Decide to pay attention in 2008 - Prince George (CANADA) Citizen

Opinion) Monday, 31 December 2007, 00:01 PST
Paul Willcocks, Special to the Citizen

VICTORIA -- I've been writing similar columns this time of year for a while now, always urging readers to make the same resolution.

Decide to pay attention for the next 12 months. To the people closest to you, but also to the way life works for people in your town and across the world. (

We're not good at paying attention. We suddenly notice people have changed -- children have grown up, parents have grown old, lovers have grown apart. We wonder, when did that happen?

Of course it happened every day, right in front of us. But we weren't paying attention.

We miss a lot. You grow close to people when you share experiences with them, travel through life together.

But if you don't notice where their lives are taking them, the little bumps and joys, you're left behind. Soon you're somewhere else all together.

And the smallest things you missed put you there. A hesitation when you ask how things are. A laugh. A brief sad look. The kind of things you don't notice, unless you're paying attention.

It's not just about the people right around you, though. I believe that when people see that something is wrong -- an injustice, cruelty, waste, foolishness -- they want to right it. If they can't, they expect those responsible to fix it, with that responsibility often falling to governments.

I have to believe that. There's not much point in writing this kind of column unless you believe that people will consider the information and analysis and -- at least sometimes -- do something with it. Just chronicling our troubles isn't enough.

I also believe it's true. It takes us a while for us to figure out there is really a problem, and then longer to decide what to do. Longer still to judge who should do it.

But we don't like to see people left behind, or children in care shortchanged, or businesses struggling with pointless government regulations and paperwork.

Eventually, we deal with the problems.

But only if we notice -- if we're paying attention.

Here in Victoria, we've suddenly noticed big problems on our streets. Drunken louts at bar closing time. A lot of homeless people, including many dealing with serious mental illness, damaging drug addictions or both.

They didn't just appear one day, a group of 50 hanging around the needle exchange, panhandlers on the corners, heaps of belongings and cold-looking people outside Streetlink, the main shelter.

But we didn't notice when the first people released from mental hospitals in the 1970s, with the promise of support in the community, started showing up on the streets. The support wasn't there; they could make their way without it; so they fell.

We didn't notice when the small group of older alcohol addicts were joined by more and more people haunted by cocaine, their limbs twitching, sores on neck and arms and faces.

Because we didn't notice, governments thought we didn't care.

If we'd been paying attention, it would never have got so bad. Instead, this all got so much worse that we now face a giant problem.

So I'm amending the resolution that I hope you'll adopt. It's still to pay attention. And really, it's best to start close to home. With the people you live with each day, the world you inhabit - the way the breeze feels on your face or the sky looks like at dusk on a middling spring day.

But when it comes to the bigger world, maybe this year we could all resolve to focus. To pick something that seems wrong, and make it better.

Maybe it troubles you that children in care are pushed out into the world the day they turn 19, with no real support or guidance. (Except for the efforts of some extraordinary foster parents.) Or you don't think people with mental illnesses should be dumped on the streets.

Pick something, and resolve to make it better by the end of the year. Demand action of politicians. Give some money. Give some time. Hold yourself accountable.


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Study indicates drug addicts' brains may be wired for relapse - Southwest Florida News Press

By Jean P. Fisher
McClatchy News Service

Drug or alcohol abusers who relapse, even after long periods of abstinence, are often reviled as too weak or undisciplined to straighten themselves out. But a University of North Carolina-Chapel Hill psychologist has found evidence that suggests, in fact, that addicts' brains may be wired in a way that makes them more prone to give in to temptation.

The research, published in the December issue of the Journal of Neuroscience, provides further evidence that addiction is a disease, not a character flaw, says Charlotte Boettiger, an assistant professor of psychology at UNC-Chapel Hill and lead author of the paper.

"It wasn't that long ago that we believed schizophrenia was caused by bad mothers and depression wasn't a disease," Boettiger said. "Addiction is maybe just a couple of decades behind."

What they did: Boettiger and colleagues peeked inside the brain to see how brain function might be different in a substance abuser. The study, conducted while Boettiger was at the University of California at San Francisco, used imaging technology to take pictures of sober alcoholics' and nonalcoholics' brains as they chose between immediate and delayed rewards. Alcoholics chose the quick payoff almost three times more often.

What they found: Scans showed that the most impulsive subjects — most but not all of whom had a history of alcoholism — had reduced activity in an area of the brain that helps assess rewards and increased activity in other sections of the brain associated with judgment and decision-making. The differences suggest that some addicts may have impaired ability to think through a decision, Boettiger said. Blood tests implicated a variant gene.

What it means: More study is needed, but Boettiger said the findings suggest new treatment approaches for addiction. Drugs for early-onset Alzheimer's disease and Parkinson's disease target the same regions of the brain, so those medicines may also be useful for alcohol or drug addiction.

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Bucking Privacy Concerns - Wall Street Journal

Staff Trained to Spot
Students in Distress;
Campus Suicides Drop

By ELIZABETH BERNSTEIN

ITHACA, N.Y. -- For 19 years as a custodian at Cornell University, Sue Welch has been taking out the garbage and mopping the floors of residence halls. Recently, she added a new responsibility: trying to prevent student suicide.

Ms. Welch noticed during a recent semester that she was repeatedly having to clean up after a particular student's apparent bouts of nausea, and told her supervisor she feared the young woman had an eating disorder. The supervisor told the residence-hall director, who encouraged the student to go to the university health center. Counselors there arranged for her to get treatment for bulimia nervosa. Ms. Welch credits the training sessions that she and other custodians attended on how to spot students with mental-health problems.

"These kids are looking to us to provide care," she says. "But they don't see administrators every day, they see me."


Ms. Welch's dual role puts Cornell at the center of a debate over the privacy rights of American college students. After years in which many colleges have said privacy rules prevent them from interceding with troubled students, Cornell is taking the opposite tack.

Its "alert team" of administrators, campus police and counselors meets weekly to compare notes on signs of student emotional problems. People across campus, from librarians to handymen, are trained to recognize potentially dangerous behavior. And starting this year, Cornell is taking advantage of a rarely used legal exception to student-privacy rights: It is assuming students are dependents of their parents, allowing the school to inform parents of concerns without students' permission.

The Virginia Tech massacre earlier this year, in which a student with a known history of troubling behavior shot and killed 32 people, set off alarms about whether schools were overemphasizing the privacy of students at the expense of their health and safety. Watching over students and keeping parents in the loop may seem like obvious approaches, but many schools decline to share information about their students either internally or externally. Schools say they fervently guard students' privacy because a federal law requires them to, and because they are afraid of getting sued. They also say college students are adults who need to be supported in their growing independence.

Many schools refuse to release information without a student's written permission, and most rarely invoke exceptions allowed in the law, known as the Family Educational Rights and Privacy Act, or Ferpa. Some colleges have paid out settlements when families sued for wrongful death of students and alleged that officials should have raised flags. But other schools have won their cases. A jury last year decided that Allegheny College, in Meadville, Pa., was justified in not alerting the parents of Chuck Mahoney to his distress before his suicide, despite warning signs and discussions among officials worried he might pose a danger to himself or others.

Ferpa allows privacy to be breached if a student is under 21 and has a drug or alcohol violation, or if there is a health or safety emergency. The law only protects educational records, and doesn't generally apply to observations about student behavior. Schools are allowed to share information with parents if students are their financial dependents, as Cornell is now doing. This fall, Cornell used the new policy to inform parents that a student living in a residence hall was no longer enrolled in classes; the university says the parents were grateful for the call and took the student home.


"When parents send their sons and daughters off to college, there's an expectation -- and I think it's understandable -- that there will be people looking out for them," says Timothy Marchell, an associate director of health services at Cornell who holds an unusual additional title, director of mental-health initiatives.

In the last six years since Cornell took it first new steps in 2002, the school has had five student suicides, it says. In the previous six years, there were 11.

Dr. Marchell, 47 years old, is a Cornell alumnus who grew up in Ithaca, the son of a guidance counselor and a nurse-teacher in the local school district. He has been at the center of Cornell's recent collaborative mental-health approach. Until a few years ago, Cornell interpreted privacy law as narrowly as other schools. Even counselors and medical doctors in the health center were reluctant to share information.

But Cornell was battling a reputation as an intense school with a high suicide rate. The university was named the most stressful of 15 top schools in a 2000 book that surveyed students. Adding to its reputation was the campus's physical isolation in the rolling hills of central New York state, and its unusual local geography. Over the years, some students and others took their lives by flinging themselves off one of Ithaca's steep gorges. Stressed-out students have sometimes joked about wanting to "gorge out." Cornell administrators say the reputation is unfounded, and that the school averages one to two suicides a year, consistent with the national average for colleges. Still, they believed that some suicides might be preventable.

Dr. Marchell, who volunteered at a local suicide hotline when he was a Cornell senior, had gone on to earn a master's degree in public health and a doctorate in psychology. In 1998, Cornell hired him with a mandate: Tackle the school's problems with student drinking.

The flash point was a campus tradition called Slope Day. On the last day of classes each May, students would converge on a steep lawn in the middle of campus to drink themselves silly. Decades ago, the university itself supplied beer trucks and barbecues. That stopped when the legal drinking age was raised to 21 in the mid-1980s, but thousands of students started toting their own alcohol to the slope. Ambulances lined up at the edge, and students suffering alcohol poisoning or injuries from fights filled the health center and the local emergency room.

Dr. Marchell urged changes such as arranging appearances by well-known bands to make regulating alcohol more palatable. The school eventually enclosed the event with a long fence, inside which it sold beer but denied it to students under 21. Underage drinking dropped sharply and alcohol poisonings began a steady decline.

By 2002, the executive director of Cornell's health center, Janet Corson-Rikert, began making mental health a communitywide responsibility. The 1999 shootings at Columbine High School had shocked educators into recognizing the danger of failing to spot troubled students. Like most colleges, Cornell was starting to see more students enrolled with severe mental-health problems, as reduced stigma and improved medications allowed more of them to reach college. The counseling center was often overwhelmed with demand for appointments.

Dr. Corson-Rikert asked Dr. Marchell and others to build a network to train people to notice problems and give them ways to report them, while still respecting student privacy. An advisory council on mental-health strategies made up of Cornell staff, faculty and student leaders had its first meeting in early 2004, and members had a realization: In school post-mortems after tragedies, "each person knew pieces of the story but no one saw the whole picture," says Dr. Marchell. "If they had shared the information, maybe we could have intervened."

Dr. Marchell spoke with several suicide-prevention organizations, who pointed the school to a surprising model: the Air Force.

In the 1990s, the service decided to try to reduce suicides by airmen and studied each case for warning signs. They learned to look at behavior changes, discipline problems and poor performance ratings as possible indicators of depression. Four-star generals began to talk publicly about mental illness and encourage all service members to watch for warning signs. Each member of the Air Force is now given training in detecting depression and other mental disorders. The Air Force's protocol is one of few suicide-prevention programs proven effective: The average annual suicide rate dropped by a third, from 13.5 per 100,000 people to 9.9.

Cornell adapted parts of the program. Dr. Corson-Rikert enlisted the university's president, David J. Skorton, to use his speeches and articles to encourage everyone on campus to watch out for each other's mental health. Counselors began seminars to teach the signs of emotional problems or addiction. Last spring, Cornell's health center began screening students who come in for any reason for signs of depression, asking them about trouble sleeping, poor appetite, difficulties concentrating or thoughts of self-harm.

In September, Meredith Shepard, a 20-year-old freshman, went to the health center with a sinus infection. On her questionnaire, she scored high for depression and was referred to a counselor, who saw her the same day. Miss Shepard told her counselor she was feeling overwhelmed with stress from roommate problems and some "deeper struggles," she says. When she was 13, she had experienced depression and anorexia, triggered by suffering she had seen on a family trip to Nepal. Now, after volunteering last year with genocide survivors in Rwanda, she was finding the transition to college difficult. She'd begun over-exercising and under-eating. The counselor referred Miss Shepard to another therapist, who also referred her to a nutritionist, a psychiatrist and a medical doctor. "It's easy to feel lost, uncared for and alone," she says, but her "team" makes her feel "constantly aware of having a safety net."

Cornell therapists also make a form of house calls: They hold free, no-appointment consulting hours in 10 locations across campus. About halfway through each semester, professors in some of Cornell's seven undergraduate colleges are asked to report students who have bad grades, seem disconnected or are failing to come to class. "That kind of checking out is a very serious thing," says Alan Mathios, interim dean of the College of Human Ecology. "So, waiting for the end of the semester to come is often too late." Two psychologists work full-time just consulting with professors and staff when they have concerns about students.

Last August, a review panel on the Virginia Tech massacre recommended that colleges do more to share information about troubled students. About half the colleges in the country had teams of administrators aimed at doing so, and as many as a quarter more have quickly added them, according to a risk-management firm that specializes in colleges' insurance.

Dr. Corson-Rikert and Dr. Marchell had started their own multidisciplinary "alert team" in 2005. It includes the director of counseling, an associate dean of students, the campus police captain, the university's judicial administrator, therapists and sometimes other administrators. The team typically has several students on its agenda each week.

Sometimes administrators are worried that a student has stopped going to class or, as happened recently, is attending classes despite having been suspended. Often the police report a student who has been arrested for excessive drinking or drugs. Therapists are legally required to keep their own patients' information confidential, so they say they don't share that. But they can receive information from other team members and follow up, and can give general professional advice.

Recently, campus police responded to 911 calls about an alarmingly disheveled and agitated young man in a campus building. They took him to the local hospital, where doctors diagnosed him as psychotic and admitted him. The next day, members of the Alert Team planned travel arrangements for the student's parents and set up a medical leave so the student wouldn't fail classes.

"We were trying to put a system in place so that when a problem gets to this level, it doesn't get worse," says Gregory Eells, the school's director of counseling and psychological services.

Protests haven't arisen over the university's interventionist approach, but administrators say many of the mental-health initiatives work privately and students know little about them. Some students say, however, that the university may spend so much time caring for the most emotionally vulnerable students that it has fewer resources left for those who are merely stressed out. Dr. Marchell admits that's a potential problem with the school's approach.

Erin Geld was disappointed by Cornell's services last year after a good friend became seriously ill. Miss Geld says she fell behind in classes, suffered mood swings, felt depressed and slept constantly. But when she called the counseling center, after a triage interview she was told she had to wait three weeks to see a school therapist, and was offered referral to a community health resource for faster help if she wished. Miss Geld says she felt the off-campus therapy was ineffective and soon quit.

"Despite stepping to the plate and asking for help, I did not really get the support I needed from Cornell," the 23-year-old from São Paulo, Brazil, who graduated in May, wrote in an editorial last March in the Cornell Daily Sun, the student newspaper. Dr. Corson-Rikert notes Ms. Geld had the choice of waiting for a school counselor appointment; she says the counseling center schedules many appointments within hours or days based on their urgency, and tries to schedule others within two weeks but doesn't always manage.


Catherine Savage had a better counseling experience. The 24-year-old, whose father committed suicide when she was seven, has seen a therapist and taken antidepressants since she was in middle school. At Cornell, Miss Savage struggled with depression. She saw a therapist at the counseling center on and off. One night during her junior year, Miss Savage called the health center crying, and said she didn't want to live. The nurse on the line told Miss Savage to go to the hospital. She was admitted for 11 days.

Some schools have been sued for requiring suicidal students to leave dorms or campuses. Miss Savage got a call from her Cornell counselor, and one of her teachers visited her. At Miss Savage's request, the counselor arranged extensions in her classes and a voluntary medical leave, and found her a treatment program in her hometown. Miss Savage went home to Madison, Wis., and attended the University of Wisconsin. Her Cornell adviser helped her pick classes that would earn Cornell credit. A year and a half later, in the fall of 2005, she came back to Cornell.

She enjoyed her classes, rejoined the Cornell University Chorus and continued to see her therapist at the health center. "All parts of the school made it clear that my mental health had to be among my priorities if I wanted to have a happy life and do all the things I came to Cornell to do," says Miss Savage, who graduated in May 2006 and works as a hospital dietician in Salt Lake City. "And they gave me the support."

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A HIDDEN SHAME: DANGER AND DEATH IN GEORGIA'S MENTAL HOSPITALS - Atlanta Journal Constitution

More deaths blamed on errors, neglect
Preventable deaths continue at understaffed, overcrowded facilities

By ALAN JUDD, ANDY MILLER
The Atlanta Journal-Constitution

An ongoing pattern of medical errors and neglectful care contributed to as many as 21deaths this year in Georgia's state psychiatric hospitals.

These deaths occurred amid intense scrutiny of the hospitals' performance, an investigation by The Atlanta Journal-Constitution shows. The seven state-run facilities remain overcrowded and understaffed, and patients still are dying under circumstances similar to those that led to more than 100 other questionable deaths in the previous five years.

One patient died this year after doctors prescribed enough anti-psychotic medication to possibly kill a person. Those doctors "were not practicing the standard of care," another physician wrote.

Another man died from a misdiagnosed bowel obstruction. "I thought maybe it was something he ate," a nurse said later, explaining why the patient's symptoms went untreated. "We were not monitoring his intake or output."

In yet another case, nurses and aides disregarded a doctor's instructions to take a vulnerable patient's vital signs — more than 700 times. When he died, hospital staff members were merely guessing his body temperature.

The continuation of preventable deaths in 2007 — at a pace similar to that of recent years — underscores the scope of the troubles that have plagued the state hospitals for years.

The facilities have been under a spotlight since January, when the Journal-Constitution reported that at least 115 patients had died from neglect or abuse or under other suspicious conditions from 2002 through 2006. State authorities substantiated almost 200 reports of patient abuse during the same period.

The newspaper reported that poor care persisted in the hospitals during those years even as federal regulators cited widespread deficiencies. In 2002, for instance, regulators ordered Georgia Regional Hospital/Atlanta to correct overcrowding and patient care problems. But in a 2006 inspection, the regulators found that many of the same failings still existed.

In response to the Journal-Constitution's articles, the U.S. Justice Department is investigating whether conditions at the hospitalsviolate patients' civil rights. The agency could ask a federal judge to appoint a monitor to supervise the facilities. It also could force the state to spend millions of dollars expanding services, creating space for more patients or otherwise improving the hospitals. The results of the federal inquiry are expected to be released in 2008.

Meanwhile, consultants hired by the state have produced scathing reviews of hospital performance. And a commission created by Gov. Sonny Perdue is studying ways to overhaul the state's mental health care system.

Officials at the Georgia Department of Human Resources, which operates the hospitals, declined to comment late last week. Over the past several months, they have said they are trying to improve all aspects of mental health care. They speak of "rebalancing" the system to emphasize community-based treatment rather than hospital admissions. But they acknowledge that community services often don't exist or, when they do, are not plentiful enough.

Georgians with serious mental illness remain about three times more likely to end up in a state hospital than residents of other states. Georgia's state hospitals readmit a significantly higher percentage of patients than the national average. And at any time, nearly 100 hospital patients are ready for discharge, but have no place to go.

Citing privacy regulations, state officials refuse to identify deceased patients or to explain why they died. The Journal-Constitution relied on hospital reports, autopsies, death certificates, a database of vital statistics and interviews with patients' families and the families' lawyers to compile a picture of conditions inside the facilities.

The newspaper's review indicated that the state hospitals are arguably as dangerous as they were a year ago. In all, 55 hospital patients died of all causes this year through mid-November, the latest date for which reports are available. Of those, as many as 21 died after what appears to have been negligent care by physicians, nurses, aides or technicians, the Journal-Constitution's examination found. They died from causes that have become familiar in the state hospitals in recent years.

At least three choked on food, vomit or foreign objects. Two died from medication errors. Two developed fatal intestinal blockages, the same condition that killed 14-year-old Sarah Elizabeth Crider at the Atlanta hospital in 2006. Her death, highlighted in the Journal-Constitution in January, prompted hospital officials to create new policies requiring staff members to monitor patients' bowel movements.

But, as the deaths from intestinal blockages show, hospital workers still often failed to recognize symptoms of life-threatening illnesses or to provide adequate emergency treatment for injuries.


A missed clue

When Keith Ross developed a high fever last April, caregivers at Southwestern State Hospital in Thomasville thought he had the flu. "His condition was not life-threatening," a nurse manager said later.

But Ross, 19, a patient in Southwestern's forensic unit, which houses criminal defendants for mental illness, died shortly after hospital workers sent him to a local emergency room. The cause of death: appendicitis and a heart inflammation.

The medical director for the state's mental health division at the time determined later that the hospital staff should have sought emergency treatment much sooner. Ross' persistent fever, she wrote, should have been "a big clue."

Ross' grandmother, Beatrice Wilson of Albany, said doctors at Southwestern State gave him antibiotics for several days before seeking emergency treatment. She still wonders why they waited, and what made her grandson so sick.

"Those questions have not been answered for me," Wilson said.

Questions also remain about the death of a 71-year-old patient last May at Central State Hospital in Milledgeville.

The woman fell to the floor as a nursing assistant put her to bed. But the patient received no medical treatment for her injuries for five days – until just a few hours before she died. The aide apparently never told the patient's physician about the fall.

The woman's "right to appropriate medical treatment was violated," a state investigation concluded. The hospital fired the nursing aide.


Breakdown

The death of a 55-year-old patient at Central State in July shows how a breakdown in communication between physicians and other staff members could result in a breakdown of care.

The patient had been blind and mute since birth. He needed a safety belt and a lapboard to keep him from falling out of his wheelchair. He came to the state hospital, a report said, when his family in DeKalb County could no longer handle his "uncontrollable and destructive behavior."

The man was prone to dangerously low body temperatures. In April, his physician at Central State instructed nurses to take the patient's temperature rectally every two hours for 90 days, and to notify him if it fell below 96 degrees.

The nurses and aides rarely followed the doctor's orders. During the last three months of the patient's life, records show, they failed to record his vital signs as instructed 739 times.

Late on July 3, according to state records, the patient had been vomiting continually for more than 24 hours. His condition worsened overnight. He vomited at least three more times, twice throwing up what nurses and aides described as "coffee-ground" material – most likely, blood from his gastrointestinal system.

The hospital staff called the doctor at 2 a.m., but he did not come to examine the patient. The staff, he said later, assured him the man's vital signs were "stable." However, a nursing aide later said she merely thought the man's temperature was 97.6 degrees — or "somewhere around there," as she put it.

The doctor ordered a suppository for the patient and told the staff to disconnect his feeding tube until morning.

Records indicate the staff next checked on the patient at 4 a.m. He had vomited again. At 5, an aide returned and found the man "just lying there," she told investigators. A nurse issued an emergency code and attached a defibrillator device to the man's chest. Nine efforts to force his heart to beat failed. At some point, a nursing aide dialed 911 to summon paramedics to the hospital.

The doctor arrived at 5:26 a.m. and pronounced the man dead 12 minutes later. Officials performed an autopsy, but the report won't be finished until January.

The state's investigation found the man's vital signs had last been checked 13 hours before he died. A report on the inquiry concluded that one nurse and one aide had been neglectful in the patient's care.

The report's recommendation for avoiding future lapses: training for the hospital staff in how to follow physicians' orders.


A barrier to care

The deaths in Georgia's state hospitals, psychiatric experts say, show the need to focus not just on patients' mental conditions but also their physical ailments.

High-quality medical care in psychiatric facilities is "extraordinarily important," said Dr. Charles Nemeroff, chairman of the psychiatry department at Emory University School of Medicine.

As a member of the commission examining Georgia's mental health care system, Nemeroff heads a subcommittee that will study quality of care issues for the hospitals, including the credentials of state-employed physicians. The state hospitals, he said, should hire physicians who have been certified by the boards overseeing specialties such as internal medicine, not just psychiatry.

Of the 190 doctors employed by the state hospitals in the fiscal year that ended June 30, just 88 had any board certification, according to the Journal-Constitution's analysis of medical licenses. Thirty-six of the 88 were certified in areas other than psychiatric medicine.

Nemeroff said people with serious mental illnesses are prone to medical disorders, such as heart disease, stroke and diabetes. They often receive poor, or no, medical care in the community. And, he said, they have "a fundamentally shorter life span" than other adults.

"This conspiracy of reasons comes together to, unfortunately, present a barrier for psychiatric patients — particularly state hospital patients — to get good medical care," said Nemeroff.

"It's a reason," he said, "to consider them an at-risk population that ought to get more attention, not less attention."


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The fight for autism - Denver Post

Parents of kids with autism struggle to free their children from the grip of the mysterious disorder - and find ways to foot the bills.

By Karen Auge

Therapist Ashley Rein swings 4-year-old Abby Tappert as her mom, Jill, watches. Rein provides Applied Behavioral Analysis therapy for Abby three hours a day, four days a week, something the Tapperts just managed to get their insurer to pay for. ( Helen H. Richardson, The Denver Post )There was a time, Jill Tappert said, when she didn't think she'd ever hear the word "Mama" from her daughter.

Abby Tappert was, in her mother's words, born limp. She couldn't suck. She didn't seem to care whether her parents were in the room or not, whether they held her or didn't. At 9 months, she couldn't sit up, and she didn't take a step until she was almost 2.

As her mother recalled Abby the baby this month, Abby the 4-year-old twirled around the family's Boulder living room, a blur of purple tights and floating ponytails.

"Look at me, look at me," she sang softly. "Look at me! Look at me!"

People are, in fact, looking at Abby Tappert.

Last month, a judge ordered the family's insurance company, Anthem Blue Cross/

Therapist Ashley Rein reads with Abby Tappert, 4, during a recent session. Applied Behavioral Analysis therapy, which some insurers deem "investigational," has proved helpful to Abby. (Helen H. Richardson, The Denver Post )Blue Shield, to cover the therapy her parents say has cost them $110,000 over the past two years.
That has gotten a lot of people's attention.

The number of children diagnosed with autism, a mysterious and often devastating neurological disorder, has exploded. But answers, proven treatment options and help for anxious and financially strained parents and their children have not kept pace.

So while arguments continue in courts, schools and insurance offices across the nation, autism continues to exact an enormous toll, emotionally and financially, on parents and taxpayers.

This year, the federal Centers for Disease Control and Prevention estimated that as many as 1 in 150 children in the United States have some form of autism. In Colorado, the estimate is 1 in 169.

In the late 1960s when she entered the medical field, the estimate was 1 in every 10,000 children, said Cordelia Robinson, director of the University of Colorado Denver School of Medicine's JFK Partners.

The medical school, JFK Partners and Children's Hospital this month were named two of 15 Autism Treatment Network centers by Autism Speaks, a nationwide advocacy group.

There is no standard treatment for autism. Science is still struggling to

Five-year-old Mikaila Griffin-Williams, above, has her mom, Sandy, lift her legs, which is part of Mikaila's occupational therapy. Sandy says Applied Behavioral Analysis therapy has been a godsend for Mikaila, who has autism. "We've got a nighttime routine now; she sleeps in her own bed, eats at the dinner table." (Mark T. Osler, The Denver Post )explain the condition itself.
In the meantime, parents often wind up searching out treatments on their own. When they do, they discover a dizzying array of options — from speech or behavior therapy to gluten-free diets to hyperbaric oxygen therapy and even something called the Weighted Therapy Belt, available on the Internet for $43.95.

Whatever they choose is likely to be very expensive, and not covered by insurance.

There is a saying in autism circles: " 'The bad news is, your child has autism. The good news is, it's treatable. The bad news is, you can't afford it,' " said Betty Lehman, executive director of the Autism Society of Colorado.

Some help is available

State and federal programs offer some

Sandy helps Mikaila calm herself as she lets out a prolonged ahhh. Sandy says Applied Behavioral Analysis therapy has been a godsend for Mikaila, who has autism. We ve got a nighttime routine now; she sleeps in her own bed, eats at the dinner table. (Mark T. Osler, The Denver Post)help, but that can be hard to come by. Programs can be fragmented, and waiting lists are the rule.
This year, Colorado's legislature funded a special program within Medicaid specifically for children with autism. There is money for 75 children 5 and younger to get up to $25,000 worth of autism therapy each year.

As of Nov. 30, 64 kids were enrolled in the program, according to the state agency that runs it.

A federal program called the Individuals With Disabilities Education Act also provides some money — although states must provide the lion's share — for treatment of children with a variety of developmental disabilities, including autism.

In Colorado, that program is administered regionally by 20 Community Centered Boards, which coordinate services for each child from birth until age 3. According to state officials, the services available vary widely from one county or region to the next. At age 3, the responsibility falls to the school district in the child's home community.

"All of our school districts are independent," Lehman said. "They don't share resources; they don't share information. The wheel is reinvented in every single school district."

The autism society is hoping lawmakers will create a statewide autism task force, much like the nationwide group Congress assembled in 2000 to better coordinate treatments.

Most insurance companies' coverage is similar to what Anthem offered the Tapperts: a lifetime maximum of 20 hours each of occupational therapy, physical therapy and speech therapy.

Among major insurance providers in Colorado, there is slight variation, but virtually none would cover the therapy the Tapperts credit for Abby's improvement, according to information provided by Cigna and Kaiser Permanente, among others .

That therapy is part of a group of approaches that fit under the heading of Applied Behavioral Analysis therapy.

The common thread among all of them is that therapists work with families to determine each child's specific problem areas — what causes a particular child, for instance, to withdraw into a repetitive behavior or begin screaming, said Phil Strain, director of the University of Colorado's Positive Early Learning Center.

Strain has developed one take on ABA therapy, called Learning Experiences An Alternative Program for Preschoolers and Parents, or LEAP.

LEAP therapists visit preschoolers with autism at home and figure out what daily activities cause the most stress and produce antisocial or noncommunicative behavior.

"Based on that analysis, we try to change things in the environment that happen before or after the behavior, and if we're lucky, we get it right and you see really significant behavior changes," Strain said.

The program is one of six the state has a contract with to provide therapy with the new Medicaid funding.

Since Medicaid began paying for LEAP therapy, therapist Kelley Bramlege has seen her caseload jump to six or seven families a week, she said.

Before Medicaid stepped in, few families could afford the $4,000-a- month cost.

Sandy Griffin-Williams said her 5- year-old, Mikaila, "has just blossomed" since beginning LEAP therapy.

"We went from not being potty trained to completely potty trained. We've got a nighttime routine now; she sleeps in her own bed, eats at the dinner table. We can go out and eat at a restaurant now," she said.

Strain, who testified on behalf of the Tapperts, said such LEAP results have been documented in hundreds of peer-reviewed articles.

"When Anthem argues that this is experimental, you have to say, if 600 studies aren't enough, are you looking for 601?"

Abby Tappert's mother isn't.

"We can't wait for perfect science," Jill Tappert said. "We're in an epidemic."

To Jill Tappert, the very fact that Abby can say, 'Look at me!' is a huge leap. That she might actually want someone to look at her, to interact with her, is bigger still.

Even as autism's hold on Abby lessens a bit, it envelops her parents' lives entirely.

Abby doesn't sleep well — so neither do her parents. Like many autistic children, Abby for years had no fear — so her parents had to constantly fear for her. Until a therapist helped teach her boundaries, and fear, Abby would blast out of her mother's grasp and into the street. So her parents moved to a cul-de-sac where passing cars are the exception. Abby needs constant attention, tireless effort, so her mother provides it.

When Abby goes to bed, Jill Tappert starts what she calls "my Abby work" — filling out forms for various programs, researching therapy, conversing via the Internet with other parents of children with autism.

One of the rare facets of autism that parents, scientists and therapists agree on is the importance of diagnosing and treating autism as early as possible.

To Jill Tappert, that meant giving up her work as an attorney and devoting her days to working with Abby.

"I even felt guilty taking a shower."

"Not medically necessary"

Anthem contended, and still contends, that the therapy Abby Tappert was getting is "investigational and not medically necessary," said Anthem spokeswoman Sally Vogler.

Anthem reviewed its autism coverage in August, Vogler said. A committee that included "physicians from various medical specialties" examined peer-reviewed medical literature and concluded no changes to coverage were needed.

Anthem officials have not decided whether to appeal, but in any case, the insurance company says the decision sets no precedent.

That hasn't kept parents across the country from watching the Tapperts' case, and e-mailing:

"My family is very interested in any information you have on this case. We have a 5 y.o. son who we pay out of pocket for private ABA therapy. We have all but given up on having insurance cover any of it "

Tappert said she and her husband, Stephen, weighed carefully the personal cost of taking on an insurance company, knowing that hours invested in the case meant hours not working with Abby.

"But we also have to weigh the benefit now with the benefit later. Even if we lost, I would absolutely not have regretted taking this on," Tappert said.

"I'd do it again."

Karen Auge: 303-954-1733 or kauge@denverpost.com


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Scientists baffled by the biology of autism

More than 60 years after psychiatrist Leo Kanner first described treatment of children with severe social, communication and behavioral problems, the condition Kanner called autism remains an enigma.

"We are still struggling to understand what the biology of autism is," said Dr. David Amaral, research director at the M.I.N.D. (Medical Investigation of Neurodevelopmental Disorders) Institute at the University of California at Davis.

In people with autism, parts of the brain seem to develop too quickly — before the receptors are ready to interpret signals, Amaral said.

"Notably, the frontal lobe, which controls things like planning and social decision-making, seems to have a rapid growth spurt between 1 and 3 years of age" in children with autism, Amaral said.

As for autism's causes, Amaral said a strong genetic link is undeniable, but environmental triggers are at play as well.

"There is no doubt that in the end, we will identify multiple causes for the disorder," he said.

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Into the minds of children - Boston Globe

December 28, 2007

EDITORIAL

CHILDREN with undiagnosed mental illness can be a harm to themselves, their families, and their schoolmates. The conditions often go undetected because parents, while sensing that something is wrong, do not press the issue with their pediatricians, who themselves are often too busy to ask the right questions. So by requiring that pediatricians treating Medicaid patients screen for common mental illnesses, Massachusetts is taking a major step forward in promoting children's mental health.

For young children, parents will be asked, but not required, to fill out questionnaires asking about sleep problems, failure to show emotion, difficulties in concentrating, and other possible symptoms of underlying conditions. Adolescents will supply the answers themselves. It will be up to the families to decide whether to pursue any recommended course of treatment.

The screening, for which pediatricians already receive reimbursement from most private insurers, will benefit both the children who get timely attention and society as a whole. Early detection of bipolar disorder, autism, or depression can lead to effective treatment that will avoid costly periods of institutionalization if the condition is left unattended. Screening also helps to take away the stigma that many people still attach to mental illness, and to create data to measure the prevalence of disorders.

There are legitimate concerns that the screening will increase caregivers' caseloads and add to the difficulties parents already experience in getting care for troubled children. One solution is the state's Child Psychiatry Access Project, in which pediatricians seeking advice by telephone from a child psychiatrist get a response within 30 minutes.

The screening will not serve its purpose if it simply becomes a pipeline to the powerful psychotropic drugs that some experts believe are used too heavily with children. More likely, though, the screening will help to galvanize children's best advocates, their parents, in pushing for more care for them from the healthcare system and their schools.

Sometimes it takes more than just one screening result to get a parent to follow up on a child's evident needs. "Some parents have to hear things three or four times," said Lisa Lambert of the Parent/Professional Advocacy League. But eventually a long-term source of frustration with a child can become a diagnosis. "With the diagnosis," Lambert said, "doors and services can open to you."

Opening doors and services for the mental-health needs of the state's poor was the goal of the federal court case Rosie D. v. Romney, which is resulting in several systemic changes. Medicaid screening is the most basic. It will make Massachusetts a leader in ensuring that children's mental disorders get the same attention as any physical ailment.

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N.Y. Law Raises Issues of States' Reach in Patient Care - Washington Post

By Chris L. Jenkins
Washington Post Staff Writer

NEW YORK -- Susan Wezel had been committed to the city's hospital wards more than a dozen times in 10 years. Her psychosis was so deep and debilitating that she lost her career and her relationship with her son, as she refused to take her medication or follow treatment.

But because of a New York state law, Wezel hasn't been hospitalized in more than a year. She doesn't wander the streets alone at night anymore. She takes her medication willingly. She even has plans to follow her dream of singing at a neighborhood nightspot, something that was unthinkable 18 months ago.

Wezel and her caseworker agree that the transformation occurred because of the law, which allowed officials to force Wezel into an outpatient treatment program after she was discharged from a hospital.

Known as Kendra's Law, it is considered one of the most far-reaching mental health statutes in the country. It gives great latitude to doctors, social workers and relatives to take mentally ill people before a judge to force them into treatment, and it provides money for clinical services.

