Former Romanian priest jailed for exorcism murder of nun - CNN.com

Former priest jailed for seven years for murdering a young nun during an exorcism. Cornici, once treated for schizophrenia, believed she had heard the devil talk to her.

BUCHAREST, Romania (AP) -- A former priest began a seven-year jail term Wednesday for murdering a young nun during an exorcism ritual when she was bound, chained to a cross and denied food and water for days.

Irina Cornici, 23, died from dehydration, exhaustion and suffocation during an ordeal that stunned Romania and prompted the Orthodox Church to promise reforms and psychological tests to screen potential clergy.

The former priest, Daniel Corogeanu, and four nuns were all convicted and sentenced in September but Corogeanu was freed pending an appeal, which he lost Tuesday. He was picked up by police in the remote northeast Wednesday and sent to jail.

Cornici, who had previously been treated for schizophrenia, had believed she heard the devil talking to her. Corogeanu and the four nuns decided to try an exorcism ritual in June 2005 using techniques that the Romanian Orthodox Church condemned as "abominable".

The church, which has benefited from a religious revival in recent years, defrocked Corogeanu and excommunicated the four nuns, who in September were handed five- and six-year jail terms.

When arrested Wednesday, Corogeanu said he would serve his term if that was God's will, the national news agency Rompres reported.

Corogeanu, a Romanian, dropped out halfway through training for the priesthood, but still served as a priest for the secluded Holy Trinity convent in northeast Romania because of a shortage of suitable candidates for convents and monasteries.

Read more!

Britney Spears taken away in ambulance - AP

ASSOCIATED PRESS

LOS ANGELES — Britney Spears was taken from her home by ambulance early Thursday and escorted to a hospital by more than a dozen police officers.

A Los Angeles police officer, who spoke on condition of anonymity because he was not authorized to speak on the matter, said the 26-year-old pop star was being taken to “get help” but did not give the ambulance’s destination.

The Los Angeles Times, citing unidentified authorities, said Spears was taken to UCLA Medical Center to be placed on a “mental evaluation hold.” Center spokesman Mark Wheeler declined to comment to The Associated Press, citing privacy laws.

Spears’ police escort included motorcycles, two cruisers, and two helicopters.

On Jan. 3, police were called to her home when she refused to return her two young sons, Sean Preston, 2, and Jayden James, 1, to ex-husband Kevin Federline, who has custody.

Officers had paramedics haul Spears to a hospital for undisclosed reasons. She was released after a day and a half in Cedars-Sinai Medical Center.

Police also went to the home Monday night after someone reported a swarm of paparazzi trespassing in the singer’s gated community. When officers arrived, they didn’t see anyone trespassing, police said, but citations were issued for several illegally parked cars.

Spears has been in a highly public downward spiral since filing for divorce from Federline in November 2006.

Her bizarre antics include shaving her head bald, attacking a car with an umbrella and bringing along a paparazzo pal on trips to a courthouse in her child custody case.
Read more!

Murder-suicide initiator was AWOL -Billings (MT) Gazette

By RUFFIN PREVOST

CODY, WYO. - An active-duty sergeant in the U.S. Army had often threatened suicide in the days before killing his estranged wife and himself, according to witness statements in police reports.

The Lovell Police Department provided reports on its investigation of the Nov. 5 incident in which Sgt. Steven D. Lopez, 23, shot Brenda Lee Davila, 22, three times before turning the gun on himself outside Davila's Carmon Avenue residence.

Lovell Police Chief Nick Lewis declined to comment on the case.

The reports include accounts from those close to Lopez who say he was struggling with depression and had worried that he might kill Davila and himself.

Dispatch logs detail three phone calls to police over 11 days in October by Sgt. Clinton Ham, who was stationed with Lopez at Fort Bragg, N.C. Ham told police he had received text messages from Lopez stating that he was suicidal.

The Army's Criminal Investigation Division, an independent unit that investigates felony crimes involving Army personnel, is looking into the incident.

Chris Grey, CID public affairs chief, said he could not comment on the ongoing investigation.

Grey said the division conducts investigations "to get to the truth, whatever the circumstances, and to ensure we know exactly what transpired."

In mid-September, Davila left Fort Bragg, where the couple lived with their two young children. She returned to Lovell with the children, planning to seek a divorce, according to a police report.

It was a dispute over custody of the children that may have set Lopez off immediately before the incident, according to eyewitness accounts of the shooting.

Lopez was due Oct. 18 at Fort Leonard Wood, Mo., for basic noncommissioned-officer training, a course required for promotion to the rank of staff sergeant. He never showed up, and he returned later to Lovell instead.

Around Oct. 15, Lopez called Chelsea Wardell, a former girlfriend, and told her he was considering leaving the Army to return to Lovell, according to a statement Wardell gave Lewis on Nov. 7, two days after the shooting.

Wardell and Lopez were previously engaged, but after Lopez returned from a deployment to Afghanistan in 2003, they split. Lopez kept in touch with Wardell in the days before his death, speaking with her almost daily, she told Lewis.

On Oct. 19, the day the Army first listed Lopez as absent without leave, Ham contacted Lovell police inquiring if Lopez was in town. Ham called again on Oct. 20, asking police to help locate Lopez.

"I'm just trying to cover my ground to say, 'Hey, he's there with his wife, 'cause I know they got a little problem, or whatever the case may be,' " Ham said, according to a police log of the conversation.

Ham called again the afternoon of Oct. 29, requesting a welfare check of Lopez, who had sent text messages to Ham that he was suicidal. A log of that conversation between Ham and police was not available.

Later that afternoon, Lovell Police Officer Robert Bifano located Lopez and met briefly with him at the police station.

Lewis states in a report that he "never received any information that Steven Lopez was to be arrested on charges of being AWOL." Lewis has said that Lopez was not listed as missing or wanted in a national crime database.

A subsequent check of the database by the Federal Bureau of Investigation shows that Lopez was not entered in the system while AWOL, Lewis wrote in his report.

Because Lopez had not been missing for more than 30 days, he was listed as AWOL but not classified as a deserter, a status assigned after a month.

The Army typically does not actively search for soldiers listed as AWOL or deserters, said Lt. Col. George Wright, a public-affairs specialist at the Pentagon.

He said such soldiers could be arrested by local law enforcement and returned to military custody, but that an arrest often was dependent on a judgment call by local police.

Lewis said the day after the shooting that he was unaware of any meeting between Lovell police and Lopez. He later discussed with Bifano the Oct. 29 meeting.

"During our conversation about this incident, Officer Bifano told me that it appeared to him Steven Lopez was AWOL, but at the time of Officer Bifano's contact with Steven Lopez, he was not told to arrest and hold Steven Lopez for Sgt. Ham," Lewis wrote.

Saw counselor twice
Wardell told Lewis that she had urged Lopez to get mental-health counseling while he was still at Fort Bragg. She said he met twice with a counselor while there, but quit going, and did not discuss his suicidal feelings with Army doctors.

"Steven told her that if he were to admit he was suicidal to the Army counselors, he would be treated like 'trash,' " Lewis wrote.

Lopez also struggled with anger he felt toward Davila, Wardell told Lewis.

She told Lewis that Lopez "wanted to come back to Lovell and try and work things out between he and Brenda, but was afraid that he would kill Brenda," the report states.

The report details Wardell's account of an incident around Oct. 27 when she visited Lopez at his sister's apartment, where he was staying.

Wardell saw a pistol on a couch and was concerned that Lopez would use it to kill himself, so she tried to take it. A confrontation followed, during which Lopez again threatened suicide, even holding the gun to his head, the report states.

Wardell took the gun and gave it to Daniel Lopez, Steven's father, who later returned it to his son, according to statements in the report by Wardell and Amy Lopez, Steven's sister.

Preliminary information indicates the gun belonged to Steven Lopez, according to police reports.

Wardell also described Lopez as "taking any and as many prescription drugs that he could find," including seven Xanax anti-anxiety pills and eight OxyContin narcotic pain pills on one day the week before the shooting.

Witnesses to the shooting described Lopez as acting drowsy, and a police report lists a plastic bag containing four pills that match the description for generic Xanax as being recovered from the scene.

Big Horn County Coroner Del Atwood said in a letter that the final autopsy report on the case, including toxicology results, is not yet complete.

Atwood and Army investigators have declined to say when they will conclude their inquiries.

It is unclear whether Lewis has concluded his investigation, stating in a letter to Lovell City Attorney Sandra Kitchen that "the final investigative report is included in this packet" of documents requested by The Gazette.

But the report provided by Lewis concludes: "The investigation is in its preliminary stage and is not complete. This is a draft report."

Contact Ruffin Prevost at rprevost@billingsgazette.com or 307-527-7250.
Read more!

A tale of two deaths: Lives of two mental ill vets end tragically - Plano (TX) Star

By Lynn Proctor Windle, Staff Writer

In the hours leading up to Pat Ahrens’ death, he waged a desperate attempt to draw attention to what he described as the indifferent way the Veterans Administration treats veterans with mental issues.

Ahrens died Saturday night at a Plano hospital from a heart attack, family members said Monday. Details leading up to Ahrens’ heart attack were not released.

His crusade against the Veteran Affairs hospital began immediately after the death of another veteran, a man whom he had met only days before at the Dallas VA Medical Center where they were both patients in the hospital’s psychiatric ward. Ahrens had found the body of Christopher Nicholas Demopoulos hanging from the second story balcony of a local hotel.

“Would it be a bigger story if something happened to another one of us?” he asked in an interview on Friday afternoon with the Plano Star Courier.

During the interview, Ahrens admitted that he had stopped taking his medication for his bipolar disorder.

“I’m not going to be a zombie. I’m not going to be locked up behind doors and cameras,” he said. “I’m intelligent and complex, and I’m not going to be treated like an animal.”

Ahrens also admitted that in the hours following Demopoulos’ death, he had been drinking heavily.

During the three-hour interview with the Star Courier, Ahrens refused to answer whether he himself was still suicidal even though he had been released from the VA Medical Center just days before. “If I say yes, you’ll call the authorities. So no, I’m not suicidal. But I am at peace with God. I have no regrets,” he said.

Ahrens said that he was released from the Dallas VA on Jan. 22. He was committed to the hospital’s psychiatric unit the previous weekend.

“I came within one hour of committing suicide. My daughter saved my life,” he said.

Ahrens was released after the state’s three-day mandatory observation period.

“He shouldn’t have been out. They [the VA] don’t care,” Dawn Ahrens, Ahrens’ former wife, said via a phone interview also on Friday.

In a written statement, VA spokeswoman Susan Poff said, “We at VA North Texas Health Care System are deeply saddened by these families’ losses. Following these tragedies, we have been in contact with the family members to offer our support. We are also providing support for the VANTHCS staff that provided care to these veterans and are affected by their deaths.”

Ahrens said he was diagnosed with bipolar disorder five years ago. He had voluntarily checked himself into the VA hospital on several previous occasions.

Mrs. Ahrens, a registered nurse, blamed the couple’s breakup last year on the VA’s inability to adequately treat the disorder.

Two lost souls

During his most recent stay at the Dallas VA Medical Center, Ahrens made friends with three other vets. One in particular was Demopoulos, a 58-year-old former Marine from Hillsboro.

Cordelia Demopoulos said her husband was a Vietnam veteran who suffered from posttraumatic stress disorder. He had been in and out of the VA mental health care system for years.

Demopoulos’ latest ordeal began Dec. 14 when he was admitted to the VA facility in Waco. He was released a week later.

By Jan. 7, he was suicidal again, his wife said.

In a journal entry dated Jan. 3, Demopoulos wrote,” I could have used more sleep…I think I blew up very badly today. Must think. Must break through.”

Reading from his journal, Mrs. Demopoulos said her husband described racing thoughts and panic attacks. He also admitted to not taking his medication.

On the advice of her husband’s psychiatrist, she called the police to pick him up for involuntary commitment. He was admitted to the Dallas VA hospital, and again, released a week later, Mrs. Demopoulos said.

After an incident on Jan. 16, Mrs. Demopoulos again called police. When she left the room for a minute, Demopoulos stripped the wires from an electrical appliance and tried to electrocute himself, she said. Again, he was taken to the VA Center in Dallas.

Within a week, on Jan. 23, the hospital called saying he was ready to be released again.

Mrs. Demopoulos said she had no transportation and pleaded with the hospital to hold him for another 48 hours, but was told no. At the very least, she wonders why her son wasn’t called.

Ahrens said Demopoulos called him that morning asking for a ride back to his Hillsboro home.

“He was very depressed. He talked and listened to me,” Ahrens said. “He kept saying he was scared of his wife.”

Mrs. Demopoulos said she’s not surprised her husband would say that.

“It’s OK that he said he was afraid of me. He was afraid of his own dog. That’s part of the paranoia. He couldn’t separate reality from the demons inside of his mind,” she said.

Mrs. Demopoulos believes he was afraid she’d call the police again.

“No more chances. Got to figure out what’s wrong. I am wrong. She is right,” Mrs. Demopoulos said reading from his journal. In another entry he wrote, “I need to stop messing up,” she said.

Demopoulos called Ahrens a second time, around 3:15 p.m. and Ahrens said he picked him up about 45 minutes later.

“I told him I had good news and bad news. I told him that I had to go to confessional at St. Marks at 7 p.m. on Wednesday, and I couldn’t get to Hillsboro and back in time,” Ahrens said. “I told him that I had got him a room and some clothes.”

Ahrens said he gave the man some money for food and left him at the La Quinta Inn located in the 1800 block of U.S. 75.

“I had to make mass, but I called and checked on him afterward. I asked him if he’d eaten, and he said he went to Denny’s to eat.”

Ahrens said he called Demopoulos between 4:45 a.m. and 5 a.m. the following day. Demopoulos did not answer.

“I wanted to get an early start to Hillsboro because I didn’t want to be driving in rush hour traffic. “I went over there, and I saw the door to the room open about six inches, and then I saw him hanging from the balcony. I’m surprised no one else saw it.”

Ahrens said he first called a friend and then called 9-1-1.

Initially Mrs. Demopoulos said she did not believe Ahrens’ story. In the past when she couldn’t be reached, her husband would call other family members. She wonders why her husband was taken to a Plano hotel instead of to family members in Murphy, just 20 minutes away.

“Was Nicholas so disoriented that he couldn’t call my son? Was he so medicated that he didn’t know what was going on around him? He was so paranoid. Was he already so far gone that he couldn’t think straight? It doesn’t make sense how he ended up where he ended up. Why did he end up at a La Quinta? He knew he could go there [to family in Murphy.] This does not make sense,” she said.

“I think Patrick was scared. He tried to do what he thought was best, but he just got into something he didn’t know how to handle,” she said. “I don’t blame Patrick now. This was one veteran trying to help another. They were living with such demons and such nightmares. Two veterans are dead because the paranoia was too strong. I blame the Dallas VA. There are just too many questions. He’s as big a victim as Nicholas.”

Plano Police said they are awaiting a report from the Collin County Medical Examiner’s Office determining Demopoulos’ cause of death, and the case is still under investigation.

VA explains

Both Ahrens and Mrs. Demopoulos blamed the VA for its revolving door treatment of vets with mental issues.

Mrs. Demopoulos said her husband’s condition was ignored because the long-term in-patient treatment he needed was too expensive. She said the VA refused to give her husband 100 percent disability because that meant he would have received more benefits and treatment.

“He wasn’t worth the government’s money. Now he’s dead,” she said.

Poff said that isn’t the case at all. Citing federal patient privacy laws, she declined to discuss the specifics in either case, but said the VA system follows a standardized approach for suicide risk assessment.

“Level of treatment and/or treatment plan is not based upon a veteran’s disability rating. All patients with a primary diagnosis or presenting complaint of an emotional or behavioral problem are assessed for suicide risk,” she wrote.

The assessment includes evaluation and documentation of factors such as the patient’s intent and plan to commit suicide. Other considerations include risk factors, protective factors, the clinician’s overall impression, the patient’s immediate safety needs, and the most appropriate setting for treatment.

Ahrens complained that the VA would cancel appointments at the last minute and that appointments with psychiatrists had to be scheduled months in advance.

Poff disputed Ahrens claims. She said crisis cases are handled immediately.

“All patients and available family members are provided with instructions regarding crisis numbers and resources,” she wrote. “In the event of a mental health emergency, veterans are seen by a mental health provider and immediately admitted to the inpatient unit if indicated. All other veterans can be seen on the same day of their request for an appointment or will be given an appointment within 30 days if that is preferred by the veteran.”

Patients admitted to the Dallas facility for acute inpatient psychiatric care generally are suffering from “exacerbation of mental or substance abuse disorders that place them at high immediate risk of suicide, aggression, or dangerous withdrawal. Disorganized thinking or impaired judgment posing a substantial risk of harm may also constitute appropriate criteria for admission,” the statement said.

Patients stay an average of eight days. “However that varies from patient to patient, depending on the individual treatment plan. Criteria for discharge from the acute inpatient psychiatric care unit are stabilization of symptoms, and the patient is no longer at an immediate risk of suicide, aggression or dangerous withdrawal.”

Ahrens said that, medication was the only treatment option he was offered, but Poff said the VA offers many treatment options while inpatient.

“While under inpatient care, they participate in community meetings, medication, education, stress management and other groups,” she said.

Ahrens said he didn’t know what else would have helped him, but in his desperate hours, he only wanted to help others avoid the same fate.

In the wake of these twin tragedies, both families are left wondering why.

Mrs. Demopoulos said her husband’s death as left her heart broken, but hopes in the end something good will come of it.

“I don’t want him to be remembered just as the man found hanging at a local hotel,” she said.
Read more!

Officer’s Slaying Leaves New Orleans Asking Why - New York Times

By LESLIE EATON

NEW ORLEANS — On Monday morning, in a bleak shopping strip almost under the Pontchartrain Expressway, Bernel P. Johnson wrestled the gun away from a young police officer and shot her dead. When backup officers arrived, he handed them the weapon.

But Mr. Johnson, 44, who had a long history of psychiatric problems, was not supposed to be anywhere near that street or any other. Just three weeks earlier, on Jan. 4, the police “observed him to be mentally ill and dangerous to others,” said Dr. Jeffrey Rouse, the chief deputy coroner, who signed the papers committing Mr. Johnson to involuntary treatment.

He was sent to a state mental institution, to be confined until he was no longer a danger to himself or others. Somehow, for reasons that remain unclear, the institution released him before the shooting. Because of privacy laws, state officials are not saying which institution it was, or how the decision was made.

But the mental health system has been in chaos since Hurricane Katrina, and questions over these kinds of releases are adding to waves of grief, anger and fear that have swept over many in the city, even as it celebrates Mardi Gras.

James Arey, a psychologist and the commander of the Police Department’s crisis negotiation team, worked closely with the slain officer, Nicola Cotton, 24. He said Mr. Johnson appeared to have been improperly released from state care, even though he had allegedly threatened to kill police officers.

“The State of Louisiana had ample time to figure out this guy,” he said. “And because they weren’t doing their job, this officer, my friend, is dead.”

Police officers are furious over what they see as a shortage of acute-care psychiatric beds at the remaining public hospital in the city and a lack of follow-up treatment. A prominent judge says the parish jail has become a de-facto replacement for closed psychiatric wards, and the sheriff who runs the prison agrees.

State officials contend that they are struggling to rebuild the system, even as more people here are uninsured and so do not have access to other treatment. Doctors warn that the stress of living in a deeply damaged city, often without family and friends, is pushing people over the edge.

And some also say that since Hurricane Katrina, the city has been attracting transients with mental health problems, who end up homeless and troubled on the streets. Or, as Dr. Rouse puts it, “It’s almost as if New Orleans has become a magnet for chaos.”

In 2004, a mental patient shot LaToya Johnson, the first female officer to be killed here. Since then, Dr. Arey said, there have been seven deaths directly involving deranged people, “where there were gunfights with the police and we had to kill them, or they killed other people.”

He said he did not think that, proportionately, there had been an increase in the number of dangerous mentally ill people on the streets, but others, including Dr. Rouse, disagree.

Certainly, the number of mentally ill jail inmates has risen, said Marlin N. Gusman, the criminal sheriff for Orleans Parish.

He said that after the flooding shut down Charity Hospital and other treatment alternatives, families who were worried about disturbed relatives would end up calling the police. “The lack of alternatives makes us the provider of first resort,” he said.

Even before Katrina hit, mental health services for the poor in New Orleans were often criticized as inadequate — as they are in many big cities with large indigent populations. The police brought obviously disturbed people to the main public hospital, known as Big Charity, which had a floor devoted to short-term and long-term psychiatric care, including 97 acute-care beds.

According to the state, there were 555 public and private inpatient psychiatric beds in and around the city, as well as out-patient clinics and supervised living programs.

Louisiana State University, which ran Charity, contends that it was too badly damaged to reopen. The university did open an emergency room in nearby University Hospital and has been slowly adding beds for seriously ill patients, along with the state, bringing the total to 268.

The state has added 133 beds elsewhere in Louisiana to help, said Dr. Kathleen Crapanzano, medical director of the state Office of Mental Health.

But beds are not the only issue, Dr. Crapanzano said. Clinics are opening, but not necessarily full time. None of the private psychiatric facilities has returned. Insurance coverage is down, and stress is up. “We are slowly but surely rebuilding and adding services,” she said. “But the need is still great.”

The family of Bernel Johnson could not be reached for comment Wednesday. But a brother and sister told The Times-Picayune of New Orleans this week that he was a paranoid schizophrenic who had threatened to harm people and once shot himself in the chest. The family’s efforts to have him treated or confined had all failed, they said.

“This is a dangerous situation,” said Judge Arthur Hunter Jr., a former police officer who now presides over a special court dealing with mentally ill nonviolent people. “Citizens need to know how dangerous it is. They don’t.” Read more!

Study shows vaccine-autism link unlikely - LA Times

By Thomas H. Maugh II

New studies in infants show that the mercury used as a preservative in vaccines is cleared from the body at least 10 times faster than researchers had previously believed, a finding that casts further doubt on the theory that the preservative causes autism.

Researchers had believed that the ethyl mercury in the preservative thimerosal is metabolized in much the same way as the methyl mercury found in fish and other sources.

But the first study of ethyl mercury in children shows that levels of mercury in the blood are only a tenth as high as expected, and the toxic element is cleared out rapidly, according to a paper to be published Monday in the journal Pediatrics.

There is a "clear relationship" between the amount of mercury that must be in the blood, the length of time it must remain there, and the likelihood of it accumulating in the brain to cause damage, said Dr. Michael E. Pichichero of the University of Rochester in New York, the paper's lead author. "Now it's obvious that ethyl mercury's short half-life prevents toxic buildup from occurring. It's just gone too fast."

The bottom line, said Dr. William Schaffner of Vanderbilt University, who was not involved in the study, is that "this is yet another study added to the increasing stack of studies that are reassuring about thimerosal's safety."

But Isaac Pessah of the UC Davis MIND Institute pointed out that the researchers had only studied healthy children. They didn't address "the key issue of whether a subset of kids with metabolic disorders would handle it differently."

Like the authors, he also noted that they couldn't examine the brain and other organs for mercury accumulation.

Still, the findings should reassure parents of millions of infants around the world who receive vaccines with thimerosal even though it was eliminated from most childhood vaccines in the U.S. in 1999, Pichichero said. Removing thimerosal would raise prices and limit availability in poor countries.

Autism strikes as many as one in 167 children born in the U.S. Many parents link the increase in cases to past use of thimerosal in vaccines. The new study was designed to address those concerns.

It confirms previous findings of Pichichero and his colleagues in studies in rhesus monkeys and in a much smaller group of infants.

In the latest study, they examined 72 newborns, 72 2-month-old infants and 72 6-month-olds at R. Gutierrez Children's Hospital in Buenos Aires, where thimerosal is still used in vaccinations.

They found that blood mercury levels spiked shortly after vaccination -- although they remained much lower than levels of methyl mercury observed in other studies -- then dropped, with a half-life of 3.7 days. The half-life of methyl mercury, in contrast, is 44 days.

They also found that levels of mercury in the blood were about the same at birth, at 2 months and at 6 months.

"That's super-reassuring evidence that you don't accumulate mercury, you get rid of it," Schaffner said.

The researchers found no evidence of mercury in urine, indicating that the toxic metal was not coming into contact with the kidneys. Most of the mercury, they found, was eliminated through the feces.

Dr. Peter Hotez of the Sabin Vaccine Institute, who was not involved in the study, characterized it as "beating a dead horse."

"On the other hand, it is useful to know that ethyl mercury does not have the same metabolism as methyl mercury," he said.

The study was funded by the National Institutes of Health. The researchers said they had in the past been paid for consulting with vaccine manufacturers.

thomas.maugh@latimes.com Read more!

TBI symptoms might really be PTSD,docs say - Associated Press

By Marilynn Marchione

The role of traumatic brain injury — blamed for symptoms plaguing thousands of soldiers returning from Iraq — might be overstated, contends a provocative military study that offers hope for successful treatment.

In many cases, post-traumatic stress and depression may be driving the symptoms, doctors reported Wednesday. And that’s good news because those are treatable.

The study by U.S. military doctors was praised by outside experts who found the conclusions convincing.

Returning soldiers have struggled with memory loss, irritability, trouble sleeping and other problems. Many have suffered mild blast-related concussions, but there is no easy way to separate which symptoms are due to physical damage and which are from mental problems caused by the traumatic stress of war. Imaging of the brain is being tested, but hasn’t yet proven to be helpful.

The new study, based on a survey of 2,525 soldiers, found that brain injury made traumatic stress more likely. The study tied only one symptom — headaches — specifically to brain injury.

“We found that the symptoms and health concerns that we expected to be due to the concussion actually proved to be more strongly related to PTSD,” or post-traumatic stress disorder, and depression, said Dr. Charles Hoge, a colonel and psychiatry chief at Walter Reed Army Institute of Research who led the study. “There isn’t a clear delineation between a psychological and a physical problem.”

Other doctors were optimistic about treatment efforts.

“It gives us hope because we’ve got good treatments for PTSD,” said Barbara Rothbaum, a psychologist who heads a trauma recovery program at Emory University in Atlanta. “If we can relieve the PTSD and depression, I’m hoping we’ll see alleviation of a lot of these physical symptoms.”

Hoge reported on the survey Wednesday at a military health conference in Washington. Results also were published in Thursday’s New England Journal of Medicine.

The journal’s editor-in-chief, Dr. Jeffrey Drazen, said editors initially were skeptical of the findings, which depart from the gloom-and-doom picture some have painted for soldiers with brain injuries.

However, the solid research methods and the “strong and robust” data linking stress and concussion symptoms persuaded them, said Drazen, who is a scientific adviser to the Veterans Administration.

The case of Eric O’Brien, a 33-year-old Army staff sergeant from Iowa’s Quad Cities, suggests the researchers may be right.

After an explosion in Baghdad in 2006, O’Brien was treated at Vanderbilt University’s brain injury rehabilitation program and at Fort Campbell, Ky., for post-traumatic stress. Now he is preparing to redeploy, this time to Afghanistan.

“I retested on a lot of the tests and they showed a pretty decent increase,” he said of his mental function tests. As for stress, “I don’t know if it’s something you just learn to deal with or if it just gets a little bit better over time,” he said. “It’s not as bad as it was.”

The vast majority of brain injuries, or concussions, are mild, but the military previously estimated that one-fifth cause symptoms lasting a year or more.

The new study tried to pin down the potential long-term effects of mild brain injury, through an anonymous survey of two Army combat brigades — one active and one Reserve — in 2006, several months after they returned home from Iraq.

Fifteen percent of soldiers reported a mild brain injury — having been knocked unconscious or left confused or “seeing stars” after a blast. They were more likely than other soldiers to report health problems, missing work, and symptoms such as trouble concentrating.

The worst symptoms were in soldiers who lost consciousness. About 44 percent of them met the criteria for post-traumatic stress, compared with 16 percent of soldiers with non-head injuries, and only 9 percent of those with no injuries.

“The same incident might have triggered both processes,” Rothbaum said, noting that after World War I, “they thought that shell shock was a neurological disorder and it turned out to have a lot of overlap with the psychological disorder.”

However, Dr. Greg O’Shanick, a psychiatrist and medical director for the advocacy group Brain Injury Association of America, said it would be over-simplifying to think that treating PTSD alone would be enough.

“It’s like having fleas and ticks,” he said. Getting rid of one may not make you stop itching, “and if you’ve got one, it makes it harder to handle the other.”

Concussions may compound stress by damaging brain areas that tamp down responses to fear, Richard Bryant, a psychologist at the University of New South Wales in Sydney, Australia, writes in an editorial in the journal.

“PTSD and depression may be the primary problem,” he writes. “Soldiers should not be led to believe that they have a brain injury that will result in permanent change.”

The military recently started screening all returning troops for concussions. Any soldiers who saw intense combat should be similarly checked for stress disorder, said Anthony Stringer, director of Emory University’s neuropsychology rehabilitation program.

The new study can be viewed as positive “if the results are used to make sure that soldiers have the care they need when they return,” he said.
PrintPrintEmailEmail
RedditRedditDiggDigg


Digg
Advertisement
Subscribe Today! Just $1.07 per week.
Classifieds

* Announcements
* Attorneys
* Automobiles
* Business
* Computers
* Education

* Employment
* Financial Services
* Mail Order Market
* Milestones
* Real Estate
* Travel

Marketplace
Mil-Mall

promo Heroes Among Us
Over one million Americans have served in Iraq and Afghanistan in the past four years, but fewer than 500 have earned a Silver Star, Navy Cross, Air Force Cross, Distinguished Service Cross, or the Medal of Honor. These are their stories of extraordinary courage under fire.
Military Discounts

Save on your purchases!
In honor of your military service, you can find regular and name brand products at a special discount.
Coupons

Instant Savings
Coupons from local markets and national brands such as General Mills and Betty Crocker.
Shoplocal
Shop Local
Local Online Deals
Find the best deals at your local stores.
Read more!

Defense: Fisher-Riza bipolar on day of chase -Cleburne (TX) Times-Review

By Leia Jobe/reporter2@trcle.com

An attorney for the woman accused of leading police on a high-speed chase in April that resulted in the death of her 9-month-old child argued the woman ran from police because she was bipolar.

Opening arguments for Aimee Andrea Fisher-Riza’s murder trial were heard Tuesday in Judge William C. Bosworth’s 413th District Court in Cleburne.

Prosecutors said she ran because she stole money from the department store where she worked.

Fisher-Riza, 36, faces charges of evading arrest and felony murder. She led Somervell and Johnson County officers on a 40 minute chase April 6 that ended in a crash in Alvarado. Her 9-month old daughter, Alexxus, was ejected and died.

“On April 6, 2007, Aimee Fisher was in a severe manic state of her bipolar disorder,” her attorney, Bill Mason, said in his opening argument. “She was psychotic, delusional and became paranoid, which are symptoms of psychosis.”

Mason said she thought the police were going to kill her. Fisher-Riza could not see what was going on behind her because the mirrors in her new black sport-utility vehicle had not yet been adjusted from the position the dealer put them in, he said.

Assistant District Attorney Martin Strahan said Fisher-Riza stole money from the Goody’s department store in Brownwood, which she managed, and that her reckless driving caused Alexxus’ death, who was sitting unrestrained in the front seat.

Strahan said Fisher-Riza stole between $28,000 and $30,000 from Goody’s and at the time of the chase had $9,000 in stolen money with her in the car, which is why she ran after police tried to stop her for speeding.

Strahan said jurors would probably see some video of the chase later and that they should be prepared to see some gruesome images of the crash scene.

“We’re here to ask for justice for Alexxus Riza, who was almost 10 months old at the time of the crash,” Strahan said.

Fisher-Riza cried as Strahan presented his argument to the jurors, but lifted her head as Mason argued in her defense.

Jury selection began at 10 a.m. Monday and lasted until 7 p.m., District Attorney Dale Hanna said.

“It was an unusually long selection process,” he said. Read more!

State hospital cemetery needs repairs -KENS-TV San Antonio

Watch Video Here.
01/30/2008

James Munoz
KENS 5 Eyewitness News

It's been around for a long time but seems to have been forgotten. Now there are calls for an old cemetery off South New Braunfels and I-37 to be cleaned up.

Mount Calm East dates back to 1924. It is the final resting place for hundreds of mentally ill patients who died at the San Antonio State Hospital.

One woman says the state needs to do a better job of maintaining the cemetery.

"It's inappropriate and inexcusable for the state to allow this to happen. It's just not right," Sarah Reveley said.

Finding the cemetery isn't easy. An unpaved dirt road behind a park leads to the locked and gated cemetery.

"My biggest concern is that it's ignored," Reveley said.

Reveley says cemeteries are supposed to be open to the public.

"This lock does not allow that, and this barbed wire is terrible, you feel like they're in prison," she said.

The fence isn't working anyway; there's a hole in the back.

More coverage
KENS video: Watch the broadcast

Reveley is concerned a stack of grave markers is proof the headstones are not being properly replaced.

"Who's buried here, do their families know?" Reveley said.

From 1924 to 1989 everyone buried at the cemetery was only assigned a number.

"And these numbers, these people had names," she said.

Most private cemeteries straighten headstones on a daily basis. Reveley says the San Antonio State Hospital should be able to handle the simple task.

"This is rest in peace? Well this is not the American way," she said.

A spokesperson for the San Antonio State Hospital says restoring the cemetery is a top priority. They're currently looking for community partners to support the project.
Read more!

Soldier Suicides at Record Level - Washington Post

Increase Linked to Long Wars, Lack of Army Resources

By Dana Priest
Washington Post Staff Writer
Thursday, January 31, 2008; A01

Lt. Elizabeth Whiteside, a psychiatric outpatient at Walter Reed Army Medical Center who was waiting for the Army to decide whether to court-martial her for endangering another soldier and turning a gun on herself last year in Iraq, attempted to kill herself Monday evening. In so doing, the 25-year-old Army reservist joined a record number of soldiers who have committed or tried to commit suicide after serving in Iraq or Afghanistan.

"I'm very disappointed with the Army," Whiteside wrote in a note before swallowing dozens of antidepressants and other pills. "Hopefully this will help other soldiers." She was taken to the emergency room early Tuesday. Whiteside, who is now in stable physical condition, learned yesterday that the charges against her had been dismissed.

Whiteside's personal tragedy is part of an alarming phenomenon in the Army's ranks: Suicides among active-duty soldiers in 2007 reached their highest level since the Army began keeping such records in 1980, according to a draft internal study obtained by The Washington Post. Last year, 121 soldiers took their own lives, nearly 20 percent more than in 2006.

At the same time, the number of attempted suicides or self-inflicted injuries in the Army has jumped sixfold since the Iraq war began. Last year, about 2,100 soldiers injured themselves or attempted suicide, compared with about 350 in 2002, according to the U.S. Army Medical Command Suicide Prevention Action Plan.

The Army was unprepared for the high number of suicides and cases of post-traumatic stress disorder among its troops, as the wars in Iraq and Afghanistan have continued far longer than anticipated. Many Army posts still do not offer enough individual counseling and some soldiers suffering psychological problems complain that they are stigmatized by commanders. Over the past year, four high-level commissions have recommended reforms and Congress has given the military hundreds of millions of dollars to improve its mental health care, but critics charge that significant progress has not been made.

