) - A member of a Russian opposition group has been hospitalized in a psychiatric facility "out of revenge" for criticizing a clinic's use of violence against mentally ill patients, her colleague said on Monday.

Yelena Vasilyeva, who heads a regional branch of the United Civil Front, said Larisa Arap had told her on the telephone that police had pushed her into an ambulance on July 5 and taken her to the hospital in Russia's Murmansk region near Finland.

She said Arap was forcefully injected with drugs.

"It was out of revenge that Larisa was hospitalized," Vasilyeva told Reuters in an e-mail.

Police were not available for comment. The clinic where Vasilyeva said Arap was kept confirmed they have a patient under that name.

Arap's doctor said she could not discuss the details of her illness over the telephone and told Reuters to call the clinic's chief doctor. The chief doctor was out of the office on Monday.

The United Civil Front activists, led by world chess champion Garry Kasparov, are vocal Kremlin opponents who accuse President Vladimir Putin of destroying democracy.

They say civil society, human rights and the rule of law had all suffered greatly under the Russian leader.

A local opposition newspaper in June published an article based on Arap's comments. It said patients at a clinic in the Murmansk region were beaten and raped.

When Arap returned to her doctor after an examination to pick up medical documents showing she was in good mental health to renew a driver's license, the doctor asked her whether she was the article's author and called the police, Vasilyeva said.

"In Stalin's times and in Brezhnev's times, psychiatric hospitals were additional prisons for dissenters," Vasilyeva said referring to Soviet leaders Josef Stalin and Leonid Brezhnev. "I do not think we want a return to those shameful pages of history."

Leaders of the United Civil Front are preparing a letter addressed to Russia's rights ombudsman demanding immediate interference with Arap's case, Vasilyeva said.

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Many question timing of Norfolk special education plan -Hampton Roads Virginian-Pilot

By AMY JETER, The Virginian-Pilot

NORFOLK -- School Board members and parents are questioning the timing of a plan to reshuffle about 300 elementary students with disabilities to different classes or schools.

The change will move more special education students to regular classrooms. It is intended to help the school division raise test scores, meet new state standards, and even out the number of students with disabilities among Norfolk's elementary schools.

Administrators decided in April to implement the plan this fall, but some people disagree with that time line.

"It's ill-conceived," said Ginny Bobby, whose 7-year-old daughter, Lilly, has autism and might need to switch classes or schools. "They're not preparing the children and the families."

Board member Stephen Tonelson, a professor of early childhood and special education at Old Dominion University, worried that the plan might not give schools enough time to adjust to the change, including making sure there are enough staff members in the schools to meet special needs, such as speech therapy.

"I'm not sure that we didn't pull the trigger a little quickly on this one," Tonelson said.

After hearing about the plan this month, School Board members scheduled a two-hour work session for Tuesday to discuss it more. The meeting will begin at 5 p.m. on the 12th floor of the School Administration Building.

The federal Individuals with Disabilities Education Act requires that students with special needs spend as much time as possible with their peers in a regular classroom.

In Norfolk's elementary schools, many students with disabilities typically have been grouped together in classes headed by a special education teacher and an assistant. T he children often traveled out of their attendance zone for these classes, and had to change schools after a few years because of space considerations.

The new plan calls for transferring about 118 students from self-contained classes in 13 schools back to their home schools, said Joan Anderson, senior director of special education services.

The change would affect some students with learning disabilities, developmental delays, autism, and orthopedic or mild cognitive impairments. It will not pose an extra cost to the school division, Anderson said.

"Our goal is to always give kids the opportunity to be academically and behaviorally successful in general education," Anderson said.

Up to 200 other students who are considered "trainable mentally disabled" or who have autism, multiple disabilities or disabilities that are severe or emotional will continue to be in classes away from the general population, Anderson said.

Several of the classes would be moved to different schools, however.

"They need to be in an elementary K-5 (school), the same one, and know they will not be moved," said Mary Beers, principal of Crossroads Elementary and a member of the committee that worked on the plan.

A proposal to integrate Norfolk elementary special education students had been in the works for years. It has taken on more urgency in recent months, after the Virginia Department of Education published new benchmarks for special education students in order to comply with new federal regulations.

One goal states that 14 percent or fewer of special education students should spend most of their time outside a regular classroom. In Norfolk, that number was 27 percent in 2005-06 - the highest percentage among South Hampton Roads school divisions.

The overall academic performances of Norfolk's special education students also missed state targets. In Norfolk, 55 percent of special education students were proficient in English/reading, and 46 percent were proficient in math. The Virginia Department of Education's benchmarks are 69 percent in English/reading and 67 percent in math - targets that no local school divisions met.

Norfolk officials think students with disabilities will learn more if general education teachers handle as much of their instruction as possible, with assistance from special education teachers when needed.

Elementary principals also said they would like to change the uneven distribution of special education classes. That distribution meant that some administrators were required to handle more of the additional responsibilities associated with special education classes.

Also, if a high number of special education students post low scores on the Standards of Learning tests, they can drag down pass rates used to determine a school's state accreditation status.

Muriel Hecht, a parent who chairs the school division's Special Education Advisory Council, said she generally supports the school division's plan, but is worried that families are learning about the change just weeks before school starts.

"They will be going cold turkey to a new school and a completely different type of learning environment with many more children in the classroom," Hecht said. "The transition would be much smoother if teachers had time to prepare their students during the school year and gradually transition them into their new classrooms."

Anderson said a letter was mailed to parents on June 15.

School Board members requested a formal time line for the move, but Anderson said there wasn't one.

They worried that parents had been cut out of the process and requested additional information about the plan, including ramifications of delaying it.

Tonelson said he is concerned that the board was unaware of the plans as they were being made.

"We really didn't know anything about this," he said, "and it does seem to be a fairly significant policy shift."

Amy Jeter, (757) 446-2730, amy.jeter@pilotonline.com Read more!

Born behind bars - Yuma Sun

Conflicting reports try to explain if the 22-year-old mentally ill mother, Ashley Ingraham, wanted the child.

BY NICOLE E. SQUIBBS, SUN STAFF WRITER

Alexa Angel Garza was born behind bars in the Yuma County jail. Her life started on a bloody mattress in a jail cell around 1:10 a.m. on Sept. 10, 2006.

No doctors or nurses were present. No medical equipment was available - not even a towel or running water. The only medication given to her mother was Tylenol.

The Sun received a copy of an official internal investigation detailing the 12 hours leading up to Garza's premature birth at roughly five months gestation.

Conflicting reports try to explain if the 22-year-old mentally ill mother, Ashley Ingraham, wanted the child. And pages of the report attempt to verify if Ingraham intentionally fell on her stomach in her jail cell, and if jail and medical staff followed the correct procedure when they gave her sanitary napkins for her vaginal bleeding, had a nurse visit her for the first time more than three hours after the bleeding began, took her vitals and doubted that she was in labor.

The Sun recently obtained the Yuma County Sheriff's Office report from Michael McGregor, the jail administrator who is currently on paid leave - in part - due to this incident.

According to the report, Ingraham was alerting jail staff that she was having "slow-timing contractions" since her booking in jail on Sept. 7.

"(I told them that) I need to see an emergency room doctor immediately," she stated in the report. "(They) tried to tell me that I was faking it, that I'm not contracting."

She was arrested on charges of disorderly conduct and domestic violence for allegedly hitting her then-boyfriend and the father of the baby, Alex Garza, 31.

The report states that a local mental health hospital had treated her for bipolar disorder, a manic-depressive illness that causes sudden mood changes, but did not specify when.

Inmates - who couldn't see into Ingraham's cell - first alerted jail staff that Ingraham was allegedly jumping off her bed and onto her stomach prior to 12:30 p.m. on Sept. 9. The report does not state what her exact actions were that day in her cell and what time they began. In the report, it states that a jail investigator told Ingraham that he had reviewed a DVD which "shows her intentionally falling on her stomach."

Ingraham admitted in the report that she resorted to the tactic to convince jail officials to take her to the hospital because she felt the medical staff was ignoring her and that this was the only way to get to the emergency room.

Ingraham told the investigator, "I might have accidentally fallen off my bed a few times ... I wasn't trying to fall on my stomach, I was trying to actually do exercise and stuff so I could try to ignore my pain and everything because (they were) not going to do nothing."

According to Ingraham, "My belly only hit the floor only amount of once ’cause I kind of slipped."

When the jail staff was first alerted of her actions at 12:30 p.m. Sept. 9, Ingraham had vaginal bleeding. The officer gave her a sanitary napkin so that medical staff could monitor the situation.

After leaving messages with seven local obstetricians, The Sun was unable to interview one to determine the possible impact of Ingraham's actions on her pregnancy.

Ingraham told a sergeant around 3:34 p.m. that she did not want to have the baby and that she was a bad mother for being in jail.

The first nurse to see Ingraham that day was nurse Radu Timis at 4:15 p.m. According to the report, Ingraham told Timis that she did not want to be pregnant. Timis said Ingraham was "faking it" and "there was nothing wrong with her, she was not in labor" and advised her to rest, according to the investigation.

However, also according to the report, Ingraham's midwife, Anette Casey, who cared for her during her pregnancy, said Ingraham "made her appointments on a regular basis and was excited about her pregnancy."

From 12:30 p.m. Sept. 9 until 1:10 a.m. Sept. 10, there are at least 11 instances where jail or medical staff either checked on Ingraham, noticed blood in her cell, gave her sanitary napkins, took her vitals, told her to rest, told her she was not in labor or reported her pleas for help to a higher jail official.

A security control officer stated in the report that "It angered me, the way (nurse) Timis handled the situation. He should have been more tuned in and gotten her butt downstairs (to go to the hospital)."

The second nurse to treat Ingraham that evening, Irene Naputi, told a shift supervisor sergeant that "I bleed more on my period than she's bleeding. She's OK," the report stated.

A unit manager for Ingraham's unit also said in the report that Ingraham's bleeding had alarmed him.

"There was a lot. There was pad, upon pad, upon pad, toilet paper and just anything you can think of in there," according to the unit manager, who was referred to as Officer B. Wilson in the report. Wilson said he spoke to his sergeant about his concern, but the sergeant told him they needed to follow the nurse's instructions.

"Regardless if she may be complaining of contractions, or whatever, she's bleeding," Wilson stated. "I can still see the toilet perfectly, and it's just like, how could somebody walk in the unit and not see that as like WOW."

Wilson added that he did not think medical personnel took Ingraham seriously.

An inmate in a cell near Ingraham's, Michele Inman, agreed. She told the investigator: "I think in the beginning ... nobody believed her, and nobody did anything ..."

Inman stated in the investigation that it "was ’round lockdown" near 9 p.m. (on Sept. 9) when "(a) person came and said they were going to get medical, but medical didn't come for a long time."

For Ingraham, the only people who could hear her cries for help that night could do nothing to help her - inmates locked in cells next to her.

Inman said she awoke because she heard Ingraham make "a cry I haven't heard" and "panicking banging."

"She was screaming and crying, but there was no officer. Nobody would come, and I swear I heard that probably a half-hour," Inman said in the report.

By the time a jail official did respond to Ingraham's cell, it was too late.

"The contractions were minutes apart, and I kept on calling for the detention officers, and they wouldn't do nothing, and then I just laid on my bed, and the baby came out," Ingraham stated.

"I began to yell and told them the baby was here. I had to put my mouth over the baby's mouth and suck out the fluid and spit it out and make sure the baby was moving," Ingraham told the investigator.

The crying stopped before 1:21 a.m., when a jail manager found Ingraham standing in her cell, holding a baby, with the umbilical cord still attached.

The Sun contacted Northend Health Associates, the former medical contractor for Yuma County jail, but officials there said nurses Timis and Naputi were no longer employed by Northend. Northend Health Associates' contract ended with the jail on June 18. The county did not renew its contract.

In the report, nurse Timis told the investigator, "I did not consider that is (sic) necessary to go to the hospital, because clinical signs were not showing me an emergency situation to send her to the hospital."

Numerous calls to YCSO spokesman Capt. Eben Bratcher for comment were not returned to The Sun by press time.

According to the report, Emergency Medical Services arrived at the jail around 1:21 a.m., about 11 minutes after the detention officer discovered the birth of the baby.

Around 1:42 a.m. the baby was transported to Yuma Regional Medical Center, where the newborn was placed into the Neo-Natal Intensive Care Unit in critical condition, due to "extreme prematurity," "respiratory failure" and brain hemorrhaging, and she was not expected to live.

She was transported to the University Medical Center in Tucson on Sept. 12, according to the report.

The Sun was unable to confirm when Alexa Garza was released from Tucson.

The child is now under Child Protective Services and residing with a nurse in Lake Havasu City, according to the father.

Ingraham was released from Yuma County jail on bond on Oct. 13. On Nov. 30, she was again booked into Yuma County jail and was released on Jan. 22. The Sun was unable to confirm the most recent charges that landed Ingraham in the local jail.

According to the baby's father, Ingraham is in a halfway house in Phoenix. The Sun was unable to confirm her location.

---

TIMELINE OF EVENTS LEADING TO THE BIRTH OF ALEXA ANGEL GARZA:

SEPT. 9, 2006

- 12:30 p.m. - An inmate alerts a detention officer that Ashley Ingraham is jumping off her bed and landing on her stomach. Ingraham tells the officer she was bleeding in her toilet. The officer gives her a sanitary pad so medical personnel can monitor the bleeding. Ingraham tells the officer she was jumping off her bed. The officer notifies a sergeant about the situation, who tells the officer to call if anything else happens.

- 3:34 p.m. - A sergeant speaks to Ingraham, who cries and says she does not want to have the baby and that she is a bad mother for being in jail and having mental issues.

- 4:15 p.m. - Nurse Radu Timis checks on Ingraham, who says she does not want to be pregnant and that is why she is behaving that way. Timis advises her to rest and decides Ingraham is not in labor.

- 7:15 p.m. - A unit manager reports to a sergeant that Ingraham has begun bleeding again. Timis returns and again says she is not in labor. Timis places Ingraham on bed rest and a feminine pad count to be collected at the end of each shift. The sergeant asks Timis if she should be taken to the hospital, and Timis says "no."

- 9 p.m. - Ingraham reports her mucus plug came out. Timis again responds and says that was not the case. The sergeant places her in a dry cell, with no flushing toilet or running water. According to the American Pregnancy Association, a mucus plug remains in front of the cervix to prevent bacteria from entering the uterus. Typically, close to birth, the plug is expelled to allow the fetus to pass through the birthing canal.

- 10:30 p.m. - Ingraham's vital signs are taken by medical personnel and appear to be normal.

- 10:45 p.m. - The sergeant passes Ingraham's information to the sergeant taking over the shift.

SEPT. 10, 2006

- 12:15 a.m. - An officer tells the sergeant that Ingraham has been yelling and complaining she is in labor. Ingraham tells the sergeant she is in labor and needs to go to the hospital and is in a lot of pain. The sergeant tells Ingraham to relax, and he will try to see a nurse about her problems.

- 12:20 a.m. - The sergeant speaks with nurse Irene Naputi, who says she has been monitoring the situation. Naputi states she "bleeds more on her period" than what Ingraham had bled onto feminine pads.

- 12:30 a.m. - A sergeant takes a medic to Ingraham to check her vitals, which Naputi says are fine.

- 1:10 a.m. - An officer tells medical personnel Ingraham has prematurely given birth to a baby girl in her cell.

- 1:21 a.m. - Emergency Medical Services arrives at the jail.

- 1:42 a.m. - The baby is transported to Yuma Regional Medical Center.

- 2 a.m. - A call is placed to jail administrator Michael McGregor. It was the first call placed to McGregor about Ingraham.

---

FATHER GIVES UPDATE ON BABY'S CONDITION

"She's doing as well as a premature baby can do. She still has a lot of problems we're gonna be facing in the future," Alex Garza, father of Alexa Angel Garza, told The Sun recently.

Garza said Alexa has respiratory and developmental problems, and although she is almost 11 months old, she is only at the developmental stage of an average 4-month-old baby. He said doctors have told him her motor skills and mentality are not going to keep up with her age.

Garza said Alexa is in the care of Child Protective Services. She is residing with a nurse at a home in Lake Havasu City and he sees her twice a month. He was unable to provide The Sun with phone numbers or names of the baby's doctors and nurses.

He said he is not dating the baby's mother anymore, and he believes Ashley Ingraham is on parole and living in a half-way house in Phoenix. He said he has not spoken to her in eight months.

Garza said he hopes to share custody of Alexa with Ingraham, unless she is not interested in custody, in which case he will try to gain full custody of their child. He is hoping Alexa will be able to come home to Yuma within the next four to five months.

"I'm trying to get an apartment of my own with a bedroom for the baby," he said.

Garza said the baby was named after him, and her middle name, Angel, was added from "the circumstances she was born under."

"Every time I talk about her, I start to get a little teary-eyed. Not only did they (Yuma County jail officials and medical personnel) mess up my child's life, but I was unable to be there in the hospital when she was born. They took that from me and from her.

"It's totally wrong what they did. Whoever's decision it was not to send her to the hospital, I hope he loses his job."

Garza said he has retained an attorney from Tucson, James Steadwell, and has filed a lawsuit against Yuma County and the jail's medical personnel.

Steadwell confirmed he made a claim to Yuma County and to Northend Health Associates "many months ago" and that the claim status was "pending," meaning it would either be resolved or go to formal litigation.

Yuma County Sheriff's Office Capt. David Reyes said the county did receive notice of a claim filed by Steadwell. Read more!

Mental Health Programs Trying to Stay Afloat -First Coast News, Jacksonville (FL)

Video here.

By Angela Williams
First Coast News

JACKSONVILLE, FL -- Booker T. Oliver says looking back on his life things would have been different without help.

"To be honest with you, I'd either be in the graveyard or in prison. That's what the bottom line is," says Oliver.

Oliver received help from the Community Rehabilitation Center. The center is designed to get the mentally ill proper medication and work them back into society.

"There's a known 65,000 individuals here just in Duval County that have been diagnosed with chronic mental illness. There are probably about another 30,000 that have not been diagnosed," says CRC Clinical Director Jimmy Hicks.

Without funding they won't be diagnosed. The center receives funding from the state and the city. The facility says a trickle down of budget cuts force the city to reduce funding and the center to reduce its staff.

"We're getting the bulk of the clients because on any given day you may catch 300 people receiving services, but we just don't have the space. We just don't have the individuals to do the service," says Hicks.

As of now the center is taking it day by day and will continue trying to make a difference in the lives they can reach for now.

"Without them I don't know what we would do because like I said, people don't really respect us no way because we are mentally ill and they say you're crazy," says Oliver.
Read more!

How to deal with mental illness in Humboldt County -Eureka (CA) Times-Standard

My Word by Marianna Pennekamp

I am passionately advocating for community understanding and support for our seriously emotionally disturbed and severely mentally ill community members. Our community desperately needs access to a seamless services system.

My personal and professional experiences, for more than 50 years, have convinced me that by working together the road to recovery and wellness can be found and sustained. The patients, their families, professional services providers and community have to be in a position of mutual respect and trust so that available resources can be accessed and utilized effectively. This is where we need and want to go in Humboldt County.

Briefly, how did we get to where we are today? In the 1970s, the population in the state mental hospitals in California was severely reduced. The patients were sent back to their home communities to be treated through a program called Community Mental Health.

Unfortunately, the money did not follow the patients, and Community Mental Health remained, and remains to this day, underfunded. Families and county-level services soon found themselves scrambling for inadequate resources to care for their loved ones. Homelessness of the mentally ill became an ever-growing problem, accounting for a significant part of the overall homeless population.

In recent years, a vision of recovery and wellness for the severely mentally ill emerged and contributed to the passage of Proposition 63, the California Mental Health Services Act, in 2004.

To build in this county what the act envisioned, a large-scale effort of public input was created, with the opportunity for every voice to be heard. Based on priorities developed from a range of forums, the Mental Health Services Act Steering Committee agreed on a nine-part plan which was submitted to the state Department of Mental Health, where it was approved.

A recent public meeting was held to review where the Humboldt County process was as of December 2006. Documentation can be obtained at the Mental Health Branch.

Among the plan's components, a Wellness Center is in an active developmental phase, prepared to offer peer support, systems information and navigation, wellness-focused activities and recovery planning support.

Outreach efforts into the extended Humboldt County communities are under way to make it possible for persons in more remote areas to access needed services.

Work with community health clinics to address timely medication issues is also under way, and access to culturally appropriate services is getting staff attention. These efforts are largely in the advanced planning stages, moving toward actual delivery as funds become available.

So is the sun shining over the delivery of mental health services in Humboldt County? Well, not quite. Actually, a dark cloud is hovering over us.

While one can be optimistic about access to mental health services for future patients, those who currently suffer from chronic mental illness often find that, when they are in a current or recurrent crisis, or need urgent medication access and management, they may have to wait for appointments. While they wait, their symptoms become more severe and require more complex -- and expensive -- responses. Their crises become family crises and, at times, highly complex community crises.

The Mental Health Branch, law enforcement and members of the National Association for the Mentally Ill (NAG) of Humboldt County have worked together in highly significant ways to bring about collaboration in crisis intervention and relevant cross-training. However, the resources to keep our core services open and staffed -- Sempervirens, Psychiatric Emergency Services and Same Day Services -- are shrinking at an alarming rate due to severely inadequate funding resources.

There are four ways for community members to respond:

* Blame the victims -- it is their fault.

* Stigmatize the mentally ill, which justifies opposing doing anything helpful -- the NIMBY phenomenon.

* Feel helpless and hopeless in the face of these issues, or

* Become fully informed and join forces -- patients, family members, communities and service providers -- to raise our voices in Sacramento and Washington.

We can do this through partnerships between patient advocacy groups, family advocates, professional organizations of mental health providers and representatives of law enforcement. We can ask judges to participate who oppose using jail as appropriate housing for the nonviolent mentally ill.

We would need the support of local government entities and of the communities impacted by the current situation who want to see a responsible solution to an underfunded chronic health dilemma.

Let us stop blaming and fighting each other. Let us raise our voices together. Let us start today!

Marianne Pennekamp is a former school social worker with the Oakland Unified School District and a retired faculty member of the UC Berkeley School of Social Welfare and HSU. She has lived in Humboldt County for 25 years and serves on the Humboldt County Mental Health Board. Read more!

Study links pesticides to autism - United Press International

LOS ANGELES, July 30 (UPI) -- A study by California state health officials links farm fields sprayed with certain pesticides to an increase in the number of autistic children.

The study, which targets organochlorine pesticides, is to be published on Monday, The Los Angeles Times reported.

The rate of autism among children who lived near the fields was very high, suggesting exposure in the womb could play a role. The study is the first to link pesticides to autism, which affects one in every 100 children, the Times reported.

The study suggests that the farther the women lived from the fields, the less likely they were to give birth to children with autism.

Scientists warn that they are dealing with a small population, so the results could be highly preliminary.

The pesticides in the farm fields are older generation compounds created in the 1950s to kill mites, the newspaper said. Read more!

Disability delays lead to personal havoc - USA Today

By Richard Wolf
July 30, 2007

Jason Hoaks was a corrections officer in Wyoming when he was diagnosed with a malignant brain tumor in 2002. He suffered a stroke during surgery that resulted in vision problems, the loss of strength and sensation on his right side, memory loss and depression. He applied for Social Security disability benefits and was denied.

Hoaks returned to work with limited duties until 2005, when his condition worsened. Again he applied for disability benefits and was denied. This time he fought the denial and won — 18 months later.

Hoaks, 26, was forced to declare bankruptcy and default on his student loans. "Financially, it's killed us," says his father, Dale. "My wife and I will never be able to retire because of these bills."

(Note: USA Today reports that the Indianapolis office of the Social Security Administration has the fourth longest average wait for hearings on whether an applicant is too disabled to work. The complete list is below.)

Hoaks' experience with the Social Security disability system isn't unusual. Of 2.5 million people who file disability claims annually, nearly two in three get denied initially. If they pursue a federal hearing, they join about 745,000 others whose appeals are backlogged. As of June, their average wait for a decision was 529 days. The lengthy waits lead to bankruptcies and foreclosures, drinking and drugs, depression and divorce, even suicide, according to claimants, their representatives and employees of the Social Security Administration.

"People are living in cars. People are going from one family member to the next," says Matt Greenbaum, a New Orleans lawyer who has represented disability claimants for 30 years. "I had a hearing the other day where the judge asked him his address. He couldn't give an address because he didn't have one."

In the Atlanta area, waits of 2½ years for a hearing are the norm. Jeffery Houston of Temple, Ga., has waited more than four years. He's sold almost everything he owned except his home and pickup.

Houston, 46, says he was injured in 1999 when 32 sheets of plate glass fell on him, shattering his shoulder. He says he suffers from congestive heart failure, chronic diabetes, asthma, phlebitis, sleep apnea and deteriorating discs in his back. Yet a judge assigned to his case ruled in 2003 that he could be a parking lot attendant.

His roommate, Linda Cleland, begs to differ. "He wakes me up screaming, 'I'm dying,' " she says. "He's in so much pain that he can't even sleep like he's supposed to."

'Lost in the system'

The backlog has a fiscal impact on states, which pay more in Medicaid and social services to people with disabilities waiting for decisions from the federal government. It has an impact on the administrative law judges, who average 693 pending cases.

The financial impact is greatest on the claimants. Those who hire lawyers or representatives customarily pay 25% of their retroactive award if they are successful, up to a federal ceiling of $5,300.

Peter Schille lives in his parents' basement in order to pay his lawyer $200 a month while waiting for his case to be decided. He wrestles with lasting effects of a heart transplant: brittle bones, stiff joints and fatigue. Other than selling paintings, he's never held a job.

Schille, 44, collected disability for 16 years until 2002, when benefits were cut off based on a redetermination of his case. He's been appealing ever since. "I'm lost in the system, and there's no one I can call," Schille says. "I feel like the system is so big, one person can't possibly do anything about it."

More than 60% of those who wait for hearings eventually win their claims, but the delays take a toll:

•Katie Probst was awarded benefits in 1991 for her lupus and depression but lost them five years later. The Clayton, N.C., woman got them reinstated, only to be told in 2001 that she had collected them improperly and owed more than $50,000. It took five years to win her appeal, during which time her husband worked seven days a week. "It was like starting over," Probst, 52, says. "I still had to prove to them that I was sick."

•Debbie Cline, 45, of Loganville, Ga., waited three years to collect insurance for bipolar and manic depression. She became homeless and moved back in with her ex-husband. "They just keep you waiting like you're a puppet," she says.

No 'really easy solution'

Michael Astrue recalls his father's disability claim in 1985 after a cerebral hemorrhage caused by brain cancer in his early 50s. He died within 18 months. The claim was approved, but the wait "seemed like agony," Astrue says.

Now the commissioner of Social Security, Astrue wants to make it easier to file for disability. He's pushing simplified procedures for extreme cases, such as terminal cancer. He's updating and expanding the list of impairments that qualify for disability. He's trying to open a national center to hold electronic hearings, thereby easing backlogs in places such as Atlanta.

All of that, Astrue says, won't be enough to stop the backlog of appeals from growing because of an aging population. Social Security projects cases to grow about 90,000 annually over the next five years. That means the backlog could hit 1 million in 2010.

