Noteworthy News Articles on Mental Health Topics, April 6-11, 2001

'Ecstasy' Is More and More Popular Among Local High School Teenagers
Alalie Nash, Ann Arbor News- 4/6/2001

Although marijuana remains the illicit drug of choice among teen-agers, a breed of designer drug is quickly creeping into weekend parties and local high school hallways. They call it "e" or "x" for short, and most teen-agers will tell you that it isn't hard to get. And while drug use among teen-agers is stagnant or declining in many areas, one drug - known as "ecstasy" - is showing a sharp rise that's expected to peak in the next few years. Pioneer High sophomore Aaron Savit figures teens enjoy the "empathetic feeling" caused by ecstasy. His friend, senior Pat Ford, says perhaps it's popular since it's fairly new. After all, marijuana - although still the biggest sell - isn't the freshest thing on the market, they say. "It's pretty easy to get, but it isn't always pure," Savit said. "I know a fair amount of people who do it. There're always a few people who do drugs to excess, but most have it under control."
    "E" has been talked about at Pioneer High for the last few years, students say. But at neighboring Saline High, it appears to have hit the student population just within the last year, said Mark Schuby, student assistance coordinator for the district. "Mainly we're still seeing the alcohol and marijuana, but there's more use of the designer drugs," Schuby said. "Ecstasy is on the rise, but about nine out of every 10 kids don't even know what it is that they're taking or buying. There's so much misinformation out there that most people don't know the real deal."
    Ecstasy, a central nervous system stimulant, became a popular drug at raves in the early 1990s and is becoming more mainstream among teen-agers and college students, police say. It's most common in an aspirin-sized pill form, ranging in cost from $10 to $30. The drug can create a feeling of euphoria. But it can also cause nervousness, hyperexcitability, rapid heartbeat, teeth grinding, scratching or rubbing skin, dizziness, loss of consciousness, eye twitching, panic attacks, muscle cramping and seizures. The long-term effects of ecstasy are now being tested and could include damage to the parts of the brain critical to thought and memory, according to the National Institute on Drug Abuse. In monkeys, exposure to ecstasy for four days caused brain damage that was evident six to seven years later, a NIDA study says.
    Pioneer High senior Dan Leonard said he believes ecstasy is a social drug. "It's the trendy drug," he said. "Some kids think a party just isn't a party without 'e.' Last year I heard about kids doing it before school because the high lasts so long." The drug is being closely tracked now by police, researchers, school officials and substance-abuse professionals. In the annual Monitoring the Future drug-use study conducted by University of Michigan researchers, ecstasy use rose among all the grade levels studied. At the high end, 11 percent of high school seniors have tried ecstasy, the study says. More than half of the 45,000 high school seniors surveyed last year said getting ecstasy would be easy.
    And unlike the previous study, ecstasy is now being used by eighth-graders, said Lloyd Johnston, the lead investigator on the study. "We've seen no evidence yet of a turnaround," Johnston said. "As we predicted, it's diffused out from the urban areas and is going down in age. It's the most rapidly-changing drug that we've seen moving in an upward direction in the last few years. Inevitably, when there's a new drug or one is rediscovered, it enjoys a honeymoon period when people aren't yet aware of the consequences." "I wouldn't be surprised if the bad news catches up soon and it starts to decline in the next few years."  Undercover officers with the Livingston and Washtenaw Narcotics Enforcement Team are seeing more of it these days. Less than three months ago, police confiscated 1,800 ecstasy pills valued at $45,000 from a 29-year-old who was walking in Ypsilanti Township. Possession of a controlled substance like ecstasy is a felony punishable by up to four years in prison.
    Ron Harrison, a social worker with a private practice in Ann Arbor specializing in treating teens with substance-abuse problems, said he has watched many drug trends over the last 19 years - including the newest designer drugs. He said talk of ecstasy surfaced among patients in his office more than a year ago. Now, he's seeing more and more teens who have tried it. "What I'm seeing in my office is consistent with what's happening in the nation. Ecstasy is now part of the package of drugs that are available, and any teen-agers who are prone to drugs would wonder about the new drug on the scene," Harrison said.
    Timothy and Jill Kotyuk are the parents of teen-age daughters and believe the key to addressing drug use - be it marijuana, ecstasy or alcohol - is to talk about the problem. They did just that during a recent meeting of the parent-teacher-student organization at Huron High School focusing on teen-agers and drug use. Their talk highlighted a personal incident, when their 16-year-old daughter had friends over when they were out of town last fall and the party turned unruly. When it was all over, police had ticketed their daughter for underage drinking and teens caused more than $8,000 in damage to their home. They're still finding beer cans in the bushes. Jill Kotyuk said they discussed ecstasy with their children after their daughter said girls attending a high school dance showed up with pacifiers around their necks - a sign of ecstasy use, since the drug causes involuntary teeth clenching. Other signs of ecstasy use include an abundance of energy, sweaty and deep breathing, hugging and touching behavior and lip biting, police say.
    "It's scary for me how accessible alcohol and other drugs seem to be," Timothy Kotyuk said. Jill Kotyuk said she thinks parents need to work together and become educated about all the drugs on the market. She recently attended a forum on designer drugs in Saline and brought her teen-agers along. "I expect that my kids will take risks and won't be perfect, but they need to understand the consequences," she said. "Now that Baby Boomers are parents, kids are saying, 'Well, didn't you do it?' I tell them that I've made mistakes and learned, and that doesn't make it acceptable for them."
    In addition to the recent forums on teen-age drug use, there's a local push to create a residential treatment program for adolescents and bring more drug education into the schools. The board of directors at Dawn Farm, a residential treatment program that serves anyone age 17 and up, recently discussed adding the first county program for youths, said James Balmer, president of the organization. Ann Arbor resident Bradley Spencer heads the Safe and Drug-Free School Advisory Committee, which is lobbying for prevention programs for all grade levels and substance abuse counselors in the high schools. Spencer, a retired teacher, became involved in 1979 after two of his students died in drug-related auto crashes. "It's troubling now to hear the experiences with ecstasy. I think we need to create a community awareness about the extent of drug use in teen-agers," Spencer said. "It comes down to the fact that I don't think students are getting the message about the dangers of drugs. We need to focus on putting a prevention network that was once in place back in place in the schools."

