Noteworthy News Articles on Mental Health Topics, September 1-8, 2000

St. Johns' Wort May Equal Chemical Anti-Depressant
Reuters, 9/1/2000

NEW YORK—St. John's wort, given to patients with mild to moderate depression, offers the same benefits as the anti-depressant imipramine, with fewer side effects, according to researchers. "The results of this study support the conclusion that the two treatments are therapeutically equivalent," writes Helmut Woelk, at the Akademisches Lehrkrankenhaus der Universitat Giessan, Germany, in the September 2nd issue of the British Medical Journal. "There was some evidence to suggest that the hypericum (St. John's wort) may be better than imipramine in relieving anxiety associated with depression although there were no differences in any of the measures of efficacy," he continued.
    Although the two treatments had the same clinical effect on depression, the patients receiving St. John's wort experienced fewer side effects than those using the imipramine. While 4 of 157 (3 percent) patients using St. John's wort stopped treatment because of adverse effects, 26 of 167 (16 percent) taking imiprimine withdrew from treatment because of negative events, including dry mouth, sweating, dizziness, nausea, weakness and headache.
    Woelk evaluated the safety and effectiveness of the St. John's wort in extract form, comparing it with 150 mg (considered a full therapeutic dose) of imipramine, one of the most frequently prescribed antidepressants. The 324 participants, who were patients in 40 psychiatric, internal medicine and general medicine practices in Germany, were randomly treated with either 0.2 percent St. John's wort extract, or 75 mg of imipramine twice daily.
    St. John's wort, or Hypericum perforatum, has been used since ancient times for treating a variety of ills, and is now a licensed medication used to treat depression and anxiety in many European countries. Although its value has been touted in previous research, few studies have actually established whether St. John's wort is as effective as tricyclic antidepressants or placebos. "In view of the mounting evidence of hypericum's comparable efficacy to other antidepressants and its safety record, hypericum should be considered for first line treatment in mild to moderate depression, especially in the primary care setting," Woelk concludes.

Anti-Smoking Pill Effective
Emma Ross, Associated Press- 9/2/2000

FLORENCE, Italy (AP) -- The anti-smoking pill Zyban could help even some of the most hardcore smokers -- those who can't stop, despite being sick with a debilitating lung disease, new research suggests. Studies have shown the drug can help up to 30 percent of average smokers stay off cigarettes for at least a year. But the medication has never been tested in people with chronic obstructive pulmonary disease, a smoking-induced lung illness that the World Health Organization estimates affects 600 million people worldwide and kills about 3 million every year.  Experts say that about 60 percent of those with the condition, known as ''smoker's lung,'' continue to smoke and that quitting tobacco is the only thing that has been shown to halt or slow its progression.
    The findings, presented Friday at the World Congress on Lung Health, showed that taking the drug almost doubled the chances of quitting, from 9 percent to 16 percent. ''They almost doubled their chances of giving up. That's about the same chance as smokers in general,'' said Dr. Donald P. Tashkin, a professor of pulmonology at UCLA and leader of the study. The study was funded by Glaxo Wellcome, the drug's maker.  Dr. Pierre Bartsch, professor of lung medicine at the University of Liege in Belgium, said the findings are important because people with chronic obstructive pulmonary disease have the most difficulty giving up smoking, which is their only chance of retarding their disease. ''Of course the results show a much lower success rate than in the general population, but these are people who were smoking almost two packets a day for 25 years,'' Bartsch said. ''It's important to show that something can help these patients give up.'' It probably wouldn't be a good treatment for those with the advanced stage of the disease -- about 40 percent of all those with the illness -- because it may not be a good idea to mix the drug with the other drugs those patients use, Bartsch said.
    Chronic obstructive pulmonary disease causes gradual, irreversible damage to the lungs, and encompasses such diseases as emphysema and chronic bronchitis. It afflicts about 15 million Americans and kills about 100,000 of them a year, according to the American Lung Association. It is the fourth leading cause of death in the United States behind heart disease, cancer and stroke.
    The study, conducted by scientists at the University of California, Los Angeles, involved 411 people about 54 years old from across the United States who had the lung illness and smoked almost two packs of cigarettes a day. All had mild or moderate stages of the disease, where patients cough, wheeze and feel breathless but don't yet need inhalers to help them breathe. Most had tried various methods to stop smoking in the past. For 12 weeks, half were given the drug twice a day, while others were given fake pills. They also got counseling. When the treatment ended, 18 percent of those on the drug had not inhaled a single puff of tobacco, compared with 10 percent of smokers on the fake pill. Three months later, 16 percent of those on the drug had stayed off cigarettes, compared with 9 percent of those not getting the medication. Scientists verified that the smokers had quit by testing their breath for traces of carbon monoxide. The number of people abandoning the medication early was about the same in both groups -- 2 percent. Those on the drug reported temporary insomnia at the beginning. Zyban costs about $60 per month. It has been available in the United States since 1998 and is currently being launched across Europe.

Douglas County Panel to Vote on Sex-Offender Limits
Arthur Kane, Denver Post- 9/2/2000

Douglas County may join other Denver metro area communities in enacting laws that restrict more than one sex offender from living under the same roof. And the county is also considering restricting group homes for sex offenders to non-residential areas. Those two issues will be discussed at a public hearing and vote of Douglas County commissioners, scheduled for Sept.12 in Castle Rock.
    The Douglas County Planning Department has recommended that the county adopt the changes "for the safety of all county residents," according to a planning department report. The report says there "is no compelling evidence or a greater treatment success rate for sex offenders housed in a neighborhood as opposed to a nonresidential area." There are 51 registered sex offenders living in unincorporated Douglas County, according to Attila Denes, spokesman for the Douglas County Sheriff's Office. While a handful live within close proximity, none share a home, he said. Roughly 20 sex offenders live at the Emily Griffith Center, a treatment home for troubled boys in Larkspur, Denes said. There are no group homes in Douglas County.
    Existing rules in Douglas County do not limit the number of sex offenders who can share a home. The zoning changes, however, would amend the definition of a "family" to say that it "shall not include more than one registered sex offender, unless related by blood, marriage or legal adoption." The changes allow for group homes in areas zoned for business, commercial or industrial uses. Other local governments that have capped the number of sex offenders per-household include: Arvada; Commerce City; Jefferson County; Aurora; Lakewood; Northglenn; Thornton; Superior; Federal Heights; and Greenwood Village.

Suicide Group Head's Son Kills Self
Catherine Tsai, Associated Press- 9/2/2000

DENVER (AP) -- After Les Franklin's teen-age son committed suicide, he channeled his grief into helping others and founded a suicide prevention organization so other families wouldn't endure similar tragedies. But ten years after the suicide of Shaka Franklin, Les Franklin has found himself inexplicably reliving the same nightmare: His troubled son, Jamon, committed suicide last month.
    Jamon, 31, was found dead of carbon monoxide poisoning in a remodeled blue Cadillac parked in a four-car garage at the family's home, which doubles as headquarters for the Shaka Franklin Foundation for Youth. Now Franklin is stepping away from that organization as he struggles to deal with his confusion and grief. ''I get angry with myself even though I know if I had done everything perfectly, this still could have happened,'' Franklin, 61, said. ''I just don't have it in me to go out and talk to kids about taking their lives.''
    The risk of suicide is thought to be up to 12 times higher for people whose immediate family members have committed suicide, but it is uncommon to find multiple suicides in a family because the suicide rate is low, said Dr. David Brent, academic chief of child psychiatry at the University of Pittsburgh School of Medicine. ''It's still a rare occurrence,'' Brent said. ''It's just so devastating when it does happen.'' Statistics show 11 in 100,000 people committed suicide nationally in 1997, according to the Centers for Disease Control and Prevention.
    A graduate of the University of Northern Colorado, Franklin was an Air Force lieutenant and IBM executive for 25 years. He also directed the governor's Job Training Office, resigning in 1995 for an unsuccessful run for Congress.  In 1990, Franklin returned home to find his 16-year-old son, Shaka, had killed himself in a downstairs bedroom of the family's 7,200-square-foot home. Shaka's suicide was attributed to his mother's failing health and an injury that ended his football season at Thomas Jefferson High School. Franklin resigned from his jobs and founded the Shaka Franklin Foundation for Youth, which offered programs to help prevent suicide among youths as well as helping underprivileged youth. A year later, the boys' mother died of cancer and Franklin, who had remarried, suffered a heart attack.
    Recognizing the losses had affected Jamon Franklin, Les Franklin offered to get his son help, but he refused, pledging not to kill himself as Shaka did. Jamon Franklin pressed ahead, graduating this summer from Morehouse College in Atlanta. He took charge of Shaka Inner City Edge, a program of the Shaka foundation which teaches inner-city children how to skate and play hockey. Friends and relatives believed Jamon Franklin was in control. ''He was the type who was quiet,'' said Earleen Reed, Les Franklin's cousin. ''That's what's so puzzling. He had such a good rapport with the children.'' Terry Patton, one of his closest friends, said it was Jamon Franklin who made sure everybody was OK. ''He never gave me any indication that he needed to talk to anyone about anything like this,'' Patton said. ''I'm wondering, did the guy have a secret life that none of us knew about?'' Franklin and his wife, Marianne, knew the younger Franklin struggled. In the months before he died, Jamon Franklin had threatened suicide, brandishing a butcher knife and screaming because his father had scolded him about dirty laundry in his room. ''I was scared to death,'' Les Franklin said. ''I was so afraid he would do what his brother did that I would give in really easy to him.'' On Aug. 14, the Franklins returned from an overseas wedding and Marianne Franklin, 50, found Jamon Franklin's body. No note was found.
    Les Franklin is bitter. ''I'm not at the point where I want to remember any good things about him,'' Franklin said, clenching his jaw. ''He promised me he wouldn't do what Shaka did. He didn't keep his word.'' His response is fairly typical for relatives of suicide victims, said Dale Emme, executive director of the Yellow Ribbon Suicide Prevention Program. ''Many people have to vent some kind of emotion somewhere, and unfortunately, sometimes it's anger,'' said Emme, who also started a suicide program after losing a son to suicide. ''Here's a man who has endured a terrible loss,'' said Robert Gebbia, executive director of the American Foundation for Suicide Prevention, an acquaintance of the Franklin family. ''He's absolutely in a state of shock. He needs time to work through this on his own.'' Unlike her husband, Marianne Franklin has chosen to continue as the foundation's executive director. ''I don't want to lose ground. People who work here, they say, 'I don't want to come here. I don't feel right,' It upsets me,'' she said, wiping her eyes. ''I hate this.''