"I don't think there is any really easy solution," Astrue says.

Some disability advocates want an agency overhaul. "The problems with Social Security are on a par with a lot of the problems that people were having with the IRS" before Congress mandated changes, says Andrew Imparato, president of the American Association of People with Disabilities.

Others say the system focuses on fraud rather than the disabled. More than three-fourths of 99,000 fraud allegations reported to the agency's inspector general last year involved disability payments.

"The system leans toward denying the case," says Marty Ford, director of legal advocacy for the Disability Policy Collaboration.

BEST, WORST WAIT TIMES
Social Security Administration offices with the shortest and longest average waits for hearings on whether an applicant is too disabled to work:

Shortest average waits

Hearing office In days

Harrisburg, Pa. 276

Charleston, S.C. 289

Middlesboro, Ky. 289

Charlottesville, Va. 314

Kingsport, Tenn. 328

Long Beach 342

Springfield, Mass. 344

Huntington, W.Va. 353

Roanoke, Va. 356

Boston 357

Longest average waits
Atlanta 932

Columbus 841

Miami 789

Indianapolis 780

San Rafael, Calif. 737

Dayton, Ohio 735

Lansing, Mich. 726

Flint, Mich. 719

Queens, N.Y. 703

Buffalo 700

Note: 2007 figures are as of June 29.

Sources: Social Security Administration and National Council of Social Security Management Associations Read more!

N.C. slashes payments for mental health services -Asheville Citizen-Times

By Leslie Boyd
LBOYD@CITIZEN-TIMES.COM

ASHEVILLE — Mental health providers are reeling again from a state cut in the rates it pays for services.

This time, the cut is between 5 and 9 percent in rates the state pays for outpatient therapy services, and it is retroactive to July 1.

“If I didn’t know better, I’d say they’re trying to see how much it would take to break the system,” said Joe Martin of Alpha-Omega Health, which delivers most of the mental health services in rural Madison, Yancey and Mitchell counties.

Brad Deen, a spokesman for the N.C. Department of Health and Human Services, said he didn’t know about the cut and that it might be tied to a Medicare rate adjustment. Whenever Medicare rates are adjusted, state Medicaid rates also go up or down. State Medicaid pays 95 percent of whatever a Medicare rate is for a service.

The result is the same, say providers: They get less money for their services.

The state mental health system has been plagued by changes since reform was mandated in 2001 and implemented in 2003. This is the third rate cut for outpatient therapy services.

In April, the state announced a 40 percent rate cut in community support services, from about $61 per hour to $40. It later backed off and set the rate at $51.

Martin said the state hasn’t allowed the system to stabilize, and services providers could find it more difficult to stay in business now.

“Every time you turn around, it’s something else,” he said. “You get increased requirements and lower rates. Somebody needs to say to them, ‘Stop! Just stop!’”

Jane Ferguson of Appalachian Counseling said she doesn’t think the cut will drive her out of business, but it does put an added strain.

“I know they’re trying to save money, I know they’ve overspent, but they’re not funding the system adequately in the first place,” Ferguson said. “The consultant they hired said the system needs millions and millions more, and they cut it.” Read more!

Mental Illness Clients Deserve Respect And Understanding -The Day, New London (CT)

Opinion:
By Jennifer Gross
7/29/2007

The article “Justice Finds No Middle Ground for Mentally Ill Defendants,” appeared in The Day on July 2. A more profound issue, perhaps, is the criminalization of mental illness, which is rooted in deinstitutionalization and the failure of our nation to provide community-based services for individuals with mental illness following the demise of public psychiatric hospitals.

At the threshold of the 21st century, a disturbing trend has become evident. As the number of hospitalized adults decreased during the second half of the 20th century, the number of prison inmates with serious mental illness was on the rise. In fact, the federal Bureau of Justice Statistics (BJS) reports that the number of inmates in jails and prisons with mental illness quadrupled in just six years — from 283,000 in 1998 to 1.25 million in 2006. This surge coincided with the closure of the last of the hospitals.

While the lofty goal of deinstitutionalization was community integration, in general the necessary resources were never provided. The result is clear. In the United States, half of inmates with mental health problems have been convicted of nonviolent offenses, primarily low-level drug and property offenses. Statistics reflected in the BJS report show that those most at risk for imprisonment are people who cannot get treatment — those who are poor, homeless, or experiencing addictions. In such circumstances, individuals are more likely to commit a crime. Prisons currently house three times more people with serious mental illness than do psychiatric hospitals. Mike Fitzpatrick, executive director of NAMI, says jails and prisons “have become the new mental hospitals.”

Despite the sometimes harsh conditions found in psychiatric hospitals, they provided the full complement of psychiatric, medical and residential services. In direct contrast to psychiatric hospitals, however, prisons are ill-equipped to provide the full range of services needed. Individuals with mental illness receive treatment that often consists of little more than medication, which may be poorly administered or monitored. Prisons cannot offer the long-term intensive supportive and therapeutic environment needed for recovery, and discharge planning for housing and employment is minimal.

Prison systems rarely provide correctional officers with mental health training. As a result, officers do not understand the behavioral symptoms of mental illness and will punish offenders with mental illness for symptoms like being noisy, refusing orders, self-mutilating or attempting suicide. This leads to a vicious cycle of isolation and ever-worsening symptoms.

In Connecticut, officers at only two state prisons — those housing the majority of inmates with mental illness, Garner and Northern — receive a mere eight hours of mental health training. A bill passed in the most recent state legislative session required the Department of Corrections to develop a four- to eight-hour-per-year mental health training program for all corrections staff working with inmates who have a mental illness, but this and other provisions of the bill were not funded.

The magnitude of the problem is evident upon examination of prison statistics in Connecticut, where the adult population of people incarcerated with moderate to severe mental illness has increased from 2,200 in 2000 to 3,700 in 2005, or from 12 percent to 20 percent.

While the lack of resources and the resulting rise in the rate of incarceration have been a betrayal of the initial promise of deinstitutionalization, a few bright spots remain. Connecticut offers jail diversion programs in all 20 arraignment courts in the state, but only about 40 percent of people with serious mental illness can be diverted, in large part due to the lack of community housing and services.

According to Thomas Kirk, commissioner of the Connecticut Department of Mental Health and Addiction Services, “... people with psychiatric disabilities who commit minor crimes that are directly related to their illness ... are better served if we divert them into treatment. As they improve with treatment it enhances the quality of community life for everyone and reduces demand on the correctional system.”

Crisis Intervention Teams offer a pre-arrest jail diversion opportunity by providing 40 hours of specialized training in psychiatric and substance abuse disorders, including crisis de-escalation techniques, to police officers who volunteer. The New London and Norwich teams have been highly successful in their efforts to link people with treatment in lieu of arrest, but are constantly hampered by lack of funding.

The 2003 Presidential New Freedom Commission on Mental Health concluded that our nation's mental health system is “fragmented and in disarray,” and recommended that the government “address mental health with the same urgency as physical health.” But until our leaders make it a priority to create and fund a community mental health system, our prisons will remain the nation's de facto mental institutions.

Jennifer Gross is the community educator at Sound Community Services in New London. Read more!

Laskowski found guilty, ill - Macomb (IL) Journal

GateHouse News Service

CARTHAGE - A Plymouth man who gave his 10-year-old son a fatal drug cocktail in 2004 has been found guilty but mentally ill by a Hancock County judge.

Judge David Stoverink made his ruling Thursday in the case of Martin Laskowski,48, on the Class X felony charge of drug-induced homicide.

Laskowski faces up to 60 years in prison when he is sentenced Sept. 25. Prosecutors said the mentally ill designation does not change any prison term Laskowski might face. Once he is turned over to the Illinois Department of Corrections, it will be up to evaluators there to determine what mental services he might require.

In a videotaped statement played during Laskowski's six-day bench trial, he admitted crushing up Oxycodone tablets, sleeping pills and other drugs with a rolling pin and mixing them with Mountain Dew.

He said he and his son, Scott, 10, made a suicide pact because they were afraid Laskowski was headed to jail, and his son would have to go livewith his mother.

Laskowski believed he was going to jail because he had been cited with several hunting infractions. Those infractions violated his probation in an Adams County theft case.

Laskowski's attorney, Sam Naylor of Carthage, used the insanity defense during the bench trial to argue his client was unable to comprehend that his actions were criminal.

In closing arguments Thursday, prosecutor Michael Vujovich of the Illinois Appellate Prosecutors office called Laskowski's Nov. 10 arrest on the probation violations a "triggering point" for the crime. Vujovich said Laskowski also passed on his hatred for his ex-wife, Chriss Bossey, to Scott.

"He was an extension of his father's will," Vujovich said of Scott. Vujovich asserted that Laskowski "shanked" himself in the abdomen with a filet knife only after seeing police arrive outside his home.

"He knew how to stab himself in such a way to survive," he said. Naylor argued that a psychotic delusion caused Laskowski to believe double suicide was the only way out of his situation.

"He was won over by his assertive son in a reversal of roles," Naylor said.

All of the mental health professionals who testified during the bench trial said Laskowski was depressed, but only the defense's expert witnesses said Laskowski said he suffered from a shared psychotic disorder involving his son.

Laskowski showed no emotion when Stoverink read his decision Thursday. During the closing arguments he appeared angry at times and shook and cried at other times.

After the verdict, Hancock County State's Attorney Jim Drozdz, who handled the prosecution's questioning of witnesses, said the case was only "about Scott."

"This isn't about Chriss (Bossey) or the defendant," he said. "We worked hard to present the best case we could, and we met our burden. I also commend the sheriff's office for the thoroughness of their investigation. It's the primary reason we were successful today." Read more!

The Atypical Dilemma - St. Petersburg Times

By ROBERT FARLEY
July 29, 2007

Skyrocketing numbers of kids are prescribed powerful antipsychotic drugs. Is it safe? Nobody knows.

More and more, parents at wit's end are begging doctors to help them calm their aggressive children or control their kids with ADHD. More and more, doctors are prescribing powerful antipsychotic drugs. In the past seven years, the number of Florida children prescribed such drugs has increased some 250 percent. Last year, more than 18,000 state kids on Medicaid were given prescriptions for antipsychotic drugs. Even children as young as 3 years old. Last year, 1,100 Medicaid children under 6 were prescribed antipsychotics, a practice so risky that state regulators say it should be used only in extreme cases. These numbers are just for children on fee-for-service Medicaid, generally the poor and disabled. Thousands more kids on private insurance are also on antipsychotics. Almost entirely driving this spiraling trend is the rise of a class of antipsychotic drugs called atypicals.

These drugs emerged in the 1990s and replaced the older, "typical" antipsychotics like Haldol or Thorazine, which are often associated with Parkinson-like shakes.

The atypicals were developed to treat schizophrenia and bipolar disorder in adults. But once on the market, doctors are free to prescribe them to children, and for uses not approved by the Food and Drug Administration.

There is almost no research on the long-term effects of such powerful medications on the developing brains of children. The more that researchers learn, the less comfortable many are becoming with atypicals.

Initially billed as wonder drugs with few significant side effects, evidence is mounting that they can cause rapid weight gain, diabetes, even death.

They're also expensive. On average last year, it cost Medicaid nearly $1,800 for each child on atypical antipsychotics. In the last seven years, the cost to taxpayers for atypical antipsychotics prescribed to children in Florida jumped nearly 500 percent, from $4.7-million to $27.5-million.

Medicaid and insurance companies have fed the problem, encouraging the use of psychiatric drugs as they reimburse less and less for labor-intensive psychotherapy and occupational therapy.

Another factor: Doctors have been influenced by pharmaceutical companies, which have aggressively marketed atypicals.

Whatever the reasons for the soaring use of psychiatric drugs in children, things have gotten out of whack, according to Dr. Ronald Brown. Last year he headed an American Psychological Association committee that looked into the issue.

"The bottom line is that the use of psychiatric medications far exceeds the evidence of safety and effectiveness," Brown said.

"What people need to do is what's in the best interest of children instead of what's in the best interest of people's pocketbooks. But children don't vote."

- - -

The ever-increasing number of kids who come through the doors of pediatrician Esther Gonzalez's office lead chaotic lives. There's more divorce and more drug use, more domestic violence and physical and sexual abuse. Working parents are overwhelmed.

"Some parents are so stressed out, they come in seeking a pill," Gonzalez said. It is easy to medicate kids; "it is very hard to change environment."

At her practice in Crystal River, she starts with a thorough screening. A child might need occupational, physical or speech therapy. Sometimes, it takes psychiatric drugs.

Despite her concerns about prescribing such medications, Gonzalez has no doubt they have saved many a child from juvenile detention.

Not prescribing drugs to a child who needs them, she said, "it's like seeing someone dying and not giving them CPR."

Among her patients is 7-year-old Matthew Peck of Brooksville. His 13-year-old brother and 16-year-old sister show scars on their arms and legs where he has bitten them. He flies into rages, kicks, scratches and pulls hair. He destroys furniture and punches holes in the wall.

His mom, Cathy Peck, said Matthew's doctors are "leaning toward" a diagnosis of oppositional defiance disorder. And he has attention- deficit (hyperactivity) disorder (ADHD).

Matthew has taken a 5 mg dose of the atypical Abilify for over two months now. He says "the blue pill" makes him feel like a different person, someone nice.

Peck, a single mother on disability from the Army National Guard, says she worries the drugs may become addictive. And diabetes runs in the family, so that's a concern. Then again ... a few months ago Matthew got hold of a steak knife and destroyed a chair.

"Am I afraid of what the medications might do to him? Yes," Peck said. "But I am also afraid of what his life would be like without them."

Matthew and his brother are playing. Suddenly Matthew raises a hand to hit him.

"Gather!" Cathy Peck yells, the trigger word to help Matthew calm himself.

He lowers his hand, shambles over to his mother, curls up behind her. Crisis avoided.

Matthew's 13-year-old sister, Marradith, said the Abilify works. "He's a different person. He's more fun to be around. He doesn't attack me anymore."

The meds help, Mom says, but therapy is integral to Matthew's treatment. She was taking him to eight sessions a week of occupational, speech and language therapy.

Matthew recently had his last occupational therapy session - but not by choice. After six years, Sensations Pediatrics Therapy in Brooksville closed shop on June 15.

That last day of business, Sensations owner Jeff Leonbruno lamented how hard it is for therapists to stay afloat. Particularly with pediatric therapy sessions, he said, there is a high cancellation and no-show rate, often four or five a day. If they don't show, he can't charge.

"It's difficult to make a living at it," Leonbruno said.

Insurance companies and Medicaid don't pay enough for therapy, he said. They do, however, pay to reimburse for psychiatric medications.

Over the years, he said, Medicaid priorities have shifted toward the elderly in nursing homes. That has put a pinch on services like occupational therapy for children with behavioral disorders.

"There's no AARP for kids," he said.

- - -

Before the FDA approves a new drug, pharmaceutical companies must demonstrate its safety and efficacy. The trials generally are done on adults.

But once the drugs are on the market, doctors are free to prescribe the drug "off label," outside the scope of the FDA's indicated use. They also can prescribe it to children.

Except for Risperdal, none of the antipsychotics is FDA-approved for children. The overwhelming majority are prescribed "off label."

"It is alarming how frequently that is being done," Brown said. "It's of concern that it is being done at all."

A child's brain and central nervous system are still developing, so drugs work differently on kids than adults, Brown said. "There are no studies that have shown they (atypicals) are safe, or for that matter, that they are effective for children."

Drug companies have little incentive to invest in such studies, given that their products already are widely prescribed to children off label.

The antipsychotics are FDA-approved for adults with schizophrenia and bipolar disorder, which used to be known as manic depression. But a study by the University of South Florida found that just 8 percent of Florida children prescribed antipsychotics last year had a primary diagnosis of schizophrenia, and 8 percent had major depression. The most common diagnosis, 38 percent, was ADHD.

Even with bipolar disorder, there is considerable debate in the mental health community about whether it is overdiagnosed, particularly in younger children.

Dr. Mark Olfson of Columbia University studied the use of antipsychotics in children and concluded that only a small percentage had psychotic disorders. Most were used to treat mood disorders, depression, anxiety and ADHD - by families and doctors who have tried everything else and are ready to step outside the well-established treatments and take more risks.

"Most child psychiatrists would probably tell you it does work," Olfson said. "But there is a real need for research, clinical experiments, to determine whether in fact it does work. Given the number of young people, it is a matter of urgency."

Mental health practitioners say they use more antipsychotics now in part because they are better able to identify some mental illnesses, including autism.

Never mind that the National Autism Association warns against the overuse of atypicals for children with autism. Last year, when Risperdal became the first and only atypical approved for use in children - specifically for irritability associated with autism - the association warned against potentially serious side effects, including lactation in boys, weight gain and development of an often irreversible movement disorder.

Rita Shreffler, the autism association's executive director, said antipsychotics should be used only for dangerously aggressive children, and even then only for a short "leveling off period."

Dr. Randall Stafford, an associate professor of medicine at Stanford Prevention Research Center, says off-label prescribing allows doctors the latitude to innovate.

But Stafford was the lead author of a study that concluded that most off-label medication occurs without enough scientific support.

Some prescriptions have become so common, he said, "You have to ask, 'Where is the data to support this use of the drug?' It's not that these off-label uses are dangerous. It's that we just don't know."

- - -

Kate Malloy knows what people will think: Every kid throws tantrums; parents just need to discipline their children.

But with 10-year-old Ryan, she said, the outbursts were beyond aggressive. He seemed outside himself.

A psychologist diagnosed bipolar disorder and recommended they see a psychiatrist.

"You are under the impression that when you go to the doctor you'll be fixed," she said. "And that isn't how it works. They don't, by any means, have all the answers."

The ADHD medication Ryan was prescribed only inflamed things, and therapy fell flat. They tried atypicals, first Risperdal. Then Zyprexa. Then Seroquel.

"In the beginning, when the meds weren't working, I hated them," she said. "I hated that they were the only option."

She took Ryan off all the medications and tried an alternative doctor, who recommended dietary supplements. That worked, but only for a while.

She went to Dr. Mark Cavitt, medical director of pediatric psychiatry at All Children's Hospital in St. Petersburg.

He says mental health practitioners operate in gray areas. The unknowns of the long-term effects of psychotropic drugs have to be balanced against the risk of not treating.

Studies show that atypicals can be effective in modifying aggressive behavior, he said, and that kids who are treated for depression and schizophrenia are less likely to fall prey to pitfalls like drug abuse and teen pregnancy. Then again: "We have to be concerned. There is no such thing as a benign psychiatric medication."

Dr. Cavitt prescribed Risperdal for Ryan. He couldn't tell when he was full and gained 15 pounds. When Risperdal stopped working, they switched to Abilify.

Mom hates to think about the possible long-term effects but has more immediate concerns, like, "Will he jump out of a moving car?"

"There are certainly downsides to medications," she said. "But when medications don't work, we are pretty much screwed. There are not a lot of options."

- - -

At the Suncoast Center for Community Health in Clearwater, the focus is on therapy. Drugs are a last resort.

Renee Kilroy, the clinical director, said the sharp increase in psychotropic medications to children is unsettling. "It's not my belief we need to put more kids on medications. They are still growing and changing."

Therapy costs more in the short term, she said, but a lifetime of medications is costlier. Suncoast can afford to take the longer view thanks to subsidies it gets from the county's Juvenile Welfare Board.

More and more, she said, they get referrals from the school system for disruptive kids. Parents tell her that the school has told them their children need to be put on psychiatric medication before they can come back - even though state law specifically forbids that.

- - -

Children younger than 6 generally should not be given psychotropic drugs. According to guidelines from the Florida Agency for Health Care Administration, it should "only be considered under the most extraordinary of circumstances."

Last year, 1,111 Florida Medicaid children younger than 6 were prescribed antipsychotics.

There is no recommendation for the use of antidepressants in children younger than 6 - yet 629 children were prescribed antidepressants last year.

Using stimulant medications for ADHD should be "rare" for kids younger than 4, the guidelines state, "and only after a failed behavioral intervention such as parent training." Last year, 367 toddlers 3 and younger were prescribed ADHD medications.

Cavitt said 3-year-olds put on psychotropic medications typically are autistic, mentally retarded or brain injured. They are extremely self-injurious or physically aggressive to others, he said.

Robert Whitaker, a journalist and author of the book Mad in America, says there is no circumstance where it makes sense to prescribe an antipsychotic drug to a 3-year-old.

"It is not a scientific use of drugs," Whitaker said. "It is an experiment. There is no data showing that they are helpful in a 3- year-old kid. None. Zero. Zip."

Rather, he said, it is using medication as a controlling device. Whitaker blames a system of "assembly line medicine," where psychiatrists are afforded less and less time with patients. Atypicals provide a shortcut to dealing with unruly children.

"It mutes your ability to respond to the world, emotionally and physically," he said. "They make them easier to manage, to others."

The pharmaceutical companies also help to shape the prescribing patterns, he said. The law forbids them from openly marketing to children off-label, but as any child psychiatrist will tell you, pharmaceutical reps for the atypicals are regular visitors.

Psychiatrists like Cavitt say the reps know the line: They are there only to provide company research and to solicit feedback on the use of their medications.

But Whitaker said it's clear why the reps for atypicals are in the offices of child psychiatrists: "They do it because they know it's effective in promoting off-label uses of their drugs.

"They are publicly traded companies trying to maximize their revenues. It increases off-label use, and doctors should quit pretending otherwise."

Minnesota is the only state that requires public reports of all drug company marketing payments to doctors. A recent New York Times analysis of those records found that doctors who took the most money from makers of atypicals tended to prescribe the drugs to children the most.

- - -

The support group for people whose relatives have committed suicide was unveiling a quilt with squares in memory of each person.

Kathy Pingleton was seated in a plastic chair in the back row when her son's name was called.

"Brandon Lee Pingleton."

Her husband, Ken, put his arm around her and they made their way to the front.

Kathy stole a glance at the section of quilt she made in honor of Brandon, a 15-year-old sophomore at Largo High School.

She worried that she made the square too busy. Lots of pictures and buttons to show Brandon's love of football, soccer and karate.

Kathy reached out a hand to light a candle in his memory. On one finger was a ring made of a guitar string that Brandon used. It reminds her of his artistic side.

Nearly four years ago she and Ken found Brandon hanging in his bedroom, just feet from where they were.

Diagnosed with ADHD, Brandon had landed in a county crisis center after he overdosed on Robitussin and told authorities he was depressed.

When he was released from the center, mom remembers taking him to a psychiatrist. After 5 minutes of evaluation - "How are you sleeping? How is school?" - the doctor doubled his dosage of the atypical antipsychotic Seroquel.

She remembers wondering why he was taking the drug when the Web site said it was for schizophrenia and bipolar disorder.

She hated what the drugs did to him, as did Brandon. He said it made him feel like a zombie.

Seroquel now carries a black box warning that antidepressants may increase the risk of suicidal thoughts in children and teenagers, and that patients should be watched closely.

Those warnings didn't come until 2004. Brandon hanged himself in 2003.

- - -

Alan Levine ran the state's Agency for Health Care Administration in 2005. He became so alarmed by the spike in antipsychotics prescribed to children that he contracted with USF to study the trend.

The study found that from mid 2002 to mid 2004, the cost of psychotropic drug prescriptions for kids increased 60 percent. Pacing that increase was an 82 percent jump in spending on atypical antipsychotics.

"It has very quietly grown as a problem," Levine said.

He wanted to reel it in, but not in a knee-jerk way that might hurt kids who need medications. "There needs to be a more sane and evidence-based approach when prescribing these drugs to children."

The use of antidepressants and ADHD medications dropped and the growth of antipsychotics slowed over a two-year period, starting in April 2004.

By then, said Robert Constantine at USF's Louis De La Parte Mental Health Institute, any psychiatrist would have been aware of the metabolic side effects of the new antipsychotics, and, for those taking antidepressants, the dangers of suicidal feelings.

As part of the $3-million state grant, USF was charged with sending out letters to physicians who were regularly prescribing outside the accepted guidelines.

For example, in the first quarter of this year, 315 children on Medicaid got antipsychotics at higher-than-recommended dosage levels.

Another common problem, Constantine said, was the practice of prescribing more than one antipsychotic at a time. Some doctors swear it works, but there isn't much scientific evidence to back that up. The first three months this year, 274 children were prescribed two or more antipsychotics for an extended period.

Joanne Mills' 12-year-old son was on 16 medications. At the same time.

"At the time we decided to put him on each one of them there was a good reason for it, or else we wouldn't have done it," said Mills, a mother of six in Homosassa.

In the last year, by integrating therapy, she said they have cut her son's 16 medications to three, including the atypical Seroquel.

He has been diagnosed with ADHD and occasionally explosive behavior. For three years, she had to hold him for three hours a night so he could sleep.

Frustrated to the nth degree, she says you walk into the doctor's office with a bubble of hope, and walk out 15 minutes later with a handful of prescriptions, for drugs you've tried before without any lasting benefit.

"The doctors throw their hands up in the air and say, 'I don't know what else to try.' "

Times computer-assisted reporting specialist Connie Humburg contributed to this report. Robert Farley can be reached at (727) 893-8603 or farley@sptimes.com.

Kids on meds: an explosion

In the last seven years, the number of children in the Medicaid fee-for-service plan who received antipsychotics has more than doubled. Prescriptions have more than tripled, and the cost to taxpapers is up almost 500 percent.

The atypicals

A new class of drugs emerged in the 1990s, touted as a better and safer way to treat schizophrenia and bipolar disorder. Here are the atypicals now on the market.
[Table]
Trade name Drug name Marketed by
Clozaril Clozapine Novartis
Zyprexa Olanzapine Eli Lilly and Co.
Risperdal Risperidone Janssen Pharmaceutica
Seroquel Quetiapine AstraZeneca
Geodon Ziprasidone Pfizer
Abilify Aripiprazole Otsuka Pharmaceutical Co.
Invega Paliperidone Janssen Pharmaceutica
About the numbers

Most of the statistics in this story are derived from Medicaid data provided by Florida's Agency for Health Care Administration.

The agency provided the same data to the University of South Florida, which was contracted by the state to study prescribing patterns. As a public service, USF prepared an analysis of the state's data for the St. Petersburg Times.

The numbers include only children on fee-for-service Medicaid. They do not include children in Medicaid HMOs or those with private insurance.

Some 720,000 children were in the fee-for-service Medicaid program last year, out of some 4.5-million children in Florida. That means the statistics in this story vastly underestimate the entire picture of antipsychotic medications prescribed to children.

The Medicaid numbers were used because the program is taxpayer- funded and the information is public. Read more!

New Connecticut Law May Save a Troubled Prison for Juveniles - New York Times

By ALISON LEIGH COWAN

MIDDLETOWN, Conn. — Two years ago, it appeared that the state youth prison here, a fortresslike compound whose scandal-scarred construction helped put the governor who built it into a prison cell of his own, was destined to close.

The state’s child advocate labeled the youth prison, called the Connecticut Juvenile Training School and opened in 2001 during Gov. John G. Rowland’s administration, “beyond repair.” Legislators piled on, and the current governor, M. Jodi Rell, called for it to be closed by next year, saying, “I cannot allow the failure of this institution to continue.”