Rebirthing Tape Reveals Pain, Gentleness
Kieran Nicholson, Denver Post- 4/7/2001

As part of the "holding therapy" Candace Newmaker underwent last April, therapist Connell Watkins alternated between drill sergeant and doting caregiver to the 10-year-old girl. The therapy was intended to dispel any influence that Candace's biological mother might have had on the child; to get Candace to unconditionally obey her adoptive mother; and to break Candace of manipulative ways. Watkins also hoped to get Candace to cough up secrets of alleged past abuse. A videotape of the "holding session," which began being shown Thursday, continued Friday for jurors in the Jefferson County trial of Watkins and Julie Ponder, two Evergreen therapists who treated Candace.  Both are charged with reckless child abuse resulting in death. Candace suffocated while wrapped in a blanket during the rebirthing therapy.
    Sheriff's Detective Diane Obbema said that during the holding session, Watkins grabbed Candace's face 90 times, shook her head 309 times, shouted in the girl's face 69 times and threatened her 49 times. Watkins also stroked her face gently, talked to her in sweet tones and encouraged Candace to scream at her - in what amounted to an emotional roller coaster ride. "Do you like your real mom to be boss to you?" Watkins says sternly. "No," says the girl. "She's still bossing you around though you haven't lived with her for four years," Watkins says. "We know she is still in your head and still bossing you." Watkins says, "Is it fun being your birth mom?" "No, I hate it," Candace replies. Watkins instructs Candace to say, "I couldn't make her love me!" "Louder!" screams Watkins. "I couldn't make her love me!" screams Candace. At one point Watkins tells Candace, "You act like a child who hates the world." "We can change that if you want to," says Watkins. "But it's almost getting too late. Got it?"   "Got it!" the girl screams back.
    Watkins then tries to get Candace to tell her about "secrets." Candace says she doesn't want to tell because it could be "embarrassing." "These are private matters, but you have to tell the people you love," Watkins says in a gentle voice. "What is it she's (biological mother) afraid of that you're going to tell?" Watkins says. "I don't know," replies Candace. "That she didn't love me?" "We already know that," says Watkins. Watkins then goes into a series of questions. "Did she hurt you physically?" "Not very much," Candace says. "Did she feed you enough?" "No, not enough." "Did you see mom have sex with other men?" "No." Candace admits her biological mother beat her bare bottom with a belt, but only a few times.
    The tape shows Candace hugging her adoptive mother, Jeane Newmaker, during a break. "Mommy, Mommy," she cries out, and they hug. They sit face to face, holding hands, Newmaker telling Candace this could be their last shot at becoming a family. "Is it hard to talk about Angie (Candace's biological mother)?" Newmaker says. Candace nods yes, Newmaker begins to cry but Watkins comes into the room and scolds Candace for making her mother weep. Later, Watkins tells Candace that she's going to get a haircut. "How short?" says the girl. Short, like a soldier's hair, Watkins replies. The haircut will be symbolic of change. Candace climbs into a chair. A woman named Denise folds the girl's long hair, which was more than halfway down her back, and begins to cut. The camera is turned off. The trial resumes Monday morning.

Mentally Ill Person Committed to a New Life
Susan Levine, Washington Post- 4/8/2001

Joe Redd had packed his garbage bags weeks early. After all this time, he worried, what if he weren't ready when his moment of freedom finally arrived? His life's possessions were few. From the wardrobe in his bedroom: several jackets of varying insulation, several pairs of pants, a meager collection of T-shirts, some battered sneakers. From the nightstand beside his bed: bus maps, a Fellowship Hymnal, the yellow cup he won during field day, the grade school books he studied regularly. But not much else. He once owned other things, but many got lost or taken. That's how it was during his 32 years at St. Elizabeth's Hospital. In outdated buildings notable for their utter blankness, belongings frequently were misplaced. Sometimes, people were too.
    Redd was a young Turk, lean, loose and out of control when he entered the sprawling mental facility in Southeast Washington D.C. Weeks gave way to months, and months to years, and though his illness subsided, he was not released. Years gave way to decades, and though the box marked on his treatment plan stated "hospitalization not needed," he was not released. He grew stiff in the knees, thick through the gut. He grew so dependent on the institution that he feared he could not survive without it. Which the institution, in the end, allowed. Though professionally obligated to help Redd face the outside world, though legally obligated to move him into it, St. Elizabeths did the opposite. It accepted that he was there. That he might always be there. That it was his choice to be there and that little could be done to change his mind. "Mr. Redd's life . . . seems essentially immutable," an administrator wrote in his record in 1994.
    Then last fall, it was agreed he should be sent back to the community. "I be glad to get away from here." Redd says this just hours before discharge, his exit from the hospital more bittersweet release than farewell celebration. "But then again, see what it is, I shoulda been gone before a whole lot of 'em." There are plenty of people he could tell goodbye, but he doesn't. He eats breakfast and checks his nightstand drawers to make sure they are empty. He sits in his ward's day room, and out front of his drab block of a building, waiting for his ride to his new home. He eats lunch and waits some more, until finally his ride drives up and the five black garbage bags -- a matched set -- are loaded, and one nurse hugs him, and another urges, "Come back and see us." Redd makes no promises. "I'll think about it," he says.
    That night, for the first time in 32 of his 59 years, he goes to bed exactly when he wants. The next morning, he wakes up exactly when he pleases. He turns on the television and nobody yells at him to change the channel. In the Oct. 4 square of his calendar are these words: I Moved.

