Notes say Easley's office told workers to kill e-mail - Raleigh News and Observer

A lawyer for the governor says the notes don't mean that. An N&O lawyer says they do

By Pat Stith, Staff Writer

State government public information officers were instructed by Gov. Mike Easley's press office to delete e-mail to and from the Governor's Office, according to notes the Governor's Office released Saturday.
Andrew A. Vanore Jr., a lawyer who works for Easley, produced notes made by two public information officers showing that they and others were told at a meeting May 29 to destroy e-mail messages. Vanore said a third public information officer, whom he would not identify, also recalled those instructions.

Vanore said, however, that the notes don't mean what they say. He also said the instructions were not followed.

The News & Observer had requested the notes of the periodic meetings of the public information officers.

Questions about the way the Easley administration handles e-mail arose after an N&O series, "Mental Disorder: The Failure of Reform," which ended March 2. The series reported on an ill-conceived and poorly executed reform plan on which the state has wasted at least $400 million.

Two days after the series ended, Easley ordered the Department of Health and Human Services to fire its public information officer, Debbie Crane. Later that day, Crane told The N&O that, to bypass the state's public records law, the governor's press office had given instructions to delete e-mail messages.

Easley's chief legal counsel, Reuben F. Young, and his deputy press secretary, Seth Effron, quickly denied that such instructions had been given.

Young, who has been vacationing with his family in China, could not be reached for comment. Effron has been instructed by Vanore not to comment.

In Young's absence, Vanore was assigned to handle the matter. Vanore was chief deputy attorney general under Easley before Easley was elected governor in 2000 and has continued to work for the governor part-time on a contract basis.

Julia Jarema, public information officer at the Department of Crime Control and Public Safety, jotted this note at the meeting in question: "Public records request -- increasing -- careful of email -- delete emails to/from gov. office everyday."

Diana Kees, public information officer at the Department of Environment and Natural Resources, recorded this note: "emails -- more & more public records requests (blogs?) be careful w/emails; delete emails to & from gov office every day."

Vanore said he did not know what the notes meant.

"It could be interpreted a number of different ways, and the only way to properly interpret it would be to talk to the individual who took the note," he said. But he said he had instructed all the employees not to talk about that issue because The N&O might file a lawsuit.

Vanore provided The N&O with a box full of e-mail messages to and from Jarema, Kees and Renee Hoffman, the governor's press secretary. Hoffman presided over the meeting May 29; Vanore said he assumed "she was the one that caused Julia and Diana to make the notes."

Vanore said the e-mail messages to and from the governor's press office were "clear and irrefutable proof" that there was no systematic intent to destroy e-mail.

Hugh Stevens, an attorney who represents The N&O, said the notes made by Jarema and Kees confirmed Crane's allegation.

"This sounds to me as though there was a concerted and willful attempt to evade the public records law by deleting the e-mails," he said. "I don't see how you can interpret it any other way."

Crane has been a central figure in the emerging public records story. When she was fired, she told her story to The N&O.

"They ask the second you e-mail them anything, to kill it, then kill it again out of your trash so it doesn't exist," Crane said. "That's what they tell all the public affairs people, that they don't want to create any public records."

When The N&O asked Effron, a spokesman for the governor, to respond to Crane's allegation, Effron said: "This office has never told anybody to destroy any public record." He said Crane was a "dishonest and untruthful" person.

Within a few hours of Crane's disclosure, Stevens, The N&O's attorney, wrote Franklin Freeman, the governor's chief of staff, putting him on notice that the newspaper might take legal action to enforce the state's Public Records Act.

The next day, March 5, Young, Easley's chief legal counsel, responded to Stevens and N&O Executive Editor John Drescher. In effect, he challenged the newspaper to put up or shut up.

Young said he had investigated the matter. "I have concluded that there is absolutely no evidence to support your allegation," Young wrote. "Should you have evidence to the contrary, I respectfully request you immediately provide it to me."

Under state law, it is a misdemeanor for someone to "destroy, sell, loan or otherwise dispose of any public records ... without the consent of the Department of Cultural Resources."

Vanore contends that policies signed by Easley and his appointee, Lisbeth C. Evans, secretary of Cultural Resources, allow destruction of e-mail messages that have "no administrative value" in the opinion of the sender or the receiver.

"What we're doing is consistent with policy," Easley said at a news conference earlier this month.

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Fixes for mental care put forward -Raleigh News & Observer

Candidates talk of broken system

To read candidates' views, go to this page and dlownload pdf file under related content.

By Lynn Bonner, Staff Writer

The next governor will be asked to repair North Carolina's fractured mental health system, which has wasted money, left sick people without adequate care, and cost lives.

The News & Observer recently reported that the state had wasted at least $400 million on a basic service called community support and had spent too little on treatment of serious mental illness.

While some people are getting services they don't need from private companies, more people are going to state mental hospitals for short stays. These short stays stabilize patients in crises but have little therapeutic value.

The N&O report also revealed that since December 2000, 192 employees had abused 82 patients at the four mental hospitals run by the state, and 82 patients had died under questionable circumstances.

Do the candidates for governor have ideas about what to do?

Lt. Gov. Beverly Perdue, a Democrat, wants to expand networks of clinics and primary-care doctors that already treat Medicaid patients to include mental health treatment. Some parts of the state are already testing that plan.

Four of the six candidates are willing to return some responsibilities for patients' care to local mental health offices, which were forced to give up most responsibility for providing care in a 2001 rewrite of mental health laws.

Three Republican candidates said they want to track down private companies that have committed fraud. Former Supreme Court Justice Bob Orr wants to know who pushed for rules that allowed questionable companies to make millions. "This is probably the biggest and most embarrassing scandal in state government in my lifetime," he said.

In separate interviews, The News & Observer asked the major candidates how they would fix the problems plaguing the mental health system. Find their answers on Page 10A.

All rights reserved. This copyrighted material may not be published, broadcast or redistributed in any manner.
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Health-services provider is unusual success -Winston-Salem (NC) Journal

By Sherry Youngquist
JOURNAL REPORTER

MOUNT AIRY -- When mental-health officials canceled a contract this month with a private agency that provided drug treatment and counseling, they turned to what has become a rarity in North Carolina’s troubled mental-health system: a public provider of treatment.

New River Behavioral Health Services, based in Boone, took over yesterday the treatment of patients in Surry, Yadkin and Iredell counties that had been served by Insight Human Services, a private agency based in Winston-Salem.

North Carolina’s $ 2.3 billion public mental-health system is in crisis after seven years of what most experts say is a failed reform effort.

But state officials say that New River’s model in Alleghany, Ashe, Avery, Watauga and Wilkes may provide a model for services across the state. New River is overseen by public officials in these five counties.

“It’s working in one area of the state,” said Dick Oliver, a spokesman for the N.C. Department of Health and Human Services. “We need more time to evaluate how successful it is.”

When most local mental-health agencies turned to private companies and nonprofit agencies to provide care, as requested by the state, New River struck out on its own.

New River works by managing a set amount of state dollars each month. It’s different from private agencies, which usually rely on a reimbursement for each service.

The state’s reform took effect in 2001. And most areas transferred services to private agencies and let another group manage the services. But officials in the mountain counties began looking for a way for New River to keep the services.

New River had more than 40 years of experience, and county officials there wanted to ensure that services would continue in those rural areas, said Ken Richardson, the board chairman of New River and chairman of the Alleghany County Board of Commissioners.

Local leaders asked the General Assembly to allow the counties to establish a public provider, and in 2006, legislators gave them the authority.

In January 2007, the five counties began doing business as New River Behavioral Healthcare. The only other public provider in North Carolina is in Rockingham County.

New River operates in tandem with a public agency called Smoky Mountain. New River provides the service, and Smoky Mountain provides the oversight.

“We look as similar to the old area authority as probably any provider in the state,” said Pam Andrews, the chief executive officer of New River. “We were able to hold on to staff, hold on to infrastructure, all the form and function that made us successful 10 years ago, 15 years ago. I have managers who have 36 years experience, and a lot of providers are not able to find that. And that’s a strength. We’ve been able to survive this roller coaster.”

Another key has been New River’s financing model.

As part of the pilot program, New River receives state money as a single stream, with an agreed-upon amount, broken down by months. The financing model went into effect for the fiscal year that began July 1, 2007.

New River will receive $5.7 million.

“We still have to file claims. We still have to show that we provide the service. But it ensures a continuous cash flow,” Andrews said.

Most private providers offer a limited menu of services. New River is comprehensive, delivering most all the mental-health services in the mountain counties - from substance abuse to day-treatment programs for chronically mentally ill to family therapy to mobile crisis.

Some services - such as psychiatric - lose money. Others don’t. New River spreads the money around to make sure that there are no losses.

But this is the first fiscal year for the financing model. And no one knows yet whether New River will have money left over or will need more by year’s end.

Regardless of what happens, New River won’t ration care, Andrews said.

“I’m telling you, I don’t see how any provider in North Carolina can survive on a fee-for-service model. There are not enough dollars in the system to support that model,” Andrews said. “Private providers are not surviving.… The continuous change of providers means the consumers don’t know what’s going on. They’re like, ‘who’s in there now? What’s happening now?’”

Officials in Surry County said that the state needs to deal with problems in the system. There, the agencies have failed to coordinate billing and have battled over reimbursements.

In the past 26 months, at least three mental-health providers frustrated with reimbursements have stopped providing services through Crossroads, the public agency in Elkin that oversees care in Surry, Yadkin and Iredell counties.

Last month, Insight Human Services announced that it would be the fourth to leave. Insight is a division of Partnership for a Drug-Free North Carolina. Its clinics in Mount Airy, Yadkinville, Statesville and Mooresville closed yesterday and were immediately taken over by New River.

But Jim Harrell Jr., a Surry County commissioner, said he is not satisfied. He is also on the area board of directors for Crossroads, and he wants to know whether Crossroads is making an already cumbersome reimbursement system more difficult.

The Surry County Board of Commissioners voted this month to ask for a private consultant or state official to evaluate Crossroads.

■ Sherry Youngquist can be reached in Mount Airy at 336-789-9338 or at syoungquist@wsjournal.com.
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14 taken from care facility still in state custody -The Columbia (SC) State

By LEE HIGGINS - lhiggins@thestate.com

Fourteen residents removed from a Winnsboro residential care facility that ran out of some patients’ medications remained in state custody Saturday, authorities said.

The state Department of Health and Environmental Control suspended the operating license of David Donnelly, owner of Peachtree Manor on Greenbrier Mossydale Road, DHEC spokesman Thom Berry said.

A preliminary hearing will be held within the next several days to review conditions at the facility, Berry said. The residents are at Trinity Place, a residential care facility in Sumter, and are in the custody of the Department of Social Services, Berry said.

The patients have a variety of health problems, including mental-health issues and cancer, Fairfield County sheriff’s Lt. Mary Anne Phillips said.

No evidence was found that patients missed doses of their medicines, but some were about to on Friday, Phillips said. “They didn’t have the dosages for the rest of the day,” she said.

Donnelly told investigators his current pharmacist would not deliver and he pledged to have the medications by Saturday, Phillips said.

Fourteen of 16 residents at the facility were taken into emergency protective custody Friday by deputies and checked out at Fairfield Memorial Hospital, Phillips said.

A Columbia pharmacist called DHEC Friday morning to express concern that residents were “running out of their medication and some had run out already,” Berry said.

DHEC sent inspectors and declared an “immediate threat” situation, which has happened a handful of times in the past 20 years, Berry said.

The facility also had no telephone service Friday, authorities said.

Donnelly’s permit to operate was revoked in 2006, but he has been allowed to operate during an appeal, Berry said. A resident being pushed in a wheelchair near the facility was struck and killed by a truck in 2006, contributing to that decision, Berry said.

Donnelly could not be reached for comment Saturday.

The Associated Press contributed to this report.

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Life in Prison Looms for Mentally Ill Bremerton Man — but Should It? - Bremerton (WA) Kitsap Sun

By Andrew Binion (Contact)
Saturday, March 29, 2008

The 27-year-old Bremerton man told investigators he was trying to kill himself when he lit his Trenton Avenue house on fire Feb. 10.

He demanded police shoot him in a subsequent standoff.

But he was arrested, and taken to jail after a brief medical evaluation.

He was initially charged with reckless burning. But on Thursday, that charge was elevated to first-degree arson.

Because of a long history of violent offenses, the most serious involving threats and attempts at suicide, another conviction for Joseph McCabe would result in life in prison under the state's "three-strike" law.

His mother, at times the target of his violence, said her son needs psychological help and believes he will ultimately kill himself if he is sentenced to life.

"I don't know how he didn't die," said McCabe's mother, Chrisanne "Cryss" Jensen of her son's numerous attempts, noting that he has spent years in prison and has never received adequate mental health treatment. "I don't know how a lot of times he doesn't die."

McCabe's case is one of a few highly visible incidents since the start of the year where Bremerton men are alleged to have committed crimes during or leading up to a suicide attempt.

In the two most serious cases, the men were taken to jail. In a less serious attempt, the man involved was involuntarily committed for three days of evaluation.

While the three cases shed light on inconsistencies with how the criminal justice and health care system deals with mentally ill suspects, they also square with what mental health advocates have said for years — that jails and prisons have become warehouses for the mentally ill.

The phenomenon comes after what advocates call "deinstitutionalization," the mass shutdown of mental hospitals, beginning in the 1960s, and the advent of antipsychotic medications. In order to receive federal dollars for in-patient care, mental health agencies like Kitsap Mental Health Services cannot operate in-patient facilities that have bed space for more than 17 patients at a time.

The overflow, advocates contend, is channelled to jails and prisons, which generally are not equipped to deal with mentally ill inmates.

One in six U.S. prisoners is mentally ill, according to a 2003 Human Rights Watch report, which notes that the rate of mental illness in the prison population is three times higher than in the general population.

A Rash of recent incidents

McCabe's latest involvement with the court system started about a month after a well-publicized suicide attempt that nearly resulted in two dead, including a Bremerton police officer who risked his life to save the suspect.

Daniel Cash was the suspect in a vandalism and attempted arson case when Bremerton Police Officer Jason Glasgow found him about to jump off the Warren Avenue Bridge with a brick tied around his neck. Glasgow was able to grab the 44-year-old Cash just as he jumped and brought him back to safety, at the risk of his own life.

Cash was taken to Harrison Medical Center. A short time later a call went out on the police scanner. The hospital was going to release Cash. Officers promptly went to the hospital, placed Cash back in custody and drove him to the Kitsap County jail, where he remained for three days in a cell with a drain on the floor for a toilet.

The attempted arson charge was dropped and Cash pleaded guilty to malicious mischief for breaking windows. Cash, who's now out of jail, told the Kitsap Sun that he spent three days in a single cell, eating baloney sandwiches for every meal.

"I was so sad," he said of the breakup with his girlfriend that triggered the mental crisis. "I needed someone to talk to bad, and I had nobody to talk to, but me and myself for three days."

Patti Hart, spokeswoman for Harrison Medical Center, said she could not comment on individual cases because of federal privacy rules.

On March 8, a 25-year-old man suspected of assaulting his wife left the couple's 1-year-old son in his car and began walking toward the Warren Avenue Bridge.

He had text-messaged his wife earlier, saying he was going to jump off the bridge and commit suicide. She called police, who intercepted the man. In contrast to McCabe and Cash, the man was admitted to Harrison for a 72-hour evaluation period, according to a Bremerton Police report.

One person in the chain of command that determines if a person should be held for mental evaluation, the "designated mental health professional," looks for evidence that a person is a threat to themselves and others and cannot use the unavailability of resources to determine if a person should be held, according to the "protocols' of the position, available on the state Department of Health and Human Services Web site.

A lengthy criminal history

McCabe's violent criminal history is a direct result of lack of treatment, said Jensen, who noted that she has struggled with depression herself and that her father was a schizophrenic.

In addition to his strike convictions, McCabe has also been convicted of assault and robbery.

His first strike offense occurred in 2001. McCabe pleaded guilty to first-degree arson and was sentenced to 31 months in prison.

In court documents, McCabe's girlfriend at the time said he had tried to kill her, and himself, by setting their High Avenue residence on fire. He also confronted Bremerton police with a knife and had to be physically subdued.

Officers wrote in reports they had prior experience with his threats and suicide attempts.

The second strike offense occurred in 2006 when McCabe attempted to kill his wife. The woman told officers that McCabe said: "If I kill you it will be easier for me to kill myself," according to court documents.

The couple then walked to the Warren Avenue Bridge in order for him to jump, but McCabe became "too scared to jump," documents said.

After a jury found him guilty of second-degree assault and two counts of violation of court orders, McCabe was sentenced to 15 months in prison.

Kitsap Mental Health Services has programs and partnerships with law enforcement to target mentally ill people who are likely to end up in jails or prisons, said spokeswoman Rochelle Doan.

"It is clear to us that we have individuals who would be better served in mental health agencies that do end up in other institutions," Doan said.

One program, called PACT, or Program for Assertive Community Treatment, takes a multidisciplinary approach, teaming up different mental health professionals to work with mentally ill people who have been resistant to treatment.

Often mentally ill people, because of the nature of their disease, are incapable of seeing their own illness. And that provides difficult challenges for those who want to help them.

"Ultimately, the client needs to, at some level, want to participate," said Beth Friedman-Darner, clinical associate director at Kitsap Mental Health.

Deputy Prosecutor Kevin "Andy" Anderson reviewed police reports over the Trenton Avenue fire and McCabe's criminal history and upgraded the charge from reckless burning to first-degree arson. He said the key to the charge is that when law enforcement officers subdued him after standoff, McCabe had no burns on his body.

"I know he burned down the house and I know he did not burn himself," Anderson said, casting doubt on McCabe's assertion that he was trying to kill himself.

McCabe's mother said her son has been diagnosed with bipolar disorder. Anderson said that if the case goes to trial, a jury will have to decide if McCabe's alleged illness mitigates his actions.

"The statute doesn't say being bipolar means a person can burn down houses with impunity," he said.

McCabe's court-appointed attorney, Jacob Murphy, said the defense will consult with mental health experts and have McCabe evaluated to determine if he had a "diminished capacity" at the time of the crime or if he was legally insane.

McCabe passed the first step, to determine whether he is competent to stand trial. Further evaluations will happen after he enters a guilty or not guilty plea. McCabe's mother said any treatment he has received since being incarcerated was perfunctory at best.

"I don't know if they did anything mental-health-related until he got to court," Murphy said. Read more!

Prescription for disaster -Kinston (NC) Free Press

Chris Lavender
Staff Writer

Prescription drug abusers often don't realize that their behavior could lead to fatal consequences. Like the nation, Eastern North Carolina is seeing an increase in prescription drug abuse cases.

According to the 2008 U.S. Department of Justice National Drug Threat Assessment report, "parents are less likely to talk to their children about the dangers of prescription drug abuse than they are about heroin, cocaine, crack, marijuana, or alcohol abuse."

According to Partnership Attitude Tracking Study data for 2006, 81.5 percent of parents perceive abuse of prescription drugs to be a growing problem among teenagers, yet only 36.2 percent of parents discuss with their children the dangers of using prescription drugs to get high.

In Kinston, Greenville and New Bern, prescription drug abuse is becoming more common, according to Port Human Services officials.

Both Matt Lambeth and Karen McNair serve as Port Human Services counselors helping people with behavior issues which include prescription drug abuse. The abuse is not age discriminatory both agreed.

For the past six years, McNair has seen a steady increase in prescription drug abuse. "I see about 40 patients a week from age 4 to about 70," she said. "The abuse is huge. It's easy to get these kinds of drugs which are becoming a hot commodity."

McNair is based in Kinston. She said people become easily addicted to prescription medication and it's difficult for officials to track abusers.

"People doctor shop to get prescriptions filled," she said. "Sometimes doctors are able to notify pharmacies about someone who is trying to fill an illegal prescription. Their name is flagged in a computer."

Mixing prescription medicine with alcohol can cause respiratory depression, McNair said. Prescription drug overdoses are increasing in the area.

"I knew one person in Greenville who died from an overdose," McNair said. "The overdoses are usually accidental."

Both McNair and Lambeth agreed more education is needed to help people avoid abusing prescription drugs. Some prescription drugs can provide users with highs similar to cocaine.

Finding alternative coping skills can help reduce someone's risk from becoming addicted to prescription drugs. "Exercise is a big mood stabilizer," McNair said.

Like McNair, Lambeth sees a wide variety of prescription drug abusers. At his Port Human Services clinic in Greenville, Lambeth works with 60 people a week in the clinic's Opioid Agonist therapy program.

"Sedative and Buprenorphine abuse is on the rise," he said. "We help identify peoples' triggers and counsel them."

The Internet has created a new tool for abusers to get their prescription drug fix, he said. The number of Internet pharmacies selling controlled and non-controlled pharmaceutical drugs has increased, according to the National Drug Assessment Threat report.

"Kids can go online and get any type of drug with very little oversight," he said. "People are ordering prescription drugs from India or Mexico suppliers and sometimes really don't know what they are getting."

According to a Pharmaceutical Research and Manufacturers of America 2007 survey, about 5.4 million adults in the United States have purchased prescription drugs from a foreign country such as Canada or Mexico. About 50 percent said they purchased the drugs from another country because they did not have a prescription for the drug they wanted, according to the survey.

Increased law enforcement and prescription monitoring programs have recently forced abusers who traditionally get their drugs through doctor-shopping, forged prescriptions or indiscriminate prescribing to use the Internet to order prescription drugs.

"It's illegal for anyone to photocopy a written prescription," Donna Ramsey, Alternative Care Treatment Systems Clinical Director said.

Before moving to Kinston, Ramsey was a mental health official working in Maine. She said "prescription drug abuse is rampant there."

Prescription drug abusers would "malinger" at area hospital emergency rooms faking illness in order to get pain medication. Ramsey said abuse is increasing because "there is an excess of medication available all over the place" in many homes' medicine cabinets.

"It's easier to hide the abuse," too she said. "The abuse can destroy families."

Ramsey said she recently attended a 16-year-old girl's funeral in South Carolina. The girl died from a prescription drug overdose, she said.

Many teens don't think there is great risk with mixing or abusing prescription drugs. According to the Partnership Attitude Tracking Study for 2005, 44 percent of adolescents in grades 7 through 12 did not perceive a great risk in trying pain relievers such as Vicodin or OxyContin that a doctor did not prescribe for them. Sixty-two percent of the teens surveyed said the drugs were easy to get from their parents' medicine cabinets and 51 percent said they didn't think the drugs were illegal.

Chris Lavender can be reached at (252) 559-1078 or clavender@freedomenc.com.

U.S. Department of Justice National Drug Threat Assessment 2008

Pharmaceutical drug abusers in a growing number of states are having greater difficulty in getting drugs through forgery.

Criminal groups are stealing pharmaceutical drugs from delivery trucks.

The number of Internet pharmacies selling controlled and non controlled pharmaceutical drugs has increased.

Methadone related deaths and overdoses have increased sharply since the 1990s.
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More than a year later, suicide still haunts mother - Gaston (NC) Gazette

BY MICHAEL BARRETT

Cars and trucks whizzing south on I-85 offered the only background music as Lynn McKee knelt by the memorial to her son on a windy morning this month.

The homemade wreath and Easter flowers she brought were carefully arranged beside a small cross, and stepping-stones etched with the words "harmony" and "wonder."

It was hard for McKee not to come to the overpass at Exit 5 in Cleveland County after David "Joey" McKee, 21, of Gastonia, committed suicide there a little more than a year ago.

Her visits have become less frequent over time. But for her and Joey McKee's other loved ones, the pain remains.

"Have I healed? No," said Lynn McKee "I can get up and go to work. I can get through most of the day without getting depressed.

"My heart is still broken wide open."

Dealing with the loss of her son and discussing the things that led to it are only a part of what Lynn McKee struggles to do each day. She also wants to raise awareness about the symptoms of people considering suicide, so that their loved ones might be able to intervene.

"The loss of a child from sickness or a car wreck is one thing," she said. "The loss of anyone from suicide is totally different."





Struggling to understand why

Lynn McKee blames her son's suicide largely on delays he encountered in applying for Social Security disability payments. Such delays have plagued the system and caused a backlog of cases across the nation in recent years.

Joey McKee had been diagnosed as borderline schizophrenic, bipolar and learning disabled. His manic depressive states kept him from holding down a job, said his mother, and he couldn't afford medicine to treat his illness.

McKee had reapplied for disability after being turned down twice in two years. He had lost 40 pounds from his thin frame and been in and out of a hospital mental ward several times - once after slitting his wrists, his mother said.

"All of his friends were just floored because he talked to them about (suicide)," Lynn McKee said. "But everybody kept on saying he'd never do it."

On the morning of March 3, 2007, McKee walked four miles from a friend's house to the Dixon School Road overpass. He leaped more than 20 feet onto the southbound lane of I-85 and was hit by a tractor-trailer.

Lynn McKee was getting ready for work when a police officer came to her door with the news.

"It was disbelief at first," she said. "I just kept saying, ‘You've made a mistake.' I just kept telling them they were wrong."

McKee was buried on a family plot in Mississippi, but his mother believes his spirit still has a strong presence at the overpass. She regularly drove there after his death to read poems and talk to him.

She fashioned the roadside memorial there with some of Joey's friends.

"I don't know what set him off," she said. "I don't know why he did it."



Dealing with the loss

A single mother, Lynn McKee came to Gastonia from Georgia four years ago with Joey and her older son, Richard, 24. They moved to be closer to her daughter, Misty Finnigan, 32, who had relocated to Charlotte.

Joey struggled to deal with the move, but he often eased his stress by writing stories and drawing. He was a "mama's boy" who dreamed of becoming a video game designer and enjoyed playing card games such as "Magic: The Gathering" with his brother.

Richard, who was a year older than Joey, nervously tapped his leg at times as his mother recently spoke from their living room.

"Basically I just miss having my partner," he said at one point, raising his head from his hand. "If I couldn't do something, (Joey) did it."

Coming to grips with what happened has been difficult. Lynn McKee said she still has "Joey moments," which render her unable to function.

There's always something missing, Lynn McKee said, although her surviving children and 17-month-old granddaughter make her happy.

"After a year, do I miss him more or less?" Lynn McKee said. "More. But I'm adjusting ... slowly."


You can reach Michael Barrett at 704-869-1826.

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Case reveals course of troubled child -St. Louis Post-Dispatch

By Nancy Cambria

EDWARDSVILLE — The mother said her daughter hid the steak knives everywhere:
under sofa cushions, in the folds of curtains, between mattresses, in the piano
bench, the dog's toy basket.

She found them about the same time her teenager — once a tiny 3-year-old they
adopted from a Panamanian orphanage — carved an obscenity in her wrist and
concealed the wound under a sweatband laced with safety pins.

The girl harbored other secrets. Kathy Rhoten of Edwardsville, said she
realized that her daughter, then 13, had been hoarding hundreds of pins and
needles in her pillowcases, threading them in the hems of her clothes and
lining her pockets.

"You name it, if it had a sharp edge, I found it hidden in my house," said
Rhoten, who coped with her daughter's increasing disobedience and rages:
lashing out with fingernails, pricking herself and classmates with tacks,
stealing and lying. Rhoten had already packed up boxes of gifts and heirlooms
because her daughter was destroying them during arguments. Her daughter poured
cleaning chemicals on carpets and loosened the slats on the ceiling fan,
causing one to fly, Rhoten said.

"We were frightened, very frightened," Rhoten said.

Kathy Rhoten is telling her story from her Clayton attorney's office because
she and her husband Steve Rhoten were indicted in December on two counts each
of criminal restraint by a Madison County grand jury. Prosecutors say about a
year ago, Steve Rhoten, with his wife nearby, used zip ties to restrain their
daughter. The charges led to their daughter being placed in foster care, where
she remains.

The Post-Dispatch is not naming the daughter because it typically does not
identify children in foster care. Kathy Rhoten's attorney also requested that
the name not be used.

Kathy Rhoten said her husband resorted to the ties to keep his daughter from
going into her bedroom where they were certain she'd hidden a knife to cut
herself again. First he tied her wrist to his belt, and they sat down at the
computer for homework, Rhoten said. Later he tied her to a sofa as the family
watched television. Rhoten said they should have taken the bedroom door off its
hinges.

"We didn't do it to punish her," she said. "We did it to protect her."

Steve Rhoten, a computer consultant, declined to be interviewed for this story
on the advice of his own attorney.

Investigator Dennis Gunderson of the Edwardsville police department said that,
regardless of the motive, the act was criminal and deserved the scrutiny of a
judge and jury.

"Anytime you lash someone to something, it may not be physical abuse, but it's
also a mental thing," he said.

Although the investigation is ongoing, Gunderson said he had found no other
signs of abuse by the Rhotens — just extreme disciplinary actions that put the
parent's actions into question. Those include their cutting electricity to the
child's room at bedtime — a move, Kathy Rhoten said, to prevent her from
staying up all night on the Internet.

"They do not understand what it's like to raise a child like this," Rhoten
said. "People just don't get it."

Ronald Federici, a neuropsychologist specializing in foreign adopted children,
said the Rhotens' story was becoming more and more common these days: Kids
suffering from early trauma and neglect behave in ways that push their parents
to the brink.

"The parents have no help, no support, no training," he said. "They go in there
with typical, normal parenting skills and the kids reject that. The parents
start getting out of control and look for ways to restrain and contain the
kids," said Federici, who has testified nationwide in abuse and murder trials
of parents who adopted from orphanages.

Federici knows of at least 16 murders in such families. And there are other
tragedies: In North Dakota, a boy adopted from Russia stands accused of
murdering his sister.

The Rhotens' lives quickly unravelled eight months after prosecutors said they
used the ties. That's when police and a child welfare investigator came
knocking. Rhoten said the investigation was triggered by an abuse hot line call
the state received just days after the Rhotens forbade their daughter from
meeting her boyfriend at a local skating rink.

Ralph Turner, an investigator with the Illinois Division of Child and Family
Services, declined to discuss the case. The Madison County State's Attorney
Office, also declined to comment.

After the hot line complaint, Steve Rhoten was ordered by children's services
to leave the house. A month later they learned of the grand jury decision when
a reporter came to their door. The parents pleaded not guilty to the charges,
which carry a maximum three-year prison sentence, though probation is more
likely.

Their daughter was taken into state custody. Kathy Rhoten was placed on a paid
suspension from her job as a special education teacher.

"She had total control over our house," Rhoten said of her daughter.

Yet despite their anguish, the Rhotens are certain of one thing: They want her
back.

"She's our daughter. We love her," Kathy Rhoten said. "We're not going to give
up on her yet. She doesn't have anyone else, and it's not her fault."

LOVE CAN'T HEAL ALL

The Rhotens already had a son. But they were unable to conceive again. They
wanted a second child so badly they say they paid an attorney $25,000 and flew
a rickety plane into a hilly rainforest village of corrugated metal shacks.
They met the 23-pound girl in the lobby of a stucco orphanage with bars on its
windows. She held a doll. She was wearing a dress.

The Rhotens saw signs of neglect and trauma, they say. When authorities allowed
the parents to return a month later, the girl's jet black hair had turned white
with lice. The doll and dress were gone. Later, in Panama City, they realized
she spoke no formal language, just a torrent of obscenities, they say.

The Rhotens are not the only ones to make these jarring journeys to orphanages
in search of a child to raise and love.

Between 1989 and 2005 the U.S. Department of Homeland Security counted more
than 234,000 children adopted by Americans from foreign countries, most from
China, Russia, Eastern European nations and Guatemala. A great majority of
these adoptions, particularly those from China, result in happy outcomes and
families who overcome early obstacles to raise thriving children.

"Our family has been made complete by our daughter," said Jan Wondra, mother of
Katie, 16, a blond, blue-eyed girl she and her husband adopted from Russia when
she was 3.

This seemed to be the case for the Rhotens. Members of the First Presbyterian
Church of Edwardsville said the little girl, though a challenge, had become a
loved and active member of its Sunday school. By second grade she wrote a book
about her adoption with crayon illustrations.

"One day a lady and a man from the United States came to the orphanage," she
wrote under a drawing of two smiling adults beside an emerald mountain, tulips
at their feet. "They wanted to adopt a sweet little girl. ..."

But she, like many of these children, has been diagnosed with Reactive
Attachment Disorder. That diagnosis did not come until October 2007, about
eight months after the daughter first cut herself and the parents used the
restraints, Kathy Rhoten said.

Reactive Attachment Disorder is an affliction of orphanage children who spent
their time as babies and toddlers mostly alone in cribs with few, if any,
caregivers to comfort, hold or speak to them. Prior to the diagnosis, the
family did not seek professional help and felt they could deal with their
daughter's numerous bizarre behaviors on their own. They attributed their
daughter's actions to her orphanage experiences, the influence of some of her
friends and an earlier childhood diagnosis of attention deficit disorder.

The Rhotens suspect that, like many children with reactive attachment disorder,
their daughter also suffered from abuse and neglect prior to even being put in
the orphanage. Many children like their daughter also suffer from fetal alcohol
syndrome and other undiagnosed disorders.

Some, like St. Charles resident Lisa Markel's then 5-year-old daughter, had
never left a room in her remote Romanian orphanage until the day she met her
parents.

Markel said she realized her daughter, now 12 and making headway with her
attachment issues, wasn't being shy the day she met her new mother and refused
to look at her or speak: It was terror.

Therapist Shirley Crenshaw, who works with area families — most recently Steve
and Kathy Rhoten — said these children lacked the hard-wiring to connect with
those who loved them. Brain scans reveal limited activity in the area
associated with bonding.

With an excess of stress hormones in their bodies, they exist mostly in a state
of "flight or fight" and use conflict to cope, she said. They often vent their
rage at their adoptive mothers to split the family and gain control.

Mothers of these children recently met at a coffee house in Chesterfield for a
support group. They've dealt with everything from school problems to feces
smeared on the walls to glass under pillows.

From their purses they proudly brought out holiday card photos: They show
poised children beaming for the camera. But the parents said those smiles were
often saved for strangers.

"What they're doing is mommy shopping," Crenshaw said. "They're looking
everywhere because they do not trust these parents to keep them."

Many parents have been ostracized by relatives because they didn't understand
the hard-line parenting and other methods recommended by therapists to deal
with their kids.

"I went from being a respected officer of a well known firm and a hero for
adopting children from an orphanage to a bad parent," said Lynda Baker at a
support meeting.

Some families also have been mistakenly reported to child welfare because
people sometimes hear the rages and suspect abuse.

Lake Saint Louis resident Sandy Davis, local chapter head of Families For
Russian and Ukrainian Adoption, said families had drained their bank accounts
to find effective therapies. Without help, she's seen families crumble.

Some parents give up and place the child up for adoption or commit their child
to the state — or return him or her to the foreign country, basically putting
the child out on the street, said Thomas DiFilipo, chief executive of the Joint
Council on International Children's Services.

An official with the U.S. State Department said it had no reliable statistics
on the outcomes of intercountry adoptions. Officials don't know how many are
disrupted. Most states, including Missouri and Illinois, don't track whether
foster children are foreign adoptees.

When adoptions fail, Davis said, the children are re-traumatized, increasing
their odds for institutionalization — or prison.

BITTERSWEET REUNION

The Rhotens continue to wait for their daughter's return — often on a wood
bench outside the family court in Edwardsville. Friends are writing letters in
support.

Instead of being forced to spend money on lawyers, the Rhotens "need to be
spending their money on getting help for this child," said Peggy Lambdin, their
daughter's former Sunday school teacher.

Kathy Rhoten's attorney Jack Spooner said he was optimistic that a judge or
jury would find that the Rhotens aren't criminals, "just a family who is in
love with their daughter and doing basically what they needed to do to protect
her."

Kathy Rhoten said they all hoped to participate in a bonding program in Ohio
for Reactive Attachment Disorder.

But Rhoten said her daughter was ambivalent about coming home.

"She has no understanding of the consequences of what she's done," she said.

If her daughter does return, the parents will stow their kitchen knives in
their bathroom because it has locks on both doors. Kathy Rhoten will resume her
regular purge of her daughter's room of sharp objects, such as the glass
paperweight she once found sharpened to a point.

