Saturday, December 17, 2005


TAC Newsletter 12/16/05


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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


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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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