Bipolar Blog by Liz

Needs to be Monitored

2010-06-15T15:32:00.001-07:00

This is again the story that I hate to hear about, mentally ill, brilliant mind, not on meds. These people do not deserve to be shot dead, but they should be monitored, if diagnosed by a medical doctor, and they choose to not take the prescribed medicine, then they should be asked to be monitored by professionals before their mania and delusions get out of control. This is again a needless death due to a severe mental illness that was not being treated with meds. because the patient chose to not take the prescribed medicine. I feel the pain of the family as I am sure they stood on the sidelines with their hands tied by laws that will not allow them to interfere with the choices their loved one chose to make in his manic/delusional frame of mind.

Officer cleared in Henry Co. fatal shooting
A prosecutor said police were justified in shooting the man, who had a mental illness but stopped taking medication.

After Donald Barry Minter pulled a hunting knife at a Kroger supermarket, after he charged police officers in the parking lot, after he led them on a high-speed chase, after he swung his knife once again when stun guns failed to stop him, a Martinsville police officer had no choice but to shoot him dead.

That was the conclusion released Monday by Henry County Commonwealth's Attorney Bob Bushnell.

In a detailed, five-page chronology of the events of April 29, Bushnell wrote that Officer Douglas Graham was "completely justified" in shooting Minter. The decision also explained how Minter, a 61-year-old former lab technician for the city of Martinsville, was driven to his death by severe mental illness.

"In a less sophisticated era, it would have been said that he was possessed by demons," Bushnell wrote.

Minter's brother, David Minter of Axton, said Monday that he understands the prosecutor's decision not to charge Graham or three other officers involved in the confrontation.

Donald Minter had struggled with mental illness most of his life, his brother said, but became "unable to deal with reality" several years ago when he stopped taking his medication.

"He had a brilliant mind," David Minter said of his brother. "But he also had schizophrenia and was bi-polar and manic depressive."

Both Minter and Bushnell said the case illustrates a need in Virginia for legislation that would enhance monitoring of mental health patients who, for whatever reason, refuse to take their medication -- posing a threat to themselves and others.

Bushnell's decision came after a state police investigation of the shooting. From more than 40 witness interviews, hundreds of documents and video surveillance from the grocery store and the officers' patrol cars, Bushnell put together the following, uncontested narrative:

At about 11:30 on the morning of April 29, Minter and his elderly mother showed up at the Kroger store on Commonwealth Boulevard, where they were well-known as regular shoppers who took pains to avoid black cashiers.

If all of the cashiers on duty were black, the Minters would return their items to the shelves and leave empty-handed. But on this particular day, after arguing with his mother, Minter shopped alone and wound up in a checkout line staffed by a black woman.

He became angry when told he owed about $65, saying his items were worth no more than $40. When the cashier picked up the telephone to call a manager, Minter grabbed the cord and sliced it with a bone-handled hunting knife.

He then placed two $20 bills on the counter and left with his groceries.

A few minutes later, when police arrived, Minter was loading his groceries into the trunk of his car. He charged at the first police cruiser on the scene, repeatedly stabbing the driver's side window so hard the knife left scratches on the glass.

Minter then ran back to his car, unaffected by a second officer's attempt to stop him with high-voltage Taser darts.

After a short struggle, and another failed Taser shot, Minter sped away. Running red lights, he led police on a chase that took them north on Virginia Avenue at speeds of up to 80 mph.

Minter's car was eventually rammed by a police cruiser and came to a stop along a chain link fence. He then scrambled out of the passenger's side window and ran off. Graham and fellow officer Anita Sowers chased after him.

After getting within 15 feet of her suspect, Sowers yelled at him to stop or she would fire her Taser. When she did, it had no effect on Minter, who then whirled around and rushed at her with his knife raised.

"Graham saw what was happening and, fearing that Minter had already cut Sowers with the knife, fired a single shot with his .45-caliber pistol at Minter's midsection," Bushnell wrote.

Minter fell to the ground, still grasping his knife. He died a short time later.

Had Graham held his fire or even hesitated, Sowers would have been injured or killed, the prosecutor said.

Investigators were unable to determine why Minter was unaffected by the Taser shots, which either missed him or malfunctioned.

As part of his review, Bushnell spoke to family members, who described Minter as a quiet and peaceful man when on his prescribed drugs. But without them, he became paranoid and aggressive.

"We all agree that Donald Minter died not because he was a bad man, but because he was a sick man whose failure to take his medications resulted in conduct that gave the police no option but to shoot him," Bushnell wrote.

Despite his struggles with mental illness, Donald Minter earned a degree in biology from Virginia Commonwealth University and spent about 25 years as a lab technician working at Martinsville's water and sewer treatment plant.

As he grew older, Minter's mental condition deteriorated to the point that he believed he no longer needed treatment, his brother said.

Bushnell said he hopes the incident will spur a new law in Virginia to require closer monitoring of people who, like Minter, become dangerous when they go off their medication.

Up to 60 percent of people with Minter's diagnosis have anosognosia, a neurological condition in which they cannot acknowledge they are mentally ill, according to Aileen Kroll, legislative and policy counsel for the Treatment Advocacy Center, an Arlington-based organization that works for better treatment of the mentally ill. Failure to take medication is a common symptom of anosognosia.

Virginia is one of 44 states that have an outpatient treatment system that is considered an effective way of ensuring that mental patients take their medications.

But according to Kroll, the criteria for those who fall under Virginia's system is too restrictive, and gaps in supervision are common.

"There are people who will argue that Virginia can't do better because of the fiscal crisis, but frankly, how can we afford not to?" Kroll said. Until the state does more to improve its understaffed mental health system, critics say, there will always be another case like the one of Donald Minter.

"He's gone," David Minter said of his brother. "But let's help somebody else who is going through this."

Worth Watching

2009-11-15T17:41:00.000-08:00

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.

Another "Probably not taking his medicine"

2009-10-25T13:03:00.001-07:00

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."

Another Lost Soul

2009-10-09T09:56:00.000-07:00

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."

New Book, Same Story

2009-09-27T11:04:00.000-07:00

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.
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Right Direction

2009-09-13T10:33:00.000-07:00

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.

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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.
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Doesn't matter

2009-08-21T19:03:00.000-07:00

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.

Lots of Reasons Why

2009-08-13T18:10:00.001-07:00

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.

Sad Realization

2009-08-11T16:25:00.000-07:00

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.

Off his Medication for Over Year

2009-08-01T11:57:00.000-07:00

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.
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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.

Good Read

2009-07-31T17:26:00.000-07:00

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 (www.rhodeislandhospital.org) 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.

Found on my Bipolar News

2009-07-25T18:08:00.001-07:00

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.

Equality on the Brain

2009-07-16T17:25:00.000-07:00

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.

Not New but worth re-reading

2009-07-15T17:25:00.000-07:00

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.

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"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."

Need more of this

2009-07-11T15:17:00.000-07:00

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

Stanford To Offer Bipolar Education Day On July 25

Bipolar Disorders
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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 http://www.bipolar.org or contact Meredith Childers at mchilder@stanford.edu.

Source
The Stanford University School of Medicine

Anger or Irritability doesn't really matter

2009-07-01T16:00:00.000-07:00

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.

Sweet n Sour

2009-06-22T19:57:00.000-07:00

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."

EEEEVVVVVEEEEERRRRYYYY DAY!

2009-06-03T17:19:00.000-07:00

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.

t

Infancy?

2009-05-25T19:26:00.000-07:00

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.

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

2009-05-13T17:55:00.000-07:00

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."

"Was At One Time taking Lithium"

2009-05-11T16:27:00.001-07:00

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.
KTDUP

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

Photo
(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."

Photo
(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."

One Size does not Fit All

2009-05-09T10:53:00.000-07:00

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
* CHART

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.
Don't Miss

* Less sun, more depression for people with SAD
* Expert Q & A: How can I safely wean off an antidepressant?

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

* MayoClinic.com: Depression
* MayoClinic.com: Mental health
* MayoClinic.com: 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."
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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.

Wishing

2009-05-06T15:57:00.000-07:00

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.

KTDUP

2009-05-04T16:16:00.000-07:00

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.

Family Pulling Away and Friends Fading Away

2009-04-30T19:15:00.000-07:00

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 http://philadelphia.phillies.mlb.com/phi/ticketing/group/mha.jsp)

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."

Lithium anyone?

2009-04-26T14:08:00.000-07:00

A lot of bipolar persons are taking lithium. I understand that it does help with the symptoms of this disorder. This article tell us possibly why.

New Light On Bipolar Treatment Drugs - Potential Mechanism Identified For Lithium Operation In The Brain

Lithium has been established for more than 50 years as one of the most effective treatments for bipolar mood disorder.

However, scientists have never been entirely sure exactly how it operates in the human brain.

Now, new research from Cardiff University scientists suggests a mechanism for how Lithium works, opening the door for potentially more effective treatments.

Laboratory tests on cells have shown that Lithium affects a molecule called PIP3 that is important in controlling brain cell signalling. Lithium suppresses the production of inositol, a simple sugar from which PIP3 is made.

Lithium inhibits inositol monophosphatase (IMPase) an enzyme required for making inositol. Importantly, this research shows that increasing the amount of IMPase causes higher levels of PIP3. This can then be reduced by lithium treatment.

High levels of IMPA2, a gene for a variant of IMPase, has previously been linked to bipolar mood disorder. This new result suggests that Lithium could counteract the changes in IMPA2.

Professor Adrian Harwood of Cardiff School of Biosciences, who led the research, said: "We still cannot say definitively how Lithium can help stabilise bipolar disorder. However, our research does suggest a possible pathway for its operation. By better understanding Lithium, we can learn about the genetics of bipolar disorder and develop more potent and selective drugs.

"Further, altered PIP3 signalling is linked to other disorders, including epilepsy and autism, so this well established drug could be used to treat other conditions. Research into Lithium could become very important over the next few years."

Lithium is currently under clinical trial for the treatment of neurogenerative disorder amyotrophic lateral sclerosis (ALS)

The research, funded by the Wellcome Trust, is published in the journal Disease Models and Mechanisms.

Delay onset?

2009-04-24T17:29:00.000-07:00

As the daughter of someone who was severely bipolar, I mean if she did not take her medicine she would be in a permanent manic state with delusions; I see the benefit of trying to delay the onset of this hereditary illness. Fortunately my two brothers and I did not "turn out" bipolar like our mother, even though we were at risk. Believe me, we were watched very closely by our father for any signs that we could be bipolar. But if this study will help identify a child who might be at risk due to a family member who is diagnosed bipolar, then this is a good thing. We need all the help we can get.

Pitt Researchers To Study Effects Of Early Intervention For Children Of Parents With Bipolar Disorder

Mood disorders tend to cluster in families and research shows that bipolar disorder is a particularly inheritable form of mood disorder. Since the strongest risk factor for developing bipolar disorder is having one or more family members with the illness, identifying and treating children of bipolar parents has become an important focus for prevention efforts.

A research team led by Ellen Frank, Ph.D., distinguished university professor of psychiatry, University of Pittsburgh School of Medicine, and director of the Depression and Manic Depression Prevention Program at the Western Psychiatric Institute and Clinic of UPMC, and Tina Goldstein, Ph.D., assistant professor of psychiatry, University of Pittsburgh School of Medicine, is conducting a study to determine whether a specific type of talk therapy called Interpersonal and Social Rhythm Therapy (IPSRT), which was developed by Dr. Frank, will help to delay or even prevent the onset of bipolar disorder in children at risk for developing the illness due to a positive family history.

"We know that the chance that a person with a family history of bipolar disorder will develop the illness themselves increases with the biological closeness of the relationship," noted Dr. Frank. "The children of parents with bipolar disorder are therefore a very high-risk group that requires our attention."

Research has shown that if a child has one parent with bipolar disorder, the likelihood that he or she will develop the illness is between 5 and 10 percent. The risk can increase to about 15 percent if other relatives, such as siblings, aunts or uncles, are also affected. A child whose parents both have bipolar disorder is at a 30 percent higher risk of having the illness.

The IPSRT treatment approach is based on research showing that people with bipolar disorder, and those vulnerable to developing bipolar disorder, have especially sensitive circadian systems - meaning that disruptions in their sleep and social schedules, particularly during periods of stress, are associated with the onset of mood symptoms.

Normal shifts in sleep and social schedules occur during adolescence. Teens tend to want to stay up later at night and sleep in later in the morning. Yet, demanding school and social schedules often do not allow teens to get adequate sleep. The Pitt researchers believe that irregular schedules during adolescence, in combination with other risk factors, may increase the chances that an adolescent with a family history of bipolar disorder could develop mood symptoms. During treatment, a trained IPSRT therapist works together with the youth and family to improve stability in the teen's daily schedules and sleep cycles and to help enhance his or her interpersonal relationships.

"The possibility that we may be able to prevent or delay this serious illness before its full expression is very exciting," said Dr. Goldstein. "By intervening early, we hope to not only prevent the development of illness symptoms, but also decrease risk for other negative outcomes associated with bipolar disorder including academic, social and legal problems."

Individuals with bipolar disorder who are the parents of a child between the ages of 12 and 18 who do not have bipolar disorder, may be eligible to participate in the study. Participation involves an initial assessment interview with parent and child and attendance at 10 to12 free weekly counseling sessions for up to three months. Interviews with parents and children also are conducted to evaluate mood symptoms. Families will be compensated for their participation.

Where does it begin?

2009-04-20T15:51:00.000-07:00

It does help to have early detection and prevention. Prevention is a strange word as most mental illness is not going to be prevented, but it can be maintained and sometimes controlled. I am glad this mother found her son, that he is currently on medicine and being seen by a mental health professional; but you can ask how long will he "agree" to take the medicine and see that professional? That is why I am not sure "early" prevention is the total answer. Continued maintenance for life is what will work. That I think is the hardest part of the mental ill process if you want to call it that. If you could chart one person's life of being bipolar, all the things they say, believe and experience are just like the next one. The bottom line I always say is that you go to bed with bipolar and you wake up in the morning with bipolar every day of your life. You have to "consciously maintain" this disorder, that is the real challenge.

Advocates rally for mental health treatment

AP
Monday, April 20, 2009

OKLAHOMA CITY (AP) — Kim Pointer's 25-year-old son had been missing for about a month when she received a strange e-mail from him that included paranoid ramblings about the government and other organizations conspiring against him.

Pointer's son previously had been diagnosed with anxiety and depression, but now she feared his mental illness had progressed.

“It was a frightening to a degree, especially when I knew he was missing,” Pointer said. “But it was more heartbreaking than anything because ... I realized that my son had something terribly wrong with him.”

Pointer shared her story Monday with dozens of advocates for improving the mental health care delivery system in Oklahoma who gathered for Mental Health Day at the state Capitol.

Pointer said she eventually found her son and got him the treatment he needed, but not before she and her family had to wind their way through a complicated and expensive system of mental health treatment in Oklahoma.

With proper medication and health insurance through a new state program dubbed “Insure Oklahoma,” Pointer said her son is receiving the treatment and medication he needs and is employed as a valet for an Oklahoma City hospital.

But according to Terri White, the new director of the Oklahoma Department of Mental Health and Substance Abuse Services, only 30 percent of the people in Oklahoma who suffer from mental illness receive the treatment they need. She said many of those people, who could be productive citizens with the help of early intervention and medication, end up instead in prisons and jails.

“If we don't have early intervention, there are serious consequences,” said White, who estimated 26 percent of Oklahomans suffer from some form of mental illness. “We do not put people in prison for having cancer. We should not put people in prison for diseases of the brain.”

Justin Jones, director of the Oklahoma Department of Corrections, confirmed that an estimated 72 percent of the more than 25,000 offenders in prison in Oklahoma have a history of mental illness.

Over the last decade, he said, the use of psychotropic medication by inmates has grown more than 300 percent.

Jones said when the state closed several of its mental health facilities in the 1990s, many of those receiving treatment never were bridged into community-based mental health programs and instead ended up incarcerated.

“I could tell you about anecdotal cases all day,” Jones said.

Jones also urged lawmakers to consider lifting a ban on access to mental health court for offenders convicted of a violent crime. He said mentally ill offenders often have previous convictions for assault or other crimes that make them ineligible for mental health court, which is designed to route mentally ill defendants into treatment instead of prison.

“It really limits a lot of people from getting the services they need through mental health court,” Jones said.

Broadway

2009-04-16T16:15:00.001-07:00

I would like to see this one.

Mental illness shatters family in Broadway musical 'Next to Normal'

NEW YORK — There are no easy answers to be found in "Next to Normal," a startling, emotion-drenched musical about one family's attempt to cope with mental illness. The show is an impressive achievement, a heartfelt entertainment that has found its way back to New York after an invaluable out-of-town retooling.

It's startling because the production, which opened Wednesday at Broadway's Booth Theatre, tackles the uncomfortable subject of manic depression with a straightforwardness that is commendable.

And it's emotional, too, in that Brian Yorkey, who wrote the book and lyrics, and Tom Kitt, who composed the music, have crafted an affecting contemporary tale that doesn't shortchange character or plot in their attempt to tell a difficult story.

"Next to Normal" traces the anguished, downward spiral of a bipolar wife and mother, played by Alice Ripley. The actress is giving one of those fearless performances that is astonishing in its theatrical intensity and vocal commitment. Watching her unravel is a harrowing experience, as are the woman's attempts to combat her problems with pills, shrinks and electroshock therapy.

As she flounders, her family suffers, too. There is her husband (superbly played by J. Robert Spencer), a pent-up helpmate who is dutiful in his devotion and devoid of passion as he bottles up his own feelings.

And an overachieving daughter with anxieties of her own, problems that mirror her mother's own troubles. Jennifer Damiano plays her with a sweet insecurity, combative with her parents and resisting the affections of her stoner boyfriend, portrayed with ingratiating loyalty by Adam Chanler-Berat.

Monitoring this family destructiveness is her mysterious brother - a charismatic Aaron Tveit - and an eerily supportive doctor played by Louis Hobson.

What these performers all have in common are powerhouse voices, able to negotiate a pulsating pop-rock score. Actually, pop-rock doesn't do justice to Kitt's often haunting melodies and Yorkey's intelligent lyrics. Both are infused with a theatricality that helps define who these people are.

Under Michael Greif's sharp direction and the kinetic musical staging of Sergio Trujillo, the actors move with ease - and sometimes gymnastically - around designer Mark Wendland's multitiered set. It quickly transforms itself from suburban home to doctor's office and serves as the nesting area for the musical's small band.

The stage has been blindingly lighted by Kevin Adams, whose array of powerful, coloured lights give off an unnerving sense of dislocation that suggests the fragile state of the lead character's mind.

"Next to Normal" was seen early last year at off-Broadway's Second Stage Theatre with much the same cast. An engagement in late 2008 at Washington's Arena Stage allowed the authors to clarify what had been a more diffuse, less focused musical.

That newfound clarity has ratcheted up the show's effectiveness, making "Next to Normal" one of the most adventurous and satisfying musicals of the season.

Movie

2009-04-13T16:00:00.001-07:00

I saw the previews of this movie and want to see it. I know a lot of homeless are mentally ill.

Capitol Hill Briefing Scheduled for April 15th About Homelessness and Mental Illness
Approximately 123,000 People on Any Given Night Are Chronically Homeless Throughout America

Capitol Hill Briefing Scheduled for April 15th About Homelessness and Mental Illness

WASHINGTON, April 13 /PRNewswire/ -- On April 15th, there will be a Capitol Hill briefing called "Honoring The Soloist - A Congressional Briefing on Homelessness and Mental Illness." Author and award winning journalist Steve Lopez, Participant Media, Corporation for Supportive Housing, HELP USA, Lamp Community, the National Alliance on Mental Illness, the National Alliance to End Homelessness and Project H.O.M.E. have join forces to host this important briefing. The briefing is part of the social action campaign that Participant Media has created on behalf of the upcoming film The Soloist -- a national effort to raise awareness about and to help end chronic homelessness in the United States. The Soloist, a DreamWorks/Universal presentation in association with StudioCanal and Participant Media, will open in theaters April 24th.

The briefing and luncheon will take place Wednesday, April 15th from 12:30 pm - 1:30 pm (ET) at the U.S. Capitol Visitors Center in the South Congressional Meeting Room, Washington, DC.

The program will focus on the issues of mental health and homelessness and the fight to end chronic homelessness. The number of chronically homeless adults dropped by 28 percent between 2005 and 2007 largely due to the increase in permanent supportive housing. This proves that with proper resources we can end chronic homelessness. However, federal programs can and need to do more. It is not acceptable, regardless of a person's mental health, for anyone to experience homelessness and with proper support and treatment, housing stability can be achieved. The Soloist tells the story of Nathaniel Ayers, a gifted musician living with schizophrenia while homeless in Los Angeles, and his friendship with Steve Lopez, a journalist for the Los Angeles Times and author of the book on which the movie is based. Their story illustrates how essential it is for people living with mental illness or who are homeless to have strong personal relations or connections. The person living on the corner is still a person and needs friendship and people who care about them.

Speakers at the April 15th afternoon briefing include:
-- Steve Lopez, LA Times journalist and best-selling author of 'The
Soloist: A Lost Dream, an Unlikely Friendship and the Redemptive Power
of Music'
-- Steve Berg, Vice President of Policy and Programs, National Alliance to
End Homelessness, Washington, DC
-- Tom Hameline, Senior Vice President of Programs, HELP USA, New York, NY
-- Casey Horan, Executive Director, Lamp Community, Los Angeles, CA
-- Hyacinth King, formerly homeless resident and board member, Project
H.O.M.E.
-- Bob Carolla, Director of Media Relations, National Alliance on Mental
Illness, Arlington, VA
-- Deborah DeSantis, President and CEO, Corporation for Supportive
Housing, New York, NY
-- Sister Mary Scullion, Executive Director, Project H.O.M.E.,
Philadelphia, PA

Media Outlets interested in attending the briefing or requiring more information should contact Amanda Krusemark; akrusemark@naeh.org; (202) 942- 8281.

