A coming crisis for those needing personal care -Raleigh News & Observer

Commentary: S. Barton Cutter

Direct support professionals carry many different job titles but help people with varying needs, ranging from providing basic physical assistance to opening avenues for people with disabilities to engage in community activities.

Whether they are known as personal-care assistants, support services technicians or other designations, their work is integral to the lives of many people with disabilities and often is undervalued except by those directly served.

In my work as a contractor for the N.C. Council on Developmental Disabilities, I see the necessity of well-trained, reliable direct-support professionals on a regular basis. As one with cerebral palsy, I also rely on direct support workers in my own life. Tom, my current support person, assists me with showering, dressing and eating so that I can earn a living, support my family and participate in my community. He is, in many ways, my lifeline to the world.

Despite Tom's critical service, many people view his line of work as menial, leading to a depreciation of this work force's value. This has led to a growing concern in the field of direct support.

An estimated 50 percent of direct support professionals leave their jobs each year. Low pay -- $8.68 an hour on average -- a lack of benefits, high burnout rates and limited training and minimal opportunity for career growth make remaining in the field untenable.

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THE STATISTICS ON THE COMING NEED FOR WORKERS IN THIS FIELD ARE STAGGERING. In the next decade, there is expected to be openings for 40,000 more nursing aides, orderlies and attendants and home-care aides. The demand for such services by individuals with developmental disabilities is projected to increase 37 percent by 2020.

To be prepared, it is vital that a portion of the money allotted to the N.C. Division of Mental Health, Developmental Disabilities and Substance Abuse be spent on improving the direct support work force.

When Gov. Mike Easley asked for a budget increase of $86.5 million for mental health in North Carolina, he cited the need for "continued development of appropriate community services to support the full continuum of care necessary to serve our citizens."

Even while trimming the requested increase to $21.3 million, the House and Senate signaled their support for the goal.

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THIS ACKNOWLEDGEMENT OF THE NEED FOR GREATER SUPPORT comes at a critical time for people in the developmental disabilities community, but the boost in resources will be effective only if that money is well-spent.

Though much of the increase will be used to address mental health and substance abuse needs, many hope this will prove to be an important first step in the development of a stable, adequate support work force for people with disabilities.

Tom, who has been working with me for less than a month, is my third support person in two years. While at first glance, this may appear above average, the average drops drastically when one realizes there may be a one- to two-month gap in services while searching for a replacement.

The N.C. Council on Developmental Disabilities is working to find innovative solutions to lead the way in addressing the direct support work force crisis. Last year, the council and other DHHS divisions invited a team from the Center for Medicare and Medicaid Studies to evaluate the current conditions of the frontline work force in North Carolina.

As a person who understands the need for qualified direct support professionals from both personal and professional standpoints, I commend the governor and the General Assembly for recognizing the growing need for a quality workforce of direct support professionals.

(S. Barton Cutter, a contractor for the N.C. Council on Developmental Disabilites, lives in Raleigh. He can be reached at barton.cutter@gmail.com)

All rights reserved. This copyrighted material may not be published, broadcast or redistributed in any manner.
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State pays nurses way to S. Africa-Raleigh (NC) News & Observer

Michael Biesecker

RALEIGH - An employee at a state mental hospital in Goldsboro used $5,000 in public money to pay for a 15-day trip to South Africa.

Gladwyn "Shryl" Uzzell, a nurse at Cherry Hospital, visited medical facilities, an orphanage, botanical gardens, a former prison for political prisoners under apartheid and the houses of Nelson Mandela and Archbishop Desmond Tutu.

She also went on a safari at a wildlife preserve known for its lions, leopards, elephants and rhinos.

Uzzell said the trip, approved by the hospital's top administrators, provided insights that will apply directly to her state job training other nurses to care for the mentally ill back home in Eastern North Carolina -- especially the tour of an AIDS treatment ward in Cape Town.

"In that country, HIV/AIDS pandemic has such an impact on their nursing staff," said Uzzell, 52, who traveled from May 26 through June 9. "I saw nurses who were able to continue doing what nursing is supposed to be about, which is about caring and putting the patient first, continuing to give and to give, without complaint."

Uzzell, a registered nurse who is pursing a bachelor's degree in nursing at East Carolina University, asked supervisors at the state hospital to pay for the trip after receiving an invitation from the International Scholar Laureate Program.

"This is a once-in-a-lifetime opportunity will enable you to join other highly acclaimed college students on a journey of discovery to one of the most exotic destinations in the world," said a letter signed by Donna J. Snyder, the program director. "The legacy of apartheid will come alive for you as you venture to Soweto ... You will enjoy dinner under the African stars, hear tales of the bush as you spend your days with Kruger [National Park] game rangers and have plenty of time to explore on your own the wonders of this fascinating land."

Nowhere does the four-page letter, which features an official-looking seal incorporating an eagle with the globe in its talons, mention that the student is expected to raise thousands of dollars for the honor of participating.

According to the Better Business Bureau, the International Scholar Laureate Program is one of at least six names used by Envision EMI of Vienna, Va. -- a private, for-profit company that markets overseas travel to students and recent graduates.

A call to Envision's headquarters was not returned, but the company's Internet site touts its history of delivering "unique experiences" on five continents.

"To say we are an 'experiential education' company is akin to saying Microsoft is a software company ... true at the core, but doesn't at all capture the true essence," the site says. "At Envision, all of the 'experiential education' experiences we create and lead do far more than share knowledge by simply doing. They all impart wisdom."

More than a dozen complaints have been filed against Envision in the last three years, according to the Web site for the BBB chapter covering the Washington, D.C., area. But the business watchdog group gives Envision a "satisfactory" rating for resolving complaints from dissatisfied customers.

Jack St. Clair, the director of Cherry Hospital, said he and Uzzell's other supervisors approved spending the $5,000 for the trip. The money came from revenue the mental hospital receives through hosting students, primarily from medical schools in the Caribbean.

Uzzell, whose annual salary is $64,528, said she paid about $1,600 of her own money to cover a three-day extension to the trip.

"I suspect the trip gave her a renewed perspective on things," St. Clair said. "You know, we all kind of get caught up in our own world of work. To get out and see other cultures and to see how other people do things, as a way to benchmark and to help remind us what we are all about, what our priorities are all about, probably gave her a renewed focus that might not have been realized as readily as being here every day." Read more!

State takes control of mental health facility's finances - Wilmington Star-News

By Vicky Eckenrode - July 30, 2008

State health officials will take over the finances of Southeastern Center for Mental Health starting Friday in an attempt to get the beleaguered facility's budget under control.

The N.C. Department of Health and Human Services warned Southeastern administrators in March that the move was a possibility after the center began struggling meeting payments for client services with the state funding it had.

"We appreciate the efforts that you and your staff have undertaken to try to resolve the Center's financial difficulties," Department of Health and Human Services Secretary Dempsey Benton wrote in a letter Tuesday to Southeastern's area director Art Costantini. "Unfortunately, we do not believe that to date those efforts have been sufficient to ensure the Center's long-term financial viability and its ability to continue to provide adequate services for consumers.

"We have concluded that it is time for the Department to fulfill its statutory obligations."

The state agency has appointed Joy Futrell, assistant area director of East Carolina Behavioral Health, to serve as the administrator and work with Southeastern to stabilize its finances.

Her appointment does not replace any of Southeastern's current management team, Benton's letter stated.

But she will be take over responsibilities such as accuracy of financial records, contracts with providers, approval of any budget changes proposed by Southeastern and approval of all requests to spend more than $5,000 on anything not directly related to services.

Though the move by the state is unusual, it will not involve the center's actual operations.

"I don't believe that would impact in any way (the center's) normal actions," Phillip Hoffman, head of resource and regulatory management for the state's mental health division, said recently. "This is focused on their financial affairs."

Costantini said one of the main goals will be to work with the state's administrator on a plan to fix Southeastern's budget. He said state officials outlined a three-month goal to pull together and implement the plan so that Southeastern can reassume control of its finances.

"We're happy that someone is coming in, because now it becomes a joint decision-making process," Costantini said. "We needed that in terms of the (state) division's input."

The center's problems this year started when administrators realized they were going to receive less in state funding than they had expected for mental health, developmental disability and substance abuse services.

The center, which acts as a pass-through for state money to private providers, tried to scale back services that could be reimbursed. But the center still started its new fiscal year in July facing a shortfall between what it had to spend and what it projected the needs to be in the community.

According to a memo from Chris Coudriet, assistant county manager for New Hanover County, Southeastern should be spending $690,000 a month in state funds to make its budget. But the center in July, its first month of the new fiscal year, spent $1.4 million, wrote Coudriet, relaying the information from his meeting with center administrators to county commissioners.

Costantini said the shortfall stemmed from several factors, including reimbursements submitted under higher rates before the center clamped down further on services.

But, he said, the numbers are still not balancing out.

"That's the problem. We're spending at twice the rate that our budget called for," Costantini said. "That's why the state said they needed finally to come in."

Vicky Eckenrode: 343-2339

vicky.eckenrode@starnewsonline.com
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Push grows for guns on campus -Longview (TX) News-Journal

By JIMMY ISAAC - July 31, 2008

Weston Cartwright remembers his first week at LeTourneau University in 2006, and how he amazed his dorm mates when he returned unharmed from a walk to a South Longview restaurant.

"They were like, 'Are you serious?' " Cartwright said.

Since then, he's seen and heard why fellow students deemed a trip into the surrounding neighborhood such a serious mistake. The 20-year-old professional flight major said gunshots, some just a block away, can be heard at least three nights a week from his campus residence.

Longview police spokesman Kevin Brownlee doesn't doubt Cartwright's estimate, considering there were reports of shootings in that area as recent as July 20, when fatal gunfire at a gas station one block from the university left one mad dead and another man injured.

"I guess we've grown accustomed to it, which might be a more dangerous thing," Cartwright said from his hometown of Sewall's Point, Fla., where's he's spending his summer break. "You just deal with it because you don't have any way to defend yourself."

He is among thousands of U.S. college students who want that changed. In a letter to the Longview News-Journal dated June 16, Cartwright called for colleges such as LeTourneau to allow licensed students and school staff to carry concealed weapons. It's a stance touted by Students for Concealed Carry on Campus, a national group of more than 30,000 college students, faculty and parents who support concealed handgun rights on campuses.

Cartwright, like the national organization, points to recent school shootings such as those at Virginia Tech University in 2007 and Northern Illinois University in May as evidence that allowing concealed weapons on college campuses is necessary.

The Texas Penal Code prohibits people who aren't licensed peace officers from carrying firearms and other weapons on any school or educational institution whether public or private. The law gives colleges the authority to allow firearms on campus, but it's not clear whether that allowance can be given to individuals or the whole student body, said Terrence Turner, LeTourneau University's director of campus security. The Texas Attorney General's office found no court decisions that could provide legal opinions on how that clause is interpreted.

Cartwright wants LeTourneau University to allow students to at least carry concealed weapons in their cars, but the university — like most East Texas colleges — maintains a gun-free zone.

"That's been an ongoing conversation among students and even faculty and staff," said Doug Wilcoxson, the university's vice president of student affairs. "It's just been the legislation that we fall under."

Utah became the first state to allow concealed weapons on state-supported colleges in 2007. At least a dozen states are considering such bills, and state Sen. Jeff Wentworth, R-San Antonio, said he will introduce a similar bill when the Legislature convenes in January.

Sen. Kevin Eltife, R-Tyler, and Rep. Tommy Merritt, R-Longview, agree with the idea and said they will likely support Wentworth's bill.

Texans must be at least 21 to get a concealed handgun license. Having older, more experienced students and faculty members — some who may have served in law enforcement or military duty — with concealed weapons might deter a school shooting in Texas, Wentworth said.

"I just think it brings a measure of safety that does not currently exist on college campuses," Wentworth said in a telephone interview. "At least it would put on notice those wacky people who go on campuses because everyone is unarmed and defenseless."

Texans for Gun Safety, a Houston-based group that seeks to reduce gun violence through education, does not support such legislation unless steps are taken to ensure mentally ill students or faculty are not carrying weapons. Tommie Garza, the group's executive director, said arming such students is the last thing any campus needs.

"It just doesn't seem like a sensible plan," Garza said. "In a workplace or a school, emotions run so high there. (If a gun is off campus) at least you have that distance to cool off, think it over."

Seung-Hui Cho, a 23-year-old undergraduate, killed 33 people at Virginia Tech before committing suicide on April 16, 2007. He had been declared mentally ill by a Virginia special justice in 2005.

In February, former Northern Illinois University student Steven Kazmierczak, 27, opened fire on that campus, killing five students and himself. His ex-girlfriend told CNN that he had stopped taking medication for anxiety, depression and insomnia three weeks earlier.

Turner, whose 33-year law enforcement career included stints with the U.S. Air Force Security Police, the Arizona Highway Patrol and Longview Police Department, does not carry a firearm as director of LeTourneau's security force despite being a state-licensed peace officer. He credits rapid response time from Longview police as a reason for low crime on his campus, but he's not convinced LeTourneau will remain a gun-free environment.

"I think we have to look at the contingencies both ways because the lawmakers are going to follow their constituency," Turner said. "We have to make sure we are prepared no matter the circumstance."

* * *

Crime on local college campuses

Officials at LeTourneau University and Kilgore College say their campuses are safe.

In its most recent crime data from the U.S. Department of Education, LeTourneau University saw an increase in burglaries in 2006 compared with the previous two years.

There were 17 burglaries and three car thefts reported in 2006, compared with 16 burglaries and no car thefts in 2004 and 2005 combined. There were two aggravated assault cases and no other reported violent crimes during that three-year period, the data shows.

Terrence Turner, the university's chief of campus security, said there have been one vehicle burglary, one residential burglary and one burglary of a coin-operated laundry machine reported to security personnel in the past year at LeTourneau.

"What I can say is if you looked at our crime statistics, we are a very safe campus," said Doug Wilcoxson, the university's vice president of student affairs. "How do we keep our students and employees safe (is first and foremost). In the midst of this part of the community, we've been a very safe place."

Kilgore College spokesman Chris Craddock said there have been no incidents involving firearms on its Longview and Kilgore campuses in the past year. The college has never authorized anyone besides campus and local law enforcement to carry any type of weapon on school property, he said.

Since Sept. 1, Kilgore College has had reports of four assaults, 16 residential break-ins and 17 car burglaries, according to campus Police Chief Bill Lewis. There have been five car burglaries since surveillance cameras were installed campus-wide in December.

Lewis said he would oppose letting students carry concealed weapons on campus.

"We're a small college — about 5,000 students," Lewis said, "but could you imagine if just a tenth of our student body — 500 people — were carrying weapons?" Read more!

Judge rules Bixby patriarch mentally unfit to stand trial - Greenwood (SC) Index-Journal

By KENNY MAPLE

Arthur Bixby might never have a day in court regarding his role in a 14-hour standoff that resulted in the deaths of two Abbeville law officers.

In probate court Tuesday, the accused murderer was found to be mentally ill and a danger to himself and others, Eighth Circuit Solicitor Jerry Peace said.

Bixby, who had been incarcerated at Johnson Detention Center in Laurens, has been committed to the Department of Mental Health.

“What that means is that the Bixby case is done for now,” Peace said. “We can’t try him until he becomes competent.”

The solicitor said those chances are slim for the 79-year-old.

Bixby was deemed not competent to stand trial by Judge Wyatt Saunders in Laurens County. As reported in The Index-Journal, Saunders ruled Bixby, who suffers from a form of dementia, was not and would not become competent.

Attention has been on the accused recently, although his family has been involved in a string of legal issues over the years.

On Dec. 8, 2003, Abbeville County Sheriff’s Office Deputy Danny Wilson and Constable Donnie Ouzts were shot to death in front of the Bixby home at 4 Union Church Road in Abbeville.

Those shootings sparked a 14-hour standoff between law enforcement and Arthur and son Steven Bixby. Both men were eventually apprehended. Arthur Bixby also was shot.

His son was found guilty on two counts of murder in February 2007 and sentenced to death by Judge Alexander Macaulay. He is on death row at a Ridgeville correctional facility.

Rita Bixby, Arthur’s wife and Steven’s mother, was found guilty of conspiracy and two charges of accessory before the fact of murder. She was sentenced by Macaulay to two life terms in prison without the possibility of parole.
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Scott Hadley, who swam to fame as teen, now tries to stay afloat as adult - Sacramento Bee

By Blair Anthony Robertson - brobertson@sacbee.com

According to the yellowed press clippings from the summer of 1970, Scott Hadley was on his way to something big – a successful life, standing in the community, or so it seemed.

Back then, nearly four decades ago, the newspapers and TV stations covered his exploits as a swimmer, especially when the lanky and lean 15-year-old swam 19 miles across Clear Lake, the largest freshwater lake in California, in 11 hours and 53 minutes.

Fifteen boats followed Hadley in the water. A representative from the Amateur Athletic Union was there to certify the record. Sports Illustrated put him in its "Faces In the Crowd" section 19 days later.

It was a simple time for Hadley. He got into the water. He stroked and kicked and breathed. The rest took care of itself.

Hadley knew important people in politics and business and was on a first-name basis with Debbie Meyer and Mark Spitz, Olympic swimming superstars. While still a teenager, the 6-foot-1 Hadley was ranked ninth in the world among marathon swimmers. At Encina High School, he was elected student body president only weeks after transferring from Sacramento High.

These days, it's a different story, a different Hadley.

People look right past him. He's 53, has fought off his demons with cocaine, and has been in and out of homelessness. He often sleeps alone along the American River with a few possessions and the cell phone his sister gave him.

"I'm just relaxing under a tree. It's probably 15 degrees cooler under here," he said by phone the other day. "I'm watching the river go by. It's very serene."

Practically everyone in the family has cut him off except sister Dana Hadley, who says she feels bad when she helps him and worse when she doesn't.

"It's just heartbreaking. He burned many, many bridges," she said. "It was a bane to my mom until she died. I cannot tell you the emotions she went through until she finally said, 'You have to stay away.' "

Politically conservative and a devout Catholic, Scott Hadley eschews government handouts and says he chooses to live a pared down life. He doesn't own a car. He stretches his money by eating the $2.99 special at Del Taco: two burritos, a taco and a small drink.

Maybe it was a curse that the high point in his life came 38 years ago, and that he could never seem to top it or, at least, build on it.

"To him, it's his big accomplishment. It picks him up and makes him feel like somebody," said sister Dana, who witnessed the swim. "He got praise from my dad. Afterwards, dad was so happy, he bought (Scott) a car."

He swam Lake Berryessa two years later. In 1973, sponsors flew him to Naples, Italy, where he placed ninth against the 125 best distance swimmers in the world. He used each swim to raise thousands for charities for the mentally ill.

But it didn't take long before people forgot him. In the spring of 1974, he tried to run clear across the country, attracting media attention once more, only to drop out in pain after a few days.

"Sometimes I had like delusions of grandeur," he said. "I wanted to run across the country and meet President Nixon. But I dropped out. I just couldn't do it."

These days, with a spotty employment history that includes a career as a funeral home embalmer and, more recently, a caregiver for the elderly, Hadley is struggling to get on track.

Often, he will think back to that swim in 1970 in Clear Lake, how the whole world seemed to be watching, how it began in the dark at 5:22 a.m. and how, halfway into it, it was too hard, too much, and he wanted to quit.

"I told myself, 'Wow, this is harder than I thought.' At the halfway point, I told my dad I wanted to get out of the water," Hadley recalled. "My dad was in the boat and he said, 'We didn't train this hard for you to quit.' "

After high school, he enrolled at American River College, but he didn't know what he wanted to do. He knew there was no money in swimming. His part-time job at a funeral home turned into a 15-year career as an embalmer.

"Then I was introduced to this white stuff called cocaine," Hadley said. "I was losing money. I lost my job. That whole beautiful life I had was gone."

By his early 40s, a disillusioned Hadley landed at a mission in Santa Barbara, the same town where he had run for City Council. He wanted to kill himself.

"For me, it felt like being in a barrel. You try to climb out and then you slip back down," he said. "It was a whole downward spiral. I was angry at God. I said, 'Why have you done this to me?' But I had really done it to myself. I blamed everybody else."

Hadley's life is not a comeback story, at least not yet. In swimming terms, he's struggling to stay afloat.

He can recall that 1970 swim as if it were yesterday, how his mother put together a blend of liver and honey he could eat in the water for energy, how the only thing he wanted after 12 hours in the lake was a plain old hot dog.

After that, things get hazy. The choices he made are hard to explain or even recall.

He has filled out applications for caregiver jobs. He shaves every day in a public restroom. He dresses neatly. And he waits for answers under that shade tree, watching the river go by.

Once in a while, he'll jump in. The strokes and kicks are stiffer now, the breaths more labored, but he's still that swimmer who made history, the one whose story remains alive in those yellowed press clippings.

"I'm never really alone," he said. "I have what I believe to be God with me. I have memories of good people, and memory is a form of companionship."
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Divided board OKs mental health director’s contract - Waynesville (NC) Smoky Mountain News

By Julia Merchant • Staff Writer

In a move that appears to be uncommon in the North Carolina mental health care field, the board of the Smoky Mountain Center for Mental Health last week approved a five-year contract for organization director Tom McDevitt.

Smoky Mountain Center is the local management entity in charge of overseeing mental health care in 15 western counties — more counties than any other such entity in the state.

The contract guarantees McDevitt a $164,892 per year salary, full employee benefits package and car until Sept. 1, 2013, when he plans to retire.

A request for salary information of the directors of the 24 state local management entities gathered responses from 15. Of those, McDevitt was one of only two that has a contract and is one of the three highest paid directors in the state.

The contract did not sit well with everyone, and divided the board in a 16 to 8 vote.

The eight who voted against the contract were from the original seven counties overseen by the Smoky Mountain local management entity. The rest of the board members are from counties to the north and east which have since merged with the organization. Three counties — Caldwell, Alexander and McDowell — only came on board July 1. The new additions now form a majority on the board, replacing that held by the seven original counties.

Some questioned why an emergency meeting was necessary since McDevitt had two years remaining on his contract.

Board members who voted against the contract have recently butted heads with McDevitt over accusations that he has abused his leadership position. They were quick to say, however, that their opposition to the contract wasn’t a personal attack on the organization’s director — rather, they called a contract unnecessary overall.

“It doesn’t matter who was in that position, but a five-year contract just seemed excessive at this time when a lot of things are unsettled in the mental health field,” said Ronnie Beale, a Macon County commissioner. Beale and McDevitt have been at odds since McDevitt threatened to pull Smoky Mountain out of a Macon County Mental Health Task Force. In a letter, McDevitt accused Beale of attacking the organization for perceived shortcomings.

Haywood County Commissioner Mary Ann Enloe was also opposed to the five-year contract.

“I think employment more or less stands for itself,” she said. “I don’t know what the purpose of a contract would be. Usually if you realize that the situation is not a good match, you don’t throw people out on the street.”

Problems between McDevitt and his board reached a fever pitch in June when McDevitt abruptly announced his resignation at a board meeting after an hour-long closed session argument over the contract and a new set of bylaws. He later retracted his announcement.

As a result of that incident, board members strived to make sure Smoky Mountain Center was protected in the contract if McDevitt was to resign his post.

“What if you got mad and quit and just went home? What kind of protection does Smoky have?” asked Swain County Commissioner Glenn Jones.

Under the contract, if McDevitt leaves before the five years is up, he’s entitled to a three-year buyout. But McDevitt can’t receive the buyout if his departure is connected to a failure to give his best effort in Smoky’s interest. Board members initially wanted that statement clarified, but board attorney Jay Coward said that wasn’t necessary. Any board decision to terminate McDevitt would be up for interpretation and would probably be contested in a court of law anyway, regardless of whether there was more clarification in the contract.

McDevitt took issue with the vagueness of the interpretation of what it meant to fail to act in the Smoky Center’s best interest.

“I think it’s so vague and ambiguous that anything I don’t do in the satisfaction of the board gives them reason to terminate my employment,” he said. He said an independent party, like a court of law, should be in charge of evaluating whether he acted in the best interest of the organization.

Ironically, McDevitt came under fire at the last board meeting for the same thing he was protesting. At that time, McDevitt attempted to amend the bylaws by including a phrase allowing for the termination of a board member at any time if they expressed negativity or criticism toward Smoky Mountain Center. The board protested and the phrase was removed.

During the meeting to approve the contract, board members raised questions about some of McDevitt’s practices. Smoky Mountain Center’s nepotism policy was a topic of concern. McDevitt’s daughter is employed by the organization, and some questioned whether she received special treatment.

McDevitt defended her employment, saying her position in medical record disposal was temporary and would be finished within eight weeks. He said the nepotism policy had become somewhat lax because of the difficulty of finding qualified employees, and that far from receiving special treatment, his daughter is the lowest paid employee in the agency.

The fact that the daughter’s position was temporary was news to Enloe.

“Never had it been mentioned to me before that it was a temporary job that would be ending,” she said.

Enloe asked about the involvement of McDevitt’s wife, who is a Realtor, in the sale of property owned by the Smoky Mountain Center.

“When Smoky sells or buys property, what real estate firm or agent handles that?” she asked.

McDevitt responded that the organization doesn’t own any property. Enloe then asked whether McDevitt’s wife was in any way involved in property transactions for the organization.

McDevitt said his wife is a Realtor with Main Street Realty, in Waynesville, though not a broker, and that “she’s been involved in assisting the foundation and purchasing properties.” The Evergreen Foundation is the private arm of the Smoky Mountain Center that owns the organization’s assets. McDevitt said that Enloe’s question was “answered in the affirmative at this point.”

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Homeless man finds comfort in Catonsville - Baltimore County (MD) Catonsville Times

By Marcia Ames - mames@patuxent.com

7/30/08 -Every now and then, as Nora Reiter drives by Salem Evangelical Lutheran Church, she'll lower her car window and ask Mark Hoffmann whether he wants some dinner.

She knows to find the 51-year-old, homeless man sitting on a bench outside the Frederick Road church, reading a newspaper or gazing at the passing traffic.

Often, he accepts her offer of food and always politely.

"I know he likes beef better than fish," said Reiter, who typically drives to the nearest fast-food chain restaurant, buys a hamburger and delivers it to Hoffmann.

"Please don't make it sound like I'm a saint," she said, agreeing to be interviewed for the Times. "All of our parishioners are being charitable toward him."

A pastoral associate and business manager at St. Mark Catholic Church on Melvin Avenue, Reiter first encountered Hoffmann in June after he began taking Holy Communion at St. Mark.

By coincidence, a Greensboro, N.C., resident familiar with Hoffmann's disappearance from that city visited Catonsville earlier this month, attended Sunday Mass at St. Mark and recognized him there.

By mid-July, Reiter had learned through his friends in Greensboro, and his 27-year-old daughter, Stroudsburg, Pa., resident Kimberly Bono, that Hoffmann had been missing since May from his seven-year residence on a park bench in the North Carolina city.

"Those people were good to him and made him feel like he was OK," she said, referring to churchgoers, merchants and residents in Greensboro. "I can't imagine how scary it would be to live out on a bench or in the woods. That would terrify me."

No one other than Hoffmann may know why he left Greensboro and caused so many to worry about his whereabouts and welfare.

Nor do they know how he made his way some 350 miles north to Catonsville.

He declined an interview with the Times, saying, "I don't want to make a statement.

"It is very kind of you to ask," Hoffmann said, holding a folded newspaper close to his face.

Bono was on vacation last week and unavailable to comment.

Having pieced together Hoffmann's history from St. Mark records, Greensboro residents and Bono, Reiter says the Catonsville native rarely speaks to anyone, has repeatedly declined housing or social services assistance and probably has a mild form of schizophrenia, including hallucinations.

His parents, Murray and Viola Hoffmann, joined the St. Mark parish in 1954, and the church recorded his birth in March 1957.

The parents lived on Locust Avenue when they died as members, she in 1994, he the following year, Reiter said.

State tax records show they had lived there since 1963, when Mark, the youngest of four children, was 6 years old and starting school at St. Mark.

He remained at the school through the eighth grade, then graduated from Mount St. Joseph High School. He later graduated from Lehigh University and worked for a while as an accountant at Duke University in Durham, N.C., 53 miles east of Greensboro, according to Reiter.

How and why he found his way to a bench in Greensboro seven years ago remains a mystery, as does his reason for leaving.

A regular presence at the church, he rarely misses Mass on weekday or Sunday mornings, Reiter said.

At the Coffee Junction on Frederick Road, owner Donna Quick noted that he comes into the shop almost daily to buy a cup of coffee, which he drinks while sitting on a chair outside the store.

"He tells you what he wants and says 'thank you,' " she said, adding that he always wears a coat and long pants despite the summer heat.

She offered no complaint about his presence there.

"He brings out the best in people," said Reiter, who knows of only one person, a businessman, who had complained of Hoffmann's presence in Catonsville.

"They are losing out on a great opportunity to be charitable," she said. "Mark is a very gentle soul."
Read more!

Fatal police shooting is a real tragedy -Silverton (OR) Stayton Mail

Commentary: CARL SAMPSON -July 30

When I think about the case in which a Silverton police officer shot and killed a man with mental problems, all I can conclude is that there are no winners.

What transpired that evening, after a homeowner called 9-1-1 as a man threw himself against the front door of her house, could only be described as nightmarish.

Having said that, I could have only wished for a different outcome, in which everyone ended the evening safely: the man, the police officer, the homeowner and her family.

As is so often the case, wishful thinking and reality are two divergent outcomes. When people die, we all think that there could have, and should have, been a better outcome.

Yet, in the heat of the moment, with a police officer under attack and a man out of control, I cannot say what I, or any other reasonable person, might have done differently if we were in his shoes.

That was among the findings of a Marion County grand jury last week, which found that Officer Tony Gonzalez’s actions that evening were justified. Yet, that finding gives no one solace. Not the family of Andrew Hanlon, for sure. And not the officer, members of the police department or anyone else involved.

There can only be the hope that similar incidences might be avoided in the future. The question is: How could similar instances be avoided?

It’s no secret what I think about the American health care system. In my opinion, it can best be described in terms of haves and have-nots.

The haves — those with fat wallets or gold-plated health insurance policies — get what they need, when they need it.

The rest of us, well, we’re just out of luck, aren’t we? Without the money to pay for treatment, we’re left to our own devices.

Politicians yap about this Band-Aid or that idea to throw the public a bone, but none of them is really interested in solving the problem, which boils down to a lack of access to health care for most people.

That’s especially true when it comes to mental health care. That people don’t receive the care they need, to me, is plain shameful.

What’s even more shameful is when a problem arises, it becomes a police matter. I do not know the details of the man involved in this most recent tragedy. However, I do know that health care, particularly mental health care, is hard to come by, and that people who are mentally ill or who have problems need ongoing treatment. Without it, tragedies like the one that took place that night in Silverton are not only possible, they’re inevitable.

Carl Sampson is a freelance writer. He can be reached at pcsampson@wvi.com. Read more!

Schizophrenia Yields Some Genetic Secrets - Washington POst

By Amanda Gardner - July 30, 2008

WEDNESDAY, July 30 (HealthDay News) -- Moving closer to the causes and effective treatment of schizophrenia, researchers say they've found specific gene variations linked to the condition.

Specifically, three rare deletions in the human genome appear to raise the risk of developing the devastating brain disease considerably.

"These findings give a great deal of hope -- for individuals with schizophrenia and their families and loved ones and caregivers -- that we're moving towards an understanding of the causes of the disease," said Dr. Pamela Sklar, corresponding author of a paper appearing inNatureand director of genetics at Harvard Medical School, Boston.

Additional findings, all reported at a Tuesday press teleconference, are detailed in two other papers published in the July 30 online editions ofNatureandNature Genetics.

But the current findings are just the tip of the iceberg, the researchers stressed.

"We've only explained a tiny fraction of why people might develop schizophrenia, and much more work needs to be done to connect specific changes to the full spectrum of other types of genetic factors that might influence schizophrenia, as well as ways they might interact with the environment," added Sklar, who is a member of the International Schizophrenia Consortium, which conducted one of the studies.

Schizophrenia, a devastating disorder characterized by hallucinations and delusions, affects some 1 percent of the population, usually appears in late adolescence or early adulthood and, despite some effective treatments, tends to be chronic.

Breakthroughs in understanding this disorder have been few and far between.

"We've been working on schizophrenia for rather more years than we care to think, and successes have not been dramatic," acknowledged Michael O'Donovan, lead author of theNature Geneticsstudy and professor of psychiatric genetics at Cardiff University in the United Kingdom.

"There has been precious little on diseases of the brain, and what seems to be emerging is that a lot of risk of brain diseases, including schizophrenia and autism, seems to be conferred by rare [gene] variants like rare deletions," said Dr. Kari Stefansson, senior author of one of theNaturepapers and CEO of deCODE in Reykjavik, Iceland.

Schizophrenia tends to run in families, hence the focus on genetic determinants of the disease.

The first two papers, inNature, compared the genomes of 3,300 individuals with schizophrenia against those of 3,200 individuals without the illness.

"We looked at a relatively rare type of DNA change where people have a substantial portion of a chromosome either missing or extra. These are called copy number changes," Sklar explained.

In this case, the consortium found three deletions: one on chromosome 1 and two on chromosome 15, which were seen multiple times in people with schizophrenia. Two of the deletions had never been recognized before. "That triples the number of specific DNA areas that may be responsible for schizophrenia," Sklar said. "All of these together were found in about 1 percent of patients." But they conferred a very large risk, multiplying the odds of getting schizophrenia by a factor of more than 10, Stefansson said.

TheNature Geneticspaper identified three "single-nucleotide polymorphisms" (changes) or SNPs that were associated with schizophrenia and appear to be risk factors for the disease. The strongest association was with a variant near the gene ZNF804A, whose function may be to regulate other genes.

According to O'Donovan, other researchers have looked at what are called "whole chapters" in the genome. In contrast, his team honed in on what he described as tiny spelling differences.

The variations identified are much more common than those reported in the previous two papers.

"In addition to rare variants, we were able to convincingly show that common variants are involved in schizophrenia. But we don't know how much of a role they play compared with rare variants," O'Donovan said. "It means that virtually all of us have genes for schizophrenia, but probably those of us who don't have schizophrenia don't have enough of the genes or possibly have not been exposed to [an environmental stimulus]."

"Schizophrenia is the ultimate human disease, affecting the things that characterize us as individuals," Stefansson added. "Perhaps with a little bit of luck, we will gain insight into the pathogenesis of schizophrenia . . . and will discover enough of the variants to put together meaningful diagnostic instruments for this very difficult disease."