Changing Attitudes
His Aunt Hilda brought him to the admission ward when months of paranoia degenerated into violent, psychotic behavior. The hospital had 5,300 patients that summer, and it signed Redd in without delay. The date was July 17, 1968. "I went there the same time that Martin Luther King was killed." It was a time of transition, away from the days when society believed disturbed minds could be warehoused for life. Countless had been, in St. Elizabeth's and public asylums across the country.
    But a revolution was underway called deinstitutionalization, the notion that lengthy confinement is tragically disabling and that the mentally ill do best when allowed to live and participate in a greater community. New drugs like Thorazine held out hope that many could do that successfully. So hundreds of thousands of people were released from crowded back wards. Funding to house and assist them often fell short, and some were as doomed on the street as they were in the hospital. Those flaws did not undercut the trend away from institutions, however. The movement had particular repercussions for St. Elizabeth's, where advocates filed and, in 1975, won a lawsuit establishing that patients have a right to treatment in the "least restrictive environment." Within a decade, its population dropped below 1,600. Within two decades, below 900.
    People sicker than Joe Redd were discharged. People as unwilling to leave as Joe Redd were discharged. He stayed -- long enough to slide into middle age and nearly out of it. "He got trapped," says Elizabeth Jones, who during the 1980s fought to reform St. Elizabeth's. Now, as the District's chief operating officer for mental health services, she oversees it. She does not fault specific individuals in Redd's case. She knows that the walls of St. E's have a way of distorting almost anyone's perspective, that workers can become as caught in the culture as patients. But she refuses to ignore their collective culpability. "They had an obligation to move him to a community environment with supervision, and the fact that that didn't happen can't be excused." Another fact she can't excuse: For nearly a quarter-century, the hospital kept Redd on its criminal side -- in the isolated fortress where courts ship the city's mentally ill lawbreakers. He was no criminal, yet for eight years his address was maximum security.
    The arc of Redd's experience is all too common here and elsewhere, despite the era of deinstitutionalization. "He's not unique," says psychiatrist E. Fuller Torrey, president of the Treatment Advocacy Center in Arlington and formerly of St. Elizabeth's. "There are many patients like him, who are part of the hospital, part of the culture, part of the family." These lives stall because an ingrained system -- as concerned with self-preservation as patient recovery -- rationalizes their presence, Torrey says. The more protracted and sheltered that presence, the harder it is for employees to see beyond individuals' failures and imagine triumphs and the possibility they might live independently. Staffs invest in patients, says St. E's social worker Daisy Wilhoit -- and sometimes in their fears.
    The institutions have their own fears, such as the headlines if a released patient commits a crime. Or freezes to death on a snowy sidewalk grate. Into the mid-1990s, St. Elizabeths' regular treatment assessments pronounced Redd too vulnerable to release; he was unable to care for himself, therefore a danger to himself and others. Employees at St. E's became so used to thinking that he would never leave, so used to seeing him as he hung out with the guards at the hospital's main entrance, that when he disappeared from the gate that October day, many simply concluded that he had died. His 32 years of hospitalization carried a steep price. In terms of a bottom-line figure, estimated by adding up the average per-patient cost annually, the bill was about $2 million. In terms of human potential, a bill is impossible to tally. "It's staggering to think of what has been lost," Jones says.

Patient No. 93,237
The day looms as idly as any at St. Elizabeth's, which has been emptied of all but 600 patients. Locked, deserted buildings make it look and feel like a decaying Hollywood stage set. "Like a ghost town," Redd says, surveying the scene. "This used to be really crowded." By now, his bulky frame is as familiar a sight here as those red-brick buildings. Age has greatly altered his facade too. Deep, arched grooves have changed the planes of his face, made them both longer and wider. His eyes are more bulbous, and they go a little popeyed when something surprises him. Something often does, Redd being less worldly than the average fifth-grader. He responds to praise with a modest shrug, to amusement with staccato laughter.
    It is late summer, and talk of Redd leaving soon remains just that. He meanders the hospital grounds with his slightly canted pitch, pointing out landmarks with the confidence of a tour guide. St. Elizabeth's spreads over 326 acres on both sides of Martin Luther King Jr. Avenue, north of Alabama Avenue. While the institution is a shell of its former self, the city's poorest and most unstable denizens continue to be brought for evaluation and, if necessary, admission.
    The July morning that Redd arrived, Aunt Hilda gave the admissions doctor what little background she could. His epilepsy had begun when he was little, about a year after he fell down a flight of stairs. The convulsions were severe and relentless, and he never knew when he might be sprawled in an embarrassing fit on the ground. According to other relatives, that accounted for his childhood talent for fighting. Medicine surely would have made a difference, but Redd's family had no wherewithal for a lot of doctor appointments and pills. He lived with a chaotic mix of siblings and cousins. Theirs was a dilapidated house in the 300 block of F Street SW, which one day would be sacrificed for a city freeway. His record indicates that his mother absented herself for substantial stretches of his growing up. His father was nonexistent.
    Epilepsy devastated his life. It was why he entered school late, floundered academically, dropped out after seventh grade, drifted with limited skills, slept in a men's mission, held only one true job -- as a dishwasher at an Army barracks -- and why, far worse, he turned paranoid, anxious, delusional and explosive and wound up in a mental ward at 27. "I was sick, it's true," he says. Yet he does not understand his illness in a psychiatric sense. He does not grasp that chronic electrical overloads in his brain's temporal lobes caused chemical changes that affected both personality and behavior. On that hot, long-ago July day when he became patient No. 93,237, he told a doctor that people always picked on him. "If they try to kill him," the doctor wrote, "he's going to try to kill them."
    Shortly thereafter, he jumped a man and was confined in isolation for two days. "It is felt at this time that the patient needs further hospitalization because he would be a danger to himself or others if not retained," his records noted. A civil court commitment that August settled the matter. It's unclear whether Redd had any legal representation at that proceeding, or for decades after. Redd was transferred among wards repeatedly. He suffered major seizures and provoked numerous altercations, which usually occurred in tandem, despite an array of drugs. He assaulted patients and two workers, and that notoriety ultimately would overshadow his entire hospitalization.
    Behind the gruff, fists-first swagger, however, hid a frightened man painfully ashamed of his educational shortcomings. He could be belligerent, yes, but also very helpful. He could be argumentative, but also cooperative and polite. A few staff members were quite fond of him. Others discounted much of what he said. They minimized his strengths. They maximized his deficiencies. In 1975, after he struck an elderly patient, they sent him to the criminal side for what was supposed to be six to eight months in a behavioral modification program. "When I had the seizures, that's what held me back. I been held back a long time."

