Noteworthy News Articles on Mental Health Topics, January 23-31, 2001

Capitol Shooter's Untreated Madness Fuels Legal and Ethical Debate
Anne Hull, Washington Post- 1/23/2001

The legal definition of "not competent to stand trial" is kept in a cell with a slit of frosted glass for a window and an outer door marked ISOLATION. He hides beneath his blanket, picking at sores. He believes the ripening of corn causes the reversal of time. This is Russell Weston, the paranoid schizophrenic who killed two U.S. Capitol Police officers in July of 1998 in a bloody shootout in the marble corridors of the U.S. Capitol. After the rampage, a judge ordered Weston to a federal psychiatric facility for treatment. The idea was to make him competent for trial. What Weston needed was a course of Risperdal or Haldol or Prolixin. But when the consent forms were put before him, Weston refused to sign. And when the gurney was on its way to forcibly medicate him, his lawyers stepped in.
    For the last 20 months, Weston's lawyers have prevented so much as one drop of antipsychotic drug from hitting their client's brain, bringing the case of United States of America v. Russell Eugene Weston Jr. to a standoff. Because Weston could face the death penalty if convicted, lawyers from the federal public defender's office argue that to medicate him for trial is to march him toward the execution chamber. But this defense is exacting a cruel cost on Weston. Two court-appointed psychiatrists have testified that his mental condition has worsened. Because Weston has received no treatment and could be dangerous, he has been kept in seclusion for more than two years, an unheard-of period of isolation in modern times. In the coming days, Judge Emmet G. Sullivan is expected to rule for a second time whether Weston should be medicated. At the last hearing in November, Weston sat at the defense table, unbarbered and bearded, like some winter wanderer who'd come in from a cardboard box on Indiana Avenue. His blue eyes roamed toward his lawyers, fit and silken, as they made the case to preserve his mental rot.

A Legal Scramble
Justice moves in cycles. Weston's rampage at the Capitol took place in an era of skepticism against the insanity defense. Ever since John Hinckley Jr. shot Ronald Reagan and was found not guilty by reason of insanity, mentally ill defendants have been left with slim cover. Three years after Hinckley's assassination attempt in 1981, Congress sharply raised the bar for the insanity plea, and switched the burden of proof from the prosecution to the defense. Many states also tightened release rules for those found not guilty by reason of insanity. The public remains in an unforgiving mood. "Jurors are more afraid of the mentally ill than mean people," said Michael Mears, a death penalty lawyer for the Georgia Indigent Defense Counsel. "It's the tenor of our times."
    A long history of psychiatric hospitalizations was not enough to convince a jury that Andrew Goldstein, the New York schizophrenic who pushed a woman to her death in front of a subway, was insane at the time of the crime. The jury rejected his insanity plea, and convicted him of second-degree murder. He is now serving 25 years in a New York prison.
    Against this landscape, lawyers have scrambled for ways to defend the mentally ill. Long before any trial, Virginia lawyers for the man accused of killing 8-year-old Kevin Shifflett of Alexandria won permission to have their client tested for an organic brain disorder; ultimately the defendant was too agitated to be hooked to the EEG machine. His lawyers had hoped the test results might bolster a possible insanity defense. Now they are questioning whether the defendant's untreated syphilis may have caused a brain deterioration that led to psychotic behavior.
    Weston's defense team embarked on a more ambitious strategy, borrowing from blueprints created by death penalty lawyers. In Ford v. Wainwright, the Supreme Court ruled that the state cannot execute an incompetent convict. Left unresolved in Ford, however, was whether the state has a right to medicate the convict against his will to restore competence for his execution. Weston's lawyers moved this question to a pretrial scenario. Can a defendant be forcibly medicated to become competent for a trial in which he could face the death penalty?
    "This is of profound ethical significance to psychiatrists," says Richard Bonnie, director of the Institute of Law, Psychiatry and Public Policy at the University of Virginia, who wrote a letter to the court at the request of Weston's lawyers, outlining the dilemmas. "No one ever thought it was a problem forcing a sick person found incompetent for trial to take medication, but the death penalty has a way of taking latent, routine issues and making them ethically anguishing." The Supreme Court has never squarely addressed what conditions must be met before a mentally ill defendant can be forced to take medication solely to be made competent for trial. The Weston case, billowing with thousands of pages of briefs and expert witnesses from Ivy League psychiatry departments, is being watched by lower courts across the country. Neither Federal Public Defender A.J. Kramer nor Assistant U.S. Attorney Ronald L. Walutes Jr. would comment for this story.
    If Weston loses the medication fight, he'll begin treatment in a psychiatric facility. Should he then become competent for trial, his lawyers could mount an insanity defense. If Weston fails to be restored to competence within a "reasonable" time period, a judge could decide to civilly commit him to a psychiatric facility indefinitely. Once that happens, legal experts say, it's unlikely he'll ever be brought to trial.
    The defense's strategy troubles some. "Keeping him in a florid psychotic condition in seclusion, leaving him as a stark raving madman is not good," says Art Caplan, director of the Center for Bioethics at the University of Pennsylvania. "It's keeping him alive, but the cost is absurd." Except that Weston's soured mind is the one hope the defense has. The government's evidence is overwhelming. Even if mentally ill, Weston managed to drive 750 miles to Washington, negotiate the one-way streets, park his truck, stuff his pocket with extra ammo, conceal his weapon, walk through the metal detectors of the U.S. Capitol, aim his .38 at the back of the head of an officer, pull the trigger and then go down a hallway and kill another.
    "Are his lawyers acting immorally?" asks Bruce Winick, a University of Miami School of Law professor and the author of "The Right to Refuse Mental Health Treatment." "No. They are trying to save his life. Does it come at the sacrifice of his emotional well-being? Perhaps it does." Weston's lawyers at one time raised the possibility that his legal interests conflicted with his medical interests, requesting Weston be assigned a guardian. The judge denied the request. And yet even the lawyer who defended the subway schizophrenic Andrew Goldstein ponders the wisdom of quarantining a defendant with his own madness. "What's better," asks Kevin Canfield, "hell on earth, or death?"

The CIA Interview
Long before his rampage at the Capitol, Weston needed antipsychotic drugs. His exasperated elderly parents in rural Illinois dealt with his ravings by turning up the volume on the TV. The theme of Weston's exhaustive psychiatric history found in court records is his refusal to take medication during two decades of mental illness. By 1996, his schizophrenia had fully blossomed. He was holed up in a one-room shack in Montana, living on Social Security disability payments and rocking on the porch because rocking made him less of a target. He had paranoias galore, some of which perked the ears of the local Secret Service in Montana but were dismissed as low-level menace. The sheriff of Jefferson County said Weston made plenty of threats over the years but that "he always went right to the border line, he always stopped just short of being arrested for intimidation."
    According to court documents, Weston showed up at St. Peter's Community Hospital in Helena, complaining that a man in a field had pointed a gun at him. He also said a dentist had implanted a chip in his tooth that allowed communication with the Russian ambassador. Still, a doctor believed Weston wasn't enough of a threat to be committed. Weston declined medication and follow-up treatment. In the summer of 1996, Weston bought a new suit, a lavish gesture for a man who bathed infrequently and had earned the nickname "Crusty" from Montana locals. He got in his truck and drove to Washington. Weston arrived at the gates of the CIA headquarters in McLean, giving his operative name as "the Moon." Because he said he had a report for the CIA director, he was brought inside the gates. An agent led Weston into a small conference room. Very calmly, Weston launched into 50 minutes of mind-bending expository. A videotape recorded the entire session. Weston appears normal. Clean-cut. Straightening his tie. Clasping his hands in his lap. An agent sits across the table from him, diligently scribbling notes in a legal pad.
Weston: Okay, I was cloned at birth.
Agent: Okay, when were you born?
Weston: That is December 28, 1956. Okay, and the assassination of John F. Kennedy, okay, it started off with, first off, John F. Kennedy was working for the government. They were working on the Ruby Surveillance System.
Agent: Rudy?
Weston: Ruby.
Agent: Ruby.
Weston: R-U-B-Y. The Ruby Surveillance System. Now, do you understand what I'm talking about, the Ruby Surveillance System?
Agent: No, you'll have to fill me in on that.
From there, Weston explains how a ruby is placed in a watch, and a small wheel inside the watch spins, producing a low-megahertz signal picked up by "satellite intel."
Weston: My father was traveling on the highway. He was hit by that interactive beam. His radio became interactive. He was told to recover a prototype watch that had been stolen from the United States government. And that was around 1952, was when that was.
Agent: Okay.
Weston: A woman who had been working for the defense department stole the watch and was trying to make a getaway with it. She was hitchhiking, and a truck driver picked her up, raped her and murdered her.
Agent: Mm-hmm.
Weston: And just threw the watch and a pocketbook out in a field. But since the watch was running, the United States government knew where that watch was.
Weston speaks with authority. The agent appears to be getting everything down.
Weston: Bill Clinton is mad because John F. Kennedy has swiped his girlfriend, confiscated his interactive television system and cut off his cocaine supply.
When the interview ended, Weston stood up to shake hands with the agent. Weston wasn't detained or arrested because he hadn't threatened the president, an official would later say. Weston told the agent to give his best to the CIA director, and then he walked out into the world.