"You never know, though," Rhoten said. "She could climb in the bathroom window.
Nothing surprises us about her."

Nancy.Cambria@post-dispatch.com
Read more!

Doctor takes unconventional approach to autism -Sacramento (CA) Bee

By Dorsey Griffith - dgriffith@sacbee.com
Saturday, March 29, 2008

In the controversial world of autism treatment, mainstream medical doctors are increasingly pitted against alternative providers in the quest to figure out causes and develop treatments.

Dr. Michael Chez, a neurologist specializing in child autism, likens talking about the neurodevelopmental disorder to discussing politics or religion.

"Many times, I have wanted to give it up, because it's hard to keep your ego from being beaten up all the time," said Chez, who practices at Sutter Health and holds a teaching position at UC Davis. "You're portrayed as part of the Evil Empire of the Darth Vader Medical Society."

Chez has weighed in with a book which explores traditional and alternative theories and approaches to autism, including his own, unconventional drug therapies. "Autism and its Medical Management" is an effort to educate parents of autistic children and the professionals who take care of them.

Coinciding with the release of Chez's book in early April are National Autism Awareness Month and the 10-year anniversary of the UC Davis MIND Institute in Sacramento, also known for innovative research into autism.

The milestones reflect a dynamic time in autism diagnosis, research and treatment. While the causes of the disorder are not yet understood, autism cases continue to mount, as do efforts to unravel its many mysteries.

The Centers for Disease Control and Prevention reports that nearly 7 in 1,000 children 8 years old are diagnosed with the illness. The number of diagnosed cases served by the California Department of Developmental Services has grown from 6,527 in 1995 to 36,952 last year.

Chez wrote his book as a user-friendly overview of what is known and what is not yet understood. The book details therapies that show promise, and others, such as detoxification treatments, that he says remain unproven.

Chez believes that once an autism diagnosis is made, parents often mistakenly delay medical intervention.

"Most people don't understand the complexities of the medical aspects of autism," Chez said. "I wanted a program that allows people to get help from a medical point of view that is scientifically based and available in the community."

Chez said autism is multifaceted with numerous subtypes and symptoms, many of which overlap with those of other ailments, including epilepsy.

Up to 30 percent of autistic children may have seizures, he said, and in one study as many as 70 percent showed abnormal patterns on an electroencephalograph test, used to measure electrical brain activity.

Treatment of those children with valproic acid, an anti-convulsant drug, he reported, has demonstrated vast improvement in language function.

Chez is working with Robert Hendren, psychiatrist and MIND Institute executive director, on a larger-scale study on use of the drug in autistic children.

Jennifer McCain brought her 3-year-old daughter to Chez a year ago because she was way behind in language development and seemed unable to process information she was hearing.

"We were concerned it was autism, but she didn't fit all the autistic criteria," said McCain, of Elk Grove. Chez found the girl had irregular brain activity and prescribed an epilepsy drug.

"We started to notice a change within a week," McCain said. "She all of a sudden started acquiring language and trying to more frequently interact with us verbally." McCain said her daughter continues to improve and has not been diagnosed with autism.

Similarly, Chez has been using the drug, memantine, an Alzheimer's disease drug, for some of his young autistic patients.

Preliminary research suggests the drug, which protects nerve cells against chemicals that cause brain damage, also is effective in improving language, social interaction and self-stimulatory behaviors in autistic children.

One of Chez's current memantine patients is the son of Dr. Louis Vismara, a cardiologist and another parent founder of MIND.

Vismara said the medication has helped his 15-year-old, in terms of his behavior and cognitive skills. He said he appreciates Chez's scientific, yet novel approach to autism treatment.

"One of the most frustrating things we parents face is a multiplicity of anecdotal information," Vismara said. "You could spend your whole life hopscotching from one hope for a cure to another without any real sense of what is going to help."

Chez acknowledged he uses some drugs not yet approved by the Food and Drug Administration for children, or for autism symptoms. But he points out that he would – and has – done the same for his own children.

Chez is the father of a 14-year-old who had stopped talking at age 3 and was diagnosed with Landau-Kleffner syndrome, a rare neurological disorder that can sometimes mimic autism.

He is also stepfather to a 15-year-old who is autistic, has a seizure disorder and is developmentally delayed. She takes drugs for seizures and the Alzheimer's medication, Chez said.

Although Chez's treatment approaches could be called "unorthodox," he distinguishes himself from the so-called DAN doctors, a group endorsed by the Defeat Autism Now organization. DAN doctors believe the disorder results when genetically vulnerable people are exposed to certain environmental toxins.

Pleasanton physician Lynne Mielke is a psychiatrist with an autistic son and now a DAN doctor. While she agrees with Chez that autism demands medical treatment, her methods are different and only occasionally include prescription drugs.

She said autistic children are systemically ill, with neurological, gut and immune system problems. She argues that inflammation and free radicals from exposure to toxins damage the brain.

Mielke takes blood, urine, stool, and hair samples from her patients and looks for abnormalities – high levels of yeast in the bowel or mercury in the blood, for example, that might benefit from detoxification therapies.

Her treatments may include chelation – a drug that helps rid the body of metals. DAN doctors also typically want their patients to adopt diets free of wheat and dairy products, and consume vitamins and other dietary supplements. Some practitioners promote use of hyperbaric oxygen therapy to increase oxygen flow to the brain.

Bruce Kaminski of Elk Grove takes his severely autistic boys, ages 9 and 11, to a DAN doctor. He said the boys have benefited from antifungal treatment for their bowel problems, chelation for mercury in their blood, and strict diets. And while he doesn't oppose prescription drugs for certain symptoms, he said, he likes the DAN approach for its emphasis on removing anything that might be harming the child.

"Within a couple of days of taking my younger boy off milk, he went from not looking anyone in the eye, to giving eye contact," he said. "That told us something."

Chez understands why parents like Kaminski choose alternative medical treatments, but remains skeptical.

"People don't have faith in medicine and want a quick fix and a miracle cure," Chez said. "I would do all these things if they actually worked."

Regardless of the professional differences, Hendren said Chez's book may help bridge some of the chasms between the various philosophies and medical approaches to the disorder.

"By taking a thoughtful look at a wide variety of treatments," he said, "parents will have a better opportunity to make informed decisions about what they want to try."
Read more!

Artist, 26, offers insight on autism -Arkansas Democrat & Gazette

FAYETTEVILLE — Taylor Crowe beamed as he tore open an envelope and rapidly read aloud the letter inside to family members gathered in the kitchen of his childhood home.

It was from the dean of the California Institute of the Arts, letting Crowe know he’d been admitted.

Crowe, who is autistic, was accepted after submitting a portfolio of sketches and paintings. He graduated last year with a degree in character animation.

Crowe, 26, shared his experiences with teachers Friday at the second day of an Autism Spectrum Disorder symposium hosted by the University of Arkansas at Fayetteville’s College of Education and Health Professions.

The symposium, which is expected to be an annual event, was started to meet the growing demand for professional development for teachers. An increasing number of autistic students are moving into Northwest Arkansas school districts, said Barbara Gartin, a UA professor and expert in special education.

When Crowe was diagnosed with autism as a 4-year-old, doctors gave his parents a prognosis of lifelong non-verbal social isolation and dependence.

He proved them wrong.

He’s had to teach himself social behavior that is instinctive to many individuals — how to detect sarcasm, how to maintain eye contact and how to express his emotions.

“I still have autism, I still struggle with things,” he said. “But I’ve worked hard to make autism part of my life, not all of it.” Crowe’s development was aided by supportive parents, a group of open-minded peers and teachers in Cape Girardeau, Mo., who adapted their techniques to help him learn, he said.

“None of you would be in this room today if you didn’t understand the potential that’s in every life,” Crowe said. “Something all of you know is that every life has meaning, every life has purpose.” Crowe’s parents videotaped him when he was an eager 2-year-old, speaking in complete sentences and gurgling out the alphabet song while spinning around in his diapers. But two weeks after his third birthday, something changed. At a meal time, he dropped his spoon on the floor.

“He started screaming, ‘ Daddy, I can’t find the words ! I can’t find the words !’” said David Crowe.

Crowe’s parents watched him seemingly lose his language and social skills, and it would take years for him to regain them.

According to the Centers for Disease Control and Prevention, 20 percent of children diagnosed with autism lose abilities after a seemingly normal period of development, an unexplainable and growing trend.

Now an adult, Crowe travels the country to tell his story, using his dad’s childhood videos to illustrate how autism hampered his development. He also tells stories that are familiar to teachers and parents, such as When Crowe was a child, he answered the doorbell.

“Is your mom home ?” the woman at the door asked.

“Yes,” he said, before closing the door in her face and returning to his previous activity.

The story illustrates that “people with autism have to learn a lot of things that come naturally to everyone else,” he said.

Autism consultant Aleza Greene said autistic children often fail to understand the “hidden curriculum” of social cues and unspoken social norms, such as personal space, conversational direction and emotional nuance.

Many also fail to recognize that their actions and body language convey meaning to others. Greene leads socialization groups that help children learn cues through play.

“We have to teach them that as long as you can be seen, you are communicating,” she said.

Crowe relied on creative educators and developed his own strategies. He continues to write “social stories,” one-paragraph descriptions of how to react to common social situations.

Recent stories include “How to introduce yourself to people,” “ Don’t hang up the phone until goodbye is heard, ” and “Don’t play April Fool’s jokes on people in the bathroom.” He also created a business card that says “I have autism” with a summary of the disorder on the back. Rather than fighting with those who tease and taunt him, he hands them a card.

Crowe is completing a children’s book about autism.

“Don’t surround a person with autism with limitations,” he told the roomful of teachers. “Don’t tell them they’ll never be able to do something. Let the person find their own limits; don’t find them for them.” Read more!

Obsessive-compulsive disorder spotlighted -Durham (NC) Herald-Sun

March 29, 2008

Mar. 29--CHAPEL HILL -- Most people occasionally worry about germs, strange noises in the night or whether they forgot to turn off the oven before leaving on vacation. But for as many as 5 million Americans with obsessive-compulsive disorder -- also known as OCD -- such anxieties are constant, and can almost literally take over their lives.

Now two expert clinical psychologists at UNC will, for the first time, use cognitive-behavioral therapy to treat couples in which one partner has OCD. The therapy has been effective in treating individuals who have OCD, and in treating couples where one partner suffers from another health problem. This is the first time the therapy will be used in couples involving a partner with OCD.

Jonathan Abramowitz, associate professor and associate chairman of the psychology department who is also director of UNC's Anxiety Disorders Clinic, and Donald Baucom, professor of psychology and director of UNC's Couples Therapy Clinic, will provide treatment for about 20 couples as part of a new study funded by the Obsessive Compulsive Foundation. The foundation, an international nonprofit educational organization, supports research on the causes and treatment of OCD.

Participating couples will receive 16 free therapy sessions and follow-up evaluations and will be paid $80 at the end of the study.

Obsessive-compulsive disorder is a psychiatric condition defined by recurrent, unwelcome thoughts (obsessions) and repetitive behaviors (compulsions) that the sufferer feels driven to perform. Persons with OCD are anxious about germs, mistakes, numbers or obsessive thoughts, and have problems with compulsive checking, washing, asking for reassurance or repetitive rituals.

People with OCD often recognize their obsessions and compulsions are irrational or excessive, but without treatment, they have little or no control over them. Abramowitz, an expert on OCD and a range of anxiety disorders, has used cognitive-behavioral therapy to successfully treat OCD patients individually.

"This therapy involves helping patients learn strategies to reduce their obsessional fears and compulsive behaviors," he said. Over time, many patients learn that they do not need to perform these rituals to stay safe.

However, coping with OCD can be complicated by a relationship, Abramowitz said.

Stress makes OCD worse. If individuals suffer alone, they worry about being late to work because they spent too much time checking the door lock, or fret about what others would say if they knew they washed your hands incessantly.

But for those in a relationship, OCD can lead to stress and arguments between sufferers and their partners, which makes OCD even worse. "It's a vicious cycle," Abramowitz said.

Another complication is how the non-OCD partner responds to the compulsive behavior. Even spouses with the best intentions may make matters worse by over-compensating for their OCD partner's fears and rituals.

In the UNC study, trained therapists under the supervision of Abramowitz and Baucom will work with both partners in each couple.

"First we will find out about the OCD symptoms and how the couple has been managing with these problems," Abramowitz said. "Then we will help the couple learn to work together to address the OCD patient's obsessions and rituals and assume a healthier relationship in which their interactions do not make OCD worse."

Study participants will be given "homework" between sessions. They will receive specific help with the OCD symptoms as well as counseling to enhance their overall relationship.

"The hope is that when both partners learn the CBT techniques, the partner without the disorder can be more helpful in encouraging the OCD mate to work through fears realistically," Abramowitz said. "This would be good for the OCD sufferers and their spouses."

One in 40 adults and one in 200 children suffer from OCD at some point in their lives, according to the Obsessive Compulsive Foundation. If you or your spouse or partner have OCD and would like to participate in the study and receive free treatment as a couple, contact the study coordinator, Michael Wheaton at 843-3951 or ocdcouples@unc.edu.

Read more!

Help for the Mentally Ill - Fox11-TV San Luis Obispo (CA)

A video look at how courts in San Luis Obispo are taking a preventive approach when it comes to crimes committed by the mentally ill.

3/29/08

Family members of the the gunman in the Black Road Auto shooting say Lee Leeds suffers from Schizophrenia -- which causes hallucinations and delusions.

About 1% of the population suffers from Schizophrenia.

Other mental illnesses like Bi-Polar Disorder and major depression are more common. Read more!

States have shortage of public psychiatric beds -Augusta (GA) Chronicle

By Michelle Guffey | South Carolina Bureau
Saturday, March 29, 2008

AIKEN --- The availability of public psychiatric beds across the country has decreased considerably over the past 50 years, with some of the worst shortages in South Carolina and Georgia, according to a recently released report from the Treatment Advocacy Center.

South Carolina's status is critical, according to the report, and Georgia has a severe shortage.

John Young, the executive director of the Aiken-Barnwell Mental Health Center in Aiken -- a state-owned outpatient facility -- said budget cuts forced the state hospital in Columbia to discontinue the use of 500 beds from 2000 to 2005.

Aiken County has just one inpatient mental health facility: the privately-owned 47-bed Aurora Pavilion Behavioral Health Services.

Getting treatment for someone with a mental illness takes the cooperation of different agencies.

Those who are involuntarily committed first come into contact with law enforcement officials. How to deal with a mentally ill individual is part of police officers' annual training.

"When we get an order from probate court for an involuntary commitment, we first take them to Aiken Regional Medical Centers, where an evaluation is done," said Aiken County sheriff's Lt. Michael Frank.

As a doctor confirms mental illness, officials from the mental health center are consulted as well. If the person is deemed mentally ill, officials search for an inpatient facility with a vacancy.

"Since there is a shortage of beds, sometimes (finding a bed) is difficult," Mr. Young said. "Aurora has been extremely good when they have vacancies at making sure that people who need to be in the hospital are in the hospital."

But sometimes the facility is full, and, most of the time, the state beds are full, Mr. Young said.

While health care officials try to find a bed, the patient stays in the emergency room.

The report states that 42 of the 50 states might have less than half the minimum number of beds considered to be reasonable (50 beds per 100,000 people) by knowledgeable experts.

The decrease of psychiatric beds in the past 50 years was in part caused by the deinstitutionalization of public mental hospitals that began in the 1960s, the report explained.

Alyce McEachern, of the South Carolina Department of Mental Health, said the agency has had substantial decreases in the past several years in its inpatient psychiatric bed capacity, leading to a "significant number of persons in behavioral crisis waiting in hospital emergency rooms inordinate periods of time for an appropriate inpatient psychiatric bed to become available."

According to the report, in 2004 and 2005 in South Carolina, there were 443 public psychiatric beds available. The minimum needed was 2,109.

"The issue of inadequate bed capacity appears to be limited primarily to indigent care beds," Ms. McEachern said. "That means that these emergency room patients are forced to await the availability of an inpatient bed, and these folks generally do not have health insurance or a source of payment to access."

Though there is a shortage of state-owned psychiatric beds in South Carolina, data from the state Department of Health and Environmental Control suggests there is an adequate supply of adult psychiatric beds at privately-owned facilities.

"The average occupancy rate in the 808 licensed non-state-owned acute psychiatric beds in 2006 was 59 percent," Ms. McEachern said.

Though there is a shortage of public psychiatric beds across Georgia, the problem doesn't seem to exist in the Augusta area.

East Central Regional Hospital, though primarily a hospital that serves people with developmental disabilities, is state-owned and has 64 mental health beds, said Kenya Bello of the Georgia Department of Human Resources.

"They've never had a diversion issue where they had to transfer people to a different hospital," she said.

Medical College of Georgia Hospital maintains 34 psychiatric beds, and the VA Hospital has 68 beds serving veterans in 17 counties in South Carolina and Georgia.

Reach Michelle Guffey at (803) 648-1395, ext. 110, or michelle.guffey@augustachronicle.com Read more!

Autistic poet gives rare glimpse into mystery illness - CNN

03/29/08
By Colleen McEdwards

CNN) -- Tito Mukhopadhyay shuffles to the front door of his home in Austin, Texas. He's coming home from school, something that would have been unthinkable just a few years ago.

His mother, 45-year-old Soma Mukhopadhyay, is considered a pioneer in a breakthrough treatment for some autistic children who face the stigma of being considered "mentally retarded."

That was a label Soma never accepted for 19-year-old Tito. And after hearing Tito's story, you'll never look at an autistic child the same way.

"How was your day?" Soma asks.

Before Tito can answer, he obsessively moves around the house, placing the TV remote in its proper place, arranging the salt and pepper shakers just so. Then he sits down in front of his specially designed keyboard to type his response.

"It was like a floating kangaroo that kept itself invisible," Tito answers.

Tito's cryptic reply is part of his medical condition. But his distinctive way of speaking is also a gift that has made him famous in a misunderstood community. VideoWatch Tito interact with his mother »

Though Tito is virtually mute, that changes when he picks up a pencil to write, or begins tapping at his keyboard.

He is a poet, and the author of several books and essays in which he eloquently describes what it's like to be autistic.

In his writings, he explains why he doesn't make eye contact, what it is like to be obsessed with a ceiling fan, and how his brain has trouble processing sound, touch and sight all at once.

Experts confirm Tito's observations of autism. One doctor described it as the way the brain fails. None can agree on its exact cause, but most believe there is a genetic predisposition to the condition, with significant environmental triggers involved.

The developmental disorder affects the way the brain works and affects the way the child interacts with society.

Some doctors and parents see a link between childhood vaccines, others suspect pesticides or drugs taken during pregnancy. The theories are endless and most experts agree there is no single cause.

Whatever autism is, its symptoms range from a mild form to rendering individuals dependent on others for life.

Many people with autism are able to take in information very well, but the wiring in the brain simply won't allow the information to be processed in the form of organized thought and language.

Tito has given experts some rare insight into what that feels like. His poetry includes stanzas like this:

"I am he.

And I am me.

I am he behind that mirror

I am me watching the he."

One of his favorite books is Plato's "Republic."

The world may have never known about Tito's gift except for the efforts of his mother, Soma, who is from India.

Doctors there told Soma that Tito was mentally retarded and beyond hope. She gave up her career in chemistry, determined to teach him.

Eventually, an organization in the United States brought Soma and Tito, then 10 years old, to the United States to study him because he defied the stereotype of an autistic child.

Soma's method of teaching Tito is called the Rapid Prompting Method. I watched her work with other children at the HALO -- Helping Autism through Learning and Outreach -- center in Austin, Texas, where she teaches while Tito attends school.

The therapy starts by asking the children to point at words on pieces of paper. Once they've mastered that, they use the stencil.

If their motor skills develop well enough, the children will type on a specially designed keyboard.

Her technique seems to be working for the children who attend therapy at HALO. There is a yearlong waiting list for four-day therapy sessions. It can take years to see progress.

Rapid Prompting has not been tested in long-term scientific studies, and Soma is not without her critics. Some criticize her methods as harsh and unproven.

During her sessions, Soma never says "good job," never rewards a child with a high-five or a treat, which is a common reward in other therapeutic techniques.

Soma is unapologetic.

"I don't see the child as autistic. I don't see the label at all," Soma says, speaking quickly in her musical Indian accent.

"I see the child as a person. And just as I would talk to any person, I would talk to a child, because the world is not going to talk to them in a very slow way."

Dr. Michael Merzenich was one of the first experts to pay attention to Soma's technique. He's a neuroscientist at the University of California, and he believes Soma's rapid prompting works.

He says there is no doubt the children are using their minds to create their own words and express their own ideas. Unlike facilitated learning techniques that have been discredited, Soma does not guide the children's hands.

"Imagine what it would be like," he says, "to be able to understand everything that's said to you -- to think and to be unable to communicate your own thoughts and ideas."

Merzenich does not believe Rapid Prompting works for all autistic children, but has no doubt it can help thousands.

I watch several young children in their therapy sessions on this day in Austin. Some struggle horribly. The session makes the children appear stressed, but they continually make small breakthroughs and answer questions correctly.

Soma conducts about 10 therapy sessions a day.

"You must be exhausted," I say to her.

"I can't be," she answers curtly but with a smile. "I have to go home now and teach Tito."

At their home, I ask Tito if he is happier now that he can communicate. He writes out a long response on a piece of paper on a clipboard.

"I can't say whether I am happy or not, because happiness is a state of my mind. So sometimes I think I'm happy. Other times it is hollowness."

It's probably a true statement for most of us at some point in our lives. Soma smiles at the response and doesn't miss a beat.

"Keep writing," she says to Tito. "Keep going." Read more!

Molehill, no mountain -Raleigh (NC) News & Observer

Sometimes, there are partisan criticisms made of public officials that just make you want to go, "Oh, for goodness sakes."

Oh, for goodness sakes.

State Republican Chairwoman Linda Daves wants Governor Easley to fire Franklin Freeman, his senior assistant for governmental affairs, from his position as the chairman of a committee reviewing state government e-mail procedures in light of public records laws. The reason for her ire is that Freeman says he doesn't send e-mail.

The Easley administration has been under fire, and justifiably so, for its handling of e-mails, or electronic correspondence used as a primary form of communication by millions of Americans. But when that communication is among government officials, it's public and it must remain so. That may mean files filling up, and it may result in some other kinds of inconveniences, but all that means is that more room for storage must be found. A public record is a public record is a public record. It's the panel's job to figure out how properly to dispose of e-mails that legitimately have no public value.

Even though Easley isn't the most open fellow in the world, and he of late has had to deal with some critical press coverage -- specifically a News & Observer series -- regarding the disheveled state of public mental health care in North Carolina, his appointment of Freeman seems reasonable enough.

Freeman is a veteran of state government, and even served briefly on the state Supreme Court. He certainly understands the issues involved, and he is known as a stand-up person who can be counted upon to deliver a straightforward opinion. And could his resistance to e-mail reveal a sort of frontier independence? Could it represent one man's stand against conformity, against being tied to the office 24/7?

The more we think about it, the better a choice he seems.

All rights reserved. This copyrighted material may not be published, broadcast or redistributed in any manner.
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Patty Duke describes battle with bipolar disorder -Palm Beach (FL) Daily News

By SHANNON DONNELLY
Saturday, March 29, 2008

When a psychiatrist told Patty Duke that she had bipolar disorder, her immediate reaction was, "Thank God!"

"Finally, it had a name," the actress told the 350-plus guests at the annual Old Bags Luncheon. "And if it had a name, that meant that people knew about it. It really did exist."

Then the doctor told her the condition was treatable.

"So I started taking the lithium," she said. "Today there's all kinds of medications, but the lithium has worked well for me.

"Hasn't it, honey?" she asked her husband, who was sitting at a table nearby.

Idaho firefighter Michael Pearce, who has been Duke's husband for 21 years, nodded. He was one of a handful of men at the luncheon, which benefits the Center for Family Services.

Duke's meandering journey to a diagnosis began decades earlier, after her manic demeanor as a guest on The Dick Cavett Show sparked concern among those who knew the young actress.

On the show, Duke introduced her then-husband Michael Tell, whom she'd married literally hours after he came to sublet her apartment.

" 'This is my husband,' I said. 'We're going to build an ark in the desert between Barstow and Bakersfield,' " she said. "People from home started calling. Anne Bancroft" — her co-star in The Miracle Worker — "came to see me at the hotel where we were staying, with the broken-out windows and all. She convinced me it was time to go home and get some help. So I did."

Duke recalls that she was pregnant by "a nice young man" and had separated from him when she met Tell.

However, most of Sean Astin's biographical references say that a 1994 DNA test proved Tell to be his father.

Duke, pregnant, annulled her 13-day marriage to Tell, returned to California, and "rested" — a euphemism for psychiatric recovery — in Palm Springs.

"That's where my son, Sean Patrick, was born. You know him better as the actor Sean Astin. He was in that movie ... um, um what was it called?" she said, asking the audience for help with blockbuster The Lord of the Rings.

"It's not just your face that falls when you hit 60," she said, laughing.

Recovered, she went to Boston for an acting job and met the married John Astin.

"Before I knew it, we were having a family," she said.

Astin divorced his wife and married Duke when Sean was 18 months old.

"John brought three sons from his marriage," she said. "And I had Sean, and then we had Mackenzie together, so we had five boys in the house."

Domestic bliss didn't last.

"My demons started again. The children would be outside my bedroom door asking to see their mom, and I would say, 'Not today, Mommy's not feeling well.'

"They would come to the bathroom door when they heard me screaming and say, 'Mommy, please don't kill yourself. We love you.' They were 2, 6 and 4 years old, I think, and I was emotionally abusing them. I didn't mean to hurt them like that. I just did."

After 10 years of marriage, her husband filed for divorce, and Duke went to the psychiatrist who diagnosed her. She took her medication and went back to work.

"Now my boys had a mom, a working mom, but she was balanced," she said.

Repairing her family proved difficult.

"The kids were always waiting for the other shoe to drop. So I had to build their trust in me, build their comfort in being around me," she said.

"When Sean Patrick graduated from high school, somebody asked him what the best thing in his life was, and he said, 'I can count on my mom now.' "

The relationship with her eldest has been rocky.

"We're always butting heads because we're so much alike. We've recently reconciled after not speaking for a long time," she said. "Yes, I've had a lot of crap in my life. But I've had some good things, too."

—sdonnelly

@pbdailynews.com Read more!

Depression May Be Contagious,Experts Say - ABC News

An Individual's Mood May Affect That of Loved Ones

By RADHA CHITALE
March 28, 2008—

Ron and Carol Rossetti had a storybook romance. The two were high school sweethearts, went to prom together and married after college.

"He was like the fun in my life," Carol Rossetti recalled. "But had I known the ride I was going to be in for, I'm not sure I would have signed up for it."

Not too long after they were married, Ron would get into terrible tempers, Carol recalled, or become very depressed. Later on, as his business grew more successful, Ron would spend money lavishly on cars: A Lotus, a Viper, a Porsche, a Hummer.

Ron Rossetti's erratic behavior took a toll on his wife. "I was just really unhappy," Carol said. "I was wanting to find the answer without giving up the marriage."

Carol Rossetti's discontent may be no surprise to many people whose spouses suffer from mood disorders. Ron was diagnosed with bipolar disorder in his late 30s, and while the news explained some of his behaviors and brought Carol a measure of relief, his wife Carol was in an unusual and vulnerable position.

Spouses are at high risk for depression when one party has a clinical disorder like depression or bipolar disorder, because they spend a large amount of time with them and are emotionally invested in their well-being.

"Was she depressed? Absolutely," Ron said. "Look what she had for a husband. & Was it a Dr. Jekyll or Mr. Hyde?"

Some studies show that if one spouse is depressed, the other can become depressed, and that up to 40 percent of people whose spouses have bipolar disorder get clinical depression. That's according to Dr. Igor Galynker, director of the Family Center for Bipolar Disorder at Beth Israel Medical Center in New York and professor of clinical psychiatry at Albert Einstein College of Medicine.

Natural Born Mimics

"We can mimic other people's facial expressions," Galynker said. "When we mimic other people's facial expressions, we also can adopt the mood that these people are in. It affects us, even on a superficial level."

But such mimicry can go beyond the superficial and become emotional. Studies in which monitors track brain activity while a subject is shown smiling or frowning faces show that the areas associated with happy or sad emotions are active when the subject is presented with the corresponding face.

This ability to tune in to other people's feelings, or empathize, can be useful, but it can also get a person in trouble if they are around someone who has depression.

"If a genetic predisposition exists, and a person is surrounded by people with a behavior, that may give rise to or create an environment that would fertilize that behavior," said Steven Lappen, a writer and frequent public speaker who has bipolar disorder.

Lappen, 58, was diagnosed with bipolar disorder at 19 and said his manic and depressive episodes during his 20-year marriage made his wife feel invisible and caused her to withdraw from him, behaving as if she, too, was depressed.

"I was so blocked up, I couldn't respond to her overtures," Lappen said. "Outside of the marriage, she wasn't depressed. She was able to tap into her vitality and vibrancy."

Lappen and his wife eventually divorced, and he later remarried a woman who also has bipolar disorder.

"The good news is that we both have bipolar disorder; the bad news is that we both have bipolar disorder," Lappen said, adding that their implicit understanding of the clinical nature of each other's moods made for a smoother relationship.

Clinical Condition?

But experts are quick to point out that clinical mood disorders are not contagious per se.

Depression and bipolar disorder are complex, rooted in genetics and subtle brain chemistry. Experts point out that these disorders cannot infect people nearby the way a virus could.

"A depressed person will not give you the same clinical disorder by contagion. They're just too complex for that," said Ian Gotlib, professor of psychology and director of the Mood and Anxiety Disorders Laboratory at Stanford University. "It is rare that you yourself will develop that same psychiatric disorder."

But a person with depression or other disorder can have a tremendous effect on those around them. Studies on college roommates show that when one person has depression, the other roommate can develop similar behaviors and feel more down.

"It's not the mimicry, it's the stress of being around them," Gotlib said. "The mood stuff happens, but it's not clinical."

Coping strategies are critical when dealing with a depressed spouse.

"If the caregiver believes the behavior is caused by the illness, they are less likely to be affected," Galynker said. "If they think the behavior is the result of a character flaw, they are more likely to be affected because then they also place blame on themselves."

Carol Rossetti never thought she had a clinical condition, but she eventually became so unhappy with her husband that they separated.

"When I left him after 34 years of marriage, I didn't think we'd get back together," Carol said. "I was perfectly fine not being with him."

But Ron quit his job and went through therapy to get his disorder under control, and after a year of separation, the Rossettis came together again. Now both Ron and Carol know how to maneuver around Ron's episodes.

"The last ½ to two years have been the most worry-free of my life," Carol said. "Now he's a born-again bipolar person."

Copyright © 2008 ABC News Internet Ventures
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Son guilty of third-degree murder for killing mother - Bucks County (PA) Courier Times

By LAURIE MASON
03/28/08

A mentally ill Abington man who stabbed his mother in his grandmother's Bensalem home to save her, he claimed, from a painful death from anorexia was found guilty Thursday of third-degree murder.

Patrick Hughes-Bygott, 22, will be sentenced next month and could serve up to 40 years in prison. He will serve at least part of that sentence in a locked mental health treatment facility.

“This is an extraordinarily sad and tragic case,” said First Assistant District Attorney Dave Zellis. “Ellen Hughes-Bygott was a caring daughter, a kind sister and a caring mother. For her to have met her end in this horrific way is just heartbreaking. The sadness is just compounded by the fact that it was her son who did this to her.”

Bucks County Judge John Rufe handed down the verdict following a three-day degree of guilt hearing in Doylestown.

Although lawyers on both sides agreed that Hughes-Bygott was mentally ill when he stabbed his 55-year-old mother more than 60 times in the head, neck and chest on Aug. 16, they disagreed on his state of mind at the time of the slaying.

Zellis argued that the murder was a premeditated first-degree killing, motivated by anger. That verdict would have netted Hughes-Bygott a life sentence.

His defense attorneys, Wallace Bateman and Robert Adshead, argued that the slaying was voluntary manslaughter. They brought in mental health experts who testified that their client was delusional and flew into an irrational rage when he attacked his mother.

The knife wounds on the mother's face underscored Hughes-Bygott's mental illness, Adshead told the judge. One of the blades went through the victim's eye and into her brain.

“It was an attempt to obliterate her face. It was overkill,” he said.

Hughes-Bygott did not react as the verdict was read. His father sat in the audience with his head in his hands. He declined to comment after the verdict.

Bateman said his client, who is taking medicine to control his mental illness, spent most of the legal proceedings in a daze.

“After it was all over he asked us what the verdict was,” he said, noting that the judge had just spoken a few feet away from him.

Hughes-Bygott was arrested within minutes of the stabbing at the Wildman Avenue home where the victim had been living with her mother. He told police that he had to kill his mother because she was sick, saying she looked like a “stick figure” and was “razor thin.”

Family members said the victim did not have anorexia.

Mental health experts who testified during the hearing said Hughes-Bygott was in the midst of a psychotic episode when he set off around 3 a.m. from his home, heading toward his mom's house with three hunting knives in his pockets.

Unable to sleep and convinced that he was being pursued, Hughes-Bygott asked his mother to give him a sedative or to take him to a hospital, according to court testimony.

Ellen Hughes-Bygott refused to do either, and they argued, police said. While he was slashing his mother, Hughes-Bygott's 91-year-old grandmother tried to intervene and was slightly injured.

Defense expert Gerald Cooke, a psychologist, testified that Hughes-Bygott believed that he was Jesus and that his mother wanted him to help her die.

“He lost control and began to stab her in a psychotically based emotional outburst,” Cooke said.

But Zellis said the mental health experts did not have a true picture of the defendant. He played for the judge two phone conversations between Hughes-Bygott and his father after the slaying, in which the defendant ranted about what a bad mother the victim was and said he was glad she was dead.

“I blame her for pretty much everything,” Hughes-Bygott said in the call, which was recorded because it was made from the county prison. “It's like God said a painful death is too good for [her]. I don't blame myself. Who the [expletive] does she think she is, treating her son like that?”

Zellis said that in addition to the stab wounds, the autopsy showed blunt force trauma, meaning Hughes-Bygott beat his mother before killing her.

Rufe will sentence Hughes-Bygott on April 24, following a hearing in which his family members and other witnesses might testify. He remains in the county prison until then.
Laurie Mason can be reached at 215-949-4185 or lmason_court@yahoo.com.

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Carmel woman who left baby in toilet gets 4-year sentence - Indianapolis Star

Peterson suffers from bipolar disorder, according to her attorney .

By Katie Merlie
March 28, 2008

NOBLESVILLE -- A Carmel woman will spend one year in Hamilton County Community Corrections for neglect of her now 3-year-old daughter, as part of a four-year sentence.

Kyle C. Peterson, 21, gave birth to the girl on the morning of Feb. 14, 2005, and left her in a toilet. The birth happened in a home in the 14000 block of Admiral Way North Drive in Carmel.

Peterson's mother got into the bathroom that morning, took the newborn out of the toilet and began resuscitation efforts. Peterson, who was an 18-year-old Westfield High School senior at the time, had repeatedly denied allegations from family and friends that she was pregnant.

She was charged with felony attempted murder and neglect of a dependent. She pleaded guilty in December in Hamilton Circuit Court to a lesser felony charge of neglect.

Judge Judith Proffitt sentenced Peterson on Thursday to four years in the Indiana Department of Correction, with three years suspended to be served on probation. Peterson will spend one year in the county's work release program after an evaluation is completed, Proffitt said.

Peterson, who did not make a statement in court Thursday, suffers from bipolar disorder, according to her attorney Robert Hammerle.

He urged Proffitt to take Peterson's condition into consideration when handing down a sentence, and asked for his client to serve only probation.

Hamilton County Prosecutor Sonia Leerkamp said Peterson lied about the pregnancy and about being on birth control.

"She received no prenatal care and had an unattended birth," Leerkamp said. "We're lucky we're here not on a murder case."