Just how far states can go to get mentally ill people into treatment is a key issue in Virginia. The state is struggling with changing its mental health system after a mentally ill gunman shot and killed 32 students and teachers at Virginia Tech in April before killing himself.

"All of this has saved my life," Wezel, 50, said in an interview at her caseworker's office in Queens. As part of the treatment order, she was given immediate access to a caseworker who closely monitors her through visits and phone calls. If Wezel fails to comply with her treatment, she can be picked up by police and taken to a hospital.

Wezel's experience with forced treatment underscores one of the most controversial issues in the care of the mentally ill. Seung Hui Cho, the Virginia Tech gunman, had been ordered into outpatient treatment, but officials didn't monitor whether he received it, and he never did.

Had something as detailed as Kendra's Law been in place, with its high expectation of accountability, officials might have been forced to monitor whether Cho got treatment, supporters of such measures say.

Virginia has an outpatient treatment law, but it is rarely used. Judges interviewed since the Virginia Tech rampage have said that they prefer institutionalization for the most severely endangered patients. Some judges said they think that ordering outpatient treatment is a waste of time because the lack of resources would make follow-up nearly impossible.

A survey conducted this year by the Virginia Supreme Court's Commission on Mental Health Reform found that judges used the outpatient treatment option in 5.4 percent of cases during the month studied.

Kendra's Law, named after Kendra Webdale, a 32-year-old woman who was killed in 1999 when she was pushed in front of a New York City subway train by a severely mentally ill man, allows courts to use a much lower standard than Virginia's to force outpatient mental health treatment.

To qualify for forced treatment under Kendra's Law, among other criteria, a person must have been hospitalized twice within the previous three years; must have shown violent behavior toward himself or others in the previous four years; and must need treatment to "prevent a relapse or deterioration which would be likely to result in serious harm to the person or others."

Across the country, supporters of such programs, known as preventive outpatient commitment laws, have called them pragmatic approaches in addressing the needs of the millions of mentally ill people who are not in institutions.

But there is intense debate among experts and policymakers about whether coercive statutes would be necessary in cases in which states increase the availability of services to the mentally ill.

Maryland does not have an outpatient commitment law. The District has a standard like Kendra's Law, but it is used sparingly.

The Supreme Court commission in Virginia recommended this month that the state expand the use of outpatient treatment for those who don't meet the criteria for forced hospitalization. The panel also called for specific procedures to monitor those receiving outpatient treatment and suggested ways to enforce it. But lawmakers also expect debate over a more expansive law that mirrors the New York statute when the General Assembly convenes next month.

"These arguments over outpatient commitment are some of the most emotional and contentious debates you'll find in mental health law," said Jeffrey Swanson, a professor of psychiatry and behavioral sciences at Duke University who is involved in a three-year study of Kendra's Law for the state of New York. "It really goes to the heart of whether we believe community mental health care can be effective without coercion and at what point we're willing to say that coercion might be necessary, legitimate and humane."

The New York statute outlines the responsibilities of local mental health agencies, spells out monitoring requirements and incorporates provisions for ordering noncompliant mentally ill people into hospitals. Those who are taken into outpatient treatment under Kendra's Law get immediate access to services. The petition process can be started by a roommate, parent, spouse, adult child or sibling, a hospital director or a caseworker, among others.

"There was nothing I could do to get her into any help before this," said Chris Wezel, 50, Susan Wezel's husband.

New York officials say the law has been effective. They conducted a survey in 2005, when the measure was up for reauthorization. The study found that a sample of patients treated under Kendra's law were more likely to participate in care, take their medication and follow up with caseworkers than when they were not treated under the law.

In addition, for those treated under the law, homelessness, arrests, hospitalizations and incarcerations dropped at least 74 percent and as much as 87 percent, the statewide survey found. Other studies conducted by mental heath researchers over the years have found similar outcomes the longer that mentally ill people stay in such coerced treatment programs.

"Coercion does work, if it's done the right way," said Mary T. Zdanowicz, former executive director of the Treatment Advocacy Center in Arlington County. She said that Virginia needs a law "that incorporates involuntary treatment, both inpatient and outpatient." Such laws get patients complete help the first time, rather than partial help over and over, she said.

But opponents of Kendra's Law say that the New York study did not use a control group for comparisons. The state's legislators were so skeptical of the available research that they called for a separate study and declined to make the law permanent. That study is due in 2009, and the law will come up for reauthorization a year later.

Advocacy groups and other mental health experts who oppose Kendra's Law say that it came with money for services, proving that coercion alone is not a solution.

The statute was accompanied by $32 million a year in state funding, much of it for medication and more caseworkers.

The law also affects a small population. Last year, about 1,800 New York residents fell under its guidelines at any given time, out of more than 400,000 mentally ill adults in the state, New York state health officials said.

"You have to consider the increase in services. It's not a slam-dunk to say that just because of the law itself, we have these better results," said Peter Beitchman, a longtime advocate for the mentally ill in New York City.

As opponents of the law have said, Andrew Goldstein, the schizophrenic man who pushed Webdale, had been denied outpatient services before the incident. He was told that there was no room for him at local treatment centers.

The issue of forced outpatient treatment resonates in Virginia because of the Virginia Tech shootings. Cho had been given an outpatient treatment order 16 months before the rampage. But it was never enforced by the local community services board or Virginia Tech's counseling center, and it was never specified which one was required to do so.

"Sometimes, those that need mental health treatment don't know they need help," said state Sen. Henry L. Marsh III (D-Richmond), who has unsuccessfully submitted bills like Kendra's Law in previous years and will do so again next month. Marsh will be chairman of the Senate Courts of Justice Committee next year, which will consider the legislation.

Staff writer Tom Jackman contributed to this report.

Virginia is going through an unprecedented

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Mo. Tries New Approach on Teen Offenders - Associated Press

By TODD LEWAN
The Associated Press
Saturday, December 29, 2007; 9:35 PM

MONTGOMERY CITY, Mo. -- At age 9, Korey Davis came home from school with gang writing on his arm. At 10, he jacked his first car. At 13, he and some buddies got guns, used them to relieve a man of his Jeep, and later, while trying to outrun a police helicopter, smacked their hot wheels into a fire hydrant.

For his exploits, the tough-talking teen pulled not only a 15-year sentence (the police subsequently connected him to three previous car thefts) but got "certified" as an adult offender and shipped off to the St. Louis City workhouse to inspire a change of heart.

It didn't have the desired effect.

"I wasn't wanting to listen to nobody. If you wasn't my momma, or anybody in my family, I wasn't gonna listen to you, period," says Korey, now 19. "I was very rebellious."

At that stage, most states would have written Korey off and begun shuttling him from one adult prison to the next, where he likely would have sat in sterile cells, joined a gang, and spent his days and nights plotting his next crime.

But this is Missouri, a place where teen offenders are viewed not just as inmates but as works in progress _ where troubled kids are rehabilitated in small, homelike settings that stress group therapy and personal development over isolation and punishment.

With prisons around the country filled to bursting, and with states desperate for ways to bring down recidivism rates that rise to 70 and 80 percent, some policymakers are taking a fresh look at treatment-oriented approaches like Missouri's as a way out of America's juvenile justice crisis.

Here, large, prison-style "gladiator schools" have been abandoned in favor of 42 community-based centers spread around the state so that now, even parents of inner-city offenders can easily visit their children and participate in family therapy.

The ratio of staff to kids is low: one-to-five. Wards, referred to as "clients," are grouped in teams of 10, not unlike a scout troop. Barring outbursts, they're rarely separated: They go to classes together, play basketball together, eat together, and bunk in communal "cottages." Evenings, they attend therapy and counseling sessions as a group.

Missouri doesn't set timetables for release; children stay until they demonstrate a fundamental shift in character _ a policy that detainees say gives kids an added incentive to take the program seriously.

Those who are let out don't go unwatched: College students or other volunteers who live in the released youths' community track these youths for three years, helping with job placement, therapy referrals, school issues and drug or alcohol treatment.

The results?

_About 8.6 percent of teens who complete Missouri's program are incarcerated in adult prisons within three years of release, according to 2006 figures. (In New York, 75 percent are re-arrested as adults, 42 percent for a violent felony. California's rates are similar.)

_Last year, 7.3 percent of teen offenders released from Missouri's youth facilities were recommitted to juvenile centers for new offenses. Texas, which spends about 20 percent more to keep a child in juvenile corrections, has a recidivism rate that tops 50 percent.

_No Missouri teens have committed suicide while in custody since 1983, when the state began overhauling its system. From 1995 to 1999 alone, at least 110 young people killed themselves in juvenile facilities nationwide, according to figures from the National Center on Institutions and Alternatives.

Does this "law-and-order" state know something others don't?

Hardly, says Mark Steward, who, as director of the state's Division of Youth Services from 1987 to 2005, oversaw the development of what many experts regard as the best juvenile rehabilitation system in America.

"This isn't rocket science," Steward says. "It's about giving young people structure, and love and attention, and not allowing them to hurt themselves or other people. Pretty basic stuff, really. It's just that a lot of these kids haven't gotten the basic stuff."

Take Korey Davis. He didn't meet his dad until he was 5. He and his siblings were raised largely by aunts and uncles. If the judge handling his case had left him in county detention centers until he reached adult age _ 17, in Missouri _ then had him serve the rest of his sentence in prison, few eyebrows would have been raised.

But a chance to save a life would have been missed. "In jail, I wouldn't never have changed what I always done," Davis says. "There was no treatment at all." He contemplates this for a second, and adds with a near-whisper: "Right now, I'd probably be dead."

In Missouri, judges can keep serious felons in the juvenile system until they are 21. That's what happened with Davis. At 15, he was sent to the Montgomery City Project, where robbers, rapists and the like get one last shot.

At first, he didn't want it.

But a year into his stay, two things knocked him back on his heels: the news that his younger brother had been shot and wounded in a gang fight, and an invitation from a counselor to sit down, after class, to read a book out loud with her.

To a boy accustomed to hiding his illiteracy, the offer felt awkward. But because this woman had given him a chance, he responded, and "when I actually learned how to read, it made everything in the world easier for me."

Three years later, Davis is a group leader _ and no softy with his peers, either. "We don't let each other get by with slick stuff, just doing the bare minimum," he says. He reads voraciously (recently, "The Bond," about three fatherless teens in Newark, N.J.). He's been accepted by a community technical college, plans to study carpentry. And, he's proud to say, his kid brother has taken to heart this advice:

"Put the guns down."

___

Many states are trying to bring down high rates of repeat offending by juveniles.

Wisconsin now treats some repeat offenders with mental health counselors in hospitals, instead of corrections officers in jails.

Illinois offers them drug treatment, job placement _ or an expedited return to custody.

And Washington state targets kids at risk of becoming its most serious offenders with early, intensive anger-management, drug and family therapy.

Research guided these approaches. One 2006 study, for example, found that anger-management, foster-care treatment and family group therapy cut recidivism drastically among teens, resulting in taxpayer savings up to $78,000 per child. Programs that tried to scare kids into living a clean life were money losers, according to the study, conducted by the Washington State Institute for Public Policy.

Missouri employs similar carrot-and-stick techniques. But it takes rehabilitation one step further by normalizing the environments of children in custody, says Barry Krisberg, president of the National Council on Crime and Delinquency, a nonprofit based in Oakland, Calif.

"It's a pretty simple concept: The more normal the environment, the more likely these young people will be able to return home and not be sucked into a criminal subculture," he says.

Montgomery City, built for Missouri's worst juvenile offenders, could be mistaken for a college campus.

In a literature class, students analyze plot lines in "Julius Caesar" and "A Farewell to Arms." In a computer lab, they write resumes and peck out cover letters to employers. In a central courtyard, they celebrate "Victim Empathy Week" by huddling in a circle with lit candles, praying silently for those harmed by their crimes.

The cottages where they sleep resemble college dorms, with one notable difference: These are all immaculate.

Ten teens are assigned to a cottage. Each gets a bed with quilt, pillow, nightstand, and an understood "space." In this space are often collected the precious remnants of a truncated childhood: dream catchers, stuffed animals, Dr. Seuss books.

"When you walk into these facilities and see 17- and 18-year-olds with dolls on their pillows, that's when it hits you: 'Hey, these really are just kids,'" says Ned Loughran, executive director of the Council of Juvenile Correctional Administrators.

Some things you won't see in this detention center: razor wire, barred windows, uniformed guards, billyclubs, or kids in orange jumpsuits with broken noses.

"We're all about creating a safe environment for our kids," Larry Strecker, Missouri's northeastern regional administrator, explains.

Here, boys wear _ well, what boys wear: jeans, knee-length Bermudas, an occasional earring, T-shirts. Staff members dress almost as casually.

To the teens, many of whom have done long stretches in adult jails awaiting adjudication, the sight and feel of Montgomery City come as a shock.

It was for Josh Stroder, who at 15 was arrested by a SWAT team in 2004 at his home in Dexter, Mo., and charged with 12 crimes, including terrorism. He confessed to improvising a bomb, which took off the front door of an appellate judge's home. No one was hurt by the blast. Police also found a car bomb in his basement.

The youth was detained in a juvenile center for a year, then sat in the Dexter City jail for 5 months before being sent to Montgomery City.

In a 6-by-9 cell, says Stroder, now 18, "there's really nothing to challenge you, nothing to stimulate you. It becomes easy to succumb to apathy, bitterness, or whatever is boiling in your brain."

He contrasts that with Montgomery City: "Here, you are faced with the possibility of reconciliation with so many people, and forgiveness. I was expecting a treatment program, but not so intense _ not the way it is here. I expected maybe to crack the surface of the ice, but not go in so deep."

Treatment comes in "group builders" _ sessions in which detainees open up to one another about traumas, crimes and family conflicts that have scarred them. Kids can also call a "circle," in which team members stand and face each other to air grievances, fears, anguish.

Two staff specialists, college graduates in counseling, psychology or social work, sit in on the circles, but the kids generally run them. "Adults lived in a different generation _ they can only tell us so much," says Korey Davis.

Teams that interact more are rewarded _ day furloughs to visit family, fishing trips, bicycle excursions, an afternoon volunteering at a food bank or a soup kitchen. Those who pull against the program _ generally, new arrivals _ quickly find themselves pressured by their peers to shape up.

"We know that when we do positive things as a group, we earn things," says Chan Meas, 17. Three years ago, he ran with a gang in Columbia, Mo., smoked dope, broke into people's homes. "Now, I look for positive people that care about others."

Montgomery City is no fairyland. It's a "Level 4" facility, meaning high security. It has isolation rooms, and every door locks automatically. Video cameras in walls and ceilings film everything, everywhere, 24-7. Kids need passes to go from one room to the next.

Kids are trained to restrain peers who threaten the team's safety. Only staff may authorize a restraint, but once they do, team members grab arms and legs and pin their peer to the floor until the child stops resisting.

This practice has its critics, such as Loughran, a former commissioner of the Massachusetts state Department of Youth Services, who called it "very, very dangerous."

"The juveniles have learned violence all their lives, and we're going to use them to control other residents? It's a confusion of roles," he says.

But Tim Decker, Missouri's youth services director, says there's never been a serious injury during a restraint, and rates of injury are markedly lower here than in states that rely on billyclubs and mace.

Besides, he says, the restraint policy reinforces the notion that "everyone in the facility takes responsibility for keeping it safe."

___

A half hour west of Montgomery City, in the university town of Fulton, there is a house that looks just right for a summer camp. It's brick, with a maple tree out front, a wide lawn and a wrought-iron sign that reads, "Welcome Friends."

Inside are comfy sofas, bookcases holding trophies, vases full of flowers, and 11 girls, ranging in age from 12 to 17, who've been convicted of truancy, assault, drug crimes, theft and forgery _ bright kids carrying darkness around inside.

This is the Rosa Parks Center, a detention home on the campus of William Woods University. Here, the girls get counseling, schooling, a feeling of togetherness.

"I had a lot of problems being angry," says Brooklyn Schaller, 15, who was arrested on drug charges and for violating a parental curfew. "I would be aggressive. I didn't care about anyone else, or anything else." But after just a year, even she has noticed a change.

"Last weekend I went home for a furlough, and me and Mom got into an argument, and so I left her alone. I let her have her space, and she came back and I listened to everything she had to say and she listened to me. And that was the most amazing thing, to sit down and talk and have someone listen to you."

What's been the difference?

Good role models help: The girls get to mingle with college students in the campus dining hall and attend campus plays and other cultural events. At the start of the school year they describe their experiences to incoming students during orientation week.

But the biggest plus, Schaller says, is that "you have people to talk to here, you have people who truly do care."

Rosa Parks Center opened in 2001, part of Missouri's response to the notion _ resurrected about a decade ago _ that it might be worthwhile to punish teen offenders by locking them up in adult prisons or in remote, sprawling juvenile prisons.

In the early '90s, a series of high-profile crimes had prompted dire predictions of teen "superpredators." Legislators across the country backed "scare-kids-straight" approaches.

But Missouri was on a different path by then, and stayed with it.

It had tried the traditional approach: From 1887 to 1983, young offenders from truants to attempted murderers were confined either at the Boonville Training School for Boys, or the Chillicothe Training School for Girls.

Boonville warehoused 650 boys, most of them minorities, in grim, two-story brick structures. There was rape and other brutality by guards, and a solitary confinement room atop the facility's administration building known as "The Hole," until judges demanded its closure.

"You had rural, white staff with inner-city kids of color, thrown in together with kids from all across the state who were disconnected from their families and neighborhoods," recalls Steward, the former director of youth services. "It wasn't a terribly successful formula."

Which is why conservatives such as John Ashcroft, the former Missouri senator and U.S. attorney general, and state Supreme Court Justice Stephen Limbaugh, a cousin of radio commentator Rush Limbaugh, joined with liberals such as the late Gov. Mel Carnahan to stick by systemwide reforms initiated in the late 1970s.

"What is remarkable about Missouri's system is that is has been sustained by conservative and liberal governments," says Krisberg, of the national crime and delinquency council. "They've seen that this is not a left-right issue. In many ways, its a commonsense issue."

A common-cents issue, too _ since it costs states between $100 and $300 a day to keep a juvenile in so-called "punitive" correctional facilities, according to a 2005 report by the Youth Transition Funders Group, a philanthropy network.

Missouri's per capita cost of its juvenile rehabilitation program is $130 a day.

"The fact is that most kids from punitive states get out, get re-arrested, and get thrown back into correctional facilities," Krisberg says. "What amazes me is that taxpayers in these punitive states put up with such rates of failure."

Miriam Rollin, vice president at Fight Crime: Invest in Kids, a nonprofit in Washington, D.C., with a membership of 3,500 police officials, prosecutors and crime victims, agrees:

"Twenty years ago, people threw up their hands and said, 'We don't know what works.' But now, we actually do know ... We're just not doing it _ or not doing enough of it."

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They Have Beds, but Not the Ones They Want - New York Times

By JENNIFER BLEYER

NORMAN BLOOMFIELD sat hunched over on his sagging twin bed at Surf Manor, a small adult home in Coney Island, and wondered why he was still there.

An elfin man with a shock of fine gray hair, Mr. Bloomfield, 60, spent three months in the psychiatric ward of Maimonides Medical Center in 2001. He then applied to Surf Manor, a faded red brick building on a bleak stretch of Surf Avenue, thinking it would serve as a temporary residence between the hospital and independent housing.

But his months at Surf Manor have turned into years, because he cannot find another place to live.

Surf Manor is one of 65 private, state-licensed facilities in the city that house a total of more than 8,000 residents. These institutions, known as adult homes, have become de facto repositories for people who have psychiatric disorders but who, like Mr. Bloomfield, can live independently.

“Some people need day-to-day assistance, but some are extremely high functioning,” Mr. Bloomfield said one afternoon in his drab yellow room, which he shares with a roommate. “It’s unfair and irrational when people who could be independent end up in a place like this and languish for years.”

Over the summer, Mr. Bloomfield and other members of an advocacy group called the Coalition of Institutionalized Aged and Disabled took steps to dramatize their plight and pressure government to take action. They set up a list of people who are waiting for independent accommodations. A few weeks ago, the number of names on the list passed the 200 mark.

The list, which the group termed the “people’s waiting list,” is a nod to the Mental Health Housing Waiting List Bill, legislation passed by the Assembly and the Senate but vetoed in 2006 by Gov. George Pataki and again in August by Gov. Eliot Spitzer.

The bill would have required a census of people who have mental illnesses and are waiting to move into specially designated housing, known as supportive housing, that would meet their needs.

The signatures gathered by the advocacy group include the names of residents of 20 adult homes who want to move into such housing. Typically, this involves individual apartments where people are responsible for their own cooking, cleaning, laundry and health care, but receive visits from support workers.

According to Geoff Lieberman, the coalition’s executive director, the goal is to prompt the state’s Office of Mental Health to help create more supportive housing specifically for adult-home residents. Sixty units of supportive housing are now in the pipeline — 20 each for Brooklyn, Queens and the Bronx — but, he said, “many more people want to move than 60.”

Jill Daniels, a spokeswoman for the Mental Health Office, confirmed that there were no more than those 60 apartments being created for adult home residents in the city, but added that such people were given priority when “housing needs and vacancies arise.”

Mr. Lieberman said that to the contrary, those people are often ignored.

“People are being warehoused in adult homes,” he said. “It’s not being viewed as it should be for many, as a steppingstone to greater independence.”

Mr. Bloomfield, sitting on his narrow bed, agreed. “We have a roof over our head,” he said. “But it’s not appropriate housing. It’s a dead end.”


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The Running Mate Who Wasn’t - New York Times

By FRANCIS WILKINSON

The federal courthouse in St. Louis is named for him. Accomplished men and women have recounted how they were awed by his intellect, influenced by his humanity, inspired and enlisted by his passion. Thomas Eagleton was a giant of Missouri politics. But he was a giant bound by ties of his own peculiar design. He spent the first part of his career in the grip of a secret. Later, he was fettered to a question he answered countless times but never resolved.

“He was a man of decency, honor, humor, integrity,” George McGovern told me recently, rattling off Eagleton’s virtues until they veered abruptly off a rhetorical cliff, “with an incredible cover-up.”

Thomas Francis Eagleton grew up in St. Louis, the second son of a successful lawyer whose own political ambitions were thwarted. As a boy, Eagleton accompanied his father on political rounds. After college at Amherst, Eagleton attended Harvard Law School, where he surrendered a coveted post on the law review in order to return home and help manage his father’s campaign for mayor of St. Louis. The senior Eagleton lost. The son never did. After law school, he initiated an unbroken string of political victories. Eagleton was elected circuit attorney of St. Louis at age 27, Missouri’s youngest attorney general at 31 and, in 1964, the state’s youngest lieutenant governor at 35. Four years later, he claimed a Senate seat.

Yet Eagleton was an unlikely running mate for McGovern, the 1972 Democratic presidential nominee. He supported a McGovern rival in the primaries, and according to the columnist Robert Novak, he spoke damagingly of McGovern off the record. But after Edward M. Kennedy and others refused McGovern’s entreaties, the call went out to Eagleton.

In a room with staff members, friends and even reporters present, Eagleton spoke on the phone with McGovern for less than a minute. McGovern’s aide Frank Mankiewicz subsequently asked Eagleton if he had any skeletons rattling around his closet. A terse denial inaugurated a latter-day industry of vice-presidential vetting.

Eagleton’s occasional hand tremors and tendency to perspire heavily were somehow overlooked in Washington. At a meeting before Eagleton’s official nomination, the McGovern campaign manager, Gary Hart was surprised, he told me rcently, to see Eagleton “pouring with sweat” in the air-conditioned room.

In the 1960’s, Eagleton and his family had taken great pains to hide his hospitalizations for mental illness, even diverting reporters with a tale about a stomach ailment. But after his nomination, an anonymous caller tipped off the McGovern campaign and the Knight news organization. The unraveling began.

With reporters rapidly closing in, Eagleton divulged at a news conference in South Dakota on July 25, 1972, that he had been hospitalized in 1960, 1964 and 1966 for what he first called “nervous exhaustion and fatigue” and later qualified as “depression.” He also said he had received electric-shock therapy. Many Democratic politicians and donors, sensing disaster, were irate. Nixon aides reveled in the Democrats’ misfortune.

Eagleton later explained that he had never considered his health history “sinister” — no closet, no skeleton. Years after, in his own narrative housed at the University of Missouri archives, Eagleton said that he had a “brief and random” exchange with his wife, Barbara, before he was asked to join the ticket. “If you should get [the nomination], won’t your health history come out?” she asked. Eagleton responded, “It could, I suppose.”

In two interviews, McGovern told me Eagleton related a longer version when they met just before Eagleton’s startling news conference. We had a meeting with Tom and his wife and Eleanor and me in Sylvan Lake in the Black Hills of South Dakota,” he said. It was Eleanor McGovern who asked the question that dogged Eagleton then and ever after. “Why didn’t you tell George about this illness?”

According to McGovern, now 85, Eagleton responded that he and his wife had had a lengthy discussion “back and forth, back and forth” and concluded that McGovern would reject him if the truth were known. “ ‘We decided you wouldn’t ask me [to join the ticket] if I told you,’ ” McGovern said Eagleton explained.

The political consultant Robert Shrum, a McGovern friend who worked on the ’72 campaign, said that in the mid-1970s McGovern told him the same story and that he heard it a second time from Eleanor McGovern many years later.

But Barbara Eagleton, the only other surviving member of the meeting’s discordant quartet, flatly denied McGovern’s assertion. “It never happened,” she told me. “Can you imagine asking that question? I think there would have been total animosity on the part of McGovern if that had happened.”

When I spoke with him, McGovern also characterized his private telephone conversations with two of Eagleton’s doctors, which took place immediately before Eagleton’s withdrawal from the race. “They both said we think he can do fine in the Senate,” McGovern told me. “But when it comes to trusting the whole country to one man, that’s different.” McGovern said Eagleton had bipolar disorder — manic depression. Barbara Eagleton said: “It was not manic depression. It was depression.”

To leave the ticket, Eagleton demanded a statement from McGovern that his health was not a factor. He got it. In a measure of the public’s ambivalence, Gary Hart said calls to the campaign, which had been overwhelmingly negative about Eagleton after the revelations, suddenly switched to overwhelmingly positive after his departure.

The public trial enhanced Eagleton’s stature. He resumed telling jokes in the Senate cloakroom, led debate on a war-powers resolution and passionately argued for an end to the Vietnam War. He was particularly proud of his successful amendment to stop funds for the bombing of Cambodia.

For years, friends in Washington sensed tension between the McGoverns and Eagletons. Eleanor’s anger barely softened. Eventually, George’s did. “I know a little about political ambition,” he told me.

Eagleton retired from the Senate in 1987, undefeated. The Eagletons returned to St. Louis, where he took up law, teaching and a hefty civic load. Though he gradually lost his health and hearing, Eagleton remained passionate about public affairs, firing off letters to protégés, friends and political leaders. He was outraged by the Iraq war, pleading with Bill Clinton in a 2006 letter to forgo “the traditional silence of an ex-president in wartime.”

Late in life, Eagleton began collecting art. He was particularly fond of the German photographer Candida Höfer, whose work features public architecture of uncluttered environs and clear boundaries. Her photographs convey the scale of the public sphere. But her libraries, theaters and government halls are containers devoid of people, empty of the struggle and striving of human affairs. In a singular political life, Eagleton had experience enough to fill the void.

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Schizophrenia takes a daughter away - LA Times

Even a loving family with ample financial resources is powerless against the disease.

By Scott Gold and Lee Romney
December 29, 2007

By the time she landed at Metropolitan State Hospital in 2006, Tiffany Sitton had been haunted by delusions for 15 of her 23 years. Spiders burrowed under her skin. Ghosts ordered her to hurt people. Schizophrenia and psychiatric drugs dulled her eyes and numbed her brain.

Hers was the most vexing kind of case, blending severe mental illness with a rebellious disposition and drug abuse. When she got to the austere Norwalk hospital known simply as Metro, she'd bombed out of virtually every other option the mental health system had to offer.

She had mastered the art of institutional life. If her caretakers wouldn't give her a match to light a cigarette, she knew how to use a gum wrapper and a light socket to set fire to a tampon. She wore studded dog collars and shredded stockings, and her hair, once as wispy as the crown of a dandelion, had been hacked off and dyed.

None of that changed the fact that she was a wealthy kid from the suburbs whose bedroom, back home in a pocket of horse ranches and eucalyptus groves in San Juan Capistrano, was waiting for her.

She was scared at Metro, and perhaps she was right to be.

Past the red sign at the door of Unit 410 -- "HIGH AWOL RISK" -- was a prove-yourself hierarchy of bulimics and cutters and patients known as picas, who swallowed staples and keys and whatever else they got their hands on. During her six-month stay, three patients attacked her. One tried to rape her.

She called home, again and again, begging to get out.

Her parents refused.

Cynthia and Michael Sitton believed they had no choice. Before she could start getting better, they thought, she had to hit bottom.

The strategy seemed to work. When Tiffany was ready to leave Metro six months later, she seemed finally willing to embrace treatment.

"I don't ever," she told her mother, "want to be in this place again."

So, one year ago, they made a pact. Tiffany would quit sabotaging her treatment, getting in fights, snorting other patients' meds. She would remember why it was good to be alive. Her parents would find a top-of-the-line hospital. When she was able, she could visit at home. They would keep her safe. They would keep her out of Metro.

The next year would be a test -- of Tiffany and her parents, and also of California's mental health system, which so often fails the toughest cases.

Unlike most who suffer from severe mental illness, Tiffany had everything going for her.

Her doctors had found the right cocktail of pills to ease her symptoms. She had a full-time advocate in her mother. Wealthy through Michael's flooring company, the Sittons had spent more than $250,000 on her care. Now they pledged to redouble their efforts.

Would it be enough?

It came out of nowhere.

Tiffany tugged on the sheets next to her mother's head and whispered into the darkness. She'd seen dogs in her room, menacing dogs with red eyes. Cynthia told her she'd had a nightmare.

"She insisted," Cynthia said recently, "that she had been awake."

And she had been.

Tiffany was 8.

Hers had not been the easiest of childhoods. Cynthia's first marriage, to Tiffany's biological father, had not ended well. Mother and daughter had spent several years living like gypsies, poor and mobile.

Still, they were unusually close, and Tiffany's gregarious spirit seemed unaffected by the turmoil. Their lives had stabilized. Cynthia married Michael, like her a recovering alcoholic. Michael adopted Tiffany, and he and Cynthia had two more children.

The Sittons dismissed the hallucination at the time. They know now that it was the first symptom of schizophrenia, a disease shared by an estimated 2.5 million Americans.

At 12, Tiffany became convinced that she was personally involved in stories that appeared on the TV news. At 13, she began hearing voices. At Aliso Niguel High School, she shaved her eyebrows and announced that she was a member of a gang called the Slick 50s, though there was no evidence that she knew any actual members.

At 15, after she pulled a knife on a schoolmate, a county psychiatrist told Cynthia to order a pizza and give Tiffany more hugs. It was the first of many times the system would fail them.

After she stole a car, Tiffany landed in juvenile hall, where a doctor diagnosed schizophrenia. It was a particularly early onset of the disease, and the timing was devastating. Tiffany had exchanged the normal, vital chapters of adolescence -- algebra homework, prom, her first kiss -- for a bewildering and often terrifying fantasy world.

Cynthia steeled herself "to do anything I had to do to make her better." She believed that there was help coming, that they could beat this.

"I still had the luxury," she said, "of naivete."

That wouldn't last long. After Tiffany got out of juvie, she ran away, hitchhiking to Los Angeles, where she lived on the streets, eating uncooked ramen noodles and using any street drug she could find. A friend found her in Compton, badly beaten.

Not long after that, despite 24-hour care at home and the efforts of a $220-an-hour psychiatrist to devise the right cocktail of medicine, Tiffany plunged a knife into her arm in the Sittons' kitchen.

She was involuntarily committed to an acute-care mental ward. That was four years ago, and it was the end of her life on "the outside," as Tiffany calls it.

"She's my kid," Cynthia said. "You feel terror. Just terror."

When the news came in December 2006 that Tiffany was ready to leave Metro, Cynthia was ready. In keeping with her pledge, she helped find her daughter a bed at Royalé Mission Viejo, a small psychiatric hospital. Papier-mache butterflies adorned pastel walls and the halls smelled of air freshener. It seemed a world away from Metro.

In the past, every time she'd bounced to a new facility, a new treatment team had evaluated her, often starting from scratch with little regard for what had been tried before. Tiffany had been diagnosed, at one time or another, with schizophrenia and five other disorders: bipolar, obsessive-compulsive, borderline-personality, antisocial personality and post-traumatic stress. With each new diagnosis came new medications.

Here, the staff seemed unusually attentive, and Tiffany hit it off with several nurses and social workers. It was a strict and rigorous treatment program, and Tiffany seemed to thrive.

She quickly became the president of her ward at Royalé, a job that required her to act as a liaison of sorts between patients and staff. She earned new privileges, such as outings with her mother: lunch, or a trip to her favorite spot, a thrift store where she spent hours assembling zany outfits of platform shoes and leopard-fringed skirts.

Cynthia had trained herself to be skeptical of the good times.

"There is a fear of enjoying it too much," she confessed one day. "The crash is just so horrible. It's like she dies, every time. You don't go to a funeral. But it's like your kid dies, again and again and again."

Still, it had been a long time since Tiffany had seemed so lucid, so self-aware.

"You're doing really well, girl," Cynthia told her one day in March, over lunch at Tiffany's favorite Chinese buffet.

"I'm trying," Tiffany said.

Her bedroom at Royalé, which she shared with a roommate, was immaculate. She kept a Bible on the nightstand. She made friends and started playing billiards in the recreation room.

She became articulate and self-aware, even poking fun at her illness. (One day at an exotic bird store, another favorite haunt, she held a parrot on her arm for a minute, then turned and whispered conspiratorially: "This bird wants to kill me.")

And she began taking responsibility for her troubles. She called her siblings -- Matthew, then 16, and Jessica, then 13 -- and apologized for being a bad role model and sabotaging her treatment.

"I don't want to do this anymore," she said one day. "I'm here because of me."

In June, Tiffany was granted a pass for an overnight home visit. The family gathered in the backyard over steaming bowls of Michael's pasta e fagioli, with kidney beans.

Tiffany excused herself regularly to smoke cigarettes and collect her thoughts on the other side of the yard. But it was a pleasant, normal evening, or as close as the family had come for a long time. They laughed about a relative who used outlandish amounts of rouge. Michael even poked fun at Tiffany's shaved head, and she smiled.

"I've always felt," she said that night, "that my life had a purpose."

There was a part of her, she confessed, that missed the drama of Metro -- the "action," she called it.

Still, she wanted desperately to recapture an independent life, and that drive was paying off. She was placed on the waiting list to move onto the A level of Royalé, reserved for patients nearly ready for release. On Level A, she would attend independent-living classes and prepare for life in a board-and-care facility on the outside.

"I think she's ready for it," Cynthia said in July. "I really do."

The Sittons had been burned by hope plenty of times.

Tiffany's schizophrenia is complicated by her bipolar disorder. Like many schizophrenics, she had also been a serious drug abuser: heroin, Vicodin, by her account just about anything that came along. Each had impeded treatment by mixing poorly with prescribed medications.

"It's like part of me wants to be sick. So I do bad things," she said on a recent afternoon. "I know I do bad things."

But as much as the Sittons seek to hold Tiffany accountable, their odyssey also speaks volumes about the mental health system.

Treatment was laughably poor in some facilities: "exercise" classes consisting of patients walking in a small circle, group therapy sessions offering the same counseling to a schizophrenic, an anorexic and an elderly patient with dementia.

Even in locked facilities, Tiffany managed to get her hands on street drugs like methamphetamine. At one point she had ground up and snorted so many medications prescribed for other patients that her insides were pocked with ulcers.

At each place Tiffany was admitted, the Sittons provided a document detailing her illness and past treatment. But on three occasions, Tiffany was prescribed antidepressants -- despite an explicit warning in the document that such drugs sent her into a manic state because of her bipolar condition. (Tiffany's caretakers declined comment for this article, citing her privacy.)

"They don't look at the history. They just talk to the patient, who is psychotic," Cynthia said. "I'm in there every day, advocating, and she still falls through the cracks. Imagine what happens to the thousands of people who don't have that."

Even at the best facilities, like Royalé, the smallest fissure can lead to disaster.

In July, Tiffany told her mother how much she liked her new roommate. That struck Cynthia as odd. The roommate was very sick and was quiet and meek, not the sort of person Tiffany was typically drawn to.