The conflicts in Iraq and Afghanistan have placed severe stress on the Army, caused in part by repeated and lengthened deployments. Historically, suicide rates tend to decrease when soldiers are in conflicts overseas, but that trend has reversed in recent years. From a suicide rate of 9.8 per 100,000 active-duty soldiers in 2001 -- the lowest rate on record -- the Army reached an all-time high of 17.5 suicides per 100,000 active-duty soldiers in 2006.

Last year, twice as many soldier suicides occurred in the United States than in Iraq and Afghanistan.

Col. Elspeth Cameron Ritchie, the Army's top psychiatrist and author of the study, said that suicides and attempted suicides "are continuing to rise despite a lot of things we're doing now and have been doing." Ritchie added: "We need to improve training and education. We need to improve our capacity to provide behavioral health care."

Ritchie's team conducted more than 200 interviews in the United States and overseas, and found that the common factors in suicides and attempted suicides include failed personal relationships; legal, financial or occupational problems; and the frequency and length of overseas deployments. She said the Army must do a better job of making sure that soldiers in distress receive mental health services. "We need to know what to do when we're concerned about one of our fellows."

The study, which the Army's top personnel chief ordered six months ago, acknowledges that the Army still does not know how to adequately assess, monitor and treat soldiers with psychological problems. In fact, it says that "the current Army Suicide Prevention Program was not originally designed for a combat/deployment environment."

Staff Sgt. Gladys Santos, an Army medic who attempted suicide after three tours in Iraq, said the Army urgently needs to hire more psychiatrists and psychologists who have an understanding of war. "They gave me an 800 number to call if I needed help," she said. "When I come to feeling overwhelmed, I don't care about the 800 number. I want a one-on-one talk with a trained psychiatrist who's either been to war or understands war."

Santos, who is being treated at Walter Reed, said the only effective therapy she has received there in the past year have been the one-on-one sessions with her psychiatrist, not the group sessions in which soldiers are told "Don't hit your wife, don't hit your kids," or the other groups where they play bingo or learn how to properly set a table.

Over the past year, the Army has reinvigorated its efforts to understand mental health issues and has instituted new assessment surveys and new online videos and questionnaires to help soldiers recognize problems and become more resilient, Ritchie said. It has also hired more mental health providers. The plan calls for attaching more chaplains to deployed units and assigning "battle buddies" to improve peer support and monitoring.

Increasing suicides raise "real questions about whether you can have an Army this size with multiple deployments," said David Rudd, a former Army psychologist and chairman of the psychology department at Texas Tech University.

On Monday night, as President Bush delivered his State of the Union address and asked Congress to "improve the system of care for our wounded warriors and help them build lives of hope and promise and dignity," Whiteside was dozing off from the effects of her drug overdose. Her case highlights the Army's continuing struggles to remove the stigma surrounding mental illness and to make it easier for soldiers and officers to seek psychological help.

Whiteside, the subject of a Post article in December, was a high-achieving University of Virginia graduate, and she earned top scores from her Army raters. But as a medic in charge of a small prison team in Iraq, she was repeatedly harassed by one of her commanders, which disturbed her greatly, according to an Army investigation.

On Jan. 1, 2007, weary from helping to quell riots in the prison after the execution of Saddam Hussein, Whiteside had a mental breakdown, according to an Army sanity board investigation. She pointed a gun at a superior, fired two shots into the ceiling and then turned the weapon on herself, piercing several organs. She has been at Walter Reed ever since.

Whiteside's two immediate commanders brought charges against her, but Maj. Gen. Eric B. Schoomaker, the only physician in her chain of command and then the commander of Walter Reed, recommended that the charges be dropped, citing her "demonstrably severe depression" and "7 years of credible and honorable service."

The case hinged in part on whether her mental illness prompted her actions, as Walter Reed psychiatrists testified last month, or whether it was "an excuse" for her actions, as her company commander wrote when he proffered the original charges in April. Those charges included assault on a superior commissioned officer, aggravated assault, kidnapping, reckless endangerment, wrongful discharge of a firearm, communication of a threat and two attempts of intentional self-injury without intent to avoid service.

An Army hearing officer cited "Army values" and the need to do "what is right, legally and morally" when he recommended last month that Whiteside not face court-martial or other administration punishment, but that she be discharged and receive the medical benefits "she will desperately need for the remainder of her life." Whiteside decided to speak publicly about her case only after a soldier she had befriended at the hospital's psychiatric ward hanged herself after she was discharged without benefits.

But the U.S. Army Military District of Washington, which has ultimate legal jurisdiction over the case, declined for weeks to tell Whiteside whether others in her chain of command have concurred or differed with the hearing officer, said Matthew MacLean, Whiteside's civilian attorney and a former military lawyer.

MacLean and Whiteside's father, Thomas Whiteside, said the uncertainty took its toll on the young officer's mental state. "I've never seen anything like this. It's just so far off the page," said Thomas Whiteside, his voice cracking with emotion. "I told her, 'If you check out of here, you're not going to be able to help other soldiers.' "

Whiteside recently had begun to take prerequisite classes for a nursing degree, and her mental stability seemed to be improving, her father said. Then late last week, she told him she was having trouble sleeping, with a possible court-martial weighing on her. On Monday night, she asked her father to take her back to her room at Walter Reed so she could study.

She swallowed her pills there. A soldier and his wife, who live next door, came to her room and, after a while, noticed that she was becoming groggy, Thomas Whiteside said. When they returned later and she would not open the door, they called hospital authorities.

Yesterday, after having spent two nights in the intensive care unit, he said, his daughter was transferred to the psychiatric ward.

Whiteside left two notes, one titled "Business," in which her top concern was the fate of her dog. "Appointment for the Vetenarian is in my blue book. Additional paperwork on Chewy is in the closet at the apartment in a folder." On her second note, she penned a postscript: "Sorry to do this to my family + friends. I love you."

Read more!

Family torn apart with issues posed by mentally ill child - Oscoda (MI) Press

Jan. 30, 2008
by Holly Nelson

HALE - Living with a handicapped and mentally ill child is challenging, according to a Hale mother, but never more so than now that it has, literally, torn her family apart.

Starla Hawley had quite a time the past few weeks, since being given an ultimatum concerning her 18-year-old son, Nathan Pemberton, who suffers from retardation and mental illness.

She is beginning to see daylight, but said she knows the challenges will never be over.

Two different dramas have been unfolding in the single-parent household.

First, Hawley contends, she was told to either turn her son out of the house or lose her three daughters, ages 13, 15 and barely 17.

Then Nathan was arrested for crimes - which may have been the result of others taking advantage of his trusting nature.

Nathan’s intelligence quotient (IQ) is 49, a number shared by less than one percent of the population.

According to Dr. Arthur Jenson, in his book “Straight Talk about Mental Tests”, an IQ of 50 or below is the threshold below which most adults cannot cope outside an institution.

In terms of age, Hawley’s son will always think and learn like a second or third grader.

That’s not his only problem. According to Hawley and as documented by mental health professionals, Nathan has also been diagnosed with schizophrenia, which is an incurable mental illness in which the interpretation of reality is abnormal and can lead to delusions and hallucinations. He suffers from bipolar disorder - which comes with extreme mood swings from mania to depression. And he is diagnosed with attention-deficit/hyperactivity disorder (ADHD), oppositional defiancy disorder, nonverbal learning disorder (NLD) and intermittent explosive disorder - a genetic condition characterized by repeated episodes of aggressive, violent behavior which is grossly out of proportion to the situation.

Nathan has been in the mental health system since he was just five years old. Medication helps control his symptoms, but nothing completely stops the violent outbursts and hallucinations - which have led to plenty of holes in the drywall and can be triggered by something as common as an echo.

His mental health problems have also resulted in Nathan shoving his sisters.

Usually, Nathan said, he can sense when he is becoming angry, “so I go to my bedroom and punch the walls,” he says.

This has been going on for 13 years, but now that Nathan is an adult, at least in the eyes of the law, it led to someone reporting him to the Iosco County Department of Human Services’ Child Protective Services (CPS) division.

The CPS worker told Hawley - remove Nathan or move the girls, also threatening that failure to act would lead to the state taking her daughters, she said.

Hawley has a long list of the agencies she contacted in an effort to find a safe place for Nathan, all without success.

Ultimately, she found temporary housing for her daughters with friends in Bad Axe and Twining.

The girls didn’t want to go, according to Hawley, but she did not want to lose them.

She gave the friends signed consents and powers of attorney to make decisions on her daughters’ behalf, but temporariness of the situation and the documents were not sufficient to enroll the girls in school.

“My girls are being denied an education,” Hawley cried. “It’s hard. They want to come home. And what about truancy laws?”

“The school’s [Hale Area] on my side. They’re making calls and trying to help,” she said.

Hawley said nothing has worked and she is being torn in half.

AuSable Valley Community Mental Health denied her request for emergency placement of Nathan - since there was no imminent danger to him or others.

The agency is, however, working to place him in a group home, where he can also be taught life skills. Hawley has been told this could take another month - 30 more days her girls would miss classes.

So Hawley got back on the phone. This time, she reached a state ombudsman. The advocate, upon learning that the CPS caseworker did not have a court order, told her the girls did not have to leave the house, according to Hawley.

One problem potentially solved, at least temporarily.

The other is not going to be so easy.

Nathan is trusting and easily manipulated, according to his mother and others who have worked with him over the years.

“He’s like a puppy dog. He trusts everybody and pretty much does whatever he’s told, as long as somebody is there to remind him,” Hawley said.

“But you could see him set something on fire and say to him, ‘That’s dangerous, Nathan.’ He agrees with you, but he doesn’t understand. That’s the NLD.”

This trait is evident in meeting Nathan. He is engaging, friendly and cooperative. Ask him anything - no matter how potentially damaging the answer might be - and he will candidly respond.

His memory is good, both regarding his own actions and what he has been told. He also appears articulate, until you realize he is merely repeating what he has heard from others.

His mother blames his current legal woes on people who deliberately use him, one young couple in particular.

Nathan would pay the pair to provide him with transportation, such as taking him to a store. He has also given them money because they needed gas, he said.

It was this couple who, after learning that Nathan receives a monthly government check, took him to the bank where it is directly deposited. There, the female half of the couple aided him in opening a checking account - all without the knowledge of his mother.

Nathan does not know how to add and subtract, Hawley said. He can scarcely read.

They also “helped” Nathan issue an $800 non-sufficient fund check to buy a four-wheeler.

Nathan was arrested on Jan. 15, charged with uttering-and-publishing, forgery and larceny in a building. If convicted of the felonies, he could be sentenced to as much as 14 years in prison.

According to Nathan, he was at a man’s house where kids hang out when he found a checkbook on the floor of a porch. The man was gone, so Nathan put the checks in his pocket.

Later, he said, his friends took one of the checks and the woman wrote it out for $250. The woman then asked Nathan to endorse it and she and her boyfriend took him to a bank. The teller refused to cash it. When he told the waiting pair, they instructed him to go back inside and retrieve the check. He tried, but says the teller refused to give it to him.

Later, a state trooper showed up at the Hawley residence and questioned Nathan about the check. He says he told the trooper that he did endorse it and attempted to cash it, but that he also explained he did not write out the check and named the person who did.

The trooper’s request for a warrant reflects Nathan’s admission, but not his alleged statements about who wrote out the check.

Nathan spent two nights in jail - without his medication - before his mother was able to arrange for his release on bond.

He was assigned a public defender who, according to Hawley, failed to inform the court of Nathan’s mental health status and was proceeding as though the young man were mentally competent.

In fact, Hawley said, the attorney was planning to have Nathan plead guilty to reduced charges.

Hawley subsequently found another attorney who, upon learning of the circumstances, agreed late last week to represent Nathan without charge.

In the interim, the mail brought more bad news - a notice from a Hale store than Nathan must make restitution for two $100 checks.

According to Nathan, this same couple suggested he could get himself and them some cash by signing one of his own checks. He did and the woman took it into a store while he and the man waited in a car outside.

“When [the woman] came out, she said they don’t cash two-party checks and wouldn’t give her any money,” he said. “I asked for my check back, but [she] said she tore it up. I don’t know where she got the other one. Maybe I dropped it.”

The copies of the checks sent him by the store show his signature on one, with the payee’s name and amount in different handwriting. The second check also appears to bear his signature; however, Nathan denies signing it. It was also made payable to the woman, with the name and amount in different handwriting.

Hawley contacted the store and learned that both checks were passed by the woman. She said the store owner agreed not to prosecute if restitution is made.

When he learned of the two checks, Nathan said, he confronted the pair. In doing so, he admitted he became angry, especially after the woman contended that he had given her the checks as payment for something.

“I did no such thing and she knows it. I was rude,” he said. “They told me to leave or they’d have me put in jail for assault and battery, so I left. I shouldn’t have been rude. I shouldn’t have called [the woman] names. I called [the woman] this morning and I told her I was very, very sorry I was rude.”

Nathan’s dog, Buddy, pressed against his master’s knee as he spoke. On Buddy’s white back were Xs drawn with a marker.

“Buddy and I were playing Tic, Tac, Toe,” Nathan explained when asked why.

After contacting the store, Hawley called the state police, seeking to have the pair charged with forgery. There will be no investigation, however, because the trooper told her that, to pursue the case, would mean Nathan would also have to go to jail, she alleges.

So, Hawley said, they are simply going to scrape together the restitution sought by the store.

Hawley has had to fight for Nathan since violent outbursts led to his diagnosis at the age of five.

This has, she said, become a way of life, one which she does not always have the education and knowledge to deal with.

“It’s chaos. I’m doing what I can do. It’s frustrating,” she said.

According to Hawley, it would be much easier if people on all levels develop a better understanding of mental illness, especially within the system.

Meanwhile, she is asking people if they think the CPS caseworker will make good on his threats, given AuSable Valley’s promise to look for a group home placement for Nathan.

She is hoping not, since she plans to bring the girls home and get them back in school yet this week.

“I love my children,” she said. “I shouldn’t have to choose between them.” Read more!

Lilly in Settlement Talks With U.S. - New York Times

By ALEX BERENSON
01/30/08

Eli Lilly and federal prosecutors are discussing a settlement of a civil and criminal investigation into the company’s marketing of the antipsychotic drug Zyprexa that could result in Lilly’s paying more than $1 billion to federal and state governments.

If a deal is reached, the fine would be the largest ever paid by a drug company for breaking the federal laws that govern how drug makers can promote their medicines.

Several people involved in the investigation confirmed the settlement discussions. They insisted on anonymity because they have not been authorized to talk about the negotiations.

Zyprexa has serious side effects and is approved only to treat people with schizophrenia and severe bipolar disorder. But documents from Lilly show that between 2000 and 2003, Lilly encouraged doctors to prescribe Zyprexa to people with age-related dementia, as well as people with mild bipolar disorder who had previously been diagnosed only as depressed.

Although doctors can prescribe drugs for any use once they are on the market, it is illegal for drug makers to promote their medicines any uses not formally approved by the Food and Drug Administration.

Lilly may also plead guilty to a misdemeanor criminal charge as part of the agreement, the people involved with the investigation said. But the company would be allowed to keep selling Zyprexa to Medicare and Medicaid, the government programs that are the biggest customers for the drug. Zyprexa is Lilly’s most profitable product and among the world’s best-selling medicines, with 2007 sales of $4.8 billion, about half in the United States.

Lilly would neither confirm nor deny the settlement talks.

“We have been and are continuing to cooperate in state and federal investigations related to Zyprexa, including providing a broad range of documents and information,” Lilly said in a statement Wednesday afternoon. “As part of that cooperation we regularly have discussions with the government. However, we have no intention of sharing those discussions with the news media and it would be speculative and irresponsible for anyone to do so.”

Lilly also said that it had always followed state and federal laws when promoting Zyprexa.

The Lilly fine would be distributed among federal and state governments, which spend about $1.5 billion on Zyprexa each year through Medicare and Medicaid.

The fine would be in addition to $1.2 billion that Lilly has already paid to settle 30,000 lawsuits from people who claim that Zyprexa caused them to suffer diabetes or other diseases. Zyprexa can cause severe weight gain in many patients and has been linked to diabetes by the American Diabetes Association.

Prescriptions for Zyprexa have skidded since 2003 over concerns about those side effects. But the drug continues to be widely used, especially among severely mentally ill patients. Many psychiatrists say that it works better than other medicines at calming patients who are psychotic and hallucinating. About four million Zyprexa prescriptions were written in the United States last year.

Federal prosecutors in Philadelphia are leading the settlement talks for the government, in consultation with the Department of Justice headquarters in Washington. State attorneys general’s offices are also involved. Lawyers at Pepper Hamilton, a firm based in Philadelphia, and Sidley Austin, a firm based in Chicago, are negotiating for Lilly.

Nina Gussack, who is representing Lilly at Pepper Hamilton, said she could not comment on the case. Joseph Trautwein, an assistant United States attorney in the Eastern District of Pennsylvania, also declined to comment.

While a settlement has not been concluded and the negotiations could collapse, both sides want to reach an agreement, according to the people involved in the investigation. Besides the escalating pressure of the federal criminal inquiry, Lilly faces a civil trial scheduled for March in Anchorage, Alaska, in a lawsuit brought by the state of Alaska to recover money the state has spent on Zyprexa prescriptions. A loss in that lawsuit would damage Lilly’s bargaining position in the Philadelphia talks.

While expensive for Lilly, the settlement would end a four-year federal investigation and remove a cloud over Zyprexa. While Zyprexa prescriptions are falling, its overall dollar volume of sales is rising because Lilly has raised Zyprexa’s price about 40 percent since 2003.

Federal prosecutors have been investigating Lilly for its marketing of Zyprexa since 2004, and state attorneys general since 2005. The people involved in the investigations said the inquiries gained momentum after December 2006, when The New York Times published articles describing Lilly’s multiyear efforts to play down Zyprexa’s side effects and to promote the drug for conditions other than schizophrenia and severe bipolar disorder — a practice called off-label marketing.

Internal Lilly marketing documents and e-mail messages showed that Lilly wanted to convince doctors to prescribe Zyprexa for patients with age-related dementia or relatively mild bipolar disorder.

In one document, an unidentified Lilly marketing executive wrote that primary care doctors “do treat dementia” but leave schizophrenia and bipolar disorder to psychiatrists. As a result, “dementia should be first message” to primary-care doctors, according to the document, which appears to be part of a larger marketing presentation but is not marked more specifically. Later, the same document says that some primary care doctors “might prescribe outside of label.”

In late 2000, Lilly began a marketing campaign called Viva Zyprexa and told its sales representatives to suggest that doctors prescribe Zyprexa to older patients with symptoms of dementia.

The documents were under federal court seal when The Times published the articles, and Judge Jack B. Weinstein of Federal District Court in Brooklyn rebuked The Times for publishing them.

The settlement negotiations in Philadelphia began several months ago, according to the people involved in the investigation.

Last fall, the two sides were close to a deal in which Lilly would have paid less than $1 billion to settle the case, which at the time consisted only of a civil complaint.

Then Justice Department lawyers in Washington pressed for a grand jury investigation to examine whether Lilly should be charged criminally for its promotional activities, according to the people involved in the negotiations. A few days ago, facing the possibility of both civil and criminal charges, Lilly opened new discussions with the prosecutors in Philadelphia. Read more!

Insanity ruling leaves Lee's Lopez not guilty - Ft. Myers (FL) News Press

January 30, 2008

A Lee County circuit judge decided that a teen who stabbed to death his best friend 145 times in 2002 is not guilty by reason of insanity.

Mario Lopez, now 21, was 15 when he was at his friend Joey Martins’ house in Cape Coral on May 6, 2002. The two got into an argument after playing a video game and Lopez grabbed kitchen knives, breaking several, and stabbed Martins across his body.

Martins’ mother, Darlene, who was upstairs taking a shower, came downstairs to discover her son being killed.

Prosecutors and Lopez’s defense team battled three times in 2006, with all three trials ending in a mistrial. Doctors testified that Lopez is psychotic and suffers from either paranoid schizophrenia or bipolar disorder.

Lee County Circuit Judge Edward Volz ruled in an order, filed Tuesday, that Lopez will be committed to the Department of Children and Families for placement in a facility to cure him of his mental disease. The judge wrote that he wants a report within six months of his status. Read more!

Suspect's life seemed normal just hours before shooting rampage - Monroe (LA) News-Star

By Robbie Evans
revans@thenewsstar.com

COLUMBIA — Raymond G. Hodges seemed like a quiet man who was always happy and smiled a lot.

Even up to a couple of hours before Hodges went on a multi-parish shooting spree — wreaking havoc on a highway between Columbia and Monroe — Hodges' life seemed normal.

He had spent most of the morning hog hunting.

But between 10 a.m. and noon, something changed.

Within a span of less than an hour, Hodges had fired upon four motorists and left one in critical condition with a shotgun wound to the head.

"He always acted normal and fine when I saw him," said David Ester, a clerk at a Columbia convenience store. "He was always real nice and friendly — a little quiet. It's really shocked me."

Hodges, a 40-year-old white man, was charged Tuesday with attempted second-degree murder and a hate crime by Monroe police after shooting a black woman in the face with a shotgun. Before shooting the woman around 1 p.m., Hodges also was believed to have fired at three other motorists as he drove his GMC Yukon into Monroe from Columbia.

He told police he suffered from bipolar disorder. That was not confirmed as of late Tuesday, but Hodges clearly was not considered dangerous in the community.

Ester said Hodges regularly purchased lottery tickets from him and seemed to be an easy-going fellow.

Mariah Freeman said she used to hang out at bars with Hodges who never appeared to act like someone who would hurt other people. Freeman said she recently saw Hodges at a local music concert and recalled that he always drank wine in a bar, which she thought was unusual.

"He was always real happy when I saw him," Freeman said. "He just didn't seem like the type of person that would do something like that."

Hodges lived in a very rural area in Caldwell Parish at his grandmother's modest wood-frame home on McKee Road, a sparsely populated area near the Ouachita River and just a few miles from the Duty Ferry.

Caldwell Parish Sheriff Steve May had the task of going to the home Tuesday afternoon to secure it before Louisiana State Police investigators arrived with a search warrant.

As sheriff's deputies and a relative stood under the carport and anxiously waited on the investigators to arrive, May said Hodges appeared to have been acting normal less than two hours before the shooting spree began.

"He had been killing hogs with his father," said May, who would not release the names of the family members. "When he left (the home) at 10 a.m. he was fine. He told his aunt he loved her and that he would see her later."

Three hours later, Hodges was in police custody.

Read more!

32 percent of Latino students try suicide -Durham (NC) Herald-Sun

By Monica Chen
mchen@heraldsun.com
Jan 30, 2008

DURHAM -- Latino high school students are twice as likely to attempt suicide as their white and black classmates, according to a recent health survey conducted by the Durham County Health Department and Durham Public Schools.

In 2007, about 32 percent of Latino high school students in Durham said they had attempted suicide in the past 12 months, according to the annual Community Health Assessment report.

Fifteen percent of other students in Durham and 13.8 percent of all high school students in central North Carolina tried to take their own lives.

Upon hearing of the findings, those familiar with the Latino immigrant population expressed shock at the high percentage, but said pressures and anxieties caused by immigration could be the cause.

Hannah Gill, a UNC Chapel Hill anthropologist who studies Latin American migrations, said cultural differences are not to blame. Rather, hostility toward immigrants and the isolation of immigrant families contribute to depression and anxiety in Latino teenagers.

"I'm surprised it's that high, but I'm not surprised there's a higher suicide rate because of the pressure placed on immigrant families," she said. "For the children of Latino immigrants, there's separation from their family. ... There's also discrimination and racism that a lot of Latino immigrants face, especially now that we're encountering a much more hostile environment toward immigrants."

The Latino population in Durham jumped 10.7 percent between 2000 and 2006, but that hasn't necessarily made it easier for the immigrants to assimilate.

A recent string of armed robberies targeted Latinos and other people with foreign features, leading to the death of Dolores Benito Gomez, a Honduran immigrant, and Abhijit Mahato, a Duke University graduate student from India.

Luke Smith, executive director of El Futuro, said the Carrboro mental health clinic has treated many Latino youths in recent years for emotional distress coupled with suicidal thoughts or suicidal intent.

Latino youths who are illegal immigrants are also limited in attaining higher education, Smith said. They must to pay out-of-state tuition for state universities in North Carolina.

At UNC, this means $19,353 a year instead of $3,705, the in-state rate.

"And so they settle for dropping out of school and there's just a kind of demoralization that occurs because they don't feel as valued as some other students," Smith said. "They also lose their extended family and ... who do they turn to? They don't have significant weird or strange psychiatric illnesses. They're just really stressed by the environment around them."

The Durham study surveyed 392 anonymous students and separated the results by black, white and Latino teenagers. The survey did not include other ethnicities or immigrant populations.

The survey, funded by the Result-Based Accountability Initiative, was an exact copy of the annual Centers for Disease Control and Prevention's Youth Risk Behavior survey. Durham Public Schools administered the survey.

Officials with DPS could not be reached for comment Tuesday.

Gayle Harris, assistant director of the county Health Department, said the results will be shared with community organizations in Durham.

"We need to understand what's going on," she said. "This isn't an issue related to school. This goes deeper than that." Read more!

Out from under an anxiety disorder, she now helps others - Springfield (MA) Republican

By Pat Cahill

SPRINGFIELD, Mass. — Rita Howie, secretary to the principal of an elementary school, is the picture of efficiency in her high heels and burgundy pantsuit. As she talks, three different people come up to her with school-related questions, and she interrupts herself briefly to give them answers. She is clearly a take-charge person.

No one would guess that in the 1970s this woman was paralyzed by unfounded fears, housebound because she never knew when she would be overcome by panic, dizziness, delusions.

Howie was suffering from an anxiety disorder.

Today, mental-health professionals know how to diagnose such disorders, which include agoraphobia, panic attacks, social anxiety, obsessive-compulsive disorder, post-traumatic stress disorder or a combination of them.

Treatment usually includes cognitive-behavioral therapy and medication.

But back then, nobody seemed to know what to do. "Every two years I wound up in a psych ward," said Howie, of Chicopee, who is now 60.

She was given inappropriate treatments like shock therapy and put in a therapy group whose other members had mental illnesses like schizophrenia and bipolar disorder.

Then, 26 years ago, Howie read an article in a local newspaper about a man with agoraphobia. He was afraid to leave his house — just as she was.

When Howie realized there was a name for what she had, it gave her hope. That same year, she volunteered for a yearlong research program on anxiety at the National Institutes of Mental Health in Bethesda, Md.

She moved 400 miles away from her home in Springfield — where her husband had tried to make life easier for his housebound wife by building her a swimming pool — and plunged into a year of spinal taps, blood tests, infusions, placebos and double-blind studies.

Howie said she was scared the whole time, but of all the participants from out of state, she was the only one who stayed. "Some people stayed one day and left," she said. "I was too terrified to leave."

By then her marriage had collapsed. But she came away from NIMH with a diagnosis, a prescription and a vow.

"When I left, they told me exactly what part of my brain was affected," said Howie, "and they gave me exactly the medication I would be on for the rest of my life." It worked.

She had told her doctor at NIMH that if he could save her, she would devote the rest of her life to alleviating the suffering of others like her. "If you can help me," she said, "I will never give up. I will help as many people as I can. I will never let it go."

Howie was true to her word. Back in Springfield, she started a Panic Disorders and Anxiety Support Group with four people. "There was a time when Rita was the only thing out there," said Richard Lombardo, of Wilbraham, who attended the group 10 years ago. "And she was magnificent."

Lombardo was 39 and had just quit a stressful job when, lying in bed at night a week later, he was filled with panic.

"It surprised the heck out of me," Lombardo recalled. He said the key to controlling his anxiety was education, and Howie's group provided it. He learned to recognize and manage the physical symptoms of his disorder.

"When you're in the middle of this, you think you're never going to feel good again," said Lombardo.

One symptom of people with an anxiety disorder is their reluctance to take medication — they're scared to do it. They will take it for one day and stop. But Howie knows that medication can work, and she pushed people to take their pills regularly.

Now Howie is retiring from the group she founded. She's handing over the reins to others.

Not many people come anymore, she said. And that's good news, because it tells her that people with anxiety disorders have other resources.

"Now doctors are diagnosing it right away," she said.

Read more!

Therapists frown on long-distance diagnosis of Spears - Associated Press

By JOCELYN NOVECK
Associated Press

You wouldn't think a pop culture diva like Britney Spears would exactly fit into the usual fare of discussions at the annual winter conference of the American Psychoanalytic Association.

But recently, on the sidelines of the gathering of hundreds of analysts from around the country, the topic did indeed arise — specifically those armchair diagnoses of the troubled starlet's mental health, popping up in celebrity magazines and tabloids everywhere.

"Britney's Mental Illness." "Bipolar Britney?" And so on. Under such headlines, articles have quoted psychiatrists or psychologists who've never met Spears, saying she exhibits "classic" signs of one disorder or another.

"I've been very upset about this," says Mark Smaller, a psychoanalyst from Chicago who attended the meetings at Manhattan's Waldorf-Astoria Hotel. "This idea of making a diagnosis of someone they've never met is completely inappropriate, and it gives mental health professionals a bad name."

Not to mention that it's medically wrong. Smaller says that to make any real diagnosis, it can take several thorough consultations with a patient at the very least.

"Trying to make such a diagnosis based purely on someone's behavior" — and worse, their behavior as portrayed selectively by the media — "is scientifically impossible," says Smaller, also director of the Neuropsychoanalysis Foundation.

Afraid of being labeled

But even more, say Smaller and other therapists, it could actually harm Spears by preventing her from getting the real help she needs. And on a broader scale, such therapy-by-media could discourage other troubled people from seeking care as well.

"It's not right to this one person," says Dr. Gail Saltz, a New York psychoanalyst and psychiatrist.

"But on a grander scheme, it also makes people afraid. They're afraid their confidence might be broken. Or they're afraid they'll become labeled. And labels are very frightening to people."

It's hardly a cause for wonder how coverage of Spears has reached the point of quibbling over which mental illness might afflict her. Each development in the Spears story has upped the scandal ante. From her "mommy foibles," to her head-shaving incident to her attacking a car with an umbrella to her painful custody dispute, her story gets so much more dire with each passing month.

But the moment that set headline writers into overdrive came on Jan. 3, when police were called to Spears' home after she refused to turn over her two boys to a representative for ex-husband Kevin Federline, locking herself in a room with one boy. Police, who said she was intoxicated, had to restrain her; paramedics were called and she was whisked away to a hospital, paparazzi in pursuit.

That's when TV's "Dr. Phil" McGraw paid a visit, then made public statements later that she was in dire need of medical and psychological help. Relatives said he'd crossed the line in talking about her publicly, and he later said he regretted making the statements.

But numerous other psychiatrists and mental health professionals have been quoted as well, speculating on what might afflict Spears. And that, says People magazine's deputy managing editor, Peter Castro, was a necessary element of the story.
Read more!

Friends say tragedy destroyed a kind man -Schenectady (NY) Daily Gazette

SCHENECTADY — William “Bob” Pearce, a homeless alcoholic, died alone a week ago in a vacant house without heat, but he was surrounded by friends at his burial Monday in Vale Cemetery.

City police found Pearce’s body on Jan. 22 inside 7581⁄2 State St. The cause of his death is unknown, and he might have been dead for days. Results of an autopsy were unavailable Monday.

The county Department of Social Services paid for Pearce’s funeral. He was buried in a section of Vale reserved for indigent people. Donations will pay for a marker for his grave.

Approximately 25 people attended Pearce’s burial. None were relatives or immediate family, just friends who met him when he sought treatment for his alcoholism, or wanted a hot meal at a local shelter or needed a warm place to sleep.

Many remembered him as a kind man destroyed by a long-lost tragedy. He was from Binghamton and came to Schenectady about 10 years ago, essentially to receive alcohol rehabilitation services, said friend Mark Mahoney. The treatment failed and Mahoney met Pearce 41⁄2 years ago in April as he drank in an alley behind a downtown business.

“He was a good friend and a drinking partner. I got to know him and I got to love him,” Mahoney said.

Pearce loved music, especially music from the 1960s, Mahoney said. “He sang out music as he walked, and he walked as best he could because he had no toes. People thought he was inebriated [even when he wasn’t],” he said.

Pearce lost his toes at least five years ago, Mahoney said, when he got frostbite from sleeping outside. “At one point, he was a strong human being, but when he lost his toes, it destroyed him,” he said.

Despite his ailments, Pearce “always walked tall, he walked straight. He has an honest and good man,” Mahoney said.

Kathy Ghikas remembered Pearce as a man who “had a lot of pain inside. He never shed tears for people to see. The tears were in his heart.”

She spent hours speaking with him, and “I wiped away his tears. He thanked me and told me I was beautiful inside and outside. He told me my heart is so kind and pure.”

At one point, Pearce asked Ghikas to marry him; she declined, saying she was already married.

Jeffrey Demers said Pearce would stop by his house and watch people play horseshoes in his yard. “He couldn’t play himself because of his feet,” he said.

Demers last saw Pearce 10 days ago. “He was all clean shaven and wanted to go to social services to get benefits, to get a place to live and to get out of the cold.”

Margaret Anderton, executive director of Bethesda House, said Pearce was on a waiting list to get into the agency’s special housing program called The Lighthouse. The 10-bed facility is for people with chronic homelessness and a debilitating condition. It provides a stable environment, case management and other services.

Bethesda House is planning to expand Lighthouse when it relocates from Liberty Street into a new facility on State Street. Its proposed $4 million facility will contain a daytime drop-in center for the homeless and mentally ill and 15 bedrooms for the chronically homeless. Read more!

The highs and lows of bipolar disorder present a formidable foe - Denver Post

01/29/08 - METRO EDITORIAL

Everyone has good days and bad days in his or her life. For many people, not letting emotions get too high when the going is good or too low when the going gets tough is a successful approach to managing the ups and downs of everyday lif

However, for many others such an approach is nearly impossible.

According to the National Institute for Mental Health (NIMH), nearly 3 percent of the American population suffers from bipolar disorder.

Known to many as manic-depressive disorder, bipolar disorder is a condition that results in unusual shifts in a person's mood, energy and capacity to function.

Unlike the typical highs and lows many people feel, the symptoms of bipolar disorder are severe — so severe they can eventually lead to suicide.

As drastic as that sounds, it's important to note bipolar disorder can be treated and many who seek and receive treatment live full and meaningful lives.

It's important to note that anyone suffering from the condition is not suffering alone.

In fact, it may help to know that many successful and notable celebrities have admitted to having bipolar disorder or are suspected of having the condition.

These include actor Ben Stiller and actress Carrie Fisher.

However, diagnosis is no easy task and many people quietly suffer for years before finally being diagnosed and getting treatment.

Once the diagnosis is made, treatment is a lifelong commitment, as bipolar disorder needs always to be managed.

Part of what makes diagnosis so difficult is there are typically long periods of "normal" moods when a person's behavior and emotions are no different from someone not suffering from the disorder.

The most obvious sign that there is a problem is when a person experiences what are referred to as "episodes."

These can be episodes of mania which are extreme highs, or depression which are extreme feelings of sadness or hopelessness.

A typical manic episode can feature any of the following symptoms.

