List of mentally ill barred from buying guns grows - Associated Press

Federal database doubles following Va. Tech shootings
By Brock Vergakis and Lara Jakes Jordan, Associated Press

PARK CITY, Utah - A federal list of mentally ill people barred from buying guns has doubled in size since the Virginia Tech shootings, and US Attorney General Michael Mukasey encouraged more states yesterday to add information to the database.

In his first policy speech since taking over as attorney general early this month, Mukasey said states have reported 393,957 mentally ill people to the federal database used to screen the backgrounds of potential gun-buyers.

As of last July, three months after the Virginia Tech shootings, states had submitted only 174,863 names to the database. Federal agencies, including the Defense and Veterans Affairs departments, also submit names, but the Justice Department could not immediately say how many.

"Instant background checks are essential to keeping guns out of the wrong hands, while still protecting the privacy of our citizens," Mukasey said.

"But as we learned in the tragedy at Virginia Tech, the checks must be accurate and complete to be effective," Mukasey told the National Association of Attorneys General. "We're making progress, and I hope that even more states will submit this information so that the national instant background check system can be maximally effective."

People are included in the federal database only after courts or other authorities have found them to have mental health problems, Justice Department officials said. Currently, 32 states submit names to the mental health database, and the federal government cannot force the other 18 to follow suit.

"We've got 32, it'd be nice to have 50," Mukasey said.

Virginia Tech student Seung-Hui Cho killed 32 people and himself in the deadliest campus shooting in US history. He bought two guns - a Glock 9mm at a Virginia store and a .22-caliber pistol over the Internet - despite a special justice's 2005 order to get outpatient treatment for being a danger to himself. There has been no indication that Cho ever received the treatment.

Had his court order been submitted to the federal database, Cho probably would have been unable to buy the guns.

Private mental health records, including diagnosis documents from hospitals or insurance companies, are not accessed or submitted to the database. Overall, more than 5 million people are identified in the background check system that is maintained by the FBI. The system also tracks the names of illegal immigrants, domestic violence offenders, and others who are barred from buying guns.

Virginia traditionally has submitted far more names of mentally ill people to the federal database than other states, Justice data show. Shortly after the Virginia Tech shootings, officials said the state had given 81,233 names to the FBI. Michigan had the second-largest submission of names then, with 73,382, the Justice data show.

By comparison, California had submitted only 27 names of mentally ill people to the database as of April 30. Since then, the state has given more than 200,000 names to the list, Justice officials said.

NRA spokesman Andrew Arulanandam said the group has no problem with the database.

"It has always been our position that whoever has been adjudicated as mentally defective or deemed to be a danger to themselves, others or suicidal, that their name be included in the national incident check system," he said.

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FBI's Gun Ban Listing Swells - Washington Post

Thousands Added To File Marked 'Mental Defective'

By Dan Eggen
Washington Post Staff Writer

Since the Virginia Tech shootings last spring, the FBI has more than doubled the number of people nationwide who are prohibited from buying guns because of mental health problems, the Justice Department said yesterday.

Justice officials said the FBI's "Mental Defective File" has ballooned from 175,000 names in June to nearly 400,000, primarily because of additions from California. The names are listed in a subset of a database that gun dealers are supposed to check before completing sales.

The surge in names underscores the size of the gap in FBI records that allowed Seung Hui Cho to purchase the handguns he used in April to kill 32 people and himself at the Virginia Tech campus in Blacksburg.

A Virginia state court found Cho to be dangerously mentally ill in 2005 and ordered him to receive outpatient treatment. But because Cho was not ordered into hospital treatment, the court's order was never provided to the FBI and incorporated in its database. Two gun dealers checked the list before selling Cho the 9mm Glock 19 and the Walther .22-caliber pistol he used in the shootings.

For nearly four decades, federal law has prohibited gun sales to people judged to be "mentally defective," but enforcement has been haphazard. A 1995 Supreme Court ruling barred the federal government from forcing states to provide the data, and 18 states -- including Delaware and West Virginia -- provide no mental health-related information to the FBI at all. Both Virginia and Maryland do provide the data.

Paul Helmke, president of the Brady Campaign to Prevent Gun Violence, a group favoring tighter firearms controls, said the most optimistic estimates suggest that even the FBI's expanded list is missing 4 of 5 Americans who have been ruled mentally dangerous to themselves or others.

"If people realized how weak our system is in terms of background checks for people who are dangerously mentally ill, they would be shocked," Helmke said. "It's clear that there could be another Virginia Tech killer buying a gun today, and there's nothing that can be done about it."

The vast majority of the individuals who were added to the FBI's list were identified by California, which provided more than 200,000 names in October, the Justice Department said. Ohio provided more than 7,000 new names, and the number of states reporting mental health data to the FBI this year grew from 23 to 32, officials said.

"Instant background checks are essential to keeping guns out of the wrong hands, while still protecting the privacy of our citizens," Attorney General Michael B. Mukasey said in a speech announcing the numbers in Park City, Utah. "But as we learned in the tragedy at Virginia Tech, the checks must be accurate and complete to be effective. We're making progress, and I hope that even more states will submit this information."

The Virginia Tech deaths, which resulted from the deadliest college campus shooting incident in U.S. history, have prompted a push by federal and state lawmakers to improve voluntary reporting by the states of those covered by the ban.

House Democrats reached an agreement earlier this year with the National Rifle Association on legislation meant to encourage states to submit timely background-check data to the FBI, by offering monetary awards and threatening penalties.

"Our position has always been that those who have been adjudicated as mentally defective or a danger to themselves or to others or suicidal should not have access to firearms" and should be added to the FBI's list, NRA spokesman Andrew Arulanandam said.

The measure passed easily in the House, but it has stalled in the Senate because of a hold by Sen. Tom Coburn (R-Okla.). He has said he opposes the legislation because he thinks its implementation would cost too much and because it lacks a mechanism to challenge inclusion on the list. He was joined by some veterans' groups, which argued that former soldiers might be denied gun-owning rights without due process.

In Virginia, Gov. Timothy M. Kaine (D) tightened state rules in May by ordering agencies to block gun sales to those involuntarily committed for inpatient or outpatient mental health treatment; previously only those committed to hospitals could not buy a gun. Maryland Gov. Martin O'Malley (D) also issued a new gun-purchase regulation, which requires buyers to sign a waiver that releases mental health records to state police.

Mukasey highlighted the expanded FBI list during his first public speech after being narrowly confirmed by the Senate three weeks ago. He also told the National Association of Attorneys General that Washington will continue federal assistance for communities struggling against rising rates of violent crime.

Aides to the retired federal judge say his priority is to repair relations with Congress and to rebuild the department in the aftermath of controversies that beset his predecessor, Alberto R. Gonzales.

"I don't think you are going to see any big new initiatives, at least not right away," one Justice official said this week.

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The Neediest Cases - Countering schizophrenia by finding solace in art - New York Times

By MICHAEL M. GRYNBAUM

Rodney Smith sat and shuffled and reshuffled a small stack of business cards he held in his large, gentle hands.

“I don’t know what it was,” he said, in a voice that seemed too small for his 6-foot-plus frame. “I just woke up one morning and it seemed like something was terribly wrong.”

Mr. Smith was describing the first time he experienced the symptoms of paranoid schizophrenia, which has plagued him for more than two decades. He began to hear voices. They warned him that he was being followed, and they threatened to hurt his loved ones. They started to destroy his life.

“I remember shaking a little and trying to figure out what it was,” Mr. Smith recalled in a recent interview. “Somehow my brain convinced me that somebody was out to do something to me or my family. And that was like hell.”

It was a hell that Mr. Smith, 39, never expected to find himself in. An Islip native, he grew up in Brooklyn, graduating from high school, taking classes at Nassau Community College and then earning $50,000 a year while working two jobs.

“We were accountants, but they didn’t call us that,” Mr. Smith said of his first job, at a Long Island nonprofit organization. “We were called bookkeepers, because they would not pay us what they would pay an accountant.”

He has retained his sense of humor, despite all that followed. The symptoms became worse. Confusion, dizziness, nightmares and cold sweats became the norm. Relationships with friends and relatives were strained. Soon he could no longer work.

He was arrested after jumping a subway turnstile — urged by the voices — and doctors at Bellevue Hospital Center gave Mr. Smith the diagnosis of paranoid schizophrenia. Though he began to receive treatment, he still struggled. He became homeless. He attempted suicide.

He finally learned to control his symptoms with help from FEGS Health and Human Services System, also known as the Federation Employment and Guidance Service, a beneficiary agency of UJA-Federation of New York, one of seven agencies supported by The New York Times Neediest Cases Fund. Taking part in a daily program for nearly two years starting in mid-2005, Mr. Smith discovered a new solace: art.

He paints regularly in a downtown studio that offers free painting supplies to artists with mental illness, and he has sold some paintings.

Canvases fill his cramped bedroom. A swirl of blue and white — “Ocean” — is wedged behind a dresser. “New York,” with a teal base and black skeins, evokes Franz Kline.

Today, Mr. Smith is matter-of-fact about the ravages of his disease. Spirituality and religion are important to him; he grew up in a Baptist church. A well-thumbed Bible sits amid his belongings. He says painting is a spiritual process, a way to express the ineffable.

“I think abstract art was created for people with schizophrenia,” Mr. Smith said. “It’s perfect. It’s a perfect medium. Art tended to be more therapeutic than trying to speak to a psychiatrist or a therapist.”

With help from FEGS, he moved into a dormitory on the Upper East Side in January, a transition space for the formerly homeless, and lives on $900 a month in Social Security disability income. Money from the Neediest Cases Fund provided $500 for dishes, towels and other household items. They offer a touch of domesticity for his home, which is tiny even by Manhattan standards.

“The room is a little small, but I have everything I need that can fit in here,” he said. “Living here after a year and a half in the homeless shelter and drop-in center is wonderful.”

But Mr. Smith, who continues to receive counseling from FEGS, understands the future he faces.

“You have to come to the realization that this is the way you’re going to be for the rest of your life,” he said. “I never met one schizophrenic go back to their regular life. It doesn’t exist. That person is dead. This is a new person in there. I will never again be the person that I was.”

His voice grew softer. “That’s the sad reality that I live in,” he said, looking away. The voice became a whisper.

“That’s the way it is.”

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Helping Mental Patients Gain Control - Wall Street Journal

By SHIRLEY S. WANG
November 27, 2007

After multiple psychiatric hospitalizations, Mary Blake decided she needed to set some treatment terms for times when she is unable to make decisions herself. So she created a document detailing the signs of deterioration that others should watch for, and noting her medication preferences. The drug Haldol, Ms. Blake knew from experience, made her hyper and belligerent and induced painful muscle cramps, whereas Thorazine worked much better.

In the document, known as a psychiatric advance directive, or PAD, she authorized her doctors to hold her at the hospital rather than allow her to sign out against medical advice. She even chose someone to feed her cat. Ms. Blake feels the PAD has helped her recognize when she needs help, and has cut down her time in the hospital. The PAD has also helped friends and family be better advocates for her with doctors.


GETTING IT IN WRITING


For more information, see:
• National Resource Center on Psychiatric Advance Directives www.nrc-pad.org
• Bazelon Center for Mental Health Law www.bazelon.org/issues/advancedirectives/index.htm
• National Mental Health Association www1.nmha.org/position/advancedirectives"It was part of the bigger process for me to take control over my life," says Ms. Blake, of Washington, D.C., a public-health official who is diagnosed with schizoaffective disorder.

People have long used advance medical directives or living wills to specify what sort of end-of-life care they want. But increasingly, psychiatric patients are using similar documents to prepare for times when they are unable to make competent decisions. With PADs, patients with mental illness can state preferences for, or dislikes of, specific treatments, designate a proxy decision-maker or make other advance decisions about care, says Jeffrey Swanson, associate professor at Duke University, who has researched PADs. Twenty-five states currently have laws authorizing such directives, and more are considering them, according to the National Resource Center on Psychiatric Advance Directives.

"The underlying goal is to try to respect patients' choices, their preferences and their autonomy even in circumstances where they're unable to exercise that autonomy themselves," says Paul Appelbaum, professor of psychiatry, medicine and law at Columbia University.

There are a number of legal and practical limitations to PADs, say clinicians and researchers. In practice, doctors use their judgment to overrule a PAD if a patient asks for treatment that is considered inappropriate or is unavailable, says Ira Burnim, legal director at the Bazelon Center for Mental Health Law. Most state laws contain such an "override" clause, according to Dr. Swanson, but to actually force a treatment or hospitalize patients involuntarily for being a danger to themselves or others requires following state law regarding involuntarily treatment, which often involves a court hearing.

Many clinicians worry that PADs allow patients to refuse all treatment or make unreasonable or unsound demands. There are also questions about how to judge if patients are well enough to create PADs, and what to do if they change their minds later if they appear to be getting more symptomatic.

Debra Srebnik, associate professor of psychiatry and behavioral sciences at the University of Washington, followed 106 patients with PADs over two years and found that doctors rated the majority of PADs as reasonable and followed them two-thirds of the time. She and other experts say that PADs are useful for facilitating communication between patient and providers, and for keeping care consistent across facilities.

The bigger problem may be that PADs aren't yet widely used, or aren't physically available when they are needed, doctors say. Delaney Ruston, a physician at the city-run Pike Market Medical Clinic in Seattle, often tells her patients with serious mental illness about PADs, but she first assesses whether their symptoms are in control enough so they will be likely to listen to the information.

She says she helped her father, who had schizophrenia, create a PAD. She kept a copy for herself, which she found initially useful when he went missing in 2005. She started calling the hospitals he listed on the PAD as preferred. But the hospitals, which didn't have a copy of the PAD, were concerned about his privacy and wouldn't tell her if he was a patient there. Ultimately, her father committed suicide before she could locate him.

Clinicians encourage patients to have several copies of their PAD and to give them to a trusted source.

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Wife Alleged Abuse Before SC Rampage - Associated Press

By SUSANNE M. SCHAFER

COLUMBIA, S.C. - Willa Beasley's daughters tried to protect their mother from her husband's beatings and the alcoholism that was jeopardizing their family's home and farm. They paid with their lives.

Court documents obtained by The Associated Press after Alton Beasley's deadly rampage this week in Aiken paint a picture of a troubled man who alternately threatened and hit his wife of 39 years and pleaded with her to return to him.

On Thursday, authorities released the tape of a brief 911 call detailing Alton Beasley's terror.

"I've been shot," an unidentified woman says, panting and out of breath. "He's come over here. He's shot four people. Please hurry. Please hurry."

The woman repeats that four people are injured, then screams. The line then goes dead.

Willa Beasley, 65, was going through a nasty divorce with her unemployed husband, a 61-year-old man who she said "drank up everything that we had" and ran up credit card debts, according to the documents. She said he spent her retirement money and did not pay tax bills.

"I had to leave the Defendant due to his mental and physical abuse," Willa Beasley said in a sworn statement. "If I did not leave, I don't believe that I would be alive much longer."

Things came to a head in July when Willa Beasley's daughters took her to a doctor and she told them the bruises on her body had come from the beatings she had endured, according to a statement written by daughter Anna Beasley Loebsack.

"The marriage of my parents Will and Alton Beasley has been volatile all of my life," she wrote. "The bruises were noticed in April and never seemed to go away."

Willa Beasley left the couple's home in Aiken at the end of July and moved in with daughter Elizabeth Beasley in Townville.

By September, she started divorce proceedings and got an emergency restraining order against her husband, said her attorney, Thomas Dunaway. The daughters sold some of the family's land to pay the bills.

On Tuesday, the estranged couple were back in court for a divorce hearing. Dunaway said Alton Beasley pushed and shoved his wife and had "a verbal altercation" with the judge. Afterward, law officers had to escort Alton Beasley from the courthouse, the lawyer said.

Dunaway said he had a brief conversation with Willa Beasley and her daughters after the hearing. The three left to have lunch at the home of Alton Beasley's parents, William and Mabel.

Then he showed up.

Aiken County Coroner Tim Carlton said Alton Beasley shot Anna Loebsack twice, then wounded family friend Eddie Pruitt, whom Dunaway said hid Willa Beasley before her husband could shoot her.

Elizabeth Beasley, 47, tried to run away, but Alton Beasley followed her to a neighbor's yard. He shot her twice before killing himself, Carlton said.

Dunaway said Loebsack, 36, who lived in Gastonia, N.C., was married and had two children, ages 8 and 10. "It's a real tragedy. She was a beautiful soccer mom," he said.

Elizabeth Beasley was not married. Court documents and the attorney describe her as the couple's daughter, though one statement from her mother indicates that Alton Beasley was not her biological father.

The abuse was not apparent to everyone.

A friend of Alton Beasley, identified in court papers as Randall Norton, said he had stopped by their Aiken home often and that he had "never seen any bruises on Willa or any other signs of abuse. She always seemed so happy."

Willa Beasley could not be reached for comment Wednesday, and her lawyer said she was too distraught to talk about the shootings.

But her sworn statements seem prophetic.

They detail financial woes stemming from her husband's drinking: utilities about to be turned off and a farm facing foreclosure. Willa Beasley's daughters had stepped in to sell off 10 acres so they could pay some debts.

"We put the farm in their name to protect it. That way, the Defendant could not use it to get money and we would not lose our home," she said in one affidavit. "I am scared of this man, he has hit me in my back leaving bruises on me, my face, arms all over."

Copyright 2007 Associated Press. All rights reserved. This material may not be published, broadcast, rewritten, or redistributed.

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Sen. Smith sees mental health future in new home - The Oregonian

The new facility will house up to 15 residents and offer treatment options
Wednesday, November 28, 2007

ELIZABETH SUH
The Oregonian

HILLSBORO -- As Luke-Dorf Inc., a community mental health organization, marked the opening of a new treatment home downtown Tuesday, Sen. Gordon Smith, R-Ore., urged greater investment in mental health care.

"It's time to understand that health care without mental health does not equal health," Smith said at the opening ceremony.


The new two-story treatment home, at Southeast Washington Street and Fifth Avenue, will provide housing for 15 residents, as well as treatment for mental illness and substance abuse. It's next to Luke-Dorf's Garrett Lee Smith Safe Haven House, which was named after Smith's son, who suffered from depression and ended his life in 2003.

Since then, Sen. Smith said he has become an advocate for mental health care.

Howard Spanbock, executive director of Tigard-based Luke-Dorf, said the new home, called a dual diagnosis treatment facility, is part of a 10-year plan to end homelessness in Washington County. He estimates there are 125 people in Washington County who are homeless and have chronic mental illness and substance abuse problems.

Treatment at a place such as the new facility will help those people and relieve burdens on emergency rooms, public services and the corrections system, Spanbock said.

The location, by the MAX line in downtown Hillsboro, is ideal for residents, because it is close to public transit and public services such as health clinics, Spanbock said.

Luke-Dorf will fill the new facility with residents in the next couple of weeks, Spanbock said. Two residents who used to be homeless and have overcome battles with chronic mental illness and substance abuse will receive stipends to live in the new home and act as role models, he said. Staff will provide treatment and coaching on jobs and life skills.

Smith said the facility, with its comfortable design and full-time treatment workers, would help restore the hope people need to make life meaningful.

"What this represents is a model for the future," Smith said.

In October, Smith introduced a bill, the Community-Based Mental Health Infrastructure Improvement Act, that would create federal funding to build and expand facilities that offer local access to mental health treatment.

James Fradenburg, 50, has been living in the Smith Safe Haven House since it opened about a year ago. The Safe Haven House, which has 10 residents, provides a home for homeless people with chronic mental illness.

Fradenburg said he was homeless for 29 years and the Safe Haven model has been effective because it provides a personal, supportive environment for people in a central location.

Elizabeth Suh: 503-294-5956; elizabethsuh@news.oregonian.com

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Mental Health Crisis - Rochester (MN) KTTC.com

Chris Hrapsky
KTTC TV

ROCHESTER, MN -- The panic, the sadness, a loss of identity.
We are in a mental health crisis.

More Americans are seeking treatment than ever before and some experts say it's still not enough.

In a NewsCenter Special Report Chris Hrapsky talks with one woman who found hope through a long journey in a dark place.

Watching the movie "One Flew Over The Cuckoo's Nest" might be the closest some will ever get to mental illness, but this isn't Hollywood. This is real life.

Joanne Ericksen suffers from depression and says, "I felt that if this was all that life would be than it wasn't worth living."

Joanne Ericksen is one of the 56 million Americans who have a mental illness, that's a quarter of all adults in this country and that's just the people who seek treatment.

Mental illness includes a variety of diseases from schizophrenia to eating disorders.

They've been around since we've been around, only now do we know so much about them.

Dr. Smick says these diseases can be passed along through heredity, they can come from traumatic experiences and drug abuse.

Dr. Annette Smick, a Psychiatrist says, "There also tends to be a gender difference. Women are twice as likely to have depression especially from ages 15 to 55. They are two to three times as likely to have anxiety disorders compared to men."

Joanne first suffered post partum depression after her youngest of three children was born.

Ericksen says, "Couldn't think, couldn't talk to anyone without crying. It was pretty rough."

She says she endured decades of fighting with the unexplained sadness. She says it always felt like a frigid, gloomy winter day, a living nightmare.

Ericksen says, "The way I describe it I was in a hole in the ground. There was dirt all around me, and it was a very deep hole. And kept trying to climb out of it, my hands scraping against the dirt and the dirt would give way and I couldn't get out."

Her job compounded her illness. As a registered nurse working at Saint Marys psychiatry department, she often found herself suffering from the same thing she was helping others treat.

Ericksen says, "So that day I was admitted as a patient. The same day that I was earlier there treating and running a group talk about the confusion for the patients."

Family trips, a child's graduation, holidays. With serious depression comes loss of memory. Something Joanne misses and would like to have back.

Ericksen says, "What I started to do is write some of those stories down in a book so I at least have some of those memories. I'm sorry. Cause it's sad to miss part of their life and my life."

Dr. Smick says, "When your depression is interfering with your quality of life. You ability to function, your ability to get up in the morning, go to work, take care of yourself, take care of your children, that's when you need to look at treatment."

Ericksen says, "I know that treatment works, and that's exciting. I know I can do a lot to work with my treatment and maintain my health, and that's exciting."

Mental illness does not mean terminal illness, Smick says stop seeing it as a weakness, ask for help, and see the light again. It works and it's being proved everyday.

The most common methods of treating depression involve counseling and medication. There are, however, more extreme treatments including the controversial use of electric shock therapy.

Wednesday night we'll look see how adequate care and insurance play into factor. And how a late Minnesota Senator is still helping to change the system.
Updated: 2007-11-29 20:55:05

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Understanding mental illness in colleges - Baltimore Examiner

By Karl B. Hille, The Examiner

Noovember 28, 2007

BALTIMORE -
If your roommate starts acting strangely or never quite fits in, trying to avoid your dorm room won’t help.

The investigation into the mental state of Virginia Tech shooter Cho Seung-Hui may stigmatize the mentally ill, experts say. However, while violence and shootings are rare on campus, mental illness is surprisingly common.

“It is a topic that doesn’t get discussed enough, particularly on a college campus,” said Patricia Lanoue, interdisciplinary studies director at the University of Maryland Baltimore County. “Substance abuse, anxiety, depression, mood disorders and other dimensions of mental illness have been a growing problem on college campuses nationwide.”

More than one in three students reported feeling so depressed “it was difficult to function,” and suicide is the third-leading cause of death for people ages 10 to 24, according to the 2006 National Student Health Survey.

College can present a risky environment for students with mental illness or a predisposition toward mental illness, said Carlo DiClemente, professor of psychology at UMBC. “There’s increasing challenges to our sense of identity and belonging, combined with experimentation with alcohol and drugs.”

While the definitive link between alcohol and drug abuse and mental illness is still subject to debate, DiClemente said, “there’s a lot of interaction between alcohol and substance abuse and emotional or psychological problems, and there’s a lot of ways they interact.”

Most people suffering mental illness do not cause harm, said J. Lavelle Ingram, director of UMBC’s counseling services.

“When we talk about mental illness, I want to be clear that violence is not the major feature,” Ingram said. “People with psychiatric disabilities are far more likely to be victims than perpetrators of violent crime.”

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More Mentally Ill Barred From Gun Buying -Associated Press

By LARA JAKES JORDAN

WASHINGTON (AP) — The number of people barred from buying guns because of mental health problems has more than doubled since the Virginia Tech shootings earlier this year, the Justice Department said Thursday.

The increase follows stepped-up reporting to a federal database used to screen the backgrounds of potential gun-buyers.

Attorney General Michael Mukasey was to announce the increase at an afternoon speech in Park City, Utah. The number of people identified in the database as having mental problems grew from 174,863 three months after the April 16 Virginia Tech shootings to 393,957 this month.

"Instant background checks are essential to keeping guns out of the wrong hands, while still protecting the privacy of our citizens," Mukasey said in comments prepared for delivery to the National Association of Attorneys General.

"But as we learned in the tragedy at Virginia Tech, the checks must be accurate and complete to be effective," Mukasey said. "We're making progress, and I hope that even more states will submit this information so that the national instant background check system can be maximally effective."

People are included in the federal database only after courts or other lawful authorities have found them to have mental health problems, Justice Department officials said. Currently, 28 states submit names to the mental health database, and the federal government cannot force the other 22 to follow suit.

Virginia Tech student Seung-Hui Cho killed 32 people and himself in what authorities call the deadliest campus shooting in U.S. history. He bought two guns — a Glock 9mm at a Virginia store and a .22-caliber pistol over the Internet — despite a special justice's 2005 order to get outpatient treatment for being a danger to himself. There has been no indication that Cho ever received the treatment.

Had his court order been submitted to the federal database, Cho likely would have been unable to buy the guns.

Private mental health records, including diagnosis documents from hospitals or insurance companies, are not accessed or submitted to the database. Justice Department officials said more than 5 million people are identified in the database, which is maintained by the FBI and also tracks illegal immigrants and people with criminal histories.
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Shooting of suicidal man justified, report says -Sioux Falls (SD) Argus Leader

By Jonnie Taté Finn and Terry Woster

PIERRE - A 26-year-old man who was shot and killed by a state trooper near Harrold last month intentionally provoked the confrontation, and the trooper was justified in his action, an investigation of the deadly incident concluded.

Authorities say Highway Patrol officer Ryan Lantz, who shot Anthony Larocco in a farm field near the small Hughes County community, "acted in the reasonable belief that discharge of his weapon was necessary to protect himself and federal officers."

That action is allowed by state and federal law, the six-page report said.

Attorney General Larry Long's office and the Division of Criminal Investigation reviewed the shooting, which happened Oct. 20. It occurred after a high-speed chase that ended on foot in the field. Lantz used a 12-gauge shotgun from a distance of 26 yards.

Col. Daniel Mosteller of the South Dakota Highway Patrol confirmed Wednesday that Lantz is back on duty.

"Although we regret the loss of life, we are in agreement with the attorney general's report. We are keeping the Larocco family and the Lantz family in our prayers. We ask the public to do the same," Mosteller's office said.

According to the Highway Patrol Web site, Lantz became a trooper in September 2005. Lantz could not be reached for comment.

According to Long's spokeswoman, the attorney general's office looks at the "big picture" before making any judgments.

"That's why it doesn't just take a day to do this," Sara Rabern said of the monthlong investigation. "(Long) talks to investigators, reads the DCI report and looks at whatever policy the agency involved adheres by. The decision isn't based on statute alone."
'Compelling' evidence

Long's report said Larocco intentionally provoked the confrontation.

"The evidence is compelling that Larocco wanted to die and purposely maneuvered the police into shooting him," the report said.

The report noted that the deadly chain of events began at 7:30 p.m., when a crisis counselor in Pierre reported receiving a call from a male who identified himself as Anthony and said that if the counselor "sent law enforcement to his house, 'people are gonna die.' "

Calls to 911 said a man had a gun, had two children in his trailer and wanted law enforcement to come to his residence, the report said.

During one of the 911 calls, the report says, a male child was on the phone with the dispatcher.

When officers began arriving at the Harrold airport as a staging area to approach Larocco's residence, a red Ford pickup with a man later identified as Larocco "deliberately drove in a circle at high speed and initiated a vehicle pursuit."

The chase covered 17 miles at speeds up to 70 mph. Several times during the high-speed chase, Larocco was seen waving what appeared to be a handgun out of the window of his vehicle, the report said.

The report said Larocco refused orders to drop his weapon and instead, "he gripped his gun with two hands, crouched or knelt down, extended his arms and aimed the gun directly at them. Trooper Lantz then fired his shotgun once at Larocco and Larocco dropped."

The weapon Larocco carried was a .177-caliber Daisy Powerline 008 Dual Ammo semi-automatic CO2-powered gas pistol. The pellet gun is "virtually indistinguishable from a standard police issue semi-automatic pistol," the report said.

The report noted that, while information was radioed to officers that Larocco's girlfriend thought the weapon was a BB gun, "they had absolutely no way to confirm that information."
He 'wanted to be shot'

Gerry Ogle, Larocco's girlfriend for more than seven years, told officers the man had been diagnosed as bipolar and had attempted suicide in the past. She said that an hour before the shooting, he had called her at work and said he was going to make the police shoot him by making them think he had a real pistol, the report said.

This scenario plays out all too often across the country, according to Bill Lewinski, a Minnesota-based behavioral scientist specializing in law enforcement issues.

Its common term is "suicide by cop" or "police-assisted suicide" where a person brandishes a weapon to entice officers to shoot, said Lewinski, who directs the nonprofit Force Science Research Center at Minnesota State University-Mankato.

"The guy definitely wanted to be shot," Lewinski said after reading Long's report.

"Somewhere around 10 to 15 percent of all people shot by cops had earlier given some indication - whether in a letter or, as in this case, to a girlfriend - they wanted to be killed," Lewinski said.

Lewinski said people such as Larocco are determined.

"The choices law enforcement are provided with in responding to these situations are very limited," he said. "Beyond that, they are responding to a problem somebody else created, so they are already behind the reaction curve and the tactical curve.

"The individual - in this case Larocco - is in charge of the situation," Lewinski said. "Just by reading the report, you can tell he led police all over the place. They couldn't contain him, and they couldn't control him."

Based on the report, Lewinski agreed that Lantz used reasonable deadly force and based his opinion on the Daisy Powerline that Larocco used.

"We have tested that type of weapon in the hands of an amateur," Lewinski said. "Amateurs can fire off several rounds in a quarter of a second - bang, bang, bang. And an officer - even with his finger on the trigger and weapon pointed at the suspect - will have two bullets in him before he can even react."

Lewinski said the daisy pistol is maneuvered easily and can be deadly. Most of the amateurs Lewinski tested aimed for the head.

"These are people with no training at all, and they were very accurate at 15 to 20 feet," he said.
Alcohol involved

Gerry Ogle and her father, Jim Ogle, questioned the need to kill the man, the report says. Jim Ogle asked for but was denied permission to go into the field and talk to Larocco before the shooting. Jim Ogle declined to comment Wednesday.

A blood-alcohol screen showed an alcohol level of 0.293 percent in Larocco's blood. That's almost four times the legal limit for driving. A drug screen was negative, as were drug and alcohol screens on Lantz, the report said.

An autopsy report said the shotgun pellets penetrated Larocco's brain, liver and right jugular.
The report also noted that:

# In February, Larocco climbed to the roof of the Harrold bar and threatened to kill himself by jumping. Police had responded to a report of a man with a knife threatening people in the bar.

# In July 2002, while in the Minnehaha County Jail on traffic charges, he tried to hang himself in his cell.

# On Dec. 1, 2002, police were called with a report that Larocco had overdosed on prescription medication. Read more!

Mental health forum focuses on what works, what needs improving - Grand Rapids (MN) Herald-Review

Marie Nitke
November 28th, 2007

About 100 people from the Itasca County area participated in a legislative forum on mental health held at the Grand Rapids Area Library Tuesday night. People with mental health issues and their friends and family joined local mental health services professionals, Minnesota Senator Tom Saxhaug, state Representatives Loren Solberg and Tom Anzelc, and Executive Director of the National Alliance on Mental Illness (NAMI) of Minnesota, Sue Abderholden, to talk about what’s working and what needs improvement in the current state and local mental health system.

“This last year was a banner year for mental illness funding at the legislature,” said Abderholden, citing about $34 million in new funding. “But it still wasn’t enough. Next year, we want to try and make up for what was missed this year.”

According to Abderholden, NAMI-MN will be seeking funding in the next legislative session for the following key issues:

• Health Care

One of the biggest flaws in the national and state mental health care system, as discussed at the forum, is the overall lack of mental heath care available at general health care centers.

“There’s too much disconnect between health services and mental health services,” said one community member. “Hospitals seem to ignore the fact that the brain is a part of the body, too.”

American Bank - Grand Rapids
“If a person was sent to the emergency room because of a cardiac arrest, that person would be attended to immediately,” said another community member. “Yet people who are in the emergency room because they are suicidal are left sitting in the waiting room, or are sent home, but they’re in just as much danger of dying.”

Abderholden and others commended the local mental health services system, citing innovative initiatives like the Crisis Response Team, which recently won a state award. Still, insiders pointed out that improvements are still needed in certain areas. Itasca County Family and Children’s Services Manager Marian Barcus, for example, said that mental health services professionals run into complications when trying to find a place willing to treat people with “dual disabilities” (such as a person who is both mentally ill and an alcoholic). Barcus said she’d like to see state regulations loosened to enable hospitals and mental health facilities to treat patients with dual disabilities.

Other mental health professionals at the forum said that rural health care centers are not given access to the same resources as those in metro areas, and asked legislators to ensure that funds are allocated equitably throughout the state.

• Health Insurance

“People need access to health insurance in order to pay for mental health treatment and medication,” states a NAMI-MN brief on it’s key issues for 2008.

NAMI-MN’s plan to ensure health insurance for the mentally ill is accessible includes deleting the four month waiting period under MinnesotaCare, continuing coverage until age 25 for youth with mental illness who are living in the child welfare system, and eliminating barriers to integrated care.

“We need a continued, even, seamless health insurance coverage option for people who have a chronic disease,” said Itasca County Health and Human Services Director Lester Kachinske.

As the current system works, pointed out another health care professional, there are fairly frequent breaks in heath insurance coverage for the mentally ill, and it is usually during those times that medications are not taken, making social, behavioral and even criminal problems more likely to arise.

• Housing

Abderholden said people with serious mental illness need stable housing with a support system in place in order to live in the community and to avoid costly hospitalizations and residential treatment. NAMI-MN will be seeking additional funds from the legislature to create more affordable housing options for the mentally ill.

• Work

Abderholden said the unemployment rate of the mentally ill is nearly 90 percent. Thomas Cook, Director of Children’s Mental Health Services, who recently moved to Grand Rapids from Wisconsin, said the biggest gap in opportunity for the mentally ill that he has noticed in the Itasca County area is employment. NAMI-MN will be seeking legislative funds to support employment, hoping to decrease the unemployment rate, and to initiate more programs that encourage employers to hire the mentally ill.

A related goal of NAMI-MN is to raise pay rates and offer more fringe benefits to mental health professionals, psychiatrists and clinical nurse practitioners. Abderholden said Minnesota is one of the bottom 15 states in the United States in terms of what it pays these professionals, which has resulted in a work force shortage.

• Criminal Justice

“A high percentage of people with a serious mental illness end up in the criminal justice system due to a mental health crisis,” states the NAMI-MN brief. “Minnesota needs to develop more mental health courts, jail diversion programs, mental health programs in the jails and discharge planning.”

• Children’s Mental Health

The use of seclusion (such as time-out rooms) and physical or mechanical restraints on mentally ill children in classrooms was a topic that most people at the forum took issue with.

A former public school teacher said such tactics can be necessary if a child is endangering himself or other children (such as if a child is threatening another child with a pair of scissors). Abderholden agreed, and said NAMI-MN is asking legislators to create additional regulations to discourage and monitor the use seclusion and restraint procedures -- not do away with them entirely -- in the interest of student safety.

• Other issues

People at the forum offered other suggestions on how to improve mental health services. One woman, for example, said she’d like to see more programs that help mentally ill parents raise their children. Another community member said he’d like MinnesotaCare eligibility requirements to be based on need and individual situations, and for the process to be less complicated. Other community members hoped for quicker, more seamless health insurance coverage for mentally ill veterans of the military.


