Asheville House Transitional Living Program Offered for Sale - Prime Newswire

Editor's Note: Although the following is a press release, not normally run on this blog, it is listed here because of its interest in Western North Carolina. Certainly if the local press would ask if cuts in funding were the reason for closure, it would hold more interest.

August 30, 2007

ASHEVILLE, N.C., Aug. 30, 2007 (PRIME NEWSWIRE) -- Asheville House, a short term transitional living program for adolescents in their latter years of high school and young adults, announced today that the program, along with its campus of residential and educational facilities in Asheville, North Carolina is being offered for sale.

Asheville House opened to residents this spring and was filled through the summer months. The program offered a unique combination of transitional living and therapeutic support focused on participants with drug and alcohol addiction. It also featured a strong educational component to support students finishing high school requirements and taking early college classes through its on site education center.

``We firmly believe in the concept of Asheville House and are anxious to locate a new owner who will be a strong steward of the work we've begun here,'' said Carolyn Bradfield, founder of Asheville House. ``We suspended operations of the facility this month when our last group of residents graduated. Our goal is to work with a new owner to re-establish the program within the coming months.''

Asheville House is located in the historic Montford District of Asheville. The campus includes two restored Victorian homes, serving as residences capable of housing up to 28 residents. They can be used for single gender or mixed gender populations. The main house includes executive offices, a commercial kitchen, laundry and dining facilities. There is a 2-story educational center for online classes and large storage building with added refrigeration capacity.

``Asheville is an ideal location for a therapeutic program,'' added Bradfield. ``It is rated one of the top 10 places to live in the country, has a tremendous labor pool of mental health professionals, a wide variety of recreational opportunities and a community that is very supportive of therapeutic programs. For those in recovery, Asheville boasts a large and diverse young people's community in recovery.''

The campus has all of the necessary permits and inspections for city occupancy. It is recognized by the city of Asheville as a commercial property and zoned as a group home. The facility is license-eligible as a residential program by the NC Department of Health and Human Services having been licensed recently by the previous owners.

The property is fully furnished, with technology and supplies necessary to open a fully functioning program immediately. Additionally, there are two passenger vans that come with the program.

About Asheville House

Asheville House was founded as a 3 to 6 month transitional living program for adolescents in their latter years of high school or early years of college. The program worked with individuals who have been in drug and alcohol treatment, wilderness therapy, residential treatment programs, or therapeutic boarding schools.

A structured and supportive home environment helped participants reintegrate with the community, learn how to live a substance-free life, and better prepare to rejoin their families and friends. To see the program website visit http://www.ashevillehouse.com. To view the renovation process and the facility in detail, visit http://www.ashevillehouse.net. Call Carolyn Bradfield at 770-480-7807 or email her at cbradfield@ashevillehouse.com for more information.

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Stokes officials hope to create mental-healthcoordinator job - Winston-Salem (NC) Journal

By Lisa Boone-Wood

Stokes County officials are working to create a local go-between position for providers of mental-health services and residents who have developmental disabilities, substance-abuse problems and mental illness.

Mental-health advocates in the county urged commissioners in July to consider a mental-health coordinator position as a solution to what they called a failing mental-health system in North Carolina.

As a result, County Manager Bryan Steen is planning the position with the county’s social-services department.

They are meeting with area hospitals and emergency responders, and working with the state to determine a salary and classification for the job, Steen said.

Under a mental-health overhaul, public agencies manage mental-health services in specific areas. CenterPoint Human Services, based in Winston-Salem, serves Forsyth, Stokes and Davie counties.

The system has too many holes, especially in rural counties, said Doris Hill, a volunteer with the Stokes County Mental Health Association who has been pushing for the position.

Hill said that Stokes residents need someone in the county, whom they know, to call on for help.

“If we have a person on top of it, we can see where the problems are from our county. “ she said. “When someone has a chronic or acute mental illness, it is hard to navigate getting treatment and medications.”

CenterPoint officials have said that the position would help improve communication.

A rush for mental-health reform has resulted in “instability and insecurity about the future,” according to a report published recently by Alice Lin, a health and human-services consultant to the N.C. Division of Mental Health, Developmental Disabilities, and Substance Abuse Services.

Stokes officials say they are taking steps to avoid further instability by having a plan in place.

Jimmy Walker, the vice chairman of the Stokes County Board of Commissioners, said that the commissioners recognize the need for the position, but they haven’t ironed out details.

“It’s important because it would be our connection between the people who have the need and those who have the resources to help with the need,” Walker said.

“I want to see the position set up in whatever way will be most effective.

“We had some people do some good work to come up with that concept. I think it’s a very positive solution.”

■ Lisa Boone-Wood can be reached at 727-7232 or at lboone@wsjournal.com.
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Report: N.C. system struggling - Winston-Salem (NC) Journal

Mental-health care changing too fast for providers, it says

By M. Paul Jackson

North Carolina’s mental-health system is changing too fast for its providers to keep up.

That was the finding from a consultant’s report analyzing the state’s mental-health system. According to the report, some mental-health patients have found it tough to get appropriate care because smaller mental-health agencies are struggling to manage within the system.

The 91-page report was released Wednesday. The N.C. Department of Mental Health, Developmental Disabilities and Substance Abuse Services commissioned it in the spring. It was written by Alice Lin, a consultant to the state’s mental-health division.

According to the report, the state has not effectively communicated the system’s changes to its Local Management Entities, the 25 regional agencies that oversee mental-health care in North Carolina.

“In the rush to complete structural changes, the public partners have lost sight of the effect on consumers,” the report read. “There has been insufficient joint effort at resolving consumer access problems.”

The report reviewed seven of the 25 regional agencies that oversee mental-health care. It said that the agencies have problems consistently managing state money and have not received enough help to improve access to care for patients.

The report comes six years after the state made sweeping changes to its mental-health system. In 2001, it shifted care from state mental-health hospitals to local agencies to help keep patients within their communities.

The overhaul did not meet with success. The Winston-Salem Journal published a series of articles two years ago showing how the changes were based on incorrect assumptions about government payments for mental-health programs.

As a result, admissions to the state’s mental hospitals have risen and smaller community agencies have been unable to effectively provide care.

State health officials said they planned to meet with some regional agencies next week to discuss the report.

“This will certainly give us a good discussion point,” said Leza Wainwright, the deputy director of the state’s division of mental health. “We think that Alice has definitely identified some issues, some that we were aware of and some, I think, she has helped bring into focus.”

The report also noted that some agencies made positive changes since the mental-health overhaul.

CenterPoint Human Services, the Winston-Salem agency that oversees the region’s mental-health services, received state approval in May to create a 24-hour crisis program for patients, for example.

CenterPoint’s crisis program includes creating short-term hospital beds for patients in crisis. CenterPoint officials declined to comment on the report.

State mental-health advocates said that the report could help spur improvements to the system.

“We welcome any objective look at the system,” said Yvonne Copeland, the executive director of the N.C. Council of Community Programs, an advocacy group for mental-health agencies.

The report recommended that the state communicate clearly about its changes to the mental-health system and said that the regional agencies should consolidate more business and information-technology services.

“As the LME implementation experience has demonstrated, trust among public partners is fragile and needs to be earned continuously,” the report said. “Six years later, the mutual trust and confidence has not kept pace with the demand of the reform tasks.”

■ M. Paul Jackson can be reached at 727-7473 or at mjackson@wsjournal.com.
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Changes won't be easy or cheap -Newport News (VA) Daily News

BY HUGH LESSIG

RICHMOND -- The governor's Virginia Tech review panel has outlined a course of action that will spark debate over guns on campus and whether taxpayers should dig deeper to help the mentally ill.

In a state still haunted by the image of gunman Seung-Hui Cho, the panel's report will create new questions about how authorities should share information about troubled students. And ultimately, the report and its 70 recommendations will create a ripple effect beyond Virginia, as other states consider ways to strengthen the social safety net and improve campus safety.

The report, formally released Thursday, presents a detailed look at the events of April 16, when Cho gunned down 32 people before killing himself, the worst school shooting in U.S. history.

It tells of a student whose behavior frightened many, but says "no one knew all the information and no one connected the dots."

And its recommendations are potentially controversial and costly for Gov. Timothy M. Kaine and the state legislature, which convenes in January.

MENTAL HEALTH

In December 2005, Cho was temporarily committed to a hospital after writing disturbing messages to one student and telling a roommate he might commit suicide. He was directed to get help as an outpatient. He kept one appointment at a counseling center, but did not return.

The panel says Cho's experience calls into question the procedures of the mental health system and the resources devoted to it.

It recommends a longer evaluation period for the mentally ill who are temporarily detained as potentially dangerous. Currently people can be detained for 48 hours, one of the shortest detention periods in the nation.

The standard for committing someone deemed an "imminent danger" to self or others is not clearly understood, the report says. The report recommends a broader standard that there is a "substantial likelihood" or "significant risk" that the person is dangerous.

It recommends additional secure beds for people temporarily detained against their will.

A leading advocate for the mentally ill in Virginia said she hopes lawmakers seriously consider funding several areas, including more secure beds in the form of crisis stabilization centers.

"You invest in the front end, or you just go back later and you invest in the back end, which ends up being more expensive," said Mira Signer, executive director of NAMI-Virginia. The acronym stands for the National Alliance for the Mentally Ill.

Del. Phil Hamilton, R-Newport News, heads the House of Delegates committee that considers mental health legislation. He has held hearings on Tech-related issues and has monitored meetings of the Virginia Supreme Court mental health commission.

He said common threads are emerging: the need for more caseworkers, more crisis centers and more money. Kaine will set the tone when he introduces a two-year budget in December.

"None of this is going to come without a hefty price tag," Hamilton said.

Kaine has vowed to make mental health a priority, but he did not discuss specifics during a press conference where the report was formally released.

GUNS ON CAMPUS

Cho killed 32 people with a pair of handguns. He bought them in defiance of federal law, since at one point he was judged to be a danger to himself, the report says.

The report recommends requiring background checks for all firearm sales, including private sales at gun shows. Kaine supports this measure.

It says the legislature should pass a law that clearly establishes the right of every Virginia college and university to regulate the possession of firearms if it so desires. Governing boards can set those policies now, but the report says education officials "do not seem to be adequately versed" in what they can do.

However, the panel recommends that guns be banned on campus unless required by law.

It also recommends that Attorney General Bob McDonnell clarify an opinion from a previous attorney general regarding the authority of colleges and universities to ban guns. It says universities have developed various interpretations, adding to the confusion.

McDonnell spokesman Tucker Martin said the two-page opinion from former Attorney General Judith Williams Jadgmann is clear. It reads in part, "It is my opinion that colleges and universities may regulate the conduct of students and employees to prohibit them from carrying concealed weapons on campus."

The Virginia Citizens' Defense League, a gun-rights group, opposes each school setting its own policy. In an e-mail sent to supporters Thursday, it says the state should allow gun permit holders, whether they are students, employees or visitors, to carry guns anywhere on campus.

And the league has long argued that fears about private sales at gun shows are overblown.

Bob Ricker, a former legislative advocate for Virginians for Public Safety, said he had not seen the report. But generally speaking, "for students at least, guns are not appropriate," he said.

PRIVACY ISSUES

The report cites "widespread confusion about what state and federal privacy laws allow." This was important in Cho's case because his parents were never told he had been involuntary committed or judged to be a danger to himself. They did not know about his troubling encounters with students and professors.

Often, the report says, people with sensitive information will not disclose it out of ignorance or because they want to hide behind a statute. It calls upon McDonnell to develop guidelines regarding how privacy laws apply to troubled students.

In a statement, McDonnell noted the report's "apt conclusion" that state and federal privacy laws "are too complex and confusing."

Kaine agreed, saying, "It is imperative that these laws be explored to give clear instruction to people working in the field."

At a separate press conference Thursday, Virginia Tech President Charles Steger said he also recognized the importance of sharing information when needed.

"If we look at a question of the balance between protecting privacy rights and the need to protect the broader society, we will certainly become advocates for a change of the laws," he said.



Staff writer Cathy Grimes contributed to this report.

Copyright © 2007, Read more!

Mental health program faces bleak future -San Gabriel (CA) Tribune

By Will Bigham Staff Writer
08/31/2007

POMONA - A local program that provides housing, employment and other services for mentally ill homeless people is in jeopardy of folding because its funding was cut from the state budget last week by Gov. Arnold Schwarzenegger.

The program, administered by the Tri-City Mental Health Center, serves about 100 people in Pomona, Claremont and La Verne, said Mary Baron, the organization's interim deputy director.

It's annual budget of $900,000 depends entirely on state funding, and with all of that money being lost, officials are now scrambling to come up with a backup plan to fund the program.

"There are no answers right now. This just happened," said Margaret Harris, chief financial officer at Tri-City. "And I believe it will be several months before any answers are known, and at that point in time Tri-City, along with all the other counties, will have to decide on whether they can afford to continue the program."

About $55 million allotted for the program was cut statewide, part of $700 million in cuts made by the governor.

The budget cuts were necessary "so we can have a significant budget reserve, because of the uncertainties that are out there about the economy," said H.D. Palmer,
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a spokesman for the state Department of Finance.

The program was established in 2000 by Assembly Bill 2034. Baron said the program "has been one of the most effective mental health programs ever."

"For Tri-City, it has been an incredibly successful program," Baron said. "The focus is on housing, on education, and on work. Our averages, as far as results, have always met or exceeded the state averages."

Baron said that in June, 25 percent of the people enrolled in the program were employed, and 96 percent were now off the streets.

"It absolutely keeps people off the street, out of jail, and out of psychiatric facilities," Baron said.

State officials suggest that money for the program is available through alternate sources, such as federal and county governments, and through money raised by Proposition 63, which established a 1 percent income tax on millionaires for services for the mentally ill.

Proposition 63 money can go only toward newly established programs, but if programs such as Tri-City's are restructured sufficiently they could qualify for the funding, Palmer said.

"We were hopeful that the governor would not have blue-lined it, so right now all the counties are working with the state to find how other financing can be received to continue these programs," Harris said.

Tri-City's program remains operational, though officials aren't sure when it may have to be shut down if funding is not secured, Baron said.

will.bigham@dailybulletin.com

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Residents Blast Plan to Relocate 16 Mentally Ill Patients - KHNL, Honolulu

Video report here.

By: Mari-Ela David

AIKAHI (KHNL) - Outrage spreads throughout a tight knit Oahu community over a plan to house mentally ill patients.

Under the plan, more than a dozen patients would live under one roof in Aikahi and they would be right next to homes and an elementary school.

More than 60 residents showed up at a meeting Thursday night to voice their concerns. Many were frustrated with the state for not telling them until the last minute about a plan they fear could bring danger right in their backyards.

The proposed site is at a home on Kaneohe Bay Drive. A for-profit organization called CARE Hawaii wants to use the Aikahi home as a care facility for 16 mentally ill patients.

"It isn't fair to the neighborhood because they're mentally ill, but they don't state what kind of illness and what offenses in the past," says Lawrence Wilcox Smith Jr., a resident who lives next door to the home.

The patients would come from Hawaii State Hospital which is plagued with problems such as overcrowding and has a history of patients assaulting staff.

"When you go to that hospital you've been sent there by the criminal justice system," says Rep. Cynthia Thielen.

The primary concern is the home is nestled in the middle of a neighborhood and is only a one-block walking distance from Aikahi Elementary School.

Thielen spearheaded a neighborhood meeting at the school cafeteria where residents demanded answers from CARE.

"Has the company decided how they're going to take care of runners? Escapees? All of these come into mind because you do have children living next door," says Claudine Tomasa, a Kailua resident.

Thielen says it's not just the safety of kids at stake, but also the patients housed there.

"Don't shove people in like cattle into just this crowded situation, that doesn't help anyone," says Thielen.

The ultimate fate of the house lies in the hands of the State Health Planning and Development Agency. Residents say they can only hope their voices will be a factor in the state's final decision.

The Department of Health was at the meeting, saying the court will determine if the patients are stable enough to live in the community.

CARE says it has adequate staff to watch over the patients at the home. The agency has applied for a permit to convert the home into a care facility.

The state will hold a public hearing on the issue Tuesday. No word yet on when SHPDA will make decision.
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Hostage taker wanted to die, sister says -Louisville (KY) Courier-Journal

By Jessie Halladay
jhalladay@courier-journal.com

Guy Ray III left police no choice but to shoot him when he came out of a bank Monday and threatened them with a firearm, his sister said yesterday.

"We feel that these officers were forced to take the action they did," said Nancy Littlefield of California. "He is responsible for what he did," she said of her brother.

Ray, 44, died Monday of multiple gunshot wounds after he came out of a National City bank branch brandishing what turned out to be an air rifle and jogged toward SWAT officers who had surrounded the building.

Eight SWAT officers have been placed on routine paid administrative leave pending an internal investigation into the shooting, said Alicia Smiley, a Louisville Metro Police spokeswoman.

The officers involved are James Kaufling, John Seymour, Jeffrey Hancock, Andrew Eichberger, Andrew Holden, Charles Newman, Bradley Harris and Donald Meredith.

Before the shooting, Ray held four female employees hostage inside the bank at 3603 Bardstown Road. He released the women shortly after police provided White Castle hamburgers to him at his request.

Within a half hour of releasing the hostages, Ray came out of the bank carrying a rifle that was later determined to fire pellets or BBs.

Littlefield said she and her parents believe that her brother, known to family and friends as Nick, went to the bank and took the hostages knowing that it would draw a large response from police.

"Nicky was there to make it happen," Littlefield said. "He had a goal. He was going to force them to shoot him."

Before Ray came out of the bank, he told hostage negotiators that he was bringing out a gun and they warned him not to do that, Chief Robert White said.

All hostage negotiation team members are trained in how to handle mentally ill suspects through the police department's crisis intervention team, Smiley said.

Littlefield said her brother struggled with mental illness since he was a teenager. Over the years he had tried several medications, but his sister said he often didn't like the side effects and would stop taking them. She said she doesn't know if he was on any medication recently.

Littlefield said her brother visited their parents a couple of days before the shooting and gave no indication that he was in a troubled state or suicidal.

While he had never made a plea for help with suicidal thoughts, Littlefield said her family had often worried that he would try to end his life.

"We knew he had always felt lost and unable to function in the world," she said. "We never expected that he would choose such a violent route."

Because he chose to end his life in such a public way, Littlefield said, she and her parents are struggling to deal with the incident. "I feel really sad for the people who were involved. … I'm horrified that these people have this pain they have to live with."

A spokeswoman for National City said none of the employees would comment. The branch, at 3603 Bardstown Road, was closed yesterday to give employees a chance to recuperate, Terri Wilson said.

"They were very, very brave," Wilson said.

Littlefield described her brother as an extremely intelligent man who earned the nickname "The Professor" in high school. She said he was mostly self-taught after dropping out of college because of his mental illness.

But she said he had an aptitude for things, such as taking apart a computer and putting it back together.

Over the years, Littlefield said, her brother would have episodes in which he was consumed by his mental illness. At other times, he would be functioning rather normally.

"There were people who really cared for him," she said.
Two have shot others

Detectives with the department's Public Integrity Unit continued to investigate Monday's shooting.

All of the eight officers involved in the incident were members of the SWAT team. They will be on restricted duty until the case can be reviewed for any potential criminal wrongdoing.

Two of the officers on leave have been involved in previous shootings.

Newman wounded Thomas R. Miller in the knee, ankle and finger during another SWAT incident June 6.

That incident followed a robbery at a McDonald's that led to Miller hiding behind a home near the robbery site. Newman attempted to subdue Miller with a Taser, but then Miller pulled a gun, prompting Newman to fire two shots, police said.

Newman was cleared of any criminal wrongdoing in that case on June 28 by Commonwealth's Attorney Dave Stengel and has been back to work since, said Maj. David Ray, head of the integrity unit.

Officer Kaufling was involved in the fatal shooting of Marshall E. Marbly in August 2002. Marbly, who was mentally ill, barricaded himself in his car and brandished a knife at officers who were called about a man standing in the street directing traffic.

Police used several less lethal options, but when an officer shouted that Marbly had a gun and he raised it, Kaufling and another officer shot him. The gun was later found to be an air rifle.

Stengel determined in April 2003 that Kaufling acted appropriately.

Reporter Jessie Halladay can be reached at (502) 582-4081. Read more!

Montana's most vulnerable citizens well-served by 2007 Legislature - Great Falls (MT) Tribune

By ROSE HUGHES

Children, elderly, and families coping with physical and mental illnesses, abuse, and disabilities, and the people who care for them, are better off today because of the work of the 2007 Legislature.

The Human Services Appropriations Subcommittee — three Republicans and three Democrats — showed us how caring people, working together, can accomplish good things.

They deserve our thanks. Reps. Edith Clark, Joey Jayne and Penny Morgan, and Sens. Dan Weinberg, John Cobb and Greg Lind worked tirelessly on the human services budget.

Their proposals passed both houses with bipartisan support and were signed into law by Gov. Schweitzer. The people of Montana should be proud of these efforts. How we treat our most vulnerable is a reflection on all of us.
Caregivers and service providers...

This Legislature helped thousands of workers across the state who provide hands-on services and care to those who need help — children, the elderly, the disabled, those with mental illness. These people do work that is physically and emotionally draining for low pay and inadequate benefits, in large part because those they care for are on Medicaid.

The Legislature provided funding to assure that these workers make at least $8.50 per hour and additional funding for wage increases beyond $8.50 per hour.

Caregivers will also benefit from a pilot program to provide health-care insurance for low-paid workers who provide personal assistance to disabled and elderly individuals in their homes.

Service providers across all human services programs received modest rate increases each year of the biennium to allow them to keep up with inflation.

These increases help ensure that needed services will be available and of high quality.
Children and families...

The Legislature increased funding for child protective services, foster care, subsidized adoption, children's mental health and flexible funding sustainability for the Children's System of Care.

The funding means better services for our abused, mentally ill and other at-risk children. The funding supports foster parents and those who adopt difficult-to-place children, attempts to keep children in their homes, and allows development of new and creative services.

Property and liability insurance coverage for foster parents and therapeutic foster parents who care for seriously emotionally disturbed youth was also funded.

The Children's Health Insurance Program was expanded to serve more children, and increased access to dental care within Medicaid and CHIP was funded.

Access to quality child care was improved, including a program to assist working caretaker relatives in paying for child care. Montana's neediest families received a modest increase in their monthly financial assistance payment.

Public health and other prevention-focused programs also received attention.

This includes expanded screening for genetic and metabolic conditions, additional funds for public health home visits, start-up funding for Community Health Centers and full funding for the tobacco use prevention program, which distinguishes Montana as one of only five states to fully implement Centers for Disease Control recommendations.

These efforts translate into families having access to more services, including preventive services, lowering future costs for more expensive services.
Developmentally disabled...

The funding system for developmental disability services underwent a major overhaul including significant funding increases, to assure the quality and availability of services.

Funding to address the adult and child waiting lists means more individuals waiting for services can get the help they need.

Funding was approved for a new Vocational Rehabilitation counselor, VR client tuition increases, and the Montana Youth Leadership Forum, which helps train youth with disabilities transitioning into adulthood.

Other legislation addressed the problems governing commitment proceedings for people with developmental disabilities, making community treatment an option, and assuring appropriate handling of court records in cases of commitment to a residential facility.

Additional legislation will make it easier for people with disabilities to testify in cases of alleged abuse and neglect.
Elderly...

The Legislature provided increased funding for services to the elderly in our nursing homes and assisted living facilities as well as those who are still living at home.

Home and community based waiver slots were increased to enable more individuals to be served in their homes and communities.

Aging Services programs which provide meals on wheels, transportation and an array of other services to the elderly also received a substantial boost in funding to expand their services.

Appropriately funding all senior services means that individuals can be served in the setting that best meets their needs.

Other important legislation for seniors included establishment and startup funding for an Older Montanans Trust Fund, designed to meet future needs of an aging population and continued funding of the Big Sky Rx program to assist those on Medicare with prescription drug costs.
Mentally ill...

The pleas of mental health advocates, providers, consumers, family members and law enforcement for desperately needed mental health care close to home were heard.

There is new funding for crisis services for uninsured seriously mentally ill Montanans, including limited funding for new community crisis beds and funding for expanded tele-medicine so that rural communities have better access to psychiatric expertise.

Legislators funded a statewide suicide prevention coordinator, a statewide suicide prevention hot line, new community drop-in programs (such as The Hub in Billings) and more money for the Mental Health Services Plan, which pays for limited mental health services and medications for people with no other insurance or ability to pay.

People with mental illness who are on probation or parole will have improved access to needed community mental health services and prescription medications.

The focus of the human services budget was to put things in place now that will reduce costs in the future.

The Legislature focused on prevention, early intervention and access to care.

It focused on providing services in our communities and stabilizing and lowering the populations of institutions, including the state prison. It increased funding for workers and providers in communities throughout the state to assure that care would be available for those who need it, now and in the future.

The human services budget is about people, and when the 2007 legislative session ended, the people won.
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Jail Savings - Bangor (ME) Daily News

Editorial
August 30, 2007

Gov. John Baldacci’s county jail consolidation plan is a welcome move to try to save tax dollars. It’s too soon to say whether the plan would work or save the amount of money promised, but lawmakers should be eager to start going through its details and testing its ideas.

The governor would have the state take over Maine’s 15 county jails, close four — in Oxford, Franklin, Piscataquis and Waldo counties — and consolidate administration. As with Baldacci’s school-district administration consolidation, more savings would come through greater efficiencies in central offices, through purchases — in the jails’ case, medical costs and pharmaceutical contracts are big — and more effective use of bed space throughout the system.

For instance, while jails in Knox or Penobscot counties are overcrowded, those in Cumberland and York are operating under capacity. Yet because counties set their own rates, according to Corrections Commissioner Martin Magnusson, York might have a per-day cost of $45 per prisoner but charge $105. That’s an added tax burden on the sending county.

Maine county jails have additional burdens that raise costs but need to be met: better service for the mentally ill, treatment for substance abuse, and services for women. Over the last three years, county jail budgets have cumulatively risen more than 12 percent annually, as the state prison costs have risen at less than half that rate. New county jail construction — even as some jails have enough space —will keep that rate high.

The governor says the first year projected savings from administrative efficiencies at the jails is conservatively $10 million. He says he believes more consolidation opportunities will push that number higher in future years. Under the governor’s plan, property tax rates would be frozen at their current levels, with added costs picked up by the state in subsequent years. That’s an attractive idea, but the public should be given a better sense of how that would work in both the short and long terms. As more details of the savings are released, this is a good place for legislators and the public to examine the potential of this plan.

The governor says he wants to build public support for this consolidation — a task that should be considerably easier than the one he launched for school-district administration. One way he could do that is to encourage money-saving suggestions from jail personnel, local taxpayers and even county officials who, after all, have been looking at county-level savings possibilities for years.

By raising this issue, Gov. Baldacci offers Maine the chance to save substantially over the long term and to create a higher-quality jail system simultaneously. The desire for this reform should be applauded by the public, but its details should be examined closely over the next couple of months. Done right, property taxpayers, as well as people in jail, could end up better off. Read more!

ValueOptions eliminates 500 jobs -Phoenix (AZ) Republic

By Ken Alltucker
Aug. 30, 2007

About 500 ValueOptions administrative positions will be eliminated this week as a competing provider takes over Arizona's $1.5 billion contract to manage Maricopa County's public mental health system.

Another 1,400 therapists and other ValueOptions clinic workers will become Magellan Health Services employees beginning Saturday when the new provider officially assumes control of the county's mental health services. Magellan hired the clinic employees to ensure a smooth transition for patients.

Yet managers, finance, information technology and other administrative jobs are no longer needed as ValueOptions exits Maricopa County. The Norfolk, Va.-based provider will retain a small staff of claims specialists and other administrative positions to tie up loose ends.

The big switch stems from Arizona's decision this year to award Magellan a three-year, $1.5 billion contract to manage behavioral health services for more than 60,000 low-income and mentally ill patients. ValueOptions held the contract since 1998, but the company was the target of many complaints about its patient care and case management.

Magellan spokeswoman Erin Somers said the incoming provider's top priority is caring for patients.

"We want to make sure the clinics are up and running Sept. 1," Somers said. "Once we get that underway and make sure we are servicing the needs of the consumers, we can take a look at gaps we have in our staffing."

She said that Magellan expects to study its case management staffing levels and decide whether additional managers are needed to ensure quality patient care.

ValueOptions has attempted to keep employees with the company through the end of this month by offering retention bonuses. Some have accepted new jobs at ValueOptions locations in other states. Other employees have already taken new jobs or returned to school.

Ortiz said about 286 administrative employees remained with ValueOptions through this week, mostly workers in the provider's quality management and evaluation departments. The other administrative workers whose jobs were eliminated already moved on.
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Killer's Parents Describe Attempts Over the Years to Help Isolated Son - Washington Post

By Brigid Schulte

Sometimes, Hyang Im Cho would become so frustrated with her son, Seung Hui Cho, that she would shake him. He rarely spoke. And when he did, it was just a few words, barely above a whisper. He never looked anyone in the eye. It was as if he lived walled off in a world of his own. Try as she might -- with countless visits to counselors and psychologists, treatment with antidepressants or art therapy, and attempts to find him friends at basketball camp or taekwondo or church -- no one could break through.

Like any mother, she wanted her son to fit in. Like any immigrant, she felt that no sacrifice was too great to make sure he found a place for himself in this new country, even if it meant overcoming the deeply ingrained stigma in Korean culture of admitting mental illness.

She knew he was troubled and isolated. But it wasn't until her son killed 32 students and teachers at Virginia Tech on April 16 that she knew just how twisted his private world had become.

And how little she knew him.

Hyang Im Cho, along with her husband, Sung Tae Cho, and daughter, Sun Kyung, spoke about Seung Hui Cho to the panel appointed by Gov. Timothy M. Kaine (D) to investigate the Virginia Tech shootings. The panel's report, formally released yesterday, paints the most complete portrait to date of Cho's frail and sickly childhood; his hopeful middle and high school years bolstered by intensive psychological therapy, medication and a supportive school environment; his misplaced aspirations to become a famous writer; and, as that dream slipped away, his descent into madness.

The report also provides for the first time some perspective from Cho's family. They were shocked when they learned of his violent writings. Cho had always been so secretive, typing away on his computer but refusing to share what he wrote. They had no idea that he had been briefly hospitalized at a psychiatric institution during his junior year at Virginia Tech and had been declared mentally ill. The son, the hospital and the court never told them.

"We would have taken him home and made him miss a semester to get this looked at," the Chos told the panel. "But we just did not know . . . about anything being wrong."

Until now, the family's only public comment had been a statement of deep remorse in the days after the tragedy. "We never could have envisioned that he was capable of so much violence," they wrote at the time. The Chos, who own a townhouse in Centreville, have been in seclusion since April. Cho's sister, a graduate of Princeton University, has been on leave from her job as a contractor with the State Department. Wade Smith, the Chos' attorney, who released the statement, did not return repeated phone calls yesterday. Smith arranged for the Chos to meet with the panel for a three-hour interview. Sun Kyung translated, as she had for many of her brother's conferences.

Although the panel said neither it nor the police had uncovered a motive for Cho's rampage, his sister provided a key piece of the puzzle. Cho began his college career as a business information technology major but, by the time he was a sophomore, decided to switch to English, which was one of his weakest subjects. Nevertheless, he was convinced that he could be a great writer. He had written a novel, which he described to teachers as "sort of like Tom Sawyer except that it's really silly and pathetic," the report said.

Later that year, after his sister found a rejection letter from a New York publishing house, she noticed that he became increasingly depressed and detached. His English grades ranged from B's to D's, and his rage grew as he felt no one understood him or his talent.

Life had always been difficult for Cho. As an infant in South Korea, he developed whooping cough and was hospitalized with pneumonia. Doctors told the family that he had heart troubles and, when he was 3, they performed an invasive procedure to examine him. From then on, Cho did not like to be touched.

In Korea, Cho had a few friends he played with. But once the family moved to the United States in 1992 to provide a better education for the children, Cho became more withdrawn. If he talked to anyone at all, it was to his sister. Even then, he would never tell her what he was thinking or feeling. She knew he was being taunted for his accent and inability to speak English, as was she. But whenever she'd ask him about it, he would always say he was "okay."

Even that limited communication disappeared when a visitor came to the home. The family noticed that Cho's palms would become sweaty, he would freeze, would sometimes cry and was able only to nod yes or no. His parents, by then working six days a week at dry cleaners, pressured him to talk. His mother urged him to "have more courage," the report said.

When Cho was still in elementary school, the family decided to "let him be the way he is," the report said.

In 1997, the summer before he entered middle school and on the school's recommendation, the family took Cho to the Center for Multicultural Human Services, where he saw an art therapist and a psychiatrist who diagnosed a severe social anxiety disorder. "It was painful to see," one of the psychiatrists told the panel. The Chos took turns leaving work early to get their son to his sessions every week. In art therapy, Cho made houses out of clay that had no windows or doors. Sometimes, when the therapist explained that his artwork showed how inadequate he must feel, Cho's eyes would fill with tears.

In 1999, during the spring of eighth grade, the clay houses morphed into disturbing caves and tunnels. Cho wrote in a school assignment about wanting to "repeat Columbine." A psychiatrist diagnosed selective mutism -- the inability to speak in certain circumstances because of profound social anxiety -- and prescribed paroxetine, an antidepressant. The drug treatment was discontinued after one year because Cho seemed much improved.

When Cho was at Westfield High School in Chantilly, his inability to communicate and lack of social skills landed him in a special education program designed to help him succeed in school. He was excused from participating in class discussions and received language therapy once a week. The plan enabled him to graduate with a 3.52 grade-point average in a demanding honors program. As a junior, he resisted further therapy. "There is nothing wrong with me," he complained to his parents, according to the panel report. "Why do I have to go?"

When Cho was a senior, his guidance counselor strongly encouraged him to attend a small college close to home. But Cho had his sights set on Virginia Tech, where he was accepted on the strength of his grades and SAT scores. When his school records were sent, as is common practice, there was no mention of the special education provisions or his condition.

At Virginia Tech, he became increasingly isolated and behaved in a bizarre manner, stabbing a carpet with a knife at a party and yelling at a teacher who told him to drop a class. His writing likewise became increasingly violent.

The night before their once-invisible son would become infamous for the worst mass shooting by a lone gunman in U.S. history, the Chos had their weekly Sunday evening phone call with him. It was typical. He was fine. No, he didn't need money. His parents ended with, "I love you."

The report does not say whether Cho answered


Read more!

