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TAC Newsletter 4/7/06


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April 7, 2006


1. CARING FOR THE MENTALLY ILL - The Birmingham News, March 27, 2006

2. A STATEMENT OF MADNESS - National Review Online, April 5, 2006

Morning News, April 5, 2006

Eagle, April 2, 2006


1. THE BIRMINGHAM NEWS (AL), March 27, 2006

[Editor’s Note: In five years, Jefferson County (Alabama) Probate Judge Alan
King, who handles commitment hearings, has ruled on more cases than the judge
before him did in twelve. Yet the number of hospital beds has decreased. More
commitments and fewer beds equal short stays and a revolving door.

Through the use of assisted outpatient treatment (AOT), counties and states can
make the best and most efficient use of inpatient hospital capacity. AOT can
provide supervision and care for those released from a psychiatric hospital,
thus keeping them from being readmitted, and in other cases the treatment
mechanism can prevent the need for an inpatient placement all together.]


By Carla Crowder, News staff writer

There is the frail, silver-haired senior citizen who won't take her life-saving
medicine, the obese woman convinced she's married to a celebrity and a wiry
twenty-something who tried to kill himself and wound up in jail.

These are just a few of the mentally ill patients who came before Jefferson
County Probate Judge Alan King in a recent week for involuntary commitment
hearings. King must decide if the patients are safe at home, or if they need
intensive treatment at a place like the state-run Bryce Hospital in Tuscaloosa.

In five years, King has handled more cases than his predecessor did in 12 years
on the bench, a trend seen around Alabama. "It's just incredible how the cases
have increased," King said.

Statewide, admissions to public psychiatric hospitals have jumped 39 percent in
five years.

At the same time, public and private treatment resources for the mentally ill
have shrunk, pushing counties to do more with less. Though commitments for
children and adults who need acute care for mental illness are on the rise,
private hospital beds for them have decreased by about 285 across the state, to
845 beds.

The result is some patients do not stay hospitalized long enough to get stable.
They may return months later, sometimes cycling in and out of facilities or even
jails, officials say.

King, who believes the system needs more hospital beds in the county, state beds
at Bryce, community programs and job opportunities for mental patients, said
he's noticed the length of stays at Bryce shorten. Ten to 15 years ago, patients
stayed 60 to 90 days. Now it's 25 to 30 days.

"This means that some patients are arguably unstable when they are released from
Bryce, thus precipitating another involuntary commitment petition being filed
and another hearing at the local hospital," King said. "This is a `revolving
door' situation that is not fair to patients or families."

The diminutive senior citizen who came before King, for example, had been
hospitalized in the psychiatric unit at Brookwood Medical Center repeatedly
after she stopped taking anti-psychotic medication. Her recent stay included an
episode of such intensity that police officers had to restrain her.

She also suffers from a kidney ailment, and part of her psychosis is thinking
that her kidney problems have disappeared, so she stops taking those
medications, as well. That could lead to a shutdown, psychiatrist Joseph Lucas
told King in the hearing.

The patient's sister struggled against tears as she talked about her concerns.
"I don't think she needs to go home right now," she said.

Yet the family cannot afford an assisted-living placement.

When it was her turn to speak, the patient did not hesitate. "I have data that
my kidneys are stable, that I am stable," the 69-year-old said. "I don't want to
be chemically dependent the rest of my life."

King decided to commit her to Bryce, a decision he made in three out of five
hearings that morning. The other two patients showed signs of stabilization, so
he decided they should remain at Brookwood.

This flood of commitments is placing pressure on the capacity of state
hospitals. The census at the state's four psychiatric hospitals has ranged from
36 percent over capacity, 131 patients, in August to 12 percent in November,
said John Houston, commissioner of the Department of Mental Health and Mental

At any time, 40 to 50 people are waiting for admission.

Houston cites a couple of contributors: Rising methamphetamine use, which can
cause psychotic-like symptoms, and the reduction in private treatment beds due
to a decrease in federal Medicaid payments. "The people who would normally go
into private beds, well, we know they have to go somewhere," Houston said.

Advocates for the mentally ill say another reason for the explosion in
commitments is that the state has not expanded community treatment options as
promised. After closing several large institutions in 2003 and reducing the
numbers of mental patients at state hospitals to comply with the federal Wyatt
lawsuit settlement, officials pledged to invest the savings in group homes,
county mental health centers and local services to allow the mentally ill to
live independently.

"The reason we have all this backlog is they didn't switch the money," said
Rogene Parris, founder of the Birmingham chapter of the National Alliance on
Mental Illness, NAMI.

"So they have more people than they should have in Bryce."

The landmark Wyatt case, filed in 1970, forced the state to treat mental
patients humanely. It lasted 33 years. After the settlement ended, state
officials promised to live up to the Wyatt standards without federal oversight.

"In my view, we still dedicate too many resources to state-run beds and too few
resources to community services," said James Tucker, a lawyer with the Alabama
Disabilities Advocacy Project, who represented Ricky Wyatt, a former Bryce

Services are even scarcer outside of Jefferson County. Many outlying areas have
no crisis stabilization beds, no place to treat people without sending them to
state hospitals and no placements for them upon release from state hospitals,
said Linda Champion, president of the state chapter of NAMI.

"Beds are good, but we need a continuum of services out there that we just don't
seem to have," she said.

Instead, jails and prisons become the de facto placements for untreated mental
patients. "They come into contact with the criminal justice system, and they're
going to be warehoused in prisons," Champion said.

Houston said funds that might have gone to community services have been needed
to add staff at the hospitals. Also the mental health department has been
slammed by soaring medication costs for its many patients. Still, the department
has expanded community (non-hospital) spending from $120 million five years ago
to $152 million this year, while facility or hospital spending has dipped from
$136 million to $133 million, budget figures show.

"I don't think you can say that dollars have been diverted or decreased, what
you can say is the demand and the need is greater than what we've been able to
respond to," he said.