About The Soloist

The Soloist, starring Jamie Foxx and Robert Downey, Jr., directed by Joe Wright, will be released by Paramount Pictures to theaters nationwide on April 24th. A DreamWorks Pictures/Universal Pictures presentation in association with Studio Canal and Participant Media, the film is based on the true story of the relationship between Los Angeles Times columnist Steve Lopez and Nathaniel Anthony Ayers, a gifted Juilliard-trained string player whose mental illness landed him among the homeless on the streets of Los Angeles. Featuring the Los Angeles Philharmonic, The Soloist is a testament to the redemptive power of music and a reminder of our connections to the most vulnerable among us. www.soloistmovie.com, or www.TakePart.com

About Participant Media

Participant Media is a Los Angeles-based entertainment company that focuses on socially relevant, commercially viable feature films, documentaries and television, as well as publishing and digital media. Participant Media is headed by CEO Jim Berk and was founded in 2004 by philanthropist Jeff Skoll, who serves as Chairman. Ricky Strauss is President. Participant exists to tell compelling, entertaining stories that bring to the forefront real issues that shape our lives. For each of its projects, Participant creates extensive social action and advocacy programs that provide ideas and tools to transform the impact of the media experience into individual and community action. Participant's films include The Kite Runner, Charlie Wilson's War, Darfur Now, An Inconvenient Truth, Good Night and Good Luck, Syriana, Standard Operating Procedure and The Visitor. For more information, visit participantmedia.com.

Fun details about the brain

2009-04-06T15:36:00.000-07:00

The Daily Graphic on Monday, March 23, carried the headline: “Mental Health in crisis”. It gave the impression that we now have a crisis in mental health. As a matter of fact, mental health has always been in crisis in Ghana.

We have refused and even today refuse to accept the fact that mental ill health is as a normal affliction as backache or cancer. We talk freely about prostrate cancer but would not acknowledge mental ill health.

Today, many consult the doctor about mental cases but the majority still consider mental illness an affliction which requires “spiritual” intervention by the native doctor.

We should disabuse our minds of the idea that mental illness is a strange ill health. The Daily Graphic was right to highlight the observation of the Chief Psychiatrist that "at any time between 30 and 40 per cent of the population suffer from one mental health problem or another".

This means that many of our health problems are more of a matter of our mental state than we think. It is this realisation which will lead to adequate mental hospitals and more than four doctors in the public service.

The mental health hospital was known not long ago as the “Lunatic Asylum”. It was outside Accra, between the “native” quarters and the European Ridge. It gave the name to the area known as ‘Asylum Down’ and it was not a place you admitted that your relations and friends were.

We have come a long way from those days.

But the progress made is far from sufficient. We do not readily accept the fact that mental health is a normal affliction and that the mentally ill can be assisted to work just as those with duodenal ulcer can.

Many years ago, I was talking to a friend of mine who had won a difficult case in court. Another friend asked me where the brilliant lawyer had his practice since he would like to consult him. When I said that he lived at the Asylum, he could not believe it.

This brilliant occasionally mentally ill lawyer came from a distinguished family of learning. The family did not feel embarrassed that one of their kind was in the mental hospital. He practised his law as part of the necessary therapy. Today, many of us would not readily admit that we have a relation in the mental hospital.

Many of the mentally ill need not be admitted in mental hospitals. Their treatment requires long hours of interaction with doctors and great understanding and assistance from relations and friends.

The power of the mind over the physical state is enormous. Many illnesses cannot be treated without dealing with the mental state. A gynaecologist friend of mine was telling me the other day how some women who wanted babies badly developed big bellies as if they were pregnant. The mind is more creative than we are prepared to believe.

The public attitude is crucial to the treatment of the mentally ill. “Lack of enough mental healthcare doctors” is not the only impediment to the treatment of patients with mental health problems.

Public understanding is most important. We have more schizophrenics among us than we realise. This should be of public concern. Treatment or management of such people requires public recognition, acceptance of the condition, knowledge and understanding.

We should rid ourselves of prejudices and do something about the crisis in mental health. As economic conditions deteriorate, the mental health of people will come under pressure. Mentally-related illnesses will increase. Doctors and hospital facilities alone cannot deal with the problem. We need public awareness and involvement.

The stresses of life in the modern world are great. Our leaders are often under severe pressure. Are they fit to take the decisions they take? These decisions affect us. We should ensure that our leaders enjoy good mental health.

We should abandon the taboo about mental illness. Public awareness of mental health should be spread. We should understand the problems and issues so that we maintain good mental health in society at large and within the national leadership.

Our present unsatisfactory national mindset may be related to the general mental health of the nation arising from the economic, social and political stresses of life. I welcome a symposium which took place at the Press Centre on April 2, 2009, which dealt with this and other matters.

Trying to do the Right Things

2009-03-30T16:34:00.000-07:00

I remember my mother's psychiatrist, years ago, telling me that the doctors in his profession were leaving the field in droves. This article is one of the reasons why. Most doctors have a conscience and try to do the right thing with their patients, but either families or the laws get in the way of treatment that makes sense. I see that the problem still exists.

IMAGINE YOU live in a small town, and your son is found to have a brain tumor. Faced with such a devastating illness, you would not hesitate to find the means to get to a medical center, even if it were in a city more than an hour from your home. You probably would search for high-quality specialists to provide the best care possible.

But consider that your son has another serious illness affecting his brain, but one you cannot see on a scan. I am referring to serious mental illness. Rather than assuming that this child deserves to have access to the same specialized care, our culture has colluded in the belief that a primary care doctor will be an acceptable provider of care.

As a pediatrician I take care of many children diagnosed with attention deficit hyperactivity disorder. For this problem I consider myself well qualified to provide excellent care. But often, what starts out as a diagnosis of ADHD proves to be much more complex. One child (I have changed details and combined stories in order to protect the privacy of my patients) did well enough for several years, but began to display increasingly angry and aggressive behavior. I made multiple adjustments in her medications, all along expressing concern to her mother. There were many obstacles to getting an appointment with either a therapist or child psychiatrist, so I continued to treat her.

Then one day, she told me she was so angry that she feared she would hurt someone. I notified the local crisis team, making it clear that I knew this family very well, that I was worried about her, and that I wanted to be called after she had been seen. No one called. They simply referred her back to me to adjust the medication.

Now I was both worried and angry. I called the one local psychiatrist who accepts the family's insurance. He told me that until he could be sure that the patient's insurance would go through, "she's your responsibility." I explained to him (not in a nice voice) that I had reached the limits of my expertise, that this girl and I both needed his help. After more days of multiple calls, she had an appointment with both a therapist and a child psychiatrist.

Another patient who had a history of severe abuse as a young child followed a similar course. For several years he did OK on his ADHD medication. But he began to fail in school. He was extremely anxious. After a particularly explosive and frightening scene that included threats of self harm, I told his mother that I was referring him to a child psychiatrist.

After jumping through multiple hoops, I was able to find a psychiatrist who had room in his practice. Yet a month later, I got a message in my office requesting a refill of his medication. I called his mother to clarify my plan to transfer his care to a child psychiatrist. She was upset that the psychiatrist's office was an hour away and wanted to keep things the way they were. When I again explained that her son needed more help than I could offer, she yelled at me, "You're just leaving us out in the cold!"

So how have we gotten to this unfortunate situation where primary care doctors, who are clearly not qualified, are expected and encouraged to treat children with serious mental illness? I believe three main factors are at work. First, the pharmaceutical industry has been successful at promoting the idea that a pill will fix these often complex problems. Second, the insurance industry has made it very difficult for primary care doctors to refer patients for any mental health services. And third, there is a severe shortage of child psychiatrists.

Together these factors have converged to back us into a corner. If primary care doctors do not provide this care, the child will not get care, and we will be in effect abandoning our patients. This is an unacceptable situation. We must address this problem on all three fronts in order to ensure that these seriously troubled children have the same access to care as a child with a brain tumor.

Dr. Claudia Gold, a pediatrician, practices in Great Barrington.

Another Area that need fixing

2009-03-22T14:31:00.000-07:00

I have personally seen some questionable people in nursing homes who fit this description. This is another area that needs to be watched carefully.

AP IMPACT: Mentally ill a threat in nursing homes

CHICAGO (AP) — Ivory Jackson had Alzheimer's, but that wasn't what killed him. At 77, he was smashed in the face with a clock radio as he lay in his nursing home bed.

Jackson's roommate — a mentally ill man nearly 30 years younger — was arrested and charged with the killing. Police found him sitting next to the nurse's station, blood on his hands, clothes and shoes. Inside their room, the ceiling was spattered with blood.

"Why didn't they do what they needed to do to protect my dad?" wondered Jackson's stepson, Russell Smith.

Over the past several years, nursing homes have become dumping grounds for young and middle-age people with mental illness, according to Associated Press interviews and an analysis of data from all 50 states. And that has proved a prescription for violence, as Jackson's case and others across the country illustrate.

Younger, stronger residents with schizophrenia, depression or bipolar disorder are living beside frail senior citizens, and sometimes taking their rage out on them.

"Sadly, we're seeing the tragic results of the failure of federal and state governments to provide appropriate treatment and housing for those with mental illnesses and to provide a safe environment for the frail elderly," said Janet Wells, director of public policy for the National Citizens' Coalition for Nursing Home Reform.

Numbers obtained through the Freedom of Information Act and prepared exclusively for the AP by the Centers for Medicare and Medicaid Services show nearly 125,000 young and middle-aged adults with serious mental illness lived in U.S. nursing homes last year.

That was a 41 percent increase from 2002, when nursing homes housed nearly 89,000 mentally ill people ages 22 to 64. Most states saw increases, with Utah, Nevada, Missouri, Alabama and Texas showing the steepest climbs.

Younger mentally ill people now make up more than 9 percent of the nation's nearly 1.4 million nursing home residents, up from 6 percent in 2002.

Several forces are behind the trend, among them: the closing of state mental institutions and a shortage of hospital psychiatric beds. Also, nursing homes have beds to fill because today's elderly are healthier than the generation before them and are more independent and more likely to stay in their homes.

No government agency keeps count of killings or serious assaults committed by the mentally ill against the elderly in nursing homes. But a number of tragic cases have occurred:

_ In 2003, a 23-year-old woman in Connecticut was charged with starting a fire that killed 16 fellow patients at her Hartford nursing home. A court guardian said Leslie Andino suffered from multiple sclerosis, dementia and depression. She was found incompetent to stand trial and committed to a mental institution.

_ In 2006, 77-year-old Norbert Konwin died at a South Toledo, Ohio, nursing home 10 days after authorities said his 62-year-old roommate beat him with a bathroom towel bar. Sharon John Hawkins was found incompetent to stand trial.

_ In January, a 21-year-old man diagnosed with bipolar disorder with aggression was charged with raping a 69-year-old fellow patient at their nursing home in Elgin, near Chicago. A state review found that Christopher Shelton was admitted to the nursing home despite a history of violence and was left unsupervised even after he told staff he was sexually frustrated.

Jackson's roommate was 50 and had a history of aggression and "altered mental status," according to the state nursing home inspector's report. Solomon Owasanoye wandered the streets before he came to All Faith Pavilion, a Chicago nursing home, and he yelled, screamed and kicked doors after he got there.

On May 30, 2008, he allegedly picked up a clock radio, apparently while Jackson slept, and beat him into a coma. Exactly what set him off is unclear. Jackson died of his injuries less than a month later. Owasanoye pleaded not guilty to first-degree murder, and after a psychiatric review was ruled unfit to stand trial. He now lives in a state mental hospital.

All Faith Pavilion co-owner Brian Levinson said his staff is trained to deal with aggressive behavior, and he disputed state findings that Owasanoye had a history of aggression. The for-profit nursing home was fined $32,500 for failing to prevent the assault.

Under federal law, nursing homes are barred from admitting a mentally ill patient unless the state has determined that the person needs the high level of care a nursing home can provide. States are responsible for doing the screening. Also, federal law guarantees nursing home residents the right to be free from physical abuse.

Families have sued in hopes of forcing states to change their practices and pressuring nursing homes to prevent assaults. Advocates say many mentally ill people in nursing homes could live in apartments if they got help taking their medication and managing their lives.

The problem has its roots in the 1960s, when deplorable conditions, improved drug treatments and civil rights lawsuits led officials to close many state mental hospitals. As a result, some states have come to rely largely on nursing homes to care for mentally ill people of all ages.

Also, mixing the mentally ill with the elderly makes economic sense for states. As long as a nursing home's mentally ill population stays under 50 percent, the federal government will help pay for the residents' care under Medicaid. Otherwise, the home is classified a mental institution, and the government won't pay.

In Missouri, more than 4,400 younger mentally ill people are living in nursing homes, in part because of a state program that helps the elderly stay in their own homes longer.

Nursing homes "are looking at 60 to 70 percent occupancy, and the statistics tell us they've got to be in the 90s to operate successfully," said Carol Scott, the state long-term care ombudsman for 20 years. "They're going to take anybody they can."

Gaps in staff training leave the homes inept at handling the delusions and aggression of the mentally ill, said Becky Kurtz, the state long-term care ombudsman in Georgia, where nearly 3,300 younger mentally ill people live in nursing homes.

"Often they'll say, 'I hate it there. I'm angry. I don't want to be there.' Sometimes the behavioral issues are the result of being ticked off you're in a nursing home," Kurtz said.

Pat Willis of the Center for Prevention of Abuse said she has seen elderly residents terrified by younger, mentally ill residents who scream and yell, day and night. "The senior residents are afraid," Willis said. "They would prefer to sit in their rooms now and keep the doors shut."

Nursing home operators say protections against frivolous transfer or discharge keep the homes from throwing out some mentally ill residents.

"Many times, the nursing home's only option becomes dialing 911," said Lauren Shaham, a spokeswoman for the American Association of Homes and Services for the Aging.

Need Parents to Live in the Real World

2009-03-19T15:28:00.000-07:00

It is true that a lot of our young people are mentally ill and probably needed help at a much earlier age. I see a lot of parents who will not get the proper treatment for their children because they are in denial of the fact that their children could be diagnosed mentally ill. I know how hard it is to grasp and admit that your loved one can be mentally ill, but these young children need help early so that they don't "self medicate" and find them selves in prison in their early adulthood. Some of them are there because their parents stick their heads in the sand when a medical professional tells them their child has a mental illness and hope they will just "grow out of it". I have had parents tell me that, then several years later I hear that the child is now in juvie hall and doing in-appropriate things. We need to help these young people, and we need parents to do a better job.

The majority of juvenile offenders transferred to adult criminal courts have one or more psychiatric disorders--and they often go untreated, found a Northwestern study.

The Psycho-Legal Department at the Feinberg School of Medicine, which conducts a series of studies called the Northwestern Juvenile Project, also found that a disproportionate number of youths tried in adult courts were minorities.

Jason Washburn, who headed the study, said the juvenile system is flawed, and trying youth offenders as adults may cause more problems than it solves.

“It’s clear to see that the kids who are referred to adult courts and sent to prison end up doing much worse [mentally],” he said. “It doesn’t have any positive rehabilitation effect and it may actually be doing them some damage.”

Illinois law states the juvenile court has jurisdiction over all youths under the age of 16 unless they are transferred to adult criminal court.

There are five felony offenses for which children over the age of 13 are automatically tried in adult criminal court:
• First-degree murder
• Aggravated criminal sexual assault
• Aggravated battery with a firearm
• Armed robbery
• Aggravated vehicular hijacking committed with a firearm

Washburn said that perhaps the most disconcerting finding is the strong link between youths being tried in adult courts and the prevalence of mental illness. About 68 percent of these youths had at least one psychiatric disorder and 43 percent had two or more.

These rates have heightened the need for psychiatric care at juvenile facilities in order to help these youths as they get older and reduce their odds of repeating criminal behavior.

Tiffany Masson, a professor at the Chicago School of Professional Psychology, who researches juvenile detention centers, said adequate mental health treatment has been a problem for the Cook County juvenile justice system for a long time.

“They have had minimal mental health treatment for juvenile offenders,” she said. “They may be getting some individual therapy, but it’s not the evidence-based therapy that they need for recovery.”

Masson said this lack of treatment is a huge concern because it may cause more problems in the future.

“The juveniles with the risk factors for delinquency, if they go unaddressed, that can lead them on a pathway to behavioral issues as adults,” she said.

Washburn said clinicians could help lower the amount of at-risk youths sent to adult criminal court by “determining how psychological factors should be mitigated and which youths may respond best to alternative sentencing.” Then, he said, it is up to the correctional system to provide more mental health care for youths who are in prisons.

“Thus far, kids in detention centers who had serious mental problems like depression, mania and psychosis have been very unlikely to get any attention for their needs,” he said.

Though there is still plenty of room for improvement, Masson said there have been significant upgrades in mental health coverage at the Cook County Juvenile Temporary Detention Center over the past few years. She attributes much of that change to the increase in media coverage of the center.

“Because of the recent media attention, there’s been quite an effort to reform the center,” she said. “They’re starting to do discussion groups and apply more cognitive-behavioral therapy these days, after only doing screenings in the past.”

In addition to the large percentage of juveniles needing mental health care, the study also found that males, African-Americans and Hispanics are at greater odds of being tried in adult criminal courts than females and non-Hispanic whites.

“When factors like the type of crime are held consistent, African-Americans and Hispanics are still being sent to adult trials at a much higher rate,” Washburn said.

Washburn also thinks recent changes have improved juvenile rights in Illinois. Until 2008, juveniles arrested for selling drugs within 1,000 feet of a school or public housing were automatic sent to adult courts.

He said this law had lead to the disproportionate number of minorities being tried in higher courts, but now that it has changed, the situation should improve in the future.

“Before the drug law was changed, Illinois’s laws were probably pretty stringent compared to other states,” he said. “Now the laws that are in place are much more fair and aren’t too far off from other states.”

Could it Be?

2009-03-09T15:31:00.000-07:00

I have heard of this, quite bizarre, but I guess diagnosable.

Can Lyme Disease Lead to Insanity, Violent Tendencies?

Can Lyme disease lead to violence, even murder?

This question has come up twice in the past month. First in the case of Travis, the chimpanzee, which mauled a woman in Connecticut. It was reported that he was suffering from the tick-borne illness and that it was either the disease itself or the medication he was taking that caused the chimp, once a star of TV commercials, to snap.

And now, the disease is being blamed for causing the mental illness of a man accused of gunning down a pastor Sunday at a suburban Illinois church.

Police did not release the gunman's name, but the St. Louis Post-Dispatch reported late Sunday that he is 27-year-old Terry Joe Sedlacek. Sedlacek’s mother said Lyme disease attacked her son’s brain and caused the psychosis that caused him to kill the pastor and wound two others. FOX News could not immediately confirm the report.

Sedlacek was reportedly taking several medications to combat Lyme disease and seizures, which nearly killed him in 2003, the paper reported.

Although the disease has been associated with mental illness, the link between Lyme disease and violence is largely unproven, said one doctor.

“Chronic Lyme disease can be associated with seizures, depression, anxiety and even psychosis has been reported,” said Dr. Marc Siegel, an internist and FOX News Channel contributor.

“It’s possible, but the problem is, something being reported doesn’t always mean it’s the cause. For example, someone may have psychosis or seizures — but Lyme disease may not be the cause — so you have to be really careful.”

The fact is that Lyme disease is very tricky.

“Determining whether Lyme disease is the cause of a related factor is the art of medicine," Siegel said. “It’s not an automatic — it depends on the case.”

Siegel told FOXNews.com that he would actually like to see the medical records of Sedlacekto to see if psychosis is even a possibility.

“It would depend on if the person has chronic Lyme disease,” he said. “You would have to look at medical records to see when he was treated and diagnosed and to see if this is even a possibility. The key question here is whether this guy ever received proper treatment early on.”

According to the Centers for Disease Control and Prevention, Lyme disease is caused by the bacterium, Borrelia burgdorferi, which normally lives in mice, squirrels, deer and other small animals. It is transmitted among these animals — and to humans — through the bites of certain species of ticks.

Connecticut, New Jersey, Pennsylvania and upstate New York all have high rates of Lyme disease. The culprit in the Northeast is the deer tick. In the Pacific coast, the disease is spread by the western-black legged tick.

Signs and Symptoms:

— A very pronounced round, red rash that spreads at the site of the bite

— Flu-like symptoms

— Fatigue

— Headaches

— Sore muscles and joints

— Fever

Treatment:

If you have early-stage Lyme disease, oral antibiotics such as doxycycline, amoxicillin, or cefuroxime axetil are most often prescribed. According to the National Institutes of Health, studies have shown that most patients can be cured within a few weeks of taking these drugs.

But if it goes untreated, Lyme disease can lead to serious health problems.

According to the Mayo Clinic, those problems include:

— Chronic joint inflammation (Lyme arthritis), particularly of the knee

— Neurological symptoms, such as facial palsy and neuropathy

— Cognitive defects, such as impaired memory

— Heart rhythm irregularities

— Memory loss

— Difficulty concentrating

— Changes in mood or sleep habits

Click here to find out how you can avoid getting bitten by a tick.

The Associated Press contributed to this report.

* See Next Story in Health

Just Common Sense

2009-03-03T19:29:00.000-08:00

This is a nice article to read even though the information is not necessarily new. I was told a lot of years ago that my mother's bipolar illness was definitely an inherited trait. My great-grandmother died in an "insane asylum" in Louisiana. But neither myself nor my two brothers were ever diagnosed as bipolar. I am glad to hear that some children and young adults are getting help early for their mental illnesses.

