A lawyer for the governor says the notes don't mean that. An N&O lawyer says they do
By Pat Stith, Staff Writer
State government public information officers were instructed by Gov. Mike Easley's press office to delete e-mail to and from the Governor's Office, according to notes the Governor's Office released Saturday.
Andrew A. Vanore Jr., a lawyer who works for Easley, produced notes made by two public information officers showing that they and others were told at a meeting May 29 to destroy e-mail messages. Vanore said a third public information officer, whom he would not identify, also recalled those instructions.
Vanore said, however, that the notes don't mean what they say. He also said the instructions were not followed.
The News & Observer had requested the notes of the periodic meetings of the public information officers.
Questions about the way the Easley administration handles e-mail arose after an N&O series, "Mental Disorder: The Failure of Reform," which ended March 2. The series reported on an ill-conceived and poorly executed reform plan on which the state has wasted at least $400 million.
Two days after the series ended, Easley ordered the Department of Health and Human Services to fire its public information officer, Debbie Crane. Later that day, Crane told The N&O that, to bypass the state's public records law, the governor's press office had given instructions to delete e-mail messages.
Easley's chief legal counsel, Reuben F. Young, and his deputy press secretary, Seth Effron, quickly denied that such instructions had been given.
Young, who has been vacationing with his family in China, could not be reached for comment. Effron has been instructed by Vanore not to comment.
In Young's absence, Vanore was assigned to handle the matter. Vanore was chief deputy attorney general under Easley before Easley was elected governor in 2000 and has continued to work for the governor part-time on a contract basis.
Julia Jarema, public information officer at the Department of Crime Control and Public Safety, jotted this note at the meeting in question: "Public records request -- increasing -- careful of email -- delete emails to/from gov. office everyday."
Diana Kees, public information officer at the Department of Environment and Natural Resources, recorded this note: "emails -- more & more public records requests (blogs?) be careful w/emails; delete emails to & from gov office every day."
Vanore said he did not know what the notes meant.
"It could be interpreted a number of different ways, and the only way to properly interpret it would be to talk to the individual who took the note," he said. But he said he had instructed all the employees not to talk about that issue because The N&O might file a lawsuit.
Vanore provided The N&O with a box full of e-mail messages to and from Jarema, Kees and Renee Hoffman, the governor's press secretary. Hoffman presided over the meeting May 29; Vanore said he assumed "she was the one that caused Julia and Diana to make the notes."
Vanore said the e-mail messages to and from the governor's press office were "clear and irrefutable proof" that there was no systematic intent to destroy e-mail.
Hugh Stevens, an attorney who represents The N&O, said the notes made by Jarema and Kees confirmed Crane's allegation.
"This sounds to me as though there was a concerted and willful attempt to evade the public records law by deleting the e-mails," he said. "I don't see how you can interpret it any other way."
Crane has been a central figure in the emerging public records story. When she was fired, she told her story to The N&O.
"They ask the second you e-mail them anything, to kill it, then kill it again out of your trash so it doesn't exist," Crane said. "That's what they tell all the public affairs people, that they don't want to create any public records."
When The N&O asked Effron, a spokesman for the governor, to respond to Crane's allegation, Effron said: "This office has never told anybody to destroy any public record." He said Crane was a "dishonest and untruthful" person.
Within a few hours of Crane's disclosure, Stevens, The N&O's attorney, wrote Franklin Freeman, the governor's chief of staff, putting him on notice that the newspaper might take legal action to enforce the state's Public Records Act.
The next day, March 5, Young, Easley's chief legal counsel, responded to Stevens and N&O Executive Editor John Drescher. In effect, he challenged the newspaper to put up or shut up.
Young said he had investigated the matter. "I have concluded that there is absolutely no evidence to support your allegation," Young wrote. "Should you have evidence to the contrary, I respectfully request you immediately provide it to me."
Under state law, it is a misdemeanor for someone to "destroy, sell, loan or otherwise dispose of any public records ... without the consent of the Department of Cultural Resources."
Vanore contends that policies signed by Easley and his appointee, Lisbeth C. Evans, secretary of Cultural Resources, allow destruction of e-mail messages that have "no administrative value" in the opinion of the sender or the receiver.
"What we're doing is consistent with policy," Easley said at a news conference earlier this month.
Sunday, March 30, 2008
A lawyer for the governor says the notes don't mean that. An N&O lawyer says they do
Posted by Marlisa at 9:58 AM Permalink
Candidates talk of broken system
To read candidates' views, go to this page and dlownload pdf file under related content.
By Lynn Bonner, Staff Writer
The next governor will be asked to repair North Carolina's fractured mental health system, which has wasted money, left sick people without adequate care, and cost lives.
The News & Observer recently reported that the state had wasted at least $400 million on a basic service called community support and had spent too little on treatment of serious mental illness.
While some people are getting services they don't need from private companies, more people are going to state mental hospitals for short stays. These short stays stabilize patients in crises but have little therapeutic value.
The N&O report also revealed that since December 2000, 192 employees had abused 82 patients at the four mental hospitals run by the state, and 82 patients had died under questionable circumstances.
Do the candidates for governor have ideas about what to do?
Lt. Gov. Beverly Perdue, a Democrat, wants to expand networks of clinics and primary-care doctors that already treat Medicaid patients to include mental health treatment. Some parts of the state are already testing that plan.
Four of the six candidates are willing to return some responsibilities for patients' care to local mental health offices, which were forced to give up most responsibility for providing care in a 2001 rewrite of mental health laws.
Three Republican candidates said they want to track down private companies that have committed fraud. Former Supreme Court Justice Bob Orr wants to know who pushed for rules that allowed questionable companies to make millions. "This is probably the biggest and most embarrassing scandal in state government in my lifetime," he said.
In separate interviews, The News & Observer asked the major candidates how they would fix the problems plaguing the mental health system. Find their answers on Page 10A.
All rights reserved. This copyrighted material may not be published, broadcast or redistributed in any manner.
Posted by david at 9:47 AM Permalink
By Sherry Youngquist
MOUNT AIRY -- When mental-health officials canceled a contract this month with a private agency that provided drug treatment and counseling, they turned to what has become a rarity in North Carolina’s troubled mental-health system: a public provider of treatment.
New River Behavioral Health Services, based in Boone, took over yesterday the treatment of patients in Surry, Yadkin and Iredell counties that had been served by Insight Human Services, a private agency based in Winston-Salem.
North Carolina’s $ 2.3 billion public mental-health system is in crisis after seven years of what most experts say is a failed reform effort.
But state officials say that New River’s model in Alleghany, Ashe, Avery, Watauga and Wilkes may provide a model for services across the state. New River is overseen by public officials in these five counties.
“It’s working in one area of the state,” said Dick Oliver, a spokesman for the N.C. Department of Health and Human Services. “We need more time to evaluate how successful it is.”
When most local mental-health agencies turned to private companies and nonprofit agencies to provide care, as requested by the state, New River struck out on its own.
New River works by managing a set amount of state dollars each month. It’s different from private agencies, which usually rely on a reimbursement for each service.
The state’s reform took effect in 2001. And most areas transferred services to private agencies and let another group manage the services. But officials in the mountain counties began looking for a way for New River to keep the services.
New River had more than 40 years of experience, and county officials there wanted to ensure that services would continue in those rural areas, said Ken Richardson, the board chairman of New River and chairman of the Alleghany County Board of Commissioners.
Local leaders asked the General Assembly to allow the counties to establish a public provider, and in 2006, legislators gave them the authority.
In January 2007, the five counties began doing business as New River Behavioral Healthcare. The only other public provider in North Carolina is in Rockingham County.
New River operates in tandem with a public agency called Smoky Mountain. New River provides the service, and Smoky Mountain provides the oversight.
“We look as similar to the old area authority as probably any provider in the state,” said Pam Andrews, the chief executive officer of New River. “We were able to hold on to staff, hold on to infrastructure, all the form and function that made us successful 10 years ago, 15 years ago. I have managers who have 36 years experience, and a lot of providers are not able to find that. And that’s a strength. We’ve been able to survive this roller coaster.”
Another key has been New River’s financing model.
As part of the pilot program, New River receives state money as a single stream, with an agreed-upon amount, broken down by months. The financing model went into effect for the fiscal year that began July 1, 2007.
New River will receive $5.7 million.
“We still have to file claims. We still have to show that we provide the service. But it ensures a continuous cash flow,” Andrews said.
Most private providers offer a limited menu of services. New River is comprehensive, delivering most all the mental-health services in the mountain counties - from substance abuse to day-treatment programs for chronically mentally ill to family therapy to mobile crisis.
Some services - such as psychiatric - lose money. Others don’t. New River spreads the money around to make sure that there are no losses.
But this is the first fiscal year for the financing model. And no one knows yet whether New River will have money left over or will need more by year’s end.
Regardless of what happens, New River won’t ration care, Andrews said.
“I’m telling you, I don’t see how any provider in North Carolina can survive on a fee-for-service model. There are not enough dollars in the system to support that model,” Andrews said. “Private providers are not surviving.… The continuous change of providers means the consumers don’t know what’s going on. They’re like, ‘who’s in there now? What’s happening now?’”
Officials in Surry County said that the state needs to deal with problems in the system. There, the agencies have failed to coordinate billing and have battled over reimbursements.
In the past 26 months, at least three mental-health providers frustrated with reimbursements have stopped providing services through Crossroads, the public agency in Elkin that oversees care in Surry, Yadkin and Iredell counties.
Last month, Insight Human Services announced that it would be the fourth to leave. Insight is a division of Partnership for a Drug-Free North Carolina. Its clinics in Mount Airy, Yadkinville, Statesville and Mooresville closed yesterday and were immediately taken over by New River.
But Jim Harrell Jr., a Surry County commissioner, said he is not satisfied. He is also on the area board of directors for Crossroads, and he wants to know whether Crossroads is making an already cumbersome reimbursement system more difficult.
The Surry County Board of Commissioners voted this month to ask for a private consultant or state official to evaluate Crossroads.
■ Sherry Youngquist can be reached in Mount Airy at 336-789-9338 or at firstname.lastname@example.org.
Posted by david at 9:29 AM Permalink
By LEE HIGGINS - email@example.com
Fourteen residents removed from a Winnsboro residential care facility that ran out of some patients’ medications remained in state custody Saturday, authorities said.
