Repairing 'reform' - Raleigh News and Observer

Those with severe mental ills seem least likely to receive help under the state's reform effort. Fixing that is now a priority

Pity Dempsey Benton, the veteran public administrator hired last year by Governor Easley to run the state's Department of Health and Human Services. With that territory has come the formidable task of salvaging North Carolina's so-called mental health reform effort.

The poorly written reform law -- that's the well-expressed opinion of a legislator who has spent years trying to improve mental health services -- placed much of the responsibility for helping the mentally ill and substance abusers in the hands of private companies. It de-emphasized the use of state mental hospitals, and then gave county and state officials little direction on what and how services should be provided.

And pity Johnnie P. Yarborough.

In 2006, the 47-year-old Yarborough, suffering from bipolar disorder and addicted to crack cocaine, was so desperate for treatment that he beat on the doors of state-run Dorothea Dix Hospital in Raleigh and a private mental hospital, seeking to be admitted.

Because of the 2001 reform law, treatment once offered by Wake County's mental health agency had become spotty or nonexistent. Yarborough was admitted to Dix 14 times during 2006, but never for more than a few days. He began fearing that he might commit a murder. He's drug-free now and working, but that's thanks to the nonprofit Raleigh Rescue Mission, where he now lives.

Yarborough was profiled in The News & Observer's Thursday installment of a series of articles on the failure of mental health reform. One sign that the effort hasn't worked is that admissions to the state's four big mental hospitals are up. But consider this as well: In a 22-month period ending last month, North Carolina spent about $1.4 billion on minor "community support" services, in some cases for people who weren't even diagnosed as mentally ill.

In the worst cases -- and there are plenty of them -- services provided at $61 an hour consisted of being taken to the movies or to a mall. That probably wouldn't have been much help to Johnnie Yarborough.

Meanwhile, just $78 million was spent on seven services that the Department of Health and Human Services says are more likely to keep people out of mental institutions. Some counties, often rural ones, have never found enough private providers for those kinds of serious treatments. So they are left mostly with basic community services to offer patients afflicted with deep-seated mental illnesses. The state has spent even less on helping alcoholics and drug addicts shake their addictions, services that logically fall under DHHS's mental health umbrella.

The system prior to reform wasn't working well either. State and local agencies often did a poor job of coordinating or of providing consistent care to a patient who moved around. Or a local agency might have treated mental disorders and addictions separately when one was linked to the other. Unfortunately, coordination continues to be a weakness because the reform law isn't clear about who is responsible for monitoring care. The public pays, but so do people like Yarborough.

Benton's job should focus on directing limited funds to the greatest needs, and then ensuring that state-local and county-to-county coordination happen effectively. He inherited a mess, but with the well-being of thousands of North Carolinians at stake, along with the efficient use of huge sums of taxpayers' money, success is the only option.

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Serious mental health patients struggle to find care in North Carolina - Associated Press

Mental-health patients in North Carolina are struggling to find serious care after 2001 reforms moved the focus of treatment from mental hospitals to community programs now dominated by a basic service that lacks professional services.

The community support program, dominated by private companies who often employ workers with only high school diplomas, is consuming 90 percent of community mental-health spending, the News & Observer of Raleigh reported Thursday. Only 4.9 percent of community spending has been going to intensive outpatient therapy aimed at those with the most serious needs.

That system is driving those with serious conditions to frequent the state mental health hospitals that nearly everybody wanted to close or reduce in size. But while short stays in state hospitals help stabilize patients in crisis, they have less therapeutic value.

In the 12 months ending in June, 8,805 patients, more than half of all patients discharged from state hospitals, stayed a week or less, the News & Observer reported. Six years ago, less than a third of those discharged, 4,881, stayed a week or less.

Johnnie P. Yarborough, struggling with drug addiction and bipolar disorder, was admitted to Dorothea Dix Hospital in Raleigh 14 times in 2006. During one stay, he fought his scheduled release.

"I knew it that it was only a matter of time that my depression and addiction combined together with the number of drugs that I was doing, that I was going to end up killing someone or being killed," Yarborough said, "and I was afraid."

Hospital social workers made appointments for Yarborough at a treatment center and set up a meeting with drug counselors, but Yarborough often failed to show up, following a common theme of those with mental illness who need help with schedules and appointments. He also met three times with a Wake County psychiatrist.

Lawmakers changed the mental health system in 2001, hoping to provide better help to people such as Yarborough. Officials wanted to take local governments out of giving treatment and instead made them responsible for monitoring private companies that would spend more time serving clients in homes, schools, homeless shelters and other everyday settings.

But the basic care services of community support replaced the county and regional mental-health offices that stopped offering psychiatric appointments and day treatment.

State Sen. Martin Nesbitt Jr., a Democrat from Asheville Democrat, said the 2001 changes was seriously flawed.

"I don't think the initial package had the thought that it needed," said Nesbitt, who has been involved in writing mental-health laws for four years. "The details weren't there. And some of the assumptions that they made on how it would progress were faulty by their very nature."

The 2001 law restructured the system but said little or nothing about what kinds of needs the area programs should meet, how much money they would need and where they would get it. During restructuring, patients lost access to the professional services that community mental-health offices offered.

Those seeking mental health since been restrained by a lack of resources or a lack of care providers. The local office that covers New Hanover and two other counties said last week the region is running out of money, so patients who don't need urgent care will be placed on a waiting list.

But elsewhere, a total of about $69 million of federal and state funds earmarked for mental-health and substance abuse treatment went unspent because of a lack of caregivers.

"We realized we've got a pretty severe shortage of providers in a whole lot of the state that we've now got to rebuild," said Nesbitt, the Asheville senator.

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Governor hard at work on solutions -Hendersonville Times-News

By Dan Gerlach

While editorials in your newspaper and others have been busy engaging in finger pointing to blame the current problems in our state's mental health system, rest assured that Gov. Mike Easley and his administration have been working to make sure it gets fixed.

It is clear that the rapid change in the mental health system led to problems, no doubt. But to insinuate that nothing has been done, or that these problems were ignored, is flat wrong. Regardless of what has happened in the past, we want to remain focused on solving problems for those in need of services. Consider the following:

In 2006, Gov. Easley recommended, and the General Assembly supported, almost $100 million in additional funding to support the mental health system, including the replacement of lost federal funds for the developmentally disabled. This year, the governor ordered additional resources be made available to keep a state presence at Dix Hospital in conjunction with Wake County.

Last year, the state Department of Health and Human Services and the administration recognized that some mental health community service providers were exploiting the system, inflating charges and wasting tax dollars.

I informed a reporter in an interview that the governor demanded that the department take immediate action to audit the finances and practices of providers, adjust rates in cooperation with responsible providers, open fraud investigations, and toughen criteria for would-be providers and to screen inappropriate service requests. These changes started in early 2007, as soon as it became apparent that community support was open to abuse.

In May 2007, Gov. Easley designated Dempsey Benton to be the state Secretary of Health and Human Service and specifically directed him to produce a set of proposals that will bring effectiveness and accountability to the state's mental health system. Sec. Benton has taken numerous steps to strengthen hospital oversight, involve independent experts and advocates, and increase accountability. The secretary's hard work has been uniformly welcomed.

Gov. Easley and Sec. Benton will soon recommend further initiatives to improve our mental health services for the General Assembly's consideration in May. More needs to be done.

Your editorial implies a lack of compassion and action for the mentally ill. This is false, as the above illustrations show.

Dan Gerlach is the senior policy adviser for fiscal affairs for Gov. Mike Easley. Read more!

Cycle of hospitalization, frustration - Raleigh News and Observer

Johnnie P. Yarborough, 47, was admitted to state mental hospitals and drug and alcohol treatment centers 33 times between 1994 and 2006.

Nicholas Stratas, a Raleigh psychiatrist who reviewed Yarborough's state hospital records, said the cycle could have been broken at any time if community mental-health workers and hospital staff had collaborated to plan Yarborough's treatment after he left the hospital. State records indicate that Wake County and hospital staff met to discuss Yarborough only once, in 1994.

Stratas, a former official in the state mental-health office, reviewed Yarborough's files for The News & Observer. He said Yarborough was telling doctors, " 'I need to be kept somewhere away from drugs.' But he is largely dealt with as a different event every time he appears at the door."

Police took Yarborough to Dorothea Dix Hospital in the early years after he threatened to kill family members or himself. After a while, he started showing up at Dix on his own.

In 2006, when Yarborough was admitted to Dix and state drug treatment in Butner 15 times, his records show no face-to-face meetings between Wake staff or private providers and the hospitals. While Yarborough was at Dix, doctors adjusted his medications, but his days there were little more than brief layovers between bouts of drinking and drug use.

Yarborough had to find his own way out of Butner after he left May 31, 2006. He went to a bus station. He started using drugs again the day he left the treatment center. He returned to Dix 10 more times that year.

YARBOROUGH'S STATE HOSPITAL ADMISSIONS, 2006:

Dorothea Dix

Admitted, discharged April 9.

Cost for one day: $689

Dorothea Dix

Admitted May 4, discharged May 8. Cost for four days: $2,756

Dorothea Dix

Admitted May 10, discharged May 11. Cost for one day: $689

Dorothea Dix

Admitted May 14, discharged May 16. Cost for two days: $1,378

R.J. Blackley alcohol and drug treatment center in Butner

Admitted May 16, discharged May 31. Cost for 15 days: $11,400

Dorothea Dix

Admitted June 20, discharged June 22.

Cost for two days: $1,378

Dorothea Dix

Admitted June 27, discharged June 28. Cost for one day: $689

Dorothea Dix

Admitted June 28, discharged June 30.

Cost for three days: $2,067

Dorothea Dix

Admitted July 31, discharged Aug. 2. Cost for three days: $2,067

Dorothea Dix

Admitted Sept. 7, discharged Sept. 8. Cost for one day: $689

Dorothea Dix

Admitted Oct. 22, discharged Oct. 23. Cost for one day: $689

Dorothea Dix

Admitted Oct. 23, discharged Oct. 25. Cost for two days: $1,378

Dorothea Dix

Admitted Nov. 23, discharged Nov. 27. Cost for four days: $2,756

Dorothea Dix

Admitted Nov. 28, discharged Nov. 29 Cost for one day: $689

Dorothea Dix

Admitted Dec. 7, discharged Dec. 8. Cost for one day: $689

Cost of his 2006 treatment:

$30,003

Cost of his state treatment since 1994:

$90,046

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Serious mental therapy fades - Raleigh News and Observer

Reforms aimed to scale back the role of state mental hospitals. Now people with severe needs are left without care

Lynn Bonner, Staff Writer

Johnnie P. Yarborough, a Raleigh crack addict with bipolar disorder, was admitted to Dorothea Dix Hospital 14 times in 2006 for short-term stays that did nothing to improve his mental health.

His frequent hospital admissions came despite a new state goal of reducing mental patients' reliance on hospitals in favor of outpatient care. Under the new philosophy, he should have been helped in a treatment center -- and someone at Dix would have helped get him there.

But each time, he stayed at Dix a day or two, maybe three, before he was discharged to the street or to a homeless shelter.

He'd show up again, asking to be locked up. Doctors said he needed long-term drug treatment, but social workers couldn't help him find any.

North Carolina's 2001 mental-health reforms aimed to make its mental hospitals places of last resort and to have as many people as possible seek treatment near their homes.

But that new network of local help, provided by private companies seeking profits, is dominated by a service called community support, which sometimes is as basic as escorting someone to the mall.

People needing more serious care are often left to fend for themselves -- or have had to enter one of the overwhelmed state facilities that nearly everybody wanted to close or reduce in size.

Signs that reform has failed:

* Spending on community support has consumed 90 percent of community mental-health spending. Only 4.9 percent has been spent on more intensive outpatient therapy.

* Spending on traditional therapy offered by licensed counselors declined 12.4 percent between 2005 and 2007. State officials wanted to de-emphasize office-based treatment, but doctors and counselors say it's generally more effective than the community programs that replaced it.

* State psychiatric hospital admissions have increased, and more patients have used the hospitals for short stays, which stabilize patients in crisis but have less therapeutic value. In the 12 months ending in June, 8,805 patients, more than half of all patients discharged from state hospitals, stayed a week or less. Six years ago, less than a third of those discharged, 4,881, stayed a week or less.

* Mental-health admissions to hospital emergency rooms increased 6 percent this past July, August and September compared with the previous three months, according to a state report. Another study last year cited "anecdotal reports" that more people with mental illness, unable to get adequate treatment, are going to jail.

* The state Department of Correction said in August that over the past five years, there has been a "steady increase" in the number of inmates with severe and persistent mental disorders.

State Sen. Martin Nesbitt Jr., an Asheville Democrat who has been involved in writing mental-health laws for four years, said the 2001 restructuring was seriously flawed.

"I don't think the initial package had the thought that it needed," he said. "The details weren't there. And some of the assumptions that they made on how it would progress were faulty by their very nature."

In again, out again

Yarborough, 47, was a regular at Dorothea Dix Hospital. The Louisburg native was addicted to crack cocaine and had been diagnosed at different times with major depression and a mood disorder.

Since 1994, Yarborough has been in state mental hospitals and drug treatment centers 33 times, sometimes getting help but never getting well. He spent nine years bouncing among relatives' homes, homeless shelters, jail, halfway houses and drug treatment. In 2006, the frequency of his hospital admissions increased.

He would show up on his own at Dix or Holly Hill, a private hospital in Raleigh where he had been treated previously, asking to get in. Holly Hill usually sent him to Dix, where he would stay for a few days before being sent away.

During a one-day stay in September 2006, he told Dix staff that he wanted to go to a drug treatment program in Charlotte. The program took only Mecklenburg residents, but a hospital social worker gave him the program's telephone number and a bus schedule for the Queen City.

He didn't go. Back at Dix a month later, Yarborough fought his planned release.

"I knew it that it was only a matter of time that my depression and addiction combined together with the number of drugs that I was doing, that I was going to end up killing someone or being killed," Yarborough said, "and I was afraid."

Hospital social workers did make appointments for him at one treatment center and set up a meeting with county drug counselors, but Yarborough often failed to show up. He also met three times with a psychiatrist who worked for Wake County.

He was on his own to get to all his appointments.

A common theme

This is a fairly common theme. People with mental illness aren't easy to work with, and they need help to schedule and attend appointments and encouragement to take their medication. The new network of caregivers finds it difficult to spend enough time with many of them.

Laura White, team leader for the state psychiatric hospitals, said it's difficult for hospitals to develop detailed community-care plans for people admitted for short stays, many of them substance abusers.

"Our hospitals aren't the best place for some of these folks," she said.

Yarborough said he didn't get better until he accepted that he has bipolar disorder -- a diagnosis from years ago -- and understood how he used crack to ward off his depression.

He has been sober for a year and is living at the Raleigh Rescue Mission, a nonprofit that ministers to the homeless and addicted. He had been there before and went back on his own.

Through the mission, he has found help from a mentor and a doctor, and he's working at a construction job.

Good intentions

The 2001 law that changed the mental-health system was designed to allow North Carolina to take better care of people such as Yarborough. It took local governments out of the treatment business and made them responsible for monitoring private companies that offer counseling, education and other services.

The aim was to increase variety, let patients choose their counselors and limit office-bound counseling sessions in favor of serving clients in their homes, in homeless shelters, schools and other everyday settings.

As they handed work to private companies, most county and regional mental-health offices stopped offering psychiatric appointments and day treatment. Hundreds of companies rushed in to offer community support, for which they could charge up to $61 an hour and have employees with high school diplomas or GEDs do most of the work.

Many counties never found enough private companies to offer a variety of serious treatments, leaving some regions with little more than the most basic services.

Patients lose services

"We became a private-driven system all of a sudden," said Debra G. Dihoff, executive director of the National Alliance on Mental Illness in North Carolina. "We're reaping the consequences of it now."

The 2001 law focused on how the local mental-health offices were to do their jobs and who had authority over them. The law says little or nothing about what kinds of needs the area programs should meet, how much money they would need and where they would get it.

In the changes, patients lost access to therapists and the other professional services that community mental-health offices offered. Some mentally ill patients who had stable relationships with doctors and therapists under the old system ended up relying on charity.

Nancy Pace was one of them. Pace, 49, who lives outside Hendersonville, about 20 miles south of Asheville, has bipolar disorder and attention deficit disorder. She has depended on the state to pay for her care.

When the changes from the 2001 law were implemented, Pace's services ended.

She bounced from office to office. She decided to see doctors at a free clinic in Hendersonville. They checked to make sure she had the proper medication for about a year. The clinic recently referred Pace to a private provider, but she was reluctant.

"Some of the other agencies, if you don't need and you don't feel like you want community support and case management, they don't want to serve you," Pace said.

Local office directors say they need: teams of doctors, nurses and therapists who will work with severely mentally ill adults; places for emergency mental-health treatment; psychiatrists; and drug detox.

Patients have lost places such as a clubhouse in Jacksonville where they could socialize with others and perform simple tasks.

Jessica Stone, who has paranoid schizophrenia, once belonged there. Her father, Jim Stone, said being around others helped his daughter realize when her symptoms were getting worse.

But the clubhouse is gone, a victim of the reforms. Stone, 32, now relies on community support to navigate life outside hospitals. She gets 15 hours a week with a worker who helps her adjust to community life.

Community support may not be exactly what his daughter needs, Jim Stone said, but it's the only service available.

"It didn't take long to get rid of all these services," he said, "and nothing has come to take their place."

Money goes unspent

The system is so tangled that even as patients struggle, local mental-health offices often fail to spend all the money the state gave them to treat patients.

Medicaid, federal insurance for the poor and disabled, is considered an entitlement, so if a resident qualifies for care and can find it, it's covered. With patients who rely on state payments, getting care is more complicated.

To get state money for treatment, the providers get permission from the county or regional office where the patient lives. Providers say it takes too long for the local offices to approve treatment and pay for it.

People looking for care can get pinched for two reasons:

* Because state money is limited, the local mental-health offices ration care. For example, a doctor may recommend six therapy sessions for a patient, but the local office may approve three.

Last week, the local office that covers New Hanover and two other counties said state-paid patients who do not need urgent care will be put on a waiting list. The region is running out of state money.

* Also, in some areas, there aren't enough service providers. Last year, $18.5 million in state money for mental-health programs went unspent, along with $3.8 million for substance abuse. Nearly $10 million in federal money for substance abuse was left over, as was $2.5 million for mental health.

Regional mental-health offices spent about 85 percent of their treatment money last year.

"We were spending out the wazoo on Medicaid, but we had a lot of state money that was going unspent," said Leza Wainwright, deputy director of the Division of Mental Health, Developmental Disabilities and Substance Abuse Services.

Legislators who had fought for more state money for mental health were baffled that local offices were giving it back.

"We realized we've got a pretty severe shortage of providers in a whole lot of the state that we've now got to rebuild," said Nesbitt, the Asheville senator.

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Parents Tell of Church Shooter's Anguish - Denver Post

By ERIC GORSKI

DENVER

A young man who killed four people at a church and a missionary training center had attention deficit hyperactivity disorder and harbored bitterness for being an outcast, his parents said in their first extended comments.

Matthew Murray however gave no indication he was about to explode in violence, they said in an interview to be broadcast Thursday and Friday on James Dobson's Focus on the Family radio program.

Although Ronald and Loretta Murray have issued statements to the media, the devoutly Christian couple gave Dobson their first public impressions of what led their 24-year-old son to go on his rampage in December.

Focus on the Family provided an advance copy of the broadcast to The Associated Press. On the program, the Murrays met David and Marie Works, the parents of two sisters who their son had killed. The Works forgave the Murrays.

Murray killed two people at a Youth With a Mission training center in suburban Denver, slept in his own bed at his parent's house that night, then drove 60 miles to Colorado Springs, where he killed the two sisters.

An autopsy concluded that he shot and killed himself.

In a portion of the interview cut from the radio show because of time constraints, Loretta Murray said her son called cousin in Utah shortly before the training center shooting, "pouring out his heart" about how depressed and lonely he was.

According to interviews and Murray's own Internet postings, Matthew Murray was a disturbed young man in search of belonging. He dabbled in the occult, briefly joined the Mormon church and turned against charismatic Christianity.

The Murrays said their son had problems communicating and writing because of his ADHD, was brilliant at computers, and felt rejected and marginalized, unable to forgive his perceived tormentors.

"The lesson is that unforgiveness leads to this bitterness and then opens you up to the spirit of Satan, to the spirit of whatever, and when that occurs, it becomes a power that people cannot control," said Ronald Murray, a neurologist.

Murray said that his son "had never expressed a desire for violence toward anybody," and that neither he nor Matthew's mother knew he owned weapons.

"He was told he was loved every day," Ronald Murray said.

In a statement to The AP, a Murray family spokeswoman Casey Nikoloric said Matthew was diagnosed with ADHD between ages 4 and 5 and began taking Ritalin at 5.

At 19, he decided to "stop all medications due to side effects" such as weight loss, drowsiness and grinding his teeth at night, and as far as his parents knew Matthew wasn't taking medication at the time of the shooting, the statement said.

Prescribing drugs such as Ritalin to treat ADHD, especially in young children, is controversial.

A year ago, the Food and Drug Administration asked ADHD drug manufacturers to develop guidelines to alert patients to "possible cardiovascular risks and risks of adverse psychiatric symptoms associated with the medicines."

Russell Barkley, a South Carolina psychologist who specializes in ADHD research, said the drugs, if taken regularly, reduce aggression and anti-social behavior.

Barkley said one study he conducted showed that 22 percent of people found as children to have ADHD had carried out an assault with a weapon by the time they reached adulthood.

"It's a sad situation, but I doubt that ADHD alone was the sole contributing factor to the violence," Barkley said, adding that other factors, such as low self-esteem and victimization, can contribute to outbursts.

Matthew Murray attended school for kindergarten and first grade but could not focus or pay attention, so the family decided to school him at home, Loretta Murray said.

Internet postings believed to have been written by Matthew rage against the strict biblical curriculum his parents used. But Loretta Murray said Matthew chose each year to continue home schooling.

In the statement to The AP, the Murrays' spokeswoman said Matthew wanted to be homeschooled, passing on the chance to attend "regular school," and talked just a few months ago about enjoying homeschool.

The night before the shootings, Matthew told his parents he was going out with friends for his birthday. The cousin called Loretta Murray just before midnight to tell her about Matthew's emotional state. She asked her husband to call him.

When Ronald Murray reached his son's cell phone at 1:15 a.m., Matthew said he was eating at a restaurant with friends and was coming home. He had just shot and killed two people at the Youth With a Mission center in Arvada.

The next morning, Matthew appeared fine, and his mother told him to be careful driving in the snow. Later, Matthew went to the New Life Church parking lot and fatally shot sisters Stephanie, 18, and Rachel, 16, and wounded their father.

In the Focus on the Family interview, Stephanie's twin sister, Laurie, told the Murrays that as she cowered in the family's van, she forgave the shooter.

"Your loss is more than mine," she told the Murrays.

Her father, David Works, said forgiveness was simply part of the Christian walk.

"Without forgiveness," Ronald Murray said, "I don't think we could have moved on."



Copyright 2008 Associated Press. All rights reserved. This material may not be published, broadcast, rewritten, or redistributed.

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E.R. To Open In March - Hartford Courant

By JOSH KOVNER

MIDDLETOWN —

Middlesex Hospital's new $31 million emergency department — 18 months in the making and more than four years in the planning — will open the week of March 24.

The new wing was designed to handle a patient caseload that has jumped nearly 50 percent in the last decade. It will be three times the size of the hospital's nearly 40-year-old emergency room — known for cramped quarters, lines in the waiting room and patients strapped to gurneys in the hallway.

On the south side of the new complex, overlooking Sumner Brook, a new helipad sits next to a wide concrete entrance ramp exclusively for ambulances. Patients and visitors can walk or drive up to the main entrance off Crescent Street. Drivers can continue down a ramp into a new 70-space parking garage underground and take the elevator up to the large new waiting room, lined with six triage rooms.

The four-story wing reaches toward Main Street Extension, capped by a circular tower that reflects some of downtown's architecture. More than 400 guests — elected officials, fire and ambulance personnel and donors — are expected at a reception March 6. An open house for the staff is set for the next day.

During a tour this week of the old space and the new, hospital CEO Robert Kiely spoke of improved patient comfort and privacy and better, swifter access to radiology and diagnostic imaging. He spoke of bedside registrations and an efficiency that wasn't possible in the old quarters. The hospital's current emergency room, built in 1969, handled 26,000 patients a year in the mid 1990s. In 2006, 40,000 people came through the doors from the 20 communities served by the hospital. The new department will serve 60,000 patients annually with ease.

"This will touch so many people in our community in a very direct way," Kiely said.

In the emergency room, already bustling in the early afternoon, Kiely paused by an alcove off a short hallway, with several beds. It's the psychiatric treatment area, where the staff responds to an increasingly complex group of patients. It's not uncommon for teenagers with substance-abuse and emotional and mental-health problems to languish here for 10 or more days, waiting for a bed to open up in the state's overloaded treatment system.

The new department will have a separate psychiatric emergency room three times the size of the alcove space, with eight large rooms.

There's also an express care center that can deal with minor medical problems — sports injuries, cuts, bruises and breaks — in an hour's time.

The staff can't wait to get into the new area, said Jacquelyn Calamari, head nurse in the emergency department.

Nurses, doctors and social workers are excited to work in an airier, more modern setting, she said. Many of the staffers were part of the planning process — helping with equipment placement and determining the size and location of work stations and patient rooms — and they want to see how it all worked out.

"We've been so overcrowded for so long," Calamari said. "They're happy to know there'll be no more patients in the hallways. I'm just so proud of people like [nursing manager] Jackie Nelson, who've worked so hard on this new E.D."

To help plan the new department, Calamari and Dr. Michael Saxe, chairman of emergency medicine, visited emergency rooms in Massachusetts, Orlando, Seattle, Detroit and throughout Connecticut. They studied emergency room design at Harvard seminars; then they weaved in input from the hospital staff.


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Disaster aid for disabled stirs worries - Boston Globe

But state officials note renewed commitment
By Connie Paige

During the 2006 Mother's Day flood, city workers in Lowell had to call around to find fresh clothing for nursing home evacuees. A failure to stockpile changes of underwear was just one of many shortcomings in disaster planning that have prompted a top-to-bottom review ever since.

But in Lowell and across the state, officials continue to face obstacles planning for the elderly and disabled during disasters. Confusion remains about the relative responsibilities of state and local authorities - a problem complicated by a shortage of funds.

Dogs and cats seem to have received more attention from the state's emergency management officials than people with disabilities, according to an advocate who has prodded various agencies for two years to develop emergency plans for those with special needs.

"There is progress," said Bill Allan, executive director of the statewide Disability Policy Consortium. "Is it enough? No. Are we any better off now than we were two years ago? I doubt it."

As the US Centers for Disease Control and Prevention concluded in a report issued last week, big challenges remain in emergency readiness nationwide. In Massachusetts, officials from three agencies that deal with it - the Massachusetts Emergency Management Agency, known as MEMA; the state Department of Public Health; and the state Office on Disability - point to a renewed commitment to disaster planning under Governor Deval Patrick, with attention to the needs of the disabled.

"In the last year or so, we certainly have jumped in with both feet," said MEMA spokesman Peter Judge.

Tom Lyons, spokesman for John Auerbach, the state public health commissioner, acknowledged that the state probably had not done enough in the past. "We're trying to change that," Lyons said. "We're trying to adjust, and refocus our efforts to make sure we're doing the right thing."

But local officials and advocates bemoan the absence of clear statewide guidelines for aiding the disabled during disasters. Local officials have tried to cobble together their own plans, but many come up short.

Concord Fire Chief Kenneth Willette, leading a townwide effort to include the disabled in the local emergency plan, said the first step is drawing up a registry of residents with special needs. But this is not as simple as it might seem.

Obviously the list should include "folks with limited mobility, folks with limited cognitive ability," Willette said. But do you incorporate people with limited English-language ability? Children with autism? All the elderly?

And once the disabled are identified, the community may need a specialized communication system to reach them during an emergency, he said. Then there is the difficulty, and expense, of equipping emergency shelters to adequately care for some of the disabled, such as those requiring a ventilator or kidney dialysis.

"Those folks really need electricity, they need to have their medical equipment with them at all times, and, in some cases, they need to be able to . . . remove the waste products," Willette said. "That's a challenge."

Providing specialized transportation, supplies, medicines, bedding, and personal care assistants for the disabled also can prove taxing, he said.

In view of the hurdles, including the strain on budgets, officials stress that the disabled should exercise personal responsibility, and that caretakers for the disabled should have backup plans.

"No community is going to be able to pick up all the disabled people and take care of them, said Leo Saidnawey, Belmont's emergency management director. "Just like [the] able-bodied, they're supposed to be prepared."

Lexington Fire Chief William Middlemiss said the trend toward fulfilling some needs is to go regional instead of local.

"We're trying to break down the governmental lines," said Middlemiss, chairman of the Battle Road Regional Emergency Planning Committee, which includes Arlington, Bedford, Belmont, Burlington, Lexington, and Medford. "If a disaster ever happened, it's going to affect populations in neighboring communities."

But when the community or the region lacks resources, officials also can turn to MEMA, said Frederick Tustin, a Winchester Fire Department captain and chairman of the Mystic emergency planning committee covering Medford, North Reading, Reading, Stoneham, Winchester, Woburn, and beyond.

Myra Berloff, director of the Office on Disability, said help is also available from her agency. She said that under the 1990 US Americans with Disabilities Act, the state is required to address needs, and she has set in motion programs to convince state and local emergency officials that they must and can fulfill those needs.

"Where we started two years ago with distrust and dissent, we now have cooperation and understanding," Berloff said. "We have come 180 degrees, from being adversaries to being partners. It has been quite a journey. Are we perfect? No. Are we working toward being better? We sure are."

Next month, for example, Medford will host a forum for the city's disabled and first responders sponsored by the disability agency, following one in Chelmsford this month.

Diane McLeod, Medford's diversity director, serves as coordinator for 20 similar forums to be held by June across the state. She said booklets will be distributed to emergency officials to help them cope with nine categories of people with disabilities, including seniors; people with service animals; those with mobility, hearing, or vision impairment; and those with cognitive disabilities, chemical sensitivities, autism, or mental illness.

Berloff said she hopes to extend the forums to other communities if she can obtain state underwriting grants.

While acknowledging state and local budgets are stretched thin, Berloff said, "Not everything costs money."

For example, she said, shelters can be prepared for the disabled who are in wheelchairs simply by adding a ramp, and people on ventilators need only to have a plug to power them.

"A lot of it is a mind-set," Berloff said. "The biggest obstacle is lack of knowledge or understanding."

Moreover, she said, the disabled should prepare for disaster by stockpiling necessities such as medication, and determining ahead of time where they might go for assistance beyond what a shelter can offer, such as a local hospital or nursing home.

Berloff said a forthcoming report will include recommendations earmarking which improvements cost nothing and which will require an infusion of cash.

In February 2006, Berloff spearheaded a gathering of about 200 state and local emergency planners, officials from MEMA and public health, and people with disabilities, who undertook the task of detailing gaps in disaster preparations. The report is being developed by task forces focusing separately on registration, personal preparedness, communication, evacuation and transportation, and sheltering of the disabled.

Lyons said he believes the report will help usher in a new sense of responsibility toward the disabled during emergencies. "We have to narrow our focus to the people who need it the most," he said.

Judge said MEMA officials hope the report will clarify the chain of command in a disaster. He said the agency has hired an accessibility and inclusion planner to help sort out goals.

Still, some remain skeptical.

Frank Singleton, Lowell's health director, said he is still frustrated - more than six years after the terrorist attacks on Sept. 11, 2001, and almost two years after the Mother's Day flood - about emergency planning for the disabled.

Singleton said a recent decision to use the University of Massachusetts at Lowell as one of three regional emergency shelters around the state shows how the best of intentions can get mired in interagency wrangling.

Authorities have estimated that of the 5,000 who might flock to the Lowell shelter during an emergency, about 500 might have disabilities, Singleton said. But, he said, local, regional, and state officials are struggling with questions about who would use the shelter, who would bankroll it, and who would stock it with necessities - while providing for the needs of the disabled.

"My first question, which has been asked over and over again, is, who is in charge?" Singleton said. "Is it the hospitals, is it the city of Lowell, is it UMass-Lowell, or is it MEMA?" Singleton said that question has not been answered.

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Allowing the Mentally Ill a Life of Their Own - Washington post

Supporters Say Patients Prosper and State Reduces Hospital Beds in Strictly Supervised Program

By Chris L. Jenkins

Rafael Rivera sat comfortably in his neat, modest apartment off Route 1, talking to his caseworker, Carlos Estrada. Seated nearby was Parnell Cornet, a psychiatrist.

"So we're going to get you a job in the coming months, right? Looks like you're almost ready to work again," Estrada said, looking around the apartment.

Rivera nodded and replied in Spanish that he was ready. He had just moved in to the apartment, and he was eager, at 56, to start a new life.

"Well, we're going to do everything we can to make that happen," Estrada said. "It's up to you."

Rivera has lived with bipolar disorder and other mental illnesses for nearly 40 years. He was in a state institution for several weeks, hoping to recover from the debilitating confusion and illness that prevented him from taking care of himself. He had been left by a longtime companion to fend for himself in the fall, Estrada said, and soon a friend had Rivera taken to a hospital.

The daily one-on-one contact by Estrada and Cornet is part of an intensive program to help the severely mentally ill such as Rivera live on their own. The state-funded Program of Assertive Community Treatment seeks to move those with serious and persistent mental illnesses back into their communities and support them with round-the-clock services to help them be self-sufficient.

"The doctors in the hospital, they wanted to control me," Rivera said in Spanish with Estrada translating. Living outside, he said, allows him to "look for a future."

The PACT program was developed in Wisconsin 35 years ago and is considered one of the most effective ways to help those with significant mental ailments live outside of hospitals and within the broader society. Many mental health experts consider the program the next chapter in the decades-long effort to move people with mental illness out of institutional settings by giving them the structure they need. Supporters often call the programs "hospitals without walls."