Read more!

Hill residents’ behavioral issues targeted -Pittsburgh (PA) Courier

By Cynthia Levy

The Hill District is probably home to more churches than most communities in the city. On seemingly every corner there is one, if not two, churches waiting to meet the needs of the community.

So it’s no surprise that in a battle to defeat substance abuse, depression and other deadly behavioral problems in the community, the Center for Family Excellence has turned to the churches.

On Nov. 15, the Center for Family Excellence was given a $200,000 grant from the Staunton Farm Foundation to address issues of behavioral health in the Hill District by utilizing the close relationship that exists between its churches and the Black community.

“We spent three to four years doing surveys and in-depth interviews with pastors on what they are seeing at ground level,” said Dr. Jerome Taylor, executive director of the Center for Family Excellence.

Taylor plans on using the funds and the results of the pastoral survey to pinpoint persons who need mental health services and to get them better access to treatment.

He said in doing the research there were common themes of behavioral problems affecting Hill residents.

“Depression was No. !, No. 2 being stress, three anxiety, fourth was substance abuse, and mood swings and schizophrenia were also common,” Taylor said.

The surveys also reported that mental disorders in Blacks were accompanied by substance abuse 40 to 60 percent of the time.

The center is also working with the Cultural Policy Council, headed by former Hill District Bethel AME’s Rev. Dr. James McLemore. McLemore now serves as presiding elder at the church.

According to the center’s research, about 50 percent of Blacks belong to churches, giving the institutions unique insight and accessibility to the Black community.

“The church is the first point of contact. People will talk about it to the minister before they’ll tell anyone else about it,” McLemore said.

The initiative will also be training the pastors on how to sharpen their sensitivity to residents and church members who may be dealing with some of these issues.

“We will be holding planning sessions to talk about the issues and try to create a registry of resources,” Taylor said.

McLemore said health professionals will also be trained on how to address Blacks with problems given the stigma some Blacks have when it comes to dealing with health care officials.

The Hill District was chosen as the starting place for the initiative primarily because it’s where the center is located. He also said that while the behavioral issues facing residents are not exclusive to that community, they are dire.

“Sometimes people are so bombarded they seek a measure of relief through over-eating or risky sexual behavior. We have folks grappling with issues in our communities,” Taylor said.

The center hopes to begin providing services by Dec. 1 and plans on taking a more proactive approach to recruiting after receiving some clients and assessing the preliminary results.
Read more!

Some tips on ruling by stereotype in Milwaukie -Portland Oregonian

By And Parker

I got a nice little Thanksgiving message last week from Milwaukie resident David Aschenbrenner telling me what he's thankful for.

He was writing in response to my Nov. 21 column ("Cooking up a turkey of a deal") about the city of Milwaukie's after-hours, behind-the-back deal to suddenly buy a $240,000 house city leaders knew was in the process of being purchased for use as a group home for the mentally ill.Some of the residents of the home would be mentally ill felons whom state and county officials certified are no longer a threat to society.

Mr. Aschenbrenner wrote: "I see once again you got your facts right in order to stir the community and to sell more newspapers. The real turkeys are the way this project was slipped into our community, and your commentary."

"We in Milwaukie are thankful for our city manager, our mayor and City Council.

"Happy Thanksgiving."

I got several similar responses, including an e-mail from City Manager Mike Swanson chastising me for failing, in the column, to represent the views of the neighbors questioning the group home.

"Even after numerous readings" of the column, wrote Swanson, "I don't find anything from the Ardenwald neighbors. When you discuss the merits of the proposal, those merits go unchallenged.

"It certainly makes it much easier to argue that both procedurally and substantively the 'deal' is a 'turkey.' . . .

"There is another side to the substantive issues."

To me, the neighborhood's position seems pretty obvious. But, OK, here you go, here's their position: NIMBY.

While there are many opinions about this issue, from what I can tell all the facts are pretty clear.

They are: We have mentally ill people in our communities.

Some of them commit crimes.

After they've served their time in state hospitals they face rigorous analysis and review by state and county officials before being placed in group homes where they get constant, 24/7 oversight and care.

Once there, all the evidence suggests they represent virtually no threat to the rest of us, arguably much less threat than "sane" criminals who are released into our communities every day with minimal or no supervision.

And the fact is, that communities everywhere -- not just Milwaukie -- promote hysterical reactions to these people and these projects that are demeaning, and in some cases, illegal. None of those facts, of course, prevent any of us from having different opinions about these issues. But the opinions don't change the facts.

The fact is, Milwaukie officials polled city councilors in a series of phone calls that arguably sidestepped Oregon public meeting laws in order to get authorization for Swanson to purchase the home out from under the nonprofit group.

The fact is, the nonprofit group had, as is required by law, informed the city of its plans to purchase the home, followed all city guidelines for siting a group home and paid the required city fees.

After all that had occurred, several residents called me angry that no public hearings had been held to get their opinions on the home.

There's a reason for that. Federal fair housing laws say it's illegal to deny a permit or "to take action against" a group home because of the disability of the individuals who would live there. That protected class includes the mentally ill.

For that reason, not only are public hearings not required, they can present legal problems for cities that, after hearing public outcry, reject a group home.

"A local government can violate the Fair Housing Act if it blocks a group home or denies a requested reasonable accommodation in response to neighbors' stereotypical fears or prejudices about persons with disabilities," according to a joint statement on group homes siting issued by the U.S. Department of Justice and the U.S. Department of Housing and Development.

Furthermore, when local officials take steps to block a group home, "if the evidence shows that the decision-makers were responding to the wishes of their constituents, and that the constituents were motivated in substantial part by discriminatory concerns, that could be enough to prove a violation."

In such cases, the courts are "likely" to find there has been discrimination, according to the DOJ statement.

So, will the nonprofit group that suddenly lost its site after public outcry drag Milwaukie and its taxpayers into court?

For the sake of mentally ill citizens everywhere, I kind of hope so.

"We're looking into legal challenges," said Bob Beckett, executive director of Oregon Regional Behavioral Services, the nonprofit that still plans to site the group home, which is partially funded by county money, somewhere in Clackamas County.

"We found the Milwaukie house through a Realtor," said Beckett. "It was a permitted use. It's reasonably close to services such as grocery stores. Given its location -- next to the railroad tracks and backing up to a vacant lot -- it was reasonably private.

"The location fit our criteria and federal laws. The price was right. It was at the end of a dead-end street. It was a good site."

"I think what the city did is absolutely shocking. I'd never heard of such a thing. I was absolutely flabbergasted.

"I can't image it's legal."

The nonprofit runs 10 other group houses across the state, including two near Southeast Foster Road and 122nd Avenue.

Beckett's experience with those group homes mirrors what I heard from several state officials last week -- that there has never been any evidence the group homes pose a credible threat to other citizens.

"I've been doing this since 1995," said Beckett, "and I've never had an incident where we've had a resident harm, or even threaten to harm, anyone in the community. Zero.

"In this country, we don't get to choose our neighbors. Somebody who buys the house next to you doesn't have to come to you and tell you about what they've done their entire lives and get your permission to live there.

"Thank goodness, that's not the way it works."

Got a response, a question or a column idea? Call or write Andy Parker: 503-294-5945; daparker@news.oregonian.com Read more!

DOC director wants more state prisons -Pueblo (CO) Chieftan

More money sought to house mentally ill.

By CHARLES ASHBY
CHIEFTAIN DENVER BUREAU

DENVER - Ari Zavaras wants the Colorado Legislature to start talking about building new state prisons again.

As executive director of the Colorado Department of Corrections, Zavaras told the Legislature's Capital Development Committee on Wednesday that despite recent efforts to reduce recidivism, the state still has a great need for more prison beds.

He highlighted several Southern Colorado prisons that he said are in need of expansion, including lockups in Pueblo and Trinidad, that add up to more than $500 million.

"Over the years, our inmate population has grown about the size of a prison a year," Zavaras told the six-member committee, which began its annual review of which capital construction projects the Legislature will fund next year.

"As of Oct. 31, 2007, the inmate population was 22,673. (Legislative Council Services) projects our population at 23,475 at the end of this fiscal year, and at 28,336 by year 2012. That really tells us the department still has some serious bed needs," Zavaras said.

Committee Chairman Sen. Bob Bacon, D-Fort Collins said there is not much chance the Legislature will be able to come up with the money Zavaras is seeking, but suggested that lawmakers should discuss some other way to obtain the money.
"This half a billion dollars is sobering," Bacon said. "I think we're at a crisis with dealing with this public safety issue."

Zavaras said efforts that he and Gov. Bill Ritter have pushed to reduce recidivism are starting to produce results.

State inmates being housed in county jails are at an all-time low, and monthly inmate growth is the lowest it's been in years, he said.

Regardless of those efforts, the department still faces some critical infrastructure needs, particularly in the San Carlos Correctional Facility located on the Colorado Mental Health Institute-Pueblo campus, Zavaras said.

He's asking the committee for nearly $60 million to double the size of that 250-bed facility, which primarily is used to house mentally ill inmates.

Zavaras also wants to start a phased expansion of the 484-bed Trinidad Correctional Facility to the 2,541-bed "mega-facility" that was initially planned. That project would cost a whopping $337 million to complete.

Other expansion projects the department is requesting include:

Expanding the 224-bed Colorado Women's Correctional Facility in Canon City by 284 beds at a cost of approximately $47 million.

Adding 384 beds to the 1,007-bed Arkansas Valley Correctional Facility in Crowley at a cost of approximately $61 million.

Turning the 500-bed Fort Lyon Correctional Facility, which also houses mentally ill inmates, into one that has 750 beds at a cost of approximately $24 million.

Despite the high cost of new prisons, the capital construction requests are only a fraction of the total requests the committee handles each year.

The committee already is trying to prioritize an estimated $516 million in requests, which range from renovating track for the Cumbres & Toltec Scenic Railroad to fixing up crumbling buildings on college and university campuses.

Rep. Buffie McFadyen, D-Pueblo West and a member of the committee, said the Legislature and the rest of the state need to consider other options to pay for new prisons, such as bonding and lease agreements, or take an issue to the voters to raise state revenues, including a possible tax increase.

"There is no question that the security and the safety of Colorado public depends upon ensuring we have enough beds in the Colorado state prisons system, and private prisons are not the answer," McFadyen said.

"We're going to have to have a very public debate . . . as to how we're going to come up with the funding. I'm a state representative who doesn't want to build more prisons. Nobody does. But we're faced with a crisis. We have no choice. We're going to have to look at every funding method possible," she said. Read more!

A Daughter Dies Suddenly, and a MotherLoses Her Way - NY Times

By ALEXIS REHRMANN

During the months after her daughter’s death in May, Felesha DeGracia eventually made a plan.

“I had to make a schedule for myself,” said Ms. DeGracia, 47. “Get up out of bed, go take a shower — because I was sitting in this house not bathing, not combing my hair, not doing nothing.”

On May 7, Ms. DeGracia’s daughter, Yasmine Tirado, was found drowned in the Hudson River at Battery Park. (Ms. DeGracia said the police considered the death a suicide, a finding she disputes)

The shocking loss left Ms. DeGracia, 47, reeling from grief, in a state that she describes with a single word: “psychotic.”

Ms. Tirado was 26 when she died and was just starting to put together her fragile life.

At 22, she had received a diagnoses of schizophrenia. “She was already living on her own, she was working, she was doing fine, and then out of the clear blue sky this happened,” Ms. DeGracia said.

About four years after her diagnosis, Ms. Tirado entered Project Renewal, a group that helps homeless and mentally ill people become independent. At the time of her death, she was doing volunteer office work and looking forward to the future.

“I talked to her two days before it happened, and she was full of life, vibrant,” Ms. DeGracia said. “She was getting her own apartment; she was so gung-ho about that. She had opened a bank account, and she went on an interview.”

Ms. DeGracia does not accept that her daughter committed suicide. “That doesn’t seem like her, not after she told me all the things that she was planning for her future,” she said.

“This tragedy,” Ms. DeGracia said, “it’s separated my family. I have prayed about it. I have cried about it. I don’t know what else to do.”

Since his sister’s death, Ms. DeGracia’s son and only other child, Kevin DeGracia, 17, has been living mostly with his grandmother in Manhattan. He declined to be interviewed. “Ever since his sister passed away, he has a lot of resentment, a lot of anger,” Ms. DeGracia said. “Not to mention the stress that you ordinarily have as a teenager.”

This summer, after taking three days of bereavement leave, three weeks of vacation and two weeks off without pay, Ms. DeGracia said she was still in no shape to return to her job as an account representative at Verizon.

“I told them, ‘I can’t come back to work, I can’t function, I haven’t slept in two and a half weeks,’” she said. “I slept sitting up, standing up. I was a bundle of nerves.”

She began seeing a psychiatrist and taking antidepressants, and was put on disability, taking home $363 week, half of her regular pay. By August, Ms. DeGracia owed $1,800 in back rent and $672 to Consolidated Edison. Her landlord was starting eviction proceedings on her $850-a-month apartment in Queens.

“My apartment is like a little box, but I can’t lose it,” she said.

She turned to Catholic Charities, Diocese of Brooklyn and Queens, one of the seven agencies supported by The New York Times Neediest Cases Fund, for help. The charity gave her $672 that was intended to cover the Con Ed bill but went toward the rent when a grant from the city’s Human Resources Administration covered her utilities. An older brother lent her some money, also to help with the rent. Ms. DeGracia said she had nearly caught up with her bills.

She started back at work full time on Oct. 29 and is grateful for the help she received from Catholic Charities. “Whenever I can give something toward the Catholic Charities, I will do that,” Ms. DeGracia said, “because, I don’t know, you kind of just saved my life.”

Her brother too, is a continuing comfort. “He doesn’t leave me alone, he bugs me — which is good, you know?” she said. “Because you could just die, you know, your soul, you could rot away. And I was rotting. I was sitting here rotting away, and he didn’t let me.” Read more!

Autistic Children Have More Gray Matterin Brains - HealthDay

By Madeline Vann

WEDNESDAY, Nov. 28 (HealthDay News) -- Children diagnosed with autism have more gray matter in their brains than healthy children, report researchers who used a novel imaging technique to analyze brain structure.

The excess gray matter in the parietal region may make it harder for autistic children to learn how to function socially by watching other people's behaviors, the researchers suggest. In contrast, increased gray matter among healthy children correlated with higher IQ, the researchers said.

The researchers, at the Fay J. Lindner Center for Autism, North Shore-Long Island Jewish Health System in Bethpage, N.Y., were to present their findings Nov. 28 at the Radiological Society of North America annual meeting, in Chicago.

The researchers analyzed the brain images of 13 males who had either high-functioning autism or Asperger Syndrome, a developmental disorder in the autism spectrum. The researchers compared the results with images from 12 healthy children who did not have autism. On average, the preteens were 11 years old.

The researchers used a technology called diffusion tensor imaging (DTI) to produce a visual map of each child's brain. Scientists usually use DTI to visualize the brain's white matter, as well as the brain fibers. However, the research team applied it to the assessment of gray matter by employing apparent diffusion coefficient based morphometry (ABM), a new method that highlights brain regions with potential gray matter volume changes.

They found gray matter abnormalities throughout the brain, but particularly in the parietal lobe, which adds to previous research suggesting that mirror neurons found in that region play a key role in autism.

The increase in gray matter probably affects the action of the mirror neurons, said study investigator Manzar Ashtari, who is now a senior neuroscientist at Children's Hospital of Philadelphia. Mirror neurons are those cells that activate when you perform an action and then see someone else perform the same action, or vice versa. These neurons have been dubbed the "monkey-see, monkey-do" cells.

"Mirror neurons allow us to learn without knowing we are learning and then respond appropriately in certain situations," said Ashtari. She hopes to explore the link between autism and mirror neurons in future studies, using brain imaging techniques to find out when, and if, mirror neurons are engaged at the appropriate times.

The challenge with imaging studies is getting beyond measures of volume to understand smaller and more localized changes, Ashtari said. Adding ABM to DTI gave the study researchers the ability to detect subtle regional or localized changes in the gray matter, which was not possible before, she said.

The brain structures of people with autism change over their life span, explained Ashtari, which poses a problem for researchers trying to understand the disorder. "I believe it's a very complex process the brain goes through with autism and we don't know much" about that process, she said.

Unfortunately, this new imaging technique can't be used to diagnose autism, Ashtari cautioned.

"Everyone is trying to find something that is very robust, to be able to say 'you take this test, do this screening, and then you know,'" she said.

Dr. Stewart H. Mostofsky is a pediatric neurologist at the Kennedy Krieger Institute in Baltimore. He agreed that it is too soon to use any imaging technique as a part of diagnosing autism.

"We are dealing with a disorder that is defined by symptoms," said Mostofsky, who was not involved in the study. He added that there are many different possible causes of autism, which means many different brain abnormalities. "The question beyond that is whether there is a common neuromechanism. That is not entirely clear. There is no evidence that would support imaging as a diagnostic tool."

Further, he cautioned that the new study had a very small number of high-functioning participants, so conclusions about brain abnormalities cannot be generalized to all people with autism.

Another expert lauded the new findings.

Dr. Vilayanur S. Ramachandran, professor of psychology and director of the Center for Brain and Cognition at the University of California, San Diego, called the new research "a landmark anatomical study which lends support to the increasing evidence that mirror neurons are an underlying cause of autism." He said the finding of excess gray matter suggests that one of the issues with the autistic brain may be a matter of malfunctioning connections between neurons, rather than the neurons themselves.

Ramachandran and his colleagues published work earlier this year in the journal Cognitive Brain Research that suggested that autistic children have a faulty mirror neuron system.

In February, the U.S. Centers for Disease Control and Prevention released statistics indicating that one in every 150 American 8-year-olds has autism spectrum disorders. A decade ago, estimates ranged anywhere from one in 500 youngsters to one in 166.

But those new statistics -- from a 14-state survey conducted by the CDC -- failed to clear up the mystery of why autism might be striking more and more children with each passing year.

More information

To learn more about autism, visit the U.S. National Institute of Mental Health. Read more!

Berkeley's new cause: Make homeless behave -LA Times

City, usually a supporter of the downtrodden, will hire monitors to report inappropriate behavior to police and social agencies.

By Maura Dolan, Los Angeles Times
November 29, 2007

BERKELEY -- Even this college town, traditionally the defender of the downtrodden, protector of the left and arbiter of political correctness, has had enough -- enough of the homeless.

After months of hand-wringing, the Berkeley City Council this week passed a law to hire monitors to patrol city streets and parks and report inappropriate behavior by the homeless and others to police and social service agencies.

The plan makes it easier for police to enforce a law against camping in public places. It bans lying down on commercial streets during the day and bars smoking on sidewalks on main commercial corridors.

It was a heart-wrenching decision for leaders of a city that was home to the Free Speech Movement, the hippies and an assortment of other anti-establishment causes.

"A lot of the council had a hard time with it," said Mary Kay Clunies-Ross, a city spokeswoman. "It is nothing that anyone really wants to do."

It was Berkeley's reputation for tolerance and generous social services that helped attract so many homeless.

One study estimated that 40% of Alameda County's chronically homeless reside in Berkeley even though the city represents only 7% of the county's population.

"Berkeley is an expensive place to live, and our streets are dirty," Clunies-Ross said. "That's because of how they are used."

In recent years the city's openness to the unorthodox has given way to discomfort over aggressive panhandling and public urination and defecation, merchants said.

Frustrated by homeless encampments, Berkeley residents and merchants recently helped reject a plan to build a public plaza near what is known as the Gourmet Ghetto in North Berkeley, home of Alice Waters' Chez Panisse restaurant. Residents and merchants feared that the homeless would just take over, Clunies-Ross said.

Geir Fredriksen, manager of a furniture design store on Shattuck Avenue in Berkeley's downtown commercial area, said he has had to usher out homeless people who wander in hoping to lounge on the plush furniture for sale.

"Instead of being so liberal and progressive here, as everyone wants to be in Berkeley, they have to address the problem," Fredriksen said. "I don't think they are doing enough, but at least it's a big issue now."

Panhandlers and men with shopping carts dotted Shattuck Avenue on Wednesday, and some of those who were not disoriented were familiar with the city's plan.

"You either go into a shelter or go into jail or you get out of town," complained Robert Ball, 60, who sat in the sun near his loaded cart. "That's what they want to do -- push us out of town and make it someone else's problem."

Not so, city officials said. In fact, they bristle at the description of the plan as a "crackdown" on the homeless. They have labeled it "Public Commons for Everyone."

Mayor Tom Bates said the idea was not to rout the homeless, but to target bad behavior by anyone, including rowdy students, addicts and the mentally ill.

Shaping the plan that way was "better politically for us because we don't want to go after just homeless people," Bates said.

Still, the effort was not politically palatable to all of the city's elected officials. The parts of the plan that were punitive passed on a split vote.

Councilwoman Dona Spring voted against the entire scheme. She complained that it would increase "the police powers" and "make it harder for individuals to lie on the sidewalk." Calling the action "amoral," she said, "There is no place else for them to sleep."

Spring said she also opposed the 25-cent parking meter hike that will pay for the $1-million program, which will include more housing and public toilets as well as programs for people 17 to 25 years old who have nothing to do during the day. The city estimates that it has about 250 homeless young people.

Although merchants on Shattuck endorsed the plan Wednesday, the men bearing the plastic cups and the shopping carts were not pleased.

"You can't sleep here, have sex" or urinate on the sidewalks, complained Jakoby Kirby, 28, a panhandler who said he had a brain tumor removed and still suffers seizures. "I somewhat agree with that, but I think it's taking people's rights away to smoke, and if people are just dozing off, that shouldn't be illegal."

Bates said Berkeley residents are no different than residents of other cities with significant homeless populations.

"People don't like to see poverty," he said.

But, he said, the city was not shunning the disadvantaged.

"Berkeley is a compassionate community, and we have more services for the homeless per capita than anyplace in the United States," he said.

maura.dolan@latimes.com Read more!

Judge: Killer incompetent -Pensacola (FL)News Journal

Mahn to return to mental facility in 14-year-old double murder case

Kris Wernowsky
kwernowsky@pnj.com

A judge ruled Wednesday that convicted double-murderer Jason Mahn is mentally incompetent to appear at a death-penalty hearing, resulting in another delay in the 14-year-old case.

On Wednesday, Circuit Judge Frank Bell said there was no doubt that Mahn, 35, diagnosed with schizophrenia, was unable to properly interact with his defense attorney or understand court proceedings.

In Florida, defendants deemed incompetent are sent to a state mental hospital for treatment until they are deemed mentally fit for court proceedings.

"Mr. Mahn needs to go back in the state hospital," Bell said. "He needs to be in an environment that is going to treat his mental illness."

Mahn, then 19, stabbed to death his father's live-in girlfriend, Debbie Jean Shanko, 36, and her 14-year-old son, Anthony Dion Shanko, on April 1, 1993, at their Bonway Drive home in Northeast Pensacola.

Bell originally sentenced Mahn to death for each of the murders. However, the Florida Supreme Court in 1998 commuted his sentence to life in prison in the mother's death and ordered a new sentencing hearing in the teen's death.

The court ruled that Bell incorrectly determined the mother's death was premeditated and also failed to consider Mahn's drug and alcohol abuse and his immaturity as mitigating factors. Mahn told police he'd taken LSD and cocaine before the killings.

Mahn remained in prison until 2001 when, as preparations began for his new sentencing hearing, he was found incompetent and ordered into the Florida State Hospital in Chattahoochee. Last April, he was moved to a mental health facility in Gainesville.

On Wednesday, doctors who have monitored Mahn offered varying testimony on whether his erratic behavior is merely for show.

Dr. Yolanda Hernandez, a forensic psychiatrist, observed Mahn during the defendant's four-month stay in Gainesville.

Hernandez said Mahn repeatedly attacked staff members and other patients and stalked a female employee at the facility. But the doctor said Mahn understood the rules and consequences of his inappropriate behavior and often manipulated staff members to get what he wanted.

"When he wanted to be clearly understood, when he wanted to cooperate, he could," Hernandez said.

Dr. Harry Krop, a Gainesville psychologist, said Mahn sometimes exaggerates the symptoms of his illness, but several tests have proven his behavior is not simply a put-on.

"I think he needs to go to the state hospital," Krop testified. "I don't think there is any other option. To make him competent, they would need to treat his mental illness."

Krop and Mahn's attorney, Donald Sheehan, said that as early as 2005, while under the care of doctors in Chattahoochee, Mahn was slowly becoming more cooperative and his comprehension was improving.

"He was more rational than I have ever seen him," Crop said.

After Mahn was moved from Chattahoochee to Gainesville, he refused his psychotropic medication, Krop said. The lack of medication essentially undid Mahn's progress at the Chattahoochee facility, the doctor said.

Sheehan, who has represented Mahn for eight years, said the State Attorney's Office could save a lot of time and effort by not pursuing the death penalty, instead agreeing for Mahn to serve two consecutive life sentences for the murders.

Assistant State Attorney John Molchan said the decision has been made to continue pursuing the death penalty.

"We look at the aggravating factors in his situation; the heinous, atrocious and cruel nature in which these murders were carried out," Molchan said.

Wednesday's four-hour hearing was highlighted by several outbursts from Mahn, who was under the close watch of three court security officers.

During Mahn's 1994 trial, court security officers placed a stun-belt on Mahn to be used during outbursts. Bell said Mahn would stand up and yell during that trial, write notes on legal pads to members of the audience and once tried to stick his finger in an electrical socket.

During the hearing Wednesday, Mahn asked if he would have the chance to testify.

"I told you this 14 years ago," Bell said. "You need to sit there and behave yourself. Your trial was quite a challenge. You are not going to stay here and be disruptive. You're not going to control this environment. This is my environment to control."

Bell then threatened to removed Mahn from the courtroom for the remainder of the proceedings. He did not do so. Read more!

Lawmakers told mental health cuts will mean loss of services - Douglas Co. (NV) Appeal

by Geoff Dornan
November 28, 2007

The legislative committee studying health issues was told Tuesday any cuts the governor orders in mental health budgets will result in reduced services.

"Everything we do is services," said Dr. Stuart Ghertner, head of Southern Nevada Adult Mental Health Services. "We are a services agency so there is no way if we cut that we don't cut services."

Carlos Brandenburg, director of Mental Health and Disabled Services, said he and his staff are looking at how they can reduce the impact of any cuts, but that there will be impacts to services.

In response to a question from committee Chairwoman Sheila Leslie, D-Reno, he said unlike the Department of Corrections, his secure facility for mentally ill offenders, Lakes Crossing, is not exempted from proposed budget cuts.

Leslie questioned how the governor could not exempt Lakes Crossing in Sparks, saying those patients are there under court orders as prisoners just like prison inmates.

"The answer is a bit higher up the food chain than me," said Brandenburg.

"It sure looks like the most vulnerable are going to suffer," she said.

The issues were raised during a discussion of the 22-bed addition to acute-care adult psychiatric beds in Southern Nevada. Those beds are scheduled to become available Jan. 1, but Brandenburg said that depends on whether the money to staff the center is cut to help reduce mental health budgets.

The beds will be immediately needed because the existing 25 beds at Westcare will lose their certification as acute-care psychiatric beds with the end of the year.

"Being an eternal optimist, I'm hoping the 22 beds will not be cut," he said.

Sen. Joe Heck, R-Las Vegas, himself a physician, said those beds are even more critical since the 2007 Legislature passed a law mandating that emergency room patients be seen in 30 minutes or less. He said that law was based in part on the ability of added beds to reduce the number of mental patients coming to emergency rooms.

Sen. Maurice Washington, R-Sparks, suggested the committee send Gov. Jim Gibbons a letter telling him how critical those beds are.

Leslie and Sen. Steven Horsford, D-Las Vegas, said they need to also tell the governor how important it is to not cut mental health budgets, which have only gotten badly needed increases from the past two or three legislative sessions.

"We can't be going backwards," Horsford said, adding that reducing mental health services puts the burden of balancing the budget on some of Nevada's most vulnerable citizens.

Gibbons has asked agencies to prepare recommendations for cuts as deep as 8 percent because of lagging sales tax revenues. Director of Administration Andrew Clinger said unless things turn around by year's end, the state will need to cut $285 million from the two-year budget approved in June.

But Gibbons has not yet announced where he plans to make budget cuts.
Read more!

Court upholds death sentence for student's killer -Associated Pess

Wednesday November 28, 2007

The Indiana Supreme Court upheld the death sentence for a mentally ill man convicted in the 1997 abduction, rape and slaying of a Franklin College student - but not without reservations.

Attorneys for Michael Dean Overstreet had argued that his severe mental illness at the time he was convicted of killing Kelly Eckart would make his execution cruel and unusual punishment under the state Constitution.

Justice Robert Rucker, who wrote the opinion issued Tuesday, agreed.

Rucker said that the 41-year-old Overstreet's mental illness impeded his thought processes to a point comparable with mental retardation. The U.S. Supreme Court has ruled that mentally retarded people are ineligible for the death penalty, and Rucker wrote that he believed Indiana's Constitution offered even greater protection.

"Because I see no principled distinction between the diminished capacities exhibited by Overstreet and the diminished capacities that exempt the mentally retarded from execution, I would declare that executing Overstreet constitutes purposeless and needless imposition of pain and suffering thereby violating the Cruel and Unusual Punishment provision of the Indiana Constitution," Rucker wrote in the 46-page opinion.

"Therefore, I would remand this cause to the post-conviction court with instructions to impose a sentence of life imprisonment without parole."

However, the other four justices disagreed with Rucker's reasoning and held that Overstreet was eligible for the death penalty.

All five justices agreed to uphold Johnson Superior Court's handling of Overstreet's case, dismissing other arguments including that Overstreet had had ineffective counsel.

No evidence of Overstreet's mental illness was presented during his trial, though he had been diagnosed. The defense instead tried to prove that someone else had killed Eckart.

The Associated Press left phone messages seeking comment Tuesday from the state public defender's office and the state attorney general's office, which handled the appeal.

Overstreet was convicted in 2000 of criminal confinement, rape, murder and felony murder in the death of Eckart.

Eckart, an 18-year-old Franklin College freshman from Boggstown, was abducted and murdered Sept. 26, 1997, as she was coming home from work in Franklin. Her body was discovered south of Morgantown just across the Morgan-Brown county line.

The case led to passage of a state law that allows murder victims' relatives to read statements in court after a judge has announced the sentence.


Read more!

Study: Utah most depressed state in the country -Deseret Morning News

By James Thalman
November 28, 2007

Utah is the most depressed state in the country, according to a nationwide study.

The first-of-its kind examination of "level" of depression and actual outcomes for those seeking help for it ranks Utah 51st on a list of 51. South Dakota has the "best depression status" in the country.

The study was conducted by Mental Health America, formerly known as the National Mental Health Association. It is the country's largest nonprofit mental health advocacy group and has 320 affiliates nationwide. The research was underwritten by a grant from Wyeth Pharmaceuticals, one of the largest drug manufacturing companies in the world. The company manufactures the over-the-counter drugs Robitussin and Advil as well as the prescription drugs Premarin and Effexor.

A spokesman for Mental Health America said the study isn't to point fingers at any state in particular but to highlight the country's major need for mental health resources, preventative treatment and federal legislation that would make mental health services as important as other medical insurance-based coverage.

The full "Ranking America's Mental Health: An Analysis of Depression Across the States" will be available at www.mentalhealthamerica.net after 7:30 a.m. Thursday.

E-mail: jthalman@desnews.com Read more!

Ranking the states on depression -Mental Health America

For state by state ranking, click here.

Heather Cobb, Mental Health America,(703) 797-2588
November 28, 2007

Alexandria, VA (November 28, 2007) - Mental Health America today released its report, "Ranking America's Mental Health: An Analysis of Depression Across the States," a first-of-its-kind study examining state and national data for statistical associations between access-to-care factors and actual health outcomes, namely a state's mental health status and suicide rate.

Included in the study is a ranking of the 50 states and the District of Columbia based on rates of depression and suicide. South Dakota is found to lead the nation with the best depression status while Utah ranked last. For the complete rankings, visit www.mentalhealthamerica.net/go/state-ranking.

"It is important to note that regardless of where each state ranks on our mehttp://www.blogger.com/img/gl.link.gifntal health scale, there is much room for improvement," said Dr. David Shern, PhD, president and CEO of Mental Health America. "While a number of factors including biology and environment impact an individual's mental health, this study shows that states can significantly improve their populations' mental health status by adopting policies that expand access to mental health treatments."

In "Ranking America's Mental Health," Mental Health America found statistically-significant associations between the following factors and better depression status and lower suicide rates:

* Mental health resources - On average, the higher the number of psychiatrists, psychologists and social workers per capita in a state, the lower the suicide rate.
* Barriers to treatment - The lower the percentage of the population reporting that they could not obtain healthcare because of costs, the lower the suicide rate and the better the state's depression status. In addition, the lower the percentage of the population that reported unmet mental healthcare needs, the better the state's depression status.
* Mental health treatment utilization - The higher the percentage of the population receiving mental health treatment, the lower the suicide rate.
* Socioeconomic characteristics - The more educated the population and the greater the percentage with health insurance, the lower the suicide rate. The more educated the population, the better the state's depression status.

In addition, the report found the following factor to be significantly associated with the level of mental health service utilization in a state:

* Health Insurance parity - The more generous a state's mental health parity coverage, the greater the number of people in the population that receive mental health services.

"The findings of this study underscore the critical need to monitor the mental health status of Americans by examining depression and the states' policies that may impact it," said Shern. "Through regular and ongoing measurement of key indicators of depression, we will be able to understand how state public policies impact a population's depression level and suicide rate - and make adjustments to benefit the millions of American affected by depression."

In developing the state rankings of depression status, Mental Health America examined four measures: 1) the percentage of the adult population experiencing at least one major depressive episode in the past year, 2) the percentage of the adolescent population experiencing at least one major depressive episode in the past year, 3) the percentage of adults experiencing serious psychological distress, and 4) the average number of days in the last 30 days in which the population reported that their mental health was not good.

This report found significant variation among the states in the levels of depression and in its most tragic consequence: suicide. Rates of depression among the states vary from around seven percent in the least depressed states to over 10 percent in states where residents reported the highest levels of depression. This difference represents a nearly 40 percent variation from the least to the most depressed states.

To achieve top ranking in the country, South Dakota yielded the best results for the four measures used to develop a composite depression status indicator. Among adults, 7.31 percent experienced a major depressive episode in the past year and 11.6 percent experienced serious psychological distress. Among adolescents, 7.4 percent had a major depressive episode in the past year. On average, South Dakotans reported 2.41 poor mental health days per month. Even though South Dakota ranked well in overall depression status, it is also important to note that the state had an age-adjusted suicide rate of 14.85, ranking South Dakota 40th in the nation, which is 300% higher than the District of Columbia, which has the lowest suicide rate.

Utah ranked 51st in depression status. For both adults and adolescents, 10.14 percent reported experiencing a major depressive episode in the past year. Among adults, 14.58 percent experienced serious psychological distress. On average, residents of Utah reported 3.27 poor mental health days per month.

"Despite the fact that some states do better than others on rates of depression and suicide, no state can be satisfied with its current status," continued Shern. "These rates can be driven lower by encouraging state policies designed to improve coverage, end discriminatory practices in insurance, and assure that qualified mental health professionals are available to serve everyone in need."

The top ten "least depressed" states are: 1) South Dakota, 2) Hawaii, 3) New Jersey, 4) Iowa, 5) Maryland, 6) Minnesota, 7) Louisiana, 8) Illinois, 9) North Dakota, and 10) Texas. The bottom ten "most depressed" states are: 42) Wyoming, 43) Ohio, 44) Missouri, 45) Idaho, 46) Oklahoma, 47) Nevada, 48) Rhode Island, 49) Kentucky, 50) West Virginia, and 51) Utah.

# # #

Mental Health America (formerly known as the National Mental Health Association) is the country's leading nonprofit dedicated to helping all people live mentally healthier lives. With our more than 320 affiliates nationwide, we represent a growing movement of Americans who promote mental wellness for the health and well-being of the nation.