The Shaka Franklin Foundation for Youth: http://www.shaka.org
American Foundation for Suicide Prevention: http://www.afsp.org

Politicians Who Hide Their Mental Health
Adam Clymer, New York Times- 9/3/2000

WASHINGTON--The only president whose wild mood swings prompted his own secretary of defense to issue orders designed to block him if he called out the Marines for protection against impeachment is also the only president known to have been treated by a psychotherapist. That president was Richard M. Nixon and both of those experiences are chronicled in "The Arrogance of Power: The Secret World of Richard Nixon," by Anthony Summers (Viking). And while other accounts in his book, including episodes of wife-beating and pill-popping, are angrily contradicted by Mr. Nixon's defenders, the revelations about the secret order and the president's psychiatric treatment have not been widely disputed. But they raise important questions. While the physical health of presidents and politicians has become a fit topic for public discussion, the overwhelming majority of politicians still hide their mental difficulties.
    The evidence is purely anecdotal, but talking to psychiatrists in Washington, it is clear that while there have been some changes since Mr. Nixon's time (when his therapist, Dr. Arnold A. Hutschnecker, visited the White House rarely and used false destinations when he signed in), they have largely been around the edges. Dr. Fred Solomon, a practicing psychiatrist here since the early 1960's, said, "I don't think the politicians are any more eager, more relaxed than they used to be about therapy for themselves." But, he said, they are "a lot more willing to have family members get help." "The recognition of usefulness for psychiatric care for family members is just moving along just fine," he continued. "Marital counseling is sought by a number of people, and there is recognition in general that mental health problems can be just as disabling as physical health problems."
    Senator Paul Wellstone, a Minnesota Democrat who has crusaded for legislation to force insurance companies to treat mental health the same as physical health, recalled a meeting at Vice President Al Gore's house a few years ago about a proposed bill. More than 30 senators were there, most with their wives or husbands. They spoke "very personally about members of their own family or close friends who struggled with mental illness, but not to the point of talking about themselves." Psychiatrists here say they understand why politicians fear disclosure. Dr. Dorothy Starr said, "I think there remains a good deal of uncertainty in the public mind about people who have been mentally ill." Another psychiatrist, Dr. Harvey Rich, said, "We hold our politicians up to a different kind of standard--you can't have a weakness of any kind."
    Representative Jim McDermott, who was a Seattle psychiatrist before coming to Congress and who has referred other members of Congress to psychiatrists, said the fear of being found out discouraged others who talked to him about getting help. But the experiences of those politicians who have publicly acknowledged mental illness--in each case treated for depression--raise questions about that widespread fear. Senator Thomas Eagleton, who was dropped as a vice-presidential candidate in George McGovern's campaign in 1972 after failing to disclose electroshock treatments for depression, was re-elected to the Senate in Missouri in 1974 and 1980. Lawton Chiles, who left the Senate in 1989, recovered from depression and was twice elected governor of Florida. And three current members of the House--Lynn N. Rivers of Michigan, Nydia M. Velazquez of New York and Patrick J. Kennedy of Rhode Island--have survived such disclosures.
    The last time a high-profile campaign tried to damage an opponent by accusing him of seeking psychiatric help was in 1988, when the Bush campaign and President Reagan sought to discredit Michael A. Dukakis. John Derdourff, a longtime Republican consultant, said he believed that "there are enough people in both parties" today "who would speak out against anybody who tried to raise that issue against a candidate that it would be very dangerous." Peter D. Hart, a Democratic pollster, said it could make a difference what office a politician was seeking. For a Congressional candidate, he said, the examples of entertainment and sports figures suggested disclosure was safe, phrased in terms of "Here's a challenge that I faced." But a candidate for president, he said, "faces a tougher barrier." Mr. Deardourff agreed, saying the public understands that the presidency is an "intensely demanding job demanding mental stability."
    Dr. Fred Goodwin, a former head of the National Institute of Mental Health, said it was important to distinguish between different sorts of mental illness--a treatable depression is one thing and schizophrenia another. "I don't think the public concerns are entirely unfounded," Dr. Goodwin said. "When we fight stigma, we shouldn't pretend that mental illnesses are just the same as physical illness. If you're talking about a disorder that affects thinking, behavior, that's different from high blood pressure or diabetes. "When the public is uneasy about something, their views may be exaggerated, there may be a lot of irrationality, a lot of fear. But when it's pervasive and hangs around, the public is at least partially on to something."
    Dr. Solomon pointed out that some politicians, like President Clinton, publicly engage in spiritual counseling while rejecting psychiatric help. And even those who discuss mental illness often do so using murky terminology. "They also pick their words very carefully, like 'counseling,' not 'therapy,' " he said. "They get medication from their internal medicine doctors, like Vince Foster did, but didn't really want to see a psychiatrist." Even Tipper Gore, praised by one psychiatrist after another for discussing her depression and treatment last year, spoke of "counseling." And when an article in the New York Times Magazine in 1993 described the family therapy received by the Gores after their son was struck by a car and nearly died, the vice president's office complained that the article should not have said he had weekly visits from a "therapist," but from a "facilitator."

Making a Dent in the Demand for Illegal Drugs
Alan Feuer, New York Times- 9/3/2000