"It gives people who have these illnesses a chance to live [with] some kind of normalcy," Estrada said, as he left Rivera's apartment. "We give them the opportunity to control their own life. We're just here to help."

Many of the participants in the program include people who have frequent episodes of very severe symptoms that are difficult to manage or who suffer from symptoms that never go away.

Their condition means they often have spent extensive time in hospitals or living on the streets. They often have abused drugs or alcohol or have been in trouble with the law.

State records show that about 77 percent of state clients in the 16 PACT programs throughout Virginia have schizophrenia. The majority have come from state hospitals after an average five-year stay.

Across Virginia, the programs are hailed for helping mentally ill people stay out of hospitals permanently. Virginia used 1,517 beds in mental health facilities last year, 107 fewer than the year before, according to state statistics. In addition, more than 85 percent of the state's 1,487 PACT clients were reported to be in stable housing last year and had not been arrested.

"The model is that we allow the client to be the center of the treatment," said Jean Hartman, director of Fairfax County's program. Arlington County also has a program.

As with most programs that seek to help the mentally ill, PACT is controversial. Although the National Alliance for the Mentally Ill calls the program "highly effective," others have concerns.

Some critics say that PACT teams rely too heavily on medication and do not offer enough long-term alternatives.

"We want to have a life of richness and meaning, and in many cases, these teams aren't going beyond making sure that people take their medication or are trying to help them get some low-level job," said Diane Engster, president of the Northern Virginia Mental Health Consumers Association, an activist group based in Fairfax. "They say they are consumer-centric, but that has to be more than just rhetoric."

Other activists, who push for giving states the power to force some mentally ill people into treatment, said that the program's potential benefits are limited because in many states, including Virginia, officials cannot force treatment, even if it has been court-ordered.

What differentiates PACT from conventional mental health programs is the size of the support team. The PACT team is usually 10 to 12 practitioners -- psychiatrists, nurses, mental health professionals, employment specialists and substance abuse specialists. Teams can include a mentally ill person in recovery who can share experiences or a family member of a mentally ill person.

The Fairfax team's day starts with a group discussion about each client. Hartman calls out each name, and either a nurse, caseworker or psychiatrist will update the group about how that person is doing.

Rather than having clients come to an office or clinic once or twice a month, team members arrange their schedules around the clients' needs. This often means outreach workers visit and spend time with their clients every day, making sure they have taken their medication and gone to their appointments. Team members also counsel clients about issues in their lives.

Virginia started its first program in 1999 and has slowly funded additional programs. Part of the reason for the incremental pace is the cost. Because each program maintains a ratio of one client to 10 staff members, each PACT team costs about $1 million a year. A team's caseload cannot exceed 100 clients.

Some mental health programs limit how long a client can receive services. PACT has no such limit. The team is there for as long as the client needs it.


Mike Yankey and Raymond Reese are roommates who live a short drive from Rivera. They are able to get on a bus and make their way around, but on a recent morning visit, they are not as able as Rivera to engage in conversation or articulate their needs.

They have shown progress, however, in being able to live on their own and care for themselves. And they can appreciate life's simple but important pleasures found outside of a hospital.

"Being able to eat your own meals, eggs, meats, stuff like that; it's better than being in a hospital," Reese, 45, said. "I like the freedom."

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Weaving a Tapestry of Purpose and Hope - Washington Post

Program Gives Adults With Cognitive Disabilities a Chance to Keep Their Days, and Fingers, Productive

By Jerry Markon

On the second floor of the Ballston Common Mall, Laurie Shanti Pippenger is sitting at a wooden loom and looking rather confused.

She is trying to weave a place mat, but strangers have interrupted her routine. She tries to review her instructions, written on a piece of paper taped in front of her.

"I think you're lost," says one of her helpers.

"I am," Pippenger says.

But then Pippenger, 31, smiles brightly, adjusts her thick black glasses and rolls up her sleeves. She grips a boat-shaped device and passes it between two layers of yarn, creating a pattern. She presses a pedal on the floor, lifting a metal shaft that holds the strings. Her motions become smooth, almost effortless.

"Once she gets in the groove, once she starts doing it, she just sort of gets in the flow," says Sharon Raimo, chief executive of St. Coletta of Greater Washington, a nonprofit group that works with children and adults who have mental disabilities.

"I love this work," says Pippenger, who has Down syndrome. "It makes me feel so wonderful to be here."

Pippenger works in a studio that is also a storefront, next to Macy's Home Furniture Gallery. It is the home of the Woodmont Weavers, a program that allows adults with cognitive disabilities to make gainful use of their days. They do that by weaving products such as place mats, purses and expensive tapestries and selling them at the store.

"There's an Irish blessing that says, 'May there be work for your hands to do,' " Raimo says. "I think that's a great thing, and that's what it gives these people. When they get up in the morning, they have something to look forward to. It gives them purpose.''

St. Coletta runs the program, which it took over from Arlington County in 2006. The program began in 1988 at the Woodmont Center in Arlington as a day program for people with disabilities. It was initiated by parents of adults at Woodmont who had mental retardation and other developmental disabilities, said Joanna Barnes, mental retardation and developmental disabilities coordinator for the Arlington County Department of Human Services.

"At the time, there was a real dearth of day activities for adults with disabilities once they left special education in school," Barnes said. "The parents got together and wanted to have a meaningful day program, and weaving was one way to make productive use of their adult children's days.''

The weavers moved to the mall in 2002. This is among an estimated 150 therapeutic weaving programs in the country, county officials said. Adults with disabilities also do other activities based in part on where they live, such as putting together small automobile parts in Michigan and stuffing envelopes in the District.

"We like to offer them the same range of choices as everyone else," Barnes said.

Raimo said weaving is a soothing activity for people with a range of mental disabilities. "It's really good for people, particularly those with autism, because it's predictable and repetitive, and they find it calming," she said.

Inside the Woodmont Weavers store one day last week, , that appeal was evident. Ruth Evans, 72, sat at her loom and calmly weaved a green napkin, a special order for a customer. The 10 weavers are well known in the mall and to their regular customers, who drop in to visit and place orders.

In the front of the store, which is shared with two artist co-ops, a range of woven items were for sale: $1 coasters, $25 purses and a tapestry of a swan for $300. The weavers choose their own colors and patterns, and several even thread their own looms. Three St. Coletta's staff members, several of whom can weave, help the weavers and manage the program.

"I love it. I love coming here," Evans, of Annandale, says slowly. Asked why she loves weaving, Evans smiles and cracks: "I get paid for it.''

The weavers are paid salaries. Officials would not specify the amount, but Evans said it's enough to buy the coloring books and children's picture books that she loves reading.

Andrea Blackmon, who coordinates the program for St. Coletta, said the weavers -- who mostly live in Arlington with family members or at group homes -- arrive weekdays about 8:30 a.m. They sit at a table and drink coffee together and then get to work on one of the more than 20 looms in the store, taking occasional breaks. They are picked up by 3 p.m.

Their ability and desire to communicate can vary. Pat Loustalot of Arlington tells a visitor: "I just like weaving. That's all." She wouldn't comment further or reveal her age.

Wes Koehne, 42, of Fairfax County can't speak. But that hasn't stopped him from weaving tapestries of ducks and cranes, several of which line the walls of the store.

The affection between staff members and the weavers is clear. A weaver named Teresa, who would give only her first name, spent several minutes hugging the staff members and then a photographer. "I love you," she tells them all.

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Forgotten Birthday Boy Sentenced - Associated Press

BRISBANE, Australia (AP) -- A man who held police at bay during a 12-hour siege because no one phoned on his birthday was sentenced Thursday by an Australian court to six months in prison.

Ashley Martin Hurst, 32, pleaded guilty in the District Court of Queensland state in the east coast city of Brisbane to charges including going armed in public to cause fear.

Hurst brandished knives and taunted police to shoot him at a house in Ipswich, west of Brisbane, on June 22, 2006 -- his birthday.

Judge Helen O'Sullivan said Hurst deserved a prison sentence because he had distressed police.

''I'm told the reason you did this is no one rang you on your birthday,'' Judge O'Sullivan said.

''Those who threaten police officers must expect custody,'' she added.

She acknowledged Hurst had a history of mental illness and drug and alcohol abuse problems.

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Benton would support legislation to report deaths - Raleigh News and Observer

By Pat Stith, Staff Writer

Dempsey Benton, secretary of the N.C. Department of Health and Human Services, said today that he would support legislation that would require all deaths in state psychiatric hospitals and other facilities operated by his department be reported to the Office of the State Medical Examiner.

"I don’t have any problem with that," Dempsey said during taping of a News & Observer/WRAL-TV program "Headline Saturday." "I think we do need to do a better job with reviewing those tragic situations and making sure that how we operate is known and understood by the public."

State law requires that all deaths of people in police custody, jails or prisons be reported but there is no requirement that "natural" deaths in psychiatric hospitals be reported.

The N&O will report on Sunday, in the last of a five-part series "Mental Disorder: The Failure of Reform," that state hospitals had labeled some deaths as natural that were actually the result of a patient being improperly medicated or choking on food.

The interview with Benton will be broadcast Saturday at 7 p.m.

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Mental-health disclosures will not be required -Arizona State University Web Devil

by Matt Culbertson
February 26, 2008

After officials said last week ASU would consider requiring students to disclose mental health histories, the University clarified its position Friday and said no such policy is under consideration.

According to a media advisory statement from ASU's Office of Media Relations issued on Friday, "ASU is not requiring — and will not consider requiring — such disclosure."

In an e-mail on Monday, ASU spokeswomen Leah Hardesty said, "We were never considering [mental health] disclosure."

Hardesty added that the campus safety recommendations following the Virginia Tech shootings "were misinterpreted, thus we distributed the media advisory to give clarification."

Hardesty did not respond for further comment or clarify how the information was misinterpreted, directing all questions to the media advisory.

In the advisory, Hardesty said that ASU was looking at recommendations in six reports on campus safety published after the Virginia Tech shootings.

These reports include looking at whether restrictions in the Family Educational Rights and Privacy Act, or FERPA, and the Health Insurance Portability and Accountability Act, or HIPAA, both federal laws, prevent school officials from receiving information, she wrote.

However, no recommendations in the reports would have required students to disclose their mental health histories, Hardesty said in the advisory.

ASU President Michael Crow told The State Press on Wednesday that ASU currently has a policy in place that allows faculty and administrators to share information about "manifested, observable" behavior in students, if they think the behavior could lead to a threat to campus safety.

But the policy would not be altered to require disclosure of mental health histories, he said.

"Our policy is directed at verbal, demonstrative behavior," Crow said.

After The State Press reported on the policy consideration on Feb. 19, media organizations including The Arizona Republic, The East Valley Tribune and The Associated Press wrote stories about the issue, and editorials in the Tribune and The State Press which were critical of the alleged policy.

Following news reports of the possibility that ASU would require mental health disclosure, the Mental Health Association of Arizona scheduled a meeting this week for a possible position statement, said MHAA Executive Director Ann Marie Berger.

Even if ASU is not requiring students to disclose their mental health history, Berger said the board of directors of MHAA would meet Thursday to discuss whether to issue a statement on the subject of how universities should handle students' mental health.

"We need to make sure that every individual can seek help and treatment," Berger said.

The MHAA board could recommend that universities require students to receive health physicals and possibly mental health evaluations, Berger said.

But the association is opposed to any invasion of medical privacy, she added.

One in four individuals have mental health problems, such as depression or schizophrenia, and one in three families are affected by mental health issues, Berger said.

The State Press's Dan O'Connor contributed to this article.

Reach the reporter at matt.culbertson@asu.edu.


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Man shot by police naked, raving -Clarion (MS) Ledger

Richard Lake
rlake@clarionledger.com
February 26, 2008

Derek Johnson died naked, convinced that he was God and screaming that the world was about to end, according to interviews with police, his family and the man who called the cops on him.

"He was a mental patient," said Derek's brother, David Johnson, who is angry that the police portrayed his brother as an armed burglar. "He was naked and screaming that he was God."

Flowood police shot Derek Johnson, 32, to death about 9:30 p.m. Sunday in a grassy field outside his apartment in the Woods of Lakeland apartment complex, a 236-unit complex at Old Fannin Road and Flowood Drive.

Derek Johnson is the seventh man to die in the metro area in the last 14 months during or after an encounter with law enforcement, including two who died after officers used a Taser.

David Johnson, who lives in Florida, said his brother had a history of schizophrenia and occasionally had delusional episodes when he did not take his medication.

He may have been having one Sunday night.

Flowood Police Chief Johnny DeWitt said two officers responded to the complex after a frantic 911 call reporting that an armed man was trying to break into an occupied apartment.

The officers, whom the chief called veterans but would not identify, chased the man around to the back of the building.

There, the chief said, the man came at them with a knife. One of the officers shot and killed him.

When told that others had described the knife as a box cutter, the chief said, "Some people might call it a box cutter."

"It was a sharp, bladed instrument," DeWitt said. "The officers felt their lives were in danger and made the decision to use deadly force."

John Hillhouse, who'd lived next door to Derek Johnson since September, made the 911 call.

He acknowledged he probably sounded frantic on the phone and said he told the operator that Johnson was mentally ill.

He called Johnson a casual acquaintance whom he'd never seen act violently. He said in casual conversations Johnson had acknowledged to him that he had schizophrenia.

Johnson worked at the nearby Back Yard Burgers on Old Fannin Road, Hillhouse and other neighbors said. He had previously worked at a nearby Shell station.

Hillhouse, 22, said he used to lend Johnson money now and then or give him a ride to the post office when he needed it.

He said the situation Sunday started about 9 p.m. when he heard yelling outside his apartment. He figured it was just someone arguing and that it was none of his business. But it persisted, so he stuck his head outside to see what was going on.

He saw Johnson out there, naked, screaming that Armageddon was coming.

Right about then, Hillhouse said, his sister arrived. He ushered her into his apartment, and Johnson tried to get in.

Hillhouse dialed 911. He said he tried closing the door on Johnson while on the phone with the police, but Johnson was able to sneak an arm inside. He had a box cutter in his hand.

He finally got the door closed about the same time the police arrived, Hillhouse said.

He did not hear the gunfire.

Neighbor Barbara Miller did.

She said she'd heard the yelling but had no idea what was going on.

Then, "just pow pow pow pow pow," she said. "Real quick."

David Johnson said his brother had been a patient at the Mississippi State Hospital at Whitfield, the state's mental hospital, more than once.

Derek Johnson had been arrested in June after a traffic stop, the only arrest on record in Rankin or Hinds counties. He was charged with possession of drug paraphernalia, lack of car insurance, improper equipment and failure to dim headlights.

Disposition of those charges was not immediately available.

Johnson's brother called the police overzealous in the shooting.

"The cops were fully aware this was a mental patient," he said. "They didn't have to kill him. This was a naked, schizophrenic man with a box cutter.

"The whole thing makes my blood boil."

DeWitt defended the officers, saying things happened so quickly that they simply reacted the way they are trained to do. Public perceptions that officers can shoot a man in the leg are far from reality, he said. He did not know whether the officers were armed with Tasers.

"When an officer pulls his weapon," DeWitt said, "he has made a decision to use deadly force. We're not trained to shoot in the leg or anything like that. They're trained to stop a threat."

The officers involved are on paid leave while the investigation continues. As is routine in deadly police shootings, the Mississippi Bureau of Investigation is handling the case.

Rankin Ledger staff writer Mark Bonner contributed to this report.
To comment on this story, call Richard Lake at (601) 961-7226.
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Former Rosewood Residents Thank Gov. For Closing It - WBAL-TV Baltimore

February 26, 2008

ANNAPOLIS, Md. -- Former residents of the old Rosewood Center for the developmentally disabled thanked Gov. Martin O'Malley with yellow roses Tuesday for his decision to close a facility where safety problems have been well-documented.

While many cheered the governor's decision to close the center last month, some families have expressed frustration and concern about how they will care for loved ones who have never lived anywhere else.

O'Malley said the state won't allow anyone to "slip through the cracks."

"Knowing what many of our families will face in moving their loved ones to new communities, it's a scary thing for a lot of people, and with that in mind we're going to be going through a process of transition with each resident and their families to ensure that their needs are met," O'Malley said.

Anna Burkett, a former Rosewood resident who now lives in Annapolis, was one of several former residents who attended to thank the governor.

"I want to thank you, Governor O'Malley, so much for closing Rosewood and letting the people be free in the community," Burkett said.

The long-troubled facility will be closed over the next 16 months to give state officials ample time to find better settings for 156 residents who live there. Reports of alarming problems with resident care at the Baltimore County facility prompted the governor to close a center that was established in 1888 as the "Asylum and Training School for the Feeble Minded."

Reports have documented mistakes in medication and feedings for profoundly retarded residents. A state report concluded problems were continuing, despite repeated warnings and state sanctions.

Department of Health and Mental Hygiene Secretary John Colmers pledged that the state's commitment to helping the residents find new homes "will continue long into the future."

Since O'Malley announced plans to close the facility, the state has created an advisory committee to help families. So far, there have been two general meetings with families, and the state will start holding individual sessions for planning soon. Colmers said a newsletter was sent out last week to families to keep them informed about the developments.

About 40 residents have been identified to move into communities this fiscal year, Colmers said.

"The next 16 months will be challenging for all of us," Colmers said. "As difficult a decision as it was to recommend closure of Rosewood, I remain convinced it was the right thing to do."

About $20 million has been put in the fiscal year 2009 budget to pay for the closure and transitions.

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Revere suspect in mom killing has record of violence, mental illness - Boston Herald

By Jessica Fargen and Mike Underwood
Tuesday, February 26, 2008

A 23-year-old Lynn man who police shot and wounded after he allegedly stabbed his mother to death in a Revere apartment has a history of violence and schizophrenia and once told court officials he hears voices, according to court records.

Cory Roche, who is scheduled to be arraigned from his hospital bed this afternoon, was shot in the torso by a Revere officer who raced to 35 Ferndale Ave. after reports of a stabbing yesterday afternoon.

Revere police say they shot Roche in self-defense after he refused to drop the blade he allegedly used to slay his own mother, 42-year-old Lisa Bryson Roche.

When police burst into the first-floor apartment, they found Lisa Bryson Roche with multiple stab wounds, Suffolk District Attorney Daniel F. Conley said.

Both Cory Roche and his mother were rushed to an area hospital. Lisa Bryson Roche was pronounced dead on arrival. Cory Roche is at Massachusetts General Hospital recovering from a gunshot wound. He is charged with murder.

Roche has a criminal record dating back to his teens when, according to court records, he was homeless, living in Revere and beating people up. According to records at Chelsea District Court:

In June 2004, Roche was arrested for trying to break into a car on North Shore Road in Revere and flashing a knife at the car owner. He pleaded guilty to those charges and was given probation. A notation on a mental health evalauation from that case reads Roche, “hears voices in head” and indicates that Roche takes prescription medication for schizophrenia.

In August 2004, Roche was part of a group of thugs who attacked a man on a Revere street and kicked him until he was unconscious. When a passerby stopped to help the victim, the group of teens knocked her to the ground and starting kicking about her head. For that crime, Roche was sentenced to 2 years in jail and ordered to undergo a psychiatric evaluation.

In 2006, he was committed to Bridgewater State Hospital after an arrest for a probation violation. He has also been arrested for possession of Ritalin pills, unarmed robbery and drinking in public. He has been homeless and lived in Charlestown and Lynn in recent years.

It’s unclear what Roche was doing at the Revere apartment yesterday afternoon.

Neighbor Kristy Gensel, 26, who has lived on the building’s third floor for three months, said she did not know Roche or his mother, but said they seemed “like a regular family.”

“I’m shocked,” she said.

Revere police and state police detectives are investigating the killing. Last night police sealed the building pending a search warrant.

Roche’s family members could not be reached for comment.

When asked yesterday if the Department of Social Services had any current or past involvement with Cory Roche or Lisa Bryson Roche, spokesman Richard Nangle said only the agency does not comment on criminal investigations.
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Bipolar disorder shatters family, ends in death -Associated Press

2/26 10:10 pm

WELDON SPRING, Mo. (AP) - The veins in Marshall Fink's neck bulged with fury as he pumped his fist, telling his parents they should stick a shotgun in their mouths and pull the trigger. His mother and stepfather begged Fink, 26, to take his medication and calm down.

That set him off.

Fink put his fingers to his head, pretending to have a gun, then pointed at his parents. He chest-bumped his mother into the garage, snarling and telling her she should die.

Shirlee and John Gentles called 911 several times the night of Jan. 11.

The police were on their way, but by the time they arrived John Gentles had fatally shot his stepson.

In a little over two years, Fink's satisfying career in the Navy dissolved into a struggle with bipolar disorder that tormented him and ripped apart his family. His psychiatrist says the stress of the Navy career he loved contributed to the disease.

"Please, Marshall, you're hurting me and I love you," said Shirlee Gentles, 52. "You're scaring me, and I just want you to get help."

She ran outside to the driveway. But Fink dragged her back inside.

"You're not going anywhere," he yelled.

Gentles grabbed her 12-year-old son, James, and managed to run to a neighbor's house.

Meanwhile, her husband took his 9 mm pistol out of the closet and showed it to his stepson, who did not have a weapon.

"Marshall, this is loaded and you're going to listen to us," said Gentles, 62. "You need to go to the hospital."

Fink lunged and got within an arm's length of his stepfather when Gentles fired one shot into Fink's stomach. He bled to death on the kitchen floor.

Police arrested Gentles, a dentist, questioned him and released him the next day. Prosecutors said he killed Fink in self-defense, and no charges were filed.
Shirlee Gentles remarried and moved to the St. Louis area when Fink was 5 years old. He grew up with two stepsisters and a half brother.

Fink's family said he and his stepfather had a good relationship, but that Fink was closer to his father, Richard "Dick" Fink, who lived near Chicago. Together, they restored classic cars and motorcycles.

Fifteen months after graduating from Francis Howell High School, Fink enlisted in the Navy, inspired by the Sept. 11 attacks to serve his country.

Fink was stationed at the Naval base in San Diego as a mechanic aboard the Peleliu assault ship.

For more than two years, his service record was clean. Fink wanted a career in the Navy, but a conflict of highs and lows was escalating inside his head.

Fink's illness developed quickly and was brought on in part by stress and lack of sleep, said his psychiatrist in St. Charles, Dr. Greg Mattingly. Fink's condition emerged about the same age as most bipolar patients, Mattingly said, and was not spurred by any specific traumatic incident.

"With bipolar, you can go from pretty much normal one day, to the next day being very, very, very sick," Mattingly said.

Fink mouthed off to his commanders, stopped eating regularly and lost 20 pounds. He grew increasingly paranoid, and in September 2005, doctors at the Naval Medical Center in San Diego diagnosed his condition as bipolar disorder, which often results in episodes of severe depression and mania.

Because of Fink's diagnosis, the Navy started discharge proceedings, considering him unfit to serve.

Devastated, Fink went AWOL, hoping it would somehow delay his discharge.

The Navy declared Fink a deserter. His mother looked for him for almost two months. Police tracked him to a motel in Yuma, Ariz.

Officers returned him to base to face a trial by court martial. Fink accepted a discharge classified as "other than honorable" in lieu of a trial.

In September 2006, Fink packed up a U-Haul and drove from San Diego to Weldon Spring in two days, hardly stopping.

As soon as he got home, he closed all the window blinds because he believed people were watching him.

Fink became a night owl. He rarely slept. He paced at night and slammed doors when he'd go outside to smoke. Once, at 2 a.m., he grabbed a pitchfork and began turning mulch in the yard.

Fink stopped eating because he thought his parents were trying to poison him. Instead of food, he took ephedrine pills, caffeine powder and drank his parents' liquor.

Shirlee Gentles says she saw more than a dozen doctors to treat her own medical problems caused by anxiety over her son.

"Every night for two years, I slept with one eye open because I thought he was going to kill us," she said. "The stress was killing me."

Three months after he came home, his parents had him committed to a hospital, where he was put on suicide watch. During treatment, Fink attacked a doctor and was put in restraints.

After almost a month, and new medication, he felt well enough to come home.

Fink found a job as a mechanic at a boat dealership and repair shop in St. Charles. His co-workers said he was funny, polite and reliable.

In the weeks before his death, Fink confided in a co-worker that he felt lonely and depressed.

Meanwhile, the family struggled to help Fink get better. This past Christmas, Fink attended a family gathering in the Chicago area where he saw his father.

"It was a real joy to have him be with us," said Richard Fink, 56, of Dundee, Ill. "He seemed good."

But he said his son complained of frequent headaches brought on by medication. So Fink stopped taking it.

Fink further isolated himself in the last days of his life. He stayed in his room most of the time.

Shirlee and John Gentles suspected he had stopped taking his medication, and his mother arranged to have him committed again.

On the night of his death, Shirlee Gentles said, Fink was tormented by anger she had never seen. "There's no way to explain what happened that day," she said.

Fink's father has questioned the shooting, wondering why John Gentles grabbed his gun instead of leaving the house to wait for police to arrive.

"If he didn't have this weapon, what would have happened? A black eye?" Richard Fink said.

When police told Gentles that Fink had died, he gasped and buried his face in his hands.

"I didn't want to kill him," Gentles told detectives. "I just wanted to stop him because I thought he was going to kill us."

Shirlee Gentles said her husband is still too distraught to discuss with anyone the night he killed his stepson.

The Gentleses' home is calm again. There is no more pacing in the dark. No more slamming doors. No more screaming.

And for the first time in more than two years, Shirlee Gentles says, she can sleep through the night without worrying.

She doesn't blame her husband for killing their son. She blames the disorder for destroying the person he used to be.

"This illness robbed us of a beautiful, beautiful son," she says. "On the one hand, I would do anything to have him back. On the other, we have peace of mind."

©2008 Associated Press. All rights reserved. This material may not be published, broadcast, rewritten, or redistributed.
Read more!

Louisiana to Revamp Mental Health Plan -Associated Press

By JANET McCONNAUGHEY

Louisiana's top health official announced a plan on Tuesday to revamp the New Orleans-area's mental health system, which has been in disarray since Hurricane Katrina devastated the area.

State Health and Hospitals Secretary Alan Levine said James McDonough, who is credited with improving Florida's prison system, will lead a "transformation team" that will spearhead several new initiatives.

Levine announced the plan at the New Orleans Adolescent Hospital, where the state recently doubled the number of adult psychiatric beds by adding 20.

Access to psychiatric treatment is a major problem in the area.

Charity Hospital, which has been closed since Hurricane Katrina struck in August 2005, had a 98-bed mental unit. It has not been replaced, leaving the Orleans Parish jail's 60 psychiatric beds the largest acute-care ward in New Orleans.

"This issue is overwhelming hospitals, law enforcement, community agencies ... and most importantly, families who have a loved one who is suffering," Levine said.

Levine said the state's Metropolitan Human Services District is supposed to work with people to prevent crisis, but has been unable to "get traction."

"We must change this, and it must start immediately," he said.

Levine's plans include adding three teams to monitor mental patients and make sure they take their medicine. One of those teams will work only with people whose problems have led to arrests or court charges against them.

Other proposals include short-term subsidies to provide safe housing for mental patients until they can get longer-term help through federal or other programs; five mental health teams to help community clinics around Orleans, Plaquemines and St. Bernard parishes; and a regional center where police could bring mental patients.

If the New Orleans-area "receiving and triage center" works out, similar centers would be set up around the state.

McDonough, a retired Army colonel and former head of Florida's drug control agency, announced last month that he was retiring as Florida's corrections secretary _ a job he was given in 2006 after his predecessor was charged with taking kickbacks from a prison contractor.

Read more!

Time for media to back off Britney - MSNBC

Pop star is lucrative subject for press, but mental illness is game-changer

COMMENTARY
By Michael Ventre
Feb. 26, 2008

Mental illness and the media are as inextricably linked as Dr. Jekyll and Mr. Hyde. My first realization of this came when I announced way back that I was going to journalism school with the intent of becoming a reporter. Since my parents couldn’t afford to fly me to Vienna at the time, and research was still sketchy regarding the benefits of shock therapy, they were somewhat helpless and had no alternative but to go along and accept my loony career choice.

Over the years, mental illness can be observed at just about any media event or gathering, displaying its credential proudly. But nowadays, in an era in which paparazzi go after celebrities like the bloodthirsty zombies went after the surviving humans in “28 Days Later,” mental illness appears to be developing in the targets of media scrutiny, not so much among the ink stained wretches themselves.

It’s impossible to say if media intrusion was a contributing factor in the tragic death of Heath Ledger. But it’s not far-fetched to suggest that the stress of being stalked by media may have caused him to turn more and more to prescription drugs for relief.

Perhaps the most prominent recent example of a celebrity having his or her mind messed with by renegade elements of the press is Britney Spears. She is said to be suffering from serious mental illness, and it can’t be getting any better by having hordes of camera-wielding assailants confronting her every time she goes to and from her car.

It should be noted first off that a celebrity is, to a reasonable extent, fair game. When someone makes a living in the public eye, that person understands there will be a certain amount of privacy that is kissed goodbye forever. It’s part of the job description, right there in the fine print with the hefty income, red carpets, velvet ropes and exclusive parties.

A celebrity also knows every move he or she makes — professionally and personally — will be praised or ridiculed, but rarely ignored. When Britney made a bunch of fans wait in line at San Diego’s House of Blues last May and then rewarded them with a half-hearted 15-minute set, I excoriated her. When she slogged through a pitiful performance last September at the MTV Video Music Awards, she invited widespread derision.

Of course there is a certain amount of responsibility Britney herself has to take for starting these brushfires of disaster.

But the issues now are whether she indeed is mentally impaired, whether the media are making it worse, and whether they have a responsibility to back off and give the woman some peace.

Remember that the media in question here are not the denizens of the Washington Post’s White House bureau, or the editorial board of the Wall Street Journal. They’re the mostly male-dominated tabloid paparazzi, followed closely by the somewhat more respectable but only slightly less harassing members of the mainstream entertainment press, representing publications like People, Us Weekly and others. And there are the television reporters from the seemingly endless wave of entertainment shows, along with Internet bloggers and stringers.

Together they all team up to chronicle Britney’s every step. Ordinarily, while it’s often distasteful, it’s expected given that level of celebrity.

Now, though, Britney is said by family and friends to be suffering from serious mental illness, including bipolar disorder and/or post-partum depression. Not long ago she exited her house strapped to a gurney after the police were called to her home. Her behavior has become more and more erratic.

I’d call this a cautionary tale about the effects of global celebrity and Hollywood excess except nobody seems to be exercising any caution, especially certain segments of the press.

I can understand that the media are in the habit of employing all-out assaults when it comes to tabloid figures, so it’s difficult to tell them to ease up. This is, after all, the way many of them make their bones. Although the absurd magnitude of it is relatively new, this dynamic has been going on for decades. Reporters and photographers in such situations aren’t accustomed to shifting into a lower gear. Big money is at stake.

Journalists are taught to maintain a healthy skepticism when it comes to the subject matter they are examining, but often that can degenerate into a deep cynicism. When members of Britney’s inner circle announce she is mentally ill, the news is usually greeted by reporters and photographers as more spin from people skilled at doing it well.

Since few in the media have training in psychology, a simpler, common-sense method of assessing the situation is required. If you’re covering a young woman who seems to be unable to provide a stable home for her kids, who abruptly shaves her head, who was taken to UCLA Medical Center for mental evaluations twice in a short period of time and was placed on “mental evaluation hold,” who refuses to take her medication, and perhaps worst of all, who gets involved in a romantic relationship with a member of the very paparazzi that is making her life miserable, it all may be a cue to leave her be. In fact, the only sane thing she has done in the past six months is kick Dr. Phil out of her hospital room.

The First Amendment to the Constitution says, “Congress shall make no law … abridging the freedom of speech, or of the press, or the right of the people peaceably to assemble …” It doesn’t say anything about the right to torment a seriously troubled young woman in pursuit of profit. And rarely does the celebrity press peaceably assemble.

Maybe, in the sad case of Britney Spears, it might be time to start.

Michael Ventre lives in Los Angeles and is a regular contributor to msnbc.com.
© 2008 MSNBC Interactive

URL: http://www.msnbc.msn.com/id/23336567/ Read more!

State office hopefuls discuss mental health -Chapel Hill (NC) Daily Tar Heel

By: Amy Eagleburger and Devin Rooney, Senior Writers
2/26/08

RALEIGH -Ten candidates running for statewide office took advantage of a mental health forum Monday to share their opinions and hear from activists on the issue.

The system's shortcomings and possible solutions were the focus of the N.C. Mental Health Coalition's forum at the RBC Center.

All of the registered candidates for lieutenant governor were in attendance, and six of the gubernatorial candidates were present. Two Republican candidates, Pat McCrory and Elbie Powers, were absent.

Pat Smathers, who is running for the Democratic nomination for lieutenant governor, said the state's situation is severe.

"If anyone tells you we are not facing a mental health crisis, they are not dealing with reality."

In 2001, the N.C. General Assembly passed a sweeping mental health care reform bill that sought to privatize care.

Seven years later, providers have overcharged the state and under-served the majority of mental health care patients, candidates said.

Audience members expressed concern that many people have received minimal care and that some needing long-term treatment were prematurely released to community support services.

N.C. Rep. Verla Insko, D-Orange, who was the primary sponsor of the reform legislation, has expressed displeasure with its unanticipated fallout.

Candidates charged that lack of detail in the legislation allowed for loopholes that private, community-based organizations manipulated for their benefit, and said those hurt were the mentally ill, developmentally disabled, brain trauma victims and substance abusers.

Every candidate admitted to varying degrees of ignorance on the subject, but all pointed to a quality they feel they have: leadership.

"I never claimed to be a good politician, but I'm a hell of a public manager," said State Treasurer Richard Moore, a Democratic candidate running for the governor nomination.

Lt. Gov. Beverly Perdue, also a Democratic contender, was in office at the time of the reform. She said that she acted to the fullest extent of her powers and that she does not accept credit nor blame for the failed reforms.

North Carolina's mental health system is in flux, with the director of the state's mental health care division set to retire Friday.

All candidates pledged to continue discussion with activists and experts to find a workable solution.
Read more!