The state Department of Health and Environmental Control suspended the operating license of David Donnelly, owner of Peachtree Manor on Greenbrier Mossydale Road, DHEC spokesman Thom Berry said.
A preliminary hearing will be held within the next several days to review conditions at the facility, Berry said. The residents are at Trinity Place, a residential care facility in Sumter, and are in the custody of the Department of Social Services, Berry said.
The patients have a variety of health problems, including mental-health issues and cancer, Fairfield County sheriff’s Lt. Mary Anne Phillips said.
No evidence was found that patients missed doses of their medicines, but some were about to on Friday, Phillips said. “They didn’t have the dosages for the rest of the day,” she said.
Donnelly told investigators his current pharmacist would not deliver and he pledged to have the medications by Saturday, Phillips said.
Fourteen of 16 residents at the facility were taken into emergency protective custody Friday by deputies and checked out at Fairfield Memorial Hospital, Phillips said.
A Columbia pharmacist called DHEC Friday morning to express concern that residents were “running out of their medication and some had run out already,” Berry said.
DHEC sent inspectors and declared an “immediate threat” situation, which has happened a handful of times in the past 20 years, Berry said.
The facility also had no telephone service Friday, authorities said.
Donnelly’s permit to operate was revoked in 2006, but he has been allowed to operate during an appeal, Berry said. A resident being pushed in a wheelchair near the facility was struck and killed by a truck in 2006, contributing to that decision, Berry said.
Donnelly could not be reached for comment Saturday.
The Associated Press contributed to this report.
Posted by david at 9:21 AM Permalink
By Andrew Binion (Contact)
Saturday, March 29, 2008
The 27-year-old Bremerton man told investigators he was trying to kill himself when he lit his Trenton Avenue house on fire Feb. 10.
He demanded police shoot him in a subsequent standoff.
But he was arrested, and taken to jail after a brief medical evaluation.
He was initially charged with reckless burning. But on Thursday, that charge was elevated to first-degree arson.
Because of a long history of violent offenses, the most serious involving threats and attempts at suicide, another conviction for Joseph McCabe would result in life in prison under the state's "three-strike" law.
His mother, at times the target of his violence, said her son needs psychological help and believes he will ultimately kill himself if he is sentenced to life.
"I don't know how he didn't die," said McCabe's mother, Chrisanne "Cryss" Jensen of her son's numerous attempts, noting that he has spent years in prison and has never received adequate mental health treatment. "I don't know how a lot of times he doesn't die."
McCabe's case is one of a few highly visible incidents since the start of the year where Bremerton men are alleged to have committed crimes during or leading up to a suicide attempt.
In the two most serious cases, the men were taken to jail. In a less serious attempt, the man involved was involuntarily committed for three days of evaluation.
While the three cases shed light on inconsistencies with how the criminal justice and health care system deals with mentally ill suspects, they also square with what mental health advocates have said for years — that jails and prisons have become warehouses for the mentally ill.
The phenomenon comes after what advocates call "deinstitutionalization," the mass shutdown of mental hospitals, beginning in the 1960s, and the advent of antipsychotic medications. In order to receive federal dollars for in-patient care, mental health agencies like Kitsap Mental Health Services cannot operate in-patient facilities that have bed space for more than 17 patients at a time.
The overflow, advocates contend, is channelled to jails and prisons, which generally are not equipped to deal with mentally ill inmates.
One in six U.S. prisoners is mentally ill, according to a 2003 Human Rights Watch report, which notes that the rate of mental illness in the prison population is three times higher than in the general population.
A Rash of recent incidents
McCabe's latest involvement with the court system started about a month after a well-publicized suicide attempt that nearly resulted in two dead, including a Bremerton police officer who risked his life to save the suspect.
Daniel Cash was the suspect in a vandalism and attempted arson case when Bremerton Police Officer Jason Glasgow found him about to jump off the Warren Avenue Bridge with a brick tied around his neck. Glasgow was able to grab the 44-year-old Cash just as he jumped and brought him back to safety, at the risk of his own life.
Cash was taken to Harrison Medical Center. A short time later a call went out on the police scanner. The hospital was going to release Cash. Officers promptly went to the hospital, placed Cash back in custody and drove him to the Kitsap County jail, where he remained for three days in a cell with a drain on the floor for a toilet.
The attempted arson charge was dropped and Cash pleaded guilty to malicious mischief for breaking windows. Cash, who's now out of jail, told the Kitsap Sun that he spent three days in a single cell, eating baloney sandwiches for every meal.
"I was so sad," he said of the breakup with his girlfriend that triggered the mental crisis. "I needed someone to talk to bad, and I had nobody to talk to, but me and myself for three days."
Patti Hart, spokeswoman for Harrison Medical Center, said she could not comment on individual cases because of federal privacy rules.
On March 8, a 25-year-old man suspected of assaulting his wife left the couple's 1-year-old son in his car and began walking toward the Warren Avenue Bridge.
He had text-messaged his wife earlier, saying he was going to jump off the bridge and commit suicide. She called police, who intercepted the man. In contrast to McCabe and Cash, the man was admitted to Harrison for a 72-hour evaluation period, according to a Bremerton Police report.
One person in the chain of command that determines if a person should be held for mental evaluation, the "designated mental health professional," looks for evidence that a person is a threat to themselves and others and cannot use the unavailability of resources to determine if a person should be held, according to the "protocols' of the position, available on the state Department of Health and Human Services Web site.
A lengthy criminal history
McCabe's violent criminal history is a direct result of lack of treatment, said Jensen, who noted that she has struggled with depression herself and that her father was a schizophrenic.
In addition to his strike convictions, McCabe has also been convicted of assault and robbery.
His first strike offense occurred in 2001. McCabe pleaded guilty to first-degree arson and was sentenced to 31 months in prison.
In court documents, McCabe's girlfriend at the time said he had tried to kill her, and himself, by setting their High Avenue residence on fire. He also confronted Bremerton police with a knife and had to be physically subdued.
Officers wrote in reports they had prior experience with his threats and suicide attempts.
The second strike offense occurred in 2006 when McCabe attempted to kill his wife. The woman told officers that McCabe said: "If I kill you it will be easier for me to kill myself," according to court documents.
The couple then walked to the Warren Avenue Bridge in order for him to jump, but McCabe became "too scared to jump," documents said.
After a jury found him guilty of second-degree assault and two counts of violation of court orders, McCabe was sentenced to 15 months in prison.
Kitsap Mental Health Services has programs and partnerships with law enforcement to target mentally ill people who are likely to end up in jails or prisons, said spokeswoman Rochelle Doan.
"It is clear to us that we have individuals who would be better served in mental health agencies that do end up in other institutions," Doan said.
One program, called PACT, or Program for Assertive Community Treatment, takes a multidisciplinary approach, teaming up different mental health professionals to work with mentally ill people who have been resistant to treatment.
Often mentally ill people, because of the nature of their disease, are incapable of seeing their own illness. And that provides difficult challenges for those who want to help them.
"Ultimately, the client needs to, at some level, want to participate," said Beth Friedman-Darner, clinical associate director at Kitsap Mental Health.
Deputy Prosecutor Kevin "Andy" Anderson reviewed police reports over the Trenton Avenue fire and McCabe's criminal history and upgraded the charge from reckless burning to first-degree arson. He said the key to the charge is that when law enforcement officers subdued him after standoff, McCabe had no burns on his body.
"I know he burned down the house and I know he did not burn himself," Anderson said, casting doubt on McCabe's assertion that he was trying to kill himself.
McCabe's mother said her son has been diagnosed with bipolar disorder. Anderson said that if the case goes to trial, a jury will have to decide if McCabe's alleged illness mitigates his actions.
"The statute doesn't say being bipolar means a person can burn down houses with impunity," he said.
McCabe's court-appointed attorney, Jacob Murphy, said the defense will consult with mental health experts and have McCabe evaluated to determine if he had a "diminished capacity" at the time of the crime or if he was legally insane.
McCabe passed the first step, to determine whether he is competent to stand trial. Further evaluations will happen after he enters a guilty or not guilty plea. McCabe's mother said any treatment he has received since being incarcerated was perfunctory at best.
"I don't know if they did anything mental-health-related until he got to court," Murphy said. Read more!
Posted by david at 9:19 AM Permalink
Prescription drug abusers often don't realize that their behavior could lead to fatal consequences. Like the nation, Eastern North Carolina is seeing an increase in prescription drug abuse cases.
According to the 2008 U.S. Department of Justice National Drug Threat Assessment report, "parents are less likely to talk to their children about the dangers of prescription drug abuse than they are about heroin, cocaine, crack, marijuana, or alcohol abuse."
According to Partnership Attitude Tracking Study data for 2006, 81.5 percent of parents perceive abuse of prescription drugs to be a growing problem among teenagers, yet only 36.2 percent of parents discuss with their children the dangers of using prescription drugs to get high.
In Kinston, Greenville and New Bern, prescription drug abuse is becoming more common, according to Port Human Services officials.
Both Matt Lambeth and Karen McNair serve as Port Human Services counselors helping people with behavior issues which include prescription drug abuse. The abuse is not age discriminatory both agreed.
For the past six years, McNair has seen a steady increase in prescription drug abuse. "I see about 40 patients a week from age 4 to about 70," she said. "The abuse is huge. It's easy to get these kinds of drugs which are becoming a hot commodity."
McNair is based in Kinston. She said people become easily addicted to prescription medication and it's difficult for officials to track abusers.
"People doctor shop to get prescriptions filled," she said. "Sometimes doctors are able to notify pharmacies about someone who is trying to fill an illegal prescription. Their name is flagged in a computer."
Mixing prescription medicine with alcohol can cause respiratory depression, McNair said. Prescription drug overdoses are increasing in the area.
"I knew one person in Greenville who died from an overdose," McNair said. "The overdoses are usually accidental."
Both McNair and Lambeth agreed more education is needed to help people avoid abusing prescription drugs. Some prescription drugs can provide users with highs similar to cocaine.
Finding alternative coping skills can help reduce someone's risk from becoming addicted to prescription drugs. "Exercise is a big mood stabilizer," McNair said.
