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TAC Newsletter 3/31/06


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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.


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

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