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January 6, 2006



2. MENTAL HEALTH TREATMENT MUST BE IMPROVED - The Daily News Tribune, January 6,

Today, December 21, 2005

December 18, 2005

5. MENTALLY ILL MAN LANGUISHES IN JAIL - Denton Record Chronicle, December 23,

6. REPORT: MEDICAL REFORM NEEDED IN JAILS - Lincoln Journal Star, December 21,

Record, March 16, 2005



We recommend recent report from NAMI-Ohio that details strategies and exemplary
programs aimed at preventing and easing interactions between individuals with
severe mental illnesses and the criminal justice system. The report, by Paul W.
Spaite and Mark S. Davis, presents details and analysis backed by well-chosen
research outcomes on the workings and effectiveness of programs in these areas:

Homeless Outreach
Crisis Intervention
Mental Health Courts
Other Types of Post-Arrest Diversion
Post Incarceration Support and Linkage to Community Treatment

Advocates looking to improve their local mental health and criminal justice
systems’ treatment of the most ill will find a wealth of ideas in the report,
which is available on the NAMI-Ohio website at:

Mr. Spaite, a co-author, encourages comments on the report and suggestions of
other programs worthy of inclusion in possible future editions to him at


2. THE DAILY NEWS TRIBUNE (Waltham, MA), January 6, 2006

[Editor’s Note: Non-treatment can equal tragedy. And when you are in one of the
few states without assisted outpatient treatment, non-treatment is in many cases
a matter not just of mistake or a broken mental health system, but one of law.]


Letter to the Editor

Daniel Westbrook had not been taking his prescribed schizophrenia medication for
six months when he slashed the throats of Claudia and Jin Chung last week. ("Off
his medication, man stabs two neighbors," Jan. 3, Daily News Tribune).

The case is an eerie echo of another early January tragedy in Middlesex County.
Richard Hartogensis’ schizophrenia was unmedicated for months before he stabbed
his wife and broke her neck.

What it will take to get Massachusetts to update its outdated mental illness
treatment laws?

Apparently the answer isn’t "(a) tragedy."

Despite a multitude of murders and suicides, incidences of violence and
homelessness, repeated incarcerations and arrests, there has been little
groundswell to help people like Westbrook and Hartogensis get treatment before
something horrible happens.

Massachusetts needs a more humane treatment law. For instance, of those enrolled
in New York’s assisted outpatient treatment program, 74 percent fewer
experienced homelessness, 77 percent fewer experienced psychiatric
hospitalization, and 87 percent fewer experienced incarceration. Participants
were more likely to take medication, less likely to be violent or commit
suicide. And their quality of life improved.

Massachusetts is one of only eight states that does not have a similar law. Rep.
Kay Kahn is a hero in championing such legislation. Middlesex County should make
a New Year’s Resolution to support her effort to lead the way in bringing
assisted outpatient treatment to Massachusetts.

Mary Zdanowicz,

Executive Director, Treatment Advocacy Center, Arlington, Va.


3. MAINE TODAY, December 21, 2005

[Editor’s Note: Stemming in significant part from federal funding policies,
states have closed psychiatric hospital after psychiatric hospital in the last
decades. The results are often shocking – especially given the increasingly
critical shortage of inpatient capacity. Yet, many mental health administrators
continue to push for the elimination of more psych beds.

Take Maine’s experience with its new hospital, which replaced a much larger one
that was closed. Insufficient capacity forced hospital administrators to turn
away sixty-one percent of qualified patients seeking admission to the facility
in the first month of operation. That is not a shortage due to changed
circumstance, but rather of short-sightedness.]


AUGUSTA, Maine — The Riverview Psychiatric Center opened barely a year and a
half ago, but a legislative committee is already taking a look at whether the
state´s new mental hospital is too small.

The Legislature´s Government Oversight Committee is requesting information from
Riverview officials and will decide next month whether to order a feasibility
study on expanding the center.

Too many people are simply being turned away from the hospital, said Sen.
Elizabeth Mitchell, chairwoman of the committee.

Statistics show the 92-bed hospital has turned away at least 40 percent of
qualified patients each month since it opened. Sixty-one percent of qualified
patients were turned away in the first full month of operation, in July 2004.

"The focus (of the committee) is on what´s happening to the people who are not
getting a bed in Riverview," said Mitchell, D-Vassalboro. "No one seems to have
a handle on that."

Riverview opened in June 2004 to replace the Augusta Mental Health Institute.
But even as the $31 million hospital was being built, some were questioning
whether it had enough beds to meet the need for psychiatric care.