More information

There's more on schizophrenia at the U.S. National Institute of Mental Health.

SOURCES: July 29, 2008, teleconference with Pamela Sklar, M.D., Ph.D., director, genetics, Harvard Medical School; Kari Stefansson, M.D., CEO, deCODE, Reykjavik, Iceland; and Michael O'Donovan, Ph.D., professor, psychiatric genetics, Cardiff University, U.K.; July 30, 2008, online editions,NatureandNature Genetics Read more!

Hospital could lose all federal payments -San Diego Union-Tribune

By Cheryl Clark - July 30, 2008

Sharp Grossmont Hospital in La Mesa has the county's busiest emergency department.
The mistakes, documented by state investigators during two inspections in April and May, included staff members restraining a highly medicated, 25-year-old man with schizophrenia in such a way that he was allowed to suffocate. In addition, hospital workers caused the death of an 83-year-old woman who had undergone a hysterectomy by injecting a dangerous anti-narcotic into her bloodstream.

Other problems included nurses who did not know or use proper CPR, an unsanitary operating-room mattress held together by tape and glue, unsafe storage and handling of food and kitchen equipment, and use of critical medications such as heparin that had expired up to a year earlier.

The investigators also said Sharp Grossmont did not have the required specialists to evaluate emergency patients needing urologists or hand, plastic and oral surgeons. Sharp Grossmont has the busiest emergency department in the county, with about 78,000 patient visits a year.

Loss of federal reimbursement would cripple most hospitals, including Sharp Grossmont, which receives 50 percent of its net patient revenue from Medicare and Medicaid, known as Medi-Cal in California. The two programs cover treatment for seniors, the poor and the disabled.

Dan Gross, executive vice president of Sharp HealthCare, said he was confident the hospital is now in compliance.

“I'm a nurse, and my heart is with every patient and every family,” Gross said. “We at Sharp are so unhappy and so keen to determine what we missed, what could we have done differently and what can we do better. We have an expectation that we provide nothing but the highest quality of care.”

In the spirit of acknowledging Sharp Grossmont's faults and efforts to correct them, Gross provided a copy of the 100-page federal report one day earlier than the government's planned release.

Sharp Grossmont's leaders had until yesterday to document how they had fixed or are addressing the deficiencies. On the deadline day, they hand-delivered their “Plan of Correction” to the Center for Medicare and Medicaid Services' regional office in San Francisco.

Regulators will review the hospital's response and schedule another visit by state inspectors, who work on behalf of the federal government. Sharp Grossmont could lose its federal money by Oct. 15 if problems continue, said Steven Chickering, head certification officer at Medicare's office in San Francisco.

Among the 450 hospitals in Chickering's jurisdiction of Hawaii, California, Nevada and Arizona, 10 to 12 a year have as many major lapses, he said. Ninety-nine percent of those facilities resolve their crises and keep their federal payments, Chickering said.

The violations at Sharp Grossmont “indicate a serious breakdown of the hospital's systems that are designed to ensure appropriate patient care,” said Kathleen Billingsley of the state Department of Public Health, which inspected Grossmont's quality of care.

Chickering called the problems “significant” in five of 18 critical categories: oversight by the hospital's governing body, observance of patient rights, monitoring and improving quality of care, nursing services and physical environment.

“These areas really need close attention and significant changes to ensure good outcomes for the patients,” Chickering said.

Gross and Michele Tarbet, Sharp Grossmont's CEO, said they have launched intense educational programs and taken disciplinary action against employees to put the hospital back on track.

They also said hospital officials have dramatically beefed up professional training of nurses and other staff members, launched rigorous reviews of the psychiatric unit and re-evaluated food storage and maintenance of food-preparation equipment.

Sharp operates the hospital under a long-term lease with the public Grossmont Healthcare District, which opened the hospital more than a half-century ago.

Gloria Chadwick, who serves on the district's board, said she and other board members knew nothing about the problems.

“Certainly it would be a public discussion, but there's been nothing like that at all,” Chadwick said. “This is certainly a concern for the community.”

The deficiencies at Sharp Grossmont first came to light in April, a few weeks after Larry Napolis, a 45-year-old heart attack victim, was placed on a ventilator in the hospital's catheterization lab. The ventilator was not turned on, said state investigators and the San Diego County medical examiner.

Napolis died March 21. The fatality was not reported promptly to state and federal officials as required, state investigators said.

As a team of state inspectors looked into the case in April, another preventable death occurred at Sharp Grossmont.

Jeffrey Christopher, 25, of Bonsall was playing cards with his mother on April 11 and became agitated when visiting hours ended at the hospital's psychiatric unit. Christopher had a history of becoming unsettled and then falling to his knees, resulting in wounds to his knees and feet.

The unit's workers took Christopher to his room and had him lie down on his stomach. They secured him to his bed with restraints at the wrists, ankles and waist, keeping his head and neck above the mattress. They also gave him several medications for his schizophrenia, including ativan and thorazine.

Although nurses continuously monitored Christopher, they did from a chair facing his feet instead of following the standard practice of checking a patient's face. One nurse assigned to his room said she saw him “scoot and wiggle himself lower onto the bed until his face was on the mattress,” according to a report by the county's medical examiner, who conducted an autopsy on Christopher.

“He then began violently hitting his face against the mattress and metal frame of the bed,” and held his breath, the medical examiner's report said.

During a staffing rotation, another nurse entered the room and saw that Christopher had turned blue.

The Medicare report said a nurse tried to resuscitate Christopher, but did not follow American Heart Association guidelines because he had not been trained adequately. Christopher died that night.

At least one-quarter of the federal report, which did not mention Christopher by name, is devoted to chronicling the series of errors that resulted in his death.

“The staff did not intervene by repositioning the patient onto his back so that he would be unable to bury his face in the mattress,” it said.

The federal report also faulted Grossmont officials for not reporting this death until six days after it happened. The government requires official notice within a day.

Gross and Tarbet, the Sharp executives, said a licensed vocational nurse who was watching Christopher didn't notice that he had suffocated.

“The (nurse) assumed that since the patient had been sedated, he was resting quietly,” Tarbet said.

Attorney Peter Haven is investigating Christopher's death for his parents, Barbara and James Christopher of Bonsall.

After learning about the federal report's contents, Haven said the inspections “confirm what we already suspect – that restraints were used inappropriately in at least one instance, and it appears there may be more widespread problems at this medical center.”

Cheryl Clark: (619) 542-4573; cheryl.clark@uniontrib.com Read more!

Cop shown clubbing cuffed vet, taking call, then going on the attack again - New York Daily News.

Vet discharged for post-traumatic stress. Title link leads to video link

BY OREN YANIV AND ALISON GENDAR
DAILY NEWS STAFF WRITERS

A city cop caught on tape beating a handcuffed Army vet paused to take a phone call and then went right back to smashing the man with his baton, police sources told the Daily News.

Officer David London, 43, was stripped of his gun and badge Monday and placed on desk duty as the NYPD Internal Affairs Bureau investigated the July 18 incident, sources said.

"He takes a cell phone break, then turns back to tuning up the [suspect]. He did it while the building security camera was rolling," a source said.

London and his partner stopped Walter Harvin, 28, as he tried to enter the DeHostos Apartment on W. 93rd St., where Harvin's mother lives, about 1:15 a.m.

"I told him don't close it because I don't have the keys," said Harvin, a vet who was discharged in 2004 for posttraumatic stress disorder.

"As I walked into the elevator he grabbed my arm. That's when I pushed him," Harvin said. "I was on the floor and he kept beating me with the stick. He sprayed me with Mace. While I was on the floor, he handcuffed me. I don't remember too much about it."

Security video from the building showed London beating Harvin after he was cuffed and on the ground, a source said.

"You are not supposed to beat a man once he is cuffed, but the video shows the [suspect] down on the ground, cuffed. They even stand him up in the corner and beat him with the [baton] some more," said a police source familiar with the security video.

As London and his partner propped the handcuffed war vet up against a wall, London's cell phone rang, sources said.

Video showed London talking on the phone for 90 seconds before he resumed beating Harvin, sources said.

London told colleagues Harvin went berserk when he was asked to show identification or proof he was entitled to be in the building.

Harvin started punching and kicking the cops, screaming, "You can't take me!" court papers say.

"He is a big guy who fought being cuffed, kicking. He was not quiet, lying there like a lamb," one source said.

London took the cell phone call only because it was an emergency, another source said, although he wouldn't elaborate.

Harvin said he didn't remember much of what happened once the beating started. He was charged with assault and resisting arrest and was released pending a hearing.

Harvin said he told the cop he served 3 1/2 years in the 101st Airborne Division, including six months in Iraq.

"[London] said he was in the Navy. It didn't matter to him. He said I was a disgrace," Harvin said.

oyaniv@nydailynews.com Read more!

Police: Killer thought victim was warlock -KOB-TV Albuquerque (NM)

Video link by clicking title.

Andres Eligeo

Bernalillo County deputies say a mentally ill man at a South Valley group home stabbed to death a roommate after a voice in his head told him the victim was a warlock.

The victim, Samuel Whitehorse, 44, was found cut in the abdomen sitting against a bathtub early Wednesday. He died later at a hospital.

Deputies arrested 27-year-old Andres Eligeo Ortega on charges of murder and tampering with evidence. He was held on a $1 million bond.

Ortega told officers a voice in his head named Steve told him to kill because Whitehorse was a warlock. Investigators say the suspect also believed he worked for the FBI and that he was aiding them.

"Based on the interviews, it sounds like he really thought he was being helpful and that it was a good, just decision as opposed to a vendetta against Mr. Whitehorse," said Sheriff's deputy Mark Kmatz.

The home's caretaker told police that Whitehorse told her he was afraid of Ortega and had made arrangements to move. Ortega and Whitehorse had a confrontation the night before in which Whitehorse said he felt threatened.

Ortega has a criminal record which includes domestic abuse and burglary charges stemming from 2002. He was ruled incompetent to stand trial and committed to a state mental hospital in Las Vegas.

(The Associated Press contributed to this report) Read more!

Suicide rates are higher in the desert -Riverside (CA) Press-Enterprise

Mark Muckenfuss - July 29

RIVERSIDE, Calif. -- People who live in the desert are far more likely to kill themselves than those who live in more temperate regions of California's Inland area.

Local officials seemed baffled by the data revealing the trend.

Experts emphasize that numerous factors might influence these numbers, including age, sex, income levels and even illegal drug activity.

While desert dwellers make up 24.7 percent of San Bernardino County's population, figures from the San Bernardino County coroner's office showed that they accounted for 36.9 percent of the suicides from May 2004 through May 2008.

That difference meant that those living in the High Desert areas such as Victorville, Barstow and Yucca Valley were 49.4 percent more likely to take their lives than the general population.

The figure is lower in Riverside County. Based on data from the same four-year period, those living in desert regions east of the Banning Pass were 30.1 percent more likely to commit suicide than those living west of the pass.

Eve Moscicki is associate director for prevention at the National Institute of Mental Health in Washington, D.C. She cautioned against drawing conclusions from the data.

"I would want to control for a lot of different factors such as age, sex, race, ethnicity, socioeconomic status," she said. "You want to control for that and rule out all of those things first."

Neither Moscicki nor any local experts contacted for this story knew of any studies on suicide that had looked at physical environment or geographical location as a risk factor.

"For years there were theories that suicide rates in the Northern Hemisphere were higher than the Southern Hemisphere," she said. "I'm not sure that's the case any more."

She did note that in Europe, suicide rates can vary from country to country. Many social factors, she said, play into those differences. "There's never a single explanation," she said.

Some regional trends have been noted in the United States as well.

"At a very crude level," she added, "we've known for years that suicides tend to be highest in the western states."

How much of a role environment plays in this is unknown. Moscicki pointed out both Nevada and Alaska rank consistently in the top 10 but share few similarities when it comes to climate or terrain. Both, however, have large areas of sparsely populated land, and isolation, she said, can be a risk factor.

And while western states' suicide rates tend to be higher -- particularly states in the Southwest -- California is an exception.

In 2005, the national suicide rate was 10.9 per 100,000 people. California's rate was 9.1, ranking it 42nd in the country.

In 2007, San Bernardino County's population was 2,026,325. With 157 suicides that year, it would have a rate of 7.7 per 100,000. Riverside County's rate for the same year was 9.4.

Augustine Kposowa is a professor of sociology at University of California Riverside who has studied the area's suicide demography. He had not noticed the trend of higher rates in desert areas, but he said the environment could be a factor.

"Extremely hot conditions can cause people to begin to ask questions as to whether life is worth living," Kposowa said. "They look around themselves and see nothing but very hot weather, the vegetation dying they are more likely to answer in the negative."

Kposowa also said age could be a factor and it does appear to have some influence on the numbers in question. For desert dwellers over age 50 in San Bernardino County, the risk of suicide is even greater. They account for 41.2 percent of suicides in that age group, making them 66.8 percent more likely to commit suicide than the general population.

But older people make up a larger percentage of the population in the desert. The most recent age demographic data for San Bernardino County was culled from the 2000 census.

It showed that 26.2 percent of the county's 50 and older population lived in desert areas. Even adjusting for the higher percentage, those over 50 are still 57.3 percent more likely to take their lives if they live in the desert. The risk is the same when looking at those over 70. Read more!

Death at state facility now requires autopsy -Raleigh (NC) News & Observer

Michael Biesecker

RALEIGH - Gov. Mike Easley signed a new law that requires all deaths in state mental hospitals to receive a formal review by a medical examiner.

Easley signed the bill, which was approved by the legislature July 18, late Monday night with several other bills he wanted to clear from his desk before going into the hospital for shoulder surgery, Easley press secretary Renee Hoffman said Tuesday.

The new law was enacted after a series of articles in The News & Observer that detailed 82 questionable patient deaths in state mental hospitals and homes for people with developmental disabilities.

Many of those patients' bodies were buried or cremated without being autopsied or examined by a pathologist.

State law already required that deaths resulting from homicide, suicide, accidents or unknown causes be reported to a medical examiner. The N&O's review of patient deaths in the state's 14 mental institutions since December 2000 showed that some recorded as "natural" and not reported were known by staff to have died of symptoms related to shoddy care.

Under the new law, all mental hospital deaths, regardless of cause, will be reported to a local medical examiner, who then assumes jurisdiction over the body. The pathologist is then required to independently determine the cause of death and submit a report to the Office of the Chief Medical Examiner in Chapel Hill.

Those written reports will be public records. Until now, the state Department of Health and Human Services has refused to identify those who died in its facilities, arguing that making the names public would violate the dead patients' privacy rights.

michael.biesecker@newsobserver.com or (919) 829-4698
Read more!

Staff shortage at new hospital -Raleigh (NC) News & Observer

Lynn Bonner

The new state mental hospital in Butner, open for about a week, already has more male patients than it can handle in its admissions wards.

Central Regional Hospital, the replacement hospital for Dorothea Dix in Raleigh and John Umstead in Butner, has more than enough space for patients but not enough staff to treat everyone eligible for admission.

The staff shortage happened because the merger of Umstead and Dix in the new hospital is incomplete, state administrators said. Patients and staff from Umstead moved into Central Regional, but the Dix staff and patients are still in Raleigh.

"All we've really done is relocate Umstead," said Dr. Michael Lancaster, the hospital's interim director. "There's a whole lot of capacity we're not using yet."

Central Regional was built to hold 432 patients, but room in its admissions unit now is capped at 110 beds.

Hospital staffers have had to look for space for male patients at Dix, at Cherry, the state psychiatric hospital in Goldsboro, or at community hospitals. The hospital is open to female patients.

The need to divert patients from the new hospital is part of the challenge of managing a complicated move, said Vicki Smith, head of the advocacy group Disability Rights North Carolina. The group monitored the transfer of patients from Umstead to Central Regional last week.

"There is this funny period between the merger of all the resources in one location," she said.

The state has not announced when Dix patients and staff will move to Butner.

Jim Osberg, head of state institutions for the Department of Health and Human Services, said he was not surprised by the diversions from Central Regional. Hospital admissions increased dramatically while the hospital was being built, he said, so Central Regional has to work within the same limits as Umstead did.

lynn.bonner@newsobserver.com or (919) 829-4821
Read more!

Merritt seeks votes to remain watchdog -Rocky Mount (NC) Telegram

By Mike Hixenbaugh

After more than three years at the head of the N.C. state auditor's office, Les Merritt is convinced his role as the "taxpayers' watchdog" is one of the more important in North Carolina.

Unfortunately, Merritt said Tuesday during a visit at the Telegram, very few voters realize the significance of his role as state auditor.

"I understand that it's a down-the-ballot race and that not a lot of money is directed toward the office," said Merritt, a Republican who faces general election opposition from a former staff worker, Democrat Beth Wood. "There might be only one statewide office that would have drawn a lower turnout than the labor commissioner race did last month – and that's the state auditor's office."

Merritt contends, though, that an effective auditor's office is key to efficient and transparent government. During the last several months, his office has investigated and reported abuse in the N.C. Department of Transportation and the state mental health care system.

Merritt's staff, among other initiatives, is working now to ensure the state employee health plan – amid rumors that the fund has fallen into debt – is being operated with the proper oversight.

North Carolina is one of only 17 states where the state auditor is selected by the electorate, which gives the office even more power and influence, Merritt said.

"I don't have to worry about being reappointed," he said. "I don't have to worry about who I upset, which gives us the freedom to be a true watchdog of state government."

Although Merritt is one of only a few Republican state officials, he said he wishes the auditor was a nonpartisan position because it would effectively remove the shroud of suspicion from the office.

That's why Merritt agreed to a new public finance agreement that requires he take only small donations, he said. In exchange, Merritt will receive state money to run his campaign.

"We operate this office from a nonpartisan position," Merritt said. "I am very sensitive to the issue and work hard to make decisions from a nonpartisan position. I believe it's important, once elected, that state officials serve everyone, not just the ones who voted for me."

Merritt has visited a few newspapers in recent weeks, hoping, he said, to touch base with reporters and editors as the election draws near.

His opponent, Wood, resigned as the director of the state auditor's training department last year after she told Merritt, her boss, that she wanted to go after his job. Wood, having made public during the primary race her discontent for the way Merritt managed the office. Wood could not be reached for comment Tuesday.

Wood has accused Merritt of using the office to promote his political agenda, and she argues that employment at the office is based upon political favors.

Merritt shook his head at those accusations Tuesday, instead contending that Wood became disgruntled when the office began to scale back the training department to save money. The disagreement caused tension, Merritt said.

"She had some strengths and worked hard," Merritt said. "But when she offered her resignation, I certainly did take it. I'll put it that way."

Regardless of who voters elect, Merritt said, he hopes voters will take a serious look at the race and vote for the candidate who they think will work the hardest to protect their tax dollars. Read more!

Craven sheriff takes reins of state association -New Bern (NC) Sun-Journal

By Francine Sawyer

Craven County Sheriff Jerry Monette took the reins Tuesday as president of the North Carolina Sheriffs' Association.

The oath of association president is similar to the oath of office sheriffs across the state take when they are sworn into office.

Monette said before being sworn in by senior resident Craven County Superior Court Judge Ben Alford that he looked forward to making an agenda with committee members of the association to take to the General Assembly.

"Mental health reform is needed," Monette said. "Transporting mental patients, often half-way across the state to a mental facility takes patrol officers off the road and out of the county."

He said he was fortunate to have funding for transport personnel to take the patients to statewide hospitals.

He said not all counties are that fortunate and he hopes to see the system streamlined.

Monette, a Democrat, has been sheriff for 14 years and has 22 years in law enforcement.

He said he has been a member of the association for 14 years.

"It's going to be a big year and I look forward to serving, There is much to do," he said.

"I am really excited about being selected as president. But I did not get here by myself. Folks who elected me, my family and staff are the major source of help. No one does it by themselves"

The association heard from guest speakers and held training sessions during the three-day event in New Bern.

The meeting ends today at 10 a.m. Read more!

Mental health report delayed -Raleigh (NC) News & Observer

Lynn Bonner

The legislature's new watchdog, its Program Evaluation Division, is finishing up a long-awaited report on how the state Department of Health and Human Services handled recent changes in mental health services.

In early May, legislators were supposed to discuss the report, titled "Compromised controls and lack of focus hampered implementation of enhanced mental health services." But it was dropped from an oversight committee agenda.

Various reasons were given for its disappearance. Sen. Fletcher Hartsell, a Concord Republican and an oversight co-chairman, said then that the committee didn't have time to talk about it. DHHS Secretary Dempsey Benton said in late May that that his staff asked for more time to comment on it.

On Monday, John Turcotte, head of program evaluation, gave a few reasons for the delay: The committee had two other hefty reports to review, the timing was bad, and "there were some things we wanted to add to the report."

In mid-April, the federal government announced it was withholding millions in federal payments to the state because of concerns that it had been paying improper claims.

"We did not want to disrupt the federal project," Turcotte said. "We did not want to do anything harmful to the state of North Carolina relative to that."

Turcotte said the report would be available to the public when the committee discusses it, perhaps next month.

Louise Fisher, a mental health advocate from Raleigh, said she spent hours trying to track down what happened to the report.

Fisher said an oversight committee member -- a legislator she would not name -- told her the committee did not want a critical report made public while the state had millions of dollars on the line.

"They were trying to keep any more money from being taken," Fisher said.

Fisher said she is interested in the report because finding out what's wrong with the system is essential to its improvement.

"How can you fix anything if you don't know where it's broken?" she asked.

The role of the state in the mental health system's failure has been a sore point for some providers, advocates for the mentally ill and regional mental health offices that are semi-independent of the state.

DHHS critics have said for the past two years that the state didn't offer timely training on new mental health services and wrote rules that allowed private companies to make a lot of money while using workers they could hire cheaply.

"I think they were sadly misinformed and just not up to the task," said Mark Sullivan, executive director of the Mental Health Association in Orange County. "It's not like nobody gave them any warnings. ... This was a disaster waiting to happen."

After program evaluation staff prepare a report, the agency involved is asked to review it. Agencies may suggest changes, Turcotte said, but they don't edit the reports.

Turcotte said the mental health report has gone through three draft stages.

"By the time the report gets to the final stages, there's been a lot of discussion back and forth," he said. "It's doubtful they can make a suggestion that will substantially change what the final recommendation will be."

lynn.bonner@newsobserver.com or (919) 829-4821
Read more!

Lilly May Need Stronger U.S. Warning for Zyprexa,Records Show - Bloomberg News

By Margaret Cronin Fisk and Elizabeth Lopatto

July 30 (Bloomberg) -- Eli Lilly & Co.'s current label warning on health risks linked to its antipsychotic Zyprexa may not be strong enough, according to court documents.

Lilly added a warning to its packaging in October 2007 saying that more than half of patients in 13 studies gained an average of 12 pounds after taking the drug for less than a year. It also says Zyprexa is more ``associated'' with higher blood- sugar levels -- a risk factor for diabetes -- than similar medications.

The warning, approved by the U.S. Food and Drug Administration, may need to be adjusted to link Zyprexa more directly to higher blood sugar and diabetes, according to a letter to the Indianapolis-based drugmaker from the agency. The document was produced for a lawsuit by the state of Alaska claiming the company withheld information on risks of Zyprexa, Lilly's top-selling drug with sales of $4.76 billion last year.

``We anticipate that additional labeling changes will be necessary when we have reviewed the results of the additional analyses that we have requested,'' FDA administrator Tom Laughren wrote to Lilly in an Aug. 28 letter.

The letter states: ``Given that you're completing these analyses and our review of them will take some time, we believe that it is in the best interest of the public health to make interim labeling changes now based on the data that we already have available.''

Zyprexa Sales

Zyprexa generates about a quarter of Lilly's revenue. Prescriptions for the drug didn't significantly decrease after its latest warning, according to data compiled by Bloomberg. A March 2004 warning about the risk of diabetes and high blood sugar spurred a 5 percent drop in sales in 2005.

Lilly hadn't submitted all the requested additional information to the agency by Dec. 11, two months after its latest labeling change, according to the documents. The documents were released yesterday after Bloomberg News filed a motion to unseal them.

``Have all the analyses been submitted to the FDA yet?'' Robin Wojcieszek, Lilly's associate director of regulatory affairs in the U.S., said in testimony that day, according to the documents, which she said also included analyses of studies dating back to 1996. ``No. they have not,'' she answered.

A lawyer for the state of Alaska read her the passage in the FDA letter that mentioned ``interim'' changes. ``There may be additional changes?'' he asked. ``That's correct,'' she said.

Label Change

Lilly doesn't expect more label changes, company spokeswoman Marni Lemons said in an interview July 8. Lemons didn't immediately return messages after business hours yesterday.

``It is safe to assume that since this letter is dated August 2007, and we made a pro-active label change in October 2007 based on all the compiled data we have at the time, we feel very confident that our label is correct and accurate as it currently stands, based on all the information that we have, all of which has been made available to the FDA,'' Lemons said July 8.

Lemons referred to the FDA questions on whether the agency had finished the additional analyses referred to in the August letter. An FDA spokesman, Christopher Kelly, didn't immediately comment.

Another label change probably ``won't have a major impact on sales per se because a lot of this information has become fairly obvious, given the CATIE study and other kinds of data,'' Les Funtleyder, a Miller Tabak & Co. analyst in New York, said yesterday in a phone interview.

Second-Generation Antipsychotics

The CATIE study, by the National Institute of Mental Heath, reviewed the effectiveness of second-generation antipsychotics, including Zyprexa. That study found that Zyprexa's advantages over an older medicine were ``modest and must be weighed against increased side effects.''

Lilly rose 64 cents to $48.26 in New York Stock Exchange composite trading yesterday. The stock has last 9.6 percent this year.

The FDA letter was submitted as evidence in March by the state of Alaska in its Zyprexa lawsuit a few days before Lilly agreed to pay $15 million to settle the case. Lilly also paid $1.2 billion to resolve claims brought by more than 31,000 patients who said they weren't adequately warned that Zyprexa could cause weight gain, diabetes or pancreas inflammation, Lemons said.

Lilly faces Zyprexa suits filed by nine other states that claim the company failed to warn of all risks and engaged in improper marketing. Separate consumer-protection investigations continue in about 30 other states, the company said May 6 in a regulatory filing. The U.S. Attorney's Office in Philadelphia is investigating off-label marketing of the drug.

Risks Downplayed

Patients suing Lilly claim the company downplayed risks for years to boost Zyprexa sales and prevent stronger warnings of possible side effects.

Lilly trained its sales force to downplay risks for Zyprexa and to encourage doctors to prescribe the drug beyond approved uses for schizophrenia and bipolar disorder, according to court documents.

Stronger warnings would have reduced the chance that state Medicaid programs would designate Zyprexa as a first-line drug for its patients, according to an undated document in the Alaska case titled ``Scenario and Contingency Planning Session, US Zyprexa Brand Team.''

Zyprexa would ``lose access and become primarily a 2nd or 3rd line treatment,'' the Lilly document states.

Studies have shown Zyprexa and similar medications known as atypical antipsychotics are associated with weight gain and an increased risk of diabetes. These studies prompted the FDA to require Lilly and other drugmakers to warn doctors of the risks in September 2003 and again in March 2004.

Information Request

The FDA told Lilly in March 2007 that it wanted more information about weight gain and high levels of sugar and fat in the blood connected to Symbyax, a drug combining Zyprexa and Prozac.

``We do not feel that current labeling for either Symbyax or Zyprexa provides sufficient information on these risks,'' the FDA's Laughren wrote, according to Alaska trial documents.

In August, the FDA requested added warnings to Zyprexa's label about hyperglycemia, or high blood sugar, weight gain and hyperlipidemia, or high level of blood fats, the documents show. Lilly should add that Zyprexa was ``associated with a greater potential to induce hyperglycemia than other atypical antipsychotics,'' the FDA said in its Aug. 28 letter.

Lilly took out references to causation for high blood sugar in the language suggested by the FDA, Wojcieszek testified in December. ``We did not include that in our proposal,'' she said.

``To this day, Lilly denies that olanzapine can induce or cause hyperglycemia, correct?'' the lawyer for Alaska asked.

``We don't feel that the -- that we have data to support that particular statement that FDA included,'' she answered.

The case is Alaska v. Eli Lilly and Co., 3AN-06-05630 CI, Alaska Superior Court, Anchorage District.

To contact the reporters on this story: Margaret Cronin Fisk in Southfield, Michigan, at mcfisk@bloomberg.net; Elizabeth Lopatto in New York at elopatto@bloomberg.net.
Last Updated: July 30, 2008 00:01 EDT Read more!

Man unfit to stand trial after Taser shooting -Winona (MN) Daily News

By Nolan Rosenkrans
.
A man twice shot with a Taser by authorities has been ruled unfit to stand trial.

Seth Allan Frick, 24, was charged with several counts of assaulting a police officer, including two felonies. Two misdemeanor counts, including a drug paraphernalia charge, were dropped.

He appeared before Judge Jeffery Thompson for a post- competency hearing Tuesday, when a doctor’s report was presented that stated he was not fit to stand trial.

The last time he appeared before Thompson, in April, Frick erupted and was shot with a Taser by a Winona County jailer.

This time, he appeared calm in court while discussing his condition with Thompson.

“You seem a lot better than the last time I saw you,” Johnson said to Frick.

“I got a little oxygen into my system,” Frick said.

Frick questioned the doctor’s ruling, saying he was deemed to be suffering from temporary paranoia, and said he didn’t know if he could explain the doctor’s decision. Johnson cut him off as he continued.

“Let’s just leave it at that,” Johnson.

Johnson accepted the doctor’s report. Based on that and Johnson’s observations of Frick in court, he recommended Frick be referred to the Department of Human Services to commence a mental health hearing for possible commitment. Johnson said that if commitment proceedings are not begun within 30 days, the Winona County Attorney’s office needed to either re-file charges or Frick would be released. Frick has been in Winona County Jail since February.

“Let’s try to do something other than warehousing him in jail,” Johnson said.

Frick was arrested Dec. 30 near a Kwik Trip on West Broadwest Street when he asked officers why they were arresting someone else during a driving under the influence stop.

Police say he refused to leave when asked and got into a fight with five officers. During the scuffle, Frick was shot several times with a Taser.

Contact Nolan Rosenkrans at (507) 458-3519 or nolanrosenkrans@winonadailynews.com. Read more!

Rural Mental Health Clinics in Fernley, Dayton to close - Reno (NV) Gazette-Journal

FERNLEY--Fernley and Dayton patients who are seeking treatment for such mental health disorders such as depression, bipolar disorder, schizophrenia, and other such disorders, must now find help at the Mental Health Clinics in either Silver Springs or Fallon.

The Nevada Division of Mental Health and Developmental Services' Eric Skansgaard, regional director for rural mental health centers, has reported that due to the State of Nevada's massive revenue shortfall ($1.2 billion), the NDMHDS has decided to consolidate all north Lyon County Mental Health Centers to Silver Springs.

Unfortunately, the consolidation is coming at a time when mental health resources, the lack of psychiatrists and other mental health professionals are deficient in the rural communities, Skansgaard added, also indicating that mental health professions in Fernley and Dayton were contacting patients to inform them of the changes, and that those patients can seek treatment from either the Silver Springs, Fallon or Carson City mental health centers.

Further, clients who live in Dayton can receive assistance from either the Silver Springs Mental Health Center or in Carson City.

Skansgaard added, although the two centers will not be operational, all of the employees will be retained.

The regional director did not disclose the number of patients that will be impacted by the change and he also did not want to disclose the number of employees who would be transferred to the new locations.

He indicated he has directed staff to work with the patients to work out a realistic transitional plan.

A Stakeholders meeting was held on Friday at the Silver Springs Mental Health clinic but the outcome of that meeting was not made public.

When word of the "consolidations" circulated throughout the Fernley community, some residents questioned how they would be able to get to either the Fallon or Silver Springs centers because of lack of transportation.

Some also questioned if transportation could not be obtained, how patients would access their prescriptions for medications.

About three years ago, the Nevada Division of Mental Health and Developmental Services considered consolidating its services in Silver Springs when the Silver Springs-Stagecoach Hospital District considered adding onto the mental health wing of the Lahontan Medical Center facility.

However, after the Division of Mental Health and Developmental Services conducted a series of stakeholders meetings in both Fernley and Dayton, it was agreed that a consolidation was not the desire of both communities, and thus those efforts to consolidate were dropped.

However, this consolidation, according to Skansgaard is a "consequence of the state revenue shortfall."

"¢The Rural Mental Health Center in Silver Springs is located in the Lahontan Medical Center's facility at 3595 Highway 50 (east). The phone number is 577-0319.

"¢The Rural Mental Health Center in Fallon is located at 151 North Maine Street, in Fallon. The phone number is 775-423-7141.

"¢In Carson City, the Mental Health facility is located at 1665 Old Hot Springs Road, #150. The phone number is 775-687-4195. Read more!

Wounds in jail death graphically described - Akron (OH) Beacon-Journal

By Ed Meyer

Summit County Jail inmate Mark D. McCullaugh Jr. suffered multiple anal injuries during his fatal 2006 struggle with sheriff's deputies from ''an object that has to be rigid and unforgiving,'' a medical examiner's official said Tuesday.

Demonstrating the injuries in a series of graphic autopsy photos — each magnifying the area of the injuries — the forensic pathologist who performed the autopsy on McCullaugh said there were three specific areas of impact into and against the anal sphincter muscle.

''The anal blood vessels are crushed and leaking blood into the tissues,'' Chief Deputy Medical Examiner George C. Sterbenz said as he narrated the photos with a red laser pointer.

His testimony marked the first time that a medical examiner's official explained McCullaugh's anal injuries in detail, and it came after Sterbenz had been on the witness stand for more than five hours over two days in the trial of Deputy Stephen Krendick.

Before court adjourned for the day, defense lawyers for Krendick began their cross-examination of Sterbenz, but did not ask any questions about the alleged anal injuries.

Krendick, 35, is charged with one count of murder for the death of McCullaugh on Aug. 20, 2006, after a violent struggle in the inmate's cell in the jail's mental health unit.

Four other deputies indicted in connection with the case are scheduled to go to trial later this year.

Sterbenz did not identify the rigid object that he said caused the anal injuries, but in questioning by Assistant Cuyahoga County Prosecutor John R. Kosko, Sterbenz did say that ''these were foreign-body, sodomy-type injuries.''

Defense lawyer James M. Kersey objected to the term sodomy, and after a conference at the bench with all of the lawyers, Judge Herman F. Inderlied Jr. ordered the term to be stricken from the court record.

Causes of death

In testimony that backed up previous Summit County autopsy findings, Sterbenz concluded his time on the stand for the state by describing the causes of McCullaugh's death.