Days later, Tiffany extinguished a cigarette with the heel of her shoe and turned to walk back inside Royalé. A staff member asked her to pick up the butt. Tiffany went ballistic.

She ranted in the hallway, then stomped into her bedroom, shattered a compact disc case and threatened to cut people with the plastic shards.

The staff soon caught her with a razor blade she had hidden in her belongings. The voices, she told her mother, were back.

Two weeks later, Tiffany's increasingly deteriorating condition caused Royalé to transfer her to an acute-care center in Anaheim.

The next day, Cynthia got a message to call the facility immediately. She dialed the phone, her fingers trembling. Tiffany, they said, had tried to commit suicide. Cynthia got her on the phone.

"So," Tiffany mumbled through her drugs, "I guess I tried to strangle myself."

It took weeks for the full story to emerge. The new roommate, Tiffany eventually confessed, was "cheeking" her pills -- taking them from nurses but spitting them out later. She'd been handing them over to Tiffany, who ground them up and snorted them, sending her brain back into a tailspin.

Life, meanwhile, marched on.

Matthew was about to start his senior year of high school, juggling his studies, school theater and the shaolin kempo martial arts classes he taught. Jess, a freshman, was hoping to maintain her 4.25 grade-point average, despite softball and dance recitals.

Cynthia, a painter of intricate realist scenes inspired by mythology and her own life, needed to tend to her career. She also needed to tend to her marriage.

She and Michael were fighting. It fell along the usual fault lines: He accused her of coddling Tiffany; she accused him of being too hard on Tiffany and of checking out entirely.

"I have been guilty of taking my pain out on him," Cynthia said. "And vice versa."

Cynthia feared, more than anything, that their two other children were starting to pay the price for Tiffany's illness. Sometimes, she said, it feels as if there is time only for crisis management -- for Tiffany.

"It's the two of them who comfort each other, and it's great that they're close," Cynthia said, and then burst into tears. "They shouldn't have to do that. I want to be with them when I'm not exhausted. I should not have to pick between my kids."

In August, Royalé agreed to take Tiffany back, but when she refused to sign a contract stating that she wouldn't kill herself, she was transferred again, this time to an acute-care facility in La Palma. There, she started abusing another patient's methadone, a synthetic narcotic used to treat heroin addiction.

"This lady got 80 CCs a day," Tiffany said later, using common medical shorthand for cubic centimeters. "She would break it down between me and my friend. The first time I got 10. But the second time she gave me 20 CCs. I was out of it."

When they made their pact at Metro, Tiffany had promised to stop abusing drugs. Now Cynthia and Michael felt they had no choice. In September, they cut off contact with Tiffany.

The acute-care center, meanwhile, was anxious to free up Tiffany's bed. She was, once again, running out of options. A social worker had tried a host of longer-term care facilities: in Huntington Beach, in Riverside. None would take her, some because they were full, others because she had been there before and had burned her bridges.

Last month, a bed opened at Metro. There were no other options.

On Nov. 6, Tiffany was placed in an ambulance and driven back to the one place she and her parents had pledged to avoid at the beginning of the year.

Unit 410 was just as she remembered.

"There's boogers on the wall in the bathroom," she said a few days after she arrived, as she walked toward the fenced courtyard to have a cigarette. "People piss their clothes and leave them on the floor. There are fights. It's not a nice place."

"Watch out," she said as she walked through the door with a visitor. She pointed to a large drying splatter of vomit.

Tiffany soon began telling members of her treatment team that her mother was conspiring to keep her inside the institution and urging her doctors not to tell Cynthia about medical decisions they were making. She told them that it was her mother who was mentally ill, not her. Tiffany had also reconnected with Cynthia's mother, from whom Cynthia has been estranged for years. She announced that she wanted to move in with her grandmother.

"She knows where my jugular is. She's going for it," Cynthia said.

The Sittons were losing hope.

"It's just breaking my heart," Cynthia said earlier this month. "I don't know who to blame anymore or what to blame."

After anguished discussions with Michael, she filed court papers seeking to give control over Tiffany's future to a public guardian. If the petition is accepted by a judge in coming weeks, Cynthia will go from having the legal right to monitor every one of Tiffany's pills to not having the right to even find out where she is.

"I don't want to do this. But I don't have anything left in my bag of tricks," Cynthia said. "I have to use our relationship as leverage. That's all I have left."

On Nov. 10, Cynthia, 45, and Michael, 46, went to Metro. It was the first time they had seen Tiffany in three months. When Cynthia and Tiffany saw each other, they stood for several minutes, their foreheads pressed together, their bodies wracked with sobs.

"Hi, cutie," Cynthia said.

Tiffany had made, in the four years leading up to that day, 18 stops at 11 facilities -- nearly every hospital Orange County had to offer and several in Riverside and Los Angeles counties.

Acute-care facilities wouldn't keep her because she's often not in crisis.

Short-term facilities said she was too sick and disruptive.

Long-term facilities said she was too healthy to stay.

She had seen at least 50 psychologists and psychiatrists.

She had been placed on nearly 40 combinations of psychotropic drugs.

They were all exhausted.

"How are you guys?" Tiffany said, finally.

"We're worried about you," Cynthia said.

"I'm fine."

"Not really."

Silence.

Tiffany bowed her head.

Cynthia wiped away a tear and rubbed Tiffany's knee.

"I don't ever stop loving you," she said.

scott.gold@latimes.com

lee.romney@latimes.com Read more!

Tantrums could mean mental illness - Sydney (Australia) Morning Herald

IF your child is sulking or throwing tantrums, it might mean more than just expressing independence or displeasure.

It could be an early sign of a psychiatric disorder, The Sydney Morning Herald quoted a US study as saying.

Throwing tantrums is common among young children. It is often used as a tool to express hunger, illness or over-stimulation, said a study by Washington University in StLouis, Missouri.

But care givers should look out for children who hurt themselves or others while throwing tantrums or those who cannot calm themselves down.

These children may be diagnosed with depression or disruptive disorders such as attention deficit hyperactivity disorder or oppositional defiant disorder.

The study's lead author Andy Belden, who is from the university's medical school, said: 'I think parents to some degree should expect their children to have tantrums

'If they are having extreme tantrums consistently, if almost every time they are having a tantrum, they are hurting themselves or other people, that is a valid reason to go and talk to your paediatrician.'

Dr Belden's team, which published its findings in the Journal of Paediatrics, analysed the tantrums of 279 children aged 3 to 6, as reported by their parents.

It compared the tantrums of healthy children with those of children who had previously been diagnosed with depression or a disruptive disorder.

Healthy children showed significantly fewer violent, self-harming, destructive and verbally aggressive tantrum behaviours than children with mood disorder, disruptive disorders or both.

They also had less severe and shorter tantrums and required less recovery time than affected children.

The team came up with five high-risk tantrum styles that could be associated with the development of psychiatric disorder.

They included tantrums marked by:


Self-injury and violence towards others or objects.

Explained Dr Belden: 'It is not uncommon at all for children to try to kick their mums because they won't buy them an ice cream cone. But if this happens 90 per cent of the time, and you have to take cover to protect yourself during a tantrum, this may mean a problem.'


An inability to be calmed without help


A tantrum that lasts more than 25 minutes

More than five tantrums a day or between 10and 20 times a month


The inability to calm oneself after a tantrum.

He added 'No one I have met can look at a tantrum and give a diagnosis, but these are definitely red flags worth looking into in terms of getting a mental health referral from a pediatrician.'

He said that tantrums in which children harmed themselves were most often associated with depression and should be seen as very serious, reported Reuters.

However, he believes that any of the above behaviours would warrant a call to the doctor.

He said: 'If it gets to the point where the parent is uncomfortable leaving the house because they are so fearful their child will have a tantrum, that should be a sign to the parent (to seek help)'.

Parents should not be overly alarmed, though - such behaviour during a tantrum is only an indicator of a psychiatric disorder. It does not mean your child necessarily has one


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Brain Turns to Positive Thoughts When Faced With Death - Washington Post

By E.J. Mundell
HealthDay Reporter
Friday, December 28, 2007;

When thoughts of death intrude, the human mind isn't paralyzed with negativity orfear. Instead, the brain instinctively moves toward happier notions and images, a new study suggests.

The finding supports the notion that people are stronger, emotionally, when faced with their own or a loved one's death than they may have ever thought possible.

"It again speaks to how resilient humans are and how this tendency to cope with threats is some sort of indicator of mental health," said study co-author Nathan DeWall, assistant professor of psychology at the University of Kentucky.

DeWall and co-researcher Roy Baumeister, of Florida State University, published their findings in a recent issue ofPsychological Science.

Humans are the only animal known to have a clear understanding that their life will end. On the surface, this knowledge could prove psychologically paralyzing -- why compete, learn and grow if these achievements will end?

However, DeWall and other scientists believe that as humans developed an awareness of death, they also evolved what's been called the "psychological immune system."

During crisis, this mechanism tilts thoughts and attitudes toward the positive -- even when the grimmest of events intervene. This mental shift is typically unconscious, DeWall said.

"That's why, when you ask people to predict how they'll respond to something negative, they usually say, 'Oh, it will be horrible, and it will last a long time,' " he said. However, studies don't bear that out -- research involving people stricken with disease or disability show that people tend to bounce back emotionally much more rapidly than they would have expected.

In evolutionary terms, "how and when this came about, we don't know for sure," DeWall said. "I suspect that this capacity to cope with potentially disastrous events in a relatively easy way really did aid our survival."

In their latest experiments, DeWall and Baumeister first primed more than 100 healthy young adult volunteers to think about death as a reality. They asked them to imagine the process of their own death, as well as what it might be like to be dead.

Another group of young adults was asked to think about an unpleasant event -- a trip to the dentist's office -- but not death.

Immediately after the priming exercise, the researchers had all of the participants undergo standard word tests that tapped into unconscious emotional states. In one test, participants were give a word stem -- "jo-" for example and asked to complete it to form a word ( i.e., "job", "jog", "joy").

According to the researchers, individuals primed to think about death were much more likely than the other participants to choose the word "joy," compared to more neutral or negative words.

In another word test, the participants were offered a word and asked to pair it with one of two other words. One of the words was similar to the target word in its meaning, while the other word was more emotionally similar. For example, "puppy" might be paired with either "beetle" (another many-legged animal), or "parade" (not an animal, but fun, enjoyable, as puppies are).

Again, people primed to think about death were much more likely to choose "parade" over "beetle" compared to the other participants. This suggests they were unconsciously preferring the positive emotion embedded in that choice, the researchers said.

"People really don't know that they do this," DeWall said. "It's actually very counterintuitive. This picks up on the idea that when people are confronted with their own mortality, these sorts of concepts -- positive emotion words -- become readily accessible to them."

Another expert agreed that humans may be hardwired to "go to their happy place" when thoughts of death intrude.

"This is interesting work, because what it's really saying is that once you are primed with this idea that you're going to die, it sets off this automatic network," said Todd Kashdan, an expert in the psychology of positive emotions and an assistant professor of psychology at George Mason University, in Fairfax, Va.

The findings suggest that, in the face of death, "I'm going to grab onto something that I know I can hang on to. It's not going to be negative things, I can't really hold on to that," Kashdan said. "So, I'm going to focus on these positive things."

"These things are happening below the level of awareness," he added.

The new findings dovetail with much of the research on how people survive -- and even thrive -- after some of life's most difficult events. In fact, people's tendency to think sunny thoughts actuallyincreaseswith age and with their proximity to the end of life, DeWall said.

"As people grow older, they become more focused on positive emotions," he said.

There's one exception to that rule, however: Clinically depressed individuals tend not to think positively when confronted with the idea of death, suggesting that their psychological immune system may have gone off-track, DeWall said.

In contrast, the minds of healthy, non-depressed people typically balance darker imaginings with more hopeful images, he said.

Kashdan stressed that the Kentucky experiments focused on the very short-term, however. Coping over the longer term may be much tougher, he said.

"What's going to happen to these people -- not over the next few minutes but rather the next two weeks, six months? Do they end up reorganizing or shifting their life projects? There's research to show that for some people, it does, and for some people, it doesn't," he said.

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Most psychiatrists open to discussing spiritual concerns - New York Times

By Randy Dotinga
HealthDay Reporter

THURSDAY, Dec. 27 (HealthDay News) -- Many doctors avoid issues of spirituality and faith when interacting with patients, but that's not true for most psychiatrists, a new study finds.

In fact, more than 90 percent of psychiatrists surveyed said it's always or usually appropriate to ask patients about their religious faith or spirituality, while just 53 percent of other doctors thought so.

On the other hand, psychiatrists were much more likely to report that crises of religious faith can worsen a patients' suffering.

"Although psychiatrists are not [typically] religious themselves, they are the doctors most comfortable with talking about spiritual issues," said study lead author Dr. Farr Curlin, an assistant professor of medicine at the University of Chicago.

According to Curlin, there has long been a tension between psychiatry and people of faith, in no small part because the father of modern psychology, Sigmund Freud, was deeply skeptical of religion. In addition, psychiatrists have "for a long time tended to associate religious belief and practice as being a sign of, if not mental illness, at least delusional behavior," Curlin contended.

The study does support the notion that, compared to other types of clinicians, psychiatrists are more dubious of religion. For example, 18 percent of psychiatrists surveyed said they were not religious, compared to 10 percent of other doctors. And, on a measure of "intrinsic religiosity," 47 percent of psychiatrists were rated as "low," compared to 36 percent of other doctors.

There have, however, been efforts to repair this "breach" between spirituality and psychology, said Curlin, who studies the roles of religion and spirituality within the context of medicine.

In the new study, researchers randomly surveyed 2,000 physicians about patients and religion, including 100 psychiatrists. A total of 1,144 doctors responded.

The findings were published in the December issue ofThe American Journal of Psychiatry; other findings from the survey were reported earlier this year.

"We found that if you look at doctors in general, the less religious they are, the less likely they think it's appropriate for them to address spiritual issues at all," Curlin said. "The opposite seems to be the case among psychiatrists. They're the least religious doctors, but they're the ones who basically see this is as part of their bailiwick, part of what they do."

Eighty-two percent of psychiatrists thought religion leads to increased suffering in some cases, compared to 44 percent of the other doctors.

"We observe that some patients really go through existential crises when they get sick -- they wonder if they've been abandoned by God, and they relive old sins," Curlin said.

On the other hand, about three-quarters of both groups said religion can help patients cope with and endure sickness.

Also in the survey, 36 percent of psychiatrists and 28 percent of other doctors said patients "sometimes" used religion or spirituality as a reason to avoid taking proper care of themselves.

Curlin believes it's appropriate for doctors to bring up religion or spirituality "anytime they think it's relevant to the patient's experience of illness or decision-making regarding course of treatment or response to that illness."

But to some doctors, he said, "there's still a strong sense that the spiritual is personal and that the practice of medicine is professional, and those two domains ought to be kept apart as far as possible."

Richard P. Sloan, professor of behavioral medicine at Columbia University, said it is disturbing that doctors believe that spiritual beliefs can lead patients to delay or refuse treatment.

Should doctors ever ask about religion in the first place? Sloan, who's written skeptically about the study of religion's role in medicine, said it can be appropriate in certain contexts.

"You need to know what characteristics of your patients might interfere with your ability to treat them well," Sloan said. Patients who are fasting during Ramadan, for example, might not be able to take four doses of a pill per day.

"The concern that I have is a number of physicians who go way beyond what's necessary and run the risk of manipulating their patients, even coercing them, invading their privacy, taking on spiritual matters as objects of intervention," he said. According to Sloan, appropriate inquiries are fine, but proselytizing has no place in the doctor's office

More information

For more on spirituality and health, visit the U.S. National Center for Complementary and Alternative Medicine.

SOURCES: Farr Curlin, M.D., assistant professor, medicine, University of Chicago; Richard P. Sloan, Ph.D., professor, behavioral medicine, Columbia University Medical Center, New York City; December 2007,The American Journal of Psychiatry

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Finding Alzheimer’s Before a Mind Fails - New York Times

By DENISE GRADY

For a perfectly healthy woman, Dianne Kerley has had quite a few medical tests in recent years: M.R.I. and PET scans of her brain, two spinal taps and hours of memory and thinking tests.

Ms. Kerley, 52, has spent much of her life in the shadow of an illness that gradually destroys memory, personality and the ability to think, speak and live independently. Her mother, grandmother and a maternal great-aunt all developed Alzheimer’s disease. Her mother, 78, is in a nursing home in the advanced stages of dementia, helpless and barely responsive.

“She’s in her own private purgatory,” Ms. Kerley said.

Ms. Kerley is part of an ambitious new scientific effort to find ways to detect Alzheimer’s disease at the earliest possible moment. Although the disease may seem like a calamity that strikes suddenly in old age, scientists now think it begins long before the mind fails.

“Alzheimer’s disease may be a chronic condition in which changes begin in midlife or even earlier,” said Dr. John C. Morris, director of the Alzheimer’s Disease Research Center at Washington University in St. Louis, where Ms. Kerley volunteers for studies.

But currently, the diagnosis is not made until symptoms develop, and by then it may already be too late to rescue the brain. Drugs now in use temporarily ease symptoms for some, but cannot halt the underlying disease.

Many scientists believe the best hope of progress, maybe the only hope, lies in detecting the disease early and devising treatments to stop it before brain damage becomes extensive. Better still, they would like to intervene even sooner, by identifying risk factors and treating people preventively — the same strategy that has markedly lowered death rates from heart disease, stroke and some cancers.

So far, Alzheimer’s has been unyielding. But research now under way may start answering major questions about when the disease begins and how best to fight it.

A radioactive dye called PIB (for Pittsburgh Compound B) has made it possible to use PET scans to find deposits of amyloid, an Alzheimer’s-related protein, in the brains of live human beings. It may lead to earlier diagnosis, help doctors distinguish Alzheimer’s from other forms of dementia and let them monitor the effects of treatment.

Studies with the dye have already found significant deposits in 20 percent to 25 percent of seemingly normal people over 65, suggesting that they may be on the way to Alzheimer’s, though only time will tell.

“PIB is about the future of where Alzheimer’s disease needs to be,” said Dr. William E. Klunk, a co-discoverer of the dye at the Alzheimer’s research center at the University of Pittsburgh. “PIB is being used today to help determine whether drugs that are meant to prevent or remove amyloid from the brain are working, so we can find drugs that prevent the underlying pathology of the disease.”

Though PIB is experimental now, studies began in November that are intended to lead to government approval for wider use.

Currently, for the most common form of Alzheimer’s disease, which occurs after age 65, there is no proven means of early detection, no definitive genetic test. But PIB tests might be ready before new treatments emerge, making it possible to predict who will develop Alzheimer’s — without being able to help.

Researchers are also using M.R.I. scans to look for early brain changes, and testing blood and spinal fluid for amyloid and other “biomarkers” to see if they can be used to predict Alzheimer’s or find it early.

Studies of families in which multiple members have dementia are helping to sort out the genetic underpinnings of the disease.

Finally, experiments are under way to find out whether drugs and vaccines can remove amyloid from the brain or prevent its buildup, and whether doing so would help patients. The new drugs, unlike the ones now available, have the potential to stop or slow the progress of the disease. At the very least, the drug studies will be the first real test of the leading theory of Alzheimer’s, which blames amyloid for setting off a chain of events that ultimately ruin the brain.

Some scientists doubt the amyloid theory, but even a staunch skeptic said the studies were important.

Among the skeptics is Dr. Peter Davies, a professor at Albert Einstein Medical College, who said: “You’ve got to try. Somebody’s going to get this right.”

But if the amyloid hypothesis does not hold up, much of Alzheimer’s research could wind up back at Square 1.

Answers are urgently needed. Alzheimer’s was first recognized 100 years ago, and in all that time science has been completely unable to change the course of the disease. Desperate families spend more than $1 billion a year on drugs approved for Alzheimer’s that generally have only small effects, if any, on symptoms. Patients’ agitation and hallucinations often drive relatives and nursing homes to resort to additional, powerful drugs approved for other diseases like schizophrenia, drugs that can deepen the oblivion and cause severe side effects like diabetes, stroke and movement disorders.

Alzheimer’s is the most common cause of dementia (artery disease, Parkinson’s and other brain disorders can also lead to dementia). Five million people in the United States have Alzheimer’s, most of them over 65. It is the nation’s sixth leading cause of death by disease, killing nearly 66,000 people a year and probably contributing to many more deaths. By 2050, according to the Alzheimer’s Association, 11 million to 16 million Americans will have the disease. “Sixteen million is a future we can’t countenance,” said William H. Thies, the association’s vice president for medical and scientific relations. “It will bankrupt our health care system.”

The costs are already enormous, $148 billion a year — more than three times the cost of chronic lung disease, even though Alzheimer’s kills only half as many people. To a great extent, increases in dementia are the price of progress: more and more people are living long enough to get Alzheimer’s, some because they survived heart disease, strokes or cancer. It is a cruel trade-off. The disease is by no means inevitable, but among people 85 and older, about 40 percent develop Alzheimer’s and spend their so-called golden years in a thicket of confusion, ultimately becoming incontinent, mute, bedridden or forced to use a wheelchair and completely dependent on others.

“It makes people wonder whether they really want to live that long,” Dr. Klunk said.

The potential market for prevention and treatment is enormous, and drug companies are eager to exploit it. If a drug could prevent Alzheimer’s or just reduce the risk, as statins like Lipitor do for heart disease, half the population over 55 would probably need to take it, Dr. Thies said.

If new drugs do emerge, they will come from studies in patients who already have symptoms, Dr. Thies said. But he said the emphasis would quickly shift to treating people at risk, before symptoms set in. Many researchers doubt that even the best preventive drugs will be able to heal the brains of people who are already demented.

Treating preventively, Dr. Thies said, “will be more satisfying to patients and physicians, and there will be an economic incentive because you’ll wind up treating more people.”

The only thing that could slow the drive for early treatment, he said, would be serious side effects — and Dr. Morris, at Washington University, said drugs powerful enough to treat Alzheimer’s would probably have strong side effects.

Researchers are especially eager to study people like Ms. Kerley, because the children of Alzheimer’s patients have a higher-than-average risk of dementia themselves, and tracking their brains and minds may open a window onto the earliest stages of the disease.

“I want to do anything I can possibly do to help find a cure or find a way to identify it earlier,” Ms. Kerley said. “We need to stop this. I don’t know if it will help my generation, but it will help my son’s.”

She figures that being a research subject may have advantages, too.

“We’re the first ones in line,” she said. “If I am genetically predisposed, and they have a preventive medication, they’ll tell me right away.”

Alzheimer’s Beginnings

Some forgetfulness is normal. Distraction, stress, fatigue and medications can contribute. A joking rule of thumb about Alzheimer’s is actually close to the truth: it’s O.K. to forget where you put your car keys, as long as you remember what a key is for. But worsening forgetfulness is a cause for concern.

Doctors use standard memory and reasoning tests to diagnose dementia, along with symptoms reported by the patient and family members. The term “mild cognitive impairment” is sometimes applied to small but measurable memory problems. But its meaning is unclear: some studies find that the impairment can resolve itself, while others suggest that it always progresses to dementia.

Even if older patients think more slowly or take longer to remember, as long as they can still function independently, they are not demented, Dr. Morris said.

In her heart, Ms. Kerley suspects that her mother’s Alzheimer’s disease began long before the official diagnosis in 2001 or even the tentative one in 1995 — years before, maybe decades. She wonders if the disease might explain, at least in part, her mother’s difficult personality and lack of interest in reading or education.

When does Alzheimer’s begin? The question haunts families and captivates scientists.

Dr. Morris said, “We think that by the time an individual begins to experience memory loss, there is already substantial brain damage in areas critical to memory and learning.”

No one knows whether the disease affects thinking, mood or personality before memory fails. Researchers think that the brain, like other vital organs, has a huge reserve capacity that can, at least for a time, hide the fact that a disease is steadily destroying it.

“I’m speculating that it does affect you throughout life,” said Dr. Richard Mayeux, a professor of neurology, psychiatry and epidemiology at Columbia University, and co-director of its Taub Institute for Research on Alzheimer’s Disease and the Aging Brain. “I think there’s a very long phase where people aren’t themselves.”

If Dr. Mayeux asks family members when a patient’s memory problem began, they almost always say it started a year and a half before. If he then asks when was the last time they thought the patient’s memory was perfectly normal, many reply that the patient never really had a great memory.

Several studies in which people had intelligence tests early in life and were then evaluated decades later have found that compared with the healthy people, those with Alzheimer’s had lower scores on the early tests.

“It raises the possibility for me that this is a genetic disorder that starts early in life,” Dr. Mayeux said.

He said those findings also made him wonder about the widely dispensed advice to read, take courses, solve puzzles and stay mentally active to ward off Alzheimer’s. The advice is based on studies showing that highly educated people have a lower risk of Alzheimer’s than do less-accomplished ones. But does that mean that mental activity prevents Alzheimer’s — or vice versa?

‘I Have Lost Myself’

The disease is named for Alois Alzheimer, a German doctor who first described it in Auguste D., a 51-year-old patient he saw in 1901. Her memory, speech and comprehension were failing, and she suffered from hallucinations and paranoid delusions that her husband was unfaithful. Unable to finish writing her own name, she told Alzheimer, “I have lost myself.”

She died in 1906, “completely apathetic,” curled up in a fetal position and “in spite of all the care and attention,” suffering from bedsores, Alzheimer wrote.

A century later, patients still die in much the same way. Although Alzheimer’s itself can kill by shutting down vital brain functions, infections usually end things first — pneumonia, bladder infections, sepsis from bedsores.

When Alzheimer dissected Auguste’s brain, he found it markedly shrunken, a wasteland of dead and dying nerve cells littered with strange deposits.

There were two types of deposits, plaques and tangles. Plaques occur between nerve cells, and are now known to consist of clumps of beta amyloid, an abnormal protein. Tangles form inside nerve cells, and are made of a protein called tau that is normally part of a system of tubules that carry nutrients to feed the cell. Once tau is damaged, the nerve cells essentially starve to death.

Until the 1970s Alzheimer’s disease was considered a rare brain disorder that mysteriously struck younger people like Auguste D.

It was thought to be different from “senility,” which was assumed to be a consequence of aging. But then researchers compared the brains of younger people who had died of Alzheimer’s with those of elderly people who had been senile, and discovered the same pathology — plaques and tangles. Senility, they decided, was not a natural part of aging; it was a disease.

The Amyloid Hypothesis

The leading theory of Alzheimer’s says that beta amyloid, or A-beta, is the main culprit, building gradually in the brain over decades and short-circuiting synapses, the junctions where nerve cells transmit signals to one other. Gradually, the theory goes, the cells quit working and die.

Everybody produces A-beta, but its purpose is not known. People who develop Alzheimer’s either make too much or cannot get rid of it. Although scientists once blamed plaques for all the trouble, more recent research suggests that the real toxins are smaller bundles of A-beta molecules that form long before plaques do.

Dr. Dennis J. Selkoe, a professor of neurologic diseases at Harvard, said that just as lowering cholesterol can prevent heart disease, lowering A-beta may prevent Alzheimer’s or slow it, particularly in the early stages — provided that drugs can be created to do the job.

Several drugs and vaccines are now being tested that either block the production of A-beta or help the body get rid of it.

Researchers are also testing anti-amyloid antibodies, which are proteins made by the immune system, as well as blood serum that contains the antibodies.

Eventually, Dr. Selkoe said, screening tests for Alzheimer’s “will be like getting an EKG in the doctor’s office at 45 or 50, and you’ll start treating right away to prevent Alzheimer’s rather than treat it.”

Other researchers are less enthusiastic, noting that there have been numerous failures and disappointments along the way. A vaccine study had to be halted in 2002 because 18 of 300 patients developed encephalitis, and 2 died. Some scientists worry that anti-amyloid vaccines in general could be dangerous, in part because the role of amyloid is not well understood and the brain may actually need it.

No Choice but to Cope

Even if current research yields new drugs, there is not likely to be a miracle pill that will bring people back from deep dementia. For now, there is no choice but to cope with the disease. Seventy percent of Alzheimer’s patients are cared for at home, and millions of families are struggling to look after them, piecing together a patchwork of relatives, friends, paid health aides and adult day-care programs.

Barbara Latshaw, 79, lives with her husband, David, and her sister in Crafton, Pa., near Pittsburgh. Ms. Latshaw, whose dementia was diagnosed in 1991, has not spoken in four years, and she can no longer smile. But she locks eyes with visitors and will not let go.

“There is still something alive in there,” said her sister, Fritzie Hess, 69. “I’m convinced of it.”

The family believes that, at least some of the time, she still understands them. They speak to her as if she does. She is with them, and yet gone, and they miss her terribly.

“We hope to keep her here at home until she passes on,” Ms. Hess said. “She’s a joy to us.”

Many families hope to keep Alzheimer’s patients at home, but not all can manage it, especially if family members have to go work or patients become combative, incontinent, immobile or unable to sleep at night.

“There are three of us taking care of my sister, and it works out beautifully,” Ms. Hess said. “We spell each other. I don’t know how these spouses manage, when it’s one on one.”

Ms. Hess and her brother-in-law are retired, and Ms. Latshaw’s daughter, Becky Bannon, 53, is free to visit many mornings to help them get her mother out of bed, massage and exercise her arms and legs, change her diaper and dress and feed her.

Ms. Latshaw used to be full of life. She loved to cook, played tennis and bridge, raised two children and took charge of redecorating the grand old family home. Then her memory began to slip: guests would arrive for dinner, and she would have no memory of inviting them. She forgot to look before pulling into traffic, and nearly caused an accident. She would wander out of the house, and local store clerks would take her home. She never turned hostile or angry, as many demented patients do, but she had vivid hallucinations of strings being caught in her teeth, and little men getting into her bed and jabbing her with broom straws. On especially bad nights, her husband would get up with her at 2 or 3 a.m. and make the two of them hot chocolate.

Aricept, an Alzheimer’s drug, made the hallucinations worse, while another drug, an antipsychotic used for schizophrenia, seemed to quell them. But the second drug had side effects: after taking it for several years, Ms. Latshaw began to grind her teeth, and could not stop moving her arms and legs.

Their father also suffered from dementia, Ms. Hess said, admitting that she wonders about herself.

“Naturally I’m a little bit concerned, but I think worry is such a waste of time, so I don’t dwell on it; I just don’t,” she said. “My friends always said, ‘You always had a bad memory.’ I see Barbara and David’s children having that same kind of memory.”

Ms. Hess has volunteered for studies at the University of Pittsburgh Medical Center, where she became the first person in the United States to have a PIB study of her brain.

“I’m very anxious to get to the bottom of this whole Alzheimer’s thing,” she said.

Nothing Left to Give

In an interview in the summer of 2006, Ms. Kerley described her mother this way: “She’s completely withdrawn in herself. She hasn’t recognized us for a few years. Basically she hums one line of one song over and over again. She seems to be stuck somewhere in her life between age 4 and 5.”

Ms. Kerley said she and her son Michael, then 21, visited every week or two.

“She loves getting her back rubbed, being smiled at, being hugged,” Ms. Kerley said. “She doesn’t know who we are. We’re going for us, not for her, because she doesn’t remember us the minute we walk out the door.”

She had signed her mother up for hospice care at the nursing home, meaning that she would receive medical care to keep her comfortable but no extraordinary measures like resuscitation if she began to fail. She said her mother would not want to be kept alive in her present condition.

“She has nothing left to give the world, and the world has nothing left to give to her,” Ms. Kerley said.

Nearly a year and a half later, her mother is still alive, even though Ms. Kerley has declined liquid nutritional supplements, antibiotics and flu and pneumonia shots.

Her mother does not even hum anymore, and spends much of her time in a fetal position, except when she is at the dinner table. She can still walk, if led.

“If my mother had her own choice, she would have offed herself a long time ago,” Ms. Kerley said. “There is no quality to her life.

“When she does go, it will be a blessing.”

Ms. Kerley has already arranged to donate her mother’s brain and her own to Washington University. She seriously doubts that she will develop Alzheimer’s. She is more like her father than her mother, she said, and she is the most educated person in her family, reads constantly and stays in shape by swing dancing two to five nights a week. And her students keep her sharp.

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Knowing the signs can prevent suicide - Portsmouth Herald

Advocates urge families, friends to seek help

kdandurant@seacoastonline.com

PORTSMOUTH — Portsmouth resident Sarah Curtin understands what the family of the 22-year-old who died after jumping from the High-Hanover parking garage Christmas morning is going through.

In July 2002, Curtin lost her brother Joseph Gagnon to suicide, when he was 22 years old.

"I feel really bad for that family," said Curtin. "I can imagine what they're going through. As a survivor, I can say it does get better, but I know right now it's a tremendous hole and loss. It's unimaginable to think about."

The young man was discovered around 10:45 a.m. on Tuesday. Portsmouth police have ruled the death a suicide and have declined to provide his name as a matter of department policy.

Ken Norton of the National Alliance on Mental Health New Hampshire said when there is a public suicide, it can raise issues for those who witnessed it or experienced similar things in their lives.

"It brings it all back and makes them feel very vulnerable," said Norton. "I would advise anyone for whom this brings up issues of loss or concern about past memories, that this is a good time to focus on their self-care skills and to ask for help if they need to."

Curtin urged the family to seek whatever help they need.

"Ask friends and family for support," she said. "Talking about it helps. I went to a suicide support group at Seacoast Hospice. Being able to share stories with others going through it was an important piece of my healing. Seek counseling, whatever you need to do for your grief process. Be patient. Everyone moves differently at different stages of grief, and that's normal."

Each year, the Out of the Darkness Walk helps raise money nationally for research and educational programs to prevent suicide and save lives, increase national awareness of depression and suicide, and assist survivors of suicide loss.

Curtin organizes Portsmouth's walk. She works closely with her mother, Marie Gagnon, and the process has been a healing one for both of them.

Curtin said she believes more people commit suicide than the public is aware.

"We're just starting to uncover those layers," she said. "I believe we are just scratching the surface. When it comes to car accidents and drug overdoses, it's more tricky to figure out if they are accidents or not."

There are signs, but often, as in the case with her brother Joe, the signs are learned when it's too late. Curtin has spent the time since her brother's death learning what to look for.

"There's deep depression," she said. "Ninety percent of suicides have a diagnosable and treatable mental illness, like substance abuse, bipolar or other psychosis. Watch for increased alcohol or drug use, risky behaviors, talking about suicide or saying 'My family would be better off without me.'

"They may start giving away prized possessions. They may purchase a firearm. They have out-of-control rage or anger."

Norton said prevention means knowing what to look for and where people can go for help.

"Isolation from family and friends is difficult this time of year," said Norton. "Seeing families coming together, the impression of happy times is hard if you're not there."

Knowing when to reach out to someone can be difficult. "We wouldn't hesitate to help if we saw someone bleeding or having chest pains, but we see these symptoms and we tend not to intervene," said Norton. "Ask them directly: 'Are you OK? Are you thinking about hurting yourself? Have you thought about treatment?' Check with others to see if they're worried."

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Mental screening for young to begin - Boston Globe

Mass. doctors to offer questionnaires for children on Medicaid

By Carey Goldberg, Globe Staff | December 27, 2007

As of Monday, annual checkups for the nearly half a million Massachusetts children on Medicaid will carry a new requirement: Doctors must offer simple questionnaires to detect warning signs of possible mental health problems, from autism in toddlers to depression in teens.

The checklists vary by age but ask questions about children's behavior - whether they are spending more time alone, seeming to have less fun, having trouble sleeping - that are designed to trigger discussion between parents and doctors. The conversations may or may not lead to a referral to a specialist.

Over the last several years, such questionnaires have increasingly become the standard of care in pediatric practices, but - spurred by legal action - Massachusetts is jumping ahead of other states by requiring the screens for all its young Medicaid recipients.

The new requirement represents "a huge step forward in a direction that is a national trend," said Dr. Robin Adair, a University of Massachusetts Medical School pediatrician and screening specialist.

Supporters say the screening can catch issues earlier, before they develop into hard-to-manage crises.

Skeptics warn that more children could end up on heavy-duty medications that they don't really need.

"In a more perfect world, screening for mental illness amongst children would clearly be a good idea," said Dr. John Abramson, a clinical instructor at Harvard Medical School and author of "Overdosed America."

"But let's look at the realities of the world we live in," he said. "What happens is that there's a very quick translation of mental health symptoms into drug treatment."

Others wonder how Massachusetts' overburdened mental health system for children will handle the new patients the screening is expected to identify.

Already, children's psychiatrists and psychologists are often overbooked. Children with serious mental illness sometimes end up stuck in psychiatric hospitals for lack of mental health services in the community.

