Sunday, November 15, 2009

Worth Watching

There has to be a compromise in the middle between the dark ages when we locked up our mentally ill and the current system that treats with no mandatory follow up. This offers both sides an alternative, let's see where this goes. I like where it says incentives for compliance(or co-operation with the prescribed medical plan) and sanctions for non-compliance.

Thornton: A court for mental illnes

History will be made in Colorado's 18th Judicial District this week when Colorado's first districtwide adult Mental Health Court will convene to hear the case of "Robert," age 37.

Robert has bipolar disorder. He frequently goes off his medication, hasn't followed through with treatment plans, has attempted suicide, and has been hospitalized three times. He has several prior convictions for shoplifting, violating restraining orders and resisting arrest. Now he says he wants to figure out a better way to live, and has volunteered for the Mental Health Court.

The court is a specialized treatment court similar to others used in Colorado for drug users and teen offenders. It's designed to divert nonviolent felony offenders who have a serious mental illness such as bipolar disorder, schizophrenia or major depression, as well as those with a combination of mental illness and substance abuse. It is not open to those with violent behavior or to sex offenders.

Most of the people who'll come before the court have been repeatedly in and out of jail. They've been charged with minor offenses that result from their mental illness, things like being a public nuisance, drinking in public, and shoplifting. They're charged with a felony because of the cost of items they've stolen or damaged. Usually they have been off their medications because they can't afford them, and live in and out of shelters.

Defendants who volunteer for the court are assessed for eligibility by a team that includes the Mental Health Court magistrate, the coordinator of the court, a treatment professional, and representatives of the district attorney's and public defender's offices.

Each participant will have an intensive treatment plan, including case management and medications, and will be closely monitored by probation officers and mental health professionals. Treatment addresses the mental illness, recurring substance abuse and criminal thinking. There will be incentives for compliance, and sanctions for non-compliance that may include re-sentencing.

The need for such a court is compelling in both human and fiscal terms:

• Approximately 250,000 people with severe mental illness are in U.S. prisons and jails at any given time.

• It costs about $30,000 to keep a person in a Colorado prison for a year.

• More than 40 percent of inmates in Arapahoe and Douglas county jails need mental health services and 20 percent of those are seriously mentally ill.

• Over the last three years, Arapahoe County alone has spent $13.6 million on 574 inmates with a diagnosis of serious mental illness. It costs 38 percent more to detain a mentally ill inmate.

• While the average prisoner stays 20 days in a metro-area jail, prisoners who are mentally ill stay an average 110 to 120 days.

• The recidivism rate of mentally ill inmates is staggering, at more than 50 percent.

The process of establishing the 18th Judicial District Mental Health Court began in 2007. Funded initially by a $75,000 federal planning grant, the court is now set to begin operations with additional federal funding of $200,000.

The court expects to see 30 cases this first year. Scott Thoemke, CEO of Arapahoe/Douglas Mental Health Network, said the cases "should provide good data to show that the mental health court is less expensive than what Colorado is doing now" with the mentally ill.

Given the crisis in Colorado's budget, the staggering cost of the state's criminal justice system and the large numbers of people with mental illness in Colorado jails, taxpayers should be eager to support investment in additional mental health courts.

Sunday, October 25, 2009

Another "Probably not taking his medicine"

It is always about the medicine, isn't it.

It took Cincinnati Police just over 24-hours to apprehend a suspect in Tuesday's fatal stabbing of 93-year-old Ida Martin of Roselawn.

When James House, III was finally in custody Wednesday night, detectives realized it wasn't the first time their paths had crossed.

What emerged from court records stirred angry emotions from people from Roselawn to Golf Manor.

House was arrested in 1998 for allegedly stabbing three different Roselawn women. Only one case made it to trial, but House was found not guilty by reason of insanity. He spent 10 years in treatment and was released in 2008.

In the Martin case, House is charged with murder. His bond was set at $1 million Thursday in Hamilton County Municipal Court.

Martin was stabbed four times while on her daily walk her her Summit Road apartment. Police said the trail led to House because of good investigative work, information from witnesses and evidence gathered at the scene. A steak knife was among the items recovered.

After leaving Summit Behavioral Center last year, House moved into a second floor apartment in the 2400 block of Losantiville Road in Golf Manor.

Neighbor Joe Dunham said House acted strangely and was a loner who didn't interact with anyone.

"You'd see him once or twice a week," Dunham stated. "You'd say 'How you doing?' He'd just keep walking with his headphones on -- like he had tunnel vision."

Cincinnati Police needed the assistance of officers from Golf Manor and the Hamilton County SWAT team to take House into custody Wednesday night.

"The guy wouldn't come out," said Dunham. "I let them know I seen him moving upstairs -- heard some footsteps -- that he was there."

Dunham said he was terrified to learn of House's prior criminal record and history of mental illness. That's because Dunham's mother lives with him.

"I was thinking about my mother. What would have happened if I wasn't there," he reflected. "Thinking about my neighbors. They're both ladies in an elderly fashion."

Attorney Peter Rosenwald represented House in 1998 and said when he was taking his required medicines he was a cooperative client.

"Most people with mental illness are never cured," Rosenwald added. "They're treated. It's controlled through medicine and therapy."

People might wonder why House was released back into the community. Rosenwald said under the law the maximum time he could be kept in treatment was 10 years -- the same sentence he could have gotten for attempted murder.

Asked why his former client might have committed another serious crime, Rosenwald said he could only speculate.

"My thinking is he probably was not taking his meds," he theorized. "I think the mental illness came back on him."

Roselawn community leaders questioned how House could have been judged mentally healthy enough to return to the population at-large.

"Justice will be served -- this time," said Minister Nate Mobley of the Powerhouse Deliverance Center Ministries. "I think it should have been closely looked at the first time.."

"We were just shocked and amazed that it was the same person who had some clinical treatment," said Michael Watson of the Roselawn Community Council. "Evidently, it didn't work."

However, Watson refused to blame the system for House's release. His bigger worry is people in the community stepping up to help stop crime.

"All I can be concerned about is people who saw it happen and didn't do anything. People who saw it happen and didn't say anything. People who had their windows open and closed their window," he said.

Both Watson and Mobley said a crime like Martin's death could happen in any neighborhood.

"We don't want to be looked at or viewed as a place that's not a good place to reside," Mobley pleaded.

Martin's family issued a statement Thursday which read, in part, "Our family is truly appreciative of the Roselawn community and all those who assisted in the quick arrest of Ida Martin's alleged assailant. This is now in the hands of the justice system. Our family will continue to cope with the loss by by honoring and cherishing the loving memories of Ida."

Friday, October 9, 2009

Another Lost Soul

This poor mentally ill man has been in solitary confinement for years. Who would ever think that solitary confinement would ever be a treatment for severe mental illness? I do not have a mental illness, but I am sure I would create one if you placed me in solitary confinement for years. Where is it stated in the medical journals that confinement is a possible plan for treatment? I still want to blame the liberal laws on this one as well. Why was this man not getting and/or accepting medical treatment before his illness got so severe that all they knew to do or wanted to do with him was arrest and confine? I know that his is not the only story of mentally ill in our prison system. Obama can go after that, in my opinion, rather than some of the other things he has on his agenda.

Critics: Tamms has harmed man's mental condition

Will Tamms supermax prison inmate Donnie White be among the inmates considered for possible transfer after spending years in solitary confinement? That may depend on how corrections officials view his mental state.

Critics believe the strict discipline and isolation White has undergone at the Tamms Correctional Center for the past seven years may have made his severe mental illness, diagnosed in prison a decade ago, worse.

But mental health professionals at Tamms concluded last year that White, 35, no longer is mentally ill and deserves the punishment he's receiving for continued bizarre behavior, ranging from suicide attempts to setting himself on fire.

In September, Illinois Department of Corrections Director Michael Randle released a 10-point plan to reform conditions at Tamms, the state's only supermax prison. Among those reforms: 45 of the prison's 250 inmates are eligible for review to determine whether they should be moved out of Tamms.

It's not clear whether White will be one of them.

"Donnie White should never have been sent there in the first place, and now he has suffered years of sustained, unrelenting trauma as a result," said Laurie Jo Reynolds, a member of the Chicago-based Tamms Year Ten Committee that has advocated for reforms at Tamms. "Prisoners like him need protection from the (Department of Corrections), not the other way around.

"If there is any real commitment to reform, we expect Donnie White to be transferred immediately," she said.

Department of Corrections spokeswoman Januari Smith said federal medical privacy laws prevented her from making any comment about White's case. It's not clear what guidelines were used to determine whether an inmate is eligible for review and transfer.

Randle put the number of seriously mentally ill inmates at Tamms at 15, or 6 percent. A 2006 U.S. Department of Justice report of state prisons surveyed nationally put the figure at 15 to 23 percent.

White may be unique, though, among inmates at Tamms who have extensive histories of severe mental illness.

Prison medical records obtained by the Belleville News-Democrat show an unusual progression: White went from being "acutely mentally ill" in 1998 to not being mentally ill in 2008. During the 10-year interval, he was given powerful psychotropic medications, sometimes forcibly administered, intensive therapy and an emergency transfer for a few months to the prison system's Dixon Psychiatric Unit.

But in 2003, when prison officials sent him to Tamms after he had 15 years added to his original sentence for in-prison convictions -- throwing urine and feces at guards at another prison -- a Corrections Department psychologist wrote that the years of therapy and drugs did nothing to help White.

The evaluation stated, "Behaviors exhibited by Mr. White include setting fire to self ... attempting to hang self with numerous items, smearing feces on self and cell, banging fist on floors, stomping on hand and other self-injurious behaviors."

The evaluation reported that White still exhibited symptoms of serious mental illness.

