Health care providerws still owe $1.4 million -Elizabeth City (NC) Daily Advance

By BOB MONTGOMERY

While one local health care provider has satisfied its nearly $500,000 Medicaid debt with the state, four others with area offices still owe nearly $1.4 million, according to the N.C. Department of Health and Human Services.

The four private providers with offices in Elizabeth City are: Life Inc., 405 W. Main Street; Pride in North Carolina Inc., 905 Halstead Boulevard; Innovative Programming Associates (IPA), 1023 U.S. Highway 17 South; and Health Services Personnel, 905 Halstead Boulevard.

Those four firms owed a total of $1.8 million and have repaid through withholding of payments $438,082 to date — or about 24 percent of the debt, according to data from the state DHHS.

DHHS spokesman Brad Deen estimates that 500 community service providers statewide owe a total of nearly $60 million in Medicaid repayments that were used for non-qualified services. The federal government announced in mid-April that it was withholding at least $138 million from North Carolina in Medicaid funding until it submits an acceptable plan to deal with the misspent funds.

All of the firms, which are paid to provide counseling and other services to mental health patients, were ordered to repay the monies DHHS said had been misspent. To speed up the recoupment, DHHS began withholding 10 percent of the firms' Medicaid reimbursements.

One local firm that owed $483,041, American Health and Human Services, has satisfied all its debt, Deen said.

Meanwhile, the other four with offices in Elizabeth City have satisfied roughly one-quarter of their debt through withholdings. According to DHHS records:

— Life Inc., which owed $1.1 million, has repaid $315,643.

— Pride in North Carolina Inc., which owed $459,051.12, has repaid $112,989.71.

— Health Services Personnel, which owed $137,784.84, has repaid $60,104.57.

— Innovative Programming Associates (IPA), which owed $129,159, has repaid $49,345.15.

When contacted, the local providers referred questions to their corporate offices.

Life Inc. executive vice president Sammy King referred questions to Sharon Raynor, president, who could not be reached.

Health Services Personnel executive Jim Southern declined to comment and referred questions to Todd Key, state director, who could not be reached.

IPA 's Tonya Boyce in Elizabeth City could not be reached for comment.

Meanwhile, Pride in North Carolina Inc.'s president, Deanna Janus, said she has appealed the state's action, although the state is still continuing to withhold 10 percent.

She said some of the funds the state wants to collect are for services that providers were told to continue providing for existing patients — then later told not to.

"The division was very clear not to reduce services," Janus said. "We were told to continue (treating them) as community service providers."

Janus said her business has tried hard to follow all the rules, many of which were unclear and provided "little guidance" from the outset.

"They set up a system destined to be abused by providers without integrity," she said. Read more!

Mentally ill Michigan inmates not being treated, expert says - Grand Rapids Press

By Pat Shellenbarger

GRAND RAPIDS -- The 31-year-old man came into prison with a long history of mental illness, including a diagnosis of bipolar disorder, depression and a couple of suicide attempts. He complained of hearing voices telling him to assault others.

Yet a prison psychologist doubted the inmate was mentally ill and suggested he stop taking the medications intended to control his mood swings and quiet the voices in his head.

Such instances of mentally ill inmates being misdiagnosed or undiagnosed are fairly common, an independent psychiatrist testified Tuesday during a hearing on a long-running federal lawsuit over conditions in a Jackson prison complex.

Only about 6 percent of inmates in the three facilities -- known as the Reception and Guidance Center, Duane Waters Health Center and the C Unit -- are treated for serious mental illnesses, well below the national average of 15 percent to 30 percent, testified Dr. Terry Kupers, a California psychiatrist who specializes in prison mental health issues.

"That is way below what other states are doing," he said.

The reason is not that Michigan's inmates have fewer mental problems, Kupers said, but their mental illnesses are going undiagnosed.

"This creates a problem," he said. "The biggest problem is people who need psychiatric treatment aren't getting it."

Kupers, called as an expert witness by attorneys representing inmates in the class-action lawsuit, spoke the day after another psychiatrist, Dr. Jeffrey Metzner, testified the state Department of Corrections is doing an adequate job of identifying mentally ill inmates.

Kupers testified some inmates told him they were advised by prison psychologists not to seek treatment for their mental illnesses, because it could hurt their ability to get into some prison programs and might discourage the parole board from releasing them.

He traced the problem to the 1980s, when the state closed most of its mental hospitals, releasing patients into the community. While funding for mental health programs was cut, many mental patients ended up homeless, and some were convicted of crimes.

"So the number of people with mental health problems in the prisons has increased massively," Kupers said, adding that the number of mental health workers in the prisons "has not kept pace with the rising population of mentally ill inmates."

Last July, he interviewed 37 inmates who had been diagnosed as not needing treatment and concluded several had serious mental illnesses. Many mentally ill inmates end up in segregation, sometimes known as solitary confinement, which only aggravates their illness, Kupers said. Some decline treatment for their mental illness, he said, because it could mark them as weak, making them a target for other inmates.

"They know they're mentally ill," he said. "They isolate themselves, which makes their mental illness worse. Prisoners tell me if you show weakness, you will be assaulted. It's dangerous to be slight, to be gay, to be weak."

American Civil Liberties Union attorney Elizabeth Alexander, representing the inmates, claimed the mental health care in the prisons is unconstitutionally inferior. Assistant Attorney General Peter Govorchin, representing the Department of Corrections, disagreed and wants U.S. District Judge Robert Jonker to dismiss that portion of the long-running lawsuit.

"You'd have thought we were talking about two different places," Govorchin said during a break in the hearing.

Send e-mail to the author: pshellenbarger@grpress.com

Read more!

Teen's dark dreams raise 'mental issues' -The Columbia (SC) State

By LEE HIGGINS
lhiggins@thestate.com

FLORENCE — The Chesterfield County 18-year-old accused of plotting to blow up his high school reportedly told a sheriff’s investigator that “once he got to heaven, he was gonna kill Jesus,” an ATF agent testified Tuesday in federal court.

Magistrate Thomas E. Rogers III is weighing whether Ryan A. Schallenberger needs a mental evaluation and is expected to decide in a day or two.

“Given the complexion of this case, I think it’s impossible that there will not be mental issues raised in the trial,” assistant U.S. attorney Buddy Bethea said.

Schallenberger faces federal charges of:

• Attempting to use a weapon of mass destruction

• Attempting to damage, by means of an explosive, property of an institution receiving federal funds

• And receiving an explosive in interstate commerce with the intent to kill, injure and intimidate any person and unlawfully damage property.

If convicted, the straight-A Chesterfield High School senior could spend the rest of his life in prison.

Schallenberger also faces state charges of making bomb threats and possession of explosive materials.

Craig Townsend, an agent with the federal Bureau of Alcohol, Tobacco, Firearms and Explosives, testified Tuesday that Schallenberger told a Chesterfield County sheriff’s investigator “once he got to heaven, he was gonna kill Jesus or something like that.”

Townsend also said Schallenberger waived his Miranda rights and told officers he wanted to kill himself.

“Ryan began (becoming) upset, stating that he wanted to die. Death was better than his life. He only wanted to kill himself,” Townsend said, reading an investigator’s report.

Federal prosecutors have said they were concerned Schallenberger might be suicidal, and he initially was on 24-hour suicide watch last week at the Chesterfield County jail. Schallenberger is now in the jail’s general population.

In court, Schallenberger’s attorney, William Nettles, questioned the prosecution’s urgency in seeking the mental exam. “I think it’s completely premature at this point to order any type of evaluation.”

Nettles said he had only received Schallenberger’s journal and had not had time to review other evidence.

Schallenberger’s 50-page journal — in which police say he detailed plans to blow up Chesterfield High — is temporarily sealed until at least midafternoon Friday, at which point Nettles would have to persuade Rogers to keep it off-limits.

Also Tuesday, the court heard a 911 tape in which the teen’s mother, Laurie Sittley, could be heard asking police to come pick up her son two days before Schallenberger’s arrest.

The dispatcher asked Sittley why.

She replied: “He just smashed his head through the wall, and if the police come here, he’s going to shoot them.”

Police say they found bags of matchstick heads and canisters of carbon dioxide and ammunition in Schallenberger’s room. According to authorities, Schallenberger told investigators he had two cans of gunpowder but couldn’t remember where he had hidden them.

The ATF turned over to the FBI several audiotapes found in Schallenberger’s room. Assistant U.S. attorney Rose Mary Parham, who also is prosecuting the case, said she doesn’t know what is on the tapes.

According to a State Law Enforcement Division analysis of Schallenberger’s computer, it appears that several hundred pages of documents, some detailing bomb-making, were deleted, said Townsend, the ATF agent.

Schallenberger told investigators that he never took explosive materials to Chesterfield High School and that no one else was involved in the plot, Townsend testified.

Over the past year, police say, Schallenberger planned to bomb the school.

His parents called police April 19 when they intercepted a delivery of ammonium nitrate — a fertilizer that, when combined with diesel fuel, can be used to make a bomb.

Schallenberger’s parents were in court Tuesday but declined to comment.

The man who reportedly sold Schallenberger the fertilizer on eBay was a gun enthusiast advertising the product as a substitute for tannerite, which is used in explosive targets, Townsend said.

Investigators later found a yearlong journal Schallenberger had kept and DVDs of two of the most tragic days in American history — the 1995 bombing of the Oklahoma City federal building and the 1999 Columbine High School shootings in Colorado.

Schallenberger had about 20 pounds of ammonium nitrate his parents turned over to law enforcement, federal court documents say.

He admitted he already made two to four pipe bombs, documents say.

Reach Higgins at (803) 771-8570.
Read more!

Deputies shoot, kill man with knives at Calif. court -Associated Press

FRESNO, Calif. (AP) — A man with a history of mental illness burst into a packed courtroom Monday wielding two carving knives and was shot to death as he threatened a judge he may have blamed for his misfortune, authorities said.

Robert Eaton, 40, had an extensive arrest record and last year, rammed his car into the Merced County courthouse out of anger that he was refused treatment by a mental health facility, Merced County Sheriff Mark Pazin said. Merced is about 50 miles northwest of Fresno.