Sterbenz said McCullaugh died from asphyxia resulting from the combined effects of chemical, electrical and mechanical restraints.

McCullaugh, who was shackled in a hogtied position, choked to death within ''minutes'' of being sprayed with ''a large amount'' of pepper spray, Sterbenz said.

Using his autopsy photos, Sterbenz also pointed out 10 distinct marks on McCullaugh's back from what he said were Taser stun-gun barbs.

In Monday's opening statements, Kosko said Krendick used an entire 16-ounce can of pepper spray, shooting it into McCullaugh's cell through an open flap in the cell door while McCullaugh was naked and restrained.

Kosko said the 16-ounce can, previously described in court records as the ''Sergeant's can,'' was the type used by deputies on numerous people in riot situations.

Krendick asked Sgt. Brett Hadley for the can after the initial confrontation with McCullaugh, and Hadley turned it over, Kosko said.

Hadley and Deputy Brian Polinger — identified by Kosko as the one who opened the cell door flap in the moments before McCullaugh was hit with the pepper spray — were indicted for reckless homicide.

The other deputies, Dominic Martucci and Mark Mayer, were indicted for felonious assault.

In their first chance to question Sterbenz, Krendick's defense team began with Akron attorney Robert C. Baker spending much of the afternoon on McCullaugh's background of psychological problems and the possible life-threatening effects of a ''drug cocktail'' that he received from a jail nurse.

The purpose of the drug cocktail — separate injections of Geodon and Ativan apparently given to McCullaugh before he was pepper-sprayed — was to calm him down, Sterbenz said.

But when Baker tried to question Sterbenz about whether the drugs and the stress from the jail-cell struggle could have caused sudden cardiac death, Sterbenz answered quickly.

''The real issue here in terms of life-threatening [injuries],'' Sterbenz said, ''is the inhalation'' of fumes from ''large amounts'' of the pepper spray.

Fumes from the pepper spray, he said, caused ''severe airway burns.''

Other factors

Krendick's other lawyer, James M. Kersey of Cleveland, contended in opening statements that a combination of heart disease and a condition known as excited delirium caused McCullaugh's death.

And on that issue, Baker followed up with Sterbenz and appeared to create the first hole in the prosecution's allegations about the cause of death.

Revealing the intricacies of his autopsy, Sterbenz said McCullaugh had a ''significantly enlarged heart'' weighing 570 grams.

Such a condition, combined with high blood pressure and blockages in the three main coronary arteries, which McCullaugh also had, could ''place someone in danger of sudden cardiac death,'' Sterbenz said.

But Sterbenz also pointed out that his autopsy report listed heart disease as a ''contributing factor'' in the death.

The trial, entering its third day, is being conducted before Inderlied without a jury. The prosecution is expected to call jail medical personnel in the next round of witnesses.


Ed Meyer can be reached at 330-996-3784 or emeyer@thebeaconjournal.com. Read more!

Court tackles tough challenge -New Orleans Time-Piscayne

By Katy Reckdahl

Anthony Bridges is bipolar. But the illness wasn't diagnosed until he was charged with marijuana possession.

Schizophrenia and bipolar disorder run in Eloise Jones' family, "generations back," she said. But she didn't get help until she was arrested for possessing drug paraphernalia.

On Monday morning, Judge Arthur Hunter honored Bridges, Jones and nearly 20 others who'd excelled in meeting conditions imposed in his mental-health court, which addresses the root cause of these defendants' criminal behavior: unchecked mental illness.

That's a challenge, given the city's overtaxed mental-health system, Hunter said. High post-Katrina rents also make it difficult to stabilize mentally ill people living in less than desirable conditions, he said.

But even cities with better-equipped mental-health systems have trouble handling people with "co-occurring disorders" -- an addiction on top of mental illness -- who make up the majority of those who end up in Hunter's courtroom.

"It's a nationwide problem," Hunter said. Some mental-health providers won't deal with addicts. And drug-rehab centers often won't take people who also are mentally ill.

More than half of the nation's prison and jail inmates have a mental-health problem, according to U.S. Department of Justice data. Rates for females are higher, with nearly three-quarters of women in local jails and state prisons reporting a history of mental illness.

Hunter's courtroom on Monday reflects those statistics. Mental-health court participants are older than the usual felony defendant. Some are graying. About half are women.

"Almost everyone has someone in their family that suffers from mental illness," said case manager Kiana Wright.

Jones, 49, can rattle off a list of kin who she believes suffer from the same affliction, from a grandmother to cousins to some of her grandbabies, she said.

Hunter said "the vast majority" of defendants in the court have some history of mental-health treatment, albeit inconsistent.

"Part of it is their lack of desire -- they've been actively using drugs," said case manager Janice Bolin. "But when they're ready to seek treatment, it's hard to get in New Orleans."

Local drug-rehab centers often have long waiting lists, especially for women, Bolin said. So she and others in the court are quick to use new resources, like the traveling mental-health teams financed by the state Department of Health and Hospitals and run by Jeffrey Rouse, a psychiatrist with the Orleans Parish coroner's office.

"We're basically providing a clinic without walls," Rouse said, bringing medication, housing assistance and other resources to those who suffer from mental illness but can't or won't go to community psychiatric clinics.

Hunter took over the felony-level court in January after its originator, Judge Calvin Johnson, retired. When it began in 2004, it was one of the earliest such courts in the nation. Now it's one of about 150 nationwide.

At least once a week, defendants take a drug test and visit their case manager. Most must also attend GED classes, observe a curfew, see a counselor and psychiatrist, and get clean if they have an addiction. Defendants are also urged to take their medication, although they can't legally be forced to do so.

The penalty for a positive drug test and other violations is jail time. A group at Monday's ceremonies lined the front row of the courtroom clad in orange jumpsuits. They did not receive a certificate.

But even defendants who perform well in mental-health court aren't guaranteed a reduced or dismissed sentence upon completion. Hunter plans to work with the new district attorney to change that.

Until then, defendants must be content with a framed certificate, a photo op with the judge and their caseworker, and some sense of accomplishment. "After all my years of running, I'm finally standing strong," Jones said. "That feels good."

. . . . . . .

Katy Reckdahl can be reached at kreckdahl@timespicayune.com or 504.826.3396. Read more!

Mother gets 19 years for newborn'sdeath - Denver (CO) Post

Diagnosed as bipolar in her 20s and hospitalized and treated several times for mental-health issues.

By Ann Schrader

GOLDEN — A 30-year-old Lakewood woman was sentenced Tuesday to 19 years in prison for giving birth in a toilet and letting the baby drown.

Cheri Kostur was charged with child abuse resulting in death for the Jan. 21, 2007, death of her daughter, Kerra.

However, a jury deadlocked in June, and a plea agreement reduced the charge to child abuse resulting in serious bodily injury.

"I miss my daughter very much," Kostur told the court, "and if I could do it over, I would help her."

Kostur also was sentenced for unlawful use of methamphetamines.

During the trial, the jury did not hear about Kostur's meth use after the judge ruled the information prejudicial and inadmissable.

The arrest affidavit states Kostur admitted to police that she smoked meth the day before Kerra's birth and marijuana two days before.

Kostur told officers she usually stayed high for a day and a half after smoking meth. She also admitted to smoking marijuana and meth earlier in the pregnancy.

Prosecutor Natalie Judson said Kostur did nothing to rescue the premature infant from the toilet. Instead, Kostur cut the umbilical cord with child-size scissors and then threw the baby into a trash can in a tied plastic bag.

Defense attorneys argued that Kostur did what she could and that she didn't know she was about to give birth.

Her attorney told the court she attempted to hang herself at the age of 9, had no education after ninth grade and was diagnosed as bipolar in her 20s and hospitalized and treated several times for mental-health issues.

Kostur's mother, Laura Porter, testified that she was angry with her daughter about the baby's death, saying she had lost another grandchild. Porter said Kostur replied: "Good, now I can hang out with my friends."

Kostur's three other children are with their fathers.

Ann Schrader: 303-278-3217 or aschrader@denverpost.com
Read more!

Experimental Alzheimer's Drug Shows Early Promise - Associated Press

By MARILYNN MARCHIONE

CHICAGO - July 29 -For the first time, an experimental drug shows promise for halting the progression of Alzheimer's disease by taking a new approach: breaking up the protein tangles that clog victims' brains.

The encouraging results from the drug called Rember, reported Tuesday at a medical conference in Chicago, electrified a field battered by recent setbacks. The drug was developed by Singapore-based TauRx Therapeutics.

Even if bigger, more rigorous studies show it works, Rember is still several years away from being available, and experts warned against overexuberance. But they were excited.

"These are the first very positive results I've seen" for stopping mental decline, said Marcelle Morrison-Bogorad, director of Alzheimer's research at the National Institute on Aging. "It's just fantastic."

The federal agency funded early research into the tangles, which are made of a protein called tau and develop inside nerve cells.

For decades, scientists have focused on a different protein — beta-amyloid, which forms sticky clumps outside of the cells — but have yet to get a workable treatment.

The drug is in the second of three stages of development, and scientists are paying special attention to potential treatments because of the enormity of the illness, which afflicts more than 26 million people worldwide and is mushrooming as the population ages.

The four Alzheimer's drugs currently available just ease symptoms of the mind-robbing disease.

TauRx's chief is Claude Wischik, a biologist at the University of Aberdeen in Scotland who long has done key research on tau tangles and studies suggesting that Rember can dissolve them.

He is an "esteemed biologist," and the research "comes with his credibility attached to it," said Dr. Sam Gandy of Mount Sinai School of Medicine in New York. He heads the scientific advisory panel of the Alzheimer's Association.

In the study, 321 patients were given one of three doses of Rember or dummy capsules three times a day. The capsules containing the highest dose had a flaw in formulation that kept them from working, and the lowest dose was too weak to keep the disease from worsening, Wischik said.

However, the middle dose helped, as measured by a widely used score of mental performance.

"The people on placebo lost an average of 7 percent of their brain function over six months whereas those on treatment didn't decline at all," he said.

After about a year, the placebo group had continued to decline but those on the mid-level dose of Rember had not. At 19 months, the treated group still had not declined as Alzheimer's patients have been known to do.

Two types of brain scans were available on about a third of participants, and they show the drug was active in brain areas most affected by tau tangles, Wischik said.

"This is suggestive data," not proof, Wischik warned. The company is raising money now for another test of the drug to start next year.

The main chemical in Rember is available now in a different formulation in a prescription drug sometimes used since the 1930s for chronic bladder infections — methylene blue. However, it predates the federal Food and Drug Administration and was never fully studied for safety and effectiveness, and not in the form used in the Alzheimer's study, Wischik and other doctors cautioned.

On Monday at the International Conference on Alzheimer's Disease, other researchers reported encouraging results from a test of a different experimental drug that also targets tau tangles. That drug, by British Columbia-based Allon Therapeutics Inc., was tested in people with an Alzheimer's precursor, mild cognitive impairment.

The tau-drug results are in stark contrast to the flop of Flurizan, which was aimed at blocking enzymes that form the beta-amyloid clumps. Myriad Genetics announced in June that it would abandon development of Flurizan after the failure. Full results were presented at the conference Tuesday.

Also, fuller results were given from a closely watched test of bapineuzumab, an experimental drug that aims to enlist the immune system to clear out the sticky brain clumps.

Its developers — New Jersey-based Wyeth and the Irish company Elan Corp. PLC — previously announced that the 240-patient study missed its main goal of improving patients' mental performance at 18 months.

But the company found a silver lining — the drug appeared to help the roughly 60 percent of people in the study who did not have a gene that scientists think makes Alzheimer's disease more severe.

The results back up the company's claims of potential effectiveness in some patients, but now there are concerns about possible side effects. Twelve cases of a type of brain swelling occurred in those on bapineuzumab and none in the placebo group. The swelling caused few if any symptoms, company scientists said, but outside experts said it may have contributed to other side effects.

Those were two or more times more common in patients on bapineuzumab than people given the dummy drug. For example, cases of anxiety occurred in 11 percent versus 4 percent on placebo; paranoia, 7 versus 1 percent. Other complaints were vomiting, high blood pressure, weight loss, and back pain.

Three deaths occurred among the 124 patients given bapineuzumab, but they were not related to the drug, said Dr. Sid Gilman of the University of Michigan, who headed the study's data safety monitoring board. One death was due to pneumonia and two others to worsening Alzheimer's disease.

Investors reacted to the news by driving down Wyeth's shares $5.01, or 11.1 percent, in after-hours trading.

Wyeth and Elan have already said they will move on to late-stage testing of bapineuzumab in more than 4,000 patients.

———

On the Net:

National Institute on Aging: http://www.nia.nih.gov

Alzheimer's Association: http://www.alz.org Read more!

Florida's DCF Secretary Resigns -WFTX-TV Cape Coral (FL)

Bob Butterworth turned in his resignation Tuesday as Secretary of the Department of Children and Families. He told Governor Charlie Crist the job "has been one of the most challenging and rewarding opportunities in my four decades of public service."

The resignation, which Butterworth had earlier discussed with the Governor, is effective August 15, 2008. The letter notes that Butterworth's commitment when Crist asked him to serve was for 18 months. He became secretary on January 2, 2007.

"It is time to pass the torch to a new secretary," says the letter, which was delivered to the Governor Tuesday morning. "It's not that all the problems are solved. This agency will never be able to say, ‘Mission Accomplished.' We only look at the accomplishments these past 19 months and say, ‘Keep it going.'

He said the agency has become "a pacesetter of your administration and made Florida a national leader in protecting children and nurturing families." He said Crist had "raised the bar on expectations" of the Department.

Butterworth, who will be 66 on August 20, was Florida's longest-serving attorney general, from 1987 through 2002. A hallmark of his tenure was a commitment to open government, a philosophy he carried into his role as secretary at the Department of Children and Families. One of his first acts as Secretary was to join a newspaper's lawsuit seeking to open otherwise confidential records in a high-profile child-abuse case. He declared that the agency would be "transparent" and that public scrutiny would make the agency better.

He took office under a pending contempt citation from Pinellas Circuit Judge Crockett Farnell against the Department secretary over the waiting list for beds to treat mentally ill jail inmates. Butterworth oversaw negotiations with judges, public defenders, state attorneys, sheriffs and mental-health providers around the state, then worked with the governor and legislative leaders to commit an additional $11 million to pay for more beds and eliminate the waiting list.

He often referred to Children and Families as "the action agency." Posters all over the agency touted the use of "common sense" and "a sense of urgency." Those same posters contained six "guiding principles: Integrity, Leadership, Transparency, Accountability, Community Partnerships, and an Orientation to Action."

Butterworth's letter to Crist says, "Reflecting your own tone of respect for state employees, we have shown the people of the Department that we believe in them." He added, "None of the things we did were my idea. We simply tapped the knowledge and creativity of our employees, from the leadership team to the front lines."

He called the employees of Children and Families and local service agencies the "unsung heroes" of state government who are "often the last hope" "for people who are in crisis during these economic times, for children who suffer abuse or neglect, for adults slipping into the frailties of old age or suffering from mental illness or substance disorders."

He also declared that the agency has "the most effective leadership team in state government."

Butterworth promoted decentralization. His management reorganization cut administrative positions in Tallahassee and moved more decision-making to regional and circuit administrators around the state.

He split off a "Children's Legal Services" division from the Department's general counsel and directed that its nearly 400 lawyers act as a statewide law firm representing "the best interests of children." If the lawyers represented children's interest well, he declared, the agency would not have to worry about legal liability in its decisions.

The Department also focused on building strong relationships with local agencies that had contracts and grants to handle a number of social-service functions. He referred to them as "our community partners." The Department reached out to advocacy groups, many of them longtime critics of the agency, and created groups such as the Child Protection Task Force and the Adult Services Advisory Panel.

Butterworth was particularly proud of the Department's accomplishments in promoting adoptions, an initiative that preceded his arrival. During the fiscal year that ended in June, 3,674 foster children were adopted. Butterworth announced a goal of reducing the number of children in "out-of-home" care, including foster homes and shelters, by half by the end of 2012. The number is already down 22 percent since the beginning of his tenure.

Florida is the only state in the country to have been given a statewide child welfare waiver to Title IV-E of the Social Security Act, which allows the use of federal foster-care funds to provide services to help keep troubled families together.

At the same time, Butterworth focused on the needs of foster children. The Department enlisted foster children and former foster children to draft "Rights and Expectations for Children and Youth in Shelter or Foster Care," and committed the agency to protecting their right to access to their own records, to be heard in court, to privacy and protection of property and to be placed with, or at least have regular contact with, brothers and sister.

He also focused on foster kids' transition to adulthood. One of his successful causes in the most recent legislative session was funding for a program called "road to independence" to help young adults pay rent and other expenses while they attended college or vocation schools after they reached 18. Children and Families itself hired more than 100 former foster children under its "Operation Full Employment," which began earlier this year.

"All of us have been inspired by the people whose lives we touch every day," Butterworth told Crist in the resignation letter. "They are the reason we are here, the reason we keep going." He added, "This has been one of the great adventures of my life." Read more!

Polk Indigent Care Plan Faces Deep Cuts -Lakeland (FL) Ledger

By Robin Williams Adams - July 29

BARTOW - Finances aren't looking good for the Polk HealthCare Plan, which provides health care to uninsured people using money from a half-cent sales tax local voters approved in 2004.

Cuts made in March to keep the plan from going into the red haven't been enough to offset the collision of people's need for care, a precipitous decline in sales tax revenue and the cost of services added to the plan before sales tax revenue dropped.

About 15 temporary employees are being let go at the end of the week, and that's just the beginning.

The plan also needs to be redesigned to offer fewer benefits, County Manager Mike Herr said, and "in all likelihood" the number of full-time employees working with the plan will need to be reduced. That could affect between seven and 14 full-time positions among the current 67.

"We continue to experience a downtown in the economy, so we have a lot less revenue coming in," Herr said. "This is a plan that really has to pay for itself while we are providing benefits to the uninsured and underinsured."

The current budget for indigent care, in which the Polk HealthCare Plan is the major player, projected $35.5 million in sales tax revenue. Usually, because the county budgets at 95 percent of what it expects, the amount received would have been higher.

Not this year. The Indigent Health Care Fund now is expected to have $32.8 million in sales tax revenue for the fiscal year ending Sept. 30. That would be about $3 million less than the $35.7 million collected in 2006-07. The $15.9 million in reserves it had on Oct. 1 has been spent or committed, finance manager Steve Yaskal said.

The plan's upper-level income eligibility was cut earlier this year from 200 percent of federal guidelines defining poverty to 150 percent. For a family of three, that made $25,755 the income cutoff, instead of the previous $34,340.

Despite that change and others approved in March, reductions in expenses "didn't come as fast as we wanted them to," Yaskal said.

Reasons include a time lag in removing people from the plan, caused by waiting until their eligibility cards expired to stop providing services; normal delay in getting bills for treatment already given; and the time needed to get changes implemented.

Medical costs paid per person also "climbed" during the past several months, Yaskal said.

ELIGIBILITY CHANGES

The budget for 2008-09 was expected to reduce the eligibility limits further, to 125 percent of federal poverty guidelines, but Herr said he thinks the economic downturn will force a reduction to "really closer to 100 percent."

That change, which would make the annual income cap $17,170 for a family of three, is one of many changes being considered.

Discontinuing coverage of dental care and eyeglasses is a possibility, Herr said, along with reductions in the rates paid to doctors. Another area, among many being looked at, would be discontinuing payment for some expensive psychotropic drugs taken by patients who have illnesses such as schizophrenia or bipolar disorder.

Other changes being considered would decrease the maximum allowable days per hospital admission, currently at 10; put a lower cap on the annual number of hospital days allowed; discontinue services to people in the range of 150 percent to 200 percent of poverty without waiting until their eligibility cards expired; eliminate all community outreach grants requested for 2008-09; and renegotiate funding given to outside agencies such as Lakeland Volunteers in Medicine, Central Florida Health Care, Peace River Center, We Care and the Polk Health Department

Measuring the full scope of these financial issues and crafting possible solutions are major reasons a meeting scheduled last Friday between the Polk County Commission and the Citizens Healthcare Oversight Committee was canceled. COC is the volunteer, commission-appointed advisory council that oversees spending of money raised by the half-cent indigent-care sales tax.

Herr now expects the meeting to occur in early August.

"We are looking at a two-week window in August where we would bring closure to some of these action items," he said.

He sent an e-mail to commissioners and COC members Tuesday evening, describing the problem and listing the options being discussed.

Yaskal and other county officials, seeing signs of danger, asked the oversight committee in February to approve changing the income eligibility rules, discontinuing retroactive enrollment and eliminating a prescription-only plan.

In March, committee members voted for those changes. They limited enrollment to 19,000, a level the plan reached in June, and rescinded a previous approval to set aside $5 million for chemotherapy, radiation and other expansions.

Several thousand Polk residents already enrolled in the plan, with income in the 150 percent-to-200 percent range, were able to stay in it until their eligibility cards expired. Cards typically are issued for six months, although people on fixed incomes can be eligible for a year.

"It's hard, when you've got people getting treatment, to say 'You can't get it,'" said Larry Skidmore, director of the county's Human Services Department.

DISAGREEMENT OVER RESERVES

The oversight committee made a slight modification in April, agreeing to pay up to $50,000 for chemotherapy and radiation charges billed between August 2007 and March 2008.

Earlier committee votes to expand cancer care, to add mental-health services and to provide more help to other programs for the uninsured were made at a time when county officials disagreed on how large a surplus should be kept as a reserve in case of changes such as this.

Some said a large reserve is important; others said more of the reserve fund should be spent, which led to expansions in coverage.

Yaskal predicted in March, when the COC made its emergency reductions, that those changes would put the fund in the black financially, with $3.5 million left at the end of 2007-08. Now that's no longer the case.

Whatever changes occur, they'll be implemented by some new management.

Ed Smith, a longtime employee who heads Community Health and Social Services, the county division that operates the Polk HealthCare Plan, has resigned effective Aug. 8. He retired previously in spring 2007 but returned to the job about a month later.

Mike Kushner, Polk's risk management director, will direct the plan on an interim basis, but Herr said different options will be studied to determine what occurs long-term. He said Smith's upcoming departure is a decision Smith made, not a directive from the administration.

"Ed has made tremendous contributions to our programs over the years," Herr said. "I'm sorry to see Ed leave."

Smith, on vacation this week, couldn't be reached for comment.

[ Robin Williams Adams can be reached at robin.adams@theledger.com or 863-802-7558. Read her blog at robinsrx.theledger.com. ]
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Murderer pleads guilty; sentenced to life in prison - Wilmington (NC) Star-News

By Veronica Gonzalez - July 29

Stacey Lee Wynn went from being a promising musician to a murderer who will serve life in prison without parole.

The 37-year-old Burgaw native and one-time saxophone and piano player has entered an Alford guilty plea to two murder, two robbery and kidnapping charges. Wynn’s plea means he potentially dodged the death penalty. An Alford plea means he pleaded guilty to the charges because he feels it’s in his best interest, but he doesn’t admit responsibility for his actions.

On April 2, 2005, Wynn bound 66-year-old Lawrence Harrison’s hands and feet and beat him to death with a toilet seat lid, said Jon David, New Hanover County assistant district attorney. It happened at the Best Value Inn & Suites on Market Street.

“He was on a coke binge,” David said. “He has a profound history of mental problems and drug abuse.”

Wynn’s attorney, Rick Miller, an assistant capital defender, said his client is bipolar and was addicted to cocaine.

David said that he doesn’t know what spurred Wynn to kill Harrison but that Wynn met him that night through another woman, a prostitute who was staying at the motel. The prostitute was either friendly with Wynn or involved with him romantically, David said.

Wynn, Harrison and the prostitute had been doing drugs and eating pizza in the motel room before the prostitute left to turn tricks, David said. When she returned to the room, she didn’t see Harrison but heard water running. Wynn told her, “I did this for you,” and she ran away, eventually calling police.

Detectives found Harrison’s body lying in the motel room in a fetal position, his hands and feet still tied up.

They also found a voided check written by Wynn, who had been writing bad checks all over town, and they discovered a watch that belonged to him under Harrison’s body, David said.

Two days later, Wynn lured another man, a 35-year-old acquaintance, to a dead-end road near the airport on the pretense of buying drugs, David said. Instead, Wynn shot Damion Thomas Jones in the side of the head, stealing coke and cash from his car on Scientific Park Drive off North 23rd Street.

A security guard spotted Jones’ car on the street and saw him slumped over in the driver’s side, David said. She called police.

At Wynn’s plea Thursday in superior court, the mother of Jones’ two sons spoke in court. She said on Tuesday that the father of her sons, whom she called Hakim, died over something foolish.

“I’m going to use this to keep my sons off the streets,” said Terika Pugh, who has 7- and 9-year-old sons. “It’s a tool. Education is important. The drug and street stuff is not the way to go. I want them to be strong black males.”

Pugh said her sons play sports, but every father-son game is another painful reminder of Jones’ death.

“Every small achievement my sons make, knowing he’s not around, it just brings it back up,” she said, adding that she’s fed up with the cycle of street violence.

Wynn disappeared for three months until authorities caught up with him in Mullins, a town in northeastern South Carolina, where he was using a false name.

Wynn has a co-defendant in the Jones murder case, Odonivinn G. Monroe, whose case is still pending, David said.

The two killings stand in stark contrast to Wynn as a teen. He had led the Pender High School band as a talented saxophone player and was offered a full ride to study music at the University of North Carolina Wilmington. Wynn eventually dropped out, Miller said.

It was at UNCW that an addiction to cocaine transformed Wynn, his mother, Mary Wynn, said in a 2005 interview with the Star-News.

Veronica Gonzalez: 343-2008

veronica.gonzalez@starnewsonline.com
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Learning the truth about suicide may save a loved one - Rochester (NY) Democrat & Chronicle

Chris Swingle - July 29

Pamela Edwards was a special education teacher, a mother and a bright, caring woman.

But at times she became depressed and behaved erratically. She received counseling and medication for bipolar disorder and was hospitalized multiple times for her mental health. Last August, she tried to take her own life by misusing medication. After a week at a psychiatric facility, she was released in good spirits with a plan for outpatient care.

Within 48 hours, she left her mother's house on Honeoye Lake in Richmond, Ontario County, and ended her life. Edwards, a native of Gates, was 56.

Her heartbroken relatives wish they had known that having a mental illness diagnosis puts someone at higher risk of suicide. They didn't realize that people who've attempted suicide are at much greater risk for trying again. They didn't know that the time after a psychiatric hospitalization is also one of greater danger.

"I don't think we were given the tools," says her sister, Laurie Gleason, 53, of Mendon. "Maybe somebody else will have the chance to save their loved one."

Dr. Yeates Conwell and Dr. Eric Caine, co-directors of the Center for the Study of Prevention of Suicide at University of Rochester Medical Center, say much is known in the prevention field, but not among the public. Myths and stigma make the topic hard for some to broach.

But talking about it and understanding the risks and what you can do are essential.

Who's at risk

Most people who take their life give some warning in words or actions. They may talk as if they won't be around or say people would be better off without them. They may give away possessions, pay off debts, change their will. Between 20 percent and 50 percent of people who die by suicide have tried before. Most depressed people are not suicidal. But most suicidal people are depressed.

Serious depression may show itself as major sadness or as a loss of pleasure from once-enjoyable activities. Experiencing at least five of the following symptoms for at least two weeks signals depression: change in sleeping patterns, appetite or weight; talking or moving unusually slow or fast; decrease in sexual drive; fatigue; feeling worthless or guilty; lessened ability to concentrate, decide or function; feeling out of control; speaking of death or suicide.

Risk is heightened when depression is combined with feeling hopeless or desperate, increased alcohol and/or drug use, severe insomnia or extreme anxiety, agitation or rage.

What you can do

Take any threats, attempts or risk factors seriously. Be willing to listen. Ask what's troubling the person.



If your friend or relative is depressed, ask if she is considering suicide. You won't plant the idea.

"It's an awkward question because you're talking about life and death," says DeQuincy Lezine, 31, who attempted suicide several times at age 18 and just completed a post-doctorate fellowship in suicide research at URMC. "But it's so much better to get it out in the open."

Be ready for a yes answer and respond in a way that encourages communication — "I didn't know you were that upset" or "Tell me what's going on" or "Have you been feeling this way for long?" or "Can I help you find someone to help with this?" suggests Caine, chairman of psychiatry at URMC.

Don't deny the person's feelings or try to talk her out of suicide. Let her know you care, that she's not alone, that suicidal feelings are temporary and that depression can be treated. It's not productive to say that she has much to live for or that her suicide would hurt her family.

If she is thinking of suicide, take her to an emergency room or walk-in clinic. Don't leave her alone. Be sure there are no firearms, drugs or sharp objects at hand.

After a crisis

Suicidal people often avoid help and might run away. Be sure there is ongoing support for getting help.

If medication is prescribed, be sure she's taking it and report any unexpected side effects.

Several of Edwards' relatives say they wish they had asked more questions before she was sent home, to be sure Edwards was ready for release, to understand the likelihood of a second suicide attempt and to understand what family members should and shouldn't do to support her — even though Edwards was saying she was fine.

"You know this person better than they know themselves," says her daughter, Kristine Pieczonka, 26, of North Tonawanda, Niagara County. "You need to trust your gut."

If suicide occurs

Risk factors apply to groups, not individuals. It's impossible to predict a specific person's risk, notes Caine. While knowledge is helpful, it's not possible to prevent every suicide.

Edwards' family met with her professional care team and made plans for companionship at home and for treatment.

"She was back with us and she seemed happy," says her mother, Elizabeth Dinehart, 82, of Richmond, Ontario County.

The true mental state of someone with bipolar disorder can be difficult for even professionals to judge. Someone can seem happy on the outside while being full of negative thoughts.

On the morning she took her life, Edwards left a note saying she was going for a walk, but she didn't return. Searchers didn't find her. Hunters discovered her remains three months later, near Dinehart's home.

CSWINGLE@DemocratandChronicle.com Read more!

FDA OKs First Generic Depakote - Web MD

By Miranda Hitti
Reviewed by Louise Chang, MD

July 29, 2008 -- The FDA today approved the first generic version of Depakote (divalproex sodium) delayed-release tablets. Depakote is approved by the FDA to treat seizures, bipolar disorder, and migraine headaches.

"Generic drugs undergo a rigorous scientific review to ensure that they will provide the patient the same amount of high-quality, safe, and effective drug as the name-brand product," Gary J. Buehler, RPh, director of the FDA's Office of Generic Drugs, says in an FDA news release. "This approval provides an additional treatment option for patients who suffer from epilepsy, bipolar disorder, and migraines."

Generic divalproex sodium will have the same safety warnings as Depakote, including a "black box" warning -- the FDA's sternest warning -- that cautions about the risk of liver damage (hepatoxicity) and inflamed pancreas (pancreatitis), including fatal cases of both. The boxed warning also highlights the risk of birth defects, including neural tube defects.

The FDA has approved the following firms to market divalproex sodium delayed-release tablets: Sun Pharmaceutical Industries Ltd. of Mumbai, India, Genpharm Inc. of Ontario, Canada, Nu-Pharm Inc. of Ontario, Canada, Upsher-Smith Laboratories of Maple Grove, Minn., Sandoz Inc. of Broomfield, Colo., Teva Pharmaceuticals USA of North Wales, Pa., Dr. Reddy's Laboratories of Hyderabad, India, and Lupin Limited of Mumbai, India. Read more!

">Federal judge says Erie collar-bomb suspect not competent to stand trial; orders treatment - Associated Press

By DAN NEPHIN - July 29, 2008

PITTSBURGH (AP) - A woman charged in a bizarre bank robbery in which a pizza deliveryman wore a bomb that ultimately killed him is not mentally competent to stand trial, a federal judge ruled Tuesday.

U.S. District Judge Sean McLaughlin agreed with a defense expert that Marjorie Diehl-Armstrong has bipolar disorder. The judge also noted her inability to work with her court-appointed lawyer.

He ordered her placed under the federal government's custody for hospitalization and treatment. He asked to be notified in 120 days — if she doesn't become competent before then — whether it is likely that she will become competent to stand trial at some point.

Diehl-Armstrong, 59, of Erie, and Kenneth Barnes were indicted in July on bank robbery, conspiracy and a firearms violation in the August 2003 robbery that left pizza deliveryman Brian Wells dead.

Wells, 46, told police he was forced at gunpoint to wear a bomb around his neck and rob the PNC Bank outside Erie. As officers waited for a bomb squad, the device exploded, killing him. Wells was named as an unindicted coconspirator, but his family says he was innocent.

Authorities contend Diehl-Armstrong planned to use the bank money to hire someone to kill her father.

Federal prosecutors had contended at a May competency hearing that she was competent — as did Diehl-Armstrong.

U.S. Attorney Mary Beth Buchanan declined to say if she disagreed with the finding, but said the judge had a lot of evidence to consider and that Diehl-Armstrong "has a lengthy and complex medical history."

"It's in everyone's interest, including the Department of Justice, to make sure defendants are competent to stand trial and if there's ever any question whatsoever, the ruling that the judge made allows the defendant to receive the proper medical care to assure her competency at trial," she said.

The Federal Public Defender's Office, which is handling her case, declined to comment, citing policy.

At the hearing, Dr. Robert Sadoff, a professor of psychiatry at the University of Pennsylvania, testified that Diehl-Armstrong "absolutely" has bipolar disorder. He has known her since the 1980s and said she's had the condition for a number of years.

Sadoff's testimony contradicted that of Dr. William J. Ryan, a forensic psychologist with the federal Bureau of Prisons.

Ryan testified that she does not have bipolar disorder and had been previously misdiagnosed. He said she has a borderline personality disorder, can be paranoid of people and has a somewhat "inflated view of herself," but was competent.

In his findings, McLaughlin recounted Diehl-Armstrong's long history with the mental health system.

After she was arrested in 1984 on charges she shot to death her boyfriend Robert Thomas, authorities "uncovered a bizarre inventory of foodstuffs including, among other things, almost 400 pounds of butter and over 700 pounds of cheese, much of which was not refrigerated and rotting," McLaughlin noted.

She was acquitted of homicide in the case in 1988.

Diehl-Armstrong is serving seven to 20 years in state prison after pleading guilty but mentally ill to killing boyfriend James Roden, 45, in 2003. Prosecutors said she killed Roden because she feared he would tell authorities of the bank robbery plot.

Diehl-Armstrong and Barnes have pleaded not guilty. Read more!