Pitt Study Finds Children Of Bipolar Parents Have Increased Risk Of Psychiatric Disorders

An estimated one in 100 children and teens worldwide has bipolar disorder. Identifying the condition early may improve long-term outcomes, potentially preventing high psychosocial and medical costs. Researchers from the Pittsburgh Bipolar Offspring Study suggest that having family members with bipolar disorder is the best predictor of whether their children will go on to develop the condition.

"A bipolar diagnosis at a young age deprives children of the opportunity to experience normal emotional, cognitive and social development, and this is why there is an urgent need to identify, diagnose and treat these patients early on," said Boris Birmaher, M.D., director of the Child and Adolescent Anxiety Program and co-director of the Child and Adolescent Bipolar Services at Western Psychiatric Institute and Clinic of UPMC, endowed chair in Early Onset Bipolar Disease and professor of psychiatry at the University of Pittsburgh School of Medicine.

Compared with the offspring of control parents, children with bipolar parents had a 14-fold increased risk of having a bipolar spectrum disorder, as well as a two-to three-fold increase of having a mood or anxiety disorder. Children in families where both parents had bipolar disorders also were more likely to develop the condition than those in families containing one parent with bipolar disorder. However, their risk for other psychiatric disorders was the same as children who had one bipolar parent.

Bipolar disorder, commonly called manic-depression, often emerges in adolescence, and is characterized by intense swings between depression, mania and periods with mixed symptoms. Bipolar spectrum disorders consist of three sub-types. Bipolar I (BP-I) is characterized by episodes of full-blown mania and major depression; bipolar II (BP-II) involves episodes of less severe mania, called hypomania, and major depression; and the third sub-type is called Bipolar Not Otherwise Specified (BP-NOS), which involves symptoms consistent with elated or irritable moods that are disruptive to daily living, plus two to three other symptoms of bipolar disorder.

In this blind study, researchers compared 388 children and teens, ages 6 to 18, of 233 parents with BP-I and BP-II to 251 offspring of 143 demographically matched control parents. Parents were assessed for psychiatric disorders, family mental health history, family environment, exposure to negative life events, and also were interviewed about their children. Children were assessed directly for bipolar disorder and other psychiatric disorders by researchers who did not know their parents' diagnoses.

"Consistent with prior research, most parents with bipolar disorder recalled that their illness started before age 20 and about 20 percent had illness that started before age 13," said Dr. Birmaher. "In contrast, most of their children developed their first bipolar disorder episode before age 12, suggesting the possibility that parents were more perceptive of their children's symptoms early in life or perhaps that bipolar disorder appears earlier in new generations."

The researchers note that these findings have important clinical implications. "Clinicians who treat adults with bipolar disorder should question them about their children's psychopathology to offer prompt identification and early interventions for any psychiatric problems that may be affecting the children's functioning, particularly early-onset bipolar disorder," said Dr. Birmaher. "Further studies are needed to help determine the clinical, biological and genetic risk factors that may be modified to prevent the development of psychiatric disorders in the children of those with bipolar disorder."

Good change

2009-02-22T13:12:00.000-08:00

Year after year I can remember my father reminding my mother's doctors that they had only 60 days to get my mother's mind back in the real world and taking her medicine correctly. He would say this because after 60 days the wonderful private psy-ward care was going to all be paid for by his cold, hard cash. The insurance and medicare would only cover for that long no matter what condition the patient was in, so this new legislation is great news for the mentally ill.

Insurance coverage for mental illness is catching up in Texas

Twenty-five years ago, Bob pressed a .45-caliber pistol against his head, straining against the desire to die.

"I felt the cold metal on my temple," he said. "It took every single [bit of] strength I had in my body not to pull the trigger to blow my brains out."

This January, a lifelong struggle with depression resurfaced dramatically. Stressed out and overworked, Bob, who is in his 50s, wanted to hurt himself again. He imagined hanging himself at the front counter at work or by the boss’s office. Bob rediscovered hope at Millwood Hospital in Arlington, receiving outpatient treatment five days a week for a month.

Then, still hurting, he was told his insurance was going to run out Friday.

"Here you’re somewhere where something is helping and you need more of it, and you don’t have enough," said Bob, who works in Tarrant County.

Unlike treatment for cancer or heart disease, some insurance companies cap treatment for mental disorders such as depression, which can be just as deadly. Treatments for other general-health conditions are often unlimited, several experts said.

But that’s changing in Texas.

Since October, insurance companies in Texas have been required to provide as many outpatient visits for mental-health services as they do for physical illnesses, according to the Texas Department of Insurance. Insurers have until June to show that policies and "evidences of coverage," such as forms, are compliant.

The parity ruling applies to companies with at least 51 employees. Small businesses are affected only if they elect to provide mental-health benefits to their employees, Insurance Department officials said.

One state lawmaker wants to go further and has filed a bill to raise the lifetime limits on mental-health services.

And next year, the federal Mental Health Parity and Addiction Equity Act of 2008 will take effect, establishing equal treatment for both mental-illness and substance-abuse conditions.

"It ends the discrimination between treating general health and mental health," said Julio Abreu, senior director of government affairs for Mental Health America. "It says that mental health is fundamental to one’s overall health. It does so by ending arbitrary limits that had not been based on medical treatment."

But some in the insurance industry say Texans will end up paying higher premiums as a result.

"A lot of employers are struggling to pay the premiums that they have right now," said Will Haff, media chairman for the Texas Association of Health Underwriters. "So you’re talking about increases. . . . That’s not something a lot of them are going to swallow."

The Congressional Budget Office estimated that parity of medical coverage would increase health insurance premiums by an average of 0.4 percent.

Because of absenteeism and other problems, the cost to employers of untreated and mistreated mental illness has been estimated at $113 billion annually, according to Mental Health America.

Costly treatments

Administrators at two local psychiatric hospitals, Millwood in Arlington and Texas Health Springwood hospital in Bedford, said co-payments and deductibles often take patients by surprise.

And even though Texas law had required that patients be provided 60 outpatient mental-health visits a year, some people ran out of benefits and had to pay out of pocket to continue treatment.

"It’s not too frequent, but it does happen," said Ramona Osburn, director of Springwood hospital and Springwood outpatient centers in the Metroplex.

In such cases, patients are informed of the full cost they have to pay.

"We also have an extensive list of resources that we can give the patient," Osburn said. "We help them get into a different program if that’s what they want to do."

Jane Phillips, director of outpatient services at Millwood, also said she’s seen people run out of benefits.

"That certainly does happen where they have just a few visits for the year," she said. "What we’ve seen more and more is that people have really high co-pays or very high deductibles."

Bob, who feared being stigmatized if his full name was used, said he had to pay more than $1,000, including a $500 deductible, just to begin treatment for the first two weeks.

Then his co-pays were about $50 a day, he said. He had to put much of it on his credit card. When he learned he was out of insurance benefits, he realized that "I would be stuck because I have no way to pay for it."

State law requires that co-payments be the same for the treatment of any illness, mental or physical.

As for parity of outpatient visits, Texas law was unclear until last year. It once stated that large companies had to provide at least 60 outpatient visits for serious mental illness.

But the law was recodified in 2003 to require the same coverage for mental and physical illnesses.

Even though the law was on the books, it wasn’t enforced by the Insurance Department, said Doug Danzeiser, a deputy commissioner.

"We were treating it under the prior language," he said.

The Texas attorney general clarified in October that group health plans must "provide the same number of visits for serious mental health" as for physical health.

Rep. Valinda Bolton, D-Austin, said the attorney general’s opinion doesn’t address lifetime benefits. She wants her bill to accomplish that.

"That’s probably the biggest issue," she said. "It doesn’t say, well you know you can have a $2 million [cap] on physical health and a $50,000 cap on mental health. The ruling, to my understanding, does not address that issue."

'An illness like any other’

Bob caught a lucky break. He was given an extension on his insurance benefits so he could continue visits at Millwood for five more days.

Though he said that probably isn’t enough time, he was grateful. His employer said he may have been limited to 30 office visits if he was not diagnosed with a serious mental illness.

"The depression stuff, it gets so bad you don’t want to talk to anybody," he said. "I’m like a bear that gets into my cave. All I want to do is hibernate, sleep."

And he feels guilty about missing so much work because he likes to help others.

"Lately I haven’t been able to help anybody," he said. "I needed to help myself."

Robin Peyson, executive director of the National Alliance on Mental Illness of Texas, said state and national laws have reflected for too long the persisting stigma about mental illness.

"Its roots go back to 200 years to where people thought mental illness was a moral issue or a character issue," she said. "Science and research clearly indicates that it’s a brain disorder. Mental illness is an illness like any other."

What’s covered The Texas attorney general has ruled that serious mental illnesses must be covered with as many outpatient visits as physical illnesses. Serious mental illnesses are defined as:

Bipolar disorders (hypomanic, manic, depressive and mixed)

Depression in childhood and adolescence

Major depressive disorders (single episode or recurrent)

Obsessive-compulsive disorders

Paranoid and other psychotic disorders

Schizoaffective disorders (bipolar or depressive)

Schizophrenia

Don't Forget the Families

2009-02-18T16:43:00.000-08:00

This is what my book is all about. Don't forget the families. Let's talk about the children and spouses of the mentally ill. The diagnosed mentally ill patient gets a lot of attention and rightfully so; but having said that, let's take time to take care of the care givers. In my opinion, without the caregivers some mentally ill persons will be on the street. My teachers aide just today told me her sister-in-law is mentally ill and currently living on the street. She said they are just waiting her out for the time that she will be either arrested or taken against her will to a psy-ward and get the medical care she desperately needs. This is the repeated story of many families around this country, sadly. Don't forget the caregivers need help and compassion as well. They are also the victims of any mental illness.

Mental illness hard on families
They often juggle desire to help loved one, fears for their own safety.

Tuesday, February 17, 2009

A thick sheaf of hospital discharge forms and medical records paint a grim picture of a Norcross woman tormented by demons that neither she nor her family were strong enough to exorcise.

Hospital records show that Na Yong Pak, 32, who is accused of setting her mother on fire and killing her, had been involuntarily committed to inpatient psychiatric treatment twice within the past six months. She had also been arrested twice since September for allegedly beating up her mother, 58-year-old Myong Hui Pak.

The tragedy of Hui Pak’s slaying last Tuesday has turned a spotlight on the anguish of thousands of families who are grappling with mental illness. Many feel they have nowhere to turn.

Family members said Yong Pak, who was diagnosed with schizophrenia and depression, set her mother on fire last Tuesday because she thought she was being poisoned. She refused to take the anti-psychotic medication that doctors prescribed when she was released from a state mental health facility Jan. 29, according to her father, Gold Pak.

“She beat her mother all the time,” Gold Pak said Wednesday. “[My wife] was scared of her.”

Experts say that the problems the Pak family faced are not uncommon.

“I’ve talked to parents who have a hard time sleeping because they’re afraid of their loved one in the house,” said Lisa Roberts, president of the National Alliance on Mental Illness chapter in Cobb County. “It’s sad for the person who is ill and the family members who are suffering. They both suffer.”

Families don’t want loved ones jailed or thrown out on the street, even when they are uncooperative or violent, said Sgt. Tracy Lee of the Gwinnett County Sheriff’s Department. Lee is a member of the county Domestic Violence Task Force. Reluctance to see a loved one imprisoned prevents some people from seeking a protective order, because a violation of the order gets the offender jailed, he said.

Getting medical help for mental illness also can be a Catch-22. Gold Pak and his adult son sought permission from a Gwinnett probate judge to have Yong Pak involuntarily committed to a psychiatric hospital in September. She went to Charter Peachford Hospital in Dunwoody for about a week and a half before being released, they said. Yong Pak also was taken to Georgia Regional Hospital in Decatur for a second round of inpatient treatment in December, after Norcross police arrested her on suspicion of battery against her mother. The family said Georgia Regional released her Jan. 29 following a seven-week stay.

Few families can afford long-term inpatient treatment at a private mental health facility. State mental hospitals in many instances are just a stopgap, where the patient is stabilized and then released, said Eric Spencer, executive director of the National Alliance on Mental Illness (NAMI) in Georgia.

Spencer said local NAMI chapters in many Georgia counties can provide resources for families of people suffering from mental illness, but the state also needs to fund more treatment options. Georgia is ranked 45th out of the 50 states on per capita spending on mental health care, Spencer said.

Plenty of people do manage to live normal lives despite having a mental disorder. Ric Hershman, 50, of Lawrenceville is one of them. Hershman was hospitalized a dozen times after he began to suffer from schizo affective disorder at about age 18. At one time, he had paranoid delusions that the world was coming to an end, but now he manages his symptoms effectively with medication and therapy. Hershman now works training volunteers for NAMI.

“People with a mental illness can live productive, constructive lives,” Hershman said. “They’re on a constant road to recovery, but that doesn’t mean that they’re not functional and caring people.”

The important thing is that safety comes first.

“What we usually tell the parents is that you have to protect yourself, first and foremost,” said Spencer. “If you can’t take care of yourself, then you can’t be there to help and protect your loved one.”

Early Death Verification

2009-02-03T15:34:00.000-08:00

The psychiatrist who last treated my mother before she died told me that her anti-psychiotic drug she had taken for over 40 years were a direct cause of her early death at the age of 73. She, like I have stated before, lost her ability to walk, control her body functions, and was impaired on her right side due to stroke-like episodes. Her brain had severe atrophy also. So, in my opinion, it is still sad the choices that bipolar persons must make, take very powerful drugs to be able to live in the "real" world or not, that is the question.

Link Between Bipolar Disorder And Risk Of Early Death From Natural Causes

Bipolar disorder appears to increase the risk of early death from medical illnesses, according to a literature review study published as the lead article this week in the journal Psychiatric Services.

The researchers comprehensively reviewed 17 studies involving more than 331,000 patients. Evidence suggested that people with bipolar disorder have a higher mortality from natural causes compared to people in the general population of similar age and gender but without mental illness. The various studies indicated that the risk was from 35 percent to 200 percent higher. The risk is the same for men and women. The most common conditions leading to premature death were heart disease, respiratory diseases, stroke, and endocrine problems such as diabetes.

"The review of data gathered from large population studies suggests that having bipolar disorder is similar to being a smoker in terms of increasing a person's risk of early death," said Dr. Wayne Katon, a University of Washington (UW) professor of psychiatry. He co-authored the study with third-year UW psychiatry resident Babak Roshanaei-Moghaddam. The article is titled, "Premature Mortality from General Medical Illnesses Among Persons with Bipolar Disorder: A Review." Katon is a noted researcher on the interplay between life-shortening medical conditions and mood disorders.

People with bipolar disorder tend to have manic phases and depressed phases in their lives. During mania, they might be too wound up to sleep, their thoughts might race, and they might have boundless energy. During depression, they might feel painfully sad, hopeless, and immobilized.

In the past, the higher premature death rate among people with bipolar disorder was attributed to a higher rate of suicide and accidents. More recently, Katon said, researchers are finding that, while rates of suicides and accidents are indeed greater among those with bipolar disorder compared to the general population, they only partly account for the higher premature death rate. Emerging evidence, Katon said, shows that the majority of early deaths among people with bipolar disorder come from medical conditions.

As psychiatric conditions such as bipolar disorder become more treatable, Katon said, "We're saving people from this illness and losing them to other medical illnesses."

The possible reasons for this higher risk of premature death are manifold. Many factors could be contributing to poor physical health among people with bipolar disorder, according to the published report. These include unhealthy diet, binge eating, lack of exercise, smoking, substance abuse, social deprivation, living alone, homelessness, lack of access to health services, biased attitudes of health professionals towards people with psychiatric illnesses, failure among psychiatrists to address their patient's medical problems, or delaying medical care because of the overriding need for psychiatric treatment.

Biological abnormalities associated with bipolar illness might also be shortening lives, Katon noted. The illness can stress the immune system and the hypothalamic-pituitary axis, a system that controls many body processes. Bipolar disorders also heighten the activity of the sympathetic nervous system, which sets off the fight-or-flight response to stress.

Katon also noted that some new antipsychotic medications used to successfully treat bipolar disorders are safer and more comfortable for the patient in some ways than previous medications, but can cause weight gain leading to obesity and other metabolic changes that predispose people to Type 2 diabetes. Some mood stabilizers, Katon added, also are associated with weight gain and metabolic disorders.

Katon mentioned new attempts to try to reduce premature death in people with bipolar disorder. These include providing psychiatrists and other mental health professionals with guidelines and training in monitoring their patients' basic physical health and teaching them how to advise their patients about smoking cessation, exercise and other preventive measures.

"Changes are also occurring in medical schools to teach new physicians in all specialties how to recognize psychiatric illnesses and to understand the serious health risks associated with mental illness," Katon said.

Increasingly, community mental health centers are adding primary-care physicians and nurse practitioners to the staff to see patients for medical conditions, he said. Medical specialty centers are also adding mental health professionals to diagnose and treat the depression, anxiety and other psychic distress that often accompany serious illnesses.

"Psychiatrists are now on the staff of a growing number of medical specialty clinics, such as centers for diabetes, heart disease and cancer, and at primary-care centers, such as family medicine practices," Katon said. "Mental health professionals are working side-by-side with providers who treat medical illnesses. New approaches to health care and wellness programs are being tested at a number of places to find effective models for preventing premature deaths associated with bipolar disorder and other mental illnesses."

----------------------------
Article adapted by Medical News Today from original press release.

Likable Ideas

2009-01-29T15:33:00.000-08:00

These items came from a different bipolar post. It is written, as you can see, from the view point of the bipolar disorder person. Like I state in my book, the family does probably share some of these ideas; but my opinion, as a person who is not bipolar, is the hardest thing about living with bipolar is the extreme patience required to live with someone who cannot think rationally most of the time. Then throw in the severe mood swings and high anger issues, and you will see that it takes a mixture of un-conditional love and super-natural patience to be able to daily keep a positive, loving attitude toward this "bipolar disorder". To be honest, since my bipolar loved one was my mother, I did not feel that I was ever given a choice of whether to love her, hate her, or continue to stay and help her. I, of course, stayed with her in my formative years, but after I left home and had the "choice" of really staying to help my blind dad with her care, did realize that I could never turn my back on her. I did love her deeply, not necessarily un-conditionally. But what I am saying is I know some people who have been married to a person who was bipolar and they chose to leave and get a divorce. I know a lot of bipolar married persons get divorces because the non-bipolar one chooses to not stay. If I were being honest, and knowing what I know about the disorder, I would have a hard time staying married to someone who has a severe illness. I hope you don't judge me too hard on that, I did say I was being totally honest. I know the bipolar disorder people are great, I work with students who are and I love them all and have total sympathy for and with them, but at the end of the day, I go to my home and they go to theirs. I do think these listed items will useful to someone who needs them though.

The Top 10 Ways to Support Your Mate. Keep in mind this is written from the point of view of the bipolar disorder “sufferer”. In the near future, we’ll revisit this topic from my wife’s point of view.
1. Give us confidence. If you can make your partner or loved one feel good about him or herself, life will be SO much easier for both of you.
2. Take an active role in our treatment. Help with med administration. Don’t count on us to be faithful to our medication, we all slip from time to time. If we are under the care of a psychiatrist or counselor, maybe a yearly session where you join us would be helpful. At a minimum, if you have questions or concerns write them down so we can take them with us to our appointments.
3. Recognize there are things we just can’t bring ourselves to do, and try to work with us on this. For example, my wife pays the bills, as my stress level goes through the roof, and I blow up at the family if I try to do it. Of course, it’s worse when I then give her a hard time for not “doing it right”. When this happens, try to be understanding.
4. Remember that we have certain strengths and super-hero abilities at times. Take advantage of this. For example, if we go hypomanic and suddenly desire intimacy for hours on end, or multiple times per day, help us out. Keep in mind our meds sometimes take this desire away for months on end, so when it does come around use this to your advantage. You might even go so far as to say “Paint the house and I’ll fulfill that little fantasy you’ve been hinting at for years…” The house will be painted in a matter of hours.
5. When we get in a really bad frame of mind, and we all do, be there for us. Don’t be afraid, don’t put up a defense against us, don’t brace yourself for something bad. Be there to talk and support. It may not be pleasant, personally I can be downright mean when in a bad frame of mind. But you’ll both be glad you were there.
6. We know when we’ve made fools of ourselves, or done something bold, brash, or stupid. We’ll be embarrassed to face you, or others affected. Don’t hang us out to dry. Step up and support us, not in a condescending way, but as you would with any loved one. Don’t say “that’s the bipolar disorder talking” or something like that. We may say that, but please let that be our decision. Accept us, don’t dwell on it, give us a hug to show you understand, and move on. We’ll be eternally grateful.
7. Embrace our diagnosis, it’s not going to change, and may not improve. Meds can control it, but we won’t be “cured”. Realize that it’s not always a bad thing, we’re still the same people we’ve always been. To look at the bright side, we now even have an official title.
8. Remember that even though we’re diagnosed, and likely medicated, things aren’t necessarily going to be easy. In fact, when the bad times come around, we now know what’s happening, and we understand why. Rather than use our old (and maybe dangerous) coping techniques, we may try harder to rein in our feelings and behaviors. This can make these episodes even more dangerous and volatile than before.
9. Help us to recognize those coping mechanisms that may not be good for us. We may not realize we are doing something, and the gentle input from a loved one may be extremely valuable.
10. Watch for triggers, and watch our behavior for clues of an upcoming change of mood or frame of mind. You are in the best position to recognize this, and to help us see and understand this.

No medical test?