Instead, the $57 million facility, which houses all but the state’s most serious juvenile offenders, is gearing up for a likely increase of its population, and an infusion of about $40 million a year. That is because of a state law Mrs. Rell signed last month that will raise the age at which criminal suspects are automatically charged as adults, to 18 from 16, starting in 2010.

Some say that the youth prison’s possible revival has been the result not only of the new law, but also of the power of the unions that represent the 300 employees who staff the place. Others cite a lack of resolve among politicians to shut down a boondoggle, while some point to fiscal and political realities, saying it would cost much more to close the prison and start again elsewhere.

Part of the reason, though, rests in the youth prison itself, which has undergone significant improvements during the last two years.

The building where the teenage offenders with the worst behavior problems had been housed in drab rooms, with slits for windows, has been converted into a youth center complete with arcade games and an art therapy room. Cinderblock cells once likened to “tiger cages” by Donald E. Williams Jr., a Democrat from Brooklyn, Conn., who is president pro tempore of the Senate, now have better shelving, desks, bulletin boards and carpet.

“It used to be a hellhole,” said Fred Phillips, a longtime youth services officer at the prison. What is there today, he said, “is a great improvement.”

Jeanne M. Milstein, the child advocate, said the prison, which opened six years ago, has improved enough that in April she agreed to shift the monitor she had installed there for the previous two years to a psychiatric hospital for children nearby.

She still favors closing the Middletown prison and opening smaller institutions for young offenders scattered around the state, so they can stay connected to their communities.

But, she said, “I don’t think there’s the political will right now by the legislature to close it.”

Connecticut has been one of three states, along with New York and North Carolina, that have set the age threshold at 16 for routinely charging criminal suspects as adults (and, as is common across the country, adult status is often given to those younger than 16 accused of serious felonies).

Under the new law, some of the 250 to 300 16- and 17-year-olds now sent each year to adult prisons run by the State Department of Correction will need to be housed in juvenile facilities. Those accused of the most serious felonies will still be handled in the adult system.

The change means the 16- and 17-year-olds who are to be treated as juveniles will get services including mental health treatment, family counseling and a probation officer as soon as they enter the system. Their records will also remain confidential — and invisible when they apply for jobs, professional licenses and schools.

“What we were doing was not working,” said Judge William J. Lavery, Connecticut’s chief court administrator. State Senator Toni N. Harp, a New Haven Democrat who pushed the legislation, said the old approach “hardens, rather than softens,” teenagers at risk of a life of crime.

Most states set the threshold for adult charges at 18, according to Melissa Sickmund, a senior policy associate for the National Center for Juvenile Justice in Pittsburgh, but 10 states have long used 17 as their cutoff age, and Rhode Island recently became the 11th, lowering from 18 largely because of budget pressures.

Incarceration at juvenile facilities is generally far more expensive than at adult prisons, even for inmates of the same age, because of the differing approaches used — one punitive, the other therapeutic.

In Connecticut, Leo C. Arnone, director of the Bureau of Juvenile Services, part of the Department of Children and Families, said the cost difference could be tenfold: The current annual budget for the Connecticut Juvenile Training School is $27.6 million, or $276,000 for each of about 100 residents, while the Manson Youth Institution in Cheshire, a correctional facility, spends about $27,000 per year for each of its 700 inmates.

“We either invest now or pay later,” said Ms. Milstein, the child advocate, arguing that the additional services rehabilitate young offenders and curtail recidivism.

But with the new state law, the budgetary considerations grow more complicated.

A report by the General Assembly’s nonpartisan Office of Fiscal Analysis predicts that the cost of absorbing some of the additional teenage offenders at the Middletown center would run $38.8 million to $43.2 million per year. Housing them elsewhere — whether at existing private or public facilities or in some new state institutions — would cost an additional $5.5 million to $11.3 million annually beyond that. And that is on top of one-time capital costs estimated at $7.5 million to $10 million for improving the youth prison, or $22.5 million to $25 million to build alternatives.

The youth prison here, whose original capacity was estimated at 240, now has 97 teenagers on site, and officials say 50 empty beds could be available immediately.

Abby Anderson, a senior policy associate with the Connecticut Juvenile Justice Alliance, a Bridgeport-based advocacy group, said the conversation among policymakers amounted to: “How do we close a facility that has all these beds if we’re going to bring all these 16- and 17-year-olds into the system?”

The Middletown center played a key role in the corruption case against former Governor Rowland, who served 10 months in prison after pleading guilty to having conspired to deprive the public of his honest services and to commit tax fraud.

In the plea, Mr. Rowland acknowledged having approved the funding for the juvenile prison, which was built by the Tomasso family of New Britain, without disclosing that the Tomassos had previously given him gifts worth $15,000.

In the two years since Mrs. Rell and others denounced the youth prison as a boondoggle, some of its shortcomings have been addressed. Building 2, once Exhibit A of the dysfunction and faulty design, has been converted into a comfortably furnished chapter of the Boys and Girls Club, where residents can participate in life-skills training workshops. Painted murals and makeshift walls hide the ugly cells that ring the perimeter of the building and now sit empty; the interior has a pool table and an art therapy room where teenagers one recent afternoon were making go-carts.

Across the courtyard, in the younger children’s living area, kites dangled from the rafters. An Oriental-style carpet covered the floor in another wing. “That, we just bought ourselves to home up the unit,” said Susan Kunst, the staff member who runs it.

The residents of that unit, mostly older teenagers, occasionally get to cook their own breakfast and leave campus for driving lessons. Unlike inmates at Manson, residents can make free phone calls home and are given some access to the Internet. Recreational offerings include Frisbee golf and a driving range.

At the Manson Youth Institution in Cheshire — whose warden, Christine Whidden, said her charges were young enough that she had to remind them “to brush their teeth and pull up their pants” — the sports tend to be basketball and more basketball. Trees hardly exist. “They used them as climbing devices,” explained Ms. Whidden. Cellblocks lacked air-conditioning until this summer.

Chris Cooper, a spokesman for Mrs. Rell, a Republican, said she remained adamant that the Middletown center was not appropriate for younger teenagers, who are sent there starting at age 13. He said the governor had ordered the Department of Children and Families to develop other options, but the legislature had not funded that effort.

“You can’t just shut something down without any alternatives,” Mr. Cooper said.

As for the new population of 16- and 17-year-olds who could be sent here once the new law takes effect, Mr. Cooper said that Mrs. Rell was “willing to have it looked at.”

State Representative Michael P. Lawlor, a Democrat from East Haven who is co-chairman of the Joint Judiciary Committee, said he agreed with the governor and Ms. Milstein, the child advocate, that it would be better to house juvenile offenders in small facilities throughout the state.

Resistance to such a move, he said, has been led “first and foremost” by the unions that represent employees at the youth prison, the largest of which, the American Federation of State, County and Municipal Employees, has substantial lobbying muscle in Hartford.

The unions do not “want it to close,” Mr. Lawlor said of the youth prison, adding that “if you create alternate programs, you have to site them somewhere, and there’s a great deal of resistance” from local communities.

“Those two factors together have made it almost impossible to shut down” the place, he added.


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New law gives students with disabilities options -Macon (GA) Telegraph

By Julie Hubbard
July 29, 2007

Students with certain disabilities who were enrolled in a public school last year and want another option may be able to transfer to a private school, paid for with state funds.

The Georgia Special Needs Scholarships Act was signed into law in May. It allows a child with disabilities - from visual problems to autism - the choice of using state money to enroll in private school this fall.

The state Board of Education just approved a list of 109 private schools statewide that will accept the vouchers. In the midstate, those schools are Mount de Sales Academy and Central Fellowship Christian Academy.

Parents have just six weeks to apply, though, and there are restrictions. Private schools may accept only those students they feel they can manage, for example, and that will leave more severely disabled students with limited options.

Students who qualify for the vouchers are those who attended a public school in Georgia last school year and who were on a tailored education plan. Students who were enrolled in private schools during the 2006-07 school year are not eligible.

'It's hard to know how many will participate,' Dana Tofig, a spokesman for the Georgia Department of Education, said last week.

There are about 180,000 students with disabilities in Georgia, but Tofig estimates that only about 5 percent of them - or about 9,000 students - may use the vouchers. On average, the tuition vouchers would total about $9,000 per child.

The state would use the money it normally sends to public schools to cover a disabled student's education for the private school tuition. The state calculates the annual voucher amount according to a student's disability, and it would cover the tuition until a student moves or graduates.

Tofig based the participation figure on a similar voucher program in Florida.

Many parents with disabled children are just now finding out about their transfer possibilities.

'I got a letter about the option,' said Ronald Cloud, a parent of two special-needs children who attend Howard Middle School, a public school in Bibb County. 'I know from being on an e-mail list to those dedicated to special education, parents are considering it.'

There were about 2,800 students with disabilities in Bibb County schools this past year who could apply, according to school officials.

Cloud said some parents who've lost trust in the public school system over services may consider the option. He said he won't use the vouchers, however, saying public schools are getting better at handling students with disabilities because they have federal oversight, testing accountability, equipped classrooms and require teacher training that private schools may not. The state is giving parents until Sept. 10 to enroll their children in a private school under the voucher program. Mount de Sales and Central Fellowship are already hearing from parents.

'We've had a number of calls for all levels of disabilities,' said Katy Prebble, president of Mount de Sales, a private Catholic school in Macon.

But the heads of both midstate private schools accepting the vouchers said they want parents to know their schools are not taking students with more severe disabilities because they are not set up to do so, and they will not change their programs.

'We're still going to look at whether a child can be successful here,' Prebble said. 'We're using the same standards.'

The school has an enrollment of 685 for the fall, and there is a waiting list for most grades, she said.

Mount de Sales, which has a tuition of about $8,000, already operates an academic support program staffed by two teachers. It helps students who may have a learning disability, such as those who need to test in a quiet room or need a test in big print, for example.

If a student on a voucher has needs that can be met at the school, there may be room in certain grades, Prebble said.

Interested parents would still have to call the school and request an admission packet, then fill out a two-page admissions form. The student would also have to take an admissions test and meet the school's requirements.

'We're not (using vouchers) to increase enrollment,' Prebble said. 'We have a few slots. We are not reserving (slots) for it.'

Central Fellowship now has about 525 students, but it could admit another 100, Headmaster Truitt Franklin said.

The school has been 'bombarded with calls' about the vouchers, he said.

It is a choice for parents who may want a religious component or smaller class size, and it gives 'the opportunity to help those that couldn't afford to go to private school' before, he said.

Their school also is not able to take students with severe types of disabilities because the school does not have the trained staff or necessary classrooms.

'If they fit in our program, believe in a Christian education and we felt like they could make it, we would accept them,' he said. 'We aren't able to handle every special-needs student.'

Mount de Sales and Central Fellowship would have to keep a progress report of each student on the voucher program and send it to the state, but the state cannot monitor private schools.

If a parent chooses the private-school voucher, the parent would lose his or her rights under the federal Individuals with Disabilities Education Act, which governs a child's program of study as well as rights for protection, appeals and redress concerns, Tofig said.

COMMENT ON THIS STORY AT MACON.COM.

To contact writer Julie Hubbard, call 744-4331.

Copyright © 2007 The Macon Telegraph, All Rights Reserved.
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Arrest made in cop shooting - San Antonio (TX) Express News

Mother says son suffers from mental illness.

Elaine Ayo
Express-News

A 66-hour manhunt for the suspect in the shooting of a San Antonio police officer ended Sunday at the same West Side apartment complex where it began.

U.S. marshals arrested Jose Miguel Gonzalez, 30, about 5:20 p.m. at the apartment he shared with his disabled mother. Marshals received a tip that Gonzalez had returned overnight to the apartment at Lago Vista Villas, a gated complex in the 4200 block of West Commerce, a news release said.

Authorities said Gonzalez would be charged in the late Thursday shooting of Officer Richard Ruiz in front of Gonzalez's apartment.

Sunday, marshals confronted Gonzalez's mother, Margarita, and her sister when they went to a nearby gas station to repair a tire on her vehicle, Margarita Gonzalez said. She added she had asked to speak with Gonzalez before he was arrested but relented when they threatened to arrest her, as well.

"I didn't want it to be like this," she said.

Marshals entered the apartment and found Gonzalez in a bedroom. After a brief struggle, they apprehended him. Police also recovered a gun at Gonzalez's apartment, the release said.

(Robert McLeroy/Express-News)

The suspect's mother, Margarita Gonzalez, says her son, who has been living with her, is mentally ill and it affects his judgment.

While police searched the apartment and gathered evidence, Margarita Gonzalez waited outside in her wheelchair. She said she had not slept much since the incident and woke up to see the "shadow of my son" standing in front of her on Sunday.

"I don't know how long he was looking at me," Margarita Gonzalez said.

She said her son then told her what had happened Thursday night and said he was "very, very sorry."

"He said, 'The officer got his gun out and that he was going to shoot me,'" she said as tears streamed down her face.

Ruiz arrived at the apartment complex about 11:18 p.m. Thursday, responding to a call about a man trolling around the complex with a gun. Police say the man retrieved a gun from his waistband as Ruiz approached.

"He sees things, he thinks ahead," Margarita Gonzalez said, explaining that her son is mentally ill and it affects his judgment.

Gonzalez had been living with his mother for a little over a year after he was badly beaten and almost died, Margarita Gonzalez said.

She said the event changed her son, adding that Gonzalez was more paranoid and always kept his bedroom door locked.

Court records show Gonzalez has been found guilty of various criminal charges, most recently of assaulting a family member in 2004.

Police say Gonzalez fled the complex through a back gate after the shooting and tried to go to his sister-in-law's home on the East Side. They believe he then returned to the complex, changed clothes and left in his red Chevy truck. Police found the truck Saturday morning after receiving a tip, police spokesman Joe Rios said.

Police said Ruiz appeared to have been wounded when he raised his arm to return fire. The bullet went in below the vest and exited near his abdomen. He also was shot in the leg.

Margarita Gonzalez said her son told her that he tried to shoot the officer in his bullet-resistant vest.

Ruiz has since been released from Wilford Hall Medical Center and is recovering at his home, a news release said.

Gonzalez was taken to police headquarters but transported to the hospital later Sunday evening because detectives noticed Gonzalez was "under the influence of unknown medication and inhalants," the release said.

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Brother's keeper can face legal quandary -Ft. Wayne (IN) Journal-Gazette

Self-neglect cases present ‘real gray area' for law

By Dionne Waugh
The Journal Gazette

Paul Varro thought he was doing the right thing for his brother Alex.

For 50 years, the Fort Wayne man cooked, cleaned and looked after his brother, who became a recluse after a brutal beating as a teenager.

But in the spring of 2005, when Alex Varro was 74, he sat on the couch and refused to get up. Paul Varro, 75, said he thought about getting his brother medical help, but his brother refused to leave the house and refused any type of medical assistance

Then Alex stopped eating.

On July 6, 2005, Paul Varro thought his brother was sleeping. He wasn’t.

The Allen County Prosecutor’s Office decided that despite all Paul Varro had done to care for his brother, he was in part responsible for his brother’s death.

A byproduct of the country’s growing elderly population has given way to an increasing problem for prosecutors: Who is responsible when elderly people stop taking care of themselves and later die?

Allen County prosecutors have charged Paul Varro with felony neglect of a dependent, accusing him of knowingly or intentionally depriving his brother of necessary support, causing his death.

Much to their dismay, prosecutors are seeing more cases of both elder abuse and neglect, Allen County Prosecutor Karen Richards said.

“I think we’re seeing more for two reasons. One, as the population ages, I think we’re going to see more and more people at risk,” she said. “And, two, since we brought Adult Protective Services into our office, they’re right here now so we’ve got more access to them and them to us, so they’re filing more cases.”

Richards said that as the county and the country’s baby boomer population prepares to retire, more and more people will be at risk.

“The entire baby boomer citizens are going to be senior citizens within a few years, so we’ve got that large population that will need services and is going to become unable to handle their own affairs,” Richards said. “That becomes an opportunity to be easily victimized.”

According to the National Center on Elder Abuse, self-neglect accounts for the majority of cases reported to Adult Protective Services across the country. Self-neglect is when people stop taking care of themselves, such as not bathing, eating or going to the doctor, at the risk of serious physical detriment.

But what’s the right thing for someone to do when the elderly person they’re caring for stops taking care of himself or herself? Unlike children, the elderly person who may have decided they no longer want to take showers or get physical checkups usually has the right to do so.

Further clouding the issue is that the person most often taking care of that elderly individual is an adult son or daughter who – most of his or her life – has considered mom or dad to be the one in charge.

Allen Superior Court Judge David J. Avery presides over the county’s hearings determining whether someone is mentally ill and a danger to themselves or others. He also determines whether people are so gravely disabled that they need to be committed to a hospital because of the danger of harm and inability to take care of themselves.

He calls the self-neglect situation “a real gray area.”

“Someone who’s competent has the right to decline medical care,” he said.

“The difficulty becomes finding if the person is not competent to decide whether they need medical care. Do they understand the significance of the decision they’ve made?”

What should you do?

Richards said her office has created a pamphlet and put information on its Web site to help people who aren’t sure what to do in such a situation.

“The correct thing to do is not nothing,” she said. “That’s the incorrect thing.”

Richards also encouraged people to get the person medical care or call Adult Protective Services, which can assist in getting the proper help. Adult Protective Services was established in 1985 in Indiana to investigate reports of abuse, neglect, self-neglect and exploitation, and to assist in finding services for endangered adults.

The local Adult Protective Services unit covers Allen, Adams, DeKalb, Huntington, LaGrange, Noble, Steuben, Wells and Whitley counties.

According to Richards’ pamphlet, a person who, in good faith, makes a report of elder abuse or neglect cannot be charged criminally or civilly.

But calling the prosecutor’s office, where Adult Protective Services is located, is not an easy thing to do, Avery said, pointing out that people can be intimidated by the idea of getting in trouble or getting someone else in trouble.

Even more intimidating, Avery said, is dealing with the fallout.

“They don’t want to negatively affect the relationship with the loved one,” he said.

Avery also suggested people contact Mental Health America, which is a national, non-profit agency based in Virginia and dedicated to helping live with and understand mental health as well as educate the public.

Often, people’s decisions to stop taking care of themselves are paired with declining health, isolation, Alzheimer’s disease or dementia, or drug and alcohol dependency, according to the National Center on Elder Abuse.

Adult Protective Services can help because the agents are sensitive to such issues and the relationships between family, Avery said.

In September 2005, Allen County prosecutors charged Alberta P. Puff, 58, with neglect of a dependent in the death of her 80-year-old mother. Willodean Puff was found lying on a mattress on top of and surrounded by foot-high piles of newspapers, Disney videos and trash, some of which had been there for years. The coroner ruled she died of malnutrition, dehydration and skin ulcers.

Alberta Puff, whom psychologists found barely competent for trial, told police her mother had been sick for more than a year but that she didn’t take her to the hospital because she “only did what Mom told me.”

Her mother refused to eat, take her medication or go to the doctor. Though Alberta Puff knew her mother could not feed herself, clean herself or do anything on her own, she did nothing, police said.

Like Puff’s case, Varro said he had his own relationship issues with his brother. He told police his brother was intimidating. Since age 16, Alex Varro had been a recluse and suffered mental problems as a result of a severe beating, Paul Varro told police. Alex had never worked.

The Allen County Coroner’s Office determined Alex Varro died from atherosclerotic cardiovascular disease, also called heart disease, with several contributing factors such as skin and bone infections with sepsis. Sepsis is usually caused by the body’s reaction to a bacterial infection and forces the immune system into overdrive, overwhelming normal blood processes. The result is that small blood clots form, blocking blood flow to vital organs that can lead to organ failure.

The office further noted that numerous maggots were found within the open wounds of Alex’s body.

“They’re obviously tough cases,” said Mark Olivero, who represents Varro. “I know people in the same situations, taking care of parents and parents don’t want to do things. What do you do? Force them to do it? They’re not easy decisions for a lot of people.”

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Suicide, mental illness remain a taboo -Wausau (WI) Daily Herald

By Robert Mentzer
Wausau Daily Herald
rmentzer@wdhprint.com

When Bonnie Forcey's husband committed suicide in 1999, some people didn't know how to treat her.

"People would actually see me and they would turn around and go the other way," Forcey said. "People I knew."

If people are not comfortable talking about suicide it may be partly because they aren't comfortable talking about any aspect of mental illness, said Forcey, who since has remarried and taken the name of her husband, Henry Kanemoto. Many who commit suicide have struggled with clinical depression, and the taboo surrounding mental illness keeps many from seeking treatment.

The issue is of critical importance in Marathon County. As of July 15, 14 people had killed themselves here since the beginning of the year, just two fewer than the county has averaged over the past five years.

Health care professionals and folks who have struggled with depression are working to understand what's happening.

"There is a stigma concerning mental health and getting help, and some people feel it's a weakness to get help," said Jeff Boodle, co-chairman of the Marathon County Suicide Prevention Task Force.

But why are illnesses affecting the mind seen differently than illnesses of the body?

"Mental illness is just that, a treatable illness." said Debi Traeder, community education coordinator with Aspirus Behavioral Health. "Just like heart disease is a treatable illness, or diabetes is a treatable illness.

"We come from this old German-Polish-Norwegian stock," Traeder said. "We want to think we can always pull ourselves up by our bootstraps. People talk about the work ethic of the Midwest, but it's because of that same work ethic that we look at mental illness as a character flaw, a weakness and not an illness."

Kanemoto said she believes the attitudes stem in part from the fact that the study of brain science is relatively young. Mental illness is taboo because it is not well understood.

"I do know a number of people personally who take antidepressants," she said. "They won't tell just anybody, but they have told me. But if they were on insulin or if they were on cholesterol pills, they wouldn't mind other people knowing."

Like most newspapers, the Wausau Daily Herald does not report suicide as the cause of death in its obituaries or in the news pages unless the death occurs in public. Following a report earlier this month on suicide rates in Marathon County, some readers wrote that it had been insensitive of the paper to provide information that could lead others to the conclusion that a reported death had been a suicide.

But is the practice of excluding this information from obituaries another symptom of the taboo on talking about suicide?

Both Kanemoto and Traeder said it might be, but that the decision ought to rest with families involved. If social attitudes change, the newspaper's policy may change as well. But publishing suicide as a cause of death in obituaries is not likely to lead to those changes, they said.

Kanemoto found solace in a support group for survivors of suicide. There she met Henry, who was coping with his own loss, and they married in 2001. The two of them now facilitate the support group, which meets the second Tuesday of each month at St. Mark's Lutheran Church, 600 Stevens Drive in Wausau.

The North Central Health Care crisis line is available to callers 24 hours a day at 845-4326 or 845-4327. The suicide prevention task force can be reached at 1-800-273-TALK (8255), or on the Web at www.healthymarathoncounty.org/spt/. The Web site also provides information including warning signs and frequently asked questions.

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Instinct, training help guide officers -Hilton Head (SC) Island Packet

By DANIEL BROWNSTEIN
dbrownstein@islandpacket.com

When two Beaufort County Sheriff's deputies prevented a man from leaping off a bridge, they performed exactly as trained, officials said.

They dropped their rigid exteriors and first tried to talk the man off the ledge.

They then picked up on a change in the man's body language, and while Sgt. Kevin Heany distracted him, his backup, Lance Cpl. Jonathan Garcia, swooped in.

Much of law enforcement training centers on basic communication skills. An increasing amount of time is also spent on recognizing the signs of mental illness. Officers are trained to detect cues in body language that can signal whether a person is about to run or stand and fight.

"It's a tough role to play," said Sheriff P.J. Tanner, a former South Carolina Criminal Justice Academy advisory board member. "Your brain is going 100 mph. You're processing the situation. You're processing the scene and you're processing what your abilities or obstacles might be. You're doing all of that while you communicate with a person."

In the case of the mentally ill or of someone about to commit suicide, the situation can turn in a moment. Any mistake by officers can have devastating effects.

Law enforcement in general has made concerted efforts to give officers basic training in recognizing the signs of mental illness in the past few years, said Bluffton Police Chief David McAllister.

"That doesn't mean that you're going to save every one," he said, "but it does mean that perhaps you can de-escalate the situation with your words."

When dealing with a person suffering from paranoid schizophrenia, for example, officers have to clue into what the real problem is and try to peel away the layers of fantasy. When someone is depressed, officers are trained not to automatically bring family into the equation without knowing the person's background.

"You really have to work at getting their trust," McAllister said. "You have to sit and talk with them. It's asking officers to give a little more of themselves so that a bridge of rapport and trust is built."

Last year, the Bluffton department sent two police officers to Kentucky for an advanced course on dealing with mental patients and crisis intervention. The goal is to have one officer per shift go through the training and partner with mental health providers to get those who need it help.

The most important tool officers have is the skill to communicate effectively and use words and body language to diffuse volatile and emotionally charged situations, officials said.

"I've seen officers go in and make things worse because they don't have good communication skills," said Tanner. "I've also seen officers go in and within minutes calm things down by using words."

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Taking bite out of homelessness -Waco (TX) Tribune

Editorial:


How many times in government do we see lofty notions expressed but never brought to fruition? More than anyone can count.

Such surely might have been the case in 2004 when the late Mae Jackson, then Waco’s mayor, initiated a 10-year plan to end chronic homelessness. The notion might have died with her. Instead, it lives on, in part because interim successor Robin McDurham and current Mayor Virginia DuPuy took it to heart.

Well they should, but not just for humanitarian reasons. Ending chronic homelessness is better stewardship of public funds than dealing with all its collateral damage.

What if the man shot last week after bedding down in a vacant Waco building had been in a shelter and on a path to self-sufficiency? Instead, he ends up in the emergency room and the building owner gets arrested.

Humanitarian concerns aside, the costs of homelessness are staggering. A Baylor University study two years ago found that the homeless cost the community more than $7 million annually.

The encouraging thing is that not only is Waco moving toward a solution, but federal officials are so impressed that it has been designated a model for other communities under the U.S. Interagency Council on Homelessness.

The city’s Homelessness Implementation Steering Committee has several goals. Chief among them is “permanent supportive housing” for 60 males. In May, the city received two federal grants totaling more than $500,000 over five years for housing and mental health services for people on the street.

The steering committee has been communicating with the Waco Veterans Affairs Medical Center to see if one of its vacant domiciliaries could be a full or partial answer. If the Waco VA hospital housed homeless veterans alone, it would be a major step.

Scandalously, almost a third of homeless people are those who served this country in the military. Mental health concerns, along with substance abuse, are the chief causes of their plight.

The VA needs to respond to the entreaty from the homelessness steering group, if only to collaborate to get homeless veterans off Waco’s streets.

Similarly, local mental-health interests are seeking to establish a 24-hour psychiatric triage center for the mentally ill. That’s something for which the VA campus would be ideally suited.

In this case, and in the case of the homeless effort, other accommodations can and will be found, organizers say. But what better place than the VA hospital?

It’s time to put lofty notions into motion.
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Benton County looking for solutions to increase in mentally ill inmates -Albany (NY) Democrat-Herald

By Gwyneth Gibby
Corvallis Gazette-Times

William Ingram sat at a table in the Benton County jail lunch room, talking fast and nonstop. He apologized for being intense.

“I’m a frantic type of person,” he said. “I’ve got a few screws loose.”

