Reports hammer mental health care - Raleigh News and Observer

Cuts to the mental health system endangered lives, two panels conclude, and reforms should be reversed

Michael Biesecker, Staff Writer

RALEIGH - Two panels appointed by the Easley administration to review North Carolina's mental health system have filed scathing reports that call for reversing bungled reforms implemented during the last seven years, saying deep cuts to hospital beds and treatment have endangered lives.
Among the key recommendations:

* Adding at least 717 full-time employees at state mental hospitals to meet patient-to-staff ratios needed to ensure safety.

* Adding psychiatric treatment beds to both the state hospital system and private facilities.

* Increasing pay to attract and retain qualified staff at the state hospitals.

* Adding trained investigators with law-enforcement experience to review complaints of abuse and neglect at the hospitals.

The reports were completed more than two weeks ago but were not made public by the state Department of Health and Human Services. Fully implementing the recommendations would cost far more than the $68 million in new mental health spending Easley has proposed for next year.

Mike Pedneau, chairman of the group assigned to review the mental hospitals, said Friday he feared the reports, sent to DHHS Secretary Dempsey Benton, would be deep-sixed. The stakes are too high and the needs too great to keep quiet, he said.

"It's going to get buried until the legislature is ready to put the budget to bed," said Pedneau, a former director of the state mental heath system. "I think these things need to be out in the public and I gave Dempsey two weeks and I haven't heard a thing from him."

Benton called a news conference Jan. 3 and pledged before a bank of television cameras that he would carry out Easley's instructions to fix a mental health system that has wasted more than $400 million while leaving thousands of patients and their families struggling to find adequate treatment.

To help him, Benton announced the creation of three work groups composed of people outside his department such as former state facility managers, advocates, representatives from private hospitals and private providers of mental health services.

Two groups -- the Hospital Management and Operations work group and the Crisis Services work group -- filled detailed reports May 13 and 14 that call for a drastic change of course.

But there has not been any word from the secretary's office about the recommendations -- no news conference, no press releases, no posts on the department's web site.

"It's not been a secret, by any means," Benton said Friday. "It's been public. I distributed the report to the legislative oversight committee."

Rep. Verla Insko, the co-chair of the legislative oversight committee for mental health, said Friday that was news to her.

"Really?" Insko, a Democrat from Chapel Hill, said when told of Benton's comment. "I have not seen either one of those reports. I have not received them."

No report has yet been filed by the third work group, which was assigned to review the safety and operational concerns at the new Central Regional Hospital, as well as review the plan to close Dorothea Dix Hospital in Raleigh and John Umstead Hospital in Butner.

The first patients are set to arrive at the new $120 million hospital on Father's Day, just over two weeks away.

Benton said he did not know whether the group would finish its review of the plan to open the hospital before the hospital opens. That panel was chaired by Daniel Stewart, Benton's deputy secretary.

Staffing, pay lag

The report filed by Pedneau's group found staffing ratios and pay at North Carolina's mental hospitals lag far behind similar facilities in Tennessee and Texas.

"We firmly believe that current levels of staffing are inherently dangerous and ... additional staff are essential!" the report says.

An acute shortage of treatment beds is leading to a revolving door at the state hospitals, with patients routinely discharged before they are stable -- sometimes directly to homeless shelters. The rapid discharges and delays of more than a month to see a doctor on the outside are leading to increased readmissions, further straining the system.

"What we've got is bone-headed," Pedneau said of the system. "It makes no sense. The taxpayers should be angry."

Benton said the governor's proposed budget does address some issues outlined in the report -- spending $7 million to add 107 new positions at the state hospitals and $22 million to boost treatment beds in private hospitals.

When asked whether he stood by assurances made five months ago that the mental health system would be fixed before Easley's term ends in January, the secretary said:

"I think 'fixed' is a term that is a long-term view. I think we're fixing the plan of how to do it. ... We're setting the course in the right direction."


michael.biesecker@newsobserver.com or (919) 829-4698
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Law Affects Insurance For Mental Health Care - Hartford Courant

Gov. M. Jodi Rell signed a bill this week designed to get insurers to pay more often for residential treatment of mental health and eating disorders.

Public Act 08-125, which takes effect Jan. 1, eliminates the "three-day rule" in current law. The rule says group (employer-based) health insurance doesn't have to pay for residential treatment of those disorders unless a patient enters the program immediately after spending three days in a hospital.


The bill still allows insurers to determine for each patient whether residential treatment is medically necessary before agreeing to pay for it.

The new law directs insurers to pay for residential treatment if the patient "has a serious mental or nervous condition that substantially impairs the insured's thoughts, perception of reality, emotional process or judgment or grossly impairs the behavior of the insured."

An attempt to lift the three-day rule had stalled in the General Assembly but was revived after The Courant reported on turmoil the rule caused for an anorexic Fairfield teenager and her family.


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Mental illness alone doesn't make a killer - Calgary (Canada) News

Experts say family killers feel a sense of failure

Linda Nguyen

Mental illness alone seldom explains why some people kill their spouses and children, according to Canadian experts in psychology and family homicide.

Sources have told the Calgary Herald that Joshua Lall -- who killed five people, including himself, inside an upscale Calgary home this week -- recently reported hearing voices and thought he was possessed by the devil.

Calgary police confirmed Friday that Lall stabbed his family to death, along with a tenant in their home.

But Martin Daly, a professor of neuroscience and behaviour at McMaster University in Hamilton, said mental illness is seldom enough to drive someone to kill his family.

"People with major psychiatric disorders are scarcely more violent than the rest of the population," Daly said. "They are commanded by the voices to do things like jump in front of a train, leap out of a window because they think they can fly -- or go to the top of a mountain because they believe they will be taken away by a flying saucer.

"Guys who (kill) their whole family are typically not mentally ill. They've decided to do this over some period of brooding and made a plan."

Lall, 34, his wife Alison, 35, and their two daughters, Kristen, 5, and Rochelle, 3, were found dead in their home on Dalhart Hill in northwest Calgary on Wednesday morning after apparently being killed Tuesday.

Their one-year-old daughter, Anna, was unharmed.

Amber Bowerman, 30, who was renting a basement suite in the house, was also killed.

Don Dutton, one of the country's foremost experts in domestic homicides, said most men who kill their wives and children are severely depressed.

"They're at the point where they can't see any point of going on," said Dutton, a psychology professor at the University of British Columbia. "Their depression is absolutely unmanageable, unescapable, and they feel they failed in some crucial way."

He said depression can manifest in ways that cause the sufferer to blame the people closest to him -- his wife, even his children.

Dutton has testified in high-profile cases, including the O.J. Simpson trial and an inquiry into why Peter Lee, a man from Victoria, B.C., killed his wife, his son, and himself last year.

A murderous rage can be triggered by pathological jealousy, where the husband may believe his wife has been cheating on him or is leaving him, Dutton said.

He said the decision to kill one's own children, usually seen in the public's eyes as innocent victims, can also have religious or symbolic connotations for the killer.

"The murder of their children can happen for a couple of reasons. If they're very religious, they want to see the child in heaven," Dutton said. "If they're not religious, they don't want the child left on their own, because there would be no one to look after them, as bizarre as that sounds. They want to take everything with them."

Most men who commit these grisly crimes are usually described by friends and family as loving, doting fathers and husbands.

"Usually in these cases, the men are completely normal people. It's rarely the psychopath, someone with anti-social behaviour, a drug dealer," Dutton said. "It's someone trapped in the normalcy of things and having it collapsed in on them."

Many domestic murder-suicide cases also follow patterns that are highly symbolic for the killer.

For instance, Dutton said, Lee may have killed his wife and children in different areas of their million-dollar home, but brought their bodies together before stabbing himself to death.

Dutton said this happens because the killer wants to join his family in death.

In this most recent case, he said, such symbolism doesn't seem to have been a factor, since investigators found Lall, his wife, his children and the tenant in separate areas of the home.

Jordan Peterson, a clinical psychologist and professor at the University of Toronto, said whatever factors contributed to the killings -- rage, jealously, depression, paranoia or something else entirely -- substance abuse could make those black emotions far worse.

"Alcohol can take a bad situation and make it a really bad situation, really fast," Peterson said.

"The murders wouldn't have been caused by a single incident, unless it was an extreme violation, such as infidelity. It would've been cumulative of a series of events."

He also said Lall doesn't fit the typical persona of a family-killer -- someone who's almost always a man aged 15 to 26, or in his 40s or 50s.

Peterson said Lall's decision to use a knife in the killings may have been due merely to its availability.

"Usually, in domestic homicides, men use knives because they're more common," he said. "There's one in every house. In the U.S., it is more likely to be guns."

Peterson offered a possible explanation for why Anna was spared.

"Babies are innocent. You have to be bloody out of your mind to kill them," he said. "That could've been his limit. He hit his limit and was so overwhelmed by the realization of what he had done that he had to stop."

© The Calgary
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LA hospital settles patient dumping lawsuits - Associated Press

LOS ANGELES (AP) -- A hospital has agreed to settle two lawsuits accusing it of leaving a homeless paraplegic man on Skid Row without his wheelchair, attorneys said.

Hollywood Presbyterian Medical Center and Empire Transportation, Inc., a patient transportation company, have agreed to pay an undisclosed amount to Gabino Olvera, who was seen dragging himself across the pavement in a soiled gown in February 2007, said Olvera's attorney, Steven Archer.

Archer said Friday that settlement details were confidential but ''it's not an insignificant amount of money.''

Olvera's lawsuit alleged the hospital was negligent in its treatment, failed to diagnose and treat his urinary tract infection and mental illness, and discharged him in a helpless condition.

The incident also prompted the city attorney's office to file a related suit.

In settling that lawsuit, the hospital agreed to adopt protocols for discharging homeless patients, train their staff, and keep statistics, Chief Assistant City Attorney Jeffrey Isaacs said.

The hospital will also allow a court-appointed referee to monitor implementation of the settlement for five years, Isaacs said. The agreement requires the hospital to pay $1 million to two Hollywood social service agencies that provide medical services and beds to homeless people recovering from hospital stays.

The hospital will also pay the city $10,000 in civil penalties and $50,000 to reimburse investigative expenses.

Empire Enterprises, whose driver was accused of leaving Olvera, agreed to a $10,000 civil penalty.

''We have now done everything we told the community last year we would do in response this incident,'' Hollywood Presbyterian CEO Jeff Nelson said in a statement. ''From the first day we promised to take action to review our policies, procedures and services for homeless patients and improve them where needed. Much of that we accomplished months ago.''

After the incident, the hospital investigated, expanded its social services staff to help place homeless patients and retrained emergency room personnel on the special needs of the homeless, Nelson said.

A city law takes effect in July that will make it a misdemeanor to take patients anywhere other than their home without written consent.

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'Man on bench' at Friendly gone -Greensboro News Record

By Lorraine Ahearn

Mark is gone.

After his seven-year solitary vigil on a park bench near Friendly and Wendover avenues, Greensboro's most visible but enigmatic homeless person has left.

One Sunday morning in May, according to the owners at the nearby BP, Mark Hoffmann, 51, came in, bought a map of the eastern U.S., and left.

He carried, as usual, his sleeping bag and belongings, and hasn't been seen since, except for a sighting along I-85, walking through Durham.

"We kind of miss him and wonder what happened to him," said Sherri Patrick, manager at Bruegger's Bagels, where Mark bought a coffee and bagel each morning, and sat at the same table near the door. "I hope nobody hurts him."

Suffering from what outreach workers believe to be schizophrenia, Mark appeared at the busy Friendly Center overpass in the spring of 2001. He neither held a sign nor panhandled, but sat on the bench, walked the shopping center, jogged in the park and was gone before each sunset.

Friends at Centenary United Methodist Church, which is next door to the park greenway, learned more about him when he began attending weekly church services that Easter, and rarely missed a Sunday until two weeks ago. He is a graduate of Lehigh University, as the church confirmed with Lehigh's alumni association; he ran track during college, then was a graduate student and accountant at Duke.

Though he was quiet and stayed to himself, Mark was enough of a fixture at the busy intersection near Wesley Long Hospital that he put a face on homelessness for Greensboro residents, many of whom were on a first-name basis with him.

Karen Bridges, president of the county's Homeless Prevention Coalition, recalled speaking to a group of older men at a Civitan meeting.

"Many of the gentlemen in that group knew him, knew he had gone to college," she said. "A lot of times with homelessness, society wants to look past it. People didn't do that with Mark. They reached out to him."

But always on his own terms. Mark isn't one of the "hidden" homeless — the uncounted who camp in the woods or sleep in cars. Nor does he fit the profile of the "chronically" homeless that the county's Housing First initiative seeks to reach — those continuously cycled from jail to ER to homeless shelter to mental health centers.

In fact, other than the drinking fountain next to the bench and the steam grate behind Wesley Long, he used no public services at all. A former Greensboro resident who befriended him, Leigh Johnson, said that Mark would not accept disability or take medication, such as drugs to quell voices and hallucinations.

Likewise, when Glenwood's Servant Center staff tried to find housing for Mark, a fellow church member said, Mark declined to move.

"It's too far from the bench," longtime Centenary church member Clara Ellis recalled him saying.

Nevertheless, help came to him. On bitter cold winter days, Ellis and her husband would persuade Mark to check into Battleground Inn to rest, shower and wash his clothes.

Apart from Mark's failing eyesight, which is the reason he was often seen holding the USA Today sports section close to his face, he is in good physical health from running on the trails, Ellis said. She said she would not expect him to hitchhike or accept a ride from a stranger, and believes he walked to Durham.

Hugo Temoche, an engineer who attends Centenary and travels the state for his job, said he spotted Mark walking along I-85 North in Durham on May 19. Mark had not attended church since May 11, and had last been seen in Greensboro May 15 or 16, according to Assistant Chief Harold Scott of the Greensboro police.

Scott said another homeless couple had begun sitting on the bench, which could have caused Mark to leave.

For Gail Haworth, a veteran outreach worker and director of the Servant Center, the idea of Mark walking north — perhaps to Baltimore, where he once had family — was unsettling.

"He's very vulnerable to anyone going past, especially on I-85," she said. "He would have no food. Where would he sleep? It's just a scary thought."

Though Assistant Chief Scott said neighbors at Friendly Center had gradually started inquiring about Mark, Clara Ellis and her husband immediately suspected he was gone when he didn't show up for church May 18. Assigned to be greeters that day, the couple left as soon as the service started, and went to the bench.

"It was just such a lonely feeling," she said. "There was nothing there."

Contact Lorraine Ahearn at 373-7334 or lorraine.ahearn@news-record.com Read more!

Health worker: Butner hospital opening is ‘heading for a train wreck’ - WRAL-TV Raleight (NC)

Raleigh, N.C. — "We're heading for a train wreck." That's what a mental health worker told lawmakers Thursday night about the opening of Central Regional Hospital in Butner.

The workers met with legislators, legal experts and community leaders in Raleigh to ask that the hospital's opening be delayed a year.

“I think we make a mistake if we don't listen to people who actually work in those situations,” said Rep. Larry Bell, D-Sampson.
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Workers said the new hospital will be understaffed and dangerous.

"The place is not safe at all,” Dorthea Dix Hospital worker Margaret Pettifored said.

"Under-staffing, mandatory overtime. We have an increase in patient and staff injuries," Bell said.

The workers also rallied Thursday outside of the Wake County Office Park on Carya Drive, where their meeting was to take place.

They said existing problems at Dorthea Dix will only be exacerbated when the Butner facility opens on July 1. Dix will close on the same date, and patients will be moved to the new hospital, beginning in mid June.

"We always need more help,” Pettifored said.

Central's opening was delayed once in January after patient advocates complained the move was happening too fast and an internal review found 30 types of hazards at the new hospital.

DHSS officials admitted that staffing will be a challenge in the new hospital, but said they will be able to meet it.

"Patients are always first,” said Larsene Taylor, a health-care technician at Cherry Hospital in Goldsboro and chair of the North Carolina Public Service Workers' Union chapter for workers in the state Department of Health and Human Services.

The state will keep 60 beds open at the Dix campus for about three years to help with the transition to the new hospital.

The entire state's mental health-care system has been under fire lately amid years of claims of wasted money, inadequate services and patient neglect and abuse. Read more!

Mental hospital workers tell their troubles at rally - Raleigh (NC) News & Observer

They came from across the state to demand safer spaces, more money

By Michael Biesecker

RALEIGH - About 200 workers from state mental hospitals across North Carolina rallied in Raleigh on Thursday to demand the right to work in a safe environment while earning a decent wage.

They told an invited panel -- including five state legislators -- that staffing levels in the hospitals had been cut so low that they were often no longer able to provide the required levels of care and still protect themselves.

Some said they were often forced to work overtime or asked to work a double shift -- 16 hours straight -- and then come in the next day and do it again.

"We care about our patients and we don't want them to get hurt," said Burnett Banks, a health care technician at Dorothea Dix Hospital in Raleigh. "We don't want to get hurt either."

As the state plan to reform the mental health system has foundered, long-time workers said patients are increasingly violent and desperate.

"These patients have been getting more violent in the last five years because they aren't getting the treatment they need," said Bernice Lunsford, a nurse at John Umstead Hospital in Butner with 22 years on the job.

Many of the out-of-town workers arrived in passenger vans rented by the N.C. Public Service Workers Union, which organized the event. In a packed meeting room where the atmosphere seemed like cross between a labor protest and a tent revival, employees opposed a plan to close Dix and Umstead and send patients to the new $120 million Central Regional Hospital in Butner.

State employees said that when they called the office of Gov. Mike Easley to talk to someone about the move they were hung up on. A few who managed to meet last week with some of Easley's aides were told only that the administration would continue to monitor the situation.

The new hospital in Butner has design flaws that could be hazardous to patients. In addition, internal projections say the hospital will open with dire shortages of qualified staff.

Even if staffed to the full level planned, administrators expect to have fewer employees taking care of more patients.

With mass shortages, managers are often attempting to close the gap with temporary workers that are more expensive than state workers and sometimes less qualified. A nurse said about 40 percent of her colleagues at Dix are now temporary staff -- a ratio they expected to be even worse at Central Regional.

Nurses said that on two-hour tours of the new facility this week -- the only orientation to the new hospital they have received -- administrators told them that if they speak out publicly about the problems, they could lose their jobs. Several said that was a risk they were willing to take to follow their consciences.

"I walked in and immediately saw problems," said Diane Spotz, a nurse at Dix. "They had electrical outlets in the patient bathrooms. We have patients who like to stick things in those."

Kris Casey, a temporary nurse who has worked at Dix for a year, issued an even more direct warning to Rep. Verla Insko of Chapel Hill, the co-chair of the legislative oversight committee on mental health.

"If you move us up there, people are going to die," Casey predicted. "I've seen a person hang themselves on a handrail. It doesn't take much."

Insko told the workers to put their concerns in writing.

"We need evidence, not opinions," she said. "I'm going to pass the information along so when we move it will be safe."

Rep. Deborah Ross of Wake County earned applause by telling the workers that in her view the move to Central Regional doesn't meet the minimum standards the legislature set out for the closure of Dix.

"If they open this hospital in its current condition it will be a violation," Ross said. "The legislators are in town Monday night. Go down and talk to them." Read more!

House budget rollout begins -Raleigh (NC) News & Observer

It favors, teachers, state workers, droput prevention; a mental health service is cut

By Dan Kane

House leaders on Thursday began moving some major pieces of what is likely to be a $21 billion budget proposal that will include modest pay increases for teachers and state employees, more money for high school dropout prevention and a deep cut in a much-maligned community services program for the mentally ill.

Highlights of what House budget writers have proposed:

Taxes and fees

The House did not go along with Gov. Mike Easley's proposed tax increases on cigarettes and alcoholic beverages. The House plan will include about $50 million in tax relief by expanding tax credits to lower income working families and small businesses who offer health insurance, and by offering a property tax exemption to veterans who have suffered disabling injuries in service and their surviving spouses.

Raises

State Rep. Mickey Michaux, a Durham Democrat, said the House would offer a 3 percent pay raise to teachers and school administrators, and raises of 2.75 percent or $1,100, whichever is greater, to every one else. Retirees would get a 2.2 percent cost of living increase. Easley has proposed a 7 percent raise for teachers and a 6 percent raise for school administrators. Everyone else would get a 1.5 percent raise and a $1,000 one-time bonus. Retirees would get a 1.2 percent cost-of-living adjustment.

Education

House Speaker Joe Hackney's signature program, dropout prevention grants, would get a big boost, up to $15 million from $7 million last year. The program allows communities across the state to pitch local programs that help students stay in school and graduate.

House leaders also called for less funding for an expansion of Easley's More at Four pre-kindergarten education program -- $23 million vs. $45 million.

The House also expects lottery proceeds to cover Easley's program to reduce class size in elementary schools, while Easley is seeking $11 million from the taxpayer-supported general fund.

House members would also make more part-time students eligible for grants offered to North Carolinians who attend the state's private colleges and universities. The Legislative Tuition Grant would go to part-time students taking at least six credit hours a semester at a cost of $1.75 million. The current threshold is nine hours a semester.

Health and Human Services

The House is proposing much deeper cuts in the community support services program for the mentally ill. Easley proposed nearly $31 million in cuts; the House upped that to $86 million, largely by proposing to tighten eligibility requirements. Dempsey Benton, secretary of the Department of Health and Human Services, said that cut goes too far and would reach into core services that the mentally ill need. He said the department could live with $67 million in cuts which is practically a split down the middle between what the House and Easley have proposed.

Justice and Public Safety

The House proposal includes $1 million to help sheriffs enforce federal immigration law, and would spend roughly $400,000 more than Easley to prevent rape victims from having to pay out-of-pocket costs of forensic exams.

Though it does not appear in budget documents released Thursday, $10 million in gang- prevention funds will be in the House budget proposal, Michaux said. He said the money would be contingent upon the passage of legislation that toughens penalties for gang-related crime.

dan.kane@newsobserver.com or (919) 829-4861
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Don't put mentally ill in our neighborhood -Joiliet (IL) News Leader

By BOB OKON bokon@scn1.com

JOLIET -- More than 100 residents showed up in opposition to a plan for a Cornerstone Services apartment building.

The eight-unit building would be built on Thomas Hickey Avenue and provide apartments for people with mental illnesses.

But residents who spoke at the informational meeting Wednesday night expressed worries about the people who would move into the neighborhood and the construction of an apartment building near their single-family homes.

"You're asking us to buy into an unknown, and we live right in that community," resident Vicky Clink said. "I don't want to live with an unknown."

The Joliet City Council is scheduled to vote Tuesday on Cornerstone's request for a special use permit, which is needed to build the apartments just east of Essington Road and on the edge of the Warwick subdivision.

The council tabled a vote on the permit earlier this month in order to have the informational meeting so Cornerstone could explain its plans.

Representatives from Cornerstone, a Joliet-based social services agency, tried to assure neighbors that they had a solid track record of providing similar housing and that only people with mild cases of mental illness would live in the building.

"We have no intention whatsoever of bringing people onto this site who are dangerous, who have a criminal background," said Deanna Watson, director of behavioral health for Cornerstone. "Our screening process is very thorough."

Watson said the people who would live in the apartments already live and work in the community.

"They go to church. They go to Jewel. They go to the same eye doctors you do," she said.

But resident after resident raised questions about Cornerstone's ability to monitor the apartments and ensure the tenants would not pose a threat to surrounding families.

"This is a social experiment in our neighborhood," one resident declared.

"There is a legitimate safety concern because you're not going to be there 24 hours a day," said another.

"We want a nice safe environment for our children to grow up in," one other residents said.

Fifty-two people spoke against the plan. When someone asked if anyone in the group of more than 100 residents at the meeting supported the apartments, no one raised a hand.

The outpouring of opposition was unlike anything Cornerstone has seen since 1990, a spokesman with the agency said. That's when Cornerstone first began a program to place people with disabilities in subsidized homes in the community. The agency now provides residential services to 140 adults and 90 children in Joliet. It provides similar services to another 100 people in other surrounding towns.

Most of its clients are people with mental or physical disabilities. But Cornerstone already provides subsidized housing for people with mental illnesses.

This building would be the first apartment building both owned by Cornerstone and provided for residents with mental illnesses. But the agency already owns a six-unit apartment building for people with other disabilities and provides duplex housing for individuals with mental illnesses. Read more!

The cycle for mentally ill homeless must end -Philadelphia Daily News

By Elmer Smith
Daily News Opinion Columnist

SOMEBODY SAID he saw "Tico" at Broad and Olney with a lye-based hair remover smeared on his face and head.

Then, on Wednesday, someone spotted him outside the Gallery eating from a trash can. At least, it looked like Tico.

At a glance, he looks like a lot of the dusty wanderers who collect cans or break into cars or disturb our peace just by being there. Men like Altico Cooper, whose homelessness results from untreated mental illnesses, find themselves suspended between periods of life on the streets and enforced stays in homeless shelters, mental-health institutions and jail cells.

They are a subset of a subculture, shadow people whose irrational choice to live on the streets has swelled the city's homeless population and prison census to a point at which the mayor has been moved to intervene.

"We have souls and lives to save," Mayor Nutter said Wednesday as he unveiled an $8.3 million plan to provide an additional 700 housing units and beds for homeless people.

It's an ambitious plan. But it diverts hundreds of public-housing units from the 48,000 people who have languished on waiting lists for months.

It provides up to 150 units of housing with services for the chronically homeless. It funds 50 beds in treatment facilities for people with addiction and mental-health issues.

Cooper, 41, is paranoid/schizophrenic, bipolar, diabetic and loved dearly by family members who spend much of their time and energy either caring for or looking for him.

"I bought him a house so he wouldn't have to live on the street," said his mother, Willie Mae Cooper, a retired city worker on a fixed income. "I pay the mortgage. But I can't make him stay there.

"They called me from Gaudenzia House last night and said he was seen eating out of a trash can at the Gallery. I just broke down when I heard it.

"He's bipolar, but he won't stay on his medication. He's got a blood clot in his leg and his sugar was up to 1,000. Anything could happen to him."

She describes a son who was an excellent student until he suddenly veered off track at age 15. By the time he was diagnosed, he had become delusional and increasingly hostile. Then, he pushed her into a wall and she had to have him involuntarily committed.

"I'm mental too," said his older brother, Martez Cooper, 46, whose mental and physical ills mirror his brother's. "I know what it was like to be out there before I got the right medications.

"I didn't think I was homeless. But I was on the street or in and out of jail."

He has served time with dozens of men who are like he is and who wouldn't have been in jail if they had been properly medicated.

"That's what happens when they don't take their medications," he said. "I take 400 milligrams of Seroquel twice a day, I take Paxil three times a day and I'm down to one milligram of Alprazolam a day.

"I was taking Xanax, but they took that from us when these Hollywood stars started abusing it."

The medication has kept him stable for four years. He cares for himself and his daughter in the house their parents bought for him and his brother. He is, after years in limbo, a success story.

"But everybody is not stable enough to be on the street," he said. "Why did they have places like Byberry [state mental hospital] if they didn't have people who need them?"

It's a good question. But, until we get an answer, we'll be spending $110 a day to jail people who should be hospitalized, and untold millions to break the cycle of addiction for those who self-medicate.

For now, families like the Coopers, who have done all that we could ask of them, will sit by the phone and pray that something happens for their loved ones before anything happens to them. *

Send e-mail to smithel@phillynews.com or call 215-854-2512. For recent columns: http://go.philly.com/smith Read more!

Mental illness stigma can overshadow career -Ontario (Canada) Business Edge

By Tess van Straaten

For much of his life, Dick Averns has known there was something different about him - he just didn't know what.

"I can remember from my earliest days having what I would call spasms and my brother would make fun of me," the 44-year old Calgarian says. "I just lived with it and was able to contain a lot of it when I wasn't in public situations."

It wasn't until three years ago that Averns, an artist and instructor at the Alberta College of Art and Design, was finally diagnosed with Tourette Syndrome.

A neurological disorder, Tourette's is characterized - and often stereotyped - by motor tics and verbal utterances.
Larry MacDougal, Business Edge
Instructor Dick Averns, left, with project participants Alex Link, Elizabeth Singer and Randi-Lee Ryder.

"A lot of the time Tourette's is not what you think it is - it's not people walking down the street and jerking their head and shouting obscenities," Averns explains. "That's quite rare and the big picture is lots of people have this."

In fact, it's estimated that one in every 100 people may have Tourette's, a figure that's similar to the statistics for autism and bipolar disorder. The number of people suffering from these and other mental and neurological illnesses prompted Averns to take action.

With funding from several Alberta colleges, Averns and a team of researchers looked at the workplace challenges facing people with mental illness.

"When you consider that one in five Canadians (according to figures from the Canadian Mental Health Association) will be affected by mental illness and that our workforce is suffering from a shortage of workers, now is certainly the time to be addressing how progressive employment strategies can heighten career success," Averns says.

The study, which used art and creative writing to help participants open up about their experiences, examined challenges such as alienation, conflict and career choice. It also shed light on the workplace stigma that often surrounds these conditions.

"In many cases when people disclosed their illness to their employer, they were adversely affected," Averns explains. "A lot of people found that they're not able to keep jobs for long."

It's something Winnipeg marketing specialist Jonathon Garwood knows all too well.

"Having bipolar has cost me numerous jobs and I can't count the number of people I know who were let go from jobs because of their illness when it came out," he says.

"It doesn't matter if you're a good employee - they can find 101 ways to let you go without it being about the mental illness."

Diagnosed in 1991 soon after entering the workforce, Garwood had a bright future ahead of him. He'd graduated at the top of his class with a commerce degree, but says the stigma of his disease was hard to overcome.

"The most painful thing about having a mental illness is not the mental illness but the stigma," says Garwood. "If we did this to people who had cancer or diabetes or MS there would be a public outcry and every politician in the country would be screaming for it to change."

Jumping from job to job, Garwood had a lot of negative employment experiences. But he also came across some forward-thinking bosses willing to give him a chance.

As a salesman at a Dufresne Furniture store in Winnipeg, Garwood was allowed to work a reduced shift when he found the standard 12-hour day too much of a struggle.

"It's just part of our culture to look after people, whatever problem or illness they may be dealing with," says Dan East, Dufresne's vice-president of new market development.

"I think it stems from the fact that we started as a mom-and-pop business in Kenora and, as we grew, we wanted to keep that environment of taking care of your people."

Now Canada's largest independent furniture retailer with stores from Alberta to Ontario, Dufresne has been named one of Canada's 50 best-managed companies for several years running. East says employee satisfaction has a lot to do with that success.

"What you put out is what you get in return. Treat people the way you want to be treated - it's not complicated, but I think a lot of businesses overcomplicate things and forget that."

One company that's on the leading edge of employee accommodation is Canada Safeway. The grocery giant has been hiring people with disabilities for more than 50 years and the retailer wouldn't have it any other way.

"A lot of companies say they want to hire people with disabilities, but we actually do it," says Safeway spokeswoman Betty Kellsey. "It's become part of the fabric of our company and it's not something we talk about as a strategy - it's something we do."

Recently nominated for the Mayor's Award in Edmonton for hiring people with disabilities, Safeway is part of a national campaign to get more employers to consider tapping into this so far under-utilized workforce in an effort to help solve the skills shortage.

"We've found people with disabilities of all kinds - whether it's physical, mental or mental illness - are very hardworking and very dedicated to their jobs," Kellsey says. "It's been a very positive experience and they bring a lot of valuable skills to the table."

Perhaps the biggest reward for employers - in an ever-tightening labour market - is loyalty.

While it can take more time to train, integrate and accommodate employees with mental or physical conditions, they're much more likely to stay in a positive work environment once they find it.

"People with disabilities who are trained well and integrated, not just in their job but also in the community network of the store, are very loyal and tend to stay longer, so, from a business perspective, it just makes sense."

Averns' study on optimizing workplace achievement came to the same conclusion. It also found small accommodations - like letting people with Tourette's have a quiet space to work - made a big difference.

"I know for myself I work better in the morning so I've changed my routine to do my writing when I'm fresh," Averns says. "The biggest thing employers can do is give people the flexibility and accommodation they need to get the job done."

Garwood couldn't agree more.

"If someone was blind, you'd get Braille," he points out. "If they were deaf, you'd supply the TTY phone (a phone enabled to send text over phone lines) - you wouldn't scream at them: 'Why can't you hear the phone?' I deal with life in different ways than the average person and all I need is a boss who is understanding."

It's something Safeway has taken to heart - partnering with organizations that represent the disabled and mentally ill to make sure local stores have the right resources on hand. And once new hires start, it's important the entire team embrace them.

"If an employee - any employee - comes in and doesn't feel welcome they'll leave and that's the main fact of the labour shortage we're in," Kellsey says.

For his part, Averns is expanding his research project. He's now looking for a large employer, like an oil company, that has workers in lots of different environments both indoors and out, who would be willing to have a more comprehensive study conducted in their environment.

"Many people are afraid to disclose their condition, but the more we know the more we can do to help," Averns explains.

"The most important thing is to be open to other people's idiosyncrasies - we all have them."

(Tess van Straaten can be reached at tess@businessedge.ca)


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Hospital boss finds money for portrait - Raleigh (NC) News & Observer

Michael Biesecker
May 29, 2008

The serene smile of the lady in the portrait to be hung at Central Regional Hospital in Butner conveys none of the turmoil in North Carolina's mental health system.

Severe cuts to staffing and patient beds have left thousands of mentally ill people languishing on waiting lists for state hospitals. Cost overruns at the new $120 million mental hospital in Butner even ruled out a large state seal planned for the lobby.

Still, hospital Director Patsy Christian found enough cash to commission a large oil painting of herself, painted by a subordinate and paid for with $250 intended to benefit patients.

Christian ordered the portrait for delivery shortly before the planned November 2007 opening of the hospital, which is intended as the centerpiece of an ambitious reform. But a fire, concerns over design flaws that endanger patient safety and the failure to hire enough qualified staff have kept Central Regional empty.

The painting has passed the time in storage.

This week, it sat in its gilded frame inside a gray cubicle at Dorothea Dix Hospital in Raleigh, where Central's executive staff have temporary offices.

An Oct. 25 sales receipt from Portraits by J. Lee shows a "unit price" of $4,250.25.

Christian, however, received a 95 percent discount, paying only $250.45 for the "Executive Portrait" and another $321.53 for the gold frame, shipping and handling included, according to the receipt.