This is a national problem, he noted. In response, the department has
established a task force to study the issues and make a report later this

State Hospitals Needed:

The youngest patient on King's recent docket at Brookwood is a 24-year-old man
who looks even younger. He is thin, and looks weary.

Police brought him in Feb. 24 because he was suffering from hallucinations and
wandering into the streets. He was first taken to jail.

"I have tried to do the best I could. I have seen after my child. My child has
never been a street child," his mother tells the judge.

But she's been fearful of his health after he swallowed a whole bottle of
medication and told her he wanted to die.

Her son sits with his hands folded in prayer. His eyes are closed and he is
mouthing words. Eventually he starts to cry.

But his psychiatrist says that his condition has improved and requests he remain
at Brookwood two more weeks to see whether he can stabilize without being
committed. King agrees.

"What I see within the involuntary commitment system, I see a lot of people who
need help, and I'm a believer that there will always be a need for Bryce
Hospital and other state hospitals because there are a lot of very sick people
who need help," King said later.

"I think the community-based programs are wonderful, and I would certainly
applaud the expansion of resources. But, from my vantage point, there are a
large number of people who need more help in an emergency situation than a
community setting can provide."



[Editor’s Note: SAMSHA recently released a Consensus Statement on Mental Health
Recovery, which was developed to present governing principles for people
recovering from severe psychiatric disorders. As with many such projects, this
one seemingly ignores those who are most acutely at the mercy of mental illness:
people for whom “self-directed,” “person-centered,” and “responsibility” are
noble but essentially hypothetical types of care.

Modes of care infused with patient choice have their role for many people, but
the Consensus Statement omits reference to treatment methods that can restore to
those incapacitated from illnesses the capability of rational choice. The
statement thus only begins its evaluation at the mid-stream of the recovery


The New Guidelines For Treating Mental Illness Need Help.

By Sally Satel

Imagine your brother has schizophrenia. When he takes his medications, he can
hold a part-time job in a mom and pop hardware store. When he stops the drugs —
something he does every few years because he simply does not perceive himself to
be sick — your brother becomes hostile, wildly delusional (believing the radios
in the hardware store are pulling thoughts out of his head), and does not come
home for days at a time, sleeping in the street and eating out of garbage cans.

Clearly, your brother is someone who needs to take those medications regularly.
Unfortunately, like about one-half of all patients with psychotic illnesses, he
lacks insight into his condition. In fact, he thinks the medications are for a
bad cold he caught back in 1988, and unless watched closely by his psychiatrist
and family (he lives with his parents who dole out the meds daily), he could
easily neglect to take them.

Recently, the federal Substance Abuse and Mental Health Services Administration
(SAMHSA), part of the Dept. of Health and Human Services, has released its
Consensus Statement of Mental Health Recovery. It is a travesty of psychiatric
care. In fact, if a psychiatrist treating patients with severe mental illness
followed most of the ten “fundamental” principles of recovery elaborated in the
statement, he would be at risk of committing malpractice.

The statement, according to the press release, was “developed through
deliberations by over 110 expert panelists representing mental health consumers
[the politically correct term for psychiatric patient], families, providers,
advocates, researchers, managed care organizations, state and local public
officials and others.” I wasn’t one of them. Despite being a member of the
Advisory Council for the Center for Mental Health Services (the arm of SAMHSA
expressly devoted to the nation's mental health services), neither I nor several
other members, nor the council as a body, was shown the document and asked to

Consider some of the “Fundamental Concepts of Recovery” from the Consensus

Concept #1 Self-Direction: "Consumers lead, control, exercise choice over, and
determine their own path of recovery by optimizing autonomy, independence, and
control of resources to achieve a self-determined life. By definition, the
recovery process must be self-directed by the individual, who defines his or her
own life goals and designs a unique path towards those goals."

Concept #2: Individualized and Person-Centered: "There are multiple pathways to
recovery based on an individual’s unique strengths and resiliencies as well as
his or her needs, preferences, experiences (including past trauma), and cultural

Concept # 3: Empowerment: "Consumers have the authority to choose from a range
of options and to participate in all decisions — including the allocation of
resources — that will affect their lives, and are educated and supported in so
doing. They have the ability to join with other consumers to collectively and
effectively speak for themselves about their needs, wants, desires, and

Concept #9: Responsibility: "Consumers have a personal responsibility for their
own self-care and journeys of recovery. Taking steps towards their goals may
require great courage. Consumers must strive to understand and give meaning to
their experiences and identify coping strategies and healing processes to
promote their own wellness."

Reality check: How can a person like your hypothetical brother described above
exercise full self-direction-empowerment-responsibility? His “choice” would be
not to take his medication — a choice that leads to relapse rather than
recovery. Should we let him, and the thousands like him, hit rock bottom every
once in a while, as the Consensus Statement seems to suggest?

The list continues, rounded out by vague feel-good directives and descriptions.
Recovery should be “holistic” yet it is a “non-linear” process, says the
statement. What? Also, patients should be treated with “respect,” and, of
course, there must be “hope.” Reminding “providers” of the need to respect
patients and instill realistic hope is patronizing. Such principles are vital to
good care, as we learn in medical school and residency. True, they are not
always practiced, but this reflects the separate, real problem of the uneven
quality of mental health treatment available.

This is déjà vu all over again. In 2003, President Bush’s New Freedom Commission
on Mental Health released its report, "Achieving The Promise: Transforming
Mental Health Care in America." President Bush had charged the 22-member group
with making a "comprehensive study" that would "advise [him] on methods of
improving the system."

Though more detailed and somewhat more sophisticated than the Consensus
Statement, the Freedom Commission report was also woefully incomplete. It, too,
failed to take on the most difficult cases, and considered severe mental illness
only in terms of a "recovery model." The model holds that sufficient therapy,
housing options, and employment programs will enable people with schizophrenia
or manic-depressive illness to take charge of their lives. Many will, but
thousands won't.