'He Wouldn't Leave'
Redd's history takes up 10 thick volumes in St. E's archives, a room in Q Building filled with boxes and files and the dry, brittle smell of old paper. The epoch contained within them was, for the institution, one of sad decline, of neglect, censure, lawsuits and court orders. In 1987, it passed in ownership from the federal government to the city, which quickly proved itself equally incapable of meeting obligations. Redd's care reveals little of that turmoil and none of the horrors commonly alleged of places like this. He variously got treatment plans, educational therapy, psychiatric reviews, recreational therapy, neurological assessments, industrial therapy, hygiene group, dance therapy, current events group, poetry sessions, rap group and nurse counseling one-on-one. Plus the daily assurance of "three hots and a cot."
    "He wouldn't leave," Joseph Henneberry says. "Joe himself kept himself here." From his office at the John Howard Pavilion, where he worked for 14 of Redd's early years there, the criminal services chief retraces the past. His building is a secured facility for offenders judged insane or disturbed. Its wards are bare walls and pallid fluorescence, austere rooms as lonely as a monk's cell -- or an inmate's. Each floor is locked. The stale, dingy lobby is safeguarded by a metal detector. With rare exceptions, courts control who goes in and out, where and for how long.
    Patient No. 93,237 walked in as one of those exceptions, sent over from St. Elizabeth's civil side because of his behavior but bound by no criminal court strictures. With the outside world a receding recollection and bad memories from his other wards, John Howard quickly became Redd's concrete cocoon. Anytime anyone talked change with him, his fears would flare and sabotage the planning. He balked at returning to the civil side. He rebuffed chances to venture into the city. He even resisted leaving maximum security. He had virtually nothing and no one on the outside, Henneberry says. Had he been kicked out, he could have ended up like one of New York City's ex-patients did a while back: Alone in a low-rent boardinghouse. Alone, epileptic and dead.
    Henneberry disputes Elizabeth Jones's belief that the system failed Redd by not pushing him harder and earlier toward release. Psychiatric drugs were fewer and less sophisticated then, he says, as were programs that might have offered what Redd needed away from the institution. "Over those years, there weren't too many services for Joe to be placed." At John Howard, Redd could count on conversation with familiar faces and praise for his beautiful voice. "Did we keep Joe alive and happy all these years?" Henneberry answers his own question. "I think we should get three stars for providing and enhancing life for the man."
    Still, what if the past is more complicated than that? What if, as others suggest, the system learned to get comfortable with Redd's reluctance and paranoia? Well before he was shifted to the criminal side, his medical record referenced his deepening dependency on St. Elizabeth's. Once he settled into John Howard, those references became a broken record.
From December 1982: "Mr. Redd is a very institutionalized man and does not visualize being able to go back and adjust to the community."
From August 1983: "Mr. Redd becomes sick, fearful and even hostile when leaving the ward is discussed with him."
From January 1985: "He has been on this ward so long that he feels that he is part of the staff."
From June 1989: "His welfare is totally dependent on the care he receives from the hospital in [the] form of medication, therapy and structure."
    Says psychologist Nuha Abudabbeh, who knew Redd during this period: "We keep these birds in the cage, and we clip their wings. And then we expect them to fly?" The pathology of institutionalization has been acknowledged for decades, which means that for decades there has been recognition of how and why and when it occurs, what should be done to prevent it, what should be done to reverse it, and who is accountable for that. The best treatment does not permit a person to become so removed, so circumscribed, that rejoining society is a terrifying, alien experience. Yet if that happens, says Steven Schwartz, "the responsibility of the folks who narrowed the world is to make the world bigger again."
    Schwartz is executive director of the nonprofit Center for Public Representation in Northampton, Mass. He's worked nationally on cases involving public mental hospitals and their generations of "kept people," and in 1992 helped to shutter the Northampton State Hospital. One of the men there Schwartz recalls vividly. In five years, he never left his building -- never once stepped into the sunshine to breathe fresh air. It took Schwartz and others more than two years of constant cajoling before he would accompany them to a McDonald's several blocks away. Today the man is on his own, in an apartment.
    At St. Elizabeth's, efforts to reverse Redd's reliance on the hospital seem from his record to have been largely perfunctory or scattershot and miserably unsuccessful. Certain staff members -- an aide on one floor, a nurse or therapist on others -- pressed hard individually to make a difference. But as his case appeared increasingly futile, especially through the institution's myopic lens, others believed he would never be reintegrated into the community.
    It didn't help that treatment options in the District were lacking or that his family had virtually abandoned him at St. E's. "You know what they call you when you stay too long?" Redd says. "Institutionalized. It means to me, it means to me that you don't wants to get out of there, that you're afraid. I was in that category. . . . I, I stayed there because I felt I had nowhere to go."
    Redd was given another round of industrial therapy, assigned to haul and store furniture with the hospital property unit. "He was an excellent worker. He could follow instructions and could learn quickly," says Rocknell Swilling, a vocational rehabilitation specialist who supervised him in 1988. Redd hustled pocket change by washing hospital employees' cars. He studied his reading and arithmetic and fixated volubly on how to be a better person. And he sang. The hospital was always ready to enjoy his rich, powerful baritone. He sang for Black History Month. He sang for Thanksgiving. He sang for employees' retirement parties. He sang for their funerals.
    Annie Fuller, whose official title was forensic psychiatric technician, considered Redd her personal challenge during the dozen years he lived on her ward. You don't need to be here, she'd prod him. You're trying to get rid of me, he'd accuse her, and there the conversation deadlocked. Fuller sighs. "It's hard getting people out of that hospital at times. . . . If Joe could have gotten an early start back to the community, maybe things could have been different for him."
    Suddenly, in 1998, Jones arrived as the hospital's director. Redd's name was on a list she was handed; he was someone stuck at John Howard, she was told. Based on the 1975 court ruling, St. Elizabeth's had an affirmative obligation to treat patients in the setting that least restricted them. No longer, Jones decided, would he be given the choice of refusing to leave.