Acute lack of mental health care -The North Platte (NE) Telegraph

By Mark Young

After referring to Region II as the "Star of the state" just a few months ago, DHHS Behavioral Health Director Scot Adams spent some time defending the luster of that star Friday.

Adams, along with Joel McCleary from DHHS Office of Consumer Affairs was in North Platte's Frontier Home for a question and answer session, fielding complaints and addressing concerns about DHHS and Region II. Under the agency's former leadership, both Region II and DHHS have drawn criticism for not recognizing that mountains of red tape were actually people in need of help.

Adams has already proven to be more accessible and opened himself up to a lot of past pains and anger from people who were frustrated with the agencies. In the end, Adams condoned a spirit of leaving the past behind and moving forward with how the agency can help now.

But there were still questions to answer. Some were concerned at the lack of psychiatric care that is available to people who are in urgent need of that kind of immediate care. Adams said that is not a problem relating solely to Lincoln County.

"There are 86 out of 93 Nebraska counties who have been identified as having a severe psychiatrist shortage," said Adams. "There are 11 Nebraska counties that don't have any kind of mental health care worker."

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Adams said there are possible long-term solutions.

"The Rural Health Commission has targeted some of those shortage areas," he said. "People can get loans through the program to go to school and come back to those areas. There is also development in tele-health, as well, where people can consult with therapists via video about a possible course of action."

While that doesn't address the immediate problem for rural Nebraska, Adams said the problem is at least being addressed and possible solutions exist. Others complained that there is a shortage of information that is available to people who need help.

Web site coming

Adams said DHHS should have a Web site available in the coming fiscal year that will be much easier to navigate and take people directly to the services available in their local regions. This conversation also led to complaints about local and state leadership, as well as a real problem with communication.

"If someone tells you that they are going to do something or even not do something for you, have them put in writing," said Adams. "As far as leadership in your community, it is very difficult to attract someone to an area they are not familiar with. It makes more sense to grow your own. You have to find bright, young people and let them know about the programs we have."

Adams said the Nebraska Legislature is going to conduct a workforce study around the state to help better identify the needs of local areas. Also in terms of communication, DHHS has two consumer specialists working in Region II that provides a direct bridge between the state and the region.

Nancy Rippen or Corey Brockway can be reached at (308) 345-2770.

Not enough accountability

Dave Homan said there are too many individual policies between regions and that none of them meet the standards of the state's policies. Homan complained that there is not enough accountability when it comes to agency leaders.

"There is no accountability and no credibility," said Homan. "They hire someone and they can end up doing whatever they want and no one holds them accountable."

Adams said multi-level government policies are a valid point, but referring to the regional makeup of the state, said the public answered that question four years ago. That's when an attempt was made to eliminate the regions and to make it a strictly DHHS state run program.

"That question was asked and that question was answered four years ago," said Adams. "What we have is what you see. I know it's difficult to let go of past pains, but it's time we tried and look forward to what we can accomplish now."

The issue of mental health is complex, Adams said. There are so many different levels of illness and there is often a stigma placed on people who have mental illness. But the reality is that many, many people suffer from one kind of mental illness or another.

"Mental health is not that important to most people," he said. "Unless you are living it like we are, it's not that big of a deal."

For that reason, Adams is hopeful that more openness from DHHS directly to the regions and those it supports will continue to better enhance the quality of life for as many people as possible. Senator Tom Hansen, who closely monitors DHHS activities and responsibilities at the legislative level also attended.

"We had a confirmation hearing in Lincoln this year and confirmed Scot," said Hansen. "I'm just here to see if we got our money's worth and I think we did."

Adams will return to North Platte Oct. 8 to discuss the issue of children's mental health. A location and time of the event has not yet been announced.

e-mail: mark.young@nptelegraph.com
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Killer's Father To Be Committed To Mental Facilty - WYFF-TV Greenville (SC_

LAURENS, S.C. -July 28, 2008 - The father of the man convicted of killing two Abbeville County lawmen in 2003, has been ruled mentally ill and will be committed to a state mental facility indefinitely.

Arthur Bixby, 78, was charged with murder and conspiracy in the shooting deaths of Abbeville County Sheriff's Sgt. Danny Wilson and Constable Donnie Outzs.

Last week, a judge found that Bixby was not competent to stand trial.

Bixby has been jailed for nearly five years since the killings and has had multiple mental evaluations.

A psychiatrist testified last week that Bixby could not assist in his own defense because he is suffering from a form of dementia.

Eighth Circuit Solicitor Jerry Peace said Tuesday that a probate hearing was held for Bixby and that the judge ordered Bixby committed because he is a danger to himself and others.

Bixby's son, Stephen Bixby, was convicted of murdering the lawmen and was sentenced to death. Rita Bixby, Arthur Bixby's wife and the mother of Stephen Bixby, is serving a life sentence for being an accessory to the killings.

Arthur Bixby, and his wife and son were upset about the widening of Highway 72 in front of their home. The Dec. 2003 shooting of Wilson and Outzs led to a 14-hour standoff that resulted in the Bixbys' arrests.

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U.S. reports drop in homeless population -International Herald Tribune

By Rachel L. Swarns - July 29, 2008

WASHINGTON: The number of chronically homeless people living in the nation's streets and shelters has dropped by about 30 percent — to 123,833 from 175,914 — between 2005 and 2007, Bush administration officials said on Tuesday.

Housing officials say the statistics, which the Department of Housing and Urban Development collects each year from more than 3,800 cities and counties, may reflect better data collection and reporting and some variation in the number of communities reporting on an annual basis. But the officials attribute much of the decline to the "housing first" strategy that has been promoted by the Bush administration and Congress and increasingly adopted across the country.

In that approach, local officials place chronically homeless people into permanent shelter — apartments, halfway houses or rooms — and then focus on treating addiction and mental and health problems. HUD defines chronically homeless people as disabled individuals who have been continuously homeless for more than a year or have experienced at least four episodes of homelessness in the past three years.

Until cities and states began adopting the program, many of those people seemed to shuttle endlessly between shelters, hospitals and the street. The "housing first" strategy has begun to stabilize that population, officials say.

"We can all be encouraged that we're making progress in reducing chronic street homelessness," Housing Secretary Steven Preston said in a statement. "But we must also recognize that we have a long way to go to find a more lasting solution for those struggling with homelessness every day."

HUD collects the statistics as part of its Annual Homeless Assessment Report to Congress. The report said that 1.6 million people experienced homelessness and found shelter between Oct. 1, 2006 and Sept. 30, 2007. Individuals accounted for 70 percent of the people living in shelters during that time. The rest were families with children. About 13 percent of all homeless adults living in shelters were veterans.

Critics of the annual report often complain that it undercounts the homeless because it does not include those in precarious living situations such as families living in campgrounds or individuals doubled up with friends or relatives.

Dennis Culhane, a professor of social policy at the University of Pennsylvania and an author of this year's report, acknowledged that "there are a lot of people in tough housing situations who don't get counted." He said the government needed a standard measure and asked communities to count people living in shelters and on the street.

He described the decline in chronic homelessness as "pretty remarkable."

Culhane said that Congress and the Bush administration has pushed local communities to focus on finding solutions for the chronically homeless, who accounted for about half of the people living in the nation's shelters in 2000. HUD has financed the development of between 10,000 and 12,000 new units of supported housing targeted for that population every year over the past four years, he said.

"It affirms the very significant change in policy shift that took place over the in the last six years," said Culhane, who studies homelessness trends and policy, of the decline in the numbers of chronically homeless. "We're moving in the right direction, without a doubt."
Read more!

October hearing set in senator's groping case - Lowell (MA) Sun

By Lisa Redmond, lredmond@lowellsun.com - 07/29/2008

LOWELL -- The defense attorney representing embattled state Sen. J. James Marzilli, who is accused of accosting four women in downtown Lowell last month, will have three months to craft his motions to try to get the charges against his client dismissed.

During a brief pretrial conference yesterday, Lowell Superior Court Judge Paul Chernoff scheduled a hearing for Oct. 23 for defense attorney Terrence Kennedy to file motions he hopes will chip away at the prosecution's case.

Marzilli, 50, is facing four counts of annoying/accosting a person of the opposite sex, attempting to commit a crime, disorderly conduct and resisting arrest all from an alleged June 3 visit to the city of Lowell during which he allegedly made lewd comments to four women, allegedly while trying to grope one woman sitting on a park bench.

He was arrested after a police footchase ended in a city parking garage, and he reportedly resisted arrest. When asked for his name, the Arlington Democrat gave the name of a Statehouse colleague.

But Kennedy said he would raise factual and constitutional challenges in this case to get the charges dismissed. He said one of the women who accused Marzilli of trying to grab her failed to repeat the allegation during her grand-jury testimony.

Kennedy also said he will challenge the constitutionality of the charge of annoying/accosting the opposite sex because it does not apply to a person who engages in the same offense against a person of the same sex.

Since his arrest, Marzilli has announced he won't seek re-election in the fall and his attorney confirmed that Marzilli has been diagnosed with bipolar disorder. Read more!

Old Asylums Decay, But Some Eye Pricey Restoration - Associated Press

CHARLESTON, W.Va. - July 28 - Equal parts graceful and eerie, massive brick and stone asylums once loomed over towns from Maine to California as the 19th century's ideal for the humane treatment of the mentally ill.

Ornate facades, turrets, sprawling grounds and sheer palatial size belied the name mental hospital. Known as Kirkbride buildings, for the Pennsylvania physician who inspired them, they flourished for half a century.

Today the forces of age and neglect, together with a century of changes in treating mental illness, have slashed the ranks of Kirkbride asylums to a handful that will need ambitious developers to save them from collapse. Many of the surviving buildings are on the National Register of Historic Places, but restoring them is not easy. The colossal structures face a slow demolition by decay because of the enormous cost of maintenance, let alone renovation.

Greystone Park Psychiatric Hospital in Parsippany, N.J., is a prime example. The 132-year-old neo-Gothic building was the largest poured-concrete structure in the U.S. before the Pentagon was built.

Many people - from preservationists to developers to elected officials - want to see it saved, but keep hitting the same wall.

"Ultimately, it comes down to money," said Carrie Fellows, the director of the Morris County Heritage Commission. "It would take unfathomable millions. Multiple millions and millions of dollars."

That's the problem for communities grappling with the physical legacy of Dr. Thomas Kirkbride, who at one time influenced the construction of nearly every mental hospital in the country.

Kirkbride in 1854 proposed a model for asylums: campuses sprawled over hundreds of acres where patients would live in self-contained communities, with the centerpiece a beautiful, enormous building that Kirkbride wanted to resemble the finest hotels of the time.

"The building became part of the treatment," said Nancy Tomes, chairwoman of the Stony Brook University history department and the author of "The Art of Asylum-Keeping," about the Kirkbride model. "The idea was to design a building that would actually help your mind recover."

That approach lost favor in the 20th century and after World War II, a series of court decisions and the development of psychiatric medications led to the closure of asylums around the country.

Neighboring communities were left to ponder whether to find some new use for the massive structures or raze them.

In dozens of places, the answer was the bulldozer. The buildings were either too dilapidated or there was no money for restoration. From the hundreds of Kirkbride hospitals that once existed, about 30 are left in 20 states, in conditions from developed to derelict.

Even those in need of costly repairs, though, can inspire a certain swashbuckling optimism.

Last year, Morgantown asbestos contractor Joe Jordan bought the former Weston State Hospital in northern West Virginia, which at 242,000 square feet is one of the largest hand-cut sandstone buildings in the world. Jordan gave the property one of its earlier names, the Trans-Allegheny Lunatic Asylum, and opened part of it to tours and other events to raise money for its restoration.

The goal is to turn the asylum into a hotel, along the lines of a former Kirkbride facility in Traverse City, Mich., said Jordan's daughter, Rebecca Jordan-Gleason.

It won't be easy. Repairing the roof will cost about $5 million, and Jordan-Gleason said it took three months just to clean the portion of the hospital now open to tours. The attempts to raise money for the restoration have also met protests from some mental health advocates, who say ghost tours and the loaded word "lunatic" are offensive to former patients.

"It's hard, but at the end of the day, when you walk around to the front of the building and look up at it, you remember why you're doing this," Jordan-Gleason said.

In Alabama, state officials and preservationists are developing a plan to save the 147-year-old Bryce Hospital, a cradle of civil rights for American mental patients. It now houses only offices.

Built on the eve of the Civil War, Bryce was horribly overcrowded by 1970, with only three psychiatrists for about 5,300 patients.

In 1972, a federal judge in a lawsuit over Bryce said mental patients had a constitutional right to individual care aimed at a cure, a precedent-setting decision that led to similar decisions elsewhere.

"The civil rights movement for people with mental disabilities started right here," said John Ziegler, a spokesman with the state mental health agency. "It had a profound effect on millions of people all over this country."

In Northampton, Mass., the debate over a Kirkbride property lasted nearly 30 years. It is now the site of a development called Village Hill that mixes housing units with commercial properties, but the decaying historic main building had to be torn down when the third floor collapsed into the basement.

"We got backed into supporting the demolition of buildings that maybe we did want to reuse," remembered Mayor Clare Higgins. "The buildings people had the most emotional attachment to couldn't be preserved."

The demolition alone cost the state about $7 million.

One of the most successful renovations is at the former Athens State Hospital in Ohio, which was taken over by Ohio University in 1988.

Renamed The Ridges, the campus has become home to the Kennedy Museum of Art, Ohio University Press, biotech labs, the Voinovich School of Leadership and Public Affairs and even a child development center in what had been the asylum's horse barn.

"We've done some absolutely beautiful renovations here," OU architect Pam Callahan said. "But it is a challenge for the university to maintain the buildings."

The university occupies about 40 percent of the roughly 720,000 available square feet, a space nearly four times larger than a typical Wal-Mart Supercenter.

"Even in a mothballed condition, buildings still need heat in the winter, roofs need to be repaired, windows need to be repaired," she said. "A threat is that the buildings will deteriorate to such a point that the buildings are not reclaimable."

For Ethan McElroy, who has photographed nearly every remaining Kirkbride facility for his Web site http://www.kirkbridebuildings.com

"Each one is one of a kind, and will never be built again," he said. "The skills that went into building them just don't exist anymore, at least not to the same degree. They're historical treasures." Read more!

Stress can be opportunity -McClathcy Newspapers

By HOWARD COHEN

MIAMI — After Silvia Clarke lost a sales executive job she had held for 18 years, the Miami Shores, Fla., wife and mother of two worried about how she would support her family of four as the household's primary wage earner.

"Having been restructured out of the company was not the worst thing that could have happened — living under that stress of not knowing what was going to happen was the most stressful thing," said Clarke, 45.

Then her youngest daughter, 6-year-old Caroline, innocently asked one day, "Mom … were you a bad worker?"

"That was the most shocking thing," she said. Clarke sat Caroline down and calmly explained that companies redirect their efforts and that even good employees can find they don't have a position in the new design.

With the daily drumbeat of slashed jobs, home foreclosures, high debt levels and skyrocketing gas and food prices, the anxiety level of the American worker is rising exponentially. Three-quarters of Americans say they are stressed about money, a jump from 60 percent two years ago, according to an April poll of 1,848 adults by the American Psychological Association.

Local therapists and mental health experts report business is brisk, as people try to cope with the cascade of economic uncertainties.

"In my private practice, within the last year or two, the stress level of my patients has increased dramatically," says Dr. Robert Schwartz, chair of family medicine and community health for the University of Miami medical school. "A lot of time it will come down to family stress, job issues, economic issues. People can't make ends meet. A lot of marital dysfunction. People overworked, complaining about bosses. I try and help people put these issues into perspective."

Physical effects


Managing the stress is critical to containing the damage it does to your body. When a person is attacked by stress, hormones go into overdrive.

When that becomes a permanent state, it has a detrimental effect on the body's chemistry and health problems ensue.

"The endocrine system is altered," says University of Miami researcher Claudio Mastronardi, who is working with mice and rats in the lab to study how stress affects the immune, neurological and hormonal functions.

"When these systems are imbalanced, psychiatric disorders might increase," Mastronardi says. "With what we are going through now — the real estate market, people on the verge of foreclosure or losing jobs without knowing what is happening tomorrow — it can cause a chronic insult to our body. It may increase chances of depression and anxiety and lower our immune defenses and make us more susceptible to develop disease."

Studies, like a 1998 joint effort by the University of California and Sweden's Sahlgrenska University Hospital, have shown that chronic stress can throw one's cortisol levels out of sync. The result can be weight gain, diabetes, cardiovascular issues and obesity.

"It is known that chronic stress stimulates the laying down of extra fat in the abdominal area and has been associated with an increased risk of diabetes, heart disease and hypertension," says Dr. Jon Shaw, a director of psychiatry at the University of Miami.

"Acute stress mobilizes with adrenaline and then, hopefully, the body adapts," Shaw adds. "But if it's left in overdrive because of chronic stressors, then the long-term effects on biology — sleep and appetite disturbance, irritability, episodic violence control issues — can be associated with the wear and tear on our systems."

Channeling stress


A key factor in combating stress is learning how to recognize it, and finding ways to channel it positively, mental health experts say.

Among the steps to take:

# Begin a daily exercise routine.

# Talk to family, friends, a mentor or clergy.

# Meditate, get a massage, do yoga or listen to your favorite music.

# Re-evaluate your goals and look at change as an opportunity for personal growth.

Many, too, turn to professional help.

Roselyn Smith, a licensed clinical psychologist in private practice in South Miami and Homestead, Fla., says her business is up about 10 percent from patients who have lost their jobs and are struggling to find new career paths.

"But I've noticed a drop-off in other patients for economic reasons," she says. Some can't afford treatment and insurance has run out.

Schwartz, the University of Miami family medical physician, reports seeing more patients seeking help for sleep disorders, fatigue, muscle pain and anxiety — all by-products of stress.

He and others help patients cope by recognizing the situation causing the stress and mapping out strategies to change behaviors. Feeling boxed in is a major contributor to stress.

"One way we define stress is an individual's adaptive capacity to demands placed on that individual," Shaw says. "People readily experience stress as painful while others may experience it as an opportunity."

In the case of Clark and her daughter Caroline, her calm explanation of her company's restructuring and her resultant job loss allayed her daughter's fears.

"That made her feel more at ease," Clarke says. "Life brings these things and the way I acted was going to show them how to act when something in the future goes bad. What they thought of me and how I handled myself in front of them was important."

Clarke also began to regularly jog and started working out on an elliptical machine.

"Those runs allowed me to be by myself and to think and rethink and reposition those thoughts. It was an opportunity to work out physically but also to put myself together again," Clarke says.

The next step was to craft a winning résumé.

"I hadn't done one in 18 years," she recalls. "That was a daunting experience. I couldn't remember what I've done. You have to go through a lifetime."

She ultimately composed a list, whittling a four-page résumé down to a more marketable two-pager. "That made me feel good: ‘I've done all of this.’ I can start rebuilding. I went through a lot of personal changes and growth. The interview process helped me build confidence."

Clarke found her new job in the same field in March. Read more!

Doing Mental Healthcare Right the First Time - Risk & Insurance

By Maurice Preter and Jeffrey Kahn

Employee mental health affects the bottom line and the culprits are many. Stress disability rates have been growing and mental health is also the leading cause of prolonged disability in people with a physical illness.

Productivity, retention and medical care utilization are all affected by common anxiety and depressive disorders. Then there are the effects on your employees of high divorce rates, single parenthood, problematic children, workplace change and so much more.

But what remains a mystery is why most companies don't pay more attention to higher quality mental healthcare, though that may be about to change.

In a trend reversal, more scrutiny of workplace mental health is starting to come about. For instance, at a recent workplace behavioral risk conference, speakers told attendees that investing in employee mental health assessment and treatment programs reduces absence, increases productivity and addresses healthcare and disability cost.

In one case, channeling mental health claims through an in-network psychiatrist reduced short-term disability claims by 56 percent. Using that method, AOL saw a 67 percent reduction in claims approvals, a 34 percent decrease in claims duration and a 73 percent decrease in claims cost.

But much of what passes for quality care these days is not and even experts can sometimes have trouble determining where better care can be found.

Ideally, added outlays for quality mental healthcare will be more than offset by savings in such costs as absenteeism, recruitment and training, reduced productivity, presenteeism and physical healthcare expenses. From the employees' perspective, the desired outcome of mental healthcare is accurate identification of the problem, appropriate treatment and, ideally, resolution of the problem.

Many people don't realize that psychiatric medication and psychotherapy are not replacements for each other. They work very well together, but they do different things. Most anti-depressant prescriptions are written by primary care doctors who don't offer real psychotherapy to go with them. And they don't always have a precise and complete diagnosis. Patients with commonplace psychiatric syndromes will usually present with such complaints as sleeplessness, dizziness, fatigue, appetite change, aches and pains or problems at home or work. But the typical 10-minute office visit is far too little time for even a skilled psychiatrist's briefest evaluation. And a primary care doctor is most concerned with rooting out physical illnesses. Even when a patient complains of 'depression,' it often an anxiety disorder and panic disorder in particular.

RIGHT THE FIRST TIME

Quality care begins with a well-done initial clinical evaluation. When people experience emotional suffering, there are usually multiple causes--'overdetermined' as psychiatrists say. The central factor is usually not the most obvious one. A patient with an emotionally distant spouse might instead complain of impending financial impoverishment. The initial evaluation should be broad and thorough, with careful attention to personal life, workplace factors, commonplace anxiety and depressive disorders, drug and alcohol use, and co-occurring and causal medical illnesses.

Just as elsewhere in medicine, the initial evaluation is where highly skilled clinicians with broad and advanced training are most useful. It is all too easy to focus on easing the pain of a divorce, while overlooking an underlying anxiety disorder whose treatment could have allowed the repair of the marriage.

Dissatisfaction at work is often caused by misery at home. Poor job performance attributed to work stress can be due to such things as a hidden conflict with a supervisor, an unrecognized depression or even an undiagnosed medical illness. Skilled mental health evaluators are trained to sort out these issues, and psychiatrists have the most comprehensive diagnostic training of all. The medical part of their training also comes in handy for those times when emotional distress can be the presenting symptom of problems like thyroid disease, cancer or other medical illnesses, including treatable conditions such as a sleep disorder due to obesity. Even more importantly, long experience in using psychiatric medications ensures that the evaluation includes appropriate and early focus on syndromes that medication might help. So getting it right the first time goes hand-in-hand with solving the problem effectively and efficiently.

But the trouble is, less trained evaluators only see what they know, even though they may be pleasant, concerned and thoughtful people. Problems overlooked at the outset don't get recognized until much later, if ever. So effective treatment is not provided and instead the problem lingers. Untreated depression, thyroid disease, family problems, alcoholism, interpersonal skill deficiencies or unexplained chest pain can be both financially and morally expensive.

Managers of employee benefits like mental health coverage need to be careful, because overreliance on the most simplified screening methods can be dangerous. Breaking down human distress into a few very simple categories is tempting and can be helpful for preliminary screening in some selected situations.

But, premature categorization interferes with high quality treatment and ends up costing many times the front-end savings. A screening test for depression may alert a clinician to the employee's unhappiness. However, that unhappiness could be due to anything from work stress to medical illness to anxiety or to one of several different kinds of depression and most likely some combination of factors. At that point, effective treatment can be provided by many kinds of well-trained mental health professionals.

The best mental health solutions require thoughtful recognition of the actual problem or problems and awareness that diagnostic refinement is an ongoing process during treatment. Any other approach is like leaving money on the table and suffering unrelieved.

If actual benefits for employer and employee are the real goal of mental healthcare, a seasoned psychiatrist is most able to recognize the many contributing factors at evaluation. And while that is not always possible, psychiatric consultation and diagnostic aids can have a major impact on quality. There haven't been many guidelines on such dilemmas as when to refer, but the accompanying chart lists some good starting points. The full 2008 source article (recognition, diagnosis and referral of workplace depression) can be downloaded for free (WorkPsych.com/publications.html).

There aren't enough psychiatrists in our network, some say. But especially in metro areas, there are many other psychiatrists who practice outside of networks. They can be found through medical schools, hospitals, other employers and by word of mouth.

What else can be done? Manhattan-based WorkPsych Associates has recently completed a project that allowed a large employer to address productivity concerns by quantifying the specific mental health and workplace root causes of absenteeism, presenteeism and more. The employer learned the advantages and disadvantages of workplace and management approaches. What's more, the process helped employees learn about some of their own issues and how to translate that knowledge into effective treatment. The custom data yielded targeted and effective solutions for both employer and employee, sometimes addressing unexpected issues with straightforward strategies.

WorkPsych has now teamed up with Golden Valley, Minn.-based OptumHealth to make more employers aware of this approach (a press release can be downloaded at WorkPsych.com/publications.html). A separate OptumHealth project recently reported that improved follow-up care for depression meant a 40 percent increase in depression recovery, a 40 percent reduction in employment loss and the equivalent of two more work weeks of productivity per year.

Solutions are there. Let's start using them!

MAURICE PRETER, M.D., is a psychiatrist and neurologist, and JEFFREY P. KAHN, M.D., is a psychiatrist; both are Manhattan-based, where Dr. Kahn is also CEO of WorkPsych Associates.

Read more!

Employee details encounter with shooter -College State (PA) Centre Daily

By Mike Joseph - mjoseph@centredaily.com - July 28

SPRING TOWNSHIP — Jason Penland sat down to paperwork at his Log Cabin Motors car dealership desk Friday morning when a man walked into his office with a "delusional" story, a request for money and a loaded shotgun.

Less than two hours later, the man, Brian Neiman, 50, lay in his Ford Bronco outside a Ferguson Township radio station, shot to death in a police fusillade after he had opened fire on the officers.

"He was about out of gas, out of money,&" Penland, 27, said Monday. “He thought people were after him — that’s all there is to it.” But there was a lot more to it.

Before his 45-minute encounter with Neiman ended, and Neiman had departed with a handshake and directions to the radio station, Penland had defused a potentially violent outcome in the office, given Neiman $20 and conceived two contingency plans.

One plan was to move fast from his chair behind his desk to try to subdue Neiman if Neiman began raising the shotgun to point it at him. The other was to ease Neiman out of the office and alert the radio station and the authorities.

Penland said Neiman had bought a car from Log Cabin Motors, a family-owned dealership between Milesburg and Bellefonte, five years ago.
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“He knew of us — we’re probably one of the last few people that he trusted,” Penland said. “When he came in five years ago he was a super nice guy, clean shaven, everything. So it really is a shame.”

The Log Cabin Motors offices include a small public space in the front flanked by two small countertops that give way to a hallway and offices in the rear.

When Neiman, coming from Milesburg toward Bellefonte, parked on the dealership lot and strode toward the offices with a shotgun, it was at first not all that alarming. Some people bring guns to the dealership to sell, Penland said.

“I saw him (Neiman) coming in through the door with the gun,” Penland’s mother, Michelle, recalled Monday. “He said, ‘I’m not going to shoot you, but this is loaded.’ ”

She said Neiman looked dirty, wearing jeans and a shirt with the Halliburton logo, and said he’d spent the night in the woods. State police at Lamar said Monday that Neiman’s parents in the western Clinton County area had asked police to search for him.

“There was some attempt to look for him Thursday night and Friday,” said Cpl. Richard Smith. “I think his parents had called us in reference to some comments he had made. I think that had frightened them.”

Neiman’s ex-wife said he was diagnosed with bipolar disorder three years ago and could become violent when he didn’t take his medication.

Once inside the office, Neiman sat down in the customer’s seat a few feet from Penland. They were separated by a corner of the desk. Penland had a laptop computer atop the desk. Neiman had a semi-automatic shotgun on his lap. It was not pointed at Penland, but he kept his right hand near the trigger.

“You could see the shell in the magazine — he would have been ready to shoot,” Penland said. “When he came in he was very polite, but he just instantly snapped when the whole money thing came up. I was just slightly nervous before that.”

Neiman told Penland a story about people looking for him. Neiman asked for money and directions to WTLR radio station at 2020 Cato Ave., Ferguson Township. Neiman said he knew someone there who could help get his message out.

Ed Fleming, director of the Central Pennsylvania Christian Institute, which runs the radio station, said Monday that, as far as he knew, Neiman did not know anyone personally at the radio station.

During their conversation, Penland said, he moved his chair sideways little by little to get closer to Neiman and to make a more direct path around the desk corner to jump Neiman if he started to aim the shotgun at him. Penland figured he had a few seconds to work with because he knew the shotgun was heavy.

Michelle Penland, the only other person there, stayed in the front office, between the front door and her son farther inside.

“I thought if worse came to worse I can go get some help,” she said, “but I wasn’t going to leave him alone.”

There were two especially bad moments for Jason Penland. The first occurred when he was looking on his laptop for directions to Cato Park to give to Neiman.

“Who you e-mailing?” Penland said Neiman asked him.

Penland quickly turned the laptop screen toward Neiman.

“I flipped this over so he could see that it was Map- Quest,” Penland said.

Later, when Penland offered Neiman $20, Neiman blew up: “An F-word tirade,” Penland said. “ ‘I can’t believe that’s all you’re giving me.’ ”

But Neiman took the $20 and left.

“He shook my hand, said thank you and walked out the door,” Penland said.

He walked right by Penland’s mother without saying goodbye.

“He just went out the door — I think he was on a mission — and we thanked God he did.”

While Neiman headed toward Cato Park, apparently stopping to buy gas with Jason Penland’s $20, Penland called the Cato Park radio station and then 911, alerting the radio station staff and enabling the police to get to the station ahead of Neiman.

They were very possibly lifesaving calls.

“The most important thing he (Penland) did was call right away and give as much and the most accurate information that he could,” Ferguson Township Police Chief Diane Conrad said Monday. “He greatly assisted us in being there before Neiman.”

Penland said the police told him he did the best thing that could have been done under the circumstances. Penland said he was saddened that Neiman had to be killed, but added:

“I don’t think it could have ended much better than it did.”

Mike Joseph can be reached at 235-3910.
Read more!

Vanda shares plunge on FDA drug rejection - Business Week

NEW YORK - July 28 - Shares of Vanda Pharmaceuticals Inc. dove to a record low Monday after the Food and Drug Administration rejected the company's experimental schizophrenia treatment, prompting the drug developer to put the program on hold.

The stock plummeted, shedding $2.46, or 73.2 percent, to 90 cents. Earlier, the stock slid as low as 80 cents-- its lowest point ever.

The company had been trying to gain approval for iloperidone in an already competitive market. Though it proved more effective than placebo in studies, the drug had similar results with some currently marketed drugs, including Pfizer Inc.'s ziprasidone.

The FDA, in its letter to the company, recommended Vanda conduct additional studies that compared the drug candidate to current treatments such as Johnson & Johnson's Risperdal or Eli Lilly & Co.'s Zyprexa. Also, additional safety data would be needed to consider another application.

In a conference call Monday morning, Vanda President and Chief Executive Dr. Mihael H. Polymeropoulos said the company wants to meet with the FDA to discuss its options. In particular, to determine why iloperidone must go through a comparative study to show it matches the effectiveness of other drugs. Several drugs currently on the market only had to show effectiveness versus placebo, he said, which iloperidone has already done.

"The agency agrees that we have efficacy similar to Geodon (ziprasidone)," he told investors. "We do not understand why they would want to run another study with another drug."

A key concern for analysts are the costs additional studies could entail. Vanda said it had cash, cash equivalents, and marketable securities of about $65.6 million.

"Under the capital available to the company today, we will not be able to conduct both the additional explicit study and the safety additional exposures (study)," Polymeropoulos said.

While not giving specific guidance, he said the efficacy study was identical to a prior study that cost about $35 million.

The company plans to provide additional financial details when it reports second-quarter profit Read more!

Study: 'Pre-dementia' is rising, especially in men - Associated Press

CHICAGO - July 28, 2008 - A milder type of mental decline that often precedes Alzheimer's disease is alarmingly more common than has been believed, and in men more than women, doctors reported Monday.

Nearly a million older Americans slide from normal memory into mild impairment each year, researchers estimate, based on a Mayo Clinic study of Minnesota residents.

That's on top of the half million Americans who develop full-blown Alzheimer's or other forms of dementia - a problem sure to grow as baby boomers age. The oldest boomers turn 62 this year.

"We're seeing that in fact there's a much larger burgeoning problem out there" of people at risk of developing dementia, said Dr. Ronald Petersen, the Mayo scientist who led the study.

Dr. Ralph Nixon, a New York University psychiatrist and scientific adviser to the Alzheimer's Association, was blunt.

"We're facing a crisis," he said.

There are no treatments now to prevent this mental slide or reverse it once it starts.

But that may be changing. Researchers on Monday reported early, somewhat encouraging results from an experimental nose spray that seemed to improve certain memory measures in a study of mildly impaired people.

The drug, for now just called AL-108, needs testing in a longer, larger study. It is being developed by Allon Therapeutics Inc., based in Vancouver, B.C.

Doctors said it shows the potential for new types of medicines that target the protein tangles that kill nerve cells, instead of targeting the sticky brain deposits that have gotten most of the attention up to now.

The studies were reported at the International Conference on Alzheimer's Disease in Chicago.

Petersen is the scientist who defined mild cognitive impairment, or MCI, as a transition phase between healthy aging and dementia. It is more than "senior moments" like forgetting where you parked the car, but not as severe as having dementia, where you forget what a car is for.

People with it have impaired memory but not other problems like confusion, inattention or trouble putting thoughts into words.

The Alzheimer's Association says more than 5 million Americans have Alzheimer's, but no estimate for this "pre-dementia" has been available until now.

Petersen's federally funded study involved roughly 1,600 people, ages 70 through 89, living in Olmstead County, which surrounds the Mayo Clinic in Rochester, Minn. All tested normal when they were enrolled in the study, but more than 5 percent had developed mild impairment when evaluated a year later.

Men were nearly twice as likely as women to develop it. That's a surprise, because some studies have found more women with Alzheimer's than men. But there may be a simple explanation:

Even though more men may be impaired, women outlive them and therefore have more time to develop full-blown dementia.

"This is a very large and important issue for our country and for the world," said Duke University psychologist Brenda Plassman. A smaller study she published earlier this year backs up the Mayo study's findings.

The mild impairment rate is two to three times larger than many researchers had expected, Petersen said.

"It's the iceberg under the tip," agreed Dr. R. Scott Turner, incoming director of the memory disorders program at Georgetown University Medical Center. A prime goal is finding drugs to treat the mild impairment before Alzheimer's develops.

The AL-108 study tried to do that. Scientists gave 144 people with mild impairment either a low or high dose of the drug or a dummy drug for 12 weeks. The study missed its main goal - a composite of various memory scores - and the low dose showed no effect. But those on the higher dose improved on some memory tasks after one month and benefits lasted a month after they stopped treatment, said the study's leader, Dr. Donald Schmechel of Duke University.

