Friday, December 30, 2005


TAC Newsletter 12/30/05


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Friday, December 30, 2005


THE OREGONIAN, January 23, 2004

[Editor’s Note: Our New Year’s wish: that our treatments, programs, and laws for
the care of people with severe mental disorders shall improve to the point where
those afflicted must no longer fear being psychotic, homeless, imprisoned and
victimized, and can instead become fixated on more mundane affairs – such as the
opinion of one Simon Cowell.]


By Michelle Roberts

"American Idol" judge Simon Cowell is known for being critical and blunt, but
never tongue-tied.

Yet that's how a Southwest Portland woman says she left Cowell when she
auditioned for the hit Fox reality show last fall in Hollywood, Calif.

Tracy Moore, 22, said she walked into a room in the Renaissance Hollywood Hotel
in September and told Cowell that she suffers from a mental illness.

"They asked me what I wanted to do with my life," said Moore, who beat more than
10,000 other pop-star hopefuls for a chance to audition for the show's celebrity
judges. "I think they expected me to say I want to be a famous recording artist.
I told them I want to start a foundation for schizophrenics."

Moore said Cowell, famous for his scathing critiques that frequently reduce
"American Idol" contestants to tears, was briefly stunned.

"Simon just blinked and said, 'What?' " Moore said, mimicking Cowell's British
accent. "I told him, 'I'm a schizophrenic.'

"It was the first time I've ever seen him speechless."

Moore, who discovered her voice while performing in musicals at Wilson High
School, always thought her talent would make her rich and famous.

But while attending Musictech College in Minneapolis, a school for performing
artists, Moore gradually began to withdraw into a world of delusions.

"I would go to school and act bizarre," she said. "I'd start thinking weird
things and not know what the truth was. I'd talk to people who weren't there."

Once, she spent an entire day walking in a circle, convinced that was the only
way to stop aliens from entering her body. She wore sandals in the snow.

Moore said her classmates were wary of her. "They didn't want to be my friend,
but they were civil," she said. "They still wanted me to sing in their bands."

During her third term at Musictech, Moore said she called home and asked her
mother to sit down. "I told her, 'I'm insane.' "

But even that insight quickly disappeared. "As my symptoms got worse, I lost my
awareness of the illness," Moore said. "After a while, I didn't know I was
crazy. You couldn't convince me that Earth wasn't being threatened by aliens."

After a hospitalization in Minnesota, Moore's parents, computer network
engineers Pam and Don Moore, moved their daughter home to Portland, where a
psychiatrist diagnosed her with schizophrenia, a chronic and debilitating mental
illness marked by psychosis, delusions and disordered thinking.

The woman who once dreamed of seeing her name in lights had to struggle to hold
down minimum-wage jobs. She says she was fired from nearly "every fast-food job
in the state." At times, Moore was afraid she'd lost not only her mind, but her
future, too. "I was really scared of what was going to become of me," she said.

There's often no cure for the illness, but by working closely with a doctor and
other mental health professionals, some people can successfully manage their

Moore's doctor experimented with several medications but found that one of the
newest medications available to treat schizophrenia, Abilify , helped mute most
of her symptoms and let her think more clearly than she had in years. Last
summer, after six weeks on the drug, Moore said she began to believe it wasn't
unreasonable to dream, once again, of a music career.

In late July, Moore talked a friend into driving her 16 hours to the Rose Bowl
in Pasadena, Calif., where she waited in line for three days for a chance to
audition for "American Idol."

Moore's waist-length hair, dyed electric blue, helped her stand out from the
throng of auditioners lined up outside the stadium.

On Aug. 1, her 22nd birthday, Moore was selected from the crowd to sing on "Good
Morning America." Later that day, Moore made the first cut when just 250
contestants -- out of the original 10,000 who showed up at the Los Angeles
tryouts -- were selected to go on to the next round.

On Aug. 4, Moore belted out Melissa Etheridge's song "I'm the Only One," for six
Fox producers responsible for paring the list of finalists down to 50.

Moore said it felt as though her heart would leap from her chest as each judge
cast their vote.







On Sept. 7, Moore found herself face to face with Cowell and fellow judge Randy
Jackson, a Grammy Award-winning producer.

After throwing Cowell off guard, Moore launched into her song.

Cowell and Jackson let Moore sing most of the song before Cowell signaled her to

"Not good enough," she remembers him saying dismissively.

Jackson wasn't so sure, "He said, 'Um, Um. Uh. I don't know. I think I'm going
to say no,' " Moore recalled.

The third celebrity judge, 1980s pop star Paula Abdul, wasn't present because
she was ill.

Moore said she politely thanked the judges and turned to walk out as Simon gave
her the biggest compliment Moore has ever heard him give: "Not good enough," she
remembers him saying. "But you can sing."

The rejection stung. For weeks after the audition, Moore would cop a British
accent and sniff, "This supper's not good enough!" or "These pants aren't good

But Moore always comes back to what Cowell said on her way out of the audition
room. "He said I can sing!"

Moore is unsure whether she will try out again next year. But she said it was
one of the most important experiences in her life.

"I really put myself out there, even after everything I've been through," she
said. "That was a huge accomplishment in and of itself."

Sure, a record deal would be nice, Moore says. But she also suspects she may
have a more important calling. She recently enrolled at Portland Community
College and is taking classes to become a mental health and addictions

If Moore could choose between superstardom or helping others who've struggled,
the choice would be clear. "I don't know what my future holds," she said. "But I
know that helping others will give my life the most meaning."


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

This E-NEWS is provided as a public service by the Treatment Advocacy Center.
There is no fee. If you would also like to receive a free subscription to the
Catalyst, our quarterly hardcopy newsletter, please forward your mailing address

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:

Treatment Advocacy Center
200 North Glebe Road, Suite 730
Arlington, VA 22203
703-294-6001 (main no.)
703-294-6010 (fax)

Friday, December 23, 2005


TAC Newsletter 12/23/05


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December 23, 2005


COLUMBIA DAILY TRIBUNE (MO), November 30, 2005

[Editor’s Note: The holidays are joyous, a time to reaffirm, reconnect, and to
celebrate our love for those closest to us – but not for all. We ask you to
dedicate a moment thinking of those unable to bask in the pleasantries of the
season through no fault of their own.]



By Tony Messenger

Every year about this time, my thoughts turn to Patrick.

I met him 16 years ago. Even though he was in and out of my life in half an hour
or less, every Christmas season, Patrick is on my mind.

This year, Monday was Patrick day. That was when an elderly homeless man walked
into the newsroom to tell his story.

The thin black man with glasses and a thick salt-and-pepper beard wouldn’t tell
me his name. He wore the kind of stout fleece jacket, gloves and wool hat that
told me he was used to weathering the elements. He wanted to talk about Jesus.

So, too, did Patrick, so many years ago.

He came up to me as I sat on a step on an outdoor mall in downtown Denver,
listening to a choir sing Christmas songs. It was cold, and I was pushing my
infant daughter in a stroller. Patrick wanted to see the baby, and I placed
myself between him and the stroller instinctively. Patrick was homeless. He
reeked of alcohol and carried every earthly belonging with him in a green Army
surplus duffel bag.

Still, it was Christmas, and he just wanted to talk.

He didn’t have family anymore, he said. Once, he was an engineer, and then
things fell apart, and he ended up on the streets and alone. Since then, alcohol
had been his only friend. He slept under a bridge not far from there. It kept
him dry, he said. We sat and listened to the familiar sounds of the holiday
season, and he asked whether he could look at my baby daughter. It would make
his Christmas season, he said, and so, I let him.

Patrick smiled as Alisha slept. I don’t know what he was thinking or why he
seemed so happy, but at that moment, I felt a rush of guilt for every time I had
ignored a plea from a homeless person who, more than cash, might have just
wanted somebody to talk to.

I’m not sure whether the man I met Monday just wanted some conversation or
simply was hoping for a few minutes of warmth on a wet, windy November day, but,
thinking of Patrick, I sat down with him and asked him to tell me his story. It
didn’t go so well. All he would talk about was Cain and Abel and the Lord trying
to talk through him. He babbled about prophecies and said he couldn’t give me
his name without permission from his God.

"Where do you live?" I asked him.

"I live everywhere," he said.

With that, he left, promising to return in an hour if God told him that was a
good idea.

He never came back.

When he left, I called Lana Jacobs to ask whether she had ever met him. Jacobs
and her husband, Steve, run a local homeless shelter, and if there’s a person on
the streets living in Columbia she’s usually met them. The man rang a bell, she
said. She thinks he has local family and sometimes stays with them.

Other times, he’s on the street. She recalls him having breakfast at her shelter
a couple of days ago.

More and more of our homeless in Columbia are like him, she says, suffering from
various psychiatric ailments, from schizophrenia to dementia. This year’s winter
could be brutal on the homeless and soon-to-be-homeless population, Jacobs says.

With heating costs going through the roof, people living paycheck-to-paycheck
will be making the kinds of decisions that sometimes lead to the streets.
Shelters will be full, as they have been in recent years, but giving hasn’t
quite kept pace with so many good-hearted folks having sent aid to the
hurricane-ravaged Gulf Coast.

With nighttime temperatures dropping below freezing this week, Jacobs envisions
there will be people showing up at shelters such as hers just looking for floor
space for the evening.

So many years ago, Patrick told me he didn’t need the shelters. They made him
give up his booze, and besides he had a prime spot under a bridge that sheltered
him from the freezing wind.

My new homeless friend didn’t seem the boozer type. Jesus, I’m guessing,
wouldn’t approve of that.

I’m hoping he comes back to tell me his story.

It’s the Christmas season, after all.


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

This E-NEWS is provided as a public service by the Treatment Advocacy Center.
There is no fee. If you would also like to receive a free subscription to the
Catalyst, our quarterly hardcopy newsletter, please forward your mailing address

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:

Treatment Advocacy Center
200 North Glebe Road, Suite 730
Arlington, VA 22203
703-294-6001 (main no.)
703-294-6010 (fax)

Saturday, December 17, 2005


TAC Newsletter 12/16/05


Visit our web site
December 16, 2005



2. TREATMENT ADVOCACY CENTER STATEMENT - U.S. Newswire, December 8, 2005

December 9, 2005

4. MENTALLY ILL IN THE JAIL? IT'S A CRIME - Los Angeles Times, December 11, 2005

December 13, 2005

- Vero Beach Press Journal, December 9, 2005

7. ANTIPSYCHOTICS, ECONOMICS, AND THE PRESS - Psychiatric News, December 2, 2005


Make sure TAC gets a percentage of the money you spend at - at no
extra cost to you! The link below will bring you to Amazon, where all you have
to do is shop.

You don't have to fill out anything special when you check out. Amazon simply
records that you came to their site via TAC’s charitable link and our Center
gets a percentage of whatever you spend. And don’t forget, Amazon offers much
more than just books; you’ll find toys, electronics, and even furniture.

