Mad pride group advocates for the right to say "no" to forced medciations for peope with mental illness. Click the link above and then log your comments here. I'd like to know what you think about forced medications.
http://www.newser.com/article/d983gkr01/mad-pride-movement-champions-minnesota-man-who-wants-right-to-refuse-electroshock-treatments.html
Monday, May 11, 2009
Sunday, May 10, 2009
A Guy, a Car: Beyond Schizophrenia
RONALD PIES, M.D. NEW YORK TIMES
Harry was one of the lucky ones. After a lifetime of schizophrenia — hallucinations, hospitalizations and all the attendant miseries — he was a genuinely new man.
This was about 20 years ago, and clozapine — then viewed as a miracle antipsychotic drug — seemed to have wrought some deep, transforming magic. True, he had put on 20 pounds and complained of mild drowsiness. But the crippling fears and fearsome voices had been quieted. We were able to discharge him from the hospital and arrange for placement in a neighborhood residence.
At his first outpatient appointment, Harry looked cheerful. He seemed to be adjusting to a life of relative normalcy. This was more than I had hoped for, given his disease and its devastation.
When the German psychiatrist Emil Kraepelin described what we now recognize as schizophrenia, he called it “dementia praecox” — premature dementia. For decades, the condition was thought to have an inevitable downhill course, much as we still see with Alzheimer’s disease. Even during my residency in the early 1980s, most of us were gloomy about schizophrenia.
We now believe that schizophrenia comprises several different disease processes and often has a more benign course. We have begun to speak not only of remission, but even of recovery — and hope.
Hope is what Harry presented to me at his most recent appointment — along with a request that raised the hairs on the back of my neck. He wanted me to sign off on his application for a driver’s license.
Suddenly, I was caught between two conflicting visions: one of my patient obeying some malign voice behind the wheel, with who knows what consequences; and another of a young man yearning to get his life back.
Driving is what guys do, Harry reminded me — guys with a real life! And a guy who drives has a fighting chance — he put this in cruder terms — to make a good impression on the ladies.
I understood completely. Long before I was of age to drive, I had experienced the exhilaration, the sense of unbridled possibility, when I sat in my father’s lap and steered our 1962 Bonneville while he worked the gas and brake. And I remembered what my widowed mother had told me, while in her late 80s, living alone in Florida: “The first thing the women ask about a man down here is, does he drive?”
A patchwork of state regulations governs the driving privileges of patients who may have neurological or behavioral problems. Some states, like California and Utah, require physicians to report a patient’s “cognitive impairment” for driving purposes.
While schizophrenia may increase the likelihood of an accident, research in the 1980s by Dr. Russell Noyes suggested that, among patients with psychiatric disorders, those with alcoholism and antisocial personality traits accounted for most of the risk. The Utah Department of Public Safety asserts that most people under active treatment for schizophrenia are “relatively safe” drivers, and clearly says that one’s accident and violation record is a better predictor of driving risk than is a psychiatric diagnosis.
Still, drugs like clozapine can impair driving skills. And the doctor’s-office-based assessment of a patient’s driving skills is only moderately correlated with scores on standardized road tests.
The part of me steeped in Kraepelin’s pessimistic paradigm did not want to sign off on Harry’s certification. The part of me that had sat in my father’s lap, feeling the first flush of manhood as we drove together, wanted to help my patient move forward with his life.
I asked Harry how he would respond if one of his “voices” commanded him to do something dangerous while driving. “I wouldn’t listen, Doc,” he replied, looking me straight in the eye.
We decided on a plan: if Harry could pass a certified driver education course, I would sign off on his license application. “Deal!” Harry exclaimed, pumping my hand.
As he walked away, I mumbled a prayer, hoping that I had made the right call. Roughly a month later, Harry strode into my office looking about four inches taller and handed me an embossed certificate from a driving school. He had passed the course “with distinction,” and I had my part of our bargain to keep.
After all, driving is what guys do — guys with a real life.
Ronald Pies, a psychiatrist, is the author of “Everything Has Two Handles: The Stoic’s Guide to the Art of Living.”
Harry was one of the lucky ones. After a lifetime of schizophrenia — hallucinations, hospitalizations and all the attendant miseries — he was a genuinely new man.
This was about 20 years ago, and clozapine — then viewed as a miracle antipsychotic drug — seemed to have wrought some deep, transforming magic. True, he had put on 20 pounds and complained of mild drowsiness. But the crippling fears and fearsome voices had been quieted. We were able to discharge him from the hospital and arrange for placement in a neighborhood residence.
At his first outpatient appointment, Harry looked cheerful. He seemed to be adjusting to a life of relative normalcy. This was more than I had hoped for, given his disease and its devastation.
When the German psychiatrist Emil Kraepelin described what we now recognize as schizophrenia, he called it “dementia praecox” — premature dementia. For decades, the condition was thought to have an inevitable downhill course, much as we still see with Alzheimer’s disease. Even during my residency in the early 1980s, most of us were gloomy about schizophrenia.
We now believe that schizophrenia comprises several different disease processes and often has a more benign course. We have begun to speak not only of remission, but even of recovery — and hope.
Hope is what Harry presented to me at his most recent appointment — along with a request that raised the hairs on the back of my neck. He wanted me to sign off on his application for a driver’s license.
Suddenly, I was caught between two conflicting visions: one of my patient obeying some malign voice behind the wheel, with who knows what consequences; and another of a young man yearning to get his life back.
Driving is what guys do, Harry reminded me — guys with a real life! And a guy who drives has a fighting chance — he put this in cruder terms — to make a good impression on the ladies.
I understood completely. Long before I was of age to drive, I had experienced the exhilaration, the sense of unbridled possibility, when I sat in my father’s lap and steered our 1962 Bonneville while he worked the gas and brake. And I remembered what my widowed mother had told me, while in her late 80s, living alone in Florida: “The first thing the women ask about a man down here is, does he drive?”
A patchwork of state regulations governs the driving privileges of patients who may have neurological or behavioral problems. Some states, like California and Utah, require physicians to report a patient’s “cognitive impairment” for driving purposes.
While schizophrenia may increase the likelihood of an accident, research in the 1980s by Dr. Russell Noyes suggested that, among patients with psychiatric disorders, those with alcoholism and antisocial personality traits accounted for most of the risk. The Utah Department of Public Safety asserts that most people under active treatment for schizophrenia are “relatively safe” drivers, and clearly says that one’s accident and violation record is a better predictor of driving risk than is a psychiatric diagnosis.
Still, drugs like clozapine can impair driving skills. And the doctor’s-office-based assessment of a patient’s driving skills is only moderately correlated with scores on standardized road tests.
The part of me steeped in Kraepelin’s pessimistic paradigm did not want to sign off on Harry’s certification. The part of me that had sat in my father’s lap, feeling the first flush of manhood as we drove together, wanted to help my patient move forward with his life.
I asked Harry how he would respond if one of his “voices” commanded him to do something dangerous while driving. “I wouldn’t listen, Doc,” he replied, looking me straight in the eye.
We decided on a plan: if Harry could pass a certified driver education course, I would sign off on his license application. “Deal!” Harry exclaimed, pumping my hand.
As he walked away, I mumbled a prayer, hoping that I had made the right call. Roughly a month later, Harry strode into my office looking about four inches taller and handed me an embossed certificate from a driving school. He had passed the course “with distinction,” and I had my part of our bargain to keep.
After all, driving is what guys do — guys with a real life.
Ronald Pies, a psychiatrist, is the author of “Everything Has Two Handles: The Stoic’s Guide to the Art of Living.”
They Don't Want to Be Normal - Newsweek
A very interesting article about a group of people with mental illness that don't feel they are cursed and talk about the OPTION of not being medicated.
Ifind this to be a very intriguing conversation and hope to see some posts here, once you've read the article.
I am PRO choice on meds. However, I also am the first to say EVERYONE must be responsible for their actions and consequently, willing to accept the consequences.
In the Dallas paper today, a man named Pete, who does not have a house, says he is houseless, not homeless. He has an area he lives in, a neighborhod he likes and supports and they seem to support him.
Thinking and living inside the box just isn't for everyone. So why does this make most people so uncomfortable?
I really want to know what you think.
Ifind this to be a very intriguing conversation and hope to see some posts here, once you've read the article.
I am PRO choice on meds. However, I also am the first to say EVERYONE must be responsible for their actions and consequently, willing to accept the consequences.
In the Dallas paper today, a man named Pete, who does not have a house, says he is houseless, not homeless. He has an area he lives in, a neighborhod he likes and supports and they seem to support him.
Thinking and living inside the box just isn't for everyone. So why does this make most people so uncomfortable?
I really want to know what you think.
Tuesday, May 5, 2009
Due Diligence
Something you are going to hear a lot in the future, is the term, Due Diligence. Some of you may know what this is. Some of you THINK you know what this is. My goal is expand your idea of what Due Diligence is and what it can do for you in a very short period of time. I also want you to get an understanding of how Due Diligence is an important part of any business decision.
The Miriam Webster dictionary defines Due Diligence:
Main Entry: due diligence
Function: noun
: the care that a reasonable person exercises under the circumstances to avoid harm to other persons or their property
While due diligence is a fairly new term for business, meaning it is not a common term in every day lingo, much less something that people always practice, I became curious as to when due diligence actually began .
The first practical example of Due Diligence that I could find comes in a form you don't quite expect. It also is a dramatic exhibit of how our societal mores and needs have changed so this is why I bring this up. But I wanted to show you something a bit extreme to get you out of the box, thinking Due Diligence is all about crunching the numbers and looking at the finances of a business arrangement. It is not. In the 15th Century the first written evidence of a Due Diligences effort was recorded by Keyser von Eichstad, a retired solider who compiled a manuscript in 1405 about the art of war and military equipment, in his book "Bellifortis". IN this book he included a drawing , and on this drawing was the inscription "Est florentinarum hoc bracile dominarum ferreum et durum ab antea sit reseratum" ("breeches of hard Florentine iron that are closed at the front"). If you havent' guessed what I am talking about, who would like to hazard a guess.
What I have just described for you the first record of the chastity belt.
During this time, it was assumed that your property was under attack and all property was the spoils of the winner. The average mentality was "What is not protected will be lost." What was being protected was not just the physical well being of the women of the kingdom, but the actual heritage of the gene pool. So along with the efforts of protect and avoid harm, we see the intent was to also perpetuate the heritage and the legacy.
Now, if we jump forward to today, at this moment, our standards have changed quite a bit. Or have they? We have investment programs, 401k's, financial plans. Most of you have visions that you want to become reality. And usually these realities entail something that can be bought or sold or even an enduring endeavor to be passed along to your children. So isn't this again, perpetuating the heritage and the legacy?
However, what has changed is our demeanor and attitudes that are engaged in this effort we call Due Diligence. Now remember, Due Diligence is nothing more than the care that a reasonable person exercises under the circumstances to avoid harm to other persons or their property.
So when building your vision, which in turn is just the practical matter of building a business plan, what efforts have you taken to avoid harm to other persons and their property.
Now while you are answering this, you will be including yourself in the definitions of persons. And you will also be including your property in this definition as well.
In our more developed society, our attitudes have grown from the "rape and pillage" business example to that of one "we can cooperate and prosper". Cooperation does NOT mean however, that you loose your ability to think and ask questions before making a decision. Cooperation is also not a substitute for the word trust. You can trust someone but choose not to cooperate with them or you can choose to cooperate with someone while not having a complete trust in them and/or their abilities.