When Andres Pastrana, the president of Colombia, said last week that the key to winning the war against drugs was taming demand in the United States, he ruffled some American feathers. Part of the problem was timing: President Clinton was about to hand him a check for $1.3 billion in aid to train and outfit a new Colombian anti-drug brigade. But Mr. Pastrana's words also rankled some people because they took no account of the myriad demand-reduction programs that are already in place in the United States.
    Officials in the office of General Barry R. McCaffrey, the White House drug czar, have a landslide of little noted statistics that show domestic demand for drugs has plunged. Use of cocaine, both crack and powder, has decreased by 70 percent in the last 15 years, said Bob Weiner, a spokesman for General McCaffrey. Consumption of all drugs by youths aged 12 to 17 years of age went down 21 percent from 1997 to 1999, Mr. Weiner said. And while drug use went up among people 18 to 25, it was still far below what it had been 20 years ago, he said. "We obviously have to do a better job of making certain that Latin American nations, for one, understand that we have a strong demand-reduction program in place and that it's working and successful," Mr. Weiner said. The programs range from a national campaign to put anti-drug commercials into movie theaters to having federal agents talk in classrooms and office parks about the dangers of drugs.
    These efforts are mirrored by a network of local programs around the country. Many were modeled after those pioneered by the Brooklyn district attorney's office. That office, which spends a good deal of time making cases against dope dealers and crack addicts, has in the last decade also focused on getting drug felons into treatment programs, as well as educating the young about the perils of illegal drugs. "It was very clear that the problem Brooklyn was having when I took over this office could not be addressed by law enforcement alone and needed something other than a traditional approach," the district attorney, Charles J. Hynes, said last week from San Francisco, where he was speaking at a conference on drug treatment programs. "And if drugs were the operative reason for the crime increase, then something had to be done about demand."
    The centerpiece of his efforts is a program called D-TAP, or Drug Treatment Alternative to Prison, which was the first of its kind in the nation when it was introduced in 1990, the first year of Mr. Hynes's tenure. Under the program, people convicted of a nonviolent, drug-related crime may choose between going into treatment or going to jail. "The D. A. said, 'I'm going to take this population that would otherwise end up in prison and divert them into treatment,'" said Anne Swern, a deputy district attorney who runs D-TAP. "If they fail the program, they go to jail. But what we've found is that D-TAP can deal with these people with risks to the public that are low and benefits that are very high both financially and recidivism-wise." Ms. Swern said about 50 percent of the people sent to prison in Brooklyn for drug crimes since the program started were re-arrested after three years, while only 23 percent of those who had entered D-TAP were back before a judge over the same period. The program has saved millions of dollars in taxpayer money, too, Ms. Swern estimated. She said it cost $69,500 a year to house an inmate with a drug habit on Riker's Island, the city's largest jail. And it cost $82,000 a year, she said, to hold a criminal in New York City before his trial and then imprison him in an upstate cell. But to treat a convict for drug abuse, even in New York State--which has the highest such costs, she said--takes between $18,000 and $21,000 a year.
    Mr. Hynes also requires every prosecutor in his office to spend at least two days each month talking to students in more than 300 schools in Brooklyn about the consequences of using drugs. This initiative, called Legal Lives, teaches children that there is a price to pay for snorting cocaine or smoking pot by having them act out situations they are certain to encounter on the street. In one script, "Pot Luck," three youths are hanging out in the schoolyard after class, and one pulls out a joint. They light up. Then the cops arrive, and everyone is arrested. "We stop the action there and ask the kids questions," said Mary Hughes, who runs the program. "Why was Bob arrested? Why was Ernie arrested? Did the police have a right to arrest them? Why? What choices did everybody make?"
    So as it turns out, crime-busters, from Mr. Hynes's office to the federal Drug Enforcement Administration, are, in fact, in agreement with Mr. Pastrana. "Everybody knows the D.E.A. as the guys who throw people in jail," said Jack Hook, who runs the agency's demand-reduction section. "But the bottom line is that to solve the drug problem in this country means education, prevention and treating those who are already addicted."

Patients' Kin Defend Barred Psychologist
Vanessa Parks, Boston Globe, 9/5/2000

AMHERST - When Eduardo Bustamante's license to practice was yanked by the state Board of Registration of Psychologists after he exchanged sexually explicit e-mails with a teenage client, it caused an uproar with many of the parents of his other patients. They were concerned about their own children - but not for reasons one might expect. Far from seeing Bustamante as a threat, they view him as their children's only salvation.
    ''He's a necessary part of our lives,'' said Forrest Stoddard. ''We just want to be able to see him. There are suicidal kids out there. These parents are desperate, they are frantic, they don't know what to do.'' Stoddard, who said his son saw Bustamante for occasional ''tune-ups,'' helped found People for At Risk Kids, or PARK. The group of patients and parents is rallying around Bustamante, a licensed clinical psychologist and author who has practiced in Amherst for 15 years. They say that Bustamante's willingness to treat severely disturbed adolescents - youths who kill cats or light fires - and his unconventional methods - lighting fires with them, teaching them the right way to throw a knife - made him an easy target. They've hired a lawyer to fight the revocation of Bustamante's license, and persuaded folk legend Pete Seeger to do a benefit concert for him Saturday night in Northampton.
    All of which is mystifying to Cambridge lawyer Stanley Spero, who filed complaints against Bustamante with the state board and in Hampshire Superior Court. Only a ''tidal wave of manipulation'' unleashed by Bustamante, Spero said, can explain why people would support any adult, let alone a therapist, who would demean and exploit a teenager and refer to her using profanity. ''His argument is, `I'm somebody who has this new technique. I'm a creative therapist and I'm being punished for it,''' Spero said. ''I do believe that every field requires some creativity. But there are certain principles and ethics that are mandated, that you must stand by.''
    Finding that Bustamante, who has a doctorate in clinical psychology from Adelphi University, violated various standards of care, the state board revoked his license to practice psychology in Massachusetts, effective this summer. He can reapply for it in three years, provided he has fulfilled certain conditions. It was the first time since 1997 that a psychologist's license had been revoked, said Jennifer Tunnera, a spokeswoman for the state Division of Professional Licensure. Bustamante is appealing the decision. The charges stem from Bustamante's relationship with Jessica McVey, who was 18 when she began seeing him as a patient. Early on in her treatment, she told Bustamante that she was attracted to him - so much so that she was unable to concentrate on therapy. She asserts - and Bustamante denies - that he told her he was attracted to her, too, but that they would have to wait before the relationship got physical, according to her civil suit filed in Hampshire Superior Court.
    McVey's mother, Linda, said in court papers that after she became alarmed by what she considered improprieties - including her daughter dressing provocatively for her appointments - she told Bustamante that he should no longer treat the girl. But Bustamante continued to see her without her mother's knowledge, telling the board later that the teenager was not a minor and that, because she was being abused by her then-boyfriend and only he knew it, he felt she was not safe. Bustamante began seeing McVey as often as three times a week, typically from 9:30 p.m. until midnight, and exchanging e-mail messages in which they sometimes talked about romantic feelings or sexual fantasies. Bustamante also had either loaned or given McVey a computer, an answering machine, and a separate phone line - all designed to ''empower'' her from her dependence on her family and boyfriend, he told the board.  Because McVey had set up ''tests'' that he must pass in order for her to trust him, including revealing information about his own life, Bustamante told the board, he sent her e-mails about affairs with previous patients and dissatisfaction in his marriage. But in testimony before the board, Bustamante said he had made up those details in order to pass her test.
    McVey, now 21, first saw Bustamante in June 1997 as part of a family therapy session with her mother and younger brother. Her brother had been seeing Bustamante for about two months. Bustamante then told Jessica, who was seeing a different therapist for problems related to past trauma, that she needed individual treatment with him. By October, she had written her initial ''love letter'' to Bustamante and her mother had intervened. During one six-day period the following April, Bustamante left 50 messages on the teen's answering machine, allegedly saying in one that he would kill her if she didn't start returning his calls. The patient was so frightened, Spero said, that she called police. By this point, Bustamante told the board, he was worried that McVey was fabricating material against him. He had introduced her to two of his brothers so that they could be witnesses, but the board found that was an unprofessional way to handle the situation, and a breach of patient confidentiality.
    Tapes of the phone calls and transcripts of e-mails were supplied to the board. ''The board swallowed, lock, stock, and barrel, all the fabricated evidence - and that's what it is,'' said Stoddard, one of the parents defending Bustamante. ''It's very easy to make up an e-mail and a phone message.'' However, Bustamante denied responsibility for only one e-mail message, the file containing explicit cybersex. In one e-mail, McVey describes a recurring image of being raped and Bustamante responds, ''Please accept a warm, unselfish hug ... At the same time, this image is a turn on to part of my brain.'' He said that the latter part of the message was written in the voice of ''Monk,'' one of several characters he and McVey had created to relate ''serious messages in a playful way,'' according to board documents. Bustamente's former office manager, Patti O'Connell, said he is currently living in Miami and working in marketing for his brother. He could not be reached for comment. The board wrote, ''the fact that [Bustamante] might have believed that his conduct was justified by the situation in which he purportedly found himself ... causes further concern as to [his] competence to practice psychology.''
    His supporters see it differently. ''Eduardo is willing to play outside the box - at his risk, and he knows it,'' said Frank Barrett Mills, the father of an adopted son who, at age 5, had no verbal skills and had never been taught to use a fork or spoon. He said his son's condition improved markedly after just a short time with Bustamante. ''He doesn't sit a child in a chair and ask them questions and say, `What does that mean?' If a child swears or kicks, Eduardo literally will accept that. He's not looking for a standard of behavior that is above what that child is capable of.'' Lori Steiner is a former patient and the mother of a former patient who she said is now doing fine. ''We have a culture hysterical about anything that smacks of sexuality,'' Steiner said. ''The sanction is way too extreme, and it's in response to that hysterical culture. Given the level of good this man does, the sanction should not be revocation. It should maybe be probation. ... This is a crime against the kids who need him.''  Many of Bustamante's supporters accuse the McVeys of lying and being motivated by money.  ''I truly believe you've got a couple of golddiggers here,'' Barrett Mills said. Spero initially requested $150,000 and later $300,000 on behalf of the McVeys, using a standard ''demand letter.'' ''That's the way our system works,'' Spero said. ''This was never, ever an exorbitant, excessive demand. It was an attempt to really get this resolved and let her go on with her life.'' He expects the civil case to go to trial sometime in the coming year if it is not settled before that.