Filling mental health void a top priority -Gray's Harbor (WA) Daily World

By Steven Friederich
August 30, 2007

A spokesperson for Behavioral Health Resources, an Olympia-based mental health organization, said they stand ready to “cover the needs” of some 900 Evergreen Counseling Center clients, but “whether that will be in the interim or permanently is up in the air.”

In the wake of Evergreen’s decision to close its doors, Grays Harbor County Health Department officials and administrators at Evergreen are exploring options with the CEO of Behavioral Health Resources and the management of another health center.

Evergreen’s volunteer board decided Monday to pull the plug after 39 years on the Harbor, concluding that a funding contract offer from the county would mean laying off 16 staff members — too big a hit for the center “to provide mental health services in accordance with ethical and professional standards.”

Evergreen, which employs 58 people and serves 937 clients, will close on Sept. 30.

Maryann Welch, the county’s director of public health, says she and three staff members will work with the center’s administrators to find alternative mental health counseling providers.

Welch planned to meet today with John Masterson, CEO of Behavioral Health Resources, which has an office in Elma. She said she will also talk with officials at Sea Mar Community Health Centers, a low-income health care provider that has a clinic in Aberdeen.

Behavioral Health Resources already sees 2,000 patients per month and has more than 350 staff members, including several psychiatrists and nurse practitioners. It operates an in-patient hospital and already manages a lot of the services that Evergreen has provided in the past.

Most of its facilities are in Olympia and one question that will have to be resolved if Behavioral Health Resources takes over the bulk of Evergreen’s load is where those services will be provided, on Grays Harbor or in Olympia or some combination of the two. That’s the kind of thing that the health care providers and county officials will be working on.

“This will not be easy, given the short time frame we’ve been provided,” Welch said. “We really need to get a response from both of them (Sea Mar and Behavioral Health Resources) on what they think they can do. And then they have to sit down with their organization and their management.”

Judith Hoefling, the community relations director with Behavioral Health Resources, said her organization already provides some mental health services to East Grays Harbor as well as to Thurston and Mason counties.

“We are the closest, major mental health provider and we will take whatever steps necessary to prepare for an influx of people who need our help,” Hoefling said.

Hoefling said her agency learned of Evergreen’s imminent closure Tuesday morning and immediately started working with county officials and Evergreen management.

Rogelio Riojas, a spokesman at Sea Mar, said he was just hearing about the closure on Wednesday.

“This is very surprising to us that they are closing their doors,” Riojas said. “We will help in whatever way we can, that’s for sure.”

Both Sea Mar and Behavioral Health Resources had been planning to enhance their presence on the Harbor in terms of mental health care, even before Evergreen’s announcement.

Sea Mar had asked the county for funds for two staff people at its Aberdeen clinic. Behavioral Health Resources had asked for money to start a new office in Aberdeen for “consumers who need intense services, which is something Evergreen didn’t provide,” Welch said. (The Daily World incorrectly reported Wednesday that Sea Mar would be providing those services.)

Behavioral Health Resources was offered a $1.3 million contract over a nine-month period starting in October. It is receiving $620,000 for the current nine-month period.

Sea Mar was offered a $160,000 contract starting in October.

Some of that money, routed from state and federal sources, had been going to Evergreen. The re-allocation was done under the watch of county-appointed citizen advisory boards, Welch said.

Hoefling said Behavioral Health Resources had not yet signed its contract. Riojas said Sea Mar would never have applied for the funding, had it known it would be taken away from Evergreen and contribute to the local agency’s closure.

The allocated budget for Evergreen went from about $386,000 per month in 2005 to around $325,000 per month in the most recent contract. The new contract offer was about $293,000 per month or $2.6 million over nine months, starting in October.

Riojas said, “If we had something to do with their closure, we feel bad about it.”

Some wondered yesterday whether anything can be done to keep Evergreen afloat.

Welch said none of the conversations she’s had so far have focused on anything the county could do to save Evergreen. Rather, “we’ve been working with BHR on the issues of transition.”

But if both of the other agencies are willing to take less money to make sure Evergreen stays at their current level of service, would the county go for that?

“Evergreen did not provide us with any information on what it might take to keep them open,” Welch said. “We don’t even know that from them. We gave them the information on what their contract would be, and they responded several days later that they would be closing their door.”

Melissa Fox, interim executive director for Evergreen, said, “Without the funding we had been receiving … if we were to remain open, we would have to reduce by a minimum of 16 direct service providers.”

That wasn’t acceptable to her or the board, she said, noting the local agency was in a “Catch-22” scenario since by cutting funding, that would mean cutting staff and not being able to live up to the county’s contract to provide adequate mental health services.

Welch said the details of Evergreen’s new contracts weren’t yet set up, “We would have expected any reduction in funding would have resulted in a reduction of staff to some extent but we expected there would be a staff increase at BHR and Sea Mar. They would offer different services and BHR, in particular, would increase their services by opening an Aberdeen office.”

Is that better than having a local agency provide mental health coverage?

“I wouldn’t characterize it quite that way,” Welch replied. “We were looking at any mental health agency that meets the requirements to operate under our funding, whether they’re based in Olympia or locally is beside the point. BHR’s services in East Grays Harbor have been very well received and we have been happy with their services.”

Hoefling said Behavioral Health Resources’s new office would be an adult out-patient facility, which could be used by persons with any kind of mental illness, but would likely specialize in helping those with bipolar disease as well as schizophrenia.

“We are very distressed for Grays Harbor and Aberdeen, but we will do what we can to help,” Hoefling said.

Riojas said that at Sea Mar’s clinics, “We try to provide as many services as possible because our patient needs are so high and they need so many services. One of the areas we try to combine is mental health and medicine. … We had no idea that our request for funding was going to impact Evergreen Counseling Services in such a way.”

Does Evergreen’s closure impact you? The Daily World would like to know. Please e-mail sfriederich@thedailyworld.com or call (360) 532-4000 ext. 134. Read more!

A True Madhouse - Princeton (NJ) Packet

By: Susan Van Dongen

A new book details the insanity of the practices performed on patients at Trenton State Hospital in the early 20th century.
image

Even more chilling than the thought of being incarcerated when innocent is the idea of being committed to a psychiatric hospital against one's will. Certainly, these are places where genuine healing can take place, especially now with the breakthroughs in medications. However, the "lunatic asylum" or "bughouse" of the past still conjures a special kind of horror deep down in the gut.

If you've shrugged off those archetypal fears, reading author Andrew Scull's soon-to-be-published Madhouse: A Tragic Tale of Megalomania and Modern Medicine (Yale University Press, $18) will bring you back to full blown disquietude. The meticulously researched book tells the story of Henry Cotton, superintendent of Trenton State Hospital in the early 20th century, whose radical ideas about healing mental illness led to countless deaths and unspeakable anguish among the patients.

Madhouse reveals a long-suppressed medical scandal, shocking in its brutality and sobering in its implications. Convinced that he had uncovered the single source of psychosis, Dr. Cotton launched a ruthless campaign to "eliminate the perils of pus infection." Teeth were pulled, tonsils were excised and stomachs, spleens, uteruses and colons were all sacrificed in the assault on "focal sepsis."

Randall McMurphy and the fictional One Flew Over the Cuckoo Nest crew had it 100 times better than the poor souls at Trenton State.

Warnings of Dr. Cotton's macabre practices fell on deaf ears for years until a legislative committee, led by Sen. William Bright, focused its investigations of waste in state government on the hospital's affairs. That's when a profusion of gothic horrors came into light.

"Ex-patients, their families and disaffected former nurses and attendants had surfaced and a litany of lurid tales had filled the pages of the state's newspapers," Mr. Scull writes. "The scandal had even begun to draw the attention of the august 'New York Times.' Stories of patients being beaten, kicked and dragged screaming into the operating room, of trolleys filled with body parts and not a few corpses streaming in the opposite direction, had aroused the archetypal fears of the horrors of the madhouse that always linger just below the surface in our collective unconscious."

Mr. Scull has written numerous books about the history of treating mental illness, and was working on a tome about "managing lunacy" in Victorian England when he stumbled on a small item about therapeutic practices in the first part of the 20th
century.

"Most of the treatments from those times were ill-conceived and have now been abandoned," Mr. Scull says, speaking from his home in San Diego. "I've (written about methods) such as electric shock therapy, lobotomies and insulin comas. Scientists have wondered where the origins of these illnesses came from and tried all sorts of things. Unfortunately, patients' rights were (weak) up until World War II.

"I came upon a reference or two to Henry Cotton, and over the years collected a number of materials," he adds. "Some of my Princeton contacts happened to know people in the New Jersey mental health bureaucracy and that got me access to a lot of hospital records."

With training at the University of Maryland and Johns Hopkins, Dr. Cotton apprenticed in psychiatry at the Sheppard and Enoch Pratt Hospital in Baltimore under the eminent Princetonian Stewart "Felix" Paton. He later obtained an even more prestigious post at the Worcester State Hospital (Worcester, Mass.) under Swiss neuropsychiatrist Adolph Meyer, himself educated in Zurich, Paris and London. Indeed, Trenton State, which had been mismanaged for years, was fortunate to get someone with such excellent scientific credentials.

Dr. Cotton began as a reformer and a progressive, with at least a few humane ideas about treating patients, for example, abolishing restraints.

"He wanted to solve the riddle of psychosis, but he was also in despair about the state of mental hospitals he encountered and wanted to find a way forward," Mr. Scull says. "Some of the reforms included doing away with restraints and re-training his doctors. Then he happens upon this idea of focal infections, poisons in the bloodstream that are affecting the brain.


"Once he's become convinced of something, he blinds himself to anyone else's theories," Mr. Scull continues. "If you're pulling out their teeth and they get better, well that's OK. If they don't get better, (the infection) must be somewhere else in the body, or he thought, 'it was too late, that's why this person didn't get better.' (For scientists like Dr. Cotton) you can find ways to explain why the treatment didn't work. The danger always was therapeutic enthusiasm."


One of the most disturbing facts that comes to light in Madhouse is the disproportionate number of women who were operated on.


"Cotton had three well-equipped operating services, two for women and one for men, which are busy most of the time," Mr. Scull writes.


One good — or terrible — example is former patient Mrs. Georgiana Phillips. During Dr. Cotton's trial, she appeared, stating that she had been committed on the grounds of "immorality, indigency and moral insanity" — in other words, prostitution.

Claiming that she had been sane when shut away and in direct violation of her wishes — and a court order — Mrs. Phillips had been "compelled to undergo a delicate operation while a patient at the state hospital."

"He removed her ovaries," Mr. Scull says. "This was also a pattern when you look at lobotomies. This is conscious gender bias at work. It's not that men were exempt from this, but among women patients 60 to 65 percent had their colons removed. Even with gender neutral parts of the body like the colon, women seemed to fall into (Dr. Cotton's) clutches."

You might wonder how one would digest and eliminate food without a colon, and Mr. Scull remarks that a patient would simply be left incontinent.

"This accounts for many of the deaths," he says. "This was murderous. There was nearly a one in two chance for death."

Dr. Cotton had almost a fetish about pulling teeth. He removed the teeth of his two sons — both of whom would go on to commit suicide — and even had his own removed.

"This is someone who genuinely believes in what he's doing," Mr. Scull says, adding that a visitor to Trenton State, who came from Johns Hopkins, observed room after room of patients with no teeth, but also no dentures. "Because they couldn't chew their food, they were malnourished. In fact, during those times, in New Jersey, if you didn't have any teeth, people suspected you had been at Trenton State."

Mr. Scull is a professor of sociology and science studies at the University of California in San Diego. He is the author or co-author of nine books, the most recent (before Madhouse) being Customers and Patrons of the Mad Trade: The Management of Lunacy in Eighteenth Century London (University of California Press, 2003), which he co-wrote with Jonathan Andrews. He earned his doctorate in sociology from Princeton University in 1974.

Even with the gruesome pseudo-science and the growing number of casualties at Trenton State, Mr. Scull writes that until the news spread, families cheerfully sent their kin to be treated.

"There was a belief that mental illness was a biological problem and could be treated," Mr. Scull says. "Very wealthy and intelligent people brought their family members to these centers. Yale professor and economist Irving Fisher brought his daughter to Trenton State for treatment and Cotton killed her."

Mr. Fisher had been an advocate of vegetarianism, exercise, hydrotherapy and paying attention to healthy bowels. In fact, he was good friends with John Harvey Kellogg and took his family to Kellogg's health center in Battle Creek, Mich.

"He only wanted the best for his child," Mr. Scull says. "That case in particular helps us understand how educated people saw the logic in (Dr. Cotton's practices). But patients were so vulnerable and controls were non-existent. Medical treatment has changed some, but even today patients put themselves in the hands and the mercies of doctors. These days, though, there are reviews and we can pull back if we decide we don't want a treatment. (In Dr. Cotton's time), once patients had been certified as mentally ill, they lost their rights as a person, lost their autonomy."

Andrew Scull's Madhouse: A Tragic Tale of Megalomania and Modern Medicine will be available in bookstores and online at www.yalebooks.com beginning Sept. Read more!

Funny, inspiring documentary helps mentally ill battle stigma - Ottawa Canada Citizen

It's hoped that a video link to this documentary will be posted once it is posted on the Canadian Broadcast System website.

Tony Lofaro, Ottawa Citizen
August 29, 2007

A woman dressed in a wedding gown walks up to a microphone. She's clearly nervous as she faces the audience in what appears to be a comedy club.

"Did you ever get the feeling you're supposed to be somewhere else," she deadpans, eliciting chuckles.

This is Eufemia Tantetti, one of the people featured in the new documentary, Cracking Up. She's not a professional comedian. In fact, she is a victim of childhood abuse and has battled clinical depression most of her life. Her mother was schizophrenic.

The fact Ms. Tantetti is able to face strangers speaks highly of her courage and the success of a course she participated in that helped her battle her demons through standup comedy.

Cracking Up follows a year in the life of 11 people who suffer from mental illness and use laughter as therapy. The documentary airs tonight at 9 p.m. on CBC.

The documentary is funny, inspiring and insightful as it shows the progress of these individuals who have no formal training in comedy but, through steady reinforcement and encouragement, take to the stage.

Their success as performers is largely attributed to Vancouver's David Granirer, a standup comic who fought depression for about 15 years and is on medication. In his course, he coaches people with mental illness to confront their disease through standup.

"Part of the healing capacity of the course is that they take incidents they're ashamed of, turn them into standup comedy, tell them to people and then have audiences afterwards tell them how wonderful they were," said Mr. Granirer, 46, in a telephone interview from Vancouver.

"All of a sudden they feel, 'I'm not such a bad person after all and people can relate to me.' It really helps to diffuse a lot of the shame they have."

Mr. Granirer is the founder of Stand Up for Mental Health, a Vancouver-based group with chapters in several Canadian cities, including Ottawa.

He says people in his course have a desire to perform standup, but they also have a commitment to "fight the public stigma" of mental illness. He says the participants in the documentary felt it was part of their "contribution to the mental health community" to bring about a better understanding of the disease.

Some of those in the documentary are Robbie Englequist, a schizophrenic, Michael, who is bi-polar and has attention deficit disorder, and Paul, who suffered a traumatic injury to his brain and spine after he fell from a balcony when he was two years old.

"When I had met Robbie, he had come through years of failure, he was frightened and withdrawn," said Mr. Granirer.

"But as the year progressed, he completely changed. It's like he came back to life. His mom says he has something to live for now and he's changed in his attitude about things."

Mr. Granirer says Robbie has developed a resilience to his personality, he's more confident and feels that he's accomplished something after going through the comedy course.

"And for the first time in his life, he's getting attention for doing something positive, instead of getting attention for getting in trouble, fighting or doing drugs." Read more!

No simple solutions to issues of mental illness-Denver Post

Editorial:
08/29/2007

The University of Colorado needs to walk a careful line between protecting its students and needlessly stigmatizing the mentally ill in the wake of a shocking attack in a student cafeteria outside University Memorial Center.

Indeed, all of society needs to practice the same balancing act between prudence and persecution.

A cashier at the Alferd Packer Grill in the UMC, identified as Kenton Astin, 39, was arrested for using a steak knife Monday to slice the throat of a freshman student. Astin then stabbed himself repeatedly before police subdued him with a stun gun. The victim, Michael George Knorps, 17, is expected to recover. Astin was hospitalized in serious condition.

In the wake of the attack, the university announced it would undertake criminal background checks on all new employees, a prudent move. It also suspended, with pay, all employees who had been recommended by the Mental Health Center of Boulder County - the agency that referred Astin to CU - until they can be checked out.

With the benefit of hindsight, there is much in Astin's background that could have warned the university that he could pose a threat to other people and to himself. Astin was arrested in Longmont in 2001 for a similar, unprovoked knife attack on a citizen. If a further red flag was needed, the fact that he used several aliases during that period - including that of Dylan Klebold, one of the two perpetrators of the mass killings at Columbine High School - would have served nicely.

Astin later was found not guilty of the Longmont stabbing by reason of insanity and sent to the state mental hospital in Pueblo, which released him two years ago to the supervision of the mental health center. CU officials said he had a good work record prior to the attack but would not have been hired if the university had known about the previous attack.

Which, of course, raises a very good question: Why wasn't the university told about that incident and other pertinent parts of Astin's record?

Unfortunately, not all good questions have good answers - let alone easy ones. Mental health experts must continually balance issues of patient privacy and public safety. It's clear, after the fact, that this time they leaned too far toward protecting Astin. But it is equally clear that unless the mentally ill are to be locked away for life, there must be some way of treating them and eventually re-integrating them into society. One of the most important steps is getting recovered patients back to gainful employment.

At this point, the issue of patient privacy stops being merely an ethical issue and assumes a pragmatic dimension. If knowledge of past offenses is too widely disseminated, it may preclude the patient from getting a job. If such knowledge leaks into the general community, it can be damaging.

Clearly, past violent acts should be disclosed to potential employers, along with current diagnoses and treatments. But employers, in turn, must treat such information with the utmost respect and use it to channel the formerly mentally ill into jobs suited to their current behavior, not refusing to hire them at all. Read more!

No simple solutions to issues of mental illness-Denver Post

Editorial:
08/29/2007

The University of Colorado needs to walk a careful line between protecting its students and needlessly stigmatizing the mentally ill in the wake of a shocking attack in a student cafeteria outside University Memorial Center.

Indeed, all of society needs to practice the same balancing act between prudence and persecution.

A cashier at the Alferd Packer Grill in the UMC, identified as Kenton Astin, 39, was arrested for using a steak knife Monday to slice the throat of a freshman student. Astin then stabbed himself repeatedly before police subdued him with a stun gun. The victim, Michael George Knorps, 17, is expected to recover. Astin was hospitalized in serious condition.

In the wake of the attack, the university announced it would undertake criminal background checks on all new employees, a prudent move. It also suspended, with pay, all employees who had been recommended by the Mental Health Center of Boulder County - the agency that referred Astin to CU - until they can be checked out.

With the benefit of hindsight, there is much in Astin's background that could have warned the university that he could pose a threat to other people and to himself. Astin was arrested in Longmont in 2001 for a similar, unprovoked knife attack on a citizen. If a further red flag was needed, the fact that he used several aliases during that period - including that of Dylan Klebold, one of the two perpetrators of the mass killings at Columbine High School - would have served nicely.

Astin later was found not guilty of the Longmont stabbing by reason of insanity and sent to the state mental hospital in Pueblo, which released him two years ago to the supervision of the mental health center. CU officials said he had a good work record prior to the attack but would not have been hired if the university had known about the previous attack.

Which, of course, raises a very good question: Why wasn't the university told about that incident and other pertinent parts of Astin's record?

Unfortunately, not all good questions have good answers - let alone easy ones. Mental health experts must continually balance issues of patient privacy and public safety. It's clear, after the fact, that this time they leaned too far toward protecting Astin. But it is equally clear that unless the mentally ill are to be locked away for life, there must be some way of treating them and eventually re-integrating them into society. One of the most important steps is getting recovered patients back to gainful employment.

At this point, the issue of patient privacy stops being merely an ethical issue and assumes a pragmatic dimension. If knowledge of past offenses is too widely disseminated, it may preclude the patient from getting a job. If such knowledge leaks into the general community, it can be damaging.

Clearly, past violent acts should be disclosed to potential employers, along with current diagnoses and treatments. But employers, in turn, must treat such information with the utmost respect and use it to channel the formerly mentally ill into jobs suited to their current behavior, not refusing to hire them at all. Read more!

Insanity ruling cleared suspect in 2001 assault -Denver (CO) Rocky Mountain News

By Berny Morson, Hector Gutierrez And Justin Coons
August 28, 2007

For Dylan Trembly, Monday's attack on a student at the University of Colorado was a grim and eerie rerun.

Trembly, 27, was stabbed six years ago. His knife-wielding attacker had an evil look in his eye and mouthed words about how everyone was "going to burn in hell."

The man was Kenton Astin, the same man held Monday in the stabbing of CU student Michael Knorps.

Astin was acquitted by reason of insanity in the 2001 attempted murder of Trembly.

"I couldn't believe it, you know," Trembly said after he learned of Monday's incident. "It blew me away. I haven't thought about it in a while."

Trembly still has scars on his left ankle and right hand from where Astin stabbed him without provocation inside a Salvation Army store in Longmont.

"He was just giving me the evil eye, and I was like, 'whoa,' " Trembly remembered as he juggled his 2-year- old son, Wyatt, on his knees. "Apparently, he was waiting for the perfect person."

Without saying a word, Astin charged Trembly, knocked him to the ground, stabbed him and tried to choke him. Trembly said he managed to wrestle the knife away from Astin, slash his assailant's cheek and gain the upper hand.

"He pulled out a Bible and started saying, 'We're all doomed . . . We're all going to burn in hell.' Apparently he thought I was the devil," Trembly said.

Astin was charged with attempted homicide and was sent to the Colorado Mental Health Institute in Pueblo. In October 2005, he was released to a halfway house at 748 19th St. in Boulder, on the edge of the University Hill neighborhood.

University of Colorado Chancellor Bud Peterson said Astin was employed at the university as a cashier at the Alferd Packer Grill from October 2006 through April. Chinook Clubhouse, a Boulder- based nonprofit that helps find employment for mentally ill men and women, had referred Astin to CU.

Peterson said Astin was not given a background check before starting work and that the school does use such checks, but at different degrees depending on employment. All Chinook-referred employees will be placed on seven-day suspension, pending review of their backgrounds, he said.

Astin had no criminal record while at the halfway house. A Boulder judge in April placed Astin on "conditional release," a status that requires less supervision and indicates that the court agreed he was doing well, said Liz McDonough, spokeswoman for the Colorado Department of Human Services. He had to continue to live at the halfway house and receive treatment at the Boulder Mental Health Center.

Trembly said he holds no animosity toward Astin, but saidthe second attack involving the same culprit is a wake-up call to the mental health profession.

"The poor man needs help," Trembly said.

morsonb@RockyMountainNews.com or 303 954-5209

Read more!

Mental disorders leading cause of homeless hospital visits - Toronto (Cananda) Globe & Mail

By ANNE-MARIE TOBIN
August 30, 2007

TORONTO — More than half of hospital stays by homeless Canadians are a direct result of mental disorders, suggests a study of mental health and homelessness released Thursday.

The report by the Canadian Institute for Health Information describes homelessness as a "harsh reality" for more than 10,000 people staying in shelters on any given night in Canada, and provides an overview of research and interventions for people living on the street and in shelters.

In particular, it pulls together hospital data on admissions in 2005-06, and the reasons behind them.

"This is the first time we're tracking this kind of information," Elizabeth Votta, an author of the report, said from Ottawa.
Internet Links

* CIHI report: Homeless and hospitalization Popup

The Globe and Mail

"It's data that's collected from Vancouver, Calgary and Toronto — primarily Toronto because that's the way the database is set up — but what it's telling us is that 52 per cent of homeless persons that are being hospitalized are being done so for mental disorders ... and that's much higher than the general population, which is coming in at five per cent."

A portion of the report looked at selected emergency rooms, mostly in Ontario, and found that 35 per cent of visits by the homeless were related to a mental disorder. Substance abuse accounted for 54 per cent of those mental disorders, followed by psychotic disorders, such as schizophrenia, at 20 per cent.

The report notes Aboriginal Peoples are over-represented among the homeless in cities across Canada, and men comprise three-quarters of the hospital visits by the homeless.

"One of the things from a stigma point of view that we want to get across is that not everyone who's mentally ill is going to become homeless, and not everyone who's homeless has a mental illness," said Ms. Votta.

"But we do have to recognize that there is that higher prevalence of mental illness and compromised mental health among the homeless."

Bill Wilkerson, co-founder of the Global Business and Economic Roundtable on Addiction and Mental Health, expressed impatience with the report, which noted homelessness is linked to stress, low levels of self-esteem and suicide.

"We have known for 25 years what this report is telling us yet again," he said. "So it's time for action, not time for more study."

Mr. Wilkerson was involved in a task force that scrambled to find housing for mentally ill people who were deinstitutionalized in Ontario in the early 1980s.

"The only difference, I think, is the problem then was new. Now it's old," he said from his home in Port Hope, Ont.

"I think we have studied this problem into the ground ... I think the city of Toronto, the city of Vancouver should both say, as a matter of public policy, living on the street is unacceptable," he added.

"We need a combination of tough love and community support, housing and drug treatment support measures, and a whole ton of compassion to resolve this issue."

Beric German of Street Health, an organization in Toronto that provides health care at shelters and on the streets, said one in five people in Canada will have a mental-health issue in their lifetime.

He noted that many people who are homeless develop mental-health problems after landing on the streets.

"In reality, the extreme stress of being homeless can cause mental-health issues, certainly can lead to depression," he said.

"You don't get enough food. You don't get enough sleep. You're in a worse situation in regard to being possibly assaulted. If you're very, very stressed out, it's very common in this country to reach for a bottle or to reach for some drug to kill the pain. And people do that. And sometimes they kill the pain too much and they end up in an emergency ward."

Homelessness can often be traced to the lack of a job and affordable housing — and German said this is something that any Canadian could face.

"There's a tremendous prejudice out there around mental health. ... They see people sometimes who are in terrible shape, and they think that somehow that person can be dismissed."

He called for a comprehensive health-care system that would provide housing, support, income and nutritious food for those who need it.

Ms. Votta said it's hoped the CIHI report will increase awareness and discussion about homelessness and foster a broader look at interventions, such as providing housing.
Read more!

Mental Health Gets Axed -Santa Barbara (CA) Independent

County Scrambles to Find Replacement Funds

Commentary: By Nick Welsh
August 30, 2007

In a case of toxic trickle-down, county mental health officials now find themselves pressed to find $1.4 million to fund a successful program that keeps mentally ill homeless people off the streets. Governor Arnold Schwarzenegger axed funding on August 25 as part of Sacramento’s convoluted and dysfunctional budget dance: In order to get the Republican votes needed to pass his budget, the governor agreed to cut $700 million from the $145-billion budget. Among the most controversial casualties was the $55 million that funded the mentally ill homeless program, created in 1999 by Assembly Bill 2034. It was from that pot of gold that the county’s $1.4 million came, funding services for 120 clients a year. Statewide, 4,700 people benefit from the program.

Given the chronic fiscal woes confronting the county mental health department — a surprise $5-million shortfall was found earlier this year — there’s no obvious substitute funding source. The governor’s aides argue that counties could use funds generated by Prop. 63 — the tax on millionaires benefiting mental health services, which voters approved in 2004 — but the language of Prop. 63 prohibits using its revenues to supplant existing mental health operations. And a statewide coalition of mental health advocates has already threatened legal action. Besides, noted county spokesperson William Boyer, the Prop. 63 money is already allocated for other services.

By all accounts, the programs funded by AB 2034 have been uncommonly successful, providing a wide range of housing, health, and job support services to the mentally ill homeless. In fact, three years ago, Schwarzenegger himself bragged about the program’s effectiveness while on a trip to Washington, D.C. According to the state’s own figures, those now enrolled in the program have experienced 81 percent fewer days locked up, 65 percent fewer in psychiatric institutions, and 76 percent fewer on the streets. In Santa Barbara, the numbers are similarly impressive. According to Roger Heroux — former director of the county Public Health Department, who now administers Santa Barbara’s federally mandated “10-year plan to end chronic homelessness” — the loss of funding would seriously hamper the effort to address the problem. Already, he noted, Santa Barbara County has more animal shelters than homeless shelters and only 12 detox beds. In fact, Heroux discovered that county law enforcement and health agencies spend roughly $40 million a year dealing with homeless people, “with nothing to show for it.” Heroux argued that housing the homeless and helping them become self-sufficient would cost dramatically less than jailing, hospitalizing, or institutionalizing them.

AB 2034 was authored by then Assemblymember Darrell Steinberg. Based on its success, Steinberg — now a state senator — also authored Prop. 63, which included language to make it legally impossible for counties or the state to use its revenues to cover ongoing mental health programs. “The whole idea was we wanted more mental health services, not just a different funding source for existing services,” explained Jim Evans, Steinberg’s spokesperson. Evans noted the state budget preserves a controversial tax shelter on yacht sales that costs the state $45 million a year.

Meanwhile, it remains uncertain how long the county can or will pick up the state’s slack. At an August 28 meeting, Telecare — the private company that provides these services for the county — announced its contract remains intact despite the lack of funding. It was not clear, however, whether Telecare had the funds needed to maintain the housing required by its clients. County mental health officials said they were evaluating their options, but were wary of a suit by advocates if Prop. 63 funds were used to sustain current programs. And there was some indication that mental health advocates might not sue, based on news from the state Department of Mental Health that $50 million in “unallocated administrative reserves” associated with Prop. 63 had just been discovered. While the advocates are confident they would prevail in court, they also recognize such a strategy would last five years. By then, the program would surely be dead. Read more!

Mississippi Supreme Court to allow Thorson to argue mental retardation - Associated Press

By JACK ELLIOTT JR.

JACKSON, Miss. -- Inmate Roger Eric Thorson will be allowed to argue before a Harrison County judge that he is mentally retarded and his death sentence should be tossed out, the Mississippi Supreme Court has ruled.

Thorson was sentenced to death for killing a former girlfriend on the Gulf Coast in 1987.

He was convicted of capital murder in 1988 in Harrison County in the death of Gloria McKinney, a Biloxi mall cafeteria co-worker whom he dated. The state Supreme Court overturned Thorson's conviction because prosecutors excluded potential jurors based on their religious preferences.

Thorson was tried again in 2002, convicted and sentenced to death. The state Supreme Court upheld the second conviction in 2004.

The U.S. Supreme Court declined to hear Thorson's appeal in 2005.

Thorson raised the mental retardation issue in a post conviction petition with the Mississippi high court. Inmates use post conviction petitions to argue they have found new evidence that might win them a new trial.

The U.S. Supreme Court ruled in 2002 in a Virginia case that it's illegal to execute people who are mentally retarded. The court said it would be a violation of the Eighth Amendment prohibition of "cruel and unusual punishment" to execute anyone with a combined IQ of 75 or lower.

In dispensing with dozens of mental retardation claims from Mississippi's death row, the state Supreme Court has required the inmates to produce an expert opinion that the defendant possessed an IQ of 75 or below and that further testing showed the inmate was not malingering.

The Mississippi court on Thursday dismissed prosecutors' arguments that Thorson should have raised the mental retardation issue when he appealed his second capital murder conviction.

Justice George C. Carlson Jr., writing Thursday for the state Supreme Court, said the justices did not set out the procedure on how inmates were to pursue mental retardation claims until after Thorson had appealed his conviction. Carlson also said Thorson was convicted before the U.S. Supreme Court ruling in the Virginia case.

Carlson said the Mississippi court had made it clear that a person convicted before the U.S. Supreme Court decision "could not be denied the opportunity to present his mental retardation claim to the trial court where he had demonstrated that his IQ fell within the range of possible mental retardation, and he had presented an affidavit of a mental health care professional that he suffered from 'mild retardation.'"

Carlson said Thorson had met those criteria. Read more!

Vietnam vets ask senators to back mental health funding - Associated Press

By JOHN MILBURN

Associated Press Writer

TOPEKA, Kan. (AP) -- Ray LaFon knows about the mental problems veterans returning from Afghanistan and Iraq may face. He has lived with his own for nearly 40 years.

LaFon, a Vietnam veteran with the 101st Airborne Division, couldn't shake the images of war. His problems cost him a marriage, businesses and countless other relationships.

"My second wife was about to divorce me. I was an absolute wreck, carried a loaded gun around all the time," he said.

The 59-year-old Basehor resident joined other veterans and clergy in urging Republican Sens. Sam Brownback and Pat Roberts to vote for a spending bill in Congress financing mental health programs for veterans and their families.

The veterans spoke of returning from an unpopular war in Vietnam to little support. Because of their experiences, they said, they understand the horrors soldiers face in Iraq, which they called a "quagmire."

LaFon served in a medical evacuation unit and became used to hosing blood out of helicopters and repairing bullet holes after missions.

But one incident scared him. LaFon was calling in a chopper to pick up a wounded soldier, having been told the landing zone was clear. It wasn't; a rocket-propelled grenade hit the chopper. Three of his best friends died, and a fourth was severely wounded.

LaFon had no way of knowing that the enemy had moved in, but for years felt responsible for the three deaths.

"They had to watch me for awhile. I carried all that guilt. I did my job. It could have been a matter of seconds," LaFon said. "The guilt really hurts."

LaFon said he is doing better, having been diagnosed with a full disability for post traumatic stress disorder. He got help from the Veterans Administration and found a support group of fellow veterans to lean on. His second marriage has recovered, and he is retired.

"I cannot have stress in my life whatsoever, because I have PTSD so severe that any stress might cause me to do something stupid," he said. "I still have a lot of problems. I relapsed once, but I have the tools now to deal with it. I came back."

The Senate expects to debate the funding bill after it returns Tuesday from a recess. Calls left with the senators' offices were not returned.

Veterans said they decided to speak out after a recent Army report found its suicide rate is climbing.

The Army had 99 suicides in 2006, the highest rate since it began tracking the statistic. Thirty were by soldiers in Afghanistan or Iraq and about half were soldiers who hadn't hit their 25th birthday. Failed marriages and relationships were blamed in up to 80 percent of the cases.

While numerous programs have been put in place in recent months to help soldiers still in uniform, the veterans said more must be done to help those who are now civilians.

Tim Saknit, leader of Pointman Ministries in Leavenworth, struggled for years with his own PTSD. He was in the Army and spent a year in Vietnam, starting in April 1969. Alcoholism and drug abuse caused him to lose contact with friends and family.