2009-01-27T15:35:00.000-08:00

On the video portion of this blog you will find several medical professionals stating that there are no current chemical or medical tests that prove what specific mental illnesses are. That is, no x-ray or blood test is going to tell us whether someone is bipolar or manic-depressive. We are all diagnosed by our symptoms that fit into a mold or category, then the trained medical staff makes an educated guess based on experience. That is pretty crazy by itself when you really think about it. All other illnesses are diagnosed by x-ray or blood tests, for example, if you have strep throat, they take a culture of your throat, send it to the lab and you get a positive or negative result. Mental illness is not a tangible diagnosis. This article talks about a study that has proven that the "grey"matter, your brain, could have early atophy if you have a mental illness. Atrophy means you have less brain in your cranium than the average person. I will say that when my mother was near death, her MRI scans were read as having severe atrophy and she was only 70-73 years old. She never had an MRI when she was early diagnosed at the age of 26. Who knows, maybe she always had early atrophy, not as much brain tissue, and maybe they might have something tangible to make an accurate diagnosis of mental illness now.

Lack Of Grey Matter In Brain Is Linked To Schizophrenia And Bipolar Disorder
Main Category: Bipolar
Also Included In: Schizophrenia; Neurology / Neuroscience
Article Date: 16 Jan 2009 - 1:00 PST

A research study led by scientists from the Gregorio Marañón University Hospital in Madrid and the Network of Centres for Biomedical Research in Mental Health Networks (CIBERSAM) shows that adolescents experiencing a first outbreak of psychosis have lower levels of grey matter in their brains than healthy teenagers. Strangely, this change was seen in patients suffering from various psychoses, including bipolar disorder and schizophrenia.

The aim of the study was to examine and locate differences in the volume of grey matter in the brains of healthy people (controls) and individuals diagnosed with psychotic outbreaks in infancy or adolescence. The researchers broke such psychosis down into three sub-groups schizophrenia, bipolar disorder and other psychoses that did not fit into either of the other two classifications.

The study, published recently in the Journal of the American Academy of Child and Adolescent Psychiatry, analysed a sample of 121 people aged between 7 and 18, inclusive. All the patients and controls were examined using magnetic resonance imaging in order to detect any possible changes in the structure of their brains.

"The interesting thing was that we found common alterations among those with two types of clinically-differentiated psychoses, schizophrenia and bipolar disorder, and this could help to improve diagnosis of these illnesses," Santiago Reig, one of the study's authors and a researcher in the Medical Imaging Laboratory of the Gregorio Marañón Hospital, tells SINC.

The study confirmed these lower levels of grey matter, the brain substance in which neurone cells are concentrated. This lack, which was shared between the schizophrenia and type 1 bipolar diaorder sufferers, means the functions of this part of the brain are "somehow atrophied".

In addition, the technique used by the experts can pinpoint the location of these alterations. For example, "patients with early psychotic outbreaks (before the age of 18) showed alterations in the medial prefrontal gyrus region of the brain, which controls processes such as cognition and the regulation of sensations", says Reig.

Improving diagnosis

"Anything that helps to detect alterations shared between distinct pathologies can help in the development of drugs and in finding common characteristics between these different diseases," the researcher tells SINC. "Results like these are fundamental for the diagnosis and treatment of illnesses," he adds.

However, it is important not to draw any causal link between alterations in this area of the brain and the appearance of these pathologies. Psychiatric disorders need more complex diagnosis. What the research does show, however, is that the majority of people with schizophrenia and type 1 bipolar disorder do suffer from this lack of grey matter and the majority of healthy people have normal levels of this substance.

"We still do not know whether this loss of grey matter is caused by the disorder or not," says Reig. This is just one more piece of the puzzle to help in understanding common features of psychiatric disorders. "Maybe relating these developments with other new findings will one day help us to solve the riddle of psychiatric disorders," he concludes.

Heard this before but good to revisit

2009-01-25T16:39:00.000-08:00

My mother's doctor shared this information with me a lot of years ago. It is good to revisit these informative data again though.

Schizophrenia And Bipolar Disorder Share A Genetic Cause

Article Date: 16 Jan 2009 - 0:00 PST

A new study from Sweden found evidence that schizophrenia and bipolar disorder partly share a common genetic cause; if one disorder runs in the family there is a good chance that the other will too. The researchers said their finding challenges the view that these disorders are separate entities, and call for a change in the way they are currently diagnosed.

The study was the work of lead author Paul Lichtenstein, a genetic epidemiologist at the Karolinska Institutet in Stockholm, Sweden, and other colleagues from Sweden and the US, and is published in the 17 January issue of The Lancet.

For the study, Lichtenstein and colleagues examined records of all patients discharged from psychiatric hospitals in Sweden from 1973 to 2004 and found 35,985 cases of schizophrenia (0.40 percent of the population) and 40,487 cases of bipolar disorder (0.45 percent of the population). They then looked in the Swedish multi-generation register, which contains information about all children and their parents in the country, and identified over 9 million individuals living in more than 2 million nuclear families between 1973 and 2004.

By comparing the patient discharge data for schizophrenia and bipolar disorder with the register, the researchers were able to identify parents, children, brothers and sisters who shared the disorders. Using a sophisticated statistical tool they then assessed risks for the two disorders, separately and together, for biological and adoptive parents, their children, full and half siblings, of patients with either of the two disorders. The tool they used was a multivariate generalised linear mixed model, and they assessed both genetic and environmental contributions to risks.

The results showed that:

* First degree relatives of patients whose discharge record showed they had either schizophrenia or bipolar disorder were at higher risk of having these disorders.

* Having a mother or father with schizophrenia raised the risk of a person having the disorder by 9.9 times, compared with someone who did not.

* Having a mother or father with schizophrenia raised the risk of a person having bipolar disorder by 5.2 times, compared with someone whose mother or father did not have schizophrenia.

* Having a mother or father with bipolar disorder raised the risk of a person having it 6.4 times, and the risk of having schizophrenia, 2.4 times, compared with a person whose mother or father did not have bipolar disorder.

* Having a brother or sister with one of the disorders significantly increased their risk of having them too, with half siblings having a lower risk than full siblings.

* Overall, relatives of patients with bipolar disorder showed increased risk for schizophrenia, including adopted children whose biological parents had the disorder.

* Heritability for schizophrenia and bipolar disorder was 64 and 59 per cent respectively.

* For both together, the figure was 63 per cent, mostly due to additive genetic effects common to both disorders, wrote the authors.

* Shared environmental effects were small but subtantial, they added.

Lichtenstein and colleagues concluded that:

"Similar to molecular genetic studies, we showed evidence that schizophrenia and bipolar disorder partly share a common genetic cause."

"These results challenge the current nosological dichotomy between schizophrenia and bipolar disorder, and are consistent with a reappraisal of these disorders as distinct diagnostic entities," they added.

In a separate press statement reported by Scientific American, Lichtenstein said he and his colleages suggest there are hundreds if not thousands of genes involved in the development of these two disorders, and many of them overlap. However, many of them have not yet been discovered.

Lichtenstein said there were many large scale studies happening around the world searching for the genes behind these disorders, and he is also researching in this area. He said scientists should look not only for overlap between these two disorders but with other psychiatric conditions too, like depression for instance.

Not In cooperation (compliance) with medical advice

2009-01-21T16:28:00.000-08:00

It really comes as no surprise that people who are living on the street or some in-mates are there because they are not taking their prescribed meds. This is the same story over and over, not new news to the family and friends of the mentally ill.

Two thirds of prisoners nationwide with a mental illness were off treatment at the time of their arrest, according to a new study by Harvard researchers that suggests under-treatment of mental illness contributes to crime and incarceration.

The study, published today online in the American Journal of Public Health, found that about a quarter of inmates nationwide had a history of chronic mental illnesses like schizophrenia, bipolar illness and depression. Researchers analyzed data collected in 2002 and 2004 from local, state and federal correctional facilities.

While only one in three were taking medications for their illness at the time of their arrest, that number jumped to nearly two-thirds during incarceration, the researchers found

"For many of them, treatment of their mental illness before their arrest might have prevented criminality and the staggering human and financial costs of incarceration," said study author Dr. Steffie Woolhandler, an associate professor of medicine at Harvard and a primary care physician at the Cambridge Health Alliance's Cambridge Hospital campus.

Woolhandler said the findings portend significant problems for Massachusetts, where the Department of Mental Health last week laid off about 100 case managers -- nearly one quarter of the staffers who supervise people with severe mental illness and make sure they get the services they need.

State officials said about 3,000 clients would lose their current case managers. The layoffs were in response to the state's economic crisis.

"You are going to pay a much higher cost in the future prosecuting these people and putting them in jail, where they have a right to treatment," Woolhandler said. "I don�t know how good a treatment it is, but the taxpayers end up paying."

The Beginning

2009-01-09T16:51:00.000-08:00

Another opinion I just formulated is this. My mother was bi-polar as was her grand-mother and I am sure this form of mental illness in my family was and is a chemical imbalance and a genetic defect. This mental illness was passed down, not created. My son in medical school just completed his clinical rotations in psy. and he said that with a mother being bi-polar, my brothers and I had a 40% chance of also being bi-polar, although we are not. But the real story is about one of my special 3rd grade students, a very sad story. Physically and sexually abused by his parents, he, his 7th grade brother and 3 years old sister became wards of the state. The sister was adopted, but the two brothers have been in and out of foster and group homes. This one 3rd grade student, 10 years old, in my opinion is manifesting mental illness. Who knows whether it is a inherited thing or the trauma of his young life. He has been on various drugs, in a foster home with a single foster mom. His meds. were changed, he hit his brothers new bicycle with a baseball bat, the brother in return hit him on the head with a rock causing a huge gash that needed staples to be fixed. The foster mom says she can't care for the brothers, so they were separated, one went to juvie for striking his brother; the 3rd grader is on his way to a psy. ward, then back into a different group or foster home, separated from his brother.So after these young men probably go through this scenario over and over again, they will be dumped out on the street at age 18 and told "Good luck". I can't imagine not having any family at all to care for me or who is concerned about my welfare at the tender age of 10 years old. No one in the whole world who "really " loves you. So let your imagination go 8 or 9 nine years into the future and see what kind of young men these guys will be when they are having to make their own way in the world. I am convinced that the 10 year old one was probably delusional today when he told me he had gotten a puppy for Christmas, that he was being adopted and all was well with him. When actually he spent Christmas in a respite home with people he never met before because he got into a fight with his brother, so all the things he told me, I am sure were things he "Wished" were happening and not the reality of his very sad life. So this is probably the birth of his very mentally ill road, starting with the adults who were supposed to love and care for him, his very parents who took a young blank slate of a child and sexually and physically abused their gift from God. No telling how his story will end. 'Nuff said. Liz.

Probably a good book

2009-01-07T16:21:00.000-08:00

I have not read this book, but I bet I could write the story, just like I wrote the book and story about my mother. The stories of the mentally are all the same, in-patient, out-patient, going from one doctor to a different one, in and out of either prison or mental institutes, family helps or does not help, tremendous ups and downs, etc. They all hear voices and are usually directly chosen by God to do something that only they can accomplish. I don't mean to sound bitter, but after you hear those stories for 48 years, you really don't want to hear them all over again, just being honest.

Understanding Mental Illness -- Author and Nurse Recalls Twenty Years of Her Life in a Psych Ward

FENTON, Mo., Jan. 7, 2009 (GLOBE NEWSWIRE) -- Do you know someone who's mentally ill -- or has been in a mental institution? These patients seem very difficult to take care of; that's why their families sent them to mental hospitals. But have you realized the burden hospital attendants are carrying, just to provide for the medical needs of these people? Get a glimpse of Donna Snyder's life as she battles the insanity-causing pressures and complexities during her twenty-year stay in a mental institution with Define Crazy.

Every day came with a new surprise for Donna Snyder when she started working as a member of the nursing staff in VA Medical Center. Through her book, Snyder recounts her experiences from day one until the end of her stay in a psych ward, recalling her patients' idiosyncrasies. She shares her encounters with the psychiatrically ill, and narrates how she was able to adjust to a peculiarly new environment. She revisits the years when she uncomplainingly dealt with those who screamed endlessly in the middle of the night, those who created trouble in the ward, and felt empathy for those who met heartbreaking tragedies at a very young age. Being in a mental institution for twenty long years taught Snyder to understand the reality of mental illness -- a reality we must all accept. As she transferred to another psychiatric institution, Snyder carried with her the lessons she got from her experiences and from the people she worked for.

Define Crazy is an enlightening book which exposes the actual setting of psychiatric institutions, and how the government deals with citizens who need help. It asserts that mental illness is not a condition one must be ashamed of; rather, it is a situation that needs proper attention to avoid unwanted incidents. For more information, log on to www.Xlibris.com.

About the Author

Donna Snyder received her nursing license in 1976 and has practiced nursing since. She completed her BSN degree from Webster University in 1998. She has worked in psychiatric hospitals since 1978. She has worked as Supervisor RNIV at the St. Louis Psychiatric Rehabilitation Center, and is currently working in an Acute Psychiatric Unit as a Health Care Professional and Registered Nurse. Additionally, she is President of the Missouri State Nurses Investment Club. Donna lives in St. Louis with her husband, son, and two dogs.

Define Crazy * by Donna Snyder, RN, BSN
A Nurse's 20 Years On A Locked Psych Ward
Publication Date: January 2, 2009
Trade Paperback; $19.99; 138 pages; 978-1-4363-5642-8
Cloth Hardback; $29.99; 138 pages; 978-1-4363-5643-5

To purchase copies of the book for resale, please fax Xlibris at (610) 915-0294 or call (888) 795-4274 x. 7876 or on the web at www.Xlibris.com.

Good book

2009-01-05T17:56:00.000-08:00

Vincent

Book Cover of 'Voluntary Madness'

Am I mentally ill? Or have I been diagnosed as such because it means that the insurance companies will pony up for my meds and my stays in the hospital only if I am placed in a category in the Diagnostic and Statistical Manual of Mental Disorders (DSM), whether I truly belong there or not?

And what is 'mentally ill,' anyway? What can it mean to say that someone is mentally ill when the DSM, the psycho-bible, is, in my and many other far more qualified people's estimation, not a scientific document, but rather an entirely subjective and seemingly infinitely amendable and expandable laundry list of catchall terms for collections of symptoms.

There is, at least in the quantifiable sense, no such thing as schizophrenia, bipolar disorder, major depressive disorder, social anxiety disorder, and a whole host of other accepted diseases listed in the DSM. There is no real test for any of them (only questionnaires and symptomatic observation). They are unduly subject to political and professional fashion, and even lobbying by special- interest groups. Hence the successive redefining of homosexuality in 1973 and 1980, and, finally, its excision from the DSM in 1987.

We are nowhere near understanding the causes and mechanisms of mental illness well enough to develop reliable diagnostic criteria for any of them. We infer backward from the symptoms to the disease, which is why, when it came to doing the research for this book, it was so easy for me to gain admission to various hospitals on the pretext of undergoing a major depressive episode, even though in at least one case I was feeling quite well.

People have often asked me how I was able to do this so easily, and I always shock them when I say, 'Anyone could do it.' Getting yourself committed is very easy. Easier than it should be.

This has been true for a long time. In 1972, psychologist David Rosenhan and a group of his colleagues and graduate students conducted an experiment in which eight participants, or 'pseudopatients,' none of whom had histories of mental illness or institutionalization, set out to see how difficult it would be to get themselves committed.

They presented themselves at various hospitals across the United States, saying that they were hearing voices. They said that the voices were repeating the words 'empty,' 'hollow,' and 'thud.' They claimed to be suffering from no other symptoms and otherwise behaved normally. All eight were admitted, seven with diagnoses of schizophrenia, and one with a diagnosis of bipolar disorder. None of the staff was able to identify the pseudopatients as impostors during their stays, though a number of patients were reported to have done so.

The pseudopatients were all discharged after an average stay of nineteen days, at which time their schizophrenia was diagnosed as being 'in remission.'

The results of the experiment were published in the journal Science, and the authors concluded ominously, 'It is clear that we cannot distinguish the sane from the insane in psychiatric hospitals.'

I am sure that another Rosenhan experiment, if conducted today, would yield equally worrying results.

But this book is not another Rosenhan experiment. Though it does cast an unabashedly critical eye on the system, the practice of psychiatry, and the prevailing view of mental illness, it does so solely through the lens of my experience.

If you are looking for evidence, you will not find it here, except in the notoriously unreliable form of eyewitness testimony. My own.

The formal case against the leviathan has been made already, and is still being made in the courts and the newspapers. A number of people, several of them professionals in the field, have written extremely well-documented exposes of psychiatry, psychiatric medications, the pharmaceutical companies, and the DSM. These books are far too seldom read, in my opinion.

I admire and support what these writers, dissenting doctors, and journalists have accomplished. Initially, I sought to follow their lead. I saw probing the phenomenon of mental illness today as an effective and provocative way to take the measure of my culture. But as I plunged myself deeper in the project, I, and it, took a sharp turn inward, becoming somewhat less about what I saw around me and more about my private struggle to find a way out of chronic mental distress, a distress that the system not only seemed unable to heal but, more often than not, had only made worse.

As you read, you will see that what begins as the mostly detached report of the proverbial journalist at large, first in a big-city public hospital, then in a private rural hospital, and finally, in an alternative treatment program, soon dovetails and then merges indistinguishably with the very personal account of a bona fide patient's search for rescue and, if possible, a touch of lasting self-awareness along the way. The journalist and the patient are both me: one doing a job, or trying to; the other slouching, in her own time, toward bedlam; and each, by turns, pushing the other up and along or dragging her down.

What follows is the record of that dual journey, shot through with observational inexactitude. This is what I saw and what I thought. It is what happened to me, inside and out. That's all. It is not, nor was it intended to be, an argument, a polemic, or an investigative report, though it is, at times argumentative, conjectural, and raw. It draws no hard-and-fast conclusions. It asks. It surmises. It prods. It also wanders, meanders, spirals, and circles back. But in the end, it does no more and no less than take you with me. And that, after all, is really what you're here for, isn't it? To come along for the ride.

That much I know I can promise you. A bumpy, loopy, sideways, up-and- down ride.

A journalist I once knew had a saying about our profession: The most you can hope to do is inform and entertain.

As an invitation to these pages, that sounds about right.

Courage is the key word!!

2008-12-28T15:13:00.000-08:00

My father used to always say that my mother was the most courageous person he knew. There are many descriptors used for the mentally ill, but courageous is the one word that is common for all. They know they have an illness that will never go away; that every day they have no choice but to wake up to another regiment of highs, lows, medicine or no medicine and if they are lucky therapy sessions. Psy-wards in and out of hospital stays or out-patient services; going from one doctor to another. Very sad circle of life for some. This article is a story that we need more of. Our loved ones have wonderful stories of courage and resolve and achievement that should be told, in spite of the stigma.

They had every kind of trophy you could imagine at House of Trophies in Boyle Heights. Soccer, basketball, baseball, football, even fishing. They had trophies 6 inches tall and 6 feet tall, plaques and desk ornaments too, for retiring cops and transit workers and for great teachers.

But nothing for musicians.

I told a clerk I needed a trophy with something a little different on it, like maybe a string player.

It was an unusual request, I could tell, but he went to his computer and came back with a printed image of a conductor and a musical symbol.

"We could do something like this," he said.

I decided to put my faith in House of Trophies and began making plans for the awards ceremony. The plan was to honor a friend I'm constantly asked about by readers and also to recognize two of my buddy's pals.

Since I began writing about Nathaniel Anthony Ayers, a street musician I met almost four years ago in downtown Los Angeles, I've been asked to speak at mental health symposiums, skid row fundraisers, universities and high schools and all kinds of award banquets.

I usually walk away with a plaque and a bad case of guilt. All those groups really should be honoring Mr. Ayers, not me. He's the one who's had to muster the courage to face each day. He's the one who has given a face to the anonymous thousands in the same fight. And he's the one whose story, I hope, is helping de-stigmatize mental illness.

I usually pass along the awards I get to Mr. Ayers, but I thought he should have his very own, which is how I ended up at House of Trophies.

Mr. Ayers had been telling me for months that he wanted to celebrate Beethoven's birthday on Dec. 16. I don't know a lot of people who walk around with Beethoven's date of birth in their heads, but nothing about Mr. Ayers is typical.

Ever since he stumbled upon the Beethoven statue in Pershing Square several years ago, he has conducted himself as if Ludwig were god of the universe and everything beyond.

Mr. Ayers had told me he'd like to perform at Beethoven's birthday party with some of his friends from the Los Angeles Philharmonic. But as the date approached, he feared he wouldn't be sharp enough to play with the pros. He said if he really worked at it, he'd be in good shape by Beethoven's birthday next year. But he wondered if we could still have a party.

Among the few dozen guests were violinist Robert Gupta, pianist Joanne Pearce Martin and cellist Ben Hong, all friends of Mr. Ayers and all members of the L.A. Phil.

Also attending was Adam Crane, the former L.A. Phil publicist who made Mr. Ayers welcome at Disney Hall concerts and became one of his closest friends. Mr. Ayers has had a tough adjustment since Crane moved on to the St. Louis Symphony Orchestra, occasionally strolling up to Disney Hall to see if Crane has decided to come back. Crane was coming to town anyway in December and adjusted his schedule to get here in time for Mr. Ayers' Beethoven party.

As the party approached, I began worrying that the man of the hour might not attend. Mr. Ayers has had a painful, chronic stomach problem for which he was refusing treatment, no matter how bad the agony. Doctors and meds, he says, are not for him. Not yet, anyway, because he recalls too vividly the days of restraints, shock therapy and Thorazine. He is still tough to be around at times and a challenge for the staff at Lamp Community, which handles hard-core, chronic cases of mental illness.

A book I wrote about Mr. Ayers came out last year, and I had been nervous about how he would react to it and to a movie based on the book that will be out in April. He once told me he preferred experiencing life to seeing it reflected in a mirror. Developing insight into one's own illness is difficult for many people. After reading the book, though, he thanked me. He said it wasn't easy to read, but he felt that he needed to. As for the movie, he said he had no desire to see it, in part because the very thought of two-dimensional images on a screen is spooky to him.