He then was sent to Tamms, where he has been in solitary confinement for nearly seven years.

Although his suicide attempts and self-mutilation continued and medications didn't work, an April 10, 2008, mental evaluation of White stated, "Inmate White does not suffer from mental illness." It concluded that White engaged in "antics" and "appears to view staff, especially female mental health providers, as a vehicle for his own entertainment."

Randle has defended the practice of treatment seriously mentally ill prisoners at Tamms, which features solitary confinement as a mainstay.

Holley McCree, who has a master's degree in social work and counsels mentally ill patients in Minnesota, has corresponded with White for more than five years. She said that while she cannot make a professional diagnosis without examining White, she said that from his letters and medical and personal history, "I feel he is misdiagnosed."

McCree said White's original diagnosis of "major depression with psychotic features" should be re-examined and post traumatic stress disorder should also be considered.

"The reason I write Donnie and other mentally ill (Tamms) inmates is because they so obviously need some help, some caring and compassion," she said.

"Tamms inmates need time out of the cell, and the ability to socialize with other inmates without a steel door between them. They suffer tremendously. No one would rationally choose to live in the circumstances at Tamms," McCree said.

Alexandra H. Smith of the Mental Health Project at the Urban Justice Center in New York City said while any mental health therapy is better than none at all, "The tension of trying to provide treatment for people in a punitive setting, I don't know how successful that can be. I think it really sends a strong message to any human being who is shackled and in a cage. ... I think that sends a message that chaining someone like an animal is not rehabilitative."

Sunday, September 27, 2009

New Book, Same Story

This author is one of the newest ones who have a family story about mental illness. But what he says in his interview is the current bottom line in America. I am proud that we are not just locking-up our loved ones, yes I had one as well, but the liberal laws that changed things in the 1950's went too far to the other side of the spectrum. As Steve says, " It is good for the patient's rights may not be good for the family." He also addressed the issue of not being able to access patient records. The records are also held in confidence no matter what. Recently, one of my Special Ed. students was going through a manic phase and ran away from school at lunch time. He was also cursing and throwing books in the classroom. While I know that other students could possibly get hurt, it was apparent that his meds. were not correct. The teachers were very upset because the administration was going to have to let him stay in the regular ed. classroom because of his rights. He has the same rights as any adult on the street, until he actually hurts himself or someone else, then there is not much any official can do to help him. Most lay people do not understand this. One of the teachers said to me"Doing nothing is not an option". I told her that doing nothing is actually an option because our hands are tied. His mother also took him to the ER one weekend because he was still showing manic episodes at home with her, but when they got to the ER all the kid did was sleep, so the ER personnel could not keep him or do much to help her at the time. She was very upset. If the medical staff does not "witness" the behavior first hand, then what the mother said was happening at home is just hearsay.

Washington Post journalist Steve Luxenberg learned he’d had an aunt, institutionalized for mental illness in 1940 and hidden by his mother for more than half a century. His new book, Annie’s Ghosts: A Journey Into a Family Secret , tells the story.

How has our approach to mental illness changed since the 1940s?
We don’t put people in mental institutions at nearly the rate we did then. In 1955, there were 550,000 patients. The country’s population is nearly double now, so you’d expect a million today. Instead we have fewer than 50,000.

Why is that?
New medicines allowed people to be treated at home. Then, later, the legal standard changed. In the ‘40s, many states had a legal obligation to give “treatment and care” to their “defectives.” Now, you cannot be forced into an institution unless you are a danger to yourself or others.

And that’s a good thing, right?
Yes. But what’s good for the patient’s rights may not be good for the family. The family might not be able to care for a patient whose behavior is erratic. That’s the ongoing conflict.

You had trouble accessing your aunt’s medical records. Why?
Medical-records management people are in charge of saying “no” to protect people’s privacy. But if we shut off medical records of people long deceased, we’re locking up information that families and medical providers ought to know. As scientists learn more and more about the genetic basis of all kinds of illnesses, access to records is an issue we’re going to have to confront.

Sunday, September 13, 2009

Right Direction

I vote for my tax dollars to be used for programs such as this. This will help a lot of mentally ill persons get off the street, if they will take advantage of it.

Recovering through housing

AT HOME: Leslie Moreno shows off her typewriter collection at Daniel's Village on Friday. photo by Brandon Wise.
September 12, 2009
SANTA MONICA BLVD — A trio of antique typewriters sit in a line atop a desk, showcased in exhibition yet still living out their created purpose, each holding a piece of paper from the platen, containing the thoughts of a 23-year-old woman.

"That one types in cursive," the woman said, pointing to the device the farthest from her.

A proud smile comes across her face as she then pulls open a drawer, revealing two very special typewriters, picking up a hard case that holds one from the 1920s, purchased from her fiancé who helped the young woman begin her growing collection.

From the books on the shelf to the typewriters on the desk to the black shawl draped over the window, these are the items that make the small room inside the former Village Motel feel more like home for Leslie Moreno, who this summer was one of eight local young adults suffering from mental illnesses to take up residence in the new Daniel's Village

"I feel safe," Moreno, who suffers from depression and bipolar disorder, said. "Being able to have my things is important to me."

Daniel's Village, the latest project of nonprofit organization Step Up on Second, celebrated its grand opening on Friday, having the distinction of being the only permanent supportive housing program in the Los Angeles area for young adults — 18-28 years old — who experience the initial symptoms of mental illness.

The program was spawned from Daniel's Place, a drop-in center geared toward the same demographic that has served more than 400 clients since it was founded 11 years ago, offering support groups for clients and families and individual consultations.

Located at 2624 Santa Monica Blvd. in an old motel, the $2.4 million project involved converting eight old units into dormitory-style rooms, each coming with its own bathroom and kitchenette. Several original pieces of the motel remain, including the old "Village Motel" and office signs, the latter of which hangs outside the resident manager's unit.

The tenants are required to meet certain criteria in order to qualify for housing, being both homeless and suffering from a mental illness.

Bulldog Realtors
The idea for a permanent supportive housing program to supplement the services at Daniel's Place was originally conceived about four years ago but faced several roadblocks on its way to completion, including opposition from neighbors in Sunset Park where it was originally proposed to be located near John Adams Middle School and its new neighbors because of the proximity to McKinley Elementary School.

The organization takes a housing first approach when it comes to treating its clients, finding that homelessness is often one of the biggest obstacles to recovery.

"We're really providing a solution to homelessness in the city," Tod Lipka, the CEO of Step Up on Second, said. "It's all about people moving in and people having a home for the first time in their adult life."

It was earlier this year when Moreno realized that she needed help, having essentially isolating herself in a bedroom for three months.

An independent person, she said it was difficult to take the first step toward recovery.

It started at a bus stop in Santa Monica.

Moreno sat at the stop crying when a stranger asked if she could do anything to help. What she received was a referral to see Ed Edelman, the Santa Monica "homeless czar."

That led to a series of referrals that brought Moreno to Daniel's Place in May.

Today Moreno has resumed taking courses at the California Healing Arts College, hoping to become a massage therapist.

There are still days that are worse than others, but Moreno is thankful regardless that she took that first step, the first step out of the room she was holed up in for three months, and the first step toward recovery.

Friday, August 21, 2009

Doesn't matter

I understand the pain and hurt the families of the slain students, but this is a law issue. It does not matter if the psychiatrist had the records or not. By law he would have to keep the information confidential until Cho actually hurt himself or someone else. They might have been able to retain the student with the 72 hour rule. Otherwise, Cho had every right to be as crazy as he wanted to be until he hurt himself or someone else. This is where the liberal laws have hurt and killed innocent people. Very big controversy and very sad.

Document filed in VT shooting suits demands former director 'admit or deny' allegations

Previous coverage

* Released mental health records provide details of Cho's counseling sessions
* Cho records may alter April 16 panel's findings
* Ex-director of Virginia Tech counseling center responds to discovery questions
* New document released in Tech shooting suit
* Virginia Supreme Court appoints special judge to Tech shooting suits
* Lawsuits keep Virginia Tech shootings at forefront
* Gov. Kaine: Tech panel won't reconvene
* Removal of students' records from Virginia Tech counseling center not authorized, Steger says
* Ex-director took Cho file "inadvertently"
* Cho records surface, raise many questions
* Complete coverage of the April 16, 2007 Virginia Tech shootings

The latest legal filing related to two $10 million civil suits brought by families unhappy with Virginia Tech’s handling of the April 16, 2007, shootings demands that former Cook Counseling Center Director Robert Miller “admit or deny” 65 allegations and statements of fact.

The filing came after Wednesday’s public release of shooter Seung-Hui Cho’s student once-missing mental health records.

Bob Hall, a lawyer for the families of slain Tech students Nicole Peterson and Julia Pryde, released the “request for admissions” filing on Thursday.

Many of the items listed are facts already stipulated to by Miller, including that he removed Cho’s mental health records while packing to leave his office in 2006.

Miller has said he found the records July 15 while searching his Blacksburg home for documents relevant to the civil suits, in which he is named as a defendant. Gov. Tim Kaine announced discovery of Cho’s missing records July 22. The Cho family authorized their release earlier this month.

Among the declarations Miller is asked to admit or deny is: “Admit that at no time during your tenure at Cook Counseling Center did you record or cause anyone to record the history you received of Seung-Hui Cho’s violent writings, violent, threatening or intimidating activities, strange attire, bizarre behavior” or complaints from English department faculty, who had grown increasingly alarmed by Cho.

Miller, the document suggests, should have fully informed his staff of the extent of Cho’s problems. And, Hall said, Miller failed to ensure that Cho was treated for mental illness.

