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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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