Like McNair, Lambeth sees a wide variety of prescription drug abusers. At his Port Human Services clinic in Greenville, Lambeth works with 60 people a week in the clinic's Opioid Agonist therapy program.
"Sedative and Buprenorphine abuse is on the rise," he said. "We help identify peoples' triggers and counsel them."
The Internet has created a new tool for abusers to get their prescription drug fix, he said. The number of Internet pharmacies selling controlled and non-controlled pharmaceutical drugs has increased, according to the National Drug Assessment Threat report.
"Kids can go online and get any type of drug with very little oversight," he said. "People are ordering prescription drugs from India or Mexico suppliers and sometimes really don't know what they are getting."
According to a Pharmaceutical Research and Manufacturers of America 2007 survey, about 5.4 million adults in the United States have purchased prescription drugs from a foreign country such as Canada or Mexico. About 50 percent said they purchased the drugs from another country because they did not have a prescription for the drug they wanted, according to the survey.
Increased law enforcement and prescription monitoring programs have recently forced abusers who traditionally get their drugs through doctor-shopping, forged prescriptions or indiscriminate prescribing to use the Internet to order prescription drugs.
"It's illegal for anyone to photocopy a written prescription," Donna Ramsey, Alternative Care Treatment Systems Clinical Director said.
Before moving to Kinston, Ramsey was a mental health official working in Maine. She said "prescription drug abuse is rampant there."
Prescription drug abusers would "malinger" at area hospital emergency rooms faking illness in order to get pain medication. Ramsey said abuse is increasing because "there is an excess of medication available all over the place" in many homes' medicine cabinets.
"It's easier to hide the abuse," too she said. "The abuse can destroy families."
Ramsey said she recently attended a 16-year-old girl's funeral in South Carolina. The girl died from a prescription drug overdose, she said.
Many teens don't think there is great risk with mixing or abusing prescription drugs. According to the Partnership Attitude Tracking Study for 2005, 44 percent of adolescents in grades 7 through 12 did not perceive a great risk in trying pain relievers such as Vicodin or OxyContin that a doctor did not prescribe for them. Sixty-two percent of the teens surveyed said the drugs were easy to get from their parents' medicine cabinets and 51 percent said they didn't think the drugs were illegal.
Chris Lavender can be reached at (252) 559-1078 or firstname.lastname@example.org.
U.S. Department of Justice National Drug Threat Assessment 2008
Pharmaceutical drug abusers in a growing number of states are having greater difficulty in getting drugs through forgery.
Criminal groups are stealing pharmaceutical drugs from delivery trucks.
The number of Internet pharmacies selling controlled and non controlled pharmaceutical drugs has increased.
Methadone related deaths and overdoses have increased sharply since the 1990s.
Posted by david at 9:16 AM Permalink
BY MICHAEL BARRETT
Cars and trucks whizzing south on I-85 offered the only background music as Lynn McKee knelt by the memorial to her son on a windy morning this month.
The homemade wreath and Easter flowers she brought were carefully arranged beside a small cross, and stepping-stones etched with the words "harmony" and "wonder."
It was hard for McKee not to come to the overpass at Exit 5 in Cleveland County after David "Joey" McKee, 21, of Gastonia, committed suicide there a little more than a year ago.
Her visits have become less frequent over time. But for her and Joey McKee's other loved ones, the pain remains.
"Have I healed? No," said Lynn McKee "I can get up and go to work. I can get through most of the day without getting depressed.
"My heart is still broken wide open."
Dealing with the loss of her son and discussing the things that led to it are only a part of what Lynn McKee struggles to do each day. She also wants to raise awareness about the symptoms of people considering suicide, so that their loved ones might be able to intervene.
"The loss of a child from sickness or a car wreck is one thing," she said. "The loss of anyone from suicide is totally different."
Struggling to understand why
Lynn McKee blames her son's suicide largely on delays he encountered in applying for Social Security disability payments. Such delays have plagued the system and caused a backlog of cases across the nation in recent years.
Joey McKee had been diagnosed as borderline schizophrenic, bipolar and learning disabled. His manic depressive states kept him from holding down a job, said his mother, and he couldn't afford medicine to treat his illness.
McKee had reapplied for disability after being turned down twice in two years. He had lost 40 pounds from his thin frame and been in and out of a hospital mental ward several times - once after slitting his wrists, his mother said.
"All of his friends were just floored because he talked to them about (suicide)," Lynn McKee said. "But everybody kept on saying he'd never do it."
On the morning of March 3, 2007, McKee walked four miles from a friend's house to the Dixon School Road overpass. He leaped more than 20 feet onto the southbound lane of I-85 and was hit by a tractor-trailer.
Lynn McKee was getting ready for work when a police officer came to her door with the news.
"It was disbelief at first," she said. "I just kept saying, ‘You've made a mistake.' I just kept telling them they were wrong."
McKee was buried on a family plot in Mississippi, but his mother believes his spirit still has a strong presence at the overpass. She regularly drove there after his death to read poems and talk to him.
She fashioned the roadside memorial there with some of Joey's friends.
"I don't know what set him off," she said. "I don't know why he did it."
Dealing with the loss
A single mother, Lynn McKee came to Gastonia from Georgia four years ago with Joey and her older son, Richard, 24. They moved to be closer to her daughter, Misty Finnigan, 32, who had relocated to Charlotte.
Joey struggled to deal with the move, but he often eased his stress by writing stories and drawing. He was a "mama's boy" who dreamed of becoming a video game designer and enjoyed playing card games such as "Magic: The Gathering" with his brother.
Richard, who was a year older than Joey, nervously tapped his leg at times as his mother recently spoke from their living room.
"Basically I just miss having my partner," he said at one point, raising his head from his hand. "If I couldn't do something, (Joey) did it."
Coming to grips with what happened has been difficult. Lynn McKee said she still has "Joey moments," which render her unable to function.
There's always something missing, Lynn McKee said, although her surviving children and 17-month-old granddaughter make her happy.
"After a year, do I miss him more or less?" Lynn McKee said. "More. But I'm adjusting ... slowly."
You can reach Michael Barrett at 704-869-1826.
Posted by david at 9:13 AM Permalink
By Nancy Cambria
EDWARDSVILLE — The mother said her daughter hid the steak knives everywhere:
under sofa cushions, in the folds of curtains, between mattresses, in the piano
bench, the dog's toy basket.
She found them about the same time her teenager — once a tiny 3-year-old they
adopted from a Panamanian orphanage — carved an obscenity in her wrist and
concealed the wound under a sweatband laced with safety pins.
The girl harbored other secrets. Kathy Rhoten of Edwardsville, said she
realized that her daughter, then 13, had been hoarding hundreds of pins and
needles in her pillowcases, threading them in the hems of her clothes and
lining her pockets.
"You name it, if it had a sharp edge, I found it hidden in my house," said
Rhoten, who coped with her daughter's increasing disobedience and rages:
lashing out with fingernails, pricking herself and classmates with tacks,
stealing and lying. Rhoten had already packed up boxes of gifts and heirlooms
because her daughter was destroying them during arguments. Her daughter poured
cleaning chemicals on carpets and loosened the slats on the ceiling fan,
causing one to fly, Rhoten said.
"We were frightened, very frightened," Rhoten said.
Kathy Rhoten is telling her story from her Clayton attorney's office because
she and her husband Steve Rhoten were indicted in December on two counts each
of criminal restraint by a Madison County grand jury. Prosecutors say about a
year ago, Steve Rhoten, with his wife nearby, used zip ties to restrain their
daughter. The charges led to their daughter being placed in foster care, where
The Post-Dispatch is not naming the daughter because it typically does not
identify children in foster care. Kathy Rhoten's attorney also requested that
the name not be used.
Kathy Rhoten said her husband resorted to the ties to keep his daughter from
going into her bedroom where they were certain she'd hidden a knife to cut
herself again. First he tied her wrist to his belt, and they sat down at the
computer for homework, Rhoten said. Later he tied her to a sofa as the family
watched television. Rhoten said they should have taken the bedroom door off its
"We didn't do it to punish her," she said. "We did it to protect her."
Steve Rhoten, a computer consultant, declined to be interviewed for this story
on the advice of his own attorney.
Investigator Dennis Gunderson of the Edwardsville police department said that,
regardless of the motive, the act was criminal and deserved the scrutiny of a
judge and jury.
"Anytime you lash someone to something, it may not be physical abuse, but it's
also a mental thing," he said.
Although the investigation is ongoing, Gunderson said he had found no other
signs of abuse by the Rhotens — just extreme disciplinary actions that put the
parent's actions into question. Those include their cutting electricity to the
child's room at bedtime — a move, Kathy Rhoten said, to prevent her from
staying up all night on the Internet.
"They do not understand what it's like to raise a child like this," Rhoten
said. "People just don't get it."
Ronald Federici, a neuropsychologist specializing in foreign adopted children,
said the Rhotens' story was becoming more and more common these days: Kids
suffering from early trauma and neglect behave in ways that push their parents
to the brink.
"The parents have no help, no support, no training," he said. "They go in there
with typical, normal parenting skills and the kids reject that. The parents
start getting out of control and look for ways to restrain and contain the
kids," said Federici, who has testified nationwide in abuse and murder trials
of parents who adopted from orphanages.
Federici knows of at least 16 murders in such families. And there are other
tragedies: In North Dakota, a boy adopted from Russia stands accused of
murdering his sister.
The Rhotens' lives quickly unravelled eight months after prosecutors said they
used the ties. That's when police and a child welfare investigator came
knocking. Rhoten said the investigation was triggered by an abuse hot line call
the state received just days after the Rhotens forbade their daughter from
meeting her boyfriend at a local skating rink.
Ralph Turner, an investigator with the Illinois Division of Child and Family
Services, declined to discuss the case. The Madison County State's Attorney
Office, also declined to comment.
After the hot line complaint, Steve Rhoten was ordered by children's services
to leave the house. A month later they learned of the grand jury decision when
a reporter came to their door. The parents pleaded not guilty to the charges,
which carry a maximum three-year prison sentence, though probation is more
Their daughter was taken into state custody. Kathy Rhoten was placed on a paid
suspension from her job as a special education teacher.
"She had total control over our house," Rhoten said of her daughter.