Convicted Motorists Check in on Holiday
Matt Helms, Detroit Free Press- 9/5/2000

It's chilly and gray outside Novi United Methodist Church, and the sun has barely risen as people arrive to breathe into a machine that will tell whether they've been drinking. What a way to spend Labor Day morning. "It's better than jail," said Dawn Eikhoff, 22, of South Lyon, a nurse's aide serving 9 months of probation for driving while impaired.
    Roughly 1,000 people like her, convicted of alcohol-related driving offenses in Oakland County, are required to check in each day of the holiday weekend. Some said it's intrusive and harsh, but it sure beats more severe punishment. "If you want to go on vacation with your family, you can't," said Rich LaPree, 34, a South Lyon carpenter who is serving two years of probation for driving while impaired. "On the good side, it keeps people honest." Novi District Judge Brian MacKenzie announced last week that the testing program will be permanent and include four additional holidays -- Thanksgiving, Fourth of July, Memorial Day and New Year's Eve. Violators pay $5 for each test to fund CATCH -- Courts Acting Together for the Community at the Holidays.
    Robert Kish of Novi said he's learned his lesson after drinking and driving two years ago in Walled Lake. He ran a red light and nearly hit a police car. "You can bet it won't happen again," the 34-year-old maintenance worker said. Like most of the nearly 180 people tested at the Novi church, he was alcohol-free Monday. Only three people at the site tested positive, said Art Levine, an owner of the private Jail Alternatives for Michigan Services, or JAMS, which administers the tests for district courts in Novi, Rochester Hills, Southfield, Ferndale and Troy. There were five test sites in Oakland County, a site in Eastpointe and one in Dearborn.
    The program focuses on those who've been convicted of drinking and driving -- people MacKenzie says are likely to have alcohol dependency problems and repeat infractions. One of those apparently likely to have dependency problems was a middle-aged man who blew a 0.024 on the test then a 0.025 about 15 minutes later Monday morning -- not near the level at which someone can be convicted of drunken driving (0.10) but something his probation officer may not like. The man blamed it on taking a cough syrup that includes alcohol earlier in the morning. He first said he needed it to help him sleep, then said it was for asthma.  Whether the man had been drinking is for judges to ponder. Levine and JAMS employee Molly Bemus were there only to conduct the tests.

As Prescriptions Pile Up, Risks Do, Too
Jane E. Brody, New York Times- 9/5/2000

At 88, Nathan, a New York businessman with a sharp, clear mind, was still going to work every day. Then an episode that resembled a ministroke landed him in the hospital, where numerous medications were administered. Within days, Nathan's mind and memory had turned to mush. The family was ready to put him in a nursing home when, at a knowledgeable relative's request, the drug regimen was reviewed and several drugs of questionable necessity were discontinued. Nathan soon returned to his previous mental state and was able to continue working for several more years. Ninety-five-year-old Anne of Boca Raton, Fla., also had a sharp mind and good memory until two potent drugs she was given for rheumatoid arthritis, along with six or seven others for related health problems, led to such severe mental deterioration that she became unable to communicate with her favorite brother. Within weeks of being taken off the two arthritis drugs and Valium, she began to come back to herself. 
    Both Nathan and Anne were the victims of polypharmacy, a "poisonous cocktail"-- as some doctors put it--of three, four or more drugs that may have side effects that render the treatment worse than the disease. Although there are no precise statistics on the incidence and consequences of polypharmacy, experts report that it is an increasingly common problem now that so many people live into their 70's and beyond, when nagging physical discomforts and chronic health problems often arise. In various studies, 10 percent to 20 percent of hospital admissions for older people were found to result directly from adverse reactions to prescribed medications

Causes and Consequences
    In a report several years ago in the Journal of General Internal Medicine, Colleen A. Colley, a pharmacist, and Dr. Linda M. Lucas, then both at the Veterans Affairs Medical Center in Portland, Ore., described the problem in detail and offered numerous suggestions to remedy it. Though polypharmacy is by no means limited to the elderly, they noted that twice a many medications were prescribed for patients 65 and older than for younger ones, and that older people used seven times as many over-the-counter drugs than the general adult population.
    Three-fourths of visits to doctors in the United States end with a written prescription, partly the result of patients' expectations that "modern medicine should provide an antidote for every symptom" and partly to save the doctor's time, the authors wrote. The problem of polypharmacy is now being aided and abetted by marketing of prescription drugs to the general public and by the increasing availability of and publicity for herbal and other nonprescription remedies with drug effects and side effects. Many patients have two or more physicians and use multiple pharmacies, so no one person knows every drug they are taking. Given the high cost of many drugs and the lack of Medicare coverage for prescriptions, many patients hoard leftover drugs and take them on their own when symptoms return. Finally, changes in drug regimens, and sometimes in the physical appearance of drugs can confuse patients who may end up taking the wrong drug, too much of the right one or two or more similar medications for the same condition.
    Polypharmacy can become a vicious cycle in which side effects caused by one or more medications are "treated" with yet another drug that has side effects of its own. And, two or more different drugs taken together can sometimes interact to cause serious complications. The problem is worse in older people in part because they metabolize drugs more slowly, resulting in a build-up of toxic doses. Then, too, a complicated medication regimen or the occurrence of side effects may result in noncompliance: the patients simply stop taking the drug or take it less often than prescribed, reducing its therapeutic benefit. This may prompt the doctor to increase the dose or prescribe yet another drug to control the problem In one study of patients discharged from a hospital, the more medications that were prescribed, the greater was the number of errors the patients made in taking them. Those discharged with six or more medications had an error rate of 70 percent.

Reducing the Risk
There are many ways patients and their doctors can avoid the hazards of polypharmacy. The start with the patient--or patient's advocate--acting as a responsible partner in his or her health care. First and foremost, don't expect a drug to be the solution for every symptom. Many heath problems are best treated with adjustments in diet and exercise habits, stress management or simple behavioral changes. For example, rather than a sleeping pill to treat insomnia, changes in habits like caffeine use, naps or bedtime routines may solve the problem without a drug.
    When any drug is prescribed, patients should insist that the name, purpose, dosage instructions and possible side effects, especially those warranting a call to the doctor, be provided both orally and in writing. Patients should also be told when to expect an improvement and, for drugs that treat hidden symptoms like elevated blood pressure or cholesterol, they should be kept informed of progress, or lack of it, being made toward the desired therapeutic goal. At each visit to a doctor, especially one new to the patient, it is crucial to provide a complete list of the kinds and amounts of every drug being taken, including over-the-counter medications and herbal remedies, which may have the same drug effects or side effects as a prescribed medication or may interfere with the effectiveness of a prescribed drug.
    For example, the herb St. John's Wort can impair the effectiveness of several important drugs, including the heart drug digoxin (Lanoxin) and the antidepressant imipramine (Tofranil). Some experts suggest a "brown bag" approach, in which patients put all their pills, including vitamins, in a bag and bring them to the doctor for review. Even if you always see the same doctor, a periodic review of what you take can help prevent polypharmacy problems.
    When you are given a prescription and are told why, be sure to fill it and take it as prescribed. Noncompliance with doctor's orders--taking too little or too much of a prescribed drug--is a major cause of polypharmacy problems. Complicated dosing schedules can also interfere with compliance. If, say, you are taking one drug four times a day, another three times a day and a third twice a day, ask the doctor if an adjustment can be made to reduce the chances that you might forget or get confused. Many drugs used for chronic health problems are available in several dosage forms, including time-released, which may permit a reduction to only one or two doses a day.
    Unpleasant side effects also lead to non-compliance with a prescribed regimen. Rather than discontinuing a drug or reducing the dosage on your own, tell the doctor about side effects you cannot tolerate; often another medication can be substituted or a change can be made to solve the problem. Finally, try to fill all your prescriptions at the same pharmacy, where a record is kept of what you are taking. And before buying over-the-counter or herbal remedies, chick with your pharmacist to see if any will interact badly with drugs you are taking.