Washington Obsession
Three months after visiting the CIA, Weston received his first course of antipsychotic drugs when he was involuntarily committed to a psychiatric facility. He had shown up at an emergency room in Montana, threatening a lab worker he believed had injected him with a needle contaminated with feces and Rohypnol. His threats earned him a stay at the Montana State Hospital in Warm Springs. Inside the hospital, after he tried to punch a nurse in the face, Weston was put in restraints and secluded for several hours. He refused to voluntarily take antipsychotic drugs. This time, he didn't have a choice. He was held down and injected.
    Over the next few weeks, he was dosed with various mood stabilizers and antipsychotics: Risperdal, Haldol, Depakote, Trilafon and Loxitane. He felt the side effects of each. The Depakote gave him terrible headaches. With the Haldol and Depakote, he could not sit still and felt woozy. He was sleeping fitfully. Three weeks into his medication, he felt "antsy" at lunch, and tired and dizzy most of the time. Substitutions were made. A nurse noted he looked oversedated. "Thinks it's Depakote," his records show. A day later, his hands were shaking. Yet he seemed to be improving: "Russell continues to do well. Is pleasant and cooperative with both staff and peers. Takes meds willingly. Personal hygiene good. Remains able to discuss his delusional system without becoming angry. Voices no threats toward anyone. Specifically denying thoughts of harming anyone when asked. His delusional system, however, remains intact."
    Weston was discharged after seven weeks, with a 31-day supply of drugs. A follow-up appointment was made for him at a clinic in Waterloo, Ill., near his parents' home. When he showed up for the appointment, he was bizarre and paranoid, according to court records. Clearly, Weston had gone off his meds. When he learned follow-up treatment wasn't court-ordered, he never returned. In the greenhouse of time and neglect, Weston's illness worsened. His obsession with Washington grew. The city was diseased by "Black Heva." He was convinced that the override console for his imaginary Ruby Satellite System was kept on the first floor of the U.S. Capitol.
    In July 1998, Weston's father came home one day and found a bucket full of dead cats that Weston had shot with a rifle. He suggested his son find another place to live. After Weston was gone, his father noticed a .38 revolver missing from the house. Just after 3:30 on the afternoon of July 24, Weston approached the ground-floor entrance of the U.S. Capitol on the House side. Officer Jacob Chestnut, in uniform, was giving directions to a tourist and his 15-year-old son. Weston allegedly barged through the metal detector. He raised his gun to Chestnut's head. The 15-year-old boy was soaked in the officer's blood. Weston turned left and ran down a short hallway, opened a door marked PRIVATE ENTRANCE and there found Special Agent John Gibson, who provided protection for Majority Whip Tom DeLay (R-Tex.). Gibson was fatally shot in the chest. Weston took three bullets himself. He was given a 50-50 chance of survival and underwent several surgeries at D.C. General Hospital. His mind was left untouched.

Time Washed in Reverse
Ten weeks after the shooting, the U.S. District Court appointed a forensic psychiatrist to evaluate Weston to assess whether he was competent to stand trial. Sally Johnson had seen her share of the mentally ill behind bars. She was the chief psychiatrist and an associate warden for the Federal Correctional Institution in Butner, N.C. She'd been the first to examine Hinckley after he shot Reagan. She later examined the Unabomber, Ted Kaczynski. Johnson had found both Hinckley and Kaczynski competent to stand trial.
    The legal standard for competence is much lower than the threshold for the insanity defense. Do you understand the role of your lawyer? The judge? The prosecutors? And can you assist your lawyers in their defense? Given Johnson's history, Weston's lawyers prepared for a finding of competence. She visited Weston at the Correctional Treatment Facility on E Street SE in Washington. A guard stood outside his door. Inside the cell, Weston was lying on a hospital bed. Johnson's evaluation would last 20 hours, stretching over four days.
    "I can explain everything very clearly to you," Weston told her. Weston recited his theories on the Ruby Satellite System, which "washes time in reverse." He described his involvement in the World Summit for Time Reverse Technology. When Johnson asked Weston to explain the role of the defense, he said he was confident that his lawyers could explain his concepts of time reversal. "They didn't just get off the pickle boat," Weston said. Johnson asked Weston about his trial. His answer was oddly prescient. He said the trial would never happen. "They will simply do a time reverse, and I'll be off and running in a different direction," he said.
    Johnson filed her report with the judge. He appeared unable to even in a hypothetical situation talk about why society might view it as wrong to kill someone. This appears to be directly related to his belief that because of his power of time reversal, no event is ever permanent. On specific questioning it is clear that he does not believe that the victims are necessarily permanently deceased.
    Johnson's opinion was that Weston was incompetent for trial. But, she added, "with adequate treatment with antipsychotic medication, there is a significant likelihood that competence can be restored." The report was a blow to prosecutors. Citing "significant gaps" in Johnson's evaluation, the U.S. attorney's office asked to have its own psychiatrist examine Weston. The judge agreed. But Weston had nothing more to say; he stopped cooperating.

Drug Dilemma
Every day in the criminal justice system, mentally ill defendants are packed off to psychiatric facilities for "competence restoration" -- 90 or 120 days of treatment with antipsychotic drugs. The reasoning is both humane and legally practical: to help a sick person, and to carry out the state's interest in having that person brought to trial. Weston was packed off, too, to Johnson at the federal prison in North Carolina. But his attorneys had put in place a safeguard: It would take a court order from the judge before Weston could be given any drugs.
    The medication issue froze the case. There were hearings and more hearings. Prosecutors cited a 1992 Supreme Court decision, Riggins v. Nevada, that said "medically appropriate" involuntary treatment can be justified for safety reasons. Weston could hurt himself or others without medication, prosecutors said. Finally, siding with the government, Sullivan signed the order to medicate. But the defense appealed and won. The U.S. Court of Appeals for the D.C. Circuit sent the matter back to Sullivan, instructing the court to dig into the more thorny implications of medicating a defendant against his wishes. Would the drugs and their potential side effects interfere with Weston's appearance before a jury, violating his ability to get a fair trial? What if Weston improved on the drugs so much, one judge wrote in his opinion, that the jury would see a completely different person from the one who burst into the Capitol? By the summer of 2000, two years after Weston's arrest, they were still stuck. The defense argued that Weston had gone so many years without treatment that his brain was toxic and might not respond to medication.
    For most schizophrenics, antipsychotic drugs dampen the delusions and impulses to act. They don't cure the illness but they can make living more tolerable. Which is what Weston deserved, according to testimony by Johnson. "I think that you would never choose not to offer a trial of treatment to someone who has never been treated, based on a belief that the likelihood of success would be diminished." "I am warehousing him in a psychotic state," she argued. Judge Sullivan called for another round of hearings before he decided. In November, a second court-appointed psychiatrist agreed with Johnson that Weston's condition was deteriorating. Keeping Weston in seclusion for two years, the psychiatrist testified, was harming him.

Standoff
Weston's lawyers have said in court that Weston could be medicated immediately if the U.S. attorney's office would back off from seeking the death penalty. But with two federal officers dead, the U.S. attorney's office will not. Judge Sullivan's much-awaited ruling is likely to be appealed by either side; neither shows the first sign of tiring from battle. Weston is being kept at the psychiatric unit at the federal prison in North Carolina. Still in seclusion, he is watched constantly by a guard through a window. One of Weston's former lawyers, who worked on the case for 16 months, offers another view from the psychiatrists and ethicists who have climbed into the witness box over the last two years.
    Weston is not tormented in his current state, says former federal public defender Barry Boss. In fact, medication could be the real cruelty. "When you have complete confidence you are immortal," Boss wonders, "what's going to happen when you're brought back to sanity and you realize what you've done?" Maybe the cocoon of madness is more humane. "Cruelty, in this case, is an abstract," Boss says.

