Monday, February 28, 2005


All About RSS, XML, and Atom News Feeds


What is headline syndication?

Many web sites and weblogs (blogs) update often with new stories and posts. If you track news from multiple online sources or need to stay informed on specific subjects, it’s a challenge to keep up with all the latest news and most recent updates. More and more content publishers, media outlets, and bloggers are turning to "syndication" -- a way to broadly deliver their headlines and frequently updated web content to news consumers via a standard distribution format (RSS), that can also be used in My Yahoo!.
Syndication describes the process of publishing simultaneously in more than one online location. It’s usually not for distributing full-text articles (though it can be), but often includes the headline and a few lines of text or a short summary of the article. On My Yahoo!, the headline links back to the complete article or blog post on the publisher’s web site.


What is RSS?

RSS stands for "Really Simple Syndication." It’s a format that web sites and blogs can use to send updated headlines to you via services like My Yahoo!. My Yahoo! gathers the content you select from a variety of sources and displays it for you in one convenient location. Syndication means you don't have to visit each site individually to see what's new -- you simply scan headlines or brief article summaries and click to read the full text. That’s the "really simple" part. And it’s "really simple" for publishers to make their content accessible this way too.
Because RSS is a relatively new format, not all sites currently syndicate their content in this way. However, many notable sites already do offer RSS, and every day the RSS offering grows. For example, news sites such as the Christian Science Monitor, the BBC, and CNet's use RSS to syndicate news headlines and summaries. Other sites use RSS to alert customers of new products or upcoming events.


What are the benefits of using receiving syndicated headlines via RSS?

There are many benefits to accessing headlines and information this way:

Efficiency -- timely news and information is automatically there when you need it;
Breadth -- headlines from the web sources you care about are consolidated;
Organization -- sources can be displayed in order of importance with the latest news on top;
Productivity -- email newsletter subscriptions and unruly bookmarks can lead to clutter and information overload.
Ultimately, you save time while consuming more information. Instead of browsing multiple sites to find information of interest, syndicated headlines are delivered directly to your My Yahoo! page. And they are consolidated in a way that's easy to scan periodically throughout the day. When a headline interests you, just click and go directly to the source.


How can I use RSS?

Typically, people use RSS to:
Gather, read, or quickly scan frequently updated headlines from a variety of sources using a "News Aggregator" or "Newsreader" program.
Incorporate syndicated headlines into their personal weblogs (often called "blogs") as a way to display information from different publishers.
Blogs are web pages which typically consist of timestamped, frequently updated links to news items and web sites. Blogging has developed into an online publishing tool used for many purposes: traditional journalism, personal diaries, collaborative journals, digital note-taking, topical group discussion forums, and hybrid combinations.


How can I use RSS on My Yahoo!?

Because My Yahoo! now supports the RSS format, you don't actually "use" RSS to benefit from it. My Yahoo! uses RSS to pull headlines and summaries from your favorite web sites and blogs. All you have to do is specify which sites you'd like to see added to your personal My Yahoo! page -- we'll take it from there.


How do I add the RSS Module to My Yahoo!?

Adding the RSS Headlines beta module is easy. Just click to add the module and follow the instructions on the page. If you don't currently have a My Yahoo! page, you can sign up here. Just choose where to display the module on your page and you've got an RSS newsreader in just a few simple clicks.


How do I know if a site supports RSS?

Any site that supports RSS can be added to My Yahoo!. Look for a small white-on-orange rectangular "XML" -- that indicates a link to an RSS file. If your favorite site doesn't yet support RSS, you can email them to request support of RSS.


Is My Yahoo! becoming a Newsreader?

Yes. A newsreader (sometimes called a news aggregator) is software that periodically polls a specified set of web sites or blogs, pulls the latest headlines, and displays them on a single page. It works a lot like My Yahoo! in gathering together content from all across Yahoo!.
With this beta release of the RSS Headlines module, My Yahoo! becomes a web-based newsreader that can display your choice of syndicated RSS feeds from tens of thousands of sources around the Web. But this is just the beginning. Your feedback on this beta release can help us improve and refine this exciting new tool. Our goal is to make it easy for all Yahoo! members to find and add RSS feeds to My Yahoo!.


What are the benefits of using My Yahoo! as my newsreader?

In addition to the benefits of headline syndication, you can customize My Yahoo! to create your own individual Internet start page. RSS headlines coupled with My Yahoo!'s 100+ customized modules and frequently used services -- such as email, maps, stock quotes, etc -- work in tandem to help you find, organize, and share information on the Web.
My Yahoo! is easy to set up quickly. You choose the page layout, pick a color or pre-built theme, and then select the content modules to add. If you've already set up your own My Yahoo! page, you can easily add another page dedicated to RSS Headlines.


How do I add syndicated headlines to my RSS module?

We've tried to make it easy, but remember this is just a beta release -- think of it as a test of how RSS might work in My Yahoo! in the future. Once you've added the RSS module, start by simply clicking the “Edit” button in the upper right-hand corner. You now have a couple of options for adding sources.
First, you can search for by keyword (ie. "England") or for the specific source or site you want to add. My Yahoo! will attempt to automatically discover the corresponding RSS URL. If the site is known, just click the "Add" checkbox.
For example, if you want to add top stories from BBC simply type "BBC" and My Yahoo! will find for the corresponding RSS URL.
This works for blogs too. For example, to add Mercury News columnist Dan Gillmor's blog, enter the URL, and My Yahoo! will find and add the RSS file.
Alternatively, if you know the specific RSS URL for the source you want, just type or paste it and click the "Add" button. Like most newsreaders available today, this is the primary way to add RSS headlines, but it means you need to know the specific URL of the source.


How do I find the URL for a site's RSS file/feed?

The little white-in-orange "XML" button () indicates that a web site supports RSS. It usually points to the site's RSS file. If you click the button, don't worry about the text in your browser -- all you need is the URL in the browser's web address bar.
To add the RSS feed to My Yahoo!, simply right click on the orange XML button to "Copy Shortcut." Go to My Yahoo!'s RSS edit page and paste ("Ctrl V") it into the "Add URL" box.


Can I import a list of sources?

If you've already set up another newsreader but want to try the My Yahoo! module, you can import the list of sites you already subscribe to. Many news readers have an export function that outputs in OPML, another format for file sharing.

If this feature is available, export and save your sources as an OPML file. Then from the RSS Edit Page click on "Advanced Import Option" in the "Add New Sources" box. Browse your local drive for the OPML file, click "OK," then click "Import." Once the OPML file is imported, your RSS Headlines module is instantly populated with your sources.
Tip: Have any friends who are into reading blogs? Chances are they use a newsreader to scan for updates. Ask them to email you the OPML file with favorite syndicated sites -- it's a great way to get started quickly.


I'm interested in adding content about a specific topic to my page, but only found a few search results. There must be more out there, why are there so few choices?

As part of making it easy to find and add RSS headlines to My Yahoo!, we are building an RSS directory. To date, this directory includes thousands of the most popular blogs and web sites that publish RSS feeds, but it is by no means exhaustive. This is where we need your help during the beta period.
Any valid RSS file can be added to My Yahoo!, whether it exists in the Yahoo! directory or not -- if you know the URL, you can add it. Once it is added to your page, the URL is also added to the directory for others to discover via search results. Ultimately, you help make the My Yahoo! directory better by finding and adding feeds we don't already know about.


How else can I discover RSS?

You are welcome to start with the Yahoo! Directory or search for RSS. You'll quickly discover there are several RSS directories on the Web today that are very helpful. Here are some of the better-known resources for finding RSS feeds:


What happens if I try to add an RSS URL that is behind a firewall?

Because the Yahoo! Feedseeker only has access to publicly available RSS files, My Yahoo! will not be able to pull syndicated feeds hosted behind firewalls. For example, if you subscribe to an internal company newsletter that is syndicated via RSS, you will not be able to read it via My Yahoo!


How do I learn more about RSS?

There's lots of information on the Web about RSS. Depending on what you're looking for, try starting here:
For non-technical people new to RSS, check out:

For experienced Internet users, check out the resources here:

For the web developer crowd, check out:

For a more technical introduction, check out:

Saturday, February 26, 2005


TAC Newsletter 2/25/05


Visit our web site
February 25, 2005




3. A DANGER ON THE STREETS - Chicago Tribune, January 4, 2005

4. VIOLENT END FOR MAN WHO SAW ANGELS - The Vancouver Columbian, December 29, 2004

5. A VARIETY OF PROBLEMS CROP UP AT THE MISSION - Herdersonville Times News, February 13, 2005


LOS ANGELES TIMES, February 16, 2005

[Editor's Note: The stories below are filled with Red Flags missed or ignored - signs that the symptomatic condition of a person with a mental illness has placed him or others at risk. Two such warnings concerning Juan Alverez:

"Juan Alvarez repeatedly refused to see a doctor. Carmelita Alvarez said she eventually requested a judge's order against her husband last year because he was mentally unstable and she didn't want him near their two children, ages 3 and 7."

"His behavior became so strange [his family] called police twice. Each time, police did nothing because Alvarez didn't seem to pose an imminent threat to himself or to others, the relatives said."]


Attorney For The Suspect In Metrolink Derailment That Killed 11, Hurt 180 Says The Case Is About Justice, Not Vengeance.

By Caitlin Liu, Times Staff Writer

Juan Manuel Alvarez, the construction worker whose suicide attempt last month allegedly caused a fiery Metrolink crash and killed 11 people, pleaded not guilty Tuesday to first-degree murder and arson.

Prosecutors have not yet decided whether they will seek the death penalty against him. Alvarez, 25, allegedly parked his Jeep Grand Cherokee on railroad tracks in Glendale on Jan. 26, hoping that a train would kill him, but he ran away when he changed his mind.

"The train, the car, actually some of the victims were burned," said Deputy Dist. Atty. Pat Dixon, explaining the arson charge that prosecutors added Tuesday after scientists corroborated evidence from the scene.

Alvarez's attorney, Eric Case, said the defendant tried to set himself on fire shortly before the crash and remains on suicide watch in jail.

"He expressed a great deal of remorse and sorrow for the damages caused by his actions," Case said.

The attorney cautioned the public against a "lynch mob mentality."

"When something like this happens and a large number of people are injured . we rise up as a society and we want an eye for an eye, but that's not what America is all about," Case said. "This case is going to be about whether we're a society dedicated to vengeance or a society dedicated to justice. What will be the justice for Juan Alvarez?"

In an interview foreshadowing strategies for the defense, Case said Alvarez suffers from an undiagnosed mental illness, possibly schizophrenia.

"I'm not sure this case will end up going to trial," Case said. "It is not a matter of whether he did it or not. This case is not a whodunit."

Alvarez admits driving onto the tracks and then leaving his SUV behind, Case said. The question is his culpability, the lawyer said.

In an interview inside Case's Studio City law office Tuesday, members of Alvarez's family said he had shown signs of mental illness since he was a boy.

The first time he tried to kill himself - as far as his family could tell - he was 9. He stood in the middle of a street, hoping a bus would hit him. But his grandmother whisked him away. Later, the boy began complaining that an "evil ghost" named Arid lived in his bedroom, said his cousin, Beto Alvarez.

As an adult, Juan Alvarez fell into a depression about a year ago, after a wrist injury made him unable to find work in construction and provide for his family, said his estranged wife, Carmelita.

He underwent surgery that left a metal pin in his wrist. But when removal of the pin was delayed because of insurance problems, he yanked it out himself, Carmelita Alvarez said.

Last year, she caught him using drugs at their Compton home, and he began to hallucinate and show paranoia.

"Out the blue, he would say, 'Why are people following me?' " Beto Alvarez recalled.

Juan Alvarez repeatedly refused to see a doctor. Carmelita Alvarez said she eventually requested a judge's order against her husband last year because he was mentally unstable and she didn't want him near their two children, ages 3 and 7.

