Deputy: Shot followed policy -Wassau (WI) Daily Herald

By Jeff Strack

Wausau police officials say their officers acted appropriately during Thursday's shooting, citing the department's policy on deadly force.

Michael John Hager, 49, of Wausau was shot in the arm and abdomen after he reportedly made threatening advances with a knife toward an officer who was on the ground.

Officer Thomas Hines fired his handgun after he perceived Hager's actions to be a threat on officer Mark Timken's life, Wausau deputy police chief Bryan Hilts said.

"We don't train to use a less than lethal weapon to defend their lives or another person's life," Hilts said.

Officers are trained to use deadly force when an assailant with an edged weapon is advancing toward them and within 21 feet of them, Hilts said. A person can cover 21 feet in the time it takes an officer to assess the situation and draw a firearm, he said.

Hilts credited Hines for firing only one shot and Timken for using a Taser instead of a firearm.

Five witnesses of the incident were interviewed and gave similar statements, police said. The Marathon County Sheriff's Department is overseeing the Wausau Police Department's investigation.

Timken and Hines are on administrative leave, per department policy. Both will be formally interviewed in the next few days after a "cooling down" time.

Both officers are well trained, Hilts said. Timken has worked for the department for 21 years and is a defense and arrest tactics instructor. Hines has worked there for 16 years and is a firearms instructor.

Once a month, Wausau police train to use their firearms at a shooting range. They also attend an annual in-service that focuses on firearm and defense tactics training.

Police have had past contact with Hager.

An officer suffered a broken wrist July 16, 1997, while responding to a noise complaint involving Hager, Hilts said. Hager knocked officer Joseph St. Amand to the ground and at one point sat on top of him, according to a criminal complaint. A second officer arrived and knocked Hager off St. Amand and used pepper spray on him.

Hager was found guilty, but not guilty by mental defect or disease, on a charge of battery to a law enforcement officer, according to court records. Hager has had other criminal charges resolved in the same manner.

Hager has been diagnosed with and treated for schizophrenia and has spent time at Winnebago Mental Health Institute.
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Cuts could hurt state's mentally ill -Raleigh News & Observer

Lynn Bonner

The state will pay less for a mental health service offered to the state's seriously ill residents.

The 7 percent cut was a surprise to advocates for the mentally ill and to providers who said they are already losing money on the service, called assertive community treatment, or ACT, teams.

The teams include psychiatrists, nurses, therapists and social workers who offer comprehensive mental health care to people with severe illnesses such as schizophrenia.

"It's just devastating," said Debra G. Dihoff, executive director of the National Alliance on Mental Illness in North Carolina.

ACT is one of five new community-based services the state offers with a proven record of helping people, she said, and the state cannot afford to lose teams.

Brad Deen, a spokesman for the state Department of Health and Human Services, said the state's Medicaid division changed reimbursement rates for a number of mental health services introduced in March 2006. The new ACT team rates, Deen said, are based on a review of national data and cost information from state providers.

Rates will go up Oct. 1 for 11 mental health services. Prices will drop on three services.

The state was criticized for setting a high, $61-an-hour rate for a more basic service, community support, while paying too little for more intensive services such as ACT teams.

A News & Observer investigation this year found that the state wasted more than $400 million on community support. Companies offered the service to people who did not need it. Workers took clients to movies and basketball games. Most of the work was done by people without college degrees.

Companies sprang up to offer the lucrative basic service rather than provide higher-end services that help keep people out of hospitals. The state later cut the community support rate.

John Tote, executive director of the Mental Health Association in North Carolina, called the ACT team cut "completely ludicrous."

Tote said his organization has the most ACT teams in the state, serving more than 1,000 clients.

It costs an average of $1,850 a month to take care of each person, he said, while the state is now paying about $1,296. Under the new rate, companies will receive about $90 less per client each month.

Tote said he could not cover the shortfall by adding more clients. If he keeps all the ACT teams running, Tote said, he will have to cut staff salaries or health insurance benefits or find other savings.

ACT teams are proven effective in helping keep people out of mental hospitals, said Fred Waddle, lobbyist for Easter Seals UCP. Easter Seals operates nine ACT teams for 500 clients.

The state should be focused on getting more ACT teams, Waddle said, not cutting the rate.

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

Freedom To Heal - Forbes

Click on post title for video report on a self-help haven for those living with mental illness flourishing through the dream of one man. Read more!

Troubling gaps in Napa County mental health care - Napa Valley (CA) Register

By Gayle Whitlock and Lawrence Swaim
August 29, 2008

It is no secret that the Napa County mental health system has trouble hiring and retaining staff psychiatrists. As the higher ups, we will be pleased to tell you that is mainly because of changes in funding — the money isn’t there. But it’s not enough to acknowledge that things are bad financially. In such situations, dedicated people should search relentlessly for innovative ways to compensates for economic limitations.

New ways must be tried, fine-tuning them afterwards as needed.
One possible way is to form a med consortium composed of nurses, case managers and psych techs that can meet regularly to do a med review for clients. They’d review the med stories of the clients, interview them, get feedback from residential treatment teams and then arrive at recommendations regarding meds. They’d communicate those recommendations to the staff psychiatrists who’d have the option of seeing the client or continuing to prescribe the meds in place, based on the recommendations of the med consortium.

Many variations of this scenario are reportedly already in use, particularly those in agencies with a public health orientation. The med consortium idea has been used in hospital-affiliated mental health programs and community-based clinics. They can function as screening panels for domestic violence, substance abuse, children at risk and high-risk behavior generally. Staff psychiatrists could see patients whenever necessary but if a med regime is working there may not be any need to do so. Clearly the Napa County Mental Health system has got to do something and this approach deserves consideration.
Sadly, lack of staff psychiatrists isn’t the only problem adversely affecting the mentally ill in Napa County. Because of demographic changes, more Latinos are beginning to come into residential treatment in Napa and many of them feel more comfortable talking to Latino counselors than Anglo ones. It isn’t enough for some staff to speak Spanish. A counselor needs to be both bilingual and bicultural for the necessary therapeutic bond to be established.

It is an astonishing reality that in the two main residential programs in Napa County, where the present writers work, there are no bilingual, bicultural counselors. When will Progress Foundation, who administers these programs, launch a hiring campaign for Latino staff? Are they trying hard enough to find qualified candidates?
The mental health system is strapped for money. Many say that is the proximate cause for the problems we’ve discussed. Lack of money is no excuse for not striving to create innovative approaches aimed at providing adequate services. And while more poor people coming into the system necessitate more thoughtful programs, race isn’t a reliable indicator of socioeconomic status, and it would be un-American and illegal to use it in that manner.

Just like anyone else, Latino families should have access to professional and timely mental health services.

(Whitlock is a counselor at Progress Place. Swaim is the SEIU shop steward at Bella House.)쇓 Read more!

Healing Voices - Forbes

Philanthropic Pitch

Edited by Richard C. Morais 08.29.08

Will Hall
Profession: Graduate student
Cause: Treatment alternatives for mental illness

Why I was moved to support this cause:

Since I was a child I've struggled with extreme emotions, voices and powerful out of body experiences. I remember falling to the ground once in third grade, writhing in agony because I believed something was grabbing my back. I saw cartoons projected on the ceiling, and my fear was sometimes so strong I fell mute. I often hid away, alone, overwhelmed and unable to describe what was going on.

At age 26, I hit a breaking point and wandered the streets of San Francisco all night hearing angry voices telling me to kill myself. I ended up on a locked psychiatric ward. For the next year, I was in and out of hospitals and homeless shelters.

My diagnosis was schizoaffective schizophrenia, and the treatment was powerful anti-psychotic medications. What the doctors had to offer didn't help me, however. I left the hospital with more problems than I had going in, and I had to cope with the trauma of restraints, seclusion, plus a stigmatizing label that offered little hope for the future.

With nowhere to turn, I started to search for an answer on my own. In 2000, some friends in the Northampton, Mass., area let me stay with them, and I got a job in a local convenience store. Then I worked in a bookstore. The daily routine of a job, getting away from the memories in San Francisco, the small town tempo--it all helped. Step by step, over these difficult years, I learned a different way of responding to my madness.

I learned about nutrition and changed my diet. I took classes in yoga and meditation and began to see an acupuncturist. I watched for early warning signs of problems and began to consider the spiritual aspects of what I was going through, listening to the voices I heard and exploring their meaning. At one point back in San Francisco, for example, I heard a loud voice telling me I had to do yoga or I would die. It was frightening, but I realized it was like the voice of an angry parent or guardian looking out for me. So that voice is why I began to practice yoga.

I might be different than most people around me, but being different also means being creative and sensitive. I stopped seeing myself as a broken person with no chance for recovery. Most importantly, I reached out to other people who had also been diagnosed as mentally ill, and we began supporting each other in discovering our own pathways to healing. For too long I had been trying to do this all on my own.

The upshot is, as I grew stronger and healthier, I was inspired to dedicate myself to helping others make it through the ordeal I had survived. Though many people find good support from doctors and medications, growing numbers around the world are calling for alternatives to the mainstream "one size fits all" approach to mental health.

What I am personally doing to support this cause:

In 2000, I met Oryx Cohen, a University of Massachusetts graduate student who had suffered similarly to me. We hit it off. We were both looking for treatment alternatives, and we wanted to meet others like us. So in 2001, we co-founded the Freedom Center in Northampton, starting with a public library computer, a free e-mail account, and one support meeting a month held in a local church. The meetings took off. People came in to share their amazing stories.
Check out the Freedom Center by watching this video

Today we've grown to a weekly acupuncture clinic, two yoga classes, a writing group, meditation group and two peer support groups. Thousands have been helped by the Freedom Center. We're trying to reach people not helped by traditional care, people looking for alternatives to medication and diagnostic labels.