A No-Drug Approach To Wellness
Anna Fels, M.D., New York Times, 1/23/2001

When I first met Mr. J. in my office he looked terrible--anxious, exhausted, demoralized. He had stopped going to work several days earlier and was mostly staying in bed. After taking his history, I recommended psychotherapy and medication for his depression. But he would not consider taking medication. He wanted to deal with his depression, he said, "without depending on drugs." Perhaps because I had been an internist for several years before becoming a psychiatrist, I was baffled by his response. In medicine the situation had been exactly the reverse. There was huge pressure to hand out prescriptions for every cough and sniffle, even when it made no real sense. "Do something to make me feel better, now," was the unspoken mandate. When a patient left my office empty-handed, it was often with a palpable sense of disappointment.
    But in my psychiatric practice, I soon came to realize, Mr. J. was far from alone in his outright rejection of psychotropic medications. In fact, he was fairly typical. Yet like many of my patients, he seemed almost dangerously accepting of the psychological side effects of drugs given for physical ailments. In his case, he was on an anti-hypertensive medicine that affected his sexuality and possibly even contributed to his mood disorder. He also reported the frequent use of two psychoactive substances with known toxicity: alcohol and cigarettes. So what was the issue here? It seemed illogical--and to a psychiatrist that's always a sign that there's something of interest going on.
    On his next visit, knowing that Mr. J. was increasingly convinced that I was missing something important, I asked him to explain his feelings about medication. After considering for a moment, he gave me a response that I was to hear, in various versions, over the following years: "I want to understand what is happening to me so that I can change. I don't believe in using chemicals to alter my mind. I don't want a 'happy drug.'"
    What took me by surprise was the strength of Mr. J's conviction that understanding his depression would necessarily lead to its resolution. Contained within his statement was a brief for the power of the conscious mind. It began to dawn on me that by suggesting medication I had inadvertently challenged one of my patient's--and the larger culture's--most deeply held beliefs, the notion that our consciousness is the central organizing and shaping force of our minds. Awareness and understanding, according to this theory, form the fulcrum by which we can move our mental world. As I reflected further, I realized to my confusion that the same concept forms the cornerstone of my own profession.
    For Mr. J. and many other patients, taking the antidepressant was tantamount to ceding the supremacy of consciousness in controlling who we are and what we do. Hidden in my apparently harmless suggestion was a subversive new notion of the self. It removed consciousness from the dominant center of the brain to merely one among many mental constellations. If Copernicus had removed us from the center of our solar system and Darwin from the apex of the natural world, this was the final indignity. By proposing medication I was suggesting that we were not even the masters within our own minds.
    From my dusty medical school memories of neuroanatomy, I resurrected a picture of the peripheral area of the brain where consciousness is thought to reside. It suddenly seemed like a small outpost. Distant from the most central, ancient portions of the brain, it was simply one among many distinct areas, each with its own biologic mandate and potential for dysfunction. Like Jupiter's moons, which circle in their own trajectories while still being held within the gravitational pull of the Sun, the various areas of the brain perform their separate functions. How could we assess the power and reach of rational thought within such a system?
    But even as I had these thoughts I was looking across to Mr. J.'s thoughtful face. He was mulling over his ideas on medication, but seemed cheered by our discussion and became more animated. We moved on to discuss the problems that he had been having with his aging parents, and by the end of the session, we decided that he would see me for psychotherapy. Over time Mr. J.'s depression resolved without medication--as most depressions eventually will. But when his symptoms returned again after only nine months, he reluctantly agreed to a trial of antidepressants. Four weeks later, when he was feeling better, I asked Mr. J. to try to describe what he felt like on medication. "I guess I feel like myself," he said, then laughingly added, "Whatever that means."

U.S. Is Said to Overstate Spending on Drug Abuse Treatment
John Donnelly, Boston Globe, 1/24/2001

WASHINGTON - Promising to further stoke the debate over America's controversial war against drugs, a Rand Corporation study has found that three federal agencies overstated their spending on drug treatment by $1 billion, and that the reported costs of some law enforcement efforts are no more than ''educated guesses.'' ''I tracked down one budget guy for the Border Patrol and asked how they figured out the drug budget and he told me, `We made it up,''' said Patrick J. Murphy, one of the study's authors and an assistant professor of politics at the University of San Francisco. ''He said 10 percent of their budget seemed too low, 20 percent too high, so they settled on 15 percent.''
    The report, a copy of which was obtained by the Globe, was requested by Barry R. McCaffrey, who stepped down last month as director of the Office of National Drug Control Policy. It examined 10 agencies that report their drug budgets to the drug policy office.  There were no allegations of misspending in the report, but the survey said ''flawed'' reporting techniques made it impossible to know how much money was actually spent on the battle against illicit drug use. Critics of US drug policy have long argued that it gives short shrift to treatment programs designed to help addicts overcome their cravings.
    McCaffrey, who did not return telephone calls seeking comment, insisted on completing the potentially embarrassing report because he wanted a better accounting of the drug war, the authors said. They noted that he had long been bothered by seemingly soft figures in agencies' budgets, even though he continued to cite the inflated treatment numbers in his defense of drug-control policy. The drug policy office said in a statement that it ''asked for the Rand reports because we want the most reliable data'' and that it has ''used the Rand findings, and will continue to do so, to improve the way drug budgets are presented to the Congress and the public.'' Rand is a consulting and research firm known for its work on complex subjects. The statement said that the FBI drug methodology has been corrected and that the Veterans Affairs and Education departments changed their data collection so as to ''substantially address Rand's findings.'' It gave no specifics.
    The most politically sensitive aspect of the Rand study, which for more than a year examined the 1998 federal drug budget of $16 billion, may be the amount spent on drug treatment. In 1998, McCaffrey's office said US agencies spent $2.8 billion on drug treatment. Rand said the actual number was closer to $1.8 billion, or 36 percent less than reported. That finding upset several members of Congress. ''If a guy wants to surrender himself for drug treatment in this country, there are not enough places to go,'' said Representative J. Joseph Moakley, a Democrat from Boston. ''I think it's terrible if they are inflating figures that show there's more drug treatment than there actually is.'' Added Representative John F. Tierney, a Democrat from Salem: ''Before we ask for more drug-control money, we ought to be sure where it's going.''
    The largest discrepancy originated from Veterans Affairs, which reported spending $363 million on specialized care for drug addicts and $710 million on related treatment for those with substance abuse problems, according to Rand. Veterans Affairs spokesman Jo Schuda said the department could not comment on the report because it had not seen a copy. She said the department reported spending $407 million on specialized care for drug addicts in 1998, and $1.1 billion overall for medical care of addicts, slightly higher numbers than Rand's. Murphy, one of the study's authors, said the department included in its accounting, for example, ''heroin addicts who were seeking treatment for a broken arm, not drug treatment.'' ''If people are serious about spending money on drug treatment, they are going to have to look at the level of services they have been providing, and it's much less than they had thought,'' Murphy said.
    The report praised the Coast Guard, Bureau of Prisons, and Defense Department for the accuracy of their accounting. But it said the methodologies used for the Immigration and Naturalization Service and Customs ''are based largely on educated guesses.'' The collection of data from the Substance Abuse and Mental Health Services Administration, which administers about $2 billion in block grants to states for drug prevention, ''is a collection of arbitrary assumptions and rules,'' the report said. And the 1998 figures from the Health Care Financing Administration are based on patient diagnoses and costs, ''but the patient data are taken from a 1983 study,'' the report said.
    The Rand report recommends that the drug control office ''define explicitly what constitutes an antidrug activity'' and that budgets should be based on ''empirical data, something more than guesses or expert judgments.'' Lynn E. Davis, a senior fellow at Rand and another of the report's five authors, said that without better figures, the drug office is unable to ''measure performance against its goals.'' She also said the lessons in the report could be applied to other federal offices that compile figures from several agencies ''to give Congress and the American people a sense whether the right priorities of money are being allocated, or whether there are gaps.''
    Herbert Kleber, medical director of the National Center on Addiction and Substance Abuse in New York and deputy head of demand reduction in the drug policy office from 1989 to 1991, said the Veterans Affairs Department has ''gotten a free ride'' for some time on categorizing non-drug-related medical care as drug treatment. He called the level of funding for treatment a ''bipartisan failure. ... It doesn't seem to matter whether you have Democrats or Republicans, drug treatment doesn't get a lot of play. No one ever lost an election being soft on drug treatment.'' Many Democrats are expected to ask for a major jump in drug treatment funding. One of them is Representative Nancy Pelosi of California. ''We are going to have much stronger oversight to make sure that money is being spent in a cost-effective way to face the demand,'' Pelosi said.