The problem with the recovery vision is that it is a dangerously partial vision.
It sets up unrealistic expectations for those who will never fully "recover," no
matter how hard they try, because their illness is so severe and their
dependence on medications so great. By neglecting the needs of the most severely
ill — that is, the individuals whose very awareness of being sick is blunted —
the Consensus recovery guidelines are applicable to only half of those with
mental illness. Picture the outrage that would be aimed at the National Cancer
Institute if it sent out “recovery guidelines” on breast cancer that ignored
half the clinical population of women with the disease.

What's more, exclusive emphasis on recovery as a goal steers policymakers away
from making changes vital to the needs of the most severely disabled.

Every few years, there are calls to abolish SAMSHA, which was created in 1992.
It should be. The main task of SAMSHA is to allocate the state mental-health and
substance-abuse block grants. It is a bureaucracy that could be absorbed by the
Health Resources Services Administration. Discretionary grants for pilot
programs — those that can actually survive a rigorous review — could be
controlled by evaluation scientists at the National Institute of Mental Health
and the National Institute on Drug Abuse.

The new Consensus Statement only fuels the well-deserved image of an agency that
is often sorely misguided and naïve in its approach to the most vulnerable (and
costly) of its constituents: the severely mentally ill.

— Sally Satel is a psychiatrist and resident scholar at the American Enterprise
Institute. She is co-author of One Nation Under Therapy, which will be released
in paperback in June.



[Editor’s Note: Each of us has a 0.58% lifetime chance of being diagnosed with
cancer of the brain or other nervous system (according to the National Cancer
Institute). It is also estimated that over 2% of Americans develop
schizophrenia or bipolar disorder and that about one mother develops postpartum
psychosis for every 1,000 births. Each of those conditions can cause delusions
and other impairments of the mind that can compel those affected to take actions
that would otherwise horrify them.

Dena Schlosser took the life of her daughter. At her trial in February,
psychiatrists testified that she had severe mood swings, hallucinations, and
religious delusions. These were attributed to postpartum psychosis. The jury
deadlocked on her insanity plea; there was a mistrial.

A week ago, one of Schlosser’s attorneys revealed that she had an inoperable
brain tumor. Today, Judge Chris Oldner found her not guilty by reason of
insanity in the death of her daughter (Schlosser had waived the right to a
second jury trial).

Did the disclosure of her brain tumor tip the scale? We’ll never know, but
columnist Steve Blow asks some probing questions of us and of all Americans.]


By Steve Blow, The Dallas Morning News

Apr. 5--So, does the tumor change anything?

That question goes out to the Dena-must-die crowd.

Just when we thought there were no more surprises in this ghastly case, word
comes that Ms. Schlosser has an inoperable brain tumor.

And though there's no way to say for sure, experts believe it could have played
a role in the religious delusions that led her to cut off her baby's arms.

So, how about now? Still certain she should die -- or at least spend the rest of
her life in prison?

Somehow I think even the most ardent eye-for-an-eye types must now rethink what
is fair and just for Ms. Schlosser.

Right? A brain tumor?

And if you are one of those rethinking this case, you have just revealed your
double standard about mental illness.

Tumors show up on CAT scans. Postpartum psychosis doesn't. And what a difference
that seems to make. Just two different types of brain illness. Either one can
lead to delusions. The only difference is ... what? Pictures?

Is that really going to be our standard for judging mental illness? Pictures to
show around?

Got 'em? Great, you get mercy. We understand tumors.

No pics? Sorry, it's lethal injection or a lifetime in prison for you. We don't
really trust things we can't see.

I suppose it's progress that only two of 12 jurors in Ms. Schlosser's trial
clung to such thinking. Only two refused to accept the unrefuted testimony of
doctors who said Ms. Schlosser was deeply mentally ill and didn't know right
from wrong when she cut off her daughter's arms. On orders from God, she said.

But judging from the talk-radio world, those two jurors reflect the attitude of

Maybe it's fear. Maybe we just don't want to believe that our brains can betray
us so completely.

It is hard to accept that for each of us, "reality" is only what our brain tells
us it is. And depending on how the chemicals there slosh together, your reality
and mine can be very different.

Your brain tells you you're reading a newspaper column right now. But is that
all? Are you sure no secret messages are being conveyed?

Dallas resident Jeanine Hayes can laugh now at the absurdity of it. But for many
years she read newspapers and magazines with absolute certainty the government
was taunting her with coded messages.

"I went from one lawyer to another, all over the state, carrying this big bag
full of papers and magazines as my evidence, trying to convince them the
government was after me," Jeanine said.

Some rushed her out the door. Others gently suggested psychiatric help. Some
tried to reason with her. But it didn't matter. "Nobody could tell me anything,"
she said. "Their reality and mine were two totally different things."

Jeanine, 58, is a different person now. New medications came along to treat her
form of schizophrenia. She's lively and funny and eager to help the world better
understand brain illnesses -- including just how "real" a delusion is.

Joel Feiner, a psychiatrist and UT Southwestern Medical Center professor, sees
the double standard that is applied to mental illness all the time.

Heart, liver, lungs -- no one thinks a thing when illness befalls those organs.

But when the illness is inside the brain, it's a different story. There are no
X-rays to examine, no blood tests to perform. And an air of judgment and
condemnation begins to slip in.

"Mental illness has nothing to do with weakness," Dr. Feiner said. "It has
nothing to do with drugs. It has nothing to do with the devil. It has to do with
changes in the neurochemistry of the brain."

He is sure that one day there will be tests to demonstrate that. Until then,
perhaps those with tumors are the lucky ones.

They have pictures to show.


4. THE WICHITA EAGLE (KA), April 2, 2006

[Editor’s Note: Vicky Collins is a messenger of hope – a symbol that having an
illness as serious as schizoaffective disorder does not mean a person cannot
have a meaningful life. At the same time, her ongoing symptoms are a reminder
that there is not yet a cure for illnesses like hers. Her faithfulness to
treatment, however, shows how such conditions can be tamed.]