Ingram’s conversation rambled from his lawsuits in federal court to the hit-and-run accident that disabled him to his belief that his mail is being tampered with. He started one lawsuit because he thinks he’s not getting equal access to food from the jail’s commissary.

“Someone who’s in here for nine days is eating better than I do,” he said, a theme he returned to over and over again during an hour-long interview. In the background, a corrections deputy gently shook his head.

Ingram, 56, has been in jail since January awaiting trial for attempted murder.

“Get this in front of a jury trial,” he said about his case. “This won’t stand up for 10 minutes. But my attorney said ‘I’m going to send you to the state mental hospital to get observed.’ I’m just fumin’. Hotter than blue blazes on the back burner.”

Ingram acknowledged he can be abusive to the staff. Almost in the same breath he said it was illegal to build a house in Indonesia without a bomb shelter and he won’t buy car insurance because he will not pay money to criminals.

Ingram’s style of conversation is far from unique among inmates in Oregon county jails. A 2005 survey conducted by the Oregon Jail Managers Association and the Oregon Department of Human Services found that 8.5 percent of jail inmates had a serious mental illness such as schizophrenia, bipolar disorder or major depression. Six Oregon counties reported more than 20 percent of their inmates had serious mental illnesses.

And the problem is growing. More than 80 percent of jails reported more inmates with mental illness in 2005 than five years earlier. Counties across the state have struggled to find ways to deal with mentally ill inmates at a time when most are facing deep budget cuts.

Benton County does not track inmates with mental illness, but the staff has seen a significant number of people who are obviously troubled.

“At any given time our population is about 10 percent people with mental health challenges that a person on the street would recognize,” jail Commander Scott Jackson said.

But he believes a trained psychologist would identify mental health problems in a much higher percentage of the jail’s population.

The Linn County jail now has a full-time staff member to assess and counsel inmates with mental health problems. Don Nelson, who does the assessments, works for Linn County Mental Health, but his salary is paid out of the jail’s programs budget.

“The county Health Department and the Sheriff’s Office made a commitment to screen people who come into the criminal justice system with mental illness,” said Frank Moore, director of Linn County Mental Health.

In the first three months of 2007, Nelson sent 26 inmates to be assessed at either Good Samaritan Regional Medical Center in Corvallis, or the state mental hospital; that was up from 16 inmates for all of 2006. Three inmates stayed at Good Samaritan for medical stabilization, and one person was committed by the court for psychiatric care.

One problem is that many people with mental illness don’t acknowledge it and won’t participate in treatment. Nelson said many of the inmates he sees have never talked to a counselor before.

“A lot of the people who haven’t had the opportunity to sit down and talk about their behavior,” Nelson said, “become a lot more open to treatment.”

Care after incarceration

Another problem is finding housing for inmates after their release from jail. Commander Jackson and Benton County Sheriff Diana Simpson are working on a plan to fund transitional housing for inmates diagnosed with mental illness. Ingram, for example, relies on Social Security for income. When he’s in jail those payments stop and he has to reapply for the benefits if he is released.

“How am I supposed to survive when I get out?” he asked.

Simpson wants to create a facility where a caseworker can monitor the progress of former inmates and make sure they are going to appointments with county mental health workers and taking their medications. The program would be paid for out of the jail-bed levy that is now used to house overflow inmates in neighboring county jails.

“We would start with a couple of people and see how that goes,” Simpson said, “then expand from there.”

In Linn County, Nelson tries to focus on inmates who are only in jail because of their mental illnesses. Their crimes tend to be nonviolent, like trespassing, disorderly conduct and harassment, and they tend to come back again and again for the same minor violations.

“We’re trying to stop this revolving door,” Nelson said.

Benton County, too, has numerous inmates who fit that category. Jackson said two of the current inmates had been arrested and jailed 11 times in the past year. Another has spent almost four of the last nine years in the jail, in multiple visits.

One man, who has been diagnosed as schizophrenic, is in jail now because he violated a restraining order his parents got believing it would be a way to get him into treatment. Their strategy backfired. Their son violated the restraining order because he wanted to get his possessions and he has nowhere else to live. But he sits in jail, not in a hospital. He is extremely intelligent and articulate, but doesn’t acknowledge any mental problems.

Jackson said his staff had watched the young man sit down and write a three-page letter without pausing, and when staff looked at it, every word was perfectly spelled backward. The man’s parents have faced endless obstacles to getting help for their son.

“Should I just let him hit me?” his father asked a judge recently. “It’s just been a hopeless circle of nonproductive imprisonments whether it’s mental health or law.”

His son had hit him before, but not to hurt him seriously.

“We have an unresolved father-son relationship interrupted by schizophrenia,” he said, and added, in a voice ragged with frustration: “Jail is worse for him than being out and if he has to come around and he needs to hit me to be committed, I’ll do that.”

For now, he remains in jail.

BY THE NUMBERS

The number of jail inmates in Oregon with a serious mental illness in 2005: 8.5 percent

The number of Oregon counties reporting that more than 20 percent of their inmates had serious mental illness: 6 Read more!

TYC contractors housing inmates have lost contracts,closed doors elsewhere - Dallas (TX) Morning News

By HOLLY BECKA and JENNIFER LaFLEUR / The Dallas Morning News

Robert Schulze was scared. He threatened to harm himself unless he was moved to another youth prison location. He lost 23 pounds in two months.

None of that raised concerns at the Coke County Juvenile Justice Center, a sprawling private youth prison in West Texas run by the GEO Group Inc. Nurses there never gave Robert his prescribed antidepressants, and prison officials never put the 19-year-old inmate on suicide watch.

Ten days later, he hanged himself from the top bunk of his solitary cell.

Texas Youth Commission investigators presented a grim report on the prison's failings to Gov. Rick Perry and other state officials in February. They could have discovered even more disturbing details had they looked beyond Texas' borders.

A three-month Dallas Morning News investigation found that private contractors housing juvenile inmates in Texas repeatedly have lost contracts or shuttered operations in other states after investigators uncovered mismanagement, neglect and physical and sexual abuse.

In Colorado, a suicide finally prompted state officials to close a private youth prison that investigators said was plagued by violence and sexual abuse. In Arkansas, former employees of a private juvenile facility said inmates were shackled and left naked on the ground in sleeping bags. And in Michigan, a private contractor was sued for allegedly allowing mentally ill inmates to languish in solitary confinement.

Last year, TYC spent nearly $17 million of its $249 million budget to do business with these and other private contractors. The agency houses about 450 young inmates with 13 private operators.

Legislative reforms passed in the wake of the TYC sex abuse scandal largely overlooked private contractors and focused instead on agency-run prisons.

"They are a much under-examined problem in the TYC system," said Scott Medlock, a prisoners' rights attorney for the Texas Civil Rights Project, which has filed a class-action lawsuit against TYC alleging widespread inmate abuse.

The News focused its investigation on three private contractors with the largest number of TYC inmates and high numbers of complaints – GEO Group, Cornerstone Programs Corp. and Associated Marine Institutes.

Those contractors have been dogged by problems in Texas strikingly similar to what led officials in other states to take action. Such problems include difficulties in attracting qualified employees, high turnover rates and inadequate care for inmates – sometimes with tragic consequences.

States that hire contractors with poor performance records "obviously have a very low regard for our children," said Isabelle Zehnder, director of the Coalition Against Institutionalized Child Abuse, a child advocacy organization in Washington state. "They're letting money or circumstances stand above children."

Many states use private companies to run adult and juvenile prisons. Contractors argue they are more innovative and can do the job cheaper. Texas' three largest private contractors acknowledge having some problems in the past, but insist they run good programs that help juvenile inmates. "No correctional facility, public or private, is immune to incidents that are inherent in the management of offender populations," said GEO spokesman Pablo Paez.

But Michele Deitch, an expert on prison privatization at the University of Texas at Austin, said research showed that privatization did not save money and that "private facilities tend to have many more problems in performance, such as higher levels of assaults, escapes, idleness."

TYC officials said they were reviewing the agency's policies on contractors but could not comment about changes under consideration. However, just days after detailed questioning by The News, TYC canceled bid requests for new contract facilities. Bidders included contractors currently operating facilities in Texas that had a history of problems in other states.

The vetting process

TYC first turned to contractors in 1974 to relieve overcrowding. Contract care facilities vary from group homes to large prisons, and over the years contractors have come to provide specialized services not available at TYC prisons, such as care for pregnant inmates.

TYC's executive director makes the final decision to hire a private contractor after a five-phase review process that includes checks on the contractor's ability to provide adequate medical care and educational and behavioral treatment.

Companies with contracts terminated in the last year "for deficiencies in performance" anywhere in the country are ineligible to bid. And, under a new policy enacted in March as the TYC sex abuse scandal unfolded, the agency reserved the right to declare ineligible bidders with canceled contracts in the last three years.

"We ask for contracts [canceled] within 36 months, because this provides us with additional information that might be important – [such as] funding, or lack of funding," said Mark Higdon, TYC's business manager for contract programs. "It might not be performance. It might be something else, and we can look at that also."

While a contract cancellation would clearly be a red flag for TYC, there are many loopholes through which worrisome contractors can pass.

Arkansas officials, for example, let an agreement with Associated Marine Institutes expire after an audit found the contractor had mismanaged its billing and failed to provide proper services to young inmates. Elsewhere, companies have negotiated deals allowing them to withdraw from their contracts, or simply shut down after states have removed youth from their facilities.

Neither of these would constitute a terminated contract as defined by Texas.

Critics say that TYC requires private contractors to provide less background information when bidding than it should. For example, TYC does not request major incident reports or disclosure of lawsuits against contractors, nor does it do any independent research.

In Florida, by contrast, companies must list and explain any "correctional facility disturbances" – major incidents, such as escapes or deaths – in any of the company's prisons. Such disturbances may be the result of inadequate staffing, poor training or other factors and raise warnings about a company's practices.

TYC should require contractors to provide all incident reports, said Ms. Deitch, a lawyer with 20 years' experience in criminal justice policy issues.

"It is absolutely important that the contracting agency has this kind of background info," she said. "If problems occur, there can be liability concerns for the state agency, and the costs of dealing with the problems can far exceed any savings from going with a low-cost contractor."

Elizabeth Lee, the new acting coordinator for TYC contract care, acknowledged the agency has no "established process for collecting information" on how its contractors performed in other states. The important thing to consider, she said, is what they're doing in Texas "and what we're doing to monitor the care of our kids."

Correcting contractors

TYC regularly reviews contract facilities. It checks program areas, such as staffing and security, at least once a year. It also uses statistical information, such as rates of confirmed mistreatment and the number of escapes, to evaluate operators. TYC quality assurance monitors also make at least two unannounced visits per year.

If a facility has significant problems, it is put on a corrective action plan, which outlines improvements and deadlines for them.

The Coke County youth prison, for example, was placed on a corrective action plan in February after Robert Schulze's suicide. The plan required Coke to improve staffing and procedures in solitary confinement. Records show that Coke was also placed on a corrective action plan in July 2006 for deficiencies in case management, which includes inmate monitoring and record keeping.

Earlier this month, TYC monitors visited WINGS for Life in Marion, just outside San Antonio, which houses female inmates and their babies, to follow up on a corrective action plan necessitated by deficiencies in staff training and documentation.

"If a facility fails any critical measure, we have to come back and check it," said Jim Humphrey, the TYC quality assurance supervisor for WINGS.

TYC has the authority to fine contractors for problems, but it has never done so in 33 years of outsourcing, officials said.

"If it comes to that, we would just stop the contract," said Paula Morelock, who recently retired after 17 years as TYC's contract care coordinator.

But it rarely does that.

The News could find only a few instances of TYC not renewing contracts because of poor performance. TYC is required to retain contractor records for only a few years, so a full review of the program was not possible.

In 2001, TYC terminated its contract with FIRST Program of Texas in Longview after repeated problems. One young woman said that when she was at FIRST, it had chronic staff shortages.

"A lot of stuff took place that shouldn't have," said Michelle, a 22-year-old who asked that only her first name be used. "There were lots of problems ... like staff having sex with the youth there and improper restraints and lack of supervision."

In 2004, TYC removed its youth from the Hemphill County Juvenile Facility, then run by Correctional Services Corp., a former state contractor, because of "grave concerns for the safety of youth."

The move followed a December 2003 complaint signed by about 30 inmates. Still, an agency review conducted shortly after the letter was sent gave the facility "above average" scores on all performance measures.

The facility was later placed on a corrective action plan. A February 2004 update from TYC staff to Ms. Morelock said: "Although they have not completed all items, the team does believe that youth are safe and that the program is stable."

But staffing shortages followed, and in June 2004, TYC removed its youth from the facility.

"We feel like we do a lot of good monitoring and do our very best to ensure that the youth receive quality services," Ms. Morelock said.

When contracts expire, TYC determines whether the facility met the terms of its agreement. The contractor completes a renewal packet, and then youth commission officials visit the facility to determine whether to extend the contract for another two years.

More often than not, Ms. Morelock said, contracts are renewed.

Critics say that TYC needs to change its policy and open the process to outside bidders each time a contract comes up for renewal.

A question of oversight

TYC already has come under fire for lax employment guidelines that allowed contractors to hire convicted felons or even sex offenders. A Texas state auditor report in March urged TYC to ban contractors from hiring employees with convictions and to require background checks of applicants.

Even with background checks, some workers with criminal records have slipped through.

A registered sex offender employed by the GEO-run Coke County Juvenile Justice Center was fired in March. Ms. Morelock said the facility told TYC that it ran a background check on the worker, but his criminal records did not turn up. GEO said the correctional officer's prior record was not uncovered because juvenile records in Texas are sealed. [See dallasnews.com for further GEO comment.]

The Texas Juvenile Probation Commission, which licenses county facilities, found the Garza County Regional Juvenile Center in Post out of compliance last year because it failed to do criminal background checks on employees before they were hired.

In a unique arrangement, TYC contracts with the county, which in turn hired a private operator, Colorado-based Cornerstone Programs, to run the Garza facility.

TYC relied on the county to vet the contractor's background, Ms. Morelock said. A Garza County official said he did not know what, if any, backgrounding of Cornerstone had been done.

It's impossible to know whether other employees of private contract facilities have criminal records because, unlike workers at state-run facilities, their names are not public information.

"The fact that [these] facilities are private simply adds one more layer of opaqueness to the process," said Ms. Deitch, the UT adjunct professor.

A few of the TYC legislative reforms will carry over to private operators. Their guards' training hours must match that of TYC employees, their younger inmates must be separated from older ones, and contractors must now conduct fingerprint background checks on all employees and volunteers in contact with youth.

"Some of the contractors were already doing that [fingerprinting], but just as a safeguard we're putting it in the contract that they all have to do it now," said the TYC's Ms. Lee.

TYC officials say the most valuable part of the agency's monitoring is staff visits to facilities.

"They're looking at grievances, they're talking to kids, they're talking to staff and they're reviewing incident reports," Ms. Lee said.

In general, though, TYC relies heavily on its contractors to police themselves.

Contractors are required to forward inmate abuse allegations, although agency monitors have raised concerns that not all make it to TYC.

Contractors also must report serious incidents to local law enforcement, but TYC reviews found facilities that failed to do so.

Critics of privatized juvenile care think more state oversight is necessary.

"Child welfare and juvenile justice systems have both a legal and moral obligation to protect kids from harm, which means they have a responsibility to exercise due diligence when it comes to placing youths in certain types of facilities," said Dr. Ronald Davidson, a university psychologist frequently hired by the Illinois Department of Children and Family Services to review juvenile care.

"Whether we look at this situation in terms of public policy or simple morality, the question we have to ask is whether our society ought to be in the business of funding gulags for children."

hbecka@dallasnews.com; jlafleur@dallasnews.com

{WebDesk} Links: More on mistreatment at contract facilities and locations of Texas private contractors.

{WebDesk} Resources: Read the state auditor's report and GEO Group Inc.'s answers to The News' questions.

{WebArch} Archive: Complete coverage of the Texas Youth Commission scandal.

dallasnews.com/extra Read more!

One Family's Struggles With Autism -Southern Pines PIlot

By STEPHEN SMITH:

Every moment of every day there's someone tugging at your sleeve -- AIDS in Africa, genocide in Darfur, Tsunami in Asia.

But collective tragedy is not an accurate or inclusive measure of human suffering, and it's well that we're occasionally reminded that most of the struggles of life play themselves out in private and are often invisible to those of us who wear the world as blinders.

Anne Clinard Burnhill's memoir "At Home in the Land of Oz: Autism, My Sister, and Me" (Jessica Kingsley Publishers, 234 pages, $17.95) is the story of a family's heroic struggle toward transcending a loved-one's life-altering disability.

Burnhill's younger sister Becky suffers from autism (Autism Spectrum Disorders), a neurobiological disability that afflicts one in 150 individuals, making it more common than pediatric cancer, diabetes, and AIDS combined.
It impairs a
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person's ability to communicate and relate to others and is associated with rigid routines and repetitive behaviors. Symptoms can range from very mild to severe -- and Becky's symptoms placed her in the median of what is still a vague categorization.

The author was the first member of her family to notice Becky's slightly odd behavior.

"Becky's adventurous spirit didn't seem quite normal to me. None of the other little kids in the neighborhood left home the way Becky would if she got the opportunity. It was as if Becky didn't realize she belonged with us, like she didn't understand that the four of us were a family. Instead, Becky was a soul unto herself, a force of nature almost. And I knew, before anyone else recognized it, that Becky wasn't like other children."

Becky rocked, spoke quickly, asked questions referring to herself in the third person, and had to be constantly supervised. She had difficulty learning shapes and letters and wasn't completely toilet trained until she was an adult.

For many years, the family struggled to obtain a correct diagnosis of her condition, but the experts labeled her as retarded and mildly mentally disturbed.

Nevertheless, the Clinards worked with Becky and, despite her handicap, included her in most of their activities, occasionally with embarrassing results.

As she grew older, Becky was placed in residential programs where her progress was slow. When she was a young adult, she lived with her parents until they identified a group home that would take her.

But she made progress: "At Rouse's, Becky learned to make her bed, do laundry, cook simple meals, plan a well-balanced menu, vacuum, and wash dishes. Her reading skills improved and she could read her favorite series, 'Goosebumps,' for herself."

In 2002, Becky was placed into the Stockton Group Home, the highest-functioning of the GHF homes. Although she hasn't progressed to supportive living where she would take care of her own needs, the family has high hopes that she will.

Currently, there are no effective means to prevent autism and no fully effective treatments. Although the Clinards prayed for a cure, there is none. However, there are indications that early intervention during the preschool years in an appropriate educational setting can result in significant improvements for many young children with autism.

As Barnwell writes so eloquently in her Introduction: "I grew up with a sister who was confused, in a time when doctors couldn't tell the difference between one mental condition and another, when parents were blamed if a child was 'not right,' when mental illness was whispered about in the privacy of kitchens and in secret family meetings. I grew up in the years before talk shows broadcast from every channel on TV, when people didn't divulge their heartaches, their disappointments. I grew up in a time when private grief was the only kind around."

It sounds odd to claim that "At Home in the Land of Oz" is a beautiful book about autism, but it's just that -- a story of love, fortitude, and infinite patience.

Stephen Smith can be reached at travisses@hotmail.com. Read more!

Scientists breed world’s first mentally ill mouse -London (UK) Sunday Times

Jonathan Leake Science Editor

SCIENTISTS have created the world’s first schizophrenic mice in an attempt to gain a better understanding of the illness.

It is believed to be the first time an animal has been genetically engineered to have a mental illness. Until now they have been bred only for research into physical conditions such as heart disease. It will allow researchers to study the disease and develop treatments using a limitless supply of laboratory animals.

Animal rights campaigners have condemned the research, saying that it is morally repugnant to create an animal doomed to mental suffering.

The mice were created by modifying their DNA to mimic a mutant gene first found in a Scottish family with a high incidence of schizophrenia, which affects about one in every 100 people. The mice’s brains were found to have features similar to those of humans with schizophrenia, such as depression and hyperactivity.

“These mutant mice may provide an important new tool for further study of the combinations of factors that underlie mental illnesses like schizophrenia and mood disorders,” said Takatoshi Hikida, of Johns Hopkins University in Baltimore, a leading researcher.

The egg cells of mice were genetically modified by inserting a gene associated with schizophrenia into their DNA. The eggs were fertilised and grown into viable baby mice using surrogate mothers.

Animal Aid, a campaign group, said rodents were not a reliable way of modelling human disease.

Contact our advertising team for advertising and sponsorship in Times Online, The Times and The Sunday Times. Read more!

Working miracles with kids gives her an inspiring Edge -Bloomington (IL) Pantagraph

By Paul Swiech
pswiech@pantagraph.com
July 28, 2007

BLOOMINGTON — On Thursday, Jamie Powers taught Kade Davis to tie a knot.

Kade is a 6-year-old Bloomington boy who was diagnosed three years ago with moderate to severe autism.

“The smile on his face was miraculous,” said Powers, a 31-year-old behavioral therapist based in Normal. “I knew it was terribly hard for him but I knew he could do it.

“When you are given a diagnosis, you shouldn’t be told that you can’t do well.”

Powers understands. At age 3, she was diagnosed with cerebral palsy. Her parents were told that she wouldn’t be able to walk or ride a bike.

Her determination and mastery of those skills and others helped to prepare her for a career using applied behavior analysis to help children and teenagers with autism, attention-deficit/hyperactivity disorder, cerebral palsy, behavior disorders and developmental delays.

Powers’s spirit and work have not gone unrecognized. Ford Motor Co. has awarded Powers a $35,000 Ford Edge and an additional $10,000 for licensing, fees and taxes as part of the auto maker’s “Edge Across America” promotion with ABC-TV’s “Extreme Makeover: Home Edition” program.

Ford solicited inspirational stories, received 115,000 entries nationwide, and named 50 winners — one in each state, according to information from John Carlson, sales manager with Bob Dennison Ford in Bloomington, and www.edgeacrossamerica.com. Powers was named the Illinois winner and is expected to receive the Edge in mid-August.

“I’m humbled,” Powers said. “I always bought old cars from dad.”

Edgy plans

Powers already has plans for her Edge, a crossover sport utility vehicle. She does her therapy in children’s homes, day care centers and schools, and brings therapy equipment, supplies, toys and books with her. Because they don’t always fit in her 2000 Ford Taurus, she has to make two trips or the children’s parents bring some equipment in their vehicle.

“Now I can fit all my equipment in my SUV,” she said.

Her father, Roy Powers of Naperville, wrote the essay about Jamie that resulted in her winning the recognition.

“She works miracles with these kids,” he said. “Because of her cerebral palsy and what she went through as a child, she identifies more with these kids and they sense it and they identify with her.”

Kade’s mother, Stacy Davis of Bloomington, said “I truly can’t think of someone else who deserves it more. She struggles with her own disability every day, yet she uses her energy to help children.”

Jamie Powers was born prematurely and spent the first three months of her life in an incubator. She was diagnosed with cerebral palsy at age 3.

“My parents always pushed me,” she recalled of her youth in Naperville. “When they were told I’d never be able to talk or hold down a job, they signed me up for speech therapy. When they were told I’d never be able to walk, they bought me a new pair of shoes. When they were told I’d never be able to ride a bike, they bought me a bike.”

She was in physical, occupational and speech therapy. She wore braces on her legs to help straighten them.

“I remember crying because it hurt,” she said of the braces and of therapy sessions. “But the more I did it, the easier it got.”

Transferred to ISU

Powers, who has lived in Normal since 1997 when she transferred to Illinois State University, has spastic cerebral palsy. While it is no longer detectable in her speech, she continues to get physical and occupational therapy from time to time because she has less control of her right side than her left side.

She has trouble typing, writing and throwing with her right hand. Her right foot turns in, meaning she has to think about every step, she has to hold onto handrails going up and down stairs, and she can’t jump.

“I knew early on that I wanted to be a therapist and work with kids with disabilities because I’ve been there,” she said.

Through her business, Power Toolz Inc., she evaluates, develops plans for, and does one-on-one behavioral therapy with special needs children.

The Davis family moved from Lincoln, Neb., to Bloomington in October 2004 so Kade could get Powers’s therapy, Stacy Davis said.

When Powers started with Kade, he wouldn’t sit in a chair, didn’t know how to ask for something, and would have an emotional “melt down” at what other kids would consider minor changes or irritations, his mother recalled. Powers has taught him to sit to do tasks, to take turns, to write his name, how to greet other people, how to ask for something, and how to deal with frustrations and control his emotions, Davis said.

“Jamie has given us and Kade the tools to succeed.”



Five facts about Jamie Powers

1. She was born three months premature in an ambulance on the way to the hospital. “I had a very dramatic entrance into the world,” she said.

2. She weighed 2 pounds 1 ounce at birth and dropped to 1 pound 9 ounces before her recovery began.

3. She has been involved in the Bloomington-Normal Jaycees and chaired for several years the McLean County Can-A-Thon to benefit local food pantries.

4. Earlier this year, she went to Haiti for a week to work at a special needs orphanage.

5. Her mother, Georgie, died suddenly of cancer three years ago. Now, Jamie is helping her father, Roy, in his cancer battle.

SOURCES: Jamie and Roy Powers Read more!

Psych hospital fills need, hospital exec says -Dayton (OH) Daily News

But concerns include whether for-profit facility will deal with the area's many nonpaying customers.

By Kevin Lamb
July 29, 2007

DAYTON — — The psychiatric hospital opening late this year meets a widely acknowledged need and — unlike Dayton's other for-profit hospitals — does so in a specialty that generates relatively low profit.

"That's why we think they'll provide a valuable service to the community," President Bryan Bucklew of the Greater Dayton Area Hospital Association said before adding a concern. The new Psychiatric Institute of Dayton at Elizabeth Place won't be so helpful unless "they help us out with the nonpaying customers as well as the money-makers."

Psychiatric patients often can't pay their bills. Most with serious mental illnesses are uninsured, under-insured or on Medicaid, largely because 90 percent are unemployed, the president's mental health commission reported in 2002.

Even those with insurance don't enrich hospitals nearly as much as heart or surgery patients, the specialties at two other local hospitals.

"Managed care doesn't want to pay for inpatient care," said psychiatry chairman Dr. Jerald Kay of Wright State University's medical school. The result is falling per-day fees for shrinking hospital stays.

"I know we're swimming upstream, for exactly those reasons," said Judy Wortham Wood, who will run the new 35-bed hospital for patients 13 and older. "This is not an easy business anymore."

But Wood's Washington, D.C., employer, United Psychiatric Group, will open its first hospital in 10 years because a 2004 state report said Ohio hospitals closed too many psych beds in response to declining fees.

"We have some great needs again," she said.

Dayton is one, Bucklew said.

"Our emergency rooms are getting a lot more patients with mental health problems," he said.

Lower reimbursements don't reduce the need for mental health treatment, Wood said.

"We know it's an illness treatment can correct," Wood said "and we know one in five will have a mental illness. That means everybody knows someone."

There are plenty of mental health patients to go around, but "the problem is, there's not enough insurance coverage for everybody," said Joseph Szoke, executive director of Montgomery County's Alcohol, Drug Addiction & Mental Health Services (ADAMHS) Board.