If, as expected, the new screening requirement turns up more children with mental health problems, "I do think it creates a potential additional access problem," said Dr. David DeMaso, chief of psychiatry at Children's Hospital Boston.

The new screening requirement stems from a lawsuit, Rosie D. v. Romney, that accused the state of falling down on its obligations to poor, mentally ill children. The federal judge in the case ruled in January 2006 that Massachusetts must improve its care, and the new requirement is the first step in the state's court-ordered remedy plan.

Families may decline the screening if they wish. If a screen turns up signs of potential trouble, it is also up to the family whether to pursue further help and an official diagnosis.

The new requirement applies to the 460,000 children and young adults covered by MassHealth, the state Medicaid program, at annual checkups from birth to age 21.

The state's private insurers generally already reimburse children's doctors for such written screens, and Medicaid will now pay $9.73 to cover the testing.

The majority of pediatricians still rely on conversational questions such as "How are you doing in school?" or "Does your child have friends?" But research shows that written questionnaires are more accurate at picking up potential problems.

The tests can also home in on children whose problems might otherwise be missed. According to national estimates, about 10 percent of children have some sort of significant psycho-social problem, from hyperactivity to anxiety to stress from living amid domestic violence.

"The earlier we intervene, the more impact we can have on brain development," DeMaso said.

The screening is not meant to produce a diagnosis, but rather to act as a "check engine light," calling attention to a potential problem, said Lisa Lambert, executive director of the Parent/Professional Advocacy League, which represents families with mentally ill children.

"If it lights up, you need to call your mechanic, find out what the problem is and if it needs to be repaired," she said.

One of the league's family support specialists, Kathy Hamelin of Fitchburg, said her own experience as the mother of an autistic son has convinced her that expanded early screening is one of the best things to come out of the Rosie D. case.

When her now 17-year-old son, Kevin, was a toddler, she said, he would scream and cry all the time, smash his head against the wall when frustrated, and flap his hands bizarrely. When she asked her pediatrician about the hand-flapping, he said, "That's nothing. That's just an excitement reflex and he'll outgrow it." In fact, she said, it is a classic autism trait. Kevin's diagnosis and treatment came only years later.

If the pediatrician had used an autism screening tool, it might have sounded an early alarm.

"Our family suffered tremendously because of this," she said, "and I just feel like if he had had early diagnosis, not only the pain and frustration we felt as overwhelmed parents would have been less, but we would have received early intervention," which "would have put him in a much better position than he is now."

As the routine screening gets underway, the state will be tracking how many children are tested and how many screens indicate a need for follow-up, said Emily Sherwood, who is overseeing the state's remedy for the Rosie D. case as director of its Children's Behavioral Health Interagency Initiatives. The state also plans to expand mental health services for children and make them more family friendly.

She said parents and clinicians may decide on a variety of responses to worrisome scores: to wait and watch a while. To handle the problems themselves. Or to seek a referral to a mental health specialist.

The screenings in doctors' offices "help us understand mental health as a part of health," she said. "It's really up to parents and primary care clinicians how they want to use this tool."

Medicaid law already requires that children be screened annually for various problems, such as hearing and vision loss, as well as for mental illness. This new requirement specifies the method of screening for mental health problems, asking clinicians to choose from among eight standard tools for the screening. Each screen is geared toward a target age; some look for specific problems, such as substance abuse and autism.

Research suggests that the screens will boost the number of children referred to mental health providers - but not overwhelmingly.

Dr. Karen Hacker, executive director of the Institute for Community Health at Cambridge Health Alliance, has used and researched mental health screening for four years, and has found that between 5 percent and 7 percent of children score high enough to cause concern. Other practices have found rates as high as 12 percent.

But, she pointed out, many of those children were already in counseling. Some families decided not to pursue further help, and of those who did, many did not show up at appointments. She has not seen a dramatic uptick in the use of psychiatric medications since the screens were added to routine care, she said, though she understands that is a cause for concern.

"We're going to have to see how this unfolds," she said.

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Ready or Not, a Home of Their Own - Washington Post

By Marc Fisher
Thursday, December 27,

This is where Gregory Hart lived for most of the past two years: down an alley alongside Ben's Chili Bowl on U Street NW, next to a trash can, curled against a concrete platform. Here, gang toughs assaulted him with a baseball bat. Here, he raised rats in a box. Here, he relied on a dog and a cat -- Bam Bam and Little Bam Bam -- to wake him if danger lurked. Here, passersby called him "retard" and shouted at him to "get a job."

And this is where Gregory Hart has lived since last Thursday: in a spacious, sunny, well-heated three-room apartment he has entirely to himself, with a stove where he can cook chicken and gravy, and with a blue comforter he chose at Target and a bed where he can sleep as long as he wants without fear of attack.

Hart, 53, has spent long chunks of his life on the streets of Washington. Mentally ill and in poor health, he has drifted through periods of drinking and drugging. Dismissed as mentally incompetent from an early age, he never attended regular school and couldn't read or write until adulthood.

"My mother tried to keep me in the house when I was young because nobody liked me," he says. "I was rejected by the population."

Hart would still be in the alley this week if not for a small but fast-growing nonprofit group called Pathways to Housing that puts chronically homeless people into their own apartments -- with daily support from social workers -- even if they're not sober, even if they lack basic housekeeping skills.

Most plans for the homeless involve moving them through shelters and group homes until they prove they are ready for permanent housing by staying sober and going to treatment for a substantial time.

But under a model called Housing First, groups such as Pathways take people as they are, in part because housing is a basic right and in part because it's cheaper. It costs $23,000 a year to care for people who have someplace to live vs. more than $40,000 a year to give the homeless the emergency services they require -- hospital ER care, detox, hours of police attention, endless trips through the court system.

In four years in Washington, Pathways has taken 130 homeless people off the streets, about 90 percent of whom are still in housing. Landlords like to rent to Pathways clients rather than other renters on public benefits because although homeless people arrive with many problems, they are closely supervised by the organization's treatment team.

In a federally funded study, 225 homeless people with severe mental illnesses were randomly placed in either a Housing First program or a traditional care model in select cities. After two years, 80 percent of the Housing First participants were still in housing, compared with 34 percent of those put through the standard approach.

As it turns out, there's a side benefit to getting the chronically homeless off the streets: Although many continue to drink and use drugs, they tend to do less of those things.

Hart still drinks, still hears voices. But he says he's drinking less because he's far from the temptations at the shelters, safe from the cold and from nights that seem as if they'll never end.

"Like many homeless people, Greg was drinking to manage his mental illness or to fall asleep in difficult conditions," says Christy Respress, Pathway's Washington program director. "When they get into housing, they often don't drink as much because they have a warm room and a real bed."

Still, Hart faces a hard road. "Getting people into housing is the easy part," Respress says. "The hard part is staying there."

Hart's life has been an excruciating series of humiliations and traumas. One of nine children who grew up at the Sursum Corda project off North Capitol Street, Hart tells of his brothers and sisters who were shot to death or took their lives, of murders and other unspeakable acts he's seen on the streets.

At another alleyway where he used to sleep, he broke into tears at the memory of one midnight assault. Less than half a block later, when a police cruiser blasted its siren, Hart yelped and bounced back into a chain-link fence, quivering until he was assured that the police weren't coming for him.

One block later, we ran into two women who grew up with Hart but hadn't seen him in decades. "Squeaky!" they shouted -- his boyhood street name -- and hugged him tight. Within five minutes, one woman had Hart's brother on the cellphone, and the two spoke for the first time in years.

"I'm back," Hart cried out. "I'm baaaaack. I got my own apartment, and I want to see you, my brother."

Pathways counselors will visit Hart daily at his new place in the Deanwood section of Northeast, enroll him in treatment, help him manage his money and eventually nudge him back toward the world of work. They've gotten him back Social Security payments he's eligible for because he worked a maintenance job for many years. One-third of his benefits go toward his rent; Pathways pays the rest, using federal and District funds.

For now, Hart is settling in. He has ideas about decoration: "Posters are for young people. If it's not in a frame, it's not going on the wall." As deliverymen bring in his mattress, Hart shakes with glee. "Pinch me! It's still not real," he says.

Then, when the men carry in a plush off-white love seat and plop it down in the living room, Greg Hart lowers himself into the deep cushions.

"Oh," he says. "Oh. Oh. That's pretty." In a few seconds, he's drifting off.

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Arrested man had mental illness - Jackson (Mississippi) Clarion Ledger

Mother planned to recommit man held in fatal stabbing, relative says

Heather Civil
heather.civil@clarionledger.com

A Jackson man jailed in the Christmas Day stabbing death of his brother was released from the State Hospital at Whitfield in April, court records say.

Lee Knight was committed to Whitfield based on a complaint from his mother, Annie Knight, in August 2006, records show.

Knight, diagnosed as a paranoid schizophrenic, had lived at Annie Knight's north Jackson home since his release.

Teresa Palmer-Jones, Lee Knight's cousin, said Wednesday that Annie Knight had planned to recommit him after the holidays. She said she didn't know why.

Yet Palmer-Jones insisted Lee Knight, 41, and his brother, Michael Palmer, 45, were close and that family members had "never imagined anything like this happening."

Nothing would have led anyone to believe violence would erupt between the brothers, she said.

Lee Knight stabbed Palmer once in the chest around 7 p.m. Tuesday as he was leaving their mothers' home, police reported.

Palmer was taken by ambulance to the University of Mississippi Medical Center, where he later died, officials say. Palmer leaves behind a wife, six children and two grandchildren.

Lee Knight is being held in the Hinds County Detention Center without bond, charged with murder.

Jackson police called the stabbing a "domestic altercation," but the family disputes reports of an argument between the brothers before the stabbing.

JPD spokesman Sgt. Jefferey Scott said he could not discuss the crime because it is under investigation.

But, he said, "the violence (we responded to) was the stabbing."

Chancery Court records said Annie Knight complained Lee Knight had threatened her with a baseball bat and thought people were trying to hurt him.

After his release from the State Hospital, he was referred to Hinds Behavioral Health Services in Jackson for treatment, according to court records.

He went to treatment, Palmer-Jones said, but she was not sure whether he was taking any medication.

Annie Knight could not be reached for comment.

"Sometimes we just don't take into account how serious mental illness is," Palmer-Jones said.

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Holiday stress can lead to depression - Sheboygan (WI) Press

Police say suicide calls pick up around the holidays

By Janet Ortegon
Sheboygan Press staff December 27, 2007

While most people are singing carols and wrapping gifts during the holidays, those who struggle with mental illness often feel increased pain and isolation. Terese Gessler knows, because she's been there.

"The bigness of it, how it comes across as being a very extreme holiday," said Gessler, 38, who was diagnosed with major depression and anxiety at age 14. "The stresses that go with it — shopping, parties, family gatherings."

Although statistics show that suicides in Sheboygan County aren't higher than at other times of the year, mental health professionals and law enforcement officers in Sheboygan see the result of the increased stress and pressure Christmas can bring.


"This can be a very lonely, depressing time for people," said Beverly Randall of Mental Health America in Sheboygan County.


In the two weeks before Christmas, the Sheboygan Police Department investigated three suicides and two attempted suicides, said Lt. Dave Schafhauser.


"Every officer here knows this type of complaint picks up during the holiday season," Schafhauser said.


According to information compiled by the Sheboygan County Coroner's office on suicides from 1988 to 2005, the majority of suicides in that time took place in May, with a total of 25 over the 17-year period. Second to that, with 23 suicides, were January, April and September. Seventeen suicides occurred in December during the period.


As of Nov. 24, the most recent date for which statistics are available, Sheboygan County has had eight suicides.


Randall said that since people do tend to have trouble coping with mental illness during the holiday season — whether or not it results in a higher incidence of suicide — the important thing is that people realize that depression is a treatable illness.


"I just feel people who reach a point in their life where they feel so hopeless and helpless that they have thoughts of ending their life should know there are resources available to them," Randall said.


And nobody knows that better than Gessler, of Sheboygan, whose severe depression led her to attempt suicide more than once.


"I've tried several times," she said. "Most of the people don't want to commit suicide, they want to get away from the pain in their life. They don't know how to stop the pain. The easiest thing is to commit suicide."


Gessler said she knew as a young teenager that she was dealing with something deeper than normal adolescent angst, but she had a hard time expressing it to people because she didn't understand it herself.


Gessler was lucky to have a supportive family around her during difficult times.


"Thank goodness for my parents," Gessler said. "They kept fighting to find help for me. They stood by me all the time and I'm so grateful. A lot of people don't have that family support … they lose more hope."


Randall said that in Sheboygan County, help is available to anyone who needs it regardless of their financial resources.


"We have a wonderful system of care for individuals no matter if they have an insurance card," she said.


Mental Health America keeps an updated list of therapists, programs and other resources for people who need help, Randall said.


"The important thing for people to recognize is that suicide is a preventable death," she said. "It's really critical that everyone recognizes some of the warning signs of depression or suicide."


To combat her depression, Gessler has undergone electric shock therapy, commitment to a mental health facility, temporary residence in a group home, years of counseling and many medications. Two years ago, she had a Vagus Nerve Stimulator implanted under her skin. Similar to a pacemaker for the heart, the stimulator sparks her brain to regulate its chemical balance and fight the depression.


The extreme treatment has helped, and Gessler is using her own experience with mental illness to help other people. She is president of the local affiliate of the National Alliance On Mental Illness and runs monthly support groups in Sheboygan for people who suffer from mental illness and their family members.


The group meets from 7 to 9 p.m. the third Thursday of each month at the United Way building, 2020 Erie Ave., and anyone with a connection to mental illness is welcome, Gessler said.


In addition, Gessler and a friend, Ruth Engelhardt, do a presentation called "In Our Own Voice," detailing their own struggles with mental illness and their efforts to find relief.


Gessler is also considering getting training to become a peer support specialist for those suffering from mental illness.


"The reason I do it is because it helps me and it gives back to the community," she said. "It's such an important (message): There is hope out there and you can get better. I'm living proof of it. Don't give up on life. There's a lot ahead."

Reach Janet Ortegon at 453-5121 or jortegon@sheboygan-press.com

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Brother Of Accused Wife Killer Blames Death On Facility Release - NBC10-Philadelphia

UPDATED: 7:46 pm EST December 26, 2007

Joseph Giongo remains behind bars, charged with killing his wife, Bernadette, in front of their 7-year-old son.

But the suspect's brother was speaking-out Wednesday, saying the alleged crime should have and could have been prevented if the mental health facility had examined his brother more closely.

Michael Giongo said his 44-year-old brother should never have been let out of the private treatment facility.

"I love him. I don't understand, but I love him as a brother, and I'll be there with him through this," Michael Giongo said.

The killing occurred three weeks after Joseph Giongo was let out of a mental health facility. Police allege that he beat his wife to death Dec. 16 inside their Conshohocken home.

"The devastation and shock that permeates our family is so intense right now that we're just coping minute by minute," Michael Giongo said.

The brother said family members had committed Joseph Giongo to Montgomery County Emergency Services, but when the family wanted him home for Christmas, loved ones had no idea how violent he could be.

Michael Giongo said Wednesday that they blame the facility for not knowing Joseph Giongo was too dangerous to be let out.

"I don't think anybody would have let him out of that state hospital had we seen anything like this coming," the brother said.

No one was available at the facility to comment Wednesday night.

"What do you think brought the mental illness on?" NBC 10's Harry Hairston asked.

"Harry, if I had the answer to that I don't think we would be sitting here today. I don't think we would be talking about a murder," Michael Giongo answered.

He said his brother started showing signs of mental illness about two years ago but was never a violent man.

"Joe was the most kind-hearted, warm person that I've ever met in my life, and for him to have snapped like this is just beyond my realm of reasoning," Michael Giongo said.

Family members said they are trying to heal, but it's difficult with the unanswered question surrounding Joseph Giongo's release from the mental facility.

"Nobody understands the why, and we're never going to get the answer to the why," Michael Giongo said.

Legal experts to whom NBC 10 talked said mental health facilities will usually call the police and prevent someone from being released if they see the person is homicidal or suicidal. But, again, no one was available at the facility to comment one way or the other, Hairston reported.

Adding to the tragedy, the Giongos' oldest son, Shane, and his brothers, 10-year-old Colin and 7-year-old Quinn, were forced out of a relative's Plymouth Meeting home by fire last week until volunteers rallied to help make repairs.


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When Both Parents Suffer Dementia, Children Suspect It Is Also in Their Future - New York Times

By DENISE GRADY

“I’ve seen a number of adult children that have not one but two parents with dementia,” said Dr. Daniel I. Kaufer, a neurologist and director of the memory disorders program at the University of North Carolina in Chapel Hill. “It’s like the perfect storm of dementia care.”

“With the sheer numbers of people who are going to develop dementia, it’s going to happen more and more,” Dr. Kaufer said. He sometimes calls it “the double-parent dementia dilemma.”

(The Alzheimer’s Association does not track the number of couples in which both partners have dementia, a spokesman said.)

Some doctors wonder if the stress of caregiving somehow accelerates the mental decline of the second spouse.

The children must confront their own increased risk. Having just one parent with Alzheimer’s triples the risk; when both parents are affected, the amount of extra risk is not certain. The children of Alzheimer’s patients “live in dread,” said Dr. John C. Morris, director of the Alzheimer’s Disease Research Center at Washington University in St. Louis.

Since 2003, both of Marjorie Hinsdale-Shouse’s 84-year-old parents have been living with her and her husband in Chapel Hill. Her father has advanced Alzheimer’s disease, and her mother has mild cognitive impairment, a memory disorder that often progresses to full-blown Alzheimer’s disease. Her mother had been looking after her father, but began to lose track of her own medications and was hospitalized twice as a result.

Ms. Hinsdale-Shouse’s husband, Marshall Shouse, quit his job managing a supermarket meat department to take care of his wife’s parents, while Ms. Hinsdale-Shouse works as a project manager for a research company. Her mother is easy-going, but her father has been difficult at times, she said, aggressive and strong enough to break door handles trying to get out. She has resorted to psychiatric medications to calm him and keep him from hurting anyone, but switched doctors when she realized he was taking multiple drugs that were not helping.

“Everything about living with dementia is like a roller coaster,” she said. “Anger, anxiety, depression, calm, oversleeping, not sleeping at all. They cycle through. You can’t even predict it.”

She and her husband have considered nursing homes, but fear that the care might not be good, that her father could be injured by another patient and that his mind would disintegrate even faster. He was an actuary and the senior vice president of an insurance company, “a smart numbers guy and the epitome of a workaholic,” she said. Now, he no longer speaks or appears to understand speech. Like an infant, he puts things in his mouth and grabs anyone who touches him. But his grip can leave bruises. He does not recognize anyone, but will return a smile.

“The saddest thing is to not have his brain, so smart, so kind, to see that person disappear,” Ms. Hinsdale-Shouse said.

She and her husband think they are doing the right thing, but at times they feel overwhelmed.

“The most difficult time for me, and I wonder if we can do this or not, is in the middle of night when you’re cleaning up something, and you have to go work the next morning,” Ms. Hinsdale-Shouse said. “I flash back to what my mom and dad were like when I was a little kid and they took care of me and it was unconditional, and I think that’s what my husband does, too.”

She cannot help wondering if she will also wind up with dementia.

“When you have two parents with Alzheimer’s, what else can you think about?” she said. “To me it seems inevitable. But that doesn’t mean it absolutely has to happen.”

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Senate Meets Briefly to Block Bush - Associated Press

By THE ASSOCIATED PRESS

WASHINGTON (AP) -- The House was quiet as a mouse the day after Christmas. But across the Capitol, the Senate was operating in an unusually efficient manner in its ongoing power struggle with President Bush.

A nine-second session gaveled in and out by Sen. Jim Webb, D-Va., prevented Bush from appointing as an assistant attorney general a nominee roundly rejected by majority Democrats. Without the pro forma session, the Senate would be technically adjourned, allowing the president to install officials without Senate confirmation.

The business of blocking Bush's recess appointments was serious. It represents an institutional standoff between Congress and the president that could repeat itself during Congress' vacations for the remainder of Bush's presidency.

In such situations, pro forma sessions also could give Bush some political cover on popular legislation he doesn't want to sign. When Congress is holding pro forma sessions and is not formally adjourned, a bill sent to a president automatically becomes law in 10 days unless he vetoes it.

That could be the fate of two bills Congress passed last week. One growing out of the Virginia Tech massacre makes it harder for people with mental illness records to buy guns. The other makes it easier for journalists and others to obtain government documents through the Freedom of Information Act.

In practice, Wednesday's pro forma process was almost comical.

''Good morning!'' Webb, sporting a respectful tie and jacket, called to the floor staff assembled just for the occasion in an otherwise sleepy and chilly Capitol. One clerk congratulated Webb on being 30 seconds early, thrice the amount of time it would take to complete the Senate's work for the day.

Climbing to the president's chair, Webb took the gavel and banged it.

''The Senate will come to order,'' he intoned, reading from a two-line script to a floor empty of other senators but witnessed from the gallery by one reporter and about a half dozen staffers. ''Under the previous order, the Senate stands in recess until Friday, December 28th, 2007 at 10 a.m.''

His work done, Webb left. The floor staff reported to those in the gallery overhead that the session had lasted nine seconds.

''I didn't appoint myself ambassador to a tropical nation,'' Webb, a former Navy secretary, novelist and TV journalist, quipped to a reporter afterwards.

Before Congress left last week, Democrats scheduled 11 pro forma sessions to fill the void until the Senate returns to regular session on Jan. 22. The purpose was to stop Bush from using the constitutional power presidents hold under the Constitution to bypass Senate confirmation and unilaterally install his nominees in office when Congress is adjourned.

Democrats wanted to block one such recess appointment in particular: Steven Bradbury, acting chief of the Justice Department's Office of Legislative Counsel. Bush nominated Bradbury for the job and asked the Senate to remove the ''acting'' in his title.

Democrats would have none of it, complaining Bradbury had signed two secret memos in 2005 saying it was OK for the CIA to use harsh interrogation techniques -- some call it torture -- on terrorism detainees.

Senate Majority Leader Harry Reid, D-Nev., said Bush refused to rule out appointing Bradbury to the job if the Senate formally adjourned. So, Reid decided to keep the Senate in session with pro forma meetings every two or three days.

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LMH leaves gap in mental health services -Lawrence (KS) Journal-World News

By Bill Simons

I watch the numerous TV ads extolling the improvements and virtues of Lawrence Memorial Hospital and its claim of serving all of our citizens. Sometimes I get mad, but most of the time I just feel sad, like tears are washing over my very soul.

I, too, am a Lawrence citizen. I just happen to be one of those that has no room at the inn because I have a serious and persistent mental illness.

Officials talk of the “safe rooms” in the ER where patients can be “treated” or monitored until they can be transferred to mental health units in Kansas City or Topeka. Believe me, the LMH ER staff are wonderful to me when I have been there. But, I receive no “psychiatric treatment;” it is merely a holding pen until an out-of-city, out-of-mind transfer can be made.

Let me tell you of my last experience so you can see how the provision of “services to all our patients,” and the provision “with a pathway to get the mental health care that they (the mentally ill) need” as stated by Dana Hale, LMH vice president of nursing, in a Dec. 20 Journal-World article really works — or doesn’t.

My therapist sent me to LMH ER because she felt I needed temporary hospitalization for medication readjustment because I was suicidal. The fine staff from Bert Nash Community Mental Health Center evaluated me and concurred with the recommendation, so they began their search to find a place for me. By the way, one of my conditions is agoraphobia and I can have terrible panic attacks if I try to leave Lawrence without family support. The Dec. 20 Journal-World article talked about transfers to Topeka or Kansas City. There is one hospital in Kansas City where I have been a number of times and where I know the staff, they know me and I feel safe — three crucial components for a successful in-patient stay.

So, Bert Nash began their phone calls. Not only did my familiar Kansas City hospital not have a single bed available, there was not a single psychiatric unit in Kansas City or Topeka with an available bed. Now what? There was talk of sending me to Osawatomie State Hospital although they are overcrowded and understaffed and not a place I needed to be. If this had been their decision that night, I would have been handcuffed and shackled like a criminal and taken to Osawatomie by the sheriff’s department.

Through the diligence of the Bert Nash staff, they finally found a bed space for me in a small Leavenworth unit. No handcuffs now! I was put in the back of a caged van and taken to Leavenworth by a contracted transportation service. In spite of my agoraphobia, I left the confines of my community, transported in a caged van to a facility where I knew no one on the staff or in the community.

And mine was a “good” experience as opposed to many Lawrence mentally ill individuals without insurance or family support. Those citizens who sometimes hallucinate and become disoriented are arrested for disorderly conduct or some other related charge and they wind up in this nation’s “new mental health system.” In a Journal-World article earlier this year, Undersheriff Ken Massey estimated that one-third of inmates at the Douglas County Jail have some form of mental illness.

This “jailing” of the mentally ill rather than providing humane hospital treatment has become a national explosion. Today, the nation’s largest mental health facility is the Los Angeles County Jail where multiple wings of the jail are set aside just for the mentally ill and where psychiatric nurses dispense powerful psychiatric drugs. Just for your information, the second and third largest mental health “facilities” in the U.S. are Dade County Jail in Miami and Rikers Island in New York City.

Yes, we are no Los Angeles, Miami or New York City, but we are following the same path. Treat us? Yes, maybe, but somewhere else, away from familiar therapists and without the support of family and friends. If no beds are available elsewhere or if we don’t have insurance, hide us away in an overcrowded state hospital. Or, worse yet, if we were temporarily psychotic and committed a misdemeanor crime, then send us off to the overcrowded county jail where we can sit and further decompose for three to six months until we can be taken to be evaluated at Larned State Hospital, well out in western Kansas, away from many friendly eyes, to a facility that just this year was found by state officials to be providing “inhumane conditions” and that was downgraded from full to conditional certification from a national agency.

To my fellow Lawrencians, I would like to think that we are a caring community, far removed from Los Angeles, Miami and New York City, but evidence here and across the state shows that we have started down that slippery slope and it seems to be gaining momentum.

Maybe in Los Angeles, but not here, not in Lawrence, Kansas. As Jesus said, “Even as you treat the least of these, you treat me.” Please, this holiday season, demand that Lawrence will stand like a “beacon on a hill,” that we will insist that LMH will provide a safe, treatment-oriented mental health unit to meet the needs of our locally mentally ill. And, so that the LMH ads will really ring true.

— Bill Simons, a Lawrence resident, was director of Project Acceptance, a consumer advocacy organization, from 1988 to 1993. For his advocacy activities on behalf of the mentally ill, he received the Bert Nash Center’s Pioneer Award in 1992, and the Independence Inc. Community Access Award in 1997.

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Overpayment to mental health providers -Hudson Valley (NY) Press

A psychiatrist improperly billed Medicaid on eight separate occasions for more than 24 hours of treatment in a single day and appears to have billed for patients he never treated, among other improper practices, according to an audit released by State Comptroller Thomas P. DiNapoli.

"Most doctors work hard, but it is difficult to imagine how anyone can put in more than 24 hours in one day on multiple occasions," DiNapoli said. "This should have immediately raised red flags and the psychiatrist should never have been paid. Better systems must be put in place by the Department of Health to prevent these types of payments from being made in the first place."

In an analysis of payments for mental health services from August 1999 to October 2006, auditors identified more than $1.3 million in Medicaid overpayments for mental health services - many of which could have been prevented with additional controls in the eMedNY Medicaid claims processing system. The State Department of Health (DOH) administers Medicaid and the eMedNY system.

Among the audit’s primary findings:

One mental health provider who was paid more than $436,000 billed Medicaid on eight separate occasions for more than 24 hours - and as high as 42 hours in one instance - of service in a single day. He admitted to auditors he did not see certain patients for which he billed Medicaid. Auditors also discovered his clinical social worker saw certain patients but Medicaid was billed at the higher psychiatrist’s rate.

389 providers submitted more than 27,000 claims valued at $662,000 for mental health services and pharmacologic management provided on the same day. Under Medicaid rules, psychiatrists who provide mental health evaluation and management services for patients cannot bill the program for prescribing medication - known as pharmacologic management - on the same day.

106 clinic-based mental health practitioners received 21,132 payments totaling more than $381,000 from June 2002 through December 2005 for services for which the clinic also received payment. When services are provided at clinics, only the clinic not the individual service provider is permitted to bill Medicaid.

1,898 instances were identified in which 27 different clinics had billed Medicaid twice at different rates for the same services. From June 2001 through October 2006, the overpayments totaled $302,568.

Auditors met with nine of these providers who double billed, eight of whom indicated that they were confused about the rules and misinterpreted DOH policy. The auditors recommended that DOH add a control to the eMedNY system to block payment for pharmacologic management when it is billed in conjunction with other mental health services. Auditors made a similar recommendation to improve the eMedNY system to block duplicate payments.

DOH indicated in its response to the audit that it would implement recommended controls and other strategies to avoid many of the overpayments found by auditors and would seek to recover any funds paid to providers in error. The complete response is included in the audit.

The findings of the audit have been referred to the Office of the Attorney General.

For a copy of the audit visit http://www.osc.state.ny.us/audits/allaudits/093008/06s53.pdf. Read more!

Army brass must answer for inattention to mental illness - Fayetteville (NC) Observer

Our View: Army brass must answer for inattention to mental illness.

If the end result of the investigation into Pfc. Jason Scheuerman’s suicide is that one NCO loses a rocker or two and another loses his stripes, you’ll know it’s a whitewash and you’ll know what to expect: more of the same. This case should make the Inspector General see stars.

Scheuerman, who killed himself in Iraq in 2005, was exhibiting suicidal and depressive behavior four months before his death. He was reported. He was interviewed. He was referred to a psychologist. He was evaluated. He was threatened, and punished, and threatened and punished again. And so, fearful of being raped in the stockade and viewing himself as a screw-up who had brought “dishonor” on his unit, he stepped into a closet and shot himself. He was 20.

A plausible argument can be made that anyone who sees a soldier with the muzzle of his weapon in his mouth and doesn’t act is too ignorant to be in the Army. But, in general, soldiers aren’t expected to be experts in mental instability — although they can be taught much more than most now know, including every line of the Army’s list of suicide risk factors.

A chaplain deserves credit for both his concern and his persistence. And give a nod to Scheuerman’s platoon sergeant, who recommended professional help — as did his company commander, under prodding from the soldier’s mother, who received what she took to be a suicide message. But: The result of the visit with the psychologist (not, it seems clear, a psychiatrist, an M.D.) was a test which established, to the psychologist’s satisfaction, that Scheuerman was “capable” of feigning mental illness. That isn’t what anyone needed to know. What the higher-ups needed to know was whether or not he was capable of self-murder. Instead, the report served to peg him as a fake, a phony and a malingerer.

Outside the operating room, the armed forces are not famous for their attention to individuals. To an extent, that’s unavoidable. But the mental health division belongs in the same category as the surgeons. Yet, for years, its leadership — the brass — has parried questions about patient care with laments about manpower needs.

Chris Scheuerman of Sanford, himself an Army veteran, brought to light this much of the story of his son’s death and then asked Congressman Bob Etheridge of Lillington to call in the Inspector General. Give Mr. Scheuerman the final word: “We will not see a statistical decrease in Army suicides until the Army gets serious about holding people accountable when they do not do what they are trained to do.”
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Insider helps the mentally ill - Honolulu Star-Bulletin

By Helen Altonn
haltonn@starbulletin.com

Marya Grambs is passionate about helping people who suffer from mental illness, because she knows personally how devastating it can be.

"I am recovering from mental illness," she says, explaining she has lived with it for many of her 61 years.

Grambs is executive director of Mental Health America of Hawaii (formerly Mental Health Association in Hawaii).

Board member Chuck Freedman said Grambs has rejuvenated the organization.

"She's an extraordinary model of leadership," he said. "I'm really impressed by her skills, which include not just knowledge, but a real insight into mental wellness.

"She has been through a lot of experiences and really made her own life well through the right kind of practice."

Grambs recently received the Daniel K. Inouye Award from the Hawaii Psychological Association for "distinguished contributions to psychology and mental health."

An effervescent, upbeat personality masks Grambs' struggles with mental illness, which she traces to her childhood.

She said her father was a brilliant man with a federal management job in Washington, D.C. He also was an abusive, severely depressed alcoholic who had guns in the house, she said.

He beat her mother and attempted suicide many times, she said, adding that she and her two younger siblings lived in terror, not knowing what to expect.

Her mother, a university professor, international scholar in human relations and author of 20 books, felt "a crazy father was better than no father at all," she said.

"I can tell you that isn't true," she said, describing her breakdown at age 17 when she left for college. She spent a year in a hospital. "It is very sobering to find yourself at age 17 with a label of mental illness and in a mental hospital."

It took a year of therapy to recover, she said, noting there was no medicine then for such disorders.

She recovered slowly and began going to college again, taking 10 years to get a bachelor's degree, she said. When she was 19, her mother was traveling, and her father became so abusive toward her brother and sister that she filed child abuse charges against him, she said.

Working on a master's degree in clinical psychology years later in California, she became involved in starting a shelter for battered women.

Grambs said she became co-director of the first shelter on the West Coast, the third in the country, and she began talking publicly about the impact of mental illness, substance abuse and domestic violence.

She married in Maryland, and she and her husband moved to California, where she earned a master's degree in clinical psychology, had a baby and divorced.

"I was always in recovery," she said. "I struggled with anxiety and depression."

When she was 30, another relationship ended, and she plunged "into an abyss again" with depression and suicidal thoughts, she said.

Medicine then available made a dramatic change in her treatment, reducing her hospitalization from a year to four months, she said.

She says she is still in recovery but her life is good, with a 25-year relationship, many accomplishments and a long list of things she wants to do to make people aware of mental illness and help them.

She cites high rates of adult and teen depression and suicide in Hawaii, pointing out mental illness is so stigmatized people would rather not get help than face the stigma.

But therapy and medicine can save lives, she emphasizes, telling others, "Here I am. I look like you. I'm a mental illness patient."

It is just a brain disease, she says, no different from any other disease or illness. Read more!

Jailing Mentally Ill Must Be Outlawed - Hampton Roads (VA) Virginian-Pilot

VIRGINIA LONG ago decided to settle for a mental health system that steps in only when an emergency arises.

Too often, even that paltry goal proves to be tragically out of reach.

The murders at Virginia Tech by a mentally ill gunman triggered an emergency-alert at the state Capitol this year.

Gov. Tim Kaine and lawmakers are rushing to draft laws making it easier to commit mentally ill people who may be dangerous. With hardly a dissent, lawmakers seem eager to budget tens of millions of dollars extra to build new crisis response clinics.

These are responsible and necessary steps, but history suggests that in a year or two the urgency will fade. State leaders will congratulate themselves on a job well done, and move on to other priorities.

If so, they will walk away from a mental health system still scarred by massive gaps in care, and still vulnerable to a breakdown like the one that left Seung-Hui Cho spiraling into madness.

That's the warning being sounded by a commission appointed by Chief Justice Leroy Hassell to oversee a thorough re thinking of state mental health services.

In a preliminary report released last week, the commission sets benchmarks to measure the state's progress and emphasizes the need for a commitment to yearly reforms, not a one-time quick fix.

The report calls for a dramatic six-year restructuring of community-based mental health clinics to ensure the availability of all levels of services, including outpatient and in-home support, residential care and emergency response.

In many communities, few services are available until a mentally ill person is in crisis, and even then police and sheriffs often must step in to fill the void.

The result is a criminalization of mental illness. Fifteen percent of the inmates in Virginia's jails and prisons have a serious mental illness. It's bad enough that adults are dumped in cells that, at best, are unprepared to treat them and, at worst, resemble a 19th century asylum. The more shocking fact is that children are even more likely to end up behind bars because no one else will take them.

Forty-three percent of youngsters in detention centers are diagnosed with mental and emotional disorders, making the Department of Juvenile Justice the state's largest provider of residential mental health services for children.

The $42 million Kaine has included in his budget marks a takeoff point for fixing a disjointed and inadequate system. But Virginia must be willing to do more, the commission report says, creating a network of services that "will draw people with mental health needs into the system rather than driving them away."

The Hassell Commission's report offers a challenging but thoughtful map for that journey of rebuilding and recovery.

Read more!

Judge orders bond for man accused in TV station crash - Associated Press

CHICAGO (AP) - A Cook County judge has set bond at $125,000 for a man accused of crashing his minivan into a glass-walled TV studio during a weekend 10 p.m. newscast.