The invoice was paid using the money collected from vending machines at John Umstead Hospital in Butner. Christian, 60, oversees Umstead and Dix, which are scheduled to be closed next month. The patients will be moved to Central Regional.

The state budget manual mandates that the dimes, quarters and bills collected from mental patients using the hospital's vending machines go to pay for recreational activities that benefit them, such as field trips: "Expenditures of profits should be as closely associated to the population or program surrounding the vending facilities as possible."

Christian, whose annual salary is $119,759, declined requests for an interview about how her portrait fit that definition. A request for her to pose for a photograph with the painting was also declined through a departmental spokesman.

Calls to the artist J. Lee were not returned. Property records for the address listed on the sales receipt show the Raleigh house is owned by J. Lee Harris.

Harris, 51, is a nurse supervisor at Umstead and a subordinate of Christian's. She also has a side business painting babies, recent graduates and family pets.

Her Web site says her work sells for between $1,000 and $25,000 a canvas. Harris' annual salary from the state is $72,788.

"I hope you like the portrait," Harris wrote in a Nov. 27 e-mail message to her boss. "I made every attempt to represent you in a timeless, warm, professional and commanding way. When I met you in 1990, I knew you were the perfect model. Now I know you are more than the perfect model, but you helped me make an exquisite representation. Love the environment and your pose!"

Then, Harris offers Christian another portrait for her home at a bargain price.

Gifts are forbidden

DHHS forbids officials to accept gifts -- anything of value -- from those they supervise.

Spokesman Brad Deen said Wednesday that Christian did not seek guidance about whether accepting the portrait at a steep discount violated that standard. No one above her in the chain of command, including Secretary Dempsey Benton, had known about the portrait, Deen said.

In a statement attributed to Harris and released by the department, the artist said the painting was a gift to the people of North Carolina and that the payment she received barely covered the cost of materials.

"Her unconventional beauty, her sense of humor and her blinding intelligence are engraved in my mind," Harris said of her boss. "I knew that with my skill and desire, I would create a painting to be enjoyed by many and become engaged with this historic moment."

Though Christian's name is on the receipt for the painting, Deen said the department's in-house lawyer determined Wednesday that no ethical violation occurred because the $4,000 discount was a gift to the state, not the hospital director.

However, that position could run afoul of state laws forbidding a state employee such as Harris from receiving state contracts. Such an act is potentially a criminal misdemeanor, according to the statute.

With morale among workers at the mental hospitals supervised by Christian already low, several employees predicted Wednesday the portrait would make her appear more like Marie Antoinette than Mona Lisa.

"We've had pay cuts, no raises, we're being understaffed to save money, corners are being cut with our safety," said Beverly Moriarty, a nurse at Dix. "Any money that's been diverted away from patients for someone's self-aggrandizement, there's definitely going to be a negative response."

Deen said Wednesday that the painting would still hang at the new hospital. "They're looking for the right spot," he said. Read more!

Shooting suspect faces assault charge -Seattle Post-Intellingencer

May 29, 2008
By TRACY JOHNSON

A Snohomish man now faces a second-degree assault charge -- and the possibility of several years in prison -- in the shooting that left three people hurt and disrupted Seattle's usually laid-back Northwest Folklife Festival.

King County prosecutors filed the charge Thursday against Clinton Grainger, a 22- year-old man who was undergoing treatment both for mental health problems and for substance abuse, according to court documents.

Grainger's gun, which he kept in an ankle holster, fired when he and another man were struggling over it in a crowded area north of the fountain at Seattle Center on Saturday.

The shot left the other man with gunpowder burns to his lip and nose. The round went through the hand of a man who was nearby and then lodged in a woman's thigh. Neither had been involved in the altercation.

Grainger told police the fight started when the other man wanted to prove he was tougher, and they were grappling for the pistol when it went off, according to court papers.

Police said Grainger explained, "I dunno; he pulled the trigger or I pulled the trigger ... the trigger was pulled."

The other man told police that he'd been sitting in a drum circle at the festival when Grainger walked by, glaring at him as if he was looking for a fight. He said a few words were exchanged, and then Grainger shoved him.

He told police Grainger reached for the gun while he tried to stop him.

Grainger will be arraigned June 12 in Superior Court. He could face roughly three to four years in prison if convicted. He remained in jail Thursday on $350,000 bail.

Prosecutors contend he may be a danger to the community despite a limited criminal record.

They said they filed the single assault charge, naming all three victims, because only one shot was fired. Read more!

Lifting the Veil of Depression -ABC News

Experimental Electrical Pulse Therapy Can Shift Moods, Possibly Cure Depression

Video and other info here.

By JOHN McKENZIE
May 29, 2008—

According to the National Institute of Mental Health, more than 21 million Americans suffer from some kind of depressive disorder. For about 4 million of the most severe cases, no treatment can help. But there is a promising experimental therapy now in clinical trials that, in essence, "rewires" the brain. It is most definitely medicine on the cutting edge.

Diane Hire of Norwalk, Ohio, is 54 years old. For the past 20 years, she has lived with severe, unrelenting depression.

"You felt like a dead person walking. There was just nothing left in me," Hire told ABC News. "I had no emotion left. I had no energy left. I had nothing. I was an empty shell of a person."

She was prescribed one anti-depressant after another, as well as psychotherapy. Nothing worked. She tried to commit suicide three times.

"It was unbearable. It was just unbearable." she said. "You start to feel that your friends and family would be better off without you." Hire reasoned, "There's just not anything that's going to change. So why live like this?"

Finally, her psychiatrist suggested a radically different, experimental treatment: deep brain stimulation, the same procedure that's been used safely for two decades to calm the tremors of Parkinson's disease and is now being tested on severe depression.

Using a brain model, Dr. Ali Rezai, a neurosurgeon at the Cleveland Clinic and lead investigator of the clinical trial for this treatment, showed ABC News how deep brain stimulation works.

"We slowly advance this probe into the brain," he said, "and it goes to the precise location where there's abnormal activity going on resulting in depression. ... [Then] we activate it by inserting tiny electrical pulses."

The pulses are mild enough so that the patient does not feel anything, but they're powerful enough to change a patient's mood.

With Hire's head immobilized in a brace and electrodes deep inside her brain, doctors start adding those electrical "pulses" to her brain. Diane feels the effects immediately.

"I'm starting to smile. I'm so happy," she said.

Minutes later, doctors increase the electrical intensity, and her mood improves further. Hire smiles, saying, "I feel good." She tells the surgeons she cannot remember the last time she felt like this.

Then, when doctors add more of the mild, electrical pulses, Hire laughs. "I just feel happier."

To keep her depression-free, doctors implant two battery-powered pacemakers in her chest with wires running under her skin to that spot deep inside her brain.

Today, Diane walks 50 miles a week and is eager to be around friends and family.

"They didn't create a new person. And they're not manipulating my mind," she is quick to point out. "This is me."

This clinical trial using deep brain stimulation to treat depression began at the Cleveland Clinic in 2003. Brown University Medical Center and Massachusetts General Hospital are also now testing this approach. According to the most recent data presented at a neurological conference in Chicago last month, eight of the 17 patients treated with deep brain stimulation have seen significant improvement.

Another clinical trial using the same treatment but focusing on a different target area in the brain is being conducted at the University of Toronto and Emory University. Several more years of testing, on both approaches, are still required before doctors have enough data to submit to the Food and Drug Administration for approval.

"There is such a huge difference," said Diane. "I can jump out of bed and look forward to the day. And I never used to do that."

Copyright © 2008 ABC News Internet Ventures
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Actor Joe Pantoliano Asks Congress to Kill Mental Illness Stigma - Scripps-Howard News Service

May 29, 2008

By Angel Booth

At the far right end of the head table, Jordan Burnham sat upright in his wheelchair and began to read his personal narrative. Regularly switching his focus from the audience to his paper, the 18-year-old became the center of attention.

"I would like to share with you a story today," he began. It was the story of Sept. 28.

That evening, the high school senior from Philadelphia, just nominated to homecoming court, jumped out of his ninth-story bedroom window in a suicide attempt.

Burnham's parents were told their son had a 40 percent chance to live, and if he survived, the varsity golfer would be paralyzed or mentally retarded. His mother had just gone to the golf course with him the for the first time the day before.

"It is by that 40 percent miracle that I am here today to tell you that there are millions of people that are having the same emotions inside that I had that night - but with your help their outcome does not have to be identical," Burnham told the crowd at a Capitol Hill briefing .

Like Burnham, Emmy award winning actor Joe Pantoliano was popular in school - voted his high school's best dressed. And like Burnham, "The Sopranos" actor was diagnosed with depression.

Both men came to the May 21 briefing to ask Congress for mental health awareness and insurance parity.

Sponsored by Pantoliano's nonprofit organization, No Kidding, Me Too!, the briefing brought together celebrities, representatives, mental health organizations and others to discuss how to erase mental health discrimination and stigma.

According to the National Institute of Mental Health, an estimated 26.2 percent of Americans 18 and older suffer from a mental disorder, a medical condition that disrupts a person's thinking, feeling, mood, ability to relate to others and daily functioning. Although mental disorders are widespread, serious mental illness is concentrated in a much smaller proportion - about one in 17. Serious mental illnesses include major depression, schizophrenia, bipolar disorder, obsessive compulsive disorder, panic disorder, post traumatic stress disorder and borderline personality disorder.

Two-thirds of people with diagnosable mental disorders do not seek treatment, according to the Centers for Disease Control and Prevention, and No Kidding, Me Too! believes this choice is directly connected to discrimination and stigma.

"It's not just a psychological illness but a physical ailment," Pantoliano said. "It should be given the same respect as other body parts."

Pantoliano argued that heart patients are given pacemakers as a preventive measure, but those with mental illness don't get treatment until he or she "breaks."

No Kidding, Me Too! is focusing the efforts of the entertainment industry to help meet its goal. Entertainers who depict characters with mental illnesses can make society more aware.

Supporting Pantoliano at the briefing was Academy Award winner Marcia Gay Harden, Pantoliano's co-star in the new movie "Canvas." In the movie Harden portrays a mother and wife with schizophrenia. Pantoliano plays her husband.

Harden departed from her prepared remarks to talk about having a family member with a mental illness, as well as being the daughter of a military father with post traumatic stress disorder.

"How can we send our men and women into war, for whatever reason, but not support them on the way home?" she asked.

"Canvas" also brought light to Panlionio's family's struggle with mental illness.

"I thought my mother's behaviors were behaviors that she chose - that she actually chose to be like that. I had no idea that my mother was living with bipolar disorder, or diagnosed clinical depression," he said.

The briefing also highlighted the real-world costs of mental illness.

Joe Santiago, the father of three, sustained a head injury in his first 30 minutes of serving in Iraq. The former Army master sergeant came home with post traumatic stress.

"People with dramatic brain injuries generally don't let you know that stuff is wrong," said Santiago, who ignored his injury for three weeks before seeking help.

The New England Journal of Medicine found in 2004 that 15.6 to 17.1 percent of those who served in combat operations in Iraq met the screening criteria for major depression, generalized anxiety, or post traumatic stress disorder after duty. Of those whose responses were positive for a mental disorder, only 23 to 40 percent sought mental health care.

Rep. Jim Ramstad, R- Minn., spoke of reaching the goal of achieving insurance parity through legislation. Ramstad is the lead cosponsor of the Paul Wellstone Mental Health and Addiction Equity Act of 2007, which would require equal health insurance coverage for mental and physical illnesses when policies cover both.

The act was passed by the House of Representatives on March 5 and the Senate passed a different version last year.

"We've got to end the stigma against mental health illness. It's time to knock the down the discriminatory barriers of treatment. It is time to treat mental illness like the public health crisis it is. It truly is America's number one public health crisis," Ramstad said. Read more!

Family Of Man Shot By Long Beach Officer Files Claim - KNBC-TV Los Angeles

May 29, 2008

LONG BEACH, Calif. -- The family of a man killed by a Long Beach police officer during a struggle has filed a wrongful-death claim against the city and Long Beach Police Department.

An attorney filed the claim Tuesday night on behalf of Roketi Mosesue's relatives and a neighbor who claims that officers beat and arrested him after the shooting. Attorney Brian Dunn said the claim is a precursor to a lawsuit.

Witnesses and family members have said an officer shot an unarmed Mosesue three to six times as he lay on his stomach in front of his house on May 17. Police contend Mosesue charged at the officers and that an officer shot him after he grabbed a baton from another officer during the struggle.

In one of the 911 calls, Billy Moses, son of the suspect's girlfriend, worried that Mosesue was being a danger to himself and to others.

"There's a guy. He's absolutely insane. He's abusing the neighbors, like, he's most likely suicidal," Moses said in the 911 call.

Moses then put his mother Kathryn on the phone.

"He was a neighbor and he moved in with me two weeks ago because he had nowhere else to go, and he's completely off his rocker," Kathryn said on the 911 audio.

Moses told KNBC that, "Rocky's the kindest person you ever met. He was always cracking jokes. He was in love with my mom."

After listening to the 911 calls, Moses said that he was worried about his mother that day and insists Mosesue was never a physical threat to anyone.

Police said Mosesue struggled with the officers and, despite having been shot with a stun gun, he continued fighting and tried to grab one officer's baton.

"Officers continued to struggle with the suspect on the sidewalk using their batons, and during the struggle, the suspect grabbed onto one of the officer's batons," Long Beach police Deputy Chief William Blair said. "As the officer and the suspect struggled for control of the baton, both fell to the ground. The suspect disarmed the officer of his baton and punched him in the face. Additional officers were requested at this time.

May 19 Video

"The other officer, seeing that the suspect was now armed with a baton and was attacking his partner, fired several shots, striking the suspect in the torso," Blair said.

Several residents contradict the police account.

Some residents said Mosesue was unarmed and not aggressive. Family members said Mosesue had a bipolar disorder, was dying of lung cancer and had had a fight with his girlfriend, which is why he was upset.

Copyright 2008 by KNBC.com and KNBC (NBC4 Los Angeles). The Associated Press contributed to this report. All rights reserved. This material may not be published, broadcast, rewritten or redistributed.

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Program gives children a voice -Eastern Wake (NC) News

May 29, 2008
By Solja Nygard Frangos

Knightdale — Marilynn Marsh-Robinson believes it sometimes does take a village to raise a child. The Knightdale mother of two volunteers with the Wake County Guardian ad Litem Program, which provides trained advocates to children in the state court system. Marsh-Robinson and more than 4,600 other volunteers across the state promote the children’s best interests.

Marsh-Robinson got involved in the program two years ago because she wanted to help those who often don’t have a voice, especially in legal proceedings. Marsh-Robinson, who had her first child when she was 16, had previously worked with teens, trying to prevent them from getting in trouble and “becoming statistics,” she said.

“I saw this program as another way to further the cause of helping children,” she said.

“Based on what I saw my now-college age daughter and middle school-age son experience, I thought children today could probably use all the help they can get, especially if their home situation is less than ideal.”

A guardian ad litem — the name is Latin and means “for this case” — is a trained, unpaid community volunteer appointed by a district court judge to investigate and determine the needs of abused and neglected children petitioned into the court system by the Department of Social Services.

The guardian’s duties include exploring all facts relevant to the case, making recommendations to the court and monitoring the case so that it will move through the court and social services systems without delays. The volunteer is appointed to represent the child only for the duration of the court’s involvement and does not serve as the child’s legal guardian. Volunteers, who don’t need to have a legal background, are asked to commit 10 to 15 hours a month to working on their assigned case.

Marsh-Robinson, who is currently finishing up her first case, sees herself as the child’s voice. After listening to the child, parents, other relatives and foster parents, her job is to make a recommendation to the court on what should happen in the child’s future.

“I play a role in situations where the state may be terminating a parent’s rights,” she explained. “Normally the decision to either reunite the child and the parent or to terminate the parental rights is made within 12 months, but sometimes it can take longer.”

That’s what’s happening with Marsh-Robinson’s case, and she says it’s starting to weigh on the child.

“The case has been going on for more than a year and I have started to see the child is affected,” she said. “Children need stability and closure, one way or another, and if that’s not happening, they begin to wonder what’s going on.”

One thing she has learned is that parents whose rights are contested are not necessarily monsters. While the parent might love the child more than anything, various limitations can make it difficult or impossible to provide an adequate environment for the child.

“Another thing I have realized is that people’s parenting styles differ, and I don’t want to impose my way of doing things on anyone,” she said. “But of course certain things, such as safety, need to be taken care of.”

While the Wake County Guardian ad Litem Program deals with children petitioned into the court system by social services, the Wake County Clerk of Superior Court’s Guardian ad Litem initiative focuses on cases filed by relatives.

“If you believe someone is unable to manage their own affairs, you can file a petition before the Clerk of Superior Court to have the person adjudicated incompetent and to have a legal guardian appointed,” said Bill Burlington, Wake County assistant clerk of court.

A typical case is an elderly parent whose children want him or her declared incompetent due to dementia or Alzheimer’s disease.

“Another common case is a mentally ill child who is turning 18,” Burlington said. “Often the parents ask to remain the child’s legal guardians even after the child becomes an adult.”

The court assigns a guardian ad litem — an attorney who gets paid for the work — to represent the person alleged to be incompetent at the incompetency hearing. Last year the program handled 390 cases.

Representatives of both programs say they would like to have more volunteers. In North Carolina, 4,618 unpaid volunteers helped 17,701 children in the past fiscal year — a significant increase over the year before.

And while Burlington said his program is blessed to have attorneys who are willing to work for very little money, Wake County has the most guardianship petitions filed in North Carolina and the number doesn’t seem to be decreasing.

For those involved, the programs can give a lot, Marsh-Robinson said.

“My consolation is knowing that I am helping make someone’s life better,” she said. “It might sound like a cliché, but I feel like I’m giving back to the community. And the process is making me a better person." Read more!

Cookie-money thief ordered to state facility - Palm Beach (FL) Post

By LARRY KELLER
May 28, 2008

WEST PALM BEACH — Saying she is "an out-of-control drug user," a juvenile court judge on Wednesday ordered Girl Scout cookie-money thief Stefanie Woods confined to a high-security facility for up to three years in order to address substance-abuse and mental-health problems.

Woods, 18, took the news stoically at first. But after she had to remove her earrings, after her tearful mother hugged her goodbye, after court deputies took her fingerprints, the realization hit Woods: She won't be going home soon.

She began crying. She asked her attorney, Lewis Hanna, if she could get out after an appeal. Then she was taken away.

Woods and Hanna had asked Juvenile Judge Moses Baker Jr. to allow her to voluntarily enter a residential substance abuse facility in Fort Lauderdale. Afterward, Hanna was stunned and angry.

"I am devastated. I'm at a loss for words," he said. He accused the Department of Juvenile Justice of recommending a stricter sentence in court than it had earlier. "I felt totally ambushed by the department," he said.

Some of Woods' prior scrapes with the law were known. She was on probation for criminal mischief and battery at the time of the cookie caper. But Wednesday's court hearing depicted a young woman far more troubled than was generally known. She told a psychiatrist for a pre-sentence report that she began drinking at age 14 and used a cornucopia of drugs that include marijuana, cocaine, heroin, Xanax, ecstasy, LSD and OxyContin.

"If all that is true, you should be dead," Baker told her. "Either you are the biggest liar that ever lived, or the biggest exaggerator who ever lived, or you're in serious trouble."

That's why, the judge said later, he was incarcerating her until there is a space for her in a highly structured, secure state facility. He said he feared she could end up dead if allowed to remain free in the interim.

"I've never seen a child abusing this many substances," the judge said.

Woods said that, while she tried all those drugs, she only abused a derivative of OxyContin, a prescription painkiller. She was hospitalized last year for a Xanax overdose. She once sold a bracelet so she could buy drugs.

But she and Hanna vehemently insisted that the pre-sentence report overstated the extent of her drug use. His client has tested negative when given random drug tests, the attorney said.

Hanna read a letter to Baker that he said Woods wrote. In it, she said she used drugs not to get high, but to suppress feelings. "My drug use comes from my emotions, which I do not know how to control," the letter said.

In addition to her drug use, Assistant State Attorney Polly McFadden pointed out that Woods had a previous arrests for burglary, keying a vehicle and battery on a boyfriend who McFadden said Woods stabbed with a pocket knife. Woods also violated a restraining order prohibiting her from having contact with the boyfriend.

Woods "takes no responsibility for her actions," McFadden told Baker. "Your honor, she has no remorse for taking money from a 9-year-old Girl Scout."

The prosecutor was skeptical about Woods' claims that she hoped to attend Palm Beach Community College in the fall. Woods had a 1.4 grade point average before dropping out of high school and was suspended at least four times for non-attendance and using profanity toward teachers. She missed getting her GED when she showed up late for the last component of the test, she said.

Baker convicted Woods on May 13 of petty theft and two counts of violating probation after a nonjury trial for her role in the stealing of $168 from 9-year-old Girl Scout Gracie Smith outside a Winn-Dixie in suburban Boynton Beach. In a letter to the judge, Gracie urged him to sentence Woods to community service in the form of cleaning up a Girl Scout camp.

Woods was a juvenile at the time of the misdemeanor offense. A girlfriend, also a juvenile, took an envelope containing the cookie sales money and got into a car that sped off with Woods at the wheel. The next day, Woods and her friend boasted and showed off for television camera crews and found themselves making national news.

Woods will remain in a secure juvenile detention facility locally until there is a bed available at a state-run facility at the second-highest security level, as ordered by Baker. That could be a month or two, a Juvenile Justice worker told the judge.

She eventually will be in a prison-like setting where she will undergo a psychological assessment - she's been diagnosed at least once as bipolar - and individual and group therapy. "It is the hope that once and for all, she will address her substance abuse issues," Baker said.

Based on reports he receives, the judge will decide whether Woods remains confined for three years or is released earlier.

She may get out of juvenile detention briefly next week. That's when she's due back in adult court to be sentenced for a "dine-and-dash" incident for skipping out on a Denny's without paying a $25.84 check she incurred with the same friend from the cookie-money theft. Read more!

New hearing for N. Plainfield man who admitted killing 2 women - Newark (NJ) Star-Ledger

May 29, 2008
BY JENNIFER GOLSON

A North Plainfield man who is seeking a new trial for the deaths of two Plainfield women will get a hearing on some of the issues surrounding his previous defense.

Superior Court Judge Edward Coleman yesterday agreed to grant John Korman Jr., 58, a hearing to determine whether his lawyer coerced him into pleading guilty in 1999 to the deaths of Paula Strazdas, 34, and Nancy Nott, 21.

He also will hear evidence on whether Korman received access to all of the discovery in his case and the discussions that led defense attorneys to decide not to mount a defense based on his post-traumatic stress disorder.

Coleman was the judge who accepted Korman's pleas as part of a deal the defendant struck with the Somerset County Prosecutor's Office, sparing him the death penalty. When Korman tried to withdraw his plea, Coleman refused, and he sentenced him in May 2000 to more than 93 years in prison.

Korman appeared before Coleman in Somerville yesterday, this time with new counsel, Denville-based Michael D'Anton, who said Korman always wanted to go to trial and still does.

"He is willing to face a trial on both murder charges realizing the state will not offer another deal," D'Anton said. The one in 1999 spared him the death penalty.

Somerset County Assistant Prosecutor James McConnell noted Coleman was the judge who took Korman's original guilty pleas and determined he entered them "truthfully and voluntarily." He also questioned Korman's motives for raising the issue now the death penalty is "out the window." The state Legislature abolished capital punishment in December.

Korman admitted killing Strazdas in August of 1995 by shooting her twice in the head and dumping her body in Raritan Bay. He admitted beating Nott with a baseball bat in 1998 and burying her behind his North Plainfield home.

Five different attorneys represented Korman at various stages of his defense before D'Anton, and several doctors examined him.

D'Anton cited Korman's psychiatric history that dates from the 1970s and stems from his service in Vietnam. When he left the military in 1970, post-traumatic stress disorder did not exist as a diagnosis, he said. In 1974, he was diagnosed with schizophrenia. He was not diagnosed with post-traumatic stress disorder until 1995, the lawyer said.

D'Anton said prior counsel failed to mount a diminished capacity defense based on Korman's psychiatric history.

In reference to the discovery, D'Anton said if Korman's lawyers were worried fellow inmates were trying to "dupe" him into making concessions they could use to their own advantage, there were other ways to get him the information.

McConnell said the discovery was voluminous and it was known fellow inmates were trying to glean information to garner favor with the state. "Even the defendant admitted that his fellow inmates were doing this," he said.

As for the diminished capacity argument, McConnell noted a report that said he "was capable of knowing and purposeful behavior when he killed those two women."

While D'Anton cited several arguments for post-conviction relief, asserting ineffective counsel, the hearing will only cover a few.

Court transcripts show Korman discussed a psychiatric defense and agreed with his attorneys not to pursue it, but there was no detail from the talks, Coleman said. There are also enough questions about the discovery to warrant a hearing on that issue and whether he was coerced into a plea.

"I don't have any record of what occurred before the defendant walked in the courtroom, put his hand on a Bible and swore to tell the truth," Coleman said.

Jennifer Golson may be reached at jgolson@starledger.com or at (908) 429-9925. Read more!

State orders Mental Health facility to suspend operations - Wilmington (NC) Star-News

By Vicky Eckenrode
Staff Writer

State officials have ordered a Wilmington facility that treats mental health emergencies and substance abusers to suspend its operations, calling conditions there detrimental to the health and safety of patients.

Southeastern Center for Mental Health, which operates the center, also faces $13,500 in penalties in connection with a number of alleged violations centering around the death of a 27-year-old woman late last year.

The woman, who is not named in the state report, had sought inpatient treatment at the center's facility-based crisis program for heroin addiction.

After being admitted and starting the detox process, the woman began complaining of chest pains and went back and forth between the center and hospital, according to a report by the state Department of Health and Human Services.

She collapsed at the South 17th Street facility on Dec. 27 and died later at the hospital. The original cause of death was listed as heroin overdose. But a pathologist with the state medical examiner's office concluded last month that the woman actually died from pneumonia.

The state pathologist said the examiner who came up with the initial cause of death did not check her heart tissue or run tests for heroin, but made his decision based on reports to him that two heroin packets were found in the woman's room after she was taken to the hospital.

"That's a pretty galloping pneumonia she had there, it didn't happen overnight," the pathologist was reported as saying in an interview to state regulators.

The suspension order, which Southeastern officials said they received Thursday, accuses the facility of neglect for failing to investigate the woman's 17 complaints of neck and back pain in the several days she was there and not communicating effectively with the hospital emergency department's physicians.

It points to the facility's nurses with not reporting the woman's low blood pressure to the on-call physician as required and for giving her a certain medication though a doctor's order said not to if her blood pressure was low.

The 60-page report also faulted Southeastern for not having a set policy of getting patients to and from the hospital emergency department, not providing proper supervision to prevent drugs from being snuck back in while they were at the hospital unattended and not reporting the woman's death properly.

The facility's medical director did not report the death to the state regulators within three days as required because it did not happen there, according to the findings.

Vicki Steele, chief financial officer for Southeastern, said facility officials are currently working on a plan of changes based on the cited violations. The plan will be submitted to the state.

"We are concentrating on the quality of care for the client," she said. "I would say that everything that we are recommending in our plan of correction has that in mind."

The center also can appeal the suspension as well as the penalty. Steele said officials would decide whether to do that once Southeastern's area director returns from vacation.

The facility stopped admitting people late last week and is referring those needing help to either area hospital emergency departments or private mental health providers, depending on the severity of the cases.

The center runs both a 12-bed detoxification center, where most of the violations were recorded by the state, and a crisis station.

The detoxification program can last up to two weeks, but averages about a week for most participants.

When the suspension order came down, the program was full. But only one person remained as of Wednesday to finish up their treatment protocol, center officials said.

The facility's other service, a crisis station, functions somewhat like a psychiatric emergency room, officials said, when someone is threatening to harm themselves or someone else or is going to be involuntarily committed.

Steele said Southeastern is discussing with the state about whether the crisis station's operations should be included in the ruling's suspension.

She said the crisis station sees an average of three to five people a day and as many as 30 a week.

"I'm very sorry this happened because it does affect a lot of citizens in our tri-county (service region)," she said. "We're working very diligently to make sure these clients are cared for.

"I think anytime you have a situation of this type, it's going to have lingering effects, but I'm hoping that we'll be able to get through this process and get through the plan of correction so the services can be restored."

Vicky Eckenrode: 343-2339

vicky.eckenrode@starnewsonline.com
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Inspector surprises Butner -Raleigh (NC) News & Observer

Michael Biesecker, Staff Writer

RALEIGH - A representative of a national accrediting organization showed up Wednesday morning for an unannounced inspection at John Umstead Hospital in Butner, a sign regulators may have found new problems at the state mental facility.

Umstead remains in trouble with the Centers for Medicare and Medicaid, despite assurances from hospital administrators that problems with federal regulators had been informally resolved last month.

The unannounced visit from The Joint Commission, a nongovernmental organization that accredits hospitals, could indicate further problems for Umstead. The commission sometimes follows up on the negative findings from federal inspectors.

"We are responding to a complaint," said Ken Powers, a spokesman for the commission. He would provide no details about the nature of the complaint that triggered the visit.

A loss of accreditation would be a significant blow to the hospital, making it difficult to receive payments from private insurers.

The state's Broughton Hospital in Morganton lost its accreditation last year after a revocation of federal money that has cost taxpayers at least $10 million so far.

The new problems in Butner aren't likely to have the same financial impact: Administrators have accelerated plans to move patients and staff from Umstead and Raleigh's Dorothea Dix Hospital to a new $120 million building in Butner.

The opening of Central Regional Hospital, scheduled for July 1, has been repeatedly delayed due to concerns about projected shortages of qualified staff and design flaws with the building that could endanger the safety of patients. But if it does open, it could mitigate the impact from any federal sanctions at Umstead.

In December, Umstead was hit with the threat of losing federal money after inspectors faulted the hospital for "failing to prevent patient abuse and failing to monitor and modify a care plan to prevent repeated incidents of patient-to-patient and patient-to-staff abuse." A subsequent report detailed how three workers at the hospital beat a mentally ill woman who was strapped to a bed.

In the intervening months, the inspectors have returned to Umstead periodically, most recently on April 25.

When asked about the findings of the April 25 visit, spokesmen for the state Department of Health and Human Services have repeatedly indicated that no written report had yet been received, but that exit interviews with the inspectors led them to believe that the problems were resolved.

"They don't want to count their chickens before they hatch," Brad Dean, a departmental spokesmen, said Friday.

A letter dated May 9, however, indicates hospital administrators were told last month to expect findings of new problems. Reviewers found that at least one patient had not been receiving prescribed psychiatric medication because of failures of communication between the hospital's doctors, pharmacists and nurses.

While DHHS spokesmen were denying any such communication had been received, hospital administrators were busy developing the latest in a series of required plans to correct the problems.

That plan, filed Tuesday, calls for increased monitoring of the hospital's medical and pharmacy staffs.

The findings from the inspection and the plan of correction have been sent to the Centers for Medicare and Medicaid, and the state is awaiting a final determination.

michael.biesecker@newsobserver.com or (919) 829-4698
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New problems found at Umstead mental facility -Raleigh (NC) News & Observer

By Michael Biesecker, Staff Writer

RALEIGH — Regulators have found new problems at John Umstead Hospital in Butner as a representative of a national accrediting organization showed up this morning for an unannounced inspection at the state mental facility.

Umstead remains in trouble with the Centers for Medicare and Medicaid, despite assurances from hospital administrators that ongoing issues with federal regulators had been informally resolved last month.

The unannounced visit from The Joint Commission, a non-governmental organization that accredits hospitals, could bode as an indicator of further problems for Umstead. The commission sometimes follows up on the negative findings from federal inspectors.

“We are responding to a complaint,” said Ken Powers, a spokesman for the commission. He would provide no details about the nature of the complaint that triggered the visit.

A loss of accreditation would be a severe blow to the hospital, making it difficult to receive payments from private insurers.

In December, Umstead was hit with the threat of losing federal money after inspectors faulted the hospital for “failing to prevent patient abuse and failing to monitor and modify a care plan to prevent repeated incidents of patient-to-patient and patient-to-staff abuse.” A subsequent report detailed how three workers at the hospital beat a mentally ill woman who was strapped to a bed.

In the intervening months, the inspectors have returned to Umstead periodically, most recently on April 25.

When asked about the findings of the April 25 visit, spokesmen for the state Department of Health and Human Services have repeatedly indicated that no written report had yet been received, but that exit interviews with the inspectors indicated the problems were resolved.

“They don’t want to count their chickens before they hatch,” Brad Deen, a departmental spokesmen, said Friday.

A letter dated May 9, however, indicates hospital administrators were told last month to expect findings of new problems. Reviewers found that at least one patient had not been receiving prescribed psychiatric medication because of failures of communication between the hospital’s doctors, pharmacists and nurses.

While DHHS spokesmen were denying any such communication had been received, hospital administrators were busy developing the latest in a series of required plans to correct the problems.

That plan, filed Tuesday, calls for increased monitoring of the hospital’s medical and pharmacy staffs.

The findings from the inspection and the plan of correction have been sent to the Centers for Medicare and Medicaid, and the state is awaiting a final determination.

The new problems come as administrators have accelerated plans to move patients and staff from Umstead and Raleigh’s Dorothea Dix Hospital to a new $120 million building in Butner. The opening of Central Regional Hospital, scheduled for July 1, has been repeatedly delayed due to concerns about projected shortages of qualified staff and design flaws with the building that could endanger the safety of patients.

michael.biesecker@newsobserver.com or (919) 829-4698
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Changes coming to mental health program -Lenoir (NC) News Topic

By Paul Teague

Following a period of uncertainty, the remaining members of the Foothills Area Program mental health management agency, including Caldwell County, have agreed to join forces with the multi-county Smoky Mountain Center, effective July 1.

The change stems from Burke County's decision to leave the Foothills group, known as a local management entity (LME), and join with Catawba County. The move left Foothills with three remaining counties - Caldwell, Alexander and McDowell. But because the total population of the three counties is below the 200,000 state minimum, the Foothills LME needed to find a new partner.

Enter Smoky Mountain, which will oversee the administrative end of mental health and substance abuse services from its headquarters in Sylva. Meanwhile, the delivery of services is expected to be performed by Boone-based New River Behavioral via three district offices, including Caldwell.