We try and give people space to find their own pathway and treatments and let them explore, with support, a variety of “wellness resources.” That might include medications or it might not. We do make people aware of the downside of the drugs, but we let them choose how they want to proceed.

Last September, for example, the Freedom Center and the New York-based Icarus Project jointly published a Harm Reduction Guide To Coming Off Psychiatric Drugs. There are a lot of risks coming off psychiatric drugs, and if someone is finding it too intense, we often say, “Why don’t you consider going back on the medication and focus for the moment on finding yourself a stable housing situation. Or feeding yourself better.”

The Freedom Center does a lot of educational work and public events, and we have been invited to talk in places like California, Alaska, Utah, Ireland and Europe. We had a “Bed Push” last summer, where we rolled a hospital bed around town to call for more choice and compassion in hospital care. I also founded “Madness Radio,” a community FM radio show now heard everywhere via the Internet. So the Freedom Center is growing from a local service to a national voice for mental health alternatives.

Hard to know where this will all lead in the future. I myself am now in Portland, Ore., completing a Masters Degree in psychology at the Process Work Institute. I miss my friends in Northampton.

What you can do:

Experiences that get called mental illness are shrouded in fear and misunderstanding. Take the time to listen without judgment or preconception to people diagnosed with mental illness and have the courage to speak up if you've ever had a brush with madness yourself.

I invite you to learn about alternative and holistic approaches and to take a stand for greater choice and options in treatments and care. And, if you are in Massachusetts, please come by and visit one of our acupuncture sessions or yoga classes.

Or visit our Web site, Freedom Center, to make a tax-deductible donation to help us spread our message of hope and vision for change. All of the Freedom Center’s services are free and run by people who themselves have a psychiatric diagnosis, so our budget is just $21,000 for the 2009 fiscal year. The volunteer-run Freedom Center is not itself a 501(C)3, but it is supported by the mental health non-profit, Choices. This umbrella group provides us with backroom services and charges us 5% for the gifts run through their organization. So tax-deductible donations are made to “Freedom Center/CHOICES Inc.”

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Lost in a lost system: a new report confirms fears - The Carrborro (NC) Citizen

Taylor Sisk - Aug 28, 2008

Valerie Kramer calls Carrboro her “fairy-tale town.” She and her son, Jeff, moved here when Jeff was entering the second grade and left, in 1997, when he was 14. Kramer was ending a bad relationship, was diagnosed with clinical depression and decided she and her son needed a new start in a new environment. She and Jeff moved to Asheville.

While in high school there, Jeff fell in with the Rainbow Family, to whom Kramer attributes his introduction to drugs. Jeff was busted for distribution of marijuana and was facing both felony and misdemeanor charges.

Around this same time, Jeff had begun to often act strangely.

Nothing he said made sense, Kramer says. “He said God sent him to this Earth to grow marijuana for sick people, and that was his mission.” Jeff’s defense attorney advised her to pay a forensic psychologist to have Jeff evaluated. He was diagnosed with paranoid schizophrenia and deemed incompetent to stand trial. He was 19.

“I didn’t know what schizophrenia was,” Kramer says. “But at 17 and 18, he really did things that I knew were not normal for him. And everyone said, ‘Well, he’s just a teenager …’ But I always knew. I mean, I had nightmares about it. I knew something was wrong.”

It must be drug-induced, Kramer believed. “I said, ‘When he gets off the drugs, he’ll be fine, right?’” She was assured by the doctors otherwise.

So she packed up all of her and her son’s belongings and moved back to the Triangle.
“I thought, ‘We’ll go back to Chapel Hill where, in general, there are more people with a higher education.’

“I asked around – everyone I knew – and they said that as far as state hospitals go, John Umstead is the best because you’ll have the brightest people there, the most resources – and so by moving here, I’m doing my son a favor. UNC Hospitals will take care of him and John Umstead is the best place. And now, five years later …”

Her nightmares persist.

The report

Last week the newly formed legislative Program Evaluation Division released a long-awaited report titled “Compromised Controls and Pace of Change Hampered Implementation of Enhanced Mental Health Services.” The report is largely focused on the now well-documented excesses in the provisioning of community support services and chronicles the general mismanagement, overspending and lack of oversight in our mental health system since the passing of reform legislation in 2001, which called for privatizing services.

Community support services include, for example, assistance with grocery shopping or homework or chaperoning to movies or ballgames. The News & Observer reported that between March 2006 and January 2008, the cost of these services rose to nearly $1.4 billion, or 90 percent of all spending for community-based mental health care services. The cost of community support services was then nearly 20 times the state’s original estimate.

State officials now acknowledge that too much money has been wasted in the provisioning of community support services and – granting that these services are vital for many who are poised to reintegrate back into their communities – that too much money is being allocated to them at the expense of services that are more time- and cost-intensive to provide – local in-patient care, for example, or everyday counseling.

The legislative report cites delays in securing federal approval of new services, which led to a delay in the implementation of oversight procedures, which in turn led to some new providers taking advantage of the system by “delivering an unchecked amount of services”; a failure to establish a baseline “against which to measure system performance and assess utilization and expenditures”; and reports to decision-makers that included “excessively dense data that are neither synthesized nor interpreted.”

In sum, the report is about mismanagement and abuses in the overhaul of our state’s pre-existing mental health care system – an initiative that most everyone now acknowledges is in serious need of some overhauling of its own.

What the report is not about is how mental health care reform is failing people – most particularly, those people most critically in need.

What remains unaddressed is whether the system we’ve put in place is structured to provide these more intensive services.

More to the point: Is it possible to provide comprehensive, effective mental health care services and make money at it?

Dr. Nicholas Stratas doesn’t think so. Stratas, a psychiatrist now in private practice in Raleigh, is one of the architects of a mental health care system in North Carolina that was, many years ago, considered a model of success. He served through the 1960s as deputy commissioner of what was then the state Department of Mental Health, which eventually was moved into the Department of Health and Human Services.

“How can you make money without cutting services?” Stratas asks. “I think it’s possible to make money at this, but it’s going to be at the cost of cherry-picking services” – providing only those services that are most cost effective – “and you’re going to have to provide truncated services. And you lose the integration of a unified system.”

A unified system, Stratas says, is essential to providing continuity of care, and continuity of care is “absolutely critical.”

“But now,” says Stratas, “we’ve got this person doing this piece and this person doing this other.”

Under the previous state-run system, community mental health clinics provided a broad suite of services under one roof.

Dr. Thomas Smith, an Asheville-based psychiatrist, is another longtime mental health care advocate who’s been vocal in his opposition to reform measures. He underscores the critical nature of those comprehensive, under-one-roof services.”

People with mental illness, he says, often face prohibitive transportation issues – no driver’s license, no car, little money for a taxi and, in rural areas, few if any public-transportation options.

“So to have everything in a central location within a community mental health clinic,” Smith says, “that was great. And to let that be destroyed was absolutely atrocious.

“Now there are private providers out there scattered here from hither to yon, all over the place; and it’s hard for these folks to get to them.”

Of cherry-picking services, Smith says: “Nobody wants to treat the difficult-to-manage folks,” those with whom it’s necessary to build a relationship over time,” those who are most in need.

Things changed

Jeff Kramer occupies a quiet space outside Weaver Street Market as a Friday afternoon gathers energy. He’s undisturbed; focused, in his manner. He’s a handsome young man; steady for the moment and sturdy. He’s on an out-patient commitment order, required to report once a month to Orange County’s community resource court. The court is a cooperative effort of the Orange County judicial and mental health systems that strives to help people who have mental health issues by linking sentences for selected offenses with services and support. After another brush with the law, and yet another brief stay in Umstead, Jeff is once again tasked to regain his footing.

Jeff has been refusing to take his medication. He’s taken it intermittently in the past, and his mother sees clear improvement in his ability to function when he does. He says now, though, that he’s through with it.

“They want to see me on medicine that is not doing anything but damage to my brain,” Jeff says. “When you put chemicals in the brain, they don’t do anything but harm. Antipsychotics will make someone sick.”

“He says he doesn’t have schizophrenia,” Valerie Kramer says. “He says it’s too bad that they convinced me of that. He says he thinks that it’s something that he did when he was younger, when he took the wrong path in life; maybe the drugs he did. He always blames himself for the way he feels and thinks he can eventually work it out. He told me the other day that he’d rather die than take the medication.”

Kramer has been frustrated by the care her son has received at UNC Hospitals: “They’ve turned him down; they’ve released him after several days. The last time he was in there – it was January of this year – he stayed only several days, was very sick, very delusional, paranoid, and this woman” – another patient – “kept kissing him.”

“They would say, ‘We can’t help him because he’s noncompliant. He doesn’t want to take his medicine.’ At the same time, that’s a classic symptom of paranoid schizophrenia. They also say he has zero insight – another classic symptom – and so they send him home.”

“The first time at Umstead,” Kramer says, “it was before all of these laws changed, and it was a good time. That was 2003. They kept him for, like, six weeks. They gave him the best treatment. I mean they really seemed to care.”

When Jeff was given his outpatient treatment plan, Kramer says, “they took so much time with me and Jeff” – doctors, social workers, a team of clinicians that he was to work with on the outside all participated.

“We all sat down and we covered this outpatient treatment plan in depth and my son actually followed it. It’s the only time in the five years that he has done that.”

Eventually, though, Jeff stumbled.

“And then they changed everything,” Kramer says, “and they started keeping him two days, three days, a week if you’re lucky.” Most recently, he stayed two weeks.