— Increased energy or activity

— Feelings of restlessness

— Extreme irritability

— Feelings of euphoria

— Inability to concentrate

— Lack of a need for sleep

— Poor judgment

— Feelings of invincibility

— Increased sex drive

— Denial of any problem

Many people around someone suffering a manic episode can tell a distinct difference in that person. Many of the symptoms can be abrasive and often are not in tune with the person's normal character or behavior.

Diagnosis as a manic episode typically occurs when the elevated mood is accompanied by at least three of the mentioned symptoms each day for a week.

On the opposite end of the spectrum, the depressed episode is often as extreme as the manic episode.

Friends and co-workers might not recognize depression since the symptoms are not as abrasive. Any of these symptoms should raise eyebrows.

— Feelings of sadness, anxiety or emptiness

— Feelings of hopelessness

— Pessimistic outlook on life

— Loss of interest in previously enjoyed activities

— Feelings of fatigue

— Excessive sleeping or an inability to sleep at all

— Difficulty concentrating and making decisions

— Chronic pain not caused by physical injuries

— Unintended and noticeable weight loss or gain

— Feelings of death or suicide

While the precise cause of bipolar disorder is not known, it has been demonstrated that bipolar disorder tends to run in families.

In addition, a person's living situation could bring on bipolar disorder.

Individual manic episodes can also be brought on by medications, making it extremely important for someone who suffers extreme highs and lows be completely honest with their doctor.

Visit the NIMH Web site at www.nimh.org for more information on bipolar disorder. Read more!

Looking to ease road for disabled - Denver Post

By Jennifer Brown
01/29/2008

Michael Meeks works at a deli filling relish cups. He knows how to cook meatballs and brownies, and he's obsessed with order — to the point that clutter could trigger an anxiety attack.

And if the 23-year-old with mild cerebral palsy and a behavioral disorder wants to keep the state services that help him live, he can never go home again.

The Colorado rule that says people with developmental disabilities cannot live with family and still have access to 24-hour services is among those laws that legislators hope to change this year.

Lawmakers also plan to tackle a waiting list for services that is 12,000 people deep and — in some cases — stretches more than a decade.

"These people are all of our problems, not just the families that have to put them to bed at night," said Christy Blakely, director of the advocacy group Family Voices Colorado.

The cause gathered momentum last fall as a legislative committee heard testimony from dozens of families fed up with Colorado's meager financial commitment to people with autism, Down syndrome, cerebral palsy and other disabilities.

The result is a host of bills to help them get jobs, at-home care and therapy. But it's too soon to tell how the issue can compete with big-ticket items such as health coverage for all Colorado children and billion-dollar plans to fix roads and bridges.

Already, a lawmaker's plan to raise the state sales tax and eliminate the waiting list for services was dropped. Advocacy groups are preparing to put a proposal on November's ballot raising the sales tax from 2.9 percent to 3.1 percent, about 2 cents for every $10.

It would cost $150 million per year to end the waiting list, according to a legislative estimate.

"There's not an extra $150 million in the budget that no one else is using," said Rep. Michael Garcia, D-Aurora. "The answer is very clear — to end the waiting list you need more money."

Garcia dropped his sales tax proposal because "it wasn't ready for prime time," but he is pushing legislation that would let people with developmental disabilities live with their families and still have 24-hour care funded by the state.

A GOP-backed proposal would dedicate 2 percent of new general fund money each year for the next five years to services for the developmentally disabled. That would mean $8.5 million next year.

"We've been sent here to prioritize with the money we've been given," said Rep. Bob Gardner, R-Colorado Springs.

Gardner refuses to identify which programs might lose cash if his bill becomes law. But some Democrats say that's what would happen.

Advocacy groups, including the ARC of Colorado, are hoping their cause can tag along with a potential proposal to insure at least some of the 790,000 Coloradans without health coverage.

A governor's panel is expected to pitch five multibillion-dollar proposals to the legislature this week.

"It's too early in the session to determine if the legislature is going to take bigger steps to end a lot of crises that Colorado has," said Darla Stuart, executive director of the ARC of Aurora.

The state is projected to spend $348 million this year on services for developmentally disabled adults and children, up from $260 million six years ago. In the same period, the waiting list for 24-hour services has gone 453 in 2001 to 1,368 in 2007.

Other legislation up for debate this year would create tax incentives for employers who hire people with disabilities, set up a state employment program and hire a "navigator" to help decide which people on waiting lists have the greatest need.

Meeks had been on the waiting list for years when the state called to offer him comprehensive services. The catch: He had to move away from his mother within three weeks.

Meeks spent a few lonely months with a host family and began to regress emotionally, said his mother, Marian Neely-Carlson. He now lives in an apartment with two roommates, but his family worries about Meeks losing services if he wanted to come home or live with a sibling.

"What happens if Michael's roommates leave, and he needs to come home a little bit?" Neely-Carlson asked. "What happens if I pass away, and he wants to live with his brothers and sisters? It would be crushing."

Jennifer Brown: 303-954-1593 or jenbrown@denverpost.com Read more!

Need for drug abuse treatment grows as budgets shrink - Daytona Beach (FL) News-Journal

By DEBORAH CIRCELLI
Staff Writer

DELAND -- The stomach scars are long and deep when Kevin Cushing lifts his shirt and reveals one of the lowest points in his life.

He's physically healed from three self-inflicted shotgun blasts five years ago but still on the mend from the addictions that drove him to maim himself. The habits he couldn't quit after almost dying are why he'll live for six months at Serenity House's newest treatment facility west of Daytona Beach.

Cushing, an electrician with his own business for 10 years, said he was spiraling out of control on crack cocaine and other drugs and doesn't remember pulling the trigger or the pain that followed.

He woke up days later in intensive care with his family standing over him. He said he lost his spleen, part of his stomach and three ribs. Doctors thought he would die.

"It haunts me -- the misery of knowing I did that kind of thing to myself," Cushing, 48, said this past week while at the new 76-bed facility. "It took me out of the real world, and I didn't even know I did it because of the alcohol and drugs."

Cushing is one of 20 who have moved into the Hugh West building since it opened last month. Clients with substance abuse and mental health problems are treated there.

He counts himself as one of the lucky ones because the agency has a waiting list of 70 people and future funding for indigent clients is in question because of state budget problems.

Serenity House and Stewart-Marchman Center, the area's largest substance abuse treatment providers, are adding more beds but worry who will pay to fill them.

Bill Janes, the assistant secretary of substance abuse and mental health at the state Department of Children & Families, is seeking an extra $10 million for treatment statewide, but with the state's shortfall and local government's struggling, he said services could be cut.

Gov. Charlie Crist is expected to release his budget proposals to legislators by Feb. 4.

Serenity House, which primarily serves uninsured clients such as Cushing, will have 30 beds vacant at other sites in the next month after some current clients are moved into the new facility, which was bought by the county from Act Corp.

Randy Croy, executive director of Serenity House, hopes for state and veterans' funding to fill vacant beds.

Stewart-Marchman Center is requesting $1 million from the Legislature to help fund a new 100-bed Bunnell treatment center expected to open at the end of the year. Half of the beds at the Vince Carter Sanctuary in Bunnell will be for indigent clients and the other for people with insurance or other private funding.

Stewart-Marchman officials said they may look at doing less residential treatment for indigent clients and more outpatient, which is less costly though not as effective.

"This is a big problem for us on the horizon," said Chet Bell, CEO of Stewart-Marchman.

The agency is trying to get businesses and individuals to sponsor rooms and wings to help with funding needs at the new facility.

"One option is always to padlock (part of the facility) until we can afford to operate it," said Ernest Cantley, president of the Stewart-Marchman Center.

The state is dealing with projected tax shortfalls of nearly $2.5 billion over two years because of the troubled housing market and other economic problems.

"It's going to be a very down year ," said Sen. Evelyn Lynn, R-Ormond Beach. "We're going to have to work together to hurt people as little as we can."

Janes, who is also director of the state Office of Drug Control, said he and DCF Secretary Bob Butterworth are doing what they can to "protect critical services."

"We have got to support substance abuse funding," Janes said. "If we don't treat the addiction and give (people) life skills, they will continue to use drugs and commit crimes and the cost to our communities and state are just repeated."

Despite almost dying, Cushing, who also has bipolar disorder, still couldn't stop using crack. He lost his business and $100,000-a-year income, was in and out of jail on various charges and ended up sleeping under bridges and in the woods the past two years.

"Once I met crack cocaine, my life ended," said Cushing, who according to police reports also threatened his former girlfriend before eventually turning the gun on himself.

Kirk Phillips, who is also at the new Serenity House facility, has lived a similar life with cocaine. The Army veteran, also bipolar, came down from New York and ended up in detox in Gainesville at the end of last year. He, too, has been in jail, was shot in the neck and once was in the hospital after injecting "every medication I could get my hands on."

"I'm sick and tired of being sick and tired," Phillips said. "I'm 44. I can't do it again."

For Cushing, this is his fourth substance abuse program, but the father of a teen-ager and a young adult also says things are different. He wants to live and have a productive business again.

"I pray to God I'm one of the ones who make it," he said. "It's the end of the road for me. This is my last chance. I'm not going to mess it up. I want to see my (future) grandchildren and give my daughter away and her be proud of me."

Funding cuts spur merger talks among treatment centers

DAYTONA BEACH -- Some area agencies are combining forces to save money and serve more clients as state and local funds dwindle.

Stewart-Marchman Center and Act Corp. are not only exploring whether to merge but currently combining call centers to handle substance abuse or mental health calls.

Consolidating some services between the area's two largest substance abuse and mental health providers saves administrative costs and will result in more patient screenings, agency officials said, along with getting people connected to services faster.

With the call centers, which already were in the same building, people at Act will be able to schedule clients for services with Stewart-Marchman and vice-versa.

Local agencies are trying to cut costs as the state deals with a budget shortfall and concerns over potential funding cuts.

"We all play pretty well together in the sandbox here in Volusia County, but I think we have to get even more creative. That's the bottom line," said Chet Bell, CEO at Stewart-Marchman Center.

Talks continue about a possible merger, or combining more services. Stewart-Marchman is also looking at whether it can get better prices for its patients by using Act's pharmacy.

The Homeless Assistance Corp., which runs a dining program, shelter and other services on North Street, and the Volusia/Flagler County Coalition for the Homeless were also in talks about whether to combine. But talks have ceased, Brian Willard, executive director of the Homeless Assistance Corp., said Friday.

Willard said his agency can be "self-sufficient" despite recent financial struggles. He said donations and grants will have to carry the agency through this fiscal year.

A DeLand agency, The House Next Door, is opening an additional office next month in Daytona Beach, sharing space at Easter Seals of Volusia & Flagler Counties on Dunn Avenue. Services there will be provided to Medicaid and Healthy Start clients.

The House Next Door provides counseling and substance abuse prevention services. It also rents an office at the Presbyterian Counseling Center on the beachside since closing its office in Port Orange more than a year ago to save on expenses.

"A lot of the people referred to us don't have the transportation to get to Deltona or DeLand," said Steve Sally, executive director of The House Next Door. "People are realizing if we coordinate things we can do better things for our community."

deborah.circelli@news-jrnl.com Read more!

When tantrums mean trouble -Pittsburgh Post-Gazette

Tuesday, January 29, 2008
By Mackenzie Carpenter

Timeouts? Forget it. Spanking? Nope.

When Marianne Peterson's toddlers went into meltdown mode, she had a simple, foolproof method for stopping them cold.

"I would lie on them," said Ms. Peterson, 57, of Ashland, Va., noting that her children, now grown, have turned out fine.

"The weight and novelty were enough to distract them," she added, "and I swear to God, they actually smiled a few times, I suppose, at my ingeniousness."

An extreme measure? Perhaps, but throughout human history toddler tantrums have driven parents wild and perhaps even a little crazy. When the kicking, back-arching, fist-pounding and shrieking erupts just when Mom gets to the head of a supermarket line of grumpy, disapproving shoppers, it's hard for a parent to remember that the "terrible twos" are just part of a young child's healthy emotional development.

Now, though, a new Washington University study is weighing in with a cautionary note: particularly severe, long-lasting and frequent tantrums may not be a sign of normalcy but possible red flags for deeper psychological disorders.

Tantrums that last more than 25 minutes, or tantrums that more than half the time involve aggression against a caregiver or violence toward objects as well as self-injurious behavior and frequent tantrums -- from 10 to 20 a day over a 30-day period -- may be a sign that professional intervention may be needed, said Andrew Belden, a postdoctoral fellow of psychiatry at Washington University's school of medicine, and one of the report's co-authors.

The study, published in the December issue of the Journal of Pediatrics, is part of a larger, long-term project by researchers at Washington University examining depression in preschoolers, about which relatively little is known -- compared with disruptive disorders such as attention deficit hyperactive disorder (ADHD); oppositional defiant disorder and conduct disorder, which are defined in a diagnostic manual for psychiatrists as aggressive or destructive behavior.

The findings on tantrums come at a time when, anecdotally at least, caregivers are reporting an increase in behavioral problems among preschoolers, for reasons that aren't quite clear. Some blame the new focus on academics in preschools, others blame poor day care or untrained caregivers or a society where family ties are increasingly strained.

"There do seem to be more stresses on parents now, but I also think there is a lot more information available to parents about child behavioral problems, and parents feel a pressure to get it all right that 20 years ago we didn't feel," says Sue Berman, a Squirrel Hill psychologist, parenting coach and founder of ProParent, which helps parents devise strategies for coping with "difficult" children.

"I'm not certain whether you're seeing more acting out, or whether it's just that parents don't tolerate it as much. Thirty or 40 years ago, we had the authoritarian parenting style, where it was completely accepted and acceptable to give a kid a swat on the tush. Fear-based parenting has been replaced by a very different approach, where we allow children to express themselves, but there's a price to be paid for that."
Normal vs. abnormal


Tantrums by themselves shouldn't worry parents -- it's how many, how long and how severe, said Dr. Belden.

"The take-home message here is about consistency. If a tantrum lasts longer than 30 minutes every time, or 90 percent of the time," then attention must be paid, "as opposed to such random, sporadic episodes that are much more typical of what we would expect to see in healthy kids."

"There were children in our study who would throw themselves to the ground and in the process hurt themselves," he said. "We had children who were taking toys and scratching themselves to the point of bleeding, "

While Washington University and other academic institutions are trying to unlock the secrets of depression in children, the notion of mental illness in toddlers -- even infants -- has been a tough sell to the public in recent years, and a number of researchers remain skeptical that such disorders as depression can be ever diagnosed in very young children.

"We have much more understanding about how it presents in adults, but in children, we're not convinced we know what it looks like to begin with," said Dr. Amanda Pelphrey, clinical psychologist at Children's Hospital Child Development Unit.

"Developmentally children change over time, and it's hard to characterize one moment in time for being a comfortably reliable indicator of how that child will be," she said. "If you have a diagnosis, you assume that there's a certain stability about that person, but among children there's a very wide range about what is normal."

The Child Development Unit at Children's has seen 1,500 youngsters over the years for a variety of problems, but not one has been diagnosed with depression, she noted.
Accurate diagnosis difficult


Small children aren't good at regulating their emotions, she added, "especially preschoolers, and that's normal, too. Much of the challenge is, how confidently can we accurately label them and assume that a psychiatric illness is involved?"

Heather Ditillo, a former Head Start teacher in Altoona, remembers "children with very, very severe tantrums. While in some cases they were normal developmental things you could see, there were a few children whose tantrums had crossed the line from anger to rage. It was obvious to me as a teacher that these weren't normal," she said. "They were regularly happening, where they were attacking other kids and throwing objects around the room."

Later, after psychological intervention, it was discovered that one child with severe tantrums had been abused and tortured and another "was sexually abused. It was heart wrenching."

Dr. Belden knows that the whole inquiry into depression in preschoolers is controversial, but be believes it's worth pursuing. Still, he doesn't want to give parents one more thing to worry about.

"My biggest concern is that parents not read into this, 'Oh my God, my kid has ADHD,' " said Dr. Belden.

"It's not like you need to have a stopwatch ready when your child has a tantrum," he said, noting that the study's findings are aimed less at parents and more at providing teachers, caregivers and other professionals with a tool to detect any underlying problems earlier.

Still, parents should stay vigilant.

If a child has more than three or four tantrums a day for five consecutive days outside the home, for example, "and parents are pretty confident it's not because of sleep, hunger or sickness," he said, they should discuss the matter with their pediatrician -- because such behavior is "not all that typical, not all that common in healthy kids."

• The five red flags that your child's tantrums could lead to more serious problems and resources for parents seeking help, C-2
Mackenzie Carpenter can be reached at mcarpenter@post-gazette.com or 412-263-1949. Read more!

Still mentally incompetent -Salt Lake City Deseret News

Man is accused of shooting his father during hunting trip

By Ben Winslow
Tuesday, Jan. 29, 2008

FARMINGTON — A young man accused of shooting his father in the face during a duck hunting trip is still mentally incompetent to face a murder charge.

Almost a year after he was found mentally incompetent, Benjamin Gully's case came before a judge in 2nd District Court on Monday for a review.

"My report indicated Mr. Gully is still mentally incompetent," said Judge Michael Allphin.

"Mentally ill and should not be released," Gully's attorney, Fred Metos, interjected.

Davis County prosecutors agreed that Gully should not be released from the Utah State Hospital, where family members have said he is undergoing treatment for a combination of schizophrenia and bipolar disorder. It will likely be another year before his case is brought back to court for a review.

In a rare legal outcome, Gully was declared not guilty by reason of insanity last year in the shooting death of his father, 61-year-old James Gully.

In 2004, police said the father and son were out duck hunting in the Farmington Bay area when Benjamin Gully shot his father. Family members have said in the past that it was not Ben Gully who harmed his father but the mental illness he suffers from.

Read more!

State begins probe at disability facility -Charlotte Observer

Jan. 28, 2008'

The mother of an autistic 10-year-old boy visited staff members responsible for her son's care Monday, a day after the child wandered from a care facility and drowned in a nearby creek.

State regulators also launched an investigation of the child's death at the home just northeast of the Mecklenburg-Cabarrus county line.

In a preliminary report, medical examiners determined the child's cause of death was accidental drowning and that his autism was a contributing factor.

Cabarrus County investigators wrapped up a separate criminal investigation of the RHA Howell Care Center-Clear Creek facility Monday afternoon.

'The focus of our investigation is whether there was any intentional harm to the child,' said Detective Bobby Bonds of the Cabarrus County Sheriff's Office. 'Obviously, that's not the case.'

Deputies identified the boy Monday as Brandon Parrish Johnson. His family lives in the Charlotte area, according to the sheriff's office. Deputies honored the wishes of Brandon's mother by not releasing the mother's name or saying specifically where she's from.

Family members and the facility's staff and residents received grief counseling Monday.

The state investigation will likely examine how the center monitors residents and review the child's individual care plan and whether it was followed, said Jim Jones, a spokesman for the N.C. Department of Health and Human Services.

Typically, officials also would look at what protocols the facility has in place to ensure that someone does not get outside unescorted, how staff members respond to alarms, how they are trained and other issues.

Brandon had been a resident since July. Staffers described him as fun-loving, active and inquisitive, and said they considered him a member of the family.

Staff members, law enforcement officers and firefighters were searching for Brandon Sunday morning when he was discovered floating in a rural creek about a five-minute walk from the center.

Brandon had been missing for about 90 minutes before he was discovered, authorities said.

A staff member tried to revive him, and he was taken to Carolinas Medical Center-University, where he died hours later.

Irene Howell opened one of the state's first intermediate-care facilities for children with disabilities 38 years ago. Howell opened the red brick buildings of the Clear Creek facility on a rural, heavily wooded campus just northeast of Mint Hill in 1986.

The center's 120 beds for adults and children were spoken for when it opened, and it remains at capacity. Its license is renewed annually, according to DHHS.

Facilities started by Howell are now owned by RHA Howell Care Centers, a private nonprofit company that has 30 centers in North Carolina.

Staff members are at the facility around the clock, and some are awake at all times, RHA Howell's chief operating officer, Missy Jones, said in an interview at the facility Monday.

Some of the Clear Creek facility's doors have alarms and some don't, Jones said. Security cameras cover every exit, she said.

'That's what helped us determine the direction (he went in) and the time he left,' Jones said.

The Observer reviewed documents from four state inspections of the Clear Creek facility conducted between September 2005 and September 2007. Investigators found no problems that merited fines or sanctions.

Jane Jackman, executive director of The Arc of Rowan County, said she has placed autistic children at RHA facilities, and they're known for providing quality care.

'It was an excellent experience, and they provide excellent care,' she said. 'I wouldn't hesitate to live there myself if I had that need.'

While Jackman was not familiar with the circumstances of the weekend death, she said, she would not hesitate to send people there again. The Arc, a United Way-affiliated agency, is an advocate for people and families affected by mental retardation.

'It's a very unfortunate, terrible tragedy. And it could happen anywhere,' Jackman said.

An estimated 50,000 people in North Carolina have autism, including about 6,300 ages 3 to 21, said David Laxton, communications director for The Autism Society of North Carolina. He said federal data show that up to one in 150 children born nationwide has some form of autism.

Autism is a developmental disorder that affects a person's ability to understand and interact with the world around them. It also affects communication and information processing.

The number of autistic children in private residential care statewide was not immediately available.

Children placed in residential facilities may have more severe needs, could have parents who are getting older and having Read more!

Fund honors man who died too young -Poughskeepsie (NY) Journal

By LARRY HERTZ

Cassidy Hines was a big, red-headed bear of a man with a quick wit, an infectious smile and a love of history and philosophy.

Hines was also a troubled young man who sometimes neglected to take proper medication for bipolar disorder and had a few scrapes with the law.

Ed Reid knew both sides of Hines - and he loved them both.

"He could make you really mad at him," said Reid, a caseworker for the River Haven Transitional Living program in Poughkeepsie. "But he was one of the smartest people I ever met - he knew more about black history than I'll ever know, and I'm black - and he had a warm side that made everyone who ever met him want to help him."

Reid said he believed Hines was defeating his demons and turning a corner in his life when he was shot and killed during a botched robbery on Garden Street in the City of Poughkeepsie Jan. 5, 2007.

"He was living in an apartment on his own and he was attending Dutchess (Community College)," Reid said. "I helped him with the admissions process. I even stood in line for him to buy his books - that's the kind of thing people would do for Cassidy.

"When I heard he'd been shot, I couldn't believe it. It really hurt because I know Cass wanted to live."

Hines' mother, New Paltz resident Lori Feinman, said she and her family would always be grateful to Reid and others at River Haven for reaching out to her son when she no longer could do so. That's why they have decided to fund an annual $500 scholarship for a graduate of River Haven programs who has gone on to college and is pursuing a career.

Feinman said she was certain her son would approve.

"The people at River Haven just did so much to help Cassidy in so many ways," she said. "We thought this would be a good way to preserve his memory."

Kenyan is helped

This year's recipient of the Cassidy Fund is Hyde Park resident Francis Adams, a native of Kenya who emigrated here after his parents were killed. He said he was facing many challenges when the people at River Haven gave him a place to live and a structure to help him get his life under control.

"Without the people at River Haven," Adams said, "I'd be living on the street - or I'd be dead."

Instead, Adams is a pre-med student at the State University of New York at Albany.

"Five hundred dollars may not seem like a lot of money to some people," he said, "but I used the money to buy my books for the school year, and there aren't many things more important in my life right now than books."

Administrators at Hudson River Housing Inc., the agency that runs the River Haven program, are hoping to augment the Cassidy Fund with additional money for the Transitional Living program. If you'd like to help, contact Elizabeth Celaya at Hudson River Housing at 845-454-5176.

Larry Hertz covers the criminal justice system and social issues. Reach him at lhertz@poughkeepsiejournal.com or 845-437-4824. Read more!

Being Carrie Fisher -Diablo Magazine San Francisco

The acclaimed writer and Star Wars star brings her one-woman show to Berkeley Rep this month.

By Peter Crooks

Carrie Fisher grew up in Hollywood’s spotlight, through good times and bad. The daughter of actress Debbie Reynolds and singer Eddie Fisher, Carrie Fisher became a cinematic icon at 19, when she played Princess Leia in Star Wars. Less than a decade later, drugs and alcohol nearly cost Fisher her life, but she bounced back as a best-selling novelist and successful screenwriter.

All of these aspects of Fisher’s life (as well as her bipolar disorder) make an appearance and are seasoned with humor in her one-woman show, which opens at Berkeley Rep on February 8. Here, Fisher discusses some of the real-life events behind the show, from her early days as a child performer to her role as a celebrity parent.

More people know you from movies and books than from your live show. Didn’t you start performing on stage as a young girl?

Well, I went on stage with my mom, but that was to keep the family together, not because I wanted the spotlight. A family outing for us was to go onstage in Las Vegas.

After growing up with parents who were very famous, what is it like to be a celebrity parent?

I learned to cook so my daughter would have some memory of her mother in the kitchen. I tried to do things that were more like a conventional parent, which was something I did not have. But my mother was a very good parent, and she still is. She lives next door. She’s a very caring, loyal, involved parent now, but when I grew up, she worked all the time. One of the reasons I have stayed with writing is that I do not have to leave home to do it.

Has your daughter been exposed to the Hollywood lifestyle?

Yes. Her father [Bryan Lourd] is the biggest agent in Hollywood. Really, she’s been exposed more from that side of the fence than mine. But, she has recently learned to appreciate whom she is related to. I’ve been in an iconic movie, but her grandmother is an actual icon. My daughter is now taking tap lessons at my mother’s studio in the valley. What teenager does that? She’s quite good. She wants to learn one of the numbers from Singin’ in the Rain as a surprise for her grandmother.

Your first movie, Shampoo, was a quintessential 1970s film filled with promiscuous sex and drugs. You were just a teenager, and your character seduced Warren Beatty with the f-word. How did your folks, who were from a different era, react to that?

My father just wasn’t involved. My mother wanted me to use the word “screw” instead. That went well. Warren had to come to the house and convince her that we couldn’t say screw.

As your friends headed off to college, you landed the role of Princess Leia in Star Wars, the movie that defined the word blockbuster. How did that film’s success change your life?

I was 19, and I didn’t even really want to be an actress—I hadn’t made up my mind. It would be like picking your major at college. This movie picked my major for me, for a number of years. Star Wars made me financially independent, which was a neat trick at that age. The character I played became a celebrity, but I wasn’t necessarily a celebrity in my own right.

Besides the Star Wars movies, you’ve been in a number of modern classics—The Blues Brothers, Hannah and Her Sisters, When Harry Met Sally… , Austin Powers. What’s your favorite?

Creatively, the most rewarding was Hannah and Her Sisters, even though Woody [Allen] and I were like oil and water. But the most fun I ever I had on a film, bar none, was The ’Burbs with Tom Hanks. We had so much fun, I would have paid to be in it. I managed to be in Tom Hanks’s two worst films—The ’Burbs and The Man With One Red Shoe.

What were the parties like on the set of The Blues Brothers?

It wasn’t parties, per se; it was just rampant, ongoing drug use. The thing I always said about John Belushi is that it was a shame that his first OD killed him. He didn’t have that close call that gave him the scare of his life. I had that, and it really put the brakes on. The thing about addicts is they cannot stop. There has never been a moment since I first understood that I was an addict that I thought, “Well, maybe I’m not.”

How old were you when you realized you were an addict?

Twenty-eight years old. After John had died.

After the Star Wars films?

Oh, well after. Drugs weren’t big on the Star Wars set—you couldn’t have worked. It would not have been possible. We were very respectful of working. We had lines to remember; we had to be there at 5:30 a.m.

But there was one time where we had stayed up all night with [Monty Python comedian] Eric Idle, and he had brought this drink back from Tunisia where they were shooting Life of Brian. They gave this drink to the extras to get them to work long hours. So Harrison Ford and I stayed up all night drinking it, and when we came into work the next day, we were not hungover—we were still drunk. When we arrived on Cloud City [in The Empire Strikes Back], we were drunk. And it’s the only time in the film that we really smile.

Your first book, Postcards From the Edge, was a best-seller in 1987. How did your success as an author compare to acting?

That was awesome. That was all me, which made me really proud. Being in Star Wars was like winning the lottery. Writing a book was like inventing the lottery. And then writing the screenplay for the film and having Meryl Streep play the lead—you couldn’t say it was a dream come true because who would even dare to dream of having Meryl play the lead in your movie? I was on the set every day to watch her.

You’re appearing in a film remake of George Cukor’s The Women coming out this fall, with a great cast—Meg Ryan, Bette Midler, Candice Bergen, Eva Mendes …

That’s going to be awesome. The director, Diane English, has been trying to get this made for 10 years. I did a scene with Annette Bening. I play a really awful person.

Meanwhile, you’ve shown up recently on all these hip TV comedies: Weeds, 30 Rock, and Family Guy.

I’ve had an acting slip of late. That episode of 30 Rock was great—a really funny, well-written character, but I missed it. My television doesn’t want me watching it for some reason—I can’t deactivate the parental controls. I love the show Weeds, but that was tough to do because I had to work with a live fish. That was the only thing I’ve ever done that has impressed my daughter.

Carrie Fisher performs at Berkeley Repertory Theatre February 8–March 30, tickets $18.50–$69, (510) 647-2949, www.berkeleyrep.org.
Read more!

Dropping of charges ends tale of incest, mental illness - Omaha (NE) World-Herald

BY TODD COOPER

She said she acted out of fear when she plunged a steak knife into her older brother's chest at their apartment near 31st and Pacific Streets.

And in doing so, Teresa Tippery said, she didn't just kill her brother, Richard E. Tippery.

She killed a man who had raped her as a child — and was attempting to rape her again.

"I stabbed him," she told the operator.

Operator: "You stabbed your brother?"

Tippery: "Yes. Tried to rape me."

Operator: "He's not breathing?"

Tippery: "No! We need an ambulance, damn it!"

From the outset, Omaha police and Douglas County prosecutors scrutinized Tippery's account, eventually charging her with manslaughter and weapon use in Richard Tippery's death.

Authorities, even some members of the Tippery family, questioned whether the chronic methamphetamine user — Teresa Tippery also had a history of mental illness — really was in fear of her brother that night.

Or, they asked, was her fury fueled by her mental illness and the sordid memories of her brother's having raped her three decades before?

In the end, Douglas County authorities had lots of questions but little proof. They recently dismissed manslaughter and weapons charges against Teresa Tippery.

It was an anticlimactic end to a case twisted with tales of incest, mental illness and drug and alcohol abuse.

"To paint her as totally remorseful would be inaccurate," said Assistant Douglas County Public Defender Steve Kraft, Teresa Tippery's attorney. "From the beginning, she was adamant that he had raped her as a child, that he tried to rape her that night and that she acted in self-defense.

"I think she felt like she was being slighted that she was even charged."

Douglas County Attorney Don Kleine said prosecutors dismissed the charges because portions of her story were backed up by evidence — and because the dead man had a history of committing the very crime that his sister alleged.

According to court files and police reports:

Several family members confirmed Teresa's account that Richard had sexually assaulted her over a year's time, beginning when he was 12 and she was 10. He also sexually assaulted another relative, they said. However, family members didn't report any of the assaults to police.

By adulthood, the siblings had parted ways.

Richard Tippery was arrested several times, Kraft said, and was convicted at least once of rape. In 1985, he was sentenced in Louisiana to more than four years in prison. Upon his release, he was required to register as a sex offender.

In 2006, Richard had recently been released from a Mississippi jail in a domestic assault case and came to Omaha. The 45-year-old stayed at his stepmother's house for a while, but she was moving.

Teresa Tippery told police that she hadn't seen her brother in nearly 20 years when he called, needing a place to stay. She relented.

"I more or less forgave him," she said. "But (I told him) I don't forget."

Their reunion was volatile right away — with the two trading blows in the month between Richard's arrival and his death. At one point, Teresa's teenage son went to the apartment and found Richard on the floor, blood pooling around his head.

Initially thinking that his uncle was dead, the son shook Richard awake. Richard told the son that Teresa had slammed a picture frame over his head.

Then, about 10 days before his death, Richard was stabbed in the stomach and an arm.

He told friends that he had been stabbed by a drug dealer as he tried to buy meth for Teresa. But friends told police they suspected that the wounds occurred during a fight between the siblings.

Family members were split on who caused the friction.

Both had chronic problems; each claimed to be the other's protector. Richard was penniless, was just out of jail and was battling a drinking problem.

Teresa had just been divorced, had lost her longtime job at the Douglas County Health Center and was battling a meth addiction.

Some family members, including a stepmother, told police that Teresa seemed obsessed with the childhood sexual assaults — and seemed to lord it over her brother. Another relative said Richard complained that Teresa would beat on him in public.

Teresa, meanwhile, insisted that Richard was two-faced: a father figure when sober and a pervert when drunk. She said Richard constantly grabbed at her.

"He said God sent him to protect me, and I'm the woman he loves," Teresa told police. "I tell him, 'I don't want you to love me that way. I'm your sister.'

"He drinks, and he brings it all up again. So I was facin' my (childhood) issues head on."

Everything came to a head on March 27, 2006. When Richard returned from taking Teresa's son to a friend's house, Teresa caught him with a bottle of booze.

She said she poured it out in the sink — angering him.

She said he came after her — grabbing at her crotch. She swung an ashtray at his head — and he pushed her against a wall and punched her. He told her to shut up, sit down and watch TV.

She retreated to the bathroom. Moments later, she said, he slid a steak knife under the door.

"He says, 'Teresa, I want you to kill me so I won't beat you,'" she told police. "Or something like that."

As she emerged from the bathroom, she said, Richard attacked her. She stabbed him twice in the chest.

Not everything squared with her version. Police found that the bathroom door didn't have a lock — prompting officers to question why Richard would have to slide a knife under the door.

And after the stabbing, Teresa waited to call 911. She first went to her ex-husband's home and dropped off her son's backpack.

However, her attorney, Kraft, said several evidentiary items bolstered her account. She had a fresh bruise on her face when police interviewed her. And she had an older black eye — the product of Richard's beating her a few days earlier, she said.

An empty liquor bottle was on an end table.

There was another critical piece of evidence: Police found Richard dead, with his zipper down. He had no underwear on.

Although Teresa resented being prosecuted, Kraft said, the court case helped her seek treatment. Court records indicate that she has undergone intensive treatment for drug and alcohol abuse and bipolar disorder.

And her family, once divided over her brother's death, is helping her recover, Kraft said.

"She's doing much better," he said. "She's had to deal with the fact that she killed her own brother.

"But there's no question she acted in self-defense. Either that or she's the most calculating person on the planet to set all this up. That's just not the case."

Before investigators closed the case, Teresa Tippery, now 45, detailed her brother's final moments.

Stabbed in the heart, he staggered a few steps and fell on his side.

She recounted his last words.

"Teresa," he said, "you got me." Read more!

Possible sale of Bryce watched by mental health advocates - Birmingham (AL) News

Tuesday, January 29, 2008
THOMAS SPENCER

Bryce Hospital, the national historic landmark mental hospital on 200 scenic acres adjoining the University of Alabama campus, is again the center of debate over the future of care for the mentally ill in Alabama.

The University of Alabama wants the land for expansion and is negotiating with the Alabama Department of Mental Health and Mental Retardation about a possible sale. Meanwhile, mental health advocates and historic preservationists are intensely interested in the terms of any deal.

For the mental health community, any sale would have to be at a fair price, with the money dedicated to replacing services that exist at Bryce and to expanding and improving patient care. Preservationists want to ensure that Bryce's national significance, both in architecture and in the treatment of the mentally ill, is protected.