Still, she said, she would be willing to reconcile with him if he "got help." The children don't know what really happened to their father, she said. When they ask, she tells them he's at work or so ill that he's in a hospital.

After the couple separated, Juan Alvarez moved in with relatives in Monterey Park. But his behavior became so strange they called police twice. Each time, police did nothing because Alvarez didn't seem to pose an imminent threat to himself or to others, the relatives said.

A few days before the Metrolink crash, Beto Alvarez lined up a construction job in Pasadena for Juan Alvarez, who was living in the Glendale area.

The night before, Juan Alvarez called Beto Alvarez, asking about his family, and then said he had to get off the phone because he had to work the next day.

On the morning of Jan. 26, Juan Alvarez left for his Pasadena construction the job but returned home to retrieve some tools, Beto Alvarez said his cousin later told him from jail. When Juan Alvarez drove onto the Glendale tracks, he was on his way to work.

Later that same day, Alvarez left his cousin a cellphone message. "He said he loved his wife and his children," Beto Alvarez said.

" 'A lot of innocent people got hurt,' " he said, quoting his cousin's message. " 'I don't know how this happened. Please pray for me. I don't deserve to live.' "


MUNCIE STAR PRESS (IN), January 1, 2005

[Editor's Note: After years of consistent psychiatric treatment for paranoid schizophrenia, the precarious situation in which Ronald Hatfield was placed on release from prison:

"When he got out, he had nothing.The only thing they did for him was set up an appointment with Comprehensive Mental Health Services. That was like a pre-appointment. He didn't see a doctor or anything until three or four weeks later."]


By Seth Slabaugh

MUNCIE - Ronald Hatfield began drinking beer to cope with mental illness after his anti-psychotic medicine was taken away from him, according to relatives.

That was a dangerous idea, psychiatrists say.

Last month, Hatfield - a 45-year-old convicted bandit who had spent 17 years in prison before being released last summer - allegedly shot and killed Ricker's convenience-store clerk Carolyn Goodwin during a robbery.

While police Chief Joe Winkle has called the murder of Goodwin an evil, unprovoked attack, relatives of Hatfield are offering an alternative explanation for the slaying.

For the last 12 years of his prison term, Hatfield was being treated with seven medications for illness including paranoid schizophrenia, his mother and other kin say.

"In prison, Ronnie was on Haldol, Trileptal and other medicine," said his sister, Deborah Mackey, a licensed practical nurse with whom Hatfield lived since August, when he was paroled.

Mackey's house is just 2 1/2 blocks from the convenience store where Hatfield allegedly killed the 59-year-old Goodwin, a shy, petite person devoted to caring for her ailing mother.

"When he got out, he had nothing," Mackey said. "The only thing they did for him was set up an appointment with Comprehensive Mental Health Services. That was like a pre-appointment. He didn't see a doctor or anything until three or four weeks later. When he did see a doctor, they tried to give him samples of medicine like Lexapro (an anti-depressant), which wasn't doing anything."

Eventually, said Mackey, "they did call him in all those prescriptions he had been on in prison, but he had no money to go get them, and we couldn't afford to buy it for him, either." She said: "Before they released him, they said they would have his disability and Medicaid set up so he would not have to worry about money and getting his medication. But then they denied his disability and never made a ruling on his Medicaid."

Hatfield was paroled in August after serving 17 years in prison for armed robbery of a liquor store, assaulting police, and weapons offenses.

During the two months before Hatfield allegedly shot Goodwin, his behavior changed, Mackey said. He couldn't sleep, and he began "talking crazy, like he was going to go get a gun and shoot the cops who put him in jail," she said.

"He spent the last couple of months drinking a lot," Mackey said. "I figured he might get in a bar fight."

Haldol is a fairly potent anti-psychotic medication, according to Philip Coons, professor emeritus of psychiatry at the Indiana University School of Medicine. Trileptal is an anti-seizure medication also used to treat psychoses.

"For people who are schizophrenic or bipolar, the chances of acting out violently aren't any more probable than somebody in the general population," Coons said. "However, if you are schizophrenic or bipolar and you also abuse alcohol or drugs, the probability of violence is higher."

On the advice of Delaware County Prosecutor Richard Reed, Muncie police have stopped commenting on their investigation of the robbery-homicide. Reed also declined comment when asked about suspicions from Hatfield's relatives that he was "on something" at the time of the Ricker's robbery. Hatfield is also a suspect in the armed robbery of a Village Pantry 17 hours before the Ricker's holdup.

According to Paul Appelbaum, chair of psychiatry at the University of Massachusetts Medical School in Worcester, when a patient stops taking medication like Haldol, over time there may be a relapse of the patient's condition and a return of his psychotic symptoms.

However, that doesn't turn the person into a ticking time bomb ready to explode in violence, Appelbaum says.

The largest study ever done on the subject, he says, showed that people with mental illness who do not abuse substances are no more likely than their non-mentally ill neighbors to be violent.

Even paranoid thoughts and most hallucinatory commands are not linked to violence, Appelbaum says.

"But rates of violence increase in mentally ill and non-mentally ill people when substances are abused, including alcohol," he said in an interview. "And they increase more among people with mental disorders. There seems to be some sort of interaction between the disorder and the alcohol or other substance that increases the rate of violence."

Stephen Marder, a professor of psychiatry at the David Geffen School of Medicine at UCLA, said: "It's hard to understand why someone with a clear record of diagnosis of schizophrenia who's stable on anti-psychotic medication and with a violent history, it's hard to understand why the medicine would be stopped, but I don't know anything about those circumstances."

Hatfield's mother, sister and other relatives believe Goodwin would be alive today if he had continued to take anti-psychotic medicine after his release from prison. They are seeking an investigation of the Indiana Department of Correction, including its parole services division - not to excuse Hatfield's alleged crime but to prevent something similar from happening to someone else. Some of the relatives say if Hatfield's parole officer had been doing her job, Hatfield would have been sent back to prison for substance abuse.

DOC official Pam Pattison has said the agency can't discuss Hatfield's medical condition or medical records while he was in prison or on parole without his written permission.

In a recent e-mail message to The Star Press, Hatfield's mother, Joann Forgason, wrote: "Ronnie called last night and said they had finally given him three or four of his meds. He sounded like the old Ronnie. I told him he needed to sign a release so his medical records could be seen and he said no problem."


CHICAGO TRIBUNE, January 4, 2005

[Editor's Note: Unambiguous evidence that Donald Cook needs and has long needed sustained and intensive treatment:

"Since 1990, the 47-year-old Chicago man, diagnosed with paranoid schizophrenia, has been charged with attacking 14 people."

"Cook has been arrested 29 times, mostly for battery, trespass and disorderly conduct."]



Does Donald Cook have to kill somebody to get taken off the streets? It certainly looks that way. Since 1990, the 47-year-old Chicago man, diagnosed with paranoid schizophrenia, has been charged with attacking 14 people. Four of those alleged attacks occurred just in the last year. Yet, over and over, he's been allowed to remain at large, exasperating the people who say he victimized them and creating a hazard to anyone unlucky enough to cross his path.

His case is a vivid illustration of the need for a more comprehensive and vigorous approach to low-level repeat violent offenders, and to potentially dangerous mentally ill patients who persistently fail to take their medication.

As Tribune reporter Carlos Sadovi recently documented, this is a chronicle of failures on the part of the people who are supposed to protect the public. Cook has been arrested 29 times, mostly for battery, trespass and disorderly conduct, and in 2004, he spent 33 days in Cook County Jail. On two occasions, he was convicted. But charges have repeatedly been dropped after he failed to appear in court.

In such instances, prosecutors are free to have him rearrested so he can face justice--but that has yet to happen. He has also been institutionalized at least 17 times and treated with medication, only to stop taking it upon his release.

One of his victims, Diane Vonneedo, was directing traffic on Aug. 11, 1998, when he approached her and punched her in the face, smashing the bone around her eye and endangering her eyesight. But he was found not guilty by reason of insanity. She occasionally sees him even now and radios her colleagues when he's headed in their direction. "I know when he takes his medication," she told Sadovi. "When he doesn't, he has that death stare."

In 2001, Cook, wearing a Superman costume, groped a woman. At that point, a Cook County psychologist evaluated him and concluded that he should not be allowed on the streets, noting that he was "delusional" and "irritable" and that the "defendant is considered a danger to others and subject to involuntary admission in a secure psychiatric facility."

There are three obvious ways to remove the danger Cook presents. The first, and most desirable, is for him to get adequate care to make sure he takes his medication and learns to function in society. The second is for him to be involuntarily committed and treated, which is unlikely due to the shortage of space in mental institutions. The third is for prosecutors to devote the time and energy needed to hold him responsible for the crimes he's charged with and to do what they can to keep him behind bars.

Offenders like Cook tend to fall through the cracks of the criminal justice system because their crimes, though violent, are comparatively minor. So going to a lot of trouble to put him in jail may seem like an unwise use of public resources.

But it's hard to escape the suspicion that, sooner or later, Cook is going to get locked up for a long time. The question is: Will it be before he commits a truly awful crime--or after?



[Editor's Note: And Michael Colvin's well-established need for care as well as the numerous opportunities to provide it:

"My approach was to tell the jury, 'Michael is mentally ill, but he isn't dangerous, and he does have a plan,' she said. She prevailed at trial. Colvin was released on Nov. 22, 2003."

"Michael Colvin lived at Skamania Cove Resort for about five months. The sheriff's office was aware of his mental illness as a result of three contacts with him before the Nov. 12 shooting."]


Colvin Shooting Highlights Problems With Justice System

On Nov. 5, a week before the shooting, Colvin called 911 and told the dispatcher he had killed someone several months earlier. A sheriff's deputy took him into custody but released him after a mental health evaluation.

By Kathie Durbin of The Columbian

USA - Michael E. Colvin's odyssey through the criminal justice system began in California's Humboldt County, where in 1998 he stole a sandwich from another jail inmate and struck a guard.

It ended in November at a Stevenson-area trailer park, after he attacked two neighbors without apparent provocation and was shot and killed by a Skamania County sheriff's deputy after brandishing a knife.

In between, Colvin spent a year in California's Folsom State Prison and three years at Atascadero State Hospital, a secure facility for the criminally insane. He was released in late 2003. His uncle, aunt and half-brother, who live in Carson, took him in when no one else would.

Colvin was 40 when he died. He was a big man who stood 6 feet 1 inch and weighed 270 pounds. He was also a paranoid schizophrenic, a mental illness characterized by delusions, hallucinations and flashes of anger that can escalate to violence.

When he wasn't taking his medication, he saw angels.

Last summer, his relatives moved him into a trailer house at Skamania Cove Resort with a sweeping view of the Columbia River. There he had a taste of freedom after four years behind bars. He swam in the Columbia River and listened to music. His neighbors brought him plates of food. They knew he wasn't quite right in the head. But until the night of Nov. 12, they didn't consider him dangerous.

"He was a really good friend," said Jeffrey Vandermoss, who lived next door to Colvin. "I also worried about him. I don't think he should have been there. He'd make people a little on edge. He'd say, 'There are too many of those darn angels around.'"

Colvin's troubled life and violent death are all too common in the world of the severely mentally ill, experts say. The criminal justice system is poorly equipped to deal with their condition. Most police officers aren't trained to handle crises involving the mentally ill. Most jails aren't staffed to deal with them. Prisons and hospitals for the criminally insane remove them from society, but the court system, with prosecutors on one side and defense lawyers on the other, doesn't always consider what's in their best interest. And support services often aren't available when they are released.

Even when treatment is available, the severely mentally ill people like Michael Colvin may resist it and self-medicate with drugs or alcohol instead.