Blame to go around -Raleigh (NC) News & Observer

Editorial:

Who botched mental health reform? The sheer size of the state's mental health system spreads responsibility far and wide, and over more than one branch of government. Ultimately, North Carolinians need to point toward solutions, not just point fingers.

That said, Governor Easley has some 'splainin' to do. Especially if the governor really thinks that his administration opposed -- and was then surprised by -- the General Assembly's reform plan of 2001.

Speaking with reporters in December of last year, Easley in effect blamed legislators for the sweeping changes that led to out-of-control privatization of much of the system, and said Health and Human Services Secretary Carmen Hooker Odom had "vigorously" opposed them.

A glance back to the General Assembly's 2001 session supports a more nuanced view. Early on, amid an atmosphere of budget-cutting and calls to close Dorothea Dix Hospital and other "institutional" centers in favor of community-based care, Carmen Hooker Buell (her name then) was properly skeptical, saying proposals then being considered were "ludicrous." Legislators apparently were persuaded by her caveats, because by October they'd taken a more substantive approach, and had set up a $47.5 million trust fund to bridge the gap to community-based care.

The reform plan, signed into law by Easley, apparently came with Buell's endorsement. In an N&O opinion piece in November 2001 she wrote that "As DHHS secretary, I've made fixing the mental health system a top priority. For the past few months, we have been doing intensive planning to reform our system. Reform has been attempted many times, but this effort is going to succeed because the time is right."

Hardly the language of vigorous opposition. Nor does it support the notion that the reform plan had come as a surprise.

Following 2001, patients' families and former providers of mental health care -- psychologists and therapists among them -- complained that vital services were being lost as for-profit companies replaced former county-based mental health agencies as front-line providers. Then, when money began to flow toward the "community support" category, the tap opened too wide, to the tune of $50 million a month in spending (for many questionable services) when the state had expected $5 million.

Easley complained in December that the state lacked power to control runaway spending, blaming the private firms. Yet his administration had signed off on the plan and had appointed the administrators who put it into effect.

That implementation was deeply flawed. Surely a governor engaged in this issue has the power and the duty to fix it. Read more!

Deputies may cane ‘Chairiff’ on jail -Portland (OR) Tribune

Sources Say
Feb 26, 2008

Since earlier this month, when Sheriff Bernie Giusto signed over many of his powers to Multnomah County Chairman Ted Wheeler, Wheeler’s aggressive use of those powers has earned him a new nickname among sheriff’s deputies: “The Chairiff.”

Many deputies are unhappy with Wheeler’s plan to open a portion of the currently unused Wapato jail for drug, alcohol and mental health treatment beds under the county’s Department of Community Justice.

The Multnomah County Corrections Deputies Association has written a counterproposal, one supported by prosecutors and others, which the union says will keep more jail beds open.

Besides logic, the union is willing to use brute political force. Wheeler hopes to put a levy on the November ballot to fund social service programs in the name of crime reduction.

According to board member Sgt. Darcy Bjork, the union has informed Wheeler that if he cuts jail beds to pay for his Wapato plan, it will spend money to “inform” November’s voters of his record on public safety.

Adams, fee could make strange ballotfellows

When the elections filing deadline hits March 13, expect mayoral front-runner Sam Adams to breathe easier. That’s because Adams’ recent move to push a vote on his street fee back to November only makes it more inviting for another serious challenger to enter the race.

His most prominent challenger, businessman Sho Dozono, is not assured of being able to push Adams into a runoff. While nine other candidates also are in the race, none of them appears to be the kind of third well-funded challenger that would make a November runoff almost a sure thing.

A November runoff would give challengers more time to make a case against Adams.

Not only that, but the street fee being on the same fall ballot would be a potent reminder that four years ago, Adams ran for City Council while promising he would oppose new tax increases. Small wonder that Adams went through such gyrations to keep the fee off the May ballot.

Street fee conspicuously absent

Speaking of the street fee, Adams raised eyebrows over the weekend when he placed his promised follow-up resolution on the City Council’s Wednesday agenda – and it did not mention either the fee or the November election.

The council originally enacted the $422 million fee plan in late January, but pulled it back after critics launched a petition drive to refer it the May ballot. Adams then seemed to promise he would ask the council to place it on the November ballot on Feb. 27.

But the new resolution only calls on the council to support the Portland Office of Transportation’s efforts to raise money for street repairs, and directs PDOT to report back on the issue by July 16.

Adams’ chief of staff Tom Miller swears his boss isn’t backing off from the fee or the November election, saying more work is needed to prepare the plan for the ballot. Critics like lobbyist Paul Romain of the Oregon Petroleum Association aren’t convinced, however, noting that Adams had an entire month to rewrite it.

– Tribune staff Read more!

Wasted money is abuse, too -Raleigh (NC) News & Observer

Ruth Sheehan, Staff Writer

Maybe it was eight years of divinity school training (on top of his medical degree) that has kept Peter Morris from shouting, "I told you so!"

Lord knows, he'd have every right.

Morris, the medical director for Wake County Human Services, was one of the last holdouts against the privatization of mental health care.

The last time I spoke with Morris in person was nearly two years ago, when the state was applying extreme pressure for the county to turn over care of even the most severely mentally ill to private providers.

Morris warned that moving too fast would make it hard for the county to maintain high standards of quality in a fast-growing industry of providers.

Carmen Hooker Odom, then the secretary of the state Department of Health and Human Services, warned in an interview that there'd be hell to pay if Wake didn't quit dragging its heels.

Finally, Wake County capitulated. And look at what the rush to privatization has wrought.

In Sunday's installment of "Mental Disorder: The Failure of Reform," we learned that at least $400 million has been wasted statewide on community support services -- while care for people with critical needs is being cut.

Many readers, I know, have been shocked that $61 an hour is being spent in some agencies for workers to take the mentally ill on excursions, to the movies and out to eat.

But let me clarify right here: The frontline workers, most with little more than a high school education, are not the ones making $61 an hour.

According to Morris, they're earning $10 to $12 an hour, many without health insurance. The ones pocketing the "overhead" are the agencies.

Let me also note that for the truly mentally ill, trips to the mall, or to the library, can be important tools for encouraging human interaction. They are therapy trips.

But not when the clients aren't even sick.

Yesterday, in Day 2 of the Mental Disorder series, came the story of Dominion Healthcare Services, a private provider peddling "mentoring" for the undiagnosed, rather than providing therapy for the seriously needy.

Astonishingly, the state claims it can do nothing to halt this sort of abuse.

And since the state forced the counties out of the business of managing care, the counties' hands are tied as well. (This, while the stated goal of mental-health reform was to care for the mentally ill as close as possible to their own communities.)

All the county can do to combat a lousy provider is send out a note saying something along the lines of, "Wake County is not referring clients to [insert name of provider here]."

"We can suggest, that's all," Morris said. "We offer our recommendations and hope."

Morris can only shake his head at what has happened to the mental-health system in the name of reform.

And while his predictions turned out to be pretty accurate, Morris derives no satisfaction from the news. He thinks the focus in mental health has been too much on strategy and not enough on outcomes. Outcomes, as in people.

"The mentally ill aren't just numbers," Morris said. "These are human beings who deserve to be treated with dignity and respect and care."

It shouldn't take a divinity degree for someone to understand that. Read more!

Mental errors ... Raleigh (NC) News & Observer

Editorial:

When the General Assembly set out to reform mental health care in North Carolina in 2001, all stated intentions and objectives were worthy ones.

Those in need were limited in their choices, it was argued, because county health agencies providing help were strained and couldn't offer all the types of care that were needed. Rather than put so many people in large institutions, it would be better to bring the services closer to them, in their communities. Those services could be turned over to the private sector, with Medicaid, the federal/state health insurance program for the poor, covering the expense for those who couldn't afford care on their own.

The system, it was agreed by professionals, legislators and state officials, was broken.

Now, a five-part News & Observer series is unveiling the sad truth: the broken system hasn't been fixed. It's been further damaged by a lack of preparation for the changes made. There was an absence of adequate rules specifying types of care and requirements for those who provide it. And the level of "community support" services offered by some of the private companies (there are 784 of them) has been inconsistent at best. Certainly the huge sums expended for that ill-defined aspect of mental health care proved to be a painful and embarrassing surprise.

Let this be said, right away: Many care providers are dedicated people doing good work. But there are problems, and they are serious.

Duck and cover

Governor Easley, who's been in office since reform of the system began, has declined to discuss with this newspaper's reporters the problems that have come to light on his watch. That hardly rates as a stand-up demonstration of public accountability.

Easley did appoint Dempsey Benton, a capable administrator and former Raleigh city manager, as secretary of the Department of Health and Human Services after Carmen Hooker Odom moved on last year. Benton candidly recognizes that he is attempting to restore order to a system that is in chaos.

When reform began, private companies eagerly signed on to provide services. The most basic of those services was called "community support," wherein workers would help people cope with daily living -- establishing routines, going to the store, to movies, and so forth. Most of the service was provided by people with high school diplomas. Companies could charge up to $61 an hour, much of it coming from Medicaid.

It's a good business. One company cited in yesterday's N&O story, Dominion Healthcare Services of Raleigh, is owned by Joel Hopkins, a former Shaw University basketball coach. Traditionally, people who needed mental health services got referrals from doctors or health agencies. But Hopkins' company has recruited clients from neighborhood visits, sometimes going door to door, and in 18 months has charged taxpayers $33.9 million for services.

Payback time

Not surprisingly, some state officials have questioned whether all of Dominion's clients needed mental-health services. Officials are demanding that Dominion and other companies repay $59 million. It's astounding to think that such an amount could have been paid out in error, or carelessly, to those who didn't deserve it. County officials, who used to provide mental health services, were charged with monitoring programs, but clearly there have been breakdowns in communications.

The state needs to rethink reform, and that's putting it mildly. Perhaps the counties ought to again be the ones that provide services -- surely officials there must be thinking what they could have done with the hundreds of millions of dollars spent on privatizing care. Maybe the plans to close hospitals, including Raleigh's Dorothea Dix, were poorly conceived.

Were this a tale of government programs run amok it would be yet another maddening account of waste. But this is about human beings. Some are in dire circumstances, indeed, and for them to go without help or care -- especially because money was being wasted that could have been used to help them -- is unacceptable. That ought to be the point of reform, and Governor Easley should not tolerate anything less.

Read more!

Treat Mental Illness Outside Prison - Lakeland (FL) Ledger

STEPHEN H. GRIMES, MAJOR B. HARDING, JOSEPH W. HATCHETT, LEANDER J. SHAW JR., BEN F. OVERTON & PARKER LEE McDONALD

Annually, as many as 125,000 people with mental illness requiring immediate treatment are arrested and booked into Florida jails. And on any given day, more than 70,000 individuals with serious mental illness reside in Florida's jails and prisons, or are under correctional supervision in the community.

Frequently, these individuals enter the justice system as the result of committing relatively minor offenses that are directlyrelated to symptoms of acute, untreated mental illness.

Unfortunately, many of these individuals find that they are either deniedcommunity-based care, or that the care they do receive is fragmented and insufficient to adequately respond to their level of need. Disabled and vulnerable, they recycle through the system, creating a revolving door of criminal and legal involvement.

Measures have been taken in the past to reform this unsystematic approach to Florida's mental health system, but to no avail. The movement from institutional treatment to community-based treatment was neverfully executed or funded, resulting in decades of fragmented mental health care. The existing community mental health system leaves enormous gaps in treatment and access, and is not designed to serve the needs of individuals who experience the most chronic and severe forms of mental illness.

Some of us have served on trial courts across the state and have witnessed firsthand the problems that are created when courts are forced to deal with mental health issues. Without propertreatment, these individuals appear and reappear in court.

But all of us know that the problems with the current system weigh heavily on law enforcement and the criminal justice system - courts see increasingly high numbers of cases, and jails are continually overcrowded.

Based on recent trends, Florida can expect the number of prison inmates with mental illness to nearly double in the next nine years to more than 32,000 individuals, with an average annual increase of roughly 1,700 individuals per year. To keep up with such demand, the state would need to open at least one new prison every year.

The state of Florida spends roughly a quarter of a billion dollars annually to treat roughly 1,700 individuals under forensic commitment, most of whom are receiving services to restore competency so that they can stand trial on criminal charges and, in many cases, be sentenced to serve time in state prison. Without a change to the system, the state faces potential forensic expenditures of a half billion dollars annually on by the year 2015.

But there is hope. A comprehensive plan was recently unveiled under the joint leadership of all three government branches, and with sponsorship from Chief Justice R. Fred Lewis and Gov. Charlie Crist. The initial six-year plan would effectively respond to the needs of individuals with mental illness by reorganizing services and service delivery to reduce demand for costly and inefficient levels of care, while reinvesting the savings in more efficient prevention and community-based treatment services.

For the first time in decades, a solution is at hand: an infrastructure for more comprehensive community-based treatment for individuals and families, an opportunity for recovery, increased public safety and savings of critical tax dollars.

Reform of our mental health system is crucial to ensuring humane treatment of all the citizens of Florida. Our jails and prisons should no longer be asylums.

Under this redesigned system of care, there will be:

Programs incorporating best practices to support adaptive functioning in the community and prevent individuals with mental illness from inappropriately entering the justice and forensic mental health systems.

Mechanisms to quickly identify and appropriately respond to individuals with mental illness who do become inappropriately involved in the justice system.

Programs to stabilize these individuals and link them to recovery-oriented, community-based services that are responsive to their unique needs.

Financing strategies that redirect cost savings from the forensic mental health system and establish new Medicaid-funding programs.

We strongly urge the Florida Legislature to adopt and implement the recommendations made for the transformation of the public mental health system. In doing so, lawmakers will achieve the dual purposes of addressing needed change and improvements in efficiency of the mental health system, as well as reducing a costly and unnecessary burden on all facets of the justice system.

[ The writers are retired justices of the Florida Supreme Court: Chief Justice Stephen H. Grimes, Chief Justice Major B. Harding, Justice Joseph W. Hatchett, Chief Justice Leander J. Shaw Jr., Chief Justice Ben F. Overton, Chief Justice Parker Lee McDonald. ]

Read more!

Studies on Depression and Teenagers - New York Times

By BLOOMBERG NEWS

Depressed teenagers who are not helped by antidepressants like Celexa or Prozac may improve if they switch drugs and receive a certain type of behavioral therapy, a review of studies found.

A separate analysis of 35 clinical trials of antidepressants in adults submitted to regulators found that the drugs were no more effective than placebos, other than a small minority with the most severe levels of depression. The study of adolescents, published in The Journal of the American Medical Association, gives mental health professionals guidance about how to treat teenagers who do not improve using antidepressants, said David Brent, a psychiatrist at the Western Psychiatric Institute at the University of Pittsburgh.

Read more!

Not all the same -Raleigh (NC) News & Observer

Letter to the editor:

As dedicated, established providers of community mental health services, we have invested significant resources to provide quality services to our communities. We were disappointed that recent articles concerning mental health reform have painted all providers with the same broad brush, as profit-driven and unconcerned about the individuals they serve. This is unfair and untrue. We are passionate about helping the individuals we serve, many of whom would be in institutions or the criminal justice system without our services.

The current rhetoric is making all providers the scapegoat for the cost of mental health care. For example, the Department of Health and Human Services' findings regarding "medically unnecessary services" are grossly overstated and have serious problems. Providers can bill for services only if a medical doctor or licensed psychologist and the department's contractor agree that the services are medically necessary. Yet the department now contends that providers should not have billed for the very services it previously approved.

We understand the challenges the department is facing to correct the unfortunate mistakes it made during the development of the community support program, including lax standards for new providers. However, arbitrarily punishing dedicated established providers and the vulnerable individuals they serve is not the solution.

Wendy Nipper, Director of Administration, Alpha Omega Health Inc., Raleigh

Jeff Jenkins, CEO, Coordinated Health Services Inc., Morrisville

(The letter also was signed by administrators for Evergreen Behavioral Management Inc., Health Care Connections of the Carolinas Inc., Native Angels Homecare Agency Inc., Southeastern United Care LLC and The Right Choice MWM Inc.)

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

S.D. must abide by federal gun law -Sioux City (IO) Argus Leader

Editorial: February 26, 2008

Ours is not the only state that is not in compliance with a federal law aimed at keeping guns out of the hands of dangerous mentally ill individuals, not by far. In fact, South Dakota is one of 28 states that is not reporting that data.

However, having plenty of company is no excuse. Establishing the system by which South Dakota can participate in this program should be a priority. But because compliance could require legislative action, it's late in the game this year.

The federal law, which has behind it the unusual coalition of the National Rifle Association and gun control advocates, could withhold federal money from states that do not report to a national database the names of those deemed dangerously mentally ill by a court. Signed in the wake of a shooting rampage at Virginia Tech that left 32 dead by the hand of a young man who should not have been allowed to buy a gun, few, if any, would oppose the program.

Instead, for states it is a question of logistics. In South Dakota, the court records of those found mentally ill and committed involuntarily are sealed. How to maintain that privacy while still reporting to the federal database is apparently the primary sticking point.

That shouldn't be insurmountable, and if any added motivation were necessary, the federal crime-fighting money that could be withheld should provide that in a year when the Legislature and the governor are at odds over the Highway Patrol's budget.

South Dakota gun shops already perform the required background checks written into federal law. That catches those legally prohibited from buying guns because of mental illness adjudications in some states and because of criminal convictions.

A reasonable system is in place. But if states aren't updating this important information, what good is it?
Read more!

The state’s mental health mess -Greensboro News & Record

Editorial:

Getting North Carolina's wasteful, inefficient mental health program on course will be like turning around an ocean liner at sea.

But for the General Assembly and next governor, improving shoddy care for the mentally ill and reining in wildly out-of-control costs to taxpayers must be priorities.

In an ongoing investigation, The News & Observer of Raleigh describes how the ill-conceived 2001 overhaul assigning services previously overseen by county and state government to the private sector has failed miserably.

The bottom line is threefold.

First, the Department of Health and Human Services is spending way too much on questionable services offered by marginally qualified private providers. Costs are estimated to be 10 times what they should have been.

Second, thousands of needy people are being lost in the shuffle. Those with serious mental problems are the most likely to be ignored in the headlong rush to uneven community-oriented treatment initiatives.

And, the four surviving mental hospitals remain under siege. All have been threatened with loss of federal insurance money because of patient-abuse charges. Instead of a hoped-for admissions drop, overcrowding prevails.

Gov. Mike Easley, whose administrators oversaw the flawed reforms, has washed his hands of the debacle which, so far, has cost state taxpayers $400 million. And only recently have legislative leaders, who carelessly rushed through the imprecise revamp, talked seriously of taking another look.

Too much, too fast has overwhelmed a fragile care-delivery network. While deferring to the private sector may sound good, there must be strict performance and financial accountability. That was and still is sadly lacking.

According to The News & Observer, since so-called reform arrived, the state's cost of caring for the mentally ill has more than doubled while nearly 90 percent of treatment is deemed unnecessary. And that doesn't begin to measure the human toll.

True reform is long past due.

Read more!

Playing with lives -Charlotte (NC) Observer

Editorial: 02/26/08

N.C.'s mental health shambles deserves more than a shrug

The estimated 212,000 North Carolinians who seek help from the state mental health system each year are among the state's most vulnerable citizens. Their well-being shouldn't be tinkered with indiscriminately.

Yet for the better part of this decade state government has been hard at work on an ill-planned overhaul of mental health that has hampered care, wasted hundreds of millions of tax dollars and made life harder for struggling patients.

That shambles deserves action, not indifference from the state's highest-ranking elected official. Gov. Mike Easley has shrugged and blamed county organizations for grievous mistakes. Yet the fact is, state bureaucrats he appointed were in charge when reforms were bungled. Gov. Easley has the authority to get things fixed, and he ought to use that power -- now.

A six-month investigation by the Raleigh News & Observer found that the state has wasted at least $400 million on an ill-conceived and poorly executed plan that pushes care to private companies in order to treat more mentally ill people in their own communities and fewer in the state's four psychiatric hospitals.

Among the N&O's findings:

• Hundreds of private providers have abused the system, charging for services that were not necessary or not performed. Most money went to the least ill patients, not the sickest.

• State Department of Health and Human Services officials agreed to pay private companies high-skill wages but did not require them to hire high-skill workers.

• North Carolina began closing down state mental hospitals before adequate funding was in place for community-based facilities.

This has been a boondoggle from day one. The General Assembly rushed legislation forcing changes without enough evidence that those changes would work. HHS rushed into reforms without laying basic groundwork. Private companies rushed to make money off the situation.

Meanwhile, nobody has been paying attention to the details, or to the best interests of sick citizens, many of them poor. That's disgraceful.

Here's what ought to happen:

• North Carolina should admit that handing over services that protect the poorest and most vulnerable members of society to the private sector is flawed. It may be OK for garbage collection, but it's too risky for mental health.

• Gov. Easley should appoint a task force co-chaired by a business executive and a mental health expert to come up with a plan to restore quality and accountability to state's mental health services. Among its tasks: recommending to the General Assembly a workable per capita funding level for mental health care in North Carolina. The state ranks near the bottom of the nation, spending $16.80 per capita. The national average is $91.12. That disparity is unacceptable.

It's time for state officials to stop playing with people's lives. Effective public mental health care is neither cheap nor easy to provide, and it's time to own up to the cost and obligation.

Ask Mike Easley to act

Contact Gov. Easley by calling 800-662-7952 or e-mail governoroffice@ncmail.net Read more!

Broughton mental facility seeks to win back funding - Charlotte (NC) Observer

MARCIE YOUNG
myoung@charlotteobserver.com

Correction: An article about Broughton Hospital in Tuesday's Local & State section gave outdated information on a patient's cause of death. An updated autopsy showed the cause was cardiac arrhythmia. The article also overstated the percentage of hospital revenue that comes from Medicare and Medicaid. Ninety-eight percent of third-party insurance revenue comes from the federal funding each year.

Officials at Broughton Hospital, one of the state's four mental health facilities, said Monday they are ready for inspectors to return and reinstate federal funding.

Broughton has gone without Medicaid and Medicare funding since August, when the federal government decided to halt payments amid concerns over a patient death and another patient injury.

The state responded to the cuts -- about $1 million a month -- by sending a team of doctors and administrators to the Morganton facility to identify and fix problems, reorganize clinical staff and retrain every employee, from housekeepers to doctors.

Now, Broughton officials are asking that the federal government review the hospital's progress and allow it to bill Medicare and Medicaid, said Director Art Robarge. About 98 percent of the hospital's annual revenue comes from such funding.

Since August, a team of state doctors and consultants has been working at Broughton to correct problems and improve care. They've focused, Robarge said, on finding ways to reduce the physical restriction of patients, revamping policies about patient falls and infection control, and reorganizing staff to ensure better clinical supervision.

"We've gone back to the drawing board, read the standards and (drawn) out a plan to make sure it's appropriate for Broughton Hospital," he said. "(We want to make sure) that what folks are doing here is in compliance with those standards."

Broughton has also been recovering from a series of hits since August, including threats that it could lose its accreditation and a shake-up in leadership when Seth Hunt was dismissed as director and Robarge, who led the hospital from 1986 to 1989, took over.

Robarge said he sent a letter Friday to the Centers for Medicare and Medicaid Services, part of the U.S. Department of Health and Human Services, asking that inspectors visit the hospital soon and assess changes the hospital has made.

If everything goes as anticipated, Robarge said, inspectors should make their initial visit to the hospital within two to four weeks. On the first visit, Robarge said, inspectors will evaluate how staff members handle aggressive patients and how they keep those situations from escalating.

The February 2007 death of 27-year-old Anthony Lowery, who died of asphyxia after a staff member sat on his torso while trying to restrain him, was one of two incidents that led the federal government to stop Medicaid and Medicare payments.

Situations where staff members have had to physically restrain patients, Robarge said, have dropped 40 percent to 60 percent since last year.

"There has been a tremendous effort to become creative at all levels and use restrictive methods only when absolutely necessary," he said.

If Broughton passes the first inspection, which Robarge said is likely, inspectors will come back to the hospital again within 30 days to make sure it is meeting other standards set by the federal government.

Even if Broughton meets all the federal government's standards during the initial and follow-up inspections, Robarge said it will still take at least an additional 45 to 75 days before Medicaid and Medicare funding is reinstated.

Broughton serves about 4,000 patients each year from the state's 37 westernmost counties and has about 1,200 employees and a $77 million budget. Read more!

Editorials implying governor didn't act are `flat wrong,' a top aide says - Charlotte (NC) Observer

From Dan Gerlach, Gov. Mike Easley's senior policy adviser for fiscal affairs:

While editorials in your newspaper (Feb. 26, "Playing with lives") and others have been busy engaging in finger pointing to blame the current problems in our state's mental health system, rest assured that Gov. Mike Easley and his administration have been working to make sure it gets fixed.

It is clear that the rapid change in the mental health system led to problems, no doubt. But to insinuate that nothing has been done, or that these problems were ignored, is flat wrong. Regardless of what has happened in the past, we want to remain focused on solving problems for those in need of services. Consider the following:

• In 2006, Gov. Easley recommended, and the General Assembly supported, almost $100 million in additional funding to support the mental health system, including the replacement of lost federal funds for the developmentally disabled.

• This year, the governor ordered additional resources be made available to keep a state presence at Dix Hospital in conjunction with Wake County.

• Last year, the state Department of Health and Human Services and the administration recognized that some mental health community service providers were exploiting the system, inflating charges and wasting tax dollars. I informed the reporter in an interview that the governor demanded that the department take immediate action to audit the finances and practices of providers, adjust rates in cooperation with responsible providers, open fraud investigations, and toughen criteria for would-be providers and to screen inappropriate service requests. These changes started in early 2007, as soon as it became apparent that community support was open to abuse.

• In May 2007, Gov. Easley designated Dempsey Benton to be the state Secretary of Health and Human Services and specifically directed him to produce a set of proposals that will bring effectiveness and accountability to the state's mental health system. Secretary Benton has taken numerous steps to strengthen hospital oversight, involve independent experts and advocates, and increase accountability. The secretary's hard work has been uniformly welcomed.

Gov. Easley and Secretary Benton will soon recommend further initiatives to improve our mental health services for the General Assembly's consideration in May. More needs to be done.

Your editorial implies a lack of compassion and action for the mentally ill. This is false, as the above illustrations show.
Feedback offers persons or groups criticized in Observer editorials, columns or news stories an opportunity to respond. Read more!

What would we do without an ER room -Hendersonville (NC) Times-News

Life In The Middle
Susan Hanley Lane
02/25/08

What would you do if someone you loved was having a heart attack and there was no emergency room to go to?

Throughout America, hospitals and emergency rooms are having a hard time staying afloat thanks to HMO reimbursement guidelines, government cutbacks and rate freezes on Medicare and Medicaid, and a growing number of uninsured patients.

Like any other business, a hospital must pay its staff if it wants them to keep coming to work. They also have to pay their heating and electric bills, and their taxes.

Most of us take hospitals for granted because whenever we've needed them, they've been there. But an increasing number of Americans are finding out that when hospitals don't get paid, sooner or later they shut down. Go to Google on your computer and type in: emergency room closings. You may be surprised to discover you have about 130,000 entries to choose from. The overwhelming consensus is that emergency rooms, along with everyone else, are feeling the pinch of a tightening economy. But there are only so many things a nation can afford to do without. Emergency rooms are not one of them.

We've been hearing promises about affordable health care for years now. It's becoming a standard election year promise. The unpleasant truth is the solutions to this national health threat will be a tough pill to swallow.

If we ever hope to truly contain the cost of healthcare, we're going to have to change the way we approach 1.) the relationship of lifestyle to disease, 2.) the breakdown of the mental health care safety net, 3.) uninsured populations accessing our health care system, and 4.) the role of large insurance companies in setting reimbursement guidelines.

1.) The relationship of lifestyle to disease: Obesity, diabetes, substance abuse, heart disease, and many cancers are often the result of lifestyle choices. Unless we do the hard work of taking personal responsibility for our own health and the health of our children, these diseases will continue to gobble up a disproportionate share of our health care dollars.

Preventive health care is not just the medicine of the future. It is the fastest way to prevent overuse of the health care system from bankrupting America. What were we thinking when we allowed fast foods to be sold in schools? Do we wonder why obesity is skyrocketing with soda machines in the hallways?

Also, Americans have a right to demand that lobbyists for large corporations, like Monsanto, not be allowed to induce legislators to enact laws that forbid farmers from saving the seeds from their own crops and/or having to buy genetically engineered seeds that do not reproduce themselves.

2.) The breakdown of the mental health care safety net: Quiz question - What facility has the largest number of mental health care patients in the United States? Answer: The Los Angeles County Jail. This is a national disgrace. A nation that refuses to care for its own mentally ill population is guilty of the basest neglect, no matter how many foreign dollars it borrows to fight the righteous wars of other nations.

Believe it or not, substance abuse comes under the umbrella of mental health care. The lack of a real strategy to eliminate the drug culture that is flourishing across America has resulted in the number of arrests and imprisonments in our large cities doubling within the last decade.

Effective drug treatment, not building new jails, is the most cost effective way to fight the drug war. For every dollar spent on treatment, seven dollars are saved on cleaning up the aftermath of drug abuse in our society.

3.) Uninsured populations accessing our health care system: It is a strain on any emergency room to eat the cost of patient care. But generally, even the uninsured pay income taxes, part of which are funneled back into the health care system by state and local governments. It's not an even trade off, but this system has allowed emergency rooms to survive for many decades.

Unfortunately, in recent years things have changed. The number of undocumented workers who do not contribute to the tax base has soared. No nation that allows non tax-payers equal access to its emergency rooms can survive when the non tax-payers using those emergency rooms is a significant part of the population. (If you doubt this, type these words into your search engine: emergency room closings in southern California.)

If we do not solve this dilemma, don't be surprised if someone you love one day has a heart attack (say on a Sunday evening) and there is no emergency room close enough to take him to in time to save him.

4.) Large insurance companies setting reimbursement guidelines for health care providers: When HMO (Health Maintenance Organizations) first came on the scene, we were told they would manage our care. Instead, they have managed their own health by cost cutting and refusing to pay the kind of fees many health care providers need to charge to stay in business.

Something like the Hill-Burton law of 1946 would place the burden of health care for the uninsured back into the hands of state governments, which could then establish guidelines allotting grants and/or loans to hospitals to sustain reasonable treatment levels based on the most recent census data.

The establishment of free or low fee clinics with emergency rooms, where indigent people could go for care, is another option to solve this problem. Tax incentives could be granted to physicians, and hospitals who agree to participate.

The answers to our health care dilemma involve tough decisions. But we can do it if we will stop settling for political promises that are nothing more than candy coated lies. Read more!

Mental health groups asked to find waysto ease fund shortfall -Wilmington (NC) Star-News

By Vicky Eckenrode
02/26/08
vicky.eckenrode@starnewsonline.com

The Southeastern Center for Mental Health is pushing providers to form group meetings and services as a way to keep more troubled people off waiting lists until a new state budget year starts in July.

Still uncertain of the size of the funding shortfall they are facing in the coming months, Southeastern officials said Monday they are trying to deal with client referrals and getting people some level of service.

The center handles state funding for mental health in the area, authorizing treatment time for people and reimbursing private providers for those services.

Last week, center officials warned local providers that there probably will not be enough money to continue services for everyone who asks for help in the next four months and raised the possibility that non-urgent cases would be put on a wait list until more state funding comes through.

They said providers would not be reimbursed for taking on new cases and that existing services could be scaled back from some people. Those who already have been approved for services will not be cut off from their current programs, officials said.

Art Costantini, director of the mental health center, said he hopes group meetings will help keep better tabs on people who need treatment and see if someone needs immediate help.

"It will keep us in touch with them," he said. "There's always a fear that if someone's on a waiting list, they're going to deteriorate."

Costantini also is asking the private providers to weigh individual cases to stretch money. If a client has been approved for a certain number of hours of service each week but does not need them all, the extra time could help someone else, he said.

Center officials announced its funding woes last week. Part of the problem, they said, stemmed from expecting to receive $7 million from the state for the current budget year that started last July and runs until June.

In November, the state informed the center it would be receiving the same amount it spent the year before, about $4.6 million.

The center also is still trying to figure out how much money needs to be paid out to providers for already approved services. Officials have authorized services, but said they are unsure how much was actually given and will be sent in for reimbursement.

Costantini said some clients are authorized for services and treatment but end up needing less time or stop receiving help.

He said the center has given providers 60 days to turn in their outstanding bills that need to be reimbursed.

Vicky Eckenrode: 343-2339

vicky.eckenrode@starnewsonline.com Read more!

Mental health sinks by the bow ... Wilmington (NC) Star News

Editorial: 02/26/08

Just when you think North Carolina's mental health "system" can't get worse, it does.


We're spending twice as much on the mentally ill as we did before "reform," but hundreds of millions of dollars have been squandered on non-medical services provided by high school graduates paid as if they were multi-degreed professionals.

In a horror story published Sunday, The News & Observer laid out merely the latest facts and figures of failure. What they add up to is that the Department of Health and Human Services was little short of criminally negligent in the way it set up a complicated, privatized and fundamentally different system that was supposed to save patients and money.

It saved neither.

With sick people kicked out of state hospitals and sent home to find services that didn't always exist, it's no surprise that at least 13 patients have committed suicide or overdosed on drugs.

With private outfits given the opportunity to bill the state for every little thing, many did. DHHS didn't notice. People who needed the most medical help didn't always get it.

When an audit ripped a gash in the hull and water started pouring in last fall, DHHS Capt. Carmen Hooker Odom slipped into a lifeboat and rowed toward a job in another state.

Admiral Mike Easley then offered a retired Raleigh city manager named Dempsey Benton the high honor of climbing to the bridge, where he is energetically directing how the deck chairs should be re-arranged. Members of the crew insist that it's only a matter of time before the vessel rights herself and takes a new course toward mental health for all.

But skeptics believe that from across the cold waters they can hear the faint strains of Nearer, My God, To Thee. Read more!

Admiral Easley must answer - Wilmington Star-News

Editorial: 06/26/08

Mike Easley is trying to dodge blame for the state's tragic mental health fiasco, but he can't. He's been governor since "reform" started in 2001. He may not have made the mess, but neither did he clean it up.