“This is a lawyer drafting his wish list of what the facts might be,” Ed McNelis, the lawyer representing several Cook Counseling center staffers in the lawsuits, said of Hall’s filing. “It does not mean they are true.”

“He could put in there, 'Admit that you shot JFK.’ It doesn’t mean you did it,” McNelis said.

Thursday, August 13, 2009

Lots of Reasons Why

I do realize that we have been locking up some of our mentally ill youths. One of the problems is the parents. Why have these young people gotten this far into a mental illness anyway that they are incarcerated? From my experience, with the special ed. children I work with, a lot of their problems are their parents. Ask any teacher and they will say that a lot of problems kids have are because of their parents. They need to do a better job.

Locking up Kids with Mental Illness

Locking up Kids with Mental IllnessA few weeks ago, we wrote about the opening of a mental health court in Philadelphia to help deal with a problem that’s overwhelming the U.S. justice system — poor mental health care in prisons, affecting up to 30 percent of those incarcerated.

Some of the problems our prisons face can be traced back to a pretty straightforward issue — our prisons are overcrowded. For instance, the prisons have been so overcrowded in California, the California prison system has been under a federal court’s oversight for years. And that court has become so frustrated by California’s lack of interest in the humane treatment of their prisoners, they recently ordered the number of prisoners cut by 27 percent within two years. The case that resulted in the court order began as the result of class action lawsuits addressing — surprise, surprise! — inadequate medical and mental health care in the prison system.

Which brings us to the sorry state of affairs in the juvenile prison system.

According to a recent New York Times article, about two-thirds of the nation’s approximately 93,000 juvenile inmates have at least one mental illness, citing surveys of youth prisons.

You’d think with such high rates of diagnosable mental health concerns in these children, you’d be offering them the highest mental health care possible, right? I mean, if anyone can be helped by such care early on, it’s likely to be children who are under the state’s care.

Sadly, that’s not the case. Just as with adults, we warehouse the children in facilities that not only do little to provide for their mental health needs, but continue to cut back in tough economic times:

At least 32 states cut their community mental health programs by an average of 5 percent this year and plan to double those budget reductions by 2010, according to a recent survey of state mental health offices.

Juvenile prisons have been the caretaker of last resort for troubled children since the 1980s, but mental health experts say the system is in crisis, facing a soaring number of inmates reliant on multiple — and powerful — psychotropic drugs and a shortage of therapists.

The children and teens in the juvenile justice system are just that — children and teens. According to surveys, more than half have histories of exposure to violence, neglect, abuse and trauma. It is estimated that up to 75 percent of young offenders have a substance abuse disorder. Other research has shown that as many as 20 percent of this group also suffer from a serious mental disorder, like clinical depression or bipolar disorder.

There are no easy answers to these problems, especially in tough economic times. States have no money, so they cut back on these “luxury” items, like adequate medical and mental health care to those under its charge. And few people care about the criminal justice system in the U.S. (since most of us have never been to prison or have any direct experience with it). Yet you can tell a lot about a society by the way they treat not only their indigent, but also their criminals. Even more so when those criminals are our own children and teens.

Out of sight, out of mind.

Tuesday, August 11, 2009

Sad Realization

Stigma surrounding mental illness remains despite abundant pharaceutical ads. The medicalization of such mental illnesses as depression and bipolar disorder, which have seen prescription drug advertisements on TV skyrocket since such advertising became permissible in 1997, has done nothing to remove the harmful stigma attached to the illnesses, according to sociologists from Indiana University and the University of North Carolina in Chapel Hill. "The findings fly in the face of current thinking about ways that stigma can be reduced," said Peggy Thoits, Virginia L. Roberts Professor of Sociology in IU's College of Arts and Sciences. Stigma has posed a steadfast obstacle to the treatment of many mental health illnesses. Negative perceptions of mental illness color the support and advice people get from their friends, family and even their physicians and can create a reluctance to seek help. The study by Thoits and lead author Andrew R. Payton, graduate student at University of North Carolina in Chapel Hill, sought to see if attitudes toward mental illness have changed since the U.S. Food and Drug Administration issued new guidelines allowing pharmaceutical companies to air TV ads. Theoretically, when a condition such as depression comes to be viewed as a treatable medical condition instead of a moral failing or spiritual condition, this should reduce the blame and stigma attached to depression. The researchers examined the Mental Health Modules in the General Social Survey during these intervening years and saw no change in attitudes toward people with mental illness, specifically when they compared depression, which was a focus of many TV commercials, to schizophrenia, for which no drugs have been advertised. "We're making a big assumption, that marketing drugs to treat some these conditions is actually penetrating the consciousness of viewers, giving them the ability to recognize symptoms and conceptualize them as disorders and to see that these disorders can be relieved essentially with drugs," Thoits said. The study was presented on Monday.

Saturday, August 1, 2009

Off his Medication for Over Year

Mental illness may play a role in Oklahoma City shooting
Suspect is off his medication, report says

A shooting suspect told police he is a mental patient and his intended victims worked for the government and had satellites watching him, a detective reported.
Featured Gallery

Harold G. Thomas, 61, was arrested Thursday after he allegedly shot up a Farmers Insurance office in south Oklahoma City. He is accused of firing three shots from his own business in a neighboring suite. Two men in the insurance office were nearly hit, the detective reported.

Bomb squad technicians spent hours Thursday examining suspicious items found inside Thomas’ business. The detective reported officers found an open gun safe there with several guns, rifles and ammunition as well as "several foil-wrapped objects and electrical tape-wrapped objects.”

Thomas told police he "is seeing visions and hearing voices,” the detective reported.

He also said he had been "off of his medication for over a year” and had been self-medicating with the energy drink Red Bull and the drug Lortab, the detective reported.

Friday, July 31, 2009

Good Read

I know that when testing my elementary students for special needs, it is very hard to describe exactly what kind of syndrome these young kids actually have. This is the same thing here with the adults.

If Bipolar Disorder Is Over-Diagnosed, What Are The Actual Diagnoses?

A year ago, a study by Rhode Island Hospital and Brown University researchers reported that fewer than half the patients previously diagnosed with bipolar disorder received an actual diagnosis of bipolar disorder after using a comprehensive, psychiatric diagnostic interview tool -- the Structured Clinical Interview for DSM-IV (SCID). In this follow-up study, the researchers have determined the actual diagnoses of those patients. Their study is published in the July 28 ahead of print online edition of The Journal of Clinical Psychiatry.

Under the direction of lead author Mark Zimmerman, MD, director of outpatient psychiatry at Rhode Island Hospital, the researchers' findings indicate that patients who received a previous diagnosis of bipolar disorder that was not confirmed by a SCID, they were significantly more likely to be diagnosed with borderline personality disorder as well as impulse control disorders.

Their research involved the study of 82 psychiatric outpatients who reported that they received a previous diagnosis of bipolar disorder that was not later confirmed through the use of the SCID. The diagnoses in these patients were compared to 528 patients who were not previously diagnosed with bipolar disorder. The study was conducted between May 2001 and March 2005.

Zimmerman, who is also an associate professor of psychiatry and human behavior at The Warren Alpert Medical School of Brown University, says, "In our study, one quarter of the patients over-diagnosed with bipolar disorder met DSM-IV criteria for borderline personality disorder. Looking at these results another way, nearly 40 percent (20 of 52) of patients diagnosed with DSM-IV borderline personality disorder had been over-diagnosed with bipolar disorder."

The results of the study also indicate that patients who had been over-diagnosed with bipolar disorder were more frequently diagnosed with major depressive disorder, antisocial personality disorder, posttraumatic stress disorder and eating and impulse disorders.

Zimmerman and colleagues note that "we hypothesize that in patients with mood instability, physicians are inclined to diagnose a potentially medication-responsive disorder such as bipolar disorder rather than a disorder such as borderline personality disorder that is less medication-responsive."

In their previously published study that concluded bipolar disorder was over-diagnosed, they studied 700 patients. Of the 700 patients, 145 reported they had been previously diagnosed as having bipolar disorder; however, fewer than half of the 145 patients (43.4 percent) were diagnosed with bipolar disorder based on the SCID. The authors state that the over-diagnosis of bipolar disorder can have serious consequences, because while bipolar disorder is treated with mood stabilizers, no medications have been approved for the treatment of borderline personality disorder. As a result, over-diagnosing bipolar disorder can unnecessarily expose patients to serious medication side effects, including possible impact to renal, endocrine, hepatic, immunologic and metabolic functions.

Zimmerman concludes, "Because evidence continues to emerge establishing the efficacy of certain forms of psychotherapy for borderline personality disorder, over-diagnosing bipolar disorder in patients with borderline personality disorder can result in the failure to recommend the most appropriate forms of treatment."

The report is from the Rhode Island Methods to Improve Diagnostic Assessment and Services (MIDAS) Project, for which Zimmerman is the principal investigator. Zimmerman said, "The MIDAS project is unique in its integration of research quality diagnostic methods into a community-based outpatient practice affiliated with an academic medical center."

Along with Zimmerman, other researchers involved in the study include Camile Ruggero, PhD; Iwona Chelminski, PhD and Diane Young, PhD, all of Rhode Island Hospital and Brown University.

Founded in 1863, Rhode Island Hospital ( in Providence, RI, is a private, not-for-profit hospital and is the largest teaching hospital of the Warren Alpert Medical School of Brown University. A major trauma center for southeastern New England, the hospital is dedicated to being on the cutting edge of medicine and research. Many of its physicians are recognized as leaders in their respective fields of cancer, cardiology, diabetes, emergency medicine and trauma, neuroscience, orthopedics, pediatrics, radiation oncology and surgery. Rhode Island Hospital receives nearly $50 million each year in external research funding. It is home to Hasbro Children's Hospital, the state's only facility dedicated to pediatric care, which is ranked among the top 30 children's hospitals in the country by Parents magazine. Rhode Island Hospital is a founding member of the Lifespan health system.

