Mental illness and the US justice system

Decriminalizing mental illness

2010-01-03T10:13:00.000-08:00

January 03, 2010 12:37 am

— By Jennifer Jacob Brown
jbrown@themeridianstar.com

Every day in the Lauderdale County Detention Facility, jail workers have to run more than just a prison for criminals. Though they lack the training and resources to do so, jail workers are forced to run a prison for the mentally ill as well.

Meanwhile, mentally ill patients are often in a state of terrified shock when they are thrown in jail because there are not enough beds in mental hospitals. As they await transfer, they are generally not seen by anyone with expertise in mental health.

The mentally ill that fill jail cells are not restricted to those awaiting beds at a mental hospital. Often, the mentally ill are in jail because they were charged with crimes their mental illness caused them to commit. With no form of mental health rehabilitation in jails, experts say their rate of recidivism is high.

But a local group of mental health workers and concerned citizens is working to change the laws and attitudes that contribute to the criminalization of mental illness. The group meets once a month, and this month they will be part of a seminar meant to educate the public and lawmakers about how criminalizing mental illness hurts both the mentally ill and the community in general.

The seminar "Treatment, Not Jail: Strategies to Prevent Criminalization of Individuals with Mental Illness", will be held Jan. 11 at the MSU-Meridian campus and is free and open to the public.

The seminar will cover both why its important to keep the mentally ill out of jail and how that can be accomplished.

One local official who's ready to see it accomplished is Sheriff Billy Sollie, whose responsibilities include running the county jail.

"The staff and facilities (at the Lauderdale County Detention Facility) were not designed, trained, or equipped deal with people who are suffering from mental illness issues, and it puts a strain on the employees and the facilities," he said.

At any given time, he said, the jail may have no mentally ill patients awaiting transfer to a mental hospital, or it might have as many as seven. "Only one," said Sollie, "creates a huge issue for the staff," and also takes up space
These numbers do not include mentally ill people who are convicted of minor crimes and sent to jail, rather than a mental health facility, over and over again. Sollie said one local person who is mentally ill has been arrested more than 30 times in the past two years, and another has been arrested 25 times during the same time period.
Sollie said getting the mentally ill out of jail and into hospitals isn't just about taking the strain off of jail workers, it's about treating people right.

"It would be providing care instead of incarceration... not hiding a problem by incarcerating it, but providing care for a resident," he said.

But keeping the mentally ill out of jail won't be as easy as 1,2,3 - Mississippi law will have to be changed.

Kristen Owen, a therapist at Weems Mental Health and president of the Meridian affiliate of the National Alliance for Mental Health - Mississippi, said that under current law, law enforcement officers don't have the authority to deem someone mentally ill and take them to an assessment facility. Their only alternative is to arrest mentally ill people who are causing a disturbance in the facility and take them to jail.

Last year, State Rep. Alyce Clarke (D-Hinds County) tried to change that, at least in Hinds County, by introducing a bill into the house that would have allowed Hinds County to create Crisis Intervention Teams - law enforcement officers trained to recognize and deal with the mentally ill and authorized to take them to an assessment facility.

The bill did not pass, but Bill Kehoe, director of NAMI Mississippi, said there is now more support for a CIT pilot program in Hinds County, including the support of the Mississippi Sheriff's Association, and NAMI is pushing to get a new bill through the legislature.

Rep. Clarke could not be reached for comment.

Owen said the Meridian affiliate of NAMI is hoping the bill will pass and will lead to legislation allowing the rest of Mississippi to use Crisis Intervention Teams or other jail diversion program as well.

The current system, Owen said, is downright inhumane. "We don't realize that these people are people," she said. "We don't lock granny's up that have Alzhiemer's, we give them treatment. But there's such a stigma associated with mental illness that we put them in jail."

"Many of our prisons," she added, "are the biggest state hospitals, and this problem of people being in jail gets worse when they close the state hospitals."
Recently, Governor Haley Barbour proposed closing some mental health facilities, including parts of East Mississippi State Hospital, to help ease the state's budget woes.

According to NAMI, a 1999 DOJ report showed that 16 percent of all inmates in state and federal prisons at that time suffered from severe mental illness. This, they said, means that there are approximately 283,000 people with severe mental illness in state and federal prisons at any given time.

Owen said trying to keep the mentally ill out of jails is not the same thing as being soft on crime. Getting treatment for the mentally ill, she said, is of benefit for the mentally ill themselves, the sheriff's departments that run the jails, and the community as a whole.

"We're not trying to get people out of punishment for their crimes," she said. "We're trying to identify people who are doing these things strictly because of their mental illness," she said. "We need to do what would get them better, and that's get them treatment."

If Mississippi allows Crisis Intervention Team programs, law enforcement agencies would partner with mental health agencies.

In incidents between law enforcement and a mentally ill person, a CIT trained officer would be able to take that person to the partnering mental health facility, and the mental health experts there would determine whether the person was severely mentally ill and have them admitted to a mental health facility.

Owen said she is hoping that a federal grant could help fund a CIT or jail diversion program, but that such a grant would likely require matching funds.

Owen said she hopes local governments will be on board because, "If it's affecting our citizens, it's affecting us as a whole... It's a cycle that continues and people just end up rotting in jail."
Want to go?

What: Seminar "Treatment, Not Jail: Strategies to Prevent Criminalization of
Individuals with Mental Illness" with speaker Margaret Severson, J.D., MSW
When: Monday, January 11, from 8 a.m. to 12 p.m.
Where: Kahlmus Auditorium, MSU Meridian, 1000 Hwy 19 N.
Admission: Free and open to the public
Registration: Required by calling Pace Cooke Emmons at (601)483-4821 or emailing pcemmons@weemsmh.com by Friday, January 8.

NY prison system opens unit for mentally ill (update)

2009-12-16T18:08:00.000-08:00

By MARY ESCH, Associated Press Writer
POSTED: December 15, 2009

ALBANY - The first inmates moved Tuesday into a new state prison unit for disruptive mentally ill prisoners that was created in response to a lawsuit filed by an advocacy group in 2002.

The 100-bed Residential Mental Health Unit at Marcy Correctional Facility in Oneida County was designed by the state corrections and mental health agencies under the terms of a 2007 settlement with Disability Advocates.

The nonprofit group sued to improve treatment of mentally ill prisoners and to stop putting inmates with serious mental illness and disciplinary issues in solitary confinement.

Inmates in the new unit will receive more mental health care, therapeutic programming and exercise.

Of the 58,690 inmates in New York state prisons, 7,844 are diagnosed with mental illness, including 2,359 with serious mental illness, said Erik Kriss, spokesman for the Department of Correctional Services.

Inmates designated as seriously mentally ill are those with schizophrenia, delusional disorder, psychotic disorder, major depression and bipolar disorder. The designation also includes suicidal inmates and those driven by psychosis or depression to harm themselves.

About 200 of those with serious mental illness have confinement sanctions for disciplinary violations, Kriss said. Traditionally, such inmates are moved to an S-block, a special housing unit with lockdown cells that reduce the need for security personnel.

The Disability Advocates lawsuit claimed that prisoners with mental illness throughout New York did not get adequate mental health treatment, and as a result, many of them were being punished with long sentences of solitary confinement, severe restrictions on property and visits, and no access to out-of-cell programming.

The lawsuit said isolation and idleness led to severe psychiatric deterioration in these isolation units, including acts of self-mutilation and even suicide.

The new mental health unit at Marcy has about 100 corrections employees and 26 Office of Mental Health employees, compared with 38 employees when it was an S-block, Kriss said.

Kriss said inmates in the new unit have constant access to both prison and mental health staff. Each inmate has at least four hours daily of programming and therapy.

''No other prison system to our knowledge affords the inmate patients the amount of time of out-of-cell programming and therapy, including group therapy and group interaction, as the RMHU,'' Kriss said.

Texas executes man at centre of mental disability row

2009-12-05T15:02:00.000-08:00

Defence attorneys for Bobby Wayne Woods argued for state to spare inmate following low scores on IQ tests

Chris McGreal in Washington

guardian.co.uk, Friday 4 December 2009 15.28 GMT

Texas has executed a child killer at the centre of a bitter dispute over what defines legal mental impairment after several courts ruled that he could be put to death despite a low IQ.

Bobby Wayne Woods, 44, was killed by lethal injection for raping and murdering his girlfriend's 11-year-old daughter after the US supreme court denied a last minute appeal by lawyers who argued that the condemned man fell within a ruling by the same court in 2002 that the mentally impaired could not be sentenced to death.

After being told that the supreme court had refused to intervene, Woods' last words were: "Bye. I'm ready."

Tests on Woods in prison put his IQ as low as 68, below the widely accepted cut off for mental impairment of 70. However, in pursuing the death penalty, the state fell back on other tests conducted when he was a child that put his IQ as high as 86.

Maurie Levin, a University of Texas law professor who represented Woods, said that he is "transparently childlike and simple" and described the execution as "a travesty".

Despite the supreme court ruling seven years ago barring the death penalty for the mentally impaired, individual states are left to decide what defines severe learning disabilities. The court said that an IQ test of "around 70" was an indicator but did not set a specific test.

Recent studies have shown that men with IQ scores lower than 70 have been executed in several states, including Texas and Alabama.

Earlier this week, the Texas board of pardons and paroles, voted unanimously that Woods, who has been described as barely literate, should be executed. The Texas attorney general, Greg Abbott, argued to the supreme court that the IQ tests on Woods were unreliable.

"The only experts to ever conclude that Woods was mentally retarded did so after he had committed this murder and had motivation to underperform," he said.

Richard Hattox, who prosecuted Woods, defended the execution.

"Woods testified, and the jury watched him reason and think and debate with me and his own lawyers," he said. "If he was going to claim mental retardation, having him testify was a mistake, because that took away any doubt."

Woods raped and slit the throat of Sarah Patterson after abducting her with her brother, Cody. The boy was badly beaten but survived.

The children's mother, Schwana Patterson, was refused permission to watch the execution because she served a prison sentence for failing to protect her daughter from sexual abuse by Woods.

Woods was the 24th person executed by Texas this year.

Florida failing to meet mental health responsibilities

2009-08-30T10:52:00.000-07:00

State funding for mental health and addiction services continues to fall in a shortsighted policy that fails to tackle problems before they escalate into far more costly outcomes.

When legislators descend on Tallahassee in the coming weeks to lay the foundation for next year’s regular session, they should bear in mind that Florida ranks 48th in mental health funding and 35th in alcohol and drug treatment funding — both abysmal national marks for a state 15th in per capita wealth.

When families in crisis cannot secure behavioral health services, they often end up in emergency rooms, behind bars or out on the streets.

And when budget cuts force the closure of hundreds of treatment beds throughout the state — including 39 beds at Manatee Glens — the societal problem intensifies.

While medical costs soar — witness the impassioned national debate over universal health care — mental health care funding drops. The state of Florida has not adjusted funding to account for medical inflation in more than two decades, according to Manatee Glens CEO Mary Ruiz.

At what cost?

This summer, Manatee Glens, the county’s hospital for mental health and addiction treatment, closed the Adolescent Recovery Center, for teenagers with substance abuse and mental health problems. Juvenile clients of the center, a residential unit with 16 beds that provided care for six to nine months, must now find services at a center in Sarasota.

Several other Manatee Glens units, which provide a lifeline to thousands of clients, are threatened — including the Children’s Crisis Unit, for those who are a danger to themselves or others, and the Walk-In Center, which serves uninsured families.

Manatee Glens, a not-for-profit institution, does not survive on state funding alone — the county and private money provide a significant share. But, Ruiz says, the state’s portion of the hospital’s annual budget has plunged from 85 percent to 55 percent during her 20-year tenure. The current budget stands at $25 million.

Ironically, Florida’s lone mental hospital, G. Pierce Memorial Hospital in Arcadia, closed in 2002 over a lawsuit that accused the state of shortchanging patients with fatal results — at least 10 patient deaths and injuries to others blamed on underfunding.

Upon closure, those patients were dispatched to various community mental health providers, and Manatee Glens received 26 clients and a promise of state funding. That money has evaporated during legislative budget cuts, and those 26 beds have been lost.

The Pierce lesson has been lost on the Legislature, as has the funding pledge. Are we doomed to repeat the past, with deadly results?

As Florida ponders spending hundreds of millions of dollars on new prison construction as the inmate population surges past 100,000, that question becomes all the more critical.

Earlier this year the Legislature failed to remedy that situation by not passing the Community Mental Health and Substance Abuse Treatment and Crime Reduction Act. The reform bill would have established mental health courts, pre-arrest jail diversion programs and law enforcement crisis intervention teams, among other measures.

Proponents, including the judicial, law enforcement and mental health communities, vow a reintroduction of the bill in the 2010 session.

According to the state Department of Children and Families, Florida spends some $250 million annually to pay for 1,700 forensic hospital beds for inmates with mental illness, and that expenditure is expected to double over the next decade.

Far more significant, though, is the number of inmates with mental illness — 17,000, and that, too, is forecast to double in 10 years. The projected cost for additional prisons, beds and services for that unfortunate growth is a staggering $3.6 billion.

Community-based treatment is key to keeping the mentally ill out of the justice system, the kind that Manatee Glens provides. That’s a more prudent and thrifty way of dealing with this particular problem.

But lawmakers should also address the broader issue, the entire spectrum of mental health services. Children, teenagers and adults should not be denied treatment for want of funding, else they, too, get caught up in the legal system or otherwise become a burden on society — by overcrowding emergency rooms or roaming the streets.

Even now, too many Manatee families are falling through the cracks. Ruiz says Manatee Glens serves one out of 30 families here, but with appropriate funding could help one out of 10.

The Legislature’s shortsighted policies of the past must be abandoned in favor of a big-picture, humanitarian vision.

New court ready for mentally-ill inmates

2009-07-19T12:11:00.000-07:00

Program will seek to move prisoners into treatment plans and out of the jail.

By Suevon Lee
Staff writer

Published: Sunday, July 19, 2009 at 6:30 a.m.
After more than a year of planning, Marion County's first mental health court opens Monday.

Funded in part by a federal grant, the nascent court is strongly modeled after similar programs established around the state, including one in Gainesville.

These programs seek to steer non-violent misdemeanor defendants with mental illness toward treatment programs instead of jail cells.

The Marion version will serve as a division of the county court and, much like the special drug and DUI courts, will be presided over by a county judge who works with the State Attorney's Office, Public Defender's Office and representatives from agencies like The Centers.

"When I first started [as a judge] seven years ago, I saw some situations that just kind of cried out for attention," said County Judge Jim McCune, who spearheaded the plan. "Mentally ill people tend to stay in the jail longer. There's nothing going on to get them out."

The Marion County Mental Health Court, one of more than 200 already established in the United States, seemingly couldn't launch at a better time.

According to Marion County Sheriff's Office projections, in 2007 there were between 327 and 1,287 mentally ill inmates at the Marion County Jail. That range is expected to increase to 459 to 1,804 by 2012 and to 1,553 to 6,101 by 2030.

In Florida alone, it's estimated that 125,000 individuals with serious mental illness are booked into jails each year.

Bob Sharpe, CEO of the Tallahassee-based Florida Council for Community Mental Health, said mental health courts have proven to be a reliable arm of the criminal justice system.

"It's had the effect of reducing the number of individuals with mental illness placed in jail. It's helped connect them with the mental health system where they may not have had exposure to the system before," he said.

The potential cost savings cannot be overlooked, either.

"It's cheaper to provide recovery services outside of a jail setting. Many participants [would be] getting treatment through government providers for mental health services," said Diana Williams, president of the National Alliance on Mental Illness' Marion County chapter. "There's just a better place for them. I'm glad we're finally on board with that."

The way the court will work is this: Misdemeanor defendants with no pending felony or DUI charges will be referred to the program through a judge, prosecutor, public defender or law enforcement officer.

If the defendant agrees, treatment providers will work with the State Attorney's Office and judge to determine if the defendant is qualified.

Eligible participants must have a mental illness that is chronic and persistent, such as bipolar disorder, schizophrenia or a major depressive disorder.

If accepted, the defendant will undergo a 12-month treatment program that includes weekly appearances before the judge, regular meetings with a case manager, required attendance at therapy and rehabilitation sessions, and compliance with certain drug and alcohol regulations.

Successful completion could result in a dropped charge; violations could lead to sanctions ranging from community service to jail.

"We need to start small," said McCune, emphasizing that he wants no more than 25 participants enrolled at a time.

"We need to be careful as to how we load this, so we can space it out and get our dynamics clearly worked out. I want to be real careful who gets in the program, and how we time people getting into the program."

The nation's first mental health court was founded in Broward County in 1997. County Judge Ginger Lerner-Wren, who to this day presides over the docket, said her goal was a "pure diversionary court model."

"The main problem is that for decades, individuals with various types of mental disabilities were really, blindly almost, being trans-institutionalized from hospital settings into jail settings," she said. "The criminalization of persons with mental illness is a very profoundly tragic social phenomenon."

The Alachua County Mental Health Court in Gainesville, an 8-year-old program that Marion's is strongly modeled after, functions less like an official proceeding than an informal dialogue between judge and participant.

One day last week, in a regular, chestnut-brown paneled courtroom, participants were seated on benches as the judge entered. Garbed in a black robe, the judge nodded and greeted the individuals, then called each to the lectern, one by one.

Seated in the jury box were representatives from local treatment centers.

"It's nice to see you. You're doing well," County Judge Denise R. Ferrero said to one defendant. "I'm impressed that you're willing to work with the doctors and not just increase the medication yourself."

At one point, the judge asked the room to applaud the "Participant of the Week," a middle-aged man whose commitment to the program earned him a certificate. He left the room smiling.

Other participants did not fare as well.

"I see you had a setback this week," the judge said to a woman whose drug test did not come back clean. "I want you to be successful," she added before sanctioning her to eight hours of community service.

That type of tough encouragement is what keeps the mental health court successful, said Sherry Browne-Davis, who works in the Alachua County court. "We try to empower them to make better decisions. We try to encourage rebuilding the foundation they had before they came to us," she said. "Nobody fits into one box. We really do try to look at every individual individually as well as whatever the setback is and to try and get them back on track."

The first meeting with team members to discuss referrals to Marion County's mental health court is Monday; the first court session is not until early August. Officials are eager to start.

"There is a need for social services [like mental health court] in the community, especially with the population of individuals we have. We've run into people who have had mental health issues before," Marion County Assistant State Attorney Toby Hunt said. "We see them over and over again. We're not addressing their problem. We're addressing the criminal part of it."

To McCune, the court would not have been possible without cooperation from various agencies and investment from community leaders.

"The strength of our program is that we have taken the time to get all the stakeholders finally working together," he said. "We could have put a program together on paper and said, 'Here it is, we can launch,' but it would have been superficial at best. It would have had no meat, no staying power to it."

Above all, McCune added, the significance of the community's gradual awareness of mental illness can't be overstated.

"That takes something of a sea change," he said. "I think we're coming around."

Artistic freedom

2009-06-20T10:37:00.000-07:00

WUWF art exhibit features works by Escambia County Jail inmates

Rebecca Ross
rross@pnj.com

Behind bars, art blooms.

In a small room at the Escambia County Jail, male inmates let their creativity run free. Using paint and pencils, some participants in the Captured Art program create idyllic scenes of bright skies and blue oceans. Others incorporate darker images —skulls and tombstones — to tell a story.

Several of those original works are now on display, through July 24, at Gallery 88, inside the WUWF Studios on University Parkway.

The Captured Art program began at the Escambia County Jail in 2007 with a volunteer teacher and donated supplies. According to Sybil Sahuque and Sharon Giraud, who began the program, its initial goal was to aid inmates with mental health issues.

"We're amazed at how far we've come since we started," said Sahuque, who serves as the program's sole art instructor. "Now there is a waiting list to get in."

"We never thought it would take off the way it did," Giraud said. "To think that we began with paper and mechanical pencils as only art supplies, we've certainly come a long way."

The popular program, funded mainly through donations of money, materials and the sale of participants' art work, is now open to inmates with exemplary behavior who pass an arts aptitude test. Because of space constraints, 10 or fewer men are accepted into the program at a time.

Sharon Gossett, a Sheriff's Department employee who works with the program, said that Captured Art brings about positive changes in participants.

"Their self-esteem has been encouraged, they want to further their education in art and maybe begin a career with what they have learned," she said. "And they have asked if they can invite the younger inmates into the program to try and mentor to them so that they do not make the same mistakes in life."

Former inmate Clarence Williams, 52, said he found self-worth through the program.

Recently released from jail, Williams was a guest of honor at the "Art from the Inside Out" opening reception Thursday.

"I always knew how to draw, but I never considered myself an artist until I got in the art group in prison," he said. "It helped me realize that I can do positive things with my life. It has made me want to do something with my art, now that I'm out."

Lynne Marshall, director of promotions & outreach at WUWF Public Media, said that the "Art from the Inside Out" exhibit is a perfect means to showcase the prison's unique art program.

"We've done several shows that highlight an issue or cause, such as hospice or breast cancer awareness," Marshall said. "When I heard about the Captured Art program and went to the jail and visited these men, I was just so moved by their stories and their work. I felt it was something that we needed to share with the community."

Susan Watson, regional director of the American Civil Liberties Union of Florida, hopes the exhibit will raise community awareness regarding the need for a mental health court.

"It's really important that we take a look at how to treat inmates with mental illness," Watson said. "The exhibit is also an opportunity to show the community some of the good things that are happening at the jail. This is a humane program that allows inmates to express themselves in a positive manner."

Sahuque, Giraud and Watson hope that the exhibit will inspire artistic volunteers to start a similar program for female inmates.

"Some wonderful things have come out of the Captured Art program," Watson said. "They should be shared."

Additional Facts
Want to go?
- WHAT: "Art from the Inside Out" exhibit.

- WHEN: On display through July 24.

- GALLERY HOURS: 8 a.m. to 5 p.m. Monday through Friday (excluding holidays).

- WHERE: Gallery 88, inside the WUWF Studios, 11000 University Parkway.

- COST: Admission is free.

- SPONSORS: National Council on Alcoholism and Drug Dependence, the Prison Book Project, Escambia County Jail Captured Art program, WUWF Public Media and the ACLU of Florida.

- DETAILS: 474-2787, or online at www.wuwf.org. Those interested in viewing or purchasing additional art may contact Sharon Gossett at 436-9823.

Death of mentally-ill inmate raises question of care

2009-06-20T10:35:00.001-07:00

01:00 AM EDT on Sunday, June 21, 2009
By Steve Peoples

Journal State House Bureau
He banged his head against the wall until his teeth were loose, says one investigator. He clawed at his chest to get the devil out.

So, prison officials moved James Davis-Reed to a special segregation cell within the “Super Max” unit of the Adult Correctional Institutions on March 27.

It is the safest place the prison offers mentally-ill inmates.

The six-cell “observation and stabilization” area is relatively quiet. Prisoners are held in isolation under 24-hour video surveillance. Psychiatrists visit three times a week.

It’s more common for staff to use restraints on suicidal inmates there, as was the case for Davis-Reed that Thursday morning.

His final hours are still under investigation.

Prison officials have confirmed he was locked in four-point restraints — bound to his bed at the wrists and ankles — “for a short period” in the morning. After the restraints were removed, 24-year-old Davis-Reed was left alone and naked — he had stripped off his gown — under motion-activated video surveillance, in a 7-foot by 10-foot cell.

A prison spokeswoman said that Davis-Reed “was on the highest level of observation.” She could not say, however, when guards realized he had stopped breathing.

Just one state official, Mental Health Advocate H. Reed Cosper, has been willing to publicly discuss the young man’s death in detail.

“He rolled himself up into a fetal kind of ball, which is kind of a regressive behavior for a really sick guy. And he managed to roll his head into a crevice between the bed and the wall, and he couldn’t get out,” said Cosper, among those investigating the incident. “He suffocated, kind of like being crucified. He didn’t suffocate in two minutes. He suffocated in 45 minutes, or 30, I don’t know.” It’s unclear if Davis-Reed was trying to kill himself.

The state police are investigating, as is the ACI. The medical examiner has ruled the death was the result of “positional asphyxia.”

No one disputes these basic facts: James Davis-Reed left the prison in an ambulance and was pronounced dead at Rhode Island Hospital on March 27. He died after spending 35 days at the ACI, transferred there after spending the previous 1,273 days in the forensic unit of the state hospital for mentally-ill prisoners.

“There are mentally-ill people for whom prison is toxic,” Cosper says. “This man was too fragile to be in prison.”

Department of Corrections Director A.T. Wall says his staff did the best it could.

“We can never say ‘no’ when a court sentences an offender to us. On any given day we have hundreds of mentally-ill offenders — diagnosed, in treatment, and on medication. The overwhelming majority adjust and are doing fine in the population,” Wall said. “Our staff worked very hard with James and the treating psychiatrist was distraught over his death, as were many of the staff that worked with him. They grieved when he died.”

JAMES DAVIS-REED had largely cooperated with the doctors after his arrest four years ago.

There was little doubt that he was a dangerous man.

He had traveled through the night of June 27, 2005, from Far Rockaway, N.Y., to Rhode Island to find his ex-girlfriend, Tiffany Joiner. He snuck in through her kitchen window at the Oxbow Farm housing complex in Middletown just after 9 a.m., and found a 10-inch kitchen knife in a drawer.

He first attacked Joiner’s 14-year-old brother, who was watching TV on the couch. Davis-Reed stabbed the boy several times in the neck, chest and back before chasing Joiner and her new boyfriend up the stairs.

The couple suffered minor stab wounds as they tried to barricade themselves in an upstairs bathroom.

The police arrived before anyone was killed.

They chased Davis-Reed through the apartment and out the back door before pinning him to the ground.

Middletown police officer Mark Minnella’s narrative described the moment immediately after the arrest: “The subject was crying and covered in blood. I asked the subject why he stabbed the other party, and his reply was, ‘I love ’em like a brother.’ ” Everyone survived the attack, including Joiner’s 5-year-old brother, who was taken to the hospital to be treated for shock.

The State of Rhode Island took custody of Davis-Reed later that day, June 28, 2005, when he was 20 years old.

His first stop was the state prison.

A judge ordered a mental competency exam less than two months later. On Aug. 26, Davis-Reed was deemed incompetent to stand trial and moved to the forensic unit of Eleanor Slater Hospital, the locked unit for mentally-ill criminals.

An incompetent defendant, according to state law, is someone who “is unable to understand the character and consequences of the proceedings against him or her and is unable to properly assist in his or her defense.”

The goal is to restore the defendant to competency through treatment, said Stacy P. Veroni, chief of the criminal division for the attorney general’s office. “Someone can be insane and competent to stand trial. … It doesn’t have to do with his mental state at the time he committed the offense. It has to do with whether the defendant can generally understand the court process.”

Davis-Reed’s public defender, Paul Tondreau, says all involved with the case agreed that his client was not fit for trial. Tondreau said the forensic unit was more appropriate for Davis-Reed. “He was getting treatment there in a setting that was preferable to the prison.”

He responded well in the small hospital unit, where he was medicated and received constant attention. After more than a year of treatment, he was reevaluated and on Dec. 4, 2007, he was deemed competent to stand trial, according to court records. Tondreau did not challenge the competency ruling, but requested that Davis-Reed be allowed to stay at the hospital until the case was resolved in court. The attorney general’s office did not object, and Davis-Reed would spend two more years in Eleanor Slater.

While still living in the mental hospital, Davis-Reed ultimately pleaded guilty to five felony counts and signed off, in September 2008, on a plea bargain that capped his prison time at 15 years.Tondreau did not raise the insanity defense, which might have kept Davis-Reed out of prison. “The client has the final say,” the public defender said recently. “It’s his decision.”

Superior Court Justice Melanie Wilk Thunberg accepted Davis-Reed’s plea bargain on Feb. 20, 2009, and ordered him to the ACI. Tondreau did not object. After more than three years in a state mental hospital, Davis-Reed was transferred to the prison that day.

Prison officials had less than 24 hours’ notice he was coming.

THE ADULT Correctional Institutions holds Rhode Island’s largest collection of the mentally ill.

One day in mid-May, at least 567 inmates, or 23 percent of the “sentenced male population,” were prescribed psychotropic medication for mental illness, according to figures provided by the Corrections Department. These do not include the intake center or the women’s unit. Of the 567 inmates, 213 were taking antipsychotic drugs for the most serious diagnoses, such as schizophrenia.

Despite the numbers, the prison’s clinical director, Frederic C. Friedman, said the ACI has “a small number of people with serious mental illness. The number of truly psychotic is small.”

It’s unclear if Davis-Reed was among the “truly psychotic.” State officials have refused to discuss his health, citing medical privacy laws. And court records relating to mental competency have been sealed.

After leaving the 20-bed mental hospital, he spent his first 34 days at the intake center — a chaotic, crowded environment that holds 1,148 inmates.

Friedman said Davis-Reed spoke to a “weekend psychiatrist within 24 hours” and visited a psychiatrist and social workers “several times” in the subsequent weeks, typical treatment for inmates.

Cosper, the mental health advocate, has suggested that ACI doctors may have changed Davis-Reed’s medications after the transfer. Citing medical privacy laws, prison officials refused to answer that question.

The ACI has partnered with the University of Rhode Island’s College of Pharmacy to control ballooning medication costs by switching to generic drugs in many cases, a collaboration that prompted a national award less than two weeks after Davis-Reed’s death.

Taxpayers spent $180,857 on antipsychotic medication for prisoners between February and April of this year, according to information Friedman provided.

He said he works to ensure that prison psychiatrists are aware of cheaper drug options, but says that specific prescription decisions are left to inmates’ psychiatrists.

“I’m concerned that in this area of fiscal restraints, the impression is being created that we sacrificed, sent somebody to the bottom line. It simply isn’t true,” said Wall. “The clinical staff was actively working with this guy and he was working with us.”

It’s unclear what triggered Davis-Reed’s deterioration. He went downhill relatively quickly at the ACI — after steadily improving over three years at Eleanor Slater Hospital.

“He had engaged in some self-injurious behavior which called upon us to place him in a smaller setting,” Wall said, declining to describe the behavior. It was Cosper who said that Davis-Reed had been knocking his head against the wall to the point of loosening his teeth, and clawing at his chest “to get the devil out.”

The smaller setting was the ACI’s observation and stabilization unit within maximum security, a special area established roughly three years ago for those with the most serious mental problems.

State law affords prison officials another option. In extreme cases, the corrections director or the director of the state Department of Mental Health, Retardation and Hospitals may file a court petition to have a mentally-ill prisoner transferred to Eleanor Slater Hospital.

Corrections officials could account for a handful of such petitions in recent years; MHRH couldn’t detail any.

The Department of Corrections did not file a petition in Davis-Reed’s case, though they acknowledge that the prisoner had become a danger to himself.

“He is by no means the only inmate who has been self-injurious in our setting. Sadly, we’re accustomed to seeing that behavior. It may not be routine, but it is not particularly rare,” Wall said. “And he had been with us for only five weeks. Lots of mentally-ill inmates have trouble settling down at first whenever there’s a change in circumstance.”

JAMES DAVIS-REED is among dozens of inmates who have died while in the care of Rhode Island’s prison system in recent years.

Altogether, 62 people died at the ACI since Jan. 1, 2000, according to data provided by the Department of Corrections. It’s difficult to say how many were mentally ill.

Davis-Reed is the only one listed as having died from “positional asphyxia.” But the prison details 13 suicides over that time, including 11 by hanging. Four inmates died from drug overdoses or acute drug withdrawal.

Rhode Island is hardly the only state in which prisoners die.

In 2006, 8 inmates died in the Ocean State, 39 died in the Massachusetts’ state prison system, 25 in Connecticut, 7 in Vermont, and 6 each in New Hampshire and Maine, according to U.S. Department of Justice statistics.

“I recognize that our job is, insofar as it’s possible, to keep everybody safe. It’s a very tall order,” Wall said. “Our record is very good. But we work with a very difficult population on a number of fronts, including mental health. Tragic outcomes can and do occur in all kinds of settings, correctional and hospital. I do not think it means that we, or I, am responsible for that outcome.”

speoples@projo.com

Michael Goforth: Evidence mounts to make changes in mental health and jails

2009-06-15T18:23:00.000-07:00

By Michael Goforth (Contact)
Monday, June 15, 2009

“We tend to use a criminal justice model for a disease and it just doesn’t work,” Judge Stephen Leifman told me in a telephone conference earlier this year. “We can’t afford to keep doing what we’re doing.”

Leifman, a special adviser on criminal justice and mental health for the Florida Supreme Court, was talking about the financial and social costs of housing the mentally ill in municipal, county and state jails.

Of an estimated 600,000 Floridians with mental illness, about 125,000 needing immediate treatment are booked into jails or prisons each year. The cost for a mentally healthy inmate is about $40,000 per year. For a person with mental illness in a state-operated psychiatric hospital, the annual cost is about $140,000

In addition, the numbers are increasing and it’s estimated that over the next decade, the state would have to build a new prison each year to keep up with the number of mentally ill inmates.

And, that doesn’t include the costs for expanding county jails for their mentally ill populations, which has been occurring on the Treasure Coast in recent years.

Speaking recently at a briefing on Capitol Hill, Leifman said, “Our criminal justice system was never intended to be the safety net for the public mental health system. Unfortunately, though, that is exactly what it has become. Too often, people land in jail for minor offenses directly related to symptoms of untreated mental illnesses because of inadequate system of community-based services and supports.

“Only through systemwide collaboration and partnerships can we begin to close the revolving door to the criminal justice system which, today, results in increased recidivism, devastation to our families and communities, wasteful government spending, and the shameful warehousing in jails and prisons of some of the most vulnerable and neglected members of our communities.”

Leifman was speaking in conjunction with release of the first significant study of mental health and jails in about two decades. That study by the Council of State Governments Justice Center and Policy Research Associates found that about 17 percent of inmates in the study suffered from “serious” mental illness.

That study, however, looked at only about 20,000 inmates at five jails. Using those figures, it was estimated that about 2 million seriously mentally ill persons are booked into jails in the United States each year.

But, it’s not just those with serious mental illness who are being housed in jails. Based on medications required, about a third of those booked into the St. Lucie County Jail each year suffer from some form of mental illness. The cost for a mentally ill person charged with a misdemeanor averages $35,000 per stay. The cost for a mentally ill person charged with a felony is about $64,000 per stay.