Yet despite their anguish, the Rhotens are certain of one thing: They want her
"She's our daughter. We love her," Kathy Rhoten said. "We're not going to give
up on her yet. She doesn't have anyone else, and it's not her fault."
LOVE CAN'T HEAL ALL
The Rhotens already had a son. But they were unable to conceive again. They
wanted a second child so badly they say they paid an attorney $25,000 and flew
a rickety plane into a hilly rainforest village of corrugated metal shacks.
They met the 23-pound girl in the lobby of a stucco orphanage with bars on its
windows. She held a doll. She was wearing a dress.
The Rhotens saw signs of neglect and trauma, they say. When authorities allowed
the parents to return a month later, the girl's jet black hair had turned white
with lice. The doll and dress were gone. Later, in Panama City, they realized
she spoke no formal language, just a torrent of obscenities, they say.
The Rhotens are not the only ones to make these jarring journeys to orphanages
in search of a child to raise and love.
Between 1989 and 2005 the U.S. Department of Homeland Security counted more
than 234,000 children adopted by Americans from foreign countries, most from
China, Russia, Eastern European nations and Guatemala. A great majority of
these adoptions, particularly those from China, result in happy outcomes and
families who overcome early obstacles to raise thriving children.
"Our family has been made complete by our daughter," said Jan Wondra, mother of
Katie, 16, a blond, blue-eyed girl she and her husband adopted from Russia when
she was 3.
This seemed to be the case for the Rhotens. Members of the First Presbyterian
Church of Edwardsville said the little girl, though a challenge, had become a
loved and active member of its Sunday school. By second grade she wrote a book
about her adoption with crayon illustrations.
"One day a lady and a man from the United States came to the orphanage," she
wrote under a drawing of two smiling adults beside an emerald mountain, tulips
at their feet. "They wanted to adopt a sweet little girl. ..."
But she, like many of these children, has been diagnosed with Reactive
Attachment Disorder. That diagnosis did not come until October 2007, about
eight months after the daughter first cut herself and the parents used the
restraints, Kathy Rhoten said.
Reactive Attachment Disorder is an affliction of orphanage children who spent
their time as babies and toddlers mostly alone in cribs with few, if any,
caregivers to comfort, hold or speak to them. Prior to the diagnosis, the
family did not seek professional help and felt they could deal with their
daughter's numerous bizarre behaviors on their own. They attributed their
daughter's actions to her orphanage experiences, the influence of some of her
friends and an earlier childhood diagnosis of attention deficit disorder.
The Rhotens suspect that, like many children with reactive attachment disorder,
their daughter also suffered from abuse and neglect prior to even being put in
the orphanage. Many children like their daughter also suffer from fetal alcohol
syndrome and other undiagnosed disorders.
Some, like St. Charles resident Lisa Markel's then 5-year-old daughter, had
never left a room in her remote Romanian orphanage until the day she met her
Markel said she realized her daughter, now 12 and making headway with her
attachment issues, wasn't being shy the day she met her new mother and refused
to look at her or speak: It was terror.
Therapist Shirley Crenshaw, who works with area families — most recently Steve
and Kathy Rhoten — said these children lacked the hard-wiring to connect with
those who loved them. Brain scans reveal limited activity in the area
associated with bonding.
With an excess of stress hormones in their bodies, they exist mostly in a state
of "flight or fight" and use conflict to cope, she said. They often vent their
rage at their adoptive mothers to split the family and gain control.
Mothers of these children recently met at a coffee house in Chesterfield for a
support group. They've dealt with everything from school problems to feces
smeared on the walls to glass under pillows.
From their purses they proudly brought out holiday card photos: They show
poised children beaming for the camera. But the parents said those smiles were
often saved for strangers.
"What they're doing is mommy shopping," Crenshaw said. "They're looking
everywhere because they do not trust these parents to keep them."
Many parents have been ostracized by relatives because they didn't understand
the hard-line parenting and other methods recommended by therapists to deal
with their kids.
"I went from being a respected officer of a well known firm and a hero for
adopting children from an orphanage to a bad parent," said Lynda Baker at a
Some families also have been mistakenly reported to child welfare because
people sometimes hear the rages and suspect abuse.
Lake Saint Louis resident Sandy Davis, local chapter head of Families For
Russian and Ukrainian Adoption, said families had drained their bank accounts
to find effective therapies. Without help, she's seen families crumble.
Some parents give up and place the child up for adoption or commit their child
to the state — or return him or her to the foreign country, basically putting
the child out on the street, said Thomas DiFilipo, chief executive of the Joint
Council on International Children's Services.
An official with the U.S. State Department said it had no reliable statistics
on the outcomes of intercountry adoptions. Officials don't know how many are
disrupted. Most states, including Missouri and Illinois, don't track whether
foster children are foreign adoptees.
When adoptions fail, Davis said, the children are re-traumatized, increasing
their odds for institutionalization — or prison.
The Rhotens continue to wait for their daughter's return — often on a wood
bench outside the family court in Edwardsville. Friends are writing letters in
Instead of being forced to spend money on lawyers, the Rhotens "need to be
spending their money on getting help for this child," said Peggy Lambdin, their
daughter's former Sunday school teacher.
Kathy Rhoten's attorney Jack Spooner said he was optimistic that a judge or
jury would find that the Rhotens aren't criminals, "just a family who is in
love with their daughter and doing basically what they needed to do to protect
Kathy Rhoten said they all hoped to participate in a bonding program in Ohio
for Reactive Attachment Disorder.
But Rhoten said her daughter was ambivalent about coming home.
"She has no understanding of the consequences of what she's done," she said.
If her daughter does return, the parents will stow their kitchen knives in
their bathroom because it has locks on both doors. Kathy Rhoten will resume her
regular purge of her daughter's room of sharp objects, such as the glass
paperweight she once found sharpened to a point.
"You never know, though," Rhoten said. "She could climb in the bathroom window.
Nothing surprises us about her."
Posted by david at 9:11 AM Permalink
By Dorsey Griffith - email@example.com
Saturday, March 29, 2008
In the controversial world of autism treatment, mainstream medical doctors are increasingly pitted against alternative providers in the quest to figure out causes and develop treatments.
Dr. Michael Chez, a neurologist specializing in child autism, likens talking about the neurodevelopmental disorder to discussing politics or religion.
"Many times, I have wanted to give it up, because it's hard to keep your ego from being beaten up all the time," said Chez, who practices at Sutter Health and holds a teaching position at UC Davis. "You're portrayed as part of the Evil Empire of the Darth Vader Medical Society."
Chez has weighed in with a book which explores traditional and alternative theories and approaches to autism, including his own, unconventional drug therapies. "Autism and its Medical Management" is an effort to educate parents of autistic children and the professionals who take care of them.
Coinciding with the release of Chez's book in early April are National Autism Awareness Month and the 10-year anniversary of the UC Davis MIND Institute in Sacramento, also known for innovative research into autism.
The milestones reflect a dynamic time in autism diagnosis, research and treatment. While the causes of the disorder are not yet understood, autism cases continue to mount, as do efforts to unravel its many mysteries.
The Centers for Disease Control and Prevention reports that nearly 7 in 1,000 children 8 years old are diagnosed with the illness. The number of diagnosed cases served by the California Department of Developmental Services has grown from 6,527 in 1995 to 36,952 last year.
Chez wrote his book as a user-friendly overview of what is known and what is not yet understood. The book details therapies that show promise, and others, such as detoxification treatments, that he says remain unproven.
Chez believes that once an autism diagnosis is made, parents often mistakenly delay medical intervention.
"Most people don't understand the complexities of the medical aspects of autism," Chez said. "I wanted a program that allows people to get help from a medical point of view that is scientifically based and available in the community."
Chez said autism is multifaceted with numerous subtypes and symptoms, many of which overlap with those of other ailments, including epilepsy.
Up to 30 percent of autistic children may have seizures, he said, and in one study as many as 70 percent showed abnormal patterns on an electroencephalograph test, used to measure electrical brain activity.
Treatment of those children with valproic acid, an anti-convulsant drug, he reported, has demonstrated vast improvement in language function.
Chez is working with Robert Hendren, psychiatrist and MIND Institute executive director, on a larger-scale study on use of the drug in autistic children.
Jennifer McCain brought her 3-year-old daughter to Chez a year ago because she was way behind in language development and seemed unable to process information she was hearing.
"We were concerned it was autism, but she didn't fit all the autistic criteria," said McCain, of Elk Grove. Chez found the girl had irregular brain activity and prescribed an epilepsy drug.
"We started to notice a change within a week," McCain said. "She all of a sudden started acquiring language and trying to more frequently interact with us verbally." McCain said her daughter continues to improve and has not been diagnosed with autism.
Similarly, Chez has been using the drug, memantine, an Alzheimer's disease drug, for some of his young autistic patients.
Preliminary research suggests the drug, which protects nerve cells against chemicals that cause brain damage, also is effective in improving language, social interaction and self-stimulatory behaviors in autistic children.
One of Chez's current memantine patients is the son of Dr. Louis Vismara, a cardiologist and another parent founder of MIND.
Vismara said the medication has helped his 15-year-old, in terms of his behavior and cognitive skills. He said he appreciates Chez's scientific, yet novel approach to autism treatment.
"One of the most frustrating things we parents face is a multiplicity of anecdotal information," Vismara said. "You could spend your whole life hopscotching from one hope for a cure to another without any real sense of what is going to help."
Chez acknowledged he uses some drugs not yet approved by the Food and Drug Administration for children, or for autism symptoms. But he points out that he would – and has – done the same for his own children.
Chez is the father of a 14-year-old who had stopped talking at age 3 and was diagnosed with Landau-Kleffner syndrome, a rare neurological disorder that can sometimes mimic autism.
He is also stepfather to a 15-year-old who is autistic, has a seizure disorder and is developmentally delayed. She takes drugs for seizures and the Alzheimer's medication, Chez said.
Although Chez's treatment approaches could be called "unorthodox," he distinguishes himself from the so-called DAN doctors, a group endorsed by the Defeat Autism Now organization. DAN doctors believe the disorder results when genetically vulnerable people are exposed to certain environmental toxins.
Pleasanton physician Lynne Mielke is a psychiatrist with an autistic son and now a DAN doctor. While she agrees with Chez that autism demands medical treatment, her methods are different and only occasionally include prescription drugs.