Twenty-5-year-old Gerald Richardson faces felony criminal damage to property of more than $100,000. He's also been charged with resisting arrest, reckless driving and operating a motor vehicle without insurance.

No one was injured in the crash at WLS on Sunday.

The crash was heard on the air and startled weekend anchor Ravi Baichwal as the van plowed into the studio's reinforced glass wall.

Attorney Angela Lockett says her client Richardson has a history of mental health problems.

At a court hearing Tuesday, prosecutors claimed Richardson "wanted to be on the news." Read more!

For teens, thrift store is a lifeline - Chicago Tribune

By Robert Channick
Special to the Tribune

Discarded sweaters and bric-a-brac aren't the only things finding new life at Hidden Treasures Gift & Thrift Store in Round Lake Beach. Cast aside because of emotional and behavioral issues, the teenage staffers themselves are working their way back into the mainstream.

A vocational outreach of Allendale Association, a non-profit Lake Villa educational and treatment center, the flourishing 5-year-old store has helped open the door to a number of first jobs, and for some kids, the outside world.

"It's tough for kids who have mental health issues to make that leap," said Jordan Luhr, Allendale's vice president of development.

Allendale reaches about 1,300 neglected, abused and mentally ill children annually through its school, residential treatment programs, outpatient facilities and group homes scattered from Highland Park to Wisconsin. Ninety-five percent of its $30 million annual budget comes from state agencies, Luhr said.

Allendale offers vocational training for its high school students, but its foray into retail was more accidental than academic.

"We were getting overwhelmed with donations of clothes and household items -- dishes, pictures, that kind of stuff -- and like most non-profits, we did not want to turn anybody away," Luhr said.

With modest expectations, Allendale opened up a small storefront in 2002 in downtown Lake Villa, which it quickly outgrew. In 2004, Hidden Treasures relocated to its current spot: tucked between a nursery school, dry cleaners and nail salon at Sweetwater Crossing, a strip mall on Illinois Highway 83 in nearby Round Lake Beach.

The store is stocked entirely through donations, and it offers merchandise in a bright, boutique-like setting. Neatly displayed racks of clothing, books, DVDs, figurines, cookie jars and curios are tightly packed in the 1,200-square-foot space. In the back is a small children's play area overflowing with toys and stuffed animals.

While the ambience is on the high end of thrift shop fare, it is the mission that sets Hidden Treasures apart, embodied in pairs of teenagers delivered by van every two hours for their daily shifts. Working four days a week, the students are taught sales, stocking and cashiering, but the underlying lesson plan is more basic.

"A lot of our students have been institutionalized or lived in a residential program for many years," said Tina Chiero, 48, the store's manager and a vocational instructor at Allendale for 10 years. "What is most important for them is they learn how to be socially appropriate."

Eight students work in the store, receiving both academic credit and a vocational wage up to $4.85 an hour, based on performance.

"If they have a good day, they'll get paid the highest rate," Chiero said. "If they're having a difficult day or a completely non-compliant day, they may not get paid anything."

For a number of students, the thrift store has been a stepping stone to more gainful employment. In September, after three months of training, Carrie Martinell, 18, of Wauconda landed a job as a cashier at a department store in Lake Zurich.

Mother of a 15-month-old girl, Martinell credits the store with building her self-confidence along with her resume. She is set to graduate in June and plans to attend nursing school.

"I like working with people," she said. "I found that out through interacting with the customers."

Although Hidden Treasures has yet to turn a profit, business has been brisk this year, with $3,500 to $4,000 in monthly sales, which roughly covers its costs, according to officials. A growing base of regular customers keeps the students busy.

"I think it's good because it gives them a little bit of a sneak peek of what it would be like to be in the working world," said Tim Adornetto, 46, of Grayslake, foraging on a recent weekday afternoon.

Bernadette Aquino, 40, a naval petty officer stationed at Naval Station Great Lakes, began to frequent the store after moving to Round Lake Beach.

"I try to come in here once or twice a week," she said, carefully sizing up offerings on a circular clothing rack. "The quality is good, the prices are good and ... the money goes to a good cause."

Finishing up the last shift, two students slipped seamlessly through the aisles, folding, hanging and restocking at the behest of Chiero. Four months into her training, an amiable 19-year-old was grateful for the experience as she nervously prepared for her first job interview that day at a department store in Gurnee Mills.

"I think it was very helpful because I learned to deal with customers -- strangers, basically -- and how to use the cash register," she said.

Not quite ready to move on, her somewhat reserved 17-year-old co-worker nonetheless offered her take on success in retail, and perhaps the world beyond.

"You've just got to be polite," she said. "It's not hard."

Copyright © 2007, Chicago Tribune
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Wilson all smiles about recent honor, resurrected career -Pittsburgh Post-Gazzette

By Scott Mervis
Tony Esparza/12 Star/CBS

Frankly, it took a while for the Kennedy Center Honors to, um, get around to Brian Wilson.

Stevie Wonder, Elton John and Paul Simon all received the honor before the founder of the Beach Boys, and it doesn't take a rock historian to know the chronology there isn't quite kosher.

It goes without saying, though, that what slowed the process for Wilson -- who received the award this month in a ceremony that will be seen on CBS tonight -- was his fragile state of mind.

For many years, Wilson was the pre-eminent living pop-music casualty, starting with the anxiety attacks that prevented him from touring with the Beach Boys and intensifying with the nervous breakdown in the late '60s that halted the production of "Smile."

It was to be the follow-up to the 1966 "Pet Sounds," considered to be one of the best pop records of all time and the gateway to a more orchestral pop sound that would fuel the Beatles' "Sgt. Pepper's Lonely Hearts Club Band" and the album-oriented rock of the late '60s and '70s.
'The 30th Annual Kennedy Center Honors'

* When: 9 tonight, CBS.
* Starring: Brian Wilson, Steve Martin, Diana Ross, Martin Scorsese and Leon Fleisher.

While many of his '60s contemporaries checked out, and others, like the solo Beatles and Dylan, flourished, the reports on Wilson in the '70s involved LSD trips, schizophrenia, adventures in psychotherapy and a lot of eating in bed.

Frontman Mike Love and The Beach Boys cruised along playing the old hits without Brian, and then without brother Dennis when he died in 1983 (and now without Carl).

The band even scored its biggest-selling hit in 1988, the year they were inducted into the Rock and Roll Hall of Fame, with "Kokomo," a song that makes Beach Boys geeks shudder.

Through all his troubles, though, Wilson was loved and cherished by just about anyone who ever stepped up to sing a vocal harmony.

His various comebacks have been warmly received, from his "15 Big Ones" in 1976, to his first solo record in 1988, to his return to the stage in 1998, to the triumphant release of a newly recorded "Smile" in 2004.

At 65, Wilson sounds invigorated and thrilled to be back on the world stage.

He has been out on tour with a solid band celebrating the 40th anniversary of "Pet Sounds" and he's excited to get into the studio to record a new song cycle called "That Lucky Old Sun."

Earlier this month, he gave us 10 minutes on the phone, during which he blew through the questions with a brevity and childlike breathlessness that was a bit disarming.

Q: There are only a handful of pop musicians who have won this Kennedy honor. What does it mean to you?

A: Well, it means people must have liked me quite a bit to have gotten that kind of honor. And the Beach Boys must have blown people's minds in order for me to get that honor.

Q: How was the ceremony?

A: The ceremony was very good. I met a lot of people. I met the president. And Itzhak Perlman did a speech and told the audience that every 250 years there's a Brian Wilson, and Beethoven was the last 250 years, so if he likened me to Beethoven, that's quite an honor.

Q: How did Lyle Lovett do with "God Only Knows"?

A: I thought Lyle Lovett's version was the best version I ever heard, including the Beach Boys'. The most loving beautiful version I've ever heard. Unbelievable.

Q: Were there any other highlights?

A: Meeting Madame Secretary. Meeting the president.

Q: What did he say to you?

A: He said, "It's an honor to be with you." [laughs] And I said, "Vice versa."

Q: Do you think he's a Beach Boys fan?

A: I don't know if he's a Beach Boys fan, but he seemed to like me.

Q: How many presidents have you met?

A: Let's see. I've met Ronald Reagan and George Bush and George Bush Jr.

Q: Now, you've been celebrating the anniversary of "Pet Sounds," which is considered among the best albums in the history of pop music. Did you have any idea you were making something that would be so well-regarded and so lasting?

A: Yes, I did. I actually was very aware that it was going to be a long-lasting album over the years, yes. Because I could feel in my heart and soul that it was a very, very spiritual album. And there was a lot of love in it. We put a lot of love in that album.

Q: Coming after "Pet Sounds," what originally was your goal with "Smile"?

A: We didn't know. We were so on drugs, we didn't know what we were doing. We were trying to make something happy, to make people smile. Something that would be like a teenage symphony to God.

Q: How important was it to you to finish "Smile"?

A: It was probably the biggest music event in my life, because it's something we started in 1967 and then 40 years later we premiered it in London and we got a standing ovation. It means a lot to be able to create that type of music. "Smile" was a very rhapsodic album with little songs and little pieces of songs.

Q: How would you describe the rivalry with the Beatles back then?

A: My rivalry with the Beatles was an inspirational thing. It meant a lot to me that the Beatles would consider me to be their rivals. It was a mutual admiration society trip between me and Paul, actually.

Q: McCartney has said that "God Only Knows" is the greatest song ever written ...

A: He said it's his favorite song.

Q: Do you have one yourself?

A: Favorite song? "Strangers in the Night" by Frank Sinatra is my favorite. I love that song.

Q: Favorite McCartney song?

A: "The Long and Winding Road."

Q: Do you have a favorite Beach Boys song?

A: "California Girls." I just love the bass line and the lyrics and the melody.

Q: Now, you went a long time without touring and then started playing a lot in 1998. What changed for you in that time?

A: Well, I started to exercise, which improved my whole being -- my mind, my body and my soul. So I got in good shape, which helped me to write songs and continue to create music.

Q: Do you have a renewed love of performing now? Because it was never your thing to start with.

A: Right.

Q: Do you have a renewed love for it?

A: Oh, are you kidding? It's the greatest thing in the world, playing for people. I'm in heaven the whole time.

Q: I understand you play piano every day. Are you also writing music right now?

A: I'm writing a song right now called "Love is Just a Song." It's done, actually..

Q: Is there a record in the works?

A: No. Actually, there's a record we're going to start in mid-January. We're going to record "That Lucky Old Sun" narrative that we did in London and premiered in Europe.

Q: Does the writing come as easily to you as it ever did?

A: Actually, it does. It comes as fast as when I was 22 years old. It'll never die in me. Even when I'm 85, I'll have that.

Q: Are you aware of the Beach Boys' influence in music today among indie-rockers?

A: I'm a little aware of it. I haven't listened to the radio in a long time, so I'm not aware of what's going on. But I've been told that a lot of young people want to emulate the Beach Boys.

Q: And older people. Are you aware that Bruce Springsteen just did a song where he was trying to do that as well?

A: Which one?

Q: "Girls in Their Summer Clothes."

A: Oh really! That's cool.

Q: Do you wish at all that the Beach Boys could be one unit working together?

A: No, actually not. I'm very happy doing what I'm doing. I'm sure Mike [Love] and Bruce [Johnston] are happy with what they're doing. And we're doing good, and everything's cool. I don't want to get back with the Beach Boys at all.

Q: Getting back to what we were talking about earlier: Obviously people are impressed to meet you. Who are you excited to meet?

A: Well, the president. And that's really about it. I met the president. And I met the Beatles. And I met Three Dog Night and Danny Hutton. I've really met most of the great people.
Scott Mervis can be reached at smervis@post-gazette.com or 412-263-2576.
First published on December 26, 2007 at 12:00 am
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Post-holiday blues leave many in seasonal slump -Binginham (NY) Press & Sun-Bulletin

By Tom Wilber
Press & Sun-Bulletin

When holiday cheer has come and gone and you are left feeling poorer, fatter and meaner of spirit, take comfort in this: It's not just you.

The season that compels us to go long on revelry during the shortest days of the year is also fraught with bipolar tendencies. The maniacal pace of shopping, cooking, traveling, corresponding and entertaining under deadline evaporates into an extended period of cold weather, dark days and bills -- left in a wake of torn wrapping paper, shedding Christmas tree needles and a mindset primed for letdowns.

"At the end of a race, when you run hard, you are exhausted," said Dr. James Holler, who practices with Endwell Family Physicians. Some recover better than others. The Yuletide season tends to be a time when patients appear with ailments related to stress, anxiety and depression, he said.

There are many factors conspiring against post-holiday health and good cheer: limited daylight, financial stress, year-end deadlines at work, limited time for fresh air and exercise, and overindulgence in fatty foods, sugar and alcohol, which can have profound effects on moodiness, energy and physical well-being. Lack of sleep and general fatigue are also culprits.

It can be a busy time for counselors. Between 10 and 20 percent of calls to eni, a Vestal-based employee assistance program, are from people trying to come to terms with holiday-related stresses, said Cornelia Cannavino, a nurse with the program.

"Feeling overwhelmed with unrealistic expectations -- that's a big one," she said.

Some people have obvious reasons to be sad when the rest of the world is glittering in revelry. They have lost somebody close. They have gone through break-ups or divorces. They are desperately lonely or financially ruined.

But it's not unusual for some people who face none of these things to feel let down after a manic holiday schedule, according to area mental health professionals. Being conscious of trouble areas and addressing them can be the difference between the feeling passing as a mild funk or developing into a more serious problem.

Like it or not, one of the first places to pay attention to is your credit card statement.

"There is a strong force pulling them to have a nice Christmas that requires spending," said Brian M. Prew a financial planner and attorney with a Binghamton firm that bears his name. "It's an incentive to go into debt."

About one out of every six people in Broome County lives at or below the poverty level, according to Census figures, and they are naturally more likely to suffer pressures related to wanton holiday spending. But even people with seemingly healthy incomes can still feel the stress of trying to make ends meet, Prew said.

"Either they want to go shopping and feel bad because they can't," he said, "or they will go ahead anyway and go deeper into debt."

If you dread family gatherings and the prospects of over-commitment, the advice from professionals is pretty straightforward. Listen to that voice inside your head urging you to avoid situations that prompt bad feelings, and let go of conflicts rooted in the past.

"I'm a firm believer that most people know there are limits in terms of what you should and should not do," said Joseph McCann, a clinical psychologist with United Health Services.

Holler offers this suggestion: Volunteer at a nursing home or agency that provides help for people.

"You'll probably feel better, because you are steering your emotions away from your own problems and making a positive difference. ... That's what we are here for, to help our fellow man."

Unless a person has an underlying illness, typically the holiday blues will pass "once the hubbub is over," Cannavino said. But people who feel their mood has darkened beyond reason might want to check with a doctor. As with other illnesses, clinical depression is most easily treated before it develops into a major health Read more!

Parents Defend School’s Use of Shock Therapy -New York Times

By LESLIE KAUFMAN

Nearly a year ago, New York made plans to ban the use of electric shocks as a punishment for bad behavior, a therapy used at a Massachusetts school where New York State had long sent some of its most challenging special education students.

But state officials trying to limit New York’s association with the school, the Judge Rotenberg Educational Center in Canton, southwest of Boston, and its “aversive therapy” practices have found a large obstacle in their paths: parents of students who are given shocks.

“I understand people who don’t know about it think it is cruel,” said Susan Handon of Jamaica, Queens, whose 20-year-old daughter, Crystal, has been at Rotenberg for four years. “But she is not permanently scarred and she has really learned that certain behaviors, like running up and hitting people in the face, are not acceptable.”

Indeed, Rotenberg is full of children who will run up and hit strangers in the face, or worse. Many have severe types of dysfunction, including self-mutilation, head banging, eye gouging and biting, that can result from autism or mental retardation. Parents tend to be referred there by desperate education officials, after other institutions have decided they cannot keep the child.

While at Rotenberg, students must wear backpacks containing a device that allows a staff member to deliver a moderate shock to electrodes attached to the limbs, or in some cases palms, feet or torso, when the students engage in a prohibited behavior. Both the children’s parents and a court must consent to the shocks.

Michael P. Flammia, the lawyer for Rotenberg, defended the practice in an interview.

“People want to believe positive interventions work even in the most extreme cases,” he said. “If they did, that is all we would use. Many of these kids come in on massive dosages of antipsychotic drugs, so doped up that they are almost comatose. We get them off drugs and give their parents something very important: hope.”

But for state officials, many behavior experts and even some former Rotenberg parents, the shock therapy at the school represents a dangerous, outdated approach to severe behavioral problems, reminiscent of the electric shock helmets used on some autistic patients into the 1980s and now discredited.

They say Rotenberg does not use shock punishments only for dangerous self-mutilation, but rather for a wide variety of actions, including shouting profanities and spitting, which are known to be effectively treated with less extreme punishments. And critics of the school say that unlike the more widely known electroconvulsive therapy, which has been used successfully in cases of severe depression and is being used experimentally on severely autistic people, applying shock as a punishment is not widely supported by the scientific community.

“People don’t use it anymore because they don’t need to. It is not the standard of care. There are alternative procedures that do not involve aversives like electronic shock,” said William Pelham, a behavioral specialist and director of the Center for Children and Families at the State University of New York at Buffalo. “And I am not talking about drugs as an alternative. I am talking about other behavioral treatments.”

Still, the parents say the shocks are making a difference in their children’s lives as nothing else has. In 2006, after New York issued an immediate ban on electric shock for behavior modification, Ms. Handon was among the parents of more than 40 children who sued and won a court injunction to keep treatments going.

In January, the state, which pays for treatment of all New York students at Rotenberg to age 21, enacted a new ban on the treatment for those students, to take effect in 2009; it also set new restrictions on who can begin the therapy in the interim. But the parents amended their suit, and a trial beginning in 2008 will decide the issue.

“The point is that at Rotenberg, they still manage Crystal to control what she needs to do,” Ms. Handon said. “Her behaviors were not acceptable for society. Now I think I can bring her home.”

The Rotenberg Center, which says it is the only school in the nation using electric shock, has been the subject of many critical reports by the news media and state investigators.

Just last week, Massachusetts investigators issued a report saying a child at the school was shocked 77 times in three hours last summer as a result of a prank.

The report, by the Department of Early Education and Care, found that a former student pretending to be a school official demanded the punishment of two students, and that counselors administered shocks without double-checking. One of the children suffered first-degree burns. “Our kids should not be sent there, and we will act immediately,” Gov. Eliot Spitzer of New York said in response to the report.

But unlike many special education schools, Rotenberg, as a matter of policy, never rejects or expels a child, except an adjudicated sex offender. As a result, it continues to get referrals from around the nation.

Currently, nearly 100 of the more than 200 children at Rotenberg are from New York State, down from roughly 140 in 2006. The school says that it also has children from 10 other states, including California and Illinois, and that it has had students as young as 10. At a cost of about $228,000 per child per year, the students receive a range of therapies, including, in the case of more than 40 of the New Yorkers, the use of electric shocks.

Just how painful those shocks are has been an area of particular debate. Technically, the lowest shock given by Rotenberg is roughly twice what pain researchers have said is tolerable for most humans, said James Eason, a professor of biomedical engineering at Washington and Lee University. The highest shock given by Rotenberg is three times the lowest amount.

The lawyer for Rotenberg, Mr. Flammia, said the current has to hurt to work. He described the highest shock as “a hard pinch.”

But a former teacher from the school, who asked not to be named because he signed a confidentiality agreement as a condition of employment and fears he could be sued for speaking to a reporter, said he had seen children scream and writhe on the floor from the shock.

Mr. Flammia called the accusation false. If a teacher saw such things, he should have reported it, the lawyer said. No teacher ever has made that sort of report, he added.

Ms. Handon said she does not care what the critics say, not even those perturbed by the report of the prank shocking. She said her fierce loyalty to her daughter’s school was not hard to understand. Crystal developed slowly as a baby. She was eventually found to be mentally retarded and placed in special education. But by the time she was 13, the local schools could no longer hold her and Ms. Handon, a divorced mother of five, was having troubles as well.

She described her daughter as “the sweetest person,” a child obsessed with Michael Jackson who loves to dance to “Billie Jean.” But Crystal’s condition led to peculiar antisocial behavior, her mother said. Even after her adolescence, she would strip off her clothes and park herself naked in the living room. She would bite herself on her arms and legs until she bled, and then would peel off the scabs until she left deep black scars.

Then there were her rages. Denied something, she would throw furniture and shatter windows. Once, she ripped the door frames out of the plaster walls of her family’s apartment. “I was always afraid the landlord was going to evict us,” Ms. Handon remembered — not an inconsequential fear for a woman like her who had once been homeless.

As a young teenager, Crystal was moved to residential placements, but even those special education schools could barely handle her. They would use restraints and psychotropic drugs. Crystal grew to 180 pounds and was “so doped up,” her mother said, “that she could barely walk straight.”

When she was 16, education officials recommended Rotenberg. At first Ms. Handon wouldn’t consider a place that used shock as therapy, but over time she began to see advantages. Rotenberg would take her child off the medicines. They would punish her only for behavior in her control, like spitting, not for bedwetting. And while the shock hurt, Ms. Handon said she believed it caused no permanent damage or health risk

In their lawsuit, the parents contend that none of the other options have been satisfactory and that other schools have simply drugged their children to remove the bad behavior, without teaching them how to behave differently. The state’s perspective, however, is that Rotenberg uses shocks too capriciously, that shocks are used to curb trivial behaviors, like cursing, and that positive reinforcement would often provide similar results.

“The use of electronic skin shock conditioning devices as used at J.R.C. raises health and safety concerns,” state evaluators wrote in 2006 after a surprise inspection. They also “compromised” the “privacy and dignity” of the students, the evaluators wrote.

Ms. Handon, however, does not share these qualms. She said she likes the fact that the school will let her visit any time, unannounced. From her computer, she can monitor Crystal’s progress. One green bar chart keeps track of the number of times her daughter has engaged in prohibited behavior; another, the number of times she was given a shock. In the past month, it appears that her daughter has been given shocks only four times, down from the 200 a month she received at first.

To Ms. Handon, this is a sign that her daughter is learning to control herself. When Crystal is too old for special education, her mother plans to keep her at home for good. In the meantime, however, she says her daughter is having too much fun.

“She loves that place,” Ms. Handon said. “If she knows she is returning from vacation on a Monday, on Saturday she will pack her bags and start begging to go.” Read more!

Sons' mental illness was her call to action -Milwaukee Journal-Sentinel

By MEG KISSINGER
mkissinger@journalsentinel.com

You can't shock Florence Mahoney.

She knows what it's like to lie in bed and wonder what garbage bin her son might be picking that night.

She's seen how mental illness can rip families apart.For the past 25 years, Mahoney, who is now retiring, has run the Hope Support Group, which met on the first Saturday of every month at St. Eugene Catholic Church in Fox Point. The group has disbanded because of Mahoney's retirement.

Long before TV talk show hosts Oprah and Dr. Phil made it socially acceptable to openly discuss such things, Mahoney made it her mission to comfort people whose family members had debilitating mental illness.

For the past 25 years, they have come from all over the Milwaukee area - young and old, rich and poor - with one common purpose, to sip coffee and to spill their guts. Mahoney always made sure to pack a box of tissues with the thermos of coffee.

Someone they loved suffered from mental illness and they were scared, confused, embarrassed, baffled, frustrated, exhausted, angry, guilty and worried sick themselves.

"You listen," she said. "You accept their grief and pain and you let them have it."

It was not easy.

"Look," said Mahoney at one meeting several months ago, shaking her finger at a man and his wife whose son was threatening to take their car. "What are you doing to keep safe?"
Learning to deal

Mahoney is 78 years old and no taller than 5 feet 2 inches. With her thick Brooklyn accent and steely blue eyes, she commands respect.

She learned how to deal with mental illness the hard way - two of her six children suffered from debilitating illnesses. Her son Peter, who died in 2000, had schizophrenia. Another son, Jim, has a mental illness and is an alcoholic, often spending months on the streets, or in jail.

"He's survived beatings, seizures, filth, incarceration and frostbite," said Mahoney. "Being homeless robs you of your dignity."

When Peter first got sick in 1979, Mahoney had nowhere to turn for advice. There were no support groups on her side of town. So she started her own with a grant from the organization then known as Alliance for the Mentally Ill.

Her mission was simple and her message was clear: You are not to blame for your loved one's disease.

"It's amazing how many people don't know that," she said.

Mahoney started each meeting the same way. Everyone sitting around the table took turns reading one of the 10 principles of support. Then, each person had a chance to report how their loved one with mental illness was doing and to raise any concerns. This was a good chance to share information. Mahoney did a lot of networking, sending people to one agency or another. Often, it was enough to just listen.

"There is a lot of guilt," said Mahoney.

She remembers the months just after Peter died of an accidental overdose.

"I was depressed," she said, looking out at the waves of Lake Michigan across the street from her house. "It was very hard."

Mahoney keeps the card that they passed out to mourners at his funeral.

"This says it all," she said, pointing to the words from the Book of Timothy:

"I have fought the good fight. I have finished the race. I have kept the faith."

Now, as Jim goes from jail to homelessness to group homes and back, Mahoney does what she can to stay connected to him.

But there are boundaries.

"You move on, but not away," she said.

It's a delicate balance.

"If he is going to visit, he has to be clean, sober, appropriate," she paused to draw breath so she could emphasize this last point. "And he cannot smoke inside."

Care for people with mental illness has come a long way in the 25 years Mahoney has run her support group, she said. But it still has a long way to go.

"A long, long way," she said.

There is still too much stigma to mental illness, she said. And Milwaukee lacks enough decent housing. It's too difficult to get disability payments, and doctors need to be more accessible to caregivers. There are complexities in getting a person who is mentally ill committed for care. Mahoney has a long list.

But she is tired. Someone else will have to fight those battles now.

For 25 years, Mahoney has taught others that you have to let go when you need to.

"It's time," she said.

If you would like to find a support group in Milwaukee, call the Alliance for the Mentally Ill of Greater Milwaukee at (414)344-0447 or go to www.nami.org. Read more!

Thanks to all who have loved Daniel -Chicago Tribune

By Kristen M. Scott

Deerfield - My son sat calmly at the Thanksgiving table this year, and I am grateful for that. His behavior has been volatile and erratic for months now, leaving me tense and anxious. Watching him wait patiently to begin eating, I thought of the people who have touched his life and mine for the last 15 years, the teachers and therapists, friends and strangers who have helped him, and guided me through the maze that is autism.

I wish I could thank them all again, and tell them how much their commitment and devotion to Daniel has meant to me, as I've struggled to parent this exceptional child I so often do not understand.

I'd thank his first bus driver, who gently took Daniel's hand when he was just 3 years old, going off alone to a special classroom, two towns away.

I'd thank again the teachers and aides who developed innovative strategies to engage him, finding his strengths and rejoicing in his victories, however brief or small.

The therapists who encouraged me to seek Daniel's best, to believe in his intelligence even when standardized testing indicated mental retardation.

The staff of Northern Suburban Special Education District, whose dedication to Daniel always made me feel that he is their one and only student.

I'd thank the strangers at the grocery store who understood when their cheerful greetings to this beautiful boy went unheeded, who did not stare while I pushed him through the aisles in a shopping cart when he was 14 years old or subdued a random tantrum in the parking lot.

I would thank the students at Deerfield High School, who accepted Daniel as a peer, with all his idiosyncrasies, and my daughter's friends, who have supported her through the challenges she has faced with her special sibling.

I'd thank the woman who comforted me recently as paramedics struggled to restrain my son after an aggressive outburst in a crowded restaurant, who held me while I cried and murmured repeatedly, "It will be all right."

And I'd say thanks again to Kimberlee Goldsmith, Daniel's teacher for the last two years, who has remained committed to his learning, despite his increasingly alarming behavior, despite his growth now into a young man too large and strong for either of us to manage. She has never given up on him, has constantly sought the bright and loving boy she knows Daniel to be, even as his moods would swing wildly, as his aggression focused on her, as he injured her as she tried to help him.

Daniel will not be at our Christmas table this year. He moved to a residential school in Wisconsin for developmentally disabled children and teens. I don't know how I will endure this, how I will let go of this child I love so deeply. But I believe this is his best shot at learning to manage his life as the young man he has become and achieving his highest potential.

I've been told he is doing as well as he is due, in large part due to the support and commitment of those who love and work with him.

So I thank them all again, those who have touched my son's life, and my own, who have supported us both through this unfamiliar journey. Thank you to them for loving Daniel, for encouraging me all these years, for telling me again that even a decision as heartbreaking as the one we are making now is the right one.

Read more!

Troubled past, fear clash in court -Spokane (WA) Spokesman Review

By Thomas Clouse
Staff writer

A judge sentenced a longtime criminal to five years in prison Monday in a case involving a mentally-ill man who decried the lack of community support and a police officer whose family made her question her profession after the suspect assaulted her during the arrest earlier this year.

David J. Brault, 41, said he was fine when he lived with his mother. But he also said he has lived on the streets of Spokane along with an estimated 1,500 other people, based on a recent count by the Spokane Homeless Coalition.

“My problems now are with mental health. I have been trying to get treated without much luck,” Brault told Superior Court Judge Maryann Moreno. “There is just no resources, no help, no money. I’m just a different person when I’m on my meds.”

But that explanation came as little comfort to Spokane Police Officer Davida Zinkgraf, who was on patrol June 3 near the intersection of Wellesley Avenue and Market Street when she spotted Brault.

Brault, who weighs an estimated 280 pounds, fit the description of a felony theft suspect. When Zinkgraf – 5-foot-1 and 140 – approached Brault, he fled.

“When (Officer) Zinkgraf caught up with Brault, he punched the officer two times in the head with a closed fist, knocking her to the ground,” according to court records. “While on the ground, Brault continued to assault the officer. Due to the nature of the assault, (Officer) Zinkgraf feared the defendant would kill her.”

The 12-year veteran called for backup and three residents came to her aid. With the extra help and a shot from her Taser, the group was able to detain Brault, whose extensive criminal career began in 1985.

“I do understand mental health issues,” Zinkgraf said in court. “But it is my belief that his mental health state had nothing to with that day.”

Later in the hearing, Brault acknowledged to previously making this statement in jail: “What do I have to do, hit one of you guys to let you know I need help?”

In addition to the fear of the incident, Zinkgraf said her pain went beyond the assault.

“I want him to realize his actions that day not only affected me but my family,” she said.

The veteran officer faced a family who wanted her to quit her career, and she briefly considered it, she said.

“But I’m not going to give that to him,” she said, referring to Brault.

Defense attorney Matt Campbell, who represented Brault, said his client has been diagnosed with bipolar disorder and other mental problems that have contributed to a criminal history that Judge Moreno described as “horrendous.”

Brault’s criminal history includes convictions for a dozen theft cases, six assaults and one second-degree robbery, according to court testimony.

“I was not on my … mental health medication,” Brault told the judge. “I’m very remorseful for what I did. I just hope you take that into consideration.”

Moreno followed deputy Spokane County Prosecutor Patrick Johnson’s request for the 60-month sentence, which was the maximum for third-degree assault.

“As we sit in the courtroom, we often forget that officers put their lives on the line,” Moreno said. “This particular officer didn’t deserve it.”

Reporter Thomas Clouse can be reached at (509) 459-5495, or by e-mail at tomc@spokesman.com. Read more!

Dix Patient: Move to Butner Will Be 'Major Disaster' - WRAL Radio Raleigh (NC)

Raleigh — Some patients from Dorthea Dix Hospital say that plans to move them to a new state mental facility in Butner are going too quickly.

Construction on the $120-million Central Regional Hospital will be complete by mid January. Officials plan to close Dix in Raleigh and John Umstead Hospital in Butner and move their patients to Central by the end of February.

Sammie Young, 38, said he was nominated as a spokesman by fellow Dix patients who have serious concerns about the upcoming move.

"It's going to be a disaster, a major disaster of mental health in North Carolina," Young said.

Young has lived at Dix for five years, not for mental health reasons like most patients, but due to his physical needs. He was shot 10 years ago, leaving him paralyzed below the neck and needing a ventilator to breath.

"It's a nice place to be," Young said and praised Dix's "nice people."

Young said patients are concerned about abuse accusations and threats to accredidation that other state mental hospitals are facing. Patients worry about the staff training and safety hazards at the new facility.

"Despite these challenges that we're facing, in general, our hospitals provide outstanding care," said Dr. Jim Osberg, who oversees state-run mental health services for the Department of Health and Human Services.

Osberg cited the services that the state will be able to offer mental health patients once Central Regional Hospital opens.

"The reason we think it's so important and of great value to patients to get into the new hospital is it is such a wonderful facility," he said. "It does have such good amenities that we can't meet today in existing hospitals."

Larger, new facilities are not the long-term answer for mental health patients, John Tote, with the Mental Health Associaition of North Carolina, said. Tote said he believes more attention should be focused on community-based care.

"We've really got to take a look at that not only in dollars and cents but in the human cost, as well," he said.

Young said all the patients want is for the state to slow down and not rush this transition.

"Butner, I don't think is ready to open," Young said. Read more!

Father speaks of incarcerated son -Conway (AR) Log Cabin

By DANIEL DOYLE
LOG CABIN STAFF WRITER

Editor's note: The following is the first in a series on local families affected by controlled substance dependence.

When Adam Bradley Dyer pleaded guilty to firing a shotgun from a vehicle in 2006, he told his attorney, family and friends that he didn't remember what happened on Hardy Street in October 2005 to precipitate his arrest.

Witnesses to the incident didn't show clear memories of the night either, when they testified in a case that landed Dyer a 20-year-sentence at the Arkansas Department of Correction's Diagnostic Unit west of Pine Bluff.

In hindsight, Dyer, then 18, shot two persons over drugs, according to an interview last week with his father, Jim Dyer, who is trying to use his son's story of mental illness and chemical dependence to inform families that face similar difficulties.

Jim Dyer isn't proud of his son's violent act, nor is he confident in the area's system for administering mental health care to families without insurance. Jim, now an engineering staff manager at BEI Precision Systems & Space in Maumelle, was unemployed when Adam was diagnosed for bipolar disorder in high school, and had no insurance. As a result, he had nowhere to place Adam for psychological evaluation after the 16-year-old began self-medicating with prescription pain killers and other controlled substances.

"He developed anxiety, and in today's culture if a kid says they have anxiety, the predominant thought is, 'He just wants drugs to sell them,'" Jim said. "And if you're in with the wrong crowd, they convince you of that, and then they convince you to self-medicate. Over a period of time the anxiety was very bad, and he was diagnosed with bipolar disorder (manic depression), which I really believe was exacerbated by the drug use and it all built on itself.

"Talking to some of his teachers that I went to high school with, I understand it's not uncommon for people to self-medicate for bipolar disorder, and one lady that I went to school with said she learned that the hard way."

What could have kept Adam from drugs and violence besides his own will? According to his father, access to an honest evaluation of the teen's mental illness may have helped.

"Adam pleaded because one of the problems that he had in court was that in times of anxiety he would blank out, become loud or violent and not remember it later. We know this because it happened with us at home," Jim said.

"At home, if we were in an argument and he would storm out and walk into his room, five minutes later he would walk out and not even remember that the argument happened. I'd still be angry, and he'd say, 'What's wrong?'

"I thought it was an act for a while, and you know, hindsight being what it is, we realize it wasn't (an act). He would black out during high stress or high anxiety. He will remember things at some points sometimes, and sometimes never. What happened here (in Adam's criminal case) was he didn't remember anything happening until the police called wanting to talk to him.

"He did not remember firing a gun. He remembered things up to a point, and nothing after, which is in fact normal for him."

With memory of the gun incident totally escaping Adam, attorney Frank Shaw had little defense against the attempted capital murder charges pending against the 18-year-old. When Jim asked the doctor who diagnosed Adam as bipolar, and prescribed him pharmaceuticals for the illness, for a letter to the court proving the diagnosis, the therapist refused and changed the diagnosis to avoid involvement in the case. Such refusals are common for professional therapists, who often prescribe pharmaceuticals for patients under an "I will never go to court for you" caveat, according to Adam's father, who had been shut out by rehab institutions long before Adam's attempted murder case.

In hopes of placing Adam under at least a 30-day evaluation for bipolar disorder and anxiety issues, toward the end of Adam's high school career Jim and wife Kelly Dyer sought out treatment facilities and heard good reviews on The Bridgeway in Maumelle. Because the Dyers had no insurance at the time, they were told they needed a Family In Need of Services (FINS) petition from the court system to treat him. While filing for the FINS petition at court, Bridgeway workers found drugs in Adam's system and decided they didn't want to treat him.