Moving Out, Moving On
Two-and-a-half years later, much has changed, which is to say Redd's entire universe has shifted, and is about to shift again, because in only five days he will walk away from St. Elizabeth's for good. But first he must check out his prospective home. It is an apartment off Bladensburg Road NE, and it will have a brand-new kitchen, hardwood floors and a queen-size bed. It will have a gold-trimmed ceiling fan, beige mini-blinds and three closets. Redd will share it with no one. He dodges the workers sawing and hammering in the small two-story building. He is unsure of what to do or say, so he looks up at the ceiling, which is stucco, only Redd does not know that word and does not know that the tiny surface bumps and whorls are inherent to stucco. He eyes them dubiously. What's wrong with it? he asks his cousin Carlene Ewing, who has come along because these days she is his closest family contact and worries about his future. It looks funny, he grumbles to Chris DeMarco, a case supervisor at the Southeast Washington agency Community Connections and the crucial point person for Redd's exit from the hospital.
    A few moments later in the kitchen, there is a second problem: The cabinets are too dark for Redd's tastes, and old besides. He wants the place across the hall, he says stubbornly -- the one with both smooth ceilings and white-ash cabinetry. That apartment won't be finished for several weeks, DeMarco warns him. "You'd have to wait." He blinks hard. He hesitates. Unaccustomed to standing at such a crossroad, he hesitates a moment more. All right, he says. He will wait.
    Never one for insight, Redd can't say exactly how he reached this juncture -- why or when he started pulling away from St. E's. Likely it was not one event or conversation that was crucial but several. In the early 1990s, Ewing reconnected with him and renewed his sense of family. "I just felt . . . that somebody should have been there for him," she explains. Several years later, a program he grudgingly attended near Catholic University compelled him to confront new people and experiences. Then, at Jones's command, came a forced march back to the civil side, where nurse Barbara Haley mounted her gentle, but unyielding campaign. When you're living in your own home, Mr. Redd, she would say, nobody will take your food from the refrigerator but you. And in your own home, Mr. Redd, she would add, you can watch TV as late as you want. Redd translated that into Reddspeak: "You don't have people who be ordering you around, telling you what to do, throwing stuff in your face. You can see yourself in a better way. . . . It puts more experience in you."
    He is unaware of other details: how his name was passed to Community Connections after the city mental health commission advanced a plan to forever upend the institutional mind-set of the system, the most expensive in the country. Its strategy: to make a single community organization responsible for everything a mentally ill individual might need to succeed and to let the individual drive the decision making. District skeptics remember myriad failed plans, which is the reason the city badly lags behind other parts of the nation in philosophy and services. It also is the reason the commission has operated since 1997 under a court-appointed receiver. Another crucial change already in progress: St. Elizabeth's will be replaced by a new 300-bed hospital, with most of those beds for criminal patients.
    Redd knew what he wanted before he met with DeMarco and her boss, David Freeman. An apartment, he informed them, throwing the words down like a gauntlet. Hospital officials, as cautious and protective as ever, had recommended a group home for maximum safety. He angrily refused. "He was challenging the status quo of the hospital, and he wasn't willing to back down," says Freeman, a towering man who is a psychologist by training. "What is the quality in somebody that stays alive in the face of that kind of environment? I think it's extraordinary."
    Freeman was totally willing to take the risk. Redd, at last, was too. Staff members at St. Elizabeth's opposed an apartment to the end, citing everything they believed Redd did not know -- or accept -- about shopping, cooking, medications, seizures, his psychiatric problems, the dangers beyond his door. They predicted he would relapse if not closely watched. A program coordinator named Sara Lee broke ranks. "Let him try," she argued. "If he doesn't make it, he doesn't make it. But at least we've given him the opportunity to try." Which is how he happens to be inspecting a stuccoed apartment off Bladensburg Road.
    There is so much to be done. He needs furniture and cleaning supplies, everything from a sofa to a mop. He needs the accoutrements of a kitchen, though he can cook little more than eggs -- boiled or scrambled. He needs a photo ID, and he should get a grocery card, though he is as ignorant of contemporary supermarkets as of washers, Zip codes and the costs of daily living. His cousin has given him directions on picking out the best furniture from Community Connections' inventory. "I don't want anything beat up and tore up. I'm, I'm trying to make sure everything is on the ball." He would like four chairs at his kitchen table in case he has visitors. "I wouldn't make it no habit to have no crowd, no big crowd. A crowd is nothin' but trouble." He would like a television, for sure, and the bigger the better. "For keeping up with the news and the world, with what's going on. . . . I missed a whole lot of things out here."

