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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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