"We had no insurance, and (Bridgeway) indicated that the FINS would not get them paid for drug rehab," Jim said. "Even with our discussions concerning his behavior, they wouldn't even see him for diagnosis." During Adam's 7-day stay at Bridgeway, according to Jim a doctor spent five minutes with the teen and later wrote that Adam was depressed.

A Bridgeway case worker spent 15 minutes with Adam and sent him home with instructions to watch five drug-related movies and "concentrate on the end consequences, not the other parts," according to the Dyers. Adam was discharged before his parents could ever go to court for a FINS hearing. During the seven days at Bridgeway, Adam was dropped from Conway Public Schools during his senior year, though he briefly attended the University of Central Arkansas' concurrent program with CPS and earned a GED before he was incarcerated.

It was during Adam's short stint in college that he started running into trouble with the law and ended up firing a shotgun at some persons he owed money for drugs, in an incident that the Dyers believe constituted one of Adam's anxiety black-outs. Adam has told his father from prison that he can now remember the victims in the shooting threatening him and his family before reaching for the shotgun in his backseat.

Two years later, the Dyers are frustrated with what they see as an outdated and morally righteous social health care system that alienates youths who are in any way connected to controlled substances.

The family is involved in a support campaign for the building of a extended-care treatment facility in conjunction with UCA and the local courts, for teens and adults regardless of the disorder or chemical dependency. Jim Dyer hopes that under the proposed program, psychological disorders and chemical dependencies wouldn't be treated as mutually exclusive ailments.

"What we were looking for when we took Adam to Bridgeway was an in-house evaluation. We wanted them to watch him for 30 days, 60 days. A manic depressive has large mood cycles," Dyer said.

"They can go even keel for 60, 90 days and then go into a depressive or manic state. It can be a very quick up and down. It can be a day or two, it can be two months. But you need to watch them everyday in normal situations, not sitting in a chair watching TV. They need responsibility. They need to still be able to do their school work. They need stress to trigger the symptoms. We need more than a 5-minute evaluation. We need a long-term monitoring facility, and there's not one in the state of Arkansas."

Jim thinks that if he would've had insurance when he took his son to Bridgeway, "all they would've done is drug rehab."

"That doesn't help the problem if someone has mental issues," Dyer said. "We shy away from those words. We shy away from 'mental issues.' But they're chemical imbalances in the brain. We need to learn what causes them. I know there are more and more studies showing that certain people have addictive personalities, ... and Adam is probably a good example. He will need to be addicted to something.

"He made 32 on the ACT and learned to play piano, bass guitar, dulcimer, anything you put in front of him. If you can funnel that addiction in a good, positive direction, then you win. And it takes teaching these people, particularly as young as we can catch them."

Adam Dyer is reportedly experiencing less stress in the controlled environment of prison and is up for release in April 2011, when he will be 24.

His parents say he intends to go to college when he is freed, and is considering using his first-hand experience with substance abuse to enroll as an addiction studies major at UCA.

(Staff writer Daniel Doyle can be reached by e-mail at daniel.doyle@thecabin.net or by phone at 505-1253) Read more!

Homelessness haunts vets -Annapolis (MD) Capital Gazette

By EARL KELLY, Staff Writer
December 24, 2007

At least 3,000 homeless veterans live in the Baltimore metropolitan area, which includes Anne Arundel County, according to social worker Patricia Lane, coordinator of homeless veterans programs at the Veterans Administration Hospital in Baltimore.
Ms. Lane said her program gets about 20 new clients each month, most of them vets from the Vietnam Era.

"Right now, Iraq and Afghanistan vets are so young, they have not exhausted their (private) resources," Ms. Lane said.

Ms. Lane said that veterans' homelessness is sometimes caused by delayed combat stress, but more often it afflicts veterans who suffered from depression and substance abuse even before they entered the military.

The military, especially during the Vietnam War era, did little to detect and treat mental health and substance abuse problems, Ms. Lane said, and society was not welcoming for those who had served in uniform.

Ms. Lane said her office helps vets deal with medical and housing problems, and whatever substance addictions they might have.

Any veteran who served for any length of time before late 1980 and was honorably discharged qualifies, Ms. Lane said, as does any vet with an honorable discharge who served two years of active duty after 1980.

Homelessness generally afflicts older veterans more than the young, said Mario Berninzoni, executive director of Arundel House of Hope, which coordinates with churches to run the Winter Relief Program for the homeless.

"It takes time to spiral down to homelessness," Mr. Berninzoni said. "It takes years and years to get to this point."

"We are going to see more of this issue," Mr. Berninzoni said. "This problem is just beginning, with all the veterans coming back from the Iraq and Afghanistan wars."

Homelessness, in general, is becoming such a problem that the Winter Relief Program has extended its operations by three weeks this winter, Mr. Berninzoni said, and will keep its doors open from Oct. 29, 2007, until April 13, 2009.

More than 40 local churches participate in the annual program, and starting a year ago, two churches now typically run shelters at a given time. The churches rotate every week, with residents moving from one church to another.

Another option for the homeless is The Light House Shelter on West Street in Annapolis.

Becky Miller, spokesman for the shelter, said Light House provided housing and employment counseling for 145 people in 2006, the last year for which the numbers were available.

Of the total, 30, or roughly 21 percent, were veterans.

Nationwide, veterans account for 23 percent of all homeless people, according to the National Coalition for Homeless Veterans. Forty-seven percent of homeless veterans served during the Vietnam Era, and 67 percent served in uniform for at least three years. Of all homeless vets, about one-third served in a combat zone.

The National Coalition and the U.S. Veterans Administration estimate that 200,000 veterans nationwide are homeless at any given time, and about 400,000 have no place to live during a calendar year.

About half of homeless veterans suffer from mental illness, and half have substance abuse problems, according to the VA's data.

Ms. Miller, of The Light House Shelter, said that homelessness is a growing problem, and not just for veterans. (The average worker in Anne Arundel County earns $12.87 an hour, she said, while the fair market rent for a two-bedroom apartment requires a minimum pay of $18.10 per hour.)

There are an estimated 10,000 homeless children in the state, Ms. Miller said, and the average homeless child is 6 years old. Read more!

Police graduation slogan causes stir -Spokane (WA) Spokesman Review

Betsy Z. Russell

BOISE – Idaho's newest police officers are not being trained to inflict post-traumatic stress, the head of officer training for the state says, despite a slogan to that effect that was featured prominently in the program for the latest police academy graduation.

"Don't suffer from PTSD, go out and cause it," urged the slogan, which was printed above the list of 43 graduates of the Idaho Police Officer Standards and Training Academy's latest basic academy.

"That's not something we encourage or condone," said Jeff Black, executive director of the POST Academy. "It shouldn't have been in there – it was inappropriate."

Black said Ada County Sheriff Gary Raney pointed out the slogan to him three minutes before the graduation ceremony was to begin Dec. 14. "We both cringed," he said.

Each POST class is allowed to vote on a slogan, Black said, and the latest class, which included officers bound for 19 police agencies around the state, selected the quote from retired Army Lt. Col. David Grossman. Grossman writes and teaches about mental survival for officers, and his work is particularly popular in military circles.

"Our class president was ex-military," Black said. "It slipped in."

In the future, class slogans won't be printed in graduation programs without first being reviewed by POST officials, Black said.

He noted that the 43 class members also voted on their graduation speaker, and they selected Nampa Deputy Police Chief Leroy Forsman, who gave a well-received speech on community involvement and treating people with dignity and respect. Black said that's the message new officers are getting in their training – not to go cause traumatic stress.

"One of the things we really strive to do is community relations," he said.

Black said he heard no complaints after the ceremony and even received several complimentary e-mails from new officers' parents thanking POST for holding the ceremony. But a photo of the portion of the program bearing the slogan was e-mailed anonymously to news media outlets throughout the state.

Last week, the photo generated lively discussion on The Spokesman-Review's Huckleberries Online blog, where comments were divided between those highly critical and those who thought the photo must have been a hoax. Black, who was back in his office Monday after traveling last week, confirmed the slogan really appeared. "We were mortified that it was in there," he said. Read more!

Dix park proposal has some unlikely allies - Raleigh (NC) News & Observer

By Jack Hagel, Staff Writer
December 24, 2007

Those who hope the Dorothea Dix Hospital campus will be preserved as a public park have a seemingly unexpected ally: the very developers who, if allowed, would line up to build on the 306 acres overlooking downtown Raleigh.

The Triangle chapter of the National Association of Industrial and Office Properties, a trade group representing the commercial real estate industry, is supporting the position that a major park at Dix would be a priceless amenity to the region. It says a park would attract locals and tourists and create new opportunity on the park's periphery without diluting Raleigh's emerging city center.

"You can't develop every last square inch if you want a lasting community," says Jeff Sheehan, a Duke Realty executive and president-elect of the NAIOP chapter.

The 156-year-old mental hospital has been the subject of fervent debate since 2002, when the state said it would close the facility after moving operations to a new hospital in Butner.

The state has mulled building offices on some of the land in which case it would have to hire -- you guessed it -- builders.

So on the surface, NAIOP's stance may seem bold: Its members build stuff. That's how they feed their families. And a piece of land as big as Dix's, not to mention its location smack between N.C. State University and downtown, has surely made mouths water at the possibilities.

But at the core, it's quite a safe position for NAIOP. It gives the group fodder to tame anticonservationist stereotypes that tend to dog developers.

And there's the political capital. Mayor Charles Meeker wants Dix to be a public park. He has new allies on the City Council -- the body with final say on development plans across the city.

But this appears to be less about posturing and more about a genuine prayer for a park, says Gregory Poole Jr., who formed a group, Dix Visionaries, to advocate for the preservation of Dix as a passive park.

"Their opportunities come on the eve and post-designating this land a park," he says. "Great parks are a magnet for the development on the periphery."

Property bordering the Dix campus would be coveted for buildings that would fence the oasis of open space, leaving plenty for developers to do.

"It's the best piece of dirt in this area by far," says Dave Lindner, president of the NAIOP chapter. "But this transcends developer interest and short-term financial gains.

"This is the only time in the evolution of the region that we're going to get this opportunity. We can't squander it."

jack.hagel@newsobserver.com or (919) 829-8917
Read more!

Martin mental court meeting with success -Palm Beach (FL) Post

By DAPHNE DURET
Palm Beach Post Staff Writer
Monday, December 24, 2007

STUART — One man had a continuous habit of flashing neighbors as they walked by his Stuart home.

Another, a homeless man, kept lingering around a Walgreens after managers asked him repeatedly to leave.

And a woman who said she was thirsty stole a bottle of water and a dollar bill from a tip jar at a Hobe Sound pizzeria.

A few months ago, all three were on their way through the Martin County court system, criminal defendants with prior histories of mental illness being charged and at times housed with mainstream defendants in a jail not equipped to care for their illnesses.

But now all three are a part of Martin County's new mental health court, an extension of a similar program in St. Lucie County providing an alternative plan for criminal defendants geared more toward counseling and medication than jail and probation.

"It gives an alternative for those people who don't belong in jail," said Judge Steve Levin, who presides over the court in Martin County. "It helps them get the help they need, and it provides relief for the jails."

The Martin County Mental Health Court, which had its first session Oct. 31, started out with five defendants. Since then, the docket has grown to about a dozen.

Among them are an Indiantown woman arrested for child abuse in October 2006 after she hit her children with a belt buckle and a 67-year-old Stuart woman found walking naked outside her apartment.

Martin County Health and Human Services Administrator Anita Cocoves said U.S. society dealt with its mentally ill with incarceration in its early history, and though society has turned to hospitalization and other methods to deal with the mentally ill, communities seem to have fallen back on incarceration.

"We seem to have gone back to where we began," she said. "And as a society we need to come up with better solutions."

Levin, Cocoves and other members of the mental health court team are optimistic that the court's approach will provide some of those solutions.

The court is patterned after the county's drug court, which allows first-time substance abuse offenders to have their charges dropped if they complete a rigorous program which includes counseling, court appearances and random drug testing.

With the mental health court, defendants charged mostly with misdemeanors are released from jail and must undergo either inpatient or outpatient mental health treatment.

They also must attend weekly court hearings, take their prescribed medicines, undergo one-on-one counseling and complete other court requirements. If they complete the program, their cases are dropped.

Court officials say it's important to point out that defense attorneys and prosecutors must both agree to send a defendant to the mental health court docket and the victim of the crime, if there is one, also must agree.

Assistant Public Defender Katie Alonzo said working with the court in St. Lucie County helped provide her with experience she hopes will help Martin's court run smoothly.

And the court's coordinator, Diane O'Neal, said court officials in Martin County are just beginning to see positive results with the defendants now on their dockets.

Those defendants have illnesses ranging from schizophrenia to manic depression, and each is progressing differently.

"It's challenging, because they can't be held to the same standards as everyone else, but they all really seem dedicated and focused on getting better," O'Neal said.
Read more!

Panel eyes committing mentally ill -Associated Press

December 24, 2007

RICHMOND (AP) — A state commission on mental-health laws has proposed making it easier to involuntarily force or "commit" a mentally ill person to a treatment facility.

The state's current standards came under scrutiny in April after a mentally disturbed student at Virginia Tech, Seung-hui Cho, killed 32 persons on the Blacksburg campus, then himself.

Under state law, a mentally ill person can be committed only if the person poses an "imminent danger to self or others."

The proposed change would allow a magistrate or special justice to commit a person to treatment if there is "a substantial likelihood" that the person would cause "serious physical harm to himself or herself" in the near future or could "suffer serious harm due to substantial deterioration."

The 30-member Virginia Commission on Mental Health Law Reform proposed the change last week. The panel was appointed in October 2006 by state Supreme Court Chief Justice Leroy Rountree Hassell Sr.

Cho had been ruled a danger to himself during a court commitment hearing in 2005 and was ordered to receive outpatient mental-health care. He never received the treatment.

In addition to the commitment proposal, the Supreme Court commission called for expanded intervention services and other steps. Many of the recommendations mirror a plan that Gov. Tim Kaine, a Democrat, offered this month and are likely to become legislative proposals when the General Assembly convenes in January.

Among the other recommendations the commission called for were:

• increasing the number of crisis-stabilization beds.

• better monitoring of mentally ill people in the community. In the case of Cho, there was confusion over who was to monitor him after he was ordered into treatment in December 2005.

Read more!

Bill aimed at mentally ill inmates awaits action - Binginham (NY) Press & Sun Bulletin

By Cara Matthews
Albany Bureau
12/24/07

ALBANY -- Lawmakers and the governor reached an agreement this year to prohibit solitary confinement of severely mentally ill state-prison inmates, but the year will likely end without its passage.

Mental health advocates have been calling Assembly Speaker Sheldon Silver's office to ask for a vote. Otherwise, they would like it passed early next year.

"We're going to be ever vigilant because in Albany, it's not over 'til it's over," said Harvey Rosenthal, executive director of the New York Association for Psychiatric Rehabilitation Services.

The Assembly, Senate and Gov. Eliot Spitzer developed compromise legislation this summer because the first bill that passed faced an almost certain veto. This year's Senate approval of the bill will still stand in 2008. The Assembly has not ruled out reconvening this year, but it appears unlikely.

If approved, the measure would require the state Department of Correctional Services to set up residential treatment units for inmates with serious psychiatric illnesses. The inmates would be offered at least four hours of therapeutic programming and/or treatment out of their cell a day, five days a week. The original legislation would have banned solitary confinement -- also called the box.

Opponents of the box said isolation in a 6-by-9-foot cell and lack of treatment worsens psychiatric conditions and punishes inmates for behaviors connected with their illnesses. Serious mental illness affects about 12 percent of the prison population in the state, or some 8,000 inmates, according to the bill's sponsors.

The settlement called for giving severely mentally ill inmates in the box at least two hours a day of out-of-cell treatment.

The Mental Health Association of New York State had hoped to see passage of a bill this year. "Every indication we have is that they remain fully supportive, and when they come back early next year, hopefully we'll see a ... bill," said Glenn Liebman, head of the group.

The Assembly fully expects the bill to be passed and enacted, said Sisa Moyo, a spokeswoman for Silver, D-Manhattan. The governor is expected to sign the legislation.

The governor was considering a veto of the first bill because it would be costly, the prisons would lose some discipline control measures and he believed an April settlement of a lawsuit filed on behalf of mentally ill inmates rendered legislation unnecessary.
Read more!

Asperger's diagnosis changes a boy's life -Waterbury (CT) Republican American

BY BRIGITTE RUTHMAN
December 24, 2007

TORRINGTON — At 17, Taylor Rosado can repair a computer. He is a high honors student and a voracious reader with a much higher than average intelligence.

He is hypersensitive to touch, smell and sound. The feel of a manufacturer's tag in the back of his shirt, or the seam in the bottom of his sock leave him unable to focus on a task. Fire alarms sound piercing. He has to work at understanding whether someone else's tears are prompted by joy or sorrow.

Taylor's behavioral symptoms are caused by a neurological disorder known as Asperger's syndrome, a form of autism.

Once so prone to causing himself harm that his mother locked herself inside his Torrington bedroom to watch over him, he suffered through life as a socially awkward autistic child without an adequate diagnosis. As a student in public schools, he was subjected to teasing and suffered from depression. Withdrawn from the world, he feared social contact.

His life didn't change until he hit rock bottom — a failed attempt three years ago to slit his throat that landed him in Charlotte Hungerford's Hospital's emergency room for two weeks.

"He had been misdiagnosed as being bipolar and schizophrenic," his mother said. "I don't know how he survived sixth grade. It becomes an isolated world when your son is banging his head against the wall and doesn't know to stop for a truck when he is crossing the road."

A more careful review of his symptoms resulted in the diagnosis of Asperger's, which is characterized by unusual social interaction and communication skills. As with many sufferers, he has above normal intelligence, but has trouble making friends, and lacks the intuitive ability to gauge social situations. He can seem bizarre and brilliant.

His diagnosis marked the beginning of intensive rehabilitation and dramatic changes.

In May of 2004, Rosado enrolled in the Brookside Campus of the Hillcrest Educational Centers in Great Barrington, Mass., a residential facility for youths who can't function in their homes. His tuition was paid by Torrington Public Schools.

As part of his therapy, he took part in the National Youth Project using minibikes, a program sponsored by the Honda Corp. which offers children the opportunity to ride minibikes if they maintain academic and counseling standards.

He graduated from the school in June and is taking specialized high school classes at the Institute of Living's Grace Webb School in Bloomfield. His tuition is also being paid by the Torrington school system.He also attends an after-school program at the Focus Alternative Learning Center in Canton under a program paid through health insurance. He serves as a mentor for younger participants at both locations.

As it is for many youths, the minibike was the ticket, his mother Stacey Ahlman said. It wasn't until he had completed lengthy safety lessons that Taylor was able to ride, and then became a leader for others.

Founded in 1969 as an innovative means of motivating autistic children between the ages of 10 and 17, NYPUM is a behavior modification program which aims to instill self esteem, values, and a sense of responsibility.

Founded in 1969 as an innovative means of motivating autistic children between the ages of 10 and 17, NYPUM is a behavior modification program which aims to instill self esteem, values, and a sense of responsibility.

Operated on a local level by 47 programs in urban, suburban and rural communities across the country, the programs are run by nonprofit or municipal youth agencies and have supported 250,000 children in its 38-year history. Honda has contributed $40 million to NYPUM.

In Great Barrington, Rosado participated in supervised rides three times a week on private property after successfully completing 21 classes in three months. He also completed extensive safety training on how to ride the bike.

"We were given diagnoses that didn't fit," Taylor's mother, Stacey Ahlman said of her son's early struggles. "His behavior was characterized by excessive head banging, dangerous and fearless attempts at all things unsafe, and a delay in speech and social development and an ongoing struggle with self-esteem. He never asked for toys. But he isolated himself with books on topics that piqued his interest."

In October, the boy who once avoided making eye contact with anyone addressed a crowd of more than 100 who gathered at the annual NYPUM convention in Los Angeles.

"He was the kid who wouldn't participate in a basketball game in school and now he is proud enough of himself to help others learn to ride," he mother said.

Taylor has learned to communicate. He spends some of his free time working at an animal shelter, and expects to get his high school diploma from Torrington High School in June. Some day, he will live independently of his mother.

"I'm going to get a job," he said. "I don't want my mom to have to do all the work."

"Maybe I will be a chef," he said. "Or join the Navy." Read more!

At Stonewall Jackson Elementary, being different is embraced - Dallas Morning News

Monday, December 24, 2007
Second of three parts
JIM MAHONEY

For the woebegone Dallas school district, bad news seems to hit the headlines with clockwork predictability. Small wonder that a lot of parents don't want their kids in a DISD school.

But Jessie Kierbow's parents wish she never had to leave. Stonewall Jackson Elementary School is one of the district's profound successes, a place where all that sometimes-hollow happy talk about tolerance and achievement has real and palpable meaning.

It's common for children who, like Jessie, have Asperger's syndrome, to loathe school: Their characteristic quirks and social deficiencies make them ready-made targets for bullies. According to some studies, as many as 90 percent of Asperger's kids have reported being tormented at school, sometimes on a daily basis.

There's a social alchemy at Stonewall that somehow escapes that kind of routine cruelty. Perhaps it's because, for years, the school has housed deaf-education and other special-ed programs alongside the mainstream student population. Maybe it's because the close-knit neighborhood just east of Mockingbird Station attracts supportive, involved parents. A lot of parents, in turn, credit the school's warm and gifted staff.

Jessie likes the school she has attended since kindergarten just fine, although, she told me with brisk matter-of-factness while giving me a tour of the building, "Once you're in the fifth grade, there's no dillydallying!"

Academically, Jessie has nothing to worry about. She has exceptional language ability – at 10, she taught herself Japanese, and she frequently peruses the dictionary to pass the time.

But social adjustment for Asperger's kids is typically tough, said Freida Apodaca, who was Jessie's fourth-grade special-education teacher.

"Intellectually, she understands that we're in school to learn, and the teachers are here to help us," Ms. Apodaca said. "In an emotional sense, she knows she reacts to things differently. She started out with a lot of barriers, like not knowing how to make friends."

Ms. Apodaca likened Jessie's initial encounter with school to the experience I might have of parachuting into a foreign country whose language and customs I don't share: "You wouldn't know what's expected."

Teachers at Stonewall have tutored Jessie not just in academics but in relating to the people around her. It's pleasant work, Ms. Apodaca said. "Jessie's a great kid. She's fun. She's got a great sense of humor."

Jessie was all business the day I visited her language-arts class at Stonewall last month. The kids were starting a new book, Island of the Blue Dolphins, and she read part of the opening chapter aloud, her pitch and intonation perfect.

It's one thing for the grown-ups to like you, of course, and quite another for the kids to accept you on the playground. Jessie is an extraordinarily gifted child, but one of her most shining triumphs came last year when she advanced to the finals of the district spelling championship – and the student body was abuzz with excitement.

"In some schools, it's a stigma if you're a special-ed student," said principal Olivia Henderson. "Here, the children don't know the difference."

It's easy to love the school itself, a vintage art-deco building with a cozy interior reminiscent of an earlier era. The gymnasium, the hardwood polished to a matte sheen by generations of kid-sized tennis shoes, served as a dance studio on the day I visited.

The fifth-graders were studying ballroom dancing for physical education (why didn't they have this when I was a kid?), concentrating hard as they step-hopped, step-step-hopped. Jessie towered over her partner – fifth grade is an age of dramatic and sometimes comic physical disparities – but they worked their way earnestly through the steps.

"Jessie just doesn't see anything negative," language-arts teacher Margaret Sorrells told me later in the morning, while the kids were working in groups on poster illustrations. "She brings out the best in everybody. She's very innocent, and children respond to that."

But the school itself, she said, provides a safe harbor for kids who might not quite fit in elsewhere.

"Maybe it's because all the parents have bought into it, or because this is a real cross-section of Dallas," Ms. Sorrells said. "Everybody rises to the best level. The rules are just expected and everybody knows it – they don't have to be enforced."

She echoed a sentiment I heard from a lot of other Stonewall teachers and parents: "This is something that's right about the DISD."

Inevitably, of course, word has gotten out. Jessie's parents made significant sacrifices to get their daughter into Stonewall as a kindergartner. Her mom lives in one of the neighborhood's few apartment complexes, unable to afford a house in the rapidly gentrifying neighborhood, but unwilling to settle for a more affordable area elsewhere.

Stonewall is closed to incoming transfers from other schools; there's just no more room. Turnover is low, and Ms. Henderson herself, who has been there for 17 years, has declined offers to go elsewhere.

The neighborhood's changing economics are a topic that Ms. Henderson approaches carefully. When another apartment complex was torn down last year to make way for expensive new houses, 30 low-income kids had to transfer to other schools – a loss, in her estimation.

"Our children are exposed to many different kinds of kids at a very young age, and they learn acceptance," she said.

"When the Jessies of the world come along, they understand."

This is Jessie's final year in the school she has attended for so long. Next year, she starts middle school.

"She's such a sweet, sweet kid," Ms. Apodaca said. "She can socialize now and feel confident with it. She keeps her heart and mind open to what people are willing to offer her."

Jessie's family and school have provided her with a sturdy foundation that many Asperger's children – that many children in general – don't get.

She knows that being different can be hard, but that it can be managed. And she knows the people who really count wouldn't change a thing.span> Read more!

Program helps mentally ill regain their independence - Associated Press

Associated Press

CHICAGO -- Sunlight streamed through the windows and the scent of sandalwood incense filled the air the day Aron Washington moved into his apartment

Tall and lithe, Washington tried a few yoga poses in the still-empty living room and spoke about his dream of starting a nonprofit corporation that would "bring right brain people and left brain people together over music and dance."

Six months ago, Washington, an artist with schizophrenia and bipolar disorder, shared a small room with two other men in a noisy, crowded nursing home for the poor, where his days revolved around the institution's schedule of meals and medicines. He got $30 a month in spending money from his disability check.

But since June 20, the 31-year-old Chicago man has proved he can live in his own apartment, with help from a small Illinois pilot program called Direct Connect. The program found him an apartment, helped him shop for furniture and got him out of the nursing home where he landed after a stint of homelessness.

"I want to start saving, start getting together a little nest egg," he said. "I want to live a purpose-driven life."

Others are less fortunate.

In Illinois, more than 9,000 people with serious mental illnesses were living in nursing homes as of June 30, 2006 -- an increase of more than 1,000 from the previous year, according to information provided to The Associated Press by state officials as a result of a state Freedom of Information Act request.

In addition, another 4,654 people with serious mental illnesses were living in a type of nursing home classified as an Institution for Mental Disease.

Many states closed large mental institutions in the 1960s through the 1980s, leaving thousands of mentally ill people homeless. A patchwork system of underfunded community-based services emerged in some states. But others, including Illinois, relied on nursing homes, largely funded by Medicaid, to care for the mentally ill.

Some lawmakers believe programs like Direct Connect could save Illinois $9,000 per person each year and help thousands of mentally ill adults, many younger than 40, who live in nursing homes. But for now, the 2-year-old program is in limbo, awaiting an end to legislative gridlock.

"As soon as final budget issues get resolved, the program should be able to obtain its funding," said Rep. Sara Feigenholtz, D-Chicago, who chairs the House panel on human services spending.

Feigenholtz, an early supporter of Direct Connect, said Illinois should strengthen programs that encourage independence and recovery. Institutions foster dependence in people who otherwise are capable of improving their lives, working and paying bills, she said.

"I'm looking forward to the data on cost-effectiveness" of the Direct Connect program, Feigenholtz said. "It will give us a roadmap of where Illinois should be investing more resources."

Not everyone agrees.

Robert Hedges, board president of the Illinois Health Care Association, a group representing nursing homes, said housing mentally ill people in apartments can be disastrous without adequate oversight to ensure they take their medications and do well. Some will end up back in institutions or on the street.

"If you ask residents with mental illnesses, 'Would you like to live out in a little apartment?' Every one of them is going to say, 'Yes.' That doesn't mean they have the ability to live on their own like that," Hedges said.

Three mentally ill people relocated by Direct Connect have moved back into institutions. They needed more medical attention for problems such as diabetes or their symptoms of mental illness grew worse after moving, said Tony Zipple, CEO of Thresholds, the nonprofit agency that runs Direct Connect.

But Illinois faces a class-action lawsuit that claims many more mentally ill people in nursing homes could live in apartments or group homes if they got help managing their lives.

Filed originally on behalf of Ethel Williams and Jan Wrightsell, two women with mental illnesses who wanted to move from an institution, the lawsuit describes the living conditions at the Chicago facility where the women lived with scant freedom, privacy or treatment.

"Residents wander aimlessly in and out of the common room and smoking room with nothing to do the majority of the day," the lawsuit states.

Benjamin Wolf, an attorney with the ACLU of Illinois, who is helping with the lawsuit, said the agency would "like the opportunity for everybody who wants the opportunity to get out of an institution."

"Illinois historically has significantly underfunded its human services and spent more proportionally on institutions rather than in the community," he said.

The lawsuit cites a 1999 landmark ruling by the U.S. Supreme Court that the Americans with Disabilities Act requires community placement of the mentally disabled whenever appropriate. The court said segregating the mentally ill amounted to "unjustified isolation," while recognizing that states need to maintain a range of facilities for people with mental disabilities.

Teresa Kurtenbach, a spokeswoman for the Illinois Department of Healthcare and Family Services, said she couldn't comment on pending litigation.

But she said in an e-mailed statement that the state has "made significant progress in the process of rebalancing the delivery of long term care services for people with mental illness to promote the use of non-institutional community options" under Gov. Rod Blagojevich.

The day Washington moved out of Somerset Place, a Chicago institution serving mostly poor adults with mental illnesses, some staff members and another resident predicted he wouldn't make it on the outside.

"They said, 'You'll be back,"' Washington said.

"I said, 'I'll be back to visit."'

Direct Connect staff want to make sure he stays on his own.

"We're not going to abandon anybody," said Zipple, adding that, while the program awaits renewed funding, caseworker time is patched together from other programs.

Caseworkers meet with Washington twice a week. Besides keeping tabs on his meds, they help manage his money, discuss vocational plans and check on his physical health. Washington has elected to have Thresholds receive his monthly disability payment, but he decides what bills get paid.

When Washington doesn't take his meds, his mind races and he ends up in jail, detox or in a hospital psychiatric unit, he said.

"It's like coming to from a seizure," he said. "Thoughts. Can't contain them, can't cease them. Just reflect upon them, sometimes I get lost in my head."

Direct Connect has helped 43 people with mental illnesses, including Washington, move into their own apartments and another eight move into groups homes.

The program, which spent $766,000 in its first 21 months, needs an infusion of money from state lawmakers before it can return to finding apartments.

"It's a new day. It's a watershed mark," Washington said of how his apartment changes his expectations for his future. "It's a necessary step I'm takin Read more!

Ex-addict goes from homeless to hopeful -Reno (NV) Gazette-Journal

JACLYN O'MALLEY
JOMALLEY@RGJ.COM
December 24, 2007

Last Christmas, Pennie Hembree was homeless, in a wheelchair, panhandling to support a methamphetamine addiction and dying of untreated internal illnesses related to her chronic substance abuse and malnutrition.

This Christmas, Hembree, 55, is sober and healthy. And for the first time in five years, she has a place to call her own.

She relies on a walker and takes medications for her spinal disease. She said she has regained her life and health by beating her addictions and homelessness.

She said she could not have overcome her street life without the help and encouragement of a Reno police officer, who works with the mentally ill and homeless, and a social worker with a local homeless medical clinic.

"When I wake up, I have one eye open, and I think to myself, 'This must be a really good drunk, or it's really all mine," she said of her new apartment. "It's hard to believe I went from dying a year ago to being here. I'm still in awe."

It's a pleasure for Hembree to invite people to her downtown Reno apartment complex and offer them a cup of coffee she made in her kitchen. She likes having a bed and showering in her own bathroom.

Social Security disability payments provide her rent money while her newfound talent as a jewelry maker could earn her some extra cash.

Hembree said she is grateful to the staff of Manor Care, a Reno nursing home that gave her furniture and furnishings for her new apartment. She lived at the nursing home during the past year while she recovered from her medical conditions and made many friends.

To give back to the community, Hembree has been volunteering at the facility since she left a few weeks ago. The staff said she is a blessing. She also volunteered during last week's free phone calls for the homeless event and plans on doing outreach with police and social workers to convince the homeless it's possible to change their lives.

"It was a really hard life out there," Hembree said as her bright blue eyes widened. "I was a lucky one. I got robbed and beat up a couple of times, but mostly, people had my back."

Hembree was a popular and friendly panhandler who won the hearts of most who walked past her along the Truckee Riverwalk -- including police, attorneys and even judges -- who would throw her a couple dollars and buy her coffee and pastries from a nearby coffee shop. Most of the time, she said, she was drunk or high when she begged for money and used what she panhandled for liquor and drugs.

Hembree usually stuck close to three friends, and she said she would beg for money wherever she would collapse when her body could no longer take walking the streets.

"I kind of knew I was killing myself, but I didn't know how bad I really was," she said.

Homeless intervention

Officer Patrick O'Bryan in late December 2006 was called to a local hospital where staff said he had to remove Hembree because they were done treating her for internal bleeding. She had refused to leave.

Hembree was wheelchair-bound from an untreated spinal disease. In a snowstorm, O'Bryan helped her get into a homeless shelter. But her condition worsened.

The next day, O'Bryan and caseworker Joan Swickard of Health Assistance of Washoe County took her to the hospital where they coordinated her treatment.

"I would be dead that night if they had not have picked me up," she said. "But they had the heart. Most don't. I would be dead if it weren't for those two."

Hembree said she had an epiphany.

If Swickard and O'Bryan cared that much about her life, she should, too. She also wanted to let them know their efforts weren't in vain.

"After I got out of the hospital last year, I stayed clean and worked my butt off for them," she said. "They gave me a great gift and touched me so hard that I told myself I can do it.

"I have no more chances left, and I don't want to let them down."

Three weeks ago, Hembree moved into her own apartment for the first time in years. She had been homeless for two years before she lived in Manor Care. She had been on the brink of homelessness for years, living in low-rent motels with various boyfriends or friends.

O'Bryan and Swickard wrote letters to the power company verifying she had been homeless for the past several years because someone had used Hembree's identity to obtain utilities and never paid for them.

"Before all of that homeless stuff, I was married, managed an apartment building and took care of foster children," Hembree said. "I was a pillar of society. And then, I started drinking too much beer, and my husband left."

Hembree said she then began using meth to make her back pain disappear. Then she turned to vodka to balance out the high she got from her meth use.

Swickard said Hembree is now a role model who will make a huge impact during homeless outreach missions.

"When we go out and people don't trust us, they'll see Pennie and won't recognize her, but they will trust her," she said. "They'll know it really does happen. She is a great success story."

Swickard said many homeless like Hembree think they are not worth saving. Many also do not have support systems, or people who are constantly monitoring them and helping them navigate the social services system.

"It's difficult for these people because they don't think they're worth it," she said. "But they have to know that we don't give up on them. We think they are worth it."

O'Bryan said Hembree still has a tough road ahead, including continued work on her substance abuse issues and making sure she can find new support systems and positive activities in the community to occupy her time.

"She's still in that downtown environment, and we'll have to see how she forges out a new life in the midst of the her old life still around her that can influence her every day," he said. "We didn't extract her from that world. We put her right back in."

Lately, Hembree has been visiting her old panhandling grounds and places she used to sleep and get drunk and high. It makes her sad, she said. But it also makes her realize this second chance is so precious.

"No one can take this away from me, but me," she said. "And I'm not."

Read more!

Firms find ways around statehealth law - Boston Globe

Alice Dembner, Globe Staff
December 23, 2007

To comply with the new state insurance law, a Burger King franchisee in Boston expanded coverage from just his salaried staff to all full-timers. To control his costs, he halved the share he pays. Only three of the 27 newly eligible employees took the insurance; others say they can't afford it.

A large human service provider toughened eligibility for coverage in response to the new law, requiring employees to work 30 hours a week to qualify. That took away the option of work-based coverage for nearly 100 low-wage workers, but made them eligible for cheaper, state-subsidized insurance. It could reduce the company's costs while increasing the state's.

Another employer split his firm into separate corporations, each with fewer than 11 full-time employees, according to his insurance broker. That way he does not have to offer insurance, nor pay a fine.

Businesses from Boston to the Berkshires are responding to the state's landmark health insurance initiative in ways that could help it succeed - or stumble.

Policy makers are watching and waiting, but said they will act if many employers dodge their obligations.