By Deb Gruver

When her schizophrenia was at its worst, Vicky Collins carried a stuffed rabbit

The rabbit, Velvie, made her feel more secure, even if people stared.

When voices told her to kill herself, Collins would clutch the soft, brown
rabbit with the red velvet dress.

Her longtime friend Kevin Bomhoff remembers the stuffed bunny.

"I noticed when she stopped carrying the (rabbit) and started carrying books,"
he said.

That's about the time Collins started getting better.

Academia replaced Velvie as Collins' security blanket. And the voices--while
they still speak sometimes--became quieter.

Collins -- a daughter, a sister and a social worker -- wants you to know a few
things about mental illness:

• You can get better.

• You can be successful.

• You can make up for the years you lost.

Collins, 47, lost about 20 of them.

A Brain Disease

Around the age most people are engrossed in their first jobs or starting
families, Collins was a patient at a mental hospital.

Now she works full time, teaches and has a master's degree in social work. Her
diagnosis is schizoaffective disorder with a borderline personality disorder.
She suffers from symptoms of schizophrenia and depression.

She agreed to spend time with an Eagle reporter and photographer to let others
glimpse everyday struggles with mental illness.

Schizophrenia is a disease of the brain with symptoms such as delusions,
hallucinations and withdrawal. Many people with the disease have trouble
expressing thoughts. Their speech can be difficult to understand.

The man accused of killing 17-year-old QuikTrip clerk Brian Hall last month in
Wichita had schizophrenia, his family says.

Anthony Ray Barnes, 40, is accused of first-degree murder and aggravated
assault. His sisters said he had stopped taking his medication before the
shooting occurred.

Comcare of Sedgwick County, which provides mental health services, says 14
percent of the nearly 5,200 adults undergoing treatment there have one of six
types of schizophrenia.

News of the shooting saddened Collins.

"Never would I harm another person," she said. "If I was in the public and
thought that about schizophrenics, I'd be scared, too."

'I Knew I Had Problems'

Collins had symptoms of schizophrenia as a young woman.

But she didn't know she had a disease.

"I knew I had problems, but I didn't know to put a name to it," she said.

As a senior in high school, she went from being an honor student to flunking
out. She had trouble concentrating and organizing her thoughts.

She attempted college but landed on academic probation.

She had migraines and began seeing a neurologist/ psychiatrist. At 20, she tried
to kill herself.

She says the voices that spoke to her were ruthless and persistent. They told
her, over and over, to kill herself.

On Jan. 2, 1984, she was taken in handcuffs to the Topeka State Hospital, a
mental hospital that has since closed. She had tried to kill herself again.

The voices were winning.

She waived her right to a hearing and declared herself incompetent. She did so,
she said, to spare her parents.

Over the years, Collins also has spent time in the psychiatric unit of a Wichita
hospital and at Comcare's "partial" hospital, a six-to-eight-hour structured
daytime therapeutic program.

Comcare has since replaced that program with one in which clients go out into
the community to receive services.

The medications Collins took initially numbed her brain and left her in a
condition that was barely better than the symptoms they tried to control, she

People who didn't know her might have described her as "not quite there."

Collins now takes eight medications daily and says they -- particularly
Clozaril--work far better.

Hard-Won Successes

In 1996--with the help of the new medications--Collins resumed her studies at
Wichita State University. She eventually earned a bachelor's degree in

But she started preparing for college four years before enrolling. To help
develop an attention span, she read children's books. To get used to sitting
still, she took art classes.

She finished her undergraduate degree in 2001. She earned a master's degree in
social work in 2003 and her license a year later.

"She's an academic animal," Bomhoff said.

Bomhoff, community support coordinator at Wichita State University's Self-Help
Network Center for Community Support and Research, has known Collins since the
'80s, first as a patient and now as a colleague.

Collins completed her practicum at the Self-Help Network, which works with
nonprofit and community organizations across the state.

She now works there full time as a project facilitator. Her colleagues say one
of her biggest strengths is helping people with mental illness learn coping

Her downtown office, filled with plants, fish and Beanie Baby bears, overlooks a
flowering Bradford pear tree.

Just recently, a fellow member of the Breakthrough Club, a place where people
with mental illnesses can go to look for jobs and socialize, asked Collins about
her job.

Does she answer phones?

Does she take out the trash?

Collins answered that she writes grants, does research and teaches classes for
WSU's Leadership Empowerment Advocacy Project, which gives students with mental
illnesses the opportunity to experience college life.

Trials of Daily Life

Despite her successes, Collins is not cured.

She struggles daily. She keeps in check with a pill planner that monitors her

Two Wednesdays ago, she was so depressed she wondered to herself who would take
care of her cats, dog, fish and hermit crabs.

Luckily a friend called her at the worst of it and helped dig her out.

While she still plans her own death at times, she no longer acts on those plans.
In the past, she overdosed on pills. At one time, she had a shotgun and shells.
She's burned herself.

"My impulse control is a lot better now," she said.

Her younger sister, Pamela Self, is proud of Collins. She said she remembers
when Collins appeared dazed and confused much of the time.

"The changes in her are just outstanding," Self said. "I am so, so happy for

A Network of Support

Collins lives alone in a two-bedroom apartment near 21st and Amidon.

About 86 percent of Comcare's patients with schizophrenia live independently.

Her interest in American Indian cultures is apparent at home. Indian art hangs
on her walls. A curio cabinet holds more Beanie Babies. Fish tanks bubble.

She gardens in a shared plot at the apartment complex. Last year, she planted
too many tomatoes, and they didn't fare so well. This year, she'll plant a
smaller crop.

She reads all the time, especially books on leadership and mental illness. She
especially recommends "The Day the Voices Stopped" by Kenneth Steele. She
listens to the radio but rarely turns on the TV in her living room, she said.

Collins is proud that she takes care of herself. She has gone from depending on
a disability check to earning her own money.

She's soft-spoken and modest but points out that her supervisors treat her like
everyone else at the office.