Saturday, July 25, 2009

Found on my Bipolar News

GOP: Democrats Censoring Mail on Health Care
Capitol Briefing
House Republicans have been prohibited from mailing out this diagram of Democrats' health-care reform plan.

By Ben Pershing
The partisan debate over health-care reform has trickled down into one of the more arcane corners of the House -- the committee on free mail, otherwise known as the Franking Commission.

One of the perks of being a member of Congress is that each lawmaker is allowed to send "franked" -- or free -- mail, as long as it is related to official business. Members use that ability to send newsletters and legislative updates to their constituents. To ensure that privilege is not used inappropriately, a majority of the bipartisan six-member Franking Commission must approve each piece to ensure it meets some basic guidelines. Mail is blocked only on rare occasions.

But now the commission has gotten involved in the health-care fight, prohibiting several Republican lawmakers from mailing out reproductions of a colorful, labyrinthine chart that purports to diagram Democrats' reform plan. The controversy was first reported by Roll Call.

The chart was produced by the Republican staff of the Joint Economic Committee and has become a popular visual aide on the minority side of the aisle, as the GOP attempts to convince the public that the majority's plan will be a confusing disaster. But Democrats have argued that the chart is an inaccurate representation of their health-care efforts, and for that reason, the three Democrats on the Franking Commission say the GOP can't use it in official mail. House guidelines say that in franked mail, "Comments critical of policy or legislation should not be partisan, politicized or personalized." But what about information that's inaccurate, or -- arguably -- just misleading?

"We have never before censored anybody's presentation of facts this way," Rep. Dan Lungren (R-Calif.) complained in an interview Friday.

Lungren, the top Republican on both the Franking Commission and the House Administration Committee, said the commission has never traditionally played a fact-checking role. He pointed out that Democrats this year have sent out numerous pieces of franked mail touting the number of jobs created by the economic stimulus package, and while Republicans might disagree with those numbers, they've never moved to block the mail from being sent out.

"We let those things go by, even though we don't think it's true," Lungren said, adding that he knows of at least 15 Republicans who have asked to mail out copies of the health-care chart in question. (For some context, Rep. Kevin Brady (R-Texas) explains the chart's purpose here. Ezra Klein mocked the chart here, and includes a chart of Republicans' own health-care "plan." )

The controversy extends beyond the colorful chart. Salley Collins, a spokeswoman for House Administration panel Republicans, said GOP members were also being told by the Franking Commission that they could not refer to "government-run health care" in their mailings, and had to dub it "the public option" instead.

Democrats, led by Franking Commission Chairwoman Susan Davis (Calif.), say they are trying in good faith to negotiate a compromise with Republicans on this subject. If the impasse isn't resolved, watch for the GOP to turn up the volume on the controversy next week.

Thursday, July 16, 2009

Equality on the Brain

Amen to all of the following: I always ask, when someone tells me that another person does not have health care, Why? Why does that person not have healthcare? Sometimes the reason is no job and why is there no job? Sometimes the answer is they don't want to work hard, don't want to get an education, etc? Let the three trinity in charge of our great nation right now, step up to the plate and give up their wonderful government healthcare and join us all with what they are proposing to pass. Let them go first. Give up what you have and see how you like the socialized medicine dole-outs.

You're going to be healthy — whether you like it or not. The Obama administration is pushing for a national healthcare bill this summer and Democrats in the Senate are responding, with a Health, Education, Labor and Pensions committee measure that would make healthcare both a right and a responsibility.

Writes the San Francisco Chronicle, "The health panel's $600-billion measure would require individuals to get health insurance and employers to contribute to the cost. The bill calls for the government to provide financial assistance with premiums for individuals and families making up to four times the federal poverty level, or about $88,000 for a family of four, a broad cross-section of the middle class." The bill passed by a 13-10 margin, with all the Republicans on the committee voting nay.

So now the federal government is taking a leaf out of Mitt Romney's Massachusetts book, with its intention to force citizens to obtain health insurance at the end of a gun. Many support this, too, with a poll last year showing that even 52 percent of Republicans find this kind of coercion palatable. (Although we should always take the findings of one poll with a grain of salt. That is, until the health czars prohibit that sort of thing.) Of course, their reasoning isn't hard to grasp. They figure that the uninsured cost the system money, so they should be forced to step up to the plate. But the point many seem to ignore is that this isn't a problem of the free market — it's a problem of socialism. It arises when you force people to be responsible for the consequences of others' decisions.

Now, many think this is only just, and this brings us to the Senate proposal to make healthcare a "right." Should it be?

It certainly sounds good. But it also sounds good to have a right to live to be 120 or not develop cancer. The question is, is it realistic and is it the government's role to try to secure it?

We first must understand the difference between moral and legal rights. For example, I think every person has a moral right to be treated with dignity, but do we want the government to try to enforce such a thing? Likewise, I do think that people in need should receive help, but who should administer it? Moreover, when we say there is a "right" to healthcare, it's rather ambiguous. What level of care? Will people have the right to play the hypochondriac and clog hospitals for frivolous reasons? Will the elderly have the right to extreme measures designed to prolong life to the tune of millions of dollars per person? Will people have the right to psychological counseling for the latest "condition" invented by head shrinkers, such as "Oppositional Defiant Disorder" or "Sibling Rivalry Disorder"?

These are not minor questions. And when deciding what kind of healthcare is a "right," we must add some perspective. Remember that for most of man's history healthcare was cheap, true enough — but life was also short. Without the miracles of modern medicine, doctors could do relatively little. Women didn't live as long as men, the infant mortality rate was high, and making it to adulthood was a dubious proposition. In fact, I once read that the average lifespan in the Roman Empire was only 22 years. (Yes, many Romans did live to be very old, but so many people died in infancy or youth, that the "average" was very low.)

So, yes, healthcare is infinitely more expensive today, but isn't it just a case of getting what you pay for? Can our unparalelled level of care be delivered "on the cheap"? And is it realistic to think that everyone could have precisely equal access to cutting edge technology and innovations? Bear in mind that an MRI machine costs approximately $2 million to buy and $800,000 per year to run, and it costs the better part of $1 billion to research, develop, and bring a new medication to market. And what happens when you remove profit from the system? Well, note that the whole nation of Canada, with its much touted socialized medicine, has fewer MRI machines than the city of Pittsburgh.

The above fact illustrates well why we have heard horror stories about healthcare rationing in Canada, Britain, and elsewhere. It also brings us to a hard, cold fact and an immutable law of economics. The fact is that no amount of good intentions will grant us a special dispensation from the laws of economics. And one of those laws is that price caps ever and always lead to rationing. Always.

This is why we had gas lines in the 1970s. It's why 20 percent of curable lung cancer patients in Britain die because of long waiting lists. It's why that nation's prostate cancer survival rate is only 44 percent while ours is 80. Still want to be more like Europe?

The fact is that socialist systems don't work. And as a great example as to why, consider what author Daniel Gavron tells us about the problems encountered in a certain Jewish commune. In his book The Kibbutz: Awakening from Utopia, he writes, "There were also several endemic weaknesses in communal life, one of which was wastage. Food was 'free,' so members took more than they needed. Huge quantities were thrown away, and expensive items were fed to domestic animals. Electricity was paid for by the collective, so members left their air conditioning on all day in the summer and their heaters on all day in winter."

This story teaches a valuable lesson: price caps and profit loss within the medical system will mean less incentive to provide healthcare and less disincentive against using it wastefully. Collectivism would only ensure that the people collectively have worse healthcare. This is a fact.

Part of the reason so many today have trouble accepting this is immaturity. What do I mean? Well, when I was a boy, I often heard my father say, "Money doesn't grow on trees." He was old school, meaning, he understood reality. In contrast, too many of us — specifically, those of the leftist persuasion — are rather childish regarding money matters. So many Americans have a buy-today-pay-tomorrow mindset; this manifests itself in the liberal use of credit, both on the individual level with credit-card debt and on the collective level when we fund social programs with posterity's pocketbook. Many of us are also raised with a style-over-substance philosophy. That is to say, we seem to behave as if good intentions are all that matter; just institute the programs and worry about the details later. I mean, eat, drink, and be merry, for tomorrow we die — and maybe there is a money tree.

The reality is quite different. We can pretend as if medical care is a right all we want, but doing the hopey-changey won't grant us that special dispensation from the laws of economics. Any which way you slice it, modern healthcare is an expensive proposition just as is modern transportation. Yet there is one difference: while we all expect that we should have a car, we don't expect it to be cheap. We will pay $450 a month for a neat set of wheels, but many are taken aback when life-saving medication costs one quarter that much.

Unfortunately, reality doesn't matter to the radical egalitarians who are marching us toward healthcare oblivion. They want everyone to have equal healthcare — even if that means it will be equally bad. And if this sounds like a radical statement, just read the following story Walter Williams relates about Sweden's healthcare system:

Sven R. Larson tells about some of Sweden's problems in "Lesson from Sweden's Universal Health System: Tales from the Health-care Crypt," published in the Journal of American Physicians and Surgeons (Spring 2008). Mr. D., a Gothenburg multiple sclerosis patient, was prescribed a new drug. His doctor's request was denied because the drug was 33 percent more expensive than the older medicine. Mr. D. offered to pay for the medicine himself but was prevented from doing so. The bureaucrats said it would set a bad precedent and lead to unequal access to medicine.

Hard to believe, I know. It's like saying that instead of doing the good you can and feeding a large number of starving people, you won't feed any if you can't feed them all. It's what happens when you have equality-on-the-brain, that type of destructive zealotry that should itself be labeled mental illness.