Sharing a cooperative spirit also does not mean that everyone who is like minded in their business strategies and outlook is a good match for your business or that you are a good match for theirs. There is more to a good match than someone who thinks like you do or has a clear background, free of negative records. And there are times when someone may have a very smudged background and still be the right person for the position you are looking to fill.
So in our kinder, more highly developed, sophisticated business models, we actually have created a new set of obstacles. How do I get the information I need to make a sound business decision? Now this is really an issue for some of you because of a possible lack of experience. You may not know what information you need or why you need it.
Peter F. Drucker
A Meeting of the Minds
CIO Magazine, Sept. 15, 1997
"I [never met] the senior manager who knew what information was available for decisions. Very few senior executives have asked the question, "What information do I need to do my job?" In part because they've all been brought up with the accounting information that they understand. But the other type of information system, they don't understand."
So many times, people know what they need in a specific area because that is where their training or experience is. But how many of us really know every detail needed for every job that makes up the company we are here to build?
What I have found in my business experience though that is the biggest hindrance, is that people are UNCOMFORTABLE in asking for information from others, for fear of OFFENDING THEM! And the reverse of that problem is that sometimes people give away TOO much information in an effort to appear a team player or to show they are cooperating.
Now I am going to give you some examples of question that you want answered when you are doing business and I just want you to make a note if asking that questions would make you comfortable or uncomfortable.
1. Are you financially sound?
2. Now ask it the question this way – have you filed bankruptcy in the past ten years and do you have enough money in the bank to pay your bills for the next 6 months?
3. Have you ever been arrested?
4. Why?
5. What type of business are your close relatives involved in?
6. What type of neighborhood do you live in? What is the estimated worth of your home?
7. How many vehicles do you own?
8. Are they paid for?
9. Have you been sued or sued anyone? What was the suit about?
10. What kind of records does your local police dept have about you? (This involves non criminal charges that were not filed.)
11. What do your neighbors think about you?
12. What kind of person do you think you are – what are your strong suits? What are your weaknesses?
13. What kind of driver are you? How many accidents have you been involved in?
14. What are your hobbies and what kind of expense is involved in them?
15. Have you ever had another name or SS#? If yes, then why?
IF you were able to say you were comfortable asking these type of questions, I bet you are doing some form of due diligence in every relationship you have. If you are not comfortable, with these, I think you can see that you might have missed some important details during your decision making process, unless you had hired someone to perform this type of research for you.
What does Due Diligence Involve for most Companies?
Due diligence involves a detailed research into a company and its plans. It involves the advisor checking out:
The business's identity - how it is owned and constituted and what changes will be necessary prior to taking the company to the market, if it is a new start up.
The business's financial health, usually based upon a detailed examination of past financial statements and an analysis of the existing asset base. This includes verification of contracts, custom lists and potential contracts and marketing strategies.
The credibility of the business's owners, directors and senior managers - including validation of the career histories of all the main players in the business is a necessity.
The future potential of the business, reflected in the strengths of its products and the probability of earnings growth over the medium- to long-term.
An assessment of the risk involved in your business, in terms of your markets, your strategy and likely future events.
Your company's business plan, in terms of how realistic it is, how solid are the assumptions used and how well it conveys your business's potential.
Due Diligence of an individual includes much of the same thing:
An Individuals’ Identity - Verifying the person is who they say they are. A background includes confirming basic identifying information such as name and SS#.
An individual’s financial health, can include litigation records, UCC filings, liens and bankruptcies and credit history.
An individual’s credibility – Criminal records, verification of past employment and business relationships, education and activities in the community help establish if this person is the right choice for the position you are considering them for.
An assessment of the risk involved in your business based upon an individual, can be further analyzed by doing just that, assessing the individual with an in depth assessment profile.
>
Reasons for Due Diligence: To prevent any unnecessary surprises while conducting business!
1. Business relationships with new clients or investors. (By both parties)
2. Past land usage of real estate acquisitions – (Pollution tort cases)
3. Public information about your competitors.
4. Use of patented processes/equipment.
5. Trade mark verification or prevention of potential theft
6. Intellectual property theft/usage.
7. Pre-employment background checks
8. Product liability defense.
9. Collection processes
10. Civil/Criminal defense research for the benefit of company or officer
What you want to know is:
Can the person do what is required of them?
What can they add to my organization that I do not have already?
Can they be trusted? Do they have integrity?
Am I proud to be affiliated with them or would it damage my reputation or cause me embarrassment or even shame?
Do I trust this person yet?
Do I respect them at least?
Do I like them or is that even necessary for me to have a business relationship with them?
And finally, before hiring any investigative or consulting business to help you gather this kind of information, make sure you know their history, background and credentials. Sometimes, how and where you got your information is just as important as to what information you gathered.
Feel free to respond or if you have any questions, call me at 972 485 4748.
The Miriam Webster dictionary defines Due Diligence:
Main Entry: due diligence
Function: noun
: the care that a reasonable person exercises under the circumstances to avoid harm to other persons or their property
While due diligence is a fairly new term for business, meaning it is not a common term in every day lingo, much less something that people always practice, I became curious as to when due diligence actually began .
The first practical example of Due Diligence that I could find comes in a form you don't quite expect. It also is a dramatic exhibit of how our societal mores and needs have changed so this is why I bring this up. But I wanted to show you something a bit extreme to get you out of the box, thinking Due Diligence is all about crunching the numbers and looking at the finances of a business arrangement. It is not. In the 15th Century the first written evidence of a Due Diligences effort was recorded by Keyser von Eichstad, a retired solider who compiled a manuscript in 1405 about the art of war and military equipment, in his book "Bellifortis". IN this book he included a drawing , and on this drawing was the inscription "Est florentinarum hoc bracile dominarum ferreum et durum ab antea sit reseratum" ("breeches of hard Florentine iron that are closed at the front"). If you havent' guessed what I am talking about, who would like to hazard a guess.
What I have just described for you the first record of the chastity belt.
During this time, it was assumed that your property was under attack and all property was the spoils of the winner. The average mentality was "What is not protected will be lost." What was being protected was not just the physical well being of the women of the kingdom, but the actual heritage of the gene pool. So along with the efforts of protect and avoid harm, we see the intent was to also perpetuate the heritage and the legacy.
Now, if we jump forward to today, at this moment, our standards have changed quite a bit. Or have they? We have investment programs, 401k's, financial plans. Most of you have visions that you want to become reality. And usually these realities entail something that can be bought or sold or even an enduring endeavor to be passed along to your children. So isn't this again, perpetuating the heritage and the legacy?
However, what has changed is our demeanor and attitudes that are engaged in this effort we call Due Diligence. Now remember, Due Diligence is nothing more than the care that a reasonable person exercises under the circumstances to avoid harm to other persons or their property.
So when building your vision, which in turn is just the practical matter of building a business plan, what efforts have you taken to avoid harm to other persons and their property.
Now while you are answering this, you will be including yourself in the definitions of persons. And you will also be including your property in this definition as well.
In our more developed society, our attitudes have grown from the "rape and pillage" business example to that of one "we can cooperate and prosper". Cooperation does NOT mean however, that you loose your ability to think and ask questions before making a decision. Cooperation is also not a substitute for the word trust. You can trust someone but choose not to cooperate with them or you can choose to cooperate with someone while not having a complete trust in them and/or their abilities.
Sharing a cooperative spirit also does not mean that everyone who is like minded in their business strategies and outlook is a good match for your business or that you are a good match for theirs. There is more to a good match than someone who thinks like you do or has a clear background, free of negative records. And there are times when someone may have a very smudged background and still be the right person for the position you are looking to fill.
So in our kinder, more highly developed, sophisticated business models, we actually have created a new set of obstacles. How do I get the information I need to make a sound business decision? Now this is really an issue for some of you because of a possible lack of experience. You may not know what information you need or why you need it.
Peter F. Drucker
A Meeting of the Minds
CIO Magazine, Sept. 15, 1997
"I [never met] the senior manager who knew what information was available for decisions. Very few senior executives have asked the question, "What information do I need to do my job?" In part because they've all been brought up with the accounting information that they understand. But the other type of information system, they don't understand."
So many times, people know what they need in a specific area because that is where their training or experience is. But how many of us really know every detail needed for every job that makes up the company we are here to build?
What I have found in my business experience though that is the biggest hindrance, is that people are UNCOMFORTABLE in asking for information from others, for fear of OFFENDING THEM! And the reverse of that problem is that sometimes people give away TOO much information in an effort to appear a team player or to show they are cooperating.
Now I am going to give you some examples of question that you want answered when you are doing business and I just want you to make a note if asking that questions would make you comfortable or uncomfortable.
1. Are you financially sound?
2. Now ask it the question this way – have you filed bankruptcy in the past ten years and do you have enough money in the bank to pay your bills for the next 6 months?
3. Have you ever been arrested?
4. Why?
5. What type of business are your close relatives involved in?
6. What type of neighborhood do you live in? What is the estimated worth of your home?
7. How many vehicles do you own?
8. Are they paid for?
9. Have you been sued or sued anyone? What was the suit about?
10. What kind of records does your local police dept have about you? (This involves non criminal charges that were not filed.)
11. What do your neighbors think about you?
12. What kind of person do you think you are – what are your strong suits? What are your weaknesses?
13. What kind of driver are you? How many accidents have you been involved in?
14. What are your hobbies and what kind of expense is involved in them?
15. Have you ever had another name or SS#? If yes, then why?
IF you were able to say you were comfortable asking these type of questions, I bet you are doing some form of due diligence in every relationship you have. If you are not comfortable, with these, I think you can see that you might have missed some important details during your decision making process, unless you had hired someone to perform this type of research for you.
What does Due Diligence Involve for most Companies?
Due diligence involves a detailed research into a company and its plans. It involves the advisor checking out:
The business's identity - how it is owned and constituted and what changes will be necessary prior to taking the company to the market, if it is a new start up.
The business's financial health, usually based upon a detailed examination of past financial statements and an analysis of the existing asset base. This includes verification of contracts, custom lists and potential contracts and marketing strategies.
The credibility of the business's owners, directors and senior managers - including validation of the career histories of all the main players in the business is a necessity.
The future potential of the business, reflected in the strengths of its products and the probability of earnings growth over the medium- to long-term.
An assessment of the risk involved in your business, in terms of your markets, your strategy and likely future events.
Your company's business plan, in terms of how realistic it is, how solid are the assumptions used and how well it conveys your business's potential.
Due Diligence of an individual includes much of the same thing:
An Individuals’ Identity - Verifying the person is who they say they are. A background includes confirming basic identifying information such as name and SS#.
An individual’s financial health, can include litigation records, UCC filings, liens and bankruptcies and credit history.
An individual’s credibility – Criminal records, verification of past employment and business relationships, education and activities in the community help establish if this person is the right choice for the position you are considering them for.
An assessment of the risk involved in your business based upon an individual, can be further analyzed by doing just that, assessing the individual with an in depth assessment profile.
>
Reasons for Due Diligence: To prevent any unnecessary surprises while conducting business!
1. Business relationships with new clients or investors. (By both parties)
2. Past land usage of real estate acquisitions – (Pollution tort cases)
3. Public information about your competitors.
4. Use of patented processes/equipment.
5. Trade mark verification or prevention of potential theft
6. Intellectual property theft/usage.
7. Pre-employment background checks
8. Product liability defense.
9. Collection processes
10. Civil/Criminal defense research for the benefit of company or officer
What you want to know is:
Can the person do what is required of them?
What can they add to my organization that I do not have already?