In March, U.S. Sen. Jim Webb, D-Va., introduced the National Criminal Justice Commission Act of 2009, which calls for a national commission to undertake an 18-month study of the impact of putting the mentally ill in jail and how the criminal justice system can be reformed to address the problem.

U.S. Sen. Pat Leahy, D-Vt., has been pushing for reauthorization of the Mentally Ill Offender Treatment and Crime Reduction Act, which would provide federal grants to state and local governments to create or expand mental health courts, offer treatment and training programs to provide support and services to reduce repeat offenders, and to train police in how to react to situations involving persons with mental illness.

In addressing the results of its study, the Council of State Governments Justice Center said, “Too often there are people incarcerated who have serious mental illnesses, oftentimes for minor offenses, who would be better served in the community. Though jails have a constitutional mandate to treat the mental illnesses of individuals under their supervision, they are ill-equipped to meet the needs of those with serious mental illness.

“Policies have relied on outdated data to determine the scope and nature of this problem. As state and local governments face significant budget shortfalls, grapple with growing jail populations, and slash spending for community-based mental health services, there has not been a more critical time for policymakers to consider the implications of this prevalence study.”

Study results are clear. Too many people with mental illness are in jails who should not be there. They can be better served and more cheaply served through community programs.

But, as time goes on without comprehensive actions, those will mentally illness and their families are abused and taxpayers are forced to pay far more than they should for far too little.

michael.goforth@scripps.com

Early intervention works for mentally ill

2009-04-06T15:35:00.000-07:00

OUR OPINION: They belong in treatment facilities, not in jails and prisons
You see them all the time: People who aimlessly wander the streets, obviously homeless and obviously in need of attention for their mental illnesses. Ever wonder what happens to them? Far too many end up in jail or prison, at great and unnecessary expense to taxpayers.

To keep just 1,700 of these people locked up, as Florida currently does, costs $250 million each year. When they are released from prison, as inevitably all of them are, their mental-health conditions have worsened.

There is a better way. Instead of warehousing these people in prisons, the state can diagnose and treat their illnesses. It can use supportive diversion programs in community-based facilities to put them on a path of recovery. This can be done at a fraction of the cost of locking them up.

This is what can be accomplished if state legislators approve HB 7103 and SB 2018. The legislation carries the ponderous title, Community Mental Health & Substance Abuse Treatment & Crime Reduction Act. Yet it represents years of work by a coalition of public and private leaders, including Gov. Charlie Crist, former Florida Chief Supreme Court Chief Judge R. Fred Lewis, Miami-Dade Circuit Court Judge Steve Leifman and others.

A Senate committee considers the bill this week and other committee hearings await before a floor vote is taken. The bills deserve the enthusiastic support of all lawmakers. If it becomes law, the proposal would achieve that legislative rarity of doing a public good while being revenue neutral (meaning it doesn't require new money) at the outset, and save the state hundreds of millions of dollars in the long term.

This would be possible because the state would begin to reverse its extraordinarily wasteful practice of putting mentally ill people who commit crimes in prison instead of treating their illnesses. Florida is not alone in doing this, but it would become the model for other states to emulate.

The law would allow Florida to use community-based mental-health resources to intervene with the mentally ill before they go to jail or prison. This is what typically happens:

A mentally ill person commits a minor offense, say being disorderly. A police officer arrives, and attempts to calm the situation. The person, under emotional duress, is unable to comply, becomes more disruptive and is arrested on a more-serious charge.

This is where the legal insanity begins. Because the mentally ill person is unable to understand the charges, he is sent to a criminal-forensic hospital where, with the help of medications, he is calmed enough to face trial. If convicted, he is sent to prison where there is no treatment for his mental illness. If exonerated, he is released, untreated, and certain to suffer another emotional episode, which starts the process anew.

The proposal would authorize pilot projects in Miami-Dade, Tampa-St. Petersburg, Leon County and the Pensacola area. The programs would use managed-care principles, using appropriate diagnosis and medication, trauma services, drug and alcohol intervention and rehabilitative services such as education and job training. The intervention will give the mentally ill the help they need to everyone's benefit.

Prison nation

2009-04-05T18:42:00.000-07:00

Reformer.com

Friday, April 3
There are few industries more recession-proof than prisons, especially in this country.
The United States has the world's highest incarceration rate, with 2.3 million people behind bars. Despite having only 5 percent of the world's population, we have 25 percent of the world's reported prison population.

Ours is a nation that loves retribution. The flip side to "zero tolerance," mandatory sentencing laws and "get tough" policies on crime is that about 1 out of every 31 American adults is either in prison, jail or on supervised release. And all this costs us, as a nation, about $68 billion a year.

The picture is even worse in Vermont. According to data compiled by the Pew Center on the States, between 1996 and 2006,

Vermont's prison population doubled in size -- from 1,058 to 2,123 inmates -- and the corrections budget went up 129 percent -- from $48 million in fiscal year 1996 for $130 million in fiscal year 2006.

The percentage of the state budget devoted to corrections has risen from 4 percent of the general fund in 1990 to 10 percent of the general fund in 2008. Our state's incarceration rate has increased 80 percent over the past decade, compared to a national average of 18 percent.

At the current rate of growth, the state will either have to ship more prisoners to out-of-state facilities -- which would cost about $82 million -- or spend $206 million to build new prisons in Vermont.

In the ongoing budget battle, it has been more or less decided that more prisoners will be shipped out of state to corporate-run private prisons, since it is cheaper. But is that the real solution to the problem of an out-of-control corrections budget?
Vermont has the dubious distinction of being one of five states (Connecticut, Delaware, Michigan and Oregon are the others) that spend more on corrections than on their higher education systems. Is that the kind of state we want to be?

In Parade magazine this week, U.S. Sen. Jim Webb, D-Va., wrote about the urgent need to reform our nation's criminal justice system. With so many of our fellow citizens in jail, Webb wrote that "either we are home to the most evil people on earth or we are doing something different -- and vastly counterproductive. Obviously, the answer is the latter."

Webb believes one of the biggest problems is that we have swamped the criminal justice system with low-level drug offenders.

According to the U.S. Department of Justice, nearly 48 percent of all drug arrests in 2007 were for marijuana offenses and nearly 60 percent of all people in state prison serving sentences for drug offenses had no history of violence or of significant selling activity.

And while blacks comprise 12 percent of the U.S. population, they account for 37 percent of those arrested, 59 percent of those convicted and 74 percent of those sentenced on drug charges.

The other factor driving the increase in the prison population is mental health. The Department of Justice estimates 16 percent of adult inmates -- more than 350,000 -- suffer from mental illness, and the percentage is even higher among juveniles.

That is why Webb says he has introduced legislation to "create a national commission to look at every aspect of our criminal justice system with an eye toward reshaping the process from top to bottom."

He believes it's time for Americans to ask some hard questions. Why are so many of our citizens in jail compared to other nations? What is this costing us in tax dollars and lost opportunities? How can we change our nation's drug policies? How can we better diagnose and treat mental illness? How can we make our prisons a place for rehabilitation rather than violence and hate?

These are questions most politicians would rather not answer. It's easier to pass a gay marriage law in our legislature that it is to pass a law that would decriminalize marijuana possession. It's easier to advocate sending more people to jail for longer stretches in the name of public safety than to honestly deal with all the factors that make the United States the world's No. 1 jailer.

We need more lawmakers at every level of government who are brave enough to deal with a criminal justice system that is a national disgrace, to make the necessary changes and to come up with better ways to keep our nation safe.

Editorial: Mental Health

2009-03-30T15:31:00.001-07:00

Better treatment

Court-ordered outpatient treatment for the mentally ill is effective for the individual and less expensive for the state. But in Pennsylvania, it's rarely used.
That's because the state's outdated 1976 mental-health law requires ill people to be a "clear and present danger" to themselves or others before a judge can order them to get treatment.

By the time people with mental illness deteriorate to that point, outpatient services are often not appropriate. They usually end up hospitalized.

If such people receive community-based treatment before they deteriorate too far, the results are positive. But people with mental illness often don't recognize they need help, and won't agree to treatment voluntarily.

Forty-two states have some form of assisted outpatient treatment for the mentally ill. And a bill pending in the state Senate would bring Pennsylvania up to date in providing round-the-clock outpatient services. (The New Jersey Senate is also considering similar legislation).

Sponsored by Sen. Stewart Greenleaf (R., Montgomery, Bucks), SB 251 would allow judges to order outpatient mental-health treatment for people involuntarily for up to six months. It would apply only to patients who have been hospitalized at least twice within the previous three years, or have been involved in a serious violent incident within the past four years.

The new standard would be a "likelihood" of danger for receiving treatment involuntarily. The bill provides for a court hearing and legal representation for the mentally ill person.

New York state implemented such a law in 1999. Five years later, a report showed that individuals in the program experienced 77 percent fewer psychiatric hospitalizations, 87 percent fewer incidents of incarceration, and 74 percent less homelessness.

Greenleaf said he's mindful of Pennsylvania's history with the mentally ill, in which too many people were institutionalized and forgotten. "We're not going back to the bad old days," he said.

Rather, mental-health advocates say, the problem now is that too many people don't receive treatment before coming into contact with the criminal-justice system. About 20 percent of prison inmates suffer from mental-health issues. Those who do end up in prison tend to stay in prison longer than other inmates, costing the state more money and denying themselves effective treatment.

Supporters estimate that court-ordered outpatient treatment would benefit about 500 people in Pennsylvania annually. They say the service network is already in place to help such people in most counties.

Greenleaf said the legislation would not cost the state more money because Medicaid pays for these services. That aspect needs to be explored more thoroughly. While the state could very well save money with fewer prisoners and fewer state hospital commitments, some county human-service agencies might face greater demand for their services.

The state Senate should move ahead with this legislation, the goal of which is more effective patient care, fewer hospitalizations, and fewer incarcerations.

Mentally ill could benefit from bill

2009-03-29T07:39:00.001-07:00

By LLOYD DUNKELBERGER H-T Capital Bureau

Published: Wednesday, March 25, 2009 at 1:00 a.m.

Responding to the growing problem of mentally ill Floridians ending up in jails and prisons, lawmakers are moving forward on a sweeping initiative that will help better identify and treat those residents. Proponents call it one of the most significant rewrites of the state mental health law since the Baker Act was passed in 1971, reforming the way the mentally ill are committed for treatment.

Although the program is ambitious, it will start off on a small scale, with three pilot projects and will not require new state funding.

But advocates say it has the potential to save the state billions of dollars in the long term by improving the treatment of the mentally ill and keeping them out of costly prison beds or forensic treatment centers.

"This bill will without a doubt ensure a more fair treatment of people with mental illness. It will not only add fairness but effectiveness to the system," said Rep. Yolly Roberson, D-Miami, as the proposal was endorsed by the House Criminal and Civil Justice Policy Council on Tuesday. "It's a win-win for all parties."

Miami-Dade Judge Steven Leifman, who has spearheaded the legislation as a special adviser to the state Supreme Court on criminal justice and mental health, said the proposal is designed to bring the state's handling of mentally ill citizens in line with new treatment systems that can help those residents avoid ending up in jails or prisons.

"We've pushed a lot of people into the criminal justice system that don't need to be there," Leifman said.

A 2007 report to the Supreme Court found on a daily basis there were about 70,000 Floridians with a serious mental illness who were in prisons or jails, or under some type of correctional supervision. The report said that annually more than 125,000 Floridians with mental illnesses were being booked into county jails.

"The vast majority of these individuals are charged with minor misdemeanor and low-level felony offenses that are a direct result of their psychiatric illnesses," the report found.

Leifman said the mentally ill prisoners were the fastest growing segment in the state prison system, saying a projection shows it could cost the state more than $3 billion over the next decade to build new prison space and maintain those beds for that population. The other escalating demand is being put on the state's forensic facilities -- where persons charged with a felony but deemed mentally incompetent are sent until they have recovered enough to stand trial.

Florida is now spending roughly $250 million a year on 1,700 forensic beds, which gives it the distinction of running one of the most costly systems in the country. At the same time, the state has been criticized by national mental health groups for being near the bottom when it comes to spending on mental health programs outside of the criminal justice system.

"We've deep-ended our system so poorly that there aren't enough resources to provide the level of services that we now know are required to keep people out of the criminal justice system," Leifman said.

The new bill aims to target people who can be diverted from the criminal justice system, while also providing better treatment for the approximately 6,000 inmates with serious mental illnesses who are released from prison each year.

About half of those inmates end up going back to prison, Leifman said. The measure has the support of key state agencies including the Department of Children and Families, the Department of Corrections and the Agency for Health Care Administration.

DCF Secretary George Sheldon, who oversees the forensic treatment centers, said the current system does not make sense in that many felons who are sent to the centers spend enough time there in recovery only to be released back into the community for "time served" once they are deemed competent to stand trial.

Under the proposal, state officials hope to use some of the money now slated for the forensic beds for the upfront treatment initiatives, thus saving the state money in the long run. "It's a much more sensible use of money," Sheldon said. "What we're doing right now is the true definition of insanity."

Leifman said another advantage of the plan is that the federal government will pay a majority of the program's costs -- through the Medicaid -- as long as the mentally ill are being treated in the community and are not being sent into the criminal justice system.

The measure calls for pilot programs to be established in South Florida, the Tampa Bay region and the Pensacola area.

A similar bill is sponsored by Sen. Mike Fasano, R-New Port Richey, in the Senate.

This story appeared in print on page BN1

Many in U.S. Prisons Lack Good Health Care

2009-01-17T09:20:00.000-08:00

Report finds high rate of chronic disease that often goes untreated
Posted January 16, 2009
By Amanda Gardner

HealthDay Reporter

FRIDAY, Jan. 16 (HealthDay News) -- The 2.3 million Americans currently being held in correctional facilities across the country suffer a much higher rate of serious and chronic illness than the general population does, a new report finds.

These individuals -- representing about 1 percent of the total U.S. population -- also have difficulty accessing care both inside and outside the correctional system, according to research published online Jan. 15 and set to appear in the April issue of the American Journal of Public Health.

It's the first such study to look at the health of all inmates nationwide at once, the researchers said.

"We largely ignore mental health in our society, and it's exacerbated here," said Craig Blakely, associate dean for academic affairs and professor of health policy and management at the Texas A&M Health Science Center School of Rural Public Health in College Station. "The findings suggest that health and mental health problems are linked to higher rates of arrest and incarceration."

"Devoting more resources to community mental health care could reduce crime rates and reduce incarceration," added study author Dr. Andrew P. Wilper, an instructor in medicine at the University of Washington School of Medicine.

Largely due to the war on drugs, the U.S. prison population has increased fourfold in the past 25 years, surpassing any other nation in the world in number of people incarcerated per capita, according to background information in the paper.

Prisoners have a constitutional right to health care via the Eighth Amendment concerning cruel and unusual punishment, yet such services are often sorely lacking, the report's authors contend.

Good data on the subject is also lacking, Wilper added. He said that he filed two federal government freedom-of-information requests -- both of which were denied -- to review copies of an U.S. Surgeon General's report on prison health care.

In their study, the authors analyzed responses contained in two Bureau of Justice Statistics surveys: the 2002 Survey of Inmates in Local Jails and the 2004 Survey of Inmates in State and Federal Correctional Facilities.

"Of these roughly 2 million inmates, about 800,000 suffered from a chronic condition that generally requires medical attention: diabetes, hypertension, a prior heart attack or a previously diagnosed cancer, among a few other diagnoses," Wilper said.

Compared to non-incarcerated citizens, inmates in state jails were 31 percent more likely to have asthma, 55 percent more prone to have diabetes, and 90 percent more likely to have suffered a heart attack.

In federal, state and local jails, 38.5 percent of inmates, 42.8 percent of inmates and 38.7 percent of inmates, respectively, had a chronic medical condition.

Among inmates with mental conditions that had been treated on the outside, 69.1 percent of federal prison inmates, 68.6 percent of those in state facilities, and 45.5 percent of those in local jails were not taking their medication at the time of their arrest. The treatment rate for mental health woes tripled after incarceration.

Fourteen percent of those in federal prisons, 20 percent of state prison inmates and 68.4 percent of those in local jails had not yet seen a health-care provider since their incarceration, despite persistent health problems, the report found.

"There's some alarming data that suggests that those [inmates] with chronic conditions don't get the care they need when incarcerated and that's Eighth-Amendment illegal," Blakely said. "The whole war on drugs has made a disaster of our judicial system and created a nightmare we can't control."

"Given the huge cost of incarceration, we're foolish not to ensure that inmates get the basic care that would allow them to have a better chance of rehabilitation," he continued. "This suggests the need for universal access to health care."

More information

Visit the U.S. National Commission on Correctional Health Care for more on this issue.

Gassing mentally ill inmates is out

2009-01-17T09:08:00.000-08:00

A judge rules that it qualifies as cruel and unusual punishment.

By Paul Pinkham Story updated at 2:33 AM on Wednesday, Jan. 14, 2009

Two mentally ill inmates suffered unconstitutional cruel and unusual punishment at the hands of Florida State Prison officials who disciplined them with pepper spray, tear gas and other chemical agents, a judge has ruled.

But the same punishment was appropriate for four other prisoners who sued the Department of Corrections on similar grounds, U.S. District Judge Timothy Corrigan of Jacksonville wrote in a lengthy order finalized Monday after a five-day bench trial in September.

Corrigan made the distinction based on the mental condition of the individual inmates at the time they were disciplined. The order means the department can no longer use chemical agents on prisoners who lack the capacity to follow orders or control their behavior, said Jacksonville attorney Buddy Schulz, who represented the inmates.

"It's significant because it's the first time a federal judge has found this type of use of force unconstitutional as it relates to seriously mentally ill inmates who are incapable of conforming to the rules of the prisons," Schulz said.

Corrigan gave lawyers for the state until Feb. 10 to come up with terms of an injunction and Schulz's team until Feb. 24 to voice objections. He directed both sides to work together, and Schulz said he's hopeful for a dialogue for reform with Corrections Secretary Walter McNeil, who has shown interest in prison mental-health issues.

Lawyers for the prison system didn't return phone calls Tuesday.

Constitutionality was the only issue at trial. Individual claims by the prisoners had been resolved previously.

Corrigan found that the use of chemical agents against recalcitrant prisoners isn't by itself unconstitutional. But he wrote that such force loses its disciplinary purpose and "becomes brutality" when inmates are gassed who cannot control their actions because of mental illness.

Former Florida State Prison Warden Ron McAndrew, now a corrections consultant, called the ruling a vindication of mental-health policies he had in place in the 1990s.

"It's a great success for the people of Florida in terms of reducing the torture of inmates in Florida's prisons, especially those that are mentally disturbed," McAndrew said.

He testified at trial that his policies were abandoned when he was replaced in 1999 by James Crosby, leading to hundreds more gassings. Crosby later became corrections secretary, then went to prison himself for taking kickbacks.

paul.pinkham@jacksonville.com, (904) 359-4107

State Lawmakers Look at Death Penalty Change

2009-01-17T09:03:00.000-08:00

Thursday, January 15 2009
One state defense attorney is asking legislators to guarantee justice and fairness by banning the execution of death row inmates who suffer from severe mental illness.

Attorney Kimberly Stevens spoke to a legislative committee on Thursday asking them to remove the death penalty as a sentencing option for some suspects accused of first-degree murder.

According to the Associated Press, the new legislation would allow a judge to declare a suspect to have a severe mental disability. If convicted, the person would face a maximum sentence of life in prison without parole.

State law already bars a death sentence for the mentally retarded and North Carolina juries also can find a defendant not guilty by reason of insanity.

The bill could be considered after the Legislature meets later this month.

European states treat mental illness before it becomes prison problem

2008-07-19T06:45:00.000-07:00

By DAN EISENSTEIN

Tennessee Voices

If, upon arriving in Maastricht, Netherlands, on July 2 I had shut my eyes, I may have thought I had not left Nashville.

The temperature was in the high 80s with humidity to match, very "un-Holland"-like. But with my eyes open, I knew I was in an old European city.

I attended the 18th Conference of the European Association of Psychology and Law (EAPL), representing the Davidson County Mental Health Court over which I preside as a General Sessions judge. Also participating from Nashville were Dr. Roland Gray, representing the Davidson County Drug Court Residential Treatment Program, and Dr. David Patzer, a psychiatrist who works with both court programs.

At the invitation of EAPL, I presented a symposium with Gray and Patzer about the Mental Health Drug courts and a unique collaborative effort that will provide residential intensive drug therapy and mental health treatment for individuals in the criminal justice system who suffer from both serious mental illness and drug addiction. This program just received a federal grant for implementation. It appears to be the only type of program in the United States where separate courts are working together on these issues.

Seth Norman, judge of Davidson County Criminal Court Division IV, who founded and presides over the Drug Court Residential Treatment Program, was not able to attend the conference but provided a video presentation used at the symposium.

I am proud to report that the conference participants with whom I spoke, mostly European psychologists, university professors and students and some law enforcement personnel, were interested and impressed with the programs. However, a few people were curious as to why so many mentally ill people were in the U.S. criminal justice system.

It appears that a much higher percentage of people incarcerated in the United States suffer from serious mental illness than in some European countries. For example, I learned in one seminar that fewer than 5 percent of people arrested for crimes in The Netherlands suffered from schizophrenia. Yet, according to a 2006 U.S. Justice Department study, 24 percent of local jail inmates reported symptoms of a psychotic disorder.

Why this discrepancy? Certainly, there are many reasons. However, one reason may be access to health care. European countries have universal health-care plans; perhaps because of this access to treatment and medication, fewer people have mental health issues that deteriorate to a level where the police and courts have to become involved.

The Europeans may be attacking this issue on the front end, thus resulting in fewer people with mental illness winding up in jails. Just something to think about.

Mentally ill need treatment, not jail

2008-07-08T15:01:00.001-07:00

By Darlene Linville, Guest Columnist

Published Sunday, July 6, 2008 5:17 PM

--------------------------------------------------------------------------------

"Treatment not jail'' is the battle cry for Partners in Crisis, a statewide advocacy organization whose members support prevention and early treatment programs designed to keep people with mental illness out of the criminal justice system and get them into treatment. Each year as many as 125,000 people with mental illnesses requiring immediate treatment are arrested and booked into Florida jails.

The National Alliance on Mental Illness in Florida theoretically chose the same battle cry, "treatment not jail," when members statewide chose initiatives for 2007, setting as No. 1 to advocate for more funding for the mental health care system, and No. 2, to work toward improving programs to keep people with mental illness from being involved with the criminal justice system. Florida's jails and prisons house more than 10 times the number of people with mental illness as the number being treated in mental health facilities.

NAMI Hernando shouted that same battle cry in 2007 with a community education seminar titled "Taking Action … Let the Dialogue Begin," at which Judge Ginger Lerner-Wren spoke about her involvement as presiding judge in the establishment of the nation's first Mental Health Court in Broward County. She talked long and hard about how the Mental Health Court in her county saved taxpayer dollars while preserving the human dignity of those living with a treatable mental illness. Treatment not jail!

Hernando County was listening. A task force was formed and with the help of Karen Nicolai, clerk of court, Jean Rags, director of Health and Human Services and Kathleen Lonergan, coordinator for the Drug Court, that same battle cry was soon picked up by others in our county. Many people gathered to discuss the need and the possibilities; from the judges to the jail warden to the State Attorney's Office, to the hospital administrators, all were in agreement: A Mental Health Court was desperately needed.

Too many people with treatable mental illnesses were spending time in a very expensive jail when their crimes were not violent, but rather were directly related to nontreatment of their mental illness. The 2006 Hernando County health needs assessment shows that Baker Act initiations are substantially higher in Hernando County than Florida's average, and have been increasing since 2000.

I am amazed at how quickly our county officials, judges, attorneys and jail personnel came together to make it all happen. The mental health court has begun hearing cases, in Judge Richard Tombrink's courtroom.

Everyone agrees a mental health court is not the final answer, but only a beginning. "Treatment not jail" includes finding the treatment necessary to keep people on essential medication and involved with adequate psychiatric care. The Harbor Behavioral Health Care Institute will do all that it can, but in these troubled times of reduced spending for necessary programs it can only do what current funding levels allow.

"Continuing the Dialogue … Decriminalizing Mental Illness" was the theme for NAMI's most recent community education seminar on May 31 at Nativity Lutheran Church. Approximately 70 people heard a panel of experts discuss the why's and how's of a mental health court. County Commissioner Chris Kingsley read the county proclamation for Mental Health Month.

Sheriff Richard Nugent and several members of the Hernando County Sheriff's Office attended the event, at which the recently graduated members of the Crisis Intervention Team were recognized. These officers form a unique group, a group that has learned through special training to recognize mental health issues and the techniques necessary to de-escalate potentially explosive situations, thus preserving human dignity and community safety. We now have 18 trained members of the Crisis Intervention Team. Once again, "treatment not jail".

The first full week of October will find NAMI on a national level observing Mental Illness Awareness Week. NAMI Hernando will be continuing the dialogue and shouting the battle cry "treatment not jail." Watch for more information in the months ahead.

Thank you for listening, Hernando County. We look forward to continuing this partnership and our fight for adequate care for the mentally ill.

Darlene Linville is president of the board of directors of NAMI Hernando. Guest columnists write their own views on subjects they choose, which do not necessarily reflect the opinions of this newspaper.

Healing

2008-07-05T07:58:00.001-07:00

"The death penalty is about revenge and hate, and revenge and hate is why my daughter and those 167 other people are dead today."

Bud Welch, father of Julie Marie Welch,
victim in the Oklahoma City bombing

"I have come to believe that the death penalty is not what will help me heal. Responding to one killing with another killing does not honor my daughter, nor does it help create the kind of society I want to live in, where human life and human rights are valued. I know that an execution creates another grieving family, and causing pain to another family does not lessen my own pain."

MVFHR board member, Vicki Schieber, testifying to the Subcommittee on the Constitution,
Civil Rights and Property Rights; Committee on the Judiciary; US Senate, February 2006

Mentally incompetent defendants on rise

2008-05-29T15:28:00.000-07:00

By Kevin Johnson and Andrew Seaman, USA TODAY
WASHINGTON — The number of accused felons declared mentally incompetent to stand trial is rising in 10 of the nation's 12 largest states, delaying local prosecutions and swamping state mental health and prison systems, a USA TODAY review finds.
These defendants cost hundreds of millions of dollars to treat and house as local governments tighten their budgets because of a slowing economy.

Legal analysts attribute the increase to a lack of mental health care, judges' increased openness to such claims and legal strategies by defendants to try to avoid harsh punishment.

"It's a huge problem," says Joshua Marquis, a vice president of the National District Attorneys Association. "It's equally bad for the accused and the victims" because cases linger.

Criminal defendants who do not understand the legal proceedings against them are generally declared by judges to be incompetent for trial. Most are referred to mental health facilities and treated. The length of treatment varies from an average of three weeks in Virginia to more than nine months in Tennessee before they are deemed fit for trial or mental health experts determine they cannot be successfully treated, the USA TODAY review found.

There is wide variation in how states track thousands of incompetency rulings, and some do not track them at all. Of the 12 most populous states, Texas reported a decline last year and New Jersey did not provide data.

Among states reporting increases:

• Florida: State policy analysts reported in March that incompetent defendants there doubled from 1,061 to 2,123 in the past five years. Florida Supreme Court Chief Justice R. Fred Lewis says that reflects a lack of access to treatment even before the accused enter the criminal justice system. Florida officials spend about $250 million yearly on treatment aimed at restoring mental fitness. The state projects the cost will double in the next seven years.

• Ohio: About 32% of 1,050 state mental hospital patients have been charged with crimes but declared unfit for trial. Most are accused felons, and that number has risen recently, says Howard Sokolov, Ohio's medical director for forensic services.

• California: Mentally incompetent defendants treated by state mental health providers increased in four of the past five years. Accused and convicted offenders now occupy 4,500 of the state's 5,000 mental hospital beds, up from 500 more than a decade ago, says the state Department of Mental Health.

Ken Murray, chairman of the National Association of Criminal Defense Lawyers' mental health committee, says competency claims are gaining acceptance among judges, prosecutors and defense lawyers in part because of growing efforts to identify the wrongfully convicted. "Some of these people who made false confessions" — and were convicted based on those statements — "had competence problems to start with," says Murray, a federal public defender in Phoenix.

Sokolov says incompetency caseloads for Ohio's mental health assessors have risen 22% in the past five years. "There is an increasing amount of people who are finding it difficult to obtain (mental health) services," he says, "and they tend to get in trouble with the law."

Contributing: Katharine Lackey

Lacking treatment options, mentally ill go to jail

2008-05-26T07:16:00.000-07:00

By DAVID GUNTER
Correspondent

SANDPOINT - In Idaho, as in Bonner County, the fastest way to land in jail without committing a crime is to suffer from mental illness.

And it's not because of any shortcomings on the part of local law enforcement officials - they already go above and beyond the call of duty when responding to situations where a mentally ill person is “in crisis.”

Where the system falls apart is after the event takes place - particularly in rural communities with limited resources. Faced with a severe lack of secure facilities, law enforcement personnel often have no choice but to incarcerate the individual, further exacerbating a shortage of space needed to house those people who actually have committed a crime.

The same holds true for the Idaho prison system, which has a markedly higher percentage of inmates with mental illness - 44 percent for juveniles; 28 percent for adults, according to the Partnership for Safety and Justice - than the national average for adults of 16 percent.

“Many people with mental illness are in the state's correctional system,” said Dr. Ann Wimberley, president of NAMI Far North - the regional chapter for the National Alliance on Mental Illness. “Some of them are there because they actually committed a crime, but some are there because of a lack of resources in their own community.”

The gap is not surprising, since Idaho ranks 49th in the nation for spending on mental health, earning the state a grade of “F” for mental health services from NAMI's national office. Although Kootenai County has a 10-bed facility that provides a temporary solution, as many as eight of those beds are used by the state at any given time, Wimberley said, which leaves Kootenai County with a shortage of its own.

“Having a safe place to take a person who's having a crisis is a big problem for law enforcement,” she added. “This is a situation that needs to be addressed by leaders of the community.”

With that in mind, NAMI Far North hosted a luncheon in Sandpoint on May 21, bringing together about 70 people representing the mental health

See NAMI, Page 3

and medical communities, elected officials from the city and county, law enforcement, the judicial system and the state Legislature. The speaker at that gathering, District Judge John Mitchell, highlighted a program that shows promise in those cases where crimes have taken place - a Mental Health Drug Court.

“In my courtroom, I began seeing a correlation between crimes of addiction and mental illness,” Mitchell said. “And if you talk to any district judge in the state, they would tell you the same thing.

“There are 5,000 inmates in the Idaho prison system and about 70 percent of that population is there for a crime of addiction,” he continued. “Almost half of them - about 1,750 people - also have a mental illness.”

Started about four years ago, the Mental Health Drug Court program in North Idaho began with five participants and has climbed to nearly 40.

“Most of our participants come to us when they are close to rock bottom - they're homeless, they're jobless,” Mitchell said. “We have saved more than a quarter-million dollars in jail costs and about $129,000 in hospital costs.”

Those figures are calculated by summing up how much these same individuals - most of whom were “return customers” to the judicial system, according to Mitchell - racked up in emergency room fees and jail time during the previous year, compared with their financial impact after joining the program. Routing people with mental illness into this group provides a network of support, education and treatment, the judge pointed out.

“This is a system-wide problem,” he said. “We have had a tendency to simply incarcerate and think that's going to solve the problem. But you need treatment.”

Mitchell also introduced a course called Crisis Intervention Training (CIT), which started in Memphis in 1988, after the fatal shooting of a mentally ill person during a response call by law enforcement.

“The program is in use in all but 10 states - and we're one of them where it isn't,” the judge said. “I'm here to start that dialog.

“Quite simply, what CIT involves is law enforcement walking a mile in health care's shoes and the other way around,” he added. “That way, when you're at somebody's house and they're unstable, you have a lot better idea of what you're getting into and a lot more options to work with, based on the knowledge the CIT program can give.”

Local law enforcement officials are on board regarding the need for training, but express frustration that they are often placed in the role of first responder to incidents that might be avoided or, at the very least, defused, before their help is needed.

“Law enforcement is ill-equipped to deal with this and we have zero options,” said Sandpoint Police Chief Mark Lockwood. “I think the hospitals look at us and say, ‘They've got the handcuffs and they take people into custody all the time,' so we get the calls. The biggest issue is that we lack facilities and a way to get these individuals the help they need.”

Lockwood applauds NAMI Far North's efforts to pull the community together in search of solutions for an issue that, by all accounts, has no easy answers.

“As a coalition - working together with NAMI, law enforcement and the judicial system - we can lobby the legislature for funds to build regional treatment facilities,” the police chief said.

“That's something we talk about every year with our lawmakers,” said Bonner County Sheriff Elaine Savage, “but this year, the legislature was not kind to North Idaho as far as treatment facilities. We have people in jail who shouldn't be there. These people don't need to be incarcerated, they need help.”

Wimberley said the Idaho Legislature already has approved funding a secure, 300-bed facility in a former warehouse on state prison property, with about 250 beds set aside for people with mental illness who have been sentenced for a crime. The other 50 beds at that prison facility, however, will be used to hold mentally ill individuals who have not committed an offense.

Like the sheriff and the police chief, the NAMI Far North president believes handling the matter at the local level would be a better direction.

“It's the right thing to do,” Wimberley said. “Rather than placing people in the correctional system, it's not only more humane to treat them in the community, it's also more cost-effective.”

NAMI Far North provides support, education and advocacy for people with mental illness, their families and friends. The group meets on the third Wednesday of every month from 6-8 p.m. at the Bonner General Hospital classroom.

Information: www.nami.org/sites/namifarnorth

Nobody's Fault

2008-05-17T09:49:00.000-07:00

The anatomy of a suicide in the Humboldt County Jail

By the HSU Journalism Department's Investigative Reporting class

--------------------------------------------------------------------------------

In January, journalism students from HSU, as part of an investigative reporting class taught by Assistant Professor Marcy Burstiner, set out to understand the intersection of the mental health and criminal justice systems in Humboldt County by investigating the death of one man: James Lee Peters, a Hoopa resident who committed suicide in the Humboldt County Jail last August. Over three months they intended to interview people who knew him as well as people who work in mental health and criminal justice. They were met with a wall of silence: Many people did not respond to repeated requests for information. People in the mental health field who did respond said they could not discuss his case because of privacy protections required under federal law. His lawyers argued that attorney-client privilege survives the death of a client. The Hoopa community, unused to anything but negative news, did not feel comfortable talking about Peters to the press.