MADD Celebrating 20th Anniversary
Janelle Carter, Associated Press- 9/6/2000

WASHINGTON (AP) -- Two decades after a group of California mothers launched a massive movement known as Mothers Against Drunk Driving, a new study marking the group's 20th anniversary finds the idea has become entrenched in American attitudes. Most Americans now support lowering the legal blood alcohol level limit to keep more drunken drivers off the roads. ''Over the past 20 years, MADD's grass-roots movement has moved the hidden horrors of drunk driving from the back-page obituaries to the front-page headlines and into the nation's social consciousness,'' said Millie Webb, president of the group. Today's American public ''wants action, not just rhetoric,'' Webb said.
    A Gallup survey conducted July 20 to Aug. 3 -- commissioned by MADD and sponsored by General Motors -- found that 72 percent of American drivers support lowering the drunken driving limit from 0.10 to 0.08 blood alcohol concentration. Sixty-five percent of the 930 licensed drivers surveyed supported a federal law requiring states to lower the limit. The survey also found that 94 percent of respondents were discouraged from drunken driving by the realization that they could kill or injure others, 91 percent by the possibility of a jail sentence.
    Nevertheless, 57 percent of respondents said they have operated a car under the influence of alcohol. There's federal evidence MADD's campaign is working. Transportation Department figures released Wednesday indicated that alcohol-related traffic fatalities dropped further to a record low 38 percent last year. In 1998, the figure was 39 percent.
    It's all a long way from the public perception of drunken driving that existed 20 years ago when some California women, angered by the hit-and-run death of a 13-year-old girl, started what has now become a national movement. Before MADD, there was no national, uniform 21 drinking age law or the scores of other drinking and driving laws now in existence. ''Before MADD began its work, the death of a child caused by a killer who drank too much before getting behind the wheel was considered an accident,'' said Transportation Secretary Rodney Slater.
    Currently, the legal blood alcohol concentration level is the national uniform standard of 0.10 in all but 18 states and the District of Columbia. Those states have already adopted the 0.08 standard, a limit MADD is now trying to make the national standard. Legislation in the Senate version of the transportation appropriations bill would require states to enact a 0.08 drunken driving law as a condition of receiving federal highway funds. The matter is being debated by House and Senate conferees.
    President Clinton sent the conferees a letter Wednesday urging them to keep the language in the final bill. ''It is imperative that we do more to save lives and keep drunk drivers off our roads,'' Clinton wrote. ''Enacting a standard of 0.08 BAC across the country is the next logical step.'' But lobbyists supporting the alcohol industry say the proposal is flawed and will punish ''responsible social drinkers.'' ''None of the research can show that 0.08 reduces either drunk driving fatalities or injuries,'' said John Doyle, spokesman for the American Beverage Institute, which represents restaurants. ''It will arrest people who are not part of the problem.''
    Under a 0.08 standard, a 120-pound woman who drinks two 6-ounce glasses of wine will likely hit the blood alcohol limit, Doyle said. ''The average (blood alcohol concentration) in a drunk driving fatality is 0.17'' Still, Webb said the standard is needed to ''jump start the next phase of the war on drunk driving. It is time for the politicians to take the politics out of this life-and-death decision.''

Social Workers Push For Respect
Eileen McNamara, Boston Globe, 9/6/2000

Karen Power has a dream job, if your dreams run to nightmares. There's the lousy pay, the dangerous working conditions, the indifference, or worse, of a complacent public toward the social work she practices. Now, her employer proposes to further enhance her status by eliminating what job security and pay incentives she has earned serving the most vulnerable among us.
    Power works for Family Service of Greater Boston, a private, nonprofit agency under contract with the state Department of Social Services to help thousands of beleaguered families from Revere to Roxbury. Most of the 40 clinicians and social workers employed by the 165-year-old agency earn an annual salary between $30,000 and $35,000, considerably less than the $45,000 pay raise Governor Paul Cellucci collected this year. In exchange for this princely sum, on a recent morning Power traversed metropolitan Boston by public transit on her regular rounds of households beyond the reach of the stock market boom. New economy, old stories: a client with a substance abuse problem and a son in a program for troubled youth; a woman with a major mental illness whose oldest child just ran away and whose two youngest just returned from foster care; a teenager anxious about returning home after months in a residential treatment program. Her day did end on an upbeat note: a foster mother asked to adopt the children in her care.
    In some ways, this is the best job Power has had in her 20-plus years in the field. She had no pension when she worked in a residence for emotionally disturbed adolescents. She had even less when she worked as an assessment counselor in a Romanian orphanage. ''We do this work because we love it,'' she acknowledged, ''and if this were Romania or we were in a recession we might not consider the action we are about to take.'' That action is a strike, a work stoppage that Power and her colleagues, represented by Local 285 of the Service Employees International Union, are prepared to initiate this month if Family Service of Greater Boston does not reconsider its contract offer.
    The agency wants to impose arbitrary productivity standards, to mandate weekend work hours, and to eliminate annual raises based on seniority, paltry sums that permit men and women on the front lines of our most pressing social problems to work their way up from salaries that start at $20,000 and top out at a little more than $40,000 after 14 years. The total annual cost of those raises to an agency with a $9 million annual operating budget and a $23 million endowment? Sixteen thousand dollars. A pittance compared to the $300,000 that Local 285 contends Family Service of Greater Boston budgets for director Randal Rucker's salary and benefits each year. ''There's a saying we have in the field, that we shouldn't ask of our clients what we don't ask of ourselves. That's about respect and that's what we are not getting,'' said Power.
    In the last decade, as a cost-saving measure, Governors William Weld and Paul Cellucci have privatized most of the human services programs in Massachusetts. Social workers like Power, as a result, make substantially less than their counterparts at DSS who are state employees. The Legislature has paid lip service to raising the pay of direct-care workers. This year it earmarked $25 million for a reserve fund for just that purpose, but when Cellucci slashed it to $15 million, lawmakers did not override his veto or challenge the hefty pay raises for his top aides and members of the moribund Governor's Council.
    If the clinicians and social workers at Family Service of Greater Boston do strike, the agency has warned it will hire permanent replacements and open a second office so that those workers will not be forced to cross picket lines. That threat has the ring of union-busting. The agency would do well to remember the experience of Tenet Health Care in Worcester last spring. The owners of St. Vincent's Hospital endured a bitter six-week strike by 535 registered nurses who walked off their jobs to protest Tenet's insistence on mandatory overtime. Nursing, like social work, is not an assembly line job. Squeeze the staff and it is the patients and the clients who will suffer. The nurses won in Worcester. The people of Massachusetts do not care nearly enough for those who care for the neediest among us, but we care even less for those who would so blatantly exploit them.

Trying to Prevent the Next Killer Rampage
Laurie Goodstein, New York Times- 9/6/2000

ITHACA, N.Y.--It was nearly four years ago when the police climbed the creaky stairs to Deborah Stagg's apartment in response to calls from neighbors who had heard her screaming and raving alone in there. Ms. Stagg was known around town as a woman so disturbed that she had once delivered her own baby by cutting her womb open with a pen knife. This time, a steak knife in hand, Ms. Stagg bolted from her barricaded bathroom and stabbed Inspector Michael Padula in the neck, a fatal wound. The police opened fire, killing Ms. Stagg.
    The double deaths were a pivotal trauma in Ithaca, where Inspector Padula was the first police officer killed in the line of duty. In the grim aftermath, the police blamed the mental health department and the mental health advocates blamed the police. In the midst of the mourning and finger-pointing, a policeman and a mental health clinic supervisor who were distant acquaintances got together over beer to talk about whether they could prevent such occurrences, jotting down ideas on bar napkins. Out of it grew a collaboration between the Ithaca police and mental health departments that some policing experts say is unmatched anywhere in the country because of its focus on pre-empting problems in addition to responding to crisis.
    Now, when the police department receives a call that someone is behaving bizarrely, making threats or talking of suicide, it is usually the two men who brainstormed in the bar--Lt. John Beau Saul of the police department and Terry Garahan, the mental health clinic supervisor--who drive to the scene together in a worn police van to assess the situation. They have paved the way for other police officers or county sheriffs and mental health workers to go out regularly on calls together. They intervene when the case is potentially dangerous, as when a young man threatened to kill the staff at a temporary employment agency and then kill himself. But they also intervene when the case might appear frivolous, as when a woman called to report Martians invading through her ceiling.
    "We go out and find these people and try to get them to get the help they need," Lieutenant Saul said, steering the van down a leafy street to visit an elderly man who had called the police to report a jar of peanut butter stolen from his bed. "If you go to other places," he said, "people like this are avoided like the plague. We actually go out of our way to find these people and engage them." The unlikely team, one a clean-cut cop, the other a long-haired social worker, uses a carrot-and-stick approach, sometimes cajoling a person into mental health treatment or contact with other social services, and sometimes, where criminal behavior is involved, using the threat of arrest or imprisonment. The result is that even Ithaca police officers who were initially cynical about the approach now say they have seen a steep decline in the number of chronic phone callers tying up police lines and time, and fewer untreated mentally ill people out on the streets. In several cases, they succeeded in defusing emotionally disturbed people who were armed and threatening violence, prodding them into psychiatric care rather than prison.
    In a study of rampage killers conducted earlier this year by the New York Times, family, friends, and neighbors of killers repeatedly said in interviews afterward that they had observed the killers behaving strangely or making threats before the crime, and had tried to alert the police or mental health officials, to no avail. The police often say that they can intervene only after the person has demonstrated a danger to himself or others. Mental health services and hospitals in most places are stretched so thin that they too are not equipped to respond. The city of Ithaca has dared to move beyond this "hands are tied" response. A maverick university town, the home of Cornell, in upstate New York at the southern tip of Cayuga Lake, Ithaca has committed the resources of its police and mental health departments to respond even when there is no immediate crisis. It allows the sharing of information between the departments about past criminal and mental health histories, treading close to a line that could raise the hackles of civil libertarians and advocates of mental health patients.