"If someone is severely mentally ill, just getting them to go to an appointment is difficult," said Mike Piper, director of the Clark County Department of Community Services.

A recent spate of violent incidents involving the mentally ill has drawn attention to the problem. On Dec. 23, 41-year-old Michael Egan was shot and killed by a man he slapped outside the downtown Portland Meier & Frank department store. Police had recently tried to have Egan committed to a hospital because of his mental illness.

On Nov. 26, Shane Cole, previously diagnosed as a paranoid schizophrenic, allegedly stabbed a neighbor to death with a kitchen knife without provocation in downtown Vancouver. His relatives said they had tried without success to get him into a residential treatment program.

Similar factors played out in Michael Colvin's life.

David Colvin, his half-brother, said Michael had visited a mental health clinic in Stevenson a few times and was taking a prescription drug to control his schizophrenia. But he said Michael took the drug only "off and on." He also managed to buy beer despite the family's attempts to keep him away from alcohol.

"He'd take the meds when I told him to take them," David Colvin said. "It was hard. He was scared. He'd have really good days when you could hardly even tell. He'd have other days when he would hear voices and have problems."

A Stolen Sandwich

Colvin's schizophrenia was diagnosed when he was a teenager. He lived for a time in Garberville, on California's north coast, and worked in the woods. Beginning in the late 1980s he was arrested a number of times for driving offenses. In 1998, he pleaded guilty to driving under the influence of alcohol, according to Blair Angus, an attorney for the Humboldt County public defender. Angus represented Colvin in court proceedings that won his release from a state mental hospital in 2003.

"The alleged incident occurred because Michael took a sandwich from a fellow inmate," Angus said. "He wanted to eat the sandwich. He was hungry. It was alleged he was surrounded by some number of corrections officers. He felt threatened. It was alleged he punched one of the officers."

Colvin pleaded guilty to battery of a custodial officer, a felony, in March 1999. He spent a year at Folsom State Prison. Then, in November 2000, he was committed to Atascadero State Prison for three years.

In October 2003 he was returned to the jurisdiction of Humboldt County Superior Court. But District Attorney Paul Gallegos petitioned the court to extend his commitment. He cited an assessment that Colvin's "severe mental disorder is not or cannot be kept in remission" if he did not remain in treatment. He said Colvin represented "a substantial danger of physical harm to others."

Angus argued against his continued incarceration. In an interview, she said she never feared Colvin and was so confident of his ability to defend himself that she asked for a jury trial and called him to testify on his own behalf. The public defender's office bought him shoes to wear for his court appearance.

"My approach was to tell the jury, 'Michael is mentally ill, but he isn't dangerous, and he does have a plan," she said. She prevailed at trial. Colvin was released on Nov. 22, 2003.

Angus said she tried to arrange housing and mental health counseling for her client but could not compel him to get treatment once he was out of the criminal justice system.

"I certainly extended myself on his behalf," she said. "He made his choice."

David Colvin said he had expected Michael would be released to a halfway house. "But they just cut him loose in Humboldt County with no money. All he had was the clothes on his back. He got on a bus and came to Carson."

Relatives Try To Help

In Skamania County, Michael Colvin's relatives tried to provide him with support. "I used to take him grocery shopping," David Colvin said. "I took him to a psychiatrist at a mental health clinic. My aunt and uncle and I would all go by and check on him. We got him the trailer. He was paying us a little every month."

Michael Colvin lived at Skamania Cove Resort for about five months. The sheriff's office was aware of his mental illness as a result of three contacts with him before the Nov. 12 shooting.

On July 13, he called 911 from a pay phone in Stevenson, said he was in danger and asked for a patrol car. That call was logged as a "mental subject."

On Aug. 25, at 1 p.m., his aunt, Alene Bush, reported him missing. According to a police report, she told a dispatcher that he "is schizophrenic and sees angels and things. He is currently not on any medication." She told the dispatcher that the family had been "going through all the channels to get him to see mental health."

At 9 p.m. that day, Luci Ann Vandermoss of Carson called to report that Michael Colvin had stolen her ex-husband Jeffrey's 1981 Chevrolet Blazer. Colvin ran out of gas in Portland. The Multnomah County Sheriff's Office arrested him and recovered the Blazer the following day.

Jeffrey Vandermoss was Colvin's next-door neighbor. They knew each other well. He said Colvin knew the Blazer was leaking oil when he took it without permission. "I think he took it with the intent of going home" to Humboldt County, he said. He added that he bore his neighbor no grudge.

Skamania County Prosecuting Attorney Peter Banks charged Colvin with taking a motor vehicle without permission. He was awaiting trial on the charge at the time of his death.

On Nov. 5, a week before the shooting, Colvin called 911 and told the dispatcher he had killed someone several months earlier. A sheriff's deputy took him into custody but released him after a mental health evaluation. "He wanted help," his uncle, Dean Bush, said. "He needed to take his medication."

On Nov. 12 at 6:30 p.m., Don Atkins, who lived two trailers down from Colvin, called 911 to report that Colvin had slugged him in the face and had beaten up his 22-year-old son, Van, who is deaf.

In an interview at his Skamania Cove trailer house, Atkins recounted the events of that evening. He said Van left to take a shower. Almost immediately, he heard him screaming and stepped outside to see what was going on. "Michael had him down on the ground with a knife," Atkins said. "He was slugging him. I was yelling at him. Then he came after me. He slugged me with both fists. He hit me in the head so hard, I saw stars."

Atkins said he had been on good terms with his neighbor and had never seen that side of him. "I fixed him a plate of food every night. He seemed appreciative."

But that evening, he said, Colvin's eyes were glazed over. He seemed possessed by anger.

Sheriff's Deputy Tim Converse and Reserve Officer Chris Fassel responded to the Atkins' 911 call. Atkins said the officers pleaded with Colvin to drop the knife, but he refused.

"I told him, 'Michael, you need to go in your trailer.' (Michael) said, 'I'm killing them and I'm killing you.' I was dumbfounded, because Michael did not put the knife down."

Converse shot twice, Atkins said. Colvin died at the scene.

It's not known whether Converse was aware of Colvin's mental illness. He was placed on administrative leave pending an investigation by the Regional Major Crimes Team but returned to patrol duties in mid-December.

The investigation was completed in early December. But Prosecuting Attorney Banks has not released the investigative report pending a final medical examiner's report. According to Undersheriff Dave Cox, a delay in getting a toxicology report back from the state medical lab has delayed its release.

New Medications

Alene Bush said she heard a call for emergency medical assistance at Skamania Cove on her police scanner that evening and called dispatchers to find out whether Michael was involved. No one returned her call.

"I was with Michael that day," she said. "I took him grocery shopping. I told him he had $60 to spend. He was in the best mood. I told him to clean up his trailer. When I left, I said, 'I love you,' and he said, 'I love you, Aunt Al.'"

Michael was on a new medication, and she wonders whether it triggered the attack. "I never saw that side of Michael, she said. "I never saw him violent."

It's also possible that Colvin had been drinking. Atkins said he had seen him carrying beer to his trailer the day before he died, though his relatives had asked residents of the trailer court not to buy him beer.

Dean Bush said he had plans for his nephew. "I had him working on my property. He wasn't retarded. He could do a lot of things."

Family members would like some answers. "I don't want to blame anyone," Alene Bush said. "Maybe Michael was wrong. But it seems like there could have been a better way."

Katherine Plowman of Ashland, Ore., Colvin's former aunt by marriage, said she had felt close to him since she took care of him when he was a child.

"I'm not saying the officer didn't feel afraid," she said. "He may have walked into this blind. But why did they have to kill him?"

Atkins, the neighbor who called police, defended the shooting. "The police were not wrong," he said. "If you have someone charging you with a knife and all you have is a gun, that's what you use. Sure, it would have been nice if they had been able to get the knife away from him. It would have been nice if they could have subdued him some other way."

The Skamania County Sheriff's Office has no Tasers less-lethal weapons that incapacitate suspects using an electrical shock. On Nov. 29, Chief Criminal Deputy Pat Bond asked the Skamania County Board of Commissioners for permission to apply for a $6,500 state grant to buy five Tasers and a training video.

Undersheriff Cox said the grant application had been in the works for two years and was not related to the shooting, adding, "If you can utilize some other form of deterrent to de-escalate a situation, you're going to do that."

Blair Angus, Colvin's attorney, said society has yet to deal with the challenges posed by the Michael Colvins of the world.

"He was lucky. He had people who were trying to do something. But for a mentally ill person to accept treatment is difficult. It takes intensive outreach. It takes money. At this point, we are putting that money into the criminal justice system."



[Editor's Note: Red flags abound at the Hendersonville Rescue Mission.]


Editor's note: The following is a description written by Hendersonville Rescue Mission Program Director Tim Jones of mission residents last summer. The mental health reform, rescue mission officials say, has dumped more homeless people needing psychiatric help into shelters.

Currently on the night of July 22, 2004, 11 of the 25 male residents who stayed here were on medication for mental illness related problems. Four of the 25 male residents had a clinical diagnosis of schizophrenia.

Recent examples of the problem include: The paranoid male resident who thought the police followed him around all day in an airplane watching him. He has a volatile temper. The male resident who had visions of Satan talking to him and sexualized images of the "bride of Christ." He also imagined bugs were constantly crawling on him and spreading throughout the dormitory. He has a violent temper. The male resident who was so disoriented that he took a shower with his shirt on. The male resident who single-handedly solved the Cuban Missile Crisis with the direct approval of the president and also went on many other "top secret missions." The male resident who thought there was a "hired killer" in the dormitory and ran out into the recreation room to escape in his underwear. He was terrified to even go back into the dorm to get his belongings. He also had fits of uncontrollable crying. The male resident who was convinced Satan lived with him and followed him around the streets during the day. The male resident who is convinced that the streets of Hendersonville are soon going to be overflowing with dangerous Iraqi women and children who are being given passports to America to escape the fighting. The male resident who went around making threats to everyone in the third person as he was speaking to an invisible person. The male resident who lost his volatile temper after the suggestion that he needed to resume his medications that God told him to stop taking. The male resident who got up in the middle of the night, stripped naked and started going through everyone's belongings and then went outside and stripped again and started chewing on broken glass. The male resident who is so paranoid that he thinks everyone walking up beside him is about to attack him. The male resident who could not carry on a conversation with staff because of all the voices speaking to him -- staff members were simply interrupting the voices and were very difficult to pay attention to. The male resident who thought he was the victim of a corporate conspiracy by Advance Auto Parts. Many of our male residents believe themselves to be the victim of large conspiracies. The female resident who has attempted suicide before and runs away from the mission and her job any time she thinks someone does not like her. This last time she threatened to get a gun and come back and take care of the person she had a disagreement with. The female resident who keeps 'transforming' into a man and cussing and screaming in a male voice and then going out and jumping the fence. She also says two other women live inside her. The female resident who keeps being chased and abused by people she does not know or cannot even describe. The female resident who was afraid of leaving her car during the day. The female resident who got up in the middle of the night, stripped naked and began rubbing on other female residents. The female resident who hears voices from God and then loses her temper over nothing and does "bad things." The child resident who became so agitated and violent with his mother that the police had to have him removed to take him to the hospital to have his medications adjusted.

These are only recent examples. There are also many, many borderline cases.


Treatment Advocacy Center E-NEWS is a publication of the Treatment Advocacy Center.