The mental health system in Humboldt and across the state turned out to be a labyrinth they couldn't penetrate; instead of answering basic questions about standard procedures one agency after another bounced them from office to office. A public information officer at Atascadero State Hospital forced them to file a California Public Records Request just to find out how its trial competency program works.

So the students poured through records: Court minutes and files that are open to public inspection; birth, death and autopsy reports; court transcripts, case files released from the district attorney's office in response to another public records request and procedural reports and data from Atascadero. Their conclusion based on the records and interviews: The untimely death of James Lee Peters was both entirely preventable and inevitable. It reflected the inability of our mental health system to help people until it is too late, and the failure of the criminal justice system to handle the people who end up in the jails as a result.

The students involved in the project were: Chris Hoff, Karina Gonzalez, Matthew Barry, Matthew Hawk, Marc Kozachenko, Tatiana Cummings, Cassandra Hoisington, Melinda Spencer, Deunn Willis, Nicole Willens, Adrian Emery and Meghannraye Sutton.

James Lee Peters spent his 25th birthday last August behind the walls of the Humboldt County Jail, waiting to be taken to a state mental hospital. He spent his previous birthday much the same way. He wouldn't live to see the next. Instead, 10 days after he turned 25, Peters took the sheet off his bed, tore it into strips, tied them together and hanged himself. He would be on life support for eight days at St. Joseph Hospital before he would die of asphyxiation.

If Peters understood what he was doing when he ended his life, it might have been the only time he fully understood his actions. Complications at birth gave him learning disabilities and a low IQ. Throughout his life he needed mental health counseling but received little. He tended to lash out when he was angry and that repeatedly put him in trouble with the law. What began as small outbursts became increasingly violent, until the criminal justice system could no longer overlook the threat he represented. Instead, as his criminal record piled up, the Humboldt County Superior Court bounced him between a variety of mental health facilities, but only to make him competent enough to stand trial.

But this story doesn't stop with Peters. Because the tragedy is that we fill our jail, and jails across the state and country, with people just like him. There are alternatives, but not in Humboldt County.

"This community treats dogs better then the mentally ill," said District Attorney Paul Gallegos. "My hope is that we [would] treat our mentally ill better than we treat a dog."

What little we know about James Lee Peters plays out through documents obtained under the California Public Records Act. Everyone he interacted with, from teachers, police officers, lawyers, doctors, counselors, probation officers and jail guards refused to speak about him or his particular case for this story. Neither would members of his family, who still grieve over his death and who intend to file suit against any party they can find responsible. As of yet, no lawsuit has been filed.

Here's what we do know. James Lee Peters, nicknamed Hans, was a Yurok Indian from Hoopa who entered the world much the same way he would leave it: gasping for air.

At birth Peters was without oxygen for several minutes. That manifested into developmental and cognitive problems. Jamie Lynn Solano gave birth to Peters at age 16; he was the first of her three children. His biological father did not acknowledge him and the first years of his life weren't easy. He suffered physical abuse and several members of his family battled with drug and alcohol problems. Sometime in his childhood Peters saw a counselor briefly in Hoopa but stopped because the family feared he would be taken from his mother. Around age five, social workers took him from his mother and he went to live with his grandmother Joyce Croix, whom Peters credited with raising him

If you drive east on Highway 299 and head north on Highway 96 through dense redwood forests, you will descend into the Hoopa Valley. Here a Ray's Food and the Lucky Bear Casino stand against a backdrop of jagged mountains. Nearby, the Trinity River flows past grounds where Hoopa residents still hold ancient healing and renewal ceremonies, such as the sacred Jump Dance and Boat Dance.

With about 2,600 people on 144 square miles, Hoopa is at once the state's largest Indian reservation and a small town where everyone knows everyone. The sovereign nation is separated from the rest of the county by both distance and culture. The tribal government administers health services on the reservation, including some drug, alcohol and mental health treatment, but offers no residential treatment facility. It educates students in conjunction with the Klamath-Trinity Joint Union School District.

Peters had a difficult time learning, so he was put in special education classes at Hoopa Valley Elementary. His fourth-grade yearbook picture shows a dark-haired boy with a big smile. The picture of him in fifth grade shows an 11-year-old boy standing straight and looking proud. (Few of the people who knew Peters at that age were willing to speak of him on the record. Most of what follows comes from reports written later by officials and psychologists who interacted with him at various stages in his journey through the criminal justice system.)

In the ninth grade, his grandmother died. Peters later said that that period in his life was emotionally difficult for him, and as a result he had trouble in school. He was involved in three physical fights, was caught with marijuana, and was expelled.

At 14, psychological evaluations determined that his verbal comprehension was "particularly impaired." He continued his education at Captain John Continuation High School in Hoopa, and was shuffled between the homes of various members of his extended family. But he lacked a primary guardian.

The lack of guidance took its toll. At 16, he picked up a rock and threw it at a teacher's car, cracking the windshield. Police charged him with battery of a school employee and he served 60 days in Juvenile Hall. In throwing that rock he threw himself into the Humboldt County criminal justice system and he would never climb out of it.

The Hoopa Valley Tribal Police station has no holding cell. Each time a suspect is arrested police drive him 60 miles to the county jail in Eureka. Taking someone that far for relatively minor crimes adds a "traumatic element" to an already traumatic situation, said Graham Hill, chief of the Rio Dell police department. While Rio Dell sits at the opposite end of the county, his department also lacks a holding cell. The drive from Rio Dell to Eureka is just 25 miles, but that extra trauma, he said, can do more harm in the long run for prisoners who are mentally ill. The geographic distance also makes it difficult for family to visit prisoners in the county jail.

Peters soon added two more infractions — criminal threat of assault and battery and assault with a deadly weapon — to his juvenile record. About that time, he landed his first and only job, that of a choker setter for Three Star Logging Company, a typical entry level job in the logging business.

As a choker setter, he would likely have trudged up hillsides machines could not access, to wrap a cable under and around a log, forming a noose so that they could be pulled up to a place where they can be put on a truck. It is not an easy job, said Robert VanNatta, part owner of a 30-year-old logging business in Apiary, Ore.

While VanNatta didn't employ Peters or know of him, he could explain the type of work Peters likely had. "You cannot exaggerate the difficulty and danger of choker setting," VanNatta said. After securing the noose, the choker setter must quickly get away or risk getting crushed from rolling logs. Peters liked manual labor, but quit after he was denied a $1.25 an hour raise. That marked the end of his employment and education.

Unable to control his anger or impulses, his offenses became increasingly serious. As an adult numerous evaluations found that he suffered from Paranoid Personality Disorder, mild mental retardation and schizophrenia. At 24, his IQ was 67, which is the equivalent to that of an average 11-year-old child. Only 2.3 percent of the population possess IQs lower than 70.

His trouble deepened in 2001. Between October of that year and August 2002, he would be arrested five times. In two of those cases he assaulted women. In one he threatened a woman with great bodily injury. As a result of those arrests, he was sentenced to a 52-week batterer's program that he would never complete, and three years probation. When released, he became a statistic.

Megan Gotcher was Hans Peters' probation officer and is now a senior officer for the Humboldt County Probation Department. There are more than 50 officers in the county, but each officer is responsible for 60-100 probationers at a time.

"If you have a hundred cases, it is hard," Gotcher said. "You deal with searches, subpoenas and home contracts. Sometimes you just have to put out the fire." Probation officers work closely with Hoopa Human Services, but are not trained in mental health services.

The Humboldt County Superior Court questioned Peters' mental health in Dec. 2001 and placed him on two years of conditional release under a program run by the county's Department of Health and Family Services. It was responsible for providing Peters with treatment and supervision while he lived in his community.

But whatever supervision it gave him wasn't enough. In Aug. 2003, police arrested him for pushing his mother and assaulting a friend of hers with a shovel, sending him to the hospital. Around that time a car accident left him with major injuries. Peters would later tell a probation officer that after the accident, he more easily lost his temper and experienced suicidal feelings.

That January, police arrested him for trespassing and vandalism. A month later, they arrested him again for attacking a man with an iron. He was sentenced to three more years probation, but this time the court ordered him to enroll with the Redwood Coast Regional Center, a private, non-profit referral agency for the treatment of people with developmental disabilities, and to participate in a counseling program run by psychologist Karl Fisher through the Hoopa Valley Tribe's Division of Human Services. While waiting for the regional center to evaluate him, he attacked an inmate and in another incident was charged with attacking a custodial officer.

Finally, in April 2004, Eureka clinical psychologist Otto Vanoni evaluated Peters and suggested that his problem was medical rather than criminal and that he belonged in a medical facility rather than a jail.

Peters was housed in isolation during the time of the evaluation, which worsened his condition, Vanoni wrote. "A failure to move him from solitary confinement and a continuation of jailing will only lead to further decomposition of functioning," Vanoni wrote. Vanoni described Peters at the time as having short brown hair, brown eyes, a mustache and "a fuzzy chin beard." At five feet, eleven inches, he weighed 155 pounds. Most important for the court, Vanoni deemed Peters mentally incapable of assisting in his own defense.

Five residential treatment facilities in California specifically treat people with developmental disabilities, but as a criminal, Peters needed to be put into a secured facility. So the Redwood Coast Regional Center sent him to the only secured facility — Porterville Developmental Center, in Tulare County, 520 miles from Hoopa.

After six months, doctors at Porterville deemed him competent and sent him to a "licensed board and care facility," according to court records. (The records don't identify the facility.) In June 2005, the regional center asked the court to terminate his commitment and release him. It argued that Peters was no longer eligible for its services as he was not developmentally disabled. In doing so it contradicted Vanoni's report a year earlier and its own subsequent finding that Peters was eligible for its services based on his diagnoses of mild mental retardation.

"It is believed now that Mr. Peters' mental status at that time of RCRC's psychological evaluation while he was incarcerated affected the results of that testing," wrote Wendy Stout, an intensive services specialist for the regional center at that time. Plus, Stout noted, Peters had not caused trouble in the eight months he'd spent in residential treatment. In layman's terms, being in jail had made Hans Peters crazy, and that tainted the psychological evaluation.

In an interview this month, San Francisco forensic psychologist Paul Good said mental retardation is a "static condition" that doesn't change and can't be cured. And as far as the courts are concerned, a competent person understands the legal process, the roles of courtroom players, legal strategies and can work with an attorney in an effective way. A person can be competent in understanding the law, but that doesn't mean they are mentally healthy.

Five months after his release, however, his anger got the best of him again. In Nov. 2005, he went to a house to talk to a woman he'd been dating. When she said she didn't want to see him, he refused to leave. Her family tried to force him out and Peters reacted by pushing a 13-year-old boy. The boy fell and injured his back against a stool. Police issued an arrest warrant, charging Peters with misdemeanor cruelty to a child.

Back in jail, things got worse. In January 2006, correctional officer Steve Christian opened the door to Peters cell to get some janitorial items and Peters punched him in the face. When officers asked him why he did it he said, "Leave me the fuck alone. Dealing with the voices in the back of my head is hard enough, I don't need to listen to you as well."

Peters later expressed remorse and apologized for his sudden outburst at Christian. "A lot of things were messin' with my head," he said. "I feel bad. No one deserves to get punched."

Again, his lawyers questioned Peters' competency and Judge Christopher Wilson ordered another evaluation. During the two years that preceded his death, Peters, whom doctors said was mentally unable to assist in his own defense, appeared in court 25 times. Five different defense attorneys represented him and he faced 10 different deputy district attorneys and three different judges. It seemed as if Peters was the hat that everyone would pass but no one would wear.

The inability to get Peters the help he so obviously needed frustrated Judge Wilson. Over the next 18 months, Wilson would repeatedly order Peter's attorneys to get him into a local treatment program or a state hospital only to be told that no place would take him. For almost three months in the beginning of 2006, Peters sat in jail while Wilson waited for the California Department of Mental Health to determine if he qualified for conditional release. In February, Eureka clinical psychologist Michael M. Ramirez determined that Peters' was still incompetent to stand trial.

But in March, the Redwood Coast Regional Center again found Peters ineligible for their services. Meanwhile Atascadero rebuffed Wilson's order and refused to take Peters.

On Nov. 6 the court acknowledged that Peters was there too long. "I'd like to know when Napa's going to come get Mr. Peters," Wilson said in court. "They said they're going to reject him because he's mentally disabled. We sent him back to the regional center. They said he's not disabled. They're just playing games with us."

Finally on Dec. 4, 2006, almost a year after his arrest, Peters was transferred to Napa State Hospital. But again, the goal was only to make him competent enough to assist in his own defense, not to silence the voices in his head. He would spend two months there and when doctors deemed him competent, he was back in the jail.

The delays Peters went through are common for the mentally ill prisoners who fill the jail, said Humboldt County Deputy District Attorney Wesley Keat, Jr. in an interview in April of this year. "Those in jail have some kind of mental illness and jailers say the jail is a mental health facility," he said. " There are a lot of people in the County Jail waiting to be transferred to a mental health facility."

The problem is that the jail is not equipped to handle such problematic prisoners, said Brenda Godsey, public information officer for the Humboldt County Sheriffs Office. "We are not a mental health facility," she said.

Humboldt County isn't the only place with this problem. One study published in 2006 estimated that jails across the country house more than 94,000 people with severe mental illness. The Los Angeles Daily News reported in April that the psychiatric patients who fill most of the 1,000 beds in Los Angeles County's Twin Towers jail facilities have turned the jail into the largest mental institution west of the Mississippi. It cited data that show that statewide, California has just 6,285 beds for mentally ill patients or 17 for every 100,000 residents. Researchers said the state needs at least 12,200 more.

The U.S. House of Representatives passed the Mentally Ill Offender Treatment and Crime Reduction Reauthorization and Improvement Act of 2008. If passed by the Senate, it would provide grants for diversion programs and increase cooperation between the criminal justice and mental health systems.

At least 13 counties in California rely on special courts for mentally ill prisoners to ease the burden. These courts only accept criminal offenders with severe mental problems and dismiss charges after the offender commits to and completes an individualized program designed for their illness, most often one that involves a residential treatment facility. After a year of sobriety and being crime-free, the defendant attends a trial and the case is dismissed. They are then given job training and GED exam preparation.

In Gainesville, Ga., a mental health court entitled HELP (an acronym for Health, Empowerment, Linkage and Possibilities.) puts prisoners on a plan for success, which includes, among other things, getting a job and taking medications. According to an article in the Gainesville Times, prosecutors, defense attorneys, case managers, treatment providers and judges work together to ensure that the prisoners stay on the right path. They review each case in weekly meetings, and determine which ones progress and which ones seem to regress.

California voters tried to address the problem back in 2004 when they passed Proposition 63, also known as the Mental Health Services Act. The statute raised an additional 1 percent tax on the 30,000 state residents (1 percent of the state population) that make an annual income of over $1 million. By 2006, the statute generated about $730 million for mental health services in California. But the law did not specifically fund mental health courts. Mental health providers across the state, and in Humboldt County in particular, complain that much more funding is needed.

A new program known as STAR (Supervised Treatment After Release) started in Humboldt County on April 1, 2007. The goal of the program is to provide evidence-based treatment in treating seriously mentally ill offenders by coordinating mental health service providers, corrections, probation, the district attorney's office, defense attorneys and community/family advocates.

The STAR program only serves 25 offenders at a time, according to its website. Regardless, Peters may have been ineligible, as it does not take inmates considered a public safety threat.

Julie Ohnemus, mental health director of the Open Door Community Health Centers said that in the past five years she has seen a jump in the number of mentally ill patients. The Arcata clinic alone sees 4,000 such patients a month, and that means that counselors can see each patient for only about 15 minutes each. That's not enough time for a doctor to properly monitor a patient. But resources are limited. The Open Door network has a total of eight counselors for both Humboldt and Del Norte counties. That's forced family practitioners to act as psychological counselors.

Hans Peters did not go to an Open Door clinic. But Ohnemus said that the clinics see people like Peters every day, released from the jail and bound to return. That's because the jail releases prisoners who suffer from severe mental conditions without any medication, and without medication they are in no condition to get themselves the help they need. "That's wrong," she said. "There's no reason not to follow up," she said.

Robynne Lute has worked as a behavior health consultant at the Humboldt Open Door since 2004. She sees about 10 patients every day. They suffer from depression, anxiety, substance abuse and chronic pain. She has lost five patients to suicide and several others to drug overdoses. One female patient hanged herself while on a waiting list for county psychiatric services.

"People are not getting what they need," she said. The county has an intensive treatment program but it only has 12 beds for three counties. There is also an emergency treatment program that can keep someone under surveillance for 72 hours. But after that it refers them to other facilities and leaves it to the patient to follow through. Meanwhile, the shortage of beds means that only people who are very sick are admitted into the two programs. "We don't have a lot of services for people that fall in between."

Perhaps Hans Peters was doomed from the start. Although suicide is taboo in the Hoopa Valley Tribe as well as many Native American cultures, rates are high and rising. The Centers for Disease Control reported in 2005 that that among American Indians/Alaska Natives ages 15 to 34 years old, suicide is the second leading cause of death and the per capita rate of 21.4 per 100,000 people is 1.9 times higher than the national average for that age group. Native Americans are disproportionately represented in the Humboldt jail. On the day Peters hanged himself, the jail housed 47 Native American men accounting for 16 percent of the total jail population. Native Americans account for just six percent of the total population in Humboldt County according to a 2006 U.S. Census estimate.

If he could have been steered to an alternate fate, it would likely have had to happen early on. But deputy public defender Christina Allbright described current California law regarding minors and mental incompetency as a "huge black hole." She noted that Humboldt County has no facility to treat mentally incompetent juvenile offenders.

Some in the U.S. Congress are trying to bolster resources for Native Americans. The U.S. Senate passed the Indian Health Care Improvement Act in February. If passed by the House it would fund greater mental health services for tribes and could address the need for in-patient mental health treatment in Hoopa.

Hans Peters wanted to get treated. After Napa released him in March 2007 he told Judge Wilson that he hoped for a normal life. "I just want to go to my programs and take my medication and do good in life and get me a job, sir," he said.

His defense attorney, David Lee, argued that Peters deserved a chance at freedom. "He's served far more time in custody on all of these charges probably than anybody would have gotten at the onset," Lee told Wilson. "It's nobody's fault he was not able to handle the criminal proceedings for many, many, many, many months based on his mitigating mental condition."

Wilson was reluctant to allow Hans Peters to be released without adequate supervision. "If there's some form of decomposition, we're back to where we were," he said in court. "And that just cost Mr. Peters two years of his life."

The process took so long that Wilson released him three times during the two years to take care of personal business: Once to visit his brother, once to cash some checks and once to go to a dentist for a root canal.

In May 2007, Peters spent two days in Sempervirens Psychiatric Health Facility in Eureka, the only inpatient care facility in Humboldt County, while waiting for acceptance into a drug treatment program.

It's not clear exactly how long Peters spent outside confinement on the last go-around, but he was back in jail June 22, this time charged with false imprisonment and two counts of battery. Yet again, the court questioned his mental capability, ordered another psychological evaluation by Dr. Michael M. Ramirez, waited for a report from the mental conditional release program and ordered Peters recommitted to Napa State Hospital for recovery of trial competency.

According to a report from Deputy Coroner Charles Van Buskirk, Hans Peters did not want to return to Napa. Instead, in an attempt to prove mental competence, he had stopped taking his court-ordered medications. At 3:15 p.m. on Aug. 29, 2007, Peters fashioned a noose out of his bed sheet. Two officers found him hanging in his 7 1/2-by-11 foot jail cell. He had pushed the ends of the cloth strips through the small holes in a ventilation grate over his toilet, using a tool he had made by chewing on a spoon.

The officers tried to resuscitate him, but it is unclear if they were able to get a response from the body. At St. Joseph Hospital, doctors put him on life support but he never regained consciousness.

In ending his life, Peters put a stop to what had become an endless cycle: Arrest, temporary treatment, release and re-arrest. The problem is that the system expects mentally ill people like Peters, a man with the mentality of an 11-year-old boy, who suffered from paranoia and who was incapable of controlling his emotions, to get themselves the help they need.

Rebecca Porteous, a licensed clinical social worker, said she sees people come in and out of jail with recurring mental issues. When the jail releases mentally ill inmates, it instructs them to see a mental health professional. If they do that within the first two weeks, they will continue their medication. But not all do.

"It is still America," she said. "And people have free will."

Congress Passes Rep. Napolitano's Mental Health Month Resolution

2008-05-17T09:47:00.000-07:00

16 May 2008

The U.S. House of Representatives passed H. Res. 1134 today, a resolution introduced by Rep. Grace F. Napolitano (D-Norwalk) recognizing May as Mental Health Month.

"An estimated 57 million Americans suffer from diagnosable, treatable mental illnesses," noted Rep. Napolitano. "This number is growing because of the epidemic of Post Traumatic Stress Disorder among veterans returning from Iraq."

"Only one in three Americans suffering from mental illness receives treatment. This statistic is unconscionable and must do more to improve access to critical services and to remove the stigma associated with seeking help," she added. "America's health practitioners, mental health organizations and community leaders - including those in faith-based communities - should use this opportunity to promote awareness and reduce and eliminate the stigma of treatment; ensure access to appropriate services; and support an improved quality of life for those living with mental illness."

The resolution includes several stunning facts about the cost and scope of the issue:

- 20 percent of the U.S. population has a diagnosable, treatable mental disorder, but only one in three receives any treatment.

- Approximately one in five children has an early, diagnosable mental disorder

- Untreated mental illness cost businesses and the American economy over $150 billion last year in lost productivity and absenteeism.

- More than one in five of our troops suffer from major depression or Post Traumatic Stress Disorder.

- More than half of all prison and jail inmates suffer from mental illness.

"Mental illnesses are diagnosable and treatable," concluded Napolitano. "Congress must act to ensure parity in treatment by investing in effective mental health programs that will lead to healthier and more productive lives for millions of Americans."

Rep. Napolitano is co-chair of the House Mental Health Caucus and a leading spokeswoman for mental health issues.

http://www.napolitano.house.gov

Disorderly conduct

2008-03-28T20:53:00.000-07:00

A little-known but widespread mental illness afflicts 4 million Americans and their families.

Today's editorial begins with a quiz — and ends with a mystery.

A single mental illness afflicts some 4 million Americans, between 1 percent and 2 percent of the population. It accounts for, or figures in, 20 percent of all psychiatric hospital admissions. More Americans have this illness than suffer from schizophrenia. A third of all young Americans who commit suicide first show symptoms of this illness.

Its name? Borderline personality disorder. Given the disorder's presence in society and the harm it does to so many lives, it is difficult to comprehend how the public and the mental health professions can know so little about it and how to treat it.

The figures above are supplied by the National Education Alliance for Borderline Personality Disorder, the organization founded to educate families, patients and care-givers about this devastating and tragic illness. The alliance, the Nation's Voice on Mental Illness and the Menninger Clinic are sponsoring a conference on new clinical approaches to the disorder, to be held Friday at Baylor College of Medicine in the Texas Medical Center.

Sufferers of BPD can't control their emotions, impulses and relationships. Many are unemployable. Of the men in prison, 12 percent have BPD, as do 28 percent of women inmates.

People with BPD usually suffer from other illnesses — depression and drug addiction, for instance — both mental and physical. A 30-year-old woman with BPD typically has the medical profile of a woman in her 60s, according to the alliance.

As yet, there is no medication approved for the treatment of BPD, but specific counseling therapies and techniques have proved effective. Those treatments are the subject of Friday's conference in Houston.

In May 2003, the Menninger Clinic moved to Houston from Topeka, Kan. It filled a gap in the clinical skills of the Texas Medical Center, and great things were expected for Houston in the field of mental health. Friday's conference is an example of the role Houston can play in increasing Americans' knowledge of mental illness and compassion for those it afflicts.

Apart from its stealth profile and difficulty in treating it, borderline personality disorder has another mystery connected to it: For some unstated reason, the Texas Legislature, by law, forbids local organizations such as the Mental Health and Mental Retardation Authority of Harris County from providing continuing treatment to BPD sufferers, except for those who also suffer from major depression.

If the aim is to save the state's taxpayers money, the result could hardly be further from it. What the state might save on counseling and management of BPD cases, it loses in lost productivity, higher jail costs and heavier burden on the general health care delivery system — a burden borne by employers and taxpayers.

Perhaps before the next session of the Legislature, one of its members will learn more about borderline personality disorder — from attending a conference or reading —and act constructively on that knowledge.

Second Chance Act Improves Mental Health Services For Prisoners, USA

2008-03-16T14:47:00.001-07:00

14 Mar 2008

The American Psychiatric Association applauds recent Congressional efforts led by Rep. Danny Davis, D-Ill., to improve treatment for the large number of people with mental illnesses and substance use disorders who are currently incarcerated in U.S. jails and prisons.

The U.S. Senate passed the Second Chance Act (H.R. 1593) this week by unanimous consent. The U.S. House of Representatives passed the legislation last fall. The legislation would provide transitional assistance to ex-offenders in an effort to reduce a return to alcohol abuse. Additionally, the legislation would extend and provide a full continuum of care for treatment of substance use disorders and improve mental health screening and treatment.

"It is a national tragedy that jails and prisons have become the primary mental health care facilities in the United States today," said APA President Carolyn Robinowitz, M.D. "This bi-partisan action represents significant steps forward in improving access to mental health services and substance abuse treatment programs for those incarcerated within the prison system."

According to a 2006 report by the U.S. Department of Justice, entitled "Mental Health Problems of Prison and Jail Inmates," more than half of the population incarcerated in U.S. prisons and jails - including 56 percent of state prisoners, 45 percent of federal prisoners and 64 percent of local jail inmates - were found to have a mental illness. Many of these inmates suffer from treatable disorders such as major depression, bipolar disorder and substance use disorder.

"People with mental illness, left untreated, can develop symptoms and behaviors that lead to their arrest and incarceration," Robinowitz said. "Treatment can help prevent incarceration. Improving funding and cooperative programs between mental health care professionals and correctional agencies is a step in the right direction."

About the American Psychiatric Association

The American Psychiatric Association is a national medical specialty society whose more than 38,000 physician members specialize in diagnosis, treatment, prevention and research of mental illnesses including substance use disorders. Visit the APA at http://www.psych.org and http://www.HealthyMinds.org.

How many jails can the country actually hold?

2008-01-25T15:07:00.001-08:00

By David Webb - The Rare Reporter
Jan 24, 2008, 22:22

Maybe more thought should be given to deterring crime

Every morning as I head for work I pass the construction site of the new south tower of the Dallas County jail complex at Industrial Boulevard and Commerce Street.

It never fails to give me the creeps.

Dallas County officials tout the new building, which is scheduled for completion by January 2009, as a long, overdue improvement. The new addition to the Lou Sterrett Justice Center will house 2,304 prisoners in a total of 36 pods of 64 inmates each, according to Dallas County Judge Jim Foster’s January 2008 newsletter, Issue 1, of what he plans to be a regular publication by his office.

Each pod will have a detention supervising office, and each floor will have medical exam facilities. It will replace two existing jails that operate at offsite locations, eliminating the need to transfer prisoners to and from the county complex, which also includes the Frank Crowley Court Building.

The price tag for the new jail — $62 million — an astronomical sum that will undoubtedly rise before completion.

Unfortunately for me, when I look at the construction site I don’t see progress in motion. What I see is an ugly, intimidating structure that will be used to warehouse people who have lost their way in life.

To me it is a grim reminder of how badly society has failed the disadvantaged — poverty-stricken children and the mentally ill to name a couple of examples.

Rather than using our resources to intervene in the lives of children who suffer from poverty and neglect and are often the victim of crimes themselves, we are using it to build jails and prisons where they can be locked away when they reach an age where rehabilitation is — if not impossible — highly unlikely. Poverty and mental illness are inextricably linked to crime, and we are using our resources to punish people instead of trying to help them overcome their disadvantages.

The criminal justice system has become an enormous economic machine, providing profits for everyone from the construction worker at the site of the new jail to the judges sitting on the benches in the courtrooms who will decide the fates of the inhabitants of the new structure — not to mention the battalions of police officers on the street who are needed to inject people into the system. The sheer number of employees and entrepreneurs engaged in the operation of the criminal justice system is mind boggling.

The truth is you couldn’t dismantle it without throwing the country into an economic crisis.

I don’t have an answer for this conundrum, nor is it a unique observation. A lawyer who was involved in social justice issues first brought it to my attention years ago when the Lou Sterret Justice Center was a new building. Since then, the problem has gotten only worse.

What I’d like to see now is for the politicians and officials my local and federal taxes help employ searching for different solutions than merely locking people up for various periods of time to keep them out of trouble. Surely, there’s a limit to how many jails and prisons can be built.

I’m all for law and order and I understand safe and humane facilities must be maintained for detaining criminals, but I’d far rather see my taxes being spent to feed and house children, the elderly, the mentally ill and others who are helpless.

Jail is not the place for that.

Maybe that would be a good topic for a story in Foster’s newsletter — what he thinks could be done to prevent people from becoming criminals rather than him citing the construction of a new jail and the hiring of new jail guards as accomplishments in 2007.

It’s just a thought.

E-mail webb@dallasvoice.com

This article appeared in the Dallas Voice print edition January 25, 2008

Mentally ill said to need treatment, not prison

2008-01-25T15:05:00.000-08:00

Thursday, January 24, 2008

By Pat Shellenbarger
The Grand Rapids Press

With the state Corrections Department gobbling up more than $2 billion a year -- one-fifth the state's budget -- a statewide coalition of judges, police, social service officials and others say there is a better way to spend taxpayers' money -- treat the mentally ill rather than lock them up.

Citing what it called "a growing statewide crisis," the new group, called the Michigan Partners in Crisis, today released a list of six initiatives it said would improve treatment of the mentally ill, reduce the state's prison population, save money and lower the crime rate.

"It's a wiser investment of state dollars," said Michael Reagan, a member of the coalition's advisory board and president of the nonprofit Proaction Behavioral Health Alliance, based in Grand Rapids.

Besides, he said, "It's the humane thing to do, and it makes our communities safer."

While no recent figures are available, coalition members believe more than half the inmates in Michigan's prisons and jails suffer some form of mental illness, often undiagnosed and untreated. That is a partly due to a decision by state officials over the past few decades to "deinstitutionalize" most mental patients by closing state mental hospitals.

While the coalition is not calling for reopening of the mental hospitals, it said the state failed to provide enough resources to treat the mentally ill in communities. As a result, some commit crimes and end up incarcerated, where they usually do not get proper treatment and often deteriorate.

"We have not deinstitutionalized the mentally ill," said Mark Reinstein, a coalition member and president of the Mental Health Association of Michigan. "We have 'transititutionalized' them," shifting them from hospitals to jails and prisons.

The coalition, asserting that most crimes committed by the mentally ill are nonviolent, called for the creation of mental health courts that would send mentally ill offenders into treatment programs rather than jails and prisons.

Diagnosing and treating mental illness before a crime occurs would be even better, Reinstein said.

For those who still need to be incarcerated, the state should improve treatment programs in the prisons to stem the high recidivism rate for mentally ill inmates, he said.

"These aren't places that fit in with treatment," Reinstein said. "What we have now isn't anywhere near what it ought to be. We have a horrible epidemic problem here."

The group called on state leaders to commission an independent study to determine how common mental disorders are in Michigan's county jails, state prisons and juvenile facilities. Last fall, the state Corrections Department estimated 16 percent of its inmates have been diagnosed with mental health problems.

"I think that's a low number," said C. Patrick Babcock, former director of Michigan's Department of Mental Health.

Deinstitutionalization was a good idea, he said, but, after the state closed most mental hospitals, "too many people fell through the cracks."

He cited the case of Timothy Souders, who died of dehydration while shackled to a bed in a Jackson prison in August 2006. Because of his mental illness, Souders, 21, could not follow prison rules, and his condition deteriorated while he was locked in solitary confinement.

The coalition is calling for an end to solitary confinement as punishment for mentally ill inmates.

Nationally, about 64 percent of county jail inmates and 56 percent of state prison inmates suffer some form of mental illness, the group said, and 75 percent of those in juvenile facilities have emotional disorders.

The current state budget includes $400,000 for a study to determine what portion of the state's 51,000 prison inmates are mentally ill.

The last independent study two decades ago found 40 percent of Michigan's prison inmates had some form of mental illness, including schizophrenia, bipolar disorder and major depression.

A 1998 study by Wayne State University found that 45 percent of Kent County's jail inmates were mentally ill.

State prison officials generally agree with the coalition's goals, Corrections Department spokesman Russ Marlan said.

"We've always said we don't think prison is the best place to treat the mentally ill," he said. "We've said all along we have to take who we get, and we do the best job that we can before releasing them.

Coalition goals

The goals of Michigan Partners in Crisis are:

Inform the public and policy makers about the impact of untreated mental illness.

Spearhead independent analysis of the prevalence of mental disorders in state prisons, jails and juvenile justice facilities; determine treatment needs.

Work with the state to improve mental health diversion services.

Get the state to suspend -- rather than terminate -- Medicaid for incarcerated people with mental illness.

End solitary confinement as punishment for mentally ill inmates.

Give state Department of Community Health greater authority to manage and provide treatment for mentally ill inmates.

Send e-mail to the author: pshellenbarger@grpress.com

Mental Health Advocates Meet in Tampa

2008-01-13T15:09:00.000-08:00

01/10/08 Seán Kinane
WMNF Evening News Thursday Listen to this entire show:

There is such widespread incarceration of people with mental illness that jails have become the largest mental health care providers in many communities, according to a report released in November by the Florida Supreme Court.

The report on how the state’s courts and social support systems manage citizens with mental illness recommends that mentally ill patients be moved out of jails and into treatment facilities that are almost always less expensive. An advocacy group for people with mental illness or substance abuse, Florida Partners in Crisis, held a board meeting today in Tampa.

John Petrila is a professor with the Florida Mental Health Institute (FMHI) at the University of South Florida. He co-chaired the Policy, Legislative, and Finance Workgroup for the Supreme Court’s report.

Michele Saunders is the executive director of Florida Partners in Crisis, which she called a diverse coalition coming together with one purpose, to better fund the mental health and substance abuse system. One way to do that, according to Saunders, is to focus on legislation in Tallahassee, including a renewal of the Criminal Justice Mental Health Substance Abuse Reinvestment Act.

Saunders said increasing reinvestment funding is one of the recommendations in the Florida Supreme Court report and Florida Partners in Crisis will seek funding from the Legislature for others.