A pill, a platitude, a pat on the back

The liaison community mental health clinics used to have with hospitals was an important element in continuity of care, helping ease the transition back into the community. Once out, an ongoing relationship with a trusted professional is the next critical step.

“It takes time to build those things,” says Thomas Smith. “But they just threw that all to the four winds. Now it’s just a piecemeal thing.”

Smith refers to “P-P-P’” clinics: “You come in and you get a pill, a platitude and a pat on the back.”

He hastens to add that there are certainly still good providers out there – but believes most are just in it for the money. And the continuity of service, that comprehensive suite of services delivered by a team, as a team, is what appears to be lost.

In order to be effective, says Nicholas Strata, that team should include a representative from a state institution, another from a local in-patient program, another from an out-patient program; a team to provide whatever the patient needs.

“The survivor in me, my inner peace,” says Jeff Kramer, “will find a way to survive and figure out some kind of method of dealing with reality.”

His mother isn’t nearly so sure.

This story is the first in a series about mental health care in North Carolina. The names of mental health care recipients and their family members have been changed.

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Family's story aids officers' training -Witchita (KS) Eagle

BY RON SYLVESTER - Aug. 30

The news of her son's death, in Marge Eilert's view, made him out to be a bad guy.

But he wasn't, she said, just sick, suffering from schizophrenia.

Two years ago, after his girlfriend had called for help, Greg Eilert struck a police officer. Then Eilert led police on a chase through Topeka before being shot four times and killed in his car by an officer.

On the second anniversary of her son's death, Marge Eilert, her husband, Ralph, and their daughter, Nancy Eilert-Way, drove to Wichita to tell a group of law enforcement officers about what their family had gone through with Greg's illness before and in the aftermath of his death.

It was the latest in the weeklong training of police and sheriffs' deputies on crisis intervention for the mentally ill.

Agencies such as the Kansas Department of Corrections and the National Alliance for the Mentally Ill hope to take similar training around the state as a first step in keeping people with mental illnesses out of what has become a revolving door of the criminal justice system.

The number of mentally ill people who end up in prison has tripled nationally during this decade. In Kansas, most inmates in prison suffer from some form of mental illness.

Greg Eilert, his family said, was a gifted woodworker, athlete and good student until he began slipping in high school. He would withdraw and become quiet. He later would be diagnosed with schizophrenia.

"He didn't lie. He didn't steal things," Ralph Eilert said of his son.

He wasn't violent by nature.

"I never in my whole life felt threatened by him," Eilert-Way said of her brother. "He had the kindest heart."

Not even his girlfriend of nine years, who called police that day, said he hurt her.

"She was scared," Eilert-Way said. "But she told us he never harmed her."

The woman took out restraining orders against him.

"Then one of them would violate the order," Eilert-Way said. "She would invite him back into her life."

Eilert went to jail twice, the last time in the spring of 2006.

"He was in jail that March," Eilert-Way said. "He wasn't competent to stand trial, so he went to Osawatomie State Hospital. Then he went back to jail."

When he got out that summer, he talked about going to see his girlfriend. His sister said she repeatedly told him he couldn't go.

Five weeks later, he was dead.

The police officer was absolved of any wrongdoing in the incident. Greg Eilert wasn't armed, but police considered his car a weapon, the family was told.

"We felt like Greg was treated like a criminal," Marge Eilert said.

By participating in crisis intervention training, the family said they hope to help police learn how to better respond to such situations.

"If you learn how to do that," Ralph Eilert said, "maybe Greg's death won't be in vain."

The class of 44 officers is set to graduate today.

Reach Ron Sylvester at 316-268-6514 or rsylvester@wichitaeagle.com. Read more!

Victim drank too much water -Mt. Clemmins (MI) Macomb Daily News

By Christy Strawser

The Macomb Daily has learned the cause of death for Macomb Township mother Andrea Jean Bean, 42, though the mystery of her bloody condo is still unsolved.

Dr. Daniel Spitz, the county's medical examiner, said Bean died from very low sodium levels, which was caused by an underlying psychological condition that led her to consume vast quantities of water.

The water forced an electrolyte imbalance, followed by a seizure, and eventually death, Spitz said. The condition is called psychogenic polydipsia, and it is often associated with schizophrenia, experts said.

"With incredibly large amounts of water, you can dilute your blood," Spitz explained. "It's a really bizarre case."

Spitz said Bean suffered before from the water-consuming condition, though he did not believe she purposely brought it on again.

"She had been found unconscious before after having a seizure, and they found incredibly low sodium," Spitz said, adding he considered it an accident. "I don't think anybody could do it as a suicidal gesture. It falls under psychiatric behavior."

Bean's family said she was emotionally broken after she lost custody of her three children to her ex-husband. She had limited supervised visitation.

Her father, John Collier, also thinks the legal system and social services should have done more to keep her alive.

Collier and his wife, a doctor, tried to be appointed as her guardians during her recent divorce, but the court refused. An outside attorney was appointed instead.

"This is a death that had no business happening," Collier said, adding, "You would be amazed how Andrea was let down by those that should have helped her."

Death from water consumption is rare, but it happened to a 28-year-old California woman last year after a radio-station sponsored "Hold Your Water" competition.

Jennifer Strange consumed an estimated two gallons of water in a couple of hours, according to published reports, and died the same day after winning the second-place prize -- a pair of tickets to a Justin Timberlake show.

Spitz could not quantify how much water Bean consumed, except that it was "way outside what a normal person" would ingest.

Bean had no illegal drugs or alcohol in her system, Spitz added. There was also no indication of what caused the significant amount of blood in her condo or to whom the blood belongs.

Bean was found July 29 face down in her bed inside her condo at Card and 24 Mile roads in Macomb Township. A 19-year-old nanny discovered her while bringing the children, 2, 7, and 9 years old, over for visitation.

There was blood smeared all over the bedroom, kitchen, and a hallway, but Bean's body was clean and injury free.

Spitz said the blood was human, but he's still waiting for the Michigan State Police Crime Lab to determine if it belonged to the victim.

"I don't think it's related to her death," Spitz said. "It may be her blood, but we don't know how long it was there. Could it have been a nose bleed, something else? It could be related to an underlying psychiatric issue."

Bean was hospitalized for mental illness at least 17 times, including a stay that ended two weeks before her death, her family said.

She tried to commit suicide in December 2006 by jumping into Lake St. Clair, and ended up hospitalized for hypothermia, court records showed.

Bean was hospitalized again after a confrontation at her ex-husband's house on June 28, 2007, where she was described by police as incoherent.

Her ex-husband, Roy Bean, 53, of Macomb Township, tried to get a personal protection order against her in April 2007, but was denied by Judge Antonio Viviano on the grounds Read more!

Southeastern announces more cutbacks in care -Wilmingon (NC) Star News

By Vicky Eckenrode

Southeastern Center for Mental Health officials informed private providers Friday about another round of service reductions for people with developmental disabilities in the area.

The center will stop paying for two developmental preschool programs that cover about 25 area children with special needs, which administrators project will save $600,000 a year.

They said they would speak with local public school systems early next week to see if they are able to take on the funding for those children.

Also, about 200 people who receive developmental therapy services, in which providers teach them how to reach goals such as applying for jobs or living on their own, will see the maximum number of hours of help fall from eight a week to four in September.

Area Director Art Costantini said the people affected would be able to appeal the cutback and have to have their cases reviewed in order to not lose the service completely in October.

Costantini said the reviews will help determine if people are actually receiving developmental therapy or instead are getting community support services that involve helping clients with ongoing tasks like taking them to a job everyday or shopping.

Private providers can be reimbursed at about twice the hourly rate if they are giving developmental therapy compared to community support.

Southeastern is responsible for allocating state funds to the private providers in the area for mental health, developmental disabilities and substance abuse treatments.

The center has struggled to meet its budget for that state funding for much of the year, prompting cutbacks in other types of client services. State mental health officials stepped in earlier this month and assumed control of the center’s finances.

Costantini, who is currently working with the state officials on a plan to get back on track, said the latest moves could get the funding in line with the $8.3 million the center has this year in state funding.

“We hope this is the last set of reductions,” he said. “It looks like the budget will be in shape Nov. 1.”

Vicky Eckenrode: 343-2339

vicky.eckenrode@starnewsonline.com
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Durham VA hospital to renovate, expand -Triangle Business Journal

Dathan Kazsuk

DURHAM – With older veterans requiring increased care and younger ones returning from two war zones, the primary care and mental health facilities at the Durham VA Medical Center will be renovated and expanded.

The 55-year-old hospital at 508 Fulton St. near Duke University Hospital is on track to have 15 percent more patient visits this year than in 2007, says Sara Haigh, staff assistant to the hospital director.

“The general veteran population is either stable or expanding,” she says. Besides aging veterans and returnees from the wars in Iraq and Afghanistan, vets who are losing their private health care due to the sour economy are turning to the VA for help, Haigh says.

A total of 5,500 square feet of existing clinical space will be renovated, and 12,000 square feet will be added. Also added will be 9,250 square feet of research space, according to a request for proposals sent to general contractors.

Construction of the clinical facility, which will cost between $5 million and $10 million, is scheduled to begin in May 2009 and should take about 18 months. Construction of the research facility, which will cost between $2 million and $5 million, is scheduled to begin late this year and should be completed in March 2011. Following that, plans call for an addition to the research wing costing $5 million to $10 million.

The research space will be split between clinical and administrative work.

Contracts for the projects have not yet been awarded. Haigh says the U.S. Department of Veterans Affairs is in the process of reviewing proposals.