His life changed when he went to the PTSD Center at Topeka Veterans Administration hospital, where he met LaFon. Though he said he still has relapses, support from fellow veterans and his ministry helps him get by, Saknit said.

"If you don't come in and get help with it, it gets worse. Trying to get these young guys to understand that is rough," Saknit said. "I've got my ups and downs. I don't have to drink anymore. I have my medication, breathing exercises, meditation, reading the Bible."

Gary Sanford, a retired Army colonel and chaplain and now pastor of Rock of Ages Chapel in Leavenworth, said increased federal funding for mental health programs is critical to help communities serve veterans of all wars.

"We came home from 'Nam and got no support whatsoever. If we turn down and veto this bill, I'm telling you, we're doing the same thing to our vets now that was done to us 30 some years ago," said Sanford, who served 30 years in the Army, from Vietnam to Desert Storm.

"Every day we're asking for money to fight the war, and I support that 100 percent. But we need to put our money where our mouth is supporting those who are coming back." Read more!

Mental health services lagging -Greensboro (NC) News & Record

By Mark Binker
Aug. 30, 2007


RALEIGH — Some mental health patients find it hard or impossible to get the services they need because government officials and private providers have struggled to keep up with the rapid pace of changes demanded by North Carolina's mental health reform effort, according to a consultants report released Wednesday.

The 91-page document does point to some successes, but is clear that the state needs to move rapidly to fix "gaps" in the system.

Most of its criticism revolves around a central theme: The pace of change has focused state and local governments on remaking the bureaucracy while leaving some mental health consumers unable to find care.

"In the rush to complete structural changes, the public partners have lost sight of the effect on consumers," the report says. "(T)here has been insufficient joint effort at resolving consumer access problems."

The report was drafted by Alice Lin, a consultant for the state Division of Mental Health. She was at one time a staff member at the General Assembly and helped write the original reform law in 2001.

That remaking of the state's mental health system was in part an effort to save money and was aimed at plugging gaps that prevented some people — for example, substance abusers and the very poor — from getting services. The idea was to better target public money to those in need and to allow government agencies to focus on oversight. Private providers, many of them nonprofits, would be leaned upon to provide the actual treatment.

Lin's report points to some things the state has done well, such as providing more money to the mental health system and giving consumers a voice in structuring the system.

"For 85 percent of consumers, things have gone well," said Leza Wainwright, deputy director of the Division of Mental Health.

The report compares North Carolina's efforts to those of other states that have taken on reform. It points out that other states such as Georgia, Ohio, Pennsylvania, and Texas have spent decades to perfect changes in their mental health system.

"It was somewhat comforting to read the pieces about what other states have done and how long it took them to do things," Wainwright said. "That makes me feel a little bit better about where we are."

But, she quickly said, the report's more critical findings also were correct.

"There are some areas where there have been some slippages," Wainwright said. In particular, she acknowledged the pace of change has forced the agency and its county partners to focus more on process and structure and less on how policies have affected individual consumers.

"That is a valid criticism," she said.

There are 25 local management entities, or LMEs, that work with the division throughout the state. They are local agencies responsible for channeling consumers to the right care. Some are made up of several counties while some, like Guilford County's, stand alone.

Because it was released Wednesday, no one at the Guilford Center had a chance to review or comment on it, said Penny Casto, a spokeswoman for the agency.

Guilford County was not one of the seven local agencies studied directly by the report's author, but the findings are thought to hold statewide.

"From our perspective, this report was way, way past due," said John Tote, executive director of the Mental Health Association in North Carolina, an advocacy group. A comprehensive checkup on how mental health reform was going should have been completed one or two years into the process, not six years on, he said.

Tote said that he, too, was still reviewing the report's findings but said at first blush the report was consistent with problems his agency has seen.

"You've got providers that can't keep up with the pace of reform," Tote said.

----------------
Findings
A recent consultant’s report gave an overview of how the state was doing with mental health reform. The summary included things the state was doing well and problems that needed to be addressed:

The good

More funding support has come to the public mental health system

Local agencies have performed well in establishing a consumer voice through the Consumer and Family Advisory Committee

There have been small and incremental improvements to the delivery system; working relationships at the staff level between the Department of Health and Human Services and local management entities, or LMEs, have been constructive

Local mental health agencies have brought new local, innovative practices, in preserving public psychiatry presence in areas with recruitment and retention challenges, and in collaboration with local hospitals

The bad

In the rush to complete structural changes, the public partners have lost sight of the effect on consumers; there has been insufficient joint effort at resolving consumer access problems

The pace and number of changes have been too fast and numerous, especially during the last two years, resulting in instability and insecurity about the future

There are inconsistent practices across the LMEs in management of state funds, and insufficient tools for LMEs to improve consumer access, monitor the provider network, and develop expertise as a management entity.

LMEs need to develop a common agenda so that meaningful dialogue with the public and private partners can take place


Contact Mark Binker at(919) 832-5549 or mbinker@news-record.com Read more!

Mental illness' effects worse for poor blacks - Dallas News

Mental illness is difficult for any race, but African-Americans often face an additional barrier of racial bias when struggling to survive in society, advocates for the mentally ill say.

Mentally ill black people who live on the streets die earlier than other street dwellers, advocates say. Their average life expectancy is 42 years – about 35 years fewer than the average healthy person, according to statistics.


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Early ovarian surgery linked to dementia - Miami Herald

By MALCOLM RITTER

Women who have their ovaries removed before menopause run a heightened risk of developing dementia or other mental problems later in life - unless they take estrogen until age 50, a new study suggests.

Experts said the research needs to be confirmed by further study, but the findings suggest another issue for premenopausal women and their doctors to discuss as they consider ovary removal.

And if they decide to go ahead with surgery, they need to consider the risks and benefits of taking estrogen to age 50, said Dr. Walter Rocca, a Mayo Clinic neurologist and lead study author.

Hormone therapy has been linked to a greater risk of dementia and heart attacks when given to women after age 65. But recent research indicates that when given before menopause or just afterward, it doesn't raise heart attack risk and may protect against dementia.

The study did not include women who had ovaries removed as part of cancer treatment, and Rocca said the results do not apply to such women. The work was published Wednesday in the online edition of the journal Neurology.

Ovaries produce estrogen. Rocca said the likeliest explanation of the study results is that removing ovaries causes a sudden deficiency of that hormone, which in turn affects the brain.

Hundreds of thousands of women have their ovaries removed each year in the United States. In women around age 45, approaching menopause, ovaries are often removed during hysterectomies as a precaution against developing ovarian cancer. In addition, some women at unusually high risk of developing ovarian cancer have ovaries removed without hysterectomies, as do others who have ovarian problems like endometriosis.

Women younger than 45 often take estrogen after ovary removal because of symptoms like hot flashes and concerns about developing osteoporosis, noted Dr. Nancy Chescheir of Vanderbilt University. But older women who have the surgery are less likely to start estrogen therapy, said Chescheir, who didn't participate in the new research.

The new study found the risk of later mental impairment was higher when the surgery was done at younger ages.

The research examined the fates of women who had one or both ovaries removed from 1950-87, and compared them to other women. Interviewers spoke with either the women themselves or somebody who knew them, asking about signs of memory impairment and any diagnosis of dementia or Alzheimer's disease.

Overall, the study found impairment or dementia in 150 of 1,489 women who'd had ovaries removed, versus 98 of 1,472 women who hadn't. That indicates nearly a 50 percent increase in risk.

A second study, which included about 2,300 women who'd had the surgery and about 2,400 who hadn't, found about a 70 percent increased risk for Parkinson's disease symptoms like tremors.

Still, that outcome was far less common than mental impairment, and experts said the evidence behind it was weaker than that provided in the mental-impairment paper. The Parkinson paper finding is "not quite ready for prime time" in terms of affecting patient care, said Dr. JoAnn Manson, chief of preventive medicine at Harvard's Brigham and Women's Hospital. She was not involved with either study.

The mental-impairment paper suggests that a premenopausal woman without a family history of ovarian cancer who has to decide on whether to have her ovaries removed should ask her doctor whether that step is really necessary, she said.

"It's very reasonable and important to have that conversation with her doctor," Manson said.

Chescheir noted that estrogen therapy carries its own risks, such as a higher rate of blood clots and breast cancer, but that ovary-removal patients younger than 50 may want to have a serious discussion of that option after surgery


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Report: Va. Tech Could Have Saved Lives - Associated Press

Virginia Tech failed to properly care for a mentally troubled student gunman and waited too long to warn faculty and students after he killed his first two victims in a shooting spree that eventually claimed 31 more lives, including his own, a panel's report concluded.

Had university officials not waited more than two hours to tell the campus about the initial shootings, lives could have been saved when Seung-Hui Cho later began his massacre inside a classroom building, according to the report, released Wednesday night.

''Warning the students, faculty and staff might have made a difference,'' the panel wrote. ''So the earlier and clearer the warning, the more chance an individual had of surviving.''

But the report concluded that while swifter warnings might have helped students and faculty, a lockdown of the 131 buildings on campus would not have been feasible.

And while the first message sent by the university could have gone out at least an hour earlier and been more specific, Cho likely still would have found more people to kill, the report found.

''There does not seem to be a plausible scenario of a university response to the double homicide that could have prevented the tragedy of considerable magnitude on April 16,'' the report said. ''Cho had started on a mission of fulfilling a fantasy of revenge.''

The eight-member panel, appointed by Gov. Timothy M. Kaine, spent four months investigating the worst mass shooting in modern U.S. history. Panel chairman Gerald Massengill declined to comment Wednesday night, but was scheduled to speak at a news conference with the governor on Thursday.

Kaine said earlier Wednesday he did not conclude from the report that either Virginia Tech President Charles Steger or campus police Chief Wendell Flinchum should resign.

The report detailed a breakdown in communication about the gunman, who had shown signs of mental health problems for years. His middle school teachers found signs of suicidal and homicidal thoughts in his writings after the Columbine High School shootings in 1999. He received psychiatric counseling and was on medication for a short time. In 2006, he wrote a paper for his Virginia Tech creative writing class about a young man who hates students at his school and plans to kill them and himself, the report said.

The university's counseling center failed to give Cho the support he needed despite the warnings, including his referral to the center in 2005 because of bizarre behavior and concerns he was suicidal, the panel said. It blamed a lack of resources, misinterpretation of privacy laws and passivity.

Individuals and departments at Virginia Tech were aware of incidents that suggested his mental instability, but ''did not intervene effectively. No one knew all the information and no one connected all the dots,'' the report said.

The report said the response by university and Blacksburg police to the dormitory shootings was well coordinated, and said the police response at Norris Hall was ''prompt and effective,'' as was triage and evacuation of the wounded.

But it also noted that university police may have erred in prematurely concluding that the first two shootings were the result of a domestic dispute.

Holly Sherman, whose daughter Leslie was killed, said the report's findings were what she expected, including ''a number of critical errors in judgment.''

''At Virginia Tech, he exhibited seriously deviant behavior that went unchecked, and the faculty did not take adequate steps to put him in check,'' she wrote in an e-mail to The Associated Press.

Diane Strollo, whose daughter Hilary was shot and survived, said she was thankful the panel recognized that an earlier warning could have derailed Cho's plans for Norris Hall.

''Had some or all of the student body been notified that 2 students were gunned down that morning, they may have had heightened sensitivity to the sound of gunshots and other suspicious activity,'' Strollo wrote in an e-mail to the AP. ''One or two minutes of notice may have been critical in saving more lives in Norris Hall.''

Derek O'Dell, who was shot in the arm, said he probably wouldn't have gone to class that morning if he had received word that a shooting had occurred in a dormitory and the killer hadn't been caught.

''I don't think anybody would have,'' he said.

------


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Cho's Problems Date to Early Childhood - Associated Press

By VICKI SMITH

RICHMOND, Va. -- The gunman responsible for the April massacre at Virginia Tech was a sickly child _ shy, frail and leery of physical contact by the time he was 3. His teachers said he began showing suicidal and homicidal tendencies by the eighth grade.

A new report that provides the most comprehensive look yet at Seung-Hui Cho also shows his parents, teachers and mental health counselors wove a safety net that held him together through most of high schoolThen, in his junior year, Cho declared "there is nothing wrong with me" and turned away from treatment, the report says. Because he was about to turn 18, his parents decided they could do little to stop him. His teachers made accommodations for his painful shyness, and he graduated with the grades and test scores that got him into Virginia Tech.

But there his support system fell apart, and unbeknownst to his family, he grew increasingly anti-social.

"What the admissions staff at Virginia Tech did not see were the special accommodations that propped up Cho and his grades," including private sessions with teachers that spared him public speaking, said the report issued late Wednesday by a panel that investigated the worst mass shooting in modern U.S. history.

Despite "the system failures and errors in judgment that contributed to Cho's worsening depression, Cho himself was the biggest impediment to stabilizing his mental health," the report said.

"While Cho's emotional and psychological disabilities undoubtedly clouded his ability to evaluate his own situation, he, ultimately, is the primary person responsible for April 16, 2007," the report said. "To imply otherwise would be wrong."

If Cho's family in Centreville had known of his troubles in Blacksburg, the report concludes, they might have been able to intervene _ and perhaps to prevent the rampage that left Cho and 32 others dead.

"We would have taken him home and made him miss a semester to get this looked at," his family told the panel's investigators.

Cho was born in South Korea and emigrated with his family to Maryland at age 8. They moved to Virginia a year later.

Cho and sister Sun were isolated by language barriers early on, and Cho remained quiet and withdrawn but had normal interests _ basketball, TV, nonviolent video games, talk shows and action movies.

His relationship with his father was strained. He spoke little to either parent, and avoided eye contact. Campus acquaintances described the same behavior at Virginia Tech.

At the urging of teachers, he went to counseling and art therapy before starting seventh grade and was diagnosed with social anxiety disorder. He rebuffed his parents' suggestions that he take part in more extracurricular activities, remaining withdrawn.

In March 1999, the eighth-grader began drawing tunnels and caves that a therapist said could signify depression, or worse. A month later, after the murders at Columbine High School in Colorado, he wrote a paper saying he wanted to repeat the attacks _ an exercise he would repeat in the spring of 2006 with a fictional tale that hinted at what was to come.

He was diagnosed in therapy with selective mutism, an anxiety disorder characterized by consistent failure to speak when speech is expected. Sufferers sometimes show "passive-aggressive, stubborn and controlling traits," the report said. Antidepressant drugs helped, and a year later, he was taken off the medication.

At Westfield High School, educators set up an individualized program to help him cope with mutism. He kept his counseling appointments and got good grades, graduating in June 2003 with a 3.5 grade point average in the honors program.

A school guidance counselor urged him to choose a small college close to home, but Cho was determined to attend Virginia Tech. The counselor offered Cho the name of a person to call if he had trouble adjusting, but Cho never called.

The first few years at college were uneventful. He requested a new freshman roommate after finding his first one too sloppy. His parents visited regularly, and his grades were good.

In his sophomore year, he moved in with a senior who was rarely home. He grew interested in writing and began to think about switching his major from business information systems to English. He submitted a book idea to a publishing house, which rejected it.

Panel member Roger L. Depue, who oversaw the FBI National Center for the Analysis of Violent Crime, called Cho's intelligence "his strongest attribute," but said he lacked any social skills.

"One of the big problems with being a loner is that one does not get helpful reality checks from people who can challenge disordered thinking," Depue wrote.

As late as the spring of 2005, Cho exhibited no behavioral problems. But serious problems surfaced in the fall.

Letters home trickled off. He clashed with English teachers, wearing dark glasses, hats and scarves to class and writing violent, disturbing papers. Roommates gave up on trying to befriend him after he stabbed a carpet in a girl's room.

In November and December 2005, female residents complained of annoying instant messages, e-mails and phone calls. Cho was referred to counseling. After campus police told Cho to stop contacting one woman, he told his roommates, "I might as well kill myself now."

That triggered a psychiatric evaluation, an overnight stay and several brief phone sessions with counselors.

After that, the report says, English professors, university administrators and others missed several opportunities to share information and get Cho help.


Read more!

Report: Mental health reform hurt patients - Raleigh Observer

By Lynn Bonner, Staff Writer

State and local officials turned their attention away from helping the mentally ill as they rushed to write new flow charts and divvy up responsibilities in the state's mental health system, a state consultant says in a new report.
Local mental health offices are unable to get patients the help they need or monitor companies that provide treatment, said the report by Alice Lin, a consultant to the state mental health division. The state has fewer psychiatrists and substance abuse counselors to treat patients, Lin found.

At the same time, private companies offering basic mental health services have flooded the state, with no way for local mental health offices to determine whether they are qualified to treat people.

The state is making vast changes to its multi-billion dollar health system, but local mental health offices and state officials do not agree on goals.

Lin worked for the legislature and helped write the 2001 law that changed the mental health system. She said the state Department of Health and Human Services wanted then to move in a different direction.

“Yet instead of addressing the fundamental disagreements, the dissension has been allowed to linger on,” she wrote.

State Rep. Verla Insko, a Chapel Hill Democrat who sponsored the 2001 law, agreed that the goal of treating patients got lost in the shuffle as local and state mental health offices fought over power.

Read more!

Why We Remember the Bad Times More Than the Good - Psych Central News

by: John M. Grohol, Psy.D.

A new scientific study confirms and potentially explains why we remember events that result in negative emotional responses more so than recollections of the good times. Researchers suggest the findings will provide insight into the symptoms and potential treatment of posttraumatic stress disorder.

The behavior, including remembering exactly where you were when you learned of the Sept. 11 terrorist attacks, or if an aging baby boomer, where you where when you learned that President Kennedy had been shot, are events that appear indelibly branded in our brain.

In the August issue of Current Directions in Psychological Science, a journal of the Association for Psychological Science, Boston College psychologist, Elizabeth Kensinger and colleagues, explain when emotion is likely to reduce our memory inconsistencies.

Her research shows that whether an event is pleasurable or aversive seems to be a critical determinant of the accuracy with which the event is remembered, with negative events being remembered in greater detail than positive ones.

For example, after seeing a man on a street holding a gun, people remember the gun vividly, but they forget the details of the street. Functional Magnetic Resonance Imaging (fMRI), studies have shown increased cellular activity in emotion-processing regions at the time that a negative event is experienced.

The more activity in the orbitofrontal cortex and the amygdala, two emotion-processing regions of the brain, the more likely an individual is to remember details intrinsically linked to the emotional aspect of the event, such as the exact appearance of the gun.

Kensinger argues that recognizing the effects of negative emotion on memory for detail may, at some point, save our lives by guiding our actions and allowing us to plan for similar future occurrences.

“These benefits make sense within an evolutionary framework,” writes Kensinger. “It is logical that attention would be focused on potentially threatening information.”

This line of research has far-reaching implications in understanding autobiographical memory and assessing the validity of eyewitness testimony. Kensinger also believes that this research may lend insight into the symptoms of posttraumatic stress disorder.


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Mental Illness Report in Upcoming Baby-Snatching Trial - Kansas City (MO) Star

By MARK MORRIS

Federal prosecutors today hammered at an expert’s report saying that scans of Lisa Montgomery’s brain tended to confirm a clinical diagnosis of mental illness.

The hearing was the first at which prosecutors challenged the scientific credibility of evidence that defense lawyers plan to present at Montgomery’s federal trial, which is scheduled to open in October.

U.S. District Judge Gary Fenner ultimately will decide what scientific evidence he will permit.

Montgomery, 39, is charged with kidnapping resulting in death in the December 2004 killing of Bobbie Jo Stinnett in Skidmore, Mo. Prosecutors accused Montgomery of strangling Stinnett and using a kitchen knife to cut her baby from her womb. The baby survived.

If convicted, Montgomery faces the death penalty.

Her lawyers have announced plans to mount an insanity defense. At today’s hearing they cited a number of conditions of which their clinical experts have said she is suffering, including post traumatic stress disorder, depression and impulsivity.

Read more!

No simple solutions to issues of mental illness - Denver Post

August 28, 2007

The University of Colorado needs to walk a careful line between protecting its students and needlessly stigmatizing the mentally ill in the wake of a shocking attack in a student cafeteria outside University Memorial Center.

Indeed, all of society needs to practice the same balancing act between prudence and persecution.

A cashier at the Alferd Packer Grill in the UMC, identified as Kenton Astin, 39, was arrested for using a steak knife Monday to slice the throat of a freshman student. Astin then stabbed himself repeatedly before police subdued him with a stun gun. The victim, Michael George Knorps, 17, is expected to recover. Astin was hospitalized in serious condition.

In the wake of the attack, the university announced it would undertake criminal background checks on all new employees, a prudent move. It also suspended, with pay, all employees who had been recommended by the Mental Health Center of Boulder County - the agency that referred Astin to CU - until they can be checked out.

With the benefit of hindsight, there is much in Astin's background that could have warned the university that he could pose a threat to other people and to himself. Astin was arrested in Longmont in 2001 for a similar, unprovoked knife attack on a citizen. If a further red flag was needed, the fact that he used several aliases during that period - including that of Dylan Klebold, one of the two perpetrators of the mass killings at Columbine High School - would have served nicely.

Astin later was found not guilty of the Longmont stabbing by reason of insanity and sent to the state mental hospital in Pueblo, which released him two years ago to the supervision of the mental health center. CU officials said he had a good work record prior to the attack but would not have been hired if the university had known about the previous attack.

Which, of course, raises a very good question: Why wasn't the university told about that incident and other pertinent parts of Astin's record?

Unfortunately, not all good questions have good answers - let alone easy ones. Mental health experts must continually balance issues of patient privacy and public safety. It's clear, after the fact, that this time they leaned too far toward protecting Astin. But it is equally clear that unless the mentally ill are to be locked away for life, there must be some way of treating them and eventually re-integrating them into society. One of the most important steps is getting recovered patients back to gainful employment.

At this point, the issue of patient privacy stops being merely an ethical issue and assumes a pragmatic dimension. If knowledge of past offenses is too widely disseminated, it may preclude the patient from getting a job. If such knowledge leaks into the general community, it can be damaging.

Clearly, past violent acts should be disclosed to potential employers, along with current diagnoses and treatments. But employers, in turn, must treat such information with the utmost respect and use it to channel the formerly mentally ill into jobs suited to their current behavior, not refusing to hire them at all.


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Vote Goes Against Group Home - Hartford Courant

Residents Gain Right To Petition To Revoke A License

By GARY LIBOW

A unanimous vote at a town meeting Tuesday granted residents the ability to petition the state to revoke the license of a group home proposed for Anchorage Lane.

Before the vote, about 100 residents who converged on the middle school heard neighbors question the safety of the site at 7 Anchorage Lane.

The state Department of Children and Families plans for five to six troubled males, between the ages of 14 and 21, to receive treatment there. DCF, since 2005, has set up about 40 therapeutic group homes across the state, in an attempt to treat clients in residential settings.

Under the plan for the group home, which is not yet licensed, DCF would hire Middletown-based Gilead Community Services to staff and operate the mental health facility.

Opposition to the Anchorage Lane site was fierce Tuesday.

Julie Koch, a longtime teacher, pointed out it would be easy for the residents to be injured, as the site is surrounded by deep water on three sides and sits close to I-95 and the Baldwin Bridge.

"We're trying to prevent a disaster," Koch said. "This is what this is all about from day one - protecting children."

Joseph Briganti, who recently moved to 6 Anchorage Lane, fears his family will be at risk.

"I don't have any trust in the state of Connecticut to help us, [or in] DCF to manage its property," Briganti said. Group home residents "could be sex offenders. They could be murderers," he said.

Senior citizen Kathryn Van Vitt asked whether the group home residents would be enrolled in local schools and work in the community. "It's a terrific intrusion to our community," she said.

The lone resident speaking in support of the site was Kathleen Foley Marshall.

Foley Marshall, who left before the town meeting vote, called on residents to open their hearts to embrace the group home site. She asked site opponents to quell their hatred and fear of having troubled people living in town in a supervised group home setting.

First Selectman Michael Pace vowed the board of selectmen would take a "very serious look" at legal avenues should DCF proceed with the group home at an unsafe location.

Pace stressed he is concerned about the "safety of everyone" - including neighbors and those who would be housed in the residential facility.


Read more!

Ex-Astronaut to Enter a Plea of Insanity on Assault Charges - New York Times

By JOHN SCHWARTZ

Capt. Lisa M. Nowak, the Navy officer and former astronaut who confronted a romantic rival at the Orlando, Fla., airport in February, will plead insanity at her trial on assault and kidnapping charges, according to a notice filed yesterday in State Circuit Court in Orlando.

The filing notes that Captain Nowak has lost 15 percent of her body mass because of manic-depressive disorder. It also cites problems in her marriage and an inability to confide in friends or family members.

A Houston psychiatrist, Richard Pesikoff, who provided a defense diagnosis in the case of Andrea Yates, a Houston mother who killed her children, is expected to testify on Captain Nowak’s behalf, the filing states. Dr. Pesikoff declined to comment.

Donald Lykkebak, Captain Nowak’s lawyer, said in a statement, “Even the most naïve observer should recognize that Lisa Nowak’s behavior on Feb. 5 was uncharacteristic and unpredicted for such an accomplished person with no criminal record or history of violence.”

The psychiatric diagnoses listed in the filing include major depressive disorder, mixed manic and depressive-like state, obsessive-compulsive disorder and Asperger’s disorder.

The notice states that the filing does not challenge Captain Nowak’s competence to stand trial, but “only raises insanity at the time of the offense.”

A spokeswoman for the prosecutor’s office, Danielle Tavernier, said the office would have no comment on the filing.

Captain Nowak’s lawyers have asked the court to suppress her statement to the police after her arrest, as well as evidence found in her car, including a folding knife, a compressed-air pistol and a mallet.


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Answering questions - Rocky Mount (NC) Telegram

Program offers families insight on mental illness

By Laura McFarland

When Augustine Jones' daughter was diagnosed as bipolar at age 15, it answered many questions about her behavior.

At the same time, it created even more that went unanswered during the following decade of visits to psychiatrists and psychologists, Jones said.

"I felt like we were alone and there was nobody out there that really understood. There was not a group around that we could relate to," said Jones of Castalia.

Then in 2005, she heard about the Family-to-Family Education Program, a class for family and friends of people with serious mental illnesses. The class gave her more information than she knew existed.

"Just being around other people that were dealing with the same thing we were dealing with, I didn't feel so alone, like there was hope," Jones said.

The free 12-week course offered by the National Alliance for the Mentally Ill offers information to caregivers and family of people with illnesses such as schizophrenia, depression and obsessive compulsive disorder, said Julia Dodd Masters, an instructor.

The next class begins at 6:30 p.m. Thursday and meets weekly, Masters said. Preregistration is required. People interested in the class should call her at 443-2585 or co-instructor Sandy Ogburn at 544-1156 for more information and to learn the location of the class.

"We have had parents come who needed this so much. They didn't know where to turn, and it did change their life. It taught them coping skills. It taught them how the brain works. It taught them how to handle behavioral outbursts," said Masters of the Battleboro community.

More than 115,000 families nationwide have completed the course, Masters said. But faced with the knowledge that more than 20 percent of adults have diagnosable mental disorders, it is not enough, she said.

Masters is passionate about the class and credits it with saving her family. In 1998, she had a nervous breakdown and was diagnosed with borderline personality disorder, clinical depression and panic attacks, she said. She all but destroyed her relationships with her husband, Ed, and three daughters.

"I was in a body that I didn't know, that I didn't like, that I didn't want to be, and I didn't know what was happening or what to do," Masters said.

Until his wife's breakdown, Ed Masters had little compassion or understanding for people that were unable to perform. After he attended a Family-to-Family class in Wilson and saw how it helped their relationship, he became trained and taught one for six years in Rocky Mount.

"I saw how hard Julia had to fight to get her health back. If it was me that became ill, I probably would have said, 'To heck with everybody else, this is me. If you don't like it, that is your problem.' I could not have fought the battle that she fought to get her life back," said Ed Masters, Eastern North Carolina regional manager for the organization.

The class helps people better understand how to support loved ones with serious mental illnesses using instruction, role playing and group activities, Ed Master said.

Jones learned how to approach different situations with her daughter and what buttons not to push.

It is not a pity party, with people just talking about their loved ones and their problems, said Ogburn. Participants share their stories, but they focus on how to make the situation better instead of wallowing in the past.

"A lot of tears are shed in this Family-to-Family class. Some are good. Some are sort of letting go of everything," said Ogburn of Rocky Mount.

Some of those tears belonged to Ogburn, who took the class in 2003 in Roanoke Rapids. Her youngest son was diagnosed with schizophrenia, and the family struggled to cope for years of fighting, alienation and just not knowing what to do.

"Most of the time our encounters with my son ended badly. They would always end with me upset and crying and him mad and his father just throwing his hands up and saying 'Forget all of it,'" Ogburn said.

Taking the class helped her recognize his social limitations and respect his boundaries, she said. Most of all, it helped her let go of the guilt she had been harboring about not being able to fix her son's problems.

"Through family-to-family I learned that I can't fix it. It is nothing I did. It's a physical change in his brain. It is a chemical imbalance. I didn't have anything to do with it, and I can't fix it. I can make it better, and I can accept it," Ogburn said.


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N.C. reviewing 14-year detention, no trial -Charlotte (NC) Observer

EMILY S. ACHENBAUM

The N.C. Department of Justice is examining the case against Floyd Brown, an Anson County man who has been held on murder charges since 1993 without a trial, the department said Monday.

Brown, who has an I.Q. of 50, is not competent to stand trial and has spent 14 years in a state mental hospital, despite never being convicted. The case against Brown hangs on one piece of evidence: A confession that doctors and former teachers say Brown never could have given.

Brown's case was the subject of an Observer investigation earlier this year.

When asked specifically about allegations that the confession, taken by SBI agent Mark Isley in 1993, was fabricated and whether Attorney General Roy Cooper's office was investigating those claims, spokeswoman Noelle Talley said the office was "examining the issues in this case." Talley declined to elaborate.

The Observer investigation found more than a dozen instances in the typed confession that contain language Brown does not know, starting with the first sentence: "On Friday, July 9th of 1993, my mama woke me up at 6 a.m. in the morning." Brown does not know dates, cannot tell time, and does not speak in complete or grammatical sentences. Once authorities had the confession, they charged Brown with the murder of 80-year-old Katherine Lynch, beaten to death in her Wadesboro home.

Isley, who has worked for the State Bureau of Investigation since 1989, spent years working on cases in a district that included Anson. He now supervises the SBI's Medicaid special investigation unit and reports to the SBI's assistant director. Isley has not responded to requests from the Observer for comment.

Isley, testifying in previous court hearings on Brown's case, said the confession was dictated to him "verbatim." Brown's attorneys have called the confession fabricated, and submitted affidavits from Brown's former teachers and current doctors to bolster their claim.

"The person who could speak or write as well as the person who gave this statement would earn a high grade on the North Carolina state writing test," said one of Brown's special education teachers, Mary Helen Gaddy.

"It is hard for me to believe that Floyd could have given this statement," said another teacher, Shirley Lindsey, after citing words in the confession -- like "mailboxes" -- as too advanced for Brown to know.

One of Brown's doctors at Dorothea Dix mental hospital in Raleigh, forensic psychologist Mark Hazelrigg, said the confession not only didn't sound like Brown, but that "Mr. Brown could not be trained or coached to talk in the same manner as the alleged confession."

Brown's attorneys had tried to get their client's case dismissed in Anson, a rural county about 55 miles southeast of Charlotte, because of their claims about the confession. A judge there denied that request.

So two weeks ago, the attorneys filed a writ of habeas corpus in Durham County, asking for Brown's immediate release. State law allows a writ of habeas corpus to be filed in the county of the applicant's choice.

In the writ, Brown's attorneys argue that Brown is being held unconstitutionally. Brown's attorneys also detailed problems in the investigation, including lost evidence and bribe-taking sheriff's detectives, who later served federal prison time.

In his decision to hold a hearing Oct. 8 on the habeas claims, Durham County Superior Court Judge Orlando Hudson Jr. noted that the allegation of a fake confession "appears to have gone un-rebutted by the prosecution."

Anson County District Attorney Michael Parker, who has the power to drop the case, has declined to comment. Read more!

Living with Autism -KRCU Public Radio, Cape Girardeau, Missouri

Click here to go to the podcast of this broadcast on August 28, 2007.

Taylor Crowe is a Cape Girardeau native and a recent graduate from the California Institute of Art. He is also autistic.

Mr. Crowe gives presentations across the country to help teachers and professionals who work with autistic children. He is helping write and illustrate a children's book and he keeps a website, www.taylorcrowe.com.

Taylor and his father, David Crowe, spoke with Southeast Public Radio’s Jacob McCleland. Read more!

Local task force's goal is crisis center for mentally ill - Greenville (SC) News

By Liv Osby
HEALTH WRITER
losby@greenvillenews.com

A blue ribbon leadership council is forming with a goal of creating a crisis stabilization center where mentally ill people can get needed treatment in an effort to keep them out of hospital ERs and jails.

"The key thing is we really have such a problem that we've got to do something different," Associate Greenville County Probate Judge Edward M. Sauvain said Monday. "The biggest issue is trying to get people out of the ER or the jail, which are high-cost alternatives."

In July alone, the Greenville County Detention Center spent $38,000 on psychiatric medications for inmates, said mental health manager JJ Larson.

Sauvain, along with Greenville County Probate Judge Debora A. Faulkner, is a member of the new council, which is being assembled by the Greenville chapter of the National Alliance on Mental Illness.

County Councilman Joe Dill is another, and NAMI plans to recruit hospital CEOs, as well as representatives from law enforcement and the business community, said executive director Kelly Troyer.

"We need a continuum of care," Troyer said. "And I'm determined to have a crisis stabilization center here."

Charleston's crisis center served 782 clients in 2005 for an average stay of 3.2 days at a cost of $1,036 each, compared with the average psychiatric hospital stay of 8.6 days at $3,870, she noted.

Dr. Martin Lutz, medical director of emergency services for Greenville Hospital System, said beyond providing more appropriate treatment for the mentally ill, he said, it would speed care for patients seeking medical treatment in the ER.

"These are complex patients," he said, adding that 15 to 20 medical patients could be seen in the time it takes to treat five mentally ill patients.

Faulker said she's confident that stakeholders will be able to establish crisis services.

"Our goal is to make sure people get the right kind of treatment and the community stays safe," she said. "And we have a tradition in Greenville County of pulling together and addressing a community problem." Read more!

Governor's cuts make health reform even harder -San Jose (CA) Mercury-News

Editorial:

The real news in Gov. Arnold Schwarzenegger's line-item budget cuts to health and social service programs isn't the damage they will do to California's safety net. It's in the governor's posturing as he tries to work out a compromise on comprehensive health care reform.