Can they be trusted? Do they have integrity?
Am I proud to be affiliated with them or would it damage my reputation or cause me embarrassment or even shame?
Do I trust this person yet?
Do I respect them at least?
Do I like them or is that even necessary for me to have a business relationship with them?
And finally, before hiring any investigative or consulting business to help you gather this kind of information, make sure you know their history, background and credentials. Sometimes, how and where you got your information is just as important as to what information you gathered.
Feel free to respond or if you have any questions, call me at 972 485 4748.
Monday, May 4, 2009
Internet Social Dialogue Experiment - Wil you help?
I am doing an experiment on social dialogue which is why I created this page. it is kind of like that old shampoo commercial.. and they tell two people, and then two more, etc. Would you ask you friends to become a fan of this page and then ask them to ask their friends. I would like to see how many fans we can develop in the next 30 days. Thank you!!!
Mental Health Articles - 5/4/09
As mental health support wanes, many doomed to homelessness
01:25 PM CDT on Sunday, May 3, 2009
By KIM HORNER / The Dallas Morning Newskhorner@dallasnews.com
Richard Antwine's last home was the county jail.
The 47-year-old ended up there, again, after another round of homeless shelters, boarding homes and psychiatric hospitals. This time, it was because he failed to report to his parole officer. He said he missed the appointment because he was hospitalized. He has severe depression and was hearing voices telling him to hurt himself. His court-appointed lawyer said he doesn't belong in jail. "Somebody dropped the ball somewhere," she said.
Antwine's situation is all too common among the chronically homeless, those with disabilities such as mental illnesses who have been on the streets long-term. But it's not new.
Also Online
Read more from this series
Chronic homelessness resulted from a shift away from the institutions that once housed more than half a million mentally ill people. Get people out of the state hospitals, experts thought in the 1960s, and they can live on their own, thanks to medications that were new at the time.
But the mental health services that were supposed to help those people adjust came up short. And many of the people, including growing numbers of Vietnam veterans, were left homeless. In the 1980s, cities looking to revitalize their downtowns tore down the cheap rooming houses where the very poor lived. Finally, in the 1990s, the political climate made it difficult to get more government money for housing and mental health treatment.
The result is today's disjointed system of psychiatric hospitals, substance-abuse treatment centers and homeless shelters. It's a system that comes at a huge expense to taxpayers and doesn't come close to solving the problem.
"We've just come to accept the fact we have homeless people roaming the streets like we have rats roaming the alleyways," said Michael Stoops, executive director of the National Coalition for the Homeless. "We have grown accustomed to having human beings living on the streets. It's kind of a sad commentary."
Shortage of services
On any given night, there are at least 1,000 chronically homeless people in Dallas and more than 124,000 nationwide. At the heart of the problem is a lack of mental health services, a deficiency that's especially acute in Texas.
The state ranks 48th nationwide in spending on mental health care for its poorest residents. And this lack of commitment goes back more than a century, if you believe Dr. J.A. Corley, the superintendent of Texas' first state hospital, the State Lunatic Asylum. He complained that the 9-year-old facility was overcrowded and underfunded after it had filled to capacity with 352 patients.
"Our sister state of California, though younger than Texas, has provided accommodations for over one thousand of her insane," Corley wrote to try to shame the Legislature. That was in 1870.
Such institutions were being de-emphasized by the 1960s, the first of a series of factors that have conspired against the chronically homeless. Among them:
•A shortage of affordable housing. Revitalization efforts in the 1980s led to the tearing down of cheap housing even as federal housing assistance programs were being cut. About 18,000 people are on a waiting list for housing assistance from the Dallas Housing Authority, and the wait is three to five years long.
"The bottom line is we have a housing affordability crisis, and it most negatively affects people on very low incomes," said Dennis Culhane, a University of Pennsylvania professor who has done extensive research on homelessness.
•Low disability benefits. Many of the chronically homeless receive disability checks of about $675 a month, hardly enough to rent an apartment and pay other living expenses.
•Disenfranchisement. People on the streets with mental illness have had little voice among lawmakers. This year, the mayors of Texas' largest cities asked for $50 million over two years to help the homeless. The measure is pending.
•Fiscal conservatism. Advocates for more housing and mental health treatment face a tough political climate.
"Over the last six years, there's no doubt that there has been a tone of fiscal conservatism that has perpetuated the reputation of Texas being stingy with mental health dollars," said state Rep. David Farabee, D-Wichita Falls, a longtime mental health advocate. Farabee said he's hopeful that federal stimulus money also will allow the Legislature to provide more mental health dollars.
•A fragmented system. Many homeless people fall through cracks because of a lack of coordination among social service agencies. A person leaving one psychiatric hospital, for example, may be told to follow up at an outpatient clinic. But if the person doesn't show up, the clinic is not likely to track him or her down because it has no funding to do so.
•Stigma. There's a lack of understanding that the chronically homeless are extremely vulnerable and need significant help putting their lives back together. Instead, they are blamed for their situation.
"Generally, mental illness is something you can't cure by yourself," said John Castañeda, executive director of Turtle Creek Manor, a Dallas center that serves people with mental illnesses who also face addictions. "To say 'pull yourself up by your own bootstraps' won't work. It's impossible."
Many challenges
Richard Antwine wants to get off the streets. He wants his own apartment. And he wants to work.
Some days, he walks several miles asking business owners if he can sweep their parking lots. He talks about making a little money clipping other homeless guys' hair, saying he once attended a barber college.
But he's up against a lot. His severe depression has left him suicidal at times. He hears those voices. He has abused cocaine and alcohol, a common escape from mental illnesses.
He has a criminal record that includes drug possession, theft and unauthorized use of a motor vehicle. The divorced father of three grown daughters does not have the kind of family support that keeps some others from spiraling into homelessness.
Antwine's sister, JoAnn Williams of Garland, has watched him through psychiatric institutions, shelters and jail for years. She cooks for him and gives him cash here and there, but she has a family to take care of and said her brother needs more help than she can provide.
"I don't know where he is from one day to the next," she said. "If I don't hear from him, I don't have no way of calling him. He don't have a phone, and I don't know if he's dead. I watch the news all the time. Sometimes I am scared to watch the news."
'Good intentions'
Across the nation, thousands of people like Antwine have ricocheted through institutions for years despite the many programs designed to help them.
"We've had a quarter-century of good intentions, well-meaning programs and human gestures, but to be honest, they have not worked," said Philip Mangano, executive director of the United States Interagency Council on Homelessness. "The antidote to homelessness is, shockingly, a place to live."
Many programs to help the homeless traditionally have not placed enough emphasis on housing, Culhane, the professor, said.
"We have a lot of homeless people who get social services, shelters, mental health services, all of which does nothing to solve their housing problem," he said. "It's not a good use of resources to spend all this money and they're still in a cardboard box on Main Street."
Mangano, who will leave his post this month, led efforts to encourage cities including Dallas to adopt 10-year plans to end chronic homelessness. This has led to increased funding for special housing and support for the chronically homeless, and that's gotten a number off the streets.
But there's still not nearly enough housing, leaving many chronically homeless people like Antwine to fend for themselves.
Passed around
Antwine's dizzying ordeal through psychiatric hospitals, emergency rooms, boarding homes and shelters in just the last four months shows how the lack of care can doom someone to the streets.
In January, he spent about two weeks at Terrell State Hospital, a psychiatric hospital with about 300 beds and several aging empty buildings that once housed nearly three times that number of patients. From there, he was taken to a clinic, but he left before seeing the doctor.
Instead of going to a boarding house as planned, he ended up at The Bridge, Dallas' homeless-assistance center. Soon after, he said, he was robbed and stabbed as he searched for an East Dallas rooming house. He recovered at a Pleasant Grove boarding house but soon left over a rent dispute. From there, he went to the Salvation Army's shelter and finally to another boarding home.
In March, Antwine was placed under the care of a special team of caseworkers who stay in close contact with patients to make sure they take medications, show up for appointments and remain stable. It's an intensive service that few receive because of strained budgets. Antwine started feeling better and made plans to move into an apartment on April 1. But even the caseworkers had no control over what happened next.
Police arrested Antwine as he walked downtown on a warrant for not reporting to his parole officer. Instead of moving into a new home, Antwine was in jail, wearing a striped uniform, eating skimpy bologna sandwiches and staring at the wall because he could not afford anything to read.
"I don't know what's going on," Antwine said last month. "I'm just sitting here doing nothing when I shouldn't be here."
'It's a travesty'
At an April 17 parole hearing, Antwine's lawyer, Raquel D. Brown, argued that her client tried to do everything right.
"That's why I think it's a travesty," she said.
On Thursday night, after a month in jail, Antwine was released.
His whereabouts were unknown.
ABOUT THE SERIES: CHRONICALLY HOMELESS
The Dallas Morning News is taking a closer look this year at the struggles of helping the chronically homeless. This article is the second in a series examining the costs of inadequate treatment and exploring possible solutions. The project received support from the Carter Center, which offers fellowships in mental health journalism.
Editorial
Pull the plug on health care holdup in Texas
Editorial board
Thursday, April 23, 2009
In Texas, access to health care is rationed by ZIP code. If you live on the border or in the state's vast rural areas, you'll have trouble getting to a family doctor.
Even if you live in a city, you might have trouble finding a family physician if you live in the wrong ZIP code.
Doctors know that, and legislators know that. There are solutions offered to fix it, but as is often the case, politics and influence can wallop good public policy.
Though Texas legislators can't make doctors, they can make it attractive for young physicians, dentists and other medical professionals to open up practices along the border, in the state's rural communities and in the inner cities where they are needed.
A bill sponsored by state Reps. Warren Chisum, R-Pampa, and Richard Peña Raymond, D-Laredo, would encourage doctors and dentists to locate in the state's underserved areas by offering to help repay their student loans. State Sen. Judith Zaffirini, D-Laredo, is sponsoring another version of the student loan repayment bill aimed solely at doctors and paid for by increasing licensing fees.
The money for the Raymond-Chisum bill would come from closing a tobacco tax loophole. Every pack of cigarettes is taxed. Smokeless tobacco — you know, "chaw," snuff, dip, even rolling tobacco — is taxed on price. That tax advantage can be widened if manufacturers cut the tax in half by offering two for one specials on a product that is a known health hazard.
Business is good enough for the "people's tobacco" — as some refer to it with a straight face — that the industry can afford high-powered lobbyists to maintain the loophole. The lobbyists are earning their money. The House version is bottled up in committee. Zaffirini hasn't rounded up the 21 votes needed to bring her bill to the Senate floor. Time is running out.
Don't expect anyone to jump up and crow about killing those bills. Instead, what opposition that does surface will focus on problems with the bills. The truth is, whatever problems there are could be fixed if the bills get an honest debate. But that cannot happen as long as the bills languish in committee or beg for support.
While the bills languish, the problem grows.
Of the state's 254 counties, 114 do not meet the national standard for one physician for every 3,500 people, according to the Texas Academy of Family Physicians. As the state's population increases, front-line doctors and other medical professionals will be in even shorter supply along the border, in rural areas and in the inner cities.
The average medical school graduate walks off the stage with a diploma and a $130,000 debt. A medical practice in a rural area won't generate enough to repay that debt promptly, so newly minted doctors opt for urban and suburban practices or gravitate toward lucrative specialty practices.
Zaffirini, Chisum and Raymond are offering help, but their bills are dying. Not from neglect, though. Quite the contrary. Somebody is paying close attention to keep them where they are.