Bomhoff and Greg Meissen, director of the Self-Help Network, say that's true.

Meissen was Collins' academic adviser at WSU. He said she put a lot of thought
into how to accomplish day-to-day successes. If she felt overwhelmed, she'd
figure out which class was the best to drop and would do the least amount of
damage to her academic record.

"And she has woven the best support system around herself," he said.

Vision Of A New Day

Collins wishes other people with mental illnesses would believe in themselves.

She says the stigma of mental illness keeps many from getting the help they

She sees a therapist once a week, a case manager once a week, a psychiatrist
every six weeks and her primary care physician, Donna Sweet, every two months.

Collins worries that the community -- and the media -- talk about mental illness
only when something such as the shooting at QuikTrip happens.

"They don't hear about those of us who work full time, who go to school full
time," she said.

She hopes she is a role model for other people.

"I have a lot of pride in what I do," she said. "With the right medicine and the
right support, you can do things you never thought you'd be able to do."

Collins hasn't tried to kill herself in years.

She partly credits her doctor for that. Sweet, Collins said, drilled it into her
head, again and again, that self-harm is not acceptable.

"I don't think anyone wants to die," she said. "They just want the pain to go

Collins reminds herself -- and others who are mentally ill -- that the next day,
you just might feel a lot better.


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TAC Newsletter 3/31/06


Visit our web site
March 31, 2006


Post-Gazette, March 30, 2006

2. A CRIME, PENALTY AND ILLNESS - The Record, March 28, 2006


March 22, 2006

5. LONG, DARK ROAD OF MENTAL ILLNESS - Denver Post, March 26, 2006



[Editor’s Note: The Treatment Advocacy Center is dedicated to facilitating the
adoption of programs, policies, and laws that can rescue people who are in
crisis because of a severe mental illness. To us, success means lives saved.
We are fully aware, however, of the importance of other mental health advocacy
efforts – including the campaign for parity of insurance coverage for
psychiatric illnesses with physical ones (or, more correctly, “other physical

The obvious argument against parity is the expense of the expanded coverage,
cost to employers, insurance companies and, ultimately, the public. The study
described below looked at the fiscal impact of granting parity in mental health
benefits to 20,000 federal employees.

And how much was the cost? – there was no measurable one.]


By Joe Fahy, Pittsburgh Post-Gazette

A new national study concludes that costs might not increase if workers are
given the same access to coverage for mental health and substance abuse services
as they have for other medical care.

The findings were based on an analysis of thousands of people covered by federal
health plans who received behavioral health services through managed care
programs. Limits on days of coverage, deductibles and other restrictions were no
different for mental health care than for physical health care.

Researchers concluded that offering equal access to behavioral health coverage
-- a concept known as parity -- "can improve insurance protection without
increasing total costs." The findings were published today in the New England
Journal of Medicine.

Other studies have reached similar conclusions, though the latest study is
larger and more rigorous, said Dr. Howard Goldman, the principal researcher and
a professor of psychiatry at the University of Maryland School of Medicine.

Many states, including Pennsylvania, already require that certain mental health
services be covered. But consumer advocates contend that there are often gaps in
coverage and that some employers aren't covered by those laws.

Efforts also are under way in Congress to "override those state laws in an
effort to make insurance more affordable for small business," said Ralph Ibson,
a vice president for the National Mental Health Association.

Consumer groups suggest that national legislation is needed to require employers
to offer parity for behavioral health care. The study noted that parity "has
been the Holy Grail of mental health policy for decades."

But many employers have opposed requirements that they offer parity "even if the
data suggest that this isn't going to be a big burden," said Dr. Russ Newman,
executive director for professional practice for the American Psychological

The study published today focused on persons covered by the Federal Employees
Health Benefits program. They were offered mental health and substance abuse
benefits on a par with medical benefits beginning in January 2001.

Researchers compared claims patterns from seven Federal Employee health plans,
analyzing data from a random sample of 20,000 enrollees per plan.

Data were obtained for two years before and two years after parity in behavioral
health care began. The study focused on people who were continuously enrolled in
a plan. Researchers also analyzed data from a matched comparison group.

The study found that rates of use and spending increased during the study period
for all plans. The increase in use might be due in part to a lessening of the
stigma concerning mental health treatment, Dr. Goldman said.

A statistically significant increase in use associated with parity, however, was
noted in only one plan. A significant decrease occurred in another plan, and no
significant difference occurred in the other five plans.

For beneficiaries who used behavioral health services, spending attributable to
parity decreased significantly for three plans and did not change significantly
for four plans.

The implementation of parity also was associated with significant reductions in
out-of-pocket consumer spending in five of seven plans.

"The primary concern has been that the existence of parity would result in large
increases in the use of mental health and substance abuse services," researchers
concluded. But they said that in the plans studied, "those fears were

Amanda Austin, manager of legislative affairs for the National Federation of
Independent Business, questioned whether findings from a study of federal
beneficiaries were applicable to her members. Forty-two percent offer health
benefits and most employ three to nine people, she said, noting her group is
opposed to mandated parity for mental health services.

In Pennsylvania, a 1998 law requires some employers to provide coverage for
schizophrenia, bipolar disorder and other mental illnesses, noted Gwen Lehman,
executive director of the Pennsylvania Psychiatric Society. Plans must provide
coverage for at least 30 days of inpatient coverage and 60 outpatient visits a
year, she said.

But she noted that co-pays and other cost-sharing can be higher for mental
health care than for other medical care. And the law doesn't apply to small
employers or to large employers who self-insure -- that is, provide coverage
without purchasing it from a health plan.


2. THE RECORD (Bergen County, NJ), March 28, 2006

[Editor’s Note: The symptoms of Lucas Schloming’s bipolar illness caused him to
fixate on Lauren Bush, the president’s niece. The M.I.T. graduate’s ex-roommate
describes him as “not the sort of person you would see saying anything offensive
to anyone -- not that sort of a person, a kind person." Yet, given his actions
towards Ms. Bush, it is understandable why the Secret Service placed a wary eye
on Schloming, eventually detaining him.