The study was sponsored by the drug maker.

In another study presented at the conference on Sunday and published on the Internet by the British medical journal The Lancet, researchers reported that dementia rates in developing countries may be considerably higher than official estimates and closer to rates in wealthy countries.

Scientists used a more liberal definition of dementia more suitable to poorer, less educated populations, where respect for family often means relatives don't regard dementia as a burden so much and may be less likely to report problems.

The study involved nearly 15,000 people in 11 sites from China, India, Cuba, Mexico and other nations. Dementia rates ranged from nearly 6 percent in rural China to nearly 12 percent in the Dominican Republic, said co-author Martin Prince of King's College in London.

The World Health Organization and the Alzheimer's Association were among the study's sponsors.

---

AP Medical Writer Margie Mason in Hanoi, Vietnam, contributed to this story. Read more!

ctor is perfect pitch man for depression support group - New Iberia (LA) Daily Iberian

July 28 - He has been a U.S. Marshal in “The Fugitive,” a turncoat in “The Matrix” and a twisted Mafia captain in “The Sopranos,” so as I waited for Emmy award winning actor Joe Pantoliano to meet me in The Daily Iberian lobby Friday morning, I wasn’t sure exactly who was going to walk through the door.

His people — yes, it seems all Hollywood types have people — contacted the newspaper earlier this month, saying Pantoliano would be available for an in-person interview July 25. If we were interested, his time range was from 10:30 a.m. to 1 p.m. We responded quickly, saying 1 p.m. would work perfectly for us.

We were quickly informed 10:30 a.m. would work better for Pantoliano, leaving me to wonder why we were given a time range in the first place. It was also a potential sign Pantoliano’s people might turn out to be more headache than necessary. In the end, nothing was further from the truth.

Pantoliano, a Hoboken, N.J., native, passed through New Iberia and the rest of South Louisiana to drum up awareness for his non-profit group No Kidding, Me Too! (www.nkm2.org), an organization that tries to break down societal barriers through brain disease education. Its goal is to empower those with brain disease to admit their illness, seek treatment and become greater members of society.

Pantoliano was in New Orleans and Baton Rouge Thursday representing No Kidding, Me Too! in conjunction with the Pharmaceutical Research and Manufacturers of America (PhRMA), which released a report last week on hundreds of mental illness medicines being tested in human clinical trials or waiting FDA approval.

PhRMA provided the stats, which include more than 300 medicines in development to treat mental disorders, and Pantoliano provided the punch.

The 56-year-old actor held nothing back in talking about his lifelong battles with depression. In a 40-minute, wide-ranging interview Friday in New Iberia, Pantoliano openly discussed how his best friend, the man who married him and his wife, committed suicide two days after the men shared a laugh on the phone. Pantoliano went on to describe how his mother, an undiagnosed bipolar sufferer, was the daughter of an alcoholic. He said that led to a dysfunctional childhood that plunged him into a lifetime of depression. He didn’t seek treatment for his mental illness until after his friend’s suicide.

“The greatest thing that has ever happened to me has being been diagnosed with clinical depression, brain disease,” Pantoliano said. “I have been able to get everything I really wanted back.”

The most interesting part of the Pantoliano interview wasn’t that he was so open with his story, but the way in which he conveyed his story.

Actors are paid to perform and Pantoliano’s résumé includes more than 120 television and film roles, but that doesn’t always mean they are perfect pitch men. However, Pantoliano is the perfect pitchman for his cause of No Kidding, Me Too!

During our interview, he never sat still. Wearing his trademark flat cap backwards and fancy cowboy boots, the actor known to some as “Joey Pants” performed as much as spoke. He was entertainingly profane as he pulled no punches in discussing his own battles with alcohol and female addiction.

He was open to suggestion, asking many times for help with the perfect word that would finish his thought. He stopped during the interview to compliment Daily Iberian photographer Bill Smith’s photos, which were hanging on the conference room wall.

For 40 minutes he made our conference room his bar room. He made the water bottles on the table seem like a couple of beers and the four men around the room seem like old buddies at a laid back barbecue.

In the end, he delivered a message of hope, asking why is it there is no shame in Viagra television commercials, but people are still hesitant to talk about depression?

“In order to get recovery, more than anything else, you have to eliminate the shame,” Pantoliano said.

It’s obvious to me Pantoliano is a great actor but the 40 minutes I spent with him was no show.

STEPHEN HEMET is city editor for The Daily Iberian. He can be reached at stephen.hemelt@daily-iberian.com.
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Freud meets finance: new focus on feelings -Investment News

More advisory firms adding psychologists

By Charles Paikert
July 28, 2008

A wealthy prospect wanted investment-grade bonds, and only investment-grade bonds, in his portfolio.

His financial adviser, not surprisingly, wanted him to be more aggressive in his investment selections.

That is where Gary Shunk came in.

Mr. Shunk, a psychotherapist and licensed clinical social worker who runs Chicago-based Wealth Psychology, was serving as a "wealth counselor" to the adviser's wealth management firm. Mr. Shunk urged the adviser to find out why bonds were so important to the prospect.

"Your agenda [as an adviser] can get in the way of the prospect's agenda, which is predominant," Mr. Shunk said.

In this case, he said, looking into the prospect's reasons for making bonds so important would give the adviser insights into the prospect's behavior as well as help earn the prospect's trust — and hopefully his business.

Demand for Mr. Shunk's services is soaring, and he isn't alone.

Wealth management, family office and other advisory firms increasingly are using psychology — and psychologists — to work both with wealthy clients and the advisers who serve them.

In one of the most high-profile examples of the trend to date, Charlotte, N.C.-based Wachovia Corp. this month hired Susan Massenzio, who has a doctorate in organizational and counseling psychology, as associate director of family dynamics for Calibre, a division of Winston-Salem, N.C.-based Wachovia Wealth Management that caters to wealthy families with more than $50 million in investible assets.

A number of other firms, including Bank of New York Mellon Corp., Commonwealth Financial Network of Waltham, Mass., and Wells Fargo & Co. of San Francisco, also are using either psychologists or psychologically trained counselors to help clients and advisers deal with issues that range from family squabbles to spoiled children to drug addiction.

The growing popularity of combining financial planning and psychology isn't confined to large firms or superwealthy clients.

"There's a growing awareness of a void in the financial services and mental-health professions around the issue of money," said Rick Kahler, a certified financial planner and president of Kahler Financial Group of Rapid City, S.D.

This year, he started the Planner-Therapist Alliance, a Yahoo list-serve group that has about 70 regular contributors from around the country.

"Planners aren't trained as psychologists, and psychologists certainly aren't trained as financial planners," said Mr. Kahler, co-author with Kathleen Fox of "Conscious Finance: Uncover Your Hidden Money Beliefs and Transform the Role of Money in Your Life" (FoxCraft Inc., 2005).

Wachovia's family dynamics practice incorporates cognitive-psychology principles in training its advisers and relationship managers to help facilitate family meetings and work individually with clients on "delicate issues" such as prenuptial agreements, Ms. Massenzio said.

"We will not provide therapy," she said, but will, if appropriate, refer clients to a professional therapist.

Psychological principles also are used to help advisers and managers with client retention and acquisition, Ms. Massenzio said.

To understand their needs, The Bank of New York asks wealth clients to take the Stratton Consultative Group's Interpersonal Leadership Styles Test, said Thomas Rogerson, Boston-based director of family wealth services for the bank's wealth management group.

"We want to educate them and make sure they understand what the issues are," he said.

Parents who have difficulty "giving up control to children while they're still alive" is the most common stressful situation Mr. Rogerson said he encounters among wealthy clients.

Facilitating family meetings to deal with the issue — or referring clients to psychologists or psychiatrists — has become "the other side of estate planning," he said.

Commonwealth is also stepping up its emphasis on employing psychology in adviser-client relationships, according to Kol Birke, who leads the firm's efforts in the area.

For the past year and a half, the company has been providing advisers with conference sessions, workshops and individual coaching focusing on psychological issues, he said.

"More and more advisers will have strategic alliances with therapists," he said. "It will become commonplace, like a referral to an estate attorney."

According to Mr. Shunk, wealthy families are preoccupied with how money affects their children.

He described a case where a father was so afraid that his son would realize the family's true wealth that he would refuse to buy things, explaining that the family didn't have the money.

"The father had an understandable concern, but I had to tell him that lying to his son wasn't the right way to address the issue," Mr. Shunk said.

Not everyone, of course, thinks that advisers need staff psychologists.

"I think understanding behavioral finance makes sense when it comes to investing, but I can't believe firms are employing psychologists full-time," said one wealth manager, who asked not to be identified.
Susan Massenzio: Wachovia hired the psychologist this month.

GROWING DEMAND
Yet those who have incorporated psychology into their practice are convinced that the demand will only grow. Within 10 years, most financial-management firms will offer psychological services, Dr. James Grubman predicted at New York-based Thomson Reuters' Wealth Management Summit last fall in Boston.

Mr. Grubman, a clinical psychologist who heads FamilyWealth Consulting in Turners Falls, Mass., works as a consultant for several large financial firms, including Wachovia's Calibre division.

"Over time, you'll see the difference become clearer between firms," said Dr. Keith Whitaker, managing director of family dynamics at Calibre. "Some will say we manage people's money as best we can; others will help clients with the experience of wealth as a whole."

E-mail Charles Paikert at cpaikert@investmentnews.com.
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Athens native celebrates passage of disabilities bill - Athens (AL) News Courier

July 28 - Jeff Ridgeway said he will join Gov. Bob Riley and others in September at a bill signing ceremony in Montgomery celebrating the passage of a new law that Ridgeway says enables people to “answer by name and not their disability.”

Ridgeway, an Athens native who now makes his home in Mobile, had been fighting for the legislation since 2004.

It was approved on the final day of the legislative session in May.

Ridgeway, 43, has been visually impaired in one eye and hearing impaired since birth. He also has a hole in his heart.

Creating the bill was an effort to ensure those with disabilities are viewed as people by a simple change in wording, Ridgeway said. Now, state laws must use phrases such as “individuals with disabilities” rather than disabled and “individuals with mental illness” rather than “mentally ill,” according to a story in the Mobile Press Register.

“This law actually changes the way the Legislature refers to people,” Ridgeway said. “Instead of handicapped or crippled, it puts the person first and the disability second.” “It’s sort of like Rodney Dangerfield says: We get no respect.”

Rep. Randy Davis, R-Daphne, worked to get the bill approved and it eventually passed the House.

House members wanted to congratulate Ridgeway in person, he said, so they invited him to visit the floor of the House.

Ridgeway, the son of Wayne Ridgeway of Athens, moved to Mobile in 1991 after his mother died to live with his sister.

Today, he lives by himself. He has been a clerk in Bruno’s Supermarket for 14 years and is an advocate for the disabled.

“I have had three open heart surgeries, brain surgery and had a stroke at age 14,” Ridgeway said. “I feel like I’ve come a long way since then.”

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Exhibit illustrates therapy - Tallahassee Democrat

By Mary Leslie - July 28, 2008

With all the excitement and distractions that The Mary Brogan Museum of Art and Science has to offer, one might miss the colorful paintings and drawings that hang on its walls.

These 17 pieces of art represent a silent and invisible pain hidden under the bustle of daily life.

The museum is hosting an exhibit called "When There Are No Words: Healing Through Art Therapy," a collection of work from the patients of Tallahassee Memorial HealthCare Behavioral Health Center.

Each was created by patients with bipolar disorder, dissociative identity disorder, severe depression or some other mental illness, said Behavioral Health Center art therapist Jennifer Pruett.

Pruett, who supervises group sessions in art therapy, said the creative process offers a window into the patients' world. Because the brain works differently when a person is making art, the simple act of looking at one's own painting or drawing can be illuminating.

The Brogan's executive director, Chucha Barber, said that part of the museum's strategic plan is a focus on health and human sciences. She said the staff was glad to help promote understanding of mental illness.

"The most obvious health (problems) get the largest amount of attention," she said. "Frankly, this is an area that doesn't always get the light shone on it."

Pruett said participants in her groups often say they aren't treated with the same compassion as someone with, say, cancer. That mental illness is regarded as taboo.

Early in the 20th century, psychology and education professionals began comparing notes on the artwork that their patients and students had created.

Pruett said they discovered that certain expressive behaviors — such as making art — enhance recovery and mental health, which leads to greater developmental and emotional growth.

"(Psychologists) were seeing their patients with mental illnesses creating art that represented their thoughts and feelings," she said.

"Educators noticed that they could tell the (level of) cognitive and developmental functioning of their students through how their art was presented."

The Behavioral Health Center has had an art-therapy program since 1996 as part of its Expressive Therapies department, which also offers both music and recreation therapies.

Because art therapists have both psychology and visual-arts backgrounds to meet the needs of their patients, Pruett is able to use a combination of techniques to help her artists.

Pruett said the groups, which can have as many as 16 participants, are great for socialization and allowing the patients to react and respond to each other.

Some days they work on relaxation, and other days they work on coping skills and problem solving. Having a group of people who can understand you can be remarkably healing.

She urges her patients to focus on creating, rather than worry about their skills. It isn't about being talented but about communicating and expressing one's self in a different way.
Read more!

Mental disorders – the burden must lift - Christian Science Monitor

July 29, 2008

For those who are said to suffer from the many different disorders categorized as mental illness, life can seem like a terrible prison from which there is no hope of escape; they often feel alone, stigmatized, and misunderstood. Those who yearn to help loved ones and neighbors with mental disorders can feel helpless as to what they can do for them and burdened with a heartbreaking responsibility.

According to the National Institutes of Mental Health, based in Bethesda, Md., "The burden of mental illness on health and productivity in the United States and throughout the world has long been underestimated." Mental disorders are the leading cause of disability in the US and Canada for ages 15 to 44, and many people suffer from more than one disorder at a given time.

Across this grim scene a bright light waits to shine truly hopeful and transformative rays. The world will be a better place for our having given the matter attention and prayer, because the issues surrounding mental illness are so central to the ills facing humanity.

In the 142 years since Mary Baker Eddy discovered it, Christian Science has delivered many people from mental torment (see report of healing of bipolar disorder in the Christian Science Sentinel, July 14, pp. 12-13). Christian Science treatment doesn't begin with conventional methods of addressing mental illness – including prescription medications with their host of side effects, or psychoanalysis – all of which assume that the cause of the trouble exists in the brain. In fact, Christian Science asserts that healing answers lie in the opposite direction. "Every concept which seems to begin with the brain begins falsely," wrote Mrs. Eddy. "Divine Mind is the only cause or Principle of existence. Cause does not exist in matter, in mortal mind, or in physical forms" ("Science and Health with Key to the Scriptures," p. 262). Mind and Principle, as used here, are synonymous with God.

The authority for that statement comes from the teaching of Jesus. Two of the Gospels tell about a man he healed who had the symptoms of severe mental illness and how Jesus restored him to "his right mind." No longer a tormented recluse, he became a functioning member of society – and an advocate of Jesus and his healing power (see Mark 5:1-20; Luke 8:26-39).

If Jesus had seen only an emotionally disturbed man who needed to be changed into a sound one, he wouldn't have been able to heal him. As Christian Science explains, Jesus healed by seeing everyone as God created them – perfect as He is, whole, free, always in their right mind. And his example shows us how we can approach the issue of mental illness and help alleviate it. To Jesus, even the most difficult of human circumstances were not hard and fast realities. They were situations to be spiritually confronted – and overcome. He specifically urged his followers to "Heal the sick, raise the dead, cleanse the lepers, cast out demons: freely ye received, freely give" (Matt. 10:8, American Standard Version). And Christian Science teaches that, as we follow Jesus' example, it's possible to maintain spiritual facts in the face of the most discouraging material appearances. This is the Christlike model for attacking any problem through prayer.

The Christ is God's transforming message of hope and healing. It speaks individually to each consciousness, without exception. When entertaining the Christ in one's thought – that is, willingly seeking to understand God's power to see His creation as He knows it – healing must result. We can all help make a difference in the lives of those who struggle to find mental peace.

On behalf of those who suffer from mental illness, we can refuse to believe that God has destined lives of pain for them. We can refuse to believe that heredity or imbalance or stigma define their identities and instead advocate for the spiritual wholeness and freedom of each individual. We can see more in the way that Jesus saw, and work at adopting the Christ consciousness, in support of these fellow beings and their families.
Adapted from the Christian Science Sentinel. Read more!

State does right with safety net for vets -Casper (WY) Star-Tribune

Star-Tribune Editorial Board - July 29

The Star-Tribune's multi-week series, "Back from War," showed clearly that Wyoming's new war veterans are struggling with some of the same issues as their counterparts across the country.

Our reporters told the stories of service men and women dealing with post-traumatic stress disorder, traumatic brain injury, physical wounds and difficult family adjustments.

The series also described how many Cowboy State veterans face the additional challenge of traveling long distances to receive treatment at Department of Veterans Affairs facilities.

The good news: State officials aren't just sitting back and leaving it up to the VA to give veterans the help they need.

In 2007, the Legislature directed the Wyoming Department of Health to identify areas where the federal government wasn't doing enough to address mental health issues affecting veterans and their families. The result was a 25-page report concluding that while there were adequate mental health services for Wyoming veterans, they didn't always connect with the help they needed, and they sometimes put off mental health care until it was too late.

Among other things, the findings showed that the federal government had failed to properly screen Wyoming soldiers for mental health problems after they returned home, and that there wasn't enough outreach to soldiers and their families.

In response, state lawmakers earlier this year approved $800,000 to make sure veterans home from Iraq and Afghanistan get the mental health care they need. The money is paying for:

-- Two veterans' advocates who travel the state and meet confidentially with veterans and their families. They provide mental health screenings and connect veterans with the services they need.

-- Travel, child care and other expenses for veterans and their families so their can receive mental health treatment.

-- Doctors to provide mental health screenings for soldiers and their families.

-- Training for doctors and other health care workers on the best practices to treat war related injuries and illnesses.

The state also has created a college scholarship program to help veterans get the education they need to find good jobs in Wyoming.

The Legislature and the governor deserve credit for the effort. As Sen. Mike Massie, D-Laramie, put it: "It didn't make sense to me that the wealthiest state in the country could not jump in and provide for its veterans when the federal government was failing them."

That's not to say that the VA has totally dropped the ball. The VA medical centers in Sheridan and Cheyenne have boosted mental health and other services, and many veterans are getting help from the federal programs.

But in creating a safety net for Wyoming veterans, the state is showing that we appreciate the sacrifices of the brave men and women who have served our country in Iraq and Afghanistan.

Is there more to be done? That's certainly a possibility. We encourage state officials to be vigilant in assessing the effectiveness of the measures they've put into place, and in determining where there are additional needs.

It's also incumbent upon health care workers, employers and friends and families of veterans to encourage the service men and women to get the help they need.

It's the least we can do.

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Woman who started fatal Wrigleyville fire sent to mental health facility - Chicago Tribune

By Matthew Walberg - July 28, 2008

A mentally ill woman who started a fire that killed four people in a Wrigleyville apartment building last year was ordered held indefinitely in a state mental health facility on Monday.

Circuit Judge James Linn issued the order after Dr. Jacqueline Jordan, a psychiatrist from the Elgin Mental Health Center, testified that Mary Smith required inpatient mental health treatment.

In May, Linn found Smith not guilty of murder by reason of insanity for the deadly March 2007 blaze at an apartment building in the 3500 block of North Fremont Street

Smith, who has been in and out of mental health facilities for nearly two decades, was wandering the streets near Addison Street and Broadway when she entered the back stairwell of the building. She later told police she set a fire in a stairwell to warm herself.

The flames claimed the lives of two residents, Jennifer Carlson, 24, and Jason Bowers, 23, and their friends, Joseph Schultz, 23, and Jerod Pilgreen, 21, who were visiting from Belvidere, Ill.

Family members of the victims asked that Linn order Smith be held indefinitely.

"Had she been kept off the streets, my son and his three friends might very well still be alive," Pilgreen's mother, Susan, told the court in a written victim impact statement.

The mental health facility will be required to provide the judge a report on Smith's progress every 60 days, said Assistant State's Atty. Mary Lacy.

If Smith does not respond to treatment, she will spend the rest of her life at the facility. But if doctors believe she has progressed to an acceptable point, a hearing will be scheduled, Lacy said.

mwalberg@tribune.com Read more!

Worst mental health problems from flood still to come - Cedar Rapids (IO) Gazette

By Bryce Bauer

July 28 - Area mental health professionals reporting a spattering of people with stress and insomnia from the floods of 2008 warn the real mental health problems won't be seen for many months to come.

Call it a state of psychological numbness.

"We are just now seeing the tip of the iceberg," said Alan Whitters, the director of the Iowa Disaster Response Team of the Iowa Psychiatry Society. "The ones we will see later are the ones that say, 'Nothing is bothering me now.'"

That's because people were surrounded by community during flood preparation, involved in a group effort laced with the hope of saving their homes. Now they are left alone to deal with the destruction. So as the shock of the disaster wears off problems like post-traumatic stress disorder can take hold.

"One of the things was, kind of, the increasing emotional distress that homeowners are starting to feel now that the floodwater is down, the sandbags are leaving and the reality of now: 'What do we do with our house sets in?'" said Stephen Trefz, the executive director of the Mid-Eastern Iowa Community Mental Health Center Iowa in Iowa City. "The mental health impacts are going to be three, four, five, six months down the road."

So psychiatrists and psychologists in Cedar Rapids and Iowa City are preparing.

The flood has caused mental stress for people directly impacted and also those who weren't. "You just have to take everyday the best you can and deal with things as they come and not get overloaded even though you do sometimes," a 65-year-old Cedar Rapids named Sharon said. She asked that her last name not be printed.

She didn't receive floodwaters in her house but was impacted during the flood. First her 95-year-old aunt's house was inundated and Sharon took her in. Then her mother, Wanda, died.

Sharon said she spent most afternoons before the flood with her mother, who had been living at Cottage Grove Pl., 2115 First Ave. SE, Cedar Rapids, but was unable to visit her in the days leading up to her unexpected death when the city flooded.

To cope she said she tries to keep herself busy by spending time with her friends and family as well as seeking the support of a psychologist. "You have to talk it out," she said. "Cry when you want to cry and not be ashamed about it."

The Iowa Department of Human Services has contracted with various mental health agencies to provide free counseling in areas impacted by natural disasters.

The Abbe Center for Community Mental Health is responsible for Linn, Benton and Jones counties while the Mid-Eastern Iowa center will cover Cedar and Johnson counties, Roger Munns, a DHS spokesman, said. The department is seeking hundreds of thousands of Federal Emergency Disaster Agency dollars to help fund the counseling.

"We are well into the process of planning for an additional eight or nine months of counseling," Munns said.

People from the Abbe Center have been distributing information door-to-door and talking with people about mental health concerns related to the flooding, Sue Blome, the center's coordinator for crisis services, said.

"We would like to, with this outreach attempt, minimize the domestic abuse, the increased abuse of alcohol or substance abuse," Blome said. Such problems, she said, were seen in Grand Forks, Ill. after that city's flood in 1997.

In Iowa City, Trefz said officials at his organization hoped to send three or four outreach counselors into its coverage area. "We are anticipating those folks will be our front line folks dealing with people," he said.

Trefz said mental health care workers saw similar latent mental health problem during the 1993 flood, but he anticipates this year to be worse. "In 1993 Iowa City was flooded and a lot of homes were under water, but nine square miles of Cedar Rapids was not under water," he said. "When a city just 25 miles above you was obliterated I think some of that stuff is going to come down."

He also noted that people in 1993 believed they'd seen a once-in-a-lifetime flood. Now that security is gone, he said.

Whitters, the doctor with the Iowa Psychiatry Society, works in Cedar Rapids in both private practice and with the Abbe Center. He said some mental health providers from New Orleans are to visit in the coming months to advise Iowa counterparts on providing counseling after a disaster.

To stave off problems, the professionals said people should not isolate themselves but reach out to support services — from fiscal to faith — that exist in their community. For problems they are seeing now — like anxiety and insomnia — they emphasize that feel stress and anger is normal after natural disasters. Whitters said sometimes it helps if people turn off the television so they aren't exposed constantly to the destruction.

Since the floods he has written several prescriptions to treat insomnia — a condition for which he normally is apprehensive about doling out medication.
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Failing the troops -Winston-Salem (NC) Journal

JOURNAL EDITORIAL STAFF

Once again, the U.S. military has failed its troops: Soldiers with physical or mental injuries can wait two months to a year before the Army acts to medically discharge them or return them to their units.

That's the finding of a House investigation, USA Today reported last week, and that waiting period is two or three times longer than the Army goal set last year.

Last year, the Army had promised to reduce that time after news broke about the red-tape delays and poor treatment at the Walter Reed Army Medical Center in Washington. An investigation by the House Armed Services Committee has found that whatever progress was made has been reversed, the newspaper reported.

Unit squad leaders and caseworkers are deluged by returning soldiers. Once again, poor planning has resulted in this country shamefully failing troops who've given it their all.

"These soldiers deserve high-quality care," House Committee Chairman Ike Skelton said in a prepared statement. "The staff members charged with providing their care are doing yeoman's work, but the current staffing levels can't handle that load."

Skelton said he was "disappointed and troubled" by the situation.

We should all be.

One way or another, these soldiers need to get on with their lives, and not be carelessly left in limbo. Congress should demand better from the Army.
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Police crisis team training put to test -Evansille (IN) Courier Press

By Gavin Lesnick

Not two hours into his first shift back from a weeklong training session on dealing with subjects suffering from mental illness, Evansville Police Department officer Chris Goergen found himself putting his new skills to use.

Goergen, a field training officer who has spent six years in the department, was dispatched to deal with a man with paranoid schizophrenia who had been acting strangely and was scaring relatives.

Thanks to the training, Goergen not only recognized the signs of mental illness, but also he knew how best to deal with them. He was patient, asked open-ended questions and kept his cool even when the man did not.

"And he was able to get help through the hospital that day," Goergen said. "His mom was just really grateful. She was extremely thankful to me that I had compassion for her son. You could see an immediate difference in that one example. The family was relieved the police knew what was going on."

Goergen was one of two Police Department officers who underwent training earlier this year in Fort Wayne, Ind., in preparation for creating a crisis intervention team.

Modeled after similar programs there and across the country, the team will act as a partnership between emergency responders and medical responders to best serve mentally ill patients. The program trains officers to identify and respond to mentally ill subjects while also improving communication with health providers.

Elsewhere, the teams have begun in response to a tragic incident — a confrontation between a mentally ill person and an officer that left one of them dead or injured.

Locally, the goal is to get the program on its feet before such an incident occurs and to, perhaps, prevent one from ever taking place.

On a broader level, its aim is to change perceptions, reactions and a system that officials say isn't as helpful to the mentally ill as it should be.

"A lot of mentally ill individuals end up getting arrested because they don't understand what the officers want them to do," said Jill Marcrum, a Vanderburgh County Superior Court magistrate and co-chairwoman of the local crisis intervention team committee. "You read the officers' affidavit of probable cause and it's clear there was a danger and there wasn't any other option but to arrest that person. So they end up in jail, where they're not going to get any help for their mental illness."

Marcrum and fellow team chair Janie Chappell, director of business development at Deaconess Cross Pointe, also attended the training in Fort Wayne.

Together with Goergen and Police Department officer Mike Sitzman, the local representatives underwent 40 hours of crisis intervention training. Officials went over a variety of mental disorders, drugs used to treat them, tactics for dealing with mentally ill subjects in a crisis and ways to improve the working relationship between emergency responders and health providers.

They also talked about the dangers of not preparing. The first Crisis Intervention Team started in Memphis when officers there shot and killed a mentally ill person who had been threatening suicide with a knife and refused to drop his weapon.

"That's one of the things we're trying to avoid," Chappell said.

In addition to getting officers certified, the team also is changing procedures between law enforcement and the hospitals.

When the team officially begins in late August or early September, one of two crisis intervention officers who bring a mentally ill subject to a hospital will fill out a form detailing what happened and why the person needs help.

"Instead of word-of-mouth, you actually have a document that says exactly what the officers saw," Goergen said, adding that formal communication has been lacking in the past.

Deaconess Hospital and St. Mary's Medical Center are also in different stages working to provide a special area for officers to bring in patients for treatment under the new program.

Working together, the different players meet through the committee and discuss the best ways to implement the team.

"The main goal is to get people in crisis the right resources," Goergen said.

Ultimately, the Evansville force will train 50 officers. Other departments will follow suit, Marcrum said, including other law enforcement agencies, university security teams, businesses and county dispatchers.

About 15 to 20 Evansville officers will go through a local training program slated for February, she said.

It's a positive movement, Goergen said, both for the day-to-day effect it has on individual patients and an overall change in philosophy he said is necessary.

"It's more of a shift in attitude about how you see somebody in crisis," he said. "It's not so much that they're scary or weird or something wrong with them. It's an illness. It's no different than cancer.">/span> Read more!

Governor signs suicide prevention act - The California Aggie, University of Califorina-Davis

Written by ALI EDNEY

Suicide ranks as one of the leading causes of death for American youths, but state officials hope to change that.

Governor Arnold Schwarzenegger signed the Jason Flatt Act this month to help prevent teen suicide by providing suicide prevention funding to schools.

The act, sponsored by state Senator Robert Dutton (R-Rancho Cucamonga), is named for a 16-year-old victim of suicide, Jason Flatt. The Jason Foundation, started by Jason's family, sponsored the bill.

"The bill authorizes school districts to use a portion of their Professional Development Block Grant funds to provide suicide prevention training to teachers," said Schwarzenegger spokesperson Camille Anderson.

Beginning in 2014, the act will allow districts who already receive the grant to offer their teachers two hours of training.

"Losing even one young life to suicide is one too many - and that is why I signed the Jason Flatt Act today," Schwarzenegger said in a written statement. "It's my sincere hope other states will follow our lead in helping ensure teachers across the nation are trained to recognize the warning signs of youth suicide."

According to the text of the act, suicide ranks as the third-leading cause of death for Americans aged 15 to 24, fourth for ages 10 to 14 and second for those of college age.

The bill was also supported by the California Teachers Association.

"It is a very important piece of legislation," said CTA spokesperson Sandra Jackson. "Teen suicide is very serious. It's the third-highest cause for student death, therefore we need to help with professional development."

While each district will fold the training into its schedule as the individual district sees fit, most trainings will probably be held on staff development days, or teacher work days, leaving school days untouched, Jackson said.

"Teachers think that it's worthwhile, meaningful and necessary to have a better understanding of suicide," Jackson said. "And to be able to [identify] stressors that would be indicators of a suicide risk. A student's life is precious, and to end it by suicide is traumatic to both the student and the community."

Some districts, like the Davis Joint Unified School District, employ special psychologists to deal with suicide prevention and other counseling needs. Certified school psychologist Deb Kimokeo works for DJUSD as the district's crisis counselor.

"My role is to help children, families and even staff members who are in crisis, either personally or as a family," Kimokeo said in a letter to parents last year. "I am often involved when families are struggling to stay together, when they are facing a life threatening illness, death or other serious change in their lives…. I frequently conduct presentations for parents and staff members on crisis intervention, suicide prevention and brain research."

Kimokeo has helped to educate students and their communities about suicide prevention and mental health awareness through workshops, classes and one-on-one sessions.

Any student registered at UC Davis (including those registered for summer session) already has access to Counseling and Psychological Services as well as peer counseling offered by The House, which is located on campus next to the UC Davis Housing Office. Students not enrolled for summer sessions who wish to make use of CAPS counseling can purchase a card for $40 to receive short-term counseling. If you or someone you know is experiencing a crisis, call 1-800-SUICIDE.



ALI EDNEY can be reached at city@californiaaggie.com. Read more!

The Report Card - Asheville (NC) Citizen-Times

Excerpts from The Report Card, issuing grades A through F, and incompletes where necessary, to a variety of news items in this space. Got an idea that makes the grade? Send it to DRussell@CITIZEN-TIMES.com.

B: To North Carolina’s General Assembly for putting time into the state’s beleaguered mental health system. Key lawmakers were optimistic that the state budget and other laws they passed would provide for more professional and less wasteful care, more local emergency services and safer psychiatric hospitals. The state budget Gov. Easley signed last week provides more than $5 million this year to run 30 “mobile crisis intervention teams,” stocked with professionals who can be called to emergencies, and allocates another $8 million a year to secure 200 beds for people in crisis at local hospitals that don’t have such space now. On the subject of mental health

A: To Western Highlands Network, the agency that oversees mental health care in eight WNC counties — Buncombe, Henderson, Transylvania, Rutherford, Polk, Mitchell, Yancey and Avery — for opening an around-the-clock call center for screening, triage and referrals. Calls to the hotline have increased dramatically over the past two years, forcing Western Highlands to hire three more people. The agency also is negotiating with Smoky Mountain Center, which oversees mental health care in 15 WNC counties, to provide the service for its area. To get mental health services in the eight-county Western Highlands Network area, call the hotline at 225-2800 or 800-951-3792.

A: To Rep. Susan Fisher for sticking to her guns and refusing to remove references to sexual orientation from anti-bullying legislation, even though the stance probably doomed passage of the measure. With protections for gay students, the bill “essentially promotes these types of behaviors as acceptable and normal,” said John Rustin of the N.C. Family Policy Council, which pushed against the measure. Said Fisher, “There are people with Ds by their names who have sworn to their preacher that they wouldn’t vote for it. So it’s more important to them (to keep that promise) than to protect children who are being harassed and bullied to the point of suicide.”

F: To Senate Republican plans to block debate on nearly all bills before the August recess unless Democrats vote to go along with the GOP’s wishes to expand offshore drilling for oil. Senate Minority Leader Mitch McConnell (R-Ky.) said any bills not related to energy will have to wait until after the recess. Funny they should push for a vote on this now, when they know good and well any drilling started now will have no discernible effect on gas prices for at least a decade.

A: To Under One Sky, an Asheville-based nonprofit that helps youth in foster care develop their own adoption plans and advocate for themselves within the foster care system, and its Rites of Passage Council. Under One Sky operates a summer camp in Old Fort, where the Rites of Passage Council began last year, borrowing from several traditions, including American Indian, said Diane Delafield, executive director of Under One Sky.

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Man behind Idaho murder-suicide was mentally ill - Associated Press

Associated Press - July 27, 2008 8:54 PM ET

LENORE, Idaho (AP) - The Nez Perce County Sheriff's office is still investigating what prompted a murder-suicide near Lenore on Friday.