The reorganization is the latest in a statewide effort to correct problems with the delivery and accessibility of mental health services. A push by the state to privatize many mental health functions floundered, according to officials, due to government reimbursement issues and faulty business models.

Caldwell County contributed $104,138 during the current budget year and is scheduled to provide the same amount of funding in the 2008-09 fiscal year.

“We are in the midst of a merger,” Foothills Area Program Executive Director Don Pagett said about the transition that will link Caldwell, Alexander and McDowell counties with Alleghany, Ashe, Avery, Cherokee, Clay, Graham, Haywood, Jackson, Macon, Swain, Watauga and Wilkes under the Smoky Mountain LME umbrella. “Smoky Mountain will be the largest (LME) by member counties and the fourth largest by population.”



Dropping the number of LMEs from 25 to nine has been a stated goal by the state, according to Pagett. He added that being in a larger group should have benefits to the county and the LME.

“(The merger) gives an economy of scale that wasn't there,” he said. “This should allow for the leveraging of grants and create more crisis beds for hospitals.”

The belief is that New River Behavioral can fill the void left by other providers who attempted to practice in the area - including Buncombe County-based ARP/Phoenix and Catawba Valley Behavioral Health - then contracted back to their home bases.

Catawba Valley Behavioral operated from a location near the Caldwell County Sheriff's Office off Morganton Boulevard. In its absence, Foothills has been using much of its in-house staff to maintain operations until New River Behavioral steps in. At a recent Caldwell County Commission meeting, Barrier said Smoky Mountain is seeking property near the Sheriff's Office to build an administrative office for the LME's central division.


“The contract for Lenoir was given to a group called ARP/Phoenix,” Pagett said. “Then they shrunk back to Buncombe (County). They had outgrown their ability to produce.

“We recruited and brought in Catawba Valley Behavioral, a private provider, and they just rolled the dice. Then they realized they had rolled the dice in the wrong direction.”

Pagett said mental health providers looked to capitalize on the privatization push, only to be squeezed when reimbursement rates did not match up with their business plans.

“They have got to get fairly high levels of productivity out of their clinicians just to stay afloat,” Pagett said. “The financing of mental health is skewed very badly now. But there are services that a lot of people need. In the end, it saves taxpayer dollars.”

Caldwell County Commissioner Don Barrier became the county's mental health representative shortly after his 2006 election and has attempted to tackle the problem.

“If you look at the mental health system in North Carolina it's in a shambles,” Barrier said. “We don't reimburse enough for service providers to stay in business.”

With no ability to create new contracts until the merger with Smoky Mountain becomes official in July, Pagett said Foothills Area Program staff members are trying to service patients for now.

“It's Foothills staff that's in Marion and in Lenoir,” he said. “I've got everybody out where the action is. All of these people are still doing their LME (paperwork) as well. I can't say everybody is getting seen that want to, but we're doing the best we can.”

Yet another problem is the burden mental health patients place on law enforcement departments, which often wind up trapped in a red-tape battle between patients and health care providers.

State law requires that law enforcement officers remain with individuals who have commitment orders or are part of a crisis intervention process. According to Hudson Police Chief David Greene, officers must devote hours away from patrol in order to monitor patients who are undergoing medical assessments or are being transported.

“When we get a commitment order or we have to do a voluntary commitment order, that's typically taking 12 hours,” Greene said. “That's time off the road, and that cuts into our manpower. Once an order is issued, you have to take them to have them examined. We wind up having to stay with them because the hospital won't take them.”

Both Pagett and Barrier are sympathetic to Greene's and other law enforcement officials' plight. But until additional crisis intervention beds are created, they said law enforcement agencies must shoulder some of the mental health load.

“We do not have the ability or the legal authority to create a bed,” Pagett said. “What we do is stay on top of the people who have beds. Sometimes the beds turn around in a matter of hours. It's a huge burden (on law enforcement), and I think the statute is wrong. I think the (North Carolina) General Assembly needs to put the responsibility on the provider community.” Read more!

Hospital Without Walls - The Denver News

By Alan Prendergast

Thursday afternoons in courtroom 151P tend to be less formal than other proceedings in Denver county courts. Judge Larry Bohning still hands out an occasional scolding ("Time's running out, Mr. Finn; you need to stay away from that alcohol"), and every once in a while somebody gets their probation revoked and heads to jail. But most of the defendants on Bohning's once-a-week mental-health docket are here to give a brief progress report, share any problems they might be having with their treatment plan or job situation — and pick up a free snack or toothbrush on the way out.

"This morning I got on methadone," says one young woman, rubbing her right arm nervously. "They've been giving me motel vouchers until I can get into housing. I try to check in once a day. I move around a lot."

"I'm coming down from being manic," says another woman in a hoodie. "The good news is that my new meds are working good."

"I'm coming out of my depression," announces an older man sporting a leather jacket and a gap-toothed grin.

Bohning nods, congratulates, asks an occasional question. "You had a job interview last week," he says to one dreadlocked visitor. "How did that go?"

The man beams back. "I'm starting at ten dollars an hour," he says.

The people who gather in 151P on Thursday afternoons are part of Denver's Court to Community program, a three-year pilot project to help low-level, mentally ill offenders connect with a range of community resources — and to keep them out of jail. Funded by a combination of grants, the effort isn't cheap; in its first year, it's enlisted 38 out of what will eventually be 75 clients, at an average annual cost of $12,000 per person. But its backers say it's a lot less expensive than having its target population of homeless, addicted and severely mentally ill residents spend much of their time in jails or hospital emergency rooms.

"This is basically a hospital without walls," says Regina Heuter, executive director of the Denver Crime Prevention and Control Commission, one of the chief sponsors of the project. "We know it takes fifteen months, on average, to get someone stabilized. But we have a year's worth of data now, and it shows that people are generally not coming back to jail, not showing up in detox. That means a decrease in those costly services."

In his three decades on the bench, Bohning has seen waves of failed initiatives to deal with the homeless and mentally ill. But this latest effort is different. "I was skeptical at first because I didn't think there would be enough funding," the judge admits. "If you don't have some short-term bed space, so these people can have a more stable environment, they're not going to stay on their meds."

The partners in the program, the Colorado Coalition for the Homeless and the Mental Health Corporation of Denver, work to ensure that the participants have access to adequate medication as well as reliable shelter. "I'm convinced we're doing some good," Bohning says. "We could use 300 more slots."

At present, the program is limited to people charged with city ordinance violations, such as trespassing or public urination — no misdemeanors or felonies. Many of the participants are familiar figures at the county jail and local hospitals. The "therapeutic jurisprudence" doled out in Bohning's court is designed to keep them out of trouble by closely monitoring their situation; failure to report back, in many cases on a weekly basis, can result in a probation violation. "They're not dropping out anywhere," Heuter says. "There's not a crack to fall between. If they don't work with us, they get prosecuted."

Since its launch, the Court to Community program has had three "graduates" and eight revocations, usually for alcohol or drug use. But there's also been an 83 percent drop in the total number of days the group has spent behind bars. One man who was in the county lockup on a weekly basis prior to joining the program — sometimes released and re-arrested on the same day — hasn't had a single arrest in more than six months. "He's not using, he's stable in his meds, and he can actually carry on a conversation," reports Shari Lewinski, the court coordinator. "This is tough stuff to treat. People start to slide back, but there are so many eyes watching, and the caseworkers are on top of things."

Modest in size but intensive, the court program may be joined by the end of the year by the first of three mental-health "triage" centers planned for the metro area. That project, backed by local hospitals and Mental Health America of Colorado, is supposed to further ease the burden on emergency rooms by offering an alternative that's more specifically geared to the needs of mentally ill clients in crisis.

Heather Cameron, the project's director at MHAC, calls hospitals "the most costly access point" for people with mental illness seeking help. Of the estimated 40,000 ER visits in the Denver area each year by people with mental-health issues, roughly half don't result in a hospital admission, she says. That population might be better served by going to a crisis center staffed by specially trained clinicians, who can do a more thorough assessment and stabilization of the patient than most hectic hospital ERs can offer.

"Seventy percent of the transports [to the ER] are by law enforcement," Cameron notes. "If you're lucky, you get a trained officer to come to your house and de-escalate a crisis situation. But the only place the officers had to take someone was the hospital emergency room." The "triage" label for her program is somewhat misleading, Cameron says — as with the court program, the overall goal is to provide links to a wider community of resources and make the critical followup and aftercare more feasible.

Lewinski expects to see the approach expand as its cost-effectiveness is demonstrated. "The good news is that the quality of life for these folks is improving," she says. "It's no picnic to cycle in and out of jail and live on the streets." Read more!

A Short Life Ends on Rikers Island, in a Place Where Suicide Isn't Supposed To Happen- New York City Village Voice

by Graham Rayman
May 28, 2008
On the day that he arrived at Rikers Island last October, Steven Morales was a major suicide risk.

He was just 17 years old, charged with murder, accused of suffocating his infant daughter. He was a product of the city's foster-care system, his mother having abandoned him at birth. He had no money, little or no ties to family, and few friends. His only solid relationship—with his girlfriend, the mother of the dead infant—was collapsing.

Morales's lawyer considered the suicide risk so great that he recommended to a judge that the teen be housed in protective custody—where, the lawyer presumed, someone would keep a closer eye on him.

Protective custody, where inmates are locked in their cells up to 23 hours a day, was introduced to Rikers by jails boss Martin Horn in 2005 to house dangerous or vulnerable inmates, who would be safer there than in the general population.

But on April 27, something went terribly wrong when Horn's supervision system broke down.

That afternoon, Morales spoke to his girlfriend on the telephone and learned that she was breaking up with him, severing his last tie to the outside world. Devastated, he returned to his cell, secured a towel to the top of his cell door, wrapped the other end around his neck, and ended his life.

The officers assigned to the unit didn't notice until one of their bosses visited the floor and found him. By then, of course, it was too late.

"Someone needs to be held accountable," says Morales's lawyer, Javier Solano, a former Brooklyn prosecutor. "Based on his history and the fact that this kid, at age 17, was accused of a horrific crime, there certainly should have been much more supervision. I don't understand how he was able to do it in that setting."

The suicide in the Robert N. Davoren Center— occurring in the very place where inmate safety is supposed to be the highest priority—raises new questions about security issues at the jails under Horn's supervision, which the Voice has been reporting on for several months.

While conditions in the jails are certainly better than they were at the height of the crack epidemic, documents and interviews have revealed that violence is still a problem in the system. A series of Voice stories, for example, disclosed a spate of cases of correction officers using inmates as enforcers.

Correction Department spokesman Steve Morello declined to comment on the suicide, pending the results of several investigations.

The city Health Department, which is supposed to oversee the jails' for-profit medical and mental-health contractor, Prison Health Services, also declined to comment, citing federal and state patient-confidentiality laws.

Morales was born David Chow. After his mother left, he lived with his father. But child-welfare officials placed him in foster care when he was still quite young. He bounced from one abusive home to another until he eventually landed with a family who adopted him at age 14. (See also "The Jail Interview Steven Morales Gave to Columbia Grads" by Molly Messick and Sarah Morgan).

About three years ago, his adoptive mother took him to Spain, for reasons that are still unclear. There, he met his girlfriend, Olga. They fell in love, and before long she was pregnant.

But Olga's family didn't approve of Morales—he was too dark-skinned for their tastes—and so they kicked their daughter out of the house, says Stephanie Heredia, Morales's adoptive sister. The couple lived for a short period on the street, getting by with money from odd jobs and family members.

In mid-2007, their daughter, Sophia, was born, and the couple decided to move to New York City. They arrived with their baby, unemployed and without prospects. They took a cheap room in a Bronx building, and Olga found a job in a New Jersey bar.

For a while, things seemed OK. "The baby had a stroller, a playpen, everything she needed," Heredia says. "They weren't doing so bad."

On the night of October 7, with Olga out at work, Morales was trying to put Sophia to bed, but the infant was crying. She wouldn't settle down.

What happened next is a matter of dispute between Morales's lawyers and Bronx prosecutors.

The indictment charges that Morales threw Sophia repeatedly into the crib face-down with such force that he left fingerprint marks and bruising on her scalp and "severe bruising" on her bottom. Then he covered her face with a blanket, suffocating her.

Morales told Solano that he gave Sophia a bottle, then wrapped her in a blanket so she wouldn't fall off the bed. Then he took a shower. When he returned to the baby's side, she was blue. Morales called 911 immediately and tried to perform CPR. It was too late.

The police began to interrogate Morales at the hospital. The interview continued throughout the night and the following day. By the end of it, Morales was admitting to throwing Sophia in the crib and placing the blanket over her head.

In all, Morales was interrogated without a lawyer for 22 hours and gave seven different statements, including three that were videotaped.

The deeply regretful Morales later told Solano that he didn't remember how many video statements he had made. "This is a situation where the kid is being classically coerced," Solano says. "The kid is not sleeping, and every three or four hours they come in and want something else."

The emergency-room doctor who examined Sophia told police that he didn't see signs of foul play, the police records show. Moreover, the medical examiner's report described Sophia as a well-nourished infant. Her body didn't show signs of abuse, except for two small bruises on her head and buttocks.

"The saddest part of the case is, we believe we had a viable defense," Solano says. "Everything corroborates his story. At most, this was a case of reckless endangerment or endangering the welfare of a child. Now, everyone will just remember him as a monster."

Morales arrived at Rikers following his arrest and was placed in the protective-custody unit. He should've had a mental-health evaluation as well.

"I thought he needed additional monitoring because of the charges and his grief—plus I wasn't sure how other inmates would treat him," Solano says.

Early in his stay at Rikers, Morales spoke of suicide, but he seemed to adjust and seemed a little more comfortable after a while, Heredia says.

After two months, Morales asked to be taken out of protective custody, and Solano says he made this request to the Correction Department. But officials there declined to do so, for reasons that are still unclear.

Heredia visited Morales. He told her during the visit that he didn't intentionally kill Sophia, and he also complained that he was having trouble reaching his girlfriend. He said he wanted to fight the charges.

"He became more optimistic," Heredia says. "But he had no communication with Olga. He couldn't reach her."

Morales finally did find a number and called her. It was then, according to Heredia, that Olga told him she was pregnant by another man. Olga told Heredia that she felt she needed another child to replace the one she'd lost.

On April 27, after that awful phone call, Morales returned to his cell and hanged himself.

By one account, after the phone call with Olga, Morales was screaming and banging on his cell door. One inmate, the sources said, screamed for an officer, but the officer told the inmate to be quiet.

Under DOC rules, Morales should have been monitored every half-hour. But sources tell the Voice that officers assigned to the unit sometimes shirk their required rounds.

"It's not clear that the regulations were followed in this case," a correction source said.

In addition, Morales covered the window in his cell door with a sheet, and the officers either didn't notice it or didn't act when they saw it, sources said.

Morales was finally discovered at 4:30 p.m. by a correction captain who was making a visit to the floor, rather than by the assigned officers, sources said. The time of death was listed as 5:20 p.m.

"If he was supposed to be under extra supervision, somebody was not doing their job," says Heredia.

It remains unclear how often Morales saw mental-health counselors during his time at Rikers.

Morales's suicide was the second in two years in the protective-custody unit at the Robert N. Davoren Center. In November 2006, Matthew Cruz, a 38-year-old New Jersey man charged in a stock-manipulation case, hanged himself by a sheet woven through his bars. The suicide was the second in recent months for one of the officers assigned to the unit, sources said. It is unclear whether that officer has been disciplined.

A State Commission of Correction report on the Cruz death concluded that the mental-health treatment he had received was inadequate, flawed, and crippled by poor decision-making and poor record-keeping that violated department policy. The commission blamed Prison Health Services Inc., a company that provides health care at Rikers under a huge Department of Health contract.

The health-care workers dismissed clear signals that Cruz intended to commit suicide, the state report said. Cruz had been placed in "close custody" after his life was threatened by another inmate. Six days before his death, he slashed both his wrists in an initial suicide attempt.

The heavily redacted report also suggests that DOC staff did not have a defibrillator on hand, as required, and that may have contributed to his death.

Last December 20, a third inmate, David Mercado, 17, of Mount Vernon, New York, hanged himself at the Davoren Center.

Jail officials had placed Mercado in a dorm with 50 other inmates, even though a Queens judge, Gene Lopez, had ordered, both in writing and from the bench, that the teen should be placed on suicide watch, according to the family's lawyer, Andrew Stoll.

For some reason, however, correction officials and PHS decided to ignore the judge and place Mercado in the general population. It is unclear whether officials even did a thorough mental-health screening of the teen. Mercado killed himself less than 24 hours after being admitted to Rikers.

Even more troubling, state reports on a series of other suicides at city jails show lapses by both correction staff and PHS medical personnel dating back to 2001.

Horn created the "close" or protective-custody program in 2005 as a way to house those inmates considered either too dangerous for the general population, or too vulnerable to other inmates because of their high-profile status or the crime they committed. For that reason, the unit is supposed to have a higher staffing level than other jail areas.

Inmates are locked in their cells up to 23 hours a day, allowed out singly for exercise, and receive an escort to other areas. They're allowed to watch television, but in plexiglass cubicles designed to prevent any physical contact with other inmates.

Out of 14,000 inmates at Rikers, 50 are currently held in protective custody, three of them involuntarily, and 19 because they are considered "predatory."

"We use close custody as a last resort when other means do not provide the requisite safety," Correction Department spokesman Morello says.

But jail observers have long objected to protective custody as an overly punitive and psychologically harmful practice. And Morales's suicide certainly raises concern that oversight of the program is not what it should be.

The Correction Department often has suicide-prevention aides on hand in the jails, but there were none in Morales's unit. Some observers suggest that the aides—who are specially trained inmates—could have acted as another set of eyes to prevent the tragedy. But the close-custody policy bans any outside inmates from entering the unit.

And some question whether it was a good idea to place Morales in such an isolated setting, given his age and the stresses weighing on him.

Teenagers are especially susceptible to mental illness in that environment, says Stuart Grassian, a psychiatrist with Harvard Medical School and an expert in the effects of special confinement. Indeed, Morales told people who visited him that he felt "abandoned and alone."

Grassian says that Morales had many of the major risk factors for suicide: his age, the charge he faced, the minimal support from outside, and the type of housing he was in. "This kind of thing is going to continue until people recognize that the people who end up in places like Rikers are mostly people whose emotional lives are out of control," Grassian says. "Placing them in solitary confinement is going to massively increase the chance they may commit suicide."

Monitoring an inmate, Grassian adds, doesn't mean just walking by and looking at him. "If the behavior isn't dramatically agitated and disorganized, you're not going to pick it up," he says.

Meanwhile, Lawrence Berg, a former upstate commissioner of mental health who is now a lawyer assisting Solano, says: "Putting someone in lockdown is the last thing you want to do with someone who has mental-health issues, and it's even worse for a teenager. And there is no reason for a suicide to take place in a controlled setting like a protective-custody unit in a jail."

Morello counters that inmates often request protective custody, and thus might feel more relaxed and safer than if they were in the general population. Once they are in the unit, he says, few ask to be transferred out.

Norman Seabrook, the president of the correction officers' union, said his understanding was that the officers in the unit did everything by the book.

To Seabrook, the broader issue is the decline in the number of officers staffing the jails. There are about 2,500 fewer correction officers today than there were 10 years ago, he says. It is common to have a single officer watching both wings of a unit, where there used to be two officers, he says.

"We just don't have enough correction officers in the department," he says. "I'm not attributing this death to that, but the point needs to be made. It's just a matter of time before something else happens, and people will try to blame the officers when they're being asked to work short-handed."

The PHS and DOC, Seabrook continues, could do a better job of screening inmates and making sure that they get the mental-health care they need. "The mental-health unit should be more diligent in ensuring that a 17-year-old be placed in a hospital where he can get the attention he needs," he says. "We may see signs of illness here or there, but we're not trained to do that."

In response to Seabrook, Morello says the staffing change was made by a prior commissioner. "Mr. Seabrook's comment here is irrelevant, since in this unit, there was more than one officer assigned," he says.

In general, Morello says, there are additional officers assigned to the close-custody unit. Plus inmates are screened by mental-health professionals on entry into the system and during subsequent periods as necessary. Additional consideration is given to candidates for close or protective custody. Also, chaplains visit such units on a daily basis, and, he says, correction officers are trained to observe suicidal behavior.

Some observers have questioned the practice of placing both adults and adolescents in the same close-custody housing. But Morello says that it's within the rules because the inmates have no direct contact.

Morello also argues that the age of the inmate and his placement in protective custody doesn't necessarily increase the odds of suicide. Of the last 20 suicides in the city's jails, only three were inmates 19 or younger, and two were in close custody, along with a third in punitive segregation.

Morello says that the 23-hour lock-in doesn't necessarily mean that the inmates are in their cells 23 hours a day. They receive the same out-of-cell activities as other inmates, and they're allowed to watch television in adjoining plexiglass cells.

"The suicides that have occurred since Commissioner Horn took office at the beginning of 2003 total 25 percent fewer than in the equal number of years prior to the start of this tenure," Morello says. But he declined to state the exact number of officers assigned to a given shift in the protective-custody unit on security grounds.

For now, the investigation into Morales's death at Rikers continues. Heredia is mulling whether to file a notice of claim against the city.

"Everyone failed this kid, and now the correction system has failed him too," Solano says. Read more!

Mental health employees picket Cherry Hospital - Goldsboro (NC) News-Argus

By Matthew White
May 28, 2008

Concerned about unsafe working conditions that they say have gotten worse since the state began its mental health reforms in 2001, about 25 members of the union UE Local 150 took to the street in front of Cherry Hospital Tuesday afternoon demanding action.

But even they acknowledged that much of that change would have to come from the state level.

"We want fairness and justice for the workers," Cherry Hospital health care technician Larsene Taylor said.

Taylor, who has been at Cherry for 16 years, also serves as secretary/treasurer for the Cherry Hospital chapter of UE Local 150, which includes the North Carolina Public Service Workers Union.

She explained that they were making the noon protest to raise awareness of the situations and conditions they face every day -- and to promote the mental health workers' public hearing on Thursday in Raleigh.

There, she explained that they will be hoping to address several issues, including turnover, wages, mandatory overtime and safety -- all things that Cherry Hospital Director Dr. Jack St. Clair acknowledged are problems.

"We just want our voice heard," Taylor said. "We're not treated right. We have a workers' bill of rights that we are asking for.

"But this has not just started, it has been going on. It's because of the crisis in the system reforms."

In fact, said Teresa Howell, an 18-year veteran of the state system and a med nurse at Cherry for the last eight, morale "is the worst I've ever seen it."

At Cherry, as at other state psychiatric institutions, the 400 health care technicians, who are all required to be at least certified nursing assistants, do the brunt of the work, attending to the patients' daily needs.

There is supposed to be at least a 5:1 ratio, not counting those cases where patients, such as those considered suicide risks, may need special attention.

On Tuesday, there were 253 patients -- including 13 on suicide watch -- at Cherry, which was enough to put the hospital into diversion status, which basically means it's full and that new incoming patients have to be diverted elsewhere.

The hospital, though, only has about 1,100 employees filling each three-shift, 24-hour period -- at least 50 less than ideal.

However, because of illnesses or other absences, the high number of patients and the low number of staffers, some of those workers were likely to be pulling mandatory overtime -- one of the group's largest complaints.

"There needs to be a law that bans it or limits it," Taylor said. "What you're doing is burning your workers out."

Unfortunately, St. Claire said that while he agrees it's not good for safety or morale, they're often left with little choice, occasionally asking employees to work up to 24 hours of overtime per week.

"On rare occasions we might exceed that," he admitted. "But everyone who comes here is told the hours are subject to change and that that includes overtime. Everyone knows the needs of the facility have to be a priority."

Still, he knows that people break down eventually, and explained that they do try to work with employees when possible to meet their individual needs.

He also explained that they're working to create as safe a work environment as possible under the circumstances -- another top concern of the union.

"They're looking at patient safety, not staff safety," health care tech Corey Bell said.

"If people in the community understood what we deal with, they'd be amazed," Ms. Howell said. "And then they want to condemn us ..."

Meaning, she explained, that if anything happens to the patients, it's more likely to make the news than are the 11 employees injured by patients during the last two to three weeks.

But there, too, St. Clair emphasized that at Cherry, he feels they're doing all they can by training staff to recognize the signs of a patient about to lose control, having a responsive coding system, teaching basic "therapeutic holds" and other soft defensive and restraining techniques, and the proper use of medicine and restraints, as well as by holding debriefing sessions after each incident.

"Many of those concerns are serious. We have patients who are very volatile and very dangerous. Safety is an issue," he said, explaining that while many injuries are relatively minor -- bruises, cuts, pulled muscles or wrenched joints often requiring, at most, only a couple of days off work -- there are some patients like the man who recently ripped the sink out of the wall in his room, who can pose a threat.

And while he agreed that even minor injuries are unacceptable, he believes they have become, in many ways, a byproduct of the 2001 system reforms.

"The problem is, we're dealing with more patients and patients with a much higher level of acuity than before," he said. "But it's a system-wide problem, not just Goldsboro."

Unfortunately, he added, the best solutions are out of his hands.

"I think we've been very pro-active in addressing these issues. I think, by and large, we offer more in these areas than the other hospitals do, but I agree with a large part of what they're saying," he said. "We need more staff and we need to pay our staff better wages, and I think a big part of it is getting those legislators on board."

And while he does expect about two dozen more health care techs and other employees to come on board in the next few weeks, resolving those concerns is one of the goals of Thursday's event, which at least one local legislator, Larry Bell, D-Sampson, is slated to attend.

Scheduled for 6 to 8 p.m., the rally will be held at the Wake County Office Park Commons Building, 4001 Carya Drive, at the corner of Poole Roads, just off the I-440 beltline at exit 15. A pre-hearing rally will be held at the location from 5 to 5:30 p.m. Read more!

The Stigma of Suicide - Tuscon (AZ) Weekly

Tucson has the third-highest suicide rate in the country. Why is almost nobody talking about this fact?

By BRIAN PARK

Susan Moreno's son, Daniel, was diagnosed with schizophrenia at the age of 18, but after an arduous five years of working on his illness, he committed suicide.
Judy Schwartz recalls her husband's last visit to the cardiologist.

He was receiving care for a heart condition. He'd previously endured coronary artery bypass surgery, and the new therapy consisted of applying pressure to his heart to expand the blood vessels.

"The day that we went there for the first time, it almost looked like he was getting shock treatment," she says. "And he said, 'I can't do this,' and I said, 'Well, why don't you try it for a couple days?'

"That night, he shot himself."

Schwartz is telling her husband's story on a recent May afternoon. It's been exactly two years, three months and 28 days since her husband committed suicide.

"It's very surreal," she says. "It's really hard; two years later, it still seems like it happened yesterday, and (yet) that it happened forever ago."

The two left the gray skies of Columbus, Ohio, after 23 years and retired here in 2003. Her husband's suicide came out of nowhere, since she always thought of him as a strong-willed individual who persevered.

Right before he shot himself, he called a neighbor and one of their sons.

"I think he just snapped. I think something just happened that night. But in retrospect, my husband had always said when he was sick before, that if anything would ever happen, he'd, you know, just take care of it."

Schwartz, who now lives in Marana, was surprised to learn that Tucson has the third-highest suicide rate out of the 54 largest urban areas in the United States. A report, published last year, divulges a sad figure: 25 out of every 100,000 Tucsonans killed themselves in 2004. Only Las Vegas and Colorado Springs, Colo., ranked higher. (Mesa ranked sixth; Phoenix was No. 14.)

Published by the National Association of County and City Health Officials, the report, "Big Cities Health Inventory," used data from 2004. Local mental-health professionals say that three to four years of lag time is typical when it comes to these types of reports, but they also say the suicide rate in town is improving.

"We're not in the place we were in 2004," says Michael Barr, the training manager at the Southern Arizona Mental Health Corporation, who has 27 years of experience in the Pima County mental-health system. SAMHC is a nonprofit behavioral health center providing crisis care and services. Dealing with suicide is what the center does, offering open doors 24 hours a day, seven days a week, and a phone line, too. SAMHC helps people in crisis, regardless of their economic level or immigration status. The center takes in 8,000 walk-ins and receives around 80,000 phone calls annually. A new mobile service enables staffers to attend to people in their homes if they can't make it to the center.

"If somebody walks in here, and they've got issues, we're going to deal with it," Barr says.

Numbers from the Arizona Department of Health Services, published in March of this year, exemplify the uphill fight Arizonans are facing in their efforts to prevent suicide. For the third consecutive year, suicide among Arizonans 65 and older increased. Elderly white men continue to be the most vulnerable population. Native Americans age 15 to 19 committed suicide at a rate 2.8 times higher than all Arizona adolescents. Lesbian, gay, bisexual and transgender youth on average are one-third more likely to attempt suicide. Arizona's suicide rate of 15.9 people per 100,000 is above the national average of 11 per 100,000, with all states in the West higher than the national average, except for California. Every 17 minutes in the United States, somebody kills themselves.

Barr points outs recent improvements in certain sectors of the population, especially Native Americans and adolescents age 15 to 19. However, suicide is still the third-leading cause of death for people age 15 to 24. "That's pretty much across the country; it's not unique to Tucson or Pima County," he says.

But there's no denying that suicide is an issue in Tucson, one that carries a stigma and an unsettling veil of misunderstanding.

"We kind of push suicide under the rug," Schwartz says. "It's not pretty, and it's a very complicated grief, and it leaves lots of unanswered questions."

Schwartz participates in Survivors of Suicide (www.sostucson.org), a group comprised of people who have lost someone to suicide. Members meet twice a month and share their experiences, offering them a chance to relate to others who are dealing with the same types of feelings.

Tyler Woods is the group's facilitator. She first became involved 12 years ago as an intern and is now a certified holistic mental-health practitioner operating out of her modest house just off of Barraza-Aviation Parkway.

She's lost nine people over the course of her life to suicide, including a boss, a grandfather and a close friend who committed suicide while on the phone with Woods, unbeknownst to her.

"I'm a survivor, too, and you just learn to live with it," she admits. "You don't get over it."

For Woods, the No. 1 reason suicide is not often discussed is the stigma that surrounds it.

"It's a don't-talk, don't-tell; there's a taboo around that," she says. "We need to change the way we look at suicide. When someone dies of a cancer, and their immune system breaks down, we bury them.

"When someone's emotional immune system breaks down, we look the other way."

No one clear answer explains Tucson's high suicide rate. Mental-health professionals candidly offer opinions and possible reasons: a large retiree and older-adult population; the state's paltry mental-health system; drug abuse; sizeable military veteran and Native American populations; the transient nature of Tucson; and the availability of firearms.

But one problem is cited more than others: a lack of education and awareness. People don't know how to recognize suicidal tendencies in each other, or how to effectively talk about suicide and prevent it.

Barr, of SAMHC, is spreading the word by leading workshops to address suicide. Over the last two years, he's started teaching two suicide-prevention programs, SafeTALK and ASIST (Applied Suicide Intervention Skills Training), which were developed by LivingWorks, a Canadian intervention organization. A half-day program, SafeTALK helps participants identify people who have thoughts of suicide and connect them to the appropriate resources. ASIST is a two-day workshop covering intervention techniques.

The training is best for people--such as caregivers, Meals on Wheels drivers, teachers and guidance counselors--who interact with certain populations prone to suicide. In the last two years, Barr says, close to 1,000 people in Pima County have been trained.

Both SafeTALK and ASIST instruct people on how to spot "invitations": indications from people who are contemplating suicide, such as an off-hand comment about killing oneself or a co-worker disclosing to a colleague that they've found a "solution" to their depression.

"We need to be helpfully nosy, not intrusive. But when you suspect that suicide might be an issue, (you have) to ask the question in a way that's not judgmental, but sincere," he says. "There are three reasons we don't address suicide: We either miss it, or we dismiss it, or we avoid it."

On the anniversary of the Virginia Tech shooting, Barr is at the Doubletree Hotel conducting a SafeTALK seminar in a banquet room overlooking the hotel's courtyard. With a slideshow presentation behind him, and cheesy paintings of saguaros on each side, he is speaking to roughly 22 people from Nueva Luz, a local drop-in center, managed by HOPE, Inc., for adults with behavioral challenges.

Barr begins the workshop by disclosing stats that elicit surprise and more than a few "whoa" moments from the crowd, including Tucson's No. 3 ranking. Using slides and video clips, he explains why being inquisitive is vital.

"Most (people) want help in staying alive; that's an underlying premise here," he says. "Most people thinking of suicide don't want to die."

Suicide is not a hot-button campaign issue. Politicians don't give wonkish policy speeches on the reasons for suicide, or lay out grandiose plans or funding approaches to fight the problem.

Councilwoman Karin Uhlich says Tucson's suicide ranking is "shocking," though to her knowledge, the issue has never been brought up in a City Council meeting. Renee Sowards, an assistant to Councilwoman Shirley Scott, concurs that suicide has not been a council item. Both sympathized with people dealing with suicide, but admitted the council is not actively working on the issue.

"I don't think our government officials skirt the issue; it's just there are so many issues out there," says Survivors of Suicide's Woods. "When I do bring it up, or when anybody brings it up to city officials, we get a card saying someone will talk to us, and nobody does. Again, it's that stigma and taboo around suicide."

The media tend to report on suicide only in sensational situations, and a lot of mental-health professionals partly blame the media for the current stigma.

Schwartz and her husband never discussed suicide; this lack of dialogue is fairly common, says Donna Carender, a private consultant in gerontology who conducts SafeTALK and ASIST.

"I do this with older adults, because they're the ones who won't talk about suicide," she says. "People think depression's normal when you're old, and it's not."

Isolation, dealing with chronic pain and/or the death of a significant other can all plunge elderly people into depression. That's why Carender is reaching out to anyone she can think of who deals with older people, from people working and living in retirement communities to the drivers for Meals on Wheels.

Carender, with a leather binder in front of her stuffed with suicide-prevention literature, reiterates the need for older adults to ask questions and bat down the stigma that persists. And the training seems to be helping: Since the first area ASIST program last November, four successful suicide interventions have occurred. And every time Carender holds a training session, she receives phone calls asking her to do more, she says.

Carender believes suicide must be discussed openly if real change is to transpire.

"We're losing over two people a day in Arizona (to suicide)," she says. "If two people a day in Arizona are getting West Nile, it's going to be in the news, but two people in Arizona taking their own life doesn't make the news."