So even if you don’t need anything from Amazon at the moment, please hit the
link, add it to your favorites, and use it every time you shop at
And please encourage everyone on your e-mail list to do so as well. Who could
say no to the chance to aid people desperately in need when the cost is only a
click of a mouse?


2. U.S. NEWSWIRE, December 8, 2005

[Editor’s Note: Rigoberto Alpizar lost his life because of the untreated
symptoms of mental illness. His tragic end commanded national attention because
of when and how it occurred; he was shot by federal air marshals on the jetway
for a flight he was ticketed to take. Below is the Treatment Advocacy Center’s
statement on the tragedy, the real cause of which was apparently that Mr.
Alpizar stopped taking his medication for his bipolar disorder after years of
treatment and stability.]



People With Mental Illnesses Like Rigoberto Alpizar Nearly 4 Times More Likely
To Be Killed In Altercations With Law Enforcement Than The General Public

By Mary Zdanowicz, Executive Director


ARLINGTON, Va., Dec. 8 /U.S. Newswire/ -- Following is a statement by Treatment
Advocacy Center Executive Director Mary Zdanowicz:

Rigoberto Alpizar's death is making headlines because he was the first person
killed by federal air marshals after September 11.

But tragic encounters between the mentally ill and law enforcement are most
often the result of an old mental health treatment system than new security

A combination of deinstitutionalization and poor treatment laws have left too
many people with severe mental illnesses like schizophrenia and bipolar disorder
without support. Unable to get the treatment they need, they instead deteriorate
until someone -- often a family member -- ends up having to call 911.

Across the country, law enforcement officers -- police, sheriffs, corrections
officials, and now air marshals -- are increasingly being forced by a weak
system to become front-line mental health workers.

-- Newspapers across the nation reported at least 50 deaths of people with
severe mental illnesses in encounters with law enforcement in 2004.

-- In 1976, the New York City Police Department took approximately 1,000
"emotionally disturbed persons" to hospitals for psychiatric evaluation. By
1998, this number had increased to 24,787.

-- Florida law officers alone initiate nearly 100 Baker Act psychiatric
examination cases each day - 40 percent more than burglary arrests.

In responding to the news of Rigoberto Alpizar's death, the chairman of the
House Aviation Subcommittee said: "The system worked exactly as designed."

Although he meant the homeland security system, that statement is also true
about the mental health system.

The system is designed to require failure before someone can get help. In more
than half of the states, someone must be "dangerous" before the courts can
intervene to order them to get treatment.

The system is designed to protect a fuzzy notion of liberty while trampling upon
real rights. Commitment laws have been stripped of all reason, refusing to
acknowledge that nearly half of those who are refusing medication actually are
unable to see that they are ill. The vast majority of those who received court
ordered outpatient treatment in New York, for instance, retrospectively endorsed
the value of the order in helping them get their lives back.

The system is designed to treat people only after it is too late. Ironically, if
Alpizar had been captured instead of killed, he likely would have received the
medication he needed from a jail cell. Our country has no trouble treating
people from behind bars to ensure they can be tried and convicted -- we just
seem to have trouble helping them get the treatment they need to allow them to
peaceably live out their lives.

Air marshals have a job to do, as do police officers and sheriff's deputies. For
the latter, much time is now spent intervening with homeless people who are
delusional, transporting people with severe mental illnesses who need emergency
evaluations to the hospital, and managing domestic disturbances, incidents of
violence, and threats of suicide.

It is time to literally stop the madness.

People with severe mental illnesses who are taking medication are no more likely
to be dangerous than the general population. But when they are not taking
medication, that is no longer true. That means that these encounters are
dangerous not only for the people who are ill, but also for officers -- compared
with the rest of the population, people with mental illnesses, usually off their
medication, killed law enforcement officers at a rate 5.5 times greater.

Refusing to help people who are too ill to help themselves is not compassionate
-- it is deadly and short sighted.
The Treatment Advocacy Center -- -- is a national nonprofit
dedicated to eliminating barriers to timely and humane treatment for millions of
Americans with severe mental illnesses.


3. NEW YORK TIMES, December 9, 2005

[Editor’s Note: Planes can be stressful, but especially so for someone affected
by the symptoms of a psychotic disorder. Since 9/11, there have been a number
of incidents involving a person overcome by delusions disrupting an airline
flight. Air marshals are placed in an untenable situation when faced with a
person who is experiencing psychiatric symptoms onboard an airplane. While the
emphasis need be on ensuring that people get treatment to avoid psychiatric
crises before boarding a plane, training for air marshals to recognize the signs
of a severe psychiatric disorder can help protect the air marshals from harm as
well as everyone else onboard.]


By Matthew L. Wald

WASHINGTON, Dec. 8 - Part of air marshals’ training entails various attack
exercises in which actors portray “bad guys” of differing kinds, including some
who are mentally ill. But marshals say the mental status of a person they must
confront on the job may have little effect on their response.

“In the street as a police officer, when you deal with an emotionally disturbed
person, you are taught to contain that person, to call for emergency services
and E.M.S.,” said John Bottone, who formerly worked as an air marshal after a
career with the New York City police. “But when you’re in an airplane, you are
emergency services, you are E.M.S., you are everybody. It’s a whole different
scenario you have to deal with.”

The marshals take a course called “Managing Abnormal Behavior” during their
preliminary training at the Federal Law Enforcement Training Center in Artesia,
N.M., said David M. Adams, a spokesman for the
Federal Air Marshal Service. But several marshals said their main training was
in the attack exercises, some intended to help them tell the difference between
someone who is a real threat and, on the other hand, someone who is simply under
the influence of drugs or alcohol and who may reach into a pocket to pull out
something as innocuous as a ballpoint pen.

In any case, discerning the finer points of a threatening person’s motivations
is not always a top priority outside of training.

“I think there’s a real fine line between somebody who is unstable and
unbalanced, and somebody who’s really fanatical about his cause,” said one air
marshal, recalling that the marshal corps existed in its present size because
there were people who had volunteered to fly airplanes into big buildings.

Mr. Bottone said mental status could not have been the first concern of the air
marshals who shot an apparently bipolar man at Miami International Airport on

“The federal air marshals weren’t sitting there saying: ‘Is this guy straight?
Is this guy bipolar?’ “ he said. “What they saw is a guy who said he had a bomb,
and it was a threat to kill them and everybody else on the aircraft.”

In fact, said Mr. Adams, the marshal service spokesman, concluding that a person
is mentally ill is not the same as concluding that he is harmless.

“A mentally disturbed person could still have a bomb,” he said. “Look at the
individual who shot President Reagan.”

Since the increase in security after the terror attacks of Sept. 11, 2001, air
travel has become much harder for the mentally ill, said Mary T. Zdanowicz,
executive director of the Treatment Advocacy Center, which lobbies on behalf of
people with mental illness. Ms. Zdanowicz said she had two brothers with
schizophrenia, one of whom flew to Washington from Boston soon after Sept. 11.
Her brother did not understand instructions to take off his shoes at the
security screening point, she said, and had trouble staying seated within 30
minutes of landing, as was required for Reagan National Airport.

“I’ve not had him fly since,” she said.

One problem, Ms. Zdanowicz said, is that a common tactic of law enforcement
officers is the wrong one to use with the mentally ill.

“Typically when they are trying to subdue someone whose behavior is escalating,
they pump themselves up, make themselves big, get in their face and try to
overpower them,” she said. “That kind of behavior will more often lead a person
with mental illness to get worse.”

After Wednesday’s shooting, the National Alliance on Mental Illness called on
the Air Marshal Service and other law enforcement agencies to review their
training to determine if it is adequate. In August 2004, the Homeland Security
Department’s inspector general found various deficiencies in the air marshal
program, including inadequate background checks on the flood of new officers.
Training problems were also cited, although they did not involve lack of
instruction in detecting mental illness.

The air marshal program has had frequent changes in organization. After the
Sept. 11 attacks, thousands of marshals were recruited to flesh out a skeletal
organization that had been part of the Federal Aviation Administration. The
expanded program was run first by the newly formed Transportation Security
Administration and later by another Homeland Security agency, the Bureau of
Immigration and Customs Enforcement, the idea being that the marshals and the
customs service could draw on each other’s personnel. But in October the program
was transferred back to the Transportation Security Administration.


4. LOS ANGELES TIMES, December 11, 2005

[Editor’s Note: If Los Angeles County Sheriff Lee Baca is overstating when he
calls his jail “the biggest mental hospital in the country,” it would only be
because it’s not a hospital. For there is no doubt that Los Angeles County Jail
houses more people with a severe mental illness than any other inpatient
facility in the nation.]



By Steve Lopez

He's 42 and bearded, thin as a dry twig, hands cuffed behind him. When he gets
out, he says, he wants to play baseball, be a rock star and get a paper route.

"Just call me Mickey Vin Priestly," he says, making up a name and telling me
it's "very miserable" on the seventh floor of the Los Angeles County Jail.
"Everybody keeps trying to poison me."

After we talk, deputies march the schizophrenic inmate back to his cell and lock
the door behind him. Mickey Vin Priestly, in custody since September on an
attempted robbery rap, immediately begins pacing his concrete box and talking to
the walls.

On the same block of Tower 1, one prisoner is banging on a door with thunderous
blows. Another man stands trance-like in front of his door for all to see, buck

The doors and windows of other cells are plastered with warnings to jail staff.

Kicker. Biter. Spitter. Suicide Watch.

"I run the biggest mental hospital in the country," Sheriff Lee Baca often says.

That's a bit misleading, since only a small percentage of inmates actually need
inpatient hospital services. But with roughly 2,000 inmates who've been
identified by the jail as having mental issues, about two-thirds of whom are in
for nonviolent crimes, Baca has a point.

People are locked up for being mentally ill, essentially, because there's
nowhere else to put them. The jail is a dumping bin, teeming with inmates the
jailers are ill-equipped and too understaffed to help, and sometimes can't even

On Nov. 16, 35-year-old Chadwick Shane Cochran's mental problems cost him his

A drifter whose friends said he suffered from paranoia and delusions, Cochran
was brought in out of the rain in October by an elderly Covina woman who let him
stay in a trailer behind her house. When he said he was afraid that people were
out to get him, she gave him a revolver, in the misguided belief that it would
make him feel safe. Instead, it got him arrested for being a felon in possession
of a gun.

Cochran's mental history landed him in the Twin Towers, along with other sick
inmates. But he wasn't as sick as some of the others, and since there's just not
room to segregate every mentally ill prisoner, Cochran got transferred over to
the hard-core Men's Central facility, which resembles a dungeon.

There, deputies had the bright idea of stashing Cochran in a windowless holding
room with 30 other prisoners and no supervision. Apparently thinking Cochran was
a snitch, two gang members tortured him for up to 30 minutes, then stomped and
beat him to death. One of the alleged killers was awaiting trial on murder
charges and the other on kidnap and carjacking charges.

Cochran was the eighth person killed in Los Angeles County jails over the last
two years.