In the first nine months of this year, according to the latest state figures, about 45,000 workers and their families gained insurance because employers picked up part of the tab. That number represents a small but significant chunk of the 293,000 newly insured state residents, a total that puts Massachusetts between half and three-quarters of the way toward its goal of covering nearly every resident.

Yet some employers are taking actions that could shift costs to the state or leave more people uninsured, potentially upsetting the delicate balance of responsibility on which the initiative rests, according to interviews with more than 20 companies, insurance brokers, and trade organizations.

When drafting the universal insurance law, "we purposely did not raise employer taxes" to pay for insurance, said Senator Richard T. Moore, cochairman of the Legislature's Committee on Health Care Financing, who plans oversight hearings within a few months.

"We thought we were treating employers fairly, and I commend the overwhelming number of employers who are doing the right thing," he said. "If some are not going to respond fairly, we'll find ways to structure the law so the loopholes get closed."

Businesses with 11 or more full-time equivalent workers are now required to offer insurance or pay a fine. The law also bars employers from offering higher-wage workers better health benefits than low-wage employees. In addition, workers with access to employer-subsidized insurance are now barred from getting state-supported coverage, and will be excluded from the state's free care program starting in April.

The provisions were designed to ensure that as many workers as possible get coverage through their employers in a state where about 70 percent of the 200,000 businesses offer insurance benefits.

For years, Doug Barlow and his business partner had paid 100 percent of the insurance cost for 11 full-time salaried workers at their three Burger King restaurants in Boston. The new law's antidiscrimination provisions led them to offer insurance to 27 hourly employees. But the potential cost - nearly $1,100 per month for family coverage - pushed them to cut the firm's contribution to 50 percent.

"I was prepared for a lot more people coming into our plan, but it didn't happen," said Barlow. Other employers said they are seeing the same pattern - expanded eligibility that does not lead to many more insured individuals.

"For most working-class people, regardless of whether the company pays part of the premium, it's very expensive," Barlow said. "Some full-time people said they'd done the math and it is cheaper for them to pay the state penalty than pay their half of health insurance."

The law requires individuals to obtain insurance by Dec. 31, if the state deems it affordable, or pay a penalty of $219. Next year, the penalty will rise.

Rebecca Posada works the counter at the busy Burger King in Center Plaza. Although she's been uninsured for the five years she's worked there and would like coverage, she is refusing Barlow's offer.

"I don't make enough" to pay $46 a week in premiums, said Posada, 26, during a morning break. She hopes to continue getting free care at the East Boston Neighborhood Health Center, and may be able to avoid the state penalty because of her low income.

Vinfen, a 2,000-person company that runs programs for mentally ill clients statewide, took a different approach that its officers said is designed to help low-wage workers. New employees now have to work 30 hours a week to qualify for insurance, up from 20.

"It's not a knee-jerk effort to reduce our costs," said Tim De Araujo, vice president of human resources. "By denying them eligibility to our plan, we gave them eligibility to the state plan. We felt this was the right thing to do."

De Araujo said he would like to see the state offer employees a choice of their employer plan or the state plan, whichever is more affordable. Two-thirds of their employees earn less than $24,000 a year, which would qualify them for state-subsidized coverage.

Separately, Vinfen renewed an offer of coverage, with a 70-75 percent subsidy, to 650 existing employees who were eligible but not enrolled. Only 72 signed up.

Some other firms have similarly tightened eligibility to control costs or try to shift employees to state plans, said Christopher DeLorey, a director of Telamon Insurance & Financial Network, and several other brokers.

Policy makers and analysts are concerned that this pattern could boost enrollment in the state-subsidized plan, which is already far above predicted levels. The bulk of the newly insured so far are covered by state-funded programs.

"Both the individual and the employer benefit" from the shift, said Michael Widmer, head of the Massachusetts Taxpayers Foundation, a business-funded financial watchdog. "But we don't have the public dollars to fund this."

Some additional public money is coming from companies required to pay fines of $295 per employee under the law because they don't offer insurance.

Northeast Knitting Mills, a small sweater factory in Fall River, dropped coverage in February because the fourth-generation family owners could no longer afford it, said president Dan Reitzas. He will pay a $13,000 fine, which is about 6 percent of his expenses, he said, but far less than the $50,000 he was paying for insurance. He is helping employees get a tax break on privately purchased insurance.

But other firms are avoiding fines by designating their employees as independent contractors or using other questionable means, employees and brokers said.

Paul Pietro, chairman of the Mid-State Insurance Agency, said he helped one of his clients set up separate corporations for each of its Massachusetts locations. Each then had fewer than 11 employees, so the insurance law did not apply. "It's a loophole," said Pietro, who declined to identify the client. Pietro said his other clients are paying the fine or expanding insurance offerings.

Moore said he had heard of similar cases. "If it's a few employers, we could publish a list of the folks using different schemes to avoid their responsibility and let their customers know," he said.

Healthcare advocate John McDonough has another suggestion: Charge those companies a large fee if many of their employees get state-subsidized insurance.

Alice Dembner can be reached at Dembner@globe.com.
Read more!

Gaps in mental care transition - Omaha World Herald

BY KARYN SPENCER

Zack Kennedy's suicide attempt had a bittersweet benefit.

His mother, Candy Kennedy, said sarcastically, "Thank goodness he lived to get his medication."

Young adults with mental illnesses similar to Robert Hawkins' may fall through cracks in the mental health system because of the disconnected smattering of services, providers and advocates say.

"It's just really frustrating. It's scary," said Candy Kennedy, who lives near Minden, Neb. "Zack gets to the point where he gets so discouraged that he doesn't want to do it anymore."

Hawkins, the 19-year-old Omahan who killed eight people and himself Dec. 5 at the Von Maur department store at Westroads Mall, had been made a ward of the state in his early teens in order to get psychiatric care.

Nebraska spent $265,000 on residential and day treatment for him.

After time, money and effort are put into stabilizing mentally ill children, they may struggle as adults to find assistance to maintain their recovery, relatives and advocates say.

"We've made this investment. If we'll just follow it through . . .," said Denis McCarville, president of the Uta Halee Girls Village and Cooper Village for Boys psychiatric residential treatment programs in Omaha.

An estimated 5 percent of adults have serious mental illnesses.

Advocates say mental illness needs to be considered a lifelong medical condition to be managed, just as diabetes requires monitoring blood sugar and diet.

The mental health system in Nebraska is split into two segments, based on the patient's age. Those younger than 19 have a separate system mainly because of parents' legal rights.

Youths may get psychiatric services ordered through the juvenile court system if they have been abused, neglected or delinquent or if their parents can't afford intensive care. Those state wards automatically get Medicaid to cover treatment.

Other youths get help through their family's insurance or personal expense.

At age 19, youths officially become adults, whether or not they are ready.

"Anybody who has parented knows: 18, 19, 20 — that's no magic age," said Eve Bleyhl, executive director of the Nebraska Family Support Network, a nonprofit organization in Omaha that helps families whose children have mental and behavioral disorders.

Young adults must seek help on their own. Their parents have no legal say about their care.

At that point, agencies that provide services and the criteria to receive help change.

"There are so many rules and regulations," said Ashley Belmudez with the Family Support Network. "There are so many boundaries, cutoffs. There are so many criteria . . .

"All they want is help."

Candy Kennedy was able to get help for her son when he was a teenager with depression. They used the Professional Partners Program through Region 3 Behavioral Health Services based in Kearney, Neb.

The program uses the "wraparound" process, gathering people close to Zack — his mother and grandparents, the local pastor, a teacher and others — to emphasize his strengths and help with his challenges.

Zack received therapy and help finding a job. His mother learned new tools and supports to deal with his behavior.

They had services for 18 months, ending in his junior year.

Kennedy became an advocate and now is the executive director of the Nebraska Federation of Families for Children's Mental Health, a statewide, family-run nonprofit organization based in Hastings.

Even with her knowledge, she didn't know where to go when Zack turned 19 and began struggling again.

"One system stops, and the other system takes over," Kennedy said. "Who knows about it, and how do you get access to those services?"

With few supports, some young adults plug along until they have a major crisis such as a suicide attempt before they are hospitalized or committed, McCarville said.

Zack, who has had bipolar disorder added to his diagnosis, has been hospitalized several times as an adult after suicide attempts.

He has about $100,000 in debt from medical bills, which add to his depression, his mother said.

"He starts getting calls from collection agencies. They want the bills paid," she said. "There's no way he can even — it's so overwhelming."

In 2003, Nebraska legislators cut a provision that let some 19- and 20-year-olds tap Medicaid for their health care. The cutback saved nearly $8 million a year.

Zack now qualifies for prescription coverage because he was indigent and was committed involuntarily — an emergency protective commitment — for being a danger to himself, his mother said.

Bleyhl, with the Family Support Network, put it this way: "You have to fall to the ground to get a safety net, and even with that safety net, you still bounce off the ground."

Those in the age group can be difficult to help. They may be eager to be independent. They might think they don't need help, or might not want it.

Some youths, particularly those leaving the foster care system, might not have family there to help them.

"Quite literally, they're out there on their own," Douglas County Juvenile Court Judge Elizabeth Crnkovich said. "It's very frightening."

The Nebraska Department of Health and Human Services has several programs to help state wards make the transition to living on their own.

Family Support Network employees spoke highly of the transitional living program, where youths get an apartment and have staff teach them job skills, budgeting and other basics in life. The advocates said more services like that are needed.

Several state entities are putting an emphasis on improving transition services.

HHS has anecdotal information, not data, about the problem, said Scot Adams, director of behavioral health.

"I don't know to what extent it's an issue," he said.

Efforts under way include:

• Gov. Dave Heineman named children's behavioral health as a priority for his administration.

• HHS created a separate administrative position to oversee children's behavioral health.

• Nebraska has been using a $750,000 grant to develop programs and strengthen the children's mental health and substance abuse system. One of the steering committee's 11 priorities is transition services.

• The Legislature formed a Children's Behavioral Health Task Force to recommend changes. HHS is developing an implementation plan by Jan. 4.

Kennedy serves on the Children's Behavioral Health Task Force and hopes change is in the works.

Her son now is applying for Social Security benefits for a mental disability. Among the benefits would be medical — an option his mother declined when he turned 19.

"My thought process was 'I want him to go out there and get a job and feel good about himself and get health insurance' and not have that thought process 'I have a disability,'" she said.

Zack's last attempted suicide was about a month ago.

He moved last week to a Catholic Charities residential treatment center in Columbus, where he might stay for up to a year. How he will pay for that is still unclear.

He feels guilty that his mother has had to pay for his medication until now.

He apologized that she had to drive him from the hospital in Kearney to his current placement.

He said he was sorry he isn't allowed to come home for Christmas. Mother and son will get to spend six hours together that day.

She told him it was OK.

"You're going to get to recovery here," she said Read more!

NC mental hospital no longer in danger of losing financing, officials say - Associated Press

RALEIGH -- State officials said that the state mental hospital in Butner is no longer at immediate risk of losing its Medicare and Medicaid financing.

State officials said Friday that federal inspectors recently spent three days at John Umstead Hospital as a follow-up to a visit in March that uncovered serious problems.

They said that the inspectors gave the hospital until March 1 to deal with remaining issues.

The inspectors provided a verbal report only.

State officials said that a written report on the inspection of the hospital is unlikely to be received until after the first of the year Read more!

County clears way for sale of former group homes - Salisbury (NC) Post

By Jessie Burchette

Three county-owned houses that have been used as group homes are now for sale.

The Rowan County Board of Commissioners declared the former Rowan House at 1127 South Main St. as surplus property Monday night.

The action came after Piedmont Behavioral Healthcare asked the county to opt out of a lease on the house. The mental health agency hadn't used the building for two years.

Commissioner Jon Barber, who serves on the Piedmont board, said previous agency discussions had centered on buying the South Main house as well as two others — the Stepping Stone Group Home at 418 South Carolina Ave. and Turning Point at 6205 N.C. 150 East.

After seeing the letter from Piedmont asking to end the lease and cease maintenance of all three buildings, Barber said he had tried to contact Dan Coughlin, executive director. Coughlin had not returned his calls.

Commissioners agreed to end the lease, specifying that Piedmont remove the contents from all three houses. The county also declared the South Main Street house surplus, opening the legal door to allow sale of the property.

The county has previously leased the three properties to Piedmont for $1 per year each.

The South Main tract is listed on the tax books for $91,541.

The county will take over maintenance on the three properties.

In other matters, the board heard information or acted as follows:

* Briefly discussed a proposed form agreement that will be used in the future for all incentive grants.

* Approved a series of budget amendments including acceptance of $20,000 in additional state funds for the Rowan County Health Department to prepare for bioterrorism or pandemic.

* Another amendment reduced by $309,000 the state allocation for day care through the Social Services Department. The reduction came because there was no waiting list for child care.

* Accepted a check from James River Equipment Company for the Soil and Water Advisory Board.
Read more!

Top 10 of 2007: N.C. mental health -Hendersonville (NC) News-Record

Number 8

If the end of 2006 looked bleak for mental health care in the mountains, the new year didn't shape up any better.

Local agencies returned from Easter weekend to learn the N.C. Department of Health and Human Services would soon slash rates for a popular mental health care program.

The news set off a backlash of criticism from elected officials, county leaders and people on the front lines of mental health care.

They feared the added financial strain would make providers fold and discourage new providers from entering this eight-county region still reeling from the October 2006 closure of New Vistas-Mountain Laurel, the region's largest provider.

"What they think they've done is slash the reimbursement rates," Henderson County Manager Steve Wyatt said. "What they may have done was slash the throats of our mental health providers."

The cut would have slashed the rate from $61 to $40 an hour for community support services, which help the mentally ill with basic life skills like preparing for job interviews.

State officials said the new rate was more in line with the actual costs of running the program. Mental health advocates and workers disagreed, and they rallied in Raleigh in opposition to the cut.

Western Highlands, the agency for mental health care in the mountains, called for the resignation of the secretary of the N.C. Department of Health and Human Services, Carmen Hooker Odom. Commissioners in Henderson and Transylvania counties soon echoed the call.

A month after the stir began, Hooker Odom announced her resignation and Raleigh had set the reimbursement rate at $51.28 an hour.

Another threat to mental health services came when Pardee Hospital decided to close an eight-bed medical detox unit. The crisis was averted when Pardee and Western Highlands negotiated an arrangement to keep the unit open in exchange for a $350,000 grant.

--Scott Parrott Read more!

A moral and political imperative - Roanoke (VA) Times

Editorial:

Virginia's leaders are united now on reforming the state's mental health system. They'll need to sustain that interest after the public's attention wanders.

Virginia's mental health care system will get a needed infusion of money and attention in the upcoming General Assembly. The April 16 mass shootings at Virginia Tech have guaranteed that.

When Gov. Tim Kaine unveiled his reform package in Richmond recently, state Republican leaders joined him and his fellow Democrats at the news conference. Such bipartisan solidarity is unusual in Virginia these days. No one even mentioned the state's disappointing revenue picture. No one dared -- not in the aftermath of 32 homicides by a single deranged student who then killed himself.

Now Richmond is eager as never before to make Virginia's gimpy, patchwork mental health system match people's need for services. To succeed, lawmakers' newfound commitment will have to outlast the public trauma.

Kaine's proposal is a good start, but it is just a start.

Assuming the plan the governor lays out in his two-year budget, or something very like it, comes out of the General Assembly next year, ordinary Virginians might assume that all, then, is well. Problem solved.

Lawmakers will know better. But danger lies in any weakening of political will for expensive reforms -- a real possibility as intense public interest fades a little more each year out from gunman Seung-Hui Cho's rampage.

A predictable, bitter irony for the families and other caregivers of Virginia's underserved mentally ill residents is that it took that horrific event to spotlight the system's gaps between institutional and community-based care, creating holes so large that their loved ones can easily fall through.

People with mental illnesses often suffer in silence, sometimes for years or even a lifetime, for fear of the stigma society attaches to mental disorders. Most mentally ill people are not violent. They don't want the public to assume they are dangerous.

Yet large-scale violence by one man has put the state's mental health care system, at last, at the top of the budget-writers' list of priorities.

Fairfax state Sen. Janet Howell commented at the governor's news conference that all branches of state government are in consensus: "Our mental health system is broken." In the aftermath of the Tech shootings, she added, "It's a moral imperative that we act."

The moral imperative has been there for years, blunted by public indifference. Now it is both a moral and political imperative. Beware, lest the issue lose its edge before the state creates an exemplary mental health system. Read more!

Snake-oil treatments for autism exploit desperate families; spotting the frauds - Poncono (ID) Record

Dan Berrett
Pocono Record Writer

In 1882, a product called the electric flesh brush, which had magnetized iron rods in its handle, promised cures for a host of maladies: malaria, paralysis, indigestion and even liver and kidney trouble.

An advertisement at the time boasted a testimonial from the sister of Liza Land Parker, whose chronic rheumatism was cured by the brush after traditional medicine failed.

The story of her recovery — and the product's seemingly limitless applications — may seem unbelievable to modern eyes.

But, in a sense, we remain equally believing today. That is according to a historical analogy developed by Dr. James Coplan, a neuropediatrician in Rosemont who shared his hypothesis with staff and families at Colonial Intermediate Unit 20 during the fall.

Families dealing with autism are especially vulnerable.

Autism, a group of developmental disabilities marked by difficulty with social interactions and communication, affects one in 150 children. The ability of people with autism to think and learn vary widely, as do their behaviors.

"They're looking for people who can offer them hope," Coplan said of the families. "They want to go somewhere where someone can offer the promise of a cure."

The Centers for Disease Control and Prevention says flatly that there is no cure for autism. Intensive and early behavioral, verbal and communication therapies tend to have the most success, doctors say. And in most cases, some degree of improvement tends to occur over time.

But the promise of a wholesale cure can still easily be found on book shelves, at the pharmacy and online.

Some say to strip your child's diet of gluten and casein, which are proteins found in wheat and milk, respectively. Pull heavy metals from the blood, a practice called chelation. Soak a child in clay baths, ask them to swallow amino acid capsules or take breaths in a hyperbaric oxygen chamber.

As many as one-third of children with autism may have tried these treatments. And several families will see benefits. But up to 10 percent of the treatments are considered dangerous, according to the CDC.

A clinical report from the American Academy of Pediatrics, of which Coplan is a fellow, recognizes this yearning, even while it remains skeptical.

"It's important for pediatricians to maintain open communication and continue to work with these families even if there is disagreement about treatment choices," Dr. Scott Myers, author of the report, wrote. "At the same time, it's also important to critically evaluate the scientific evidence of effectiveness and risk of harm."

While Coplan was careful not to cite any specific treatment by name, he warned parents to be watchful for certain traits that many have in common with one another — and with the electric flesh brush:

* Our product will never hurt, only help: Quite often, a treatment's backers will promise that their cure only helps, and cannot possibly harm the user. Scientifically tested medical treatments do not make the same claim.
* Endless applications: Does the product claim to cure a range of illnesses or syndromes? Are they equally adept at fixing metabolic, respiratory, circulatory, neurological and bone problems? Can they cure diseases and genetic disorders alike? "If something sounds too good to be true, it usually is," Coplan warned.
* Reliance on testimonials: Just like Liza Land Parker's sister, be wary if anecdotes and testimonials from interested individuals are the only real evidence for the treatment.

"Ask yourself this: Who else besides the people who are buying and selling this therapy are advocating it?" Coplan asked. "Is there anyone who hasn't bought or sold it who is pitching it?"

Testimonials are naturally biased. Those who think the treatment helped them will come forward, while those who were left bitterly disappointed will move on.

"You're looking at a very selective subset," Coplan said. "You have no way of knowing if it's 1 percent of the sample or representative."

* Lack of scientific study: The best scientific evidence is a controlled experiment. That means two sample groups of people with similar mixes of age, gender and socio-economic factors. One gets the treatment, the other does not. Study them before and after treatment is administered. Do the results of the two groups differ? Is this difference statistically higher than what would occur through simple chance?
* Expectation bias: Sometimes, faith and hope that a treatment must work can deceive the patient or parent into seeing benefits where none actually exist. Expectation bias sets in — we see what we expect to see.

Coplan cited his own work as a researcher during the development of secretin, a pancreatic hormone that was rumored to cure autism. The researchers gave one group secretin and the other salt water, without telling parents whose children received which treatment. Coplan asked the parents which one they thought their child received.

"The parents' guesses were no better than tossing a coin," he said. "If they were blind to what their kid was getting, they couldn't tell."

Those who provide the treatment are lone wolves: "People who are heavily invested in something that is a quack therapy style themselves as underdogs of the conventional medical establishment," Coplan said. "They almost revel in the role of being oppressed underdogs."

The lone wolf argument is premised on certain assumptions, as summed up by James Harvey Young in his book, "The Toadstool Millionaires: A Social History of Patent Medicines in America before Federal Regulation."

"Doctors — at least some of them — did not want to cure people. They got more profit from keeping the patient sick," Young wrote. "(T)hey were blind to the one dazzling new discovery that was destined to end forever the pain and suffering of disease."

For all his warnings, Coplan — and the CDC, for that matter — do not dispute that individual children may sometimes benefit from some alternative treatments. But their lack of medical proof should be a warning sign.

There are also what he called opportunity costs. "Every hour and dollar you spend on X are hours and dollars you're not spending somewhere else," he said.

The final piece is guilt, he said. While parents may gravitate toward whoever is going to offer them hope, what happens when that miraculous cure never materializes?

"If the kid doesn't get better," Coplan said, "the parents get blamed." Read more!

Free to Die in Iowa - Wall Street Journal

Civil libertarians and the mentally ill.

BY MICHAEL JUDGE
Sunday, December 23, 2007

IOWA CITY, IOWA It's the time of year when the Frank Capra classic "It's a Wonderful Life" is aired on cable channels at all hours. You know the story: How George Bailey, played by Jimmy Stewart, arrives on a bridge in a fit of despair, ready to take his own life. How the angel Clarence steps in and gives him a glimpse of what Bedford Falls would be like if he had never existed. How in the end the town comes together to save George from financial ruin, and the angel Clarence gets his wings.

Well, after the death of Sonny Anthony Iovino, a 55-year-old, mentally ill Vietnam veteran who froze to death here last month under the Benton St. Bridge, I don't think I'll ever see "It's a Wonderful Life" in quite the same way. There was no kindly angel to rescue this man, who suffered from chronic schizophrenia. He wasn't standing on a bridge thinking of ending his life; he was huddled beneath one trying to stay alive.

His community, my community, didn't come together to save him from ruin. Instead it refused him shelter, refused him even the most basic of medical care when he needed it most.

On Nov. 7, at 3:57 p.m., police responded to a report of a body under the Benton St. Bridge. Upon arrival they found Iovino, nearly naked, dead. The Johnson County Medical Examiner determined the cause of death to be hypothermia. Local police officers had tried to get Iovino the care he needed just 48 hours before his death. But he was refused a bed at the local homeless shelter and then turned away from the Veterans Affairs Medical Center here because he was "uncooperative."

After Iovino's death, a spokesman for the VA Medical Center told the Cedar Rapids Gazette, "If somebody doesn't want to be treated, you can't treat them." This is simply not the case. Given his debilitated state, the VA psychiatrist on duty could have forced Iovino to receive the treatment that might have saved his life.

Most states, including Iowa, have passed assisted outpatient treatment (AOT) laws. According to these statutes, "you must continue to take your medication or you may be committed," says Dr. E. Fuller Torrey, author of "Surviving Schizophrenia" and president of the Treatment Advocacy Center, a nonprofit dedicated to eliminating barriers to the treatment of mental illnesses. Dr. Torrey notes, however, that states often fail to use AOT laws because of strict commitment standards and poorly outlined procedures.

In fact, Iowa's commitment standard is better than many states', which demand that a person be an "imminent" danger to himself or others. In Iowa, however, to be eligible for AOT a person must lack sufficient judgment to make responsible decisions concerning treatment; and be either (1) a danger to self/others or (2) unable to satisfy the need for "nourishment, clothing, essential medical care, or shelter so that it is likely that the person will suffer physical injury, physical debilitation, or death."

When Iovino was picked up by police just two days prior to his death, he was digging up the earth with his bare hands, talking to himself, barefoot in frigid weather, and huddling near a building's exhaust vent to stay warm. He was at the very least a danger to himself.

Police convinced Iovino to put his shoes back on and cited him for trespassing. They received another call a few hours later and found that he had removed all his clothing but his pants. They again helped him get dressed and sent him on his way. When called back a third time, they took him to the VA Medical Center, where he asked for medicine. When the VA did not admit him, the officers took him to the county jail, which also refused him, saying he needed immediate medical care.

"It happens increasingly often," says Dr. Torrey. "As many states, Iowa included, shut down beds for mentally ill patients then there's two places they can go: the streets and jails. Our nation's jail keepers are tired of being their communities' primary mental-health facility."

But that's precisely what they are. According to a study by the Justice Department last year, 56% of state prisoners, 45% of federal prisoners, and 64% of local jail inmates suffer from mental illnesses. There are now more mentally ill Americans behind bars than in hospitals.

Nevertheless, civil libertarians seem more concerned with a patient's civil rights than his very survival. For example, despite a study released in 2005 by the New York State Office of Mental Health showing a marked decline in arrests, hospitalizations, incarcerations, homelessness, and threats of violence and suicide for patients under that state's "Kendra's Law," the New York Civil Liberties Union lobbied against the law's renewal that same year.

Even without a well-functioning AOT program, Iovino didn't have to die that November night. The VA Medical Center could have filed what is called an "emergency petition" and held him for several days.

"There is no question that the VA doctors could have done a short-term commitment," says Dr. Torrey. "That generally keeps a patient in the hospital up to 72 hours." Once a patient is held under emergency petition, court commitment procedures can go forward.

So, why wasn't Iovino held and treated at the VA Medical Center, where he had asked for medication? A VA spokesman assures me they are "aware of what the law says." But perhaps they're not fully aware. Or perhaps they'd just grown tired of his antics. It's hard to say.

One thing's certain: No kindly angel received his wings the night Sonny Iovino froze to death.

Mr. Judge, an Iowa-based freelance journalist, is a contributing editor at the Far Eastern Economic Review. Read more!

Apartment helps man gain upper hand over mental illness - Associated Press

By CARLA K. JOHNSON
Associated Press Writer

CHICAGO -- Sunlight streamed through the windows and the scent of sandalwood incense filled the air the day Aron Washington moved into his apartment

Tall and lithe, Washington tried a few yoga poses in the still-empty living room and spoke about his dream of starting a nonprofit corporation that would "bring right brain people and left brain people together over music and dance."

Six months ago, Washington, an artist with schizophrenia and bipolar disorder, shared a small room with two other men in a noisy, crowded nursing home for the poor, where his days revolved around the institution's schedule of meals and medicines. He got $30 a month in spending money from his disability check.

But since June 20, the 31-year-old Chicago man has proved he can live in his own apartment, with help from a small Illinois pilot program called Direct Connect. The program found him an apartment, helped him shop for furniture and got him out of the nursing home where he landed after a stint of homelessness.

"I want to start saving, start getting together a little nest egg," he said. "I want to live a purpose-driven life."

Others are less fortunate.

In Illinois, more than 9,000 people with serious mental illnesses were living in nursing homes as of June 30, 2006 - an increase of more than 1,000 from the previous year, according to information provided to The Associated Press by state officials as a result of a state Freedom of Information Act request.

In addition, another 4,654 people with serious mental illnesses were living in a type of nursing home classified as an Institution for Mental Disease.

Many states closed large mental institutions in the 1960s through the 1980s, leaving thousands of mentally ill people homeless. A patchwork system of underfunded community-based services emerged in some states. But others, including Illinois, relied on nursing homes, largely funded by Medicaid, to care for the mentally ill.

Some lawmakers believe programs like Direct Connect could save Illinois $9,000 per person each year and help thousands of mentally ill adults, many younger than 40, who live in nursing homes. But for now, the 2-year-old program is in limbo, awaiting an end to legislative gridlock.

"As soon as final budget issues get resolved, the program should be able to obtain its funding," said Rep. Sara Feigenholtz, D-Chicago, who chairs the House panel on human services spending.

Feigenholtz, an early supporter of Direct Connect, said Illinois should strengthen programs that encourage independence and recovery. Institutions foster dependence in people who otherwise are capable of improving their lives, working and paying bills, she said.

"I'm looking forward to the data on cost-effectiveness" of the Direct Connect program, Feigenholtz said. "It will give us a roadmap of where Illinois should be investing more resources."

Not everyone agrees.

Robert Hedges, board president of the Illinois Health Care Association, a group representing nursing homes, said housing mentally ill people in apartments can be disastrous without adequate oversight to ensure they take their medications and do well. Some will end up back in institutions or on the street.

"If you ask residents with mental illnesses, 'Would you like to live out in a little apartment?' Every one of them is going to say, 'Yes.' That doesn't mean they have the ability to live on their own like that," Hedges said.

Three mentally ill people relocated by Direct Connect have moved back into institutions. They needed more medical attention for problems such as diabetes or their symptoms of mental illness grew worse after moving, said Tony Zipple, CEO of Thresholds, the nonprofit agency that runs Direct Connect.

But Illinois faces a class-action lawsuit that claims many more mentally ill people in nursing homes could live in apartments or group homes if they got help managing their lives.

Filed originally on behalf of Ethel Williams and Jan Wrightsell, two women with mental illnesses who wanted to move from an institution, the lawsuit describes the living conditions at the Chicago facility where the women lived with scant freedom, privacy or treatment.

"Residents wander aimlessly in and out of the common room and smoking room with nothing to do the majority of the day," the lawsuit states.

Benjamin Wolf, an attorney with the ACLU of Illinois, who is helping with the lawsuit, said the agency would "like the opportunity for everybody who wants the opportunity to get out of an institution."

"Illinois historically has significantly underfunded its human services and spent more proportionally on institutions rather than in the community," he said.

The lawsuit cites a 1999 landmark ruling by the U.S. Supreme Court that the Americans with Disabilities Act requires community placement of the mentally disabled whenever appropriate. The court said segregating the mentally ill amounted to "unjustified isolation," while recognizing that states need to maintain a range of facilities for people with mental disabilities.

Teresa Kurtenbach, a spokeswoman for the Illinois Department of Healthcare and Family Services, said she couldn't comment on pending litigation.

But she said in an e-mailed statement that the state has "made significant progress in the process of rebalancing the delivery of long term care services for people with mental illness to promote the use of non-institutional community options" under Gov. Rod Blagojevich.

The day Washington moved out of Somerset Place, a Chicago institution serving mostly poor adults with mental illnesses, some staff members and another resident predicted he wouldn't make it on the outside.

"They said, 'You'll be back,'" Washington said.

"I said, 'I'll be back to visit.'"

Direct Connect staff want to make sure he stays on his own.

"We're not going to abandon anybody," said Zipple, adding that, while the program awaits renewed funding, caseworker time is patched together from other programs.

Caseworkers meet with Washington twice a week. Besides keeping tabs on his meds, they help manage his money, discuss vocational plans and check on his physical health. Washington has elected to have Thresholds receive his monthly disability payment, but he decides what bills get paid.

When Washington doesn't take his meds, his mind races and he ends up in jail, detox or in a hospital psychiatric unit, he said.

"It's like coming to from a seizure," he said. "Thoughts. Can't contain them, can't cease them. Just reflect upon them, sometimes I get lost in my head."

Direct Connect has helped 43 people with mental illnesses, including Washington, move into their own apartments and another eight move into groups homes.

The program, which spent $766,000 in its first 21 months, needs an infusion of money from state lawmakers before it can return to finding apartments.

"It's a new day. It's a watershed mark," Washington said of how his apartment changes his expectations for his future. "It's a necessary step I'm taking in what I'm going to do in life." Read more!

Home for abused children suedover broken bones - Associated Press

EUGENE, Ore. (AP) - Guardians of three children who suffered broken bones have sued a Eugene-area treatment home for severely abused and disturbed children.

Plaintiffs are seeking $200,000 from the Jasper Mountain treatment home for each child for suffering, plus medical expenses.

Jasper Mountain Executive Director Dave Ziegler, meanwhile, is sparring with child welfare officials, accusing the government of overstepping its authority and being unfair to Jasper Mountain.

State officials say they're just doing their job.

"Our interest remains that (Jasper Mountain) work with the children in a way that's safe for children, and that children are not being injured by program staff," said Madeline Olson, assistant administrator of the state Addictions and Mental Health Division.

State records show that the problems at Jasper Mountain began when children were injured while staff members were trying to calm them down.

In December 2005, an 11-year-old child suffered a broken ankle when he was threatening younger children, according to the state human services agency.

A staff member asked the child to move away. The child took one step onto a nearby stair, dropped his weight and broke his ankle, according to the agency.

In March 2006, a 12-year-old girl's upper arm was broken in two places after a staff member placed her arm behind her back and held it there to restrict her movements.

And in August 2006, a 12-year-old boy suffered a broken wrist after staff members delivered the news that his mother had died, according to Jasper Mountain officials. The boy ran out the door of the residence, turned and braced the door closed with his arms. When staff chased after him and pushed on the door, the force snapped the boy's wrist.

All three children eventually left Jasper Mountain, said their attorney, David Paul of Portland, who has filed a lawsuit against Jasper Mountain in Lane County Circuit Court.

"I'm not going to necessarily prove they were abused, but I'm going to prove they weren't given appropriate care. And that's the standard here, especially when you're taking care of children," Paul said.

But Ziegler said it's really the promise of money that's driving the lawsuit. Paul "stepped forward and talked the families of the kids into getting some money out of this," he said.

The three incidents within a nine-month period sparked a wave of investigations by five state and federal agencies, including one by the state Child Protective Services and one on behalf of the federal Centers for Medicare and Medicaid Services.

Investigators criticized Jasper Mountain about its use of containment holds, saying they should be used in emergencies only.

Still, child protective services eventually ruled that each allegation of child abuse stemming from the broken bones were "unfounded."

The use of restraining holds is a controversial issue nationwide. Government agencies are moving toward a position that restraining holds should be reserved for rare circumstances.

Ziegler is a nationally known proponent of using restraining holds for therapeutic purposes.

"There are therapeutic benefits to drawing a line for kids and not letting violent kids get violent to themselves and get violent to others and, at times, that requires physical direction," he said. Read more!

Reaching out in a time of pain -Milwaukee Sentinel-Journal

Son's mental illness led them to 25 years of helping others

Dec. 22, 2007
Laurel Walker

Dorothy and Dick Wutt know all too well how tortuous it is to have a loved one in the grips of mental illness, how desperate the search can be for answers.

In 1981, as they drove their 21-year-old suicidal son, Phil, to the Waukesha County psychiatric hospital fearing for his life, he got out of the car intent on putting himself in front of a train. Fortunately, a police officer arrived and helped get him to what was then Northview Hospital.

"It took me five years to go over that railroad track in Waukesha without getting a sick feeling in the pit of my stomach," Dorothy Wutt said. "It was awful."

Though Dorothy, now retired, was a nurse at the time - Dick is a retired insurance claims adjuster - she said she didn't fully understand the long, hard journey that was ahead.

"We were in shock for a long time," she said. "We were in a grieving process. It took us a couple of years to deal with it."

Yet in dealing with their son's illness, the Wutts reached out to others in similar circumstances.

First, to learn.

Then, to teach and share what they'd learned.

Then, to advocate.

Dorothy Wutt had facilitated a grief and loss support group at the hospital in West Allis where she worked, so she felt comfortable turning to a support group for families of those with mental illness during their crisis. First it was with the Mental Health Association of Waukesha County, and then with the local chapter of the National Association of Mental Illness, or NAMI, as it is now called.

Soon she began to lead the group.

"Thank God you don't know what the future holds," she said, laughing about it now. Little did she know she would be in it for the long haul.

Twenty-five years later, the couple is still at it, month after month, year after year. Dorothy, 73, leads the monthly group discussions and arranges for public speakers while Dick, 76, offers behind-the-scenes support and set-up help.

The first thing on any family member's agenda, she said, is getting help for their loved one. They often bring with them a frustration that no one is listening, she said.

They also bring a sense of stigma, Dick added. People often are concerned and feeling that they will be blamed for the mental illness of a child or spouse.

The Wutts listen, and they surely don't blame.

Sue Walker (no relation), who began working in the mental health hospital in 1981 when Phil was an inpatient and who is now supervisor of community support programs for those with mental illness, said she's watched Dorothy Wutt's leadership of the group and her constancy from the start.

"She has this ability to connect because she's able to share her own experiences," Walker said. "She connects well - and it means a great deal to the families."