On Monday, Eaton drove back there in a Toyota Camry he hijacked from someone who was hired to take him to a doctor's appointment, Pazin said. He ran past guards and through a set of metal detectors at the front door holding a knife in each hand, he said.

As attorneys and witnesses cried out, Eaton charged through the doors of Courtroom 2 and into the well where lawyers were standing in the midst of court proceedings, Chief Deputy District Attorney Harold Nutt said.

"As soon as he hit the inside doors, I was behind him and I started yelling that he had a knife," said Nutt, who saw Eaton approach as he stood in the hallway talking with a colleague. "The officers started yelling at him, and yelling at everybody else to get down, and at that point it was rather chaotic. People started screaming, people started heading for the door, and I just ran back outside."

As Judge Brian McCabe tried to hurry his court clerks out of the courtroom through his chambers, Eaton held the knives aloft in a stabbing position about 30 feet away, Nutt said.

When Eaton refused to drop the weapons, several officers fired directly at him, and the man died on the courtroom floor, in front of a few dozen witnesses, law enforcement officers and others doing business in the court, Pazin said.

"There is a likelihood that he and Judge McCabe may have crossed paths in his courtroom," Pazin said Monday. "He had the knives in tow and literally left the vehicle running and came straight over to the courthouse."

Nutt said a public defender told him he recognized the suspect as a previous client with a history of mental illness.

Eaton had an arrest record dating back nearly two decades for car theft, vandalism and other charges, Pazin said.

No other injuries were immediately reported, but the courthouse was locked down for hours as investigators interviewed witnesses and officers involved in the incident, said sheriff's spokesman Tom MacKenzie. Read more!

N.J. Gov's Medicaid co-pay plan troubling, human services chief concedes - Assoiated Press

The state human services commissioner Monday said it was a "valid concern" that poor people would avoid medical care if Gov. Corzine's proposal to charge them new fees for prescription drugs and some hospital visits is approved.

Corzine proposed co-payments for Medicaid recipients to raise $7.55 million for the cash-strapped state budget.

Legislators fear the payments could prompt poor people to forego health care, especially senior citizens, the disabled and mentally ill.

"I do think it's a valid concern," Jennifer Velez, the state human services chief, told senators during a Monday hearing. "I couldn't tell you that it's not."

New Jersey is among eight states that doesn't charge Medicaid co-payments for prescription drugs.

Corzine proposes a $6 co-payment on emergency room visits that aren't a true emergency to raise $550,000, and a $2 co-payment on prescription drugs to raise $7 million. The prescription drug co-payment would be capped at $10 per month per person.

Corzine proposes spending $33 billion next fiscal year, but legislators and advocates for the poor fear the co-payments, even if small, could be too painful for people with little margin for extra expenses but serious medical problems.

"They obviously will make a choice, whether it's food, clothing or shelter, as opposed to pursuing their meds," said Sen. Dana Redd, D-Camden.

Velez said the state has little choice. Corzine has proposed $2.7 billion in cuts amid chronic budget woes.

"There are very few, if any, really good options," Velez said. "This is not a particularly good option, but the reason why it's in the budget this year is the dire situation."

Mary Lynne Reynolds, executive director of The Mental Health Association in Southwestern New Jersey, said 5,000 New Jerseyans with mental illnesses live in boarding homes.

She said most of those people receive Medicaid and Social Security insurance that pays for room and board and a $50 per month personal allowance to buy personal effects and amenities such as snacks and newspapers.

Legislators and Corzine must adopt a budget by July 1.

This is the third time the Democratic Corzine has proposed Medicaid co-payments since becoming governor in 2006. His fellow Democrats who control the Legislature rejected them the first two times.
Read more!

Former Broward librarian is found dead on Death Row - South Florida Sun Sentinel

By Jon Burstein
April 29, 2008

A former Broward County librarian who killed two ex-girlfriends in attacks almost two decades apart died Monday morning on Florida's Death Row.

William Coday, 51, bled to death in his cell at Union Correctional Institution in Raiford from what are being called self-inflicted wounds, said one of his attorneys, George Reres. Coday had a history of suicidal behavior and had attempted to kill himself while awaiting trial at the Broward County Jail.

"He did have a death wish," Reres said.

The Florida Department of Corrections is investigating Coday's death, but cannot disclose how he died, said Jo Ellyn Rackleff, a department spokeswoman. He was found dead in his cell at 2:42 a.m.

Reres said Coday's death raises serious concerns about security onDeath Row.

"Obviously, having something sharp enough that you can cut yourself is a problem for the Department of Corrections," Reres said. "They are supposed to be watched and monitored hourly. How can he bleed to death without being found? A lot of questions come to mind."

An autopsy was performed on Coday's body Monday at the local Medical Examiner's Office in Gainesville.

Coday was on Death Row for the July 1997 murder of ex-girlfriend Gloria Gomez — a frenzied killing in which he used a hammer to beat her and when that broke, he used a second hammer and a knife. She was stabbed 41 times, cut 46 times and suffered 57 blunt injuries. Gomez was alive for all but the last of the hammer blows and stab wounds, according to forensic evidence at his trial.

The crime occurred almost 20 years after Coday used a shoemaker's hammer to beat to death his ex-girlfriend Lisa Hullinger in Hamburg, Germany, where the two Americans were students. His attorney in that case used an insanity defense and he was sentenced to three years in prison. He was released after 15 months behind bars and sent back to the United States with orders to get psychiatric help. He got some help but dropped out, partly because of the cost, he said.

The bespectacled Coday later got a job as a foreign languages librarian at the Broward County Main Library in Fort Lauderdale. Colleagues described him as mild-mannered and soft-spoken, fluent in five languages. It was at the library that he met Gomez, who had immigrated from Colombia.

They dated for a year until Gomez broke up with him, sending him into an emotional tailspin and causing his colleagues to fear he was suicidal. He begged Gomez to talk to him, luring her to his Victoria Park apartment on July 11, 1997, after concocting a tale that he was dying of cancer.

After the killing, Coday fled to Europe and North Africa. He returned in October 1997 to New York City, where he was arrested.

Coday attempted to kill himself at the Broward County Jail in September 2000, slicing his wrist and hand. His attorneys and a psychologist said they didn't learn about the attempt until eight days later.

As a result of his treatment, 11 jail workers were disciplined.

A jury convicted Coday of first-degree murder in 2002, recommending death.

But the Florida Supreme Court tossed out the death sentence in 2006, ruling that the judge shouldn't have disregarded testimony and evidence from six mental health experts who found that Coday suffered from serious mental illnesses. The case went back to the judge, who again sentenced Coday to die.

Gloria Gomez's family, who live in a remote area of Colombia, could not be contacted Monday. Hullinger's parents, Charlotte and Robert Hullinger of Cincinnati, Ohio, eventually founded the national support group Parents of Murdered Children.

In an e-mail Monday, Charlotte Hullinger wrote: "Does the news I received today about Bill's death bring me peace and a sense of justice? No. Does it ease my fears that perhaps there could be a new trial and someday he could be released, possibly to kill for the third time? Yes."

Coday is the subject of an upcoming book by author Stella Sands.

"[His death] surprised me because on Death Row one would have assumed that he was more closely watched," Sands said. "It didn't surprise me because he was a very brilliant man and I don't think he could live with himself. He knew he was highly flawed as a human being."

Jon Burstein can be reached at jburstein@sun-sentinel.com or 954-356-4491.

Copyright © 2008, South Florida Sun-Sentinel Read more!

A prisoner's plea for help -Toronto (Canada) Sun

After admitting guilt 29 times, all he wants is a doctor
By MARK BONOKOSKI
April 29, 2008

Sometime after 9 a.m. today, Don Jail inmate Ronnie Roberts will appear in Courtroom 111 at Old City Hall -- this time via video -- for what will end up being his 29th remand.

He will then be formally told that he will be returned to court from his cell at the Toronto (Don) Jail, this time in cuffs and in person, on May 12.

It's already in the books.

The video remand should take all of two minutes.

Ronnie Roberts' crime, and the reason for his incarceration since last October, basically boils down to the fact that he had a $4.49 (plus tax) beer to wash down a chicken dinner at a Swiss Chalet while on a pass from the Keele Centre federal halfway house -- unquestionably a violation of his long-term offender order to abstain from drugs and alcohol, but nonetheless a rather minor breach on the scale of one to 10.

On his first day in court, 29 appearances ago, Ronnie Roberts attempted to plead guilty to the breach charge.

He was not allowed.

On court appearance No. 25, and still in jail, he finally got his guilty plea read into the court record.

Today he is still waiting to be sentenced, and he will now have to wait until at least May 12 -- if it indeed happens then.

"How many times should anyone have to ask to plead guilty before his guilty plea is finally accepted?" asks Daniel Brodsky, the lawyer now representing Roberts.

"And then, after pleading guilty, how many times should someone have to be hauled back-and-forth to court before he is actually sentenced?

"Is this the good use of taxpayers' money?"

The reason 45-year-old Ronnie Roberts has been left blowing in the judicial wind is because, truth be known, no one wants to deal directly with the fact -- or knows how to deal directly with the fact -- that Roberts has a treatable brain injury that, left untreated, will only see him back in court, somewhere down the line, on some other charge,

So his case keeps getting punted.

What Brodsky wants for his client, in a nutshell, is treatment for the clinically diagnosed brain injury that has been plaguing Roberts since he banged his head on a railway track back when he was an 8-year-old boy.

OUTSIDE PRISON SYSTEM

Otherwise, short-form version, he will be perpetually before the courts through no intentional fault of his own.

Psychiatrists -- and eminent ones -- have already testified to this fact, and they have also testified that the only place Roberts can get treatment that will put him on the straight and narrow is outside the prison system.

It exists nowhere else.

Ronnie Roberts' last court appearance -- and I was there in the gallery -- was on April 9, in Courtroom 112 at Old City Hall, Mr. Justice Peter Harris presiding.

Mr. Justice Hugh Atwood was supposed to have been present to hear the case but, as with Roberts' previous appearance on March 5, which I also attended, Judge Atwood was again waylaid in a Brampton court and unable to attend.

Not that it mattered.