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The Center does not accept donations from pharmaceutical companies. Support from individuals who share our mission, however, is essential to our ability to effectively help our most vulnerable citizens. The Treatment Advocacy Center is a 501(c)(3) not-for-profit organization. All contributions are tax-deductible to the extent allowed by law. Donations to the Treatment Advocacy Center should be sent to:

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Friday, February 25, 2005


Syliva Plath


by Syliva Plath

Stasis in darkness.
Then the substanceless blue
Pour of tor and distances.
God's lioness,
How one we grow,
Pivot of heels and knees!--The furrow
Splits and passes, sister to
The brown arc
Of the neck I cannot catch,
Berries cast dark
Black sweet blood mouthfuls,
Something else
Hauls me through air----
Thighs, hair;
Flakes from my heels.
Godiva, I unpeel----
Dead hands, dead stringencies.
And now I
Foam to wheat, a glitter of seas.
The child's cry
Melts in the wall.
And I
Am the arrow,
The dew that flies,
Suicidal, at one with the drive
Into the red
Eye, the cauldron of morning.

Saturday, February 12, 2005




Visit our web site
February 11, 2005


1. MORE HOMELESS MENTALLY ILL THAN EXPECTED ACCORDING TO UCSD STUDY - University of California, San Diego News, February 1, 2005

2. LOST ASYLUM - Worcester Magazine, January 20-26, 2005

3. SPOKANE GROUP HOME SHUTTING DOWN - The Spokesman-Review, January 27, 2005

4. SISTER'S HOPE IS HOME - Raleigh News & Observer, January 10, 2005



[Editor's Note: A new study from the School of Medicine of University of California, San Diego (UCSD) gives stark perspective to the inextricable meld between severe psychiatric disorders and homelessness. Many studies have documented the prevalence of people with severe mental illness among those who are homeless; the findings vary somewhat but approximately one-third of those living on our streets are afflicted with mostly treatable psychiatric illnesses.

The USCD researchers took a converse approach, determining the percentage of people with serious mental illness in San Diego County who are without a place to live. They found that 15% are, or about one in seven. Over all, about only one out of every 500 Americans is homeless.]


Interventions Urged

By Sue Pondrom

The prevalence of homelessness in persons with serious mental illness in San Diego County, the nation's sixth largest metropolitan area, is 15 percent - a higher percentage than suggested in previous studies, according to new research by investigators at the UCSD School of Medicine.

Published in the February 2005 issue of the American Journal of Psychiatry, the study noted that homelessness in this population might potentially be reduced or prevented with substance abuse treatment and help in obtaining public-funded health benefits (Medicaid, or MediCal in California). Because homeless mentally ill were more than twice as likely to be hospitalized as non-homeless patients, the investigators said improved care for homeless persons with serious mental illness may be cost effective or at least result in improved patient outcomes with only moderate increases in total costs.

The research was conducted among an ethnically diverse population of 10,340 San Diegans with serious mental illness (both homeless and those with housing) who were treated by San Diego County Adult Mental Health Services (AMHS). While one-fourth to one-third of homeless persons are estimated to have a serious mental illness, this is one of the first studies to document and describe the other side of the picture - the number of mentally ill who are homeless.
"Homelessness is more common in patients with serious mental illness than I would have guessed," said the study's first author, David Folsom, M.D., co-director of the UCSD Combined Family Medicine-Psychiatry Residency Program and the assistant medical director of St. Vincent de Paul Village's Family Health Center, a free medical clinic located in one of San Diego's largest homeless service agencies.

According to the UCSD researchers, homelessness was most frequently associated with people who were diagnosed with schizophrenia or bipolar disorder, who were substance abusers, and who had no public-funded health care. Men were also more likely to be homeless than women, as were African Americans. Latinos and Asian Americans were less likely to be homeless.*

"Homelessness is an increasingly important public health issue, with seriously mentally ill persons most at risk for homelessness," said the study's senior author, Dilip Jeste, M.D., UCSD Estelle and Edgar Levi Chair in Aging, professor of psychiatry and neurosciences, director of the UCSD Sam and Rose Stein Institute for Research on Aging, and a geriatric psychiatrist at the VA San Diego Healthcare System. "In addition to the trauma experienced by these individuals, there is also a cost to society. Homeless persons have a significantly more-frequent use of expensive emergency services** and are more likely to spend more time in jail."

The study noted that in San Diego, African Americans comprise 5 percent of the general population, 11 percent of the AMHS population with serious mental illness, and 16 percent of the homeless patients with serious mental illness treated in AMHS. Latinos contribute 23 percent of the general population, 19 percent of the AMHS patients, and 12 percent of the homeless.

"It is possible that the higher rate of homelessness among African Americans may be in part due to fewer community resources for this group of patients, whereas the larger Latino community may be able to provide more resources to protect against homelessness," the study said. "However, African Americans have been found to be at higher risk of homelessness in other cities with larger African American populations, such as New York and Philadelphia***."

The authors also said that an investigation of homeless persons in Los Angeles, only some of whom had mental illness, found lower rates of homelessness in Caucasians and Latinos than in African Americans.

Noting that treatment for substance abuse has been reported to improve outcomes, the researchers said "access to substance abuse treatment is more difficult for homeless persons with serious mental illness than for other homeless persons. Similarly, patients who did not have MediCal insurance were twice as likely to be homeless as patients with MediCal; homeless persons with psychotic disorders have been reported to have greater difficulty obtaining and maintaining entitlement benefits than non-psychotic homeless persons."

The authors concluded that "although it would be naïve to assume that treatment for substance use disorders and provision of MediCal insurance could solve the problem of homelessness among persons with serious mental illness, further research is warranted to test the effect of interventions designed to treat dually diagnosed patients and to assist homeless persons with SMI obtain and maintain entitlement benefits."

The study was funded by the National Institute of Mental Health and by the Department of Veterans Affairs. Additional authors were William Hawthorne, Ph.D., Laurie Lindamer, Ph.D., Todd Gilmer, Ph.D., Anne Bailey, M.S., Shahrokh Golshan, Ph.D., Piedad Garcia, Ed.D., Jurgen Unutzer, M.D., and Richard Hough, Ph.D.


WORCESTER MAGAZINE (MA), January 20-26, 2005

[Editor's Note: One major contributor to the ranks of people with severe mental illness among the homeless is a lack of sufficient inpatient facilities to provide treatment, support, and an avenue to recovery. We hope not, but chances are that some Worcester State Hospital patients may soon be living in shelters and lining up at food kitchens.]


More Mentally Ill Patients Will Face Life on the Outside When State Replaces Worcester State Hospital

By Charlene Arsenault

In the sticky-hot summer of 1989, Rick LaFortune decided he was the Messiah. As Jesus, he descended on a park in downtown Leominster, where, to begin saving the world, he stripped naked and folded his clothes neatly in a pile. The police grabbed him, throwing him into a blanket and a cell, in that order.

LaFortune had been coaching at the Special Olympics and was getting sloppy about the small dose of medication he was supposed to take. Over the years, that formula -- stress and med changes -- preceded many of his breakdowns, beginning in 1968, when he was 16 and a high school student in Fitchburg.

He doesn't elaborate on what precipitated that first episode (sometimes he does elaborate, sometimes he veers off the question), but just says he wasn't adjusting well in school. He was institutionalized in Jamaica Plain, where they diagnosed him as paranoid schizophrenic. "I wound up in a hospital that was, quite frankly, brutal," says LaFortune. "It was something that made One Flew Over the Cuckoo's Nest look like a picnic. And I got electric shock treatments there. I was terrified."

After landing in facilities every few years or so, including Worcester State and Gardner State hospitals, he knows what makes for a good hospital. He speaks highly of both and attributes much of his wellness to the staff there; to him, state hospital care beats private hospital care hands down.

LaFortune is now one of the de-institutionalized. It's been seven years now since he was committed to a hospital. He lives by himself in a subsidized apartment in Fitchburg, one of many countless mentally ill people who cope in the community.
He is luckier than a lot. He's had a family structure to assist him in getting the right help when he was going off the deep end. He's also found the right programs, had caseworkers to negotiate his insurance (now Mass. Health) and psychologists to tinker with his meds. Not everyone has that, argue advocates for the mentally ill, a situation which indirectly contributes to the homeless and jail population.

LaFortune credits state facilities like Worcester State Hospital for helping him. He liked the care. He liked the structure and familiarity. It provides a sense of security that can't be felt elsewhere, especially to the mentally ill.

"There is a part of the population, myself included," says LaFortune, "that when I become very sick or very manic and psychotic, I need a safe place to be and for me that is usually a locked unit where they can be forceful with me, but in a gentle way. You need a place like Worcester State for that. You need a place where people can be safe and you need a place where they can get tough love. One of the biggest things Worcester State did for me was give me discipline. There are two or three people I know who are still at the state hospital who've told me that they would rather live there than in the general community because people accept them there."

Gov. Mitt Romney's administration has been hot to shut Worcester State down practically from the day he took office. (The facility, which houses 156 inpatient beds, was built in 1833 and celebrated its anniversary yesterday.) In his very first February budget speech, Romney unveiled a plan to close Worcester State Hospital and wipe its $24 million budget off the books. There was an immediate backlash from advocates for the mentally ill.

"He wanted to take all the people and move them out here, there and everywhere," says state Sen. Harriette Chandler (D-Worcester), who battled the closing. "The largest number would have gone into community services. There was no question in anybody's mind that there weren't appropriate services. There wasn't careful thought given to what the whole movement meant. It sounds good on paper, but these are human beings who are very sick people."

The fear is that when institutions close, the needy are cast to community services that can't take care of them. "We just don't do a good job," says James McDonald, longtime advocate for the mentally ill and vice president of the Central Alliance for the Mentally Ill (part of NAMI). "In the hospital, you have nurses, you have doctors, you have your meals served and social workers. You must have the same thing in the community. We don't have that. We did at one time. We did have enough case managers. We did have enough apartments, but there are more and more people. You're almost unable to get into the services of the DMH unless you're very seriously ill."

Once Romney announced his intentions to close Worcester State, the Legislature responded quickly, requiring a study from the state Department of mental Health to justify closing the hospital. DMH Commissioner Elizabeth Childs expanded the study to examine the entire department and its inpatient capacity needs. A year later, rumors flew that the Romney administration was looking to shut down Worcester State Hospital as well as Westboro State Hospital to make room for a new hospital, reducing the total number of beds and placing discharged patients in community facilities and treatment.

The administration says shutting the two suffering hospitals would streamline the budget. We'd get a nice, new, state-of-the-art-facility, but one that would leave fewer beds for the mentally ill in the state. The money saved could be pumped into the community to buffer the wave of de-institutionalization that has already begun and would have to continue.
Much like what occurred in the '80s when then-Gov. Michael Dukakis instigated de-institutionalization, 268 of the 900 mental health patients in the state will be discharged this year. The Department of Mental Health thinks it's a great idea. You get a different view when you talk to people who care for the mentally ill.

After two date extensions, in March, 2004, the DMH delivered that feasibility study that was demanded of them in March. It favored the idea of building the new hospital and recommended "community placements of 268 adult continuing care inpatient clients who are ready to leave." It was critical of the efficiency of both the Worcester and Westboro facilities, too, pointing out ancient heating systems, lack of cooling systems and old electrical units. It estimates that $59 million in capital costs would be needed to keep both facilities in operation over the next 10 years. "Existing facilities at either Worcester State Hospital or Westboro State Hospital do not provide a sound option for consolidated impatient capacity in Central Massachusetts over the long term," reads the report.

According to Lester Blumberg, DMH's chief of staff, "The existing infrastructures at either Worcester or Westboro are insufficient to sustain a capacity of 270 beds, which is the number we have estimated we need for the Central Massachusetts facility. Not only is the physical plan inadequate, but we have learned so much more about the environment of care in the decades since these buildings were built. They are institutional in look and feel and they therefore promote institutionalization."

A commission of 15 people, chosen to study Romney's plan, met for the first time on Monday, Jan. 10, when it was announced that the state Designer Selection Board brought on Ellenzweig Associates Inc. to study where -- and how -- to build the new 320-bed hospital. The plan for a new facility has real momentum.