"Bryce Hospital could be a national mental health museum," said Dr. Tom Hobbs, the director of Birmingham's Western Mental Health System. "I don't think it is really important who owns Bryce Hospital. I think what is really important is that whoever owns it understands the importance of restoring and preserving its historical significance."

Turning off Campus Drive, the entrance road to Bryce leads up a hill through columns of towering oaks, past a sprawling lawn populated with gargantuan magnolias. At the top of the rise is the original four-story Italianate hospital, topped with a high dome. Opened in 1861 as the Alabama Insane Hospital, the massive hospital no longer houses patients, and just two floors of the core building are occupied by administrative offices.

Building deteriorating:

Unused portions, including long, multistory wings, are sealed off, with broken windows and damaged roofs allowing in weather and a slow tide of deterioration.

"We've had to let this building go," said John Ziegler, a spokesman for the mental health system. The department concentrates its resources, Ziegler said, on the more modern facilities on the campus where about 500 people receive care.

"The department's posture is that we exist to care for people," he said. "Nothing will be done to this campus as a whole unless it is for the betterment of the entire system."

That's the aspect of any deal that will by eyed closely by mental health advocates.

"We are going to follow these negotiations very closely," said James Tucker, associate director of the Alabama Disabilities Advocacy program, one of the parties that helped settle a long-running federal lawsuit over conditions in Alabama's mental health system.

That lawsuit, Wyatt vs. Stickney, originated at Bryce in 1970. At the time, more than 5,000 patients were warehoused there in conditions that were compared to a concentration camp. Bryce in the 1960s had three psychiatrists on staff, and beds just six inches apart crammed the hallways.

The Wyatt case, overseen by federal Judge Frank Johnson, was as significant to the rights of the mentally ill as landmark decisions such as Brown vs. the Board of Education were to the broader civil rights movement. Wyatt established a right to minimum standards for the care and rehabilitation of people with mental illness.

Community treatment:

That case, and others like it, began a shift away from the long-term sequestering of the mentally ill and toward more community-based treatment. The decision came at a time when better medical treatments had become available that allowed people with mental illness to function productively in society.

"The focus is on stabilizing the patient and getting them back to their community," said Roxanne Bender, assistant director at Bryce. "Today, we don't keep anyone here a day longer than they have to be here. The average stay is 60 days."

Alabama's mental health system has moved in that direction, but the work is incomplete, according to Tucker. Even with a patient population of 318, Bryce is too large, he said, and more resources for acute and long-term care are needed in communities around the state.

The sale could be an opportunity, Tucker said. "They certainly don't need to be at a facility that has hundreds of beds," he said. "Such a facility does not comport with modern treatment models. But people with mental illness need to be assured that those dollars are devoted to people who need treatment."

Beyond the needs of the mental health system, the state has an interest in preserving the historic hospital, advocates say. More than a century before it became a symbol of what was wrong with mental health treatment, Bryce was a national model for a revolution in humane care.

Authorized by the Alabama Legislature in 1852, Bryce was part of a wave of asylums built across the country at the urging of proponents of the Moral Treatment movement, including reformer Dorothea Dix.

According to Steve Davis, a historian on the Bryce staff, the Alabama Insane Hospital was recognized as the closest to the ideal model advocated by mental health pioneer Dr. Thomas Kirkbride.

Radically departing from a past when the insane were shackled away in dungeon cells with no expectation of recovery, the new Alabama hospital featured inspirational architecture. Patient wings were oriented so that natural sunlight flowed in. Private rooms afforded views of a magnificent landscape. The environment was designed to be conducive to a cure.

No straitjackets:

Under the leadership of its first superintendent, Peter Bryce, restraints and straitjackets were eliminated. Photos of patients seated at white-tableclothed dinner tables dressed in their Victorian outfits look like scenes from the Titanic. The hospital had flush toilets, hot water and gas lights.

"We think Peter Bryce has a lot to do with how we treat patients even today," said Bender. "It's just amazing this man had such vision. This was a state-of-the-art hospital, one of the best in the world."

Patients participated in theatrical productions. They published a newspaper and engaged in work therapy, growing crops, tending cattle and making their own clothes. There was even a coal mine on the campus.

Tom Hobbs served on a committee that last year compiled and presented to Mental Health Commissioner John Houston a preservation plan for the historic structures. The report recommends immediate steps to secure important structures from further deterioration. It raises the possibility that a restored main building could house a national museum exploring the history of mental health treatment. "Bryce Hospital is so significant not just from a local perspective, but from a national perspective," Hobbs said. "The least we can do is to protect that part of the campus."

University of Alabama spokeswoman Cathy Andreen said the university and the department of mental health are planning to hire a consultant to look at mental health needs. Andreen said the university shares concern for patients, Bryce employees and the hospital's historical significance.

"It would be premature to speculate about the nature, time frame or specifics of any potential agreement," Andreen said. "Our campus master plan, which governs decisions about the use of university property, has an appropriate focus on the preservation of historic buildings."

Ziegler said Houston will present a long-range plan for the system to the governor early this year. It will be in the context of those needs that the sale of the Bryce property will be considered, Ziegler said.

E-mail: tspencer@bhamnews.com Read more!

Mental-health parity / Time has come -Atlantic City (NJ) Press

Editorial: Tuesday, January 29, 2008

Question: Should anyone who is currently covered by a health-insurance plan in New Jersey be eligible to receive mental-health coverage under the same terms and conditions provided for physical illnesses?

That is, should the same copayments, deductibles and benefit limits apply to mental disorders - including treatment for alcoholism and substance abuse - as apply to physical disorders, no matter what size company you work for or what kind of health plan your company has?

We'd guess that the answer would be a resounding "Yes."

And that's what a complex bill sponsored by state Sens. Joseph F. Vitale and Barbara Buono, both D-Middlesex, would do.

The question for many is whether the state and small businesses can afford it. (Some of the changes in coverage required under the bill would apply specifically to the state workers' benefit plan and to companies with fewer than 50 employees.)

But two factors argue in favor of the bill.

First, many of the people who need treatment for mental disorders but who face strict limits on mental-health coverage end up in the state/federal Medicaid program - which means that taxpayers end up paying for their treatment.

Second, New Jersey's existing law on the subject, which specifically requires equal treatment only for so-called "biologically based" mental illnesses, is woefully out of step with current research. Science is tracing more and more behavioral disorders back to the biology of the brain. The distinction in the current law no longer makes sense.

And regarding alcoholism and substance abuse specifically, the medical community is virtually unanimous that they are biologically based diseases, not simply failures of willpower or character. So how does a society justify treating these illnesses differently from, say, diabetes?

The Vitale/Buono bill - which would require treatment parity for all conditions listed in the Diagnostic and Statistical Manual of Mental Disorders, the chief diagnostic reference for mental-health professionals - is certainly on the right track.

In fact, when you consider the societal costs of alcoholism, substance abuse and other mental illnesses, not providing equal medical coverage for such diseases simply makes no sense, fiscal or moral.

If most mental disorders are, in fact, biologically based - and that is where the science is going - a rational society would ensure that they are covered the same way as other diseases are covered.

The bill requires that any mental-health treatment be based on a prescription from a licensed health-care provider; insurers would retain the right to challenge the medical necessity of the treatment.

But at the very least, the loopholes created by the patchwork of state and federal laws that address this issue would be closed by the Vitale/Buono bill. These are loopholes that some people with mental disorders now fall right through because the law hasn't caught up with the science: The brain is an organ, no different from the lungs or the heart.
Read more!

Woman cited hours before highway deaths - Associated Press

By DENISE LAVOIE, Associated Press Writer

BOSTON - A woman who killed herself and her sister's two small children by walking into oncoming interstate traffic had a minor car accident and State Police cited her just hours before the double murder-suicide.
Marcelle "Marci" Thibault, 39, showed no signs of impairment when three State Police troopers arrived to the scene of the accident - the same highway where she would later die - around 6:50 p.m. on Jan. 11, State Police Capt. Barry O'Brien told The Associated Press on Friday.

Thibault told troopers she must have fallen asleep at the wheel and brushed her 2003 Lincoln sedan against a guardrail, causing minor damage to the sideview mirror, O'Brien said.

Initially, another motorist had stopped to assist and told police Thibault appeared agitated, but she was rational and responsive when troopers arrived, O'Brien said.

"They interacted with her for about 15 minutes, and they didn't observe any impairment, no signs of any drug or alcohol, she had a valid license, so after she was cited, she continued on her way," O'Brien said.

Less than three hours later, she killed herself and her twin sister's two children by walking into oncoming traffic on Interstate 495, less than 10 miles from her earlier accident.

After being cited for failure to stay in marked lanes, Thibault drove to the home of her sister in Brentwood, N.H., where she picked up her 5-year-old niece, Kaleigh Lambert, and 4-year-old nephew Shane Lambert for a planned sleep-over party.

On her way home to Bellingham, authorities say Thibault pulled over to the side of Interstate 495 south in Lowell, undressed herself and the children, took them in her arms and walked into oncoming traffic. They were fatally struck by two cars.

Middlesex District Attorney Gerry Leone has said the woman had a brief history of mental illness. Leone announced last week the deaths were not accidental.

"We were aware of the prior traffic stop and a complete development of the facts supported our findings in this tragic incident," Leone's spokesman Corey Welford said Friday.

Ken and Danielle Lambert, the parents of the children, said in a statement Friday night that the events leading to the deaths of their three family members were "most unfortunate." No one could have possibly predicted the outcome, they said, adding that they would never have intentionally put their children in harm's way.

"Our hope is that families and officials will gain a better understanding of mental illness and provide better treatment protocols in the future," the parents' statement said. "Perhaps increased knowledge of these issues will prevent incidents like this from happening in the future."

Friends and family said Thibault was a doting stay-at-home mom to her teenage children and volunteered to organize activities for teens at her church. She often threw parties for her young nieces and nephews, like the "pirates and princesses" sleep-over she picked up her sister's only children for Jan. 11.

Young said earlier he did not know the specifics of the mental health treatment Thibault had received, but described it as a "brief, isolated incident in her life" within the past year and said she appeared to have fully recovered.

Read more!

Santa Monica seeks out the most vulnerable - Los Angeles Times

Agencies assess the homeless in a plan to get those most at risk of dying off Santa Monica's streets. If that works, the next 10 people will be aided.

By Francisco Vara-Orta
Los Angeles Times Staff Writer

January 29, 2008

With its storefront tributes to Southern California's surfing culture and L.A.'s hipster elite, the leafy dinosaur topiary and gleaming signs that promise multiple movies, Santa Monica's Third Street Promenade is a popular destination for tens of thousands each week.

In the middle of the night, it is a destination of another sort for a smattering of the city's chronically homeless. It is those inhabitants whom social workers hoped to encounter early Monday.

One man, wrapped in an orange scarf and dingy blankets, slept near the entrance to Barney's Beanery. A nearby walker was draped with his only personal belongings, protected from the almost constant drizzle.

"Am I in your way or something?" he asked after he was awakened at 3:15 a.m.

"No, you're fine," John Maceri said. "We're with the city of Santa Monica and we want to help you."

Maceri, the executive director of the Ocean Park Community Center, was one of 50 people helping conduct a survey of the chronically homeless in Santa Monica in the early morning.

It was the fourth of seven days during which teams of people from the city, nonprofit social service agencies, the Department of Veterans Affairs and the county's Department of Mental Health are attempting to count the number of homeless. The goal is to find those who are at the greatest risk of dying on the streets.

Although the man in the orange scarf didn't know it, he is part of a growing social experiment that some experts say is helping shrink the chronically homeless population in major urban centers.

Maceri and two colleagues interviewed him for about 30 minutes, asking about his vital statistics and health. He is in his late 40s, a veteran and hearing-impaired, he told the social workers. The Third Street Promenade, he said, is his home.

"I live on the Promenade!" the man in the orange scarf proclaimed as Maceri jotted down answers and Ed Parker, a street outreach coordinator for Step Up on Second, complimented him on his receptiveness to their questions.

After the interview, the social workers handed him a $5 gift certificate from a fast-food restaurant. Maceri and his teammates went through the same process with seven other people sleeping on the Promenade. Five of them agreed to take their survey.

"The people out here in the middle of the night sleeping are the most challenging to get to use social services," said Danielle Noble, the leader of Maceri's group and senior administrative analyst with Santa Monica's Homeless Services office.

Noble and others say their hope is to get the most vulnerable homeless people into housing and help all the chronically homeless get in touch with agencies that can get them off the streets more quickly.

The project is the latest of Santa Monica's efforts to end its chronic homeless problem. Every night, an estimated 600 people sleep at shelters and on the city's sidewalks, streets and benches, city officials say.

The city formally launched its Chronic Homeless Project in 2004. As of this month, 77 people who had been chronically homeless are now housed, according to Julie Rusk, human services manager for Santa Monica.

In October, Rusk said, the city decided to collaborate with Common Ground, a New York City nonprofit group that launched a similar, successful effort to house homeless people living in Times Square.

Common Ground's approach is a technological breakthrough, said Gary Blasi, a UCLA law professor who has studied homelessness for 25 years.

"It's innovative because you are looking at the root of the problem and finding the homeless instead of them finding you," said Blasi, who observed another Common Ground effort in December on Los Angeles' skid row.

"Normally, the chronically homeless make it to agencies when in crisis, like emergency rooms," Blasi said. The Common Ground "approach isn't an exact science but targets the chronically homeless, the more difficult ones, that the shelter system historically leaves out."

In December, volunteers from county agencies and social service groups canvassed about 40 blocks of skid row with Common Ground, plotting the concentration of tents and sleeping bags and identifying hubs of drug activity.

The surveyors counted 471 people regularly sleeping on the area's streets and persuaded 350 of them to be interviewed. Recently, Los Angeles County supervisors unanimously approved a $5.6-million plan to house and provide health services for the 50 most vulnerable homeless people on skid row identified by the survey.

Each person is given a "vulnerability score" that is determined by factors such as length of homelessness and physical and mental health status, in an effort to predict an individual's risk of dying on the streets.

Rusk said that Santa Monica's goal is to house the 10 most vulnerable people as soon as possible. Once they are housed, efforts will be directed toward housing the next 10 most vulnerable people, going down the list as far as possible, Rusk said.

During an initial head count last Friday morning, the Santa Monica surveyors counted 277 individuals sleeping on streets in the early morning. The teams are scheduled to go out again from 3 a.m. to 5 a.m. today and Wednesday.

A public briefing on the survey will be held at 3 p.m. Thursday at the Santa Monica Main Library Auditorium, 601 Santa Monica Blvd.
Read more!

Before autism strikes - Los Angeles Times

A study will use behavioral therapy in babies at risk of developing the disorder.

By Linda Marsa
Special to The Times

January 28, 2008

CAN autism be prevented? It sounds like a very long shot. But that is the focus of innovative research at the University of Washington that will use behavioral techniques with infants genetically at risk for the condition to try to stave off the symptoms of this baffling neurological disorder.

If the approach proves beneficial, it could save thousands of children from a life of social isolation and permanent disability.

"This is a very exciting and potentially revolutionary study because it is the first to focus on infants," says Alice Kau, an autism expert at the National Institute of Child Health and Human Development in Bethesda, Md. "Diagnosis and intervention at such a young age could prevent the development of full-blown autism."

Once an exceedingly rare diagnosis, autism is thought now to afflict 1 in 150 newborns, more than Down's syndrome or childhood cancers, and the steep rise in these numbers has lent urgency to the search for better ways to reverse or even halt the development of the disorder. Experts don't know what causes autism, but they do know that it runs in families. When infants have an autistic older brother or sister, the odds that they will develop the disorder are five to 10 times higher than in the general population.

The federally funded $11-million study, which enrolled its first patients last week and is expected to last four years, will eventually involve 200 Seattle-area infants 6 months or younger upon enrollment, each of whom has an older sibling diagnosed with autism.

Half of the babies will be monitored by specialists and referred for community treatment. Mothers and infants in the other group will participate once a week for 12 weeks in social interaction workshops that promote the formation of emotional bonds. All the children will be evaluated at 12 months.

Next, those infants in the treatment group will undergo an intensive intervention program called applied behavior analysis (see box), and parents will be taught how to encourage play and communication. At 24 months, the children will be assessed again.

Although the researchers cannot know which of the 200 babies would have gone on to receive a diagnosis of autism, they can see whether the number was reduced from the expected autism rate in children with autistic siblings, which is 1 in 20.

In children with autism, a glitch in the brain's circuitry seems to cause a profound disconnect, interfering with the natural acquisition of language and social skills that most of us learn instinctively. Scientists speculate that "too many neural connections develop and they're not connecting to the right places," says Dr. Nancy J. Minshew, director of the Center for Excellence in Autism Research at the University of Pittsburgh.

Autistic traits can be bewilderingly diverse and include rigid, repetitive rituals, bizarre fixations, temper tantrums and an inability to concentrate, communicate intelligibly, form emotional bonds, read social cues or even make eye contact.

Some children with autism can be high functioning with normal or above-average IQs and are able to blend in, while others have some mental retardation, struggle with spoken language and are socially withdrawn.

But strides in treatment have been made. Growing evidence suggests that intensive behavioral therapy of the kind to be used in the University of Washington study can improve the chances that a child with autism will develop normally or be less severely affected.

The belief is that like stroke victims, children can learn compensatory strategies to help them overcome their deficits and form new brain pathways. These behavioral techniques maximize social engagement, says Dr. Stephen Dager, an autism researcher and psychiatrist at the University of Washington in Seattle who is not involved in the current study. "The more you can encourage that in a child, the more they will have an incentive to develop language as a tool of social interaction," he says.

The earlier the intervention occurs -- usually before the age of 3 -- the better the outcome, Dager adds. "These are critical developmental windows for laying down patterns of social interaction and language," he says. "If they miss these milestones, it's a lot harder to catch up."

The hope of the University of Washington study is that these same therapeutic approaches that work to ameliorate autism in older children may, in the younger, high-risk siblings, prevent autistic symptoms altogether by intervening while the youngsters' neural circuitry is still forming.

But even if the study falls short of that dream, researchers expect to learn much from it. Because autism can't be reliably identified until about age 2, the scientists hope to uncover subtle clues that would help them spot kids with autism earlier, before obvious symptoms emerge.

"That way, in the future, we'll know better who needs to start early interventions," says Annette Estes, associate director of the University of Washington Autism Center and one of the study investigators. "Right now, the only thing we can tell parents of at-risk infants to do is wait, watch -- and worry. We'd like to do better than that."
Read more!

Life cycle of ADHD - Los Angeles Times

Does medication make a difference in the long run for kids suffering from the disorder? New research suggests it doesn't.

By Melissa Healy
Los Angeles Times Staff Writer

January 28, 2008

Doctors and parents have long been left to guess at which children with a diagnosis of attention-deficit hyperactivity disorder, or ADHD, will go on to become adults with significant attention problems, how well they will navigate the challenges of adulthood and whether early recognition of -- and medication for -- their condition will make any difference in the trajectory of their lives.

Now a series of studies following 457 Finnish children from birth to ages 16 to 18 offers a glimpse of how the primary symptoms of ADHD typically evolve. At the same time, the studies raise provocative questions about the long-term effect of treating those symptoms with medication.

The studies focus on a subset of 188 Finnish teens considered to have "probable or definite ADHD" that will follow them into adulthood and 103 kids with conduct disorder -- behavior issues that fall short of an ADHD diagnosis but put kids at higher risk for similar problems. Those teens were compared with a group of Finnish teens with no ADHD diagnosis.

Researchers found it is the can't-sit-still kids -- the stereotype of the "ADHD generation" -- who are most likely to mature out of the disease. Among those with persistent ADHD, they also found, half have problems with cognitive skills that are key to success in adulthood, but half have no such deficits.

And when researchers compare the findings from Finland to studies of Americans with ADHD, an even more intriguing discovery emerges: By the time they're in their late teens, those who receive drugs for attention problems seem to fare about the same as those who do not.

That is sure to fuel a simmering debate over the extent to which American kids with ADHD receive medication, often with little other support. In Finland, medication for ADHD is extremely rare.

"This begs the question: Are current treatments really leading to improved outcome over time?' " wrote UCLA neuropsychologist Susan L. Smalley and co-author Dr. Marjo-Riitta Järvelin in a special section of December's Journal of the American Academy of Child & Adolescent Psychiatry. Smalley co-directs UCLA's Center for Neurobehavioral Genetics. Järvelin is a professor of public health and of medicine at Imperial College School of Medicine in London and University of Oulu, Finland, respectively.

UCLA neuroscientist Robert Bilder, who was not involved in the Finnish research, said the studies suggest that ADHD might best be treated, in some kids, by shoring up weaknesses in underlying cognitive skills rather than by focusing exclusively on behavioral symptoms that can change with age.

"We all hope in the future we'll find the optimal combination of treatments -- whether behavioral or pharmacological -- that'll provide young people with these problems the best chance to succeed in school and social environments," Bilder said. "It's clear so far that no treatment's been identified that's a panacea."

Two decades ago, as the diagnosis and medication of American children with ADHD began to soar, researchers and psychiatrists scarcely entertained the possibility of adults with ADHD. Today, experts estimate that 4.4% of American adults -- more than 10 million people -- suffer from attention problems serious enough to warrant a diagnosis of ADHD.

But like the generation of children first diagnosed in large numbers with ADHD, research on what the disorder looks like across the life span has just begun to mature.

Symptoms that persist

The new research suggests that, as children with ADHD grow into adolescence, it is the dreamy, forgetful, inattentive types who are most likely to continue to struggle with the disorder -- especially if they also suffered from depression, anxiety or serious behavior problems in their preteen years. When their childhood symptoms included hyperactivity and impulsiveness as well as inattentiveness, their chances of having adult ADHD grew higher still.

Underscoring the strong role of genes in the development of attention deficit disorders, the studies found that a child's likelihood of having ADHD that persists into adulthood is significantly greater if either parent -- but especially his or her father -- suffers from serious attention problems too.

By contrast, those whose childhood symptoms were confined to hyperactivity are the most likely to mature out of the disease in adolescence, the Finnish studies found. By age 18, most with persistent ADHD will struggle with mental rather than physical restlessness.

In all, roughly 2 in 3 of the Finnish children who were diagnosed with ADHD as children continued to exhibit severe attention problems between ages 16 and 18.

In an introduction to the special section, Smalley points out several similarities and one intriguing difference between the Finnish children who were studied and their counterparts in the United States. ADHD appears with similar frequency in each of the two populations. Each population also has similar variations in symptoms of the disorder and similarly high rates of social and emotional problems -- depression, anxiety, defiant behavior -- that often afflict adolescents and adults with ADHD.

In Finland, as in studies of U.S. populations, about half of older teens with persistent ADHD performed poorly on tests of short-term, or working memory, and in cognitive skills that are key to problem-solving, making plans and executing tasks. And in each group, roughly the same proportion of children "mature out" of the disorder.

Although about 60% of American children diagnosed with ADHD are medicated -- at least at some point -- for its symptoms, virtually no Finnish children are given medication. And yet, by the time they reach 16 to 18 years old, these two populations look very much the same.

In an interview, Smalley stressed that the studies do not cast doubt on the short-term benefits a child with ADHD may get from a stimulant or other medication that treats the symptoms of the disorder. She cited recent studies showing that at the end of one year, children medicated for ADHD symptoms function better at home and school than those who get behavioral and cognitive therapy. But after three years, the difference between the two groups begins to wane.

A range of options

"We really need to look at how effective, really, is medication alone in long-term prevention" of the intellectual deficits and psychiatric problems that plague those with ADHD at higher rates than those without, Smalley said.

She also emphasized that the studies show that ADHD is "an extreme on a continuum" of normal for humans. Just as kids range across a spectrum in glucose tolerance or reading ability -- putting some at higher risk of diabetes or dyslexia -- they are also distributed across a spectrum in terms of their ability to focus, the strength of their working memory and their propensity for developing social and emotional problems. As children age, some will "age out" of the disorder, no longer meeting diagnostic standards for ADHD.

A growing body of research suggests that children and adults with ADHD may have compensating strengths as well, Smalley said, including a willingness to take intellectual risks and to conceptualize things on a grand scale. Their brains just work differently than those of people with a greater ability to focus on and digest detail, she said.

If better medication or specialized therapy, or both, can drive down the risks that these children will be hobbled by academic failure, ill-chosen impulses and other psychiatric problems, their other talents could shine through, Smalley said. And the world would be a better place for it, she added.

"We need to step back and embrace neurodiversity, diversity in human behavior and try to work on ways to embrace and enhance being at the extreme, instead of only focusing on the deficits and disorder aspects of ADHD," Smalley said.

Read more!

Pediatricians call for ABC to cancel TV show linking vaccines and autism - Boston Globe

By Elizabeth Cooney
January 28

A new ABC courtroom drama is drawing fire from a physicians’ organization and local pediatricians over its verdict on vaccines and autism.

The American Academy of Pediatrics is calling for ABC to pull Thursday night’s debut of “Eli Stone," a courtroom drama. In the episode, the main character wins a case after arguing that a childhood vaccine containing a mercury-based preservative caused the defendent to develop autism.

“A television show that perpetuates the myth that vaccines cause autism is the height of reckless irresponsibility on the part of ABC and its parent company, The Walt Disney Co.,” AAP president Dr. Renee R. Jenkins said in a statement. “If parents watch this program and choose to deny their children immunizations, ABC will share in the responsibility for the suffering and deaths that occur as a result.”

Dr. Robin Adair, assistant professor of pediatrics at University of Massachusetts Medical School, supports the academy’s position.

“I agree with the concern that the show might frighten people away from vaccinating their children due to a risk that I think is fairly conclusively shown not to exist,” she said in an interview. “Yes, it’s put out there as entertainment, but these sorts of things can be influential.”

The link between the additive thimerosal and autism has been promoted by parents and advocacy groups despite repeated research studies finding no basis for the belief. The most recent study came earlier this month from the California Department of Public Health, which found that after thimerosal had been removed from vaccines, autism diagnoses continued to rise

Read more!

State Acts to Plug Gaps in Mental Health System - Washington post

By Sandhya Somashekhar

RICHMOND, Jan. 28 -- The Virginia General Assembly continued to move forward Monday to overhaul how the state cares for people with mental illness, promising to fix a system whose flaws were exposed last year after the shootings at Virginia Tech.

Committees of the Senate and House of Delegates endorsed a variety of revisions, including tightening restrictions on gun ownership by the mentally ill and lowering the standard by which a person can be committed to a mental institution against his or her will.

A bill passed by the House Courts of Justice Committee would ensure that those who have been ordered to seek treatment are monitored by mental health workers. Seung Hui Cho, the gunman who shot and killed 32 students and teachers at Virginia Tech in April before killing himself, was ordered into treatment in 2005, but the local mental health agency never followed up.

One revision would put Virginia's mental health system in line with those elsewhere, such as in New York, that give states greater authority in deciding who needs outpatient treatment, lawmakers said.

"What we did today was the most significant change in mental health law in Virginia in over 25 years," Sen. Ken Cuccinelli II (R-Fairfax) said. "Of course, the reason the political momentum is there is because of the tragedy at Virginia Tech. I just wish it didn't take someone going so far for us to get legislation like this."

But some advocates say many of the bills do not go far enough in repairing gaps in the state's system and preventing another large-scale tragedy.

"On a scale of one to 10, Virginia right now is a one when it comes to mental health," said Jonathan Stanley of the Arlington County-based Treatment Advocacy Center. "With this, they're jumping to a two or a three. As far as I'm concerned, this is a very modest change."

A major hurdle for some of the changes will be funding. Gov. Timothy M. Kaine (D) has set aside $42 million in his proposed budget to pay for mental health changes, but several lawmakers said Monday they were concerned that some efforts could require substantially more money at the same time that the state faces one of the worst budget pictures in years.

In particular, a bill advanced by the Senate Courts of Justice Committee on Monday would create a statute similar to New York's Kendra's Law, which gives social workers, doctors and relatives more power to bring mentally ill people before a judge and force them to get outpatient treatment.

"Most of us support the concept on this, but it has a huge, huge fiscal impact," said Sen. Janet D. Howell (D-Fairfax), the chief sponsor of the Senate bill that includes most of the other changes. "We just don't have the caseworkers to do that right now, and we just don't have the funding."

Among other changes, Howell's bill would lower the bar for who could be involuntarily committed.

Currently, people must be deemed an "imminent danger" to be hospitalized against their will. Under Howell's bill and a similar one advanced by a House committee last week, there must be a "substantial likelihood" that a person would cause "serious physical harm to himself" in the near future or could "suffer serious harm due to substantial deterioration."

Stanley and others advocate an even lower standard that would give relatives and doctors more options to seek help for those who refuse it. Howell, however, said that the overhaul will probably be a multiyear effort that is phased in because of its costly and complicated nature.

Many of the changes, which have bipartisan support in the House and Senate and have been endorsed by Kaine, were proposed in the wake of the Virginia Tech killings. Cho was able to buy guns and avoid treatment despite a long history of mental illness.

Read more!

Bill aims to avert school violence - Denver Post

By Jennifer Brown

A think tank of educators, law officers and mental-health experts would research and test the best ways to prevent school violence under a bill announced Monday by Gov. Bill Ritter.

The School Safety Resource Center would choose five schools or colleges to test ways to thwart shootings and other emergencies.

"We want Colorado to be a leader in preventing violence, not enduring it," said Ritter, who as Denver district attorney spent days at the scene of the Columbine High School shootings.

If Senate Bill 1 becomes law, the resource center would help districts monitor bullying, truancy and high-risk behavior to try to prevent school violence.

"There is no pain that can match that," said Rep. Amy Stephens, a Monument Republican sponsoring the measure.

The center likely will have about $480,000 its first year to hire five researchers, said co-sponsor Sen. John Morse, D-Colorado Springs.

State Education Commissioner Dwight Jones said the resource center would help Colorado move into "prevention mode." Every school district was required to create a safety plan after Columbine, but most are focused on responding to crisis, he said.

Read more!

In a Way, He Took Our Lives, Too - Washington Post

After 45 Years, the Hurt, and Questions, Still Linger

By Margie Goldsmith
Special to The Washington Post
Monday, January 28, 2008; C08

When I think of my father, I see fragments of him: sad brown eyes, a downcast mouth, huge hands clasping and unclasping indecisively. I see his 6-foot-2 frame towering over me, his enormous feet digging into the sand at Bailey Beach as he barbecues hamburgers. I see him playing the piano, singing songs by Cole Porter and Rodgers and Hart. But mostly I conjure a shattered pair of eyeglasses, a wristwatch with a broken crystal, a worn brown leather wallet containing two crumpled dollar bills. Those were the only possessions the police returned to my mother after my father jumped from the 14th story of a Philadelphia office building.

I try to picture the scene -- he drives to the advertising agency. It's Saturday, so no one's around. He's lied to my mother about having to work that day. Does he lock his office door? Does he take a drink from his dented silver flask? Has he written the note already or does he write it then? He goes to the window and opens it. It's winter. Does he climb right out on the ledge or does he hesitate? What is he thinking at that instant as he steps into the air?

It happened 45 years ago when I was only 18, so the whole thing is just fragments in my memory. But it haunts me. It starts when I read about a suicide or see it in a movie or play. As the word springs to life in my mind, I feel not sadness but shame, maybe because suicide is still such a taboo. When my father died, the radio announced that he had fallen out of a window by accident. Fallen out of a 14th-floor window on a blustery cold day by accident? I don't know who gave the radio station that information -- probably our lawyer, a good family friend, trying to protect us.

If someone asks how your father died and you say heart attack or cancer, they tell you how sorry they are and the subject is over. But if you answer "suicide," they ask, "Suicide?" This is not a substitute for "I'm sorry," but rather a shortcut to what they really want to know: Did he take pills? Slit his wrists? Shoot himself? Whenever anyone asks, I say my father died in a freak accident.

They say only about a third of suicides leave notes. My father's was typed on yellow copy paper. It said he loved us, that he knew my mother, my younger sister and I would be fine, and that he wished he could take Kathy, my older sister, with him. The day before my father killed himself, he'd taken Kathy to her first mental institution. As he said goodbye and the thick steel door locked him out, he felt as though he were the one who should have been inside.

He'd been depressed before. At Brown University, he'd tried to kill himself with a rubber gas hose. He'd also been in the hospital for shock treatment. The week before he killed himself, he'd been depressed and wanted to go to the hospital, but my mother talked him out it because she knew he hated shock treatment. For months afterward, she lay sobbing on the sofa, drinking herself into oblivion with vodka, and saying over and over again, "If only I hadn't canceled the bed."

The night of his death, I went into his den and rummaged through his desk drawer. He was an advertising copywriter who hated his job, thought he was a hack, and wanted to write detective stories. As I looked under his typewritten pages, I saw a small black spiral notebook with his familiar scrawl: "Wednesday: Bad. Friday: Worse. Tuesday: Terrible."

One million people worldwide take their lives each year. My family was dysfunctional before he did it, but after, we were wounded in new ways. My mother blamed herself until she died 20 years later. Kathy spent the rest of her life in a mental institution, terrified of heights.

And me? I dealt with it by doing drugs, drinking myself into oblivion, and going through eight years of therapy. I gave up the drugs and drinking, regained my self-esteem and graduated from therapy. I married and divorced twice but never had kids because I was so afraid they might be subject to the same depression.

Even though it happened so many years ago, at some moments it all rushes back, and I have to fight not to cry. I can see his body falling from the air. And I wonder, in those last few seconds of his life as he was hurtling down toward the sidewalk, did he think, if only for just a brief second, of me?

Read more!

Spears Has `mental Issues, ' Friend Says - Associated Press

NEW YORK (AP) -- Barbara Walters says she has been contacted by Britney Spears' manager and ''very good friend,'' Sam Lutfi, who says the pop singer has seen a psychiatrist.

Lutfi told her the 26-year-old pop singer ''is suffering from what he describes as mental issues which are treatable,'' Walters said Monday on ABC's ''The View.''

''He said that she has been to a psychiatrist and that she, I assume, is starting some kind of treatment,'' said Walters, a co-host on the ABC daytime talk show.

''She has been having mood swings. She's been having trouble sleeping, and also she is in touch with her mother -- 'cause we had heard she wasn't -- and her mother has been very supportive of whatever it is that Britney is going to do,'' Walters said.

Lutfi has been staying with Spears constantly, ''and he got in touch with us,'' Walters said. ''I can't vouch for this, he seemed to be very knowledgeable and he certainly was very nice.''

Spears' attorney, Sorrell Trope, didn't immediately return a phone call seeking comment Monday. Spears' spokeswoman at Jive Records, Gina Orr, didn't immediately respond to an e-mail seeking comment.

Spears has spiraled downward since filing for divorce from Kevin Federline in November 2006. Her bizarre public antics include shaving her head bald, attacking a car with an umbrella and bringing along a paparazzo pal on trips to a Los Angeles courthouse in her custody case with Federline.

The singer was taken to a Los Angeles hospital by paramedics earlier this month after police were called to her home because of a dispute involving her sons Sean Preston, 2, and Jayden James, 1. She has lost custody and visitation rights with the boys.

Spears reportedly has had a rocky relationship with her mother, Lynne Spears, whose book about raising her family in the spotlight was put on indefinite hold last month after younger daughter, Jamie Lynn, 16, announced that she is pregnant.