"Ranking America's Mental Health: An Analysis of Depression Across the States" was supported through an unrestricted educational grant from Wyeth Pharmaceuticals.

For the full report and ranking of the 50 states, please visit www.mentalhealthamerica.net/go/state-ranking.

Read more!

Model could be free in 19 months -Chicago Sun Times

November 27, 2007
BY ERIC HERMAN

Prosecutors tried to put Jeanette Sliwinski away for life. But the former model -- after being convicted of killing three men during a botched suicide attempt -- will walk out of prison in a year and a half.

Sliwinski, 25, was found guilty last month of killing three musicians when she rammed her car into theirs at a Skokie intersection on July 14, 2005. Prosecutors charged her with first-degree murder. But on Oct. 26, Judge Garritt Howard found her guilty of reckless homicide, a lesser charge.
» Click to enlarge image
Jeanette Sliwinski was sentenced to eight years in prison Monday.
(Courtesy)

In a Skokie courtroom Monday, Howard sentenced Sliwinski to eight years, out of a maximum possible sentence of 10 years. The law requires Sliwinski to serve only half her sentence. And with credit for the two years and four months she has been in Cook County Jail, she will be due for release in 19 months.

"It's just kind of ridiculous. Someone's going to walk away free after possibly two years -- a year and a half, two years -- in return for three innocent lives. Is that justice?" said Scott Meis, 27, the younger brother of victim Douglas Meis.

"We're all very distraught," said Rebecca Crawford, the widow of victim John Glick, as she left the courthouse after the sentencing.

Prosecutors had argued Sliwinski was eligible for a 20-year sentence -- a contention Howard rejected. Assistant State's Attorney Michele Gemskie then asked for the 10-year maximum, saying Sliwinski had endangered the public by driving 87 mph along Dempster Street in an effort to kill herself.

But defense lawyer Tom Breen painted Sliwinski as a kind woman who suffered from a mental illness that was misdiagnosed.

"Had she been properly treated by people who cared about her and people who knew what they were dealing with, this event would never, ever have occurred," Breen said.

Sliwinski wept during emotional testimony from family members of Glick, 35, and Meis, 29. A friend and former bandmate of Michael Dahlquist, 39, also testified.

"I am deeply saddened, disillusioned and angered that a human being who clearly was cognizant of her actions when she killed three innocent people could conceivably get out of prison at a younger age than the ages of the three people whose lives she stole," said Crawford, Glick's widow.

Before Howard sentenced her, Sliwinski stood and read a statement, sobbing as she struggled to finish.

"There is not a day that goes by that I do not think about the grief and pain that I've caused . . . I take full responsibility for my actions and the terrible loss that I have caused."

The statement did little to assuage the grief and anger of the victims' families. "It felt really insincere. It felt really fake," Scott Meis said afterward.

Howard found Sliwinski guilty but mentally ill, meaning she will receive psychiatric treatment while in state prison. Read more!

A New Mindset for Prison Operator -St. Petersburg (FL) Trend

For original story with additional information, click here.

By Amy Keller

In the late 1950s, the state opened the South Florida State Hospital in Pembroke Pines as a treatment facility for people suffering from severe and persistent mental illnesses such as schizophrenia and major depression. But by the late 1980s, the hospital had become little more than a human warehouse where the mentally ill wandered about naked and shared toothbrushes from a communal bucket. When passers-by complained of seeing nude patients from the street, state workers responded by painting the hospital’s windows black. Patients sat idle; therapy was almost non-existent.

A class-action lawsuit in 1988 produced some improvements, but a decade later the hospital was still dysfunctional. Patients often wandered off the grounds, and the hospital lacked good treatment programs. Ineffective treatment meant few patients could be discharged. With few beds opening up, incoming patients faced a yearlong wait to be admitted.

Fed up, the state Legislature and then-Gov. Lawton Chiles decided in 1997 to privatize the facility. At the time, Wackenhut Corrections, a south Florida-based company that operated 21 correctional facilities, including two prisons in the state, was looking for new opportunities from privatization of government services. After learning of the state’s desire to privatize the south Florida hospital, Wackenhut purchased an 87-bed, private psychiatric hospital in Fort Lauderdale for $6 million and spun off a company, Atlantic Shores Healthcare, to provide mental health services.

In November 1998, Atlantic Shores was awarded the contract to take over the state hospital, which became the first state mental hospital in the nation to be turned over completely to a private company.

The results? While the state isn’t achieving big savings [“Cost of Care,” below], privatization has improved services to some of its sickest, most vulnerable citizens at a facility once considered unmanageable. The company, meanwhile, now doing business as GEO Care, has been able to leverage its success at the south Florida hospital into additional contracts in Florida and New Mexico — and possible contracts in other states like Nevada, Georgia and Utah that are considering privatizing the operation of mental health facilities.

An analysis by the Department of Children and Families revealed little difference between the cost of private and state-run forensic facilities, which are for the treatment of people in the criminal justice system who are mentally ill. Most have been adjudicated incompetent to proceed or found not guilty by reason of insanity. The costs ranged from about $330 to $360 per bed day ($120,000 to $130,000 per bed year). The cost breakdown: 85% salaries and benefits, 5% prescribed medicines and 10% other costs, such as food and other expenses.

Those who look to South Florida State Hospital for a model in how privatized mental health services can work, however, should pay close attention to a key factor: Both the company and the state credit the improvement in the hospital’s operations in some part to an accountability plan that spelled out goals and desired outcomes clearly and established ways to monitor performance carefully as the contract proceeded.

At the south Florida hospital, the transition from state control wasn’t smooth. The hospital’s unionized staff reacted angrily to the takeover, and Atlantic Shores encountered picket lines, protests, thefts and vandalism as it replaced state workers with its own. Even some newly hired employees had their doubts: “I went into it being fairly skeptical, as I had been a state employee for seven years and believed the general myth that privatization meant generally ‘take the money and run,’ ” recalls Kevin Huckshorn, whom Atlantic Shores hired as the assistant administrator of the hospital’s clinical programs.

But as Atlantic Shores whacked away at inefficiencies, the hospital’s operations began to improve. The state employed four people to procure supplies and equipment. Atlantic found it could get by with one. Also on the payroll were more than a dozen psychologists who spent most of their time conducting psychiatric assessments of patients — a somewhat pointless task since the hospital never established programs to address the disorders it documented.

In all, the company cut about 200 jobs from the hospital’s 700-employee staff, including many of the psychologists. Some of the savings went for higher salaries to hire top talent in the mental health field and to create treatment plans oriented toward preparing patients for lives outside the hospital. Atlantic Shores implemented programs to engage patients in art, music and other therapies and skill-building courses. Instead of sitting in their hospital units, some 90% of the hospital’s patients today participate in programs in the Town Center, a building in the center of the hospital campus.

While the average stay at South Florida State Hospital was 8½ years when Atlantic Shores took over, today the average stay is less than a year. Readmissions to the hospital have dropped to around 2% annually. The company bases its approach to treatment on the concepts of William A. Anthony, a Boston University professor and one of the founders of the modern movement in psychiatric rehabilitation.

In 2000, Atlantic Shores issued tax-exempt bonds to replace the old hospital facility with a new building that helped it streamline operations further and improve security. Instances of patients walking away from the facility fell from 30 or 40 per year to two or three. Atlantic Shores also assigned employees to track patients after their release and coordinate further care with local community mental health centers.

“The project worked better than any of us could have ever dreamed,” says Huckshorn. Other observers, including Gayle Bluebird, a registered nurse and independent consultant on patient rights issues who served as a resident advocate at the state hospital during the transition, validate Huckshorn’s view: “I think the privatization has allowed for more creativity, a more focused approach to treatment.”

Steppingstone

The company, of course, wasn’t in business out of the goodness of its heart. Even as it negotiated the South Florida State Hospital contract, it was looking ahead to future business. “We kind of recognized this new business line as very similar in many respects to the corrections business line, in that they were all large state-run facilities, many of which were not running all that well,” says Dale Frick, who oversaw the project’s development. Frick is vice president of project development and client relations for GEO Care, the company descendant of Atlantic Shores. “Of course, we saw a large national market availability of these types of facilities and projects.”

And in fact, the south Florida project has provided a huge springboard for Atlantic’s parent company, which changed its name to GEO Group in 2003 and renamed Atlantic Shores Healthcare as GEO Care in 2005. The original South Florida State Hospital contract of $30.8 million has grown to $35.7 million. And GEO now has several other contracts to run new mental care facilities in Florida, including a $2.7-million-a-year contract to provide mental health services at Palm Beach County jails.

Earlier this year, GEO opened two facilities to help the state deal with a 300-person backlog of mentally incompetent inmates awaiting placement to treatment facilities from county jails. Together, the contracts to operate the two facilities — the 100-bed South Florida Evaluation and Treatment Center Annex in Miami and the 175-bed Treasure Coast Forensic Treatment Center in Indiantown — are worth $34 million.

GEO’s track record in Florida has other states taking notice. At the south Florida hospital, the company regularly hosts visitors from other states curious about the privatization model. Many of the several hundred state mental health facilities around the country don’t reach minimum constitutional standards for care, Frick says. “If the states can’t do it and can’t bring it up to the necessary levels, they might look to a company like ours to come in and do it for them or help them do it. It’s just a nice market.”

But if GEO’s performance at South Florida State Hospital was motivated in part by a desire to create a showcase to attract future business, the results also reflect the provisions of a tough contract insisted on by state negotiators, most particularly Ed Feaver, secretary of the Department of Children and Families when the state negotiated the contract with Atlantic Shores in 1998.

“I’ll have to give Feaver a lot of credit. Those negotiations were fairly drawn out,” says Bill Marvin, former executive director of the Florida Statewide Advocacy Council, an independent group that protects the constitutional and human rights of people receiving services from state agencies. The state agreed to evaluate Atlantic Shores’ performance based on outcomes and effectiveness rather than on how many workers it employed per patient, but it insisted on a strict set of measurements, standards and goals that Marvin says made a big difference.

Built into the contract, for example, was a provision that Atlantic Shores would be fined if the hospital did not receive accreditation from the Joint Commission on Accreditation of Healthcare Organizations, which the hospital had never been able to attain, within one year. Under Atlantic Shores, the hospital earned its accreditation within 10 months. Another part of the contract involved assigning a member of Marvin’s group, Phil Ketchum, to monitor the facility. Ketchum made sure patients were discharged properly. If patients were discharged prematurely, he’d intervene.

“For the next two or more years, he monitored weekly, if not multiple times a week and became an integral part of making the administration aware of everything that was wrong and making sure they corrected the problems,” recalls Marvin. The council also established a local advocacy committee in the county assigned strictly to South Florida State Hospital. The committee reviewed abuse reports and patient complaints and established a “very strong working relationship” with Atlantic Shores.

The oversight, says Huckshorn, was “kind of uncomfortable for us, but in retrospect, smart.” The state also froze the hospital’s budget for the first four years before it began granting 3% cost-of-living increases. And it mandated clearly defined guidelines and expectations for admissions and discharges of patients.

Prison problems

By contrast, GEO Group’s prison operations haven’t been models of good performance — particularly in states where government monitoring has been poor. In October, the Texas Youth Commission abruptly canceled its $8-million annual contract with the GEO Group after Texas Youth Commission inspectors found fetid conditions, including feces-smeared cells and insect infestations throughout the Coke County Juvenile Justice Center. The commission subsequently fired four state-paid monitors, whom a newspaper investigation revealed had previously worked for GEO.

Similar problems have been reported at other GEO-run correctional facilities in Texas, including the Dickens County facility in Spur. And youth prisons that GEO Group ran in Louisiana and Michigan were closed in 2000 and 2005, respectively, amid allegations of abuse and neglect. And at a recent congressional hearing, the GEO Group came under fire for not offering substantive drug treatment and vocational training programs for the federal prisoners it houses at the Rivers Correctional Institution in Winton, N.C.

While GEO’s operation of three Florida prisons hasn’t been an issue, a state inspector general’s report concluded in 2005 that GEO Group and another private prison operator had received $6.7 million in alleged overpayments from the state for vacant jobs and other questionable expenses. The audit report attributed the overpayments to the failure of the now-defunct Correctional Private Commission to properly enforce contract provisions. GEO, which was absolved of criminal wrongdoing, eventually reached a $290,952 settlement with the state and the Department of Management Services, which now oversees the state’s private correctional facilities.
Treating sexual predators

GEO Care’s sternest test in the mental health services market lies ahead: Along with the contracts in south Florida, the company has a $18.9-million contract to take over operation of the Florida Civil Commitment Center, a former prison in Arcadia now used as a treatment facility for offenders designated “sexually violent predators” under the state’s Jimmy Ryce Act. That 1998 law allows the state to hold those who have been convicted of a sexually violent offense and who are considered likely to re-offend at a secure facility for long-term control, care and treatment.

The state DCF, which had hired Pennsylvania-based Liberty Behavioral Healthcare Corp., to run the facility, didn’t renew that company’s contract after the Miami Herald published a report last year depicting chaos and mismanagement inside the 14-acre compound, including violence, drug abuse and alleged sex among both inmates and staff.

Aside from cleaning up operations at the center, GEO faces the task of determining what kind of programs can be used to treat sexual predators — it’s unclear whether such offenders can in fact be rehabilitated. The company has assembled a consulting team that includes several board members of the Association for the Treatment of Sexual Abusers. GEO has broken ground on a facility that will increase the center’s capacity from 600 to 720 and should be finished by spring 2009.

With 17 states now operating post-incarceration civil commitment programs for sex offenders, there’s market potential for GEO if it can turn around the Florida Civil Commitment Center. “We want to become a national model because it is evolving, and other states don’t know exactly what they’re doing with this population either,” says Frick.

Promising potential

Frick says the company is targeting about two to three new contracts a year in the mental health services area. To expand any faster would be “dangerous,” he says.

But the arithmetic of mental health services means mental health will likely remain a focus for GEO. “The typical correctional bed generates only $20,000 to $25,000 per year as compared to the GEO Care bed, which generates in excess of $100,000 per year per bed,” GEO Group Chairman and CEO George Zoley recently told investors.

Because mental health facilities are more expensive to run, Frick says the margins for correctional services and mental health services are about the same. When asked whether the company had turned a profit at the south Florida hospital from the outset, Frick demurred, saying only that “none of the projects have ever been a loss leader.”

Meanwhile, GEO Care revenue has risen from $33 million in 2005 to $127 million in 2007 and is expected to hit $180 million next year. “It’s just a different market. It’s not that it’s more lucrative,” says Frick. “It’s just that it’s new, it’s available and it’s large.”

Bed Costs in Florida
(fiscal year 2006-07)
Facility
Beds

Read more!

Diagnosing the counseling center -University of Miami (FL) Hurricane

Center's director touts the positive, some students disagree

By: Karyn Meshbane // News Editor

Anorexia. Depression. Thoughts of suicide. Coping with rape, confusion and stress.

Students visit the counseling center for many reasons, each looking to talk to someone.

The University of Miami's counseling center, which opened in 1946, has developed programs, such as Sexual Assault Response Team and Body Acceptance Resources & Education, to assist and monitor students.

Although the center has opened its doors to 449 students this semester, not all have received the help they were expecting.

WATCHING STUDENT BEHAVIOR

After it became public that Virginia Tech student Seung-Hui Cho had been diagnosed with severe anxiety disorder before going on a shooting rampage, several universities looked into training faculty and administrators to monitor student behavior.

Although UM faculty members do not go through any formal training, Counseling Center Director Pamela Deroian, a licensed psychologist with a doctorate, said she encourages faculty members to notify her of "irregular student behavior."

"Faculty have a different vantage point of what goes on with students," said Deroian, who has been with the counseling center for 17 years and became director in June. "We've focused a lot on the English Department, specifically creative writing, and I've gotten calls from professors about several things to look into."

Deroian noted that the counseling center has focused on other areas as well, including the law school.

While Deroian plans these programs and activities for groups of students through the counseling center, five other administrators on campus are involved with weekly assessments of individual students who may be at risk to themselves or others.

The Student Assessment Committee comprises Deroian, Dean of Students Ricardo Hall, Health Center Director Dr. Howard Anapol, University Ombudsperson Mariana Valdes-Fauli, Case Manager Nicole Abramson and Assistant General Counsel Judd Goldberg. Goldberg does not sit in on the meetings, Hall said, but he is aware of what is discussed because his role is to ensure that the committee is following the Health Insurance Portability and Accountability Act.

Although students are guaranteed privacy when they go to the counseling center, Hall noted there are exceptions to the Family Educational Rights and Privacy Act, a federal law that protects the privacy of students' education records.

"The only way [the case manager and I] see files is if something has happened that places the student at risk," Hall said, which refers to a section of FERPA about inspection of education records. "There are specific exceptions to FERPA that provide means for communication to allow other people to know if a student may be at harm."

Students who visit the counseling center are required to consent in writing. Deroian said this is similar to any consent form signed at a regular practitioner's office. Deroian said The Miami Hurricane was not allowed to see a copy, citing privacy issues.

Hall said most students know they are being discussed by the committee unless a case is called under review immediately such as within 24 hours of an incident.

Deroian said that the committee met for years prior to the Virginia Tech massacre, and the center has made no significant changes since then because the university "determined we were already doing a good job," Deroian said.

Still, Deroian is in the process of writing policy guidelines for the Counseling Center because there currently are none. Some other universities, such as Tulane and Emory, use the Diagnostic and Statistical Manual of Mental Disorders as guidelines.

The good, bad and ugly

The university's counseling center will be reviewed in February by an external group comprising counseling center directors from different parts of the country.

"I want to know the good, the bad and the ugly," Deroian said.

Some students say there is some of all three, but Deroian cannot comment on any specific student cases because of the Health Insurance Portability and Accountability Act. Also, The Hurricane cannot gauge whether the following are isolated cases because these are only instances from four students out of hundreds who attend the counseling center yearly.

"I went to the counseling center last fall because I had some legal trouble, and some girlfriend trouble, and I was overwhelmed," said a junior in the School of Communication, who asked not to be named because of the personal nature of his situation. "I was considering suicide, I was depressed and I was in tears when I went to the counseling center. They helped me immensely, and I can't even describe where I would be right now if I hadn't gone in there."

Other students, 25 last year, have been committed to a hospital as a result of their situations. Such removals are done in accordance with the Baker Act, a Florida statute that allows for involuntary examination, and can be initiated by a mental health professional.

Although the Baker Act is unique to Florida, each state has its own mental health laws that call for involuntary commitment under specific circumstances.

One student, a junior who lives off-campus, said he was committed to Mercy Hospital for one night his freshman year in spring 2006. The student said he was no risk to himself and recalls saying he loved life while at the counseling center, but he thinks his disheveled appearance was the reason he was sent to the hospital.

The student, who asked that his name be withheld because he fears disciplinary recourse by the university, said he went to the Counseling Center because he was feeling "depersonalized" and was having conflicts with his religion and spirituality. After a couple hours at the counseling center, he said he was escorted to an ambulance by police officers and taken to the hospital. There he received multiple examinations, including a blood test and a CAT scan, which had to be paid for by his parents.

"He sought help by professionals, but they didn't help," said his mother, who went to the hospital that night to see her son. "Instead it cost us thousands of dollars, aggravation and maybe even humiliation for [student's name]. I wish I hadn't been reminded of this horrible incident. There was a huge lack of human warmth."

Patricia A. Whitely, vice president for Student Affairs, said the university errs on the side of caution when using the Baker Act, especially after Virginia Tech.

"If my staff determines a student needs to be Baker Acted then that's the decision they will make," Whitely said, referring to using the Baker Act in general, not the student mentioned above.

Hall said fewer than five students have been withdrawn from the university by the committee this year.

"We've had severe depression, psychotic episodes in classrooms and other potential crises, but it's not a great number," he said.

Hall noted that students are often referred to a counseling center off-campus if their treatment requires long-term care.

"The counseling center, like most university counseling centers, isn't set up for long-term care, but rather short-term crisis," he said. "It's not staffed or equipped to do [long-term]. The university recognizes the services it can provide, as well as our limitations."

Senior Ben Brislawn, who was referred for off-campus counseling this year, said he was pleased with the counseling center, but thinks he shouldn't have to pay for alternate therapy.

"I was a little surprised because I think that it should be a place that people can go to talk to somebody whether they have depression, anxiety or any mental issues," Brislawn said. "I think you should be given access to services on campus if you seek them."

Still, Deroian said students are never forced or penalized if they do not adhere to the counseling center's recommendation to continue therapy off campus. She also noted that students are never turned away from the counseling center.

In contrast, one student, a rape victim, said that she was told to seek guidance off-campus during her second visit to the counseling center, or else her admission would be revoked.

"I felt like I was being victimized a second time," said the student, a junior who had to pay about $2,000 for off-campus counseling. "Because our insurance would have to pay for treatment, I had to tell my parents, which I never would have done otherwise."

As a matter of policy, The Miami Hurricane does not name rape victims.

Although university officials cannot comment on any specific student cases because of the Health Insurance Portability and Accountability Act, Hall said he is aware that some students will walk away from the counseling center unhappy.

"I know that sometimes we look like the bad guys," Hall said. "But everything we do is in the best interest of the student."

Karyn Meshbane may be contacted at k.meshbane@umiami.edu.

Counseling Center facts

Founded in 1946

Office Hours: 8:30 a.m. to 5:30 p.m.

Located in building 21-R in the apartment area

Pamela Derorian, the center's director since June although she had been with the counseling center for 17 years, is the fourth director since the center's creation. The previous director was Malcolm Kahn, who led the center for 16 years

The center has four licensed psychologists, one counselor who has a doctorate and is getting her license next year, one social worker, one post-doctorate counselor, three interns who are in their last year of a doctoral program in psychology and three practicum students

Counseling Center Facts

Though the counseling center has been on campus since 1946, it has not been accredited since the 1980s. Currently, the counseling center's training program is certified by the American Psychological Association, and the university is seeking accreditation by the International Association of Counseling Services.

According to the Journal of Counseling and Development, six of UM's nine sister schools were accredited in 2003. Also, the University of Florida, the University of North Florida, Florida International University, Florida A&M, Florida State University and the University of South Florida are all accredited.

"I'm surprised UM is not accredited," said Chun-Chung Choi, the Outreach Coordinator for UF's counseling center. "I thought they were very well established."

According to the IACS 2006 National Survey of Counseling Center Directors:

41.7 percent of centers are supported by mandatory fees. 22.6 percent comes from student health fees, 16.6 percent from a student life fee, and only 2.5 percent of these fees are specifically identified as a counseling center fee.

On average, counseling centers saw 9 percent of enrolled students last year.

58 percent of schools offer psychiatric services on campus, and provide 22 psychiatric consultation hours per week on average.

Directors report that 40 percent of their clients have severe psychological problems, 8 percent have impairment so serious that they cannot remain in school, or can only do so with extensive psychological/psychiatric help, while 32 percent experience severe problems but can be treated successfully with available treatment modalities.

2,368 students were hospitalized for psychological reasons.

51 percent of centers participated in depression screening days. 10,430 students were screened and 2,735 were referred for counseling.

16.6 percent of centers participated in Anxiety Screening Days. 3,280 students were screened and 617 were referred for treatment.

6.8 percent of directors report that their administrative responsibilities often interfere with their counseling effectiveness

28 states share mental health records with the FBI: Alabama, Arkansas, Arizona, California, Colorado, Connecticut, Florida, Georgia, Illinois, Iowa, Kansas, Kentucky, Maryland, Michigan, Missouri, North Carolina, New Hampshire, New York, Ohio, South Carolina, Tennessee, Texas, Utah, Vermont, Virginia, Washington, Wisconsin, Wyoming

- FBI data compiled from from stateline.org, citing FBI Read more!

Probe into clinic deaths reveals safety violations - Charlotte (NC) Observer

November 28, 2007

N.C. regulators probing the deaths of at least 13 patients in a Charlotte company's methadone clinics have fined the firm $27,000 for violations of safety-and-treatment rules.

A state report detailing the allegations specifically mentions the deaths of two people who received methadone at a Statesville clinic run by McLeod Addictive Disease Center, a nonprofit based in Charlotte.

The report says McLeod didn't follow precautions that might have prevented the deaths, and then failed to report the fatalities to a state agency as required.

The fines were among the heaviest of more than 200 imposed this year by the N.C. Division of Health Service, which oversees facilities ranging from methadone clinics to group homes for mentally ill children. Methadone clinics administer the drug to those recovering from addictions to heroin, and increasingly, to powerful painkillers.

McLeod President Eugene Hall on Wednesday called the accusations untrue, and accused investigators of being ill-informed about how his clinics work. He said none of McLeod's seven other clinics were fined even though they operate under the same rules and management as the Statesville office.

He said he will appeal. 'This is just terribly frustrating and angering to me.'

The fines stem from the state agency's investigation of at least 16 McLeod patient deaths in just over a year. Officials list two probable causes: methadone toxicity, and a lethal combination of methadone and other drugs.

State officials declined to comment Wednesday, saying they are wrapping up their inquiry and wouldn't speak about their findings until complete.

They have said they began the investigation because of recent federal advisories about the dangers of methadone.

They also have said they are checking for deaths in the 27 other methadone programs around the state, but it's unclear whether any of those face the intensive reviews given McLeod.

Regulators probed the Statesville clinic in October. Their report zeroes in on the October 2006 death of a 28-year-old man. He died of acute methadone and oxycodone toxicity, plus an abnormal build-up of fluid in the lungs caused by heart failure.

Oxycodone, sometimes marketed under the better-known name of OxyContin, is a powerful painkiller; methadone is sometimes used to wean people off oxycodone addictions.

An autopsy report also showed that the man had ingested benzodiazepines -- sedatives doctors warn methadone patients against taking. The mixture can send patients into a sleep so deep that they stop breathing and die.

Still, patients combine the drugs for the euphoric high they can't get from methadone.

According to the state report, the 28-year-old tested positive at least three times for the sedatives after he began treatment.

`I wanna go up'

The state report also accuses McLeod of improperly increasing the man's methadone dosage more quickly than a doctor recommended. The report quotes the man's sister as telling the state: 'They give you such high doses, it just puts them to sleep.'The dead man's father, who was also being treated at the clinic, told the state if a patient wanted a higher dosage, 'all you had to do was stand at the window and say, `I wanna go up.' They never asked you nothing.'

The clinic's medical director told investigators the man's death prompted policy changes at McLeod in April. The clinic began using a more immediate test for benzodiazepines. It allowed doctors to keep prospective patients out of the program until they gave up the sedatives.

Other changes included new limits on dosage increases and upgraded patient-education sheets warning about the dangers of mixing drugs.

But the state report said the changes weren't enacted in time to save a 53-year-old woman who died in April, nine days after starting treatment. The state report says her counselor's notes did not contain required documentation about the risks of methadone.

She had a history of depression, and was taking Prozac and fentanyl, a painkiller.

State rules required McLeod to report the deaths to the Division of Health Service Regulation within 72 hours.

Investigation criticized

Hall said regulators at the N.C. Division of Mental Health told him to send the reports to them. An official with that agency even praised the thoroughness of McLeod's reporting, he added.

When officials at mental health failed to send the reports on to their sister agency, they stacked up on one official's desk, he said. Some were even misplaced, he said, requiring McLeod to re-send copies.

He accused regulators of using criteria not normally applied to methadone clinics.

'If these standards were to apply,' he said, 'there's no (methadone) program in North Carolina that can operate.' Read more!

Mom let baby drown on formula -Associated Press

Woman with bipolar sentenced to prison for neglect

Nov. 28, 2007

Green Lake - A judge sentenced a woman to seven years in prison for neglect in the death of her infant, noting that the child drowned on her formula when left with a bottle propped in her mouth and held in place with ribbons and a robe belt tied to crib railings.

"She was at the total mercy of those who cared for her (and) she drowned drinking her bottle," Green Lake County Circuit Judge W.M. McMonigal said.

Christine L. Williams, 23, of Wautoma pleaded no contest in August to a charge of child neglect causing death, carrying up to 25 years in prison, and several unrelated forgery charges in a consolidated plea deal with the Green Lake and Waushara county courts.

Her 5-month-old child, Kora Kanneman, was found dead in her crib when Williams lived in Princeton in 2003.

At Wednesday's sentencing, the judge contrasted the child's treatment with the love he had witnessed when spending time with an infant grandchild in recent weeks.

Most mothers, he said, would cradle an infant in their arms as she was fed.

"They would gaze proudly at her face while she drank," he said. "When I talk about cradling a child and gazing at her with pride and joy, I am not speculating. I have experienced it, and I am not a mother."

The judge discounted the defense contention that Williams' background and childhood should be considered since she had an absent father, was abused and her mother died when she was 16. She also has bipolar disorder.

McMonigal told Williams those factors could not "rationalize, justify or excuse you from being a mother who would protect her baby. It is a rare mother who would ignore a child."

Since the death she had another child but gave up parental rights amid neglect allegations, and she had a third child in October now in foster care, prosecutors said.
Read more!

'An American tragedy' -Newark (NJ) Star-Ledger

Haven of hope for strung-out vets

November 27, 2007
BY NYIER ABDOU

Victor Hardman didn't recognize the signs -- the sleepless nights, the aversion to large crowds, the alienating sense of being changed.

Like many young soldiers returning from a difficult tour in Iraq, Hardman, 24, of Newark, who served with the 1st Infantry Divi sion, was too busy enjoying being home to think he could suffer from post-traumatic stress disorder.

"I didn't see it. We were just partying," Hardman said yesterday. He returned from Iraq in 2005.

But the problems grew as Hardman's unit was readying to return to Iraq. There were nightmares and difficulties with his girlfriend. He started to isolate himself and cer tain triggers -- loud noises, thunder and lightning, the smell of barbecue -- would upset him. He never returned to Iraq.

"I was all messed up," Hardman recalled. "I wanted to give up on everything."

Yesterday, Hardman, dressed immaculately in a dark gray suit and a stylish but understated tie, addressed a room of veterans advo cates and supporters, lauding the Hope for Veterans Transitional Housing Program where he cur rently resides.

The program, launched in 2004 at the Lyons Veterans Administration Campus in Bernards Township, currently has 70 fully booked beds for homeless veterans and hopes to open its new wing, with 25 additional beds, in the coming weeks. Run by the Parsippany- based nonprofit Community Hope, the Lyons program is the largest transitional housing facility for homeless veterans in the state.

More than 6,500 veterans are believed to be homeless or living in temporary housing across New Jersey, according to a study released this month by the National Alliance to End Homelessness. Community Hope's executive director, J. Michael Armstrong, called it "truly an American tragedy."

"I'm a homeless vet and I'm trying to make it, but it's hard," said Hardman, now a student at Lin coln Tech. "There are a lot of guys still going through what I went through. ... There are people in Iraq who've seen 10 times worse than what I've seen."

Most residents at Hope for Veterans are referred from the VA's mental health unit or the drug rehabilitation program at the Domiciliary for Homeless Veterans, a more intense, short-term program on the Lyons campus. Hope for Veterans is seen as a step-up program where residents can stay for up to two years.

But veterans can wait from a couple weeks to a couple months to get into Hope for Veterans, mak ing the new wing a welcome addi tion. Some 35 people are currently on the waiting list, Armstrong said

"You try to look at the bright side," Armstrong said. "You're helping some people. Success breeds success."

Treatment at the Domiciliary and the stability and peer support of Hope for Veterans were what Army veteran Fred Ohweiler needed to finally kick an alcohol and drug problem that left him cut off from his family and living at a shelter in Newark.

"The Domiciliary saved my life," said Ohweiler, 51, of Morristown. Without Hope for Veterans, he added, "I'd be dead or on the street."

Today Ohweiler, one of Hope for Veterans' first "graduates," runs the Foxhole Cafe, a veteran-staffed cafe and catering business on the ground floor of the Hope for Veterans building -- a former psychiatric hospital that had been left vacant on the Lyons campus for years.

Recently trained in culinary arts, Ohweiler deftly plated dainty cakes at yesterday's celebration be fore ducking back to the cafe to ladle out chili and whip up a few sandwiches for his regulars.

He's had other offers, but for now, Ohweiler prefers to keep close and give back. "It's really a gift to be able to come to work and love what you're doing," he said.

"I am able to put my hand out to others coming through the rehab program," Ohweiler said. "If nothing else, they can say, 'If he can do it, so can I.'"

Nyier Abdou may be reached at nabdou@starledger.com or (908) 429-9925. Read more!

Mental health help for veterans - McClatchy-Tribune News Service

McClatchy-Tribune News Service

The wars in Iraq and Afghanistan, marked with the terror of suicide attacks and lethal roadside bombs, are triggering mental illness in returning veterans at much higher rates than in past wars. But some crippling emotional problems, such as depression and post-traumatic stress disorder, don't surface immediately. And recent studies have shown that initial mental health screenings fail to unveil such disorders.

So it's good - for veterans, their families and everyone else - that the Defense Department and the Department of Veterans Affairs now do two screenings of veterans returning from the Persian Gulf and the Hindu Kush. Veterans are first evaluated upon their return from active duty. Then, three to six months later, they are contacted and urged to be screened again. Veterans' groups have been calling for several years for better ways to uncover and treat mental illness, and they have welcomed this new policy. It shouldn't have taken so long to get it up and running.

The new practice was adopted after a study conducted at the Walter Reed Army Institute of Research and published this month in the Journal of the American Medical Association found that examining soldiers twice may help clinicians catch far more mental health problems.

The process helps identify those who need further treatment at VA hospitals. All VA hospitals, among them the highly regarded medical center in Northport, have geared up to deal with the outcome of the new policy.

The predictable result is that the number of veterans needing health care has risen sharply. Last month, the VA said that more than 100,000 soldiers were being treated for mental health problems, half of those specifically for PTSD. In the study, initial screenings of nearly 89,000 veterans uncovered 4.4 percent needing treatment. Six months later, after a second look, the total was 11.7 percent.

The new policy addresses a problem that should have been solved long ago. Large numbers of veterans have lacked proper treatment so far. That's a great disservice to those who have served this country.


All rights reserved. This copyrighted material may not be published, broadcast or redistributed in any manner.
Read more!

Mental Health Beds Progress - Dunn (NC) Daily Record

By Steve Reed

Efforts to re-open mental health beds at the former Good Hope Hospital site in Erwin appear to be moving forward.

Harnett County Commissioner Gary House, a long-time Good Hope supporter, said Bill Larrison has been authorized to act as a go-between with interested parties in getting the beds reopened.

Mr. Larrison is a unit manager for the Sandhills Center and former manager of the Good Hope mental health unit.

Sandhills is a local management entity for mental health, developmental disabilities and substance abuse services. It serves an eight-county region including Harnett and Lee counties, and operates at least one access center in each of these counties.

The county's only mental health beds, which were located at Good Hope, closed in 2005.

"Bill will act as an intermediary between a consultant we've hired from Horizon Health Care and all necessary parties," Mr. House said. "Bill has been in contact with Horizon Health and the consultant will be in place in December in an effort to make the opening of these beds a reality."

Parties involved in the effort to reopen the beds include Betsy Johnson Regional Hospital, Harnett County, the state, Good Hope and Sandhills, Mr. House said.

"We have had an engineering study and environmental study done. Bill and the consultant will take it from this point," Mr. House said. "They will work on getting the appropriate licenses and beds along with all of the ancillary services such as dietary, laundry and the pharmacy. Once we know exactly what needs to be done, we will apply for some grant funding."

Lost License

Good Hope lost its state license for mental health beds earlier this year. According to correspondence between Good Hope attorney William Stewart and state Assistant Attorney General June S. Ferrell, Good Hope notified the state the hospital was closing, but planned to resume its mental health services in the future.

But the state refused to issue a license to Good Hope in 2007, and Good Hope filed a petition asserting its license had not and should not have lapsed.

Jeff Horton, chief operating officer of the North Carolina Department of Health and Human Services' Division of Health Service Regulation, said in August the state would review any proposal from hospital supporters.

"However, any proposal must meet building code and physical plant and safety standards, as well as conformance to the certificate of need law," Mr. Horton said.