Schwarzenegger should have used his budget cuts Friday to signal to Democratic leaders, voters and the health care community that he's interested in reaching a health care accord. Instead, by reserving the biggest cuts for safety-net programs, he made reaching a compromise that much harder.

Time is running short. Only 18 days remain before the Legislature adjourns for the year. Californians should not accept another year of inaction on reducing the number (7 million) of uninsured residents and reining in skyrocketing costs.

Schwarzenegger and Democratic leaders in the Legislature must demonstrate that they're willing to forge a compromise on health care. It's now clear that the governor's plan, which has a lot to like, is not going to receive the necessary support from Democrats to pass.

It's equally clear that Schwarzenegger is not going to sign the Democrats' proposal as is. The governor sees the Democrats' requirement that employers not offering coverage pay 7.5 percent of payroll into a fund to provide insurance as too onerous.

Despite the differences, the divide between the two sides could be easily bridged. Making a compromise would be a great benefit to all of California, and a major political victory for the governor and Democrats. Given the budget debacle, Schwarzenegger and Democratic leaders should have a strong interest in closing the legislative session on a positive note.

One thing the governor could do to reach out to Democrats is to offer to work together next year to restore the cuts to health and social service programs.

The most painful - not to mention shortsighted - cut was trimming $55 million from programs to provide mental health services to the homeless. Numerous studies have demonstrated that failure to treat mental illness will only result in higher costs to taxpayers as the mentally ill spiral deeper and deeper into decline.

The governor also should seek to restore in 2008 the $8 million he trimmed from the new prescription-drug discount. Schwarzenegger previously had lauded the prescription-drug discount as a great program for seniors with low incomes who too often had to choose between filling their prescription or buying groceries.

But the scale of the problems created by the cuts are minuscule when compared with addressing the state's health care crisis. The latest Field Poll showed 69 percent of Californians want the state's system to be reformed.

That's a mandate that should require Schwarzenegger and the Legislature to act.
Read more!

State health cuts perplex officials -San Mateo County (CA) Daily Journal

By Michelle Durand

Local officials are still determining the state budget’s effects on San Mateo County but speculate the millions cut by Gov. Arnold Schwarzenegger’s line-item vetoes translate into devastating hits to two novel approaches for providing universal health care and eradicating homelessness.

Changes are also afoot for the juvenile justice system which keeps all but the most serious minor offenders in county detention centers and takes post-incarceration monitoring responsibility away from the state.

The combination, along with other nips and cuts, are included in the list of the county’s disappointments.

“The good thing is that [the governor] did sign the budget even if it was 55 days late. But it makes hits to funding for those who need it most,” said Deputy County Manager Mary McMillan.

The elimination of the entire $55 million budget for the Integrated Services for Homeless Adults with Serious Mental Illness Program undercuts HOPE, the county’s 10-year plan to eliminate homelessness.

The governor suggested using Proposition 63 — the Mental Illness Services Act — to fund the programs instead. Supervisor Jerry Hill, who helped spearhead HOPE, said there are legal questions about the possibility. Until the matter is resolved, the county will receive no state dollars.

The budget doesn’t spell the end of HOPE but does put a crimp in its progress, Hill said.

“It just slows us down,” Hill said.

Health coverage takes a knock

The budget also looks likely to throw a wrench into the county’s plans to provide universal health coverage.

Schwarzenegger deleted $106.3 million from rate increases for Medi-Cal managed care plans — a veto McMillan said is the most significant and troublesome for San Mateo County.

“It’s unfortunate that we’ve worked very hard to get to a place to have a sustainable program and now we aren’t sure,” McMillan said.

The cut may affect how the Health Plan San Mateo pays its physicians and hospitals. With nearly half of the funding gone, clients won’t immediately see a difference but hospitals may withdraw from the plan rather than stomach a rate increase.

The decision is perplexing to HPSM Executive Director Maya Altman because Schwarzenegger proposed the rate increase in his May revise.

“He also cut money for outreach to get people signed up for Medi-Cal. All of this runs counter to his health care reform proposals. It’s bizarre,” Altman said.

Like most departments, Altman said the reality of the cuts won’t be clear for a week or so.

Other health care and social service cuts include $12 million for the Adult Protective Service Program, $23 million to replace human services computer equipment and $8.5 million for pandemic flu planning.

The governor did offer the county one bright spot for its overcrowded jails, preserving Proposition 36 funding.

A justice overhaul bill signed at the same time as the budget also has officials anticipating local ripples.

Local juvenile offender shift

Beginning next month, all but the most serious juvenile criminal offenders will be housed locally rather than at the Department of Juvenile Justice, formerly known as the California Youth Authority.

San Mateo County does not house as many minors in the system as other counties — there are 43 juveniles currently — but could still be a big change financially and logistically.

The county will receive $117,000 per juvenile every year from the state but Chief Probation Officer Loren Buddress worries it may not be enough.

“These juveniles bring with them enormous problems,” Buddress said, ticking off violence, mental health issues, gang affiliation and psychotropic medications among the issues.

“It’s just not a huge amount of money. It remains to be seen if it is enough,” Buddress said.

Juvenile Judge Marta Diaz will decide if any of the San Mateo County wards at CYA should be transferred back but Buddress expects only a small amount or only the girls will be.

In either case, Buddress said the more serious offenders will likely be sequestered from the others with a different style of programming. The costs and requirements of such housing are also unknown, he said.

“There are just a huge number of questions to be asked and answered,” Buddress said.

Once juveniles are released from custody, their responsibility falls on the hands of the local court rather than state probation.

The post-incarceration period has yet to be named — it’s not parole or probation, Buddress said — but counties will received $15,000 per juvenile.

“It’s yet to be determined if that is underfunded, overfunded or appropriate but I have concerns. It isn’t a large amount for probation and treatment,” Buddress said. “Like everything else, we just don’t know yet.”

Michelle Durand can be reached by e-mail: michelle@smdailyjournal.com or by phone: (650) 344-5200 ext. 102. Read more!

Mentally ill still lack care -Las Vegas Review-Journal

New psychiatric hospital needs more staff, lacks beds

By ANNETTE WELLS
REVIEW-JOURNAL

About a year ago, Southern Nevada's emergency medical services manager, Rory Chetelat, made a prediction.

He said the new Rawson-Neal Psychiatric Hospital would not be large enough to handle the patient load and, unless a solution were found, people with serious mental health problems would continue to inundate area emergency rooms.

Chetelat's crystal ball seems to be working well.

Just about daily, 70 to 80 people with mental health problems are held in emergency rooms because the 242 psychiatric beds between Southern Nevada Adult Mental Health Services and WestCare are taken, he said.

The numbers of mental health patients in emergency rooms are similar to what they were a year ago, before the Rawson-Neal facility started admitting patients.

And, though the mental health agency has secured state funding to open 22 beds at its campus along West Charleston Boulevard, that plan is on hold because staffing isn't in place, said Stuart Ghertner, director of outpatient services.

To buy more time for the mental health agency to hire more staff, the state has extended until Dec. 31 its contract with WestCare. The nonprofit entity serves indigent and low-income Nevadans and is providing the mental health agency with 25 psychiatric beds.

Beyond Dec. 31, WestCare faces the termination of the contract.

But if the staffing issue at the mental health agency is not resolved, "we will again look to extend WestCare with the available funds,'' state Sen. Joe Heck, R-Las Vegas, wrote last week in an e-mail.

"At this point, the 22 beds is not an issue of funding, but an issue of adequate staffing," he said.

Even if the mental health agency is able to use the additional 22 beds, there's still a question of whether the Las Vegas Valley will ever have enough psychiatric beds or, at the very least, reach the national average for psychiatric beds per capita.

"We will be adding 22 more beds but losing them at WestCare, so we're just trading off,'' Ghertner said. "At the end of the day, there's a lot of people with mental illness in emergency rooms, and the problem is due to the lack of bed space.''

From an emergency services standpoint, Chetelat said this compromises the medical care of people needing emergency treatment.

Hospitals are required to hold mental health patients, regardless of whether they have a medical problem, until they can go to an inpatient psychiatric facility. Sometimes such patients remain in emergency rooms up to five days.

"Twenty to 25 percent of our total emergency beds are occupied by mental health patients or individuals who really need to be somewhere else,'' said Chetelat, who along with other state and local health officials receives daily reports on emergency room patients and wait times. "I think things have gotten better. Some hospitals are setting aside separate areas to hold mental health patients and our patient wait times are going down, but this is a burden on emergency room staff.''

What's frustrating, Ghertner said, is mental health officials know what the solution is -- more beds -- but can't fix the problem. On top of that, there's staffing issues, both on the clinical and administrative side, in the mental health arena.

Hired less than a year ago, Ghertner is also running the inpatient side of the mental health agency because of the recent resignation of K.C.R. Nair and David Rosin. Nair was director of inpatient services at Rawson-Neal, and Rosin was the medical director for the state's Division of Mental Health and Development Services and was overseeing the psychiatric hospital.

Then there's the area's growth, said Mike Willden, director of the state's Department of Health and Human Services, which oversees the Division of Mental Health and Developmental Services.

"We're always going to be working at full capacity. Comfortably meeting the needs of the community is going to be an issue,'' he said. "All of the surveys (national) about psychiatric beds indicate that for a community the size of Las Vegas, we should have 533 inpatient psychiatric beds available to the public.''

Kirby Burgess, vice president of WestCare, said, "We're essentially just treading water'' in Southern Nevada with respect to resolving mental health issues.

In 2005, the Legislature allocated $7 million for the use of 50 psychiatric beds at WestCare's facility along Martin Luther King Boulevard. That funding was to expire last year but was extended to June 30, but only for 25 beds.

That extension was scheduled to end on Sept. 30 but again was extended until Dec. 31 because of the need by the mental health agency to fill positions.

Willden said WestCare's pricing structure also changed, so the extension to the end of 2007 only funds 20 beds.

Burgess says it costs WestCare a little less than $500 a day per mental health patient. The average stay is five days, he said.

Though Nevada has made some headway in hiring physicians, psychologists, social workers and nurses, psychiatrists are a different story.

Nevada doesn't offer competitive salaries for psychiatrists comparable to other Southwestern states, Ghertner said.

"We're hopeful that in the next legislative session we can see an increase in the base salaries for psychiatrists,'' he said. "Our proposal is to increase the salaries of psychiatrists by 10 percent. ... From my perspective, that's a high priority.''

The mental health agency has 29 psychiatrists. It is budgeted for 45.

In the meantime, Ghertner and Willden said there are ideas to revamp outpatient services that might help improve the flow of mental health patients.

One of those ideas is to work with WestCare on bringing together a triage, medical clearance and a possible psychiatric observation unit, Willden said.

Burgess said WestCare is in talks with the state about providing more mental health services, especially triage services.

WestCare operates a 50-bed community triage center at its Fourth Street location for individuals with behavioral health or substance abuse problems. This is a partnership between Clark County and the cities of Las Vegas, North Las Vegas and Henderson.

Ghertner said he also hopes to hire a psychiatrist to work night shifts so that incoming mental health patients either at area emergency rooms or Rawson-Neal can get processed into the system faster. As it stands now, patients who come in after hours aren't processed until the next day.



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Legislators are hypocrites on mental health benefits - Ashland (WI) Daily Press

Commentary

By Mary Conroy
August 27, 2007

In 1995, Bob and Peg Tumminello's adolescent son Chris became severely depressed. A psychiatrist prescribed antidepressants. Chris attended therapy regularly, worked on his issues, and took his medication.

After 30 therapy sessions, Bob's insurance company wouldn't allow Chris any more outpatient visits that year. After some time without therapy, Chris' emotional pain worsened. He took an overdose.

Fortunately, his parents got Chris admitted to the hospital. Their insurance paid the first $16,000 for each inpatient admission, and the Tumminellos (not their real name) had to pay the rest. Chris needed more than one admission.

At the same time, Bob had kidney problems. He also followed doctors' orders and had three kidney procedures done. When they didn't work, the doctors recommended surgery. All of Bob's procedures were covered by his insurance, because the insurers considered the kidney problems physical ones, not mental ones.

Since then, the Tumminellos have accumulated $60,000 for medical costs the insurance company didn't cover. They've paid an additional $70,000 in interest and indirect costs such as lights to help with seasonal affective disorder.

Bob worked 50-hour weeks with another part-time job until he retired, when he took a minimum-wage job. Peg still works full time. They figure they'll have the medical bills paid off in five more years. Because of his illness, Chris can only work part time.

The Tumminellos wouldn't be in this position if Wisconsin had a mental health parity law -- one that required every health insurance policy to pay the same amount of money for mental health coverage as for coverage of other illnesses. State law requires group health policies, except for self-insured policies, to cover mental health problems. But insurers only have to pay $7,000 per year and only $2,000 of that for outpatient therapy. This figure hasn't increased since 1985.

Since 1995, advocacy groups have asked the state Legislature for parity in mental health coverage. The Senate approved parity in 2001, but the bill got stuck in an Assembly committee. Later compromises for a mere cost-of-living increase never made it to a Senate vote or any Assembly action.

Each time either bill was considered, people like Peg testified before legislative committees about the impact our current law had on them. Some lost their savings, others their homes. Still others lost their children.

On the other side, businesses claimed they wouldn't be able to offer health insurance if they had to offer parity. The legislators chose to believe them, even when research showed that health insurance premiums did not rise in states that provided parity.

The state Senate's Healthy Wisconsin bill has two provisions that relate to mental health. One provides parity. That's only just.

The other provision gives Wisconsin residents the same health benefits as the state Legislature had in January. And guess what? The legislators have far better mental health benefits than most of their constituents. Since 1998, they've had no cost or dollar limits on outpatient visits each year. They get one 30-day inpatient stay per year.

So during most of the hearings on parity and the cost-of-living increase, legislators have been sitting pretty with their own mental health benefits. As we begged for crumbs, Wisconsin legislators turned their backs on people with mental illness and their families.

How many of us have forgone therapy we couldn't afford while legislators saw therapists whenever they needed to? How many of us have watched our children's mental illness spiral out of control while legislators' children got therapy that was prompt and affordable? And how many years will it be until legislators stop perpetuating this fraud on the citizens of Wisconsin?

Mary Conroy is a Madison-based freelance writer.


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Man Killed After Bank Standoff 'Looking For A Way Out? - WLKY-TV Louisville (KY)

Video here.

LOUISVILLE, Ky. -- The father of a man shot dead by Louisville Metro Police after a hostage situation at a Bashford Manor bank said his son had a history of mental illness and may have been looking for a way out.

SWAT officers shot and killed 44-year-old Guy Ray III just before noon Monday after they said he charged at them with what later turned out to be a pellet gun.

Investigators say Ray held seven people hostage inside the National City Bank branch on Bardstown Road for several hours before coming out with the gun.

Ray's father said his son had been battling depression for years and likely chose the bank because he knew police would respond quickly and use deadly force if threatened.

Guy Ray Jr. said his son was a mild-mannered, nice, sweet person.

The officers who fired on Ray are on paid leave pending the outcome of an internal investigation.

Chief White said he believes the officers acted properly. Read more!

Outpatient mental care more accessible - Hendersonville (NC) Times-News

Adult residents of Transylvania County and surrounding areas now have more access to outpatient mental health services thanks to a new program at the Transylvania Community Hospital.

BREVARD -- Adult residents of Transylvania County and surrounding areas now have more access to outpatient mental health services thanks to a new program at the Transylvania Community Hospital.

The AgeWell Fresh Start Program provides outpatient services for adults and seniors with a wide range of mental, emotional and social needs. The behavioral health program treats patients covered by Medicare with dementia, anxiety, depression, psychosis, bipolar disorder, post-traumatic stress disorder and other mental health disorders.

A free, confidential assessment and evaluation is completed in the admissions process. Transportation is also provided for patients who need help getting to the program.

"This program is for adults who need intensive outpatient treatment, but who don't need the acute treatment offered by an inpatient psychiatric facility," said Linda Dodds, director of the AgeWell Fresh Start program.

Two psychiatrists, Dr. Pamela Lowe and Dr. Patti Snodgrass, supervise the care of all patients in the program. The program also provides step-down treatment for patients in an inpatient facility with a focus on helping people reintegrate into the community. Group treatment, discharge planning and case management are provided by Carol Ward, licensed clinical social worker. Ward also coordinates treatment with caregivers and community providers.

The program welcomes referrals from family members, primary care providers and facilities. It is located at 89 Hospital Drive. For more information, call 862-6393. Read more!

University, Mobile Mental Health enter psychiatrypartnership - University of South Alabama News

By: Ashley Gruner
8/27/07

Mobile Mental Health will be joining the University of South Alabama's Department of Psychiatry in a partnership beginning next year.

Dr. Samuel Strada, dean of USA's College of Medicine, explained that 11 psychiatrists from Mobile Mental Health will be entering the partnership with USA, and three or four more will be joining the partnership within the next year. Approximately 20 USA faculty members in the department will now be teaching alongside the Mobile Mental Health psychiatrists.

All of the psychiatrists are board certified in at least one sub-specialty. Dr. Strada explained the partnership relies on teams. "Every faculty member has multiple roles, including clinical training and researching," he said.

The partnership also provides an advantage for teachers, in that they learn along with the students. By obtaining variable experiences, teachers can rotate through various positions.

According to Dr. Ronald D. Franks, vice president for health sciences, the partnership has been evolving over the past three years.

"The partnership is the best experience for students and residents. It has been evolving for several years and it will continue to expand. We have had very positive feedback from students and residents," said Franks. The partnership and positive feedback will also encourage recruitment of residents.

The collaboration with Mobile Mental Health was not established simply because of the retirement of Dr. Charles Rich, current head of psychiatry at the school of medicine. Strada and Franks explained that the growing relationship with Mobile Mental Health was in fact a result of Dr. Rich's experience and has been progressing over the last several years.

As Dr. Strada explained, the department is retaining, not relinquishing, its responsibility.

They explained the partnership will prove to be a relatively easy transition that will provide great opportunities for USA, as well as Mobile Mental Health.

Mobile Mental Health has approximately 670 employees and provides care for more than 13,000 people a year in Mobile and Washington counties.

"Mobile Mental Health is the largest provider of mental health in the state. We are very blessed to have this opportunity," said Franks.

The move to hire professors from Mobile Mental Health is much more effective than recruiting psychiatrists from outside of the area.

"Mobile Mental Health has the most comprehensive access to teaching. They are the best option. They have the most psychiatrists, best network of services and infrastructure. We cannot duplicate the amount of service they have done over the years. We are here to partnership," said Strada.

Strada believes the partnership will be a "broadening experience for students" as well as faculty. "The partnership provides opportunities for students to spend time with experts in their field," said Strada.

The partnership is something to celebrate, as it gives a mutual advantage for both Mobile Mental Health and USA. "It is similar to a national model that plays to the strength of the medical school. People can see how it is a very effective, integrative health system and how it has done well in a very cost-effective way," said Franks.

Franks and Strada both feel that the partnership will continue to strengthen USA's relationship with the mental health center, while at the same time, allow students to participate in a rewarding experience in their field of study. Read more!

With spotlight on PTSD in urban youth, officialsvow cooperation - San Francisco Chronicle

By Jill Tucker, Chronicle Staff Writer

The significance of post-traumatic stress disorder in urban youth has been largely overlooked and avoided in public schools, yet it is a problem that no longer can be ignored, state and local officials agreed Monday.

That consensus followed a Chronicle story Sunday describing the dramatic implications for inner-city schools that have a significant number of children who are affected by trauma from living in violent neighborhoods.

An estimated one-third of children living in urban war zones have PTSD, according to recent research and the country's top child trauma experts. Yet few of these kids are ever diagnosed or treated.

"There's no question that untreated post-traumatic stress disorder, untreated mental illness and other emotional issues have a direct connection to the high school dropout rate, the achievement gap and other failures for students who don't make it," said state Sen. Darrell Steinberg, D-Sacramento. "There's no question."

Symptoms of PTSD include outbursts of anger, trouble sleeping, inability to concentrate and heightened anxiety - all of which make it virtually impossible to do well in school.

"I think it's something that we can't ignore," said San Francisco Superintendent Carlos Garcia. "I think we have no choice but to address it, whether we like it or not."

Mayor Gavin Newsom and Public Health Director Mitch Katz agreed and promised to push for solutions.

Proposition 63, enacted in 2004 as a special income tax on the rich to raise money for mental health programs, could help. About $250 million is available for identifying and treating the disorder in children.

Yet school officials are required to develop a plan with county health officials in order to qualify for the money - something that doesn't seem to be happening as it should across the state, said Steinberg, the measure's author.

"School officials should be working to become best friends with county mental health officials," Steinberg said.

Prop. 63 gives priority to early intervention among youth, including children exposed to trauma, as well as school-based mental health services.

That means, Steinberg said, that inner-city schools with lots of students suffering PTSD symptoms are prime candidates for the cash.

Getting mental health counselors would be a welcome relief at San Francisco's John Muir Elementary School in the Western Addition.

As the children filed into classrooms Monday on their first day back after summer break, Deborah Estell, a school health worker, wondered what the year would bring.

She recalled polling students last year, asking them how many knew someone in jail and how many knew someone younger than 20 who had been shot or killed.

Among the 60 or so kindergartners, 90 percent knew someone in jail, and more than 75 percent knew someone who had been shot or killed.

"The need is great," she said of dealing with PTSD symptoms even in the district's youngest students. "Kids bring with them anger, fear and pain."

"We need more support," said Juanita Wilson, a teachers aide at John Muir. "We need to help these kids with the baggage they bring to school. Schools have got to be more than schools."

Mayor Newsom acknowledged the devastating effect of trauma on children and the community.

"This is life in every big urban center," he said. "This is real. This is raw."

Newsom ticked off several programs that help families cope with violence, including school health centers and community response teams that approach families touched by homicide.

"We've got to do more," he said. "We've got to do much more."

The mayor said he would push collaboration with the school district to bring in Prop. 63 money.

"This is a great opportunity with a new superintendent," he said. "The point for us is not to screw that up."

Steinberg, the author of Prop. 63, said the measure offers significant hope for school and city officials but won't meet the financial need by itself.

School districts can't contribute, educators and advocates said Monday, because their budgets already are stretched thin trying to teach the three R's.

"Solving problems takes resources," said Phil Halperin, a board member with the advocacy group San Francisco School Alliance. "You have to bring to the table people who know how to fix this and have the expertise. Those are mental health officials, not school officials."

At the same time, school sites are ideal for identifying and treating PTSD, mental health experts say. It's where the children are, where they feel safe.

"It's not the school's responsibility to be able to treat children who have post-traumatic stress disorder or any other mental illness," said Katz, San Francisco's director of public health. "But we think from the health point of view, that having clinics located at the school would yield more youth going forward and receiving those services."

Katz said creating health clinics at schools - with full capability of mental health assessment and some treatment - would be ideal.

He said The Chronicle's attention to the issue would open doors between the county health services and the schools.

"I will certainly make sure at my end that we'll talk to the new superintendent," he said.

On his end, Garcia welcomed support.

"We're willing to open up our schools for people to help us," he said. "I still believe schools are the hub of a community."

At the state level, Superintendent of Public Instruction Jack O'Connell said PTSD symptoms in children, and their treatment, must be part of a statewide conversation on the achievement gap.

In November, he will hold a summit to address the disparity in standardized test scores and high school completion between African American or Latino students and their white or Asian peers.

"I'm sure this will be a topic," he said. "We need to bring the services our students need onto the school campus."

E-mail Jill Tucker at jtucker@sfchronicle.com. Read more!

A Memoir of Schizophrenia - Time Magazine

By Andrea Sachs

"My mind has been both my best friend and my worst enemy," says Elyn Saks, the author of The Center Cannot Hold (Hyperion). It's hard to argue with that. While Saks has soared to the top of academia — a graduate degree from Oxford, a law degree from Yale, and a tenured professorship at the University of Southern California — she has also been shackled and involuntarily committed to a mental hospital.
Saks, 52, has schizophrenia, a chronic brain disorder that affects one in a hundred Americans. People with schizophrenia (which affect men and women equally) sometimes suffer from hallucinations, delusions, and imagined voices.

Saks' remarkable new book is a voice from a country rarely heard from, the land of psychosis. Like Girl, Interrupted by Susanna Kaysen and An Unquiet Mind by Kay Jamison, The Center Cannot Hold is the beautifully written saga of a young woman grappling with mental illness and ultimately triumphing. A movie may soon be appearing at a theater near you, given Hollywood's intense interest in the book. TIME's publishing reporter, Andrea Sachs, met with Saks (no relation) during the author's recent book-tour stop in Manhattan.

TIME: Was your illness evident when you were a child?

SAKS: In a way, I had a very good and normal childhood. I had loving and caring parents. But I had a lot of quirks or problems when I was growing up. I had phobias and obsessions. I believed that there was a man standing outside of my window every night, waiting to break in and kill us all. A lot of kids have that fear, but mine lasted for years and years.

When was your first episode?

At seven or eight. I asked my dad, 'can't we go to the cabana?' He kind of snapped at me, 'I already said no, and the weather's not great. I need to go back to work.' And at that moment, I disappointed my dad. It felt like falling apart, my self losing coherence. Imagine a sand castle with all the sand sliding away in the receding surf. So in the end, there's no center to take things in and process them and view the world. That was the first kind of scary, weird thing. Even more alarming, when I was 16 or 17, I suddenly, having just read Sylvia Plath and identifying with her, got up in the middle of the day [at school] and started walking home several miles away, something I'd never done before. I was a good girl — I never skipped school. And as I was walking, the houses got very ominous and foreboding, and I started to think that they were sending me messages. 'Look! See! You must see! You are bad! You are evil!' I didn't hear it as voices; they were thoughts, but I thought they were thoughts put in my head by the houses. It was very scary.

You were a Marshall scholar at Oxford University in England. You write that your life began to unravel there. What happened?

I became very depressed. I totally lost my appetite and lost a huge amount of weight. I thought that I wasn't supposed to speak, because speaking would spread my evil around. Obviously, it's hard to make friends if you can't talk with people, so I was very socially isolated, which was extremely painful. And I had mild paranoid ideas that people were talking about me and laughing at me behind my back, which may have been true, because I looked kind of bizarre walking down the street gesticulating and talking to myself.

You were put in a mental hospital against your will. What was that like?

It was horrifying. It's demeaning and debilitating to have choice taken away in general, to not be respected as an autonomous agent. To be put in a hospital is an extreme version of that. You're totally isolated from friends and family, and from your work. Freedom of locomotion is gone; freedom of choice is gone...It causes resentment and anger. I don't say that it's the case that nobody should be ever be hospitalized against their will, but I think that we should really study ways to help people seek the treatment that would be best for them. One of the things that forcibly hospitalizing people does is deter them from seeking help in the future.

What's it like to have a psychotic episode?

It's like a waking nightmare. You're terrified, you're confused, you have beliefs that are bizarre and frightening and confusing. I hallucinate a little bit, but not much. Mostly I form delusional beliefs, like that I have killed lots of people with my thoughts, or people are setting off nuclear explosions in my brain, or my brain's going to leak out of my ears and drown people. Weird things like that, which are obviously terrifying.

What protection does medicine offer you?

It's very good. The new meds I'm on [Clozapine, an anti-psychotic medication] make the episodes come further apart; they last less long when they happen, and they're less intense when they happen. So it's a kind of floor below which I don't go. When I was on Navane [another anti-psychotic medication] back in New Haven, and the first five or 10 years in L.A., I was teetering on the edge all of the time. A slight breeze would push me over into the land of psychosis. Now, I'm mostly well. I'm mostly thinking clearly. I do have episodes, but it's not like I'm struggling all of the time to stay on the right side of the line.

Do you still experience schizophrenic symptoms?

Even today, with all the treatment and all of the medication, I still have transient psychotic thoughts, probably daily. Where a thought like, I've killed people, comes to my mind and I just say, oh that's your illness acting up.

How has being schizophrenic affected your social life?

The first two years I was ill at Oxford, I had no friends at all. It was very painful. I was unable to work. Somehow my analysis with Mrs. Jones [her psychoanalyst] in England interrupted those kind of negative symptoms, and I became able again to work and make friends. To me, friends have been one of the main things that have kept me doing well. But in terms of romantic relationships, when I became ill, I went seven years without a single date. I was so tortured by my internal demons that there was no space for another person. And then I started flirting with this guy down in the library named Will, which he didn't pick up on. He left the law school, and [later] we met in the hall, and I said, 'Let's do lunch sometime.' So he called me up and invited me to lunch. The next day, he brought a feather from his parrot, and placed it on my computer. I asked my friend that night, 'Kenny, do you think a guy who plucks a feather from his bird and places it on your computer likes you?' He said, 'I don't know, Elyn, but he likes you better than he loves his bird!' I ended up falling in love with Will [who is now her husband]. I actually told him that he was the first person I'd ever been in love with that way, and he said that made him very sad. But he's been a really great part of my life.

What is the biggest misconception that people have about schizophrenia?

There are lots of misconceptions about schizophrenia, [like that] patients are truly wild. In fact, of all the major mental illnesses, they're the least violent. People can't hold jobs, certainly not high-powered jobs...Can't have close friends and family. Can't live independently. A lot of those have some truth; they're true of a certain portion of people with schizophrenia. But it seems to me that a lot more than is now the case could be leading far more gratifying [lives]. When you tell someone, 'you're not going to be able to work,' or 'scale down your expectations,' then they do. And yet work gives most people so much of a sense of well-being, productivity. You're taking away from someone a thing that could be an important tool in their recovery by having these kind of negative expectations.

What advice would you give to other people suffering from mental illness?

Seek good care and a clinician you can really trust. Choose your friends wisely, and also choose friends that you can trust. Try to learn your illness — what it looks like when it starts happening, so you can take steps before it really takes you over.

What has happened since you 'came out' as a schizophrenic?

Most people have been enormously supportive, and kind and encouraging, and some thankful. I'm getting a lot of emails from fellow consumers. People call us mental health consumers now — that's the P.C. way to say it.     Read more!

Attack: Ex-mental patient held - Denver Post

Alleged assailant has criminal history, including 2001 knife assault

By Manny Gonzales and John Ingold

Campus police said they didn't know what triggered the attack by the assailant, identified as 39-year-old Kenton Astin, about 9:45 a.m. at the University Memorial Center, or UMC.

Astin had a criminal history that included a 2001 knife attack, and he had been treated at the state mental hospital in Pueblo before being released under the supervision of Boulder County's mental-health center.

The victim, Michael George Knorps, 17, from the Chicago area, was gashed in the throat and underwent an hour-long surgery but was expected to recover, said CU-Boulder chancellor G.P. "Bud" Peterson. The wound was described as non- life-threatening.

"He's doing as well as can be expected," Peterson said.

Some witnesses told the Daily Camera of Boulder that they initially mistook the episode for staged drama.

"Everyone thought he was doing a skit or something, but it ended up being real," said Cory Ravelson, a CU freshman.

After the attack, police said, the assailant ran away, shouting he had bomb-making materials in his backpack and screaming about the world coming to an end.

A Boulder County sheriff's deputy and a Boulder police officer who happened to be near the UMC chased the man, who began stabbing himself with what was described as a steak knife.

The officers used a Taser stun gun to subdue the suspect, who suffered multiple stab wounds and was taken to a hospital in serious condition.

"Both officers responded instantly, and this individual was Tasered and subdued and quickly put in an ambulance and sent to the hospital," CU spokesman Bronson Hilliard said. "Our own officers responded on the heels of those two, who just happened to be in the right

place at the right time."
Within minutes of the attack, a text-message alert was sent to 1,300 students signed up for an emergency communications system designed in response to the Virginia Tech University massacre in April.

As a result of the stabbing, the number of students subscribing to the campus alerts was expected to double by the end of Monday, Hilliard said.

Officials expect to work out some bugs with the text-messaging system but said it was effective in alerting students.

University and mental-health officials were meeting late Monday to figure out how Astin, who was arrested in 2001 for stabbing a Longmont man at a Salvation Army shop, could get a job where he had contact with students.

It doesn't initially appear that the Mental Health Center of Boulder County, which supervised Astin, disclosed information about his history of violence, CU officials said.

"In terms of his psychological profile, we were told that he didn't appear to be violent or have an active propensity for violence," Hilliard said. "Obviously a criminal-background check would have told us a different story."

Peterson said that the university would conduct background checks on all future hires and has suspended all employees with pay who were referred by the mental-health center and similar treatment programs while CU reviews their partnerships. CU has more than 7,000 employees.

Astin was arrested by Longmont police in 2001 for an unprovoked attack on a man at a shop at 516 Main St.

According to a police report, Astin pulled a knife from his bag and charged another customer, "yelling something about God sending him."

At the time, Astin went by several aliases, including Jerry Buckley and Dylan Klebold - the latter the same name as one of the students who shot students at Columbine High School in 1999.

Astin was later found not guilty by reason of insanity and sent to the state mental hospital in Pueblo, which released him about two years ago to the supervision of the Mental Health Center of Boulder County, authorities and CU officials said.

The health care center, through a treatment program, placed him in a six-month job as a cashier in the Alferd Packer Grill in the UMC last semester.

During his time on staff, he didn't exhibit violent behavior, officials said.

"He had a good work record, showed up on time and was reliable," Hilliard said.

But CU's chancellor added that Astin wouldn't have been hired for the job if the university had known about the stabbing.

Barbara Ryan, executive director of the mental-health center, which serves Boulder and Broomfield counties, said she didn't know what the protocol was for revealing past criminal behavior with potential employers.

The program, which typically treats severely mentally ill patients, has had the


Read more!

So, What Made Me an Addict? - Washington Post

Experts Debate Whether Disease or Defect Is to Blame

By Maia Szalavitz
Special to The Washington Post

Many people think they know what addiction is, but despite non-experts' willingness to opine on its treatment and whether Britney or Lindsay's rehab was tough enough, the term is still a battleground. Is addiction a disease? A moral weakness? A disorder caused by drug or alcohol use, or a compulsive behavior that can also occur in relation to sex, food and maybe even video games?

As a former cocaine and heroin addict, these questions have long fascinated me. I want to know why, in three years, I went from being an Ivy League student to a daily IV drug user who weighed 80 pounds. I want to know why I got hooked, when many of my fellow drug users did not.

A bill was introduced in Congress this spring to change the name of the National Institute on Drug Abuse (NIDA) to the National Institute on Diseases of Addiction, and the National Institute on Alcoholism and Alcohol Abuse (NIAAA) to the National Institute on Alcohol Disorders and Health. In a press release introducing the legislation, Sen. Joseph R. Biden Jr. (D-Del.) said, "By changing the way we talk about addiction, we change the way people think about addiction, both of which are critical steps in getting past the social stigma too often associated with the disease."