Because the VA is a federal hospital, state regulators with the Certificate of Need system, which is designed to keep health-care costs down, have no say over the project.

According to the Department of Veterans Affairs, 774,000 veterans live in North Carolina, making the state among the nation’s 10 most populated by military vets.

Douggy Johnson, director of the Wake County Veterans Services Office, an agency that assists veterans and their dependents, says veterans are having trouble getting primary care appointments at the Durham VA hospital.

“I think it’s very much needed,” he says of the expansion. “There are already a lot of veterans here who need services.”

Plans call for administrative offices on the first floor of the hospital to be moved. The first floor then will be renovated for patient care, and a two-story addition will be constructed. The second floor of the addition will house mental health facilities, which are needed to deal with brain injuries and post-traumatic stress disorder, or PTSD.

“PTSD has become much more of a circumstance veterans are willing to talk with us about,” says Dave Rainy, a Department of Veterans Affairs communications officer. “It’s been an ages-old problem but one the military and VA has been willing to deal with.”

The mental health center will allow for the screening of returning veterans for traumatic brain injuries. Haigh says many soldiers have suffered some sort of brain injury due to explosions, and the VA is being more vigilant in checking for such injuries and helping those who have been injured.

“Because of the number of … explosive devices used, that’s something that in past wars would have killed a soldier, but with better armor, they are more able to survive those injuries but might have a longer-lasting brain injury,” she says.

Sometimes, she says, the injury is so subtle that soldiers do not even realize they’ve been hurt.


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Family of slain coach sues hospital that freed mentally ill killer - Seattle Post Intelligencer

The family of slain tennis coach Michael Robb is suing Harborview Medical Center for releasing the West Seattle man's deranged killer days before the June 26, 2005 slaying.

Robb, who coached at Newport High School in Bellevue, was driving home when then-17-year-old Samson Berhe stepped up to his car and shot him in the side of the head. Robb, a 46-year-old married father of one, lost his life in the random attack.

According to the lawsuit filed in King County Superior Court earlier this month, Berhe had been confined in a Harborview psych ward at least three times in the year before the shooting. He'd also been involuntarily committed for months at a time, and was being monitored by a King County-paid social worker when the killing occurred.

Four days before Robb was slain, four Seattle police officers took Berhe to Harborview after he attacked a friend. In reports, officers said Berhe's family was afraid for their own safety and asked that he be held at the psych ward.

Social workers examining Berhe described him "very bizarre … disorganized and nonsensical," according to court documents. A psychiatrist examining him found he'd been off his medication for six months, and determined he was a threat to himself and other people.

Hours later, though, a hospital official ordered Berhe be released because officials had insufficient evidence to detain the young man, in part, attorney's for Robb's family argue, because Berhe's family didn't answer several calls to the house made after midnight the day after he was taken into custody.

Berhe was "acting crazy and running around on the street" when his parents picked him up outside the hospital June 23, 2005. Three days later, police say, he killed Robb.

Prosecutors charged Berhe days after the killing, which we wrote on here. He's currently in a state mental institution, deemed to have been insane at the time of the killing. You can read about that here.

Also named in the suit are King County and the University of Washington, which operate Harborview. No response has been filed.
Posted by Levi Pulkkinen at August 28, 2008 6:09 p.m. Read more!

Patient advocates: N.C.'s mental health system needs fixing - WRAL-TV Raleigh (NC)

Video link by clicking post title.

RALEIGH, N.C. — Recent reports of patient abuse and neglect at Cherry Hospital in Goldsboro is more proof that the state's troubled mental health-care system needs restructuring and more funding, patient advocates say.

"There isn't a system of psychiatric facilities in this state," said Vicki Smith, executive director of Disability Rights North Carolina. "What we have are individual hospitals."

Smith said there needs to be a consistent standard level of care across the state's four psychiatric hospitals and that right now, hospitals only try to meet the minimum standards of care to receive funding.

She blamed that on job vacancies, lack of training, lack of supervision and oversight and inadequate pay. Many state agencies also rely on a temporary work force, and that means the quality of patient care is not always the same, she said.

Better recruiting and retention are needed, she said, to attract more qualified and attractive job candidates.

It's something the state's mental health oversight committee also suggested at a meeting earlier this week. John Tote, with the Mental Health Association in North Carolina, says the General Assembly needs to make more funding available.

Advocates believe Health and Human Services Secretary Dempsey Benton has taken aggressive steps to overhaul the system since taking over last year.

For example, he's starting to hold workers more accountable, Smith said. His recent decision to close a ward at Cherry Hospital in Goldsboro in the wake of a patient's death sends a big message, she said, partly because there aren't enough beds for patients there.

On Thursday, Benton said the Division of Mental Health must find an independent hospital management firm to evaluate Cherry Hospital.

However, Smith and Tote are concerned that any progress Benton is making could suffer a setback when a new governor is elected in November and if a new DHHS secretary is appointed.

"Four months left scares me," Smith said. "What concerns me is that with a new administration, the tendency will be to study the problems."

That would not be true if the gubernatorial candidates are already investigating and discussing the problems the mental health system faces. Advocates say they have not heard any specific plans from either candidate so far, however.

"Folks are going to be behind the eight ball, and if that's the case we'll see a perpetuation of the situation," Tote said. Read more!

Mental hospital to be run by outside firm -Raleigh News & Observer

Lynn Bonner

A management firm will take control of the state's troubled mental hospital in Goldsboro and conduct a top-to-bottom evaluation of the hospital's operations, staff and management.

The state Department of Health and Human Services hopes to have the firm in place by mid-September, said Leza Wainwright, a director of the state mental health division. She could not recall another instance in which the state hired a company to manage a hospital.

Cherry is in danger of losing its federal money after investigators discovered this month that a 50-year-old patient, Steve Sabock, was left sitting in a chair without food and adequate water for more than 22 hours while workers played cards and watched television. Last week, two workers beat a patient.

Federal investigators are inspecting the hospital this week, and a decision is expected Monday about whether Cherry can keep its federal payments. Cherry receives an average of $798,000 in federal funds each month.

The outside firm, which has not been chosen, will run the hospital during the evaluation, Wainwright said. The state wants the company to assess "staffing, organizational structure, the competence and effectiveness of managers and supervisors at all levels, and all other components of hospital management and operational activities."

Hospital director Jack St. Clair stays, Wainwright said. But St. Clair will report to the new managers, who offer "that additional comfort level that another set of eyes are looking at all situations."

DHHS Secretary Dempsey Benton last week expressed confidence in St. Clair, but also said hospital administrators did not do enough to discipline the 16 workers responsible for Sabock's poor treatment. One nurse resigned, but no one was fired. Two health care technicians accused in last week's beating were fired Wednesday.

Advocates for the mentally ill and concerned legislators are despairing over what to do about conditions at Cherry. The state personnel office is reviewing salaries of health care technicians and hospital directors, according to Gov. Mike Easley's office. Critics think those jobs pay too little to attract the best talent.

State administrators have also directed Cherry to hire more security officers. The hospital police have only one officer on each shift, and the state would like to have at least two people working at the same time, Wainwright said.

Cherry needs more security workers to respond to threats of violence, Wainwright said.

"Only having one individual in any eight-hour shift is not adequate," she said. Read more!

Virtually psychotic -Red Bluff (CA) Daily News

By RICH GREENE-DN - 08/28/2008

It may not be Universal Studios' new Simpsons ride, but the line sure is shorter and the lesson much more valuable.

Tehama County Health Services Agency is offering a rare experience this week - a chance to virtually step into the shoes and head of a schizophrenic.

A virtual simulator, on loan from Jensen Pharmaceuticals, lets people feel, see, hear and even smell what it's like to deal with schizophrenia

The simulation takes about six minutes and is available at the Mental Health Day Center at 1445 Vista Way from 8 a.m. to 5 p.m. today, and at St. Elizabeth Community Hospital Friday morning. Appointments can be made in advance or the public may simply stop by.

Mental Health Director Ann Houghtby said the idea is to educate the public about what it's like to deal with the mental disease.

Even those who work in the mental health field have said the simulator brings a new level of understanding.

"You never know for sure unless you experience some psychosis yourself," clinical social worker Wanda Cassairt said.

Cassairt went through the simulation Tuesday and said she believes it would be a good experience for local law enforcement to go through.

Houghtby said, while conditions differ from person to person, the simulator mirrors some of the more common complaints including voices in the head, command language and visual hallucinations.

Schizophrenia's symptoms do not creep up gradually, but instead sufferers experience what is known as a psychotic break,
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St. Elizabeth Imaging Center
according to Houghtby. The intense, brutal psychotic break often lands the patient in the hospital where it is diagnosed.

Advancements in drugs have come a long way from the anti-psychotics first used mainly to sedate those with schizophrenia, but they still have a long way to go, Houghtby said.

Some patients are able to work routine jobs, but finding the right balance of medication is an ongoing problem.

Even with a proper balance, sufferers often forget or won't their pills because of the voices in their head - an effect the simulator offers first hand.

---------

Staff writer Rich Greene can be reached at 527-2153, extension 109 or rgreene@redbluffdailynews.com
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Too pained to live - Chico (CA) News-Review

By Robert Speer - roberts@newsreview.com

By the time someone diagnosed Daniel Brocchini’s mental illness as borderline personality disorder, he’d been suffering for more than a decade. Unfortunately, the diagnosis, given on June 3, did not result in the care he needed. Two weeks later, on June 17, he was found dead on his bed at a local recovery house.

There were several empty pill containers on a nearby dresser and a binder containing a suicide note at the foot of the bed. “I can’t take anymore pain,” he’d written, quoting one of his favorite bands, Social Distortion. “None of you believed me. Maybe you’ll believe me now.”