Hospital Wars

Meanwhile, the hospital war continues.

Good Hope Hospital supporters have rejected the Harnett Forward Together Committee's resolution urging "immediate removal of all barriers, including appeals by Good Hope Hospital and the Town of Lillington that now prevent creation of the hospital, scheduled to commence construction in the first half of 2008."

The resolution was signed by the HFTC's board of directors and announced at its sixth annual anniversary celebration on Nov. 15.

Good Hope, in partnership with Texas-based Triad Hospital, wants to build a for-profit hospital in Lillington.

Harnett Health System meanwhile, a partnership of Harnett County, Betsy Johnson Regional Hospital and WakeMed, plans to build a not-for-profit hospital in Lillington which will join Betsy Johnson to become part of a two-hospital system operated by HHS.

HHS has been granted a state certificate of need to build the hospital, which is to be located on the 130-acre Bridgewater biotech park site in Lillington on U.S. 421 across from the Harnett County Courthouse.

An architectural firm has been hired and Betsy Johnson CEO Ken Bryan has said his hospital is moving forward with its plans.

Meanwhile, the state has denied Good Hope's 2005 CON application. A ruling is still pending in the state Court of Appeals on Good Hope's 2003 CON application.

Flip-Flop

Lillington Mayor Glenn McFadden, in a letter to The Daily Record, accused HFTC of flip-flopping on the hospital issue and urged HHS to build a facility comparable to the proposed Good Hope Hospital with all-private rooms, intensive care beds and mental health beds.

The issue of semi-private beds at the HHS facility has long been a point of contention in the battle to build a new hospital in Lillington.

Mr. Bryan said in an August interview HHS wants to offer more private beds at its new Lillington hospital.

"We're pursuing a sincere effort to get more private beds," he said.

Under the current CON design, Mr. Bryan said the hospital rooms are private for the first 33 patients, only becoming semi-private after the hospital admits 34 or more patients.

Mayor McFadden said health care is more important than economic development.

"That is why Lillington and a senior analyst with the state Department of Health and Human Services agree that Good Hope Hospital's scope of services in the 2005 CON are superior to those provided by Harnett Health System," Mayor McFadden said. "The question we should be asking is why was the senior analyst's decision overturned? That has yet to be answered.

"Do we need to accept inferior services for the sake of economic development? I truly believe health care is much more important than economic development," he said.

Good Hope Board of Trustees Vice Chairman Pat Cameron said the hospital's board will meet Thursday night to discuss several issues.

Attempts to contact Betsy Johnson spokesperson Jennifer Franklin and Lee Anne Nance of the HFTC were unsuccessful by press time.

Read more!

Mental health: ongoing need for services, awareness - Ellensburg (WA) Daily Record

Efforts under way to close service gaps

By MIKE JOHNSTON
staff writer

KITTITAS COUNTY – The source of Jessica Bell’s passion about getting mental health services as early as possible to people who need them runs deep in her life, and it still hurts.

Bell’s best friend since sixth grade, Julie, took her own life on Sept. 12, 2002, the day the two were planning to run together — just weeks before Bell would leave to attend her first year at Central Washington University.


Julie, a year ahead of Bell, had been struggling with depression and attended Western Oregon University. They went to Ilwaco High School together near Long Beach in southwest Washington.

“We were on the cheerleading squad together; she was captain of the squad,” said Bell, now 23, of Ellensburg. “We did so much together. She was so happy-go-lucky and involved in so much in high school. She was a student body officer, got good grades and was a great student. You could say she probably was the most popular girl in school.”

“Julie had that ability to bring people together and motivate them. I mean, she was a great role model.

“That’s why it was such a terrible, terrible loss, such a hurt we all felt. We all felt helpless and numb and couldn’t understand how it could happen.”

For Bell, Julie’s death totally erased the myth that only certain types of people need more serious mental health services. She, and others in her community, learned that mental health problems affect all people of all ages, and those from all ethnic, social and economic backgrounds.

“I grieved deeply about Julie’s death, but I also chose to see what I could do about it,” said Bell, adding that Julie possibly had a more serious, underlying mental health issue than depression.

Bell became an advocate for making more people aware of the need for mental health screening and services, and knowing the symptoms that could be a warning. Julie’s parents started a Long Beach-area chapter of the National Association on Mental Illness, or NAMI.

Bell started a NAMI chapter on campus at CWU and joined with a disability group at Central to bring speakers who raised awareness about mental health disorders. Since graduating from Central in 2006, she has become more active in the Ellensburg NAMI chapter and serves on the Kittitas County Mental Health/Developmental Disabilities Board.

Both groups are working to bring more services, awareness and assistance to county residents with the help of local, nonprofit agencies, like Central Washington Comprehensive Mental Health, law and justice agencies and local schools.

“I don’t want what happened to Julie to happen to others,” Bell said. “I don’t want people with problems to fall through the cracks in their need for help.”

Challenges

Challenges

Harry Kramer said Central Washington Comprehensive Mental Health, or CWCMH, also doesn’t want people failing to get the services they need. He said the nonprofit agency is attempting to close the services crack with funding from a variety of sources.

“There is not a lack of services or a lack of availability,” Kramer said, “but there are restrictions on who can access them. We have programs here that really work. We outreach to the community and go into homes, nursing homes and assist local schools and our detention centers.

“The demand for our services is growing. We’re working hard to keep up and, at the same time, provide high standards of care.”

Kramer, who has a Ph.D. in counseling psychology, oversees CWCMH’s services in Kittitas and Klickitat counties, and in Lower Yakima Valley. The agency is private, nonprofit and is the sole, publicly funded provider of mental health services for low-income people eligible for Medicaid. It also is the single largest provider of these services in the county and also serves those whose health insurance does pay for services.

Locally, there also are private psychiatrists, psychologists, therapists and counselors who offer services to area residents, but are not publicly funded through Medicaid. Others gain help through pastors of local churches.

The continuing challenge, Kramer said, is keeping access to care open to those who need it who don’t qualify for Medicaid because their incomes are not low enough, or their problems are not bordering on suicide or they have problems not covered by public or private insurance plans.

The federal government about five years ago put new restrictions on how Medicaid funds can be used and what types of mental illnesses can be treated with federal block funds. This cut out certain people that CWCMH had been serving in the past, thus creating a group of citizens who are under-served when it comes to mental health services.

The changes required CWCMH to halt the use of a sliding fee scale that allowed those in the under-served group to get services and pay what they could afford.

A father recently brought his child to CWCMH inquiring about help for his adolescent son but learned he didn’t qualify. Yet the agency did a mental health screening for the child and referred him to other local agencies or programs that could help.

“It’s frustrating to our staff to have someone come in truly seeking help, but we’re not able to, at times,” Kramer said. “We’ll always do all we can. We know people struggling with these issues are in emotional pain that directly affects their daily functioning and quality of life.”

Stigma

Rick Weaver, CEO-president of CWCMH, said this concern goes beyond the under-served group, sometimes called the “working poor,” to those in the community who are homeless and living off friends and relatives and who need help to even apply for Medicaid.

“Of those people with major mental health disorders, two-thirds of them can avoid hospitalization or institutionalization if they are diagnosed earlier and steady treatment is applied,” said Weaver.

The state Legislature has worked to fill the gap with additional funding and requirements that insurance companies offer mental health services, but more is needed. Kramer said CWCMH works to gain grants that can help pay for services to this growing under-served group.

Services also are being provided through other state programs that assist local public schools or work with juvenile offenders and their families, Kramer said. CWCMH also works to raise funds in its three-county service area to reach the un-served group.

Kramer said many people struggling with mental illness don’t seek help because of the stigma associated with having such a problem.

“People with mental health disorders can include anyone; they are doctors, nurses, presidents, lawyers, judges and the guy at the local gas station,” Kramer said. “It could be the person next door. With early diagnosis, treatment and help people can recover; they can cope and function well in life.”

Read more!

Moving ahead on mental health care - Burlington (VT) Free Press

By Anne B. Donahue

A fresh perspective is helping from the consultants who reviewed plans to replace the decertified Vermont State Hospital and offered several key messages: Vermont State Hospital served many needs that don't belong together in a replacement institution. We have the opportunity now to do better.

Initial treatment of serious illness belongs in a medical center. Long-term rehabilitation after being stabilized -- just as after a stroke or hip surgery -- needs a different setting and focus.

Most care belongs with community outpatient providers. Access should be close to home where a person's natural supports are.

I haven't mentioned "mental health." As the Institute of Medicine said in "Crossing the Quality Chasm," the same principles apply to all health care: safe, effective, patient-centered, timely, efficient, and equitable.

What model do the key messages suggest?

First, strengthening community supports in prevention and primary care. The last statewide survey found that shortages in psychiatry were leading to unnecessary hospitalizations, because it took a crisis to get services. It shouldn't surprise us, nor can we shirk responsibility, when inflationary pressures for this care equal that of other health care.

We also need adequate numbers of longer-term programs to get folks out of the hospital when they no longer need it. A limited number of beds (at most 15 statewide) need to be in a secure setting for rare situations where symptoms could create public safety concerns.

Acute-care beds must be redistributed from Waterbury. Throughout health care, higher-level services are being diverted to community hospitals. There must be assurance that appropriate population-based distribution of beds exist for serious psychiatric illness.

Finally, we don't want quadruple bypass surgery accessible at every hospital. That tertiary level needs to be located where specialized expertise has been gathered. This is equally true for severe, treatment-refractory psychiatric illness.

Meeting these goals -- identifying the right types of care in the right numbers and the right places -- is the essential planning task remaining. The support of the consultant report is a valuable tool toward implementing the Futures plan sketched out in 2005.

One challenging issue is how we address those who do not have the capacity to make their own medical decisions, particularly if it affects where care can be delivered.

Whether it is your grandfather suffering from dementia and wandering away, your seriously developmentally delayed cousin who needs birth control, or your partner on life support, we set social standards for making choices for and protecting the rights of those who cannot make their own decisions.

Money cannot drive limitations on the rights of self-determination. Hitching grandpa to a clothesline would cost less than home care, but that does not make it acceptable.

What a person would have wanted, if able to decide, is paramount. We affirm that "The state of Vermont recognizes the fundamental right of an adult to determine the extent of health care the individual will receive." The Institute of Medicine tells us that mental illness, even psychosis, does not necessarily affect decision-making capacity.

The United States and Vermont constitutions require that clear proof of lack of capacity as well as strong justification exist before the state can take away one's freedom or choice of medical treatment. Finding the right balance for one of the highest levels of invasion of personal autonomy -- the involuntary injection of mind-altering drugs -- can be challenging, but is not impossible.

The cards are beginning to fall into place for progress on closing the doors of VSH. We must move ahead firmly without losing sight of our guiding principles of a system that is consumer-directed, trauma-informed and recovery-oriented.

Anne B. Donahue is a Republican member of the Vermont House from Northfield.

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Study: Suicide, healthcare linked - United Press International

ALEXANDRIA, Va., Nov. 28 (UPI) -- A state-by-state survey finds depression tends to be least common where access to mental healthcare is easiest, a U.S. advocacy group said Wednesday.

The report by Mental Health America compared rates of suicide and depression with factors like average income and education, the number of psychiatrists and psychologists relative to population, whether residents report they cannot afford healthcare and whether state laws require insurers to cover mental illness.

"It is important to note that regardless of where each state ranks, there is much room for improvement," said Dr. David Shern, president of Mental Health America. "While a number of factors including biology and environment affect an individual's mental health, this study shows that states can significantly improve their populations' mental health status by adopting policies that expand access to treatments."

The study was funded by Wyeth, but Mental Health America said that the pharmaceutical company was not involved in the design.
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Court upholds death sentence for student's killer - Associated Press

INDIANAPOLIS

The Indiana Supreme Court upheld the death sentence for a mentally ill man convicted in the 1997 abduction, rape and slaying of a Franklin College student - but not without reservations.


Attorneys for Michael Dean Overstreet had argued that his severe mental illness at the time he was convicted of killing Kelly Eckart would make his execution cruel and unusual punishment under the state Constitution.


Justice Robert Rucker, who wrote the opinion issued Tuesday, agreed.


Rucker said that the 41-year-old Overstreet's mental illness impeded his thought processes to a point comparable with mental retardation. The U.S. Supreme Court has ruled that mentally retarded people are ineligible for the death penalty, and Rucker wrote that he believed Indiana's Constitution offered even greater protection.


"Because I see no principled distinction between the diminished capacities exhibited by Overstreet and the diminished capacities that exempt the mentally retarded from execution, I would declare that executing Overstreet constitutes purposeless and needless imposition of pain and suffering thereby violating the Cruel and Unusual Punishment provision of the Indiana Constitution," Rucker wrote in the 46-page opinion.


"Therefore, I would remand this cause to the post-conviction court with instructions to impose a sentence of life imprisonment without parole."


However, the other four justices disagreed with Rucker's reasoning and held that Overstreet was eligible for the death penalty.


All five justices agreed to uphold Johnson Superior Court's handling of Overstreet's case, dismissing other arguments including that Overstreet had had ineffective counsel.


No evidence of Overstreet's mental illness was presented during his trial, though he had been diagnosed. The defense instead tried to prove that someone else had killed Eckart.


The Associated Press left phone messages seeking comment Tuesday from the state public defender's office and the state attorney general's office, which handled the appeal.


Overstreet was convicted in 2000 of criminal confinement, rape, murder and felony murder in the death of Eckart.


Eckart, an 18-year-old Franklin College freshman from Boggstown, was abducted and murdered Sept. 26, 1997, as she was coming home from work in Franklin. Her body was discovered south of Morgantown just across the Morgan-Brown county line.


The case led to passage of a state law that allows murder victims' relatives to read statements in court after a judge has announced the sentence.

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For Disabled, Getting a Handle on Expenses and Identifying Income Sources isn't Easy, but is Essential, Says Allsup - Raleigh News and Observer

Whether it's a credit counselor to help you reduce debt, a financial advisor to help find the best sources of income or a claims representative to help streamline the SSDI application process, individuals with disability shouldn't be ashamed to ask for help.

BELLEVILLE, Ill. - If you suffer an illness or accident that leaves you unable to work, there's a good chance you won't have the resources to keep you financially afloat until you begin drawing Social Security disability benefits. Be prepared for an average two-year wait, warns Allsup Inc., the nation's leading Social Security Disability Insurance (SSDI) representation company.

"Having a significant disability in itself is a life-altering matter, but combined with no longer having the ability to earn a paycheck, the financial impact can be devastating," said Paul Gada, product manager for Allsup.


According to Gada, the first steps in trying to minimize financial problems are understanding expenses and sources of available income. With about one-half of all bankruptcies attributed to injury, illness and medical bills, many people with disabilities don't have enough income to offset their expenses.

"Ideally, individuals should be planning for a potential disability before it occurs by taking advantage of their employer's long-term disability and workers' compensation insurance," said Gada. "If they don't have this protection, they need to act quickly in determining how they will generate needed income and how they can reduce expenses. What's challenging to so many is that one of the most widely available sources of income - Social Security Disability Insurance - often takes a long time to get."

Examining Expenses

When people lose their job, an immediate reaction is to look at how to reduce expenses. But when someone becomes disabled they are not only out of a job, they usually have to face higher expenses for medical costs, alterations to their home to make it accessible or hiring people to perform tasks they used to do themselves. As a result, it's extremely important to determine where expenses can be eliminated or scaled back. It's also important to avoid using credit cards as a line of credit because high interest rates will simply add to long-term debt.

Gada advises individuals not to eliminate health insurance. Even after you begin receiving SSDI benefits, there is still a two-year waiting period before you are eligible for Medicare. Keeping insurance while waiting for Social Security disability benefits, and then during the gap until Medicare is available, can be essential to protecting your financial security. If COBRA is available through your former employer, it may be a good starting point because you may qualify for an 11-month extension beyond the typical 18 months allowed under COBRA.

Gada notes that individuals that find they are falling behind in paying bills should meet with a credit counselor to help organize their debts and establish a payment plan. The National Foundation for Credit Counseling (www.debtadvice.org) is a non-profit organization that offers free and low-cost help to individuals needing advice on getting out of debt.

Identifying External Sources of Income

Once there is a general understanding of expenses, it's important to look at all potential sources of income. Beyond accumulated wealth or income of a spouse, people who can't work because of a disability have three externally generated options for realizing income: income from a private or employer-paid disability policy, workers' compensation or income from Social Security Disability Insurance.

Only about one-third of employees have private disability insurance, according to the Social Security Administration, and workers' compensation is only a source of income for those injured at work or suffering from a work-related disability. SSDI, on the other hand, is the largest benefit program for individuals with disabilities, paying out more than $75 billion in benefits to 6.8 million workers with disabilities in 2006.

Gada notes, however, that not all individuals are eligible for Social Security benefits. Among the requirements:

-- You must have worked and paid into Social Security through mandatory payroll taxes (FICA) for five of the last 10 years;

-- You must have been disabled before reaching full-retirement (65-67 years old, depending on your current age); and,

-- You must meet Social Security's definition of disability, which generally means being unable to work due to a medically determinable mental or physical impairment expected to result in death or last for at least 12 months.

People who do qualify for Social Security disability should file as soon as possible. The wait for a final decision in 2007 is now 524 days (about 17.5 months) and the average monthly benefit is $996. Individuals that have long-term disability insurance may get added help from their provider in securing Social Security disability benefits as some insurers have agreements with SSDI representation organizations like Allsup. Individuals without long-term disability also can seek the help of representation organizations.

Tapping Your Retirement or Home Equity for Income

Additional income options may be available to some individuals, including tapping retirement or home equity, but both have significant downsides, according to Gada.

For example, you are generally subject to a 10-percent tax penalty for taking distributions from your IRA before age 59 1/2. However if you have a qualifying disability, you can take early distributions without penalty. To be considered disabled by the Internal Revenue Service, which oversees the rules for retirement distributions, you need to provide proof that you are unable to do any "substantial gainful activity" because of your physical or mental condition. You also need to have a doctor show that your condition is expected to result in either death, or to "be of long, continued, and indefinite duration." Similar rules apply for early distributions from 401(k) accounts for financial hardship.

"The downside is you are borrowing against income you need for retirement, so you may simply be delaying financial problems. But for people facing immediate living expenses or high credit card debt, this may be their only option," said Gada. He emphasized that reviewing such a major decision with a retirement or financial planning advisor is a good first step.

Tapping equity in their home is another option used by those trying to make ends meet after suffering a disability. This can include taking out a home equity loan, home equity line of credit, second mortgage or reverse mortgage. This can be risky, however, because half of all mortgage foreclosures are the result of a disabling injury or illness. For example, in most states, an individual's home is protected if he or she is forced into bankruptcy. But if you take out a mortgage, the mortgage amount can be lost in the bankruptcy proceedings.

"Your home can be a source of income, but more importantly it's a place to live," said Gada. "As a result, any equity-seeking options should be evaluated carefully and only taken after consulting with a trusted financial advisor."

Asking for Help

While family and friends can be an incredible source of emotional and financial support, individuals facing disabilities - and their families - also should seek out professionals to help them.

"Whether it's a credit counselor to help you reduce debt, a financial advisor to help you find the best sources of income or a claims representative to help you streamline the SSDI application process, you shouldn't be ashamed to ask for help," said Gada. "The earlier and more proactively you seek help, the more support you can get to help put you back on the right track."

About Allsup

Allsup Inc. is the nation's premier Social Security Disability Insurance representation company. Since 1984, Allsup Inc. has helped nearly 100,000 Americans with disabilities receive their entitled disability benefits. Today, the company has about 460 professionals focused

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Mental patient backlog jams ER - Atlanta Journal

Crowded psychiatric hospitals mean emergency rooms are often forced to furnish a temporary bed.

By Alan Judd, Andy Miller
The Atlanta Journal-Constitution

Patients with acute mental illnesses are increasingly forced to wait up to three days in Georgia hospital emergency rooms before being admitted to state-run mental hospitals.

These backups of mentally ill patients —- which worsen the overall congestion and wait times in ERs —- stem from a lack of available beds in the state psychiatric facilities, hospital officials on Tuesday told a state commission studying reforms of Georgia's mental health system.

If the state psychiatric hospitals can't take mental health patients immediately, ERs must keep them until a transfer is possible. Yet, in some cases, the mental hospitals are refusing to admit these transferred patients, including children, and are sending them back to the emergency room, the panel was told.

Gov. Sonny Perdue formed the mental health commission after The Atlanta Journal-Constitution this year reported chronic problems with underfunding, understaffing and crowding in Georgia's seven state mental hospitals. The Journal-Constitution reported that, from 2002 through 2006, at least 115 state hospital patients died under suspicious circumstances. In an additional 194 cases, hospital workers physically or sexually abused patients, the newspaper found in its series, "A Hidden Shame.''

The U.S. Department of Justice, in response to the newspaper articles, is investigating whether hospital conditions violate patients' civil rights.

The average ER wait for a mentally ill patient at Southern Regional Medical Center in Riverdale has increased from 20 hours in 2006 to 29 hours this year, Patricia Ryding, a Southern Regional administrator, told commission members. In the past four months, the waits have averaged 34 hours, she said.

One violent, agitated 7-year-old girl waited at Southern Regional for about 24 hours before being sent to Central State Hospital, a state-run facility in Milledgeville. The mental hospital denied admission for the girl even though Southern Regional doctors determined she met medical criteria for a psychiatric stay, Ryding said. The girl was sent back to Southern Regional.

And this month, a violent 21-year-old man waiting for a transfer set a fire in a room in Southern Regional's emergency department, forcing an evacuation, Ryding said.

The state has contracted with private facilities, such as Peachford Hospital in Dunwoody, to handle overflow from the state mental hospitals. Still, Peachford's chief executive, Matt Crouch, told the commission, "Emergency rooms are now the pinch point in a mental health system that's not functioning very well.''

ERs in Georgia are already overwhelmed with the rising number of uninsured and with increases in aging patients needing more services, the Georgia Hospital Association says. "The mental health problem only exacerbates this [ER crowding] problem,'' said Kevin Bloye, a GHA vice president. Backups of mentally ill patients in ERs —- detailed earlier this year by the hospital association —- have worsened recently, hospital officials say.

Steven Kiner of Emory Healthcare told the panel Tuesday that "our big concern is that there's no course of treatment in the ER."

"All we're doing is housing them in beds,'' said Kiner, intake and assessment coordinator of psychiatric services for Emory University Hospital and Emory Crawford Long Hospital. The waits for mental patients at those hospitals also have increased, he said.

The state psychiatric hospitals often operate at or above 100 percent capacity, far above generally recommended levels.

Patients treated at state hospitals, though, often end up cycling back through the system after discharge because of a scarcity of mental health services in their communities, the commission was told.

"There are no children and adolescent services in our area,'' said Amy Cason of Phoebe Putney Memorial Hospital in Albany. She said children with mental health problems are in the ER for more than 20 hours before being sent to a hospital.

WellStar Health System psychiatrist Chris Riddell said some patients wait 72 hours for a transfer.

Commission members listened, generally without comment, as family members, social service groups and consumer advocates detailed gaps in community services for people with mental illness.

Parents of Georgians who are hearing-impaired said mental health services are available in other Southeast states, but not in Georgia.

Funding cuts have curtailed mental health counseling for patients with HIV, added Lee Maxwell, a counselor for AID Atlanta, an advocacy organization.

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ACLU backs Baca's jail demolition plan - LA Times

By Stuart Pfeifer
Los Angeles Times Staff Writer

November 27, 2007

Los Angeles County Sheriff Lee Baca has an unusual ally in his plans to manage the nation's largest jail system -- the American Civil Liberties Union.

Melinda Bird, senior counsel for the ACLU of Southern California, said she planned to tell the Board of Supervisors today that she supported Baca's proposal to demolish the outdated, overcrowded Men's Central Jail and build a new jail in its place.

Bird said the county should consider reducing the number of inmates held in the county's six jails -- about 19,000 a day -- by using alternatives such as home detention or residential treatment for those who are addicted to drugs or mentally ill. If the county slashes the number of inmates in custody, Bird said, it could replace Men's Central Jail in downtown Los Angeles with a smaller and less expensive facility. That would make more sense than spending tens of millions to refurbish the jail, she said.

Baca estimated that building a new downtown jail could cost between $500 million and $800 million.

The existing jail, which opened in 1963, has been plagued by poor electrical, plumbing and ventilation systems, and a design that makes it difficult for guards to keep close watch on inmates. The jail was the scene of a string of inmate homicides in 2004 that led an independent monitor to call for its closure. A federal judge described conditions at the jail as "inconsistent with basic human values."

"We need a new, modern jail," Bird said. "It may not cost as much as you think. . . . We will be fine with a far smaller jail than we have now. If you're talking a smaller facility, then Baca's plan to demolish and build a new facility makes perfect sense. It's only if you say you have to rebuild 6,000 beds that it becomes prohibitively expensive."

The ACLU has said the jail's 3,800 inmates are not given enough time and space to exercise and that many of them are denied adequate medical and mental health treatment.

The problem with the jail, Bird said, "is the way it was built and designed. It's an antiquated facility and it cannot be repaired. It's filthy. It's a linear design, which was outmoded 20 years ago."

County supervisors are expected to consider what to do with Men's Central Jail next year.
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Many Steps Must Occur Before Someone Can Be Forcibly Committed - Washington Post

Wednesday, November 28, 2007; A16

In a civil commitment hearing, a Virginia court decides whether a person needs to be committed against his will to a mental hospital for up to six months. In most counties, the general district court appoints "special justices," typically lawyers well-versed in mental health issues, to hear the cases and make the rulings.

But before someone faces a commitment hearing, he must be held under a temporary detention order. The order can be sought by "any responsible person," according to Virginia law: a parent who seeks help for a child, a police officer who thinks someone needs attention, a mental health practitioner who thinks a patient needs treatment.

At this stage, Virginia law requires that the local Community Services Boards, the government agencies that oversee mental health services in each jurisdiction, screen the person to determine whether he is an imminent danger to himself or others or unable to take care of himself, needs treatment and is unwilling to volunteer for it. If the screener makes such a determination, a magistrate can issue a temporary detention order, forcing the person to be hospitalized for a maximum of 48 hours.

During that time, an attorney is appointed for the person, and an independent evaluator -- a psychiatrist, psychologist or clinical social worker -- conducts a second examination. The evaluator then files a report with the special justice.

Within two business days, a commitment hearing must be held. The independent evaluator might or might not attend and testify, and be cross-examined, or the special justice can rely just on the written report. The defendant also might testify. The defense attorney can make a closing argument.

Before the hearing begins, however, the person is asked whether he wants to voluntarily enter treatment for a minimum of five days. In some counties, as many as half the hearings end when the person volunteers. But if the person declines to volunteer, the hearing proceeds. When the testimony ends, the special justice must decide whether there is clear and convincing evidence that the person is an imminent danger or unable to care for himself.

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Commitment Rule Is Key To Changing The System - Washington Post

Interpretation of Criteria Varies Among Counties

By Tom Jackman

The Fairfax County teenager was candid with the social worker: When he was in jail two weeks earlier, he'd been hallucinating and thought people were turning into zombies.

The 18-year-old, who also had escaped from a mental clinic, said that he believed in aliens from outer space but that he didn't think they were probing his mind. And he was joking and cooperative, the social worker wrote in an internal report. He planned to go to college and look for a job.

So, the social worker decided, the young man was not an "imminent danger to himself or others," and he was released.

Three days later, Michael Kennedy gathered seven guns from his home in Centreville, hijacked a van, drove to a nearby county police station and fatally shot two veteran officers before police killed him.

As Virginia wrestles with how to fix its mental health system after the massacre at Virginia Tech in April, one of the most crucial issues facing legislators and Gov. Timothy M. Kaine (D) comes down to those two words: "imminent danger." Judges and magistrates cannot order people into a treatment facility unless they meet this standard. Virginia is one of only five states that have such a high bar for commitment. Maryland abandoned the standard after tragedies there in 2002, and the District has a lower bar.

But when a psychologist examined Seung Hui Cho in 2005, it was determined that Cho did not meet the imminent danger standard. So he was never committed, and he never received treatment. On April 16, Cho killed 32 people and himself at Tech, bringing unprecedented scrutiny to the state's fractured mental health system.

A special subcommittee of the Courts of Justice Committee in the House of Delegates will begin assessing and drafting legislation on the standard. Kaine and lawmakers in both parties have said they expect the issue to be a priority for the General Assembly in January. But as the Kennedy case shows, the high standard was an issue well before the Tech massacre. The state Supreme Court convened a mental health commission last year, with a task force focused specifically on the imminent danger standard. The commission's report is due soon.

The problem is that imminent danger is "a vague term that's inconsistently applied and overly restrictive," said Bruce J. Cohen, a psychiatrist at the University of Virginia who is on the Supreme Court task force. "Most states have gotten rid of it."

Virginia law does not define exactly what "imminent danger" means, and statistics supplied by local jurisdictions indicate that the standard is applied differently from county to county in the approximately 14,000 cases heard annually statewide. That means that a person might be committed in one county but freed in another.

"Make it easier to get help for mentally ill people before they hurt themselves or others," said a Reston man whose son has been in and out of the mental health system for years and spoke on condition of anonymity to protect his privacy. "We just need a lower threshold to get help for people."

Legal Standards

Virginia law says that for a person to be involuntarily committed to a mental hospital, he must present "an imminent danger to himself or others as a result of mental illness" or be "so seriously mentally ill as to be substantially unable to care for himself." The standard is used in civil commitment hearings, usually held in hospitals, at which a family member or mental health professional asks a special justice to order someone into psychiatric treatment against his will.

Families and experts say the rulings in those hearings set precedents throughout the counties in which they're held, creating a standard that emergency room doctors, social workers, psychologists and others try to anticipate. In Fairfax, families say the special justices are particularly rigorous in applying the imminent danger standard, and statistics show they dismiss more than half the cases they hear, a far higher rate than in much of the rest of Virginia.

In contrast with Fairfax, Alexandria and Arlington County dismiss about a third of their commitment cases. In Richmond, less than 6 percent of cases were dismissed in fiscal 2006-07, and 94 percent were ordered into treatment. Norfolk orders about 80 percent into treatment. The statistics in Prince William and Loudoun counties are similar to those in Fairfax.

The Reston man who advocates eliminating the standard called for help recently after his son obsessed that federal authorities were eavesdropping on him. He destroyed a toilet and punched holes in the wall. Fairfax's Mobile Crisis Unit came to their home and "agreed that he was very disturbed," the man said. "But in their judgment, what he was saying and doing would not pass the threshold for imminent danger. And having sat through these hearings before, I had to agree with them."

A few weeks later, with what his father described as "a crazed look in his eyes," the young man attacked his father. The father called police, and the son was arrested. He is being treated in a mental hospital while awaiting trial on an assault charge. It took the criminal charge to get the young man held.

"Ideally, when we see terrible things happening," the father said, "we should have been able, before that point was reached, to say, 'This kid is in danger and needs to be treated.' We just couldn't get past that threshold."

Until 2003, Maryland required a "clear and imminent danger" to get an emergency psychiatric evaluation. Two events involving mentally ill people, including the shooting of two Prince George's County sheriff's deputies in 2002, helped persuade the legislature to delete the words "clear and imminent."

Under the District's legal standard, someone must be mentally ill and "likely to injure himself or others," which some advocates think is too tough.

There's hardly unanimity on the issue in Virginia. And the future of "imminent danger," and whether more people are forced into treatment, might hinge on whether a coalition of libertarians and former mental health patients can successfully fight to preserve the standard as the proper test to decide how to handle a mentally ill person who doesn't want help.

"I would make the standard higher than what it is," said Alison Hymes, who is on the task force examining the commitment process. "I think we're having too many people committed in Virginia, people who are committed who are not a danger to anyone."

"In most places, the hearing is a joke, kind of like Cho's hearing," she said, referring to the commitment hearing in December 2005 for Cho, the Tech gunman.

After Cho was temporarily detained overnight in a mental hospital for expressing suicidal thoughts and possibly stalking female students, he was examined briefly by a psychologist. At his commitment hearing the next day, neither the psychologist nor the police officer who detained him appeared. The attorney for Cho, theoretically fighting for his client's freedom, instead read the allegations against him into the record.

Defenders of the process say, however, that after a doctor determined that Cho was not mentally ill or an imminent danger, the special justice ordered Cho into outpatient treatment. Most special justices would have dismissed the case without a hearing once a doctor found no illness or danger, experts said, but the special justice in Cho's case sought help for him. But Cho did not follow through, and the local Community Services Board did not check to see whether he had.

"I feel that we've had a very emotional reaction to the tragedy at Virginia Tech," Hymes said. "This is being used in an emotional way, and we're getting bad law. I think they're going to erode our civil rights."

The imminent danger standard arose in several states in response to the previous governmental practice of building large asylums and then dumping the mentally ill there without due process or adequate resources. As squalid conditions and sordid practices were uncovered in the 1950s, the pendulum swung toward patients' rights: Hundreds of thousands were "deinstitutionalized," or released from the asylums, and new legal standards -- "imminent danger" in many states -- were installed.

In 1955, 558,239 patients were in public psychiatric hospitals. By the mid-1990s, the number had dropped to fewer than 72,000. By 2002, the total had fallen below 50,000.

But the same states that implemented the imminent danger standards rejected them over the past decade, most often because of incidents that involved the mentally ill.

Because of the Tech massacre, Virginia is going through that process.

Seeking a 'Model'

Experts agree that there has been no uniform approach to the commitment standard among counties. "There's no case law on this," said George W. Dodge, for 19 years a special justice in Arlington. "There's no power; there's no codification of anybody's role. That's how barren the whole state is." He said the Supreme Court panel "has a wonderful opportunity to create a constructive model in dealing with the mentally ill."

Because there is no uniform standard, someone can manipulate the system. The 21-year-old son of another Reston man is an example of such people. The son "knows that when he wants to be admitted to a facility," the man said, "he simply states he has thoughts of committing suicide. Unfortunately, he rarely wants to be committed, and he simply states that he does not want to kill himself or others and that he is not hearing voices."

The man said his son "can be in a serious mental psychosis, but he seems to always have the ability to control his mental problems if someone is asking 'a few questions.' Especially when the 'wrong' answers to those questions will have him committed."

The result, in many counties, is that jails have become the country's repositories for mentally ill people and that police constantly encounter people who need treatment but often must commit a crime to get it.

"To use the criminal justice system to get the person into treatment, it's not fair to the county, it's not fair to the person, and it's not fair to the officer," Fairfax Maj. Thomas Ryan said. "They have to get that person off the street. They're clearly a crime victim waiting to happen. The only way the system says we can assist that person is to arrest them. That's absurd."

It appears likely that Virginia will revise its standard. The task force on commitment, headed by Fairfax lawyer and special justice Mark Bodner, has been considering suggested changes to imminent danger. Cohen, the U-Va. professor and task force member, said proposed wording such as "a substantial likelihood that in the near future" a person might cause "serious physical harm" to himself or others is probably going to be suggested to the General Assembly when the commission issues its report.

"We're trying to tighten the criteria with regard to 'serious physical harm,' " Cohen said, "but broaden the issue and loosen the time frame requirements."

Staff writer Chris L. Jenkins contributed to this report.



Virginia is going through an unprecedented examination of its mental health system after the slayings at Virginia Tech in April. This is the first of an occasional series of reports about problems in the system

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LESBIAN 'KILLER'S' MENTAL WOE - New York Post

By LORENA MONGELLI

November 28, 2007 --

A college student who confessed to killing the husband of her alleged lesbian lover was diagnosed with bipolar disorder at a Manhattan hospital but released without medication, her Brooklyn landlady said yesterday.
Anastasiya Andreyeva, 25, "went crazy" in a Fordham University class two weeks ago and was taken to the unnamed hospital, said landlady Rosemary Iadarola, quoting the woman's husband, Kirill Berezovski.

Andreyeva was diagnosed with bipolar at the hospital, but released after three days without drugs, she said.

Andreyeva was arraigned yesterday on charges of fatally stabbing a friend, Aleksei Kats, 30, on Monday and held without bail pending a psychiatric evaluation. Prosecutors said she confessed.