In November, a committee of health professionals concluded Riverview was too
small. Although some in the group disagreed, a majority felt the state should
expand the facility.

The hospital is designed so it can easily be expanded. But not everyone thinks
it should be.

Maine doesn´t need more hospital beds, and instead would be better office
investing in improved community mental health services, said Brenda Harvey,
deputy commissioner of the Department of Health and Human Services.

Harvey said improved community services would allow patients to leave hospital
care sooner and to get treatment closer to their homes. Better crisis response
services could help keep people with mental illnesses out of the state hospital
entirely, she says.

"I think there are many things we can look at before we build more hospital
beds," Harvey said.


4. WILLIAMSPORT SUN-GAZETTE (PA), December 18, 2005

[Editor’s Note: And where will those refused needed inpatient psychiatric care
end up? Chances are that many of them will instead find, or not find, treatment
in jail.]


By Katie Prince, Sun-Gazette Staff

State mental hospitals have emptied rapidly over the past 10 years, while the
number of mentally ill state prisoners has increased, a trend that has left many
people asking whether society is doing what it should for the mentally ill.

“Prisons are the mental hospitals of today,” said state Secretary of Corrections
Jeffrey Beard during a recent interview with the Sun-Gazette.

Beard claimed that over the past five years, the mental health population in
prison has increased from 14 to 19 percent, and figures from the state
Department of Corrections back him up.

Of the nearly 40,000 male prisoners in the state system in 2004, the last year
for which data are available, 6,600 were classified as suffering from a mental
illness, according to the state Department of Corrections. Of the state’s 1,826
female inmates, 806 were so classified. Overall, just over 18 percent of state
inmates had a mental illness in 2004 and were participating in treatment, the
state reported.

Into the community

The hospital closings are spurred by federal mandates as well as state officials
who believe long-term institutionalized psychiatric treatment is a thing of the
past. They say treatment for people with serious mental illnesses should happen
in the community. Critics say that communities are not equipped to handle such a
task — at least not now.

“’Close the institutions’ has been the rallying cry of mental health advocates
from the ’60s through to the present, and political directives mandated
discharges of patients,” said Dr. Dilwyn Symes, a psychiatrist at Divine
Providence Hospital, which provides short-term acute care for people with mental

“And these patients went to flop houses with little or no follow-up,” he said.
“And they committed crimes. Arrested, sentenced and incarcerated, many of the
mentally ill were essentially transferred from state hospitals.”

The idea of deinstitutionalization is not new and is supported by a wide swath
of opinion. Although serious mental illnesses such as schizophrenia and mood
disorders are not curable, strides in psychotropic medication since the 1960s
have made the diseases increasingly treatable.

The push to close state hospitals began in Pennsylvania in 1979. Five hospitals
were closed by 1984. The effort slowed, but began anew in 1990 with the closure
of Philadelphia State Hospital. Over the next eight years, five more hospitals
closed, and early this year the state Department of Public Welfare announced the
closure of Harrisburg State Hospital.

According to welfare officials, the state got rid of 2,203 state hospital beds
over an 11-year period. The closure of the hospital in Harrisburg, expected by
the end of January, will add about 218 to that figure.

A success story?

Joan Ernie, deputy secretary of welfare, chalked that number up as a success for
the state and the mental health community.

“We’ve moved over 2,000 people into the community very successfully,” she said.

While acknowledging that some of those people are in prison, Ernie claimed the
circumstances that put them there are sometimes the result of “misunderstanding”
and “stigma.”

Whatever lands someone with a mental illness in prison, once there, a lack of
beds in state mental hospitals taxes correctional officers, whose facilities and
staff aren’t equipped to deal with psychotic episodes.

“It’s a difficult problem,” said Dave Desmond, retiring warden of the County
Prison. “The trend has been going on for several years. There simply are not
enough beds in state mental hospitals.”

In the last couple of years, it has become increasingly difficult to have an
inmate committed to one of the two state mental hospitals who accept prisoners,
Warren and Mayview, he said.

It takes about three and a half hours to drive to Warren, more than four to get
to Mayview, and according to several sources, deputy sheriffs have been turned
away at the door.

Debbie Duffy, an administrator of the county’s Mental Health-Mental Retardation
program, agreed that bed availability at state hospitals has become a problem
for county prisons. There are times, she said, when an inmate will sit in an
emergency room for two days waiting to be admitted.

“I don’t think, frankly, that we do a very good job dealing with addictions or
the mentally ill,” Beard said.

Shirley Moore, superintendent of the State Correctional Institution at Muncy, a
women’s prison, said about a third of the state’s female inmates have mental
health issues, a statistic seconded by Beard.