His only directives: “Bury me in Tahoe. Forget I ever lived.” He was 26 years old.

The signs of his torment had been visible for years. There were scars up and down his arms and across his chest from where he’d cut himself. He’d attempted suicide several times. He suffered from panic attacks, clinical depression and extreme anxiety. He was in almost constant emotional and physical pain. And he was deeply addicted to alcohol and drugs.

For years his mother, Evelyn Denk, had tried to get help for him. Over and over, she’d tried to sign him into public mental-health inpatient facilities here and elsewhere (they lived for many years in Lake Tahoe). Most of the time they were turned away, and when he was admitted, it was only for short stretches.

To Denk, the events surrounding Dan’s suicide were the last in a long line of encounters with a broken mental-health-care system that didn’t seem to know how to treat this terribly troubled youth. Too often, she charges, it viewed him as just an alcohol and drug addict, without recognizing the underlying mental illness that was causing his addictions.

The system, she insists, is horribly dysfunctional.

She gives this example: In mid-May, Dan was seen at Butte County Behavioral Health for an evaluation. Several medications were prescribed, and he and she were told to obtain them through his family doctor. That was Dr. Robert Roth, at the Chico Family Health Center.

At the time Dan was living at Stairways, a clean-and-sober recovery house. In his May 16 notes on Dan, obtained by Denk, Roth writes that the request to provide medications wasn’t accompanied by “any of their diagnostic or therapeutic information and … I think it would be really helpful to have a more clear idea as to what the psychiatric diagnosis is given the problems he has.”

Roth could have called BCBH, but the agency has one of the most opaque phone systems in the county. You’re more likely to get a recording than get through to someone, but the recording doesn’t take messages: Call back later, a woman’s voice says. And when you do get through and ask to be transferred to someone, you’re liable to be told—as I was this week—"We don’t transfer calls here.”

Roth’s solution? He gave Dan a note to take to BCBH “because I really professionally reached the point of exhaustion with that organization in its failed communications.”

(Roth did not return a CN&R phone message.)

On June 10, clinicians at BCBH worked up a safety plan for Dan. He was to continue residing at Stairways, and Stairways staff was “to supervise [him] and ensure [his] safety.” He was also to call the BCBH crisis line and check in when he got home, to rely on a list of anxiety-relieving techniques ("Listen to music,” “Go for a walk,” etc.), to take his meds, to call the crisis line again the next day, and to check in with various resources (group therapy, BCBH Outpatient Services, Dr. Roth) in the coming weeks.

“For someone with Dan’s disease, I can tell you this is too much,” his mother said. “Plus it’s not Stairways’ job to do that.” She also wondered why a drug regimen prescribed on June 3 wasn’t to be evaluated until July 1, nearly a month later.

His group therapy was to be via Proposition 36, the treatment-not-jail initiative voters approved in 2000. He’d gone to court on June 4 to answer to a misdemeanor drug possession charge, and Judge Steven Benson had assured everyone in court that day that they would get help if they wanted it.

Evelyn Denk was there, and for a moment she was encouraged. “You put your hope in these programs and the things you’re told, and then they’re just not there. They’re so not there.”

According to the National Association for Personality Disorder, BPD is “a disorder in which a person is unable to regulate emotions or control impulses. Their behavior can be seen as maladaptive methods of coping with constant emotional pain.”

Thus the cutting, the alcoholism, the drug addiction and the attempts at suicide, which Denk sees as cries for help.

The disease, according to the NAPD, is a “biologically based disorder of the emotional regulation system that may be due to genetics factors, the environment or a combination of the two.” It tends to run in families with a history of mental illness, depression, ADHD or addiction, and often is characterized by abnormal levels of the neurotransmitters serotonin and dopamine in the brain.

It’s a difficult illness to treat. There’s no one-size-fits-all medication, and medications must be closely monitored and adjusted over time, as BPD symptoms often change. The best course is to combine such regimens with both individual cognitive behavioral therapy and group training that teaches emotional regulation skills, distress tolerance, improved interpersonal relationship behaviors and self-awareness, or mindfulness.

Needless to say, such a sophisticated treatment program was not available for Dan Brocchini. “He was work, hard, hard work,” Denk said, “and nobody wanted to invest that much.”

Laurie Feldman is the BCBH family nurse practitioner who diagnosed Dan Brocchini as having borderline personality disorder. In a phone conversation, she addressed a number of the issues raised by Evelyn Denk, while endeavoring not to talk specifically about her son because of confidentiality concerns.

The fact that someone is suicidal doesn’t necessarily mean he or she is a candidate for inpatient care, Feldman said. “Most people are not permanently suicidal,” she explained. “It tends to be off and on.”

So when is a suicidal person admitted? When that person is “being suicidal and is also unable to contract for his or her own safety,” Feldman responded. Signing what is known as a “no harm” contract, in which a person promises not to commit suicide and to stick to a safety plan, “is considered an adequate alternative to hospitalization.”

She agreed that BCBH’s communication is “a problem—oh yeah.” When she arrived at the agency six years ago, she wanted to make the system more accessible, she said. For a while she served on a health-care coordinating committee, which came up with the idea of having a central phone number and even went so far as to get a number, but “it never went anywhere.”

And she agreed that the entire mental-health-care system is broken. “We’re using our jails as inpatient units,” she said. “Taxpayers’ money is going to prisons, not health care. … The system fails people on a daily basis.”

In recent weeks, the county department had to lay off nearly 30 clinicians due to state-imposed budget cuts. A few have been rehired using money from the Mental Health Services Act, the initiative that taxes millionaires slightly for mental-health services, but the money must be used for new services, not existing ones, so the impact of the layoffs remains heavy, Feldman said.

(A phone message left for BCBH Assistant Director Lisa Cox was not returned.)

Dan Brocchini is the second of Evelyn Denk’s five children to die. She lost a 5-month-old baby boy to sudden-infant-death syndrome 23 years ago.

Her response then was to get involved in a national SIDS awareness chapter in her town and become a trained counselor to other parents who lost children. “They called me whenever they brought in a baby,” she said. She did that for three years, until it became too much emotionally. She shifted to other charitable work and is especially good at marketing, she said.

She intends to take a similar approach this time and has contacted the NAPD seeking to volunteer to raise BPD awareness in the Chico area. It’s the most stigmatized and least understood mental illness, she said, and too often its sufferers are dismissed as merely substance abusers.

In the meantime, she’s trying to obtain her son’s medical records from BCBH so she can find out what really happened to him there. The agency has insisted, however, that to get the records she must go through probate to become the executor of his estate, which she said amounts to “the $5 he had in his wallet and his comic books.”

All she has left of him now are some photos of a cute little boy, his many poems—some of them splattered with blood—and various documents and notes he obtained or made in the days before his death. They don’t take up much space in her north Chico apartment.

She’s convinced he didn’t really want to die. For one thing, the suicide note had no message for her, the person he loved most in the world. “He would have said goodbye if he meant to die,” she said. And it also contained a list of the meds he’d taken, as if he wanted whoever found him to save him.

“I believe he was trying to force them to treat him by taking himself to the edge,” Denk said, tears in her eyes. “He miscalculated, perhaps because he was clean and sober and his tolerances weren’t where he thought they were. An attempt to be taken seriously cost him his life.”
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Ravas ruled insane -Medina (OH) Gazette

By ALLISON WOOD - August 28th, 2008

MEDINA — Two psychological evaluations of the mentally ill man accused of killing his mother in her Hinckley Township home determined he was insane at the time of the offense last year.

Patrick M. Ravas, 27, is accused of stabbing Noella Ravas, 62, in her Salem Court residence several times while she was on the phone with a 911 dispatcher in the early morning hours of Nov. 28. She was pronounced dead at a local hospital a short time later.

Ravas is charged with counts of aggravated murder, murder and aggravated burglary, and has pleaded not guilty by reason of insanity to the charges.

Common Pleas Judge Christopher J. Collier has ruled Ravas is competent to stand trial, meaning he is mentally capable of contributing to his own defense.

Ravas was diagnosed with schizophrenia and was hospitalized years before his mother’s death, court records show.

The evaluations were completed by Kathleen Stafford and Dr. Stephen Noffsinger of the Akron Psycho-Diagnostic Clinic. Stafford’s evaluation was completed earlier this year, while Noffsinger’s recently was finished.

Both experts also offered testimony last year during the trial of Steven Latham, who was convicted on four counts of aggravated robbery for shooting a sheriff’s deputy and at three other deputies at his Litchfield Township home in 2006.

It will be up to a jury to determine if the experts’ testimony should be believed, county Prosecutor Dean Holman said.

Another pre-trial hearing is scheduled for Sept. 19.

Ravas has been in the Medina County Jail since his Nov. 28 arrest.

Wood may be reached at 330-721-4050 or allisonwood@ohio.net.
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Mental unit will take its services to the patients -Winston-Salem (NC) Journal

y Richard Craver

A 24-hour mobile crisis unit has been established to provide timelier mental-health care to residents in Davie, Forsyth and Stokes counties, Forsyth Medical Center said yesterday.

More than $1 million in grant money, including $675,000 over three years from the Duke Endowment, has been dedicated toward the unit within Forsyth Behavioral Health at the hospital.

An additional $350,000 was provided from CenterPoint Human Services through the hospital's foundation to help pay for equipment and operational expenses for the first 12 months.

The unit, which will operate year-round, is expected to complement the face-to-face assessment services already provided by a mental-health access team in the hospital's emergency department.