John Petrila said the Legislature has to follow up on the Supreme Court’s recommendations.

Saunders agrees that investing in up-front services will save the state money in the long run.

Mark Speiser is a circuit court judge in Broward County and is chair of the Florida Partners in Crisis Board. He said it was important for people with mental illnesses to have access to appropriate treatment.

One way to keep people with mental health issues out of the criminal justice system and get them needed care is through mental health courts. The country’s first mental health court was established in Broward County in 1997.

Within the next few months, Hillsborough County will begin a felony mental health court to reduce the criminalization of mental illness, headed by Hillsborough Circuit Court Judge Debra Benhke.

Benhke said there are advantages to having a mental health court as opposed to keeping everyone in the criminal court system.

Judge Speiser said the Mental Health Court in Broward County serves as a successful model for the one in Hillsborough.

The group Mental Health America of Greater Tampa Bay will host a Mental Health Brainstorming Council on Saturday, Feb. 2 from 9 a.m. until noon at St. Lawrence Catholic Church on Himes Avenue in Tampa.

For information on the Tampa Bay Region Mental Health Brainstorming Council II meeting Feb. 2, contact Scott F. Barnett at (813) 972-2618.

Scientists say teen brain, still maturing, is key to understanding behavior

2007-12-08T13:59:00.000-08:00

Scans show that the brain doesn't mature until age 25; increasingly, courts are considering such findings as they decide what punishments fit teen crime.

By Malcolm Ritter
ASSOCIATED PRESS

Sunday, December 09, 2007

NEW YORK — The teenage brain, Laurence Steinberg says, is like a car with a good accelerator but a weak brake. With powerful impulses under poor control, the likely result is a crash.

And, perhaps, a crime.

Steinberg, a Temple University psychology professor, helped draft an American Psychological Association brief for a 2005 case in which the U.S. Supreme Court outlawed the death penalty for crimes committed before age 18.

That ruling relies on the most recent research on the adolescent brain, which indicates the juvenile brain is still maturing in the teen years and reasoning and judgment are developing well into the early to mid-20s. It is often cited as state lawmakers consider scaling back punitive juvenile justice laws passed during the 1990s.

"As any parent knows," wrote Justice Anthony Kennedy for the 5-4 majority, youths are more likely to show "a lack of maturity and an underdeveloped sense of responsibility" than adults. " These qualities often result in impetuous and ill-considered actions and decisions."

He also noted that "juveniles are more vulnerable or susceptible to negative influences and outside pressures, including peer pressure," causing them to have less control over their environment.

Some child advocates have pointed to the Supreme Court decision and the research as evidence that teens — even those accused of serious crimes — should not be regarded in the same way as adults in the criminal justice system.

Dr. David Fassler, a psychiatry professor at the University of Vermont College of Medicine who has testified before legislative committees on brain development, says the research doesn't absolve teens but offers some explanation for their behavior.

"It doesn't mean adolescents can't make a rational decision or appreciate the difference between right and wrong," he said. "It does mean, particularly when confronted with stressful or emotional decisions, they are more likely to act impulsively, on instinct, without fully understanding or analyzing the consequences of their actions."

Experts say that even at ages 16 and 17, when compared to adults, juveniles on average are more impulsive, aggressive, emotionally volatile, reactive to stress and vulnerable to peer pressure. They also are more prone to focus on and overestimate short-term payoffs and underplay longer-term consequences of what they do. And they're more likely to overlook alternative courses of action.

Violence toward others also tends to peak in adolescent years, says psychiatrist Dr. Peter Ash of Emory University. It's mostly likely to start about age 16, and people who haven't committed a violent crime by age 19 only rarely start doing it later, he said.

The good news, he said, is that a violent adolescent doesn't necessarily become a violent adult. About two-thirds to three-quarters of violent youth grow out of it, Ash said. "They get more self-controlled."

Some of the changes found in behavioral studies are paralleled by changes in the brain itself as youths become adults. In fact, in just the past few years, Steinberg said, brain scans have given biological backing to common-sense notions about teen behavior.

It's one thing to say teens don't control their impulses as well as adults, but another to show that they can't, he said. As for peer pressure, the new brain research "gives credence to the idea that this isn't a choice that kids are making to give in to their friends — that biologically, they're more vulnerable to that," he said.

Consider the lobes at the front of the brain. The nerve circuitry there ties together inputs from other parts of the brain, said Dr. Jay Giedd of the National Institute of Mental Health.

This circuitry weighs how much priority to give incoming messages such as "Do this now" versus "Wait! What about the consequences?" In short, the frontal lobes are key for making good decisions and controlling impulses.

Brain scans show that the frontal lobes don't mature until age 25, and their connections to other parts of the brain continue to improve until at least that age, Giedd said.

The inexplicable behavior and poor judgments teens are known for almost always happen when teens are feeling powerful emotions or intense peer pressure, conditions that overwhelm the still-maturing circuitry in the front part of brain, Giedd said.

Giedd emphasized that scientists can't yet scan an individual's brain and draw conclusions about how mature he is, or the degree of responsibility he takes for his actions.

Brain scans do show group differences between adult and teen brains, he said, "but whether or not that should matter (in the courtroom) is the part that needs to be decided more by the judicial system than the neuroscientist."

There's nothing particularly magic about age 18 as a standard dividing line between juveniles and adults in the courtroom. Different mental capabilities mature at different rates, Steinberg notes. Teens as young as 15 or 16 can generally balance short-term rewards and possible costs as well as adults, but their ability to consider what might happen later on is still developing, he said.

A dividing line of age 18 is better than 15 and not necessarily superior to 19 or 17, but it appears good enough to be justified scientifically, he said.

Steinberg said he thinks courts should be able to punish some 16- or 17-year olds as adults. That would be reserved for repeat violent offenders who have resisted rehabilitation by the juvenile justice system and who could endanger other youths in the juvenile system if they returned. "I don't think there are a lot of these kids," Steinberg said.

For the rest, he says it makes sense to try rehabilitating young offenders in the juvenile justice system. That's better than sending them through the adult system, which can disrupt their development so severely that "they're never going be able to be a productive member of society," Steinberg said. "You're not doing society any favor at all."

Most experts conclude that rehabilitation works better for juveniles than for adult offenders, Ash said. And just as parents know how irrational juveniles can be, he said, they also know that rehabilitation is a key goal in punishing them.

"What we really want," he said, "is to turn delinquent kids into good adults."

Additional material from Associated Press writer Sharon Cohen.

Younger suspect in murder had 'mental problems'

2007-12-08T08:39:00.001-08:00

Brother arrested in separate bat attack

BY AUSTIN L. MILLER
STAR-BANNER

FORT McCOY - Born prematurely at six months, William Myers weighed only a pound. At age 4, he was diagnosed as a schizophrenic with suicide rage disorder. He lived in several foster homes while his parents went through a bitter divorce, his family said. And now, at age 16, he stands charged with being an accomplice in the baseball bat slaying so brutal, a prosecutor has suggested it was done for "entertainment" or "pure meanness."

"He always had mental problems and issues," Irma Smith said about her stepson, whose 17th birthday Thursday was spent at the Juvenile Assessment Center.

Such was the life of Myers, as told by Smith and the boy's father, William, in an interview with the Star-Banner at Fort McCoy park.

Friday's arrest was yet another shock for the family. Myer's 18-year-old brother is in jail in an unrelated case on charges of beating someone with a bat. Now, the family says they are receiving phone death threats and someone tried to run Smith off the road.

On Friday, Myers and his 18-year-old cousin, James E. Roberts, were arrested by Ocala police and charged with the murder of 44-year-old Robert T. Leigh behind a Western wear store on Northwest Blitchton Road Police say Roberts swung the bat so hard that part of Leigh's head was lopped off.

Both Smith and Myer's father insist the teenager is "not a bad person." They conceded that he is a follower and not a leader.

"Growing up, he always craved attention," Smith said.

Myer's father and stepmother, who said they have received death threats, dispute the claims of the teen's aunt, Sherry Ann Mahle, that young Myers was kicked out of the home. Both said the situation that caused Myers to leave was spurred by two things.

On Oct. 20, the family hosted a birthday party at their Salt Springs home for Mahle and he wanted to drink. Because he was only 16, Smith told him no. After that, Myers decided he wanted to live with his mother, a person they say he seldom sees.

"I wasn't going to deprive him of his mother, so he went there," Myers' father said.

Not long after he went there, however, Myers got into trouble. The couple said Myers did not want to return home because he wasn't going to obey their rules. He then went to live with his aunt, Mahle, her husband and his cousin.

Mahle said in a Tuesday interview with the Star-Banner that Myers told her that he had been kicked out of the house.

Like Smith, Mahle believes her son also has had problems too big to handle. Mahle said Roberts never got over the death of his older brother six years ago, who was struck and killed by a car. He got into trouble, despite her efforts to get counseling for him and a general education diploma, she said.

The bat allegedly used in the slaying had belonged to Roberts' brother, and was a gift on his 12th birthday.

So far, the State Attorney's Office has not made a decision on whether Myers will be charged as an adult. They also have not made a decision on whether Roberts will face the death penalty. Myers is, by law, too young to face the death penalty, if convicted of first-degree murder.

Smith said there is another reason her stepson should be treated differently.

"He doesn't have a mental capacity of an adult," Smith said. At the time of the slaying, Myers was attending GED classes.

Myers' family hopes William will be transferred to a mental facility "to get help," his father said.

While the family is dealing with one son facing the possibility of a long time behind bars, they are also coping with Myers' brother, Michael, who is currently at the Marion County Jail in an unrelated case for allegedly beating someone with a baseball bat.

According to a Nov. 16 Marion County Sheriff's Office report, 18-year-old Michael Myers reportedly barged into a Salt Springs home and hit a 20-year-old man in the face and several areas of his body with a bat. The victim received a total of 12 stitches for lacerations to his upper lip and the back of his head. In an interview with the Star-Banner, Michael Myers denied hitting the man. He said the man was drunk and fell down the stairs. He declined to answer any questions about his brother.

Mahle said her son's bat was not used in that incident. Smith and the elder Myers didn't want to talk about Michael Myers' case.

The younger Myers cannot be reached for comment.

As for Myers and Roberts, Myers' father and stepmother said "they will stand by them."

"We will go to every visit, be at every court date, and be there every step of the way," they said.

They said "they're sorry for Leigh, his children and his family."

To keep his memory alive, the Leigh family has created a Web site in his honor. A section of the site read: "During the final months of his life, all he wanted was to reunite with his children, Rob and Illaena Kaye Leigh. While it is tragically too little, too late, we hope to honor his memory by doing something."

Austin L. Miller may be reached at austin.miller@starbanner.com or 867-4118.

Common Thread of Shooters' Desperate Isolation Suggests Need for Early Intervention

2007-12-08T07:40:00.000-08:00

Dec. 7, 2007

As the shocked residents of Omaha, Neb., struggle to pick up the pieces after Wednesday's massacre by a gunman at an area mall, psychological experts say the incident is yet another reminder of the inadequacies of the U.S. justice and health care systems when dealing with mentally troubled individuals.

In past incidents -- including the Virginia Tech massacre in April and the Trolley Square Mall shooting in February -- the perpetrator was later described as a loner, an outcast.

"All have that same theme of alienation and isolation," said Beverly Hills-based forensic psychiatrist Dr. Carole Lieberman. "Many of these shooters have been picked on by their peers or felt 'out of the loop.'"

"I think much of this stems from how we've become a much more isolation-oriented society," said Carolyn Wolf, senior partner at Abrams, Fensterman, Fensterman, Eisman, Greenberg, Formato & Einiger, LLP -- a mental health law practice in New York. "With computers and all of the technology that we now have available, people are much more easily able to be isolated, and with isolation comes withdrawal -- withdrawal from friends and family, as well as withdrawal from the medical system."

But mental health experts say these tragedies have something else in common -- they all point to a mental health system that minimizes the chances that these outsiders can get access to proper psychological services, which would possibly stop the tragedies before they occur.

"The gamut of mental health services has been lacking severely across the country," Wolf said.

"There are many dollars that are allocated for physical services, but mental health has been significantly overlooked," she said. "What all of this highlights is a very significant need for increased funds to help people who suffer from mental illness."

And it's not just a funding problem, they say. The set of laws governing intervention for mental health concerns are a patchwork across the country. New York, Wolf notes, has a state law providing for mental health warrants in which people can go through the courts to have their loved ones ordered to mental health treatment if they fear that they could become dangerous.

In Florida, legislation known as the Baker Act allows judges, law enforcement officials or mental health professionals to order individuals to receive mental health care if they are determined to pose a danger to themselves or others.

But not all states have such laws. And even in these states, admitting an individual in a potentially dangerous state of mental health is no simple task.

"You always have to meet certain legal standards in order to admit someone for mental treatment," Wolf said. "A person has to be deemed dangerous to themselves or others before they will intervene."

The solution, Wolf said, appears to lie in a combination of improvements, both within and outside the system, from increased funding, to better legislation, to a better overall understanding among the public of mental health issues.

"People need to become more educated as to what some of the signs of illness are, as well as the options for treatment," she said.

With this in mind, let's take a closer look at the Westroads Mall shooting, as well as other high-profile cases of mass shooting in the past.

Dec. 5, 2007: The Westroads Mall Shooting

The first hint that something terrible was happening at an Omaha mall came in the form of a 911 call received at 3:42 p.m.

Shortly afterwards, nine people at the Westroads Mall were dead -- including 19-year-old gunman Robert A. Hawkins.

Hawkins had reportedly been fired from his job at a McDonald's in the previous week, and had recently broken up with his girlfriend. According to reports by The Associated Press, Hawkins left a note in the home of his adopted family before the shooting spree. In it, he said he was "sorry for everything" and would not be a burden on his family anymore.

He also wrote, "Now I'll be famous."

"Robert was a desperate young man, who felt unseen and unloved by his parents, his girlfriend, his boss and the rest of the world," Lieberman said. "The only way he knew to become 'somebody' that others paid attention to was by creating news of his wreaking violence.

"Since he felt he wouldn't become famous for positive contributions to society, he settled for infamy as a mass shooter. Because he felt powerless and weak, he wanted to go out as someone who could inflict mass hysteria, fear, injury and death."

Indeed, those who knew Hawkins say he was an "introverted, troubled young man."

Hawkins, from Bellevue, Neb., was kicked out by his family about a year ago. He moved in with a friend's family, and Debora Maruca-Kovac and her husband welcomed him into their home and tried to help the teen.

In a TV interview, Maruca-Kovac described Hawkins as "a troubled young man who was like a lost pound puppy that nobody wanted."

And Hawkins had also experienced run-ins with the law -- missed opportunities, Lieberman said, for the detection and proper treatment of his mental problems.

"One difference between Robert and Cho Seung Hui [the gunman at Virginia Tech] and the Columbine shooters is that he had been convicted for felonies and misdemeanors," she said. "While he had the attention of the court, he should have been ordered into psychiatric treatment, or even juvenile detention."

April 16, 2007: The Virginia Tech Massacre
In some cases, however, the mental problems displayed by a shooter are too vivid to ignore.

Such was the case with Virginia Tech student Cho, whose disturbing video he shot of himself before he went on a shooting rampage sweeps away any doubt about his disturbed state of his mind.

The video, which Cho mailed to NBC News in a two-hour hiatus during the horrific shooting spree, features a violent and disorganized diatribe which psychological experts say offers a glimpse into a mind twisted by psychosis and rage.

"It appears that this was not schizophrenia, but some form of severe mental illness accompanied by paranoid delusional thinking, as reflected in his rantings on the video about people with trust funds and cognac and vodka," Dr. Redford Williams told ABC News shortly after the incident. Williams is director of Duke University's Behavioral Medicine Research Center in Durham, N.C.

Dr. Kathyrn Moss, attending psychiatrist in the Personalities Disorders Clinic at NewYork-Presbyterian/Weill Cornell, agreed that a combination of mental distress and isolation likely led to Cho's behavior.

"This is a mix -- a constellation of factors that came together in a horrific way," Moss said. "It's not just one thing. It can't be."

But his grave isolation -- as well as spotty access to mental health services -- could have played an important role in the student's rampage, which left 32 people dead and another 25 injured.

Records show that there were several instances during which Cho could have received the mental health help he needed. The police brought Cho to a mental health center in December 2005, where social worker Kathy Godbey determined that he represented a danger to himself or others, and that he could be put in temporary custody.

After another evaluation, psychologist Roy Crouse concluded that Cho was "mentally ill but did not present an imminent danger to himself or others, and did not require involuntary hospitalization."

As a result, a court magistrate released Cho, ordering outpatient treatment and follow-up. It is not clear whether Cho was ever contacted or participated in such treatment.

Moreover, questions linger as to whether Cho's mental health records were allowed to be released to his parents before the shooting took place.

Feb. 12, 2007: The Trolley Square Mall Shooting
Much like the most recent rampage in Omaha, the February shooting that occurred in Salt Lake City, Utah, took place in a bustling mall.

The Trolley Square Mall tragedy was the first mass shooting at a mall in 2007. In total, nine people were shot -- five of them fatally.

And the profile of the killer bears some similarities to others who have committed these types of shootings. Sulejman Talovic was an outsider, 18-year-old Bosnian immigrant who lived with his mother in Salt Lake City.

According to local reports, Talovic had a history of minor run-ins with the law. He was also a high school dropout.

But despite his past problems, for most there was little warning that he would show up at the Trolley Square Mall on a busy evening and start shooting people.

Though no clear motive for the rampage was ever established, a local newspaper reported shortly after the incident that Talovic claimed to be involved with a local gang.

Marie Smith, 23, a manager at a Bath & Body Works in the mall, later told The Associated Press that she had seen the gunman raise his gun and fire at a young woman during the incident.

"His expression stayed totally calm," Smith told the AP. "He didn't seem upset, or like he was on a rampage."

Feb. 13, 2005: The Hudson Valley Mall Shooting
According to local reports, Robert Bonelli Jr., age 24 at the time, was a shy outsider who lived in constant fear of being picked on for his nearly 300-pound physique.

And after his shooting rampage at the Hudson Valley Mall in Kingston, N.Y., which left two people wounded, mental health experts believe that it was this insecurity and isolation that may have been a key part of what drove him to the act.

"It is that same theme of alienation and isolation," Lieberman said. "Many of these shooters have been picked on by their peers or felt out of the loop."

According to a report in the Poughkeepsie Journal, Bonelli walked into a Best Buy holding an AK-47 rifle replica loaded with 60 rounds of ammunition. He began firing randomly, and he didn't stop until he had expended all of his ammunition.

His family would later reveal that they believed Bonelli had a death wish -- and that he wanted the police to do the job.

''It drove him to have himself killed by law enforcement that wasn't there in time,'' his uncle, John Bonelli, told the Journal. ''Because if they were there in time, this kid would have been in a body bag.''

Bonelli pleaded guilty to committing the shooting on May 20, 2006, and he was subsequently sentenced to 32 years in prison.

April 20, 1999: The Columbine Massacre
The school shooting at Columbine High School took place at the hands of students Eric Harris and Dylan Klebold on April 20, 1999. Many have pointed to the tragedy as both a template and catalyst for future shootings.

Indeed, Cho referenced the killers in his chilling video. And Bonelli reportedly had a picture of the killers taped to one of his bedroom walls.

But the case also raised awareness among many parents that the social isolation and brooding rage that can lead to such an attack could develop at home -- and largely unnoticed.

"In this case, the shooters were living with their parents, but their parents didn't have a clue who they really were," Lieberman said, adding that the episode shattered the illusion of the safety and security of an upper-middle-class upbringing.

"What matters is the attention and the love that the child is getting from their parents," she said.

In total, the rampage by the two students claimed the lives of 12 students and a teacher. The attacks wounded 23 others, and both of the boys committed suicide following the incident.

Lieberman said that if there is any lesson to be learned from Columbine -- as well as other more recent tragedies -- it is that parents and others should be on alert for the signs of dangerous mental health conditions -- and intervene before it is too late.

"People should report their suspicions to family members, the police, doctors, teachers and others in authority," Lieberman said.

Information from The Associated Press was used in this report.

Orlando-area judge frees mentally ill woman who killed her parents in '88

2007-12-02T18:08:00.000-08:00

She has been in state mental hospitals most of the time since their deaths in '88.

Rene Stutzman

Sentinel Staff Writer

December 2, 2007

SANFORD

When Stephanie Gardner stops taking her medication, things go very wrong. For months in 1988, she heard voices in her head, telling her to kill her parents. One night, she stood up from a card game, walked into another room and shot her father and mother with a .38-caliber handgun.

Since then, she's spent most of her days locked in state mental hospitals.

Soon that will end. A judge ruled Friday that Gardner is well enough to be set free. Circuit Judge O.H. Eaton Jr. ordered her released from the state hospital in Chattahoochee and into a privately run home for the mentally ill in Miami.

There she'll be supervised, but she won't be locked up. That, said Assistant State Attorney Chris White, makes her a risk.

Gardner has been diagnosed with bipolar schizoaffective disorder.

She doesn't believe she's mentally ill, however, according to three medical experts who testified Friday in Seminole Circuit Court. If Gardner stays on her medication, she should be fine, said psychiatrist Jeffrey Danziger. If, however, she walks away from the Miami facility, she's almost certain to stop taking her medicine, he said.

Gardner doesn't like taking her medication and can't be trusted to take it, White said.

"This woman killed two people," he said.

He pleaded with the judge to leave her locked in the state hospital.

Gardner was a 30-year-old mother of two in June 1988 when she got up from her card game and killed Daniel Dinda, 66, and Carolyn Dinda, 60, at the couple's home near Oviedo. During her trial, witnesses testified to her strange beliefs, such as radio transmitters in her teeth were tracking her and that microwaves from satellites were displacing the souls of her children.

A jury found her not guilty by reason of insanity. Eaton later ordered her hospitalized indefinitely.

Gardner has been released before, always under supervision, but things did not go well.

About a year after she was released to a group home in Jacksonville in 2000, she went off her medicine, became unmanageable, stopped going to treatment sessions and bought a car.

When a different judge found out, he ordered her to jail for several weeks then into a more restrictive group home.

Four years later, in late 2005, she went off her medication again and disappeared for weeks. She traveled from Jacksonville to Tampa then flew to Washington, where she was taken into custody. No one had reported her missing.

Since then, she's been locked up.

For months, medical experts at the hospital in Chattahoochee and her lawyer have argued that she's stable enough to release.

Dr. Bruce Chlopan, a psychologist, testified Friday that in the year or so he's treated her, she has had no delusions or hallucinations.

Defense attorney Tim Caudill argued that the law does not allow the state to keep a mental patient locked up just because she might stop taking her medicine and become unstable.

The judge agreed.

Rene Stutzman can be reached at rstutzman@orlandosentinel.com or 407-324-7294.

Legislation Improves Mental Health Services For Mentally Ill Prisoners

2007-11-21T17:51:00.001-08:00

19 Nov 2007

The American Psychiatric Association (APA) applauds recent Congressional efforts to acknowledge and improve treatment for the large number of people with mental illnesses and substance use disorders who are currently incarcerated in U.S. jails and prisons.

According to a 2006 report by the United States Department of Justice (DOJ), entitled "Mental Health Problems of Prison and Jail Inmates," more than half of the population incarcerated in U.S. prisons and jails - including 56 percent of state prisoners, 45 percent of federal prisoners and 64 percent of local jail inmates - were found to have a mental illness. Many of these inmates suffer from treatable disorders such as major depression, bipolar disorder and substance use disorder.

On November 13, the U.S. House of Representatives passed, by a vote of 347 to 62, the Second Chance Act, legislation sponsored by Congressman Danny Davis (D-Ill.). The legislation would provide transitional assistance to ex-offenders in an effort to reduce recidivism. Additionally, the legislation would extend and provide a full continuum of care for treatment of substance use disorders. The legislation also seeks to improve mental health screening and treatment and provides grants for family treatment programs. In August, the U.S. Senate Judiciary Committee approved similar legislation, sponsored by Senator Joseph Biden, Jr. (D-Del.).

The Mentally Ill Offender Treatment and Crime Reduction Reauthorization and Improvement Act (H.R. 3992 and S. 2304) aims to improve services for mentally ill prisoners by reauthorizing and boosting funding for a grant program that provides treatment for inmates and training for law enforcement officers who treat them. The House bill is sponsored by Representative Robert Scott (D•Va.) and the Senate bill is sponsored by Senators Edward Kennedy (D-Mass.) and Pete Domenici (R-N.M.). On November 7, the House Judiciary Committee passed H.R. 3992, which will now head to the full House for a vote. On November 5, the Senate introduced S. 2304.

In response to the legislative actions, the APA issued the following statement:

"It is a national tragedy that jails and prisons have become the primary mental health care facilities in the United States today.

"People with mental illness, left untreated, can develop symptoms and behaviors that lead to their arrest and incarceration. Mental health and substance use disorder treatment in appropriate settings is often the answer, and adequate funding for such treatment is urgently needed.

"Ending the 'criminalization of the mentally ill' and the inappropriate incarceration of persons with mental illness could prevent unnecessary building of correctional facilities and make room for violent and repeat offenders.

"Providing more adequate funding and cooperative programs between mental health care professionals and correctional agencies is a step in the right direction. Providing these cooperative resources could, in the end, help improve overall public safety."

"We applaud the bi-partisan action taken by both the House and Senate. If enacted, the legislation would represent significant steps forward in improving access to mental health services and substance abuse treatment programs in the United States for those incarcerated within the prison system."

About the American Psychiatric Association

The American Psychiatric Association is a national medical specialty society whose more than 38,000 physician members specialize in diagnosis, treatment, prevention and research of mental illnesses including substance use disorders. Visit the APA at http://www.psych.org and http://www.HealthyMinds.org.
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Article URL: http://www.medicalnewstoday.com/articles/89196.php

Main News Category: Mental Health

Also Appears In: Psychology / Psychiatry,

Psychiatric overhaul urged

2007-11-21T14:45:00.000-08:00

Gov. Charlie Crist and the chief justice of the Florida Supreme Court called for a major overhaul of the state's mental health system on Wednesday to better address the needs of the severely mentally ill.

Crist and Chief Justice Fred Lewis released a 170-page report that lays out an ambitious plan to help the mentally ill who end up in jails and prisons because they haven't received the treatment they need.

Florida leaders say it's time to change the system to ensure that the mentally ill get the help they need before they get in trouble with the law and wind up incarcerated. Not only will it help the troubled, it will save money and better protect the public.

The report, sponsored by the Supreme Court, envisions using money now spent on mental health treatment for prisoners deemed incompetent to stand trial. Instead, those individuals would be targeted for intensive community-based mental health treatment before they get arrested.

Money for the project would also come from Medicaid, which doesn't cover people in institutions but can pay for treatment before they're institutionalized.

"What we're doing is focusing on this very small group of people who are costing the state a ton of money and are recycling through the criminal justice system," said Miami-Dade County Judge Steven Leifman, chairman of the Supreme Court's mental health subcommittee. "About 80 percent of those people can live comfortably and safely in the community."

Leifman said the project will need about $20-million in general revenue to get started, but after that, it will be able to sustain itself with Medicaid money and the $48-million now being used for the extra forensic mental health beds that he says will no longer be needed.

"You need to have the money up front to develop a system of care for them to move them into the community," he said. "We have people in there on third-degree felonies that don't have to be there."

Leifman said the plan eventually will save money. The state currently spends $250-million per year on 1,700 beds for mentally ill inmates. At this rate, the state will be spending $500-million per year by 2015.

That money is designed to restore competency to inmates so they can be tried for their crimes and then sent to jail or prison, where they continue to cost the state money.

Leifman said treating mentally sick people earlier will prevent them from becoming high-cost inmates.

Leifman led a subcommittee that studied the state's mental health system after the state Department of Children and Families found itself overburdened with the mentally ill. It got to the point the agency couldn't get inmates into treatment beds within the 15 days required by state law. In some cases, inmates languished in jails for months, straining jail guards' resources and, in some, cases harming themselves.

Hillsborough County sued the DCF in an effort to get the agency to follow the law.

Pinellas Circuit Judge Crockett Farnell threatened to fine and even jail then-DCF Secretary Lucy Hadi if she didn't follow the law.

Eventually the Legislative Budget Commission called a special meeting and allocated nearly $17-million to create more beds and $48-million annually to cover the costs.

But the Supreme Court recognized that wasn't the ultimate solution and directed a mental health subcommittee, led by Leifman, to study the issue and seek solutions.

"It's extremely positive, and it's recognizing the impact mental health issues are having on the criminal justice system," said Pinellas-Pasco Public Defender Bob Dillinger, who pushed for the DCF to
address the inmate issue last year. "It can be done in a way that eventually saves a ton of money."

But the push to revamp how Florida deals with the mentally ill is coming during one of the worst economic downturns for the state in more than a decade.

Even Chief Justice Lewis acknowledged the challenge of Florida's budget situation on Wednesday. "Today I hope we are going to discuss plans and programs and ideas that may be implemented without creating unrealistic expectations," he said.

Crist had not reviewed all the recommendations included in the report, but said that the budget situation won't keep him from pushing for changes in the mental health system.

"We have some difficult times, but my heart is there," Crist said.

Rep. Bill Galvano, a Bradenton Republican and chairman of the House committee that deals with mental-health legislation, said lawmakers would likely consider the recommendations during the 2008 session. He said that despite bad financial times it was apparent to him that the current "system is broken."

"Even in a bad economic year, it may well be worth the fight," Galvano said.

Times staff writer Chris Tisch contributed to this report.

Gassed Behind Closed Doors

2007-11-20T17:58:00.001-08:00

Michele Gillen (CBS4) Necessary discipline or cruel and unusual punishment?

A controversial practice regarding the treatment of the mentally ill in Florida's maximum security prisons has some attorneys and mental health experts raising concerns over its use.

"Here they are just gassing him. You can see they are just spraying him in the face," said Miami attorney Leon Fresco. "I would describe it as the eighth amendment does - cruel and unusual punishment."

According to lawyers representing mentally ill prisoners who have been incarcerated in Florida prisons, the state allegedly allows guards to spray inmates suffering from mental illness with chemical agents to "discipline them."

"They call these inmates bugs. They say these inmates are bugs. A bug is a term they use for a crazy person. And they gas them and it's just shocking and it's just something we can't allow it to continue anymore," said Fresco who has been investigating the treatment of the mentally ill behind bars.

"If they see behavior they don't like they gas them, just like you'd gas a bug that you don't like," said Fresco.

"They're acting out because of their mental illness and as a result of that they're being punished, pure and simple," said Randy Berg, co-counsel for Florida Justice Institute. "This certainly by anyone's definition, I think, is torture. This is a practice of the Florida Department of Corrections currently to gas known mentally ill inmates who are acting out by banging on their cells."

Jerome Maxime Thomas of Lauderhill says he prays every day that his son Jeremiah, who has been diagnosed with severe mental illness, will survive his incarceration at Starke Prison and the alleged chemical gassings he has been subjected to over a period of years, despite orders from the medical staff that he was not to be gassed given his severe mental illness.

"My son has told me he should have died many times, but the Lord has kept him alive," said Thomas, "Something must be done, because it's going too far."

Lawyers say Thomas, who was convicted of second degree murder and robbery and is scheduled to be released in 2018, has been gassed with an arsenal of chemical agents including pepper spray and CN gas, which is prohibited in many prisons because of a link to inmate deaths.

"He (Jeremiah) was gassed twice a day, sometimes as many as eight days in a row," said Berg.

After the gas, prisoners are usually asked if they would like a shower to wash the toxic chemicals. The water apparently doesn't always do the trick and some inmates suffer burns.

According to Department of Corrections written instructions guards are only allowed to use one second bursts of a chemical agent, but that rule is reportedly not always followed.

Lawyers for former inmate Curt Massie, who suffered second degree burns across his body, says he was gassed with OC and CN gas for making a funny face at a nurse who failed to give him his anxiety medication. Massie's attorneys say he has second degree burns over more than 60-percent of his body from the procedure.

Massie allegedly was gassed repeatedly in his cell despite pleading with the guards to stop. Records show that one guard admitted that his "use of force report" was altered by adding the words "kicking his cell door" to justify the use of the gas on Massie.

"From a taxpayer standpoint it makes absolutely no sense that we're wasting our resources to gas the guy, make him decompensate, send him to the hospital where we are spending tax dollars to attempt to bring him back to mental competency or stability bring them back and gas them again," said Berg.

Attorneys suing the state over the procedure have been able to obtain videotapes of a handful of gassings. Videotaping gassings was instituted to monitor the use of the chemicals but several wardens prohibited the filming.

"It's certainly inappropriate to use chemical agents for mentally ill people who are acting out solely because of their mental illness," said Berg. "We should be sympathetic to their treatment because they're going to get out. If you treat human beings like animals and literally like rats they're going to be that way when they get released to society so it's in our best interest to treat these people like human beings while they're in there."

Curt Massie was freed from prison last month. Jeremiah Thomas is set to be released in 5 years.

"I hope that someone is listening. I hope that those who are viewing will take account. And will tell themselves we can not allow this to continue," said Thomas.

"I would submit that these people are much worse off than when they went in when we release them," said Berg "and some of these people frighteningly enough get released directly from close management from solitary confinement to the street, that as a citizen frightens me quite frankly. We're making these people more and more angry, more and more mentally ill, and then releasing them directly to the street, it makes no sense."

Given the pending lawsuit against the state, the current secretary of corrections cannot discuss any particular cases involved; however, he met with Michele Gillen to address the overall policy of chemical gassing the mentally ill.

According to James McDonough, Secretary of Corrections, "We do not use chemical agents for punishment. We do not use chemical agents for discipline. We only do it to insure the security and reduction of harm."

"The fact that the videotaping was discontinued in prior administrations a concern to you:" asked Gillen.

"Enough of a concern that we have a policy that says you sure as hell better videotape," said McDonough. "We are seeing the incidents of chemical agents and physical force going down, not slightly but deeply."

Council seeks alternatives in treating the mentally ill

2007-11-19T19:44:00.000-08:00

Circuit Judge Janet Ferris remembers a case when a mentally ill man was charged with battery on a law enforcement officer.

The man was sleeping on a bench at Florida State University when the officer came up him and told him he was trespassing. The man, thinking the officer was the devil and trying to hurt him, struggled with the officer.

He ended up in jail.

Ferris said she's concerned that many people who are mentally ill, like this man, end up languishing in the Leon County Jail without really getting the treatment they need.