I May Be Mentally Ill, But I Still Have Sex
Inadequate sex ed has put people with psychiatric disorders at a needlessly high risk of diseasePublished April 23, 2009 by Josey Vogels in My Messy Bedroom SEE Magazine
Most of us have had the opportunity, at least once in our lives, to tee-hee or snicker as someone demonstrated how to use a condom by deftly rolling it over a banana or some other phallic-shaped fruit or vegetable. But imagine if you saw this and it led you to believe a banana with a condom on it must be present during sex to prevent infection.
It sounds ridiculous, I know, but it’s a conclusion you have to account for when you’re teaching safe sex practices to someone who is delusional, for example. But an even bigger roadblock to providing sex education to the mentally ill is the general assumption that mentally ill people don’t have sex.Which is just simply not the case.
In fact, studies in the U.S. and Canada have shown that patients in long-term psychiatric facilities are as sexually active as outpatients, whether they’re having sex with other patients or with partners who visit them. Yet, in most cases, institutions don’t even bother doing regular Pap smears or STI (sexually transmitted infection) testing on patients — and never mind trying to understand the unique problems that put the mentally ill at greater risk for sexual health problems and HIV infection. As a result, an estimated 19 per cent of people who are mentally ill are HIV-positive.
Someone with schizophrenia may be more at risk because they have a strong “command force”; that is, their brain makes them to do things most of us would think better of. If someone suffers from bipolar disorder, their extreme mood swings can put them at greater risk as well. “The manic are often grandiose, and impervious to potential danger and the results of their actions,” says Jane Reiha, a nurse in London, Ont., who works with the mentally ill. “The depression phase can also put them at risk, she adds, as sex is often the only pleasure left to them. “Often, people with mental illness seek sex with just anyone for a source of warmth, or because sex is cathartic, and a reassurance that you’re still alive — it may be one final attachment to reality.”
Thanks to funding cutbacks, the trend toward de-institutionalization means more mental health patients are being released into the community, increasing their exposure to risk.
“On the ‘outside,’ there may be increased opportunity for sexual encounters,” says Reiha. “And their limited capacity to deal with additional threats to well-being, and their disadvantaged economic and social status — like cohabitating with others in rest homes — can bring them into contact with high-risk groups like drug users.”
Unfortunately, says Reiha, there is a persistent belief that talking to the mentally ill about sexual issues will simply encourage promiscuity. Most health professionals would rather hang on to the belief that this group is asexual. The line they usually get from the staff when they ask to come and speak at their homes is: “Our clients do not have sex.”
But as far as Reiha is concerned, the human need for intimacy, warmth, and sexual expression is universal and people are sexual beings all the time, regardless of health, illness, or disability. The mentally ill have a tremendous need to express their feelings, to have their concerns and needs validated, and to be given the information necessary to manage life, she adds. They also have specific needs and considerations when it comes to sexual health.
According to Reiha, women with schizophrenia often have a history of abuse and usually have chaotic and unsatisfying sex lives as adults. “This is compounded,” she says, “by the fact that they can get pregnant.” In fact, birth control, is another hot topic. “Permanent birth control takes power away from the patient, but we have to think about whether or not the patient is even able to make those decisions.”
Which is why she tends to focus on condom use, especially because condoms also help prevent STI. But this can be tough when you’re dealing with people who may suffer from delusional thinking, have bizarre ways of communicating and a short attention span. (Doesn’t sound all that different from trying to teach teenagers, if you ask me, but I think I see her point.)
To overcome these obstacles, Reiha uses a lot of interactivity, role-playing, and visual aids when teaching the mentally ill about sexuality. “There may be a finger dexterity problem, for example,” Reiha says, “so the key is to practice opening the condom package and rolling it on, repeating often.”And no, they don’t use bananas.
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Clue to lithium benefits in bipolar patients
By Mark Cowen
24 April 2009
Dis Model Mech 2009: Not yet available online
MedWire News: Researchers have identified a possible mechanism for how lithium stabilizes the mood of patients with bipolar disorder, a finding that may lead to the development of more effective drugs to treat the condition.
Lithium has been use to treat bipolar disorder patients for more than 50 years and is one of the most effective treatments for the condition. However, researchers are unsure how lithium works in the human brain.
In laboratory cell tests, Adrian Harwood, from Cardiff University in the UK, and team found that lithium affects the molecule phosphatidyl inositol triphosphate (PIP3), which is important for controlling brain cell signaling.
Specifically, lithium inhibits inositol monophosphatase (IMPase), which is required for making the simple sugar inositol, from which PIP3 is made.
Importantly, this research shows that increasing the amount of IMPase causes higher levels of PIP3, but that PIP3 levels can be reduced with lithium treatment.
The gene IMPA2 – which produces a variant form of IMPase – has previously been linked to bipolar disorder. The current research suggests that lithium could counteract the effects of the altered IMPA2 protein. Harwood commented: "We still cannot say definitively how lithium can help stabilize bipolar disorder. However, our research does suggest a possible pathway for its operation.
“By better understanding lithium, we can learn about the genetics of bipolar disorder and develop more potent and selective drugs.”
He added: "Altered PIP3 signaling is linked to other disorders, including epilepsy and autism, so this well established drug could be used to treat other conditions. Research into lithium could become very important over the next few years."
The research will be published in a forthcoming issue of the journal Disease Models and Mechanisms.
MedWire (www.medwire-news.md) is an independent clinical news service provided by Current Medicine Group, a part of Springer Science+Business Media. © Current Medicine Group Ltd; 2009
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Friday conference aims to help the exonerated cope with life after prison
5:01 PM Mon, Apr 27, 2009 Jennifer Emily/Reporter DALLAS MORNING NEWS
When the wrongly convicted are released from prison, there is little help provided as they try to adjust their new lives
A conference Friday at the Christian Chapel CME Temple of Faith, 14120 Noel in Dallas, is trying to remedy that. It's held from 8 a.m. to 3 p.m.
It's called "A Day for Social Justice: The 2009 Dallas Interfaith Exoneree Conference."
Tickets range from $15 to $25, depending on whether you want lunch. Attendence is free for exonerees and their family members.
The deadline for advance registration is Thursday. Contact jlpage@uta.edu for more information. You can also register from 8 to 8:30 a.m. Friday at the conference.
Dallas County - with 19 DNA exonerations - has cleared more inmates through genetic testing than any county in the nation since 2001 when Texas began allowing post-conviction DNA tests.
According to the press release:
The University of Texas at Arlington School of Social Work is sponsoring the conference with Central Dallas Ministries and the Christian Methodist Episcopal Church. The Hogg Foundation, a UT Austin organization that helps raise awareness of mental health issues, also is supporting the event..
Dallas County District Attorney Craig Watkins is the special guest and a conference speaker. Watkins founded his office's Conviction Integrity Unit in July 2007. It oversees the review of hundreds of DNA cases in conjunction with the Innocence Project of Texas. More than 20 people who were wrongly convicted in Dallas County have been exonerated.
Dr. Jaimie Page, director of the Exoneree Project at the UT Arlington School of Social Work, is organizing the event along with Social Work graduate students Crystal Joshua and Chasity Alexander. They hope to educate the faith-based community about the service gaps that exonerees experience and aim to raise money to close those gaps.
Dr. John Stickels, assistant professor in criminology and criminal justice, started a chapter of The Innocence Project of Texas at UT Arlington in 2003. Some of his students are working to exonerate inmates believed to have been wrongly convicted. Dr. Stickels also serves on the board of the Innocence Project of Texas.Some clients have served almost 27 years behind bars, the professors say.
"Exonerees aren't given a dime when they leave prison. Many don't have a place to lay their heads that night," Dr. Page said. "If they have no family - and many do not - they are essentially homeless."
Exonerees are not eligible for benefits that actual parolees can receive because they are, in fact, innocent, Dr. Page noted. She said the Exoneree Project hopes to fill a six- to eight-month gap in services. Proceeds could be used for medication, identification, toiletries and clothing, but also counseling and immediate housing upon release.
During the conference, several exonerees are scheduled to talk about their experience. Several panel discussions also are planned. The topics are: UT Arlington School of Social Work's Exoneree Project: An Overview of Texas Exonerations and Exoneree Issues; Legal and Legislative Experts: Wrongful Convictions, Dallas County Efforts and Legislative Update; and Faith Leaders: Spirituality, Social Justice and Roles of Interfaith Leaders.
HEALTH & SCIENCE
"Mental health home" proposed to boost care for psychiatric illnesses
The idea builds on the patient-centered medical home concept endorsed by the AMA and other medical societies.
By Victoria Stagg Elliott, AMNews staff. Posted April 27, 2009.
Jim Dearing, DO, a family physician in Phoenix, often refers patients with significant mental health issues to a psychiatrist. But he rarely hears back from the specialist. In addition, his patients sometimes come to him with a prescription in hand, but are unable to name the doctors they saw or articulate the care plan.
"Psychiatrists treat them to the left, I treat them to the right, and patients get lost in the middle," said Dr. Dearing, who is on the American Osteopathic Assn. board of trustees.
To increase the coordination of care between physical and mental health and make this situation less likely, two psychiatrists published a paper in the April Psychiatric Services. They suggest creating a "mental health home" for patients with serious mental ills.
Their goal is to increase the access to behavioral, social and medical services that these patients require and to reduce the risk of repeated hospitalizations, incarcerations and homelessness. Access to primary care, in particular, is important because many of the newer medications used to treat mental illnesses put patients at increased risks for diabetes and other metabolic problems.
"We work primarily with a population of seriously mentally ill people, and they have the most disability and the most difficulty, not only with mental illness, but with all sorts of comorbidities. We're struggling with this population to coordinate services and integrate primary and specialty care," said Thomas E. Smith, MD, lead author and associate professor of clinical psychiatry at Columbia University's College of Physicians & Surgeons in New York. This proposal "is taking the same principles and overall approach of the medical home but tailoring it to individuals with serious mental illness."
Drugs used to treat mental illnesses can increase a patient's risk for diabetes.
The idea of a medical home for those with serious mental illnesses or other health problems is not new, and the details in the Psychiatric Services paper have much in common with community mental health centers, a concept first established in the 1960s. These organizations still exist, although many now operate much differently.
"It's old wine in new bottles, and it's absolutely the exact right thing to do," said Carl Bell, MD, director of the Institute for Juvenile Research in the Dept. of Psychiatry at the University of Illinois in Chicago. He also is chair of the American Psychiatric Assn.'s Council on Social Issues and Public Psychiatry.
The APA is working to understand the implications of the medical home concept on the specialty because the care model has been put forward for a broader base of patients by the AAP and AOA as well as the American College of Physicians and the American Academy of Family Physicians. These organizations issued "Joint Principles of the Patient-Centered Medical Home" in March 2007. Their principles defined the comprehensive primary care approach as one involving an ongoing relationship with a physician who leads a team and coordinates care across all areas of the health care system, all stages of life and all aspects of a person's well-being. It includes patients' active participation in decision-making. It also involves enhanced access through open scheduling or other options.
The American Medical Association signed on to the concept in November 2008, although the organization is continuing to study funding issues for the medical home model. A report on the topic is due from the AMA Council on Medical Service at the Annual Meeting in June.
Generating a buzz
So far, the response to the mental health home proposal has been enthusiastic.
"The article is absolutely right on," said Kim Griswold, MD, MPH, associate professor of family medicine and psychiatry at the University at Buffalo in New York. "If anyone needs a medical home, it's a person with serious mental illness. We have neglected this population." She researches primary care access for this population.