The child, who is in the father's custody, is healthy, although she did suffer from seizures in the past, Leerkamp said.
Call Star reporter Katie Merlie at (317) 444-5549.
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Iowa County Board OKs Ghost Hunters -Associated Press

March 28, 2008

IOWA CITY, Iowa (AP) -- County officials have given their informal OK for ghost hunters to check out a one-time insane asylum to see if any spirits are lurking about.

The Johnson County Board of Supervisors took the initial action on the request from the Johnson County Historical Society, which gives tours of the 153-year-old building.

Brandon Cochran, museum operations assistant for the historical society, said there have never been reports of ghosts or bizarre happenings at the building and that bringing in a paranormal team is "kind of taking the pre-emptive approach.

He wants an Iowa-based paranormal investigative team to come in for one night. Cochran said he hopes they don't find any paranormal activity and the investigation can put to rest any speculation.

A four-person Carroll Area Paranormal Team will use thermal imaging equipment and voice recording systems, Cochran said.

A date for an investigation wasn't set and an agreement will have to be drafted releasing the county of any liability before the supervisors formally approve the request, Cochran said.

The remaining wing was built in 1855 and housed mentally ill patients who were deemed insane. It was a self-sufficient 160-acre site with residents growing corn, potatoes, wheat, hay and tobacco.

The building is now called Chatham Oaks, and houses people with physical and mental disabilities. Chatham Oaks officials said there wouldn't be a problem with the paranormal team coming in as long as it didn't disturb residents, said county facilities director Dave Kempf.
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The Murky Politics of Mind-Body -New York Times

By SARAH KERSHAW

From Plato and Aristotle to Descartes, the great thinkers have for millennia argued over what is known in philosophy as the “mind-body problem,” the relationship between spirit and flesh. Dualism tends to win the day: The mind and the body, while linked, are separate. They exist independently, perhaps mingling but not merging.

The debate lives on these days in less abstract form in the United States: How much of a difference should it make to health care — and health insurance — if a condition is physical or mental?

Decades of culture change and recent scientific studies have blurred the line between these types of disorders. Now a critical moment has been reached in a 15-year debate in statehouses and in Congress over whether treatment for problems like depression, addiction and schizophrenia should get the same coverage by insurance companies as, say, diabetes, heart disease and cancer.

This month, the House passed a bill that would require insurance companies to provide mental health insurance parity. It was the first time it has approved a proposal so substantial.

The bill would ban insurance companies from setting lower limits on treatment for mental health problems than on treatment for physical problems, including doctor visits and hospital stays. It would also disallow higher co-payments. The insurance industry is up in arms, as are others who envision sharply higher premiums and a free-for-all over claims for coverage of things like jet lag and caffeine addiction.

Parity raises all sorts of tricky questions. Is an ailment a legitimate disease if you can’t test for it? A culture tells the doctor the patient has strep throat. But if a patient says, ‘‘Doctor, I feel hopeless,’’ is that enough to justify a diagnosis of depression and health benefits to pay for treatment? How many therapy sessions are enough? If mental illness never ends, which is typically the case, how do you set a standard for coverage equal to that for physical ailments, many of which do end?

The United States has a long history of separating the treatment of mental and physical illnesses, dating back to the days when the severely mentally ill were put in poorhouses, jails and, later, public asylums. That ended after the deinstitutionalization movement of the 1960s, but mental health experts and advocates say that the delivery of services is still far from equal, because emotional illness is still not considered to be on a par with medical illness.

Countries like Canada and the United Kingdom, with national health care systems that don’t limit access to any services, have long ago moved toward merging these two branches of health care, and the Scandinavian countries are known for treating mental illnesses as medical diseases, according to researchers who have studied the various systems.

In the United States over the last five years, research studies examining the link between physical brain abnormalities and disorders like severe depression and schizophrenia have begun to make a strong case that the disorders are not scary tales of minds gone mad but manifestations of actual, and often fatal, problems in brain circuitry. These disorders affect behavior and mood, and they look different from Parkinson’s disease or multiple sclerosis in brain imaging. Still, a growing number of studies — and many more are under way — are making the biological connection, redefining the concept of mental illness as brain illness.

“Insurance companies balk at this, but there are striking similarities between mental and physical diseases,” said George Graham, the A.C. Reid professor of philosophy at Wake Forest University. “There is suffering, there is a lacking of skills, a quality of life tragically reduced, the need for help. You have to develop a conception of mental health that focuses on the similarities, respects the differences but does not allow the differences to produce radically disparate and inequitable forms of treatment.”

While squarely in the minority, some still question the legitimacy of calling any mental ailment a disease. A louder chorus argues that addiction is a behavioral and social problem, even a choice, but not a disease, as many mental health professionals and the founders and millions of followers of Alcoholics Anonymous maintain.

Critics of parity say that anything that would not turn up in an autopsy, as in depression or agoraphobia, cannot be equated with physical illness, either in the pages of a medical text or on an insurance claim. These critics also say that because the mental abnormality research is so new, it should still be considered theory rather than an established basis for equal payment and treatment. “Schizophrenia and depression refer to behavior, not to cellular abnormalities,” said Jeffrey A. Schaler, a psychologist and an assistant professor of justice, law and society at American University in Washington. “So what constitutes medicine? Is it what anybody says is medicine? Is it acupuncture? Is it homeopathy?”

Nevertheless, as federal parity legislation has wobbled along over the years, 42 states have adopted their own versions of parity, offering a patchwork of standards for insurance companies on coverage for addiction and mental illnesses. A federal law would extend insurance parity to tens of millions more Americans who are not covered under the laws and set one broad standard for the nation. As the states have experimented with parity, however, many providers have complained that insurance companies have often found it easy to deny benefits by ruling that claims are not “medically necessary,” a potentially tough standard when it comes to ailments of the mind.

Meanwhile, attitudes about mental illnesses and addiction have changed significantly in the decades since advocates for the mentally ill — and for parity — first tried to include broad coverage of mental illnesses in the nation’s insurance plans. Pop culture has normalized and even glamorized rehab and even suicide attempts, chipping away slowly at social stigmas and lending strength to the idea that the sufferer of a mental illness or addiction may be a victim, rather than a perpetrator. Still, a cancer patient generally remains a far more sympathetic figure than a cocaine addict or a schizophrenic.

But scientific advances may go a long way to help the parity cause. The biological and neurological connection lends strength to the notion that mental illnesses are as real and as urgent as physical illnesses and that there may, at long last, even be a cure in this lifetime, or the next.

And if you can cure something, you can treat it and there is a finite quality to that treatment — and its cost. So you may, if you are an insurance company, be a lot more willing to pay for it.

“The more research that is done, the more the science convinces us that there is simply no reason to separate mental disorders from any other medical disorder,” said Thomas R. Insel, director of the National Institute of Mental Health, which has conducted a series of studies on the connection between depression and brain circuitry and on Thursday released an important study showing a connection between genetics and the ability to predict the risk for schizophrenia.

Last fall, the Senate passed its own parity bill with substantial differences from the House bill, which had been co-sponsored by Representative Patrick J. Kennedy, Democrat of Rhode Island. Mr. Kennedy has admitted to struggling with addiction and depression.

Supporters and opponents both expect the negotiations over how to reconcile the two bills to be protracted; President Bush, who has voiced support for the more limited coverage called for in the Senate bill, has said he would not support the House version, which estimates a cost to the government of $3.8 billion over the next decade through coverage from federally funded insurance. The bill also includes ways to offset the cost.

The precise impact of the House bill on private health insurance premiums was difficult to calculate, insurance industry experts said, but they said that increases to group plans would be likely, with some of the costs passed on to employees. Neither bill applies to employers with 50 or fewer employees or to the individual insurance market.

Despite such warnings that premiums might increase, however, it is unclear by how much. Such extensive parity requirements have never been tested on a federal level, and one question is how many people might take advantage of new benefits even if they were available.

The uncertainty is plain when experts try to estimate the effect. The Congressional Budget Office estimated that the Senate bill, with its minimalist approach, would increase health-plan costs by four-tenths of one percent. However, a report released last month by the Council for Affordable Health Insurance, an insurance industry group, estimated that state-based parity formulas were likely to increase rates by about 5 to 10 percent, on average. And a 2006 study in The New England Journal of Medicine, examining the costs associated with a parity program put into place by President Bill Clinton for all federal employees, found that it actually didn’t increase the use or the cost of mental health services. And that plan, it said, was similar to the one proposed in the more generous House bill.

The House bill would require insurance companies that offer mental health benefits to cover treatment for the hundreds of diagnoses included in the Diagnostic and Statistical Manual of Mental Disorders, from paranoid schizophrenia to stuttering to insomnia to chronic melancholy, or dysthymia.

The Bush administration and other opponents say the list of disorders is far too broad. That leads from parity to another, parallel morass in the fields of psychiatry and pharmacology. Both fields are accused of over-diagnosis and of seizing on fashionable diagnoses — bipolar disorder or post-traumatic stress disorder, for example — for financial gain or through highly subjective assessments.

“It’s the phone-book approach of possible conditions,” said Karen Ignagni, president of America’s Health Insurance Plans, an industry group representing insurance companies that cover 200 million Americans. “And this comes at a time when advocates have made a very persuasive case about the importance of covering behavioral health.”

But in the halls of Congress, at least, the mind-body problem is far from resolved, particularly when it is uncertain who the next president will be.

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1,929 homeless people are in Durham,Orange, Wake counties - Durham (NC) Herald-Sun

RALEIGH -- The 2008 Triangle Point-In-Time Count, a recent one-night private census conducted by homeless service providers throughout Durham, Orange and Wake counties revealed there are at least 1,929 homeless men, women and children in the Triangle living on the streets and in homeless shelters.

The count further revealed:

-- Some 291 children, or 15 percent of the total homeless here, lived in shelters the night of the count.

-- Some 127 -- 7 percent -- of homeless people lived unsheltered under bridges, in abandoned houses or in camps.

-- Some 272 -- 14 percent -- of the homeless were considered chronically homeless. Chronically homeless is defined as more than one year of homelessness or four periods of homelessness in the last three years, and a disability or substance abuse diagnosis.

-- Some 218 -- 11 percent -- of the homeless were military veterans.

The total number of homeless people has increased since the first Point-In-Time Count in 2006 when there were 1,720 homeless persons, but there were some positive findings over the two-years since then:

-- The number of people who are homeless in families dropped from 530 to 473 (an 11 percent decrease).

-- The number of chronic homeless people dropped 15 percent, from 321 to 272.

-- The actual number of people unsheltered declined by 30 percent, from 182 to 127.

Wake, Durham and Orange counties all have 10-year plans to end homelessness: Wake County is into year three, Durham is entering year two and Orange is now beginning to implement its plan.

All the plans have targeted strategies for identifying and engaging individuals on the street and assisting those who are chronically homeless.

"The good news is that those at greatest risk, those homeless people with a disabling condition, homeless families with children, and homeless individuals on the street, are moving out of homelessness into permanent housing," said Stan Holt, Triangle United Way's homeless specialist.

"Unfortunately, the current economy, the lack of affordable housing, and the growing anecdotal evidence from emergency service providers who are seeing more individuals with mental illness, is impacting the number of single individuals who are finding themselves homeless." Read more!

Asperger's: My life as an Earthbound alien - CNN

One CNN manager recently learned -- at 48 -- that she has Asperger's syndrome, a form of autism. Today she shares an inside view of life with the condition.

ATLANTA, Georgia (CNN) -- Recently, at 48 years of age, I was diagnosed with Asperger's syndrome. For most of my life, I knew that I was "other," not quite like everyone else. I searched for years for answers and found none, until an assignment at work required me to research autism. During that research, I found in the lives of other people with Asperger's threads of similarity that led to the diagnosis. Although having the diagnosis has been cathartic, it does not change the "otherness." It only confirms it.

When I talk to people about this aspect of myself, they always want to know what it means to be an "Aspie," as opposed to a "Neurotypical" (NT). Oh, dear, where to start . ...

The one thing people seem to know about Asperger's, if they know anything at all, is the geek factor. Bill Gates is rumored to be an Aspie. We tend to have specialized interests, and we will talk about them, ad infinitum, whether you are interested or not. Recognizing my tendency to soliloquize, I often choose silence, although perhaps not often enough. Due to our extensive vocabularies and uninflected manner of speaking, we are called "little professors," or arrogant.

I don't quite understand small talk, and early in my adult life, solecisms were frequent. At meetings, I launch into business without the expected social acknowledgments. It's not that I don't care about people, I am just very focused on task. Do you have to rehearse greeting people to reinforce that you should do it? I do.

I am lucky to have a very dear friend who savors my eccentricities. She laughs, lovingly, about one particular evening at a restaurant. Before she could get seated, I asked her what she knew about the golden ratio and began to spew everything I know about it. I re-emphasize how lucky I am to have her as a friend, because this incident occurred long before I was diagnosed.

A misconception is that Aspies do not have a sense of humor. It is true that we can be very literal, so we often miss the humor in everyday banter, but we can and do enjoy even subtle humor. Our literal interpretations, however, can be problematic.

In first grade, whenever someone made a mess in the classroom, the teacher would ask a student to get the janitor. The student would come back with Mr. Jones (not really his name), who carried a broom and large folding dustpan. When I was asked to get the janitor, I looked all over the school and reported back to the teacher that I could not find it. After all, the person was Mr. Jones, so the janitor must be the object, right?

I lack the ability to see emotion in most facial expressions. I compensate for this deficiency by listening to the inflections in people's voices and using logic to determine emotional context. The words people choose, their movements, or even how quickly they exit a meeting can provide clues to emotion.

I also have intensified senses -- touch, taste, smell, sight, and sound -- so I am attuned to lights, noise, textures, and smells. In a "busy" environment, I will eventually go into sensory overload and my mind will go blank. When this happens, I have to "go away" mentally for a brief period to regain focus. When I "return," I have to piece together what occurred while I was "away." The additional mental processing I must do to function every day is fatiguing, and I don't handle "ad hoc" very well. Being asked to respond quickly in the midst of all this other processing is difficult, sometimes impossible.

I am so sensitive to touch that a tickle hurts me. This is the hardest concept for most people to understand. How can a tickle hurt? All I can tell you is that it does, so I avoid being touched except by those who have learned how to touch me.

Hugs are dispensed infrequently, but if I do hug someone, I resemble Frankenstein's monster, arms extended to control contact. When my dad (who I suspect is an Aspie, too) and I hug, we both have "the approach." We sometimes miss and have to re-approach a couple of times until a brief, awkward hug is achieved.

In school, other children noted my differences, and I was bullied (and tickled into fits of despair) for years. Already needing extended periods of time alone, my response was to become even more of a loner. Uh oh. When you are weird, you are a joke. When you are a loner, you frighten people. It's always the quiet ones. ...

I am married (wow!), and my brilliant husband is an absolute sweetheart. I don't know any other man who has the self-confidence to be pushed away (sometimes sharply), both physically and mentally, as often as he has been. He has been gentle and patient (and, yes, frequently emotionally depleted) as we both worked through my need for space, tendency to go so deep into my own world that the real world and everyone in it cease to exist, and sensitivity to touch during the 26 (soon to be 27) years of our marriage.

I live with anxiety, because the world can be overwhelming and people have expectations that I always, sooner or later, fail to meet. I cannot begin to tell you how many times I have been told that I am rude, inaccessible or cold, yet I have never purposely tried to harm anyone, nor do I mean to be, well, mean.

I could tell you so much more, but instead let me share one last insight. Don't pity me or try to cure or change me. If you could live in my head for just one day, you might weep at how much beauty I perceive in the world with my exquisite senses. I would not trade one small bit of that beauty, as overwhelming and powerful as it can be, for "normalcy."
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The man who made lists to fend off depression -Reuters

By Arthur Spiegelman

LOS ANGELES (Reuters) - His mother suffered dark depressions and tried to dominate his life. His sister and daughter had severe mental problems, his father and wife died young and a beloved uncle committed suicide in his arms.

So what did Peter Mark Roget, the creator of Roget's Thesaurus, do to handle all the pain, grief, sorrow, affliction, woe, bitterness, unhappiness and misery in a life that lasted over 90 years?

He made lists.

The 19th century British scientist made lists of words, creating synonyms for all occasions that ultimately helped make life easier for term paper writers, crossword puzzle lovers and anyone looking for the answer to the age-old question: "What's another word for ..."

And according to a new biography, making his lists saved Roget's life and by keeping him from succumbing to the depression and misery of those around him.

"As a boy he stumbled upon a remarkable discovery -- that compiling lists of words could provide solace, no matter what misfortunes may befall him," says Joshua Kendall author of the just published "The Man Who Made Lists" (Putnam, $25.95), a study of Roget's life (1779 to 1869) based on diaries, letters and even an autobiography composed of lists.

Kendall, in a recent interview, said Roget cared more for words than people and that making lists on the scale that he did was obsessive-compulsive behavior that helped him fend off the demons that terrorized his distinguished British family.

Madness was a regular guest in Roget's home, Kendall said. One of his grandmothers either had schizophrenia or severe depression, Roget's mother lapsed into paranoia, often accusing the servants of plotting against her. Both his sister and his daughter suffered depression and mental problems.

Then there was the case of Roget's uncle, British member of Parliament Sir Samuel Romilly, known for his opposition to the slave trade and for his support of civil liberties. He slit his own throat while Roget tried to get the razor out of his hands.

Unlike a Thesaurus, no one understood Uncle Sam's last words: "My dear....I wish..."

Indeed, to quote most of the Thesaurus listing for pain, Roget's was a life filled with grief, pain, suffering, distress, affliction, woe, bitterness, heartache, unhappiness, infelicity and misery.

NOT WHOLLY EVIL

Kendall said, "The lists gave him an alternative world to which to repair." Many writers have declared their debt to Roget, including Peter Pan's creator, J.M. Barrie. In homage, he put a copy of the Thesaurus in Captain Hook's cabin so he could declare: "The man is not wholly evil -- he has a Thesaurus in his cabin.

The 20th century poet Sylvia Plath called herself "Roget's Strumpet" to pay respects for all the word choices he gave her.

But the British journalist Simon Winchester holds Roget responsible for helping to dumb down Western culture because his work allows a writer to look it up rather than think it out.

Roget made his first attempt at a Thesaurus at age 26 but put aside the effort and did not publish his book until 1852 when he was in his 70s and retired. He then kept busy with it for the rest of his life.

It became an instant hit in Britain but did not sell that well when an American edition was published two years later. But when Americans went crazy for crossword puzzles in the 1920s, the Thesaurus assumed its place on reference shelves.

Kendall's book is written in a style that he calls "narrative non-fiction" which contains a lot of dialogue and descriptions of how Roget and his friends feel and think, all, he says, based on source material.

"I did a lot of work to stitch together a narrative," he said, adding that all the scenes in the book are based on actual events. Read more!

L.A. County Pays for Shelter for Mentally Ill Youths -Ontario (CA) Inland Valley Daily Bulletin

Alison Hewitt

Beds and services for mentally ill youths at emergency shelters, including facilities in Pomona and El Monte, were funded this week by Los Angeles County.

A maximum allotment of $807,000 through June 2009 will allow shelters to provide services to limited numbers of emotionally disturbed or mentally ill teens and young adults. The clients will receive food, clothing, counseling and shelter for up to 29 days while staff helps them qualify for permanent-housing programs, welfare, vocational programs or mental-health treatment.

"Our intent is to have as many of these shelter beds available countywide as possible, so youth have a place to stay while they're being stabilized," said Sandra Thomas, the deputy director for the transitional-age youth bureau in the county's Department of Mental Health.

The county Board of Supervisors approved the item unanimously, including an amendment from Supervisor Mike Antonovich to give priority for beds to current and former foster children.

The county began focusing more on services to teens and young adults after state voters approved the Mental Health Services Act in 2004. The act provided state money that allowed the county to customize programs for people ages 16-25, said Terri Boykins, the division chief for transitional-age youth with DMH. Before, the age groups were birth-18 and 19-59.

"We began realizing we couldn't provide services (for youths) the same way we work with children or adults," Boykins said.

The Pomona shelter at 310 Foothill Blvd. is a former hotel now serving as a family shelter. It will set aside 12 beds to serve emotionally unstable youths.

The El Monte center, at 1171 N. Durfee Ave., is also a renovated hotel that serves as an emergency shelter for families, Boykins said.

Both shelters are run by the California Hispanic Commission on Alcohol and Drug Abuse.

All five shelters granted funding will receive $85 per client per night in DMH's ongoing efforts to reach out to mentally ill teens and young adults, Boykins said.

"This is a specialized population," she said. "Many are kids who may not want services, but they need services When they don't know where or if they'll have a place to sleep tonight, mental-health services isn't the No. 1 thing on their list."

Meeting their basic needs in the temporary shelters will help them focus on working with a counselor to qualify for assistance from more permanent county programs, Boykins said.

Working with them on a daily basis helps develop the necessary trust to help the youth, many of whom will likely be homeless or leaving the county probation system or foster-care system. Counselors will help guide them through things like enrolling in GED or vocational programs and applying for county benefits.

"Instead of sitting around the shelter all day waiting for the next meal, the shelter has staff to help the kid to make the phone calls or use the Internet to find out more," Boykins said.

"These are kids that would otherwise go unserved," Boykins said. "People need a place to stay and feel safe for other outreach efforts to work."

Read more!

Abington man ruled too impaired in mother's death -The Philadelphia Inquirer

By Larry King

An Abington man who repeatedly stabbed his mother last summer in Bensalem was too impaired by mental illness to be guilty of first-degree murder, a Bucks County judge ruled yesterday.

Patrick Hughes-Bygott, 22, instead was convicted of third-degree murder in the Aug. 16 slaying of Ellen Hughes-Bygott, 56.

The victim suffered nearly 60 stab wounds, nearly all in the head, neck and face. The slaying took place in front of her 90-year-old mother, in whose Bensalem home she was living and who pleaded with her grandson to stop the attack.

Judge John J. Rufe's verdict settled what the prosecutor called "an extraordinarily sad and tragic case" of a mentally ill mother slain by a mentally ill son who claimed to have been abused as a child, and pursued by government spies and mob hitmen as an adult.

Patrick Hughes-Bygott pleaded guilty but mentally ill March 11 to a general homicide charge. That led to a three-day degree-of-guilt hearing in which Rufe was asked to determine whether the killing was first-degree murder, third-degree murder or voluntary manslaughter.

After deliberating for about 30 minutes, Rufe announced that the defendant's mental illness rendered him unable to control or conform his conduct to the law.

Two mental-health experts had testified that Hughes-Bygott was suffering from psychotic delusions at the time he killed his mother.

Early that morning, he had called her from his home in Abington, claiming he was in danger. She told him to come to his grandmother's house, where she made him a bed on the floor and talked to him.

Within two hours, an argument erupted - apparently over the son's demand to be given a "downer" for his anxiety or taken to a hospital. He attacked his mother with three knives he brought from home for protection, pausing only to remove his frantic grandmother from the room when she tried to intervene.

He told arriving police that he stabbed his mother in an act of mercy, falsely claiming she had been dying of anorexia. Then he begged the officers to "finish her off."

First Assistant District Attorney David Zellis argued that Hughes-Bygott, long enraged by what he claimed was an abusive childhood, had lashed out in retaliation.

"There is malice. There is rage," Zellis said in court. Premeditation "can happen within seconds, and that's what happened here."

Robert Adshead, one of Hughes-Bygott's defense attorneys, countered that he was unable to form a rational intent to kill.

"He actually thought that his mother desired him to kill her," Adshead argued. "That's how delusional he was."

Hughes-Bygott is scheduled to be sentenced April 24; the maximum term for third-degree murder is 20 to 40 years. Because he was found guilty but mentally ill, he will be placed in a secure mental health facility until deemed well enough for prison.

"Until his mental illness is alleviated, if ever, he stays in the mental institution," Adshead said after the verdict.

That's a big "if," said Adshead and co-counsel Wallace Bateman, noting that Hughes-Bygott had remained expressionless in court, mostly staring at his shoes.

"After the judge announced the verdict, [Hughes-Bygott] had to ask us what the verdict was," Bateman said.

Defense psychologist Gerald Cooke testified that Hughes-Bygott probably began suffering from paranoid schizophrenia about three years ago. A binge drinker and daily marijuana smoker, he was suspended last spring from the University of Vermont for abusing drugs.

His claims that his mother physically, sexually and emotionally abused him throughout his childhood will be explored at his sentencing hearing, defense attorneys said.

Ellen Hughes-Bygott long suffered from bipolar disorder. Yesterday, Zellis called her simply "a caring daughter and a caring mother."

"For her to meet her end in such a horrific way is just heartbreaking," the prosecutor said. "The sadness is just compounded by the fact that her son did this to her." Read more!

Bay City woman to be charged with intent to commit murder in assault of police officer - Bay City (MI) Times

by Ryan J. Stanton
March 27, 2008 17:21PM

Bay City Police Officer Michael Socia found himself in a scuffle with a 50-year-old woman on Thursday when he went to serve her a mental health petition for hospitalization.

The woman, who lives on the 100 block of E. North Union St., resisted Socia's attempts to serve her the papers, allegedly hitting the officer over the head with a snow shovel and sending him to the hospital instead, according to police and family members.

The incident happened around 1 p.m.

For more than two hours afterward, several Bay City police officers arrived and remained on the scene, along with the woman's 21-year-old daughter, Sheena Fullerton of Kawkawlin.

Several items, including a large shovel and a metal bat, remained scattered in the front yard, which was roped off by police tape. Socia was taken to Bay Regional Medical Center for non-life threatening injuries, police said.

Deputy Chief Thomas Pletzke said the petition Socia tried to deliver was for an examination. He said the woman was taken to Bay Regional Medical Center.

The investigation will be forwarded to the Bay County Prosecutor's Office where charges will be brought for assault with the intent to commit murder, Pletzke said.

Bay County Animal Control was on the scene to deal with the woman's five dogs, three of which were taken away, witnesses said.
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My Crazy Brother - Paonia (CO) High Country News

by Ray Ring

I used to get mad at my brother for being crazy.

Because some of the time, he wasn't crazy. Or he didn't act crazy. In those good spells, he could be the together older brother, a guy who was good with tools, had a precise pool shot and a talent for massaging brown clay into sculptures of beautiful women. He could take apart the engine of a car or motorcycle, lay out the pieces in neatly labeled envelopes, fix what was broken and put it all back together so it worked. He could talk physics and chemistry and make a good spaghetti. He could see into people and make perceptive remarks.

Most of the time, though, he could barely function. He would hang from a cigarette as if it alone sustained him, and pace back and forth because he couldn't be still and couldn't figure out where to go. He would stare at people and things too long and not answer when spoken to.

In his worst times, he acted completely crazy. Hallucinating, he lined his walls with crinkled aluminum foil to try to block out the voices only he could hear. His movements grew stiff and jerky. His stare seethed with anger.

Or even worse, he would soar on optimism, exuberantly telling me he'd finally cured himself and would be all right from now on - that look lighting his eyes.

I would look at him acting so crazy, and sometimes I thought: Come on, John, knock it off.

You're probably also involved in craziness somehow. The issue cascades through communities and families. Most of us don't talk about it much, because it's too personal. Too burdened with despair and desperate hopes, guilt, blame, feeling sorry for others and ourselves. We're not even supposed to use the word "crazy." It's politically incorrect, but it's the most succinct description I know.

This story needs to be aired because it has meanings beyond vicious fate and one family struggling to cope. It's about people needing help in general, and how that isn't much in fashion these days. And it illuminates dark aspects of Western culture that we prefer to keep hidden.

One out of every six people in this country will suffer a diagnosable episode of mental illness this year. One out of every 17 is seriously mentally ill, a category of disasters that includes bipolar disorder, major depression and schizophrenia.

The National Alliance on Mental Illness, an advocacy group founded in 1979, gives the United States the grade of "D" for our systems of mental-health awareness and care - nearly complete failure. Nationwide, we spend more than $100 billion per year on it. The total keeps rising, and the number of people being treated keeps rising. The wider impacts on society - the annual costs of untreated mental illness - total another $100 billion.

The only feel-good rush on this issue came during the 1950s to the 1970s, when nationwide reforms freed many people from long-term warehousing in mental hospitals. Now we have one-tenth the number of hospitalized crazies we had back then. But we traded one set of failures for another - we have more mentally ill people in jails and prisons than in hospitals. And in our communities and on the streets, the billions of dollars have fallen short, and mostly we've chosen to look away from the sick rather than set up adequate treatment and support.

I'm focusing on the deficiencies in our systems of public care, for those who can't afford private psychiatrists and thus fall onto the ragged safety nets. Even for the wealthy, though, there are no easy answers, if there are any answers at all.

For my brother, it worked like this: John was born in 1947 in Tucson, Ariz., where our parents had moved for the healthy, dry air. Then they moved to California, where I was born in an ambulance, and then Indiana, then Illinois, where my younger brother, Mike, was born. Our father, Ray Sr., was an entrepreneur who chased opportunity while suffering physical illnesses and subtle symptoms of craziness, including unpredictable moods and an inability to stay in one place. As Ray Sr. failed in business, he aimed his demand for perfection and his angry frustration at his first seed - John. In his eyes, John could never do anything right.

Like many crazy people, John probably had his illness encoded into his genes, and childhood stress activated it. From the time he was an infant he rarely smiled. By fourth grade, he had trouble concentrating. He was hearing his own thoughts. Our mother, Kate, took him to his first psychiatrist. More clouds emerged. When John was 13, Ray Sr. went into the hospital for an operation for symptoms that turned out to be cancer, and John punished himself: He took a baseball bat into his bedroom, locked the door and began smashing his toys. Kate and I stood outside the door listening to the breakage, calling to him, getting no response. Kate didn't know what to do and phoned an Episcopal priest, who came in his black outfit and called through the door, "John, do you know who this is?" John's voice came through the door, "Santa Claus?" and he kept on with the bat. I remember grinning at his crazy humor. Smiling was my nature, and I did it so much that Kate thought something might be wrong with me.



Our father finally killed himself with cigarettes and lung cancer when John was 15, I was 13 and my younger brother was 10. Kate finished raising us, taking a series of jobs, including elementary school teacher, editor of educational materials, real estate agent, and finally an adjunct English teacher at a community college. All of this has been toughest on her.

John's path alternated between periods of lucidity and paranoia and hallucinations. He made a few unsuccessful attempts at college, then enlisted for four years in the Army, hoping the structure would straighten him out, serving in the South and Germany as a radar technician. Then he had a few brief civilian jobs. He tried enlisting a second time, but by then he had been diagnosed as schizophrenic, so the Army had no more use for him. He began what would eventually become hundreds of sessions with psychiatrists and counselors. He tried outpatient treatment and hospitals run by universities, counties, private businesses, and the Veterans Administration, the long grind of antipsychotic medications, even shock treatments. At times he wandered the streets incoherently, or landed in jail.

The first years of John's intermittent care were in the Illinois system. Then he and my mother returned to Tucson, where he spent 17 years in the Arizona system. I left Illinois for Colorado, but wound up in Tucson for most of John's crazy years there. I was old enough to be a better witness, and I saw how the Arizona system was itself crazy and sad.

Our family didn't have a lot of money for treatment. John got by mostly on small disability payments from Social Security and the Veterans Administration, and whatever the public mental-health care system could do for him. Arizona's system, like those of the other Western states, is a complicated array of dozens of agencies and companies, some of which operate to make a profit on craziness. The federal government provides some money through programs such as Medicaid and Social Security disability, but state governments are in the driver's seat. Every year, the legislatures and governors allocate state money for the systems, and it doesn't have much to do with what's needed. The principle is called "managed care," which really means managing costs.

"It's an oxymoron approach," says Chick Arnold, a lawyer who has pressed a class-action suit against Arizona's system since the 1980s, demanding a series of improvements. "The companies (and agencies) get a finite amount of money to provide an open-ended commitment for service for a growing population. They can't do it. ... The system is designed to screen people out, not in. It's all about cost containment."

At most, John would see a psychiatrist for one 15-minute visit per month. Most of his interactions with the system came through his case managers and counselors, each of whom juggled many dozens of patients. Much of the treatment is based on medications that try to soothe or dampen the brain chemistry. John would get his meds in pills, liquid potions or injections. All the meds had bad side effects, such as tardive dyskinesia - uncontrollable pacing, stiffness of posture, facial grimacing.

John would take his meds for a while, stabilize, and then stop taking them. He would fly without meds for weeks or months, then crash. Sometimes when he had bad spells, my mother and I would ally with local prosecutors and go to court, testifying against him, saying he was a danger to himself or others, the legal standard for court-ordered commitment to treatment. The commitment would last for a week or so in a locked hospital ward, then longer periods of follow-up and mandatory meds outside the hospital, sometimes for as long as a year. Always the commitment would end, and then the cycle would begin again. All this is familiar to people who pay attention to crazy people.

John tried taking megavitamins and nutritional powders. He paid to consult with psychics. Once, he drove to California to try to talk to the guy who wrote a popular book on primal scream therapy. The guy refused to see him.

When he wasn't in hospitals, John lived wherever Tucson landlords would rent to a crazy person, usually cockroach-infested dives. In one big apartment complex that was filled with various losers, one of his neighbors got stabbed, and the police helicopter regularly flew over with its glaring spotlight and warlike noise. The wait for federal subsidized housing stretched out for years, and he could rarely take advantage of it.



In the bad spells, he forgot to eat and grew extremely thin. Or he got mad at everything and everyone, sometimes attracting the cops. The busts I know about were for leaping out of bushes and threatening strangers with a hammer, for taking the hammer into a convenience store and causing a disturbance, for tearing the windshield wipers off a parked car, throwing rock salt into the swimming pool in his apartment complex, and for forgetting to show up in court. Landlords evicted him for hurling rocks through his windows and breaking his door. During visits to our mother's house he broke dishes, threw a hammer through the wall, broke furniture, or pounded on the front door demanding to be let in. One time when they were driving together, he became agitated and told her, "Pull over or I'll put your face through that windshield." Sometimes the cops took him to hospitals, and sometimes to jail. At least once he set a fire in his cell.

He had a series of troubled cars - a Ford Falcon, a Mercury Comet, a Ford Pinto, and then an old International Harvester Scout. He worked on them constantly to keep them going. During bad spells, he caused a few car wrecks.

Most of the world had no sympathy for him. Banks dunned him with extra charges for bounced checks, and he would struggle to keep track of all his bills, especially the ones from ambulances and other mental-health providers, with their complicated deductibles and formulas for benefits. Bills from the phone company, other utilities, car insurance and the dentist often came faster than he could afford.

In desert heat above 100 degrees, he went around in a long-sleeved shirt with a T-shirt under it, and long pants. He wore down the heels of his shoes with his pacing. He loaned money to "friends" and never got it back. He was incapable of bargaining and often got rooked. Now and then, he picked fights with strangers and put up no resistance as the blows began to fall - punishing himself like that. One of the times I talked him into going to a hospital, we sat on chairs in the waiting room, and suddenly he curled down onto the floor, a catatonic escape.

Music could soothe him. In his lucid spells, he liked a good joke. He could talk Arizona Wildcats basketball. He had a persistent hope of creating something special and lasting, a breakthrough in physics or some other wild dream. One time I asked him what he was up to, and he said, "The never-ending battle against entropy." I had to look it up: the natural tendency of all things in the universe to fly apart.

I would get angry at him, wanting him to take his meds, regardless of their side effects, because the alternative seemed worse to me. Now and then he threatened to commit suicide. I got tired of hearing it. Sometimes I secretly wished for him to die, thinking it was the only way for him to find relief, and also because it would end my duty.

Then in 1995 at the age of 47, he bought a pistol from a guy he found in the classified ads, took it home to his latest one-room apartment in Tucson, lay down on his bed, and, sometime during the night, shot himself in the head. I do not know the exact date of his death - only that it was sometime in late April or early May - because it took a while for his body to be found. He was that alone at the end.

I know there are many dedicated professionals in Arizona's mental-health care system. But sometimes it seems as if the system mostly amounts to passing out guns. Maybe for some crazy people that's the only effective treatment.