Seeing a Future
In his first month of opportunity, he does the following: He goes by himself to the Million Family March on the Mall, meeting a group of nice Tennesseans on the bus and discovering with shock that a bottle of water can cost $3. He sits at his kitchen table and studies his schoolbooks. He calls Literacy Volunteers of America after his cousin passes on the number and catches three buses to the group's downtown office, where a woman asks him to read a series of words out loud and a short story about the importance of family. He watches "The Price Is Right" every day and football games every weekend. He eats a lot of eggs, Frosted Flakes and hot dogs. The apartment could work out, he thinks. "I got to get a little used to it, a little, uh, uh, uh, recorded to it," he stammers, hands circling like windmills as he searches mentally for the word.
    By his sixth month of opportunity, it is working out indeed. He has logged but a single seizure, his best stretch ever. Not that he's been completely healthy; in January he was diagnosed with gout, and when the doctor advised him to cut back on processed meats, Redd went, well, cold turkey. He would never eat another hot dog, he vowed. No more bologna, either. In fact, no red meat of any kind. His resolve greatly complicates Tuesday afternoon shopping at the neighborhood Safeway. "Joe, you want that big pack of eggs you got the last time?" Redd scrutinizes his grocery cart, empty except for a loaf of wheat bread and 64 ounces of chicken wings, before he answers Valerie Bethea. She is his prime contact at Community Connections, as petite as he is big, as young as he is old. They work well together; he is picking up her cooking pointers, as well as her subtle tips about diet and budget shopping. "I get tired of eggs all the time," he complains. "How about waffles?" They swing over to the frozen food aisle. He reaches for the 10-count Eggos, one shelf over from the Safeway waffles on sale for $2.69. Wait a minute, she says, you get two boxes of Eggos for $3 or the Safeway brand with 24 waffles. He figures the price and volume differential. He is a quick learner. "Get me that big box," he says.
    Every month Redd receives a $530 Social Security disability check. He pays $350 toward his rent, $25 for his phone, $10 for his medicines and the rest for laundry, clothing, bus fare and miscellaneous expenses. For groceries he gets $30 a week, which pains him acutely as he heads toward the checkout with more than a dozen items. "This comes to everything I got in my pocket!" he grouses, clumsily swiping his shopper's card through the machine.
    These days he has goals, plans. He wants desperately to better his reading enough to earn a GED. He talks about it nonstop and invariably mentions the story he saw on the news, about an elderly man who accomplished this same thing. Why, Redd says, jabbing his finger at an imaginary television, "if that man can get a GED at the age of 79, I can get one!" He visits Community Connections regularly and is in its advisory group of clients. When its members picked officers, they chose Redd as their outreach and hospitality coordinator. "I'm really proud of him," says his cousin, Ewing, beaming. "Just the fact that he wanted to [get out] and he's done it."
    The walls of his apartment remain as bare as the institution's. Still, his success so far -- his absolutely humdrum day-to-day existence -- hints at how different his road might have been. In ways big and small. As Ellen Harris sees it from her perspective at the Bazelon Center for Mental Health Law in Washington, living on the outside is not just living without locked wards, constant supervision, a hierarchy of privileges, activity therapies, a false community and everything else that an institution imposes. "It's the mundane pleasures of life," she says.
    Redd now calls St. Elizabeth's "that worry joint." He has returned just twice since Oct. 4. Once for a routine medical test. Once to perform at the hospital Christmas party. "Go tell it on the mountain," he sang, his liquid-velvet voice, smooth and full and resonant, enveloping everyone in the room. But this is what he would really like to go tell. To the people left behind. "The main thing, what it is, when you be there for so long, you don't want to die there. I was in St. Elizabeth's for 30 some years. It ain't no use for being afraid to come out."

With Costs Up, HMOs to Monitor Patients
Liz Kowalczyk, Boston Globe- 4/8/2001

At the urging of several major employers, the two largest HMOs in Massachusetts are about to put ''managed'' into managed care. Joining a growing number of health plans nationwide, Blue Cross and Blue Shield of Massachusetts and Tufts Health Plan have hired national companies with sophisticated computer software to search patients' insurance claims and pharmacy records for those who are not receiving, or may not be obeying, the best medical treatment for their condition. Armed with lists of potential medical errors, medication conflicts, and cases of noncompliance, company or HMO nurses will call these patients or their doctors and try to persuade them to change. One company, Active Health Management of New York, has software that can detect 600 potential treatment problems and already is sorting through the claims of 1 million Americans. Employers hope that computers and extra nurses checking up on doctors and patients will keep workers healthier and out of the hospital and, in the long run, will save money.
    ''The sad truth is that HMOs have by and large not yet fulfilled their promise in the way health care is delivered,'' said Dolores Mitchell, executive director of the Group Insurance Commission, which manages benefits for 263,000 state employees and retirees and their families, 30,000 of whom will be monitored by Active Health. ''Some members get very good medical care and some do not. There is clearly a gap left to be filled - delivering the very best of medicine to the entire population.'' Until now, she said, health maintenance organizations have had limited success at directing care for their sickest and most expensive members, partly because the plans were focused on expansion and partly because the technology wasn't fully developed.
    But with HMOs demanding hefty premium increases for the third straight year, employers are demanding innovative programs to improve the quality of care and reduce costs. Many HMOs already have some disease-management programs, but these new companies will be the next test of managed care, and of whether it is possible to analyze millions of members' claims quickly and accurately and change the behavior of patients and their physicians.
    Doctors, some of whom are insulted that HMOs and now outside companies are looking over their shoulders, are skeptical. Even some health plan executives are not convinced that the programs will improve care. ''If over six months, the computer spits out 2,000 names and after making phone calls you've found only 50 valid issues, then you have to question the cost effectiveness of this kind of program,'' said Dr. Robin Richman, vice president and medical director for quality improvement at Tufts. ''So far the reality and the hope of this kind of technology haven't jived.''
    But under its new contract with the state, Mitchell requested the ''risk intervention'' program. So as a pilot program, Tufts will transmit to Active Health medical claims and pharmacy data on the 30,000 state employees and family members enrolled in the Tufts preferred provider organization. Patients' names will be deleted; they will be identified by numbers only. Active Health will try to match the data with 600 scenarios that signal treatment problems, such as a patient who has picked up insulin prescriptions to treat diabetes, but has no insurance claims for eye exams. (Blindness is a long-term risk of the disease.) Tufts' own doctors will call the patients' physicians, and employers will not have access to the data. But Richman said companies such as Active Health analyze claims for a limited period, meaning that the data are sometimes incomplete.
    Six large employers, including Polaroid, Gillette, and Houghton Mifflin, have urged Blue Cross to sign a similar contract with Active Health or another company to identify health risks in 120,000 employees enrolled in the insurer's plans. Blue Cross is reviewing proposals. ''Employers are looking for any port in a storm,'' said Bill Hubert, manager of corporate benefits for Polaroid, which saw premiums jump as much as 20 percent this year. ''We're watching health care costs go out of sight and we know there's waste and inefficiency.''
    Meanwhile, Blue Cross has signed a more limited contract with a disease management company, American Healthways of Nashville, to search pharmacy and claims data on 8,000 patients with congestive heart failure, looking for those who are not filling their prescriptions or visiting doctors. Company nurses also will manage those cases, contacting patients to make sure they're weighing themselves daily to monitor fluid gain, a signal of heart failure. Robert Stone, executive vice president of American Healthways, anticipates a 20 percent reduction in treatment costs in the first year.
    In both cases, the companies and the HMOs say their aim is to win cooperation from physicians, who have historically bristled at this sort of interference. And with good reason, said Dr. Richard Parker, associate medical director for a 40-doctor internal medicine practice with the CareGroup network. At one point, an HMO sent him a list of 20 women who failed to have a mammogram or a Pap smear. He followed up on each one, and in almost every case there was a reasonable explanation, he said. Some women had seen a doctor outside the HMO's network and paid for the test themselves, so they didn't generate a claim. Others didn't want the test or had previously had a hysterectomy, making a Pap smear unnecessary. ''The effort is noble but very often the data is poor,'' Parker said. ''Many doctors have become so tired of incorrect data, they just throw it out.''
    Susan B. Connolly, a partner at William M. Mercer in Boston who is advising the group of six employers, said HMOs have tried various tactics to control costs, but the benefits from those strategies are running out. Employers, she said, favor comprehensive risk intervention programs over management of a single disease because they take into account the patient's entire medical situation. ''The evidence is that HMOs have negotiated very good discounts [from providers] and reduced inpatient hospital stays,'' she said. ''But we still have high medical inflation. When we go and analyze it, we see 20 percent of people driving 80 percent of the costs, still after all these years.'' Still, it's unclear whether the new data search programs will be able to squeeze additional dollars from the health care system. Health plans would not discuss the price of the programs, which usually charge the HMOs a per-member, per-month fee.
    Dr. Judith Frampton, a nurse and director of clinical programs and quality measurement for Harvard Pilgrim Health Care, said that HMOs have had asthma management programs for years and have made progress. Harvard Pilgrim has reduced emergency room visits among children by at least 28 percent and days in the hospital for adults by at least 26 percent since 1996. But Dr. Alan Sokolow, chief medical officer for Empire Blue Cross/Blue Shield, New York's largest health plan, said intervening in medical care sometimes ends up costing more, not less. Empire has enrolled 500,000 of its 4 million members in an Active Health Management program, and while it has caught thousands of potential medical errors, ''we have never attempted to calculate any return on this program and I don't think as it's currently constituted there is one,'' he said. One of the problems the company flagged was a 1-year-old with numerous emergency room and doctor's office visits for asthma. The child was placed on medication. ''ER visits are expensive, but drugs are not cheap either,'' Sokolow said.