Moore said that over the past several years, she has seen an increase in the
number of mentally ill inmates, particularly inmates with a “dual diagnosis” —
someone who has both a serious mental illness and a substance abuse problem.

In some cases, people with a mental illness “self-medicate” with drugs and
alcohol, using substances to balance volatile mood shifts and soothe anxiety.
Drugs and alcohol can provide at least the illusion of a level of control they
don’t otherwise have, several sources say.

“Some people need chronic care,” Beard said. “They don’t get it (in the
community), deteriorate and come back.”

Recidivism is particularly high among inmates with a mental illness or drug
addiction. Although Beard admitted the prisons could do a better job dealing
with people with mental illness, he suggested that the community doesn’t have
the same resources as the corrections system.

Ernie said there is a “wide berth” of programs in the community for people with
mental disorders, and suggested that prisons should be more diligent when
releasing someone with a mental illness into the community to make sure a
support system is in place.

Chief Public Defender William J. Miele says the blame touches virtually all
sectors of government.

“We fail miserably, as a society, as a criminal justice system,” he said. “The
prison systems fail miserably, and we’re surprised we have recidivism.

“We always look for an easy answer. We thought if we deinstitutionalized,
everything would be wonderful, but now they’re out on the street and getting in


5. DENTON RECORD CHRONICLE (TX), December 23, 2005

[Editor’s Note: A lack of inpatient facilities cannot only result in people
with psychiatric illnesses ending up in jail. It can also, like in Texas, keep
them there.]


By James M. O’Neill / The Dallas Morning News

Frederick D. Harris, a homeless man with schizophrenia, has been confined in a
jail cell for over four months, waiting for a state hospital bed to open up.

A judge declared Mr. Harris, 41, incompetent to stand trial on a burglary charge
Oct. 6 and ordered that he receive proper medical care so he could eventually be
tried. But Mr. Harris remains imprisoned at the Dallas County jail, lethargic
from the doses of Haldol the jail gives him as a stop-gap measure.

Mr. Harris is among dozens of mentally ill inmates waiting for beds in the
overloaded state hospital system. The Dallas Morning News first reported the
problem in July, when at least 10 inmates declared incompetent to stand trial
were on a wait list.

But the problem has only worsened. County officials now estimate that 35 to 50
mentally ill inmates have been waiting for beds, some for six months.

Virgil Melton, the county's felony courts coordinator, said the state hospital
system has also refused to take two pregnant women who had been declared
incompetent. So the jail – already under intense scrutiny for inadequate health
care – must provide the women's care.

"Things are even worse than before," confirmed Kenny Dudley, director of the
state hospital section of the Texas Department of State Health Services. "We've
not had progress increasing capacity."As a result, these mentally ill inmates –
many of whom, like Mr. Harris, have been charged with minor offenses – must wait
in jail, where health care is spotty. A report by a corrections expert this year
noted that some Dallas County inmates did not receive their antipsychotic
medication for weeks or even months. Several federal civil rights lawsuits have
been filed against the county over jail care. And last month, the U.S. Justice
Department announced it was launching an investigation into health care at the

Even if mentally ill inmates do get medication while in the jail, it is nowhere
near the comprehensive treatment they would receive in the state hospital
system, mental health advocates say.

And often they are held in isolated single cells because they are a risk to
injure themselves or others – a setting that advocates say only exacerbates
their illness.Mr. Dudley said that while the hospital system's capacity remains
the same, demand keeps growing. Five years ago, mentally ill inmates took up
about 300 of 2,200 beds available statewide. They now take up more than 700
spaces, reducing the number of civilian patients the system can treat.

Mr. Dudley said the state Legislature provided virtually no increase in funding
this year, despite the backlog.

He said the department has submitted a special request to the Legislature for
money to staff a few hundred more beds.

Ed Moughon, superintendent of Big Spring State Hospital, said his hospital took
10 patients from the Dallas jail last week, but the wait for others is likely to
extend another month or two.

Mr. Moughon said the demand is driven in part by a dearth of community programs
to help mentally ill people, especially those who don't stay on their

Mentally ill patients sometimes fail to take their medication because many
antipsychotic medicines have unpleasant side effects, including weight gain, dry
mouth, slurred speech, lethargy, sexual impotence and shaking, according to
experts. In addition, when someone on such medication starts to feel better,
they think they no longer need the drug. Or they self-medicate with illegal
drugs or alcohol to try to stem the effects of their mental illness.

When off their medication, mentally ill people can quickly deteriorate and wind
up on the street, committing minor crimes that land them in the legal system.

Mr. Moughon said community programs that are sophisticated enough to help such
patients are essential to fix the larger problem.