"The county jail has become like a mental-health facility," Ferris said. "And that's hard because it's a jail. It's not a mental-health facility. So I think the idea is to try to move them out of the jail as quickly as possible."

The Criminal Justice Mental Health and Substance Abuse Advisory Council, created in mid-September, met last week to discuss its plans to create a mental health court to make treatment more accessible and effective for people who are mentally ill and to reduce their length of stay in the jail. Similar courts have been created in Miami-Dade, Sarasota and Gainesville.

"The big thing is linking them to services in the community," said Kendra Brown, court mental health coordinator. Such services include housing, transportation, treatment plans and medication.

A mental health court would put all criminal cases that involve mental health issues on the same docket, which would be heard by the same judge trained to deal with these issues, said Merribeth Bohanan, assistant public defender.

Council members say many of the mentally ill who have not received the treatment they need are repeat offenders and they place a strain on resources. This population is rapidly growing in Leon County.

In a report, the council showed that the jail's annual expenditures on mentally ill inmates increased from about $128,000 in 2004 to $162,000 in 2006.

In any given month between 20 and 30 percent of the jail's 1,200 inmates are treated by its mental health staff, said Colleen Meringolo, health services administrator for Prison Health Services, which has a contract with the jail. Their conditions range from depression to schizophrenia.

"We do not charge people for services," Meringolo said. "If they don't have the money, they don't have the money. We still see them."

In October, the jail spent about $16,000 on prescription drugs, she said. Staff members include a licensed psychiatrist, who works 12 hours a week, a licensed clinical social worker who works 40 hours a week and a mental health coordinator, who works 30 hours a week.

The council put together a state grant application, which it submitted Nov. 1. The members won't find out if they will receive any money until early next year, but they plan to move forward with the mental health court proposal with or without the money.

In order to establish the mental health court, the council will need Chief Judge Charles Francis to sign an administrative order.

Ferris said the mental health court would be similar to the drug court model in that it would put more of an emphasis on treatment.

"We're trying to lead them to sobriety as opposed to just punishment," she said.

A sick system: Reform Florida's treatment of mental illness

2007-11-17T19:29:00.001-08:00

State prisons and county jails throughout Florida are filled with people who suffer from mental illnesses.

That says as much about the condition of our society as it does the inmates.

"On any given day in Florida, there are approximately 16,000 prison inmates, 15,000 local jail detainees and 40,000 individuals under correctional supervision in the community who experience serious mental illness," according to a state report issued Wednesday.

Those troubling statistics were compiled in a report by a legislative Mental Health Subcommittee that recommends substantial changes in the treatment of mentally ill Floridians, especially those accused of crimes. Indeed, radical reform is needed.

The Florida Supreme Court called for the report. As a result, the subcommittee produced a 180-page document that exposes ineffective and outdated systems, treatments and practices.

"The first state psychiatric hospitals were opened in the United States during the 1800s, and were intended to serve as more appropriate and compassionate alternatives to the neglect and abuse of incarceration" that befell the mentally ill, according to the report's executive summary.

Asylums became crowded, lacked staff and "turned into houses of horrors."

By the mid-1900s, a half-million people were held in such places. A belief emerged "that people with serious mental illnesses could be treated more effectively and humanely in the community."

There was some logic in that belief. But mental hospitals released thousands of people and "unfortunately," the subcommittee report says, "there was no organized or adequate network of community mental health centers to receive and absorb these newly displaced individuals."

Promises of sustained increases in community-based funding evaporated. With limited options available, mentally ill men, women and juveniles struggle to cope. Inappropriate behavior, homelessness, substance abuse and minor crimes often lead to arrest and incarceration. Now, the report says, "jails and prisons once again function as de facto mental health institutions for people with severe and disabling mental illnesses. In two centuries, we have come full circle, and today our jails are once again psychiatric warehouses."

The report calls for Florida to develop a system that effectively and humanely treats mentally ill people for their illnesses and prevents them from getting stuck in costly, dangerous jails. Taking these steps won't be easy or inexpensive but they are the right steps to take

Mentally Ill Prisoner Could Be Executed

2007-11-11T16:38:00.000-08:00

Insanity On Death Row

Nov. 11, 2007
--------------------------------------------------------------------------------
(CBS) When it comes to prisoners on death row who are insane, the law is very clear: you cannot execute them. The Supreme Court has ruled it unconstitutional and deemed it "cruel and unusual punishment."

But can medication make a prisoner sane enough to be executed? That question is being asked in the case of convicted killer Greg Thompson.

As correspondent Lara Logan reports, Thompson was originally found competent to stand trial, but prison doctors have concluded he is mentally ill and they give him medication every day.

Thompson's lawyers argue that he is still insane on the medication, which he was taking the day 60 Minutes met with him.

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Thompson told Logan he had to stab his food to eat it. "Especially eggs. They be popping up," he said. "Hit me in the face. You got to stab it. And then you gotta eat it quick. Real quick."

60 Minutes met Thompson inside a maximum security prison in Nashville.

He has been diagnosed as schizophrenic and psychotic by both prison doctors and those hired by his lawyers. And he has been medicated by the state for most of his 22 years on death row. Thompson receives a daily cocktail of anti-psychotic mood-stabilizing pills, and injections twice a month.

Asked if he knows why he's getting medication, Thompson told Logan, "Yeah, I’m nuts."

He says he only takes 10 pills a day now.

"What happens if you don’t take them?" Logan asked.

"I go lulu," Thompson replied.

"Tell me what going lulu is for you," Logan asked.

"In a few days I would like lose my mind and it would be trying to explode on me," he replied. "I got in a fight with the guards a lot of times, you know. Tried to kill a few."

"Did you kill any of them?" Logan asked.

"No," Thompson said. "But at the time they was turning into insects. And I wanted to kill them."

"The guards were turning into insects?" Logan asked.

"Yeah, they were giant insects," Thompson said. "They was acting just like the guards, but they were aliens. And I had to kill the aliens. They were attacking the world."

A psychologist who has been evaluating Thompson for nine years says he sees, hears and smells things that aren’t there, and suffers from extreme paranoid delusions and hallucinations.

But when Thompson was put on trial for murder 22 years ago, his lawyers did not raise insanity as a defense. He confessed, was convicted and sentenced to death for killing Brenda Lane. She was 28 years old, well-liked in her community and she had been married just a few months.

The facts of what happened on New Year's Day in 1985 have never been in dispute. Thompson and his girlfriend, a juvenile, wanted to get from Tennessee to Georgia, so they kidnapped Brenda Lane, stole her car and then drove around for an hour and a half on remote country roads, as Thompson searched for a place to kill her.

They stopped along a rural country road near a field. Thompson then stabbed Brenda four times in the back and drove off, leaving her to die alone in the cold and the dark.

"I thought I had to kill to survive," Thompson told Logan.

Thompson told 60 Minutes he heard voices in his head that night.

"You thought people were after you," Logan remarked.

"Yes," he replied.

And then in chilling detail, he described exactly how he killed Brenda Lane.

"She got into the front seat driver's seat. And I had the knife on her. And I sat in the back seat. And…," Thompson said.

"You jumped in the car and pulled a knife on her?" Logan asked.

"Yeah. Uh-huh," Thompson acknowledged. "Knife was already out. It was a butcher knife."

"She must have been scared," Logan remarked.

"Yeah, she was crying," Thompson said.

"She was terrified for her life," Logan said.

"I know. I know," Thompson replied.

Asked what he felt, Thompson said, "She knows she’s going to die."

Why did he kill her?

"There was no reasoning at that point," Thompson said. "It was just get away."

"Tell me how it happened. Describe it for me," Logan asked.

"Just turned her around and she didn't move and I stabbed her four times," Thompson recalled. "I wanted her to die quickly."

Asked why he wanted her to die quickly, Thompson told Logan, "Not in pain. I didn't want her to be suffering in pain."

"You think if somebody stabbed you four times in the back you're not gonna suffer?" Logan asked.

"Not really, no," Thompson said.

"You know she was still alive when you drove away," Logan pointed out.

"I heard her scream," Thompson said.

Thompson managed to escape to Georgia but was arrested there after setting Brenda Lane's car on fire. Frankie Floied, an investigator in the case back in Tennessee, says it could have taken months to find the body if Thompson -- over the telephone - hadn't given such precise, intricate, directions to the place he killed her.

"What was going through your mind at the time when you were talking to him on the phone?" Logan asked Floied.

"How calm he was," the investigator remembered. "There was no remorse. There was no passion. It was just matter of fact. 'If you'll take, you take this road, this road, this road and this road.'"

"So exact," Logan remarked.

"It’s like you telling me how to find a Frisbee that you've tossed and lost," Floied said.

"So what did that mean to you?" Logan asked.

"Cold, impassioned. Just a cruel person," Floied replied.

That was the picture prosecutors painted of Thompson at his trial. But it wasn't a complete picture, according to Thompson’s current lawyers, Dana Chavis and Steve Kissinger, who are appealing his case. They say Thompson had severe mental problems dating back to his childhood and they are fighting to keep him alive.

"If he knew what he was doing at the time, and he was competent to be executed at the time that sentence was given, why shouldn't he die for what he did?" Logan asked.

"I think the evidence points overwhelmingly to the fact that he was insane at the time," Kissinger said.

"But it was never proved," Logan said.

"Of the offense," Kissinger said.

"And it wasn’t raised at the trial," Logan said.

"Right," Kissinger said.

"He told them exactly what he’d done. He even told them where he’d thrown out the murder weapon, so they could find that on the side of the road," Logan remarked.

"I think the fact that Greg Thompson can remember things does not detract from the fact that at the time of the crime he was suffering delusions and he was hearing voices," Chavis said.

"Never brought up at the trial," Logan pointed out.

"That’s correct, never brought up at the trial because the trial attorneys did not consult with the proper people that would have seen those clear signs of Greg’s psychosis at the time, the clear signs of psychosis that everybody agrees about right now," Chavis said.

Three years ago, a federal appeals court ruled that a lower court should examine evidence that Thompson was mentally ill at the time of the crime. One judge called it "powerful mitigating evidence." But then the Supreme Court narrowly overruled the decision, saying it was too late to raise that issue. Barbara Brown, Brenda Lane’s only sister, who sat through every day of Thompson’s trial, is frustrated by the lengthy legal process.

"I don't believe that he was insane at the time he killed her. Uh, now I don't know. He's been sitting on death row 22 years. Almost anyone might be insane after this period of time," Barbara said. "It's just not right that he was given a death sentence and it not carried out."

Brenda Lane is buried on a hillside about a mile from her sister Barbara’s house. Every Sunday, Barbara goes back to the same church where she and her sister played piano, sang and prayed together. Barbara thinks the legal system is protecting Thompson and has forgotten her sister.

"It destroyed my family basically. My mother certainly never got over it," she said. "And my dad absolutely wanted to see him executed."

Both parents and Brenda's husband have all died since she was killed. "Even my husband has now passed away," Barbara said.

"I think our hearts go out to the sister," Chavis said. "And of course, what happened is a terrible tragedy. But the point now is that Greg Thompson is psychotic, that he's delusional, that he does not have a rational understanding of why the state seeks to execute him."

In what could be a last-chance appeal, Thompson's lawyers only have to prove he is insane now and doesn't understand what's happening to him, even when he is on medication, as he was during the 60 Minutes interview. He appeared most of the time to be delusional.

"Well, see I wrote some songs and sent them to Hollywood," Thompson told Logan.

Asked who he'd written them for, he said, "Garth Brooks, Reba McIntyre."

Thompson told Logan he likes country music, and that the first song he wrote was "Dirty Dishes in the Sink."

He also said he had gotten paid twice, and that the last check that was sent to him was for $444,000.

"$444,000? What did you do with that money?" Logan asked.

"I sent it to Brenda Lane's family," Thompson said.

"You sure about that?" Logan asked.

"Yeah," Thompson said.

"What if I said to you there was no check?" Logan asked.

"It’s in my name," Thompson insisted.

"What if I said to you, though, there was no check, it’s in your head, not in your name?" Logan asked.

"No, there was a check. It wasn’t in my head, you know," he claimed.

"Are you a con man? Are you acting for me?" Logan asked.

"No. I’m serious. This is me. This is who I am," Thompson replied.

"How can you be sure that Greg Thompson is not just acting up, that he’s not just pretending?" Logan asked attorney Dana Chavis.

"For over 20 years, prison doctors have administered very powerful anti-psychotic drugs to Greg Thompson. I don’t know of any doctor that would prescribe or force that type of medication upon a person unless they believed they were truly psychotic," Chavis replied.

Asked what the effect of that medication is, Chavis said, "It doesn't take away his mental illness. He's always insane. But what it does is that it hides that insanity."

"But it doesn't actually make him normal?" Logan asked.

"Not at all," Chavis replied.

But does Thompson understand that taking the medication may make him appear sane enough to be executed?

"Well, I had a -- I made a choice years ago. That if I were to get to that point I'd rather be normal than insane," Thompson told Logan.

"Why is that?" she asked.

"Because it hurts. I’m tired of being mentally ill, you know. So if they want to kill me at the end, then they kill me at the end," he replied.

"I think I have to forgive him," Brenda Lane's sister Barbara Brown said. "I am a Christian and we are to forgive people. It's hard."

"But you want him to die for what he did," Logan remarked.

"Yes, I do want to see him executed," Barbara said.

Thompson's lawyers are going back to federal court this month and hope eventually to get a ruling that Thompson -- despite his medication -- is mentally incompetent and should not be executed. The Tennessee attorney general, who declined 60 Minutes' request for an interview, is expected to argue that Thompson understands why he is being punished, is not insane, and therefore should be executed.

Asked if he's afraid to die, Thompson said, "I'm on drugs right now. And I feel good. I'm not afraid. When I -- when these drugs wear off a little bit I'll be afraid again."

"If you were executed what do you think would happen to you afterwards? What comes next?" Logan asked.

"Well, I know that the dead can speak," Thompson said.

"The dead can speak? You think you would die?" Logan asked.

"I think it'd be a horrible ending," Thompson said. "Because if the dead can speak that means you got thought in the grave. You got thoughts going on in the grave. I don't know about that."

Our Brush with Homeland Security: Can Better Understanding of Mental Illness be Legislated?

2007-10-22T19:27:00.000-07:00

Posted October 22, 2007 | 12:26 PM (EST)

June 21, 2002. JFK airport in New York. Just nine months after September 11th, my friend and I have just been asked to disembark our flight to California by the airline's head of security. My jaw is a vice. I grind my teeth. It's 9:00 a.m.

My friend, Sam, is also the subject of my first feature-length documentary, A Summer in the Cage. The film chronicles Sam's battle with manic-depressive illness, also known as bipolar disorder. I'm traveling with Sam that June of 2002 while he is in the midst of a delusional, paranoid manic episode. He has spent the last two hours with his shirt off, genuflecting in front of the jetway, praising God, and swaying back and forth. He's 6'7" and weighs 300 pounds.

When we finally board another flight, I spend the next seven hours trying to contain his psychological torrent. Sam praises Osama bin Laden (in the context of fighting for what he believes, however unpopular). He accuses passengers of being armed federal air marshals sent to capture him. The in-flight film, I Am Sam, unglues him as he begins to audibly bawl over the coincidence and poignancy of Sean Penn playing a mentally challenged father named "Sam." Eventually, we finally arrive in Los Angeles where five policemen are waiting to take Sam into custody for his alarming behavior.

Fortunately, I was with Sam that day to explain what was going on to flight attendants, passengers, and eventually the LAPD (they took Sam to a mental health facility instead of to jail and possibly worse with the climate of federal legislation on terrorism). It was one of many moments throughout the course of shooting my film where being a filmmaker was sacrificed so that I could help Sam as a friend. Had I not been accompanying Sam, the episode could very well have ended up like the bloody gun battle that happened to Sam's beloved Oakland Raiders player, Barrett Robbins, who also suffers from bipolar disorder. During a manic episode in Miami, Robbins was shot by the police after he took on several Miami policemen who wanted to arrest him for trespassing. It is imperative that we better educate both the police and medical responders of the symptoms and manifestations of mental illnesses so tragic conflicts and misunderstandings like these can be avoided in the future.

In addition, a better understanding of mental illness needs to extend beyond first-responders to the criminal justice system that is faced with a growing number of people with mental illnesses. According to Human Rights Watch and Bureau of Justice Statistics (BJS) report, "Mental Health Problems of Prison and Jail Inmates" (2006), "the rate of reported mental health disorders in the state prison population is five times greater (56.2 percent) than in the general adult population (11 percent)." The stresses involved in navigating the penal system can severely exacerbate the symptoms of a mental illness. The pressures of lock-up, confinement, isolation, intimidation, sanitary conditions, and the mercurial pace of adjudication create an environment where detainees with mental illnesses are set to fail. Unfortunately, these symptoms of mental illness are often not recognized or understood by the prison staff, leading to violent outbursts or unnecessary harsh treatments and punishments for the unstable inmates. If we want to instill proper rehabilitation and start breaking the cycle of recidivism that faces those who suffer from mistreated mental illnesses, our prisons must be better equipped to recognize and properly treat mentally ill inmates. (Pete Earley's Crazy: A Father's Search Through America's Mental Health Madness is an excellent personal and journalistic inquiry into the penal and court systems' failings, contradictions and inhumanities).

Sam and I were lucky that day when we got off the plane. I was educated on bipolar disorder and the symptoms of mania. I know Sam as a loving and peaceful person who suffers from a mental illness and I was able to convey that to the LA police officers. But I have witnessed and read about countless instances of first responders who misunderstand the symptoms of mental illness to tragic results. I hope that my film, and others like it, can help spark interest and motivate people to better educate themselves about the symptoms and signs of mental illnesses. With that knowledge, I hope that viewers will encourage legislators to support increased education and training for the first responders and correctional officers that are increasingly coming into contact with people suffering from mental illnesses.

A Summer in the Cage will air on Sundance Channel at 9 p.m. EST Monday, October 22, 2007 check local listings. More information about bipolar disorder and the film can be found here.

Early treatment works for those with mental illnesses

2007-10-15T15:12:00.000-07:00

By Ella Kaple
Guest Columnist

Mental illnesses are medical conditions that disrupt a person's thinking, feeling, mood, ability to relate to others, and daily functioning. Just as diabetes is a disorder of the pancreas, mental illnesses are medical conditions that often result in a diminished capacity for coping with the ordinary demands of life. Serious mental illnesses include major depression, schizophrenia, bipolar disorder, obsessive compulsive disorder (OCD), panic disorder, post traumatic stress disorder (PTSD), and borderline personality disorder. The good news about mental illness is that recovery is possible.

Mental illnesses can affect persons of any age, race, religion, or income. They are not the result of personal weakness, lack of character, or poor upbringing. Most importantly, mental illnesses are treatable. Most people diagnosed with a serious mental illness can experience relief from their symptoms by actively participating in an individual treatment plan.

In addition to medication treatment, psychosocial treatment such as cognitive behavioral therapy, interpersonal therapy, peer support groups, and other community services can also be components of a treatment plan and that assist with recovery.

In Crawford County, those services are provided each day by Community Counseling Services, Inc., and funded by the Crawford-Marion Board of Alcohol, Drug Addiction and Mental Health Services. Last year alone, over 4,000 individuals received services from our system of care.

Here are some important facts about mental illness and recovery:

Mental illnesses are biologically based brain disorders. They cannot be overcome through "will power" and are not related to a person's "character" or intelligence.

Mental disorders fall along a continuum of severity. Even though mental disorders are widespread in the population, the main burden of illness is concentrated in a much smaller proportion -- about 6 percent, or 1 in 17 Americans -- who suffer from a serious mental illness. It is estimated that mental illness affects 1 in 5 families in America.

Mental illnesses usually strike individuals in the prime of their lives, often during adolescence and young adulthood. All ages are susceptible, but the young and the old are especially vulnerable.

Without treatment the consequences of mental illness for the individual and society are staggering: unnecessary disability, unemployment, substance abuse, homelessness, inappropriate incarceration, suicide and wasted lives.

The best treatments for serious mental illnesses today are highly effective; between 70 and 90 percent of individuals have significant reduction of symptoms and improved quality of life with a combination of pharmacological and psychosocial treatments and supports.

With appropriate effective medication and a wide range of services tailored to their needs, most people who live with serious mental illnesses can significantly reduce the impact of their illness and find a satisfying measure of achievement and independence. A key concept is to develop expertise in developing strategies to manage the illness process.

Early identification and treatment is of vital importance. By ensuring access to the treatment and recovery supports that are proven effective, recovery is accelerated and the further harm related to the course of illness is minimized.

Stigma erodes confidence that mental disorders are real, treatable health conditions. We have allowed stigma and a now unwarranted sense of hopelessness to erect attitudinal, structural and financial barriers to effective treatment and recovery. It is time to take these barriers down.

According to the president's New Freedom Commission on Mental Illness, the annual cost of untreated mental illness is $70 billion in the United States. Untreated depression alone costs the nation a staggering $40 billion a year. While anyone who's ever suffered from a mental illness, or had a family member of friend suffer from a mental illness, can easily understand the human cost of untreated mental illnesses, there is also strong evidence for the financial tolls involved. Recent research indicates that mental health treatment can more than pay for itself through sustaining a healthy workforce -- enhancing what can be viewed as "human capital."

Here are some startling facts:

Approximately 50 percent of students with a mental illness aged 14 or older drop out of high school. This is the highest dropout rate of any disability group.

Twenty-four percent of state prisons and 21 percent of local jail inmates have a recent history of a mental disorder.

An estimated 65 percent of boys and 75 percent of girls in juvenile detention have at least one diagnosable mental disorder.

Between 2000 and 2003, emergency department visits with a primary diagnosis of mental illness increased at four times the rate of other emergency department visits.
We know that treatment outcomes for people with even the most serious mental illnesses are comparable to outcomes for well-established general medical or surgical treatments for other chronic diseases. Early treatment success rates for mental illnesses are 60 to 80 percent. This is well above the estimated 40 to 60 percent success rates for common surgical treatments for heart disease.

As a nurse who has worked with individuals with serious mental illness and substance abuse disorders and as a long time member of the Crawford-Marion ADAMH Board, I know that treatment works and that people recover. Recovering people work. Working people pay taxes. Investing in good mental health services is an investment in our community.

Death penalty: Eye for eye

2007-10-07T13:04:00.000-07:00

But opponents want moratoriumS to halt 'murder of murderers.'

Sunday, October 07, 2007
By TONY NAUROTH

The Express-Times

The Supreme Court of the United States will soon be considering one of the most important death penalty cases in decades.

The issue centers on the use of lethal injection as the executioner's tool in a case involving two inmates on Kentucky's death row.

Ralph Baze and Thomas Clyde Bowling Jr. sued the Bluegrass State in 2004, claiming the needle amounted to cruel and unusual punishment.

Locally, some say any form of capital punishment is just plain wrong.

Lehigh University Chaplain Lloyd Steffen is a longtime opponent of the death penalty. He's even written a book about it -- "Executing Justice: The Moral Meaning of the Death Penalty."

Steffen is a professor of religion and a minister with the United Church of Christ, which is taking a strong stand against the death penalty.

Karen Berry, head of the Social Action Committee of the Unitarian Universalist Church of the Lehigh Valley, says her church adopted a moratorium resolution earlier this summer and is hoping for formal action from the Pennsylvania Legislature to make some type of death penalty moratorium official statewide.

And during the weekend of Oct. 19-20, Amnesty International is sponsoring the 2007 National Weekend of Faith in Action on the Death Penalty when churches throughout the country will hold events to bring attention to the issue.

The fight is in the courts

This connection between religious and secular organizations is at the forefront of the struggle to rid states of what organizers see as a barbaric and unfairly administered penalty for the crime of murder.

The courts are where the fighting has begun.

All 37 states that perform lethal injection use the same three-drug cocktail, but at least 10 of those states suspended its use after opponents alleged it was ineffective and cruel, according to the Death Penalty Information Center.

The three consist of an anesthetic, a muscle paralyzer, and a substance to stop the heart. Death penalty foes have argued that if the condemned prisoner is not given enough anesthetic, he -- or she -- can suffer excruciating pain without being able to cry out.

Baze, 52, has been on death row for 14 years. He was sentenced for the 1992 shooting deaths of Powell County Sheriff Steve Bennett and Deputy Arthur Briscoe.

Bennett and Briscoe were serving warrants on Baze when he shot them. Baze has said the shootings were the result of a family dispute that got out of hand and resulted in the sheriff being called.

Bowling was sentenced to death for killing Edward and Tina Earley and shooting their 2-year-old son outside the couple's Lexington, Ky., dry-cleaning business in 1990.

Lethal injection is just one battle; the war consists of opponents fighting against all forms of capital punishment.

'Seamless garment of life'

When asked if churches have any business getting mixed up in the politics of whether states should, or should not, execute criminals for the most heinous crimes, Steffen says, "Sure they should. All the mainline churches have taken positions opposing the death penalty, and Pope John Paul II has said the death penalty is inimical to the 'seamless garment of life.' "

Steffen is not encouraging the justice system to let the most vile criminals out onto the streets, he's just looking for the same kind of consideration parents use when their kids act out -- give them a time out.

"If people took a time out to study the problem," he says, "they would be against the death penalty."

Perhaps the Bible verse from Hebrews 10:30 applies here: "'Vengeance is mine,' saith the Lord." And from Deuteronomy 32:36: "For the Lord will be judge of his people."

But what do the people do when a Timothy McVeigh blows up an office building in Oklahoma City, snuffing out 168 souls? Or -- much closer to home -- when Martin Appel robbed the bank in East Allen Township, executing three to leave no witnesses. Appel was sentenced to death, but got off death row through appeals.

Death for 'horrific crimes'

Northampton County District Attorney John Morganelli still chafes at that decision.

"We need to keep the death penalty on the books for any horrific crimes that come along," Morganelli says. He maintains Appel is one of those criminals. Besides, Morganelli says Pennsylvania has had a "de facto" moratorium on death sentences for decades.

"We've only had three executions, and all of those came after they stopped appealing their cases.

Steffen refers to those same three cases as "voluntary" executions. He has visited death rows in Pennsylvania and Tennessee and says death row confinement usually means solitary confinement for years.

"There are a lot of suicides," he says. "It's torturous for them. All three executions have been volunteers. They drop all appeals; it's a mental illness situation."

Pennsylvania's primary method of execution is by lethal injection which, according to Amnesty International, is the same method used by China, Guatemala, the Philippines and Thailand.

New Jersey's method of execution is also by lethal injection. However, The Garden State does have a formal moratorium on executions, due to legislation passed in 2006.

Steffen says too many convicts who were innocent slip through the cracks.

"There have been 124 nationwide," he says.

Return to Martin Appel case

When Illinois Gov. George Ryan commuted his state's death sentences in a blanket order in January 2003, he was making a statement against the death penalty. He was nominated for a Nobel Peace Prize for that action and has stumped in Harrisburg for a moratorium on the death penalty in the Keystone State.

Morganelli, who authored his own book about the Appel case, says those seeking a death penalty moratorium in Pennsylvania "are all do-good organizations that don't believe in punishment and that everybody can be rehabilitated. They're just anti-law and don't carry much credibility."

Morganelli's book is titled "The D-Day Bank Massacre: The True Story Behind the Martin Appel Case."

Morganelli says he's more concerned about inmates who manage to get paroled and end up killing again. He names Reginald McFadden and "Mudman" Simon as two examples.

He also says the American justice system already has a built-in safeguard against making mistakes -- a jury of 12 who must vote unanimously for the death penalty.

"We just had a case where it went 11 to 1," Morganelli says, citing the Andrew D. Paschal verdict. Paschal was convicted of gunning down Marcellus McDuffie outside Larry Holmes Ringside Restaurant and Lounge, in Easton on May 14, 2006.

Death penalty not logical

Maria Weick of the Lehigh Valley Committee Against Killing and the Pennsylvania Death Penalty Abolition Coordinator for Amnesty International, says "Pennsylvania is a really hard case when it comes to the death penalty."

Both she and Steffen say the single most difficult roadblock to a moratorium is politicians.

"Pennsylvania politicians," Weick scoffs, "are married to the idea that supporting the death penalty means they're tough on crime."

Weick says Pennsylvanians are split 50-50 for and against the death penalty.

She admits, "Moratoriums are an act of desperation. But they are a way of getting people to think about the issue."

Steffen says they act to increase public awareness.

Weick adds that the death penalty makes no logical sense.

"Think about it," she says, "Do we drug the drug dealer? Do we rape the rapist? Then why do we murder the murderer?"

Tony Nauroth is a features writer with The Express-Times. He can be reached at 610-258-7171 or by e-mail at tnauroth@express-times.com.

The Associated Press contributed to this report.

Mental health courts and activism are topics of conference

2007-09-29T07:38:00.000-07:00

09/28/07
WMNF Evening News Friday

By Seán Kinane

Today was the final day of this week’s Mental Health Conference at the TradeWinds Island Resorts in St. Pete Beach.

The three-day conference was co-hosted by the Florida Council for Community Mental Health and the Florida Psychiatric Rehabilitation Association.

This morning’s plenary speech was by David Shern, president and CEO of the advocacy group Mental Health America.

A year ago Shern left his tenured position as Dean of USF’s Florida Mental Health Institute because he felt he could be a more effective advocate for people with mental illness from outside of academia. Shern said that his decision had a lot to do with frustration that his nephew Kyle could not receive adequate mental health care.

The title of Shern’s plenary was "Mental Health In America: Where is the Outrage?" Shern feels that the topic of mental health is so important but that people don’t care enough about it.

Shern said that another reason people should be outraged is because the U.S. has the worst mental health in the developed world.

The high rates of mental illness in the United States contribute to the overall healthcare crisis in the country, according to Shern.

One of the meeting’s breakout sessions dealt with Mental Health Courts -- How to provide recovery and hope. Mental Health Courts attempt to take people with mental health issues out of the criminal justice system to get them the care they need.

Ginger Lerner-Wren has been the judge of the nation’s first mental health court since its establishment in Broward County in 1997. Lerner said the purpose of court-based diversion models such as a mental health court was to stop the criminalization of mental illness and there are several questions that can be asked to see if mental health courts are successful.

Judge Lerner shared in David Shern’s outrage and said that motivated her community to form Broward’s pioneering Mental Health Court.

Lerner told the mental health professionals in the audience some of the reasons why she and her coworkers are so committed to the goals of the mental health court.

Lerner said that the rate of repeat arrests of people who have gone through her misdemeanor court is between 9 and 12 percent. Even though the court doesn’t receive funding, Judge Lerner is able to brag about its success.

For more information:

Mental Health America

Broward / 17th Circuit

FCCMH

Mentally ill offender re-entry: silent crisis in our communities

2007-08-10T19:16:00.000-07:00

By GARY BEMBRY
guest columnist

Friday, August 10, 2007

On May 22, Department of Corrections Secretary James R. McDonough announced a subtle, but significant, change to the agency's mission statement. Normally, such a change would not be compelling, but to those concerned with the safety of our communities and the well-being of its citizens, it is indeed an important — and noteworthy — change of direction.

The revision, according to McDonough, places a "renewed emphasis on the preparation of inmates for re-entry into society as part of our mission. This is an anti-crime measure of the utmost importance to our state."

We commend the secretary's vision, understanding of the problem and firm commitment to address the issue of offender re-entry. But this is not a battle he — or any one person — can win on his own. He will need the help of our Legislature, other state agencies and Florida's communities to accomplish this ambitious goal.

Here's why.

Too many ex-offenders leave prison unprepared for life on the outside and eventually return. In fact, in April 2007 there were almost 92,000 inmates in Florida's prisons, and more than 44 percent of them had been in prison before.

The issue of recidivism is especially troublesome for those incarcerated with a mental illness. It is estimated that 20 percent of the prison population has a serious mental illness and that almost three-fourths of inmates with a mental illness have a co-occurring substance-abuse disorder. Mentally ill offenders also have a higher-than-average rate of recidivism, cycling in and out of criminal justice and corrections settings with alarming regularity.

As McDonough moves forward with his progressive plans, we hope that he focuses on issues such as having transitional housing for ex-offenders with a mental illness when they are released. If we don't, then we are placing them directly into homelessness, for which they can be sent back to jail.

Those with a known mental illness also should be connected to local mental health and substance-abuse counseling services before they are released. We need to maintain some sort of tracking that may include a period of parole and a way to know if they are treated in a hospital emergency room or have an encounter with police. In fact, we need to work directly with law enforcement to explore additional means of intervention that can resolve issues in ways other than re-incarceration.

In addition to being a public-safety issue, our lack of success in keeping ex-offenders from re-entering the corrections system costs Florida taxpayers millions each year. With 20 percent of the 10,000 ex-offenders released every year having a significant mental illness, we are paying $120 million annually for their re-entry into the prison system.

That is more than our state spends on all children's mental-health services in a year.

Investing in community-based mental health programs that can provide transitional centers and support staff is the key to tracking, counseling and guiding ex-offenders with mental illness toward safe and healthy actions and away from our prison gates.

It's what is best for them and our communities, and we applaud McDonough for taking the first steps to address this complicated issue. Now it is up to all of us to ensure that he is successful and that some of our most vulnerable citizens have a fighting chance to succeed.

Bembry is chair of the Florida Council for Community Mental Health and CEO of the Lakeview Center in Pensacola. E-mail: gbembry@bhcpns.org

Mentally ill ex-cons need help in order to adjust

2007-08-07T15:09:00.001-07:00

On May 22, Department of Corrections Secretary James R. McDonough announced a subtle, but significant, change to the agency’s mission statement. Normally, such a change would not be compelling, but to those concerned with the safety of our communities and the well-being of its residents, it is indeed an important — and noteworthy — change of direction.

The revision, according to Secretary McDonough, places a “renewed emphasis on the preparation of inmates for re-entry into society as part of our mission. This is an anti-crime measure of the utmost importance to our state.”

We commend the secretary’s vision. But this is not a battle he — or any one person — can win on his own. He will need the help of the Legislature, other state agencies and Florida’s communities to accomplish this ambitious goal. Here’s why.

Too many ex-offenders leave prison unprepared for life on the outside and eventually return. In fact, in April 2007 there were nearly 92,000 inmates in Florida’s prisons, and more than 44 percent of them had been in prison before.

The issue of recidivism is especially troublesome for those incarcerated with a mental illness. It is estimated that 20 percent of the prison population has a serious mental illness and that nearly three-fourths of inmates with a mental illness have a co-occurring substance-abuse disorder. Mentally ill offenders also have a higher-than-average rate of recidivism, cycling in and out of criminal justice and corrections settings with alarming regularity.