No one knows" exactly what leads up to any person committing suicide, says John McIntosh, a psychology professor at Indiana University South Bend who has studied 50 years of nationwide statistics. But he's one of the experts who've noticed that, collectively, Westerners lead the nation in suicide rates.

No other measurement of mental illness distinguishes the West so clearly - not rates of depression and "serious psychological distress," not the shortages of money for treatment. In public spending on mental-health care, for instance, some Western states are below average, with New Mexico and Idaho nearly last, while some Western states are above average.

For suicide, nine of the top 11 states are in the West, a trend that holds year after year and decade after decade. And the degree of the lethal regional difference is stunning: Nevada, Montana, New Mexico, Wyoming, Idaho, Utah, Colorado, Arizona and Oregon range from 19 to 15 suicides per 100,000 people - more than twice as high as New York and Washington, D.C., the healthy end of the scale. The rate in Washington state is nearly as high as its neighbors in the region, and even mellow California ranks 50 percent higher than New York and D.C.



Some 8,000 Westerners will kill themselves this year, a hefty portion of the national total of more than 30,000 suicides. Much of the cause, McIntosh suspects, is embedded in our Western culture. "Potential contributors," he says carefully, "include the personality or attitudinal or world-view differences across the country." Patty Limerick, a prominent Western historian at the University of Colorado, frames it more frankly: In the West, "we won't admit our sorrows until they become cataclysmic."

Wallace Stegner is considered the Shakespeare of the West, one of our most important writers and thinkers. He wrote of the region's "geography of hope," and the inevitable poisonous disappointments that blossom from that hope. His life fits the pattern. "Stegner experienced a hardscrabble childhood. His father, George, a failed farmer and career bootlegger, dragged long-suffering wife Hilda and their two boys to remote locations," says Carlin Romano, in a review of a new biography of Stegner. "The Stegners lived in 20 different residences over 10 years to avoid raids on George's bootlegging. ... At one point, Hilda deposited Stegner and his brother in a Seattle orphanage, one of the writer's most painful memories. ... He came to hate his abusive father ..."

Wallace Stegner's father committed suicide (and killed his mistress) in a Salt Lake City hotel in 1939. Four years later, Stegner published an autobiographical novel, Big Rock Candy Mountain, which "yields insights into the origins of the most important themes of his life and writings - how man relates to his family and to his surrounding environment," according to Patricia Rowe Willrich, a literary critic who profiled Stegner shortly before his death in 1993. In Big Rock Candy Mountain, Stegner described a character, Bo Mason, based on his father:

"He was born with the itch in his bones. ... He was always telling stories of men who had gone over the hills to some new place and found a land of Canaan, made their pile, got to be big men in the communities they fathered. But the Canaans toward which Bo's feet had turned had not lived up to their promise. People had been before him. The cream, he said, was gone. He should have lived a hundred years earlier.

"Yet he would never quite grant that all the good places were filled up. There was somewhere, if you knew where to find it, some place where money could be made like drawing water from a well, some Big Rock Candy Mountain where life was effortless and rich and unrestricted and full of adventure and action, where something could be had for nothing."

Stegner's themes echo. Westerners by nature tend towards transience. The early white settlers came here to escape or find something new and better - that Big Rock Candy Mountain - and the same urge continues today. Waves of migration come from other regions. People bounce from California to Montana to Arizona, thinking nicer scenery will somehow solve their problems, or that they'll find a fresh start in a booming city, or forge deep connections in some small rural town. When nothing is solved, the beautiful mountains or rivers or deserts become a taunt. And guns - the most popular method of suicide - are easily available.

"We encourage people to move here and lie to them about it being paradise," says Arnold, the Arizona mental-health lawyer. Western states, exploding with population growth, have flimsy communities. Families are strained or fragmented by the churning. Our frontier mentality makes us suspicious of government and public services. We expect people to tough it out on their own. "The dream of a freer life, independence, that kind of individualism, works against community and familiar structure," says Bill Handley, an associate professor at the University of Southern California who studies how Western writers deal with these themes. "There's a whole literature of loneliness in the West."

Among the other cultural factors linked to suicide: Westerners are the least likely to attend church. We're more likely to abuse alcohol and prescription drugs. We have high rates of divorce. A 1992 study even found that country music, with its refrains of loneliness and failure, could contribute to suicide rates.

Sheila Linwood, who runs a suicide-prevention group in Grand Junction, Colo., sees high rates of suicide among the young men who work far from their families in the booming construction and oil and gas fields. "It's huge isolation," she says. When they suffer depression and other mental illness, she says, "They really do feel like no one else in the world can understand, no one is going to help them out. It's not a healthy atmosphere." Some suicides never make it into the statistics, she says. "If you're putting up an oil derrick, it's dangerous work, and if you have a mental-health condition, you may not take the precautions you need to take."



I don't know whether my brother would've fared better if he'd stayed in the Illinois system. I do know that when he moved back to the West, his chances worsened. But he was a Westerner, in his origin, his conclusion and his transience. He lived in at least six states, two countries, and more than a dozen apartments and houses in Tucson alone, not including hospitals. Sometimes he was willing to seek help, but often he was reluctant. He was also a victim. All the very crazy ones are born into it, or hit with it, regardless of the choices they make or how they try to live their lives.

I go around with thoughts that I should've done more for John. In Tucson, I saw him roughly once a week. On holidays and other special occasions, he came over to the house where I lived with my wife and kids. He tried to interact, but sometimes was too far gone. The kids called him Uncle John, and he was sweet to them, but generally he wasn't good in groups. So most of the times I was with John in the desert, it was just the two of us (my younger brother took his own path, to New Mexico, Europe and California). We had our routines: I took John out for burritos, or we went to a bar to shoot pool. We went to movies, where he could lose himself in the big screen. He helped me work on my cars.

The hikes were the best times we shared. We liked to go at sunset. One trail meandered through washes in the Tucson Mountains to a pioneer's homestead that had fallen into decay. The roof and windows were gone, and just stone walls remained on a concrete pad. Sometimes we hiked up the canyons of a bigger range, the Santa Catalinas, where we often found the magic of water flowing in the desert. Or I would drive us up to the summit of that range for hikes in the cool pines. John would sit on the passenger seat next to me, refusing to look at the panoramic views out his side window. He just stared straight ahead, but I know the scenes outside registered in him and helped him.

Our favorite hike was Tanque Verde, a canyon between two ranges, where we almost always found water. I would take off my shoes and persuade him to take off his, and we would wade on the sandy bottoms as the sunset flared into dusk and bats emerged on fluttering wings.

I always said goodbye to John with a hug. He liked that, too. He rarely felt the touch of other people. Over the years he had a few girlfriends who valued his intellect, his intensity and his struggle, but they all ultimately gave up on him. At least one was a fellow crazy, and two were counselors with their own troubles. Counselors aren't supposed to lie down with people like John because it's considered unprofessional and unhealthy. But I saw them as heroic.

He was so alone that sometimes he would call me and say nothing, just looking for a voice. Sometimes I got angry at the long pauses, when his calls interrupted my life. I felt I was expected to carry him, but I had competing duties to my wife, my kids, and myself. "Family members feel badgered," says Clarke Romans, director of the National Alliance on Mental Illness's Tucson chapter. "The mentally ill person sucks the attention of most of the family. Others in the family feel shortchanged. Families walk around with this aggravated sense of rage, because they're not getting the services they deserve."

When I decided to leave Tucson, fleeing the sun-baked urban mess - chasing my Big Rock Candy Mountain, headed north to the Rockies - I thought about taking John with me. It seemed close to impossible, on top of moving the wife and kids and facing who knows what changes ahead. My wife thought I was crazy to consider it. When I told him we would move soon, he took off driving his old Scout, heading north, fully crazy and somehow imagining, I think, that he could prove he could relocate himself. He drove about 120 miles and ended up out of gas and with a dead battery in an old mining community, walking beside the road for hours, hungry and hallucinating. The cops there scooped him up, thank you, and called me, and my wife and I drove up and brought the Scout back to Tucson. They committed him to a hospital and long-term outpatient meds, again. And we left without him.

The last time he and I talked, about nine months after I moved away from Tucson, it was a long-distance call. My life still felt shaky from the move and I was under more than the usual stress. I picked a fight with him about his driving. He spent too much of his paltry income on gas, insurance and repairs, and for too long I had lived with the fear that he would hurt someone else by driving when he was crazy or acting out his anger. I told him angrily that he should sell that old truck. Within a few weeks, he did sell it. He used some of the money to buy the gun.



There was a lot of turnover, and his case manager changed four times during his last year. He ended up amid strangers and without wheels, trapped in one place with only his madness. Tucson had a lousy bus system, like many Western cities, and that also helped kill him. He lost his last shreds of hope.

He pulled the trigger in the springtime, the season of suicide. A few days later, a comedy videotape arrived in my mailbox. He had ordered it for my kids.

In the 13 years since John killed himself, there have been some improvements in the system. New medications have fewer side effects. But still there are no cures, and horror stories are legion.

Prodded by many lawsuits, Arizona has increased its spending on mental health. Now, it's eighth in the nation - but that still works out to $136 per capita, about half the price of a small iPod. Tucson has a few more services for crazy people, but case managers still suffer burnout. "The ratio is way up in the 70 to 100 clients per case manager," says Romans. "That kind of ratio makes it impossible for case managers to actually do their jobs. It contributes to a high turnover rate - people quit because they can't help people like they thought they could."

"The Arizona system is not particularly good," says Bob Hess, director of the National Alliance on Mental Illness' Arizona chapter. "But as a nation we're not good - basically everyone stinks together."

For 12 years, I've lived in Bozeman, Mont., a prosperous New West college town. If you're crazy in Bozeman and having a serious breakdown, you'll probably be hauled more than 100 miles, to the nearest hospital psych ward. On some nights every psychiatric bed in Montana is full. Then the Bozeman hospital (which has no psych unit) might admit you to spend the night under watch of a security guard.

Recent scandals in Western states include physical and sexual abuse, even suicides, right inside hospitals. More changes are needed, but they must be cataclysmic, not just incremental. We must change the way we think about mental health. As Dr. Bruce Kahn, with the nonprofit Valley Mental Health in Salt Lake City, says, "We need a health-care policy that would not discriminate based on which organ of the body is afflicted."

I think back to how John would get frustrated and smash things he cared about. Sometime in the 1970s, when he was living in Illinois with Kate, I came from Colorado for a visit. Somehow he got pissed off at the car he had at the time, the old Falcon. He took a hammer and began beating on it in the driveway.

From inside the house, I could hear the kawack of the hammer blows on steel and the tinkling broken glass. I went out, thinking I might be able to handle it. When I confronted John in the driveway, though, he didn't seem to know me. He walked around the crumpled machine, selected another spot and smashed it. I asked him to move the car down the street, telling him he was disturbing the neighbors - grasping for sanity. Wild-eyed, he said he wanted to do it here. He held the hammer over his head and glared at me, scaring me. I grabbed his wrist and punched him on the forehead. He punched me and ripped my shirt as I took the hammer and pulled away. We faced each other, panting for air and bleeding onto the blacktop. Then I thought, What the hell? I handed him back the hammer and went back into the house. The hammer blows began anew.

Now my only regret about that scene is that I didn't appreciate the statement he was making. I should have built a bonfire, eased back in a lawn chair and shouted encouragement: "You missed a spot, John! There's a piece of chrome trim sneering indifference! Go get 'em, crazy John!"

When I returned to Tucson for his funeral, I went hiking in Tanque Verde Canyon at sunset. I found water and went barefoot into it. Walking up the trail out of the canyon, alone in the dusk, I heard a great horned owl hooting. The huge bird was perched atop a tall saguaro cactus silhouetted against the full moon. I watched the owl for a long time. The owl tipped forward to let loose each hoo-hooo-hooo-hooo! with all the volume and force in its body. Hoot after hoot.

On that trip, I also went to the apartment where John killed himself. I felt the terribleness there. Then another strange thing happened: The feeling changed to something golden, like a sunrise coming into the room and into me. I am not a religious person, but I could feel John in it, telling me he had finally found a better place. I have never felt that feeling again. It is not enough to put my turmoil to rest. But I am proud of how he bore his burden, and I understand that he needed to find a way out.



I inherited John's toolboxes, including that ball-peen hammer. And I have a cardboard box with a few things I gathered from his last apartment: a little plastic trophy he won in a pool tournament, triangles for his mechanical drawing, the classified ads where he shopped for the gun. And notebooks in which he kept meticulous journals at times. March 16, 1987: "Just when you think you have an upper hand ..."

I remember him most vividly when I'm driving by myself, no one there to distract me, and a song comes on the car stereo. There are many sad songs that honor outlaws, victims of crashes and other tragedies. There are no songs for the mentally ill. But a few of Bruce Springsteen's ballads remind me of John, like "Philadelphia," about a gay man wandering the streets as he dies of AIDS, and "Highway Patrolman," about the bond between brothers. And there's Steve Earle's ballad with the line: "Even Jesus couldn't save me, though I know He did His very best ... Swing low, swing low, swing low and carry me home."

I'll look over, and there he is, sitting on the passenger seat just like he used to. "Hey, Juaaan," I say, drawling the amusing nickname only he and I knew. He doesn't turn, just sits stiffly and stares straight ahead, like he did in life. Or I'll see him in the corner of my eye, standing in the corner of a room in my house, stiff with his hands shoved in his pockets. If I look directly, he vanishes. Many people have ghosts like this. We don't talk about it to anyone.

I watch my children for any signs of the craziness, hope to hell nothing surfaces. I can imagine nothing worse.

I know how people can be single-issue voters. There are some who care about nothing except abortion, or gun rights. For me, the need to improve public mental-health care outweighs other political issues. A champion of funding for the mentally ill could trash a few rivers and still have my vote. I can't say that better funding would've prevented my brother's suicide. But it might improve the day-to-day lives of others.

If I were in charge, my program for crazy people would include a decent apartment, a good burrito, movies, hikes. And cats and dogs and whores, so the crazy people can touch and be touched physically, without judgment. And a place for hammering things to smithereens, without endangering other people.

My thoughts will not be welcomed by all who are touched by mental illness and suicide. But maybe this story will resonate in your life, offer you some support for decisions you've made, both good and bad. I hope it will also raise awareness. That's all I can offer. I can't talk about it any more than this.

When we were boys together in Illinois, John and I played in the muddy, slow-flowing creeks and sought out slithering black leeches and the crawdads lurking under rocks. We also had a big swamp behind our house, and we tramped around there looking for snakes and rabbits. John always liked animals. He found little birds that had fallen from their nests, brought them into the house, and we tried to feed them. Sometimes he discovered nests of rabbits where the maintenance crews were cutting tall grass. He brought the tiny rabbit babies to the house, and we fed them with little doll bottles of milk. He also brought in snakes, concerned that they might not survive the coming winter.

One of John's childhood projects was building a clubhouse in our backyard. He put all kinds of work into it, and all of us neighborhood boys used the clubhouse to hide from grownups and fool around. Then a tornado came along and smashed the clubhouse flat, spreading the old lumber across several yards. That didn't discourage John. He gathered some of the scuffed boards and torn roofing paper and nails, and made a flat-bottomed boat. Of course it leaked, but he made the joints tight enough that it floated, or sank slowly. We took that boat to the high-school pond and it kept us just out of reach of snapping turtles. We took it into the mysterious swamp, poling through the black waters and muck and thickets of cattails and brush. We used that boat for years, exploring and re-exploring the swamp. That's how I think of John's life: A tornado came through, and he did his best to make something of the wreckage.

Ray Ring is HCN senior editor Read more!

Ex-Dallas death row inmate gets life in prison in plea deal - Dallas Morning News

Prosecutors end pursuit of death penalty in 1991 case

March 27, 2008
By JENNIFER EMILY
jemily@dallasnews.com

A man whose death sentence was overturned last year by the U.S. Supreme Court agreed to life in prison Thursday in exchange for Dallas County prosecutors not seeking to execute him. The plea bargain likely means LaRoyce Smith will die in prison.

District Attorney Craig Watkins had said as recently as 11 months ago that he would seek the death penalty against Mr. Smith after the high court overturned his sentence for a second time. The Supreme Court overturned the sentence – but not the conviction – because it ruled that the jury at Mr. Smith's trial was not allowed to consider his low IQ of 78 and that he was a 19-year-old ninth-grader as mitigating factors.

Mr. Smith's plea deal comes one week after a special prosecutor made a plea bargain with a man whose Dallas County conviction and death sentence were overturned by the Supreme Court because of racial bias in jury selection. In that case, Thomas Joe Miller-El pleaded guilty to murder and aggravated robbery, and prosecutors agreed not to seek the death penalty.

In Mr. Smith's case, Dallas County prosecutors David Alex and Kim Schaefer said they offered the plea bargain because even if a jury again sentenced Mr. Smith to death, they would be in court for years litigating issues of mental retardation. The prosecutors said they also would have faced federal court litigation over matters dealing with the guilt/innocence portion of Mr. Smith's original trial.

As part of the plea deal, Mr. Smith, 37, agreed to drop those issues in court.

"Let's say we tried him again and got a death sentence," Mr. Alex said. "They wouldn't have killed him. They would have relitigated those issues."

Mr. Smith's attorneys declined to comment. Mr. Smith's family also said they did not want to talk.

Mr. Smith was convicted in the 1991 shooting and stabbing of Jennifer Soto, the 19-year-old night manager at a DeSoto Taco Bell where he also worked.

If the case had gone back to trial and Mr. Smith was given a life sentence, he would be eligible for parole after serving 15 years because of the law at the time. Those who commit capital murder today and are given a life sentence are not eligible for parole.

He also pleaded guilty to aggravated kidnapping, burglary of a building and retaliation. His sentences for those crimes of 99 years, 20 years and eight years, respectively, will each be served consecutively to the life sentence. Under Thursday's plea bargain, it is possible – though unlikely – for Mr. Smith to become eligible for parole after serving 37 years.

Ms. Schaefer said the law regarding mitigating factors changed as the district attorney's office was litigating Mr. Smith's case.

"It's hard to look the [victim's] family in the eye and tell them the system failed them," she said.

Ms. Soto's mother, Brenda Soto, said after the hearing that it was difficult for her to approve the plea agreement but did so to avoid future hearings and trials. She said that though the legal battle is over, she will do whatever she can to make sure Mr. Smith isn't granted parole.

"I went along with it to put an end to it. I was tired," she said. "There will always be someone to speak in her behalf. There will always be a voice for her somewhere."

Mr. Smith apologized to the Soto family in court by saying he was sorry for "the actions" and "the events."

"He never said he was sorry for killing Jennifer," Brenda Soto said. "I don't know if he's truly sorry."

As part of the plea agreement, Mr. Smith, who has been in prison since his 1991 conviction, must meet with the Soto family if they choose. Brenda Soto said she likely will meet her daughter's killer because, "I've got 17 years worth of questions bottled up in me."

At the time of Mr. Smith's conviction, jurors had to answer two questions when deciding if a defendant deserved a death sentence. Was the conduct deliberate? Did the defendant still pose a threat? Answering yes to both questions meant death.

In 1991, the state Legislature added a third question that allowed jurors to consider mitigating evidence that could lead to a life sentence.

The Supreme Court first threw out Mr. Smith's death sentence in 2004 on a 7-2 vote and ordered the Texas Court of Criminal Appeals to take action. The state appeals court upheld the conviction in an 8-1 vote.

The Supreme Court then voted 5-4 last year to once again toss Mr. Smith's sentence, leading to Thursday's plea bargain.
Read more!

Court of hope - Portland Oregonian

March 27, 2008
HOLLY DANKS

HILLSBORO -- The defendants waiting on the hard wooden benches in Marco A. Hernandez's courtroom quiet down and stand as the Washington County circuit judge enters.

Every other Monday afternoon in 304C, that's where the court formalities end.

At the start of a recent Mental Health Court session, the 50-year-old judge tells the crowd he shredded his ankle his first time snowboarding. One of the defendants, diagnosed as a bipolar alcoholic, says falling is the best part and volunteers to teach him how to do it right.

Another time, a meth addict with a bipolar diagnosis says she is discouraged that her theft conviction keeps her from getting a decent job.

"I started out washing dishes and I was a janitor," Hernandez barks, waving his arm as the defendants laugh. "I went all the way through college and my first job was a maid! What's up with that? A four-year degree and I'm a maid!"

Hernandez leads Mental Health Court as part inspirational speaker, part compassionate confessor, part stern uncle.

The banter puts the mentally ill defendants at ease. Hernandez shows he believes in them and trusts them. In turn, they don't want to disappoint.

The rapport between judge and defendants, along with intense supervision and hard work by a team of court, corrections and mental health staff, has helped the special court navigate the ups and downs of its first year.

"So, what's going on?" the judge asks a big man who has schizophrenia and a cocaine addiction. Hernandez earlier sent the man to jail on a probation violation.

"I'm doing the classes, I'm out of jail, I'm sleeping in the Coop every night," the man says, referring to a Luke-Dorf Inc. group home for mentally ill substance abusers. "I'm going to classes. I'm observing the rules every night."

"You're not using coke?"

"No. I'm happy with myself, you know."

Hernandez leads the courtroom in a round of applause. "That's how it's going to be from now on. I told you that's what would happen."

"I know, I didn't believe you," the man humbly agrees.

"You wouldn't be the first," the judge casually notes.

As Mental Health Court pushes to get defendants through probation successfully, Hernandez uses an informal give-and-take style that fosters communication and offers encouragement.

After less than a year of operation, the court celebrated its first graduation in January.

The graduate, who didn't want to be interviewed or identified, was convicted of identity theft. Like many mentally ill people, the 26-year-old woman, diagnosed as schizophrenic, struggled at home and ended up living with drug-addicted criminals who took advantage of her for her monthly $550 Social Security checks.

Now that she can function without weekly probation visits and twice-monthly court sessions, she will see a probation officer once a month until her sentence is served.

To be accepted into Mental Health Court, which started in March 2007, defendants must be on probation for nonviolent misdemeanors only. Among requirements, they have to abstain from drugs, attend alcohol or drug counseling, get a job and attend court every two weeks.

In turn, court officials and mental health providers help them find housing, medications and public assistance.

"Our goal is to get them stabilized," Joe Simich says. The Mental Health Court's coordinator is a Washington County probation supervisor with 22 years of corrections experience.

"With the normal court process, the goal often is different -- satisfying conditions, paying fees, doing community service," Simich says. "We want to make sure they have some stable housing and stable meds, then we start taking on some of those conditions."

In the end, officials say, the public wins as well.

Most of the court's participants were regularly in and out of jail on minor charges. They would shoplift, trespass, harass people on the street, drive drunk, use drugs, get picked up for disorderly conduct. Over and over, they were a nuisance to the community and took up police time, jail beds and court dockets. Some also were in and out of hospitals, on suicide watch or needing medications.

"To the extent that these 20 aren't using up jail beds and committing new crimes, I think it is working," Hernandez says.

The program fluctuates between 20 and 21 participants. Hernandez would like to double the number but says the staff may be able to handle only 10 more without additional help.

Mental Health Court operates without a budget. Court, corrections, law enforcement and mental health personnel are paid through their regular jobs and work part-time with the special court. Money comes from the county Mental Health Department, a couple of hundred dollars at a time, to help participants find a place to live until they get jobs or their own public assistance kicks in.

Jeff MacLean, the deputy district attorney assigned to Mental Health Court, makes sure that violent offenders are excluded and sentences are not reduced.

"The higher level of supervision tends to be working better with these people," he says.

Aimee VanHouten, 30, of Hillsboro grew to appreciate that intense supervision. VanHouten, who used methamphetamine to self-medicate her bipolar condition, ended up in the special court after being convicted of ID theft.

"At first, I thought Mental Health Court was horrible. I would've told people not to do it, because I was being held accountable and I didn't like it," VanHouten says. "But then I decided to be sober, to get my life back together, and now I like the accountability of it. I don't want to fail Judge Hernandez."

A 2004 study of the King County, Wash., Mental Health Court, the second-oldest in the nation, found that it reduced recidivism by nearly 76 percent in participants.

Washington County's Mental Health Court is one of six in Oregon. In Clackamas County, 55 people graduated from its Mental Health Court in 2005-06. Officials there said only three committed new crimes.

The Washington County team struggles to deal with the breakdowns that can haunt the mentally ill.

One woman died from a heroin overdose. Some participants attempt suicide, abuse alcohol or use illicit drugs. Some miss appointments and classes. Every session, the judge metes out jail time or community service to those who slip up.

"I'm not messing around," Hernandez bluntly tells a man who left the Coop and was caught using drugs. "We had a deal. I've gone way out of my way to help you out on this, but you aren't doing your part."

Hernandez and Simich say they have learned to look at how far the participants have come, not how far they have to go.

One woman with a bipolar diagnosis used to be hospitalized several times a week, threatening suicide. Since she's been coming to Mental Health Court -- and since Hernandez sent her to jail for 90 days for using meth again -- "we broke her of that and she did well for a while," Simich says.

"I don't want to be a failure. I know I'm doing things I'm not supposed to do," the woman sobs to the judge and her fellow participants. "My mind freezes. I can't even think of anything."

"I'm not going to give up on you yet," Hernandez offers. "But we've got to get past the drug use."

Afterward, Hernandez explains that participants "really are invested in coming to Mental Health Court. They want to do well, they want to tell me and the others they are doing well."

Heather Wiegele, 30, who was diagnosed as bipolar at age 13, was convicted of drunken driving and skipped out on her probation. She says she appreciates that Hernandez, who told her she had to comply or go to jail, is tough but fair.

"I never thought I'd be giving props to a judge," she said after court in January.

Clean and sober for 71/2 months, Wiegele asked Hernandez during court in February if she could move to Arizona to be closer to family. The judge conferred with the rest of the team and said she needed to get a job and finish the program here.

"When she came in last year, I thought she was going to die, she was literally shaking," Hernandez explains later.

A couple of weeks after she professed she was ready to leave, Wiegele's depression got the best of her. She drank, took 60 of her anti-anxiety pills and ended up in the hospital. Now she's back in Mental Health Court and attending extra Alcoholics Anonymous meetings. She has a landscaping job and has moved into the Coop.

"I was very worried about you," Hernandez tells her the next he sees her.

"I'm trying to be a little more honest this time," Wiegele acknowledges.

"Well, good," the judge responds. "You are proving me wrong."

"I'm not the kind of girl," she shoots back, "who wants you to be right."

Holly Danks: 503-221-4377; hollydanks@news.oregonian.com Read more!

What's in a name, anyway? - Knight Ridder

March 27, 2008

Mar. 27--In these politically correct times, words like "mental retardation" can wind up on the endangered list. In Missouri, it winds up on the Senate floor.

Two bills in the Missouri General Assembly seek to change the name of the state's Division of Mental Retardation and Developmental Disabilities. Senate Bill 756 and House Bill 1627 are asking to change the name to the "less offensive" Division of Developmental Disabilities.

However, there are two camps in the debate. One sees society as a whole defining "retardation" in negative terms and wants to change the name to reduce the stigma. The opposing side sees it as a government attempt to cut services to severe mentally impaired residents.

Garry Hammond, president and chief executive officer of Family Guidance Center for Behavioral Healthcare, said Missouri is only one of a handful of states that still use the term "mental retardation."

"What Missouri is doing is entirely consistent with national trends and is consistent with what family members would also like to see," he said. "But they also need to adequately fund services for individuals with developmental disabilities."

Bob Bax, director of public affairs for the Missouri Department of Mental Health, said the department supports the name change. Using the term retardation hinders the department efforts to reduce stigma.

"The one thing we want to clarify is that changing the name of the division does not change the mission of the division," he said.

"And using the term mental retardation and developmental disabilities is redundant," Mr. Bax added. "Mental retardation is one of a number of developmental disabilities."

But Bert Sterbenz, president of Missouri Voice of the Retarded, said names do make a difference when it comes to funding. He said lumping the severely mentally

retarded under the same banner as those with less serious mental conditions would limit their treatment options.

"This thing is posed as being a politically correct thing supposedly to keep people from getting their feelings hurt," Mr. Sterbenz said. "But the bills have very little to do with people's feelings. The dirty little secret is that the division can determine eligibility as they always have."

Mr. Sterbenz also sees it as a ploy by state government to privatize care.

"It will be much more easy to overlook the mentally retarded," he said.

Rich Taylor, a psychologist with the Center: A Samaritan Center, said he believed the name change was a good idea, especially since there is a stigma attached to the term "retardation." But he too expressed some concern that services to the severely mentally ill may be privatized as a result of a name change.

"There's certainly a lot of difference between severe and mild disabilities in terms of functioning ability," he said. "The more severely retarded need more intensive services."

Alonzo Weston can be reached

at alonzow@npgco.com. Read more!

The Windshield Effect - The Ventura County (CA) Record

By Joan Trossman Bien 03/27/2008

Parents of autistic children in Ventura County, there is a musical show just for you. A production is arriving at the Thousand Oaks Civic Plaza on April 3, which has the potential to be both entertaining and life altering. But be prepared to laugh and cry because “Thing to Thing to Thing from Crazy Sane…with Autism, Biofeedback and the Brain” was written by a woman who intimately knows the drill.

Lynette Louise is presenting a one-woman show about her life and her groundbreaking methods of successfully treating autistic children. Louise is the mother of eight grown children, six of whom were adopted and four were diagnosed as autistic.

Louise had a difficult childhood. She grew up in Canada with a mother who she says was not easy to live with.

As she gathered up children to become her own family, she was pathetically uninformed about the true nature of autism. “All I knew about autism was I had seen an Elvis Presley movie called A Change of Habit. In that movie they have a little girl who is autistic,” Louise says.

Louise says at that time, the prevailing theories about autism were relatively crude. “Way back, they thought autism was caused by moms not being affectionate enough to their kids. They called it Refrigerator Moms. If we can’t see an injury, like a spike sticking out of some guy’s head, we assume somebody did something to them. That’s what they blamed it on for a long time, and it still shows up in the older practitioners.”

With that theory as the only available information, Louise said, “I had this little guy, and I thought his mom did it to him. I thought I could just love him out of it. Behold, I was on big learning curve.”

But Louise was up to the challenge. She is now an internationally renowned autism expert. Some of her own family in Canada was adopted, so it was natural for her to look to adoption as a way of having more children.

“Adoption is really great, and autistic kids are different in a really neat way,” Louise says. “They bond, but they bond in an unusual fashion. You have to have the eyes to see that bonding, and I have the eyes that can understand what it is they are attracted to or not attracted to. I have a gift in that.”

2Louise says she has empathy for autistic children which can only spring from personal experiences that are similar. “For me, it was almost like kindred spirits, because when I was young, I had a lot of sensory issues.”

Louise had her own scrambled brain signals to deal with, which she refers to as sensory integration issues.

“Sound was colorful to me,” she says. “I would watch the radio — synesthesia. You usually grow out of it. I did.”

Some of her unusual brain signals made growing up more difficult, yet she had no idea her perceptions of life were different from those of other children.

“For example, it took me a long time of knowing someone before I could recognize them,” Louise says, “because I would first, maybe, capture their eyes, their nose, how they talked, and eventually I could see the whole picture and recognize them. It is a temporal lobe problem. I didn’t even know I had it until I was an adult.”

Before Louise had celebrated her 30th birthday, she had adopted four toddler boys with autism in varying degrees. Then she added two troubled teenage girls into the growing family. After her third marriage ended, she had to work an assortment of jobs to support her large brood. She says she was on her own, and her family in Canada was not offering any help. She worked as a mail carrier and as an advice columnist. She performed stand-up, acted in films and even hosted her own cooking show on Canadian television.

Throughout those years, Louise home schooled her children, providing the individual attention each required. She relocated her family to the United States in 1996 because Canada did not permit such an arrangement. For a year and a half, Louise traveled the country in an RV with her family in tow. During that time, she developed a one-on-one treatment based in play therapy where the parent serves as the therapist.

This breakthrough did not come all at once, and Louise says each child needs to have their therapy individually tailored. Louise says she was open to any option which held even a glimmer of hope. “Medications, diet, auditory integration, play therapy, family counseling and neurofeedback all became part of the mix.”

It was then that Louise found Dr. Harold Burke, the clinical director of the Brain Therapy Center in Westlake Village. Louise offered to work for him, and together they explored using neurofeedback with autistic children. It was due to Louise that Dr. Burke was able to include autism in his practice at the time. “Neurofeedback is biofeedback for the brain and is the most effective treatment for ADHD [attention deficit hyperactivity disorder],” Louise says. “It has been subjected to double-blind studies, and the efficacy has been established.”

Burke agrees. “Neurofeedback is effective but flies kind of below the radar screen of a lot of doctors. There are now two controlled studies which have been published. Lynette has tapped into that.”

“It is like getting glasses and all of a sudden they can see,” Louise says of how the patient feels when neurofeedback is effective. “When your brain is balanced, the world is so bright and clear that they call it the Windshield Effect. It is as if someone cleaned the windshield.”

Louise has a unique approach to her therapy. She travels to the home of the patient and stays there for a few days. While there, she shows the family that neurofeedback has the possibility of making inroads to helping autism in a matter of days.

“When I go into a home, the family is so on-edge about the problems the child faces,” Louise says. “I tell them to relax, they are going to have a different child in three days. I have technology. I treat the whole family. I teach them how to use the tools.”

Recently, Louise says, she had a child experience a breakthrough. “I was just working with a family and, after a few days, the child said, ‘You found me again.’ It helps their brain to stabilize enough to express an emotion. They experience a clear, happy comfort. They feel relief immediately.”

In 2004, Louise founded the Brain and Body Clinic in Santa Monica. But most of the treatment still takes place in the child’s home. She also has a home in the tiny Texas town of Teague where two of her children now live.

Louise decided to use her best skills as a performer as a way to communicate this treatment for autism to the public. She said the idea came to her after having some success with one of her own sons. “All of a sudden, I have this methodology where my son is not hitting himself, and it is so easy to do,” Louise says.

“How could you not want to do a show? I felt I had to write a show. It was six hours and I had to bring it down to three hours.”

The show is a unique approach to teaching and stands on its own as entertainment. Louise shares the stage with a rack of costumes, which she casually slides into just as she seamlessly takes the audience through her often painful personal experiences. Louise has the eternally beautiful face of an actress, and skillfully puts her arms around the audience in order to share her most intimate moments. She bares her private life and events, which cannot be easy to reveal, such as when she learned that her third husband had molested one of her daughters. There is nowhere for Louise to hide as this is her truth, not that of a character or a playwright. This brave vulnerability is the thread which runs through the 20 years of learning how to be a parent to her four autistic children.

Even more daring is her addition of music to the show. The songs were written by Louise, music director Mitch Kaplan and Clifford Bell. The stark simplicity of the production has enabled Louise to take the play out of the theater and into professional conferences about autism across the country. Louise is on a passionate one-woman crusade to help autistic children and their families live fuller and less stressful and demanding lives. Families of autistic children will leave the theater with renewed energy and a rare glimpse of optimism for the future.

Burke says the show is simply great theater. “It has a combination of poignancy and education and some humor,” he says. “The part that I am most attracted to is the educational message that there is a treatment out there called neurofeedback.

“What she is trying to accomplish in the show is to get this across to the public in a way that is not just a lecture,” Burke says. “As much as I have been around people with autism or acquired brain injury, I teared up a couple of times watching the show in her own personal moments working with her own children.

“I am hoping she will get a wide audience with it,” Burke continues. “Lynette’s show is pioneering and I’ve never seen anything quite like it.”

Lynette Louise’s Thing to Thing to Thing opens April 3 at the Thousand Oaks Civic Arts Plaza’s Janet and Ray Scherr Forum Theater (2100 E. Thousand Oaks Blvd., Thousand Oaks) and runs every Thursday through May 1. Tickets $30 available at the box office (449-2787) or through Ticketmaster.

Parents of autistic children get in free when you bring a photo of your child to the box office.
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Can those with illness representthemselves? - USA Today

By Joan Biskupic
3/26/08

WASHINGTON — Indiana Solicitor General Thomas Fisher Wednesday urged the Supreme Court to allow judges to bar confused and incoherent defendants from representing themselves to keep a trial "from descending into a farce."