Meanwhile, some mentally ill inmates on the list for a hospital bed end up
waiting in jail longer than their eventual sentence. That's a likely scenario
for Mr. Harris.

On Aug. 18, close to midnight, Dallas police responded to a burglary in progress
at a US Subs restaurant at 190 Continental Ave. According to the police report,
they found the glass door on the side of the building broken, observed Mr.
Harris coming toward them carrying three boxes and arrested him after a brief

The three boxes contained frozen hamburger patties.

Mr. Harris' lawyer, Shoshana Paige, a public defender, said she could tell when
she first met Mr. Harris that he was mentally ill and probably couldn't stand
trial. But an exam to gauge competency costs $300, and defense lawyers can't
file requests for such exams until after the case has gone to a grand jury and
an indictment has been issued.

Mr. Harris was indicted on a felony burglary charge Sept. 7.

According to court records, Mr. Harris was raised in Celina by his
great-grandfather, a wheat farmer.

He attended special education classes in school and dropped out soon after
starting high school. He has usually been homeless. At age 20, he began
hallucinating, which led to a stay at the Wichita Falls State Hospital. He had
many subsequent treatments for schizophrenia.

"Unfortunately and not surprisingly, he has also had ongoing problems with
compliance with taking his medications," according to a medical history in his
court file.

Dr. Michael Pittman, a psychiatrist often hired to conduct competency
evaluations of defendants, met with Mr. Harris on Sept. 23 to determine whether
he could stand trial. Dr. Pittman noted that Mr. Harris "rambled about voices
that told him to do things, such as cut himself."

He noted that Mr. Harris had an "increased rate of blinking, some rocking to and
fro and abnormal mouth movements probably caused by long exposure to older
antipsychotic medications."Dr. Pittman concluded that Mr. Harris was not
competent to stand trial. On Oct. 6, District Court Judge Mary Miller ordered
him to a state hospital for treatment. He's still waiting to go.

On Thursday, Ms. Paige visited Mr. Harris in the jail. He told her he had been
off his medications for about a month and hadn't eaten in the two or three days
leading up to the burglary incident.

She said he is getting Haldol in jail, but it makes him groggy. He told her he
just wanted to get to the hospital. "It makes me want to cry," she said.


6. LINCOLN JOURNAL STAR (NE), December 21, 2005

[Editor’s Note: Continued deinstitutionalization means treating tens of
thousands of those most stricken by mental illnesses in jail and prison rather
than psychiatric facilities. Consciously or not, we have made correctional
facilities our preferred venue for inpatient psychiatric treatment.]


By Butch Mabin / Lincoln Journal Star

Nebraska’s county jails are failing to provide adequate health care to
prisoners, according to a report Tuesday by the Nebraska affiliate of the
American Civil Liberties Union.

The report called on state legislators and local officials to address what it
called the sometimes life-and-death situations arising from the shortcomings.

“We have received complaints from all over the state with a common theme:
prisoners are being denied medications,” said Tim Butz, ACLU Nebraska executive
director. “Be it heart, diabetes or mental health medicines, the problems we
hear are the same - jails are not providing important medicines to prisoners.”

The study, prompted by “many, many complaints” recieved by the ACLU from inmates
and their families, identified five causes of the corrections healthcare
* Counties are not spending enough on prisoner healthcare.

* The state cuts people from Medicaid when they enter jail, thus denying
counties access to those funds.

* The state has not revised its jail standards in more than a decade, though the
Jail Standards Board has recommended changes.

* The planned closure or downsizing of state regional mental health centers has
resulted in more mentally ill people being placed in jails, which lack the
services to treat them.

* There are no statewide standards for handling prisoners’ health care

Sen. Kermit Brashear, speaker of the Legislature, said Tuesday he had not yet
read the report, but he said shortcomings in corrections health services would
not surprise him.

“Given the burgeoning populations in state prisoners and county jails, I would
not be surprised if there were problems,” Brashear, of Omaha, said Tuesday.

Michael Behm, executive director of the Nebraska Crime Commission, said he
disagreed with some findings in the report.

For example, he said, the report noted jails lack standardized requirements for
evaluating what medicines incoming inmates should be receiving.

Said Butz: “It seems to be the practice to stop prisoners from taking any
medications when they enter jail. This can be dangerous, as some medications
cannot be abruptly stopped in a safe manner.”

Behm said the commission’s Jail Standards Division investigators regularly
inspect 78 county and city jails in the state for compliance with standards,
including those pertaining to the admission of inmates.

“All inmates have the right to adequate medical care,” he said.