Law-enforcement sources said the 5-foot-3 Andreyeva was having an affair with Kats' wife, Elina, 25. But Andreyeva's lawyer, Joseph Stello, strongly denied it.




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Suspect in 2 killings 'snapped,' LAPD says - LA Times

By Jean-Paul Renaud
Los Angeles Times Staff Writer

A South Los Angeles man who allegedly dismembered his father's body and dumped the pieces beside a freeway near Fresno had a "history of mental issues," police said Monday.

Los Angeles Police Cmdr. Pat Gannon said Mulushewa Tebedge, 33, used a knife to cut off his father's arms and head in the family's apartment last week to better "handle the body."

But Tebedge apparently had less of a problem handling his sister. After stabbing her to death, Tebedge allegedly dumped her clothed body beside a freeway in Santa Barbara, police said.

The killings occurred during the Ethiopian family's traditional Sunday night dinner, police said.

"He snapped and believed his family was out to get him," Gannon said.

Tebedge was charged Monday with capital murder. He is being held without bail, according to the Los Angeles County district attorney's office. Prosecutors say they have not decided whether to seek the death penalty.

The charge stems from the Nov. 19 discovery of 75-year-old Getahun T. Reta's remains beside Interstate 5 in rural Fresno County.

A Caltrans worker found them stuffed into two suitcases and a duffel bag.

The Fresno County Sheriff's Department identified Reta as a Los Angeles resident and directed LAPD detectives to his home in the 1200 block of West 39 Street.

When authorities knocked on the door Wednesday, police said, Tebedge jumped out of one of the second-floor apartment's windows and ran.

He was apprehended a block away.

Tebedge gave police a "rambling" confession of what had taken place three days earlier in Apartment 9, Gannon said.

Tebedge told police that he killed his father and sister, Zerfie Tibeje Getahun, 33. He placed his sister's body in the family's car and drove to Santa Barbara, where he left it in a ditch off U.S. 101.

Tebedge said he returned to the Los Angeles apartment, placed his father's remains in the luggage and drove four hours north to Fresno.

After Tebedge dumped the remains, his car broke down, he told police. He left it at a gas station and returned home in a rental car, he said.

"He had a history of mental issues that we're aware of," said Gannon, who is in charge of the South Bureau homicide unit.

"But, on the other hand, he was able to think this thing through well enough to be able to take one body up north outside of Fresno and then take the other body outside of Santa Barbara," he said.

When police arrived at the family's apartment, they sensed something was wrong.

"You could tell quickly that someone was hurt and bled significantly," Gannon said.

After being questioned, Tebedge led police to his sister's body, officials said.

Tebedge is scheduled for arraignment Dec. 10.

jp.renaud@latimes.com
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A Theory That Raises Questions - Schizophrenia may start in the womb - Washington Post

By Shankar Vedantam
Washington Post Staff Writer

Over the past several decades, a steady stream of studies has documented that people born in winter and spring have an increased risk for schizophrenia, a serious mental illness characterized by disordered thinking, hallucinations and other psychotic symptoms.

Explanations for the increased risk have ranged from the astrological -- different signs of the zodiac have been associated with various mental problems -- to accounts that suggested the risk came from seasonal variations in sunlight.

In recent months and years, scientists have developed a different explanation: Studies show the increased risk of schizophrenia appears linked to maternal infections during the first and second trimesters of pregnancy -- especially flu infections. Since the flu peaks in the fall, this might explain why babies born in the winter and spring have the higher risk.

The research is both intriguing and troubling. For one thing, it suggests that the origins of diseases such as schizophrenia might start as early as the womb. Indeed, symptoms of schizophrenia, which typically emerge in late adolescence or early adulthood and affects about 1 percent of the population, may only be the very last stage in a long process.

"Often what we see in the form of schizophrenia, bipolar disorder and even some of the more neurological disorders like Alzheimer's disease [is] the end stage where people show symptoms," said Thomas Insel, director of the National Institute of Mental Health. "The best model is in Parkinson's disease: You don't show the symptoms until you have lost 80 percent of the neurons in the substantia nigra," an area of the brain that helps produce the neurotransmitter dopamine.

But if research into the links between early maternal infections and schizophrenia might one day provide researchers with clues about how to attack the disease before symptoms become apparent, it also raises difficult public health conundrums.

That's because the newest studies suggest the culprit may not be infections such as the flu per se, but pregnant mothers' immune reactions to such infections. Current guidelines recommend that pregnant women get a flu shot -- and the point of the flu vaccine is to set off an immune reaction. If the risk for schizophrenia is increased as a result of maternal antibodies, might protecting mom and baby from the flu raise the risk the child could get schizophrenia years down the road?

The research into the links between maternal flu and schizophrenia is still considered preliminary, which makes any policy conclusions premature, but scientists studying the connection are starting to worry. National guidelines issued by the Centers for Disease Control and Prevention recommend that pregnant women get flu shots.

"Obviously, the safe thing to do is to go with the experts, and the experts are the CDC," said Paul Patterson, a professor of biology at the California Institute of Technology and one of the leading researchers into the link between maternal infections and schizophrenia. "However, if it was my wife, I would not [want] her vaccinated."

Patterson said he would try to protect a pregnant family member from the flu by suggesting she keep away from infected people and by enforcing a regimen of regular hand-washing among all family members.

However, he conceded that such measures might not be as effective as flu shots and that women who get the flu because they don't get a flu shot might not only put their future children at increased risk for schizophrenia, but also incur numerous other risks from the illness. Careful prevention techniques, moreover, are unlikely to help pregnant women who have toddlers, because small children tend to bring home endless streams of viral infections.

Insel praised Patterson's research into the connection between infections and schizophrenia, but he warned against rushing to revise flu shot recommendations.

"It raises a question but does not provide an answer," Insel said of the newest research. "We are not ready to jump from any of this to the policy dimension."

The Evidence

Hints about the schizophrenia-winter connection have been around for decades.

Epidemiologists have found that children of women who were pregnant during widespread flu epidemics seemed to have higher risk for schizophrenia. But critics have said there's insufficient evidence to assert a causative relationship because such studies did not confirm that the pregnant women had the flu.

Besides, other factors seemed to trigger the same effect: One wartime study found that pregnant women whose husbands died were more likely to have children who later developed schizophrenia.

A research breakthrough came in 2004 when Alan Brown, a psychiatrist at Columbia University and the New York State Psychiatric Institute, got access to data from a study that collected blood samples between 1959 and 1966 from thousands of pregnant women at different stages of their pregnancy.

In an analysis that compared blood samples from the mothers of 64 children who went on to develop schizophrenia with blood samples of similar mothers whose offspring did not, Brown and his colleagues showed that women who had higher levels of influenza antibodies in their first or second trimester of pregnancy had offspring who were three to seven times more likely to develop schizophrenia.

Brown calculated that if the women had not had the flu during pregnancy, 14 percent of the schizophrenia cases could have been prevented, an effect he calls potentially enormous for a disease believed to have several complex genetic and environmental factors.

Brown and other researchers also began seeking evidence that mothers who contracted other infections during pregnancy also had children who were at increased risk of schizophrenia; they also began looking for common pathways between the infections. One appeared to be an immune system protein, or cytokine, called interleukin-6; cytokines are activated not only through infections but also through stress.

Brown, Insel and Patterson all hasten to point out that, while schizophrenia is a relatively rare disease, as many as 10 percent of women get the flu while they are pregnant, and many pregnant women contract other infections and experience stress. This suggests that the vast majority of women who have their immune systems triggered during pregnancy will not have children who develop schizophrenia.

Insel also cites evidence that genetics may play a more dominant role than the environment in determining who gets schizophrenia: Studies of identical twins show that when one child develops schizophrenia, the other has a 50 percent chance of developing the disorder, too.

However, some of the increased risk among identical twins may be a result of maternal infections during pregnancy -- and not genetics, Patterson argues. That's because those identical twins who share a common placenta -- and who are, therefore, more likely to receive the same maternal cytokines -- seem to have a higher risk of schizophrenia than identical twins who do not share a common placenta.

(While the science assigns no blame to mothers for these risks, the long history of blaming parents for the disorder suggests it might be useful to note that people's immune systems are beyond their control, and pregnant women cannot be held responsible for the flu-schizophrenia link.)

E. Fuller Torrey, a Washington psychiatrist with a long interest in schizophrenia, said the link between early maternal infections and schizophrenia is strong. He believes that infections and immune reactions in young children, not just maternal infections during fetal life, might be involved in elevating the risk for schizophrenia.

Animal research conducted by Caltech's Patterson along with William Carpenter and James Koenig at the Maryland Psychiatric Research Center at the University of Maryland appears to support the theories of Brown and others.

Pregnant rodents given flu infections seem more likely to have offspring that show some of the behavioral symptoms of schizophrenia, such as social withdrawal and anxiety. When the effect of maternal antibodies is blocked, the offspring do not go on to develop such symptoms.

Patterson said he also hoped to see new epidemiological studies that specifically looked at whether pregnant women given flu shots had offspring with a higher risk of schizophrenia than pregnant women who did not receive flu shots.

"It is true that vaccinations do not cause the same degree of immune activation as an infection," he said. "But if you are recommending universal vaccinations for every woman who is pregnant, you are asking for increased risk for schizophrenia because some women are going to have a very strong reaction."

What should pregnant women do until useful policy conclusions can be drawn?

Experts say the best bet is probably to stick to official public health guidelines on the flu shot, and to try to limit infections and stress during pregnancy.

"I was raised in the Midwest, so I believe the best motto is, 'Everything in moderation,' " Koenig said. "Keep your life as well balanced as possible." ¿

Comments:vedantams@washpost.com.


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Will Kids Outgrow ADHD? - Washington Post

Experts Help Parents Put Findings in Perspective

By Lindsay Minnema
Washington Post Staff Writer

New findings that attention-deficit hyperactivity disorder may stem from a developmental delay that children could outgrow, rather than a cognitive deficit, have raised questions for parents of the 4.4 million children diagnosed with the disorder.

The findings from a National Institute of Mental Health study, published online by the Proceedings of the National Academy of Sciences, compared brain scans of 446 children with and without the disorder. The brains of children with ADHD appeared to develop normally but more slowly, lagging on average about three years behind other children.

We spoke with several experts about what the findings might mean for parents.

Why the sudden change in thinking?

It's not really sudden. Scientists have long suspected that ADHD may be tied to delays in brain development, but until now there has been little biological evidence. In the new study, biological differences were most evident in the cortex, the part of the brain that governs attention, planning and judgment. On average, in children with ADHD, thickening of the cortex appeared to peak at age 10.5, compared with age 7.5 in children without the disorder.

"It helps present a better, non-stigmatized, biological explanation for why . . . some kids have ADHD symptoms," said William Coleman, professor of developmental and behavioral pediatrics at the University of North Carolina and chairman of the Committee of Psychosocial Aspects of Child and Family Health at the American Academy of Pediatrics. "They're not bad, not lazy, not unmotivated. They don't have bad parents. They just have a developmental lag."

Does this mean that my child will outgrow his ADHD symptoms by the time he's a teen?

Perhaps.

"[The study] doesn't show that the brains of kids with ADHD completely 'normalize' by age 12 or so," the study's lead author, Philip Shaw, wrote in an e-mail last week. "We only looked at one aspect of brain development. Many other structural and functional brain differences persist in the brains of teens with ADHD."

"While a lot of people with ADHD do improve with age, as many as two-thirds still have symptoms of the disorder which persist into adulthood," Shaw said. Among possible explanations: There may be more than one genetic variant of the disorder, or perhaps some kids with ADHD have other conditions that are responsible for their symptoms.

"The primary problem may be a learning disability," Coleman said. "[Researchers] say that once the cortex thickens, kids get better, but if they have ongoing, undiagnosed problems, their symptoms may persist."

So, should I stop giving my child stimulant medications, such as Ritalin, to help with attention problems?

That's beyond the reach of this latest study. "The study gives no implication of what treatments should be used," said Judith Rapoport, chief of the child psychiatry branch at the National Institute of Mental Health and one of the authors of the study.

An estimated 2.5 million children in the United States took medications for ADHD in 2003, according to the Centers for Disease Control and Prevention.

Thomas Kobylski, past president of the Child and Adolescent Psychiatry Society of Greater Washington, says intervention with behavioral therapy or medication is important so that children don't fall behind academically or develop secondary problems, such as anxiety or low self-esteem.

"The field has clearly stated that delays are worrisome," he said. "You don't want kids to become more delayed. You don't want them to fall behind."

Whether medication is appropriate depends on a careful evaluation of a child's symptoms, environment, relationships and demands placed on him, Coleman said. "Always ask your physician: 'What is normal for my child developmentally?' "

Wou ld it help to hold a child back in school so he can catch up to his peers?

That depends, said Coleman, who generally advises against holding a child back in school for academic reasons alone. But if a child is feeling left out and is socially or emotionally behind his peers, it may benefit him to stay back a grade, he said.

Isn't there a way to help nudge the development process along?

Sadly, no. Adolescent brains are structurally different from children's brains, and there is no known way to speed up the growth process, Coleman said. What does help many children is a combination of medication and therapy -- working closely with parents, teachers and physicians to help a child work through academic and social weaknesses.

Comments:health@washpost.com.


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A Stable Doctor for a Scattered Life - New York Times

By ELISSA ELY, M.D.

It was clear when we met that the patient’s intelligence was severely limited. He could hardly find his own thoughts. Rocking in a chair not built for rocking, he gave a scattered history of head trauma and explosiveness. He was fresh from prison (another sentence for assault), living in the shelter and tired of himself. He hated hurting people, he said. He wanted a medication to cure this once and for all.

We reviewed his psychiatric hospitalizations. There had been many. He would be started on some new medication, then be discharged to the streets with two weeks of pills and a diagnosis to add to his definition of self. “I’m bipolar schizophrenic with attention deficit and P.T.S.D.,” he said, using the initials for post-traumatic stress disorder. Polysyllabic diagnoses always tell more about a hospital than a patient.

Freed, he would suddenly decide that he had always wanted to see downtown Baltimore, or that he needed to catch up with an old friend who might still be in Seattle. When the two-week prescription ran out, there was no refilling doctor. It wouldn’t take long before some slight motion of a stranger would enrage him; another assault, another admission, another medication.

He took them in a cloud, dozens of them, and could not remember their names — except for one. It had worked perfectly for him. He even knew the dosage: it was Haldol, 15 milligrams. “At hour of sleep,” he said, reciting from the hospital chart.

No one gives Haldol to patients with brain damage anymore, especially at such a high dose. It is an old-school antipsychotic that causes restlessness, Parkinsonian stiffness, the involuntary movements called tardive dyskinesia, and — rarely but unforgettably — a dystonic reaction, in which muscles go into spasm and the patient is left outwardly paralyzed but inwardly in agony.

“Haldol has terrible side effects for some people,” I said.

“Oh, yeah,” he replied, as I recall. “I had a friend who took it once. His eyes rolled back, his head snapped, he couldn’t swallow, he was crying and screaming in pain, man, it was terrible. But 15 milligrams at hour of sleep is what I need.”

The specificity of this limited man was impressive. He knew the name of the drug he wanted — a drug no one takes voluntarily — and its dosage. Would he take another medication with it to prevent side effects? He was firm. It was Haldol at a high dose, and nothing else. Against educated instinct, I wrote a prescription: Haldol 15 milligrams at hour of sleep. His experience trumped mine.

The homeless shelter called the next morning. After one dose, he had gone into a catastrophic dystonic reaction. It was just as he had described; his eyes rolled, the neck snapped back. He was sent by ambulance to an emergency room, shot full of Benadryl, and returned, shaking, to the shelter.

The friend he had been talking about was himself. In his simple-minded way, he had given warning. But I had not heard correctly. I had been listening literally, instead of with a third ear. A day later, he disappeared with no forwarding address or phone number. I assumed I had driven him away. I certainly would have driven me away.

That was the end of the story. Then, eight months later, there was a call from an E.R. nurse somewhere in Florida. “I’m sitting here with Mr. X,” she said. “He gave us your name and said that you’re his psychiatrist. He speaks very highly of you, and he’d like to make a follow-up appointment.” She made it sound as if the office door had just shut behind him.

“He’s in Florida,” I said, confused.

“Yes. But he’s thinking of taking a bus back to Boston, and wants to know how your schedule looks for next week.”

One humbly learns. The harm I had caused in a single meeting was nowhere near as important as the idea that he had a doctor of his own, someone he could call from an emergency room in Florida for a follow-up appointment after eight months, someone — at last — who would see him again.

That mattered. The rest, it turned out, was easily forgiven.

Elissa Ely is a psychiatrist in Boston.

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Judge Questions Security At Mental Facility - WKRC.com Cincinnati (OH)

The judge who sent Russell Bravard to Summit Behavioral Center says today the courts may have to find another place to send inmates who need psychiatric help.

Bravard is still on the loose tonight, and considered armed and dangerous. Over the weekend, police recaptured Jonathon Kirkendall, who escaped with him.

In this developing story alert, Local 12's Rich Jaffe shows what's behind the security questions at Summit.

In court this morning, charged with escape, prosecutors made it very clear, they didn't want Jonathon Kirkendall returning to Summit Behavioral Center. They want him locked up at the Justice Center. A judge sentenced Kirkendall to serve time at Summit, after finding him not guilty by reason of insanity on a serious assault charge from Athens County. The fact that he and roommate, Russell Bravard, were able to escape on Thanksgiving is an issue for the judge who sent Bravard there in the first place.

Judge Alex Triantafilou, Hamilton County Common Pleas: "If we feel that Summit is not a secure facility, we'll start to order those we feel are a danger to be held at the Justice Center, which would contribute to the problem we have there with overcrowding, we rely very much on Summit as a place that's secure, that's why this is a particular concern."

Russell Bravard has a serious, violent criminal history. He had to be restrained by deputies at his initial appearance, but he was found not competent to stand trial and sent to Summit until he can help with his own defense.

"Summit is run by the State Mental Health Department, not Hamilton County. So, while Hamilton County Judges use this facility, they don't really have oversight here. However, they are in a position to decide whether or not they'll use it."

Demanding answers, Judge Triantafilou says he's just beginning to ask the questions.

"I intend to look into it further and ask some questions of our court administration to be sure that we are familiar with how things operate at Summit, and before we send other folks there that it's a secure facility."

Judge Triantafilou tells us he will be sending a letter outlining his concerns to the CEO of Summit, Elizabeth Banks. Local 12 attempted to contact Ms. Banks about these issues, however, we did not hear back from her today.

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Depression Linked to Bone Loss in Younger Women - KVOA HealthDay News (Tuscon AR)

By Amanda Gardner, HealthDay Reporter

MONDAY, Nov. 26 (HealthDay News) -- Premenopausal women struggling with depression have lower bone mass than do non-depressed women in the same age range, a new study found.

The bone loss was most pronounced in certain regions of the hip, which is troubling given that hip fractures are one of the most serious -- and potentially fatal -- consequences of osteoporosis.

The level of bone loss seen in the depressed women was the same or higher than that associated with other, established risk factors for osteoporosis, including smoking, low calcium intake and lack of physical exercise, the researchers said.

The findings, published in the Nov. 26 issue of the Archives of Internal Medicine, could have implications for the prevention of osteoporosis.

"Premenopausal women with depression should be screened for low bone mass," said Dr. Giovanni Cizza, senior author of the study who conducted the research while at the U.S. National Institute of Mental Health. "They should do a bone mineral density measurement, because osteoporosis is a silent condition. Until someone fractures, you don't know you have osteoporosis."

Cizza is now a staff clinician at the U.S. National Institute of Diabetes and Digestive and Kidney Diseases.

A woman's bone mass peaks during youth then thins after menopause. Previous, preliminary studies had suggested that depression might be a risk factor for low bone mass in older women.

For this study, Cizza and his colleagues looked at 89 women with depression and 44 women without depression. The women ranged in age from 21 to 45. The depressed women were taking antidepressant medications.

Seventeen percent of the depressed women had thinner bone density in the femoral neck, a vulnerable part of the hip. Only 2 percent of non-depressed women, by contrast, had thinner bone in this area.

Twenty percent of depressed women also had low bone density in the lumbar spine, compared with 9 percent of the non-depressed women.

Blood and urine samples also revealed that the depressed women had lower levels of "good" proteins called cytokines. "The bad cytokines that may cause bone loss are higher," Cizza said.

It's not clear what role antidepressants might play, but by relieving the depression, the drugs may also help bone mineral density, the researchers said.

More information

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Mental side-effect warnings sought for flu drugs - Washington Post

By Christopher Lee
The Washington Post

WASHINGTON — Food and Drug Administration (FDA) experts are recommending new label warnings about possible dangerous psychiatric side effects of influenza drugs Tamiflu and Relenza, documents show.

The FDA documents, posted Friday on the agency's Web site, were prepared for a meeting Tuesday of the FDA's Pediatric Advisory Committee.

Studies revealed 596 cases in which patients who took Tamiflu experienced "neuropsychiatric events" such as delirium, delusions or hallucinations. The episodes sometimes led to impulsive behavior and self-injury. Tamiflu is made by Roche Holdings.

The problems tended to occur within 24 hours of first taking the drug, and the majority were in patients younger than 21, mostly in Japan, according to the documents. In five cases involving pediatric patients, the reported delirium resulted in death, and there were three reports of suicide in adults.

"In the remaining reports of delirium with impulsive behavior and self-injury, patients were attempting to flee or escape from windows or balconies and were unsuccessful in their efforts," the FDA documents say.

Tamiflu, available in pill and syrup form, can treat the symptoms of seasonal influenza. In a bird-flu pandemic, many experts think the drug could help reduce the length and severity of symptoms.

Safety concerns about Tamiflu arose two years ago after reports of 12 deaths and 32 cases of psychiatric problems in children in Japan. Labeling for Tamiflu in the United States notes that self-injury and delirium have occurred, primarily among pediatric patients.

Now FDA regulators are recommending that U.S. labeling be updated to note that "fatalities have occurred in adult and pediatric patients in Japan, the onset may be abrupt, and fatal events have occurred even while the patient was being monitored."

Regulators cautioned that no causal link has been established between the drug and the abnormal behavior, and that delirium and other problems can be complications of influenza.

Roche spokesman Terry Hurley said reports of abnormal behavior were "infrequent."

Regarding Relenza, an antiviral drug made by GlaxoSmithKline that is in the same class as Tamiflu, FDA experts said studies turned up 115 cases of psychiatric problems, including 74 cases in patients younger than 21. Seventy percent were in Japan. No potentially related deaths were reported.

Because Relenza, which is inhaled by mouth, is not easily absorbed, experts said the problems probably were related to the influenza rather than the treatment.

Nevertheless, they recommended updating Relenza's label to note that "postmarketing reports of hallucinations, delirium and abnormal behavior have been observed in patients" receiving the drug for treatment of influenza. The label does not warn of psychiatric side effects.

Glaxo spokesman Jeff McLaughlin said, "A review of clinical trial data and postmarketing reports demonstrated no evidence of a causal association between Relenza and neuropsychiatric adverse events."

William Schaffner, chairman of the Department of Preventive Medicine at Vanderbilt University School of Medicine in Nashville, Tenn., said the proposed warnings are "prudent and appropriate."

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Counseling Hot Lines Help Farmers - Associated Press

By KRISTIN M. HALL
Associated Press Writer

NASHVILLE, Tenn. — American farmers no longer have to stoically face all that Mother Nature and the economy can dish out.

At least eight states offer free mental health hot lines to assist farmers and producers through difficult patches. During times of exceptional drought, such as the one that has covered the Southeast this year, the hot lines report a jump in calls from farmers needing emotional counseling and stress management.

The confidential hot lines offer a variety of resources such as vouchers for therapy sessions, referrals to mental health providers and trained financial experts who can analyze a farmer's bills. Some hot lines are operated by nonprofit or religious organizations while others, like Tennessee's, are a part of a university's agriculture department.

Agriwellness Inc., a nonprofit devoted to the behavioral health of people in agriculture, coordinates hot lines in Iowa, Kansas, Minnesota, Nebraska, North Dakota, South Dakota and Wisconsin and gets an average of 12,000 to 14,000 calls a year.

Michael R. Rosmann, the executive director of Agriwellness, said drought is especially tough on farmers and producers because its effects last over more than one season.

"It wears down people's spirits. You don't know when it's going to end and what you're going to do about it," Rosmann said.

Georgia Gov. Sonny Perdue's decision to recently lead a state vigil praying for precipitation may have been derided, but Rosmann thinks the gesture brought immense comfort to many people.

Richard Jameson, a 53-year-old farmer in western Tennessee, watched his cotton and soybean crops shrivel under several weeks of extreme heat and a prolonged drought this year. He says it would have been harder to weather the crisis if he hadn't decided on his own to seek therapy about nine years ago.

"I was waking up at 4 a.m. every day with my heart pounding," Jameson said. "I had gotten to a point in my life when I knew I needed help."

Jameson says his regular visits to a therapist in Memphis, about 50 miles from his Haywood County farm, help him realize that he isn't alone in dealing with depression.

"Farmers often work by themselves. That near isolation can really exacerbate feelings of worthlessness, anxiety or depression," Jameson said. "We feel like nobody in the history of mankind has any idea what we go through."

Rural farming families face several obstacles to getting mental and emotional help in times of crisis, says Kathy Bosch, extension specialist at the University of Nebraska-Lincoln. Bosch has studied Nebraska panhandle farmers and ranchers who are now in their eighth year of drought.

"There has been a stigma attached to asking for help," Bosch said. "Some of them were very leery or cautious to ask for help."

The University of Tennessee's hot line has reached an estimated 15,000 farm families since 1986.

"We can't solve all the problems, but we can help people think through a number of alternatives," said Clark Garland, a professor and coordinator of the hot line.

Untreated stress can push farmers into substance abuse, domestic abuse or suicide, according to Rosmann, who is also a clinical psychologist. About 2 percent of callers to the Agriwellness hot lines are people who are suicidal and rates of suicide are higher among rural males than their urban counterparts, he said.

"One of the things that helps is talking to other people and sharing feelings of uncertainty or disillusion. The verbal sharing of stress helps a lot," Rosmann said.

Jameson said he's not embarrassed to talk about his therapy with other Tennessee farmers and will encourage them to take advantage of the hot line as they prepare for next year's season.

"It's going to get colder, the nights are longer, all the bills are starting to come in. It's hard to be joyful and cheery when you're going through this," Jameson said.

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For mentally ill young adults, a safe haven - LA Times

Daniel's Place in Santa Monica is a support center that can be, for some, a home away from home.

By Martha Groves
Los Angeles Times Staff Writer

It's not at all typical for a 27-year-old man to enlist Buster the Bunny and Peter the Penguin to facilitate conversations with his mother.

But Jan Kyas can tell his plush go-betweens things he finds it hard to say directly to people. His mother, Jirina Kyas, has embraced this communion; she talks to them as well when speaking right to her son doesn't work.

A former high school percussionist and Santa Monica College graduate, the young man learned as an adult that he suffers from Asperger's syndrome, a form of autism characterized by difficulties with social and communication skills, and the often attendant depression and anxiety. He carries the stuffed animals in his backpack.

Kyas has no qualms about trotting out his inanimate menagerie when he visits Daniel's Place, a Santa Monica support center for mentally ill young adults and their families. Other participants don't bat an eye in the center's group room, the walls of which are plastered with their original drawings.

After all, these are people who all have their own ways of coping. Sometimes it's growing a dramatically spiked mohawk. Sometimes it's singing the oldies on a karaoke machine. Sometimes, amazingly, it's using humor. Despite enduring frightening psychotic breaks and the vagaries of medication, the participants at Daniel's Place saw fit to dub a furry white mascot "Bipolar Bear."

Founded in 1998, Daniel's Place, on Ocean Park Boulevard near the Santa Monica Airport, is a program of Step Up on Second, a nationally recognized Santa Monica recovery center for individuals middle age or older who have chronic mental illness.

Daniel's Place provides support, education and information about available services to adults 18 to 30 and their families. It also connects families as they struggle with issues related to mental illness, primarily bipolar disorder, major depression and schizophrenic disorders. The program has served hundreds of young adults and has 79 active cases, said Emily James, team leader and program director.

Many of the young people referred to the center are experiencing their first episodes of mental illness. Their families, meanwhile, are suddenly having to grapple with their children's bewildering behavior.

For many of the young adults, Daniel's Place is a home away from home -- or the closest thing to a home that they have. They can play and listen to music, take cooking classes, use a computer and chat.

"Daniel's Place gives young adults a safe place in which to understand the implications of having a mental illness while pursuing recovery, wellness and their goals," said Robin Kay, acting chief deputy director of the Los Angeles County Department of Mental Health.

Daniel's Place was initially funded by Arthur Greenberg, a founding partner of the Los Angeles law firm Greenberg Glusker, and his wife, Audrey. The program is named for their son Daniel, who was born in 1959. He attended Harvard School for Boys, acted, played football and graduated from Princeton.

While in college, Daniel had his first psychotic break. Thanks to treatment and medication, he was able to finish school. He then spent several years at Step Up on Second, first as a client and then as a caseworker and outreach worker.

But Daniel continued to struggle with his illness, and it ultimately led to his suicide in 1997.

"He touched the lives of many other people isolated by their illness and got them connected to Step Up," said Tod Lipka, chief executive and president of Step Up on Second.

Susan Dempsay, the retired executive director of Step Up on Second, encouraged the Greenbergs to provide the seed money for a separate program for young people. Her son, Mark Klemperer, 47, had known Daniel Greenberg in elementary school. Klemperer, the son of actor Werner Klemperer and the grandson of composer-conductor Otto Klemperer, suffered a mental break in high school and, Dempsay said, has been homeless many times since.

"Daniel's Place was, I have to say, a first in Los Angeles and almost a first in the country," Dempsay said. "People were not paying attention to this young group."

Matt Lord, 28, said he feels that Daniel's Place helped save his life. While at the University of Florida, he started slipping into depression. "When I was awake, I seemed alone even when I was with people," Lord said. "My life was narrated by thoughts that weren't mine."

He drifted in and out of mental hospitals and lived in a rough "board and care" home. Eventually, he was diagnosed with schizoaffective disorder (a condition with characteristics of both schizophrenia and a mood disorder) and bipolar disorder. A county caseworker referred him to Daniel's Place.

"Another guy in my peer group talked about the TV talking to him," said Lord, who sports long dark hair and a goatee. "It opened the gate. I had that too. It was a supportive network." Lord now takes several medications to manage his illness and works as an assistant at the center.

"It's a cozy, safe environment," he said. "It bursts with hope and understanding."

That has been the case for Jan Kyas and his mother. They first sought the center's help in 2005 after Jan (pronounced Yahn) had a bad reaction to an antidepressant and spent every night walking around the house because he could not sleep. Fearful of his erratic behavior, his mother hid all the kitchen knives.

Since beginning sessions at the center, Jan has felt comfortable and accepted, Jirina Kyas said. She and other mothers have formed a support group. A Buddhist chanting group started by Clare Lowenau, whose daughter has schizoaffective disorder, helped Jan open up to the point that he now sings and leads discussions of fiction and poetry.

Whenever Jirina Kyas has trouble communicating with her son, Buster the Bunny comes out.

"Hey, Buster, can you tell Jan that I need to talk to him?" she told the slightly worn stuffed animal as she held it on her lap one recent afternoon in the group room.

Jirina Kyas said Jan carries the animals everywhere. "They keep us company when we watch TV, lined up on top of the sofa," she said. "They eat lunch with us."

Daniel's Place has had a profound effect on her and her son. When he decided to attend Santa Monica College, she joined him. She is now a research scholar at UCLA, where she has studied play therapy, among other subjects.

The center's success stories have won attention. Los Angeles County recently provided a $125,000 grant that will be used to expand the center's hours and services.

Further expanding its mission, Daniel's Place is slated to open its first permanent supportive housing next fall. The $2.4-million project will transform a vacant motel on Santa Monica Boulevard into Daniel's Village, with eight units for mentally ill young people.

"We know for people with mental illness that permanent supportive housing is the answer," Lipka said. "Daniel's Village will provide the opportunity to get that needed support early on, as well as develop independent living skills such as shopping, budgeting money and paying bills."

Getting a diagnosis of mental illness does not doom a young adult to a lifelong struggle, Lipka said. Daniel's Place, he said, is about "encouraging the person to take over the management of their illness. You can lead a life of self-sufficiency."

martha.groves@latimes.com
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A searing account of life with schizophrenia - Boston Globe

By Judy Foreman

Most of us have never had to live inside our heads as all hell is breaking loose.

We've never faced the terror of falling apart, of totally losing our grip on reality. We've never experienced the horror of hearing strange voices tell us to do terrible things. Most of us, in other words, have never had schizophrenia, one of the most common and most severe forms of mental illness.

Elyn Saks has.

In her gripping new book, "The Center Cannot Hold," an insightful look inside the mind of a person with schizophrenia, she describes her many traumatic experiences.

In one of the earliest episodes, a quarter-century ago, she's in the emergency room of a major academic medical center, in the midst of a breakdown. The doctor "and his whole team of ER goons swoop down, grab me, lift me high out of the chair, and slam me down on a nearby bed with such force I see stars. Then they bind both my legs and both my arms to the metal bed with thick leather straps.

"A sound comes out of me that I've never heard before - half-groan, half-scream, marginally human, and all terror. Then the sound comes out of me again, forced from somewhere deep inside my belly and scraping my throat raw. Moments later, I'm choking and gagging on some kind of bitter liquid that I try to lock my teeth against but cannot. They make me swallow it. They make me . . . I am finally powerless."

You would never suspect, reading that and the other remarkable stories she tells, that Saks graduated first in her class from Vanderbilt University. That she won a Marshall Scholarship to Oxford. That at Yale Law School, she was editor of the law journal. Or that today, at 52, she is happily married, a law professor at the University of Southern California, and an adjunct professor of psychiatry at the University of California in San Diego.

To be sure, Elyn Saks is not typical of most people with schizophrenia, noted Dr. Dost Ongur, director of the schizophrenia and bipolar disorder program at McLean Hospital in Belmont. She is extremely high-functioning, compared to other people with schizophrenia, or, for that matter, the rest of us. It's somewhat of a mystery how she has done so well, but she's certainly benefitted from an increasingly sophisticated array of medications and unending work on herself.

Saks's decision to go public with her inner struggle is another milestone in the battle to destigmatize mental illness, Ongur said. It allows people blessed with comparatively undamaged brains to understand, if only vicariously, what it feels like to live with a brain gone wild.

"Imagine how difficult it would be to be confused and disoriented ... and to live in fear that someone was about to harm you or your family," said Ongur. The hopeful message from Saks's journey is that it shows "that a diagnosis of schizophrenia is not the end of someone's productive life. It's not a death sentence."

Schizophrenia, once thought of as a failure of parenting, is now known to be a brain disease characterized by psychosis (a loss of contact with reality) and thoughts that are delusional, such as the false conviction that one is being persecuted or that one's actions are being controlled by outside forces.

One theory, supported by numerous studies, is that in schizophrenia, there are too few brain cells that produce a chemical called GABA, the brain's chief inhibitory neurotransmitter. Brain scans also show that people with schizophrenia "have slightly less brain tissue" than normal, Ongur said.

An emerging theory is that schizophrenia, which tends to run in families, may also be a failure of myelination, the process by which a fatty, protective sheath is laid down on the wires, called axons, that connect brain cells to each other.

Without proper myelination, the brain of a person with schizophrenia cannot squelch disturbing thoughts, such as the fear of death of oneself or a loved one, said Dr. George Bartzokis, a professor of neurology at the David Geffen School of Medicine at UCLA who does research on schizophrenia. "Your ability to inhibit those thoughts, which has to be faster than the thoughts themselves, isn't there. So the person thinks that these thoughts are not coming from himself "but from God or whatever. It's very disturbed thinking."

Bolstering this theory is the fact that one of the genes associated with schizophrenia is neuregulin, whose job is to help put myelin on the axons of brain cells.

Newer, so-called "atypical" antipsychotic drugs such as Clozaril, Zyprexa, Geodon, Risperdal, Seroquel, and Abilify help many people, including Saks.