In the meantime, the discharges have already started to occur. A MHW (mental health worker) at Westboro State Hospital, speaking on the condition of anonymity, says they've already felt the movement. "I talked to my supervisor about this," he says, "and she said that although it may mean that some people may lose their jobs, she thinks it'll be beneficial for the patients because the conditions at the hospitals are deplorable."

The discharge rate, he explains, seems to have sped up so much that the units are getting cleaned out far earlier than they used to be. "In the past, we'd get residents from the locked units and then put them into residential settings," he says. "They had much more time to follow their treatment plan and cope with their problems. They're now sending people through so fast that they're not confident in these [residential] houses. I think in the long run, the patients are going to suffer in a sense that they have deadlines to meet. They'll get into the community when they're not ready to go into the community, and end up homeless."

Blumberg argues that no one is left behind, and references as an example the closing of Medfield State Hospital, where of the 255 patients discharged, only 7% have required hospitalization again. The DMH's discharge plan, he says, is being timed to allow for development of these services to support those clients.
"Each person who is discharged has an individually developed community treatment plan that is designed to meet their needs," says Blumberg. "We are enhancing existing community residential services to provide these individuals with the support they need. For the most part, they are moving into existing residential settings that have vacancies created by other clients who are ready to move through the continuum of care to less-intensive services." He points toward visiting nurse services, supported living services (where staff visits the home), day treatment and clubhouses.

"I feel that it would be a good idea to build a new hospital," says an RN who currently works at Worcester State Hospital. "Both buildings are quite old and do need to be updated, so a new hospital would be in the best interests of the patients."

Yet among advocates, the fear is that in its rush to complete the project, the DMH and the Romney administration is failing to grasp the depths of care that some mentally ill people need. Jo Masserelli, who directs a training project to teach human service workers in conjunction with Catholic Charities and also offers a few beds to those in need, says, "I would say people need more than just programs. They need more than just service involvement. Another presumption is that just because a human service exists that it takes care of everything. I think families need some assistance to become competent to help other family members. I think there are a lot of troubled people. Mental health services can address some of those troubles, but certainly not all. I would say I'm highly in favor of a responsive and well-done de-institutionalization, and that's been the bulk of my work."

"I know that the patients being discharged are ready from what I see," says the Worcester State RN. "They're ready to go into the community. But to some, [the hospital] is almost like a home."

Phil Hadley, president of the National Association of the Mentally Ill/Massachusetts chapter, staunchly maintains improvements need to be made before de-institutionalization is even considered. There are 3,000 families among NAMI members who are affected by mental illness and he says they struggle with a large degree of stigma and inability to get proper help. "They limit people from 10 to 14 days and they're not much better than when they went in," says Hadley. "There is no follow-up after they get out of the hospital. When the patient is in the hospital and is seen by a psychiatrist and then when they're discharged, if they have a psychiatrist on the outside -- that's important. There is no communication between the in-house doctor and out-house doctor. They don't talk. It's very frustrating. Unless they have a person who is an advocate for them, by nature of the disease, these people aren't thinking correctly and they need an advocate. They don't know what to do. They end up on the street."

Chandler walked away from that first commission meeting last Monday with a positive vibe, but with many questions, including not only where the money will come from to build it, but the issue of siting, which Chandler and others say will prove to be one of the hot buttons. NIMBY (not in my backyard) always plays a part in such moves.

"I've been led to believe by Commissioner Childs, who is a psychiatrist who researched this carefully, that what she is talking about constructing is a state-of-the-art building that will use the synergy of our neighboring institutions, like UMass or Tufts Veterinary School," says Chandler. "We have a lot of things going on, but we can't close it down in sort of a thoughtless manner as we did 10 years ago."

State Rep. James Leary (D-Worcester), also on the commission, says, "I'm cautiously optimistic that we'll get a consensus on this. I think there are two major issues -- one is the siting, and the second is we have to get an answer: Is the Romney administration really ready to spear the cost on this? The bottom line has to be to take care of these patients. It has to be done in a humanitarian way. I don't know that we always have the services. It varies. It's something we have to address, and it often depends on year-to-year funding."

"People need social workers, occupational training and, at the simplest level, they need to be reminded to take their medication," continues Chandler. "The people who are able to leave Worcester State are people for who modern medicines have made a difference, but it makes no difference if they can't remember to take them. The need will never go away. Where are these social services? Can we have an inventory, please?"

So here's what happens next: At the feasibility commission's meeting, they rejected the Legislature's deadline date and voted to submit the final synopsis on April 1, 2006. The previous deadline would have given the commission only two and a half months to report. Unworkable, they said. They also delayed their next meeting for 60 days in order to have a chance to tour two newer state hospitals and the New Hampshire State Hospital as models.

It's been seven years since LaFortune had a big slip, starting to hallucinate while living alone in his apartment in Clinton. "I was seeing bugs," says LaFortune. "Nobody else could see bugs, but I could. I could see them crawling all over me and all over my bed. So I got two cans of Raid. I sprayed the whole apartment with it and sprayed myself with it. I had a meeting with a nurse for my shot, and they smelled it. They said, 'You're not leaving.'"

Today, he's fairly well adjusted and spends his days taking care of his dad, who needs him now. He's also licked smoking, cut down on sweets and works out at the Y a couple of hours a day. It's still tough to keep the weight down: years of mood-altering drugs took a toll and sparked diabetes. He takes 13 pills a day and some make him very tired.

"There are two meds that I'm taking now that haven't changed in seven years," says LaFortune, who says the "older" drugs work much better for him. "I'm feeling better than I've ever felt. Things are going great. I've weaned myself off being dependent on therapists and doctors. I don't see a psychiatrist as often as I used to. I have a therapist I see frequently. I have my own network now."

LaFortune is one of the lucky ones. "For the mentally ill we have very little," says McDonald. "Mental illness is a medical illness. We don't take a person who has cancer and say you can't stay in the hospital, we're going to put you in an apartment down in the Main South area. Why do we, or why does this administration, do this? This administration has been brutal."

Even if there are unforeseen obstacles, it'll take five to eight years to build a new hospital. Already, though, the wave of de-institutionalization -- the transfer of patients to the neighborhoods of our cities and towns -- is here. Advocates pray we're ready.


THE SPOKESMAN-REVIEW (WA), January 27, 2005

[Editor's Note: State hospitals are not the only endangered venues of intensive treatment. Often the most supportive type of care for a patient being released from a hospital is a group home. Yet in many communities, apparently including Spokane, the use of these facilities is being discouraged, perhaps inappropriately so. Independent living is always the ultimate goal for a person with mental illness but being prematurely thrust into it can be nothing more than a guarantee of rehospitalization.]


Jan. 27--Craig Ferguson lives in a tiny room in a sprawling group home in south Spokane. A small television sits atop a record player that no longer spins. A cloth picture of two elk, horns interlocked in battle, hangs above his bed.

On Wednesday, Ferguson stood under the door frame leading to his room, and stared at the plastic bags filled with his clothes. After 14 years at the Hilltop Center, Ferguson is moving.

"I'll be all right, I guess," said Ferguson, 47. "It's been a good place to be."

This week, the Hilltop Center announced that it would close its 21 beds for the mentally ill, blaming a decrease in referrals from mental health systems and a restructured county payment system.

"I've been in this business for 40 years," said Elaine Charon, operator of Hilltop and two other homes, which will remain open. "I feel like it just isn't feasible anymore."

Once cornerstones of the support network for mentally ill people trying to live in the community, the group homes have watched the number of beds gradually dwindle, as county officials have publicly encouraged more independent living arrangements. Spokane's Regional Support Network, which provides public mental health care in the county, said it will subsidize 193 beds in group homes this year, down from 209 beds two years ago.

County officials did not immediately respond to requests for interviews on Wednesday.

In an e-mail message to providers last week, an RSN official said, "Everyone has openings, but we cannot afford to fill beds at a rate that is not financially sound for us." The official said the county is "constantly over budget" on its residential spending.

At Sunshine Terrace, residential care coordinator Ken Niccolls said he has noticed a decline in referrals but said the home has survived in part because of its size; the home operates 60 beds in Spokane Valley.

"I understand that there are not as many referrals," Niccolls said. "We might be better off than most people because we have a larger (facility)."

Kathy Weiss, administrator at Valley View Living Center in Spokane Valley, said the home has several vacancies but said she was confident her numbers would bounce back.

"It's kind of the nature of the business," Weiss said. "You see that ebb and flow."

At Hilltop Center, 605 S. Bernard St., several of the residents said they have tried living independently but struggled to stay on their medications, off the streets and out of jail.

Steve Adams, a 39-year-old former dishwasher who has schizophrenia, said when he lived on his own, he stayed up all night drinking cup after cup of coffee. He has lived at the group home for two years, where staff members monitor his medications.

"I went off my medication a few weeks ago, and I just started falling to pieces after about seven or eight days," Adams said. "I couldn't even water my plants."

Pam Brault, the home's operator, said that for years the home has responded to personal emergencies -- both minor and serious -- from former clients.

"Usually within a month of a client moving out, they are back at the front door wanting a meal," Brault said. "Of course you aren't going to say no to a hungry person."

Brault said the home will close Feb. 18. The home's operators are working with case managers to find housing for the residents, Brault said.

On Wednesday, several residents packed their clothing and belongings, even though it may be several weeks before they leave. On the second floor, a man who has lived at the home for two years filled a bag with cigarettes and packets of sugar that he had hidden in his sock drawer. He said he had previously lived in group homes, on the streets and in shelters.

This, he said, was just another move.

"Just got to keep on moving," he said.


RALEIGH NEWS & OBSERVER (NC), January 10, 2005

[Editor's Note: Below is another episode in Ruth Sheehan's chronicling of the release of Phil Wiggins into the community after decades in state hospitals. It appears that the efforts of his sister, and perhaps the spotlight provided by this series, have secured Mr. Wiggins with a facility well-suited to the task of easing his transition into the community - a group home.]


By Ruth Sheehan, Staff Writer

On a quiet cul-de-sac in Zebulon sits Phil Wiggins' future.

The group home is a pale gray Cape Cod with a varnished front door. It is indistinguishable from the other homes in the neighborhood; if anything, it's nicer.

The interior is airy and bright. Couches and chairs surrounding a fireplace make the living room homey. Above the mantel is a painting of a black Jesus.

The bedrooms are simply furnished; the shared bathroom gleams. The entire place is spotless.
Louise Jordan, Wiggins' sister, approves.

I have been following Wiggins' journey from state psychiatric hospitals back into the community for eight months. Wiggins, 61, who suffers from schizophrenia, has spent the past 44 years in Dorothea Dix or, more recently, Cherry Hospital in Goldsboro. But now the state, to comply with a federal mandate, is shifting even the most severely mentally ill into neighborhoods and houses like this.

Last spring, it looked like Wiggins was on a fast track for his move. The hospital planned to release him to Wilson County, even though Jordan lives in Raleigh, and Wiggins hasn't lived anywhere but a psychiatric hospital since he was 17.

Jordan's concerns about his fascinations with fire and chemicals were largely ignored. She feared that in this move, as in a previous attempt two years earlier, he wouldn't receive the services or attention he needs.

Since then, though, the process has slowed dramatically. The hospital agreed to release Wiggins to Wake County. Jordan finally feels like the state is paying attention.

On the day we visited the group home last week, Jordan eyed the other residents, wondering how her brother would fare in this world.

It is an open question. But the group home gives her hope.

This home is owned and run by a registered nurse who operates several group homes for the mentally ill in the area. She asked not to be named or have the exact location of the homes disclosed because many of her neighbors have no idea what goes on in the tidy houses.

This home seems as near to perfect as Jordan expects to find. The owner promises round-the-clock care. One attendant sleeps at the house; another is on hand, awake, all night, too.

Jordan is impressed with the supervision -- Wiggins has a history of wandering.