The court exhibits which lawyer Brodsky had previously filed to give Judge Atwood an overview of Roberts' case -- and they added up to a substantial box load -- had not yet made their way to the judge's Brampton office.

Fast forward five weeks to Ronnie Roberts' 28th court appearance on April 9, and those files had still not made it up to Brampton. In fact, as it came out in court, they were still sitting in the Old City Hall office of courtroom exhibits clerk, Mike Rose -- under his desk, no less.

"Being used as a foot stool," as Brodsky later put it.

It was Mr. Justice Peter Harris, in fact, who ordered today's court appearance, and he ordered it solely to ensure that those aforementioned files had finally made it to Judge Atwood's office so that he would be prepared to deal with the case when Ronnie Roberts appears again -- and this will be for the 30th time -- on May 12, supposedly for sentencing.

Two more exhibits were added to that box, and they came in the form of columns written here about the inordinate number of delays in the Ronnie Roberts case.

If Roberts and Brodsky lucked out at all back on April 9, it was in having Mr. Justice Peter Harris sitting on the bench.

Way back at the preliminary stages of Ronnie Roberts' provincial court dealings, Judge Harris was one of the first judges before which Roberts appeared following his arrest.

And he thought, no doubt rightly, that the case belonged in the mental health court.

Once there, however, the Crown prosecutor disagreed and, since the Crown's approval is necessary if a case is to proceed in mental health court, brain-damaged Ronnie Roberts got bounced back into the regular court system that has been kicking him around ever since.

So, today's appearance by Ronnie Roberts -- his 29th thus far -- means absolutely nothing when it comes to closure, which is why he will appear on a TV screen in Courtroom 111, and not in the prisoners' dock.

It will be just another day in court.

And just another remand. Read more!

Man hospitalized for killing father -Baltimore Sun

By Nicole Fuller

April 29, 2008

An Anne Arundel County man with a history of mental health problems was sentenced yesterday to treatment at the state's maximum-security psychiatric hospital for killing his father - a crime prompted by a psychotic episode, according to a court-ordered psychological evaluation.

John Scott Bealefeld, 43, of Linthicum pleaded guilty to one count of second-degree murder for the beating death of his father, Maurice Bealefeld, 74, last summer at the home they shared.

Though he pleaded guilty, he was found 'not criminally responsible,' akin under Maryland law to an insanity plea.

John Bealefeld apologized in court yesterday,

'I truly had mental problems going back to even before 1991,' when he was committed to a mental health facility, he said. 'I just feel I won't be able to hurt anyone else where I'm going.'

Anne Arundel Circuit Judge Paul F. Harris ordered that Bealefeld, now being held at the county detention center, be transferred to the state-run Clifton T. Perkins Hospital Center.

'This is one of the most tragic, sad cases I've had since being a judge,' Harris said. 'It's a shame the [victim] passed in such a tragic manner, especially at the hands of his son.'

Bealefeld's defense attorney, Heather E. Tierney, told the judge that her client was in the throes of a 'psychotic episode' at the time of the killing.

'He had stopped taking his medicine because voices told him so,' Tierney said. 'He does still hear voices from time to time.'

Twice in recent years, Maurice Bealefeld had petitioned the courts to evaluate his son's mental health and was denied.

Prosecutor Kathleen E. Rogers said, 'hindsight is certainly 20/20,' but she declined to criticize past court decisions.

In 2002, John Bealefeld received probation on a second-degree assault charge alleging he had struck his father.

John Bealefeld's sister, Sharon Brown of Baltimore, called the home on the morning of May 14, 2007, to speak to her father and, according to Rogers, he told his sister in a 'sarcastic' tone, 'I killed Dad. I beat him to death. Is that OK?'

When police arrived at the home where father and son lived in the 400 block of Nancy Ave., they found John Bealefeld smoking a cigar outside.

John Bealefeld told police his father had 'disrespected him' and it was a 'justifiable homicide,' Rogers said.

Brown told the judge of her father: 'All he wanted to do was get help for my brother.'

nicole.fuller@baltsun.com Read more!

Uma Thurman's parents testify at stalking trial - Associated Press

NEW YORK (AP) -- The former mental patient accused of stalking Uma Thurman appeared at her front door repeatedly at odd hours, and he left her a frightening letter, according to testimony Tuesday by two of the actress' employees.

Thurman's housekeeper Dorota Janas testified on the second day of Jack Jordan's trial that he rang the bell at the actress' Greenwich Village town house at least twice a day for at least 10 days last summer.

Jordan, 37, is on trial in Manhattan's state Supreme Court charged with stalking and aggravated harassment. He was arrested in October 2007 after following and trying to contact Thurman from early 2005 until about a month before his arrest. He faces up to a year in jail if convicted.

His lawyer, George Vomvolakis, says Jordan is a former mental patient who has been diagnosed as schizophrenic and bipolar and should be in psychiatric treatment, not in jail.

Janas, testifying through a Polish interpreter, said she saw Jordan sitting on the front stoop a few days before another employee called police. Some time later, she retrieved a letter Jordan had left for Thurman on the stoop.

Samara Koffler, a film producer who was Thurman's former personal assistant, testified that she returned from the Bahamas in August 2007 and saw the letter Janas had found. She read part of it in court.

''Dear Uma,'' Koffler read, ''I love you completely. Unless rousted, I'll spend the night in front of (Thurman's address).''

At another point, she read: ''Ask your assistant to let me wait inside until you return. I feel afraid that if I see you with another man I'll kill myself.''

Koffler said she told Thurman about the letter and called 911 and told police ''an unstable man'' was hanging around the house.

The 38-year-old Thurman -- who has starred in ''Pulp Fiction,'' ''Kill Bill,'' ''The Producers,'' and ''My Super Ex-Girlfriend,'' among other films -- hired a private detective and allowed installation of surveillance cameras around the house, where she lives with her two children.

Earlier in the day, Thurman's parents testified.

Her father, Robert Thurman, said his reaction after reading e-mails from Jordan was to try to remember the FBI's telephone number. He said in court Tuesday he was seeing Jordan for the first time.

Her mother, Birgitte ''Nena'' Thurman, testified that she believed Jordan ''was someone who would benefit from medical attention.'' She said the first time she spoke to the defendant was in 2005 when he called her home in Woodstock, N.Y., and told her that he ''and my daughter had a predestination to be together.'' She said he asked her to relay that message.

''I tried to assure him in no uncertain terms that this was just a fantasy and he was projecting,'' Thurman said, and that her daughter had no interest in him.


Read more!

Quieting the Demons and Giving Art a Voice New York Times

Madness: A Bipolar Life
By Marya Hornbacher. Houghton Mifflin. 299 pages. $25.

Poets on Prozac: Mental Illness, Treatment and the Creative Process.
Edited by Richard M. Berlin, M.D. Johns Hopkins Press. 200 pages. $21.95
Marya Hornbacher is a virtuoso writer: humorous, articulate and self-aware. She is also, as she has now documented in two books, incurably mentally ill.

Even on the best possible treatment, Ms. Hornbacher tiptoes along the same high wire as Plath, Lowell, Woolf and the rest of the unbalanced artistes. Off medication, she reliably falls into a turmoil of confused self-destruction, which, as she would be the first to acknowledge, means heartbreak and worry for her friends and relatives, challenges for her doctors, and, in the age-old contradiction, new fodder for her muse.

For scientists trying to parse the mystery of brain and mind, she is one more case of the possible link between mental illness and artistic creativity. With all our scans and neurotransmitters, we are not much closer to figuring out that relationship than was Lord Byron, who announced that poets are “all crazy” and left it at that. But effective drugs make the question more urgent now: would Virginia Woolf, medicated, have survived to write her final masterpiece, or would she have spent her extra years happily shopping?


Ms. Hornbacher brings to the discussion more than the usual pairing of disturbed brain and talented mind. Her talent has created a third self, an appealing, rueful narrator who can look back on three decades of manic-depressive illness, much of it untreated, and spin a story that is almost impossible to put down. In the same way that the psychiatrist Kay Redfield Jamison experienced, recorded and then analyzed her own case in the 1995 classic “An Unquiet Mind,” Ms. Hornbacher provides the perfect trifecta of perspectives.

Readers of her well-received book “Wasted,” published in 1998 when Ms. Hornbacher was 24, left her in a state of tenuous recovery from a long struggle with anorexia. The first pages of “Madness” describe how illusory that recovery was. Prescribed an antidepressant, the common treatment for anorexia, she took a slow-motion swan dive into the full-blown anxiety, agitation and despair of bipolar disease made worse by exactly the wrong medication. Her plunge went unrecognized by her attendant mental health professionals, including one who suggested a regimen of candles, baths and aromatherapy.

Hot water did nothing to help; neither did alcohol, lots of it. Ms. Hornbacher finally picked a psychiatrist at random from the Minneapolis phone book and happened onto a good one. Her illness was accurately diagnosed and properly medicated in short order.

On television, that encounter would cue the credits, but the book has barely begun. What follows is an unsparing saga of severe refractory manic-depressive illness, with treatment often undermined by Ms. Hornbacher herself. “For years after I was diagnosed, I didn’t take it seriously. I just didn’t feel like thinking about it. I let it run rampant, and these are the results” — a jagged decade of health and productive work alternating with relapses, hospitalizations, electroshock treatments and slow climbs back to tenuous health.

The self-absorption of mental illness can be off-putting, or just plain dull. It is a testament to Ms. Hornbacher’s talent that her book is neither. She writes in a fluid staccato well suited to her stuttering reality, with a wicked ear for dialogue and a baseline common sense that contrasts with the immense senselessness of her worst manic episodes.

As for the central question of whether treating the illness impairs the creativity, Ms. Hornbacher weighs in firmly on the side of her meds, imperfect though they may be. “For me, the first sign of oncoming madness is that I’m unable to write.” Depression silences her; mania may flood her mind with glittering words, but they scatter before she can get them down. Only the prosaic morning meds (21 pills, at last count) will let her trap the words on the page.

More reflections on the same subject can be found in “Poets on Prozac,” a collection of essays solicited from published poets with psychiatric illness. Most of the 16 contributors are decades older than Ms. Hornbacher, but while they may lack her vivid prose style, they do supply a long-term perspective on the terrain.