It is easy to see why this is such a problem. In prison, those with mental illness often experience rapidly declining physical and mental health, which makes a life of homelessness, poverty and a pattern of recurring crime, arrest and re-incarceration all the more likely.

So what happens to them? The sad truth is that unless they are arrested again, we often have no idea. Because those with a mental illness are the most ill equipped to succeed in re-entry to society, we are indeed setting them up for failure.

We hope Secretary McDonough focuses on issues such as transitional housing for ex-offenders with a mental illness when they are released. If not, then we are placing them directly into homelessness, for which they can be sent back to jail.

Those with a known mental illness also should be connected to local mental health and substance abuse counseling services before they are released.

We need to maintain some sort of tracking that may include a period of parole and a way to know if they are treated in a hospital emergency room or have an encounter with police. In fact, we need to work directly with law enforcement to explore additional means of intervention that can resolve issues in ways other than re-incarceration.

Establishing this tracking system is crucial as the highest risk of recidivism of mentally ill ex-offenders is in the first six months after release from prison.

In addition to being a public safety issue, we are paying $120 million annually for their re-entry into the prison system.

That is more than our state spends on all children’s mental health services in a year.
Investing in community-based mental health programs that can provide transitional centers and support staff is the key to tracking, counseling and guiding ex-offenders with mental illness.

— Gary Bembry is chairman of the Florida Council for Community Mental Health and CEO of the Lakeview Center in Pensacola. He can be reached at (850) 469-3702 or gbembry@bhcpns.org.

Mental Disabilities

2007-07-25T06:17:00.001-07:00

The ABA assessment team concluded:

The State of Florida has a significant number of people with severe mental disabilities on death row, some of whom were disabled at the time of the offense and others of whom became seriously ill after conviction and sentence.@ ABA Report on Florida at ix.

And, while Florida has recently excluded individuals suffering from mental retardation from the death penalty, it has not extended its logic to those suffering from severe mental disabilities. Id. at xi.

The ABA assessment team recommends that the logic regarding those with mental retardation be extended to those with severe mental disabilities, noting that mental illness can effect every stage of a capital trial. Id at xxxviii.

Certainly, the distinction between the mental impairment of the mental retarded and the mental impairment of the mental ill and corresponding culpability of those inflicted with each condition appears to be arbitrary.

Furthermore, even in the case of the mentally retarded, Florida has created a procedure that will produce arbitrary results, as ABA assessment team acknowledges.

The legislation and rule governing mental retardation procedures makes a distinction between those individuals whose cases are final and those who are not. See Fla. Stat. ' 921.137; Fla. R. Crim. P. 3.203. Those whose cases are final receive none of the protections as those whose cases are not final, including, but not limited to a jury`s consideration of the issue and the sixth amendment guarantee to effective assistance of counsel. These distinction depending on where a defendant is in his criminal process are arbitrary.

The ABA assessment team also criticized the burden of proof imposed on capital defendants and recommended that the State be required to disprove a defendant`s substantial showing that he is mentally retarded. ABA Report on Florida at xxxviii.

The imposition of the burden of proof on the defendant will undoubtedly cause the decision as to who is mental retarded and does not get executed and who is not retarded and gets executed to turn on arbitrary factors, such as whether records demonstrating onset before the age of 18 exist, are family members still alive who can advise mental health experts as to the defendant=s adaptive skills, etc.

The Wrong Place to Treat Mental Illness

2007-07-08T14:01:00.000-07:00

By Marcia Kraft Goin

Sunday, July 8, 2007

Last month the Supreme Court rightly blocked the execution of Scott Panetti, a Texas man who was convicted of a double murder and who suffers from delusional schizophrenia. The case drew public attention to the intersection between mental illnesses and executions.

But what about those who are mentally ill and imprisoned but not on death row? A national conversation on this issue is urgently needed.

There is a pervasive attitude in this country that such people are getting what they deserve: After all, like Panetti, they are in jail for something.

But did you know that the Los Angeles County Jail houses the largest psychiatric population in the country? That's not justice. That's emblematic of a national emergency.

Before the 1960s, people with mental illnesses were generally cared for in institutional settings, mostly state-run psychiatric facilities. Many advocates correctly saw this as "warehousing" people who could be cared for in less restrictive settings. Federal legislation and the courts powered a move toward deinstitutionalization, calling on states and counties to provide resources for social services, vocational rehabilitation and treatment services. The introduction of effective antipsychotic medications also drove the trend toward deinstitutionalization.

In the decades since, community-based services have helped many people. But the situation today constitutes a national failure.

What's gone wrong?

Most important, the necessary community resources didn't materialize in anywhere near the level that was needed. Also, antipsychotic medications, while powerful treatments, don't work in isolation. Patients need a relationship with a psychiatrist, clinic or other stabilizing force to ensure adherence to drug regimens and achieve the best possible recovery.

Deinstitutionalization has succeeded in decreasing the overall number of hospital beds, but an unforeseen consequence has been the proportional increase in the number of people with mental illnesses housed in the criminal justice system. Worse, once imprisoned, people with mental illness are shown to have much longer incarcerations than other inmates, primarily because a prison environment and lack of treatment aggravate the very illness that has led to their objectionable or antisocial behavior.

While no one would argue that Scott Panetti belongs on the streets, his case compels us to consider the justice system's role: Is it to mete out punishment that seeks retribution, or are there cases where real justice means effective treatment that seeks rehabilitation?

Consider again Los Angeles County: In 2002 there were 38,600 psychiatric evaluations at the inmate reception center of the Twin Towers jail. Of these, 23,190 people (60 percent) were found to be in need of mental health treatment. A reasonable person could not fail to see the correlation between decreased funding for mental health resources, the closure of hospital beds, homelessness and the criminalization of mental illnesses. Untreated and lacking access to long-term care, people with mental illnesses often end up with symptoms and behaviors that result in jail time.

Cuts in state Medicaid budgets promise to exacerbate these problems. Not only is this shift in funding a blight on our society, it also costs money -- a lot of money. Corrections officials, mental health workers, medication, amortization of buildings and time spent by police in court all cost more than treating patients appropriately in their community. This doesn't make financial sense, much less humanitarian sense.

When considering the direction of public policies that affect those with mental illnesses, politicians and other officials must be guided by the latest research.

Government-funded studies have shown in recent years that jail-diversion programs, which help people get the treatment they need, result in positive outcomes for individuals, communities and the criminal justice system. While jail diversion does generally result in lower criminal-justice costs and greater treatment costs, studies are underway to analyze the differential.

The question the court answered in the Panetti case was about one's fitness to be executed, but in many more cases, the question is about the appropriateness of incarceration at all.

The writer is a past president of the American Psychiatric Association and director of residency training in the Psychiatric Outpatient Department at Los Angeles County General Hospital/University of Southern California School of Medicine.

Coping with Mental Illness: Help Is Here

2007-07-05T15:17:00.000-07:00

COURT HOUSE— More than 44 million Americans suffer from a mental health disorder according to the National Institutes of Mental Health, 80 percent of which also have a sub-stance abuse problem.

“He’s been through counseling, seven rehabs, overdosed four of five times,” said the North Wildwood resident and mother of a schitzo-affected adult son suffering from severe anxiety, bi-polar disease, and substance abuses.

The Herald is withholding the names of mother and son to protect their privacy.

What this mother described is termed by psychiatric professionals as a dual diagnosis, oc-curring when an individual is affected by both an emotional or psychiatric illness and chemical dependency.

The woman describes her son as a shy boy, who experienced extreme emotional highs and lows and delusions of grandeur.

“He doesn’t listen,” said the North Wildwood resident, “he does not think logically.”

She said she feels alcohol and drug use was what escalated the situation with her son’s mental health.

“We had a lot alcoholism in our family, mostly functioning alcoholics, but in those days we didn’t know. People didn’t talk about their problems.”

At 14, her son had his first suicidal overdose.

Afterward, she sought assistance from Cape Counseling Center in Court House.

“It’s very hard for kids,” she said. “He came out of rehab and re-entered school at 16 so-ber, but his friends were drinking and smoking pot. Of course he wanted to do what they were doing.”

Her son, now in his thirties, was in the Ancora facility last year where he connected with Rachel Parzio-Corso, an advocate with New Jersey Protection and Advocacy, Inc. (NJP&A).

Designated by Gov. Christine Todd Whitman in 1994, NJP&A serves as a free service agency of attorneys and advocates who monitor investigations, respond to cases and teach people to be self-advocates.
Parzio-Corso, who also has a son with mental health issues, attends a jail task force monthly and responds to cases such as when a person is in jail and doesn’t have access to proper medication, or in the case of this North Wildwood mother’s son, assists patients in receiving the best treatment for their particular situation and assuring their rights are pro-tected.

Parzio-Corso said issues she comes in contact with are overmedication in psychiatric hospi-tals and extended incarceration for offences that may have been escalated into extended is-sues because the person is mentally ill.

She said she also deals with more minor issues in psychiatric hospitals such as laundry be-ing returned to a mentally ill person with holes and burns, or not returning at all.

“We’re trying to put an end to issues like that,” Parzio-Corso said.

The Group for the Advancement of Psychiatry reports that 320,000 people who suffer from severe mental illness are incarcerated in our jails and prisons today.

Parzio-Corso told the Herald that 15 to 20 percent of inmates are mentally ill, and they will spend an average of eight times longer incarcerated than other inmates due to infrac-tions stemming from response to lack of proper treatment and medication.

Cape Counseling is working to change this situation by heading it off before mentally ill individuals get into trouble.

The non-profit group provides mental health education programs throughout the county, support groups for patients and families, and a free service program, Families F.I.R.S.T., which provides education and support for family members of loved ones with mental ill-ness, to assist them in situations such as this North Wildwood mother and her son.

Cape Counseling also provides psycho-educative services to local police departments in how to interact with a mentally ill suspect, or just in an everyday situation.

“Lower Township has been wonderful,” said Samantha Knocke, a family support special-ist at Cape Counseling’s center in Court House.

Some police departments in Gloucester and Camden counties employ special agents to handle situations with mental health issues because they can be so particular and difficult to manage.

“I’ve seen the police beat my son,” the North Wildwood mother said. “He gets scared, you back him in to a corner, and he reacts. But you have to look at both sides. The person is afflicted and afraid, those interacting with them don’t know how to properly handle them.”

It’s situations like these that called for the creation of the Families F.I.R.S.T. program.

The program defines mental illnesses as physical brain disorders that profoundly disrupt a person’s ability to think, feel, and relate to others and their environment.

Mental illnesses, according to their literature, are more common than cancer, diabetes, or heart disease.
The program has over 40 active participating families in this county; another 60 participants are what the program terms “inactive.”

“But they are always welcome. Once you are a part of Families F.I.R.S.T, you are always welcome to come back,” program manager Jodi Hynes told the Herald.

“You just have to hope you get the right kind of help. It’s scary,” the North Wildwood mother said.

“We work to protect what we call the patient bill of rights,” Parzio-Corso said. “We focus on making sure these people are treated with dignity and respect.”

She told the Herald the three biggest problems she has seen through her work are; lack of housing, affordable and also availability of half-way house situations, safety, because of hos-pital incidents, and mentally ill patients continually being incarcerated, instead of receiving proper treatment.

“It (mental illness) comes in so many shapes and forms. As long as a person gets the treatment, they can live a normal life,” said Parzio-Corso.

Contact Gillin-Schwartz at (609) 886-8600 Ext 24 or at: mschwartz@cmcherald.com

Inmate care declines

2007-06-24T06:08:00.000-07:00

AUDIT ON PRISON MENTAL HEALTH TREATMENT

Inmate care declines
Turnover, lack of therapists partly to blame

By CARLOS CAMPOS
The Atlanta Journal-Constitution
Published on: 06/23/07

Mentally ill inmates in Georgia's prison system — many of whom are eventually released — are not getting enough treatment and care, and in some cases are getting worse due to a host of problems outlined in a recently-conducted independent audit.

Inmates suffer from a lack of therapy and counseling as a result of insufficient staffing, employee turnover, technological glitches and other concerns, problems that persist in spite of previous audits that sounded the same alarm, the report says.

The consequences are grave, according to an Atlanta human rights law firm tracking the issue. Six mentally ill inmates have either been slain, or killed themselves, since October 2005 at three of the 33 Georgia prisons that care for inmates who need specialized mental health treatment.

"From our experience, when you don't have enough mental health professionals to oversee this population, people start dying, people start coming out of prison in body bags," said Sarah Geraghty, a lawyer for the Southern Center for Human Rights.

The report is critical of the "lockdown" of some mentally ill inmates in isolation cells for 23 hours a day, causing them to "clinically deteriorate" or "not clinically improve." Given that roughly 95 percent of inmates are eventually released, it means that thousands of mentally ill criminals return to the street as sick — or sicker — than before.

The 37-page audit, obtained by The Atlanta Journal-Constitution under the state's Open Records Act, calls the problems "serious" and "systemic."

The health of mentally ill inmates isn't the only issue on the line. Taxpayers could again end up footing the bill for costly litigation related to poor mental health care.

Threat of suit looms

The prison system estimates it spent "millions" of dollars complying with a series of consent orders from a 1984 federal class-action lawsuit covering every aspect of prison conditions, including deficiencies in its mental health care system. The system was released from federal supervision in 1998.

The threat of another costly federal lawsuit looms large, because the Southern Center for Human Rights — which specializes in prison and jail conditions — has set its sights on mental health care delivery in Georgia prisons.

Department of Corrections officials acknowledge many of the problems cited by correctional health care expert Dr. Jeffrey L. Metzner, but say some of the most serious results of poor mental health care — violent attacks on inmates and staff — have recently gone down inside of Georgia's prisons even as the number of ill inmates has grown.

"There are cracks in the system," said James DeGroot, supervisor of the Department of Corrections' mental health services division. "The system's not broken, but we do have to tend to the infrastructure now stressed by the rapid growth."

DeGroot provided the AJC with numbers of incidents involving mental health inmates that show suicides dropped from 6 in 2005 to 2 in 2006 and one so far in 2007; assaults on prison staff fell from 371 in 2005 to 308 in 2006; assaults among inmates fell from 971 in 2005 to 821 in 2006.

The number of homicides, however, has grown. There was one homicide in 2005 and one in 2006 among the mentally ill population. But there have been two slayings of mental health inmates so far in 2007. Five of the alleged perpetrators in this year's homicides were also mental health inmates.

Southern Center lawyers are confident they can document at least two more violent deaths among the mental health population, Geraghty said.

DeGroot said the deaths must be put in a broader context.

"I don't want to abdicate responsibility for any homicides, suicides or assaults — one is too many," DeGroot said. "But the incidents are relatively low. "

The report was addressed to Georgia Department of Corrections Commissioner James Donald, who declined an interview request for this article.

Metzner, who was paid $10,000 to conduct the audit at the prison system's request, declined comment and deferred questions to the state Department of Corrections.

More mentally ill inmates

Robin Graham, whose mentally ill son Bryan was hospitalized following a scuffle with guards, said she has had a difficult time getting proper treatment for him.

"They look at them simply as 'they broke the law,' not 'they have a problem,'" said Graham, who has hired a lawyer to look into her son's incident. "And there's hundreds of thousands of cases across the United States of people who have had mental illness and done something [illegal] and are never paid any attention to. Your departments of correction, your police forces, your judicial systems have no clue. Absolutely none"

Prison officials say they are dealing with a potentially volatile, difficult population, some of whom have compounded their illnesses with drug abuse.

About 16 percent of the prison population in Georgia receives mental health services.

Those services range from routine outpatient treatment — medication and therapy similar to what functioning people in private life get — to hospitalization for the sickest. Inmates with more serious problems are segregated from the general population in mental health wings inside prisons. Thirty-three of the state's prisons and probation detention centers offer mental health services.

The number of mentally ill inmates in Georgia's prisons has surged since 1999, the year after the system was released from the supervision of federal court. But as the population of mentally ill inmates has grown, the amount of professional help provided to them has gone down.

In August 1999, there were 132 counselors who provided 2,382 hours of psychiatric and psychological help to 4,425 mentally ill inmates, according to Metzner's report. In December 2006, 188 counselors provided 1,830 hours of care for 8,054 inmates.

Prison officials have been repeatedly warned of the shortcomings.

Geraghty, of the human rights group, called the persistent problems "disturbing." "The mental health caseload is skyrocketing and the number of mental health professionals is plummeting."

While under the supervision of the federal courts, the prison system increased staffing levels to make sure mentally ill inmates were cared for. DeGroot said the prison system "began losing ground" in 2000 because of budget cuts.

As a result, unlicensed counselors — who are allowed in prison — are not receiving clinical supervision, raising "serious risk management issues," Metzner wrote. Turnover and vacancy rates among mental health staff and correctional officers in prisons are also high. At Chatham County's Coastal State Prison alone, the vacancy rate among guards is about 40 percent, according to the report.

DeGroot said 2006 — the year covered by the most recent Metzner report — was particularly bad because of a spike in the number of sentenced inmates transferred from crowded county jails into the prison system. "We've grown so fast in calendar year '06 that without the staff growing now there are cracks in the infrastructure," DeGroot said.

Basic therapy

DeGroot led a tour June 13 for an AJC reporter and photographer of some of the mental health units at Phillips State Prison in north Gwinnett County.

The housing units were clean, and most of the inmates appeared calm while participating in therapeutic exercises. Some stared off into space, some held their heads in their hands and some rocked back and forth or twitched nervously.

Therapists talked to the inmates about the importance of proper hygiene in one class. In another, a therapist asked a group of mentally ill inmates to name their favorite color and their reason for choosing it.

An African-American inmate responded "white." When asked by the therapist why he chose white, he matter-of-factly responded "That's the color I am. I'm just in disguise."

A couple of the inmates who spoke with an AJC reporter said they felt safe and treated well inside the mental health wing by most staff members and guards. They had minor complaints about being forced to take medication, or the occasional surly prison guard.

In contrast, Geraghty of the Southern Center for Human Rights showed the AJC a folder full of photos of mental health inmates who had cut themselves at Phillips State Prison.

Some of the inmates had cut their forearms, throats and chests, spilling blood onto their cell floors and uniforms. The photos were gathered during a 2004 lawsuit against the prison system in which the center claimed an "epidemic of self-injury" among mental health inmates at Phillips.

Graham, who had a son at Phillips (he is now at Georgia State Prison in Reidsville), said she's not surprised by the report's findings. "They're basically nonexistent," Graham said of corrections' mental health services.

Graham said there were a few mental health personnel who have been helpful to her. But mostly, she felt ignored and kept in the dark about her son's needs.

On March 21, her son attacked a female prison guard at Phillips. When asked why, according to a report of the incident, he told authorities "Jesus told him to do it." Graham, who suffers from shizo-affective disorder, landed in an Atlanta hospital with a collapsed lung, cracked ribs and other injuries in the ensuing scuffle with guards who responded to the attack. Graham, who was serving five years for assaulting a Cobb County police officer, now faces additional criminal charges in Gwinnett.

DeGroot said he doesn't think the prison system's mental health system is in crisis.

"We could improve. The staff's hearts, most of them, are in the right place, and doing a good job. I think we're providing help to people who for so long have not received much, if any, help. We're dealing with the most disenfranchised population."

The criminalization of mental illness under capitalism

2007-06-23T16:39:00.000-07:00

Friday, June 22, 2007
By: Crystal Kim

Prisons replace hospital care

The writer is a member of the Party for Socialism and Liberation and research coordinator of a free-standing psychiatric clinic.

Whether it is Cho Seung-Hui and the Virginia Tech killings or Angela Yates and the murders of her young children, mental illness is an underlying factor in many tragedies in the United States. Approximately 1,000 homicides a year are committed by mentally ill individuals who are not receiving proper treatment.

This comes as no surprise. In the United States—the richest country in the world—the healthcare system is not designed to treat the mentally ill. Rather, mental illness is ignored until the problem explodes.

The largest mental health facility in the United States is not a hospital. It is the Los Angeles County Jail, which holds 3,000 mentally ill inmates on any given day.

The more than 10,000 mentally ill inmates incarcerated in New York state prisons surpass the number of patients in the state’s psychiatric hospitals.

About 10 percent of prisoners suffer from mental illness. Most have committed misdemeanors caused either in whole or in part by psychiatric disorders. They need treatment, not incarceration. Yet, the federal government and state authorities use tax dollars to keep them locked up in subhuman conditions, exacerbating the problem.

This alarming trend began in the 1960s. Since then, jails and prisons have become the new psychiatric hospitals for the mentally ill. Driven by corporate greed, the mentally ill in the United States are being punished for their mental ailments.

Working-class people with mental health problems are the most vulnerable to becoming victims of the system.

Corporate and government collaboration

In 1955, 560,000 people in the United States were being treated for mental health problems in state hospitals. Adjusting for population increase, we would expect there to be about 930,000 individuals being treated in state hospitals today. This is not the case. Fewer than 55,000 people are being treated in such facilities.

Where then are the hundreds of thousands of people with mental health issues? Most are imprisoned by, or otherwise caught up in, the legal system. Between 170,000 and 300,000 mentally ill individuals suffer today in jails and prisons. Another 500,000 are on court-ordered probation.

Since 1960, more than 90 percent of state psychiatric hospital beds have been eliminated. Mental health professionals and sociologists call this "deinstitutionalization." As a result of this phenomenon, many mentally ill patients who need hospital care are in prison instead.

What’s behind deinstitutionalization? In short, the culprit is capitalism.

In 1952, French surgeon Henri Laborit began experimenting with a drug called chlorpromazine. Chlorpromazine was originally developed to treat allergies, but Laborit tested it to see if it could sedate his patients before surgery. Laborit found that chlorpromazine made his patients feel very relaxed. Laborit convinced his colleagues, psychiatrists Jean Delay and Pierre Deniker, to administer chlorpromazine to schizophrenic patients. To their surprise, the most disturbed patients became calm and placid. This was a major breakthrough in psychopharmacology.

Upon hearing about the success of chlorpromazine as a psychiatric drug, the pharmaceutical company that had developed chlorpromazine, Rhone-Poulec, sold the rights to another pharmaceutical company—Smith Kline & French. Known today as GlaxoSmithKline, it is the second largest pharmaceutical company in the world. In 2006, GSK earned $13billion in profits.

Smith Kline flew Deniker all around the United States to speak with psychiatrists about the psychiatric treatment properties of chlorpromazine. The company hoped it could sell chlorpromazine on the U.S. market. When this plan failed, Smith Kline undertook a new approach.

Smith Kline arranged for Deniker to meet with state legislators. Deniker explained to them that state governments could save millions of dollars by prescribing chlorpromazine to mentally ill patients housed in state hospitals. He argued that this would allow patients to be deemed well enough to be discharged. This, of course, would earn Smith Kline billions in profits.

Without regard for whether a patient could continue to afford the drug after discharge, and ignoring its dangerous side effects, state legislators were thrilled by the prospect of no longer having to fund treatment for the mentally ill. State hospitals were already under fire for cruel and inhumane treatment of mentally ill patients. Such treatment was depicted in the popular novel-turned-film "One Flew Over the Cuckoo’s Nest."

With chlorpromazine, state legislators were able to kill two birds with one stone. They could save millions of dollars by emptying psychiatric hospital beds, while also escaping public criticism for the appalling quality of treatment in state hospitals. The lawmakers enthusiastically accepted Smith Kline’s proposal.

Smith Kline marketed chlorpromazine under the name Thorazine. In the first eight months on the market, it was administered to over 2 million patients. In the first 10 years, it was administered to 50 million people. Within 15 years, Smith Kline’s revenues had doubled three times.

The advent of Thorazine, followed by the establishment of Medicaid and Medicare, led the White House to believe that perhaps state psychiatric hospitals were not necessary at all.

In 1963, President John F. Kennedy signed the Community Mental Health Centers Act. This law authorized Congress to spend up to $3 billion to build a national network of community mental health centers to replace state psychiatric hospitals. Congress proudly stated that the community mental health centers would allow even the most severely ill patients to be near home as long as they were taking Thorazine.

State hospitals began emptying their beds almost immediately. Between 1955 and 1994, the number of patients in state psychiatric hospitals decreased from over 500,000 to less than 100,000. From 1963 to 1980, alone, the inpatient population fell more than 75 percent.

The community mental health centers that were promised by Kennedy and Congress, however, were never built. The promise of $3 billion in funding was a big lie. The government turned its attention to "more pressing" matters, namely prosecuting the war of aggression against the Vietnamese people and covering up the Watergate scandal.

Hundreds of thousands of mentally ill patients were dumped onto the streets. This was due to government collaboration to meet the capitalists’ bottom line. By the 1980s, many former patients began arriving in jails and prisons. This trend is called "transinstitutionalization."

Into the prison system

The U.S. population increased by 16 percent between 1980 and 1995. In that period, the number of incarcerated people rose from 501,886 to 1,587,791—an increase of 216 percent!

Have people in the United States become that much more "criminal?" No. The repressive capitalist state apparatus has been extended. Deinstitutionalization has made jails a "repository" of the mentally ill. Instead of being treated as a medical matter, mental illness is being punished as a criminal matter.

A 1973 study of Santa Clara County in California shows that the county jail population rose 300 percent in four years. This jump followed the closure of Agnews State Psychiatric Hospital, located in the same county. (L.A. Teplin, "Journal of Hospital & Community Psychiatry," 1983)

A 1992 Public Citizen survey showed that 29 percent of jails in the United States incarcerate people who have no charges against them but are simply waiting for a psychiatric evaluation, a hospital bed, or transportation to a psychiatric hospital.

Moreover, most severely mentally ill people in jail are incarcerated because they have been charged with a misdemeanor due to an underlying psychiatric disorder. (E.F. Torrey, "Out of the shadows: Confronting America’s mental illness crisis." John Wiley & Sons, 1997)

For example, one mentally ill prisoner in Miami was arrested 26 times in six years for minor crimes such as panhandling and being a "sanitary nuisance." A schizophrenic prisoner in Denver was jailed over 28 times in two years for causing disturbances. In his lifetime, he had been jailed over 100 times.

On average, the mentally ill are jailed six times longer than other inmates charged with the same crime.

Case in point: Miami

What are the conditions like for the mentally ill in U.S. jails and prisons?

Former Washington Post reporter Pete Earley got an unprecedented look at Miami’s main jail—Miami-Dade Pretrial Detention Center. Earley’s investigation was prompted when his own son was thrown into the criminal "justice" system due to a severe mental illness. Earley described his observations of the Miami jail in "Crazy: A Father’s Search Through America’s Mental Health Madness." (G.P. Putnam’s Sons, 2006)

Earley’s description is purely observational, not analytical. Nonetheless, he gives valuable insight into the plight of the mentally ill.

According to Earley, on an average day Miami-Dade Pretrial Detention Center has 700 inmates on antipsychotic drugs. Most of these inmates get locked up on the ninth floor, officially known as the "primary psychiatric unit" but referred to as the "forgotten floor." Inmates are held in large group cells with as many as 50 persons in each cell.

The guards on the ninth floor do not receive special training on how to handle mentally ill inmates. Nurses on the ninth floor earn $2,000 less per year than nurses in Miami hospitals.

The ninth floor has three wings, one of which is reserved for suicidal inmates. Mentally ill inmates who have attempted suicide are held in solitary confinement in cells that have shatter-resistant glass fronts. They are kept naked, and the temperature of the entire wing is kept at around 50 degrees F (10 degrees C) to deter "trouble."

Each cell has a plastic bed built so the prisoner can be strapped to it spread-eagled. Suicidal inmates are not given sheets, blankets or pillows. They are not allowed to have any sort of entertainment, including radio, magazines and books. They have nothing to do but sleep or look out the glass front. Under these sadistic conditions, a suicidal individual’s mental health can only further deteriorate.

There is only one psychiatrist for the entire ninth floor, which allows him to spend an average of 12.7 seconds with each inmate on any given day. He has no authority or time to perform comprehensive mental exams. There is no doctor-patient confidentiality.

The psychiatrist is required to prescribe cheaper drugs to mentally ill inmates even if they report responding well to a different drug. Switching drugs can cause a mentally ill person’s condition to rapidly deteriorate. But this is a risk that Miami’s decision-makers are willing to take to cut down on expenses.

This is a snapshot of what life is like for hundreds of thousands of mentally ill people in the United States today.

Crisis rooted in capitalism

Until the early 19th century, the mentally ill were regularly imprisoned. The work of activists like Dorothea Dix forced legislators to build psychiatric hospitals so that the mentally ill could be treated.

Two hundred years later, the gains have been negated by the inexhaustible greed of capitalists and the politicians they keep in their pockets.

The U.S. mental health system is one example of the wanton greed enforced by the capitalist system. Capitalism upholds the ownership of private property by a few rich capitalists, while the rest of us are exploited in varying degrees. Capitalism is geared toward generating profit, not attending to people’s needs.

Capitalism has made illness into a source of billions in profits for pharmaceutical giants like Pfizer and GlaxoSmithKline each year.

It is cheaper for the state, and more profitable for private corporations, to imprison mentally ill people than to treat them. State governments pay private companies that run psychiatric hospitals regardless how much care they provide their patients and how good or bad that care is. Keeping beds empty increases the owners’ profit margins. Therefore, hospitals push toward prematurely discharging patients rather than ensuring them sufficient treatment.

It does not have to be this way.

The healthcare system must be stripped of its profit motive. This would ensure that patient care is the very top priority. Funding could be used for research and better training of healthcare workers, so that the deplorable conditions common in state psychiatric hospitals of the past are not repeated. Without the profit motive governing health care, aggressive, community-based, long-term follow-up care and treatment could become a reality.

This can only happen through a monumental struggle to reorganize health care so that it benefits people and not predatory drug companies, insurance companies and private hospitals. The healthcare system, along with capitalism itself, must be overturned to meet the needs of all people, especially those with mental illnesses who need help the most.

Florida Supreme Court Reduces Death Sentence Because of Mental Illness

2007-05-31T15:11:00.000-07:00

The Florida Supreme Court reduced a death sentence to life without parole because of the defendant's serious mental illness. The court noted that this was "one of the most documented cases of serious mental illnesses this court has reviewed." In its decision rejecting the trial judge's death sentence for Christopher Offord (pictured), the justices unanimously held that the death penalty was a disproportionate punishment due to Offord's long-standing mental problems. Medical records show that Offord, who was convicted of killing his wife in 2004, suffers from schizophrenia and bipolar disorder and has been in and out of institutions since he was a young boy. The trial judge had imposed a death sentence despite the fact that she found Offord had committed the murder under the influence of extreme mental or emotional disturbance and lacked the capacity to appreciate the criminality of his conduct. The jury had unanimously recommended a death sentence.
(Associated Press, May 24, 2007). See Mental Illness.

Social workers could ease jail crunch

2007-05-18T15:13:00.000-07:00

BY LORETTA TACKETT

PAINTSVILLE HERALD EDITOR

The Department of Public Advocacy (DPA) will submit a 2008 budget proposal which includes money to put a social worker in each of its 30 state offices, including Pikeville, hoping to address the revolving door of the justice system by getting more than half of their clients out of jail and into treatment.

Approximately 68 percent of DPA clients suffer from substance dependency and 58 percent are mentally ill, said DPA Commissioner Ernie Lewis, asserting DPA is concerned with lack of treatment options in overcrowded local jails, including the Big Sandy Regional Detention Center (BSRDC).

The Administrative Office of the Courts (AOC) shows the BSRDC, which is located in Paintsville and houses inmates from Johnson, Martin, Magoffin and Lawrence counties, held 181 inmates in a 110-bed facility last year.

DPA Public Information Officer Dawn Jenkins said Friday there were 200 in a 134-bed capacity - increased by a change in space requirements for each inmate by state law due to statewide overcrowding in jails - and one-third were sleeping on the floor.

In a 2006 visit to Pike County Jail, a University of Kentucky researcher found 236 inmates in a 142-bed facility - 89 of whom were state inmates - and one-half were on the floor, according to a special report the DPA called "Realizing justice during difficult times."

Incarceration rates in Kentucky are skyrocketing, says the DPA, with public defenders caseloads growing for the seventh consecutive year.

Over 300 salaried public defenders represented 140,000 cases last year, Lewis said, which was a 4.3 percent growth and the highest number of cases in DPA history.

The Paintsville office, which serves Johnson, Lawrence, Martin, and Magoffin counties, had 1,600 cases for four attorneys.

The problem in Eastern Kentucky has been complicated with the appearance of federally-funded programs like Operation UNITE, which makes drug-related arrests and offers some assistance to prosecution, but not to defense.

The problem prompted the DPA to hold public forums in 2005 out of concern for ineffective counsel and led to assistance from the 2006 General Assembly, decreasing the number of new cases opened per attorney.

The DPA received funding during the last legislative session to hire 36 more attorneys statewide, Lewis said, adding the goal is to get the caseload down to 400 per lawyer, which is still above the national average.

The 2006 General Assembly also funded the Social Worker Pilot Project, putting a social worker in the public defender's offices in Morehead, Owensboro, and Covington, and will place a fourth one in Bowling Green in July.

"The focus is to work with persons with substance abuse, mental illness, or both and treat them so they don't come back into the justice system," said Jenkins, adding Lewis has been meeting and will meet with legislators, judges and defenders in all trial regions before the 2008 General Assembly to seek support for a social worker in all 30 offices across the state.

The goal is to address the root causes of criminal behavior such as chronic alcohol and substance abuse, mental illness, and illiteracy, Jenkins reported

The project would cost about $1.2 million, Lewis said, asserting, "We think the state will actually save money."

"And better yet, save lives," said Public Defender Jay Barrett, who has been serving as trial division director for the DPA.

The DPA reported the Commonwealth saves $47.12 every day a Kentucky inmate is treated rather than jailed, and a program like the social work project resulted in $15 million in savings for Rhode Island.

Asserting the DPA does not have scientific evidence concerning the effectiveness of the Social Worker Pilot Project yet, as researchers at the University of Louisville are working on it, Jenkins said social workers are making referrals to whatever is available, similar to the way drug court works.

"We have to expand treatment," Lewis said, as only 20 percent of the 68 percent with substance abuse problems are getting treatment.

Many are sleeping on the floor while in withdrawal from drugs, a condition about which Lewis said, "You're not going to get better."

"The BSRDC facility is overcapacity most of the time and without mental health and substance abuse treatment," said Paintsville Public Defender Howe Baker. "Many of our clients will continue to return to the criminal justice system unless we can address their root problem."