To be sure, governors can't do everything. Like Jim Hunt before him, Easley has focused most of his attentions on education. That was smart for our children, our state's future and Easley's political fortunes.

Also like Hunt before him, Easley focused too little on improving mental health. He left that to others.

In 2001, well-intentioned citizens, experts and legislators studied the issue and came up with a variety of recommendations. They sounded nice, particularly to families of patients hospitalized far away.

But plenty of people (including the Star-News editorial board) expressed doubts that these programs would work.

If Carmen Hooker Odom, Easley's secretary of health and human services, had doubts, she did not express them publicly. Nor did she or her public relations people dispute news stories and editorials that said she and her aides supported the plan.

The chief legislative backer of the changes told The News &Observer that "she (Hooker Odom) never told me she opposed it. No one in the department ever told me they opposed it."

Yet Easley is now insisting that Hooker Odom expressed opposition "vigorously."

How? By holding her breath and hoping somebody would notice and ask what was wrong? Read more!

Reform just keeps getting worse -Hendersonville (NC) Times News

Editorial: 02/26/08

The alarming rate at which the state's mental health care system is hemorrhaging money is the latest sign that the Legislature's overhaul led to disaster.

The Raleigh News & Observer reported Sunday that the state has wasted more than $400 million on so-called community support services. The newspaper based its investigation on a state audit of services provided to more than 12,000 people.

The report found that state officials with the Department of Health and Human Services and the Division of Mental Health defined the services too loosely and agreed to pay too much. The audit said 89 percent of the services were medically unnecessary or given in the wrong amount.

As the Times-News first reported in the spring of 2005, the reform has been a slow-motion train wreck.

The state wanted to treat fewer people in large state hospitals and more in their own communities. Regional coalitions of counties would manage providers and ensure equal access.

Instead, county-operated services shut down and the state reduced hospital beds before new local providers were in place. With nowhere else to go, people in need of treatment flooded jails, hospital emergency rooms and homeless shelters.

Now we learn that the local providers that did spring up hired high school graduates to take people to the movies or shopping while charging taxpayers $61 an hour. In the meantime, people who needed more than a companion at the movies or a day at the mall couldn't get the more intensive treatment they needed.

Mental health care advocates lay much of the blame on Carmen Hooker Odom, the Health and Human Services secretary for six years, and Mike Moseley, the mental health division's director. Hooker Odom resigned last year for a job with a New York foundation and Moseley, no doubt seeing the handwriting on the wall, announced his retirement Friday, two days before the N&O published its report.

While those two deserve some of the blame, plenty of others deserve a share too, including state Rep. Verla Insko, D-Chapel Hill, who sponsored the reform legislation, and Gov. Mike Easley.

Easley shifts the blame to the regional coalitions that manage the providers.

"All we are is the banker," Easley said.

Hmm. The state holds the purse strings and defines what the services are. That sounds like plenty of control to us. It is obvious that the state has failed to provide the leadership, oversight and accountability that would make any reform work.

So far, the mental health reform mandated more than six years ago has only made things worse for the most vulnerable among us. State officials need to stop pointing fingers and figure out how to ensure that people who need help the most get treated by professional and accountable providers.
Read more!

Alternative school closes doors -Wilson (NC) Daily Times

By Gina Childress | Daily Times Staff Writer

New Opportunities, an alternative learning facility located on Douglas Street, has stopped providing services to Wilson County students.

Bob Kendall, public relations director for Wilson County Schools, said the district received notification from Neil Weeks, vice president of operations for New Opportunities, through an e-mail correspondence Feb. 8.

"This is to inform you that effective February 22, 2008, Wilson County Alternative School, 'New Opportunities' will no longer provide services to clients in Wilson County. The school system will need to address transition of current students to appropriate alternative school programs," Weeks writes in the e-mail.

This short notice has left the school system scrambling to make accommodations for six children.

Youth attending the facility were classified as at-risk youth who experienced behavioral difficulties in a school setting and could not be placed in a classroom environment. They were offered therapeutic activities to assist with behavior management and social skills, as well as being taught core academics.

Wilson County Schools entered into a contract with New Opportunities on Aug. 22, 2005, to provide services for children referred to as exceptional students according to the state guidelines set by the N.C. Department of Public Instruction.

According to Kendall, three elementary students and three middle school students were affected by the closing. Elm City Elementary and Darden Middle schools were chosen to house the displaced children.

Kendall said the classes at Elm City and Darden have been staffed with certified exceptional teachers and certified exceptional teacher assistants.

A search is under way for an agency that will provide immediate therapeutical services for the students, Kendall said.

Messages requesting comment from Curt Winbourne, president of the facility, were not returned. However he did issue an e-mail statement:

"Our decision to close our facility is for business reasons. We have enjoyed our relationship with Wilson County Public Schools and are grateful for the opportunity to serve the youth of this county," Winbourne said.

Stephanie Alexander, chief of the Mental Health Licensure and Certification Section of the N.C. Division of Facility Services, said the license of the facility is still valid.

"As of right now, the database shows the facility has a valid license beginning Jan. 1 through Dec. 31 of this year," said Alexander.

gina@wilsontimes.com | 265-7821 Read more!

State must avoid mental health crisis -Daytona Beach (FL) News-Journal

By STEPHEN H. GRIMES
02-026-08

Annually, as many as 125,000 people with mental illnesses requiring immediate treatment are arrested and booked into Florida jails. And on any given day, more than 70,000 individuals with serious mental illnesses reside in Florida's jails and prisons or are under correctional supervision in the community. Frequently, these individuals enter the justice system as the result of committing relatively minor offenses that are directly related to symptoms of acute, untreated mental illnesses.

Unfortunately, many of these individuals find that they are either denied community-based care or that the care they do receive is fragmented and insufficient to respond adequately to their level of need. Disabled and vulnerable, they recycle through the system, creating a revolving door of criminal and legal involvement.

Measures have been taken in the past to reform this unsystematic approach to Florida's mental health system, but to no avail. The movement from institutional to community-based treatment was never fully executed or funded, resulting in decades of fragmented mental health care. The existing community mental health system leaves enormous gaps in treatment and access and is not designed to serve the needs of individuals who experience the most chronic and severe forms of mental illnesses.

Some of us have served on trial courts across the state and have witnessed firsthand the problems that are created when courts are forced to deal with mental health issues. Without proper treatment, these individuals appear and reappear in court. But all of us know that the problems with the current system weigh heavily on law enforcement and the criminal justice system -- courts see increasingly high numbers of cases and jails are continually overcrowded. Based on recent trends, Florida can expect the number of prison inmates with mental illnesses to nearly double in the next nine years to more than 32,000 individuals, with an average annual increase of roughly 1,700 individuals per year. To keep up with such demand, the state would need to open at least one new prison every year.

The state spends roughly a quarter of a billion dollars annually to treat roughly 1,700 individuals under forensic commitment; most of whom are receiving services to restore competence so that they can stand trial on criminal charges and, in many cases, be sentenced to serve time in state prison. Without a change to the existing system, the state faces potential forensic expenditures of a half-billion dollars annually by the year 2015.

There is hope. A comprehensive plan was recently unveiled under the joint leadership of all three government branches and with sponsorship from Chief Justice R. Fred Lewis and Gov. Charlie Crist. The initial six-year plan would effectively respond to the needs of individuals with mental illnesses by reorganizing services and service delivery to reduce demand for costly and inefficient levels of care, while reinvesting the savings in more efficient prevention and community-based treatment services.

For the first time in decades, a solution is at hand: an infrastructure for more comprehensive community-based treatment for individuals and families, an opportunity for recovery, increased public safety and savings of critical tax dollars. Reform of our mental health system is crucial to ensuring humane treatment of all the citizens of Florida. Our jails and prisons should no longer be asylums.

Under this redesigned system of care, there will be: programs incorporating best-practices to support adaptive functioning in the community and prevent individuals with mental illnesses from inappropriately entering the justice and forensic mental health systems; mechanisms to quickly identify and appropriately respond to individuals with mental illnesses who become inappropriately involved in the justice system; programs to stabilize these individuals and link them to recovery-oriented, community-based services that are responsive to their unique needs; and financing strategies that redirect cost savings from the forensic mental health system and establish new Medicaid funding programs.

We strongly urge the Florida Legislature to adopt and implement the recommendations made for the transformation of the public mental health system. In doing so, lawmakers will achieve the dual purposes of addressing needed change and improvements in efficiency of the mental health system, as well as reducing a costly and unnecessary burden on all facets of the justice system.

Grimes is a former chief justice of the Florida Supreme Court. He authored this commentary with former chief justices Major B. Harding, Leander J. Shaw, Ben F. Overton, Parker Lee McDonald and former Justice Joseph W. Hatchett. Read more!

Shot over snowball, Olney youth dies -Philadelphia Inquirer

By Joseph A. Gambardello, Dwight Ott and Robert Moran

Teven Rutledge's father wants to know what kind of man would shoot a boy over a snowball.

Keith Wilson uttered the question yesterday afternoon, just hours after his 15-year-old son died from a gunshot wound to the head.

Teven, who had battled ADHD and a bipolar disorder, was shot Sunday - his birthday - after a snowball fight with friends on the 4800 block of D Street in Feltonville turned vicious.

Accounts differed as to what exactly happened, but they agreed on one point: The killer apparently left and then came back before shooting Teven, of the 400 block of Lindley Avenue in Olney.

Police said the gunman had been hit in the face with a snowball, but the victim's friends said the snowball had hit another youth, who then complained to the adult.

"What grown man is going to shoot a kid over a snowball?" Wilson asked.

Police Chief Inspector Keith Sadler had one word for it: horrendous.

Police were looking for a neighborhood man known to local youths as Omar. Sadler said a search of the man's house turned up drugs, but no suspect, on Sunday.

Still, Sadler said, investigators needed more witnesses to come forward.

Wilson acknowledged that Teven could have "a tough mouth, like most kids."

"But I taught him how to avoid trouble," the dockworker said.

Teven attended Community Council, a private school that works with children who have emotional and behavioral problems, under contract with the Philadelphia School District.

"He overcame a lot," Wilson said while waiting for his wife, Alisha Rutledge, to return home. "He had learned to come home on time, to do the dishes, to do the laundry. He made a lot of progress."

"I got to see through a child's eyes what it's like to be misunderstood," he said.

After Teven died at 11:34 a.m. at Temple University Hospital, Travis Davis, 13, and his brother Wayne George, 17, who were among those involved in the snowball fight, returned home and climbed the blood-stained, crumbling concrete steps where their friend had been mortally wounded.

They emerged later with a large blue blanket on which they had written "RIP Teven. We're going to miss you," and nailed it to the front of the rowhouse.

Catherine Briggs, 15, said she watched the snowball fight from her porch on D Street.

She said that after one youth was hit by a snowball, he spoke in Spanish to a man who had just come out of a store.

"He [the man] said to Teven, 'He wasn't playing with you,' " Briggs said. "Teven said he didn't mean to hit him."

She said the man picked up some snow and threw it at Teven, whose age police incorrectly reported Sunday as 16.

The teen then went to his friend's house to call his father, and while there, Tara Briscoe, his friend's mother, told him to stay inside.

But when she went to tend to something in the kitchen, she heard a gunshot.

She opened the door and Teven, bleeding from a wound over his left eye, fell into her, Briscoe said.

As she used a towel to stanch the bleeding, Briscoe said, she urged the teen to stay calm.

"OK, Moms," is how he replied, she said.

"He wasn't even involved," Travis Davis said of the gunman. "He was taking up for somebody else."

A neighbor cited another possible factor in the shooting, saying that teenagers who hung out in front of the house where Teven was shot would taunt people walking by.

"They were talking at people, making jokes at people," said Tracey Cooper, 40, the block captain of the 4900 block of D Street. She did not know the teens but said they began to gather at the house after the family moved in a few months ago.

Wilson hopes police catch the killer soon, but he does not want the punishment to be death.

"I know God will take care of this," he said.

Another man, Joseph Best, is serving 25 to 50 years in prison for a 2003 shooting in retaliation for a snowball fight in which his daughter was involved in West Philadelphia.

Ebony Smith, then 10, suffered permanent brain damage in the shooting exactly five years and one day before Sunday's attack.

Contact staff writer Joseph Gambardello at 215-854-2153 or jgambardello@phillynews.com. Read more!

Deputies may cane ‘Chairiff’ on jail -Portland (OR) Tribune

Feb 26, 2008

Since earlier this month, when Sheriff Bernie Giusto signed over many of his powers to Multnomah County Chairman Ted Wheeler, Wheeler’s aggressive use of those powers has earned him a new nickname among sheriff’s deputies: “The Chairiff.”

Many deputies are unhappy with Wheeler’s plan to open a portion of the currently unused Wapato jail for drug, alcohol and mental health treatment beds under the county’s Department of Community Justice.

The Multnomah County Corrections Deputies Association has written a counterproposal, one supported by prosecutors and others, which the union says will keep more jail beds open.

Besides logic, the union is willing to use brute political force. Wheeler hopes to put a levy on the November ballot to fund social service programs in the name of crime reduction.

According to board member Sgt. Darcy Bjork, the union has informed Wheeler that if he cuts jail beds to pay for his Wapato plan, it will spend money to “inform” November’s voters of his record on public safety.

Adams, fee could make strange ballotfellows

When the elections filing deadline hits March 13, expect mayoral front-runner Sam Adams to breathe easier. That’s because Adams’ recent move to push a vote on his street fee back to November only makes it more inviting for another serious challenger to enter the race.

His most prominent challenger, businessman Sho Dozono, is not assured of being able to push Adams into a runoff. While nine other candidates also are in the race, none of them appears to be the kind of third well-funded challenger that would make a November runoff almost a sure thing.

A November runoff would give challengers more time to make a case against Adams.

Not only that, but the street fee being on the same fall ballot would be a potent reminder that four years ago, Adams ran for City Council while promising he would oppose new tax increases. Small wonder that Adams went through such gyrations to keep the fee off the May ballot.

Street fee conspicuously absent

Speaking of the street fee, Adams raised eyebrows over the weekend when he placed his promised follow-up resolution on the City Council’s Wednesday agenda – and it did not mention either the fee or the November election.

The council originally enacted the $422 million fee plan in late January, but pulled it back after critics launched a petition drive to refer it the May ballot. Adams then seemed to promise he would ask the council to place it on the November ballot on Feb. 27.

But the new resolution only calls on the council to support the Portland Office of Transportation’s efforts to raise money for street repairs, and directs PDOT to report back on the issue by July 16.

Adams’ chief of staff Tom Miller swears his boss isn’t backing off from the fee or the November election, saying more work is needed to prepare the plan for the ballot. Critics like lobbyist Paul Romain of the Oregon Petroleum Association aren’t convinced, however, noting that Adams had an entire month to rewrite it.

– Tribune staff Read more!

Louisiana to Revamp Mental Health Plan - Associated Press

NEW ORLEANS (AP) -- Louisiana's top health official announced a plan on Tuesday to revamp the New Orleans-area's mental health system, which has been in disarray since Hurricane Katrina devastated the area.

State Health and Hospitals Secretary Alan Levine said James McDonough, who is credited with improving Florida's prison system, will lead a ''transformation team'' that will spearhead several new initiatives.

Levine announced the plan at the New Orleans Adolescent Hospital, where the state recently doubled the number of adult psychiatric beds by adding 20.

Access to psychiatric treatment is a major problem in the area.

Charity Hospital, which has been closed since Hurricane Katrina struck in August 2005, had a 98-bed mental unit. It has not been replaced, leaving the Orleans Parish jail's 60 psychiatric beds the largest acute-care ward in New Orleans.

''This issue is overwhelming hospitals, law enforcement, community agencies ... and most importantly, families who have a loved one who is suffering,'' Levine said.

Levine said the state's Metropolitan Human Services District is supposed to work with people to prevent crisis, but has been unable to ''get traction.''

''We must change this, and it must start immediately,'' he said.

Levine's plans include adding three teams to monitor mental patients and make sure they take their medicine. One of those teams will work only with people whose problems have led to arrests or court charges against them.

Other proposals include short-term subsidies to provide safe housing for mental patients until they can get longer-term help through federal or other programs; five mental health teams to help community clinics around Orleans, Plaquemines and St. Bernard parishes; and a regional center where police could bring mental patients.

If the New Orleans-area ''receiving and triage center'' works out, similar centers would be set up around the state.

McDonough, a retired Army colonel and former head of Florida's drug control agency, announced last month that he was retiring as Florida's corrections secretary -- a job he was given in 2006 after his predecessor was charged with taking kickbacks from a prison contractor.

Read more!

Lawsuits challenge use of 'chemical restraints' in nursing homes - Trial Magazine

Valerie Jablow, Associate Editor

For David Couch, an attorney in Little Rock, Arkansas, Robert Harris was “just a grumpy old man” suffering from mild dementia who should not have died eight weeks after admitting himself to a nursing home.

Harris wanted to be around people, said Couch, and felt bored staying at the house of his daughter, who was often away at work.

“He was a very active man, set in his ways. He was complaining a lot about stuff, walking around” at Lawrence Hall Nursing Center in Walnut Ridge, Arkansas, Couch said. “Because he was so active, the people at the nursing home thought he had psychotic problems and that he needed drugs.”

The complaint in the wrongful death lawsuit filed by Harris’s estate against the nursing home and an adjunct hospital alleges that the drugs administered shortly after his arrival—Risperdal, a so-called atypical antipsychotic, and Haldol, an older antipsychotic—caused Harris to become “an involuntary catatonic prisoner.” In detailing claims that the defendants had inadequate staff and failed to monitor his condition, the complaint alleges that after Harris started the drugs, he stopped eating and drinking normally, lost almost 10 percent of his body mass within a month, could not walk about as he did before, became confused and increasingly drowsy, and then developed incontinence that required a catheter.

The catheter was inserted improperly, puncturing Harris’s urethra, Couch said. Harris died from a massive infection. (Downing v. Lawrence Hall Nursing Ctr., No. CV-2002-67 (Ark., Lawrence Co. Cir. filed June 10, 2002).)

In being treated with so-called chemical restraints, Harris was not alone: In recent years, increasing numbers of nursing home residents have been prescribed antipsychotic medications to manage their behavior. The most recent research, by Becky Briesacher at the University of Massachusetts Medical School, shows that nearly 30 percent of the nation’s 1.4 million nursing home residents received the drugs in 2001, up almost 10 percent from 1999. Most, like Harris, do not have a diagnosis of psychosis but are prescribed the drugs off-label, for management of dementia. (Becky Briesacher et al., The Quality of Antipsychotic Drug Prescribing in Nursing Homes, 165 Archives Internal Med. 1280 (2005).)

Many doctors and researchers acknowledge that the drugs, approved by the FDA for use only in those suffering from schizophrenia and mania, can calm or sedate agitated or otherwise disruptive demented patients. But their use in those suffering from dementia is not without controversy.

Congress passed legislation to address the issue more than 20 years ago. The Omnibus Budget Reconciliation Act (OBRA) of 1987 contained provisions to improve nursing home care, including minimizing the use of physical and chemical restraints, with penalties for noncompliance.

“The issue was to free people from unnecessary drugs and excess dose and duration and to make sure the drugs were not being used for the convenience of staff or for punishment of patients,” said Michael Harper, a doctor specializing in geriatrics at the San Francisco VA Medical Center. “With patients with difficult behaviors, one of the easiest things to do is sedate them with antipsychotics and other drugs.”

Briesacher said that after OBRA was enacted, prescriptions for antipsychotics in nursing homes dropped—for a time.

“Then, in the early 1990s, this new generation of atypical antipsychotics came out. They were pushed really hard by the drug companies with the promise that they had fewer side effects” than the older generation of antipsychotics, she noted. “So people felt more comfortable using them in populations other than those who had schizophrenia, and that included nursing home residents who had dementia.”

Harper said the drugs are used in nursing homes to control several different behaviors.

“Sometimes they’re prescribed for patients with psychotic symptoms, sometimes for patients with violent behavior, agitation, which is very broadly defined,” he said. “Most experts would say that antipsychotics are most likely to have a beneficial effect if you have a really targeted symptom that you can monitor, to see if it improves. But the problem with all these drugs is regression to the mean, so they almost always look better in people’s experience because you start them when someone’s at their worst and then they’re likely to get better.”

Despite the medical breakthrough that atypical antipsychotics represented, in April 2005 the FDA ordered a so-called “black box” warning for the drugs when used off-label in the elderly suffering from dementia. Seventeen studies of the drugs showed that the death rate in that group was higher than in those taking a placebo.

A year later, a widely cited study showed that the drugs’ adverse side effects in those suffering from Alzheimer’s disease outweighed their advantages in the treatment of the patients’ aggression or agitation. (Lon Schneider et al., Effectiveness of Atypical Antipsychotic Drugs in Patients with Alzheimer’s Disease, 355 New Eng. J. Med. 1525 (2006).)

In fact, in congressional testimony in February 2007, FDA researcher David Graham estimated that as many as 15,000 elderly people die every year in nursing homes from the off-label use of antipsychotic medications.

“We have pretty strong evidence that atypical antipsychotics increase the risk for falls, fractures, and some people even say death,” said Briesacher. “In the population that has dementia, the benefits are really unclear.”
Finding the facts

For attorneys handling cases where chemical restraints—including tranquilizers and antidepressants as well as antipsychotics—may be a factor, figuring out how to prove negligence can be tricky.

On February 9, 2006, Helen Marciniszyn was admitted to a personal care home (also known as an assisted-living facility) with mild dementia and an unsteady gait. Two months later, she was dead from complications of a hip fracture from a fall at the home.

What happened at the home in the intervening months is central to a lawsuit against the home and its corporate owners brought by Philadelphia attorney Robert Sachs on behalf of Marciniszyn’s children. (Shields v. Indep. Blue Cross, No. 07-11090 (Pa., Del. Co. Com. Pleas filed Aug. 22, 2007).)

Outlining claims of negligence and wrongful death, the complaint alleges that the day after Marciniszyn was admitted, a doctor, without seeing her, prescribed Seroquel, an atypical antipsychotic, for psychosis. Less than two weeks later, another doctor prescribed a tranquilizer, Ativan, again without seeing her.

The doctors were not the only ones not seeing Marciniszyn; according to Sachs, the family was discouraged from visiting her in the first two weeks of her stay at the home.

“They were told that their mother needed to get adjusted to the facilities,” Sachs said. “So the family had no idea that with these drugs that she had never taken before, she was out of it. They deprived the family of the opportunity to protect her from these medications.”

Five days after the Ativan was prescribed, Marciniszyn fell, breaking her hip. The complaint alleges that the home improperly restrained her with drugs and that the medications placed her at an increased risk of falling.

“It wasn’t just the use of the atypical antipsychotic, but the combination of both drugs that created a situation where it was a foregone conclusion that she would fall,” said Sachs.

Memphis attorney Parke Morris is handling two cases of chemical restraints in nursing homes. His clients are suing the homes for wrongful death and negligence after the deceased were prescribed large quantities of powerful tranquilizers and antidepressants. (Stotts v. Beverly Enters., No. CT-001376-03 (Tenn., Shelby Co. Cir. filed Mar. 11, 2003); Johnson v. Orion Memphis, No. CT-005181-06 (Tenn., Shelby Co. Cir. filed Dec. 15, 2006).)

Morris said vigilant family members can be crucial to proving these cases, because they are often the first to notice changes in a resident’s behavior. But sometimes luck, too, plays a role in determining whether chemical restraints were used.

“In one case, surgery before the patient’s death showed unmetabolized pools of the tranquilizer Ativan,” Morris said. “But in the other, we were lucky to have an employee come forward after the case was filed, who claimed he was fired for warning the family about chemical restraints.”

Although nursing homes are required to have a pharmacist review drug use for each patient at least every 30 days, oversight is minimal, according to Armon Neel, an independent geriatric con;sultant pharmacist in Griffin, Georgia.

“Consultant pharmacists can make all kinds of recommendations to the physician about drug therapies and inappropriate drug doses, but if the doctor does not want to accept that, he can move right on. There is no oversight, and that is wrong,” Neel said.

He also sees an inherent conflict of interest in how pharmacists review drug plans in nursing homes.
“Although a nursing home pays for a consulting pharmacist, the consulting pharmacist usually works for a pharmacy provider, often a big chain operation that the nursing home contracts with for drugs. There’s a conflict of interest, because in the nursing home the intention is to keep patients away from unnecessary drugs, and the pharmacy provider wants to move market share: More drug use, larger drug costs.”

In response to such critiques, Barry Straube, chief medical officer at the Centers for Medicare and Medicaid Services(CMS), which funds more than 60 percent of nursing home care, told the Wall Street Journal that the agency “has initiated a more rigorous process to oversee appropriate use of medicine” and that the number of nursing home inspections resulting in citations for drug misuse jumped nearly 50 percent between 2004 and 2007. (Lucette Lagnado, Prescription Abuse Seen in U.S. Nursing Homes, Wall St. J. A1 (Dec. 4, 2007).)

In December, Sen. Charles Grassley (R-Iowa) asked the inspector general of the Department of Health and Human Services to investigate the use of anti;psy;chotics in nursing homes. His letter noted that Medicaid spent $5.4 billion on atypical antipsychotics in 2005, 25 percent of which was for nursing home residents.
Time and money

Lawyers say the use of antipsychotics in nursing homes is tied to the widespread problem of inadequate staffing in these facilities and the industry’s focus on the bottom line. Sachs believes money is at the heart of the matter.

“Especially in for-profit homes, the nursing staff realizes that they can supervise more people if the patients are less active,” he said. “They encourage the prescription of potent medications that have the effect of sedating and tranquilizing patients, thus reducing their activity level. This is important, because in a for-profit care environment, having fewer care providers improves the bottom line. So the employees look good because they are managing a higher patient load, the owners look good because they’re earning greater profits, but residents suffer from reduced quality of life because when people are sedated, they are often at greater risk of falling.”

Charlene Harrington, a researcher at the University of California, San Francisco, noted in congressional testimony in November 2007 that total average of staff at nursing homes has not increased since 1997, and nurse staffing hours per resident day have declined 25 percent since 2000. That decline, she said, is tied to poor quality: A 2001 study commissioned by CMS found that 97 percent of nursing homes do not meet the minimal guidelines defined by the study for the level of nurse and patient interaction needed to prevent harm. (CMS, prepared by Abt Assoc., Appropriateness of Minimum Nurse Staffing Ratios in Nursing Homes: Report to Congress Phase II Final (Dec. 2001).) And CMS currently has no numbers for minimum staff.

Couch said this problem is central to what happened to Robert Harris.

“If they had more people there to interact with him, they wouldn’t have had to give him drugs. They took the easy way out, in my opinion. They just didn’t have the time or inclination to deal with Harris,” he said.

“I would say that 75 percent of people in nursing homes on antipsychotics shouldn’t be on them. People are bored, they don’t have anything to do, and they’re old. Once an adult, twice a child—they’re like kindergarten kids. If what was going on in our nursing homes was going on in our kindergartens, we’d be appalled as a nation.” Read more!

Man ruled insane getting out in 5 after taking wife's life? - Seattle Post-Intelligencer

By HECTOR CASTRO
P-I REPORTER

Thomas Gene Gergen never denied he killed his pregnant wife, Kari, in the couple's Shoreline home early on Jan. 5, 2003.

But after a series of mental evaluations at Western State Hospital, the courts determined Gergen was not guilty by reason of insanity, and he was committed to the custody of the hospital for treatment.

Now, five years later, Gergen, 35, might be set free, albeit under tight supervision.

Thursday, at a hearing in King County Superior Court, a judge will consider whether Gergen's mental health has improved enough for him to move off the Western State campus and into an apartment attached to his mother's Lakewood home.

It's a move Gergen's doctors and his lawyer said he is ready to make, but it's a move the victim's family opposes.

"He's not cured. He's not curable," said Kari's father, John Osterhaug. "He's prone to murder. You don't cure that."

Richard Lichtenstadter, the defense attorney handling Gergen's case, said he believes his client is ready for this but doesn't blame the Osterhaugs for their opposition.

"I think anyone can understand why a family that has been through this would feel that way," Lichtenstadter said. "How could you not?"

When Gergen was arrested in 2003, suffering from a gunshot wound to his face that investigators say was self-inflicted, he was initially charged with domestic violence first-degree murder and first-degree manslaughter. His wife had been seven months' pregnant at the time, and the shooting also killed the fetus, a girl she had planned to name Hazel.

But investigators discovered that the killings came at the end of a lengthy period of decline in Gergen's mental health, marked by increasing paranoia and even delusions.

Twice he came near getting help for his mental health breakdown -- once while on a visit with family in Kentucky in early December 2002, and again the night before the slayings, when his wife and mother tried to have him admitted to a hospital in Seattle, without success.

Soon after his arrest, according to court documents, Gergen began a treatment regimen in the King County Jail that included Risperidone, a psychiatric medication often used to treat schizophrenia. Within a month, his delusions faded, according to his attorney and court records.

Doctors diagnosed him with schizoaffective disorder, and in February 2004 he was acquitted by reason of insanity. But he also was found to pose a substantial danger, so he was committed to Western State as criminally insane.

Once there, according to court documents, Gergen was held in the hospital's Center for Forensic Services, a secured facility with locked rooms and where workers at a control station watch patients around the clock, monitoring the 29 cameras located throughout the building.

Gergen became a model patient. According to court records, he participated in group therapy, met regularly with a therapist, became a leader among the patients, even ran patient meetings. Soon, he was going on organized field trips with the staff.

Lichtenstadter said Gergen's progress appears rapid in part because his mental illness had gone undiagnosed until the slayings.

"He never was treated in the community so his first treatment happened since he did this," the attorney said.

By July 2006, doctors at Western State were recommending Gergen could move from the secure facility into the hospital's Community Program. There, the day is heavily structured, but patients can earn increasing privileges that include furloughs from the facility, from the hospital and even permission to drive a car.

Osterhaug's family opposed what amounted to a conditional release from Western State, arguing at the time that Gergen could escape, go off his medications and come after them. They also let the court know they no longer believed Gergen was insane when he killed his wife.

They said Gergen had been abusive to their daughter and killed her because she intended to divorce him.

"Rather than be released, I believe he should face trial for murder," John Osterhaug wrote in a letter to the judge.

But the courts, following the recommendations of the doctors, granted the conditional release in October 2006. Over the past year, Gergen has flourished in the Community Program, Lichtenstadter said. He has not attempted escape, has maintained his medical regimen, committed no infractions and continued to participate in his therapy.

"He's working, has a job. He's doing really well," Lichtenstadter said. "He's sort of the poster boy for what can happen with treatment."

The ultimate goal of the program, as suggested by its name, is to prepare a patient for eventual return into the community.

Kris Flowers, Western State spokeswoman, said only 5 percent of the patients who have gone through the program ever reoffend.

"It's a very, very structured program," Flowers said. "It has been challenged at times because they are people who have committed some heinous crimes."

Just to get into the program, she said, patients work through several levels of treatment. Typically, the patient's treatment team is the one that recommends they be placed in the program. That recommendation is then reviewed by the hospital's Risk Review Board.

That same board also reviews any other modifications for patients, such as Gergen's possible move off campus.

Should Gergen's modified release be approved, he would be closely watched. Patients in the community are seen regularly by a clinical nurse specialist, still must participate in therapy and still must take medication.

"He's going to be continued to be monitored by the staff at Western State Hospital. If Western State ever sees any issues or any problems, they have the authority to bring people back into their hospital immediately," Lichtenstadter said.

After the shooting, the immediate reaction of Kari Osterhaug's family was not just grief but also sympathy for Gergen, whom they had liked, and his family. It was why they did not push prosecutors to seek a criminal trial that could have ended with Gergen in prison.

"I didn't want to hurt them," Ingrid Osterhaug said, referring to Gergen's family.

Both said they believed Gergen would be better off in a mental hospital, rather than a prison.

Although they felt he needed treatment, both parents said they were told by prosecutors and victim advocates that such treatment would take years, up to 20, or nearly as long as a criminal sentence would have been had Gergen been convicted at trial.

"I think we were misled as to Tom's fate," Ingrid Osterhaug said. "I never would have gone without a trial if I had known he was going to be out on the streets again."

Lichtenstadter said his client is ready to live in the community again.

Gergen now knows he has a mental illness and is committed to taking his medications, largely because of his own remorse over the murders he committed, the attorney said.

"It's a horrific tragedy. He doesn't mince words about what happened. It's something he lives with every day," Lichtenstadter said. "All he wants to make sure is that he's safe."

But Osterhaug's parents remain unconvinced and pin their hopes on delaying, for as long as they can, Gergen's full release into the community.

"He will be a model patient until the time comes that he meets another woman," Ingrid Osterhaug said. "And God help her."
P-I reporter Hector Castro can be reached at 206-448-8334 or hectorcastro@seattlepi.com. Read more!

Budget cuts to hurt those most in need -Nassau (NH) Telegraph

Editorial:

Five weeks ago, when Gov. John Lynch delivered his annual State of the State address, it was pretty clear that the existing two-year budget that went into effect in July 2007 wasn't etched in concrete.

While the governor didn't make specific reference to it in his 3,280-word address that day, a looming $50 million deficit this year swung over his head like the mythical sword of Damocles.

So when Lynch said that "barring an emergency" he would not support any legislation that would necessitate an increase in spending this year, he was only scratching the surface of what, by all accounts, is a worsening economic picture for the state.

That's why it wasn't much of a surprise earlier this month when the governor announced $50 million in proposed cuts in a bid to keep the budget in balance through the end of the fiscal year June 30.

Nor was it much of a surprise when the Legislative Fiscal Committee voted last week to approve a reduction in spending of $46.4 million. Another $3 million that would come from the legislative and judicial branches will require approval from the full Legislature.

The prospect of slicing $50 million from a two-year budget of $10.3 billion – about one-half of 1 percent – doesn't seem like much on paper, of course, but it does if you are the agency counting on that money to provide what you feel are essential services to citizens of New Hampshire.

And as is usually the case when state governments run into revenue problems, the budget correction tends to impact those individuals most in need of the state's assistance.

The biggest piece of pie – $22 million – will come from the Department of Health and Human Services, including $7 million in payments to hospitals to treat Medicaid patients. Services to the mentally ill, substance abusers and cancer prevention are among the programs that will get less money this year than originally intended.