Read more!

Mental health patient abuse -Charlotte Observer

Better community-based services would improve care delivery system

From Vicki Smith, executive director, Disability Rights NC, Champions for Equality and Justice:

Last year, 2007, was a dangerous year for individuals living in the state psychiatric hospitals. A veteran lawmaker was skeptical of the abuse recently reported at John Umstead Hospital, saying, "Well, I seriously doubt that it happened, but if it did, it certainly is a travesty and should be addressed." Asked to elaborate, he said, "We just don't usually beat folks. It's not the kind of thing that usually goes on in our mental hospitals."

He is wrong. Cherry, Broughton and now Umstead have been cited by the federal government for treatment conditions so poor that residents have been abused and in some cases died.

So, who is responsible for the increased violence in our state hospitals? Umstead Director Stephen Oxley was quoted as saying, "This is not a problem of our hospitals screwing up, of just not doing what they're supposed to do. ... We're being confronted with a significant increase in violence in our facility." If it's not a problem of the hospitals, then what is the problem? Apparently, one solution would be to blame the victims of this violence, residents with mental illness who are in the hospital, often not voluntarily, to receive treatment.

There are more suitable places to look for the cause of this systemic problem. First, the inevitable consequence of understaffing, overwork and low wages is poor employee morale. Poor employee morale often results in staff turnover, making it even harder to ensure that workers are appropriately trained. Poorly trained workers provide poor services. In a health care system, this translates to poor patient care -- in state hospitals that means increased abuse and neglect. This is the fault of the system that provides the staffing ratios of patients to health care workers and establishes employee salaries. It cannot be resolved by isolated after-the-fact firings.

Secondly, there must be adequate community-based services including crisis facilities to prevent, when possible, the necessity for hospitalization. Without appropriate community services, especially crisis intervention, people with mental illness can experience rapid escalation of symptoms. Added to this dangerous lack of services is the long transport from local neighborhoods to overcrowded state hospitals. Now it is beyond crisis. It is a tragedy waiting to happen.

A community-based service delivery system for people with mental illness, substance abuse issues or developmental disabilities cannot be built by simply closing down institutions. There must be an array of regionally based community services. There must be adequate housing, supported employment opportunities, safe recreation and other service options readily available across the state. As people move through the service delivery system, there must be crisis services including trained first responders.

But most importantly we have to stop thinking the bottom line is preceded with a dollar sign and recognize that what we are really spending -- not saving -- is human lives.
The views in For The Record are the writer's, and not necessarily those of the Observer editorial board. Read more!

Ignored, mental illness costs lives -Framingham (MS) MetroWest Daily

By DEBORAH E. GAUTHIER

Things happen in this world that break your heart. You feel it crack, and it takes every ounce of composure you possess to keep from crying, wailing, screaming against God or fate or whatever controls the complex, sometimes treacherous human mind.

Such was the case on a recent Friday afternoon when Middlesex, Mass., District Attorney Gary Leone ruled murder/suicide in the deaths of Marcelle Thibault, her niece, 5-year-old Kaleigh Lambert, and nephew, 4-year-old Shane Lambert.

What might have been?

The three died when they walked into traffic on Rt. 495 in Lowell. Thibault, Leone said, had a brief history of mental illness. The deaths were heartbreaking when it was thought to be an accident; it is even more so now that it’s known they might have been prevented.

Tears flow.

Such was the case a day earlier when a 23-year-old man in Honolulu threw a 2 1/2-year-old boy off a bridge and onto a busy highway. Mental illness has yet to be targeted as the reason for the tragedy, but only the most vile, or the most insane, of men could do such a thing.

Tears flow.

Such was the case in Mobile, Alabama when the father of four children, after an argument with his wife, threw those children, aged 4 months to 4 years, over a bridge and into the murky, raging waters of a river.

Mental illness surely played a role in those deaths.

Tears flow.

Such was the case two weeks ago when the decomposing bodies of four children — ages 5 to 17 — were found in a home in Washington, D.C. It’s speculated they died sometime in September. Their mother is charged in their deaths. She said the children were possessed.

Again, mental illness played a role in the death of a child.

Tears don’t help

Tears flow, but tears won’t heal any of those families torn apart by mental illness.

Mental illness continues to be thought of as something that can be overcome by mere strength of character. Yet it is a disease that must be treated seriously. How many more children must die before every one of us — family members and the medical community — give it the attention, and the treatment, it deserves?

X Deb Gauthierwries for MetroWest Daily News in Framingham Mass. Read more!

Overhaul state's mental health services - East Brunswick (NJ) Homes News Tribune

Editorial: 01/27/08

There have been numerous studies of New Jersey's mental hospitals over the years — nearly all of them offering alarming indictments as well as blueprints for change — and Richard J. Codey devoted a great deal of time and energy as acting governor to highlighting the problems in the mental health system and then attempting to solve them. But to what end? A recent investigation of the state's largest mental hospital, Ancora, by Gannett New Jersey newspapers reveals a situation as desperate and depressing as ever.

The investigation was instigated by a suicide at the hospital in early December. The suicide pointed to systemic failure: Everyone from the neophyte guards assigned to watch the patient that night to the chief executive who neglected to have the patient psychologically evaluated, even after he ran away, was culpable. Only the lowly guards paid with their jobs.

Even as the gruesome mistakes of that death were uncovered and publicized, the public and former patients came forward with more tales of abuse and neglect. The probe eventually found that few at the hospital were safe: Ancora recorded an absurdly high number of attacks on both employees and patients.

Eventually, an Assembly committee said last week it would hold hearings on the matter in an attempt to discover what was going wrong and how it might be fixed. We hope the hearings will lead to changes that are both meaningful and lasting.

Of course, the mental health system might benefit from an infusion of money. The state, in particular, is short of group homes and affordable housing and, according to the newspaper report, half of Ancora's more than 700 patients could be released to some place less restrictive but have nowhere to go. And there is a real question whether the state's hiring freeze benefits either the patients or the bottom line, since the state ends up spending millions every year on overtime.

It is also clear, however, that the system's greatest weakness is not money but will. Its greatest failure is one of leadership. Gov. Jon S. Corzine can, and should, do more to try to highlight the failures and lead the way to change. While he cannot do it on his own, he does have the power to hire someone who might. Kevin Ryan's forceful but all-too-brief tenure at the Division of Youth and Family Services has proved that eager, intelligent and unstinting leadership can create drastic change in seemingly hopeless bureaucracies. Corzine needs to devote the time, attention and, if need be, the money to recruiting someone of that caliber to overhaul the state's mental health services. The time has come to stop accepting anything less. Read more!

With mental health bill mired, Ramstad's legacy at stake - Minneapolis-St. Paul Star-Tribune

By KEVIN DIAZ, Star Tribune

WASHINGTON - Long-stalled legislation to fling open the doors of treatment to those with mental health issues remains deadlocked in Congress, casting a shadow on a pivotal race to replace Rep. Jim Ramstad, who has staked his political legacy on the bill's passage.

The nine-term Minnesota Republican has said he has no plans to run for reelection this year, but he wants to see his mental health legislation become law before he leaves the House.

Yet legislators and advocates who have worked closely on the bill say it remains mired in a standoff between competing House and Senate versions, and that Ramstad's more ambitious House plan -- named for the late Sen. Paul Wellstone -- has little chance of becoming law.

Ramstad, 61, says negotiations are at a "delicate phase" and that there's still hope. "I fully expect the bill will pass this year, and I'm not retiring until Dec. 31," he said.

Political observers note that Ramstad has left himself an opening to renege on his planned retirement by linking it to his signature "parity" bill, which would require insurers to cover mental health conditions the same way as physical ailments.

Ramstad, a recovering alcoholic with a deep personal interest in mental health and chemical dependency, remains elusive on the question of retirement.

In an interview, he said "I haven't left anything open." But he declined to say unequivocally whether he will leave Congress at the end of the year if he does not get the mental health parity bill he wants.

"In one capacity or another I will continue to lead the fight for people with mental illness and addiction," he said, declining to elaborate further.

Since his surprise retirement announcement in September, Ramstad has been dogged by reports that he is weighing entreaties from Republican leaders to reconsider.

Meanwhile, the campaign of Republican hopeful Erik Paulsen, a former Ramstad staffer, has reported almost $390,000 in campaign fundraising, a larger haul than any of the DFLers in the race. Paulsen announced his candidacy Sunday.

But Eric Tostrud, Paulsen's finance chairman, has suggested that there's another $100,000 in contributions "on the table" as potential donors wait to see what Ramstad does.

Compromise elusive

It also remains unclear how much compromise Ramstad would require from the Senate to declare victory on a parity bill.

"There's no question we're going to continue to fight for the House bill," Ramstad said. "We might not get everything we want. We probably won't get everything we want. I've been around long enough to know that. But we're going to push for the strongest bill we can get."

To be sure, both sides are expected to hold to their strongest negotiating positions in public, and Ramstad made clear that he doesn't want to "negotiate in the press."

Critics of the House bill say Ramstad and lead sponsor Patrick Kennedy, D-R.I., are shooting for the moon. Carrying forward a cause that Ramstad has championed since the 1990s -- along with Wellstone, whose brother suffered from a bipolar disorder -- their bill would dramatically expand health insurance for people with mental disorders or chemical dependency.

Over the years, it has run into a solid wall of opposition from employers and insurers, who fear it would mandate expensive new treatments and drive up costs. A less stringent plan, which has the backing of a broad coalition of insurance, professional and business groups, was approved unanimously by the Senate last year.

Backers of the Senate version say that's the best deal they're likely to get and that pushing for more coverage mandates could fracture a fragile coalition they've formed with some consumer groups.

Marilyn Richmond of the American Psychological Association calls the Senate plan a "historic opportunity" to pass legislation ending insurance practices that discriminate against the mentally ill. But, she warned, "it's at risk of ending in deadlock if Congress is unable to negotiate a bill that is acceptable to both the House and the Senate."

Another backer of the Senate plan is fellow Minnesota Republican John Kline, who says Ramstad's "overreaching" has delayed a final deal. As the ranking Republican on the House subcommittee that deals with health legislation, Kline sought unsuccessfully last year to scrap the House version and replace it with the Senate bill.

"Had we done that," he said, "we would have a mental health parity law."

Instead, Kline says, two years of negotiations are now hanging in the balance, with Ramstad holding the most important cards. "It's in the hands of the proponents of mental health parity to get this into law by moving to the Senate version," he said. "If not, it's going to be difficult."

Legacy at stake

But Ramstad and his allies don't see much reform in the Senate bill, even if it's being carried by Sen. Ted Kennedy, D-Mass., Patrick Kennedy's father. One of the core differences is that the House bill bases coverage on conditions outlined in the diagnostic manual of the American Psychiatric Association. The Senate version largely defers to insurers on how to decide what conditions are covered.

David Wellstone, the late senator's son, believes that discretion would leave too many people without coverage. He feels strongly enough about it that he requested that the Wellstone name be dropped from the Senate bill. "There's no way I'm going to leave my dad's name on a bill that is not as strong as it could be," he said.

Another Ramstad ally is Chaska resident Kitty Westin, who became a national advocate for treatments of eating disorders after her 21-year-old daughter Anna committed suicide in a struggle with anorexia. The Senate bill, Westin notes, still excludes eating disorders.

Wellstone and Westin have been buoyed by Ramstad's strong backing in the House. Headed for a final vote on the House floor in coming weeks, the Paul Wellstone Mental Health and Addiction Equity Act has 273 co-sponsors, more than enough for easy passage.

But then it will be up to a conference committee to reconcile House and Senate versions that many skeptics say are irreconcilable.

"It's not just a policy issue," Ramstad said, "it's a matter of life and death for a lot of people."

It may also be a matter of Ramstad's political legacy, if not his future.

"He is so committed and passionate about it," Westin said. "He's worked so hard. It's something that will always be a part of his legacy."

Kevin Diaz • 202-408-2753
Read more!

Legislature taking a look at Pierce County's dispute with state - Tacoma (WA) News Tribune

M. Alexander Otto; alex.otto@thenewstribune.com

The state has been running the Pierce County mental health system since Jan. 1.

From the county’s point of view, it’s going pretty well so far.

“We haven’t had any reports of disruptions” in services for the roughly 15,000 patients who rely on publicly funded services, said David Dula, mental health manager for Pierce County Human Services.

In the Legislature, however, the transition raises problems for some lawmakers.

Legislators have introduced four bills they say are aimed at keeping the state mental health system running smoothly in the wake of Pierce County’s decision to turn its operation over to the state after a funding fight.

However, Rep. Jeannie Darnielle, D-Tacoma, says the bills are “punitive,” and, if passed, would hurt Pierce County.

“These are very serious and disturbing bills,” she said.

They are meant to punish the county for not “living within the spending limits set by the state” and for failing to raise sales taxes to help cover mental health costs, as some counties, including King and Spokane, have done, Darnielle said.

Not so, said Sen. James Hargrove, D-Hoquiam, sponsor of two of the bills.

“Our intent is to keep the rest of the system from unraveling,” he said. “We don’t want every other county that thinks they may be short of money to roll out on us, too. That would be a real mess.”

Two of the four legislative proposals, Senate Bill 6404 and House Bill 2750, would ban counties that stop contracting with the state to provide mental health services from resuming the arrangement in the future, barring additional legislative action.

(Though not named in the legislation, Pierce is the only county to have taken that action.)

The bills also would, among other things, allow for-profit companies to contract with the state to run the departing county’s mental health system.

House Bill 2784 and Senate Bill 6665 would prevent the state from extending funding for mental health pilot projects if counties opt out of the state system, once the original funding period is over. Pierce County currently has one of two such projects in the state.

The four bills remain in committee.

In Pierce County, the biggest effect if state money for pilot projects ends is that the county’s detoxification unit would lose its funding this summer, when the original funding authorization ends.

The 16-bed unit on Pacific Avenue has been operating at or near capacity since mid-2006. Before then, drunk or high people picked up by law enforcement usually wound up in jail, said Craig Adams, the Pierce County sheriff’s legal adviser.

The detox unit has been a “very valuable tool for Pierce County,” he said. “It’s an alternative to incarceration, a humane way to deal with people who may have substance abuse problem (that) saves scare jail resources.”

A goal of SB 6404 and HB 2750 is to get a managed-care company to run the Pierce County mental health system, Hargrove said. The idea is to manage costs and integrate patients’ care among various providers.

Opening the bidding to for-profit companies and not just non-profits and other counties also would encourage as wide a bidding pool as possible, said Doug Porter, an assistant secretary in the state Department of Social and Health Services.

Pierce County would be banned from bidding on its local contract, Hargrove said, because outside companies would be less likely to bid if Pierce County could re-enter the system. With its experience, Pierce County would “have a leg up,” he said.

Companies “will say the likelihood of us getting this is zero” and not bid, said Hargrove, who introduced the bill at the request of DSHS.

HB 2784 and SB 6665 not only would end funding for Pierce County’s detox unit, but also would give the funding to what the legislation describes as a county “east of the Cascades” that still participates in the state system.

The bills are intended “to show appreciation for the work done by Spokane,” said the House bill’s sponsor, Rep. Mary Lou Dickerson, D-Seattle. “Spokane’s been very cooperative.”

Dickerson declined to say more but Porter said Spokane was one of the counties that raised sales tax to cover local mental health costs. It remains in the state system and is in talks with the state about ongoing funding issues.

Darnielle said she is talking with “as many people as possible” to explain the “entirely negative outcome” for Pierce County if the bills are passed.

She is working with others in the Pierce County delegation on legislative solutions that would be more beneficial to Pierce County. For example, she said, Pierce County’s funding for the detox unit could be extended and Spokane County could receive money as well.

M. Alexander Otto: 253-597-8616

SOUTH SOUND
• Mental health bills’ drift: Don’t copy Pierce County
• Toll takers tout service
• a victory for conservationists Sleek critters get second chance
• Traffic Q&A
• Plenty of reasons to be proud
• WASL math finds a way to worry students
• New hope for community center
• Callaghan: What’s on tap: Politics, sports and a mix of both
• Merryman: Just get a job? Just get clean? It’s not that simple
• Lights & Sirens: AP: Death penalty decision delayed in Carnation killings

SPORTS
• Bedard deal done? Mariners won’t say
• Good news: M’s get ace, nobody dies
• KINGS 103, SONICS 101 Martin’s mad dash pushes Sonics’ skid to 14
• Woods on par with Arnie
• Want Super Bowl ticket? Fork over $4,300
• Boling: One more season for Holmgren to get calls right
• McGrath: Good news: M’s get ace, nobody dies
• Seahawks Insider: Super Bowl Day 1
• Mariners Insider: The Bedard trade rumors
• Huskies Insider: Jon Brockman makes mid-season Wooden list
• Preps: Boys basketball rankings, scoring leaders

Read more!

'American Idol' contestant puts spotlight on rare disease - Chicago Tribune

By Bonnie Miller Rubin

When a 26-year-old Chicagoan recently moved on to the next round of "American Idol," she was furthering more than her musical ambitions.

The popular show recently opened its seventh season featuring a video clip of Angela Martin and her 8-year-old daughter with Rett syndrome, raising awareness about a little-known genetic disorder.

"The e-mail started flying in as soon as the show was over," said Chuck Curley, director of the International Rett Syndrome Research Foundation and a father of a 12-year-old with the condition. "This is a huge moment for us."

No one knows how far Martin will go in the competition, but advocates hope that such national exposure can do for the disorder what Michael J. Fox did for Parkinson's disease, Christopher Reeve for spinal-cord injuries and Katie Couric for colon cancer.

For the 6,000 or so "orphan diseases" in the United States, such awareness is a key way to funnel more dollars into research.

In the two days following the Jan. 15 premiere of "American Idol", the Rett syndrome Web site notched 10,000 hits, or 1,000 more than all of December, Curley said. "We don't think that's a coincidence."

For Marcia Adamski of Midlothian, just hearing the name was validation.

"I was so excited ... I just wanted to pick up the phone, start calling everyone I know and just scream," said Adamski, whose 2-year-old granddaughter has the disease.

Martin's tuneful rendition of "Signed, Sealed, Delivered" was strong enough to move her to the next round in Hollywood, which airs Feb. 13.

If fate smiles on the aspiring singer and she survives all the way to the finals in May, she will get to educate -- as well as entertain -- some 33 million viewers weekly. (Average price of a 30-second commercial: $875,000.)

"Not a chance we could afford to reach people like this," said Curley from his suburban Boston home.

Rett syndrome strikes girls almost exclusively, affecting about 1 of every 10,000. Toddlers develop normally until 6 to 18 months, when, inexplicably, they start regressing, losing speech and motor skills. Eventually, they become profoundly disabled, requiring assistance with virtually every aspect of daily living. There is no cure.

The illness, which is caused by a gene mutation, followed the usual course for Martin's daughter, Jessica Creamer, who is treated at Shriner's Hospital.

"Our entire family was in denial," a relative said.

Like all contestants, Martin is sequestered from the media. On camera, she described the struggle: "Her feet started to turn in ... her face wasn't growing, her brain wasn't growing. It's like she fell asleep and woke up and that was it," the South Side resident said

"It's not about fame for me. It's about getting her the best care, the best therapist. The doctors told me that my daughter was never going to walk or talk. I'm going to get that for her."

It may not be about fame, but there's no question that a star-studded spokeswoman can turn an obscure ailment into a fashionable cause.

Autism is a prime example. Once ignored by the medical community, the Autism Society has seen its budget grow to $20 million. And a new advocacy organization -- Autism Speaks, launched in 2005 -- expects to raise $50 million this year.

The upstart group was founded by NBC Universal chairman Bob Wright and his wife, Suzanne, to help their grandson, which may explain why Jerry Seinfeld and Paul Simon have been recruited for fundraising.

Finding a celebrity has become a popular route for maladies without ribbons or marathons, said Mary Dunkle of the National Organization for Rare Disorders. (The government defines "rare" as afflicting fewer than 200,000 Americans.)

That Washington-based group generated some buzz from an actor when it launched in the early 1980s. Jack Klugman of TV's "Quincy M.E." devoted a couple of episodes to obscure illnesses, as well as testifying before Congress.

Still, a household name is no guarantee, Dunkle said. "It doesn't really accomplish much if the celebrity doesn't have an obvious reason for speaking out," such as a loved one.

"And they can be high maintenance for an organization," she added.

A personal connection has often been the catalyst for research, said Dr. Peter J. Smith, a developmental pediatrician at the University of Chicago. He cited President John F. Kennedy for focusing attention on mental retardation in the early 1960s because of his sister, Rosemary's, diagnosis. (Another sister, Eunice Kennedy Shriver, helped startthe Special Olympics.)

Smith doesn't see the "American Idol" publicity leading to medical breakthroughs soon.

But the spotlight can improve quality of life with better care assistants, and legal and educational services, he said. "These families need help ... and they need it right now."

Support can't come too soon, said Curley, who has already detected a difference when talking to beleaguered parents or soliciting donations. "Now I just mention 'American Idol' ... it changes a cold call to an ice breaker."

-----------

brubin@tribune.com

To learn more about Rett

For more information, contact the Rett Syndrome Research Foundation athttp://www.rsrf.org

Read more!

Don't put public figures on the couch -Christian Science Monitor

y Ralph Keyes

Yellow Springs, Ohio

It's become commonplace to conclude that those who disagree with us politically are out of their minds. How else could we explain the fact that – in our eyes – their positions are so catastrophically wrong?

überconservative Michael Savage has argued for years that liberalism is a form of mental illness. Georgetown law professor Rosa Brooks says President Bush should be committed. Others have called Mr. Bush a madman. "I seriously believe we have to start asking questions about his mental health," said two-time presidential contender Dennis Kucinich recently. When Mr. Kucinich himself said he'd seen a flying saucer, Fox News commentator John Gibson wrote, "Now we know who's really crazy."

As for the sanity of GOP candidates: Rolling Stone writer Matt Taibbi intimated that Mike Huckabee was "full-bore nuts." In a Vanity Fair article, Michael Wolff concluded that Rudy Giuliani was "quite literally, nuts," and "actually mad."

Calling public figures crazy is not an entirely new phenomenon. During Franklin Roosevelt's first years in office, whisper campaigns portrayed him making paper dolls, laughing hysterically at press conferences, tended by psychiatrists disguised as servants, and confined to a straitjacket for extended periods of time. What's new is the application of modern tools to this public sport. Arguing that Ronald Reagan, Bill Clinton, and George W. Bush all showed evidence of brain pathology while in office, neuropsychiatrist Daniel Amen has even suggested that anyone seeking the presidency should have their brain scanned.

It is possible to disagree with political figures without questioning their sanity, of course. I'm no fan of Kucinich, but I don't think he's crazy. Bush's policies may be dangerously misguided and ill-informed, but it doesn't follow that he's out of his mind. Obviously, many think otherwise. Based on this conclusion they question his emotional fitness to hold high office. Even if they are right, however, do we really want to make candidates pass a psychological test in order to run?

In 1964, nearly 1,200 psychiatrists out of more than 12,000 polled by mail pronounced Barry Goldwater mentally unfit for high office. "If Goldwater wins the presidency," wrote one, "you and I will be among the first into concentration camps." This judgment was passed on a man who later became one of the nation's most fervent defenders of civil liberties and an advocate for including gays in the military.

In the current climate of psychological paranoia, many of history's greatest leaders might have been disqualified from running for office, if not locked up. Melancholy Abraham Lincoln would undoubtedly be diagnosed as clinically depressed by contemporary commentators, as he has been by historians. Winston Churchill, who spent his entire adult life struggling with what he called a "black dog" of crippling depression, would be, too. We should be grateful that such leaders held office in a time when the conventions of psychoanalysis were not routinely applied to public figures.

Once we stop judging candidates' psyches, we can focus better on their performance. I would much rather have a high-performing leader with neurotic traits than one on a more even keel who can't do his or her job effectively. Coolidge, Hoover, and Ford were among the most emotionally stable of 20th-century presidents, but not ones we consider particularly effective. Bill Clinton, on the other hand, who admits to having emotional "issues," governed quite capably.

This isn't to say that the mental health of presidents shouldn't concern us. Toward the end of their time in office, both Lyndon Johnson and Richard Nixon exhibited signs of instability that put in question their ability to carry out their duties. That's why the 25th Amendment – which provides a mechanism to remove an incapacitated president – is so important.

As for candidates, rather than presume to peer into their psyches, can't we evaluate them on (1) their positions, and (2) their record in public life? Mr. Giuliani's erratic, vengeful performance as mayor of New York may make him unsuited for higher office, for example, but doesn't make him nuts. Flinging about terms such as "nuts," and "crazy" when evaluating candidates degrades political discourse.

There are more than enough ways to legitimately challenge candidates whose views we don't care for without questioning their sanity in the process. Once unleashed, that dog could come back to bite our entire political process. Or has it already?

Ralph Keyes's book "Retrotalk" will be published this year.
Read more!

Judge: Shooting death suit against state police can proceed - Boston Globe

January 27, 2008

CORINTH, Vt.—A federal judge says a family can proceed with its lawsuit against the Vermont State Police for the June 2006 shooting death of their mentally ill son.
more stories like this

On Friday, U.S. District Court Judge J. Garvan Murtha rejected the state's argument that the troopers involved in the shooting of Joseph Fortunati were protected from a lawsuit because they were carrying out their official duties.

Police say Fortunati was shot as he attempted to point a handgun at troopers.

"Considering the circumstances they faced, it cannot be determined at this stage of the proceedings that it was objectively reasonable for the officers to believe their actions -- using a SWAT team, shooting Fortunati with bean bags and live ammunition -- did not violate his right to be free from excessive force," Murtha said in a 21-page decision.

Fortunati family attorney George Spaneas said was "very pleased" with the judge's decision.

"I think the judge's conclusion was well thought out and correct," he said.

Vermont Assistant Attorney General David Groff said he was disappointed, but it would not stop the state from invoking the argument that the officers were "immune" from the lawsuit at a later date.

"We think that there are grounds for immunity to be granted, so obviously we're disappointed with the decision in that respect, but it certainly doesn't preclude us for applying for immunity down the road as the facts come in," Groff said.

No decision has been made on whether to appeal Murtha's decision, Groff said.

Fortunati, 40, who family members said suffered from schizophrenia and bipolar disorder, was camped out near Copper Mine Road in Corinth in summer 2006. He reportedly pointed a handgun at his brother, Robert Fortunati, when family members tried to convince him to move on June 24.

When state tactical troopers tried to arrest Fortunati he fled, ignoring commands to surrender.

Police say Fortunati was shot after he pulled a handgun and pointed it at troopers. His family says he was obeying orders to drop the weapon.

A state review of the shooting concluded police acted appropriately.

------ Read more!

Homeless make connections - Flagstaff (AZ) Daily Sun

By LARRY HENDRICKS
Sunday, January 27, 2008

Scott Cookston, 47, moved to Williams from Texas with his wife and 17-year-old son in 2000.

In December, after his wife's four-month hospital stay put them in a financial hole, he and his family were evicted from their home. They moved to Flagstaff in order for Cookston to look for construction work and started living in a motel on East Route 66.

He found work for a time but said he "worked his way out of a job."

"We're living in the Royal Inn now," Cookston said. "I'm looking for work now."

Cookston was one of more than 200 homeless people who attended Saturday's Project Homeless Connect in Flagstaff. By doing so, he said he's found a better line on getting services he and his family need to get them back on their feet and, they hope, into a permanent home.

TWO DOZEN AGENCIES

PHC is a one-day effort, begun in San Francisco in 2004, designed to bring all services necessary in tackling the needs of a community's homeless into one spot for the benefit of the homeless, according to information from the Flagstaff Project Homeless Connect.

More than two dozen agencies -- social service, faith-based, governmental, health care -- were present at Saturday's event, which took place in the St. Pius X church on the corner of North Fourth Street and Cedar Avenue.

More than 130 communities across the country have participated in PHC in the past, and this is the first attempt for Flagstaff, said Christina Menuccini, spokesperson for the Northern Arizona Behavioral Health Authority.

In the church, more than 70 volunteers and as many homeless "guests" milled about the loud space filled with activity.

DOING IT ALL RIGHT HERE

Volunteer Tim Brookshire said his first connection happened at 9:30 in the morning. He was introduced to a man who had been laid off from a factory job in Kingman two months ago. The man, who Brookshire declined to identify, had been living hand-to-mouth at the time he lost his job. The man lost his home and decided to move to Flagstaff, because he heard there was a better job market.

"He said he got more accomplished today than two weeks of running around," Brookshire said.

"The only thing he needed was his birth certificate," Brookshire said, adding that a member of the Catholic Charities Projects for the Assistance and Transition of Homelessness went online and ordered a copy of the man's birth certificate right there.

Brookshire said the man's experience is an example of how PHC works.

"Because all the services were right here, with people in similar circumstances as him, he could do it all right here," Brookshire said.

DON'T TAKE A HOME FOR GRANTED

Doris Taylor said Flagstaff is her hometown. She is a nurse by training. She moved out of the city to be with her husband, but she and her husband are separated now.

"I never thought I'd find myself in a homeless situation," Taylor said, adding that she is currently staying at Hope Cottage, a shelter for women.

Her support system is her "Christian experience" and the faith-based volunteers who encourage and direct her out of being homeless.

Her short-term goal is to get into transitional housing or get some rental assistance.

"I would count my blessings," she said. "I would not take a home for granted."

She added that she is currently interviewing for jobs.

"By this time next week, I'll be working," she said with a smile. "There's resources to come out of being homeless, if you want."

MAYOR, CITY MANAGER VOLUNTEER

The volunteers went through a training program prior to Saturday's event in order to understand what they should "anticipate," Menuccini said. The volunteers were told they would come across families, single parents, mentally ill, substance-addicted and more.

Among the volunteers working the front lines were new City Manager Kevin Burke and Mayor Joe Donaldson.

Menuccini said that the breakfast to kick off PHC saw 140 people looking for food. In all, 200 people had come through the building seeking services by noon, she added.

Funding for the effort came primarily through private donations with matching funds from the county, and volunteer efforts.

The guests came to the event any way they could -- primarily walking, Menuccini said. But vans were available at the church to take the guests to services they qualified for, including shelters and more.

The volunteers and service providers will be tracking the guests to determine which services they received and how they will fare in coming days, Menuccini said. She added that because Saturday's event was the first for the community, she is unsure how successful it will be or how many of the city's homeless were reached.

Service providers are already considering a summer PHC, Menuccini said.

RAN OUT OF RESOURCES

Cookston said that after his wife's hospital stay last year, they ran out of resources, were evicted and began motel living. They have no "real" support system, he said.

And once a person starts living in a motel, it is a "predicament that's hard to get out of again," he said.

Cookston said he was glad he, his wife and son came to PHC.

"I'm hoping something like this can actually help," he said.

Larry Hendricks can be reached at 556-2262 or lhendricks@azdailysun.com.

Project Homeless Connect services:

-- Mental illness recovery;

-- Job services registration and job referrals;

-- Medical and dental services, immunizations, HIV testing, blood screenings;

-- Inpatient and outpatient substance abuse and mental health services;

-- Food, clothing, blankets, haircuts, hygiene items and more;

-- Social Security, food stamps; Arizona Health Care Cost Containment System application;

-- Domestic violence counseling;

-- Shelter assistance; move-in assistance, bus tickets; rent assistance, utility assistance;

-- Alcoholics Anonymous literature;

-- Veterans Administration benefits.

For more information on how to help, contact Christina Menuccini at Northern Arizona Behavioral Health Authority at 556-2662, or Wenda Meyer at Coconino County Community Services at 522-7943.
Read more!

In More Cases, Combat Trauma Is Taking the Stand - New York Times

By DEBORAH SONTAG and LIZETTE ALVAREZ

When it came time to sentence James Allen Gregg for his conviction on murder charges, the judge in South Dakota took a moment to reflect on the defendant as an Iraq combat veteran who suffered from severe post-traumatic stress disorder.

“This is a terrible case, as all here have observed,” said Judge Charles B. Kornmann of United States District Court. “Obviously not all the casualties coming home from Iraq or Afghanistan come home in body bags.”

Judge Kornmann noted that Mr. Gregg, a fresh-faced young man who grew up on a cattle ranch, led “an exemplary life until that day, that terrible morning.” With no criminal record or psychiatric history, Mr. Gregg had started unraveling in Iraq, growing disillusioned with the war and volunteering for dangerous missions in the hope of getting killed, he testified.

Nonetheless, the judge found that Mr. Gregg’s combat trauma had not rendered him incapable of comprehending his actions when he shot an acquaintance in the back, fled the scene, and then pointed the gun at himself as a SWAT team approached — the helmeted officers “low crawling,” Mr. Gregg testified, and looking “like my own soldiers turning on me.”

When combat veterans like Mr. Gregg stand accused of killings and other offenses on their return from Iraq and Afghanistan, prosecutors, judges and juries are increasingly prodded to assess the role of combat trauma in their crimes and whether they deserve special treatment because of it.

That idea has met with considerable resistance from prosecutors and judges leery of creating any class of offenders with distinct privileges. In Mr. Gregg’s case, for instance, Judge Kornmann cautioned the jury that nobody got “a free pass to shoot somebody” because they “went to Iraq or Afghanistan or the moon.”

Still, more and more, with the troops’ mental health a rising concern, these defendants are succeeding in at least raising the issue of psychological war injuries. Aggressive defense lawyers, many in the military bar, are insisting that Iraq or Afghanistan be factored into the calculus of justice in these cases. They are arguing that war be seen as the backdrop for these crimes, most of which are committed by individuals without criminal records.

“I think they should always receive some kind of consideration for the fact that their mind has been broken by war,” said Lt. Col. Colby Vokey, Western regional defense counsel for the Marines.

Last year, California became the first state to pass legislation dealing with the small fraction of Iraq and Afghanistan veterans who end up entangled with the law. Updating a Vietnam-era statute, Gov. Arnold Schwarzenegger quietly signed a bill that permitted judges to divert troubled veterans into treatment programs.

“This is going to be on my tombstone, this bill,” said Pete Conaty, a Vietnam veteran who lobbied for it. “It has been a personal crusade of mine to make sure we don’t make the same mistake with Iraqi vets as we did with my generation.”

But the California law applies only to lesser crimes, as, in all likelihood, will any bills that it inspires, like one being debated in Minnesota.

Iraq and Afghanistan veterans facing homicide charges must defend themselves without the benefit of such laws. And in so doing, they often provoke intense moral and legal wrangling, turning local courthouses into unlikely forums for debate on the effects of the war.

Generally that debate takes place behind closed doors during plea negotiations. In cases that go to trial, however, the scene can be surreal, with Iraq commanding center stage as testimony about fingerprints and blood spatter alternates with questioning about mortar attacks in Baquba and civilian casualties in Baghdad.

Service members, sometimes wearing dress uniforms and spit-shined shoes, introduce their psychiatric evaluations into evidence and put their military colleagues on the stand to argue that the crime in question was completely out of character.

Tim Long, for instance, a company first sergeant with the South Dakota National Guard, testified about Mr. Gregg, whom he had nominated for a Bronze Star. “He’s a young farm boy, you know?” he said. “Competent young man. My friend.”

A Disorder Is Recognized

Born during the Vietnam War era, the combat version of what became known as the PTSD defense is being dusted off for a new generation of war veterans.