Detective Kevin Messelt says 34-year-old Cody Alan Dwire was mentally ill, experiencing delusions and paranoia. Dwire shot and wounded his mother, Kathleen Dwire, and fatally shot Ralph Douglas Mack before turning the gun on himself.

Messelt says Dwire was placed in a California hospital between 2003 and 2007 after being accused of attempted murder and burglary in Humboldt County, Calif. Prosecutors declined to pursue the charges because of his illness.

Investigators are still trying to determine exactly how the shootings occurred, but believe it began when Dwire approached his mother and filed a single shot at her head with a Taurus .44-caliber Magnum handgun. The bullet went through a hat she was wearing, but missed her.

Both Kathleen Dwire and Mack tried to disarm Cody Dwire, and during the scuffle she was shot in the arm and Mack was reportedly shot twice in the chest. Kathleen Dwire managed to break away and run to a nearby home to call police. Sometime after the scuffle, Cody Dwire shot himself in the head with a 7 mm short Magnum rifle.

Copyright 2008 The Associated Press. All rights reserved. This material may not be published, broadcast, rewritten or redistributed. Read more!

Psychologist Warns Against Turning Bullies Into Criminals - Providence Journal

July 27, 2008

Bullies are the new group everyone loves to hate, and can hate with impunity.

School psychologist Israel "Izzy" Kalman finds this state of affairs not merely bizarre, but dangerous to children -- really dangerous, and in several ways.

Throughout his early career, Kalman specialized in healing interpersonal conflict, especially sibling rivalry. But after the 1999 shootings at Columbine High, he found himself in the awkward position of advocating for bullies -- not bully ing, mind you, but the kids labeled and punished as bullies.

In a phone interview, Kalman said, "We only care about the so- called victims. But every kid thinks he's the victim. The parents want the schools scrubbed of aggression. Schools can't do that. They promise they will, but they can not deliver." But they can pretend to be on top of the problem by bullying the so-called bully.

The unusual thrust of Kalman's work began in a 1970s college course in group dynamics, taught by a professor who literally just sat there. The group discussed the readings, grew heated with disagreements that they wanted the professor to settle, but had to find ways of working things out, peer to peer. Kalman said, "I could see how well people got along when you leave them alone."

And he began to notice that when kids squabbled, the fight got worse when the parents got involved. Teachers can't leave students to battle it out, but again, teacher intervention always escalated the fight. And if a kid can get the other kid punished, in essence she manipulated the parent, the teacher or school into doing her dirty work for her. Then the punished child wants retribution, and on it goes.

Kalman says that 90 percent of bullying is name-calling and insults. Big deal. He wonders whatever happened to "sticks and stones may break my bones, but names will never hurt me?" The other 10 percent is pushing and shoving that cause no actual hurt. Fighting is natural. Aggression helps humans survive and achieve. Fighting between kids teaches them coping skills, the benefits of negotiation, the limits of force and the natural consequences of hurting one another.

Kalman teaches kids to ignore name-calling. "Bullying is only fun if you get upset. Don't get upset. It's impossible to keep picking on someone if it doesn't upset them. If you act like a victim, it invites acceleration."

And he teaches adults to ask his "magic questions." He says, for example, "If you're my student and you tell me that 'Johnny called me an idiot,' I ask: 'Do you believe it?' Most of the time the kid quickly answers 'no.' Then I say 'good,' and the problem is over. You realize nothing terrible happened, so there's nothing to get upset about. If you answer yes, it's still your problem for believing you're an idiot.

"But if I reprimand Johnny and call his parents, will that make him like you? No. He'll want to get back at both of us. If he gets suspended, will he like school? No. Plus, you got Johnny punished, so you now can provoke him and get him in trouble again. Johnny will look for ways to get back at you, and on it goes endlessly. I've taught both of you that you should get upset by insults, and that how you feel is someone else's responsibility. Also, you learn that neither of you has freedom of speech because you're going to be punished if you say something insulting. Freedom of speech is the cornerstone of our democracy, but kids don't have freedom of speech."

Kalman's Web site -- bullies2buddies.com -- is eloquent about the protection of children's First Amendment rights.

So he's freaked about what he considers to be our culture's bloodlust for bullies. "Both the far left and the far right can hate bullies, because everyone thinks the bully is the other person. But the bullies are us. How many people do you know who never upset anyone else?"

His voice rises, "If I punish Johnny, I teach you [the 'victim'] that a person deserves to be punished even if he didn't hurt you. Every little thing that upsets you is a crime. For every little problem, we have to make the world change -- not ourselves. We want children to develop self-confidence, but how can they do that if other people solve their problems for them? So we teach children that they are entitled to a life where they are never bothered. That's impossible. The only way children can go to school without being bullied is to have a separate school for each kid. The only place where everyone is always nice is heaven, and you have to die to get in."

Kalman admits that many school staff and mental-health professionals don't buy it. They complain that bullies have to "be held accountable" and shouldn't be allowed to get away with it. Kalman says, "What's better? That the victim got away with getting the bully punished? Anti-bullying activists love to say that such- and-such percent of bullies become criminals. No. We make them become criminals."

He concludes, "I'd been a school psychologist, teaching kids how not to be bullied, for about 20 years before Columbine. A year later, on the day of the anniversary, I was at the national convention for school psychologists. There were 5,000 school psychologists. The government official who gave a keynote address announced that they would make bullying a class of harassment. So now we can legally prosecute kids for being bullies?! Everyone stood up and gave him a long standing ovation. I thought, my God, what are my colleagues so happy about? Where is compassion? We're pleased to take a whole class of children and treat them like criminals? This is a failure of our profession. We want the legal system to solve this problem for us. Now anti-bullying psychology is just law enforcement."

Kalman's conflict-management techniques are simple, logical and easy to do. His Web site is information-packed. But he's swimming upstream. Most people refuse to see the fierce aggression in their own selves, or in the predatory laws they're so keen on passing.

Julia Steiny, a former member of the Providence School Board, consults for government agencies and schools; she is co-director of Information Works!, Rhode Island's school-accountability project. She can be reached at juliasteiny@cox.net , or c/o EdWatch, The Providence Journal, 75 Fountain St., Providence, RI 02902.

(C) 2008 The Providence Journal. via ProQuest Information and Learning Company; All Rights Reserved Read more!

Judge says county could benefit from judicial reforms - Ashtabula (OH) Star Beacon

By MARGIE TRAX PAGE

ASHTABULA — Ashtabula County has needs, Supreme Court Justice Evelyn L. Stratton acknowledged Sunday, and she feels she has just the plan to fill them.

Touting a justice docket for the mentally ill and a new plan to help Ohioans access $84 billion in available state aid, Stratton campaigned at Walnut Beach Sunday afternoon following a fundraising event at the home of Ashtabula residents Ruth and John Austin.

Stratton is up for re-election in the fall.

“I feel I understand the needs of a large rural county like Ashtabula,” Stratton said.

Stratton promoted her work in mental health reform, which has helped establish mental health dockets in courts across the state. These dockets help mentally ill or mentally disabled offenders find help and treatment in lieu of incarceration.

“The prison system here has a high percentage of people with mental health issues. Six years ago I became very interested in changing that,” Stratton said. “I knew we had to find a way to keep people from recycling in and out of the prison system.”

Grant money is offered to counties that utilize these dockets, Stratton said.

Stratton said the program makes sense economically and ethically.

“It costs $30 a day for supportive housing for the mentally ill,” Stratton said. “And it costs $1,500 a day in the prison system. I feel thousands of dollars can be saved or pushed back into a more efficient and productive justice system that is better for the residents of Ohio.”

Included in that plan is law enforcement Crisis Intervention Training (CIT) for police officers. Five Ashtabula County police officers have completed the CIT program, Stratton said.

“(CIT) is teaching officers to mitigate a problem with an offender before it escalates. Talking someone down instead of unwittingly hyping them up is safer for everyone,” Stratton said.

Stratton is also a supporter of the Ohio Benefit Bank, a program that began in January under the wing of Gov. Ted Strickland to help Ohioans access $89 billion in state aid including food stamps, tax returns and aid for dependent children.

The program is open in most public libraries, Stratton said, and residents can become certified to help others use the program.

“These are resources that can help families here in Ashtabula County and everywhere in Ohio,” Stratton said. “The help was there, but accessing it was a major issue. It is my dear hope that people and senior centers and food banks and other neighborhood programs will take this access and help the people of Ashtabula County.” Read more!

Army begins treating PTSD in the field -McClathcy Newspapers

By MIKE THARP

Sgt. Seth "Doc" Musikant could be a recruiting poster for the Army's new approach to PTSD, post-traumatic stress disorder.

Last April, Musikant and his team were driving around a traffic circle in the city of Tuz. It was their second time through the roundabout that day, and between trips somebody had planted a homemade bomb. It blew up their Humvee.

One of his comrades was killed, and three were wounded. In the frenzy that followed, Musikant handed his M-4 rifle to the Iraqi interpreter, screaming, "Pull security!" Then Doc, a medic, scrambled to treat the wounded

Musikant, with the 3rd Battalion, 6th Field Artillery of the 10th Mountain Division's 1st Combat Brigade, was on his second tour in Iraq. Although he felt that he'd proved he had guts during his first tour, in Baghdad in 2005, the incident in Tuz bothered him. "It's like there's an invisible wall," Musikant said about the anxiety that temporarily troubled him.

He went to see the brigade's main mental health officer, Maj. Kyle Bourque.

"I told him it was bothering me," the 23-year-old former art student recalled. "I literally walked away with scratches. He said not to keep it inside, gave me some Ambien (a sleep aid). I still don't talk about it with anybody I don't know."

Never has the U.S. military been forced to confront so much of "the battle behind the battle" - the psychic and emotional wounds of war. What's more, grunts no longer bear the brunt of such attacks; thanks to suicide bombers and homemade bombs, drivers, cooks and other rear-echelon troops have also been killed and wounded.

A recent Rand Corp. study (criticized by the military for relying on too small a sample), calculated that some 300,000 out of 1.6 million veterans of these two wars have suffered some sort of PTSD or TBI, traumatic brain injury, which used to be called a concussion.

Nor has the military ever faced such sharp criticism for its handling, or mishandling, of the mental well-being of its troops. But never before have commanders and their troops dealt with the problems and the stigma of PTSD more directly than they've begun doing in Iraq and Afghanistan.

For one thing, it's cheaper to treat PTSD than it is to train a new recruit. For another, said Bourque: "The healthier their personnel, the better off the Army is."

Now the Army identifies a condition called Acute Stress Reaction (ASR) - the immediate aftermath of a traumatic incident in a combat zone. Since PTSD takes months, sometimes years, to manifest itself, military doctors and counselors prefer the new term to describe what they regard as normal reactions among troops confronted by abnormal situations.

Last year, the Army launched a mandatory training program to identify and treat the causes and symptoms of PTSD. The Pentagon no longer treats visits to a counselor as an adverse factor in giving security clearances.

What the 10th Mountain's 1st Brigade Combat Team has been doing for the past 11 months in Kirkuk province offers an inside look at how a gung-ho, gun-slinging outfit is dealing with the toll its troops cannot see.

Because its commander, Col. David Paschal, one month into this tour, had to deal with the deaths of four of his personal security detail, the 3,500-strong 1st Brigade is probably more proactive about the problems posed by PTSD than many of its Army counterparts are.

Its troops generally agree that during this tour, much more is being done for soldiers gripped by nightmares, flashbacks, survivor's guilt, apprehension and thoughts of suicide.



"The command has zero tolerance for blowing off a soldier's concerns," said Sgt. 1st Class Keven Duncan, himself wounded in Baghdad during his unit's 2005 tour. (It was Musikant who pulled him out of a burning Humvee.)



The Army's term for what happens when soldier sees what Col. Paschal calls "things so horrific that no human should ever have to see" is called a CID, a Critical Incident Debrief. That mandatory session takes place 24 to 72 hours after an event that may be sapping a soldier's will to fight.

All the soldiers involved in the incident gather, and Bourque and one of the unit's chaplains join them at the medical clinic or the company command post. The meeting persuades soldiers to re-experience what happened so there's a common view of the facts. Sometimes, participants write accounts of what happened; they're asked to include not just the facts, but also their feelings - even smells - of what went down.

That first meeting is supposed to show the soldiers several things:

-The Army isn't looking for fault or blame.

-The Army isn't looking to send them home.

-Other soldiers feel the same ways they do. "We help them take an abnormal event and normalize it as much as possible," says Capt. Miller Eichelberger, a brigade chaplain.



- More help is available than was in the past. Capt. Lindsay Tepelsky and her unit, the 528th Combat Stress Center at the brigade's main base, said they help dozens of soldiers a month with problems ranging from acute stress reaction to marital problems to sleeplessness.

After the first talk among soldiers directly affected by an event, treatment begins for those who say they need it and those singled out by their immediate leaders.

One common approach is regular one-on-ones with a psychiatrist or social worker in the unit. The combat stress detachment sends its counselors out to the soldiers' "workplace" - a remote hilltop communications outpost or a base inside an Iraqi village. Seeing traumatized troops in surroundings familiar to them helps them open up more, Tepelsky said.

In theater, commanders administer a Unit Needs Assessment, which anonymously asks soldiers questions about their health, behavior, family and other issues.

Mental health pros such as Tepelsky give feedback from the survey to leaders. "The Army says, 'Let's address things before they spiral out of control,' " she explained.

If the anxiety persists or worsens, the soldier is sent to a "fitness" program at two big nearby U.S. bases, where there are classes, consultation with a therapist and an exercise regimen. Counselors and chaplains continue to meet the soldier regularly to gauge progress, or a lack of it. Some are given temporary limited duty or even some in-country time off.

Only a few return to the unit's home base, Fort Drum, N.Y., or elsewhere for further treatment. Fort Drum recently opened an off-base clinic and other facilities for long-term care of its troops.

Although brigade officers insist that any stigma once attached to seeking psychological counseling has disappeared, some enlisted soldiers disagree.

"There sure as hell is" a stigma, said one female noncommissioned officer. "I wouldn't want it on my record." Added an enlisted man, "Everybody wants to be hooah (enthusiastic), and nobody wants to be thought of as a (wuss)." Neither would be quoted by name as he and she weren't authorized to speak to the media.

Some soldiers have found ways to cope with PTSD and other stressors. Sgt. Andrew Bennett, 22, a tall, taciturn infantryman from Seattle nicknamed "Robot" for doing square roots in his head while talking over his Humvee's internal radio, was wounded in the neck and shoulder during his unit's 2005 deployment to Baghdad.

When Bennett was being treated at Fort Drum, he didn't go near a counselor, and he was glad to redeploy to Iraq last year. "I didn't feel I needed it," he said. "I didn't have any of the PTSD symptoms. I sleep fine and don't have nightmares."

The 1st Brigade has been aggressive in pinpointing and dealing with its troopers' mental health in part because of what its commander, Col. Paschal, went through. He sat in a Critical Incident Debrief after an IED shredded a Humvee in their convoy a month into their deployment. Four of his own bodyguards were killed.

Nearly a year later, as he talked about what his brigade was doing about PTSD, Paschal recalled that event. Sitting in his small office, insisting that his soldiers will immediately pick up "fear or doubt in your eyes or voice," he suddenly stopped talking.

He looked at his boots, then at his big hands, rubbing them together, swallowing and blinking. Finally, he completed his thought - that he and his sergeant major had put the remains of the four dead soldiers into black rubber body bags.

The colonel looked up: "There's not a day goes by that I don't think about 'em."

Tharp is an editor with the Merced (Ca.) Sun-Star.

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S.C. woman is the new Mrs. USA - Columbia (SC) The State

Fighting stigma her platorm.

By ISHMAEL TATE - itate@thestate.com

Steadman Baptist Church pastor Ray Truett is 2-for-2.

In February, he predicted parishioner and friend Gariane Phillips Gunter of Batesburg-Leesville would become Mrs. South Carolina.

And she did.

Next, he said she would be crowned Mrs. USA.

And Thursday night, during the 2008 Mrs. USA pageant in Las Vegas, she indeed won the title.

“When they called out Mrs. North Carolina as the runner-up,” Gunter, 30, said Saturday, “I burst into tears.”

The moment was complete when husband, Tracy, and 2½-year-old daughter Isabella joined her onstage. The toddler quickly claimed a spot in her mother’s lap.

The Mrs. USA National Pageant, established in 1986, celebrates “the achievements of married women throughout the 50 states and U.S. territories,” according to the pageant Web site.

In Las Vegas, Gunter said she competed against 52 other “incredible married women,” adding “any one of them would have made a fine Mrs. USA.”

“But everything just fell into place for me,” Gunter said.

“It was just the right time.”

A third-year psychiatry resident at Palmetto Health, Gunter’s platform is fighting the stigma associated with mental illness.

“(The judges) got to see and hear it, and they agreed I should be the one to carry that message,” she said.

Going into Thursday night’s final, Gunter said she felt a sense of calm come over her.

“I think it gave me the confidence to show my true self,” she said. “I put it all in God’s hands, and that’s how I was able to get this far.

“That’s what’s so amazing,” Gunter added. “I didn’t try to be somebody that they would pick. I didn’t try to fit a mold. I just came as myself, and they picked me based on who I am.”

Gunter and her family are flying back to South Carolina today, after spending a couple of days taking in the sights of Las Vegas.

Gunter, who will return to work Monday, said she feels blessed and encouraged.

“Being a woman and mother, trying to raise children in a culture that sometimes tries to fight you,” she said, “knowing there are women fighting is very encouraging.”

Back in Batesburg-Leesville, many supporters got text messages from Gunter’s nephew, who was sitting in the audience during Thursday’s pageant, keeping people updated on pageant developments.

Truett was one of those people.

“I was thrilled, but I wasn’t surprised,” Truett said Saturday.

“I think Gariane has the physical beauty, as well as the spiritual beauty, and it comes out.”

Reach Tate at (803) 771-8549
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Officers weigh many factors in use of force -Salem (OR) Statesman-Journal

Legislature could take up issue after fatal shooting

By Alan Gustafson and Dennis Thompson Jr.
Statesman Journal

When a Silverton police officer fired five bullets into an unarmed man who was charging toward him and defying orders to get down, he followed the basic premise of deadly police force: he shot to kill.

Experts say residents commonly assume police shoot to disable by aiming at arms or legs. But that's not how they are trained.

"That's television stuff, and it's an absolute no-no," said Joseph McNamara, a former police chief of San Jose and now a fellow at Stanford University's Hoover Institution.

"You're trained to shoot for the chest. You're least likely to miss there. And don't forget, every time you miss, that bullet can go a mile away and kill some innocent bystander."

A Marion County grand jury ruled Thursday that Silverton Officer Tony Gonzalez, 35, was legally justified when he shot and killed Andrew Hanlon, 20, as Hanlon charged at the officer on a residential streetcorner.

The June 30 fatal shooting happened after the officer responded to a burglary report. Gonzalez fired seven times at Hanlon, hitting him five times, officials said.

Gonzalez reportedly fired his gun as he was backing away from Hanlon, who was screaming, kicking and swinging his arms at the officer.

Despite the grand jury's finding of a justified shooting, Hanlon's family remains adamant that deadly force wasn't necessary. As they tell it, Hanlon was agitated on the night of the shooting and possibly in the throes of mental illness.

But they point out that he weighed about 120 pounds and posed no match physically for Gonzalez, a former Marine and cagefighting coach who weighs about 240 pounds.

Gonzalez reportedly was equipped with a shock-inducing Taser but did not use it.

As Hanlon's family sees it, the case illustrates a larger problem with police use of deadly force on mentally ill people. In recent years, several mentally ill people have been shot and killed during confrontations with police in Portland. All of the shootings were deemed legally justified.

"What does not make sense to me is, over and over again in Oregon and elsewhere, that a confrontation between law enforcement and a person with mental illness ends up with a mentally ill person dead," Melanie Heise, Hanlon's sister, said Friday.

The shooting death of the young man from Ireland probably will spur the 2009 Oregon Legislature to take a fresh look at deadly police force, said Peter Courtney, D-Salem, president of the Oregon Senate.

"I want to know if we're doing enough training, and this case maybe speaks to that," he said.

Courtney predicted that state lawmakers also will examine police procedures and training for defusing incidents involving people with mental illness.

"The issue of mental illness and law enforcement is an issue that should concern the Oregon Legislature," he said. "It has to."

Through the years, legislators have repeatedly grappled with concerns and issues connected to the use of deadly force by police.

Last year, the 2007 Legislature passed a law requiring every Oregon county to draft a plan for investigating police shootings. The legislation, requested by Attorney General Hardy Myers, was intended to bring uniformity and fairness to the procedures set in motion by a police shooting.

The major police agencies in Marion County already had their own plans in place for investigating such incidents.

Under the county's new plan, as before, the district attorney has the ultimate authority about whether a case will go before a grand jury for review.

In Oregon, police may use deadly force if their lives or the lives of others are in imminent danger. Oregon grand juries rarely indict officers in deadly force cases.

When it comes to headline-grabbing police shootings, the general public and the news media often fail to take into account the independent role of the grand jury review process, McNamara said.

"Ultimately, the decision to justify the shooting or not is made by people outside the police department," he said. "When I was a police chief for 18 years and lectured my people all the time on this, I said, 'Remember, the ultimate decision about whether you were justified in pulling the trigger will not be made by me. It will be made by civilians, and that's the way our system works.' "

Force choices

Oregon police officers are trained to use a variety of types of force to get suspects and residents to comply with orders, said Cameron Campbell, the director of training for the state Department of Public Safety Standards and Training.

They also are taught when to use which type of force, and are repeatedly drilled to help make snap judgments easier to make, Campbell said.

"Officers need to respond with a level of force appropriate and reasonable given the totality of the experience," he said. "You go directly to the level of force necessary given the totality of the circumstance."

There are many factors officers have to take into account when using force besides whether the suspect is armed or not, Campbell said.

Environmental factors are a concern. Is the suspect hidden in shadow, or in the light of day? Is he or she hiding behind a wall, or out in the open? Is it rainy or dry?

The officer also has to weigh his fitness and presence against that of the suspect, Campbell said. Is the suspect younger or older than the officer? Does he or she have a bigger build, or display a better fighting ability? What are the chances the suspect could overpower the officer?

Range of training

Officers receive 12 hours of classroom training in use of force at the police academy, more training in their defensive tactics class and countless hours rehearsing different scenarios, Campbell said.

The idea behind the training is to give officers a head start in making split-second decisions under pressure.

Officers also need to stay on top of their training after leaving the academy, Campbell said.

"They are what we call perishable skills," he said. "If you are not engaged and active, they will disappear over time."

Silverton Police Chief Rick Lewis said Friday that members of his 17-officer agency take part in periodic training in the use of force.

"The training includes a number of regular test questions on use of force given different scenarios and how they're to respond," he said.

He added that the small police agency has its own certified Taser instructor.

As it stands, Lewis said, there are no plans to provide additional training for officers following the fatal shooting. But that could change.

"We always look for additional training," he said. "The more they're trained, the better equipped they are to deal with not only that type of situation but any situation."

Different levels

The level of force that officers can use starts with their very presence.

"The mere fact that an officer arrives and is in uniform can and most often does neutralize the aggression, without the officer saying anything," Campbell said.

Beyond that, an officer can issue verbal commands, use hand holds to subdue a suspect, or take out his or her baton, pepper spray or Taser and bring a suspect down, Campbell said.

If officers must shoot a suspect, they are taught to fire until the threat is no longer a threat, Campbell said.

"You continue to fire until the person goes down," he said.

Warning shots are a myth, and actually illegal.

"What goes up must come down," Campbell said. "There's a lot of negligence involved in firing a warning shot. I wouldn't want that bullet coming down around my house."

Subduing a suspect with a shot to the arm or leg or shooting a gun out of the person's hand are more myths, he said.

"These guys are not Wyatt Earp. Most officers cannot hit a gun in someone's hand," Campbell said. "Movies and television are very good at portraying that, but that is not real life."

When an incident has escalated to shooting, the officer's heart rate rockets and adrenaline pours into the bloodstream.

"With all that happening, fine motor skills are lost," Campbell said. "They become deteriorated."

That's why officers are taught to shoot center-mass, at the torso of a person.

"It's the largest part of the body, the biggest target," Campbell said.

Progress shown

Nationwide, law enforcement agencies have made progress in reducing the use of deadly force, McNamara said.

Across the country, police shoot and kill hundreds of people each year, ranging from 455 in 1993 to 343 in 2005, according to U.S. Department of Justice statistics.

McNamara cited growing awareness of mental-health issues, increased training and growing reliance on Tasers as possible reasons for the decline in deadly police shootings.

"It's a major concern of police agencies to hold down deaths, and the police have actually made some achievements," he said. "The ones police hate the most, of course, are the shootings of mentally ill people, as opposed to some bank robber who's shooting it out with the police."

Even with specialized training, police officers can be hard-pressed to defuse incidents involving a person suffering from a psychotic episode, McNamara said.

"It's always a cop's toughest job, and it's one in which the police suffer the most injuries because they really don't want to hurt someone who's mentally ill, so they will be taking more risk than they might if it's a violent felon," he said.

Courtney cited the recent Salem police response to a local psychiatric patient's escape as a stellar example of law enforcement going all out to resolve a dangerous situation without deadly force.

Police officers used multiple Taser shocks to subdue Oregon State Hospital escapee Michael Sands after he bolted from a locked psychiatric ward July 11. Sands reportedly carjacked a vehicle in West Salem, rammed a police car, resisted a police dog and assaulted an officer before police arrested him.

"That, to me, was a remarkable instance of law enforcement dealing with an extraordinarily dangerous, fast-paced situation," Courtney said. "They were up against it. Serious injury or death could have been involved at any given time and they found a way to bring it under control. They moved very quickly, very reasonably and very effectively to bring a very successful conclusion to a near-impossible situation."

agustafs@StatesmanJournal.com or (503) 399-6709; dmthomps@StatesmanJournal.com or (503) 399-6719

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Expert: Bipolar disorder often unrecognized- Lowell (MA) Sun

By Christine Phelan, cphelan@lowellsun.com

The announcement that state Sen. J. James Marzilli Jr. suffers from bipolar disorder, following his arrest, has some shaking their heads in bewilderment, some in disgust.

But not psychiatrist Gary Sachs, who directs Massachusetts General Hospital's Bipolar Clinic and Research Program. For Sachs, Marzilli's erratic behavior during his June 3 visit to Lowell -- during which he was accused of accosting four women in as many hours, followed by a foot chase and ultimately his arrest in a city parking garage -- is well within the boundaries of the disease that affects some 9 million Americans.

"It's an equal-opportunity condition," Sachs said, noting that the average age of onset is ages 15 to 19, and that half of his clinic's patients are 18 or younger.

Marzilli faces two court hearings this week. Tomorrow, he will be in Lowell Superior Court for a hearing into charges lodged in the downtown Lowell incidents. On Thursday, he faces another hearing in Middlesex Superior Court in Woburn, on a civil complaint filed by three women who say they were harassed by Marzilli in other incidents.

Following his arrest, Marzilli was admitted to McLean Hospital, a psychiatric hospital in Belmont. His attorney said Marzilli was diagnosed with bipolar disorder.

"Jane," a Massachusetts Trial Court employee who did not want her real name used, said she was diagnosed as bipolar about seven years ago at age 35, but had been diagnosed years earlier as suffering from
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either depression or manic episodes depending on the phase she was in.

Jane, who is married and has always maintained employment, is now being treated by drugs and therapy to level her moods.

What she doesn't understand is how Marzilli, who as a politician leads a very public life, could show no signs of the disorder until age 50.

"I never did anything crazy, but If you talked to anyone who knows me, they would tell you they knew something was wrong from early on,'' Jane said.

Sachs said, "There are people who've had episodes that've gone undetected, and those that have their first episode later in life. I don't know Sen. Marzilli, but the kind of multiple incidents where he was using very poor judgment, that is something that, during an episode, is a common symptom. There's no doubt about that."

While just under 3 percent of Americans have bipolar disorder, Sachs said fewer than one in three cases are recognized, despite reliable methods to diagnose the disease. And because it's so often diagnosed in tandem with other mental illnesses, like depression and anxiety disorder, early treatment is critical.

Bipolar patients on average live dramatically briefer lives -- sometimes by as much as two decades -- due to alcohol and drug abuse, or suicide.

Bipolar disorder is characterized by dramatic and uncontrollable shifts in mood, ranging from euphoric highs to, more frequently, debilitating depressive episodes. While its exact origins are unknown, major emotional events -- like death or divorce -- can ignite bipolar mania, as can an overabundance of the stress hormone cortisol, produced by the adrenal gland, and even bodily inflammation, both of which may affect brain circuitry, Sachs said.

Biological stressors of an episode -- especially the lack of sleep -- can exacerbate the intensity of an existing episode.

Treatment usually involves both drugs and talk therapy.

But what makes bipolar disorder -- previously called manic depression -- distinct is patients' almost incredible disconnect with reality, Sachs said.

"With depression, we don't appreciate what is missing: the capacity to experience pleasure," he explained. "But when we get to mood elevation, it's the opposite -- we don't appreciate the downside of anything. You can't make perceptions accurately. It's a kind of colorblindness. You can't see those red lights, and you're going to get a lot of tickets if you get caught."

And while there's intense debate about over-diagnosis, Sachs said there is a larger issue.

"We do have reliable ways to make diagnoses," Sachs said. "But there are a lot of inaccurate diagnoses, we miss cases, or we conclude that because we saw one or another star that the whole dipper is there. We have an absolute duty to our patient to give them a systematic diagnosis."

Sun reporter Lisa Redmond contributed to this story. Read more!

McCain backs expansion of disabilities protection - Associated Press

Associated Press

Republican presidential candidate John McCain is pledging support for a proposal to expand protections for disabled people under an 18-year-old landmark civil rights law.

Speaking from Cottonwood, Ariz., by satellite to a disabilities forum in Columbus, Ohio, McCain said Saturday that revisions to the Americans With Disabilities Act must leave no doubt that it was intended to protect from any discrimination that's based on physical or mental disabilities.

The Supreme Court generally has exempted from the law's protection people with partial physical disabilities, as well as people with physical impairments that can be treated with medication or devices such as hearing aids.

”We must clarify the definition of a disability to assure full protection for those the law is intended to serve,“ said McCain, who was spending the weekend at his nearby northern Arizona getaway.

A month ago, the House passed a bill to extend protections to people who take medicine to control epilepsy, diabetes or cancer, or use prosthetic limbs. McCain, a co-sponsor of the 1990 law, said he intends to support a similar bill in the Senate.

Democratic presidential candidate Barack Obama, who was headed back to the United States from an international trip, has said he supports the bill so that it could override court decisions that narrowed the law's scope.

Obama on Saturday brushed aside Republican criticism of his overseas trip and stood outside the famed 10 Downing Street to say that both President Bush and Sen. John McCain were moving his way on the key issues of Iraq and Afghanistan.

Hours before flying home, Obama also suggested his poll numbers might dip in the coming days, adding: ”We have been out of the country for a week. People are worried about gas prices and home foreclosures.“

At the same time, he said the journey to two war zones, the Mideast and Europe was important because ”many of the issues that we face at home are not going to be solved as effectively unless we have strong partners abroad.“

Republicans have criticized Obama throughout his trip, and McCain's campaign said recently the Democrat was taking a ”premature victory lap“ with more than 100 days remaining in the presidential campaign.

In Arizona, McCain took a swipe at the headline-making trip in a radio address on Iraq and energy that his campaign made available to the media: ”With all the breathless coverage from abroad, and with Senator Obama now addressing his speeches to the people of the world, I'm starting to feel a little left out. Maybe you are, too.“

But Obama sought to turn that back on his critics. He said McCain had earlier been ”telling me I was supposed to take this trip. He suggested it and thought it was a good idea.“

”John McCain has visited every one of these countries post-primary that I have,“ he said.
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'There's jobs for us, and we need the work' -Des Moines (IA) Register

By NIGEL DUARA - nduara@dmreg.com

Rodrigo Rodriguez, a contract laborer, arrived in Postville on June 1 after being recruited by Bravo Labor Agency.

He once drove a cement truck in central Texas, but he was unemployed in May. He said he heard through the grapevine that there was work in Iowa.

Rodriguez, 35, said he was given $50 in Texas by Bravo, and another $50 when he arrived in Postville by bus. He borrowed $20 from a plant supervisor to get by.

Laborers contracted by the Bravo labor firm arrived in Postville in groups of five or 10.

Gavino Bravo, son of the company's 93-year-old patriarch, said the company's standard procedure is to buy the workers' bus tickets and loan them $50 for the trip.

"From what I understand, 90 percent of the companies will give them a loan (the day of arrival)," Bravo said.

Rodriguez said he's been treated well while working on the kill floor of the plant.

"They gave me a residence, which I didn't have, they gave me a job, which I didn't have," said Rodriguez, who is bilingual. "The point is, we need jobs, there's jobs for us, and we need the work."

Texas to Iowa, and back again

Diana Morris is a hardscrabble, self-described "country girl" from Amarillo, Texas, who grew up on the margin.

She's been in and out of mental institutions to treat her bipolar disorder and schizophrenia. As a girl, she lived with her father and six cousins inside a station wagon. On hot nights, she slept on the roof of the car.

Morris heard about the jobs at Agriprocessors at $10 an hour.

She wanted to get out of Texas, away from the crack habit she picked up a decade ago and the cycle of addiction, rehab and relapse.

Morris spent three days on a bus north to Postville with the $15 a recruiter gave her and a wet, persistent cough from bronchitis.

A real-estate company in town, GAL Investments, showed her to a house south of town. The lights didn't work and the space was cramped, but she was under a roof.

She went through orientation at Agriprocessors. After a week, her bronchitis worsened and she saw a doctor. She missed two days of work.

When she returned, she said a supervisor called her aside. His message:

" 'You're terminated,' like that," she said the supervisor told her. "Then he said I had 30 seconds to decide if I wanted a ticket back to Amarillo."

An Agriprocessors spokesman declined to comment about Morris' situation.

Morris declined the bus ticket offered her, but the local radio station raised about $200 for her bus ticket and some money to make it back to Texas.

Before she left, Morris said she wasn't worried - it was just another hard bump on a tough road. Read more!

FDA faulted over unapproved uses of medications -Associated Presss

By RICARDO ALONSO-ZALDIVAR

WASHINGTON - When a state trooper pulls over a speeding motorist, the officer usually writes out a ticket on the spot.

When federal regulators catch a drug company peddling prescription medications for an unapproved use, it takes them an average of seven months to issue a warning, according to a draft report by congressional investigators. It typically takes four more months for the company to fix the problem. During that time, a lot prescriptions can be written.