Buford Furrow Spared by His Mental History
David Rosenzweig, Los Angeles Times- 1/25/2001

Federal prosecutors dropped their plan to seek the death penalty against white supremacist Buford O. Furrow Jr. after getting access to voluminous medical records showing that he had tried for a decade to get treatment for homicidal and suicidal urges, U.S. Atty. Alejandro N. Mayorkas said Wednesday. In agreeing to allow Furrow to plead guilty and receive a mandatory life prison term for his hate-motivated shooting rampage in the San Fernando Valley, prosecutors were following Justice Department protocols that require them to weigh mitigating factors, such as mental illness, when seeking the death penalty.
    Mayorkas said his prosecutors did not possess those records when they obtained permission from former U.S. Atty. Janet Reno early last year to bring a capital case against Furrow for killing a Filipino American mail carrier and seriously wounding four children and an adult at a Jewish community center in Granada Hills on Aug. 10, 1999. After surrendering the next day, Furrow told FBI agents that he killed Joseph S. Ileto because the postal worker "looked Asian or Latino" and that he shot up the North Valley Jewish Community Center to send a "wake-up call for Americans to kill Jews." Furrow, a 39-year-old engineer from Washington state, entered his guilty plea early Wednesday before U.S. District Judge Nora Manella. He showed no emotion during the proceedings and calmly answered most of her questions with a "Yes, Your Honor," or "No, Your Honor." Manella set sentencing for March 26.
    Mayorkas said afterward that Furrow, a follower of the racist and anti-Semitic group Aryan Nations, "is a pathetic, cowardly man. What he did was remind us that we are all one." While sharply condemning Furrow's "racial bigotry and religious intolerance," Mayorkas said the defendant had a long history of mental problems. He said his office did not know how extensive or serious those troubles were until late last year, when the federal public defender turned over Furrow's complete medical files.
    Two government psychiatrists reviewed and analyzed more than 2,000 pages of medical records going back 10 years. They showed that Furrow had checked into psychiatric hospitals on three occasions and made frequent visits to hospital emergency rooms, complaining about everything from panic attacks to wanting to kill himself and others. In October 1998, Furrow tried to commit himself to a private psychiatric facility. While being interviewed, he became angry and threatened staff members with a knife. He was arrested, pleaded guilty to assault with a deadly weapon and was sentenced to six months in jail. The psychiatrists also studied records of Furrow's outbursts at the federal Metropolitan Detention Center, where he has been in solitary confinement since his arrest. Even while behind bars, Furrow continued to threaten to kill nonwhites, including a Latino inmate and several guards, according to court records. He also was said to have threatened violence against his former wife, vowing to deliver her son's head to her on a platter.
    Furrow, wearing handcuffs and leg irons, was brought into Manella's courtroom shortly after 8 a.m. Wednesday. He smiled and joked with his lawyers before the judge took the bench. In response to one query by the judge, Furrow said he was taking five medications, and rattled off their names. But, he said, "I feel clear-headed enough to follow" the proceedings. Justice Department attorney Bobbi Bernstein read into the record a chronological account of Furrow's odyssey--from the day he left Washington state with seven automatic weapons and several thousand dollars stolen from his father to the day he surrendered to the FBI. She disclosed one new detail: When Furrow arrived in Las Vegas after fleeing Los Angeles, he looked up the names of synagogues there, and considered attacking one of them. "However, because his picture was being broadcast on national television and because he believed he had already succeeded in making the statement he wished to make, the defendant decided to 'get it over with' and turn himself in to the FBI in Las Vegas," Bernstein said. She told Manella that Furrow was not insane when he killed Ileto or when he fired 70 rounds into the community center, wounding a receptionist, a teenage counselor and three boys, ages 5 and 6. Manella told Furrow that by agreeing to plead guilty he was also agreeing to spend the rest of his life in prison. The plea agreement bars him from appealing the sentence or seeking a presidential pardon. Furrow said he understood. "Are you pleading guilty here because you are in fact guilty?" the judge asked. "Yes, your honor," he said. "I find the pleas to be freely and knowingly made," Manella said. "The pleas in this case are accepted."
    The Ileto family sat in the back row of the courtroom. A few young women fought back tears. Later, the family joined Mayorkas, the prosecution team and other law enforcement officials at a news conference. "We are just relieved that this is closed, that we don't have to go to court to hear any testimony," Ileto's brother Ismael said on behalf of the family. Relatives of the North Valley Jewish Community Center victims did not attend the court hearing. But Nancy Parris Moskowitz, the center's president, said afterward: "I think it means that a door has closed finally." Like the Ileto family, she said, many members of the center are relieved that a possibly lengthy trial has been averted. "There are some individuals who had trepidation about going to the courthouse, seeing this individual, and just reliving the pain of having to see him," she said. "This allows us to not have to go through that."
    Rabbi Marvin Hier, founder of the Simon Wiesenthal Center and the Museum of Tolerance in West Los Angeles, said he was satisfied that Furrow will go to prison for life. "In one respect Buford Furrow was right when he said he was trying to register his crime as a 'wake-up call to America,' " Hier said. "What these haters are doing in this country and all over the world is showing how much damage a single individual bent on destroying society can accomplish." Furrow's parents, who live outside Olympia, Wash., could not be reached for comment Wednesday, but a neighbor who is close to them, Clint Merrill, said the couple have taken all the publicity about their son "pretty hard." Debra Mathews, Furrow's ex-wife, had no comment. In addition to the federal charges to which he pleaded guilty, Furrow faces murder and hate-crime charges filed by the Los Angeles County district attorney's office. A spokesman for Dist. Atty. Steve Cooley said Wednesday that in light of Furrow's federal court plea, it appears as if any local prosecution would be considered double jeopardy under the state penal code.

Conference: Substance Abuse and Eating Disorders Linked
Ephrat Livni, ABC News- 1/26/2001

There are more than 5 million Americans — mostly women — who suffer from eating disorders, such as bulimia, which is characterized by compulsive bingeing and purging. Of those, experts estimate about half also have a substance abuse problem. Although the link between the two is still unclear, some scientists believe there is a connection and that ignoring it makes it impossible for sufferers to recover. "We know bulimics are more likely to have substance abuse issues than anorexics," Dr. Steven Hyman, director of the National Institutes of Mental Health, told physicians, nutritionists and substance abuse experts at a conference earlier this week at the National Center for Addiction and Substance Abuse at Columbia University in New York. "What we don't know well is the order, or what caused what. There are shared risk factors, but we need more information." Hyman suspects the two may originate in the same area of the brain, saying, "Both are in part disorders of learning."

Firsthand Knowledge
Karen Eklund, a recovering alcoholic and bulimic, understands the relationship between food and alcohol issues. Sober and abstinent from bulimia for more than 17 years, Eklund works as an in-patient counselor at the Betty Ford Center in Rancho Mirage, Calif. "If the eating disorder is severe, [the alcoholic] will never get sober," she says. While she did eventually seek treatment for her alcoholism, her struggle with keeping down food remained a secret. After about a year of sobriety, however, Ecklund could no longer sustain her habit of throwing up 40 times a day and sought treatment for bulimia as well. She says she is grateful she survived, but worries that other women won't if experts — from both the eating disorder and substance abuse fields — don't become conscious that these two problems often co-exist and that they present unique treatment problems.
    "Treating chemical dependency may be more straightforward, whereas eating disorders are much more ambiguous," says Dr. Karen Spedowfski, a psychologist at the Kaiser Permanente Chemical Dependency Recovery Program in Santa Clara, Calif. Substance abusers, she explains, know they have to abstain from drugs or alcohol in order to get better, "But with food it's much more tricky."  Because eating disorder patients will have to keep ingesting food for the rest of their lives, they have to learn new thinking and eating habits. "With eating disorders it's more of a gradual stepping away from symptoms," says Spedowfski. "It takes longer [than substance abuse problems]."
    But as she has seen in some of her own patients with both problems, dealing with chemical dependency alone may leave the person vulnerable to his food problem: Celebratory meals recovering substance abusers often share in order to have "good, clean fun," can be tortuous for eating disorder patients. In fact, according to outgoing CASA president, Joseph A. Califano, Jr. it's not unusual for non-eating disorder patients to turn to binge eating during substance abuse treatment and early recovery anyway, so counselors need to be especially aware of the prevalence of both problems. "All women entering a substance abuse program should be screened for an eating disorder and vice versa," agrees Terence Williams, a professor of psychology at Rutgers University in Piscataway, New Jersey.  Still, Williams is not sold on the hypothesis that eating disorders and substance abuse are necessarily linked.