Like the elderly, Native Americans suffer from higher than normal suicide rates. Three suicides have already occurred on the Tohono O'odham nation this year as of this writing, after seven in 2007.

But Dawn Nesja is sanguine. She's only two months into her new job as youth-suicide-prevention grant manager for the nation, and she's laying the groundwork for preventative measures across the reservation. Originally from the Chippewa Nation of North Dakota, she's been living in Arizona for three years now, after growing up in Wisconsin. This year is proving to be fruitful; she's received federal grant money and is staffed with three specialists.

Native Americans age 15 to 19 commit suicide 2.8 times more than everyone else their age; that's why Nesja's work is imperative. Programs aimed at youth are sprouting up in schools and community centers--anywhere younger people can be told they're appreciated. In Nesja's opinion, the community is finally asking for help and is ready to confront suicide, which has plagued not only the Tohono O'odham, but nations all over the United States, for far too long.

"They think it's time," she says. "They're ready; they want to heal."

Nesja explains why suicide strikes so many Native Americans year after year.

"It has to do basically with substance abuse, alcohol and drug addiction, physical and sexual abuse; there's just a lot of abuse, mostly dealing with the historical drama the people have gone through," she says. "We're now focused on building cultural supports and values."

The younger generation must be dissuaded from suicide, and Nesja is planning numerous projects, such as physical activities like hoop dancing, to keep young folks active and healthy.

The awareness campaign is just getting underway, but the fact that behavioral health services on the reservation are becoming stressed due to an increase in people asking for help is a wonderful sign.

The rebellious stage for Daniel Moreno started at age 17; at least that's what his mom thought. Growing up, Daniel had always been a well-behaved and ambitious kid, a runner with plans to go to Harvard.

Then he started refusing to go to school. His mom told him to get a job or get out; he started living in a friend's garage.

When he was 18, Susan Moreno learned her son wasn't just being rebellious.

"I had him involuntarily committed," says Susan Moreno. "That was the first time I heard the word schizophrenia. ... I had to go online and look it up; I didn't even know what it was."

Schizophrenia can interfere with a person's ability to think clearly, to distinguish reality from fantasy, to manage emotions, to make decisions and to relate to others, according to the National Alliance on Mental Illness (NAMI). The illness affects more than 2 million American adults age 18 and older.

Susan is president of the board of directors for NAMI-Southern Arizona (www.namisa.org). NAMI-SA is a nonprofit offering advocacy, education and support to people affected by serious mental illnesses.

After Daniel's diagnosis, he and his family went through five strenuous years. He tried living on his own, but that didn't work. He went through a bulimia stage due to the drugs he was prescribed. After the engine blew up in his truck, he tried to commit suicide. Susan found him on the floor of his bedroom in time to save his life.

In June 1995, Daniel decided to participate in a schizophrenia study at the National Institute of Mental Health (NIMH) in Bethesda, Md. Daniel and Susan thought it was a wonderful situation: Daniel was contributing to research on schizophrenia while being in the care of some of the best doctors in the world.

Three days before he was supposed to come home for Christmas, Daniel went outside to smoke a cigarette on the seventh floor of the NIMH offices. He scaled a glass wall 6 feet up and jumped to his death.

Just that morning, he had gone shopping, buying some boxer shorts.

"He was just feeling fine, we thought. All I can say is that I don't think it was Daniel in his right mind; it was Daniel in his delusional mind," Susan says. "What I believe is that schizophrenia took my son."

The numbers weren't on Daniel's side.

"In the 18-to-44 age group for individuals with schizophrenia, the suicide rate is roughly eight times the normal population," says Clarke Romans, executive director of NAMI-SA, and Susan's colleague. "Suicide's a difficult thing to study, but I think one of the main reasons is that the symptoms of the illness are so dramatic that the individuals really have a hard time coping with the illness and making any progress in what you'd call normal living.

"I think they just become hopeless, many of them," he adds.

According to statistics crunched by NAMI-SA and the NIMH, about 100,000 people in the Tucson area suffer from the three major mental illnesses: schizophrenia, bipolar disorder and major depression.

Romans says 70,000 of these people are undiagnosed and untreated, raising the possibility of suicide. Another obstacle: Mental illnesses aren't always covered under insurance policies. Arizona is one of only eight states without mandatory mental-health-insurance parity, meaning, for instance, that someone needing care for schizophrenia is not always covered, but a smoker and drinker who needs care for heart disease is always covered. To Romans, this is nothing but gross discrimination.

"Why do we have this? It's mostly because of ignorance of mental illness, and I hate to say it cynically, but treating mental illness isn't very profitable, so insurance companies are against it," he says. "So when you have that landscape, it's not surprising that the suicide rate for people with mental illness is a lot higher."

A bill to fix this inequality passed the State Senate Health Committee on a 5-1 vote in April, but it was referred to the Appropriations Committee, where no meetings are scheduled, and hopes are dim. The U.S. House and Senate have passed similar federal bills, but the two bodies have not reconciled their differences, leaving things hanging in Washington, D.C., too.

The legislative delay aside, Michael Barr of SAMHC remains optimistic that Tucson is improving its suicide problem--but the city still has a long way to go. The preventative efforts need to continue, and awareness must be raised to put suicide on the city's radar. All parties need to work together; more organizations and employers are going to need to be trained in programs like SafeTALK and ASIST.

"Some people can't deal with their problems, so they begin to conceptualize thoughts of suicide, so they're in this river of suicide," Barr says. "If nothing is done, then they can go over the dam and try to commit suicide. We're trying to stop it upstream." Read more!

Man Dies After Woodland Police Tasering -News 10 Sacramento (CA)

Dave Marquis, Reporter
May 28, 2008

WOODLAND, CA - Investigators with the Woodland Police Department are looking into the circumstances surrounding the death of a man Wednesday after he was Tasered by officers.

Woodland police officers used several Tasers and their batons to subdue the man who'd left a mental health facility just minutes before. Police say the suspect had been dropped off at the Safe Harbor residential facility in North Woodland on Tuesday night.

About 9 a.m. Wednesday, the man became agitated and aggressive and left the voluntary facility. The staff called police and officers arrived minutes later and say the man did not respond to their orders as he walked down a nearby road.

When he became aggressive and approached officers, they decided to fire their Tasers.

"When the suspect did not follow officers' orders to get down on the ground and began approaching them with a pencil in his hand, they decided it was time to use their Tasers," said Lt. Charles Wilts of the Woodland Police Department. "At least two were fired."

An eyewitness, who did not want his name used, says the man appeared to be "stunned and confused ... (He was) a big fellow and before I knew it, he got cracked a few times with a baton pretty hard. It didn't seem to really faze him."

A third arriving police officer then Tasered the suspect again, and when he finally fell to the ground, he was subdued by officers. "(Officers) immediately started CPR and called for emergency medical assistance," said Lt. Wilts.

The suspect was pronounced dead about an hour later at Woodland Memorial Hospital.

Woodland police defend their use of Tasers in the case. "We believe that the Taser is a very, very safe approach to dealing with people, both safe for the individual and the officers," said Wilts.

However, some experts believe police officers could benefit from more training in dealing with those who are mentally ill. "Policemen don't generally believe how debilitating having a mental illness is," said Michael Summers with the Yolo County Department of Alcohol, Drug and Mental Health Services. Summers will teach the first class on how officers can better deal with the mentally ill in September.

Summers said the average police academy involves about 1,000 hours of training but that only a handful deal with issues involving disabilities. He said research shows 20 percent of an officer's time is spend on those with such issues.

Summers said his class will help officers learn better ways to handle people who are mentally disabled. "How to talk to people, de-escalation techniques, how to talk people down," he says.

An autopsy will be performed on the still-unidentified victim and the Yolo County District Attorney's Office will assist Woodland police in investigating the incident. Read more!

California Senate rejects inmate medical bill-Associated Press

May 28, 2007

SACRAMENTO (AP) - The state Senate on Tuesday rejected a demand from a court-appointed receiver for nearly $7 billion in bonds to improve medical care and mental health services for state prison inmates.

The move sets up a possible clash with the federal courts.

Senators who reluctantly voted for the bill said the state has little choice because a federal judge in San Francisco could order the money taken directly from the state treasury.

Senate Republicans voted against the bond money, which needs a two-thirds majority to advance to the Assembly. They said the bill was premature because of a possible federal court settlement of various prison-related lawsuits, including over health care.

The bill failed 22-14, five votes shy of the two-thirds majority. Senators are expected to seek another vote on the bill Thursday.

"We have no choice but to pay," said Senate President Pro Tem Don Perata, D-Oakland. "You don't really get an opportunity to fool around with a federal court judge."

Current medical and mental health treatment care is so poor that two federal judges have ruled it violates inmates' constitutional rights.

But Republicans said a settlement proposed in federal court could reduce the prisons' population and in turn lessen the need for medical and mental health services.

That possible settlement between the state, inmate advocates and
law enforcement authorities was announced May 19 and could end a
series of lawsuits related to California's prisons.

At the heart of the legal complaints is overcrowding and the myriad problems that accrue from that. California's 33 state prisons have about 170,000 inmates, about 70 percent over their designed capacity.

Proper medical care and mental health treatment have suffered as the prisons have become ever more cramped, say the prison advocates
who have sued the state.

A three-judge panel was created as a result of the federal lawsuits. The judges have the option of releasing thousands of inmates early or capping the prison population.

The bill rejected by the Senate on Tuesday dealt with two aspects of those lawsuits - improving medical and mental health treatment.

Court-appointed receiver Clark Kelso asked for $6 billion to build new medical and mental health care facilities to house 10,000 inmates. Another $1 billion would go to improve existing prison health clinics.

Republicans questioned the proposed spending, noting that just last year the Legislature and Gov. Arnold Schwarzenegger agreed to a $7.4 billion bond plan to add 53,000 prison and county jail beds statewide. About $900 million of that money would go to new dental,
mental health and medical facilities.

Republican lawmakers said Kelso might be able to take the money he requested - or at least some of it - from the $7.4 billion in bonds.

"It's time for us to step back and see how we can coordinate that solution," said Sen. George Runner, R-Lancaster. "We need to have a single solution. We don't need three solutions."

Sen. Mike Machado, D-Linden, who carried the bill, said reducing the prison population - as called for in the proposed settlement - will not necessarily mean a reduction in the need for better mental health and medical care.

The three-judge panel is scheduled to hear details of the proposed settlement during a hearing Friday in San Francisco. Negotiators said it would set a target of reducing prison crowding by 2011 without releasing inmates early.

That would be done mainly by diverting parole violators and some criminals into alternative punishments or treatment programs instead of sending them to prison if they would serve less than a year.

Machado produced a letter in which the federal judge promised to prevent the court-appointed receiver from spending more money than
necessary.

"To that end, I will not permit my Receiver to continue to undertake a construction program that becomes unnecessary due to changed circumstances, including any future reductions of the prison population," Henderson wrote.

(Copyright 2008 by The Associated Press. All Rights Reserved.) Read more!

Care facility gets warning from state -Baltimore Sun

By Tanika White
May 28, 2008

For the second time in a month, the state health department has warned a suspected unlicensed assisted-living facility that it has 30 days to apply for a license or face possible criminal charges.

The operator of the group home, Toni L. Jones, was cited by the health department's Office of Health Care Quality for providing assisted-living services to five residents, each of whom has mental disorders.

In a letter informing Jones last week that she was in violation of licensing regulations, health officials reported finding five men at 7094 Macbeth Way in Eldersburg. Each resident suffered from schizophrenia, among other conditions, including asthma, depression, hypercholesterolemia and borderline diabetes. Most were on regimens of several daily medications.

Jones told state investigators that all five residents required supervision when taking their medications and assistance with money management, according to documents. She also said that four of the five residents paid her $600 a month "for care" and that the fifth paid nothing.

The state is investigating the residents' health and living conditions to determine whether sanctions - such as fines or criminal charges - are warranted.

If the residents "have health concerns, then at the very least [the operators] should be licensed," said Wendy Kronmiller, director of the Office of Health Care Quality, which licenses and certifies most types of health care facilities. "And if they're in bad circumstances or if they're at risk, then we'll do more. We are concerned when people, in addition to their mental illnesses, have or develop health care problems which require supports that they may not receive in an unlicensed setting."

Kronmiller's office oversees more than 1,300 licensed assisted-living facilities, but it has difficulty identifying and shutting down unlicensed operators. In the past two years, at least 30 such homes have been fined for not having licenses, but officials say they believe many more exist.

Last week, the health department reported that it was investigating the recent death of Donald F. Matthews, a mentally ill man who was residing in an unlicensed assisted-living facility in Lauraville. Assisted-living facilities provide supervision and services for adults who require help with medication, dressing, hygiene and other needs.

Most unlicensed homes come to the state's attention because of tips from neighbors or community activists.

Reached by phone, Jones said the health department is mistaken about the nature of her home.

"We're not assisted living, and we're not a group home," Jones said. "We're neither of those things."

She would not elaborate on why she was housing five men with mental illnesses, except to say that they had been homeless.

The men had been living about a week in the Eldersburg home - which, according to tax documents, is owned by Marcella L. Jones and Marthenia V. Jones - when the health department warned Toni Jones about the licensing regulations. The relationship between Marcella, Marthenia and Toni Jones was unclear.

Before that, the men had been living since July 2007 in a house in the Windsor Hills neighborhood of West Baltimore. Toni Jones said she moved them out of the Windsor Hills home because the electricity had been cut off.

Jones, who is listed as the resident agent of a locally based company called Lifespan Inc., rented the house at 2801 N. Loudon Ave. in her company's name.

Kronmiller said that Jones' company should not be confused with Maryland Lifespan, one of two trade associations in the state representing long-term care and assisted-living providers.

The owner of the Windsor Hills house, Toyin Bello, said Jones and her husband, Von Key, owe him close to $20,000 in unpaid rent and utility bills.

Jones said she stopped paying the rent last fall because the home was in disrepair and not fit for habitation.

"He's upset because the payment stopped," Jones said. "We were trying to find them another place to live. You have to be careful when you find people who are homeless a place to live."

Bello, who lives in Columbia and rents out several other houses in the Baltimore area, said Jones did not pay rent, buy food or toilet paper, or staff the house where the men lived.

On several occasions, Bello said, contractors sent to the Windsor Hills home to make repairs were turned away by one or more of the residents, who said they were not allowed to let anyone in without staff present.

"Every time I came there, they would always ask me for money. There was no telephone. There was no food," Bello said. "There was no toilet tissue inside the house so they would use paper. The toilet was blocked so many times. I feel very, very bad for their clients."

Inside the home, guidelines and rules were posted inside plastic sleeves, giving the residents emergency phone numbers and important instructions.

One posting instructed clients to "1. Walk quickly, quietly and calmly out of the group home. 2. Continue to walk until you get to the bus stop. 3. Wait at the bus stop until the staff comes to tell you that it is safe to return to the home."

On May 8 or 9, Bello said, BGE had shut off power to the house on North Loudon Avenue because of unpaid bills. By May 12, the residents had been moved to Eldersburg.

Lifespan Inc. has run into trouble before over unpaid rent.

Lifespan breached leases at four residences on Walden Willow Court in Baltimore County in 2006 and owes nearly $14,500 in back rent and damages, court records show. Jones never appeared in court to contest the claims of her landlord, Regional Management Inc. Since the May 2 judgment was issued, Lifespan has not paid the money ordered, records show.

Jones could not be reached for further comment about why Lifespan rented the four residences.

tanika.white@baltsun.com

Sun reporter Doug Donovan contributed to this article.

Copyright © 2008, The Baltimore Sun Read more!

Hospital opening too rushed -Spring Hope (NC) Enterprise

Eidtorial:May 27

Just when mental health advocates begin to hope that state officials understand the need for undoing the damage caused by an ill-conceived “reform” of the state’s mental health system, somebody makes another boneheaded decision guaranteed to make a bad situation worse.

The latest display of bureaucratic brain damage revolves around the planned opening of the new $120 million Central Regional psychiatric hospital supposed to take the place of Dorothea Dix and John Umstead hospitals when they are scheduled to close by July 1. Patients from the two hospitals are to begin moving to Central Regional on June 15.

But it turns out that, despite three delays in opening, many design and safety defects found at Central Regional remain to be fixed. It also turns out that the new hospital will have a serious shortage of trained staff when it opens — a 21 percent shortfall in nurses, 38 percent in psychologists, 36 percent in medical doctors, and 14 percent in psychiatrists.

With the state mental health system already broken, Logic and common sense might dictate that the state delay the closings of the existing hospitals, fix the safety hazards in the new hospital, and make sure that the new hospital has enough trained staff ready to go before Central Regional opens.

Forget common sense. State officials have instead accelerated plans to use the new hospital and close the old ones, without waiting for the repairs or more staff. Officials are in such a hurry they aren’t even giving new employees at Central Regional a thorough orientation on the new hospital and its equipment, relying instead on a two-hour “walkthrough” and handouts. This rush to open and lack of preparation, mental health experts warn, will lead to chaos and poorer care.

This is stupid behavior by supposedly smart people — the same kind of behavior that has caused the current mess we already have. What’s the rush? There’s no real need for such haste and no good reason not to have Central Regional fully ready before it opens. If citizens don’t complain and if community mental health advocates don’t protest loudly, then stupidity will win again at the expense of the mentally ill. And that, simply, is sickening as well as insane. Read more!

Many Conditions Still Meet With Skepticism From the Public - ABC News

By DAN CHILDS
May 27, 2008

Intermittent Explosive Disorder. Oppositional Defiant Disorder. Mathematics Disorder.

If you've never talked to your doctor about these conditions, it should come as little surprise; they are arguably some of the stranger diagnoses floating around in the medical literature. And whatever you might think, many medical professionals say that these disorders are legitimate conditions that often warrant treatment.

Yet, this acceptance within the medical community has not quelled debate on the existence of many of these conditions.

"Illness is always a social construct," notes Dr. Nortin Hadler, professor of medicine and microbiology/immunology at the University of North Carolina at Chapel Hill, and author of the book "Worried Sick: A Prescription for Health in an Overtreated America."

"People have to agree -- both people, in general, and those in the medical community -- that a life experience should be labeled an illness," Hadler says. "For example, the Victorians medicalized orgasm, and we medicalize the lack of it."

Dr. Igor Galynker, director of The Family Center for Bipolar Disorder at Beth Israel Medical Center in New York, says that some psychiatric conditions, in particular, tend to be a target of widespread controversy.

"In psychiatry, part of a disorder is clinically defined and part is societally defined," he says, adding that conditions, such as Attention Deficit Disorder, or ADD, are particularly contentious.

"An ADD diagnosis is very controversial, especially after a recent paper suggested some children with ADD 'grow out' of it at age 25," he says. "That would mean that ADD is a phase in development, rather than a disease. ... It is all fluid."

But not all medical experts believe many of these disorders should be dismissed so readily by the public.

"Individuals should not think these disorders are trivial," says Dr. David Kupfer, a clinical professor of psychiatry at the University of Pittsburgh Medical Center, who is part of the team charged with drafting the new Diagnostic and Statistical Manual of Mental Disorders (DSM), a periodically updated compendium of psychological conditions for professional reference. "They are real. By having them in the DSM, hopefully it makes the stigma less."

The following are just a few of the many controversial diagnoses in the medical literature today.

Intermittent Explosive Disorder

Imagine, for a moment, the worst manifestations of aggression: domestic abuse, road rage, a tendency to pick fights for no good reason. While to some, such behavior would constitute a mere personality problem, to others it suggests a psychological condition known as Intermittent Explosive Disorder.

"The way [Intermittent Explosive Disorder] is described right now, it refers to somebody who repeatedly fails to control their aggressive drive," Galynker says. "They may act completely out of proportion to a situation."

And while the diagnosis may sound odd, it may be more common than you think. A June 2006 study funded by the National Institute of Mental Health found that Intermittent Explosive Disorder may affect as many as 7.3 percent of adults in the United States, mostly men.

While these people may fly into uncontrolled rage on a fairly regular basis, many feel remorse or embarrassment for their actions afterward. For this reason, Galynker adds that Intermittent Explosive Disorder can be thought of most effectively as an "aggression disregulation" and that a lot of people have gradations of it.

But is it for real? Galynker, for one, thinks so. And he says those who live with Intermittent Explosive Disorder often experience the consequences of their rage.

"A lot of people can't manage their aggression, and a lot of them end up in jail after an explosion," he notes.

But, as with many such disorders, some people may question whether someone who has been diagnosed with such a condition should be held fully responsible for their actions. Indeed, while some may argue that applying such diagnoses to this type of disposition could give some people a blank check for bad behavior, others might say the condition could warrant leniency.

Galynker, however, is adamant that an Intermittent Explosive Disorder diagnosis should not be enough to get someone off the hook for hyperaggressive behavior.

"The fact that people can't control their behavior doesn't mean that they are not responsible for their behavior," he says.

A number of different drugs are used to treat Intermittent Explosive Disorder, including anti-anxiety medications, like Valium and antidepressants, like Prozac. Psychiatrists have also used behavioral therapy to treat those with the condition.

Morgellons Syndrome

Perhaps one of the strangest and most controversial medical mysteries out there today, Morgellons syndrome involves the sprouting of inorganic material -- including fibers and crystals -- from the skin.

No solid evidence yet exists for the condition, and many doctors today say it is likely more a psychological condition than a physical one. That is, of course, assuming that the individuals who say they suffer from it do not actually have these objects growing from their skin.

In 2006, Brandi Koch of Clearwater Beach, Fla., told ABC News that she was one of many to suffer from the condition; she claims she has colored fibers coming out of her skin.

"The fibers look like hair, and they're different colors," Koch said.

And while most medical professionals doubt the existence of the condition, at least one -- pediatrician Dr. Greg Smith of Gainesville, Ga. -- claims to actually have experienced the condition firsthand.

"It felt like somebody stuck a pin in my toe and wiggled it and it just continued to hurt," Smith told ABC News in 2006. "I've certainly had those crawling sensations, and the fibers which come out of the skin are really bizarre, and really odd."

However, Dr. Vincent DeLeo, chief of dermatology at New York's St. Luke's-Roosevelt Medical Center, weighed in on what he'd say to someone who came to him with this condition: "I don't think this is any different than many patients I've seen who have excoriations and believe that there is something in their skin causing this."

DeLeo says the open lesions are a result of scratching the skin.

Sibling Rivalry Disorder, Mathematics Disorder and Caffeine-Related Disorders

Maybe you never got along with your little brother or sister. Perhaps numbers make your stomach turn, or maybe you drink a bit too much coffee for your own good.

If you're like most people, none of these situations poses a real threat to your daily routine. But take any of these situations and imagine them magnified exponentially. Suddenly, you're dealing with Sibling Rivalry Disorder, Mathematics Disorder or one of any number of Caffeine-Related Disorders.

Like some of the other diagnoses on this list, these conditions appear in one form or another in the DSM. And Kupfer says there is a good reason for including them; specifically, he says these collections of symptoms can often cause a certain level of personal distress or impairment -- the very definition of a disorder.

"In a way, what we are looking for is to diagnose things reliably to allow individuals to seek treatment," Kupfer says.

With regard to Sibling Rivalry Disorder, treatment can mean counseling that could solve family problems or prevent future psychological conditions. Teaching someone to cope with caffeine abuse may save them from sleep-related problems. It is in these situations, Kupfer says, that labeling such conditions as disorders is helpful.

But Hadler cautions that labeling can also have its downsides.

"A label will always change your self perception," he says. "Sometimes it elicits a positive change, sometimes a negative one."

And as far as Mathematics Disorder goes, most are skeptical that receiving such a diagnosis will get you much pity from your teachers.

"Would anybody actually say, 'I have math disorder and I'm getting treatment, and that's why I'm not successful'?" asks Dr. Dost Ongur, clinical director of the schizophrenia and bipolar disorder program at Harvard University's McLean Hospital in Belmont, Mass. "No, you would never get something like that. Math disorder is not like diabetes."

Oppositional Defiant Disorder (ODD)

Oppositional Defiant Disorder, or ODD for short, is a diagnosis that is applied to children who display such frequent and aggressive defiance of their parents that it disrupts the lives of those within the family.

According to the Mayo Clinic Web site, as many as one in 10 children may have oppositional defiant disorder in a lifetime, and it is often associated with other childhood behavioral disorders, such as ADD.

Galynker says the roots of this disorder are most likely genetic; aggression, he says, is one of the most highly inherited qualities. And genetic links to the kind of aggression seen in children with ODD have been proven in twin studies. Based on this, he says, ODD is likely a very real disorder.

"It's their internal characteristic to argue with their parents," he says. "Some deal better with this, while others deal worse."

An official diagnosis of ODD would likely be met first with counseling, and later with medications to help control a child's behavior. Parents may also receive counseling in order to learn more about how to control their children's behavior.

But many would argue that the blame should be more squarely placed on nurture than nature -- in order words, that parenting styles are more likely to be responsible for this disorder than genes. Ongur says it is little surprise that this may be the commonly held perception.

"For these disorders, I think it makes sense for the lay person to have that kind of reaction -- not because they are fake disorders, but because of the way it plays out in society," he notes.

Hadler, however, has a different take -- that ODD is yet another example of the medicalization of commonly seen behavior.

"No young child can be a brat anymore," he says. "Now, what right do we have to do that?"

Dissociative Fugue State

The stories are rare, but they are out there.

A successful lawyer -- a husband and father of two, active in his community -- disappears, only to be found six months later, living in a different city under a new name in a homeless shelter.

A man without an identity walks into a hospital, saying he woke up on the street with no wallet or identification, and says he has no idea who he is. His family locates him two weeks later, after which he returns to normal.

Such cases are examples of dissociative fugue state. In these cases, an individual will disappear, leaving everything behind -- including their memories and identity. In some cases, the sufferer even assumes a new identity, which persists until they are reunited with their old surroundings and allowed to return to their old persona.

Few psychological disorders have attracted such wonder from the public -- and sparked so much debate among experts in the field. Nowadays, most psychological experts agree that such cases are not simply about individuals running away from their problems, but, rather, a legitimate condition.

"The thing that people experience as 'fugue state' does happen," Ongur says. "There are people who wake up in other cities and don't know what has happened."

The fugue state is actually part of a larger family of conditions known as dissociative memory disorders. The trigger for these conditions is usually a traumatic event -- the death of a loved one, for example, or an extraordinarily stressful event at work. It is also more common in those who bear past trauma from events like natural disasters and war.

Chronic Fatigue Syndrome (CFS)

Chronic Fatigue Syndrome, or CFS, has garnered additional support as a legitimate diagnosis in recent years. Today, the U.S. Centers for Disease Control and Prevention (CDC) recognizes it as a condition that affects between 1 million and 4 million Americans.

Of these individuals, according to the CDC, only about half have consulted a physician for their illness -- even though it has been known to cause serious impairment in some.

As the name implies, CFS is most often associated with severe, debilitating fatigue. Non-specific pain and other symptoms are also common hallmarks of the condition, which is disproportionately experienced by women. As the condition persists, patients will often become depressed at the current lack of proven treatments to remedy the problems they experience.

But while the condition is starting to receive more attention and support, the underlying causes largely remain a mystery. Some have cited Epstein-Barr virus as a likely culprit. Others point to anemia, while still others implicate allergies.

Perhaps it is for this reason that the borders of this diagnosis remain contentious at best. Symptoms run the gamut from long-lasting flu-like symptoms to memory loss. Treatment can involve antidepressants, antihistamines or acupuncture.

To Hadler, CFS seems less like an actual condition and more like a rapidly growing hodge-podge of symptoms associated with a number of different diagnoses that are becoming increasingly more prevalent.

"Now it overlaps with post-traumatic stress disorder, fibromyalgia -- all of these labels include symptoms of fatigue," he says.

Still, dozens of studies -- many federally-funded -- are seeking answers as to the true nature of this condition.

Multiple Personality Disorder

It's been the stuff of horror movies and big-screen comedies. Yet, the truth behind Multiple Personality Disorder -- or Dissociative Identity Disorder (DID), as it is known today -- is, in most cases, a far cry from these dramatic interpretations of this classic psychological condition.

"Even when a patient says it's a different personality, it's nothing magical," Ongur says. "When people describe it, it is really a very extreme version of the more familiar feeling of disintegration. If you are under extreme stress or have had certain past experiences, the way the mind functions may actually break down."

Those who experience DID will create at least one "alter" personality that manifests itself in certain situations -- in essence, "taking control" of one's personality. These changes occur involuntarily, and DID in its most severe forms can limit one's ability to interact with others.

By the same token, the condition can occasionally go mostly unrecognized. Football great Herschel Walker is just one example; in his recently released book, "Breaking Free: My Life with Dissociative Identity Disorder," Walker says his life was fragmented by a number of independent "alters" -- at least one of which led him to attempt suicide.

Ongur says early psychological trauma is one of the most common underlying causes of the disorder.

"When people describe these things, it is certainly often associated with a severe history of child abuse," he says. "This was one way for them to cope."

And, as in Walker's case, psychological treatment involves unifying the alters into a single personality -- allowing those who suffer from the condition to regain full control over their lives.

"The task is to get this person feeling whole again," Ongur says.

Social Anxiety Disorder (SAD)

If there is a success story among psychological conditions once considered spurious, it is that of Social Anxiety Disorder (SAD), psychological experts say.

"The whole issue of social phobias was once considered something that was not very important," Kupfer says. "As we discovered, this can cause a tremendous amount of impairment, and there are a whole lot of issues developmentally which affected coping with it."

In labeling this as a disorder, he says, medical professionals have been able to help millions of people who otherwise would have been told that they were simply shy.

Ongur agrees. "It's familiar to people because it's shyness, but it's really extreme shyness," he says. "It is something that can be very real and very impairing."

Those who suffer from SAD often find themselves faced with seemingly insurmountable anxiety when it comes to interacting in certain social situations. Most common are feelings of being watched, scrutinized and criticized by others. So intense is this anxiety that it can sometimes lead to a panic attack.

In most cases, these fears are unreasonable. Counseling can often help those who live in near-constant fear of being embarrassed or humiliated in front of others. Coaching in social skills may also be needed in order to help those with SAD better integrate themselves into comfortable social circles.

"Social phobia ... is a relatively new diagnosis," Galynker says. "Many people have difficulty socializing, of course. This is just a label to help treat people who have it."

And Galynker says the changing perception of SAD and psychological conditions like it will hopefully help remove the stigma so often associated with such disorders.

"Everybody has a problem, really," he says. "Nobody does not have some sort of diagnosis."

Katie Escherich contributed to this story

Copyright © 2008 ABC News Internet Ventures
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Man gets life for killing parents -Northwest Flordia Daily News

David Angier

PANAMA CITY - Ricky Morris' children do not yet know he's a murderer.

"They love you," Karen Morris told her husband Wednesday in a Bay County courtroom. "They don't know you did it, and one day I'll have to tell them that, but until then, they love you."

Ricky Morris, 25, pleaded guilty Wednesday to two counts of first-degree murder for shooting to death his parents, Raymond and Deborah Morris, in their Fountain home Feb. 3. The state had decided not to pursue the death penalty in Morris' case, so Circuit Judge Don T. Sirmons gave him the only sentence left, life in prison. Florida law does not allow for parole in Morris' case, so the sentence means Morris will die in prison.

But his family asked Sirmons to send Morris to a prison where he can receive help for his mental illness.

"The Ricky Morris that did what he did was not the same person I had children with," Karen Morris told Sirmons. "He wouldn't have done this if he wasn't mentally ill."

Morris' aunt, Cindy Morris, told the judge her brother was so determined to get Ricky Morris help for his mental conditions, he was willing to risk his life.

Raymond Morris asked a judge to send his son home with him as a condition of probation for a gun charge in 2005.

"(Raymond Morris) did say this to me several times, that ‘I would give my life to get my son the help he needs,'" Cindy Morris said. She said "the system failed" to protect her brother by not checking on Ricky Morris' progress while he was out on probation.

Ricky Morris stood by calmly as three family members went before the judge, all asking for a sentence that would provide him help.

Sirmons said he could recommend the Department of Corrections place Ricky Morris in a facility that will give him mental health treatment but said Ricky Morris will have to take some responsibility.

"No one can force you to take your medication," Sirmons told him.

Ricky Morris called 9-1-1 about 7:12 p.m. Feb. 3 to report he had shot his father, Raymond, 51, and mother, Deborah, 47. He said he also wanted to kill his brother, Raymond Morris III, but he was not home.

Raymond Morris was shot twice with a 30-30 rifle while in bed. Deborah Morris was shot once and was found on the bedroom floor.

Ricky Morris said nothing Wednesday, other than to answer the judge's questions and to tell one family member he loved him. Read more!

Guilty but insane: Balance care, safety - Portland Oregonian

Letters to the editor compilation:

Clackamas County District Attorney John Foote's opinion piece, "Halting the release of violent criminals" (May 27), obfuscated the real issue. Nationally, housing the mentally ill in jails and prisons has been a disaster for states and municipalities in terms of cost and recidivism.

The largest mental health provider in the United States is the Los Angeles County Jail, where the disabled are warehoused with little or no treatment for their illnesses.

In contrast, Oregon's system of mandated treatment via the Psychiatric Security Review Board boasts a sub-2 percent recidivism rate and costs the taxpayer much less.

As one of those taxpayers, I am proud of the way our state has chosen to treat its mentally ill population. Our system's balance between public safety and compassion for the mentally disabled should be considered a template for other systems nationwide.

JIM SECHRIST West Linn

John Foote's idea that safe facilities are needed to house the criminally insane is a good one. The current system tips the "civil rights" of the criminally insane to far outweigh both humane practicality and public safety. The offenders and the public would benefit from the lifetime incarceration of violent criminals in a safe and caring facility.

The concept of placing the criminally mentally ill into our neighborhoods with bottles of pills that they have the right not to take is the Catch 22 that applies today. Foote is right to challenge it.

The mentally ill deserve more loving care. The families and the community deserve more sane policies. The current model of "catch, commit, give 'em a pill, and release" needs to be abandoned with a sane mental health model that includes lifetime care in safe facilities for those with incurably damaged brains.

J.C. SCOTT Tigard

John Foote has the question backward. The question isn't why patients are being discharged from Oregon State Hospital; the question is why Oregon citizens with mental illness cannot receive treatment in the outpatient world so that crimes are not committed.