"Cherry-picking can still occur," he said, if the new hospital takes more than its share of patients with private insurance. Those subsidize other hospitals' unpaid bills.

Wood's hospital plans to make its profit margin through know-how, she said.

"This is the only business we do. We believe full integrated services make it work," she said.

Ultimately, Szoke said, the hospital's for-profit nature doesn't have to matter "as long as the quality of care is consistent. When people start to cut corners, that's when you have problems. Poor quality is not a bargain at any price." Read more!

Kids housed in units with violent teens -Atlanta Journal-Constitution

Continuing Series: A Hidden Shame: Danger and Death in Georgi'as Mental Hospitals

At two psychiatric hospitals, children live alongside adolescents charged with rape, other predatory behavior.

By Alan Judd, Andy Miller
7/29/07

One patient had been charged with rape and aggravated sodomy.

Another was accused of child molestation and rape.

Yet another who entered Central State Hospital in April faced charges of aggravated assault, rape and aggravated child molestation.

All three were teenagers —- and all three were housed in Central State's adolescent unit, alongside mentally ill children possibly as young as 6.

This volatile mix occurs with regularity at the two adolescent units in Georgia's state psychiatric hospitals, officials say. Along with chronic overcrowding and inadequate staffing, records show, it creates an atmosphere conducive to fighting and sexual assaults.

"There is concern that children who are small in stature and powerless to defend themselves are not safe in state hospitals," wrote regulators with the Department of Human Resources in 2000, after investigating complaints by two adolescent patients who said other teens attacked them at Central State.

Placing teenagers accused of violent crimes amid children with disorders like schizophrenia and autism leaves the younger patients "vulnerable, extremely vulnerable," said Dr. Andrea Bradford, the state hospitals' former medical director.

The state says it is taking steps to separate adolescent patients by age groups. But officials have acknowledged for years that commingling young forensic patients with mentally ill children creates a dangerous situation. For the same reason, the state hospitals almost always segregate adult forensic patients in secure units.

Charges of assaults

Today, a picture of the troubles in the adolescent units emerges from a review of incident reports, internal investigations and other public documents.

In 2001, for example, a 12-year-old boy in the adolescent unit at Georgia Regional Hospital/Atlanta reported that his roommate, an older teenager, had tried to rape him.

At Central State, in Milledgeville, a 15-year-old boy said in 2005 that another adolescent patient had sexually assaulted him. The other patient said the sex was consensual, records show, so state investigators declared the allegation to be unsubstantiated.

Other cases allege beatings and consensual sex between male and female teenagers.

Mentally ill children "may not be able to report [assaults] or defend themselves," Bradford said. Moreover, she said, the hospitals don't have enough workers to monitor the older patients, many of whom are in the institutions to be evaluated for their fitness to stand trial, either as juvenile offenders or as adults.

"Some of it is really inappropriate placements of troubled teenagers who don't have something that can be treated in a hospital setting," Bradford said in an interview. "But there isn't any other place for them, as far as the judge is concerned."

The situation grew especially acute at Central State this spring.

A Superior Court judge ordered the hospital to admit a teenage defendant for pretrial psychiatric evaluation. Like two others already on the adolescent unit, this patient was facing charges for felony sex crimes, including child molestation. Eight other patients had been committed to the unit by juvenile court judges. The unit's other 11 patients were admitted for mental health treatment, not forensic evaluation.

Bruce Callander, Central State's chief of psychiatric treatment and forensic services, asked for relief in an April 11 memo to Bradford, then the medical director supervising all seven state hospitals. In the memo, obtained by The Atlanta Journal-Constitution under Georgia's open records laws, Callander said Central State's adolescent unit was confronting "increasingly difficult challenges."

"Half of our current population is under the jurisdiction of a court," Callander wrote. "Given the physical configuration of our unit, it is difficult if not impossible to separate these populations due to space issues as well as staffing issues. We simply do not have the staff to address the issues of male/female, big/small, passive/ aggressive, etc., much less separate them within the unit."

'A tremendous range'

After adolescent units at two other state hospitals closed earlier this decade, the remaining facilities at Central State and Atlanta began accepting young patients from a broader area. The Atlanta hospital admitted only adolescents between 13 and 17 years old, all from metro Atlanta and other North Georgia counties.

Central State, by contrast, drew 11- to 17-year-old patients from the lower two-thirds of Georgia, plus children as young as 6 from across the state.

In his memo, Callander wrote: "That is a tremendous range when you consider the needs of a 6-year-old who may be autistic compared to a 17-year-old who is charged with rape and associated with a gang. . . . I do not feel comfortable serving both, given the mix of children and adolescents we are currently seeing here."

Officials are beginning to place older adolescents in the Atlanta hospital and younger ones at Central State, said Gwen Skinner, director of the state's mental health division. But the agency has set no firm age limits on either group, and mentally ill children may still live among adolescents accused of crimes.

"Just because you're involved in the court system does not make you not mentally ill," Skinner said in an interview Friday.

When Callander wanted to send the new forensic patient from Central State to the Atlanta hospital, Bradford declined his request. She wrote back to Callander that Atlanta's adolescent unit already had five new patients, that patients were at "a high level of acuity" and that the unit's regular physician was out sick. "The unit is too fragile at this point to take on this adolescent," Bradford wrote.

In the interview last week, Bradford added: "It was not a good situation to bring a forensic patient with that kind of history into."

Callander last week declined through an assistant to comment.

Bradford declined to give a reason for her resignation as medical director for Georgia's mental health division in May.

Both adolescent units have had trouble keeping enough workers to adequately care for patients.

Inadequate staffing levels came into question in the Atlanta hospital's adolescent unit in February 2006, when 14-year-old Sarah Elizabeth Crider died after a night of medical inattention. Crider was one of at least 115 state hospital patients who died under suspicious circumstances from 2002 through 2006, as reported in the Journal-Constitution series, "A Hidden Shame." The newspaper also documented at least 194 cases of patient abuse during the same period.

The U.S. Justice Department is investigating whether conditions in Georgia's state hospitals have violated the civil rights of patients.

At Central State, Callander wrote, attacks on employees in the adolescent unit exacerbated staffing shortages.

One employee had recently suffered bruised ribs and a dislocated thumb, and was kicked in the bladder, Callander wrote. One worker's hair was pulled out. Another sustained a thumb injury. And a nurse, attacked twice, resigned. The same child caused all those injuries, Callander said: a 5-foot, 8-inch, 230-pound girl, 13.

Other states separate

Many other states take a different approach to treating young mentally ill patients and criminal defendants.

Texas and Michigan, for example, have special adolescent forensic units separate from wards that treat young psychiatric patients. Arkansas operates a separate unit for adolescent sex offenders. Indiana and Oregon closed their adolescent psychiatric units altogether; both now treat young patients in community settings rather than state hospitals.

Bradford said she suggested creating a forensic adolescent unit at another hospital, which would have freed space at Central State and Atlanta for mentally ill youths. Skinner said she hopes to divert mentally ill adolescents to other treatment programs.

"We don't necessarily want to serve children on the grounds of state hospitals," she said.

Dealing with diverse groups of children and adolescents challenges psychiatric hospitals to provide the best possible care, said Dr. Nada Stotland, a Chicago psychiatrist and the president-elect of the American Psychiatric Association.

Young forensic patients may require intensive supervision, or could be housed in their own units apart from other patients, Stotland said. Those approaches, she said, would require money for more hospital workers.

But, she said: "You have an absolute obligation to protect the other kids."

Read more!

Autistic children wait for help - Milwaukee (WI) Journal Sentinel

Getting into Medicaid program takes a year; families struggle to afford therapies

July 29, 2007

In the debate over early intervention therapy for Wisconsin's growing population of children diagnosed with autism -- and who should pay for it -- one thing is clear: Hundreds of children with autism aren't getting the therapeutic aid many medical experts say represents their best hope of attaining a normal life.

Although there is no known cure for autism spectrum disorders, or developmental disorders characterized by impairments of social functioning and both verbal and non-verbal communication, studies show that some children with autism are able to achieve near-normal functioning through a rigorous combination of speech, occupational and physical therapies.

But these therapies are expensive, and the waiting list for the state's popular Medicaid waiver program, which covers intensive therapy for autistic children, is up to 1 1/2 years and counting. So some desperate parents are spending thousands of dollars.


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Racine resident Hasmig Tempesta said she and her husband have spent close to $20,000 on speech and occupational therapy for their son Zach, who was diagnosed with autism when he was 2 years old.

When Zach stopped responding to his own name, the Tempestas took out a second mortgage on their home to help pay for the therapy. They waited for more than a year to receive the waiver benefit.

"It was crazy expensive," Tempesta said.

According to the latest estimates, early intervention costs an average of $40,000 a year for one child, and some providers say center-based therapy can cost significantly more.

The Department of Health and Family Services, citing a state budget deficit of $1.5 billion, said the state would lean on private insurance companies to continue funding the Medicaid children's waiver program.

"The number of children continues to rise," said Karen Timberlake, chairwoman of the 2004 Governor's Task Force on Autism. "The state can't do this all by itself."

Health and Family Services has proposed $83.4 million for intensive therapy for autistic children for the 2007-'09 biennium, a $7 million increase from the previous biennium. But the plan allows only 200 new children to enter the program each year -- 50 fewer a year than originally planned when the program began in 2004.

What this means for the nearly 300 children who have already been waiting as long as 1 1/2 years to be seen by a therapist, some providers say, is that they might have to wait even longer.

Health and Family Services said it expects 250 children a year will make the transition out of intensive therapy, making room for new children, but Glen Sallows, who runs the Wisconsin Early Autism Project in Madison, said he expected the waiting period to increase to about two years.

"If there were plenty of slots open, why would people be waiting so long?" Sallows said.

With more Wisconsin children being diagnosed with autism, many, including state health officials, agree that the current turnover rate is not nearly enough to keep up with demand. The waiver program provides early intensive therapy to 1,745 autistic children. According to Health and Family Services, about 2,070 children will be in the program by 2009.

Maureen Durkin, a University of Wisconsin-Madison epidemiologist, said the health care system isn't meeting the needs of children with autism.

Families are "definitely in a bind," said Durkin, who led a Wisconsin study on autism prevalence that was part of a national study by the Centers for Disease Control and Prevention.

The Medicaid waiver benefit subsidizes 20 to 35 hours a week of intensive in-home therapy for up to three years, for children younger than 8. But these hours also include travel, supervision and team meetings, which parents say leaves less time for one-on-one therapy.

Furthermore, the only kind of intervention that has proved effective in controlled studies is early, intensive therapy for 40 hours a week, Durkin said.

Sessions with a behavioral therapist are typically two or three hours long, during which the child is asked to complete small tasks such as doing a simple puzzle. Through repetition and praise, the child learns social, motor and language skills. Children receive five to eight hours of one-on-one instruction a day.

A study of 24 autistic children from the Madison-based Wisconsin Early Autism Project in 2005 found that after four years of intensive therapy for 30 to 40 hours a week, the children's IQ increased an average of 25 points. Moreover, nearly half the children achieved average intelligence, according to the study's authors in the American Journal on Mental Retardation.

Early intervention is crucial because by the time children turn 6, their development is 90% complete, Durkin said.

Health and Family Services said families on the waiver list can get Medicaid coverage for some therapy and medical services, but many devoted parents have resorted to making out-of-pocket payments, digging into their savings to provide their children with the chance of getting better.

Sonja Bingen of Burlington said her family was "in a panic zone" when her son Joey was diagnosed with autism at age 3. Bingen said she knew something was wrong with Joey when he stopped talking and wouldn't make eye contact. Bingen doesn't know when her son -- who turns 5 in September -- will receive the Medicaid waiver benefit, but they have been waiting for almost a year. She and her husband have paid about $30,000 out of pocket for behavioral therapy since last August.

"To see those years going by and have no one care . . . it's horrible," Bingen said.

Tempesta said that her son Zach, now 3, has been receiving intensive therapy for three months and has already improved by leaps and bounds.

"He can roll a ball back and forth and stack blocks end to end. Before, he would just knock the blocks on the floor and run away," Tempesta said. "When you think of autistic kids, (you think of them) slamming their heads against the wall or screaming. But my kid was just a happy kid that was lost."

To see more of the Milwaukee Journal Sentinel, or to subscribe to the newspaper, go to http://www.jsonline.com.

Copyright (c) 2007, Milwaukee Journal Sentinel
Distributed by McClatchy-Tribune Information Services.
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Campus Life: After 24 Years, Psychologist Departs -The Emory University Wheel

by Leisha Chi Posted:

For the past 24 years, Charles Lawe has helped hundreds of people transform their lives through his work with the Emory Counseling Center.

But now, five years after being diagnosed with multiple myeloma, a rare form of cancer that attacks plasma cells in bone marrow, Lawe is retiring to deal with his own stress from his battle with a deadly illness.

Lawe, associate director of the Emory Counseling Center and adjunct professor of psychology, has been fighting off the side effects of his treatment drugs and plans to spend more time with his family.

Since his arrival in 1983, Lawe has worked extensively on issues of depression, anxiety and stress management. In recognition of his service to the University, the Office of Campus Life named Lawe last year's recipient of the Helen W. Jenkins Lifetime Achievement Award.

Lawe says fulfilling human potential is one of the underlying philosophies in his approach to helping patients.

"I believe that psychology and the work that we do is more than just re-mediating symptoms but to grow and expand your potential and capacity, to become more mindful of themselves," he said. "What is really important is what touches the heart. This is the value that I try to live by."

Lawe said he would miss the close-knit community connections he formed over the years more than anything else at Emory.

His work was especially rich and rewarding because of his ability to work with students at key times in their lives, he said.

"The gratification we receive is in the depth of the relationships we have with people,," he said. "Not to sound hokey or anything, but that is a very profound experience. Those relationships are very special."

Downplaying suggestions of selflessness, Lawe said his work with the Counseling Center has been an outlet through which he can better deal with his condition, which renders him "almost comatose" on some days.

"I have seen some people that just fade and go into themselves and get depressed," he said. "I fail to see how that is helpful, and for me, coming to work and helping others helps me too. It shows that I have some value, which feels good."

Lawe remains optimistic that research will ultimately deliver a cure for the disease, and stressed that it was important for him not to view himself as a victim in the meantime.

"Cancer is not about me. I'm just one person with it," he said.

In lieu of throwing a traditional retirement party, Lawe has requested that colleagues make donations to the Winship Cancer Institute in support of multiple myeloma research.

Teddy Weinberger ('87GSAS, '90PhD) used to see Lawe for therapeutic counseling while he was a doctoral student. He praised Lawe's style as one that transcended typical doctor-patient relationships.

In a letter nominating Lawe for the Lifetime Achievement Award, Weinberger wrote: "Chuck never pretended to have all the answers nor did he present himself as a human being without struggles. He allowed me to ask him personal questions and they revealed a human being who deals honestly with his own issues. It was up to me, in part through my work with Chuck, to deal with my own."

Lawe said therapeutic work in reaching out to troubled individuals is especially important now, in light of the Virginia Tech tragedy. He emphasized that it is important to foster an atmosphere of openness by providing a place of confidence, where people can "let down their defenses to be who they really are."

He also said that there is a need to de-stigmatize counseling and mental illness.

"There is no shame in needing help when you are struggling and that you acknowledge that it's a strength to seek help," he said.

Even though it has been more than 15 years since he graduated, Weinberger said he still makes an effort to keep in touch with Lawe.

"Chuck has had a powerful and long-lasting influence on my life ... In a way, I divide my life into BC and AC: Before Chuck and After Chuck," he wrote in his letter.

Mark McLeod, director of the Counselling Center, has worked closely with Lawe for the past two decades and said he will be missed.

"He is an incredibly bright man, wonderful sense of humor, can be pretty intense. I have really come to admire the courage and dignity and humor that he brings to fighting his current illness," McLeod said.

- Contact Leisha Chi at

pchi@emorywheel.com
Read more!

Camps gone, units empty - Tacoma (WA) News Tribune

Tacoma program for homeless called inefficient

JASON HAGEY; The News Tribune

Nearly a year into Tacoma’s experimental attempt to rid the city of homeless camps, officials have found success – and a curious problem: fewer homeless campers than they expected, and more money than they needed to find them all apartments.

Last year ago at this time, dozens of camps littered the city’s brush-covered hillsides and the spaces beneath freeway overpasses. Today, they are virtually gone, said John Briehl, director of Tacoma’s Human Rights and Human Services Department. When a new camp is found, police and public works employees quickly remove it, he said.

One fear – that Tacoma’s strategy to put campers into subsidized apartments would attract the homeless from other cities – hasn’t been realized. Another concern – that there wouldn’t be enough money to move all of the homeless from camps into apartments – hasn’t proved to be the case, either.

In fact, there are far fewer people in apartments today than anyone expected, leaving the city’s social service partners with at least 15 empty units that can’t be used for anyone else. Just 39 people were in the program as of last week, Briehl said. Tacoma budgeted $1.1 million for the first year, an amount that was expected to house up to 100 of the estimated 250 to 300 people thought to be living in the camps.

Tacoma’s plan employed a strategy known as Housing First, a relatively new approach to homelessness that’s being used in cities throughout the country. Rather than focus first on problems that often lead to homelessness, such as drug and alcohol addiction or mental illness, the Housing First model places people in an apartment first and then attempts to address any underlying issues.

NARROW FOCUS

The Tacoma Rescue Mission intends to pull out of its partnership with the city when its contract expires next month, mainly due to frustration over the narrow focus and empty apartments. Executive director David Curry said the program is doing good for those people who are in it, but he doesn’t believe it’s an efficient use of public funds. At the start of the effort, the mission rented 15 apartments – half of what it expected to eventually need – using money provided by the city.

“We never had enough people to fill them,” said Curry, who is running for Tacoma City Council.

The rent on apartment units varies, but generally runs about $500 a month for the Rescue Mission, Curry said.

It’s not that there aren’t enough homeless people in Tacoma to fill the units, Curry said. There just weren’t enough people who met the criteria: homeless and living in a camp, and without a major criminal record.

Curry pressed city officials to let him place other people in the paid-for apartments, if only temporarily, but officials were slow to respond. He finally concluded the program wasn’t a good fit for his agency.

“This was a good effort, it just needs to be more efficient,” Curry said.

Briehl emphasized that the program is a trial effort, and the goal was purposely limited to homeless camps. It will be up to the City Council to decide whether to expand it to other homeless populations, he said.

“We’re kind of at a crossroads now,” Briehl said.

Another city partner, Greater Lakes Mental Healthcare, also encountered struggles and considered pulling out, but decided to continue with a slightly revised strategy. Officials intend to conduct a more detailed assessment of potential clients, paying particular attention to criminal records, drug and alcohol involvement, and mental illness, said Jim Kuether, clinical manager. The agency encountered more criminal drug behavior than it expected, Kuether said. Conversely, it didn’t receive enough people with mental health challenges, clients the agency is equipped to address.

Greater Lakes provides case management for six people from Tacoma camps, down from a peak of 17, Kuether said. Four people left voluntarily, and the rest of have been evicted or asked to leave, he said. The agency currently has seven empty apartments.

Officials expect the number of people to grow soon if the city expands the program. The six current clients are doing well, Kuether said.

“We certainly don’t see it as a failure,” he said. “Overall I’m feeling good.”

The Metropolitan Development Council is the most enthusiastic partner. The agency’s staff is currently providing case management for 22 people living in 20 rentals.

“I think we’ve had a great year,” said Rose Stidham, vice president of development.

FEWER CAMPERS

Last fall, outreach workers went through all of the homeless camps identified by police and public works employees in Tacoma and informed the people they found that camping would no longer be permitted. Campers could accept the city’s offer of housing, move on to another place or face arrest for trespassing.

A few more than 70 people were referred for housing, and 17 were denied, most because of a criminal record. Although a record wouldn’t automatically disqualify someone, the private landlords working with the city and its partners rejected those with the worst offenses. A total of 56 people were initially housed and assigned to a caseworker from one of the city’s social service agency partners.

Since then, 18 people have been evicted or have left the program. The program never came close to running out of room or money.

It’s not clear why officials encountered fewer people in the camps than they expected. As word spread of Tacoma’s planned crackdown, some people probably left the city, social service workers said. The city’s original estimate of as many as 300 probably was a little high, as well, they said. The higher number came from the police; outreach workers estimated there were about 100 or so people in the camps, said the Metropolitan Development Council’s Stidham.

After the initial sweep, the housing offer was taken off the table. Anyone found camping now is told to move on or referred to a shelter.

“We’ve basically declared the camps closed,” Briehl said.

As a result, the number of homeless people living on the streets might be higher, Briehl said, though that’s not confirmed. An evaluation of the program’s effectiveness being conducted by the University of Puget Sound is expected by late next month, he said. After that, it will be up to the City Council to decide whether to expand the city’s Housing First model to other homeless populations, Briehl said.

Councilman Tom Stenger is highly critical of the effort, which he claims isn’t about helping people so much as cleaning up real estate.

“If you call it Cleaning Empty Lots First, it’s successful,” Stenger said, “The program isn’t what was sold to us.”

Other council members are more positive. Councilman Mike Lonergan, the former director of the Tacoma Rescue Mission, agrees with Stenger that it’s primarily about cleaning up camps, but he doesn’t view that as a bad thing. He said people seem to be amazed at how well Tacoma’s crackdowns on homeless camps and panhandling have worked.

Councilwoman Julie Anderson said it’s obvious the effort has cleaned up Tacoma’s physical landscape. She’s hoping the UPS evaluation will show whether the case management has been effective. She suspects that it has been and said she favors expanding the effort.

“It’s been a great experiment,” Anderson said.

Jason Hagey: 253-597-8542

jason.hagey@thenewstribune.com Read more!

Jumper's father questions Taser use in death - Spokane (WA) Review

Jonathan Brunt
July 28, 2007

The father of the man who jumped from the Monroe Street Bridge is questioning the Spokane Police Department’s use of a Taser on his son seconds before he fell to his death.

The 28-year-old man was discovered sitting on the railing of the bridge Thursday evening and remained there for 20 hours as police negotiated with him to come down. His father, Dave Breidenbach, identified him as his son, Josh Levy.

Spokane Police Chief Anne Kirkpatrick said in a news conference after he jumped that the Taser was used in an attempt to take Levy to the ground when negotiators successfully got Levy to come off the ledge.


But only one probe of the Taser made contact with Levy, Kirkpatrick said, and he got back on the railing, jumped and died after landing on rocks below.

“I was assured all day that no violence would be taken toward my son,” Breidenbach said. “I don’t believe that firing a Taser at a nonviolent potential suicide victim is a tactical maneuver.”

At the press conference, Kirkpatrick said police successfully got him to come down from the railing after negotiating a way for him to “save face.”

“One of the successful options that we give people in distress is, ‘You make it look like we took you into custody,’ and that was exactly what we were doing in talking with him,” Kirkpatrick said. “Our tactical plan was to apply one application of the Taser to bring him to the ground so we could get him in that custody.”

Breidenbach said Saturday that in the past seven years his son had dealt with severe depression and had been diagnosed with paranoid schizophrenia and bipolar disorder. Earlier in the week, Breidenbach had picked up his son from Western State Hospital and brought him to stay with him in Spokane. Levy grew up in Spokane and later, Bainbridge Island, where Levy’s mother still lives.

Levy had attempted suicide before and jumped from three bridges in Western Washington without suffering significant injuries, Breidenbach said. Levy also had been talked down on other occasions from Western Washington bridges.

Marilyn Wilson, Spokane Mental Health’s clinical services director, said one or two staff members of the agency were on the scene for a short time Friday morning to consult police.

She said she didn’t know enough about the specifics of the case to assess what happened. “It’s a very difficult situation that nobody can ever predict,” she said. “Everybody does the best they can do in a situation like this.”

Abe Ferris, who leads a support group with the Depression and Bipolar Support Alliance, questioned why a Taser would be used on a nonviolent person in a suicidal state.

“Why would you agitate them more?” Ferris asked.

Spokane County sheriff’s negotiators came to the scene a few hours before Levy jumped. Sheriff Ozzie Knezovich said the Spokane Police Department next week will lead a debriefing session on the incident, which he will attend. He said the Police Department retained command at the scene.

“Until I get all the information I would be just shooting from the hip,” Knezovich said.

Mayor Dennis Hession, who was at the scene Friday, said Saturday he was quickly briefed on the incident by the chief.

Kirkpatrick is “giving some time for the officers involved to settle in and recover from the stress and the emotion of this event, and I’m doing the same thing with the chief,” Hession said.

“The officers invested their hearts, their souls into helping him,” Kirkpatrick said at Friday’s news conference. “So for them to see that occur is truly devastating to them as well.”

Breidenbach compared the event to last year’s death of Otto Zehm, a janitor who suffered from mental illness and died after he was falsely accused of a crime and Tasered and hogtied by police.

“We’re going to give substantial time and effort to see that this never happens again to another person who is non-confrontational and non-aggressive,” Breidenbach said. “I just want this not to happen again.”

Elida S. Perez contributed to this report.

Jonathan Brunt can be reached at jonathanb@spokesman.com or (509) 459-5442. Read more!

A blogging we shall go

Still looking for volunteers to help keep this news blog updated. Fun, exciting, work at home, no pay, just gratitude. Email: david@ncmentalhope.org if interested. Read more!

Report:Mental health patients straining rural hospitals - AP

CONCORD, N.H. --As funding for community-based mental health services declines in the state, more people are turning to hospital emergency rooms in rural areas, a new report finds. And the hospitals are saying they are not always able to provide the care.

The report from the Foundation for Healthy Communities says emergency room visits from patients whose primary problem was psychiatric rose by 15 percent between 2003 and 2005.

"If you don't have a doctor's office or a clinic to call and you're having a crisis, then the place you turn is the emergency room," said Shawn LaFrance, the foundation's executive director and the author of the report.

But rural hospital emergency rooms are ill-equipped to care for patients with severe psychiatric emergencies, hospital administrators said, with no psychiatrists on staff and no have safe or secure facilities for patients who may be a danger to themselves or others.

The hospitals rely on local mental health providers to assess the patients. If their problems require inpatient care, patients are transferred to larger hospitals in the southern part of the state.

The report found appropriate hospital beds often are hard to find for uninsured patients, the sickest patients often are released from the state mental hospital without referral to local services and small hospitals often are forced to provide less-than-ideal care because of limited facilities.

"We're not designed to deal with mental health emergencies; we're designed to care for medical care emergencies," Louise McCleery, the CEO of Upper Connecticut Valley Hospital in Colebrook, the state's smallest hospital, told the Concord Monitor.

McCleery said she's been frustrated by her hospital's inability to care for psychiatrically ill patients and with the difficulties her staff has encountered in transferring patients to more suitable settings.

"I live that report," she said.

The report found that about 25 percent of psychiatric emergency room visits last year were for repeat patients. That number suggests that those patients aren't getting adequate outpatient care, experts said.

Louis Josephson, CEO of Riverbend Community Mental Health in Merrimack County, said in his county, patients using the emergency rooms tend to be people who are not receiving ongoing care, often uninsured patients who can't afford treatment.

"They end up in emergency rooms, which is the most expensive place to care for someone and has the least adequate care," he said.