"He was a fish out of water," Baca said of Cochran. "These inmates were sharks,
and he was in the shark tank."

An unguarded shark tank. Overcrowding or not, there's no acceptable explanation
for taking a nonviolent offender fresh out of the mental wings and tossing him
into an unsupervised room full of heavyweight thugs.

County supervisors, with good reason, are tired of hearing Baca's explanations
and promises of improvement. But they should pay more attention to one of the
sheriff's main points: In a better system, Cochran wouldn't have been in jail.

"We would have taken the gun, booked it away, and trotted him off to a mental
treatment area in the community somewhere, so he could get the problem
addressed," he told me.

But there's currently no provision for such a thing. In fact, all mental health
services are in absurdly short supply. The state mental hospitals are
ridiculously understaffed and often chaotic and dangerous. Community clinics are
few and far between. Emergency room beds for acute mental problems are in such
short supply, patients often end up back on the streets and, sooner or later,
back in jail.

The jailhouse, in fact — despite the horrors and staffing problems — is one of
the few places where mental health care is available. The county Department of
Mental Health runs a quasi hospital, dispenses meds and offers psychotherapy.

"My comment on running the largest mental hospital in the country is a plea for
help," says Baca.

None of this lets the sheriff off the hook, of course. If he knows he's got
people in his jail who shouldn't be there, the least he could do is keep them
safe even if he can't provide the kind of help they need.

But it's not often that you hear a law enforcement official asking, as Baca is,
that prosecutors and courts de-emphasize criminal behavior in consideration of
the cause of that behavior. He wants greater use of drug and mental health
courts to divert people into drug rehab and mental health programs rather than

He also wants more people scouring the streets "and looking under bridges" for
homeless, mentally ill and substance-abusing people, steering them toward help
before they find trouble. Proposition 63 money, which will start flowing in
January, will make some of this possible, and it's about time.

What I've learned this year about mental illness is that there are no cures, and
there are no easy fixes, either, for a system that's been shamefully neglected
for decades.

But I've learned, too, that lives can be reclaimed, and that when the sheriff
keeps reminding us he runs the biggest mental hospital in the country, it's
meant to shock and embarrass us. And it should.


5. ST. PETERSBURG TIMES (FL), December 13, 2005

[Editor’s Note: A youth with bipolar disorder who gets in trouble when not
taking his medication steals a six-pack of beer from a neighbors garage.
Whether through court intervention or not, clearly what is needed is a way to
keep that young man on his medication. That solution was not so clear, however,
to Circuit Judge Ric Howard of Citrus County, FL. Judge Howard’s answer for
Adam Bollenback? A ten-year prison sentence designed to “break his spirit.”

Bollenback has served 40 months already – almost seven months per beer. When he
went into jail, Florida had no mechanism to order him to treatment in the
community. If the clemency board releases him, he will reenter a world where
assisted outpatient treatment is an option]



When Circuit Judge Ric Howard sent Adam Bollenback to prison in 2002, he did so
with the stated intention of aiming to "break (Bollenback's) spirit."

How he intends to measure the success of that strategy remains unclear. If the
goal was to scare the Inverness teenager, then Howard may well have succeeded.
Being stabbed in the neck with an ice pick wielded by a fellow inmate tends to
create that result.

It is less likely that Bollenback is coming around to Howard's view that an
outrageously outsized prison sentence is commensurate with justice. Serving 10
years in an adult prison for the petty crime of stealing a six-pack of beer
tends to generate feelings of being abused, not helped, by the judicial system.

Bollenback's case has stood as the local gold standard of unfair and
inappropriate sentences by Howard until being eclipsed by the recent William
Thornton ruling. Bollenback, however, should not be allowed to languish
anonymously in his imposed hell for years to come simply because his case no
longer is front-page news.

Like Thornton, Bollenback is seeking justice outside the Citrus County
Courthouse. On Thursday, he will get a chance at freedom and at rebuilding his
life when the Florida Board of Executive Clemency is scheduled to consider his
clemency request.

The four-member board, led by Gov. Jeb Bush, should waste no time in granting
Bollenback's release.

Strict law-and-order types may carp that Bollenback is a criminal and deserves
punishment. And they have a point. Up to a point.

Bollenback did commit the crimes for which he was convicted, and they were not
the first blemishes on his record. He has a record as a juvenile of battery and
assault, although the circumstances of those offenses (he was charged with
aggravated assault after throwing a stick, for example) raise legitimate
questions about the fairness of the charges against him.

The crimes for which Howard sentenced Bollenback in 2002 involved stealing a
six-pack of beer from the open garage of a neighbor who later said that had she
known at the time that such a harsh sentence was a possibility she never would
have called the police.

The teenager also managed to slip away briefly from a deputy who was taking him
to jail, which says as much about the deputy's actions as it does Bollenback's.

Bollenback also has been diagnosed as having bipolar disorder, and his mother
told the judge that the offenses occurred when he was off of his medications.
This aspect of the case should have received the court's attention, but it was

The state Department of Corrections considered Bollenback's crimes and record
and recommended that the 17-year-old wear an electronic monitoring ankle
bracelet for two years. The Department of Juvenile Justice recommended a short
term in a juvenile detention facility.

Howard rejected all of that pertinent information and chose to use Bollenback to
send a message not just to the teen but to the community at large that he will
be tough on crime. Bollenback's life was to be sacrificed in order to make a

While we want our judges to be firm and no-nonsense, we demand that they also be
fair and to dispense justice with compassion and an understanding of the facts
of the case. Howard's sentence failed those tests.

Even those who would side with Howard must concede that having served 40 months
in prison, Bollenback has more than paid back society for his crimes. It is now
up to the state Board of Executive Clemency to correct this gross error and to
save this young man's life.


6. VERO BEACH PRESS JOURNAL (FL), December 9, 2005

[Editor’s Note: As we have documented over and over again in the E-News,
thousands of lives are lost or wasted because someone with an untreated
psychiatric disorder is left to the symptoms of their illness until it is too
late or released from treatment too soon. That makes the scenario detailed
below all the more unimaginable. A person who was placed in a psychiatric
facility because he was deemed dangerousness walked away to tragic results. Yet
it is not that he escaped the facility that is most shocking – it is that the
facility’s policy is not to stop committed patients who are leaving from doing


By Adam L. Neal

INDIAN RIVER COUNTY — Sebastian River Medical Center officials said Thursday
their policy states they cannot stop anyone committed under Florida's Baker Act
from leaving their hospital.

They cited the policy as to why they didn't prevent a Micco man involuntarily
committed under the Baker Act by the Brevard County Sheriff's Office from
leaving the hospital Tuesday and returning home.

The man, whose name wasn't released by law enforcement agencies, was shot four
times in the torso by an Indian River County sheriff's deputy later that night
when local detectives reported he made an aggressive move with an ax. He remains
at Holmes Regional Medical Center in Melbourne.

"If they walk out, we can't stop them," said Daisy Knowles, director of
marketing for the Sebastian hospital. "The deputies already left so we couldn't
do anything about it."

Sgt. Andrew Walters, spokesman for the Brevard County Sheriff's Office, said
once deputies transport a Baker Act patient to a receiving facility such as SRMC
and the person is admitted, the custody is relinquished to the hospital or
center. The Sheriff's Office doesn't have any supervision requirements after the
patient is admitted.

"That doesn't mean we won't help them out if a patient is combative or
something. Our focus is on the safety of the patient and the safety of the
medical staff," he said. "But once we turn them over to the receiving facility,
we are done."

Florida statutes state a Baker Act patient "may not be released by the receiving
facility or its contractor without the documented approval" of a psychiatrist,
clinical psychologist or designated physician devoted to mental-health patients.
Indian River sheriff's officials said the man left SRMC without medical

The Indian River County Sheriff's Office was called when hospital officials
noticed the man was gone, but Knowles said she didn't know how long he had been
missing before they called authorities.

When Indian River deputies Karl Joe Alexander Moody and Daniel Hatch went to the
Micco home to check on his well-being, authorities said the man was wielding an
ax, according to a Brevard County sheriff's report. Moody shot the man when he
made an aggressive move toward them with the ax, an Indian River County
sheriff's report stated.

State and local agencies are investigating the shooting. In accordance with
policy, Moody was put on paid, non-disciplinary leave pending the outcome of the


7. PSYCHIATRIC NEWS (Vol. 40, No. 23), December 2, 2005

[Editor’s Note: The NIMH CATIE study comparing different anti-psychotic drugs
has garnered attention, both within the mental health field and without it.
Below Dr. Steven Sharfstein, President of the American Psychiatric Association,
give his reasonable take on its significance.]


By Steven Sharfstein, M.D.

When was the last time that the results of an NIMH study on schizophrenia made
the front page of the New York Times? The first phase of results of the Clinical
Antipsychotic Trials of Intervention Effectiveness (CATIE) was published in the
New England Journal of Medicine in its September 22 issue. In this "real world"
prospective study, 1,500 outpatients with schizophrenia were randomly assigned
to one of four atypical or one typical antipsychotic medication and then
followed over 18 months.

The findings indicated that a very high percentage of the patients (nearly
three-fourths) discontinued their assigned medication before the 18 months due
to intolerable side effects, lack of efficacy, or some other reason. There were
few differences among the five medications in terms of rates of discontinuation
or efficacy. Patients in all groups showed only modest improvement in their
average symptom scores over time.
Dr. Jeff Lieberman and colleagues, who conducted the study, should be commended
for this "head-to-head" study of antipsychotic medications. Unlike in most other
psychopharmacologic studies, participating patients were allowed to receive
other psychotropic medications and were studied for an extended time period.
This study is likely to have profound implications for clinical practice and for
the policy decisions that are likely to be made as a result of the high cost of
atypical antipsychotic medications.
Medicaid today spends more than $3 billion per year on antipsychotic
medications—more than any other drug class. The newer drugs account for $10
billion in total annual sales and account for 90 percent of the national market
for antipsychotics. The use of typical (or older) antipsychotic medications has
dropped dramatically in the last decade. The atypical antipsychotics cost much
more than the older drugs, depending on the drug (from three to 10 times more).
Many state Medicaid programs are short on funds in part because of the high cost
of schizophrenia drugs.

Newspaper stories underscored the implications of the study for state Medicaid
programs and other payers. Further, the stories were both implicitly and
explicitly critical of the marketing by Big Pharma. As the New York Times
editorial accompanying its September 20 front-page story stated, "A
government-financed study has provided the strongest evidence that the system
for approving and promoting drugs is badly out of whack.... The nation is
wasting billions of dollars on heavily marketed drugs that have never proven
themselves in head-to-head competition against cheaper competitors." The
newspaper stories also underscored the fact that antipsychotic drugs are very
much a halfway technology and that patients are better after taking them but
certainly not well. Again, as the New York Times stated, "The current state of
schizophrenia treatment leaves a lot to be desired."