So I was shocked when, at the last minute, he decided to see a screening for cast and crew. Many of his friends at Lamp play themselves in the movie because director Joe Wright insisted on not using actors. They were excited about seeing themselves on the screen, and Nathaniel wanted to be with them, rather than miss what in effect was his own party.

We sat together at the Arclight. I'd seen the movie, but still I was anxious, and so was Mr. Ayers. He kept his eyes closed through the entire film, but he experienced it -- felt it, really -- in his own way. He loved the music, grumbled at certain depictions, laughed at funny lines and joined in the shout-outs when his friends saw themselves up on the screen.

I was humbled by him, proud of him, worried for him. What he's got doesn't go away. Every day's a challenge.

The first award at the Beethoven party was presented in absentia to Peter Snyder, an L.A. Phil cellist who retired last week after nearly 40 years with the orchestra.

Snyder has already moved up to the Central Coast and couldn't make the party. He was the musician who volunteered to give lessons to Mr. Ayers in a vacant skid row apartment three years ago, hoping it would make Mr. Ayers comfortable enough to move in off the streets of skid row.

Those lessons were the key, I think, even though Mr. Ayers resisted moving indoors, saying that he couldn't leave Beethoven alone on the streets of downtown L.A. Crane got him past that by going to the Disney Hall gift shop and getting a bust of Beethoven to place in the apartment. Mr. Ayers has lived in that apartment ever since.

At the Beethoven party, held in a basement music room at the L.A. Times, Crane's plaque was inscribed "Mensch of the Century."

Mr. Ayers was not just the man of the hour but the life of the party. He warmed nicely to the crowd, had a smile on his face most of the evening and was in his glory when Gupta and Martin offered a rousing rendition of the Mendelssohn Violin Concerto.

He also did pretty well in his own performance despite the lack of any rehearsal, playing cello to Martin's piano on the Bloch Prayer and a bit of the Schubert Arpeggione Sonata.

Standing tall on the piano throughout the performance was Mr. Ayers' new trophy, a gaudy 2-foot-tall beauty with metallic red and the best fake gold available. It was inscribed:

"Disciples of Beethoven Award

"For a half century of devotion to music. For a talent that knows no bounds. And for a story of courage and perseverance that speaks to thousands."

No Mental Illness

2008-12-22T16:34:00.000-08:00

No mental illness here, Just old fashioned greed and a warped sense of the "Pretty boy" syndrome in my opinion.

Unless politics is a mental illness Blagojevich is sane!

By Usha Nellore
Examiner Columnist 12/19/08

It is now official. Illinois Governor and Democrat Rod Blagojevich was caught with his hands in the cookie jar and was arrested for his latest egregious run against federal law. For three years the feds scrutinized his wheelings and dealings, but not until now was he nailed with what seems like irrefutable evidence on tape, trying to sell Barack Obama's Senate seat to the highest bidder. As governor of Illinois he had the power to appoint the next senator to the vacated seat -- and did not take this task lightly.

He saw in it the perfect opportunity to angle for a Cabinet post in the Obama administration or perhaps an ambassadorial appointment. From Jesse Jackson Jr. to Valerie Jarrett, the latter being Barack Obama's confidante and adviser, he was certain all were for sale in exchange for the appointment. At one point in time he confessed on tape that he wanted to bag himself a position in a nonprofit organization affiliated with labor unions. This, he believed, could be achieved by appointing someone to the seat favorable to the Obama camp. The unions, pleased, would grant him his Christmas wish and pull him into a $250,000 per annum job for his benevolence.

Now the pundits shake their heads and exclaim these machinations are the worst ever in the annals of political corruption and can only be explained by Blagojevich having taken leave of his senses. In an article by Susan Saulny of the New York Times, Mike Jacobs, Illinois state senator, said Blagojevich may have lost his grip on reality. He said of his friend, "I am not sure he is playing with a full deck of cards." Cindy Canary of Illinois Campaign for Political Reform is quoted in the same article as saying she is trying to figure out the pathology to explain Blagojevich's actions. James Carville, Democrat and political commentator, laughs self-consciously and tells Wolf Blitzer of CNN Blagojevich's sins do not reflect our political system. In other words, Blagojevich is a rare political mutation wrought by delusions of grandeur and ambition run amok.

What nonsense! Blagojevich did not arrive at this behavior without previous experiences in the bazaar of politics. He was a state legislator in Illinois, a prosecutor and a member of the U.S. House of Representatives. He bought and sold a lot of favors. Businesses fed his campaign coffers in exchange for state contracts. Antoin Rezko, now in prison for fraud and bribery, collected campaign money for Blagojevich as he did for President-elect Obama.Obama endorsed Blagojevich in 2002 and again in 2006. Blagojevich endorsed Obama in 2004 after he won the Democratic nomination.

It seems someone from the Obama camp did speak to Blagojevich about this Senate appointment because the governor was apoplectic on tape that the Obama camp was unwilling to offer him anything more than gratitude for giving them the appointee they wanted. Did this contact from camp Obama bother to tell the feds that Blagojevich had an auction scheme to put Sotheby's to shame?

Suppose the feds and the Chicago Tribune editors had not been after Blagojevich for the past few years and suppose the governor had not been caught with his pants down by hard-nosed Patrick Fitzgerald, U.S. attorney for Chicago. Then what would have happened? That is the right way to ponder this melodrama. Union bosses, would they have given the governor what he wanted for a Senate appointment that suited their fancy? Obama and camp, would they, in exchange for the governor's favor, have given him a position, perhaps as ambassador to Serbia, striking two fruits with one stone, appointing a man of Serbian origin to the post and banishing him to Belgrade?

If the answer to these questions is a resounding "No!" then Blagojevich is a lone lunatic in the jungle of politics tormented by a disorder robbing him of his mind. If the answer to these questions is a "maybe," then Blagojevich's only affliction is a case of one rascal nosing out all the other possible rascals in his neighborhood! Let us not insult those who struggle courageously with mental illness everyday by lumping them with Blagojevich.

Interesting history, but don't want to re-visit

2008-12-17T15:55:00.000-08:00

Mentally ill inmates: Modern-day Bedlam

by Bob Joondeph, Guest opinion
Wednesday December 17, 2008, 1:14 PM

When Captain Craig Ward, who manages the Union County Jail, referred to the behavior of an inmate with mental illness as "bedlam," he was spot on. (The Oregonian, Mentally Ill Inmates Strain Rural Jails, Dec. 14.)

The word "bedlam" is defined as: "a place, scene, or state of uproar and confusion." It originated as the popular name for first insane asylum in London: The Hospital of St. Mary of Bethlehem. Bedlam Hospital started taking people with mental illness in 1357. Conditions were awful. According to a visitor, the noise was "so hideous, so great; that they are more able to drive a man that hath his wits rather out of them." Violent or dangerous patients were manacled and chained to floors or walls. Londoners could visit Bedlam and pay a penny to stare at the inmates. According to The Catholic Encyclopedia:"one could peer into their cells and laugh at their antics or violent fights. Visitors were permitted to bring long sticks with which to poke and enrage the inmates."

Fortunately, we have made great progress in our understanding of mental illness since the heyday of Bedlam. Through early identification, the devastating effects of major mental illness may be avoided. Through counseling, medications, social supports and individualized therapies, those who experience major mental illness can and do recover and return to productive membership in society.

But left unidentified and untreated, these disorders may prevent a person from working and undermine family and social supports. While mental illness does not itself render a person more dangerous than others, poverty, isolation and substance abuse may lead to criminal behavior and time in jail or prison. Everyone (the person, the victim, their families, the jail, the community) would be better off if that person had received assistance early on. Yet, for decades, we have severely underfunded mental health and chemical dependency services.

Now, as The Oregonian pointed out, the Governor's Recommended Budget continues this tradition by calling for a 90% cut in non-Medicaid adult community mental health funding.
Under pressure from the federal government, Oregon is taking steps to correct the deplorable conditions at Oregon State Hospital. And yet we continue to look the other way while our jails are asked to carry on the tradition of Bedlam Hospital. Mental health treatment can and should be provided to inmates. Community mental health services need to provide more screening, treatment, housing and supports. Cutting these services will not only contribute to more human suffering and homelessness but will also generate higher back-end costs to taxpayers due to avoidable prison, jail and hospital days.

What can we realistically do? For starters, we should seek efficiencies by regionalizing community mental health services, including housing and acute care. We should continue to integrate the delivery of mental health services with physical health. We should demand greater accountability for the use of public resources through reporting of clear, measurable outcomes. We should assure that all Oregon inmates are properly screened for mental illness and have access to adequate treatment. And we should provide the funds to get this done.

To do less is to direct Captain Ward and his colleagues throughout Oregon to operate modern-day Bedlams.

Inmates

2008-12-15T15:59:00.000-08:00

In my opinion, some inmates could be viable members of society. A lot of our mentally ill persons are incarcerated. This is due largely to the fact that they are not taking the correct medically prescribed drugs. I had a meeting with parents about a child in the fourth grade that I knew to be diagnosed as bi-polar. At this meeting the dad finally admitted that his father was bi-polar, he was bi-polar and he was very sad to hear that his child was following in the footsteps of the two generations before him. This dad said that his whole life in school, he could not stay focused and he was placed in the corner of the room, alone. He would refuse to work and was mostly in a depressed frame of mine through his elementary school experience. He said his dad takes a huge amount of medicine daily to maintain his mental illness. This dad said that he dropped out of school and now works a minimum wage job with no hope for anything better the rest of his life. Thankfully, he also stated that he did not want this for his child and that he would actively seek the proper medical care for his fourth grade child. I am amazed at the parents who are not brave enough to admit to teachers that they have mental illness in their families and would choose to not help their poor children who are innocent victims of the repeat behaviors of their parents. This is our children and the future of America and they deserve the best chance for success they can get. Parents of mentally ill children need to also get past the "stigma" of mental illness and do their job, get their children to licensed medical professionals for the proper help with their illness. Ignoring the problem is not a solution. Keepthedialogueup!!!

In N.H., more women inmates

Study cites lack of alternatives

CONCORD, N.H. - Women are being incarcerated in New Hampshire at a faster pace than men due largely to crimes involving drugs and alcohol and because of a lack of rehabilitative and treatment options, according to a study by The New Hampshire Women's Policy Institute.

Poverty, mental illness, unemployment, and domestic violence are underlying factors, the study found.

"Women's role as primary caregivers for children complicates both their incarceration as well as their path to rehabilitation," the study's authors wrote.

The study said the upward incarceration trend will have future costs on taxpayers and their children.

"While New Hampshire's current correctional model is effective in protecting public safety during an offender's incarceration, it is costly and ineffective in terms of long-term successful rehabilitation. New Hampshire would do well to experiment with another model, and the female offender population, being less violent and more directly involved in the care of children, would be a good place to start," the authors recommend.

The study estimates that on any given day about 430 women are behind bars in the state's prison for women and in county jails. Another 1,450 were supervised in their communities last year, and about 960 were released from jail - for a total of 2,850 involved with the system at some point.

Female admissions to county jails increased by 24 percent between 2003 and 2007 compared with a 14 percent increase during the period for men, the study said. Female admissions to state prison increased 64 percent during the period.

Additionally, in six of New Hampshire's largest communities, arrests of women increased 25 percent between 2002 and 2006 compared with 9 percent for men. Alcohol offenses among young women were one of the fastest-growing categories. The communities studied are Concord, Manchester, Keene, Laconia, Plymouth, and Portsmouth.

The study estimates that two-thirds of the female inmates have children and nearly half are single mothers who must turn to relatives or the state foster care system to care for their children during their incarceration. The authors estimated that 1,300 children are affected annually.

Corrections officials told the institute the growing number of pregnant inmates is straining the system. One jail superintendent said he contacted the state to arrange care for an unborn child but was told the state could not intervene because the child was not yet abandoned or neglected. Estimated costs of a pregnant inmate are $20,000 for medical care and transportation.

The study also said the system is taxed by inmates' mental health issues. Two-thirds of the women said they had a previous diagnosis of mental illness.

"The jails are functioning as an integral part of the state's mental health system without sufficient resources to identify and treat mental health problems," the study concluded.

Another Promising Bit of Research

2008-12-14T14:54:00.000-08:00

Bipolar Disorder Genes, Pathways Identified By Indiana University Neuroscientists

Main Category: Bipolar
Also Included In: Neurology / Neuroscience; Psychology / Psychiatry
Article Date: 24 Nov 2008 - 1:00 PST

Neuroscientists at the Indiana University School of Medicine have created the first comprehensive map of genes likely to be involved in bipolar disorder, according to research published online Nov. 21 in the American Journal of Medical Genetics.

The researchers combined data from the latest large-scale international gene hunting studies for bipolar disorder with information from their own studies and have identified the best candidate genes for the illness.

The methodology developed at the IU Institute of Psychiatric Research enabled Alexander B. Niculescu III, M.D., Ph.D., and his team to mine the data from the genome-wide association studies and other study results on the levels of gene activity in human blood samples and in animal models. Genes with the highest levels of prominence were determined to be the most active in contributing to the disorder.

The researchers also were able to analyze how these genes work together and created a comprehensive biological model of bipolar disorder.

"Based on our work, we now project that there will be hundreds of genes - possibly as much as 10 percent of the human genome - involved in this illness," said Dr. Niculescu, who is an assistant professor of psychiatry and director of the laboratory of neurophenomics at the IU School of Medicine. "Not all genetic mutations will occur in every individual with bipolar disorder. Different individuals will have different combinations of genetic mutations. This genetic complexity is most likely what made past attempts to identify genes for the disorder through genetic-only studies so difficult and inconsistent."

Dr. Niculescu compared the process to a Web search. "The process was similar to a Google approach, the more links there are to a page on the Internet, the more likely it is to come up at the top of your search list. The more experimental lines of evidence for a gene, the higher it comes up on your priority list of genes involved in the disorder."

Until now there have been few statistically significant findings in searches of the human genome as it applies to bipolar disorder, he said.

"By integrating the findings of multiple studies, we were able to sort through, identify genes that were most likely to be involved in bipolar disorder, and achieve this major breakthrough in our understanding of the illness," Dr. Niculescu said.

Bipolar disorder, sometimes called manic depression, affects nearly 2.3 million Americans. A serious illness, people who suffer from it can experience mild or dramatic mood swings, shifts in energy and a diminished capacity to function.

Dr. Niculescu, a practicing psychiatrist and a molecular geneticist, said this work opens exciting avenues for psychiatric researchers and clinicians, as well as for patients and their families. "First and foremost, these studies will lead to a better understanding of bipolar and related disorders," he explained. "Second, the researchers now plan to study individuals to see which combination of genes is present in individuals to come up with a genetic risk score."

The goal, he said, is to be able to apply the risk score to test individuals even before the illness manifests itself for preventive measures - lifestyle changes, counseling, low-dose medications - or to delay or stop the illness from developing.

"Third, in individuals who already have the illness, genetic testing in combination with blood biomarkers for the disease, could help determine which treatments works best so personalized treatments could be developed," Dr. Niculescu said.

The research was done in collaboration with colleagues at the Scripps Research Institute, the University of California- San Diego, SUNY Upstate medical University and the National Institute of Mental Health. IU researchers involved were Helen Le-Niculescu, Ph.D., John I. Nurnberger, M.D., Ph.D., Meghana Bhat, M.D., and Sagar Patel.

Grant funding for the research was provided by National Institute of Mental Health.

Indiana University School of Medicine

Pay Attention America

2008-11-30T15:38:00.000-08:00

Another very sad story. This young man was on meds for bipolar disorder according to his dad. His life should never have ended at all.

Horror as teenager commits suicide live online

A video capture showing a police officer in the bedroom of Abraham K Biggs, hours after the teenager took an overdose

Mike Harvey, Technology Correspondent, in San Francisco

Comment: When hate comes to your homepage | Should forum members be prosecuted?

A 19-year-old man in Florida committed suicide live on the internet as hundreds of web surfers watched - taunting him and offering encouragement.

Abraham K. Biggs, from Broward County, Florida, announced his intention on an online forum, posted a suicide note on another and then took an overdose of pills in front of his webcam, broadcasting his final moments on Justin.tv.

Mr Biggs lay on his bed motionless for several hours before members of the website became alarmed. With the video still streaming, viewers eventually called the local police, who broke down the door, found the body and switched off the camera. Up to 1,500 people were viewing, according to one report.

A video clip posted on the net shows a police officer entering the room, his handgun drawn, as he checks for any sign of life. Mr Biggs was a member of bodybuilding.com under the name CandyJunkie and was also known under the alias of Feels Like Ecstasy on Justin. tv. He had apparently threatened to commit suicide before.

On Wednesday he went on the bodybuilding.com forum and detailed the amount of drugs he was going to take. The moderators of the forum reportedly did not take him seriously because of his past threats and other forum members egged him on. “You want to kill yourself?” one said. “Do it, do the world a favour and stop wasting our time with your mindless self-pity.”

In his suicide note Mr Biggs said that he had hurt other people and hated himself for being a failure. “I am an a@#hole. I have let everyone down and I feel as though I will never change or never improve. I am in love with a girl and I know that I am not good enough for her,” he wrote.

As he lay on the bed after taking the pills, many forum members continued to insult him, believing that it was a hoax.

Wendy Crane, an investigator with the Broward County medical examiner's office, said Mr Biggs died from a toxic combination of opiates and benzodiazepine, a drug used to treat insomnia and depression.

At least one of the drugs was prescribed to him and it's unclear how he got the others, she said. He started blogging at 3am on Wednesday and his body was found by police 12 hours later.

Mr Biggs' father, Abraham Biggs Sr., told ABCNews.com that he was not home when his son died. He said his son struggled with depression and had been prescribed benzodiazepine to treat bipolar disorder. The 19-year-old had been "doing better," his father said, "He was a good kid."

Mr Biggs senior said he was upset that Justin.tv streamed his son's suicide live. "There seems to be a lack of control as to what people put out on the Internet," he said. "There's a lot of garbage out there that should not be, and unfortunately this was allowed to happen."

Justin.tv, named after Justin Kan, its first star, is an open network of thousands of live channels based in San Francisco.

“We regret that this has occurred and respect the privacy of the broadcaster and his family during this time,” Michael Seibel, CEO of Justin.tv, said.

“We have policies in place to discourage the distribution of distressing content and our community monitors the site accordingly. This content was flagged by our community, reviewed and removed according to our terms of service.”

The video feed has been taken down, but clips have been posted elsewhere on the net and copies of the suicide note can also be found, though many of the forum posts have been deleted by their authors.

Mr Biggs’s friends have posted RIP messages on his MySpace page, with some still asking him to pick up his phone.

Last year a British man hanged himself live on webcam. His suicide was witnessed by about 100 chatroom users. Kevin Whitrick, 42, from Telford, Shropshire, killed himself after being goaded in an “insult” chatroom at the Paltalk website. One of the users is claimed to have told him: “F***ing do it. Get on with it.”

According to one charity that works to prevent suicide, there have been at least 17 deaths in Britain since 2001 involving chatrooms or sites that give advice on suicide methods.

New Spirit

2008-11-24T17:20:00.000-08:00

Hopefully we are entering a new American spirit of open-ness about ethnic, cultural, and even medical differences. I am personally tired of the prejudice and judgmental biases that affect our American culture. Everyone has a story to tell about their family or lives. I was born and raised in the South and I will confess that there is still a lot of prejudice there about almost everything. None of us are really any "better" than the others. We are all pieces of energy on earth trying to co-exist. Thanks again for reading this blog and staying informed and spreading the language and vocabulary that helps our mentally ill loved ones.

PRESS RELEASE

Glenn Close, Alma Powell, and Quincy Jones to Be Honored at AARP The Magazine's 2009 Inspire Awards

Last update: 10:50 a.m. EST Nov. 24, 2008

WASHINGTON, Nov 24, 2008 /PRNewswire-USNewswire via COMTEX/ -- - Peter Gallagher, Dr. Susan Love, and Richard Cohen Also Recognized -

AARP The Magazine, the definitive voice for 50+ Americans and the world's largest-circulation magazine with 34 million readers, today announced the recipients of its fifth annual Inspire Awards. The Inspire Awards pay tribute to 10 extraordinary people who inspire others to action through their innovative thinking, passion and perseverance. The 2009 honorees include Glenn Close (Mental Health Advocate), Richard M. Cohen (Voice for the Chronically Ill), Martin Eakes (Lending to the Poor), Katherine Freund (Transportation Activist), Peter Gallagher (Alzheimer's Advocate), David E. Hayes-Bautista, Ph.D. (Latino-Health Researcher), Quincy Jones (Global Poverty Fighter), Susan Love, M.D. (Cancer Crusader), Rose Nakamura (Compassionate Caregiver), and Alma Powell (Children's Advocate).

"These leaders set a great example for all on how passion can support and spark change in creative, innovative ways. Their stories are truly inspiring," said Nancy Graham, Vice President and Editor of AARP The Magazine.

Honorees will receive their Inspire Awards during a private cocktail reception and dinner hosted by television host James "JB" Brown at the National Museum of Women in the Arts in Washington, D.C., on December 8, 2008. Television journalist and mental health advocate Jane Pauley will also make a special appearance to present the Inspire Award to Glenn Close.

All ten profiles appear in the January/February 2009 issue of AARP The Magazine, in homes now and available online at www.aarpmagazine.org.

THE 2009 INSPIRE AWARD WINNERS

Glenn Close - Mental Health Advocate

Perhaps best known for her portrayal of the deeply troubled Alex Forrest in Fatal Attraction, Glenn Close, 61, is no stranger to the affects of mental illness off-screen as well. The Emmy Award winner has a more personal connection with this issue, which strikes five percent of the U.S. population and affects one in four families. In a rare public statement, Close reveals to AARP The Magazine that she has two family members who suffer from serious psychiatric disorders. "I've seen mental illness firsthand," she says. "I know there are millions of people affected, and it's not just the patient who is suffering. It's everyone around them." Two years ago the actress began working with Fountain House ( www.fountainhouse.org), a nonprofit organization that she discovered while searching for help for her relatives. Fountain House offers its members assistance with jobs, education, and housing and also provides a supportive community. In 2009, Close will take her involvement a step further, headlining a national advertising campaign intended to diminish the stigma of mental illness. "When I first thought about doing this, I wondered if people would think that I was mentally ill," says Close. "Then I thought, 'What's the alternative? Not to do it?'" Close acknowledges that continued research into better treatments is important. But erasing the stigma, she says, is the first step.