Rural areas in New Hampshire, particularly the North Country, have special challenges posed by low population density and poverty. Few mental health workers choose to practice there, said Dr. Jonathan Burroughs, the medical director of the emergency department at Memorial Hospital in North Conway.

As a result, most mental health care is provided by community mental health centers, private nonprofit groups such as Riverbend that have contracts with the state. Josephson and others said that the centers could provide more comprehensive care if they received more state money for treating uninsured and underinsured patients.

In the North Country, one community health center serves seven hospitals spread throughout three counties. Most nights, according to McCleery, the center has only one psychiatrist on call, which creates delays when multiple hospitals have psychiatric emergencies.

The North Country has also suffered the loss of its secure inpatient facility. Androscoggin Valley Hospital in Berlin, which used to provide beds for patients in need of commitment, closed its unit this month.

------

Information from: Concord Monitor, http://www.cmonitor.com Read more!

A good reason to invest in community mental health care-Sarasota Herald-Tribune

Guest Opinion:

By Gary Bembry

On May 22, Department of Corrections Secretary James McDonough announced a subtle, but significant, change to the agency's mission statement. Normally, such a change would not be compelling, but to those concerned with the safety of our communities and the well-being of its citizens, it is indeed a noteworthy shift.

The revision, according to McDonough, places a "renewed emphasis on the preparation of inmates for re-entry into society as part of our mission. This is an anti-crime measure of the utmost importance to our state."

We commend the secretary's vision, understanding of the problem and commitment to address the issue of offender re-entry. But this is not a battle he -- or any one person -- can win on his own. He will need the help of the Legislature, other state agencies and Florida's communities. Here's why.

Too many ex-offenders leave prison unprepared for life on the outside and eventually return. In fact, in April there were nearly 92,000 inmates in Florida's prisons, and more than 44 percent of them had been in prison before.

The issue of recidivism is especially troublesome for those incarcerated with a mental illness. It is estimated that 20 percent of the prison population has a serious mental illness and that nearly three-fourths of inmates with a mental illness have a co-occurring substance-abuse disorder. Mentally ill offenders also have a higher-than-average rate of recidivism, cycling in and out of criminal justice and corrections settings with alarming regularity.

It is easy to see why this is such a problem. In prison, those with mental illness often experience declining physical and mental health, which makes a life of homelessness, poverty and a pattern of recurring crime, arrest and re-incarceration all the more likely.

So what happens to them? The sad truth is that unless they are arrested again, we often have no idea. We do know, however, that we are setting them up to return, because those with a mental illness are the most poorly equipped to succeed in re-entry to society.

As McDonough moves forward with his progressive plans, we hope that he focuses on issues such as having transitional housing for ex-offenders with a mental illness when they are released. If we don't, then we are placing them directly into homelessness, for which they can be sent back to jail. If we are trying to avoid seeing repeat offenders, this is an odd way to go about it.

Those with a known mental illness also should be connected to local mental health and substance abuse counseling services before they are released. We need to maintain some sort of tracking that may include a period of parole and a way to know if they are treated in an emergency room or have an encounter with police. We need to work directly with law enforcement to explore additional means of intervention that can resolve issues in ways other than re-incarceration.

Establishing this tracking system is crucial, as the highest risk of recidivism of mentally ill ex-offenders is in the first six months after release from prison. Those who do not receive adequate discharge planning or a continuity of treatment and needed supports upon release are at a particular disadvantage during this critical readjustment period.

In addition to being a public safety issue, our lack of success in keeping ex-offenders from re-entering the corrections system costs Florida taxpayers millions each year. With 20 percent of the ex-offenders released every year having a significant mental illness, we are paying $120 million annually for their re-entry into the prison system.

That is more than our state spends on all children's mental health services in a year.

Investing in community-based mental health programs that can provide transitional centers and support staff is the key to tracking, counseling and guiding ex-offenders with mental illness toward safe and healthy actions and away from our prison gates.

It's what is best for them and our communities, and we applaud Secretary McDonough for taking the first steps to address this complicated issue. Now it is up to all of us to ensure that he is successful and that some of our most vulnerable citizens have a fighting chance to succeed.

Gary Bembry is chairman of the Florida Council for Community Mental Health and CEO of the Lakeview Center in Pensacola. Phone: (850) 469-3702

E-mail: gbembry@bhcpns.org Read more!

Shortage of beds for mentally ill is a crisis -Columbus (OH) Dispatch

Letter to editor:

I am writing to express my appreciation and acknowledge the importance of the July 15 article by Dispatch Medical Reporter Misti Crane regarding the shortage of local psychiatric-hospital beds, "Shortage of beds getting worse." I applaud Crane's attention to this problem, which demands our collective attention.

Crane's article clearly documents the significant erosion of public and private inpatient psychiatric-treatment capacity and highlights the troubling problem people in central Ohio face when accessing inpatient psychiatric treatment. One in four people is affected by a mental illness or addiction at some point, making the concerns regarding access to care a key indicator of health and wellness. Regardless of someone's age, race, gender or socioeconomic status, anyone may be affected. As the article mentioned, access to inpatient psychiatric treatment is not only a challenge in central Ohio but also nationally. And there are no simple solutions.

When central Ohio experiences peaks in demand for inpatient services, there are not always an adequate number of beds to immediately meet the need. Hospital emergency rooms and Netcare, ADAMH's 24/7 crisis center, bear the burden of providing interim care until a bed becomes available. These inpatient psychiatric-treatment issues affect our system's ability to meet the urgent needs of those suffering from a mental illness.

ADAMH, the Alcohol, Drug and Mental Health Board of Franklin County, which funds, evaluates and plans for the necessary publicly financed mental-health and substance-abuse services in our community, recognizes the urgency of this issue locally. Through local partnerships with community-based providers, our community mental-health system is building recovery support so that Franklin County residents can receive treatment and go on to lead healthy, productive lives. As the largest purchaser of publicly supported inpatient psychiatric treatment in central Ohio on behalf of Franklin County residents, we are committed to working with the Ohio Department of Mental Health and private hospitals in supporting both short- and long-term solutions to this issue.

We know that work needs to be done and stand ready to work with the leaders of both public and private hospitals to address the shortage of inpatient psychiatric beds.

THOMAS J. BONASERA
Board chairman
ADAMH Board of Franklin County


Columbus Read more!

Father found guilty but mentally ill in son's death - AP

CARTHAGE, IL (AP) - A Hancock County judge has found a Plymouth man guilty but mentally ill after he gave his 10-year-old son a fatal mix of soda and pain killers.

Martin Laskowski, 48, is scheduled to be sentenced Sept. 25 for the November 2004 death of his son Scott.

"I have waited two years and eight months for this day, and now when I go to visit him at his grave site I can say to him, 'Justice is going to be served,"' said Chriss Bossey, the boy's mother and Laskowski's ex-wife who now lives in Florida.

Judge David Stoverink's guilty-but-mentally ill ruling Thursday after a six-day bench trial means Laskowski will be evaluated by the state Department of Human Services, then sent to a mental health facility or prison.

He faces up to 60 years in prison but credit for time served means he likely will serve far less time.

In a videotaped statement that aired during a 2006 court hearing, Laskowski said he mixed the painkiller oxycodone and other pills in a glass of soda. He said he didn't want to give his son the lethal cocktail, but his son insisted.

"He (Scott) kept saying, 'I want to die, Dad. I want to die,"' Laskowski said on the video. "I didn't want my son to think his dad was a liar."

Bossey, who left Plymouth in July 2004, said she always expected Laskowski would be convicted.

"I never doubted he would be found guilty," she said. "I knew from the beginning that Scotty would never have done what this man stated he did on his own."

Authorities said they found the fourth-grader dead on a bed next to his father after he had been absent from school for a few days. Martin Laskowski was found with a knife stuck in his abdomen.

Defense attorney Sam Naylor argued Laskowski was mentally ill when he killed his son, but the judge said Naylor "did not show clear and convincing evidence" that Laskowski was insane.

Information from: The Quincy Herald-Whig, http://www.whig.com Read more!

Pot use linked to risk of psychosis- AP

BY MARIA CHENG
07/27/2007

LONDON - Using marijuana seems to increase the risk of becoming psychotic, researchers report in an analysis of past research that reignites the issue of whether pot is dangerous.

The new review suggests even infrequent use could raise the small but real risk of this serious mental illness by 40 percent.

Doctors long have suspected a connection and say the latest findings underline the need to highlight marijuana's long-term risks. The research, paid for by the British Health Department, is published today in the medical journal the Lancet.

"The available evidence suggests cannabis is not as harmless as many people think," said Dr. Stanley Zammit, one of the study's authors and a lecturer in the department of psychological medicine at Cardiff University.

The researchers said they couldn't prove that marijuana use itself increases the risk of psychosis, a category of several disorders, with schizophrenia being the most commonly known.

There could be something else about marijuana users, "like their tendency to use other drugs or certain personality traits, that could be causing the psychoses," Zammit said.

Marijuana is the most frequently used illegal substance in many countries, including the United Kingdom and the United States. About 20 percent of young adults report using it at least once a week, according to government statistics.

Zammit and colleagues from the University of Bristol, Imperial College and Cambridge University examined 35
studies that tracked tens of thousands of people for periods ranging from one year to 27 years to examine marijuana's mental health effects.

They looked for psychotic illnesses as well as cognitive disorders, including delusions and hallucinations, bipolar disorder, depression, anxiety, neuroses and suicidal tendencies.

They found that people who used marijuana had roughly a 40 percent higher chance of developing psychotic disorders later in life. The overall risk remains very low.

The scientists found a more disturbing outlook for "heavy users" of pot, those who used it daily or weekly: Their risk for psychosis jumped to a range of 50 percent to 200 percent. Read more!

Tilt test spots early Asperger's - BBC News

Parents can check whether their baby is likely to have a form of autism by doing a simple test of head movement, say US scientists.

Babies with Asperger's kept their head straight when their body was tilted, the University of Florida team found.

Doing the tilting test in all infants at the age of six months could catch more cases early, they say.

The findings appear in Proceedings of the National Academy of Sciences.

Asperger's syndrome is a form of autism, a condition that affects the way a person communicates and relates to others.

However, people with Asperger's syndrome usually have fewer problems with language than those with autism.

This means the condition often goes undiagnosed for some time.

Autism is usually diagnosed by the time the child is three years old, whereas Asperger's may not be diagnosed until the child is six or seven.

Previously, Dr Osnat Teitelbaum and colleagues found infants who were later diagnosed with autism had shown a host of abnormal movement patterns at an early age.

They set out to see if the same might be true in children with Asperger's syndrome.

They looked at videos of 16 babies and toddlers who had later been diagnosed as having Asperger's.

The infants displayed movement abnormalities comparable to those previously seen in the autistic children.

The infants with Asperger's showed some reflex movements that should have disappeared by their age of development and others that failed to appear.

Movement milestones

These included abnormal facial expressions, falling to one side while walking and failing to keep their head in line with the body when tilted.

Although not all of the abnormal movements were present in each of the infants, the researchers believe the tilting test would be a good way to screen for Asperger's syndrome and autism.

They said: "The tilting test should be routinely performed on all infants beginning at six months, particularly if there is a history of autism or Asperger's syndrome in the family.

"This simple, non-invasive test takes 20-30 seconds and can be performed by the infant's paediatrician or parents," they said.

An abnormal result would mean the child would need more testing for the possibility of Asperger's syndrome or other autistic spectrum disorders, they said.

The National Autistic Society welcomed the research.

A spokewoman said: "The earlier a diagnosis is made, the better the chances are of a person receiving appropriate help and support.

"There is evidence to suggest that intensive early intervention can result in a positive outcome for some children."

Read more!

Easley signs mental health bill - Raleigh News & Observer

From Staff Reports
July 27, 2007

Gov. Mike Easley signed a bill that requires insurance companies to cover mental illness in the same way as physical illness, his office announced today.

House Bill 973 will become effect July 1, 2008.

Health insurance policies can have different co-payment for mental and physical illness. The legislation requires parity with physical illnesses be extended to mental health conditions inclding: bipolar disorder, major depressive disorder, anorexia nervosa, bulimia, schizophrenia, paranoia and post-traumatic stress disorder.

"This legislation ends what has effectively been a form of discrimination in the health insurance coverage of those with mental illness," Easley said in a statement. "Requiring insurers to provide the same coverage for co-payments, doctors visits and hospitalization means patients will be treated fairly, whether being seen for physical or mental illness." Read more!

Bush's last chance to fix the VA - Chicago Tribune

Editorial:

Veterans Affairs Secretary James Nicholson is leaving his job, and his successor will face a breathtaking array of problems. The department has a backlog of 400,000 pending disability claims. Revelations of shoddy treatment at Walter Reed Army Medical Center, which is run by the Defense Department, brought new attention to complaints about treatment at the 1,400 clinics and hospitals run by Veterans Affairs.

Nicholson is a Vietnam veteran, but veterans groups questioned whether he represented their interests. He was reluctant to call for emergency funds to assist soldiers wounded in Iraq and Afghanistan, until a $1 billion shortfall in 2005 moved him to plead for more money. He underestimated how many servicemen and servicewomen would return from those conflicts with mental health issues.

Despite all the problems, the department announced in May that top executives in Veterans Affairs would receive $3.8 million in bonuses.

Nicholson appeared to be catching up when he promised on July 17 to add mental health testing for all combat veterans and mental health services at more than 200 medical centers. But two days later, he announced his resignation, throwing uncertainty over his promised changes.

The problems at the VA predate Nicholson. For that matter, they predate the Bush administration.

In 1999, former VA Secretary Ed Derwinski succinctly summed up what was plaguing the department.

"A dramatic decrease in the number of veterans; an obsolete, under-utilized hospital system that has been slow to adjust to modern medicine and its emphasis on outpatient care; and population shifts that have moved many veterans to locations far removed from hospitals built after World War I and World War II," Derwinski said.

The next secretary will have the benefit of the clear-eyed work of a presidential commission headed by Bob Dole and Donna Shalala. The commission briefed President Bush this week on its recommendations for overhauling veterans' health care and disability benefits. Bush has a game plan to consider. Now he needs a hands-on leader to carry it out.

Copyright © 2007, Chicago Tribune Read more!

Mental patient confused by plea - Williamsburgh (VA) Virgina Gazette

By Amanda Kerr

JAMES CITY -- A guilty plea by a mental patient on charges of attempted rape and abduction was rejected in a rare action by Circuit Judge Samuel Powell III over concerns the man didn't understand the deal. The central issue is competency.

Vincent Rondell Peoples is charged with the rape and abduction of an Eastern State nurse last September while he was committed at the hospital. He was arrested in December and indicted by a grand jury in May.

His attorney, George Pearson, told Powell on Thursday that his client had undergone a psychological evaluation in General District Court and was deemed competent to stand trial.

But during the hearing, Peoples appeared disoriented and most of his responses were mumbled and inaudible.

When the judge asked Peoples if he had discussed the nature of his charges with his attorney, he said no. But when asked the same question several more times he said yes.

Peoples also appeared to have difficulty understanding the charges against him. When asked if he was guilty of abduction and attempted rape, he said he wasn't guilty of abduction.

Powell repeatedly explained that the legal definition of someone who is guilty of abduction is "any person who, by force, intimidation or deception, and without legal justification or excuse, seizes, takes, transports, detains or secretes the person of another."

It wasn't clear if Peoples understood.

After a series of unsuccessful questions and answers between Powell and Peoples, the judge said he couldn't accept the plea agreement.

"I don't think he can make a plea freely, knowingly and voluntarily," he said.

Powell ordered that the case go to trial instead. In a moment of clarity, Peoples chose to be tried by a judge without a jury. Pearson indicated he will file for a second competency evaluation.
Read more!

Help for mental illnesses -Charlotte Observer

DAVID INGRAM

Those who suffer from mental illness could see better coverage from health insurers under a new law described as a landmark for the mentally ill in North Carolina.

The law will require insurance companies to cover mental illnesses at least as favorably as they cover physical illnesses. It will apply to plans issued or renewed on or after July 1, 2008.

Rep. Martha Alexander, a Charlotte Democrat, championed the idea for more than a decade in the General Assembly. Before this year, it had never gotten out of committee. Gov. Mike Easley signed it into law Friday with Alexander at his side.

"For too many years, we have been unfair to those with mental illness," Alexander said in a statement, "and now these patients will be treated on par with other patients and not discriminated against."

Senators voted 36-12 for the bill July 3. Final legislative approval came nine days later with a 111-2 House vote.

The law would cover such mental illnesses as bipolar disorder, obsessive compulsive disorder and schizophrenia. Plans would have to provide 30 combined inpatient and outpatient days per year and 30 office visits per year.

Health insurance companies had resisted the legislation for years, citing the potential for increased costs to them and to premium payers. Read more!

Deputies seek help dealing with county'smental patients - Curry Coastal Pilot, Brookings (OR)

By Valliant Corley

GOLD BEACH – Curry County deputies are being stretched to the limit with only six available to patrol and investigate crimes. Now, the sheriff's department is pleading with the Health and Human Services Department for help in transporting mental patients from hospitals to court and back.

"People need to understand other requirements and issues we have at the sheriff's office," County Commissioner Marlyn Schafer said Friday. "We aren't even through the first month of the new budget and people are very stressed. We will do our very best but I think most people won't think we are."

She shared the request from the sheriff's department to Human Services.

"We used to have 14 people in patrol. We now have six. Our people are already working overtime," Capt. Dennis Dinsmore said in an e-mail to human services managers Terry Bell, David White and Janet Masters.

The memo continued, "Our concern is, when do we see the attendant physical and mental problems caused by overwork, (and we lose) them due to illness?"

He said that even the jail staff is unwilling to take the overtime.

"A transport like this necessitates 12 hours minimum," Dinsmore said.

"Due to the staff reduction, at best we have two deputies on days and two deputies on swing. There are days when there is only one person on," Dinsmore said.

"When we have to do a transport such as this, in a perfect storm situation, (it could) result in having no one to respond to emergency or other calls for service," he said.

"In addition, as in the last week or two, when we are notified at 9 a.m. that we are expected to have someone in court or available to you within four hours when the drive time alone is four hours," he said.

"So I would ask that you always examine other options for transport – the secure transport groups that are available before you come to us," he said.

"Additionally, you always ask that the client be in your office two hours before court," Dinsmore said.

"Is that really necessary? If you have sent them out to a secure unit and have been talking with that staff, why do you need to see them for two hours? Our staff reports that at the most you normally see them a few minutes and then we sit around with the client," Dinsmore said. "This is two hours more time you are paying. Can you examine that requirement?"

Dinsmore said the sheriff's office would continue to work with Human Services, "but please take our operation and public safety for the citizens of Curry County into consideration."

Dinsmore wrote the memo after receiving one from Sgt. John Ward saying he was having a difficult time finding people to take patients from Roseburg or Coos Bay back to Curry county for a court appearance, and then return them.

Ward said that he has had dedicated people "willing to sacrifice what little free time they have, we just have to catch them at the right time."

On the one request, he had a deputy willing to make the drive to the hospital and back, but he needed to back in time to work his 5 p.m. patrol shift.

In that case, a patient needed to be transported from Mercy Hospital in Roseburg to arrive at the courthouse by 1:30 p.m. for a 3 p.m. hearing, during which it appeared the patient would be committed. Then, likely, the patient would need to be taken to Coos Bay. Read more!

Resolve dispute over mental health center -Mobile (AL) Register

Opinion: Friday, July 27, 2007

THE ONGOING conflict between Mobile Mental Health Center officials and Probate Judge Don Davis is disturbing. Each party accuses the other of making decisions or recommendations that are not in the best interests of mentally ill clients under their supervision.

Since these clients by definition are unable to act independently, how they are treated not only affects their lives but the safety of the public at large.

The Virginia Tech massacre earlier this year is a tragic example of the worst that can happen when a mentally ill person is mishandled in the courts and treatment system. A special governor's panel is investigating how Seung-Hui Cho slipped through the cracks in that state's system and ended up killing 32 people and himself.

Judge Davis and the Mobile Mental Health Center should be working closely together in the best interests of the patients who come into the system, and to ensure that citizens are protected from dangerously mentally ill persons. As reported by the Press-Register, the parties are so seriously at odds that John Houston, commissioner of the state Department of Mental Health and Mental Retardation, is trying to mediate the conflict.

Tuerk Schlesinger, the CEO of Mobile Mental Health, accuses Judge Davis of attacking the organization, substituting his own opinions or those of unqualified people for the recommendations made by professionals, and subjecting professionals to monthly status hearings that keep them in court into the evening hours.

Judge Davis, unfortunately, refused to be interviewed for the story, making it more difficult for the public to weigh the validity of the arguments. But in correspondence with the newspaper and with state officials, he has been critical of the mental health center and the recommendations it makes in cases of court-ordered commitment and inpatient or outpatient supervision of clients.

In one letter, Judge Davis said, "I will continue to document the problems so that if a tragedy occurs, I will have a clear conscience that I executed my best efforts to resolve the problems."

Mobile Mental Health Center's reputation is generally good. Another judge, District Judge Michael McMaken, is the current president of the center's governing board, and he defends the quality of service. Likewise, a spokesman for Commissioner Houston's agency describes the Mobile Mental Health system as "excellent."

Some occasional disagreements between the agency making recommendations and the judge issuing the orders are probably inevitable, but differences of opinion should not be so frequent or so severe as to require the intervention of a state agency commissioner.

We hope that Commissioner Houston can successfully resolve the divisions and that both sides will cooperate. One option may be to appoint an independent monitor with expertise in both mental health treatment and the law to literally sit in Judge Davis' courtroom and help determine who's right and who's wrong.

The stakes are too high for this conflict to continue. Mentally ill people who need court intervention must get the right kind of treatment, in both the health care and court systems. Read more!

Mental pickup ends in police shooting -KRQE Albuquerque (NM)

MORIARTY, N.M. (July 26, 2007) - A Torrance County deputy shot the subject of a mental-health pickup order this afternoon when the man allegedly came to the door with a gun in his hand.

Deputies serving the hospital order said when they went to the man's house near Moriarty, he opened the door and greeted them with a weapon forcing them to shoot.

Deputies were familiar with the man when they went to his house today but they had no idea he was a Moriarty police officer in the 1980's.

A home on Appaloosa Street became the center of a crime scene.

It was surrounded by officers investigating what when wrong just before 3 p.m.

Three officers arrived at the man's home after a doctor ordered a mental health pick up order.

"When the hospital sends out the mental health pick up order, we're obligated to go in and pick up the individual for their safety and for their health," Torrance County Sheriff Clarence Gibson said.

But deputies say the homeowner opened the door armed with a gun.

Investigators believe one deputy fired two shots hitting the man once in the upper torso.

He was then combative with them.

"Sadly to say he's not a normal man," a neighbor said. "He's troubled man with mental problems."

Neighbors say the man was odd and could be seen fishing in the dirt and spray painting the roads.

"And pretending he's shooting at traffic passing by," the neighbor said. "It looked to me like a weapon. I had reported it."

Deputies have had plenty of visits here before doing welfare checks after someone called the department concerned for his well being.

The man was less then helpful

"The deputies have responded in the past, checked on him," Gibson said. "He made contact with them, said he was fine and slammed the door."

The three officers involved in the shooting are now on standard leave taking away a third of the Torrance County's force that is only nine strong.

Ten reserve officers will help pick up the load.

The man who was shot is now at UNM Hospital and is stable and expected to survive.

Officers are guarding him on patrol outside his room.

Officers will tell you they know it can be dangerous serving mental health pick up orders.

John Hyde is accused of killing two Albuquerque officers in august 2005 when they went to pick him up for a mental health evaluation.

Unknown to the officers, Hyde had allegedly killed three other people earlier in the day. Read more!

R.I. to receive $300,000 federal grant to aid homeless - Boston Globe

WASHINGTON --Rhode Island will receive $300,000 in federal funding to help the homeless.

That's according to Sen. Jack Reed, who says the grant is intended to help homeless people with mental illness or drug addictions get treatment and move into stable and permanent housing.

The money is being awarded by the U.S. Department of Health and Human Services' Substance Abuse and Mental Health Services Administration.

Reed says it's estimated that nearly one-quarter of homeless people suffer from mental illnesses


Read more!

Report: N.C. lags in care for women -Raleigh News & Observer

Carolina Astigarraga, Staff Writer

RALEIGH - When Pam Dickens found a lump in her breast two years ago, she was confronted with some bad news.

It was not that the lump was necessarily malignant -- it was that because she was in a wheelchair, she could not even take a mammogram to find out.

Dickens, women's health coordinator for the N.C. Office on Disability and Health, hopes the 2007 North Carolina Women's Health Report Card will help more handicapped women get the care they need. Nearly one in three women in North Carolina have some disability, according to the report.

The report card, released Wednesday by the Center for Women's Health Research at UNC-Chapel Hill, looks at changes from 2001 to 2005.

Improvements, or lack thereof, on issues such as reproductive health, preventive care, chronic diseases and the new category of mental health, were rated A through F.

The good news: Fewer women are smoking and dying from heart disease and stroke, and more are getting screenings for cancer.

The bad news: Pretty much everything else.

Social barriers are worsening. More than 16 percent of all North Carolina women have no health insurance; that is true for more than 63 percent of Hispanic women.

This is likely due to unemployment and rising health-care costs, said Carol Lorenz, associate director of the center and one of the report card's authors.

Diabetes, obesity and high cholesterol are rapidly increasing in women.

A new section on mental health highlighted a growing population of women depressed after giving birth, and depressed in general, especially among African-Americans.

Some state officials say they aren't down about the report's results, but they're taking action.

"My goal ... is for this state to be the healthiest state," said Lt. Governor Beverly Perdue. "Every time we see one of these report cards every two years, it's up to us to make the state of those statistics better, more positive."

North Carolina poet Jaki Shelton Green, who will talk up the report card across North Carolina, spoke of the importance of preventive care.

"We must nag someone, and nag them compassionately, to get that mammogram that she's been putting off. ... Urge your grandmother to ask her physician about vaccination against pneumonia, help your cousin quit smoking now that she is pregnant," Green said. "Women need to become our own advocates."

Another way for statistics to improve is to get them into the public eye, Lorenz said.

"[What] we're trying to do is get the legislatures a lot more aware of the status of women's health and to engage them more in the center's work," said Lorenz, who called many of the statistics alarming. "Our role is to put the information out and make sure it gets into the hands of appropriate people."

Meetings for 25 to 50 people will begin in September in the homes of trained community health leaders around the Triangle area to explain the report. The center will also mail 20,000 copies to health-care providers, advocacy groups and others.

To view the report go to www.cwhr.unc.edu/index.pl.

Staff writer Carolina Astigarraga can be reached at 932-2025 or carolina.astigarraga@newsobserver.com.
Read more!

Evicted man back home, waiting for his day in court -Winston-Salem Journal

By Scott Sexton
JOURNAL COLUMNIST

Maybe you remember reading a couple of weeks back about Cornell Amos. He is the former Marine struggling with a range of mental-health problems who was unceremoniously kicked out of his modest Healy Towers apartment by the powers that be at the Winston-Salem Housing Authority.

Amos’ transgression? He had been arrested on Dec. 30 for possession of crack cocaine, an offense that most certainly would justify a swift and immediate eviction.