Superficial Similarities?
There are superficial similarities, such as craving and lack of control, he says, but it's dangerous to lump all eating disorders in one category, since there are major differences in the characteristics of anorexics, who starve themselves, compared to bulimics who binge eat. Additionally, because the treatment model for addiction focuses narrowly on the substance, a regular addiction treatment program will not help someone with an eating disorder deal with her body image and self-evaluation issues, Williams says. The NIMH's Hyman admits the connection is "an unproven hypothesis," but believes that further gene research will lead to the link. In the meantime, he says, it's critical to raise awareness and intervention among counselors so that people seeking treatment get appropriate help. "We're not going to succeed by picking out a single target at a time," he said

Rape on Campus: 3 Percent of Women Report Rape, Attempted Rape During Typical Year
Geraldine Seale, ABC News- 1/27/2001

About 3 percent of college women say they have been victims of rape or attempted rape during a typical school year, according to a government report released today. The study, "The Sexual Victimization of College Women," looks at the frequency and nature of sexual assault on American college campuses, and is based on interviews with college women. About 1.7 percent of female college students reported being raped, and about 1.1 percent said they were victims of attempted rape, according to the report from the U.S. Justice Department's National Institute of Justice and Bureau of Justice Statistics. About 1.7 percent of the college women reported being coerced to have sex. An estimated 13 percent of college women had been stalked since the beginning of the school year, according to the study. The high incidence of stalking surprised the researchers, said lead author Bonnie S. Fisher of the University of Cincinnati.  In general, she said, the study shows how official statistics probably underestimate campus rape. To put the statistics into context, she said, consider that the researchers only asked women about their experiences during one academic year. "These numbers would be much higher if we asked about since they were enrolled here," Fisher said.

Most Rapes Occur in Residences
The vast majority of the women were attacked after 6 p.m. in living quarters, according to the report. Of the rapes on campus, almost 60 percent were committed in the victim's residence, 31 percent occurred in other living quarters and 10 percent were perpetrated at a fraternity. Most off-campus incidents also occurred in residences, but many others were in bars, dance clubs, nightclubs and workplace settings.  Most of the sexually assaulted women knew the person who victimized them, according to the report. For both rapes and attempted rapes, nearly 90 percent of the victims knew the offender, who was usually a classmate, friend, ex-boyfriend or acquaintance.  Most rape and attempted rape victims reported they did not suffer additional injuries during the victimization. Of those who did — about one in five — the incidents resulted in additional injury, most often "bruises, black eyes, cuts, swelling or chipped teeth."
    Researchers found that for about half of the incidents categorized as completed rapes, the women did not consider the incident to be rape. Completed rape was defined in the study as "unwanted completed penetration by force or threat of force."  "Women may not define a victimization as a rape for many reasons, such as embarrassment, not clearly understanding the legal definition of the term or not wanting to define someone they know who victimized them as a rapist or because others blame them for their sexual assault," the report said.

Different Wording, Different Statistics
The main component of the study was presented as a survey of "unwanted sexual experiences," and obtained information on incidents that victims may not have thought to be criminal. In another companion component, a different methodology was used, focusing on incidents victims perceived as crimes. The estimates of completed and attempted rape from the main component were 11 and six times greater, respectively, than those of the companion study.
    According to the researchers, the differences between the two components of the study illustrate how different methodologies can influence estimates of rape. The two studies were conducted at the same time, employing similar samples and interviewing methodologies. Differences arose when the context under which the surveys were conducted changed, as did the wording of the questions used to screen for victimizations and the wording used to determine the type of incident. Since rape statistics have been the subject of controversy in the past, pitting feminists and conservatives against each other with different numbers, this study can help show how a range of results come about, the researchers said. "Our results shed some light on some of these measurement issues," Fisher said.

Estimate Too Low?
According to Kim Gandy, executive vice president of the National Organization for Women, the new government study is likely more reliable than those relying only on rapes reported to the police or campus security. Still, she said, the report probably underestimates the problem of rape in campus. "I'd say [3 percent] is too low," she said. "It's appallingly high when you think about the number of women on a campus, but at the same time I believe it is substantially higher in reality." The surveys were conducted between February and May 1997, and were administered to women who were enrolled in college at the start of the 1996 fall semester. The results are based on telephone surveys of randomly selected national samples of women who attended two- or four-year colleges or universities. The sample sizes were 4,445 respondents for the main component and 4,432 for the companion component.

Ypsilanti Man, Accused of Student's Homicide, Had Been In and Out of Treatment
Art Aisner & Marianne Rzepka, Ann Arbor News- 1/28/2001

It's 2 a.m. on a cool August morning and the staff at Gianni's Koney Island in Ypsilanti is bracing itself for the usual post-bar-closing crowd to rumble in any minute. The vacant tables are cleared, the silverware set, and the regulars are in their usual spots. All except one, waitress Shannon Poe thought to herself. She did not see Brian Williams, the often mild-mannered yet unpredictable customer who lived across the street from the 24-hour diner near the Eastern Michigan University campus. He wasn't sipping coffee in the back booth as he did routinely so many times during her two years of employment there. It was a good thing, Poe remembers thinking.  After all, it had only been two days since the 40-year-old man with unkempt afro-style hair and bulging eyes burst into the restaurant with a large kitchen knife. Williams declared he was looking for someone and suddenly left without explanation, taking the 8-inch blade with him. Less than a day later he was back, unleashing a verbal tirade at the owner when he asked Williams to leave before calling police. "Maybe we won't have to call the police tonight," she said to co-workers as the regulars shuffled in. And then, like clockwork, a cluster of customers huddled by the diner's picture window to get a better glimpse of the spectacle unfolding outside: a grown man casually strolling by completely naked. Without even really looking, Poe knew it could be only one person. Another waitress called police, again, about Brian Williams.
    That's when he is accused of beating to death a man he encountered in a Kalamazoo bus station. Williams has been charged with the Aug. 17 beating death of Kevin Heisinger, a University of Michigan graduate student. No reason has been given for the slaying, but what authorities do know is that Williams, who had been diagnosed as paranoid schizophrenic in his teens, was not taking his medication. He went through cyclical battles with medication for years and had been charged in the past with assault. He was a frequent visitor at homeless shelters and police stations because of his erratic behavior. Documents show he had been discharged from Washtenaw County's mental health services only three months before.