Follow up

2008-11-18T16:47:00.000-08:00

This is a follow on an article and story that happened earlier this year. Keepthedialogueup!!!

Local family raises money to fight mental illness

A mistreated mental illness took the lives of Danielle Lambert's twin sister and two young children nearly a year ago. Pushing aside her anger and frustration, Lambert and her husband, Ken, have their used their grief as a driving force to prevent similar tragedies.

Keep Sound Minds, a nonprofit organization dedicated to the memories of Kaleigh and Shane Lambert and Marci Thibault, is aimed at promoting mental health awareness by pushing for better education and policy changes.

"We wanted to prevent this from happening again to another family," said Lambert, who suggested starting an organization a few weeks after her two children were killed. "I had to do something."

Family members say a sudden, unexpected psychotic relapse on the night of Jan. 11, 2008, caused Lambert's sister, Marci Thibault, to pull over to the side of Interstate 495 South in Lowell, undress herself, 5-year-old Kaleigh and 4-year-old Shane, take them in her arms and walk into oncoming traffic. The Lamberts' only children and Thibault were killed by two cars.

"We go through the scenarios and there were so many missed opportunities," Lambert said.

Thibault was treated for a brief episode of mental illness last September, but she said a lack of education, discussion and follow-up "led to tragedy."

Many in the community came out in support of a bowling benefit yesterday for Keep Sound Minds at PiNZ in Milford. Such support has been consistent since the January accident, said the Lamberts, who live in Brentwood, N.H. Lambert is one of eight Coady sisters, born and raised in Bellingham.

The Lamberts are gearing up for a larger fundraising event slated for March at the Sheraton Hotel in Boston. The benefit will launch a scholarship fund and will feature guest speakers, a raffle and silent auction.

Through Keep Sound Minds, the Lambert, Coady and Thibault families hope to raise awareness and increase education about mental disorders.

One target area focuses on changing law enforcement procedures and recognizing mental illness as a public safety issue.

The Lamberts still wonder why police didn't seem to respond appropriately to her behavior just hours before the double murder-suicide.

State police said 39-year-old Thibault had a minor accident and was cited on I-495 North in Andover on her way to pick up her niece and nephew. Another motorist told state police she appeared agitated, but she was rational and responsive when troopers arrived.

Lambert said she believes Marci showed police "clear signs of psychosis," but then snapped back to normal by the time she arrived in Brentwood.

"She seemed perfectly normal," she recalled.

The Lamberts later learned from a witness that Thibault said she was "taking (the children) to heaven."

"I knew it wasn't malicious," Lambert said. "I knew it was her illness that came back."

Choking back tears, she said she would have never let her sister take the children if she showed signs of instability.

"I didn't know much about mental disorders, neither did a lot of people in the family," said Ken Lambert, clutching his tearful wife's hand. "If we had known more, this could have been prevented."

Another goal of Keep Sound Minds is to eliminate the stigma associated with mental illness, said Ken Lambert.

"People don't want to talk about it, but you need the knowledge," he said. "Education can protect people."

Changing procedures to discharge mental health patients can also prevent needless tragedy, the Lamberts said.

In Thibault's case, Danielle Lambert said doctors "belittled" her concerns about her sister.

"It was scary to me, but they told me, 'Don't worry,"' she recalled after doctors diagnosed Thibault with bipolar disorder and let her leave the hospital. "They took away my fear."

During the holiday season last year, the Thibaults and Lamberts celebrated Christmas together and felt Marci had improved.

"She loved kids .. she loved our kids," Danielle Lambert said. "And they were so excited to go with her."

The faces of the Lamberts' children still smile from an etching on a gold pendant hanging from Danielle Lambert's neck.

"They were beautiful kids, we miss them so much," she said. "We never thought we'd be in this place, but we're trying to do something positive."

Michelle Simpson, who volunteered at yesterday's bowling event, credits the Lamberts' initiative.

"I was inspired by how they turned a devastating tragedy into something positive," said Simpson, whose husband grew up in the Coadys' Bellingham neighborhood. "They want to make a change and prevent a similar tragedy from happening in the future."

For more information, visit www.keepsoundminds.org.

Not Surprising Facts

2008-11-11T16:29:00.000-08:00

One In Five Hospital Admissions Are For Patients With Mental Disorders, USA

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About 1.4 million hospitalizations in 2006 involved patients who were admitted for a mental illness, while another 7.1 million patients had a mental disorder in addition to the physical condition for which they were admitted, according to the latest News and Numbers from the Agency for Healthcare Research and Quality.

The 8.5 million hospitalizations involving patients with mental illness represented about 22 percent of the overall 39.5 million hospitalizations in 2006. AHRQ's analysis found that of the nearly 1.4 million hospitalizations specifically for treatment of a mental disorder in 2006:

- Nearly 730,000 involved depression or other mood disorders, such as bipolar disease.
- Schizophrenia and other psychotic disorders caused another 381,000.
- Delirium -- which can cause agitation or inability to focus attention -- dementia, amnesia and other cognitive problems accounted for 131,000.
- Anxiety disorders and adjustment disorders - stress-related illnesses that can affect feeling, thoughts, and behaviors - accounted for another 76,000.
- The remaining roughly 34,000 hospitalizations involved attention-deficit disorder, disruptive behavior, impulse control, personality disorders, or mental disorders usually diagnosed in infancy or later childhood.

This AHRQ News and Numbers is based on data from Hospital Stays Related to Mental Health, 2006 (HCUP Statistical Brief #62). The report uses statistics from the 2006 Nationwide Inpatient Sample, a database of hospital inpatient stays that is nationally representative of inpatient stays in all short-term, non-Federal hospitals. The data are drawn from hospitals that comprise 90 percent of all discharges in the United States and include all patients, regardless of insurance type, as well as the uninsured.

AHRQ

Notable New Books

2008-11-10T16:21:00.000-08:00

Four new books tell the true stories of mental illness

Updated 1h 15m ago |


Enlarge	Courtesy of Patrick Tracey

Bound for illness: Tracey's sisters Austine, 10, and Michelle, 17 from Stalking Irish Madness.

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No. 7-10: Diabetes, Obama and mental health

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By Deirdre Donahue, USA TODAY

According to the National Institute of Mental Health, one in 17 Americans suffer from serious mental illness. Four new memoirs deal with the harsh reality of people and families who cope with a chronic, disabling condition. Two focus on bipolar disorder (sometimes called manic depression), which is found in about 5.7 million adults. Another examines a family legacy of bipolar disorder and suicide. The fourth addresses schizophrenia, which afflicts an estimated 2.4 million Americans. This severe disease causes hallucinations and delusional thinking. USA TODAY critiques the new titles.

Hurry Down Sunshine
By Michael Greenberg
Other Press, 234 pp., $22

In this powerful memoir, writer Michael Greenberg describes the terrifying summer his 15-year-old daughter, Sally, became a stranger to herself and to her father. In August 1996, the lively teenager became, almost overnight, manic and uncontrollable, unable to stop talking as words poured out. The cause: the onset of bipolar disorder. Taken to a Manhattan emergency room, Sally was immediately placed in the hospital's psychiatric unit.

BETTER LIFE: Bipolar disorder help available that actress Vivien Leigh missed

With spare, unemotional prose, Greenberg captures what it's like to have a mentally ill child and the way the disease strips him of his sense of control over his daughter's health. He describes the powerful anti-psychotic medications that Sally receives, and how she responds. Eventually she is released from the hospital and returns to high school.

Greenberg offers no miracle cure: Sally struggles with the disorder today. And to his credit, he does not demonize the overworked but caring doctors who treat his daughter.

Stalking Irish Madness: Searching for the Roots of My Family's Schizophrenia
By Patrick Tracey
Bantam, 273 pp., $24

In this fascinating memoir/travelogue, Irish-American journalist Patrick Tracey describes the journey he has taken in life because of schizophrenia.

His story begins in Boston as two of his older sisters were diagnosed in their early 20s with the disease. One withdrew into herself in dark despair. The other acted out in outrageous ways, thinking she was the bride of Christ. Thirty years later, both live in group homes. Their fates seemed linked to that of their Irish-American grandmother, who was institutionalized for 31 years with schizophrenia until her death.

Tracey fled the USA for many years, until a conversation with a London doctor led him back to the disease that haunted him. He interviewed scientists: Its cause remains a mystery. He traveled to Ireland looking for his grandmother's relatives. In the end, he returns to Boston to reconnect with his sisters.

Scattershot: My Bipolar Family
By David Lovelace
Dutton, 292 pp., $24.95

The author of Scattershot has an extraordinary grasp of what it means to have bipolar disorder. David Lovelace grew up in Massachusetts with bipolar parents. His brother is bipolar, as is David. In the year 1986, every Lovelace male was committed to a psychiatric hospital at some point.

Only his sister does not have the disease.

Yet Scattershot is not a horror story but rather a portrait of a loving if sometimes crazy family. Lovelace's father is a brilliant theologian and an expert on Puritan thinkers including Cotton Mather. His mother is an artist. Lovelace is a published poet and bookseller.

He details how his parents, his brother and he all follow the same biochemical pattern. They zoom from manic highs of creativity to bottomless lows. This empathetic memoir illustrates that medication is as essential for people with bipolar disorder as insulin is for diabetics.

Blue Genes: A Memoir of Loss and Survival
By Christopher Lukas
Doubleday, 248 pp., $24.95

In Blue Genes, TV producer and director Christopher Lukas describes the shadow of sorrow that suicide has cast over his life.

The book opens in 1997 with the suicide of the author's older brother, the Pulitzer Prize-winning journalist J. Anthony Lukas. This continued a terrible family tradition. Their 33-year-old mother had committed suicide in 1941, when her sons were 6 and 8, after struggling with bipolar disorder for years.

In Blue Genes, Lukas movingly describes what it was like to grow up the child of a suicide. Lukas' father became an alcoholic, and the boys were sent to boarding school. He writes about feeling abandoned and angry. He also describes his loving but complex relationship with his brother.

Yet this memoir also affirms the joy Lukas has found in being a husband and father. His story will resonate with readers who have lost friends or family members to suicide.

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Technical but Interesting Anyway

2008-11-05T16:20:00.000-08:00

Here is a medical research article that is interesting although medically technical.

Original Article

Magnetic resonance imaging brain activation in first-episode bipolar mania during a response inhibition task

Stephen M. Strakowski, Caleb M. Adler, Michael A. Cerullo, James C. Eliassen, Martine Lamy, David E. Fleck, Jing-Huei Lee and Melissa P. DelBello

Division of Bipolar Disorders Research, Department of Psychiatry, and the Center for Imaging Research, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA

Correspondence to Dr Stephen M. Strakowski, Department of Psychiatry, University of Cincinnati College of Medicine, 231 Albert Sabin Way (ML0559), PO Box 670559, Cincinnati, OH 45267-0559, USA. Email: Stephen.Strakowski@uc.edu

KEYWORDS

bipolar disorder • first-episode mania • fMRI

ABSTRACT

Aims: Impulsivity is common in bipolar disorder, especially during mania. Understanding the functional neuroanatomy of response inhibition, one component of impulsivity, might clarify the neural substrate of bipolar disorder.

Methods: Sixteen DSM-IV first-episode, manic bipolar patients and 16 matched healthy subjects were examined during a first manic episode using functional magnetic resonance imaging while performing a response inhibition task. All subjects were studied using a 4.0 Tesla Varian Unity INOVA Whole Body MRI/MRS system. The response inhibition task was presented using non-ferromagnetic goggles, and task performance was recorded during scan acquisition. Imaging data were analysed using analysis of functional neuroimages. Group contrasts were made for the specific response inhibition measure.

Results: The groups performed the task similarly, although both demonstrated relatively poor rates of target response, but high rates of successful 'stops'. Despite similar behavioural results, the groups showed significantly different patterns of functional magnetic resonance imaging brain activation. Specifically, during response inhibition, the healthy subjects exhibited significantly greater activation in anterior and posterior cingulate, medial dorsal thalamus, middle temporal gyrus, and precuneus. The bipolar patients exhibited prefrontal activation (BA 10) that was not observed in healthy subjects.

Conclusions: Bipolar and healthy subjects exhibit different patterns of brain activation to response inhibition; these differences may reflect different functional neuroanatomic approaches to response inhibition between the two groups.

Bias learned from the Liberal Media?

2008-10-29T18:03:00.000-07:00

This article also discusses the stigma viewed by many in America of the mentally ill. It is stated here and questioned about how the stigma gets introduced into the minds of the average American anyway. One theory is through the media which I find as a funny dichotomy, almost an oxymoron. The liberal media should embrace the mentally ill, they are usually outside the mainstream in their thinking which should be right "up the alley" of the media.

Patient Groups Tackle Stigma Attached To Bipolar Disorder And Other Mental Illnesses With New Tools

Mental illness is one of the last surviving stigmas in today's liberal society. Class, race, religion, gender and sexual orientation, are all off-limits now as reasons for discrimination, social exclusion, jokes or disparaging remarks of any kind. Where these are concerned, we've come a long way in terms of tolerance, fairness and sensitivity to the feelings of others; as a rule, words are chosen carefully so as not to offend and legislation ensures fair treatment. Mental illness, however, despite affecting one in four of us at some point in our lives, still provokes prejudice, especially in the workplace. Job applications frequently ask potential employees to declare treatment for a mental illness. Those who answer truthfully are invariably unsuccessful and those in work who report mental illness can find themselves passed over for promotion. As a result many people with mental illness experience rejection, unemployment and a sense of social isolation through no fault of their own. Fewer than 20 per cent manage to hold down a job, according to patient advocacy groups.

"Living with mental illness is tough enough without having added to the burden of illness, the pain and rejection of stigma," points out John Bowis, a member of the European parliament. But it's not just employers who are to blame. "We all contribute to the stigmatisation of people, who if they had a physical problem, would receive our sympathy and support," he suggests.

Stigma attached to mental illness appears to remain a worldwide problem, affecting people of all cultures. In a recent survey among people with bipolar disorder, conducted globally by the pharmaceutical company AstraZeneca, 88 per cent said they felt stigmatised and socially isolated on account of their condition. Bipolar disorder, characterised by severe and recurring mood changes along a spectrum ranging from overactive, excited behaviour (mania) at one end to deep depression at the other, usually requires pharmacological treatment and psychosocial training in behavioural strategies to maintain mental equilibrium. Therapies are available that could potentially help many people who are currently keeping their illness to themselves, struggling on without medication. Treatment would give them a better chance to lead fulfilling lives at work and home. Unfortunately, perceived stigma is a major factor stopping them coming forward for diagnosis and treatment. The issue is a serious one because there is a high risk of suicide among inadequately managed people with bipolar disorder.

A Lexicon to help the media avoid negative stereotyping

How public perceptions of mental illness are formed and give rise to stigma is debateable. The role of the media may be merely to reflect rather than shape public perceptions; but many people believe misrepresentations of mentally ill people are constantly reinforced unnecessarily by all kinds of media from newspaper and broadcast news-reporting, to literary fiction, TV drama and film. In Spain, the US and the UK, over half of people with bipolar disorder, and their carers, said they believe the media is a major propagator of discrimination against people with mental illnesses.

Ignorance is the root cause of stigma. Overcoming it requires education and greater awareness at public level of what mental illness involves and how recovery is possible with treatment, say organisations such as the World Federation for Mental Health (WFMH). As they see it, the media could be potential allies in changing public attitudes.

The WFMH and six other patient advocacy groups recently collaborated on a publishing initiative for journalists titled "The Lexicon: International Media guide for Mental Health" with the help of an educational grant from AstraZeneca. "The Lexicon" has been designed in consultation with people with first-hand experience of mental illness as well as senior journalists, to help journalists promote responsible and accurate coverage of mental health issues and to give a balanced perspective. Journalists can consult "The Lexicon" when writing news stories involving a mentally disturbed person to select appropriate terminology and to write with sensitivity instead of opting for pejorative labels. It includes expert contact details, facts and statistics about mental illness, the correct definition of much misused terms like "schizophrenic" and "split personality", and gives examples of good and bad reporting.

Discussing "The Lexicon" at a recent AstraZeneca media event, WFMH immediate past president Dr Patt Franciosi said: "It shows journalists how to replace words that hurt with words that could help". Instead of terms no better than playground insults such as "nutter", "psycho", "schizo" and "sicko", The Lexicon suggests instead using the person's correct diagnosis or a term such as "disturbed" which does not carry condemnation. Before publishing a story involving a mentally ill person, Dr Franciosi suggests journalists should ask themselves if mentioning a diagnostic label is relevant. She advises. "Read it through and ask yourself - is this offensive? If it involved a relative of yours, would you want someone to say that about them?" The Lexicon is available from the website www.forum4mentalhealth.com/lexicon.

"Learning about Bipolar Disorder"

Another publishing initiative from the WFMH, also supported by an educational grant from AstraZeneca, is an educational 'tool-kit' titled "Learning about bipolar disorder". This is aimed principally at people seeking help for mood disorders but includes a special section for healthcare professionals.

"Until the nature of bipolar disorder is better understood, and until stigma is reduced, many people with mood disorders will avoid or delay seeking help and remain in denial," believes Dr Franciosi. "In the process, marriages are wrecked and jobs lost." Around 27 million people worldwide are affected by bipolar disorder. It is the sixth leading cause of disability, yet much of it goes undiagnosed for years, she points out. The tool-kit is designed to empower people with bipolar disorder and their families by giving them the information they need to recognise, accept and manage symptoms more effectively. Of equal importance is the inclusion of advice directing them on how to create and maintain a healthy lifestyle, she notes. "Over half of people with bipolar disorder abuse substances such as alcohol. This has to be recognised and help given to overcome it."

The "Learning about Bipolar Disorder" tool-kit also provides information for health care professionals in primary care to whom people with bipolar disorder are likely to turn first for help. Explaining bipolar disorder to new patients presenting with mood disorder symptoms can present a challenge Dr Franciosi acknowledges. "Primary care staff cannot be expected to teach every patient all they need to know in detail." The tool-kit offers them a way to pass on that information in a format that is quick and easy to access and in which medical knowledge is translated into layman's language.

As a patient information guide Dr Franciosi claims the tool-kit is particularly effective for a reason. "We found that what makes this special is the inclusion of personal stories. These are what hit home the most," she explained. "People read the experiences of others and find they resonate with their own." It helps them find the means to understand their own illness history and articulate it, and to see how others have learned to manage their condition. "Cultural differences are reflected in people's stories but these have nothing to with who gets bipolar disorder and who doesn't. The condition affects people of all cultures and people are vulnerable to it throughout the world."

Two Weeks to Go

2008-10-20T15:33:00.000-07:00

I am not expressing an opinion of either Presidential Candidate on this blog, but the following information should be read. The information in this article shows where each candidate stands on an issue that is close to the heart of a lot of us in America. Please stay informed, make informed, educated decisions on the issues that affect us. Don't just expect "someone else" to take care of things for you.

The 2008 Presidential Election
Mental Health: The Candidates & Party Platforms

Explore the Candidates

In early 2008, the National Alliance on Mental Illness (NAMI) sent a questionnaire to all presidential candidates in each party. We encouraged candidates to provide us with other relevant materials or explanations of their positions on issues involving mental health even if they did not have time to respond to the questionnaire.

NAMI offers these responses and excerpts from party platforms for educational purposes only. NAMI is a non-profit, non-partisan organization. Non-profit charitable organizations, including NAMI state and local affiliates, are prohibited by law from endorsing specific candidates. This information should not be used by any NAMI affiliate to endorse any candidate.

Democratic Presidential Nominee

Sen. Barack Obama of Illinois
Questionnaire response

Republican Presidential Nominee

Sen. John McCain of Arizona
Sen. McCain provided NAMI with a Mental Health Statement in lieu of a response to our questionnaire. The Campaign informed NAMI that it is his policy not to respond to questionnaires.

View statements or responses of former presidential candidates who responded.

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New Bill Explaination

2008-10-18T11:35:00.000-07:00

Here is one good explaination of the new mental health bill that was passed tagged along with our bail-out plan.

Parity legislation helps people with mental illness

By DOMINIC HODGKIN and CONSTANCE HORGAN
GUEST COLUMNISTS

More than one in four Americans will suffer a mental or addictive disorder at some point in life. Lawmakers have now granted them a level playing field in health insurance. Congress took a historic step when, as part of the financial bailout package, it passed legislation prohibiting insurers from discriminating against people with mental illness and addictive disorders.

This is great news for the 113 million Americans who faced unequal treatment under insurance plans that apply tougher benefit limits or higher copayments for mental illness or addiction treatment than they do for medical and surgical conditions.

For decades, science has been gradually lifting the curtain on mental illness and addiction, making effective treatment available for many disorders. With this watershed legislation, policymakers are helping to close the door on the age-old culture of stigma toward people with mental illness or addictive disorders.

The bill's passage may prove unexpectedly well-timed. With the economy in trouble, there will undoubtedly be more need for mental health services. Research shows that economic recessions lead to more family stress, suicides, drug abuse among teenagers and binge drinking.

News of the bill's passage was buried by the drama-filled bailout. Indeed, some derided it as an earmark tacked on to the package, like the one for wooden arrows. These comments were off-target. The parity legislation was not a random item sheltered by the rescue package.