Limit to death penalty sought

2007-05-13T14:30:00.000-07:00

Bill would protect the mentally ill
Andrea Weigl, Staff Writer

James Floyd Davis was sentenced to death for killing three people during a workplace shooting more than a decade ago at a Buncombe County tool plant. At least one psychiatrist has concluded that Davis was experiencing paranoid delusions and believed he was waging a "holy war" against co-workers conspiring against him.

A bill pending before the legislature would allow Davis, 59, who was diagnosed in 1973 as schizophrenic, to use his delusions at the time of the killings to try to have his death sentence overturned.

State Sen. Eleanor Kinnaird, a Carrboro Democrat, has proposed allowing defendants with severe mental illness to avoid the death penalty if they were too mentally ill to understand their actions at the time of their crimes. The defendant could either ask a judge to rule on the issue before trial or ask a jury to consider it during the trial's sentencing. Those already on death row could file an appeal.

Kinnaird said the bill does not allow these defendants to avoid prosecution or punishment; they could still be charged and face spending the rest of their lives in prison.

But prosecutors oppose the bill, saying the measure is so broad that it could be applied to all murder defendants facing the death penalty.

"Every time, some hired gun comes in and espouses there's mental illness," said Buncombe County District Attorney Ron Moore, whose office prosecuted Davis. "We haven't tried anyone capitally in this state without some kind of diagnosis."

The bill does not say which diagnoses qualify someone as being severely mentally ill. Rather, the bill defines severe mental illness as someone being unable to appreciate the wrongfulness of their conduct, to use rational judgment or to conform their conduct to the law. Each side is likely to present competing testimony from mental health experts, and the question would be decided by a judge or a jury.

Moore said the jury in Davis' trial considered evidence about his mental illness and still sentenced him to death. Moore said a psychiatrist recently found Davis competent enough to fire his lawyers and drop his appeals. He described Davis as "lucid" and "articulate" during recent court hearings.

The rationale behind the bill is similar to successful efforts in recent years to outlaw the death penalty for juveniles and the mentally retarded: a killer's young age, limited mental functioning and severe mental illness make them less culpable for their crimes and not deserving of the death penalty.

"By a certain reasoning, people with certain mental illnesses can be held responsible, but they aren't the worst of the worst because of the illness that they have," said Richard Dieter, executive director of the Death Penalty Information Center, a nonprofit anti-death penalty group based in Washington.

Mental health advocates agree, saying the bill extends the protection already available to those who are mentally retarded to those with severe mental illness.

"These people probably have no real understanding of what occurred," said Julia Leggett, a lobbyist for the Alliance for Disability Advocates.
A few states eyeing it

North Carolina is one of at least three states, including Indiana and Washington, considering such a proposal. Connecticut is the only state that has such a law.

In a poll earlier this spring, 52 percent of 574 North Carolina voters surveyed said they would not support the death penalty for those with severe mental disability. The poll was released by N.C. Policy Watch, a progressive think tank, that hired Public Policy Polling to conduct the survey, which had a margin of error of 4 percentage points.

Last year, the American Bar Association, as well as The American Psychiatric Association and the American Psychological Association, passed identical resolutions about mentally ill defendants and the death penalty. The resolutions said defendants should not be executed if they had severe mental illness at the time of the crime or if their illness prevents them from helping their lawyers handle their appeals, leads them to give up their appeals or makes them unable to understand the purpose of their execution. North Carolina's legislation does not go that far.

But at least one of Davis' lawyers hopes the bill could help Davis and others on death row.

"There is a significant number on death row who are suffering from mental illness," Asheville lawyer Leah Broker said. "I don't think they got fair trials, especially in my client's case. It would give another avenue for review."

She said Davis' trial lawyers didn't present enough evidence about his history of mental illness that she believes could have swayed jurors. Davis' appeal based on those issues was filed in 2000 and has never been heard, she said.

On May 17, 1995, Davis killed co-workers Gerald Allman, Frank Knox and Anthony Balogh and injured Larry Codgill. Davis had been fired two days before the shooting. Knox's widow, Phyllis Knox, declined to comment about the legislation, although she has previously said she opposes the death penalty.

Staff writer Andrea Weigl can be reached at 829-4848 or andrea.weigl@newsobserver.com.

Hundreds of mentally ill youth prisoners can’t see psychiatrist

2007-05-06T04:33:00.000-07:00

Elizabeth Hernandez

May 4, 2007 - 9:37PM

AUSTIN — Young inmates on psychotropic medications at one Texas youth prison have not seen a psychiatrist since January, health providers told lawmakers Friday.

State lawmakers said they were shocked at yet more revelations of problems involving the state’s juvenile corrections agency, this time detailing major gaps in health coverage for incarcerated boys and girls.

Sen. John Whitmire, D-Houston, said health care in the Texas Youth Commission "ain’t worth a damn" and questioned whether the state should continue its contract with the University of Texas Medical Branch. He is co-chairman of a legislative committee charged with investigating the agency.

"It’s so bad, I think we need to start over, like from scratch," Whitmire said. "We got to throw this one out."

At Evins Regional Juvenile Center in Edinburg, mentally ill inmates see a psychiatrist by teleconference only and do not have face-to-face visits, a youth commission official said. At West Texas State School in Pyote, where alleged sexual abuse by administrators grabbed the attention of lawmakers in February, the doctor and psychiatrist have never even met, said Dr. Sheri Talley, who is the doctor at Pyote.

About one-third of 250 people at West Texas State School have psychiatric problems, Talley said.

At Corsicana Residential Treatment Center, there are two part-time psychiatrists for 170 youth, all of whom are diagnosed with serious mental illness and sent there to stabilize before beginning their "socialization" program at other youth commission facilities.

One of the psychiatrists is leaving at the end of May, said Nancy Slott, the agency’s health services administrator.

At Ron Jackson State Juvenile Correctional Complex in Brownwood, children have not seen psychiatrists since January, meaning mentally ill youth are on psychotropic medicine with no oversight, officials said.
There are 460 youth living in the two-prison complex.

Slott said she has hired a contract psychiatrist to go to the school there once a week beginning May 14. He will commute from San Antonio, she said.

Because it is difficult to recruit child psychiatrists to Edinburg, the youth commission lets mentally ill youth there visit with a psychiatrist in Austin by teleconference. He is available eight hours a week, Slott said.

The psychiatric problems are among many the agency’s new leaders are trying to address, said youth commission spokesman Jim Hurley. He did not know of any plans to send a psychiatrist to Brownwood before May 14 but said the agency will do what it takes to get youth proper care.

Teleconferencing for health care, like that done at Evins, is becoming increasingly popular as a way to bring medical care to rural areas, Hurley said.

"Obviously, the best would be a face-to-face meeting, but if we’re having trouble making something available, we’ve got to do something to bring medical care," he said.

The intake unit in Marlin, near Waco, where all youth are processed, is "wholly inadequate" because it is not big enough and does not ensure patients’ confidential conversations with health providers won’t be overheard, said Sandra Ferrara, director of youth services for UTMB.

Whitmire asked why lawmakers didn’t learn of these problems sooner.

Dr. Ben Raimer, UTMB’s vice president and chief executive officer for community health services, said he told the Legislature that UTMB needed more money in years past, and even asked to get out of the contract.

"There is no oversight in the current system," he said.

Elizabeth Amazeen, the facility nurse manager at Giddings State School, where children who commit murder are sent, said in the past year she has seen more mentally ill and more violent youth in the infirmary.

"They are hurting each other; they are hurting the staff," Amazeen said.

"Our nurses are weary. They cannot keep up with the injuries they are seeing."

____

Elizabeth Hernandez covers the state capital for Valley Freedom Newspapers. She is based in Austin and can be reached at (512) 323-0622.

Mentally ill inmates get state boost

2007-05-05T07:05:00.000-07:00

New initiatives and centers open to provide psychiatric treatment.

By ASSOCIATED PRESS

Published May 4, 2007

JACKSONVILLE - A $16.6-million infusion from state leaders and new initiatives will allow the Department of Children and Families to meet state requirements to get mentally ill inmates into hospitals and out of county jails.

Last fall, mental-health advocates and court officials lambasted the state for failing to meet a state law, resulting in hundreds of severely ill inmates being locked up in county jails for months instead of moving them to psychiatric hospitals in 15 days as required by law. Some judges threatened to fine former DCF Secretary Luci Hadi and hold her in contempt.

DCF statistics indicate the situation is improving.

In early January, there were 270 people on the waiting list for mental health facilities for more than 15 days, said Al Zimmerman, a DCF spokesman. By the middle of next week, that number should be zero, Zimmerman said.

DCF officials have contracted with GEO Care, which runs the South Florida Evaluation and Treatment Center in Miami, to oversee new beds at two facilities owned by the state that were turned into treatment centers.

In March, an unused Department of Corrections building in Miami became the South Florida Evaluation and Treatment Center Annex and an empty Department of Juvenile Justice building in Martin County is now Treasure Coast Forensic Treatment Center.

The two new centers have about 400 staff members to care for 275 mentally ill patients.

As part of legislation approved Wednesday and sent to Gov. Charlie Crist, the Legislature is funding 39 new beds, plus keeping open the beds it funded in December.

The legislation sets aside about $4-million to pay for community grants to try to keep people out of jail and $2.5-million for in-jail treatment.
The in-jail treatment programs are operating already in Pinellas and Orange counties, but Zimmerman said officials would like to see it go statewide.

"This bill is a win-win for everyone, " said Sen. Gwen Margolis, D-Bay Harbor Islands. "For those who are mentally ill, it moves them to centers

Friday My View: Mental health isn't simply a safety issue

2007-05-03T16:54:00.000-07:00

By Maggie Labarta
MY VIEW

Kudos to Gov. Charlie Crist for swiftly signing an executive order that establishes the Gubernatorial Task Force for University Campus Safety, which will review all security measures on Florida's college and university campuses.

One of the benefits of this important response to the tragic events at Virginia Tech will be the increased dialogue regarding the treatment of students with mental illness. As this occurs, we should consider a few important points.

The first is that the overwhelming majority of people with mental illness are not violent. In general, those with a mental illness are more likely to be the victims than the perpetrators of violent crime. The tragedy in Blacksburg should not make us afraid of those with mental illness, but it should make us realize that mental illness cannot be ignored without consequences.
Without early and consistent care, the condition of those who suffer from certain illnesses can deteriorate, making their symptoms more severe and increasingly difficulty to treat.

Second, for far too many Floridians, mental illness remains untreated because of a lack of sufficient investment in our state's mental-health system. Florida currently ranks 48th in the country in per-capita spending for mental-health services, 47th in Medicaid spending for child beneficiaries, and 43rd in Medicaid spending for adult beneficiaries.

Florida also ranks second in the number of homeless, first in the number of substantiated reports of child abuse and neglect, second in the number of children in juvenile detention facilities, and third in the number of prison inmates in comparison with other states.

A significant portion of these problems can be traced to the lack of mental-health care. It is an embarrassing and unfortunate testimony to our lack of commitment to care for those with mental illness; we are not adequately funding proven and cost-effective local mental-health programs.

The success of these programs in communities across our state proves time after time that treatment and community supports work and that access to local mental-health care is the key to providing those with mental illnesses with much-needed help at a reasonable cost to taxpayers.

Without adequate investment in the mental-health system through the funding of community-based services, we will by default be investing in hospital inpatient services, emergency-department care, shelters, foster care, juvenile detention facilities, jails and prisons.

Or worse.

Today's college campuses are more vulnerable than ever to problems associated with untreated mental illness simply because more young people than ever with mental illness are in school.

The Americans with Disabilities Act bans the exclusion of students because of mental illness, but is there enough support on campus for ill students suddenly faced with the additional financial, social and academic pressures of college life?

Florida's institutions of higher learning are assessing their capacities to deal with an increasing number of students with mental illness and are working toward needed changes. Undoubtedly, however, some of these students will require services that will be beyond our colleges' and universities' capacities to meet those needs, and they will rely on community-based programs to help.

Our communities with colleges and universities have an excellent history of collaboration on these issues, but often, students and others end up encountering mental-health services through the legal system instead. Just as we wrongly depend on emergency departments to be the front door for physical health care (instead of focusing more on routine and nonemergency care), jails often end up being the front door for mental-health care.

We must reach these people sooner - long before they are referred for treatment by the courts. That is accomplished through the recognition that mental illness can affect anyone and needs early identification.

We must remove the stigma of mental illness, continue efforts to educate the public on the facts about mental health, and encourage people to seek treatment early. Identification works only if there is an adequately funded array of community-based programs that can provide care after screening and early identification.

Establishing a task force focused on campus safety is a needed and important step. But identification and communication is just part of the battle to prevent another tragedy as happened at Virginia Tech.

Our failure to treat mental health is one of the significant health issues in this state. Until we are serious about addressing it, the number of people left untreated until they commit a crime will continue to increase. And that is an unnecessary risk that none of us should be willing to take.

Maggie Labarta is the chairman of the board for the Florida Council for Community Mental Health and the CEO of Meridian Behavioral Healthcare in Gainesville. Contact her at maggie_labarta@mbhci.org.

Change mental-health services

2007-04-29T04:38:00.000-07:00

Albert "Lee" Mountjoy

April 29, 2007

Changes need to be made in how Florida treats the mentally ill. I grew up in Christiansburg and Blacksburg, Va. The tragedy at Virginia Tech hit close to home for me on many levels.

Mass killer Seung-Hui Cho is another example of why the public needs to be educated, brought out of the "dark ages" concerning the treatment of mental illness.

Just like cancer, diabetes or heart disease, mental illness is a medical condition, a very serious medical condition. It is not something a person is too weak or not moral enough to control.

When people with diabetes experience the symptoms of their disease, they are immediately treated with insulin or sugar to prevent the most serious consequences of coma or death. When people show up at an emergency room with chest pain, they are immediately triaged, given an EKG and baby aspirin to prevent a full coronary.

But when mentally ill people ask for help at a mental-health facility in Florida because they are experiencing new symptoms or an increase in the intensity of their illness, the response is, "Come back if you become suicidal or homicidal." I cannot begin to understand the reasoning behind a professional telling a person in crisis, asking for help, "You're not sick enough yet. Come back when you have a plan for suicide or a desire to kill." Is that what professionals call "rational thinking"?

There needs to exist in mental-health facilities in Florida a standard triage protocol as exists in all emergency rooms. When mentally ill people ask for help because their medication is not working, they are experiencing new or an increased intensity in the symptoms of their illness, help should always be available. They should never be turned away.

Who can say that by the time a person reaches the point of suicidal or homicidal thoughts taking form, they will continue being able to reach out for help before a tragedy occurs? The nation saw the answer to that question at Virginia Tech.

Those who do understand the problems in Florida's mental-health facilities suggest the solution is too costly. State mental-health facilities are understaffed; personnel are underpaid and overburdened. My response is, "one ounce of prevention is worth more than one pound of cure." Prisons for mentally ill inmates, lifetime incarcerations and the loss of productive citizens like those victims at Virginia Tech cost the state and the federal government far more than allocating more money for psychotropic medications and treatment.

Please do not wait one more day, one more suicide or one more tragedy to make the needed changes. Educate the public and allocate the funding today.

Albert "Lee" Mountjoy lives in Kissimmee.

Activists fight jails' solitary cell rules

2007-04-29T04:35:00.000-07:00

By JAY STAPLETON
Staff Writer

DAYTONA BEACH -- It's called "the buck naked cell."

For mentally ill inmates placed in solitary confinement at the Volusia County Branch Jail without clothing to prevent suicide, the experience is frightening.

And demeaning.

But the practice is commonly used in jails and prisons throughout the country, and what some lawyers find most troubling is that the practice is used for people who have yet to stand trial.

"Telephones constantly ringing. Other inmates screaming. Sleep is difficult," inmate Brett Roberts testified during a court hearing on his treatment Wednesday. "I began to bang my head on the door, and I was told by an officer the governor was there to evaluate me for the death penalty."

Human rights activists say mentally ill inmates, who are increasingly finding themselves in county jails as social service budgets are slashed, are at special risk of abuse. Roberts' claims of taunts by those watching him, including jokes about his genitals, are plausible, they said. Prison officials did not address his specific claims, but said protocols were followed.

Calling for change, an attorney with the National Prison Project of the American Civil Liberties Union said Thursday there are alternatives to "stripping a person," including giving inmates suicide-proof gowns. Other options include closer monitoring of possibly suicidal inmates and building cells that make suicide "very difficult."

But such care is staff-intensive and costs more.

"That's why many resort to the far-cheaper option of throwing someone naked into a bare concrete cell," said David C. Fathi, who has brought lawsuits against jails and prisons throughout the country over how mentally ill people are treated in confinement.

In calling jails and prisons "asylums of last resort," Fathi says cost is most often the reason prisoners are held naked, a practice the group finds inhumane and unnecessary. An appeals court recently compared the practice "to a 1930s Soviet gulag," he said.

Roberts, 26, of Titusville spent a month locked up at the county jail for a violation of probation. There was no indication Roberts, who was first diagnosed with bipolar disorder at 19, was psychotic or a danger to himself or others when he was moved here Feb. 12, according to testimony.

He'd pleaded no contest to a charge of fleeing from officers at a traffic stop and got probation. He was doing well and holding a job.

"People couldn't even tell I was mentally ill," Roberts said.

But when his court-ordered urine sample tested positive for marijuana, he was sentenced to spend six months in the county jail.

Within two weeks, paranoia and delusions that he was going to be killed prompted officials to move Roberts into seclusion. He was placed in a bare cell with a bunk, a toilet, a sink and no movable objects. The medication he got was not what Roberts had requested, and jail doctors never checked with the inmate's physician, he testified.

At times, Roberts testified, he was strapped into a restraint chair and sprayed with a chemical stunning agent because he did not comply with corrections officers. He refused to take his medication, according to testimony.

"He didn't start to get bad until he came to Volusia County," said Virginia Chester, his assistant public defender.

She argued Roberts should complete his sentence at home, claiming the mental breakdown was preventable and his civil rights were violated.

Circuit Judge William Parsons had ordered Roberts released last month until a hearing to determine whether he endured cruel and unusual punishment.

But the judge found the way Roberts was treated was neither cruel nor unusual.

"What does the jail do?" he pondered.

How Roberts was handled "beats the heck out of hanging yourself," he said.

He found care was taken to avoid injury to Roberts. There was no evidence his mental condition worsened because of a change in his medication, the judge said in disagreeing that a constitutional violation occurred.

All agreed, including the county's head of inmate mental-health treatment, who testified jail is not the place for those proven to be mentally ill.

But Dr. David Hager, director of mental-health services for Prison Health Services, defended the psychiatric treatment, saying Roberts was medicated under approved practices. Hager saw Roberts three times at the jail and said he had started "to stabilize."

Asked by attorney Chester if his treatment was humane, Hager answered, "That's a difficult question to answer in a corrections setting. A correctional setting is a different world, with different priorities."

Prosecutor Carine Jarosz told the judge Roberts shouldn't be allowed to use his mental illness as an excuse.

"He still did the crime," she said. "And he still needs to be punished accordingly."

The American Civil Liberties Union has called for reform of how mentally ill inmates are treated. A federal judge in New York is reviewing the settlement in a lawsuit that could impact how mentally ill inmates are treated in other states, including Florida, in the future.

The New York agreement calls for extensive reviews of all prisoners sent to solitary confinement.

The National Prison Project's Fathi said more reform is needed.

"The fact that so many (people with mental illness) end up in jails and prisons because there's no place else for them needs to change."

jay.stapleton@news-jrnl.com

New Rules for Confining the Mentally Ill

2007-04-25T05:27:00.000-07:00

April 25, 2007

By SARAH KERSHAW

New York State would more closely scrutinize its use of solitary confinement for mentally ill prison inmates under the proposed terms of a legal agreement scheduled for review by a federal judge on Friday.

New York is one of several states that have faced lawsuits over the means used to punish mentally ill prisoners, and, under a settlement reached last week, it has agreed to consider changes in how it uses solitary confinement as a disciplinary measure with the mentally ill.

Many advocates hail the agreement as a watershed in prison reform because of the effects long sentences in isolation have had on the most vulnerable prisoners, including suicide and self-mutilation.

Some mentally ill inmates serve months to years in punitive segregation, locked up for 23 hours a day and sometimes restricted to a diet of cabbage and a pasty flour loaf three times daily for up to 30 days for misbehaving.

Disability Advocates Inc. and the Legal Aid Society of New York sued the state over the practices five years ago, and the resulting agreement goes before Judge Gerard E. Lynch of the Southern District of New York on Friday for final review.

If the agreement is approved, as expected, the state will not be barred from the use of solitary confinement, or punitive segregation, to discipline mentally ill prisoners, but it would have to provide far more assessment and services for mentally ill inmates in solitary. In addition, the state would be required to review the reasons for and the length of proposed segregation sentences.

Many mental health advocates believe that the New York settlement will create pressure on other states to review their policies of confining mentally ill prisoners.

Others, including state lawmakers and advocates, said the agreement was only a small step toward stopping inhumane treatment of these prisoners. Many of those advocates were particularly disheartened last fall when Gov. George E. Pataki vetoed a bill that would have banned the use of solitary confinement for the mentally ill in New York.

"We see the settlement as a step in the right direction because it provides additional resources and services for treating the mentally ill in prison," said Robert Gangi, executive director of the Correctional Association of New York, an advocacy group that is now lobbying the new administration in Albany to stop sending mentally ill prisoners into isolation. "But it falls far short of the policy changes that are needed to ensure humane and appropriate treatment for all the mentally ill people in prison."

In New York, with one of the largest prison populations in the country, mental illness has been diagnosed in about 8,400 of the 63,000 inmates, according to the State Office of Mental Health. The number of inmates has decreased significantly in the last few years, but Mr. Gangi said the number of mentally ill prisoners was rising, possibly because the condition is being more accurately diagnosed.

Under the agreement, mentally ill prisoners sent to solitary confinement would be entitled to leave their cells for therapy and treatment for two to four hours daily. Their placement in solitary confinement would have to be preceded by extensive reviews, all prisoners entering the system would be screened for mental illness, and the state would be required to provide some mentally ill prisoners with alternative residential housing.

State officials said that because of both the agreement and their own budgetary priorities, they had set aside an additional $9 million in the 2007-8 fiscal year for programs within existing prisons and new or renovated facilities to accommodate mentally ill inmates, a total of $57.5 million dedicated to mentally ill inmates.

The agreement also stipulates that New York prisons, which local and national advocates say are unique in using restricted diets to punish prisoners already in segregation, cannot use the cabbage-and-loaf punishment for more than seven days with mentally ill prisoners without "exceptional circumstances."

Lawyers who brought the suit and national prisoner rights advocates said the New York settlement was unique in covering all mentally ill prisoners, from the time they enter the system until they leave, whereas some states have merely stopped sending prisoners with major mental illnesses to prisons with especially harsh conditions.

"The proof of the pudding is in the eating," said David C. Fathi, senior staff counsel with the American Civil Liberties Union’s national prison project, who has handled several cases around the country regarding the treatment of mentally ill inmates. "We will have to see how this is implemented. But on paper, it is very significant, a victory and a step forward."

He added, "Now we can point to New York and say, if New York can do it, why can’t you do it?"

Mentally ill posing challenge for TYC

2007-04-22T11:50:00.000-07:00

State leaders ask if the prisons are really the best places for such juveniles.

By LISA SANDBERG
Copyright 2007 Houston Chronicle Austin Bureau

AUSTIN — Texas Youth Commission staff have to watch for more than just poor behavior when looking after Zachariah Tarver — they have to ensure he's not hanging himself, slicing his veins, writing on the walls with his blood or drinking cleaning fluid.

It's not easy. Tarver has done these things before, threatening or attempting suicide at least a half-dozen times in the 10 days after he was plucked from a psychiatric hospital and sent to TYC late last year, agency records indicate.

The youth, now 18 and confined to TYC's Corsicana Residential Treatment Center, has spent virtually every day since his arrival on suicide watch. He hallucinates, and he responds to questions from doctors with a smile, no matter what is asked of him, according to the records, which were provided by his family.

Psychiatrists hired by TYC diagnosed him with major depression, bipolar and schizoaffective disorders and drug dependence.

Now, as state leaders work to overhaul TYC, many are asking the question: Are juvenile prisons the best settings for mentally ill youths like Tarver?

He had two brushes with the law, including taking his father's car without permission, before being sentenced to TYC last year for driving without a license and violating curfew.

"I personally don't think that the mentally ill should be treated like law violators if their medical problems are causing the behavior," said Sen. John Whitmire, D-Houston, who co-chairs the joint legislative committee investigating the myriad problems that beset the agency.

Whitmire said confining juveniles who are mentally ill should be a last resort.

In the wake of a scandal involving reported sexual or physical abuse of inmates by guards at several TYC facilities, lawmakers are promising to substantially reduce the system's offender population and make it a place for seriously delinquent youths whose behaviors aren't caused by illnesses.

But they're also grappling with issues of public safety since some mentally ill inmates have committed violent offenses.

A bill making its way through the Legislature would keep those with misdemeanor convictions out of the TYC system and would provide local communities more resources to treat most mentally disturbed youths in community-based settings closer to home.

The task is daunting, given the number of youths with mental health issues who wind up in TYC.

The agency decided mental health services were required for nearly 38 percent of the 2,700 youths it received in 2005.

Leaving in worse condition

Until she resigned under pressure last week, Corrine Alvarez-Sanders, TYC's assistant deputy executive director for rehabilitative services, had worked with young inmates for 15 years and said too many who are mentally ill don't get appropriate treatment and leave in worse condition than when they arrived.

Secured lockups are appropriate for some mentally ill offenders with violent tendencies, but every one of those would be better served in smaller residential treatment centers, she said.

"I don't want to say that all of our facilities are producing outcomes that are worse. But what's clear to us is the interventions don't match the specialized needs that are present," Alvarez-Sanders said.

All too often, poorly trained staff extend the TYC terms of mentally ill inmates, confusing a mental health issue with a bad attitude or anti-social behavior, she said.

Excessive confinements

She's seen those with borderline intelligence disciplined for failing to complete written assignments they were incapable of doing.

"I'm not going to minimize the fact that we have kids in our care that are confined for excessive lengths of time," she said.

Juveniles entering TYC spend several weeks at the Marlin Orientation and Assessment Unit, 25 miles east of Waco, undergoing a battery of psychological, emotional, vocational and chemical dependency tests.

Those deemed suffering from severe mental disorders are assigned to either the Corsicana Residential Treatment Center or the Crockett State School, which have specialized psychiatric care, higher staff-to-offender ratios and rehabilitative programs tailored to their needs, Alverez-Sanders said.

But, clearly, not everyone who needs mental health services gets them.

Severe problems

Marquieth Jackson has spent 3 1/2 years at TYC but only one month at Corsicana, where no one could handle him, said the attorney representing his Houston family. Jackson was sent to a facility in Beaumont that specializes in drug treatment.

No one could dispute that Jackson suffered from severe emotional and behavioral problems when he was sent to TYC at 12 for violating probation by breaking a window, one of his numerous encounters with police.

Before he ever stepped foot in TYC, he'd been diagnosed as being bipolar and depressed, with schizoaffective and attention deficit hyperactivity disorders, according to TYC records provided by his mother, Tarsha.

By age 4, he'd been kicked out of day care for aggressive behavior. At 10, he assaulted a teacher.

He was committed twice to psychiatric hospitals and received intensive counseling from the Mental Health and Mental Retardation Authority of Harris County.

Incapable of following rules

Tarsha Jackson said her son has received virtually no mental health treatment or medicine since arriving at TYC. (The agency cannot discuss specific cases.)

Like most offenders, Marquieth came into the system with a nine-month minimum sentence. His mother said he's too mentally ill to follow TYC rules. "I tell them, 'You've had him since he was 12. If he hasn't been able to work your program in 42 months, what are you going to do? Keep him until he's 42?' "

In a sign that things may indeed be changing, Tarsha Jackson received word recently that her son, who's now 15, would soon be discharged on a mental health release.

She's relieved but insists she's realistic about the difficulties ahead.

"We're going from (the unit) to (a psychiatric) hospital. No pit stops," Jackson said.

Zachariah Tarver's mother, Terri Lovelace, is still waiting to hear whether her son soon will be released.

lsandberg@express-news.net

RESOURCES

MENTAL DISORDERS

Texas Juvenile Probation Commission statistics indicate 38 percent of TYC inmates arriving in 2005 suffered from mental health disorders, although the agency indicated the number could be as high as 50 percent. Of those deemed mentally impaired by the agency:
• 11 percent: Confined for nonviolent misdemeanors;
• 17 percent: Confined for violent felonies;
• 20 percent: Confined for nonviolent felonies, such as car theft or burglary;
• 3 percent: Confined for violent misdemeanors, such as noninjury assault

School Violence: The psychology of youthful mass murder and what to do about it

2007-04-21T07:14:00.000-07:00

Practical Police Psychology
with Dr. Laurence Miller

Q: Just when we were so preoccupied with the fear of terrorism, now comes news of the deadly Virginia Tech shooting. It looks like school violence is back in the news. What causes someone to commit mass murder? What are the effects on individuals and communities? How can law enforcement and the general public best prevent, respond to, and recover from episodes of school violence?

A: School violence is not really back in the news because it never left. Most recently eclipsed by the war on terror, incidents like Virginia Tech – as with Littleton, Columbine, and others – remind us that most killers of Americans are still our own citizens and that many of these murders take place where we expect them least, our schools. This column will provide some insight into the psychology of this modern form of mass murder and provide some practical recommendations for preventing, responding to, and recovering from school violence.

Demographics of School Violence

The good news is that youth violence as a whole has been decreasing in frequency since the 1970’s. However, during the same period, the severity of juvenile violence has dramatically increased, with a greater number of homicides and involving more potent weapons. In addition, students are committing violence at increasingly younger ages. According to National School Safety Center, almost 3 million crimes are committed on or near a school campus each year, accounting for 11 percent of all reported crimes in the United States.

In this context, high-profile multiple murders on school campuses, horrific though they may be, are still relatively low-frequency events. Much more common are the everyday instances of bullying, harassment, and nonlethal violence that occur on school campuses across the nation and the world. These, too, can be psychologically traumatizing and may set the stage for episodes of explosive violence.

School Victimization

The kinds of intimidation and harassment that would get an employee fired at almost any job is routinely tolerated by school authorities when it occurs between students. In virtually every case of school violence studied, the perpetrators had been harassed or persecuted in some way by other students and their efforts to have their cases resolved by school authorities were rebuffed or ignored. Of course, a far greater number of bullied students suffer in silence without seeking to redress their injustice with a greater atrocity.

Peer victimization is the experience of being a target of the aggressive behavior of other students. Indirect aggression is carried out through a third party or in some way that conceals the identity of the aggressor. Relational aggression is behavior which damages peer relationships and acceptance within the social group. In verbal victimization, the student’s status is attacked or threatened with words and this can be exceedingly vicious and damaging to a student’s psyche and self-image.

Studies have shown the effects of school victimization to include lowered self-esteem, increased loneliness and isolation, anxiety and panic attacks, depression and suicidal thoughts, psychosomatic symptoms, and posttraumatic stress disorder. Victimized children miss more days from school, suffer impaired academic performance, and make more trips to the doctor.

Only rarely, do disturbed, desperate students resort to violence but, when they do, it often highlights systemic problems that have occurred for a long time – a strong parallel with workplace violence.

School Violence Perpetrators

For all the media attention given to school violence, very little empirical work has been done in the psychology of this kind of youthful mass murder. Accordingly, much of what we know about school violence perpetrators has been extrapolated from studies of other types of mass murder, especially older perpetrators of workplace violence, who have been studied for several decades, as opposed to school shootings, which are a more recent phenomenon.

The cycle of violence typically begins when the student undergoes an event or series of events that he perceives as the "last straw" in a cumulative series of humiliations. Based on his predisposing personality and psychological dynamics, his reaction will consist of some combination of persecutory ideation, projection of blame, and violent revenge fantasies. As thoughts and emotions stew, the student isolates himself from the input of others and enters a mode of self-protection and self-justification in which a violent act may come to be perceived as "the only way out." The actual commando-style mission may be executed impulsively and all at once, or it may undergo numerous revisions and months of planning. The violent act itself may be carried out alone or with the collaboration of like-minded compatriots. In most cases, the episodes end with the death of the perpetrator(s), either by their own hand or by responding law enforcement authorities.

Preventing School Violence

Academic administrators who remain unmoved by the human costs of school violence might want to consider the potential legal and financial liabilities. In Stoneking v. Bradford Area School District, 1988, the court found that, if a school is aware of dangerous and unlawful activities on its premises and takes insufficient action to address them, it may be found liable under the 14th amendment. School officials may be protected from liability, however, if they can demonstrate due diligence in their prevention of crime on campus.

Accordingly, the following recommendations are adapted from a large body of work in the area of workplace violence that can be productively applied to the academic setting. Law enforcement officials, in particular, should be aware of these concepts because local police departments are typically the main agencies contacted by schools for advice on violence prevention programs, and they are almost always the first to be called when a crisis erupts.

Clear Policies. Schools should have clear, strong, consistent, written policies against bullying, intimidation, and harassment. They should have effective security programs, a standardized, confidential, and user-friendly reporting system, a supportive faculty, open channels of communication, and training in verbal negotiation and conflict resolution skills. Schools must have a clearly understood policy of zero tolerance for violence. This should be contextualized as a safety issue, the same as with rules about fire prevention or disaster drills. Plans should be in place that specify how threats are reported and to whom, as well as a protocol for investigating threats.

Safe Discipline. As in the workplace, many acts of violence relate to the perpetrator feeling he was treated unfairly by the administration; some of this relates to confusion over the very zero-tolerance policy cited above. Schools should develop an individualized disciplinary program that strikes a balance between a too heavy-handed approach that might discourage reporting and participation, and a too lax approach that gives the impression of ambivalence and lack of control. Discipline should occur in stages, with a clear policy and rationale for each action taken. School officials should not be afraid to "pull rank" where student safety is concerned.

Safe Suspension or Expulsion. If it comes to that, suspension or expulsion from school can be clear and firm, without being inhumane. This should include a systematic process of documentation of the precise behaviors and rule violations that have necessitated these actions. The student and his family should be treated with reasonable respect, but should understand that the action is final and will be backed up. The student should be informed of any counseling or other services offered by the school for the transition period. For behaviors that constitute criminal acts, school officials should report these to local law enforcement or their own school police if they have them.