The mobile-crisis unit has been operated on a limited basis since May 12. It has three full-time employees and one vehicle. There are plans to add two more employees and another vehicle. There are no income criteria for eligibility for the service.

"This unit will help meet a huge need in our community regarding helping people with psychiatric, substance-abuse or disability issues," said Jeff Eads, the community-operations manager of CenterPoint.

"It will allow people to be treated at their home, their school, their work or other settings, rather than having them entering a hospital setting or being hospitalized to resolve their crisis."

According to the hospital, about 4,500 people were examined last year by its mental-health access team, "in part because of a lack of adequate community-based mental health-crisis services."

Forsyth officials project that the mobile crisis unit will serve more than 900 people in its first year.

A long-term goal for the hospital is establishing a behavioral-health crisis center on its main campus, which would include consultation rooms, a special waiting area and 24-hour observation.

According to the fiscal research division of the General Assembly, there are 1.1 million North Carolinians with health issues involving mental illness, development disability or addictions -- not including the homeless or those living in institutions.

The division also reported that an average of 350,000 residents are examined each year through programs focused on those three health categories.

Mental-health assistance and treatment received considerable focus during the recent General Assembly sessions, in part because of media reports of incidents in which mental-health patients were harmed by a lack of timely care.

Many problems have occurred since a 2001 overhaul of the state's mental-health system, which was intended to move patients from state psychiatric hospitals to community programs.

To help combat continuing problems, legislators approved $5.7 million for the 2008-09 budget to help subsidize the cost of 30 mobile crisis teams. There are currently 19 such units in the state.

They also approved $1.9 million for six crisis teams to help developmentally disabled residents, and $6.1 million for local walk-in clinics for crisis and immediate psychiatric care.

Local mental-health officials expect to learn by mid-September how much money they will receive from the state for the mobile crisis unit and the local walk-in clinics. Cornerstone operates a walk-in clinic at the Behavioral Health Plaza.

"We need to have something like a 24-hour walk-in clinic to evaluate and treat people going through a mental-health or substance-abuse crisis in a more appropriate and less-restrictive environment," said Andy Hagler, the executive director of the Mental Health Association of Forsyth County.

The creation of the mobile crisis team for the three counties is part of an initiative to provide such coverage "within 30 miles or 30 minutes of every resident in the state," said John Tote, the executive director of the Mental Health Association of North Carolina.

The funding "was recognition by the General Assembly that there is a tremendous assessment gap in the state," Tote said.

"But even with the expansion of the mobile crisis teams, we will continue to struggle with lacking enough resources

to meet the entire need," he said.

"The center that Forsyth is planning is a step in the right direction as well."

■ Richard Craver can be reached at 727-7376 or at rcraver@wsjournal.com. Read more!

Mental illness - past or present - is not a crime Toronto (Canada) Globe & Mail

ANDRE PICARD - August 28, 2008

Is having a bout of mental illness something that should result in a police record?

Astoundingly, that is the reality in much of this country.

It is an egregious breach of civil rights, yet the practice continues because people who suffer serious mental illnesses such as depression, bipolar disorder and schizophrenia are all too often voiceless, powerless and victims of well-entrenched stereotypes.

To understand this story, a little background is in order. In the post-9/11 era, police checks have become the norm in our society; it is a simple way of weeding out pedophiles and other "bad" people, or at least giving the illusion of doing so.

If you apply for a job or a volunteer position - fundraising at the local hospital, coaching a peewee hockey team, helping out with the school choir or any other of those innumerable, thankless tasks - you will have to agree to a police check.

These checks come in two forms.

The first is a search of the computerized records maintained by the Canadian Police Information Centre. If you have a criminal record, the information is likely to show up in CPIC.

The second is a police records check. In addition to CPIC, local, municipal and provincial police forces maintain their own computerized records.

These records contain all manner of information about any contact you have with police, whether you are a criminal, a victim or a witness.

When you have a loud party and the neighbours rat you out, both your names are in the system. A Good Samaritan calling 911 is in there, and so are the people they are calling about, even if they are harming no one but themselves.

People who suffer bouts of mental illness tend to have a lot of encounters with police. They make suicide attempts and threats of suicide. Sometimes they starve themselves, drink or drug themselves silly, make paranoia-spewing phone callsand trash their cars. And these are the "respectable" people with nice homes and good jobs, not the stereotypical "crazy" street people.

These encounters all result in a police record.

"So what?" you may ask.

Aside from the principle that we should not accept gratuitous violations of civil rights, there are practical harms being done every day. Take the example of Ontario, where the Mental Health Police Records Check Coalition has done a wonderful job bringing this issue to light.

If you apply for almost any volunteer post in Ontario working with children, the elderly, people with disabilities etc. you must undergo a Vulnerable Person Screening.

This report will tell the volunteer agency if there are red flags on a person's police record. Some police forces simply make the vague statement that there is "information of concern," while others provide details such as "suicide attempt" or "arrest under the Mental Health Act."

(Incidentally, when people are detained under the terms of the Mental Health Act, it is not an arrest. Police have the legal right to take people who are a danger to themselves for treatment at a medical or psychiatric facility, but police tend to use the misnomer "arrest.")

Mental illness is a medical issue. What business do police have disclosing this information to potential employers? Some police forces retain and release this information for up to 25 years after an "encounter."

Police in London, Ont., no longer release mental-health information contained in police records, a change made as part of a settlement of a human-rights complaint.

That should be the norm everywhere in Canada.

Police records contain other sensitive medical information, including whether a person who has encountered police is infected with HIV, hepatitis or other diseases. Police would not dream of releasing this information as part of a background check. So why is it okay to disclose suicide attempts, psychotic episodes and other cries for help?

It's done because of lingering stereotypes about people with mental illness being violent and untreatable.

The reality is that the mentally ill are far more likely to be victims of violence than perpetrators, and it is those with severe, untreated mental illness who tend to be violent, but are unlikely to be applying for work - volunteer or otherwise.

The reality, too, is that the vast majority of people who suffer a bout of mental illness get better. For many, part of the healing process from these horribly isolating and soul-destroying illnesses is reintegrating into the community. That means getting work, volunteering and building social networks anew.

That's what makes these policies doubly horrific. They not only discriminate against people for no good reason, but they can set back their recovery and destroy their hope of being a "normal" citizen again.

Having a mental illness - present or past - is not a crime. But discriminating against people with mental illness in this manner is.

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Cherry fires 4 workers -Raleigh News & Observer

Lynn Bonner

Cherry Hospital fired three employees Wednesday and told a part-timer not to come back to work, after the beating of a patient last week.

Two of the fired employees were health care technicians charged with beating a male patient at the state psychiatric hospital in Goldsboro.

Taniko Dominique Upton, 33, was accused of hitting the patient in the abdomen, then hitting and punching the man in the head and side after he fell to the floor. Upton said he was wrongly accused.

William Kenneth Johnson, 52, was accused of holding the man during the initial assault, then joining in the beating once the victim was on the floor.

The part-time worker and the third full-time worker were nurses, said Tom Lawrence, a state Department of Health and Human Services spokesman. Lawrence, who could not provide the nurses' names, said that he was not certain of the reasons for the action against the nurses but that they might have been held at fault for not reporting what they knew about the beating.

The firings came a day after investigators arrived at Cherry for a review of hospital operations. Investigators are checking to see what changes have been made at the hospital after the discovery this month that a patient, Steven Sabock, died in April after sitting in a chair for 22 hours without food while hospital staff watched television and played cards nearby.

Dempsey Benton, head of the state agency that oversees the psychiatric hospitals, criticized hospital administrators for their lenient treatment of the 16 staff members found to bear some fault in Sabock's negligent treatment. One nurse resigned, but no one was fired.

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

Jesse James Deconto, Staff Writer Comment on this story - Raleigh (NC) News & Observer

Jesse James Deconto

HILLSBOROUGH - Orange-Chatham District Attorney Jim Woodall could announce plans this fall for a fifth capital murder trial in a district that hasn't sent anyone to the death chamber since 1948.

On Wednesday, a judge scheduled a Rule 24 hearing for Kenneth White, 40, accused of killing his pregnant girlfriend, Ebony Robinson, 21, and their unborn child whom family members named Elijah. Woodall is scheduled to announce at the hearing Oct. 28 whether he'll pursue the death penalty for White.

Woodall will have to decide whether there are aggravating factors in the case. Examples would be the presence of additional felonies connected to the slaying or a manner of killing that is especially "heinous, atrocious or cruel."

On a Friday morning in early December, Robinson was found dead on a gravel road outside Hillsborough, shot several times. She was about eight months pregnant.

White is charged with one count of murder. No laws on the books in North Carolina would allow an additional homicide charge.

Superior Court Judge Carl Fox Fox, who scheduled the hearing, also found White competent to stand trial. In June, Superior Court Judge Allen Baddour had ordered a psychiatric evaluation in response to a defense motion to have the suspect committed for mental health treatment. Fox based his decision Wednesday on the results of that evaluation.

"He is viewed as capable of proceeding to trial," Fox said.

White lived for years at 4020 Sudbury Road, Durham, in a house he owned with his wife, Erica White. Across the street, about a half-dozen houses down, Robinson lived in the home of her mother, Effie Steele.

The day before the shooting, Robinson told her sister Sandra Steele that White was the baby's father, according to a search warrant. Steele wanted Robinson to confront White, but Robinson said he had previously told her, "I have a gun, and you know what I'll do."

Despite the threats, Robinson's mother told investigators White was supposed to help her daughter look for a place to live in Hillsborough on the day of the killing.