She is relieved that the home's chemicals, cleaning supplies and such, are kept in a locked closet. Even the food is locked up. The residents are given smoking breaks every two hours, and Wiggins will not have his own lighter or matches.

Jordan still worries about the smoking but marvels at how things have changed since last summer, when Wiggins' caseworker at Cherry Hospital suggested that Jordan consider placing Wiggins at Oliver House, a rest home described in The News & Observer weeks earlier.

"What a journey it's been from Oliver House to here," Jordan said.

But the real journey lies in the weeks ahead, when a bed comes open. In the next few weeks, Wiggins will visit the group home himself. If he likes it, it will be his new address.


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Tuesday, February 08, 2005


The Rights of the Mentally Ill

The Rights of Persons with Mental Illness

From here.

Read about Deliberate Indifference here.

Purpose and Summary
This statement expresses the convictions of the National Mental Health Association (NMHA) with regard to the rights of persons involved with the mental health system and/or who are recovering from mental illness (including children, adolescents and their families). The NMHA is committed to promoting adherence by all treatment systems to the policies and principles set forth herein and to assisting our state and local affiliates in working with their state and local governments to do likewise. This pledge also includes adherence to the ADA, IDEA, the Rehabilitation Services Act, the Fair Housing Act, and other legislation that protects the rights of citizens, especially those recovering from mental illness. This statement consolidates prior policies that addressed rights issues.

Equal justice under the law is a fundamental concept in American jurisprudence. Yet persons with mental illness are often denied equal justice in virtually every part of our country. Too often discriminatory practices proceed from the misconception that people who are in the mental health treatment system are incapable of exercising the rights of citizenship. In fact, the decision to institutionalize people or treat them against their will may be based upon the assumption that to resist treatment recommendations is evidence that one is incapable of making such a judgment. This completely ignores the principle that a person is competent unless legally proven otherwise. While major strides have been made, people with mental illness continue to be denied rights as citizens, dignity as human beings, and a life free from stigma.

The NMHA recognizes that myths and misinformation prohibit the full participation of individuals recovering from mental illness in their communities. For example, despite common misperceptions, persons with mental illness are not more violent than people without mental illness. NMHA has worked to educate the public, as well as legal and medical advisors, providers, educators, and the media about laws protecting rights and to provide information that counteracts stigmatizing attitudes, language and behavior.

Specific Rights
The NMHA reaffirms its commitment to equal justice and protection of legal rights for all persons with mental illness, including children, adolescents and their families. To carry out this principle, NMHA pledges itself to protecting the civil rights of persons who are recovering from mental illness. The following rights are specifically identified because they are most likely to be abridged:

Rights Regarding Benefits and Service Delivery

The right to receive timely, culturally appropriate and complete information about rights upon enrollment in a health plan, upon entering the treatment system, and at any time upon request. This information must include benefits and services, as well as information about how to access available services, appeal a decision, lodge a complaint, and/or get help to navigate a service delivery system.
The right to be fully informed of all beneficial treatment options covered and not covered, including related costs.
The right to have advance directives about treatment preferences-and the right to have them honored.
The right to insurance parity, including freedom from limits based on annual and lifetime expenditures, days or visits, copayments, or diagnosis.
The right to the least restrictive and least intrusive response to a need for mental health services.
The right to sue the health plan for authorization denials that result in harm to the consumer.
The right to expedited reviews and appeals from one's health plan when the situation is emergent or urgent.
The right to access services in one's own community, including but not limited to crisis intervention, emergency, diversion, rehabilitation, outreach, housing, employment, and mobile services, including the right to seek care from a provider who does not participate in the health plan, if the provider network is insufficient.
The right to be fully involved in treatment, referral and discharge plans as they are developed, implemented and revised. Parents and guardians have the right to meaningful involvement in developing and implementing the treatment plan for their children who are still minors, as well as for their adult children if consent is given by the adult consumer.
The right to be fully informed of treatment side effects and treatment alternatives in order to make informed decisions without coercion or the threat of discontinued services.
The right to selectively refuse undesired treatment services without the loss of desired services.
The right to receive services from providers who have appropriate language skills and linguistic support services.
The right to be directed to treatment modalities that are culturally competent according to ethnicity, sexual orientation, religious beliefs, and disability.
The right to access medically necessary and effective medications without being subjected to "fail first" policies, discriminatory or excessive copayments, or time-consuming prior authorization paperwork.
The right to receive appropriate, specialized and individually tailored education as a component of treatment for youths.
The right to receive treatment services in one's own community, with reasonable efforts to serve children and adolescents while they remain in their homes.
The right to be transported to treatment facilities by medical personnel, rather than law enforcement agents.

Rights Related to Preservation of Liberty and Personal Autonomy
The right to receive treatment services in a setting and under conditions that are the most supportive of personal liberty, with restrictions of that liberty only as needed to preserve safety.
The right to easy access to any available rights protection service and other qualified advocates, including federally-funded protection and advocacy systems.
The right to assert grievances and to have them addressed in a timely manner, as well as with an external reviewer upon request, with no negative repercussions.
The right to the use of voluntary admission procedures wherever possible.
The right to receive treatment and services only with informed consent, except as over-ridden by a court.
The right to establish advanced directives and living wills and to appoint surrogate decision-makers (with durable power of attorney), specifying how one wishes to be treated in an emergency or if s/he is incapacitated, as permitted by law.
The right to be free from any form of corporal punishment.
The right to a humane treatment environment affording appropriate privacy and personal dignity and protection from harm.
The right to converse with others privately, to have convenient access to the telephone and mail and to see visitors during regularly scheduled hours in inpatient or residential facilities.

Rights Related to Competency
The right to be deemed competent to exercise all constitutional, statutory and common law rights and privileges and to manage one's own affairs unless restricted or limited through appropriate due process procedures.
The right to inexpensive, stigma-free guardianship procedures that are the least intrusive necessary to accomplish the provision of appropriate services and which include a delineation of the duties of the guardian.
The right to have all restrictions explicitly enumerated in the court order and to have copies provided to the interested parties.
The right to legal counsel for every threat of loss of a privilege or right.
The right to easy access to a person's attorney or legal representative while under a commitment order.
Where involuntary commitment to an inpatient facility is deemed necessary, the following rights should apply (at a minimum):
due process hearing,
provision of counsel,
minimum burden of proof of "clear and convincing" evidence,
a jury trial (at their election),
presentation of witnesses and opportunity for cross examination,
clear standards for commitment based upon constitutional principles, and
commitment based on proof that:
the person requires the confinement being sought by the petitioner,
the place of confinement can provide the treatment being sought by the petitioner,
there are no less restrictive but suitable alternatives to the placement being sought, and
a specific overt act of dangerousness (including a stated threat).
Rights Related to Seclusion and Restraint:

Seclusion and restraint should be used only after other less restrictive techniques have been tried and failed, and only in response to violent behavior that creates extreme threats to life and safety.
Seclusion and restraint procedures should not be used on individuals with medical conditions that would render this dangerous.
Facilities should have written procedures governing the use of seclusion, restraints, and restraining procedures. These procedures should require the documentation of alternative, less intrusive intervention approaches that were tried and the rationale why these failed or were not appropriate.
Facilities should never use seclusion or restraint as punishment or for the convenience of staff.
Use of restraints and seclusion should always be implemented by experienced and trained staff, overseen by senior medical staff, approved by a physician, and be well-documented and justified in a consumer's file.
Seclusion and restraining procedures should be used only for the amount of time needed to restore safety and security of the consumer and others.
People in seclusion and restraints should be monitored on a continuous basis.
Facilities should be sufficiently staffed to reduce the need for physical and chemical restraints and the use of seclusion.
All staff should be trained and demonstrate competence in non-physical intervention techniques and in safe use of restraining procedures.
Facilities must be held accountable for all uses of seclusion and restraints, collect data and report it to the appropriate state agency or regulatory bodies. Failure to produce appropriate data or adhere to clinical guidelines should result in sanctions.
Facilities should apply the use of advanced directives, where they exist, that address the use of seclusion and restraint.
Consumers should be informed that specific behaviors may result in the use of restraining procedures or seclusion. Cooperation of the consumer with the procedure should be sought.
An individual's age, developmental needs, gender issues, ethnicity, and history of sexual or physical abuse should be taken into account when implementing seclusion and restraining procedures.
Rights Related to Privacy and Information Management:

The right to access and supplement one's own mental health record.
The right of parents or guardians to access their minor children's mental health records, except where such information is protected by law.
The right to receive information about confidentiality protocols when consumers join a new health plan or begin treatment with a new clinician, as well as on request on an ongoing basis.
The right to withdraw, narrow or otherwise modify terms of consent for information to be released.
Consumers have the right to be informed of:
the type(s) of information that will be disclosed (nature and extent);
who has the authority to disclose information;
to whom the information will be disclosed; and
for what purpose(s) the information is needed.

Approved by the NMHA Board of Directors June 11th, 2000

Expires on December 31st, 2005

Monday, February 07, 2005


Upcoming Workshop in New Mexico Posted by Hello

Friday, February 04, 2005


Funny Stories

Are we going to the dogs?

In 1997 or 1998, Judge Eichholtz, of the mental health court, Sara Lynn Carson, of the Marion County Mental Health Association, and myself were nominated for some sort of annual award in Vigo County. Perhaps it was named something like "Innovator of the Year." In addition to the honor of being nominated, we were invited to the honor's banquet in Terre Haute.

We all met on the day and I drove us down.

It was a very nice and formal affair. We smoozed and mingled. Met contacts and networked. We sat down to dinner. Then we had to sit through two hours of awards being given out.

Finally, our category came up. It came down to us and a new program in Vigo County. In this new program, dogs were taken around to nursing homes, group homes, and mental hospitals. It was "pet therapy."

The big moment came, after the speaker praised and praised our program...then he announced the winner....THE DOGS. The dog therapy program won the award.

Although we did not win this award, the citizens of Vigo County thought enough of our program to copy it there. They even kept the name that I had come up with---The PAIR Program.

The fact that the PAIR Program being nominated lead to an article being publish in some legal journals and a designation by the National Mental Health Association as a "best practices" model. To date there are programs in Missouri, Washington, Texas, and Alaska, these are programs that copied the original PAIR Program from Marion County.

From this web site:
PAIR (Psychiatric Assertive Identification and Referral Program)

"This is a Hamilton Center and MHA program designed to address the needs of persons with mental illness who have been charged with certain criminal offenses. The goal of the program is to identify these individuals as soon as possible and facilitate the release into community-based treatment. Persons can be referred by anyone and after approval, can participate in the program." ------
Mental Health Association in Vigo County, 620 8th Ave.,Terre Haute, IN 47804
(812) 232-5681 Fax (812) 234-2863

Read about it here.

We joked for weeks that our program was going to the "dogs."


Treatment Advocacy Center News Feb. 4, 2005


Visit our web site February 4, 2005

1. POIGNANT WITNESSES TO MENTAL-HEALTH NEEDS – Philadelphia Inquirer, February 1, 2005

2. LETTER TO THE EDITOR (untitled) -
National Law Journal, January 17, 2005

Pittsburgh Post Gazette, January 31, 2005

4. KILLING EXPOSES FLAWS IN MENTAL HEALTH SYSTEM – Collinsville Herald Journal, January 19, 2005

Collinsville Herald Journal, January 19, 2005


1. PHILADELPHIA INQUIRER, February 1, 2005

[Editor’s Note:

“I’m sorry; we can’t do anything for your loved one unless they are dangerous enough to commit to a hospital or willing to come in for help.’”

Yes indeed – to have those as the only two avenues to treatment leaves thousands stranded by the symptoms of severe mental illnesses.
We commend the New Jersey advocates striving for a greater access to care for those in crisis.]