Survivors Prepare For New Life
Lisa Victoria Martinez, Denver Post- 4/8/2001

After ending a romantic but abusive relationship of several years, Candace Pulliam found herself in yet another situation she says she couldn't get out of. "The cycle kept going," Pulliam said. "I just kept letting people abuse me." This time, she received verbal abuse from her boss, Pulliam said. She eventually was fired from the job she thought she would hold until retirement. Pulliam decided enough was enough. With the help of Safe House Denver Inc., she took control of her life.
    Pulliam was among 14 survivors of domestic violence to successfully complete the Home Based Business Entrepreneurial Program Saturday in Denver. The 26-week course, now in its second year, is taught by instructors from the College of Business at the University of Colorado at Denver. It teaches women the fundamentals of creating and running a business. Looking back, Pulliam never would have thought she could make it this far. Having her certificate will enable her to launch a new business, "The Art Concierge," a full-service art business designed to help people acquire art sculptures and paintings.
    Pulliam owes her survival and professional success to SafeHouse and CUDenver's commitment to the students, she said. "I have never been associated with a group of people who care so much about me," she said. "None of us would have made it through any other college course. But this was different. We have all had similar experiences and supported each other while bettering ourselves." The Coleman Foundation provided funding for transportation, books, parking and child care for the students.  These women have overcome numerous obstacles, said Judy Carrier, project manager for outreach services at SafeHouse. "The barriers are sometimes so huge for these women to be self-sufficient," she said. "Some are still in abusive relationships and have to sneak out of the house just to make it to class."
    Barbara Butler is one of the many survivors who have successfully completed the program, having graduated last year. "Before coming to SafeHouse, I was living in hell," she said. "It's such a demeaning experience. I never thought I would be a part of domestic violence." For five years her attacker beat her, and almost strangled her to death. She just published her new book, "Thinking out of the Box: Strategies for Handling Change." "This program gave me the tools necessary to put my life back together and move forward," she said.

Tinkering to Begin on Sex Offender Law
Associated Press, 4/9/2001

HARTFORD, Conn. (AP) A week after a federal judge proclaimed the state's sexual offender registry law unconstitutional, he begins fielding suggestions on how to fix it. U.S. District Judge Robert N. Chatigny struck down Connecticut's version of ''Megan's Law'' because he said it failed to provide due process. The law, he said, did not give convicted offenders and opportunity to demonstrate why they do not belong on the state's Web site.  He plans to confer by telephone on Monday with lawyers on how to repair the law, The Hartford Courant reported. The attorneys represent the state, which is defending the registry, and ''John Doe,'' the offender who filed the constitutional challenge. Connecticut legislative leaders have said they will make whatever changes are necessary to keep registry available to the public and on the Department of Public Safety's Web site.
    State Attorney General Richard Blumenthal said he will appeal the ruling. ''Is the stigma greater if the name and public information is on the Internet, as opposed to the police visiting the neighborhood and telling parents who live next door that their neighbor is a convicted sex offender?'' Blumenthal asked. Every state has a sex-offender registry under a version of ''Megan's Law,'' named after a New Jersey girl killed by a sex offender in 1994. The laws are controversial among civil libertarians and Chatigny's ruling is not without precedent. Registries usually are authorized by a version of ''Megan's Law,'' named after a New Jersey girl killed by a sex offender in 1994. However, the creation of some registries predated her death.
    A Massachusetts judge made a similar ruling two years ago. In response, the Massachusetts legislature established a three-tiered risk classification system, as well as a hearing process in which offenders can present evidence that they pose no threat. The board must consider 20 factors at the private hearings, which can last a day or more. Indigent offenders are entitled to counsel. ''It is a very expensive process,'' said Ann Dawley, chairwoman of the Sex Offender Registry Board. ''Our budget is $4.9 million for the next fiscal year.
    Connecticut Rep. Michael P. Lawlor, D-East Haven, a member of the advisory board for the Center for Sex Offender Management, said the examination prompted by Chatigny's ruling is healthy. He does question whether the state will find the right balance of public safety and private rights. ''One thing is for sure,'' he said. ''No state has figured it out perfectly.''