What is incomprehensible is that Mr. Schloming should be allowed to remain
untreated while in the criminal justice system. As his father so rightly noted,
"What illness in the United States is left untreated for nine months when the
treatment is known?"]


By Tom Davis

His crime was stalking Lauren Bush, the president's niece. His problem is that
he suffers from bipolar disorder.

Prior to the incident, 32-year-old Lucas Schloming was not taking his
anti-psychotic medication. He had no job, and he was living at his parents' home
in Cambridge, Mass.

Schloming's punishment doesn't fit the crime, his family says.

He was ordered for a 30-day psychiatric evaluation that took three months. No
medication was given during that time, they say.

After the evaluation, he was found mentally incompetent to stand trial. He has
been at the Federal Medical Center in Butner, N.C., for six months – still, with
no medication being given, his father says.

Because of his mental illness, he's being treated like a "political prisoner,"
says his father, Skip Schloming. "He's being incarcerated without a trial."

Millions of people with mental illness commit crimes. Many of them are guilty.
In the eyes of the public, however, few are presumed innocent, mental health
advocates say.

Once they enter the judicial system, people with bipolar disorder, schizophrenia
and other disorders are at a disadvantage, advocates say. They lack
understanding of their illness and the legal system.

Many can't speak for themselves. Nor can many afford a lawyer, since the vast
majority of people with mental illness are poor. They lack the wherewithal to
cop a plea bargain and cut themselves a break.

According to the U.S. Department of Justice, nearly 16 percent of the nation's
incarcerated population is mentally ill, and 53 percent of the inmates with
severe mental illness have been convicted of violent crimes, versus 46 percent
for all other inmates.

Those with mental illness serve longer sentences than people with comparable rap
sheets, said Ron Honberg, director for policy and legal affairs for the National
Alliance on Mental Illness.

"There's no doubt that mental illness works against them in the criminal
process," Honberg said.

The issue of medication is complicating the process, Honberg said. Lucas
Schloming didn't take his. Instead of focusing on improving his situation, he
obsessed over what got him into trouble.

"He is a brilliant, potentially high-functioning person who has gotten totally
derailed by his persistent and worsening medication non-compliance," his father

Schloming knew his son was sick. He was off his medication for long periods of
time, and he wasn't regularly meeting with mental health professionals. He knew
his son had feelings for Lauren Bush. But he never considered him a threat.

"He has never shown any hostility or outward acts to anyone outside of the
family," Schloming said. "He only gets angry at the family."

Initially, Lucas got Bush's e-mail address off the Internet, his father said. He
sent her online photos of herself as a model and photos of roses. The messages
were mostly bizarre or incomprehensible, his father says.

Eventually, the Secret Service came to his home, interviewed his son and decided
he was not a threat, his father said. They told him not to e-mail her, he said,
and he complied.

But a week later – unbeknownst to his family -- he flew from Boston and planned
to approach Bush at Princeton University, where she's a student. He never did,
but the Secret Service hunted him down and arrested him last year.

"His intentions were only to explain himself – not in any way to harm her," his
father said.

Assistant U.S. attorney Eric Schweiker, who's helping to build the case against
Lucas Schloming, had little to say in response to the father's claims. He called
it a "serious case, and we're handling it that way."

Meanwhile, with the help of the National Center on Institutions and
Alternatives, Schloming's family has provided a detailed diversion proposal –
including several doctors' recommendations that he be medicated involuntarily --
to lawyers involved in the case.

A hearing has been scheduled for April 11 in U.S. District Court in Trenton.
Skip Schloming says it's about time.

"What illness in the United States is left untreated for nine months when the
treatment is known?" he asked.


3. ACCENTURE NEWS, March 30, 2006

[Editor’s Note: The E-News has featured many types of programs designed to
divert people with severe mental illnesses to treatment rather than
incarceration and to keep those being released from jails and prisons from
returning to the correctional system. The diversion program in Maricopa County,
AZ (which includes Phoenix) stands out as among the most comprehensive,
accessing the chance for treatment at a number of points in the criminal justice


ValueOptions, the Regional Behavioral Health Authority (RBHA) for Maricopa
County, announced today that its Court Advocacy and Jail Diversion programs, in
partnership with Maricopa County Comprehensive Mental Health Court and Maricopa
County Adult Probation, have significantly reduced the rate of new offences
(recidivism) among offenders with Serious Mental Illness (SMI) to five percent,
nearly half the relapse rate of general population offenders.

"Now we have evidence that appropriate response addressing the treatment needs
of people with mental illness both reduces the crime rate and improves public
safety," said Shelley Curran, Director of Court Advocacy and Jail Diversion
programs for ValueOptions Arizona. "With 9 percent recidivism among general
offenders, the success of the collaboration between ValueOptions and the
Maricopa County Adult Probation Department SMI Unit perfectly illustrates how
coordination between the criminal justice and behavioral health systems can
successfully improve offender outcomes and reduce the use of costly and
ineffective jail days."

The ValueOptions Jail Diversion program currently has a 70 percent completion
rate for persons with SMI who have been booked into Maricopa County Jail, which
results in avoiding additional jail time by having charges dropped after
successful participation in mental health treatment. This unique partnership
among judicial officers, attorneys, ValueOptions' treatment providers, and
correctional service personnel overcomes fragmentation in the continuity of care
for mental health consumers in the justice system by improving communication and
collaboration. When persons with SMI are booked into jail, the ValueOptions Jail
Diversion Team intervenes on behalf of them to prevent inappropriate jail
sentencing by accurately identifying, treating and applying mental health

"The need for good collaboration between the criminal justice and mental health
systems is absolutely critical," said Michael S. Shafer, Ph.D., Associate Dean
of the College of Human Services at Arizona State University, and a consultant
to the Maricopa County Superior Court. "The ValueOptions/Maricopa County Adult
Probation partnership is a good example of this. Together, they have made great
strides in strengthening the partnership between the bench and behavioral health

Each month, between 250 and 300 persons with SMI are booked by police in
Maricopa County. Within 15 minutes of being booked, the ValueOptions Jail
Diversion Team is notified via its proprietary Data Link System that connects
them directly to the Sheriff's Office. The Diversion Team - a clinical
coordinator and two clinical court liaisons - works quickly to meet with the
client, makes an assessment, attends the preliminary hearing, and coordinates
with the court system to identify alternatives to jail.