In a case closely watched by numerous states, defense lawyers and psychiatric experts, Fisher asked the justices to reverse an Indiana ruling throwing out a defendant's attempted-murder conviction because he was denied his Sixth Amendment right to represent himself.

A majority of the nine justices appeared open to arguments that a mentally ill defendant who is found competent to stand trial but is not able to communicate clearly could be kept from representing himself.

Ahmad Edwards, who was caught shoplifting a pair of shoes at an Indianapolis department store, shot and wounded a security guard and bystander as he tried to flee. It was several years after the 1999 incident before Edwards, diagnosed with schizophrenia and delusional disorders, was deemed competent to stand trial. The trial judge denied Edwards' request that he be able to defend himself without a lawyer, based on Edwards' record of delusions, schizophrenia and communication troubles.

A jury convicted Edwards of attempted murder and battery with a deadly weapon and sentenced him to 30 years in prison. Edwards appealed, saying he had been denied his Sixth Amendment right to self-representation.

The Indiana Supreme Court agreed, declaring that the Constitution demands that a person who is competent to stand trial be allowed to forego a lawyer if that is his choice.

In Wednesday's spirited arguments, Fisher contended the Sixth Amendment allows judges to impose a higher standard of competency for self-representation because of the nature of a trial and the level of coherent communication required. He said that if a defendant is not able to clearly communicate his case, the entire point of a trial — designed to give both sides an equal chance — is lost. Fisher stressed a state's interest in a trial that appears fair to the public.

Backing Indiana was Deputy U.S. Solicitor General Michael Dreeben, who stressed the importance of "fairness and the appearance of fairness." Dreeben said states and the federal government have an interest in keeping a delusional defendant from representing himself in a manner that "casts the justice system in disrepute."

Nineteen other states also are siding with Indiana.

Mark Stancil, representing Edwards, countered that the right to defend oneself against charges "belongs to the accused, not to the state." Rejecting arguments about a potential "farce" in the courtroom, Stancil emphasized the importance of the Sixth Amendment right and insisted that if a state has found a person competent to stand trial, he should be able to defend himself in court.

Relying on past high-court rulings, Stancil said the Sixth Amendment protects the defendant's choice to proceed on his own. He said Edwards made that choice and the trial judge should have respected it.

Signaling that they may be ready to revisit their prior cases in the area, several justices worried about the spectacle of a delusional defendant tainting his case or the waste of state resources in the event of a mistrial.

"What goes on is very costly to the state," Justice Anthony Kennedy remarked about a trials disrupted by defendants who try to take their case into their own shaky hands.

Stancil insisted that the notion a jury would be forced to listen to "rants" was "overblown." He said the normal rules of criminal procedure would force a defendant to proceed in an orderly fashion. If he was disruptive, then the judge could declare that a lawyer had to represent the defendant.

By that time, Justice David Souter said, "the damage is done."

Other justices who appeared to sympathize with states' plight were Chief Justice John Roberts and Justices Ruth Bader Ginsburg and Stephen Breyer.

Justice Antonin Scalia was most vigorous in challenging Indiana's position. He suggested that states should wait to see how a defendant does at trial, rather than predict his behavior based on psychiatric tests. "It's his constitutional right," Scalia said. "Give it a try."

A ruling in the case of Indiana v. Edwards is likely by the end of June when the justices recess for the summer.
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Police: Officers Fire Tasers 9 Times; Man Kept Coming With Knives - News4 Jacksonville (FL)

Video of story here.
March 27, 2008

JACKSONVILLE, Fla. -- Despite taking several shocks from two police officers' Taser guns, a mentally ill man got up and kept coming at them with two steak knives, police said one day after the man was shot and killed.

The incident began just before 11 a.m. Tuesday when a caseworker making a daily check on 30-year-old Sierra White at his Arlington apartment met resistance and called for police assistance.

With White's behavior increasingly erratic and threatening, he went back inside his apartment and officers said they thought they heard the sound of a gun being "racked," or loaded. The officers took cover but continued to try to talk to White.

The incident escalated when White withdrew two knives from his pockets -- one in each hand -- and began threatening the officers, police said.

Two officers deployed their Taser guns, but repeated shocks appeared to have no effect. Police said that when White got up and threatened a police sergeant, he was shot four times.

"He was up, making a move in a threatening manner toward the officer when the officer used the lethal force," Graham said.

White died at the scene.

"A knife is considered a lethal weapon. A Taser is non-lethal," Graham said. "If the defendant has a knife ... they would have been well within state law to go immediately to their firearms. That was just a conscious decision by our officers to try to do everything possible to keep from having to go to lethal force."

A realistic-looking BB-gun was found in the victim's pocket, but police said they found no "true firearms" in his apartment.

At a news conference on Wednesday, Graham said White had a criminal history, including burglary and an assault with a deadly weapon.

"He's been known to carry a knife," Graham said.

An examination of the Taser gun found that one officer pulled the trigger four times and another officer fired five shocks from his Taser gun. Graham said it's possible the probes were not making contact or became dislodged.

The Jacksonville Sheriff's Office and the state attorney's office were conducting separate investigations whether appropriate force was used in the incident.

This is the eighth police-involved shooting of 2008 and the fifth person to have died in the incidents. One police officer was shot in the altercations. That officer is recovering from his injuries.

"We hope that we can get through our career and not have to take somebody's life, but if we have to do it, it's part of the job," Graham said.

Previous Story:

* March 26, 2008: Mental-Health Patient Killed In Police Shooting


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Attorneys question man's emotional problems after videotaped beating - KVUE-TV Austin (TX)

Video report here.

Attorneys question man's emotional problems after videotaped beating

March 25, 2008
By RUDY KOSKI
KVUE News

Emotion was the focus Tuesday of the civil rights lawsuit filed against an Austin police officer and two former officers.

The case is about the controversial arrest of Ramón Hernandez in 2005 and it spun on two points Tuesday: What was Ramón Hernandez thinking before and after his confrontation with police, and how the jury reacted when they at last got to see the video of his arrest.

Hernandez attempted to convince the jury that he is still hurt, emotionally. Psychologist Dr. John Watterson testified about counseling Hernandez eight days after the 2005 arrest. According to Dr. Watterson, Hernandez told him he lost control of his emotions because he was shot with a stun gun, was scared and was still traumatized.

But defense attorney Tom Stribling argued that Hernandez had emotional problems before his arrest. Watterson agreed, but also said Hernandez was reacting to all the events in his life before and after the confrontation. Watterson concluded, Hernandez suffered from what’s called an adjustment disorder. While on the stand, Hernandez admitted he was diagnosed with schizophrenia in 2006.

The police dash camera video was played for the jury for the first time in the trial. As the use of force by the police officers escalated, some members of the jury grimaced. One juror held her hand to her mouth, while others simply sat and stared at the video screen.

Hernandez told the jury he is not suing the officers for stopping him September 21, 2005 after he left the scene of an accident. He told the jury, his lawsuit was filed for what the officers did after he was handcuffed and on the ground. Hernandez claims it was excessive. And once in custody, he was not resisting. He said, he did not feel the punches thrown by Officer Christopher Gray or that Officer Heilman had his boot to his neck. But later in jail he felt pain.

All three officers took the stand Tuesday and testified, claiming Hernandez was resisting and still a threat. Joel Follmar admitted to the jury that he told Internal Affairs investigators that he felt he had to join in because he was a trainee at the time. But he also said, he perceived Hernandez as a threat and was resisting, because he was moving his feet. He also described the punches he threw as being weak.

Dr. Casey West, who treated Hernandez in the emergency room after the arrest, was one of the last to testify on Tuesday. According to Dr. West, he did not find any bruising or abrasions to the back and Hernandez did not complain about being in severe pain. But West did admit, the bruising could have come later, and by the time Hernandez made to the hospital he had already been sedated.

Attorneys’ for Hernandez could close out their case late Wednesday. Final arguments may take place on Thursday.
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Police should be required to record interrogations - Daytona Beach News Journal

By A. RUSSELL SMITH
03/26/08

In the court of law, the difference between guilt and innocence can often be no thicker than the edge of a dime. Many times, claims that the defendant confessed are a key part of the prosecutor's case. Unfortunately, under current Florida law, the court's determination about whether a confession was illegally forced from a suspect, or whether the suspect ever really confessed at all can be no more accurate than flipping that thin dime.

Contrary to what most Floridians think, the law does not require police to record their interrogations of felony suspects. Instead of listening to an audio recording or watching a video, judges have to listen to hours of conflicting testimony about what happened during the interrogation process. Often, the court's ruling about whether a suspect was given his rights; whether a police officer intimidated him into confessing; or whether the confession ever really occurred amounts to little more than an educated guess. This diminishes the reliability of the criminal justice system, wastes tax dollars and ties up judges, lawyers and police officers in court.

The Florida Legislature has a unique opportunity to enhance the integrity of the criminal justice system while saving the taxpayers money, by enacting legislation requiring the recording of felony interrogations by law enforcement. House Bill 721 and its companion, Senate Bill 1434 would require just that.

We know that false confessions occur. In 26 percent of cases where DNA later exonerated a wrongfully convicted person, police claimed that person confessed, even though science later proved he could not have committed the crime. Research shows murder cases make up 81 percent of the total number of crimes in which defendants falsely confessed. This doesn't just mean that innocent people are going to prison for murder; it means that murderers are remaining free, because investigations are being closed after the wrong person is arrested.

Police interrogations often involve extreme intimidation and persist for several hours. Under these conditions, people undergoing interrogations may become weary, and can convince themselves that if they just confess, they can go home and fix everything later. This is especially true of innocent people, because their innocence gives them a false sense of security. The elderly, juveniles and the mentally ill are also especially vulnerable.

But recording interrogations doesn't just benefit suspects; it helps law enforcement. For example, John Couey's confession in the Jessica Lunsford murder case in Citrus County was thrown out of court because the judge decided that he may have asked for a lawyer during questioning, something the police swore he never did. Had that interrogation been recorded, the judge wouldn't have had to guess who was right.

With mandatory recording of interrogations, most suspects' claims of improper police conduct disappear. The courts have to conduct fewer suppression hearings and those few remaining hearings are shorter. When criminal defendants are confronted with a recording of themselves confessing, more of them plead guilty rather than insisting on jury trials. The FBI recommends that felony interrogations be recorded, saying that electronic recordings "help enhance an officer's credibility" and "increase public confidence in police practices."

More than 11 states and 5,000 local jurisdictions require interrogations to be recorded, and prosecutors and police in those jurisdictions believe that the recordings are an asset to their cases. Not one jurisdiction that has adopted mandatory recording of felony interrogations has ever repealed the legislation.

It's clear that recording felony interrogations makes the courts more reliable, saves money and benefits both law enforcement and those accused of crimes. Nonetheless, the Florida Sheriff's Association opposes the bill. This opposition is especially hard to understand, when we consider that the same Florida Sheriff's Association fought for and won passage of a law that requires all internal investigations of police officers to be recorded.

I believe that all Floridians deserve the same rights as cops accused of wrongdoing, and that they want our courts to have the information they need to make the right decision in every case.

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Dangerous and mentally ill: A system in restraints - Seattle Post-Intelligencer

Wednesday, March 26, 2008

By CAROL SMITH

Before James A. Williams was charged with stabbing a young Seattle woman to death, he stood before a King County Superior Court on a different occasion, accused of assaulting a different stranger, and asked to speak in his own defense.

In the midst of a passionate and rambling argument explaining why he shot a stranger at a Seattle bus stop, he paused to deliver this judgment:

"I didn't even ask to be born," he told the judge. "If I had my way I would never have been born, but unfortunately, I was."

In some sense, it is a wish echoed by a mental health system that failed to predict the emergence in the last few decades of a class of violent, mentally ill offenders, such as Williams.

The year Williams, 48, was born, the United States was on the cusp of a grand experiment to free the mentally ill from insane asylums, a shift that would eventually and disastrously claim him as a casualty and, if what he is accused of is true, cost Shannon Harps, 31, her life. Harps, a Sierra Club worker, was walking outside her Capitol Hill condominium at about 7 p.m. on New Year's Eve when a man attacked her with a butcher knife and commanded her to die. Williams' DNA was found on the knife.

That such a tragedy occurred in King County, which offers a comprehensive and progressive system for dealing with mentally ill parolees, has both the public and the mental health community asking what went wrong.

It's a question underscored by a spate of gruesome killings linked to mental illness around the country, from the most recent campus shooting in Illinois, to the psychiatrist who was hacked to death in her New York office last month.

Since April 2000, 512 Washington inmates have been designated as dangerous and mentally ill, the same designation Williams received when he got out of prison in 2006 for the bus stop shooting. Of those, 466 are living in the community. Those who volunteer to enroll in a special supervision program receive extra help with housing and mental health care in addition to being closely monitored by the Department of Corrections.

Williams' case, like the nearly identical case 10 years ago when a psychotic man stabbed a Seattle firefighter to death outside the Kingdome after a Mariners game, has once again forced the issue of how society deals with those who are severely mentally ill and have criminal histories -- a population that has been exploding even as the resources to deal with it have dwindled. At the same time, laws intended to safeguard the rights of the mentally ill seem instead at cross-purposes with keeping the public safe. To be committed to a mental hospital today, even for a brief period, an individual must be in imminent, provable danger of harming himself or others.

Nervous breakdown

Williams should have been a success story. He was one of 70 dangerous mentally ill offenders living in King County, which does provide services and has some housing that takes psychiatric patients with violent histories. Despite getting intensive intervention, supervision and financial help, he slipped the grasp of the medication that kept him somewhat stabilized, and the efforts of a dozen caseworkers, corrections officers, counselors and others who struggled to keep him from exploding.

The reasons have their roots in the history of psychiatric care in the last half of the last century. Williams' own story, pieced together from psychiatric records included in public filings, and court records obtained by the Seattle P-I, is a case history of the dark side of deinstitutionalization.

Williams was born in 1959 in Camden, Ark., at the tail end of the decade that also produced Thorazine, the first "miracle" anti-psychotic medication. For the first time, doctors had a medicine to treat delusional symptoms, opening the door for treatment outside the restraints of a hospital. Like the social change it helped instigate, however, the medicine also had nasty side effects that made many patients refuse to take it. Neither deinstitutionalization, nor the medicines that spawned it, worked as intended.

Williams was only 8 when his mother died under mysterious circumstances. He never knew his father. After his mother's death, he was shuffled among households, living with various aunts and grandparents.

At age 12, he had his first "nervous breakdown" and was admitted to Arkansas State Hospital for about a month for treatment of "obsessive, psychosomatic thoughts." After his release, he dropped out of seventh grade and started doing drugs. Eventually, he graduated from huffing lighter fluid off rags to shooting methamphetamine.

At 17, he was convicted of burglary and landed in an Arkansas penitentiary for the first time. Meanwhile, his mental health continued to deteriorate, and signs of a virulent anti-social personality disorder began to emerge in a foreshadowing of his future.

In 1982, after breaking up with a girlfriend, he told doctors he had "such hatred for her that he has serious thoughts about taking a knife and going and cutting her up." According to his treatment notes, "He spends a great deal of time thinking about how he would like to get even with people whom he believes to be the blame for what has happened to him." Doctors diagnosed him with schizophrenia. He was 22.

The conclusion doctors made 25 years ago: "Prognosis is considered poor at this time because of apparent lack of motivation to follow through with any treatment recommendations"

That prognosis would prove prophetic.

Missing pieces

Over the next decade, a series of progress notes from Arkansas mental hospitals and prisons traces Williams' dizzying circuit among hospitals, jail and the streets, a loop that mimicked that of countless other psychiatric patients. Hospitals, gutted by budget cuts after deinstitutionalization, had neither the beds nor legal grounds for keeping them. Prisons and jails were not equipped to treat them. And landlords didn't want them.

This was not the intended consequence of the push for community care of the mentally ill. Three decades ago, it was far too easy to warehouse patients for abnormal social behavior, a loose criterion that let families offload their more difficult or embarrassing relatives.

"People in state hospitals in the early '60s did not get there based on imminent danger," said Richard Kellogg, director of the Mental Health Division of the state Department of Social and Health Services.

In 1963, when President Kennedy signed the Community Mental Health Centers Act, the vision was to provide prevention, intervention and treatment outside of institutions for all ages and incomes based on ability to pay.

"But when patients were deinstitutionalized, no one envisioned such a subset (of patients) with this degree of violence," Kellogg said.

The visionaries missed other pieces necessary to help psychiatric patients succeed in the community, in particular the need for affordable housing.

"The 1963 act didn't envision the relationship (of outcomes) to housing, and mental health service is not housing," Kellogg said. "That major point got lost."

Nor did the reformers foresee the effects of a rising street drug culture on crime and a growing consumer appetite for violent entertainment.

"Our culture changed. We have a more violent culture today," he said. The right infrastructure wasn't in place to safeguard either them, or the public.

Instead they went to jail, in droves.

"The census of mentally ill in King County Jail is second only to that at Western State Hospital," said David Aiken, supervisor of the Special Needs Unit, the section of the Department of Corrections that oversees dangerously mentally ill offenders after release from prison. A 2006 Department of Justice report says 45 percent of federal prisoners have symptoms of serious mental illness. The percentages are even higher in local jails -- 64 percent -- and state prisons --56 percent.

The population of people with mental illness in jails in turn jammed up what was left of the state hospital system. The number of beds nationwide, which peaked at about 565,000 beds in the 1970s, is now down to about one-tenth of that, which some argue is no longer sufficient to meet demand.

Before 1990, Western State Hospital did about 300 evaluations for "competency restoration" a year, said Mark Allen, a mental health counselor in the forensics unit at Western. Today, the hospital does about 3,000 outpatient admissions a year to determine whether a person is competent to stand trial.

Western, which is at capacity, has a current patient census of about 1,000 patients, including 300 criminal offenders. In addition, there are about 230 beds sprinkled around King County that will take psych patients who are committed involuntarily.

But that isn't enough. At any given time, an estimated 20 percent of those who have been identified as qualifying for involuntary commitment under the state's strict committal laws still can't get beds and wait out their 72-hour "holds" in ERs or other nonpsychiatric facilities. When the holds are up, they walk.

To qualify for a longer stay in the hospital, a patient has to do something extreme. Allen recalls a mother who pleaded with the mental health community for six months to try to have her mentally ill son hospitalized. Finally, he stabbed her.

Then he was committed.

"The majority of people with mental illness in the community are not violent and in fact are not more likely to commit violent crimes than nonmentally ill people," Kellogg said. "But there is a subset, that we have growing knowledge of, coalescing around co-substance abuse, multiple admissions, including jail time, and a history of social inadequacy."

That was Williams' subset.

Clear and present danger

By the turn of the '90s, Williams was a 31-year-old vagrant described in records as "unkempt, very dirty, agitated, loud and cursing." Now labeled a "chronic paranoid schizophrenic" he had already cycled on and off powerful anti-psychotics multiple times, typically abandoning them as soon as he was out of prison or the hospital. Psychiatrists say going on and off meds multiple times can erode their effectiveness, creating a class of patients who become untreatable over time.

In the previous 10 years, he had been committed for "terroristic threatening" of his grandfather, then jailed for assaulting an elderly woman. He'd been in prison for writing hot checks, and back in treatment for delusions that his grandmother was trying to kill him with the TV remote control.

He claimed that medicine was destroying his brain. He was known to carry a knife and said he slept with a loaded gun. "If people try to mess with me," he told a counselor in 1990. "I will get pleasure in killing them."

Throughout, notes from repeated mental evaluations show Williams' grounding in reality morphing to quicksand.

"He believed that he was an FBI and CIA agent, and that he also worked for the U.S. Army, God and the devil," said one such note.

Doctors in Arkansas called him a "clear and present danger" to himself and others.

Then he vanished, and the mental health facility where he was periodically seen throughout the 1980s "terminated" his chart.

In a disturbing prelude to events to come, Williams popped up in a new city, this time in Florida, where he racked up three convictions on separate occasions for assaulting a man with a knife, for bashing another man's face into a fire extinguisher and, ominously, for terrorizing a woman.

According to the 1993 police report from that incident, "As the defendant rubbed on her leg (victim), the defendant was talking about 'killing women' and 'cutting women from their eyes to their throat.' "

Stranger violence

It's not clear when, how, or why Williams arrived in Seattle, but this chapter of his life starts on another prophetic note.

In 1995, he was arrested for shooting a stranger at a downtown bus stop. In the police report of that initial incident, there is this bold-face warning: "DO NOT RELEASE!!! SUSPECT SHOT A STRANGER WITH A LARGE CALIBER PISTOL. THE SUSPECT IS A DANGER TO ALL CITIZENS ..."

Despite his record, prosecutors determined Williams' prior offenses in other states didn't qualify him to be prosecuted under the state's three-strikes criteria that would have put him in prison for life. Instead, Williams was convicted and sentenced to 11 years for the shooting. In prison, his behavior continued to spiral out of control. He was put in restraints for fits of rage, forced to take medication and racked up 248 violations for damaging property and assaults. When his release date came up in 2006, he was a textbook case for the Dangerous Mentally Ill Offender program. A judge ordered him to 24 months of community supervision, and Williams agreed to take part in the program.

Although he became increasingly difficult to handle, he was checking in with his corrections officer as he was supposed to, said those who were responsible for tracking him.

"Assuming he didn't commit a murder," Kellogg said, "the system worked."

Degree of imminence

The case raises a host of disturbing and complicated issues that come down to how much risk is too much for society to bear. For sexually violent predators, the state has decided there is a class of offenders -- Level 4 -- that should remain locked up for mental health treatment even after serving their prison time because of their danger to the public.

Should a similar risk category be created for violent offenders with certain combinations of personality disorders, mental health diagnoses and track records with treatment compliance? Should the public be notified -- as it is with sex offenders -- when offenders with violent and serious mental health histories are released? Is the bar too high for getting people committed? And should the three-strikes law be applied differently for those who have severe mental illnesses?

David Weston, chief of mental health services for the state, said he knew of no other states that had tried such measures. Washington would be setting precedents.

"I don't think the public mental health system was ever designed to guarantee 100 percent safety," Kellogg said. "Whether it should be or not, is an open question."

Earlier this month, King County Prosecutor Dan Satterberg convened a task force to examine the Williams case. It is still in the fact-gathering stage and has yet to draw any conclusions or propose solutions.

Many of the issues boil down to money -- more money for housing, for treatment centers, for supervision, say those who are closely watching this case.

The program that monitored Williams is already under financial strain. In 2007, it overspent its budget by $400,000, and in response may have to slash the number of years it will provide mental health help to those enrolled from five years to 2 1/2 years. Weston said he is trying to find other funds to keep services available for the full length of time, but hasn't found them yet.

And that won't help the many others who corrections officers say are equally likely to be dangerous, but who don't fit the eligibility requirements for the mentally ill offender program and receive no such coordinated assistance at all.

The high thresholds for commitment also frustrate those who track mentally ill offenders.

To be hospitalized, the person must be a danger to self or others, or gravely disabled. And there must be a trail of evidence, including witnesses, to persuade a court. The threat must be imminent, not based on hearsay, and specifically related to a serious mental illness. A threat made by a mentally ill person because he or she is angry or frustrated wouldn't qualify. In addition, the county, which evaluates people for involuntary commitment, is also bound by law to ensure they are treated in the "least restrictive" setting, which usually means in community clinics and housing.

Only "designated mental health professionals," who work for King County Mental Health, can decide to commit someone against their will. In 2006, these evaluators, most of whom are not psychiatrists, but do have master's-level degrees in psychology-related fields, did 5,500 such crisis assessments. Of those, 2,169 patients were hospitalized.

Critics say that isn't enough, and that of those who do get hospitalized, too few get held long enough. To hold someone for more than 72 hours requires an additional court order.

"We need to change the degree of imminence," said Randy Vanzandt, a community corrections officer who tracks dangerous mentally ill offenders for a living.

That, however, would cost more. State hospitals are expensive to run. Filling a bed in a state psychiatric hospital costs $145,000 to $190,000 a year.

Making commitments easier also raises constitutional issues. In our society, you can't lock people away just because they might do something, or say they're going to do something.

"There is no perfect way of predicting dangerousness is the bottom line," said Weston, who also heads the mentally ill offender program in Olympia. "It remains an inexact science."

Losing it

Reading the "chronos"-- a history of Williams' supervision -- is like watching a man self-destruct in slow motion.

The community corrections officers, nurses, counselors and social workers assigned to his case reached out repeatedly to help him. They got him clean-and-sober housing. He lost it for drinking and drugging. They got him an apartment. He got himself evicted for threatening residents with a butcher knife. They drove him to appointments at his mental health clinic and ordered him to take his meds. He flung the medicine in their faces. They arrested him multiple times for breaking his supervision requirements in the hopes of getting him back on meds, or committed to a hospital for treatment. Each time he eventually was released back to them. His primary supervisor kept at it even after Williams said he would lay in wait and shoot him with a sawed-off shotgun as he reported to work

The day Shannon Harps was killed, Williams checked in with his community corrections officer, who noted he was "barely holding it together."

"But that was his baseline," said Dan Weiss, who saw him that day. "That's how James was every day."

In September 2007, Williams went to jail for threatening a woman at his housing facility. He pleaded guilty and received a psych evaluation on his release. How or whether he was treated in a psychiatric facility after that evaluation is not known because laws keep those records private.

What is known is that Shannon Harps, an adventuresome traveler, who loved to backpack and was working to improve the environment, a young woman who impressed her friends with her grace and integrity, was killed 10 days after Williams' release from King County Jail.

Williams has pleaded not guilty to the crime. Read more!

Corrections officers face daily struggle to keep offenders, public safe - Seattle Post-Intelligencer

Wednesday, March 26, 2008

By CAROL SMITH

Just before first light, Randy Vanzandt pedaled downtown, past the Seattle Emergency Center, where some of his offenders hang out, and left down Yesler Way. Throughout the city, the eight-to-five office crowd queued up for its first caffeine hits of the day. Ahead of him, he could make out a young woman, buzz cut, all edges, angular bone and harsh words -- someone he knew.

The woman had a warrant out for failing to show up for supervision. "I rolled up on her and invited her to take a walk," he said. Then he strolled both her and his bike the remaining 1 1/2 miles to the Department of Corrections' special needs unit south of the stadiums.

Vanzandt, lanky and affable, chuckles at the recounting of his commute.

His shift hasn't started yet, and he's already made his first arrest of the day.

Invisible dangers

Vanzandt is one of seven corrections officers in charge of supervising more than 200 offenders who have severe mental illness, personality disorders or developmental disabilities along with histories of petty crime, drug addiction, assault, robbery or murder. Their caseload also includes the state's "Dangerous Mentally Ill Offenders" -- people coming out of prison who have psychiatric histories that warrant extra supervision and support.

James A. Williams, charged in the random stabbing death of a young Seattle woman on New Year's Eve, was one of theirs. So was Daniel Culotti, who was shot dead after attacking a stranger in Westlake Plaza in 2006. So was Paul Pearson, who threw lighter fluid on three pedestrians in downtown Seattle in January 2007, setting a woman's hair on fire.

The dangerous mentally ill who wander the streets of Seattle go unseen by most of us. Some blend with the office crowd. Others are the homeless we hurry past, avoiding eye contact until we cease to notice them at all.

The special needs corrections staff does see them -- in alleys, and hospital waiting rooms, and needle-littered parks. They spy them on MySpace or Internet dating sites.

It's a job few take, or want. They get spit on, sworn at, and are paid less than corrections staff for other jurisdictions on top of it. They've learned not to bring up their occupation at parties.

"When people find out what you do," said Patty McGuinness, another of the corrections officers. "It's a conversation stopper."

'Word salad'

Mornings in the office resemble an improv skit with overnight messages providing the scenario. The police called -- one of their offenders passed out in the library with a needle in his arm and insists he wasn't using. Sound Mental Health called -- someone was a no-show for the third time. An apartment manager called -- "There's been a bit of an incident. ... "

Occasionally the offenders leave messages, too -- threatening, pleading or on a good day, just checking in. Sometimes, it's hard to tell what they're saying.

"It's just total word salad," Vanzandt said.

The corrections crew scrambles to fish their offenders out of jails and emergency rooms, arrest those with warrants out, drive some to appointments and knock on the doors of others. Sometimes a quick eyeballing is enough to assess whether someone is at "baseline" or beginning to fall down the rabbit hole of their disease.

"We try to plan things, but in this business you never know," Dan Weiss said, adjusting the geek-cool glasses that suit his mellow manner. Weiss is prepping for the morning sweep with fellow officers Kathy Woik, "the queen of structure," and McGuiness, who projects an unflappable maternal compassion no matter what chaos unfolds.

Woik's morning, too, has started with a jolt.

"Can you believe it, Brett Favre is retiring?" Woik, an avid Green Bay Packers fan, shakes her head and chews over the news. "I've seen him block. He's a guy who would do whatever it takes, you know?"

The corridor

The corrections officers usually hit the field in groups of three. They go out armed with handcuffs, fast reflexes and a dark sense of humor. "Got pepper spray?" one asks as they head out.

Their unmarked van, painted drizzle gray, is unnoticeable to most of us, but well known to the city's street people. For many, it's their only touchstone with reality. "In a weird way, they start to think of us like family," Weiss says.

With its battered laptop docking stations and its Happy Meal hula girl mascot mounted to the dash, the van functions as part mobile office, part holding cell and full-time command center.

On this morning, the van rolls down Western Avenue, slowing as it passes the Millionair Club. As soon as the van appears, a stringy-looking man ducks his head and edges backward through the clump of day laborers gathered in front.

"Hey, there's one of ours," said Thomas McJilton, the driver, his watch cap pulled down against the chill. McJilton, a former roofer, is the only one of the crew who doesn't come from a mental health background. Among the rest of them, they have 60 years as counselors and case workers. His colleagues rag him about that to his face, but call him "a natural" behind his back.

Weiss, riding shotgun, peered at the guy moving opposite the crowd and shook his head. "Not anymore," he said. "He's done."

McJilton turned left, looping through "the corridor," a territory bounded by South Jackson and Wall streets and Sixth Avenue and the waterfront, where their offenders like to hang out. They clatter past a disheveled woman in purple, who waves at them. She, too, is designated dangerous, and mentally ill, but they have no business with her today.

That makes two offenders in as many blocks. Before the next few hours are up, they will have spotted, stopped or spoken with a dozen more.

Missing tools

In between stops, their phones ring constantly. They duck in and out of conversations on their Nextels the way stunt drivers weave through traffic, trying to get their offenders into treatment, or housing or jail, manipulating the system to try to keep them stable and out of trouble.

McGuiness hunches over her phone in the back of the van, waging a verbal chess match with a young man under her supervision for robbing a bank. He doesn't believe he's schizophrenic. He's stopped checking in, and hasn't been taking his meds. She's trying to get him to come back to see her so she doesn't have to arrest him for violating his supervision.

"No," she says patiently. She's been over this with him many times already. "You can't hire yourself to give a second opinion on yourself." A long pause. "I understand that, but you're not qualified to give a second opinion."

The officers have to make judgment calls within a system that seems as irrational as the offenders they supervise.

They can put their offenders in jail, but not a mental hospital. They can order them to take their meds, but they can't force them. If they manage to convince the county mental health professionals their offenders need emergency mental treatment for their own safety, or the public's, the odds are the offender will bounce back after 72 hours because of lack of beds in specialized psychiatric care. They know housing is critical for a mentally ill offender's stability -- but there is almost none.

"I have only the tools in my toolbox," McJilton said. "And the tools I have aren't necessarily the right ones."

Night sweep

Just before quitting time, the group crams into supervisor David Aiken's office for an emergency meeting. The staff has just gotten word the Dangerous Mentally Ill Offender program may have to cut services for participants from five years to 2 1/2. That would mean 40 of their offenders could lose their housing by April 1.

"Homeless DMIOs (Dangerous Mentally Ill Offenders) are a huge concern," Aiken said. "We don't want that to happen."

With no solution in sight, the meeting breaks up so the late crew can do a night sweep.

McGuiness, McJilton and Weiss grab bulletproof vests and climb back into the van.

The colors have nearly bled out of the day, but it's not long before they land on a skinny guy in a familiar red jacket on a Pioneer Square street corner. McJilton throws the van in reverse and screeches backwards.

"Drop it, Omar," Weiss yells. Omar's bag of Cheetos lands on the ground, and he leans against the van while they pat him down. He's been designated dangerous by the state and has a warrant out for going AWOL on his supervision. His supervisor has been trying to get him into inpatient treatment for months. He has a habit of slicing himself open and putting chicken bones and other foreign objects inside. He's also homeless.

Before this shift is up, they will arrest one more -- a chronic alcoholic woman whose belongings are crammed into a plastic bag from Harborview, along with her discharge instructions.

Weiss reads it through. The instructions say, "Do not drink alcohol."

It's dark by the time the team drives into the tunnel entrance to the jail to unload the pair for booking.

Omar cooperated, McJilton said a few minutes later as he drove the emptied van back into the rain. "It's cold out, and he knew he had a bed for the night."

P-I reporter Carol Smith can be reached at 206-448-8070 or carolsmith@seattlepi.com.

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Lilly Settles Alaska Suit Over Zyprexa -New York Times

By ALEX BERENSON
March 26, 2008

Eli Lilly has agreed to pay $15 million to the state of Alaska to settle a lawsuit claiming that the company’s schizophrenia drug Zyprexa caused patients to develop diabetes, Lilly and the state said Wednesday morning.

The settlement is something of a surprise, coming three weeks into a trial over the state’s claims in Anchorage. The state sued to recoup medical bills it said were generated by Medicaid patients who developed diabetes while taking Zyprexa. The case had not yet reached the jury, although closing arguments were expected this week.

Because Alaska is such a small state, with only 670,000 residents, the $15 million figure is a relatively large payment by Lilly. Many other states have sued Lilly with similar claims or are participating in settlement talks led by federal prosecutors in Pennsylvania.

While there is no way of knowing whether the $15 million payment to Alaska will represent a benchmark for the broader talks. But if it does, Lilly might need to pay billions of dollars to resolve the bigger cases. Lilly and the prosecutors have already discussed an overall settlement of the state and federal investigations and suits that would require Lilly to pay $1 billion to $2 billion in fines and restitution, according to people who have been briefed on the talks.

In addition, Lilly has already paid $1.2 billion to settle 30,000 individual lawsuits from people who say they developed diabetes after taking Zyprexa.

Alaska and Lilly discussed a settlement before the trial began, and mediation efforts resumed last week, according to the statement announcing the settlement.

State court judge Mark Rindner, who was overseeing the case, may have put new pressure on Lilly to settle last week, when he flatly rejected Lilly’s arguments that he should dismiss the case because the Food and Drug Administration is responsible for regulating drug makers. Judge Rindner said the F.D.A. had done an inadequate job of overseeing the industry.

Zyprexa helps calm the hallucinations and delusions associated with schizophrenia and bipolar disorder. The drug is widely used, with sales of $4.8 billion last year, about half in the United States. More than 23 million people have taken Zyprexa since it was approved in 1996.

But Zyprexa also can cause severe weight gain, blood sugar changes and cholesterol problems, and it has been linked to diabetes by the American Diabetes Association.

Internal Lilly documents show that Lilly played down Zyprexa’s risks to doctors and was concerned that any link between Zyprexa and diabetes would hurt the drug’s sales.

Documents also indicate that after Zyprexa’s approval the company encouraged doctors to prescribe Zyprexa to people who did not have schizophrenia or bipolar disorder. Drug companies are allowed to promote their medicines only for uses approved by the Food and Drug Administration, although doctors can prescribe drugs for any use.

In the statement Wednesday morning announcing the settlement, Lilly did not admit wrongdoing. The company said it believed the agreement would be in the best interests of the state, the company and patients.

“A settlement helps us get back to what we want to focus on as a company — developing important new medications through research and partnerships with doctors and patients,” Robert A. Armitage, Lilly’s general counsel, said in the statement.