Saks also has lots of social support, including a husband who, she said in a telephone interview, can now tell before she can when she is about to "flip" into a psychotic episode.

Saks readily concedes that, despite intensive therapy and medications, she is not cured of schizophrenia. No one is.

To help her cope, she does some academic work every day because that helps keep her oriented toward reality. She schedules ample rest time and has learned to keep stress to a minimum. (Stress has been shown to inhibit myelin production.) And unlike most people with schizophrenia, she believes that psychotherapy - in her case, ongoing psychoanalysis - helps her cope.

Many, perhaps even most, psychiatrists think that the thought processes of people with schizophrenia are too disordered to allow psychoanalysis, a particularly intense form of talk therapy, to be useful. But Saks said that, in her case, anyway, "psychoanalysis has helped me make meaning out of the struggle."

Saks said that the meaning she has drawn is that it's time to stop "marginalizing people who are different. Many people think that those with mental illness are to blame and that it's OK to criticize them."

"I did not overcome great odds by sheer force of will," she said. "A huge number of resources have been and still are invested in me - long-term therapy and medications. We need to put more resources into the system so that other people with schizophrenia can live up to their potential as well."

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Brain pattern associated with genetic risk of Obsessive Compulsive Disorder - University of Cambridge Press

New findings could help predict risk of OCD as well as lead to improved diagnostics.

Cambridge researchers have discovered that individuals with obsessive compulsive disorder (OCD) and their close family members have distinctive patterns in their brain structure. This is the first time that scientists have associated an anatomical trait with familial risk for the disorder.

These new findings, reported today in the journal Brain, could help predict whether individuals are at risk of developing OCD and lead to more accurate diagnosis of the disorder.

Obsessive compulsive disorder is a prevalent illness that affects 2–3 % of the population. OCD patients suffer from obsessions (unwanted, recurrent thoughts, concerns with themes of contamination and ‘germs', the need to check household items in case of fire or burglary, the symmetrical order of objects or fears of harming oneself or others) as well as compulsions (repetitive behaviours related to the obsessions such as washing and carrying out household safety checks). These symptoms can consume the patient's life, causing severe distress, alienation and anxiety.

OCD is known to run in families. However, the complex set of genes underlying this heritability and exactly how genes contribute to the illness are unknown. Such genes may pose a risk for OCD by influencing brain structure (e.g. the amount and location of grey matter in the brain) which in turn may impact upon an individual's ability to perform mental tasks.

In order to explore this idea, the researchers used cognitive and brain measures to determine whether there are biological markers of genetic risk for developing OCD. Using magnetic resonance imaging (MRI), the Cambridge researchers captured pictures of OCD patients' brains, as well as those of healthy close relatives (a sibling, parent or child) and a group of unrelated healthy people.

Participants also completed a computerised test that involved pressing a left or right button as quickly as possible when arrows appeared. When a beep noise sounded, volunteers had to attempt to stop their responses. This task objectively measured the ability to stop repetitive behaviours.

Both OCD patients and their close relatives fared worse on the computer task than the control group. This was associated with decreases of grey matter in brain regions important in suppressing responses and habits.

Lara Menzies, in the Brain Mapping Unit at the University of Cambridge, explains, “Impaired brain function in the areas of the brain associated with stopping motor responses may contribute to the compulsive and repetitive behaviours that are characteristic of OCD. These brain changes appear to run in families and may represent a genetic risk factor for developing the condition. The current diagnosis of OCD available to psychiatrists is subjective and therefore knowledge of the underlying causes may lead to better diagnosis and ultimately improved clinical treatments.

“However, we have a long way to go to identify the genes contributing to the distinctive brain structure found in OCD patients and their relatives. We also need to identify other contributing factors for OCD, to understand why close relatives that share similar brain structures don't always develop the disorder.”

For further information, please contact the University of Cambridge Office of Communications on 01223 332300


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Bolingbrook man's felony charges dismissed - Chicago Sun-Times

BY JENNIFER GOLZ Sun-Times News Group

WHEATON -- A Bolingbrook man has been cleared of his felony burglary charges after successfully completing DuPage County's Mental Illness Court Alternative Program.

Christopher R. Sievers, 23, of the 300 block of Brighton Lane, was facing one count of burglary and two counts of residential burglary for a series of break-ins he committed in a Lisle neighborhood in March 2005.

He was caught after a homeowner reportedly surprised Sievers as he was trying to make a getaway through a side door of an Arbor Ridge subdivision home in the middle of the night.

There was a brief exchange between Sievers and the homeowner, which even included a hand shake, and then he left, allowing the homeowner to call police.

Sievers hadn't make it out of the subdivision before Lisle police stopped him, according to reports. Found in his car were DVDs, Xbox games, gift cards and wireless phones, reportedly taken from two homes and a vehicle in the neighborhood.

Sievers was arrested and charged that night and released a day later after posting 10 percent of his $20,000 bond. By that September, he was enrolled in the county's MICAP program.

MICAP is a court-supervised program that allows criminal defendants with mental illness to seek mental health services as an alternative to punishment. Upon successful completion, charges are reduced or even dismissed, as in Sievers' case.

Copyright 2007 Associated Press. All rights reserved. This material may not be published, broadcast, rewritten, or redistributed.



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Iraq vets help each other - Charlotte Observer

BARBARA BARRETT

The letter landed in Army Sgt. 1st Class Chad Stephens' mailbox in the Williamston armory last week. It ran three pages. It was from a Marine who had served in Beirut.
The Marine described his nightmares and experiences and referred to Stephens' 11-year-old son.

"He said I need to make sure that little guy grows up," Stephens said. "I thought it was a good letter. He gave me good advice."

The News & Observer ran a series called The Promise two weeks ago that detailed Stephens' struggles since an N.C. National Guard battle in Baqouba, Iraq, in June 2004. One of Stephens' gunners, Spc. Daniel Desens Jr., was killed in the fight. Stephens, a platoon sergeant, was awarded a Silver Star after trying to save Desens.

Several of Stephens' soldiers left messages on the News & Observer's Web site, share.triangle.com, last week discussing their own problems.

"I was there with Chad in Baqubah Iraq and I do suffer from PTSD," wrote one sergeant. "It is real and I too call on Chad from time to time for help."

Another soldier wrote, "I still find myself living around our patrol schedule, almost 3 years later, I cant work more than 20 hours a week, I have trouble with short term memory, I get angry very easily where before it was a rare (occurrence). Things I used to enjoy are now hard to do."

Many of those responding to the series said war adversely affects many soldiers, and that, often, veterans only feel comfortable talking with other vets.

Soldiers often see a military bureaucracy wrestling with how to help troubled vets, especially Guard soldiers living civilian lives, scattered from other members of their units.

"It's a counseling thing," said Staff Sgt. Leo Schnack, who served with Stephens and lives in Durham. "Vets get along with other vets. They're able to bypass that wall, that first barrier of communication."

National Guard troops don't drill for 90 days after returning home from their combat tours. The theory is that soldiers need time with their families and home lives.

A proposal in Congress would shorten time away from the unit to 30 days, because experts are beginning to realize that soldiers need to spend time with other soldiers.

The bill, called the "Yellow Ribbon Reintegration Program," authorizes $23 million, would require pre-deployment counseling for soldiers and families, post-deployment follow-up care, and the hiring of more than 200 people to administer the program. It has been referred to the House and Senate Armed Services committees.

Stephens has been diagnosed with post-traumatic stress disorder. He has wrestled with skittishness and nightmares since returning to his home in Ahoskie from Iraq.

"One thing: If you've got a problem, you ought to get help," Stephens said. "The other thing is, the military's not helping everybody that needs help, especially the Guard."

Pentagon surveys indicate that up to 20 percent of the men and women who serve in Iraq and Afghanistan could come home with signs of PTSD.

And about one-third of active-duty troops and up to half of National Guard soldiers could return with a broader array of mental health symptoms, according to surveys.

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Police officer credits crisis program in Rte. 9 rescue - Boston Globe

By Milton J. Valencia, Globe Staff

FRAMINGHAM - Officer Brian Curtis has heard it before: No one could help him, no one understood, no one cared. The man was dangling in the cold darkness Friday night from a foot bridge 30 feet above Route 9 in Framingham Centre, and Curtis was trying to respond with what he'd learned recently in an innovative program.

"You have to break that barrier; you've got to make them understand you're trying to help," he said.

If Curtis, a 24-year-old rookie, has learned anything in his nine months on the force, it's that sometimes people just need someone to talk to. And for the past four months, he's been working with counselors who have helped him and other officers know how to make a difference with them.

In the Jail Diversion Program, police have been working with mental health specialists to provide resources for people who need emotional help more than law enforcement assistance. The program was founded in Framingham four years ago in partnership with Advocate Inc., a mental health agency, and expanded this year to a handful of other communities in Greater Boston.

In all the chaos Friday, Curtis's conversation helped let down the man's guard, and other officers pulled the man to safety. He was taken to a hospital and referred for mental health counseling.

"It wouldn't do him any good to arrest him," Curtis said.

Urban police districts often have few resources to draw on when working with the mentally ill, but through the Jail Diversion Program, police have been coached on how to talk to them and get them referred for counseling. The effort has proved to be more productive than a criminal justice system that in the past has often returned the mentally ill to the streets without getting proper help, said police and a mental health advocate.

"It's the most humane and dignified and appropriate response for many of these calls," said Sarah Abbott, director of the Jail Diversion Program. "We want to get the bad guys, but we want to do something with the mentally ill."

The state Department of Mental Health has expanded the Jail Diversion Program to Milford, Lawrence, Taunton, Waltham, and Watertown this year, hoping to build off the success Framingham police have had in identifying and helping people with mental illness.

The program was founded as a way to deal with hostage cases in which mental illness is often a factor. Soon after, patrol officers handling everyday calls started working with counselors like Abbott. In the past four years, Framingham officers have referred 2,000 people for intervention. Just last week, Abbott said, she worked with eight people who needed help.

Abbott said the program has proved helpful in more quickly identifying people with mental illness, so counselors can intervene before they become a danger to themselves or others. She noted police calls that have turned deadly when officers confront a dangerous suspect who suffers from mental illness, such as the Boston police shooting last week of a correction officer who displayed mental problems.

"We like to think if we can intervene quicker, then we can avoid a potentially deadly outcome later on," Abbott said.

Officers who have worked with the counselors have picked up the techniques. Talk to the person, let them know you'll listen, the counselors tell officers. Be personal. Say their name.

"It's another tool in our belt," said Framingham police Lieutenant Paul Shastany. "When the mentally ill create nuisance crimes, it's sometimes better not to arrest them but to get them help."

Curtis said he listened to Abbott speak with a woman who was having hallucinations, believing crabs were surrounding her. He saw how Abbott quickly identified the woman's religious beliefs and let her pray before bringing her to a hospital. In another case, he listened to how Abbott spoke to a man who had just taken pills to kill himself, persuading him to seek medical help.

When Curtis arrived on the scene Friday night, at the bridge spanning Pleasant and High streets at the entrance to Framingham State College, he said he tried to imagine what Abbott would have said.

"I'm trying to understand you, so you need to explain it," the officer told the man. He kept repeating the man's name, to keep their conversation personal. "Why don't you tell me what's wrong with you," Curtis said.

Cars were passing under the bridge until police shut down Route 9, and spectators began gathering. One witness described how Curtis stood patiently as the man dangled, holding onto the rail, sometimes nearly letting go. Police closed the road as firefighters and state and local police positioned themselves to be able to catch the man if he jumped.

"I walked over and introduced myself and said, 'Hi, I'm Brian Curtis with the Framingham Police Department," he said. "I was just trying to talk to him and get him to talk to me."

Milton J. Valencia can be reached at valencia@globe.com.

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BY JENNIFER GOLZ Sun-Times News Group

WHEATON -- A Bolingbrook man has been cleared of his felony burglary charges after successfully completing DuPage County's Mental Illness Court Alternative Program.

Christopher R. Sievers, 23, of the 300 block of Brighton Lane, was facing one count of burglary and two counts of residential burglary for a series of break-ins he committed in a Lisle neighborhood in March 2005.

He was caught after a homeowner reportedly surprised Sievers as he was trying to make a getaway through a side door of an Arbor Ridge subdivision home in the middle of the night.

There was a brief exchange between Sievers and the homeowner, which even included a hand shake, and then he left, allowing the homeowner to call police.

Sievers hadn't make it out of the subdivision before Lisle police stopped him, according to reports. Found in his car were DVDs, Xbox games, gift cards and wireless phones, reportedly taken from two homes and a vehicle in the neighborhood.

Sievers was arrested and charged that night and released a day later after posting 10 percent of his $20,000 bond. By that September, he was enrolled in the county's MICAP program.

MICAP is a court-supervised program that allows criminal defendants with mental illness to seek mental health services as an alternative to punishment. Upon successful completion, charges are reduced or even dismissed, as in Sievers' case.

Copyright 2007 Associated Press. All rights reserved. This material may not be published, broadcast, rewritten, or redistributed.



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State could change laws on mentally ill offenders - Stamford (CT) Advocate

By Zach Lowe

Original Stamford Advocate article: State could change laws on mentally ill offenders

STAMFORD - Mario Rizzi thought he saw gorillas in his back yard last year and fired two shots at them, court records show. Months earlier, he had killed four pet parrots with a toilet brush.

Rizzi, 44, faces up to two years in prison for those crimes, but his attorney says he suffers from severe psychiatric problems that caused him to hallucinate and behave strangely.

The Stamford resident said he has been severely depressed since a divorce 10 years ago and his father's death in 2002.

'I can't take the pain no more,' Rizzi said in an interview after pleading guilty in state Superior Court in Stamford Wednesday to six misdemeanors. 'I'm sitting by myself, just hiding in a corner. I have no more feeling.'

Offenders like Rizzi may be able to avoid a criminal record if state officials adopt a special probationary program for mentally ill offenders. The program - the subject of discussions by the state's sentencing task force - would give mentally ill offenders the chance to enter treatment instead of going through the court process, if they can prove their mental illness contributed to their alleged crime.

The cost of arranging additional treatment could be offset by keeping offenders out of prison, experts said.

The program, if enacted, would place Connecticut on the cutting edge in dealing with offenders suffering from moderate or severe mental illnesses - a group that makes up about 20 percent of the state's prison population, national experts said.

The task force will likely recommend a version of the program to the state legislature this year, members said.

There is still debate about how many times a person could use the program and whether they had been enrolled in it should remain on a version of their record that only is available to law enforcement.

'It sounds like a very progressive program,' said Stephen Bush, a defense attorney who heads the Jericho Project, a Memphis, Tenn., program that helps mentally ill offenders receive treatment instead of prosecution when possible.

There are about 150 courts nationwide that deal only with mentally ill offenders, but most require them to plead guilty before entering treatment, said Henry Steadman, director of the National GAINS Center, a federally funded organization devoted to finding better ways to treat mentally ill defendants.

That guilty plea remains on offenders' records even if they avoid prison sentences by complying with treatment, Steadman said.

The Connecticut proposal would not require a guilty plea. Offenders would have the charges dropped as long as they stayed in treatment and obeyed conditions set by a judge.

Offenders charged with violent felonies would not be eligible.

The proposal 'sounds great,' said Rizzi, who had no record before pleading guilty to shooting at the imaginary gorillas and killing the parrots.

'He'd be a perfect candidate,' said his attorney, Christian Bujdud.

The proposal mirrors a program already available for first-time offenders who commit minor crimes. Unlike that program, the new proposal would allow offenders to enter the program more than once and be open to defendants with previous records, state officials said.

Prosecutors could object to any application for the program. A judge would make the final ruling, officials said.

The task force is debating whether to limit the number of uses to two for any offender, officials said.

'These guys are among the most difficult offenders to deal with,' said Robert Farr, the task force chairman and head of the Board of Pardons and Paroles. 'If you lock them up, many of them get out and start committing crimes again.'

Larry Uliano of Bridgeport was on probation three years ago when Bridgeport police caught him with an unloaded rifle. Uliano, who suffers from fetal alcohol syndrome, said he was high on angel dust at the time.

Uliano, 41, said he was sent back to prison for three years and was diagnosed there as a paranoid schizophrenic with severe attention deficit disorder.

He is now on parole and said he received very little help in prison. He might have recovered earlier if the state had another option for the mentally ill, he said.

'You're only treated as a number in prison,' Uliano said. 'They don't care if you're sick, you're cold, or you're hungry.'

His drug relapses are fewer now that he's on the proper combination of medications, he said, explaining that he had taken angel dust to 'stop all these thoughts speeding through my mind.'

'Now I ain't got those thoughts,' Uliano said. 'I'm going to be straight.'

Relapses will happen with mentally ill offenders, and court officials overseeing treatment must be patient in order to help people recover, Steadman said.

'It can't be one dirty urine test (for illegal drugs) or one skipped session and you're sent right back into the court system' to plead guilty, he said.

The state also would have to spend millions setting up treatment programs, experts said.

'You can have the best program in place, but if you don't have some place for people to get treatment, it's not going to work,' said Ronald Honberg, director of policy and legal affairs for the National Alliance on Mental Illness in Virginia.

Rizzi said he wishes he had the chance to get treatment instead of possibly going to prison when he is sentenced in January.

'I'm scared,' Rizzi said. 'I don't deserve this.'

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Double Outsiders - Hartford Courant

When The Developmentally Disabled Are Also Gay, The Burdens Become Even Greater

By HILARY WALDMAN

When John Bernard was a young man, his father would drive him to dances.

But Bernard never knew quite how to explain that it wasn't the girls he found interesting. He liked the boys.

That's tough enough for any young person, but Bernard has mental retardation, making his sexual identity a leap from social quicksand into a fully loaded minefield.

In the unforgiving eyes of so many, it made Bernard both a "fag" and a "retard" — two of the first epithets young children learn to demonize each other on the playground.

For Bernard and others with developmental disabilities, the discovery that they are homosexual can add a layer of secrecy and stigma to an existence that already hovers on society's sidelines.

Living in the shadows, the search for love can lead to exploitation or risky behavior. But more often, gay or straight, love for people with intellectual disabilities remains a blind alley, leading only to social isolation.

Parents, caregivers and professionals have only begun to accept that people with intellectual disabilities not only deserve to participate fully in school and work, but also may crave the third dimension that makes life meaningful — love. But the idea that a young man with mental retardation may be looking for Mr. Right remains a topic discussed only in whispers, if at all.

Decades after his trips to the dances, John Bernard chose a Sunday afternoon after church to reveal to his parents the secret he's harbored for many of his 48 years.

"I'm gay, mother," Bernard announced, perhaps a little too loudly, to the lunch crowd at Hawley's family restaurant in his native western Massachusetts.

His 80-year-old mother's response was matter of fact:

"You're not gay," she told him. "You're straight." Then she warned him about the risk of getting AIDS.

Later, the Bernards consulted their family doctor about the possibility of medication to repress their son's desire.

The dismay of Bernard's otherwise loving and supportive family had echoes of darker days in the history of mental retardation, when sterilization was commonplace, laws prohibited marriage and people with "feeble minds" were locked in institutions.

But their reaction was not unusual.

"We do a great job supporting people residentially and vocationally," said John D. Allen, a veteran gay activist in New Haven who founded the country's first support group for gay people with intellectual disabilities. "But family, relationships, companionship, that's what make our lives sizzle, and we as a profession do an awful job supporting that."

A Place To Go

Nine years ago, Allen took a daring step toward changing that.

On the first Monday of each month, about a dozen members of the Rainbow Support Group gather on worn, overstuffed couches in a slightly shabby converted factory building to talk about their lives as homosexuals. For members, a group meeting may mark the first time that they are free to openly accept and explore their gay identities.

"So what's going on?" Allen asks at a recent meeting, clasping his hands together.

One man reports proudly that he went to the Special Olympics and did not get into any trouble in the men's room this year.

Two men who travel from New York to attend the support group talk about their first date.

"I've known him for five years and he's known me for five years," one offers.

Allen then introduces the group to Bernard, who is dressed neatly in a pumpkin-orange T-shirt and navy shorts.

"Why do you want to be part of the group?" Allen asks, sounding just a bit like Mr. Rogers.

"I want to meet a nice guy to be with," John Bernard answers, without inhibition.

Before telling his parents at the family restaurant that day, Bernard had revealed his secret to David Morin, the director of Bernard's Chicopee, Mass., group home. Unlike Bernard's parents, Morin was not shocked by his client's revelation.

But he feared that trying to help Bernard express his sexual identity might lead them both into a societal black hole.

Morin went online and searched on the words "gay people with disabilities and relationships." He was surprised to find the Rainbow Support Group just an hour's drive south in New Haven.

Allen never planned to combine his interest in gay rights with his work supporting people with developmental disabilities. In the late 1990s he had just founded the New Haven Gay and Lesbian Community Center, so his name was in the news. And he made his living working with people with developmental disabilities.

But people desperate for an outlet made the connection and reached out.

Allen wrote down the name of every caller.

"I realized that maybe the reason we couldn't find anything was because there was nothing," Allen recalled. Within two years he had collected 15 names. He hosted the first Rainbow Support Group meeting in September 1998. Many of the original members still don't miss a meeting.

"At least once a month people can come and experience what it means to be a gay person," Allen said.

"People say, 'How do they know they're homosexual?'" he said. "They know the same way everybody else knows."

Looking For A Date

Often, the experience remains lonely and sad.

Ginger Burke was 17 when she noticed that women, not men, stirred the romantic feelings her teachers talked about in sex education class. But she dated a man for years before she joined the Rainbow Support Group and came out as a lesbian.

Admitting that was one thing, though; acting on it was another.

At 30, Burke recently decided to try a gay bar in her search of companionship. An enlightened caseworker agreed to drive her and act as a chaperone.

"I just wanted to dance and have fun without getting stared at," said Burke, who lives in a Middlefield group home.

Bulky in her sweat shirt, jeans and sneakers, Burke said she "felt like an alien" among the more stylish, non-disabled bar patrons. Most of them just ignored her. While the caseworker sat at a table in a dark corner, pecking at her laptop, Burke danced alone."I felt like I was just dropped off by a Mars machine that planted me there," she said.

With so little access to healthy relationships, exploitation is common. Sometimes, simple desperation can result in trouble.

Steve Belske has asked a lot of men for their phone numbers. But at 40, he has never had a date. He's tried approaching strangers at Wal-Mart. But the non-disabled men he finds attractive shun his advances.

From his childhood experimenting with the boys in his neighborhood to the time when a man took his money in exchange for sex, just about every one of Belske's liaisons has gotten him into trouble.

Now, he rarely leaves the dim, cinderblock-walled apartment in New Britain that he shares with Jack, a little white poodle mix. When he does go out, he must be accompanied by a caseworker. He's had a drinking problem, so bars are out.

With his slight build and youthful face, only Belske's receding hairline hints at the approach of middle age. Cerebral palsy prevents him from straightening his knees, creating a bouncy gait when he walks. And sometimes he talks a little too loudly, probably because he doesn't hear very well.

But Belske can be articulate and thoughtful about his future. Every week he puts $100 in the bank, savings for a house. He carefully chooses his clothing, picking trendy Crocs clogs for the summer and collecting colorful rubber bracelets that stretch up his forearms.

Belske looks around the room at the men and women who mingle awkwardly at the support group each month and sees only people he believes are more disabled than he is.

"I keep going, I think maybe I can make a friend there," Belske says, sounding disappointed. "But you saw everybody there."

Dating for people with developmental delays can be difficult, whatever their sexual preference. Even if two people are interested in each other, it can take months just to set up a meeting among guardians and caregivers — sometimes as many as a half-dozen people — who must sign off before anybody even thinks about heading to a movie or a restaurant.

Leslie Falanga tried to help her brother, Andrew, arrange a date with a man he met at the support group. Because neither man could drive, transportation was an obstacle. And with house rules that prohibit closed bedroom doors, privacy was not an option.

So Falanga dropped her brother off at the other man's group home. It was a junior high-style first date, with bright lights and hovering chaperones. When it was time to say good night, a staff member drove Andrew home.

And the relationship "really didn't continue," Falanga said. The logistics were just too difficult.

Bad Choices

With little or no education about relationships, limited support and so few outlets for social interaction, many of those who are gay and have developmental disabilities end up looking for love in the wrong places, or not looking at all.

"We don't give these people the tools" to make better decisions, John Allen said. "We don't give them sex education, because they're not supposed to be having sex."

Conventional sex education isn't the answer either, experts agree. In this vulnerable population, the line between consensual relationships and sexual abuse can be blurry. And with estimates that 90 percent of people with mental retardation have been sexually abused during their lives, it is natural for caregivers to be wary.

But ignoring the issue of sex altogether can be a big mistake too, advocates say.

Teenagers with developmental disabilities may not be able to learn at the same pace as their non-disabled peers. But their sex drives generally develop right on schedule, says Leslie Walker-Hirsch, editor of the new book "The Facts of Life and More: Sexuality and Intimacy for People with Intellectual Disabilities."

So at the same time they are living in mature adult bodies, people with mental retardation can be left without the social skills and knowledge so important for healthy sexual development.

Lucille Duguay, program director of the Oak Hill Center for Relationship and Sexuality Education in Hartford, contends that more explicit sex education for disabled young adults would go a long way toward preventing the pitfalls.

She is developing a curriculum that introduces students with intellectual disabilities to the basics of relationships and romance that would be available to special education programs and agencies that support people with intellectual disabilities. Although she won two grants to develop the curriculum and it is almost ready for distribution, educators so far have been slow to embrace the idea.

"Providers are concerned — 'Are you teaching those people to have sex?'" Duguay says.

Slow Evolution

If attitudes are changing, they are changing slowly.

The recognition that romance is a fundamental right for people with disabilities is another step in a slow, often sad, evolution in the nation's treatment of people with intellectual disabilities.

In 1895, Connecticut pioneered marriage restrictions for people then known as the "feeble-minded." Sterilization laws followed, and later segregation in institutions.Even people such as Robert Hedlund and Tim Wakeman, who have experienced comparatively rich gay lifestyles, still struggle.

Hedlund, 60, lived with a male partner for 24 years before the man died in 2002.

Wakeman's mother allowed him to spend time at the Cedar Brook Cafe, a well-known gay bar near where he grew up in Westport.

Wakeman, 58, comfortably drapes his arm over Hedlund's shoulder as they settle onto a couch at a recent Rainbow Support Group meeting. The pair met at the group last year and have since struggled to develop a friendship. Once, they considered sharing an apartment, but that plan fell through. Now, they see each other at monthly meetings and when they are lucky enough to find a staff member willing to drive them to the mall or a park where they can take a walk together.

Making a relationship work is hard for Hedlund and Wakeman, who have supportive friends, family members and paid staff who try hard to help them get together. Most people aren't even that lucky.

In a study completed for his doctoral thesis, Allen found that the job of helping people with disabilities navigate relationships often falls to the least trained and lowest paid direct-care workers, who must frequently improvise, because there are no formal guidelines.

Allen found that direct-care staff members receive little formal training about sexuality and relationships for their clients, except when it's about sexual abuse.

"What winds up happening is people get this heavy-handed information and training," Allen said. "It's usually punitive."

There are, nonetheless, some optimistic signs.

The state Department of Developmental Services recognizes the Rainbow Support Group and has even given Allen some funding. And big national advocacy organizations such as the ARC have policy statements affirming the rights of mentally retarded people to engage in romantic relationships. Most direct service agencies also have quiet policies supporting sexual expression.

With books and conferences on the subject spreading the word across the nation, albeit slowly, Leslie Walker-Hirsch predicted that the appearance of a person with mental retardation dancing at a gay bar may someday become as accepted as a disabled worker bagging groceries at the supermarket.

"We're asking better questions," Walker-Hirsch said. "Instead of asking how we punish John and Mary who are caught kissing under the stairs — or John and Bill or Mary and Henrietta — we are asking, 'How can they have a full life?'"

Answering those questions, though, still poses a significant challenge.

David Morin said he knew nothing about the homosexual social scene when John Bernard told him he'd like to date a man. So Morin approached it the same way he would have if his client had said he'd like to study art.

Morin took Bernard to a gay and lesbian bookstore in Northampton, Mass. He helped him get his ear pierced, and now Bernard proudly displays a sparkling stud in his right lobe. Now, Morin is trying to find a gay bar in Springfield so his client can experiment a little more with the gay social scene.

"If he finds a boyfriend, we'll provide transportation," Morin said.

But Morin admitted that it's tricky.

"How far are you going to let them go on a date?" He asked. "Hand-holding? Kissing? Intimacy?"

Contact Hilary Waldman at hwaldman@courant.com.

Copyright © 2007, The Hartford Courant

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Iraq vets' troubles appear long after return - Pittsburgh Post Gazette

By Wade Malcolm, Pittsburgh Post-Gazette

It started about a month after he came home, innocently enough. Staff Sgt. Frederick Johnson missed his fellow soldiers.

During a year stationed at Anaconda base in Iraq -- nicknamed "Mortaritaville" -- he says he looked after them like a father, eyes always focused on the horizon, scanning for danger.

And at night, he clutched a half-gallon bottle of any liquor he could find, emptying two or three a week.

After he returned home in December 2005, his dangerous coping methods progressed to crack cocaine. Already depressed by separating from the Ohio-based 373rd Medical Company -- the only people, he said, who could understand his war experience -- he grappled with his emerging fear of crowds, his aversion to loud noises and the horror of his nightmares. They often ended with him leaping out of bed into a low crawl position.

After a year battling addiction and the lingering effects of the post-traumatic stress disorder (PTSD), which the Army initially failed to diagnose, Sgt. Johnson, 38, is starting his life over at the VA Pittsburgh's Highland Drive Division.

He is among thousands of soldiers overlooked by previous mental health screening methods that, according to a new Army study released earlier this month, "substantially underestimate the mental health burden" of Iraq War veterans.

With increased congressional funding, the Army is trying to stop soldiers in Sgt. Johnson's situation from slipping through the cracks. The study compared results from soldiers who received only an initial mental health screening and those who received initial screening and then were reassessed after several months.

The second screening, called the Post-Deployment Health Re-Assessment, was started after preliminary data from an earlier study of the single screening indicated that soldiers were more likely to report mental health distress several months after return than right after they came home.

The single assessment approach failed to identify thousands who later developed mental illnesses -- most notably PTSD.

The study found that after a second screening, the number of soldiers referred to treatment for mental illness more than doubled from 3,925 out of 88,235 in the first to 10,288 in the second. The second screening also showed a 75 percent increase in soldiers deemed a mental health risk and a 73 percent surge in those diagnosed with PTSD.

Among the measurable symptoms, researchers said, were soldiers' reports of relationship conflicts, which quadrupled several months after coming home.

For reservists like Sgt. Johnson, the results were even more pronounced, possibly because their civilian lives lack the support network afforded full-time soldiers for dealing with post-combat stress, the study notes.

The research, believed to be the Army's first ever in-depth study of PTSD, used the information provided by soldiers returning from Iraq between June 1, 2005 and Dec. 31, 2006.

"They got a late start considering the war started in 2003," said Ramona Joyce, spokeswoman for the American Legion, a veterans advocacy group. "But better late than never."

Researchers based at Walter Reed and the U.S. Army Center for Health Promotion and Preventive Medicine published the findings in the Journal of the American Medical Association.

The results indicate the first three to six months after deployment are key to diagnosing and treating mental illness, particularly PTSD, before soldiers' lives unwind, said one of the study's lead researchers, Dr. Charles S. Milliken of the Division of Psychiatry and Neuroscience at the Walter Reed Army Institute of Research.

"Sometimes the person with the mental issue is the last to know," said Dr. Milliken. "They might not come looking for help, but if we can catch the symptoms before they become a problem, they'll be better off."

Massive health buildup

The military has hired thousands of new mental health clinicians and created a call center to track down veterans who never had a second screening. At its 10 Western Pennsylvania hospitals, the Department of Veterans Affairs has created 221 new positions in the past three years to treat mental health patients, spokeswoman Heather Frantz said.

Like all returning combat veterans, Sgt. Johnson received an initial mental health check when his deployment ended in 2005, but it failed to foretell his future problems. His mental health was never reassessed.

According to Dr. Milliken, the tough-minded, conquer-all-obstacles mentality the military teaches may make it more difficult for some soldiers to admit they have a problem.

For many soldiers, the initial euphoria of coming home may also mask problems churning below the surface. With 15 years in the Army -- three on enlisted active duty and the last 12 in the Reserves -- Sgt. Johnson said his case was a combination of the two.

Going against training

"I didn't know I was going through PTSD and depression, but I knew something was going on," he said. "And the soldier in me said, 'Suck it up and drive on.' So that's what I did."

Self-medicating and fearing sleep, he said he would stay up for days at a time, on the lookout for drugs or hunkered down alone at a corner bar stool with a double shot of Remy Martin, afraid of becoming violent if he interacted with other people. He avoided crowds, as if still in Iraq, because he remembered them as easy targets for mortar attacks. He dreaded the sound of helicopters because it reminded him of dead or wounded soldiers being flown into his medical unit.

One night, he reached a low. Now homeless, he realized he had run from one side of his hometown of Chester, Delaware County, to the other in a crack- and alcohol-hazed panic, hiding in trees and bushes along the way fearing someone was chasing him and trying to kill him.

He was hospitalized Jan. 22, having already failed an Army drug test. He said he wishes the current mental health detection methods -- the VA now sends mental health clinicians directly to the reserve unit for screening sessions soldiers are required to attend, Dr. Milliken said -- were in place after his tour of duty.

"I wish we would have had a more extensive homecoming, instead of just seeing the chaplain and turning in our gear and going home," Sgt. Johnson said. "I didn't even know what PTSD was until this year."

With the help of medication and therapy, his life has entered its rebuilding stage. A social worker in civilian life before leaving for war, he has also taken steps toward building a nonprofit organization and a Web site, www.heroestoday.org, which will aim to help homeless veterans in the Pittsburgh area.

Sgt. Johnson could soon face the prospect of a complete detachment from the military. He said he is in the process of being discharged for the failed drug tests. A spokesman for the 99th Regional Readiness Command said privacy regulations prohibit release of information about drug testing or possible pending discharges.

Sgt. Johnson's story may represent another problem soldiers experience in dealing with mental illness.

Some psychiatrists who study PTSD, like retired Brig. Gen. Stephen N. Xenakis, worry that military commanders are using drug abuse and other PTSD symptoms as reasons to discharge troubled troops slowing down their units.

"That needs to be reexamined really carefully," Dr. Xenakis said. "We're seeing that a number of soldiers are getting discharged for behavior reasons or personality disorders when they are, in fact, suffering from PTSD or blast concussions. ... We need to revisit our policies and procedures on that."

Soldiers discharged for misconduct lose their disability benefits even though "that behavior was a sign or a symptom of their underlying mental health issue," Dr. Xenakis said.

Sgt. Johnson said he's received encouragement to appeal the Army's initial decision to discharge him for misconduct. He may try to fight for his disability benefits, but he has no interest in preserving his military career.

"I don't have any fight left in me when it comes to the Army," he said. "Besides, if I fought to stay in, I would just get sent to Iraq again anyway."

Wade Malcolm can be reached at wmalcolm@post-gazette.com or 412-263-1878.
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Dr. Drug Rep - New York Times

By DANIEL CARLAT

I. Faculty Development

On a blustery fall New England day in 2001, a friendly representative from Wyeth Pharmaceuticals came into my office in Newburyport, Mass., and made me an offer I found hard to refuse. He asked me if I’d like to give talks to other doctors about using Effexor XR for treating depression. He told me that I would go around to doctors’ offices during lunchtime and talk about some of the features of Effexor. It would be pretty easy. Wyeth would provide a set of slides and even pay for me to attend a speaker’s training session, and he quickly floated some numbers. I would be paid $500 for one-hour “Lunch and Learn” talks at local doctors’ offices, or $750 if I had to drive an hour. I would be flown to New York for a “faculty-development program,” where I would be pampered in a Midtown hotel for two nights and would be paid an additional “honorarium.”