The report from the Government Accountability Office delves into a gray area of medical practice and federal oversight: the use of medications to treat conditions other than the ones the drugs were approved for, a practice known as "off-label" prescribing.

Although widely accepted, off-label prescribing can amount to an uncontrolled experiment. While some patients benefit, others get drugs that do not do them much good and end up wasting their money. Some people have been harmed by unexpected side effects.

What makes the practice so difficult to get a handle on is a web of seemingly contradictory laws and regulations.

Drug companies are forbidden to promote medications for uses that have not been validated by the Food and Drug Administration on evidence from clinical trials. Doctors, however, can use their own independent judgment in prescribing medicines. Also, under guidance proposed by the FDA this year, drug companies could distribute to doctors scientific articles that suggest new and unapproved uses for medications.

The situation has raised concerns for Sen. Charles Grassley, R-Iowa, who fears that federal programs such as Medicare and Medicaid are paying billions for medications used for questionable purposes while bulking up the bottom line for pharmaceutical companies. Indeed, a 2006 study suggested that more than 20 percent of prescriptions written in the United States are for off-label use.

The review that Grassley requested by the investigative arm of Congress found that the FDA is ill-equipped to catch even blatant marketing abuses by drug companies. The agency does not have any staff exclusively assigned to monitor whether companies are following the rule against marketing drugs for unapproved uses.

The FDA "isn't keeping track of how drugs are marketed for off-label use, even though marketing for off-label use is illegal and it's the FDA's job to enforce that law," Grassley said in a statement. "As a result, drug makers aren't being held accountable for promoting unapproved use of medicine and patient safety is diminished."

Instead, the job is handled by the office that oversees all drug advertising, including television commercials and magazine ads. That office has 44 full-time employees assigned to review ads. Last year, they had to dissect the fine print on some 68,000 advertisements.

The office tries to set priorities, by focusing first on misrepresentations that could have a damaging impact on human health. But the report found that the FDA lacks a system for tracking all the material it receives.

From 2003-2007, the office issued 42 notices of possible violations, which usually prompted the drug maker to drop its promotional claims. The cases included a drug approved for breast cancer and rectal cancer that also was being promoted for treatment of gastric, cervical, uterine, ovarian, renal, bladder, thyroid and liver cancers.

An additional 11 cases involving off-label promotions wound up in the hands of the Justice Department during the same period. Last year, for example, Bristol-Myers Squibb Co. agreed to pay the government more than $500 million to settle claims involving a series of alleged infractions, including promoting the drug Abilify _ approved to treat schizophrenia and bipolar disorder _ for treatment of dementia-related psychosis and for use in treating children. Read more!

Audit raps community support mental health service - Asheville (NC) Citizen-Times

Leslie Boyd

A report by the state auditor has found a number of problems with the N.C. Department of Health and Human Services oversight of billing for the controversial one-on-one mental health service called community support.

The audit report, released earlier this month, says the department’s Division of Medical Assistance:

- Did not properly document the factors that went into the decision to contract the review function to a Virginia-based corporation, Value Options, so there are few records about project expectations and goals.

- Turned off a system control that would have helped to weed out illegitimate claims, allowing virtually all claims to be approved.

- Did not adequately document its review of the services provided by Value Options.

- Did not adequately settle a claim related to overbilling by Value Options for its reviews of community support services. In addition, the division did not properly account for the recovery of the amount that was over-billed.

Originally, the local management agencies had responsibility for the reviews, but then-Secretary Carmen Hooker Odom announced in March of 2006 that Value Options would take over the review function on June 1.

“I think the report just says what most of us felt two years ago,” said Joe Martin, director of Alpha-Omega Health in Madison, Mitchell and Yancey counties. “(The switch) was poorly planned and Value Options was given the go-ahead to approve everything.”

Audit: Contract rushed

According to the report, the decision to award the contract to Value Options was rushed and poorly planned and executed.

Hooker Odom approved the contract without informing the legislature, said John Tote, executive director of the Mental Health Association of North Carolina.

The day the contract was announced, Tote said, Hooker Odom attended a meeting of the legislative committee that oversees the mental health system and did not mention the contract. Moments after the meeting concluded, she announced the contract.

“I clearly think this shows there was more going on than we knew,” Tote said.

According to the audit, the division believed having a single entity doing the reviews would save money, but the auditor found no documentation to support that assumption. The auditor also found no documents that summarized forecast data. The division failed to project needs and costs for the services, so there was no way to measure whether services were being overbilled.

Nesbitt weighs in

“There was no plan, no organizing, no execution,” said N.C. Sen. Martin Nesbitt, D-Buncombe, co-chair of the legislative committee that oversees the mental health system.

“She did this in a hurry. … None of this surprises me because in the last few years the department hasn’t managed anything very well.”

Originally, several of the local management agencies, including Western Highlands Network, were supposed to perform the reviews. Arthur Carder, CEO of Western Highlands, said his agency had provisional approval to do it.

“Suddenly we were told we couldn’t do it and it was going to Value Options,” Carder said.

Once Value Options took over the reviews, the state’s computer system began rejecting most of the Medicaid claims for mental health services, so the state turned off the function, allowing all claims to be approved.

“It does not appear that the division performed appropriate planning to gain an understanding of the data needs and system capabilities of the contractor to ensure accurate system integration,” the report says.

The report also criticizes the division for not monitoring the performance of Value Options.

Division’s rebuttal

In its rebuttal, the division said it did not have the personnel to perform onsite reviews and other oversight, and that Value Options has a stringent internal review process.

Finally, the report criticized the division for turning off the “program edit” that was meant to help catch inappropriate claims.

The lack of monitoring, the disabling of the system control and an unclear definition of what the community support service was supposed to be led to millions of dollars in cost overruns, and DHHS cut the rate it paid for the service in April 2007.

At the time, Gov. Mike Easley said the cost overruns came about because the companies that provided community support services were breaking the rules.

But Tote and others say the definition of community support was poorly written, leaving it open to interpretation, and when the computer control was turned off, every interpretation got approved.

“I don’t think service providers saw this as a field day,” Carder said.

“I think most of them were just trying to get the best services they could to meet their clients’ needs. The problem was that nobody was reviewing the claims to see whether they were appropriate.” Read more!

Program helps officers learn how to deal with homeless and mentally ill - Wilmington (NC) Star-News

By Matt Tomsic

“Everything I had was gone.”

When Ricky Kenneth Hubbard spoke with Kure Beach Police Patrol Officer Jamie King on May 10, Hubbard didn’t know where he was or what he was doing.

Hubbard’s health began to fail in early May, causing him to lose his job.

“Of course when the paycheck stops, I lost my apartment and really didn’t have anywhere to go,” Hubbard said.

After that, his memory is spotty until he spoke with King at Kure Beach.

“I was so sick,” Hubbard said. “I don’t even know how I wound up there. I don’t have a clue. I don’t even know what I was doing; I was just so sick I couldn’t concentrate.

“And then Jamie ... kind of gave me some direction, maybe there was some hope.”

King had participated in the Crisis Intervention Team training, which teaches police officers how to handle situations with the homeless or people suffering from mental illnesses.

Instead of arresting Hubbard, King put him in touch with Sharon Bundick, a CIT instructor and the manager of PATH at Mental Health Association in N.C. Inc. PATH stands for “projects that assist with the transition from homelessness.”

With Bundick’s help, Hubbard moved into the Good Shepherd Center in Wilmington. Since the transition, Bundick has helped Hubbard apply for Section 8 housing vouchers and disability benefits.

“Everything I had was gone,” Hubbard said. “What’s really amazing is one period I’m doing fine, paying the bills and everything else, then the next week it’s all gone. Without (King’s) intervention, I don’t know what I would do, where I would have gone.”

Getting started

Carolyn Craddock and Anita Oldham of the Southeastern Center for Mental Health approached law enforcement officials in March 2007 about starting a Crisis Intervention Team program.

“They wanted to help us, and we wanted to help them,” said Lt. Herald Adams of the New Hanover County Sheriff’s Office.

Adams and some other officers went through training in the fall of 2007 then decided to start their own in New Hanover County. Their program is the only one of its kind in Southeastern North Carolina, Adams said.

Since local training began on Jan. 7, officers and service providers have said it has improved the way officers respond to calls involving the homeless or mentally ill.

Statistics from the Memphis, Tenn., Police Department, the first department to start a CIT program, show that injuries are down for both officers and consumers, arrests are down and use of force also is down, according to the department’s Web site.

The New Hanover County Sheriff’s Office and Wilmington Police Department have about 20 officers who have been through CIT training. Robeson County has three officers who are certified, and Pender County has sent officers to the training as well, Adams said.

How it works

When the 911 center gets a call that involves a lower-end charge against a homeless person or someone with a mental illness, a CIT officer tries to respond.

“They’ll try to help get that person to the proper place instead of the jail,” Adams said

Often, the officers will connect the person experiencing the crisis with area service providers who usually take over from there, he said.

The aim of the training is to stop the revolving door that has the homeless and mentally ill rotating from the street to jail and back again.

Katrina Knight, executive director of the Good Shepherd Center, said she is a big fan of the CIT program.

“We’re really excited that one’s being implemented in this community,” she said. “I’m hearing very good things from officers about it.”

Communication problems

Despite some success, Knight said getting CIT trained officers to respond to an emergency at the shelter has been a problem.

“When it breaks down for us, so far, is in the implementation,” she said.

Staff at the Good Shepherd Center were notified of the program and told to request a CIT officer when they dial 911.

“As far as I know to date, when we request a CIT officer, 100 percent of the time the dispatcher says, ‘I don’t know what you’re talking about,’” Knight said.

She added that the center has made more than 10 calls requesting a CIT officer in the past few months.

A red sign by every phone reminds staff: “When calling 911, please add: ‘I would like to request a CIT officer.’”

Adams said officers are aware of the breakdown, and they are working with dispatchers to correct the problem.

They also are working on a CIT training program for dispatchers, he added.

“It’s so new to the area that we’re keeping a running log on the CIT officers,” he said. “So after every school, we’ll send a list to the 911 center.”

The list goes to the supervisor, who passes on the information as he sees fit, Adams said.

Knight said she understands it will take time to train dispatchers and more officers.

“We’re not criticizing the program at all,” Knight said. “I think this is a huge benefit to our community, and I really applaud the folks that have worked to make it happen.”

Giving back

As for Hubbard, he still has a lot of work left to do since meeting with Officer Jamie King on May 10, but he’s starting to get back on his feet. He’s gotten his housing voucher and began working odd jobs through Good Shepherd’s work placement program.

“It’s all going to work out,” Hubbard said. “I’m trying to stay upbeat with it right now.”

Hubbard’s also added another item to his to-do list since his encounter with King.

“I’ve actually talked to Sharon about doing some volunteer work for these guys,” he said. “Because I’m going to give back what they’ve done for me, because obviously they did give me a glimmer of hope that everything’s not lost.”

Newsroom: 343-2378
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One homeless man's life: A tale of woe that ended in his death over a 24-ounce beer - Belleview (IL) News-Democrat

BY BETH HUNDSDORFER

GRANITE CITY -- Thomas "Tommy" Muffler could barely see out of his swollen eyes after he received a beating that lead to his death five days later, but he didn't go to the hospital -- he found his way to Eddie's Lounge, the place where he hung out, met friends, looked for odd jobs and maybe a place to sleep for the night.

Muffler, 48, worked handyman jobs that paid enough for homemade cigarettes or a couple of cold beers. The brand didn't matter. When police found his body, there was a can of Milwaukee's Best Ice ale between his knees.

"I paid him $5 to $10 an hour or I would pay him by the job," said Muffler's friend, Robert Ostresh, who hired Muffler to do maintenance on his rental properties.

When he didn't have money, Ostresh said Muffler drank beer in an alley with friends near the Kirkpatrick Homes, the city's housing project.

It wasn't always this way. Muffler once lived in an Alton apartment and had a wife.

"Tommy was a really nice guy, but he had issues about being responsible. He liked to drink. He didn't like to work," Ostresh said. "He had some personal issues, too. He was separated from his wife before he died."

Ostresh, who stands 6-foot-4 , and Muffler, who was 5-foot-2, had a kind of "Mutt and Jeff" friendship, Ostresh said.

"Even though Tommy didn't have anything, he'd give you the shirt off his back," he said.

Muffler wandered the streets and alleys, sometimes staying at friends' homes for a night or two, but always wandered back to Eddie's Lounge at 2900 Nameoki Road.

"I don't think he liked how he was living, but he didn't do much to change it," Ostresh said.

Muffler collapsed and died on Oct. 12, 2007, in a driveway in the 2500 block of Nameoki Road. An autopsy showed Muffler died from complications of a beating delivered five days earlier, police said, by Brandon C. Bouck and Joseph Lee Raines, who beat Muffler and took his 24-ounce beer.

Last week, Bouck received a seven-year prison sentence after pleading guilty to second-degree murder in Muffler's attack. Raines is scheduled to be sentenced on Tuesday.

Muffler had been beaten by Raines the week before when Muffler refused to buy him alcohol, Ostresh said.

"He didn't understand why they didn't leave him alone," said Muffler's brother, Charles Muffler. "He didn't bother anyone."

Three days before he died, Tommy Muffler came into Eddie's Lounge. It was dollar beer night. It was also the last time Charles Muffler saw his brother.

"His face was swollen. It looked like his jaw was broke. His ribs were hurt," Charles Muffler said.

Muffler sustained injuries to his head, arms and genitals. Three of his ribs were fractured and his left lung collapsed.

Police Detective Kenneth Wojtowicz told a coroner's jury Muffler worried that there may have been warrants for his arrest on a public intoxication charge that made him resist seeking medical treatment. Muffler didn't have any money or health insurance to cover the cost of an emergency room visit, Ostresh said.

"I told him he needed to get it looked at, but he just said he would be all right," the victim's brother recalled.

Charles Muffler heard about his brother's death from Ostresh. Police called Ostresh after they found his number in Thomas Muffler's wallet.

"He didn't do nothing to deserve that," Charles Muffler said. "He was just Tommy."

Violence against the homeless is rising, said Michael Stoops, acting executive director of the National Coalition for the Homeless in Washington, D.C.

"Life on the streets is rough and dangerous," Stoops said. "Part of street life is getting into rumbles."

The homeless don't seek medical attention after attacks, generally, because they don't have money or health insurance, so Stoops said they minimize the injuries or try to "tough it out."

The homeless make easy targets, Stoops said, because they are visible and vulnerable and often unwilling to go to the police.

"They have often had bad experiences with police who chase them away from homes or businesses," Stoops said. "There's no 'Officer Friendly' for the homeless. They wrongly think that the police won't do anything when they become victims, so often they won't even report it."

There's also the disturbing trend of videotaping staged boxing matches between the homeless called "Bum Fights" and putting them on the Internet, Stoops said.

The National Coalition for the Homeless sponsored two bills: One would require law enforcement to track crimes against the homeless, while the other would make the homeless a protected class, like race, disability or sexual orientation, making it easier to prosecute attacks as hate crimes.

Last year, 28 homeless people were murdered in the United States, Stoops said, up from 20 in 2006.

Contact reporter Beth Hundsdorfer at bhundsdorfer@bnd.com or 692-9481. Read more!

DHHS chief: Mental health fix needs better tools - Raleigh (NC) News & Observer

Lynn Bonner

Ed Masters of Rocky Mount gets calls every month or so from parents asking for his help at a magistrate's office or a hospital getting a mentally ill adult child committed to an institution.

In many rural North Carolina counties, the first place to turn when symptoms of mental illnesses begin to overwhelm patients is a sheriff's office or people such as Masters, a volunteer advocate for the mentally ill.

Help is on the way, in the form of $20 million the General Assembly recently approved to help provide more local services. But before the first dollar is spent, an ongoing power struggle between the state and the local mental health offices has state administrators warning that the effort could fall short -- and will be legislators' fault if it does.

Regional mental health offices, run by local boards, have struggled for years to find enough doctors and psychologists to offer high-level services to the sickest people. In 2001, the state forced local offices to stop treating patients. As a result, the state never achieved a central goal of the 2001 reforms: to have fewer people admitted to state mental hospitals.

Once local offices stopped offering treatment, some patients with severe mental illness lost contact with psychiatrists on the public payroll and clogged local emergency rooms instead. State mental hospital admissions boomed, and the hospitals' short-term wards filled with people who could not find care near their homes.

Now the legislature has given the state Department of Health and Human Services about $5.75 million to help pay for 30 mobile crisis teams, a service used to calm volatile patients and take them to hospitals or clinics. About $14.2 million will be used to buy space in local hospitals for psychiatric patients and to start mental health clinics where people can seek care after they leave hospitals.

"I think it's an excellent move," Masters said. "It's a lot better than locking somebody in jail."

Dempsey Benton, state Department of Health and Human Services secretary, warned that legislators did not give his office the power to ensure immediate improvements.

"If problems emerge in those areas for which we requested the ability to have an immediate service impact, it will be through a lack of the legislative and administrative tools we sought from the General Assembly," Benton said in a written statement.

Faster action sought

In an interview, Benton said he wanted legislators to allow the state to more quickly take powers away from local offices that don't do a good job. The Easley administration complained for months that it took too long -- nine months -- to take jobs away from local providers who weren't getting proper services to needy patients. After three months of poor performance at a local office, the state had to offer six months of tutoring before taking over.

The legislature responded by giving local offices six months rather than nine months to improve. Benton said that's still too long.

"They should be able to carry out these functions," he said. "We're at a point where we need to see performance within a reasonable period of time or shift that responsibility" to another local office."

The extra money and responsibility going to local offices heightens the department's concerns about local performance.

"Are we concerned? Yes," said Dr. Michael Lancaster, co-director of the state Division of Mental Health, Developmental Disabilities and Substance Abuse Services. "The legislature has given us a great opportunity to build a strong system. We don't want this to slip."

Though legislators have shown more confidence in the DHHS since Benton took over last year, the department itself does not have a good record.

The state took away responsibility for approving most services from nearly all local offices and gave it to a private company, ValueOptions. The result was overuse of a lucrative service called community support, in which patients received mental health help they did not need. Other seriously ill people went without high-level treatment that could have kept them out of hospitals.

A News & Observer investigation earlier this year showed that the state wasted at least $400 million on community support. Legislators want DHHS to give the task of approving patients' care back to local offices.

Legislators who worked on the mental health budget said Benton's criticism surprised them.

State Rep. Verla Insko, a Chapel Hill Democrat who works on mental health laws, said that if DHHS would use the powers it has, administrators wouldn't have to keep arguing about local offices not doing their jobs.

"We've been arguing about this now for about a year and a half," she said, and if the department had started to fix local problems 18 months ago, they would have been solved by now. Insko said DHHS administrators are "not going to do it until they have it [the law] the way they want it."

Local offices' failures

Benton pointed to local offices' failures to get follow-up appointments with community providers within seven days for patients discharged from state hospitals. The appointments are essential to making sure patients are taking their medicine and starting their routine care. The appointments are important to keeping people from returning again and again to state hospitals.

But almost all local offices fail to meet state standards for giving patients follow-up care.

In the last three months of 2007, only six local offices of the 24 reporting connected at least 42 percent of patients who left state help with a community provider within seven days. Only 35 percent of patients got such follow-ups statewide.

The state has never tried to take the job away from any of the 18 offices it says fail to meet standards.

It would be difficult to take jobs away from a local office because its follow-up treatment falls short, said Dick Oliver, head of a DHHS team that works with local offices. The law allows the state to take "functions" away from a local office, and it could be difficult to pinpoint problems leading to lack of follow-up appointments, he said.

DHHS is figuring out what it wants to do with the new money for local care and should start rolling out plans for spending the mobile crisis money with 30 days, Benton said. The local clinics may take longer, he said, with the timing depending on how quickly 30 psychiatrists can be hired.

State officials expect that the new clinics will help discharged hospital patients and mentally ill people released from jails and prisons get doctors' appointments.

Little effect expected

The advocates for the mentally ill doubt that the new money will have much impact. The mobile crisis money is going to be stretched thin.

"I don't think you'll notice much of a difference," said Gerry Akland, a member of the National Alliance on Mental Illness' Wake County chapter.

And finding psychiatrists to work in rural counties -- after many of them lost their government jobs earlier this decade -- will be a challenge, they said.

Dr. Marvin Swartz, a Duke University psychiatrist, said no one should expect a quick improvements. Swartz, who has been an adviser to DHHS, said that the department doesn't have enough people to handle all the power it wants and that the local offices can't quickly take on a load of new responsibilities.

He and Joseph Morrissey, a health policy professor at UNC-Chapel Hill, are starting a mental health policy institute to help local offices figure how what works best in their regions.

"We need to think long and hard and have a long-term plan about how you implement change," Swartz said. "That has been one of the massive failures of reform. How do you get from here to there? What are the resources you need?"

lynn.bonner@newsobserver.com or (919) 829-4821
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Parents speaking out on suicide -Spokane (WA) Spokesman Review

Karen Dorn Steele

When Joshua Levy jumped off the Monroe Street Bridge a year ago, a firefighter watching from a kayak in the Spokane River said the mentally ill young man frantically flapped his arms while falling feet-first to his death.

"He was desperately trying to fly," Robert H. Trautmann said in a report.

Levy, a 28-year-old schizophrenic college student with a large and caring family, had flown off other bridges, landing in the frigid waters of Puget Sound and swimming to safety.

He'd been tackled and talked down from other suicide attempts and had been hospitalized five times since his 21st birthday.

But police had never before fired a Taser at him – a decision made in the town where he was born and where he'd returned only three days earlier to live with his father after being released from a mental hospital in Western Washington.

After reviewing Spokane Police Department records they'd requested last year but obtained only recently with the help of the Center for Justice, Levy's family is speaking out about what they think went wrong – and what they hope to do about it.

His parents, David Breidenbach, of Spokane, and Susan Levy, of Bainbridge Island, also are working with Disability Rights Washington in Seattle, a federally funded nonprofit investigating the death of their son.

They are asking these questions:

•Why was the severely mentally ill Levy released from Western State Hospital on July 24 without a confirmed plan for treatment by Spokane Mental Health?

•Why did Washington State Patrol officers who encountered Levy jumping in and out of traffic on Highway 195 near Hatch Road about 4 a.m. on July 26 not deliver him to Sacred Heart Medical Center – or at least inform his family of his erratic behavior?

•Why didn't Police Department negotiators make more use of trained mental health advisers during the long standoff on the Monroe Street Bridge on July 26 and 27?

•Why, after Police Chief Anne Kirkpatrick's officers had promised the family they wouldn't use force on Levy, did they deploy a Taser and rush his position – causing him to jump?
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"It's taken months to get the records. After reviewing them, we have so many questions," said Levy, a former KREM-TV public affairs director who is now with a health consulting business on Bainbridge Island, in an interview last week.
The prologue

It's unclear why Levy was released from Western State Hospital on July 24 with a two-week supply of medication to control his schizophrenia but without an appointment at Spokane Mental Health, which was supposed to continue his care under a formal agreement reached July 17 in Pierce County Superior Court.

The hospital "didn't close the loop and make sure people in Spokane knew Josh was coming. They should have called on the day he was released," said David Carlson, the lawyer from Disability Rights Washington investigating Levy's death.

"We weren't contacted by anybody" until the morning of July 27, said David H. Panken, CEO of Spokane Mental Health.

In a July 17 court declaration, Western State Hospital's Dr. Edward Pierce said Levy could be kept stable if he took his medications reliably – but he wasn't "intrinsically motivated" to do that.

Nonetheless, Pierce and Marylouise Jones, a Ph.D. mental health expert, said Levy "appears to have reached the maximum benefits of patient hospitalization." They recommended his release to Breidenbach's home in Spokane, with "screening upon arrival" at Spokane Mental Health.

Levy's "less restrictive alternative" treatment agreement says the "Spokane Mental Health Center has agreed to assume responsibility including case management." On July 12, Jim O'Hare, of Behavioral Health Care Options – a Las Vegas-based company that provides managed care to Spokane's regional mental health network – signed a release form: "will accept consumer upon discharge."

But Levy had no screening appointment set up when he arrived in Spokane late July 24 with his father, who had driven across the state to pick him up.

At 4:30 p.m. July 25, records show Western State Hospital's Peter Bruce called Spokane Crisis Services, asking that Levy be seen as a walk-in. He also informed the Spokane agency that Levy had been discharged the day before.

In its response, the crisis agency said: "Spokane Mental Health has no knowledge of this case."

Crisis Services called Levy at 4:40 p.m. and noted he "agreed to be called the following morning to come in for a walk-in."

That 24-hour gap in care would prove critical on the evening of July 26, when Spokane Mental Health would tell police responding to the Monroe Street Bridge that they'd "never heard" of Levy.

On the evening of July 25, Breidenbach said his son left his South Hill house for a bike ride – and didn't return home by bedtime.

Somewhere between High Drive and Hatch Road at Highway 195, Levy crashed his bike. About 3:40 a.m. July 26, troopers were told of several 911 calls reporting a "male jumping into traffic" on the highway.

Trooper J.A. McKee's report said Levy admitted walking into traffic and said he was looking for the bike he'd crashed earlier. McKee said he refused to give Levy a ride to his father's house because he felt he'd been uncooperative.

A second trooper offered to drive Levy to the house on West 22nd Avenue just after 4 a.m. – but didn't ring the doorbell or inform Breidenbach that his son had been acting strangely in traffic.

Later that morning – about 10 hours before Levy would appear on the Monroe Street Bridge – father and son had breakfast together.

"He went to bed and I went to work, and that was the last I saw of him," Breidenbach said.

At 4:15 p.m. that day, Spokane Crisis Response tried to call Levy at his father's home.

"Wasn't reached and no message was left," the records say.
On the bridge

The standoff on the bridge began about 7:19 p.m. July 26 when Levy arrived with his bicycle and sat on the bridge rail with his feet dangling over.

Police cleared the bridge of traffic and closed Lincoln Street.

At 8:53 p.m., Levy was described by dispatchers as a white male with a Star of David tattooed on his right calf. At 10:15, he was identified as a "possible John Levy."

Officer Daniel Waters, a trained Police Department hostage negotiator, said in his report that they'd tried early on to identify the man on the bridge. "Our local MHP (mental health provider) had no information on Levy," he noted.

Police stayed on the bridge all night.

At 5:59 a.m. July 27, they learned Levy had met with a mental health counselor at Western State Hospital before arriving in Spokane and was provided with medication.

At 6:12 a.m., Spokane Mental Health "advises no record," the police reports say. Western faxed information on Levy to Spokane Mental Health about an hour later, Panken said.

Susan Levy said she first learned of the incident when Spokane police called her about 7 a.m. – after her son had been on the bridge all night.

Police hadn't yet called Breidenbach on the South Hill. Levy had to inform Breidenbach herself that their son was on the bridge.

Levy said she'd faced similar calls from police when her son jumped off the Agate Pass Bridge and the Warren Avenue Bridge in Western Washington.

Based on those encounters, Levy said she told Spokane police that although her son had jumped before, he wasn't trying to kill himself. He just didn't know how to de-escalate the crisis once it began.

"I told them he's a very nice guy with a very bad disease," she said. "I gave them Dave's number. I couldn't believe they hadn't called him."

Breidenbach said he went immediately to the bridge, but police refused to let him talk to his son.

"I basically was told to stand back, they didn't want any family members to get close," he said. "I wanted assurances no force would be used. They said, he'll be allowed to determine his own fate."

According to one report, the police rejected family contact with Levy "because his reaction to questions from negotiators was not positive."

Kirkpatrick promised him that no force would be used and Levy would be allowed to "save face" by surrendering on his own, Breidenbach said.

He's deeply angry that didn't happen.

"Somewhere along the way, the rules got changed and we were playing a different game. We were totally kept out of the loop and were provided with no information," he added.

Kirkpatrick said she didn't speak to Breidenbach before Levy's suicide, only afterward, and she didn't make the decision to use the Taser. "That decision was made by the tactical people at the command post. It was their collective thinking," Kirkpatrick said.

As the confrontation dragged on into the afternoon, Susan Levy said, she called Sacred Heart's psychiatric unit. Her son had been hospitalized there and diagnosed with paranoid schizophrenia when he was 21 after he stabbed himself in the neck.

"They said the fact that he's up there so long is a very good sign he's coming down. They assured us they'd have a really good doctor waiting for him at Sacred Heart," she said.

During the bridge standoff, records show police made minimal use of mental health experts – for less than an hour during the 20-hour standoff. Spokane Mental Health offered the services of their assistant medical director, but police never called, Panken said.

Mental health experts generally aren't used as negotiators for police in unsecured crises such as the bridge standoff, Panken added.

At 7:15 a.m. July 27, police asked Crisis Response Services for assistance for a "man threatening to jump" off the bridge.

At 7:30 a.m., Shelby Whitworth of the crisis agency went to the bridge and consulted with police, asking what role she could play. Whitworth knew Levy had jumped from two bridges and had just been released from Western State.

At 8:40 a.m., incident commander Lt. Judi Carl asked Whitworth whether they should use "confrontation" with Levy. Whitworth said she'd defer to police judgment and if they got him into custody, "she'd start proceedings to revoke" his release from Western.

"Police agreed there was not much more Spokane Mental Health could provide at this time," the records say.

By noon July 27, the city negotiating team was replaced by county sheriff's deputies because city police had been on the bridge all night.

By mid-morning, police had been warned there could be a "dramatic ending" – with Levy trying to take a police officer with him over the railing. That information came from a Poulsbo police negotiator who said Levy tried to jump off a bridge after a police officer grabbed him. Assisting officers pulled both men to safety.

Levy's family thinks that information may have persuaded officers to try to use a Taser to end the standoff. Susan Levy said it was an exaggerated account of an earlier incident on the Agate Pass Bridge.

"He never tried to take anyone down," she said. In a previous interview, Deputy Chief Mark Duncan, of the Bainbridge Island Police Department, also denied Levy was trying to pull an officer over the bridge, saying he was "just trying to lean back to jump."

Spokane police came up with the Taser plan, according to the sheriff's report. Officer Michael McCasland was assigned to shoot the older-style, X26 Taser with a maximum effective distance of 21 feet. Three officers hid behind a large cement pillar where Levy couldn't see them.

When negotiators persuaded Levy after 3 p.m. to step down from his perch onto the bridge portico to urinate, McCasland fired the Taser. It missed.

A KREM-TV video shows the white streak of the Taser wire veering off over Levy's left shoulder. Levy then hops back onto the ledge where he'd been perched for hours.

When he sees several officers running at him, he arises from his perch and jumps feet first off the bridge, landing on the rocks 130 feet below.

Firefighter Trautmann reached him first, confirming his death.

"Everyone was in shock that the male had jumped," Officer McCasland's report says.

Police officers should probably have deployed two Tasers in case one malfunctioned, said Carl, the incident commander.

"Was this a tragedy? You bet," Carl added.
The aftermath

Immediately after Levy's suicide, Kirkpatrick ordered her officers to her conference room, where they were told to write reports by July 30. They were given the rest of the day off.

In the conference room, Assistant Chief Jim Nicks announced there would be no Internal Affairs investigation.

On Oct. 2, Disability Rights Washington filed several records requests with the state for Levy's medical history. It also asked the city of Spokane to provide its police records within 24 hours.

In its letter to the city, the center said it had probable cause to believe that Levy had been "abused or neglected."

Assistant City Attorney Rocky Treppiedi responded on Oct. 31 that it would take "24 days, not hours" to provide the records. On Nov. 2, Treppiedi said the center still couldn't have any records because the investigation into Levy's death was still "open."

Disability Rights asked the Center for Justice to intervene in the records battle. The center finally received the city records in late May and the Washington State Patrol records on July 16.

Disability Rights is reviewing the long-awaited Spokane records, Carlson said.

"We think there were systemic problems with the police and the mental health system, including communication problems," Carlson added.

Panken agrees.

"If we'd known Josh was being released and could have had conversations with Western about his release conditions, we might have been able to intervene much earlier. We feel very badly about it," Panken said.

As a result of police debriefings after Levy's death, Kirkpatrick said she'd be more likely to deploy the department's SWAT team rather than regular patrol officers in a future high-risk suicide standoff on a bridge. She said she wouldn't rule out the use of Tasers – saying tactical decisions should be made in the field – but she's giving her officers more training in mental health issues for the department's crisis intervention teams. And Kirkpatrick said she's keenly aware of the family's "deep hurts" on the anniversary of their son's death.

"Everyone is reflecting upon this incident," she said.

This weekend, on the anniversary of Levy's suicide, his parents, three siblings and other relatives are gathering on Bainbridge Island, where he's buried in a woodland cemetery.

At The Unveiling, a Jewish mourning ritual, they'll place a monument on Levy's grave and share memories of his life. They've brought rocks from the Lochsa and other rivers he floated and from the other wild places he loved, including Alaska and Hurricane Ridge.

And they'll remind themselves of how much he was loved.

"He had a future and a family. He had a horrible disease, but he was not alone. He was not a nameless, homeless person on the bridge that day," Susan Levy said.

Levy and Breidenbach say they aren't interested in a lawsuit, but in preventing future tragedies for the mentally ill.

"We have to make it better for other people, other families, so this doesn't happen again," Levy added.

Documents (PDFs):

• Spokane Police Department reports

• Washington State Patrol report of earlier incident

• Kitsap County Sheriff's Office report of previous jump

• Advocates' request for city of Spokane records

• Petition for Levy's release from Western State Hospital Read more!

Failing to seek treatment common -The Reading (PA) Eagle

The misunderstanding and fear associated with mental illness often prevent people from seeking treatment.

Ron and Sharon Seaman of Albany Township learned that firsthand when Sharon began experiencing symptoms of schizophrenia in 1999.

In 2004, when treatment finally started turning their lives around for the better, they wanted to do something to help other families facing mental illness.

Ron, 55, and Sharon, 51, became active in the local chapter of the National Alliance on Mental Illness, or NAMI.

Ron is now president of the volunteer board.

Sharon educates people about mental illness.

The Seamans followed a typical path, said Dr. Edward B. Michalik, head of the Berks County Mental Health/Mental Retardation program.

The person with mental illness refuses to acknowledge the illness and resists treatment, so the family adapts to the changes as best it can, he said. Meanwhile, symptoms worsen.

The longer the delay in getting help, the greater the lasting impact of the symptoms and the more difficult the treatment is likely to be, Michalik said.

With mental illness, relationships, jobs and sometimes even homes are lost, he said.

"It's really a pay-now-or-pay-later type of issue, no matter what type of illness you struggle with, physical or mental," Michalik said.