In mid-afternoon stock trading Wednesday, Lilly shares were down 9 cents each, to $50.08. Read more!

Broughton Hospital gets good news fromfederal inspection - Associated Press

Mar 27, 2008

MORGANTON, N.C. -- The state mental hospital in Morganton may get Medicaid and Medicare payments to treat patients again soon.

The state Department of Health and Human Services said Thursday that federal inspectors visiting Broughton Hospital this week have determined major problems they highlighted last year have been fixed.

A department spokesman called it one step toward the hospital receiving federal reimbursements again. The payments stopped after an inspection in August 2007.

The surveyors did find another problem related to patient services provided by outside contractors. Inspectors will have to return later to check for improvements in that area.

The payments stopped after inspectors found that a patient who was supposed to be under close supervision had fallen. Problems first surfaced after a Broughton patient died in February 2007. Read more!

Perdue: Fighting OLF joint effort -Elizabeth City (NC) Daily Advance

Lt. governor discusses Obama, health care, spending reform

By BOB MONTGOMERY

Lt. Gov. Beverly Perdue said Thursday she agreed with U.S. Sen. Richard Burr on one thing about the U.S. Navy's proposed jet training field in eastern North Carolina — that community support is essential in any decision.

But she strongly disagreed with Burr's statement Wednesday during a visit to the TCOM facility in Weeksville, in which he said the responsibility for responding to the Navy's study of sites in Camden and Gates counties for the outlying landing field rests with North Carolina's governor.

"I think it's critically important our office expresses opposition and the congressional delegation has a strong voice," she said. "It's all of us, not just one of us."

Perdue, a Democrat who hopes to be the state's next governor, met with editors at the offices of The Daily Advance Thursday afternoon as part of a seven-stop campaign swing through eastern North Carolina. The visit also included a fundraiser in Elizabeth City and a greet-and-meet event with voters in Williamston, according to her campaign spokesman, David Kochman.

Perdue is hoping to succeed outgoing Democratic Gov. Mike Easley, who is barred by state law from seeking re-election.

During the interview, Perdue talked on issues ranging from education, health care, transportation, ethics reform and the economy to her support of Illinois Sen. Barack Obama for president.

"I think he's an incredibly talented leader," she said of her endorsement of the Illinois senator, who is locked in a tight presidential primary contest with New York Sen. Hillary Clinton.

"Whoever wins will be historic for North Carolina," she said, noting that Obama would be the first black and Clinton the first woman elected president.

Likewise, if Perdue wins, she'll become North Carolina's first woman governor.

Twenty years ago, it might not have been possible for her to be her party's nominee for governor, she said. Attitudes have changed, she said, and today she believes her experience as a teacher, a state lawmaker, director of geriatric services at a community hospital and her leadership roles as lieutenant governor make her the most qualified candidate.

"I'm running because I actually believe I have the unique capacity to lead North Carolina in the 21st century," she said.

On some of the other issues, she said she supports:

Expanded health care to make sure every child in the state is covered and that health insurance is more affordable and accessible to North Carolina's families and small businesses. She said expanded health care can be "a good economic development tool to help hard-working, low-wage earners to cover the children." She chaired the Health and Wellness Trust Fund Commission, which created Senior Care, the state's drug benefit initiative to help low-income seniors afford costly prescriptions.

Renewing the push for a trust fund plan called "Endowment for Positive Gubernatorial Campaigns" that would help "take the money out of politics," she said. Responding to last week's removal of state Rep. Thomas Wright of Wilmington from office for failing to disclose his financial contributions, Perdue said "you can never do enough" to reform ethics rules for public officials.

Health and Human Service Secretary Demspey Benton's efforts to fix the state's mental health system, including the 14 public mental health facilities. She said she was disturbed to read reports of Medicaid abuse involving community service providers who earned more than $60 an hour to take patients to movies. "That's just stupid," she said. Perdue said the state must resume a larger role in overseeing the mental health system.

Creating a BRAC (Base Realignment and Closure Commission) budget reform system to find $250 million a year in efficiencies to curb government spending. "The BRAC system is the most apolitical system I've seen in my life," said Perdue, who led the state's efforts to protect the state's military presence during the Defense Department's Base BRAC process. She said recommendations of the BRAC Budget Reform Board she's proposing would be voted on as a whole, rather than individually.

"With this kind of reform, it will happen," she said, referring to government savings for efforts like stopping the transfer of $170 million annually from the state Highway Trust Fund.

(Contact Bob Montgomery at

bmontgomery@coxnc.com) Read more!

Broughton gets 2nd inspection - Asheville Citizen Times

Leslie Boyd

Inspectors from the Centers for Medicare and Medicaid Services (CMS) are at Broughton State Hospital this week.

The hospital was decertified for Medicare and Medicaid in September after one person suffocated while being restrained improperly, and Laurie Arwine, of Waynesville, fell and was severely injured while she was supposed to be closely supervised.

Earlier this month, Broughton’s director, Dr. Art Robarge, submitted a request to CMS to reinspect the hospital. Inspectors are expected to be at the hospital through Friday.

Mark Van Sciver, a spokesman for the state Department of Health and Human Services, said inspectors will give a verbal report to Robarge after the inspection; a written report will come later.

“This is a first step,” Van Sciver said. “If this inspection goes well, then CMS will remove the (immediate jeopardy finding).”

CMS then will return for a recertification inspection within 30 days.

Earlier this week, DHHS released its new procedures for reporting deaths at all state facilities, including psychiatric hospitals, which previously were not required to report all deaths.

James Osberg, chief of the State Operated Services Section, said all deaths in any state-operated facility must be reported to the local medical examiner’s office.

Under the new requirements, facility personnel must notify the local medical examiner before moving the body.

Osberg also said the new policy clarifies the facilities’ responsibilities for reporting all deaths to the appropriate agencies.


Read more!

FDA Probes Allergy Drug and Suicides - Associated Press

By MATTHEW PERRONE,AP

WASHINGTON (March 28) - The Food and Drug Administration said Thursday it is investigating a possible link between Merck's best-selling Singulair and suicide.

FDA said it is reviewing a handful of reports involving mood changes, suicidal behavior and suicide in patients who have taken the popular allergy and asthma drug.

Merck has updated the drug's labeling four times in the past year to include information on a range of reported side effects: tremors, anxiousness, depression and suicidal behavior.

FDA said it asked the Whitehouse, N.J.-based company to dig deeper into its data on Singulair for evidence of possible links to suicide. The agency said it has not established a "causal relationship" between Merck's drug and suicidal behavior. An agency spokeswoman said the review was prompted by three to four suicide reports it received since last October.

It could take up to nine months before agency scientists can draw any conclusions, FDA said in a posting to its Web site.

The agency recently began notifying the public earlier about possible safety issues. The policy change came after the FDA was criticized for acting too slowly on information about the risks of Merck's painkiller Vioxx and, GlaxoSmithKline plc's diabetes pill Avandia.

Merck officials stressed that the FDA's inquiry is based on reports, not clinical studies - which are the standard tool for evaluating drug safety. The company said none of the 11,000 patients enrolled in 40 Singulair trials has committed suicide.

"We have no indication that anything about the mechanism of Singulair is consistent with these events," said George Philip, director of research and product development. "But because suicide is a life-threatening event we thought it was important to provide this information in the product label."

Merck said it recently added reports of suicide to Singulair's label, which already listed suicidal thinking and behavior as reported side effects.

In clinical trials of asthma patients, the most common side effects were headache, flu, abdominal pain and cough.

With sales of $4.3 billion last year, Singulair is used by millions of patients in the U.S, according to Merck. First approved in 1998, it's part of a class of asthma and allergy drugs that includes AstraZeneca's Accolate and Critical Therapeutics's Zyflo.

FDA said it is also reviewing reports of side effects with those drugs. Their labeling does not contain language about suicide.

"Patients should not stop taking Singulair before talking to their doctor," FDA said in its statement, adding that doctors should monitor patients for suicidal behavior and mood changes.

Shares of Merck & Co. Inc. rose 8 cents to close at $44.78.
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Study Hints of Gene Link to Risk of Schizophrenia - New York Times

By BENEDICT CAREY

A new study has found that rare and previously undetectable genetic variations may significantly increase the risk that a person will develop schizophrenia.

Experts said the study, while not identifying the cause of the disorder, provided a striking demonstration of how new gene-scanning technology can open a new frontier in the quest to understand the biology of mental disorders.

Until now, researchers had focused on finding common and known genetic variations that, when acting in some combination, might increase the risk for schizophrenia. They have had little success. The new analysis, being published Friday in the journal Science, detected extremely rare and unknown mutations that turned up three to four times as often in people with schizophrenia as in those without it.

The findings point scientists to previously unappreciated developmental problems that may help them develop more effective treatments, experts said.

Researchers have tried for generations to understand the biological underpinnings of schizophrenia, which affects 1 percent of the population, causing scrambled thinking and delusions. They have analyzed how drugs prescribed for the disorder affect brain cells. They have run large genetic studies, looking in vain for some shared pattern.

The new study suggests that, if anything, the genetics of the disorder are even more complex than many had presumed. But if replicated, experts said, the study’s results will significantly alter the course of psychiatric research.

“This paper represents a paradigm shift in the way we think about identifying genes in schizophrenia,” said Dr. Matthew State, director of the neurogenetics program at Yale University School of Medicine, who was not involved in the research. “That is what the authors say in the paper, and it’s true.”

Dr. Samuel Barondes, a professor of psychiatry at the University of California, San Francisco, said the new findings in no way disproved the idea that multiple common variations could act together to increase schizophrenia risk. Studies searching for such dark conspiracies of genes are under way and still promising.

“But this new work is not business as usual, in any way, and can lead to real insight,” Dr. Barondes said. “This is a field that has been grasping for straws, and this study is one big straw.”

In the study, a collaboration that included the National Institute of Mental Health, the University of Washington, Seattle, and Cold Spring Harbor Laboratory, investigators analyzed blood samples from 150 people with a diagnosis of schizophrenia and 268 without a psychiatric disorder. Using new high-resolution techniques that quickly scan the entire human DNA map, the researchers looked for rare variations that disrupted the function of genes. Some of these mutations are inherited; others occur spontaneously during or near conception.

They found 53 such mutations over all and reported that the mutations that disrupted genes were three times as likely to turn up in people with schizophrenia as in those without it. A similar analysis, in 83 people who developed a rare form of schizophrenia that strikes in childhood, found that those patients were four times as likely as healthy people to have a rare gene-altering mutation.

The mutations varied from person to person but were concentrated in genes known to be involved in brain development.

“The take-home message is that there’s a new way to search for genetic links, and this new method goes straight to the underlying biology,” said the senior author, Jonathan Sebat, an assistant professor of genetics at Cold Spring Harbor Laboratory.

Mary-Claire King, a co-author and a professor of medicine and genomic sciences at the University of Washington, said the findings helped explain several facts about schizophrenia, including why genetic selection has not caused it to disappear.

“A constant influx of new mutations that occur purely by chance, out of the blue, can explain the persistence of schizophrenia in all parts of the world and throughout human history,” Professor King said.

One of the mutations identified in the study, for instance, distorts a protein that is involved in guiding neurons to their proper places during brain development. Another mutation that turned up changes the shape of a molecule that transports glutamate, a chemical that excites neurons and is heavily involved transmitting signals between brain cells.

Both mutations are processes that biologists can explore to learn about the causes of schizophrenia, and possibly other mental problems. The glitches, too, may well act in concert with other gene variations. But gene-scanning technology is improving so quickly that subsequent studies should help clarify those interactions, experts said.

“My dream,” Dr. Sebat said, “is that we’ll do this kind of high-resolution analysis across tens of thousands of people and have full catalogs of variations that will tell us something not only about schizophrenia but about bipolar disorder, autism, depression, all of these disorders.”

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N.C. mental health system meltdown must be reversed - Asheville Citizen Times

The astronomical price paid in human suffering ought to shame every past or present lawmaker who had any role in the failed attempt begun in 2001 to reform and privatize North Carolina’s mental health system.

The most recent reminder of that suffering can be seen in the incompetent care that led to Broughton State Psychiatric Hospital in Morganton, one of the state’s four hospitals for the mentally ill, losing its Medicare and Medicaid certification.

As Medicaid officials were investigating the death of another patient at Broughton, they discovered the record of Laurie Arwine and decided to decertify the hospital.

Egregious case

Arwine fell several times and was seriously injured after being given medications that cause dizziness, agitation and unsteadiness and being left to wander the halls unassisted. She had a number of bleeds into her brain and multiple skull fractures as a result of the falls.

Inspectors found, among other things, that the staff failed to supervise Arwine properly and failed to adjust her treatment plan after she fell at 10:30 a.m. and again about 12:30 p.m. She fell a third time at 2:05 p.m.

The injuries she sustained left Arwine with no sense of taste or smell, partial aphasia — loss of language, seizures and symptoms of post-traumatic stress disorder.

Broughton’s decertification continues to cost state taxpayers millions of dollars.

The circumstances at Broughton are a stark reminder of the cost of government ineptitude, not only to the mentally ill but to the rest of us as well.

Some of the goals of reform were noble — to bring care closer to home, to give patients more choice — but a system that worked was dismantled and seven years later, the system that was supposed to replace it has failed to materialize.

Reform badly conceived

From the beginning, the reform was poorly conceived and inadequately funded. Inept administration and a yearslong paralysis on the part of lawmakers despite repeated crises has driven many dedicated providers from the field, fed up with constant rule and rate changes, inadequate reimbursement, interminable paperwork and frequent audits. They’ve left behind desperate patients who, thanks to an inability to get timely appointments and stable treatment, often end up in crisis.

When that happens, those who lack the resources to be treated at private mental hospitals end up at one of the state’s four mental institutions — often after passing through a hospital emergency room or jail.

The ironic result is serious overcrowding in the state’s psychiatric hospitals. The need for those hospitals was supposed to diminish as new outpatient services became available in communities. But those services have failed to materialize.

The Raleigh News & Observer reported in January that during the last five months of 2007, state investigators found dangerous conditions at two of the state mental hospitals and problems at all four that resulted in threatened losses of Medicaid and Medicare reimbursements. Only Broughton lost its certification.

In February 2007, community hospitals were told that the public psychiatric hospitals could no longer accept all the patients needing treatment, the newspaper reported as part of a series on mental health care in March.

“At times, the census on our admissions units has been so high that it has caused us serious concerns regarding patient safety and treatment capability,” wrote Michael Moseley, then director of the state Division of Mental Health, Development Disabilities and Substance Abuse Services. Moseley recently retired.

Other problems

The newspaper also reported:

• Patients are rapidly cycling in and out of the state’s mental institutions, often being discharged before they are ready to be released, and returning repeatedly. Some, known to be suicidal, have committed suicide shortly after being released.

• Patients have also suffered abuse. In one instance, three employees at Cherry Hospital in Goldsboro beat a patient so severely they broke his nose and fractured a rib, the News & Observer reported.

n Since 2000, 82 patients have died in the state’s mental institutions in ways that raise concerns, the News and Observer reported, in some cases as a result of suicide or homicide.

“If you overwhelm a system beyond its point of capacity, it can’t do everything it needs to do,” Dr. Jeffrey Geller, a psychiatrist from the University of Massachusetts medical school who is monitoring the hospitals for the federal government, told the News & Observer.

In the midst of this, state officials plan to close two psychiatric hospitals, Dorothea Dix in Raleigh and John Umstead in Butner, when the new, smaller Central Regional Hospital in Butner opens.

What can they be thinking?

Read more!

State to report all deaths at mental health facilities - Associated Press

The Associated Press

RALEIGH, N.C. - The head of the state Department of Health and Human Services has announced several changes in mental health treatment, some of which would reverse a 2001 reform plan that let companies, not the government, provide the treatment.

The News & Observer of Raleigh reported that DHHS Secretary Dempsey Benton said Wednesday that he plans to ensure basic psychiatric care in North Carolina and buy space for the mentally ill in community hospitals.

He said that that all institutional deaths will be reported to a medical examiner.

The N&O reported recently that as part of the reforms the state wasted at least $400 million on service known as community support while not spending enough on treatment of serious mental illness.

The newspaper also reported that some deaths in mental institutions were wrongly reported as being the result of natural causes and therefore, weren't investigated

Its report found that 192 employees abused patients and 82 patients died under questionable circumstances at four state psychiatric hospitals since December 2000.

Under the new policy, hospitals must report all deaths by telephone to a medical examiner, Benton told a legislative committee on mental health. The medical examiner will decide whether an autopsy will be performed.

The DHHS said officials changed the policy in order to increase openness and oversight.

"This is only one step in a comprehensive re-examination of our procedures covering the death of anyone in the care of our facilities," said James Osberg, the chief for state-operated facilities for the Department of Health and Human Services. "This policy includes the steps the facilities must take to report any death to the proper state and federal authorities."

Osberg's section oversees the state's 15 mental heath, developmental disabilities and substance abuse facilities.

Benton's proposal to have basic psychiatric services across the state comes in response to complaints about a lack of public mental-health treatment. For example, Benton said local offices should have psychiatrists who work only for the public system, not ones who also work for private providers.

Benton did not put a price on most of the proposals, but he estimated an annual cost of $65 million to $70 million.

Read more!

Court Hears Mentally Ill Defendent Case - Associated Press

By MARK SHERMAN

The Associated Press
Wednesday, March 26, 2008

WASHINGTON -- Several Supreme Court justices suggested Wednesday that defendants with a history of mental illness can be judged competent to stand trial or plead guilty, yet forfeit their constitutional right to represent themselves.

The court heard arguments in a case from Indiana in which a judge prevented a defendant from acting as his own lawyer at trial out of concern that the proceedings would become a farce.

Justice Stephen Breyer said that allowing judges' discretion in those cases could increase public confidence in the criminal justice system and reduce the number of "very disturbed people ending up in prison because they are disturbed, not because they're guilty."

Ahmad Edwards was convicted of attempted murder and other charges in 2005 for a shooting six years earlier at an Indianapolis department store.

He was initially found to be schizophrenic and suffering from delusions and spent most of the five years following the shooting in state psychiatric facilities. But by 2005, he was judged competent to stand trial.

Edwards asked to represent himself. A judge denied the request because he was concerned that Edwards' trial would not be fair. Edwards, represented by a lawyer, was convicted anyway and sentenced to 30 years in prison.

He appealed, and Indiana courts agreed that his right to represent himself had been violated, citing a U.S. high court decision from 1993. The courts overturned his conviction and ordered a new trial.

The justices appeared to be concerned with the difficulty trial judges would face if forced to allow defendants like Edwards to represent themselves.

Even if a judge could step in once the trial was under way and order a lawyer to mount a defense, "the damage is done" by that point, Justice David Souter said.

Mark Stancil, representing Edwards, said that once a judge decides that someone can be tried, "I think you have to give him a chance to stand up in open court."

After all, Stancil said, Edwards could have entered a guilty plea without raising any constitutional concerns.

Only Justice Antonin Scalia appeared strongly on Edwards' side of the defendant.

"He can plead guilty if he wishes and that's OK," Scalia said. "Only he can't put on an incompetent defense?...The state still has to prove his guilt beyond a reasonable doubt."

Indiana Solicitor General Thomas Fisher said the right to self-representation is not absolute. "It is within the state's authority to override self-representation when the defendant can't communicate coherently," Fisher said.

Scalia shot back, "I sometimes think lawyers can't communicate coherently."

The record of the case is filled with confusing or incomprehensible writings from Edwards that the judge and Indiana officials said bolstered their position.

Stancil said at other times, though, that Edwards provided lucid answers to legal questions from the judge.

Justice Anthony Kennedy was not impressed by Stancil's observation. "There are all kinds of nuts who can get 90 percent on the bar exam," Kennedy said.

Defendants may be ruled competent to stand trial if they understand the proceedings and are capable of assisting their lawyer. The question in this case is whether states may impose a higher standard for measuring a defendant's competency to be his own lawyer.

The high court recently saw an aspect of this dilemma in the case of Scott Panetti, a mentally ill killer from Texas who was nonetheless judged competent to stand trial and allowed to represent himself.

Panetti was convicted and sentenced to death after personally arguing that only an insane person could prove the insanity defense. He dressed in cowboy clothing and submitted an initial witness list that included Jesus Christ and John F. Kennedy.

The court blocked his execution in June, in a ruling that did not address his role in his own defense.

A decision is expected by summer.

The case is Indiana v. Edwards, 07-208.


Read more!

Court Looks at Legal Role for Mentally Ill - New York Times

By LINDA GREENHOUSE

WASHINGTON — A landmark Supreme Court decision 33 years ago gave criminal defendants the right to represent themselves at trial.

The right to proceed without a lawyer, the court said then, was a logical corollary to the Sixth Amendment right to the assistance of counsel. If the Constitution gave people the right to a lawyer, the justices reasoned, then it necessarily gave them to right to dispense with one, as well.

But what about a defendant who is mentally ill and who, although technically competent to stand trial, has come to the perhaps delusional conclusion that he is better off without a lawyer?

That was the question for the court during an argument on Wednesday. The court’s precedents suggest that the standards for competence to stand trial and competence to represent oneself are one and the same. But at least some justices appeared convinced that the issue required a fresh look.

The case is an appeal by the State of Indiana from a ruling by its State Supreme Court that a judge violated a defendant’s right to self-representation by refusing to let him proceed without a lawyer.

The defendant, Ahmad Edwards, was a schizophrenic who was originally deemed incompetent to stand trial on a charge of attempted murder. After two prolonged hospitalizations over nearly three years, Mr. Edwards was found competent to stand trial.

Represented by a court-imposed lawyer, he was convicted by a jury and sentenced to 30 years in prison.

The Indiana Supreme Court held that Mr. Edwards’s competency to stand trial meant that he was competent to represent himself. In its appeal to the United States Supreme Court, Indiana v. Edwards, No. 07-208, the state included in its brief excerpts some motions Mr. Edwards filed with the trial court that led the judge to conclude that he should not be permitted to represent himself.

For example, one “motion to dismiss” included this sentence: “Defendant prays Psalm 15.5 for innocent of court property to be dismissed wherefore, so shall it be done.”

Addressing the justices, the Indiana solicitor general, Thomas M. Fisher, said the judge was “justified in requiring a higher level of competency for self-representation in order to prevent the trial of Ahmad Edwards from descending into a farce.”

Justice Antonin Scalia, the member of the court who takes the broadest view of various rights under the Sixth Amendment, challenged Mr. Fisher to explain why the judge could not have waited to see how Mr. Edwards would actually handle himself.

“By waiting to see if in fact he will turn the trial into a farce,” Justice Scalia said, “you avoid the risk of depriving him of his right to represent himself, which is certainly a very important constitutional right.”

Justice Scalia had a similar exchange with Michael R. Dreeben, a deputy United States solicitor general, who argued for the federal government on Indiana’s behalf. Mr. Dreeben said the court should not adhere to a rigid rule that would “force the state to have the train wreck occur when the evidence is very firm and reliable that it will occur.”

He said the state’s interest lay in “starting the trial from the beginning in a coherent and orderly way and not subjecting the defendant to the risk of an unfair trial based on the defendant’s own incompetence.”

Justice Stephen G. Breyer was among the justices most sympathetic to the state’s argument. Defendants representing themselves “do surprisingly well,” Justice Breyer said, citing a study noted in a brief filed by the American Psychiatric Association. But, he added, “there is a small subclass” of defendants who fare badly on their own.

Why not have “a rule which permitted a state to deal with this subclass of disturbed people who want to represent themselves?” Justice Breyer asked Mark T. Stancil, the lawyer for Mr. Edwards. “This is a perfect instance where the states should experiment.” Mr. Stancil replied that such an approach “undermines the fundamental premise of the Sixth Amendment, which is it’s his defense.”

He offered examples of his client’s evident understanding of the proceedings. That provoked a dismissive comment from Justice Anthony M. Kennedy, who said, “There are all kinds of nuts who could get 90 percent on the bar exam.”

The standard for competence to stand trial, formulated in a 1960 Supreme Court decision, Dusky v. United States, is fairly basic. It requires that a defendant have “sufficient present ability to consult with lawyer with a reasonable degree of rational understanding” and a “rational as well as a factual understanding of the proceedings against him.”

Mr. Fisher, the Indiana solicitor general, said the standard for competency to represent oneself should require more, “that it is within the state’s authority to override this right where the defendant cannot communicate coherently with the court or the jury.”

To that, Justice Scalia responded: “Cannot communicate coherently? I sometimes think that the lawyers cannot communicate coherently.”

Read more!

Court: Can Mentally Ill Defendant Be Own Lawyer? - Reuters

By REUTERS

March 26

WASHINGTON (Reuters) - The U.S. Supreme Court considered on Wednesday whether mentally ill criminal defendants who have been found competent to stand trial must be allowed to represent themselves.

Attorneys representing Indiana and the Bush administration argued before the high court that a judge can reject a request from such a defendant to be his own lawyer to prevent the trial from becoming a farce.

Indiana Solicitor General Thomas Fisher and U.S. Deputy Solicitor General Michael Dreeben said the government's interest in the fairness of criminal proceedings can outweigh a defendant's request to proceed as his own lawyer.

But attorney Mark Stancil, representing the defendant in the case, said eliminating the right of self-representation violated a fundamental constitutional principle.

The case involved Ahmad Edwards, who was convicted of attempted murder and other charges in 2005 following a shooting outside an Indianapolis department store in 1999.

Edwards suffers from mental illness, including schizophrenia and delusions. He spent most of the five years after the shooting in state psychiatric facilities.

But by 2005, he was found by psychiatrists and the judge to be competent to stand trial, able to consult with his lawyer and having a rational understanding of the proceedings against him.

Although Edwards wanted to act as his own lawyer, the judge denied his request. Represented by a lawyer, Edwards was convicted and sentenced to 30 years in prison.

Of the nine Supreme Court members, Justice Antonin Scalia seemed most supportive of allowing defendants like Edwards a chance to represent themselves.

"By waiting to see if in fact he will turn the trial into a farce, you avoid the risk of depriving him of his right to represent himself, which is certainly a very important constitutional right," Scalia said.

Fisher said a defendant's right to self-representation can be overridden by the state when the defendant cannot communicate coherently with the judge or jury.

Several justices seemed concerned about the difficulty trial judges would face if they have to allow defendants like Edwards to represent themselves.

'GIBBERISH'

Justice Ruth Bader Ginsburg cited some of the letters Edwards had sent to the judge. "If this is how this man speaks and thinks, how could a jury be exposed to it? It would be gibberish."

Justice David Souter appeared opposed to Stancil's proposal of allowing self-representation and then having a lawyer assume control if problems occur. "By the time a standby lawyer is required to take over, the damage is done."

Stancil said Edwards lucidly answered legal questions from the judge. But Justice Anthony Kennedy did not appear persuaded. "There are all kinds of nuts who could get 90 percent on the bar exam," Kennedy said.

A ruling is expected by the end of June.

Read more!

Care of mentally ill inmates challenges jails -Greenville (SC) News

By Ben Szobody
STAFF WRITER

For the 82-year-old man with Alzheimer's and divorce papers, senior care options came down to the county detention center.

Unwanted by his family and arrested repeatedly for offenses including touching women at care homes, the man bedded in the infirmary for three months and relied on staff and other inmates to help with incontinence and dementia-related problems, jail officials said Tuesday.

He's part of a growing dilemma facing jail officials over how to handle mentally ill inmates, and one of an increasing number of seniors who end up in the detention center as state mental health funding shrinks and centers deal with overwhelming caseloads, county and mental health officials say.

Instead of hiring standard nurses, Jim Dorriety, assistant county administrator for public safety, said he's now looking for mental health specialists, and that his four-person in-house mental health staff is the only one in the state.

Out of roughly 1,300 jail inmates currently, detention center figures show an average of 166, or 13 percent, were on medication for mental illness each of the last three months.

It's one of several interlocking areas of specialty treatment emerging at the just-expanded detention center, where officials say trained volunteers now offer substance abuse treatment, outreach groups address chronic homelessness and another panel deals with vocational rehabilitation.

In a County Council committee meeting to discuss the issues Tuesday, Councilman Joe Dill said he was glad to see a "giant step" without a tax increase. Dill publicly raised the mental health problem last year when he said a mentally ill man he knows was arrested and sentenced to solitary confinement because of his behavior in court instead of being sent to a mental institution.

A part-time case manager was hired at the jail on Monday, using non-tax revenues generated by fees at the jail canteen and other areas, to help hunt for places where inmates can go, a time-consuming chore that takes away from the care others receive, Dorriety said.

A "stabilization unit" also is on the drawing board, a physical place where inmates can get treatment and then progress through other areas as they improve.

Meanwhile, the Greenville chapter of the National Alliance on Mental Illness has used a $12,000 grant to pay for a program that includes mental health treatment groups and advocacy in court, executive director Kelly Troyer said.

About 170 inmates attended support groups over the past five months of 2007, Troyer said, and NAMI advocated for 22 inmates in court cases last year. Among the successes: One female faced a 10-year sentence because of a third shoplifting offense, but instead received one year of probation.

"The judges have been very open," Troyer said, in part because they are tired of seeing repeat offenders and want to see people change.

The group agitates for more mental health beds and gets offenders treatment at the behest of judges, but how to pay for the program going forward is an open question, she said.

Jennifer Larson, the jail's mental health manager, told council members Tuesday that the new mental health service is still "not nearly enough" to deal with the overall problem.

A county memo about the Alzheimer's patient written by Dorriety to County Administrator Joe Kernell shows he was arrested on charges of criminal domestic violence in November after his wife of 26 years reported that he "scratched her hands and pushed her" during a struggle over the keys to his vehicle.

He was released later that month to an assisted living facility, where he was arrested for touching women, according to Dorriety and the memo. Dorriety told council members that the man didn't have a criminal thought process, but that his illness made him compulsive.

During his jail stint, he was served with divorce papers and "couldn't comprehend what was happening," the memo says, while mental health staffers helped him through the court process "to protect his assets" and get him a guardian.

"He does not belong in jail," the memo said.

By February, jail staffers had found an assisted living facility in Georgia, where the man now lives in a group home with 10 other men. However, the home required a two-month medication supply and advance payments, which the detention center provided at a total cost of $2,457, according to two Dorriety memos.

He said he asked the man's attorney for partial repayment.

Councilwoman Xanthene Norris referred to a "crisis in funding" for mental health in Tuesday's meeting while questioning if Greenville Mental Health could afford to collaborate on jail patients.

Dill, who is running for the state House, said he has noticed that Greenville Mental Health gets less funding than Charleston, where caseloads are lighter.

Larson and Dorriety said the jail asked the National Institute of Corrections to survey Greenville's operation and help with the pending stabilization unit. The NIC rates the facility "on par" or better compared to how other jails are grappling with the problem, Larson said.

Dorriety said the jail modified the questions it asks inmates to determine their mental health, at the recommendation of NIC.

The stories pile up.

One mentally ill inmate released recently had nowhere to go and remained in the detention center lobby for the night and the following day before setting his pants on fire, according to another memo provided by Dorriety.

He was arrested, "which is what he wanted," but he refused mental health medication and treatment for his burned leg, the memo said, in addition to appeals from his mother.

The detention center asked the court for an order to treat him against his will, the memo said.

Another 250- to 300-pound man with the mentality of less than a 10-year-old was arrested for burglary in a church and had to be kept separate from other inmates, the memo said. Nurses took him out of his cell when he cried and called his mother to help quiet him.

He was eventually released for home monitoring, Dorriety's memo said. Read more!

Man Killed by Deputy Was Mentally ill -Lakeland (FL) Ledger

By Eric Pera
THE LEDGER

BABSON PARK - Relatives of Jackie Chelednik say the mentally ill 38-year-old man didn't have to die grappling with a Polk County sheriff's deputy who responded to a Babson Park home Friday to check on a domestic disturbance.

The 911 call made by Chelednik's disabled father, Jack, was an error in judgment that he'll forever regret, said Anthony Chelednik, 44, of New Jersey, one of the elder Chelednik's three sons.Still, the family questions whether the confrontation could have been handled differently and had a less tragic outcome. Jackie Chelednik stabbed the deputy with a kitchen knife and was shot to death.

Deputy Richard Larence didn't know that Chelednik suffered from a mental illness when he responded to the house.

"I don't think the police knew he (Jackie) was mentally ill or medicated," Anthony Chelednik said. "This officer rolls up and automatically pulls a Taser and points it at my brother, not knowing he's mentally ill. He's not all there, but he's harmless."

Jackie Chelednik suffered from bipolar disease and schizophrenia for roughly half his life. After graduating high school in New Jersey, he became permanently disabled by his mental afflictions, and has been supported by his parents all his life.

But his family said he had never had a history of violence. They are in shock over the death of Chelednik, who they say inexplicably turned on Larence with a kitchen knife after the deputy arrived at his home with a Taser in one hand and his handgun drawn.

After ordering Chelednik to put down his knife and getting no response, Larence shot the man with the Taser but it had no effect, according to Polk Sheriff Grady Judd.

Chelednik, who a family member said was about 5 feet, 10 inches tall and 220 pounds, began stabbing the deputy. Judd said Larance's life was saved by his bulletproof vest, and that ultimately, Larence was forced to shoot Chelednik multiple times, killing the man and wounding himself in the scuffle.

Larence is at Lakeland Regional Medical Center and is expected to recover from a leg wound.

The incident left Chelednik's family crushed and perplexed. They said they're heartsick over the deputy's injuries, but wonder how things might have turned out if Larence could have taken more time to assess the situation.

"This isn't a cut-and-dry case," said Ronald Chelednik of Arizona, Jackie's uncle. "This person who's now deceased has never been incarcerated, never had an altercation. If somebody has Alzheimer's and they're playing with a knife, is the same thing going to happen? It's a sad set of circumstances."

Larence, a 12-year veteran of the Sheriff's Office, was placed on routine paid leave while the Sheriff's Office and State Attorney's Office investigate the shooting.

Judd described him as an outstanding deputy, and said he acted to protect himself. When the Taser didn't disable Chelednik, Judd has said, the deputy "was forced to use his firearm or he would have been killed."

The shooting was precipitated by a heated exchange between Jackie Chelednik and his father, a former roofing and siding contractor from New Jersey forced into early retirement 20 years ago after a hernia operation left him disabled.

Jackie Chelednik split time between his father in Babson Park and his mother, who lives in South Carolina. Anthony Chelednik said his parents, though separated, still visit each other fairly often.

But on Friday, Jackie Chelednik wanted to return to South Carolina, and he and his dad got into an argument. Anthony Chelednik said his father gave him the following account of what led to Jackie's death:

Having spent a week hospitalized for a severe cold or perhaps the flu, Jack Chelednik returned home Friday to find his son agitated, perhaps over the extended separation from his mother. The younger Chelednik didn't require constant supervision, his brother said, but he wasn't capable of living on his own.

"He's not the type of guy who can work or pay bills," Anthony Chelednik said, "but he's not ill enough to where he can't feed himself or ride a bike."

He said his brother's frustration over having to wait to go back to South Carolina turned to anger, and he took a kitchen knife and started stabbing a table, an unusual display for his normally docile brother. That prompted Jack Chelednik to call 911, but in the midst of his conversation Jackie hung up the phone.

Minutes later, a representative of the Sheriff's Office telephoned the household to confirm the 911 call, but by then Jackie had settled down and his father asked the authorities not to come.

Larence was sent to check on the report of a potentially dangerous situation and arrived to find the younger Chelednik on the porch.

"He's not very talkative and he doesn't communicate very well," Anthony Chelednik, a roofing contractor, said of his brother. "I just feel like the officer didn't handle it right ... My dad feels like it's his fault. He never called 911 before, he never had to.''

"I always told my mom and dad to put him in a home, they're both in their 60s," Anthony Chelednik said. "They said they wouldn't want to do that to their son. They thought that if they put him into a home, he'd be treated bad."



[ Eric Pera can be reached at eric.pera@theledger.com or 863-802-7528. ] Read more!

Man Shot by Police Received Daily Mental Health Visits - NBC12 Jacksonville (FL)March 25, 2008

Video of story here.