The results of the study should be of deep concern to psychiatrists as we
struggle with this extraordinarily disabling illness. One implication is that
this is a cautionary tale on the reliance we have all had on Big Pharma
promotions as the major source of information about the newer drugs' presumed
superiority to the older agents. Better efficacy and lower side effects are
undoubtedly found by some patients who use the newer versus the older
medications; however, the wholesale benefits of these newer medications compared
with the older ones were not confirmed by the first phase of the CATIE study.
Second, the press coverage of the New England Journal of Medicine report did not
emphasize, as the authors of the study did, the need for individual choice about
the best antipsychotic medication regimen for patients who may have differences
in family history, weight concerns, co-occurring conditions, and other factors.
It would be regrettable if the main impact of this study and its press coverage
was on the economics of treatment instead of the clinical needs of patients with
this devastating disorder.

Psychiatrists need to be more aware of the efficacy of the less expensive, older
medications compared with the newer medications when evaluating and recommending
treatment for patients with schizophrenia. Just because a medication costs more
doesn't mean that it has superior efficacy. But just because a medication costs
more doesn't mean that the medication should not be part of an approved
formulary. The CATIE study highlights what we already know as
psychiatrists—antipsychotic medications are an incomplete treatment in enabling
patients with schizophrenia to overcome their illness. We need accessible
psychosocial treatments in addition to medications in order to help patients
regain their social and vocational functioning and progress to recovery.


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Sunday, December 11, 2005


TAC Newsletter 12/09/05


Visit our web site
December 8, 2005



2, 2005

December 7, 2005
4. A VERY PERSONAL COMMITMENT - The Star-Ledger, December 01, 2005

5. A TRIBUTE TO DR. MORTON BIRNBAUM - Catalyst, Winter 2001



1. STOCKTON RECORD (CA), Nov 24, 2005

[Editor’s Note: Thomas Testa, a Deputy District Attorney for California’s San
Joaquin County, knows all too well of untreated mental illness – it’s his job to
prosecute those charged with crimes because of actions resulting from symptoms
rather than intent. The murder cases mentioned below involve, of course, only
an infinitesimally small proportion of Stockton’s population with a severe
psychiatric disorder – yet they are only the most egregious consequences of
allowing psychosis to go unchecked. They are also horrific symbols of thousands
of other lives harmed, allowed to waste, or that are otherwise diminished
because of an absence of treatment.

We are surprised that Mr. Testa, a lawyer, did not identify one of the most
formidable obstacles to consistent treatment in his county – state laws that
prize the right of those incapable of making rational medical decisions to
“chose” to be free from undeniably needed psychiatric care.]


Local, National Cases Shine Harsh Spotlight On Group

By Scott Smith, Record Staff Writer

STOCKTON -- San Joaquin County Deputy District Attorney Thomas Testa said in
recent years he has prosecuted too many murderers with previously diagnosed
mental health problems and is tired of it.

In each case, Testa said, a person died under heinous circumstances while the
killer goes to state prison or a mental hospital. Countless relatives grieve
because the defendant failed to stay on prescribed psychological drugs, he said.

Testa wonders if a local agency could have stepped in. He said he holds family
members responsible for failing to make their mentally ill relatives take
prescribed medicine.

"I suggest they even go so far as to count the pills," he said.

But the situation is not that simple, said attorneys and psychologists who work
with San Joaquin County residents struggling with mental illnesses. The
percentage of mentally ill people committing violent crimes is low but usually
gains public notoriety.

"Like any minority group, people suffering from mental illnesses are painted
with a broad brush as criminals," said Ellen Schwarzenberg, a San Joaquin County
deputy public defender assigned to the mental health court.

Mental illness, which results from a chemical imbalance in a person's brain,
should be treated as a disease and not criminal behavior, she said. Police don't
understand the problem and frequently take a person to jail rather than to
mental health treatment facilities, she said.

Testa said crimes committed by mentally ill people make national headlines,
punctuating those local cases he prosecutes. He cited four Stockton cases in the
past couple of years:

# Wayne Osborg Jr., 32, was convicted and sentenced to two consecutive life
sentences in August for bludgeoning two men when he didn't show up at a
treatment home for his mental illness.
# Khanh Duy Phan, then 34, was convicted in March 2004 for decapitating his
18-month-old daughter and sentenced to state prison for 26 years to life.
# Peter Nhim, then 18, was convicted in October 2004 of second-degree murder in
the stabbing death of a 9-year-old family friend.
# Robin Rials, then 17, pleaded guilty to first-degree murder in March 2004 but
avoided prison after a judge ruled she was insane when she set fire to an
abandoned trailer where a man slept.

Linda Collins, a court liaison for San Joaquin County Behavior Health Services,
bemoaned a stigma that mentally ill people are criminals rather than fighting a
chronic illness. She urges better education, especially for law enforcement and
court officials.

Collins managed a program focused on treating mentally ill inmates in the County
Jail. The program was successful at reducing recidivism but funding dried up
with budget cuts in recent years, she said.

Proposition 63, passed by voters last year, promises to turn the tide for
mentally ill people caught in the legal system, she said. It taxes Californians
earning more than $1 million annually to fund programs for mentally ill people.

"I work with those people who have done heinous things," she said. "But I've
also seen people return and recover to a full and productive life."


2. ASSOCIATED PRESS, December 2, 2005

[Editor’s Note: Whether or not sex offenders should be retained after the
expiration of their prison sentences is a morass of moral conundrums. It is
also an issue outside our area of focus, and expertise. We can easily, however,
insist that those adjudged to be sexual predators should not be placed in the
general population of a general psychiatric hospital, and admire the
self-sacrificing gesture of Dr. Brandon Krupp.]


By M.L. Johnson, Associated Press Writer

PROVIDENCE, R.I. (AP) -- With a repeat sex offender about to be released from
prison after serving 16 years for raping a young boy, Gov. Don Carcieri directed
state officials put him in a different institution: the state mental hospital.

Dr. Brandon Krupp, who ran the hospital's psychiatric services, opposed the
plan, saying it would not protect the public and could put other patients at
risk. When his protest went unheeded, he quit.

"Doctors aren't jailers," Krupp said in an interview shortly after leaving the
job. "Hospitals aren't prisons."

Krupp's resignation is an extreme reaction to a growing problem: no one knows
what do with sex offenders who seem likely to commit more crimes. Seventeen
states have laws that allow them to hold sex offenders who have completed their
prison terms. More recently, governors in other states have tried to use mental
health laws to keep sex offenders in psychiatric hospitals once their prison
terms end.

New York Gov. George Pataki used his state's mental health law to order a dozen
sex offenders held when their sentences ended. Doctors released one after a
psychiatric review last month, but the others remain hospitalized while an
appeals court reviews their case. In Rhode Island, Carcieri directed state
officials to commit Todd McElroy to the Eleanor Slater Hospital in October,
shortly before he was due for parole on a 42-year sentence for kidnapping and
raping a 10-year-old boy.

McElroy, who is schizophrenic, had been held for more than a year in the
hospital's forensic unit, which has prison-like security. But Krupp says
McElroy's schizophrenia is now under control, and he no longer belongs in a
hospital. As his parole date neared, McElroy moved voluntarily to a regular unit
at the hospital while he awaits a court hearing to determine whether he will be
freed. He shares a 16-bed, coed ward with patients who have done nothing wrong.
He has access to a day room, nurses' station and the outside. Krupp and other
doctors say McElroy's confinement is a gross misuse of medical facilities.

The Rhode Island Psychiatric Society took the unusual step of calling a news
conference to oppose the state's plan to commit McElroy. The American
Psychiatric Association has opposed similar plans, saying government officials
seem more intent on punishing sex offenders than treating them. Medical
guidelines require that a person be mentally ill, dangerous because of the
illness and capable of being treated before they are committed to a hospital.

Most sex offenders don't meet that criteria, said Roxanne Lieb, director of the
Washington State Institute for Public Policy, a state-funded think tank.
Washington passed the first sex offender commitment law in 1990 and holds them
in a secure, separate facility.

"Typically, they are not mentally ill by a traditional definition of the word,"
Lieb said. "They don't have a mental disorder, they don't have a thinking
disorder, they are not psychotic."

Howard Zonana, who teaches forensic psychiatry and law at Yale University, said
the problem is really "how you separate the mad from the bad." Studies show a
significant percentage of prisoners have anti-social personalities, but not all
of them belong in psychiatric hospitals, he said.

"Why not put in every murderer in a hospital after they've served time for
manslaughter?" he asked. But H. Reed Cosper, Rhode Island's mental health
advocate and McElroy's former lawyer, said it's silly to split hairs over why
sex offenders commit their crimes. If they are mentally ill and dangerous, they
should be confined, he said.

Another problem with hospitalization is cost. The 17 states with sex offender
commitment laws spend $224 million per year to keep them in separate, secure
buildings, according to a study by the Washington State Institute for Public
Policy. Holding them in a psychiatric hospital like Slater would cost even more
because of the additional medical care, Zonana said.

That's one reason why members of the National Association of State Mental Health
Program Directors do not want sex offenders in the hospitals they run. Sex
offenders draw limited resources from other patients, the group's spokesman Roy
Praschil said. And, many doctors disagree about whether people can even be
treated for pedophilia and other violent behavior.

From the 1930s to about 1970, 26 states had laws letting sex offenders opt for
psychiatric treatment rather than prison, Zonana said. But those programs died
after graduates raped, or even killed, again. Jeff Neal, Carcieri's spokesman,
declined to discuss McElroy, but acknowledged that mental health laws are not an
ideal way to handle sex offenders. He said the governor plans to introduce a
bill to increase prison terms and set up electronic monitoring for people who
assault children. McElroy and his attorney declined to discuss his case.

Krupp said he hopes his resignation will stir public debate and lead to a better
solution. "This isn't about me wanting this or any other sex offender
unfettered, free on the streets," he said, but "to think that the quick fix for
this is to shove them in the hospital is absolutely wrong. It's neither
appropriate nor will it actually get you the safety you want, because we're not
a prison."


3. CANTON REPOSITORY (OH), December 7, 2005

[Editor’s Note: It couldn’t have taken Frank McKnight long to write the 97
words in the letter below, but those few minutes spent made the message of
treatment law reform ring in papers throughout his community.]


Letter to the Editor

On Nov. 28, you ran the story, “Schizophrenic who killed parents strives for
normal life.” What a sad story. Even more so because of the laws in our state
that limit treatment to those with severe mental illnesses.

These people are unable to access treatment voluntarily because of the symptoms
of their illnesses — they simply don’t realize how sick they are.

Several states, including Michigan, Florida and West Virginia, have enacted
assisted outpatient treatment laws that make court-ordered outpatient treatment

These laws have literally saved lives. It’s time that Ohio does the same.

Frank McKnight, Jackson Township


4. THE STAR-LEDGER (Newark, NJ), December 01, 2005

[Editor’s Note: We’ve seen the reactions of many governors to the issues
affecting severe mental illness – disinterest, encouragement, action,
stonewalling, and ignorance among them. We’ve never seen this.]