When people are found not guilty by reason of insanity and sent to a psychiatric hospital, what do you expect? Doctors, nurses and therapists treat their patients. Although treatment isn't cure, many people can be helped with medication so that they are no longer dangerous. When treatment has succeeded, why wouldn't you discharge someone from the hospital?

Hospitals are not prisons. Prisons have replaced the state mental hospitals at a much higher financial and a much higher personal cost for citizens.

It is well established that many people with chronic psychotic illness do not have the ability to know that they are ill because of frontal lobe deficits. If there is no mechanism to enable these people to receive treatment, they will not take medications because their brains tell them they are not ill.

Contrary to public opinion, most mentally ill people who do not accept treatment are not "choosing" to be ill, homeless, hungry, assaulted, jobless and so on. Treatment over objection in the outpatient world is the only humane way to ensure ill people treatment and to improve public safety.

MAUREEN C. NASH, M.D. Forest Grove Read more!

Child health care varies widely among states -USA Today

By Julie Appleby

Only 46% of kids visit the doctor and dentist at least once a year in Idaho, but 75% of Massachusetts children do. Infant mortality rates are 2.5 times higher in the District of Columbia than in Maine. And South Carolina kids are 5.7 times as likely to wind up in the hospital for asthma as those in Vermont.

These measures of children's health are part of a report out today by The Commonwealth Fund, a private foundation that studies health issues and supports efforts to cover more people. The report found that top-performing states tend to have lower rates of uninsured children than those ranked at the bottom but also have higher health costs.

While other studies have considered how children fare, this is the first to compile an array of 13 measures relating to access to medical care, quality and cost for children in each state. Overall, Iowa ranked first and Oklahoma ranked last. Among the findings:

•Vaccinations. The percentage of children who received five recommended vaccinations from ages 19 months to 35 months ranges from 94% in Massachusetts to 67% in Nevada.

•Uninsured. The percentage of uninsured children ranges from 5% in Michigan to 20% in Texas.

•Costs. Utah has the lowest spending per person at $3,972. The District of Columbia has the highest at $8,295.

The report uses data from government agencies as well as private groups, such as the Kaiser Family Foundation, a non-partisan research group. It concludes that all states fall short in one area or another and could improve.

If all states performed as well as the top state in each category, the report says, an additional 4.6 million children nationwide would have health insurance, 11.8 million more would visit the doctor and dentist at least once a year, and nearly 800,000 more would be current on their vaccinations.

Karen Davis, president of The Commonwealth Fund, says the low rate of immunizations in some states could be remedied by upgrading systems to track them and notify parents and providers.

"If we had a modern information system, we would be reminding patients and primary care physicians that (the children) are overdue for their shots," Davis says.

The report comes amid efforts by many states to bolster insurance programs aimed at families.

President Bush in December signed an extension of funding for the State Children's Health Insurance Program after twice vetoing Congress' attempts to expand it. The program, which sends federal money to the states through March 2009, has cut the percentage of uninsured low-income children by 25% from 1996 to 2006, according to the Congressional Budget Office.

Top-ranked Iowa attributes its success in part to providing a range of services and coordinating care among doctors, hospitals and clinics.

"We focus on coverage to be sure, but also access to social, emotional and mental health services, dental services and prenatal care," says Christopher Atchison, associate dean of the College of Public Health at the University of Iowa.

Matthew Davis, an associate professor of pediatrics and public policy at the University of Michigan, disagrees with researchers' decision to mark down states for having higher spending levels.

Yet overall, he says, the report is useful and shows that "states can learn from each other." Read more!

Psychiatrists: Don't open till hospital's safe -Raleigh (NC) News & Observer

Michael Biesecker, Staff Writer

RALEIGH - An influential doctors' group cautioned state officials Tuesday against opening a new state mental hospital in Butner until the facility is safe for patients or staff.

The N.C. Psychiatric Association, a professional organization for psychiatrists with more than 900 members statewide, expressed its concerns in a letter to Dempsey Benton, the secretary of health and human services.

"Currently, there is much attention to the question of whether the new hospital, in its architecture and staffing, is safe," the letter states. "NCPA is officially opposed to moving to the new hospital until its building and staffing are sufficient to ensure a safe treatment environment for these vulnerable patients and their dedicated staff."

State mental health administrators are forging ahead with plans to open Central Regional Hospital by July 1 despite projected shortages in qualified professional staff and lingering concerns over design flaws with the $120 million building that safety inspectors worry could endanger patients.

At the same time, the state will close Dorothea Dix Hospital in Raleigh and Umstead Hospital in Butner, with the transfer of the first patients scheduled for June 14.

Timing

With people in need of help languishing on long waiting lists for admission, and reform of state mental-health care floundering, doctors, state mental health workers and advocates are growing increasingly vocal about whether it's the right time to be reducing hospital beds.

Benton declined to be interviewed about the association's letter Tuesday. "He'll take the letter under advisement," said Mark Van Sciver, a health and human services spokesman.

The NCPA is the state affiliate of the American Psychiatric Association, the nation's leading group for psychiatrists.

The letter was signed by Stephen I. Kramer, president of the state association. He said that to his knowledge, the group has never before felt the need to voice its members' concerns to the state.

He said some of the association's members had discussed their concerns with Michael Lancaster, co-director of the state division of mental health, but serious questions remain.

"Dr. Lancaster did talk to some of us, and he seemed very optimistic this could be done in time for the timetable we were given, but we have no independent way to assess that," said Kramer, who is also the director of adult inpatient psychiatry and neuropsychiatry at Wake Forest University Baptist Medical Center in Winston-Salem. "We want to be sure we're on the record as wanting the safety features to be in place and the staffing to be adequate."

Lancaster declined through a spokesman to be interviewed Tuesday.

Vacancies

Over the past six months, The News & Observer has revealed internal documents and meeting minutes showing that career DHHS officials have serious concerns about opening the new hospital. An inspection May 13 lists 16 unresolved safety and security issues at the new hospital, including hundreds of door handles and bathroom handrails that suicidal patients could use to anchor nooses made from bedsheets or clothing.

With patients due to arrive in less than three weeks, records released last week showed 63 nursing positions yet to be filled -- a vacancy rate of 21 percent. There's a 36 percent vacancy rate for medical doctors, and 38 percent of positions for psychologists are empty.

The vacancy rate for psychiatrists is more than 14 percent, according to the projections.

michael.biesecker@newsobserver.com or (919) 829-4698
Read more!

Auditor speaks out on Nesbitt -Asheville (NC) Citizen-Times

Jordan Schrader

Sen. Martin Nesbitt should have disclosed his ties to the former sponsor of his son’s stock-car racing team, even if a state ethics expert assured him the law didn’t require it, the state auditor says.

“The obligation to bring ‘sunshine’ arises out of a higher duty as a public official even if not technically required by State law,” Auditor Les Merritt said in a statement released Tuesday along with his report on Nesbitt.

Merritt said he released the findings because Nesbitt came forward about the investigation in an interview with the Citizen-Times.

The Republican auditor found the Asheville Democratic lawmaker had a “potential conflict of interest” in serving on committees considering issues involving Blue Cross Blue Shield of North Carolina, which before this year was Nesbitt Racing’s most prominent sponsor.

But the State Ethics Commission says it told Nesbitt in 2007 he didn’t have to list the relationship on a financial disclosure form.

The case has sparked a debate between the two government watchdogs over jurisdiction and led lawmakers to file a bill that would strip the auditor of authority over ethics matters.

Besides disclosing his ties to the insurer, Nesbitt should also have resigned from the committees if he couldn’t “represent the public objectively and independently,” said Frank Perry, Merritt’s investigative audits director.

“If I want to maintain an association with a Blue Cross Blue Shield … it seems that I should remove myself from a committee that takes up issues pertaining to them,” Perry said.

Nesbitt said stepping down from the Senate’s health care committee and as co-chairman of the legislature’s mental-health oversight panel is exactly the goal of the political opponents who have questioned his Blue Cross ties.

“My people need me in the health care debate,” Nesbitt said. “I’ve led the charge” on children’s health insurance and fair mental-health insurance. “I’m leading the charge trying to straighten out this mental health system that’s in dire straits.”

Blue Cross spokesman Lew Borman declined to comment on the auditor’s report, but pointed out: “Quite often Blue Cross and Sen. Nesbitt had different points of view on certain pieces of legislation.”
Read more!

Senate Republicans block plan to improve medical care in California prisons - Los Angeles Times

By Michael Rothfeld

ACRAMENTO — In an ominous sign for efforts to end federal oversight of state prisons, state Senate Republicans on Tuesday rejected a $7-billion proposal to build medical facilities intended to improve unconstitutionally poor healthcare for inmates.

The plan was created by a federal receiver and backed by Republican Gov. Arnold Schwarzenegger. U.S. District Judge Thelton Henderson, who appointed the receiver, wrote a letter last week urging lawmakers to approve it.

But Senate Republicans balked at the bill's high price tag and objected that it had not been coordinated with other plans that could dramatically affect state prisons, such as a proposal for settling a federal court case on overcrowding by reducing the inmate population by tens of thousands.

In two days, some of the same Republican legislators, the Schwarzenegger administration, inmates' lawyers and other parties to the overcrowding case are scheduled to report in federal court whether they agree to the settlement, which would divert some convicted criminals and parole violators into local treatment programs, county jails and alternative forms of incarceration.

Advocates for inmates in the case assert that overcrowding is the main cause of substandard healthcare in California prisons. Republican lawmakers and some local officials have expressed reservations about the proposed deal. A panel of three federal judges is poised to hold a trial that could result in a mass release of prisoners if the settlement talks fail.

The construction program and the settlement proposal are part of an overarching but largely disconnected state effort to bring the sprawling prison system and the care of inmates up to constitutional standards. Both now appear to be in some danger of sinking without legislative support.

"The problem . . . , quite frankly, is the amount of money we're talking about," said state Sen. Dave Cogdill (R-Modesto), who leads the Senate's Republican minority. "We think there are more responsible ways to move forward to get where we need to go and to do it in a much more frugal manner."

Republicans said they needed to make sure that all pending prison overhaul efforts -- including a separate state and local plan approved last year to build more beds -- would be connected.

Democrats said they feared the federal judges monitoring state prisons would not take the refusal to cooperate lightly. Henderson seized prison medical care from state control in 2006.

"This is just another example where the state has failed to enforce its own laws," said state Sen. Michael Machado (D-Linden), who wrote the bill to build medical facilities, SB 1665. "How many more times are we going to abdicate our responsibility and let the federal courts come in and govern the state?"

Receiver J. Clark Kelso wants to spend the $7 billion to build up to seven facilities with a total of 10,000 beds for inmates with long-term medical and mental health problems, and to renovate existing clinics at the state's 33 prisons. He wants to begin construction early next year.

Schwarzenegger's office said in a statement that "the receiver's plan is necessary to bringing our prisons' healthcare up to constitutional levels, as required by the federal courts. We're confident that the Legislature understands the need to improve our prison healthcare system and to do it in a financially responsible way."

Machado said he would request another vote on the measure Thursday, before a deadline passes for the Senate to approve the legislation.

Kelso said he remained optimistic that the Republicans might change their minds by then. If they don't, he said, he will be forced to take hundreds of millions of dollars directly from state coffers this year to continue operating, as opposed to borrowing nearly all of the $7 billion, as he had proposed.

The receiver could also seek an order from Henderson to compel the state to provide money, but Kelso said that would be a last resort.

"I'm proceeding step by step," Kelso said. "You don't jump to the end at the beginning."

Several Senate Republicans had previously indicated they would support the construction plan, but on Tuesday they met in private before the vote and decided as a group to oppose it.

State Sen. Dave Cox (R-Fair Oaks) said he thought it possible that some Republicans would change their minds by Thursday if there were a strategy to coordinate the receiver's plan, the proposed lawsuit settlement and last year's prison spending measure.

"You need to do this as a package," Cox said.

Because the bill would take effect immediately, it needs approval from two-thirds of the Democrat-controlled Senate, or 27 votes. On Tuesday, the measure garnered 22 votes, with 14 Republicans voting against it. Three Democrats and one Republican also abstained.

Machado's bill would authorize $6.9 billion in borrowing through a type of bond that do not require voters' approval. The debt would be repaid over 25 years, with average annual interest payments of $527 million, according to a Senate analysis.

The plan calls for an additional $100 million from the state's general fund.

In a letter to Machado last Thursday, Henderson said he had heard that support for SB 1665 "may be wavering" in light of questions about the proposed settlement to reduce overcrowding.

He asked the senator to communicate to colleagues "the urgency" of approving the legislation.

Henderson wrote that the settlement, with which he is also involved, would not eliminate the need for new medical facilities to improve healthcare.

While acknowledging that the receiver's proposal "asks for a significant amount of funds," the judge called it "an appropriate, cost-effective plan" that could be scaled back later if possible.

"I have directed my Receiver to continue working with you and other members of the Legislature to ensure the bill's expedited passage," the judge wrote.

michael.rothfeld@latimes.com

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Group home, Nebraska town settle discrimination lawsuit - The Asssociated Press

A behavioral health services company will get a permit to build a group home it was denied last year by the village of Palmer — plus $30,000 for its trouble.

Life Quest Inc., the village and its mayor, Arlo Bockerman, have settled the federal lawsuit the company filed in January.

Life Quest sued the central Nebraska village and Bockerman after the Village Board denied the company a permit last December to build a group home to serve 14 people with mild mental disabilities.

Since 2003, Life Quest has run a housing program in Palmer serving more than 40 people with mental disabilities who need 24-hour care. The group home would be for those who have less demanding mental disabilities. While those in the group home would still receive support services, they would be afforded more independence than those in the housing center.

The lawsuit said Palmer and its leaders infringed on the rights of the mentally ill by denying construction of the home — even after a zoning commission approved Life Quest's request for a permit.

The lawsuit said Bockerman told the owner of Life Quest that he would have approved a home for the elderly, but not for the mentally ill, because he "did not want any more of those people here."

The lawsuit also said the city had denied residents of Life Quest's existing mental disability housing center access to the village swimming pool, library and other public services.

The settlement requires the village and its mayor to comply with the federal fair housing and disability laws, as well as provide Life Quest residents with access to public events, such as football games, held on the village-owned fields.

"The village agrees to continue providing all residents living in Life Quest's housing with access to the swimming pool on the same terms as all other citizens of the Village," the settlement says.

For its part, Life Quest promised not to build additional facilities in Palmer for the disabled for 10 years and agreed to hire additional staff for the new group home, as well as undertake other security efforts.

Life Quest attorney Beth Pepper of Baltimore says her client's objective in filing the lawsuit was simply to help treat mentally disabled people in the community.

"The village has recognized that right, and we're very, very happy that it has," Pepper said Tuesday.

There was no admission of liability by either the village or Bockerman as part of the settlement.

A message left by The Associated Press at the village hall Tuesday was not immediately returned; neither was a message left Tuesday at the home of Bockerman. Read more!

Wartime PTSD cases jumped roughly 50 percent -Associated Press

By PAULINE JELINEK

The number of troops with new cases of post-traumatic stress disorder jumped by roughly 50 percent in 2007 amid the military buildup in Iraq and increased violence there and in Afghanistan.

Records show roughly 40,000 troops have been diagnosed with the illness, also known as PTSD, since 2003. Officials believe that many more are likely keeping their illness a secret.

"I don't think right now we ... have good numbers," Army Surgeon General Eric Schoomaker said Tuesday.

Defense officials had not previously disclosed the number of PTSD cases from Iraq and Afghanistan.

Army statistics showed there were nearly 14,000 newly diagnosed cases across the services in 2007 compared with more than 9,500 new cases the previous year and 1,632 in 2003.

Schoomaker attributed the big rise over the years partly to the fact that officials started an electronic record system in 2004 that captures more information, and to the fact that as time goes on the people keeping records are more knowledgeable about the illness.

He also blamed increased exposure of troops to combat.

Factors increasing troop exposure to combat in 2007 included President Bush's troop buildup and the fact that 2007 was the most violent year in both conflicts.

More troops also were serving their second, third or fourth tours of duty - a factor mental health experts say dramatically increases stress. And in order to supply enough forces for the buildup, officials also extended tour lengths to 15 months from 12, another factor that caused extra emotional strain.

Officials have been encouraging troops to get help even if it means they go to civilian therapists and don't report it to the military.

"We're trying very hard to encourage soldiers and families to seek care and to not have them feel in any way, shape or form that we're looking over their shoulder or that we're invading their privacy," Schoomaker told a group of defense writers.

Noting that stigma is a problem in American civilian society, not just the military, he said, "I think that's the preferred way to do it."

The accounting of diagnosed cases released Tuesday shows those hardest hit last year were Marines and Army personnel, the two ground forces bearing the brunt of combat in Iraq and Afghanistan.

The Army reported more than 10,000 new cases last year, compared with more than 6,800 new cases the previous year. More than 28,000 soldiers altogether were diagnosed with the disorder over the last five years, the data showed.

The Marine Corps had more than 2,100 new cases in 2007, compared with 1,366 in 2006. More than 5,000 Marines have been diagnosed with PTSD since 2003, the data showed.

Navy officials who would have data on Marine health issues did not return a phone call seeking to confirm the numbers released by Schoomaker's office.

Schoomaker said he believes PTSD is widely misunderstood by the press and the public - and that what is often just normal post-traumatic anxiety and stress is mistaken for full-blown PTSD.

Experts say many troops have symptoms of stress, such as nightmares and flashbacks, and can get better with early treatment.

The Pentagon had previously only given a percentage of troops believed affected by depression, anxiety, stress and so on - saying up to 20 percent return home with symptoms of mental health problems. A recent private study estimated that could mean up to 300,000 of those who've served have symptoms.

The Veterans Affairs Department said recently it has seen some 120,000 Iraq and Afghanistan veterans who have received at least a preliminary mental health diagnosis, with PTSD being the most common diagnosis at nearly 60,000.

An undisclosed number of troops also go to private care providers who are part of the huge military health care system. Schoomaker noted that National Guard and Reserve troops often go home to communities where there is not a veterans facility nearby.

"We're working very hard with the VA and with the National Guard and Reserves to get a better feel for, a grasp on, how big this is," Schoomaker said, adding that over time officials will be able to collect data and get "a better feel for, handle on, the numbers."
Read more!

Our view: Losing Dayton's Twin Valley has to be offset - Dayton Daily News

By Dayton Daily News

Gov. Ted Strickland ambushed Dayton when he decided in January to close Twin Valley Behavioral Healthcare, and Dayton still is not taking the decision well.

He wants to shutter the 110-bed mental health facility on Wayne Avenue to save money. In the future, patients from the Dayton region will be treated at state facilities in Cincinnati, Columbus or Toledo. The move will mean law enforcement officials will lose time and money ferrying mentally ill defendants to these sites. And mentally ill patients who are not in trouble with the law will be sent farther from home, making it more difficult for their families — who are invariably needed to help keep them stable — to be part of their treatment.

Dayton got no advance notice of the closing, which is bad form, not to mention insulting. Further infuriating the locals, the Ohio Department of Mental Health had no clue that its decision would hurt Wright State University's psychiatric residency program and Wright-Patterson Air Force Base's psychiatric residents. (The state and Twin Valley's patients, incidentally, were benefiting every bit as much as the young doctors from that work.)

This is what happens when people don't have the courage to just come out and tell you what they're going to do to you before they do it.

Now Dayton is paying a price a second time because the governor doesn't want to cut his staff off at the knees and cave to criticism. Moreover, the Greater Dayton Area Hospital Association has been beating up the governor pretty badly, and some of his people are getting sick of it.

But look at it from the locals' point of view: Area hospitals are going to start seeing patients in their emergency rooms that, in the old days, would have gone to Twin Valley. They don't have the space to segregate them; they're worried about security and they know the pressure will be on them to set aside more beds for costly psychiatric patients.

In other words, the governor's cost-cutting move is going to help him, but it's going to cost them.

Ohio House Speaker Jon Husted, of Kettering, is behind an effort to put off the closing for six months and to get more than $6 million set aside for Dayton's loss. The governor may veto those ideas, which would just further alienate everybody and do nothing to help Dayton-area patients.

If everybody would just put down their weapons and think about the patients and their families, a compromise could be worked out. Dayton doesn't have a public hospital, meaning that area hospitals are already eating the costs of a lot of charity care. Asking them to absorb the cost of more psychiatric care, too — when other areas of the state aren't being required to do the same — is ridiculous.

Absolutely, the governor has a budget problem, but he is letting the mental health department make its cuts on the backs of people in Dayton.

Dayton put out an over-the-top request for more than $20 million as a financial offset. That request went nowhere, but there is at least sentiment in the House and Senate for giving Dayton some money for a "crisis care" center — a facility that would fall short of a full-fledged Twin Valley. You'd think the governor would see that as a statement of trying to make the best of a raw deal, an act of good faith.

At this point, getting all hung up about who's more wrong, or who has been most wronged, is losing perspective. The discussion needs to be about minimizing how much mentally ill people are hurt — not how bruised the governor is or the hospitals will be. Read more!

Cincinnati Man Sentenced to 10 Years in Prison for Raping Sleepwalker - Associated Press

Man schizophrenic, HIV positive.

CINCINNATI — A homeless man in Cincinnati accused of attacking a woman who appeared to be sleepwalking has pleaded guilty to charges of rape and felonious assault and has been sentenced to 10 years in prison.

Fifty-three-year-old Dexter Ford initially was charged with kidnapping, felonious assault, attempted rape and two counts of rape, carrying a maximum prison sentence of 46 years in prison. His trial was to begin Tuesday.

As part of a plea deal, Ford pleaded guilty to one count of rape and one count of felonious assault. Another count of rape, one count of attempted rape and one count of kidnapping were dropped, FOX affiliate WXIX reported.

Prosecutors say the 24-year-old victim is a severe epileptic who sometimes seems confused after an intense seizure. Witnesses told police in November that they saw Ford assault the woman while she was walking near Interstate 71 in Cincinnati.

Ford has been diagnosed with schizophrenia and is HIV positive.

Read more!

Youth Services Bureau to break ground on new facility -Wesminister (MD) Advocate

Services include counseling, immediate suicide assessments, violence assessments, mobile treatment for teens and adults who are chronically mentally ill.

Mary Scott
28.MAY.08

Soon the Carroll County Youth Services Bureau will be able to serve more community members.

Groundbreaking is set for Wednesday for its new facility, which will allow it to see more people than it can in its current building.

Since 2003, the CCYSB has had to turn away thousands of people they were not able to serve, according to Lynn Davis, executive director of the CCYSB.

“Being a helping profession and all, that’s not what we wanted to do,” Davis said.

The CCYSB is a nonprofit that provides counseling services to children, families and single adults.

Services at the CCYSB include basic counseling, immediate suicide assessments, violence assessments, mobile treatment for teens and adults that chronically mentally ill and a program for kids who have become involved in Juvenile Services.

Gary Honeman, assistant director of the CCYSB and counseling director, said that the center takes the family concept very seriously.

“The whole concept, it takes a village to raise a child — I’m not sure how much of a village we really have left,” Honeman said. “Kids in families in our culture tend to be pretty isolated. We don’t see the kind of community networks that existed years ago.”

Honeman said that counselors see a lot of children and adults struggling from trauma and separation in divorce. They see so many in fact, that the CCYSB offers a seminar every month on separation and divorce for parents going through it.

Included in the CCYSB’s mission is to help everyone they can, which means no one is turned away from services because of inability to pay, according to Davis.

Davis said that in 2007, about 55 percent of the clients that walked through the CCYSB were medical assistance clients, meaning they were low-income.

The 22,000-square-foot new facility is being built at Kate Wagner and Washington Roads. Davis said once completed, it will hold a large conference center and clinical rooms for counseling.

“Our projection for completing it is 12 to 15 months. That’s what we’re hoping for,” Davis said. “Our hope is that the outside work will be done and we might be doing indoor work by the time really bad weather hits.”

Davis estimated the total costs for the building would come to about $6.2 million at the most, but said that a good portion of the costs would be covered by various grants the CCYSB received.

Mary Scott can be reached at 410-857-3316 or mary.scott@westminsteradvocate.com

- Advocate Staff Writer Read more!

Simpson firm still on care provider list -Elizabeth City (NC) Daily Advance

By BOB MONTGOMERY
Tuesday, May 27, 2008

A local mental health care provider's recent bankruptcy filing won't affect its ability to continue providing Medicaid-funded services, a spokesman for the state agency overseeing the mental health program said.

American Health and Human Services Inc. of Elizabeth City recently filed for Chapter 11 bankruptcy reorganization in the Wilson-based U.S. Bankruptcy Court for the Eastern District of North Carolina.

The petitioner, Andrea Simpson, AH&HS chief executive officer, listed 25 creditors from whom the company is seeking relief.

Brad Deen, spokesman for the N.C. Department of Health and Human Services, said the state has no mechanism for ending Medicaid payments to mental health providers that file for bankruptcy.

"In a nutshell, it depends on the individual circumstances," Deen said. "There could be certain circumstances that could affect their ability to provide services, such as capital on hand and overhead. (But) in and of itself, bankruptcy isn't a problem."

Deen said AH&HS is still on the state's list of approved Medicaid providers.

Simpson could not be reached Tuesday.

Last year, AH&HS was among five area mental health care providers DHHS said had charged the state nearly $2 million for services that weren't medically necessary. The providers used mentors, or clinical service providers, to conduct one-on-one training and counseling with clients. Hours for that interaction were then billed to DHHS and paid for with Medicaid funds. Audits of mental health providers statewide determined that more than 500 collectively owed the state more than $60 million for charges for non-qualified services.

Recently, Deen said AH&HS had repaid the state nearly $500,000 it owed by having a portion of its current Medicaid payments withheld.

A meeting of Simpson's creditors is set for 10 a.m. on Tuesday, June 10. Read more!

Virginia executes killer - Associated Press

ARRATT, Va. (AP) -- A man whose lawyers claimed he was mentally disabled was executed Tuesday night for killing a convenience store owner in the first execution in Virginia in nearly two years.

Kevin Green, 31, who was convicted of the August 1998 slaying of Patricia Vaughan, was pronounced dead at 10:05 at Greensville Correctional Center in Jarratt.

Green declined to give a final statement, telling a prison official, "No, I don't got nothing to say."

Green was the third U.S. inmate to die since the Supreme Court upheld the constitutionality of lethal injection in April. Georgia became the first to execute an inmate May 6, ending a seven-month halt on capital punishment nationwide.

The U.S. Supreme Court, a federal judge and Gov. Timothy M. Kaine each refused Tuesday to halt the execution.

Green's execution was scheduled to begin at 9 p.m., but was delayed for about an hour when his attorneys attempted to get the federal judge to step in, Department of Corrections spokesman Larry Traylor said. Once Judge James R. Spencer of the United States District Court for the Eastern District of Virginia declined, the execution proceeded.

Green shot Vaughan and her husband, Lawrence, while robbing their convenience store in rural Dolphin, more than 50 miles south of Richmond. Patricia Vaughan, 53, died at the scene. Lawrence Vaughan survived.

Police say Green confessed, telling them he and his nephew took a bus to northern Virginia and blew all but $170 of the $9,000 they stole on prostitutes, marijuana and clothes.

His nephew, 16 at the time, pleaded guilty and was sentenced to 23 years in prison.

Kevin Green went to trial and was found guilty of robbery and capital murder and sentenced to death in 2000. A year later, the Virginia Supreme Court ordered a new trial because of juror problems. Green was convicted again in 2001 and again sentenced to death.

The Vaughan family had waited 10 years to see the sentence carried out.

"I feel like we're the puppets and they're being the puppeteers," said Marsha Brown, one of the Vaughans' two daughters. She watched Green's execution with her father, sister, husband, stepmother and two local officials.

"It's just a fine line between being hopeful and helpless. I really regret that another life has to be involved -- that an execution has to happen -- but I just think it needs to be carried out," she said.

Green, through his attorneys, declined to be interviewed. Green requested that prison officials not release the contents of his last meal, Traylor said. Traylor said Green did not meet with family or a spiritual adviser Tuesday but did speak to his attorneys.

Green was the 99th person executed in Virginia since the U.S. Supreme Court reinstated capital punishment in 1976. Virginia ranks second only to Texas, which has executed 405. Read more!

Study supports new county jail -Memphis Commercial Appeal

Alternative programs also touted to reduce inmate population

By Alex Doniach

Faced with an increasing inmate population, Shelby County could save millions a year by investing in a new $480 million jail, according to a county-funded study released this month.

The $250,000 jail master plan prepared by South Carolina consulting firm Carter Goble Lee also found that the county could cut hundreds from its jail population next year by funneling about $2 million into jail alternatives, such as treatment programs for drug users and the mentally ill.

But with a jail population approaching 3,000, consultant Bob Goble predicts a new facility or an expansion of the jail at 201 Poplar will be necessary within the next five years.

"If they will build a new, contemporary design, it's going to pay off in the long run for the taxpayers, because eventually the savings on staffing will offset the added cost to build a new jail," Goble said.

The study offers a few options, but said the county could save the most in daily expenses by building a new jail Downtown with about 3,500 to 4,000 beds, costing the county $400 million to $500 million.

Remodeling the existing facility, which has about 2,800 beds, would cost about $180 million. Female inmates are housed in a separate facility.

Sheriff Mark Luttrell, who commissioned the study and will present the findings to the County Commission on Wednesday, has long pushed for a new and more efficient jail, which could cut down on staff.

But Luttrell, a career corrections professional who helped stabilize the Downtown jail after years of federal court scrutiny, said he's realistic about the county's budget pressures, including its $1.8 billion debt.

"Ideally, we would love to have a brand new facility that would be operationally more efficient, but the debt reality in Shelby County may keep us from going to that extent," Luttrell said. "The fall-back option for me is renovating the current facility and adding an annex."

Yet after an initial look at the study, County Commissioner Mike Ritz said he was unwilling to consider millions in construction costs, at least for now.

"Let's hold off two years and then let's make a decision that uses all existing facilities in a phased sort of way so the county taxpayers are never faced with a $500 million deal," he said.

The inmate population has climbed since 1997 -- although not dramatically -- from an average daily population of about 2,679 to 2,776 for the first nine months of 2007.

Although the population has actually decreased in 2008, down to an average population of about 2,500 from January to April, the study predicts the combined male and female population will exceed 3,000 by 2011.

Luttrell said the jail, which opened in 1981, is inefficient and costly to run because it divides inmates into 40-bed living units, requiring too many jailers. A more efficient facility could hold about 64 inmates per unit, he said, which would enable fewer jailers to monitor more inmates.

Luttrell said with a new facility, he could reduce jailers by about 300, saving millions.

Beyond new construction, Luttrell said he hopes the county will further fund programs that would help keep the jail population down.

These include the District Attorney's jail screening program, which weeds out inmates before they're booked. It also names the Memphis Police Department's Crisis Intervention Team and Project Jericho, two programs that divert the mentally ill to appropriate treatment programs.

The study estimates expansion of these programs would cost the county about $2.3 million, but could save about $6.4 million next year by decreasing the daily population by about 200. It costs $87 a day to keep someone in jail.

Despite the high cost to taxpayers, county Mayor A C Wharton said he supports the expansion of the Jericho Project and other programs, calling it "spending on the front end to prevent greater costs on the back end."

-- Alex Doniach: 529-5231
Scripps Lighthouse

Read more!

Mental Health: A Question Of Priorities - KPCRT-TV Houston

Story Vided here.
By Robert Arnold
May 26, 2008

HOUSTON -- Local 2 investigates a call for help from those working in our mental health care system. Those struggling to provide mental health care look to state legislators for more funding. Local 2 investigative reporter Robert Arnold spoke with a Houston lawmaker who said it is going to take more than money to fix our area's problems.

"I don't think there's a lot of question about what we need," said state Rep. John Zerwas.

Zerwas sits on the House Appropriations Committee. He is also chief medical officer for the Memorial-Hermann System. Zerwas said the debate is not just about what services are needed for the mentally ill.

"The infrastructure and the ability for people to tap into readily available mental health services doesn't exist within Houston, Harris County or surrounding region," said Zerwas.

State budget cuts caused a lack of hospital bed space and scarce funds for long-term outpatient care. This has created a crisis-driven system. Many of those with mental illness cycle in-and-out of acute care hospitals and emergency rooms, or don't get help until they're arrested and thrown in jail.

"Is it the most reasonable, cost effective way to deliver health care services? Absolutely not," said Zerwas.

Zerwas argues simply throwing more money into mental healthcare won't solve all the problems. He says there first has to be an overarching plan.

"Houston in particular really has not developed the network of primary care clinics and access to certain types of health care that other cities across the nation have," said Zerwas.

While those Local 2 Investigates spoke with agree with that statement, they also argue part of the problem is they believe Texas does not put mental illness on the same level as medical illness.

"There really is no comprehensive plan for mental health services in Harris County," said Lois Moore, chief administrator for the University of Texas’ Harris County Psychiatric Center.

"We're not putting the resources in proactively to make an effective difference," said Dr. Steve Schnee, head of the Mental Health Mental Retardation Authority of Harris County.

"We've seen the same phenomenon with cancer, with coronary disease," said Jeff Webster, senior vice president and administrator for the Harris County Hospital District. "People don't have access to primary care and preventative care, then it becomes chronic and it's no different with behavioral health."

Even though Health and Human Services spending accounts for 40 percent of Texas' budget, mental illness is rarely at the forefront.

"I don't know there's a really been a spotlight on it that would help us say this needs to rise to the top of the priorities for the state of Texas," said Zerwas.

Those in the mental health care industry say in the end it's all about choosing where to spend the money.

"We have to decide, 'Are we going to spend it in the jailhouse treating patients with psychiatric illness over there or are we going to take it to medical homes, provide appointments, provide therapy and psychiatry in the medical setting,'" said Dr. Britta Ostermeyer, deputy chief of psychiatry for Ben Taub Hospital.

Trying to curb the number of mentally ill patients showing up in the ER in crisis, the Harris County Hospital District recently added psychiatrists and counselors to all of its community based health centers -- a move which earned the hospital district the American Psychiatric Association's Gold Award.

Last session, legislators did commit an extra $82 million for mental health care in Texas. Those Local 2 spoke with said it's a great start, but when you spread $82 million throughout the state, they say it does not go far enough.

Studies have shown treating mental illness on an on-gong basis has high success rates --schizophrenia 60 percent, depression 40 percent and bipolar disorder 80 percent.