The model has been promoted mostly as a way to improve primary care, and proponents were happy to see specialists express interest.
"There's a longstanding problem integrating mental health and physical health. The fact that the mental health community is interested in the medical home is a very good sign," said Robert Phillips, MD, MSPH, director of the AAFP's Robert Graham Center for Policy Studies in Family Medicine and Primary Care.
But concern stems over the possibility of creating multiple medical homes. In addition, care in the proposed mental health home will tend to be coordinated by a behavioral health clinician who is unlikely to be a physician.
"The family is at the center of the medical home, and they are not well-served by the fragmentation of having two homes. We have got to collaborate in such a way to provide for the needs in one home," said Jane M. Foy, MD, professor of pediatrics at Wake Forest University School of Medicine in North Carolina. She also is chair of the AAP Task Force on Mental Health.
Creating a mental health home faces similar barriers to the medical home, including finding funding streams and educating physicians on how it should work, and reimbursement for mental health services can be more challenging. In addition, mental illness tends to be more stigmatized than physical health issues, and many experts believe this will prove to be a significant stumbling block to improving coordination of care.
This content was published online only.
01:25 PM CDT on Sunday, May 3, 2009
By KIM HORNER / The Dallas Morning Newskhorner@dallasnews.com
Richard Antwine's last home was the county jail.
The 47-year-old ended up there, again, after another round of homeless shelters, boarding homes and psychiatric hospitals. This time, it was because he failed to report to his parole officer. He said he missed the appointment because he was hospitalized. He has severe depression and was hearing voices telling him to hurt himself. His court-appointed lawyer said he doesn't belong in jail. "Somebody dropped the ball somewhere," she said.
Antwine's situation is all too common among the chronically homeless, those with disabilities such as mental illnesses who have been on the streets long-term. But it's not new.
Also Online
Read more from this series
Chronic homelessness resulted from a shift away from the institutions that once housed more than half a million mentally ill people. Get people out of the state hospitals, experts thought in the 1960s, and they can live on their own, thanks to medications that were new at the time.
But the mental health services that were supposed to help those people adjust came up short. And many of the people, including growing numbers of Vietnam veterans, were left homeless. In the 1980s, cities looking to revitalize their downtowns tore down the cheap rooming houses where the very poor lived. Finally, in the 1990s, the political climate made it difficult to get more government money for housing and mental health treatment.
The result is today's disjointed system of psychiatric hospitals, substance-abuse treatment centers and homeless shelters. It's a system that comes at a huge expense to taxpayers and doesn't come close to solving the problem.
"We've just come to accept the fact we have homeless people roaming the streets like we have rats roaming the alleyways," said Michael Stoops, executive director of the National Coalition for the Homeless. "We have grown accustomed to having human beings living on the streets. It's kind of a sad commentary."
Shortage of services
On any given night, there are at least 1,000 chronically homeless people in Dallas and more than 124,000 nationwide. At the heart of the problem is a lack of mental health services, a deficiency that's especially acute in Texas.
The state ranks 48th nationwide in spending on mental health care for its poorest residents. And this lack of commitment goes back more than a century, if you believe Dr. J.A. Corley, the superintendent of Texas' first state hospital, the State Lunatic Asylum. He complained that the 9-year-old facility was overcrowded and underfunded after it had filled to capacity with 352 patients.
"Our sister state of California, though younger than Texas, has provided accommodations for over one thousand of her insane," Corley wrote to try to shame the Legislature. That was in 1870.
Such institutions were being de-emphasized by the 1960s, the first of a series of factors that have conspired against the chronically homeless. Among them:
•A shortage of affordable housing. Revitalization efforts in the 1980s led to the tearing down of cheap housing even as federal housing assistance programs were being cut. About 18,000 people are on a waiting list for housing assistance from the Dallas Housing Authority, and the wait is three to five years long.
"The bottom line is we have a housing affordability crisis, and it most negatively affects people on very low incomes," said Dennis Culhane, a University of Pennsylvania professor who has done extensive research on homelessness.
•Low disability benefits. Many of the chronically homeless receive disability checks of about $675 a month, hardly enough to rent an apartment and pay other living expenses.
•Disenfranchisement. People on the streets with mental illness have had little voice among lawmakers. This year, the mayors of Texas' largest cities asked for $50 million over two years to help the homeless. The measure is pending.
•Fiscal conservatism. Advocates for more housing and mental health treatment face a tough political climate.
"Over the last six years, there's no doubt that there has been a tone of fiscal conservatism that has perpetuated the reputation of Texas being stingy with mental health dollars," said state Rep. David Farabee, D-Wichita Falls, a longtime mental health advocate. Farabee said he's hopeful that federal stimulus money also will allow the Legislature to provide more mental health dollars.
•A fragmented system. Many homeless people fall through cracks because of a lack of coordination among social service agencies. A person leaving one psychiatric hospital, for example, may be told to follow up at an outpatient clinic. But if the person doesn't show up, the clinic is not likely to track him or her down because it has no funding to do so.
•Stigma. There's a lack of understanding that the chronically homeless are extremely vulnerable and need significant help putting their lives back together. Instead, they are blamed for their situation.
"Generally, mental illness is something you can't cure by yourself," said John Castañeda, executive director of Turtle Creek Manor, a Dallas center that serves people with mental illnesses who also face addictions. "To say 'pull yourself up by your own bootstraps' won't work. It's impossible."
Many challenges
Richard Antwine wants to get off the streets. He wants his own apartment. And he wants to work.
Some days, he walks several miles asking business owners if he can sweep their parking lots. He talks about making a little money clipping other homeless guys' hair, saying he once attended a barber college.
But he's up against a lot. His severe depression has left him suicidal at times. He hears those voices. He has abused cocaine and alcohol, a common escape from mental illnesses.
He has a criminal record that includes drug possession, theft and unauthorized use of a motor vehicle. The divorced father of three grown daughters does not have the kind of family support that keeps some others from spiraling into homelessness.
Antwine's sister, JoAnn Williams of Garland, has watched him through psychiatric institutions, shelters and jail for years. She cooks for him and gives him cash here and there, but she has a family to take care of and said her brother needs more help than she can provide.
"I don't know where he is from one day to the next," she said. "If I don't hear from him, I don't have no way of calling him. He don't have a phone, and I don't know if he's dead. I watch the news all the time. Sometimes I am scared to watch the news."
'Good intentions'
Across the nation, thousands of people like Antwine have ricocheted through institutions for years despite the many programs designed to help them.
"We've had a quarter-century of good intentions, well-meaning programs and human gestures, but to be honest, they have not worked," said Philip Mangano, executive director of the United States Interagency Council on Homelessness. "The antidote to homelessness is, shockingly, a place to live."
Many programs to help the homeless traditionally have not placed enough emphasis on housing, Culhane, the professor, said.
"We have a lot of homeless people who get social services, shelters, mental health services, all of which does nothing to solve their housing problem," he said. "It's not a good use of resources to spend all this money and they're still in a cardboard box on Main Street."
Mangano, who will leave his post this month, led efforts to encourage cities including Dallas to adopt 10-year plans to end chronic homelessness. This has led to increased funding for special housing and support for the chronically homeless, and that's gotten a number off the streets.
But there's still not nearly enough housing, leaving many chronically homeless people like Antwine to fend for themselves.
Passed around
Antwine's dizzying ordeal through psychiatric hospitals, emergency rooms, boarding homes and shelters in just the last four months shows how the lack of care can doom someone to the streets.
In January, he spent about two weeks at Terrell State Hospital, a psychiatric hospital with about 300 beds and several aging empty buildings that once housed nearly three times that number of patients. From there, he was taken to a clinic, but he left before seeing the doctor.
Instead of going to a boarding house as planned, he ended up at The Bridge, Dallas' homeless-assistance center. Soon after, he said, he was robbed and stabbed as he searched for an East Dallas rooming house. He recovered at a Pleasant Grove boarding house but soon left over a rent dispute. From there, he went to the Salvation Army's shelter and finally to another boarding home.
In March, Antwine was placed under the care of a special team of caseworkers who stay in close contact with patients to make sure they take medications, show up for appointments and remain stable. It's an intensive service that few receive because of strained budgets. Antwine started feeling better and made plans to move into an apartment on April 1. But even the caseworkers had no control over what happened next.
Police arrested Antwine as he walked downtown on a warrant for not reporting to his parole officer. Instead of moving into a new home, Antwine was in jail, wearing a striped uniform, eating skimpy bologna sandwiches and staring at the wall because he could not afford anything to read.
"I don't know what's going on," Antwine said last month. "I'm just sitting here doing nothing when I shouldn't be here."
'It's a travesty'
At an April 17 parole hearing, Antwine's lawyer, Raquel D. Brown, argued that her client tried to do everything right.
"That's why I think it's a travesty," she said.
On Thursday night, after a month in jail, Antwine was released.
His whereabouts were unknown.
ABOUT THE SERIES: CHRONICALLY HOMELESS
The Dallas Morning News is taking a closer look this year at the struggles of helping the chronically homeless. This article is the second in a series examining the costs of inadequate treatment and exploring possible solutions. The project received support from the Carter Center, which offers fellowships in mental health journalism.
Editorial
Pull the plug on health care holdup in Texas
Editorial board
Thursday, April 23, 2009
In Texas, access to health care is rationed by ZIP code. If you live on the border or in the state's vast rural areas, you'll have trouble getting to a family doctor.
Even if you live in a city, you might have trouble finding a family physician if you live in the wrong ZIP code.
Doctors know that, and legislators know that. There are solutions offered to fix it, but as is often the case, politics and influence can wallop good public policy.
Though Texas legislators can't make doctors, they can make it attractive for young physicians, dentists and other medical professionals to open up practices along the border, in the state's rural communities and in the inner cities where they are needed.
A bill sponsored by state Reps. Warren Chisum, R-Pampa, and Richard Peña Raymond, D-Laredo, would encourage doctors and dentists to locate in the state's underserved areas by offering to help repay their student loans. State Sen. Judith Zaffirini, D-Laredo, is sponsoring another version of the student loan repayment bill aimed solely at doctors and paid for by increasing licensing fees.
The money for the Raymond-Chisum bill would come from closing a tobacco tax loophole. Every pack of cigarettes is taxed. Smokeless tobacco — you know, "chaw," snuff, dip, even rolling tobacco — is taxed on price. That tax advantage can be widened if manufacturers cut the tax in half by offering two for one specials on a product that is a known health hazard.
Business is good enough for the "people's tobacco" — as some refer to it with a straight face — that the industry can afford high-powered lobbyists to maintain the loophole. The lobbyists are earning their money. The House version is bottled up in committee. Zaffirini hasn't rounded up the 21 votes needed to bring her bill to the Senate floor. Time is running out.
Don't expect anyone to jump up and crow about killing those bills. Instead, what opposition that does surface will focus on problems with the bills. The truth is, whatever problems there are could be fixed if the bills get an honest debate. But that cannot happen as long as the bills languish in committee or beg for support.
While the bills languish, the problem grows.
Of the state's 254 counties, 114 do not meet the national standard for one physician for every 3,500 people, according to the Texas Academy of Family Physicians. As the state's population increases, front-line doctors and other medical professionals will be in even shorter supply along the border, in rural areas and in the inner cities.
The average medical school graduate walks off the stage with a diploma and a $130,000 debt. A medical practice in a rural area won't generate enough to repay that debt promptly, so newly minted doctors opt for urban and suburban practices or gravitate toward lucrative specialty practices.