I thought about his proposition. I had a busy private practice in psychiatry, specializing in psychopharmacology. I was quite familiar with Effexor, since I had read recent studies showing that it might be slightly more effective than S.S.R.I.’s, the most commonly prescribed antidepressants: the Prozacs, Paxils and Zolofts of the world. S.S.R.I. stands for selective serotonin reuptake inhibitor, referring to the fact that these drugs increase levels of the neurotransmitter serotonin, a chemical in the brain involved in regulating moods. Effexor, on the other hand, was being marketed as a dual reuptake inhibitor, meaning that it increases both serotonin and norepinephrine, another neurotransmitter. The theory promoted by Wyeth was that two neurotransmitters are better than one, and that Effexor was more powerful and effective than S.S.R.I.’s.

I had already prescribed Effexor to several patients, and it seemed to work as well as the S.S.R.I.’s. If I gave talks to primary-care doctors about Effexor, I reasoned, I would be doing nothing unethical. It was a perfectly effective treatment option, with some data to suggest advantages over its competitors. The Wyeth rep was simply suggesting that I discuss some of the data with other doctors. Sure, Wyeth would benefit, but so would other doctors, who would become more educated about a good medication.

A few weeks later, my wife and I walked through the luxurious lobby of the Millennium Hotel in Midtown Manhattan. At the reception desk, when I gave my name, the attendant keyed it into the computer and said, with a dazzling smile: “Hello, Dr. Carlat, I see that you are with the Wyeth conference. Here are your materials.”

She handed me a folder containing the schedule of talks, an invitation to various dinners and receptions and two tickets to a Broadway musical. “Enjoy your stay, doctor.” I had no doubt that I would, though I felt a gnawing at the edge of my conscience. This seemed like a lot of money to lavish on me just so that I could provide some education to primary-care doctors in a small town north of Boston.

The next morning, the conference began. There were a hundred or so other psychiatrists from different parts of the U.S. I recognized a couple of the attendees, including an acquaintance I hadn’t seen in a while. I’d heard that he moved to another state and was making a bundle of money, but nobody seemed to know exactly how.

I joined him at his table and asked him what he had been up to. He said he had a busy private practice and had given a lot of talks for Warner-Lambert, a company that had since been acquired by Pfizer. His talks were on Neurontin, a drug that was approved for epilepsy but that my friend had found helpful for bipolar disorder in his practice. (In 2004, Warner-Lambert pleaded guilty to illegally marketing Neurontin for unapproved uses. It is illegal for companies to pay doctors to promote so-called off-label uses.)

I knew about Neurontin and had prescribed it occasionally for bipolar disorder in my practice, though I had never found it very helpful. A recent study found that it worked no better than a placebo for this condition. I asked him if he really thought Neurontin worked for bipolar, and he said that he felt it was “great for some patients” and that he used it “all the time.” Given my clinical experiences with the drug, I wondered whether his positive opinion had been influenced by the money he was paid to give talks.

But I put those questions aside as we gulped down our coffees and took seats in a large lecture room. On the agenda were talks from some of the most esteemed academics in the field, authors of hundreds of articles in the major psychiatric journals. They included Michael Thase, of the University of Pittsburgh and the researcher who single-handedly put Effexor on the map with a meta-analysis, and Norman Sussman, a professor of psychiatry at New York University, who was master of ceremonies.

Thase strode to the lectern first in order to describe his groundbreaking work synthesizing data from more than 2,000 patients who had been enrolled in studies comparing Effexor with S.S.R.I.’s. At this time, with his Effexor study a topic of conversation in the mental-health world, Thase was one of the most well known and well respected psychiatrists in the United States. He cut a captivating figure onstage: tall and slim, dynamic, incredibly articulate and a master of the research craft.

He began by reviewing the results of the meta-analysis that had the psychiatric world abuzz. After carefully pooling and processing data from eight separate clinical trials, Thase published a truly significant finding: Effexor caused a 45 percent remission rate in patients in contrast to the S.S.R.I. rate of 35 percent and the placebo rate of 25 percent. It was the first time one antidepressant was shown to be more effective than any other. Previously, psychiatrists chose antidepressants based on a combination of guesswork, gut feeling and tailoring a drug’s side effects to a patient’s symptom profile. If Effexor was truly more effective than S.S.R.I.’s, it would amount to a revolution in psychiatric practice and a potential windfall for Wyeth.

One impressive aspect of Thase’s presentation was that he was not content to rest on his laurels; rather he raised a series of potential criticisms of his results and then rebutted them convincingly. For example, skeptics had pointed out that Thase was a paid consultant to Wyeth and that both of his co-authors were employees of the company. Thase responded that he had requested and had received all of the company’s data and had not cherry-picked from those studies most favorable for Effexor. This was a significant point, because companies sometimes withhold negative data from publication in medical journals. For example, in 2004, GlaxoSmithKline was sued by Eliot Spitzer, who was then the New York attorney general, for suppressing data hinting that Paxil causes suicidal thoughts in children. The company settled the case and agreed to make clinical-trial results public.

Another objection was that while the study was billed as comparing Effexor with S.S.R.I.’s in general, in fact most of the data compared Effexor with one specific S.S.R.I.: Prozac. Perhaps Effexor was, indeed, more effective than Prozac; this did not necessarily mean that it was more effective than the other S.S.R.I.’s in common use. But Thase announced that since the original study, he had analyzed data on Paxil and other meds and also found differences in remission rates.

For his study, Thase chose what was at that time an unusual measure of antidepressant improvement: “remission,” rather than the more standard measure, “response.” In clinical antidepressant trials, a “response” is defined as a 50 percent improvement in depressive symptoms, as measured by the Hamilton depression scale. Thus, if a patient enters a study scoring a 24 on the Hamilton (which would be a moderate degree of depression), he or she would have “responded” if the final score, after treatment, was 12 or less.

Remission, on the other hand, is defined as “complete” recovery. While you might think that a patient would have to score a 0 on the Hamilton to be in remission, in fact very few people score that low, no matter how deliriously happy they are. Instead, researchers come up with various cutoff scores for remission. Thase chose a cutoff score of 7 or below.

In his study, he emphasized the remission rates and not the response rates. As I listened to his presentation, I wondered why. Was it because he felt that remission was the only really meaningful outcome by which to compare drugs? Or was it because using remission made Effexor look more impressive than response did? Thase indirectly addressed this issue in his paper by pointing out that even when remission was defined in different ways, with different cutoff points, Effexor beat the S.S.R.I.’s every time. That struck me as a pretty convincing endorsement of Wyeth’s antidepressant.

The next speaker, Norm Sussman, took the baton from Thase and explored the concept of remission in more detail. Sussman’s job was to systematically go through the officially sanctioned “slide deck” — slides provided to us by Wyeth, which we were expected to use during our own presentations.

If Thase was the riveting academic, Sussman was the engaging populist, translating some of the drier research concepts into terms that our primary-care-physician audiences would understand. Sussman exhorted us not to be satisfied with response and encouraged us to set the bar higher. “Is the patient doing everything they were doing before they got depressed?” he asked. “Are they doing it even better? That’s remission.” To further persuade us, he highlighted a slide showing that patients who made it all the way to remission are less likely to relapse to another depressive episode than patients who merely responded. And for all its methodological limitations, it was a slide that I would become well acquainted with, as I would use it over and over again in my own talks.

When it came to side effects, Effexor’s greatest liability was that it could cause hypertension, a side effect not shared by S.S.R.I.’s. Sussman showed us some data from the clinical trials, indicating that at lower doses, about 3 percent of patients taking Effexor had hypertension as compared with about 2 percent of patients assigned to a placebo. There was only a 1 percent difference between Effexor and placebo, he commented, and pointed out that treating high blood pressure might be a small price to pay for relief from depression.

It was an accurate reading of the data, and I remember finding it a convincing defense of Effexor’s safety. As I look back at my notes now, however, I notice that another way of describing the same numbers would have been to say that Effexor leads to a 50 percent greater rate of hypertension than a placebo. Framed this way, Effexor looks more hazardous.

And so it went for the rest of the afternoon.

Was I swallowing the message whole? Certainly not. I knew that this was hardly impartial medical education, and that we were being fed a marketing line. But when you are treated like the anointed, wined and dined in Manhattan and placed among the leaders of the field, you inevitably put some of your critical faculties on hold. I was truly impressed with Effexor’s remission numbers, and like any physician, I was hopeful that something new and different had been introduced to my quiver of therapeutic options.

At the end of the last lecture, we were all handed envelopes as we left the conference room. Inside were checks for $750. It was time to enjoy ourselves in the city.

II. The Art and Science of Detailing

Pharmaceutical “detailing” is the term used to describe those sales visits in which drug reps go to doctors’ offices to describe the benefits of a specific drug. Once I returned to my Newburyport office from New York, a couple of voice-mail messages from local Wyeth reps were already waiting for me, inviting me to give some presentations at local doctors’ offices. I was about to begin my speaking — and detailing — career in earnest.

How many doctors speak for drug companies? We don’t know for sure, but one recent study indicates that at least 25 percent of all doctors in the United States receive drug money for lecturing to physicians or for helping to market drugs in other ways. This meant that I was about to join some 200,000 American physicians who are being paid by companies to promote their drugs. I felt quite flattered to have been recruited, and I assumed that the rep had picked me because of some special personal or professional quality.

The first talk I gave brought me back to earth rather quickly. I distinctly remember the awkwardness of walking into my first waiting room. The receptionist slid the glass partition open and asked if I had an appointment.

“Actually, I’m here to meet with the doctor.”

“Oh, O.K. And is that a scheduled appointment?”

“I’m here to give a talk.”

A light went on. “Oh, are you part of the drug lunch?”

Regardless of how I preferred to think of myself (an educator, a psychiatrist, a consultant), I was now classified as one facet of a lunch helping to pitch a drug, a convincing sidekick to help the sales rep. Eventually, with an internal wince, I began to introduce myself as “Dr. Carlat, here for the Wyeth lunch.”

The drug rep who arranged the lunch was always there, usually an attractive, vivacious woman with platters of gourmet sandwiches in tow. Hungry doctors and their staff of nurses and receptionists would filter into the lunch room, grateful for free food.

Once there was a critical mass (and crucially, once the M.D.’s arrived), I was given the go-ahead by the Wyeth reps to start. I dove into my talk, going through a handout that I created, based on the official slide deck. I discussed the importance of remission, the basics of the Thase study showing the advantage of Effexor, how to dose the drug, the side effects, and I added a quick review of the other common antidepressants.

While I still had some doubts, I continued to be impressed by the 10 percent advantage in remission rates that Effexor held over S.S.R.I.’s; that advantage seemed significant enough to overcome Effexor’s more prominent side effects. Yes, I was highlighting Effexor’s selling points and playing down its disadvantages, and I knew it. But was my salesmanship going to bring harm to anybody? It seemed unlikely. The worst case was that Effexor was no more effective than anything else; it certainly was no less effective.

During my first few talks, I worried a lot about my performance. Was I too boring? Did the doctors see me as sleazy? Did the Wyeth reps find me sufficiently persuasive? But the day after my talks, I would get a call or an e-mail message from the rep saying that I did a great job, that the doctor was impressed and that they wanted to use me more. Indeed, I started receiving more and more invitations from other reps, and I soon had talks scheduled every week. I learned later that Wyeth and other companies have speaker-evaluation systems. After my talks, the reps would fill out a questionnaire rating my performance, which quickly became available to other Wyeth reps throughout the area.

As the reps became comfortable with me, they began to see me more as a sales colleague. I received faxes before talks preparing me for particular doctors. One note informed me that the physician we’d be visiting that day was a “decile 6 doctor and is not prescribing any Effexor XR, so please tailor accordingly. There is also one more doc in the practice that we are not familiar with.” The term “decile 6” is drug-rep jargon for a doctor who prescribes a lot of medications. The higher the “decile” (in a range from 1 to 10), the higher the prescription volume, and the more potentially lucrative that doctor could be for the company.

A note from another rep reminded me of a scene from “Mission: Impossible.” “Dr. Carlat: Our main target, Dr. , is an internist. He spreads his usage among three antidepressants, Celexa, Zoloft and Paxil, at about 25-30 percent each. He is currently using about 6 percent Effexor XR. Our access is very challenging with lunches six months out.” This doctor’s schedule of lunches was filled with reps from other companies; it would be vital to make our sales visit count.+

Naïve as I was, I found myself astonished at the level of detail that drug companies were able to acquire about doctors’ prescribing habits. I asked my reps about it; they told me that they received printouts tracking local doctors’ prescriptions every week. The process is called “prescription data-mining,” in which specialized pharmacy-information companies (like IMS Health and Verispan) buy prescription data from local pharmacies, repackage it, then sell it to pharmaceutical companies. This information is then passed on to the drug reps, who use it to tailor their drug-detailing strategies. This may include deciding which physicians to aim for, as my Wyeth reps did, but it can help sales in other ways. For example, Shahram Ahari, a former drug rep for Eli Lilly (the maker of Prozac) who is now a researcher at the University of California at San Francisco’s School of Pharmacy, said in an article in The Washington Post that as a drug rep he would use this data to find out which doctors were prescribing Prozac’s competitors, like Effexor. Then he would play up specific features of Prozac that contrasted favorably with the other drug, like the ease with which patients can get off Prozac, as compared with the hard time they can have withdrawing from Effexor.

The American Medical Association is also a key player in prescription data-mining. Pharmacies typically will not release doctors’ names to the data-mining companies, but they will release their Drug Enforcement Agency numbers. The A.M.A. licenses its file of U.S. physicians, allowing the data-mining companies to match up D.E.A. numbers to specific physicians. The A.M.A. makes millions in information-leasing money.

Once drug companies have identified the doctors, they must woo them. In the April 2007 issue of the journal PLoS Medicine, Dr. Adriane Fugh-Berman of Georgetown teamed up with Ahari (the former drug rep) to describe the myriad techniques drug reps use to establish relationships with physicians, including inviting them to a speaker’s meeting. These can serve to cement a positive a relationship between the rep and the doctor. This relationship is crucial, they say, since “drug reps increase drug sales by influencing physicians, and they do so with finely titrated doses of friendship.”

III. Uncomfortable Moments

I gave many talks over the ensuing several months, and I gradually became more comfortable with the process. Each setting was somewhat different. Sometimes I spoke to a crowded conference room with several physicians, nurses and other clinical staff. Other times, I sat at a small lunch table with only one other physician (plus the rep), having what amounted to a conversation about treating depression. My basic Effexor spiel was similar in the various settings, with the focus on remission and the Thase data.

Meanwhile, I was keeping up with new developments in the research literature related to Effexor, and not all of the news was positive. For example, as more data came out comparing Effexor with S.S.R.I.’s other than Prozac, the Effexor remission advantage became slimmer — more like 5 percent instead of the originally reported 10 percent. Statistically, this 5 percent advantage meant that only one out of 20 patients would potentially do better on Effexor than S.S.R.I.’s — much less compelling than the earlier proportion of one out of 10.

I also became aware of other critiques of the original Thase meta-analysis. For example, some patients enrolled in the original Effexor studies took S.S.R.I.’s in the past and presumably had not responded well. This meant that the study population may have been enriched with patients who were treatment-resistant to S.S.R.I.’s, giving Effexor an inherent advantage.

I didn’t mention any of this in my talks, partly because none of it had been included in official company slides, and partly because I was concerned that the reps wouldn’t invite me to give talks if I divulged any negative information. But I was beginning to struggle with the ethics of my silence.

One of my most uncomfortable moments came when I gave a presentation to a large group of psychiatrists. I was in the midst of wrapping up my talk with some information about Effexor and blood pressure. Referring to a large study paid for by Wyeth, I reported that patients are liable to develop hypertension only if they are taking Effexor at doses higher than 300 milligrams per day.

“Really?” one psychiatrist in the room said. “I’ve seen hypertension at lower doses in my patients.”

“I suppose it can happen, but it’s rare at doses that are commonly used for depression.”

He looked at me, frowned and shook his head. “That hasn’t been my experience.”

I reached into my folder where I kept some of the key Effexor studies in case such questions arose.

According to this study of 3,744 patients, the rate of high blood pressure was 2.2 percent in the placebo group, and 2.9 percent in the group of patients who had taken daily doses of Effexor no larger than 300 milligrams. Patients taking more than 300 milligrams had a 9 percent risk of hypertension. As I went through the numbers with the doctor, however, I felt unsettled. I started talking faster, a sure sign of nervousness for me.

Driving home, I went back over the talk in my mind. I knew I had not lied — I had reported the data exactly as they were reported in the paper. But still, I had spun the results of the study in the most positive way possible, and I had not talked about the limitations of the data. I had not, for example, mentioned that if you focused specifically on patients taking between 200 and 300 milligrams per day, a commonly prescribed dosage range, you found a 3.7 percent incidence of hypertension. While this was not a statistically significant higher rate than the placebo, it still hinted that such moderate doses could, indeed, cause hypertension. Nor had I mentioned the fact that since the data were derived from placebo-controlled clinical trials, the patients were probably not representative of the patients seen in most real practices. Patients who are very old or who have significant medical problems are excluded from such studies. But real-world patients may well be at higher risk to develop hypertension on Effexor. +

I realized that in my canned talks, I was blithely minimizing the hypertension risks, conveniently overlooking the fact that hypertension is a dangerous condition and not one to be trifled with. Why, I began to wonder, would anyone prescribe an antidepressant that could cause hypertension when there were many other alternatives? And why wasn’t I asking this obvious question out loud during my talks?

I felt rattled. That psychiatrist’s frown stayed with me — a mixture of skepticism and contempt. I wondered if he saw me for what I feared I had become — a drug rep with an M.D. I began to think that the money was affecting my critical judgement. I was willing to dance around the truth in order to make the drug reps happy. Receiving $750 checks for chatting with some doctors during a lunch break was such easy money that it left me giddy. Like an addiction, it was very hard to give up.

There was another problem: one of Effexor’s side effects. Patients who stopped the medication were calling their doctors and reporting symptoms like severe dizziness and lightheadedness, bizarre electric-shock sensations in their heads, insomnia, sadness and tearfulness. Some patients thought they were having strokes or nervous breakdowns and were showing up in emergency rooms. Gradually, however, it became clear that these were “withdrawal” symptoms. These were particularly common problems with Effexor because it has a short half-life, a measure of the time it takes the body to metabolize half of the total amount of a drug in the bloodstream. Paxil, another short half-life antidepressant, caused similar problems.

At the Wyeth meeting in New York, these withdrawal effects were mentioned in passing, though we were assured that Effexor withdrawal symptoms were uncommon and could usually be avoided by tapering down the dose very slowly. But in my practice, that strategy often did not work, and patients were having a very hard time coming off Effexor in order to start a trial of a different antidepressant.

I wrestled with how to handle this issue in my Effexor talks, since I believed it was a significant disadvantage of the drug. Psychiatrists frequently have to switch medications because of side effects or lack of effectiveness, and anticipating this potential need to change medications plays into our initial choice of a drug. Knowing that Effexor was hard to give up made me think twice about prescribing it in the first place.

During my talks, I found myself playing both sides of the issue, making sure to mention that withdrawal symptoms could be severe but assuring doctors that they could “usually” be avoided. Was I lying? Not really, since there were no solid published data, and indeed some patients had little problem coming off Effexor. But was I tweaking and pruning the truth in order to stay positive about the product? Definitely. And how did I rationalize this? I convinced myself that I had told “most” of the truth and that the potential negative consequences of this small truth “gap” were too trivial to worry about.

As the months went on, I developed more and more reservations about recommending that Effexor be used as a “first line” drug before trying the S.S.R.I.’s. Not only were the newer comparative data less impressive, but the studies were short-term, lasting only 6 to 12 weeks. It seemed entirely possible that if the clinical trials had been longer — say, six months — S.S.R.I.’s would have caught up with Effexor. Effexor was turning out to be an antidepressant that might have a very slight effectiveness advantage over S.S.R.I.’s but that caused high blood pressure and had prolonged withdrawal symptoms.

At my next Lunch and Learn, I mentioned toward the end of my presentation that data in support of Effexor were mainly short-term, and that there was a possibility that S.S.R.I.’s were just as effective. I felt reckless, but I left the office with a restored sense of integrity.

Several days later, I was visited by the same district manager who first offered me the speaking job. Pleasant as always, he said: “My reps told me that you weren’t as enthusiastic about our product at your last talk. I told them that even Dr. Carlat can’t hit a home run every time. Have you been sick?”

At that moment, I decided my career as an industry-sponsored speaker was over. The manager’s message couldn’t be clearer: I was being paid to enthusiastically endorse their drug. Once I stopped doing that, I was of little value to them, no matter how much “medical education” I provided.

IV. Life After Drug Money

A year after starting my educational talks for drug companies (I had also given two talks for Forest Pharmaceuticals, pushing the antidepressant Lexapro), I quit. I had made about $30,000 in supplemental income from these talks, a significant addition to the $140,000 or so I made from my private practice. Now I publish a medical-education newsletter for psychiatrists that is not financed by the pharmaceutical industry and that tries to critically assess drug research and marketing claims. I still see patients, and I still prescribe Effexor. I don’t prescribe it as frequently as I used to, but I have seen many patients turn their lives around because they responded to this drug and to nothing else. +

In 2002, the drug industry’s trade group adopted voluntary guidelines limiting some of the more lavish benefits to doctors. While the guidelines still allow all-expenses-paid trips for physicians to attend meetings at fancy hotels, they no longer pay for spouses to attend the dinners or hand out tickets to musicals. In an e-mail message, a Wyeth spokesman wrote that Wyeth employees must follow that code and “our own Wyeth policies, which, in some cases, exceed” the trade group’s code.

Looking back on the year I spent speaking for Wyeth, I’ve asked myself if my work as a company speaker led me to do bad things. Did I contribute to faulty medical decision making? Did my advice lead doctors to make inappropriate drug choices, and did their patients suffer needlessly?

Maybe. I’m sure I persuaded many physicians to prescribe Effexor, potentially contributing to blood-pressure problems and withdrawal symptoms. On the other hand, it’s possible that some of those patients might have gained more relief from their depression and anxiety than they would have if they had been started on an S.S.R.I. Not likely, but possible.

I still allow drug reps to visit my office and give me their pitches. While these visits are short on useful medical information, they do allow me to keep up with trends in drug marketing. Recently, a rep from Bristol-Myers Squibb came into my office and invited me to a dinner program on the antipsychotic Abilify.

“I think it will be a great program, Dr. Carlat,” he said. “Would you like to come?” I glanced at the invitation. I recognized the name of the speaker, a prominent and widely published psychiatrist flown in from another state. The restaurant was one of the finest in town.

I was tempted. The wine, the great food, the proximity to a famous researcher — why not rejoin that inner circle of the select for an evening? But then I flashed to a memory of myself five years earlier, standing at a lectern and clearing my throat at the beginning of a drug-company presentation. I vividly remembered my sensations — the careful monitoring of what I would say, the calculations of how frank I should be.

“No,” I said, as I handed the rep back the invitation. “I don’t think I can make it. But thanks anyway.”

Daniel Carlat is an assistant clinical professor of psychiatry at Tufts University School of Medicine and the publisher of The Carlat Psychiatry Report.

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At Odds Over Degrees of Assistance - New York Times

By JULI S. CHARKES

WARMING centers began operating this month in Peekskill, New Rochelle and Mount Vernon as part of a campaign by the county to help get the chronically or “hard-to-place” homeless off the streets and into a shelter. Noticeably absent from the list, however, was White Plains, where local clergy members, homeless advocates and government officials are grappling with what constitutes fair treatment for those unable — or unwilling — to enter the county’s shelter system.

“What you’re seeing is the eye of the storm right now,” said Paul Anderson-Winchell, executive director of the Grace Church Community Center, a nonsectarian social service agency that provides shelter services in the city.

At issue is a proposal by Westchester’s county executive, Andrew J. Spano, to provide chairs instead of cots at the warming centers, a decision his chief adviser, Susan Tolchin, called a “humane solution to a difficult problem.”

The warming centers are intended to serve homeless people who are ineligible for the county’s conventional shelter system, because of drug problems or mental illness, or because they refuse to adhere to shelter requirements. Those in the system receive counseling and job training as well as guaranteed shelter, but in return, they must agree to be drug-free and contribute a portion of their income or benefits. Many resist, choosing to remain outside instead.

“There are a hundred different stories,” said John H. Rubin, director of Open Arms, a homeless shelter for men in White Plains.

The centers are intended to provide a safety net during the winter months and help eliminate a disturbing sight: About 50 men and women in and around the White Plains area pass the nights in parking lots, stairwells and other hideaways because they have nowhere else to go. The county’s Department of Social Services is conducting an outreach program to help locate the street homeless and persuade them to come inside.

“We want to try and eradicate this problem,” said Diane Atkins, the department’s deputy commissioner.

But in White Plains, local clergy members and advocates for the homeless have held two rallies downtown in the last several weeks to protest Mr. Spano’s proposal, saying that providing only chairs was a senseless way to treat less fortunate members of the community who are already compromised when it comes to health and basic quality of life issues.

“We have a deeply held conviction that warming seats are not the answer to the problem,” said the Rev. C. Carter Via, pastor of White Plains Presbyterian Church, after addressing a crowd of about 70 participants at the first rally last month.

In response, Mr. Spano said the centers could use cots instead of chairs, if the local municipality agreed. “This isn’t about chairs or cots,” he said. “It’s about getting people off of the street.”

White Plains has struggled with how to handle the homeless for years. Two incidents in 2005 crystallized the issue for many: a homeless sex offender fatally stabbed a woman in a White Plains parking garage, and the county closed an overnight shelter for homeless men at the county airport and opened a 43-bed “drop-in” center on Court Street in White Plains. After complaints from the city, including criticism that the drop-in shelter was close to City Center, the county closed it in August.

“This particular group of nonconforming sector of the homeless is very difficult to handle,” said Joseph M. Delfino, the mayor of White Plains.

According to Mr. Spano, at least 20 men from the Court Street drop-in shelter have been persuaded to enter the county system. “Our ultimate goal is to get them the counseling to lead productive lives,” he said.

According to Mr. Delfino, White Plains provides 500 beds in four conventional shelter systems. “We’re managing,” he said. “We’re doing our share.”

He called helping the street homeless a “humane responsibility,’’ one that needs to be shared by all 44 communities in the county. In addition to the new warming centers, the City of Yonkers is also home to a full-time drop-in shelter.

Mr. Anderson-Winchell said that he and other homeless advocates would pursue negotiations with the city and the county to reach common ground, a goal he said was attainable, given the good intentions on all sides. “I think a solution will be found,” Mr. Anderson-Winchell said.

That might include using local churches as drop-in shelters over the winter months. White Plains Presbyterian Church, for example, has offered to provide up to 19 beds for the chronically homeless, Pastor Via said. He said that he and at least two other church leaders who are also willing to provide space for the homeless plan to meet with Mayor Delfino and the Common Council next week to gain support, if not outright approval.

But as the debate rages, homeless people like Joseph Braun were left with few options for where to spend the night, particularly as temperatures drop. Mr. Braun, 45, a day laborer from Florida, drifted to New York a couple of years ago and was unable to find work. When his money ran out, he said, he tried securing a place in a Westchester shelter but was denied because of his Florida residency. With nowhere else to turn, he began using the drop-in shelter in Court Street until it closed.

“That’s when everything got messed up,” he said. Since then, he said, he has “made do” finding refuge on the streets. He declined to be more specific.

Mr. Rubin, of Open Arms in White Plains, describes the street homeless in and around White Plains as the “most at-risk members” of the homeless community — men and women struggling with mental health issues, drug dependency or illness. As examples, he cited case studies of individuals he has counseled, including an undocumented woman with leukemia and a man with bipolar disorder who abuses his medication.

As different as they may be from each other, Mr. Rubin said, they have one thing in common. “These are people who are suffering,” he said.

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Amid Affluence, the Hidden Homeless - New York Times

By ANNIE CORREAL

ON the border of Garden City and Hempstead, where handsome homes with manicured lawns give way to a crumbling housing project, sits a large, empty house with an unusual guardian.

A homeless man named Charles Tegeler, 47, has slept in the boarded-up, burned-out house on the corner of Hilton Avenue and Jackson Street since August, when the family that owned the house was forced out by an electrical fire. He wards off intruders by night and does repair work for the owner, Dennis Bassett, by day.

Mr. Bassett said that he had hired Mr. Tegeler to do odd jobs over the past two years and that he lets him sleep on his properties because he wants to keep at least one man off the streets.

“No one is looking at the fact that people are living in alleys downtown,” said Mr. Bassett, a real estate agent now living in Garden City. “No one wants to look at that because life is too good on Long Island, because they can go home and lock their doors.”

Although homelessness is more visible in towns like Hempstead, where people huddle in alleys and places like the loading dock outside National Wholesale Liquidators, there are homeless people hidden throughout Long Island. And the problem is growing, say those who work with the homeless.

“I’ve seen an upward trend and I am concerned about it,” said Joan Noguera, executive director of the nonprofit Nassau-Suffolk Coalition for the Homeless.

Any trend is hard to quantify because the United States Department of Housing and Urban Development applied new guidelines this year for counting the homeless. Only those living in emergency shelters, transitional housing, abandoned buildings or on the street and who identified themselves as homeless could be counted.

At the beginning of this year, the coalition’s census of unsheltered homeless people reported 781 homeless people in Nassau County and 1,728 in Suffolk County.

This year, the coalition received $10 million from the Department of Housing and Urban Development to distribute among about 40 agencies for homeless shelters, food pantries and homeless intervention.

“But the numbers only tell a piece of the story,” Ms. Noguera said.

On Long Island, the problem of homelessness can be camouflaged by its general affluence and by the system that takes in the homeless — shelters on the Island are small, mostly unmarked homes, run by churches or nonprofit groups, that resemble boarding houses. The homeless population is also spread out — living in campgrounds and parks and on beaches — and is harder to see and to count.

“They may be hidden, but they’re there,” Ms. Noguera said.

Homelessness is more widespread on Long Island than it appears, said Samuel Miller, regional interagency homelessness coordinator for the Department of Housing and Urban Development. The homeless include seasonal workers, military veterans, people discharged from hospitals, domestic violence victims and youths leaving foster care, he said.

“People don’t realize who the homeless are,” said Mr. Miller, who lives in Suffolk County. “What we see and what is out there are two different things.”

In Suffolk, officials have struggled to house the mentally ill since three major psychiatric hospitals closed in the 1990s. “We had to pick up the pieces at our own expense,” County Executive Steve Levy said. “It placed a tremendous burden on the county, but we have done a pretty good job in trying circumstances.”

In 2003, the average number of families living in motels was 112; in 2007, it has been reduced to an average of one, meaning that sometimes there is none, according to the Suffolk County executive’s office. People are instead housed in shelters with cooking facilities and access to health care and job training.

Nassau is developing a 10-year plan to house the chronically homeless, as part of an effort being undertaken by 320 counties nationwide. The goal is to get people in permanent housing, rather than in motels or shelters.

“Emergency housing is important, but you have to get to the root of the problem,” County Executive Thomas R. Suozzi said.

Using federal, state and county dollars, Nassau will spend $5.8 million for emergency shelter in 2007. It has budgeted $2.1 million for Housing and Urban Development programs, including a homeless intervention program, over the next five years.

Many homeless are not physically on the street, but, like Mr. Tegeler, are in places unfit for living, from houses without basic facilities to barns. Others, including working families, live doubled or tripled up with other families or stay with friends and relatives.

They rely on other help, too.

Last Saturday, as temperatures fell, Hempstead’s homeless and elderly flocked for a free Thanksgiving dinner at the South Hempstead Baptist Church. Down the hill, about 50 laborers lined up in an empty lot near the Home Depot for steak served off a grill by Victor Rodriguez, a prison chaplain based in Hempstead who had gathered donations from restaurants and grocery stores to feed out-of-work laborers, several of them homeless.

Homelessness is widespread among low-income families on the Island because of high rents and a lack of rental property, officials say; only 17 percent of properties are rentals, according to the Long Island Index, an annual study of local economic and social trends, compiled for the nonprofit Rauch Foundation.

To prevent families from becoming homeless, organizations like the Nassau-Suffolk Coalition provide temporary assistance, but only up to $1,000. The average monthly rent on the Island is $1,600 , Ms. Noguera said.

Returning veterans are finding themselves homeless, too. Senator Charles E. Schumer’s office estimated that in 2007, 2,000 homeless veterans live on Long Island.

John A. Sperandeo, chief of social work services at the Veterans Affairs Medical Center at Northport, said it can be hard for those in the military to save money for a down payment or for rent, and many veterans return with new mental and physical disabilities. The Northport hospital runs a homeless program with the Salvation Army that has served 447 veterans this year.

Advocates for the homeless like Jay T. Korth, who runs Catholic Charities’ housing program on the Island, want more housing for lower-income workers built to help stem the number of people becoming homeless. “We need more housing options, we need expansion of what’s there,” he said.

But construction is costly, there is little land to build on, and zoning in most towns makes it hard to build multifamily houses for the working class and working poor, Mr. Korth said.

“The future doesn’t look very good for Long Island, housing-wise,” he said.

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Why suspend the death penalty? - Akron (OH) Beacon Journal

Ohio doesn’t protect adequately the rights of the mentally ill

Saturday, November 24, 2007

In 2002, the U.S. Supreme Court barred the execution of defendants with mental retardation. Since then, Ohio has complied with the letter and spirit of the ruling, applying, for instance, accepted definitions in assessing whether a defendant was mentally retarded when committing the crime.

In evaluating the conduct of capital punishment in Ohio, the American Bar Association's Death Penalty Moratorium Implementation Project concluded that the state could do a better job of ensuring that defendants with mental retardation are represented by adequate counsel.

The panel noted the need for defense attorneys to have a full appreciation of their client's limitations. More, steps must be taken to ensure the rights of mentally retarded defendants are protected during police interrogations and investigations.

That element of adequate counsel echoed in the panel's discussion of the way the state handles capital defendants with mental illness. The value cannot be overstated of a defense attorney who grasps the breadth, nuance and challenge of the affliction. In many ways, Ohio does the right thing. Akron and other jurisdictions have trained police officers to handle effectively the 'special needs' of those with mental illness. What the bar association panel found is that taking decisive steps to ensure adequate counsel is just the beginning of improving in this realm.

Most urgent is the need for the state to declare clearly that it will not execute an inmate determined incompetent to proceed with matters pertaining to his or her case. That simple and powerful step would bring an essential element of humanity to the process. The panel advised that if a mental disorder or disability wasn't sufficient for removing the death penalty, a jury should be made aware that such an illness serves as a mitigating factor.

Further, the state lacks a way for a 'next friend' to act on behalf of a prisoner on death row suffering from mental illness. The panel explained that such a mechanism for rational decision-making is particularly important in light of seven of the 26 executions in Ohio since 1999 involving prisoners who 'volunteered' to waive their post-conviction appeals.

The sad reality is, Ohio presses forward with post-conviction proceedings even though mental illness impairs an inmate's judgment and ability to communicate. There is no requirement for the appointment of an expert in mental health during such proceedings. Thus, the state invites the risk of killing someone who has little clue or cannot assess sufficiently the surrounding events. That isn't worthy of a state keen to draw the distinction between a prisoner's brutality and its commitment to justice.

Ohio shouldn't proceed with the death penalty until it formally evaluates these issues involving mental illness, and mental retardation, looking squarely at what officials do in the public's name.
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Homeless Vets Help Their Own - KCRG.com, Cedar Rapids (IA)

By Josh Hinkle, Reporter

IOWA CITY - A homeless veteran's death two weeks ago in Iowa City has prompted several groups to fight back. Sonny Iovino died from hypothermia under a bridge near downtown. Now that incident is inspiring the community to fight back against the homeless problem.

About 1,300 people are homeless right now in Johnson County. Iowa City's Shelter House can only hold 29. 15% of those now staying there are veterans like Len McClellan.

McClellan says, "(I had) bad luck, being taken advantage of, ending up with what I could put in my car."

He is part of the group “Vets Helping Vets.” Monday, they're opening up an account at Wells Fargo in the hope of becoming a non-profit to serve homeless vets in emergencies.

McClellan says they hope to "get some things like a vets center for the guys to come to, get a cup of coffee, talk, try and find the resources to fill their needs."