Approaching the Mentally Ill
    The approach in Ithaca goes beyond that of other cities in which police departments have begun programs for dealing with the mentally ill. The model most commonly copied is from Memphis, where a specially trained police unit responds to crisis calls about emotionally disturbed people, referred to by the police as EDP's. Other cities, like Los Angeles and Birmingham, Ala., have paired social workers with police officers who respond to crises involving the mentally ill, said several experts who study policing.
    What is unusual in Ithaca is the emphasis on prevention, and the decision to devote police resources to following up on people with chronic problems who do not always want to accept help. Over the course of the summer, Mr. Saul and Mr. Garahan revisited several cases, including those of a mentally ill crack addict who was resisting drug treatment, an angry schizophrenic who had threatened his ex-wife and was making harassing phone calls to public officials at their homes, and a paranoid factory worker who wanted the police to investigate "mind intrusion machines" that he insisted were planted in his home and workplace. By August, Mr. Saul and Mr. Garahan had succeeded in steering two of those individuals into treatment and were still making weekly visits to persuade the crack addicted man to enter a drug detoxification program.
    "That's pretty unique. I haven't heard of that type of follow-up before," said Melissa Reuland, a research associate at the Police Executive Research Forum, a Washington nonprofit group whose members include chiefs from the nation's larger police departments. "This really is problem-solving in action, identifying hot spots and partnering with service providers in your community who have expertise where you don't. If we could subject this to a really critical legal and ethical analysis, I think it's got some promise."
    But such aggressive police involvement has a risk, said Henry Steadman, the president of Policy Research Associates, which studies mental disorders and the criminal justice system. "There is a potential invasiveness there for individuals who would feel coerced into mental health services because the police are still checking up on them in the role of police officers," Mr. Steadman said. "If the person is simply seen as in need of treatment, then why should the police be hanging around forcing the person into treatment?" Ron Honberg, director of legal affairs at the National Alliance for the Mentally Ill, said, "I think it's great that Ithaca cares enough to do something creative. I just worry that if it's done the wrong way it conjures up images of Big Brother at its worst."
    The police are often on the front lines of mental health care in this country, like it or not. For instance, the Ithaca Police Department was called on Aug. 26, 1999, when the managers at Stafkings, a temporary employment agency, arrived at work to hear two chilling messages on their answering machine from an unemployed man who said he was frustrated that he had not been offered a job. "I'll kill all y'all in there. I ain't playing, man," he said, spitting out his words in the recorded message, "The day that I kill all you I'll probably kill myself because I'm upset enough."
    In many smaller police departments that have not been trained in threat assessment, the routine response would be to document the complaint and leave it at that. In Ithaca, the police department contacted Mr. Garahan, who, as supervisor of the county outpatient mental health clinic, knew the man who had left the message. Jason James, who is 21, suffered from psychotic episodes and had received a diagnosis of schizoaffective disorder at the clinic, but had quit treatment. The phone threats indicated he had reached a critical stage. Found at his house, Mr. James was charged with aggravated harassment, but was told that he could avoid jail by committing to a program of counseling and psychiatric medication. Mr. James, accompanied by Mr. Garahan, appeared in court before Judge Judith Rossiter, who often works closely with Mr. Garahan and Mr. Saul to devise alternatives to prison for emotionally disturbed people. Judge Rossiter dropped the charge on the condition that Mr. James resumed treatment.
    One day last month, Mr. James rode his bicycle to Ithaca's mental health clinic, which he does daily to receive his daily medication. Soft-spoken and serious, Mr. James said that now that the voices had faded, he knew he needed the treatment. He said he still struggled, however, to explain his illness to his family and friends. "They just wave their hands and say, 'He's sick,' 'he's crazy.' I want people to see that I am getting treatment, that I am living a better life," he said, before riding off to a job interview.

Emphasizing Persistent Vigilance
    Often, however, people are far less compliant, even when facing arrest. All summer, Mr. Garahan and Mr. Saul worked on the case of Nicholas Celia, a 44-year-old man with a record of convictions for assaults on civilians and police officers, and a history of alcohol and drug abuse as well as psychiatric problems and hospitalizations--the three factors that experts say indicate a potential for future violence. Recent studies have found that the mentally ill are no more violent than other people, except when they are off their medications or have been abusing drugs or alcohol. Looking like a pirate in a blue bandanna and hoop earring, Mr. Celia wandered the Ithaca Commons, the city's open-air street mall, sometimes mellow and bumming cigarettes, sometimes screaming and menacing. He was repeatedly arrested on charges of harassment and assault once on Mr. Garahan, who got an order of protection against Mr. Celia and began to carry pepper spray. Even some of Mr. Celia's friends at the regular Wednesday night dinner of the local mental health advocacy group said in interviews that Mr. Celia was starting to scare them and needed help.
    Mr. Garahan and Mr. Saul decided to use the newest, most aggressive tool they had to compel Mr. Celia into treatment: Kendra's Law, named for Kendra Webdale, who died after being pushed n front of a New York City subway train by a mentally ill man. They filed a petition asking a judge to order Mr. Celia into outpatient drug treatment and counseling. At his hearing, Mr. Celia interrupted a psychiatrist testifying that he had examined Mr. Celia and diagnosed bipolar disorder, or manic-depression. "I would like to say, Your Honor, I am getting a little upset hearing these lies and innuendo, and this is what happens when I am under stress and this is a farce to me," Mr. Celia said, speaking loud and fast. The judge ordered Mr. Celia to report to the outpatient clinic for injections of Haldol.
    In his police car after the hearing, Lieutenant Saul volunteered that he was uneasy at the idea of forcing psychiatric drugs on someone. "I have a miniature soul-search about it, but then maybe if Deborah Stagg had been forced to take medication, Mike would still be alive," said Mr. Saul, who wars a small pin on his uniform in honor of Michael Padula, the dead policeman.
    Mr. Celia's response was to flee. He went to New York City, checked in to Bellevue Hospital's psychiatric ward, returned to Ithaca, was arrested, hospitalized again and released, returned to New York City, was arrested and sent again to Bellevue before being transferred to a county hospital for long-term treatment. In a telephone interview from Bellevue in August, Mr. Celia, now more subdued, insisted he needed no treatment, saying, "What's happening to me is an injustice."

An Appreciated If Unenvied Job
Even in this politically liberal college town, however, it is hard to find a civil libertarian or mental health consumer who objects to the work of Mr. Garahan and Mr. Saul. Some do oppose the law stemming from the Kendra Webdale killing, but all said in interviews that they were glad there were officials with mental health experience to call in emergencies. Much of Mr. Garahan and Mr. Saul's work boils down to protecting emotionally disturbed people from hurting themselves or from being victimized by others. After months in which they tried to convince the woman obsessed with Martians to seek treatment, she set a fire in her apartment to exorcise the extraterrestrials. She walked to the police station and was hospitalized.
    And when Mr. Garahan and Mr. Saul responded to the elderly man who had reported a jar of peanut butter missing, they found him living in a basement apartment swarming with flies, with feces tracked across the floor and a bare light bulb that had burned through a lampshade. They called building inspectors, who condemned the place. They called an ambulance for the man, in keeping with their approach that "medicalizing" a mental illness is less threatening for the person. "I know it doesn't look like compassion, but it is for his best and for the neighborhood's best," Mr. Saul said to neighbors curious about the ambulance. The landlord has since renovated the apartment, Mr. Garahan said. As to whether they have ever stopped a rampage killer, Mr. Garahan said, "You do this stuff and you don't know whether you prevented something or not. But I do know that the ability of the two disciplines, police and mental health, to work together has a tremendous effect on a lot of people's lives."