Responding to School Violence

Sometimes, despite the best efforts at prevention, a dangerous situation begins to brew and a violent incident becomes a distinct possibility. Or the incident just erupts explosively and personnel have to respond immediately. In either case, the effectiveness of the response will be determined by how thorough the pre-incident planning and training have been.

Warning Signs of Impending Violence. It’s always best for school officials to know their individual students, but generic warning signs include deterioration or changes in dress, speech, facial expression, increased agitation, anxiety, isolation and/or depression, evidence of substance use, or preoccupation with violent events in the media. Almost always, the student’s peers will know something is up way before parents or teachers, which is why a safe and confidential reporting system is so important.

Defusing Violence. Planning and training for defusing potentially violent episodes should be developed, put in place, and reviewed periodically. Elements of such a protocol include initial actions to take when danger begins to escalate, codes and signals for summoning help, chain of command for handling emergencies, appropriate use of verbal control strategies and body language, scene control and bystander containment, tactics for dealing with weapons, and hostage negotiation procedures.

Recovering From School Violence

The crisis is not over when the police and TV crews leave. Students or faculty may have been killed, others wounded, some held hostage, and many psychologically traumatized. Schools should proactively establish policies, procedures, and training for responding to the aftermath of a violent incident, and the plan should include the following elements.

Law Enforcement, Physical Security, and Cleanup. A school representative should be designated to work with local, regional, and/or federal law enforcement. Within the limits of safety, the crime scene should be kept intact until investigators have gone over the area. There should be someone assigned to immediately check, protect, or restore the integrity of the school’s data systems, computers, and files. Physical cleanup of the area, pending approval from law enforcement, should be conducted in as respectful a manner as possible.

Mental Health Mobilization. This includes a prearranged plan for school representatives to contact local mental health professionals immediately, arrange for the clinicians to meet first with school officials for updates and briefings, conduct crisis counseling with affected students, faculty, and families, and arrange follow-up schedules for mental health clinicians to return for psychological services as needed.

Student and Family Interventions. Another designated school official should notify the victims’ families of the incident and be ready to offer them immediate support, counseling, and referral services. The school should arrange time off for grieving and traumatized students and faculty. After the initial stages of the incident have passed, mental health clinicians should help students and school officials find ways of memorializing the victims.

Media and Public Relations. A media spokesperson or public information official should be designated to brief the media and shepherd them away from grieving students, family members, and faculty. School officials should cooperate with law enforcement authorities as to the timing and content of news releases.

Legal Issues and Post-Incident Investigations. These measures include notifying the school’s legal counsel who should be asked to respond to the scene, if necessary. Investigatory questions include the nature of the perpetrator(s), their relationship to fellow students and faculty, history of disciplinary action or suspension, specific circumstances or institutional stressors that may have led to the incident, the role of mental illness or substance abuse, any warning signs that should have been heeded, and a thorough review of the school’s overall security, threat assessment, and critical incident response protocols.

In summary, if any good can come out of a school violence episode, it will be in the form of improved policies and procedures that adopt a best-practices model to the prevention, response, and recovery to and from any kind of institutional mass violence. In these efforts, law enforcement agencies have a vital role to play.

More on the VA Tech Active Shooter Incident NOTE: To learn more about this topic, see:
Miller, L. (1999). Workplace violence: Prevention, response, and recovery. Psychotherapy, 36, 160-169.

Miller, L. (2001). Workplace violence and psychological trauma: Clinical disability, legal liability, and corporate policy. Part I. Neurolaw Letter, 11, 1-5.

Miller, L. (2001). Workplace violence and psychological trauma: Clinical disability, legal liability, and corporate policy. Part II. Neurolaw Letter, 11, 7-13.

Miller, L. (2002). How safe is your job? The threat of workplace violence. USA Today Magazine, March, pp. 52-54.

Miller, L. (2002). Posttraumatic stress disorder in school violence: Risk management lessons from the workplace. Neurolaw Letter, 11, 33, 36-40.

Laurence Miller, PhD is a clinical and forensic psychologist and law enforcement educator and trainer based in Boca Raton, Florida. Dr. Miller is the police psychologist for the West Palm Beach Police Department, a forensic psychological examiner for the Palm Beach County Court, and a consulting psychologist with several regional and national law enforcement agencies. Dr. Miller is an instructor at the Criminal Justice Institute of Palm Beach County and at Florida Atlantic University, and conducts continuing education and training seminars around the country. He is the author of numerous professional and popular print and online publications pertaining to the brain, behavior, health, law enforcement, criminal justice, and organizational psychology. His latest books are Practical Police Psychology: Stress Management and Crisis Intervention for Law Enforcement (Charles C Thomas, 2006) and the forthcoming Mental Toughness Training for Law Enforcement and Street Psychology 101 (Looseleaf Law Publications). Dr. Miller can be contacted at (561) 392-8881 or online at docmilphd@aol.com.

Disclaimer: This article is for educational purposes only and is not intended to provide specific clinical or legal advice.

Colleges face surge of troubled students

2007-04-21T07:12:00.000-07:00

By DAVID CRARYAP
NATIONAL WRITER

NEW YORK -- Across America, college counseling centers are strained by rising numbers of mentally ill students and surging demand for mental health services - a challenging trend as campus officials try to identify potential threats like the unstable Virginia Tech gunman.

And even when serious emotional problems are detected, university officials often feel constrained in how they respond due to an array of laws and policies protecting students' rights and privacy.

"The number of people coming to colleges who've had psychiatric treatment has increased tremendously," said Dr. Gerald Kay, a psychiatry professor at Wright State University and chair of the American Psychiatric Association committee on college mental health.

"Now they're able to come to college - that would not have been the case earlier," Kay said. "You've got a very large number of people who may have some vulnerabilities. It has stressed the availability of resources."

Reasons for the surge include the Americans with Disabilities Act, which gives mentally ill students the right to be at college, and increasingly sophisticated medications which enable them to function better than in the past.

Recent surveys and studies underscore the scope of the increase.

A survey last year by the American College Health Association found that 8.5 percent of students had seriously considered suicide, and 15 percent were diagnosed for depression, up from 10 percent in 2000. The Anxiety Disorders Association of America found that 13 percent of students at major universities and 25 percent at liberal arts colleges are using campus mental health services.

Dr. Chris Flynn, director of Virginia Tech's counseling center, has declined to discuss details of gunman Cho Seung-Hui's case, but said the center's staff - which includes a psychiatrist and 11 psychologists - treats about 2,000 students per school year.

In December 2005, a magistrate ordered Cho to undergo an evaluation at a private psychiatric hospital after two women complained about annoying calls from him, and an acquaintance reported he might be suicidal. An initial evaluation found probable cause that Cho was a danger to himself or others as a result of mental illness, but court papers indicate he was free to leave the hospital within days - a step allowed only if hospital officials judged him no longer a danger.

"We have to provide services to students with mental illness - it's not grounds to exclude them from our property," Flynn said. "We cannot discriminate against the mentally ill, nor do we want to."

He said the type of complaints lodged against Cho by the two women are a common and challenging phenomenon on campuses nationwide.

"It is very difficult to predict when what someone perceives as stalking is stalking, and then how it might translate into violence later," Flynn said. "Clearly, if anyone had any warning about a violent incident, people would have stepped in and acted."

Psychologist Sherry Benton, assistant director of counseling services at Kansas State University, has conducted research concluding that students' mental health problems are more complex and severe than 20 years ago.

"We're well aware that problems are getting worse, but what hasn't happened is increasing funding for mental health services," she said. "Most centers are now overwhelmed. Business has gone up and up, but budgets have remained the same or been cut, and that's a huge problem."

One factor, Benton said, is that mental health services are usually not among the categories assessed during colleges' periodic accreditation reviews. If schools needed good services to remain accredited, they might invest more, she said.

Benton views the rising demand for campus mental health services as a good news-bad news development.

"We do get a lot more students into college who have mental illness but are no problem whatsoever," she said. "They do need support and use medication; they go on to lead full, productive lives."

On the downside, she and her colleagues see stress levels among students far higher than a generation ago due to increased workloads and financial strains, often coupled with lack of healthy lifestyles.

Complicating the overall picture is a web of laws and policies that limit the options for worried staff members. Troubled students generally can't be forced to obtain treatment, and privacy laws may limit sharing information about them, even to the extent that some parents have sued schools - including the Massachusetts Institute of Technology and the Oregon Institute of Technology - for not advising them of their children's serious disorders.

Nonetheless, officials on many campuses have set up committees to pool information about students with emotional or behavioral problems so patterns can be detected in what might otherwise be seen as isolated incidents. The trick, officials say, is to find the proper balance between respecting a student's rights and protecting the university.

"That's the tightrope administrators have to walk," said Wright State's Gerald Kay.

"The issue in most instances is how do you bring these people into some sort of treatment."

Benton said any student who issues threats should be dealt with forcefully, regardless of privacy guidelines.

"Safety trumps confidentiality every time," she said. "If someone is a danger to themselves or others, then confidentiality is out the window and you notify who you need to notify to ensure the safety of them and those around them."

Peter Lake, a law professor at Stetson University, contends that officials on many campuses have been too deferential to privacy concerns, at the risk of safety at their schools.

"There's a false consciousness of privacy in higher education - as an institution, we don't like to share information," he said.

"Now, you're going to be seeing a greater emphasis on a management team or a safety czar - someone whose job it is to look at students' overall profiles," Lake said. "It's not only a good idea - it's an idea we can't live without."

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On the Net:
American College Health Association: http://www.acha.org/

Jump in troubled students alarms mental counselors

2007-04-19T17:20:00.000-07:00

SPOTTING THE WARNING SIGNS

Erika Hobbs and Leslie Postal
Sentinel Staff Writers
April 19, 2007

The shootings at Virginia Tech exposed a college trend that worries campus mental-health counselors: rising numbers of troubled students who may not be getting the help they need.

Cho Seung-Hui was reported to police and spent time in a psychiatric hospital, Virginia officials said Thursday, but none of that intervention prevented him from killing 32 people and himself this week.

Mental-health officials at several Florida campuses said they face the same budget constraints and privacy considerations that complicated efforts to help Cho, a sullen student who alarmed English instructors with his violent writings.Despite their best efforts, officials said, someone can slip through the cracks.

"We could tell you today the students that keep us awake at night," said Lesley Sacher, director of Thagard Student Health Center at Florida State University.

College counseling centers across the country report not only an upswing in the number of patients who visit the clinics, but also a surge in the number of freshman students with mental-health problems.

A 2006 National Survey for Counseling Center Directors done by the University of Pittsburgh shows that 92 percent of counseling-center directors nationwide reported concerns about an increased number of students with serious problems.

They also reported jumps in the numbers of students who hurt themselves and those who sought crisis counseling during the past two years.

Clinic directors in Florida say that often the best they can do is screen students carefully and stay alert.

For example, Sacher said mental-health professionals see many students who saw psychiatrists in high school, who take medication to cope and need additional care in college. They are "extra-bright, unbelievably talented, but extraordinarily fragile," she said.

Waits can take weeksBut getting help for them can be difficult.At FSU, students wait three to five weeks to see Sacher's two psychiatrists. Three years ago, the center, which serves FSU's 40,000 students, didn't have any. Last fall, the University of Florida's director of student affairs pleaded with the state for more money for its clinics.

The University of Central Florida has one counselor for every 3,250 students. Industry standards call for one for every 1,000 to 1,500 people. Like officials at the other universities, David L. Wallace, the UCF counseling center's director, said he could double his staff and "it would not be out of line."His counselors deal with emergencies and problems that can be handled quickly, referring students with chronic and more-intense issues to off-campus facilities. They do not have much time for prevention and training programs that might, for example, help students recognize signs of depression in classmates.

"These are the things that so often get put on the back burners," Wallace said. "There is strong recognition there is need for more help, and sometimes the funding is just not available."Campus clinics only see those students who want help, of course.

How to reach the rest, including students such as Cho, is much harder.

In November and December 2005, two women complained to police at Virginia Tech that they had received "annoying" calls and computer messages from Cho, police said.

After the second complaint, the university obtained a temporary detention order and took Cho away for psychiatric evaluation because an acquaintance reported he might be suicidal, authorities said.

About the same time, Cho was referred to the university's counseling service after an English instructor expressed alarm at his writings, police said. It is not clear whether he followed through with treatment.

'It's a difficult thing'Counselors, teachers and administrators in Florida said they walk a fine line not only in picking out who might be a threat, but also in what to do about it.

Thomas Krise, chairman of UCF's English department, said he thinks his Virginia colleagues tried to help Cho.

"It's a difficult thing," Krise said. "English professors are very well-trained, but we're not trained as counselors or psychiatrists. . . . It doesn't sound to me like they missed something.

"The screenplays and assignments that alarmed classmates and instructors were filled with violence, profanity and other vulgarities -- not much different at first glance from video games and gore films on the market today.

Students often write that way, and creativity doesn't indicate mental illness, educators said.

"Stephen King is not chopping up people and putting them in the basement" just because his writing depicts horrific acts, said Stephen Schlow, chairman of UCF's film department.

But since Monday's massacre, the issue of disturbed students has been a frequent topic of conversation.

"That's almost all we've talked about in my office," Schlow said."My guess is that if it were truly disturbed, we would notice it," he added. "That doesn't mean if we said the person is truly disturbed, we would get any more action than they got in Virginia."

Schools can be stymied

Universities have limited options when a student refuses counseling. They can't force an adult to seek care and can't legally contact parents without permission. Most won't expel a student for refusing treatment.

What administrators often do is focus on a behavior. If a student won't stop cutting himself, making suicide threats or stalking others, Florida schools often step in and recommend he take a break to recuperate, said Wayne Griffin, director of UF's Counseling Center.

Peter Lake, a law professor at Stetson University and co-author of The Rights and Responsibilities of the Modern University, said universities need better systems for reporting and intervening in such problems.

A dean may not know faculty has talked to a distressed student or that the student faced trouble with police. Campuses need a strong central system and policies in place to get help quickly, including those that permit professionals to warn the community if a patient poses a danger.Officials at FSU and UF say they have similar systems in place. But after Virginia Tech, they say, every higher-education institution will be reviewing its policies to ensure they catch distressed students before disaster happens.

"This will change higher ed forever," Lake said.

Erika Hobbs can be reached at ehobbs@orlandosentinel.com or 407-420-6226.
Leslie Postal can be reached at lpostal@orlandosentinel.com or 407-420-5273.
Information from The Associated Press also was used.

Legal win for mentally ill inmates

2007-04-19T17:17:00.000-07:00

State agencies agree to provide more treatment, reduce time in solitary

By PAUL GRONDAHL, Staff writer
First published: Wednesday, April 18, 2007

ALBANY -- Thousands of severely mentally ill inmates in New York's prisons will receive more treatment as part of a landmark settlement in a federal lawsuit brought by prisoner advocates.

The agreement is expected to be signed April 27 by a federal judge and the parties involved.

It was negotiated after five years of litigation and two weeks of a nonjury trial before U.S. District Judge Gerard E. Lynch in New York City.

"This greatly expands the mental health services available within the prison system," said Cliff Zucker, executive director of Disability Advocates, a not-for-profit group in Albany that was the plaintiff.

About 8,000 of the state's 63,000 inmates have been diagnosed with serious mental illness. Hundreds are kept in solitary confinement and studies have shown they are far more likely to commit suicide or injure themselves.

Along with adding staff, resources and new beds for mentally ill inmates, the settlement bans some seemingly barbaric prison practices, such as:

Stripping naked mentally inmates suffering an acute psychotic episode, segregating them in a Plexiglas-walled cubicle and leaving them with nothing but a thin pad on a cement floor.

The use of punitive "restricted diets," a loaf made from bread and cabbage, for punishment.

It also adds two to four hours of therapy outside the cell for mentally ill prisoners currently locked down in 23-hour solitary confinement.

Dan Odell, a spokesman for the state Office of Mental Health, which was a defendant in the lawsuit along with the state Department of Correctional Services, expressed satisfaction at the resolution of the case. He said details have not yet been worked out, but the settlement will require more mental health professionals and other resources to the prison system.

In the recently adopted state budget, Gov. Eliot Spitzer called for an additional $60 million over three years for services for mentally ill inmates. That includes $50 million in capital construction costs, $2 million for Office of Mental Health staffing and $2 million for Correctional Services staffing this year, growing to $9 million a year in 2009.

Construction money will be used to build facilities for 405 mentally ill prisoners, with 305 transitional intermediate care program beds for those with mental illnesses and a 100-bed residential mental health unit for severely mentally ill inmates who otherwise would be placed in solitary confinement. Also, all new inmates will be carefully screened by professionals for mental illness for the first time.

Spitzer spokeswoman Christine Pritchard said: "Through a considerable investment in state resources in the budget this year, the Spitzer administration has committed to providing significant improvements to the services and housing available for mentally ill inmates."

Sarah Kerr, staff attorney for Prisoners' Rights Project of the Legal Aid Society in New York City, said: "We believe there's real commitment now in the leadership of the state agencies that will result in true reform for mentally ill prisoners."

Kerr, who spent five years working on the lawsuit, and attorneys with Disability Advocates were joined by attorneys with Prisoners' Legal Services of New York and pro bono lawyers with Davis Polk & Wardwell, a New York City law firm.

Also Tuesday, advocates lobbied at the Capitol for passage of a law to end all solitary confinement for mentally ill inmates.

"We're moving full-speed ahead," said Harvey Rosenthal, an organizer of the event and head of the New York Association for Psychiatric Rehabilitation Services.

Paul Grondahl can be reached at 454-5623 or by e-mail at pgrondahl@timesunion.com.

By themselves
In 2002, the Times Union published "The New Asylums," a special report by Paul Grondahl that looked at New York state's use of 23-hour solitary confinement as a disciplinary measure for inmates. Read the archived series at timesunion.com/specialreports/newasylums

US prisons rife with mental health problems

2007-04-19T05:21:00.000-07:00

Source: www.InsightJournal.com

By Jase Donaldson
Mar 20, 2007 - 8:26:03 AM

A new report states that over half the nation’s jail and prison inmates suffer from mental health disorders.

The study, released by the US Department of Justice’s research arm, confirms what wardens, inmates and corrections officers already know – that large numbers of convicts routinely exhibit symptoms of mania, anxiety, depression or psychotic disorders.

The report’s findings are based on a representative survey of more than 25,000 prisoners nationwide. The study showed that mental health problems were associated with an inmate’s violence and prior convictions. Those state prisoners with mental disorders were more likely to have at least three prior incarcerations and to have broken prison rules.

Mentally ill inmates were also twice as likely to have been injured in a prison fight, and substantially more likely to have been abused as a child and homeless in the year before their arrest. Three out of four were dependent on drugs and alcohol, with 37% saying they used drugs at the time of their crime.

Experts called the study disturbing. They said it illustrates a direct relationship between community health care gaps and the large numbers of mentally ill people who wind up in the criminal justice system.

Bill Emmet, of the Campaign for Mental Health Reform, said, "If one out of three people incarcerated in this country are receiving mental health treatment, it shows that there is something very wrong with the way services are delivered in the community. People need services before they do something that might result in their incarceration."

Furthermore, the study found that:
Female inmates had higher rates of mental illness than men – with 73% of females in state prisons reporting symptoms, compared to 55% of all males.

The prevalence of mental illness in prisons varied by race, with 62% of white inmates suffering from problems, compared to 55% of blacks and 46% of Hispanics.

Over half of mentally ill inmates had a family member who was incarcerated, and about 19% lived in foster care at some point while growing up; twice the percentage of inmates without mental health problems.

Article: US prisons rife with mental health problems
Date: Mar 20, 2007
Author: Jase Donaldson

It's Not About The Firearms

2007-04-18T17:55:00.000-07:00

By Bob Cesca

A firearm in the hands of the wrong person can be deadly. The presidency in the hands of the wrong person can also be deadly. Air travel safety regulations have convinced some of us that a finger-nail clipper in the hands of the wrong person can precipitate a terrorist attack. From these examples, it doesn't make sense to ban either the presidency or manicure devices.

What makes much more sense is to focus on the issues that prompt a maniac to use a firearm to kill innocent people; a president to kill innocent people; or a terrorist to kill people. When it comes to the latter, those of us on the progressive side of the nation haven't spent much time blaming the explosive devices or the box cutters, but rather the policies which have fostered so much resentment against the United States. We all know the list and it has nothing to do with hating us for our freedom.

So what causes a maniac to murder 30 people in cold blood? It can't possibly be about the 9mm handguns, in the same way terrorism isn't about access to beverage containers.

Yeah, I'm one of those progressives who has long since conceded the gun debate. It's not because of the gun lobby's simplistic talking points, it's not because of the hunters who think it's most excellent to kill innocent animals, and it's definitely not due to a lack of thought about the issue.

It's primarily about focus. Who or what is really to blame for the shameful level of gun violence in America?

The focus has to be aimed point-blank at the cold, brutal reality that there exists a serious inability to cope with American pop, economic and social pressures; a criminal lack of understanding of mental and physical health issues; and the problem solving examples instilled upon us by our elected leaders in a time when visual and printed access to information is at an all time high. These are just some of the elements at play, and they each carry a significant amount of blame. Not the guns.

President Bush himself has told us that shooting without negotiation is the only answer. The generation of kids in my daughter's demographic has to struggle in order to recall a time without this preemptive war. The only evidence they possess that indicates reasoning and negotiating with an enemy actually works is what they read about in history books. Their president and vice president have told them that the Speaker of the House shouldn't talk to our enemies because open dialogue is somehow a reward, rather than a rational responsibility.

And irresponsible behavior doesn't end at the front gate of the White House or at the steps of Capitol Hill.

Every day we're bombarded from all sides by marketing that tells us that our bodies aren't ripped enough. Our credit score is too low, but a Visa card is priceless. We need a bigger car. We need more chemically polluted foods, then the diet pills to interdict with the chemicals, then more medications to interdict with the diet pills, then additional meds to give us boners and free-flowing piss when our organs stop functioning from all of the above. We need plastic surgery to feel accepted. We need acceptance in order to be popular on MySpace. We have to redecorate our homes, buy a souped up chopper, eat brick oven pizza with five varieties of cheese and we need to display bumper magnets that prove to the dickhead behind us in traffic that we unequivocally support the troops.

Meanwhile, the divide between the people who can easily purchase all of these items and the people who can barely afford to keep their city water turned on is growing larger and larger, while the middle class is disappearing. It used to be that a guy could work 40 hours a week in a blue collar job and still be able to own a home, send his children to college and take his family on vacation every summer, with a pension waiting for him on the other side.

In every city, as well as a staggering number of suburbs, crime is becoming the only way to keep up with the 21st Century version of the American Dream (now with easier pissing power!).

Besides, aren't our kids supposed to shoot before they talk?

Who should we really be afraid of, anyway? The black kid with the oversized NFL parka or the white man in the suit rationalizing that it's okay if he pollutes the air or pumps our kids with mercury-contaminated vaccinations and high fructose corn syrup until they're fat, diabetic, cancerous globules lumbering diligently from the drive-thru to the waiting list for gastric bypass surgery? Obviously the black kid in the NFL parka is the one to fear because, let's face it, even though it's going to be a painful torturous death, the white man will kill you with snack foods that come in "fun" shapes -- AND he offers a fully stocked biggie-sized menu. (The non-snark answer is that the white man in the suit selling high fructose corn syrup is the one to fear, given the choice.)

Despite all of it -- coupled with gun ownership -- most of us don't run around killing people. The answer, they say, is to ignore these societal factors if you choose to. Be your own person! An individual! You know, like they teach in schools where everyone is forced to dress the same and where the creative arts are being downsized.

Yet in an era when we're being marketed to and categorized without even knowing it, how can we possibly avoid the perils of the modern American Dream (now featuring Crazy Bread!)? Combine this with record foreclosures, record bankruptcies and a health care system that, if you can afford it in the first place, will provide you with something for your Restless Leg Syndrome while refusing to cover your psyche meds and therapy sessions.

Millions of American citizens with an array of mental illnesses are walking around without the means to be diagnosed in the first place, much less to be treated properly -- and a growing number of those Americans are Iraq veterans. Health insurance carriers won't insure you if you have a prior history of anything from basic depression to full blown schizophrenia (2 million diagnosed Americans with schizophrenic disorders and counting), even though many mental illnesses erase the ability to discern between a first-person-shooter video game and a group of students on a college campus. Mental illness is the difference between keeping a handgun for self defense and using it to liberate human beings from their oppressive world.

Give a person with an untreated and severe mental illness a handgun and a target, and another Virginia Tech massacre waits in the wings. Take away the handgun, and it'd be homemade explosives. Take those away and it'd be poison in the cafeteria food (beyond the legal poisons already mixed in). What else can be taken away? Basic freedoms and liberties, maybe? Video games?

The key, as best I see it, is to leave most of the guns alone (and the video games, Senator Clinton) and provide real health insurance for everyone, then to begin the slow process of rebuilding a viable middle class in America.

If the NRA, among others, truly wants to win this debate, it should dedicate a large percentage of its lobbying resources to promoting guaranteed affordable (free is better), comprehensive health care coverage for every American. Additionally, if you want to keep your firearm, tell your elected representatives that tax breaks for the wealthiest Americans should be rolled back in favor of serious tax breaks for the middle class. This will begin to close the divide between crime and earning an honest living. Proper health care will begin to tackle the rate of untreated mental illnesses which, at the very least, will reduce the numbers of gun crimes by those of us who aren't able to handle or fully process the torque of modern American reality.

UPDATE: Wednesday, 4/18/07. Just wanted to add something here. I am most definitely not blaming the VT massacre on the president. You're welcome to believe that, but you'd be terribly wrong. All I have suggested is that the president's shoot-first preemptive approach isn't setting the proper example for an entire generation of Americans.

FROM THE COMMENTS: Virigina Tech student "Tim" has made some outstanding points:
It is not about guns. The deaths of over 30 students and faculty of Virginia Tech should not be blamed on two guns. Guns do not kill people, people kill. We choose the debate of gun control at this time, because there are no other times in which it is as appropriate. I question the thought process of those who state that this would have been less of a problem if more people carried guns - if only one of the students sitting in one of those classrooms could have reached into his or her bag to pull out a handgun to end the situation sooner.

We give names to people like the shooter at Virginia Tech - Monsters, Maniacs, Evil-doers. Before they were given those names, we gave them the names of son, neighbor, friend, and fellow student. In order to explain why one of us would do something like this, we must first expel the person from the village and label him an outsider.

When people talk of the need to bear arms in order for protection, they speak of incidents of unknown assailants in the home or down a dark alley. They speak of the hidden maniacs and monsters amongst us. They never speak of the person sitting next to them at work, at home, or in the classroom that has been emotionally been pushed beyond reason, because then it becomes a son, neighbor, friend, fellow student, or yourself.

In a society of concealed handguns, the dark alleys do not concern me as much as the emotions of myself and my fellow man who in the moments of irrationality can cause unknown horror.
TimVirginia Tech Student

cross-posted from Huffingtonpost.com
Authors Website: http://www.campchaos.comAuthors Bio: Bob Cesca is a writer, director, and producer as well as the founder of Camp Chaos Entertainment, an animation studio based near Philadelphia. He's written and produced literally hundreds of animated shorts as well as music videos for Iron Maiden, Meat Loaf, Everclear, Yes and Motley Crue. Just after 9/11, Bob produced and directed an independent feature film titled The War Effort: a mockumentary satirizing the nation's knee-jerk patriotism which arose following 9/11. He's also the creator of the animated sketch show "ILL-ustrated" which aired for two seasons on VH1and MTV2. Bob grew up in Northern Virginia and graduated from Kutztown University with a degree in Political Science. He's the editor of the RealityBasedNation.com blog.

"Mary Winkler May Testify Wednesday"

2007-04-18T17:53:00.000-07:00

Mary Winkler may or may not take the stand Wednesday morning.

Mary Winkler’s psychologist took the stand Tuesday, making disturbing testimony.

The psychologist testified that Mathew Winkler would force Mary to perform explicit sexual acts against her will.

Dr. Lynn Zager said, "She said he did not stop and that raised concerns that perhaps it would hurt her, hurt her body. He made some comment that she could have surgery to fix it."

Dr. Zager also testified that Mathew tried to stop the couple’s then one-year-old daughter from crying by covering her face. D

r. Zager said, "Putting his hands over her nose and the baby’s mouth to keep her from crying and she described how Mathew had done that their other children when they were babies."

Mary's adopted sister Tabitha Freeman said the couple would often plan trips to see them, but cancel at the last minute.

She said, "We were upset that we had not been seeing her, and we told Matt about it, and he called the children together and told us that Mary wasn't our sister anymore and that we should never expect her to be there for us ever again."

The psychologist also testified that Mary Winkler suffered from mild depression and post-traumatic stress disorder from her childhood.

She said Mary's mental illness got worse with the abuse.

The psychologist said Mary could not have planned or intended to commit a crime because of the mental illness.

Va. Tech Gunman — Warning Signs?

2007-04-18T17:39:00.000-07:00

Apr 18, 2007

(WebMD)

Virginia Tech gunman Cho Seung-hui was a moody loner who took antidepressants and wrote gory fiction, news reports say. But nobody could have predicted from this that he would commit violent acts, experts tell WebMD.

Officials have identified Cho, 23, as the gunman who Monday shot and killed 32 people on the Virginia Tech campus.

"When a tragedy like this happens, we want to know how to defend ourselves and our families. We are very eager to see this as a gross aberration that might have identifiable warning signs," Jeff Victoroff, M.D., tells WebMD.

But that simply isn't the case, says Victoroff, an associate professor at the University of Southern California and an expert on human aggression and the neurobiology of violence. People like Cho have, throughout history, appeared without warning in every human culture.

"It is true that people like Mr. Cho and the Columbine shooters exhibited some aberrant behaviors that, with 20-20 hindsight, might have tipped off sensitive observers," Victoroff says. "But we don't usually attend to those warning signs because they are so common among adolescents. ... We will never be altogether safe from such people."

Unless they have previously acted violently or threatened violence, there's simply no way to predict whether a person will commit a violent act, says Robert Irvin, M.D., medical director of a long-term residential treatment program that is part of the Bipolar and Psychotic Disorders Program at Harvard's McLean Hospital in Belmont, Mass.

"The greatest predictor of acts of violence is prior acts of violence. Lacking that, we cannot say who will be violent and who will not," Irvin tells WebMD.

"There is no reliable predictor of who or who not to avoid. Because that quiet, lonely person who is not so verbal may be very fearful himself and the least harmful person in the world."

Mental Illness, Antidepressants, and Violence

Could the antidepressants that Cho was said to have been taking made him violent? No, Irvin says.

It's not known whether Cho was taking antidepressants under a doctor's supervision, whether he was taking the medications properly, and whether he was taking some drug other than antidepressants.

"Certainly just being on an antidepressant does not increase your risk of engaging in violence," Irvin says. "Antidepressants causing increased risk of self-harm have been talked about, but there is much more evidence to support that they are effective in treating depression. The risk of self-harm is much greater when patients are left untreated."

Might underlying depression be to blame? Probably not, Irvin says.

"People who are hopeless, who don't experience any joy or happiness, their thoughts are far more likely to tend toward self-harm than harm to anyone else," Irvin says. "If they are moved to violence, they are far and away more frequently the victims."

There is a form of depression — some think it a form of psychosis — which doctors call "major depression with psychotic features."

People with this kind of depression have delusional thinking — such as believing everybody at their workplace is very clearly out to get them, perhaps by putting bugs in their offices in order to control them.

"If you are paranoid, perceiving you are threatened when you are not, you might be prone to violence," Irvin says. "But these are people who, if given a choice, would hurt themselves or flee before acting in an aggressive way toward others."

Victoroff agrees that paranoid individuals are more prone than others to commit violence.

"Someone who has a grossly distorted threat-perception system is more likely to commit violent acts," he says. "Humans respond to threat by flight or by fight. Those predisposed to respond with fight who regard innocent people all around them as terribly threatening to them, will be prone to harm those innocent people."

Even so, Victoroff says, the majority of people suffering paranoia do not commit violent acts, so it's impossible to say whether a particular paranoid man or woman will become violent.

We tend to think that only mentally ill people would commit horrific crimes. But this may be false reassurance, Irvin says.

"One of the reasons we try to understand this aberrant behavior in terms of an illness is that it gives us a sense we can identify these people ahead of time. But just because the act is crazy does not mean the person suffered from a defined psychiatric illness," he says.

"It is an ongoing debate whether these people need to be dealt with in the criminal justice system or the mental health system."That's because there are two basic forms of violence: sudden, impulsive acts of aggression and premeditated violent acts."

Premeditated aggression enters the realm of pathologic sociopathy — and there is no good known treatment for sociopaths," Irvin says.

Cho's Violent Fiction

But shouldn't Cho's violent fiction have sounded an alarm? The Chicago Tribune reports that a creative writing teacher was so disturbed by Cho's writing assignments that she referred him to a counseling center.

The Tribune quotes a fellow student as saying that Cho wrote a play in which a boy violently suffocates his stepfather with a Rice Krispies treat.

Writing students do often write frightening things, says Carol Lee Lorenzo, an author and fiction teacher at Atlanta's Callanwolde Fine Arts Center. Where students cross the line, she says, is when they write about actual experiences. In such cases, she says, she returns the assignment and asks the student to justify the violence in terms of the story they are telling.

In her 20 years of teaching fiction writing, Lorenzo says she's never referred a student for counseling.

"Writers reveal things in fiction that are not autobiographical, but are part of our own deep mysteries we are trying to explore," she says. "This does not mean we take these impulses all the way as our characters do. But we have to explore that, or why would anybody read anything we write?"

Perhaps Lorenzo comes close to the terrible truths behind Cho's crime when she talks about why writers describe violent acts.

"Writers are often scared of what is not spoken. So sometimes writers will work with violent things that are expressive of the deep, dark, unfulfilled emotional experience of their lives," she says. "What scares us is this: What if it does become fulfilled in real life by not being expressed in fiction?"

Perhaps this is what happened to Cho.

"We should be more scared of the potential of the human personality than of meeting a grizzly bear in the woods," Lorenzo says. "We are so capable of violence, and yet we have these wonderful controls. If you don't look down at the deep, rich, dark mysteries inside you, you are an even scarier person because it can jump up on you without warning."

By Daniel DeNoon

Reviewed by Louise Chang©2005-2006 WebMD, Inc.