She said autistic children are systemically ill, with neurological, gut and immune system problems. She argues that inflammation and free radicals from exposure to toxins damage the brain.
Mielke takes blood, urine, stool, and hair samples from her patients and looks for abnormalities – high levels of yeast in the bowel or mercury in the blood, for example, that might benefit from detoxification therapies.
Her treatments may include chelation – a drug that helps rid the body of metals. DAN doctors also typically want their patients to adopt diets free of wheat and dairy products, and consume vitamins and other dietary supplements. Some practitioners promote use of hyperbaric oxygen therapy to increase oxygen flow to the brain.
Bruce Kaminski of Elk Grove takes his severely autistic boys, ages 9 and 11, to a DAN doctor. He said the boys have benefited from antifungal treatment for their bowel problems, chelation for mercury in their blood, and strict diets. And while he doesn't oppose prescription drugs for certain symptoms, he said, he likes the DAN approach for its emphasis on removing anything that might be harming the child.
"Within a couple of days of taking my younger boy off milk, he went from not looking anyone in the eye, to giving eye contact," he said. "That told us something."
Chez understands why parents like Kaminski choose alternative medical treatments, but remains skeptical.
"People don't have faith in medicine and want a quick fix and a miracle cure," Chez said. "I would do all these things if they actually worked."
Regardless of the professional differences, Hendren said Chez's book may help bridge some of the chasms between the various philosophies and medical approaches to the disorder.
"By taking a thoughtful look at a wide variety of treatments," he said, "parents will have a better opportunity to make informed decisions about what they want to try."
Posted by david at 9:08 AM Permalink
FAYETTEVILLE — Taylor Crowe beamed as he tore open an envelope and rapidly read aloud the letter inside to family members gathered in the kitchen of his childhood home.
It was from the dean of the California Institute of the Arts, letting Crowe know he’d been admitted.
Crowe, who is autistic, was accepted after submitting a portfolio of sketches and paintings. He graduated last year with a degree in character animation.
Crowe, 26, shared his experiences with teachers Friday at the second day of an Autism Spectrum Disorder symposium hosted by the University of Arkansas at Fayetteville’s College of Education and Health Professions.
The symposium, which is expected to be an annual event, was started to meet the growing demand for professional development for teachers. An increasing number of autistic students are moving into Northwest Arkansas school districts, said Barbara Gartin, a UA professor and expert in special education.
When Crowe was diagnosed with autism as a 4-year-old, doctors gave his parents a prognosis of lifelong non-verbal social isolation and dependence.
He proved them wrong.
He’s had to teach himself social behavior that is instinctive to many individuals — how to detect sarcasm, how to maintain eye contact and how to express his emotions.
“I still have autism, I still struggle with things,” he said. “But I’ve worked hard to make autism part of my life, not all of it.” Crowe’s development was aided by supportive parents, a group of open-minded peers and teachers in Cape Girardeau, Mo., who adapted their techniques to help him learn, he said.
“None of you would be in this room today if you didn’t understand the potential that’s in every life,” Crowe said. “Something all of you know is that every life has meaning, every life has purpose.” Crowe’s parents videotaped him when he was an eager 2-year-old, speaking in complete sentences and gurgling out the alphabet song while spinning around in his diapers. But two weeks after his third birthday, something changed. At a meal time, he dropped his spoon on the floor.
“He started screaming, ‘ Daddy, I can’t find the words ! I can’t find the words !’” said David Crowe.
Crowe’s parents watched him seemingly lose his language and social skills, and it would take years for him to regain them.
According to the Centers for Disease Control and Prevention, 20 percent of children diagnosed with autism lose abilities after a seemingly normal period of development, an unexplainable and growing trend.
Now an adult, Crowe travels the country to tell his story, using his dad’s childhood videos to illustrate how autism hampered his development. He also tells stories that are familiar to teachers and parents, such as When Crowe was a child, he answered the doorbell.
“Is your mom home ?” the woman at the door asked.
“Yes,” he said, before closing the door in her face and returning to his previous activity.
The story illustrates that “people with autism have to learn a lot of things that come naturally to everyone else,” he said.
Autism consultant Aleza Greene said autistic children often fail to understand the “hidden curriculum” of social cues and unspoken social norms, such as personal space, conversational direction and emotional nuance.
Many also fail to recognize that their actions and body language convey meaning to others. Greene leads socialization groups that help children learn cues through play.
“We have to teach them that as long as you can be seen, you are communicating,” she said.
Crowe relied on creative educators and developed his own strategies. He continues to write “social stories,” one-paragraph descriptions of how to react to common social situations.
Recent stories include “How to introduce yourself to people,” “ Don’t hang up the phone until goodbye is heard, ” and “Don’t play April Fool’s jokes on people in the bathroom.” He also created a business card that says “I have autism” with a summary of the disorder on the back. Rather than fighting with those who tease and taunt him, he hands them a card.
Crowe is completing a children’s book about autism.
“Don’t surround a person with autism with limitations,” he told the roomful of teachers. “Don’t tell them they’ll never be able to do something. Let the person find their own limits; don’t find them for them.” Read more!
Posted by david at 9:06 AM Permalink
March 29, 2008
Mar. 29--CHAPEL HILL -- Most people occasionally worry about germs, strange noises in the night or whether they forgot to turn off the oven before leaving on vacation. But for as many as 5 million Americans with obsessive-compulsive disorder -- also known as OCD -- such anxieties are constant, and can almost literally take over their lives.
Now two expert clinical psychologists at UNC will, for the first time, use cognitive-behavioral therapy to treat couples in which one partner has OCD. The therapy has been effective in treating individuals who have OCD, and in treating couples where one partner suffers from another health problem. This is the first time the therapy will be used in couples involving a partner with OCD.
Jonathan Abramowitz, associate professor and associate chairman of the psychology department who is also director of UNC's Anxiety Disorders Clinic, and Donald Baucom, professor of psychology and director of UNC's Couples Therapy Clinic, will provide treatment for about 20 couples as part of a new study funded by the Obsessive Compulsive Foundation. The foundation, an international nonprofit educational organization, supports research on the causes and treatment of OCD.
Participating couples will receive 16 free therapy sessions and follow-up evaluations and will be paid $80 at the end of the study.
Obsessive-compulsive disorder is a psychiatric condition defined by recurrent, unwelcome thoughts (obsessions) and repetitive behaviors (compulsions) that the sufferer feels driven to perform. Persons with OCD are anxious about germs, mistakes, numbers or obsessive thoughts, and have problems with compulsive checking, washing, asking for reassurance or repetitive rituals.
People with OCD often recognize their obsessions and compulsions are irrational or excessive, but without treatment, they have little or no control over them. Abramowitz, an expert on OCD and a range of anxiety disorders, has used cognitive-behavioral therapy to successfully treat OCD patients individually.
"This therapy involves helping patients learn strategies to reduce their obsessional fears and compulsive behaviors," he said. Over time, many patients learn that they do not need to perform these rituals to stay safe.
However, coping with OCD can be complicated by a relationship, Abramowitz said.
Stress makes OCD worse. If individuals suffer alone, they worry about being late to work because they spent too much time checking the door lock, or fret about what others would say if they knew they washed your hands incessantly.
But for those in a relationship, OCD can lead to stress and arguments between sufferers and their partners, which makes OCD even worse. "It's a vicious cycle," Abramowitz said.
Another complication is how the non-OCD partner responds to the compulsive behavior. Even spouses with the best intentions may make matters worse by over-compensating for their OCD partner's fears and rituals.
In the UNC study, trained therapists under the supervision of Abramowitz and Baucom will work with both partners in each couple.
"First we will find out about the OCD symptoms and how the couple has been managing with these problems," Abramowitz said. "Then we will help the couple learn to work together to address the OCD patient's obsessions and rituals and assume a healthier relationship in which their interactions do not make OCD worse."
Study participants will be given "homework" between sessions. They will receive specific help with the OCD symptoms as well as counseling to enhance their overall relationship.
"The hope is that when both partners learn the CBT techniques, the partner without the disorder can be more helpful in encouraging the OCD mate to work through fears realistically," Abramowitz said. "This would be good for the OCD sufferers and their spouses."
One in 40 adults and one in 200 children suffer from OCD at some point in their lives, according to the Obsessive Compulsive Foundation. If you or your spouse or partner have OCD and would like to participate in the study and receive free treatment as a couple, contact the study coordinator, Michael Wheaton at 843-3951 or firstname.lastname@example.org.
Posted by david at 9:05 AM Permalink
A video look at how courts in San Luis Obispo are taking a preventive approach when it comes to crimes committed by the mentally ill.
Family members of the the gunman in the Black Road Auto shooting say Lee Leeds suffers from Schizophrenia -- which causes hallucinations and delusions.
About 1% of the population suffers from Schizophrenia.
Other mental illnesses like Bi-Polar Disorder and major depression are more common. Read more!
Posted by david at 8:58 AM Permalink
By Michelle Guffey | South Carolina Bureau
Saturday, March 29, 2008
AIKEN --- The availability of public psychiatric beds across the country has decreased considerably over the past 50 years, with some of the worst shortages in South Carolina and Georgia, according to a recently released report from the Treatment Advocacy Center.
South Carolina's status is critical, according to the report, and Georgia has a severe shortage.
John Young, the executive director of the Aiken-Barnwell Mental Health Center in Aiken -- a state-owned outpatient facility -- said budget cuts forced the state hospital in Columbia to discontinue the use of 500 beds from 2000 to 2005.
Aiken County has just one inpatient mental health facility: the privately-owned 47-bed Aurora Pavilion Behavioral Health Services.
Getting treatment for someone with a mental illness takes the cooperation of different agencies.
Those who are involuntarily committed first come into contact with law enforcement officials. How to deal with a mentally ill individual is part of police officers' annual training.
"When we get an order from probate court for an involuntary commitment, we first take them to Aiken Regional Medical Centers, where an evaluation is done," said Aiken County sheriff's Lt. Michael Frank.
As a doctor confirms mental illness, officials from the mental health center are consulted as well. If the person is deemed mentally ill, officials search for an inpatient facility with a vacancy.