While state spending will no doubt be an issue in the gubernatorial race this year – that's what happens when you sign off on a budget that contains a 17 percent increase in spending – the reality is that New Hampshire is hardly unique.

An Associated Press story this week reported that some 18 states are experiencing deficits in their current budgets totaling $14 billion. When you add anticipated revenue shortfalls for 2009, that figure balloons to $34 billion.

Consider:

In Rhode Island, Gov. Donald Carcieri is looking at a work force reduction of 1,000 in order to get a handle on a projected shortfall of $385 million next year.

In Minnesota, state officials will release the latest economic forecast this week that is expected to be two or three times larger than the $373 million deficit projected three months ago.

And in California, Gov. Arnold Schwarzenegger has proposed a 10 percent across-the-board budget cut in order to offset a projected $16 billion deficit in the 2008-09 budget year.

Back in New Hampshire, if things weren't bad enough, the $50 million approved here last week represents only the tip of the iceberg. Early deficit estimates for the budget year that begins July 1 are running around $100 million, or twice as high as the current year.

Given that it's unlikely either the governor or the Legislature are going to consider raising taxes or fees in an election year, all the budgetary pressure will be brought to bear on the spending side of the ledger.

We can only hope, then, that they will be particularly sensitive to the needs of those individuals who are most dependent on the state for assistance in the first place.
Read more!

Police Fatally Shoot Mentally-Ill Man -WLBT-TV Jackson (MS)

Video of story here.

By Monica Hernandez
monica@wlbt.net
02/25/08

John Hillhouse says his time living at the Woods of Lakeland apartment complex in Flowood has been pretty quiet. He never thought he'd have to make a frantic phone call to police Sunday night. And he never thought that call would be about his neighbor.

"He was a nice guy. I've known him as long as I've been here. I'd take him places he needed to go," Hillhouse said.

Hillhouse said he heard strange screaming noises last night. That's when he discovered his neighbor, Derek Johnson, naked and screaming in a bush near his apartment. Hillhouse says he knew that Johnson had a history of schizophrenia.

"I knew last night was an episode," said Hillhouse.

But when Johnson tried to get into Hillhouse's apartment with a boxcutter, he called police for help.

"That's all I wanted, everything to be safe, everyone to be okay."

But Hillhouse says he didn't expect what happened when police arrived.

"Police chased Derek Johnson from his apartment to this spot between the shell station and the apartment complex's entrance. That's where they finally caught up with him. That's where they shot and killed him."

But his family says they're not sure if it was the right thing to do.

"I think any man with a gun can defend himself without lethal force against a man with a knife, or a boxcutter."

"It's an unfortunate incident that occurred, but these officers are trained to use deadly force when the need arises," said Flowood Polic Chief Johnny DeWitt.

The neighbor who called police says he's upset that police are saying Johnson was a suspect for burglary. He was having an episode, and they tried to characterize him like a criminal.

"We had a very frantic 911 call that a person was trying to break into a place with a knife; that's all these officers knew when they arrived on the scene," said Chief DeWitt.

As for Johnson's brother, he says he just wants justice for his brother, and he wants to clear his brother's name.
Read more!

Guns and the mentally ill -Brandenton (FL) Herald-Tribune

Florida and other states lax in providing records for database

Feb. 26, 2008 at 4:30 a.m.

As the one-year anniversary of the shooting massacre at Virginia Tech approaches, state and federal officials report that they are making strides toward strengthening a national database designed to keep guns out of the hands of people with a history of mental illness.

The database, used by gun dealers to run instant background checks on prospective buyers, now contains the names of about 402,000 people who have been ordered by a court to receive mental health assistance, according to USA Today.

That is roughly triple the number listed in the database last April, when a troubled young man named Seung-Hui Cho fatally shot 32 people and injured 26 others at Virginia Tech before taking his own life.

Investigators learned afterward that Cho had once been ordered by a magistrate to seek mental health care -- and would have been blocked from buying weapons if Virginia had been more diligent in reporting the names of people with mental health problems to the database.

The massacre focused attention on serious flaws in the background-check system. At the time of the shooting, only 22 states were reporting names of people sent for mental-health counseling.

The number of participating states is now up to 32. Last month, President Bush signed a bill offering grants to states to help them send their records to the database. If states don't participate, they stand to lose federal funding for other law enforcement programs.

Judging from USA Today's examination of database records, the vast majority of states --including Florida -- have a long way to go before they become full partners in the reporting process.

About half of the 402,000 records in the database are from California, which just added its files on mental-health court orders last fall. Two other states, Virginia and Michigan, account for almost all of the rest, the newspaper found.

Some states are making progress. Florida, for instance, has added 9,674 records since last year. But, given Florida's overall population of 18 million, many cases undoubtedly go unreported.

Other states have a worse track record. USA Today reports that 16 states have sent 50 records or fewer to the database and seven have reported only one record each.

The Brady Campaign to Prevent Gun Violence estimates that the database should have at least 2 million mental-health records. "We're missing 80 to 90 percent of the mentally ill," the group's president, Paul Helmke, told the paper. "... That's scary."

There are, of course, no guarantees that the Tech massacre would have been prevented if Cho had been blocked from buying weapons from legitimate dealers. He could have obtained guns illegally or chosen another means of attack.

And the database certainly won't stop all shooting sprees. Steven Kazmierczak, who shot and killed five students before taking his own life at Northern Illinois University this month, had been undergoing psychiatric treatment. He was able to buy his guns legally, though, because he'd never been ordered by a court to seek help.

But, even with its limitations, a strengthened federal database would surely reduce the likelihood of violent rampages.

All states, including Florida, should be working hard to accelerate the reporting of records to the database.
Last modified: Tuesday, Feb. 26, 2008 at 2:03 a.m. Read more!

Investigattion: Woman Promises Autism Cure? - WKPX-TV San Francisco

Reporting
Anna Werner

CBS 5) There are thousands of children in the Bay Area diagnosed with autism, and parents are desperate for help. Families are looking at all kinds of treatments. A CBS 5 investigation uncovers an autism treatment that's promised as a cure.

It's being pitched at seminars across the country, several of which we attended with an undercover camera. At a seminar in Orange County, we heard that promise.

"We are talking about fixing the brain, fixing the brain forever," the program's inventor, Claudie Gordon-Pomares told parents. She said she can repair the brain through sensory stimulation called "Monitored Multi-cortical Activities for Additional Pathways and Synapses," or MAPS.

"Of course it works, because it's been proven" Gordon-Pomares said. "Doesn't matter the age, doesn't matter how long parents have tried something."

Who is Gordon-Pomares? Her Canadian center, the Brain Repair Institute, has been featured on local news. Her website shows amazing before and after results, and parents who like it.

Gordon-Pomares says it's a miracle cure for the brain she's spreading all across North America. Reaching parents including Chris and Holly Wetz, whose 5-year-old son Matthew was diagnosed with a type of autism.

"Trying to decide what to do, what would be the best thing to do, was really overwhelming," Holly Wetz said. The family had already tried many treatments. "We took him off wheat, we took him off milk," she said, which failed to help.

Although it cost $5,000 for just six months, the Wetz's decided to give MAPS a try.

"When you're a parent with an autistic child and you've tried everything, you know, you're like, 'Wow! We're going to miss our opportunity, we better do it,'" Chris Wetz said.

But one year later, Wetz said "You know we weren't getting anything. We kept getting promises."

So CBS 5 Investigates went to ask Gordon-Pomares, who insisted the treatment works.

"I believe the brain can fix itself," she told CBS 5.

And why does she say that? "Any brain dysfunction, any mental disorder is fundamentally a serotonin and a dopamine issue," Gordon-Pomares said. "So it can be a child with Down's Syndrome who has a low level of serotonin. It's not really a specific diagnosis- more the dysfunction going to the function."

"That is what is sometimes termed as psychobabble," said Dr. Bryna Siegel, director of the Autism Clinic at UCSF. Siegel is a world renowned expert on autism who reviewed the MAPS program for CBS 5 Investigates.

"She's using concepts that on the surface sound like she knows what is going on," Siegel said.

Siegel was also shown undercover video of the seminar recorded by CBS 5 Investigates.

"I think I would feel absolutely comfortable saying that there is no way that this is a cure for any case of autism," Siegel said.

CBS 5 asked Gordon-Pomares why top experts have said her program is not good.

Gordon-Pomares replied, "Well there are quite a few who say it's good. Experts Gordon-Pomares said, like pioneering brain researcher and UC Berkeley professor Mark Rosenzweig. He said, 'there's no problem, I will put my name behind MAPS and demonstrate it, the validity of it, to the world'."

So CBS 5 Investigates went to ask Rosenzwig about the MAPS program.

"Now when you say MAPS, what is MAPS?" Rosenzwig responded.

When we asked if he had validated Gordon-Pomares' work as she claims, his reply was "In order to do that I would have to know about it and look into it carefully and I haven't done that, so I do not put my name behind her work."

"Are they taking advantage of the parents & families with autistic children?" CBS 5 asked Dr. Siegel.

"Absolutely, it's totally exploiting a very very vulnerable population," Siegel said.

Gordon-Pomares responded to Siegel's statement by saying "No, I don't believe a parent who's fighting the world to save their child is vulnerable."

So is Gordon-Pomares really doing anybody any harm? In Dr. Siegel's professional opinion, yes.

"She's taking people's money and she's misrepresenting science," Siegel said, "especially when parents are told to take their kids out of school, or in the case of the Wetz's, to stop other therapies." "That's the very definition of unethical conduct. Because you are withdrawing something that is of benefit and replacing it with something that has no theoretical or empirical basis."

Gordon-Pomares responded: "I believe that they have to trust parents more. Parents are very intelligent."

"We did the research and everything," Chris Wetz said. "But you know, we got duped."

Gordon-Pomares claims to be a neuroscientist with two degrees from a university in France. But that university says it has no record of anyone graduating by that name. Read more!

Family members: Man depressedbut not a danger - Medford (OR) Mail-Tribune

February 25, 2008

Distraught family members of a suicidal Eagle Point man shot by police Sunday say Dan Waggoner was depressed and desperate but not a danger to others.

"I was there the whole time. He had a nervous breakdown. He just needed some help and they shot him up," said Amy Brown, the mother of three of Waggoner's seven children.

Deputies responded to a 9-1-1 call placed by Brown at the 1100 block of Dahlia Terrace at 3:40 p.m. Sunday and shot him when he exited his home and refused to put down his gun.

He was in critical condition today at Rogue Valley Medical Center after surgery for the gunshot wounds Sunday.

Brown, who no longer lives with Waggoner, had driven to his house when she heard gunfire from the home. Waggoner had threatened to commit suicide over the breakup of their 5-year relationship and the pending foreclosure on the property, she said.

"He'd told me 'They can take my house and they can my body with it,' " said Brown. "I heard a shot and I thought he did it. I was calling 9-1-1 as I was running. I got him to come out. And he did put the gun to his head."

Deputies were told by Brown that Waggoner was suicidal and armed with a shotgun and other weapons — including a hand grenade, said Sheriff Mike Winters. Jackson County's SWAT team and negotiators, Oregon State Police and Shady Cove police were called. Waggoner fired shots at the SWAT armored carrier. A deputy shot Waggoner after the armed man fled his home following a two-hour standoff when Waggoner failed to comply with the deputy's orders, said Winters.

"He was clearly instructed on multiple occasions to put down the weapon," he said.

The negotiator's approach didn't work, Brown said.

"SWAT ended up going up the driveway. Dan called me, he said, 'Amy, get SWAT out of here or I'm gonna die'. Dan was scared. He couldn't rationalize," she said.

Ruth McCall has a 9-year-old son with Dan Waggoner. She, too, spoke with Waggoner earlier in the standoff. Waggoner was calm during their conversation, she said.

"He said he was in a standoff with the sheriff's department," said McCall. "He said him and Amy had gotten into a domestic. He was really calm. He said this would all blow over. It was the last thing he said to me."

Both women said Waggoner is a good father but prone to fits of rage where he throws things or breaks inanimate objects. But he has never physically hurt anyone — and the standoff was never a hostage situation, they insist.

"Dan just had one of his flip-out moments," McCall said. "He couldn't handle not having Amy and the kids in his life. He let things escalate to a point where he couldn't turn back and he didn't know what to do."

Winters said calls involving the mentally ill are increasing. Of the 30 sheriffs' units working Sunday, 28 were assigned to suicide calls throughout Jackson County. These types of calls create a dangerous situation not only for the deputies, but for the individual as well, Winters said.

"We deal with this on a daily basis," said Winters. "The last thing we want to do is get involved in a use of force issue. It's difficult on the officers that are involved, and on the families that are involved."

The deputy involved in the shooting has been placed on paid administrative leave while a full investigation by the Major Assault and Death Investigation Unit ensues.

— Sanne Specht Read more!

Crisis team targets suicide; Among leading causes of death in Connecticut - Manchester (CT) Journal-Inquirer

By: Anne Pallivathuckal , Journal Inquirer
02-25-08

ENFIELD - For most people the onset of spring means warmer weather and uplifted spirits, but for some, the forecast is not so sunny.

March signals the beginning of spring, but it is also the beginning of a three-month period when suicide rates generally peak. ≈

In order to fight this growing problem, a local community group is trying to raise awareness and educate the public on suicide prevention.

The Crisis Prevention and Response Team of Enfield was created last March after a sudden jump in the rate of suicides from November 2006 to March 2007, when seven people killed themselves.

The crisis prevention team is composed of representatives from law enforcement, social services, town and state government, the fire department, and youth services.

"It's a really comprehensive group of individuals from the community," Rep. Karen Jarmoc, D-Enfield, one of the organizers of the crisis prevention team, said recently.

The group meets on a monthly basis to discuss strategies to coordinate education, intervention, and prevention efforts.

The team also works with the Enfield-based North Central Coalition to Prevent Adult Suicide, a grass roots organization dedicated to preventing suicide through increased awareness and education, and the Greater Enfield Alliance for Youth and Families.

The goal of the crisis prevention team "is to strengthen the services that already exist and support the two coalitions," Social Services Director Pamela Brown, who is the facilitator for the crisis prevention team, said recently.

"Another focus of the group is to increase awareness for the public to be able to recognize the signs of suicide and depression and encourage people to get help when they see the signs," Brown said.

The crisis prevention team has distributed handouts listing warning signs of suicide throughout the community, some specifically targeting youths.

However, suicides are not restricted to particular age groups or income levels, but affect all segments of the community.

Attempts, deaths on the rise

Enfield police statistics show that the number of suicide attempts and deaths increased from 2006 to 2007.

In 2006, there were 57 suicide attempts and three suicides. In 2007, there were 78 suicide attempts and seven suicides, according to police records.

However, it has been difficult to identify any correlation between the suicides.

"We haven't been able to find any discernable trends or commonalties," Police Chief Carl J. Sferrazza said recently. "The suicides that we've had do not appear to be related in any way."

Brown noted that the victims encompass a wide range of ages and life circumstances.

JoAnn Kubick, a member of the crisis prevention team, said recently that there are several risk factors for suicide, the most common being depression, particularly if it's untreated.

Kubick is also the community liaison for the Windsor-based Community Health Resources.

Community Health Resources has a program geared specifically toward suicide prevention. The program is supported by the state Department of Public Health through funding from a federal grant.

"The biggest thing about suicide is that depression is the No. 1 cause of suicide," Kubick said. "People just want their psychological, emotional pain to stop."

Studies have shown that about 90 percent of people who die by suicide have mental health disorders such as depression, bipolar illness, or mood disorders, Kubick said.

Depression, though, is a diagnosable and treatable illness since it has medical and biological causes, she said.

"That's what makes it so tragic," Kubick said.

Depression triggers

Major events such as the loss of a relationship or job, moving, or going off to college can trigger depression.

According to Kubick, research indicates that depression tends to set in about mid-November and increases during the holiday season.

As the general population feels happier with the onset of spring, people that are depressed don't. As a result, they fall deeper into their depressed state and some even take the extreme step of taking their own lives - which is why suicide rates generally peak from March to May, she said.

Some of the other risk factors for suicide include: withdrawal from family and friends, possibly feeling anxious and unable to sleep, feeling lethargic or having no sense of purpose, a tendency for persons to hurt themselves, dramatic mood swings, and uncontrolled anger and rage, Brown said.

In Connecticut, between 2000 and 2004, suicide was the second highest cause of death among 15- to 17-year-olds and 25- to 34-year-olds, Kubick said. It was the third highest cause of death among 20- to 24-year-olds, she said.

But the age group that is seeing the fastest growing rate, both in the state and nationally, are the elderly, those 65 years old and older, where depression is highly prevalent, Kubick said.

Risk factors for the elderly

A sense of helplessness is also a risk factor and the loss of mobility, health problems, and general loneliness are the most common causes of that emotion among this age group.

Helplessness and hopelessness are the two primary emotions that accompany someone that's suicidal, Kubick said.

However, reaching out to the elderly and trying to help them has been difficult since many of them feel they should be able to handle it on their own, she said.

Jarmoc said it's important for people to understand that it's all right to seek help and there are resources for people who need it.

"It's OK to ask for help and help is available," Jarmoc said. "Enfield has a really strong base of services for people who are in crisis."

Those seeking assistance for themselves or someone they know can call Community Health Resources' 24-hour toll free help line at 1-877-884-3571.

The United Way's 24-hour Infoline is 211.

The National Suicide Prevention Lifeline is 1-800-273-TALK (8255).

The North Central Coalition to Prevent Adult Suicide has established monthly support groups for survivors of the suicide of a friend, family member or a loved one. For more information, call (860) 995-5827.

Kubick also invited residents to join and help spread the message of suicide prevention.

"We are always looking for volunteers in the things we do," Kubick said, adding that the volunteers are given free training.

To volunteer, contact Kubick at (860) 731-5522, ext. 312. Read more!

Companies cash in on new service - Raleigh News and Observer

Community support is lucrative for providers, but reviews say many clients don't need it. Now the state wants money back

Lynn Bonner, Pat Stith and David Raynor, Staff Writers
(Second of five parts)

Joel Hopkins is no longer a basketball coach, but he's still recruiting. Instead of finding hoops stars, he's looking to sign clients for his mental-health business.

Hopkins, the former Shaw University coach, built Dominion Healthcare Services by having workers go door to door in poor neighborhoods, looking for people to sign up for a mental-health service called community support.

In 18 months, Dominion charged taxpayers $33.9 million for the service, more than all but one other agency, billing up to $61 an hour for services that included taking clients to school appointments and to charities for free clothes.

Dominion has operated in up to nine North Carolina counties. The company, based in Raleigh, has about 1,000 employees and an aggressive marketing strategy.

"We have community fairs, friends and family days, and we do present our services to the whole entire community," Hopkins said of the company he started in 2001. "It's called community support, and we want the community to be aware. We go to churches, civic groups, Boys & Girls Clubs, all over the community, to let people know where there are services out there for them."

State officials now say that some clients of Hopkins' company -- and others like it -- don't need mental-health services. They're having second thoughts about some of the companies they allowed to bill the government for community support.

The state has demanded repayment of $59 million from companies that broke the rules; it has asked Dominion to repay $1.5 million. The state is trying to stop the company from billing Medicaid, the federal health insurance program for the poor and disabled.

Last year, workers from local mental-health offices reviewed client records on 493 companies and found problems ranging from paperwork errors to the provision of community support to thousands of people who didn't need it.

Community support is a new service, born in 2006 as the state sought to move treatment out of government offices and into people's homes, schools, community centers -- places where they live their lives. Community support was one of more than a dozen services that the federal government agreed would qualify for Medicaid funding, but it ended up costing far more than everything else combined.

Hundreds of companies flooded the state's new mental-health market to offer the lucrative community support services. In the first three months, through June 2006, 277 companies received taxpayer money to provide community support. At the same time, far fewer companies signed up to provide more intensive treatment.

By the end of last year, the pool of companies offering community support had nearly tripled, to 784. The rules were designed to allow almost anyone who made the right promises into the business.

"When community support got started, the threshold for qualification was pretty low," said Dempsey Benton, secretary of health and human services.

It's the state's responsibility to set the standards for providers, he said. "We're trying to catch up in that part of the program."

Where the money was

In 2001, a legislative initiative set the state mental-health system on a new course. The old order, in which county mental-health offices provided most of the services, was flawed, nearly everyone agreed. County offices decided what services they would offer, and clients had limited choices.

Legislators received studies showing that the state relied too much on its psychiatric hospitals. They ordered the county offices to become monitors -- rather than providers -- and opened the way for private companies to dominate community care.

Those companies flocked to provide community support, with the work done largely by workers with high school diplomas. That's where the money was.

Among the entrants was Dominion, selling mental-health services the way some publishers sell magazine subscriptions.

Community support, the most basic of the new services, is supposed to help people with mental illnesses or addictions stay in their homes or in school by focusing on needed skills. The guidelines provided leeway for workers to help meet individuals' needs.

An adult, for example, may be taught how to manage bus schedules or a budget, while a child may be focused on ways to stay out of trouble in school.

Within the first few months, community support was costing taxpayers $50 million a month, 10 times more than state administrators had expected. About a year after the service started, the state cut the $61-an-hour rate it was paying by about $10. By that time, the state had spent $619 million in 12 months.

While money flowed to community support, serious treatment suffered. From March 2006 through the end of January 2008, community support cost $1.4 billion, 90 percent of all spending. During that period, the government spent $78 million -- 4.9 percent -- on the seven services that department officials say are more likely to keep people out of hospitals.

Officials had intended to spend more on intensive services than on community support.

In September, 43,579 people received federally funded community support, at a cost of $74.6 million. Assertive community treatment, a more intensive service for severely mentally ill adults, was the second-most costly service that month. Companies were paid $2.2 million to help 1,698 people.

Dominion has one psychiatrist under contract who is the company's medical director, but she does not bill through the company for individual treatment. Dominion makes nearly all its money from community support.

Searching for clients

Traditionally, companies receive referrals from county or regional mental-health offices, social workers, schools or juvenile courts. Sometimes, a potential client will get a recommendation from a friend or family member.

Local mental-health officials complained about Dominion's practice of searching neighborhoods for clients and sometimes having a minister make follow-up calls.

Wake County's mental-health administrators called Dominion customers in October 2006 to find out how they came to sign up with the company. One mother said her child's therapist mentioned the company, "but then they were going door to door ... they came to our door handing out flyers," Miki Jaeger, head of the Wake mental-health office's quality management team, wrote in a letter to the state Mental Health Division.

State officials don't like the companies' scouring neighborhoods for clients, but they allow it.

"We do not, to our knowledge, have any authority to stop that from happening at this point," said Tara Larson, an acting deputy director in the state Medicaid office.

In a little more than a year in the community support business, Dominion received more in Medicaid payments than older nonprofit corporations such as Easter Seals UCP.

Notes by a Dominion community support worker detailing activities with a client, a woman, described the same activities day after day. The worker refers to herself by the initials CSSQP, for community support services qualified professional. The worker and client spent 3 1/2 hours together each time, according to the notes on April meetings, allowing a bill of about $180.

For April 23, 2007, the worker wrote she and the client did this:

"CSSQP prompted consumer for a community outing. CSSQP talked to consumer about actions she needed to be successful in fulfilling aspirations. CSSQP discussed with consumer about having a mentor and how she felt about having a female role-model to look up to because she will have someone to help her. CSSQP discussed [with] consumer how the program will be linking her to programs and other services to help her."

For April 24, 2007, she wrote:

"CSSQP prompted consumer for a community outing. CSSQP talked to consumer about actions she needed to be successful in fulfilling aspirations. CSSQP discussed with consumer about having a mentor and how she felt about having a female role-model to look up to because she will have someone to help her. CSSQP discussed [with] consumer how the program will be linking her to programs and other services to help her." This section of the note was identical to the previous day's, except for the last sentence: "CSSQP discussed with [consumer] some activities that needed to change in her life."

The state wants Dominion to pay back $1.5 million, and state and local mental-health offices are trying to strip the company of its licenses to bill Medicaid.

An administrative law judge said the state can't act until the company runs through its appeals. Hopkins has hired well-known trial lawyer Willie Gary to sue the state, one of its contractors and several local mental-health offices for $1.3 billion. Dominion claims the counties are discriminating against the company because its owners are African-American.

Hopkins, 39, is best known as NBA star Tracy McGrady's high school coach. He coached at Durham's Mount Zion Christian Academy for eight years and at Shaw University for two years. Dominion is an extension of his long-held desire to help children, Hopkins said.

In the early 1990s, law enforcement agencies around the Southeast investigated a nonprofit organization Hopkins ran with his brother, John. Triangle Housing/Homeless and its spinoffs used poor children and homeless people to canvass for donations.

Dominion was incorporated by a church that never existed, Hopkins acknowledges. The incorporation papers listed the incorporator as Dominion Christian Church, with the address of a home in Bahama in northern Durham County. Hopkins said he intended to start the church, but he didn't.

Troubled history

Before it found gold in community support, Dominion ran youth group homes in Wake County. The state sanctioned the company for not doing enough to keep children from running away and for failing to conduct criminal background checks of employees.

One of Dominion's state directors, Jerry Wright, was convicted in 2002 of 10 counts of obtaining property under false pretenses after a Medicaid fraud investigation into his work at Lutheran Family Services. Wright, a former foster parent supervisor there, was ordered to pay $25,021 in restitution.

Hopkins defended hiring Wright, who he said does not handle money at Dominion.

In the past 14 months, state and local mental-health offices' investigations and reviews of Dominion's practices and patient records found billing problems, people getting community support who did not need it and the company charging for work it didn't do.

About a year ago, investigators called Dominion patients in the Charlotte area. One of the complaints was that Dominion was offering community support as a mentoring service.

In calls to 11 patients or their guardians, investigators found that eight did not know they were receiving a mental-health service and did not know what their diagnosis was. Ten of 11 did not know that community support is a mental-health service.

Hugh Eighmie II, a lawyer with Gary's firm who is working on the Dominion case, said company workers told clients they were signing up for mentoring so they wouldn't be scared away from mental-health treatment.

Mental illness carries a heavy stigma, especially in minority communities, Eighmie said, and it's important to talk to clients in terms they can understand.

"They do understand terms like 'mentoring,' " he said.

Others questioned, too

Dominion is not the only company with bills attracting attention.

Workers at American Health & Human Services, a community support agency in Elizabeth City, billed Medicaid for picking children up for school, watching them take tests and eat lunch, and watching them play after school, according to company records.

One community support worker spent eight hours with an elementary school student. His goal for the day was to "increase frequency of on task behavior and following directions."

This is the worker's report of what happened from 10:01 a.m. to noon on Jan. 3, 2007:

"1. Client entered gym class quietly. Mentor extended verbal praise to client for his behavior. Client responded by saying thank you.

2. Client participated in the class activities. Mentor complimented client for his class participation. Client responded by saying thank you.

3. Client listened to the gym teacher instructions. Mentor complimented client for being attentive. Client responded by saying thank you.

4. Client lined up quietly to go to lunch. Mentor complimented client for following teachers' directions. Client responded by saying thank you."

The worker made similar notes for the rest of the school day and for two hours after, logging an eight-hour day and allowing American Health & Human Services to charge $488.

Reviewers from the regional mental-health office criticized the services for not building skills or working toward clients' goals.

The state wants the agency to repay about $500,000. American Health & Human Services owner Andrea L. Simpson has repaid some money but said he would appeal the most recent repayment order for $211,957.

Simpson said the company stopped sending workers into schools, though he thinks workers still need to be there.

"You have to teach a child a skill," he said. "If you cannot get their behavior under control first, then you can't teach them a skill."

He blames the state for the confusion about what companies are allowed to do; early on, the state did not require training in community support. Then, when his workers went to training sessions, he said, instructors would not give answers about what's right or wrong.

Wayne Peel of Williamston, who runs an independent company that trains community support workers, said the early lessons the state required did little to help providers new to the mental-health field.

"The training in the beginning was inadequate," Peel said. "I don't think you would find anyone that disagreed with that."

State officials underestimated how many people with little knowledge or training in mental health would start offering community support, he said. "Didn't have any," Peel said of some of the providers' experience. "Nada. Zero."


lynn.bonner@newsobserver.com or (919) 829-4821 Thursday: Seeking serious help? Don't count on it.
Read more!

Newspaper: North Carolina seeks repayment for mental health services - Associated Press

North Carolina officials are trying recover $59 million from companies that they believe broke the rules in providing a mental-health service called community support, The News & Observer of Raleigh reported today.

Workers from local mental-health offices who reviewed client records on 493 companies last year found problems that included minor issues, such paperwork errors, to larger issues, such as thousands of people getting community support even though they didn't need it, the newspaper reported.

The state started community support in 2006, as a way to move treatment from government offices to people's homes, schools and community centers. The federal government ruled the program qualified for Medicaid funding.

In the first three months, through June 2006, 277 companies received taxpayer money to provide community support. By the end of 2007, the number had nearly tripled to 784.

Dempsey Benton, state secretary of health and human services, acknowledged the rules to qualify for the program were lax.

"When community support got started, the threshold for qualification was pretty low," Benton said.

"It's the state's responsibility to set the standards for providers," he said. "We're trying to catch up in that part of the program."

Among the companies that offered community support was Dominion Healthcare Services, which has caught the eye of state regulators. The company was started by former Shaw University basketball coach Joel Hopkins, 39, who is best known for coaching NBA star Tracy McGrady in high school.

His employees knocked on doors in poor neighborhoods in up to nine counties, asking people to sign up for community support. Among the services for which the Raleigh-based company charged the state were taking clients to school appointments and to charities for free clothes.

"We have community fairs, friends and family days, and we do present our services to the whole entire community," Hopkins said of the company he started in 2001.

"It's called community support, and we want the community to be aware. We go to churches, civic groups, Boys & Girls Clubs, all over the community, to let people know where there are services out there for them."

The state has asked Dominion to repay $1.5 million and is trying to stop the company from billing Medicaid, the federal health insurance program for the poor and disabled. An administrative law judge said the company must be allowed to finish its appeals before the state can act.

In turn, Hopkins has sued the state, one of its contractors and several local mental-health offices for $1.3 billion, claiming the counties are discriminating against the company because its owners are black.

The goal of community support is to focus on the skills needed to allow people who suffer from addictions or mental illnesses stay at home or in school. An adult could be taught to manage a bus schedule or a child could learn skills to stay out of trouble at school.

The program has proved expensive. In the first few months, community support cost taxpayers $50 million a month — 10 times more than state administrators had estimated. By the time the state cut its $61-an-hour rate to $51, it had spent $619 million in 12 months.

From March 2006 through the end of January 2008, community support cost $1.4 billion. Spending on the seven services officials said are more likely to keep people out of hospitals was $78, or 4.9 percent, during the same period.

In September, when community support cost $74.6 million, 43,579 people received the service. The second most costly service that month was assertive community treatment, a more intensive service for severely mentally ill adults. Companies were paid $2.2 million to help 1,698 people.

The state is trying to get money from companies other than Dominion, including American Health & Human Services, a community support agency in Elizabeth City. The state wants that company to repay $500,000.

While owner Andrea L. Simpson has repaid some money, he said he plans to appeal the most recent repayment order for $211,957.

The state has some blame for the confusion, he said, because it did not require training for community support at first. When training started, instructors wouldn't provide direction on what was right or wrong, he said.

Wayne Peel of Williamston, who runs an independent company that trains community support workers, said the early training was inadequate, especially for new providers.

"I don't think you would find anyone that disagreed with that. State officials underestimated how many people with little knowledge or training in mental health would start offering community support," he said.

"Didn't have any," Peel said of some of the providers' experience. "Nada. Zero."


Read more!

Mentally ill need our help -Raleigh (NC) News & Observer

Ruth Sheehan, Staff Writer

This morning at 11, I'm scheduled to sit in on a meeting about the future of Phil Wiggins, the 64-year-old schizophrenic man whose journey through the state's mental health system I have chronicled for nearly four years.

It will not be a happy meeting.

For the umpteenth time, Wiggins' sister Louise Jordan and mental health workers familiar with his case will be documenting why this man who spent 43 years in a state psychiatric hospital continues to need intensive supervision and guided care now that he's out.

If that seems like a no-brainer, the documentation is necessary because Wiggins' hours of service have been cut, and cut, and cut again. Two years after being released from the hospital, he is supposed to be well enough to get by with 12 hours of "community services" per week. These are the services that help keep him connected to reality; along with his powerful medications, the one-on-one helps him keep the voices in his head at bay.

The irony that this meeting will be held as The News & Observer launches its Mental Disorder series is not lost on me.

The series lays out in painstaking detail how the state has been hemorrhaging hundreds of millions of dollars -- while in most cases, services for the truly ill have not improved.

That so much money has been wasted while services are being cut to people like Wiggins borders on the criminal. (Stay tuned for more as the series unfolds.)

To family members of the mentally ill, of course, it comes as no real surprise.

They are the ones who saw a glimmer of hope in the state's mental health reform process. They saw the promise it held for loved ones shunted away in psychiatric hospitals.

They also saw those hopes dashed as county-run mental health programs were forced to close shop, turning care over to a hodgepodge of private providers -- some good, some not.

Now family members watch as their mentally ill loved ones are bounced from worker to worker, and doctor to doctor, as critical services are cut time and again.

Until his appeal is heard and his hours restored (if ever) Wiggins is spending most of his time at his group home in Zebulon, alone, watching TV, counting the minutes until his next cigarette -- descending, his sister fears, further and further into the chaos of his troubled mind.

Wiggins is a reminder of a few truisms about the severely and persistently mentally ill: They do not get better. They do not go away.

But they do need our help.

What is so tragic about the state's disastrous venture into mental health reform is that for once, the money was being spent -- too often, though, it didn't make it to the folks with the greatest needs.

The shame is that is the people who can least tolerate change are the ones who have had their worlds turned upside down -- first by a well-intentioned but less-than-thorough legislature, then by a bungling bureaucracy unable to control a money-hungry industry growing up around our most vulnerable citizens.

My greatest fear is that, given all the wasteful spending detailed in the series, state lawmakers will punish the state Department of Health and Human Services with a huge budget cut.