The "right" to healthcare will ultimately mean the right to the kind of care we can already get for free. We should also note that members of Congress won't avail themselves of this right. They'll still have their special health plan.

Well, at least someone will still be getting the best healthcare.

Wednesday, July 15, 2009

Not New but worth re-reading

This is not new news, but the topic is always worth re-visiting.

People With Schizophrenia Say Bias Is Part of Their Lives

WEDNESDAY, Jan. 21 (HealthDay News) -- People with schizophrenia often expect to be discriminated against, and are, in various aspects of their life, new research finds.

The study, which included 732 people with schizophrenia in the United States and 26 other countries, found that 47 percent reported discrimination in making or keeping friends, 43 percent from family members, and 27 percent in intimate or sexual relationships. Also, 29 percent of the participants said they experienced discrimination while trying to find or keep a job.

What the study referred to as positive discrimination was reported by less than 5 percent of the participants.

The researchers also found that 64 percent of the participants didn't bother applying for work, training or education because they expected to fail or to face discrimination, and 55 percent anticipated discrimination when seeking a close relationship. However, more than a third of participants who expected these types of discrimination did not actually experience it.

Most participants, 72 percent, also told the researchers that they felt they needed to conceal their diagnosis of schizophrenia.

The findings appear online and in an upcoming print issue of The Lancet.


"This study opens a new arena of research characterizing the nature and extent of discrimination against people with mental illness," study author Graham Thornicroft, a professor at the Institute of Psychiatry, King's College London, and his colleagues wrote in a news release issued by the journal. "Rates of both anticipated and experienced discrimination are consistently high across countries among people with mental illness. Measures such as disability discrimination laws might, therefore, not be effective without interventions to improve self-esteem of people with mental illness."

"Even allowing for the possible effect of anticipated discrimination influencing patients' views of their experiences, negative experienced discrimination in many domains of life might be related to prior coercive mental-health service intervention," the authors continued. "If confirmed by further studies, this finding might guide mental-health services to promote social inclusion and to rely less upon compulsory treatment in the future."

The study points to the kind of research required to improve understanding of stigma and discrimination, according to an accompanying editorial by Beate Schulze of the Research Unit for Clinical and Social Psychiatry at the Center for Disaster and Military Psychiatry in Zurich, Switzerland.

"By investigating actual discrimination and self-stigma, the study brings together the structural and cognitive perspectives that have not previously been combined," she wrote. "However, what remains to be done is to determine the effect of discrimination on health and social outcomes and translate these findings into effective public-health strategies."

Saturday, July 11, 2009

Need more of this

I would like to see these open house forums in every state.

Stanford To Offer Bipolar Education Day On July 25

Bipolar Disorders
Find Causes, Symptoms & Treatments Research Depression Options
Current Article Ratings:

The Stanford University School of Medicine will host its fifth annual Bipolar Education Day on July 25. Individuals with bipolar disorder, their families, caregivers, friends and interested community members are invited to attend.

The free event will be held at the William R. Hewlett Teaching Center at 370 Serra St., located on the main campus.

More than 5.7 million Americans have bipolar disorder, a psychiatric illness that causes unusually intense shifts in mood, energy and behavior. Bipolar Education Day gives scientists and clinicians an opportunity to discuss the previous year's research findings with individuals and families affected by the disorder.

This year's speakers include Terence Ketter, MD, professor of psychiatry and behavioral sciences and chief of Stanford's Bipolar Disorders Clinic; Po Wang, MD, and Jenifer Culver, PhD, from the Stanford Bipolar Disorders Clinic; Manpreet Singh, MD, from the Stanford Pediatric Bipolar Disorders Program; and representatives from the National Alliance on Mental Illness and the Depression and Bipolar Support Alliance. Speakers will discuss treatment options that can help patients manage their symptoms. An afternoon question-and-answer session will follow the talks.

"I'm looking forward to a chance to share some of the latest advances in research at this year's Education Day," said Ketter.

The program runs from 8:30 a.m. to 2:30 p.m. and includes complimentary morning beverages and an afternoon snack. Pre-registration is required. For more information or to register, please visit or contact Meredith Childers at

The Stanford University School of Medicine

Wednesday, July 1, 2009

Anger or Irritability doesn't really matter

This is another good article about diagnosing young children with bipolar. This addressed the symptom of being irritable for no reason. We know that pure anger is a huge symptom of bipolar in adults so it would only make sense that is a very young child like 7 years old, that instead of anger it could be seen as severe irritability. I do see this in my special ed. students and one in particular who is entering the 2nd grade this year and has already been diagnosed as bipolar. He has a family history, can't focus, and most days if very irritable. Makes sense to me.

Irritability Should Be Considered When Diagnosing Bipolar Disorder In Children
Main Category: Bipolar
Also Included In: Pediatrics / Children's Health; Depression
Article Date: 26 Jun 2009 - 0:00 PDT

A new study from Bradley Hospital and The Warren Alpert Medical School of Brown University, as well as two other institutions, adds to mounting evidence that clinicians consider irritability as a symptom when diagnosing pediatric bipolar disorder.

Reporting in the July issue of the Journal of the American Academy of Child and Adolescent Psychiatry, researchers say a small percentage of children with bipolar disorder experience manic episodes without extreme elation - one of the hallmarks of the disorder - and are diagnosed based on irritable mood alone.

"Diagnosing children with bipolar disorder is challenging. One of the chief controversies is whether irritability should be included among the criteria for this diagnosis because it can also overlap with a number of other psychiatric disorders, such as attention deficit hyperactivity disorder," says lead author Jeffrey Hunt, MD, a child psychiatrist and training director at Bradley Hospital. "Our findings confirm that while irritable-only mania is uncommon, it does exist - particularly in younger children - and should be considered in a bipolar diagnosis."

Bipolar disorder is characterized by dramatic mood swings from euphoria, elation and irritability - the manic phase of the disorder - to severe depression. Bipolar disorder often begins in late adolescence or early adulthood, although it can develop as early as the preschool years. Recent studies have shown that the number of children and teens being treated for bipolar disorder has grown dramatically in the last decade. Although it is unclear what has caused this increase, experts believe it may be due in part to more aggressive diagnoses by physicians and a greater awareness of pediatric bipolar disorder in the medical community.

Hunt and colleagues studied 361 children between the ages of 7 and 17 with bipolar disorder participating in the multi-site Course and Outcome of Bipolar Illness in Youth (COBY) study at Bradley Hospital and Alpert Medical School, the University of Pittsburgh and the University of California-Los Angeles. COBY is the largest and most comprehensive study of children and adolescents with bipolar disorder to date.

Researchers quantified the frequency and severity of manic symptoms of each participant, including whether irritability and elation were present. Based on this data, the group was then reclassified into three subgroups: elation-only, irritable-only and both elated and irritable.

Approximately 10 percent of children fell into the irritable-only category, while elated-only constituted about 15 percent. Nearly three-quarters experienced both elation and irritability. The irritable-only participants were significantly younger in age than the other two groups; however, there were no other sociodemographic differences between the groups. There were also no significant differences in terms of bipolar subtype, rate of psychiatric comorbidities, severity and duration of illness, and family history of mania and other psychiatric disorders. However, depression and alcohol abuse in second-degree relatives occurred more frequently in the irritable-only subgroup.

"The fact that the irritable-only and elation-only subgroup had similar clinical characteristics and family histories of bipolar disorder provides support for continuing to consider episodic irritability in the diagnosis of pediatric bipolar disorder," says Hunt, who is an assistant professor of psychiatry and human behavior at Alpert Medical School. Hunt is also training director of the child and adolescent fellowship and triple board residency programs.

The authors say continual, long-term follow-up of this study sample will help clarify whether the presence or predominance of elation or irritability at baseline will predict future clinical outcomes.

The research was funded by a grant from the National Institute of Mental Health. Study co-authors include Jennifer Dyl and the late Henrietta Leonard from Bradley Hospital and Alpert Medical School; Christianne Esposito-Smythers, Martin Keller, Lance Swenson and Robert Stout from Alpert Medical School; Boris Birmaher, David Axelson, Neal Ryan, Benjamin Goldstein, Tina Goldstein, MaryKay Gill and Mei Yang from the University of Pittsburgh Medical Center; and Michael Strober from the David Geffen School of Medicine, University of California at Los Angeles.

Monday, June 22, 2009

Sweet n Sour

I understand that it is very scary to put a small child on an anti-psychiotic drug. If weight gain is the only side-effect, then it is a no-brainer. If the diagnosis fits and the medicine works, then these children should be on the correct medicine.

Antipsychotic drugs for kids raise hope, worry

(06-21) 19:38 PDT -- Increasingly powerful antipsychotic drugs available on the market, and growing evidence that starting these medications early can help children with conditions like bipolar disorder, is putting doctors under more pressure than ever to diagnose and treat young people with mental illnesses.

As a result, some doctors say, mental illness, especially bipolar disorder, has been overdiagnosed much the same way attention deficit hyperactivity disorder was in the 1980s.

"ADHD was the diagnosis du jour in the '80s. Now it's become bipolar disorder," said Dr. Andrew Giammona, who heads the psychiatry department at Children's Hospital Oakland. "We're in a quick-fix society, and parents want to believe that if we had this treatment, we can get it fixed and move on."

Before the 1990s, bipolar disorder was a rare diagnosis in children under age 19. By 1994, U.S. doctors were reporting about 25 cases per 100,000 young people, and by 2002 that number had jumped to 1,000 cases per 100,000, according to data from the National Center for Health Statistics.