Instead, late that morning someone called Orange County 911 to report hearing a gunshot, a pause and then three more rapid shots. The caller reported seeing a maroon vehicle back quickly down Wrenn Road.

Robinson's body was found at the end of that road.

Later that day, investigators searched White's home, seizing bullets for at least two guns: a .357 Magnum and a 9 mm. They also took a stroller and baby swing with Ebony's name on it, according to the search warrant.

jesse.deconto@newsobserver.com or (919) 932-8760 Read more!

Brian Wilson pays tribute to that old Cali sun with new album - Associated Press

By SOLVEJ SCHOU

BEVERLY HILLS, Calif. – Brian Wilson sits on a plush couch in his living room, smiling nervously.

On the back porch of the Beach Boys visionary, his family's 15 pooches yip and scramble over one another. Inside, photos of his children with wife Melinda Ledbetter – 11-year-old Daria, 10-year-old Delanie and 4-year-old Dylan – lace the walls.

The two-story house, snuggled deep in a gated hillside community in Beverly Hills, is immaculately clean, with beige carpeting and marble floors. Housekeepers tidy up downstairs. A swimming pool overlooks the sun-drenched valley below. It all resembles a postcard.

"I'm happier now than I was a year ago," Mr. Wilson says. "I started exercising, and I started eating more of the right food, and I started feeling better. I just get up in the morning and say my prayers."

Gangly and tall in a pinstriped dress shirt, his graying hair swept back into waves, the wizard songwriter and composer behind such '60s Beach Boys hits as "Good Vibrations" and "California Girls" stares with sharp blue eyes, frequently fidgeting.

A lot has changed for the historically reclusive Southern California native, who speaks with a slight slur, a result of his drug-abusing past and medicated journey through mental illness.

He is a second-round father at age 66. (Musician daughters Wendy, 38, and Carnie, 40, from his first marriage, tour as The Wilsons.) Following 2004's long-awaited rock opera Smile and a 2005 Christmas release, he has a new, ambitious solo album, That Lucky Old Sun, due out Tuesday. He is touring behind the material, pushing through years of stage fright.

"I think the new album is just as good as anything the Beach Boys ever recorded," says Mr. Wilson. "Playing these songs live, I feel proud. You know that funny feeling you get in your stomach, like, 'Oh my God, this is sounding great!' "

Two years ago, he says, he recorded 18 songs, then chose 10 last year for Capitol Records/EMI. He came up with the album's lush orchestration and music while 43-year-old bandmate Scott Bennett scribed the lyrics, with colorful narrative interludes by longtime collaborator Van Dyke Parks.

The outcome is a blend of up-tempo pop and piano-based ballads. The title track, a cover of the old standard "That Lucky Old Sun," flows into the bouncy anthem "Morning Beat," setting the album's tone.

"Van Dyke Parks, Brian and Melinda thought this should be a love letter to Los Angeles. At this point, Brian was 65 years old, and it just felt right to embrace his legend and be a bit nostalgic," Mr. Bennett says.

Songs such as "Forever She'll Be My Surfer Girl" touch on Beach Boys melodies while "Mexican Girl" adds a dash of salsa flavor. "Midnight's Another Day" and "Oxygen to the Brain" reference Mr. Wilson's dark days in the '70s and '80s, when he receded from the spotlight into isolation, drugs and weight gain.

Ending the album on an uplifting note, "Southern California" reminisces about co-founding the Beach Boys in 1961 with his late brothers Carl and Dennis. Mr. Wilson sings, "It's magical/ Living your dream."

"Yes, Brian had a rough time of it, with his mental health, but I would kill to have the kind of catalog he does, and tour everywhere with his brothers like he did," says Mr. Bennett, who confirms that Mr. Wilson "is on a heavy dose of antidepressants."

Regardless, Mr. Wilson has hit a creative stride in his life.

Inspiration comes at night when he sits down alone at his Yamaha synthesizer and grand piano in his purple-curtained music room.

"When I go to the keyboard, I feel holy, like an angel over my head. I feel very holy. When we did [the Beach Boys hit] 'God Only Knows,' I felt holy about that, too. A godly something comes through me," Mr. Wilson says, motioning with his hands. "I'm always thinking about melodies. The melodies come from my brain and my keyboards. I play a really pleasant keyboard. It sounds so pleasant it makes me want to write melodies."

But life as a busy dad and touring musician can be overwhelming. Mr. Wilson describes a house full of kids and dogs as "very loud" and "a madhouse." He frequently takes walks at a nearby park.

"The kids make me feel a little jumpy," he says. "Sometimes I want to get out of the house to get away from my kids, but I love my kids a lot. I love my kids. ... Quiet time comes around 10 at night when I go to sleep. It's peace of mind. Things run smoothly at night. During the day, things are more rough."

Later on during this interview, when Ms. Ledbetter comes home with their small son Dylan – floppy-haired, barefoot and wearing a Hawaiian shirt – Mr. Wilson brightens. He's quieter when it comes to daughters Wendy and Carnie, who live fewer than 10 miles away.

"I don't talk to them very much. I used to. I recorded with them at one time, but I don't talk to them a lot," he says, explaining that the women are "really busy."

Questions about the Beach Boys' current status get lukewarm responses as well. Mr. Wilson, who formed the band with his brothers, cousin Mike Love and school friend Al Jardine, split with most of the group's surviving members years ago amid legal squabbles. Mr. Love and later Beach Boys bandmate Bruce Johnston tour as the Beach Boys Band while Mr. Jardine has his own Endless Summer Band.

Mr. Wilson stresses the subject's touchiness: "We don't want any publicity about me getting back with the Beach Boys, 'cause I don't want to. They're not my group anymore. That's Mike and Bruce's group now. I'm on my own, and I would rather do that than go back to the Beach Boys."

He says the unreleased songs he recorded, including a slow, smooth version of "Proud Mary," will form another album. He gushes that "the only person I really want to work with is Paul McCartney." He would also like to record "a rock 'n' roll album inspired by Phil Spector's type records – a really hard rock album that really rocks, with big orchestration, the whole bit."

Yet, he also views his future gingerly, as day to day.

"I look forward to today," he says.

"I never look forward to the future because I think to myself, 'What if there's an earthquake, what if I die or someone I love dies?' I get those kind of thoughts all the time."

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Program aims to free up jail space - Corvallis (OR) Gazette-Times

BY MICHAEL BOOTH

Benton County Sheriff Diana Simpson will start a pilot program by September that she hopes will free up jail space, save some money and get frequent jail inmates with mental illnesses the help and supervision they need.

Simpson’s office has rented two studio apartments in the county-owned complex at 525 Monroe Ave., where she intends to house two people with mental illnesses who would normally be held in the jail.

“People with mental illness issues require a lot more supervision in jail,” Simpson said. “The goal is to reduce reincarceration, improve care and aleviate overcrowding issues.”

Undersheriff Scott Jackson, the former jail manager, said that jailing people who suffer from mental illnesses interrupts their treatment, which only makes the problem worse.

“Social Security and disability (payments), Medicaid/Medicare and the Oregon Health Plan are either suspended or terminated when they are incarcerated,” Jackson said.

Benton County Commissioner Jay Dixon echoed Jackson’s frustration with the suspension or termination of services to the mentally ill while they are in jail.

“We think we’re in a system where you’re innocent until proven guilty,” Dixon said. “If you’re thrown in jail, the (services) stop. That’s just wrong.”

The apartments will cost the Sheriff’s Office $370 a month. That compares favorably with the average cost of $150 a day to jail every inmate — or $1,050 a week, Simpson said.

For inmates with mental health issues, Benton County Mental Health and the sheriff’s office share the bill for medical evaluations and medications.

The agencies will initially pay treatment costs for those participating in the housing project. But, if people in the housing project regain lost services by getting out of jail, they may not need to.

Although a committee has not been formed, Simpson has met with members of the Benton County Defense Consortium, Benton County Mental Health, agencies focused on the issues of mental health and homelessness, District Attorney John Haroldson and Judge Locke Williams to determine how best to implement the program.

“It will take both (prosecutors) and public defenders to buy into (the program) and help identify those who will be suitable for it,” Simpson said.

The first two candidates to be housed have not yet been selected. Mental health professionals, as well as attorneys, will help make that determination, Simpson said.

Drawbacks to selection for the program are funding-related, Simpson said.

Funding for the apartments will come from a portion of a renewed jail levy, which includes a provision for jail bed rentals from other counties. That provision allows for funding of the housing program.

The language of the levy states the money can be used only for those on probation or parole. Because the Probation and Parole department is funded by the State, the Sheriff’s Office only receives funding for those with felony convictions.

Essentially, Simpson must choose inmates with mental health issues who have a felony record, are on probation or parole, are homeless and do not present a risk to the public.

Despite the restrictions, Simpson said there are plenty of candidates to choose from.

Once in the program, they will be supervised by a parole and probation officer trained in mental health issues.

Parole and probation officer Abe Griswold will get additional training in how to deal with the mentally ill and will be supervising the program.

“I’m anticipating frequent contact, two to three times a week,” Griswold said. “We’ll make sure they’re taking their meds and have a structured environment.”

Those housed in the apartments will have to volunteer willingly to be housed and must follow the standard rules of their parole or probation, including a curfew of 10 p.m. to 8 a.m., dependent upon employment hours.

Dixon said the larger problem of mental health and homelessness cannot be solved in the criminal justice system.

Benton County District Attorney John Haroldson agrees, but sees the program as an important step.

“We work in a system where you only benefit by having more options,” Haroldson said.

Simpson knows the program cannot end homelessness or mental illness, but she hopes the program will be successful and, potentially, can expand.