With treatment, most people with mental illness can return to their former lives or, with some changes, live productive lives, Michalik said.


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"There's help out there," he said. "It's treatable.

"Without treatment, you lose so much of your life."

Ron spent five years trying to persuade Sharon to get help.

In 2004, he called Michalik for advice because she was refusing to take the anti-seizure medication she had been on since she was 19 and her physical health was in jeopardy.

That call led Ron to a caseworker and a team of mental health professionals who convinced Sharon that she should be hospitalized for treatment.

"I was afraid I would go in one kind of person and come out another kind of person (that) maybe I didn't want to be," she said. "I thought it was like being a born-again Christian or something like that. It's not like that.

"They helped me get my former person back."

Ron said Sharon would not come as far as she has without the support of family, friends and NAMI.

Even though Ron worked in the county government for 23 years, he didn't know the county's casework contractor, Service Access Management Inc., was available to help families in their situation, he said.

"We were kind of baptized by immersion," he said. "Every day you found out something you didn't know before.

"There are individuals to help you. NAMI has a phone number you can call. We maintain a library where you can get information on a host of mental illnesses.

"Ask for help and support."

•Contact reporter Mary Young at 610-478-6292 or myoung@readingeagle.com. Read more!

Panic attacks are common, treatable and rooted in fear - Chicago Tirbune

By SUSAN KUTCHIN PALLANT - CHICAGO TRIBUNE

CHICAGO-- When I see a young adult with chest discomfort, complaining of tingling in the fingertips, an episode of hyperventilation, and stating he had an upsetting event, such as a heated conversation with a girlfriend, I can comfortably say it's a panic attack."

Northbrook licensed psychotherapist Mona H. Ber-man explains the phenomenon as a false alarm that stimulates the fight-or-flight response. There's no mountain lion stalking you, or any real threat, but an inborn defense reaction kicks your body into gear, and a load of adrenaline is unleashed.

This can cause a variety of daunting symptoms: pounding heart, lightheadedness, rapid breathing and other symptoms.

"Anxiety disorders are chronic and don't get cured," said Berman. "But they can be managed."

Panic attacks become problematic and become panic disorder when the symptoms aren't ignored and the fear of the next attack is so overwhelming that it becomes life altering.

"When that happens, if the person starts avoiding places and situations [agoraphobia] that may trigger another attack, their life becomes smaller and smaller," Berman said.

The long-term solution is to not be afraid of what's happening during a panic attack. Berman compares it to having a cold: "You have uncomfortable symptoms, but you're not scared. It's annoying, but you know it's not dangerous or life threatening."

The goal is to understand and accept that a panic attack is not dangerous.

"The treatment of choice is cognitive behavioral therapy, with or without medication," Berman said. "Expose yourself to anxiety-producing situations and learn that while panic attacks can be alarming, they're typically short-lived and harmless."

For Anthony, highway driving no longer triggers panic attacks.

"I was wrong to think I was supposed to live without fear," he said. "Learning to do things even with the fear was an epiphany."

Anxiety Association of America: adaa.org


Date published: 7/27/2008 Read more!

Kicking Depression: The Book of Proverbs helps to improve my life - Palm Beach (FL) Post

By Christine Stapleton

There was a time when I secretly scoffed at the people in line at the bookstore waiting to pay for self-help books.

Puh-leez. Your life is so pathetic and you are so clueless that you need some sanctimonious, money-grubbing guru to tell you how to solve your problems? You poor soul.

I lost that attitude pretty quick. When you're in enough pain - physical or mental - you will try just about anything to feel better. Even self-help books.

There are some wonderful books about depression. You can read them in the privacy of your home without judgment from self-righteous, pompous fools like me standing behind you at the bookstore.

When you have a stigmatized illness such as depression or bipolar disorder there is much comfort in meeting others - even on the page of a book - who have endured the same desperation and have come out the other side. For me, learning about the physiology of depression and the chemistry of the brain gave me tremendous relief. These writings convinced me I was not weak or lazy. I was sick.

Then I found the other books. These were not written for or about the mentally ill, but they gave me insight, hope and a new way of thinking about and living with depression.

From the teachings of the Dalai Lama - a guy I knew only from the movie Caddyshack - I learned change was inevitable and what I was going through would not last. From William Styron I learned great literature can be born of mental illness. I dabbled in Melody Beattie and Eckhart Tolle.

But I have gained my greatest strength from reading The Book of Proverbs. I was never much into the Bible. Of course I never sat down and read it. It just made me uncomfortable. I preferred sleep, bacon and eggs on Sunday mornings. I figured I had read most of John Grisham's books, I might as well give the Bible a chance. Mental illness has a way of prying open a closed mind.

Wisdom, knowledge, humility, honesty, simplicity, respect and compassion. To stay healthy needed a new way to think and act. I found it. Like Baskin-Robbins, The Book of Proverbs has 31 ways to make your life better.

Now, in the mornings, after I take my medications and skim the headlines, I read a proverb.

Some days I forget. Still, it has become enough of a routine to have left myBible looking well used. That is one of the blessings of my depression. Read more!

PTSD leaves physical footprints on the brain - San Francisco Chronicle

Justin Berton

At a recent conference for some of the area's leading neurologists, San Francisco physicist Norbert Schuff captured his colleagues' attention when he presented colorful brain images of U.S. soldiers who had returned from Iraq and Afghanistan and were diagnosed with post-traumatic stress disorder.

The yellow areas, Schuff explained during his presentation at the city's Veterans Affairs Medical Center, showed where the hippocampus, which plays major roles in short-term memory and emotions, had atrophied. The red swatches marked hyperfusion - increased blood flow - in the prefrontal cortex, the region responsible for conflict resolution and decision-making. Compared with a soldier without the affliction, the PTSD brain had lost 5 to 10 percent of its gray matter volume, indicating yet more neuron damage.

Schuff, who was dressed in a Hawaiian shirt just as colorful as the brain images he'd brought, reminded his colleagues that while his findings were preliminary and the trials ongoing, researchers were at least inching closer to finding the biological markers that distinguish a brain affected by PTSD. As the technology of brain imaging improves and the resulting data are refined, doctors believe that one day they will be able to look at a computer screen and see PTSD as clearly as they now see a brain tumor.

"But we're still in the infancy of neuroimaging," Schuff cautioned later in his office. "Do you get PTSD because you have a small hippocampus? Or does a small hippocampus mean you'll develop PTSD? That, we still don't know."

Schuff's research is at the forefront of a bold push by the Department of Defense to address PTSD, the psychological disorder that will haunt an estimated 30 percent of the veterans returning from the current two wars, according to the Pentagon. Forty thousand veterans from Iraq and Afghanistan, Pentagon officials say, have already been diagnosed with PTSD, which is defined as an anxiety disorder triggered by exposure to traumatic events; symptoms can include nightmares, flashbacks and panic attacks.

Left untreated, clinicians say, patients with PTSD are more likely to engage in anti-social behaviors such as alcohol and drug abuse. The disorder, neurologists are now learning, can also lead to long-term maladies, such as Alzheimer's and dementia.
Manhattan Project urgency

The quest is to understand how the disorder begins inside the brain. The Defense Department has invested $78 million in San Francisco's Northern California Institute for Research and Education at the VA center in the past four years, making it the largest VA research institute in the country and the only one that specializes in neuroscience. With 200 researchers on staff, and an estimated 40 ongoing studies that rely on 60 to 80 veterans as research participants, the center has the urgency of a Manhattan Project site, this time searching for a way to end a mental health crisis.

The Department of Defense "has such a compelling need for these answers," said Dr. Thomas Neylan, an associate professor of psychiatry at UCSF and director of the post-traumatic stress disorder program at the VA center. "They want to know these answers now, which is the right approach. We want the answers now; people are still going off to the war, coming back, and a lot of them are suffering for a long time."

The search for PTSD biological markers through brain imagining is the primary concern of five research centers in the country, including teams at Harvard and Emory universities. Researchers believe that once the markers are defined, successful treatments can be developed.

Since 1995, magnetic resonance imaging, or MRI, has been used to explore the brain through mostly black-and-white images with fuzzy resolution. But in the past few years, advances in computer-imaging technology have enabled neurologists to detect the smallest changes in brain activity.

At the San Francisco VA center, thanks to the installment five years ago of a $4 million MRI machine called the 4T - T stands for Tesla, a unit of magnetic field - Schuff and his colleagues are now able to look into the brain at 1 millimeter resolution, in color and in 3-D. By contrast, Schuff said a 1.5T MRI machine could not register atrophy on PTSD brains. But the 7T MRI machine that was installed at the UCSF Mission Bay campus last year can detect microscopic neuron damage that a 4T is incapable of "seeing."

"With each stronger magnet, we get a finer view of what's going on in the brain," Neylan said.

These advances allow neurologists not only to further understand PTSD, but to study its relationship with brain trauma, one of the leading injuries incurred by soldiers in the Iraq and Afghanistan wars.
The effects of IEDs

At the VA conference, titled "The Brain at War: Neurocognitive Consequences of Combat," Col. Karl Friedl, director of the U.S. Army Telemedicine and Advanced Technology Research Center, explained why brain injuries have become more prevalent. The main cause: the improvised explosive device, or IED, a homemade device that has become the enemy's signature weapon.

While some well-armored soldiers were able to survive the IED blasts, incurring no outward signs of damage, they later complained of dizziness and "having their bell rung," symptoms consistent with the lesser-known mild traumatic brain injury (mTBI).

As many as 150,000 troops have been diagnosed with brain injuries, the Congressional Brain Injury Task Force reported last year, but it's unknown how many suffer from mTBI. Mild brain injuries are less often diagnosed because soldiers often believe getting knocked around is part of the job. But over time, with each successive mild brain injury, the effects can become more severe.

The link between mild brain trauma and PTSD is being studied at the VA center in San Francisco by Dr. Gary Abrams, whose preliminary studies show that the overlap between PTSD patients and sufferers of mild brain trauma injury "is tremendous." Abrams has yet to release definitive numbers.

During the next two years, Neylan expects the center will produce a few major findings in terms of possible treatments and advances in neuroimaging. One of the outcomes of the advanced brain imaging could be a prescreen test for soldiers to detect brains already showing PTSD tendencies. Neylan, who specializes in the role sleep plays in a healthy mind, is working on a study of police officers who are resistant to PTSD.

"We're using this opportunity to also see why some people are able to walk away from these situations and live healthy lives," he said, "and why others are not."

Recent attempts to estimate frequency

Iraq and Afghanistan: The number of post-traumatic stress disorder cases is in dispute. The Pentagon estimates 30 percent of veterans from the Afghanistan and Iraq wars will be diagnosed with PTSD. Vietnam War: In 1988, a study by the Centers for Disease Control and Prevention estimated the rate of Vietnam vets with PTSD at 14.7 percent. But the 1990 National Vietnam Readjustment Study calculated the rate at 30.9 percent. Both relied mainly on self-reporting. In 2006, a paper in the journal Science added to the debate by estimating the rate at 18.7 percent. World War II: Though there was no official PTSD diagnosis until 1980, after World War II the term "shell shock" was reported by veterans troubled by combat experiences. Researchers such as Dr. Charles Marmar at the San Francisco VA center's Northern California Institute for Research and Education estimate the number of WWII vets with PTSD is consistent with the 1-in-5 figures found in Vietnam and the Persian Gulf War. - Justin Berton
Experiments probe further into post-traumatic stress disorder

Four PTSD-related research experiments at the San Francisco Veterans Affairs Medical Center:

Nasal spray: Scott Panter is developing a battlefield-ready nasal spray for troops who suffer brain trauma. After the trauma occurs, the brain swells, causing tissue damage. Panter's nasal spray, applied within 20 minutes of a trauma, would aim to stop the swelling process. Troops could carry the spray in their packs and self-apply or administer to others.

D-cycloserine: Dr. Charles Marmar is conducting trials on PTSD patients using D-cycloserine. The drug, which was originally used as an antibiotic for tuberculosis, has also proved to help lab animals "unlearn fear responses." Given in small doses 30 minutes before a therapy session, D-cyclo is meant to help PTSD patients open up about their traumatic experiences and become more willing to engage in therapy. The hypothesis is that the group taking D-cyclo will make more and faster progress in therapy.

Blood/gene test: Dr. Lynn Pulliam is trying to establish a blood profile to diagnose PTSD. Using gene array technology, researchers will be able to take an RNA test, much like a DNA test, to determine whether a patient "tests positive" for PTSD.

Sleep experiment: Dr. Thomas Neylan is conducting a study on improving veterans' sleep habits without drugs. Neylan said PTSD patients often feel anxious about sleeping, in part because they anticipate insomnia but also because they worry about nightmares. Subjects are coached to avoid substances that interfere with their sleep. "If we get them to sleep better at night," Neylan said, "they'll have fewer nightmares and feel better during the day."

- Justin Berton

E-mail Justin Berton at jberton@sfchronicle.com.

This article appeared on page A - 1 of the San Francisco Chronicle Read more!

Refugees in Utah face unique medical care challenges - Salt Lake City Tribune

By Lisa Rosetta

Her head drooping, Florida Ndagijimana buries her face in the palm of her hand, her delicate fingers catching the tears snaking down her cheek. Paul Swoboda, her doctor, hasn't been able to find her a traditional healer. It's devastating news for a 20-year-old woman who thinks a spell has been cast on her family since they fled a refugee camp in Uganda.

Ndagijimana's 5-year-old daughter has been hospitalized with unexplained bouts of fever; Ndagijimana, meanwhile, is wrestling with severe depression and anxiety. Today she is in Swoboda's office complaining of pain in her abdomen that is keeping her up at night.

"We were trying to find her a traditional healer, see if that might help," Swoboda says, "because clearly medication hasn't worked."

This is a typical day for Swoboda, one of only two Salt Lake City doctors who contract with the Utah Department of Health to give hundreds of refugees their first physical exam within 30 days of arriving here.

Swoboda and colleague Mara Rabin are among the first Utahns who reach out to many exhausted and bewildered refugees. The physician team is their door into a health care system that they may only have access to for eight months, which is the temporary Medicaid coverage they are entitled to as refugees.

Driven from their homelands and forced to spend months, sometimes years, in refugee camps, they show up at the Salt Lake Family Health Clinic with health histories that range from a lack of basic care to torture.

Some have suffered perforated ear drums from untreated ear infections and have lost their hearing. Others have mouths full of black, decaying teeth.

Two of Swoboda's Burmese patients have shorter legs because their feet are partially gone, blasted off by a land mine they stepped on that wasn't strong enough to do more damage, he said.

Tropical infectious diseases, which some American doctors have never treated, are commonplace. Schistosomiasis, a waterborne parasite that burrows into the skin and migrates to the lungs and liver, is frequently seen in southeast Asians, Swoboda said. So is Strongyloides, a roundworm that lives in the tunnels of the small intestines.

Tougher to identify are refugees' mental health problems, among them depression, anxiety and post-traumatic stress disorder.

While up to 35 percent of refugees are victims of torture - for Somalis, that number can be as high as 90 percent - the symptoms of PTSD may not appear until months after a refugee has been seen by a doctor, said Rabin, who is also the medical director of the Utah Health and Human Rights Project.

A car accident or a troubling encounter with an authority figure can send a person who has been "white knuckling it" for years reeling. "One pin drops out and the trauma comes flooding back," she said.

Barriers to care

Language, culture and a lack of transportation can easily dissuade a refugee from getting help - or a doctor from offering it.

"Unless you have interest or empathy or compassion for an individual, you just want to get them in and out of your office as fast as possible," Rabin said.

At the Salt Lake Family Health Clinic, the two doctors strive to be culturally sensitive, but diagnosis and treatment can be difficult.

Their patients hailing from nearly every region of the world, Swoboda and Rabin hear more than a dozen languages spoken in their offices. They've tried to pick up a few words from every one of them: "Welcome." "Take a deep breath." "Are you in pain?"

Their physical interactions with patients also had to be learned. A Burmese woman will shake their hands, but an Afghan woman, who might perceive the gesture as overly familiar, will not. In some cultures, walking in front of an elderly person is considered rude. So is making direct eye contact.

"I don't shake hands with people," Rabin said, "I try to take cues with eye contact, ask the interpreter, 'Is it OK I'm looking this person in the eye? May I shake their hand?' I always sort of ask before I do something."

Lost in translation

Swoboda and Rabin rely heavily on interpreters to help them communicate with their nonEnglish speaking patients - a problem if the interpreter isn't well versed in the lexicon of medicine or has objections to something being asked of them.

Some male interpreters, for example, won't ask a woman if she is pregnant or when her last menstrual period occurred. Others don't believe in mental health diagnoses and won't refer a family for help. Sometimes, the words simply get lost in translation.

Rabin once asked a Burmese family if they were victims of violence or torture. They said no, and then smiled and laughed - an odd response, the doctor thought. She asked the interpreter, who was hard of hearing, to explain how he had phrased the question.

"I asked them if they torture children," he told Rabin.

Swoboda's patients have misunderstood directions for medications and for whom they had been intended, he said. One man lathered up in a cream designed to treat scabies, which was actually meant for his children.

Interrupted care

Juggling priorities after their initial visit, refugees are often more concerned about learning English and finding work than tending to their health, Swoboda said. Surgeries are put off; appointments are broken.

The state's resettlement agencies play a key role keeping tabs on refugees once they've been seen at the clinic. But in the coming months, they will be busy. Swoboda said more than 100 refugees will filter into Utah each month.

They will need help with Medicaid cards, interpreters and transportation to doctors' offices. Even the most trivial of matters has the potential to disrupt their care.

One woman's doctor, Swoboda said, rescheduled her appointment and left a message on the patient's phone, but she missed it because she didn't know how to access voice mail.

"There are people who fall through the cracks for all kinds of reasons," he said.

One boon for continued care: After their initial Medicaid eligibility ends, many refugees qualify to remain covered due to their low incomes.

Human strength

Despite the challenges, these doctors don't want to do anything else. Seeing people from all over the world who have endured "unbelievable, adversarial, tragic life situations and make it through is a testament to the resilience of the human species," Rabin said.

She recounted the story of a Bosnian couple who she saw five years ago. Survivors of severe war trauma and torture, they arrived in Utah with high blood pressure and diabetes. Rabin made home visits because they were too frightened to leave their apartment.

Today, their blood pressure is under control and they are being treated for depression. They are happy, they have told her, and are taking walks outside.

The last time she saw them, she says, "They just looked radiant."
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The shooting of Ricky L. Moore: No easy answers - Dayton (OH) Daily News

By Tom Beyerlein

What is the criminal justice system to do with a man like Ricky L. Moore?

Moore — who was shot and killed July 19 by a rookie Dayton police officer on the verge of being fired — was a fairly low-level criminal, but a completely incorrigible one. His lengthy rap sheet, mostly consisting of crimes committed in Springfield, speaks of a man who rarely drew breath outside a jail, prison or locked psychiatric unit. Sometimes it was a matter of just days between Moore's release from confinement and his next criminal offense.

He also was mentally ill — found not guilty by reason of insanity of felonious assault after hitting a woman in the head with a Smirnoff vodka bottle in 2005. He was diagnosed with schizophrenia, his family said, and court records show his mental illness made him hear voices in his head. The judge ordered Moore forcibly medicated at Dayton's state mental hospital in 2005 after he refused to take anti-psychotic medicine.

Moore was mentally unstable as recently as six months ago, but his family said he wasn't receiving any kind of community mental health services when Officer Jack Brooks shot and killed him near his mother's home on West Parkwood Avenue in Dayton. His mother, Gladys Moore, said she doesn't know if he took his anti-psychotic medicine the day of the shooting. Autopsy results may tell.

"I think the issue for a guy like this is: Is he really mentally ill or does he use mental illness to avoid going to prison?" said Bob Mullins, a spokesman for Montgomery County's mental health board. "Is (his recidivism) because he's mentally ill or because he's a criminal? Did he fall through the cracks or was he a bad dude who got shot by a cop?"

The answers don't come easy, but it's clear there are lots of men like Moore in the prison system. According to the Ohio Department of Rehabilitation, 28 percent of men who entered prison in 2007 had, like Moore, three or more prison confinements. And a September 2006 Justice Department study found that 56 percent of inmates in state prisons showed signs of serious mental illness.
More on daytondailynews.com

* Moore may not have been on his medication at the time of shooting
* Questions linger after Dayton cop kills mentally ill Springfield man
* Shooting victim had criminal past
* Books can help tackle difficult issues with kids
* Former rehab center to become homeless shelter
* Man fatally shot by Dayton officer was released from Twin Valley
* Man in officer-involved shooting just released from Twin Valley
* Therapist for teen must keep parents involved
* Twin Valley to close doors Monday
* Transgender people step out, risk ridicule, worse

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Community assessment results analyzed - Lenoir (NC) Caldwell Topic

Gina Story, Staff Writer - July 26,

The results are in for the 2007 Caldwell County Community Assessment, and they show the community is concerned about several topics including unemployment, tobacco usage, illegal dumping and elder care issues.

In planning for the 2007 assessment, the Caldwell County Health Department and Healthy Caldwellians joined forces to conduct the county's first ever assessment.

The assessment was conducted in two parts: a stakeholder's survey and a door-to-door community survey. It asked questions about health, community services and other important topics.

The stakeholder's survey was directed to those entities that provide services to the people of Caldwell County. The people surveyed were chosen because of the nature of their work and interaction with residents.

Some of the top comments and concerns from stakeholders were access to medical care, lack of dental care, weaknesses in the county's mental health system and loss of jobs and unemployment.



The door-to-door survey was conducted during the day, in the early evening and on Saturdays throughout Caldwell County. The results of the door-to-door survey showed Caldwell County residents were concerned about health issues including heart disease, heart attacks and obesity, as well as societal concerns such as alcohol and drug abuse, and unemployment.

The survey's results were tallied, and during the recent Caldwell County Community Summit 2008, were used to begin formulating a plan of action.

"We had a good group. A few more than 70 people attended," said Jan Pritchard, executive director of Healthy Caldwellians said. "It was a good diverse cross-section of the county. Many of the instrumental agencies and service providers were in attendance. We had folks from local government there. We had law enforcement there. We had people from the medical community there."

The meeting was facilitated by Joan Evans of the Moses Cone Health System in Greensboro and included more than just discussion about numbers.


"We identified and shared with those in attendance what the priorities are and the people in attendance were asked to do some round tables in naming agencies or individuals who might take the lead in confronting these issues."

Pritchard said that the round table discussions were extremely helpful in identifying areas in which there are needs and agencies that people need to be made aware of.

"We do have a lot of resources in Caldwell County for a county our size. We have an abundance of services, and it's just a matter of connecting," Pritchard said. "Education is key."

Pritchard said that the county is meeting its timeline in confronting important health issues, and she added it's always good to meet with the community and find out how needs are changing and what can be done to fix small issues before they become major ones.

"We are on the right track in our community with most everything except that obesity issue," Pritchard said.

One of the health issues Pritchard said came to the forefront during the assessment was aging issues such as Alzheimer's disease.

The issues that appeared in the community assessment will be used to guide both Healthy Caldwellians and the Department of Social Services in the coming years. The community also is asked to brainstorm and work with agencies on these issues.

"We're going to set up an e-mail network," Pritchard said of seeking the community's support to combat the issues. "When we put our collective heads together, then we can make some in roads in seeing that the needs are met. We gladly invite community residents to join us in this. They can bring fresh eyes and new perspectives to these issues." Read more!

Troops say health worsens after deployment -Marine Times

By Kelly Kennedy - Jul 26, 2008

Three months after they return home from Iraq or Afghanistan, service members are reporting their overall health as “fair” or “poor” — as opposed to “good,” “very good” or “excellent” — at much higher rates than when they first return home.

One out of 40 troops, or 2.5 percent, rated their health as “fair” or “poor” immediately after returning home, but three to six months later, the number shot up to one out of seven, more than 14 percent.

The Armed Forces Health Surveillance Center compared results from pre-deployment assessment forms that are filled out just before service members head to Iraq or Afghanistan with post-deployment assessment forms that are filled out just after they return home, and then with post-deployment reassessment forms, which are filled out three to six months later.

“From pre-deployment to post-deployment to post-deployment reassessments, there were sharp increases in the proportions of deployers who rated their health as ‘fair’ or ‘poor,’ ” states a report in Military Surveillance Monthly. “This is not surprising because deployments are inherently physically and psychologically demanding.”

However, researchers called the jump in “poor” health assessments months after returning home “not intuitively understandable,” though they noted that symptoms of post-traumatic stress disorder can emerge or worsen several months after the stressor that caused the disorder. Physical problems also have been linked to PTSD.

The rate generally has increased since September 2007, according to the report. Active-duty, National Guard and reserve troops continue to report more mental-health concerns and exposure issues. About 5 percent of Army Reserve soldiers reported mental health concerns immediately after they returned home, but six months later, that more than doubled to 12 percent.

“Commanders, supervisors, family members, peers and providers of health care to redeployed service members should be alert to emerging or worsening symptoms of physical and psychological problems for several months, at least, after returning from deployment,” researchers recommended in the report. Read more!

Family still has questions about shooting -Salem (OR) Statesman Journal

By Thelma Guerrero-Huston - July 26

A grand jury investigation into the fatal shooting of an Irish national by a Silverton police officer has left the victim's family with more questions than answers.

The family of Andrew Hanlon, 20, who was shot and killed June 30, questioned the findings of the Marion County grand jury and the methods of the district attorney's office.

"The DA's public statement (is) that the 'process was allowed to work.' Our response is, allowed to work for whom? Certainly not for civilians. Certainly not for the mentally ill. Certainly not for Andrew," Mel Castelo, Hanlon's aunt, said in a shaky voice during a news conference Friday morning in downtown Portland.

"I beg to differ with the DA," Castelo said. "The process does not work."

In its investigation, the seven-member grand jury said Silverton police Officer Tony Gonzalez, 35, was justified when he shot and killed Hanlon while responding to a reported burglary in progress.

Hanlon, a citizen of Ireland who had remained in the United States illegally after his six-month visa expired, died at the scene. He was not armed, a detail released for the first time Thursday.

Melanie Heise, Hanlon's sister, said she wants to learn why confrontations between police officers and the mentally ill in Oregon and in the United States often have a fatal ending.

"I acknowledge that my brother was disturbed and perhaps even agitated on that night," Heise said. "What does not make sense to me is over and over again, in Oregon and elsewhere, that a confrontation between law enforcement officials and a person with mental illness ends up with the mentally ill person dead. In Andrew's name, I will commit myself to solving this problem."

Nathan Heise, Hanlon's brother-in-law, questioned why Gonzalez, "a 240-pound martial-arts expert and cage fighter, (did) not feel that he could disable and arrest a 120-pound kid that was unarmed … and why the Taser (in Gonzalez's possession) was not drawn instead of a service weapon when Andrew was down on the ground?"

The brother-in-law also said that a number of witnesses who came forward with information about what they witnessed on the night that Hanlon was killed were not allowed to testify before the grand jury.

He accused the Marion County District Attorney's Office of picking and choosing grand jury witnesses who favored law enforcement's view of the shooting.

Don Abar, the Marion County acting district attorney, disputed the allegations.

"We presented all relevant information," Abar said. "These investigations have got to be thorough. You want all available facts."

Abar defended the district attorney's decision to not tell the public early on that Hanlon was unarmed the night he was shot and killed, saying that fact could have led people to make an unfair snap judgment.

The investigation into the shooting took about two-and-a-half weeks, with police delivering their findings to the Marion County District Attorney's Office last week, said Woodburn police Detective Sgt. Jason Alexander, who oversaw the inquiry.

The grand jury met from 9 a.m. to 5 p.m. Thursday to consider the case. Once the panel made a decision, prosecutors promptly released a statement, which included top-to-bottom details about the events that transpired the night of the shooting.

Details continued to filter out Friday as the public and journalists asked questions about the now-public investigation.

For example, toxicology reports reviewed by the grand jury showed trace amounts of cannabis in Hanlon's system at the time of his death, Abar said.

That detail conflicts with what Steve Crew, the family's attorney, told reporters at Friday's meeting.

Crew, who said he had received some documents related to the shooting from the Marion County District Attorney's Office but still was waiting for copies of the investigation and the 911 tape recording, said the toxicology report had found that Hanlon "did not have drugs or alcohol in his system" at the time of his death. The recording of the 911 call was released Friday afternoon.

On the night of the shooting, Gonzalez fired seven shots at Hanlon, hitting the Silverton resident five times, according to the district attorney's statement.

Despite two autopsies — one in Oregon and one in Ireland — it still is not known which of the bullets that struck Hanlon delivered the fatal blow, Crew said.

The attorney also said that a decision has not been made about whether the family will pursue a wrongful-death lawsuit.

Asked whether it's common for grand juries to not indict officers involved in fatal shootings, Crew said, "I've never heard of a case where an officer has been indicted on that in Oregon."

The shooting of Hanlon is the state's latest crucible for distilling questions about police treatment of people with mental illness and the use of excessive force on unarmed, mentally ill people.

The case is expected to become a catalyst for state lawmakers during the 2009 Legislature to take a new look at the use of lethal force by police.

Oregon Senate President Peter Courtney, D-Salem, said he expects lawmakers, as part of an in-depth review of lethal force, to examine issues of police training, particularly as they relate to dealing with mentally ill people.

"Are we doing all we can as legislators to support sufficient training? Are we asking the kinds of questions we should be asking about the use of deadly force?" he said.

Courtney declined to comment on the grand jury's findings in the Silverton case.

The case has drawn national and international attention, as well as outrage by some residents.

Candy Carey, a Silverton business owner and a friend of Hanlon's family, said she was appalled when she heard the grand jury's decision but not surprised.

"I was absolutely sickened," Carey said. "I went online and read what the DA released. I found holes in their story you could drive a truck through. How can a 250-pound man who is a cage fighter and a former Marine be afraid of a 135-pound kid?"

Silverton resident Robert Skille, who did not know Hanlon or his family, said the use of deadly force on a young man who may have been mentally ill doesn't seem right.

"The verdict that came out was probably the only thing the court could say because it's one person's story against another, and one of them is dead," Skille said.

Kevin Lierman, a friend of Hanlon, said he thinks Gonzalez's actions were overly aggressive given the situation.

"It was a confusing situation, for A.J. and the officer, and it ended in the worst way possible," Lierman said.

Unless the Silverton Police Department raises a concern about Gonzalez's conduct, there will be no investigation by the state Department of Public Safety Standards and Training to determine whether his police certification should be revoked, said Cameron Campbell, the department's director of training.

As it stands, the grand jury's decision to not indict Gonzalez is final.

"This is not over for us," said Castelo, Hanlon's aunt. "This is not finished. We will continue to press on for answers until we have them, however we need to press for those answers."

Statesman Journal reporters Dennis Thompson Jr., Alan Gustafson, and Danielle Peterson contributed to this story.

tguerrero-huston@StatesmanJournal.com or (503) 399-6815 Read more!

Ex-wife: Suspect struggled with bipolar disorder - State College (PA) Centre Daily Times

By Chris Rosenblum - crosenbl@centredaily.com

July 25 - On his sunny days, Brian Neiman could be loving and gregarious.

But, his ex-wife said, he struggled with bipolar disorder and would suddenly turn angry and threaten to harm friends. He talked about his guns.

That dark side apparently emerged Friday when he jumped into his Ford Bronco with a shotgun and headed for the Christian radio station WTLR at Cato Park in Ferguson Township.

At the station, police intercepted Neiman, who rammed cruisers and fired at officers before dying in a fusillade of shots.

The news saddened but didn’t completely surprise Jean Neiman, who divorced her husband in 2006 after a 13- year marriage and had been hiding from him ever since. She worried something would happen to him.

“He could be such a sweet man,” said Jean Neiman, who lives in Mifflin County. “He loved doing things for me. He loved to give me whatever I wanted, when he was doing good.
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“But there was a side to him that made me very afraid, and I didn’t feel safe with him.”

Neiman, 50, reportedly lived in Pottersdale, a small Clinton County community. In nearby Karthaus, he attended Community Alliance Church. A local resident working at Benton’s Market in Karthaus said Neiman was “known but not well liked.”

“He threatened people,” said the store employee, who did not want to be identified.

Originally from York County, the Neimans moved to Pottersdale after they married, and he found work as a coal stripper at the River Hill Coal Co. in Kylertown.

Hours after Friday’s shooting, she recalled they listened to WTLR together so much they felt like they knew the announcers.

Neiman said her ex-husband became increasingly paranoid and suffered a breakdown. After he was diagnosed in 2005 with bipolar disorder, he took off to Wyoming, where he liked to hunt. He lived for about a year in Casper and may have worked in the oil fields.

While he was there, according to his ex-wife, he was jailed and hospitalized at Wyoming State Hospital after “he torched a couple of buildings and blew up a camper.”

Staff at the Casper Star-Tribune, however, said they could find no reports about Neiman, and that local police reports yielded no records concerning Neiman except traffic violations. A clerk in the city’s municipal court said Neiman had an outstanding warrant for running a red light because he failed to show up for hearings.

The Wyoming Department of Corrections has no record of Neiman in any of their facilities, but their records would not include stays at state hospitals.

When Neiman returned to Pottersdale in 2006, his marriage quickly fell apart. Jean Neiman said she feared for her safety. That year she sought a divorce, citing an “irrevocably broken” relationship.

Of the man she once loved, she remembers his laugh: “You could hear it for miles. It would ring out.”

But without medication, she said, he would fall into rages against people, friends even, and make “ambiguous threats.”

“I never wished him any ill,” she said. “I’ve done nothing but pray for him that he would get well.”

On Thursday, everything appeared fine when Neiman visited his old employer, Stocker Chevrolet, on Benner Pike. Tim Gill, the dealership sales manager, said he thought Neiman left his job there in 1997.

Gill, who didn’t speak to Neiman, recalled nothing strange about him as he chatted with staff members Thursday.

“He seemed OK,” Gill said. Friday, though, Neiman drove through the dealership parking lot without stopping. During the morning, he was seen buying gas at Bellefonte Snappy’s Cigarette Outlet, a bearded man in a white car with Wyoming license plates.

At Log Cabin Motors, he walked in and told the stunned owner his shotgun was loaded. He then set off for the radio station, intent on broadcasting a message about drugs and a conspiracy.

Jean Neiman’s voice caught as she remembered her ex-husband and his battles with mental illness.

“When he was diagnosed and got on medication, it was great,” she said. “Then he just went manic again. That’s when things got really bad.”

Chris Rosenblum can be reached at 231-4620. Staff writers Jennifer Thomas and Mike Joseph contributed to this report.
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