By Marcia Windness Coward

Nothing alarms a parent like losing a child to mental illness. Thus, many family members gathered to urge New Jersey to fix its broken mental-health system at the public hearing of the Governor’s Task Force on Mental Health at Camden County College on Jan. 19.

Having had my son, Mark, die at age 38 after his five-year battle with rapid-cycling bipolar disorder, I empathized with parents at the hearing to whom trauma was no stranger. Parents seeking homeless offspring. Frustrated mothers watching their children lose health and hope. Parents becoming invisible in the information loop. Parents battling the judicial system. Mothers departing crisis centers when workers felt unqualified to handle their children’s mental illness and developmental disability. Families yearning to keep others’ sons and daughters from falling through the cracks.

Members of New Jersey’s Alliance for Persons Affected by Mental Illness pressed for continuity of care as essential to recovery. Their “continuity wish list” included generous increases in funding; treatment beds; training/retention/oversight; family-agency communication; varied, safe, affordable, accessible housing; and better integration of services for mental illness and co-occurring disorders such as addiction and brain injury – in a seamless stream.

I appealed for improved records and discharge procedures. I was thankful to see friends from South Jersey affiliates of the National Alliance for the Mentally Ill. We were all grateful to acting Gov. Richard J. Codey for his attentive task force and to timekeeper Terri Wilson, deputy commissioner for disability services of the state Department of Human Services, for her compassion.

It’s about time that families’ voices rang loud and clear, I thought. Too late for my family but, hopefully, in time to help others.

Jerry Lindauer, NAMI Mercer executive director, expressed our dream. “I’m here to ask you to eliminate this phrase from the vocabulary of the mental-health system: ‘I’m sorry; we can’t do anything for your loved one unless they are dangerous enough to commit to a hospital or willing to come in for help.’ “

He then posed a question that summed up the system’s dilemma: “What’s needed for a treatment system that can address the anguish of these families left to helplessly observe their loved one’s deterioration and one that will also support consumer autonomy and self-determination?”

I heard in Lindauer’s challenge the enormous potential of “consumers,” people with severe disorders such as major depression, schizophrenia and bipolar disorder – people like my son Mark, a devoted biostatistician at the University of Chicago Hospitals before life veered out of control. In fact, NAMI NJ’s recent Freedom From Stigma campaign honored Mozart, Beethoven, Lincoln, Emily Dickinson, Billie Holiday and Virginia Woolf – all mentally ill – for their luminous legacies.

The millions of individuals who are treatment-compliant are most likely to rebuild lives and bridges to loved ones. Their insight, perseverance and faith deserve celebration. However, mental illness often lies unrecognized, denied, untreated. If chaos ensues, how much autonomy can be expected of consumers?

Lindauer and others called for involuntary community treatment with safeguards for consumer rights and involuntary outpatient commitment when seriously impaired individuals appear at risk but do not meet legal criteria for involuntary hospitalization – that is, posing imminent danger to self, others or property. Most witnesses favored intervention.

No matter how wrenching the toll of mental illness, Kathleen Foster of National Park rejected incarceration as an alternative to treatment. The NAMI Gloucester County member serves as a facilitator at Marlton’s Rap Room Parent-to-Parent program, where she helps families find treatment settings for adult children. She knows the system nationwide.

So it carried weight that Foster joined the chorus for jail diversion. “Neither prison nor jail is equipped to recognize, manage, and/or alleviate psychiatric symptoms,” she indicated, also deploring punishments of mentally ill inmates sent to the Albert C. Wagner Youth Correctional Facility by state jails and prisons unable to manage psychotic episodes.

Foster’s dedication to the mental-health system was spurred by the death of her son, Christian, at age 28 while he awaited long-term treatment seven years ago. Foster said she was encouraged by two developments in the field. The first is the opening in February of Day Top-South, a long-term adolescent treatment facility in Pittsgrove. The second is the assumption of treatment of mentally ill inmates in all state prisons by the University of Medicine and Dentistry of New Jersey.

Yet another witness, whose 22-year-old succumbed in 1988, advocated for earlier intervention and treatment of juvenile mental illness. “Twenty percent of U.S. Children [may] have emotional disorders,” said Barbara Steltz of Barrington. “Suicide – the 11th cause of death overall – is the third-most prevalent killer in the 10-14 and the 15-21 age groups.” Steltz closed on the theme of family tragedy. She said, “We cannot afford to lose our children in any way.”

We all hoped New Jersey heard.

Marcia Windness Coward writes from Moorestown.

2. NATIONAL LAW JOURNAL, January 17, 2005

[Editor’s Note: Dr. Darold Treffert for years has championed for Wisconsin, first endeavoring for progressive treatment laws and then – once he had helped secure among the most advanced for his state – the use of such laws to aid those most lost to acute mental illnesses. Below Dr. Treffert brings his message to a broader audience, the readers of the National Law Journal.]

Letter To The Editor

As a psychiatrist long interested in providing a reasonable balance between clinical realities and civil liberties for the severely mentally ill, I was encouraged by “Mental health law: States allow courts to force treatment,” by Tresa Baldas [NLJ, Jan. 3, Page 4] reporting that 42 states have enacted laws to permit mandated treatment on an out-patient basis when necessary for certain seriously ill psychiatric patients.

But I was discouraged to read the remarks of a “civil rights” attorney that such treatment is “heavy handed” and “without evidence that it will make people’s lives any better or make society any safer.” Those comments ignore mounting evidence of the benefits of assisted outpatient treatment for patients and society.

For example, among the first 1,409 persons who received assisted outpatient treatment under Kendra’s Law in New York, 63% fewer experienced hospitalization, 55% fewer had episodes of homelessness, 75% fewer were arrested, and 69% fewer were incarcerated. Fewer hospital stays, less homelessness, fewer arrests and remaining in the community instead of being in jail or prison do qualify as “making people’s lives better.” Studies also show significant reductions in the risk of violence and victimization of the mentally ill so “society is safer” as well.

Wisconsin has one of the most progressive mental illness treatment laws in the country. The Wisconsin Supreme Court upheld the law when it was challenged, as have other courts, explaining that “[b]y permitting intervention before a mentally ill person’s condition becomes critical, the legislature has enabled the mental health treatment community to break the cycle associated with incapacity to choose medication or treatment, restore the person to an even keel, prevent serious and potentially catastrophic harm, and ultimately reduce the time spent in an institutional setting.” In Re Dennis H., 647 N.W.2d 851 [Wis. 2002].

For years I have been concerned about cases in which the mentally ill are “dying with their rights on”-circumstances where scrupulous concern for patient rights unreasonably overshadowed appropriate concern for the patient’s life. The recent trend toward better balancing the right to be free with the right to be rescued is to be commended because it does afford people who need our help the right to a better life. Lawmakers in Michigan and Florida deserve tremendous credit for using their legislative powers, and wisdom, to build a more compassionate and sensible system of care. [Readers are referred to Donald A. Treffert, “The MacArthur Coercion Studies: A Wisconsin Perspective,” 82 Marq. L. Rev. 759 [Summer 1999] for further reading.]

Darold A. Treffert, M.D.

Fond du Lac, Wis.

3. PITTSBURGH POST GAZETTE, January 31, 2005

[Editor’s Note: As mental health courts proliferate, so does the media coverage of them. A number of articles replete with their successes have been featured in the E-News. The one below on the Allegheny Mental Health Court brings us a strong figure, the kind that makes Sheriffs, Police Chiefs, and County Supervisors sit up in their chairs – in the first three years of the court program only 27 of 311participants in the program were arrested on new charges. That shows success not only in facilitating needed treatment and stability for those who go before the court but also in diminishing the burden and expense on Allegheny County correctional facilities.]


By Joe Fahy, Pittsburgh Post-Gazette

At a time when many communities are trying to keep criminal offenders with mental illnesses out of prisons and jails, the state’s first mental health court has shown promising results.

About 84 percent of people served by the Allegheny County Mental Health Court have stayed out of trouble with the law while under the court’s supervision, according to the county Department of Human Services.

From the start of the court in mid-2001 through last June, 27 of 311 people under the court’s jurisdiction were arrested on new charges, said Amy Kroll, the department’s director of forensic services. Twenty-two others were taken into custody for probation or parole violations.

Officials believe those results are encouraging as many communities struggle with rising inmate populations. Many inmates cycle in and out of incarceration at significant cost to taxpayers.

Failing to address the needs of mentally ill offenders “is a drain on the law enforcement community and the judicial and prison systems,” said state Sen. Robert Thompson, R-Chester. He noted that nearly one in five inmates in Pennsylvania prisons and jails are believed to have a mental illness, about three times the rate of the general population.

“If we can get these individuals in treatment and stabilized, we can begin to stabilize our costs,” said Thompson, chairman of the Senate Appropriations Committee.

Thompson co-authored a resolution approved by lawmakers last year to provide a report to the Legislature and the governor on the Allegheny County Mental Health Court and two initiatives for serving mentally ill criminal offenders in Chester County and Philadelphia.

That report will be based on a series of studies, coordinated by state officials and the Council of State Governments, of the fiscal impact of those programs and the advisability of replicating them in other communities. Preliminary results of the studies are expected later this year.

Reacting to requests from officials in many states, the Council developed the Criminal Justice/ Mental Health Consensus Project to improve the criminal justice system’s response to people with mental illness. Thompson co-chaired the steering committee for the project, which issued recommendations in a 2002 report.

County officials began developing the programs years ago “because we realized jails and prisons are not good places for people in terms of their health or prospects for rehabilitation,” said Patricia Valentine, deputy director of the Office of Behavioral Health.

Since the 1980s, the county has had a diversion program that works with district justices, with the goal of having minor charges dismissed after 90 days if offenders agree to mental health treatment, Kroll said. The program served 683 people in 2003.

The same year, she said, 870 people with mental illnesses were served by another program that works with people who typically face more serious charges or who have criminal records. It petitions judges to consider alternatives to incarceration, such as house arrest.

The mental health court, a collaboration involving the courts, the public defender’s and district attorney’s offices, and the county Department of Human Services, has an annual budget of about $700,000 that includes some in-kind services, Kroll said. Funding has come from foundations and public sources.

The court generally serves people with mental illnesses who do not have serious criminal histories and who are not facing a probation violation or criminal charges that include homicide, sex crimes, drug trafficking, certain thefts and assaults, or driving under the influence of alcohol.

If officials determine the case is appropriate for the court, a mental health service plan is prepared and submitted to the judge. The judge must accept the plan and participants must agree to abide by its terms before they are released from jail.

Staffers provide help with obtaining housing and mental health treatment and reinstating public assistance benefits. Participants continue to be supervised by the court throughout their probation, with “reinforcement hearings” held at least every 90 days to encourage compliance with the plan.

Mental health courts are modeled after drug courts, which originated in Florida in the 1980s, said Christy Visher, a principal research associate at the Urban Institute in Washington.

The courts are based on the premise that judges can be more persuasive in directing a defendant’s rehabilitation than probation officers or caseworkers, she said.

Evidence suggests the courts are effective, at least while participants are under court supervision, she said.

In general, the courts tend to cost more to operate than other courts, Visher said. Hearings can be longer and participants may make more court appearances.

But research indicates the courts can cut costs in other ways, primarily through the savings that result from reduced crime, she said.

Visher said Allegheny County would need to follow participants after court supervision ends to better assess the local mental health court’s success. But even short-term success is “better than doing nothing at all,” she said.

Michelle Leigh Bailey-Baird, the court’s public defender, expressed strong support for the court despite her concerns that rising case loads have made supervising participants more difficult.

The court experienced “growing pains” during its first 21*2 years, according to a report prepared by a consultant for a local foundation and posted on the Department of Human Services’ Web site.

The report noted that fewer people were accepted into the court than planned and average time spent in jail before release was longer than anticipated. Kroll said officials are working to address those issues.