“I’m seeing it all the time now,” said David P. Sheldon, a civilian lawyer in Washington who represents military personnel. “And I will not be surprised to see this resonate as a consistent theme over the next few decades when people will be committing crimes after suffering repeated traumas in Iraq.”

It was in 1980, five years after the Vietnam War ended, that the psychiatric establishment first recognized post-traumatic stress disorder. Vietnam veterans quickly summoned it as a primary legal defense. In many cases, the veterans argued that they had been rendered temporarily insane as a result of flashbacks to the war while committing their crimes.

One of the first murder defendants to do so successfully was Charles G. Heads, who was found not guilty by reason of insanity for killing his brother-in-law a decade after he left Vietnam. Medical experts contended that Mr. Heads believed he was “cleaning out a hooch,” or hut, in Vietnam when he kicked in a door and shot his victim.

As time went on, the PTSD defense met increasing resistance just as the use of the insanity defense was limited by many states.

Taking a more cautious approach, the current generation of war-era defendants is most often using combat trauma not to escape culpability but to explain state of mind.

Were it not for their deployment to Iraq, they argue, they probably never would have committed the crime. Before Iraq, they claim, they were not paranoid, aggressive, jumpy or suicidal; they did not carry around loaded weapons, drink to excess, misread threats or explode in anger.

“In many of these cases, you have a nasty mix: a gun, intoxication and someone inaccurately assessing their environment and the consequences of their behavior,” said Thomas Grieger, a recently retired Navy forensic psychiatrist.

In general, the veterans raise their combat trauma during plea negotiations or in the sentencing phase of trials, hoping for reduced charges or a lesser sentence.

Occasionally it works.

Anthony J. Klecker, a former marine, pleaded guilty to criminal vehicular homicide for a drunken crash that killed a high school cheerleader, Deanna Casey, in Minnesota in 2006. But his lawyer argued that Mr. Klecker, 29, who had already spent a year in jail, should be sentenced to six months of inpatient treatment instead of the 48 months in prison called for by sentencing guidelines.

“Tony would never, ever claim his war experiences, associated psychological injuries and alcoholism should excuse him from responsibility for Ms. Casey’s death,” his lawyer, Brockton D. Hunter, wrote the judge. But, he said, Mr. Klecker was a “psychological casualty of the war in Iraq who unsuccessfully sought treatment from an overstrained Veterans Administration.”

The state judge agreed to impose the alternative sentence, and Mr. Klecker was admitted to a dual program for substance abuse and PTSD at the Veterans Affairs hospital in St. Cloud, Minn.

But then things got complicated. After getting into a verbal fight with another veteran, Mr. Klecker lost his residency privileges. He was returned to jail; the prosecutor is seeking once more to send him to prison.

‘A Tale of Two Places’

“This is really a tale of two places,” James Gregg’s lawyer said during his opening statement in 2005 in the federal courthouse in Pierre, S.D.: the Crow Creek Indian Reservation where the killing took place and “a very, very faraway” place, “a place called Iraq.”

By framing the case this way from the start, the lawyer, Timothy J. Rensch, made it clear that Mr. Gregg’s explanation for the “murder in Indian country,” as the charge read, would be inextricably bound to his year as a National Guardsman in Iraq.

That approach rankled the prosecutor, who referred to it as “waving the flag,” although Mr. Rensch stated that he was not trying to use Iraq “as an excuse” since Mr. Gregg was arguing self-defense.

“But you need to understand about Iraq and what happened to Jim over there for you to be able to see things from his point of view, and understand his thinking, and especially understand, really, his desperation at the end,” Mr. Rensch said.

On the evening of July 3, 2004, Mr. Gregg, then 22, spent the night with friends in a roving pre-Independence Day celebration on the reservation where he grew up, part of a small non-Indian population. They drank at a Quonset hut bar called the Pit Stop, in a trailer community and finally at a mint farm where they built a bonfire, roasted marshmallows and made s’mores.

According to the prosecutor, Mr. Gregg got upset because a young woman accompanying him gravitated to another man. This, the prosecutor said, led to Mr. Gregg spinning the wheels of his truck and spraying gravel on a car belonging to James Fallis, 26, a former high school football lineman who grew up performing American Indian dances on what is called the powwow circuit.

Some time later, a confrontation ensued. Mr. Gregg was severely beaten by Mr. Fallis and, primarily, by another man, suffering facial fractures. Later that night, with one eye swollen shut and a fat lip, he drove to Mr. Fallis’s neighborhood.

Mr. Fallis emerged from a trailer, removed his jacket, asked Mr. Gregg if he had come back for more and opened the door to Mr. Gregg’s pickup truck. Mr. Gregg then reached for the pistol that he carried with him after his return from Iraq. He pointed it at Mr. Fallis and warned him to back away.

Mr. Fallis moved toward the trunk of his car, and Mr. Gregg testified that he believed Mr. Fallis was going to get a weapon. He started shooting to stop him, he said, and then Mr. Fallis veered toward his house. Mr. Gregg fired nine times, and struck Mr. Fallis with five bullets.

Mr. Gregg drove quickly away, ending up in a pasture near his parents’ house. From there, he spoke on the phone to his best friend, Jacob Big Eagle, who told him that Mr. Fallis was dead.

According to Mr. Gregg’s testimony, he then put a magazine of more bullets in his gun, chambered a round and pointed it at his chest.

“Jim, why were you going to kill yourself?” his lawyer asked in court, seeking to rebut the prosecutor’s contention that guilt had driven him to suicidal despair.

“Because it felt like Iraq had come back,” Mr. Gregg said. “I felt hopeless. All that happened, no one would believe me. That I didn’t want this to happen. I never wanted to shoot him. Never wanted to hurt him. Never. Everything happened just so fast. I mean, it was almost instinct that I had to protect myself.”

Tense Courtroom Atmosphere

The atmosphere in the courtroom was tense throughout the trial, with American Indians on one side of the aisle and white ranchers on the other. Complicating matters, the participants in Mr. Gregg’s case traveled, in a sense, back and forth between the bluffs of the Missouri River and those of the Tigris as they grappled with the relevancy of his military experience.

Mr. Gregg joined the National Guard at 18. He was studying at a technical school, with the goal of becoming a diesel mechanic, when his combat engineering company, whose expertise resided in bridge building, was shipped to Iraq in the spring of 2003.

“He left for Iraq enthusiastic and energetic and eager to serve his country,” wrote one of four mental health professionals, including two government officials, who diagnosed PTSD in Mr. Gregg. He “returned impaired by PTSD complicated by his disillusionment with the military operation in Iraq.”

After building a bridge across the Tigris River, his National Guard company effectively became an infantry unit. Mr. Gregg estimated that he searched well over 10,000 vehicles and fired over 1,000 rounds.

Mr. Gregg found checkpoint duty unbearable, said Michael Furois, a Department of Veterans Affairs psychologist who treated him after his arrest. According to Mr. Furois’s testimony, Mr. Gregg disliked “standing guard at a gate when the Iraq civilians would bring in their dead or wounded and would be yelling and crying and blaming those at the gate for that occurring.”

After many months in Iraq, Mr. Gregg testified, he began to think about suicide, hoping that his “chance” at death would come if he volunteered for dangerous missions. His superior officer, Sergeant Long, testified that he selected him for a nighttime patrol team, instructing them never to hesitate when they perceived a threat because “if you hesitate, you’re dead.”

Cross-examining Sergeant Long, Mikal G. Hanson, an assistant United States attorney, asked him if he were implying that his instruction about hesitating had caused Mr. Gregg, on his return to the United States, to shoot “an unarmed civilian.”

“I hope not,” Sergeant Long said.

When Mr. Gregg’s tour of duty ended in March 2004, he started drinking heavily to ease his stress and expressed the wish that he had died in Iraq.

Mental health experts for the defense said, as one psychiatrist testified, that “PTSD was the driving force behind Mr. Gregg’s actions” when he shot his victim. Having suffered a severe beating, they said, he experienced an exaggerated “startle reaction” — a characteristic of PTSD — when Mr. Fallis reached for his car door, and responded instinctively.

Mr. Gregg’s trial lawyer put it theatrically: When Mr. Fallis rushed at Mr. Gregg, he said, Mr. Gregg switched into military mode. “What does he think?” the lawyer said. “Lethal threat, lethal threat, lethal threat, neutralize threat, boom, boom, boom, boom, boom, boom, boom, boom, boom, continues to shoot.”

The prosecutor, reflecting his skepticism about this explanation, asked Mr. Gregg if he had been a “walking time bomb” since Iraq. “You’re not telling this jury,” Mr. Hanson said, “that National Guard members like yourself that went through that experience are a threat to kill people?”

Mr. Gregg: “I wouldn’t know.”

The prosecutor also referred to Mr. Gregg’s military experiences for his own purposes, asking whether military trainers tried to strengthen soldiers’ minds as well as bodies.

“Not really,” Mr. Gregg said. “They actually break down your mind.”

“Break down your mind,” Mr. Hanson said. “Explain that to the jury.”

“They break down your mind, and then they try to build you back up,” Mr. Gregg said.

“Into a killer?” the prosecutor asked.

“Yes,” Mr. Gregg said.

The jury found Mr. Gregg guilty of second-degree but not first-degree murder. The judge later referred to this as having “dodged a bullet, so to speak.”

The Sentence: 21 Years

Judge Kornmann also said in court that he found the case troubling, calling the sentencing hearing “one of those days” when he wondered whether he should have declined the offer by Tom Daschle, the former Senate majority leader from South Dakota, to nominate him for a federal judgeship.

“I see these stickers that people have on their vehicles saying, ‘Support the troops,’ ” Judge Kornmann said. “I don’t see much support for the troops as years go on when these people come back injured and maimed.”

Nonetheless, the judge said that Mr. Gregg did not deserve any of the “downward departures” from sentencing guidelines that his lawyers had requested in consideration of his military service, his PTSD and his crime-free record. The mandatory minimum for a federal offense involving a gun is 10 years, and Mr. Gregg’s lawyers indicated that they hoped he would be sentenced to no more than 12.

Judge Kornmann handed down a 21-year sentence.

Through a relative who works for the prominent law firm of WilmerHale, Mr. Gregg secured the company’s services; his case was taken pro bono.

In late June, Mr. Gregg’s lawyers filed a habeas corpus petition, seeing to vacate his conviction on the basis of ineffective assistance of trial counsel. Mr. Rensch, they argue, did not demonstrate that Mr. Gregg’s state of mind was heavily influenced by being “vividly aware of specific, dramatic instances of past violent acts” by his victim.

While Mr. Gregg awaits the outcome, he is locked in a federal medical prison in Rochester, Minn., where he tried to kill himself on one occasion and has been placed on suicide watch episodically. If all efforts to free him fail, he is projected to be released on July 22, 2023, a few weeks shy of his 42nd birthday.

Read more!

Lead Linked to Aging in Older Brains - Associated Press

NEW YORK (AP) -- Could it be that the ''natural'' mental decline that afflicts many older people is related to how much lead they absorbed decades before?

That's the provocative idea emerging from some recent studies, part of a broader area of new research that suggests some pollutants can cause harm that shows up only years after someone is exposed.

The new work suggests long-ago lead exposure can make an aging person's brain work as if it's five years older than it really is. If that's verified by more research, it means that sharp cuts in environmental lead levels more than 20 years ago didn't stop its widespread effects.

''We're trying to offer a caution that a portion of what has been called normal aging might in fact be due to ubiquitous environmental exposures like lead,'' says Dr. Brian Schwartz of Johns Hopkins University.

''The fact that it's happening with lead is the first proof of principle that it's possible,'' said Schwartz, a leader in the study of lead's delayed effects. Other pollutants like mercury and pesticides may do the same thing, he said.

In fact, some recent research does suggest that being exposed to pesticides raises the risk of getting Parkinson's disease a decade or more later. Experts say such studies in mercury are lacking.

The notion of long-delayed effects is familiar; tobacco and asbestos, for example, can lead to cancer. But in recent years, scientists are coming to appreciate that exposure to other pollutants in early life also may promote disease much later on.

''It's an emerging area'' for research, said Dr. Philip Landrigan of the Mount Sinai School of Medicine in New York. It certainly makes sense that if a substance destroys brain cells in early life, the brain may cope by drawing on its reserve capacity until it loses still more cells with aging, he said. Only then would symptoms like forgetfulness or tremors appear.

Linda Birnbaum, director of experimental toxicology at the U.S. Environmental Protection Agency, said infant mice exposed to chemicals like PCBs show only very subtle effects in young adulthood. But more dramatic harm in areas like movement and learning appears when they reach old age.

Animal studies also show clear evidence that being exposed to harmful substances in the womb can harm health later on, she said. For example, rodents that encounter PCBs or dioxins before birth are more susceptible to cancer once they grow up.

Studying delayed effects in people is difficult because they generally must be followed for a long time. Research with lead is easier because scientists can measure the amount that has accumulated in the shinbone over decades and get a read on how much lead a person has been exposed to in the past.

Lead in the blood, by contrast, reflects recent exposure. Virtually all Americans have lead in their blood, but the amounts are far lower today than in the past.

The big reason for the drop: the phasing out of lead in gasoline from 1976 to 1991. Because of that and accompanying measures, the average lead level in the blood of American adults fell 30 percent by 1980 and about 80 percent by 1990.

That's a major success story for environmentalists. But work by Schwartz and Dr. Howard Hu of the University of Michigan suggests that the long-term effects of the high-lead era are still being felt.

In 2006, Schwartz and his colleagues published a study of about 1,000 Baltimore residents. They were ages 50 to 70, old enough to have absorbed plenty of lead before it disappeared from gasoline. They probably got their peak doses in the 1960s and 1970s, Schwartz said, mostly by inhaling air pollution from vehicle exhaust and from other sources in the environment.

The researchers estimated each person's lifetime dose by scanning their shinbones for lead. Then they gave each one a battery of mental ability tests.

In brief, the scientists found that the higher the lifetime lead dose, the poorer the performance across a wide variety of mental functions, like verbal and visual memory and language ability. From low to high dose, the difference in mental functioning was about the equivalent of aging by two to six years.

''We think that's a large effect,'' Schwartz said.

Hu and his colleagues took a slightly different approach in a 2004 study of 466 men with an average age of 67. Those men took a mental-ability test twice, about four years apart on average. Those with the highest bone lead levels showed more decline between exams than those with smaller levels, with the effect of the lead equal to about five years of aging.

Nobody is claiming that lead is the sole cause of age-related mental decline, but it appears to be one of several factors involved, Hu stressed.

If so, it would join such possible influences as high blood pressure, diabetes, stroke, emotional stress and maybe education level, said Bradley Wise of the National Institute on Aging. Nobody knows exactly what causes mental decline with age, he said.

Although the studies by Hu and Schwartz suggest lead is involved, Wise and others say they don't prove the link.

''I think many things impact how we age, but I think right now it's maybe premature to be giving lead a huge role in our age-related cognitive decline,'' said Dr. Margit L. Bleecker, director of the Center for Occupational and Environmental Neurology in Baltimore. Still, she called the lead hypothesis ''a very interesting idea'' deserving more study.

Others were more impressed.

''The new evidence from these studies should concern people'' said epidemiologist Andrew Rowland of the University of New Mexico. ''These two research groups are finding adverse effects on the aging brain at low levels of lead exposure. More work needs to be done, but these studies are raising important questions.''

In any case, scientists still face some basic mysteries about the delayed effects of lead. For example, when does it actually harm the brain? Does a high level in the shinbone merely identify those who were the most harmed by chronic exposure decades ago? Or does lead in the bone continue to do its dirty work over a lifetime, leaching into the bloodstream and continuously hammering the brain?

''I think that both things are happening,'' Schwartz said, though he suspects most of the damage occurred in the past, during years of higher exposure. Hu's suspicions are similar.

Just how lead impairs brainpower is still a mystery. And so is the question of whether anything can be done to help people who have absorbed a lot of lead over a lifetime.

A medical procedure called chelation can remove lead from the body, but it wouldn't help in this case, said experts, who had few suggestions.

For younger people, prevention is a clearer strategy, Hu said. He called for tougher federal standards on lead exposure in the workplace.

And plenty of low-income neighborhoods could use a strong effort to remove lead from old houses, many of which still have lead paint, Rowland said. ''It's there on the walls, it's on the radiators, it's underneath the top layers of paint. In places where the paint is crumbling, there's still exposure going on,'' he said.

Yet another question: Who really has to worry about long-ago lead affecting their brainpower? What about people born after the high lead levels of the 1970s were history?

Schwartz noted that most Americans younger than 30 have gotten much less lead from the environment than the men in his study did. And Hu hopes that the lead effect will peter out in the future.

However, Hu points out that there's still lead in the environment, and exposure remains especially high in many developing countries. And citing evidence that lead can cross the placenta, he says women who grew up in the 1970s might dose their fetuses with the metal.

''Kids who grew up in the 21st century have a lot less to worry about'' than their elders, Hu said. But ''it's hard for me to be totally optimistic the current generation is completely scot-free.''

Read more!

Stories That Speak for Themselves - New York Times

By CLARK HOYT

TODAY and for the past two Sundays, The Times has devoted front-page play and pages
of inside space to a continuing investigative series called “War Torn,” about veterans of Iraq or Afghanistan who have killed or been charged with killings after returning home.

It is an important and tragic subject to which an investigative team has devoted more than eight months of reporting, including research into local news reports and court records, and extensive interviews with some of the veterans, their families, victims’ families and law enforcement officials often sympathetic toward both the victims and their killers.

But The Times made some missteps at the beginning of the series, and critics have pounced, accusing it of demonizing veterans and exaggerating the problem even as some mental health professionals have thanked the newspaper.

The first part, which dominated the top of Page One on Jan. 13, featured a photo montage of 24 young men, some in military uniform, some in prison garb. The article began with the story of Matthew Sepi, a 20-year-old plagued by nightmares from Iraq, who went looking for beer to help him sleep and wound up killing a gang member and wounding another with an AK-47 in a dangerous neighborhood.

“Town by town across the country, headlines have been telling similar stories,” the article said. “Taken together they paint the patchwork picture of a quiet phenomenon, tracing a cross-country trail of death and heartbreak.”

The article said the newspaper had found 121 such cases, many of which appeared to involve “combat trauma and the stress of deployment — along with alcohol abuse, family discord and other attendant problems.”

The Times was pointing out terrible examples of something the military itself acknowledges: large numbers of veterans are returning from Afghanistan and Iraq with psychological problems. And, as the initial article said, a Pentagon task force found last year that the military mental health system was poorly prepared to deal with this wave of distress.

The Times was immediately accused — in The New York Post and the conservative blogosphere, and by hundreds of messages to the public editor — of portraying all veterans as unstable killers. It did not.

But, the first article used colorfully inflated language — “trail of death” — for a trend it could not reliably quantify, despite an attempt at statistical analysis using squishy numbers. The article did not make clear what its focus was. Was it about killer vets, or about human tragedies involving a system that sometimes fails to spot and treat troubled souls returning from combat?

Finally, while many of the 121 cases found by The Times appeared clearly linked to wartime stresses, others seemed questionable. One involved a Navy Seabee accused of arranging her ex-husband’s murder during a bitter child custody battle, and another involved a soldier who was acquitted of reckless homicide in a car crash after a jury concluded that his blood alcohol level was below the legal limit and that many other accidents had happened on the same stretch of road.

Some readers wanted to know how the rate of homicides by veterans compared with the civilian rate. Several bloggers did back-of-the-envelope calculations and said the homicide rate for returning veterans was lower than the rate for the general population. So, what’s the problem, they wondered. I asked Martin T. Wells, a professor of statistical sciences at Cornell University, to take a stab at a comparative calculation. The homicide rate for returning combat veterans could be better or worse than the civilian rate, he determined, depending entirely on how many of the 1.6 million military personnel who have been deployed in the Afghanistan and Iraq wars actually saw combat, a number the Pentagon does not have.

The journalists most responsible for the series — reporters Lizette Alvarez and Deborah Sontag and their editor, Matthew Purdy — argued against trying to make a comparison to civilian homicide rates. The military does not accept people with mental problems or records of serious crimes — the likeliest killers in the civilian population — so its rate is likely to be lower and the comparison irrelevant.

But they implicitly invited the comparison with a calculation of their own: Based primarily on news reports, their article said the number of homicides involving active-duty military personnel and new veterans was 89 percent higher in the six years since the wars began than in the six years before. And that increase came, the article said, even though “the American homicide rate has been, on average, lower.”

It seems analytically shaky to compare admittedly incomplete news reports from two periods and express the difference as a precise 89 percent — especially, as a Pentagon spokesman said in The Times, given that the news media may not have been as sensitive to the military status of accused killers in the period before the wars.

Purdy urged me not to get lost in the numbers as I looked at the first two articles. I agree with that, but I believe The Times tangled itself in numbers right at the start. Bill Keller, the executive editor, said the newsroom’s computer-assisted reporting unit normally screens articles with statistical analyses. Some of the problems might have been avoided if someone in the unit had read the first article before it was published. But Terry Schwadron, the editor who oversees the unit, which created a database for the 121 cases, said that did not happen. “I read the story in the paper, and I shared some concerns” with Purdy, he said.

Purdy defended the series. “It is an intimate exploration of a devastating cost of the war that merits national attention and focus but has not received it,” he said, because “it is playing out in one community at a time ... with no comprehensive attention from the military.”

Keller agreed. “I believe this series is an important public service that explores in riveting detail the emotional stresses war places on this important community and the problems the military faces in coping with those stresses,” he said.

The individual stories the series has told so far are indeed sad, powerful and important. One hopes they will goad the military to figure out what went wrong and what needs fixing.

But the questionable statistics muddy the message. A handful of killings caused by the stresses of war would be too many and cause for action. Sometimes, trying to turn such stories into data — with implications of statistical proof and that old journalistic convention, the trend — harms rather than helps.

The public editor serves as the readers' representative. His opinions and conclusions are his own. His column appears at least twice monthly in this section.
Read more!

While many know the pain associated with suicide, those left behind know there is help - Central Ohio News Network

Video of this story here.

By JONA ISON
Gazette Staff Writer

Thirteen years ago, Dick Ginther's life changed suddenly and dramatically - much like that of more than 30,000 other Americans.

There wasn't a hurricane, a terrorist attack or a war - but the same thing that happens to thousands of families every year - someone he loved died by suicide.
"I didn't see it coming, but someone might have from the outside looking in," Dick said.

Elizabeth Anne Ginther was 33 when she shot herself.


She graduated from Bishop Flaget High School where she enjoyed playing basketball before enlisting with the Marines after graduation. While in the service, Anne started having seizures and was discharged, so she went to The Ohio State University to become a forest ranger.

Anne's seizures subsided for a period of time, then returned with a vengeance, causing her to quit her ranger job - one she dearly loved.

The day of Anne's death, she had gone to a wedding with her father, but Dick didn't notice anything terribly wrong with her emotions that day. Like most loved ones left behind, Dick can only contemplate what was going on in her mind because there was no note left behind.

"It was just, 'boom,'" Dick said. "You always look back and try to see if you did something wrong."

Each year, twice as many people in the U.S. die by suicide than by homicide.

But in Ross County, where homicides are relatively rare, death by suicide is not.

While there were 11 homicides in Ross County between 2004 and 2006, there were 38 deaths by suicide, according to the Ohio Department of Health's vital statistics database. And, if research assumptions that there are 25 attempts for each suicide completed are correct, there were 950 suicide attempts in Ross County during that same time frame.

Meanwhile, state numbers show suicides in Ross County have doubled since 2000. In 2004 to 2006, 38 suicides were completed and, by contrast, from 1998 to 2000, there were 19 suicides completed.

Those numbers are also well above other southern Ohio counties, as Highland County had 26 deaths by suicide, Fayette and Pickaway counties each had 12 from 2004 to 2006.

And, of counties with a population of around 70,000, Ross County leads all other counties in suicide rate - topping (and in some cases, more than doubling) the rate other counties such as Belmont, Erie, Hancock and Jefferson.

Treatable disease, preventable death
Dick realizes there is nothing he did that caused his daughter's death, but he is hopeful his story may help someone else.

"If I can help anybody, one person," Dick said of his reasons for sharing his story. "I think it should be out in the public. You can't hide this."

Suicide typically is the result of mental health and/or substance abuse diseases, which are treatable, but the stigma surrounding suicide has hampered treatment being sought as a solution. Only half of suicide victims have sought treatment at some point in their lives and only 34 percent are receiving treatment at the time of their deaths, according to the Suicide Prevention Action Network.

In former Surgeon General David Satcher's 1999 call to action to prevent suicide, he pointed out the importance of talking about suicide and not blaming the victim or stigmatizing those left behind in preventing future deaths by suicide.

"Compounding the tragedy of loss of life, suicide evokes complicated and uncomfortable reactions in most of us. Too often, we blame the victim and stigmatize the surviving family members and friends. These reactions add to the survivors' burden of hurt, intensify their isolation, and shroud suicide in secrecy," he wrote. "Unfortunately, secrecy and silence diminish the accuracy and amount of information available about persons who have completed suicide - information that might help prevent other suicides."

Since 1999, suicide prevention coalitions have formed on national, state and local levels. Last year, the Ross County Suicide Prevention Coalition was formed with the help of grants and has been working to spread awareness. The coalition consists of public agencies, counselors, law enforcement, clergy and those who have been affected by suicide.

Juni Frey, associate director of Paint Valley ADAMH, says the local coalition is off to a strong start.

"I think our coalition has been great. I've seen a lot of coalitions and the Ross County coalition is very well organized and very well-attended," Frey said. "The people who come are very committed."

After getting involved with the coalition, co-director Barbara Mahaffey began researching local statistics through police and coroner reports.

Law enforcement reports showed 785 suicide attempts, threats and completed between 2000 and 2007. She is hopeful her research will start revealing the causes because the majority of people don't leave notes behind. Mahaffey's research has shown over the past seven years, 63 percent of people in the city and 95 percent of people in the county left no note.

"Suicide is an impulsive act. It's different when you're in emotional pain to process a solution," Mahaffey said of the lack of notes. "Some act within eight tenths of a second on impulse. There's not a lot of time to interrupt or distract the behavior. There's not that many people that leave notes behind and take the time to think through the process."

Those local numbers, which Mahaffey is still compiling, also have been showing middle-aged men are completing suicide in our area at a slightly higher rate than nationally.

"I wouldn't say that we're any different (here) than nationally, but what we've been seeing recently, it would appear our numbers are looking like that are getting higher," Frey said. "We don't know the reason."Mahaffey's research of law enforcement reports show the majority of people who threaten, attempt or complete suicide, 57 percent in the city and 66 percent in the county, are between 26 and 55 years old.

"Research shows the older we get, especially males, the higher our risk is. Generally what we see in our community, as far as numbers go, the highest numbers (of completed suicides) are middle-age males. We don't see large numbers of 89-year-old males because, one, there are less of them, and two, sometimes their death isn't as easily recognized (as a suicide) as a 41-year-old male."

The reason for the lack of recognition is method - the younger male often uses a gun while an elderly male is more likely to overdose on medication which many times can be considered accidental, Frey added.

Seeking treatment
Donna Collier knows the truth of that local statistic too well.

On the outside, her husband, Craig, was a successful businessman. He helped run the family businesses, Carpet Liquidators, Cardinal Carpet and Chillicothe Furniture, and was active in business society. At home, however, Craig was a person who recognized he was ill and sought treatment for those illnesses by attending AA, talking with a psychiatrist and taking medication to help control mood swings caused by bipolar disorder, Donna said.

"He was one of those people who were larger than life. He was interested in everybody and everything all the time," Donna said. "We could both meet the same person and he could tell me everything about them."

At one point, Craig's medication stopped working properly, and he was hospitalized while doctors worked to determine new medication. Afterward, he was back to his normal self until four or five months before his death in 2005. Craig's medication had stopped working again and it was changed, Donna said, but the new medication didn't seem to work right either.

"He kept telling me, 'I have to give it a little time. This medication is just not working well,'" Donna said.

On Nov. 17, 2005, Donna arrived home to find Craig, 47, dead from a self-inflicted gunshot wound. Although devastated, Donna remains positive and talks about Craig with her children and friends.

"I had him as a husband for 28 years and that (day) was just one day," Donna said. "I understand he really tried hard, and it was really difficult for him. If I could, I would change the outcome of what happened, but if you get into all of the whys, hows or could have dones, you'll drive yourself crazy."

Craig's treatment was effective for at least a decade since his diagnosis and typically is effective for many people, Frey said.

"Treatment is very effective for those who seek it," Frey said. "I think that's what is lacking a lot of times. People, we find, who have died by suicide have not sought treatment. I don't know that we've figured out a way to get them into treatment."

That's why suicide prevention coalitions are focusing on education in hopes of getting more people into treatment. Drug company advertisements may be some help with awareness, Frey said, because those advertisements spread the word that there are ways to treat depression.

"They talk about depression being not that big a deal. Just take a pill. Maybe it's not that simple, but it's treatable," Frey said.

Breaking the silence
Those drug company ads, along with prevention coalitions and loved ones left behind who aren't afraid to talk about suicide, are the first steps in lowering the number who die by suicide, the goal of Satcher's 1999 call to action.

Dick Ginther understands that, and often finds himself at the pond in the family orchard where Anne's ashes were put to rest.

"You think about her every day and you have to talk about her ... You can't just forget her. She was here for 33 years," Dick said.

Family and friends of someone who dies by suicide are at greater risk for contemplating or attempting suicide themselves. Remembering the loved one and talking are keys to processing the grief for the entire family and moving forward in life, Donna said. Since Craig's death, Donna has returned to college for a degree in social services and recently met another man.

Such communication is not just a key for those left behind, but also for those contemplating suicide as a solution, Dick said.

"If something is really bothering you, talk to somebody. If you can't talk to your mother or father, talk to the clergy, find somebody," Dick advised.

(Ison can be reached at 772-9367 or via e-mail at jison@nncogannett.com Read more!

Mental health coverage improving -Poughkeepsie (NY) Journal

By Lubna Somjee

Many insured individuals with mental health issues have not been able to access care they need. This is because many insurance companies do not offer mental health parity. With legislation, however, this has been changing, including in New York.

Parity means equal treatment for medical and mental health care. Without it, people often must pay higher co-pays for mental health services and access to a limited amount of visits. Once visits allotted by their insurance company have run out, they often cannot afford to continue treatment by paying out of pocket.

Timothy O'Clair's family, along with numerous groups, including the New York State Psychological Association, the New York State United Teachers and the National Alliance for the Mentally Ill, lobbied for more than a decade to try to gain mental health parity in New York state. In late 2006, Timothy's Law was passed.

The legislation is named for Timothy O'Clair, a 12-year-old who committed suicide in 2001. Timothy's parents had sought mental health treatment for their son starting when he was 8. Each year they exhausted their 20 outpatient visits allowed by the insurance company and would pay out of pocket to continue treatment. When the family could no longer carry this financial load and as a last resort, they decided to place him in foster care so he would be eligible for Medicaid. His parents continued to hold shared custody and paid a significant amount for statutory child support. Timothy was finally placed in a residential facility. Several weeks after his discharge, he killed himself. Since this tragedy, the O'Clair family has advocated for mental health parity. Highlights of the law include:

-- Insurance companies must provide at least 30 inpatient days of treatment and 20 outpatient days of mental health treatment per year.

-- Insurance companies are required to provide coverage comparable to medical coverage provided under the policy for adults and children (under age 18) with certain mental health issues. These include: schizophrenia/psychotic disorders, depression, bipolar disorder, delusional disorders and anorexia.

-- Comparable coverage is also provided for additional childhood specific mental health issues, including attention deficit disorders, disruptive behavior disorders or pervasive developmental disorders, and where there are one or more of the following:

-- Serious suicidal symptoms or other life-threatening self-destructive behaviors

-- Significant psychotic symptoms.

-- Behavior caused by emotional disturbances that places the child at risk of causing personal injury or significant property damage.

-- Behavior caused by emotional disturbances that places the child at substantial risk of removal from the household

-- Co-payments, co-insurances and deductibles for mental health treatment would be comparable with those for physical illnesses.

Federal bills

Many insurance companies in New York have responded quickly to this law. As a result, individuals have found their co-pays have decreased to match other medical co-pays and they have been provided unlimited visits for certain mental health disorders, as the law stipulates. Some companies have yet to flawlessly integrate this law. For example, some patients struggling with one of the mental health issues listed above have run into obstacles trying to obtain unlimited visits.

There is a push to pass a federal law that would require mental health parity that is broader than Timothy's Law. Both the U.S. Senate and the House of Representatives proposed bills in late 2007. Although neither mandates insurance companies must provide mental health coverage, they are strong bills.

The Senate bill requires insurance companies provide mental health coverage for a much broader range of mental health diagnoses than what Timothy's Law requires. If passed, this would allow individuals struggling with numerous and varied psychological issues to be able to access unlimited care they need. This bill includes parity for those with substance abuse issues as well. The Senate bill also requires parity for out-of-network services, assuming you have a plan that has out-of-network mental health benefit (meaning if your plan covers you to see mental health providers who are not on your insurance panel). If the bill passes, you could see a mental health provider of your choice no matter whether they participate with your insurance company, or not, and have parity.

The House bill is slightly different and requires that if insurance companies provide mental health coverage, they cover all psychiatric diagnoses. This initially sounds wonderful; however, there are two potential drawbacks people are worried about. One, given that it covers all mental health diagnoses, it might be considered too broad and perhaps unlikely to be passed. The second potential drawback is the House bill would mandate insurance companies cover all disorders, and these companies might question covering minor disorders. Insurance companies may then choose not to offer mental health benefits at all - which would be a huge step backwards.

Federal legislation focusing on parity would help those with mental health issues obtain care, afford care, improve health and save health-care dollars.

Lubna Somjee, Ph.D., is a clinical and health psychologist practicing psychotherapy and consulting in the mid-Hudson Valley. Her column is published on the fourth Sunday. Somjee is a member of the Hudson Valley Psychological Association and can be contacted through www.LubnaSomjee-phd.com Read more!

The homeless deserve shelter and our help -The Sacramento (CA) Bee

By Joan Burke - Special to The Bee

When I began volunteering at Maryhouse, the daytime drop-in center for homeless women and children, the sheer number of women who turned to Loaves & Fishes for help was stunning. Single mothers, women so paranoid they were afraid to come for breakfast lest we poison them, street women, young runaways, older displaced homemakers, women whose strength was inspiring, women so fragile I feared for their survival.

Maryhouse welcomed 586 women in 1987, my first year as a volunteer. Today, it serves more than 2,000 women a year. And the barriers they face are overwhelming: homelessness, childhood abuse and neglect, domestic violence, addiction, early pregnancy, interrupted education, poverty. As we sat down individually with each woman, we reassured her to take things one step at a time and that Maryhouse would always be there to help them.

In 15 years of working at Maryhouse I realized that homeless women were wonderful, imperfect human beings just like the rest of us, and that if you were able to help one of these women in desperate need, she would be immensely grateful and empowered.

One woman who came to Maryhouse is in her late 40s but looks much older. She has been homeless for 20 years due to a truly horrifying drug and alcohol addiction. Drugs cost Rebecca her suburban home and her four children. I was amazed when her oldest son told me he remembered her carpooling and coming to his Little League games before she started using drugs. The woman I know sleeps outside and is often angry and incoherent, despite her obvious intelligence.