"Since there is a shortage of beds, sometimes (finding a bed) is difficult," Mr. Young said. "Aurora has been extremely good when they have vacancies at making sure that people who need to be in the hospital are in the hospital."
But sometimes the facility is full, and, most of the time, the state beds are full, Mr. Young said.
While health care officials try to find a bed, the patient stays in the emergency room.
The report states that 42 of the 50 states might have less than half the minimum number of beds considered to be reasonable (50 beds per 100,000 people) by knowledgeable experts.
The decrease of psychiatric beds in the past 50 years was in part caused by the deinstitutionalization of public mental hospitals that began in the 1960s, the report explained.
Alyce McEachern, of the South Carolina Department of Mental Health, said the agency has had substantial decreases in the past several years in its inpatient psychiatric bed capacity, leading to a "significant number of persons in behavioral crisis waiting in hospital emergency rooms inordinate periods of time for an appropriate inpatient psychiatric bed to become available."
According to the report, in 2004 and 2005 in South Carolina, there were 443 public psychiatric beds available. The minimum needed was 2,109.
"The issue of inadequate bed capacity appears to be limited primarily to indigent care beds," Ms. McEachern said. "That means that these emergency room patients are forced to await the availability of an inpatient bed, and these folks generally do not have health insurance or a source of payment to access."
Though there is a shortage of state-owned psychiatric beds in South Carolina, data from the state Department of Health and Environmental Control suggests there is an adequate supply of adult psychiatric beds at privately-owned facilities.
"The average occupancy rate in the 808 licensed non-state-owned acute psychiatric beds in 2006 was 59 percent," Ms. McEachern said.
Though there is a shortage of public psychiatric beds across Georgia, the problem doesn't seem to exist in the Augusta area.
East Central Regional Hospital, though primarily a hospital that serves people with developmental disabilities, is state-owned and has 64 mental health beds, said Kenya Bello of the Georgia Department of Human Resources.
"They've never had a diversion issue where they had to transfer people to a different hospital," she said.
Medical College of Georgia Hospital maintains 34 psychiatric beds, and the VA Hospital has 68 beds serving veterans in 17 counties in South Carolina and Georgia.
Reach Michelle Guffey at (803) 648-1395, ext. 110, or email@example.com Read more!
Posted by david at 8:55 AM Permalink
By Colleen McEdwards
CNN) -- Tito Mukhopadhyay shuffles to the front door of his home in Austin, Texas. He's coming home from school, something that would have been unthinkable just a few years ago.
His mother, 45-year-old Soma Mukhopadhyay, is considered a pioneer in a breakthrough treatment for some autistic children who face the stigma of being considered "mentally retarded."
That was a label Soma never accepted for 19-year-old Tito. And after hearing Tito's story, you'll never look at an autistic child the same way.
"How was your day?" Soma asks.
Before Tito can answer, he obsessively moves around the house, placing the TV remote in its proper place, arranging the salt and pepper shakers just so. Then he sits down in front of his specially designed keyboard to type his response.
"It was like a floating kangaroo that kept itself invisible," Tito answers.
Tito's cryptic reply is part of his medical condition. But his distinctive way of speaking is also a gift that has made him famous in a misunderstood community. VideoWatch Tito interact with his mother »
Though Tito is virtually mute, that changes when he picks up a pencil to write, or begins tapping at his keyboard.
He is a poet, and the author of several books and essays in which he eloquently describes what it's like to be autistic.
In his writings, he explains why he doesn't make eye contact, what it is like to be obsessed with a ceiling fan, and how his brain has trouble processing sound, touch and sight all at once.
Experts confirm Tito's observations of autism. One doctor described it as the way the brain fails. None can agree on its exact cause, but most believe there is a genetic predisposition to the condition, with significant environmental triggers involved.
The developmental disorder affects the way the brain works and affects the way the child interacts with society.
Some doctors and parents see a link between childhood vaccines, others suspect pesticides or drugs taken during pregnancy. The theories are endless and most experts agree there is no single cause.
Whatever autism is, its symptoms range from a mild form to rendering individuals dependent on others for life.
Many people with autism are able to take in information very well, but the wiring in the brain simply won't allow the information to be processed in the form of organized thought and language.
Tito has given experts some rare insight into what that feels like. His poetry includes stanzas like this:
"I am he.
And I am me.
I am he behind that mirror
I am me watching the he."
One of his favorite books is Plato's "Republic."
The world may have never known about Tito's gift except for the efforts of his mother, Soma, who is from India.
Doctors there told Soma that Tito was mentally retarded and beyond hope. She gave up her career in chemistry, determined to teach him.
Eventually, an organization in the United States brought Soma and Tito, then 10 years old, to the United States to study him because he defied the stereotype of an autistic child.
Soma's method of teaching Tito is called the Rapid Prompting Method. I watched her work with other children at the HALO -- Helping Autism through Learning and Outreach -- center in Austin, Texas, where she teaches while Tito attends school.
The therapy starts by asking the children to point at words on pieces of paper. Once they've mastered that, they use the stencil.
If their motor skills develop well enough, the children will type on a specially designed keyboard.
Her technique seems to be working for the children who attend therapy at HALO. There is a yearlong waiting list for four-day therapy sessions. It can take years to see progress.
Rapid Prompting has not been tested in long-term scientific studies, and Soma is not without her critics. Some criticize her methods as harsh and unproven.
During her sessions, Soma never says "good job," never rewards a child with a high-five or a treat, which is a common reward in other therapeutic techniques.
Soma is unapologetic.
"I don't see the child as autistic. I don't see the label at all," Soma says, speaking quickly in her musical Indian accent.
"I see the child as a person. And just as I would talk to any person, I would talk to a child, because the world is not going to talk to them in a very slow way."
Dr. Michael Merzenich was one of the first experts to pay attention to Soma's technique. He's a neuroscientist at the University of California, and he believes Soma's rapid prompting works.
He says there is no doubt the children are using their minds to create their own words and express their own ideas. Unlike facilitated learning techniques that have been discredited, Soma does not guide the children's hands.
"Imagine what it would be like," he says, "to be able to understand everything that's said to you -- to think and to be unable to communicate your own thoughts and ideas."
Merzenich does not believe Rapid Prompting works for all autistic children, but has no doubt it can help thousands.
I watch several young children in their therapy sessions on this day in Austin. Some struggle horribly. The session makes the children appear stressed, but they continually make small breakthroughs and answer questions correctly.
Soma conducts about 10 therapy sessions a day.
"You must be exhausted," I say to her.
"I can't be," she answers curtly but with a smile. "I have to go home now and teach Tito."
At their home, I ask Tito if he is happier now that he can communicate. He writes out a long response on a piece of paper on a clipboard.
"I can't say whether I am happy or not, because happiness is a state of my mind. So sometimes I think I'm happy. Other times it is hollowness."
It's probably a true statement for most of us at some point in our lives. Soma smiles at the response and doesn't miss a beat.
"Keep writing," she says to Tito. "Keep going." Read more!
Posted by david at 8:51 AM Permalink
Sometimes, there are partisan criticisms made of public officials that just make you want to go, "Oh, for goodness sakes."
Oh, for goodness sakes.
State Republican Chairwoman Linda Daves wants Governor Easley to fire Franklin Freeman, his senior assistant for governmental affairs, from his position as the chairman of a committee reviewing state government e-mail procedures in light of public records laws. The reason for her ire is that Freeman says he doesn't send e-mail.
The Easley administration has been under fire, and justifiably so, for its handling of e-mails, or electronic correspondence used as a primary form of communication by millions of Americans. But when that communication is among government officials, it's public and it must remain so. That may mean files filling up, and it may result in some other kinds of inconveniences, but all that means is that more room for storage must be found. A public record is a public record is a public record. It's the panel's job to figure out how properly to dispose of e-mails that legitimately have no public value.
Even though Easley isn't the most open fellow in the world, and he of late has had to deal with some critical press coverage -- specifically a News & Observer series -- regarding the disheveled state of public mental health care in North Carolina, his appointment of Freeman seems reasonable enough.
Freeman is a veteran of state government, and even served briefly on the state Supreme Court. He certainly understands the issues involved, and he is known as a stand-up person who can be counted upon to deliver a straightforward opinion. And could his resistance to e-mail reveal a sort of frontier independence? Could it represent one man's stand against conformity, against being tied to the office 24/7?
The more we think about it, the better a choice he seems.
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Posted by david at 8:50 AM Permalink
By SHANNON DONNELLY
Saturday, March 29, 2008
When a psychiatrist told Patty Duke that she had bipolar disorder, her immediate reaction was, "Thank God!"
"Finally, it had a name," the actress told the 350-plus guests at the annual Old Bags Luncheon. "And if it had a name, that meant that people knew about it. It really did exist."
Then the doctor told her the condition was treatable.
"So I started taking the lithium," she said. "Today there's all kinds of medications, but the lithium has worked well for me.
"Hasn't it, honey?" she asked her husband, who was sitting at a table nearby.
Idaho firefighter Michael Pearce, who has been Duke's husband for 21 years, nodded. He was one of a handful of men at the luncheon, which benefits the Center for Family Services.
Duke's meandering journey to a diagnosis began decades earlier, after her manic demeanor as a guest on The Dick Cavett Show sparked concern among those who knew the young actress.
On the show, Duke introduced her then-husband Michael Tell, whom she'd married literally hours after he came to sublet her apartment.
" 'This is my husband,' I said. 'We're going to build an ark in the desert between Barstow and Bakersfield,' " she said. "People from home started calling. Anne Bancroft" — her co-star in The Miracle Worker — "came to see me at the hotel where we were staying, with the broken-out windows and all. She convinced me it was time to go home and get some help. So I did."
Duke recalls that she was pregnant by "a nice young man" and had separated from him when she met Tell.
However, most of Sean Astin's biographical references say that a 1994 DNA test proved Tell to be his father.
Duke, pregnant, annulled her 13-day marriage to Tell, returned to California, and "rested" — a euphemism for psychiatric recovery — in Palm Springs.
"That's where my son, Sean Patrick, was born. You know him better as the actor Sean Astin. He was in that movie ... um, um what was it called?" she said, asking the audience for help with blockbuster The Lord of the Rings.
"It's not just your face that falls when you hit 60," she said, laughing.