The program's success is confirmed through personal stories of persons with SMI
who have been through the process. Arthur, diagnosed with schizophrenia, who was
recommended to the Comprehensive Mental Health court, is a good example. "Judge
Hyatt saved my life ... I didn't need to be on the street yet, I needed to be in
a place with more structure," said Arthur. "My PO (Parole Officer) and the team
at ValueOptions, they got together and discussed what I needed. Then they
brought me in and asked me what I want. The people at ValueOptions, they helped
me get back on my meds. They told me ... that I could move forward. My family
wants me around and I feel better about who I've become."

Recognized nationally for its success, the ValueOptions/Maricopa County
Comprehensive Mental Health Court and Maricopa County and Adult Probation
partnerships will be presented at the National GAINS Center's 2006 National
Conference - "System Transformation at the Interface of the Criminal Justice and
Mental Health System" - April 5-7, 2006 in Boston, MA, as an example of
innovative programs being developed which transform the treatment and recovery
of persons with SMI. The National GAINS Center, which has operated since 1995,
collects and disseminates information about effective mental health and
substance abuse services for people with co-occurring disorders in the justice

Formal jail diversion consists of three types of intervention: Clients may be
released from jail with conditions that include treatment; clients may be place
on unsupervised probation, which includes mandatory treatment; or, clients may
be given the opportunity for deferred prosecution in an intervention that
includes increased judicial participation and supervision, as well as required
treatment over a specified period of time.

ValueOptions' Jail Diversion Program intervenes on behalf of persons with SMI to
prevent inappropriate jail sentencing through the accurate identification,
treatment and application of associated mental health services. The program
identifies persons with SMI and works with them at four critical points in the
criminal justice system:

1) Upon initial contact with law enforcement officers specially trained through
ValueOptions' Crisis Intervention Training (CIT) to identify and manage SMI

2) Upon booking, through ValueOptions' proprietary Jail Data Link System with
the Maricopa County Sheriff's Office, to readily determine individuals who may
be eligible for diversion from the criminal justice system,

3) Upon conviction, to determine appropriate sentencing, including jail
diversion, through ValueOptions' collaboration with the Maricopa County
Comprehensive Mental Health Court,

4) Upon parole, through ValueOptions' Correctional Officer/Offender Liaison
(COOL) Program, to facilitate successful re-integration of persons with SMI into
the community.

The program also includes education, advocacy and outreach to help communities
engage in the successful reintegration of recovered SMI clients.


4. DES MOINES REGISTER (IA), March 22, 2006

[Editor’s Note: We wish that nobody would have to experience the symptoms of
mental illness - – the racing thoughts, summersaulting moods, disjointed
perceptions of what is and is not there, unshakable certainties that what is
false is in fact true. At the same time, our care of those with serious
psychiatric illnesses would be transformed if everyone could feel what it is
like to be psychotic for only for a little while.

So yes, we like the idea of a hallucination machine, and we can think of no
better group of people to make use of it than the members of law enforcement.]


Device Shows What It's Like To Suffer Severe Mental Illness

By Tom Alex, Register Staff Writer

Des Moines Police Officer Paul Tieszen stepped onto a city bus and into a world
he's only heard about.

"Things flash out of nowhere. Small voices saying, 'Go get your medication.' The
bus driver is talking to you normally and all of a sudden he starts calling you
'Your Highness.' Then he becomes part of the hallucination," Tieszen said. "It's
a whole busload of children, then it changes to a busload of adults. There's a
nurse involved. You see normal things and then all of a sudden someone pulls up
next to you and says, 'Get off the bus.' "

The bus wasn't real, but the officer's reactions were. And he quickly got a
glimpse of what it's like to suffer from a severe mental illness.

Tieszen's window into the world of hallucinations was provided by a high-tech
virtual reality mask that police use to better understand the mentally ill
people they come in contact with.

"You are in the role of the individual on the bus," he said, trying to describe
the experience. "You are seeing what is in the mind of someone who is like

The device is called a virtual hallucination machine. It was introduced to
police by Teresa Bomhoff, president of the National Alliance for the Mentally
Ill of Greater Des Moines.

She said the mask was created by a Belgian pharmaceutical company to give mental
health providers, police and the public an idea of what it's like to experience

"We want people to get a more empathetic understanding of what people with
hallucinations are experiencing," she said.

The effort is more than an interesting experience. Confrontations with the
mentally ill can turn deadly:

* June 7, 2005 -A Polk County sheriff's deputy shot and killed Jonathan McCourt,
47, outside the Polk County Courthouse after McCourt spray-painted his own
pickup truck, shouted profanities and then pulled a toy gun from the waistband
of his pants. McCourt's wife said he had not taken prescribed medication for a
mental disorder.

* April 18, 2005 -A Des Moines police officer shot and killed Daniel Scott, 38,
after paramedics were called to treat a suicidal man who had made cuts on his
wrists. Officer Martin Seibert said Scott threatened to shoot and motioned as if
he were going to fire a gun. Scott was unarmed.

* Feb. 17, 2005 -Ankeny police fatally shot Arman Zilic, 20, after they were
asked to investigate reports of a suicidal man armed with a sawed-off shotgun.

Such cases are why Polk County taxpayers spend $300,000 each year to support the
Eyerly-Ball Mobile Crisis Response Team, which is called upon to help defuse
situations that involve unstable subjects, some of whom are armed when the first
officer shows up.

The team gets about 140 calls per month -198 in January.