More Information:

*
Mental Health and Mental Retardation Authority of Harris County
Anyone in a psychiatric emergency or in need of information can call 713-970-7000 or 866-970-4770.
* If the person voluntarily seeks treatment, he or she may call or go to the Neuro-Psychiatric Center (MHMRA), located at 1502 Taub Loop, 713-970-7070, or Ben Taub General Hospital (HCHD), located at 1504 Taub Loop, 713-793-2000. Both of these facilities are in the Texas Medical Center.
The University of Texas Harris County Psychiatric Center
* If you or someone you love needs help with mental illness or general counseling, please call our facility for a confidential assessment. We want to help you or assist you in locating the right source. We can be reached at 713-500-8800.
Mental Health America of Greater Houston
If you or someone you know needs help finding information and referral services on mental health or mental illness in the Greater Houston area, we can help. We can be reached at 713-522-5161 or www.mhahouston.org.

Previous Local 2 Investigates Stories:

* May 24, 2008: Local 2 Investigates System In Crisis
* May 23, 2008: Roadmap For Mental Illness Recovery?
* May 22, 2008: Mentally Ill Crowding Jail, Courts
* May 22, 2008: 2 Cries For Help, 2 Tragedies
* May 21, 2008: Local 2 Investigates Mental Health Crisis

If you have a news tip or question for KPRC Local 2 Investigates, drop them an e-mail or call their tipline at (713) 223-TIPS (8477). Read more!

We owe them that much - Wilmington (NC) Star-ews

Editorial: uesday, May 27, 2008 at 8:46 a.m.

As Americans take time today to remember those who gave their lives in service to their country, we must not forget those who are still serving, risking their lives in Iraq and Afghanistan in a war that may continue for years to come. And those who have come home after serving, many of them nursing life-changing injuries, both physical and mental.

These young men and women chose to serve. But when they leave, will their country reward their service by beefing up the sagging GI bill? Or will those veterans return to find that they can't afford the college education they were promised?

After World War II, troops returning home found opportunity waiting. The GI Bill provided an expense-paid free education for many young people who otherwise might not have been able to go to college. Those veterans brought leadership skills and maturity into the college classroom; they left with a knowledge to take into the postwar job market. This "Greatest Generation" helped our country thrive in the years following the war.

Today, that GI Bill pays only about half the cost of a four-year degree. Yet recruiters continue to dangle the education benefits in front of young prospects.

The president opposes efforts in Congress to reinvigorate the GI Bill. The Pentagon fears that troops might actually take advantage of the provision instead of signing on for another tour of duty.

Those are stumbling blocks; they shouldn't prevent Congress and the president from reaching an agreement that's in the best interest of both our country and the young men and women who protect it.

The House and Senate passed bipartisan legislation that would attempt to restore the promise of the GI Bill: a college education. About half the Senate's Republicans voted for this "support the troops" measure.

In effect, it would pay the full cost of attending any public university and would offset some of the cost of attending a private college. President Bush thinks $51 billion is too much to spend on those who have been fighting his war. Sen. John McCain, who is sponsoring a less generous package, didn't take time from his presidential campaign to vote on this one.

The Republican bill backed by McCain, Richard Burr of North Carolina and Lindsey Graham of South Carolina would cost several billion dollars less but would do little to improve veterans' college prospects. It would increase payments and allow veterans who choose a long-term military commitment to pass their benefits to a child or other relative. That provision could encourage retention and defer payment of some of those benefits.

But it would still cover less than 60 percent of the cost of a college education, and benefits wouldn't necessarily increase at the same rate as higher education costs.

Bush has vowed to veto the more generous bill, assuming the House and Senate can agree on a full military appropriations package. House Republicans think they can make the veto stick. In that case, there's certainly room for compromise. But it must be a compromise that fulfills the GI Bill's promise of an education but which also contains incentives to encourage longer service.

Expensive? Yes.

But the president and many other politicians take every public opportunity to pay lip service to the sacrifices these young men and women are making for their country. This isn't a handout. It is well-deserved payment for services rendered.
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Officers talk suicidal juvenile off MU parking garage - Columbia (MO) Tribune

May 26, 2008

A dramatic scene unfolded late Monday morning as local law enforcement officers talked a suicidal juvenile mental health patient out of leaping from the five-story Maryland Avenue parking garage near University Hospital.

Boone County Sheriff’s Department deputies were dispatched at about 11:45 a.m. in response to reports that a juvenile had escaped the Mid-Missouri Mental Health Center, known as Mid-Mo. En route, the deputies learned that Mid-Mo staff had located the patient on top of the Maryland Avenue parking garage on the University of Missouri campus.

The sheriff’s department requested help from the MU and Columbia police departments. The Columbia Fire Department also was called to the scene. All agencies worked to close off access to the garage and the surrounding streets.

An MUPD officer made the initial contact with the juvenile patient, who was sitting on the outer wall of the top level of the parking structure with his feet dangling over the edge, the sheriff’s department said in a news release.

While the officer was negotiating with the patient, the young man stood up on the wall and placed his feet on the edge. The negotiation continued and the officer finally convinced the patient to step down from the wall and on to the parking surface.

The negotiating officer and sheriff’s deputy were then within 15 feet of the juvenile. He moved closer to the two officers as the negotiation went on. When the patient was about 6 feet from the two officers, his attention momentarily shifted to a third officer, allowing the first two officers a chance to rush forward.

The officers secured the juvenile and took him into custody. Officers then transferred the patient back to the Mid-Mo staff.

Read more!

Shifting inmates’ medical bills won’t help taxpayers - Asheville (NC) Citizen-Times

Editorial:

A state House committee wants the North Carolina parole board to release prisoners who are terminally ill or have diseases that make them no longer a threat to public safety.

An estimated 162 people would be eligible for freedom if the measure is enacted and the savings, according to a Department of Corrections official, could reach “hundreds of thousands to millions of dollars.”
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“This is something we can do that will protect the public and protect our state from financial” problems, said Sen. Tony Rand, D-Cumberland, the bill’s primary sponsor.

Okay, so the state is saving money. As for the taxpayers, however, their savings are zilch.

Backers of the plan freely admit the purpose is to shift the costs of those prisoners’ medical care from the Department of Corrections to the federal government or private insurers.

Feds would pay

Very few, if any, prisoners have private health insurance. The cost of their care will be picked up by the federal Medicare and Medicaid programs, mostly Medicaid, or local health agencies.

“Mainly, what we’re trying to do is to get the federal government to pay for this care,” said Rep. Paul Stam, R-Wake.

The federal government is financed by you and me and the rest of the nation’s taxpayers. We’re still footing the bill, just doing so through a different government.

This is one of the many problems with the United States’ fragmented “system” of providing health care: It encourages governments and private industry alike to “save” money by shifting the cost to someone else. The “savings” in President Bush’s plan to reduce Medicaid reimbursements accrue only to the federal budget, not the taxpayers’ wallets.

No real savings

There’s nothing wrong with releasing terminally-ill prisoners or those whose conditions make them no threat to others. Why should we continue to allot prison space to someone who has Alzheimer’s disease or is crippled when people who are dangerous are left free for lack of available cells? But let’s not kid ourselves into thinking there is any cost savings for the taxpayers.

Reform challenges

A convoluted system such as ours creates the opportunity for a lot of people to make a lot of money. That means any attempt to reform it, whether it be a broad-scale plan such as the Clintons attempted in the 1990s or more measured approaches, will run into fierce opposition from people who have a lot of money to spend to protect their interests.

Health care is a highly regulated profession, as it must be. It is difficult to cut costs without reducing levels of care. Duplication of facilities and services means duplication of costs. When we try to curb waste by adding new paperwork, that just takes money away from care, according to Mike Hopping, a psychiatrist who left the state mental-health system early in the disastrous reform movement.

Until the day the people demand a sensible health-care system, regardless of which deep pocket becomes a bit shallower, governments will continue to play a shell game with medical costs. And it’s a shell game taxpayers cannot win, because under each shell is a bill.
Read more!

A lot is riding on prisoner's release, including state's approach to parolees = Sacramento (CA) Bee

By Andy Furillo

First in an occasional series following Ronald Eugene Williams as he returns to the Sacramento region and attempts to stay out of prison.

On Saturday, Ronald Eugene Williams will walk out of San Quentin State Prison and and embark on another uncertain encounter with his own freedom.

If it works out right, he'll get a ride to the foothills of Auburn, check into the drug treatment center the state has arranged for him, stay for six months, get a job and stay out of prison.

If it works out the way it's always worked for Williams over the past 17 years, he'll score some methamphetamine and maybe beat up the mother of two of his daughters – again. Then he'll go back to prison for the 12th time.

He says he has "done some wrong things" and "turned some wrong roads" in a criminal career that stretches back two decades. When he gets out Saturday, he'll have no family to greet him – none of his six children or their five mothers. If it weren't for the treatment program, he'd have nowhere to go.

"In essence," Williams said in an interview, "I'm paroling to nothing."

The outcome of Williams' assignment to liberty bears enormous consequences for the state of California. Every day, 370 people not terribly unlike him get out of prison and return to their communities, their paths blocked by drug addiction and mental infirmity, unemployability and shattered families.

For seven out of 10, the trail leads only to the next lockup, at a cost to taxpayers of billions of dollars a year.

Mark Carey, the immediate past president of the American Probation and Parole Association and an adviser to the state's expert panel on recidivism reduction, said California can't fix its corrections crisis if it can't solve the Ron Williams mystery.

"A lot of these people, they can't rub two quarters together," Carey said. "They're bounced from place to place, and they only know one particular lifestyle. Without a very intensive program and support mechanism, they're just not going to make it."

The scariest part, Carey said, is their numbers.

"California," he said, "has thousands of these people."

Father disputes memories

How Williams' return shakes out is a problem that has vexed California for more than a decade. To get a better view of the perils of a parolee's return to society, The Bee asked Williams if it could tag along with him when he gets out of prison.

He agreed, first sitting down for an hourlong interview at the prison, outside a classroom beyond the exercise yard.

Smiling and friendly, but guarded and cautious in his comments, Williams, 44, reflected on the story of a man whose past foretells a foreboding future.

According to state and local records, over the past 20 years he has been arrested 31 times, charged in 20 separate criminal filings, convicted of nine felonies, returned to prison on 11 parole revocations and sentenced to 18 1/2 years behind bars. He's served 8 1/2 of those years, thanks to good-behavior credits.

Four convictions were for domestic violence. Three were for drugs, one for weapons possession and one for theft, according to his prison rap sheet.

Williams said he has never reflected on his criminality.

"No," he said, "because I really didn't think. I just did. Because I was caught in a cycle of addiction – just use, use, use."

A December 2005 psychological report, based on Williams' account of his upbringing, profiled the history of a military brat, the fourth of five children in a family where he said the parents boozed heavily, dabbled in drugs, fought with each other, beat their children and gambled "a lot."

Frederick Williams, 72, a retired Air Force master sergeant, said his son's recollection of their family life is off the wall.

"Did anybody in the house gamble? Yes," the elder Williams said. "Drink? Yes. But there was no problem problem. I worked every day and retired with high honors, high rank. I've had a sturdy household for 35 or 40 years.

"Ron picked his own problem up," the father added. "Everybody helped him or tried to help. I've spent thousands of dollars trying to keep him afloat. He's the one that failed, and he's failed everybody."

By age 10, Ron Williams had taken up alcohol and pot.

His life already askew, Williams' shaky psyche took a blow when his older brother, Kenneth, raped and murdered a woman in 1980 while burglarizing a house in Roseville. He is serving a 25-years-to-life sentence.

The case generated enough publicity to stigmatize 16-year-old Ron.

"It destroyed my life," he said in the San Quentin interview. "I lost my friends, especially females. I started hanging around with people who didn't care, and people who didn't care were into drugs, into crimes."

In a journal filed in later court papers, Williams wrote that the case turned him into a "living death victim."

Williams dropped out of Foothill High School but did earn his GED. He joined the Air Force but got kicked out for selling stolen property, according to his psychiatric report. Then he was arrested and imprisoned in Texas, where he was stationed, for selling marijuana.

Back in Sacramento, Williams continued to get into trouble. He smoked and dealt cocaine, then traded in the crack for crank, which he sold, snorted and smoked.

He's been in and out of prison ever since.

He gets clean in prison

In each of Williams' domestic violence cases, the victim was a woman named Kristine Kaestner, the mother of two of Williams' daughters.

"When he is not on drugs, Ron is a good person," Kaestner said. "But when he's on drugs, it makes him out to be a monster."

His most recent conviction came for punching Kaestner in the face in 2005. She said he broke her nose.

Paroled in January 2007, he went on a meth run and stopped checking in with his parole agent. He was rearrested last June and sent back to prison.

Bipolar, polysubstance-dependent, antisocial and "narcissistic," according to the psychological report, Williams has always used his prison time to get himself clean.

"It got to be where coming to prison was almost like a relief," Williams said.

He said he hasn't used any drugs since his reincarceration.

"That's the only time I'm clean, when I go to prison," Williams said. "But I get out, and things are overwhelming, so I get high."

In his most recent confinement, Williams completed one 16-week treatment program operated by Full Service Addiction Recovery Services. He also enrolled in the California Re-entry Program, a volunteer-based group that tries to give inmates headed home the social skills necessary to keep them out.

Directors from both organizations gave Williams top marks for his in-custody performance.

"He's very earnest about his recovery," said Full Circle's program chief, Claire-Elizabeth DeSophia.

"He's trying very, very hard," said Allyson West of the re-entry group.

State beefs up parole help

California corrections officials know they must find a way to stop the churn of return offenders to stand a chance of resolving the state's corrections crisis.

As of May 14, the state housed 170,910 inmates, mostly in 33 prisons that are filled to 198 percent of their designed capacity. Another 122,122 offenders were out on parole.

The numbers have driven California prison spending to the $10 billion per-year range.

As far as prison releases go, Williams' scheduled departure from San Quentin comes at almost a perfect time for a parolee sincere about rehabilitation.

Since he went back to prison, the state has embarked on a new approach to parolees, one with heavy emphasis on programs aimed at problems such as drugs and anger management, one that looks to attack the factors that cause an offender to offend.

It has beefed up spending on parole programs to record levels of more than $200 million a year.

More money for residential programs, drug treatment and batterers' classes, followed by assigning parolees to day reporting centers and outpatient care, have greatly expanded the state's arsenal to corral potential parole violators.

It's a bag of tricks that makes Robert Ambroselli, deputy director of the California Department of Corrections and Rehabilitation's parole division, think Williams "absolutely" can turn it around this time.

"The key here is that parole agents have tools that allow them to tailor their supervision to meet the offenders' needs now much more specifically than they ever did in the past," Ambroselli said.

Treatment costs $90 a day

When he gets out Saturday, Williams will head to a 10-bedroom house that sits on the side of an oak-studded hill amid a bucolic community of well-kept creekside homes, just off Highway 49 outside Auburn.

He'll join about six other residents at the faith-based Hope, Help & Healing house, three of whom also are parolees. He's ticketed for a six-month stay at a cost of $90 a day, paid by the state.

It won't be the first time Williams has enrolled in a treatment effort. Two previous tries ended in relapse and returns to custody.

What's different this time?

Williams said he thinks he's "found my bottom," Alcoholics Anonymous phraseology for a life that can't go any lower. He said he's also come to terms with his older brother's crime and wrote him a letter for the first time in 25 years.

"I've come to peace with it," Williams said.

Carey, the Minnesota-based parole expert, said the state's only hope for people such as Williams is to bombard them with every program it's got.

"Drug treatment is a start, but by itself it is not likely to be effective for him," Carey said. "He's going to need a lot of intense treatment and loads of support if he's going to have a chance."
Read more!

Publicist crusades against stigma after a breakdown - Westchester (NY) Journal News

BY HEATHER SALERNO • • May 27, 2008

As the high-powered head of her own public relations firm, Terrie Williams represented some of the world's biggest celebrities: Eddie Murphy, Chris Rock, Sean (Diddy) Combs and Janet Jackson.

Her days and nights were spent spinning from movie premiere to news conference to glittering gala.

But was dying inside.

Every morning, she'd wake up sick with anxiety, trying to summon the strength to get out of bed.

"I would get to an event and be smiling and think, 'You don't know. Two hours ago, I was on the floor and had no idea how I was going to get here.' "

For 30 years, Williams lived a secret life of overwhelming sadness. In 2004, at age 50, she had a breakdown, and for the first time was diagnosed with clinical depression.

She realized she had a mission: to smash the silence surrounding depression and help others heal.

Though every race and ethnicity grapples with the stigma of depression, Williams says it's more prevalent among African Americans, who are less likely than whites to get professional help.

"It's taboo in our community," she says. "We'd rather tell someone we have a relative in jail or on drugs than to say (they're) dealing with a mental illness."

Williams addresses the issue in a new book, "Black Pain: It Just Looks Like We're Not Hurting" (Scribner, $25), in which she calls the problem an epidemic. She's also part of Healing Starts with Us, a grass-roots campaign intended to raise awareness of depression.

As part of the national campaign, Williams is expected to visit churches, hospitals, police precincts and schools in 50 cities during the next two years.

Each stop will feature dramatic readings from Williams' book, which includes powerful testimonials from well-known personalities like supermodel Beverly Johnson, actor Blair Underwood (whose mother was diagnosed with depression) and boxer Mike Tyson.

"Black Pain" also details the cultural reasons why many African Americans refuse to acknowledge depression and seek treatment.

Williams says that black people have a history of not talking about their feelings, rooted in the struggle to survive the horrors of slavery and racism.

"We could be raped and tortured without receiving any help, our children could be sold away from us, our loved ones murdered without repercussion -- we had no choice but to play it close to the vest," she writes.

Notorious episodes like the Tuskegee experiment, during which 400 black men with syphilis were left untreated for 40 years so the government could study the disease, also contributes to a deep-seated distrust of the medical system.

Religion, too, plays a part.

Williams says that because church is such an important part of the black community, "sometimes, for many, to do anything other than to pray to God for help is a betrayal."

That outlook was understandable once upon a time, she says. Now, Williams believes, African Americans can no longer afford to keep quiet.

She argues that depression is at the bottom of widespread societal problems, like crime, gang violence and drug and alcohol addiction. According to the National Alliance on Mental Illness, the suicide rate among African Americans from age 10 to 14 increased 233% over a 15-year span, compared to 120% for whites in the same age group.

"It's in the violence, it's in the aggression, that we show how we're feeling," she says. "And it's killing us."
Read more!

This doc sees everyone -Anchorage Daily New

By GEORGE BRYSON
gbryson@adn.com
(05/26/08)

It was the typical mixed bag of patients. A few with chronic back pain. An older man with advanced-stage liver disease. Three patients with HIV. A few more with crippling mental health disorders complicated by histories of drug abuse and attempted suicide.

Typical, that is, if you happen to work at the Anchorage Neighborhood Health Center, where a small staff of eight physicians frequently treats men, women and children who other doctors in town refuse to see.

Only this time they weren't getting examined privately in a small room. All were being treated together as part of the center's weekly Drop-In Medical Group Appointment, also known as DIGMA -- a two-year-old experiment in low-cost alternative health care.

Offering medical advice to patients who assemble in groups is nothing new. The ANHC and other clinics nationwide have long provided disease-specific support groups for diabetes sufferers, as well as pre-natal counseling in a class setting for women.

But the DIGMA idea, in which patients who suffer a wide range of maladies gather together in a conference room for treatment and discussion, is offered nowhere else in Alaska -- and far less frequently anywhere else in the U.S., according to Dr. Thomas Hunt, the center's medical director.

"I think many clinicians look at this and say this is really pretty absurd," Hunt said. "You've got a room full of 14 people -- all of whom are medically hyper-complex -- and it's noisy and it doesn't seem, on the surface, as respectful or organized as a standard medical visit."

Nor is it all that profitable for the health center, Hunt said.

Homeless people pay the clinic nothing. Low-income Alaskans pay a sliding-scale fee that begins at $15 for those who live below the federal poverty level. Middle income patients pay the standard $80-$160 fee, depending on type of treatment. And those on Medicare end up costing the clinic money.

But the kind of treatment the patients receive in the sessions -- which combine medical care with psychological care -- is probably more therapeutic than a conventional doctor's visit, Hunt said.

"All these folks are at great risk of dying in the next few years," he said. "And this is the sort of support they need that's way more important, in many ways, than all the medicines I can give them."

THE GROUP

Not anyone can attend. Participants are invited to the DIGMA sessions from Hunt's roster of patients. Each signs a confidentiality agreement to get around federal patient privacy rules. About half of those who show up on any given Tuesday morning simply drop in unannounced, while about half call ahead to ensure there's room.

Each meeting includes a check of vital signs by a nurse in one corner, followed by a consultation with Hunt, who might prescribe various treatments and medications, in another. Meanwhile, those awaiting their turns sit in a circle in the center, where behavioral specialist Ebony McClain-Owens leads a group discussion.

"In many ways they come for me, but they stay for her," Hunt said after a recent session, noting McClain-Owens' skill at getting patients to share stories about how they cope with pain and their own personal challenges.

The April 22 session was a case in point, even while the discussion then veered away from ordinary ailments toward addictions, beginning with 26-year-old Ann McIntosh, who along with four other patients in the room, agreed to be named.

Depression is the root of her problem, McIntosh told the others. At 12 she was diagnosed with a bipolar disorder. But the physical injuries she suffered during a stint in the U.S. Army a few years ago left her feeling even more depressed -- and ultimately addicted to heroin.

"Sometimes I wanted to die, and heroin seemed like the logical way to die," McIntosh said.

By comparison, the story told next by 21-year-old Jamie Lemke -- a newcomer to the sessions -- sounded tame and manageable. At least on the surface.

Manicured and neatly dressed in a maroon sweater and skirt suitable for a job interview, Lemke told the others that she'd grown addicted to heroin too. But a month ago, she dug herself out with the help of Suboxone, a heroin detox drug, and by separating herself from people who use. Sometimes you have to hit rock-bottom before you realize that you need to change your life, McClain-Owens told the group.

She wasn't sure she'd sunk that low, Lemke said.

Well, the lower limit is always relative, McClain-Owens said. "I know families that are living in their car. To them that's not rock-bottom yet. Now losing their car -- that would be rock-bottom."

BOTTOM LINE

There are times when the Anchorage Neighborhood Health Center struggles to survive, too.

The ANHC receives about $3 million a year in federal funding and other grants to cover its $11 million annual budget. But the rest has to come from patient fees. And accepting patients who can't afford to pay in full doesn't help cover the clinic's costs -- and can't continue indefinitely, according to Hunt.

"It's our mission," he said, "but it's not our business model."

Against that backdrop, the center has been trying to cut its expenses. Earlier this year, its board of directors decided to close its Mountain View facility and consolidate all services -- which include prenatal care, dentistry, chronic disease management and 24-hour, on-call primary care -- at its central clinic in Fairview, located at 1217 E. 10th Ave.

Looking for more efficiencies, such as the DIGMA group-doctoring model, might help too, though it's only marginally more cost-effective, Hunt said. The dozen or so patients he sees during a two-hour DIGMA session isn't a whole lot more than the 10 patients he would otherwise see in a typical morning.

The real reason to do it is the quality of care, Hunt said. That and the feedback the staff receives that indicates the patients seem to love it.

Dr. Jean Antonucci, a family-care practitioner in Farmington, Maine -- who recently wrote an article for the American Academy of Family Physicians on treating patients with a variety of illnesses in a group setting -- says the response from her own patients has been "overwhelmingly positive."

They meet as a set-class, rather than the drop-in model used in Anchorage.

"They're my neediest patients, no matter what they have wrong with them," Antonucci said.

She picked them because they lack self-confidence and assertiveness and problem-solving skills -- what she calls "global principles" for health care.

"That's the thing that patients can't get a handle on," Antonucci said. "That's why they can't manage their health problems."

Simply meeting in a group might help too, Hunt said.

"For everyone to recognize everyone else's humanity is very therapeutic," he said. "To recognize a 'little bit of me in them' and 'a little bit of them in me' is humbling and enriching at the same time.

"I love to watch that." Read more!

Broward County may cut $18 million in social services to provide tax relief - South Florida Sun-Sentinel

By Scott Wyman
May 26, 2008

Proposed cuts in social services Mothers soon may not be able to turn to Broward County government for help collecting child support from fathers, and day care centers might no longer be licensed locally.

Those are among cuts that county commissioners are considering to provide $100 million in property tax relief next year.

Programs that help the homeless, mentally ill and disadvantaged could be slashed as much as $18.1 million by the time spending plans are to be approved in September. Some of the cuts being considered:

Child support enforcement The county has decided to end its program that helps mothers collect child support payments and has stopped accepting new clients. The county hopes the state Department of Revenue and private attorneys will provide the assistance. Savings: $1.3 million

Medication for addiction recovery The county supplies 90 days of medicine to people going through its addiction recovery program but is considering cutting that to no more than 30 days. A month's supply is the national standard for recovery centers. If deeper cuts are needed, the medication could be cut to 21 days' worth. Savings: $250,000 to $269,000.

Help for domestic violence victims Help for victims would be reduced or eliminated. Victims could turn to the state for help. Savings: $238,000 to $536,000. Day care center licensing The county would stop licensing the centers and leave it to the state to take over the task. State safety standards are less restrictive. Savings: $735,000.

Assistance to homeless The county would trim its support for transitional housing by 10 percent. Savings: $363,000. Child visitation The OUR House Visitation program would be eliminated. The program gives children supervised weekly visits with estranged parents in a home-like environment. Families with issues such as domestic violence and substance abuse are referred to the program. Savings: $108,000.

Care for mentally ill The county's crisis-stabilization unit that provides 19 beds to the indigent with severe mental illness would be closed. People would be directed to hospital emergency rooms. Savings: $1.2 million. Read more!

Counseling center's goal: Arm the saints -Greensboro (NC) News-Record

By Jennifer Atkins Brown
Sunday, May 25, 2008

Pastor of a United Methodist and Presbyterian church in a small community in Virginia, Kelly Giese had been looking for a pastoral group that could serve as a sounding board -- a place to deal with the pressures that go along with leading a church.

When she heard about a new program being offered through the Chrysalis Counseling Center in Greensboro, she knew she'd found what she was looking for. Supported by the Greensboro-High Point-Lexington Districts of the Western North Carolina Conference of the United Methodist Church, the Chrysalis Center offers psychotherapy and consulting services to individuals, families and churches. Formerly the Methodist Counseling Center, the center changed its name to the Chrysalis Center with a goal of being more ecumenical and reaching out to other denominations.

In May, the center started a Pastoral Care Consultation Group. The group is open to pastors of all denominations and meets monthly for four hours at a time to reflect, encourage and learn from common experiences.

Giese was part of the inaugural group of pastors who participated.

"I'm really hoping it's a place where we can share the good and the difficulties and be honest about where the rough spots are," she said.

In addition to helping in the care and feeding of congregations, the Pastoral Care Group may also lead to certification as a pastoral care specialist.

"We're finding that a lot of ministers didn't get adequate training in how to meet people where they are and how to meet critical needs," said Gary Kling, director of the Chrysalis Counseling Center and one of the group's facilitators.

Previously a Methodist minister for 28 years, Kling knows the stress that goes along with being a pastor, and in his work with the Chrysalis Center he's seen the need to better equip pastors to deal with mental health and other issues that affect church members.

"People are now coming to church with issues, seeking more services, and mental health needs are a part of that demand," Kling said. "This group provides a meeting place and through pastoral care and counseling education, a teaching center to help them meet those needs."

Several subjects may be covered in the group, including understanding treatment of addictions; marriage and family issues; care and counseling in grief and loss; and dealing with conflict and crisis intervention.

"A lot of ministers are so overwhelmed by work, they see this as not all that important," Kling said. "I'm trying to emphasize this is a life saver, ministry saver and church grower."

Giese is excited about how her participation will hopefully help her be a better pastor.

"I suspect relying on the strength of others rather than going it all alone is a good thing," she said. "I look forward to sharing ideas of what has helped and what to avoid."

The cost of attending the group is $100 per four-hour session.

"We welcome contributions by individuals, churches or organizations that would like to offset the cost or would like to provide this for their pastor," Kling said. "When you have a church that extends care through every aspect, you'll have people talking about their church being a caring, loving community."

Kling said one of the center's main goals for 2008 is to provide a Samaritan Scholarship Fund for those who cannot afford counseling.

Kling said he would love to see the new Pastoral Care Group attract pastors from across the Southeast.

"I'd love for this Triad area to be a beacon for ministers needing to recharge, renew and remission their ministries," he said. "My hope is that we're arming the saints and providing churches with a way they can be more loving, be disciples and be less frightened by people who have problems."

For more information about the Chrysalis Counseling Center or the new Pastoral Care Consultation Group, call 852-0626. The center is at 612 Pasteur Drive, Suite 405, Greensboro.

Contact Jennifer Atkins Brown at 574-5582 or jennifer.brown@news-record.com.

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Community Support Services viable, needed -Charlotte Observer

IN MY OPINION | CYNTHIA HOUSER

Caregivers provide valuable assistance

Much has been said about "wasted money" and "glorified baby sitting services" in regard to the Community Support Services, a new service born out of Mental Health Reform.

I have a family member who received these services and our experience was completely different. During the time she has been receiving services from Catawba Valley Behavioral Health Care, she has made strides emotionally, physically and socially that would not have been possible without theses services.

She was taken to the YMCA for water aerobics twice weekly and was taught about nutrition. Currently my daughter reads food labels and makes informed decisions by comparing sugars, fats, and carbohydrates. This education in nutrition with the combination of exercise has resulted in the loss of 48 pounds for my daughter.

If the state does not implement a maintenance piece, my daughter and other clients who have made progress will regress. With the new Community Support Services, a client may easily lose service hours by making too much progress or too little. It's a "Catch 22" situation; there is no way a client can keep their hours.

Social outings are viewed by the state as unnecessary and are mostly nonexistent for clients.

My opinion is that clients cannot become more integrated with their communities if they do not have access to their communities through social interactions. Individuals who are disabled and spend too much time alone become more focused on their disability, more withdrawn and lose self confidence.

Mental Health Services of Catawba County has, and still strives to be, a model LME (Local Management Entity). Recently, in the Mercer Report, Mental Health Services of Catawba County was rated as a tier one (above average) LME.

The state mandated that LMEs merge. This resulted in further depersonalization of service to clients. Raleigh is pushing for more mergers. LMEs in the mountains may have to merge with LMEs in Raleigh, an absurd proposal that benefits the state government at the cost of the clients.

Gov. Mike Easley tried to implement a reform model that had failed in one state and was failing in another. There should have been pilot counties where this model could have been tried to make sure it was feasible.

Community Support Services were and still are a viable and needed service for clients. If providers have their clients best interest at heart, these service will be implemented in a way that is cost effective and a benefit to the clients.

In my opinion | Cynthia Houser
Cynthia Houser lives in Newton and has been an advocate for people with disabilities for the last 18 years. Read more!

Scientists test brain pacemakers for depression - Associated Press

By Associated Press

WASHINGTON (AP) - It's a new frontier for psychiatric illness: Brain pacemakers that promise to act as antidepressants by changing how patients' nerve circuitry fires.

Scientists already know the power of these devices to block the tremors of Parkinson's disease and related illnesses; more than 40,000 such patients worldwide have the implants.

But psychiatric illnesses are much more complex and the new experiments with so-called deep brain stimulation, or DBS, are in their infancy. Only a few dozen patients with severe depression or obsessive-compulsive disorder so far have been treated in closely monitored studies.

Still, the early results are promising. Dramatic video shows one patient visibly brightening as doctors turn on her brain pacemaker and she says in surprise: "I'm starting to smile." And new reports this month show that some worst-case patients - whose depression wasn't relieved by medication, psychotherapy, even controversial shock treatment - are finding lasting relief.

Six of 17 severely depressed patients were in remission a year after undergoing DBS and four more markedly improved, and more than half of 26 obsessive-compulsive patients showed substantial improvement over three years, say studies from a team at the Cleveland Clinic, Brown University, and Belgium's University of Leuven.

"Not all patients get better, but when patients respond, it's significant," says Dr. Helen Mayberg of Emory University, who has implanted about 50 depression patients. Her first remains in remission after five years; she estimates that four of every six show enough improvement to be classified "responders."

"We're rewiring the brain in many ways," says Dr. Ali Rezai, chief of the Cleveland Clinic's Center for Neurologic Restoration.

There's a need for innovative therapies. Up to 20 percent of depression patients and 10 percent of those with obsessive-compulsive disorder are treatment-resistent - several million people in the U.S. alone.

The rationale behind DBS is credible, says Dr. Wayne Goodman of the National Institute for Mental Health: Surgery sometimes helps worst-case patients by destroying misfiring patches of brain tissue. The electrodes are placed into similar spots, but don't destroy tissue - the electrical signals can be adjusted and turned off.

But it's not yet ready for prime-time, Goodman cautions. He worries that because the electrodes already are widely available, centers without proper training will start offering the $40,000 implant surgeries to psychiatric patients before science proves if they're really valuable.

"It is an invasive, experimental procedure," he warns, with risks including bleeding in the brain and infections. He calls DBS "the last resort for stringently selected patients."

Earlier this month, federal health officials and the Cleveland Clinic brought together the field's leading researchers to highlight progress so far and debate if it's time for much larger studies - even whether DBS might be tweaked to help people with traumatic brain injuries, such as Iraq war veterans.

"There's not enough awareness of what the potential is of this kind of stimulation," says meeting co-chair Dr. Margaret Giannini, who heads the government's Office on Disability.

In deep brain stimulation for Parkinson's, a wire is implanted within a walnut-sized area known as the thalamus, a hub of sensory information. That electrode is connected by a cable running through the neck to a pulse generated under the collarbone. Tiny electrical zaps disable overactive nerve cells, blocking tremors.

Scientists don't have nearly as much understanding of what goes awry to cause depression or other psychiatric illnesses - but they do know the thalamus isn't the right spot for those patients. They're focusing instead on two regions with names only a neurologist could love - the ventral capsule/ventral striatum and so-called Brodmann Area 25. Ignore the names; the point is that these are regions where brain circuitry involved in mood and anxiety intersect.

It's not yet clear who should have DBS in which spot, or if there are still other target areas. Much of the research to date has been funded by electrode manufacturers, with some paid for by the government - and consists of measuring patients' disability before and after DBS, not more rigorous studies that randomly assign patients to treatment.