But opinion polls find weak support for the concept of addiction as a disease, despite years of advocacy by such agencies as NIDA and NIAAA and by recovery groups. A 2002 Hart poll found that most people thought alcoholism was about half disease, half weakness; just 9 percent viewed it wholly as a disease.

So what does science have to say? Addiction research has advanced dramatically since my high school years in the early 1980s, when I began using marijuana and psychedelics, then cocaine, in the hope they would relieve my social isolation. My progression from psychedelics to coke was fed by a definition of addiction that still causes widespread misunderstanding. In 1982 -- around when I first tried cocaine -- Scientific American published an article claiming it was no more addictive than potato chips. This was based on the fact that cocaine users, unlike heroin users, do not become physically sick when they try to stop taking their drug.

Addiction, by this reasoning, is a purely physiological process, one that results from drug-induced chemical changes in the brain and body. Over time, with heroin and similar drugs, the article explained, the user develops tolerance (needs more of the drug to experience the same effect) and eventually becomes physically ill if he doesn't have access to an adequate dose. Addiction, by this theory, is primarily an attempt to avoid physical withdrawal.

I bought into this idea because it was confirmed by my experience: I never had a problem stopping marijuana, LSD or mushrooms, none of which cause significant physical dependence. I expected cocaine to be similar and, therefore, safer than heroin. With no physical withdrawal to avoid, stopping should be a snap. Or so I thought.

By the time I got suspended from college for my involvement with cocaine, I was smoking it, often daily. And because I believed that my suspension meant I'd already ruined my life, I felt I had no reason not to try heroin. I just didn't care.

Heroin became my drug of choice. It calmed me, gave me distance from my obsessions and anxieties. Over time, cocaine made me feel anxious, but heroin always soothed and smoothed. I continued taking both, injecting higher and higher doses.

Today's most widely accepted definition of addiction -- used in psychiatry's latest edition of its diagnostic manual, the DSM-IV-TR -- recognizes that compulsive use of a substance despite negative consequences is key. And that's exactly what I experienced: At least six times, I made it through the physical sickness of heroin withdrawal -- the shaking, diarrhea and vomiting -- only to use again because I wanted the drug. This compulsive aspect helps explain why we can now consider video games and, yes, even potato chips more addictive than we did in the past.

But the DSM retains a focus on physical aspects of addiction: It calls addiction "substance dependence," suggesting that physical need is critical. Tolerance and withdrawal are part of the criteria used to diagnose the condition, even though pain patients taking opioids as directed may experience both and not actually be addicted. Studies find that less than 1 percent of people who take pain medications and don't have a past history of drug problems become addicted. Many pain patients who stop opioids after the source of their pain has been removed even undergo withdrawal without realizing it: It's called "hospital flu." But the vast majority have no difficulty refusing further medication.

As a result, experts -- including NIDA director Nora Volkow -- have called for the official name of the disorder to be changed from "substance dependence" to "addiction" in the next edition of the DSM. They say the confusion between physical dependence and addiction leads to under-treatment of pain: Surveys find many patients, even those who are dying, don't receive enough medication for effective relief. Physicians are even criminally prosecuted for "over-prescribing" when patients with painful conditions become physically dependent on opioid drugs.

Your Brain on Dope

But if physical symptoms don't define addiction, does it follow that addiction is a brain disorder? Matters are murky here as well.

While researchers have argued that addiction is a disease because drugs change the brain, the fact is, most users -- even of drugs such as heroin -- do not become addicted. While 50 percent of American soldiers in Vietnam tried heroin or opium, only 10 percent continued to use such drugs after returning home, and just 1 percent became long-term opioid addicts, according to a federally funded study by University of Washington sociologist Lee Robins.

Further, all brain changes are not indicative of disease. Learning itself changes the brain. FMRI brain scans of London taxi drivers and virtuoso violinists show changes that embody the effects of years of practice in relevant brain regions -- however, no one argues that this means they are ill.

As a result, scans alone cannot prove that addiction is a disease. "The idea that fMRIs can explain addiction is based on the same unscientific grounds as phrenology," says psychologist Stanton Peele, a longtime opponent of seeing addiction as a disease and author of the new book "Addiction-Proof Your Child."

In my own experience, I stopped using when addiction threatened my core values. On my last day taking heroin, I found myself considering seducing a man to get drugs. Because I despised this guy and had a serious boyfriend, I was shocked that I would consider it: I knew that that was addictive behavior. At that point, my personal definition of an addict was someone who violates her own principles to get drugs. I sought treatment the next day and never used cocaine or heroin again.

In Peele's view, addiction is a bad habit, a learned behavior that gets out of hand, an exaggeration of the human tendency to put off pain in favor of immediate pleasure. Even, in some instances, a rational choice when life presents little opportunity for connection, purpose or joy.

Volkow disagrees. She has pioneered brain-imaging research on addictions, looking for ways in which they differ from ordinary learning. "Drugs of abuse affect multiple systems, not just those involved with learning and memory," she says, adding that they interfere with regions that put the brakes on unwanted behavior.

"What happens in the brain of the addicted person is equivalent to a state of deprivation. It changes the brain from operating in a situation where someone has a choice and does something because he wants to do it to a situation where it feels like need," she says.

That, too, comports with my experience: Cocaine seemed to affect my motivation, leading me to take more even when I knew it would fuel a burst of paranoia, not euphoria. While at first it brightened and enhanced other joys, over time it sucked the pleasure and color out of my life. But although I could consciously see this, I felt I couldn't stop.

Another relevant factor seems to have been my youth: We now know that the frontal cortex, the seat of judgment, the region that should apply the brakes, is not fully developed until the early to mid-20s. I quit at 23; when I look back on my behavior now, the sheer stupidity of some of the risks I took shocks me. Genetic research also suggests that certain people are more prone to addiction, particularly those with other mental illnesses such as depression, a condition I also have.

So does that make it a disease? Some would argue that my response to treatment proves it. I underwent seven days of detox, 30 days of rehab, then three months in a halfway house and ongoing self-help support. Later, antidepressant medication helped reduce the distress that I'd previously self-medicated with heroin.

As Thomas McLellan, chief executive of the Treatment Research Institute in Philadelphia and professor of psychiatry at the University of Pennsylvania, notes, treatment for addiction is as effective as treatment for other chronic diseases that involve lifestyle change, such as diabetes and asthma.

Stigma-Proofing Addiction

Just calling it a disease, however, may not reduce the moral stigma tied to addiction -- as some hope. University of Nevada psychologist Steven Hayes is studying people's unconscious responses to words. "Disease" was as stigmatizing overall as clearly pejorative terms such as "drunk," and was more stigmatizing overall than such terms as "addict" and "intoxicated," he says.

Consider the historical treatment of people with epilepsy or "madness." Or the fact that we think "tough" rehabs are good, despite evidence suggesting otherwise -- though we wouldn't even contemplate "getting tough" with diabetics. Says McLellan: "Yes, people with epilepsy were sent to priests and shamans, too -- but that was the 18th century. Addicted people are still told to get religion."

The program I attended, for example, told me that I would not recover if I didn't surrender to a higher power, make amends and pray. This is not how most diseases are treated.

Further, labeling people with a brain disease characterized by lack of self-control can have negative consequences, particularly for adolescent users, most of whom are not addicts, suggest NIDA surveys and other research. In many teen rehabs, youths are told that they have "chronic, progressive" illness with a 90 percent chance of relapse. Forcing teens, whose identity is not fully formed, to accept an "addict" identity can be a self-fulfilling prophecy.

As Peele points out, "Self-efficacy and the image of the ability to control oneself are critical to recovery" -- as they are to maturation. For the same reason, it's a bad idea to tell people that without treatment, recovery is impossible. In fact, most addicts who recover do so without treatment. Among those who relapse, belief in the disease model is predictive of greater severity, research shows.

So is addiction disease or learned behavior? Given its complexity, some experts say, what probably matters most is which view best yields compassionate and effective treatment. ?

Maia Szalavitz is a senior fellow at Stats.org and the author, with Bruce D. Perry, of "The Boy Who Was Raised as a Dog and Other Stories From a Child Psychiatrist's Notebook" (Basic Books) and the author of "Help at Any Cost: How the Troubled Teen Industry Cons Parents and Hurts Kids" (Riverhead).


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Maine's ER emergency - Lewiston (ME) Sun Journal

By Lindsey Tice , Staff Writer
Sunday, August 26, 2007

LEWISTON — It’s just after noon on a recent Monday, and St. Mary’s Regional Medical Center’s emergency room has just gotten slammed.

Two trauma patients. A guy from a car accident. A handful of mentally ill patients and addicts. People with various illnesses, injuries and levels of pain.

A man in jeans and an open-back johnny walks unsteadily down the hall. From a corner bed, a woman’s staccato snores are drowned out every few minutes by the sound of a man retching.

In a curtained cubicle at the far end of the ER, Florence Doe, 84, and her daughter, Diane, patiently wait for a doctor. Florence had been feeling sick and weak that morning. After she passed out, an ambulance brought her in.

“I’ve been here a couple of times this year,” said Florence, who was a nurse during World War II. “They give very good care. Very good care.”

Good care is what St. Mary’s prides itself on. But 17 years after it built its current ER, and about seven years after the department’s last expansion, the hospital says it needs a bigger, better place if that level of care is to continue.
It plans to spend — and has gotten state approval for — $8.5 million to triple the size of its ER.

And the Lewiston hospital isn’t alone.

• Less than two miles away, Central Maine Medical Center — struggling with its own 17-year-old facility — says it will seek state approval next year for an ER expansion.

• In Portland, Maine Medical Center plans to nearly double the size of its ER, while Mercy Hospital renovated its ER two years ago and is discussing plans to expand again.

• In Norway, Stephens Memorial Hospital got a new ER four years ago, while Rumford Hospital debuted one last year.

• Maine General Hospital overhauled and expanded two ERs — one at Augusta and one at Waterville — several months ago.

More patients come in every day, Maine hospital officials say. There are greater mental health issues. More medical technology to consider. Increasing demands for privacy.

They need the space, they say. Now.
During its worst days — days just slightly busier than that recent Monday — St. Mary’s moves its least serious patients from the ER back into the waiting room. It has 21 beds, and sometimes that’s just not enough.

“The actual need is there,” said Nurse Manager Anita Lalonde.

Gurneys in the hall
On average, U.S. hospitals get 383 ER visits for every 1,000 area residents, according to the Maine Hospital Association. New England averages 439. Maine averages 540, ranking it fourth in the nation per capita.

And the number is growing.
Emergency room visits rose 26 percent between 1993 and 2003, according to a national survey. Local hospitals say their ER visits increase up to 8 percent every year.
National experts say a shortage of primary care may be to blame. Or a lack of health
insurance. Or an aging population. No one really knows for sure.

In Maine, experts believe substance abuse and mental health crises are sending a greater number of people to the ER.

“Our behavior population has increased, my gosh, I don’t know how many fold. Maybe four or five,” said Marge Powell, a longtime nurse at St. Mary’s. “Some of it is truly sick, sick stuff. I’ve seen a psychotic child at 4 (years old).”

Maine experts also say high quality emergency care — and the immediate availability of that care — may be leading some patients to use the ER instead of a family doctor, even though ER visits are often more expensive.

“Consumer expectations have increased,” said Mary Mayhew, vice president of the Maine Hospital Association. “People don’t necessarily want to wait to get into a doctor’s office or squeezed into an appointment.”

But the ER’s popularity causes problems for both hospitals and patients. When an ER gets busy, wait times skyrocket. When people rely on expensive emergency care, health-care costs skyrocket.

Right now, capacity is the biggest problem, local hospitals say. When an ER can’t
handle a sudden influx of people, patient privacy and medical care can suffer.

At Central Maine Medical Center, for example, patients end up lying on gurneys in the hall.

CMMC’s emergency room was built in 1990 to handle about 25,000 visits a year. It now gets 52,000 and is full “almost every day, usually by midday,” said spokesman Chuck Gill. The hospital wants to spend about $15 million to $20 million to expand the ER.

“We don’t want to get to the point where we’re not providing good care,” said Peggy McRae, nurse manager for the emergency department. (While still commonly referred to as ERs, most hospitals now call them emergency departments, reflecting their growth in size and the types of problems they treat — from sprained ankles to psychiatric patients.)

Of central Maine’s six hospitals, four have either built a new ER, dramatically expanded or plan to. The fifth, Bridgton Hospital, just opened its doors in 2002.
The sixth, Franklin Memorial in Farmington, has no immediate plans for an expansion, but officials expect the issue will come up.

“In the long-term plan, in the next three-to-five-year plan, it’s being looked at, that’s for sure,” said George Long, nursing manager for Franklin Memorial.

Rising costs
While expansions may help hospitals keep up with patient demand for ER services, there is a question of cost. When a hospital does a building project, patients often end up paying in the form of higher hospital bills.

Consumers for Affordable Healthcare, a Maine-based advocacy group, hasn’t tracked ER expansions in particular, but it does watch hospital expansions in general.
“That’s an issue we very much care about because it drives up costs,” said Policy Director Hilary Schneider.

Before hospitals spend millions to dramatically expand their ERs, she’d like the hospital industry to find out exactly why ER visits are increasing. She’d like to see doctors’ offices — many of which are now hospital-owned — provide an on-call doctor so patients don’t have to go to an ER after business hours. And she’d like to see ERs refer non-emergency patients to local primary care doctors rather than treating them, as long as the patients can wait.

She believes those changes could help ease the burden on ERs, without the expense of major expansions.

“Hospitals are a billion-dollar, several-billion-dollar industry,” she said. “They should be able to figure out this issue.”

In an effort to control health-care costs, Maine does require hospitals to seek state approval for any large building project. Four hospitals applied this year. Three of them asked for ER expansions.

All of the ER projects — at Mid Coast Hospital in Brunswick, Maine Medical Center and St. Mary’s — were approved. Each will cost between $8.5 million and $25 million.

St. Mary’s plans to triple its ER space with a design that calls for 30 exam rooms instead of 16 curtained areas, a second triage room, a separate ambulance bay for psychiatric patients and a decontamination suite. The current ER was built in 1990 to handle up to 25,000 visits a year. The hospital now gets about 30,000. The new ER will accommodate 37,000.

At $8.5 million, it’s the cheapest expansion of the three approved this year. The hospital will fund-raise the money, and officials say they won’t pass down the cost to patients.

“I don’t think it (the cost) will impact patients, especially those here,” nurse manager Anita Lalonde. “But they should be entitled to the very best possible care.”
CMMC will seek formal approval for its expansion early next year. To pay for the $15-million-to-$20-million project, the hospital will use some of the money it already has and borrow the rest.

“We need to have the facilities that match the demand for our services,” said Gill. “With the wrong facility we can’t guarantee patient safety and quality of care.”
Hospitals say they’ve tried to work around their ER issues, tried to put off expensive expansions.

Because primary care physicians seemed to be lacking in the area — a problem that draws patients to the ER — both CMMC and St. Mary’s routinely recruit family practice doctors to Lewiston-Auburn. Because non-emergency cases can quickly clog an emergency room, CMMC and St. Mary’s also offer separate fast-track areas for sprains, colds and other minor health issues.

They say they’ve also tried to nudge ER patients toward primary care doctors. At St. Mary’s, for example, the ER gives patients a card with the number of its physician referral line. The goal: Get ER patients to follow up with, and sign up with, a regular doctor.

“We do our best to get them out of that groove and get them into primary care,” said spokesman Russ Donahue.

But hospitals say demand still outpaces their ER capacity. Expansion, they believe, is their last best option.

“We probably should have done it five years ago,” said Gill at CMMC.
‘It’s always been busy when we’ve been here.’

Back at St. Mary’s, the ER quiets down.

It’s just after 1 p.m. and patients with minor problems have been treated and sent home. Three of the five psychiatric exam rooms have been cleared. The two trauma patients have been moved.

Of the 10 or so ER patients left, some are waiting for tests, some are waiting for doctors and a few, including Florence Doe, are waiting to be admitted. After examining her, Florence’s doctor still isn’t completely sure why she passed out.
As she and her daughter, Diane, wait for her to be moved upstairs, they talk about the hospital. Florence had visited the ER twice in six months, once for pneumonia and once for the flu.

“They get right at you,” she said.

Although she’s never had to wait long or go back to the waiting room during an ER rush, Florence and her daughter said they would support an expansion.

“It’s always been busy when we’ve been here,” Diane said.
ltice@sunjournal.com
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The family effects of mental illness -The Chapel Hill News

GUEST COLUMN
By Mary Lynn Piven
August 26, 2007

Earlier this year, I participated in the National Alliance for the Mentally Ill (NAMI) Family-to-Family program, in a course dedicated to families that have a loved one with mental illness.

My dad developed a mental illness when I was a girl. Although dad died in 1981, over the last two decades I have seen and felt the reverberations of his illness on our family relationships. I can count on one hand the times that we have spoken about him during family dinners. As children we were silent in our shared shame, and as adults, we are silent in our shared pain.

Dad was a well-liked postal clerk in a small, rural community who became progressively preoccupied with a worry that grew into a fear that he would come up short in the post office cash drawer and this would present a humiliating situation in front of his co-workers.

This progressed to ideas that his co-workers were somehow determined to trap or humiliate him. He began to "read into" what others were saying. Eventually, he tried to turn himself over to the FBI for an offense that had no basis in reality. These two episodes culminated in my father being committed to the Dorothea Dix Hospital. We were never clear on dad's diagnosis, but in many ways, it did not matter. He felt socially embarrassed by the episodes and subsequent hospitalizations.

I do not think he ever accepted that he had a mental illness, but blamed my mother and job stress for his "nerves," and took prescribed medication only intermittently, when his "nerves" were especially bad.

After more than two decades and 10 children together, my parents separated. Dad died suddenly at home from what we believe was an undiagnosed heart condition. Until his death, my father and our family carried the shame of having a mental illness in a community that attributed mental illness to a character defect, not a brain disease. As his family, we did not know how to understand the patterns of his illness, nor did we know how to respond to his unpredictable moods, his treatment of my mother or his noncompliance with medication. Without benefit of modern medications or a relationship with a psychiatric professional, my dad died a lonely man, estranged from most of our family.

The NAMI Family-to-Family program began in 1979, too late for my family to learn the necessary skills to understand dad's illness. While attending this program last spring, I often thought about how our family might be different if the Family-Family program existed while my father was alive. Attending the Family-to-Family Program gave me an opportunity to talk with spouses, mothers, fathers, daughters and sons, eager to widen their understanding of the causes and treatments of mental illness, eager to learn current knowledge about mental illnesses and to develop communication skills to enable them to keep that fragile emotional connection with their loved one over the long haul.

For the greatest part of my life, talking about dad to anyone outside my mom, brothers and sister felt like a betrayal. Because of the Family-to-Family program, I now feel like I am honoring my dad rather than betraying him. I also learned that to fight the myths and barriers to mental illness detection and treatment within our society, we must start by fighting the stigma within our own families.

One place to start this fight is by taking the NAMI Family-to-Family program. This program is a free 12-week course for family caregivers of individuals with severe mental illnesses that discusses the clinical treatment of these illnesses and teaches the knowledge and skills that family members need to cope more effectively.

This rigorous course covers a series of topics on serious mental illness including current information about the nature of schizophrenia, major depression, bipolar disorder (manic depression), panic disorder, obsessive-compulsive disorder, borderline personality disorder, and co-occurring brain disorders and addictive disorders. It provides current information about medications, side effects and strategies for medication adherence and information on current research related to the biology of brain disorders and the evidence-based treatments that are most effective treatments to promote recovery. It helps participants gain empathy for their family members by understanding the subjective, lived experience of a person with mental illness.

The course helps family members learn practical skills needed in everyday living by providing special workshops on problem solving, listening and communication techniques, as well as offering strategies for handling crises and relapses. Just as important as learning the facts, the program also focuses on care for the caregiver: coping with worry, stress and emotional overload that living with mental illness can bring.

The course, often through the group participants, offers guidance on locating appropriate supports and services within the community and provides information on advocacy initiatives designed to improve and expand services for those with mental illness.

In early September, several Family-to-Family courses are scheduled in the Chapel Hill, Hillsborough and Durham areas. If you have a close family member with a serious mental illness, and would like to participate in this challenging, valuable and tuition-free course, call 929-7822 to get more information and to register.


Mary Lynn Piven is a resident of Chapel Hill and an assistant professor in the School of Nursing at UNC-Chapel Hill.
The Chapel Hill News
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Headway in developing a faster-acting antidepressant - LA Times

The key might be provided by studying the effect that ketamine, an anesthetic, has on a neurotransmitter.

By Denise Gellene

After years of little progress, scientists are making headway in the search for a better, faster-acting antidepressant. Experiments with an anesthetic called ketamine have yielded important clues about the biology of depression, leading scientists to attack the mood disorder in new ways.

Improved treatments are sorely needed. Depression affects about one in 10 adult Americans each year, while current drugs work in only 50% to 60% of patients, can cause sexual problems and take weeks to work. They also carry a small risk of suicidal thoughts and behaviors in adolescents and young adults.

All existing antidepressant drugs work in much the same manner. They act on a handful of neurotransmitters -- brain chemicals that pass messages along defined pathways -- that belong to a family called monoamines and circulate in a relatively small portion of the brain.

The most recognized of these neurotransmitters is serotonin, low levels of which have been linked to depression. Drugs such as Prozac and Celexa are aimed at raising serotonin levels available to the brain. The other transmitters targeted by antidepressants are dopamine and norepinephrine. Wellbutrin is an example of an antidepressant that boosts levels of these neurotransmitters but not serotonin.

Scientists first discovered these neurotransmitters affect depression in the 1950s when they found that the tuberculosis drug iproniazid also lifted patients' moods. The drug blocks an enzyme that converted serotonin, dopamine and norepinephrine into inactive forms, and after some study the drug was marketed for depression. Pharmaceutical companies have developed drugs targeting the trio of neurotransmitters ever since.

Because it is expensive to discover and develop new drugs, it is safer for pharmaceutical companies to stick with known biological targets than to head in risky new directions, said Dr. Carlos Zarate Jr., a researcher at the National Institute of Mental Health. As a result, "we have not made substantial gains in terms of antidepressants," Zarate said.

But recent studies on ketamine have pushed researchers to change how they think about depression. The anesthetic acts on glutamate, the brain's most plentiful neurotransmitter, which circulates widely in the brain and hasn't been linked to depression in the past.

In a small experiment led by Zarate last year, five of 18 people who received a single intravenous dose of ketamine experienced a dramatic lifting of their depression the first day and were still much better a week later. All patients in the experiment had first tried regular antidepressants but did not improve on them, according to the study published last August in the Archives of General Psychiatry.

Similar fast improvements were found in a study of eight patients conducted at Yale Medical School and published in Biological Psychiatry in 2000.

The rapid response was encouraging, Zarate said, suggesting that a faster-acting antidepressant may be possible. Current antidepressants take two to three weeks to begin working, and until recently, "it was just accepted as fact we couldn't do any better," he said.

Dr. Gerard Sanacora, director of the depression research program at Yale Medical School, said the results also mean that glutamate may have a more direct role in depression than serotonin and other brain chemicals targeted by current antidepressants.

"The fact that it acts so rapidly means that it is getting closer to the core of depression," Sanacora said.

In some ways, it's surprising that researchers studying depression didn't suspect the role of glutamine, which is an amino acid, in the disorder sooner. Malfunctions in the glutamate system have long been linked to other psychological and neurological disorders, including schizophrenia and Alzheimer's disease. Glutamate has long been associated with learning and memory.

"It is hard to image anything glutamate is not involved in," said Sanacora. "It is really what makes the brain run."

Still, scientists haven't yet figured out how the glutamate system goes awry in depression.

One theory is that glutamate leaks from brain cells, perhaps in response to chronic emotional stress, and causes changes in key brain structures.

The hippocampus, which processes memory, and the parts of the cortex, where decisions are made, are known to be smaller in depressed people. Perhaps, Zarate said, excess glutamate caused cells in these brain structures to shrivel. High amounts of glutamate are toxic to brain cells and cause the death of some neurons in stroke patients, he noted.

Ketamine is not approved for treating depression and Zarate said it was too soon to give it to patients outside the confines of a clinical trial.

Ketamine can cause hallucinations and confusion and is sometimes abused as a club drug. In fact, he said, all patients who received the drug in his study reported out-of-body hallucinations.

But studying the workings of ketamine in the brain may provide researchers with information that could lead to a new class of fast-acting antidepressants.

Zarate and colleagues reported last month that ketamine blocks a glutamate receptor, called NMDA, on the surface of nerve cells.

As a result, glutamate can't bind to it anymore and instead binds and activates another receptor, called AMPA. The increased activity of AMPA is what produces ketamine's mood-elevating effects, Zarate concluded.

Drawing an analogy, he explained: "If you imagine a bifurcated garden hose and you block the left nozzle, you will get a massive amount of water through the right."

A number of drugs that work on glutamate have been approved as treatments for neurological disorders and are now being tested against depression.

Among them are Forest Laboratories' Namenda, which is approved to treat Alzheimer's disease symptoms, and Sanofi-Aventis' Rilutek, which is used to slow amyotrophic lateral sclerosis, or Lou Gehrig's disease.

Neither is expected to be a big breakthrough. Namenda is not a powerful blocker of the NMDA receptor and Rilutek doesn't work very quickly.

Zarate's group at the National Institute of Mental Health is planning a trial in which depressed patients will receive a dose of ketamine, followed by regular doses of Rilutek, which scientists hope will maintain patients' recovery.

Other drugs targeting glutamate are on the way, although it could be many years before they reach patients. For example, an experimental Merck & Co. drug that blocks a sub-unit of the NMDA receptor is now in clinical trials.

In May, Pfizer Inc. reported on a study of 30 depressed patients who received an experimental intravenous drug that also blocks that same sub-unit of the NMDA receptor.

The antidepressive effect of the drug, CP-101,606, was similar to that of ketamine, said Dr. Sheldon H. Preskorn, chairman of the department of psychology and behavioral sciences at the University of Kansas School of Medicine-Wichita, who led the study.

Within 24 hours, more than half of the patients in the study had a "bright affect," were smiling spontaneously and talked more rapidly, Preskorn said. Their about-face was so remarkable "that had I not seen it myself, I would not have believed it," Preskorn said.

Many questions remain.

No one knows whether depressed patients will tolerate or respond to a second dose of a ketamine-like drug. Patients in trials so far have received only one dose.

In addition, the rapid personality overhauls induced by the drugs have implications for family and social relationships that will need to be addressed, probably through counseling or therapy, Preskorn said.

"The drugs deal with the hardware problem," he said.

"Once that's done, we still have to deal with the software issue."

denise.gellene@latimes.com

*

The pursuit of happiness

Here are some other drugs under study as possible antidepressants.

* Agomelatine, yohimbine: Works on the sleep-wake cycle.

* Scopolamine: Targets the brain's cholinergic system.

* Mifepristone, CRF1 antagonists: Lowers levels of the stress hormone cortisol.

* Remicade: Reduces inflammation.


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Using Muscle to Improve Health Care for Prisoners - New York Times

By SOLOMON MOORE

Last year, shortly after receiving extraordinary powers to overhaul the medical system in California’s prisons, Robert Sillen, armed with a stack of court papers, issued a blunt warning to cabinet officials at the governor’s office in Sacramento.

“Every one of you is subject to being in contempt of court if you thwart my efforts or impede my progress,” said Mr. Sillen, a silver-haired former hospital administrator chosen to carry out the overhaul of the prison medical system as the result of a class-action suit brought by a prison advocacy group.

Backing up his warning, Mr. Sillen handed out copies of a federal court order that named him the health care receiver for the California prison system.

In a subsequent warning, Mr. Sillen threatened to “back up the Brink’s truck” to the state’s treasury, if need be, to finance better medical services for the state’s 173,000 inmates.

State figures show that court-ordered changes to California’s prison system, including those in Mr. Sillen’s health care domain, have cost more than $1.3 billion, and the meter is still running.

For decades, California officials have tried to bring order to the state’s prison system, which is the largest in the nation. There have been lawsuits, special legislative committees and a declaration of a state of emergency by Gov. Arnold Schwarzenegger, but never has one person attacked a problem, piece by piece, with such blunt force and disregard for political convention as Mr. Sillen has the prison system.

Mr. Sillen, whose $500,000 annual salary puts him among California’s highest paid public officials, said he had never visited a prison or thought much about the penal system until a recruiter called last year to persuade him to accept what the recruiter called a “mission impossible.”

Now he has the power to hire, fire, raise salaries, build facilities, waive laws, tap the state treasury and have jailed any bureaucrat who tries to thwart him.

“In my opinion, Robert Sillen is not going to be happy until he’s running the entire prison system,” said a state assemblyman, Todd Spitzer, an Orange County Republican and one of Mr. Sillen’s detractors. “He’s a man who has utter disdain for the legislature despite the fact that we’re the appropriate body for budgeting.”

Mr. Sillen asked the federal courts last month to take on the costly — and politically contentious — task of reducing California’s prison population, including the early release of some felons.

The appointment of Mr. Sillen as federal receiver in February 2006 resulted from a class-action lawsuit brought by the Prison Law Office, an advocacy group based at San Quentin. A federal court in the suit found an average of 65 preventable inmate deaths a year in the prison medical system, which the court ruled was tantamount to cruel and usual punishment.

The California prison medical system was the biggest state agency ever ordered to be taken over by a federal court. The takeover was the most aggressive of several federal interventions into dysfunctional prison operations in California in the past 12 years. The federal courts also involved themselves in the prison system’s mental health, dental care, access for disabled inmates and juvenile detention operations, and in the use of force by corrections officers.

Mr. Sillen, 64, had been the executive director of the Santa Clara County Valley Health and Hospital System. Since beginning his new duties in May 2006, he has attracted hundreds of new employees to the prison medical work force. The medical staff had been experiencing a 20 percent vacancy rate, but Mr. Sillen raised salaries, in some cases by as much as 64 percent. He has siphoned off so many clinicians from other public health agencies that some now face shortages.

Mr. Sillen’s critics say that he has an authoritarian streak that has led him to wrest more control than he was given in his appointment by the court. Most troubling to some of his opponents is Mr. Sillen’s acknowledgment that he has no idea how long the changes will take or what they will cost.

The Prison Law Office filed a complaint in federal court in June saying that Mr. Sillen’s plans have “no concrete details of how any of the goals or objectives are to be accomplished, no real timelines and no metrics.”

In an interview in his office in San Jose, Mr. Sillen dismissed the group’s assertions. “When people ask me how long and how much,” he said, “I have a stock answer: Long. Much.”

Mr. Sillen speaks in rapid-fire, thrust-and-parry sentences often punctuated with profanity. He said his confrontational approach and broad federal powers were essential in trying to turn around an agency that had repeatedly failed to comply with court-ordered changes.

In a response to a demand by state lawmakers that he abide by state budgeting rules, Mr. Sillen wrote in a letter to the California Department of Finance last year that California’s appropriation process was “an immense waste of time (read taxpayer dollars) for little, if any, redeeming value” and that he felt “neither compelled nor obligated” to abide by state budget requirements.

Mr. Sillen says California politicians are reaping what they have sown. He attributed the state’s prison problems to tough-on-crime lawmakers who made political hay out of sentencing laws that filled the state prisons without expanding either the facilities or their services.

He has a standard diatribe concerning the criminal justice system that includes issues like the neglect of poor neighborhoods and the lack of alcohol treatment programs.

“I wouldn’t even be here if it weren’t for the politics,” Mr. Sillen said. “No one gets elected in Sacramento without a platform that says, ‘Let’s get rid of rapists, pedophiles and murderers.’ ”

Mr. Sillen says he has no need to curry public favor because he is backed by the federal court. He adds that, although few will say so publicly, his mission has given some politicians the political cover to embrace changes that might otherwise have been deemed too soft on crime.

Aides to Mr. Schwarzenegger, a Republican, said the threat of further court intervention was used to enact a $7.7 billion prison plan in April. The law will expand capacity by means of new construction and the transfer of 8,000 inmates to private facilities outside California.

Mr. Sillen, however, was unimpressed. Having made the governor aware of the need for new prison medical facilities, Mr. Sillen carved $1 billion out of the plan for his own projects and publicly criticized the expansion of prison space without adequate budgeting for medical workers.

After 15 months on the job, Mr. Sillen acknowledges that sick prisoners still suffer in ways deemed unconstitutional by the federal court and points to recent deaths as an indication of a long road ahead. In one case, Jonathan J. Smith, 32, a quadriplegic serving time for armed robbery, died while shackled in a prison van. The van, which had no air-conditioning and no medical staff, became lost for five hours last summer while returning to Centinela State Prison in Imperial County after a doctor’s appointment. Temperatures reached 109 degrees that day, contributing to Mr. Smith’s death, according to corrections officials.

In another case, a child molester, Melvin Fergerson, 61, died in December in his infirmary cell at Avenal State Prison. Prison officials said that Mr. Fergerson, who suffered from heart disease, had sat naked and nearly motionless for two days before his death.

Those incidents were among 552 inmate deaths in the prison system since 2006, according to the most recent state figures. Of those deaths, 161 warranted investigation of potential poor medical practices, according to an internal report. The report marked the first time in years that state officials had conducted thorough reviews of prisoner fatalities.

The poor state of medical care in California’s prisons was evident in the West Block clinic at San Quentin, the state’s oldest penitentiary and the first to be visited by Mr. Sillen. “It was unclean, it was unkempt, and there were no sinks, no phones, no faxes, no way to communicate, no nothing,” Mr. Sillen said. “And that’s the clinic. It was just worse than Third World conditions.”

Mr. Sillen announced that he would put San Quentin “under a microscope” and began a three-month program to address the problems.

He has since built a $1.6 million triage center and has broken ground on a larger, $150 million medical center, but the West Block clinic is such a low priority that it is still in the same small dirty room at the back of a prison gymnasium that had been converted into a dormitory to relieve overcrowding.

Women who work there as nurses avert their eyes as they pass 380 inmates who are lounging on rows of double bunk beds, standing in open showers or sitting on exposed toilets that line one wall of the former gymnasium.

A doctor who visits three times a week sits at a desk next to a toilet. He treats some 80 to 100 inmates each visit and cleans his hands with antibacterial sanitizer. There is still no sink.


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Case called 'perfect storm of injustice' -Durham (NC) Herald-Sun

By John Stevenson
jstevenson@heraldsun.com

DURHAM -- Because their pleas for mercy fell on deaf ears elsewhere, defense lawyers have turned to Durham's top judge in a last-ditch effort to free a mentally retarded man held 14 years without trial for allegedly killing a woman in Wadesboro.