With problems ranging from mild unmedicated depression to schizophrenia treated with an unorthodox megavitamin technique, these writers also focus on trapping the words — and all agree that the sick brain often spells catastrophe for the creative mind. While mental illness may form a part of the creative cycle, if untreated its own cycles invariably take over. “Depression steals the voice,” writes Liza Porter. “Silence breeds depression. Depression breeds silence.”

Meanwhile, the actual hard work of editing a mass of thoughts into a finished product is purely linear. It requires detachment and perspective, what Andrew Hudgins calls the “chemical Zen” of Paxil. “I have no idea if the drug has changed my work at any fundamental level,” writes Mr. Hudgins, a professor at Ohio State University, “but I doubt that it did, which is a great comfort.”

Even the poet’s reliable liquid elixir of inspiration is given short shrift here. Dylan Thomas be damned: it is the first national poet of Wales, Gwyneth Lewis, who writes: “I used to keep notes of my altered states of mind under the influence of drink in the hope that they would offer startling new images for poems. They didn’t. It was impossible to decipher my handwriting, and I kept throwing up. Another poetic myth bites the dust.”


Read more!

Cut loose - Raleigh (NC) News & Observer

Editorial:

Some patients leave state mental hospitals with skimpy follow-up plans that leave them at risk -- another tangle in 'reform.'

Two days before a North Carolina man, called only "TC" by the advocacy group Disability Rights North Carolina, shot himself to death, he was discharged from an involuntary commitment at the Broughton state mental hospital in Morganton. Doctors sent the dangerously ill man home with an "aftercare plan" that consisted only of his promise to call his family doctor, and despite knowing the following, according to Disability Rights:

"At the time of his release, TC's hospital records contained information that TC had a family history of mental illness; that he was being treated with medication for bi-polar disorder; that he had been involuntarily committed once before following a suicide threat; that the current hospitalization had followed a standoff with police who had to taser TC in order to take him into custody; that he had threatened to shoot any officers who tried to intervene; that he told his family he took 100 Valium; that in talking with family his speech was slurred and he was 'drifting in and out'; that he was intelligent and would try to minimize the event so he would be discharged; that he lost his job the day of the event; that he and his long-time girlfriend, who had a tumultuous relationship, had recently broken up; that he did not have any local support system; that he had anger management issues; that he had been treated for depression with medications for seven years; that he had access to weapons; and that he was aggressive and combative toward hospital staff."

TC is one of three patients profiled in a Disability Rights report who ended up dead after spending just a few days, or hours, in state mental hospitals and with little attention to how they would be cared for on the outside. (TC is Carl Wayne Tournear, identified in a recent series of articles in The N&O about the state's mental health care system. He killed himself on Aug. 3.)

A second patient was a 17-year-old Orange County youth. The third was released to a homeless shelter that actually had been shuttered a few days earlier. According to the report, 1,182 people were released from mental hospitals to homeless shelters last year. That is a disgrace, but not surprising as shelters, jails and prisons increasingly become way stations for the mentally fragile.

The report comes as the state tries to right a seven-year-old reform effort that was to provide more space in the big state hospitals for seriously ill residents but more services in local communities for those whose illnesses were stabilized.

Disability Rights makes sensible suggestions, including hiring more local and hospital staff to coordinate after-care services and setting a statewide policy for local mental health offices. Earlier this month, before the report was released, the state decided on its own to place county liaisons in hospitals to help identify appropriate services for patients returning home -- a welcome step.

Disability Rights has uncovered another hole in the state system that needs to be patched. Until the agency responsible for carrying out reform, the Department of Health and Human Services, gets better control of local and statewide services, troubled North Carolinians are likely to continue falling through the local-state cracks. Read more!

Detainees’ Mental Health Is Latest Legal Battle - New York Times

Saturday, April 26, 2008

Next month, Salim Ahmed Hamdan, a Yemeni who was once a driver for Osama bin Laden, could become the first detainee to be tried for war crimes in Guantánamo Bay, Cuba. By now, he should be busily working on his defense.

But his lawyers say he cannot. They say Mr. Hamdan has essentially been driven crazy by solitary confinement in an 8-foot-by-12-foot cell where he spends at least 22 hours a day, goes to the bathroom and eats all his meals.His defense team says he is suicidal, hears voices, has flashbacks, talks to himself and says the restrictions of Guantánamo “boil his mind.”

“He will shout at us,” said his military defense lawyer, Lt. Cmdr. Brian L. Mizer. “He will bang his fists on the table.”

His lawyers have asked a military judge to stop his case until Mr. Hamdan is placed in less restrictive conditions at Guantánamo, saying he cannot get a fair trial if he cannot focus on defending himself. The judge is to hear arguments as soon as Monday on whether he has the power to consider the claim.

Critics have long asserted that Guantánamo’s climate-controlled isolation is a breeding ground for madness. But turning that into a legal claim marks a new stage for the military commissions at Guantánamo. As military prosecutors push to get trials under way, they are being met with challenges not just to the charges, but to Guantánamo itself.

Pentagon officials say that Guantánamo holds dangerous men humanely and that there is no unusual quantity of mental illness there. Guantánamo, a military spokeswoman said, does not have solitary confinement, only “single-occupancy cells.”

In response to questions, Cmdr. Pauline A. Storum, the spokeswoman for Guantánamo, asserted that detainees were much healthier psychologically than the population in American prisons. Commander Storum said about 10 percent could be found mentally ill, compared, she said with data showing that more than half of inmates in American correctional institutions had mental health problems.

With their filings, Mr. Hamdan’s lawyers are setting the stage for similar challenges to the procedures of Guantánamo in some 80 expected war crimes cases, lawyers for other detainees say. “The issue of mistreatment of prisoners, the miserable lives they live in these cells, will come up in every case,” said Clive Stafford Smith, a lawyer for 35 detainees.

The case of Salim Hamdan is already a landmark because the Supreme Court used an earlier case against him to strike down the Bush administration’s first military commission system in 2006. But that case, like most of the legal battles over Guantánamo, did not affect conditions there.

Detainees lawyers argue that the effects of intense isolation have gradually turned the prison camp into something of a highly fortified mental ward. Mr. Hamdan’s lawyers say his place as one of the best-known detainees has not spared him.

In more than six years of detention, Mr. Hamdan has had two phone calls to his family and no visits. He has been disciplined, legal filings say, for having a Snickers bar that was given to him by his lawyers and for possessing too many socks.

“Conditions are asphalt, excrement and worse,” he wrote his lawyers in February. “Why, why, why?”

At Guantánamo, there are no family visits, no televisions and no radios. A new policy will for the first time permit one telephone call a year.

In the cells where Mr. Hamdan and more than 200 of Guantánamo’s 280 detainees are held, communication with other detainees is generally by shouting through the slit in the door used for the delivery of meals. Mail is late and often censored, lawyers say.

Conditions are more isolating than many death rows and maximum-security prisons in the United States, said Jules Lobel, a law professor at the University of Pittsburgh who is an expert on American prison conditions.

The military prosecutors declined to comment on the claims about Mr. Hamdan’s condition. As is common at Guantánamo, their legal filings were not made public before the scheduled court date. But defense filings released by Mr. Hamdan’s lawyers recited some prosecution arguments.

The prosecutors argued that the way that Mr. Hamdan was being held did not constitute solitary confinement in part because “detainees can communicate through the walls.” They said that Mr. Hamdan had denied having mental problems and that he was no model detainee, spitting at guards, threatening assault and throwing urine.

Speaking generally, Commander Storum said, detainees are enemy combatants held safely. “We are holding the right people,” she added, “in the right place, for the right reasons, and doing it the right way.”

Prosecutors have said Mr. Hamdan, now about 39, helped Mr. bin Laden elude capture after the 2001 terror attacks. He is charged with transporting weapons for Al Qaeda and being a bin Laden bodyguard and driver.

In recent weeks, his case has drawn wide notice because the defense asserted that senior Pentagon officials exerted improper influence over military prosecutors and pressed cases for political reasons. Hearings on that issue, also scheduled for next week, may expose the internal workings of the military commissions. The former chief Guantánamo prosecutor, Col. Morris D. Davis, who has become a critic of the way the war crimes system is run, is slated to testify for Mr. Hamdan.

But the claim about Mr. Hamdan’s mental health could expose the workings of Guantánamo. According to military statistics, three-quarters of the detainees have been held recently in two “camps” that look much like American prisons. Camp 5 and Camp 6, heavily guarded concrete buildings, hold men who have yet to face trial. Behind a heavy door, each cell has a handful of sanctioned items including a cup and a Koran.

Officials concede that the daily two hours of recreation in a chain-link pen is sometimes offered in the dark. From inside their cells, detainees cannot see the outdoors. From the exercise pens they sometimes can see only a sliver of sky.

Michael E. Mone Jr., a Boston lawyer, visited a client last month in Camp 5, where Mr. Hamdan is held. Mr. Mone said his client, an Uzbek detainee, asked why he could not be held in a place where he could see the sun.

This winter, lawyers for Abdulghappar Turkistani, a detainee in Camp 6, received a letter describing life there. “Losing any contact with anyone,” he wrote, “also being forbidden from the natural sunlight, natural air, being surrounded with a metal box all around is not suitable for a human being.”

Reporters are not permitted to interview detainees, and some international groups, like Amnesty International, have been denied access to detainees.

In leaked reports in 2004 investigators for the International Committee of the Red Cross, who do see detainees, said their treatment, including solitary confinement, amounted to torture. But the Red Cross usually keeps its conclusions private.

As a result, much of what is known about current conditions at Guantánamo comes from lawyers, who visit regularly under tight restrictions. Many describe the men as depressed or delusional. Some, they say, show obvious signs of what some of them call Guantánamo psychosis.

Four detainees are believed to have committed suicide in 2006 and 2007, but the military has never released the official details.

Some of the men are increasingly paranoid and some are losing touch with reality, said Rebecca P. Dick, a Washington lawyer who visited two Afghan detainees in March. “One client said, ‘I’m talking to the ceiling now,’ ” Ms. Dick recalled.

Six detainees, according to military officials, are now on hunger strikes. They are fed liquid nutrition through tubes inserted in their nostrils daily.