Codey Spends A Night Walking In The Shoes Of Greystone Psychiatric Patients

By Lawrence Ragonese, Star-Ledger Staff

He booked himself into Greystone on Tuesday. There was no court order, no police
involvement. It was a voluntary overnight commitment to the state psychiatric
hospital for one Richard J. Codey. Yes, the state's acting governor.

Trying to keep the spotlight on mental-health issues, Codey checked in at the
nearly 600-patient hospital in Parsippany for a 14-hour, firsthand look at how
patients live and the care they receive.

The 58-year-old celebrity patient asked for no special privileges -- though he
could not shed his own security detail. He ate dinner and breakfast with other
patients, watched TV with them in a day room, sang Christmas carols with them
and then trudged off to room 2-15B for sleep.

Codey did not come to Greystone empty-handed. He bought pizza and soda for his
fellow patients in Ward 73 and arranged a musical show through the First
Presbyterian Church Choir of Caldwell. He gave out specially designed T-shirts
featuring a basketball logo and the words "Giving Recovery A Shot" on the front
and "Gov. Codey #1" on the back.

He even gave one patient, Robert Romash, his governor's watch.

In return, Codey got hugs, high fives, big handshakes and plenty of thanks.

"There were a couple things I wanted to do," Codey said in a pre-bedtime
interview late Tuesday night. "One, bring a little joy into their lives and make
it something that otherwise would not have been. They wouldn't have had a
concert, wouldn't have had pizza, wouldn't have gotten shirts. It adds a little
holiday cheer for them, something they normally would not get."

Second, he wanted to continue calling attention to the needs of the state's
mentally ill and to try to eliminate the stigma residents face.

Codey arrived at Greystone at 5:14 p.m. Tuesday. He was greeted by patient Dave
Lambert outside the Abell complex as a host of hospital officials and employees
looked on. The acting governor was led to his room, unpacked his bags and asked,
"So when's dinner?"

Late for dinner, Codey sat alone but was quickly joined by eight patients who
peppered him with comments and questions.

"We are so proud of the things you have done for this state," said Philip, a
patient wearing headphones and a backward blue baseball cap.

"Are you related to Buffalo Bill Codey?" asked patient Robert.

"Why don't you run for president?" asked another patient, as Codey laughed and
several patients chanted for him to be president.

Later, he joined patients in the Abell auditorium for entertainment he arranged.
Corinne Tracy led a flute trio, Heather Jones played handbells, Barbara Piercy
played piano and the Retromen chorus from James Caldwell High School sang
holiday songs. Two enthusiastic patients, one named Peggy and another named
Codey, joined them onstage for the finale, "Santa Claus is Coming to Town."

Then it was off to Ward 73 for a pizza party financed by the acting governor's
political action committee. For his bedroom, the governor used a vacant program
room at no cost to taxpayers.

Codey has long been an advocate of better mental-health care in New Jersey. In
the 1980s, he went undercover as an employee at now-defunct Marlboro State
Psychiatric Hospital to shine a light on problems there. Since replacing James
E. McGreevey as governor last year, Codey and his wife, Mary Jo, have made
mental-health care in New Jersey a priority issue.

"People like Peggy, that's what this effort is all about," Codey said, referring
to his singing partner. "She is so funny and smart. Helping her, providing good
care for people like her is important. She deserves it."

The acting governor formed a state Mental Health Task Force and has worked to
enact its recommendations, including eliminating liens against patients who
cannot afford state hospital care, setting up a trust fund to create more
housing for the mentally ill, forgiving student loans for people who take
hard-to-fill social services jobs and providing free mental-health screenings
for pregnant women without health insurance.

"It's a quality-of-life issue," he said at breakfast yesterday. "Statistics show
us one in every five New Jersey families today have someone with some kind of a
mental illness. It crosses all barriers -- rich, poor, black, white, male,
female. It's hitting all segments of society."

Patients gave Codey an earful about their situations. Most complained about the
quality of food. Codey agreed, calling his dinner of broccoli and cheese with
some bread crumbs "absolutely terrible."

Some patients wanted a better outdoor smoking area. One asked for the
installation of a change machine to make it easier for patients to use pay

Others spoke to him of their personal situations.

William, 41, of Rockaway Township, lamented the recent death of his mother. He
said he hopes to overcome a bipolar disorder and eventually get back into the
work force.

Robert, 39, of Jefferson, said he has been at Greystone six times in 17 years.
He has overdosed three times, including after the deaths of his grandmother and
a best friend. He said he first began to sense psychiatric problems in his late
teens when he got an overwhelming urge to put his hand under a running

He wanted Codey to grant him one wish.

"I know there is no magic pill. But that's what I want," Robert said. "I want
the governor to give me a magic pill to make this all go away."


5. CATALYST (Vol 3, No. 6), Winter 2001

[Editor’s Note: Morton Birnbaum, a pioneering crusader for the care of people
with severe mental illnesses who is inextricably intertwined with the effort to
create “a right to treatment,” passed away on November 26 in Brooklyn from the
effects of a stroke.

Holding degrees in both medicine and law, he supported himself through his
gerontology practice in Bedford-Stuyvesant while working nights and weekends on
pro bono legal cases targeted at securing wholesale increases in the quality and
quantity of care for individuals with acute psychiatric disorders. As he
described, "I make my living as a doctor, and throw it away as a lawyer."

We can make no better tribute to Dr. Birnbaum than the one below by Rael Jean
Isaac, author of Madness in the Streets, which commemorated his receipt of our
Torrey Advocacy Commendation.]


By Rael Jean Isaac

When we think of the giants of mental health reform in the United States, the
names of Dorothea Dix (the woman who through her single-minded devotion
persuaded state legislatures to create the system of asylums for the mentally
ill), Clifford Beers (father of the National Association for Mental Health and
the child guidance clinic), and Albert Deutsch (whose Shame of the States
exposed the extent to which asylums had been allowed to deteriorate, with
patients left untended and untreated) come to mind. But there is another
individual, his contribution today generally overlooked , who belongs in the
class with these pioneering figures: Morton Birnbaum, father of the concept of a
"right to treatment."

Today this is such a familiar principle that it is hard to believe that in 1960
it was considered an outlandish notion. The first two sentences in Birnbaum's
seminal article of that year, The Right to Treatment, sum up its thesis: "The
purpose of this article is to advocate the recognition and enforcement of the
legal right of a mentally ill inmate of a public mental institution to adequate
medical treatment for his mental illness. For convenience, this right will be
referred to as the right to treatment." Birnbaum argued that, "incarceration by
the state in a mental hospital without proper treatment is a deprivation of
liberty without due process [i.e., unconstitutional]."

The article accumulated rejection slips. Birnbaum remembers his disappointment.
"I sent the article off. It seemed to me absurdly simple. I couldn't understand
that no one would accept it. I could show you maybe fifty rejections. I sent it
off to the New England Journal of Medicine - it came back. I sent it to the
Journal of the American Medical Association. It came back. American Journal of
Psychiatry; it came back. I sent it to Harvard Law Review, Yale Law Review. They
didn't even send it out for peer review lots of times. One journal sent it back
with a note saying, 'This is preposterous.' I sent it out for a couple of

Finally, in 1960, the American Bar Association Journal not only published the
article, but accompanied it with an editorial endorsing the idea. And, in its
Sunday edition, the New York Times published an article about this novel idea of
a "right to treatment."

Birnbaum's background made him a surprising advocate for mental patients. He
received his law degree from Columbia in 1951 and subsequently went to medical
school, in 1957 receiving his M.D. in general medicine, not psychiatry. His
interest was in catastrophic illness, the kind of illness which the average
person or family could not cope with financially. He came to focus on severe
mental illness as the chief catastrophic illness where improvement in care was
most needed, developing the ideas for his ground-breaking article as a
post-doctoral fellow at the Harvard University Training Program for Social
Scientists in Medicine in 1958-59.

But even the favorable editorials did not have the effect Birnbaum expected.
Says Birnbaum: "I thought once it got published, the doors would break down and
everyone would say, 'What a wonderful idea, you discovered a new penicillin.'
But nobody broke down the doors. What amazed me was that the only real comments
I got on it were from two patients in state hospitals. One was Donaldson in
Florida and the other was a guy, Stevens, in New York." Birnbaum took on both
cases at his own cost. Fifteen years later, O'Connor v. Donaldson became a
landmark Supreme Court ruling. (Birnbaum pursued the "right to treatment"
Stevens case with equal tenacity, but Stevens was finally freed by an
administrative decision, not through victory in the courts.)

Well before his triumph in freeing Donaldson, who had been held in Florida State
Hospital for fourteen years, the "right to treatment" had a major impact on
mental health law. (Ironically, much to Birnbaum's disappointment, the Supreme
Court used other grounds, not the "right to treatment," to release Donaldson.)
Birnbaum's testimony in 1961 before a Senate subcommittee looking into mental
health law led to the drafting of a model bill with a provision recognizing and
enforcing the right to treatment. But the language did not survive. Enacted in
1964, the final model bill had only a phrase referring to the right.

While Birnbaum was, of course, deeply disappointed, only two years later the
U.S. Court of Appeals for the District of Columbia recognized the right to
treatment on the basis of that hesitant reference in the 1964 bill.

Birnbaum has been a consistent advocate both for mental hospitals and for
treatment. He harbored no hidden agendas, as would so many in the emerging
mental health bar, who invoked the "right to treatment" in order to achieve the
opposite: massive deinstitutionalization coupled with the right to refuse
treatment. In his 1960 article, Birnbaum wrote that he did not expect any major
decrease in the number of hospitalized patients since the new neuroleptic drugs
had produced only a slow, irregular drop in the patient population, patients
continued to relapse despite the drugs, and no radically new methods of
treatment were on the horizon.

Birnbaum harbored a simple, humanitarian conception that would, alas, turn out
to be naive. He conceived of the right to treatment as a pragmatic solution to
the hitherto intractable problem of maintaining decent conditions in state
hospitals. Periodically there would be exposes of dreadful conditions and public
wrath would force improvements, but then the situation would revert to its
previous condition. Birnbaum saw the right to treatment as an enforcement
device. As he explained in a 1971 article in The Alabama Law Review, he proposed
giving the patient the right to obtain his discharge from a hospital, regardless
of the severity of his illness, if the hospital was unable to prove that it
lived up to objective, institution-wide standards (like a set ratio of patients
and physicians) for providing adequate treatment.

Birnbaum was convinced that if the public discovered courts were discharging
severely ill patients because hospitals were not providing treatment, it would
(as he wrote in The Right to Treatment) "force the legislatures to increase
appropriations sufficient to make it possible to provide adequate care and
treatment so that the mentally ill will be treated in mental hospitals."
Birnbaum even wanted to limit the right of hospitals to discharge sick patients
into the community. In his 1971 article he wrote: "If no family is available,
and if no publicly supported halfway house, or similar facility is available,
the patient may not be discharged."