But the people who will be hurt most by such a move are the ones already hurting the most. Folks like Phil Wiggins.

ruth.sheehan@newsobserver.com or (919) 829-4828
Read more!

Easley must lead -Raleigh (NC) News & Observer

Editorial: John Drescher, Executive Editor
02-24-08

After reading our series that starts today and ends next Sunday, you will see that the state has wasted at least $400 million as it changed the way it treats the mentally ill.

You also will learn that the most seriously ill are getting less care than they did before the "reform."

The person ultimately responsible for managing this initiative -- Gov. Mike Easley -- now says his administration opposed the 2001 changes enacted by the legislature. Yet there is little proof that anyone representing Easley opposed the changes.

Easley has tried to distance himself from the issue. He clearly doesn't want to engage. But he doesn't have a choice. There's too much at stake -- in taxpayer money and human cost.

Simply put, Easley needs to lead.

One burden of leadership: Sometimes you have to deal with issues you'd rather ignore. Some issues are popular with voters. This is not one of them. No one gets elected governor saying he will deliver good care to the mentally ill at a reasonable price to taxpayers.

In a December news conference, Easley said the state was merely the banker, supplying the money for companies to provide services to the mentally ill.

Easley is wrong. His administration set the rules for the new program. It set the reimbursement rates. It had the responsibility to set and enforce standards.

I'd like to be able to tell you Easley's further thoughts on the subject. But he declined repeated attempts by The N&O's Pat Stith to discuss it.

Stith, one of the best investigative reporters in the country, has studied the state's mental health system for six months. Few people understand it as well. That might make Easley nervous.

The governor couldn't make the time to talk with Stith. But he did find the time recently to appear on the public TV show, "The Woodwright's Shop."

Easley and host Roy Underhill worked on a walnut table together. It's good -- I guess -- that we have a well-adjusted governor who enjoys his free time so much.

But there are 10 months left in his last term. There are plenty of projects on the state's workbench.

Easley has appointed Dempsey Benton, Raleigh's former city manager, to lead the state agency in charge of mental health.

Benton is an old pro -- a skilled, capable public manager, although he has little experience in delivering social services.

But Benton is digging in. Easley should too. As chief executive, he should be able to ask Benton hard questions about what the goals are, how the state is going to meet the goals and how it's going to measure success.

Anyone who works with wood knows you measure twice and cut once. When it comes to mental health reform, Easley missed on the first cut.

We'll see if he has the skill -- and the will -- to get it right on the second cut.

john.drescher@newsobserver.com or (919) 829-4515. Read the Editors' Blog atnewsobserver.com.
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Professor shares pain, loss -Milwaukee Journal Sentinel

Daughter's death by drug overdose leads Northouse to warn students

By SCOTT WILLIAMS
swilliams@journalsentinel.com

Waukesha - It is a lecture Rich Northouse wishes he had given to his daughter.

The mild-mannered math professor is planning to deliver an emotional warning to students at the University of Wisconsin-Waukesha next month about the dangers of drug abuse.

The admonition will come too late for his daughter, Nicole, who died from an accidental overdose 15 months ago at age 35.

The agony of losing his daughter turned to anger for Northouse when one of Nicole's friends told him at the funeral that his daughter had been experimenting with drugs since childhood.

"I had no clue," Northouse said.

That was when the 69-year-old professor knew he had to take action.

So he will address students - and some parents, too, he hopes - when he delivers a lecture titled "The Nightmare of Losing My Daughter to Drugs."

The March 11 presentation is part of a series of lectures in which faculty members on the Waukesha campus are encouraged to discuss hobbies or other personal interests outside of the classroom.

Northouse's plan to delve into something so deeply personal and painful has raised eyebrows on campus.

"Good for him. But wow - wow," said Victoria Paaske, a fellow faculty member who has talked with Northouse about his planned lecture.

"Life is a classroom," she added. "There's no reason why anybody couldn't learn from his life lessons."

Northouse hopes to reach his audience with a bit of shock value, by describing his daughter's overdose in vivid detail and displaying a photograph of her at her funeral. He makes no apology for using dramatic tactics to steer young people away from drug abuse.

"I want an impact," he said.

The hourlong lecture, which is free and open to the public, is at noon March 11 in the student center at UW-Waukesha.

Patrick Schmitt, the campus dean, said officials might consider posting a caution for attendees if Northouse goes ahead with showing images from the funeral.

However, Schmitt said faculty members are given considerable leeway in structuring their lectures.

"It's good to hear about personal experiences," he said. "It is an opportunity to kind of branch out."

Northouse, who has taught math at UW-Waukesha for about four years, lost his daughter in November 2006 after she overdosed on OxyContin and other prescription drugs.

The Milwaukee County medical examiner's office concluded that the overdose was an accident.

Growing up in Glendale, Nicole had a long history of mental health problems. Family members believe she began abusing drugs in high school or earlier to ease the suffering.

By the time she was diagnosed with bipolar disorder and schizophrenia, she was an adult - and also an addict.

Her mother, Marcia Northouse, blames the mental illness for pushing her daughter into drugs.

"It wasn't just drugs," Marcia said. "There was always this underlying thing that we didn't quite understand."

The Northouses divorced 20 years ago but have remained on friendly terms.

If he had another chance, Rich Northouse said, he would recognize that drugs changed his daughter's personality, and that he needed to penetrate that in order to reach her.

He hopes parents will attend his lecture so they can hear his message about watching for warning signs of drug abuse and learning how to confront their children.

"If just a few people realize what can happen," he said, "that would be a real good thing." Read more!

Mentally ill unfairly portrayed as violent -Boston Globe

By Dr. Ronald Pies

The man had his hands around my neck so quickly I didn't have time to react. I was a second-year resident in psychiatry. He was an impulsive loner with a history of alcoholism who, unbeknownst to the staff, had returned to the inpatient unit intoxicated.

Fortunately, before the man could do serious harm, three patients had pulled him off me. In 25 years of psychiatric practice, this was the first and last time any patient laid a hand on me in violence.

And yet, in recent weeks, the news has been full of horrendous stories involving killers with known or suspected mental illness. As I write this, the nation is still reeling from the shootings at Northern Illinois University. Press reports now indicate that the shooter had a long history of mental illness and had recently stopped taking antidepressant medication.

To make matters worse, three psychotherapists have been assaulted or murdered in the past month. The most brutal attack involved a Manhattan psychologist murdered by a man who also gravely injured a psychiatrist. The New York Times reported that the accused man blamed the psychiatrist for having him institutionalized 17 years ago; apparently, the psychologist was not the intended victim. And only a few weeks ago, a social worker in Andover was killed, allegedly by her 19- year-old patient, during a visit to the man's home.

What do these attacks say about mental illness? Surely they create the impression that individuals with mental illness are a dangerous and violent lot. And as professor John Monahan and colleagues at the University of Virginia School of Law wrote recently, "the more a member of the general public believes that mental disorder and violence are associated, the less he or she wants to have an individual with a mental disorder as a neighbor, friend, colleague, or family member."

Yet the impression that we are awash in a sea of psychotic violence is clearly unfounded. Writing in the Nov. 16, 2006, New England Journal of Medicine, Dr. Richard A. Friedman of the Weill Cornell Medical College notes that only about 3 to 5 percent of violence in the general population is attributable to those with "serious mental illness," conventionally defined as schizophrenia, major depression, or bipolar disorder. The combined lifetime prevalence of these conditions in the US general population is estimated at 19 percent - far larger than their contribution to violence.

Furthermore, it is wrong to tar all emotionally disturbed individuals with the same stereotype-tainted brush.

True: A 1980s study from the National Institute of Mental Health found, using community surveys, that individuals with schizophrenia, major depression, or bipolar disorder were two to three times as likely as those without these illnesses to commit acts of violence. However, to put this in perspective, substance abusers had more than twice the rate of violence as those with these serious mental illnesses.

Moreover, the study found that the vast majority of individuals with serious mental illness were not violent: The lifetime prevalence of violence among people with schizophrenia, major depression, or bipolar disorder was 16 percent, versus 7 percent among people without a mental illness. Those with anxiety disorders had no increased risk of violence.

Even more reassuring is the 1998 MacArthur Violence Risk Assessment Study, led by John Monahan and Henry Steadman, now of Policy Research Associates, which advocates for better mental health services. Unlike the NIMH study, which surveyed people randomly in the community, the MacArthur study evaluated psychiatric patients recently discharged from the hospital. And unlike the NIMH study, which relied solely on self-reports of violence, the MacArthur study used a combination of self-reports, collateral informants, and police and hospital records.

The MacArthur study found that the prevalence of violence among discharged psychiatric patients without a substance abuse disorder was similar to that among community-dwellers who didn't abuse substances. Furthermore, violence by these discharged patients rarely involved vicious attacks on strangers or clinicians. Usually, it resembled violence committed by other community-dwellers, such as hitting a family member inside the home. Lethal violence among the discharged patients was very rare.

In the February 2008 issue of Psychiatric Services, Monahan and Steadman conclude: ". . . for people [with mental illness] who do not abuse alcohol and drugs, there is no reason to anticipate that they present greater risk than their neighbors."

That said, mental disorders do increase susceptibility to substance abuse, and thus indirectly increase risk of violence. Moreover, as Eric Elbogen of University of North Carolina Chapel Hill School of Medicine wrote me in an e-mail, ". . . a subgroup of people with mental illness likely uses alcohol and drugs to 'self-medicate' psychiatric symptoms." In my experience, this behavior may reflect the inadequate, fragmented care often provided to those with mental illness who also abuse drugs or alcohol so-called "dual diagnosis" patients.

The image of the violent mentally ill person must also be tempered by research from Linda A. Teplin, of Northwestern University. Teplin finds that those with mental illness are much more likely to be victims than perpetrators of a violent crime. Among psychiatric outpatients, about 8 percent reported committing a violent act, whereas about 27 percent reported being the victim of a violent crime.

What can be done for the relatively few mentally ill individuals who do become violent? The good news is that adherence to treatment is associated with reduced risk of violence. Research from Elbogen and colleagues finds that as self-reported adherence to outpatient psychiatric treatment increases, violence decreases. Though treatment varied significantly from site to site, Dr. Elbogen tells me that "typically [patients] had a combination of case management, pharmacotherapy, [and] psychotherapy or group therapy."

An understanding and supportive family may also reduce the risk of violence in their emotionally disturbed loved ones. Finally, all of us can support increased funding for comprehensive, compassionate treatment of those with mental illness, substance abuse, or both.

Recent events have shown us that anyone may become the victim of a violent person with severe mental illness. And yet, we must put the violence-mental illness link into perspective. The patient who assaulted me more than 25 years ago was 1 in 1,000. Nearly all those I have treated since have been nonviolent. Most have coped heroically with unspeakable sorrow and pain. In truth, I would trust many of them with my life.

Dr. Ronald Pies is a clinical professor of psychiatry at Tufts University and a professor of psychiatry at SUNY Upstate Medical University in Syracuse, N.Y.
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TV show focuses on mental health issues -Pleasantown (CA) Argus

By Andrew Cavette, STAFF WRITER

FREMONT — The Rev. Barbara Meyers sat in a makeup chair Wednesday night in the corner of a small, public-access cable-TV studio, ready for her show to start.

Meyers, a minister for the Mission Peak Unitarian Universalist Congregation, is the host of "Mental Health Matters," a program shown in the Tri-City area and other parts of the East Bay.

Cecelia Burk, who volunteers her cosmetological talents for the show, touched up Meyers' cheeks before letting her rejoin the small group of enthusiastic Bay Area residents buzzing around the studio's equipment. They adjusted the cameras, fixed the lighting, checked the sound, and then the show began.

After working for IBM for 25 years, Meyers went back to school and, in 2004, earned a master's degree in divinity from Starr King School for the Ministry in Berkeley. Her ministry focuses on mental health issues.

One day Paul Clifford, a member of Meyers' congregation, approached her about a project.

At the time, Clifford was producing another public-access cable-TV show and thought Meyers should produce a program about mental health. Clifford loaned Meyers his crew and his studio time to do a pilot episode.

In that episode, Meyers talked about the stigma attached to mental illness. It was recorded last March.

"I got a fair number of people who told me they had seen it," Meyers said after the show premiered. "I could see that it was something positive."

She recruited a crew from her
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congregation, some of whom have someone in their family with a mental illness or have mental health issues themselves. Other crew members simply want to learn more about television work.

Gwen Todd, a member of Meyers' congregation,produces her own public-access cable-TV show for Toastmasters International and had contacts with Comcast in Fremont. When she heard Meyers' idea for the show, she offered her services.

"It's a very good show and is very much needed," Todd said. "The crew is getting a lot better as we all develop our skills."

Comcast provided the group with six weeks of training in how to operate the cameras, the sound equipment and the control room. Meyers said Comcast gives them the use of the equipment and the studio time free of charge.

Whatever small expenses remain for post-production are covered by Alameda County Behavioral Health Care Services, Meyers said.

"All of the reasons for not doing (the show) disappeared," she said.

Curtis Lum directed Wednesday night's taping. Outside of the show, Lum is a computer technician.

"My wife is part of a mental health group, and I have always wanted to (direct)," Lum said.

Lum's wife, Kathryn, has schizoaffective disorder (closely related to schizophrenia) and was a guest on the show's second episode. They are both members of the National Alliance on Mental Illness and often participate in fundraising events for the organization.

After her guest appearance, Kathryn Lum joined the show's small group, and she now handles the craft services — baking and bringing snacks for everyone on the crew.

On Wednesday, the group taped an episode that focused on peer support and self-help, something that Kathryn said has helped her a great deal.

"I've found my best friends from self-help organizations," she said.

Juan Bernardo Gonzalez co-directs the show with Curtis Lum.

Bernardo is a member of Alameda County Behavioral Health Care Services' Pool of Champions, a mental health consumer interest group. He never really saw himself working in television, he said, but thought the show is important because it helps to remove the stigma of mental illness.

"We are trying to reform and educate," Gonzalez said. "This is part of a big effort for social inclusion."

He also said that the group has been in contact with Ramon Adame, news anchor for the Spanish-language channel Univision.

"Hopefully, in the near future, we are going to be able to broadcast in Spanish," Gonzalez said.
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Ill treatment of the mentally ill -Philadelphia (PA) Daily News

By ANN ROSEN SPECTOR

SO FAR THIS month:

David Tarloff allegedly killed a therapist and tried to kill a psychiatrist in New York last week, ostensibly because the psychiatrist, had been part of a team that had Tarloff committed to a mental hospital 17 years ago.

Tarloff had been sent to three psychiatric hospitals in the last year for evaluations, and was released from all of them within days. His brother Robert said his family had tried repeatedly to get him hospitalized for longer periods, but the hospitals wouldn't keep him.

Steven Kazmierczak killed five students and wounded many more at Northern Illinois University. His girlfriend, Jessica Baty, was quoted as saying he'd discontinued his anti-depressant medications three weeks before because they made him "feel like a zombie." Reports suggest that while on his meds, Kazmierczak was a great guy; when off them, less so.

Discharged from the military (they won't say why), fired from his coveted job at a prison (they won't say why), he was a different man when he was under some form of treatment.

Latina Williams killed two students and herself at Louisiana Technical College in Baton Rouge. So far, there has been no explanation of her behavior, which seemed to come out of nowhere. Perhaps the small number of victims is the reason this story had no legs; perhaps it's because the other two stories had more drama.

I guess we're lucky February is a short month.

We know that the vast majority of the mentally ill aren't violent, yet stories like these make the public wary of such statistics. But the fact remains that the United States has no effective policy to treat the mentally ill. None. And there are no resources or major policy initiatives in the pipeline for any in the foreseeable future.

When the Constitution was written, there was no understanding of mental illness - people who were crazy were simply kept out of sight in rural areas or institutionalized in urban ones. Asylums weren't created to cure mental illness but to keep "those people" away from the rest of society.

Just like the age-old treatment of drilling holes in the skulls of the insane to let the evil spirits escape, the "cure" was really for society. Once your head has holes in it like a bowling ball, you no longer pose a threat to others.

Once antipsychotic drugs were created, the concept of institutionalization was less palatable. The theory: Give schizophrenics their meds, and they can walk among us, get jobs and become competent members of society.



EXCEPT FOR ONE problem: No one can be compelled to take medications, and the side effects of many psychopharmacological drugs are unpleasant.

So the person goes off the pills - and then what? If they're adults, neither their families nor the legal system can do much to intervene.

Sure, you can get someone involuntarily committed to a hospital for evaluation, but we're talking two to three days. Most people are then released onto the street. The legal system is not competent to rule on mental competency (no lawyer jokes, please), because it's a medical issue.

It's also a "who's going to pay?" issue. Insurance companies are reluctant to provide parity between physical and mental diseases. If you break your arm, care is standard and predictable: X-ray, cast, come back in six weeks. But depression, unipolar or bipolar, and schizophrenia - those treatments might exceed the "up to 20 visits a year" allotted under most managed care.

Sounds crazy, doesn't it?

We have the psychological understanding and mental health professionals to provide high quality care - but we don't fund it. Perhaps we should ask Halliburton to open a new division.

*

Ann Rosen Spector is a clinical psychologist in private practice in Center City and an adjunct faculty member in the Department of Psychology at Rutgers-Camden. Read more!

Editorial: Listen to the families of the mentally ill - Washington, D.C., Naitonal Examiner

WASHINGTON (Map, News) - The campus massacres at Northern Illinois University and Virginia Tech underscore the urgent need to change the way we deal with mental illness. But government fixes, while necessary and overdue, are not enough.

Families should have as much say as mental health professionals in making decisions about their mentally ill members. Who, after all, is more likely to spot subtle but significant changes in a person’s mental state — a relative who’s lived with that person or a social worker just assigned to the case? And who’s more likely to ensure the patient follows treatment protocol, a family member or an indifferent bureaucrat?

Well-meaning attempts to protect the privacy rights of the mentally ill have backfired because they are based on a faulty premise. A person who suffers from a serious mental illness does not have the capacity to make rational decisions to control his condition.

The only question remaining is whether family members or the government should be in charge of managing his care. The answer is: both. Virginia state Sen. Ken Cuccinelli, R-Centreville, who had been pushing for reform of his state’s mental health system well before the Virginia Tech massacre, wants to give responsible adults the ability to commit minors for up to 96 hours — even if they object.

As it stands now, parents can only stand by helplessly and watch their children deteriorate until they pose “an imminent danger.” Cuccinelli’s good friend, Michael Garbarino, was one of two Fairfax County police officers gunned down in 2006 by 18-year-old Michael Kennedy, who friends described as suffering from hallucinations. Kennedy’s parents later told officials they had taken their son to see mental health professionals many times, but were repeatedly told he was not a threat to himself or others. Well, the mental health professionals were wrong.

Likewise, the parents of Virginia Tech gunman Seung Hui Cho were unable to monitor their son’s downward spiral — even after a judge ordered him into mental health treatment — due to misapplied privacy provisions of the federal Health Insurance Portability and Accountability Act, which needs to be revised.

As it stands now, the mentally ill are “free” to live on steam grates until they do themselves or someone else harm, but their families can do little to help them until a tragedy occurs. Only our society’s overwhelming discomfort with mental illness prevents us from finding a sensible solution somewhere in between.
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Attacked, but nowhere to go -Lancaster (PA) Intelligencer-Journal

Photos and other information on this story here.

After brother’s death in state prison, local man sues; hopes for better care of mentally ill inmates

By LINDA ESPENSHADE

Nine months after Carl Scherer could have been released on parole from Houtzdale State Correctional Institute, another inmate beat him to death inside their locked prison cell.

Guards watched and waited to intervene.

Parole officials had approved Carl, who had severe schizophrenia, for release until prison officials said he was too mentally ill to be paroled.

Instead, they kept him in the general prison population at Houtzdale where, the prison's chief psychologist later testified, Carl was like "a goldfish in a shark pond."

On Wednesday, Carl's brother, Pete Scherer III of Manheim Township, may find out if the state Department of Corrections will be held responsible for Carl's Aug. 6, 2002, death.

Scherer is suing the Pennsylvania Department of Corrections — including individual Houtzdale administrators, mental health staff and officers. Also named in the suit are Wexford Health Sources, which was Houtzdale's behavioral health care provider, and two of its subcontracted psychiatrists.

According to the civil suit, filed by the Lancaster law firm of Gibbel Kraybill & Hess in 2004, the prison staff and mental health professionals violated Carl Scherer's Constitutional rights and his protection under the Americans with Disabilities Act, which ultimately contributed to his death.

No trial date has been set, though a settlement conference is scheduled for Wednesday.

All the defendants have denied violating Scherer's rights, either through "specific action or inaction," in briefs filed with U.S. District Court for the Western District of Pennsylvania.

However, in November 2007, after attorneys wrangled for three years, Judge Kim R. Gibson ruled there was enough evidence for a jury trial.

Pete Scherer, a local Realtor, said he filed the case out of indignation at the way the state correctional system dealt with his brother's mental illness. He hopes the lawsuit will force some change.

"If someone were treated properly as a result of this, I would feel that it was worth it," said Scherer.
•••

Carl Scherer, who grew up in Northumberland County, had few skills except his voice. His was convinced he was going to be a soul singer, said his childhood friend James Crawford of Montana.

Carl would go to Philadelphia and wait for Kenny Gamble, a legendary singer, songwriter and producer, to finish performing. Then he would try to persuade Gamble to sign him.

Carl would follow him down the street, singing, just so Gamble would listen to him, Crawford said. Eventually, it worked.

Albert Corbacio, Carl's uncle, remembers the day his nephew brought home a contract with Philadelphia International Records, Gamble's production company.

" 'Uncle Al, they loved me,' " Corbacio remembers his nephew saying.
But Carl couldn't find the courage to sign the contract. " 'They expect me to be good,' " he told his uncle.

"Beautiful," Corbacio answered. "You don't come back with a contract if you're no good."

Instead of signing, the man whom Crawford described as "smart, bright, caring, funny, outgoing, but a little unstable" became very unstable.

During the next couple years he had nervous breakdowns and attempted suicide. He was diagnosed with schizophrenia, bipolar disorder and chronic paranoia, according to the complaint filed by Pete Scherer's attorney, Dwight Yoder.

In 1995 police arrested Carl for stealing a car. In 1998, he violated parole by making harassing phone calls to a stranger.

"He brought the car back; he just brought it back too late," Yoder said. "He made (repeated) phone calls, again arising out of his mental illness, but he didn't do anything that would make us recoil and say, 'Hey, this guy's dangerous.' "

Nevertheless, the judge sentenced Carl to two to seven years at Houtzdale State Prison.

•••
Life in state prison, where the turnover of psychiatrists was so high that some stayed for only a day, exacerbated his illness, according to Dr. Jerome Gottlieb, the Lancaster County psychiatrist who prepared an expert report for the case.

"His records indicate that the medications were constantly being adjusted or changed, such that at no time was he stable for any lengthy period of time," Gottlieb wrote. He also reported that Carl often refused his medication, which led to repeated cycles of psychotic behavior.

In spite of Carl's chronic psychosis, Houtzdale's licensed psychological manager described Carl during his deposition as a likable man.

"Carl was a wonderful guy. … He was an innocent," said Francis Schuster. "That is, he was not aware of how bizarre he was, and I had never seen anything from him that indicated malice or duplicity. He was right up front and naive, profoundly naive."

Nevertheless, Carl's illness made it easy for him to earn a misconduct (always because of something he said, his brother claims). Schuster said he and other mental health staff members would ask correctional officers for leniency on Carl's behalf.

In September 2001 the Pennsylvania Board of Probation and Parole granted Carl parole.

But before he could be released, Carl's illness became so severe he was involuntarily committed to Cresson State Correctional Institute, where prisoners with acute mental illness are stabilized. Schuster said Carl was in danger of "harming anyone who oppose(d) his psychotic interpretation of reality."

Prison officials then sent a letter to the judge recommending Carl's parole "be revoked due to his mental health problems," according to a deposition of Henry Tatum, deputy superintendent for facilities management at Houtzdale.

The reasoning incenses Yoder, who believes Carl should have been released to a place where his mental health needs were addressed.

"They took away his only opportunity to get the care he needed and left him in there, not because he didn't meet the criteria for being paroled, but because he has a mental illness. I mean, it's outrageous in my mind. …

"That's not the point of the correctional institutions — to house individuals with mental illness."
•••

Carl was eventually transferred into the general population at Houtzdale in late 2001.

In July 2002, Carl was found rummaging through trash cans, threatening to kill himself. After being watched for a few days in the mental health unit he was returned to the general population.

On July 29, after Carl made a threatening comment to another inmate, he was assigned to the restricted housing unit for 60 days as punishment.

He was strip-searched and put in a cell measuring about 7-by-9 feet, with two bunks on top of each other, a commode and a sliver of a window, according to court documents. A week later, Carl was moved to a double cell with Joseph Monica, a prisoner who had a history of violence, according to Yoder's complaint.

Carl and Monica were confined to this cell more than 23 hours a day.
According to the deposition of John McCullough, the former superintendent at Houtzdale, several people could have ordered, or at least requested, that Carl be held in a private cell or housed somewhere other than the RHU: the lieutenant for the restricted housing unit, the mental health staff or McCullough himself.

Yoder maintains that their refusal to intervene led to the inevitable violence to come.

If somebody breaks his leg and isn't able to work, he's not punished by being made to run on a treadmill, Yoder said.

"But that's exactly what they did here: They gave him a misconduct for his mental illness. Then they put him in a situation that made his mental illness worse, and he ended up getting killed.

"It was highly predictable and highly preventable."

At 6:58 a.m. on Aug. 6, 2002, an argument ensued over a food tray. Carl told corrections officer James Oliver that Monica was threatening to kill him, according to legal documents. At 7:02 a.m. Oliver saw Monica and Carl fighting, but he didn't call for help for five more minutes.

Oliver radioed Officer Tracey Hoyt, in the control center, to open the cell door, but he refused even though another guard was three cells away. Meanwhile, Monica beat Carl's head against the steel bed frames, according to the documents.

The cell door was opened within a minute or two, but Carl's injuries were fatal.
Former Houtzdale superintendent McCullough said in his deposition that Department of Corrections policy is to have a commanding officer present before a cell door is opened. However, he said, corrections officers are allowed to make exceptions.

Nevertheless, Susan McNaughton, spokesperson for the DOC, said there waas no wrongdoing or misconduct by any of the department officials.

In an e-mail, she wrote: "We are confident that staff acted appropriately in the housing placement of the inmate and in reaction/response to the Aug. 2002 incident."

The Centre County coroner ruled the primary cause of Carl's death was "violent motion of the head, resulting in injury to the brain." The coroner also noted Carl's body had five times the therapeutic level of Artane, a medication that is supposed to counteract the side effects of psychotropic medications.

Dr. Muhammad Zahid Husain, who prescribed the Artane to Carl, had just graduated from psychiatric residency, according to Gottlieb, had not passed his psychiatric boards, had almost no experience in prisons and was given no orientation to Houtzdale and its procedures and policies.

Gottlieb guesses Carl hoarded the medicine to use for suicide or a high. Yoder holds Husain responsible for prescribing Artane to Carl, who had a long history of noncompliance.

Monica, the cellmate, was later convicted of manslaughter.

Pete Scherer believes Carl would still be alive today, if he had been paroled and become a resident in a structured program where he could have been monitored and coached to get a job.

Thinking about what could have been doesn't help Pete Scherer now, except to make him more determined to do something to change the system that resulted in his brother's death, even if it requires compensatory and punitive damages.

None of the attorneys for the psychiatrist Husain or Houtzdale's behavioral health care provider would comment for this article, citing the upcoming trial.

"The Department of Corrections has improved its evaluation and assessment of inmates over the years," said DOC spokesperson McNaughton, "to better identify those individuals with mental health issues to ensure they receive appropriate housing and treatment."

Ultimately, the decision will rest with a jury if a settlement is not reached first.

"There's a lot of people who I think need to take responsibility for what happened," said Yoder. "It should have never happened."

What Scherer hopes for
Pete Scherer believes no one person is to blame for the death of his brother, Carl,
Instead, he blames a complacent state prison system for not doing enough to treat and protect inmates with mental illness, like his brother.
Some of the changes he is hoping his civil suit will inspire include:
• Better understanding and systemic improvement of issues and problems of mentally ill inmates.
• Better communication with families and the treatment programs inmates are involved in.
• Better policy that defines how corrections officers deal with day-to-day treatment of mentally ill inmates.
• More outreach to utilize the resources of volunteers.
• Better treatment and follow-up advocacy to address the needs and problems of an increasing mentally ill prison population.
• Better preparation and a more successful process for parole and placement of inmates with mental health issues.
E-mail: lespenshade@lnpnews.com Read more!

Women's shelter seeks funding help -Rocky Mount (NC) Telegram

By Eric Klamut

Providing services and shelter to victims of domestic and sexual abuse, My Sister's House has been a haven for battered women for more than 20 years.

But recently, the agency is running into some problems.

Entering the year with a $50,000 deficit, My Sister's House is operating on an already tight budget of $500,000, said Meredith Holland, executive director of My Sister's House.

"We need funding within the community to help with the deficit," Holland said. "We're operating on a thread to keep going."

With a staff of 21 and locations in Rocky Mount, Nashville and Tarboro, My Sister's House gives those suffering from mental, physical and sexual abuse a place to turn their lives around, Holland said.

Through its shelter in Rocky Mount, its programs, a hotline and services such as helping women file protection orders in court, Holland said the agency is looking to improve its services.

"We're looking at what we have and make it better," she said.

In 2007, My Sister's House fielded 1,800 crisis calls, 1,400 in-person meetings and housed 202 women and children at its shelter.

Staff members accompanied individuals in court 651 times in the Twin Counties during that same year.

Last month in Nash County alone, the agency took 127 crisis calls, met with 75 women, 34 children and four men.

"That's just one county," Holland added.

The agency's deficit resulted from a loss in state funding. Determined, Holland said she is hoping a fundraising dinner planned for May at Benvenue Country Club will help the situation.

"Our goal is to build a new shelter," she said.

When women come to My Sister's House, Holland said each individual's circumstances are different.

"Not everybody needs a warrant or to take out a protective order," she said. "Some people come in and just want to talk. Others need services like shelter or clothing."

Some even seek food, which is donated to the agency.

Because of budget woes, some programs will be slimmed down to accommodate increased expenses, Holland said.

"We don't charge for services," Holland said. "You want to continue to serve the people without cutting services. We're going to be cutting some things, but not trimming too much."

Other service include a resale store in Rocky Mount and school programs to help prevent teens from becoming involved in abusive relationships.

"We talk about body image, peers, gossip and choices so that they don't get themselves into situations," Holland said.

For more information on My Sister's House, call the Nashville office at 462-0366. Read more!

From the streets to a home: A Sheltercare success story - Eugene (OR) WKVAL-TV

Video of this story here.

By Elissa Harrington

SPRINGFIELD - The Department of Human Services has given a grant of more than 300 thousand dollars to Sheltercare. Sheltercare is a program for mentally ill and homeless adults.

The local program currently serves 11 clients but this money now allows them to expand. We took a closer look at just what Sheltercare does and met one young lady who credits the program for saving her life.

JoDee King is just like many other young woman. She enjoys decorating, makeup, collects artwork, and cherishes her cat. Bet you wouldn't guess just months ago King was living on the streets.

She has suffered from bipolar disorder her entire life but recently was unable to afford medications and tried to commit suicide. "I just pretty much felt like there was nowhere else to go and in my mind that was logical," she says.

After recovering in the hospital last summer she left only to find herself with no job, no money, and no place to live. "I didn't know what to do."

That's until she met Dave Witham. the Sheltercare TIP Program Manager. He says, "Many people who come to me like JoDee have gone through many atrocities that no individual should have to go to. But yet they have this zeal for life."

Like thousands of other's, Sheltercare helped King by setting her up with a house Witham got her back on her feet with a furnished apartment, counseling and in their case friendship. "I know that he wants the best for me," says King. She says it's humbling to think just months ago she was living under a bridge, when now, she works 26 hours a week, is back on meds, and is excited for her future.

Even more exciting is this new grant that these two know will open the door for so many others. "When you are depressed all you can think about it dying," says King. "To go from that to thinking maybe I have something to offer even in the smallest way is a big deal."

Sheltercare has served the Eugene area more than 35 years.
Read more!

Senate to vote on autism bill Tuesday -Racine (WI) Journal-Times

BY PAUL SLOTH
February 24, 2008

Parents of children with autism are crossing their fingers as they wait for the state Legislature to do something about insurance coverage for their children’s treatment.

A bill before the state Senate would require health insurance policies — as well as self-insured governmental and school district health plans — to cover the cost of treatment for autism, Asperger’s syndrome and pervasive developmental disorder not otherwise specified.

Wisconsin health insurance plans are currently not required to cover the treatment of autism spectrum disorders, and those in need depend on an employer’s willingness to offer this kind of coverage.

"We’re hoping to get it pushed through. We’ve been writing and calling our legislators," said Cindy Schultz, a local mother who started Autism Solutions, a Racine support group for families dealing with autism. "There’s a bunch of moms in the circle of autism, you could say, that have been trying to stay on board with this."


Treatment can be costly and most parents of children with autism end up paying out of pocket, Schultz said.

According to Senate Bill 178, the treatment must be provided by a psychiatrist, a psychologist, a social worker who is certified or licensed to practice psychotherapy, a paraprofessional working under the supervision of any of those three types of providers, or a professional working under the supervision of an outpatient mental health clinic.

The bill is expected to pass in the Senate, according to a spokeswoman for Senate Majority Leader Russ Decker, D-Weston.


"There’s pretty broad (bipartisan) support," said Carrie Lynch, Decker’s spokeswoman. "It wouldn’t be a partisan issue."

Lynch said she isn’t sure what will happen to the bill if it does pass in the Senate then moves to the Assembly.

Parents have been asking for help so they can provide early treatment for their children as soon as they are diagnosed with autism. There is help from the state through a program that helps families pay for in-home therapy, but families must wait for more than a year to get on a list to receive the assistance.

It has attracted families from outside the state who move to Wisconsin because of the program, Schultz said, making it even more difficult.