Mr. Stafford Smith said one of his clients, a hunger striker, was fixated on a mathematical formula that he believed proves that he will be the next to die.

Another detainee, Mr. Stafford Smith said, has smeared feces on his cell walls. “When I asked him why he was doing it, he told me he had no idea,” Mr. Stafford Smith said.

Last month a lawyer for nine detainees who are members of China’s Uighur ethnic minority told a Congressional committee that one of them, Huzaifa Parhat, said that life at Guantánamo was like having already died. The lawyer, P. Sabin Willett, said Mr. Parhat asked the lawyers to pass on a message. He told them to tell his wife to remarry.

Military officials often dismiss such descriptions as accounts by gullible lawyers manipulated by terrorists trained to make false claims of mistreatment.

Detainees’ lawyers say the military methodically understates the mental illness at Guantánamo for public relations reasons.

In military commission proceedings in recent weeks, there have been hints that some of the men facing charges may be deteriorating psychologically.

A military lawyer for a Sudanese detainee said her client appeared frantic and asked that he be evaluated.

When a judge asked a Saudi detainee the name of a lawyer, the detainee’s answer was: “I have been here for six years. Thank God I can even still remember the names of my own family.”

But Mr. Hamdan’s case is the first in the current system to try to air fully the claim that Guantánamo is warping the minds of the men held there.

Commander Mizer said Mr. Hamdan talked unendingly about his desire to moved to Camp 4, the only place at Guantánamo where detainees are permitted to live communally. Camp 4 is believed to house 50 or fewer detainees who officials classify as highly compliant. Mr. Hamdan blames his lawyers for failing to get him out of Camp 5, Commander Mizer said, and will talk only about that. “He refuses to talk about his case,” he said.

The trial is now set to begin on May 28. But twice in recent months, Commander Mizer said, Mr. Hamdan has said he was dismissing Commander Mizer from the case. “He said, ‘I don’t ever want to see you again,’ ” Commander Mizer said.

There is only one subject, he said, that Mr. Hamdan discusses: Getting out of his cell in Camp 5 at Guantánamo Bay.
Read more!

Facility for mentally ill is under fire -Tulsa (OK) World

by: SARA PLUMMER
4/27/2008

FAIRLAND -- Police Chief Woody Greenfeather estimates that more than half of the calls his department receives have something to do with a local residential care facility for mentally ill clients.

"If we wrote a report for every call we got, we'd need a new file cabinet," Greenfeather said.

Green Country Residential opened two years ago in a renovated motel that sits along the main road in Fairland. It recently was under investigation by the Oklahoma Department of Health after complaints surfaced about care at the center.

Dorya Huser, chief of long-term care with the Oklahoma Department of Health, said the center is not a 24-hour nursing facility and its 26 residents can come and go, although they do have assistance with medication and meal preparation.

The recent investigation found several deficiencies at the Ottawa County facility.

Green Country administrator Cindy Bedford referred all questions to her attorneys, David Jones and Mike Torrone with Logan & Lowry law firm in Grove.

Torrone would not comment.

Green Country Residential is owned by Bedford Enterprises LLC, and Cindy Bedford is listed as a stockholder and partner.

Day care across the street

Residents, police and business owners have raised concerns about the facility and its residents since it opened.

"Fairland used to be a place you could keep your door unlocked, your car unlocked. Not anymore," said Rachel Greer, an employee at Growing in Grace Day Care, just across the street from Green Country Residential.

Several incidents at the day care have involved Green Country residents, including residents coming in and demanding ?cqtrash, trying to get in the back door and following an employee.

The latest incident occurred March 13 when a resident jumped the fence into the playground area while children were outside.

"It scared the children tremendously. He jumped the fence like it was nothing," Greer said. "One parent said if it happened again, he was going to file child endangerment charges. Quite a few parents are upset."

Greer said one solution is similar to the day-care's procedures.

"We have activities and lesson plans to keep our kids entertained," she said, and perhaps Green Country needs an activities director to give residents something to do other than wander around town.

"That's all they do is roam," said day-care employee Kari Woods.

Police

The police chief said many of the people in Fairland who call in are worried, not just about their families, but the Green Country residents.

"It's not that they dislike them, but that they need better supervision," Greenfeather said.

Calls have included residents walking in the middle of the street, walking into people's yards, going through trash, attempting to get into vehicles and threatening suicide. Greenfeather said when he was an officer, he witnessed Bedford, the center's administrator, give a resident 15 minutes to evacuate the center. When the resident was escorted off the grounds and he came back to the center, Bedford reported the person was trespassing, he said.

Greenfeather said Bedford no longer does this, but arranges for the resident's transfer.

The whole situation puts a strain on his department, Greenfeather said.

In addition to responding to calls, the police department also is responsible for transporting Green Country residents when there is an incident, he said.

When the department receives an Emergency Detention Order, an officer has to take the resident to the hospital in Miami, Okla., then to a judge in Claremore to rule whether the resident needs further evaluation. If the judge rules for further evaluation, the officer takes the resident to Wagoner, then the officer returns to Fairland.

The whole trip can take four to eight hours, Greenfeather said, and Fairland has a three-person department with two full-time officers, a part-time officer and a reserve officer.

"If we have to take one, we can leave the town uncovered for four hours," he said.

Documents

Responding to complaints about resident care, the state Department of Health started an investigation on April 2, and it concluded Thursday.

In the report, the Health Department cites several deficiencies including failing to provide supervision for residents diagnosed with mental illness, failing to administer mood-stabilizing medications ordered by doctors and failing to protect residents from harm and unreasonable risk of harm.

On Feb. 14, a resident walked away from Green Country and was walking along the side of the road when he was hit by a truck and killed. The same resident was missing from the facility seven times in 37 days.

Green Country failed to report all of the resident's disappearances to the Health Department. The center also did not report to the Health Department when a resident jumped into a day-care's play area and when residents were involved in verbal and physical assaults with each other.

One of the center's rules is if a resident wishes to leave the facility, the resident must notify the staff on duty. In the report, a clipboard was found outside the laundry room that residents were supposed to sign, date and explain where they were going, what time they left and when they would be back.

The report also cites the center's daily journal records that document incidents of resident altercations, residents going through trash cans at local businesses and knocking on nearby Fairland residents' doors asking for cigarettes.

Another deficiency listed on the investigation report is that the center did not comply with a 10-day notice when a resident is involuntarily transferred or discharged and did not include explanations for the transfers or discharges.

Green Country has 30 days to submit a plan of correction for the deficiencies.

According to a letter addressed to Bedford, investigators are recommending a fine of up to $10,000. Read more!

Critics slam treatment as jails deal with mentally ill - Daytona Beach News Journal

By DEBORAH CIRCELLI
Staff Writer

Gas masks over their faces and clad in armor, four correctional officers storm Ciara-Paige Green's cell, then push the naked young woman onto her bunk.

In the video, Green gags from a chemical agent sprayed in her cell and repeatedly yells to the male and female officers, "I can't breathe," as one officer holds her head and others appear to pin her on the bed for a few minutes.

The New Smyrna Beach woman was 19 and at the Volusia County Branch Jail on charges of striking police and corrections officers when the video was recorded last year. She has several mental illnesses and has struggled with cocaine addiction.

Wearing only handcuffs and leg irons, Green, in the video, is lifted off the bed by two female officers, then walked out of her cell. Another officer, aiming a handheld video camera, records the cell "extraction" while a supervisor looks on. Seconds later, Green is pushed against the wall for pulling away, according to jail reports. As the camera keeps rolling, the officers struggle to get Green, still fighting, up stairs. She's then strapped into a restraint chair and a bed sheet placed over her.

This example from October is one of nearly three straight days where officers held video cameras to record Green naked on and off for more than two hours in what inmates and attorneys call the "buck naked cell," for people on suicide watch. She was put in mental health lockdown or disciplinary confinement all but three days of her more than six-month jail stay and put in restraint chairs for hours at a time for threatening to harm herself and assault staff, officials say.

Her attorney and family say if the jail's psychiatrist had prescribed proper medications for her mental problems, she wouldn't have been a danger. Her appointed lawyer says some of the methods used on Green were malicious, unnecessary and meant to degrade.

"That's not a way to treat an animal much less a human being," said her attorney, Assistant Public Defender Jay Crocker.

Her case, according to the Public Defender's Office, is not isolated and a prime example of the need for change in how inmates with mental illnesses are treated in the county jail. Other groups statewide want more services to divert people with mental illnesses from jails.

Public Defender James Purdy and a local faith-based group are calling for the Volusia County Council not to renew its contract in October with a private health care company unless safeguards are in place for inmates to receive medication.

Local officials are also seeking more community services.

"There certainly are a lot of inmates in the Branch Jail that we would agree would be better off in other circumstances," said Volusia County spokesman Dave Byron. "We are sort of the repository."

FAMILIES WAIT FOR CHANGE

Meanwhile, family members like Green's mother, Debi Green, 52, watch loved ones revolve in and out of jail, crisis units and hospitals -- many for charges such as resisting arrest, battery on an officer or lesser crimes.

Green, now 20, sits in a state mental hospital in Chattahoochee after being sent in February from the jail to a local crisis unit.

She was found incompetent to stand trial for possession of drug paraphernalia, resisting arrest with violence and a probation violation for battery on a correctional officer.

"God, the cruelty," Debi Green cried recently in her New Smyrna Beach kitchen, with her hand against her heart, as she watched the October video of her daughter. "They've stripped her of her dignity."

About 1 a.m., after being video recorded naked in her cell over almost three days, Green rips her mattress with her teeth. Out of the material from the mattress cover, she makes a skirt and a top to cover her breasts. She is then placed in a restraint chair for fear of hurting herself with the material.

Court reports from psychiatrists show Green's mental illnesses, which include post traumatic stress from abuse, bipolar, schizo-affective and borderline personality disorders cause impaired judgment, erratic behavior and poorly controlled anger.

MAKING THINGS WORSE?

Her attorney says the way she was treated in jail only aggravated her condition.

"They were doing things to tweak her and try to set her off," said Crocker, who is a board member for the Mental Health Association of Volusia County. "You don't have to invade somebody's privacy especially when they are naked. It's pretty outrageous."