Birnbaum's first clear victory in achieving court recognition (and enforcement)
of the right to treatment was in Wyatt v. Stickney, the famous Alabama case in
which Birnbaum served as co-counsel. (The lead attorney was Alabama lawyer
George Dean.) It was a Pyrrhic victory because he had inadvertently teamed up
with lawyers who were intent on subverting his concept. Bruce Ennis, and the
other lawyers who cut their teeth on Wyatt v. Stickney (and would form the
Mental Health Law Project) had no interest in promoting treatment. Ennis said
frankly that he initially refused to touch right to treatment cases and only
decided to become involved in Wyatt v. Stickney because there was advance
information that the judge would not only endorse the existence of a "right to
treatment" but would set standards so high Alabama could not meet them, and
would be forced to embark on radical deinstitutionalization.

When it turned out that Alabama indeed could not meet the standards imposed by
Judge Frank Johnson, Birnbaum looked to the federal government. He decided to
challenge the constitutionality of the 1965 Medicaid legislation that excluded
state mental hospital patients under age sixty-five from Medicaid benefits.
Because of Medicaid's matching provisions, he calculated that if Medicaid
included state mental hospital patients, Alabama would be able to quadruple its
expenditures on these patients without increasing state appropriations. It was
at this point Birnbaum ran aground on the insistence of Dean, Ennis and the
other like-minded lawyers involved in the case, that state mental hospitals
should be done away with in favor of alternative community facilities. Says
Birnbaum: "My arguments that a sufficient number of alternative facilities were
not available were of no avail." Disillusioned, Birnbaum dropped out of Wyatt v.
Stickney and turned to his opponents in the case. "I said maybe you're
interested. They're going to give a judgment against you, you'll need the money.
For $100 of Alabama funds, you'd get $300 of federal funds. Without it you're
going to get nothing."

In fact, Birnbaum had much more in common with his ostensible chief opponent in
the case, Alabama Health Commissioner Stonewall Beauregard Stickney, than he did
with the members of his own legal team: both of them genuinely wanted to improve
treatment of the mentally ill. At the outset, Stickney had conceded Birnbaum's
case: patients had a right to treatment. Stickney approached then Governor
George Wallace, who agreed to bring the state of Alabama into a suit challenging
the Medicaid exclusion.

Perhaps nothing in his career proved his single-minded dedication to the welfare
of the mentally ill so much as Birnbaum's willingness to forge an alliance with
George Wallace, then a presidential candidate and a symbol of the populist far
right, whom Birnbaum, as a political liberal, regarded with horror. The
incipient alliance ended abruptly when Governor Wallace was shot and paralyzed.

Birnbaum brought his suit, Legion v. Richardson, in 1972, asking that the
Medicaid exclusion be declared unconstitutional. In the end, he would lose the
suit. But on crucial issues, Birnbaum never gives up. During the Clinton
administration, he brought suit again in federal court (Doe v. Shalala) to end
the Medicaid exclusion. The importance of this issue, long neglected by
advocates for the mentally ill, has now been recognized by the Treatment
Advocacy Center.

One of the most striking aspects of Birnbaum's writings is his ability to
recognize key problems long before they come to general attention. Birnbaum
touched on many of the issues that TAC president E. Fuller Torrey, through his
books and articles, has brought to public awareness. In 1970 Birnbaum was
writing about the dwindling number of psychiatrists addressing the needs of the
seriously mentally ill; the failure of the new community mental centers to treat
them (Birnbaum pointed out that in 1969, for all the publicity about their role
as an alternative to state hospitals, the centers accounted for only 4% of
inpatient care episodes for those under 65 and only 2% of those over that age);
the failure to provide "support and rehabilitative services needed by the
severely ill"; the growing number of homeless people roaming the streets in
various states of undress.

Dr. Birnbaum, who maintains a modest geriatric practice in the run-down Bedford
Stuyvesant section of Brooklyn, has said wryly: "I make my living as a doctor
and throw it away as a lawyer." Evening and weekends over the last decades he
has persevered on the lawsuits he has brought to improve conditions for mental
patients - e.g., against the two-tier system of care in psychiatric units of
general hospitals and in state hospitals (1982), against the egregious
overcrowding in Kingsboro Psychiatric Center (1986). His litigation and other
activities, as Birnbaum has written, "are essentially both a one-man activity
and personally financed, as I receive no fee or subsidy."

Dr. Birnbaum has always followed his own star and this is probably the reason
his enormous contribution has been overlooked. If he had been willing to swim
with the tide, and join forces with the Mental Health Law Project in its battle
to "free" involuntary mental patients from both institutions and treatment, he
would doubtless have been celebrated as a "father" of what passes today as legal

To Birnbaum it would have been unthinkable to betray his vision for the sake of
fame and recognition. He has never become an organizational leader, although he
tirelessly mobilized support of organizations as amicus curiae in the early
lawsuits he brought. Now in his mid-seventies, Dr. Birnbaum perseveres in his
driven, selfless quest to improve the lot of the mentally ill. We humbly salute


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extra cost to you! The link below will bring you to Amazon, where all you have
to do is shop.

You don't have to fill out anything special when you check out. Amazon simply
records that you came to their site via TAC’s charitable link and our Center
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Order copies for the people you love (including yourself!) and TAC gets a
percentage of the money you spend (these using the links below will also let
Amazon know you are a TAC supporter).

Beasts of the Earth: Animals, Humans, and Disease

191 pages (March 2005) Rutgers University Press; ISBN: 0813535719

"This book is a wonderful combination of very readable scientific and historical
underpinnings of past and present epidemics of the spread of diseases from
animals to people."—Sidney M. Wolfe, M.D., director, Public Citizen’s Health
Research Group, Washington, D.C.

Surviving Manic Depression: A Manual on Bipolar Disorder for Patients, Families,
and Providers

by E. Fuller Torrey, M.D. - 416 pages (January 8, 2002) Basic Books; ISBN:

"A lucid, thorough guide to every aspect of living with bipolar disorder ...
[this book] covers symptoms, treatment and advocacy ... [The book] explain[s]
what mania and depression feel like from the inside, the causes and risk
factors, the range of possible medications and treatments, and 10 special
problems for manic depressives like alcohol abuse and medical noncompliance.
There's also a section on bipolar disorder in children and a list of frequently
asked questions. This is a valuable resource for anyone touched by the illness."
- Publishers Weekly

The Invisible Plague: The Rise of Mental Illness from 1750 to the Present

by E. Fuller Torrey, M.D. - 400 pages (January 2002) Rutgers University Press;
ISBN: 0813530032

"Important and provocative." - Dr. Gerald Grob, psychiatric historian

"In their refreshing, thoroughly documented, cogent reply to the current
generally accepted interpretation of the incidence and even the existence of
insanity, Torrey and Miller point out many holes in the arguments of other
recent historians of the subject and don't push any single approach to
schizophrenia and manic depression." - William Beatty, American Library

Surviving Schizophrenia : A Manual for Families, Consumers and Providers

by E. Fuller Torrey, M.D. - 480 pages 4th edition (May 8, 2001) Quill; ISBN:

"A comprehensive, realistic, and compassionate approach... Should be of
tremendous value to anyone who must confront these questions." - Psychology

"E. Fuller Torrey is a brilliant writer. There is no one writing on psychology
today whom I would rather read." - Los Angeles Times

Street Crazy, The Tragedy of the Homeless Mentally Ill

by Stephen B. Seager, M.D. - 216 pages (November 30, 2000) Westcom Press; ISBN:

"Mental illness profoundly affects most of us, often through the sad story of a
sick relative or friend, and if you've ever wondered what was happening, this
book will answer your questions simply and clearly. I can't recommend STREET
CRAZY highly enough." Carla Jacobs, former member, Board of Directors for NAMI


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Saturday, December 03, 2005


The PAIR Program listed as a 'best practice" model

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TAC Newsletter

Visit our web site
December 2, 2005


1. HOME ELUDES PATIENT - Raleigh News & Observer, November 28, 2005

2. MANDATORY TREATMENT LAW NEEDED IN ALBERTA - Edmonton Sun, November 26, 2005

3. A HALT IN MEDS LED TO SUICIDE - North Jersey Herald & News, November 22, 2005

Express, June 1, 2005

5. SILENT PAIN OF SUICIDE - Rockford Register Star, November 17, 2005


1. RALEIGH NEWS & OBSERVER (NC), November 28, 2005

[Editor’s Note: The odyssey of Phil Wiggins continues. After more than forty
years of living in inpatient facilities, Mr. Wiggins was placed in the community
as a result of North Carolina’s decision to eliminate psychiatric beds and rely
more heavily on less intensive community placements.

Neither we nor virtually anyone else is pushing for a return to the mid-20th
century era of wholesale institutionalization, when hundreds of thousands of
patients with a mental illness were warehoused in psychiatric hospitals for
periods of years or even decades. Given the undeniable dearth of inpatient
capacity today, however, we cast a wary eye towards any plan that will further
diminish the ability to tend to those who still require long-term care in a
psychiatric facility.

Revolutionary advances in treatment allow the majority of people with severe
mental illnesses to live and often thrive in the community. Yet, whether for
crisis stabilization or longer, some people with acute psychiatric disorders
still require the intensive treatment and support of a psychiatric hospital.]


By Ruth Sheehan, Staff Writer

Phil Wiggins should have been kicked out of his group home in Zebulon a month
ago today.

The holdup is that the county cannot find him a place to go.

Wiggins, 62 and schizophrenic, spent 44 years in state psychiatric hospitals
until last spring when, under the aegis of mental health reform, he was released
into community-based care.

I've been following his journey for nearly a year and a half now. His progress
has brought great hope. But there have been setbacks, too. He is on his fifth
community-based social worker already. He seems so mild-mannered, but he's
tricky and quick -- and more trouble than most folks getting paid $10 an hour
want to mess with.

Last month, he tried to set a fire outside the group home with baking soda,
cologne and matches pilfered from another resident's room. That's when the
eviction notice came to his sister, Louise Jordan, who lives in Raleigh.

Since then, the county has tried, without success, to find another suitable home
for Wiggins. Jordan has visited three possibilities.

One, near Hedingham, left her sobbing. The second, on the south side of Raleigh,
was neat enough, but it catered to patients who were high-enough functioning
that they could cook for themselves.

The third is very nice, located in a typical North Raleigh neighborhood with a
park up the street.

But there, as at the second home, the clients are higher-functioning than
Wiggins. Several have jobs at sheltered workshops. A couple have notes from
their doctors allowing them to stay in the home for up to three hours without

These are what the advocates refer to as "cream puffs," residents who need
assistance but can manage basic self-care fairly well on their own.

Wiggins is no cream puff.

He will wear the same dirty clothing day after day if allowed.

He needs help with personal hygiene.

His pockets need to be searched every time he enters the house.