Two Psychiatrists Say They Feared Wife of Surgeon-Defendant Was in Danger
Samuel Maull, Associated Press- 9/7/2000

NEW YORK (AP) - Two psychiatric professionals testified Thursday that they contacted a woman who allegedly was murdered by her husband, a plastic surgeon, because they feared she was in danger. Dr. Stanley Bone, a psychiatrist, said he warned Gail Katz-Bierenbaum in November 1983 that she was at risk. Bone said her husband, Dr. Robert Bierenbaum, was his patient and had authorized him to speak to her. ''Did you warn her that she might be in danger?'' asked Assistant District Attorney Daniel Bibb. ''Yes,'' Bone replied. Bone told State Supreme Court Justice Leslie Snyder that he thought it would help his patient to speak to Katz-Bierenbaum. ''It doesn't help him if he's in a position to do anything that causes harm to his wife,'' Bone said.
    Dr. Shelley Jurand, testified that she called Katz-Bierenbaum at home. ''I wanted to hear her voice because I was concerned for her safety,'' Jurand said. ''I didn't think I'd hear her voice.'' Bierenbaum, 44, who now lives and practices in North Dakota, was charged last month with the murder of Katz-Bierenbaum, 29, 14½ years ago when they lived in New York City. Her body was never found. Prosecutors allege that Bierenbaum, a licensed pilot, killed his wife in their Upper East Side apartment, packaged the body, and dropped it into the Atlantic Ocean from a small private airplane.
    Katz-Bierenbaum, who was working on a doctorate in clinical psychology when she vanished, was last seen July 7, 1985. On that day, Bierenbaum, then a resident at Maimonides Hospital, told police his wife was missing. Snyder said Thursday that she expects jury selection for the trial to begin Sept. 18. Bone and Jurand said they were troubled about testifying at the hearing on whether Bierenbaum's statements to them may be used at his murder trial. They said the feared they were violating doctor-patient privilege rules. When the witnesses hesitated to answer questions, Snyder ordered them to respond, telling them that doctor-patient privilege issue is a legal matter which she will resolve after the hearing. Prosecutors say the statements, apparently damning, should be allowed, while the defense says they are protected as doctor-patient exchanges.
    Another Bierenbaum psychiatrist, Dr. Michael Stone, testified earlier in the hearing that he had written Katz-Bierenbaum a letter on Nov. 20, 1983, telling her she was in danger as long as she stayed with her husband.  Stone, who apparently was trying to shield himself from civil liability, has since retained a lawyer who has advised Stone that he should not testify at trial and he should not relinquish any documents concerning Bierenbaum.  Meanwhile, the New York Psychiatric Association and the American Psychoanalytic Association filed a joint ''friend of the court'' brief in which they said the court should exclude the defendant's psychiatric records and statements he made to his psychiatric professionals.

Connecticut Files Class-Action Lawsuit Against Four HMOs
Donna Tommelleo, Associated Press- 9/7/2000

HARTFORD, Conn. (AP) - Attorney General Richard Blumenthal filed a federal class-action lawsuit Thursday against four major health insurers, charging the companies continually put profits over patients. The suit demands no money but seeks sweeping reforms of the industry. ''It's a cause whose time has come,'' said Blumenthal. ''Abuses by HMOs have been a fact of life for years now.'' Blumenthal sued the state affiliates of Anthem Blue Cross and Blue Shield, CIGNA HealthCare, Oxford Health Plans and Physicians Health Services and their respective parent companies. The insurers cover nearly 2 million people in the state.
    The suit accused the companies of failing to tell patients what drugs are covered in their plans; stalling payments to doctors and other providers; mishandling patient complaints; making arbitrary coverage decisions; and withholding information on appealing those decisions. Blumenthal said he wanted all of those issues addressed through changes in the way the companies operate. ''In no way are we trying to damage the businesses,'' he said. ''In fact, there's a lot of evidence that companies which have reformed their practices actually are doing better because they eliminate a lot of the administrative costs.'' Blumenthal, who said his lawsuit is the first such case filed by a state, has been a key figure in similar lawsuits against the tobacco and firearms industries. He said he hopes other states will join this effort.
    Kathy Fiala, an asthma patient, learned from her pharmacist that the drug her doctor prescribed was not on CIGNA's approved list. The Marlborough woman, one of two plaintiffs joining Blumenthal at a news conference Thursday, said she opted for a substitute approved by CIGNA. ''The substitute wasn't as good as what my doctor prescribed,'' she said. She eventually changed her plan to Anthem, which does cover the drug. Renee Piontkowski, of Weston, said she was satisfied with her coverage from Anthem until the insurer switched its mental health care provider at the beginning of the year. ''From that point on, there was a dramatic change in how we were treated,'' said Piontkowski. She said she has paid about $10,000 for psychiatric treatment for her teen-age daughter this year.  Piontkowski said she was repeatedly given the run-around when she tried to file claims or contact a supervisor.  ''At this point I felt it was incompetence or a deliberate act to deceive, and I called the attorney general's office,'' she said. The first correspondence from Anthem did not arrive until eight months after her first phone call - and by then, she said, it was too late to file some of her claims.  Blumenthal said the suit is the result of a two-year investigation into scores of patient complaints. Nearly one half of all complaints his office has received over the past several years are related to health care coverage, he said.
    Oxford officials had not seen the complaint but said they usually pay claims within seven days of receipt. Oxford also said its drug benefits are approved by the state Department of Insurance and said members are told which drugs are covered. ''We are disappointed in the attorney general's decision to file suit without consulting us and without verifying any of his basic allegations. We would, of course, welcome the opportunity to sit down with his office to resolve these concerns,'' the company said.
    Shelton-based PHS also defended its record while saying it was willing to discuss reforms with Blumenthal. But the company said lawsuits would only create barriers to access and increase costs. Anthem Blue Cross and Blue Shield said its Connecticut HMO was recently cited by the National Committee for Quality Assurance as one of the best in the nation. CIGNA spokesman Mike Fernandez said the company had not seen the complaint and could not comment on specifics. ''As a major Connecticut, employer, however, we would have expected the attorney general to have extended us the courtesy of reviewing our standards, practices and quality of care and customer service initiatives before instituting suit,'' Fernandez said in a written statement. ''Had he done so, we are confident that he would have found them to be among the best in the industry.''

Revised Michigan Mental Health Plan Discussed
Amy Franklin, Associated Press- 9/7/2000

LANSING--Sandy Libstorff told state health officials Wednesday about the educators and mental health advocates in Monroe County who helped bring home her 15-year-old autistic son after two years of treatment. A private company providing mental health services in Monroe would not have been able to offer the services Libstorff's son, Dustin, requires to live at home, she told state Department of Community Health officials at a public hearing about its revised mental health plan.
    "The bottom line is that care must be there for the next Dustin who comes along," she told the auditorium filled with mental health officials and advocates. Libstorff supports the state's revised plan for mental health services that would open competition to outside providers if county boards, which currently provide services, cannot meet new requirements. She joined dozens of other speakers who questioned whether the department would be able to convince the federal Health Care Financing Administration that open competition is not a good idea in Michigan.
    The federal government has asked the state to open competition beyond the 49 county-sponsored Community Mental Health Services programs currently providing prepaid health plans for Medicaid recipients. The state revised its original plan, which would have allowed open competition, after hundreds of people testified at public hearings last year about being uncomfortable receiving mental health care outside the county mental health boards.
    "The danger with open competition would be splitting off services under different providers," said Glenn Stanton, director of the state Bureau of Quality Management and Service Planning. Under the revised plan, the state will fully open competition in areas where county mental health boards cannot meet new requirements, including the ability to serve at least 20,000 Medicaid recipients. Mark Reinstein, public policy director for the Mental Health Association, called the department's plan disappointing and inadequate. He said open competition would improve mental health services.