Also, the number of children diagnosed with autism continues to grow, said Schultz, who started Autism Solutions after her son Gavin was diagnosed with autism.

"There is a generation of children entering the schools without ever having had in-home therapy," Schultz said. "It’s sad because, these kids, there’s so much hope for them if you start working with them right away." Read more!

Mother Is Held in Slaying of 3 Children -New York Times

By ROBERT D. McFADDEN and ANGELA MACROPOULOS

A Long Island woman described as emotionally disturbed and afraid of losing custody of her children called the police on Sunday and led officers into a blood-spattered bedroom where her young daughter and two small sons lay slain on a bed, investigators said.

The woman, Leatrice Brewer, 27, who lived with the children in an apartment in the Nassau County hamlet of New Cassel, was taken to a hospital for physical and mental examinations, the police said. Late Sunday evening, she was charged with the murder of all three children.

Neither the police nor the county medical examiner said what caused the death of the children, who were identified as Jewell Ward, 6; Michael Demesyeux, 5; and Innocent Demesyeux, 18 months old. But investigators said one appeared to have been drowned, while the others had been slashed to death.

“It was a very disturbing scene, not only because they were children,” Detective Lt. Kevin Smith of the Nassau police said of the bedroom where the victims were found, at 891 Prospect Avenue in New Cassel. He declined to give details, pending inquiries by homicide detectives and the medical examiner.

The killings on Sunday appeared to add another grim chapter to a growing casebook of children slain by mothers: five drowned in a bathtub near Houston; two battered with rocks in Tyler, Tex.; three drowned in San Francisco Bay. The cases — some ending in verdicts of not guilty by reason of insanity — have ignited a national debate over mental illness and the legal definition of insanity.

Nassau authorities declined to discuss any motives behind Sunday’s killings. But relatives and acquaintances described Ms. Brewer as emotionally unstable.

The two fathers of the children said they had tried through the courts to gain custody. Ricky Ward, Jewell’s father, said he had been trying in Family Court for a year. “Whenever I tried to get my daughter, Family Court wouldn’t let me,” he said. “The courts wouldn’t hear me out. I blame this on Leatrice Brewer and Family Court.”

In the 12 years that he had known her, Mr. Ward said Ms. Brewer had tried to kill herself a number of times. The Nassau police said they were investigating a report that she had jumped out a window of her apartment on Sunday. “He problem was her mind state,” Mr. Ward said. “She wasn’t stable and wasn’t able to communicate. She didn’t want anyone to have her kids. It’s a tragedy that my daughter’s gone.”

Innocent Demesyeux, the father of Ms. Brewer’s two sons, said that he and Ms. Brewer had been battling in court for 18 months over visitation rights and custody of the boys, and that she feared she might soon lose custody.

“I’ve been fighting to see them,” he said. Interviewed while sitting in a car parked outside the scene of the killings, Mr. Demesyeux, 28, of Hollis, Queens, said he had last seen his sons a month ago. He said that he and Ms. Brewer had a date in Nassau County Family Court on Monday, and that he had hoped to win the case. He said Ms. Brewer had missed court dates recently and had refused to take drug tests, which he said he had passed.

He said that he had recently been in contact with a county child protective services agency and that a representative was to have visited Ms. Brewer’s apartment on Friday. It was unclear if that visit took place.

Some neighbors said Ms. Brewer had behaved bizarrely. “I used to see her walking down the street during the day in her pajamas,” said Lisa Jones, who said she was a distant relative of Ms. Brewer. Asked if Ms. Brewer had seemed mentally unstable, Ms. Jones said, “Absolutely.”

Tatiana Wideman, 13, who said she had been a baby sitter for Innocent, said of Ms. Brewer: “She was stressed out. Everybody knew it. She would go around asking people for money.”

The Rev. Elijah Crawford, pastor of the Healing Power Church, spoke on behalf of the family at the Westbury home of a relative of Ms. Brewer’s, where family members had gathered. He said he had been told that Ms. Brewer had snapped because money she had expected from a social services agency — money she needed for the children — had failed to arrive.

“She didn’t get it, and snapped out,” the pastor said. He later said of family members: “They don’t know what happened. All they know is that she snapped. They said she had great love for her children. It’s just something that happened all of a sudden.”

Lieutenant Smith said the police responded to a 911 call at 8:55 a.m., summoning them to the Prospect Avenue address. It is a white-brick, two-story apartment building on the northwest corner of Swalm Street.The avenue, lined with commercial and residential buildings, is the main thoroughfare of New Cassel, a hamlet in the town of North Hempstead with 13,000 residents.

The 911 caller was apparently Ms. Brewer, but the police declined to specify what was said. Officers arriving at the scene found a building with four apartments, two on the ground floor and two upstairs, and were met on the second-floor landing by Ms. Brewer, who took them into her apartment, No. 3, and then into the bedroom, where the three children lay on a bed.

The children, the lieutenant said, were “obviously dead.”

Homicide detectives and dozens of police officers arrived shortly afterward, along with a crime scene investigation truck, which pulled into a driveway behind the building. The avenue was cordoned off to vehicular traffic, and yellow tape was set up to contain the large crowd — people from New Cassel and adjacent Westbury, as well as members of the news media — who gathered to watch the police activity.

Many people emerging from nearby church services joined the throng, and the talk for much of the day was of the deaths of the children, whose bodies were in the building all day and into the evening. They were to be taken to the medical examiner’s office in Mineola, and an autopsy was planned for Monday.

While the debate over degrees of mental illness and the legal definition of insanity continues, mental health experts and defense lawyers in recent years have been encouraged by the outcome of several high-profile cases in which mothers who killed their children have been found not guilty by reason of insanity and committed to mental institutions instead of prisons.

Last year, Lashuan Harris, 24, who threw her three young sons to their deaths in San Francisco Bay in 2005, was declared insane by a judge one day after a California jury found her guilty of second-degree murder. The defense argued that she was schizophrenic, borderline mentally retarded and convinced that she was acting on orders from God when she threw the boys — ages 6, 2 and 16 months — into the water.

In 2006, Andrea P. Yates, who drowned her five small children in a bathtub at their home in the Houston area in 2001, was found not guilty by reason of insanity in her second trial. In 2002, another jury had convicted her of murder, rejecting defense claims that she was so psychotic that she thought she was saving the souls of her children by killing them. An appeals court overturned that conviction because of erroneous testimony by a prosecution witness.

And in 2004, Deanna L. Laney, who bashed in the heads of her sons, 6 and 8 years old, in Tyler, Tex., in 2003, saying that God had ordered her to do it, was acquitted of murder by reason of insanity.

Her lawyers argued that insanity was the only way to explain why Ms. Laney, a deeply religious woman who had home-schooled her children, would kill her sons without shedding a tear. Psychiatrists testified that Ms. Laney believed that she was chosen by God to kill her children as a test of faith.

Daryl Khan contributed reporting. Read more!

What do we tell the parents? -Louisville (KY) Courier-Journal

02-24-08
Commentary: By Allan Tasman

How should I answer the parents of a seriously mentally ill child in the University of Louisville Hospital Emergency Psychiatric Service, who is suicidal and needs hospitalization, when they ask me why no beds are available anywhere in our community today and may not be for several more days? If the proposed state budget cuts for mental health are enacted, I'd better find a good answer for these distraught parents, because this situation will arise more and more.

Twenty per cent of adults, children and the elderly experience a mental disorder needing treatment during a given year. According to the U.S. Surgeon General's landmark 1999 report, "Mental disorders impose an enormous burden on ill individuals and their families. They are costly for our nation in reduced or lost productivity (indirect costs) and in medical resources used for care, treatment and rehabilitation (direct costs)." Each year, a higher proportion of those expenditures comes from public sources. Today in Kentucky, more than 50 percent of mental health expenditures come from federal, state and local funds, providing essential support for a complex, but fragmented and inadequate, system of care.



Kentucky was once, in the 1970s, a proud national leader in mental health services, provided through its network of Community Mental Health Centers (CMHCs) and state hospitals. Funded with seed money from the federal government and supplemented by state and local funds, our state network became a model for the nation, enabling Kentuckians to receive services in their own communities -- Seven Counties Services (SCS) in Louisville -- regardless of where they lived. Unfortunately, state funding did not keep pace with needed levels of support, and our state has not been seen as providing a model system of care for many years.

In spite of inadequate state support for mental health, some progress was made in the next several decades. In the mid '80's, the departments of psychiatry at the state's two medical schools expanded educational and clinical collaboration with the public providers, resulting in better trained psychiatrists at the state hospitals and CMHCs. During the 1990s, U of L's psychiatry department led the development of a partnership with SCS, Central State Hospital, University Hospital and the Kentucky Department of Mental Health to implement a regional mental health crisis intervention system, based at University Hospital's Emergency Psychiatric Service. This program received national recognition as an innovative clinical partnership that led to a decrease in state hospital admissions and a decrease in emergency mental health visits at a time when emergency mental health visits were skyrocketing nationally.

To regain the momentum of Kentucky's community network, and to re-establish its status as a model for other states, Kentucky embarked upon a collaborative strategy of planning, bringing together state officials, legislative leaders, consumers and mental health professionals. The 2000 General Assembly created the Kentucky Commission on Services and Supports for Individuals with Mental Illness, Alcohol and other Drug Abuse Disorders, and Dual Diagnoses (known as the HB 843 Commission).

House Bill 843 established a planning process that emphasized local participation and decision making. The Regional Council in Louisville, a consumer/professional partnership, continues to meet today, determining the local community's needs and forwarding regional plans to the state planning commission.

Unfortunately, a disconnect has occurred between the Regional Planning Councils and the legislative and executive branches of government. Small and inadequate amounts of new funding, when authorized at all by the state government, have been earmarked for new services without regard to how existing services can be sustained. Although new services are sorely needed, continued efforts to "tighten the belt" and "operate more efficiently" have resulted in a strained and more fragmented network that can no longer meet our patients' needs.

Appropriations for CMHCs have been flat-lined and reimbursement rates have been frozen for years, leaving no choice for CMHCs but to more narrowly restrict services. CMHC non-profit affiliates find themselves serving more and more people without any funding to support the clinical needs. For example, the Department of Psychiatry at U of L provided almost $4 million in uncompensated mental health care last year, and the amount continues to grow alarmingly. The catch phrase "do more with less" no longer has meaning.

At a time when Kentucky ranks 42nd in mental health funding, 49th in depression status, has one of the highest suicide rates in the nation, and finds its mental health system receiving a grade of "F" from the National Alliance for the Mentally Ill (the nation's largest mental health advocacy group), mental health care clinicians are being asked to plan for a 12.5 percent cut in state funding in each year of the next biennium, rather than planning for even one dollar of the $75 million in increased funding that the "843" planning process determined is urgently needed to maintain even a minimally adequate level of services.

Let's put a face on those persons who will be impacted by cuts and the lack of services. Look at your family at the dinner table, the person across the street, the person next to you at the movies and the person next to you on the bus. With 20 percent of the U.S. population requiring mental health care each year, there is little doubt that each of us has a friend, colleague or family member who will need mental health services in the coming year.

There is substantial evidence that early intervention leads to better outcomes for psychiatric illnesses, just as for all medical illnesses, and to substantially reduced costs for care. So, common sense tells us that when services are unavailable, our families and friends suffer more and the cost to our society increases needlessly.

We need visionary political leadership -- leadership that will not tolerate neglecting our most vulnerable citizens, and leadership that will recognize and place value on their needed mental health treatment. Otherwise, maybe one of our politicians can provide a good answer for me to give to those parents anxiously waiting in our emergency room.

Allan Tasman, M.D., is professor and chairman of the Department of Psychiatry and Behavioral Sciences at the University of Louisville School of Medicine. He is also past president of the American Psychiatric Association, the world's largest organization of psychiatrists. Read more!

uts could affect Marshall mental health services -South Bend (IN) Tribune

02/24/08
ANITA MUNSON

PLYMOUTH -- Federal funding cuts could produce what Bowen Center officials called "a dilemma" in services locally.

The Otis R. Bowen Center for Human Services Inc. operates the Shady Rest and the Russell House for the chronically mentally ill, as well as cluster homes and apartments, in Plymouth.

Kurt Carlson, president and chief executive officer of the Bowen Center, told Marshall County Commissioners last week that the center would "deploy resources from other counties to Shady Rest and Russell House," adding, "if the unintended happens, we may not be able" to continue services in the current manner.

Carlson referred specifically to the Federal Budget Reduction Act, which he fears could seriously reduce available Medicaid funding. Carlson said even though Bowen Center is among "the most aggressive" in using the Medicaid option in Indiana as a primary funding source, the reduction could cause a "lot of ripple effects."

Fewer case managers, fewer mental health services, a longer waiting time for services, potential program elimination and, in a worst-case scenario, the closing of residential facilities are possible scenarios Carlson mentioned.

The Bowen Center owns four facilities in Marshall County, where it has operated since its 1961 inception as the Four County Mental Health Clinic. The name was changed in 1977 to honor former Gov. Otis Bowen. The center also serves Allen, Huntington, Kosciusko, Noble, Wabash and Whitley counties.

With a total of 411 full-time accredited staff, the center employs 72 in Marshall County under the direction of Robert Ryan. The center paid local wages and benefits of more than $2.7 million during fiscal year 2007.

Bowen Center reports indicate the center served 1,477 patients from Marshall County during fiscal year 2007, representing 12 percent of the total patients served by the center. Of those served, 666 were children or adolescents, or more than 45 percent of those served in Marshall County,

The majority of services in Marshall County during the same period were outpatient, partial hospital and residential. Additionally, residents also utilized the center's inpatient facility at Warsaw.

More than 60 percent of client referrals to Bowen Center come from local agencies, most of which are within the court/criminal justice system. Criminal and court referrals, center records indicate, represent about 27 percent of the referrals within Marshall County, or about 400 patients.

Many of them, Bowen officials said, are indigent and unable to pay. The center typically writes off 40 cents for every dollar billed to patients, and the write-off amounted to nearly $400,000 for Marshall County locations in the fiscal year ending June 30.

Marshall County provided $236,000 in funding in 2007, and the center requested $233,690 for calendar year 2008.

Medicare/Medicaid accounts for 69 percent of the center's annual funding, while county funds amount to about 4 percent, Bowen Center figures indicate. Indiana kicks in 5 percent, federal funding outside of Medicare/Medicaid adds another 5 percent, and private-pay individuals, insurance and other sources amount to 16 percent.

The budget act effect

If the Federal Budget Reduction Act goes into effect in May as scheduled, Indiana would limit the amount of Medicaid spending the Bowen Center and other community mental health centers (CMHCs) can bill each year. Bowen Center leaders figure they will need to cut Medicaid expenditures system-wide by $3.5 million a year, meaning about 35 case managers could be eliminated.

The federal act also will modify how Bowen Center can bill for its case management and other services, officials explained. One change is that services must be rehabilitative, not used to maintain clients at present functioning levels. That means that chronically mentally ill patients could, in the future, have fewer residential programs and fewer services in the local school system.

Bowen Center officials urged the county commissioners to support Indiana Senate Bill 350 to help offset the effect of some of the federal changes.

The bill allows the use of county property tax funds to be used for state matching funds to leverage additional federal Medicaid money, they said.

The bill directs local government to pay the county property tax funds directly to the Indiana Division of Mental Health & Addictions (DMHA), instead of funding the Bowen Center directly from the county's general fund.

"So you can leverage about $380,000" by sending the money to the state instead of directly from the county's general fund to the Bowen Center, Jay Baumgartner, senior vice president, financial services, Bowen Center, told the commissioners.

"We had stable funding for about a dozen years," Carlson told commissioners. "This just goes against the grain to have to think of reductions in services."

Staff writer Anita Munson:
amunson@sbtinfo.com
(574) 936-2920
Read more!

Our shredded safety net -Raleigh (NC) News & Observer

N.C.'s mental health 'reform' a recipe for tragedy

Mark Sullivan
02-24-08

CARRBORO - Eight years into mental health reform, North Carolina has thus far dodged a bullet. Much of the postmortem on the origins and unfolding of the reform effort has been done. But how much worse can things get, and what will it take to bring about real and meaningful change? If recent developments do not mark a turning point in reform, the turning point will be marked by tragedy on a massive scale.

Consider that after all of this time, just three of 24 Local Management Entities (the organizations charged with ensuring needed services are available) in North Carolina are meeting minimum standards for routine care. Just 45 percent are meeting minimum standards for urgent care. How bad must things get before we are willing to rethink the fundamental assumptions that the new system was founded on?

North Carolina ranks near the bottom in the nation in per capita funding for mental health care at $16.80, compared with the national average of $91.12. Yet our problem is much bigger and more complex than underfunding.

After the first six months of the fiscal year, the Division of Mental Health, Substance Abuse and Developmental Disabilities reported that only 30 percent of mental health funds and 20 percent of substance abuse funds that had been budgeted had been expended.

On the surface it might look like the system is overfunded, but what these numbers signal is that needed services are not being provided because they are unavailable.

A core problem with the new system is that it was built upon a fundamentally flawed assumption; that the private sector will always outperform anything run publicly. It is a wildly popular notion, and a key reason why this particular plan was able to gain support in North Carolina.

The private sector is far superior in many arenas, but not necessarily when it comes to protecting the poorest and most vulnerable members of society. Private providers pick and choose which services they will provide, based on what will best meet the needs of the agency, as opposed to public entities whose first responsibility is to meet the needs of the citizenry. Departments of social service, child protective services and health departments are county run -- why not mental health?

In Orange, Person and Chatham counties, Caring Family Network, the agency designated as the Comprehensive Service Agency (CSA) in our area, has determined that it could not financially sustain service provisions and will cease offering services effective March 12. CSAs are designated to provide psychiatry, psychotherapy, crisis services, substance abuse counseling and community support. They are meant to replace our old public "safety net" clinics to ensure that a basic level of service is available to the community.

l l l

THE NEW SAFETY NET IS THE CRIMINAL JUSTICE SYSTEM.

We know what happens when people who need psychiatric care do not receive it. Most suffer quietly, some lose their jobs, are engulfed by addiction, lose their housing, fill hospital emergency departments, crowd jails and prisons or take their own lives.

But Wendell Williamson, the UNC law student who opened fire on Franklin Street on Jan. 26, 1995 with a military rifle, killing two and injuring two, tells another story. Alvaro Castillo, who allegedly killed his father and fired eight shots at Orange High School in 2006, made a convincing argument for the importance of mental health treatment. Most recently, Steven P. Kazmierczak made his case at Northern Illinois University.

Calling up these names risks reinforcing some stigmatizing stereotypes about people with mental illnesses. When people hear of mental health disorders, they too frequently conjure up images of the most severe, least common cases. They do not think of someone like me, though I represent a more common picture of someone with a mental disorder.

Only a small fraction of people who experience mental health disorders present a danger to others. But when one considers the scale at which our system is failing, it is clear that a new tragedy is only a matter of time; it's a statistical certainty.

The formula is simple: Take a population of 9,061,032 North Carolinians, of which approximately 356,000 adults have serious mental illnesses and 192,000 children have serious emotional disturbances. Next, systematically restrict access (either intentionally or unintentionally) to treatment for those who need it. The result equals tragedy on a massive scale.

We will never be able to prevent every tragedy, even with an excellent mental health system. But by restricting access to care for 550,000 of our most deserving and needy residents, we are stacking the odds against ourselves.

Health and Human Services Secretary Dempsey Benton has been called upon to salvage the system. He is by all accounts a capable administrator, and he has taken steps that show he means business. But with less than a year left in Gov. Mike Easley's administration, Benton will have to be a miracle worker to provide leadership that amounts to something more than too little, too late.

County officials have a rare opportunity to step in and do something that is fiscally responsible, morally right and politically popular. Will they stand by and wait for the state, the Local Management Entities or a private provider to replace the safety net while the system is in free fall? If so we may be in for a very hard landing.

(Mark Sullivan is executive director of the Mental Health Association in Orange County.) Read more!

Reform wastes millions, fails mentally ill - Raleigh News and Observer

Graphics, video and other information on this story here.

Mental-health changes aimed to improve community treatment, but providers took clients shopping, swimming and to movies for $61 an hour

By Pat Stith and David Raynor, Staff Writers

North Carolina's mental-health reform was supposed to improve treatment for the mentally ill and provide good value for taxpayers. It has done neither.

The state has wasted at least $400 million in an ill-conceived and poorly executed plan to treat more mentally ill people in their own communities and fewer in the state's four psychiatric hospitals, a News & Observer investigation shows.

Local governments, forced to stop offering treatment, were replaced by providers out to make a profit. Most of their workers were high school graduates, not licensed professionals, but the bill was stunning. In a few months, the cost of the community support program was $50 million a month, more than 10 times what the state had expected.

Providers took some clients to movies or shopping, charging taxpayers $61 an hour.

Meanwhile, some seriously ill people had to do without treatment. Services that were more likely to help them avoid hospitalization were in short supply.

It was almost a year before the state reacted.

Hundreds of providers have abused the system, the state now says, charging for services that were unnecessary or were not performed.

So far, the state Department of Health and Human Services has demanded that the providers pay back $59 million. A government review last fall of more than 12,000 people receiving a rapidly expanding community service indicated that hundreds of millions of dollars had been wasted. That review said 89 percent of the treatment was medically unnecessary or given in the wrong amount.

Since the General Assembly ordered sweeping changes in 2001, the cost of caring for the mentally ill has more than doubled, to $1.5 billion a year.

Here's one example of why: Last February, a worker employed by a Durham provider spent five hours with a 13-year-old girl, asking about her day at school and assisting with her homework, according to a government audit. The worker, called a paraprofessional, wrote that "While [the child] was reviewing the vocabulary word, Paraprofessional went to the store for [the child's] mother."

For that session, the company was paid $305.

North Carolina tried to change too many things too quickly, according to Paula Cox Fishman of Greensboro, an activist who has followed reform closely.

"It's a mess," she said. "It's going to be hard to turn this runaway train around."

Responsibility for carrying out mental-health reform fell to the Department of Health and Human Services, led for six years by Carmen Hooker Odom, Gov. Mike Easley's appointee. Department officials made key decisions that hobbled the program. They defined too loosely the community support services companies would offer, and they agreed to pay too much for it.

'Worse off right now'

Harold Carmel, president of the N.C. Psychiatric Association, holds the Easley administration responsible.

"The devil was in the details," Carmel said in an interview. "And they didn't think through all the details. They were overwhelmed by the task. They still are."

Hooker Odom announced her resignation last May, two weeks after informing the governor about what she called a "deeply disturbing" audit of mental-health providers.

Easley and Hooker Odom, the two officials most responsible for implementing mental-health reform, declined to be interviewed.

Rep. Verla C. Insko, a Democrat from Chapel Hill, was the primary sponsor of the reform law. She is not proud of the results.

"I think we're worse off right now," Insko said. "What they did was bring in easy-to-serve people, maybe even people who ... didn't need the service."

She said the lack of proper treatment is causing more people who are mentally ill or who have a substance-abuse problem to be taken to hospital emergency rooms -- or jail. And they're rotating in and out of the state's psychiatric hospitals. On some days, state hospitals are so full that they are refusing to accept new patients.

Since 2001, at least 13 people committed suicide or overdosed on drugs less than a week after being discharged from state hospitals. Some died within hours.

In a case that grabbed headlines in May 2007, Stephen Ryan Gibson led state troopers on a 70-mile chase in a stolen car. The chase ended with his shooting death on Interstate 40 in Raleigh. Gibson, 23, had been sent to Dorothea Dix Hospital on an involuntary commitment order a month earlier.

Hospital officials decided outpatient care was enough and released him in less than two hours. Records show the adult admissions ward at Dix was at or over its capacity for much of that week.

Counties forced out

More than six years ago, the General Assembly voted overwhelmingly to tear down, then rebuild, the way the state treats mentally ill people, about 210,000 of whom seek state help each year.

The state set out to reduce the use of its four hospitals and shift treatment to communities. A study requested by legislators said part of the additional cost could be paid for with money saved by shrinking hospitals and staff.

Federal, state and local governments provide mental-health services to the poor. A little more than a third of the cost is borne by the state and local governments in North Carolina, the rest by federal taxpayers.

Before reform, mental-health services were provided at the local level by county and regional groups and the private providers who, in effect, worked for them.

After reform, counties were forced to get out of the treatment business. They formed local groups that were supposed to manage the providers.

But the state got the plan backward, forcing the counties to divest first.

"We were told to do it right away," said Yvonne Copeland, executive director of the N.C. Council of Community Programs, which represents the county entities.

Services at the local level started drying up with little or nothing to take their place, and the state eliminated more than 500 hospital beds. No one expected that it would take years to get approval for a new, supposedly improved package of community services from the federal government.

Federal approval of the new services didn't come until late December 2005. The state launched its new community services three months later, on March 20, 2006.

The Department of Health and Human Services had planned for years for that Monday in March, writing descriptions for the services it wanted, figuring out how much to pay and haggling with federal officials over the details.

Finally, on March 20, the state began offering an array of mostly new services to people suffering from mental illness or substance abuse. Seven of the services, including intensive in-home therapy for severely emotionally disturbed children, are most likely to keep people out of hospitals. Two other, more basic, services were known as community support.

And from that day to this, community support services have hemorrhaged money.

Stunning costs

In January 2005, the state told the federal government those two services, community support for children and community support for adults, would cost less than $5 million a month.

Now department officials say that estimate was flawed and should have been increased.

As Carmel said, the devil really was in the details. The state:

* Set a $61-an-hour rate for services performed by workers with only a high school diploma.

* Allowed providers to recruit clients and determine what services they needed, which permitted providers to refer clients to themselves.

* Allowed people to receive 30 days of service without government authorization.

* Allowed companies to start work immediately and qualify later.

The latter two actions came because the state was concerned that people who had been served under an old community program would be denied or that there wouldn't be enough companies to provide service.

"I think, with the benefit of hindsight, we made those initial entrance criteria more liberal and loose than they needed to be," said Leza Wainwright, deputy director of the Division of Mental Health, Developmental Disabilities and Substance Abuse Services.

Taxpayers would pay dearly for each of those decisions.

In the summer and early fall of 2006, officials at Health and Human Services apparently paid little or no attention to the bills pouring in. They saw that more people were being served, but they had expected it, Wainwright said. They had hoped for it.

If officials had been alert, they would have been stunned. About 90 percent of the money was going to the two community support services.

In June 2006, the bill for community support was $27.5 million, half as much as the state had expected to pay in a year. By August, the bill had almost doubled, to $50.7 million. It continued to grow.

By February 2007, when the Health and Human Services accountability team started an audit, the monthly bill was $93.5 million.

"I've heard the analogy used here that this sort of lined up to be the perfect storm," said Jim Slate, the director of budget and analysis at Health and Human Services. "Did we know it was going to do what it's done? No. Nobody had a clue."

Health and Human Services had expected that the child and adult community support programs would be delivered, in part, by people with college educations and even advanced degrees. The department had agreed to pay a "blended" rate for that mix.

"The initial rate of $61 per hour assumed that the higher skilled staff would be involved in about one-quarter of the services rendered," Hooker Odom, the former secretary of health and human services, told Easley in a letter last April. She said her department's auditors had discovered that 98 percent of the service was being provided by high school graduates.

What Hooker Odom did not say in her letter was pivotal: Her department had agreed to pay high-skill wages without requiring high-skill workers.

By November, when Health and Human Services declared a moratorium on new providers, 784 were being paid for community support -- but only 137 for more critical services.

The numbers tell the story: From March 2006 through January 2008, community support for children and adults cost nearly $1.4 billion, 90 percent of new community spending. During that same period, the government spent $78 million -- 4.9 percent -- on the seven services more likely to reduce the need for hospitalization.

Officials had intended to spend more on those more intensive services than on community support.

The department concedes that it set the rate too high for the two community support programs and too low for most of the other services for more seriously ill people. It cut the rate for child and adult community support last April but still has not raised the rates paid for the other services.

Audit reveals abuses

Recollections differ now as to when Health and Human Services officials realized that mental-health reform spending was out of control. By some accounts, it was October or November 2006, but officials waited until early 2007 to do anything about it.

"I guess we just did not foresee the magnitude of the problem," Wainwright said.

On Jan. 16, 2007, auditors were finally ordered to saddle up.

Dan Gerlach, senior adviser to the governor, was stunned when he learned Jan. 17 about the explosion in spending: "I said, 'Holy cow!' " He notified legislative leaders the same day.

After the audit results were in, Hooker Odom huddled with top officials of her department on Wednesday, April 4. She told a subordinate to poll her Rate Setting Review Board, some of whom had already left for Easter. They agreed to slash the rate paid for community support to $40 an hour.

Hooker Odom, in a memo to the governor two weeks later, described some of the abuses her auditors had uncovered: Providers had been taking children swimming, or to a movie, or out to eat, all for $61 an hour.

They went to the mall, too. A bill from a company in Greensboro showed a worker taking an 18-year-old on a two-hour trip to improve his social skills. "He went to the game room and talked with one of the kids there ... Progress made."

The bill: $122.

A Pinnacle company worked on even more basic skills. "Staff suggests client to get up," one document reads. "Client agreed to get up." Other activity included suggesting eating breakfast and taking a shower. They later went for a ride. The bill was $366.

The state saw bills such as these and cut the rate. The outcry from providers was immediate.

On April 26, the department backtracked, raising the rate to $51.

But the damage had been done: Setting the rate for community support too high, and leaving it there for slightly more than a year, cost taxpayers $118 million.

The overpayments have continued on a lesser scale: The state is still paying high-skill wages but won't start requiring high-skill workers until March 1.

In the last week of April, Hooker Odom began telling subordinates that she would resign to take a job as president of Milbank Memorial Fund in New York, a foundation that studies health policy.

Easley said she had been planning her move for months. He issued a statement praising her.

"She has handled one of the most challenging jobs in the state with great skill," he said.

Assigning blame

Easley has tried to distance himself from mental-health reform. He blames legislators, saying Hooker Odom "vigorously" opposed the sweeping changes approved in 2001.

"It just happened sort of overnight in late October [2001], and we never thought they would do it," Easley told reporters at a December news conference.

Easley blames the agencies formed by county governments, which were partly responsible for keeping an eye on those providers.

"All we are is the banker," the governor told reporters. "We can audit, and we can offer suggestions, but they're not accountable to DHS [Health and Human Services]. DHS has been getting a black eye over the system not working, and they don't have any way to control it."

The state in November hired Mercer Health Benefits LLC for $794,000 to evaluate the county programs. That study is due May 15, in time for the legislature to consider it this summer.

Copeland, representing the county groups, said her members aren't blameless, but she says the governor is off-base.

"The counties did not close up the hospitals," she said. "Let's be clear that the [counties] have no authority. They only administer the state's policies. That's it."

Insko acknowledges that legislators tried to do too much too fast. She wishes they had started the program on a small scale.

But she rejects Easley's recent statement about her reform bill.

"I understand that the governor has said that the secretary opposed it," Insko said, referring to Hooker Odom. "She never told me she opposed it. No one in the department ever told me they opposed it."

Hooker Odom's replacement, Dempsey Benton, is trying to repair the mental-health system. The former Raleigh city manager has cut spending on community support by 19 percent, taken direct control of the state's psychiatric hospitals and won the confidence of legislative leaders.

"This program is going to have to be doing much better in terms of balancing the expenditures with the quality of service," Benton said. "I expect it to be under a microscope."

(Staff writer Michael Biesecker and news researcher Brooke Cain contributed to this report.)

Read more!

State starts getting a grip on spending -Raleigh (NC) News & Observer

Pat Stith, Staff Writer

State officials have succeeded in reeling in some of the extraordinary costs of the community support program for people who are mentally ill or suffering from substance abuse.

Medicaid spending on community support for children and adults still averaged $72 million a month in October, November and December -- about 16 times more than the N.C. Department of Health and Human Services had expected in January 2005. But payments in those three months were down almost 20 percent compared with payments made during the previous three months.

"We're not where we need to be to meet our budget," said Dempsey Benton, secretary of health and human services. But spending is moving in the right direction, he said.

Medicaid, a tax-funded program that pays medical bills for poor people, spent about $1 billion in North Carolina last year on community support for children and adults. Community support is supposed to teach skills. An adult might be taught how to behave on the job; a child might be taught how to get organized to do homework.

Since early last year, when officials realized that spending on community support was out of hand and began trying to do something about it, the state has made changes, some mandated by the General Assembly. Since last spring, the Department of Health and Human Services has:

* Reduced the hourly rate for community support to $51 from $61, a savings of about 16 percent.

* Conducted a series of audits and demanded repayment of $59 million. Through mid-January, the state had recovered $14.8 million.

* Stopped allowing new providers in the program except under special circumstances.

* Referred three providers suspected of criminal misconduct to the Medicaid Investigations Unit in the Attorney General's Office, said Grayson G. Kelley, chief deputy attorney general.

* Urged its contractor, ValueOptions Inc., to review individual requests for service more aggressively. In the early months of the program, the company approved almost every request.

* Drastically reduced the amount of service an individual can receive without a prior authorization from ValueOptions.

Other changes are coming March 1, including:

* Clarifying the definition of community support for children, emphasizing that it is a "rehabilitative, treatment service" and not a social support service, a recreational program or a mentoring program.

* Clarifying the roles of employees of community support providers based on their education levels. The department found last year that 98 percent of those services were being provided by high school graduates.

* Establishing a limit on how much community support an adult can receive.

Benton can tweak the new array of community services the department rolled out March 20, 2006, but he can't make basic changes without the approval of the federal Centers for Medicare & Medicaid Services. Going back to that agency is risky.

"That's what people tell me," Benton said. "The staff says that when we go back to Medicaid [CMMS], they may want to totally change the program. That's the risk." Read more!

How much money was wasted? -Raleigh (NC) News & Observer

There is no way to determine precisely how much money the state has wasted on mental-health reform. This is how The News & Observer concluded that amount was at least $400 million:

The primary element was a government audit. This past fall, the state completed a review of community support provided to about 12,000 people. Auditors determined that 36 percent of the services they received were medically unnecessary.

At that point, through September 2007, Medicaid had paid $1.147 billion on community support, with more bills for that period on the way. Applying the 36 percent figure against that total amount results in potential waste of $413 million.