And then there is his fascination with fire and chemicals. A few weeks ago, the
house attendant in Zebulon discovered that Wiggins had poured sugar and vanilla
flavoring into one of his drawers with plans to set the mixture on fire.

Now the county is trying to find a day program that will allow Wiggins to
attend, so that a personal social worker can be with him from late afternoon
until late evening, after he goes to bed. The county needs to find him another
worker for the weekends.

And the group home in Zebulon has had to hire an extra person to be on hand, and
awake, during the night.

Wiggins wanders, after all. He goes through other residents' belongings. He
stashes items that might be interesting to light on fire.

Essentially, Wiggins needs one-on-one care, 24 hours a day. But the community
isn't quite ready to provide it.

So much for the supposed economies of community-based care; so much for market
forces providing all the care that's needed for the mentally ill in our state.

Mental health reform sounds so simple; real life is far more complicated.


2. EDMONTON SUN (Alberta, Canada), November 26, 2005

[Editor’s Note: The United States does not have a patent on the problems caused
by untreated, acute psychiatric disorders. Neither is it the only country to
have developed new and effective treatment laws to address the myriad of new
challenges presented by deinstitutionalization. And U.S. advocates are not the
only ones who struggle to put the reformed laws in place for the benefit of
those overcome by serious mental illnesses.

Exchange the phrase “assisted outpatient treatment” for the Canadian equivalent
“community treatment order,” and this article easily fits in with any of the
numerous ones on efforts to reform U.S. treatment laws that have been featured
in the E-news.]



By Mindelle Jacobs, Edmonton Sun

There is overwhelming evidence that mandatory community treatment for people who
are seriously mentally ill has enormous benefits for both patients and the

And this week, the head of mental health services for the Capital Health
Authority told a fatality inquiry that Alberta needs so-called community
treatment orders (CTOs).

"What a number of psychiatrists are saying is we need some (legal authority) to
treat these patients who are recidivistic," Patrick White told the inquest into
the shooting deaths last year of RCMP Cpl. Jim Galloway and Martin Ostopovich.

Ostopovich, who had been diagnosed as paranoid and delusional, was gunned down
by police after he killed Galloway during a Spruce Grove standoff.

The Alberta government, however, is still not convinced of the merit of CTOs,
although varying forms of mandatory treatment laws exist in 46 U.S. states and
some provinces.

Basically, CTOs compel outpatients who are likely to harm themselves or others
to take medication. If they don't, they can be committed.

In Canada, Saskatchewan and Ontario have CTOs and Quebec has a court-directed
version. Nova Scotia has just passed CTO legislation and Newfoundland is
considering it.

Seriously mentally ill patients in B.C. who are likely to harm themselves or
others can get conditional leave from hospital if they agree to take their meds.

Manitoba and Alberta also have leave provisions. But the criteria for forcibly
committing mentally ill people to hospital in Alberta are so narrow that
patients don't often get leave because they're considered dangerous.

But for people who can be safely treated on an out-patient basis, CTOs can
significantly reduce the so-called revolving door syndrome - mentally ill people
who repeatedly relapse and end up back in jail or hospital.

Since 1999, for instance, New York state has had court-ordered assisted
outpatient treatment to force people with mental illness and a history of
hospitalization or violence to participate in community-based services.

This year, the New York State Office of Mental Health released a study on the
effectiveness of the legislation.

The study observed the lives of several thousand people before and after they
were placed on mandatory community treatment. It found that incarceration
dropped by 87%, homelessness fell by 74% and psychiatric hospitalization
plummeted by 77%.

In addition, suicide attempts or self-harm dropped by more than half, and there
was about a 50% reduction in the abuse of drugs, booze and physical harm to

More than 80% of the participants reported that mandatory community treatment
helped them get and stay well.

The study clearly shows the benefits of CTOs, says John Gray, a psychologist and
president of the Schizophrenia Society of Canada, adding CTOs should be
available countrywide.

"When a person is ill enough to need ... compulsory hospitalization and
treatment, it makes sense to have that in the least restrictive environment
possible," he says.

The Alberta government, however, still isn't convinced of the benefits of CTOs.

The province has asked the Alberta Mental Health Board to review the
effectiveness of CTOs, says Alberta Health spokesman Howard May.

"It's a controversial, emotional area and ... you're always balancing public
safety with personal rights."

But Gray argues it's silly to make a civil liberties argument in the case of
people who are so sick they think they're getting messages from the TV.

"Do you really have civil liberties when you think that the CIA is chasing you
or you see things that aren't there and you can't think logically? Is that real

Former Antarctic explorer Austin Mardon, who has had schizophrenia for 13 years,
is also pleading with the government to bring in CTOs.

"We're not inventing something new," he says. "I believe that there's a lot of
lost human potential."


3. NORTH JERSEY HERALD & NEWS (NJ), November 22, 2005

[Editor’s Note: The importance of medications for illnesses like bipolar
disorder is self-evident, and reinforced by the words of doctor after doctor,
scientific article after article, and experience after experience of those with
such illnesses who have failed to maintain treatment. Yet even mental health
professionals can lack an appreciation of the consequences of discontinuing
treatment, even for a relatively short time. Jim Enron, a psychologist with
bipolar disorder, forgot to take his medication on a family trip.]


By Tom Davis

You'd think the last candidate for suicide would be a psychologist.

But psychologists say: Never underestimate the power of mental illness.

Ask Judy Eron, a clinical social worker and singer-songwriter. Her husband, Jim,
was a licensed psychologist who killed himself a decade ago after he abruptly
stopped taking lithium.

Shouldn't a psychologist know better?

Eron, who grew up in Millburn, calls it "the question of the ages." The
circumstances can be completely benign and harmless, she said.

"We left on our regular summer trip to Washington State, and we were about four
hours from home when Jim said, 'I forgot to bring my lithium,'Ÿ" Eron said.

"With my acute 20/20 hindsight, clearly we should have just turned around and
gone home to get the lithium. But we were immensely ignorant, despite both being
mental health professionals."

Once Jim entered the realm of "mania," she said, there was no bringing him back.

Eron recounts her husband's year-long decline and the events leading to his
death in "What Goes Up ... Surviving the Manic Episode of a Loved One"
(Barricade Books).

Eron, who now lives in Texas, said her book is "what I would have wanted to read
then," as she struggled to care for her husband. She considers it a guide for
people who care for people who suffer from mental illness.

Mental health professionals have lined up to endorse the book, saying it's a
"must-read" for anyone who has a loved one with serious mental illness.

"I have no doubt that her candid description of her experience will be healing
to others," said Xavier Amador, a Columbia University professor and a member of
the National Alliance for the Mentally Ill's board of directors.

But it's also for those who - because of their credentials - may feel as if
they're immune.

Brain disorders don't discriminate, mental health professionals say.
Psychologists often have to treat other psychologists for mania and other

"Mental illness can be biologically inherited. Secondly, it can be learned,"
said Samuel Shein, a Teaneck psychologist. "If I had a rejecting and abusive
parenting, I can end up feeling very, very inadequate and depressed as an adult.

"Patients learn it or inherit it and so do mental health professionals," he
added. "We're the same."

While her husband suffered, Eron searched for resources. Although there were
many books on depression, only a few dealt with someone who is manic.

"We were so ignorant," she said. "In kindness to myself, I remind myself that
almost none of the current books on bipolar had been written in 1996-97, when
all this happened."

In the book, Eron talks of her husband's decline with hopelessness. Her many
years of experience were useless once Jim was engulfed in his "horrific" state
of being.

At that point, Eron said, she and her husband had just read Kay Redfield
Jamison's "Unquiet Mind," in which she describes her own manias, with a certain

"It's part of the illness to want to be off meds, to feel that juice," Eron
said. "I think that influenced Jim and reminded him of the power of mania."


4. SAN ANTONIO EXPRESS (TX), June 1, 2005

[Editor’s Note: It is easy, especially when symptomatic, for someone with a
severe psychiatric disorder to fail to comprehend the risks of foregoing
treatment. Likewise, it is easy for those who love the person to
underappreciate the magnitude of unfamiliar conditions.]


By Dr. María Félix-Ortiz (Q & A)

Dr. Felix-Ortiz: Thank you for your columns regarding bipolar disorder. It
really makes me realize how naïve I was about the disorder. My son was diagnosed
several years ago and tried to convey his misery by phone, as he lived in a
different state. Unfortunately, he became a statistic and took his own life last
year. He was 33 years old and refused to be on medication for his lifetime. I
naïvely thought he'd deal with it as we all have blue/down-in-the-dump days. We
were lucky that his remains were found by a man walking his dog in a wilderness
area. It was not unusual for my son to be out of touch for months at a time. So,
again, thank you for your articles. It really has helped me to realize the
anguish he was going through. Sincerely,


Dear PS: I'm so sorry for your loss. Your story is a sad reminder that bipolar
illness can be deadly. Depression is the common cold of mental health, but the
illness ranges in severity from simple sadness to suicide. We, as a community,
must take action to protect and to keep our facilities well-funded and open, so
that there are places locally for our loved ones when they are ill, where they
can remain close to family during their episodes of mental illness.


ROCKFORD REGISTER STAR (IL), November 17, 2005

[Editor’s Note: Some tragic deaths get more attention than others. Headlines
appear when a person is harmed because of someone else’s severe mental illness
goes untreated. Yet, a suicide of a person due to an acute psychiatric disorder
rarely finds newsprint, unless done in some particularly attention-getting

The nation’s media has emphatically, and rightly, memorialized the lives of the
2,000 servicemen and women lost in Iraq. For good reason, few people have been
more greatly mourned, cherished, and revered than the 3,000 who perished on
September 11, 2001.

Thirty thousand Americans commit suicide every year; 5,000 of them suffer from
schizophrenia or bipolar disorder. Where are their headlines?

More information on suicide and severe mental illness is in our fact sheet at: ]


Stigma Of Mental Illness Persists, And Family Members Are Left Behind To Suffer
The Loss

By Geri Nikolai, Rockford Register Star

Police officers, coroners, chaplains, EMTs — all can tell wrenching stories of
dealing with suicide victims.

Sally Cantwell of Rockford has experienced it even more painfully. Her son,
Michael, took his own life on Valentine’s Day 2004. He was 30 and had been
fighting drug addiction for 10 years.

Sally and her husband, Ray, got a call from police at 4:45 that morning: Come to
your son’s home right away.

When they arrived and learned that Michael had hung himself, Sally screamed and
slumped to the ground.

“You go numb, it’s such a shock,” she said.

To Ray, it “hurt so bad it was almost physical.”

Dozens of Rock River Valley families feel that pain each year. In 2005, there
have been 26 suicides in Winnebago County. Over the past 12 years, the county
has recorded 20 to 39 suicides each year. In Boone County, the numbers have
ranged from zero to five; in Ogle, three to 10.

Families of suicide victims will meet Saturday at SwedishAmerican Hospital in
Rockford to take comfort from one another in the Survivors of Suicide Day of
Conferences. Around the nation, more than 30 similar gatherings will take place,
including a national telecast and local panels to shed light on the problem,
help families and answer questions.