Court documents describe the case as a "quintessential example" of a prosecution run unconstitutionally amok, a "perfect storm of injustice."

On Oct. 8, Judge Orlando F. Hudson will hear arguments about whether the defendant -- Floyd Lee Brown -- will continue to be detained at the state's Dorothea Dix Hospital in Raleigh, and whether the homicide charge against him should be dismissed.

The hearing will be in Durham County Superior Court, and is based largely on a writ of habeas corpus application drafted by the Durham-based Center for Death Penalty Litigation. Hudson granted the application earlier this month.

A writ of habeas corpus is a judicial mandate to bring an inmate into court so it can be determined if his detention is unlawful.

Brown, 43, reportedly has an IQ of 50 and the mind of a 7-year-old. He was first declared mentally incompetent to stand trial in August 1993.

Last year, he was offered a chance to plead guilty to a drastically reduced charge of voluntary manslaughter for the slaying of Catherine Lynch. The deal would have given him credit for time spent at Dorothea Dix.

However, the proposed plea bargain fell apart because Brown couldn't understand it.

Court documents indicate there are problems with the case other than the defendant's limited mental capacity. They include lost evidence, corrupt investigators and a purported confession that psychiatrists said was too sophisticated to come from Brown.

In fact, the chief detective and another investigator in the case pleaded guilty to federal racketeering charges not long after Brown was arrested, according to court documents signed by Hudson.

To make matters worse, the federal indictments alleged that investigators Roland L. Hutchinson and Robert L. Poplin Jr. made misleading reports and gave false information to the Anson County District Attorney's Office.

"It appears to the Court that the only evidence ... to link Mr. Brown to the charges which resulted in his commitment to Dorothea Dix Hospital is the confession, the veracity of which has been challenged," Hudson wrote two weeks ago. "The challenge appears to have gone un-rebutted by the prosecution."

In addition, officers knew Lynch had been attacked in her home two years before her death, but they failed to investigate a possible link between that incident and the murder, defense documents contend.

The documents, filed in Durham County Superior Court, do not mince words.

They say that "all of the elements for the perfect storm of injustice, a brutal murder in a small town with no suspect; corrupt cops who believed the ends justified the means; and a man with the mind of a little boy lacking both the knowledge and the means to defend himself, have converged over the life of Floyd Brown. As a result, Floyd has been confined to Dorothea Dix Hospital for the past 14 years because his mental retardation prevents him from ever becoming competent to stand trial."

It doesn't end there.

"This case illustrates that desperate men will do desperate things," the documents add. "Having no leads and under pressure to solve the case, the Anson County Sheriff's Department and the North Carolina State Bureau of Investigation turned to information from patrons and residents of a liquor house as justification for their pursuit of Floyd Brown. Then, when they could not find any evidence to link Floyd to the murder of Catherine Lynch, they conspired to create the best evidence they could: a fabricated confession."

The documents conclude: "Perhaps the greatest injustice in this case is that the Office of the District Attorney has defiantly refused to acknowledge the lack of evidence against Floyd Brown, the injustices committed against him by those sworn to uphold justice, and has refused to exhibit the courage to do justice in this case by dismissing ... the charges against Floyd and allowing the insidiousness of this case to see the light of day." Read more!

Housing plan for homeless ahead of goal - Portland (OR) Oregonian

Audit - In two years, Portland moves 1,039 people and 717 families into housing

ANDY DWORKIN
The Oregonian Staff

Portland's made a great start on its 10-year plan to end homelessness, putting more chronically homeless people into houses than projected, according to an audit released today.

How the city will fare in the plan's final seven-plus years is less clear, the audit said, and city officials must set more solid goals if it hopes to sustain progress -- including defining what it means to "end homelessness."

"It's very positive so far. They've set specific goals and met them," said Drummond Kahn, the city's director of audit services. "As we get further along, it's going to get more challenging" because the city's goals are cloudier and because, after first helping those more amenable to housing, the remaining homeless population may be harder to serve.

The audit reviews all portions of the city's anti-homelessness plan, passed in late 2004. That plan focuses on the chronically homeless -- single adults with disabilities, including addictions and mental health problems, who have been homeless or repeatedly in shelters for at least a year.

In 2004, that group comprised about a tenth of Portland's homeless population but used about half the roughly $30 million spent on services for the homeless. The plan tries to get chronically homeless people directly into "permanent supportive housing," where people can live and get support services, instead of moving people through a series of shelters to permanent homes.

The city surpassed many key plan goals, the audit found: In the plan's first year, the city added 254 new housing units, well over the 160-unit goal. Through the first two years, 1,039 chronically homeless people and 717 homeless families were moved into housing, above the goals of 565 individuals and 500 families.

Some other goals were not met: There is still no location set for a day access center to connect homeless people to services, a goal set for 2006. And the city hasn't met all its goals for discharging more people from jails, hospitals and other institutions into homes, though it has made improvements.

The audit's main recommendations are to improve a system for tracking data on homeless people and to set more detailed, measurable goals to help guide the plan through 2015.

"They've been on a good path for the first two years. There are now many different paths to get to year 10. They need to select from among those," Kahn said.

Key goals in the next two years include getting more private people involved in serving the homeless, city officials said.

The audit helps prove the thesis that it's better to put homeless people directly into permanent housing than temporary shelters, said Commissioner Erik Sten, who oversees the Bureau of Housing and Community Development.

Community support

With that evidence, the city can ask business and community groups to do more to help the homeless. For instance, evangelist Luis Palau is helping coordinate an effort by local churches to offer support to people recently moved into houses. Connecting recently homeless people with support groups, including some nonreligious options, is key because many chronically homeless people have no family or close friends to support their life-altering move into housing, Sten said.

The city also needs to work more with the county and other communities, such as Gresham, to combat homelessness, according to Heather Lyons, who oversees the housing bureau's efforts to end homelessness. And hospitals are working on a plan to fund housing for homeless people who need to be discharged, instead of giving them motel vouchers or sending them to shelters, she said.

Sten added that he hopes to have a site picked by this fall for a day center. That will most likely be somewhere in Old Town.

A final looming question is how the city will define success. No one expects homelessness to end completely. But city officials do hope to have few or no chronically homeless people by 2015.

"What we need is a system that says, 'If you're homeless, there's somewhere to go, and people care about you and get you back on your feet,' " Sten said.

Andy Dworkin: 503-221-8564; andydworkin@news.oregonian.com
Read more!

Federal report: Santa Fe County jail not up to par - AP

August 26, 2007

SANTA FE (AP) - Conditions at the Santa Fe County jail haven't improved enough to meet US Department of Justice standards and in some cases have gotten worse.

That's according to the most recent Justice Department report on the facility.

The report says medical care at the facility has "deteriorated significantly" since August 2006, access to mental-health care has improved but remains sub-par, and short staffing is an ongoing and persistent problem that exacerbates the other two.

The Department of Justice has reviewed the jail quarterly since 2004. At the time, the jail was run by a private contractor. The county took over administration of the jail about two years ago.

Spokesman Stephen Ulibarri says county officials will meet with the Justice Department in September to discuss what will happen if the county can't meet standards.

Copyright 2007 The Associated Press. All rights reserved. This material may not be published, broadcast, rewritten or redistributed. Read more!

Living with disabilities: Aging parents face unknown - Provo (UT) Daily Herald

By JOE PYRAH

Randy DeRose has his eye on a Harley-Davidson.

With slicked-back hair and an easy smile, Randy has been doing his best to earn one since his brother gave him his first ride. But even if he meets his reading and writing marks, it's not going to happen.

Arms weakened by Down syndrome, the 40-year-old would never be able to hold up a 700-pound motorcycle, never mind the rest. But it's a goal to work toward, says his mother Lena DeRose, and Randy, the youngest of six children, is always up for a challenge.

The 84-year-old Springville mother should know. She has had her son by her side since the day four decades ago when she told off a doctor for suggesting she leave her newborn in the care of the state. "I said 'How can you insult me like that?' "

Facing the ravages of age, including death, groundbreaking parents like Lena are among the first who have to ask themselves what will happen to their 40 and even 50-year-old mentally disabled sons or daughters once they aren't around.

When Randy was born, mentally disabled infants rarely felt the embrace of a mother or father, says Kathy Edwards, director of Recreation and Habilitation Services in Provo.

"Doctors would go to parents and say 'Don't look at them, don't touch them, take them to the training school,' " Edwards said.

The state Training School in American Fork -- now known at the Developmental Center -- took in many children during the early years of it's 75-year history, almost regardless of the level of mental disability. The center now houses about 250 people who are considered extremely disabled.

But that first generation of defiant parents shunned the Training School, did look at their children, did touch them, and by all accounts provided a good life, a life that is now coming to an end.

And so Lena, whose husband died two years ago, struggles to find a reasonable solution for her son.

"My oldest boy told me 'Don't worry about him.' But I do. I do," she says softly with Randy next to her taking on corn on the cob with the precision of a surgeon.

From birth, the lives of special needs children intertwine inextricably with their parents.

"We told ourselves, 'He'll go where we go, stay where we stay and if our friends don't like it, we'll find new friends,' " said Reed Cornaby of Salem, about his and his wife's decision to take their son Kenneth home 42 years ago. Kenneth has Down syndrome.

Cornaby and his wife Lucy take Kenneth to and from his job at Macy's three times a week. When the LDS couple goes to the temple, their son goes with them. And there are always plenty of group activities, like Thursday's end of summer bash for Recreation and Habilitation Services. RAH provides recreational and educational programs for people with disabilities. The organization offers social skill instruction, assistance in getting jobs and becoming independent, education in dressing and grooming and sports and recreational activities, according to its Web site, rah-provo.tripod.com.

"He's such a sweetheart," Reed said, about Kenneth. "He won't go to bed until he tucks us in and pulls the covers up around our necks."

Much like their attention to detail during life, the Cornabys have planned meticulously for when they aren't around to be tucked in anymore. They have set up a trust specific to Kenneth that details his support once they die. The 80-year-olds also are confident their six other children will be lining up to take Kenneth.

"We've studied this since Day 1," Reed said.

Not everyone has prepared as thoroughly as the Cornabys, or has other children willing to take the reins. There are those, says Edwards, who never thought they'd see such a day.

"Almost to a person they all thought their children would pass on before they did," Edwards said.

Lena was told her son would die by the age of 16, the Cornabys were told 17. But a funny thing happened when those disabled children began living at home: They started living longer.

According to a study from the Centers for Disease Control and Prevention, life expectancy for those with Down syndrome nearly doubled, from 25 years to 49 years, between 1982 and 1997. The study cites not only better treatment options but also the turn from institutionalization to family care. Life expectancy for many types of mental disability continues to increase as well.

Options for providing for mentally disabled children run the gamut, from family members simply taking over, to group homes, to government assistance.

Getting state aid is possible, but there's a waiting list 1,800-strong. Those in critical need can take cuts in line, however. Applicants may qualify based on state standards of mental retardation and related conditions such as cerebral palsy, autism or severe epilepsy. For example, years ago Randy DeRose was determined to have the capacity of an 8- to 10-year-old. His mother says that hasn't changed much.

The state Legislature has increased funding to help care for the growing population of mentally disabled adults, said George Kelner, director of the state Division of Services for People with Disabilities.

This year the division received an additional million dollars to go with an additional $2 million the year before. Because of 3-to-1 federal grant dollars, that money was able to help 700 people on the waiting list and brought the number of disabled adults being served by the state to 4,500. State services include everything from non-medical supervision to life skills training to help getting dressed.

"We're hopeful and requesting the governor give consideration to build more money in his budget," Kelner said.

Gov. Jon Huntsman won't begin budget planning until later this year, said spokeswoman Lisa Roskelley, though his priorities include health care.

There are also businesses like Danville Services Corp., which provides home or apartment living options and support throughout Utah and several other Western states.

Lena would like to see her son in an assisted living facility, not only to provide him a social setting but to allow her other children to focus on their own lives and those of their children.

But after 40 years of daily devotion, it's proving difficult to break those bonds.

"If I could break him now before I die," she says, before trailing off. A pause, then a look that focuses somewhere in the distance.

"It's going to be the hardest thing I'll ever do."

What is Developmental Disability?

There are approximately 4.5 million individuals with developmental disabilities in the United States. Developmental disabilities are severe, life-long disabilities attributable to mental and/or physical impairments, manifested before age 22. Developmental disabilities result in substantial limitations in three or more areas of major life activities:

capacity for independent living

economic self-sufficiency

learning

mobility

receptive and expressive language

self-care

self-direction

Without appropriate services and supports, the choices open to people with developmental disabilities, including where they live, work, and play, are minimal. They are isolated rather than fully integrated and included in the mainstream of society. Persons with developmental disabilities require individually planned and coordinated services and supports (e.g., housing, employment, education, civil and human rights protection, health care) from many providers in order to live in the community.

Source: U.S. Administration on Developmental Disabilities

Places to contact for help:

Recreation and Habilitation Services

374-8074

Utah Division of Services for People with Disabilities

http://www.hsdspd.state.ut.us/

American Fork Office

861 E. 900 North

American Fork, UT 84003

(801) 763-4100

Provo Office

150 E. Center St.

Provo, UT 84606

(801) 374-7005
This story appeared in The Daily Herald on page A1. Read more!

Serving a group often neglected - Philadelphia Inquirer

Dental clinic caters to patients with disabilities.

By Stacey Burling

Sharmaine Jackson had a surprising reaction after her mentally retarded daughter's most recent dental exam.

She cried.

It had been that hard, she said, to find a dentist who would accept Medicaid and was comfortable treating a frightened 15-year-old with mental and physical disabilities.

"A lot of places that I've taken my daughter to didn't even want to touch her," said Jackson, who lives in West Philadelphia. Many of her daughter's teeth were damaged by medications, and dentists' offices make the teen, Gina Davis, jumpy.

Jackson was thrilled to find a new clinic for people with developmental and physical disabilities in Philadelphia. The clinic, with inviting lighting and exam rooms scaled for wheelchairs, is operated by Elwyn, which serves people with mental retardation and other disabilities.

Because so many people have had complaints similar to Jackson's, Elwyn decided to open a second clinic this summer in West Philadelphia. Its first is on the grounds of its headquarters just outside Media.

Jackson said her daughter, who needs to go back for extensive work, handled her visit to Elwyn's clinic far better than usual. Unlike her mother, she didn't cry.

"She actually said she would go back there," Jackson said.

Though business is still slow, the nonprofit Elwyn expects to serve 1,800 patients at the Philadelphia dental office. About 1,400 now go to Media, some traveling from as far away as Lancaster and Allentown.

No one considers this ideal. In fact, advocates for the mentally retarded would prefer that people who can visit a dentist without general anesthesia go to the same dentists as the rest of us. But they grudgingly acknowledge that's not happening and say they are thankful Elwyn is serving a desperate need.

"The problem with access is fairly universal, whether it's in a big city or it's rural," said Emilee Langer, a consultant on dental issues who recently worked with the University of Pittsburgh to expand services to special-needs patients. "The need is tremendous."

Caregivers face long waits for appointments for disabled people who may not understand how to brush properly and may take medicines that accelerate tooth decay. "It's a recipe for disaster," she said.

Before opening the new clinic, Elwyn participated in a study on the issue that yielded a 295-page report last year to the Pennsylvania Developmental Disabilities Council. The report, which culled information from national sources and surveys of dentists and caregivers in Pennsylvania, called the lack of access to dentists a "pervasive theme."

Arc of Pennsylvania, which advocates for people with mental retardation, has made legislation to improve dental care a priority this year. Pennsylvania's Department of Public Welfare, which administers the Medicaid program and spends $100 million a year on dental care, encourages dentists to serve the poor and disabled, but without extra funding.

Everyone agrees fixing the problem won't be easy. Advocates say Medicaid needs to pay dentists more, and dentists need more training in working with people with disabilities. Arc even suggests requiring dentists to treat a certain number of disabled patients.

"You could give me $100 million, and I'm not sure I could solve the problem," said Mark Goldstein, a pediatric dentist who directs Special Smiles Ltd. His 5-year-old program in North Philadelphia serves the most disabled patients, those who need complete sedation and often have gone decades without dental care. It handles 1,200 cases a year. Some patients travel five hours.

Most disabled patients don't need the kind of care that Goldstein's program provides. Some require no special treatment. Elwyn is targeting the middle group - people who need extra patience and possibly conscious sedation, people who may have behavior problems that can make them unwelcome in many waiting rooms and disrupt patient flow in tightly scheduled practices.

Paul Westerberg, DPW's chief dental officer, said only about 7.5 percent of the state's dentists can legally provide general anesthesia or conscious sedation. (Elwyn won't offer conscious sedation in Philadelphia until the spring.)

Most people with mental retardation or other serious disabilities are covered by Medicaid, the government health insurance program for the poor. Many states have stopped covering routine dental care for adults, but Pennsylvania's and New Jersey's Medicaid programs still do. The rates paid to dentists who provide care are usually lower than those paid by private insurers, advocates said.

Only about a quarter of Pennsylvania's 8,000 dentists accept Medicaid, and there's no requirement that they accept a certain number of poor patients. Advocates say many of the dentists on the state's Medicaid list tell callers - disabled or not - that they're not accepting new patients.

Patients with a disability have a doubly tough time. Many dentists say they don't feel comfortable dealing with the behavioral issues and extra medical problems that often accompany mental retardation. Plus, these patients are time-consuming.

"Everything you do on these patients takes so much longer, but the insurance companies don't allow for that," Goldstein said.

The state pays a $125 behavioral management fee for some patients with developmental disabilities, Westerberg said. That should be an incentive to take more of them.

Dina McFalls, director of Philadelphia Coordinated Health Care, which helps people with mental retardation find health care, pointed out that many dentists aren't happy with private insurance rates, either. "I don't think it's just the rates," she said. "I think this is not an attractive population to serve and I think many dentists are not taking any insurance. It's just a very difficult issue to solve."

Because of the access problems, mentally retarded people often have serious dental problems. This is especially true of adults who live at home, advocates said. Group homes must make sure clients are at least seen regularly by a dentist.

"We have 340 people enrolled in our day program and, of those individuals, I would guess easily 50 percent of them have not had regular dental care," said John Felp, executive director of Arc of Philadelphia.

Advocates say there's growing evidence that good dental and physical health go together. Plus, rotting teeth, and the pain that goes with them, can lead to behavior problems, especially in people who can't communicate well. Imagine how you'd act if you had a toothache you couldn't tell anyone about. For months.

Elwyn had a dental clinic on its 400-acre grounds for its own residents for decades. It started taking patients from the outside two years ago, said Susan Proulx, executive director of corporate clinical services. It treats patients with mental retardation, autism, mental illnesses or other disabilities.

It has been able to make money "through efficiency, efficiency, efficiency," Proulx said.

Donna Heenan, director of dental services, said the staff learns what makes each patient comfortable. One man loves felt-tip markers. "We get good behaviors from him if he thinks he's going to get Magic Markers." Another loves Billy Joel, so they play his CDs during his exams. The staff has learned the names of another patient's stuffed animals.

Elwyn had several dentists try out for three days in Media before choosing Walter Nagaji-Okumu to be the first practitioner in Philadelphia. Nagaji-Okumu, who is originally from Kenya, also has a master's degree in public health and is particularly interested in working with people with disabilities.

He strives to be friendly, patient and calm.

On a recent day, he saw Harold Gordon, a mildly retarded man from Ardmore, for a quick exam. Nagaji-Okumu slowly explained his every movement. "This chair moves up and down," he said. "We'll move you up a little . . . and tilt your head back."

When Gordon looked a little startled, Nagaji-Okumu reassured him, "OK. Don't get scared."

Later, he asked Gordon to stick out his tongue. "Can you please put your tongue up here? I'm going to touch with my fingers."

Gordon looked nervous but cooperated well.

When it was over, Nagaji-Okumu asked whether Gordon flossed. He said he used a toothpick. "You know floss can do a better job probably than a toothpick," the dentist said gently. "It won't hurt your gums."

As Gordon was leaving the exam room, he smiled and said, "You know what? I like you. You're a nice guy. You know how to talk to people." Read more!

Nashua boy inspires mom to join fight for autism awareness -Nashua (NH) Telegraph

By Pamme Boutselis, Telegraph Correspondent

NASHUA – Cameron Michalewicz was 4 years old and had never spoken. His mother, Jessica Menchion, expressed concern to her son’s pediatrician, who told her that some children just speak later than others. When Menchion learned that she could take Cameron to a local public school for testing, she wasted no time.

“There, I was told that Cameron’s testing showed he did, in fact, have a developmental disorder,” Menchion said, “but it needed to be medically diagnosed by a specialist before we could proceed further.”

With the school testing report in hand, Menchion finally received a referral from Cameron’s pediatrician to a specialist who diagnosed her son with PDD-NOS – pervasive development disorder not otherwise specified – in the Autism Spectrum.

While Menchion knew deep down something was wrong, it was heartbreaking to hear the diagnosis.

“All those years of uncertainty were now gone. All those years of early therapies we could have entered Cameron in were now also gone,” she said. “I can’t help but wonder what more could have been done for him. Where would my loving son now be if he had been diagnosed earlier?” Cameron is now eleven.

According to Autism Speaks, a nonprofit organization dedicated to increasing awareness of autism spectrum disorders, funding research for a cure, advocating for the needs of families affected by autism, one in 150 individuals is diagnosed with autism, making it more common than pediatric cancer, diabetes and AIDS combined.

Occurring in all racial, ethnic and social groups, autism is four times more likely to strike boys than girls. Autism impairs a person’s ability to communicate and relate to others. It is also associated with rigid routines and repetitive behaviors, such as obsessively arranging objects or following very specific routines. Symptoms can range from very mild to severe. Autism spectrum disorders can usually be reliably diagnosed by age 3, although new research is pushing back the age of diagnosis to as early as 6 months.

New research also shows that when parents suspect something is wrong with their child, they are usually correct.

Menchion says she felt that deep concern and frustration of knowing something was wrong with her child.

“To know your child is suffering, yet not know how or why. To spend so many sleepless nights kneeling beside your child’s bed, listening to him screaming and crying at the top of his lungs. To know that the feel of your touch would make him cry harder and scream louder,” she said. “The toll it takes on you emotionally is overwhelming.”

In 2006, Menchion, who lives in Nashua, learned of Autism Speaks’ Walk Now for Autism, which is the country’s largest grassroots autism walk program and the organization’s signature fundraising and awareness event, taking place in communities across the U.S., as well as in Canada and the United Kingdom.

This is Menchion’s second year participating in the walk, which will be held in Nashua on Sunday, Sept. 9, at Greeley Park.

Team CamaJama, Cameron’s nickname, is currently 22 members strong and includes his mom, siblings Julia, age 9, and Nicholas, age 7, his aunts and mom’s co-workers.

Erica Jacobson, New England walk manager for Autism Speaks, heads up the walk in Nashua; Burlington, Vt.; and Providence, R.I. She anticipates more than 2,000 participants will attend this year’s event, the fifth anniversary of the walk.

Jacobson said the 2006 walk raised approximately $150,000 and most importantly, 85 cents of each dollar raised goes towards national research.

“At this year’s walk,” Jacobson said, “we hope for more money raised, more participants and a greater awareness raised by publicity.”

Jacobson noted that there are many misconceptions regarding autism, including the perception that people who are affected have the intelligence of the character in the movie “Rain Man.”

“Some people believe that the children affected will never be able to speak or they won’t have the chance to live independently,” Jacobson said. “With early intervention and research, they have an opportunity to work toward this goal.”

Menchion feels the biggest misconception is that people don’t see what many of these children are capable of accomplishing.

“Autism has a very large spectrum, and every case is different,” said Menchion.

Cameron displayed many of the “symptoms” often portrayed by the media, such as screaming, repetitive movements and strong sensory issues.

“Now, after working with him over the years, many of the stereotypical tendencies have subsided,” Menchion said. “Unless you get into a conversation with him, you would not even know he was different at all.”

Rock 101 WGIR FM, Wireless Zone, WMUR Channel 9, the Boston Red Sox, National Grid and Abercrombie and Finch Pub are the walk’s sponsors this year.

Jacobson said, “Many local companies have also provided discounts for walk day supplies, such as water, food, tents and bounce houses.”

The public can get involved by contributing to the walk itself financially or by volunteering their time on the planning committee, forming or joining a team, or walking alone. There’s plenty of opportunity to volunteer on walk day or to assist in putting up posters or distributing brochures in neighboring communities.

For more information, visit www.autismwalk.org/nh.
Read more!

New test for special education students is making schools nervous - Austin (TX) American Statesman

By Melissa Mixon
Monday, August 27, 2007

As students return to class today, schools across the state are bracing for a change that will force some in special education to take a tougher test than they've been required to in years past.

Some district officials worry that the change could have ripple effects and ultimately hurt their federal accountability ratings.

The exam will be given for the first time next spring, and some special education students will have to be tested at their grade levels instead of their actual learning levels.

Colleen Horton, public policy director at the Texas Center for Disability Studies at the University of Texas, says the test is cramming "square pegs into round holes."

Her 16-year-old daughter has autism and is a 10th-grader at Westlake High School. With the new test, her daughter, who reads at a third-grade level, could be tested on the 10th-grade curriculum.

"If you've got a lot of students that are not taking these tests or that are being forced to take a test that they're not capable of, then the school ratings will go down, and the special education students will be blamed, and that's just not fair," Horton said.

State officials have been scrambling to compile the test since April, when new and controversial federal regulations mandated that states either develop grade-level tests for some special education students or require that those students take a regular state accountability test, a move that probably would be brutal for most school ratings.

The test is called the TAKS-M or TAKS-Modified, after the Texas Assessment of Knowledge and Skills.

It will have fewer answer choices than the regular test (three instead of four), text will be written in a larger font, and sentence structure will be simplified. And unlike its predecessor, the State-Developed Alternative Assessment II, the TAKS-M will require students to answer grade-level questions despite their personal learning levels.

State officials say they do not know how schools will be affected by the test, but they say the first one or two years could be the most difficult.

"Our biggest concern is that, initially, students will be taking an assessment that they're unprepared for," said Criss Cloudt, associate commissioner for the Texas Education Agency.

Officials estimate that 80,000 to 100,000 Texas special education students will take the TAKS-M this year.

Because it's the first year, teachers know little about the test, its grading standard or its effect on schools trying to meet federal academic targets set by No Child Left Behind Act.

It's also unclear how school districts will handle a new federal cap on the number of students passing the TAKS-M test who can be counted toward a district's "adequate yearly progress" reports.

The reports are used by the federal government to gauge school performance. Poor federal ratings could lead to sanctions and possible school closures.

Though the TAKS-M will affect only federal ratings this year and the next, it could eventually affect state accountability ratings, according to state officials.

Under the new regulations, only 2 percent of a district's student body can be counted as taking and passing the TAKS-M, when it comes to federal ratings. If more than 2 percent of a district's students take the TAKS-M, the excess students are counted as automatic failures, even if they pass.

The same rules apply to a new 1 percent cap on the state's TAKS-Alternate test, which is reserved for students with the most severe cognitive disabilities.

Students took a practice version of TAKS-Alternate last spring, but there was no cap, and all counted as failures on the schools' accountability ratings.

If the TAKS-M cap is applied to last year's student testing figures, it could negatively affect some districts' scores.

In the Leander district, 4.2 percent of the total student population took either a math or reading version of SDAA II last year. Ninety-eight percent of the students passed the test.

But if those same students were eligible to take the TAKS-M test this year and passed, only half would be counted toward the district's federal rating. The other half would be counted as failures. That would be 165 more failing scores than last year, when there was a 3 percent cap.

"It's difficult to tell if it's going to make or break us. But when you're doing the accountability game, it can take just one student," said Sarah Martinez, the district's director of special education.

Figures from the Austin school district weren't available last week.

Capping the number of students whose passing scores can or can't be counted is nothing new to Texas. The SDAA II had a similar 3 percent cap last year. But the latest caps are the most rigorous that have ever been placed on the state, said Shannon Housson, director of the Texas Education Agency's division of performance reporting.

Patrick Rooney, a senior policy adviser for the U.S. Department of Education, said the caps were derived from statistics that say special education students make up 10 percent of the population nationwide.

Of that group, only 1 percent have extremely severe cognitive disabilities, which accounts for the cap on TAKS-Alternate, and 2 percent have less severe cognitive levels, hence the cap on TAKS-M.

"One of the main outcomes of No Child Left Behind is trying to increase the achievements of all students and to raise the expectations for all students," Rooney said. "And special education students have for a long time been kind of a forgotten group."

Another major difference between the new test and the SDAA II is that the TAKS-M will require an across-the-board statewide grading standard, rather than letting administrators and parents determine a student's passing rate for each district.

Under the SDAA II test, the grading standard for each student was determined by a committee of school officials and parents who evaluated whether the student had met individual goals and progress reports. Test scores from those students then counted toward a school's federal rating.

TAKS-M scores will also count toward school ratings, but some officials say they will prevent schools from setting lower standards to achieve higher accountability ratings.

The TAKS-M "is going to be the rigor of grade-level instruction and pretty significant grade-level performance that wasn't such a rigorous accountability measure under SDAA II," said John Fessenden, an education specialist for the Region 13 Education Service Center.

Officials in the Austin, Leander, Round Rock and Hays districts said they have known that special education was shifting toward grade-level testing, but they said the limited information on the new test has made them nervous.

"There's a lot of concern that school districts are going to have problems with this, this first year," said John Thornell, executive director of assessment for the Hays district. "There are so many unknowns about this right now, and there's nothing to tell us, 'Here's what's going to happen.'"

The old vs. the new

State's new TAKS-M requirements:

Students must be tested at their grade levels.

A district cannot count more than 2 percent of its students who took and passed the TAKS-M for its federal ratings.

Student grading standards are determined by the state.

State's old SDAA II requirements:

Students could be tested at either their grade levels or their learning levels. It was up to district officials and parents to decide which one.

A district could not count more than 3 percent of its students who took and passed SDAA II for its federal ratings.

Student grading standards were set by parents and district officials.

mmixon@statesman.com; 246-0043 Read more!

A girl with autism longs to fit in - Savannah (GA) Morning News

By Columnist Anne Hart
August 26, 2007

Ask Azrael DuBose what she dreads most about going back to school and the Savannah 10-year-old responds: the bullying.

Ask her what her one wish is, and her answer is equally as painful.

"That kids learn more about autism and not make fun of it.''

Azrael is just like any other cute little girl. She has freckles, pet pugs she adores and a little sister who likes to tag along. But Azrael also has a disorder called Asperger's syndrome, a form of autism that makes it difficult to pick up on the social skills that come naturally to most people.

Azrael's been teased so cruelly she comes home in tears. She prefers to be with her family or adults, than with children.

Insults from kids include asking her the antiquated "Were you born on Jupiter?," calling her the B-word, spreading rumors and simply leaving her out.

Azrael and her parents, Christy and Randy, agreed to share Azrael's story in hopes of increasing acceptance of children with autism, specifically Asperger's.

The older Azrael gets, the more difficulty she has fitting in.

That's why Azrael joined an ongoing social skills group designed to teach everyday skills such as how to carry on a simple conversation, deal with bullying and, most important, how to make friends. The goal is to decrease isolation and anxiety.

The next 8-week course, organized by The Mindspring Center and the Matthew Reardon Center, begins Sept. 8. The group therapy is open to all children with communication, behavior and learning disorders.

The DuBoses hope the group will help make Azrael's fifth-grade year one with less heartache, less ridicule, less longing for acceptance.

"Asperger's makes me wonderful"

Expect to hear a lot about autism this school year. Schools are struggling to cope, as an increasing number of children are diagnosed with the neurological disorder.

Today, one in 150 children has autism or an autism spectrum disorder, which encompasses several related disorders such as Asperger's. In the 1970s, the commonly held belief was that three in every 10,000 children had autism.

If teaching autistic children how to process basic social cues sounds ridiculous, then chances are you don't know anyone suffering like Azrael.

Azrael - whose name means "with the help of God'' - has good verbal skills and already reads on a seventh-grade level.

But she doesn't understand body language, facial expressions or nuances in language. She doesn't speak sarcasm, but instead takes what you say literally. She tends to skip clichés and standard greetings.

"Did you know the bushbaby pees on his hands?" is how Azrael greeted a woman at church recently.

Similar to others with Asperger's, also called "the geek syndrome," Azrael has a high IQ and is teeming with talent. She loves music and animals, wants to be a zoologist and can tell you all about the eating habits of a kinkajou.

Which are all traits that make Azrael fascinating - to adults - but turn her into a prime bullying target in a mainstream elementary classroom.

Unlike some other disabilities, Asperger's has no immediately obvious physical symptoms.

"Asperger's is an invisible disability," said Azrael's mom, a special education teacher.

As a result, children with Asperger's often are mistaken as simply having a personality flaw and being defiant smart alecks who speak their minds, even if what they have to say is insulting.

Azrael, whose diagnoses also include attention deficit hyperactivity disorder and obsessive compulsive disorder, becomes irate when classmates don't follow rules. "It's hard to make friends when you are perceived as a tattle-tale,'' said Christy DuBose.

The phone rarely rings for Azrael. She's not often invited to go places.

Stephanie Warren, licensed clinical social worker and psychotherapist who helps run the social skills group, says despite the challenges, Asperger's can be a gift.

"These are really interesting kids who just need to be taught skills that come naturally to others, such as why they shouldn't bore someone by talking in depth about the barometric pressure during a hurricane on March 30, 1937," Stephanie said.

Stephanie's husband of 12 years has Asperger's. He put the disorder's positive traits to good use and became an aerospace engineer.

Azrael's parents want their daughter's future to be just as bright. Her mom even bought Azrael a T-shirt that reads "Asperger's makes me wonderful."

At the start of school, Azrael and her parents will do what they always do: bring her new teacher a stack of Asperger's books and hope Azrael's wish comes true.

That children stop making fun.

And Azrael starts making friends.

Contact Anne Hart at annehart1@bellsouth.net. Read her past Sunday columns at savannahnow.com/node/93615 Read more!

Mental Health Budget Cuts: "Rehabilitation is Cheaper than Incarceration--Dignity is Priceless - California Progress Report

By Kate L McLaughlin

Several years ago on the streets of San Francisco, my husband Mark and I simultaneously experienced both sides of a controversial issue. Our son Michael, freshly released from a psychiatric hospital where he’d received treatment for Bipolar Disorder walked with us. Much improved but still struggling with anxiety, low-level mania, and paranoia, he began to unravel as the day grew long.