Zaffirini, Chisum and Raymond are offering help, but their bills are dying. Not from neglect, though. Quite the contrary. Somebody is paying close attention to keep them where they are.
I May Be Mentally Ill, But I Still Have Sex
Inadequate sex ed has put people with psychiatric disorders at a needlessly high risk of diseasePublished April 23, 2009 by Josey Vogels in My Messy Bedroom SEE Magazine
Most of us have had the opportunity, at least once in our lives, to tee-hee or snicker as someone demonstrated how to use a condom by deftly rolling it over a banana or some other phallic-shaped fruit or vegetable. But imagine if you saw this and it led you to believe a banana with a condom on it must be present during sex to prevent infection.
It sounds ridiculous, I know, but it’s a conclusion you have to account for when you’re teaching safe sex practices to someone who is delusional, for example. But an even bigger roadblock to providing sex education to the mentally ill is the general assumption that mentally ill people don’t have sex.Which is just simply not the case.
In fact, studies in the U.S. and Canada have shown that patients in long-term psychiatric facilities are as sexually active as outpatients, whether they’re having sex with other patients or with partners who visit them. Yet, in most cases, institutions don’t even bother doing regular Pap smears or STI (sexually transmitted infection) testing on patients — and never mind trying to understand the unique problems that put the mentally ill at greater risk for sexual health problems and HIV infection. As a result, an estimated 19 per cent of people who are mentally ill are HIV-positive.
Someone with schizophrenia may be more at risk because they have a strong “command force”; that is, their brain makes them to do things most of us would think better of. If someone suffers from bipolar disorder, their extreme mood swings can put them at greater risk as well. “The manic are often grandiose, and impervious to potential danger and the results of their actions,” says Jane Reiha, a nurse in London, Ont., who works with the mentally ill. “The depression phase can also put them at risk, she adds, as sex is often the only pleasure left to them. “Often, people with mental illness seek sex with just anyone for a source of warmth, or because sex is cathartic, and a reassurance that you’re still alive — it may be one final attachment to reality.”
Thanks to funding cutbacks, the trend toward de-institutionalization means more mental health patients are being released into the community, increasing their exposure to risk.
“On the ‘outside,’ there may be increased opportunity for sexual encounters,” says Reiha. “And their limited capacity to deal with additional threats to well-being, and their disadvantaged economic and social status — like cohabitating with others in rest homes — can bring them into contact with high-risk groups like drug users.”
Unfortunately, says Reiha, there is a persistent belief that talking to the mentally ill about sexual issues will simply encourage promiscuity. Most health professionals would rather hang on to the belief that this group is asexual. The line they usually get from the staff when they ask to come and speak at their homes is: “Our clients do not have sex.”
But as far as Reiha is concerned, the human need for intimacy, warmth, and sexual expression is universal and people are sexual beings all the time, regardless of health, illness, or disability. The mentally ill have a tremendous need to express their feelings, to have their concerns and needs validated, and to be given the information necessary to manage life, she adds. They also have specific needs and considerations when it comes to sexual health.
According to Reiha, women with schizophrenia often have a history of abuse and usually have chaotic and unsatisfying sex lives as adults. “This is compounded,” she says, “by the fact that they can get pregnant.” In fact, birth control, is another hot topic. “Permanent birth control takes power away from the patient, but we have to think about whether or not the patient is even able to make those decisions.”
Which is why she tends to focus on condom use, especially because condoms also help prevent STI. But this can be tough when you’re dealing with people who may suffer from delusional thinking, have bizarre ways of communicating and a short attention span. (Doesn’t sound all that different from trying to teach teenagers, if you ask me, but I think I see her point.)
To overcome these obstacles, Reiha uses a lot of interactivity, role-playing, and visual aids when teaching the mentally ill about sexuality. “There may be a finger dexterity problem, for example,” Reiha says, “so the key is to practice opening the condom package and rolling it on, repeating often.”And no, they don’t use bananas.
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Clue to lithium benefits in bipolar patients
By Mark Cowen
24 April 2009
Dis Model Mech 2009: Not yet available online
MedWire News: Researchers have identified a possible mechanism for how lithium stabilizes the mood of patients with bipolar disorder, a finding that may lead to the development of more effective drugs to treat the condition.
Lithium has been use to treat bipolar disorder patients for more than 50 years and is one of the most effective treatments for the condition. However, researchers are unsure how lithium works in the human brain.
In laboratory cell tests, Adrian Harwood, from Cardiff University in the UK, and team found that lithium affects the molecule phosphatidyl inositol triphosphate (PIP3), which is important for controlling brain cell signaling.
Specifically, lithium inhibits inositol monophosphatase (IMPase), which is required for making the simple sugar inositol, from which PIP3 is made.
Importantly, this research shows that increasing the amount of IMPase causes higher levels of PIP3, but that PIP3 levels can be reduced with lithium treatment.
The gene IMPA2 – which produces a variant form of IMPase – has previously been linked to bipolar disorder. The current research suggests that lithium could counteract the effects of the altered IMPA2 protein. Harwood commented: "We still cannot say definitively how lithium can help stabilize bipolar disorder. However, our research does suggest a possible pathway for its operation.
“By better understanding lithium, we can learn about the genetics of bipolar disorder and develop more potent and selective drugs.”
He added: "Altered PIP3 signaling is linked to other disorders, including epilepsy and autism, so this well established drug could be used to treat other conditions. Research into lithium could become very important over the next few years."
The research will be published in a forthcoming issue of the journal Disease Models and Mechanisms.
MedWire (www.medwire-news.md) is an independent clinical news service provided by Current Medicine Group, a part of Springer Science+Business Media. © Current Medicine Group Ltd; 2009
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Friday conference aims to help the exonerated cope with life after prison
5:01 PM Mon, Apr 27, 2009 Jennifer Emily/Reporter DALLAS MORNING NEWS
When the wrongly convicted are released from prison, there is little help provided as they try to adjust their new lives
A conference Friday at the Christian Chapel CME Temple of Faith, 14120 Noel in Dallas, is trying to remedy that. It's held from 8 a.m. to 3 p.m.
It's called "A Day for Social Justice: The 2009 Dallas Interfaith Exoneree Conference."
Tickets range from $15 to $25, depending on whether you want lunch. Attendence is free for exonerees and their family members.
The deadline for advance registration is Thursday. Contact jlpage@uta.edu for more information. You can also register from 8 to 8:30 a.m. Friday at the conference.
Dallas County - with 19 DNA exonerations - has cleared more inmates through genetic testing than any county in the nation since 2001 when Texas began allowing post-conviction DNA tests.
According to the press release:
The University of Texas at Arlington School of Social Work is sponsoring the conference with Central Dallas Ministries and the Christian Methodist Episcopal Church. The Hogg Foundation, a UT Austin organization that helps raise awareness of mental health issues, also is supporting the event..
Dallas County District Attorney Craig Watkins is the special guest and a conference speaker. Watkins founded his office's Conviction Integrity Unit in July 2007. It oversees the review of hundreds of DNA cases in conjunction with the Innocence Project of Texas. More than 20 people who were wrongly convicted in Dallas County have been exonerated.
Dr. Jaimie Page, director of the Exoneree Project at the UT Arlington School of Social Work, is organizing the event along with Social Work graduate students Crystal Joshua and Chasity Alexander. They hope to educate the faith-based community about the service gaps that exonerees experience and aim to raise money to close those gaps.
Dr. John Stickels, assistant professor in criminology and criminal justice, started a chapter of The Innocence Project of Texas at UT Arlington in 2003. Some of his students are working to exonerate inmates believed to have been wrongly convicted. Dr. Stickels also serves on the board of the Innocence Project of Texas.Some clients have served almost 27 years behind bars, the professors say.
"Exonerees aren't given a dime when they leave prison. Many don't have a place to lay their heads that night," Dr. Page said. "If they have no family - and many do not - they are essentially homeless."
Exonerees are not eligible for benefits that actual parolees can receive because they are, in fact, innocent, Dr. Page noted. She said the Exoneree Project hopes to fill a six- to eight-month gap in services. Proceeds could be used for medication, identification, toiletries and clothing, but also counseling and immediate housing upon release.
During the conference, several exonerees are scheduled to talk about their experience. Several panel discussions also are planned. The topics are: UT Arlington School of Social Work's Exoneree Project: An Overview of Texas Exonerations and Exoneree Issues; Legal and Legislative Experts: Wrongful Convictions, Dallas County Efforts and Legislative Update; and Faith Leaders: Spirituality, Social Justice and Roles of Interfaith Leaders.
HEALTH & SCIENCE
"Mental health home" proposed to boost care for psychiatric illnesses
The idea builds on the patient-centered medical home concept endorsed by the AMA and other medical societies.
By Victoria Stagg Elliott, AMNews staff. Posted April 27, 2009.
Jim Dearing, DO, a family physician in Phoenix, often refers patients with significant mental health issues to a psychiatrist. But he rarely hears back from the specialist. In addition, his patients sometimes come to him with a prescription in hand, but are unable to name the doctors they saw or articulate the care plan.
"Psychiatrists treat them to the left, I treat them to the right, and patients get lost in the middle," said Dr. Dearing, who is on the American Osteopathic Assn. board of trustees.
To increase the coordination of care between physical and mental health and make this situation less likely, two psychiatrists published a paper in the April Psychiatric Services. They suggest creating a "mental health home" for patients with serious mental ills.
Their goal is to increase the access to behavioral, social and medical services that these patients require and to reduce the risk of repeated hospitalizations, incarcerations and homelessness. Access to primary care, in particular, is important because many of the newer medications used to treat mental illnesses put patients at increased risks for diabetes and other metabolic problems.
"We work primarily with a population of seriously mentally ill people, and they have the most disability and the most difficulty, not only with mental illness, but with all sorts of comorbidities. We're struggling with this population to coordinate services and integrate primary and specialty care," said Thomas E. Smith, MD, lead author and associate professor of clinical psychiatry at Columbia University's College of Physicians & Surgeons in New York. This proposal "is taking the same principles and overall approach of the medical home but tailoring it to individuals with serious mental illness."
Drugs used to treat mental illnesses can increase a patient's risk for diabetes.
The idea of a medical home for those with serious mental illnesses or other health problems is not new, and the details in the Psychiatric Services paper have much in common with community mental health centers, a concept first established in the 1960s. These organizations still exist, although many now operate much differently.
"It's old wine in new bottles, and it's absolutely the exact right thing to do," said Carl Bell, MD, director of the Institute for Juvenile Research in the Dept. of Psychiatry at the University of Illinois in Chicago. He also is chair of the American Psychiatric Assn.'s Council on Social Issues and Public Psychiatry.
The APA is working to understand the implications of the medical home concept on the specialty because the care model has been put forward for a broader base of patients by the AAP and AOA as well as the American College of Physicians and the American Academy of Family Physicians. These organizations issued "Joint Principles of the Patient-Centered Medical Home" in March 2007. Their principles defined the comprehensive primary care approach as one involving an ongoing relationship with a physician who leads a team and coordinates care across all areas of the health care system, all stages of life and all aspects of a person's well-being. It includes patients' active participation in decision-making. It also involves enhanced access through open scheduling or other options.
The American Medical Association signed on to the concept in November 2008, although the organization is continuing to study funding issues for the medical home model. A report on the topic is due from the AMA Council on Medical Service at the Annual Meeting in June.
Generating a buzz
So far, the response to the mental health home proposal has been enthusiastic.