Nationally, about 30,000 suicides are reported each year. Experts say the real
number is higher because sometimes no one knows whether the death is accidental
or intentional, and some cases are unreported because of family pressure.

The local numbers reflect these national trends:

Males are four times more likely to kill themselves than females.

Females are three times more likely to attempt suicide than men.

Whites are more likely to commit suicide than other races.

The national rate of suicide among youth has declined slowly in the past 12
years, but it remains the third or fourth leading cause of death among males and
females ages 15 to 30.

Suicide rates increase with age and are highest for people 65 and older.

The most common method suicide for men is a gun; for women, poison.

Local Deaths ‘Alarming’

As facilitator for the local Ray of Hope suicide survivors group, Karon Pfile
gets a report on suicides from the Winnebago County coroner’s office every six
months. The reports this year, with 26 suicides as of Nov. 15, are “alarming,”
Pfile said.

“Nationally, elderly suicide is on the rise, but here, it’s more young people,
from their late teens on up,” she said.

Pfile puts some of the blame on the disease of depression and the way society
views it.

“Clinical depression is a mental health need with a known physiological cause as
much as diabetes,” Pfile said. But insurers don’t see it that way. Many don’t
cover mental health to nearly the extent they cover physical health.

Depression, bi-polar disorders, drug/alcohol abuse and psychosocial stresses
like isolation all contribute to the approximately 30,000 suicides reported in
the U.S. every year, said Dr. Raymond Garcia, a psychiatrist at the University
of Illinois College of Medicine at Rockford and medical director of Singer
Mental Health Center.

Garcia believes suicide is on the rise, partly because in today’s mobile
society, some people lose their social support system. That’s especially true of
older folks.

“Telecommunications is a double-edged sword,” Garcia said. “It separates us from
one-on-one contact.”

The depression that leads to suicide is a feeling not understood by most people
who have not experienced it, said Dr. Charles Smith of Rockford, a retired
internist whose 28-year-old daughter, Carrie, took her life three years ago.

Carrie showed signs of depression in high school and college, but her parents
didn’t suspect a serious problem. That surfaced years later, seemingly out of
the blue.

Carrie, a college grad, lived in Chicago, where she was doing research on
Parkinson’s disease at the University of Illinois. She was, said her dad, “a
stunning woman and so personable I admired her social skills.”

One reason the Smiths had not worried about Carrie during her teen bouts of
minor depression was because of how well she took care of herself. That
continued into adulthood. Carrie, in fact, ran 26-mile marathons, including one
in Ireland she dedicated to her mother because it was a fundraiser for
arthritis, which Bobbi Smith has.

But late in 2001, depression hit hard.

“All of a sudden she was so sick,” Charles said.

Carrie withdrew from family and friends. She sought help, got medicine and
treatment. It was an uphill battle, but by spring, Carrie seemed improved.

“We now know this is a common experience,” her father said. “She got better, had
a burst of energy. Three days later, she took her life.”

Reaching Out

That was May 7, 2002. Charles and Bobbi Smith have dedicated their lives since
then to preventing suicides. Among their efforts are eight support groups for
people with depression or bi-polar disorder that meet weekly in Rockford,
Belvidere, Oregon and Freeport.

The groups are vital, said Charles Smith, because most of us are woefully
inadequate at understanding the pain of someone with clinical depression.

“As a doctor, I knew the clinical stuff,” he said, “but as to the personal side
of depression, I had no idea.”

He has learned that being depressed is like being in a “black hole and believing
there is no way out. And they feel ashamed because they can’t get past it.”

Even when they approach medical professionals for help, some patients with
depression feel they are bothering caregivers who have more important medical
cases to tend, Smith said. The depressed or suicidal patient gets the “oh, it’s
you again” treatment.

That’s why Smith started the local meetings, which he calls Group Hope.

“These patients are so sick of feeling isolated. Here is a place they can talk
safely with others who understand,” he said. “They talk about suicidal thinking,
things they won’t tell their doctor or family, and they help and encourage each

Families who lose someone to suicide go through many emotions, including grief,
guilt and anger. The pain seems unbearable.

“They say nothing is more painful than to lose a child to suicide,” said Dr.
Smith. But there is a worse pain, he believes — the pain Carrie and those like
her felt as they sunk into a depression so deep that death seemed the only way

The Role Of Drugs

The Cantwells know their son, Michael, took his own life. But drugs were the
real killer, they believe.

Michael, said his mother, Sally, was a most unlikely candidate for suicide.

“If God handed you an order form and said order a baby boy, he was what you
would have ordered,” she said. “He was a perfect kid growing up. He never had a
mental or emotional illness until he got into drugs.”

He was the kind of kid who, while vacationing in London, noticed a market vendor
who was making no sales. Michael took the money he’d saved for souvenirs and
bought two velvet wall hangings.

After graduating from Rockford Lutheran in 1991, Michael did his first two years
of college at DePaul in Chicago and Rockford College here. Then he transferred
to Northern Illinois University, where his parents discovered his drug use.

They pulled him out for a semester, and he seemed to be over it. But back at
school, the problem rose up again.

That became the pattern for Michael for 10 years. He managed to graduate from
NIU and land a job. Then he'd lose it.

The cycle continued. During his sober, employed stints, he seemed fine, enjoying
family, friends and pets and, occasionally, baking “monster” cookies for his
niece and nephew.

Michael wanted to get off drugs. He asked his parents for help. He tried several
programs. Sally recalls sitting on a park bench with a sobbing Michael one
afternoon when he told her:

“I can’t expect you to understand this. I don’t understand it myself. But I can
tell you one thing. I wouldn’t wish this on my worst enemy.”

In late 2003, the Cantwells could tell their son was slipping. He was seeing a
psychiatrist and taking medication, but his mood was dark.

If they hadn’t lived it, the Cantwells might still believe that drug addiction
and suicide don’t occur in families like theirs: a middle class, Christian,
two-parent home.

Now, Sally is on a mission to make sure Michael’s death makes a difference. She
talks to groups about Michael’s charm, potential and fall to addiction.

“See these baby shoes,” she said. “I expected his feet to learn to walk in
these, and someday to walk in a graduation ceremony ... and maybe down a
hospital corridor to see his own baby.

“I didn’t expect these feet to take him up a sidewalk to a crack house.”

You Can Help

Suicide can be prevented, experts say. It will take a change of attitude in
society, the acceptance of the view mental illness is not shameful and that no
one is immune.

“It can happen to anyone,” said Garcia. “The majority of us have some type of
mental illness.”

Because isolation can lead to depression, Smith encourages church groups and
others to take note of people who are alone much of the time and involve them in
personal contact activities.

Experts say to watch for signs of serious depression and get help if the person
is a minor or urge the adult to seek help. Some people who would resist going to
a counselor or psychiatrist might be willing to talk to their family doctor,
suggested Smith.

If you have a friend or family member who is suffering depression, don’t
discount the sadness they feel, Smith said. If you simply urge them to cheer up,
you’re not helping. In fact, they may feel like you’re judging them and finding
them a failure because they can’t shake off the blues.

You can validate the person’s feelings by saying “I am so sorry you experience
that” or “I can’t imagine what it’s like.”

If you worry someone is suicidal, don’t avoid the subject, said both doctors.

“It’s a common misperception that if you bring it up, you give them the idea,”
said Garcia. “But that’s not the case. If that’s part of their plan, it’s
already in their mind.”

Be especially concerned if you notice behavioral changes like withdrawal from
society; giving away possessions; and, in some way, saying goodbye, Garcia said.

“Definitely talk to that person and let them know help is available,” he said.

Bringing the topic into the open, added Smith, immediately provides some small

“These people are so sick,” he said, “they need every ounce of support we can
give them.”



CONTACT, 24-hour hot line: 815-636-5001
National Suicide Prevention Hot line: 800-273-TALK (8255); calls go to Janet
Wattles Center emergency services
Wattles weekday hot line: 815-720-5028
Wattles after hours/weekend hot line: 815-968-9300
Ray of Hope suicide survivors group: 815-636-4750
Your family doctor or hospital
Mental Health Association of Rock River Valley: 815-226-4770
Information about support groups for people with depression or bipolar disorder:
Information about presentation on drug abuse/suicide from mother of victim:
National Hopeline Network: 800-SUICIDE
Depression and Bipolar Support Alliance: 800-826-3632


Previous suicide attempt
History of mental disorders, especially depression
History of alcohol and substance abuse
Family history of suicide
Family history of child maltreatment
Feelings of hopelessness
Impulsive or aggressive tendencies
Barriers to getting mental health treatment
Loss (relational, social, work, financial)
Easy access to lethal methods
Unwillingness to seek help because of the stigma attached to mental health
Local epidemics of suicide
Isolation or a feeling of being cut off from people

Source: CDC


Suicide Awareness Voices of Education:
National Strategy for Suicide Prevention:

American Association of Suicidology:

National Institute of Mental Health:
National Center for Injury Prevention and Control:


Males are four times more likely to die from suicide than females.
Women report attempting suicide during their lifetimes three times as often as
White suicide rates are more than twice as high as nonwhites.
In 2002, 132,353 people were hospitalized after suicide attempts
A suicide death happens once every 16.6 minutes in the U.S.
It is the 11th ranking cause of death for all Americans; eighth for men; third
for young people.
Youth suicide rates increased more than 200 percent from the 1950s to the late
1970s. From the late ’70s to mid-1990s, rates remained stable and, more
recently, have slightly declined.
Diagnosis groups at particular risk include depression, schizophrenia, drug
dependency and adolescent conduct disorders.
The risk of suicide rises to more than 50 percent in clinically depressed
60 percent of suicides were by people with depression.
The risk of suicide in alcoholics is up to 70 percent higher.
There are 790,000 attempts in the U.S. each year and about 30,000 reported
There are 5 million living Americans who have attempted suicide.
There are 25 attempts for every death by suicide; the ratio is 100-200:1 for the
young and 4:1 for the elderly.
Suicide rates are highest in the Mountain states.

Source: U.S. Centers for Disease Control


U.S. suicide data from 2002, the most recent year for which statistics are
Total deaths: 31,655 (86.7 per day)
Males: 25,409
Females: 6,246
Whites: 28,731
Nonwhites: 2,924
Ages 15 to 24: 4,010
Ages 65 or older: 5,548

Firearms: 54 percent
Suffocation/hanging: 20 percent
Poisoning: 17 percent
Falls: 2.3 percent
Cut/pierce: 1.8 percent
Drowning: 1.2 percent
Fire/flame: .5 percent

Ages 5 to 14: .6
Ages 15 to 24: 9.9
Ages 25 to 34: 12.6
Ages 35 to 44: 15.3
Ages 45 to 54: 15.7
Ages 55 to 64: 13.6
Ages 65 to 74: 13.5
Ages 75 to 84: 17.7
Ages 85+: 18

Source: American Association of Suicidology


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