By Grayson Kamm
March 25, 2008

JACKSONVILLE, FL -- Police say the mentally ill man shot by an officer was getting daily visits from a case worker, which indicates he was part of a special state program.

He has been identified as 30-year-old Sierra White.

The Department of Children and Families will not comment on specific cases, and could not confirm whether the man shot Tuesday was getting any state care.

But DCF spokesman John Harrell was able to share general facts about the program with First Coast News.

Harrell says nearly 12,000 people in Duval County get mental health care funded through DCF. Of those people, only 200 get daily visits from the FACT team.

The "Florida Assertive Community Treatment" teams that cover Jacksonville arrange daily visits from a mental health case worker to clients who meet at least one of four criteria:

1)Multiple past arrests

2)An observed potential for violent or suicidal behavior

3)A history of substance abuse

4)A history of not taking their medication

Clients must volunteer for the program, Harrell said.

The daily visits are intended to cut down on the number of hospital stays, reduce the potential for violence, and increase the chances that clients will get medication and treatment when they need it.

Each of the two FACT teams that serve Jacksonville is made up of experienced case workers and a doctor Harrell said.

According to DCF research, Harrell says the FACT teams have proven to be very helpful for clients across Florida. But he admits no program can help every person, every time.
Read more!

Mich. Senate OKs health care budget -Associated Press

David Eggert
March 25, 2008

A divided Michigan Senate on Tuesday passed a spending plan that would provide health care to the poor and disabled.

But Republicans and Democrats got into some skirmishes over whether young adults should be denied Medicaid and if courts should be created for the mentally ill in the $12.5 billion Department of Community Health spending plan that takes effect Oct. 1.

Republicans blocked Democrats' efforts to continue allowing 19- and 20-year-olds to qualify for Medicaid, saving $14.5 million.

Sen. Deb Cherry, a Burton Democrat, said taking away Medicaid coverage for those young adults is foolish. Some are living on their own after leaving foster care, she said, and others would turn to more costly care in the emergency room if they don't have health insurance. "I don't think we wish to have those young adults without health insurance," Cherry said.

Republicans responded that Democratic Gov. Jennifer Gran- holm has in the past proposed not allowing new 19- and 20-year-olds to be covered by Medicaid. The federal government doesn't require Medicaid coverage for that age group.

Sen. Roger Kahn, a Saginaw Republican overseeing the community health budget, said lawmakers shouldn't lose sight that overall spending would increase $434 million, or 3.6 percent, over current spending in the Senate bill, which passed 20-18.

He added that Medicaid caseloads aren't growing as fast as expected for the first time in years, which could free up money later on for the extra spending pushed by Democrats.

Democrats were unable to create pilot courts for criminals with mental illnesses, a proposal backed by Granholm.

The courts could have diverted some offenders to community-based treatment rather than sending them to jail.

Democrats and Republicans differed over whether more money should be spent to increase awareness of sexually transmitted diseases, bring meals to seniors, improve access to dental care for underserved children and prevent cancer.

Spending on health care ranks second-highest in the state budget, behind only money for K-12 schools.

Besides paying the health costs of Michigan's 1.5 million Medicaid recipients, the Senate-passed bill would increase reimbursements to pharmacists, pay mental health workers more, ban tobacco in psychiatric facilities and add pregnant patients to managed-care plans.

The measure will be considered by the House next month.

A final deal on that budget and other state spending for the next fiscal year will hinge on revised tax revenue estimates released in May.

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'She Has An Illness,' Boy Said Of Mom Accused In Stabbing - MSNBC

By STEPHEN THOMPSON
March 25, 2008

LARGO - Three years ago, while his parents were in the midst of a bitter divorce, Bradley Driscoll, then 12, told a court-appointed psychologist he didn't feel safe with his mother.

"I wouldn't want to spend 30 minutes with her alone," Bradley told psychologist Herbert Goldstein, according to court documents. "She once pulled all the phones out of the house because she did not want me to call my dad and go home.

"I don't know what she's capable of," he said.

On Saturday, Bradley, now 15, was at a court-ordered supervised visit with his mother in a psychiatrist's office when she pulled a 15- 1/2 -inch decorative dagger and a 12-inch drywall knife from her purse and attacked him, Largo police say.

Celeste Minardi, 55, stabbed her son in the abdomen, severely injuring his intestines, Largo police said. He was also slashed across the throat twice - one cut was 8 inches long, the other 3 inches- and over his right eye, police said.

Bradley remained at Bayfront Medical Center on Monday evening; his condition was not being disclosed at the request of his family, a hospital spokeswoman said.

Minardi was charged with attempted murder. The Dunedin woman was being held without bail at the Pinellas County Jail.

'I Don't Want To Be With Her'

A clearer picture of Minardi's mental history and relationship with her son emerged Monday from documents related to her divorce. Included in the five-volume case are snippets of Goldstein's interview with Bradley.

"I don't want to be with her," the then-sixth-grader told Goldstein. "She doesn't provide a civil environment and she acts crazy sometimes, like kicking my dad in a restaurant.

"She has an illness ... a mental illness," Bradley told the psychologist. "If she doesn't, she acts like it.

"I hope she gets better but right now I don't want to see her," Bradley said. "I'm forced to ... it's court ordered."

He said he couldn't wait for the visits to come to a close. He said he didn't love her.

Bradley's father is Gulfport City Attorney Timothy Driscoll, previously city attorney for St. Pete Beach. He filed for divorce from his wife in August 2004, after, among other things, he learned she had advertised herself for group sex on the Internet, the divorce suit says.

His wife denied the charge. Their son was 11 at the time.

Though trained as a licensed practical nurse, Minardi became a homemaker once Bradley was born, the file says. In 1986, she was in an accident that left her with nerve damage and chronic pain, and she has been diagnosed with bipolar disorder, court documents say. The file also says she was taken into custody at least twice under the state's Baker Act.

Driscoll wanted primary custody of his son and sought a psychological evaluation of all three members of the family. The attorney, who was grossing roughly $136,000 a year, also wanted his wife evaluated to see whether she could return to work, but she would not cooperate with a disability analyst during an interview, the records show.

Her attorney, Carl T. Boake, took exception to Driscoll insisting that Minardi work because Driscoll knew she was mentally ill, the court records show.

At one point, Driscoll asked for an injunction because his estranged wife was telling the staffs in Gulfport and St. Pete Beach he wasn't paying child support when he was, and that he had kidnapped their son, the records show. On Oct. 26, 2005, Circuit Judge Amy Williams barred Minardi from going to her husband's office or to either city hall in Gulfport or St. Pete Beach, the records show.

Minardi was also at one point barred from going to Shorecrest Preparatory School, which her son attended at the time, the court records show.

The day after Williams entered her order, a mediated agreement was filed, with Driscoll agreeing to pay $3,600 a month in alimony, the court records show. He was given sole parental responsibility.

Boy 'Is Frightened Of His Mother'

Minardi was allowed to see her son during visits supervised by psychiatrist Gerard Boutin or anyone Boutin referred the pair to, the documents say. The visits were three hours long on alternating weeks, and Driscoll agreed to pay for them. By then, however, Bradley was already seeing his mother during supervised visits, and she spent much of the time bad-mouthing his father, he told Goldstein.

Even though he said he couldn't wait for the supervised visits to end, Bradley told Goldstein he didn't feel he was in any danger during them.

"I feel more comfortable because I'm safer ... knowing she won't attack me and go crazy," the boy said.

Minardi had told Goldstein that she would be "devastated" if Driscoll was given sole parental responsibility.

"I think my husband is brainwashing my son against me," she said.

When asked if she had any weakness as a parent, she said, "I hug too much," according to a report Goldstein wrote.

Goldstein found her to be manipulative.

"Bradley is frightened of his mother," Goldstein wrote. "We should be concerned about her anger to the level of rage and the fact that she has apparently made threats to kill in the past," he wrote in his evaluation, which was filed Nov. 9, 2005, when the divorce was finalized.

The following year, Minardi asked the court to make her husband give her more money. Her health coverage lapsed and she was paying Morton Plant Hospital $112.50 a month to pay for an unanticipated stay. Her medications were also running $1,000 a month, she said in a court motion. Her attorneys withdrew from the case two months later, citing irreconcilable differences. Read more!

Lawsuit eyed to keep mentally ill out -Staten Island (NY) Advance

Tuesday, March 25, 2008
By KAREN O'SHEA

STATEN ISLAND, N.Y. -- A state assemblyman yesterday threatened legal action to halt a controversial plan to house mentally ill people in a former convent in St. George.

After a meeting yesterday with local leaders and representatives of Saint Vincent Catholic Medical Centers on the proposal to convert the shuttered Fort Place convent into 59 studio apartments for the mentally ill, Assemblyman Matthew Titone (D-North Shore) said a lawsuit against the hospital and the state Office of Mental Health is a possibility.

The state has acknowledged that some of the residents battling mental illness could include people recently released from prison or former drug addicts, and that has neighbors and politicians fuming. Titone wants assurances that nobody with a history of sexual assault will be housed in the facility, but he said Saint Vincent could not explain its screening process during yesterday's meeting at Borough Hall.

"We will explore every possible opportunity to address this. If that means filing a lawsuit down the line, so be it," said Titone, who participated by phone in the meeting, which was attended by Borough President James Molinaro, State Sen. Diane Savino and Jon Del Giorno, a lobbyist for SVCMC.

The Manhattan-based hospital system recently closed a $3.3 million deal to buy the convent from the Daughters of St. Paul, and the state has issued a conditional approval of the project. Titone said yesterday that he was "furious" after reading about the closing in the Advance, especially since SVCMC had promised to keep him informed "every step of the way" during an earlier meeting about the proposal.

Gabor & Marotta LLC, the law firm Titone recently joined, would bring the suit, he confirmed. Firm partner Daniel Marotta is a St. George resident who is active in the Staten Island Downtown Council. Other local attorneys are also offering their help.

A court challenge could focus on what SVCMC originally told the community about its plans and what it promised the state in its application to run the program.

A hospital spokesman told the Advance in 2005 that the convent would be converted to a facility for "stable" people struggling with mental illness.

A few months later, however, the Advance reported the hospital had submitted a proposal to the state that showed newly released prison inmates from places such as Sing Sing and former substance abusers struggling with mental illness could be among those housed there.

"The question is -- which one is it?" Titone asked yesterday.

Brian Morris, a public relations consultant for SVCMC, said he expects the hospital to allay many of the fears when it gives a detailed presentation to the same group of elected officials next month.

Except for Building Department permits, the convent conversion needs few approvals from the city.

The state's mental hygiene site selection law applies only to licensed programs housing four to 14 people -- typically smaller, group homes for developmentally disabled or mentally ill people. In those cases, the state must notify the local community board, which can suggest alternate sites or request an administrative hearing to challenge the location.

But no such law exists for licensed programs with 14 or more beds, although the provider must notify the community board of its plans.

Sen. Savino and Titone plan to meet today in Albany today with the commissioner of the Office of Mental Health, said Ms. Savino. She plans to show the commissioner a map of myriad social service programs already located in the area, and press the case that the facility is too big and inappropriate for the Fort Place convent.

Councilman Michael McMahon (D-North Shore) accused the Manhattan-based SVCMC of not doing the right thing by the borough when it sold off the former St. Vincent's Medical Center in West Brighton, now Richmond University Medical Center, as part of its own bankruptcy reorganization. McMahon's chief of staff attended yesterday's meeting at Borough Hall.

"I don't think you can take them at their word on anything," McMahon said of SVCMC.

Karen O'Shea covers real estate news for the Advance. She may be reached at oshea@siadvance.com. Read more!

Tech Families React to Settlement -Associated Press

By KRISTEN GELINEAU and SUE LINDSEY
March 25, 2008

Those close to the victims of the Virginia Tech mass shootings offered mixed reactions Tuesday to a proposed multimillion-dollar state settlement and whether it will properly honor their loved ones.

Families of the victims have until Monday to say whether they'll accept the settlement, which would give $100,000 to representatives of each of the 32 killed and ensures that families will have the chance to talk to the governor and university officials about the shootings.

Under the proposal, a copy of which was obtained by The Associated Press, $800,000 would be available to injured victims. They and the families of those killed could seek additional money from a $1.75 million hardship fund.

Roger O'Dell, whose son Derek was among two dozen wounded April 16, said while he considers the proposal a very reasonable offer, he is concerned about how the money would be split among the survivors. The proposal only states that the money would be distributed 'based on a matrix acceptable to the commonwealth, with a maximum payment of $100,000 to any individual.'

'I'm inclined to believe this will not be settled by April 15th,' O'Dell said. 'I think there are too many question marks in the proposed offer.'

Seung-Hui Cho, a mentally disturbed student, killed two people in a dormitory just after 7 a.m. University officials did not send an e-mail alert until more than two hours later _ just before Cho killed 30 others in a classroom building across campus and then committed suicide.

Twenty-two families have filed notice with the state that they may sue. They have until April 16 to file. Families of all deceased victims and the survivors would be eligible for a payout under the settlement.

By accepting the proposal, family members would give up the right to sue the state government; Virginia Tech; the town of Blacksburg, where Virginia Tech is located; Montgomery County; and the New River Valley Community Services Board, which provides mental-health services in the area.

Cho had been ruled a danger to himself during a court commitment hearing in 2005 and was ordered to receive outpatient mental health care. He never received the treatment.

Diane Strollo, whose daughter Hilary was shot three times but is back at Virginia Tech, said she believed the negotiations were ongoing.

'The families want accountability, justice and change,' she said. 'We have yet to see it.'

O'Dell said there is no consensus among the families regarding the offer, though many feel it's 'good in a number of respects.'

'It's totally across the board as to how people feel. Some people feel that there is no wrongdoing and therefore there's no obligation by the state or the university to be paying anybody anything,' O'Dell said. 'At the other end, there's some who feel that this agreement _ proposed settlement agreement _ doesn't go nearly far enough and there needs to be much more money put into it.'

The total cost of the proposed settlement, including attorneys' fees and a $1.75 million fund for charities, comes to about $8.5 million, plus the cost of reimbursing and paying for medical and psychological treatment for victims' families and survivors.

In October, the families and surviving victims received payments ranging from $11,500 to $208,000 from the Hokie Spirit Memorial Fund, set up in the days after the shootings to handle donations that poured into the school.

In contrast to the Virginia Tech shootings, attorneys say there is little to indicate lawsuits might be pending against Northern Illinois University over its response to a Feb. 14 attack on campus. In that case, former student Steven Kazmierczak, 27, opened fire in a lecture hall, killing five people before killing himself.

Chicago attorney Kathleen Zellner, who has won several high-profile lawsuits, said the school might avoid being sued because there's no indication of glaring shortcomings in its security response.

Police entered the NIU lecture hall just minutes after the shooting began, and the school launched its emergency alert system _ sending out e-mails and posting messages on Web sites to notify students a possible gunman was on campus _ before authorities could confirm the gunman acted alone and was dead.

Attorney Michael Helfand, who monitors Chicago's legal scene for an online lawyers referral service, said attorneys would have been hotly pursing NIU lawsuits weeks ago if they thought they could win one.

There doesn't appear to be talk about a settlement in NIU's case similar to the one being offered in the Virginia Tech case.

'We have not had any such discussions,' NIU spokeswoman Melanie Magara said Tuesday.

She referred other questions to the school's legal department. Messages left at the office were not returned Tuesday afternoon. Read more!

Family sought help for mom accused of throwing sons off bridge - Associated Press

March 25, 2008
By JEFF CARLTON

DALLAS - Khandi Busby's siblings insisted Tuesday that she was a ``good mama,'' but was bipolar, off her medications and denied psychiatric care the night before police say she threw her two sons off a highway overpass and then jumped after them.

``If people knew Khandi before this they would know that was not her,'' her sister Tameka Busby said outside the courtroom. ``It wasn't nothing but an attack from the devil.''

New details emerged Tuesday about Busby's mental decline, the same day a family court judge issued an order keeping the two boys, ages 6 and 8, in foster care.

The 8-year-old boy, who had been on life support, remains in the hospital and is in critical condition but ``improving daily,'' said Marissa Gonzales of Child Protective Services. He has a broken arm and other injuries, his aunt said. His 6-year-old brother is already in foster care.

Busby remains jailed on charges of injury to a child and attempted murder. Her bond was set at $2 million.

Witnesses say she threw her sons from an overpass 22 feet onto Interstate 30 traffic lanes March 12 during morning rush-hour traffic, then jumped herself. She and one of the boys were hit by passing cars, but all three survived.

John Turner, Busby's father, said he saw his daughter throw the boys over the railing and leap after them. The whole incident took about four seconds, he said.

Busby tossed the older brother first, then the younger and ``then she went over head first,'' Turner said. ``I was speechless.''

Turner said his daughter was diagnosed as bipolar last year and had recently stopped taking her medication. She had been receiving medical care at a mental health and mental retardation clinic.

Family members acknowledged the obvious signs of her mental decline, including convictions for assault and criminal trespass and three investigations by Child Protective Services on allegations of neglect. One investigation resulted in Busby taking parenting classes and another time the boys were placed in foster care for about five months.

A few days before the incident, one of Busby's sisters summoned an ambulance to have paramedics treat her sister because of her odd behavior. But ``they refused to deal with her need,'' Khalilah Busby said.

``I knew something was wrong with her and she just wasn't herself,'' Khalilah Busby said. ``Things happen, people get depressed and sometimes if you don't know how to bounce back and you don't have the support you need, you just lose it. She was out of her mind.''

The night before the incident, Turner said, he tried to get her admitted to a psychiatric center but was turned away because she didn't have proper insurance coverage.

``He said, `Yeah, your daughter needs treatment and needs to be admitted into the hospital. She needs some psychiatric help,''' Turner said a care worker told him.

``I said, `Can you keep her overnight?' They said, `No, because the insurance doesn't cover it.'''

Tameka Busby said she was unsure if her sister's oldest son, still in the hospital, is aware of what happened.

``If he is ready, I am going to explain to him that your mama was not your mama at the time this incident happened,'' Tameka Busby said. ``It wasn't her that did it.''

Busby's sisters, as well as one of the boys' parental grandfathers, said they are unhappy with the boys staying in foster care. But the state has already ruled out placing the boys with some relatives because of Child Protective Services investigations into those homes, Gonzales said.

The judge's temporary custody order keeps the boys, ages 6 and 8, in foster care under the authority of Child Protective Services. A status hearing on their custody is scheduled for May 27. Read more!

A disorder in disguise -Toronto (Canada) Globe and Mail

TRALEE PEARCE
March 25, 2008

It was a routine question: "Is there anything else you want to add?"

And in retrospect, Ridwan Tahseen's decision to answer the school counsellor truthfully was nothing less than life-changing. Otherwise, he may have been on a fast track to schizophrenia. Mr. Tahseen's university grades had plummeted so far that the 20-year-old was talking to his counsellor about being suspended. Feeling he had nothing to lose, he blurted out a string of disturbing revelations: He was devastated by a breakup. He had been cutting himself. In crowds, he thought people were staring at him and about to harm him.

"She was shocked," says Mr. Tahseen, pulling up his right sleeve to reveal the wide scar he showed her that day. Faded now, it runs along his inner arm, elbow to wrist.

In a swift chain of events, he was referred to a program at Toronto's Centre for Addiction and Mental Health specializing in monitoring and treating young people with early signs of severe mental illness.
Thanks to early intervention, Ridwan Tahseen, 22, has been able to tackle the symptoms of schizophrenia he began experiencing two years ago.

Doctors saw in him hints of schizophrenia. "They said, 'You don't have it. But we have seen symptoms of it,' " Mr. Tahseen, now 22, says in an interview in a CAMH meeting room. He and his doctors have been tackling his early symptoms in the hopes of either preventing schizophrenia from happening or, if it does occur, lessening its severity. Schizophrenia is perhaps the biggest mystery of modern psychiatry. A person with schizophrenia has trouble distinguishing between what is real and what is not.

He may hear voices or experience hallucinations, paranoia, delusions, serious disability and violent impulses.

Three in every 100 people will experience a psychotic episode in their lifetime and one in 100 will have schizophrenia. Often emerging

during the teenage years, many of the signs - a sudden drop in grades, irritability, feeling suspicious and withdrawing from family - happen to look a lot like adolescence in general.

"It's hard to differentiate the beginnings of illness from normal adolescent turmoil but there are differences," says Jean Addington, a psychiatry professor, researcher and the director of the Prevention through Risk Identification, Management and Education program Mr. Tahseen visited.

While there have been advances in treating people immediately after their first psychotic episode, many researchers are looking to detect the risk factors before they erupt. Even successfully treated schizophrenia patients say that getting a handle on their condition earlier could have spared them some of the more serious effects, such as hospitalization.

The PRIME Clinic has been open for nearly a decade, but the field of preventative mental-health care is still in its infancy, so patients often double as research subjects.

Dr. Addington and her colleagues at clinics in Connecticut, North Carolina and Calgary follow patients for years after they first seek help.

By looking back at the particular warning signs in those patients who go on to develop full-blown schizophrenia, the researchers are able to refine their understanding of which "prodromal," or pre-illness, symptoms are the most predictive.

Their most recent research, published in January in the Archives of General Psychiatry, drew on the experiences of 291 patients and identified five reliable early-warning signs. Until recently, the only hard evidence of risk was that one in 10 people with a parent or sibling with schizophrenia would go on to develop it, which, Dr. Addington says, wasn't much use as a preventative measure.

Some of the risk factors are similar to the full-blown characteristics of the illness, such as unusual thought content, suspicion/paranoia, perceptual anomalies, and disorganized communication. Others are not, such as a feeling of grandiosity. Of people with the five symptoms, 20 to 40 per cent go on to experience psychosis within 30 months.

Only a handful of PRIME patients go on to suffer a first episode each year, Dr. Addington says, yet about 200 people visit the centre's first-episode clinic.

"We're just touching the tip of the iceberg. So where are all the others?" she asks. "It may be some of them don't think they have an illness. It may be stigma, or fear of what doctors might confirm. Or they may believe the early symptoms."

Hence the push to increase mental-health literacy among teachers, counsellors and anyone who deals with youth, says Chris Summerville, the interim CEO of the Schizophrenia Society of Canada. Up to 70 per cent of people with schizophrenia recover, he says. "We can enhance that recovery with early discovery."

And that doesn't mean simply prescribing anti-psychotic medication early. Treatment for PRIME patients begins with psychological and social help, and attention for related problems such as depression.

Young patients are strongly advised to steer clear of marijuana, since recent studies have linked heavy pot use with an earlier and more intense onset of schizophrenia.

Those studies may also be a clue that schizophrenia as we know it is on the rise, says neuroscientist James Kennedy, head of the Psychiatric Neurogenetics Section, at CAMH and a professor of psychiatry at the University of Toronto.

"Since marijuana is more widely available in North America over the past 40 years or so, this could be contributing to increased rates of schizophrenia."

For those not detected early, Dr. Kennedy's genetic research aims to minimize the negative side effects of anti-psychotic drugs, such as obesity, diabetes and the involuntary movements known as tardive dyskinesia. A new lab is about to open at CAMH this month to offer this gene-based pharmacological advice to psychiatrists before they prescribe.

There's a good chance that Mr. Tahseen will never receive this analysis. He has stayed in school, now studying international development; he plays soccer regularly, and works part-time. His psychiatrist visits have been scaled back to once monthly and he continues to use sleeping and anti-anxiety medication only occasionally.

Every time a Columbine-style shooting is in the news, though, he sees an alternate path his life could have taken as a result of his budding paranoia. "You don't think about who is innocent. You're so frustrated and sad and angry. At that point, that's what I felt."

David can relate. He was a popular 24-year-old student with good grades when a breakup - in addition to heavy pot use, he believes - triggered a severe first episode in which he was hospitalized after threatening roommates.

David, who declined to be identified, was released to

his parents' home outside

Toronto and months later sought help at CAMH. Diagnosed with schizoaffective disorder - schizophrenia with an added mood disorder element - he began a successful five-year course of anti-psychotic medication and psychosocial therapy.

Still, he wonders what might have happened if he had been flagged early. He did visit his university's health centre before his first episode, describing mood swings and suicidal feelings.

"They prescribed the wrong drugs, without any follow-up, without any referral to a psychiatrist," he says, adding that negative side effects of the drugs, including twitches, only added to his instability. "They had an opportunity early on to get [me] some intervention, to get some help. I was at risk of something."

Compounding the problem, however, is the fact that paranoia itself can deter people from seeking help. Marie Asuncion, 23, had her first episode at 15. Before that she recalls rebuffing a schoolmate who asked her if something was wrong. "Could I have gotten a little bit of support?" Ms. Asuncion asks. "But at the same time, if I told everyone what was wrong I probably would have gotten more sick, because you worry about what people are thinking about you."

Mr. Tahseen has been coached to tweak this kind of thinking. When he worries he's being watched, he tells himself, "Maybe they're not looking at you. Maybe they're looking at the logo on your shirt."

Mr. Tahseen is confident he has dodged schizophrenia, "I feel I'll never end up there."

Risk factors

Signs a teen may be at risk

of developing psychosis:

trouble concentrating

or thinking clearly.

confusion about what is real or imaginary.

hearing voices or seeing things that aren't really there.

feeling suspicious

or paranoid.

disorganized speech, racing or slowed-down thoughts.

irrational ideas of special identity or abilities.

problems with social activities at work or at school.

people who have a family member who has a mental

illness, and who are now

experiencing their own difficulty functioning, are also considered to be at some risk.

Source: CAMH

Resources for treatment

Schizophrenia Society of Canada: http://www.schizophrenia.ca

Canadian Mental Health

Association: http://www.cmha.ca

Centre for Addiction and Mental Health: http://www.camh.net

Prevention through Risk

Identification, Management

and Education Clinic (PRIME): http://www.camh.net/prime_clinic

PRIME clinic, Calgary Health

Region: http://www.thesoonerthebetter.ca and http://www.earlypsychosis.ca
Read more!

Culture gap - Boston Globe

In other countries, symptoms of mental illness vary, with treatments that American doctors are just beginning to appreciate

By Patricia Wen, Globe Staff | March 24, 2008

LOWELL - Heap You's doctors thought she was crazy. The Cambodian immigrant kept saying her neck was going to explode, though an examination showed nothing physically wrong. One hospital put her on antipsychotic medication.

But eventually, the mother of five was referred to Dr. Devon Hinton, a psychiatrist with a clinic in this city's struggling downtown. She arrived in his office one spring day 10 years ago with her neck upright and rigid, even as she sobbed about her troubled family life. She told Hinton that she didn't want to move her neck because excessive "wind," bottled up in her body, might surge through her neck, break blood vessels, and kill her.

Hinton realized the patient was not out of her mind. The Harvard assistant professor, who specializes in treating Southeast Asian patients, knew that some Cambodians believe that the circulation of wind throughout their bodies maintains their health, and poor circulation from an ill body can cause a dangerous strokelike explosion of wind.

Hinton, speaking in You's native Khmer language, told her to taper off her antipsychotic medications, according to his records, and handed her prescriptions for two other drugs - one to help her sleep, another to control her anxiety attacks. He urged her to continue her traditional Cambodian practices to help "wind" flow.

After regular therapy sessions with Hinton, You's emotions stabilized. And she trusted these words from him: You're not going to die from your neck vessels bursting.

Hinton was one of the first foot soldiers in a national push to offer more culturally sensitive mental health care to immigrant groups, often in small clinics in urban areas. These clinicians are part cultural anthropologists, part psychiatric professionals, part medical detectives. A key part of their work is properly diagnosing mental illness that patients often first articulate as body pain, headaches, or stomach ailments.

"You often see emotions expressed as a bodily symptom," said Dr. Glenn Saxe, a psychiatrist at Children's Hospital Boston who has helped develop a new mental health clinic for Somalian refugees.

Among newcomers to this nation - one in eight Americans is now foreign-born - mental illness can be an alien, stigmatizing term, and many immigrants from Latin America, Africa, and Asia are far more likely to talk initially about physical ailments than seek psychiatric services.

Over the past several years, top mental health specialists have begun a number of new initiatives to improve psychiatric care for immigrants. The Massachusetts Department of Mental Health, along with a team of researchers, are educating primary care doctors around the state about what physical symptoms might be signs of mental disorders.

Primary care clinics in Somerville and Cambridge, run by the Cambridge Health Alliance, are going a step further, installing computerized educational programs in Portuguese, Spanish, and Creole, aimed at teaching immigrants how fatigue, intestinal complaints, and other physical ailments, as well as intense homesickness or loneliness, can be signs of depression.

Researchers say cross-cultural psychology was once relegated to the margins of mental health practice, viewed as a kind of exotic sideshow to mainstream medicine. But ever since a 1999 surgeon general's report on mental health found the impact of culture has been "historically underestimated," a growing number of clinics focused on immigrants' needs have opened. Many have blended traditional practices from patients' homelands with conventional Western treatments, and have hired translators and staff who share the patients' immigrant roots.

Like many other clinicians, Hinton, who practices at Arbour Counseling Services, in Lowell, is careful not to overgeneralize about any ethnic group. Not every Cambodian with anxiety disorders, for instance, will focus on neck pain. And some neck pain is just that - and needs an X-ray follow-up. But after working with Southeast Asian refugees for more than two decades, Hinton has identified more than 400 Cambodian patients who complained about neck ailments while being diagnosed with panic and anxiety disorders. In research papers he has published, he calls the phenomenon "sore-neck syndrome."

Hinton said each immigrant group has a particular "ethnophysiology," or the way in which they perceive their body's inner workings. He said English and German culture often raise "heart-focused" complaints when conveying anxiety, while Latin American cultures refer to attacks of "nerves."

Hinton said many Cambodians believe in the importance of wind, and that this wind must exit regularly through their feet and hands. But when their extremities become cold, perhaps because of an involuntary physical response to stress, they worry that the wind is becoming trapped in their torso.

As a result, Hinton said, they develop culturally rooted fears about the trapped wind suddenly bursting through the neck. He sees it as his job to reverse this type of snowballing, disastrous thinking - which can lead some doctors, unfamiliar with Cambodian culture, to mistakenly think the patient is psychotic.

During Hinton's sessions with You, he asked her to rotate her neck repeatedly while he was present, a way of convincing her that she would not die from such movement. He encouraged her to use native treatments to help alleviate her stress, such as "cupping," in which a person places a suction cup on the forehead for several minutes to help the wind flow. When the cup is removed, it leaves a red circular mark that looks like a raised welt, which can remain for days.

"It helps me suck my headache out," the 50-year-old You said in an interview in her Lawrence home. Her therapy with Hinton has convinced her she will not die of "wind overload," she said, and she no longer has the overwhelming worries that she once did.

But, at home now and then, she still uses the "cupping" technique, which she learned from her grandparents in Cambodia, and has since encouraged her children to use it as well. She also continues to take what she calls "Dr. Hinton's medicine," including a sleep medication and an antidepressant.

Hinton believes that his encouragement of "cupping" practice helped build You's trust in him, and explains in part why she continues to confide in him about her family and financial struggles.

Ultimately, Hinton diagnosed Heap with depression and a panic disorder common among Cambodian refugees, particularly those who lived through the brutal Khmer Rouge regime, responsible for killing more than 1 million Cambodians in the late 1970s.

Dr. Francis Lu, a specialist in cultural diversity with the American Psychiatric Association, who is familiar with Hinton's work, said the typical American clinician may find it a daunting task to understand the nuances of all the culturally diverse groups in this country.

"We don't know all the intricacies of hundreds of cultures, but that doesn't mean we throw up our hands," Lu said. "There's a certain body of knowledge that we're collecting. And at least we should know what we don't know."

Read more!

Proposal Would Clarify Law On Sharing Student Information - Washington Post

Colleges Would Gain Flexibility in Providing Help

By Maria Glod

Nearly a year after the shooting rampage at Virginia Tech, the U.S. Department of Education has proposed regulations to clarify when colleges can release confidential information about students who might be a danger to themselves or others.

The massacre April 16 raised concerns among educators nationwide about properly balancing privacy and safety concerns. A panel appointed by Virginia Gov. Timothy M. Kaine (D) found that "widespread confusion" about privacy restrictions led to communication lapses among officials who dealt with mentally ill student Seung Hui Cho before he shot and killed 33 people, including himself.

LeRoy Rooker, director of the Department of Education's family policy compliance office, said the proposed guidelines would not make any substantive changes in a college's responsibility under the Family Educational Rights and Privacy Act of 1974. But, he said, the rewritten regulations would make it clear that schools wouldn't be penalized for reporting fears about students who might be a danger to themselves or others. Colleges must abide by privacy regulations to receive federal funds.

"What we're saying to schools is you don't need to get tripped up over it," Rooker said. "If you think someone is at risk, maybe a student who is contemplating suicide, or if you think a student is potentially at risk to do harm to others and you feel it's necessary to disclose that, do what you have to do."

The shootings at Virginia Tech have prompted efforts by officials and educators nationwide to make college campuses safer by tightening security, improving mental health services and creating systems to alert students of danger. In the fall, the Department of Education, in a first step toward helping schools and parents navigate complex privacy laws, released user-friendly brochures on the topic.

The proposed regulation goes a step further, tweaking guidelines to make it explicit that parents are among the parties who can be contacted if a student is at risk, Rooker said. It also gives schools more flexibility in defining a potentially dangerous situation.

College officials said the changes, while small, would help ensure that counselors have the tools they need to reach out and build support systems around troubled students.

"This gives us a little more flexibility to help people who aren't in a position to help themselves and to keep others safe," said Jeff Pollard, director of counseling and psychological services at George Mason University.

Pollard said it is equally important that the law allows, but doesn't require, that schools contact parents. For instance, he said, it could do more harm than good to call a parent if the student had been abused by that parent. "I want to be able to, but I don't want to be mandated to," Pollard said.

Kaine's panel found that at Virginia Tech, officials and others sometimes wrongly thought that educational or medical privacy laws prevented them from sharing information. The panel found, for instance, that police could have informed Cho's parents when female students complained about his behavior. The report also noted that the law applies only to records and that professors or administrators who notice a student acting strangely can share that information with police and parents.

Ada Meloy, general counsel for the American Council on Education, said the regulations would help clear up that confusion.

"The changes that are proposed in the regulations provide additional assurance that colleges and universities acting in good faith can disclose information from education records in health and safety emergency situations to parents and to others who have a reason to need to know the information," Meloy said.

Universities and others have until May 8 to submit a response to the proposed regulations. Rooker said the department will consider those responses and could make changes. He said a final regulation probably would be in place this fall.

Read more!

From Forgotten Luggage, Stories of Mental Illness - New York Times

By ABIGAIL ZUGER, M.D.

The Lives They Left Behind

Suitcases From a State Hospital Attic. By Darby Penney and Dr. Peter Stastny. Bellevue Literary Press. 205 pages. $25.

A trunk in a dusty attic holds a sleeveless peach-colored silk dress belted in creamy lace, a cane topped with a carved duck’s head, kid gloves, a riding habit, a few red leather date books and an eight-page typed essay analyzing Napoleon Bonaparte’s love life.

Trunks like it usually inspire dress-up games, memory exercises and writing class assignments, not works of medical history — although that discipline could often sorely use some human interest. This particular trunk is an exception: it belonged to a delicately featured Frenchwoman who walked into Bellevue Hospital in Manhattan one day in 1932 to engage the doctors in a dialogue on paranormal communication, and was committed to psychiatric wards for much of the rest of her life.

She wound up a long-term resident of Willard State Hospital, a gigantic institution in upstate New York that opened its doors to the incurable mentally ill in 1869 and closed in 1995, sending its last thousand or so patients out to smaller facilities. Left behind in an upstairs storeroom were hundreds of pieces of patients’ luggage.

Curators poking through were transfixed by the power and pathos of the contents, their ordinariness a sad contrast to the tangled aberrancy of the owners’ lives. After a decade of cataloging and research, a small subset of the material became the subject of an exhibition, and now a book.

One set of 18 pieces of luggage held the complete wardrobe and household goods of a successful midcareer nurse who became convinced her co-workers were conspiring against her. She reluctantly assented to temporary hospitalization at Willard and never left; increasingly incapacitated by paranoia and old age, she died there in her 80s.