The one flaw in that scenario is that when Amos was kicked out with barely a chance to scoop up some clothes and his medicine, he hadn’t been convicted. Prosecutors dismissed the charge June 14.

Never mind the pesky little principle that a person is innocent until proven guilty. Amos was put out shortly after 9:30 a.m. on July 12, and given one chance to collect as much as he could grab.

A funny thing happened, though. Liza Baron, a lawyer with Legal Aid of North Carolina Inc., filed a motion Monday asking for a temporary restraining order that would force HAWS to let Amos back in.

Clearly a jurist who understands the concept of due process, Judge William Graham of Forsyth District Court signed the order almost as soon as it landed on his desk and gave Amos his home back.

“It’s temporary for now and there are no guarantees, but we’re pleased,” Baron said. “The order said that he shall immediately be let in.”

Rules are rules

The timing of the events in this mess couldn’t have been more backward.

The eviction hearing was put on a court docket for June 6, eight days before his criminal case was scheduled. So it would appear that the outcome of the drug case never really mattered and that HAWS officials assumed that Amos must be guilty and would be convicted as a matter of course. And the fact that the eviction hearing was continued until June 19, five days after the dismissal of the criminal case, makes it worse.

Larry Woods, the executive director at HAWS, didn’t return my phone calls yesterday, but when I asked about Amos’ case the day that he was locked out, Woods had plenty to say.

He cited a U.S. Supreme Court ruling from 2002, which held that public-housing agencies can kick anyone out who has been charged with a drug crime. “We have the legal right to evict, and it doesn’t have to involve a conviction,” he said.

Judging by phone messages and comments left on the Winston-Salem Journal’s Web site, more than a few people back that reasoning, flawed though it may be.

“I agree with Mr. Woods,” wrote one person who used the screen name Legal Eagle. “If you let one person break the rules, then where does it stop? If the speed limit is 65 and I know it and I choose to speed, I am breaking the law and endangering other drivers. If I get caught, then I have to pay the consequences.”

That’s true. But people who get tickets have the right to be heard in court.
A Solomon-like approach

Legal Eagle did raise a good point, though, one that bears repeating and underscoring. “You have to consider the safety of other people living in public housing,” Eagle wrote.

The trick is balancing that consideration with Amos’ rights. In a motion for the restraining order and relief from judgment - a nice legal way of saying “Cut the man a break” - Baron wrote that Amos’ mental illness, added to the fact that his criminal case had been dismissed, means that he “will suffer substantial and irreparable harm if he continues to be padlocked from his home.”

A hearing on Amos’ permanent eviction is scheduled for Aug. 2 in Forsyth District Court. I’m no judge, but there is a fair solution. Let Amos back in his place, and recommend strongly that he keep taking his medication. He knows the rules by now. One slip-up, one conviction for so much as loitering, then boot him.

Just because HAWS officials can kick a man out without a conviction doesn’t mean they must.

■ Scott Sexton can be reached at 727-7481 or at ssexton@wsjournal.com. Read more!

Jail doctor: Media politicizing mental health issue -Daytona Beach (FL) News-Leaer

By ANNE GEGGIS
Staff Writer

DAYTONA BEACH -- Resolution of the simmering controversy concerning county jail inmates denied their medicine was set back Wednesday when the jail psychiatrist walked out of a meeting of mental health providers.

Dr. David Hager, who works for Volusia County's provider of jail medical services, said he wouldn't meet in the presence of media representatives.

"It's not a political issue,'' Hager said, saying the media has politicized the issue. He first objected to a New-Journal reporter attending the meeting and then to the presence of Big John, a local radio personality, who is also a member of the subcommittee.

"Media (coverage) of this serves no purpose," he said.

Flagler/Volusia Behavioral Health Consortium -- a group of mental health providers from several agencies -- formed the subcommittee in response to reports that inmates at the Volusia County Branch Jail routinely are taken off their psychotropic drugs, even if the inmate has been diagnosed as mentally ill.

These concerns emerged a year after Prison Health Services, a national, for-profit company based in Tennessee, took over medical care at the jail from Halifax Medical Center in 2005. Last month, the first lawsuits against Prison Health were filed, with inmates claiming needed medications were withheld.

Fellow subcommittee members couldn't convince Hager that his presence was key to resolving the issue -- and ensuring those with diagnosed mental illness continue to receive their psychotropic medicine.

"I came here today feeling like this was not so big a problem that we couldn't sit down and figure it out," said Shirley Holland, manager of Halifax Behavioral Health, a youth mental health facility. "If you leave, I'm going to feel that maybe it's something we can't work out."

Hager exited the room, leaving Cindy Clifford, director of Volusia County Corrections, to answer questions.

Hager has stated on previous occasions that he believes mentally ill inmates wouldn't be at the jail if they were receiving the correct medicine and weren't abusing illegal street drugs. He has said dispensing psychotropic medicine in jail encourages inmates to barter and trade them illicitly.

Clifford defended Hager's approach.

"We have a decrease in the use of force," Clifford said. "We have a decrease in the number of suicides. We're not seeing what I believe we would see" if the system wasn't working.

Most of the proceedings Wednesday were dedicated to making sure community mental health providers, such as Act Corp. and Halifax Medical Center, were getting information about inmates' mental health histories into the correct hands at the jail.

Nancy Perkins, director of outpatient services for Act Corp., a community mental health services agency, said Act is often familiar with inmates they have been treating in the community for 10 or 20 years.

"We want to give this information to the jail and feel like it's been respected," said Perkins, explaining it often becomes harder to stabilize a patient once he or she becomes unstable.

Clifford said she would report back to the subcommittee after she talked to Hager.

anne.geggis@news-jrnl.com Read more!

Man shot, killed after attacking grandparents -Springfield (MO) News-Leader

Amos Bridges
abridges@news-leader.com

Authorities said mental illness may have played a role in a fatal attack this morning in which a Douglas County teen was shot and killed after attacking his grandparents with a kitchen knife.

William A. Nation, 18, was shot by his grandfather after entering his grandparents’ bedroom about 6 a.m. and stabbing both with a knife.

Nation had been living with Jerry and Katie Garrison for about a year in their rural home, about 13 miles east of Ava on Missouri WW east of Missouri C, said Chief Deputy Trampus Taylor of the Douglas County Sheriff’s Office.

Investigators don’t think Nation was taking any prescription medication or illegal drugs, but he had been seeing a mental health counselor, Taylor said. “Parents and family members said he had been hearing voices.”

When deputies arrived this morning they found Jerry Garrison, 62, had been stabbed multiple times in the head, shoulders and back before he was able to retrieve a handgun and shoot Nation.

Nation’s grandmother, Katie Garrison, 60, was stabbed in the face, authorities said. She was transported by helicopter to a Springfield hospital for treatment, while her husband was transported by ground ambulance.

“They were conscious and alert whenever I last saw them,” Taylor said.

Nation was pronounced dead at the scene. An autopsy is scheduled Thursday.

Taylor said it was not immediately clear whether Nation had attended school in the area. Authorities contacted his parents, who live in Arkansas and Florida, to notify them of their son’s death. Read more!

'Dad time' helps with special-needs kids -McClatchy Newspapers

Debbie Cafazzo, McClatchy Newspapers

TACOMA, WASH. - When Benjy Mogensen's work day is over, his play day begins. His 10-year-old son, Cody, makes sure of that.

One day they might head for the backyard and bounce on the trampoline together. Another day, they'll stroll their neighborhood with the family dog, Daisy.

"When I come home, it's my time," said Mogensen, a manager for several UPS stores in Washington state. "No matter how tired I am, Dad and Cody play."

After outdoor activities tire him, Cody might climb into his parents' bed and switch on the TV. Then it's snuggle time, as Benjy pretends to snore and Cody pretends to giggle.

Cody is autistic and thrives on predictability and structure. Knowing there's "Dad time" at the end of his day is important to him. Cody's mom, Jennifer, said her husband is a homebody who's happiest spending time with her and their son.

"She has to encourage me to get out," he said, smiling.

His wife was the one who told him about a group called Dads Supporting Dads. It's for fathers of children with special needs -- physical, cognitive, emotional or a combination.

The group, started at least 20 years ago in Pierce County, is one of the oldest groups in the Washington State Fathers Network, which provides support and resources for fathers of children with special needs.

"So many men don't talk to each other, or don't like to share," said Mogensen, who has been involved with the group for several years. But he said being part of Dads Supporting Dads has offered him a wealth of information, gleaned from the experiences of other fathers in the group, as well as from the expert speakers who are invited to meetings.

A place to talk

He and Dr. Alan Gill, a family physician and the father of an autistic 14-year-old son, Matt, lead the group together.

"It's a place where dads can talk about their experiences with people who will understand and support them," said Gill.

Paul Bala, a father of a mentally and physically disabled 29-year-old son, Daniel, served as the group's coordinator for about six years and is still a member.

"It's been a good experience for me," Bala said. "It helps regenerate the fire sometimes."

"Parents are pretty much on their own," said Gill. "They may get help from physicians or social workers. But basically parents have to learn to take care of their children. Working with other parents is probably the single best way to learn the system and learn the ropes."

Often, said Gill, parents find themselves in survival mode. Between visits to the doctor, therapy sessions and meetings with teachers, there never seems to be enough time. Parents of children with physical disabilities spend extra time feeding or bathing their kids or taking care of their other personal needs. Parents of children who are mentally challenged might need to work extra hard on problem behaviors. Some children have both physical and mental disabilities.

"For parents of kids with disabilities, it's so physically and mentally draining," said Mogensen. "It's hard to find time to be alone [as a couple] unless you have support. It takes a toll on marriages."

Including fathers

Although there are many family support groups that relate to specific disabilities, they are often "mom-driven," said Gill.

"Men may be less oriented [than women] toward sharing or admitting there's a problem," he said. "But we have the same experiences, the same losses, the same sense of grief."

"Traditionally, there's been a lot of women's groups," said Bala. "But things are changing, and now there's an opportunity for guys to get together."

Betty Johnston, who oversees Dads Supporting Dads and other programs for PAVE, a parent group for families with disabled kids, thinks dads are often "left out of conversations."

"Dads have some different needs and concerns," she said.

Mogensen said dads may be in denial initially about their child's problems. He remembers what it was like to learn of Cody's autism.

"You don't want to hear it," he said. "There's disbelief. It's very sad."

Bala points out that other dads may brag about their son's physical accomplishments, talking about his home run or touchdown. But "your kid can't do anything like that." Other dads of disabled children understand the disappointment like no one else can, he said.

While there is some help from the government for these families, it's limited. Cody was able to take skiing lessons, thanks to a pilot program that provides outdoor activities for disabled children.

But Gill and others point out that state caseworkers struggle with case loads of several hundred children, while waiting lists stretch into the thousands statewide.

"We have a system that's very fragmented," said Gill. "There are medical issues, school issues, mental health issues, social support issues."

Worries about future

For example, parents of disabled children often worry about what will happen when their kids leave the public school system.

"When he's 21, we hit the end of the line," Gill said. "Is he going to have a job? Where is he going to live?"

At age 67, Bala worries about what will happen to his son after he and his wife, Maureen, are no longer alive to care for him. Daniel has cerebral palsy, which makes mobility difficult. He is also deaf and has some mental disability.

Bala began searching for housing programs for his son when Daniel turned 24. He was on the verge of moving his family to New York state, where he thought there would be more opportunities, when a spot opened at a supported living home in Puyallup, Wash., last year.

"We kept beating on doors, and finally something opened up," he said. "We beat on enough doors."

Watching his friend Bala help his son transition to adulthood, Mogensen knows what struggles lie ahead. But for now, he's grateful for the small miracles that come his and Cody's way.

He was surprised, and happy, when his son learned to speak. It was a skill he thought the boy might never acquire. He's impressed by Cody's sharp memory, which comes in handy for studying spelling words and math facts.

"He has such a joy for music," Mogensen said. "At church, during worship, he jumps up and down. He loves the music."

He was proud when Cody was able to overcome his fear and hop on a ski lift. And every day after work, there's "Dad time." Cody makes sure of that.

Read more!

`Parity' Bill Faulted - Hartford Courant

By DIANE LEVICK

Officials in Connecticut and at least eight other states are campaigning to revise a federal bill they fear would erode health insurance benefits that their state laws require for consumers with mental health problems.

The proposed legislation, which the critics say is well-meaning, aims to make mental health disorders covered on the same terms as other health problems, a concept called "parity." It builds on a 1996 federal parity law.

However, attorneys general and state regulators say U.S. Senate bill 558, while helping some people, could result in weaker mental health insurance benefits - if any - for other consumers in some states.

"The federal Mental Health Parity Act will pre-empt and invalidate services in Connecticut and elsewhere, undermining and undoing important protections for our most vulnerable citizens," Connecticut Attorney General Richard Blumenthal said.

Officials in Connecticut and other states have been writing to their senators to enlist their efforts in opposing or changing the bill. Sen. Christopher J. Dodd, D-Conn., asked Connecticut officials to put their concerns in a letter, and they're hopeful that he and other senators will continue advocating for the bill's revision.

It was passed in February by the Senate Health, Education, Labor and Pensions Committee on a bipartisan vote and is pending before the full Senate. The bill was introduced by Sens. Pete Domenici, R-N.M., Edward M. Kennedy, D-Mass., and Mike Enzi, R-Wyo.

Domenici's press secretary, Chris Gallegos, said Wednesday that Dominici and Kennedy are working to resolve the issues that have been raised about the bill before it hits the Senate floor.

One of the big concerns is that the federal legislation in many cases would pre-empt Connecticut's broader parity law.

The federal bill doesn't require an insurance policy to cover mental health at all.

Connecticut requires a group or individual policy to cover mental health and do it on the same terms as it covers other medical services. For instance, co-pays and hospitalization coverage for mental problems aren't supposed to be different from what insurance covers for cardiac care.

On the other hand, the Connecticut law does not apply to the many self-insured plans in which employers set aside money to pay for workers' health care and hire insurers or other firms to process claims and handle other administrative functions. The federal bill would apply to self-insured and fully insured health plans.

The bill would pre-empt state parity laws when it comes to employer policies for 51 or more workers. That's somewhat unusual because federal laws often recognize that states may have already adopted stronger measures, and don't pre-empt them.

Connecticut is also worried because its parity law does not distinguish between large or small employer groups. So the federal measure could end up pre-empting Connecticut's law at employers of all sizes, said Vicki Veltri, general counsel in Connecticut's Office of the Healthcare Advocate.

In addition, the bill appears to exempt an insurance plan from its parity requirements if they cause more than a 2 percent increase in total plan costs, according to a letter to Dodd from Blumenthal and state Healthcare Advocate Kevin Lembo. Connecticut law does not allow such an exemption.

"For there to be true mental health parity, mental health services must be provided without regard to artificial cost thresholds that would never be tolerated for physical health insurance policies," the letter said.

Connecticut Insurance Commissioner Thomas Sullivan has also written to Dodd to say his agency can't support the bill as currently drafted.

Among other concerns with the bill is that it does not specify which mental disorders it should apply to, so it may not help as many people as Connecticut's parity law, Veltri said. Connecticut's law, she noted, applies to the many diseases and disorders described in a diagnostic manual known to mental health professionals as the "DSM-IV."

Read more!

Panel Calls for Improved Veterans Care - Associated Press

WASHINGTON (AP) -- A presidential commission on Wednesday urged broad changes to veterans' care that would boost benefits for family members helping the wounded, establish an easy-to-use Web site for medical records and overhaul the way disability pay is awarded.

The nine-member panel, led by former Sen. Bob Dole, R-Kan., and Donna Shalala, health and human services secretary during the Clinton administration, also recommended stronger partnerships between the Pentagon and the private sector to boost treatment for traumatic brain injury and post-traumatic stress disorder.

A 29-page report was presented to President Bush in the Oval Office, just after the Senate addressed some of the issues Wednesday morning by passing sweeping legislation to expand brain screenings, reduce red tape and boost military pay.

''Gone are the countless calls for appointments,'' said Shalala, who said the proposals would provide more customized, personalized care to injured Iraq war veterans. ''Gone are the days of telling the same thing to doctors over and over again.''

Bush said he has instructed Veterans Affairs Secretary Jim Nicholson and Defense Secretary Robert Gates to take all the recommendations seriously and implement the ones they have the power to enact. He called on Congress to make the recommended changes under its authority.

That way, Bush said, ''we can say with certainty that any soldier who has been hurt will get the best possible care and treatment that this government can offer.''

About six of the 35 proposals require legislation, while the rest call for action primarily by the Pentagon and Department of Veterans Affairs. The expected price tag for the whole package was about $500 million each year, with added costs that could push it to $1 billion in later years.

Among the recommendations was an indirect rebuke of the VA -- a call for Congress to ''enable all veterans who have been deployed in Afghanistan and Iraq who need post-traumatic stress disorder care to receive it from the VA.''

Only recently, the VA has taken steps to add mental health counselors and 24-hour suicide prevention services at all facilities, after high-profile incidents of veterans committing suicide. In the past, the VA had failed to use all the money for mental health that was allotted to it.

''Making the significant improvements we recommend requires a sense of urgency and strong leadership,'' the report read. ''The experiences of these young men and women have highlighted the need for fundamental changes in care management and the disability system.''

The report does not seek to directly criticize or lay blame for shoddy outpatient treatment at Walter Reed Army Medical Center that brought a public outcry for change and creation of the commission. It cited a need to move forward, saying there was no need to ''reiterate'' the findings of news reports that uncovered substandard care by the Defense Department and VA.

Among the proposals:

--Boost staff and money for Walter Reed until it closes in the coming years. Also urges Pentagon to work with the VA to create ''integrated care teams'' of doctors and nurses to see injured troops through their recovery.

--Restructure the disability pay systems to give the VA more responsibility for awarding benefits.

--Require comprehensive training programs in post-traumatic stress and traumatic brain injuries for military leaders, VA and Pentagon personnel.

--Create a ''My eBenefits'' Web site, developed jointly by the VA and Pentagon, that would let service members and doctors access private medical information as the injured move from facility to facility to receive treatment.

--Provide better family support, because one-third of injured Iraq war veterans reported that a family member or close friend had to relocate to care for them. It calls for training and counseling for families of service members who require long-term care and improved family leave and insurance benefits for family members.

''We owe our wounded soldiers the very best care, and the very best benefits, and the very easiest to understand system,'' Bush said. ''And so they took a very interesting approach. They took the perspective from the patient, as the patient had to work his way through the hospitals and bureaucracies. And they've come up with some very interesting and important suggestions.''

Bush created the panel March 6 to investigate problems in the treatment of wounded veterans following the disclosures at Walter Reed.

The White House event followed the Senate's vote by unanimous consent on legislation that seeks to end inconsistencies in disability pay by providing for a special review of cases in which service members received low ratings of their level of disability. The aim is to determine if they were shortchanged.

The bill also would boost severance pay and provide $50 million for improved diagnosis of veterans with traumatic brain injury or post-traumatic stress disorder. The House was considering similar measures.

''It has been hurry up and wait for the results of this commission report and now the White House is telling our vets to wait even longer,'' said Sen. Patty Murray, D-Wash. ''That's why the Senate has moved ahead with our Wounded Warriors Act. The public is waiting, our veterans are waiting.''

Paul Rieckhoff, executive director of Iraq & Afghanistan Veterans of America, agreed.

''It is important for the American public to understand that the Walter Reed fiasco is not over,'' he said. ''Everything is not fixed. The follow-through will be the most important part.''

Bush commented on the report after a dramatic lap around the South Lawn jogging track with two soldiers: Sgt. Neil Duncan, who lost both of his legs in Afghanistan in 2005, and Spc. Max Ramsey, who lost his left leg in Iraq in 2006. They were aided by prosthetics. Bush met both men at Walter Reed last year. The White House said the timing of their visit -- on the same day as the report -- was a coincidence.

Dole said he planned to make sure the Bush administration implements the panel's recommendations.

''We did this because it was important,'' he said. ''We're expecting somebody to follow-up on it. I'm going to be watching closely to make sure it happens.''

------


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State faults hospital staff - Boston Globe

The following editor's not ran in the Sept. 30, 2007 Boston Globe:

Editor's note: A July 26 article about Pembroke Hospital did not
include the reason Paul Zani resigned from his job as chief executive
officer because the Globe had not been given that information. Since
then, it has been learned that Zani left his job for health reasons and
his resignation was not related to investigations initiated by state
agencies."

Pembroke Hospital employees yelled and swore at patients, engaged in inappropriate horseplay, and failed to report a patient's stolen credit card on which $650 had been charged, all in possible violation of state regulations or hospital policy, according to an investigation by the state Department of Mental Health.

The 142-page report by department investigator Michael V. Bogosian was completed on May 30. It examined two whistle-blowers' allegations that patients at the private psychiatric facility, which draws from across the region, were being mistreated.

The department also completed a second report in June. That 10-page document, released Tuesday, outlines steps the hospital needed to make, including specific training for workers in how to be respectful and maintain appropriate boundaries with patients, and training that focuses on reducing the need for restraining patients.

That second report, by Michael H. Weeks, the director of licensing, noted that the hospital on its own already had identified and fixed many problems. Employees identified as being disrespectful or abusive are no longer employed there, he wrote. A new chief executive officer, Elaine Glaser, was hired in May and "has produced significant improvements."

The investigation, which began in October and was completed in May, concluded the following:

One female staffer had sex with a male patient and a male former patient, and used cocaine and heroin while on duty. Numerous other staffers knew about the drug use but failed to notify the state, as is required. The woman is no longer employed at the facility.

The system for filing complaints against workers by patients was dysfunctional. Some complaints apparently never were filed and paperwork was disorganized. Hospital officials failed to follow up on complaints.

Staffing was inadequate on many occasions and "short staffing can contribute to a dangerous environment," the investigator wrote. For example, in February a nurse was sexually assaulted by a male patient and another patient needed to come to the nurse's rescue.

The whistle-blower employee at the hospital whose letter triggered the investigation had asked to remain anonymous, but the state inadvertently released his name to the hospital. He still works at the facility.

In a written statement, Arbour spokeswoman Judith A. Merel said the hospital had made strides to address the problems raised by the state, such as hiring a new chief executive, Elaine Glaser.

The hospital also has hired a new human rights officer, who reports directly to Glaser and tracks complaints and incidents; has beefed up training in crisis intervention; and reinforced its policies on employee conduct and work rules, such as inappropriate contact and language with patients.

All identifying information about patients and employees, as well as medical information, was redacted in the public copy of the investigation. More than 40 people were interviewed by the investigator.

The investigation began last fall when the department received a letter from a hospital employee, stating the hospital housed a "prevailing atmosphere of disrespect and disregard for appropriate psychiatric care" and a "culture of hostility and disrespect . . . perpetuated by the approach that many staff, both [mental health associates] and RN's, seem to take toward patients that involves yelling and swearing."

A former employee later sent an e-mail and letter alleging that a worker was having sex with patients and was using cocaine and heroin.

The private psychiatric hospital has 115 beds and is a division of Arbour Health System, whose five psychiatric hospitals and outpatient facilities make it the largest provider of its kind in the state. Pembroke offers inpatient evaluation and crisis intervention for teenagers, adults, and elders with mental illnesses and addictions.

Pembroke Hospital's chief executive officer, Paul Zani, resigned in March amid several investigations. The US Occupational Safety and Health Administration opened an investigation after a report of patient assaults on employees, but it was closed without a finding of violations. The state Department of Social Services also initiated investigations related to alleged problems in the girls' adolescent unit. One investigation was closed without a finding and one is still open, Merel said.

After a surprise visit in March from the state Department of Mental Health, the hospital agreed to cap its admissions after the department determined the facility had staff for only 81 patients. The hospital plans to ask the state in August to increase the allowed number of beds to about 90, Merel said.

The investigation completed in May found that mental health workers and nurses yelled and sometimes swore at patients. Staff would engage in inappropriate behavior such as slapping buttocks, and backs of heads, or flicking ears, the investigation found.

One patient filed a complaint saying a credit card had been stolen and $650 had been charged at Wal-Mart and a gasoline station. The investigator criticized the hospital for not reporting the alleged felony to the state and for failing to investigate properly.

The whistle-blower had asked state officials to keep his identity confidential, writing he "was very concerned, not only for [his] continued employment but for [his] personal safety as well." His name, however, was inadvertently revealed, the investigation found.

The whistle-blower had sent his original letter to the state Department of Public Health, which forwarded it to Mental Health. Public Health mistakenly identified the man as a former employee, according to the first report. The original complaint letter, complete with the whistle-blower's full name, was sent to Pembroke Hospital by Mental Health, the report said


Read more!

Good Hope Says State Took Mental Health Beds Permit -Dunn (NC) Daily Record

By Steve Reed
7/24/2007

Good Hope Hospital has lost its state license for mental health beds.

The bad news comes at a time when Good Hope has secured a partner to help reopen the mental health beds.

In a news conference yesterday at the former Erwin hospital, a local group which has been working for more than a year to reopen Good Hope's mental health unit appealed to the community for support in getting it back.

Harnett County Commissioner Gary House, a longtime supporter of Good Hope Hospital and member of the group, said, "We will ask the Division of Facility Services to end their opposition to the efforts by our committee and allow the license for mental health beds to be restored to Good Hope."

Mr. House was joined at the conference by fellow members of the committee, including Erwin Mayor Patsy Carson, Town Manager Alan Thornton, Pat Cameron, Vic Fowler and Louise Taylor.

According to correspondence between Good Hope attorney William Stewart and state Assistant Attorney General June S. Ferrell, Good Hope notified the state the hospital was closing, but planned to resume its mental health services in the future.

But the state refused to issue a license to Good Hope in 2007, and Good Hope filed a petition asserting its license had not and should not have lapsed.

Mr. Stewart told Ms. Ferrell in his letter that the state on many occasions has allowed health care facilities to maintain licenses for beds and services that have been suspended. He cited Presbyterian Specialty Hospital in Charlotte as an example.

"The state allowed it to be licensed for inpatient beds for at least five years where no inpatients were admitted to the facility," he said.

No Response

Given the current status of psychiatric services in Harnett and Lee counties, exacerbated by the impending closing of Dorothea Dix Hospital, Mr. Stewart said it could only benefit the community to have inpatient psychiatric services resume at Good Hope as soon as possible.

"No other provider has attempted to meet this need. Good Hope has been the only entity that has been willing to and has provided in-patient psychiatric services for over 16 years," Mr. Stewart wrote.

In a July 9 letter to Mr. Stewart's firm, Ms. Ferrell said the state had decided to reject Good Hope's offer and suggested the hospital consider filing another certificate of need application.

Mr. House said three letters have been sent to the state's Division of Facility Services, two by him and one by the Harnett County Board of Commissioners asking for an inspection of the Erwin facility. To date, Mr. House said the county has not received an answer to its request.

Harnett Health System, a partnership of the county, Betsy Johnson Regional Hospital and WakeMed, which is competing with Good Hope to build a new hospital in Lillington, said it has been supportive and participated in efforts in the county to create short and long-term solutions to mental health issues.

"In the spirit of cooperation and finding shared solutions, the Harnett Health System remains willing to continue to work diligently with all parties in moving forward in a cooperative fashion," HHS spokesperson Jennifer Franklin said. "The HHS is not currently working on any separate plan for mental health inpatient beds as the shared approach is seen as the best approach for residents of Harnett County."