County officials said Green was given the standard paper gown and blanket, but damaged or refused to use them.

Green wrote in letters to her mom that the jail wouldn't give her a paper gown. One video confirms that officers did not give her a paper gown after making her remove her jail-issue orange pants and shirt.

She asked for a blanket and was shown naked. They replied they would return with one.

Corrections officers also testified that Green's problems were behavioral, not mental. They said she'd kick and cuss at officers, pull hair and threaten to kill them and their families. She was in jail for battery on a law enforcement officer and a new charge of battery on a corrections officer.

Her mom was not allowed to visit throughout her more than 180-day stay. Jail documents stated if Green improved her behavior, she could have recreation and visitation. But that never happened.

COUNTY'S SIDE

"This was a very troublesome inmate. This woman was a handful," Byron said.

He spoke for the county-run jail system after the jail's director, Marilyn Chandler Ford, would only respond in writing for this story, and after her responses were reviewed by Byron. "Whether she was a danger because of her mental illness or whatever factor," Byron said, "it doesn't change the fact that this was a dangerous person. It's not the Mayo Clinic out there. We have a fiduciary responsibility to the taxpayers to balance humane care and cost of care."

County officials also said Ciara-Paige Green wouldn't take medicine prescribed.

The inmate, in written complaints and in court, said she wasn't getting psychotropic medication that stabilized her prior to going to jail and the jail psychiatrist kept switching her medications.

Dr. Stephen Young, forensic psychiatrist for the 7th Judicial Circuit, who found Green incompetent to stand trial in March, defended jail psychiatrist Dr. David Hager, saying he cares about inmates. He said Green was a "complicated case" and had a large volume of medical records.

USE OF RESTRAINTS

Dr. Henry C. Weinstein, a psychiatrist and chairman of the American Psychiatric Association's Committee on the Mentally Ill in the Criminal Justice System, calls practices such as restraint chairs "primitive." He says solitary cells and isolation only worsen an inmate's mental condition.

Byron said the restraint chair is used frequently for dangerous inmates. Video cameras are used when inmates have to be forced from their cells. But in Green's case, Ford said the videos also were to document her behavior so mental health staff could conduct a thorough evaluation. But they also said some of the video recording of Green naked went on "longer than preferred."

"Our point of view is this was handled in a professional manner," Byron said. "Was it a pleasant occurrence? No. Was it the way you would hope these situations work out? No. Is it common for people to be video taped naked? No."

Ford also said in written responses, "Inmate Green was not injured during her incarceration -- but our officers were," including an officer who jail officials said had some of her hair pulled out.

"The general public, including the Public Defender's Office, cannot even imagine what the correctional officer has to handle," Ford said.

DOZENS COMPLAIN

Public Defender James Purdy and several other attorneys report dozens of local cases of inmates being kept naked and not given psychotropic medications. Green is one of 84 inmates defense attorneys documented during a two-year period ending in October who complained the jail took them off the psychotropic medications they were on before incarceration, which Purdy said interferes with their defense. More complaints are coming in, and the American Civil Liberties Union also is collecting information.

"My concern is there are other ways to deal with people who are suicidal besides putting then in a cell nude and leaving them there," Purdy said.

The jail health provider, Prison Health Services, also has faced criticism locally and nationally in lawsuits regarding inmates not receiving psychotropic medication. The county is also being sued. Hager would not comment and is resigning at the end of May to seek a job out of state. But company officials said inmates who need them receive psychotropic medications.

"We are taking care of the mentally ill," said Rita Jorgensen, who oversees mental health services at the county jail for Prison Health. The company is open, officials said, to subcontracting out the mental health portion of the contract with Act Corp. County officials, meanwhile, say Prison Health Services is doing an "excellent" job and saving the county money.

Circuit Judge Joseph Will, who handled Ciara-Paige Green's case, said the numerous reports he's heard from inmates about the suicide cell are "horrible," and "alarming," including being strapped for extended periods of time in a bed without clothing.

"Are the reports true? I don't know," Will said. "I know if it happened to me or one of my children, I'd be very angry -- so it causes me great concern," he said.

Act's crisis unit uses two cloth hospital gowns for people on high-risk watch, and they are allowed to wear their underwear. Cameras are mounted discretely in ceiling corners. In state prisons, wrap-around garments for suicidal inmates are being phased out in favor of an over-the-head smock made of tear resistant fabric, not paper.

County Chairman Frank Bruno said he plans to look into Green's case and others that are brought to him.

"We have got to treat people with all due humanity," he said.

TOO LITTLE TOO LATE?

For Ciara-Paige Green, her mom fears, it may be too late because experts say with each mental breakdown there is more brain damage.

Debi Green has been fighting for several years to get her daughter into substance abuse and mental health treatment since a judge ordered her daughter into a program in 2004, but bed space was never available.

"She needs mental health help, not punishment," her mother said. "I've been fighting for a long time and it hasn't done any good. All I can do now is hope my fighting helps somebody else."

When Ciara-Paige Green finally got sent to a substance abuse treatment program this past January, she walked out after just two days. When police caught her three days later, she was charged with possession of drug paraphernalia, resisting arrest with violence and a probation violation and sent back to jail.

Court and jail documents said she was "extremely regressed" back at the jail, refusing to eat or drink and threatening suicide. Her attorney was able to get her transferred out of the jail at the end of February to Act Corp.'s crisis unit and March 20 to Florida State Hospital.

Her mom wishes the jail had sent her daughter to the crisis unit or hospital earlier.

Ciara-Paige Green has a history in and out of juvenile detention centers and a troubled childhood, including a turbulent custody battle between her parents and abuse as a child and adult, records show. She even had altercations with her mother.

In a Daytona Beach News-Journal interview with Ciara-Paige Green two years ago, when she was at home stable for three months on medication, she said she wished she could "be normal" and not take medicine. She hoped to go to college, but was having problems concentrating to take the placement exam.

She later stopped taking her medicine and ended up in jail last July for twice elbowing an officer, police said, while trying to flee Halifax Health Medical Center. She was taken there by police to be examined for excessive use of cocaine.

WHAT'S NEXT FOR CIARA?

Green is at Florida State Hospital until doctors and a judge say she's competent to stand trial. She likely will then be sent back to jail to face criminal charges. But her mom and attorney fear the cycle will start over again and she won't receive the same medications.

Crocker said Green could face 11 years in prison for various charges that he said are "attributable directly to her mental illnesses."

Last weekend, Debi Green drove to the state hospital for Parents Day. Ciara-Paige Green is back on medication she took prior to her jail stay, her mom said. During the visit, at times she was delusional, talking about people who don't exist, Debi Green said. But at other times she was in good spirits, visiting with other clients and their families. It was a big change, her mom said, from her daughter talking in the third person and not making sense more than a month ago.

She said she's still holding out hope for her daughter to lead some semblance of a normal life.

Ciara-Paige Green wrote in a Jan. 6, 2008, letter to her mom while in jail that she's optimistic.

"I am in need of God's help and I'm tired of being locked away," she wrote. "I've spent most of my life in lock up -- so many family days I missed, years never to be able to be celebrated again, but like you wrote me a while back. There is light ahead."

-- Staff Writer Jay Stapleton contributed to this report. Read more!

Getting HELP: Special court designed to helpmentally ill - Gainesville (GA) Times

By Stephen Gurr
sgurr@gainesvilletimes.com

It took an armed standoff with police to finally get Ron the help he needed for his depression.

Suicidal and waving a loaded .357 Magnum in a public place, the bankrupt 46-year-old was certain he would be shot by officers.

"I had lost my faith," he said, after losing his home and watching his marriage slide toward failure. "I saw everything disintegrating around me."

Police did not shoot Ron, though he says he "fully expected" to be shot. They talked him into putting the gun down, handcuffed him, and took him to a mental health facility, where he spent six days. Afterward, his thoughts still fixated on suicide, Ron was booked into the Hall County jail on a pair of misdemeanor weapons charges. It was there that he was given the option of applying for entry into Hall County HELP Court, a treatment court for people whose criminal acts are rooted in mental illness.

Nearly a year after entering HELP (an acronym for Health, Empowerment, Linkage and Possibilities), after attending court-ordered counseling, taking two anti-depressant medications daily and being monitored by a case manager who made home visits, Ron stood proudly in the well of a courtroom on the fourth floor of the Hall County courthouse, where Superior Court Judge Kathlene Gosselin presented him with a graduation certificate.

"He came in with major depression and had us all worried," Gosselin told the courtroom, where more than 30 active HELP court participants looked on. "He has worked really hard with lots and lots of problems. He's kept on track the whole time."

Ron's wife, standing by his side at the ceremony, managed to say through tears of joy, "he's a lot better, and I'm very thankful."

Said Ron, "The Lord puts people in our lives to help us get through these things. We are all in this program because we made some poor choices. If we stay on track, we can make correct choices."


"Everyone ... has a lot to deal with"

Hall County HELP Court started in December 2004 as one of four accountability courts in the local judicial system, with the focus on people suffering from mental illnesses.

Many of its participants are referred to the court by detention officers or medical workers at the Hall County jail, followed by a clinical interview conducted by a psychologist to determine a diagnosis.
Those diagnosis have ranged from depression to bipolar disorder, schizophrenia and post-traumatic stress disorder.

Prosecutors work with defense attorneys to decide which candidates are right for the program. Offenders who have committed serious violent felonies such as sexual assaults, armed robberies or attacks on police officers are denied entry. More often the charges involve disorderly conduct, domestic violence, drugs, shoplifting, DUIs and other misdemeanors.

Like Hall County's drug court, some HELP participants may have their charges dismissed with successful completion of the program, though not all will. Some may see reduced jail sentences. There are no guarantees, though there is the hope of a healthier, more productive life.

Some will come out of the program with vastly different lifestyles, new jobs and new outlooks on life. In other cases, graduates may never be able to hold down a job or even acknowledge their mental illnesses, but just convincing them to take their medication regularly will be regarded as a success.

Like other accountibility courts, the prosecutors, defense attorneys, case managers, treatment providers and judge work as a team in reviewing each case in weekly meetings, determining who has made progress and who has taken a step backward.