One suitcase of small items (including a bronze model of the Washington Monument) belonged to an upstate carpenter whose obsession with Margaret Truman and repeated efforts to contact her for marriage earned him attention from the Secret Service, even within the walls of Willard. The government lost interest when he developed delusions of being Jesus Christ, although his family in Ukraine continued to write to his doctors for decades.

One dilapidated satchel of religious materials belonged to a German-born Dominican nun whose life slowly crumbled into a confusion her order wanted no part of. In the hospital, she was lewd and flirtatious, proposed marriage to a variety of men, spoke of giving birth to a dachshund and of her breakfast eggs hatching to chickens in her stomach. In her old age she announced she was 11 and happily waited to be sent home.

These patients stayed at Willard through the treatment vogues of the last century. Shock therapy was practiced, and the first psychotropic medications were given with enthusiasm. The hospital itself was a giant version of a therapeutic community, incorporating a working farm and workshops.

None of it appeared to make much difference to these inmates. As they aged, some of the worst psychoses burned out of their own accord, but few patients were in any condition to be repatriated to the real world. The book’s photographs are transfixing: vibrant young adults newly admitted to the hospital in the grips of wild confusion turn into slack-jawed, dull-eyed (but sometimes quite rational) old men and women.

The photographs, in fact, speak far louder and more clearly than the authors’ strident prose, for what could have been a uniquely affecting work proves to be almost unreadable.

Stories about the experience of illness are in vogue these days. Some seek to humanize medical science, while others (like those in the movie “Sicko” from Michael Moore) aim to change health policy with the brute force of anecdote.

The authors, Darby Penney and Dr. Peter Stastny, are in the second camp. Both are prominent patients’-rights advocates: Dr. Stastny is described on one advocacy Web site as a “dissident psychiatrist” and Ms. Penney as a “long-time activist.” Their platform is clearly stated in the book’s first pages: much mental illness is “understandable reaction to stress,” orthodox psychiatry often “stands in the way of healing” and even the most “distressed” patients will fare better outside institutions.

All may be legitimate subjects for debate, but basing a complex argument on fragmented and archaic case histories is problematic both for science and for style. A coherent scientific argument demands complete, current data, not reinterpreted glimpses of the past. Meanwhile, all the eerie, evocative power of the contents of the trunks is sucked right back up by these haranguing narrators, whose awkward prose thumps and screeches like a politician declaiming through a faulty microphone.

Readers with the stamina to tune them out will be rewarded with an unusual view onto the locked back wards of psychiatry, where that always controversial border between health and illness remains far more mobile and porous than most of us like to think.

The Frenchwoman in whose trunk Edwardian elegance mingled with modern scholarship was transferred among several psychiatric hospitals for her first few years in the system. Still deep in the grips of her obsession with the supernatural, she arrived at Willard State in 1939 at age 43. For decades, she would speak only to demand her release. She developed permanent Parkinsonian symptoms from the drugs she was given. She was discharged to a rooming house in a nearby community in her 80s (“There is no evidence of gross psychiatric symptomatology,” her last physician wrote) and died at 90. She never reclaimed her trunk.

Read more!

Dad Who Put Baby in Oven Faces Penalty - Associated Press

GALVESTON, Texas (AP) -- Jurors who rejected a young father's claim that he was insane when he burned his infant daughter in a microwave must now decide his punishment.

Prosecutors are asking that Joshua Mauldin be sentenced to life in prison for stuffing his daughter Ana in a microwave and turning id t on for 10 to 20 seconds. His defense attorney asked for probation so his client could continue receiving psychiatric treatment.

Jurors deliberated Mauldin's punishment for 2 1/2 hours Tuesday without a decision. They were set to resume working on Wednesday.

Earlier Tuesday, the jury convicted Mauldin, 20, of felony injury to a child, dismissing his claim he was having a psychotic episode when he put his then-2-month-old daughter in a Galveston hotel microwave in May 2007.

Mauldin had pleaded not guilty by reason of insanity. The conviction came after about four hours of deliberations, which began Monday afternoon.

Galveston County prosecutor Xochitl Vandiver asked jurors to give Mauldin a life sentence because Mauldin had given his daughter a life sentence as well -- one of physical and emotional scars.

Mauldin at first told police his daughter had been severely sunburned, later changing his story and saying he had accidentally spilled hot water on her while making coffee.

Ana suffered second- and third-degree burns to her left ear, cheek, hand and shoulder and required two skin grafts after being in the microwave. Part of her left ear had to be amputated.

''She will always for the rest of her life be reminded just by looking in a mirror,'' Vandiver said.

Prosecutors said Mauldin was angry that he was in a loveless marriage and took it out on his daughter. Just before putting her in the microwave, Mauldin had punched the baby and put her in the hotel-room safe and refrigerator.

They also said Mauldin had a history of violence and of lying about being mentally ill to get out of trouble.

But Mauldin's defense attorney, Sam Cammack III, said Mauldin has been wracked by mental illness since he was 10 years old. Cammack asked jurors to be merciful and give his client probation so he could continue receiving treatment.

Michael Fuller, a psychiatrist who examined Mauldin, earlier testified he could not conclude Mauldin was insane at the time of the crime. However, Fuller on Tuesday said Mauldin was not violent and would benefit from receiving treatment outside of prison.

''Let's give the kid the rest of his life in prison for hurting his child when we can't explain what happened? Don't do that,'' Cammack told jurors.

During the trial's punishment phase, Mauldin's mother, Joanie, pleaded for mercy.

''There is no way someone in their right mind would do something like that,'' Joanie Mauldin told jurors, crying.

Heather Croxton, Ana's foster mother, testified the little girl's wounds still need to be cleaned every day, and that she screams during the painful process. The little girl, who lives with Croxton and her family in College Station, has physical therapy five days a week.

Croxton said she hopes to adopt Ana, who turned 1 earlier this month. A trial to terminate the Mauldins' parental rights is scheduled for April.

Read more!

Colleges Ponder Anti-Drinking Efforts - Hartford Courant

By DANIELA ALTIMARI

MIDDLETOWN —

Colleges across Connecticut have taken a number of steps to cast off the drinking culture that infuses so much of campus life.

The tactics they've employed include strictly enforcing existing rules, aggressively screening students for signs of risky behavior, establishing peer support programs and enlisting the help of local police, bar owners and those hovering "helicopter" parents.

"Have we solved the problem? Not yet," said Walter Bernstein, vice president of Western Connecticut State University. "But I am convinced that the first step toward solving the problem is admitting that a problem exists."

The scale of that problem was on full display Monday, when leaders from more than 20 colleges in Connecticut came to Wesleyan University to honor the work they have already done and remind themselves of just how much more remains.

The statistics are startling: About half of all college students in the U.S. binge drink or abuse drugs.

One quarter of them meet the medical criteria for drug or alcohol dependency, compared with about 8.5 percent of the general population. And college women, though they lag behind their male peers in terms of alcohol consumption, are catching up fast.

Those are the findings of a 2005 study conducted by the National Center for Addiction and Substance Abuse at Columbia University. Joseph A. Califano Jr., founding chairman of the center and one-time chief domestic aide to President Lyndon Johnson, presented Monday's keynote address.

"Thirty-two kids were killed [at Virginia Tech] by a crazy kid with a gun and the nation went into mourning," Califano said. Yet every week, more than two dozen college students die because of injuries related to alcohol or drugs and scarcely anyone notices, he said.

Drug use is also increasing, according to Califano. Four percent of college students said they used marijuana daily, according to the study. That is even more troubling because today's marijuana is far more potent that that of the 1960s and '70s. "It's not the right of passage parents might have thought it was," Califano said.

The colleges and universities represented on Monday are part of the Connecticut Statewide Healthy Campus Initiative, a partnership of the state departments of mental health and addiction services and higher education, as well as the Governor's Prevention Partnership. They range in size from tiny Lyme Academy College of Fine Arts (total enrollment: about 180 students) to the University of Connecticut.

But each has a stake in addressing risky behavior among its students. It is "part and parcel of our mission," said Wesleyan President Michael Roth. "You cannot learn the things you need to learn as a college student if you continue on a path" of unhealthy behavior, he said.

Read more!

After Campus Shootings, U.S. to Ease Privacy Rules - New York Times

By TAMAR LEWIN

The Federal Education Department proposed on Monday new regulations to clarify when universities may release confidential student information and, after the Virginia Tech shootings last year, reassure college officials that they will not face penalties for reporting fears about mentally ill students.

The proposed regulations were prompted by concerns that colleges were overemphasizing the students’ privacy rights under the Family Educational Rights and Privacy Act to not intercede with young people who appear troubled.

Although the law has always had a health and safety exception that allows releasing confidential information in emergency situations, many college officials have been wary of invoking it, fearful of being found to violate the federal privacy law.

Even though the regulations would provide no major substantive changes, lawyers who specialize in education said they were important to the extent that they stop administrators from invoking the privacy act as an excuse for inaction.

“You’re the dean, you think a student’s in trouble, and you want to pick up the phone to call his parents or his doctor,” said Sheldon Steinbach, a lawyer at Dow Lohnes in Washington. “But you’re worried that you’re violating the law and you’re going to lose all your federal funding.”

“The safety and health provision’s always been there,” Mr. Steinbach continued. “But these regulations provide a psychological safety net for young, risk-averse administrators.”

The Virginia Tech shootings in April left 33 people dead, including the student gunman, Seung-Hui Cho. A report by a panel that Gov. Tim Kaine of Virginia named found that because university officials misunderstood federal privacy laws as forbidding any exchange of a student’s mental health information, they missed numerous indications of Mr. Cho’s mental health problems.

A federal report in June found widespread confusion over the laws.

“There were concerns and confusion about the potential liability of teachers, administrators, or institutions that could arise from sharing information, or from not sharing information, under privacy laws, as well as laws designed to protect individuals from discrimination on the basis of mental illness,” that report said. “It was almost universally observed that these fears and misunderstandings likely limit the transfer of information in more significant ways than is required by law.”

The new rules would create a safe harbor for campus administrators who see a significant threat to the health or safety of a student or others and disclose confidential information to people who can respond.

“If, based on the information available at the time of the determination, there is a rational basis for the determination, the department will not substitute its judgment for that of the educational agency or institution in evaluating the circumstances and making its determination,” the proposed regulations said.

Ada Meloy, general counsel of the American Council on Education, said the proposed regulations should prove helpful.

“Colleges and universities tend to be very law abiding and sometimes go too far to be sure they’re in compliance,” Ms. Meloy said. “But because of the shocking nature of recent happenings on some college campuses, there is more understanding that to err on the side of withholding information can have dire consequences.”

The proposal would also bring the 1974 privacy law into the 21st century. It would extend coverage to students attending class online, discuss data theft and let universities release student information to contractors and consultants to whom they outsource work.

The proposal also clarifies, but does not change, the often misunderstood rules on parents’ access to their children’s college grades and other records. The privacy law lets universities give parents the education records of students claimed as dependents on their tax returns.

Universities may also give parents information about students younger than 21, dependent or not, if they violate drug or alcohol policies.

Read more!

One Drug, Two Faces - New York Times

By ALEX BERENSON

ANCHORAGE — Two courtrooms, two floors of the Nesbett Courthouse, two views of Zyprexa.

In Courtroom 403, lawyers read corporate memorandums to a jury that must decide a lawsuit brought by the state of Alaska, which claims that the drug maker Eli Lilly hid the dangers of Zyprexa, Lilly’s best-selling schizophrenia medicine.

At the same time, in Courtroom 301, William Bigley had his own opinions on Zyprexa, and all the other drugs he has taken since 1980 to battle demons that only he can see. On this day, March 14, a state court judge would decide whether Mr. Bigley should be held for 30 days in a psychiatric hospital.

Mr. Bigley, 55, told the judge that the drugs were “poison” and that he did not need them. “I’m fine,” he said. His words were sadly undercut by his regular pronouncements that he knows President Bush, owns a private jet and has seen flying saucers. Of all the facts at issue in the two courtrooms, one is beyond debate. Mr. Bigley is not fine.

Even so, Mr. Bigley’s hearing — which had an unexpected outcome — offered a textbook illustration of the agonizing choices faced by mentally ill patients as they consider taking Zyprexa and similar medicines, called antipsychotics.

By calming the hallucinations and delusions that plague people with schizophrenia, drugs like Zyprexa allow many patients to live outside psychiatric institutions.

But the documents being discussed in Room 403 offered plenty of evidence that Mr. Bigley, whatever his delusions, has good reason to dislike the medicines.

All antipsychotics have side effects, and Zyprexa’s are among the worst, according to the American Diabetes Association and independent scientists. In many patients, Zyprexa causes severe weight gain that can lead to diabetes, as well as sharply higher cholesterol and triglyceride levels in the blood. Those are all risk factors for heart disease, the leading killer in the United States.

Further, the documents introduced in Courtroom 403 show that for much of the last decade, Lilly executives played down those risks. Among themselves, in internal e-mail messages and memorandums, they shared worries that Zyprexa’s sales would fall if the drug was linked to weight gain or diabetes.

In 2002, for example, the Japanese government ordered Lilly to warn Japanese doctors against giving Zyprexa to people at high risk for diabetes. But Lilly did not add a similar warning to Zyprexa’s label in the United States. Internally, Lilly executives acknowledged that the warning had hurt Zyprexa sales in Japan.

“The impact of the label change in Japan has been very profound,” two senior Lilly executives wrote in a memorandum on July 1, 2002. “There has been a 75% drop in new patients who are being put on the drug.”

Indeed, as American doctors have learned on their own about the connection between Zyprexa and diabetes, prescriptions for Zyprexa have plunged. Since 2003, they have slid 50 percent.

Yet Zyprexa, which sometimes works better than other antipsychotics on severely ill patients, remains widely used. In the United States, it is still prescribed almost four million times a year. It had sales worldwide of $4.8 billion in 2007, half in the United States.

Mr. Bigley’s case illustrates why psychiatrists and patients feel they have no choice but to use Zyprexa, whatever its side effects. Mr. Bigley, a thin man with greasy black hair, cloudy eyes and a salt-and-pepper beard, has been hospitalized more than 70 times since his first breakdown in 1980.

Psychiatrists say he has paranoid schizophrenia with symptoms of mania. Over the years, he has been medicated with Zyprexa, Risperdal, Haldol, Thorazine and many other psychiatric drugs, despite his objections.

Exactly how many times Mr. Bigley has been put on Zyprexa over the years is unclear. But medical records from his hospitalization in December 2006 refer to his complaints that Zyprexa was making him hungry — a common side effect. Psychiatrists took him off Zyprexa and gave him Seroquel, another antipsychotic, in its place.

In 1999, a judge found him incompetent to care for himself and appointed a guardian to oversee his affairs.

The records also show that neither Zyprexa nor any other drug has given Mr. Bigley any lasting relief, and that he always stops taking his medicines after being released from the hospital. Unmedicated, Mr. Bigley is jittery and quick to anger. In conversations with a reporter, he was nearly incomprehensible, spewing complaints and curses about the way he is treated.

But Mr. Bigley has never been known to be violent or suicidal. Despite his psychosis, he has survived Alaska’s harsh winters. He bounces among apartments, group homes and the Alaska Psychiatric Institute, the state-run mental hospital in Anchorage, mumbling about the Secret Service and other favorite topics to anyone who will listen.

But he makes one point with absolute clarity: He does not want to be medicated or hospitalized.

On March 14, he repeated that request to state court Judge Jack W. Smith, who was hearing the psychiatric institute’s request to confine him.

There was little reason to believe that Judge Smith would side with Mr. Bigley. Hearings like his usually last only a few minutes. Psychiatrists and advocates for the mentally ill say that judges prefer not to second-guess doctors and typically rubber-stamp the requests of hospitals to confine and medicate patients.

As he sat before Judge Smith, Mr. Bigley — who had asked that his hearing be open to the public — hardly seemed like a good candidate for release. He fidgeted and interrupted the proceedings as his lawyers shushed him. He had been brought to the Alaska Psychiatric Institute on Feb. 23, after squabbling with housemates at his group home, where a resident called the police.

Dr. John Raasoch, a doctor at the hospital who treated Mr. Bigley, said that Mr. Bigley had irritated the staff and other patients.

“He’s yelling, swearing on the unit, he hit the door,” Dr. Raasoch said. Antipsychotic medication would calm Mr. Bigley and make him more cooperative, the doctor said.

“There’s no point to have a psychotic individual in the hospital and not be able to treat him,” he said. “I think he’s suffering severe distress.”

But Judge Smith appeared worried about both the side effects of antipsychotic medicines and that Mr. Bigley’s history suggested he would not benefit from them.

“We’re getting a short-term fix that doesn’t change Mr. Bigley’s underlying condition,” he said.

Under Alaskan law, a person cannot be forced to take medicine against his will simply because a psychiatrist says he is unhappy or delusional. Mr. Bigley could be confined and medicated only if Judge Smith found he was violent, suicidal or a grave danger to himself because of his mental incompetence.

Mr. Bigley was not violent or suicidal, Dr. Raasoch said. But the doctor said he was in grave danger because he might irritate other people, including police officers, to the point where he might end up being hurt.

“He’s very inappropriate,” Dr. Raasoch said. “He gets up in people’s faces. I think the majority of people would just punch him.”

Elizabeth Brennan, the public defender representing Mr. Bigley, agreed that Mr. Bigley can be difficult. But Mr. Bigley is not in grave danger simply because he is a nuisance, and confining and medicating him would not help him, she said.

“The hospital has not shown that treatment will improve him,” she said.

After nearly an hour of testimony, mainly from Dr. Raasoch, Judge Smith appeared troubled by the thought of confining or medicating Mr. Bigley against his will.

“It sounds like aside from getting in and out of the hospital, he gets by,” the judge said. “That’s a choice that he should be allowed to make.”

And so Judge Smith ordered the hospital to release Mr. Bigley, though he acknowledged that Mr. Bigley was likely to be picked up again in a few weeks, or months at most.

“I don’t find by clear and convincing evidence he’s gravely disabled,” Judge Smith said.

Though the decision was unusual in such cases, Mr. Bigley did not seem overly surprised, or even pleased.

“There’s nothing wrong with my head in the first place,” he said to the judge, inserting a seven-letter epithet. Within a few seconds, he began to hector Steve Young, his state-appointed guardian, demanding that he be given a hotel suite. “He’s going to give me a dirty place,” Mr. Bigley complained.

With that thought, Mr. Bigley headed for the street, his brain in chaos but his body free from the side effects of the medicines he will not take. One floor up, lawyers for Lilly and the state argued on, debating whether Zyprexa’s benefits outweighed its risks — a choice Mr. Bigley, sound mind or not, had already made.

Read more!

State Offers Settlement To Families Of Victims - Washington Post

By Tim Craig

RICHMOND, March 24 -- State officials are offering the families of those killed in the April 16 Virginia Tech massacre about $100,000 each if they give up their right to sue the state and university, officials and family members familiar with the agreement said last night.

Under the proposed offer, the state would not admit liability but would justify the payments as a way to avoid a series of lawsuits. The offer came after several weeks of closed-door talks between attorneys for the state and attorneys for families of the victims.

The office of Gov. Timothy M. Kaine (D) declined to comment last night. Several family members refused to comment publicly last night, describing the offer as something that could change. The Associated Press reported last night the family members have until March 31 to accept the offer.

As part of the deal, the state would create a fund to help pay for the medical expenses of some of the more than two dozen students and faculty members injured in the shooting, state officials familiar with the offer said. The families of the 32 victims killed by the shooter would get about $100,000 each. The money would come from taxpayers.

Any settlement or payout from the state would be in addition to the $8.5 million in private donations that Virginia Tech distributed to the victims and their families last fall.

The families of those killed in the shooting by Virginia Tech student Seung Hui Cho of Fairfax County received payments of $208,000, unless they wanted a portion of the money to be used for a memorial scholarship. The injured received between $40,000 and $90,000 and free tuition, depending on the lengths of their hospital stays. The money was free of state and federal taxes.

More than two dozen victims filed claims against the state's insurance policy in October, the first step in possible legal action. The claims alleged that Virginia Tech and the state were negligent in the shootings because they failed to respond to Cho's mental disorder soon enough, did not quickly lock down the campus the day of the shootings and failed to have an effective emergency response plan. Cho killed himself.

State officials had argued that Virginia's liability would be limited because of the legal protection known as "sovereign immunity," a concept that it can do no wrong and cannot be sued. In the 1970s, the General Assembly waived the state's immunity for tort claims but capped potential damages at $100,000.

Read more!

Virginia offers Tech shooting victims' families $100,000 in settlement - The Associated Press

RICHMOND -- Families of those killed in the Virginia Tech massacre would receive $100,000 each under a settlement the state is proposing to prevent lawsuits, according to a victim's relative who received a copy of the proposal.

Medical and counseling expenses would be provided to the families of the 32 killed and dozens of surviving victims, said the person, who asked Monday to remain anonymous because those involved were told not to discuss the settlement.

Families would also have the opportunity to question the governor and university officials about the shootings, according to the family member.

Families were asked to say by March 31 whether they were comfortable with the proposal. If they agree, they cannot sue the state government, including Virginia Tech.

Seung-Hui Cho, a mentally disturbed student, killed the 32 victims and wounded several others at Virginia Tech on April 16 before committing suicide.

At least 20 families have filed notice with the state that they may sue. They have until April 16 to make such filings.

Attorneys for families and officials in the governor's office did not immediately return calls to The Associated Press.

"My people are pretty unhappy with it, and I don't blame them," Edward Jazlowiecki, a lawyer for the family of slain student Henry Lee, told The Virginian-Pilot of Norfolk.

Jazlowiecki said Lee's family faults Virginia Tech for not warning those on campus sooner that a gunman may be loose.

Cho shot his first two victims in a dormitory just after 7 a.m., but university officials did not send an e-mail alert until more than two hours later - just before Cho killed 30 others in a classroom building across campus.

The proposal would require all claimants to agree and says the state can withdraw the proposal if not enough parties do, the family member said. Other relatives of victims declined to talk to the AP.

In addition to the $100,000 payments to each of the families of those killed, another $800,000 would be reserved for the injured, with a maximum of $100,000 to any person.

The proposal also would set up a fund to reimburse or advance expenses not covered by insurance for medical, psychological and psychiatric care for victims and their immediate families.

Gov. Timothy M. Kaine would meet with victims and relatives three more times over the next two years to review legislative and administrative responses to the shootings.

Victims and families also could meet with senior Virginia Tech officials within six months of the settlement to ask questions and discuss changes made to the campus since the tragedy, as well as memorial activities. They also would receive an update on the investigation from the university and state police.

In October, the families and surviving victims received payments ranging from $11,500 to $208,000 from the Hokie Spirit Memorial Fund, set up in the days after the April 16 shootings to handle donations that poured into the Blacksburg school.

The proposed settlement would keep the fund, which had been scheduled to close this past December, open to accept contributions for at least five more years.
Read more!

Mental-health care at crisis point in county -Sonoma (CA) Index-Tribune

By Emily Charrier INDEX-TRIBUNE STAFF WRITER

Sonoma County, like so many regions in America, is reaching a crisis point in the quest for mental-health care. Dwindling county resources and limited state and federal reimbursement has made mental-health care the redheaded stepsister to physical health care, and more and more hospitals are slashing programs to save cash.

Mental-health care professionals seem to agree that the answer to this problem lies in merging the public and private sectors of health care.

"The county needs to hold the private sector just as responsible," said Dr. Dick Kirk, a Sonoma-based psychiatrist and a member of the Sonoma Valley Health Care District board. "We need to all come together and figure out what's best for our
community."

In February, Santa Rosa Memorial Hospital announced that it would be closing its 18-bed psychiatric unit in April, after the unit reportedly lost $22 million in the last three years. The facility was the last inpatient psychiatric unit in the county, leaving residents with only Psychiatric Emergency Services in Santa Rosa, which can hold clients for a maximum of 23 hours. The patients from Memorial's unit will now become the county's responsibility. Due to limited bed space, many will be sent to hospitals outside the county for treatment.
"These would have been losses absorbed by Memorial," said Art Ewart, Sonoma County's director of mental health services. "But the bottom line is that these costs will be shifted to the public sector in the forms of letter of guarantee payment we send along with patients being admitted to regional hospitals."

Ewart agrees with Kirk that the private sector should be held responsible for providing some portion of mental-health care. Ewart said his office has been working with officials at Memorial and Kaiser to attempt to develop a joint venture in mental-health care. He said his department is examining what would be required to open a 16-bed acute-care facility, and discussions are ongoing.

"Whatever is done, the county must have partners in this venture," Ewart said. "This is a public/private problem to be solved."
State and federal reimbursement of mental-health care is at an all-time low, with the average larger hospital like Memorial being reimbursed for only three (days) out of a nine-day hospital stay, giving many hospitals incentive to cut mental-health programs and facilities. In turn, the county is receiving less and less money from the state, meaning many non-hospital mental-health programs are getting cut.

"The public sector is poorly financed for its essential mission - treatment of the seriously mentally ill - let alone picking up responsibility for the larger numbers of mild- to moderate-mentally ill (clients)," Ewart said.

Kirk said the county must take the reigns on the issue of mental-health care, but he does see the potential for smaller district hospitals to help. Last year Sonoma Valley Hospital joined with the Palm Drive Hospital District, the North Sonoma County Hospital District and the Mendocino Coast District Hospital to sign a joint powers agreement and create the Northern California Health Care Authority (NCHCA). This will allow the hospitals to share specialists, equipment and resources to save costs at all the participating hospitals.

While the organization is still defining its goals, Kirk said he has hopes of integrating mental-health care into NCHCA's mission. He said this could come in the form of a local referring system, which would help ensure mental-health care patients can navigate the path to treatment.

"It could be the equivalent of having local community mental health centers through the district hospitals. It may be an experimental pilot program through the JPA," Kirk said, adding that he also plans to reach out to the mental-health clinics around the county to join the joint powers agreement. "We need to expand so it's not just a group of district hospitals," he said.

For the time being, mental-health patients in Sonoma are left with few places to turn. As mental-health care falls more and more on the public sector, many have expressed concerns that jail will become a holding pen for the mentally ill. Ewart said this is not the case.
"We track the number of mentally ill in jail very carefully and that number has not changed in the last several years," he said. "I do believe there is evidence that homeless mentally ill people, particularly those with substance abuse issues, do get arrested more often than others with mental illness. That is why we were dismayed to see the governor's budget last year will end all the homeless mentally ill grants around the state. That was an over $2 million program we've had to dismantle."

Ewart knows Sonoma County's mental-health care system is riddled with problems, but said it will take more than the county's efforts to solve the mental-health care crisis.

"This inpatient crisis in Sonoma County is symptomatic of a larger health-care reimbursement crisis in the United States," he said. "The county will not be the default provider of a failed national health-care reimbursement system." Read more!

Mental health care coverage may get boost -Tuscon (AZ) Citizen

Mom goes without insurance to help pay son's medical bills

RYN GARGULINSKI
Tucson Citizen

Samuel Woodburn is only 9, but he already has four diagnosed ailments, regularly takes three medications and has had five doctors' appointments this month.

His mother goes without health insurance so his family can pay the medical bills that mount because of limits the insurance company places on mental health care.
"We chose Sam over me," said Rhonda Woodburn, 50. "We don't have a choice; he has all his stuff. I go every day hoping I won't fall, I won't get hurt."

Unlike many other states, Arizona does not require health insurance companies to offer the same level of coverage for mental health care as required for physical health care.

Mental health copays and deductibles are often higher, covered hospital stays are often shorter and limits are frequently set on the number of visits to a mental health specialist each year.

Coverage gaps lead to mental illness that goes untreated or even undiagnosed, mental health advocates say, which can cost all of us.

"Clinical depression is the single-biggest cause of lost time and hours in American business today," said Clarke Romans, executive director of the southern Arizona chapter of the National Alliance on Mental Illness. "It's bigger than our diseases, respiratory illnesses and other major sources of lost time to American employers."
Hope, and help, may be on the way for families such as the Woodburns, with legislation offering mental health care parity.

Four proposals at the state and federal levels target the limitations private companies place on mental health treatment.

Although the language differs slightly in each bill, the intent is the same: equal coverage.

Efforts over the years in the state Legislature to achieve equal coverage have failed, supporters say, because of powerful business and insurance lobbies and a continuing stigma against those with mental illnesses.

Insurers argue they provide what's most needed and that their services are adequate.

"We design our benefit plans to reflect market demands," said Regena Frieden, spokeswoman for Blue Cross Blue Shield of Arizona. "We believe our mental health benefits are strong, and this is a mandate, not a market-driven decision."

The two federal bills hold the most promise of becoming law, with the U.S. Senate passing its version in September and the U.S. House of Representatives passing its on March 5.

Now the two chambers need to agree on a version they can pass along to the president to sign into law.

There is less hope at the state level, where both the Senate and House bills are stalled. They have been referred to committees, but no hearings are scheduled.
An estimated 100,000 people in the greater Tucson area have a serious mental illness diagnosis such as schizophrenia, bipolar disorder or major depression, Romans said.

At least 80,000 lack diagnosis or treatment, he said.

"Yes, you can function," Romans said. "You can absolutely function. But you are known as the weirdo on the job or someone who has a hell of temper or for breaking down and crying or some other behavior. Many people go through life undiagnosed and untreated, so they cope."

Even those whose conditions have been diagnosed may go untreated - unless they or their spouses are among the 10,000 whose incomes are low enough to qualify for state-funded mental health services or they are among the 2,000 who can pay out of their pockets once private insurance benefits run out, Romans said.

"What really totaled me is why insurance companies fight this," he said. "Many studies have shown when companies offer this coverage, overall, economically it's a winner, or at least it breaks even."

One study, conducted by Delta Airlines in the 1990s, showed that employees were happier and more productive with increased mental health benefits, according to the federal agency Substance Abuse and Mental Health Services Administration.

The cost of Delta's mental health program is only 10 percent of its overall health care budget, SAMHSA reported.

The National Business Group on Health found treatment for mental illness and substance abuse in 2001 totaled $104 billion, which is less than 8 percent of the $1.4 trillion spent on overall health care across the nation.

Katie Smith, 48, has been wrestling with major depression along with attention deficit and anxiety disorders for years. She also struggles with the coverage of mental health care provided by her husband's insurance plan.

She's been hospitalized eight times for mental health issues, three recently in Arizona for which her copay was $500 per visit. If those visits had been for physical health issues, each copay would have been $200.

"It came out of my pocket," she said. "It put us in debt. We had to put it on our MasterCard."

The insurance also limits in-patient stays for mental health care to 30 days, Smith said.

"If it were a physical medical condition, it would be up to the doctor to stay as long as necessary," she said. "And it would be covered."

Smith also has a higher copay for treatment by mental health specialists than physical health specialists and her visits are limited to 30 per year.

Last year, she needed four extra visits: two at $75 each and two at $115 each.
Many people need weekly therapy sessions, exceeding the 30-visit limit, Romans said.

Samuel's diagnosed conditions include:

• Speech apraxia, in which a person has trouble saying what he wants to say correctly and consistently.

• Hypoxemia coordination disorder, in which too little oxygen gets to the brain, resulting in poor judgment, memory loss, inattentiveness and a decrease in motor coordination.

• Asperger syndrome, which is similar to autism and may manifest in difficulty reacting in social situations, inability to pick up on social cues, dislike of any change in routine, apparent lack of empathy, unusual facial expressions or postures, delayed motor development and heightened sensitivity to loud noises, lights or strong tastes or textures.

• Attention deficit hyperactivity disorder, which commonly results in impulsiveness, hyperactivity and inattention.

A month's worth of a single medication can cost $140, with just a fraction covered by insurance, Woodburn said.

If the Woodburns qualified for a public-funded system, the medication would be free.

"Last time I checked, my husband made $70 over the limit that would qualify us," she said.

Although Samuel needs speech therapy in addition to what he receives in his third-grade special education classes, Woodburn said the family cannot afford it.
"Mental illness has a 72 percent success rate for recovery," Romans said. "Compare that with the best practices for heart disease, with 52 percent, or respiratory ailments with 42 percent."

The key, however, is being able to afford the treatment.
"We're scared," Woodburn said, especially when the economic downturn makes affording groceries tricky.

"It's hard," she said, "and I know I'm not the only parent in this position. It's sad. It's really, really sad."

The Arizona Republic contributed to this article. Read more!

From Forgotten Luggage, Stories of Mental Illness -New York Times

By ABIGAIL ZUGER, M.D.

The Lives They Left Behind
By Darby Penney and Dr. Peter Stastny. Bellevue Literary Press. 205 pages. $25.

A trunk in a dusty attic holds a sleeveless peach-colored silk dress belted in creamy lace, a cane topped with a carved duck’s head, kid gloves, a riding habit, a few red leather date books and an eight-page typed essay analyzing Napoleon Bonaparte’s love life.

Trunks like it usually inspire dress-up games, memory exercises and writing class assignments, not works of medical history— although that discipline could often sorely use some human interest. This particular trunk is an exception: it belonged to a delicately featured Frenchwoman who walked into Bellevue Hospital in Manhattan one day in 1932 to engage the doctors in a dialogue on paranormal communication, and was committed to psychiatric wards for much of the rest of her life.

She wound up a long-term resident of Willard State Hospital, a gigantic institution in upstate New York that opened its doors to the incurable mentally ill in 1869 and closed in 1995, sending its last thousand or so patients out to smaller facilities. Left behind in an upstairs storeroom were hundreds of pieces of patients’ luggage.

Curators poking through were transfixed by the power and pathos of the contents, their ordinariness a sad contrast to the tangled aberrancy of the owners’ lives. After a decade of cataloging and research, a small subset of the material became the subject of an exhibition, and now a book.

One set of 18 pieces of luggage held the complete wardrobe and household goods of a successful midcareer nurse who became convinced her co-workers were conspiring against her. She reluctantly assented to temporary hospitalization at Willard and never left; increasingly incapacitated by paranoia and old age, she died there in her 80s.

One suitcase of small items (including a bronze model of the Washington Monument) belonged to an upstate carpenter whose obsession with Margaret Truman and repeated efforts to contact her for marriage earned him attention from the Secret Service, even within the walls of Willard. The government lost interest when he developed delusions of being Jesus Christ, although his family in Ukraine continued to write to his doctors for decades.

One dilapidated satchel of religious materials belonged to a German-born Dominican nun whose life slowly crumbled into a confusion her order wanted no part of. In the hospital, she was lewd and flirtatious, proposed marriage to a variety of men, spoke of giving birth to a dachshund and of her breakfast eggs hatching to chickens in her stomach. In her old age she announced she was 11 and happily waited to be sent home.

These patients stayed at Willard through the treatment vogues of the last century. Shock therapy was practiced, and the first psychotropic medications were given with enthusiasm. The hospital itself was a giant version of a therapeutic community, incorporating a working farm and workshops.

None of it appeared to make much difference to these inmates. As they aged, some of the worst psychoses burned out of their own accord, but few patients were in any condition to be repatriated to the real world. The book’s photographs are transfixing: vibrant young adults newly admitted to the hospital in the grips of wild confusion turn into slack-jawed, dull-eyed (but sometimes quite rational) old men and women.

The photographs, in fact, speak far louder and more clearly than the authors’ strident prose, for what could have been a uniquely affecting work proves to be almost unreadable.

Stories about the experience of illness are in vogue these days. Some seek to humanize medical science, while others (like those in the movie “Sicko” from Michael Moore) aim to change health policy with the brute force of anecdote.

The authors, Darby Penney and Dr. Peter Stastny, are in the second camp. Both are prominent patients’-rights advocates: Dr. Stastny is described on one advocacy Web site as a “dissident psychiatrist” and Ms. Penney as a “long-time activist.” Their platform is clearly stated in the book’s first pages: much mental illness is “understandable reaction to stress,” orthodox psychiatry often “stands in the way of healing” and even the most “distressed” patients will fare better outside institutions.

All may be legitimate subjects for debate, but basing a complex argument on fragmented and archa