Mental illness escalating
More than 5 percent of American adults have a serious mental illness, almost half of them between the ages of 25 and 44, according to the National Alliance for the Mentally Ill. There are about 1.4 million people in Michigan with some form of mental illness and about 140,000 have a serious disorder such as Obsessive Compulsive Disorder and Multiple Personality Disorder, according to state figures. Federal administrators, using different standards, estimate up to 485,000 adults in the state have a serious mental disorder. During the past decade, Washtenaw County's budget for mental illness services has held steady at about $40 million, said Kathleen Reynolds, director of Washtenaw County Community Mental Health. At the same time, the total number of clients rose from 1,911 in 1991 to 2,700 in 2000.
    Statewide, general fund appropriations for mental health rose by about 2.5 percent from 1987 to 1998, taking into account inflation and accounting changes, according to a study done for the Michigan Nonprofit Association. At the same time, the number of mentally ill receiving services increased. In the period from 1991 to 1999, the number of mentally ill people served in the state rose from 159,210 to 225,035, according to information provided by the state Department of Community Health.
    That doesn't bother state Sen. Beverly Hammerstrom, R-Temperance, who said closing the larger state psychiatric hospitals should have led to savings for mental services. "We should be able to do more programs with what we have," said Hammerstrom, who chairs the Senate committee on families, mental health and health services. The challenge now is to make the available money work "effectively and efficiently and get the most bang for our buck," she said. But Liz Brater, an Ann Arbor Democrat and ex-state representative, said available money goes to treat the most acute cases and the rest fall through the cracks. The result, she said, is an increase in homelessness and in the jail population.
    A 1999 U.S. Department of Justice study found that 16 percent of all inmates in federal prisons suffer schizophrenia, manic depression and other severe mental illnesses. That roughly translates to more than 280,000 inmates on any given day, four-times the number of people in state mental hospitals nationwide. And that's only in federal facilities. There's never been a statewide study of inmates in Michigan. However, a preliminary study completed in 1999 showed that 34 percent of inmates in Wayne, Kent and Clinton county jails suffered from a "serious mental illness." About 15 percent of the 305 inmates at the Washtenaw County Jail are on psychotropic drugs to battle a myriad of mental health problems, including clinical depression and anti-social behavior, officials said.
    In a report issued last summer, the lobbying group, the Michigan Mental Health Association, listed several problems with mental health services in the state, including the fact that a disproportionate amount of the budgets for community mental health go to people who are developmentally disabled. Although about 86 percent of the caseload are mentally ill patients, they receive only about 41 percent of the expenditures, according to the report. In Washtenaw County, about 69 percent of the caseload is made up of people with mental illnesses; they get 50 percent of the total budget, according to county figures.

Strange behavior turns to tragedy
    Heisinger, 24, was a bright Northwestern University graduate heading to Ann Arbor for orientation at the University of Michigan's graduate School of Social Work when his bus pulled into the Kalamazoo station around 3 p.m. Williams also boarded a bus that morning hoping to visit his father in Chicago. His late-morning Greyhound bus briefly stopped in Kalamazoo. He got off during the stop and never returned. Witnesses told police Williams walked around the station for hours, mumbling and uttering words at passers-by before going into the rest room. Investigators think Heisinger probably darted from his bus to use the rest room before resuming the trip that was supposed to begin a career dedicated to helping people like Williams. But his encounter with Williams that summer day would also be his last. The beating took only 30 seconds, police said, but was so severe that even an officer who arrived within 20 seconds from the building's police mini-station could offer no help. Officers arrested Williams while he attempted to hijack a bus occupied only by a driver.

A 20-year battle with schizophrenia
Williams, 40, was diagnosed as a paranoid schizophrenic in his late teens while serving in the U.S. Navy. The Navy granted him a general discharge after Williams experienced some disciplinary problems. In 1995 he became more stabilized and his brother moved him to Ypsilanti and enrolled him in computer classes at EMU. Williams always had an interest in computers, his brother said. Amos Williams agreed to pay the tuition with the condition that his brother take his medication. But even that incentive wasn't enough. "He would complain that the side effects made him dull, heavy and slow and that it affected him in class. So he would stop," his brother said.
    Williams also became a client of the Washtenaw County Community Mental Health. Local mental health officials declined to speak about Williams' case because of privacy restrictions, but it was clear from frequent encounters with Ypsilanti police that he had difficulty staying on his medication. In 1996 alone, officers had contact with Williams on several occasions. Williams finally did get help in the form of a court order requiring him to take his medication in 1997. But that came only after he was arrested for hitting another mental health patient. Prosecutors charged Williams with assault but later dropped charges because the victim didn't cooperate, court records showed.
    Amos Williams, who lives in Detroit, had planned to meet with his brother a week before the killing in Kalamazoo because he and his mother had sensed problems with Brian during phone conversations. "It seemed he was not well stabilized, but I wasn't aware he was spinning out of control," he said. The news of his brother being charged with open murder hit Amos Williams like a freight train.   Williams, a retired Detroit Police lieutenant who now practices law, is serving as his brother's attorney in the criminal case. He said he will turn the case over to a criminal defense attorney if his brother is found competent to stand trial at a Feb. 21 hearing. Until then, he continues to research his brother's medical files to determine where and how his brother fell through the cracks in the mental health system.
    According to Williams, Washtenaw Community Mental Health sent his brother a letter in May - three months before the beating death in the Kalamazoo bus station - notifying him that his services were being terminated. Local mental health officials could not comment specifically on the letter, but said it is generally given to clients that no longer meet the medical criteria for services or the criteria to continue receiving services they initially received. The letter states that clients can appeal the termination, but Amos Williams said his brother never did. He questions whether Brian ever received the letter, and if he did, would even understand what it meant because it's written in bureaucratic language. "He could've gotten it and thought it was their way of saying he no longer needed treatment or medication," he said. "They're trusting a person they know is a paranoid schizophrenic to understand this."
    Williams makes no excuses for his little brother. He does, however, think the mental illness and lack of medication were the biggest factors leading to the crime. "When he's medicated, he's a caring, sensitive individual who is just mentally ill, but the pattern is always the same when he's off," he said. "He becomes a volatile and dangerous person, even though that's not his nature." Williams also is critical of the system because it spends money on the mentally ill after they're already behind bars for committing crimes. He believes it would be cheaper to increase out-patient services to those with illnesses before the criminal justice system becomes a factor. 'We will have to deal with this issue like (government) deals with disease and hunger and I don't know how many more killings need to take place before it gets addressed. Even if it can't be fixed, it must be addressed."

Perception of Unsafe Conditions Continues to Plague Ypsilanti
Art Aisner & Marianne Rzepka, Ann Arbor News- 1/28/2001

Ypsilanti today is a far cry from the 1970s and early '80s when overwhelming numbers of mentally ill people loitered in restaurants, wandered city streets and waded into downtown library's fountain with bars of soap. However, that history has left an impression about the city that's been hard to shake. "The perception of safety - that downtown is dangerous - is still here and it's just not true," Police Chief George Basar said. There were 21 group homes for 165 mentally ill people in Ypsilanti, not including unlicensed homes, before the city asked the state to cap the number of group homes in 1977.
    A nationwide change in the approach to mental health care in the '80s led to sweeping cuts by the state that affected the Ypsilanti Regional Psychiatric Hospital in York Township, which closed in April 1991 along with nine other hospitals closed statewide within a few years. During its 60-year history, the hospital housed more than 45,000 psychiatric patients and the number of patients peaked in the 1960s at about 4,100. The hospital on the 830-acre site on Platt Road in York Township is closed, but the Center for Forensic Psychiatry next door still is operating with more than 200 criminals and defendants undergoing treatment and evaluation. Plans are to turn the property into a technology park to open by 2004.
    And the city was ready to accommodate, at least logistically, said Mayor Cheryl Farmer. Many of the city's large homes were already split into rooming houses due to the influx of bomber plant employees during World War II. What the community didn't anticipate was the impact the former patients would have on an already deteriorating downtown. Many of the residents spent their days wandering around the city, hanging out in lobbies, stores, the library and restaurants. The change was sudden, said the police chief.  "It seemed like on a Sunday these people were definitely mentally ill, and then on Monday it's like they were completely cured. They literally opened the doors at Ypsilanti Regional and kicked those folks loose from the hospital," said Basar. Even before the state hospital closed, Ypsilanti area communities were complaining that they had more than their share of mentally ill patients.
    In 1985, Ypsilanti Township filed suit in Washtenaw County Circuit Court to prevent the state from issuing any more temporary or permanent licenses in the township for adult foster care homes, which take care of elderly, handicapped and mentally ill adults.  The township suit said 41 percent of the adult foster care homes in the county were located in the township and in Ypsilanti. Together, the two municipalities made up 5 percent of the county's 720 square miles. The suit caused the state to place a moratorium on licensing additional foster care homes in the township, but that action was rescinded two years later because it violated federal discrimination laws.
    Kathleen Reynolds, director of Washtenaw County's Community Health Organization, remembers Ypsilanti State Hospital and doesn't think that kind of treatment should return. The problem was that "people would go there and not get out," she said. "They would be there 30 and 40 years and didn't need to be there." Many of the mentally ill don't need to be institutionalized, said Reynolds. "I believe we have the skills in the community" to help the mentally ill, she said. "Good community care is preferable to institutions."
    Michael Vincent, a former Ypsilanti police officer who now defends many accused criminals with mental illness, thinks community mental health needs to do more to help the mentally ill. "I think community mental health organizations have an obligation to make sure that people take their medication, and if you can't, don't release them into the community," he said. "If you're not going to confine them, you must have a system to watch them." He referred to the hospital's closing as the "death of downtown" because it became a receptacle for those former patients. "The hospital closing was like an earthquake or another traumatic event that changes a community," he said. "The problem was that with an earthquake, every one sees or feels it happening. No one saw this because they didn't want to or have to until it was right in front of them."
    Since the early '90s, the state's larger group homes - which might have up to 12 beds each - have been replaced with smaller six-bed residences run by the county mental health organization, Reynolds said. And administrators have been distributing the adult foster homes throughout the county, breaking up the concentration in Ypsilanti and Ypsilanti Township, she said. Basar said he's noticed a different atmosphere in town. The number of licensed adult foster care homes has dropped to 11, only seven of which care for predominantly mentally ill people. As to complaints that the city and township have more than their share of mentally ill in group homes, Reynolds said, "It's just a perception we need to be working on."