In addition to getting treatment and medication through AVITA Community Partners, the local state-affiliated mental health treatment provider, participants must get jobs, if they are able, secure steady living arrangements, and are encouraged to earn General Equivalency Diplomas. Finding meaningful, worthwhile jobs and housing for participants is a huge challenge for people who "live on the margins financially," Gosselin notes.

Like other accountibility courts, the judge can impose sanctions if certain requirements aren't met.
During one recent court session, a woman who missed a doctor's appointment and a group therapy session had to face the judge. "I have to believe you're not taking this seriously," Gosselin said.

The woman broke into tears, telling the judge, "I'm human. There's a lot on my plate I have to deal with by myself."

"Everyone in the courtroom has a lot to deal with," Gosselin responded. "And while you were in (jail) work-release, you were managing OK."

The judge gave the woman 24 hours in jail. Some get community service, or more time in court. Others have spent days or weeks in jail for not fulfilling their obligations to the court.

Many never will. The graduation rate for HELP court is under 50 percent. Court officials say most drop out or are terminated from the program not because of mental health issues, but because of drug addictions.

More than half the participants are "co-occurring," meaning they struggle daily with drug and mental health problems.

Gosselin hopes HELP's graduation rate will improve after the court recently put co-occurring participants on one treatment track and those with mental health issues only on another.

"I think a lot of people we've lost just couldn't get a handle on their drug problems," she said.


"Not just a job"

Some who come before the judge can hardly hold their heads up or speak during their first day in HELP Court, known as enrollment.

During a recent enrollment session, a young woman was led into court wearing the customary jail attire of jumpsuit, leg chains and shower shoes, took a seat at the defense table and answered the judge's questions tearfully. "We all know you can do this," Gosselin told her.

Later the judge recalled another young woman, this one just 17, who came to the program after a drug arrest, suffering from a severe mood disorder and habitually cutting herself. "You had to almost force her to talk to you the first few months in the program," Gosselin said.

Now, the same young woman is held up as one of the court's successes. Her words of hope are quoted on the back of the HELP graduation program: "I used to hate thinking about the future because I thought that I had nothing to look forward to, but now I know that I have a lot to look forward to," she wrote. "I can be successful in life. I am so glad I have changed. I love the new me."

Ron can remember the turning point for him, while in counseling at AVITA, when he reflected on all the problems he and his wife had endured. "I looked at my depression and realized that no matter what was happening in our lives, we were basically OK," he said. "The structure and support of the HELP system was important as far as keeping me on that track."

Ron has high praise for Gosselin. "Her patience, to me, is just astounding," he said. "She realizes that people are struggling with medical changes and when you're in this state of mind, you're not always the most happy, friendly person."

He also praised his court case workers, who made home visits or checked in by phone to get a feel for how his life was going. "The people in this program really care about the people who are in it," Ron said. "My sense is that this is not just a job for these people, it's a calling."

Rachel Ayers, the clinical case manager for HELP Court, believes it offers community-wide benefits.
"It's so much greater than the one client," Ayers said. "When they get healthier, their family is healthier, their workplace is healthier. It's so far-reaching, the effect that mental fitness can have as opposed to mental illness."

Gosselin said she could point to the statistics that show diverting these offenders from jail saves taxpayer dollars. But in the end, she said, "it's the right thing to do for somebody who's sick.

"All over the country, jails and prisons are dealing with the mentally ill, because we are not dealing with them in other ways," she said. "If it is indeed your mental illness that's causing you to enter the criminal justice system, keeping you in and out of jail instead of getting the treatment you need ... then we should be providing that." Read more!

Volunteer helps kin of the mentally ill -San Francisco Chronicle

Shelah Moody, Chronicle Staff Writer

For 24 years, Luisa Perez, 79, has helped Spanish-speaking families of mentally ill people as a volunteer with the National Alliance on Mental Illness of Santa Clara County. The alliance offers support, education and practical advice, including treatment options, to anyone concerned about mental illness, primarily schizophrenia, bipolar disorder, clinical depression and obsessive compulsive disorder.

Perez herself was referred to the alliance for help when two of her six children were diagnosed with schizophrenia in the '80s."I had never heard about what schizophrenia was about; it was just some weird word," said Perez, who grew up in San Jose. "When Connie started behaving badly and doing a lot of weird things, I couldn't figure out what was the matter with her. I thought maybe she was on drugs. She was a good student in school, and then her grades started failing."

Perez began attending support groups at NAMI Santa Clara, where she met other people in her situation. She began learning as much as she could about schizophrenia, and attended state conferences on mental illness.

"I noticed that there weren't any Spanish-speaking people, people who looked like myself," said Perez. "I thought, 'This information should be getting into the Spanish-speaking community.' "

For 15 years starting in 1984, she organized and taught more than a dozen De Familia a Familia (Family to Family) classes, providing the families with up-to-date medical information and advice about how to assist and advocate for their ill relatives. From 2003 to 2008, Perez served as vice president of NAMI Santa Clara's Latino Outreach program. She has also spoken at NAMI conferences about her work.

Although she had no formal education beyond high school, Perez can explain complex concepts and medical and psychological terms for her clients.

"We're in there to help people come forward and gain some of the resources that are available," said Perez.

Perez's daughter Connie, 42, is in a locked mental health facility in Fremont, where she ended up after she was arrested for assaulting her mother. Perez's son Mark, who also had schizophrenia, died in undetermined circumstances in February. He was 37. Perez's goal is to help Connie, who once had a job and her own apartment, overcome the disease so that she can begin living independently again.

Perez works with NAMI from her Campbell home, providing telephone and one-on-one peer support. She said some of her Spanish speaking clients feel more comfortable speaking with her at her home than in the offices of the alliance.

"People trust me, and they feel that I can help them protect their families," said Perez. "I have a little office here at my house, and I have all this information. I know that a lot of these mothers - all they want to do is just talk. I also have a hot line, (408) 378-6988, here at my house where I answer questions or just talk on a friendly basis to people who call in."

Last year, Perez received the Junior League Award from Santa Clara County for her outstanding volunteer work. In 2006, she was honored at the 12th Annual Behavioral Institute Conference in Universal City (Los Angeles County).

On June 16, Perez will travel to Orlando, Fla., where she will be presented with the NAMI Multicultural Award for 2008. This year she also organized an all-day seminar in Spanish at the NAMI California Conference in Burlingame, where activist Dolores Huerta of the United Farm Workers was one of the guest speakers.

Perez has found a high incidence of mental health problems among immigrants from Mexico and other Latin countries.

"I think there is depression among many ethnic groups, especially now, when a lot of people are losing their homes and their jobs," said Perez. "People are overextending themselves, and there are higher expectations. People feel that this is a country where you can fulfill your dreams, and right now, it's a lot more difficult to achieve. People come in and they are working in the fields and in the restaurants where they pay the lowest wages. Rents are so high and everyone wants a car. People need two incomes to pay a $1,500 rent.

"It's pretty sad for people who come to the U.S. from foreign countries and are faced with all of these obstacles that are a lot bigger than what the established person here in this country can understand. I think that causes a lot of depression."

For information on the National Alliance on Mental Illness of Santa Clara County, go to www.namisantaclara.org.

Each week, The Chronicle features a Bay Area resident who has won a Jefferson Award for making a difference in his or her community. The awards are administered by the American Institute for Public Service, a national foundation that honors community service. Bay Area residents profiled in The Chronicle are also featured on CBS 5-TV and KCBS-AM, which are Jefferson Award media partners, along with The Chronicle.

E-mail Shelah Moody at smoody@sfchronicle.com. Read more!

Explaining bipolar disorder -Austin American Statesman

By Eric Dexheimer
Sunday, April 27, 2008

With his mood disorder diagnoses, Billy represents a growing issue for the Texas Youth Commission. Ten years ago, a quarter of the youth sent to the agency were identified as having a mental illness. Today, it is closer to half.

One reason, advocates say, is that communities often are ill-prepared to meet the needs of delinquent teenagers who also struggle with mental illness. The Texas Juvenile Probation Commission estimates that about 60 percent of Texas youth who need mental health help don't get it.

Critics say finding psychiatric help for clients without insurance, in particular, can be an uphill battle. Billy is such a client.

Indeed, because of shortages of treatment opportunities, mentally ill children have landed in lockup without even committing crimes. A 2003 U.S. General Accounting Office study estimated that in 2001, 9,000 youth with psychiatric diagnoses were funneled into the juvenile justice system simply because there was nowhere else for them to go.

Many, however, are sentenced for criminal or disruptive behavior related to their illness. Successful treatment is elusive. Three-quarters of juveniles with a mental illness diagnosis will be re-arrested within three years of being released from the Youth Commission.

Billy's condition is a particular concern. The number of young people treated for bipolar disorder increased 40-fold in the United States between 1994 and 2003, according to a September 2007 report.

The reasons for the dramatic increase are unclear. Yet juvenile justice experts say they consider bipolar disorder, along with depression and schizophrenia, one of their biggest current challenges.

Bipolar disorder, which is characterized by dramatic mood swings, depression and impulsive behavior, can be treated with drugs. But because there is no single therapy, it requires diligence and persistence as dosages and drug combinations are tweaked. Children with unstable lives can struggle with the regimen.

And, experts say, if patients fail to stay on top of their treatment, those very qualities can evaporate, causing a downward spiral.

edexheimer@statesman.com; 445-1774 Read more!

Survey answers on NC mental healthquestions - The Associated Press

By The Associated Press

Here are three questions posed by The Associated Press to the eight major-party candidates for governor on the topic of mental health, followed by their unabridged responses. The responses were edited for AP style:

1. In 2001, lawmakers began to overhaul the state's mental health treatment system by shifting more patients from institutional care to community-based treatment by private doctors and services. The reforms have stalled and are widely regarded by critics and advocates of the mentally ill as a failure. As governor, what will you do in your first two years in office to improve the state's mental health care system?

2. Do you support a law - as proposed by a campus safety task force led by Attorney General Roy Cooper - to bar handgun sales to people who have been involuntarily committed to mental hospitals?