Medication was prescribed for about two-thirds of those patients, according to the National Institute of Mental Health. Antipsychotic medications are among the most popular made by pharmaceutical companies. Earlier this month, a U.S. Food and Drug Administration panel recommended approval of three antipsychotic drugs for use in treating schizophrenia and bipolar disorder in children and teens. The FDA will make a final decision on Geodon, Seroquel and Zyprexa in the coming weeks.

While better drugs and increased diagnoses have been a blessing for many families, at FDA hearings in Washington, doctors and parents voiced concerns that the medication can cause long-term health problems - specifically, extreme weight gain that can lead to metabolic disorders like diabetes.
Not a trivial decision

"It would be controversial enough if it was just a diagnosis, but the diagnosis comes with these very potent medications," said Glen Elliot, chief psychiatrist and medical director of the Children's Health Council in Palo Alto. "My main message is parents need to be apprised that this is a cost-benefit analysis. You don't trivially put somebody on a medication."

As with ADHD, many thousands of children and teens really do have a mental illness that can be treated effectively with medication and therapy. Oakland parent Barbara Carlson said her son was 7 when he started having fits of violent rages, smashing windows and throwing chairs. After several days of testing, he was diagnosed with bipolar disorder - but she was reluctant to put him on medication. "He was just so young," Carlson said. "I thought, 'He has his whole life ahead of him, what if this is the wrong diagnosis?' It was very scary to put him on medications."

Seven years later, she said the drugs have improved his life dramatically. He's had weight problems, but he's excelling in school and is active in sports and making friends.

Many mental health experts said they've felt pressure from families with troubled children to make a diagnosis and start treatment - a reaction that's understandable if the child is clearly having problems. But if doctors don't have the proper training to accurately diagnose a mental illness, children may not get the right treatment, said Dr. Robin Dea, director of mental health services for Northern California Kaiser Permanente.
Depression and mania

"I tell doctors, 'You have to be honest with yourself about your own level of experience with this condition,' " Dey said. "We have to be honest with ourselves about whether the medications are working, and if they're not working you need to keep questioning the diagnosis."

Bipolar disorder is thought to affect about 1 percent of children, although studies vary and some experts believe it affects as many as 5 percent of children.

The disorder in adults is marked by extended cycles of depression and mania, although people can have long periods of time where they have no symptoms at all. During manic periods, adults may get grandiose ideas, feel euphoric and be impulsive and make poor decisions.

Children with bipolar disorder tend to cycle through moods faster than adults, and they are more likely to be extremely irritable than euphoric, said Dr. Kiki Chang, director of the Pediatric Bipolar Disorders Program at Stanford University School of Medicine. Experts note that these children are not just kids with behavior problems.

"An irritable kid is most likely not bipolar, he's probably just upset about something," Chang said. "Bipolar kids may be extremely explosive, extremely angry. But they have to have these other symptoms: they're not sleeping as much, their mind is going faster and they're making poor decisions."
Hard to tell the difference

It's not always easy for doctors to tell the difference between a kid with bipolar disorder and one who's dealing with teenage angst or has some other problem, like post-traumatic stress. Giammona at Oakland Children's Hospital said he once diagnosed a child with bipolar disorder only to discover later that the patient had a food allergy that was making him extremely irritable.

"There's a lot of overlap with other potential diagnoses," he said. "There can be lots of reasons for symptoms that look like bipolar disorder. Just because they have the symptoms of the disorder doesn't mean they have it."

Dale Milfay, vice president of the National Alliance on Mental Illness in San Francisco, said it's crucial that children with mental illness get a correct diagnosis as soon as possible and start treatment right away. There may be medical advantages to early treatment, she said, but children also benefit from staying in school and developing crucial relationships with friends and family.

"The earlier people are diagnosed, the better their chances," Milfay said. "But you wouldn't want these drugs to be overused. There needs to be some real criteria that this is not something a primary care doctor can just diagnose."

Wednesday, June 3, 2009


This sounds like a broken record, I see this almost every day in the world of Special Education. The parents take their children off the medicine and don't take them to their counselors. Here is a very true list of what we have seen in the last two weeks of school

1. "M"'s mom takes him off his meds. because we only have two weeks left and surely we don't need him to take his drugs, he is a 4th grader who then goes "poo" in his pants and spreads it around the school in little "poo" bombs.
2. "Z" is tired of working and when the teachers give him an assignment he says"I am not doing any more Effing work" His mothers solution was to have him write 100 times at home that he will not use the "F bomb" again. The next day he got into a fight and used the "F bomb" with the assistant principal which earned "Z" the right to have On Campus Suspension and miss his end of year party
3. "J" does not take his medicine and his mother says it won't hurt him to miss a few days, so he flies around the room, uses the F-bomb with a teacher, won't stay in his chair at all and can't focus, so he had a wasted learning day and the teachers had to send him to the principal where he was told if he did not take his meds. the next day he would join "Z" in OCS, he made the right choice the next day and took his meds.
4. "C" admits that his mother spreads his meds. on a half PBJ sandwich because he can't swallow the pill but he has actually been feeding it to the dog which explains why the teachers were puzzled when the mother said his meds had been increased in the last month and were perplexed as to why he can't pass the second round of State Mandated Tests and now has to attend summer school.

So you decide, is it important to take your prescribed meds.? absolutely "YES".

Youth with history of mental illness gets probation for break-in

BLOOMINGTON -- A 12-year-old Bloomington boy who broke into two homes in Normal last year was placed on 60 months probation Wednesday and ordered to cooperate with attempts to help him avoid future problems with the law.

McLean County Assistant State’s Attorney Aaron Hornsby described Sept. 18 as “a truly frightening day and what were truly frightening crimes.”

The youth and a second boy got off the school bus where they were scheduled to attend special education classes and instead broke into two homes, said Hornsby.

An 83-year-old resident of one of the homes saw the two as they left his property and called police. When the 12-year-old was stopped, he was waving two knives, said the prosecutor.

The youth’s background includes a history of mental illness and two suicide attempts, according to Hornsby.

The state asked that the minor be placed on probation until he is 21 years old.

In her remarks prior to her decision to place the youth on probation until he is 17, Judge Elizabeth Robb said she was troubled by reports indicating the child was taken off medication by his mother and missed counseling appointments.

Calling the mother’s decisions irresponsible, Robb told the parent, “he’s not going to function without medication.”

The mother was ordered to work with child welfare, school and court services staff assigned to the child’s case.

Defense lawyer Art Feldman agreed that the child’s mental health issues must be addressed.

“It’s clear to me that the minor has mental health issues. It’s a matter of how to deal with them,” he said.

An Aug. 3 hearing is scheduled to review the boy’s progress.


Monday, May 25, 2009


Sometimes I read information about mental illness and it seems like the field is still in it's infancy. This stigma that has prevailed forever may have kept a lid on a lot of research and just real facts. We shall see.

Psychiatrists rewriting the mental health bible
The Diagnostic and Statistical Manual of Mental Disorders, commonly called DSM, is getting an update. Now experts must decide what is a disorder and what falls in the range of normal human behavior.
By Shari Roan
6:12 PM PDT, May 25, 2009
Reporting from San Francisco -- Is the compulsion to hoard things a mental disorder? How about the practice of eating excessively at night?

And what of Internet addiction: Should it be diagnosed and treated?

As the clock ticks toward the release of the most influential of mental health textbooks, psychiatrists are asking themselves thousands of complex and sometimes questions.

The answers will determine how Americans' mental health is assessed, diagnosed and treated.

Over the next 18 months, psychiatrists will hammer out a draft of the fifth edition of the American Psychiatric Assn.'s Diagnostic and Statistical Manual of Mental Disorders, more commonly called DSM-V. Nowhere have the discussions been more heated, the ramifications most vividly foretold, than here at the organization's annual meeting.

Some psychiatrists warn that the tome runs the risk of medicalizing the normal range of human behaviors; others vehemently argue that it must be broad enough to guide treatment of those who need it.

But all agree that the so-called bible of psychiatry is expected to be considerably more nuanced and science-based than the last edition, DSM-IV, published in 1994.

Brain imaging and other technologies, plus new knowledge on biological and genetic causes of many disorders, have almost guaranteed significant alterations in how many mental afflictions are described.

"There are no constraints on the degree of change," said Dr. David J. Kupfer, chairman of the DSM-V task force and a psychiatrist at the University of Pittsburgh's Western Psychiatric Institute and Clinic.

The book will describe disorders in more detail, acknowledge variations that haven't been viewed as part of "classic" illness and explain how conditions differ based on age, race, gender, culture and physical health, Kupfer said.

Planning on the text began almost a decade ago, and leaders delivered a progress report to their colleagues last week. They emphasized that the book, slated for publication in 2012, should better reflect the lives and complexities of real people, not simply the most severe cases or most cut-and-dried diagnoses.

Critics of the current edition -- and there are many -- say that it allows for diagnosis only after a dramatic threshold has been reached.

"We are really hoping we'll be able to improve things," Kupfer said. "And that will help us do a better job of taking care of our patients."

Used around the world and available in 13 languages, the book has evolved from its humble origins in 1952 as a dry collection of statistics on psychiatric hospitalization. It is now used by not just psychiatrists, but internists, family practitioners, psychologists, social workers, courts and education professionals to guide the diagnosis and therapy for a host of mental and behavioral conditions. More than one million copies of DSM-IV have been sold.

Having a DSM diagnosis can mean an autistic child will get services from the public school system or that an adult is covered by workplace anti-discrimination laws.

For health insurance companies, it has become a basis for decisions on paying for care.

Some have questioned whether those writing the new book may be influenced by the pharmaceutical industry. Over the past two decades more medications have become available to treat mental disorders, and some doctors worry that the text may be written in a way that expands the market for drug therapies.

Wednesday, May 13, 2009

What's this? Bipolar and/or Autism? Interesting.