As Gambling Sites Proliferate, the First Online Generation Grows Vulnerable
Guy Gugliotta, Washington Post- 1/28/2001

He heard about Internet gambling from his friends in the dorm. He bet $10 on a basketball game, and won. It was "intriguing," so he tried it again. And again. He was up "quite a bit" by the end of the month. Watching the games on television became "a lot more interesting," even when he started to lose, he said. And lose he did. He doubled up. Lost again. Started betting $500 a game. Still lost. In a few months he was down $7,000, his girlfriend said he "wasn't the same anymore," and his grades took a nosedive. In the classroom, he spent his time surfing the Net, looking at point spreads.
    This young man, who spoke anonymously about his gambling addiction at a seminar for athletic administrators hosted last year by the National Collegiate Athletic Association, is representative of what appears to be a growing problem in the United States. The explosion of Internet sites dedicated to gambling has made wagering much more accessible than it ever was. As a result, more people are prone to getting deep into debt through gambling, and even to becoming gambling addicts, experts say. And young people appear to be especially vulnerable. The NCAA's speaker, who described himself as a junior at a Division One college in the Mid-Atlantic region, told his parents about his gambling, and they paid his debts in time for him to recover academically, he said. A friend wasn't so lucky. In the hole for $5,000, he had to quit school and work to cover his losses.
    "In virtually all studies of the rates of gambling problems at various ages, high school and college-aged individuals show the highest problem rates," said an advisory on Internet gambling and addiction issued by the American Psychiatric Association last week in the days leading up to the Super Bowl, the biggest sports betting event of the year. The advisory was aimed at university news services and other news outlets serving young people.
    Nowhere are young people more at risk than on the Internet. They are the first online generation, as comfortable in cyberspace as their parents were in front of the television. Once in college, they are besieged by credit card companies eager to sign them up. "When the college kids tap out on their cards, they use their parents' cards," said Kevin O'Neill, deputy director of the Council on Compulsive Gambling of New Jersey. "Then they call us up, or their parents call [1-800-522-4700 is the national help line]. We'll see a lot of bailouts next week." Rick Smith, executive director of the Interactive Gaming Council, said he had not read the APA advisory and could not comment. He said he was not authorized to comment on whether Internet gambling organizations are targeting teenagers and young adults.
    The congressionally chartered National Gambling Impact Study Commission estimated there were 6.9 million potential Internet gamblers in 1997 and revenue of about $300 million. One year later, the pool of potential users had grown to 14.5 million and revenue was $651 million. And it is potentially the worst type of gambling: "From the psychiatric point of view, it's roughly like drinking alone versus drinking in a bar," said Sheila Blume, chairwoman of the APA's Addicted Patients Committee. "Here's someone sitting at a computer with the door closed, and the family has no idea what they're doing. At least when you're in a bar, you're getting feedback."
    The Council on Compulsive Gambling of New Jersey estimates that $75 million to $80 million will be wagered on the Super Bowl in Nevada, the only state where sports betting is legal. Betting on the Super Bowl is exceeded only by the collective "March Madness" of the NCAA's season-ending basketball tournament. The council also estimates Americans will place an additional $4 billion in illegal Super Bowl bets, a great deal of it on the Internet, where the number of available sites exceeds 1,000.
    But sports betting is not the only game in cybertown. The sites offer lotteries, bingo, cards, casino games, slots and horses. Besides the ban on sports betting, U.S. law forbids interstate gambling, but there is considerable ambiguity about whether a bettor is betting illegally when the server is on a Caribbean island, in Central America or farther away. "Women tend to be casino gamblers, or they do bingo or slots -- it's 'Just leave me alone at a slot machine; I'm okay,' " O'Neill said. "Guys are into the competitive stuff -- blackjack, craps, sports betting." But experts agree that players of both sexes are learning about gambling at an early age and get virtually no warnings about the possible dangers. "Public attitudes toward gambling are quite positive," said psychiatrist Jeffrey L. Derevensky, a youth gambling specialist at Montreal's McGill University. "This is the first generation of youth who will grow up when gambling is not only legal, but government-sanctioned."
    Keith Whyte, executive director of the National Council on Problem Gambling, noted that states took in $25 billion in lotteries alone in 1999, and that in 2000, revenue from legal gambling is likely to reach $60 billion when it's totaled up. "I believe that many states are very reluctant to look at problem gambling," Whyte said. And teenagers and young adults are the age group most at risk: "Gambling as a phenomenon among kids is two to four times as bad as for adults," Derevensky said. "Four [percent] to 8 percent of adolescents have a very serious gambling problem." Studies since 1989 have shown an average of 66 percent of U.S. children ages 12 to 17 gambled for money in the previous year, with a mean age of 12 for their first wager.
    Despite these warning signs, experts say national surveys on habits of abuse do not ask about gambling, nor is there an upsurge of grass-roots consciousness-raising or opposition to it. "Young people have more problems, and they are into risk-taking," Blume said, noting that young gamblers are just as susceptible to getting hooked as young drinkers or drug abusers. "There's a feeling of invulnerability -- you never think anything bad is going to happen to you." Gambling abuse is also largely invisible. "It's not as easy to trace as alcoholism," said Daniel Nestel, the NCAA's senior assistant director of federal relations in Washington. "There's no substance."
    And in the credit card age, there's no fear of bookies, loan sharks or leg-breakers. "Our students can get three cards with $5,000 credit limits," Nestel added. "Once you've signed up with one, the other companies will find you." Finally, gambling and the Internet are familiar companions for today's kids. At his son's computer lab, O'Neill found "seventh-graders didn't need any instruction. They can go right to [gambling sites]. I asked them, 'What do you think of this gambling stuff?' " O'Neill recalled. " 'Oh, Mr. O'Neill, it must be all right,' they said. 'It's online.' "