The report mentioned the case of Sarpy County Jail inmate Robert Pantona, who,
prior to his incarceration, was taking a doctor-prescribed medication for an
anxiety disorder.

Pantona, despite repeated requests, did not receive the medication while he was
incarcerated. He hung himself in his cell July 15, 2002.

A former Douglas County Jail inmate said Tuesday jail staff denied her
medication for bipolar disorder, though the jail received records from her
treating hospital that a psychiatrist had prescribed the drugs.

“I was told I didn’t meet the standards,” Kim Findlay, 46, said in an interview.
Findlay said she was released Dec. 13 after spending eight days in jail.

During that time, she said, she suffered severe mood swings, was unable to
sleep, and began to hear voices.

Ken Fields, a spokesman for the jail’s medical services division, said he could
not comment on specific cases. But he said inmates’ medical needs are evaluated
by healthcare professionals during the intake.

Final decisions on appropriate medications are made by medical doctors and, in
some cases, psychiatrists, he said. Fields added that verifications of incoming
inmates’ prescriptions can sometimes “take days” to complete.

The ACLU report was most concerned with what it said are failings in the care of
mentally ill inmates. According to the report, the move away from regional
mental health centers to community-based programs has often shifted mentally ill
people into jails.

“Community services would of course be a tremendous benefit, if they existed in
every community,” the report stated. “Unfortunately, many communities lack any
community-based mental health services.”

Mike Thurber, director of the Lancaster County Jail, said the jail is meeting
its inmates’ medical needs, but acknowledged the facility struggles to care for
mentally ill prisoners.

The jail has a doctor on call and a nursing staff seven days a week, he said.

“But we are struggling like every jail across the country with our mentally ill
inmates ... We’re a jail, not a hospital.”

Some mentally ill inmates can be placed in emergency protective custody at the
Crisis Center or at the Regional Center, he said. But that still leaves a number
of inmates with mental health issues, he said.

“I don’t know if there really is any answer,” he said.

Thurber said the department for three years has received a grant from the U.S.
Justice Department to divert some inmates from incarceration to a more
appropriate alternative.

Thurber said the jail has used the grant money to hire caseworkers who screen
inmates for mental illness.



[Editor’s Note: There are glimpses, however, of an emerging understanding that
the shearing of inpatient capacity has gone too far. One of those signs comes
from New Jersey in the form of 50 new beds.]


By Sarah Lynch, Daily Record

The state will add another 50 beds when it reconfigures Greystone Park
Psychiatric Hospital over the next two years, acting Gov. Richard Codey said
Tuesday as he visited the hospital to formally launch the demolition of a large
dormitory building.

The 50-bed expansion, at a cost of nearly $20 million, comes at the
recommendation of Codey's Task Force on Mental Health, which called for a
larger, 510-bed hospital in light of continuing overcrowding in the state
hospital system.

The dormitory is being demolished to make way for the new hospital, a project
set in motion five years ago because of problems with security and living
conditions at Greystone, which opened in 1876.

"For too long, we looked the other way as people with mental illness needed our
help," Codey said. "Today we are making the way for a new Greystone, one that
reflects a new focus in improving mental healthcare across the state."

Groundbreaking for the $190 million hospital is expected to come this summer,
followed by two years of construction.

After his remarks, Codey turned toward a 100-ton hydraulic excavator sitting
next to the 103-year-old dormitory, the second-largest building on the campus,
measuring 208,000 square feet. It has been closed since 1992.

"All right, we're going to start the demolition," Codey said. "Go!"

The wrecker extended its mechanical arm and tore away at the stone walls,
ripping out a top-floor windowsill, a chunk from the roof and portions of
another window. An assembled crowd cheered and clapped.

The onlookers included George Brice Jr., of Lindenwold, a task force member who
has received treatment for bipolar disorder for 23 years.

"This is just another example of how individuals like myself, (diagnosed) with
mental illness, how we can look to the future," he said.

The state originally envisioned a new hospital that would be much smaller, but
gradually added more beds to the proposal in recent years in the face of
concerns about the number of patients who could need hospitalization.

The state is also expanding outpatient beds, in hopes of treating more patients
outside the hospital. Greystone's patient population has stayed at about 550,
even as more outpatient beds opened in the past few years, however. Codey said
the hospital will be close to capacity when it first opens, but that the patient
population should drop in following years.

His task force is recommending a $200 million trust fund to bring more
affordable housing to people with mental illness, along with other improvements
in mental health services such as a loan forgiveness program for college
graduates who go into social services.

The new hospital will centralize programs and services under one roof, cutting
down on patients' travel time across the sprawling campus and improving
security. It will also have smaller, more personalized living spaces.


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