Knowing we needed to get Michael back to the hotel, we decided to grab an early dinner. Just outside the restaurant the three of us encountered a homeless man who clearly suffered from symptoms much like Michael’s.Propelled by some magnetic force, these two young men gravitated toward one another with aggressive posturing and angry words. Had Mark not been present to intervene and lead Michael away, violence would have ensued. Instead, however, we guided our son toward greater calm while the other fellow spiraled out of control, his loud rantings echoing through the street until someone eventually called the police. Two young men. Both ill. One, with support, walked away. The other, on the street and alone, went to jail.

As is too often the case, illness became crime; and unfortunately, budget cuts enacted last week by Governor Schwarzenegger will almost certainly result in an increase of similar cases. The now unfunded Integrated Services for Homeless Adults with Serious Mental Illness program supported over 4500 people. Through housing, medical treatment, job counseling, and perhaps most significant, a sense of belonging, this program returned dignity to an often disenfranchised group. What will happen to them now?

According to William Shryer, Clinical Director of Diablo Behavioral Healthcare and Program Director for DBH Neuroscience Seminars, even more will go to jail. “Our budget will decimate children’s and the homeless’ ability to access mental health services. What this will mean is that sicker individuals will end up in the Criminal Justice system and require more money to handle the situation. This is truly biting the nose to spite the face. The “5 P” principal, “Prior Planning Promotes Professional Performance” was not at work here.”

Many agree with Shryer. “It was a terrible blow,” said Nancy Peña, director of Santa Clara County Mental Health Administration. “We’ll be trying to figure out what we’re going to do as we go forward on this. These consumers have critical mental health needs and they’re going to need to be moved into some service.”

The mentally ill in Santa Clara County are fortunate to have an advocate dedicated to retaining services. Let’s hope every administrator in every county is equally intent on identifying funding sources and programs. It would be far too easy to shut the doors and ignore the profound consequences of that action. Local leaders must commit to a “best practices” philosophy as they search for ways to serve their constituents, and they must realize that this commitment will likely result in better care for the mentally ill as well as greater fiscal responsibility. Rusty Selix, executive director of the California Council of Community Mental Health Agencies, has said that the cost of incarceration can be six times higher than the cost of enrolling someone in a mental health program. Rehabilitation is much cheaper than incarceration.

Kate L. McLaughlin, mental health advocate, speaker, and author of “Mommy, I’m Still In Here”, is a member of the Depression and Bipolar Support Alliance, the National Alliance on Mental Illness, and the Juvenile Bipolar Research Foundation. Reach her at katelmclaughlin@gmail.com Read more!

Caught between what she wants — and what is -Traverse City Record-Eagle

Kathy Gibbons
August 26, 2007

A woman stopped in the other morning.

She looked nice, like anybody else. But as she talked, I could tell something wasn't quite right. And she was upset.

She'd come to Traverse City from her home downstate to participate in a music program for adults. Now 44, she said she'd attended Interlochen Arts Camp as a teen and after just a few days, her clarinet playing improved exponentially — and she never forgot that wonderful experience. She still plays as much as she can, and when she saw the information about the adult program this summer, couldn't wait to come.

The thing was, she was ejected from it mid-way through for causing what the people in charge described as disruptions. A security officer escorted her as she packed up and left.

"That's usually what happens to somebody like me: 'Get rid of her,'” she said. "I was distraught, upset. I was trying so hard to do well.”

She'd spent the night before she stopped here sleeping in her car, in a parking lot at a library. She could have gone home, but she didn't want to show up there ahead of schedule. She didn't want her 83-year-old mother to know what had happened; her mother is always telling her she shouldn't be trying to do things like this program.

"I don't ever want to tell her what happened here and that's why I'm sticking it out,” she said.

She admitted it wasn't the first time she'd been thrown out of something like this, or come close. Why?

She has Asperger's syndrome, a form of autism that a Web site on it described as being characterized by "social isolation and eccentric behavior.” It sounds like she doesn't tell anyone about it up front, either. The people in charge of this program didn't know; neither did she mention it to the woman who ended up being her roommate for the few days she was here. (The roommate spoke kindly of her, by the way.)

"I'm emotionally and socially a little odd,” she said. She was first diagnosed in her later 20s, after she already had earned bachelor's and master's degrees. "I'm a little more reactive.”

And that's so hard, because she really, really just wants to be liked.

"I'd give the shirt off my back to be liked, to be appreciated, and to be needed,” she said. "But it's hard to make people like me.”

She also wants a career — if not in music, then anything that would enable her to support herself. She lives on total disability, which she said makes her ashamed. She even tried to become a teacher once, but the people in charge didn't think it was a good idea.

After she left, I thought about her a lot, and how it seems she is trapped. She has dreams and feels she has it in herself to achieve them and yet, Asperger's is the very thing in herself that always gets in the way.

"It's me against the world,” she told me. "I've always wanted the happy ending.”

I hope she finds a way, given everything, to get it.

Reach Kathy Gibbons at kgibbons@record-eagle.com

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Drug makers step up giving to Minnesota psychiatrists - Twin Cities Pioneer Press

Unique law reveals money defenders say is for research, education

BY JEREMY OLSON

One in three Minnesota psychiatrists has received funding from drug manufacturers in the past five years, including seven past presidents of the Minnesota Psychiatric Society, two state drug policy advisers and 17 faculty psychiatrists at the University of Minnesota.

While drug company funding is hardly limited to mental health providers, a review of the latest Minnesota public data shows a much higher proportion of psychiatrists receiving money for research, lectures and consulting than other medical specialties.

Drug companies reported $2.1 million in contributions to Minnesota psychiatrists in 2006, up from $1.4 million in 2005.

It's arguable whether the money influences how doctors prescribe drugs or how doctors on influential advisory boards recommend how and when drugs should be used. The psychiatrists who take the money see it as a necessity in a system that needs more education about mental illness and shortchanges mental health research.

Health policy advocates believe the drug companies are getting a return on their investment regardless of whether the doctors know the money is influencing them.

"They wouldn't keep doing it - piling on more and more dollars - if they didn't think it was successful," said Joel Albers, a St. Paul pharmacist and health economist.

From 2002 through 2006, the nation's drug manufacturers reported $73 million in gifts, grants and reimbursements under Minnesota's one-of-a-kind reporting law. Payment records for 2006 were released earlier this summer and have been added to a Pioneer Press database at twincities.com that allows readers to search by name for doctors, nurses or institutions that have received money.

The state's reporting system is imperfect, as drug companies apply different criteria for the types of payments they must disclose. Some include scientific grants that are in doctors' names but actually go to their research institutions. Others include only the meals, gifts and perks Minnesota lawmakers were targeting when they passed the reporting law a decade ago.

The tally nonetheless is a crude indicator of the involvement and influence of the drug industry in medical care nationwide, especially in areas like psychiatry that rely heavily on some of the nation's most expensive drugs.

Such lawmakers as Sen. Chuck Grassley, R-Iowa, have been scrutinizing the Minnesota data and proposing federal laws to either disclose or restrict the money drug companies give doctors. Locally, the Minnesota Department of Human Services is considering tighter restrictions on members of its drug formulary committee, who advise the state on which drugs are most effective and offer the best value.

One committee member, Dr. John Simon, has received more than $570,000 since 2002 from six drug companies, according to state reports. Most of that was from Eli Lilly, whose antipsychotic drug Zyprexa is the most costly each year for Minnesota's fee-for-service health program for the poor and disabled.

While the committee offers guidance on numerous medications, its advice on mental health drugs is crucial. More than 200,000 Minnesotans are enrolled in the fee-for-service program, and 80 percent of them take at least one psychiatric medication.

Simon said pharmaceutical companies pay him to speak at conferences and clinics about their drugs or about the conditions treated by their drugs. While the situation hasn't occurred, he said, he would abstain from any committee votes involving drugs he has been paid to discuss.

He did vote in December 2004 for an unrestricted state policy with respect to Strattera, a nonstimulant drug Lilly makes for attention deficit disorder. Upon reflection, he said, he should have abstained or acknowledged his funding from Lilly before voting. However, he said, he also cast votes advising restrictive policies on Lilly drugs that regulate insulin and cholesterol.

"I certainly don't need to take care of the pharmaceutical companies," said Simon, who was appointed to the formulary committee by the Minnesota Psychiatric Society. "They're big boys and can take care of themselves by other means."

"Most of the psychiatrists who are really good," he added, "have ties to industry."

State records show 187 psychiatrists received $7.4 million from drug companies from 2002 through 2006. Twenty-eight received at least $50,000 during that period, while others received smaller amounts for gifts or speaking engagements. The median amount received was $2,700, which is three times the median amount of $900 for other types of doctors who received payments.

The state psychiatric society is reviewing literature and research on drug company influence and plans to offer members training on how to avoid conflicts, said Dr. Jeff Hardwig, society president.

"Does drug company marketing affect our practice? I think the answer must be yes," said Hardwig, a northern Minnesota psychiatrist with no drug company ties. "Practicing psychiatrists must be aware of how that might influence them and be on guard against undue influence."

Simon said psychiatrists are getting a greater share of drug company money because primary care doctors need more education about mental illness and how to treat it: "Go into your family practice clinic and complain about chest pain and see what they say, and then go in and complain about bipolar disorder and see what they say."

Former pharmaceutical executives said drug companies are interested in teaching doctors about treatment standards, because that will increase the number of doctors who act on that information and prescribe their pills. However, they said, pharmaceutical companies usually start by hiring doctors who are frequent prescribers of their drugs.

Psychiatric drugs are unique. If patients have success with certain medications, their doctors aren't likely to switch them, even when cheaper alternatives are available. That increases the stakes for drug companies to make sure their drugs are tried first.

It also makes decisions by formulary committees and other advisory boards particularly important. If Minnesota's formulary committee votes to restrict how a certain drug is prescribed, the state usually follows that recommendation.

A spokesman for industry trade group PhRMA said earlier this year that the money reflects valuable research and education that is advancing medicine. The group has questioned the relevance of the state database, because it mixes research grants with gifts and other types of unrelated payments.

Dr. David Adson, of the University of Minnesota, reportedly has received more than $560,000 since 2002 from drug companies. However, Adson said, most of that money is for research grants that pass directly to the university.

Like Simon, Adson has a state advisory role: He is the clinical leader of a program that notifies doctors whenever their prescriptions for antipsychotics and other psychiatric drugs are out of step with clinical standards.

Top psychiatrists are in demand, so it isn't surprising to find them giving paid lectures or conducting drug-company research while also serving on advisory committees, said Al Heaton, pharmacy director for Blue Cross and Blue Shield of Minnesota. But Heaton, who also serves on the state formulary committee, said those connections need to be disclosed upfront.

"It's better to have it kind of come out from under the rock, and people can create their own opinions and judgments, versus if it's not disclosed, and then you find out after the fact," Heaton said. "Then you just assume it was bad."

The psychiatric society nominated Simon to the state formulary committee because of his expertise and credentials, Hardwig said, but is considering whether it should ask him to step down.

Simon told the society this week he would do so if asked, to avoid even the appearance of a conflict.

MaryJo Webster contributed to this report. Jeremy Olson can be reached at 651-228-5583 or jolson@pioneerpress.com.

Search the database at twincities.com to see if your doctor received payments from pharmaceutical companies.
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Mowing, mental health training lure her, too -Corning (NY) Star-Gazette

By GEORGE OSGOOD

Like a lot of country folks, Lael Eggler grows flowers and vegetables. The owner of The Gaines Company loves to read (her latest: Bill Bryson's "A Walk in the Woods," about traveling the Appalachian Trail). In her CD player: the soundtrack from "Wicked," the untold story of the witches of Oz. (It's fabulous," she said. "You have to buy it.")

Her passions: her children, plastics (as in plastic lures) and mowing. Yes. Mowing.

"I love mowing the grass," she said. "When my kids left, I was glad, because then the mowing was all mine. I have a push mower and a tractor and a Gravely. Mowing is so peaceful."

Well, OK.

Eggler also teaches nurses and other professionals about mental illness, through her training with National Alliance of Mental Illness.

"The course is a whole semester long," she said. "It's very rewarding. I educate people on what causes mental illness. It's all about brain chemicals and legitimate emotions -- anger, frustration, joy, sadness. The thing is, you can't live in one emotion for too long. You have to move on."

Her training has helped Eggler carry on in a stressful business despite the loss of her husband and life partner.

"You have to learn to take care of yourself first," she said. "The business is exhausting sometimes. But if I'm exhausted, that's not good for business."

What's good for business is old school, she said.

"You have to have open lines of communication," she said. "You need personal contact and you have to provide personal service.

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In the pursuit of happiness - Chicago Sun-Times

Danes top list, but quantifying this state of being can be tricky and elusive

BY ARTHUR MAX AND TOBY STERLING
August 26, 2007

AMSTERDAM, Netherlands -- The tiny Himalayan kingdom of Bhutan long ago dispensed with the notion of Gross National Product as a gauge of well-being. The king decreed that his people would aspire to Gross National Happiness.

That kernel of Buddhist wisdom is increasingly finding an echo in international policy and development models, which seek to establish scientific methods for finding out what makes us happy and why.

New research institutes are being created at universities like Oxford and Cambridge to establish methods of judging individual and national well-being. Governments are putting ever greater emphasis on promoting mental well-being -- not just treating mental illness.

''In much the same way that research of consumer unions helps you to make the best buy, happiness research can help you make the best choices,'' said Ruut Veenhoven, who created the World Database of Happiness in 1999.

Americans crack top 15
When he started studying happiness in the 1960s, Veenhoven used data from social researchers who simply asked people how satisfied they were with their lives, on a scale of zero to 10. But as the discipline has matured and gained popularity in the last decade, self-reporting has been found lacking.

New studies add more objective questions into a mix of feel-good factors: education, nutrition, freedom from fear and violence, gender equality, and perhaps most importantly, having choices.

Veenhoven's database, which lists 95 countries, is headed by Denmark with a rating of 8.2, followed by Switzerland, Austria, Iceland and Finland, all countries with high per capita income. At the other end of the scale are much poorer countries: Tanzania rated 3.2, behind Zimbabwe, Moldova, Ukraine and Armenia.

The United States just makes it into the top 15 with a 7.4 index rating. While choice is abundant in America, nutrition and violence issues helped drag its rating down.

Does wealth buy happiness?
Wealth counts, but most studies of individuals show income disparities count more. Surprisingly, however, citizens are no happier in welfare states, which strive to mitigate the distortions of capitalism, than in purer free-market economies.

''In the beginning, I didn't believe my eyes,'' said Veenhoven of his data. ''Icelanders are just as happy as Swedes, yet their country spends half what Sweden does [per capita] on social welfare.''

Adrian G. White, of the University of Leicester, included twice as many countries as Veenhoven in his Global Projection of Subjective Well-being, which also measures the correlation of happiness and wealth. He, too, led his list with Denmark, Switzerland and Austria.

Bhutan, where less than half of the people can read or write and 90 percent are subsistence farmers, ranks No. 8 in his list of happy nations. Its notion of GNH is based on equitable development, environmental conservation, cultural heritage and good governance.

U.S. researchers have found other underlying factors: married people are more content than singles, but having children does not raise happiness levels; education and IQ seem to have little impact; attractive people are only slightly happier than the unattractive; the elderly -- over 65 -- are more satisfied with their lives than the young; friendships are crucial.

But the research also shows that many people are simply disposed to being either happy or disgruntled, and as much as 50 percent of the happiness factor is genetic.

Not just measuring smile time
At Cambridge's Institute of Well-being, another group has expanded the standard happiness questionnaire to 50 items and is incorporating it into a European Social Survey of 50,000 people.

It aims to weigh not only personal feelings (''I'm always optimistic about my future''), but how people function (''I feel I am free to decide for myself how to live my life'') and their relationships with others (''To what extent do you feel that people in your local area help one another?'').

The idea is to find out how well-being varies across Europe, says the Cambridge proposal, acknowledging that it is more than just measuring smile time.

According to Sabina Alkire, of the Oxford Poverty and Human Development Institute, ''Happiness is more complicated than we originally thought.'' AP

Copyright 2007 Associated Press. All rights reserved. This material may not be published, broadcast, rewritten, or redistributed.

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A long, painful wait - Charlotte Observer

FRED KELLY
August 26, 2007

Nearly all American workers pay the federal government for insurance in case they get too sick to keep a job. But thousands of disabled workers wait longer for help in the Charlotte region than almost anywhere else in the nation.

Many lose their homes, fall into bankruptcy or go without needed medicine awaiting Social Security disability payments. Some die before their cases are heard.

In one case, a Gastonia man took his own life.

David "Joey" McKee, 21, couldn't afford medicine to treat his manic depression and waited two years to learn whether he qualified for disability. In March, he jumped from an overpass into traffic on Interstate 85 near Kings Mountain.

"My son didn't have to die," said his mother, Lynn McKee. "The system failed him."

The disability program is supposed to provide a safety net for workers who become injured or mentally ill, but an Observer investigation found the system is flawed for a large swath of North Carolina because administrative law judges fail to issue enough rulings to keep pace with incoming cases.

The Carolinas have about 48,500 pending disability cases, including 8,704 in the Charlotte region. Waits at Charlotte's Disability Adjudication and Hearing Office rank among the longest nationwide, 125 out of 141 offices, a recent national report says.

Delays plague the nation's entire system. But applicants in the Charlotte area waited, on average, more than 20 months for disability benefits last year, about four months longer than workers nationally. At the same time, Charlotte judges decided fewer cases than their peers.

Charlotte judge Duncan Frye said judges in his office work "exceptionally hard" to reduce wait times but do not have enough support staff to collect applicants' medical records and prepare cases for hearings. Budget constraints have left the disability court with vacancies, said Frye, who is also executive vice president of the Association of Administrative Law Judges, which represents disability judges nationwide.

The nation's disability court system is suffering from vacancies, and the federal government says the Charlotte office employs 3.7 staff members per judge, compared with 4.2 nationally.

A panel that advises the president and Congress on Social Security authored a 2006 study that found judges, on average, issued 401 decisions the prior year. Despite thousands of pending cases, two Charlotte judges handed down fewer than 300 in 2006.

Social Security Administration Commissioner Michael Astrue testified to Congress in May that the agency asks judges to produce 500 to 600 decisions a year. He also testified that the agency wants to make some judges more productive.

He wields little authority to force change, however. By law, disability judges face no annual performance reviews and essentially can be removed only for corruption or misconduct. They are paid between $109,000 and $151,000 a year.

"They do whatever they want," said Linda Fullerton, president of the Social Security Disability Coalition, an advocacy group for applicants. "There is no oversight. They can run amok."

Extreme bottleneck

For the typical worker, the process is painstaking from the start.Employees seek help when illness strikes. They must produce extensive documentation of work and medical history, then wait up to five months for an answer.

Of the tens of thousands of claims filed in the Carolinas each year, about two-thirds are denied. Many appeal; their claims are again usually rejected.

Those who persist ask to appear before administrative law judges at local hearing offices.

That's when the longest wait starts. Years can pass before Charlotte judges issue a decision from their offices inside a four-story building on Carmel Road in south Charlotte.

Through interviews, documents and the results of a Freedom of Information Act request, the Observer found:

• Charlotte judges, on average, decided fewer cases than judges in other offices in the Carolinas: 375 cases per judge last year, compared with a combined average of 427 at offices in Greensboro, Raleigh, Columbia, Charleston and Greenville, S.C.

• At any given time, half of the six courtrooms at the Charlotte hearing office are not in use. The Observer spent about 40 hours monitoring the office this month.

Around 3 p.m. on a Friday, an office worker observed an empty waiting area when an applicant failed to show up. She said to no one in particular, "We might as well go home." The office closes at 4:30, but lawyers for applicants say hearings are rarely scheduled after 3 p.m. Judge Dennis Dugan issued 188 rulings last year, the fewest among judges in the Charlotte office. Frye, Kevin Foley, Ronald Osborn and Robert Egan also issued fewer than 400 decisions. Saul Nathanson issued the most with 484.

The Observer repeatedly left messages for all the judges seeking comment. None agreed to speak publicly, saying they are prohibited from doing so.

Jamie Horwitz, a spokesman for the Association of Administrative Law Judges, defended the Charlotte judges' productivity. He gave explanations for their output but did not specify the judges' names.

Horwitz said two judges were assigned to spend 20 percent of their work hours hearing cases and 80 percent performing other duties. Some judges were assigned to Medicare cases, which he said are not counted as disability rulings.

In addition, he said Social Security assigned a third judge from the office to serve as a mentor to new judges, which prevented him from ruling on more cases, he said.

Another judge, Horwitz said, missed time from the bench to care for his wife, who died after a lengthy illness.

"Statistics are often misleading," Horwitz said.

Waits expected to worsen

In July, the average wait in Charlotte rose to 658 days, up 48 days from 2006.

With baby boomers reaching peak ages for disabling illnesses, the number of pending cases nationwide more than doubled to 738,000 between 2001 and 2007.

By 2010, some experts say, the figure will reach 1 million.

In Charlotte, complaints surfaced last year when Ronald McKoy, homeless and HIV positive, died as a resident of the Uptown Men's Shelter while waiting to find out whether he qualified for benefits.

Some homeless shelters said many of their beds are filled by people waiting for disability benefits. The payments -- which average about $947 a month -- could have helped McKoy and other applicants rent homes and obtain food and medicine, social workers said.

At a hearing this month, Robert Greathouse told a disability judge he lives on food stamps and the generosity of relatives. Once, he said, he lived in a homeless shelter because he could not work and had no income. Hearings are typically private, but a judge allowed an Observer reporter to watch, with the consent of Greathouse.

Greathouse, 45, said he used to install telephone systems for a living but applied for disability in January 2004 when it became too painful to work. He said he has had dizzy spells and trouble with his vision since he was bitten by a poisonous spider.

He now lives with relatives in Lincoln County and his mother pays his medical bills.

Greathouse said he isn't surprised by the long wait because acquaintances told him the process would take at least two years.

"I'm frustrated," he said. "I have a cyst on my spine. I have no ability to pay to have it treated."

After listening to testimony for more than 30 minutes, the judge told Greathouse he needed more time to make a decision. Saturday, Greathouse's lawyer said the judge awarded him benefits.

Courtrooms often empty

On a typical weekday, applicants from an area that spans the mountains near Asheville to as far east as Lumberton wait anxiously with attorneys to appear before a Charlotte judge.Sometimes, a handful of applicants and their friends and family fill part of the waiting room. Other times, the place is empty.

"You would think with all these backlogged cases, the place would be slammed with people," said Sharon Dye, who represents ailing workers.

Dye represented McKee, the Gastonia man who killed himself.

McKee tried to work as a retail stocker and store clerk but couldn't keep a job. Diagnosed as bipolar, border schizophrenic and learning disabled, McKee quit two jobs because he said he was depressed.

In 2004, McKee applied for disability to help pay for medicine to treat his mental illness. A psychologist's report says he was hearing voices and hallucinating.

He was turned down twice for disability. A March 2005 rejection letter says his condition was not "severe enough to be considered disabling."

But his family says he later slit his wrists and went to a hospital threatening to kill himself multiple times before he leaped from the Dixon School Road overpass onto Interstate 85. He was hit by a tractor trailer. Relatives said he was not taking his medication because he could not afford it.

After McKee's death, relatives said they attended his disability hearing in July and asked Judge Saul Nathanson whether McKee would have qualified for benefits.

"He said, `Absolutely. He should have gotten them a long time ago,' " McKee's sister, Misty Finnegan, said the judge told them. "We just want to know why it took so long."

Nathanson did not respond to messages.

Agency under fire

Social Security officials said turnover has affected the number of decisions judges issue. This year, the Charlotte hearing office has had one judge and four support staffers leave, the agency said in an e-mail response.

The office, which now has nine judges and 36 support staff members, is planning to hire seven new employees, the agency said.

Some experts say there is a simple explanation why some judges issue more decisions than others.

"We have some judges who are not that productive and should be made to be more productive," said Richard Warsinskey, president of the National Council of Social Security Management Associations, which represents 3,500 field office managers. "There should be some minimum accountability."

Lawmakers say the waits represent a large volume of the complaint calls they receive from constituents.

In March, U.S. Rep. Sue Myrick, R-N.C., of Charlotte, wrote a letter to Astrue, the Social Security commissioner. She said the wait times are unacceptable.

"The backlog in our area is reaching a crisis situation," the letter reads.

Astrue responded in writing a month later, saying that he was aware of the severe delays in North Carolina.

He blamed budget woes. Congress has appropriated the agency $700 million less than President Bush has requested in recent years, he noted. The result is the agency cannot afford to hire enough employees, he wrote.

To help speed the process in Charlotte, Social Security is holding some hearings by video teleconference. Applicants see an off-site judge on a screen.

Also, since fiscal year 2006, he said the agency has transferred more than 1,100 cases to other hearing offices.

Still waiting

Horace Duncan says the pain in his abdomen is so severe its feels like someone is sticking him with "sharp needles." Diagnosed with a carcinoid tumor, Duncan says he can no longer work as a small-engine repairman because he constantly vomits his meals, loses control of his bowels and can lift only 3 or 4 pounds at once.

Duncan, 54, of Belmont applied for disability benefits in 2005 because he had no income. He lives with his mother, who uses a wheelchair. They survive on her $558 monthly Social Security checks.

Although he has been hospitalized numerous times this year and had multiple surgeries, his disability application was rejected three times.

Duncan was waiting for a disability hearing when he received a letter in October from Social Security. A judge had dismissed his case, the letter said.

Social Security says Duncan did not file the necessary paperwork in time to receive a hearing. Duncan says the agency is at fault and he has re-applied.

Now Duncan is bracing himself, because he knows the process is slow.

"It's frustrating," Duncan said. "I need someone to help me."

Until that happens, he said, all he can do is wait.

-- STaff writer Joshua Lanier contributed.

-- Fred Kelly: 704-358-5027

Observer Read more!

TROSA expansion will add new dimension to healing -Durham Herald-Sun

By John Stevenson : The Herald-Sun
jstevenson@heraldsun.com
Aug 25, 2007

It has been 13 years since a Durham agency known as TROSA opened its doors and began changing lives for the better.

It is now the largest residential therapeutic community in the state, designed to rehabilitate drug and alcohol addicts who get in trouble with the law.

Rather than going to prison, participants live in TROSA facilities for two years while trying to kick their addictions and learn job skills. The goal is to mold them into productive members of society rather than lifelong criminals or homeless people.

The acronym stands for Triangle Residential Options for Substance Abusers.

At any given time, about 350 people are in the program at its main facility on James Street. About 70 more live in "transitional housing" along Roxboro Street.

Over the years, the agency has been highly praised for its success in bringing about the mental changes necessary to overcome addictions.

Soon, the physical side of the human equation will get equal attention.

TROSA broke ground last week for an 11,000-square-foot community center that will feature a large gymnasium and exercise area. Classrooms and a game room also will be included.

The building will be finished in about a year.

"Recovery is a holistic process at TROSA," said Kevin McDonald, the agency's president and chief executive officer. "Physical health is just as important as emotional health and job training. Building this community center is the right thing to do for the people in recovery at TROSA."

Program participants are excited.

One of them, 24-year-old Hilary, who asked that her last name not be used, said Friday she believed the new community center "will be great for a couple of reasons.

"I feel that exercise is an important part of recovery," she said. "When I came here 15 months ago, I wanted to get myself back together in more ways than one. I wanted not only to get off drugs, but to make my mind and body stronger, too. Exercise helps get out your negative feelings."

Hilary works in the TROSA president's office, polishing her computer skills and improving her social graces in hopes of getting a good job later.

Although she will graduate from TROSA before the new gym opens, she vows to return for frequent visits.

Ashley Cox, a former program participant who joined the staff three years ago, also is looking forward to the new facility.

"This just gives us more comprehensiveness, a more well-rounded program," he said. "It's a big jump for an organization like ours. We need to be as much about play as about work here. It's a happy balance."

Cox said he was highly fulfilled by his duties as a TROSA community-relations associate.

"I've had good jobs and made good livings before in my interim times [between substance-abuse binges]," he said. "But this job is more than that. It's a really personal thing. It's not about the paycheck but about helping others."

Michelle Kucerak, TROSA's director of development, said the community center and gym would be more than just an exercise area. It also will provide a long-needed setting for graduation ceremonies, Christmas programs and other large gatherings.

"Now, we do not have a space big enough for all of our residents to be in the same room at the same time," said Kucerak. "The community center will allow that to happen."

Because of the historical lack of a large meeting space, TROSA graduations have been held at Duke, the Durham Armory, the N.C. School of Science and Mathematics and other locations.

Kucerak credited the W.K. Kellogg Foundation and the Stewards Fund with providing gifts and grants to make the new community center possible.

But she said more was still needed for items like basketball goals, bleachers and exercise equipment.

"We've got the money for the building," Kucerak said. "Now we need funds for the fixtures. Believe it or not, a single basketball goal costs $10,000."

District Judge Craig Brown was a founding board member of TROSA and remained on the board until last year.

Like others, he was excited about the gymnasium groundbreaking.

"The residents are changing the way they live as well as the way they think," he said. "This facility will help with that. The body and the mind both need attention. It's all about teaching good life skills."
Read more!

Peace at Home programs help with emotional,social problems - Westchester (NY) Journal News

By HEMA EASLEY
August 25, 2007

The interaction was loving but firm. Five children sat around a table with four adults as part of Rockland Jewish Family Service's social skills program for young children with autism spectrum disorders. The task at hand was to make individual artwork on a piece of paper with shared glue, paint and colored string.

Michele Leibowitz leaned toward Jean-Luc Leys and said, "Say to Vivek, 'Can you please pass the glue?' "

When Jean-Luc mumbled the request looking down at the paper, Leibowitz placed her hands on his head and guided it toward his peer.

"For him the most important thing is to focus on the interaction that is happening," said Leibowitz, director of clinical programs at Rockland Jewish Family Service, or RJFS. "The purpose of the group is to teach and develop social interaction skills. At this age it's all about play."

For two decades, Rockland Jewish Family Service has offered services in the county to individuals and families with social and emotional problems as well as services for people with special needs. Now in its 20th year, the agency is expanding its services and programs under the banner of "Peace at Home" to reach a wider audience in Rockland County.

The expanded program - family-based services and older-adult care - offers support and counseling to individuals and families dealing with marriage and family issues, mood disorders and depression, autism spectrum disorders, divorce and separation, anxiety, parenting issues, bereavement support or life-stage issues.

The Peace at Home services are available to all county residents regardless of income, race or religious background, and not just people of the Jewish faith, as the agency's name would suggest, Leibowitz said.

"It's an exciting time for Rockland Jewish Family Service," Maria Dowling, acting executive director, said in a statement. "We are able to offer a seamless provision of services that address and identify the needs of our community members ranging from children with autism, youth with behavioral issues, individuals coping with depression, anxiety, marital issues, grief and loss, to families of older adults living with Alzheimer's disease."

Alexandra Leys, Jean-Luc's mother, was referred to Rockland Jewish Family Service through her son's occupational therapist. The family moved to Rockland from Florida in January after they found little help for Jean-Luc, who has been found to have autism spectrum disorder and auditory processing disorder.

Leys said the social skills program at Rockland Jewish Family Service had helped Jean-Luc tremendously. The group meets weekly for an hour. At the end of the session, the group leader meets with the parent or caregiver to reinforce the skills taught during the therapy session.

"He is more engaged in social situations," said Leys, a Tappan resident. "When he meets people he says, 'Hi, how are you doing?' He understands social cues."

The agency also is offering new programs for older adults, among the fastest-growing segment of the community.

Among them is a program for individuals and their families living with Alzheimer's disease and related disorders, offered in collaboration with the Alzheimer's Association of Rockland County.

An RJFS aide visits the affected family and coordinates services for it, which include arranging respite and psychological services for the primary caregiver and contacting Meals on Wheels for food.

The aide also provides options to family members to help them make decisions about a loved one's care.

"It takes quite an emotional and physical toll on the caregiver," said Doris Zuckerman, director of older adult programs, who has been dealing directly with Alzheimer patients.

The services are offered on an open-ended basis because the illness is of long duration, she said.

Several RJFS services for older adults and their caregivers are offered free, including assessment, supportive counseling and community education.

A sliding-scale fee is available to income-eligible individuals who don't have insurance. Read more!

Judge: RISD must pay for girl's care -Dallas Morning News

Private treatment for behavior disorders could strain schools

By MICHAEL GRABELL
mgrabell@dallasnews.com

August 25, 2007

A recent Dallas court ruling has parents of special education students hopeful that more public schools could be required to pay for private care for their children's behavioral disorders.

A judge ruled that the Richardson Independent School District had failed to provide an appropriate education, as required by federal disability law, for a student with severe disorders.

The case may be the first of its kind because it deals with a new trend in mental health care – private hospitals that have public charter schools on their campuses. As a result, the district will probably have to reimburse the student's parents more than $50,000 for her stay at the hospital.

The decision handed down Tuesday might give parents an option to get more public funding for private care of children with behavioral disorders. But special education administrators worry that might put a greater burden on schools to provide social services that the community doesn't.

Richardson ISD had argued that the girl's parents withdrew her from her public school and placed her in the private facility for medical reasons because of problems at home, not at school.

But the judge sided with the parents' assertion that getting her behavioral problems under control went hand in hand with making progress in her education – a responsibility shared with the schools.

"Education is more than reading and writing," said Kay Lambert, who specializes in education policy for disabled-rights group Advocacy Inc. "For a child with a disability, you have to look at the total picture of what the child is going to need in order to be able to function when she gets out of school."

Myrna Silver, attorney for the parents of the girl identified in court documents as "Leah Z.," said the case exemplifies the importance of the Individuals with Disabilities Education Act, which ensures that children with disabilities get a good education.

"If it weren't for IDEA, then Leah probably would not have been in public school to begin with," Ms. Silver said. "She probably would have been warehoused somewhere."

An attorney for Richardson ISD said she was still reviewing the decision and wouldn't comment on its impact.

Arrangements involving private hospitals should be the last resort and not the solution, said both advocates for the disabled and representatives for school districts. The goal of the act is to integrate children with disabilities into a normal public school environment.

Several disorders

By the time Leah was 4, she had been found to have attention deficit disorder and oppositional defiant disorder, a psychiatric condition that caused her to frequently lose her temper, argue with adults and deliberately annoy people.

At age 6, she was also found to have bipolar disorder, which triggered rapid mood swings.

Her parents tried eight private schools before enrolling her in Richardson schools in the fifth grade in 1999.