Study: Drug Treatment Spending Low
David Ho, Associated Press- 1/29/2001

WASHINGTON— Dealing with the effects of drug, alcohol and cigarette abuse cost states about as much as they pay for higher education, a private study estimates. States spent $81.3 billion dealing with substance abuse in 1998 — or about 13 percent of their budgets, according to the study being released today by the National Center on Addiction and Substance Abuse at Columbia University. The three-year, state-by-state study, titled "Shoveling Up: The Impact of Substance Abuse on State Budgets," put New York at the top in percentage of funds — 18 percent of its budget — spent to "shovel up the wreckage" of abuse. South Carolina had the lowest percentage — under 7 percent.
    "Substance abuse and addiction is the elephant in the living room of state government, creating havoc with service systems, causing illness, injury and death and consuming increasing amounts of state resources," said Joseph A. Califano Jr., the center's president. Only about 4 percent of the amount spent, or $3 billion, was for prevention and treatment programs, Califano said. The rest of the money spent was drawn from state services ranging from law enforcement and welfare to health care and education.
    The report recommends greater investment in prevention and treatment, particularly among prisoners to keep them from committing drug-related crimes after their release. "Governors who want to curb child abuse, teen pregnancy and domestic violence and further reduce welfare rolls must face up to this reality: Unless they prevent and treat alcohol and drug abuse and addiction, their other well-intentioned efforts are doomed," Califano said. Total state spending in 1998 was $620 billion, with 13.1 percent related to substance abuse, the report said. By comparison, states spent on average 13.1 percent of their budgets on higher education, 11.3 percent on Medicaid and 8.3 percent on transportation. State justice systems had the largest portion of the expenses attributed to substance abuse, spending $30.7 billion on prisons, juvenile justice and court costs.
    The White House Office of National Drug Control Policy said the report demonstrates the need for a "balanced strategy" to deal with drug abuse. "We cannot simply arrest our way out of the problem," Edward H. Jurith, acting director of the office, said in a statement. "Treatment programs that follow a criminal from arrest to post-release follow-up must be implemented to end the cycle of drug abuse and crime." Federal estimates, using 1995 data, place the overall federal, state and local costs of drug and alcohol use at $277 billion annually, including law enforcement and social programs.
    The new study, which does not include federal funds, relied on data from the states about their spending on prevention programs, research and health care costs directly related to substance abuse. For indirect costs, researchers estimated the "burden" on state resources. For example, to estimate substance abuse costs in elementary and high school education, researchers considered the expenses caused by all abusers. Mothers who drink while pregnant and have children with fetal alcohol syndrome influence the costs of special education when those kids go to school. Student drug use affects the need for drug testing and health care, and drug-related violence might require more spending on security and repairs. Teachers who abuse substances can cost the state in productivity, work time and more expensive health insurance.
    Of the states, New York's estimated 18 percent amounted to more than $8.6 billion. Massachusetts was second, spending 17.4 percent of its budget, or $2.7 billion, followed by California, which spent nearly $11 billion, or 16 percent of its state budget.  Puerto Rico spent the smallest percentage of its budget, 6.1 percent, on substance abuse. South Carolina spent 6.6 percent, and Connecticut spent 7.6 percent of its budget. In terms of substance-abuse spending per person, however, the District of Columbia topped the list, laying out $812 per resident. North Dakota spent the least, $155 per person. Susan Foster, the study's principal researcher, cautioned against comparisons between states because the report does not include federal funds and states spend different proportions of their budgets on social programs.

Mentally Ill Inmate Received Inadequate Treatment
Dan Harris, ABC News- 1/30/2001

Felix Jorge was caught on tape screaming while guards physically removed him from his prison cell in the throes of a full psychotic breakdown. Less than 72 hours later, he committed suicide. This is the story of how he got here. In 1992, at age 22, Jorge was arrested for holding up a woman with a toy gun. He was sent to prison for three to six years. Despite a history of psychiatric hospitalizations dating back to his childhood, it took seven months before prison officials realized the full extent of Jorge's mental illness. According to prison documents obtained by ABC News, after a psychotic episode in which he "barricaded himself in his cell" and "said his mother was calling him," Jorge was diagnosed with paranoid schizophrenia and sent to the Central New York Psychiatric Center. After treatment, the doctors sent Jorge back to Auburn State Prison with a warning to officials there that he "could have the potential for imminent danger to himself." "At Auburn, the first day he's back, he's made to stand trial for having had a psychotic episode before he left," recalls Jorge's attorney, Ed Miller, "and he's punished for it." Jorge was found guilty of "creating a disturbance" and "refusing a direct order," and he was then sent to solitary confinement or the "hole."

Treatment Discarded, Lucidity Detoriated
In the hole, Jorge soon began refusing his medications as paranoid schizophrenics often do. And despite the fact that the doctors had recommended "continual daily counseling…to encourage him to accept" the drugs, Jorge never got such counseling. "Without that, he was lost," explains Miller. "He was a dead man." After three months without medication, Jorge tried to kill himself by swallowing 150 Tylenol pills. After he got back from the hospital, he was again punished: He was found guilty of "self-inflicted bodily harm." He was sent back to the hole. One month after that, he was transferred to the Clinton Correctional Facility. But his medical file evidently got lost in the shuffle. And when the prison psychologist at Clinton evaluated Jorge, she decided he didn't require any services. Without medication, he once again deteriorated.

Videotape Documents Forcible Removal
rison guards made a videotape of their actions because they are required to document every forcible removal of an inmate. In the video, one can see the guards removing Jorge from his cell, while they beat his hands in order to get him to let go of the bars.  Jorge had barricaded himself inside. He had started a fire, cut himself, soiled himself and was screaming at imaginary voices. Guards were ordered to extract him to take him in for psychological treatment. As they subdued him, Jorge cried for help. On the tape, one can hear Jorge say, "My name is Felix Jorge. Number 93A-3824. They're going to kill me." (Incidentally, the guards were actually following procedure and were not charged with excessive force. New York state officials refused comment, but they have agreed to settle a lawsuit brought by Jorge's family for $250,000.) After this incident, Jorge was then seen by a doctor and put under observation. "They put him in what's ironically called the Observation Unit," says Miller, "where in the end, he was left unobserved for 50 minutes, though he was on a suicide watch." In those 50 minutes, Jorge was supposed to be checked every 15 minutes. He was not. When the guard finally did check on him, Jorge was dead. He had stuffed wet toilet paper up his nose and down his throat.  "New York State could not be clearer in sending us the message: they don't value these lives, these lives are not valued," claims Miller. Officer Herbert Perry, who was supposed to be watching Jorge the night he died, was initially fined and suspended. But within weeks, he was reinstated. And at the end of the year, he received an excellent performance evaluation.

Sex Offenders to Take Part in Drug Study
Julia C. Martinez, Denver Post- 1/31/2001

Colorado prison officials plan to launch a chemical experiment this summer aimed at quelling sex offenders' sexual appetites.  The program would use Prozac, Zoloft and other antidepressants to dry up their sexual fantasies, state corrections chief John Suthers told lawmakers Tuesday. The goal is to develop effective treatment programs for sex offenders once they're released, said Peggy Heil, director of the sex offender treatment program for the Colorado Department of Corrections.  Officials were quick to point out the experiment is not chemical castration - an issue that generated controversy in past legislative sessions. "It's using antidepressants ... to reduce the sex drive of inmates and reduce the fantasies that keep them offending," Dr. Mary West, the DOC's deputy director of special operations, said at a joint meeting of the House and Senate judiciary committees. The controlled scientific experiment, which could start around July, will be funded by the federal government. Sex offenders would volunteer for the one-year program and be carefully monitored.
    As long as the experiment is voluntary and inmates are properly notified, the study itself should not raise serious concerns, state public defender Dave Kaplan said. But there are questions as to why the experiment is being conducted, he said. "If the study is successful, how is this going to help with public safety? Is this maybe going to shorten prison sentences and maybe help with parole?" Kaplan asked. Heil said the DOC would ask for about 100 volunteers, all of whom would be carefully monitored. Some would be given a placebo, others the active medication. "We have to make sure that any research would not be coercive," she said. "There would be no penalty for dropping out. We would tell them any possible side effects that could happen to them."
    Heil said the experiment stems from studies in Canada and at Harvard University that showed antidepressants "help decrease deviant sexual interest." "Obviously, we would help them figure out how to stay on the medicine out on the street," she said. Currently, a quarter of the state's 16,000 inmates are identified as rapists, child molesters and other sex offenders. Corrections officials have estimated that 1,600 sex offenders will be released unsupervised from prison or parole within the next few years. Suthers said the new program did not require legislative approval. He said the DOC received the necessary OK from the University of Colorado's Institutional Review Board, the body that must grant permission to do human experimentation.
    Over the years, various lawmakers have tried and failed to fashion laws requiring the use of chemicals to lower sex offenders' sex drives. In 1997, an effort that would have required two-time child sex offenders to agree to a "chemical castration" if a psychiatric evaluation deemed it appropriate passed the House but was killed in the Senate. Chemical castration involves the injection of a drug such as DepoProvera, which reduces the male sex hormone testosterone. Heil said it is currently used to treat only the most extreme sex offenders in prison and those released under supervision. Suthers emphasized that the new experiment does not amount to chemical castration. "It's a medicinal regimen that will balance depression and things like that," Suthers said. "On the basis of our programs, we now know how extensive their fantasy life is, and we're trying to deal with that through medicines, chemicals."
    Sex offenders are thought to be incurable and, therefore, remain a danger to society once released from prison. State law requires sex offenders released without supervision to register with local law enforcement within one business day. About 8,000 sex offenders are registered with law enforcement across the state. Sen. Ken Gordon, D-Denver, chairman of the Senate Judiciary Committee, said the experiment could prove positive. "I think it might actually work," he said. "I don't think you can force somebody to take that stuff, but the program is voluntary and the (antidepressants) have been shown to reduce someone's libido."