About 10 to 20 people show up regularly. Individuals are allowed to speak about their particular concerns of the day. Usually, a speaker is scheduled for an educational segment. Sometimes, old-timers return.

"We need success stories" from them, Dorothy said.

They have seen success with their own son, now 47. After the initial onset of his schizophrenia and hospitalization more than 25 years ago, he now lives on his own in Waukesha.

The Wutts, who have older twin sons and a younger daughter in addition to Phil, said "he considers his life good."

He handles his own finances, recently completed a peer support program, and enjoys friendships and finds support at community social recreation and job readiness centers, they said.

Earlier this month, the Wutts were deep into their annual holiday ritual of preparing roasters full of food for the NAMI Christmas party. Nearly 200 people - clients with mental illness and their families - attended. (I've seen the Wutts' dedication up close for several years now at the event, a cause close to the heart of First Mate. My husband is current president of the NAMI Board and co-cook of the dinner's vegetable casserole.)

Today's mammoth party had its start in the Wutts' Brookfield basement decades ago.

In those first years of their son's illness - he spent six months in the hospital and then six months in a group home - the Wutts organized a Christmas party for a couple dozen residents of group homes.

"We just got a bang out of it," Dorothy said. And so did the guests. There was food and games and a seasonal spirit.

The party soon outgrew their home and NAMI took over its planning, though the Wutts have been faithful volunteers ever since. Dick knows how to get Santa to show up and distribute donated gifts to the appreciative audience.

They're also steadfast participants - Dick mans the grill - at NAMI's summer picnic for clients and families.

"The two of them together have been a mainstay of NAMI," said John Quaal of the Village of Pewaukee, former board president who first got to know the Wutts when his own son became mentally ill. "Whenever there's something to be done, Dick and Dorothy have been there."

As Dorothy's decades-long leadership of the support group continued, Dick got involved elsewhere.

He served as a board member for NAMI and for the past 20 years has been sitting on the Waukesha County Health and Human Services Board, where he advocates not only mental health programs, but for services to other of our most fragile citizens, as well.

The Wutts have long been dedicated to social action through their church, Immaculate Heart of Mary in West Allis. For 30 years they've helped out monthly at the St. Ben's meal program that feeds the homeless and hungry in Milwaukee. Dorothy brings meatloaf.

Now, retired after 27 years as a hospital nurse and supervisor, Dorothy Wutt is a volunteer parish nurse who does wellness checks and offers some health care to church members. She also took her medical expertise to Liberia twice, in 2005 and 2006, part of a parish-to-parish visit of volunteers in which she worked in pharmacy services.

It's clear that the Wutts have never been one-shot volunteers in anything they do. Even in a cause not of their choosing - as when mental illness struck their family - the Wutts seem to jump in heart and soul to help countless others.

Call Laurel Walker at (262) 650-3183 or e-mail Read more!

Police Leaders Charged, Not Officer WhoDid Shooting - Associated Press

12/21/2007
By MARCUS WOHLSEN


SAN FRANCISCO (AP) -- No one claims the police chief or his lieutenant fired a shot when officers gunned down a mentally unstable woman in the coastal Northern California city of Eureka last year.

Yet they, not the officers who fired on her, are the ones charged with manslaughter in a case that has puzzled criminologists and law enforcement veterans, who say they've never heard of commanding officers having to defend themselves against criminal charges just for issuing orders.

"It's a novel legal theory to indict people who didn't do something, particularly when they didn't say, 'Go ahead and shoot this woman,"' said David Klinger, a University of Missouri-St. Louis criminal justice professor who has studied police use of deadly force.

Chief David Douglas and Lt. Tony Zanotti were not part of the raid on Cheri Lyn Moore's apartment; they had been directing the tactical response from a command post elsewhere in the apartment complex.

Both plan to plead not guilty to involuntary manslaughter when they're arraigned Feb. 21, said Bill Bragg, a lawyer for Douglas, who retired in October 2006, and Bill Rappaport, Zanotti's lawyer.

If convicted, Douglas and Zanotti would face up to four years in prison.

The officers who fired the shots have not been charged.

The indictments announced last week against the two commanders remains sealed. Humboldt County prosecutors could not be reached for comment by The Associated Press and have said little publicly about the since the day it happened.

On April 14, 2006, Moore was grieving the one-year anniversary of her son's death and began suffering a "mental health crisis" and called Humboldt County's mental health services line, according to a wrongful death lawsuit filed by another son.

Police soon arrived at her apartment in Eureka, a remote city of 26,000 in the heart of California redwood country, but the welfare check turned into a standoff when she would not answer the door.

The 48-year-old grandmother brandished a flare gun from her second-story window, threw clothes into the street and threatened to burn down the building, according to police.

"She was an immediate threat to human life, to the building, to the officers, and to civilians surrounding that area," Zanotti testified at a September inquest into Moore's death.

After two hours, she was seen putting the gun down, and officers stormed the apartment.

Moore was brought down by nine shots fired from a shotgun and an assault rifle; officers said she pointed the flare gun at them. She died at the scene.

Key to the manslaughter case against Douglas and Zanotti is whether their decision to send in a SWAT team showed judgment so poor that it amounts to criminal negligence.

"It's pretty clear from the evidence that the problem came from the order to go into the apartment," said Gordon Kaupp, a San Francisco attorney representing the son in the wrongful death suit, filed in May. "The cops here knew she had a mental health history and chose to ignore (that)."

Crisis negotiators should have had more time, and police should have used non-lethal weapons to subdue Moore, according to her son and mental health advocates.

Law enforcement groups and lawyers defending the officers argue that finding the commanding officers criminally liable for the split-second decisions they make in unpredictable and potentially violent situations could seriously hinder police.

"It gives one pause to think what this most extreme kind of second-guessing will do to chill their willingness to keep facing those dangers for us," Eureka City Attorney Sheryl Schaffner wrote in an e-mail to The Associated Press. Her office is overseeing the officers' defense in the civil case.

Even Ira Blatt, president of the Humboldt County chapter of the National Alliance for the Mentally Ill, conceded that by the time police showed up at Moore's apartment, it might have been too late for a peaceful resolution.

"I know that the police oftentimes get blamed when what you have is a failure of the mental health system," said Blatt, who believes Moore's death could have been avoided if she'd had better, more consistent access to treatment. "Law enforcement first responders have a very difficult job." Read more!

Man held in 'rampage' - Baltimore Sun

By Madison Park and Gus G. Sentementes

December 22, 2007

The man charged in what a prosecutor described yesterday as a "violent rampage" at a Harford County manufacturing plant stabbed not only his estranged wife but also her current boyfriend, according to newly released court documents.

David Daniel Kennedy - a man with mental health problems whose marriage broke apart a few weeks ago, according to his relatives - told police after his arrest that he wanted to kill his wife, the court records show. As he was ordered held without bond, the woman, Beth Kennedy, remained in serious condition at Maryland Shock Trauma Center.

Police said the 32-year-old woman was cut and stabbed in the back, neck, face and chest. The man identified as her boyfriend was discharged from Shock Trauma, but another stabbing victim remained at the hospital in fair condition.

The fourth stabbing victim was discharged from an area hospital.

The plant that was the site of Thursday's attack, Harford Duracool, in the 2100 block of Pulaski Highway near Havre de Grace, was closed yesterday as the company offered counseling to employees, a spokesman said.

Meanwhile, the man who picked up David Kennedy along a highway in the chaotic moments after the stabbings said he thought the bloodied man was a dazed car-crash victim.

"He said he needed a ride, and I said, 'Get in,'" said Stephen Wright, an accountant who lives in Churchville. "I thought I was being a Good Samaritan."

Kennedy, 37, is charged with four counts of attempted murder, four counts of first-degree assault and carjacking. He participated in a bail review at District Court in Bel Air via a video feed from the Harford County Detention Center.

Kennedy stared into the camera, saying little except to answer the judge's questions.

Prosecutor David Ryden described the incident at the plant Thursday as "nothing short of a violent rampage that terrorized people in that area and the business." Ryden added that the defendant has a history of violence, with previous convictions for disorderly conduct, battery and two handgun charges.

Court records show that Kennedy's mother sought a temporary protective order against him in 2002, accusing him of using drugs and becoming violent. But she did not appear in court to follow up on the request, records show.

Defense lawyer Marcus Jenkins told the court yesterday that Kennedy has medical issues, with pins in his wrist, three herniated discs in the back and a mental health disorder.

"He is taking prescription drugs and takes scheduled drugs for an addiction," Jenkins said.

District Judge Victor K. Butanis denied Kennedy bail, saying, "I'm very concerned about the safety of the community."

Kennedy wrote in court documents that he works as a part-time framer for Fisher Builders, in Delta, Pa., and had lived with his mother intermittently for the past 20 years.

Yesterday morning, some of his closest relatives - his mother, brother and aunt - expressed shock at the incident, and sorrow for the people who were hurt. They said Kennedy had been diagnosed with bipolar disorder.

Jenny Strong, the suspect's aunt, said that Kennedy had been married for about three years, and that he and his wife had lived in a rented house on a farm near York, Pa., for the past year. She said David Kennedy worked for the farm owner, while his wife worked at Duracool, where he also had worked for a few months in the past.

"He loved her," said Barbara Kennedy, 61, the suspect's mother.

John R. Kennedy, the suspect's brother, said David and Beth Kennedy had been doing well together until recently. But about three weeks ago, the woman left to live elsewhere, he said. He said she tried to get him evicted from the home.

"We're not trying to throw stones or nothing, but if she had just left him alone, none of this would've happened," John Kennedy said.

Christine Hayden, who spent four years with Kennedy and had two children, now 12 and 14, with him, said Kennedy never physically abused her but that he displayed a temper.

Hayden, who lives in Colora in Cecil County, had been fighting Kennedy in court for unpaid child support, but she said he saw and spoke to his children regularly.

Others stabbed in the incident were named in court documents yesterday as Gani Veseli, who was stabbed in the face and was released from an area hospital; Dominick Quartara, the man described as the boyfriend, who was stabbed in the head and neck area and was discharged from the Shock Trauma; and Johnny Poling, who had been cut in the throat and ear and had a fractured jaw. Poling was in fair condition at Shock Trauma yesterday.

The remaining victims were released from area hospitals, said Sgt. Christina Presberry, a spokeswoman for the Harford County Sheriff's Office.

Nine employees were injured after Kennedy, in search of his wife, went to the plant, which manufactures refrigeration systems, Presberry said.

Officials said that, in the parking lot, Kennedy struck several vehicles and a female employee with his truck. Three other female employees were injured trying to escape, police said.

Kennedy's truck also rammed a utility pole and circled wildly until it broke down and was left on the median of U.S. 40, witnesses said. Kennedy carjacked a 2003 Jeep Grand Cherokee, threatening to kill the driver, according to court documents.

The driver, Wright, said he was westbound on Pulaski Highway when he stopped to pick up a man.

Wright said he stopped the car after driving less than 1,000 feet when he noticed the suspect's knife and two sheriff's cars following. He got out of the Jeep and was not injured. Kennedy drove the Jeep to Havre de Grace, where he was later arrested, police said.

madison.park@baltsun.com gus.sentementes@baltsun.com
Sun reporters Jennifer McMenamin and Sumathi Reddy contributed to this article.

Copyright © 2007, The Baltimore Sun Read more!

Pam's story: 'Mom, let's kill ourselves' -Phoenix (AZ) East Valley Tribune

Mary K. Reinhart, Tribune
Part 1 of a 6-day series

On a sunny Sunday morning in early fall, Mesa police Lt. Kevin Kazmaier drove his wife and youngest son home early from church, before 12-year-old Zack could disrupt the Mormon service and embarrass his brother again.

Zack had been spiraling out of control for weeks, but no hospital would take him. Years of psychiatric medications and advancing puberty were buffeting his mind and body. He was manic, attacking brother Mike with a paper-towel rod and threatening to kill himself at every turn.

Sixth grade at Field Elementary School began with such promise, but now his teachers were saying they just couldn’t handle him.

His longtime psychiatrist adjusted Zack’s medications three times in September, then told Pam and Kevin Kazmaier to get used to their son’s bizarre behaviors. The family would learn later she was battling her own demons.

Pam was spiraling, too, but in the opposite direction. Her bipolar disorder, undiagnosed for most of her life, was banking dangerously low. The family’s one solace — a small cabin in Taylor where the boys rode all-terrain vehicles — was threatened by neighbors complaining about the noise.

As Kevin drove back to join his older boy at church, Pam started changing into more comfortable clothes. She moved slowly, methodically. Like she was pushing through a fog.

Her obsessive-compulsive side, along with the mania of her bipolar illness, accounted for her neat-as-a-pin house and had served her well as a detail-oriented obstetrics nurse at Banner Mesa Medical Center.

She meticulously charted Zack’s medical, school and social progress, filling a 5-inch binder with legal and medical documents, notes and photographs.

A little mania would have come in handy now. But it had abandoned her, leaving only the black hole of depression. She looked up as Zack walked into the bedroom.

“Mom, let’s kill ourselves,” he suggested, grinning from ear to ear.

He had tried so many times before. In fact, the boy had been trying to end his life for most of it. He’d put ropes around his neck, cut himself with knives, leaped from moving cars and nearly threw himself off the roof of a parking garage at Fiesta Mall.

His mother kept a blue suit handy for his funeral, fully expecting him to one day succeed, like his 14-year-old cousin before him, just a few months earlier. He shot himself with a gun that Pam and Kevin had given to his father.

Now, as she considered the burly, brown-eyed boy, it seemed like the only choice they had left.

“OK,” she said.

Together in death, Pam thought, they would be free.

Released from the tangled web of the mental illnesses that bound them, that they couldn’t escape and that consumed all of Pam’s time and energy. Drugs, doctors, therapy sessions, teacher conferences. None of it was working. Zack was getting worse.

Pam was drowning, neglecting her own mental illness and shouldering the burden of caring for Zack. She hadn’t worked since he was born, or slept much either, in the same house with a boy who had night terrors and regularly threatened his life and theirs. She had dedicated her life to her family, her Mormon church and, most of all, Zack’s illness. She had completely lost herself.

Zack had become her reason for living and, it seemed now, her reason for dying.

If they were gone, Pam thought, Kevin and Mike would be free to live their lives without the burden of a mentally ill mother and son.

No more calls from school. No more worries about how their “crazy” family looked to Mike’s junior high classmates or the neighbors or Kevin’s colleagues at the Mesa Police Department, where he commanded the bomb squad.

No more of Zack’s outbursts at their Mormon Church ward and at Boy Scout meetings.

Pam was too tired to bother with killing herself. But the boy was bent on it, and she couldn’t let him go alone. In her psychosis, she reasoned she needed to protect her son on his journey to the other side, like a loving mother holds her child’s hand while crossing a busy street.

They would take their medicine — more than they should — and then drift off to sleep together. Zack gathered his pills. Pam collected her own, and began swallowing handfuls.
She didn’t need to help Zack take his; he’d been doing it four times a day for years.

Zack taped a note to the master bedroom door: “We are taking a nap.” They locked the door and pushed an antique oak dresser in front of it.

They wrote their goodbyes to Kevin and Mike and slipped the paper inside one of the pillow cases.

“Mike and dad we love you!” Zack wrote. “life iss to hard”

“Mike — Kevin — Your life will be better (without) us. Charlie — we’ll be seeing you!” Pam wrote. Charlie was her nephew, Zack’s cousin, who had killed himself.

“Do not take us to the hospital. Let us go,” read another note, tucked inside the Book of Mormon. “We can’t live in your world. Zack said give all my swords to Quentin. Mikey we love you with all our heart.”

Pam took a picture of Jesus off the wall and placed it between them on the quilt as she lay down on the bed next to Zack. They held hands. The room swirled, then went black.
Finally, she would get some rest. Read more!

Killer’s mental illness, threats recallee -Boston Globe

SCOTT ALLEN; The Boston Globe
Published: December 22nd, 2007

BOSTON – Ann Marie Tavares loved her wayward son, Daniel Thomas.

But friends and family told detectives investigating her 1991 murder in Massachusetts that he should have been locked up long ago because of his volcanic temper.

Daniel had done jail time for robbery, and he’d gone to drug rehab to avoid more – only to be kicked out for stealing and abusing drugs.

But Ann Tavares, a laundromat manager in the Boston area, had raised Daniel and three older sisters alone after she and her husband split in 1968. She was protective of her troubled youngest, who had bipolar disorder and anxiety attacks.

As a friend told police, “He was Ann’s baby,” and she had invited him to live in her Somerset home.

Daniel Tavares claimed he was hearing voices when he stabbed his mother over and over again the night of July 11, 1991. He told police he “just started swinging” with a 12-inch knife after an evening of drinking and taking LSD.

Police found 14 vials of psychiatric medications on the dresser in Tavares’ bedroom.

His history of mental illness persuaded Bristol County District Attorney Paul Walsh to accept a guilty plea to manslaughter rather than pursue murder charges, prompting criticism recently from police involved in the investigation.

“To me, it was definitely homicide,” said former Somerset Police Chief James Smith. “Certainly, when you stab someone 16 times, there’s an intent there.”

Walsh said later that he feared Tavares’ psychological problems could suggest that he didn’t understand what he was doing on the night of the killing.

“We have to prove that he possessed a sound mind. … If we can’t prove that, he’s found not guilty,” Walsh said in a recent interview, noting that Tavares got the strictest sentence possible for the lesser charge.

Others who know Tavares argue that mental illness doesn’t explain his long pattern of violence and threats.

”Certain people in the world just have evil in them and I hate to say it but I think it was with him, pure evilness,” said Daniel T. Tavares Sr. of Zephyr Hills, Fla.

Some suspect the truth might be worse than Tavares’ rap sheet.

In 2000, he contacted police to say that he could tell them where to find the body of 32-year-old Gayle Botelho, who he said had been killed by two acquaintances after “some wild party” in 1988.

Investigators unearthed Botelho’s skeletal remains in a makeshift grave behind the Fall River, Mass., house Tavares had lived in at the time of her disappearance. Like Ann Tavares, Botelho had been stabbed to death.

Walsh said he believes Tavares didn’t kill her, but said he didn’t prosecute the others because he didn’t want to rely on an admitted killer’s testimony.

“Your whole case is based on his words,” he said. “That’s a skinny case.”

Among prison guards at MCI-Cedar Junction, Massachusetts’ maximum-security prison in Walpole, Tavares became known as a loud-mouthed malcontent who spat at guards passing his cell, tossed feces or urine at them, and made violent threats.

”He was what guys refer to as a cell warrior,” said an officer who once worked at MCI-Cedar Junction and spoke on the condition of anonymity. ”He was always making trouble from his cell.”

Because of his behavior, prison officials repeatedly extended Tavares’ prison term, taking away more than 1,000 days of ”good time” that would have entitled him to earlier release.

Tavares lived in Cedar Junction’s Departmental Disciplinary Unit – a prison within a prison – for more than seven years, making him one of the isolation unit’s longest-serving inmates.

For years, he wrote threatening letters to public officials and family members from his cell, prompting a Massachusetts State Police investigation in 2006.

“He threatened to kill me,” said the elder Tavares. “He said he’d come down here when he got out and break all my ribs and maim me.”

However, Tavares couldn’t be charged with a crime, prosecutors said, because, as an inmate, he had no ability to carry out the threats.

By the time Tavares came up for release, Worcester District Attorney John Conte had been replaced by Joseph Early, who said he knew nothing of the threats.

By June 2005, Tavares had a new ally in Washington resident Jennifer Lynn Freitas, who described herself as his fiancé and defended him in online chatrooms. From then on, Tavares told prison officials repeatedly about his desire to join Freitas in Graham, where he’s now suspected of killing Brian and Beverly Mauck.

Prison officials prefer to resolve misbehavior internally, but guards at Souza-Baranowski Correctional Center in Shirley, Mass., drew the line Dec. 1, 2005, when Tavares allegedly slammed a guard in the face with the cast on his left hand. Three months later, Tavares allegedly spit on another guard.

For the incidents, he lost six months of “good time,” but guards also asked the Worcester district attorney’s office to file assault charges.

Prosecutors agreed, but the office didn’t file charges until a Walpole prison official, going through paperwork for Tavares’ scheduled release June 14, 2007, contacted Souza-Baranowski about the unresolved assaults.

Prison officials filed the complaint, but the delay gave Tavares’ lawyer ammunition to argue that prison officials were unfairly trying to extend Tavares’ sentence again.

By July 16, the only thing that separated Tavares from freedom was raising the $100,000 bail he faced in the prison assault charges. His problem would be solved in a brief hearing barely noticed outside Judge Kathe Tuttman’s courtroom in Worcester.

A transcript shows Tavares’ lawyer did 80 percent of the talking, while assistant district attorney William Loughlin made general remarks about Tavares’ history of violence and suggested that he might leave the state.

Loughlin had so little information about Tavares that he never mentioned his egregious prison record that included more than 100 serious disciplinary complaints, never said Tavares had killed his mother, and never challenged Tavares’ claim that he was about to begin a new life as a welder.

Tuttman quickly concluded Tavares had done his time and released him.

Early defends his office’s handling of Tavares’ hearing, saying that a district court judge had agreed to hold Tavares on $100,000 bail pending his trial.

“We did our job,” Early said. “We told the court he’d take off, and unfortunately he did.” Read more!

Decision about McDowell's mental health services up in the air - McDowell County (NC) News

By MIKE CONLEY
nconley@mcdowellnews.com

Local leaders will have to make a decision soon about the future of mental health services in McDowell.

"Before the N.C. Department of Health and Human Services forces us to make a decision, we want to make the best possible decision for McDowell," said Commission Chairman Andy Webb.

Since 1969, Foothills Area Program has provided mental health, developmental and substance abuse services to children and adults in McDowell, Alexander, Burke and Caldwell. But the past year has seen sweeping changes to mental health services in North Carolina. Like others, Foothills has changed from being an area program that provided and managed mental health and substance abuse services to a Local Management Entity (LME) that manages services provided through private or public agencies.

The state’s mental health reforms have caused a great deal of changes and uncertainty about existing programs.

The Burke County Commissioners voted to withdraw from Foothills LME and join with Catawba County for the provision of Burke’s mental health services. That left Foothills no longer able to meet the state’s population threshold and it could cease to exist by July 1, 2008.

"We are required by law to either grow or merge," said Foothills Director Don Pagett, "and our viable option is to merge."

Both McDowell and Caldwell officials agreed to stay with Foothills for one more year and, in the meantime, do a thorough examination of all the options available for mental health. Rather than waiting to see what happens to Foothills, county leaders are looking to join with another LME.

Over the past few months, county officials have narrowed their choice down to joining with either one of two LMEs: Western Highlands District or the Smokey Mountain District. Like Foothills, they receive state funding for mental health, substance abuse and developmental disability programs.

"We are in the process of making an assessment," said Webb. "It’s a complicated matter."

Based in Asheville, Western Highlands District covers Buncombe, Henderson, Madison, Mitchell, Polk, Rutherford, Transylvania and Yancey. Smokey Mountain District, based in Sylva and Boone, provides services to Haywood, Avery, Jackson, Alleghany, Swain, Wilkes, Watauga, Ashe, Clay, Macon, Graham and Cherokee.

"Both districts are extremely well managed by seasoned and professional public servants," said County Manager Chuck Abernathy.

County officials have heard proposals from representatives of both mental health districts. They are also seeking input from folks with Foothills Industries, The McDowell Hospital, the Sheriff’s Office, the school system, Pagett and the McDowell County representatives on the Foothills board of directors.

"There’s a tremendous amount of people involved in this," said Webb. "We want to understand what is the best fit for McDowell County."

For the past week, local people who are recovering from drug addiction have talked about Matrix, a treatment program offered by Catawba Valley Behavioral Healthcare (CVBH). They are worried about the program ending because CVBH has said it could no longer staff the mental health center on Spaulding Road.

Pagett said Thursday that the Matrix program and other similar services would continue here in McDowell even if CVBH no longer provides them.

A recommendation about which district to go with will be on the agenda for the McDowell County Commissioners in January and February. The effective date of the transfer must occur prior to the new fiscal year, which starts July 1, 2008.

"This transition will not happen overnight," said Webb.
Read more!

Virginia Tech massacre voted top story - AP

The massacre of 32 people at Virginia Tech by a mentally disturbed student gunman was chosen the top story of 2007 by US editors and news directors in The Associated Press' annual vote.

The rampage, which prompted colleges around the country to reassess their emergency response systems, received 82 first-place votes out of 271 ballots cast for the top 10 stories.

The mortgage crisis, which roiled the US housing market, was the No. 2 story, and the war in Iraq placed third. Iraq was the No. 1 story in 2006, and has finished in the top three since 2002 - the year of the pre-war buildup.

Here are 2007's top 10 stories, as voted by AP members:

1. VIRGINIA TECH KILLINGS: Seung-Hui Cho, 23, who had avoided court-ordered mental health treatment despite a history of psychiatric problems, killed two fellow students in a dormitory on April 16, detoured to mail a hate-filled video of himself to NBC News television, then shot dead 30 students and professors in a classroom building before killing himself. It was the worst mass shooting in US history.

2. MORTGAGE CRISIS: A record-setting wave of mortgage foreclosures, coupled with a steep slump in the housing market, buffeted financial markets, caused multibillion-dollar losses at major banks and investment firms, and became an issue in the presidential campaign.

3. IRAQ WAR: The "surge" that sent more US troops to Iraq was credited with helping reduce the overall level of violence. But thousands of Iraqis and hundreds of US personnel were killed nonetheless during the year, and Iraqi political leaders struggled to make meaningful progress toward national reconciliation.

4. OIL PRICES: Oil prices soared to record highs, at one point reaching nearly $100 a barrel. The high prices, which burdened motorists and owners of oil-heated homes, nudged Congress to pass an energy bill that ordered an increase in motor vehicles' fuel efficiency.

5. CHINESE EXPORTS: An array of Chinese exports were recalled, ranging from toys with lead paint to defective tyres to tainted toothpaste and food. Despite the high-profile problems, America's trade deficit with China was running at record-high levels.

6. GLOBAL WARMING: Warnings about the consequences of global warming gained intensity with new reports from scientific panels and a Nobel Prize to Al Gore for his environmental crusading that included the film "An Inconvenient Truth." Across the US, many state governments sought to cap emissions blamed for global warming.

7. BRIDGE COLLAPSE: An Interstate 35 bridge over the Mississippi River in Minneapolis collapsed during the evening rush hour on Aug. 1, killing 13 people and injuring about 100. The disaster fuelled concern about possible structural flaws in other bridges nationwide.

8. PRESIDENTIAL CAMPAIGN: In a yearlong drama with shifting subplots, large fields in both major parties battled for support ahead of the caucuses and primaries that will decide the 2008 presidential nominees. Hillary Clinton and Barack Obama led among the Democrats; some polls showed five Republicans with double-digit support.

9. IMMIGRATION DEBATE: A compromise immigration plan, backed by President George W. Bush and Democratic leaders, collapsed in Congress due to Republican opposition. The plan would have enabled millions of illegal immigrants to move toward citizenship, while also bolstering border security. The issues remained alive in the presidential campaign.

10. IRAN'S NUCLEAR PROGRAM: Worried that the ultimate goal is a nuclear arsenal, the United States and other countries pressed Iran to halt uranium enrichment. Iran said it never had a weapons program. A US intelligence report concluded there was such an effort, but it stopped in 2003.

Just missing the Top 10 were the Southern California wildfires and the resignation of Alberto Gonzales as attorney general.

The balloting reflected a diverse news year, with 27 different stories receiving at least one first-place vote. The mortgage crisis got 48 first-place votes, Iraq 40 and oil prices 25.

Write-in votes were cast for two events that occurred after AP's ballot was distributed - the shooting at an Omaha mall that left nine people dead, and the Mitchell Report on use of performance-enhancing drugs in baseball.

Another write-in vote was for "cheaters and liars" - collectively addressing the many athletes and other public figures entangled in scandals.

Among stories about pop culture celebrities, the saga surrounding the death of Anna Nicole Smith got the most votes, finishing in 32nd place ahead of such stories as the Israeli-Palestinian conflict, the departure of Tony Blair as British prime minister, and the military crackdown in Myanmar.

"Anyone who picks the Anna Nicole Smith story in the Top Ten should be beaten with sticks," commented Mike Bailey, managing editor of The Courier News in Elgin, Illinois.

John Moeur, managing editor of the Daily Herald in Roanoke Rapids, North Carolina, suggested that 2007's top development was broader than those on the ballot - and distinctly bleak.

"In our opinion, the top story must reflect the nation's stifling problems and the inability of either the Bush administration or the Democrat-led Congress to find solutions other than bickering," he wrote on his ballot. Read more!

Kucinich's brother found dead - Associated Press

Brother was off medication for mental illness.

By M.R. KROPKO
December 19, 2007

CLEVELAND (AP) -- The youngest brother of Democratic presidential candidate Dennis Kucinich was found dead at his home Wednesday.

Perry Kucinich, 52, was found face down by another brother, Larry, at about 9 a.m., said Powell Caesar, a spokesman for the Cuyahoga County Coroner's office.

There were no signs of foul play, Caesar said. An autopsy was being performed Wednesday.

Larry Kucinich had taken his brother shopping Tuesday and then took him home but couldn't get an answer when he tried calling him Wednesday, Caesar said. He told officers his brother had a history of mental illness and had stopped taking his medication, according to a police report.

Dennis Kucinich took a flight from Washington to Cleveland after learning of the death, said his office press secretary, Natalie Laber.

"He was very close to Perry and he's taking this very hard," Laber said.

Kucinich, 61, is a six-term congressman from Ohio who is making his second bid for his party's nomination; he sought the nod in 2004. He registers in low single digits in polls and has raised little money for what is considered another long-shot run. Kucinich, who is known for his liberal views, has attracted a devoted following.

In a statement, Kucinich said his brother was a talented artist who recently had some of his works on display at a local art gallery.

"He had extraordinary insights. Although he struggled with mental illness, with the help of his family and friends, he was able to lead a productive life," Dennis Kucinich said.

Perry Kucinich was the fifth child of Frank and Virginia Kucinich. The family's struggles are discussed in Dennis Kucinich's recently released book, "The Courage to Survive."

Besides his brother Dennis, Perry Kucinich is survived by brothers Frank, Gary, and Larry, and by sisters Theresa and Beth Ann. They all live in northeast Ohio.

A Democratic rival, New Mexico Gov. Bill Richardson, offered condolences to Kucinich and his family. "Barbara and I will keep your family in our thoughts and prayers," Richardson said in a statement. Read more!

Despite Signs, Suicidal Soldier From N.C. Not Taken Out Of Iraq - Associated Press

SANFORD, N.C. -- Private First Class Jason Scheuerman nailed a suicide note to his barracks closet in Iraq, stepped inside and shot himself.

"Maybe finaly I can get some peace," said the 20-year-old, misspelling "finally" but writing in a neat hand.

His parents didn't find out about the note for well over a year, and only then when it showed up in a government envelope in his father's rural North Carolina mailbox.

The one-page missive was among hundreds of pages of documents the soldier's family obtained and shared with The Associated Press after battling a military bureaucracy they feel didn't want to answer their questions, especially this: Why did Jason Scheuerman have to die?

What the soldier's father, Chris, would learn about his son's final days would lead the retired Special Forces commando, who teaches at Fort Bragg, to take on the very institution he's spent his life serving -- and ultimately prompt an investigation by the Army Inspector General's office.

The documents, obtained by Freedom of Information Act requests filed by Chris Scheuerman, reveal a troubled soldier kept in Iraq despite repeated signs he was going to kill himself, including placing the muzzle of his weapon in his mouth multiple times.

Jason Scheuerman's story -- pieced together with interviews and information in the documents -- demonstrates how he was failed by the very support system that was supposed to protect him. In his case, a psychologist told his commanders to send him back to his unit because he was capable of feigning mental illness to get out of the Army.

He is not alone. At least 152 U.S. troops have taken their own lives in Iraq and Afghanistan since the two wars started, contributing to the Army's highest suicide rate in 26 years of keeping track. For the grieving parents, the answers don't come easily or quickly.

For Jason Scheuerman, death came on July 30, 2005, around 5:30 p.m., about 45 minutes after his first sergeant told the teary-eyed private that if he was intentionally misbehaving so he could leave the Army, he would go to jail where he would be abused.

When the call came out over the unit's radios that there had been a death, one soldier would later tell investigators he suspected it was Scheuerman.

Scheuerman spent his early years on military posts playing GI Joe. The middle child, he divided his time after his parents' divorce between his mother's house in Lynchburg, Va., and his father's in North Carolina where he went to high school.

He was nearly 6 feet tall and loved to eat. His mother, Anne, said sometimes at 10 p.m. she'd find him defrosting chicken to grill.

Likable and witty, he often joked around -- even dressing up like a clown one night at church camp, said his pastor, Mike Cox of West Lynchburg Baptist Church. But he had a quiet, reflective side, too, and sometimes withdrew, Cox said.

"You always knew how he felt. He wore his emotions on his sleeve," his mother said. "If he was angry, you knew it. If he was upset, you knew it."

Scheuerman liked military history and writing, but decided college wasn't for him. After a short stint in landscaping, he followed what seemed an almost natural path into the military. His mother had spent a year in the Army, and his father, a physician's assistant, retired as an Army master sergeant. One of his two brothers also joined and is now in Afghanistan.

He enlisted in 2004 and was sent to Iraq from Fort Benning, Ga., in January 2005 with the 3rd Infantry Division. On leave a few months later, Scheuerman told his father he was having a hard time with combat and killing people.

"I've seen war," his father said. "I told him that a lot of what he was seeing was normal. That we all feel it. That we're all afraid."

Back in Iraq, things didn't improve. One soldier -- whose name was blacked out on the documents like most others -- said he saw Jason put the muzzle of his rifle in his mouth, and told investigators other soldiers had seen him do something similar.

"He said it was a joke," the soldier said. "He said he had thought about it before but didn't have a plan to do it."

Scheuerman was reprimanded for not bathing or shaving and spending too much time playing videogames. He misplaced a radio and didn't wear parts of his uniform. Sometimes, Scheuerman was singled out for punishment, one soldier told an investigator. "I don't know why," the soldier said. Another said his noncommissioned officers were yelling at him "more days then not."

His platoon sergeant said in a disciplinary note that Scheuerman's actions put everyone in danger. "If you continue on your present course of action, you may end up in a body bag," he wrote.

In another, his squad leader said, "You have put me into a position where I have to treat you like a troublesome child. I hate being in this position. It makes me be someone I don't like."

Scheuerman was made to do push-ups in front of Iraqi soldiers, which humiliated him.

As he was punished, "it appeared as though he was out of touch with reality; in a world all his own," his platoon sergeant said in a report.

After the punishment, Scheuerman slept on the floor of his unit's operation's center in Muqdadiyah, about 60 miles north of Baghdad.

An Army chaplain who met with him about a month before he died said his mood had "drastically changed." He said Scheuerman demonstrated disturbing behavior by "sitting with his weapon between his legs and bobbing his head on the muzzle." He told Scheuerman's leaders to have his rifle and ammunition magazine "taken from him immediately" and for him to undergo a mental health evaluation.

Scheuerman checked on a mental health questionnaire that he had thoughts about killing himself, was uptight, anxious and depressed, had feelings of hopelessness and despair, felt guilty and was having work problems. But in person, the psychologist said, he denied having thoughts of suicide.

Less than a week later, Scheuerman's mother got an e-mail from her son telling her goodbye. She contacted a family support official at Fort Benning and later received a call saying her son had been checked and was fine. Later, her son sent her an instant message and said her phone call had made things worse.

The same day as her call, Scheuerman's company commander requested a mental evaluation, noting that the private was a "good soldier" but displays "distant, depression like symptoms."

Visiting with the psychologist for the second time, Scheuerman said he sometimes saw other people on guard duty that other soldiers do not see, suggesting he was hallucinating. And he said that if he wasn't diagnosed as having a mental problem, he was going to be in trouble with his leader. Yet he again denied being suicidal, the psychologist reported.

The psychologist determined Scheuerman did not meet the criteria for a mental health disorder, and that a screening test he had taken indicated he was exaggerating. He told Scheuerman's leaders he was "capable of claiming mental illness in order to manipulate his command."

Still, when he sent Scheuerman back to his barracks, he told the private's leaders that if Scheuerman claimed to be depressed, to take it seriously. He recommended Scheuerman sleep in an area where he could be watched, that most of his personal belongings and privileges be taken away for his safety.