DEMOCRATS

RICHARD MOORE

When reading The News & Observer's series on mental health I was struck by Professor Joseph Morrissey's summary of the problem: "Solving these systemic problems will require the capacity to analyze proposed solutions, check out their costs and benefits in advance, monitor policy and program implementation, and assess outcomes on an ongoing basis. No multibillion-dollar enterprise in corporate America operates without this type of intelligence function."

As the only candidate for governor that has run two state agencies, I am very familiar with the challenges of operating vast bureaucracies with silo-funding streams and have experience in breaking down those barriers to change and improvement. I will bring a decade of public managerial experience to bear on our mental health system.

First, I will finish any of the outstanding initiatives Secretary Benton began, but remain incomplete, in order to ensure a smooth transition. This includes gaining approval from Centers for Medicaid and Medicare Services to end the blended payment rates. My budget will include funding for an internal inspection team to ensure we do not forfeit millions in Medicaid/Medicare payments because our hospitals are not in compliance with federal rules. And I will ensure we are filling key positions related to our mental health system with the most highly qualified individuals by offering sufficient salaries to attract them.

Concurrently, I will begin my own improvements starting in our institutions. I will develop an interagency team that will be dispatched immediately to investigate all deaths that occur in our mental hospitals. The team will include investigative personnel from the Department of Crime Control and Public Safety and will be required to file timely reports with the hospital, the DHHS Secretary, the medical examiner/pathologists, and the family. It will also be forwarded to the district attorney if there is any suspicion of wrong doing by anyone in the facility.

Second, to increase the quality of care our patients are receiving in state hospitals, we will seek to institute a career ladder of sorts for the medical and patient technicians working directly with patients in our hospitals. To advance on the ladder and earn a higher salary, the staff will achieve more advanced levels of certification. We will ask the community colleges, universities, and medical hospitals to design continuing education courses that will be offered during the work day. Much like we have done in our schools and in child care, we will raise the wages of our employees by raising the quality of care they provide.

Because more than 20 percent of the patients admitted to our mental hospitals last year were dependent on alcohol or drugs and because our psychiatric hospitals admitted more drug addicts than schizophrenics last year, I will commit more resources to substance abuse treatment programs.

As governor I will seek to further our knowledge base on mental health issues and develop improvements by working with our research institutions to convene regular task forces of experts to study these complex mental health issues and develop workable solutions on an ongoing basis. Currently, Secretary Benton has a number of working groups meeting regularly to develop solutions, but I want to institutionalize the dialogue and grow the state's knowledge base on mental health issues.

From those groups we will 1) seek to create meaningful, clear objective criteria for the local management entities, 2) design effective clinical and fiscal competencies with incentives for those exceeding the criteria and penalties for those who fail, 3) develop standard protocols for mental health care to ensure consistency of treatment between providers, 4) develop a system of statewide case management through health care community networks, or a "medical home" system and 5) develop a funding mechanism to ensure our low wealth counties have the resources they need to attract high quality providers so all patients can have access to high quality care.

2. Yes.

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DENNIS NIELSEN

1. We must first define the exact problem and then work towards real solutions. Hoping will not work we need real definitions of problems and then together set real goals and milestones to implement the fixes. This is a complex issue and one that requires strong leadership to define and fix. We also need to separate those that need help; citizens with mental illnesses, disabilities and those with substance abuse need different programs, we must do away with a one size fits all approach.

2. Handgun sales: I don't like a law that is so broad so I would have to see the actual legislation to see if I would or would not support it.

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BEVERLY PERDUE

We need to get serious about the goal of quality health care for all North Carolinians - and that must include mental health care.

My background in health care tells me that it makes no sense to separate mental from physical health care. The best research confirms that many patients have mixed mental and physical health issues. Thus I am proud that my plans for expanding health care coverage to all children and more low-wage working parents have been praised by such leading advocates as Adam Searing of the North Carolina Health Access Coalition for containing "the most significant changes in health care access in North Carolina in, quite literally, decades." To read more, go to http://bevperdue.com/healthcare.

As North Carolina's next governor, I also want to establish the national model for an integrated approach to behavioral and primary health services for patients with mental health, development disability, and substance abuse problems. It will be one of my top goals to break down the barriers to the coordination of mental and physical health care.

North Carolina's Medicaid program has recently moved to the forefront in emphasizing the importance of a "medical home" for the primary care of adults and children. Our Community Care of North Carolina has developed a very cost-effective and quality-driven model of statewide case management through health care community networks. We need to extend this kind of collaboration and community network to the delivery of mental health services.

In my view, the concept of a medical home should play a major role in helping to revitalize our badly tattered mental health system within and outside of Medicaid. Patients with severe mental illness need the security of a medical home as well as strong inpatient professional service. We should also strive to define a basic level of mental health services to which needy patients should have access.

Recent events have made us all too painfully aware of what can happen to those who fall through the gaping holes in our mental health care system. While in the long-term my focus is on closing those holes, it would be irresponsible not to take what steps we can in the short-term to avert tragedy. The Campus Safety Task Force led by Attorney General Cooper has proposed a law to bar handgun sales to people involuntarily committed to mental hospitals. We should take such a sensible step in the interests of the safety of our students and of our communities.

I know that improving our mental health system is easier said than done. Yet we cannot stop until we have a system where the local and state levels work in a coordinated fashion to assure access to appropriate services for all North Carolinians. We will need to adopt a disciplined approach with lots of two-way learning between government officials and the mental health community.

That will require sound leadership and coordination throughout state government. We need stability, a shared vision, and a focus on quality outcomes for all those who depend on our mental health, developmental disability, and substance abuse services. I will be the kind of dedicated, hands-on governor who can provide this needed leadership on health care generally and mental health in particular.

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REPUBLICANS

BILL GRAHAM

1. The first step I will take is to bring all interested parties involved to the table to discuss the failure of our current system as well as any successes. We have some of our nation's premier experts on mental health in our state, yet we have failed to use them. Our mental health professionals understand what needs to be done, we need a governor who will listen to them. I would immediately increase funding for our mental hospitals and for other programs that offer treatment to those who are considered high risk or critical.

After the initial steps, I will work with our mental health professionals and experts to devise a plan that will meet the needs of our mentally ill citizens. We will begin with pilot programs so that we can quickly identify any problems. Once I am satisfied that we have a workable system that will fully meet our needs, I will then launch the new mental health system statewide.

2. Yes.

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PAT MCCRORY

1. It is no secret that North Carolina has people who suffer some form of mental illness and need state help. It is also no secret that the last eight years have seen escalating waste, fraud, institutional ineptitude, bureaucratic bungling, and now, finger pointing as to who is to blame for this sorry state of affairs. Responsibility for mental health care falls under the broad mandate of the governor and his secretary of Health and Human Services. Now the governor is trying to "pass the buck" to the Legislature, which approved privatizing many mental health care services without, apparently, having appropriate service levels defined and without having clear guidelines of responsibility and supervision in place. Such lapses could explain other puzzling proposals as the one recently where HHS planned to close two mental health hospitals without having enough beds in place to replace them.

Parceling out treatments to private sector facilities located closer to the patients themselves makes sense. The existing plan needs considerable redrafting in terms of quality, costs, patient care, oversight, and state follow up but can be salvaged. The new governor first needs to take responsibility for fixing the problem and actually begin fixing it ... putting policies and procedures in place to make sure the patients who are depending on the state for help get the help they need. Those actions will be my starting point for mental health reform. The governor's office is responsible and accountable for mental health in North Carolina. If the legislature is making that job harder, the governor needs to let us know and then he needs to step up to the plate and do his job.

2. Yes.

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BOB ORR

1. We must have leadership, the right concept of care, the appropriate resources, and a rigorous oversight process. Administration officials have admitted that they have been aware of the problems in mental health, yet have taken no action to fix them. The next governor must be ready to take on the challenge of addressing our broken mental health care system from the first day in office. Among the reforms needed, we must determine where privatization is a viable business model, implement a fair and efficient reimbursement process that pays for actual care, fully fund the Mental Health Trust Fund, and ensure that the state has a secure, long term supply of mental health care providers. Please visit my web site at http://www.Orr2008.com for my full proposal.

2. Yes.

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ELBIE POWERS

1. Apparently, lawmakers may not have the best answers or solutions. I will replace some agency directors with knowledgeable and efficient people in their proper fields, removing ones placed by favoritism or the buddy-buddy system. Who are these inefficient agency directors? To find out, I go down the ladder in each department to the working people. The following statement from an individual who is a worker within the mental health system. "The state passed the buck to private providers. Now the private providers are collecting money for services that they are not necessarily providing. Also, they appear as they don't care about the individual. All they are worried about is collecting the money. The dollar has become what's important. Also there are approximately 800 private providers now that are fighting to offer services. Another issue that concerns me is that we have had individuals that have worked on their own for years, now all of a sudden they need a one on one worker. What this means is the facility draws down huge dollars for this individual to have a baby sitter for several hours a day."

2. Definitely, yes on this question unless a unique situation reveals it to show otherwise.

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FRED SMITH

1. It is important that we move forward with reform that creates a structure of clarity, certainty, and confidence, providing appropriate leadership and a plan that more clearly identifies the roles and responsibilities of the State, the Local Management Entities (LME's), and the care providers. To accomplish this we must:

- place clear responsibility on the state for providing care for the long-term and more difficult chronic cases of mental illness and disabilities that cannot be appropriately served in the community and require the expertise and services provided through our state psychiatric hospitals and facilities for the developmentally disabled.

- develop the community capacity for short-term acute psychiatric care by working with our LME's, community hospitals, and other providers to establish and reinforce our abilities to serve consumers in crisis, providing a hub around which to build community services while reducing dependency on the State's psychiatric hospitals.

- develop the community capacity to provide individuals with mental illness, developmental disabilities, and substance abuse with appropriate ongoing assistance and services necessary to provide the greatest opportunity to live a productive and quality life.

Building a strong system of community based mental health services is not going to happen as a result of increased and constantly changing state rules and regulations coupled with poorly developed and sometimes inadequate provider reimbursement policies. Building community access and choice is going to require leadership focused on understanding the needs and identifying and addressing the barriers to success. This requires a willingness and devotion to working closely with our community hospitals and other care providers, the LME's and local governments, consumers, families, and advocates to find solutions.

2. Yes.

END

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