Still, Diane Hire of Cleveland, the patient whose first smile was recorded, illustrates the hope.

The 12-year Navy veteran was medically discharged for depression and spent a decade on disability, unable to function. "I basically felt like a dead person walking. I had no feelings, no emotions," she told the scientists' meeting.

Her DBS was switched on in January 2007, and "my whole world changed," says Hire, 54. She's not back to work yet: "It is a real challenge to learn how to live as a healthy person again," she adds, saying she doesn't handle stress or multitasking well. But, "I wake up every day looking forward to what's ahead." Read more!

Giving those with mental illnesses a chance at a normal life - Tri-City (CA) Herald

By Michelle Dupler, Herald staff writer

The thing that stands out most when Charlie Mc Cary and Darrin Ceriale talk about their jobs is how much they enjoy being taxpayers.

While other people grumble about how much of their paycheck goes to the government, it gives those who battle long-term mental illnesses a sense of normalcy to contribute to programs like Medicare and Social Security, instead of being recipients.

"People don't realize that mentally ill people want to be taxpayers," Mc Cary said. "We don't want mental illness."

The Kennewick woman has fought a 10-year struggle with bipolar disorder, general depression, anxiety and attention deficit hyperactivity disorder. Ceriale is schizophrenic.

But both are recovering and stable, and returned to work through programs offered by Lourdes Wilson House.

Wilson House is a clubhouse for people with long-term mental illnesses, such as schizophrenia, bipolar disorder or major depression. It gives them a place to socialize and learn life and job skills that will help them lead stable and fulfilling lives.

Sometimes that involves learning how to write a rsum or practicing job interview skills, like Ceriale did before landing his janitorial job at the federal building in Richland.

But it also can mean putting people to work.

People placed into what the clubhouse calls transitional employment work for Wilson House, which sends them to a job assignment in the community for six to nine months.

Linelle Summers, the clubhouse's employment services representative, beats the pavement, convincing businesses to give clubhouse members a chance at a job.

When they agree, Summers or another job coach accompanies the employee to work for two weeks of training, then turns them loose to do the job.

There are weekly checkups, so the job coach can see if the employee or the business has any problems. Wilson House also guarantees a replacement if the employee takes a sick day or doesn't work out.

"There's never any downtime," Summers said.

Often, transitional employment becomes permanent, like it did for Ceriale when he worked at The Market in Pasco before it became a Save-A-Lot store.

He worked in the store for more than five years, getting more and more responsibility over time, until he was asked to train another employee who came from Columbia Industries, he said.

When The Market closed in late 2006, he had to look for another job, which meant brushing up on his job search and interviewing skills.

The Kennewick man naturally is shy, and ran into obstacles when his job interviews didn't follow the scripts he had read in books. So he learned to be more flexible when he answered questions. He finally started a new transitional employment assignment at the federal building a couple of weeks ago.

He likes the structure of his new job, where he gets a list each day of what he needs to do and when.

And he's excited to be giving something back by paying taxes.

Summers said each employer is aware the person coming from Wilson House has some form of disability, although it's up to each individual employee whether to disclose what that is.

"The illness isn't the ability to do the job," Summers said. "We're not asking any employer who hires someone to do anything but make an accommodation, to work with a person with a disability, to be productive. The person has the power, the ability and the desire to do the job."

For Mc Cary, the desire to work is coupled with the desire to help other people like her. She just passed a test administered by the state that will allow her to become a peer counselor. In the meantime, she started part-time transitional employment at Lourdes Counseling Center in Pasco, setting appointments and making reminder calls.

She credits Wilson House with helping her get back on her feet once she started her recovery from mental illness.

"Wilson House was a fantastic opportunity for me to get acclimated to being able to choose what I want to do, and work in the areas I like to do," Mc Cary said.

She'd like to see more businesses give people with mental illnesses a chance to prove that they can be good employees. She recalled times that she was fired when her employers found out she had mental illnesses.

"Mental illness is a stigma that needs to be changed," she said. "We can recover and we do recover."

w For more information about how to hire employees through Wilson House, call Summers at 545-3390.
Read more!

Challenging stereotypes - Honolulu Advertiser

By Sue Kiyabu
May 25, 2008

Susan's thin braid of black hair falls over one eye. Her face, fixed in black and white, allows us to stare back, to examine the round shape of her eyes, her broad nose and the wayward gray hair that sprouts from the top of her hairline.


The image is striking in its detail, but it's her voice that captivates.

Articulate and without self-pity, she speaks about her struggle with obsessive-compulsive disorder. She shares her need to check her front door lock 50 or 60 times a day, and her ability to listen to a song for 15 hours straight — putting on headphones to hide her illness from neighbors. She says with wisdom and conviction, "There is no such thing as normal."

Jaime also stares straight ahead, seemingly confrontational and impatient, except she has a pain in her eyes that's hard to ignore.

Wearing loud, flowered tights, Jaime's looming pregnant belly is semi-exposed and a lace bra peeks out behind a silky wrap. This is not a celebrity portrait of motherhood.

On an accompanying audio recording, Jaime talks in a clipped British accent about her debutante ball at age 16, skiing in Switzerland, living at The Ritz-Carlton and embassies in France and Italy. Back then, she says, she was full of hope. Now she is homeless and pregnant, a Desert Storm veteran suffering from chronic pain, post-traumatic stress disorder and panic attacks. She says, "Mental illness discriminates no one."

Jaime and Susan are among 55 individuals featured in photographer Michael Nye's traveling interactive exhibit, "Fine Line: Mental Health/Mental Illness," which aims to challenge stereotypes and preconceptions about mental illness. His large-format, black-and-white portraits are combined with audio, allowing the subjects the power of their own words. Some stories are tragic, some hopeful. Each subject struggles with various mental health issues, such as schizophrenia, bipolar disorder, depression or anxiety. The exhibit has traveled to more than 30 cities in the United States.

Nye says, "Stories take us inside complicated issues, where you can find empathy for someone's life. I wanted stories to be in context of someone's larger life. Not just about mental health — but if they are a musician or a teacher, or a philosopher or someone who was a homeless person, that their story about mental health is also the larger story of their life and what they do and what they believe in."

According to Mental Health Kokua, a statewide organization dedicated to assisting Hawai'i's mentally ill and sponsor of the exhibit: roughly 25 percent of Hawai'i residents age 65 and older suffer from some type of mental illness; more than 85,000 people statewide suffer from depression; and in recent years Hawai'i had one of the highest rates in the country for teens reporting suicidal thoughts or suicide attempts.

"Everyone knows someone who is affected by mental illness," Nye says. "It's such a relevant issue right now. ... We talk about our physical health and our diets and what we eat, but we rarely talk about mental health and it's so important. The name of the exhibit is "Fine Line," and it represents the fragility between mental health and mental illness."

The idea for the exhibit surfaced about six years ago when Nye's friend Kerrie Crouch committed suicide. A former architecture student at the University of Texas at Austin, an athlete, a poet, painter and naturalist, Crouch was a multitalented individual who built a house by himself at age 19. At 21, he was diagnosed with schizophrenia. For the next 30 years he struggled.

"Knowing Kerrie and learning about schizophrenia, the amount of courage it takes, the stamina, made me want to learn more," says Nye, in his soft, Texas accent. "Sometimes, you just want to hold on to someone else's story."

Nye, a former lawyer, did some research. He learned about brain chemistry and neuroscience. He traveled the country, visiting a diversity of support groups and asking for volunteers for his project. The response was overwhelming. He photographed and interviewed each person included in "Fine Line" over a period of five days, usually ending up with about four hours of tape. From there, he edited their stories to about five minutes. Each person had final approval of the finished piece.

"I found myself being inspired over and over at the resilience and strategies," Nye says. "What we have in common, not so much the differences we have. The illness doesn't define someone — they want to be useful and helpful and they want their life to count for something. I think we all strive for that in our lives."

Sue Kiyabu is a freelance writer living in Honolulu. Read more!

Combat leads to brain injuries in one-fifth of veterans - Knight-Ridder

May 25, 2008

SAN FRANCISCO -- Among the legacies of combat for up to 20 percent of veterans are brain injuries that can impair basic functions for months, years or decades, according to numerous medical experts who spoke at a recent conference here on combat-related brain injuries.

While clinicians currently work with a sparse arsenal for treating these largely invisible injuries, the speakers also attested to the Bay Area's role as a hotbed of research and innovative treatments for combat-related neurological trauma.

"(The Bay Area) is one of the leading centers for treatment and research of neurological conditions associated with warfare," said Steve Tokar, spokesman for a nonprofit organization that administers health research at the San Francisco Veteran's Affairs Medical Center.

The nonprofit also organized the recent conference, titled "The Brain At War."

During the day-long event, more than a dozen experts in neurology, psychiatry and brain imaging described to an audience of nearly 100 scientists and journalists nascent efforts to develop effective treatments for brain traumas sustained by combat veterans in Iraq and Afghanistan.

Studying brain injuries is a new front line of medical research, they stressed, and the field is still only in its infancy. The researchers acknowledged the current limited treatment options, and the challenge of even diagnosing the conditions, while also presenting data on the most promising

avenues of research.

"The brain is by far the most complex organ," said Dr. Michael Weiner, director of the Center for Imaging of Neurodegenerative Diseases at the San Francisco VA.

"The complexity of the heart and lung are trivial by comparison," he continued.

"The heart is a pump and the lungs are a bellows. But the brain is an incredibly complex computer. So we don't even fathom the mechanisms of these disorders."

Weiner described to the group, however, data from brain scans showing tantalizing hints of change in the brain structure with post-traumatic stress disorder and traumatic brain injuries.

"We're excited that this is going to give us a better way to engage in diagnostic testing," he said, although Weiner emphasized that the data is still preliminary and not available for clinical use. The holy grail of research in this area is finding physical evidence of the conditions, such as a blood marker, instead of reliance on self-reporting of behavioral changes.

Those with post-traumatic stress disorders, usually called PTSD, and traumatic brain injuries, or TBI, share many of the same symptoms, including a change in behavior or personality, confusion, agitation, trouble with memory and concentration, difficulty sleeping and decreased coordination.

"It's a hard question as to who's TBI or PTSD," said Dr. Anthony Chen, a neurologist at the San Francisco VA who spoke at the event. "That's one of the biggest scientific and medical questions."

Chen is also co-director of the tentatively named Center for Neurohealth Treatment and Research, a 12,000-square-foot facility scheduled to open in 2010 at the Martinez Veteran's Affairs Medical Center.

The center, formed by a consortium of researchers and clinicians at the San Francisco and Martinez VA medical centers, and the University of California, Berkeley and UCSF, will offer cutting-edge care and research.

But the two types of brain trauma are caused by distinctly different factors, the researchers said. TBI occurs when the head violently hits an object, or vice versa, or by a head wound that pierces the skull.

PTSD arises from life-threatening experiences invoking feelings of intense fear or horror.

Roughly one in five veterans serving in combat zones develop some degree of PTSD, according to Dr. Charles Marmar, chief of mental health services at the San Francisco VA, who spoke at the conference.

And those numbers have held steady for armed conflicts throughout history, he said, from the Vietnam war and World War II to the Aegean war more than 2,000 years ago.

"War is war, and sustained combat takes a toll," Marmar said.

Marmar described how cognitive behavioral therapy -- the best treatment yet for PTSD, he said -- was found during a clinical trial to be even more effective when used with a decades-old tuberculosis drug that fell into disuse.

The drug, D-cycloserine, accelerated the rate at which the fears and phobias associated with PTSD were "extinguished," Marmar said.

With cognitive behavioral therapy, therapists assist patients in reliving the traumatic experience in a safe environment where they'll come to no harm. With repetition, the painful experience often loses its grip.

"The combat memory has been fast frozen," Marmar explained. "We take it out of the memory and process it with less fear."

He said that anti-depressants also relieve symptoms, and Marmar said he and his staff are using aerobic exercise and yoga as treatments. All three show evidence of literally building up brain cells, he said, which harnesses the brain's power to heal itself.

Another researcher, Dr. Scott Panter, with the San Francisco VA's Neurology Services, described to the group animal studies on a form of nasal spray that could be used in the battlefield to ameliorate brain trauma by bolstering protective neuronal circuitry.

This preventive approach to brain injuries also points to a "key research gap," said Col. Karl E. Friedl, Ph.D., director of the Telemedicine and Advanced Research Technology Center at Fort Detrick in Maryland, who was a speaker at the event.

"We spend most of our time on injuries after the fact," Friedl said.

"We could have a huge impact with a pretty good return on investment by preventing injuries."

Reach staff writer Suzanne Bohan at sbohan@bayareanewsgroup.com or 650-348-4324.

Read more!

Local mental health group teaching doctors to spot PTSD in veterans - Wilmington (NC) Star-News

By Vicky Eckenrode
May 25, 2008

When Dan Hickman left Iraq, there were stark differences from when he came home from Vietnam decades earlier.

There were no critical debriefings like today. No references for counseling services.

"When you came back from Vietnam, nobody asked you how you were," said Hickman, who in Iraq commanded the 30th Heavy Separate Brigade, North Carolina Army National Guard's largest brigade. "It wasn't a topic of conversation. Nobody even heard of PTSD (post traumatic stress disorder)."

Hickman, whose civilian job is executive vice president of Cape Fear Community College, said the culture was one that sidestepped discussions about mental health and the stress of returning from combat.

"I call it the John Wayne generation, you just sucked it up and moved on," he said. "Your only refuge was your buddies and for some alcohol and things like that."

Despite the changes, Hickman said more can be done to help soldiers who serve in Iraq, particularly for so-called citizen soldiers who aren't returning to careers on military bases, but are instead thrown back into their civilian jobs and communities.

For some, the transition is jolting.

PTSD training

Mental health educators at Wilmington's SEAHEC, South East Area Health Education Center, recognized more ways to receive help was needed.

The nonprofit, which focuses on training health care professionals in the region, began working on a project in 2006 to teach more people about picking up on the signs of PTSD in their patients.

The group soon paired with officials at a Defense Department-funded pilot program in Chapel Hill where the federal government is looking for ways local community agencies can be used to help citizen soldiers and their families nationally.

The multi-million-dollar national demonstration project is based at the University of North Carolina.

"One of their missions is education and training primary care physicians and mental health providers," said Sheryl Pacelli, director of mental health education at SEAHEC.

As a result, the state's nine AHEC offices are in the middle of holding seminars for doctors on the subject. All nine across the state are scheduled to be covered by June. The one in Wilmington earlier this year drew about 100 participants.

The idea is to get physicians and mental health providers, particularly those with little experience with patients who have served in the military, to understand more about the military culture, the reluctance of some veterans to discuss issues and the Veterans Affairs Department's clinical guidelines for treating PTSD.

Pacelli said that the majority of those returning are able to make the transition within 18 to 20 months, but that others will continue to be affected in their daily lives by the experience.

She said the hope is that family doctors will be more familiar with the signs so that if their patients come in with other physical complaints, they can better tell whether there are stress-related symptoms and have an idea of what resources to refer them to.

She said the pilot training program developed in Wilmington has been used around the state and could be part of a national rollout.

Nationwide issue

Mental health treatment among the citizen as well as active duty soldiers has been a high-profile issue nationally.

Earlier this month, the Pentagon changed a policy so soldiers no longer have to disclose whether they have received mental health treatment for PTSD as part of their applying for security clearance.

And Congress is debating a bill to improve treatment for service members and veterans with mental injuries, while lack of access to help and coverage continues to be an ongoing criticism.

Access for guardsmen and reservists can be particularly difficult in rural parts of North Carolina far from VA medical facilities and Vet Centers in the state, Peter Leousis, principal investigator for the Citizen Solider demonstration program, testified to a U.S. House subcommittee in February.

Leousis, deputy director of UNC's Odum Institute for Research in Social Science where the program is based, said more than 10,000 guardsmen and reservists in North Carolina have returned from Iraq.

He also pointed to a 2007 study published in the Journal of the American Medical Association showing that clinicians identified 20 percent of the active duty and 42 percent of reserve component soldiers returning from Iraq as needing mental health treatment.

A heavily circulated study from RAND Corp. in April stated that one in five Iraq and Afghanistan veterans, or 300,000, have reported PTSD or major depression symptoms, but only a little more than half have sought treatment.

After the initial phase of PTSD training wraps up, the SEAHEC program organizers will start planning the next round on traumatic brain injury, which has stemmed a wave of rehabilitative services and care because of war-related wounds.

Hickman, who has spoken at training seminars for North Carolina's citizen soldier program, said the goal is to make it an ongoing program. He said there is early discussion about setting up a clinic in the Asheville area to make access easier for guardsmen and reservists there.

"Soldiers can develop defense mechanisms when they're there," he said. "The trick is to get out of that when you get home. You have to unload those stresses."

Vicky Eckenrode: 343-2339

vicky.eckenrode@starnewsonline.com
Read more!

ADHD can cost adults 20 or more workdays a year - Associated Press

By RANDOLPH E. SCHMID
05/25/08

WASHINGTON -- When "Fidgety Philip" grows up, the problems of attention deficit disorder can multiply into loss of nearly a month's work per year.

Long seen as a problem for children, attention deficit hyperactivity disorder was first described in 1845 by Dr. Heinrich Hoffman, who wrote "The Story of Fidgety Philip."

More recently, it has been recognized as continuing into adulthood for some people, and new research seeks to estimate the effect of ADHD on workers.

This lack of ability to concentrate costs the average adult sufferer 22.1 days of "role performance," per year, including 8.7 extra days absent, according to researchers led by Dr. Ron de Graaf of the Netherlands Institute of Mental Health and Addiction.

It might be cost-effective for employers to screen workers for ADHD and provide treatment, the researchers suggest.

"There were many more people than most of us who have done these studies had expected," that were affected by adult ADHD, said Dr. Ronald C. Kessler of Harvard University, a co-author of the report. "People don't come for treatment for this ... it's kind of one of those hidden things," he said in a telephone interview.

"It's an enormous impairment," Kessler said, citing absences, accidents and low performance on the job.

Kessler said he had worked with workers suffering depression and found that treatment costing $1,000 could help prevent $4,000 in lost productivity.

"It sure looks like the effect would be as big, if not bigger, for ADHD," he said. "We're looking around for an employer or two who might be willing to give this a try."

Linda S. Anderson, president of the Adult Attention Deficit Disorder Association, said workplace assistance and treatment can be vital,

Most people think of ADHD as a children's problem, but when it continues into adulthood people have a problem coping with the workplace and need assistance, said Anderson, who was not part of the research team.

The new study may underestimate the adult rate of ADHD, she said, noting that many victims may not have jobs. Those who do often struggle to keep up, but there are treatments available, she said.

The majority of the lost performance was associated with reductions in quantity and quality of work rather than actual absenteeism, the researchers said.

Many employers assume occasional absences are part of the cost of doing business, but the paper noted that, "typically they expect their workers to be working when they are on the job."

To find that most of the ADHD-related loss occurs on days when the worker is present is both striking and disturbing from an employer perspective, the authors said.

Researchers interviewed 7,075 workers aged 18 to 44 in 10 countries, concluding that an average of 3.5 percent had ADHD. Their findings are published in Tuesday's online edition of the journal Occupational and Environmental Medicine.

In 2006, a study led by Kessler estimated that 4.4 percent of adults aged 18 to 44 in the United States experience ADHD symptoms and some disability.

The new research estimated the U.S. rate at 4.5 percent among workers, costing an average of 28.3 days performance.

The highest rate was for France, 6.3 percent, but the lost time was lower at 20.1 days.

Other countries studied and ADHD rates among adults, and estimated days lost per affected worker, were Lebanon, 0.9 percent, 19.4 days; Spain, 1.3 percent, 1.1 days; Colombia, 1.9 percent, 29.4 days; Mexico, 2.4 percent, 6.1 days; Italy, 3.4 percent, 22.2 days; Germany, 3.5 percent, 13.6 days; Belgium, 3.7 percent, 16.5 days; Netherlands, 4.9 percent, performance improved.

The researchers were unable to explain why the ADHD affected workers in the Netherlands had improved performance rather than the declines seen in every other country studied.

"We periodically find one of those blips, we just don't know why," Kessler said.

In a separate study issued earlier this month, researchers led by Kessler reported that major mental disorders cost the U.S. at least $193 billion annually in lost earnings alone. That study was published in the American Journal of Psychiatry.

The new international study was supported by the World Health Organization, U.S. National Institute of Mental Health, John D. and Catharine T. MacArthur Foundation, the Pfizer Foundation, U.S. Public Health Service, Fogarty International Center, Pan American Health Organization, Eli Lilly and Company, Ortho-McNeil Pharmaceutical Inc., GlaxoSmithKline and Bristol-Myers Squibb Company. Read more!

Soldier's suicide makes him a casualty of a hidden war - Colorado Springs Gazette

By TOM ROEDER
May 25, 2008

No bugle blew taps for Fort Carson Sgt. Chad Barrett at his service in February in Mosul, Iraq. Days earlier, the auditorium at Forward Operating Base Marez had been packed with hundreds of mourners, including the highest-ranking generals in Iraq, who came to honor five men killed by a bomb.

Combat heroes get memorial services in Iraq with full military honors. Barrett, with the 3rd Brigade Combat Team, got a "remembrance." Just the first few rows of seats in the auditorium were filled. There were no generals.

His widow, Shelby Barrett, said Sgt. Barrett deserved honors. He fought to be allowed to return to combat for a third time, before being overcome by his demons from past tours in Iraq.

She worries he'll be forgotten this Memorial Day because he took his life.

"I want people to remember Chad," she said. "He was a hero."

The mentally ill Iraq veteran who had pulled bodies from the Pentagon rubble after Sept. 11 died in Mosul after taking an overdose of painkillers and sleeping pills.

Just a few days before he died, the Army had pledged to redouble efforts to prevent suicide in its ranks. In 2006, 102 soldiers took their own lives - the most suicides since 1990 when the Army was 300,000 soldiers larger.

In 2007, the Army had 89 confirmed suicides with 32 more under investigation.

On the day he died, Barrett had written his wife an e-mail earlier in the day saying he felt useless and lonely as a .50-caliber gunner shunted to a desk job. He complained that he wasn't allowed to carry ammunition because commanders who knew his history of mental problems feared he'd hurt himself or others.

"They isolated him plain and simple," his widow said this month.

Barrett has a stack of papers indicating how troubled her husband was when commanders gave in to his pleading and sent him to Iraq with the brigade in January.

Barrett had suffered traumatic brain injuries from bombings during his 2003 and 2005 tours in Iraq

He served in the 2003 invasion with a unit based in Germany. He returned in 2005 with Fort Carson's 3rd Brigade.

Barrett said her husband performed his duties valiantly, showing his expertise with firearms on near-daily combat missions. But he came home from his second tour a changed man.

"He was different," she said. "He was angry."

Doctors found that portions of his brain controlling anxiety and anger had been permanently damaged in the roadside blasts.

Barrett has a copy of a letter from her husband's commander, Capt. Karen Baker, urging the Army to medically discharge Barrett because his mental illness - he attempted suicide in June - left him unfit for duty.

The Army, though, says Barrett was given the go-ahead for war duty.

"Chad Barrett was cleared by SRP to deploy prior to his deployment, that is about as much as we can tell you," brigade spokesman Maj. Mike Humphreys wrote in an e-mail from Iraq. SRP refers to the soldier readiness processing system at Fort Carson that determines whether troops are ready for war

The Army said it can't discuss details of Barrett's death because of privacy laws and an ongoing investigation.

Doctors at Fort Carson say they struggle with sending soldiers with mental health issues back to war. There's a sizable group of troops in Iraq from the post who require medication for symptoms ranging from depression to sleeplessness, they said.

A main factor in whether soldiers return to war is whether they're eager to go

"You rely 90 percent on what a patient tells you," said Col. Jim Terrio, who oversees clinical services at Evans Army Community Hospital.

Barrett wanted desperately to stay in the Army and wanted to go to Iraq. His widow said it was a mix of emotions that drove him, ranging from patriotism and loyalty to friends to a deep-seated fear of what would happen if he was discharged.

"This was the only world for him," she said. "He loved fighting for his country."

In a meeting with commanders, Barrett said he was ready to go and downplayed the things that haunted him. He forbade his wife from talking about the problems she was seeing at home.

"This is what he wanted," she said.

When the couple met over the Internet, 10 years earlier, Barrett was a different man.

"He was loving, compassionate and very, very understanding," Shelby Barrett said. "He was everything I thought he was."

The couple married in 2001 and moved to Fort Lee, Va., where Barrett was assigned when terrorists attacked New York and Washington, D.C., on Sept. 11, 2001.

Barrett was sent to the Pentagon, where he was attached to a mortuary affairs team digging through the remains of the building where 125 died.

That's when cracks in Barrett's psyche started showing from stress.

"He couldn't stand to be around a barbecue after that," Shelby Barrett said.

He put that aside as he eagerly headed to war in 2003.

"He was gung-ho," she said. "He couldn't wait to go."

His e-mails home during the first Iraq tour were basically love letters and reflected that he was glad to be part of the effort in Iraq.

The couple had a few fights after he came home, but her husband calmed down after a few months, Barrett said.

The tone of the e-mails changed during his second tour in Iraq.

"He would tell me, `I wonder if this will be the last time I can tell you I love you,'" Barrett said.

She later learned his vehicle had taken three direct hits from roadside bombs.

"He witnessed people dying," she said. "He witnessed his soldiers dying."

When Chad Barrett came home in 2006, "his personality had changed 180 degrees," his wife said.

The couple fought bitterly. At night "he would wake up in a cold sweat or would curl up into a ball," Barrett said.

The rage Shelby Barrett witnessed so frequently in 2007 erupted at a bar where he threw a stool at hecklers who didn't like his singing. What scared her is that her husband often didn't recall his outbursts.

In June, after an argument, Barrett called his wife and told her he was going to kill himself.

She called police. When they arrived, Barrett was unconscious from an overdose of pills. Police officers took him to the hospital where he underwent a mental health assessment.

Commanders didn't ostracize Barrett and seemed eager to help, Shelby Barrett said.

"It didn't get him in trouble, they were very protective of him," she said.

The Army found in September, though, that Barrett's troubles were enough to recommend a medical discharge for post-traumatic stress disorder and traumatic brain injury.

"All of a sudden, he was going to be nothing," Shelby Barrett said of her husband's reaction.

Instead, he fought the pending discharge and talked his way back to Iraq.

"He was ecstatic," Shelby Barrett said. "He couldn't wait."

But the return to Iraq exacerbated what was going on in Barrett's mind, his wife said. E-mails show anger, loneliness and paranoia.

In the early morning hours of Feb. 2, friends found Barrett near death in his room. He died at a hospital.

As the "remembrance" ended in Mosul, the mourners didn't march up to salute Barrett's picture, something that's common at other services for war dead.

They just stood there, staring at the portrait of a troubled man - an Army sergeant who, his widow said, wanted desperately to be remembered as the hero he was.

© 2007 Belleville News-Democrat and wire service sources. All Rights Reserved. http://www.belleville.com Read more!

Gaston legislator files mental health bill -Gastonia (NC) Gaston Gazette

May 25, 2008
By Barry Smith

RALEIGH - A Gaston County legislator has filed a bill that would reduce dollars going into mental health community support funding and give the funds to other health programs.

Rep. Wil Neumann, R-Gaston, said community support services went over-budget by about $508 million during the current fiscal year. He wants to take the state's share of that spending - about $154 million - and redistribute it to other programs, including $42.6 million for Medicaid inflationary increases.

In the preamble to the bill, Neumann suggests that cost overruns for community support services must be contained to provide funding for other Medicaid and mental health programs.

"A lot of what they're trying to do is good," Neumann said.

The bill would restrict community support services only to individuals whose health condition would cause them to be institutionalized if those programs aren't made available to them.

John Tote, executive director of the Mental Health Association of North Carolina, an advocacy group for the mentally ill, said that provision could pose problems.

"You are talking about hundreds of providers and thousands of clients around the state," Tote said.
Tote said he would agree that some of the money was misspent.

"A lot of the programs and services were viable," he said.
Community support services provide an array of services for the mentally ill, Tote said.

"It is designed to be skill developing," Tote said. "It is designed to be outreach in nature."

Neumann agreed that in some cases, community support services did good work.

"When they're working with children and they're trying to help the kids, it's good," Neumann said.
But some clients are being paid to offer unnecessary services, Neumann said.

"They don't have a diagnosable disease," Neumann said. "That's the problem."

Neumann's bill also prohibits the Department of Health and Human Services from consolidating area mental health systems, known as local management entities.

Tote sees that provision as "symbolic" since currently the department does not have the authority to consolidate those organizations.

Neumann said he doesn't want the department wasting time and resources trying to get the agencies to consolidate.

Barry Smith can be reached at bsmith@link.freedom.co Read more!

Did gunman know right from wrong? -Seattle Post-Intelligencer

May 22, 2008
By VANESSA HO
P-I REPORTER

King County jurors must now decide if accused gunman Naveed Haq was an angry, suicidal man who planned the Jewish Federation shootings with the intent to kill and deliver a message -- or if he was delusional, thought he was on a mission from God, and had intended only to take hostages.

After five weeks of conflicting and emotional testimony, attorneys delivered closing arguments Thursday in the high-profile case, in which Haq, 32, is accused of killing one woman and wounding five. Charged with 15 criminal counts, he has pleaded not guilty by reason of insanity.

"He was frustrated, he was angry, he was suicidal, but he wasn't insane," Deputy Prosecutor Don Raz told jurors. "His mission was to end his life and to finally be something ... and in his death deliver a message about the plight of Muslims through the world. He planned. He intended."

Raz said Haq, an unemployed Tri-Cities man with a mental illness, knew the nature of his actions when he searched for directions to the Jewish charity in Belltown, test-fired the guns, concealed the weapons in his computer bag, and choose the gun with the easier trigger pull.
haq photo
Zoom Dan DeLong / P-I
Defense attorney C. Wesley Richards uses an illustration of a stick of dynamite to describe the mental state of his client, Naveed Haq,far left. He told jurors Haq didn't know right from wrong when he entered the offices of the Jewish Federation and began shooting.

He said Haq knew right from wrong when he hid his gun behind his bag while forcing a teenage girl into the building to get past a security system, and when he stayed out of sight to avoid a front-door security camera. He also did not shoot randomly, Raz said.

"He's hitting people, and these are people he wants to control, people who have called 911 or are trying to get away," Raz said, holding up at one point the blood-stained phone one victim used to call for help.

Killed during the July 28, 2006, rampage was 58-year-old Pamela Waechter.

Defense attorney C. Wesley Richards said Haq has a schizoaffective or bipolar disorder, from which he had suffered persistent delusions, paranoia and suicidal tendencies for 10 years.

"Mr. Haq had a delusional belief that by coming to the Jewish Federation and getting on CNN that he could change the course of two wars, the war in Iraq and in Lebanon," Richards said.

"He didn't know right from wrong. He thought he was going to save lives."

With a picture of a lighted stick of dynamite next to him, Richards portrayed Haq as a troubled man reeling from problems: insomnia, debt and a medication switch that he said led to road-rage incidents, a bar attack and lewd conduct at a shopping mall months before the attack.

The day of the shooting, Richards said Haq believed he heard one victim say "awesome" after he shot her, and a voice saying "murder" as he stood over Waechter's body.

Haq also reported later that he felt someone else was controlling the trigger and that God was validating his work through the "accuracy" of his shooting, which he considered "uncanny" for an untrained gunman like himself.

"Yes, he could perceive a phone call down the hall. He could perceive Pamela Waechter running. But he believed he was there at the behest of God, doing God's work. He was very mistaken about that," Richards told the jury.

Richards said Haq did not intend to kill the victims, pointing out that he did not kill two victims who testified that Haq had pointed his gun at their head or face.

Richards also said Haq had insufficient time to premeditate the shootings in the roughly 20 seconds that five of the women were shot.

Raz countered that Haq did not describe the shootings as a mission from God until 18 months after the shooting, and just before the defense's evaluator was about to talk to prosecutors.

"It looks like a man providing advantageous information and trying to rationalize in his mind, so he can sleep at night," Raz said.

"Imagine if your teenage son or daughter came in and said, 'Mom, Dad, remember when I wrecked the car 18 months ago? God was driving.' "

Haq held his head low during much of the day, nodding at his parents when escorted through the doors by sheriff's deputies.

At the end of the day, his parents approached the victims and shook their hands.

"I'm so sorry," said Mian Haq, the defendant's father. Then Christina Rexroad, who had been critically wounded, gave Nahida Haq, the mother, a big embrace.

If convicted of first-degree murder, Haq faces life in prison without possibility of release. If found not guilty by reason of insanity, he faces commitment at a mental hospital.

Jurors were expected to begin deliberations Friday. Read more!

Life of struggles helped Salter lead by example -Saginaw (MI) News

Saturday, May 24, 2008
THEO KEITH

Johnnie Salter struggled with mental illness, but he also counseled lawmakers, played a pivotal role in a documentary and won over some doubters along the way.

Salter died Tuesday in his Saginaw Township apartment of natural causes. He was 55.

Salter overcame bipolar disorder, a developmental disability, drug use and an abusive foster care parent to touch others with his story, acquaintances say.

''Johnnie could have easily been angry at the world because of what he went through,'' said Tim Ninemier of Bay City, Salter's boss and director of customer service and recipient rights at the Saginaw County Community Mental Health Authority. ''But he went the other way.''

Salter went through decades of struggles. He battled heavy drug use in his teens and 20s and was first hospitalized with mental illness in 1973.

His foster father beat Salter with an electrical cord, said Saginaw resident Mark Leffler, Salter's friend and a customer service advocate at the authority.

In 2004, Salter became a parking lot monitor at the authority, 500 Hancock in Saginaw, and many of those who worked in the building remember seeing his smile as they entered.

That same year, Salter won an Everyday Hero award at a mental health banquet. The award recognized his success and recovery in living independently on his own terms.

''When I first started working here, Johnnie wasn't doing very well, and he called a lot,'' Leffler said. ''He was demanding, and I didn't like him very much.

''But then I went to the Everyday Hero awards. I heard his story, and was ashamed for not liking him at first.''

Salter was best known for his role in the 2007 half-hour documentary ''1 in 5: Overcoming the Stigma of Mental Illness,'' produced by Ric Mixter and his company Airworthy Productions of Saginaw Township. The documentary aired on PBS affiliate Channel 19/35 WDCQ/WDCP.