"The article is absolutely right on," said Kim Griswold, MD, MPH, associate professor of family medicine and psychiatry at the University at Buffalo in New York. "If anyone needs a medical home, it's a person with serious mental illness. We have neglected this population." She researches primary care access for this population.
The model has been promoted mostly as a way to improve primary care, and proponents were happy to see specialists express interest.
"There's a longstanding problem integrating mental health and physical health. The fact that the mental health community is interested in the medical home is a very good sign," said Robert Phillips, MD, MSPH, director of the AAFP's Robert Graham Center for Policy Studies in Family Medicine and Primary Care.
But concern stems over the possibility of creating multiple medical homes. In addition, care in the proposed mental health home will tend to be coordinated by a behavioral health clinician who is unlikely to be a physician.
"The family is at the center of the medical home, and they are not well-served by the fragmentation of having two homes. We have got to collaborate in such a way to provide for the needs in one home," said Jane M. Foy, MD, professor of pediatrics at Wake Forest University School of Medicine in North Carolina. She also is chair of the AAP Task Force on Mental Health.
Creating a mental health home faces similar barriers to the medical home, including finding funding streams and educating physicians on how it should work, and reimbursement for mental health services can be more challenging. In addition, mental illness tends to be more stigmatized than physical health issues, and many experts believe this will prove to be a significant stumbling block to improving coordination of care.
This content was published online only.
Sunday, May 3, 2009
The Latest News in the Mental Health Arena
Are Researchers Cherry Picking Participants For Studies Of Antidepressants?
ScienceDaily (Apr. 29, 2009) — Findings from clinical studies used to gain Food and Drug Administration approval of common antidepressants are not applicable to most patients with depression, according to a report led by the University of Pittsburgh Graduate School of Public Health.
Published in the May issue of the American Journal of Psychiatry, the study suggests only a small percentage of people with depression qualify for these studies, and those who do not qualify are often treated with the same medications but may suffer poorer clinical outcomes.
A part of the National Institute of Mental Health-funded Sequenced Treatment Alternatives to Relieve Depression (STAR*D) project – the largest study of the treatment of depression conducted in the United States – researchers compared symptoms and outcomes in depressed patients who met phase III study inclusion criteria to those who did not. Phase III studies for antidepressants determine the effectiveness of the drug in comparison to a placebo. The inclusion criteria for these studies are not standardized nor subject to federal guidelines, resulting in some variation from study to study in the profile of eligible patients. Typically excluded are patients with milder forms of depression, who might be more likely to respond to a placebo drug, and those who may have chronic depression or psychiatric and medical co-morbidities – additional illnesses or conditions.
After assessing 2,855 patients treated with citalopram, a commonly prescribed selective serotonin reuptake inhibitor for mood disorders, study authors concluded that fewer than one in four, or 22.2 percent, of the patients met the usual criteria for inclusion in phase III antidepressant trials.
"Only a small percentage of depressed patients in our study would have qualified for inclusion in phase III efficacy trials of depression drugs," said study lead author, Stephen Wisniewski, Ph.D., professor of epidemiology and co-director of the Epidemiology Data Center, University of Pittsburgh Graduate School of Public Health. "This raises major concerns about whether results from traditional phase III studies can be generalized to most people with depression, who also often suffer from anxiety, substance abuse and other medical and psychiatric problems."
When Dr. Wisniewski and colleagues further assessed how well patients did on treatment, they found that those who met the eligibility criteria for phase III trials had better outcomes, including higher remission rates, less severe side effects and serious adverse events. The depression remission rate in the patients who met the criteria was 34.4 percent, compared to only 24.7 percent in the ineligible group. Additionally, the drug response rate also was higher in the eligible group – 51.6 percent compared to 39.1 percent of the ineligible group.
"Results from research studies suggest more optimistic outcomes than may exist for real-world patients receiving treatment for depression," said Dr. Wisniewski. Although phase III eligibility criteria could be changed to include a broader population of patients, Dr. Wisniewski cautions that this could come at the cost of more serious side effects in patients who have co-morbidities and are generally sicker. These patients may not be able to safely tolerate the drugs being tested. Instead, he suggests medical care providers who treat patients with depression use their professional judgment by noting that most phase III findings are based on patients who may be very different than those under their care.
The study was funded by the National Institute for Mental Health. Co-authors include A. John Rush, M.D., National University of Singapore; Diane Warden, Ph.D., M.B.A., and Madhukar Trivedi, M.D., University of Texas Southwestern Medical Center; Andrew Nierenberg, M.D., and Maurizio Fava, M.D., Harvard Medical School; Bradley Gaynes, M.D., M.P.H., University of North Caroline School of Medicine; James Luther, M.A., University of Pennsylvania School of Medicine; Patrick McGrath, M.D., Columbia University Medical Center; Philip Lavori, Ph.D., Stanford University School of Medicine; and Michael Thase, M.D., University of Pittsburgh School of Medicine.
Columbia Daily Spectator
COLUMBIA UNIVERSITY
Theater April 26, 2009 - 11:56pm
Broadway and TV put mental illness on center stage
by Liz Lucero, Lily Cedarbaum, Laura Hedli, and and Kelicia Hollis
In conjunction with Spectator’s “Mind Matters” series, several A&E reporters explored the manner in which mental illness is depicted and examined in entertainment. Famous artists are not exempt from mental illness, and many have recently used their art as not only a means of catharsis, but also as a forum for discussing their illnesses. In the past few months alone, theater and television have addressed depression, bipolar disorder, suicide, ADHD, and the role mental health plays in our society.—Ruthie Fierberg
NEXT TO NORMALFormer Columbia students Brian Yorkey. CC ’03, and Tom Kitt, CC ’96, are the creative forces behind Next to Normal. Originally entitled Feeling Electric, the musical concerns the unraveling of a nuclear family trying to come to grips with the delusions of its troubled matriarch.
Diana (played by Alice Ripley) is a suburban housewife who suffers from bipolar disorder. Haunted by a tragic event in her past, she seeks a combination therapy of specialists and pharmacological cocktails. Meanwhile, her husband struggles to cope with her illness, her daughter hankers for her parents’ attention, and her son remains the omnipotent golden boy. The musical had its start at the New York Musical Theatre Festival in 2005, and made its off-Broadway debut at Second Stage Theatre last season.
Unique in content, Next to Normal was the only production to ever feature a song and dance in Act I that closely detailed the risky psychiatric procedure of electroshock therapy. But with its uptown transfer, its creators have done away with this controversial scene in the operating room, and director Michael Greif (of Rent) has opted for sincerity.
It was a wise choice, because while Next to Normal doesn’t promise happy endings, it makes you feel anything but numb. Composer Kitt and book writer and lyricist Yorkey have created an addicting pop-rock score that moves a taboo subject to Broadway’s center stage.—Laura Hedli
Next to Normal is playing at the Booth Theatre (222 W. 45th Street). Rush tickets are available for $25, and regular tickets can be bought at www.telecharge.com.
KERNEL OF SANITYWhen a show leaves you confused about what happened, you know the topic will circulate in your head for a long time after the final bows. Such is the case with New Federal Theater’s Kernel of Sanity.
Set in the ’70s, Kernel of Sanity is about a day in the life of Frank Tracy, a washed-up actor who retreated to the Midwest to escape his past. Later we meet his reluctant girlfriend, Rita, and Roger Peterson (a fellow actor from their past collaboration on One Flew Over the Cuckoo’s Nest).
On the surface, the theme of insanity enters the play when Frank receives a letter from the government. They have registered him as mentally insane, a label that results in a monthly stipend. But this is just the tip of the iceberg.
When Roger stops by unannounced, his long periods of silence mixed with enraged tangents about becoming Smokey Robinson beg the question—who is really insane?
What was fact at the beginning of the show eventually turns into fiction. Rita tells Frank she is pregnant, but later claims that she was only proving she could act. Roger admits to having murdered a producer. When Frank asks him if it is true, Roger refuses to tell him.
They all know their lives are on a downward slope toward self-destruction, yet none of them try to stop it. Roger carries around a prop gun, Frank is perpetually writing his autobiography, and Rita has a psychotic obsession with Janis Joplin. The levels of lunacy rise more and more until all sense of reality is lost.
What the characters learn is that mental instability is not a joke. Because of mental disintegration, people become recluses, pathological liars, and even murderers. The worst part is that you don’t even realize you are insane until it is too late. All you can do is hope that there is just one Kernel of Sanity left.—Lily Cedarbaum
Kernel of Sanity is playing at the Henry Street Settlement (465 Grand Street) until May 3. Call 212-598-0400 for tickets, which are available for $20.
BREAKING BADIn AMC’s hit drama Breaking Bad, the name of the game is desperation.
Although it affects everyone to a certain extent, desperation takes a significant toll on the show’s protagonist, high school chemistry teacher Walter White (Bryan Cranston)—it pushes him to open up his own crystal meth lab, and subsequently to the edge of his sanity.
In the pilot episode, Walt frantically drives the RV that doubles as his meth lab through New Mexico, wearing only underwear and a gas mask, and with a gun in tow. Just three weeks before this first scene, he was a normal (albeit bored) family man. However, soon after his 50th birthday, he is diagnosed with stage three terminal lung cancer.
Faced with the realization that there will not be enough money for his wife Skyler (Anna Gunn), his son Walter Jr. (RJ Mitte), who has cerebral palsy, and his unborn daughter to survive when he is dead, Walt looks for a way to provide for them. He decides to put his chemistry skills to good use: cooking and dealing crystal meth with one of his former students, Jesse Pinkman (Aaron Paul).
This decision splits Walt into two very different people. At home, he tries to be the loving husband and father he has always been. In the drug world, he is Heisenberg, the absolutely ruthless man who makes the purest meth. The stress of his double life makes it almost impossible for him to function well in either role.
Now in its second season, the show makes it hard to tell how tight of a grip Walt actually has on his sanity. Nonetheless, it is visibly becoming more difficult for him to live with himself, the things he has done, and the things he knows he will do.
In last Sunday’s episode, “Negro y Azul,” the show highlighted the increasing flimsiness of Walt’s justification for his meth business. He is becoming a big shot as Heisenberg, testing the limits of his morality as a cold-blooded dealer. He manipulates Jesse and convinces him to expand their operation.
In terms of securing his family’s future, expanding the business may be the best move for Walt—but at what cost? Steadily, he is creating enemies much more threatening than himself, and the precious time he has left with Skyler is strained, as she is now beginning to suspect that he is hiding something.
Walt is playing a dangerous game with both the law and his health, and it seems that there are few, if any, safe exits left. Big problems loom for this divided soul, and he may lose more than he hoped to win.—Liz Lucero
Breaking Bad airs Sundays at 10 p.m. on AMC.
FOR COLORED GIRLS WHO HAVE CONSIDERED SUICIDE WHEN THE RAINBOW IS ENUF“Sometimes you have to dance to keep from dyin’,” the women declared as they danced and stepped onstage, each unified with the others yet distinguishable by her respective colors.
Ntozake Shange’s For Colored Girls Who Have Considered Suicide When the Rainbow is Enuf—presented this past weekend by Columbia’s Black Theater Ensemble—is a choreopoem exploring the plight of women of color. The women’s stories are of mental and sexual abuse, exploitation, and manipulation.
Each woman represents a distinct color, just as each one struggles with distinct situations that have exacted all her strength and exhausted her to frailty of stature and will. The play deals with the way “colored girls” are perceived in the world, but, more importantly, it also deals with how they view themselves.