She and I have been through a lot together: the loss of her children, her drug and petty theft arrests, her initially successful attempts at recovery that ended in relapse after months of sobriety and the tragic death of her daughter, an 18-year-old college student, in a car accident. Our shared history is such that she crosses herself and starts crying whenever she sees me. I know that when she is ready to try recovery again, Loaves & Fishes will get her into a program. I know we will not turn our back on her now.

Frequently, a woman will stop me in a grocery store or on the street and say something like, "Joan! Don't you remember me? I came to Maryhouse years ago, and you helped me get into WEAVE. I'm working at the Franchise Tax Board now. DeWayne is 14 and plays football for the freshman team. All of you were so kind to me – I'll never forget how scary it was sleeping in our car. Thank you!"

About 30 percent of the guests at Loaves & Fishes have long-standing and complicated problems. The other 70 percent are "crisis homeless." Some event or string of events – the loss of a job, injury or illness, domestic violence, eviction – has left them homeless, but with some help, they will quickly get back into more stable housing.

The oft-repeated phrase, that many of us are just one paycheck away from homelessness, has validity. A recent survey by Fannie Mae on homelessness found that 28 percent of Americans say that there has been a time when they were worried that they might not have a place to live.

Being homeless is especially difficult for children. It is hard to overestimate the negative effects of homelessness on a child. Living in a shelter with all sorts of strangers is very scary for them. Absent are all things familiar: school, pets, friends, their neighborhood. Their parents, or more likely their mother alone, are also frightened. Worst of all, children lose their sense of security, which should be every child's right. Mustard Seed, the school for homeless children at Loaves & Fishes, gives these children a place to be kids again and works with their parents to regain a home for themselves and their children.

Loaves & Fishes offers guests a hot, generous midday meal, but our work involves more than Maryhouse and Mustard Seed. It also includes Friendship Park which has bathrooms, showers, telephones, hot coffee and donated pastries; a library; Genesis for mental health services; a nurse; jail visitation; a legal clinic; Mercy Medical Clinic; a day labor program and Sister Nora's Place, an overnight shelter for mentally ill women. Other independent programs on the Loaves & Fishes campus are Clean & Sober for recovery services; Family Promise, an inter-faith shelter for families; Side-By-Side, a ministry to homeless persons; Self Help Housing for finding affordable housing; and Women's Empowerment, support and job readiness classes for homeless women.

For 25 years, Loaves & Fishes has welcomed each guest with a simple invitation, "Come in, sit down and have a bite to eat. Then we'll talk." We are grateful that Sacramento now has a 10-year plan to end homelessness, the keystone of which is a "housing-first" approach. Basically, it's the same approach Loaves & Fishes has used for 25 years. Accept people as they are, and offer them the help they need. Don't require people to cure themselves of their addiction or mental illness before you help them. Treat them with dignity and respect, and surround them with open doors to services.

Loaves & Fishes believes that the cure for homelessness is as simple as it is obvious: enough housing to go around. Our goal is to put Loaves & Fishes out of business. As director of advocacy for Loaves & Fishes, I work to help create more housing for the poorest of the poor, the people who come to Loaves & Fishes each day. I agree with Phillip Mangano, the director of the United States Interagency Council on Homelessness, that future generations will look back and wonder how we allowed people to sleep in tents and cars. They will regard homelessness as we now regard slavery: a social evil to be ended, not managed.

Each of us in Sacramento can choose to end homelessness here in our own community. We can volunteer at charities and financially them, which help homeless people or provide housing for them. The cumulative effect of simple acts of human kindness is mighty. When we see disheveled street people and campers, we can remember that mental illness, physical and developmental disabilities and the ravages of addiction are likely to have played a role in their homelessness. We can refuse to arrest people for being homeless. We can advocate for and support efforts to increase the supply of safe, decent, accessible and affordable housing in Sacramento.

There are so many people in need of housing that a large-scale effort is needed; when Sacramento opened the waiting list for Housing Choice Vouchers, formerly known as Section 8 certificates, for five days, more than 35,000 households applied. We can ask the city of Sacramento to adopt a citywide inclusionary housing policy instead of its current patchwork approach. We can thank the county of Sacramento for being the first place anywhere in the United States to require that some of all new housing – 3 percent – be reserved for the poorest of the poor, people living on incomes that are 30 percent or less than the median income. We can ask the state of California to create a permanent fund to help pay the cost of affordable housing. And we can look forward to the day when we go to sleep at night safe in our own beds knowing that no one in Sacramento sleeps outside for lack of a home of his or her own.
Read more!

Coming in from the cold -Portland (OR) Oregonian

Editorial: Portland should take the next -- big, bold -- step in helping the homeless

Build it and they will come. It seems such an appealing idea for a baseball diamond. For another homeless shelter? Not so much.

There's a pervasive notion that the more a city does to care for the homeless, the more of the homeless care to show up. The statistical truth is that street people make up about the same percentage of the population in every urban area across the country. In Portland, that numbers about 15,000 people per year. Sooner or later, most of them end up in Old Town.

Four years ago, city Commissioner Erik Sten unveiled a plan to "end homelessness" by 2015. Many scoffed. It turns out he was on to something. Sten convinced social service agencies to focus on those he called "chronically" homeless, people who had been on the street for at least a year. This turned out be a pretty homogenous group: single adults, disabled and/or addicted, many with mental health problems. Though they made up only 10 percent of the homeless population, they were consuming half of the $30 million the city spent on homeless services each year.

Sten persuaded Portland to concentrate on moving these people into housing as quickly as possible. Early results are encouraging, with much more effective collaboration among social service providers and reinvigorated efforts to harness the community's clear willingness to volunteer.

In a dramatic next step, Sten now wants to build a day-access center offering enhanced services. He's set his sights on the Northwest Portland block bordered by Third and Fourth avenues, Flanders and Glisan streets. The new building could include homes for other social service agencies, have low-income housing on its upper floors, and include the 165 parking spaces that the city still owes Northwest Natural from land cleared for the Classical Chinese Garden.

And how does Sten hope to pay for all this? The upcoming opportunity to expand the River District Urban Renewal Area into Old Town, he says, could generate an extra $200 million to be spent in the neighborhood.

We remain concerned about the amount of money Portland spends each year caring for the homeless. And we remain convinced that other municipalities across the region could -- should -- find ways to contribute. But Sten's track record on providing innovative, effective, long-lasting, results-based leadership on this front is too strong to ignore.

In the 1980s, changes in the federal welfare system, an epidemic of crack cocaine use, and society's decision to deinstitutionalize the mentally ill created what Sten calls "a perfect storm" of homelessness. Cities have been struggling to keep up ever since. The chronically homeless are men and women all but completely alienated from the communities in which they live. They have severed all ties with family and friends. "We have one last chance to reawaken in them the human spirit," Sten says. "They are people whose souls are broken."

When it meets on Feb. 13, the Portland Development Commission has the opportunity to give the green light to a project that will set to repairing some of those broken souls. It should do exactly that.
Read more!

Mental health plans lauded -Schenectady (NY) Gazette

By Sara Foss (Contact)

NEW YORK STATE — If people with mental illnesses are going to lead productive and successful lives, they need three things: housing, medication and employment, according to the executive director of the National Alliance on Mental Illness-New York State.

Gov. Eliot Spitzer’s proposed 2008-09 budget touches upon all three of these areas.

It increases housing for people with mental illnesses and makes a small investment in vocational training for the mentally ill, two moves that are strongly supported by mental health advocates. But the budget also looks to save money — about $18 million — by restricting the antidepressants doctors can prescribe to mentally ill patients, a proposal mental health advocates oppose.

Overall, the budget recommends $3.7 billion for the state Office of Mental Health, a $1.4 billion increase over 2007-08.

“We’re very positive about the budget, especially given the financial climate of the state,” said Glenn Liebman, CEO of the Mental Health Association of New York State. “What’s impressive about the budget, given the financial issues that have occurred this year, is that the governor has clearly identified social services, especially mental health, as a priority.”
A place to call home

The budget calls for 1,500 new units of supported housing — permanent housing with support services for the mentally ill — and 500 new efficiency apartments for people with mental illnesses who want more independence. It also includes capital funding to purchase adult homes for conversion into Office of Mental Health housing.

In addition, Spitzer has proposed a new $400 million Housing Opportunity Fund that would fund new affordable and supportive housing; some of this housing — the state has yet to determine how much — will be for people with mental illnesses.

“The governor has done a lot to advocate for mental health housing,” said Jill Daniels, a spokeswoman for the state Office of Mental Health. “Right now, there’s just a need for affordable housing.”

This year’s budget included 2,000 new housing units of housing for the mentally ill.

Advocates for people with mental illnesses praised the housing piece of Spitzer’s budget. Right now, they said, many people with serious mental illnesses such as bipolar disorder and schizophrenia are hospitalized, homeless, in jail or living with aging parents.

“If a person has no place to live, then their recovery has no chance of happening,” said Trix Niernberger, executive director of the National Alliance on Mental Illness-New York State.

She said the new housing proposed by Spitzer would only make a dent in the need — an estimated 40,000 mentally ill New Yorkers lack decent housing.

“There’s such a huge need that we’re very pleased [with the proposal],” she said. “But it’s not going to begin to meet the need of 40,000 people.”

She added that the number of housing units funded by the Office of Mental Health amounts to about 6.2 percent of the 600,000 New Yorkers with serious mental illnesses.

“There’s not enough housing for people with mental illnesses,” Liebman said.

NAMI-NYS also supports the creation of a mental health waiting list bill that would require the state Office of Mental Health to keep local waiting lists of people with mental illnesses who are eligible for housing with services but have not received housing with services. The group believes that this would enable the state to better determine the need for housing for the mentally ill. Niernberger said that the state Office of Mental Retardation and Developmental Disabilities maintains a waiting list for housing and that that list has worked well.
Employment help

The budget also includes $800,000 to expand access to the vocational educational services provided by the state’s Personalized Recovery Oriented Services program, which helps people with severe and persistent mental illnesses attain employment and housing and improve their overall functioning.

About 85 percent of people with severe mental illnesses are unemployed, Liebman said.

“There’s some funding for employment,” he said. “We’d like to see more.”

“There’s more that we could be doing in terms of services for those with mental illnesses,” Niernberger said. “For years and years, there weren’t many opportunities, so we’re grateful, but there’s still such a dearth.”

NAMI had wanted the budget to include $500,000 for a pilot program that focuses on cognitive rehabilitation — improving the brain function of people with schizophrenia in the hopes that they’ll have an easier time finding and retaining a job.
Major medicine issue

Mental health advocates plan to fight one of the governor’s mental health proposals. This proposal would create a preferred drug list for antidepressants, meaning that doctors would only be able to prescribe the antidepressants on the preferred drug list to patients on Medicaid.

As of now, doctors can prescribe the antidepressants that they think patients need without worrying about whether the drugs are covered by Medicaid.

Advocates for the mentally ill worry that patients won’t get medication they need if a preferred drug list is adopted.

“Mental illness is diagnosed by symptoms,” Niernberger said. “We don’t always know [why people respond to a certain drug].”

She said some people may respond to one drug, but not another. And generic drugs may not be as effective, in some cases, as brand-name drugs.
Support system boost

Mental health advocates also lauded the budget’s investment in the mental health work force. The budget will fund the third year of a cost-of-living adjustment to the salaries of mental health human services workers, as well as a 2.5 percent cost-of-living adjustment each year through 2011-12, an investment of almost $400 million.

A better-paid work force will improve treatment and services for the mentally ill, Liebman said.

“There are a lot of issues with being able to recruit and retain quality staff in mental health,” Liebman said. “The salaries and benefits are not as good. The working conditions can be difficult. You can create the best system of care in the world, and if you don’t have anyone to implement it, it becomes very difficult to run a program.”

The Mental Health Association of New York had hoped the governor would include funding to help defray the health care costs of mental health workers in the budget.

“When you’re making $18,000 to $20,000 a year, if you get a stipend of $350 a year for co-pays and deductibles, that’s certainly very helpful,” Liebman said.

According to the state Division of Budget, the state’s mental hygiene agencies — the Office of Mental Health, Office of Mental Retardation and Developmental Disabilities and the Office of Alcoholism and Substance Abuse Services — will serve more than 1 million people in 2008-09, including 600,000 people with mental illnesses.
Read more!

Courts' options limited for the mentally ill -Concord (NH) Monitor

By Joelle Farrell
Monitor staff

Eric Searles, a homeless man and a registered sex offender in Vermont, was found incompetent to face criminal charges in June 2007. Prosecutors, who had charged him with simple assault and failure to register as a sex offender, lost their hold over him. He was released with the understanding that he undergo mental health treatment that could restore him to competency so he could face charges.

Instead, Searles, 45, was arrested again in November, charged with raping a woman he met at a Manchester homeless shelter. His $7,000 cash-only bail was reduced to personal recognizance bail when the issue of competency was raised. He'd been out of jail on that charge for a few weeks when he was arrested again and charged with sexually assaulting a homeless woman in a Concord laundry this month.

Cases like Searles's point to an issue that frustrates prosecutors, judges and mental health professionals alike, especially in New Hampshire, where the burden of proof falls to prosecutors to show why a mentally ill person should be held in a jail or psychiatric hospital.

Once a defendant is declared incompetent to stand trial, prosecutors have only two options:

• If the person can be restored to competency through treatment within 12 months, a judge can order him or her to be held in jail or at a psychiatric hospital until then.

• If a person is not restorable, the charges are dropped, but prosecutors may seek to have the person involuntarily committed to a psychiatric hospital through civil courts.

But prosecutors must meet a high standard to persuade a judge to hold a person against his or her will, whether through criminal or civil courts. They must produce "clear and convincing evidence" that the defendant poses a danger to himself or others.

"When you ask if somebody is dangerous, you really are asking if they're overtly dangerous," said Dr. James Adams, the state's chief forensic examiner, who performs the majority of competency evaluations in the state. "The civil commitment laws of this country are designed to protect people's freedoms."

More often, a judge will release a defendant who is found incompetent (restorable or not) and advise him to seek mental health treatment, a recommendation that is often ignored.

"The judge may order the defendant to be treated, but the judge has no way of compelling that to occur," Adams said. "So unless the defendant, just out of respect for the judge, does what he's told, he doesn't have to do it. Nothing will happen to him if he doesn't do it."

District judges, attorneys and police officers say they've watched people who suffer from mental illness or drug abuse problems churn through jail, court and mental health facilities.

"We deal with people who suffer from mental illness literally on a daily basis," said Concord Police Chief Robert Barry. "And our workload is higher because of the lack of resources that these people can access outside of the criminal justice system. So when they commit criminal acts, we're left with no alternative other than to run them through the criminal justice system in order to protect the victims and keep the peace."

Many "well-known incompetents" are accused of petty crimes like shoplifting or exposing themselves, Barry said, and don't appear to pose a serious threat to themselves or others. But in other cases, the question of their potential danger is murkier.

"You can't always predict human behavior," said Manchester District Court Judge Norman Champagne. "There's a lot of frustrations. You just hope that a person like that is not a danger to society. . . . Making that call is sometimes a difficult thing to do."

An hourlong evaluation

Adams, of Concord, has performed competency evaluations for the state for 10 years. During his tenure, he has seen the number of evaluations quadruple to about 300 a year.

To be competent, a defendant must understand the charges against him and have a rational understanding of the trial procedure. He also must also have sufficient ability to assist his attorney in his defense and understand the range of punishments, the elements of the crime and the colloquy of plea bargains available to him.

The state has no designated inpatient psychiatric facility where a person facing criminal charges can be evaluated over the course of several days, as other states do, Adams said. Evaluations are done on an outpatient basis and typically take one hour, which can be too little time to weed out malingerers or best determine a treatment plan, Adams said.

Adams estimates that between 5 and 10 percent of those he evaluates are faking, which can be difficult to sort out during the short evaluation. And those who could be restored with treatment are often left to deal with their problems on their own, he said.

"An outpatient order for restoration has no teeth really, it's meaningless," Adams said. "And many people just ignore them, and there's nothing that can be done really."

Unless a person is charged with a violent crime, proving he or she is dangerous can be difficult.

James Johansson, a 37-year-old registered sex offender from Massachusetts, was found incompetent to stand trial on charges that he sexually assaulted two girls, ages 14 and 15, from Concord in 2006. The charges were dropped in April 2006. That December, Johansson was arrested at Concord High School: He was waiting for one of the girls he allegedly assaulted.

Johansson was found incompetent and unrestorable, so he could not be prosecuted. Prosecutors wanted him held, but doctors said he did not qualify for involuntary commitment to the state hospital, according to court records.

Adams said he could not speak specifically about the Johansson case, but his evaluation of Johansson's mental health are noted in Johansson's criminal file. Adams said Johansson's understanding and maturity level are not normal, which could explain why he is attracted to girls much younger than he is.

"I see no indication that the defendant suffers from pedophilia per se or antisocial personality, per se," Adams said, according to court records. "He simply has poor judgment and deficient verbal skills and seems to associate with people closer to his own intellectual age."

Johansson could not be prosecuted because he did not understand the legal process he was going through. Adams concluded that he could not be restored because he knew of no programs in the state that could help Johansson become competent within 12 months.

"If they cannot be restored in 12 months, then there's no other legal means to dispose of the case through the system except to have the case dismissed," said Merrimack County Attorney Dan St. Hilaire.

Sometimes, a person does not receive intensive psychiatric help until he or she is already charged with a serious crime. Eric Dickner, a Concord man who suffered from delusions for years, was not committed to a secure psychiatric facility until he pushed his father down a stairway, killing him. Dickner, 41, was found incompetent to stand trial on a manslaughter charge. Prosecutors had him committed through civil court to the secure psychiatric unit at the state prison.

"His parents had, since the onset of the mental illness, (gone) to a number of state agencies and organizations to get help for him," said Ed Cross, a public defender who represented Dickner in court. "They were told, 'Well, if he's not a danger to himself or others, there's nothing we can do about it.' Unfortunately, one day, they found out he was dangerous."

Little space

The state hospital on Clinton Street and the secure psychiatric unit at the state prison provide inpatient psychiatric treatment to those who suffer from serious mental illness. But the beds are often full, and anyone who is struggling with drug abuse - as many charged with crimes are - are ineligible for inpatient services.

That leads many who are released into the community to re-offend, landing them in jail or prison, where officials are struggling to provide enough mental health treatment.

"Our prisons have really become sort of de facto mental health institutions," said Louis Josephson, CEO of Riverbend Community Mental Health.

Riverbend, which provides $2 million in free mental health care to low-income people, can provide free counseling and help a person receive prescription medications if he or she is diagnosed with a mental illness. But those who also struggle with substance abuse receive much more limited intervention. The state requires that a person attend to substance abuse problems before he or she can qualify for reduced-cost or free health care. That's because it can be hard to determine if a person's problems stem from drug abuse or mental illness, Josephson said.

But many who come to Riverbend or who end up in jail suffer from both substance abuse and mental illness. Riverbend can only help them find a drug counseling program but cannot provide free counseling or medication to help with a mental illness because neither the state nor the federal government will pay for it.

"We can effectively, clinically work with those people, but the state right now won't pay us to do it, and I think that is shortsighted," Josephson said. "We can intervene earlier before people have committed an offense."

For those who commit crimes and end up in jail, they can spend months waiting to get into an inpatient drug and alcohol counseling facility. Some are turned away because of their mental health issues, Josephson said.

"They end up sitting at the house of corrections on a wait list that is months long," St. Hilaire said. "That's a typical case - it happens more often than not."

The Merrimack County House of Corrections, which houses between 200 and 270 prisoners, has seen a large increase in the number of inmates classified as significantly and persistently mentally ill, said Nancy Gallagher, the jail's sole mental health coordinator.

"Every year, we've doubled since I've been here, and they're staying much longer," she said.

The state prison is expanding its mental health offerings after Gov. John Lynch and the Executive Council approved a four-year contract with a new provider. The effort targets those who are not in need of 24-hour care provided at the secure psychiatric unit but cannot reside in the general prison population because of their mental health problems, said Jeff Lyons, a spokesman for the state Department of Corrections.

There's also an effort to establish a mental health court in Concord, which would divert less serious offenders into treatment programs rather than jail. Mental health courts, which already operate in Keene and Nashua, would allow court officials to follow defendants' mental health and drug abuse treatment, just as a probation officer tries to ensure a person on probation doesn't commit new crimes.

But expanding mental health services for the poor and uninsured could be expensive. It would cost between $75,000 and $100,000 to hire a person to oversee the mental health court, let alone expand services to deal with a larger number of people seeking help, Josephson said.

Still, it costs about $31,000 a year to house an inmate, and many who leave have lingering substance abuse or mental health problems, making them more likely to re-offend.

"Certain people fall through the cracks," said Concord Prosecutor Scott Murray. "Ultimately the state is going to pay, whether it's going to pay for them to be incarcerated or if you can get them into an effective drug treatment program." Read more!

Advocates push for replacement of Eastern State - Associated Press

Jan. 26, 08

LEXINGTON, Ky. -- Mental health advocates are pushing for a new $130 million hospital to treat the seriously mental ill in Kentucky.

Joseph Toy, president and CEO of Bluegrass Regional Mental Health-Mental Retardation Board, says Kentucky lawmakers should act on a plan to replace Eastern State Hospital.

"The time to act is now," Toy said at a rally Friday.

Eastern State Hospital, which currently treats mentally ill patients, is more than 180 years old.

State government currently has a $434 million budget shortfall in the fiscal year that ends June 30. Kentucky's projected budget shortfall over the next two fiscal years is more than $800 million.

Gov. Steve Beshear has already slashed 3-percent from the current state budget, and has said the next two-year budget will likely be austere. Beshear outlines his budget proposal Tuesday night at a joint session of the General Assembly.

Nevertheless, Toy says building the new hospital is a matter of priorities.

"If there is a priority with our elected officials, then it will get done," Toy said.

Steve Nunn, the Cabinet for Health and Family Services' deputy secretary, said Beshear's administration is trying to find ways to make a new hospital a reality.

"We're going to continue to work together to make this happen," Nunn said.

Jack Ballard, president of the design firm CMW Inc., revealed architectural plans for the new hospital. Ballard said it would be a 308-bed facility with four connected housing units.

"It's going to be like nothing else in the country," Ballard said.

Kelly Gunning, who heads the Lexington branch of the National Alliance on Mental Illness, called on the more than 150 people attending the rally to urge state legislators and Beshear for their support.

"We must be bold," Gunning said. "We must act now."
Information from: Lexington Herald-Leader, http://www.kentucky.com
Read more!

Mentally ill patients strain EMS resources -Austin (TX) American-Statesman

By Tony Plohetski

The man with a history of mental health problems once called 911 for medical help three times in one day: in the morning for an injury, in the afternoon for ingesting poison and for unknown reasons that night.

Paramedics responded each time and took him to a hospital. Two days later, the man called them back — twice — and went to a hospital in both instances.

All told, paramedics went to the man's house 290 times in two years.

As emergency rooms continue to be crowded by mental health patients who can't get beds elsewhere, Austin-Travis County Emergency Medical Services officials have begun trying to figure out how they can better serve such patients, perhaps without loading them into a hospital-bound ambulance.

To figure out the scope of the problem, they recently created a database to identify patients who most frequently summon paramedics and are studying the nature of their complaints.

Among their findings:

Ten patients made up more than 1 percent of the system's 130,000 contacts with patients in two years. Their most common complaints were stomach or chest pain, injuries or respiratory problems. Paramedics also responded to calls when the patients exhibited behavioral problems.

Nearly all of the patients went to a hospital emergency room each time, sometimes crowding into already overflowing facilities.

The patient who was seen 290 times in the two-year period was evaluated by paramedics twice on 36 days and nine times in a separate seven-day period.

Officials would not disclose the names of the patients, citing medical law that protects patient identities.

"We are seeing a small segment of the population we are spending a lot of time with," said EMS Division Commander David Andersen, who has compiled the database. "What we are doing now just isn't working. Taking these patients to the hospital over and over and over just isn't meeting their needs."

EMS officials said such calls also can tie up ambulances and crews for several hours, requiring paramedics from other parts of the city or county to respond to medical calls during that time.

The average call and visit takes more than an hour and $300 in EMS labor, gas and medical equipment.

EMS Acting Director Ernie Rodriguez said officials began trying to grasp the significance of the problem several months ago. In part, they tried to evaluate whether the types of complaints 911 operators listed on dispatch forms matched the actual illness when paramedics arrived.

But Rodriguez said officials also wanted to look at their role in treating mental health patients, particularly since last fall, when Austin's mental health authority cut the number of patients it sends to the Austin State Hospital, a facility for people with mental illness.

The Austin Travis County Mental Health Mental Retardation Center began reducing the number of people it sends to the state hospital by 43 percent last fall, after it exceeded its quota and got word from the state to either stop or pay millions to care for those extra patients.

Emergency rooms have since served as a safety net for those people, even though officials said they don't have proper mental health treatment programs or wards designed for such patients.

That arrangement has left some patients in emergency room beds for days or weeks at some hospitals, where they can be monitored by police or security guards until they no longer pose a danger to themselves or others, said Dr. Corey Jones, chief of emergency medicine at St. David's Medical Center.

"The ERs are jampacked, and we lose a significant capacity of our rooms" with those patients, Jones said.

In those instances, patients may also suffer from not having a physician who knows their medical histories or what medicines they should be taking, said Dr. Ed Racht, the EMS medical director.

Medical officials, including Jones and Racht, said EMS' effort to better triage mental health patients would probably ease emergency room crowding.

Rodriguez said EMS officials are exploring several options and are looking to a couple of other EMS systems across the United States for help.

"We have to come to a real understanding of what their needs are and come up with innovative ways to meet them," he said.

One possibility, he said, is that the system might hire a nurse who would be stationed in the 911 dispatch center and could talk to mental health patients about their concerns before sending an ambulance.

The agency also could create a "community health paramedic," who could respond to calls and who could regularly check up on patients to make sure they are taking medications and going to doctor's appointments.

EMS officials said they have indications such efforts could work: Last year, they temporarily reduced the call volume for one patient by meeting with her and her mother to discuss other ways they could help her, primarily by sending her to social services.

Racht, who was part of the meeting, said the effort worked until the woman was arrested, and then her frequent calls resumed.

Rodriguez said he's hopeful the agency will come up with more specific plans in coming months.

"I think it would revolutionize how we currently deal with a large part of our population," he said.

tplohetski@statesman.com; 445-3605
Read more!

Cops: Murder suspect confessed to killing -Seattle (WA) Post-Intelligencer

Diagnosed with schizophrenia by doctors in Texas and Arkansas

By BRAD WONG
Jan. 26, 08

A King County judge found probable cause to detain the man Seattle police have linked to the New Year's Eve stabbing death of Shannon Harps on Capitol Hill.

Judge Eileen Kato did not set bail at the hearing Saturday, but prosecutors expect to ask that he be held in lieu of $1 million.

The suspect, James Anthony Williams, 48, who was not present at the hearing Saturday, apparently confessed to killing Harps in an interview with police investigators, said King County deputy prosecutor Scott O'Toole.

First-degree murder charges are expected to be filed Tuesday in the case.

O'Toole called Williams "a troubled man," and told reporters after the hearing that the suspect would be competent to stand trial.

Williams, of Seattle, is a felon who has been diagnosed with schizophrenia by doctors in Texas and Arkansas.

Seattle Deputy Police Chief Clark Kimerer announced Friday that the State Patrol Crime Lab had matched the suspect's DNA to evidence found at the crime scene in the 1500 block of East Howell Street.

While police have not publicly talked about the specific DNA evidence against the man, sources told KOMO/4 that there was evidence on the knife he apparently used and under her fingernails.

Harps, 31, reportedly scratched the man as he attacked her. Police learned he was in the area the night of the slaying and asked him to submit a DNA sample in an interview, Kimerer said.

Detectives talked with him because of his suspicious behavior.

Harps, a Sierra Club organizer who had moved from Cleveland, was trying to enter her condominium building when she was stabbed several times. Police believe the attack was random and that she and the man did not know each other.

Witnesses reported hearing screams and spotting a man running from the scene. Her death rocked the Capitol Hill community and officers increased patrols following the crime.

The man, who has been described as a transient, has had several run-ins with police in Seattle and other states. In 1995, a judge sentenced him to prison for shooting and wounding a man in downtown. He has been in and out of mental health facilities and the court system.

Since Jan. 16, he has been in King County Jail after he was arrested for violating a probation requirement that he meet with his mental health provider.
P-I reporter Brad Wong can be reached at 206-448-8137 or bradwong@seattlepi.com.
Read more!

Research into lithium offers new hope for ALS -San Bernadino (CA) Sun

Leo Greene, Staff Writer
01/26/2008

Editor's note: Daily Bulletin reporter and videographer Leo Greene has been documenting his journey since being diagnosed with ALS, Lou Gehrig's disease, in August 2006.

Italian researchers claim to have stopped ALS dead in its tracks.

By stopped, they mean no progression.

By ALS, we mean the incurable disease for which there has been no significant medical breakthrough.

The Proceedings of the National Academy of Sciences, no slouch as scientific journals go, has accepted the researchers' paper for publication. We should see the details of their possibly landmark study in early February, a journal spokeswoman said.

I want to avoid overstating the significance of these findings from what is, after all, only a single, small clinical trial.

But on its face, it's significant.

Sixteen ALS patients were given two drugs: Riluzole, the generic name for the only drug approved for treating ALS, and lithium, a mood stabilizer used for bipolar disorder and depression.

Another 32 patients took only the Riluzole.

The patients - 16 on lithium and 32 not - were watched and evaluated over a period of 15 months.

The results of the trial were announced in early November at a Parkinson's disease conference in Italy. News of the findings was carried in an Italian science journal.

At the end of the 15 months, 30 percent of the group not taking lithium had died. Those who remained suffered on
Advertisement
average 50 percent decline.

This is what one would expect with ALS.

For those taking lithium, however, there were no deaths. Additionally, the ALS patients taking lithium experienced no meaningful disease progression, according to Francesco Fornai of the University of Pisa.

Two years after starting on lithium, only two had died, one from a heart attack and the other, who suffered from an advanced, aggressive case to begin with, from ALS-related causes.

The rest remained stable with no progression.

"Two years of nonprogression, that would be dramatic and unheard-of," said Dr. Laura Nist, chief of the Loma Linda University Medical Center ALS Clinic.

Nist remained skeptical, however, noting that the trial was small and details on the methodology have yet to be made public.

"I want to be encouraged. But right now I have more questions than answers," she said.

Since the dramatic findings were announced back in November, news has spread. PALS - People with ALS - around the globe have been asking their physicians for lithium.

I first heard about the trial from Alan Felzer, a retired Cal Poly professor and Claremont resident diagnosed with ALS in August 2007, a year after my diagnosis.

After getting the news about his condition, Alan and his wife, Laura, sought out second and third opinions from specialists in San Diego, San Francisco and Loma Linda. Someone out there on the cutting edge had to be close to a cure.

Alan is a self-described optimist.

"When I first got it, I figured this is going to be like one of those things on TV - the Lone Ranger - where everybody in the last two minutes gets saved," he said.

But none of the doctors were brandishing six shooters or dispensing lifesaving solutions.

As an electrical-engineering professor with grounding in science, Alan knew how to conduct his own research. He scoured the Internet along with his science-savvy daughter.

Karen Felzer, with a Harvard doctorate, investigates the causes of aftershocks as a USGS earthquake seismologist based at Caltech. She also makes occasional after-quake appearances on local and national TV news shows.

The father-daughter Internet searches developed a sense of urgency. Alan's illness seemed to be progressing faster than average.

Back in August, Alan experienced some difficulty walking. "But it wasn't anything that serious," Karen said.

Now, he requires a walker or a wheelchair, and he's losing strength in his arms.

One day in December, Karen put her infant son down for a nap and decided to make an all-out assault on the Internet, clicking on every link that came up like rabbits in a carnival shooting gallery.

"I saw this link that said lithium plus Rilutek, and I didn't think much of it," she said.

This rabbit, however, led her to a whole new place.

Karen was used to reading studies where successes were tallied, usually with laboratory mice, in marginally better outcomes. The Italian study was different.

"To have 16 people not progress, I'd never seen anything like that before," she said.

Alan got his doctor to prescribe lithium at a dose matching the Italian trial. He took his first pill on Jan. 4.

In the Internet forums where people share information about ALS, Karen found others starting on lithium. She joined forces with a man in Brazil who had developed a spreadsheet to keep track of PALS on lithium.

Humberto Macedo is a 41-year-old PALS, computer systems expert and family man.

Together, Karen and Humberto are running their own international clinical trial.

"Today we're 30 PALS worldwide on a spreadsheet," Humberto said via e-mail. "Hopefully we'll be 50 soon."

My name is on that sheet. I took my first pill Jan. 17.

Dr. Nist offered one admonishment for those planning to give lithium a try: Do it under a doctor's supervision. Lithium can be used safely but only with constant monitoring.

Karen and Humberto agree. Their trial requires participants to submit the results of regular blood tests.

Now, we monitor, watch and wait.

Humberto calls lithium "the first real hope."

It could buy us time until better treatments, even restorative treatments, are developed.

For Alan, the results of the Italian study provide "every reason not to hesitate. I'm optimistic."

And if in the end things haven't worked out quite the way we had wanted, "We won't be sad," said Humberto.

No, my friend. The taste of hope is sweet, even if it's only for a short time.

We won't be sad.

Karen Felzer's trial Web site can be accessed at http://alslithium.atspace.com/index.html.
Read more!

County establishes mental health task force -Macon County (NC) News

By Jessica Richardson
01/24/08

Macon County is taking progressive steps to improve mental health care in the area. At the recent Macon County Board of Commissioners meeting, vice chair Ronnie Beale brought forward an idea to enact a Macon County Mental Health task force. As liaison to the mental health committee, Beale said he has “never been so frustrated in his life,” about how mental health in western North Carolina is all but a broken system.

Beale said that he wants to determine financially where the county is regarding mental health and move forward to broaden mental health resources.

“I see Macon County taking the lead,” he said, “in coming up with effective services.” He added that people with mental illnesses deserve better services in the area.

He also noted how the former school provider, Meridian, has recently pulled their services for students, amplifying the lack of services for youth in the county.

Along with getting a better grasp on the resources being spent directly or indirectly on mental health, he said his goals with the taskforce are “to find out exactly where we’re at, who are the providers in Macon County and what we can do as a county government to improve services.”

The board approved the committee with the following members that Beale proposed: Jim Bruckner, MC Health Dept. Director; Kathy McGaha, Healthy Carolinians; Dan Sandoval, CEO Angel Medical; Sheriff Robert Holland; Assistant Andy Shields; Mike Diadig, private provider; Jane Kimsey, Director MC Dept. Social Services and two anonymous citizens with mental health illnesses.

Beale said he believed the task force is the “first step” towards a solution.

In favor of the task force, commissioner Jim Davis said, “Thank you for your help with something that needs to be done. We are leading the way in trying to fix so called ‘mental health reform’ from the state.” He spoke critically of the state’s reform, saying it was “a euphemism for cutting funding.”

During public session, Mary Ann Widenhouse thanked Sheriff Robert Holland for a recent mental health meeting that addressed the issues of transporting mental health patients and the lack of availability for stays in 24-hour facilities.