To be conservative, we assumed no medically unnecessary treatments have occurred since Oct. 1, and we rounded down to $400 million. There are other circumstances that could raise that figure, although some of those would duplicate the waste found in the audit:

* For 12 months, the department paid $60.96 an hour for services that it later said were worth only $51.28 an hour. Had the state paid that lower hourly rate, it would have saved about 16 percent. At that point, those services had cost the government about $739 million. Sixteen percent of $739 million is $118 million.

* Since April, the state has paid $51.28 an hour for the two community support services, a number that is still too high given that the state is paying for, but not requiring until March 1, a blend of professionals and workers with high school diplomas. A proper rate to pay for a service provided overwhelmingly by workers with only a high school diploma has not been established.

* The state has said providers overbilled by $59 million, although that number continues to shrink as some win on appeal.

Mental Health series

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Read more!

Who was in charge? -Raleigh News & Observer

Dozens of key people worked on implementing North Carolina's mental health reforms. Who had responsibility?

Gov. Mike Easley appoints the secretary of the Department of Health and Human Services, which oversees mental-health policy. Easley, a Democrat, now says that his administration opposed the reforms and says DHHS acted only as a banker. He blames counties for the reforms' failure. But his administrators concede that they wrote rules too loosely and agreed to pay too much for a basic service.

Carmen Hooker Odom was Easley's choice as secretary of health and human services for more than six years. She had a reputation as a hands-on administrator who was involved in key decisions of mental-health reform. After her department finally realized that spending was out of control for a new program called community support, she left to work for a nonprofit in New York. Easley praised her performance.

Rep. Verla Insko of Chapel Hill was the primary sponsor of the 2001 reforms and is co-leader of the oversight committee. "We all fell short," she said. "Nobody gets an A or a B on this." She said that the Easley administration didn't oppose reform and that the Department of Health and Human Services "didn't have the expertise it needed." Read more!

Hospital hopes Sunday visit will reverse Medicare termination ruling - Waynesville (NC) Mountaineer

By Vicki Hyatt

Staffers at Haywood Regional Medical Center have one more shot Sunday at an inspection process they hope will save them from a fate too dire to think about — the loss of Medicare reimbursements, the bulk of the hospital's revenue source.

Medicare patients scheduled for surgery were notified Friday the procedure was cancelled, and as of midnight Saturday, the hospital had to refer Medicare patients to other hospitals in the region.

The decertification occurred Friday at the end of a day-long survey by a nine-member team from N.C. Department of Health and Human Services Division of Health Service Regulation. Hospital officials said they were told the error rate in dispensing medications was too high and that, beginning Sunday, the Medicare program would not pay for any services performed at the hospital. Any Medicare patients already hospitalized, however, would be covered for up to 30 days.

The action, said David Rice, hospital president and CEO, followed the finding of a 7.7 percent error rate found during the Friday visit. While this rate is within the 10 percent allowable margin of error for the licensing agency, the Joint Commission on Accreditation of Healthcare Organizations, it exceeds the 5 percent tolerance level for Centers for Medicare and Medicaid Services, the federal agency that regulates the federal medical programs.

“We did not know until they were done with the survey that the rate had to be above 95 percent,” Rice said. “They felt since we had difficulty with this when they came through on Jan. 30, and we did not hit target on the second pass, they would lift the Medicare program so we had to make a change.”

Some of the errors found during the latest visit involved things that happened before medications were administered. Others involved the timing of when medications were dispensed.

“If you record the action before you give the medication, that’s an error,” he said. “You have to determine whether you can give it first. A lot of the things involved timing. We did not commit any life-threatening mistakes or any that would put a patient at risk.”

Rice said the inspection turned up other areas where improvements could be made, but the medication issue was the one deemed to put patients in “immediate jeopardy” and thus result in such extreme action.

Hospital officials were working late into the night Friday and through the weekend to address an issue that could threaten the facility’s continued operation. It is estimated about 57 percent of the caseload at the hospital involve Medicare recipients, Rice said.

Officials were able to convince the chief official at the state’s regulatory division to give them one last inspection. Intensive refresher courses were being held on all floors in preparation for the Sunday inspection where much is at stake.
Rice expects the survey team to be at the hospital throughout the day and to know their findings at the day’s end.

It will take about a week before the Feb. 22 report is available in written form, Rice said, which makes it frustrating because the hospital doesn’t know exactly what the inspection team found.

“This is rare,” he said of the Medicare ruling. “They told us on exiting we would have to deal with CMS out of Atlanta. We hope we can comply with their expectations and this will be lifted.”

The January visit was based upon an anonymous complaint, Rice said. In examining each of the records pulled by the inspectors during that visit, officials could not find any instance that resulted in a patient death, he said. The complaint was also related to a medication issue, he added.

Dr. Shannon Hunter, the chief of the hospital’s medical staff, said she has worked with many hospitals.

“Having a 100 percent compliance rate is not the norm,” she said, noting her first encounter with the state’s regulatory agency was Friday. “I wish they were more collaborative as opposed to punitive. I asked them if they were allowed to make suggestions. They said they weren’t. It was very frustrating.

Hunter and a colleague contacted every member of the medial staff Saturday to offer an update on the hospital situation.

The Feb. 22 visit was a followup one to a Jan. 30 survey where Rice said problems with medication issues were also found. A Feb. 12 letter from the CMS office in Atlanta notified Rice of the Medicare payment termination because of deficiencies found under four sections of the Medicare Conditions of Participation for hospitals. A copy of the report was not available for review.

In the letter, the hospital was notified its Medicare payments would cease unless a corrected plan of action was submitted. That plan was completed, but the Friday inspection results were unable to short-circuit the action.

There is a special called board meeting at 6:30 p.m. Sunday where the facility's governing board will discuss the issue. Read more!

Don't get sick before July 1 -Wilmington Star-News

Editorial:

North Carolina's famous mental health "reforms" are claiming new victims. Most people who seek help at Southeastern Mental Health Center apparently won't get it until July 1.

Southeastern says it won't have the money. The only new cases it will accept are those deemed urgent - a tricky judgment, needless to say.

Among those turned away will be people suffering from mental illness, drug and alcohol addiction or developmental problems. They and their families will have to cope without help from the state's catastrophically dysfunctional mental health system.

In this complicated chaos of divided responsibilities, it's hard to discern where the biggest problem lies. But as of Friday, a state mental health official said she was unaware of similar problems at other agencies. She also confirmed that Raleigh has no extra dollars to bail out Southeastern.

The state's story is that Southeastern got the same number of dollars it spent the year before, which was what the General Assembly decreed.

Southeastern's story is that it had asked for $2.4 million more in the past year, and even though it didn't spend that much, it assumed it would get the asked-for amount in the current year.

It didn't. Then the bills started rolling in from more than 100 private "providers," as assorted therapists, social workers and others are called. Thanks to reform, it is they, not public employees, who get the work. Southeastern says this makes it harder to keep track of the money.

No doubt. And no doubt private providers aren't giddy at the prospect of seeing their incomes shrink between now and July 1.

But the people who might turn out to be the most unhappy are those forced to watch someone they love suffering without help - possibly getting worse and even doing something terrible to themselves or someone else.

State officials seem to be working hard to fix what went wrong with "reform." There's some reason to hope that they might succeed eventually.

But for the moment, "reform" remains a cruel failure, and the pain it has caused in these parts will worsen until at least July 1.
Read more!

Leaders, funding mitigate problems -Charlotte (NC) Observer

Mecklenburg's programs have unique advantages

PAM KELLEY PKELLEY@CHARLOTTEOBSERVER.COM

Mecklenburg County, like the rest of North Carolina, has been buffeted by ineffective mental health reforms. But smart leadership and generous local funding have helped Mecklenburg weather the turmoil better than most counties, local mental health advocates say.

Consider:

• No other county has a broader range of services than Mecklenburg, including multiple substance abuse services and a mobile crisis unit that responds to mental health emergencies. That spectrum allows more people to get care in their own communities -- a key objective of mental health reform. Mecklenburg's urban population provides a plentiful work force to give that care.

• Mecklenburg sends the fewest patients per capita to the state's psychiatric hospitals. Instead, many are treated locally at Charlotte's Randolph Behavioral Health Center. "That's better for the consumer, better for their care," says Grayce Crockett, head of the Mecklenburg Area Mental Health Authority.

• Reform mandated that public mental health agencies stop offering services so private providers could take over. But Mecklenburg's agency successfully lobbied to keep managing care of some of the most challenging cases -- children in the custody of social services. "That was huge," Council for Children's Rights Director Brett Loftis says.

Mecklenburg hasn't been immune to problems. The state's decision to hire ValueOptions, a private company, to handle treatment approvals for people on Medicaid created a backlog that caused critical treatment delays. "That's just been a horrendous failure," Loftis says.

Loftis argues that the state also erred when it dropped a policy that gave local mental health agencies control over which providers served Medicaid patients. That policy helped weed out bad companies. Now, "there's no quality assured," he says.

That's one reason, he says, that many workers providing new community support services are ill-trained and poorly supervised.

Advocates credit Mecklenburg mental health director Crockett's strong leadership for mitigating problems. "She is a guru. She's very sharp, very knowledgeable," says Ellis Fields, who directs the Mental Health Association of the Central Carolinas.

Credit is also due to Mecklenburg commissioners, Crockett says. They spend more per capita on mental health services than any other N.C. county. Mecklenburg last year spent more than $60 per capita. That's more than twice the per capita spending of Durham's mental health agency, which ranked second.

That money helped treat more mentally ill citizens and provided services the state doesn't pay for, such as mental health services in jails. It also helped make up for the fact that Mecklenburg's state funding is the lowest per capita.

Mecklenburg's mentally ill citizens also benefit from strong advocacy organizations, Crockett says.

Those advocates butt heads with Crockett, but that's OK, she says. "They need to hold folks' feet to the fire and make sure people get the services they need." Read more!

Mentally ill suffer under faulty system -Charlotte (NC) Observer

Guest Column | Selbert Wood Jr.

More taxpayer dollars are spent every year, but fewer are helped

I live in the state of North Carolina, but since 2001, I have also lived in the state of mangled care, as our state attempts to manage public-funded mental health care. What began seven years ago as an effort to increase access, choice and effectiveness of services has developed into a quagmire of haste and collapse.

Private providers have started, changed and stopped. Local management entities have merged, changing systems and functions. Service definitions alter frequently, just as reimbursements are reduced and availability of care diminishes. Clinical services that require heavily regulated credentials and expertise are difficult to find, while community support and hospitalizations increased.

Existing and new providers throughout the state, including HopeRidge, Telecare, Mountain Laurel, and New Vista, have closed. Caring Family Network, the largest provider in Chapel Hill, announced recently that it will close in April. Many providers have ceased some services or closed entire service centers.

It is impossible to fly a plane while building it in mid-air.

Services are eroding in our communities while psychiatric hospitalizations have increase 21 percent. In the past three years 49,137 fewer consumers (34 percent) have received clinical therapy. They have dropped out of services, moved to an inappropriate form of care or faced expensive, disruptive care in institutions.

During the same three years, persons receiving services through state funding and federal block grant dollars have dropped 61 percent (or 32,474 people).

Medicaid expenditures have skyrocketed, with more than $76 million a month getting doled out for community support. A little over half of those cases are deemed medically necessary and only one in ten received the appropriate intensity and duration of services.

Readers would be hard pressed to find any fans of our current system. Every gubernatorial candidate has a policy statement or platform plank to change it.

We must do better for the families who need our help instead of placing them in expensive hospital or prison beds and outside their own communities. There is enough money to provide clinical services, but the existing funding and infrastructure should be better utilized.

Reduce the inefficient and overly managed system, which some estimate may spend around 65 percent in administrative oversight instead of care delivery for consumers in our communities.

We have redundancy in our system, with 25 LMEs, Value Options and several divisions in the Department of Health and Human Services performing similar functions in our communities when it comes to authorizing and managing care.

They are often in conflict with each other, to the detriment of care delivery and stability.

We know there are limited resources and finite funding for the care of the populations we serve. Appropriate care should be maximized to the best of our ability. If there is a problem, however, with an overused or inappropriate service, then the answer is not making all care harder to access.

Issues of accountability for this care cannot be addressed merely by increasing bureaucracy.

I am constantly reminded that the process may be complicated, but the impact is simple: enhancing lives.

It is time to focus on service delivery and not turf protection. It is time to invest our existing resources in families instead of sending them to hospitals and building 800 new prison beds each year.

It is the time for politicians, bureaucrats and citizens to step up and untangle this mangled care.

. Read more!

The horrors of the bipolar life -Providence (RI) Journal

by Terri Cheney.

Terri Cheney was the classic overachiever. First she attended Vassar, then law school. Later she became a high-powered Hollywood attorney. But while at Vassar she developed a severe eating disorder. Even before college she had suffered from long bouts of depression. In the end, Cheney wound up being diagnosed as bipolar/manic-depressive — a condition from which this reviewer likewise suffers.

Bipolar disorders are an incurable category of mood disorders that involve a “cycling” between profound gloom and extreme euphoria. In the manic phases, patients are apt to be highly irritable. They are also likely to be personally, sexually or financially reckless, and a danger to themselves.

Especially dreaded is the so-called “mixed state,” which consists of all the agitation of mania without the euphoria, thus tripling the pain and self-hate inherent in depression, and often leading to suicide.

As Cheney reveals in her superb new book, Manic: A Memoir, she spent a great deal of time in the mixed state, and made several very real attempts to kill herself.

In her manic moments, she frequently embarked upon ill-conceived sexual adventures, spent lavishly, and reveled in the utterly false grandiosity with which all those thus afflicted are horribly familiar. Cheney also embarrassed herself in public, wound up raped or nearly raped more than once, and even met with arrest. When she was depressed, she could barely muster the strength (or ambition) to return phone messages at work.

Various mixes of drugs failed to moderate Cheney’s condition. Eventually, she even tried electroshock (or ECT) therapy, which only made things worse. ECT triggered “the most severe manic episode of my life. Previous episodes had lasted several days. . . . This one lasted weeks” and ended with another suicide attempt. Cheney downed a hoard of stockpiled pills. “They tell me my exterminator found me. I love the irony of that. . . . Instead of spiders, he found me, sprawled on the living room carpet, with blood and foam coming out of my mouth.”

For someone who has wrestled with the same demons, Cheney’s book reeks with scary deja vu. It is all here: The sudden, unexpected, rapid-cycling flights into sadness, fits of rage, or mad schemes. The crushing, anxious desperation and futility. The dizzying euphoria that lifts you ever higher as your endorphins pop like fireworks near the top, where the world is yours, and you are a superhero, answerable to no one.

Cheney’s remarkable chronicle of her painful odyssey is as eloquent as it is brave. It is also profoundly necessary, both for her and for us. “Telling my story is what’s kept me alive, even when death was at its most seductive,” Cheney writes. “That’s why I’ve chosen to share my personal history, although some of it is still painful to recall. . . . But the disease thrives on shame, and shame thrives on silence, and I’ve been silent long enough.” MANIC: A Memoir, Read more!

Daring to Think Differently About Schizophrenia -New York Times

By ALEX BERENSON

NORTH WALES, Pa. — SCIENTISTS who develop drugs are familiar with disappointment — brilliant theories that don’t pan out or promising compounds derailed by unexpected side effects. They are accustomed to small steps and wrong turns, to failure after failure — until, in a moment, with hard work, brainpower and a lot of luck, all those little failures turn into one big success.

For Darryle D. Schoepp, that moment came one evening in October 2006, while he was seated at his desk in Indianapolis.

At the time, he was overseeing early-stage neuroscience research at Eli Lilly & Company and colleagues had just given him the results from a human trial of a new schizophrenia drug that worked differently than all other treatments. From the start, their work had been a long shot. Schizophrenia is notoriously difficult to treat, and Lilly’s drug — known only as LY2140023 — relied on a promising but unproved theory about how to combat the disorder.

When Dr. Schoepp saw the results, he leapt up in excitement. The drug had reduced schizophrenic symptoms, validating the efforts of hundreds of scientists, inside and outside of Lilly, who had labored together for almost two decades trying to unravel the disorder’s biological underpinnings.

The trial results were a major breakthrough in neuroscience, says Dr. Thomas R. Insel, director of the National Institute of Mental Health. For 50 years, all medicines for the disease had worked the same way — until Dr. Schoepp and other scientists took a different path.

“This drug really looks like it’s quite a different animal,” Dr. Insel says. “This is actually pretty innovative.”

Dr. Schoepp and other scientists had focused their attention on the way that glutamate, a powerful neurotransmitter, tied together the brain’s most complex circuits. Every other schizophrenia drug now on the market aims at a different neurotransmitter, dopamine.

The Lilly results have fueled a wave of pharmaceutical industry research into glutamate. Companies are searching for new treatments, not just for schizophrenia, but also for depression and Alzheimer’s disease and other unseen demons of the brain that torment tens of millions of people worldwide.

Driving the industry’s interest is the huge market for drugs for brain and psychiatric diseases. Worldwide sales total almost $50 billion annually, even though existing medicines have moderate efficacy and have side effects that range from reduced libido to diabetes.

The glutamate researchers warn that their quest for new treatments for schizophrenia is far from complete. The results of the Lilly trial covered only 196 patients and must be validated by much larger trials, the last of which may not be finished until at least 2011. Other glutamate drugs are even further away from approval. And even if the drugs win that approval, they may be viewed skeptically by doctors who have been disappointed by side effects in other drugs that were once been hailed as breakthroughs.

Still, for Dr. Schoepp, the drug’s progress so far is cause for celebration — and relief.

“I don’t think people appreciate how much money, time and good technical research goes into what we do,” he says. “Sometimes, people think the idea is the thing. I think the idea can be the easy part.”

LILLY continues to develop LY2140023 and has begun a trial of 870 patients that is scheduled to be completed in January 2009. But Dr. Schoepp is no longer involved in its development. He left Lilly in April to become senior vice president and head of neuroscience research at Merck, where he oversees a division of 300 researchers and support staff members.

Dr. Schoepp’s new base is a modest office on the top floor of a four-story Merck building here in North Wales, north of Philadelphia. He has a view of the building’s big front lawn and a busy two-lane road called the Sumneytown Pike. The huge Merck research complex called West Point, where 4,000 scientists and support staff members work, is less than a mile to the north.

For Dr. Schoepp, 52, the Merck job is the latest stop in a research career that began at Osco Drug’s store No. 807 in downtown Bismarck, N.D. He grew up in Bismarck in a working-class family; at 16, he started working at the Osco, which has since closed. He quickly decided to become a scientist.

“I just found it fascinating,” he says. “I was hungry for science.” While reading a magazine for pharmacists, he noticed an ad for a free pamphlet published by Merck called “Pharmacists in Industry.” He wrote away for the pamphlet, which convinced him that he could have a career developing medicines.

He applied to North Dakota State University, where he focused on psychopharmacology, a discipline that studies the way chemicals affect the brain. “I was really interested in psychiatric disorders,” he says. “I fell in love with dopamine.”

His love affair was so consuming that his wife joked that “dopamine” would be his daughter’s first word.

Although scientists sometimes decide to study a disease because of problems it has caused among family members, Dr. Schoepp says his fascination with mental illness has been purely academic. “My family has more heart disease than anything else,” he says.

After graduating from North Dakota State, he received a scholarship to a doctoral program in pharmacology and toxicology at West Virginia University. He graduated in 1982. Nearly five years later, he joined Lilly, which was about to introduce Prozac, the first modern antidepressant — a drug that changed both psychiatry and the public perception of depression and mental illness.

Prozac became a blockbuster almost instantly after Lilly introduced it in 1987, making the company one of the most visible players in Big Pharma and giving it room to invest in long-shot scientific research. Ray Fuller, a Lilly scientist who was a co-discoverer of Prozac, encouraged Dr. Schoepp to focus his attention on glutamate.

Glutamate is a pivotal transmitter in the brain, the crucial link in circuits involved in memory, learning and perception. Too much glutamate leads to seizures and the death of brain cells. Excessive glutamate release is also one of the main reasons that people have brain damage after strokes. Too little glutamate can cause psychosis, coma and death.

“The main thoroughfare of communication in the brain is glutamate,” says Dr. John Krystal, a psychiatry professor at Yale and a research scientist with the VA Connecticut Health Care System.

Along with Bita Moghaddam, a neuroscientist who was at Yale and is now at the University of Pittsburgh, Dr. Krystal has been responsible for some of the fundamental research into how glutamate works in the brain and how it may be implicated in schizophrenia.

Schizophrenia affects about 2.5 million Americans, about 1 percent of the adult population, and it usually develops in the late teens or early to mid-20s. It is believed to result from a mix of causes, including genetic and environmental triggers that cause the brain to develop abnormally.

The first schizophrenia medicines were developed accidentally about a half-century ago, when Henri Laborit, a French military surgeon, noticed that an antinausea drug called chlorpromazine helped to control hallucinations in psychotic patients. Chlorpromazine, sold under the brand name Thorazine, blocks the brain’s dopamine receptors. That led the way in the 1960s for drug companies to introduce other medicines that worked the same way.

The medicines, called antipsychotics, gave many patients relief from the worst of their hallucinations and delusions. But they also can cause shaking, stiffness and facial tics, and did not help the cognitive problems or the so-called negative symptoms like social withdrawal associated with schizophrenia.

In the 1980s, drug companies looked for new ways to treat the disease with fewer side effects. By the mid-1990s, they had introduced several new schizophrenia medicines, including Zyprexa, from Lilly, and Risperdal, from Johnson & Johnson. At the time, the new medicines were hailed as a major advance — and the companies marketed them that way to doctors and patients.

In fact, the new medicines, called second-generation antipsychotics, had much in common with the older drugs. Both worked mainly by blocking dopamine and had little effect on negative or cognitive symptoms. The newer medicines caused fewer movement disorders, but had side effects of their own, including huge weight gain for many patients. Many doctors now complain that the companies oversold the second-generation compounds and that new treatments are badly needed.

“People say that there are drugs to treat schizophrenia,” says Dr. Carol A. Tamminga, professor of psychiatry at the University of Texas Southwestern, in Dallas. “In fact, the treatment for schizophrenia is at best partial and inadequate. You have a cadre of cognitively impaired people who can’t fit in.”

WHILE most of the industry focused on second-generation medicines during the 1980s and 1990s, a handful of academic and industry researchers found intriguing hints that glutamate might provide an alternative treatment pathway.

Psychiatrists and neuroscientists have wondered about a possible connection between glutamate and schizophrenia since the early ’80s, when they first learned that phencyclidine, the street drug commonly called PCP, blocks the release of glutamate.

People who use PCP often have the hallucinations, delusions, cognitive problems and emotional flatness that are characteristic of schizophrenia. Psychiatrists noted PCP’s side effects as early as the late 1950s. But they lacked the tools to determine how PCP affected the brain until 1979, when they found that it blocked a glutamate receptor, called the NMDA receptor, that is at the center of the transmission of nerve impulses in the brain.

The PCP finding led a few scientists to begin researching glutamate’s role in psychosis and other brain disorders. By the early 1990s, they discovered that besides triggering the primary glutamate receptors — NMDA and AMPA — glutamate also triggered several other receptors.

They called these newly found receptors “metabotropic,” because the receptors modified the amount of glutamate that cells released rather than simply turning circuits on or off. Because glutamate is so central to the brain’s activity, directly blocking or triggering the NMDA and AMPA receptors can be very dangerous. The metabotropic receptors appeared to be better targets for drug treatment.

“Rather than acting as an all-or-nothing signal, they fine-tune that signal and modulate that signal,” said P. Jeffrey Conn, director of a Vanderbilt University drug research program. “It’s really an attempt to be very subtle in the way that you regulate the system.”

During the 1990s, molecular biologists discovered genes for eight metabotropic glutamate receptors, which were located at different places inside nerve cells and had different structures. The finding allowed for the possibility that drug companies could create chemicals to turn them on and off selectively, rather than hitting all of them at once.

For Dr. Schoepp and others, finding the receptors was only the first part of the struggle. They also had to find chemicals that would either block or trigger the receptors selectively. At the same time, the chemicals had to be relatively easy to formulate and capable of crossing the blood-brain barrier, which protects the brain from being easily penetrated by outside agents.

The work was arduous, but the Lilly scientists made slow progress. In 1999, Dr. Schoepp and two other scientists published a 46-page research paper that detailed scores of different chemicals that produced reactions at the glutamate sites.

At about the same time, scientists at Yale, led by Dr. Moghaddam, were demonstrating that activating metabotropic glutamate receptors in rats could reverse the effects of PCP — a seminal finding, providing the first proof that altering the path of glutamate transmission in the brain might help relieve the symptoms of psychosis.

Although the finding in rats was promising, developing animal models for schizophrenia and other brain diseases is extremely difficult, said Paul Greengard, professor of molecular and cellular neuroscience at Rockefeller University.

Even when compared with diseases like cancer, brain disorders are notoriously complex. Scientists have only a limited understanding of the chemistry of consciousness, or of how problems in the brain’s electrical circuitry affect the ability to form memories, learn or think.

“We do not know with any of these neuropsychiatric disorders what the ultimate basis is,” Dr. Greengard says. “Let’s say you could find that too much of protein X was involved in schizophrenia. Would you then know what schizophrenia is? You would not.”

Nonetheless, the findings in rats were promising. Those studies, as well as Dr. Krystal’s tests in 2001 of volunteers given ketamine, a drug that has effects similar to PCP, hinted that the glutamate drugs might help to treat the cognitive and negative symptoms of schizophrenia. Drugs currently on the market do little to treat those symptoms.

Even before the findings at Yale, Lilly had put its first metabotropic glutamate receptor compound into human testing. Researchers initially tested the drug on patients with panic disorder, and it showed some positive results. But Lilly stopped human testing of the drug in 2001 when long-term testing in animals showed that it caused seizures.

Even so, Lilly decided that it had enough evidence to justify tests of another chemical compound, LY404039, that affected the same receptors.

“They had to take a risk on letting these drugs be tested on models or for disorders that were justified purely on pretty basic science,” Dr. Krystal says. “There is nothing with these drugs that is straightforward or makes developing them a basic path.”

When it tried to test LY404039 in humans, the company ran into yet another hurdle. The human body didn’t easily absorb it. So Lilly created a drug that the body could absorb, LY2140023, which is metabolized into LY404039 in the body.

Bingo. LY2140023 was the drug that got Dr. Schoepp jumping out of his office chair in 2006, nearly three years after the first trials in humans began. In the Lilly test, the drug was slightly less effective over all than Zyprexa, which is considered the most effective among the widely used schizophrenia treatments.

But LY2140023 also appeared to have fewer side effects than Zyprexa, which can cause severe weight gain and diabetes. The new drug also appeared to improve cognition, something that existing treatments don’t do, said Dr. Insel of the National Institute of Mental Health.

IF Lilly’s new round of tests confirms the drug’s efficacy by early next year, the company is likely to move ahead to an even larger clinical trial, involving thousands of patients, that could lead to federal approval for the compound. Still, approval is at least three to four years away, and other big drug makers are already scrambling to compete with Lilly.

In January, Pfizer agreed to pay Taisho Pharmaceutical, a Japanese company, $22 million for the rights to develop Taisho’s glutamate drug for schizophrenia. Taisho will receive more payments if the drug moves forward in development.

Since it hired Dr. Schoepp, Merck has also been moving aggressively. It has struck two deals since December to work with Addex Pharmaceuticals, a Swiss company, to develop glutamate drugs for schizophrenia, Parkinson’s and other diseases. Merck has paid Addex $25 million so far, with more payments to come if the drugs move forward.

Another glutamate drug, meanwhile, has been shown in preclinical studies to reverse mental retardation in adult rats, a finding that previously appeared impossible, Dr. Insel said.

Dr. Steven M. Paul, the president of Lilly Research Laboratories, says Lilly expects competition in glutamate research to intensify. “We’d like to believe we have a head start here, and hopefully a good head start,” he says. “But this area will heat up here; this will be an area where there will be a lot of investment.”

For Dr. Schoepp, the sudden interest in glutamate is exciting, and he acknowledges that he eagerly awaits the results of the large Lilly trial early next year. And what if the drug fails in that trial, after all the work that he and scientists around the world have put in?

“I would probably go out and have a beer,” he says. “You have to define failure. If you collect information and it tells you what you need to know, you’re not a failure.”
Read more!

Daring to think differently about schizophrenia - New York Times

By ALEX BERENSON

NORTH WALES, Pa. — SCIENTISTS who develop drugs are familiar with disappointment — brilliant theories that don’t pan out or promising compounds derailed by unexpected side effects. They are accustomed to small steps and wrong turns, to failure after failure — until, in a moment, with hard work, brainpower and a lot of luck, all those little failures turn into one big success.

For Darryle D. Schoepp, that moment came one evening in October 2006, while he was seated at his desk in Indianapolis.

At the time, he was overseeing early-stage neuroscience research at Eli Lilly & Company and colleagues had just given him the results from a human trial of a new schizophrenia drug that worked differently than all other treatments. From the start, their work had been a long shot. Schizophrenia is notoriously difficult to treat, and Lilly’s drug — known only as LY2140023 — relied on a promising but unproved theory about how to combat the disorder.

When Dr. Schoepp saw the results, he leapt up in excitement. The drug had reduced schizophrenic symptoms, validating the efforts of hundreds of scientists, inside and outside of Lilly, who had labored together for almost two decades trying to unravel the disorder’s biological underpinnings.

The trial results were a major breakthrough in neuroscience, says Dr. Thomas R. Insel, director of the National Institute of Mental Health. For 50 years, all medicines for the disease had worked the same way — until Dr. Schoepp and other scientists took a different path.

“This drug really looks like it’s quite a different animal,” Dr. Insel says. “This is actually pretty innovative.”

Dr. Schoepp and other scientists had focused their attention on the way that glutamate, a powerful neurotransmitter, tied together the brain’s most complex circuits. Every other schizophrenia drug now on the market aims at a different neurotransmitter, dopamine.

The Lilly results have fueled a wave of pharmaceutical industry research into glutamate. Companies are searching for new treatments, not just for schizophrenia, but also for depression and Alzheimer’s disease and other unseen demons of the brain that torment tens of millions of people worldwide.

Driving the industry’s interest is the huge market for drugs for brain and psychiatric diseases. Worldwide sales total almost $50 billion annually, even though existing medicines have moderate efficacy and have side effects that range from reduced libido to diabetes.

The glutamate researchers warn that their quest for new treatments for schizophrenia is far from complete. The results of the Lilly trial covered only 196 patients and must be validated by much larger trials, the last of which may not be finished until at least 2011. Other glutamate drugs are even further away from approval. And even if the drugs win that approval, they may be viewed skeptically by doctors who have been disappointed by side effects in other drugs that were once been hailed as breakthroughs.

Still, for Dr. Schoepp, the drug’s progress so far is cause for celebration — and relief.

“I don’t think people appreciate how much money, time and good technical research goes into what we do,” he says. “Sometimes, people think the idea is the thing. I think the idea can be the easy part.”

LILLY continues to develop LY2140023 and has begun a trial of 870 patients that is scheduled to be completed in January 2009. But Dr. Schoepp is no longer involved in its development. He left Lilly in April to become senior vice president and head of neuroscience research at Merck, where he oversees a division of 300 researchers and support staff members.

Dr. Schoepp’s new base is a modest office on the top floor of a four-story Merck building here in North Wales, north of Philadelphia. He has a view of the building’s big front lawn and a busy two-lane road called the Sumneytown Pike. The huge Merck research complex called West Point, where 4,000 scientists and support staff members work, is less than a mile to the north.

For Dr. Schoepp, 52, the Merck job is the latest stop in a research career that began at Osco Drug’s store No. 807 in downtown Bismarck, N.D. He grew up in Bismarck in a working-class family; at 16, he started working at the Osco, which has since closed. He quickly decided to become a scientist.

“I just found it fascinating,” he says. “I was hungry for science.” While reading a magazine for pharmacists, he noticed an ad for a free pamphlet published by Merck called “Pharmacists in Industry.” He wrote away for the pamphlet, which convinced him that he could have a career developing medicines.

He applied to North Dakota State University, where he focused on psychopharmacology, a discipline that studies the way chemicals affect the brain. “I was really interested in psychiatric disorders,” he says. “I fell in love with dopamine.”

His love affair was so consuming that his wife joked that “dopamine” would be his daughter’s first word.

Although scientists sometimes decide to study a disease because of problems it has caused among family members, Dr. Schoepp says his fascination with mental illness has been purely academic. “My family has more heart disease than anything else,” he says.

After graduating from North Dakota State, he received a scholarship to a doctoral program in pharmacology and toxicology at West Virginia University. He graduated in 1982. Nearly five years later, he joined Lilly, which was about to introduce Prozac, the first modern antidepressant — a drug that changed both psychiatry and the public perception of depression and mental illness.

Prozac became a blockbuster almost instantly after Lilly introduced it in 1987, making the company one of the most visible players in Big Pharma and giving it room to invest in long-shot scientific research. Ray Fuller, a Lilly scientist who was a co-discoverer of Prozac, encouraged Dr. Schoepp to focus his attention on glutamate.

Glutamate is a pivotal transmitter in the brain, the crucial link in circuits involved in memory, learning and perception. Too much glutamate leads to seizures and the death of brain cells. Excessive glutamate release is also one of the main reasons that people have brain damage after strokes. Too little glutamate can cause psychosis, coma and death.

“The main thoroughfare of communication in the brain is glutamate,” says Dr. John Krystal, a psychiatry professor at Yale and a research scientist with the VA Connecticut Health Care System.

Along with Bita Moghaddam, a neuroscientist who was at Yale and is now at the University of Pittsburgh, Dr. Krystal has been responsible for some of the fundamental research into how glutamate works in the brain and how it may be implicated in schizophrenia.

Schizophrenia affects about 2.5 million Americans, about 1 percent of the adult population, and it usually develops in the late teens or early to mid-20s. It is believed to result from a mix of causes, including genetic and environmental triggers that cause the brain to develop abnormally.

The first schizophrenia medicines were developed accidentally about a half-century ago, when Henri Laborit, a French military surgeon, noticed that an antinausea drug called chlorpromazine helped to control hallucinations in psychotic patients. Chlo