Recovered, she went to Boston for an acting job and met the married John Astin.
"Before I knew it, we were having a family," she said.
Astin divorced his wife and married Duke when Sean was 18 months old.
"John brought three sons from his marriage," she said. "And I had Sean, and then we had Mackenzie together, so we had five boys in the house."
Domestic bliss didn't last.
"My demons started again. The children would be outside my bedroom door asking to see their mom, and I would say, 'Not today, Mommy's not feeling well.'
"They would come to the bathroom door when they heard me screaming and say, 'Mommy, please don't kill yourself. We love you.' They were 2, 6 and 4 years old, I think, and I was emotionally abusing them. I didn't mean to hurt them like that. I just did."
After 10 years of marriage, her husband filed for divorce, and Duke went to the psychiatrist who diagnosed her. She took her medication and went back to work.
"Now my boys had a mom, a working mom, but she was balanced," she said.
Repairing her family proved difficult.
"The kids were always waiting for the other shoe to drop. So I had to build their trust in me, build their comfort in being around me," she said.
"When Sean Patrick graduated from high school, somebody asked him what the best thing in his life was, and he said, 'I can count on my mom now.' "
The relationship with her eldest has been rocky.
"We're always butting heads because we're so much alike. We've recently reconciled after not speaking for a long time," she said. "Yes, I've had a lot of crap in my life. But I've had some good things, too."
@pbdailynews.com Read more!
Posted by david at 8:44 AM Permalink
An Individual's Mood May Affect That of Loved Ones
By RADHA CHITALE
March 28, 2008—
Ron and Carol Rossetti had a storybook romance. The two were high school sweethearts, went to prom together and married after college.
"He was like the fun in my life," Carol Rossetti recalled. "But had I known the ride I was going to be in for, I'm not sure I would have signed up for it."
Not too long after they were married, Ron would get into terrible tempers, Carol recalled, or become very depressed. Later on, as his business grew more successful, Ron would spend money lavishly on cars: A Lotus, a Viper, a Porsche, a Hummer.
Ron Rossetti's erratic behavior took a toll on his wife. "I was just really unhappy," Carol said. "I was wanting to find the answer without giving up the marriage."
Carol Rossetti's discontent may be no surprise to many people whose spouses suffer from mood disorders. Ron was diagnosed with bipolar disorder in his late 30s, and while the news explained some of his behaviors and brought Carol a measure of relief, his wife Carol was in an unusual and vulnerable position.
Spouses are at high risk for depression when one party has a clinical disorder like depression or bipolar disorder, because they spend a large amount of time with them and are emotionally invested in their well-being.
"Was she depressed? Absolutely," Ron said. "Look what she had for a husband. & Was it a Dr. Jekyll or Mr. Hyde?"
Some studies show that if one spouse is depressed, the other can become depressed, and that up to 40 percent of people whose spouses have bipolar disorder get clinical depression. That's according to Dr. Igor Galynker, director of the Family Center for Bipolar Disorder at Beth Israel Medical Center in New York and professor of clinical psychiatry at Albert Einstein College of Medicine.
Natural Born Mimics
"We can mimic other people's facial expressions," Galynker said. "When we mimic other people's facial expressions, we also can adopt the mood that these people are in. It affects us, even on a superficial level."
But such mimicry can go beyond the superficial and become emotional. Studies in which monitors track brain activity while a subject is shown smiling or frowning faces show that the areas associated with happy or sad emotions are active when the subject is presented with the corresponding face.
This ability to tune in to other people's feelings, or empathize, can be useful, but it can also get a person in trouble if they are around someone who has depression.
"If a genetic predisposition exists, and a person is surrounded by people with a behavior, that may give rise to or create an environment that would fertilize that behavior," said Steven Lappen, a writer and frequent public speaker who has bipolar disorder.
Lappen, 58, was diagnosed with bipolar disorder at 19 and said his manic and depressive episodes during his 20-year marriage made his wife feel invisible and caused her to withdraw from him, behaving as if she, too, was depressed.
"I was so blocked up, I couldn't respond to her overtures," Lappen said. "Outside of the marriage, she wasn't depressed. She was able to tap into her vitality and vibrancy."
Lappen and his wife eventually divorced, and he later remarried a woman who also has bipolar disorder.
"The good news is that we both have bipolar disorder; the bad news is that we both have bipolar disorder," Lappen said, adding that their implicit understanding of the clinical nature of each other's moods made for a smoother relationship.
But experts are quick to point out that clinical mood disorders are not contagious per se.
Depression and bipolar disorder are complex, rooted in genetics and subtle brain chemistry. Experts point out that these disorders cannot infect people nearby the way a virus could.
"A depressed person will not give you the same clinical disorder by contagion. They're just too complex for that," said Ian Gotlib, professor of psychology and director of the Mood and Anxiety Disorders Laboratory at Stanford University. "It is rare that you yourself will develop that same psychiatric disorder."
But a person with depression or other disorder can have a tremendous effect on those around them. Studies on college roommates show that when one person has depression, the other roommate can develop similar behaviors and feel more down.
"It's not the mimicry, it's the stress of being around them," Gotlib said. "The mood stuff happens, but it's not clinical."
Coping strategies are critical when dealing with a depressed spouse.
"If the caregiver believes the behavior is caused by the illness, they are less likely to be affected," Galynker said. "If they think the behavior is the result of a character flaw, they are more likely to be affected because then they also place blame on themselves."
Carol Rossetti never thought she had a clinical condition, but she eventually became so unhappy with her husband that they separated.
"When I left him after 34 years of marriage, I didn't think we'd get back together," Carol said. "I was perfectly fine not being with him."
But Ron quit his job and went through therapy to get his disorder under control, and after a year of separation, the Rossettis came together again. Now both Ron and Carol know how to maneuver around Ron's episodes.
"The last ½ to two years have been the most worry-free of my life," Carol said. "Now he's a born-again bipolar person."
Copyright © 2008 ABC News Internet Ventures
Posted by david at 8:09 AM Permalink
By LAURIE MASON
A mentally ill Abington man who stabbed his mother in his grandmother's Bensalem home to save her, he claimed, from a painful death from anorexia was found guilty Thursday of third-degree murder.
Patrick Hughes-Bygott, 22, will be sentenced next month and could serve up to 40 years in prison. He will serve at least part of that sentence in a locked mental health treatment facility.
“This is an extraordinarily sad and tragic case,” said First Assistant District Attorney Dave Zellis. “Ellen Hughes-Bygott was a caring daughter, a kind sister and a caring mother. For her to have met her end in this horrific way is just heartbreaking. The sadness is just compounded by the fact that it was her son who did this to her.”
Bucks County Judge John Rufe handed down the verdict following a three-day degree of guilt hearing in Doylestown.
Although lawyers on both sides agreed that Hughes-Bygott was mentally ill when he stabbed his 55-year-old mother more than 60 times in the head, neck and chest on Aug. 16, they disagreed on his state of mind at the time of the slaying.
Zellis argued that the murder was a premeditated first-degree killing, motivated by anger. That verdict would have netted Hughes-Bygott a life sentence.
His defense attorneys, Wallace Bateman and Robert Adshead, argued that the slaying was voluntary manslaughter. They brought in mental health experts who testified that their client was delusional and flew into an irrational rage when he attacked his mother.
The knife wounds on the mother's face underscored Hughes-Bygott's mental illness, Adshead told the judge. One of the blades went through the victim's eye and into her brain.
“It was an attempt to obliterate her face. It was overkill,” he said.
Hughes-Bygott did not react as the verdict was read. His father sat in the audience with his head in his hands. He declined to comment after the verdict.
Bateman said his client, who is taking medicine to control his mental illness, spent most of the legal proceedings in a daze.
“After it was all over he asked us what the verdict was,” he said, noting that the judge had just spoken a few feet away from him.
Hughes-Bygott was arrested within minutes of the stabbing at the Wildman Avenue home where the victim had been living with her mother. He told police that he had to kill his mother because she was sick, saying she looked like a “stick figure” and was “razor thin.”
Family members said the victim did not have anorexia.
Mental health experts who testified during the hearing said Hughes-Bygott was in the midst of a psychotic episode when he set off around 3 a.m. from his home, heading toward his mom's house with three hunting knives in his pockets.
Unable to sleep and convinced that he was being pursued, Hughes-Bygott asked his mother to give him a sedative or to take him to a hospital, according to court testimony.
Ellen Hughes-Bygott refused to do either, and they argued, police said. While he was slashing his mother, Hughes-Bygott's 91-year-old grandmother tried to intervene and was slightly injured.
Defense expert Gerald Cooke, a psychologist, testified that Hughes-Bygott believed that he was Jesus and that his mother wanted him to help her die.
“He lost control and began to stab her in a psychotically based emotional outburst,” Cooke said.
But Zellis said the mental health experts did not have a true picture of the defendant. He played for the judge two phone conversations between Hughes-Bygott and his father after the slaying, in which the defendant ranted about what a bad mother the victim was and said he was glad she was dead.
“I blame her for pretty much everything,” Hughes-Bygott said in the call, which was recorded because it was made from the county prison. “It's like God said a painful death is too good for [her]. I don't blame myself. Who the [expletive] does she think she is, treating her son like that?”
Zellis said that in addition to the stab wounds, the autopsy showed blunt force trauma, meaning Hughes-Bygott beat his mother before killing her.
Rufe will sentence Hughes-Bygott on April 24, following a hearing in which his family members and other witnesses might testify. He remains in the county prison until then.
Laurie Mason can be reached at 215-949-4185 or firstname.lastname@example.org.
Posted by david at 8:08 AM Permalink
Peterson suffers from bipolar disorder, according to her attorney .
By Katie Merlie
March 28, 2008
NOBLESVILLE -- A Carmel woman will spend one year in Hamilton County Community Corrections for neglect of her now 3-year-old daughter, as part of a four-year sentence.
Kyle C. Peterson, 21, gave birth to the girl on the morning of Feb. 14, 2005, and left her in a toilet. The birth happened in a home in the 14000 block of Admiral Way North Drive in Carmel.
Peterson's mother got into the bathroom that morning, took the newborn out of the toilet and began resuscitation efforts. Peterson, who was an 18-year-old Westfield High School senior at the time, had repeatedly denied allegations from family and friends that she was pregnant.