Potential Partner

Mr. House also announced at yesterday's news conference that Horizon Health wants to partner with Good Hope to reopen its mental health unit.

Horizon Health is a 26-year-old Texas-based corporation and the largest contract manager of psychiatric services in community-based hospitals within the United States.

"The trustees of Good Hope Hospital voted to accept Horizon's proposal and to move as quickly as possible to facilitate final details and prepare the facility for occupancy," Mr. House said. "We feel this is a win for Harnett County and Betsy Johnson (Regional) Hospital. Mental health patients will be able to be placed quickly and locally instead of waiting in emergency rooms."

Mr. House said Horizon manages more than 2,800 inpatient psychiatric beds at more than 110 hospitals. It was cited by Forbes magazine in October 2005 as one of the nation's 200 best small companies.

He said the partnership with Horizon would be an economic boost for the Erwin community and Harnett County as well, by creating 30 jobs with combined annual salaries of more than $1.2 million.

"With appropriate cooperation and support, we can have this inpatient facility up and running by Jan. 1, 2008," Mr. House said.

Four Steps

Mr. House said there are four steps needed to restore mental health services to Good Hope Hospital.

First, his committee and a Horizon Health representative plan to host an open community forum within the next three weeks.

"The purpose of this forum is to allow input from providers and consumers as a way to improve the access and quality of services we plan to offer," Mr. House said.

Mr. House said the administration of Betsy Johnson Regional Hospital, the Harnett County Board of Commissioners, Sandhills Mental Health Center CEO Michael Watson and other agencies have been invited to be active participants. Mr. House said he hopes they will make public commitments soon.

In the meantime, Harnett County Commission Chairman Teddy Byrd has directed County Manager Neil Emory to arrange a meeting between Mr. House, Mr. Watson, Harnett Health Systems CEO Ken Bryan and Mr. Emory, to discuss mental health services in Harnett.

Mr. House thus far has objected to the limited invitation, saying he feels his entire committee should be allowed to participate in that meeting.

Mr. Byrd said Mr. House is still invited to participate.

"The intent is to call the principals together, Mr. House, Mr. Watson, Mr. Bryan and Mr. Emory, and have a frank and open discussion about where we go next," Mr. Byrd said. "It is likely that we will address legal issues and strategies about dealing with state agencies that we may not want to be made public just yet." Read more!

Mental health program slowed - Fayetteville Observer

Community group blames state for stalling process

By Jennifer Calhoun
Staff writer
july 24, 2007

ERWIN — The state is hindering efforts to provide inpatient psychiatric services in Harnett County, a community action group said Monday.

The group, which was formed last year to bring mental health services back to the county, said the state is putting political obstacles in its path.

The group is made up of representatives from the county’s Board of Commissioners, the Department of Social Services, Sandhills Mental Health and mental health advocates. It was formed to find ways to re-establish inpatient mental health services in the county after Good Hope Hospital — the county’s only inpatient psychiatric service provider — closed in April 2006.

Since then, the group has formed an agreement with Horizon Health, a national psychiatric services company, to provide inpatient mental health services at Good Hope.

The program would hold 16 beds and treat patients 18 years and older who suffer from psychiatric symptoms, said county Commissioner Gary House, a member of the action group. The program also would have a separate clinical track for patients over the age of 65. The service area would include Harnett County and parts of Lee, Wake, Johnston, Sampson and Cumberland counties.

If approved, the new facility could open by Jan. 1.

It would bring 30 jobs to the county worth $1.2 million a year, House said.

But the state is keeping the agreement from becoming a reality, said Pat Cameron, who is a spokesman for the group, director of the county’s Department of Social Services and a member of Good Hope’s board of trustees.

“We started this process a year ago and I’m very frustrated we have not moved further,” he said.

Cameron blamed the trouble on the hospital’s ongoing legal battles with the state.

In 2006, the state repeatedly turned down Good Hope’s requests to build a new hospital. The hospital finally closed down early last year.

Now, the state is throwing up roadblocks for Good Hope getting the mental health beds, Cameron said.

He said the state’s Division of Health Service Regulation asked hospital officials to renovate the facility. But after the hospital complied, the state did not respond to requests for an inspection.

“Instead of embracing it, they’re putting up obstacles,” Cameron said.

Jim Jones, a spokesman for the state, said state employees could not comment on the situation because of pending legal issues between Good Hope and the state.
Staff writer Jennifer Calhoun can be reached at calhounj@fayobserver.com or 486-3595. Read more!

Mental health program slowed - Fayetteville Observer

Community group blames state for stalling process

By Jennifer Calhoun
Staff writer
july 24, 2007

ERWIN — The state is hindering efforts to provide inpatient psychiatric services in Harnett County, a community action group said Monday.

The group, which was formed last year to bring mental health services back to the county, said the state is putting political obstacles in its path.

The group is made up of representatives from the county’s Board of Commissioners, the Department of Social Services, Sandhills Mental Health and mental health advocates. It was formed to find ways to re-establish inpatient mental health services in the county after Good Hope Hospital — the county’s only inpatient psychiatric service provider — closed in April 2006.

Since then, the group has formed an agreement with Horizon Health, a national psychiatric services company, to provide inpatient mental health services at Good Hope.

The program would hold 16 beds and treat patients 18 years and older who suffer from psychiatric symptoms, said county Commissioner Gary House, a member of the action group. The program also would have a separate clinical track for patients over the age of 65. The service area would include Harnett County and parts of Lee, Wake, Johnston, Sampson and Cumberland counties.

If approved, the new facility could open by Jan. 1.

It would bring 30 jobs to the county worth $1.2 million a year, House said.

But the state is keeping the agreement from becoming a reality, said Pat Cameron, who is a spokesman for the group, director of the county’s Department of Social Services and a member of Good Hope’s board of trustees.

“We started this process a year ago and I’m very frustrated we have not moved further,” he said.

Cameron blamed the trouble on the hospital’s ongoing legal battles with the state.

In 2006, the state repeatedly turned down Good Hope’s requests to build a new hospital. The hospital finally closed down early last year.

Now, the state is throwing up roadblocks for Good Hope getting the mental health beds, Cameron said.

He said the state’s Division of Health Service Regulation asked hospital officials to renovate the facility. But after the hospital complied, the state did not respond to requests for an inspection.

“Instead of embracing it, they’re putting up obstacles,” Cameron said.

Jim Jones, a spokesman for the state, said state employees could not comment on the situation because of pending legal issues between Good Hope and the state.
Staff writer Jennifer Calhoun can be reached at calhounj@fayobserver.com or 486-3595. Read more!

We must do better by our children - Durham Herald-Sun

By Stephanie Fanjul : Guest columnist
Jul 24, 2007

As Americans, we are accustomed to the perception that our quality of living is better than that of many other countries. We drive new cars. We have big houses. Our children get the best life has to offer. Or do they?

A new report issued this week by the Foundation for Child Development sheds light on how, in spite of our caring words, we are still failing our young children. The report, 2007 Special Focus Report on International Comparisons, is part of a larger annual Child and Youth Well-Being Index Project, which has been following the overall well-being of American children since 1975. This new report compares the United States and four other English-speaking countries (Australia, Canada, New Zealand, and the United Kingdom) on 19 points related to child well-being, including poverty rates, parental employment levels, infant mortality, childhood overweight, education levels, and pre-school enrollment.

The results for our very youngest children are appalling:

-- The U.S. has the highest percentage of children living in poverty as well as the highest percentage of households with children where at least one parent is employed. This means that while more American parents are working, they are not able to raise their families above the poverty threshold.

-- The U.S. has the highest infant mortality rates of the countries studied.

-- The U.S. has the highest rate of childhood obesity of the countries studied.

-- While the number of babies born to American teenagers is decreasing, it is still higher than the other countries studied.

-- Despite the massive federal effort of No Child Left Behind, American children still score lower on both reading and mathematics tests than their counterparts in the four other countries.

-- The U.S. lags behind the United Kingdom and New Zealand in pre-school enrollment for 3 and 4 year olds.

Clearly, our social policies are not keeping pace with how we think we live. We are not supporting working families in ways that foster success and we are ignoring the fact that children raised in poverty experience long term hardship including lack of basic necessities, poorer overall health, behavior problems and poorer educational outcomes. We are not making meaningful efforts to curb childhood obesity. And by gutting mental health and early childhood education programs, we ensure that families in crisis stay in crisis. But aren't we the grownups?

Where I come from, being the grownup means keeping the goal in mind, setting a good example, and making the tough decisions.

America's young children need a champion. They need a grownup in power. They need clear, dedicated effort from both the public and private sectors to address these major issues through sound, thoughtful policy and a commitment to channel the resources needed to improve the outcomes for all young children, but especially for those in households with limited economic resources. If we don't, we are leaving behind an America that is educationally weaker than many of our neighbors and thus, economically disadvantaged. But we can address this. We can live up to our own expectations. We are the grownups -- it is our choice.

Stephanie Fanjul is president of N.C. Partnership for Children, Inc. Read more!

It's inexplicable that mental hospital made exceptionsfor felons - Wilmington (DE) News Journal

OUR VIEW

The State of Delaware requires criminal background checks for prospective employees of schools, day cares, nursing homes -- extending even to regular volunteers, coaches and temporary contract personnel. Registries are kept of complaints and violators by overseeing state agencies. The obvious reason is to protect vulnerable, dependent and trusting persons from abuse and exploitation.

As a matter of law, these requirements took effect through the 1990s. Too often common sense gets goaded by some precipitating incident of mistreatment and outrage.

So it is confounding that of all places the Delaware Psychiatric Center has "grandfathered" employees with criminal records including violent assault. The only protection apparently is they would be reviewed in case of a job change or disciplinary action. Elsewhere, the state Department of Health and Social Services expressly prohibits convicted felons from working as certified nursing assistants.

It is hard to understand this staffing exception at the state-run mental hospital as anything other than job protection. It's particularly questionable in light of reported retaliation against supervising nurses who report substandard handling of patients.

And now the federal Centers for Medicare and Medicaid Services, which monitor government funding for care, are investigating. Hearings already scheduled by state House Majority Leader Richard Cathcart for August and September also have several lines of inquiry to pursue. U.S. Attorney Colm Connolly's alert to federal civil rights investigators also raises the stakes for hospital administrators.

The bland assurances thus far that hospital management processes, disciplinary procedures and staff paperwork are sufficient, despite the tension, need shaking up to clarify that medical standards are uppermost, and that this is not a labor standoff.
Read more!

Transylvania to be able to fill mental health gaps -Hendersonville Times-News

BREVARD --Transylvania County received an extra $75,000 from the N.C. Office of Rural Health and Community Care to fill service gaps in mental health care.

It is the second time the Health Department received the grant to help fill voids left in the wake of the closure of New Vistas-Mountain Laurel.

NVML was the region's largest mental health care provider, serving eight counties including Transylvania, before closing Oct. 31, 2006.

Several smaller mental health care providers stepped in to fill the void when NVML closed.

"We want to make sure they're on a pathway to sustainability," Health Director Steve Smith said.

A community stakeholder group, composed of mental health care providers, patients, advocates and others, will decide how to spend the money. Read more!

Legislators urged to expand state's autism resources - AP

CAPE GIRARDEAU, Mo. (AP) - As understanding and awareness of autism grows, the state needs to expand its response to the disorder, advocates and parents of autistic children told a state panel.

In testimony before a panel of legislators, physicians, parents and educators on Friday in Cape Girardeau, advocates said the definition of autism has been expanded to cover a range of behaviors in people who can function but have traits of the more serious forms of the condition.

Sen. Jason Crowell, R-Cape Girardeau, said academics and private organizations also are paying more attention to the disorder.

“It is now incumbent on the General Assembly to dovetail with those efforts,” he told the 16-member panel, which is led by chairman Sen. Scott Rupp, R-Wentzville, and Sen. Jolie Justus, D-Kansas City.

Friday's meeting was the first for the group, which will have three more hearings in the next two months before making recommendations for legislation and state policy.

One in 150 children is diagnosed with a condition that is in the “autism spectrum” and autism costs $90 billion nationally, according to the Centers for Disease Control and Prevention.

The Missouri Legislature appropriated $2.6 million this year for an autism treatment and diagnostic center for southeast Missouri, and increased spending on autism treatment to $3.6 million.

Besides studying current needs, the panel members need to determine what has been done in the past to guide future lawmakers, Rupp said.

“This is the road map to move people forward so we don't form another blue ribbon commission and the report goes on the shelf,” he said

Officials of some current programs outlined their efforts to help those with autism.

The Tailor Institute of Cape Girardeau helps people with extraordinary talents who also exhibit some of the symptoms of autism.

“The Tailor Institute can offer promise and potential,” said Carol Statler, director of the institute. When clients can explore their talent, she said, “I see that look, and it is the promise of a more meaningful future.”

The Tailor Institute, however, can help only six people at a time, she said.

The Collaborative Autism Intervention Project sponsored by the University of Missouri-Columbia Thompson Center for Autism and Neurodevelopmental Disorders also focuses on children with autism.

Matt Stoelb, director of the center, said 25 children ages 2 to 12 are being treated, with strong results. Two people served by the project are no longer exhibiting symptoms of autism and 75 percent have begun speaking again after six or more months.

“There are a lot of signs locally that the efforts are coming to fruition,” Stoelb said. “The results are far more likely to be astounding with younger kids.”

Adults with the condition have a hard time finding treatment, said Marilyn Cox, who said she cannot find a place to train or treat her 36-year-old son, Brian, to become independent.

Justus said she hoped the state's response to autism won't become a partisan political issue.

“We need to cut down the wait time for kids getting diagnosed and bring together innovative programs,” she said. Read more!

Mother Battles School System = WMAZ-TV, Macon, GA

Video of this story can be viewed here.
7/24/2007

By: Lorra Lynch

A Houston County mother is set to go to trial in October for violating the state's attendance laws.

Betsy Loiacono says she kept her 7-year-old autistic son out of public school based on medical advice from her doctor.

According to letters from the Houston County school system written to Loiacano, school officials disagree with the doctor about what's best for the child.

Last school year, Austen Anderson learned at home in his mom's dining room turned classroom. His mother set-up the room to teach her son after a doctor said it would best for Austen to learn at home.

Betsy Loiacono said the doctor diagnosed Austen with autism and post-traumatic stress disorder due to an alleged incident on a school bus.

Based on the doctor's advice, Loiacono asked the school system to provide a teacher to help Austen at home.

School officials turned down the request and said that if Loiacono wanted to keep him home, she would have to sign forms saying that she would home-school him.

She refused to sign the forms saying, "The home school would basically allow them to wash their hands of all legal responsibility to provide him with an education, the same as any other child with a medical illness."

According to letters to Loiacono by Houston County's director of special education, educators want Austen to attend the autism program at Perdue Primary School. The letters also said the state's attendance laws applied to Austen.

Loiacono's lawyer Hatcher Graham is challenging that decision. He said, "They are not qualified, absolutely unqualified to say this child is medically fit to go to school. Not a one of them has a medical degree."

Loiacono said she believes a doctor, not the school system, knows what's best for Austen. She said, "I think they'd like the public to think they're just doing their job, but this is about a whole lot more than that. Their abuse of power, being able to harass, intimidate and bully parents into doing things their way or go to jail and that's a heck of an ultimatum to be faced with."

In an effort to be fair and balanced, Eyewitness News called the Houston County Board of Education for comment.

Spokesperson Beth McLaughlin wrote in a response that they could not comment on the case based on the family's right to privacy. She went on to say, "We deny any wrongdoing in this situation in proposing anything that would do harm to her child."

The school system and Loiacono are currently trying to reach an agreement to reintegrate Austen Anderson into public school, but have not been able to agree on how long that should take.

In a letter to Loiacono's attorney the Special Education Director wrote "We respect any physician's diagnosis of a medical problem; however, we ask that Austen's physician respect the educational judgment of the educators of this school system." Read more!

Jailed psychiatrist retains license - New York Post

By LAURA ITALIANO

July 25, 2007 -- Last summer, a bipolar Florida psychiatrist with a history of alcohol abuse and violence went off his meds, got in his car and drove to New York City to better hide, among the crowds, from the evil "forces" pursuing him.

He peeled off the trans-dermal patch that dispensed medication directly into his skin, and threw it out his car window as he drove.

Once in the city, he parked on the West Side - leaving his wallet in his car - and walked to the New York Waterway terminal at 39th Street and 12th Avenue.

There, unprovoked on a sunny July afternoon, he admittedly grabbed a 2-year-old boy named Thorin who lived nearby and happened to be playing with his plastic bicycle.

Then, when Thorin's terrified mother tried to stop him, he threw her to the concrete and choked her into unconsciousness, stopping only when two bystanders hoisted him off her.

"I begged, I begged, I begged," the hero mom, Jil Novenski, testified in tears yesterday - recounting her horror to a Manhattan judge in hopes that the psychotic stranger may be locked up forever.

"I screamed, 'Oh, God! Please, no!' I thought for sure he was going to kill me in front of my son. I wanted to make sure that if I was going to die, he wasn't going to get [Thorin.]

"He squeezed harder and harder," Novenski remembered of the stranger's hands around her throat. "Then, everything went black."

Amazingly, the psychotic shrink - child psychiatrist Dr. William Johns III - remains licensed to practice medicine in Florida, West Virginia and Hawaii, according to online records.

This, despite his having been in jail for the full year since admittedly attacking the woman and her son.

Johns quickly told cops he was Jesus Christ, trying to save the boy from some vague "danger."

"I tightened my grip on her when the two guys came over because I thought they might try to pull me off of her," he admitted, according to court documents.

Johns, who has a history of severe alcohol dependence, drunken driving, violence and stopping his medications, is now fighting to be freed so he can attend an outpatient psychiatric program near his hometown, Vero Beach.

He pleaded not guilty by reason of mental illness in April. Yesterday's hearing, which continues today, will determine if his next move is out the door or - as prosecutors and Novenski hope - into a locked psych facility.

"Otherwise, what are we waiting for?" Novenski, 39, told The Post yesterday. "He's going to kill somebody."

laura.italiano@nypost.com Read more!

Lapses' blamed in death of inmate - Philadelphia Inquirer

Mentally ill and in Delco prison, she died of neglect and indifference, her family says in a lawsuit.

By Mari A. Schaefer and Jeff Gammage
Inquirer Staff Writers

A mentally ill woman died last year after being held for six weeks in Delaware County Prison without receiving medication for a thyroid condition, according to a lawsuit filed in U.S. District Court.

The suit says the family of 38-year-old Cassandra "Sandy" Morgan of Aston repeatedly "attempted to contact" the privately operated county prison to express concern over her mental condition and hypothyroid problem. The family's lawyer, Harold I. Goodman, said the family had been "virtually ignored."

Morgan died in Riddle Memorial Hospital on March 29, 2006, four days after lapsing into a coma at the prison. Her death resulted from complications caused by hypothyroidism.

She had been imprisoned after being charged with shoplifting at the Wal-Mart in Upper Chichester on Feb. 16, 2006.

James Morgan, her brother, said that the Public Defender's Office had not returned his repeated calls for help, and that the prison had made no attempt to contact them about his sister's medical condition.

"At any point in the system where she could have been saved and treated humanely, there were lapses," said Goodman, of Philadelphia. The lawyer called the case an "institutional failure" and a convenient way to get Morgan off the streets.

Michael Joseph Harper, the assistant public defender who represented Morgan, said he had not heard from her family until she had been hospitalized in a coma. "I returned those calls."

Among defendants in the lawsuit are the county, the prison, Crozer-Chester Medical Center in Upland, and the Geo Group Inc., the Florida company that manages the prison.

A call to John Reilly, deputy superintendent of the George W. Hill Correctional Facility - the county prison - was not returned yesterday. Robert DiOrio, the lawyer for the prison, said he was not familiar with the case and would not comment.

Morgan was arrested after trying to leave the Wal-Mart with a shopping cart containing more than $550 in merchandise.

According to police reports, Morgan said that she "was the owner of Wal-Mart," and that "everything in the store belongs to her."

She was arraigned, bail was set at $10,000, and she was sent to Delaware County Prison.

On March 25, 2006, four weeks after she was found "incompetent to stand trial," Morgan was discovered unresponsive on the floor of her cell.

The lawsuit says "a series of institutional failures" began months earlier when Morgan was released from Crozer-Chester Medical Center. She had been committed there on Jan. 19, 2006, after an altercation with two of her sisters.

Crozer-Chester determined that Morgan should be transferred to Norristown State Hospital for long-term psychiatric care, the suit contends. Her family and Morgan agreed with the transfer.

Morgan was found at that time to be schizophrenic and noncompliant with treatment for her hypothyroid condition.

Instead of transferring her to Norristown, however, a doctor with Crozer-Chester discharged Morgan to her family.

Calls to Crozer-Chester for comment yesterday were not returned.

Nine days after her release, Morgan was arrested at Wal-Mart.

Morgan first developed symptoms of schizophrenia while a freshman at York College, according to her brother.

He said Sandy Morgan had loved children and poetry, and had once run track and played in the band at Chester High School. She grew up in a close-knit family of seven children, he said.

Even after her illness was diagnosed, she earned a bachelor's degree at Neumann College in Delaware County and was working toward a master's degree in education. She was also a caregiver for her bed-ridden mother.

"I know her condition seemed to worsen once my mother passed," James Morgan said. He said the family had been very involved in his sister's life and care.

The experience of mentally ill inmates has recently been the the subject of a Justice Department report. It's "a national tragedy," the National Alliance on Mental Illness said last year, after the release of the federal study.

In the report, issued in September, researchers found that 64 percent of prisoners in local jails, 56 percent in state prisons, and 45 percent in federal lockups showed symptoms of serious mental illness. The rates were even higher for women.

County jails hold inmates - including potentially innocent people awaiting arraignment or trial - for shorter periods, while state and federal prisons hold offenders sentenced to a year or more. Generally, the study found, the longer the incarceration, the greater the opportunity for an inmate to be assessed and treated.

Mentally ill inmates in state prisons were most likely to receive treatment - but still, only 34 percent were being helped. In local jails, the figure was 17 percent.

The ramifications are profound - for corrections officers and prison administrators as well as inmates - because those with unaddressed mental-health problems are more likely to assault another prisoner or an officer, the Justice Department found.

In Pennsylvania, there is no uniform system or standard for providing care in local jails, according to National Alliance on Mental Illness officials.

"Every county is a little bit different, and you've got 67 counties," said James Jordan executive director of NAMI Pennsylvania.

A NAMI task force has begun a study of the care in county jails, including access to treatment and medication.

Read coverage of other deaths at Delaware County Prison at http://go.philly.com/inquiries Read more!

Critics of schools for mentally retarded say system needs help -San Antonio Express News

Lisa Sandberg
Express-News Austin Bureau

AUSTIN — Texas spends about $110,000 annually on each of its mentally retarded state school residents, but abuse in the system seems rooted, in part, in the fact that entry-level workers make less than $20,000 a year and start with just two weeks worth of training.

As tales of abuse and neglect by employees at the state schools unfold this week, critics are comparing conditions at the institutions for the mentally retarded with the juvenile jail system, which was rocked this year by its own abuse scandal.

In some ways, the state schools fare worse.

Entry-level correctional officers at the Texas Youth Commission earned over $3,000 more last year than entry-level direct care workers do now in their jobs with the mentally retarded.

TYC correctional staff received the same 80 hours of training, but after abuse allegations were publicized, that amount was widely attacked as inadequate. Workers now get 300 hours of training.

Mike Gross, vice president of the Texas State Employees Union, which represents 2,500 employees at the 12 state schools, said, "We can't keep enough people who are willing to work for those salaries or find people who are really prepared to do the work."

Turnover rates at the Austin State School, he said, have reached 50 percent a year.

Poor working conditions help explain the hundreds of confirmed abuse and neglect cases that have occurred at the state's schools over the past seven years, Gross said.

Documents released Monday from nine of the schools show confirmed instances in which hundreds of mentally retarded children and adults were hit, kicked, knocked down, dragged or humiliated by workers. In other cases, residents needing intensive supervision were left on their own long enough to scald themselves with water, eat cigarette butts or be sexually abused by other residents.

The records show numerous instances in which abusive employees were allowed to remain on the job.

"The system is broken and it needs to be reformed," said Amy Mizcles, director of governmental affairs for The ARC of Texas, an advocacy group for people with intellectual and developmental disabilities.

A spokeswoman for the agency that oversees the schools said the state has moved swiftly in dealing with cases of abuse and neglect and has instituted safeguards to reduce abuse.

The state requires mandatory training, drug tests and background checks, said Cecilia Fedorov, a spokeswoman for the Texas Department of Aging and Disability Services.

"At the same time," she added, "we're dealing with human beings, and you can never guarantee that each human being is going to be perfect."

Caring for the 4,900 adults and children who live in state institutions is not easy. All have been diagnosed with mental retardation; 62 percent also suffer from a psychiatric disorder. Thirty-seven percent are considered medically fragile, meaning they have chronic health problems.

This year, lawmakers approved an additional $48.8 million for the state schools, enough to hire 1,600 more workers. Some advocates for the disabled say more money is not the solution.

"We'll dump another $50 million into this broken system," said Jeff Garrison-Tate of Advocacy Inc., which champions moving beds from large institutions into smaller community-based settings. Read more!

Inmates can get health benefits when released -Corning (NY) Star-Gazette

Advocates say new law will help keep people from returning to jail.

By Cara Matthews
clmatthe@gannett.com

ALBANY -- Gov. Eliot Spitzer has signed legislation that will suspend rather than terminate Medicaid benefits for prisoners while they are incarcerated so they can re-enter society without having to wait two to three months for benefits to restart.

The legislation is being hailed by advocates, who have been pushing it for about 10 years, and the New York State Association of Counties.

"The initiative's been pushed for years, and we've always made the argument that this is a cost saver," said Glenn Liebman, head of the Mental Health Association of New York State. "It's one of those bills that's been around forever -- that were so logical and made sense -- and yet never happened."

Stephen Acquario, executive director of the Association of Counties, said the new law gives former inmates access to health care and mental health treatment, "two of the tools they need to stay out of jail and become productive members of their community."

"It costs considerably less -- in taxpayer dollars and in social capital -- to provide health care treatment and mental health service than it does to fund the revolving door of recidivism into our county jails," he said in a statement.

The legislation is one of nearly 200 the governor has signed or vetoed in recent days. The Medicaid bill is an important one that will especially help former inmates with chronic diseases who "need immediate and uninterrupted attention, and will provide a more seamless transition from prison to community living and increase the chance that offenders will not return to prison in the future," said Jeffrey Gordon, a spokesman for Spitzer.

The daily cost for housing an inmate in a local jail ranges from $291 in New York City to more than $100 for counties outside the city, according to the Association of Counties. Counties and New York City house hundreds of inmates awaiting transfer to state prisons, representing a total of $38 million in annual expenses for counties, the group said.

Currently, New York terminates Medicaid benefits to prevent fraud, the bill's sponsors, state Assemblyman Keith Wright, D-Manhattan, and state Sen. Kemp Hannon, R-Nassau County, said in a memo supporting the legislation. Federal la