"It can be hard for officers in the field to determine what's going on. That's
why they call us," said Mary Elliott, a nurse who works with the crisis team.
"And it's why something like this is helpful."

Officers lined up earlier this month and slipped on the mask for a trip on the
city bus, or the other altered reality, the pharmacy.

At one point, the driver picks up a microphone and talks to a dispatcher.

When he finishes he says, "They like to keep track of me."

Then a small voice tells the wearer: "They want to keep track of you."

It was the first time Tieszen was able to see distorted reality from the other
side of the badge.

"The neurons are firing images in random order. Like being awake but dreaming.
Like a lot of jumbled thoughts," he said. "Like being trapped in a nightmare but
you are awake."

Tieszen said he's had several real-life experiences with people who are

"A guy on the south side supposedly had a bomb in his car. He was paranoid
schizophrenic. We checked out the car. He was seeing wires he had not seen
before. He thought the CIA was planting it," Tieszen said. "He actually was
seeing wires, but they were to the power seat of his vehicle. You could not
convince him they belonged in his car."

Police Chief William McCarthy said the hallucination machine broadens any
officer's experience.

"We have to deal with behavior. But any time we can have a better understanding
of human nature, it strengthens our capabilities," he said.


5. DENVER POST, March 26, 2006

[Editor’s Note: There is no way, of course, for everyone to experience what it
is like to be in the grip of untreated schizophrenia or bipolar disorder.
Pieces like this one, however, can help build the understanding of the impact of
such illnesses, both on the person afflicted and those who love them.]


By Chuck Reyman

Nearly six years ago, my brother-in-law died at the age of 47 from emphysema.
Most of our family was there for the several-hour vigil: his sisters, father and
mother, stroking his head, murmuring sweetly, softly. While emphysema served as
the polite and official cause of his death, the Larry I had known since his late
teens had died many years before.

Larry's long decent into the dark night of mental illness, more specifically
paranoid schizophrenia, began when he was 23 years of age. I remember clearly
when he visited my wife and me in the small western Pennsylvania town where I
was attending graduate school that his behavior had already begun to change. He
would occasionally "check out" of conversations and go to a place where, at
least momentarily, we couldn't reach him. At the time, we chalked it all up to
youthful angst and the kind of self-absorption with which we were all familiar.

Upon our return to Colorado eight months later in January of 1975, we began
receiving phone calls from my wife's parents about Larry's odd behaviors and
"episodes." One in particular was about Larry, in a fit of undefined
frustration, deliberately banging his head into a wall.

Although we didn't realize it at the time, a visit to their Colorado Springs
home that winter brought us face to face with the unnerving specter of Larry's
now full-blown mental illness. To begin, his physical appearance had
deteriorated. His hair was matted and dirty. He was unshaven, and his clothes
bore no evidence of planning or awareness or care.

Far more unsettling was his behavior. He spoke aloud to himself almost
constantly, occasionally reporting in to the rest of us what he was hearing and
explaining why he was afraid. The government's plot to poison all of us with
fluoride in our drinking water was a frequent topic, along with the assassins
who lay in wait for him, and the dentist, the evil dentist who wanted to do him
harm. Because of my complete lack of comprehension of what stood before me, I
honestly thought I could solve it all by taking him for a walk around the block.
I returned from that walk, however, much sobered and with a very real sense of
foreboding born of the emerging realization of what our family and Larry were

From that day on and through the course of the next 23 years, our family and the
seeming legions of mental health professionals who rotated in and out of Larry's
deteriorating life bore witness to our own version of an American tragedy. The
tragedy of this promising young life laid to waste by an insidious mental
illness had an inevitable quality to it. We all knew, including some part of
Larry, that we would at some point get the phone call from his counselors that
they had found him dead in his room, or that we would all gather around his
deathbed in some hospital and wait for the end. By the time he reached his
mid-30s, he was slowly wasting away, subsisting on Coca-Cola and Marlboros. With
the body and stamina of a 70-year-old, Larry was vulnerable to a common cold
escalating into something that could kill him.

Along the path to oblivion, however, Larry provided us with many lighthearted
and at the same time heartbreaking moments. At the dinner table it was routine
for Larry to slurp his ubiquitous Coca-Cola with such ferocity that it brought
all conversation to a halt. He would sheepishly look up from his glass, murmur,
"Oops, I'm sorry," and then burst out laughing along with the rest of us. When
we would gather to watch TV, Larry would inevitably begin a conversation -
softly at first but with increasing volume - with the many phantom voices in his
head. "Larry, you're talking to yourself," one of us would eventually say. "I
was?" he would respond sweetly, always sweetly. "I'm sorry."

Two cruel features of Larry's brand of paranoid schizophrenia made the simple
task of taking his medications a continuing challenge: His counselors told us
early on that there were aspects of his illness that Larry actually enjoyed -
not having to go to work and not having to keep his room tidy, to name two.
Secondly, his mistrust of his doctors and counselors justified - in his troubled
mind - his ongoing reluctance to take his medications. Of course another factor
was the medications themselves. Though much improved now, throughout the '80s
and much of the '90s, prescription drugs designed to mollify the more
debilitating effects of paranoid schizophrenia produced at best modest results
often in tandem with troublesome side effects.

Against the backdrop of my brother-in-law's life and death, I read with interest
the ongoing Medicaid and Social Security solvency debates, especially as they
relate to funding for mental health. While the federal Medicaid funding levels
proposed by the current administration are shameful, I am heartened to read that
the Colorado legislature will propose restoring some of those Medicaid cuts at
the state level. These modest gains would mean a great deal to mental health
professionals and the families of those who suffer. To me and my family, they
would acknowledge, albeit belatedly and timidly, the memory of our loved one so
full of promise and yet broken in time by the ravages of mental illness.

Several days after his death, our family gathered at a quiet place to honor
Larry. In the embrace of the shadows cast by a nearby tree, we mourned a life
that might have been, and held close the empathy and compassion our dear one
bequeathed to all of us.


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