Leaders in both houses had been vigorously discussing the bill for months, and had largely approved it. It was the culmination of years of bipartisan efforts by Sens. Ted Kennedy, Pete Domenici and the late Paul Wellstone, and Reps. Patrick Kennedy and Jim Ramstad, among many others.

Mental illness has long been a target for discriminatory practices in private insurance markets. As a result, starting in the 1990s many states, among them Washington, passed parity laws, and the federal government passed a limited law in 1996.

But those measures had large loopholes. States often exempted important diagnoses such as addictions and eating disorders. Moreover, 82 million people are covered by employers exempt from state regulation. As for the federal law, it banned only special dollar limits on mental health coverage, allowing plans to continue using other limits and exclusions.

A Brandeis University survey of private health plans found that more than 90 percent had special annual limits on outpatient mental health and addiction treatment, and 40 percent required substantial copayments (more than $20 per visit, or 20 percent of charges). Those provisions result in high out-of-pocket costs for patients needing longer treatments.

The new federal law improves on the 1996 one in a variety of ways. First, it applies to addictions as well as mental health. Addictions are one area where the public and the patient benefit considerably from treating the problem. Successful treatment should reduce crime, car accidents and emergency room use, all of which impose costs on society. Arbitrarily limiting addiction treatment makes little sense.

Second, the new law prohibits a wider range of discriminatory practices, such as the use of special limits on the number of days or visits per treatment episode or per year. Those changes should improve access and reduce the cost for many of the millions suffering from these disorders. However, large increases in utilization are unlikely under managed care. Plans retain the ability to deny or curtail treatment based on their review criteria (although they must now disclose those criteria).

The bill applies only to people with private insurance, but sets a good precedent for mental health coverage in any future expansion of coverage to the uninsured. It's tragic that people with mental and addictive disorders are overrepresented in this group.

With any luck, the bailout will avert an economic depression. But just in case, it's critical that many more people now have better mental health coverage to weather good times and bad.

Good News

2008-10-05T15:35:00.000-07:00

We will see in the future how this bill will help everyone.

Mental-health parity law a big win for Kennedys

Tucked into the Wall Street bailout bill was a breakthrough for the estimated 113 million Americans suffering from mental illness - a provision making it illegal for health insurance companies to discriminate against patients suffering from psychological or behavioral disorders.

Adoption of the measure, hailed by a leading mental health advocacy group as a "great civil rights victory," marks the end of a decade-long struggle led by Senator Edward M. Kennedy of Massachusetts and his son, Representative Patrick Kennedy of Rhode Island, to ensure parity for mental illnesses in the eyes of the American healthcare system.

"The miracles of modern medicine make mental illness just as treatable today as physical illnesses," Kennedy, who is being treated for brain cancer, said in a statement. "After 10 years of debate, Congress has finally agreed to end discrimination in health insurance coverage that plagues persons living with mental illness for so long."

Kennedy added: "It will now be the law of the land that people with such illnesses deserve the same access to affordable coverage as those with physical illnesses."

The lead Republican sponsor in the Senate, Pete V. Domenici of New Mexico, singled out the Massachusetts Democrat for credit, calling his efforts remarkable. "This has been a labor of love for us," Domenici said in a statement.

The mental parity law, one of many amendments included in the legislation to broaden legislative support for the bailout package, requires health insurance companies to charge the same deductibles, copayments, and out-of-pocket expenses for mental health treatments as for all other illnesses.

Among other requirements, the law also requires the US Department of Labor to report to Congress every two years on how group health plans are complying with the law.

The nonprofit Mental Health America estimates that 67 percent of adults and 80 percent of children requiring mental health services do not receive help, in large part because of discriminatory insurance practices.

"This is a historic day and a great civil rights victory for millions of Americans who have been unable to access mental health treatment," said David Shern, the organization's president and CEO. "With approval of this bill we will tear down the walls of stigma and discrimination and open the doors to the power and promise of treatment and recovery."

Bill will Help with Insurance costs for the Mentally ill and their Employers

2008-10-02T17:53:00.000-07:00

One of the issues in the mental illness debate is, will employers feel like giving a mentally ill person a chance to prove that they can be a productive and dependable employee. I see this in the school system. I have some teachers who will take the time and use their teaching energy in a positive way to take the extra time it takes to work with a mentally ill student. On the other hand, a lot of teachers don't have the patience to give them the benefit of the doubt and just want them out of their rooms. I say "Thank you to the educators who will give those students not only a second chance but a third and fourth chance if needed.

Lawmakers make a final push for mental health bill

By KEVIN FREKING – 2 hours ago

WASHINGTON (AP) — Talk about going out with a win.

Sen. Pete Domenici, R-N.M., has spent years fighting for legislation that would require insurance plans to treat mental health patients on par with those who have physical ailments. No more higher copays or deductibles for the mental health treatments. No more limits on visits to the doctor that differ from the caps for other patients.

Domenici, after six terms, is leaving office this year. One of his final votes was on the mental health legislation he fought so hard for over the years.

The mental health protections are part of a massive bill designed to help the economy. Dominici senses that somehow the bill will become law, even though many lawmakers from both parties are unhappy with the economic bailout.

Domenici has a daughter diagnosed with atypical schizophrenia. He got involved in the parity issue after joining a National Alliance on Mental Illness support group nearly 20 years ago. On his way home from work, he and his wife, Nancy, would meet with other parents of children with mental health problems.

"The first real understanding of how broad the problem was came from those meetings where I met with mothers and fathers who had children who were mentally ill, and they were going bankrupt because they couldn't pay the health bills, or their children were in jails instead of hospitals," Domenici said.

He said perceptions about the ability to treat mental health problems have changed greatly over the years, but coverage has also become an expensive proposition. So, he and others, such as the late Sen. Paul Wellstone, D-Minn., began pushing for health insurance parity. Pushback came from those who would have to bear most of the expense.

"Those who stood to lose fought hard and that was principally insurance companies and businesses," Domenici said.

Employers and insurers were concerned that legislation would have required plans to cover a "telephone book" of conditions, raising costs beyond what companies and their workers could afford and potentially negating companies' ability to offer any health coverage at all.

The legislation now before the House does not mandate that group health plans cover mental health or addiction treatment, only that when plans do so, the coverage must be equitable to other medical coverage. The insurance industry is now a strong supporter of the parity legislation.

In 1996, Sens. Wellstone and Domenici won passage of a law banning insurance plans that offer mental health coverage from setting lower annual and lifetime spending limits for mental treatments than for physical ailments.

The pair again teamed up in 2001 on a predecessor to the legislation now before the House. After Wellstone was killed in a plane crash in 2002, Sens. Edward Kennedy, D-Mass., and Mike Enzi, R-Wyo., took on larger roles in getting a bill passed in the Senate.

The requirement for equal treatment in insurance coverage would apply to health plans that cover more than 50 employees — potentially reaching 113 million people nationwide.

Health officials contend that equal protections for mental health conditions would lead to a healthier, more productive work force.

"There's a phenomenon ... where you've got a psychiatric illness and you're able to get around but you can't do your work at the same quality you did before," said Dr. Nada Stotland, president of the American Psychiatric Association.

"Many workers today are in the service industry. If a person on the other end of the line is depressed, they may have shown up to work and they may be present, but they will not necessarily make us happy about the company that we're calling. They'll be slow, unhappy and maybe irritable, and their powers of concentration won't be good. So, more and more companies want to see their employees treated."

Overall, the parity legislation is expected to cost the federal government about $3.4 billion over 10 years. That's because employers will have more health expenses that they can deduct from their income taxes.

Continuing Progress on Mental Health Bulls

2008-09-28T14:06:00.000-07:00

Editorial: Time for parity for mental health coverage

by The Grand Rapids Press Editorial Board
Sunday September 28, 2008, 3:00 AM

WHY IT MATTERS

Mental illness can be just as terrible and even deadly as physical illness, but isn't treated that way by some insurers.

Diseases of the mind aren't always as visible or obvious as those of the body. But depression, schizophrenia and other serious ailments can be just as debilitating and deadly as diabetes and heart disease. Still, mental illness is too frequently treated differently by health insurance companies.

Last week, the U.S. House of Representatives passed a bill that will improve insurance coverage for people with mental illness. The bill caps more than a decade of debate on the question, and marks an important step forward in addressing diseases that are increasingly treatable and beatable, provided they receive proper attention and care.

The legislation mandates mental health parity, making it illegal for insurance companies to set lower limits on treatments than are set for physical ailments. The bill prohibits higher co-pays for mental health treatment, too. And it requires equal treatment for substance abuse, provided that it is offered by a medical plan.

Those provisions would end restrictions in many insurance plans that can force people with long-term illnesses such as bipolar disorder or anorexia to pay for their own treatment or forgo treatment altogether because they can't afford the cost.

A mental health parity bill has already passed the Senate by a vote of 93 to 2. The House legislation passed by a vote of 376 to 47.

The two versions need to be reconciled. President Bush has expressed support.

Nearly every member of Michigan's congressional delegation -- Democrat and Republican -- voted for the measure. The sole exception was Rep. Peter Hoekstra, R-Holland.

The bill could raise costs. Any hike in insurance premiums is difficult, especially given the skyrocketing price of health care generally. However, the Congressional Budget Office projected that an earlier version of the parity bill would increase premiums for group insurance rates by only four tenths of one percent.

Untreated and under-treated mental illness carries costs of its own, from worker absenteeism to family break-up. Building a better system of healing and prevention for mental illness will decrease those expenses to individuals and society.

The bill contains safeguards for small business, exempting those with fewer than 50 employees. The legislation does not mandate that mental health coverage be made available by businesses that don't currently offer health coverage. And it does not specify which mental illnesses should be covered, allowing health plans discretion to deal with more controversial and questionable diagnoses. If coverage is rejected, the bill requires a health plan to explain why.

In all, the measure strikes the right balance between costs and the health care needs of ordinary people. Those who suffer from mental illness -- estimates are as many as one in four adults in the United States -- know those conditions can leave them alone and adrift. Congress and the president can throw them a lifeline by completing and signing this important legislation.

Much needed Legislation

2008-09-25T16:33:00.000-07:00

We should be involved with our senators and congressmen to see that legislation gets passed.

Mental-Health Bill on Tap

By JANE ZHANG

Congress is on the verge of clearing legislation to require most employers and health insurers to put mental-health on par with physical illnesses.

That includes coverage for hospital stays and doctor visits, as well as co-payments and deductibles. Plans that offer out-of-network coverage for physical problems will have to add equivalent mental coverage.

But the legislation doesn't specify what disorders must be covered. Kathleen Mahieu, who heads behavioral health consulting at benefit-consulting firm Hewitt Associates LLC, said there is consensus that major problems such as serious depression, schizophrenia and substance abuse should be covered, but employers differ whether to cover autism, attention deficit disorder and some others. If coverage is rejected, the legislation requires the health plan to explain why.

Still, patient advocates welcomed the changes. "This is the biggest step we've ever taken in terms of integration of mental illness into the larger health care system," said Andrew Sperling, director of federal legislative advocacy for the National Alliance on Mental Illness.

Over the last 15 years, both the House and Senate had passed different versions of the bill, only to see them founder. This time, the bill has support of business and insurance groups. On Tuesday, the House passed a standalone bill and the Senate attached the same language to a tax measure. Now, the two chambers must reach agreement on how to pay the $3.4 billion cost over 10 years before lawmakers leave town.

The legislation doesn't require insurance plans sold to individuals, employers with fewer than 50 workers, or those that don't provide any health coverage, to offer mental health coverage.

It applies to about 150 million people: 82 million in federally regulated plans funded by employers, 31 million in state-regulated plans and 36 million children and adults covered by managed-care Medicaid programs, the federal-state health insurance for the poor, a Senate aide said.

The legislation ends such common restrictions as 30-day hospital stays or 30 visits to a mental health professional if the plan doesn't similarly curb treatment for physical problems, Ms. Mahieu said. Reimbursement rates for doctor visits or hospital stays must equal the percentage paid for physical illnesses.

About one in four employers told a Hewitt survey they already offer mental health parity, but it's unclear whether their plans would meet the bill's requirements. President Bush has signaled support; the legislation would be put into practice nationwide by January 2010 if it becomes law.

That will make a big difference for people like Loretta Geyer, a 51-year-old social worker in Euclid, Ohio. She said she spent $4,619 out-of-pocket on medical care last year, mostly to treat her bipolar disorder. To save money, she said she often waits to get treatment until her condition worsens.

Her therapist doesn't accept insurance coverage, and Ms. Geyer, who sees her often once a week, pays out-of-pocket and then seeks reimbursement from her insurer, which pays her for 40% of the first 10 visits a year after a $300 deductible.

Employees might find an increase in premiums or deductibles because of the legislation. A survey by the American Benefits Council, an industry group, found 39% of large employers said they will charge employees higher premiums, while one in four also said they would change benefits or adjust total compensation, including slowing down wage increases. One in 10 said they will do both.

Death of a Genius

2008-09-21T13:28:00.000-07:00

This book you will find in my book list on this blog. What a good looking young man and mind that succumbed to his chronic depression. Time Magazine gave him a fabulous write up worth reading as well.

David Foster Wallace: The Death of a Genius

By Lev Grossman Thursday, Sep. 18, 2008

David Foster Wallace

Suzy Allman / The New York Times / Redux

What would you write if you could write absolutely anything? This is the question that, as a reader, one imagined David Foster Wallace facing. Whereas ordinary authors resorted to the standard tricks of the trade--write what you know, look deep into your soul, whatever--Wallace seemed to have no earthly constraints. He knew everything and could look into anybody's soul he wanted to. Any writer in America would have killed for his talent, but the man to whom it belonged killed himself. On Sept. 12, Wallace's wife discovered his body at their home in Claremont, Calif. He had hanged himself. He was 46.

He was David Foster Wallace only on the page. His first agent suggested that he use his middle name, to distinguish him from another David Wallace, and it stuck. Born in 1962 and raised in Illinois, he was a competitive junior tennis player--at 14 he was ranked 17th in the Midwest. He studied philosophy at Amherst College and then Harvard, and when he was only 24, he published his first novel, The Broom of the System. In 1996 he vaulted into the upper ranks of the literary world with Infinite Jest, his 1,079-page (and 388-footnote) meta-epic of tennis, drug addiction, art, terrorism and loneliness set in a future when each year is known by the name of its corporate sponsor (e.g., the Year of the Trial-Size Dove Bar). Infinite Jest was the quintessence of 1990s literary maximalism, and it became instant required reading. Enough with those '80s party-boy writers! Here was a novelist with the industrial-strength intellectual chops to theorize even our resolutely anti-intellectual age. Wallace became a reluctant literary pinup, with his stubbly outsize chin and his shoulder-length hair. He was America's No. 1 literary seed, at the top of a hierarchy that was, one suspects, largely meaningless to him.

Reading it now, with the burden of hindsight, one sees that Infinite Jest is ominously infested with suicides, including that of the hero's father, who cooks his own head in a microwave. But back then, Wallace seemed invulnerable. How could a man who had put such crowds of people on the page--Wallace's ear for dialogue was unmatched in contemporary fiction--truly be lonely? Once you've gone inside the mind of a critically burned toddler, as Wallace did in his short story "Incarnations of Burned Children," what horrors can't you face? When he accepted a professorship of creative writing at Pomona College in 2002 and then got married in 2004, one imagined that his relentlessly generative genius might finally be undergoing some domestic mellowing.

Now we have some idea what it was that he couldn't face. Since his death, Wallace's family has stated that he was chronically depressed. He had been taking medication for his condition for 20 years and had occasionally been hospitalized. "Everything had been tried," his father said, "and he just couldn't stand it anymore."

What was "it"? In Infinite Jest Wallace wrote--in a passage that now reads like a lucid cell-phone call from the pilot of a crashing 747--that clinical depression is "lonely on a level that cannot be conveyed ... Everything is part of the problem, and there is no solution. It is a hell for one." What Wallace suffered was both agonizing and indescribable, even by him. And that last may have been what made it unbearable. Like Hamlet--who gave Infinite Jest its title--he had that within which passeth show. Even if he could have written on and on, an infinite number of words, it would never have been enough.

Oneofthose days

2008-09-18T15:31:00.001-07:00

This was one of those days. My bipolar student has not been sleeping for about 1.5 weeks. I know this is a red flag with the mentally ill. His mother is a nurse and has been working nights, single mom, I am sure she makes more money on nights. But in the meantime, my student, I will call him Dane, is staying up all night worried about her not being there. So today was the day, today was the day that he could not handle it anymore, restless, would not sit in his seat, then started the running. When he is on edge he starts running around the school; mother was called, etc. What is sad for me is that I know what he faces and his mother faces in the future. The principal has already started documenting his behavior and is starting the process for him to go to a "behavior" school. Of course his intelligence level is extremely high, but the regular ed. teachers just want him out of their class. He is a great student, as long as he gets his sleep and takes his medicine, (heard that before?) I was saddened by seeing another instance of the mentally ill not being able to live in the "real" world. If the mentally ill can't "act" like the rest of the world, then they are asked to go somewhere else. I have been asking the teachers to have patience, they just don't understand just how much patience is required for the mentally ill. I want Dane to stay at the school in his neighborhood with his friends, but unfortunately his actions will ensure that he will be forced to go some where else. very sad. I just hope that we don't read about Dane committing suicide in the future, I won't have any regrets that I did all I could to help this child and I hope the other teachers don't read about Dane in the papers one day and wonder if they did all they could for this child.

To change the subject, this article is talking about me as well. I did write the book, I did tell the family's best kept secret, and I, even after all those years, changed the names of the family. When I started writing the story about our mother, my brothers thought it was "kinda" cute. Then when I got the book published, they both called to say "You did change our names didn't you?" So I will tell you that we are guilty of giving in to the stigma, and are still doing it. If you asked my brothers now about their mother, they would be hesitant to admit that she was as ill as she was. Some of us can admit that our loved ones are severely ill, some can't. I really have a hard time believing that I am actually working with students who are bipolar as I said when my mother died that I never wanted to work with that "disorder"again ever in my life. Now I am getting paid to do just that; go figure.

Mothers’ stories of mental illness

by Wendy Elliott/The Advertiser
View all articles from Wendy Elliott/The Advertiser
Article online since September 18th 2008, 10:14
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Mothers’ stories of mental illness

BY WENDY ELLIOTT

Kings County Register

Marty is a grandmother several times over, but she feels as if the umbilical cord is still attached to her own son, Adam.

“Sometimes, he’s like a four-year-old who wants to go out and play on the highway.

“He’s a threat to himself.”

Marty’s tears flow as she describes life with a paranoid schizophrenic. She wipes them away with her hand, though, and keeps talking.

Although he always acted out, at the age of 17, Adam began behaving erratically.

“He’d burn himself with cigarettes. He wouldn’t go to school. He did really weird things.”

Adam became a skilled tradesman, but “every time there was a crisis, he’d lose it.”

This strong and handsome man, now in his early 30s, has lost a wife, two children, a home and every job he’s ever had.

“He doesn’t see what you and I see. He hears voices in his head.”

Mental health professionals have told Adam his illness was all in his head, Marty says, suggesting he take Tylenol.

“He’d sit babbling in front of the doctor. He wouldn’t help him. In fact, he left him and walked out the door. Those that are ill need help.”

She terms adult protection services useless: “‘Go and stay with your mother,’ they’d say.” And, Marty adds, community services treat the mentally ill as capable of work. They’re not.

She blames a healthcare system that doesn’t help the mentally ill.

“They do not want to deal with it – financially.”

Marty says her son was only diagnosed four years ago. He spent a month in the hospital, “was totally drugged and then told to go work in the woods. He could hardly lift a chain saw.”

He tried suicide. He’s slept in clothing bins and eaten out of dumpsters. Since sick people are ill, they act strange, often getting evicted. Adam has slept in a tent and frozen while trying to pick apples. Local police know him well: they chase him out of public places if he is behaving erratically but, sometimes, his mother says, officers have given him money.

“Sometimes, he’ll lose it and break things. I’ve lost 50 TVs while he looked for microchips.”

While some families get burned out trying to help - “they had to let them go or lose their minds,” Marty has made her son’s improvement a mission.

“There isn’t anything I won’t do for that child. He’s living on the edge of society like he’s transparent. When I look at my son, I see the loving, sharing, compassionate person he is. He’d give away his shirt to help someone else.

“He can be very angry and frustrated,” she notes. When he’s on his meds, he’s 100 per cent better. “He still can’t concentrate, but he wants to work. I’ve got a piece of him back.”

Marty has been to court twice to try to access treatment for Adam. With the involuntary treatment law, she encountered a warm-hearted judge.

“I sat there, read my letter and cried. I told him, he’s not an adult, he’s my child and he’s going to do something to hurt someone.”

Adam has been criminalized because of his illness on an assault charge.

This judge ordered him treated and he spent two weeks at Valley Regional Hospital. The result, Marty terms, was a miracle.

“It’s a blessing. I see his blue eyes and there’s life there. He’s a grown man, but it’s like the first day of school.”

Looking back, Marty says, “this has been hell.”

No pill for disease, stigma and lack of support

Pat, whose son, Jack, also has schizophrenia; says he was diagnosed when he was about 23 - he is now 37.

“It has been a long road for our family, and that illness has coloured all of our lives. It is just the saddest thing to see what happens to a young person with this disease.”

Pat says support he receives from any mental health professionals is minimal and credits monthly visits with his psychiatrist for keeping him out of hospital.

“The medication that these patients need to take is no magic pill: it enables them to function somewhat normally. Believe me, I pray for a magic pill.”

Stigma is a big problem. As a culture, Pat believes, we punish the ill and vulnerable.

“As it is now, he has not made any new friends since he became ill. Understandably, people are sometimes frightened or put off by his demeanour.”

Jack, who holds down a job in a restaurant kitchen, has social contact with his siblings and parents.

“It must be a very lonely existence for him.He is one of the fortunate ones: he can hold a job and maintain an adult living arrangement.”