When a friend and fellow homeless vet froze to death a few weeks ago, it sparked a renewed interest in citizen involvement with this problem. Now others are looking into new ways to house the homeless.

The National Alliance on Mental Illness of Johnson County has a lodge-style facility in the works to house six to eight homeless people with mental illness. The group is applying for a community development block grant for the $400,000 facility.

Former NAMI Director Gene Spaziani says, "They will watch each other in terms of meds and other requirements that they may have jointly."

But a report by the Iowa Council on Homelessness shows veterans are less likely than the rest of the homeless population to have a mental illness. While McClellan and his comrades say that project is a step, they want to make certain their group of homeless heroes isn't forgotten.

He says, "People look down on the homeless, and it's not their fault they're in this situation."

Homeless advocates and supporters will spend the night in boxes and tents during the second annual John's Sleepout in Iowa City on Dec. 8. The event is named for John Stewart, a man who was murdered under a bridge near downtown Iowa City in 2004. To register for the event, call the Shelter House at 319-338-5416, ext. 102.

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Maine's crazy mental health cuts -Portsmouth (NH) Herald News

By Herb Perry
November 22, 2007 6:00 AM

Last week, I was talking with a staff member of Counseling Services, Inc., a nonprofit organization that provides community mental health and substance abuse treatment and support services for southern Maine residents.

As pleasant as she was, the conversation itself was disturbing — we talked about how Maine is trying to balance its books on the backs of the state's most vulnerable residents.

The state plans to cut its spending, and therefore the federal funds it gets, to community mental health services by $100 million in its current biennial budget. Excised would be $20 million in state funds, primarily in the form of reduced rates, and because the federal government matches MaineCare dollars 2-to-1, the actual decrease will be $60 million.

But hold on — it gets better. The state also hopes to realize another $40 million saving by implementing a managed care system.

What's the definition of a "pipe dream"?

The proposed cuts "complement" — that is, add to the effect of — five years of flat or reduced funding to community based mental health services.

CSI will suffer a $3.5 million cut, 15 percent of the agency's $24 million annual operating budget. It laid off more than 20 clinical and administrative staff members last July. But it is not alone.

Several agencies have closed their doors; others have curtailed programs and laid off staff. Disappeared are services such as outpatient counseling clinics and residential programs for children in crisis. The state's largest agency, Sweetser, closed two residential facilities.

People have suffered, are suffering, and will suffer because of the state's actions. Experts predict that more people with mental illness will end up on the streets, in shelters, hospitals and jails. More people will commit suicide.

There is a fiscal cost, as well.

According to Steven Price, CSI's public and community relations manager, "The people who are losing their community mental health services will require greater emergency services, costing Maine taxpayers more money. Preliminary research shows some local police departments have experienced double-digit increases in calls for police emergencies over a 60-day period after the start of the budget cuts.

" ...(I)t's much less expensive to house homeless people than to let them struggle to survive on the street."

About the budget cuts, Sherry Sabo, CEO of Counseling Services, Inc., said, "It's just a loss for the community."

And the community is you and me.

Mental illness affects 60 million Americans, one in every four adults and one in every five children. According to CSI, "Mental illness is more common than cancer, diabetes or heart disease, making it the leading cause of disability in the United States.

"Almost everyone has a family member, friend or colleague" who has a psychiatric disability. People with mental illness include police officers, veterans, lawyers, doctors, small-business owners, teachers and — yes — journalists.

Old-fashioned, imprecise, pejorative, "crazy" remains the word many employ to describe those who will bear the burden of Maine's shortsighted, ill-conceived budget cuts. But, given the unnecessary personal, social and fiscal costs these cuts will cause, what word — especially in its pejorative sense — better characterizes Maine's $100 million fiasco?

Herb Perry is a reporter for the York Weekly. He can be reached at hperry@seacoastonline.com. Read an archive of his In Other Words columns, and his personal story of battling schizoaffective disorder, at http://archive.seacoastonline.com/news/10012006/nhnews-a-o1-schiz-intro.html.

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Hospital shrinks to qualify for funds - Raleigh News and Observer

Staff shortages, training at issue

Lynn Bonner, Staff Writer

Broughton Hospital in Morganton, one of four state mental hospitals, has made itself smaller in an effort to restore federal money lost because of problems with patient care. Officials have shut down parts of the hospital where short-term patients stay -- keeping vacant 38 beds in what has been a heavily used unit -- to concentrate staff in fewer areas.

Broughton lost its ability in August to collect about $1.3 million a month in federal insurance money after investigations into patient treatment found problems with hospital staffing and training. The hospital also no longer qualified for money from a related federal program that brought millions of dollars to the state last year.

The federal government cut insurance payments to Broughton after one patient died and another was seriously injured. In February, a 27-year-old man suffocated after staff members held him to the floor, with one person reportedly lying across his chest. Months later, a patient who was supposed to be closely supervised suffered a serious head injury in a fall.

The state sent in a team to try to fix problems at Broughton. Whittling away at the number of patients was a way to deal with a shortage of psychiatrists.

"We're doing this as a stopgap measure to get us ready for our recertification," said Mike Moseley, director of the state mental health division. "That's our only intent. We want to be recertified just as quickly as we can."

Moseley said patient space has decreased only temporarily, until the hospital can hire more psychiatrists.

In the meantime, he said, patients get better care.

"Psychiatrists have to run from building to building when you have major vacancies," he said.

Broughton is short six psychiatrists. The hospital Web site also posted jobs this week for 13 registered nurses and two staff psychologists.

Some patients are checking into local hospitals rather than going to Broughton, or traveling to state mental hospitals in Granville County, Raleigh or Goldsboro.

Under pressure

Liz Smith, a past president of the Western North Carolina chapter of the National Alliance on Mental Illness, said it is "horrible when people are diverted" to hospitals hundreds of miles from their homes. It's hard enough for people from some western counties to get to Morganton to visit relatives at Broughton, she said, never mind driving to Raleigh or Goldsboro.

The hospital has a longstanding shortage of psychiatrists, Smith said, one that's not likely to be solved in a few months. What's more likely to happen, she said, is that after inspectors come through, the hospital will start using those 38 beds again, whether or not they have enough psychiatrists to treat the patients.

"The pressure is on the hospital to accept people, because there's no place for them in their communities," she said.

Short-term admissions to the state mental hospitals have jumped in recent years, so much that this year the state division of mental health decided to stop new people from coming in when the admissions areas are at 110 percent of capacity.

Broughton was able to stop using 38 short-term beds because admissions dropped over the past month, said Dr. Michael Lancaster, a top administrator in the state mental health division. He is directing the hospital's reorganization.

The hospital is concentrating on filling key job vacancies, he said. But Lancaster said the need for fewer admissions beds could be long-lasting if communities have to cut back on their use of state hospitals to show the hoped-for results.

Depending on the outcome of the division's mock inspection next week, state administrators may ask federal inspectors to come back as soon as possible. In the best case, Lancaster said, federal inspectors will return in mid-January and decide that the hospital can once again qualify for federal money.


lynn.bonner@newsobserver.com or (919) 829-4821
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Questions follow patient's escape - The Oregonian

State hospital - A delay in alerting police has a slaying victim's family asking why

WENDY OWEN
The Oregonian

For 20 minutes, Christopher Mark Walker talked with his mother inside a Portland care facility Wednesday while his state mental hospital escort, whom he had locked outside, called supervisors in Salem rather than the police.

According to police records, nobody called 9-1-1 for at least 45 minutes. Meanwhile, Walker, who was sentenced to the state hospital 18 years ago for killing his estranged girlfriend, walked out a back door and disappeared.

Portland police caught Walker, 46, early Thursday after a short footrace along Northeast Martin Luther King Jr. Boulevard. He faces a felony escape charge.

On Friday, the Oregon State Hospital's interim superintendent, Maynard Hammer, said his staff will review the decisions that allowed Walker to leave the Salem hospital with only one escort. He said he didn't know enough details yet to comment on the delay in calling police.

Walker had attained a privilege level in June that allowed him a single escort from Salem to Portland to visit his mother, Hammer said. The more trustworthy the patient, the higher the privilege level. Walker was in a unit at the hospital that prepares patients to transition back into the community.

"Our job for patients . . . is to treat them so they can live at a reduced level of care in a community. You really can't do that without some levels of trust," Hammer said. "When you have a case like this happen, it makes you wonder whether we're dotting all the i's and crossing all the t's."

Hammer also questioned the use of a single escort in any situation because of the potential for something to go wrong, including illness.

The delay in notifying police, or the public, frustrates relatives of the woman killed by Walker. "I am very upset that (Walker) is on such loose security monitoring," said Barbara Saddler, the victim's mother. Walker stabbed 20-year-old Dena Saddler to death at a downtown transit mall in 1988 after she filed a restraining order against him.

Since being sentenced to the state hospital, Walker has a history of other violations, according to state officials and news accounts.

In 1996, Walker was placed on so-called conditional release, which allowed him to live off the hospital grounds in Salem, but he had to undergo random drug tests and check in with a case manager, among other requirements.

"He did well on conditional release for a number of years," said Mary Claire Buckley, executive director of the Psychiatric Security Review Board. "Then, he had a relapse."

In 2003, Walker tried to blow up a propane tank at Amerigas Propane Co. in Northeast Portland. Firefighters used a water turret to douse the flames after Walker lit the end of a propane hose and used it like a mini-flamethrower to keep away police, according to news reports at the time.

A few months before the propane incident, the Psychiatric Security Review Board, which had given Walker the conditional release, revoked it twice when he failed to report to his case manager and left town.

He was on abscond status when he attempted to blow up the propane tank, Buckley said. He served about a year in prison for arson and burglary.

Saddler said she and her family didn't know Walker was visiting his mother in Portland until they heard he had escaped. Similarly, when he tried to blow up the propane tanks, Saddler learned about it on the evening news.

Saddler said she isn't worried for her safety, but for the safety of others.

"He's interested in getting drugs," she said. Walker was suffering from a drug-induced psychotic episode at the time he killed Dena Saddler.

Sgt. Brian Schmautz of the Portland Police Bureau said officers were watching Walker's old haunts and areas known for street drug sales when they spotted him Thursday, leading to his arrest.

Hammer wouldn't disclose where Walker was being held Friday. He also declined to comment about any disciplinary action that might be taken regarding the state employee from whom Walker escaped.

Wendy Owen: 503-294-5969; wendyowen@news.oregonian.com

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Depression diagnoses on rise in hospitals - Reno (NV) Gazette-Journal

Jason Hidalgo (JHIDALGO@RGJ.COM)

The rate of patients admitted to American hospitals with depression as a secondary diagnosis nearly tripled from 1995 to 2005, a new report finds.

The prevalence of patients admitted to hospitals for other conditions but are also found to suffer from depression jumped from 93 per 10,000 people to 247 per 10,000 people, according to the U.S. Agency for Healthcare Research and Quality. Meanwhile, the number of patients admitted solely for depression within the same 10-year period remained stable — falling slightly from 45 per 10,000 people to 42 per 10,000 people.

In Nevada, hospitalizations for depression alone dropped from 4.1 per 10,000 people to 2.6 per 10,000 people from 2002 to 2005, said Pam Owens, senior research scientist for the agency. Add secondary diagnoses for depression to the list, however, and the rate climbs up from 45.9 per 10,000 people in 2002 to 58.1 per 10,000 people in 2005, Owens said. The agency couldn’t provide an analysis of how much Nevada’s numbers have changed from 1995, Owens said.

“Unfortunately, we’re only able to look at four years worth of data for Nevada because previous data wasn’t available,” Owens said. “The data seems to suggest that some of the trends we’re seeing nationally are also going on in Nevada.”

According to the study, people with a secondary diagnosis of depression were 3.5 times more likely to have a primary diagnosis of alcohol and substance abuse than patients who didn’t have depression. The cost of the 2.9 million hospital stays in 2005 that involved depression as a primary or co-existing illness cost nearly $22 billion.

The report also focuses just on the numbers and doesn’t delve into potential reasons why cases for depression are on the rise. Contributing factors can include an actual increase in the number of people suffering from depression, improved recognition of depression by health care providers and family members, or even more willingness among insurers to pay for treatment of depression, Owens said. The true reason won’t be known, however, until an actual study is done to find out the cause for the increase in depression cases, Owens added.

“Mental health is an under-recognized condition,” Owens said. “Clearly, more attention needs to be paid to hospitalizations and the treatment of depression. Studies have shown a strong link between the mind and the body. We need to investigate why this is happening.”
The fact that rates for depression as a primary diagnosis have stayed flat while the prevalence for depression as a secondary diagnosis have increased likely means that better recognition plays a major role in the nearly 300 percent jump seen nationwide, said Dr. Ole Theinhaus, chairman of the University of Nevada School of Medicine’s psychiatry department.

Another challenge with tracking depression via hospital admissions is that it can also include patients who don’t necessarily have a major depressive illness but end up developing depression symptoms because they’re apprehensive about needing treatment at a hospital. Such patients typically return to normal once they’re no longer in pain and are out of the hospital, Theinhaus said.

One important thing the study points out, though, is the need for increasing awareness and recognition among health care providers and society in general of depression and its symptoms, Theinhaus said.
“Any psychiatrist will confirm that you can walk into (a hospital) today, take a random floor and you could probably diagnose a number of patients who meet the diagnostic criteria for depression, and nobody has bothered to address it,” Theinhaus said.
“It’s not about pointing fingers — a primary caregiver can be so focused on the catastrophic illness or event, which can require a lot of skill and attention. Sometimes, it’s the nurse who picks it up, or a clergyman or family member.”

Dr. Mark Broadhead, a behavioral health expert with Renown Health, said identifying potential depression in patients is a priority at their medical center. Part of the reason is that primary care physicians are becoming more astute in identifying potential depression, which can negatively impact patients’ recovery from other conditions, Broadhead said.

“The number of requests for psychiatric consultations for patients hospitalized at Renown has increased significantly over the past seven years,” Broadhead said. “Psychiatric disorders, such as depression, play an important role in how other diseases such as cardiovascular disease, diabetes, stoke and endocrine disorders effect patients. Treating depression has been shown to decrease the frequency of visits to primary care doctors in the general outpatient setting.”



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Mental health care under a cloud - Atlanta Journal Constitution

Questions: Case of Lawrenceville psychiatrist employed at Rome hospital and accused of sexual misconduct raises quality-of-care issues.

By Alan Judd

Dr. Mohammad Qureshi seemed typical of the psychiatrists at Georgia's state mental hospitals.

He was young, with just a few years' experience. He trained at a foreign medical college. And he was willing to work for the relatively low pay the state offers those who treat the extremely difficult patients occupying its psychiatric facilities.

But for five months this year, while working at Northwest Georgia Regional Hospital in Rome, Qureshi was under suspicion for sexually molesting patients on his second job 90 miles away.

Still, he continued seeing patients at the state hospital until police arrested him in late September. At least 12 women have told authorities that Qureshi fondled them during psychiatric examinations at a Gwinnett County clinic.

The psychiatrist's arrest prompted an investigation at Northwest Georgia Regional. But no patients there made allegations against him.

"There is no evidence of any misconduct by Dr. Qureshi," said Kenya Bello, a spokeswoman for the Department of Human Resources, which runs the state hospitals.

Qureshi, 45, of Law-renceville, has pleaded not guilty. He is out on bail awaiting trial on sexual assault charges, and faces the possibility of years in prison. DHR fired Qureshi from Northwest Georgia Regional, and the state medical board could suspend or revoke his license.

The case is playing out as officials face questions about the quality of medical care in the state's seven psychiatric hospitals.

The U.S. Justice Department is investigating whether poor care in the facilities violates the civil rights of patients. Meanwhile, a panel appointed by Gov. Sonny Perdue is examining the role of the hospitals' staff physicians in creating and sustaining dangerous conditions, among other issues surrounding mental health care in Georgia.

The inquiries followed articles in The Atlanta Journal-Constitution reporting that at least 115 patients died under suspicious circumstances from 2002 through 2006, many after questionable medical treatment.

Qureshi's lawyer, Andrew Margolis, did not respond to requests for an interview. He proclaimed his client's innocence at a hearing last month.

Qureshi, a native of Pakistan, is a U.S. citizen, according to his state personnel records. He graduated from Sindh Medical College at the University of Karachi in 1986 and trained at the University of Connecticut from 1999 to 2003. Files on his medical licenses in New York and Georgia do not show where he practiced during the 13-year interval.

Qureshi came to Georgia in 2006 after working for 19 months at a state mental hospital in Ogdensburg, N.Y., on the Canadian border.

At the St. Lawrence Psychiatric Center, hospital administrators received no complaints about Qureshi's behavior, said Dr. Hari Sanghi, the clinical director.

"Nothing," Sanghi said. "We don't have any adverse record on him. He was doing his job properly. We did not see any problems."

Qureshi left the New York hospital, Sanghi said, to be near his parents after they moved to Georgia.

He went to work at Northwest Georgia Regional in November 2006. His annual salary was $108,000 for a 32-hour work week —- a significant cut from the $145,000 a year he earned in New York.

About the same time, Qureshi took a second job with the Gwinnett-Rockdale-Newton Community Service Board, which operates several mental health clinics in three counties outside Atlanta.

In April, according to recent court testimony, two female patients at the community service board's Lawrenceville clinic complained that Qureshi had touched them inappropriately. The board's director warned Qureshi but kept him on the staff, a police detective testified.

Qureshi's personnel file does not reflect whether anyone at the community service board notified state officials about the allegations. In fact, the file makes no mention of Qureshi's other job in Rome.

By September, complaints about Qureshi had escalated.

A 43-year-old woman alleged that during a psychiatric session, Qureshi instructed her to disrobe and then fondled her. Over the next few weeks, 11 more women came forward to Gwinnett authorities with similar allegations.

Northwest Georgia Re-gional suspended Qureshi shortly after his arrest on Sept. 28. He remained on the state payroll until Oct. 22, three days after a Gwinnett County magistrate judge bound the case over to Superior Court for trial.

State personnel officers thoroughly checked Qureshi's background and credentials before hiring him, said Bello, the DHR spokeswoman. Sanghi, who was Qureshi's supervisor in New York, said he gave him a positive recommendation when Georgia officials called for a reference.

Past ethical lapses do not necessarily disqualify physicians from working in Georgia's state hospitals. At least five doctors now employed in the facilities were hired despite having been disciplined for drug abuse. Another had temporarily lost his license because of alcohol use. Yet another had been punished for sexual misconduct with two patients at a private psychiatric hospital.

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The Peace Drug - Washington Post

Post-traumatic stress disorder had destroyed Donna Kilgore's life. Then experimental therapy with MDMA, a psychedelic drug better known as ecstasy, showed her a way out. Was it a fluke -- or the future?

By Tom Shroder

THE BED IS TILTING!

Or the couch, or whatever. A futon. Slanted.

She hadn't noticed it before, but now she can't stop noticing. Like the princess and the pea.

By objective measure, the tilt is negligible, a fraction of an inch, but she can't be fooled by appearances, not with the sleep mask on. In her inner darkness, the slight tilt magnifies, and suddenly she feels as if she might slide off, and that idea makes her giggle.

"I feel really, really weird," she says. "Crooked!"

Donna Kilgore laughs, a high-pitched sound that contains both thrill and anxiety. That she feels anything at all, anything other than the weighty, oppressive numbness that has filled her for 11 years, is enough in itself to make her giddy. .

But there is something more at work inside her, something growing from the little white capsule she swallowed just minutes ago. She's subject No. 1 in a historic experiment, the first U.S. government-sanctioned research in two decades into the potential of psychedelic drugs to treat psychiatric disorders. This 2004 session in the office of a Charleston, S.C., psychiatrist is being recorded on audiocassettes, which Donna will later hand to a journalist

The tape reveals her reaction as she listens to the gentle piano music playing in her headphones. Behind her eyelids, movies begin to unreel. She tries to say what she sees: Cars careening down the wrong side of the road. Vivid images of her oldest daughter, then all three of her children. She's overcome with an all-consuming love, a love she thought she'd lost forever.

"Now I feel all warm and fuzzy," she announces. "I'm not nervous anymore."

"What level of distress do you feel right now?" a deeply mellow voice beside her asks.

Donna answers with a giggle. "I don't think I got the placebo," she says.

FOURTEEN YEARS AGO, Donna Kilgore was raped.

When the stranger at the door asked if her husband were home, she hesitated. Not long, but long enough. That was her mistake.

"That was it," Donna, 39 now, is saying. "He pushed in. I backed up and picked up a poker from the fireplace. I was screaming. He says, 'I've got a gun. If you cooperate, I won't kill you.' He unzipped his jacket and reached in. I thought, this is it. This is how I'm going to die. My life didn't flash before my eyes. I wasn't thinking about my daughter. Just that one cold, hard fact. I checked out. I could feel it, like hot molasses pouring all over my body. I went completely numb."

She dropped the poker.

Afterward, she stayed strong. She wasn't going to make the classic victim's mistake of blaming herself for provoking the attack. She had no doubts about that. She'd screamed and screamed until the police came through the door. (They later reported that her attacker jumped up, clutching for his pants, saying, "She said I could!")

And, bottom line, she'd survived. She'd be fine, she told herself. She was wrong.

"It was what it must feel like to have no soul," she says. She quit all her hobbies. A passion for tennis died. Devastating nightmares woke her in the dark, her heart racing and palms slick. She dreamed of explosions, tornadoes, bears eating people.

"Psychologists will tell you to go to your happy place," she says. "Well, my happy place had bears in it."

Five years passed. Whatever went wrong, or right, in her life, it felt like it was happening to someone else. She found a wonderful, loving man -- she could still recognize those qualities, even though she couldn't respond to them fully -- and remarried. She had more kids. But even her family felt alien. It was "almost like going overseas and being an exchange student, living with someone else's family . . . I didn't like being close to people, and my children didn't understand that. Mommy was always busy." She was often irritable, and felt an unaccountable anger, which sometimes morphed for no obvious reason into a heavy-breathing, sweat-streaming rage. Almost worse, she couldn't feel the love she knew surrounded her. "I was afraid it was gone -- when you look at your child and say, 'I would die for that child in a heartbeat,' I didn't feel it -- and I was afraid I would never get it back."

As she says this, she never breaks eye contact. Talking about her trauma and her treatment is a decision she's made, she says. "It's important." But it is also, obviously, hard, and she looks a little pale as she explains what it was like for those five years: "I would put my finger on my arm, and it would be like touching a dead body."

Incredibly, she didn't see a connection to the rape. Then, one evening, she was sitting on her couch watching a disaster show on TV -- she calls her interest in the genre "an addiction"-- when her apartment door opened. Something about the angle of it seemed odd. As she looked at the door, the room began to swirl. "It was kind of like a whirlwind, make-you-dizzy moment, and I saw the whole thing, that man pushing through the door, the warm molasses pouring down, my body going numb. I call it, 'when I left my body.'"

Now she understood: She had left her body -- and never come back.

The panic attacks began at work one Friday. She felt butterflies in her stomach, then couldn't breathe. "I thought: 'Oh my God, I'm dying. I'm having a heart attack.'"

It passed, but she was shaken, especially because she'd also been having fainting spells and migraine headaches. She went to a neurologist "sure they were going to find a brain tumor."

The doctor was getting ready to order an MRI scan when Donna just blurted it out: "Things don't feel real to me."

The doctor turned. "Oh? There's a word for that," she remembers him saying. The word is dissociation, which happened to be a prime symptom of post-traumatic stress disorder, or PTSD.

PTSD is usually triggered by combat, rape, childhood abuse, a serious accident or natural disaster -- any situation in which someone believes death is imminent, or in which a significant threat of serious injury is accompanied by an intense sense of helplessness or horror. Not all or even most trauma victims develop PTSD, but enough do so that nearly 24 million Americans, or 8 percent of the population, have suffered from it at some point in their lifetime. It is estimated that in any given year, more than 5 million Americans have active PTSD -- a costly problem in humanitarian and economic terms. Drug and alcohol abuse are all-too-frequent consequences of PTSD, as is loss of productivity and the need for expensive, long-lasting medical treatment.

The ever-lengthening Iraq war will count among its other costs a legacy of thousands of veterans in need of psychiatric treatment. The government estimates that already more than 50,000 soldiers -- about 4 percent of those who have been deployed to Iraq and Afghanistan -- have been treated for symptoms of PTSD. Many more might actually have it: Military studies put the number at 12 to 20 percent of those returning from Iraq and 6 to 11 percent of those returning from Afghanistan. And the news gets worse.

"Vets with PTSD are particularly costly to the [Veterans Affairs] system," says Linda Bilmes, a lecturer in public policy at Harvard's Kennedy School of Government. "They constitute 8 percent of the claims, but 20 percent of the payments." Bilmes, who has studied the ongoing costs of the wars, estimates that treating Iraq vets with PTSD over the next 50 years will cost taxpayers $100 billion. This is based on findings that one-third of vets with PTSD will remain unemployable, and all suffering with PTSD will have a much higher than normal likelihood of needing treatment for physical ailments. And that's just the direct costs to the budget. "Assuming that the war continues, though with lower deployments, through 2017," she says, and assuming the rate of PTSD isn't being underreported, the cost of lost economic productivity to the U.S. economy will be in excess of $65 billion.

Whatever the cause, the symptoms of PTSD are fairly consistent, and Donna's -- which rated severe on a standard diagnostic test -- were typical. Her prognosis was not great. Some antidepressants can diminish symptoms, and various forms of psychotherapy can, long term, sometimes untangle the psychological knot at the root of the problem. But the nature of PTSD makes therapy problematic. The very symptoms -- acute anxiety, heightened fear, diminished trust and inability to revisit the trauma -- are a direct roadblock to healing. At least one-third of people with PTSD never fully recover.

On that day of Donna's first diagnosis, the doctor sent her up to the seventh floor, the psych floor, to begin years of therapy and medication, none of which helped much, Donna says.

And then she found Michael Mithoefer and became the first to take one of his little white capsules.

THE CAPSULES RESIDE IN A SAFE, armed with an alarm and bolted to the floor of Mithoefer's office, a 1950s-vintage cottage on the road between downtown Charleston and Sullivans Island. It's been tastefully remodeled to create a softly lit, high-ceilinged sanctuary in the back, scattered with art and furnished with, among other things, the ever-so-slightly inclined futon where Donna got crooked.

The elaborate security is occasioned by what is inside the capsules: MDMA, a synthetic compound that is a chemical cousin to both mescaline and methamphetamine. Unabbreviated, MDMA is a real mouthful -- 3,4-methylenedioxymethamphetamine -- but it is far better known by its street name, ecstasy, millions of doses of which are synthesized in criminal labs from the oil of the sassafras plant. At one point, Mithoefer recounts, agents of the Drug Enforcement Administration, there to inspect the security arrangements, inquired about the therapist who rents the office adjoining the safe room.

"I guess they were concerned she might drill through the wall into the safe and steal the MDMA," Mithoefer says. "Though there's such a small amount in there, and it's so readily available on the street in such large quantities, I don't see how that would be worth the effort, even if she were so inclined."

Mithoefer became a psychiatrist in 1991, after a decade as an emergency room doctor -- he had found himself less interested in the bodily traumas his patients suffered than the psychological traumas that so often preceded their appearance in the emergency room. He's got that mellow, empathic vibe that they just can't teach at therapy school. He always seems moments away from a sympathetic chuckle, an understanding murmur or a sage observation. A fit 61, with a brown ponytail and relaxed dress code, Mithoefer has become the accidental point man of a movement to revive medical research into psychedelic drugs. His Food and Drug Administration-approved PTSD study that began with Donna Kilgore in April 2004 is now nearly completed, with 18 of 21 subjects having undergone the double-blind sessions. Two Iraq veterans with war-related PTSD, the study's first, are cleared to begin. Close behind are similar studies in Switzerland and Israel. At Harvard's McLean Hospital, researchers are set to evaluate MDMA therapy as a way to alleviate acute anxiety in terminal cancer patients. In Vancouver, Canada, the effectiveness of an ongoing program to treat drug addiction with another potent psychedelic drug, ibogaine, is under scrutiny. There is a proposal, based on case histories, to study the ability of LSD to defuse crippling cluster headaches.

All of these studies are directly or indirectly funded by a surprisingly robust organization whose roots stretch back 40 years to the psychedelic movement of the 1960s. Before Harvard lecturer Timothy Leary started channeling aliens and urging college kids to turn on and drop out, an intense cadre of doctors and researchers had come to believe that psychedelic drugs would revolutionize psychiatry, providing those with a wide spectrum of psychological problems -- or even just ordinary life difficulties -- the ability to, basically, heal themselves.

But Leary's bizarre career, which morphed from doing research on psychedelics to cheerleading their widespread abuse, obscured whatever medical potential the drugs may have had. Instead, authorities focused on the risks, and often exaggerated them. Richard Nixon famously called Leary "the most dangerous man in America." After a slow start, regulators and legislators cracked down hard. Millions of dollars in enforcement efforts were unable to end abuse of psychedelic drugs, but they effectively stamped out sanctioned research into their healing potential.

A small group of psychedelic researchers and therapists willing to break the law continued their work clandestinely. A much larger group did not flout the law, but waited in the wings and is now emerging. Experience had convinced these therapists that psychedelics, along with significant risks, had potential for even more significant benefits.

This may have been especially true of MDMA.

Mithoefer states the case in an article he wrote for a book of scholarly essays, Psychedelic Medicine: Social, Clinical and Legal Perspectives:"The reported results [of early therapeutic use] include decreased fear and anxiety, increased openness, trust and interpersonal closeness, improved therapeutic alliance, enhanced recall of past events with an accompanying ability to examine them with new insight, calm objectivity and compassionate self-acceptance."

In short, a therapist's dream. Or is it a hallucination?

THE PROMISE OF A BLOCKBUSTER TREATMENT, one that doesn't just address symptoms but defuses underlying causes, is a particularly seductive vision right now. A report issued last month by the National Academy of Sciences' Institute of Medicine emphasizes the uncertain effectiveness of current PTSD treatments, and the urgent need of returning soldiers who will suffer from it.

To a non-scientist, the very preliminary results of Mithoefer's study would suggest that MDMA might be just what the doctors ordered. Of the subjects who have been through both the MDMA-assisted therapy and the three-month post-experiment follow-up tests, Mithoefer reports, every one showed dramatic improvement.

But scientists are a cautious lot. "It's potentially nice to hear those things," says Scott Lilienfeld, an associate professor of psychology at Emory University. But until results are statistically analyzed and peer-reviewed for publication, "you can't really judge them. The plural of anecdote is not data." Especially with a drug that has considerable risk, Lilienfeld cautions, it pays to be skeptical.

A.C. Parrott, a psychologist at Swansea University in Britain who has devoted a large part of his career to studying the dangers of MDMA, is far more than skeptical. "MDMA is a very powerful, neurochemically messy and potentially damaging drug," he says. The government "should never have given it a license for these trials. Certainly I would not give it a license for any further trials."

But one of the nation's premier PTSD researchers, Roger K. Pitman, a professor of psychiatry at Harvard Medical School, disagrees. Morphine is a powerful, potentially damaging drug, Pitman says, "and we use it to treat the pain of cancer patients. Sound medical reasons should trump."

Current treatment for PTSD is "partial at best," he says. "There's a lot of room for improvement, and we need to be looking for novel treatments."

Though Pitman calls the MDMA study "a fringe hypothesis" -- "I've never heard anybody talk about it at any PTSD meeting I've ever attended in 25 years" -- he also observes that, based solely on a description of the preliminary results, "this seems worth further study. A lot of new ideas meet with rejection and skepticism, and we need to be careful not to be prejudiced against something just because it seems wacky. If it has a 5 percent chance, or even a 1 percent chance, of being effective in treatment of PTSD, it's worth pursuing."

AS THE SESSION TAPE ROLLS TOWARD THE FIRST HOUR, the giggles have passed. Donna Kilgore is still on the crooked couch, but she sounds very level. She's talking about her husband. Her voice is clear, calm, but you can hear something in it, something rising in the throat like water from a newly tapped spring.

"I just have a deep feeling of gratitude for all the love and understanding he's shown. I know it's been tough on him, not understanding what I've been going through and not knowing how to help. But if it wasn't for him, I don't think I'd be here."

The study protocol requires that a hospital crash cart and a trauma doctor be present during all therapy sessions, in case the drug precipitates a medical emergency. They are waiting a room away, a reminder that this is a test of a potent experimental drug, though you'd never know that from the calm, sober tenor of the conversation. It's really more of a monologue: Michael Mithoefer and his wife, Annie, a nurse and co-therapist, mostly listen, only occasionally murmuring supportively. This is their treatment plan: Construct a reassuring, protective environment and "let the drug do its work."

"He used to spend a lot of time laughing and cutting up," Donna continues about her husband, "but things have gotten so serious. I love him with all my heart, but there just hasn't been that warm fuzzy feeling, how you get excited every time you see him. It's put a damper on it. I don't fully enjoy anything. I don't enjoy my kids. I don't enjoy my dog.

"It's frustrating, just going through the motions day after day after day. I don't get any joy out of it."

She stops talking, and you can hear the faint strain of music coming from her headphones. She takes a deep breath. The blood pressure cuff, on a five-minute timer, starts to inflate.

"It sucks to just exist, and not live," Donna announces.

FIRST SYNTHESIZED IN 1912 -- A BYPRODUCT IN THE MANUFACTURE OF A DRUG TO SUPPRESS BLEEDING -- MDMA was little known until a former Dow Chemical researcher named Alexander Shulgin tried it himself in 1977. Shulgin had made his reputation, and made Dow millions, by inventing the first biodegradable pesticide. After that success, he was able to work on whatever he chose. He chose psychedelic drugs, based on a transforming experience he had with mescaline in the late 1950s. "I understood that our entire universe is contained in the mind and the spirit," he wrote. "We may choose not to find access to it, we may even deny its existence, but it is indeed there inside us, and there are chemicals that can catalyze its availability."

Shulgin made it his business to find those chemicals. In a New York Times profile in 2005, when Shulgin was 79, he estimated that he'd synthesized 200 psychoactive compounds and tested them on himself. Their effects ranged from paralyzing him with fear to granting him ecstatic visions. With MDMA, he was convinced that he'd found something special.

"I feel absolutely clean inside, and there is nothing but pure euphoria," he wrote in his field journal. "The cleanliness, clarity, and marvelous feeling of solid inner strength continued . . . through the next day. I am overcome by the profundity of the experience."

It's not well understood why MDMA, or any psychedelic drug, can produce extraordinary experiences. But in MDMA's case, the crude explanation seems to involve a drug-forced rush of serotonin in the brain. Serotonin assists in the transmission of nerve impulses and plays a role in regulating a wide range of sensations and impulses, from mood, emotion, sleep and appetite to sensation, pleasure and sexuality. One recent study pointed out physiological similarities between a brain under the influence of MDMA and the post-orgasmic state, also known for producing emotional closeness and euphoria.

Whatever the cause, Shulgin saw in the overwhelming positive feelings the drug engendered huge potential as an aid in the psychotherapeutic process. "I made samples of it for a good therapist friend of mine, Leo Zeff, which brought him out of retirement and into the enthusiastic task of making it available internationally with his psychotherapy friends," Shulgin recalls in an e-mail. "Its popularity spread in part by his enthusiasm, but in part by the fact that its ability to open the doors of communication made it widely popular as a social drug."

BY MULTIPLE ACCOUNTS, MDMA EMERGED AS A STREET DRUG IN 1984 at a new and instantly hot Dallas nightclub called Starck. Sold at $12 a hit, MDMA -- which Zeff's crowd had nicknamed Adam, for its presumed potential to return man to innocent bliss -- became ecstasy. Part of the drug's appeal was that it made dancing feel great, and staying up all night easy. But there was more. Here's an account of first-time ecstasy use from that period, recalled in the Austin Chronicle in 2000:

"The street lights got brighter, I could see the stars, car lights, even the shadows in this alley were, you know, more so. And I felt this tingle that began in my fingers and spread all over my body, coming in waves, just this indescribable feeling of aliveness. It was as if the nerves in my skin had been dormant all these years and were just now waking up and stretching. Just like that. And after this initial rush