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!