Saturday, May 31, 2008

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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Friday, May 30, 2008

'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
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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.
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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."
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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.
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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
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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.
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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.
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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.
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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."
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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.
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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.
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Thursday, May 29, 2008

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.”
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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."
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