(Editor’s note: all the names in this article have been changed to protect families from the stigma of mental illness.)

Exciting Research

2008-09-14T16:43:00.000-07:00

This is interesting in that one of the reasons why we don't have more information on BPD is because we have not been able to successfully do testing with laboratory mice. I know that a lot of medical problems have been solved or helped dramatically by the research done in the lab. We have always known that BPD is a chemical im-balance so we will hope for a cure not just the ability to contain and maintain this disorder.

Bipolar Disorder: Manic Mouse Made With One Gene Missing

ScienceDaily — Bipolar Disorder (BPD or manic-depressive illness) is one of the most serious of all mental disorders, affecting millions of individuals worldwide. Affected individuals alternate between states of deep depression and mania. While depression is characterized by persistent and long-term sadness or despair, mania is a mental state characterized by great excitement, flight of ideas, a decreased need for sleep, and, sometimes, uncontrollable behavior, hallucinations, or delusions. BPD likely arises from the complex interaction of multiple genes and environmental factors. Unlike some brain diseases, no single gene has been implicated in BPD.

A major limitation to progress in research and treatment has been the lack of an appropriate animal model for BPD. This work was developed to create such a model based on a genetically engineered defect in the GluR6 gene. The glutamate receptor 6 (GluR6 or GRIK2, one of the kainate receptors) gene resides in a genetic linkage region (6q21) associated with BPD. Kainate receptors respond to the neurotransmitter glutamate, and recent research in mood disorders suggests that the glutamatergic system may play a role in causing mood disorders.

Until now, the role of GluR6 in regulating the mood swings of BPD has been unknown. Furthermore, the gene encoding the GluR6 receptor has recently been linked to treatment emergent suicidal ideation with antidepressants in a pharmacogenetic study. Notably, individuals with bipolar disorder are most susceptible to antidepressant-induced dysphoric states. In this study, mice of several strains were used to investigate this issue. Mice who were missing the GluR6 gene were compared with control mice.

The mice underwent a series of tests designed to approximate the symptoms of mania. The researchers found that mice that were missing the GluR6 gene exhibited many of these symptoms. They were more active in multiple tests and super-responsive to amphetamine, which is used in animal models to approximate hyperactivity. These mice also exhibited less anxious or more risk-taking type behavior and less despair-type behavior. They also tended to be more aggressive.

Notably, BPD is most often treated with a class of medications known as mood stabilizers; lithium is perhaps the best known of these medications. The researchers found that chronic treatment with lithium reduced hyperactivity, aggressive displays, and some risk-taking type behavior in mice missing the GluR6 gene. When biochemical tests were conducted, they also suggested that GluR6 may play a unique role in regulating some of the symptoms of mania. This new animal of mania permits researchers to better understand bipolar disorder and to screen for new treatments that if successful in the animal model can then be translated to the clinic.

Familiar Story

2008-09-08T16:51:00.000-07:00

This is the same story that is being lived by a lot of families all across America. Our loved ones need help before they commit a heinous crime. They need help before they retreat into a delusional nightmare and are un-treatable. Please see that this situation is real. We do need new commitment laws, but our mentally ill loved ones, the severe ones, need to have medicine administered before they reach the "involuntary commitment" level of mental illness. They deserve a better life and so do the community and families that are affected by their mental illness. I have lived this story and I am sure a lot of you have as well. There is nothing more frustrating than trying to get your mentally ill loved one help or trying to get them to accept the help that is being offered them. They have all of the right of refusal until they actually hurt themselves or someone else, then their behavior becomes a police concern. That is the whole problem. This mother calls her son's illness the intruder, we called my mother's the monster. My dad would announce that the "monster has reared it's ugly head again" when she would go into her manic, delusional person. I feel her pain.

A 'gravely disabled' mental health care system

State's broken process wastes money, chances, lives

By CAROL SMITH
P-I REPORTER

Liz Browning nudged open the unlocked door of her son's Capitol Hill apartment and recoiled at the floor blanketed with garbage -- drifts of unopened bills, mounds of cigarette butts, rotting food and feces.

"Hello ... hello?" Her voice captured on a video taken in March sounds strained, wishing her 22-year-old son into view, and at the same time terrified of what she might find. "We brought you some food. ..."

She was startled, as her son Marc loomed into the frame -- tall, baby-faced handsome but disheveled, his long dark hair hanging in his face, a cigarette hole in the crotch of his drooping pants. He muttered to himself, and glared at the camera.

Browning felt sick from the stench. She forced herself to keep talking, trying to reach some part of him that remembered who he was before: Marc -- the funny, sweet-natured scion of a prominent Seattle family and descendant of legendary firearm inventor John M. Browning; Marc -- the boy who once played Michael Darling in a Seattle Intiman Theatre production of "Peter Pan." That Marc had disappeared.

Mental illness is an insidious form of identity theft, erasing one future and replacing it with another.

But the state's mental health care system abets the crime. The Brownings, like thousands of other Washington families dealing with mental illness, are snared in a Kafkaesque system that won't help people with serious symptoms until they are in imminent danger of harming themselves or others, or gravely disabled -- standards so high they exclude many who desperately need help.

But this strategy ends up costing the public more money, and puts citizens at greater risk, a scenario tragically highlighted in this state by a string of high-profile slayings by people who had severe mental illness but could not be treated despite signs that they needed help.

How the state treats -- or fails to treat -- its mentally ill is in the headlines again after Tuesday's bloody shooting spree, which left six dead. The family of Isaac Zamora -- the man arrested in the Skagit County killings -- has said the state didn't deal with his mental illness to help him and to protect the public.

It's not for lack of spending money that the state has failed. A Seattle P-I analysis found that the state spends at least $1.8 billion a year directly and indirectly dealing with mental illness, or its aftermath. Of that money, $530 million is spent directly on mental health care. The rest -- $7 out of every $10 -- goes toward prisons, police, homeless shelters and other social services that deal with the consequences of lack of treatment and preventive care.

This approach keeps people cycling through the streets, courts and jails. Beyond that, it squanders opportunities to intervene early on when there may be a better chance for successful treatment and recovery.

Ultimately, it wastes minds and costs lives.

The intruder

Liz Browning took in the bunker of her son's illness. An upright vacuum lay toppled on a table. Shaving cream blotted part of the bathroom mirror, and glass from a broken window littered the floor. Electronic devices -- a television, an iPhone and a computer -- all smashed. It appeared that a frantic intruder had trashed the place.

Marc insisted to his parents that there were people shadowing him -- people who vandalized his property and spoke to him in "voices you don't want to hear."


	Dan DeLong / P-I
Liz Browning wipes away a tear after visiting her son Marc at Western State Hospital.

But Marc's connection to reality had been spotty and fading for months. He started to lose himself in pieces. Strangers called his parents to tell them they'd found Marc's phone buried in their yard. Other strangers found his wallet in the street. Occasionally he would show up on the veranda of his family's gracious Capitol Hill home, ranting through the door until, feeling trapped, his mother called 911.

Now Browning stared into the face of the intruder. The invader had taken up residence in Marc's mind. The invader's name was schizophrenia.

A few months earlier, Marc had called for help. "I love you a lot," he began in a voice message left on his parents' phone: "If I could ask for one thing -- if you could find me a good hospital ... I just can't do it ... I'm not thinking right -- everything is just going poorly for me. If I could just feel better, look to the future ... I feel so lost."

Over the next three days, Browning and her son went to three hospitals -- the University of Washington Medical Center, Harborview Medical Center and Swedish Medical Center -- none of which would or could accept Marc because he wasn't sick enough.

"You almost hope they are really, really bad," Browning said. "And that's just so wrong."

Do not pass go

Hospitalizing someone for mental illness has morphed from a medical decision into a legal issue, said Dr. Peter Roy-Byrne, chief of psychiatry at Harborview. "It's like if someone came into the ER with chest pain or cardiac arrhythmia, and we had to tell them, until they have a heart attack or need a heart transplant, we can't do anything."

Then when patients are sick enough to go to the hospital, they are often more difficult to treat. Or patients get stabilized just enough to be sent back to the community, where, without sufficient services and follow up, they fall apart again. In what becomes a malevolent sort of social Monopoly game, the players are constantly forfeiting their gains to start over -- or go to jail.

For families, it's a grim game with stakes that are too high. There's a complex web of reasons for their frustrations.

Washington is one of the few states where neither families nor their doctors can decide that someone needs to be committed involuntarily for care. The only people who can make that petition are county-designated mental health professionals -- government workers, who are not typically psychiatrists or clinical psychologists.

There are 28 such workers to handle crisis calls from a county with a population of 1.8 million, a ratio that frustrates many clinicians who say that between the laws and the decision-making process, they are frequently unable to provide care, or are forced to release people when they are still in a precarious mental state.

Strict application of only the most severe criteria for commitment, coupled with a critical shortage of psychiatric hospital beds, prevents many people from being hospitalized when they might most benefit from it. Group housing with supervised treatment, scarce to begin with, is disappearing, limiting options for people facing hospital discharge. Although community outpatient mental health programs exist, the majority of patients who end up in them eventually vanish from treatment.

Nearly two-thirds of people who used public mental health services at least once never returned, according to the state's Institute for Public Policy Research, which recently looked at compliance levels. In the lexicon of mental health workers, they are known as "leavers."

"We wouldn't let an Alzheimer's patient leave the hospital to go sit on a sidewalk grate and rot," Roy-Byrne said. "But we do that all the time for people who are mentally ill."

Jails as 'psych wards'

Between January, when he asked for help, and March, when the police finally put him into restraints and hauled him to West Seattle Psychiatric Hospital, Marc's prognosis darkened.

By then, whatever inclination he might initially have had to help himself had been subsumed by illness. On his admission, Marc told social workers he wanted to "get a restraining order against the police because they won't leave me alone."

According to hospital notes, he didn't seem aware of why he had been brought in. He was angry, his mood unstable, and he denied being sick. He refused antipsychotic medication, and the hospital by law couldn't force injections without an additional court order. Within days, Marc was out of control, attacking staff members during an altercation over his smoking privileges. Several orderlies had to forcibly restrain and sedate him.

Then they called the police.

On April 24, Browning waited behind a glass enclosure while her son, wearing an orange jailhouse jumpsuit, was led into the courtroom. He seemed oblivious to the seriousness of the occasion, or even why he was there.

Marc stared around the courtroom, and glimpsed his mother behind the glass. The judge dismissed the charges and ordered him to Western State Hospital to be re-evaluated for civil commitment. When the judge asked him if he had anything to say to the court, he said: "Why is my mother crying?"

Psychotic break

After the hearing, Browning stood on a street corner outside the jail still shaking with frustration. She had been operating on adrenalin for months as her attempts to get treatment for Marc verged into theater of the absurd. At every turn, either the law, or the disease, blocked her attempts to intervene.

On this day, her shoulders hunched forward, and fatigue pressed its thumbs under her eyes. Behind her, the giant image of a man somersaulting down a wall in perpetual freefall decorated the side of a county parking structure, an apt, if unintended, metaphor.

It felt, she said, like they were back where they started, only worse off. Now instead of a treatment plan, her son had a jail record.

"It's like I don't even know him anymore," she said.

Marc, the youngest of three children, was an unassuming, well-adjusted, happy kid growing up, said family and friends.

"He was a sensitive and sweet with a natural charm and kindness," said his older sister, Ann.


		Photo Courtesy Of Liz Browning
	Marc Browning, shown at age 2 in 1988. Growing up, Marc was a well-adjusted, happy kid.

Though he was smart, school was hard for him, and he drifted with little ambition, said one of his elementary school teachers.

In eighth grade, his parents sent him to a small private school for boys with dyslexia, but his problems continued. A year later, a school psychiatrist diagnosed him with bipolar disorder.

During his junior year in high school, he was hospitalized for depression and suicide risk. Though he graduated and started college at Eastern Washington University, he dropped out in January 2005 -- the middle of his freshman year -- to go live with his older brother in Las Vegas.

One night, Marc began tearing apart the attic in the house he shared with his brother, looking for cameras he was convinced were tracking him. He accused his brother of controlling his thoughts. His parents persuaded him to go voluntarily to a hospital in Las Vegas for a week, then flew him back to Seattle.

But at home, his mental health continued to deteriorate, and in June 2005, a court committed him to a private psychiatric hospital. This time, Marc was uncooperative and tried to escape. The hospital wouldn't take him back.

So his parents did.

Marc's behavior grew increasingly erratic and frightening. He withdrew to his room for days at a time. Once, he slammed a chair through a window. His mother began locking herself into her own room at night, fearful of what he might do next.

In February 2006, the Brownings were able to get him committed on an involuntary basis, this time to Harborview Medical Center, where doctors diagnosed him with schizophrenia.

He was 20 years old.

For Liz Browning, her son's diagnosis confirmed a haunting heritage she had feared on some level since her children were young -- a genetic loading the family couldn't escape.

A genetic bullet

On a recent morning, Browning hurried to meet her mother-in-law, Gloria Browning, at a Belltown cafe. They have much in common -- both strong-willed and articulate, they also share a body of knowledge few of their friends comprehend. It's Gloria to whom Browning turns when she needs someone who understands how mental illness shape-shifts a life.

The cafe is just steps from where Gloria Browning lives in a luxury high-rise condominium, and also where many of the city's mentally ill wander the streets, untreated and unhinged. She rarely goes out in her neighborhood after nightfall.

This irony is not lost on Gloria, now the matriarch of her famous family, but she speaks unflinchingly about the Browning legacy. Browning inventions helped build the most widely used firearms of the 20th century -- weapons that saw the nation through two world wars.

No gun John M. Browning designed, however, and no amount of wealth the family enjoyed, could defend against the genealogical bullet ricocheting through their family tree.

Gloria had six sons. Her eldest, namesake of his famous grandfather, leapt from the Golden Gate Bridge at age 27 after suffering for years with symptoms of schizophrenia and struggling to tolerate his medications.

He left a note saying he wished he could have lived.

A few years after his older brother's death, a second son shot himself. That son had struggled with addictions, including to anti-anxiety medications.

Now, two of Gloria's grandsons, including Marc, also struggle with mental disorders.

Gloria keeps track of advances in brain research and hopes for the day better treatments and earlier interventions let more of those with severe mental illness reclaim their lives.

The imposter

Liz Browning thought Marc had almost gotten his own life back.

After hospitalization at Harborview in the spring of 2006, he was released and lived for seven months at the Inn, a transitional group home in Seattle, which since has closed. There, he was supervised to make sure he took his medications, and soon, the witty and easygoing Marc re-emerged.

Encouraged, his family supported a move to his own apartment. He found one himself, outfitted it from Ikea and started back to school at Seattle Central Community College. He stayed on his antipsychotic medication, and paid his bills on time. His past few years began to seem a surreal detour.

But it's under this cloak of normalcy that mental illness lays its trap. People living with mind disorders start to believe that they no longer need the programs or medications that keep their thoughts in line, the voices at bay.

Within a year, Marc quit his medications. He stopped going to school. Quit paying his bills. Stopped making sense.

Because he had been out on his own, the mental health system had no mechanism for intervening, no way to break the freefall to come. Untreated, schizophrenia has its own kind of gravity, sucking its victims in like a black hole.

Even Marc could feel himself slipping. In January, he called his parents for help.

Browning saved the message, and plays it when she wants to make a point -- to doctors, to lawyers, to mental health professionals -- that the Marc they see -- the hostile youth, the disoriented inmate, the uncooperative patient -- that Marc is an imposter.

She plays it for herself.

Call back later

Liz Browning puts out a pot of tea for visitors on her back porch one recent sunny morning. She has a low threshold for small talk, and the conversation quickly turns to mental disorders. If schizophrenia has seized her son's mind, it has also taken over her own life, consuming most of her time and energy. After the April assault charges, a mental health court ordered Marc to an involuntary commitment at Western State Hospital, where he remains today. His progress there has been slow, aggravated she feels by the long periods of time he spent off medications as he pinballed through the system.

Doctors confirm that it's harder to recover from each psychotic break.

"My greatest fear is the psychosis will be so damaging, we can't get him back at all -- that he will be so ill, he's not really treatable," she said. "I might not know what I am fighting for."

She's helping to spearhead a movement to train more defense attorneys for work in mental health courts. She's advocating for the need to get commitments sooner. She's trying to organize an effort to create long-term care facilities where people with intractable mental illness can live together, work and have a decent quality of life.

But what she really wants, right at this moment, is to reach her son. She picks up the phone and dials the pay phone in the community room of his ward at Western State. A patient answers. She introduces herself and reminds the patient that she's met him, that she's Marc's mother, that Marc's the one who always wears a stocking cap. Could he tell him she's on the line?

Browning hangs on, the phone cradled against her shoulder. A few minutes pass. The patient never returns. Marc never picks up.

"I'll have to call back later," she says, to no one in particular.

This is what having your life hijacked by mental illness is like, being on perpetual hold.

Waiting to connect.

Too sick to Realize

2008-09-06T15:30:00.000-07:00

A lot of mentally ill persons can be too psychotic to realize they are extremely ill. Most people do not want to medicate anyone unless they are not in the proper frame of mind to make positive decisions. If a person is so sick, like the man in Washington State this week, that they think God is talking to them and they shoot innocent people in the name of God, then some intervention should be done for the sake of the innocent in the community. The laws used to be, years ago in one direction, now they have gone too far in the other direction. Surely we can find some happy medium so that the diagnosed mentally ill can be happy and the community does not have to suffer having their loved ones shot down by someone who is not in cooperation with what the medical staff has prescribed for their treatment. I keep repeating this after another innocent person has been needlessly killed.

Liz

Experts: Larry Evans Jr. faces long stay in mental facility after verdict in murder trial

Treatment Need for new law? Time for healing

MANSFIELD -- Larry Evans Jr. probably won't leave a mental health facility anytime soon.

Evans, 40, was found not guilty by reason of insanity Tuesday for the Dec. 26 shooting deaths of his brother and his neighbor. He will be committed to the Timothy B. Moritz Forensic Unit, a maximum security psychiatric hospital in Columbus.

In six months, the court will receive a status report on Evans. The court then will revisit his case every two years.

Relatives of the victims -- Mansfield police Officer Brian Evans and Robert Houseman -- worry that Evans could be a free man in a relatively short time. If convicted, Evans would have faced the death penalty.

But according to one local expert, those like Larry Evans who are placed in psychiatric facilities usually serve terms very close to what they would have served in prison.

"The length of time they can be held is equal to the maximum sentence for the highest charge they would have faced," Richland County Mental Health & Recovery Services executive director Joe Trolian said. "Very rarely are people restored (to sanity) in six months. If that happens, that's a pretty good indicator something was missed."

The Moritz Forensic Unit, under the direction of the Ohio Department of Mental Health, has a capacity of 76.

"It's maximum security by any sense of the term," department hospitals deputy director James Ignelzi said.

Ignelzi explained the facility's role.

"With Larry, he's already been found insane," he said. "Our job is to treat him. He's committed to us, not sentenced to us."

Recommendations on the Evans case will be made by hospital officials.

"We work for the court," Ignelzi said. "The court has total control of this case."

Sandra Cannon, chief of the Office of Forensic Sciences for the state health department, elaborated.

"Larry will stay under the jurisdiction of the court for life," she said. "He will not be released until he is no longer a threat. The judge makes that decision.

"He might not (end up) in Moritz, but he'll be in a facility for a good long time."

Hospital officials would continue to monitor Evans if he is ever released.

"We really do try to balance public safety," Cannon said. "If he's a risk, we're not going to recommend him (for release)."

Only one-half of 1 percent of criminal cases involve people found not guilty by reason of insanity, Ignelzi said.

Trolian said it is much more common for people to be found incompetent to stand trial. They often can be restored to the point where they can help with their defense.

Evans was found competent to stand trial, but three doctors ruled he was insane the night of the shootings.

"They're basically taking a look back at the time of the crime," Trolian said. "Was the person in a position to determine right from wrong?"

Relatives of the victims lamented the ruling, saying Evans wouldn't be sufficiently punished.

Trolian said he could understand their feelings.

"I feel there should be a sentence included so you serve the minimum sentence in some type of restrictive facility," he said. "We're letting the mental illness completely excuse the action."

Ohio House Bill 299 would change that. Introduced in August 2007, the bill would establish a process for courts to order and community mental health boards to oversee the provision of assisted outpatient treatment.

Assisted outpatient treatment is a less restrictive alternative to involuntary hospital commitment. It's for people with mental illness who may not require hospitalization, but who don't adhere to voluntary outpatient treatment.

The proposal targets patients who have had multiple psychiatric hospitalizations and have histories of dangerous behavior.

"It would be more consistent with laws around the country," Trolian said. "Ohio is definitely behind the times."

Rep. Tom Patton, R-Strongsville, introduced the bill after a May 2007 incident in which Timothy Halton, who had a severe mental illness, shot and killed Cleveland Heights police Officer Jason West. Halton, who reportedly was known to be violent when off his medication, shot West with no provocation.

Mary Kay Pierce, executive director of the National Alliance on Mental Illness, Richland County, is another backer of House Bill 299.

"There has to be a way we can get people help," she said. "These are brain disorders. They may not even realize how ill they are.

"I'd like to get people help when we know they need it. Under Ohio law, you can't make people get treatment unless they're a threat to themselves or others."

Pierce was in the courtroom Tuesday for Evans' trial. She saw the pain, anger and hurt that followed the verdict.

"There's so many families that are hurting right now," Pierce said. "The incidents that happened are devastating, not only to the immediate families, but to many individuals who know and loved both men who lost their lives."

Pierce knew Brian Evans, who went through National Alliance on Mental Illness crisis intervention training, and found him to be compassionate. She has talked to Trina Evans, Brian's widow, several times. Pierce said she is available to any of the families involved.

"We're only in the beginning stages of helping our community get through this," she said.