She was charged with felony attempted murder and neglect of a dependent. She pleaded guilty in December in Hamilton Circuit Court to a lesser felony charge of neglect.
Judge Judith Proffitt sentenced Peterson on Thursday to four years in the Indiana Department of Correction, with three years suspended to be served on probation. Peterson will spend one year in the county's work release program after an evaluation is completed, Proffitt said.
Peterson, who did not make a statement in court Thursday, suffers from bipolar disorder, according to her attorney Robert Hammerle.
He urged Proffitt to take Peterson's condition into consideration when handing down a sentence, and asked for his client to serve only probation.
Hamilton County Prosecutor Sonia Leerkamp said Peterson lied about the pregnancy and about being on birth control.
"She received no prenatal care and had an unattended birth," Leerkamp said. "We're lucky we're here not on a murder case."
The child, who is in the father's custody, is healthy, although she did suffer from seizures in the past, Leerkamp said.
Call Star reporter Katie Merlie at (317) 444-5549.
Posted by david at 8:04 AM Permalink
March 28, 2008
IOWA CITY, Iowa (AP) -- County officials have given their informal OK for ghost hunters to check out a one-time insane asylum to see if any spirits are lurking about.
The Johnson County Board of Supervisors took the initial action on the request from the Johnson County Historical Society, which gives tours of the 153-year-old building.
Brandon Cochran, museum operations assistant for the historical society, said there have never been reports of ghosts or bizarre happenings at the building and that bringing in a paranormal team is "kind of taking the pre-emptive approach.
He wants an Iowa-based paranormal investigative team to come in for one night. Cochran said he hopes they don't find any paranormal activity and the investigation can put to rest any speculation.
A four-person Carroll Area Paranormal Team will use thermal imaging equipment and voice recording systems, Cochran said.
A date for an investigation wasn't set and an agreement will have to be drafted releasing the county of any liability before the supervisors formally approve the request, Cochran said.
The remaining wing was built in 1855 and housed mentally ill patients who were deemed insane. It was a self-sufficient 160-acre site with residents growing corn, potatoes, wheat, hay and tobacco.
The building is now called Chatham Oaks, and houses people with physical and mental disabilities. Chatham Oaks officials said there wouldn't be a problem with the paranormal team coming in as long as it didn't disturb residents, said county facilities director Dave Kempf.
Posted by david at 8:02 AM Permalink
By SARAH KERSHAW
From Plato and Aristotle to Descartes, the great thinkers have for millennia argued over what is known in philosophy as the “mind-body problem,” the relationship between spirit and flesh. Dualism tends to win the day: The mind and the body, while linked, are separate. They exist independently, perhaps mingling but not merging.
The debate lives on these days in less abstract form in the United States: How much of a difference should it make to health care — and health insurance — if a condition is physical or mental?
Decades of culture change and recent scientific studies have blurred the line between these types of disorders. Now a critical moment has been reached in a 15-year debate in statehouses and in Congress over whether treatment for problems like depression, addiction and schizophrenia should get the same coverage by insurance companies as, say, diabetes, heart disease and cancer.
This month, the House passed a bill that would require insurance companies to provide mental health insurance parity. It was the first time it has approved a proposal so substantial.
The bill would ban insurance companies from setting lower limits on treatment for mental health problems than on treatment for physical problems, including doctor visits and hospital stays. It would also disallow higher co-payments. The insurance industry is up in arms, as are others who envision sharply higher premiums and a free-for-all over claims for coverage of things like jet lag and caffeine addiction.
Parity raises all sorts of tricky questions. Is an ailment a legitimate disease if you can’t test for it? A culture tells the doctor the patient has strep throat. But if a patient says, ‘‘Doctor, I feel hopeless,’’ is that enough to justify a diagnosis of depression and health benefits to pay for treatment? How many therapy sessions are enough? If mental illness never ends, which is typically the case, how do you set a standard for coverage equal to that for physical ailments, many of which do end?
The United States has a long history of separating the treatment of mental and physical illnesses, dating back to the days when the severely mentally ill were put in poorhouses, jails and, later, public asylums. That ended after the deinstitutionalization movement of the 1960s, but mental health experts and advocates say that the delivery of services is still far from equal, because emotional illness is still not considered to be on a par with medical illness.
Countries like Canada and the United Kingdom, with national health care systems that don’t limit access to any services, have long ago moved toward merging these two branches of health care, and the Scandinavian countries are known for treating mental illnesses as medical diseases, according to researchers who have studied the various systems.
In the United States over the last five years, research studies examining the link between physical brain abnormalities and disorders like severe depression and schizophrenia have begun to make a strong case that the disorders are not scary tales of minds gone mad but manifestations of actual, and often fatal, problems in brain circuitry. These disorders affect behavior and mood, and they look different from Parkinson’s disease or multiple sclerosis in brain imaging. Still, a growing number of studies — and many more are under way — are making the biological connection, redefining the concept of mental illness as brain illness.
“Insurance companies balk at this, but there are striking similarities between mental and physical diseases,” said George Graham, the A.C. Reid professor of philosophy at Wake Forest University. “There is suffering, there is a lacking of skills, a quality of life tragically reduced, the need for help. You have to develop a conception of mental health that focuses on the similarities, respects the differences but does not allow the differences to produce radically disparate and inequitable forms of treatment.”
While squarely in the minority, some still question the legitimacy of calling any mental ailment a disease. A louder chorus argues that addiction is a behavioral and social problem, even a choice, but not a disease, as many mental health professionals and the founders and millions of followers of Alcoholics Anonymous maintain.
Critics of parity say that anything that would not turn up in an autopsy, as in depression or agoraphobia, cannot be equated with physical illness, either in the pages of a medical text or on an insurance claim. These critics also say that because the mental abnormality research is so new, it should still be considered theory rather than an established basis for equal payment and treatment. “Schizophrenia and depression refer to behavior, not to cellular abnormalities,” said Jeffrey A. Schaler, a psychologist and an assistant professor of justice, law and society at American University in Washington. “So what constitutes medicine? Is it what anybody says is medicine? Is it acupuncture? Is it homeopathy?”
Nevertheless, as federal parity legislation has wobbled along over the years, 42 states have adopted their own versions of parity, offering a patchwork of standards for insurance companies on coverage for addiction and mental illnesses. A federal law would extend insurance parity to tens of millions more Americans who are not covered under the laws and set one broad standard for the nation. As the states have experimented with parity, however, many providers have complained that insurance companies have often found it easy to deny benefits by ruling that claims are not “medically necessary,” a potentially tough standard when it comes to ailments of the mind.
Meanwhile, attitudes about mental illnesses and addiction have changed significantly in the decades since advocates for the mentally ill — and for parity — first tried to include broad coverage of mental illnesses in the nation’s insurance plans. Pop culture has normalized and even glamorized rehab and even suicide attempts, chipping away slowly at social stigmas and lending strength to the idea that the sufferer of a mental illness or addiction may be a victim, rather than a perpetrator. Still, a cancer patient generally remains a far more sympathetic figure than a cocaine addict or a schizophrenic.
But scientific advances may go a long way to help the parity cause. The biological and neurological connection lends strength to the notion that mental illnesses are as real and as urgent as physical illnesses and that there may, at long last, even be a cure in this lifetime, or the next.
And if you can cure something, you can treat it and there is a finite quality to that treatment — and its cost. So you may, if you are an insurance company, be a lot more willing to pay for it.
“The more research that is done, the more the science convinces us that there is simply no reason to separate mental disorders from any other medical disorder,” said Thomas R. Insel, director of the National Institute of Mental Health, which has conducted a series of studies on the connection between depression and brain circuitry and on Thursday released an important study showing a connection between genetics and the ability to predict the risk for schizophrenia.
Last fall, the Senate passed its own parity bill with substantial differences from the House bill, which had been co-sponsored by Representative Patrick J. Kennedy, Democrat of Rhode Island. Mr. Kennedy has admitted to struggling with addiction and depression.
Supporters and opponents both expect the negotiations over how to reconcile the two bills to be protracted; President Bush, who has voiced support for the more limited coverage called for in the Senate bill, has said he would not support the House version, which estimates a cost to the government of $3.8 billion over the next decade through coverage from federally funded insurance. The bill also includes ways to offset the cost.
The precise impact of the House bill on private health insurance premiums was difficult to calculate, insurance industry experts said, but they said that increases to group plans would be likely, with some of the costs passed on to employees. Neither bill applies to employers with 50 or fewer employees or to the individual insurance market.
Despite such warnings that premiums might increase, however, it is unclear by how much. Such extensive parity requirements have never been tested on a federal level, and one question is how many people might take advantage of new benefits even if they were available.
The uncertainty is plain when experts try to estimate the effect. The Congressional Budget Office estimated that the Senate bill, with its minimalist approach, would increase health-plan costs by four-tenths of one percent. However, a report released last month by the Council for Affordable Health Insurance, an insurance industry group, estimated that state-based parity formulas were likely to increase rates by about 5 to 10 percent, on average. And a 2006 study in The New England Journal of Medicine, examining the costs associated with a parity program put into place by President Bill Clinton for all federal employees, found that it actually didn’t increase the use or the cost of mental health services. And that plan, it said, was similar to the one proposed in the more generous House bill.
The House bill would require insurance companies that offer mental health benefits to cover treatment for the hundreds of diagnoses included in the Diagnostic and Statistical Manual of Mental Disorders, from paranoid schizophrenia to stuttering to insomnia to chronic melancholy, or dysthymia.
The Bush administration and other opponents say the list of disorders is far too broad. That leads from parity to another, parallel morass in the fields of psychiatry and pharmacology. Both fields are accused of over-diagnosis and of seizing on fashionable diagnoses — bipolar disorder or post-traumatic stress disorder, for example — for financial gain or through highly subjective assessments.
“It’s the phone-book approach of possible conditions,” said Karen Ignagni, president of America’s Health Insurance Plans, an industry group representing insurance companies that cover 200 million Americans. “And this comes at a time when advocates have made a very persuasive case about the importance of covering behavioral health.”
But in the halls of Congress, at least, the mind-body problem is far from resolved, particularly when it is uncertain who the next president will be.
Posted by Marlisa at 6:01 AM Permalink