A Strategy to Fight Domestic Violence
Francie Latour, Boston Globe- 9/8/2000

Sometimes, after the fights and the unwanted advances, and the sounds neighbors try not to hear, a door is all that stands between a woman and a man who wants to kill her. For two Boston women this year, it wasn't nearly enough. Yolanda Herrera Diaz opened the door of her Jamaica Plain apartment to a man who had pursued her for months. Minutes later, as she cooked dinner, Oscar Urrea allegedly slashed her with a butcher knife, stabbing her to death. She was 25. Tameka Reeves never had a chance. When the 20-year-old opened the door to her mother's Dorchester home in August, her longtime boyfriend, Dane Atteck, shot her in the forehead, killing her before turning the gun on himself.
    Yesterday, in a gathering that drew US Attorney General Janet Reno, top city officials and a host of victims' advocates, the presiding judge of Dorchester District Court launched a new court session dedicated solely to domestic violence cases, vowing to place many more barriers between victims of abuse and their abusers.  In the most-comprehensive approach to date, Judge Sydney Hanlon said the court would provide a kind of one-stop shopping, offering services for victims and defendants. The court will hear all domestic violence cases from beginning to end, bringing specially trained prosecutors, probation officers, investigators, and victims' advocates together with victims and offering everything from special translators to shelter referrals and even emergency economic aid.
    The project will also focus on the most high-risk offenders, making them accountable, while allowing other offenders who want to change the ability to participate in batterers' programs. ''This is truly a day that the community of Dorchester can celebrate and be happy,'' said Mercedes Tompkins, a founder of the Dorchester Community Roundtable, a network of advocates, law enforcement and community leaders that formed in 1991 to address domestic violence. ''Happy in the knowledge that our community will be free of violence.'' After almost a decade spent nurturing collaboration among police, probation, medical workers and others to tackle the problem, Tompkins said, ''We are now on the threshold of dealing with domestic violence on the next level, of getting the judicial system to respond to the community's issues of domestic violence.''
    Reno hailed the new court as a project that could become a national model for tackling domestic violence, much in the same way Boston's strategy to combat youth crime became a blueprint copied by other police departments.  Saying she felt at home in a city that has pioneered new collaborations in crime-fighting, Reno said, ''From the very beginning, Boston has been the place that has shown the nation what can be done... when the people are heard.''
    The $1.9 million pilot project, funded by the Department of Justice, will target domestic violence in a court that issues the second-highest number of restraining orders in the state each year. And it will try to promote public awareness in a community whose diversity presents unique burdens for enforcing the law and protecting victims.  Until yesterday, when accused batterers faced a judge in Dorchester, they could be lined up alongside defendants facing any number of charges, from public drinking to drug possession. Now, domestic violence defendants will face charges surrounded only by others accused of abuse themselves, setting a tone officials hope will reinforce the seriousness of the crime. Under Hanlon, the court will conduct all arraignments, hearings, probation reviews and hear all restraining orders.

Shedding Light on Seasonal Affective Disorder
Clare Oh, Washington Post- 9/8/2000

On the last morning of August, the rain started early as a slow drizzle that persisted all morning. A thick mass of gray clouds covered the sky, and a heavy fog rolled through the city's landscape — seemingly nature's farewell to summer. It was a day in which many people, no doubt, struggled to get out of bed. But if you are one of the 10 million Americans with seasonal affective disorder, or SAD, and overcast day and summer's end can also bring on a debilitating depression. For many, what is commonly known as the "winter blahs" or "winter blues" can start as early as the final days of August to early September and persist until the beginning of spring, when warmer weather and longer days bring a heightened sense of euphoria and hyperactivity.
    Norman Rosenthal, a leading pioneer in the study of SAD, believes that many people—about 20 percent of the adult U.S. population— experience some level of psychological and physical change during the fall and winter. Of that number, 6 percent, or 10 million Americans, are affected severely enough to be diagnosed with this disorder. In his book on seasonal affective disorder, "Winter Blues," Rosenthal writes, "We know that the great majority of the population experiences some seasonal changes in feelings of well-being and behaviors, such as energy, sleep, eating patterns, and mood, to a greater or lesser degree. At one end of the spectrum are those that have few, if any, seasonal changes. At the far end of the spectrum are patients with SAD, whose changes in mood and behavior are so powerful that they produce significant problems in their lives." According to Rosenthal, individuals with seasonal affective disorder also experience a heavy depression on overcast days, regardless of the season. Other symptoms associated with this disorder include: extreme disruption in sleeping patterns (either too much or too little), lethargy and fatigue, overeating (especially a marked craving for carbohydrates), feelings of despair and hopelessness, irritability, anxiety, decreased sex drive and moodiness.
    The far-reaching impact of these symptoms is often so disruptive that individuals with SAD are unable to function normally at work and in their relationships. Jennifer, who didn't want her full named used for this column, learned she had SAD a year ago, but she says that throughout her life, she recognized the effects of diminished light on her mental and physical well-being. "I just had no desire to see friends or go out. It's like my home becomes my cocoon, and I just want to stay there all day and night." Last year was especially bad, she says. "It got to the point where I was so terrified of leaves falling off trees. I dreaded the end of summer for months, and soon as the light started changing at the end of August, I would become instantly depressed." It wasn't until several years ago, however, when she realized the severity of her condition. "I used to joke that I was solar powered because I had so much energy when the sun was out," she says. "Whenever it was rainy or cloudy, I was out of commission. I felt completely exhausted; I didn't want to do anything because I was so uninterested in everything. I was so tired during my work days that I would come home for lunch and just fall asleep."
    Because psychological and physical effects of light are so common, individuals with SAD often do not realize that they have a severe health condition that can actually be treated. In fact, many cast aside their depression and severe lack of energy as a normal part of winter. One person in Rosenthal's book suffered from debilitating winter depression for 41 years before seeking treatment. "I thought it was normal to feel like that during the winter," she explains.
    Dr. Michael Terman, director of the Winter Depression Program at Columbia-Presbyterian Medical Center in New York, N.Y., is a leading researcher in seasonal affective disorder. According to Dr. Terman, the difference between the more common "winter blues" and SAD is that people with the latter have a depressive disorder. Many people gain weight or experience a lack of energy in the winter but without severe mood changes.
    Even as a young child, Neal Owen, a resident of Olney, Md., who has SAD, started feeling the effects of seasonal changes. "I remember that the beginning of the school year was the toughest on me." He recalls that the early signs of fall would catapult him into a deep sense of lethargy. He also felt unmotivated to do school work. Because Neal did not understand the origin of his psychological and emotional changes, the condition progressed into adulthood, impacting his work and personal life. Neal's doctor tested him for a variety of conditions — thyroid dysfunction, mononucleosis and vitamin deficiency. But at the end of all the testing, Neal and his doctor were still left without answers. "My doctor was left scratching his head. He did not know what was going on with me so he referred me to another doctor." That doctor was a psychiatrist who understood that Neal's condition was due to a chemical imbalance. Through trial and error, Neal's doctor prescribed several medications-six in total-in an effort to abate his symptoms, but the side effects were often worse than his original symptoms. "The drugs made me feel nervous and jittery. They effected my speech, and I was unable to sleep through the night, like I had drank too much coffee."
    Fortunately, Neal was proactive about finding an effective therapy. He contacted researchers at the National Institutes of Health (NIH) who were at the time conducting research on SAD and the effects of light therapy on patients. The NIH researchers had developed a light box that simulates spring light. Participants of the study could take one home on an on-loan policy. So, Neal took one home. "I sat in front of the light box in the morning for two hours and sure enough, I was feeling better. At the end of the week, I had to return the light box and attributed my improvement to just feeling more motivated. I felt like it wasn't the light box." But a few days without the light box, Neal's symptoms returned. "A few days without the light box," he said, "I couldn't get out of bed. I wore out the snooze button and I realized it was the light box that had helped me." Eventually, Neal worked with the researchers at NIH in perfecting a usable light box and several years later, he started his own company in Gaithersburg, MD, dedicated to creating and selling light boxes.
    In addition to the light box, researchers are continuing to develop new therapies for SAD. Dr. Terman and his research group are now investigating a computerized system of lighting that would simulate the dawn light of spring while the person is still asleep. "In effect," he says, "the therapy would end when the person wakes up."
    Although she still periodically battles with depression, Jennifer uses her light box to help her deal with the unpredictable weather and seasonal changes. "I keep it on my night stand by my bed so that when I wake up, I immediately turn it on. The light box makes me feel better, and helps me with my energy level. I'll always have this condition, but I know that there's a way to deal with it. I'm okay with that."

___ Ways to Cope with SAD ___

• Purchase necessary lighting equipment. If the light tubes in a light box are old, consider replacing them.
• Put your exercise and dietary program in place.
• Do what you can to keep predictable stresses to a manageable level over the winter.
• Plan one or more winter breaks in a southern place—if feasible and affordable.
• Consider consulting appropriate professionals—such as a therapist, physician, or dietician—so that they are on board at the beginning of the winter season.
• Get outdoors and enjoy the beauty that nature has to offer at this time of year.
• Be sure to keep your bedroom shades up and shutters open so that you can benefit from the first rays of morning sunlight.

Source: From "Winter Blues" by Norman E. Rosenthal, MD