Still, the results are encouraging, the report found, calling the number of participants who had subsequent problems with the law “remarkably low.”


[Editor’s Note: Whether by design or just how it works out in practice, mental health systems often gravitate towards the care of the less ill at the expense of those more gravely so. A common example of that is in the article below: Johnny Johnson missed appointments and was as a result dropped from his service program. Yet, in many if not most instances, should not missed appointments be a strident sign that a patient’s condition may be deteriorating and he or she is in more need of help than ever?

We know that it expends extra resources to track down patients unable to walk through a clinic’s door; we also, however, see the tragedies created by not doing so.]


By Bill McClellan

Johnny Johnson was convicted Monday of first-degree murder and on Tuesday a jury decided he should die for his crime. And why not? He had bludgeoned a 6-year-old girl to death with a rock after trying to rape her. What jury would spare the life of a man who committed such an unspeakable crime?

We can be sure that the jurors took into consideration the fact that Johnson was, and is, mentally ill. According to testimony at the trial, the 26-year-old Johnson has suffered from mental illness since his early teens. The first diagnosis was depression. Later, the diagnosis changed to schizoaffective disorder, which is similar to schizophrenia. In 2002, ADAPT of Missouri, which is a social service agency that works with the mentally ill, placed Johnson with a psychiatrist. From February through June of that year, Johnson regularly saw his caseworker, but then he missed appointments and a supervisor for ADAPT wrote Johnson a letter saying that the agency would cancel services to him on July 31. By the time that letter was written, Johnson had quit taking his medication. He moved out of his grandmother’s house. He was like an unstable element, waiting to explode. He killed Casey Williamson on July 26.

So you’re like me. You read about this case and you think, Why would an agency cancel services when a mentally ill person starts missing appointments? Isn’t that some kind of a warning sign?

A friend in the social service world told me that yes, of course, it’s a warning sign, but to understand why an agency would drop a person when he or she needs help the most, you have to understand the funding mechanism of something called the Community Psychiatric Rehabilitation Program. CPRP is the main state program that provides community-based services for the mentally ill. The problem with CPRP, my friend said, is that it funds only face to face contacts. Consequently, many agencies require their caseworkers to produce a certain number of hours of face to face contacts each week. An agency does not get paid to search for missing clients.

I called ADAPT of Missouri to find out if this might explain why the agency had decided to drop Johnson. I asked to speak to the chief and was directed to Bill Lertiz. “I have no comment,” he said.

I called my friend back. “I’m told ADAPT requires 22 hours a week of face to face contact,” my friend said. “That’s not unusual. But if you don’t think 22 hours is a lot, consider that it doesn’t include the mountains of paperwork, travel time to and from clients’ homes, phone calls to family, landlords, doctors, police and courts as the caseworker tries to assist the clients with their various needs. That’s unbillable time. You think you have time to go looking for somebody? All of these agencies have waiting lists of people who want help. So you get rid of those who miss appointments and replace them with somebody who will make their appointments.”

Of course, the clients who keep appointments are generally the ones who are maintaining pretty well. They’re taking their medications. They have a support system. It’s when they slip out of their support system – Johnson moved out of his grandmother’s house – that their cases hit crisis mode. And that is when agencies drop them.

You don’t have to be “soft on crime” to think something is wrong with this system. I called the Department of Mental Health. Nobody was available to discuss the program or its funding.

Truth is, though, you can’t blame the department. The funding is inadequate to help all the people who want services, much less all the people who need them. When you talk about funding, you have to talk about the Legislature. You can’t blame the legislators. There isn’t enough money to do everything. You can’t blame the agencies. If they don’t think about billable hours, they’ll end up going out of business.

That leaves Johnson. We can blame him. But when a man’s history reads like a road map to disaster and when the system rejects him when he needs help the most, should not the system bear some responsibility?

5. YORK DAILY RECORD (PA), January 12, 2005

[Editor’s Note: We have often pointed out the dire need for more inpatient psychiatric beds. Not surprisingly we view any hospital closure with trepidation. That feeling is compounded by the shock to any area’s mental health system by eliminating a large state hospital. Not only must appropriate inpatient care be found for some of the patients but the community care infrastructure must also be braced for an influx of a large group of clients whose conditions are among the most acute. The preparations take money and time. The Pennsylvania Department of Public Welfare has announced that it will close Harrisburg State Hospital and have appropriate care of its patients within one year. That proposed transition is perilously short.]


Mental Health Experts Worry About Funding After The State Hospital’s Closure.

By Jennifer Nejman

As Harrisburg State Hospital prepares to close, York County mental health experts have praised the effort to move more people to community living situations, such as group homes, but some have expressed concern about how quickly that will happen.

Last week, officials from the Pennsylvania Department of Public Welfare announced that they plan to close Harrisburg State Hospital within one year. This follows years of dropping patient counts at the oldest state hospital facility in Pennsylvania.

The hospital serves 258 patients who have diagnosed mental illnesses with a staff of about 540 people at its 200-acre campus in Dauphin County, according to the welfare department.

Of those patients, about 115 are York and Adams county residents, said Steve Warren, administrator of York/Adams Mental Health-Mental Retardation Program.

Warren said his program will play a role in the hospital’s closing by finding places for 60 residents of York and Adams counties to live in those counties. Those numbers could change based on evaluations, he said.

People who live in Harrisburg Hospital will be assessed and determinations made based on where they would like to live and on their clinical conditions, he said.

The other York and Adams county residents, who are determined to still require hospitalization like what was provided at Harrisburg State Hospital, will be moved to Wernersville State Hospital in Berks County, Warren said.

York/Adams Mental Health-Mental Retardation already has 250 people living in the two counties through programs. Through the Community Hospital Integration Projects Program, people may live in apartments and houses with supervision.

“They’ve been successful,” Warren said. “We’re looking at this as a significant CHIPP expansion.”

Warren said he believes that his program should meet the deadline and supports moving people to the community settings.

Funding for patients’ moves

Kristin Stroup, director of mental health services at Bell Socialization, said her organization’s main concern is that enough money follows Harrisburg Hospital patients into the community.

Bell Socialization works with the county’s mental health-mental retardation program through CHIPP. Stroup said she believed that her organization would be involved if hospital patients were transferred to York County.

Money from CHIPP comes from the state. Some years there have been no increases, which can make it difficult when the expenses to run the program – such as transportation, utilities and staff pay – increase, Stroup said.

Sometimes, the waiting list to get into a residential home program can be up to 6 months, she said.

She said she would feel more comfortable if the Harrisburg State Hospital were closing in a year and a half.

“I’m not saying it can’t be done,” Stroup said.

The state has not released details on how much money will be distributed to community programs, said Christina Novak, state welfare department spokeswoman.

In a statement last week, Welfare Secretary Estelle Richman said the state intends to return the millions of dollars used to run the hospital to support programs in the communities.

The logistics of offering services

Some mental health service providers cannot even begin to plan until they know more details.

York Hospital is the only hospital in York and Adams counties that has inpatient psychiatric services, said Allen Miller, director of behavioral health at WellSpan Health. The hospital regularly sees patients from the Harrisburg and Carlisle area.

Patients currently are transferred from York Hospital to Harrisburg State Hospital. When the hospital closes, patients may need to come to the hospital before moving to a residential situation, Miller said.

In addition, the hospital provides services for people who live in residential situations who may have depression or a medication issue that requires short-term hospitalization, he said.

So the volume of patients served at inpatient and outpatient programs should increase, Miller said.

A backup could occur if the proper services are not set into place, Miller said, explaining that patients have waited months in York Hospital’s inpatient unit to be transferred to Harrisburg State Hospital. If the hospital doesn’t exist anymore, that wait could lengthen if they are waiting to get into Wernersville or another facility, he said.

“We’re going to need a different level of care, some place for these people to go if they don’t go to the state hospital,” Miller said.

He said that he is in favor of the concept of moving patients out of Harrisburg State Hospital.

“It’s going so quickly – that, I think, is raising the concerns,” Miller said.

6. PATRIOT NEWS (Harrisburg, PA), January 14, 2005

[Editor’s Note: Below Dr. Cheryl Dellasega provides an analysis of the closing of Harrisburg State Hospital. She looks at whether it should be closed, whether the community system is and can be ready for the wave of released patients, and provides some interesting conjecture on why the announcement and timing are so unusually abrupt.]


Patients Or Property Behind Hospital Closure?

The bureaucratic leap from considering the closure of Harrisburg State Hospital to an actual plan has to amaze anyone familiar with the mental health system or state-level decision-making. Rarely do proposals get enacted with such speed, but when a prime piece of real estate is involved, the usual rules seem disregarded.

Not long ago, a five-year plan to downsize the hospital gradually to 150 beds was agreed upon after a summit involving community and professional stakeholders. Despite the work to forge this agreement, it now seems to have never existed. As with previous moves to deinstitutionalize, the public is being told having seriously ill patients treated in the community is not only good for patients, it’s better than being confined in a state hospital.

One wonders: If this is so beneficial how did state hospitals and similar institutions (prisons, for example) ever gain foothold, let alone survive?

The reality is not a single study shows deinstitutionalization to benefit patients or their families. The numbers cited in the recent Patriot- News article on what happened to 91 HSH patients released in 1994 can be deceptive if one focuses not on those with questionable outcomes but the 52 who “are served by mental health services in the community.” What we aren’t told is where they live in the community, or how many times they were arrested without incarceration, treated in emergency rooms or hospitalized.

These statistics are also misleading because 2004 is a different mental health world than 1994. The average wait time for an appointment with a psychiatrist is two months, and if you’re looking on behalf of a child, good luck. Within recent years, five inpatient units have closed (Edgewater, Carlisle, Hanover, Hershey Medical Center’s geriatric unit and York Memorial), and those that do remain open try to keep their length of stay under three days.

A 1999 article published in the American Journal of Psychiatry followed patients discharged from the Philadelphia State Hospital in 1990. During the first year after hospitalization, the 321 patients in their study required anywhere from 6 to 158 days of psychiatric hospitalization with an average of 76 days (about 25 of the typical three-day stays mentioned above).

Another study in Vermont showed that when patients left the state hospital, they had very little integration into the community, and 87 percent required at least one rehospitalization.

Digging further into the research literature, it quickly becomes apparent that while community placements are cheaper, they don’t reduce symptoms or improve the level of the patient’s function. Scientists evaluating the outcomes of several studies following deinstitutionalization noted that while it’s feasible to have mentally ill patients live in the community there is little evidence it enables them to function better.

These are just the hard costs of deinstitutionalization. When (and it seems to be a “when” rather than an “if” already) HSH closes, many patients will be transferred to Danville or Wernersville State Hospitals, requiring families from Dauphin and surrounding counties to travel nearly twice the distance to visit their loved one.

Then there is the safety issue. While a certain group of patients (probably those on the discharge track already), can be safely treated in the community, many cannot. Who among us would welcome a group home for persons with poorly controlled schizophrenia, manic depression or psychosis into our neighborhood? In the state hospital, these individuals are safe – to themselves as well as other people. Twenty-four hours a day, excellent nurses provide them with supervision and support.

Not so ironically, HSH is located on a property that is a lush green jewel in the midst of concrete urban Pennsylvania. It already has been stated that the facilities there will make ideal offices for state workers – perhaps the same ones pushing for closure. I suggest you visit the campus some time and see for yourself. EMPLOYEES NO doubt will benefit from an office complex on the grounds of what used to be HSH. The opportunity to have more space and to work in beautiful old buildings surrounded by trees and flowers, close to the city but without the parking problems, is appealing.

It’s patients who need the high-level security, support and services currently found in HSH and communities who have to serve as substitutes for it who will stop and wonder: Can any price be worth it?

Cheryl Dellasega, Ph.D., of Hershey is an author who writes on mental health issues.


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