“We’ll reassess the program after six months or a year,” Simpson said. “If it has been a success, perhaps we can look into stable funding and more apartments. If not, we’ll scrap it and find something more effective.”

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Roseville assemblyman fights psychiatric hospital expansion - Sacramento Bee

By Cynthia Hubert - chubert@sacbee.com

A state assemblyman is trying to block the expansion of troubled Sierra Vista Hospital in Sacramento, despite arguments that the region is facing a critical shortage of beds for psychiatric patients.

"I am not going to enable dysfunction," said Assemblyman Ted Gaines, a Republican from Roseville. "I will apply as much pressure as possible to see that this expansion does not go forward" until Sierra Vista passes a state audit and shows "true management accountability," he said.

The hospital, which has been cited by state inspectors more frequently than any private psychiatric facility in California since 2004, is planning to add 48 beds. Construction has begun at the facility on Bruceville Road, but before Sierra Vista begins treating more patients, the hospital needs approval from the state Department of Public Health.

In a recent letter to public health director Mark Horton, Gaines said he has "grave concerns" about the quality of care at the hospital. He urged the department to fully investigate Sierra Vista and "if necessary, revoke their state license."

Sierra Vista officials responded Wednesday by announcing they have hired two administrators to work with a "best practices" team to improve conditions at the facility.

"Our goal is to provide the highest level of quality, compassionate care for individuals and their families during times of crisis," Sierra Vista's chief executive officer, Nancy Purtell, said in a written statement.

Hospital administrators argue in their expansion application that more psychiatric beds are badly needed. Sierra Vista has 72 beds.

Figures from the California Hospital Association show that Sacramento County and the state have far fewer beds for mentally ill patients than experts consider "minimal."Sacramento County has one psychiatric hospital bed for every 4,336 people, compared with the one bed per 2,000 people recommended by national experts.

"We're in dire straits," said Sheree Kruckenberg, vice president of behavioral health for the hospital association. "We are a state of 37 million people, and we have only 6,000 psychiatric beds. We are at crisis proportions."

People in immediate need of mental health services in the area routinely get stranded in emergency rooms, endure treatment delays or are sent far outside the region, Kruckenberg said.

State officials will not consider the bed shortage when deciding whether to approve Sierra Vista's $8 million expansion.

"The application will be evaluated on its merits," said state health department spokesman Ken August.

The hospital's regulatory record includes 111 citations by state inspectors since 2004. At least three patients have died because of poor care at the facility since 2000, according to state regulators. Most of Sierra Vista's problems stem from inadequate staff and training, according to records.

Including Sierra Vista, Sacramento County has three private, acute psychiatric hospitals, plus a county mental health center, for a total of 317 beds, according to the hospital association. Yolo, Placer and El Dorado counties have a combined total of only 51 beds, according to the hospital association's figures.

The association's figures show that the number of psychiatric beds in California has plunged by 31 percent since 1995.

Part of the reason for the shortage, Kruckenberg said, is that insurance reimbursement rates often fail to cover the full costs of psychiatric care. California hospitals also are subject to costly requirements for earthquake protection and relatively high mandates for nursing coverage, she said.

In a report released earlier this year, the Treatment Advocacy Center, a nonprofit advocacy group for mentally ill people and their families, said California has about 17 public psychiatric beds per 100,000 people, and that represents a "severe" shortage.

Georgia Jenkins, whose daughter Jennifer died at Sierra Vista in 2000 at age 16, said her family felt they had no choice but to send her to the hospital when she expressed fear that she might harm herself. "Nobody really gave me an option," Jenkins said.

Records show that the Sierra Vista staff ignored "critical changes" in the teen's condition and failed to keep close watch on her. Jennifer Jenkins tied a sheet around her neck and hanged herself from a doorknob.

"The place is not safe," said Georgia Jenkins, who successfully sued Sierra Vista for wrongful death. "It scares the hell out of me that they are thinking of expanding."

Sierra Vista's new management structure should help iron out problems, Purtell said.

Sierra Vista has added a chief operating officer who will work with Purtell on "implementation of ongoing improvements," her statement said, and a new compliance officer will seek guidance from the state to make sure the hospital meets regulatory standards.
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Social service advocates back Perdue reorganization - Atlanta Journal Constitution

By CRAIG SCHNEIDER - August 27, 2008

Social service advocates on Wednesday praised Gov. Sonny Perdue’s plan to restructure the state’s health and human services superagencies, if only because they say the services couldn’t get much worse.

“There are so many issues with so many of the programs, it can’t help but help,” said Linda Lowe, a consumer health-care advocate.

The plan announced by the governor Tuesday aims to improve services to the most vulnerable Georgians“ the elderly and mentally ill, and abused and neglected children. Some of the agencies responsible for assisting them have been wracked with scandals, lawsuits and federal reviews.

The plan, which requires the Legislature’s approval next year, would separate mental health into its own department, apart from its current umbrella agency of the Department of Human Resources. The plan also would combine under a Department of Health agencies overseeing public health, the regulation of health care providers and the administration of health insurance plans like Medicaid for the poor.

Supporters hope the restructuring also improves the health of Georgians in general. They stressed the desperate need to do so; Georgia routinely ranks among the worst states for obesity, cardiovascular deaths, infectious disease and diabetes.

The agencies slated for change track illnesses, prevent the spread of disease, enable the elderly to live satisfying lives, ensure that restaurant food is safe, and create public health policies.

State Rep. Mark Butler (R-Carrollton), who served on the task force that formed the recommendations, said all citizens benefit when the state takes care of its most vulnerable residents, such as the mentally ill.

“If the state doesn’t take care of these people,” Butler said, “they end up committing crimes, sometimes property damage, sometimes hurting people. They end up in our jails.”

Lowe, a health-care advocate for 30 years, said the state’s Division of Public Health has been neglected as its parent agency, the Department of Human Resources, has focused on the scandals over mental health and children’s welfare.

“Public Health protects us from hazards, whether it’s bioterrorism or infectious disease,” she said. “The general public needs all of that.”

Supporters of the restructuring said, though, that they see numerous hurdles ahead for the plan. Public hearings this fall will precede the filing of legislation in January, Butler said.

Opposition could come from those who see the plan as adding on to government due to the creation of a separate mental health department, Butler said. But he said the structure for a separate mental health agency is largely in place, and that he does not expect the restructuring to cost the state more money.

If anything, Butler expects the restructuring will lend itself to a top-to-bottom review of services, aiming for greater efficiency and cost savings.

While some social service advocates praise the plan, a few have expressed concerns that splitting up various services could hamper communication between agencies and their assistance to people.

The restructuring itself could be rough, Butler said, coming at a time of reduced state money, and could lead to “turf wars” as agencies fight to hold onto their funding.

If the Legislature passes the restructuring bill by the start of the next state fiscal year in July, some changes and funding shifts could begin soon after, Butler said. The entire restructuring of the health and human services could be in place by the middle of 2010, he said.

– Staff writer Andy Miller contributed to this report.
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Jealousy may be murder motive -Raleigh (NC) News & Observer

But defense cites poor mental health

Martha Quillin

RALEIGH - Charles Dickerson didn't want Brenda Fox to marry another man. If he couldn't have her, nobody would.

That's what Wake County Assistant District Attorney Frank Jackson told jurors during opening arguments in Dickerson's first-degree murder trial Wednesday.

Dickerson did explode with anger and beat Fox beyond recognition on Feb. 10, 2006, but his attorney, George Kelly, told the jury it was because Dickerson had suffered a series of psychological blows. Bipolar disorder and borderline mental retardation made him ill-equipped to cope with the strain.

Dickerson's attorneys have acknowledged that he killed Fox, a 42-year-old mother of four who had also taken care of one of Dickerson's sons, Charlie. Fox went to Dickerson's Raleigh home on Feb. 10 to discuss taking custody of the boy. Fox had already told Dickerson she was going to get married the next day.

When Fox didn't return home that evening, her fiance, Tom Kennedy, testified, he and two of her daughters began calling area hospitals to see if Fox had been injured in an accident. Then the two young women went to Dickerson's house.

They found the door locked. When a neighbor told them Dickerson had left earlier in their mother's car, they first feared he had left her bound and possibly injured to prevent her from getting married.

Brenda Fox's two daughters testified about finding their mother's body. Jenny Fox, 24, told the jury she helped her sister reach an unlocked bedroom window and look inside.

Her sister, Jolyn Fox, 20, testified: "It was the worst sight I'd ever seen. I said, 'Jenny, there's a body in there, and I think it's Mom.' "

During jury selection, lawyers had warned that evidence in the case would include a number of grisly crime scene photographs showing large amounts of blood. Wednesday afternoon, the state introduced those pictures along with a 30-minute video of the Pettigrew Street house where the killing took place.

Jurors watched the video in silence except for occasional narration by a Raleigh police officer who was in the courtroom to tell jurors what they were seeing.

They passed photos of Fox's body through the jury box as well, seeing what police encountered in the house: Fox's body, face down on the floor in her own blood, and her battered face when they turned her over.

Dickerson's attorneys had asked visiting Superior Court Judge Orlando Hudson not to allow the photos, saying they would serve no purpose but to inflame. Anticipating they would be allowed, Kelly asked that the jurors also look at what he called the bigger picture of Dickerson's life.

The defense attorney said that life included being raised without a father; losing both his grandparents and then his mother; being unable to step up to the role of a good father to his own two boys because of his mental health problems; losing the family home he had inherited to foreclosure; and then, learning that the woman he loved was going to marry someone else.

The state is seeking the death penalty in the case. The trial is expected to last up to two weeks.

martha.quillin@newsobserver.com or (919) 829-8989 Read more!