Widenhouse said she was pleased to know that Commissioner Ronnie Beale is forming a mental health task force, but later added that she was disappointed she had not been asked to serve on the task force.

“So frequently in the past, those of us who have a personal experience have not been brought to the table,” said Widenhouse. She said she has lived with her own mental illness as well as learned to cope with that of her mother for the past 50 years.

In a later interview, she added, “It’s sad that we have to say the [people with mental illness] members are anonymous. I have a mental illness and I have lived with it for years,” she said. It only increases the stigma, she said.

She agreed with a statement from NC Senator John Snow (at the recent mental health meeting) that a stigma about people with mental health conditions exists and that having law enforcement officers transport involuntary patients only reinforces that stigma.

She also stressed that state facilities are the most expensive way of treating mental health patients and not always the best, citing a study by Christina Thompson and Heart of the Matter Consulting, Inc. The consulting group was commissioned to do a study on North Carolina’s mental health system, which was reported to a legislative committee in Dec. 2006.

Services have been privatized here in western North Carolina as a part of the state’s “mental health reform.” In her study, Thomas suggests that mobile crisis units that can actually go to a person’s home as a significant benefit. “That way, they don’t have to go through the trauma of coming in [to an emergency room or to Balsam],” said Widenhouse.

Another idea is a peer-run 24-hour crisis center. People like Widenhouse that have been trained as peer support specialists, would run such a center. Training local community responders who can respond to a crisis was also suggested in the study.

Widenhouse noted that Smoky Mountain Health Services is looking towards placing mental health care providers at emergency rooms, because that is often the first place people go. The area also has an Assertive Community Treatment Team, which Widenhouse said is surprisingly successful for a rural area. The treatment team links people with significant mental illnesses or substance abuses with another team member that is available 24 hours a day as a supportive contact.

Access to help before a crisis happens needs to improve, she said. More community education would also be beneficial and could help people so that it doesn’t escalate to the point of a crisis.

Widenhouse said she is also interested in having crisis intervention team training in Macon County, but she would need the cooperation of law enforcement and the county. She pointed to a model of crisis intervention that seems to be working well for the Memphis Police Department. According to their website, www.memphispolice.org, the agency has a Crisis Intervention Team, which is a community partnership with mental health advocates and family members. Started in 1988, the program has organized, trained and implemented a special unit in the department. “This unique and creative alliance was established for the purpose of developing a more intelligent, understandable and safe approach to mental crisis events,” reads the website.

Cited benefits of the program are immediate crisis response, decreased arrests and use of force, identification of underserved mental health patients, reduced use of restraints in the ER, better trained officers, decreases in officer injuries, fewer victimless crime arrests, a decrease in liability for health care issues in the jails and cost savings.

Several people have joined in an effort to start a local chapter of the National Alliance on Mental Illness (NAMI) to be called NAMI Appalachian South. According to a press release, the organization sponsors free, 12-week programs such as family-to-family workshops covering the nature and treatment of mental illnesses, coping skills and available resources. Other programs include a peer-to-peer course for citizens and programs for health care providers and the public.

NAMI has approximately 220,000 members through affiliates across the country. Established in Wisconsin in 1970, by parents of adults with severe and persistent mental illnesses, NAMI is a grassroots organization providing support, education and advocacy for families and persons with mental illnesses such as clinical depression, bipolar disorder, schizophrenia, panic disorder, obsessive-compulsive disorder, anxiety disorder, post-traumatic stress and others.

For more information about NAMI, go to www.nami.org or www.naminc.org for North Carolina NAMI. For information about the local affiliate, NAMI Appalachian South, contact Ann Nandrea at 369-7385, Carol Light at 526-9769 or Mary Ann Widenhouse at 524-1355.

Board supports JCPC

In a related subject, Teresa McDowell, chair of the Juvenile Crime Prevention Council and Linsey Gallira, juvenile court counselor, asked the board of commissioners to pass a resolution in support of continued state funding to the council’s sponsored programs.

“Without the JCPC, there would be more court youth delinquents in centers,” said Gallira. She noted that the juvenile delinquent centers are expensive as well, costing about $99,225 a year for each child. Funding the JCPC programs pales in cost comparison and often brings juveniles into a community of acceptance, promotes self-esteem and positive behavior.

According to McDowell, funding for JCPC has been removed from the state’s continuation budget for fiscal year 2008/2009. “This is the first year it’s not even in the budget,” she said.

JCPC helps fund programs such as Hawthorne Heights, an emergency placement for youth instead of detention centers. Other programs include Project Challenge and wilderness programs.

“I’ve seen it work magic,” said Gallira. “The youth grow self-esteem and feel like they can belong to something in these programs.”
Read more!

Work is an inalienable right -Richmond (IN) Palladium-Item

Commentary:

In the Declaration of Independence, our beloved country's forefathers declared for every person the inalienable rights of "life, liberty, and the pursuit of happiness."

The right to work and pursue a job or career of our liking is for the benefit of all these inalienable rights. It is a very important inalienable right in itself. To deny anyone who has a desire to work is total discrimination against that person's inalienable rights.

This is why I'm speaking out against discrimination of my people, the mentally ill, handicapped and disabled. I'm especially speaking out for their inalienable right to work. In so doing they may have a better chance to be productive citizens.

One factor in which discrimination is used against the mentally ill, handicapped and disabled is many employers' unfair hiring practices. Jane Zimmerman is an employment consultant for Community Connections, an agency which seeks jobs for people with disabilities. When asked if discrimination is a big factor when trying to find her clients employment, she explained, "Absolutely: The work environment has become more competitive for businesses. They are required to be more productive with fewer resources. Therefore they may be less likely to hire a disabled person because of these higher demands."

Also when asked how difficult discrimination makes it to get a person with a disability a job, she replied, "It is more challenging because of preconceived notions that a disabled person may be less productive. I have to convince employers that the person is capable of handling the job responsibilities. Sometimes the person is unable to be a self-advocate and this makes my job more difficult. Not all disabled fall into this category. Some disabilities are not as noticeable as others."

Employers need to come to the realization that many disabled people can work if given the chance.

According to the American Disabilities Act, if companies employ a disabled person they can get a tax break for hiring that person. This is the Work Opportunity Tax Credit Program, or WOTC.

So, to all you employers in Richmond, give us back our inalienable rights and hire people with disabilities. Make this beloved country of ours a real democracy. By hiring people with disabilities you will be doubly blessed, for our forefathers and signers of the Declaration of Independence will smile on you.

For more information on WOTC, contact Dorothy at WorkOne (765) 962-8591, ext. 246. Read more!

Maybe he died of mental illness -Wilmington (NC) Star-News

Editorial: Maybe he died of mental illness

Brunswick County Sheriff Ron Hewett has been curiously slow about releasing public documents that shed light on his activities, but say this for him: When an inmate dies in his jail, he doesn't keep mum until the Star-News finds out about it three months later - as New Hanover County Sheriff Sid Causey did when Gary Rummer died after his neck was broken and his brain was injured five years ago.

After an inmate died in his jail Wednesday night, Hewett called in reporters the next day and told them about it.

According to Hewett, the encounter that ended in the death of 32-year-old Senaca Marrell Vaught was caught by a camera, and the videotape has been sent to the State Bureau of Investigation.

If the tape bears out the sheriff's account, it would seem hard to fault his deputies. Hewett said they went to Vaught's cell because he had been kicking the door. Vaught, who weighed 650 pounds, attacked them. One pepper-sprayed him and both wrestled him to the floor. He stopped breathing.

The deputies and a nurse tried for 40 minutes to revive Vaught, but could not. A preliminary autopsy concluded that he had not died from "blunt force trauma" - in other words, he wasn't beaten to death. Given his size, it might not have taken much to stop Vaught's heart.

At this point the main question would seems to be why this inmate had not received a psychological examination.

He'd been taken into custody on Christmas Day, accused of assaulting his own mother. He'd been put into an observation cell Jan. 16 for exhibiting "bizarre and erratic behavior" and was considered a danger to himself, according to Hewett. Yet he didn't have an appointment for a psychological evaluation until Feb. 1.

Jail might have been the wrong place for Vaught. But North Carolina's mental health "system" let him stay there for almost a month without professional help.

He might have gotten some next week. He didn't make it.
Read more!

Despite inquiry, firm has new name -Elizabeth City (NC) Daily Advance

State says AH&HS debt still stands

By BOB MONTGOMERY

A local counseling business that owes the state nearly $500,000 in Medicaid funds has changed its name, but that doesn't clear its debt, a state official said Tuesday.

American Health and Human Services Inc., has restructured with a new name, Christian Empowerment Resource Center in Elizabeth City, according to a letter being circulated in the community signed by Andrea L. Simpson, president and CEO.

"The name can change, but they're still liable for that money," said Brad Deen, spokesman for the N.C. Department of Health and Human Services. "They can change the name all they want. They're still in the program."

The N.C. Department of State has no record of Simpson's new business, according to its Web site.

Simpson's letter also states that services already offered will continue to be provided, including community support, outpatient therapy and medication management.

But he noted that, "Due to the restructuring process, counseling and medical services are on hold until further notice."

Simpson could not be reached Tuesday to explain the reason for the name change, or to say where patients will get services in the interim. AH&HS is under investigation by both the Department of Health and Human Services and the Department of Labor's Wage and Hour Bureau.

The DHHS has ordered Simpson's business to repay the state $483,041 in Medicaid funds it received dating back to March 2006 for overbilling and providing services that "were not medically necessary."

The business is among 185 community service providers in North Carolina that overcharged the state an estimated $45 million in Medicaid funds for unnecessary services. The program is an outgrowth of mental health reform. The state is still trying to determine exactly how much money each provider owes, according to Deen.

In the meantime, he said Simpson's business is still listed as a Medicaid provider that is having 10 percent of its funds withheld until the entire amount owed is repaid.

Simpson has said he would appeal the most recent order to repay $211,957, which is in addition to the $271,084 he was ordered to repay last summer.

Four other local mental health care providers have also been ordered to repay the state thousands of dollars for Medicaid-related overbillings, according to Deen.

The local community service providers are associated with Albemarle Mental Health Center and perform mentoring and counseling for mental health patients, reimbursed with Medicaid funds through the state DHHS.

Charles Franklin, area program director for AMHC, could not be reached for comment on how the cutbacks and waste of Medicaid funds is impacting patience served by the direct providers.

In the meantime, Simpson has apparently circulated a letter announcing a restructuring and name change for his business.

Christian Empowerment Resource Center lists Simpson as president and CEO, Dr. Patrick Hines as medical clinical services director, Dr. Jerome Brite as pharmacy supervisor, Dr. Esther Lyons as psychiatrist, Nicole Martin as chief therapist and Felicia Cofield as clinical therapist.

Its addresses are listed as 504 E. Elizabeth Street, Suite 1, Elizabeth City, and 110 W. Market Street, Hertford.

Simpson's letter invites residents to attend a "meeting for parents" and dinner at 6 p.m. Thursday at the Hugh Cale job training center, 524 S. Road Street.

"After our restructuring process, the new Christian Empowerment Resource Center will provide you and your family the opportunity to receive wholeness and healing through the power of faith," Simpson's letter states. "This faith-based approach will be rendered at the request of you and your family.
Read more!

Wake Schools Investigate Injuries to Student With Autism - WRAL-TV (Raleigh) NC

Video of this story here.
Jan. 25 5:50 p.m.

Raleigh — Wake County school administrators are investigating how a student with autism wound up with a broken arm and a shattered tooth.

Jamaal Smith, 15, came home from Martin Middle School on Wednesday with the injuries. The teen has severe autism and doesn't speak.

"He can't tell us what's going on with him. We're trusting the school to take care with our kid, and here he comes home with his arm broken," said his father, John Smith. "They say he took a hard impact, whatever happened to him."

Interviews with teachers and assistants at Martin Middle indicate Jamaal appeared to be fine when he left school, said Michael Evans, spokesman for the Wake County school system.

"What we're trying to do right now is walk back through the day. The student is in a self-contained classroom and has a very high student-to-adult ratio."

District policy calls for one teacher and one assistant to be present for every six special-needs student, and students with autism are always supposed to be attended.

The private service hired to transport Jamaal to and from school will also be interviewed, officials said.

"I'm not blaming anyone for this, but if it was an accident, how can someone not seen him fall, not seen this kind of an impact if his arm was shattered like that?" said his mother, Anitra Smith.

Raleigh police said it's unlikely an assault took place, but if evidence winds up pointing to one, it would mark the second time in two years the teen was hurt while in the school system's care.

In 2006, while Jamaal was at Carnage Middle School, he was beaten by former teacher Christina Wolfe. She was convicted of assault on a handicapped person and stripped of her teachers license.

The family has a pending lawsuit in the 2006 incident.

"If someone does know something (about what happened Wednesday), please inform the principals or someone," Anitra Smith said.

* Reporter: Dan Bowens
* Photographer: Terry Cantrell
* Web Editor: Matthew Burns
Read more!

Shooting of Mentally Ill Man Ruled Self-defense - KPLR-TV St. Louis

January 25, 2008

St. Charles, Mo — The prosecuting attorney in St. Charles County rules that the fatal shooting of a mentally ill man by his stepfather was justifiable homicide.

Prosecutor Jack Banas says no charges will be filed against Dr. John Gentles in the death of his stepson, Marshall Fink, 26. Banas says Gentles acted in self-defense. Fink was shot on Jan. 11.

Banas says Fink had shown increasingly erratic and often violent behavior over the past 18 months, and relatives feared for their safety. His mother says Fink was bipolar and had lived at home since being discharged from the Navy because of his illness. Authorities say Fink threatened both his mother and stepfather on the day of the shooting.

(Copyright 2008 Associated Press. All rights reserved. This material may not be published, broadcast, rewritten or redistributed.)

Copyright © 2008, KPLR
Read more!

Assembly works on mentalhealth reform legislation - Roanoke Times

The bills in both houses aim to ensure patients get court-ordered treatments.

By Michael Sluss
804) 697-1585

RICHMOND -- Both houses of the General Assembly are moving forward with sweeping mental health reform legislation, encountering little opposition as they try to fix long-neglected problems exposed by the Virginia Tech shootings.

A House of Delegates committee endorsed legislation Friday that would broaden the standard authorities use to mandate treatment for people with potentially dangerous illnesses. The House Courts of Justice Committee will vote Monday on a comprehensive bill that reforms mandatory outpatient treatment laws and clarifies requirements for monitoring patients getting court-ordered treatment.

A Senate subcommittee worked into the evening Friday on similar legislation, which should go to the Senate Courts of Justice Committee on Monday.

Mental health reform has been identified as a top priority by Gov. Tim Kaine and lawmakers in both parties, and bipartisan support appears to exist for a broad array of bills aimed at fixing shortcomings in the state's overburdened, underfunded system.

The bills largely reflect recommendations made by a state Supreme Court commission on mental health commitment law and by a gubernatorial panel that investigated the Tech shootings.

"We've really revamped the whole involuntary commitment process," said Del. William Fralin, R-Roanoke, who served on a House subcommittee that fine-tuned legislation dealing with the commitment process.

Kaine and lawmakers want to fix gaps in the system that may have contributed to Tech gunman Seung-Hui Cho's failure to get court-ordered mental health treatment. Cho had been ordered to receive outpatient treatment in 2005 after a Montgomery County special justice determined him to be an "imminent danger." But no state authority monitored Cho to make sure he complied with the order.

Comprehensive bills moving through both houses could fix such problems. The bills cover every step of the commitment process, from the initial examination of the patient to the roles that courts and local community services boards play in ensuring compliance with treatment orders.

Lawmakers also are advancing bills to change Virginia's criteria for involuntary commitment of a mentally ill patient from the current standard of "imminent danger" to "substantial likelihood" of causing harm to self or others. The House Courts of Justice Committee endorsed its version of the bill (HB 559) Friday.

Some mental health advocates have raised concerns that the relaxed standard will force more people with mental illnesses into coerced treatment, making recovery more difficult. They also have questioned whether state funding will be sufficient to improve outpatient care.

But Mira Signer, the executive director of the Virginia office of the National Alliance on Mental Illness, said lawmakers so far have been attentive to input from those with mental health needs. Lawmakers appear to be trying to strike a balance between addressing public safety needs and preserving the rights of people with mental illnesses.

"It requires a very careful weighing and conscientious decision-making, and it seems like that's happening," Signer said. "It seems like the voices of consumers and family members have been heard."
Read more!

Utah State Hospital review praises patient care, costs - Salt Lake City Tribune

By Julia Lyon
01/25/2008

A review of the Utah State Hospital, which cares for mentally ill children and adults, praises patient care and finds bed costs to be mid-range compared to nearby states.

The report from the Office of the Legislative Auditor General, released Friday, was requested by Sen. Curtis Bramble, R-Provo, and Rep. Rebecca Lockhart, R-Provo. It was completed with the assistance of clinical psychologist Joel Dvoskin.

Last year, Lockhart sponsored a bill calling for private proposals to operate the hospital, to see if it could be operated more efficiently. The bill did not pass.

Lisa-Michele Church, executive director of Utah's Department of Human Services, said this week she remained puzzled by the push toward privatization. Last February, she raised concerns about the proposal in a letter to the Joint Health and Human Services Appropriation Subcommittee.

"Other states who have tried privatization of similar services find no measurable costs savings," she wrote. "Let's learn from others' experience in this area."

The audit highlights challenges at the hospital and makes recommendations. For example, although the facility has sufficient number of beds for adult and children referred for treatment, the demand for beds for adults involved in the courts was greater than availability.

The audit recommends the state consider developing alternatives for some "incompetent defendants." One man suffering head trauma was held at the hospital for 1.5 years after he failed to pay a taxi driver and was charged with a class B misdemeanor. Read more!

Fewer inmates, new programs enable prison closings - Buffalo (NY) News

Opinion: By Brian Fischer
Updated: 01/25/08 6:46 AM

As statewide crime rates continue to drop, New York’s prison population continues to decline. Our correctional system has lost nearly 9,000 inmates over the last eight years, a drop of 13 percent, from a high of nearly 71,600 in 1999 to fewer than 62,500 now.

Much of that decline can be attributed to the forward thinking of the State Legislature through enactment of innovative and appropriate early-release statutes for nonviolent offenders.

These include shock incarceration, Rockefeller Drug Law reform, merit time and supplemental merit time, comprehensive alcohol and substance abuse treatment, work release and the creation of the Willard Drug Treatment Campus.

By March 31, 2010, the prison population is projected to be even 1,200 lower than it is today. Those numbers alone more than justify our plan to close four correctional facilities: Hudson, a medium- security prison in Columbia County (Hudson’s work-release component will remain open), and three minimum-security camps that are half-empty — Mt. McGregor in Saratoga County, Gabriels in Franklin County and Pharsalia in Chenango County.

But the $20.6 million annual cost to hire 375 new employees and the $70 million capital construction price tag of expanded treatment and programs for mentally ill inmates and incarcerated sex offenders — mandated by the courts and State Legislature in efforts to better treat mental illness while protecting the community from dangerous sex offenders — make the case for closure even stronger.

To help meet those costs while ensuring effective prison operation, the planned closures will save $10.4 million in operational costs in 2008-09 and $33.5 million in 2009-10, plus nearly $30 million by avoiding needed capital construction projects.

Inmates at the facilities we close will fill vacancies at other facilities operating below capacity. And I expect every employee at the four facilities to be offered another job in state corrections, with most able to remain at home by filling positions at nearby prisons that will remain open.

Moreover, staff and host communities will have a year to prepare for the closures, as required by Correction Law 79a and 79b. That statute also requires my agency, in consultation with other appropriate state agencies, to seek alternative use of each facility and to strive to lessen the hardship on affected staff.

With program and treatment needs increasing and the prison population continuing to decline, closing correctional facilities is the appropriate management decision.

Brian Fischer is commissioner of the Departmentof Correctional Services. Prior tothat he held various professional positionsat Correctional Services for more than 30years, including superintendent at severalfacilities. Read more!

Mental Illness: The Silent Disorder -WATE-TV Knoxville

The following 8 stories and others are part of a package produced by WATE-TV, Knovxville, TN. They can be viewed by clicking here.

Supervisor uses her depression to help care for the homeless
Friendship House, located on Lamar Street next to the old Knoxville High School, is a drop-in center offering social services to those who need it most, the homeless.
more>>

Treatment center leads to teen's turnaround after drugs, alcohol abuse
6 News traveled to Raleigh, North Carolina recently to meet a teen whose parents staged an intervention and got him into residential treatment at Peninsula Village, just outside Knoxville.
more>>

Counseling, support group helps woman reclaim her life from depression
Many people who suffer from clinical, or major, depression aren't keen to seek treatment. Some may think the depression is a sign of weakness. They may fear the stigma attached to mental illness or may think it will go away on its own.
more>>

Local mother and 2 children all diagnosed with bipolar disorder
If you hear the term bi-polar, you may think of someone who goes from extreme highs to extreme lows, very quickly. But that's usually not the case.
more>>

Peninsula outpatient program helps people take control of their lives
At Peninsula's Outpatient Recovery Education Center, treatment means more than just therapy or managing medication. The goal is helping people take control of their lives and begin the recovery process.
more>>

Students learn how to cope with stress in Mental Health 101
Young people are naturally "curious" and likely have lots of questions about mental illness. But they often talk more "openly" with their friends and peers than with their parents. For this reason, some teenagers may have misinformation about mental illness.
more>>

Police in Knoxville get in depth training for helping mentally ill
People suffering from severe forms of mental illness who may be off their medications can turn violent in some situations. And fatal incidents in the past led the Knoxville Police Department to create a new training program so officers can handle the situations safely.
more>> Read more!

Healing home - Rutland (VT) Herald

By Sarah Hinckley Herald Staff
January 25, 2008

Former U.S. Surgeon General C. Everett Koop made a visit to Castleton on Thursday to honor a man who has dedicated at least 3-1/2 decades of his life to working with the mentally ill.

Willem Leenman, 58, has owned and directed Forty Seven Main Street, an 11-occupancy home in Castleton for people living with afflictions such as schizophrenia, bipolar and severe depression, full time since 1979.Koop, who served from 1981 to 1989, presented Leenman with a coin minted specifically by the surgeon general — a privilege the office holds.

"It was really nice, I was really touched by the whole thing," said Leenman on Thursday afternoon. Koop stayed after the late-morning ceremony and joined residents and staff for lunch.

During an interview prior to the ceremony, Leenman said he was embarrassed to be recognized for his work.

"I've always tried to keep a low profile," he said. "No one is proud to live at Forty Seven Main Street. There's a stigma attached to mental illness that is very much there."

The place Koop called an oasis for people with mental illness was founded in 1969 by Leenman's parents. They were inspired after staying at Spring Lake Ranch in Cuttingsville.

Although the actual address is 706 Main St. in Castleton, the name of the center came from its original address. When Leenman's parents moved to Castleton, the houses were not numbered, as they had been in their native country, the Netherlands. One day his father started at the end of the street and counted off by odd number until he arrived back at the house. Its original name was Therapeutic Community Center, which the younger Leenman changed after taking the helm.

In 1985, when his parents retired and returned to Europe, Leenman went to a friend for advice about taking over the business. He was told not to do it, that the private-care home would never survive.

"I don't like to be told I can't do something," said Leenman. "I think it was fantastic that I didn't have a clue what I was getting into."

There are 12 staff members at the house, which relies largely on private funding to stay open.

"I'm a lousy business person, I find it philosophically impossible to make money off someone else's unhappiness," Leenman said. He admits complying with ever-changing state regulations has made it difficult some years to stay on top financially. "If we make a profit, we make maybe $2,000. Some years we make no profit."

Otto Marx is the psychiatrist for Forty Seven Main Street and is on-site at least once a month. He has worked with Leenman and the residents for about 11 years.

"People really get the individual attention they need," said Marx, about what makes Forty Seven Main Street unique. "(That) is often hard to come by in a country where everyone likes things in categories."

For the last two years the home has not accepted females because more males were coming through the door. There is no set time that residents, who range in age from 20 to 60 years old, stay at Forty Seven Main Street; there are too many factors at play.

Leenman has worked to establish a community among residents and staff. Besides contributing to the household chores and working in the garden at the home, residents have also participated in the Multiple Sclerosis Walk and in the local CROP Walk.

"We try to get our residents to look beyond (themselves)," Leenman said. A request at Forty Seven Main Street is to have residents do each of the following every day: something for community, something for themselves, something artistic, something intellectual and something physical.

"I wanted to have something that looks like a community, where everyone can be the best person they can be — whatever that means — where everyone can feel safe and everyone can grow."

Contact Sarah Hinckley at sarah.hinckley@rutlandherald.com.
Read more!

A costly wreck in need of a cleanup -Portland (OR) Oregonian

Commentary: Steve Tackett-Nelson
Friday, January 25, 2008

Over the past 30 years there has been a quiet movement to criminalize being mentally ill while indigent. No law was enacted, no edicts issued. But the unplanned effect of isolated events has been a gradual drift in public policy. And unplanned drift can have expensive consequences; remember the last voyage of the New Carissa.

In the 1980s it was possible for a person to sign in voluntarily to Oregon State Hospital if his mental symptoms became unbearable. But then came a drop in voluntary admissions and a surge of civil commitments. Why? The patients certainly hadn't changed. The answer is that the state hospital stopped accepting voluntary admissions.

Now it's nearly impossible to voluntarily get into a psychiatric hospital, even when a person is dangerous to himself or others. Psychotic patients stack up in emergency rooms every weekend. When they finally get into a community hospital, the race is on to get them out the door again.

It's all about the bucks. Community hospitals don't want psychiatric units because they lose money. Emergency department patients who are too sick to send home have to be admitted, regardless of their financial health. Theoretically, patients who don't improve soon are transferred to state hospitals, but state hospitals are overflowing.

Two-thirds of our state hospital capacity serves forensic patients. Civil commitment has been replaced by criminal justice. By law, forensic patients must be hospitalized until they improve. Most are little different from the former voluntary patients, but now they get no treatment until they break the law.

Psychotic people don't intend to become criminals. Legally, they lack the capacity. But they can't work, are troublesome tenants and often self-medicate with alcohol or drugs. Sooner or later, they drift afoul of the law. Outpatient mental health programs aren't funded for the volume of indigent people who need treatment. But just say "PSRB," and the door magically opens.

Oregon's Psychiatric Security Review Board has 745 people under its jurisdiction, up 60 percent since 2000. Half are on conditional release, in 22 counties. PSRB patients who, clinically, could be discharged fill 40 beds. Because they are entangled in the criminal justice system, they are "criminally mentally ill." This is an odd concept. We never hear about the "criminally diabetic." PSRB patients clog the state hospital because there are no suitable residential placements.

It's an old story. Everybody wants to go to heaven, but nobody wants to die. Everybody wants lower taxes, but no one wants to slash government spending by having a group home in their backyard. A recent example is Washington County Sheriff Rob Gordon ejecting a new secure residence from Cornelius and proposing that local law enforcement have veto power over PSRB releases.

No one intended to criminalize mental illness, but skimping on treatment for moderately ill people paradoxically pushes them into more expensive predicaments. It costs less to keep people healthy than to rehabilitate them.

We need to reverse the slow-motion shipwreck that is Oregon's mental health system. The longer we wait, the more expensive it will be to clean up the wreckage.

Steve Tackett-Nelson is president of the Oregon Psychiatric Association.
Read more!

Groups work on State Hospital plan-Honolulu Star-Bulletin

By Helen Altonn
haltonn@starbulletin.com
Jan. 25, 2008

Patient overcrowding continues to plague the Hawaii State Hospital in Kaneohe for the mentally ill as two groups seek solutions through the mental-health and court systems.

"We are working with the courts to try and close the front door and develop services in the community so we can appropriately move people out," state Health Director Chiyome Fukino recently told lawmakers.

The hospital, designed for 168 to 178 patients, struggles with a high population because most are forensic patients sent there by the court.

The population hit 202 in August, the highest since 1994. It was about 194 this week.

This is within the licensed capacity but "still is much higher than ideal," said Dr. Thomas Hester, chief of the Health Department's Adult Mental Health Division. "It presents a lot of challenging staffing and space problems."

Fukino said the mental-health system is providing services to more than 14,500 residents, compared with "barely 4,000" in 2003.

"Fortunately, the administration and staff worked very well together, and we have not seen a spike in injuries to the staff or other patients as a result of assaults," Hester added.

The hospital was operated under federal court oversight from 1991 until December 2004 because of overcrowding and unconstitutional conditions. Significant changes were made, but assaults against staff and patients, some with serious injuries, drew legislative attention in 2006.

The governor convened a task force at the Legislature's request to recommend possible changes to reduce the hospital's population and encourage community-based services for forensic patients.

The task force, led by Sen. Rosalyn Baker (D, Kapalua-Kaanapali-Lahaina-Maalaea-Kihei-Makena), has completed a 61-page report with detailed procedural, legal and policy recommendations.

"I think we were able to move a number of issues forward that are contributing to overcrowding at the state hospital," Baker said. More than 40 government and private organization representatives met every month for more than a year and "really did a good job," she said.

The entire system is under study by a Mental Health Transformation group organized under a federal grant of nearly $11 million for five years.

The group is holding statewide community meetings to gather information for a comprehensive mental-health plan to transform what Fukino calls a "court-driven system."

The group is working with consumers to determine the greatest needs for a complete system, she said.

Hester said the Adult Mental Health Division has implemented jail diversion programs and made other changes to address problems and improve services. More changes are expected as an outgrowth of the task force, he said.

Baker introduced Senate Bill 2160 with some of the group's recommendations "to continue discussion and see how much we can accomplish." Other bills will be in the administration's legislative package, she said.

"The recommendations all are important if we're going to make sure that somebody who is mentally ill and interacts with criminal justice is appropriately dealt with," Baker said. "Folks that don't need to be at the State Hospital can be dealt with in another setting," she said, stressing the need for "appropriate placements."

Looking at what other states do, she said the task force found "we had restrictive policies and procedures with regard to how long people can be held, how soon they get re-evaluated and conditional release.

"Just a lot of things are impeding the system, and we're trying to look at how you make sure you're protecting the person who is mentally ill, as well as society, if there have been some bad acts."

With the courts filling up the small hospital in Kaneohe with forensic patients, she said, "Anybody in the community who needs that kind of hospital care really can't get it. It is a shame. It was not designed to be a forensic facility.

"We need to try to really put facilities and programs in place that address those needs in the community, because they spill over into the larger community."

Read more!

F.D.A. Requiring Suicide Studies in Drug Trials - New York Times

By GARDINER HARRIS

After decades of inattention to the possible psychiatric side effects of experimental medicines, the Food and Drug Administration is now requiring drug makers to study closely whether patients become suicidal during clinical trials.

The new rules represent one of the most profound changes of the past 16 years to regulations governing drug development. But since the F.D.A.’s oversight of experimental medicines is done in secret, the agency’s shift has not been announced publicly.

The drug industry, however, is keenly aware of the change. Makers of drugs to treat obesity, urinary incontinence, epilepsy, smoking cessation, depression and many other conditions are being asked for the first time by the drug agency to put a comprehensive suicide assessment into their clinical trials.

In recent months, the agency has sent letters — it would not say how many — to drug makers requiring that they use such a scale. Merck, Sanofi-Aventis and Eli Lilly are all using a detailed suicide assessment in clinical trials being conducted now.

The seeds for the new federal effort were planted four years ago with the discovery that antidepressants may cause some children and teenagers to become suicidal. Top agency officials at first discounted the finding but commissioned researchers from Columbia University’s department of psychiatry, led by Kelly L. Posner, to reanalyze the drugs’ clinical trials. This work caused the drug agency and its experts to view the risk as real.

Then it received an application for rimonabant, a much-heralded obesity drug developed by the French drug giant, Sanofi-Aventis. As agency medical reviewers pored over the drug’s clinical trial data, they discovered hints that it could cause psychiatric problems, too.

Unsettled by their experience with antidepressants, agency reviewers again mandated the use of Dr. Posner’s system. The assessment found that the drug doubled the risks of suicidal symptoms. In June, an F.D.A. advisory committee voted unanimously that the agency reject rimonabant because of its psychiatric effects, and Sanofi-Aventis withdrew the application although the drug is sold in Europe.

Just this month, the results of a trial of Merck’s obesity drug, taranabant, were published showing similar psychiatric problems. Meanwhile, fears have grown that drugs used to treat epilepsy, seizures and mood disorders may have similar effects. An extensive examination of these medicines by the drug agency should be completed this year.

Suddenly, agency officials realized that multiple classes of medicines might cause dangerous psychiatric problems.

“Clearly we were somewhat surprised when this signal emerged in the pediatric antidepressant data,” said Dr. Thomas P. Laughren, director of the drug agency’s division of psychiatry products. “So various groups within F.D.A. are now looking at suicidality more broadly as a possible adverse event.”

The drug agency’s concerns are consistent with a growing body of research confirming that behavior is heavily influenced not only by genes but also by seemingly innocuous changes in body chemistry. Drugs not reaching the brain were once thought to be largely free of mental effects.

“One lesson from pharmacology is that you can see effects on emotion and cognition without the drug entering the brain if a drug leads to peripheral changes in” other chemicals that enter the brain, said Dr. Thomas R. Insel, director of the National Institute of Mental Health.

Some critics say that the agency’s new-found focus on psychiatric side effects is long overdue.

“The list of drugs that causes psychiatric problems is a very long one,” said Dr. Sidney M. Wolfe, director of Public Citizen’s health research group.

Medicines to treat acne, hypertension, high cholesterol, swelling, heartburn, pain, bacterial infections and insomnia can all cause psychiatric problems, effects that were discovered in most cases after the drugs were approved and used in millions of patients.

Some drugs cause depression so often that doctors prescribe antidepressants prophylactically with them.

Among medicines still for sale, the F.D.A. has determined that the drugs’ benefits outweigh their psychiatric risks. Still, the agency now wants to uncover such problems more reliably and before approval.

There are two reasons that the F.D.A. for years was inattentive to the psychiatric effects of new medicines. First, distinguishing between mental problems that spring from a disease and those that result from its treatment is often difficult. For antidepressants, many researchers suggested that suicidal behaviors resulted because, as patients’ depression lifted, they suddenly had the energy to carry out previous suicidal thoughts.

Second, drug side effects are often first identified in clinical trials when multiple doctors treating hundreds of patients record similar problems in trial notes. But terms to describe depression or suicidal thoughts can vary widely, making them hard to discern.

“The whole spectrum of suicidal thoughts, ideation and attempts is much more difficult to define and study than” other drug problems, said Dr. Eric Colman, deputy director of the drug agency’s division of metabolic and endocrine products.

Indeed, the agency’s initial review of the effects of antidepressants in children was plagued by inconsistent and erroneous observations by investigators. A 10-year-old boy who tried to hang himself was listed only as having a “personality disorder,” an overdose of 11 tablets was called a “medication error” and a girl who slapped herself in the face was labeled as having attempted suicide.

Dr. Posner’s team spent months reclassifying these events as either a suicidal symptom or not. The team created a detailed questionnaire called the Columbia Suicide Severity Rating Scale, now adopted by the drug agency as an often mandatory test to be used in clinical trials.

The last time one medicine’s side effect led the F.D.A. to broadly re-examine its drug approval process was in 1992, when it discovered that Seldane, a popular antihistamine, could cause dangerous heart arrhythmias. Tests r