''His foster dad told Johnnie, 'You'll never be anything,' '' Mixter said. ''Johnnie must have told me a half-dozen times during the filming (of the documentary), 'I am going to be somebody.' When he finally did get attention, that must have been a great source of pride.''

Mixter said he'll remember Salter as ''one of the greatest stories I've told in my career.''

Salter, however, never tried to be anything more than a regular guy.

''Someone came up to him just last week and said, 'Johnnie, you're a celebrity!''' Leffler said. ''And he said, 'No. No, I'm not. I'm just a person.' ''

Salter met with state Sen. Roger Kahn, a Saginaw Township Republican, several timess to advocate for mental health funding.

''Saginaw has lost a true advocate,'' Kahn said.

Salter is survived by his brother, Addie Salter of Bridgeport. Family and friends may call at Browne's Mortuary, 441 N. Jefferson in Saginaw, from 2 p.m. to

8 p.m. Tuesday. The funeral service will start at 11 a.m. Wednesday at New Mount Calvary Baptist Church, 3610 Russell in Saginaw. v Read more!

Moseley joins ECU medical staff -Kinston (NC) Free Press

Michael Moseley of Kinston has been appointed as affiliate professor in the Brody School of Medicine's Department of Psychiatric Medicine at East Carolina University.

The term of the appointment began in April 2008 and runs through January 2011.

Moseley, who recently stepped down as the director of the North Carolina Division of Mental Health, Developmental Disabilities, and Substance Abuse Services, is a current member of the Boards of Visitors at East Carolina University and the University of North Carolina at Chapel Hill.

Immediately preceding his recent retirement announcement, Moseley served two terms on the Board of Directors of the National Association of State Mental Health Program Directors as a member-at-large and as the Southern Regional representative, respectively. He was the first North Carolina director ever to be elected to serve in those capacities. Read more!

Adult prison hospital a possibility -Ventura County (CA) Star

By Zeke Barlow
May 24, 2008

A plan to raze the Ventura Youth Correctional Facility in Camarillo and build a 1,500-bed hospital for adult prisoners in need of mental and medical care is under consideration.

The proposal, which is still in its exploratory phase, would transfer the 242 youth wards at the facility elsewhere and bring in adult prisoners from around the state who have serious, long-term medical and mental issues.

Seven hospitals that will house 10,000 inmates are set to be built around the state. The Camarillo site, at 3100 Wright Road, is one of three proposed to begin construction in Southern California in 2009.

Along with Stockton and San Diego, the Camarillo site was chosen because it is on existing state property and has access to a work force, said Clark Kelso, the receiver in charge of the California Prison Health Care System.

Though the proposal still has to go through an extensive review process before it is finalized, many local politicians said they are against closing the youth facility and bringing in older prisoners.

"I don't care whether they have their full faculties or they are mentally challenged, I think that hardened criminals are not what we want," said Don Waunch, vice mayor of Camarillo. "I know that they need a place (to build), but you hate to see it come to your county."

State forced to pay

If Kelso decides Camarillo is the best place for a hospital, the local government might not have much say in the matter.

Kelso was appointed by a federal court to oversee and improve California's prison healthcare system after it was determined the system violated constitutional protections from cruel and unusual punishment. He effectively works outside the purview of the state.

Kelso said that while he'll take the feelings of the local community into consideration, he knows that some places may not be receptive to a new prison facility.

"I need to put these people somewhere in order to provide constitutional levels of care," he said. "I can't be in a position where if someone says no, I back off."

In the coming months, he hopes to show the communities the need for the facilities, as well as their security and potential for jobs. The facility, which could be as large as 90,000 square feet, would undergo an extensive permitting process where the public would have input, and would likely take many months.

The facility is expected to have an annual operating budget of hundreds of millions of dollars, he said.

The current facility's program for youths who battle forest fires every year would remain.

A bill in the state Senate would authorize $6.9 billion in revenue bonds for the projects. Because the hospitals are a result of a federal court decision, the state is effectively forced to pay for the hospitals.

Kelso said the hospitals would house long-term prisoners with medical conditions such as diabetes, liver disease, hypertension and morbid obesity. Others would be treated for mental conditions ranging from schizophrenia and depression to those who are bipolar. Court rulings have found the Department of Corrections and Rehabilitation doesn't provide adequate care for those individuals.

Jeopardize the public safety'

What would happen to the wards currently at the Camarillo facility is still being decided. David Finley, who is the supervisor there, said he's drawn up a plan on where the wards might go, though the information is still confidential.

The 12-building, 85-acre campus was built in 1962 as the Ventura School for Girls and started taking in male prisoners in the 1970s. The population was once as large as 1,000 but has shrunk as plans to reduce the population surfaced over time, including one last year to move most of the girls to their home counties to serve out their sentences.

The facility houses not only some of the most troubled and difficult to rehabilitate girls, but also the most expensive prisoners. One year at the correctional facility costs taxpayers about $230,000, mainly because there are so few wards, so many employees and so much unoccupied space.

Still, many think the current facility is much better than one with adult prisoners.

"Right now, you have girls and boys there, and that is very different than having adult men who have raped and murdered and done some of the worst offenses and on top of that have mental health issues," said state Assemblywoman Audra Strickland. "I believe that an adult prison will jeopardize the public safety in Ventura County."

Camarillo Mayor Charlotte Craven said she thinks the facility should stay because it helps young women rehabilitate themselves.

"I think the girls are getting the short shrift," she said.

Since news of the potential change surfaced in the past few weeks, workers at the detention facility have been talking about the change and worried about what would happen to the 430 jobs there, said a counselor who works there. Read more!

Scientists test brain pacemakers for depression - Raleigh News and Observer

By LAURAN NEERGAARD, AP Medical Writer

WASHINGTON - It's a new frontier for psychiatric illness: Brain pacemakers that promise to act as antidepressants by changing how patients' nerve circuitry fires.
Scientists already know the power of these devices to block the tremors of Parkinson's disease and related illnesses; more than 40,000 such patients worldwide have the implants.

But psychiatric illnesses are much more complex and the new experiments with so-called deep brain stimulation, or DBS, are in their infancy. Only a few dozen patients with severe depression or obsessive-compulsive disorder so far have been treated in closely monitored studies.

Still, the early results are promising. Dramatic video shows one patient visibly brightening as doctors turn on her brain pacemaker and she says in surprise: "I'm starting to smile." And new reports this month show that some worst-case patients - whose depression wasn't relieved by medication, psychotherapy, even controversial shock treatment - are finding lasting relief.

Six of 17 severely depressed patients were in remission a year after undergoing DBS and four more markedly improved, and more than half of 26 obsessive-compulsive patients showed substantial improvement over three years, say studies from a team at the Cleveland Clinic, Brown University, and Belgium's University of Leuven.

"Not all patients get better, but when patients respond, it's significant," says Dr. Helen Mayberg of Emory University, who has implanted about 50 depression patients. Her first remains in remission after five years; she estimates that four of every six show enough improvement to be classified "responders."

"We're rewiring the brain in many ways," says Dr. Ali Rezai, chief of the Cleveland Clinic's Center for Neurologic Restoration.

There's a need for innovative therapies. Up to 20 percent of depression patients and 10 percent of those with obsessive-compulsive disorder are treatment-resistent - several million people in the U.S. alone.

The rationale behind DBS is credible, says Dr. Wayne Goodman of the National Institute for Mental Health: Surgery sometimes helps worst-case patients by destroying misfiring patches of brain tissue. The electrodes are placed into similar spots, but don't destroy tissue - the electrical signals can be adjusted and turned off.

But it's not yet ready for prime-time, Goodman cautions. He worries that because the electrodes already are widely available, centers without proper training will start offering the $40,000 implant surgeries to psychiatric patients before science proves if they're really valuable.

"It is an invasive, experimental procedure," he warns, with risks including bleeding in the brain and infections. He calls DBS "the last resort for stringently selected patients."

Earlier this month, federal health officials and the Cleveland Clinic brought together the field's leading researchers to highlight progress so far and debate if it's time for much larger studies - even whether DBS might be tweaked to help people with traumatic brain injuries, such as Iraq war veterans.

"There's not enough awareness of what the potential is of this kind of stimulation," says meeting co-chair Dr. Margaret Giannini, who heads the government's Office on Disability.

In deep brain stimulation for Parkinson's, a wire is implanted within a walnut-sized area known as the thalamus, a hub of sensory information. That electrode is connected by a cable running through the neck to a pulse generated under the collarbone. Tiny electrical zaps disable overactive nerve cells, blocking tremors.

Scientists don't have nearly as much understanding of what goes awry to cause depression or other psychiatric illnesses - but they do know the thalamus isn't the right spot for those patients. They're focusing instead on two regions with names only a neurologist could love - the ventral capsule/ventral striatum and so-called Brodmann Area 25. Ignore the names; the point is that these are regions where brain circuitry involved in mood and anxiety intersect.

It's not yet clear who should have DBS in which spot, or if there are still other target areas. Much of the research to date has been funded by electrode manufacturers, with some paid for by the government - and consists of measuring patients' disability before and after DBS, not more rigorous studies that randomly assign patients to treatment.

Still, Diane Hire of Cleveland, the patient whose first smile was recorded, illustrates the hope.

The 12-year Navy veteran was medically discharged for depression and spent a decade on disability, unable to function. "I basically felt like a dead person walking. I had no feelings, no emotions," she told the scientists' meeting.

Her DBS was switched on in January 2007, and "my whole world changed," says Hire, 54. She's not back to work yet: "It is a real challenge to learn how to live as a healthy person again," she adds, saying she doesn't handle stress or multitasking well. But, "I wake up every day looking forward to what's ahead."

Read more!

Escaped patient returned to Dix - Raleigh News and Observer

Residents near facility not alerted

Michael Biesecker, Staff Writer

RALEIGH - A mental patient with a violent criminal history escaped from Dorothea Dix Hospital on Thursday, amid concerns about whether the state facility is adequately staffed to supervise patients.
Harnett County sheriff's deputies picked up the patient at a medical center in Dunn late Thursday night and took him back to Raleigh.

Dix Hospital administrators first acknowledged the escape Saturday, after a public information request from The News & Observer. The patient's name and other identifying information were blacked out of the report released by the hospital's internal police department.

A report filed with the Harnett sheriff identified the escaped patient as Jamelle Curtis Shaw, 32, of Fayetteville.

Court records show Shaw has felony convictions on burglary and drug charges, and misdemeanor convictions for assault, assault on a female, disorderly conduct and indecent exposure.

Cumberland County prosecutors deferred charges for trespassing and communicating threats earlier this year after Shaw was deemed mentally incompetent to stand trial, according to court records.

Shaw became upset after a legal hearing at Dix on Thursday and escaped after a struggle with a health-care technician assigned to watch him, according to the Dix report.

Though Shaw's mental state was defined as being of "imminent danger to himself and others," administrators at Dix didn't notify residents in surrounding neighborhoods of his escape.

Raleigh Police spokesman Jim Sugrue said his department was notified of the escape, though no written report was filed.

Jimmy Creech, the neighborhood watch coordinator for Boylan Heights, said he received no warning a mental patient had escaped.

"That is concerning," said Creech, whose home is about four blocks from the hospital. "It would have been good for them to let us know so we could have taken precautions and possibly help identify someone who wasn't from the neighborhood."

Staff vacancies at Dix Hospital have worsened in recent months as officials have moved to close the aging facility by July 1.

In April, two patients, one a registered sex offender, walked out of Broughton Hospital in Morganton. Federal regulators cited Cherry Hospital in Goldsboro with deficiencies after a patient escaped last year.

Mark Van Sciver, spokesman for the state Department of Health and Human Services, said Saturday that hospital administrators would conduct an internal review of the patient's escape.

(News researcher Brooke Cain contributed to this story.)

Read more!

Ready or not, hospital will open - Raleigh News and Observer

Dozens of key jobs haven't been filled. Workers say the transition will be disastrous

Michael Biesecker, Staff Writer

RALEIGH - State mental health administrators are accelerating plans to open a psychiatric hospital in Butner despite internal projections showing severe shortages of qualified staff.
With patients due to arrive at Central Regional Hospital in about three weeks, 63 nursing positions have yet to be filled -- a vacancy rate of 21 percent.

There is a 36 percent vacancy rate for medical doctors, and 38 percent of positions for psychologists are empty. The vacancy rate for psychiatrists is more than 14 percent, according to the projections.

The hospital's pharmacy may not be able to open with the rest of the facility because of a shortage of pharmacists.

With so many key positions vacant, many rank-and-file employees fear a situation that won't be safe for staff or patients.

"There won't be enough staff available in a crisis," said Beverly Moriarty, a state nurse who helps coordinate staffing at Dorothea Dix Hospital in Raleigh. "This is a train wreck waiting to happen. The administration knows it's going to be a catastrophe, and they're moving ahead anyway. I don't understand it."

A 12-year veteran, Moriarty was among a group of mental health workers who rallied Friday at Dix. Lunch-hour protests are becoming a weekly ritual.

The state Department of Health and Human Services plans to close Dix and John Umstead Hospital in Butner by July 1. Patients from the two hospitals are to start moving to Central Regional on June 15.

The N.C. Public Service Workers Union, which represents many mental health workers, wants to delay the closure of Dix by a year.

Plans call for most of the staff at Central Regional to be drawn from employees currently at Dix and Umstead. But even if the full number of positions allocated for the new hospital were filled, the staff-to-patient ratio will be less than what is now offered at the older hospitals.

An internal projection comparing a 26-bed ward for adults at Dix shows two nurses on duty during each of the three daily 8-hour shifts. At the new hospital, just one nurse per shift will be expected to care for the same 26 patients.

Health-care technicians, the lower-skilled workers who have the most one-on-one contact with patents, will also be trimmed by about half, according to the report.

A thrice-delayed opening

A centerpiece of the foundering effort to reform the state's mental health system, the opening of the $120 million hospital has been delayed at least three times because of a fire and design flaws inspectors worry could endanger patients.

On Wednesday, the same day an article in The News & Observer disclosed internal documents showing many of the safety hazards have yet to be fixed, employees were told the schedule for moving to the new hospital was being hastened by two or three days.

"They want to make the move a fait accompli," Moriarty said, suggesting higher-ranking officials are trying to close Dix before opposition can build to stop them.

Jim Osberg, the director of the state system of mental hospitals and homes for the developmentally disabled, said the schedule had been accelerated so the move could be completed before the week of July 4, when many employees are expected to take vacation.

The staffing shortages are being overblown, he said.

"We will be able to staff adequately for safe and appropriate care," Osberg said. "While there are some shortfalls in staff, at least to this point, we are working on contingencies to manage the shortfalls."

Those plans call for hiring temporary staff. Hiring highly skilled professionals on a short-term, contract basis can cost a third more than hiring a permanent employee.

"It's not preferred, but it's necessary," Osberg said.

Beyond the expected

The true staffing shortfalls at Central Regional could be even worse than the administration's projections. Several Dix employees say they have accepted transfers to the new hospital but are looking to get jobs elsewhere as quickly as possible.

Facing $4-a-gallon gas and a new commute to Butner that is well over an hour round-trip, some of the Dix employees said they just couldn't afford the move.

"Half of my salary would go to gas," said Floyd Mims, a health-care technician. The starting pay for his job is $11.42 an hour.

Chronic staffing shortfalls were among the issues that led to the recent decertification of Broughton Hospital in Morganton. The problems, which were identified in the wake of patient deaths, led to federal officials cutting off Medicaid and Medicare reimbursements to the hospital, costing state taxpayers at least $10 million so far.

The workers said the opening of the new hospital is so poorly planned that their orientation to the new facility consisted of a two-hour walk-through of one floor at the new hospital. They were given a packet of instructions and told to read them at home.

A nurse said she had received no training on how to use the computers at the new hospital, how patients' medications are to be kept secure, or how to evacuate in case of a fire or other emergency.

Mims said it typically takes four days of orientation for a worker just to transfer from one ward to another at Dix.

"There's no way you can do orientation in two hours," said Mims. "It's totally unacceptable."


michael.biesecker@newsobserver.com or (919) 829-4698
Read more!

Suicides linked to work-related stress up in Japan - Associated Press

By MARI YAMAGUCHI
The Associated Press
Saturday, May 24, 2008; 6:33 AM

TOKYO -- The number of people who committed suicide or tried to in Japan because of work-related stress has doubled in the last five years, a government report said, illustrating the growing anxiety many here feel from increased workloads and competition.

The Health Ministry report said 81 people committed suicide or tried to commit suicide because of stress at work in fiscal year 2007 _ up from 66 in 2006 and 40 in 2003. It did not specifically say how many of the 81 committed suicide.

The report also found that a record high 268 people _ including the 81 _ developed work-related mental conditions such as depression. The report was published Saturday in Japanese newspapers.

Japan has one of the highest suicide rates in the world. About 32,160 people killed themselves in 2006 _ the latest government statistics available for a full year. The report comes as the country battles a series of suicide fads including the latest string that involves people mixing household chemicals to create lethal fumes.

People in their 30s and 40s were most prone to stress due to working too many hours or personal relationships at work, the report said. Some of the workers had worked about 160 hours of overtime a month, it said. A typical work week in Japan is 40 hours.

"Many people endure their sufferings alone, trying not to show their weakness" to colleagues, the mainstream newspaper Yomiuri said in a commentary. "We urge employers to work harder to create a stress-free working environment."

The report based its findings on the number of people who committed suicide or attempt to whose families received workers compensation for their deaths or injuries.

Under the Japanese labor law, an employer has to pay compensation to employees or their families for work-related accidents, illnesses and deaths. The families of suicide victims fill out applications to receive the compensation, and the government determines their eligibility.

If illnesses or deaths are proven to be work-related, employees or their families can receive a one-time payment or an annual stipend based on his or her base salary.

Separately, the government granted workers compensation last year to 392 other people who had strokes, heart attacks and other brain and cardiac illnesses, including 142 who died.

Most of the cardiac and brain patients were people who worked excessively long hours, the report said.

More than one-third of them reported working between 80 and 100 hours of overtime a month, with another 25 percent saying they worked between 100 and 120 hours of overtime monthly. About 10 percent of them did more than 160 hours of overtime, or an average of five extra hours a day, including the weekend.

Under the Health Ministry guidelines, the family an employee who died after filing monthly overtime of 80 hours or more is usually entitled to receive compensation.

Read more!

Teen in middle-school murder called competent - Miami Herald

Two mental health experts say a teenager accused of murdering a classmate in Miami is competent to stand trial. But his lawyers argue that he is not guilty by reason of insanity.

A judge said at a competency hearing Friday that 18-year-old Michael Hernandez was found capable by the experts to stand trial in the 2004 killing of his middle-school classmate. The teen's lawyers have requested a full hearing on the issue. That will be on Tuesday.

The new evaluations were ordered after Miami-Dade County jail officials gave Hernandez medication.

Hernandez faces life in prison if convicted of fatally stabbing 14-year-old Jaime Gough. Hernandez was also 14 at the time and has confessed to the killing.

Read more!

Reports show abuse at state's mental hospitals - Associated Press

More than 70 employees at Texas' 10 state mental hospitals have been fired and dozens others disciplined since 2005 over allegations of brutal beatings and other physical abuse, according to a newspaper report.

Disciplinary records obtained by The Dallas Morning News show the violence against patients included chokeholds, headlocks and threats. Hundreds of other employees have been fired for other violations, including sleeping on the job and overmedicating patients, the records show.

There are about 18,000 patients and about 7,400 employees working in the state psychiatric hospital system.

State officials say there will always be reports of abuse and neglect in an institutional setting. And they say they take any allegations of mistreatment seriously. But the records show that as in other state-run facilities, abuse and neglect are systemic, the newspaper reported Sunday.

Texas juvenile prisons, group homes for the disabled, and state schools for people with mental disabilities all came under fire last year for reports of widespread physical and sexual abuse. The state psychiatric hospitals, like other systems for vulnerable Texans, are chronically starved for cash, advocates of more state funding say, and services at the local level can't keep up.

"You get what you pay for," said Rep. Garnet Coleman, D-Houston, who has bipolar disorder. "When you financially dumb something down, you make services cheap, something's got to give. Unfortunately, it usually ends up being a mentally ill or disabled Texan."

Officials with the Department of State Health Services, the agency that runs the psychiatric hospitals, say abuse and neglect are "absolutely not" pervasive — and verified cases are actually dropping.

In the past two years, they confirmed 15 "Class I" cases — the most serious abuse. On average, investigators substantiate 5 percent of the more than 2,000 allegations they examine annually. And nearly 90 percent of patient deaths since 2005 were attributed to natural causes, agency spokesman Doug McBride said. Five were suicides, and none were the result of abuse.

State officials acknowledge that the psychiatric hospitals are stressful environments; there are times, McBride said, when employees "do not handle a situation appropriately." But they say the rules for reporting abuse and neglect are stringent and confirmed cases of physical and sexual abuse are reported to police.

And they balk at the suggestion that conditions bear a resemblance to the state schools for people with mental disabilities, where the U.S. Justice Department has intervened twice in recent years.

The psychiatric hospitals, which have about 2,500 patients daily, had 137 confirmed abuse cases in 2007. The state schools for people with disabilities, which have twice as many residents, have an average of 300 confirmed abuse cases per year.

But some advocates fear the mentally ill patients may face greater risks. Patients of the psychiatric hospitals are largely indigent, transient and not connected to their families, so they have few allies as they bounce through the mental health system.

"It's a population that's easy to abuse because they're not on the radar in any way," said Richard Hansen, a Texas mental health advocate who was chemically restrained, shackled and beaten to the point of broken ribs years ago while suffering from bipolar disorder in a New York mental hospital.

But there are few alternatives, advocates say, because smaller community-based services are as strapped as the state system.

Other employees were punished for offensive treatment, from using racial slurs on patients to making verbal threats and sexual advances. Some ignored patients' cries for help while they watched TV, played video games and wrote text messages. Others stole state property and sold tobacco products to patients.

McBride said employees are carefully screened and are terminated the moment they're found unfit for their jobs.

Hansen said many employees are conscientious, but conditions vary from hospital to hospital and ward to ward. Some are simply warehouses, where patients are often overmedicated and ignored. In others, patients frequently turn up with unexplained injuries, he said.

Aaryce Hayes, a mental health policy specialist with Advocacy Inc., said the Department of State Health Services is working to improve the state hospital system, from incorporating trauma-informed treatment into care regimens to increasing employee empathy training. It is also trying to reduce reliance on restraint and seclusion to keep control of patients.

But it's hard to improve when the state hospital system is so overburdened, she said. Right now, the state funds just 27 percent of mental health needs in the community. There are more than 450,000 adult Texans with serious and persistent mental illness, everything from schizophrenia to major depression, she said.

"If we said we were serving just 27 percent of people who had cancer, or diabetes, nobody would be comfortable with that," Hayes told the newspaper.

Texas ranks 48th in the country in per capita funding for people with mental

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Long-time psychiatric patient pleads guilty to shooting - Raleigh News and Observer

By Sarah Ovaska, Staff Writer

RALEIGH — A man who has spent the past seven years in a psychiatric hospital pleaded guilty today to second-degree murder in connection with a 2001 shooting in a Southeast Raleigh duplex.
Dwayne Haywood, 29, has been at Dorothea Dix Hospital since shortly after his arrest in 2001 and was considered too mentally ill to be tried in court until recently. At one point he believed he was the sixth member of the family pop quintet the Jackson 5.

Haywood pleaded guilty to fatally shooting Abraham “Blackie” Payne, 22, in Payne’s home at 324 Maple St. just before midnight on June 19, 2001. Superior Court Judge Orlando Hudson sentenced Haywood to 13 years in prison, giving him credit for the seven he’s already spent in the state psychiatric hospital.

Wake assistant district attorney Howard Cummings said that, after the shooting, Haywood took another man at gunpoint and made him drive to the Raleigh-Durham International Airport — despite not having a ticket and the airport being closed for the night.

There, Haywood threw his gun into a trash can and was arrested by police. The connection between Payne, the victim, and Haywood was unknown, but both men were from Brooklyn, N.Y. Cummings said in court that when Haywood confessed to the shooting in 2001 he told police that he was seeking revenge for an assault that had occurred outside of North Carolina.

But Haywood’s mental stability has been questionable since a young age, according to a psychiatrist's report submitted to court today.

He was first classified as “emotionally disturbed” in 1990, when he was 11, and was placed in special education classes. When he was 16, he was imprisoned for an attack at a Rite-Aid pharmacy where he ransacked the store and then slashed three people with a box-cutter, causing one victim to need 120 stitches, according to the report written by Nicole Wolfe, a forensic psychiatrist.

Haywood was hospitalized in a psychiatric center in 2000 in Central New York, where he spoke of being the creator and had violent behavior.

In 2001, Haywood again was arrested, this time for armed robbery, and went back to psychiatric hospitals in New York. He told psychiatrists there that he thought he was the Jackson 6, the biological brother of Michael Jackson. He also thought he as the “Chosen One” and was diagnosed with bipolar disorder.

Haywood was released on May 30, 2001 and last visited a New York psychiatric center on June 11, 2001. Eight days later, he was in Raleigh and shot Payne.

Since July 2001, Haywood has been at Dix after beings declared incompetent to stand trial, according to the psychiatric report. He has been taking medication for years to stabilize his mental state and no longer has delusional beliefs, Wolfe wrote.


sarah.ovaska@newsobserver.com or (919) 829-4622
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Cedar Rapids social worker faces three state charges - Cedar Rapids (IA) Gazette

CEDAR RAPIDS — A Cedar Rapids social worker has denied allegations of inaccurate billing, falsification of patient records and improper physical contact with a client that were brought against her by the Iowa Board of Social Work.

"It was a surprise to me," Pamela Nelson-O'Neil said Thursday afternoon.

The board charged Nelson-O'Neil on May 12 and announced the charges in a news release issued Wednesday.

According to the statement of charges, Nelson-O'Neil falsely billed Medicare for services that were never provided. The physical contact charge stems from an incident in which she held a client's legs and sat on a chair with the client during a therapy session, according to the board's statement.

"Given the mental health history and diagnosis of the client, such actions pose the possibility of psychological harm to the client, and are a substantial deviation from standard and prevailing practice," according to the board's statement.

The statement did not say when the alleged actions occurred. Don McCormick, a spokesman for the board, said that information isn't public.

Nelson-O'Neil said she'll defend herself against the charges at a hearing July 7 in Des Moines. She declined further comment.
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Financial trouble could leave women in shelter without a home - San Francisco Chronicle

SAN FRANCISCO -

The economic situation gripping the nation has extended its clutch to a new target: a charitable organization that houses about 60 women with mental and physical health problems.

The Marian Residence for Women, a subsidiary of the St. Anthony Foundation, will close its doors this summer, leaving the women scrambling to find a new place to live.

A private entity, St. Anthony Foundation is reliant on donations. Although this year’s charitable alms are consistent with past amounts, the fear that people will soon tighten their spending has forced the organization to restructure its priorities.

“Any organization with the longevity of St. Anthony’s is going to periodically assess our program’s needs,” said Francis Aviani, a spokeswoman for the organization. “It’s a painful process, but we have to take into consideration future economic developments.”

Along with providing a bed, the Marian Residence offers three meals a day and employs on-site case workers for its patrons, Aviani said. The shelter is intended to be a transitional residence, and any woman who stays longer than six months is evaluated for appropriateness.

The program’s case workers will work extensively with the displaced women to help them get into affordable-housing units or other shelters before the Marian Residence officially shuts its doors Aug. 31, Aviani said.

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9/11 Workers Face Chronic Mental Impairment - Washington Post

THURSDAY, May 22 (HealthDay News) --

Workers and volunteers involved in recovery efforts at the World Trade Center following the 9/11 terrorist attacks have much higher levels of psychological distress than the general population, new research shows.


The study analyzed mental health questionnaires completed by more than 10,000 World Trade Center recovery workers between 10 months and 61 months after Sept. 11, 2001. It found that 11.1 percent of the workers met criteria for probable post-traumatic stress disorder (PTSD), 8.8 percent had probable depression, 5 percent had probable panic disorder, and 62 percent had substantial stress reaction.

In addition, PTSD in the workers was significantly associated with loss of family members and friends; disruption of family, work and social life; and higher rates of behavioral symptoms in their children.

Surveillance and treatment programs for the recovery workers need to be continued, the researchers concluded.

The study was published online in the journalEnvironmental Health Perspectives.

"Many who worked at Ground Zero in the early days after the attacks have sustained serious and long lasting physical and mental health problems. This study scientifically confirms high rates of mental health issues in a large number of responders," study co-author Dr. Dennis Charney, dean of Mount Sinai School of Medicine in New York City, said in a prepared statement.

Charney is also executive vice president for academic affairs at the Mount Sinai Medical Center, which offers a range of medical and mental health programs for 9/11 responders.

"The levels of PTSD prevalence (in the WTC workers) are comparable to those seen in returning Afghanistan war veterans and are much higher than in the U.S. general population and consistent with the mental health problems in the WTTC Health Registry," study co-author Dr. Jeanne Mager Stellman, visiting professor at Mount Sinai School of Medicine, and chair of the department of environmental and occupational health sciences at SUNY-Downstate in Brooklyn, said in a prepared statement.

The study did find that the prevalence of mental health problems among WTC workers declined from 13.5 percent to 9.7 percent over the five years of observation.

More information

The U.S. National Institute of Mental Health has more about PTSD.

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Study Finds Big Social Factor in Quitting Smoking - New York Times

By GINA KOLATA

For years, smokers have been exhorted to take the initiative and quit: use a nicotine patch, chew nicotine gum, take a prescription medication that can help, call a help line, just say no. But a new study finds that stopping is seldom an individual decision.

Smokers tend to quit in groups, the study finds, which means smoking cessation programs should work best if they focus on groups rather than individuals. It also means that people may help many more than just themselves by quitting: quitting can have a ripple effect prompting an entire social network to break the habit.

The study, by Dr. Nicholas Christakis of Harvard Medical School and James Fowler of the University of California, San Diego, followed thousands of smokers and nonsmokers for 32 years, from 1971 until 2003, studying them as part of a large network of relatives, co-workers, neighbors, friends and friends of friends.

It was a time when the percentage of adult smokers in the United States fell to 21 percent from 45 percent. As the investigators watched the smokers and their social networks, they saw what they said was a striking effect — smokers had formed little social clusters and, as the years went by, entire clusters of smokers were stopping en masse. So were clusters of clusters that were only loosely connected.

Dr. Christakis described watching the vanishing clusters as like lying on your back in a field, looking up at stars that were burning out. “It’s not like one little star turning off at a time,” he said. “Whole constellations are blinking off at once.”

As cluster after cluster of smokers disappeared, those that remained were pushed to the margins of society, isolated, with fewer friends, fewer social connections. “Smokers used to be the center of the party,” Dr. Fowler said, “but now they’ve become wallflowers.”

“We’ve known smoking was bad for your physical health,” he said. “But this shows it also is bad for your social health.”

Smokers, he said, “are likely to drive friends away.”

Their paper is to be published Thursday in The New England Journal of Medicine.

“There is an essential public health message,” said Richard Suzman, director of the office of behavioral and social research at the National Institute on Aging, which financed the study.

“Obviously, people have to take responsibility for their behavior,” Mr. Suzman said. But a social environment, he added, “can just overpower free will.”

With smoking, that can be a good thing, researchers noted.

But there also is a sad side. As Dr. Steven Schroeder of the University of California, San Francisco, pointed out in an editorial accompanying the paper, “a risk of the marginalization of smoking is that it further isolates the group of people with the highest rate of smoking — persons with mental illness, problems with substance abuse, or both.”

These are people, Dr. Schroeder notes, who already suffer from being stigmatized.

It is not clear how to resolve that problem, Dr. Fowler said. “What we are seeing is that there is a fundamental trade-off to having a campaign to really change people’s behavior,” he said.

Dr. Christakis and Dr. Fowler published a similar study last year on obesity, asking about the rise of a health problem.

The new study also looked at smoking initiation but, because many more adults were stopping smoking than starting in the years of the study, its main focus was on cessation. Still, Dr. Christakis said, smoking initiation followed the same patterns as cessation: people started and stopped smoking in groups.

Such studies of social networks and behavior like smoking are extremely difficult because what is needed is detailed information on people’s behavior and the behavior of their family, their relatives, their neighbors and co-workers, their friends and their friends of friends. Dr. Christakis and Dr. Fowler discovered one data set that had what they needed but, they and others say, there may not be any others.

The data were from the federal Framingham Heart Study. It was initiated after World War II to follow the population of Framingham, Mass., in order to understand the causes and consequences of heart disease. Researchers regularly examined the study participants, weighing them, doing medical exams, asking them whether they smoked. In order to keep track of the subjects over the years, even if they moved away, the investigators asked for the names and contact information of close friends, co-workers and neighbors.

That meant, though, that the data set also contained all the information that would be needed for an analysis of social networks and the spread of obesity or, in this case, for an analysis of social networks and the decline in smoking, Dr. Christakis and Dr. Fowler realized.

The researchers focused on 5,124 people in the Framingham study who had 53,228 friends, relatives and neighbors as part of their social networks.

They noticed that, on average, smokers clustered in groups of three. Over the years, as fewer and fewer Americans smoked, the number of clusters declined but the clusters that remained stayed the same size, which meant that smokers were not stopping smoking one by one. They were stopping in groups.

Education also played a role. Those with more education were more highly influenced by their friends, and their friends were more likely to influence them. And some social contacts were more influential than others. A spouse’s quitting was more powerful than a friend’s, and a friend’s quitting was more powerful than a sibling’s. If someone you name as a friend quits, that has more of an effect than if someone who names you as their friend quits. Co-workers had an influence only in small firms where everyone knew one another. The effects were greater among casual smokers than heavy smokers.

The study and the obesity study that preceded it, said Duncan Watts, principal research scientist at Yahoo! Research in New York, provide a new view of society.

“We tend to think of individuals as atomized units, and we think of policies as good or bad for individuals,” Dr. Watts said. “This reminds us that we are all connected to each other, and when we do something to one person, there are spillover effects.”

And, he added, when the same sort of effects show up in the spread of obesity as in the decline of smoking, that should be a signal.

“Something very powerful is going on here,” Dr. Watts said.

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