One of my SPED students is diagnosed as being high functioning autistic and bipolar. What a great discovery if they are related and sometimes are often twin diagnosis.

Optimism For Bipolar Disorder And Schizophrenia If Psychiatrists Abandon 19th Century Dogma, Uk

Nineteenth century thinking about schizophrenia and bipolar disorder must be abandoned if psychiatry is to progress, said a leading UK psychiatrist. At a meeting of the Biochemical Society, Professor Nick Craddock from Cardiff University urged his profession to embrace the opportunities offered by new research methodologies.

Advanced technology and the large sample sizes in research have led to unprecedented advances in the identification of specific genetic risk factors for psychiatric disorders as recently as the last two years. "For more than 100 years there has been a widespread assumption that bipolar disorder (manic depression) and schizophrenia are completely separate diseases. Recent evidence, particularly from molecular genetics, shows the situation is not so simple. Some of the susceptibility genes are shared," he said.

Strong genetic associations have been reported in bipolar disorder and schizophrenia. Emerging data provide a powerful resource for exploring the relationship between psychiatric characteristics. "This new knowledge will help to explain why some people receive a diagnosis of schizophrenia at one time and bipolar disorder at another time and why some receive a mixed diagnosis - so called 'schizoaffective' disorder," he said.

It is already clear that, in general, genetic associations are not specific to one of the traditional diagnostic categories. For example, one gene variation (ZNF804A) is associated with risk of both bipolar disorder and schizophrenia, and some rare 'copy number' variations are associated with the risk of autism and epilepsy as well as schizophrenia. "There is an urgent need to think beyond diagnostic "boxes" and consider how variations in brain biology and function lead to the huge range of clinical variations seen in people with psychiatric diseases," said Professor Craddock.

Whilst many family and twin studies have demonstrated the importance of genetic factors influencing susceptibility to bipolar disorder, only recently have research technologies started to identify these risk factors. It is, according to Professor Craddock, a successful start to a long journey.

"We know that there are many genes involved in bipolar disorder. Two such genes have been strongly implicated in recent studies of over 10,000 individuals," he said. The action of both genes is thought to be through effects on the basic control of the excitability of nerve cells. Although not of immediate clinical use, this new understanding will open up new avenues for research and should ultimately lead to improved treatments.

Professor Craddock concluded, "This is a time of rapid progress in bipolar disorder research. Those with illness can be optimistic for the next generation."

Monday, May 11, 2009

"Was At One Time taking Lithium"

These are key words, at one time was taking. Just because you feel " normal" does not mean you can stop taking your meds, the meds are the "reason" why you are feeling so well. Please take your prescribed meds so these things don't happen to innocent people.

Uncle says mental illness at root of Manchester pacemaker attack
By Matthew Wilde
Waterloo Courier

(Waterloo Courier)
This is the rural Manchester home of Charles Fierstine, a cabin that is similar to a barn in appearance. It is where authorities say Fierstine's son, Jesse, 32, attacked his father on April 25 and cut a pacemaker out of his father's chest. Jesse Fierstine then fled across the bridge in front of his father's home and hid in the garage at his nearby home until he was arrested.

Mental illness may explain why a rural Manchester man cut the pacemaker out of his father's chest, a family relative says.

Jesse Lewis Fierstine, 32, is charged with attacking his father, Charles Fierstine, on April 25 and cutting his father's pacemaker out of his chest. Delaware County authorities have said it is one of the more unusual and gruesome crimes they've ever handled.

Jesse Fierstine is charged with attempted murder and is being held on $750,000 cash bond in the Delaware County Jail.

Jim Fierstine, Jesse's uncle, and law enforcement officers say Jesse Fierstine suffers from bipolar disorder but was not on medication at the time of the attack. Officials said he struggles with reality.

"He (Jesse) asked me to take him for a walk (outside) today," Deb Lynch, Delaware County Jail administrator, said recently. "He doesn't comprehend anything."

Jim Fierstine of rural Garber, while waiting to visit his nephew in jail, said he and other family members are convinced Jesse's mental state caused the attack. Sheriff's deputies said Jesse told them he'd drunk a bottle of wine before the attack.

Jesse and his father are close, Jim Fierstine said. Charles Fierstine, a 63-year-old retired dairy farmer, had heart problems, and those health problems bothered Jesse, he said.

By going after his father's pacemaker, Jim Fierstine believes, his nephew thought he was in some way helping his dad.

"I think that was on his mind, but who knows what was going on in there," he said. "If he intended to (just) murder him, one good blow to the heart would have done that."

(Waterloo Courier)
This is the mobile home where Jesse Fierstine lived in rural Manchester. He was hiding in the adjacent garage when authorities arrested him April 25 on suspicion of assaulting his father. His uncle said Jesse Fierstine suffers from bipolar disorder and was not taking medication at the time of the attack.

Charles Fierstine is recovering at University of Iowa Hospitals and Clinics in Iowa City, his brother said, and has undergone medical procedures to repair the damage.

"He's coming along fine. We think he will pull through," Jim Fierstine said.

Emotionally, the family is doing "as well as possible," he added. Rather than being angry, "they (the family) want help for Jesse, especially his dad."

That means treating Jesse once again for bipolar disorder. At one time, Jesse Fierstine was seeing mental health professionals and taking lithium, a commonly prescribed medication to manage the problem, law enforcement and family said.

Jim Fierstine said Jesse was at his parents' home three miles southeast of Manchester the night of the attack. Jesse lives nearby in a mobile home. The properties are separated by a creek and connected with a foot bridge.

At about 10:30 p.m., Jim Fierstine said, Donna Fierstine found her husband and son fighting. She ran to the nearby house of another son, Jayson, to call 911. Court documents said Jesse Fierstine struck his father in the head with a flashlight and piece of firewood and then cut out his father's pacemaker with a pocket knife, leaving a gash 6 1/2 inches long and 3/4-inch wide. Deputies found wires protruding from Charles Fierstine's chest.

Jim Fierstine said Jesse has struggled to hold full-time jobs and that his parents support him in return for his help with their acreage. On his application for a public defender, Jesse said he was self-employed making less than $200 per month.

Jim Fierstine said his nephew eagerly helps with chores like mowing and shoveling snow. He also saved an abandoned baby squirrel by having a cat that recently had kittens nurse it, he said.

"That," he said, "is the Jesse I know."

Sgt. Larry Gronwold said the sheriff's department has participated in at least two mental health committals for Jesse in the past.

Jail staffers said they've requested mental help for Jesse through his attorney and have asked he be put back on lithium but that he must be seen by a psychiatrist first. He has been segregated from other inmates for their safety and his own, jail administrator Lynch said.

"I don't think he has the mental capacity to be with other inmates," Lynch said. "He's very polite to me."

Saturday, May 9, 2009

One Size does not Fit All

Sometimes I read ideas that I think are just common sense anyway. We already know that women sometimes are not taken as seriously as men when it comes to mental illness. We have a lot of body things that have to be in balance for us to be healthy women; thyroid, hormones being the largest ones. Then if you have a mental illness in the family, it has been known to travel across generations. We know this, please listen up.

New report underscores women's mental illness concerns

* Story Highlights
* HHS's Office on Women's Health releases new report on women's mental health
* Women suffer from major depression, anxiety disorders at higher rate than men
* Half of all mental illnesses occur before age 14 in both men and women
* Need for early detection and destigmatization of mental illnesses, researcher says

updated 7:08 p.m. EDT, Fri May 8, 2009

* Next Article in Health »

* Read

By Shahreen Abedin
CNN Senior Medical Producer
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(CNN) -- For the first 45 of her 50 years of living, Bonnie Neighbour used to wake up feeling sorry to be alive.
Bonnie Neighbour has struggled with mental health issues for almost all of her 50 years.

Bonnie Neighbour has struggled with mental health issues for almost all of her 50 years.
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"Even when I wasn't actually depressed, I would open my eyes in the morning and wonder if there wasn't something else; I would have preferred an alternative to being alive," she says.

She recalls being depressed as a young child. In her late teens, she started having mood problems that eventually escalated into clinical depression.

"At some point, I was suicidal. I would suffer cycles of depression and mania," Neighbour said. "I wouldn't sleep for days, and the less sleep I would get, the more revved up I'd become, and then I would make irrational decisions and act out. Then I'd alternate with serious depressive episodes.

"At one time, for nine months, I wasn't even able to leave the house [because of depression]." At age 30, she was diagnosed with bipolar disorder.

Neighbour's story isn't uncommon.

"Action Steps for Improving Women's Mental Health," a new report by the U.S. Department of Health and Human Services' Office on Women's Health (OWH), explores the role gender plays in the diagnosis, course and treatment of mental illness. It calls for specific actions to counteract the inadequacies in this field.

According to the report, women are nearly twice as likely as men to suffer from major depression. They are three times as likely to attempt suicide, and they experience anxiety disorders two to three times more often than men. Chart: Gender and mental health »

While these statistics are not new, their importance is generally underplayed, says Wanda Jones, Dr.P.H., health scientist and director of the OWH. She notes that whereas past reports have focused on bringing mental health to the forefront of concern -- such as the 1999 publication "Mental Health: A Report of the Surgeon General" -- few have focused primarily on the specific mental illness issues specific to women, hence the need for such a publication.
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Among the actions recommended by the new report are the needs to underscore the essential importance of women's mental health to overall well-being, improve how primary care doctors and mental health professionals interface with each other, develop a greater understanding in the role of gender in mental illness, recognize the role of trauma and violence against women and its subsequent impact on mental illness and address cultural biases that serve as barriers to treatment for many women.