But by the time Leah reached high school in 2003, she had two more behavioral diagnoses: separation anxiety disorder and pervasive developmental disorder, which impaired her social and communication skills, similar to autism.

At Westwood Junior High School, Leah attended "behavior adjustment" courses. But she began acting out, arriving late and leaving early and walking out of class without permission almost daily.

"The district's obligation to provide Leah a free appropriate public education during her ninth-grade year turned into a Sisyphean challenge: every brief period of modest gain ended in acute regression, with no progress from peak to peak," U.S. District Judge Barbara Lynn wrote in her ruling.

Leah disrupted tests, overturned furniture and cursed at teachers. She was caught engaging in inappropriate activities with boys at school.

"We were taken aback when we discovered that our daughter was not being fully supervised," said Leah's mother, Carolyn. "She wasn't being managed. She was managing them."

The parents' last name also is not identified in court records, and it is being withheld by The Dallas Morning News out of concern for their daughter's protection.

At the parents' request, the district reassigned Leah, offering her one-on-one instruction with a long-term substitute at Richardson High School. Despite having tested at a fourth-grade level a year before, Leah was now struggling with second-grade curriculum.

'Spinning out of control'

Leah's behavior worsened, and she became physically aggressive at home.

"She was just spinning out of control," her mother said. "She was regressing. They would not acknowledge it."

Her psychiatrist recommended that Leah's parents send her to a residential treatment center to get her behavior under control. In April 2004, they removed Leah from Richardson ISD and placed her at the Texas NeuroRehab Center, an Austin facility for children with severe psychiatric and behavioral problems.

The center has the University Charter School on its campus, where Leah could receive special education. The family and insurance paid for her room and board and medical care, while the charter school is financed by taxpayers.

At first, Leah was so aggressive that she had to be restrained 20 times in her first month. But after two more months of intensive counseling and new medication in the structured environment, she began to improve.

Her parents pleaded with Richardson ISD to begin paying for her to remain at the private facility, but school officials countered that Leah's behavior deteriorated even further at the treatment center.

"The district's position is that it did and can continue to provide an appropriate education in the least restrictive environment," said Nona Matthews, whose law firm represents more than 400 districts statewide.

The family requested a hearing under the Individuals with Disabilities Education Act. The hearing officer sided with the parents' argument that behavioral treatment was intertwined with Leah's ability to learn and ordered the district to reimburse the family $56,000.

Richardson ISD appealed the decision in Dallas federal court in March 2005. The district argued that it shouldn't have to pay because Leah had options within the public schools.

Judge Lynn disagreed.

Richardson's solution "was inappropriate and not reasonably calculated to confer any educational benefit upon Leah," she wrote in her order. "Only the structured environment of a residential placement could offer her any hope of benefit."

The parents and the district will go to court next month to determine how much the parents should be reimbursed. And the Richardson school district hasn't decided whether to appeal.

New legal territory

While there have been several special education lawsuits in the past, advocates for the disabled say courts rarely rule in favor of the parents.

Leah's case also appears to be the first time that a federal court has ruled on a special education case in which the parents' request involved an alternative that was part-public and part-private.

The Texas NeuroRehab Center has been providing such treatment for nearly 60 years. But when the Legislature passed a bill creating charter schools in 1997, the University of Texas opened several such schools at residential treatment centers, including one at the center.

Advocacy Inc. is concerned that such charter schools are a setback for disabled students who used to attend public schools.

"That was the highlight of their day: They got to get out of the facility and be among kids their age, where not everyone has a disability," Ms. Lambert said. "All of a sudden, the facility decided to convert to a charter school and the child never leaves."

Experts on both sides of the issue said the ruling should be taken as a sign of a bigger problem: the lack of funding for special education from the state and federal government.

"The school districts are sort of at a loss," said Angela Lello, public policy director of the Texas Council for Developmental Disabilities. "They don't have what they need to provide the support for students that have challenging behaviors."

And school districts worry that such rulings will create a heavy toll when they're already strapped for cash.

When the law was enacted in 1975, Congress committed to paying for 40 percent of special education programs. But it is reimbursing school districts only 17 percent, said Chris Borreca, a Houston lawyer who represents the Texas Council of Administrators in Special Education.

"The social service fabric in our state puts an awful lot of responsibility on our school districts," he said. "Why don't we have mandatory respite care to be provided by the county mental health program? ... School districts are often the only game in town where it's required."

As for Leah, her parents decided to put her in a private school for children with emotional disorders. She is now getting ready to graduate.

"She has had numerous successes," her mother said. "She still has to hurdle her challenges every day, but we're proud. We're proud." Read more!

Children who survive urban warfare sufferfrom PTSD, too - San Francisco Chronicle

By Jill Tucker

Here are the stories of three children exposed to trauma ...

Tierra Turner's older brother was shot and killed on a busy Bayview street last summer.

By the time Tierra, 11, arrived at the scene with her mother, a yellow tarp covered 18-year-old Anthony Brooks' body. Nearby, a second tarp covered his friend, Monte Frierson.

Standing outside the police tape, Tierra broke down, her small body heaving with sobs.

Two weeks later, Tierra started the sixth grade.

Along with a Tinker Bell backpack and pink Princess cell phone, she carried the deaths with her to Visitacion Valley Middle School each day, absentmindedly writing "RIP Ant and Monte" on the cover of her notebooks and in sidewalk chalk on the playground. As the months passed, her grades slipped and her temper often flared.

At her school, the principal and staff see the signs and symptoms of trauma-related stress in many of their students - the hostile outbursts, the sliding grades, the poor test scores or the inability to pay attention.

They are among the countless children in San Francisco's toughest neighborhoods who experience murder, violence and trauma - an often unavoidable consequence of living in an urban war zone.

The violence, layers of it overlapping year after year, can eventually take up residence in the children's minds. Like combat veterans, they develop post-traumatic stress disorder - the soldier's sickness.

As many as one-third of children living in our country's violent urban neighborhoods have PTSD, according to recent research and the country's top child trauma experts - nearly twice the rate reported for troops returning from war zones in Iraq.

Los Angeles Unified officials conduct annual surveys, finding similar rates of PTSD within the schools in that city's most violent neighborhoods. Implementing a group treatment program, one developed by the district, has come in fits and starts, however.

In the Bay Area and across the country, meanwhile, PTSD in these urban children is generally undiagnosed, untreated and almost completely off the radar for policymakers and education officials.

A Stanford University researcher, however, believes schools should be on the front lines when it comes to recognizing and treating children with symptoms of PTSD, and has identified Visitacion Valley Middle School as the ideal place to test a therapy involving 17 one-on-one sessions with a trained counselor.

"We have to pay a lot more attention to this," said Dr. Victor Carrion, director of the Stanford Early Life Stress Research Program. "PTSD basically feeds on avoidance. The more you avoid it, the worse it gets."

But Carrion lacks ongoing funding and said the study has stalled despite a waiting list of students at the school.

Nearly a third of the 105 students in Tierra's sixth-grade class at Visitacion Valley said they have seen or knew someone killed with a gun, according to a poll school officials administered last fall.

"The violence permeates the lives of the children," said school Principal James Dierke. "It's something they carry around with them like a coat, all day long."

Yet, these children, while hurt and scared, can be helped.
Tierra's trauma is recognized

The F-word flew smoothly out of Tierra's mouth as if it had been there before, which it had.

The profanity didn't faze Dierke, who sat beside her in his office in June, a day before school let out for the summer.

Tierra continued the rant - something about a boy she wanted to beat up. It wouldn't have been the first fistfight the girl waged, punching larger opponents with the full force of her 110 pounds on her 5-foot, one-inch frame.

Dierke didn't blink at Tierra's language or tough talk. She wasn't in trouble. The two were just chatting.

"Are you going to summer school?" Dierke asked, changing the subject. "You need to."

She didn't look at him when she said yes.

Tierra, now 12, had been a good student in elementary school, both in classwork and behavior. At home, she was outgoing and would tease her brother or laugh as he danced for girlfriends. She called him NuNu. She doesn't remember why - maybe it was just easier to say than Anthony.

But now, his death hangs over Tierra and her family.

Tierra cried and screamed the day he died and then withdrew, said her mother, Marian Hawkins-Turner.

"She just kind of went into a shell," Hawkins-Turner said one afternoon last spring while her daughter was still at school.

Except for one particular day.

That day, Hawkins-Turner sat on the couch across from Tierra's open bedroom door. Her daughter sat on her bed, repeatedly stabbing a teddy bear with the pointed tip of a plastic comb.

"What are you doing?" the mother asked her daughter.

"This is what I want to do to the person who killed my brother," Tierra responded.

At school this year, Tierra's grades slid, she was belligerent in class, mouthy to teachers and at times a troublemaker on the playground. She spent more than her fair share of sixth grade in administrators' offices getting scolded or punished.

One spring afternoon, she ran through the school halls yelling obscenities, chasing a boy who teased her. He hadn't been mean, but she punched him anyway.

"Don't forget I'm going to beat your ass tomorrow," she yelled after him.

She looked like a bad kid with a bad attitude. But Dierke knew different.

Based on Tierra's behavior, Dierke and the school's social worker Chuck Waters identified her earlier this year as eligible for the Stanford PTSD study.
School's students affected

Visitacion Valley Middle School sits on a hilltop, bordered by an open-space park and low-income neighborhoods. Many students live in nearby public housing units, including Sunnydale's decrepit barracks-style row houses.

About 70 percent of the students are considered low income, 25 percent are English learners and 18 percent are in special-education programs.

Every year, there are double-digit homicides in the surrounding communities of Visitacion Valley, Bayview and Hunters Point, as well as countless nonlethal shootings.

In Dierke's office, a television screen rotates through security images of the school's hallways and parking lots. On his desk is a folder with daily crime statistics from the area. He stays in frequent contact with police officials and social services agencies.

He knows before Monday morning whether he'll need grief counselors on hand because of a weekend tragedy.

"We have kids who are literally stepping over criminal activity to get here to school," Dierke said. "We have a lot of kids who have seen a tremendous amount of violence."

There was the former student who watched a man hold a gun to his mother's head and rape her.

There was the girl who nearly tripped over a dead body lying next to the path as she ran to school.

There were the three boys who watched a gunfight while they waited for their school bus, bullets flying before 8 a.m.

And there have been many like Tierra - their sibling, father, mother or close friend slain.

They seem numb to the violence, even as its emotional aftermath festers inside.

Dierke always knew the trauma stayed with the children. He also knew they couldn't function in class or on the playground because of something that had happened to them sometime in years past or as recently as over the weekend.

Until a couple of years ago, he just didn't know what to call it.

Now he knows. But doing something about it is something else entirely.
Staff, teachers trained

The teachers and staff at Visitacion Valley say they see PTSD symptoms play out in the students on a daily basis.

They see it in the playground fistfights and in subpar schoolwork. They see it in seemingly unprovoked emotional outbursts - sometimes taking the form of tears streaming down students' faces and other times uncontrolled rage and clenched fists.

"It's really responsible for not having kids reach their academic, social and emotional milestones," said Stanford's Carrion, an associate professor of adolescent and child psychiatry. "The symptoms really cause impairment."

Carrion is testing the school-based therapy, with counselor interns or the school's social worker trained to provide the 17 one-hour sessions. He also trained the school's entire staff to recognize the signs and symptoms of PTSD.

His treatment is designed to be used by school counselors to help children who have multiple symptoms related to trauma. The treatment is prescribed on the basis of the symptoms rather than an official diagnosis by a psychologist or psychiatrist - which would cost additional time and money that the schools don't have.

About six students over the last two years have participated in Carrion's study, which requires parental approval and cooperation - at times a difficult hurdle depending on the stability of a student's home life.

During the sessions, students talk with a trained mental health professional, describing in detail the trauma they've experienced. They also identify the triggers that remind them of the trauma, cues that set off outbursts, anxiety or even panic - loud voices maybe, seeing the color of blood, or someone touching them. And they find ways to react differently.

The treatment helps children understand that what they are going through - the fear, the outbursts and the lack of concentration - is completely normal given what they have experienced or witnessed.

"When students understand that, their self-esteem goes up and they become a survivor rather than a victim," Carrion said. "What happens if they don't get treated, they become violent themselves."

Therapist intern Laura Strom, who helped Carrion conduct the research, recalled one of the first Visitacion Valley students who participated in the study.

The girl's life had been a living hell.

When she was 5, her father set her closet on fire as she huddled on her bed. He had hoped to kill everyone inside the house. Firefighters rescued her. Two years earlier, she had been removed from her home and health workers found cockroaches in her ear. At age 9, she saw her brother stabbed in the back. At 14, she had PTSD.

Cockroaches, police cars and the sight of syringes triggered symptoms: withdrawal, fear, anxiety.

After the treatment, the girl's self-esteem improved, Strom said. The girl's grades went up. Her PTSD symptoms decreased.

School officials would like to see Tierra enrolled in the treatment this year. But that might not be possible. Carrion's research grant from the American Academy of Child Adolescent Psychiatry ran out. He is looking for more funding, perhaps hundreds of thousands of dollars to hire full-time therapists for the study.

With school starting Monday, he doesn't know how many - if any- students will get to participate.
PTSD symptoms like ADD

Social worker Chuck Waters often saw several students each day in his closet-size office in Visitacion Valley's counseling office.

Some were there with average symptoms of teenage angst; for others, it was about so much more. They were his regulars.

The school has a few dozen programs that aim to help them - golf, Girl Power lunches, group sessions for students with incarcerated parents, tutoring, flag football, music classes, a garden, violence-prevention programs, anger management and schoolwide sessions on the power of positive thinking.

But Waters knows many of the students need more help than the school can now give.

PTSD can look a lot like attention-deficit disorder, he said, with the lack of concentration, poor grades and inability to sit still.

"It's so hard to diagnose," he said. "It's one kid at a time."

Yet it almost guarantees that these students - often African American or Latino and low income - won't do as well on standardized tests as their wealthier, whiter and safer peers.

"Post-traumatic stress is rampant," said Meredith Rolfe, administrator for the California Department of Education's Safe and Healthy Kids Program Office. "There doesn't seem to be the realization of the relationship to academic achievement."

"It explains the achievement gap," said Trish Bascom, executive director of San Francisco Unified School District's Health Programs.

Providing mental health services - and PTSD treatment - in schools is ideal because that's where the children are, and it's often the one place they feel safe, both Rolfe and Bascom said.

Dierke is frustrated by the lack of attention to the issue.

"If we can do it for the asthma kids or if we can do it for the fat kids, we ought to be able to figure out what to do about this," he said.
Tierra's life goes on

Tierra was in the kitchen, fixing a ham, mustard and white bread sandwich for herself and her 4-year-old cousin. Her mom sat on the couch a few feet away, her face drawn. "I didn't sleep much last night," Marian Hawkins-Turner said.

She had gone to play bingo the night before, a regular game at a parlor up the street. Hawkins-Turner said she was scanning her bingo cards when four men with guns drawn burst into the building. She didn't realize what was happening at first.

Across the room, one of the four men eyed the crowd, waving a gun at chest level, its muzzle scanning for victims. The men took money and fled.

"I flashed on my son," she said the next day. "I was a nervous wreck. I'm just tired of people dying."

Tierra carried the two sandwiches to the living room, knelt on the floor and took a bite.

She said nothing about her mother's story. Her face showed no emotion.

A few months later, and a mile from where her brother died, Tierra was baptized at Calvary Hill Community Church, her body cloaked in a white robe as she was immersed in the water, her sins removed and her soul cleansed.

She said she wanted to get baptized because when she dies, she wants to go to heaven. There, Tierra believes, she will see her brother again.

The symptoms of post-traumatic stress disorder

A diagnosis of PTSD requires meeting specific criteria outlined in the Diagnostic and Statistical Manual of Mental Disorders. Those include exposure to a traumatic event that caused a response involving intense fear, helplessness or horror; in children that might include disorganized or agitated behavior.

Subsequent symptoms, lasting longer than a month, include:

-- Re-experiencing trauma through dreams or thought

-- Acting or feeling as if the traumatic event were recurring

-- Avoidance of feelings or activities

-- Sense of foreshortened future

-- Feeling of detachment or estrangement from others

-- Irritability or outbursts of anger

-- Difficulty concentrating or sleeping

-- An exaggerated startle response

-- Intense distress from cues that symbolize or resemble an aspect of the traumatic event

Source: National Center for Posttraumatic Stress Disorder, U.S. Department of Veterans Affairs
Online resources

National Center for Posttraumatic Stress Disorder - The federal Department of Veterans Affairs site devoted to PTSD:

www.ncptsd.va.gov

National Child Traumatic Stress Network - The site includes information about PTSD in children as well as resources for finding help:

www.nctsnet.org

Los Angeles Unified School District Trauma Services Adaptation Center for Schools - This site includes resources for parents, teachers and students:

www.tsaforschools.org

E-mail Jill Tucker at jtucker@sfchronicle.com. Read more!

Band's story attracts movie script writer -Chico (CA) Enterprise-Record

Father thought music would be good therapy for Asperger's

By CHRIS GULLICK

Once again a band of four Chico teens and pre-teens is getting national recognition.

After receiving local attention in the Enterprise-Record in January 2006, the band was featured in People magazine, then on the Rachael Ray Show. In between and after those spotlights, the group played for schools and conventions locally, in Sacramento and in Oregon.

Now, Jet Fuel Only has been optioned for movie rights for Lifetime Television.

For three days, Judd Parkin, a script writer from Los Angeles, is following band members and their family around, listening, questioning and observing, to gather material for the story.

He explained that he read the People magazine article about Jet Fuel Only late one night and handed it directly to his wife, telling her to read it.

He knew at once it would make a good movie, he explained, an immediacy that doesn't usually happen.

It's a story about the transformative power of music, he noted, and it's a success story for the Goodson family.

It began when Dan Goodson promoted music as an educational, brain-developing therapy for his sons, Sawyer Goodson, who has a form of autism called Asperger's Syndrome, and Evan Goodson, who spoke with an impediment.

Goodson thought playing music could be a way to involve Sawyer in social activities and give Evan practice on speech.

He hoped it would also work to help socialize his youngest son, Cameron, who has a more profound form of autism.

From the first time they played for students at Jay Partridge School in spring 2005, Goodson's wishes began to come true.

"To us, it's already been successful," Goodson noted. "Music is not the end. The end is a socially experienced kid."

Sawyer, 13, and Evan, 12, have friends now, he said. They practice at the Goodson house weekly, with fellow members Emma Blankenship, 13, who has been with the group since it began, and new member Holly Rumiano, 10. The practice days have become social occasions, with other friends coming over to listen and join them for pizza afterward.

Goodson smiles broadly when he talks about the boys' friends, recalling how he worried over their social problems before they became a rock band.

Evan has graduated from speech therapy at school and even Cameron has benefited beyond any expectation, changing from a speechless, fearful little boy to a chattering child who tentatively smiles at visitors.

Friday evening, the band played at Monstros Pizza — a performance that was their first on the music scene.

Previous performances have all been at schools or at autism conferences, Goodson explained.

The band has had a lot of offers, he admitted, but they choose carefully among them, keeping the kids' school schedules uninterrupted and accepting only those that will be positive and enriching experiences.

Goodson said they were willing to take a chance on a TV movie because it could potentially reach a lot of people.

"It's a good chance to get awareness for autism," he said.

While he admitted that it didn't really have to be music — it could have been karate or skateboarding, or many other social activities — he said he believes music is an elemental form of communication, so it could help the boys with that skill that caused them so much trouble.

And the benefits have been phenomenal, Goodson said.

Apparently others have found them amazing, too, since the attention keeps coming.

Parkin said he found the story compelling, as a parent whose son was attention deficit and hyperactive. Although his son's disability was far less severe than autism, he said he related to the frustrations the Goodsons faced.

After spending these few days fact-finding in Chico, Parkin said he would begin by organizing a story line before writing a script. He anticipated having to call or e-mail Goodson dozens of times before the process was finished.

Some of the core threads are becoming apparent, he stated. Then, he described how, in casual conversation with Goodson or his wife Julie, he'd know instantly, "That's a scene."

Lifetime has a 12-month option on the story and Parkin hopes to have it approved for production by then, but that doesn't happen often.

The network has the final say on whether or not it's produced.

"They're God," he said.

Inside Monstros, the band completed its set with a crash of a cymbal, a few final guitar notes and a clamoring, clapping response from the audience.

Cameron, who had been swaying to the music and mouthing all the words as he watched beside the stage, clapped along.

Then he hugged his mom while people from the audience crowded around the band members to praise and congratulate them.

Staff writer Chris Gullick can be reached at 896-7760 or cgullick@chicoer.com.

BACKGROUND: Jet Fuel Only, a rock band whose members are 10 to 13 years old, began as music therapy for Dan and Julie Goodson's three sons.

WHAT'S NEW: The band was featured in People magazine and on the Rachael Ray Show, and now the group has been optioned for a Lifetime movie.

WHAT'S NEXT: Judd Parkin, a script writer visiting from Los Angeles, will write the family's success story. Read more!

True Life - I Have Autism - MTV.com

Video produced by MTV on autistic teen can be accessed by clicking.

Jeremy is autistic and about to turn eighteen years old. He is trying to find his voice so that he can make some friends his own age. Read more!

Judge: RISD must pay for girl's care - Dallas Morning News

Private treatment for behavior disorders could strain schools

By MICHAEL GRABELL

A recent Dallas court ruling has parents of special education students hopeful that more public schools could be required to pay for private care for their children's behavioral disorders.

A judge ruled that the Richardson Independent School District had failed to provide an appropriate education, as required by federal disability law, for a student with severe disorders.

The case may be the first of its kind because it deals with a new trend in mental health care – private hospitals that have public charter schools on their campuses. As a result, the district will probably have to reimburse the student's parents more than $50,000 for her stay at the hospital.

The decision handed down Tuesday might give parents an option to get more public funding for private care of children with behavioral disorders. But special education administrators worry that might put a greater burden on schools to provide social services that the community doesn't.

Richardson ISD had argued that the girl's parents withdrew her from her public school and placed her in the private facility for medical reasons because of problems at home, not at school.

But the judge sided with the parents' assertion that getting her behavioral problems under control went hand in hand with making progress in her education – a responsibility shared with the schools.

"Education is more than reading and writing," said Kay Lambert, who specializes in education policy for disabled-rights group Advocacy Inc. "For a child with a disability, you have to look at the total picture of what the child is going to need in order to be able to function when she gets out of school."

Myrna Silver, attorney for the parents of the girl identified in court documents as "Leah Z.," said the case exemplifies the importance of the Individuals with Disabilities Education Act, which ensures that children with disabilities get a good education.

"If it weren't for IDEA, then Leah probably would not have been in public school to begin with," Ms. Silver said. "She probably would have been warehoused somewhere."

An attorney for Richardson ISD said she was still reviewing the decision and wouldn't comment on its impact.

Arrangements involving private hospitals should be the last resort and not the solution, said both advocates for the disabled and representatives for school districts. The goal of the act is to integrate children with disabilities into a normal public school environment.


Several disorders

By the time Leah was 4, she had been found to have attention deficit disorder and oppositional defiant disorder, a psychiatric condition that caused her to frequently lose her temper, argue with adults and deliberately annoy people.

At age 6, she was also found to have bipolar disorder, which triggered rapid mood swings.

Her parents tried eight private schools before enrolling her in Richardson schools in the fifth grade in 1999.

But by the time Leah reached high school in 2003, she had two more behavioral diagnoses: separation anxiety disorder and pervasive developmental disorder, which impaired her social and communication skills, similar to autism.

At Westwood Junior High School, Leah attended "behavior adjustment" courses. But she began acting out, arriving late and leaving early and walking out of class without permission almost daily.

"The district's obligation to provide Leah a free appropriate public education during her ninth-grade year turned into a Sisyphean challenge: every brief period of modest gain ended in acute regression, with no progress from peak to peak," U.S. District Judge Barbara Lynn wrote in her ruling.

Leah disrupted tests, overturned furniture and cursed at teachers. She was caught engaging in inappropriate activities with boys at school.

"We were taken aback when we discovered that our daughter was not being fully supervised," said Leah's mother, Carolyn. "She wasn't being managed. She was managing them."

The parents' last name also is not identified in court records, and it is being withheld by The Dallas Morning News out of concern for their daughter's protection.

At the parents' request, the district reassigned Leah, offering her one-on-one instruction with a long-term substitute at Richardson High School. Despite having tested at a fourth-grade level a year before, Leah was now struggling with second-grade curriculum.


'Spinning out of control'

Leah's behavior worsened, and she became physically aggressive at home.

"She was just spinning out of control," her mother said. "She was regressing. They would not acknowledge it."

Her psychiatrist recommended that Leah's parents send her to a residential treatment center to get her behavior under control. In April 2004, they removed Leah from Richardson ISD and placed her at the Texas NeuroRehab Center, an Austin facility for children with severe psychiatric and behavioral problems.

The center has the University Charter School on its campus, where Leah could receive special education. The family and insurance paid for her room and board and medical care, while the charter school is financed by taxpayers.

At first, Leah was so aggressive that she had to be restrained 20 times in her first month. But after two more months of intensive counseling and new medication in the structured environment, she began to improve.

Her parents pleaded with Richardson ISD to begin paying for her to remain at the private facility, but school officials countered that Leah's behavior deteriorated even further at the treatment center.

"The district's position is that it did and can continue to provide an appropriate education in the least restrictive environment," said Nona Matthews, whose law firm represents more than 400 districts statewide.

The family requested a hearing under the Individuals with Disabilities Education Act. The hearing officer sided with the parents' argument that behavioral treatment was intertwined with Leah's ability to learn and ordered the district to reimburse the family $56,000.

Richardson ISD appealed the decision in Dallas federal court in March 2005. The district argued that it shouldn't have to pay because Leah had options within the public schools.

Judge Lynn disagreed.

Richardson's solution "was inappropriate and not reasonably calculated to confer any educational benefit upon Leah," she wrote in her order. "Only the structured environment of a residential placement could offer her any hope of benefit."

The parents and the district will go to court next month to determine how much the parents should be reimbursed. And the Richardson school district hasn't decided whether to appeal.

New legal territory

While there have been several special education lawsuits in the past, advocates for the disabled say courts rarely rule in favor of the parents.

Leah's case also appears to be the first time that a federal court has ruled on a special education case in which the parents' request involved an alternative that was part-public and part-private.

The Texas NeuroRehab Center has been providing such treatment for nearly 60 years. But when the Legislature passed a bill creating charter schools in 1997, the University of Texas opened several such schools at residential treatment centers, including one at the center.

Advocacy Inc. is concerned that such charter schools are a setback for disabled students who used to attend public schools.

"That was the highlight of their day: They got to get out of the facility and be among kids their age, where not everyone has a disability," Ms. Lambert said. "All of a sudden, the facility decided to convert to a charter school and the child never leaves."

Experts on both sides of the issue said the ruling should be taken as a sign of a bigger problem: the lack of funding for special education from the state and federal government.

"The school districts are sort of at a loss," said Angela Lello, public policy director of the Texas Council for Developmental Disabilities. "They don't have what they need to provide the support for students that have challenging behaviors."

And school districts worry that such rulings will create a heavy toll when they're already strapped for cash.

When the law was enacted in 1975, Congress committed to paying for 40 percent of special education programs. But it is reimbursing school districts only 17 percent, said Chris Borreca, a Houston lawyer who represents the Texas Council of Administrators in Special Education.

"The social service fabric in our state puts an awful lot of responsibility on our school districts," he said. "Why don't we have mandatory respite care to be provided by the county mental health program? ... School districts are often the only game in town where it's required."

As for Leah, her parents decided to put her in a private school for children with emotional disorders. She is now getting ready to graduate.

"She has had numerous successes," her mother said. "She still has to hurdle her challenges every day, but we're proud. We're proud."


Read more!

Governor's cuts slash human services -Springfield (IL) Journal Register

State's needy hit hard in the name of health program

By DANA HEUPEL
August 25, 2007

Despite Gov. Rod Blagojevich's quest to provide health care for needy Illinoisans, his state budget cuts slash deeply into health and human services programs also designed to help the most vulnerable residents.

On Thursday, Blagojevich unveiled $463 million in cuts to the budget lawmakers had sent him Aug. 13. Well over $100 million of that amount came from health and human services programs and projects.

The cuts were as large as $11 million for payments to community agencies serving the developmentally disabled and as small as $10,000 for a program to help residents of a decaying Chicago neighborhood. They eliminated money for food pantries, homeless shelters, a veterans home, substance abuse clinics, autism programs and help for the disabled and mentally ill, along with scores of other programs.

"He's cutting from programs - poor people who can least afford to receive the cuts," said the Rev. Jennifer Kottler, deputy director of Protestants for the Common Good and a frequent advocate before the General Assembly on human services issues.

Many of the services, she said, are not wholly funded with taxpayer dollars, but if they didn't exist, state government would have to provide them.

"These are all needed services within the community," Kottler said after being asked to review the governor's vetoes.

Justin DeJong, a spokesman for the Governor's Office of Budget and Management, said in an e-mail Friday that Blagojevich trimmed some human services programs because "the General Assembly overestimated programmatic cost when they prepared the budget. The governor's reduction veto brings spending in line with projected costs for the upcoming year."

As for cuts in human services projects proposed by individual legislators, DeJong said: "While certain initiatives may serve a purpose for a particular community or organization, the state already has many programs in place to meet these important needs.

"These were not all easy decisions," DeJong said, "but we believe we ended up with a budget that better reflects the needs and values of the people of our state."

At times, however, Blagojevich's choices appeared contradictory. For instance, he removed a $25,000 grant to a homeless group in Chicago, while leaving in $100,000 for a homeless shelter in Elgin. Those sorts of decisions left some to wonder whether the governor was simply rewarding his friends in the legislature and punishing his detractors, such as House Democrats and Senate Republicans, whose leaders have squabbled with him.

"It just does not make a lot of sense on a political basis or a basis of principle, other than I'm one of the evil House Democrats," said Rep. Greg Harris, D-Chicago, who is among a small group of lawmakers who consistently pursue human services and health legislation.

Among Harris' initiatives chopped from the budget were programs to provide adult day care for seniors with Alzheimer's disease, housing and food for families with AIDS, mental health care for refugees and immigrants and job training for the homeless. In all, they totaled about $330,000.

"It's not about providing health care to people who are needy. It's not about providing social services or substance-abuse help. It's about a political agenda," Harris said. "And the people who suffer for it are the most vulnerable people in our community."

Blagojevich signaled his intention Aug. 14 to cut the budget that lawmakers had just handed to him and to institute a $463 million program to extend health coverage to low-income Illinoisans.

However, questions arose soon afterward about whether the governor had the authority to fund new programs without budget authorization. Blagojevich's staff then said he would find money elsewhere in the budget for his health care initiative, the governor's unrelenting crusade during this year's session of the General Assembly.

"It doesn't make a lot of sense what things he's chosen to cut versus not," Kottler said Friday.

"I'm all for health care, too, but not at the expense of these cuts."

Dana Heupel can be reached at 788-1518 or_dana.heupel@sj-r.com.

A budget of contradictions

Two bridges to be half-repaired; programs governor praised cut

By CHRISTOPHER WILLS

THE Associated Press

Gov. Rod Blagojevich apparently wants to repair half a bridge.

Blagojevich’s cuts to the state budget include at least two cases where he rejected a request for half the money for a bridge-repair project but approved another request for the other half of the money.

That wasn’t the only odd result of his budget decisions.

The Democratic governor also cut the money to add 80 beds at a veterans retirement home in LaSalle. Last year, he praised that same project and said “we owe it” to Illinois veterans.

The budget cuts he announced this week also spared most of the spending requested by members of a legislative committee with the power to block the health-care programs he hopes to launch soon.

Legislators said Friday that Blagojevich is obviously punishing his enemies and rewarding his friends, or potential friends.

“It’s so transparent what the governor’s doing, what his motives are. I don’t think I’ve ever seen anything quite so political,” said Sen. Bradley Burzynski, a Clare Republican whose spending requests were approved by the governor.

Burzynski sits on the Joint Committee on Administrative Rules, an obscure legislative panel that will review a series of rules the governor wants to change so that he can expand health care programs. If JCAR rejects the changes, his health programs will be blocked.

But several legislators said JCAR might be less inclined to support the governor’s changes if he’s using their spending requests as leverage.

“That, to me, is so insulting. I don’t think I have ever, ever felt so embarrassed,” said Sen. Maggie Crotty, D-Oak Forest, another JCAR member.

Crotty criticized the governor for reducing Medicaid payments to hospitals and nursing homes, as well as trimming a cost-of-living increase for workers who care for developmentally disabled people. Rather than a 2.5 percent increase to cover the last three years, they’ll get just 1.6 percent.

Blagojevich did not explain specific cuts when he announced them Thursday. He would not answer questions about them Friday.

But aides deny that politics or retribution played any part in his cuts, which the legislature could vote to restore.

“We cut projects we didn’t think were essential or couldn’t afford,” said Deputy Chief of Staff Becky Carroll.

Carroll couldn’t explain why the governor treated similar projects differently or why he rejected half of a bridge repair project, except to say that she assumed it was simply a question of how much the state could afford.

The bridge projects were added by two lawmakers, one a House Republican and the other a Senate Republican. Each requested half the total cost.

Blagojevich, following a pattern he used throughout the budget, approved the House request but rejected the Senate request.

Blagojevich needs House Republican support if his vetoes are going to survive there. In the Senate, however, President Emil Jones has promised to block any override attempt, so Republican votes don’t come into play.

But House Republicans said the governor’s strategy isn’t likely to help him — partly because they doubt he’ll ever actually spend the money set aside for their projects.

“This governor has shown he can’t be trusted,” said Rep. Randy Ramey, the Carol Stream Republican who requested the bridge repairs. “If we don’t override, I’ll bet you 10-to-1 he doesn’t release the money anyway.”

Blagojevich did back away from one of his budget cuts Friday, saying it was a mistake.

He had made a variety of cuts to the court system, but the Chicago Daily Law Bulletin reported that the governor’s office now says the administration will work with judges to restore the money. Read more!

Coverage of Cho may renew stigma of mental illness - Roanoke (VA) Times

By Duncan Adams

News coverage of Seung-Hui Cho's killing spree at Virginia Tech tied together mental illness and violence in a bloody knot.

Such cause-and-effect entanglement distorts reality and could discourage people with common psychological ailments from seeking help, said Amy Forsyth-Stephens, executive director of the Mental Health Association of the New River Valley.

"The progress we've made in fighting the stigma of mental health treatment will probably backslide for 25 years," she said.

Speculative diagnoses for Cho after the shootings have ranged from Asperger syndrome to the in