For Colored Girls consists mainly of monologues, one overlying theme of which is the exhaustion of women who are historically supposed to be able to handle everything. Their questioning of their entire existence is described by Lady in Yellow: “bein alive & bein a woman & bein colored is a metaphysical dilemma.”
Despite this inner conflict, the play is not about suicide, but rather about the strength and communal support it takes to prevent mental collapse. The women help each other through their suffering, and celebrate the reclaiming of mind, body, and essence through dance, song, and step.
The unity of the bright colors is a constant reinforcing connection that prevents the women from becoming mentally insane. In many ways, both the written work and the production’s use of light and color render depression and suicide a solitary and lonely act—in stark contrast to the happiness the women want for themselves. But they dance to keep from dying, illustrating that unity is the most useful survival technique.—Kelicia Hollis
ScienceDaily (Apr. 29, 2009) — Findings from clinical studies used to gain Food and Drug Administration approval of common antidepressants are not applicable to most patients with depression, according to a report led by the University of Pittsburgh Graduate School of Public Health.
Published in the May issue of the American Journal of Psychiatry, the study suggests only a small percentage of people with depression qualify for these studies, and those who do not qualify are often treated with the same medications but may suffer poorer clinical outcomes.
A part of the National Institute of Mental Health-funded Sequenced Treatment Alternatives to Relieve Depression (STAR*D) project – the largest study of the treatment of depression conducted in the United States – researchers compared symptoms and outcomes in depressed patients who met phase III study inclusion criteria to those who did not. Phase III studies for antidepressants determine the effectiveness of the drug in comparison to a placebo. The inclusion criteria for these studies are not standardized nor subject to federal guidelines, resulting in some variation from study to study in the profile of eligible patients. Typically excluded are patients with milder forms of depression, who might be more likely to respond to a placebo drug, and those who may have chronic depression or psychiatric and medical co-morbidities – additional illnesses or conditions.
After assessing 2,855 patients treated with citalopram, a commonly prescribed selective serotonin reuptake inhibitor for mood disorders, study authors concluded that fewer than one in four, or 22.2 percent, of the patients met the usual criteria for inclusion in phase III antidepressant trials.
"Only a small percentage of depressed patients in our study would have qualified for inclusion in phase III efficacy trials of depression drugs," said study lead author, Stephen Wisniewski, Ph.D., professor of epidemiology and co-director of the Epidemiology Data Center, University of Pittsburgh Graduate School of Public Health. "This raises major concerns about whether results from traditional phase III studies can be generalized to most people with depression, who also often suffer from anxiety, substance abuse and other medical and psychiatric problems."
When Dr. Wisniewski and colleagues further assessed how well patients did on treatment, they found that those who met the eligibility criteria for phase III trials had better outcomes, including higher remission rates, less severe side effects and serious adverse events. The depression remission rate in the patients who met the criteria was 34.4 percent, compared to only 24.7 percent in the ineligible group. Additionally, the drug response rate also was higher in the eligible group – 51.6 percent compared to 39.1 percent of the ineligible group.
"Results from research studies suggest more optimistic outcomes than may exist for real-world patients receiving treatment for depression," said Dr. Wisniewski. Although phase III eligibility criteria could be changed to include a broader population of patients, Dr. Wisniewski cautions that this could come at the cost of more serious side effects in patients who have co-morbidities and are generally sicker. These patients may not be able to safely tolerate the drugs being tested. Instead, he suggests medical care providers who treat patients with depression use their professional judgment by noting that most phase III findings are based on patients who may be very different than those under their care.
The study was funded by the National Institute for Mental Health. Co-authors include A. John Rush, M.D., National University of Singapore; Diane Warden, Ph.D., M.B.A., and Madhukar Trivedi, M.D., University of Texas Southwestern Medical Center; Andrew Nierenberg, M.D., and Maurizio Fava, M.D., Harvard Medical School; Bradley Gaynes, M.D., M.P.H., University of North Caroline School of Medicine; James Luther, M.A., University of Pennsylvania School of Medicine; Patrick McGrath, M.D., Columbia University Medical Center; Philip Lavori, Ph.D., Stanford University School of Medicine; and Michael Thase, M.D., University of Pittsburgh School of Medicine.
Columbia Daily Spectator
COLUMBIA UNIVERSITY
Theater April 26, 2009 - 11:56pm
Broadway and TV put mental illness on center stage
by Liz Lucero, Lily Cedarbaum, Laura Hedli, and and Kelicia Hollis
In conjunction with Spectator’s “Mind Matters” series, several A&E reporters explored the manner in which mental illness is depicted and examined in entertainment. Famous artists are not exempt from mental illness, and many have recently used their art as not only a means of catharsis, but also as a forum for discussing their illnesses. In the past few months alone, theater and television have addressed depression, bipolar disorder, suicide, ADHD, and the role mental health plays in our society.—Ruthie Fierberg
NEXT TO NORMALFormer Columbia students Brian Yorkey. CC ’03, and Tom Kitt, CC ’96, are the creative forces behind Next to Normal. Originally entitled Feeling Electric, the musical concerns the unraveling of a nuclear family trying to come to grips with the delusions of its troubled matriarch.
Diana (played by Alice Ripley) is a suburban housewife who suffers from bipolar disorder. Haunted by a tragic event in her past, she seeks a combination therapy of specialists and pharmacological cocktails. Meanwhile, her husband struggles to cope with her illness, her daughter hankers for her parents’ attention, and her son remains the omnipotent golden boy. The musical had its start at the New York Musical Theatre Festival in 2005, and made its off-Broadway debut at Second Stage Theatre last season.
Unique in content, Next to Normal was the only production to ever feature a song and dance in Act I that closely detailed the risky psychiatric procedure of electroshock therapy. But with its uptown transfer, its creators have done away with this controversial scene in the operating room, and director Michael Greif (of Rent) has opted for sincerity.
It was a wise choice, because while Next to Normal doesn’t promise happy endings, it makes you feel anything but numb. Composer Kitt and book writer and lyricist Yorkey have created an addicting pop-rock score that moves a taboo subject to Broadway’s center stage.—Laura Hedli
Next to Normal is playing at the Booth Theatre (222 W. 45th Street). Rush tickets are available for $25, and regular tickets can be bought at www.telecharge.com.
KERNEL OF SANITYWhen a show leaves you confused about what happened, you know the topic will circulate in your head for a long time after the final bows. Such is the case with New Federal Theater’s Kernel of Sanity.
Set in the ’70s, Kernel of Sanity is about a day in the life of Frank Tracy, a washed-up actor who retreated to the Midwest to escape his past. Later we meet his reluctant girlfriend, Rita, and Roger Peterson (a fellow actor from their past collaboration on One Flew Over the Cuckoo’s Nest).
On the surface, the theme of insanity enters the play when Frank receives a letter from the government. They have registered him as mentally insane, a label that results in a monthly stipend. But this is just the tip of the iceberg.
When Roger stops by unannounced, his long periods of silence mixed with enraged tangents about becoming Smokey Robinson beg the question—who is really insane?
What was fact at the beginning of the show eventually turns into fiction. Rita tells Frank she is pregnant, but later claims that she was only proving she could act. Roger admits to having murdered a producer. When Frank asks him if it is true, Roger refuses to tell him.
They all know their lives are on a downward slope toward self-destruction, yet none of them try to stop it. Roger carries around a prop gun, Frank is perpetually writing his autobiography, and Rita has a psychotic obsession with Janis Joplin. The levels of lunacy rise more and more until all sense of reality is lost.
What the characters learn is that mental instability is not a joke. Because of mental disintegration, people become recluses, pathological liars, and even murderers. The worst part is that you don’t even realize you are insane until it is too late. All you can do is hope that there is just one Kernel of Sanity left.—Lily Cedarbaum
Kernel of Sanity is playing at the Henry Street Settlement (465 Grand Street) until May 3. Call 212-598-0400 for tickets, which are available for $20.
BREAKING BADIn AMC’s hit drama Breaking Bad, the name of the game is desperation.
Although it affects everyone to a certain extent, desperation takes a significant toll on the show’s protagonist, high school chemistry teacher Walter White (Bryan Cranston)—it pushes him to open up his own crystal meth lab, and subsequently to the edge of his sanity.
In the pilot episode, Walt frantically drives the RV that doubles as his meth lab through New Mexico, wearing only underwear and a gas mask, and with a gun in tow. Just three weeks before this first scene, he was a normal (albeit bored) family man. However, soon after his 50th birthday, he is diagnosed with stage three terminal lung cancer.
Faced with the realization that there will not be enough money for his wife Skyler (Anna Gunn), his son Walter Jr. (RJ Mitte), who has cerebral palsy, and his unborn daughter to survive when he is dead, Walt looks for a way to provide for them. He decides to put his chemistry skills to good use: cooking and dealing crystal meth with one of his former students, Jesse Pinkman (Aaron Paul).
This decision splits Walt into two very different people. At home, he tries to be the loving husband and father he has always been. In the drug world, he is Heisenberg, the absolutely ruthless man who makes the purest meth. The stress of his double life makes it almost impossible for him to function well in either role.
Now in its second season, the show makes it hard to tell how tight of a grip Walt actually has on his sanity. Nonetheless, it is visibly becoming more difficult for him to live with himself, the things he has done, and the things he knows he will do.
In last Sunday’s episode, “Negro y Azul,” the show highlighted the increasing flimsiness of Walt’s justification for his meth business. He is becoming a big shot as Heisenberg, testing the limits of his morality as a cold-blooded dealer. He manipulates Jesse and convinces him to expand their operation.
In terms of securing his family’s future, expanding the business may be the best move for Walt—but at what cost? Steadily, he is creating enemies much more threatening than himself, and the precious time he has left with Skyler is strained, as she is now beginning to suspect that he is hiding something.
Walt is playing a dangerous game with both the law and his health, and it seems that there are few, if any, safe exits left. Big problems loom for this divided soul, and he may lose more than he hoped to win.—Liz Lucero
Breaking Bad airs Sundays at 10 p.m. on AMC.
FOR COLORED GIRLS WHO HAVE CONSIDERED SUICIDE WHEN THE RAINBOW IS ENUF“Sometimes you have to dance to keep from dyin’,” the women declared as they danced and stepped onstage, each unified with the others yet distinguishable by her respective colors.
Ntozake Shange’s For Colored Girls Who Have Considered Suicide When the Rainbow is Enuf—presented this past weekend by Columbia’s Black Theater Ensemble—is a choreopoem exploring the plight of women of color. The women’s stories are of mental and sexual abuse, exploitation, and manipulation.
Each woman represents a distinct color, just as each one struggles with distinct situations that have exacted all her strength and exhausted her to frailty of stature and will. The play deals with the way “colored girls” are perceived in the world, but, more importantly, it also deals with how they view themselves.
For Colored Girls consists mainly of monologues, one overlying theme of which is the exhaustion of women who are historically supposed to be able to handle everything. Their questioning of their entire existence is described by Lady in Yellow: “bein alive & bein a woman & bein colored is a metaphysical dilemma.”
Despite this inner conflict, the play is not about suicide, but rather about the strength and communal support it takes to prevent mental collapse. The women help each other through their suffering, and celebrate the reclaiming of mind, body, and essence through dance, song, and step.
The unity of the bright colors is a constant reinforcing connection that prevents the women from becoming mentally insane. In many ways, both the written work and the production’s use of light and color render depression and suicide a solitary and lonely act—in stark contrast to the happiness the women want for themselves. But they dance to keep from dying, illustrating that unity is the most useful survival technique.—Kelicia Hollis
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