Reasons for the gender disparities in mental health are still unclear, according to Jones. Part of the difference is based on biology. Female hormones, thyroid disease and brain biochemistry have all been cited as possible reasons. Genetics also play a part, as family history has proven that mental illness repeats itself across multiple generations. Socio-cultural reasons also contribute to the difference.

Jones stresses that the "one-size-fits-all" approach to diagnosing and treating mental illness is not an effective approach and that acknowledging the gender differential is key to adequately and appropriately treating women.

The new report also underscores the relative young age at which mental illness often sets in for both males and females. Half of all mental illnesses occur before age 14, and three-fourths occur by the age of 24, according to the publication. Among the more common mental illnesses seen among young women: eating disorders, which can start in advance of puberty and yet last a lifetime.

Jones emphasizes the dire need for early detection and treatment of mental illnesses in young women. "When these young people grow into adults, they're more likely to end up in the criminal justice system, homeless on the streets, poor performers in school and ultimately bounced into a system that's incapable of helping them with their needs," she explains.

Another point Jones stresses is about the negative stigma around women's mental health issues. "We have to accept that mental illness is not a sign of weakness; it's not a choice. But it is treatable, and our own innate resilience protects us and plays a critical role in combating mental illness, especially depression and anxiety," she says.

Despite the relief Neighbour initially felt after finally being diagnosed with bipolar disorder, she recalls that instead of getting better, she started to get worse. The mood-stabilizing medications she was prescribed were so sedating that she slept 16 hours a day, which led her deeper into her depression. "The doctor said, 'This is how things are, and it will only get worse,' and that's what I started to believe. It became a self-fulfilling prophecy," she says.

There is a common thread to Neighbour's experience and that of other women suffering from mental illness: societal beliefs often pressure women into accepting their mental illness as "just how things are," citing hormones and traditional views of women as the emotional, weaker sex as reasons to simply accept their current situation. According to Jones, it's a barrier that keeps women from seeking treatment for an otherwise largely treatable disease.
Health Library

* Depression
* Mental health
* Adjustment disorders

Despite numerous barriers to access and adequate mental health treatment for women, recent developments in female-specific care provide a new area of hope. Over the last decade, researchers have begun to develop trauma-informed care services, which focus on the high prevalence of trauma -- such as childhood sexual abuse, relationship violence and coerced sex -- that women are more likely to have experienced compared to men. The HHS reports that 40 percent of women report a history of sexual violence, compared to only 10 percent of men. In some mental health treatment programs, recognizing these underlying factors and treating women accordingly has led to dramatically improved outcomes.

In 2005, Neighbour discovered the concept of mental health recovery, which is focused on identifying triggers and symptoms that would cause her behavior to get worse, and responding with actions that she recognized helped her calm herself. She learned that there were other tools beyond medications that could help treat her mania and depression. "I went from focusing everything on 'being' my illness, to focusing on finding fulfillment."

After holding 30 jobs in 15 years, Neighbour now holds a steady full-time job and serves as a volunteer to help others in their own recovery from mental illness. She describes her healing as an ongoing process and critical to it is a network of peers who have had similar life experiences.

"Now I wake up, and I ask how can I go out and change things? I just get excited when I wake up every morning," she says.

Wednesday, May 6, 2009


This is great. I wish I had this and I wish and hope for all family members to take advantage of this.

Classes available to help cope with mental illness
Comet staff report

Do you have a loved one who suffers with serious mental illness?

The National Alliance on Mental Illness (NAMI) provides free help to families with loved ones who are suffering with mental illness.

A Family-to-Family educational class taught by trained NAMI family members who have a mentally ill loved one will possibly begin May 7 in Delphi.

The eleven-week, nationally recognized education and support classes have been taught to thousands of family members. The classes include information about the causes of mental illness, what the various diagnoses mean, upto date information on medications and side effects, where help is available, the signs of relapse and coping with stress and emotional overload.

A University of Maryland study of 95 families demonstrated significant benefits to participating in the Family-to- Family classes. Compared to a control group, six month following their classes, graduates had a greater knowledge of the causes and treatment of mental illness. Family members felt less burdened by a loved one's illness and had an improved understanding of the mental health system. Family members also showed a reduction in depression.

Monday, May 4, 2009


Mental Illness’ Secondary Symptom

May 4, 2009 by admin

Jamie Carter
Class of 2009
Guest Commentary

It is incredible that in today’s society that prides itself on being accepting, diverse, and politically correct, a widespread stigma of a large group of people can still exist. Unfortunately, though, such stigmas do exist, and one of the most prominent and dangerous ones is the stigma of mental illness.

Those who suffer from mental illness are often thought of as being weak, or merely unable to “suck it up and deal with life.” Illnesses such as depression, however, are real illnesses, much like any other sickness. The brain is a part of your body, and much like the rest of your body, it too is susceptible to disease.

In college, such a stigma can be dangerous. Friendships are often the most important part of a student’s life. You live, eat, take classes, and go out with your friends. The risk of losing or alienating these friends, then can seem like the biggest danger in the world, and will often cause a person who needs help to refrain from seeking the help they need if it is thought that they will lose their friends in the process.

Simple comments made during a conversation can lead someone who so desperately needs this help to not seek it. It is a sad fact that many of the same people who would never condone a racial joke, or stereotyping based on religion, sex, or physical disability, would, without a thought, make a joke or a simple remark that demonstrates not only ignorance, but a fear, of people suffering from mental illness. If you heard your friends making fun of or expressing doubts about depression and suicide as real illnesses, would you want them to see you sitting in the lobby of the Counseling Center in O’Boyle? Most likely not.

The fact that this stigma still exists, and is prevalent on college campuses, creates a vicious cycle that discourages those who need help from getting it before their illness spirals out of control, and when it does spiral out of control, it can become an even scarier issue that can continue to perpetuate stereotypes. Continued ignorance and fear about mental illness is dangerous, and if people, many of whom may be your friends, who need help, feel as though they can’t seek it, their illness may lead to additional and associated problems such as alcohol and drug abuse, cutting or other means of self-harm, and in the most drastic of cases, attempted suicide.

So, be there for your friends. You may not know that one of your closest friends is dealing with a mental illness. Think before the next time you make a lighthearted remark about suicide, bipolar, or ‘crazy people’ – it may not be lighthearted to everyone. It could be a matter of life and death.

Thursday, April 30, 2009

Family Pulling Away and Friends Fading Away

Yes this scenario is the repeated scene for every mentally ill person and their families. I totally understand what this girl is saying. My mother also was discharged from the hospital with no place she would agree to go to and was also very close to becoming another homeless statistic. Amazing how similar all the stories are. Please KTDUP!!!

Daniel Rubin: With Phillies, fightin' to help the mentally ill

By Daniel Rubin

Inquirer Columnist

A perfect day. We're sitting behind home plate at Citizens Bank Park, midafternoon, as the Washington Nationals stretch and shag flies in the sun. Next to me, Melissa Maani talks about mental illness.

"It changes the dynamics of the day - every day, every holiday," she says. "Everything is different."

Maani is the Phillies' graphic artist. Her latest work hangs in left field, the "HK" that honors the late announcer Harry Kalas.

She's hoping to get another message in front of the fans. For 19 years, she lived with a loved one suffering from schizophrenia. She watched as friends grew distant. Relatives pulled away, too.

What if the team helped raise awareness of the subject, which nearly went unmentioned when she was growing up in Glenolden?

The Phillies made this pitch: Sell 500 seats to a game this season and we'll host a Mental Health Awareness Night.

So Maani's asking for a little help. She has until May 8 to sell 300 more tickets to the May 26 game against the Florida Marlins. That's a Tuesday night. For $14, you can sit above the third-base side in Sections 330 to 333 in a seat that normally goes for $24. (If you're interested, go to

I figure we should be able to help her out. We'll be helping a lot more people than Melissa Maani.

Unspoken things

She doesn't want to identify which family member is ill. She puts it this way:

"I'm the only person who has never denied her the reality of what she thinks happened to her."

So let's leave it as a loved one.

"I was taught when I was young not to speak about it outside of the family," says the 36-year-old, a hearty woman with spiky dark hair who grabs my forearm when she laughs, which is often.

In high school, she wrote lots of reports about schizophrenia. "I wanted to make it better. Fix it."

She couldn't, of course. Her relative's fragile mental health reached a crisis point five years ago. She was about to be released from a hospital to Maani's care.

Maani lives in a two-story house. "She couldn't remember how to walk up stairs," said Maani, who didn't know where to turn.

Meanwhile, the nurses at the hospital told her that if she didn't pick her up, the relative would be homeless.

Uncharacteristically, Maani mentioned to a coworker what she was going though. The colleague said her mom had the same illness. Call Edie Mannion, she said - the therapist with the Mental Health Association of Southeastern Pennsylvania.

Better days

Mannion let Maani know her rights, steeled her nerve. She even recommended a nuclear option for changing the hospital's mind: calling Action News.

That wasn't necessary. The hospital let the woman stay a few days until a place was found in a nursing home equipped to care for the woman, whose diagnosis is paranoid schizophrenia. Things are better now.

As we sit there soaking up the sun, watching batting practice, Maani says the mentally ill are the true heroes, just for getting by.

"Life in general is hard enough," she says. "Then, to hear voices and things you are unsure of, and to have such strong fears . . . they just can't handle so much. They're more afraid of you than you are of them."

If Maani sells her 500 tickets, the team will let her show a short film about mental illness. She'll ask Mannion to throw out the first pitch. I called Mannion, to ask what she'd like the public to know.

"Everyone should be aware of their own mental health," she said. "I think we are all recovering from something."

The National Alliance on Mental Illness figures 26 percent of American adults have some amount of mental illness. "With unemployment and the war," Mannion said, "there are going to be more mental-health issues than ever, hitting all different segments of society."