Ecstasy Seizures Way up in Michigan, Feds Say
Detroit Free Press, 4/9/2001

ROMULUS, Mich. (AP) -- The club drug ecstasy is coming into Michigan by air from Europe and across the border from Canada, with millions of dollars worth seized but large amounts getting through, authorities say. About 80 percent of the drug is manufactured in Holland, the Detroit Free Press said Monday. It said about 100,000 tablets were seized in metropolitan Detroit last year, with a street value of $2.5 million. Virtually none was seized the year before. "We didn't see much at all, and then it's like, zoom, it just took off," said Wesley Grose, assistant port director for passenger operations for U.S. Customs in Detroit.
    In September, agents discovered 55,000 tablets of ecstasy in a hidden compartment of a passenger's suitcase at Detroit Metropolitan Airport. The passenger came on a flight from Amsterdam. The Detroit division of the U.S. Drug Enforcement Administration said it has increased surveillance of the border and airport. "We have intelligence these traffic organizations are coming through Canada and supplying metro Detroit," said DEA special agent Rich Isaacson.
    Last year, about 8 percent of high school seniors nationwide said they had used ecstasy in the past year, according to the University of Michigan's annual Monitoring the Future survey. The Michigan Department of Community Health says it has no data on the use of ecstasy among Michigan young people. "It's something that snuck up on us and pervaded youth culture," said Ellen Thompson of the Oakland County Health Division's office of substance abuse. "We had a sense this was going on, but nobody has had information."

Researchers Detect Evidence of a Virus in Schizophrenics
Robin Eisner, ABC News- 4/9/2001

N E W Y O R K— Scientists have identified a piece of a virus in nerve tissue of schizophrenia patients, a finding that opens the possibility of someday helping these people with antiviral drugs. The Johns Hopkins University researchers say it is the first time that a portion of a virus has been found in either the cerebrospinal fluid or brain tissue of a small group of newly diagnosed schizophrenic patients — strong evidence the virus might play a role in the onset of the disease in these patients.

Virus Piece in Small Percentage of Schizophrenics
In a study of 35 schizophrenics, the investigators found the molecular footprint of the virus, or a piece of its ribonucleic acid or RNA, in about 30 percent of the patients with acute schizophrenia and 7 percent of the people with the chronic form of the disease. The RNA was not found in the brains or cerebrospinal fluid of 12 people who did not have the disease. "While a low level of retrovirus expression occurs in most human tissues, we found an unexpectedly high level of expression in cerebrospinal fluids from individuals who’d had a recent onset of schizophrenia," says Dr. Robert Yolken, director of the Stanley Division of Developmental Neurovirology at Johns Hopkins and lead author of the research, which appears in the current issue of Proceedings of the National Academy of Sciences.
    Characterized by hallucinations and distorted perceptions of reality, schizophrenia is a devastating psychiatric illness that affects one in 100 people in the United States and results in the annual expenditure of $65 billion in health care and related costs. Some people have one psychotic episode, while others have many episodes in a lifetime, leading relatively normal lives during the interim period. But people with chronic schizophrenia, or those with a continuing and recurring pattern of illness, do not fully recover normal functioning and require long-term treatment with a variety of medications. There is no single cause of schizophrenia, and like other diseases, it results from an interaction of genetic, behavioral and other factors.

Endogenous Virus Activated Somehow
The piece of the virus was created, the researchers say, by the activation of an endogenous retrovirus, called HERV-W, in these patients. Unlike HIV and other retroviruses, endogenous retroviruses are a part of the human genetic blueprint, having become part of the human genome millions of years ago. What causes the activation of the virus is unknown. If the RNA is infectious also is unknown.  Yolken says his study supports a retroviral link to schizophrenia in some percentage of patients and could arise from a two-hit process. The first hit probably occurs around birth, when infection by an outside retrovirus leads to insertion in the human genome or the rearrangement of retroviruses already in the genome. Later in life, he says, something triggers the existing retroviruses to become active and the person starts to display symptoms. That something could be due to other genes the person has or something else in the environment. "While our report does not explain why the retrovirus becomes active in the first place, it presents clues as to what might happen when it does become active," says Yolken. "Our ultimate hope is that we can interfere with the retrovirus by preventing it from becoming active. If we can do that, it may give doctors another method of treating schizophrenia."

Other Genes Probably Play a Role
Commenting on the study, Dr. David Garver, professor and associate chairman for research in the department of psychiatry and behavioral science at the University of Louisville, Ky., says the results might provide an explanation for what he finds in certain populations of patients with acute schizophrenia. These patients have brain swelling and an inflammatory response that could be indicative of a viral infection, he says. "I would like to send Dr. Yolken the cerebrospinal fluid from these patients to see if he can find the RNA." Garver says it is unlikely the virus by itself is causing the schizophrenia, but probably is acting in concert with the background genetic information of the individual and leading to the activation of the viral genes.

Many Children Can't Get Mental Health Care in Massachusetts
Alice Dembner, Boston Globe- 4/10/2001

Despite an infusion of state money in the last year, services for mentally ill children remain so overburdened that 350 children needing hospitalization were turned away from one hospital group in the last 40 days because all its beds are full. Nearly half of those beds are occupied by children well enough to move to residential programs, but those are also overflowing. One young woman with autism and behavioral problems remains in a locked hospital ward more than 10 months after doctors said she was ready for a less restrictive facility.
    Underscoring the danger of the mental health care shortage, a survey of Boston high school students released yesterday showed that 20 percent had seriously considered suicide and 8 percent had attempted suicide in 1999.  ''It's like a dam that's breaking,'' said John Auerbach, executive director of the Boston Public Health Commission, which is cosponsoring a gathering today of top policy-makers, legislators, health providers, and advocates to brainstorm for possible solutions. ''There's an attempt to plug a hole, and two new holes start springing leaks,'' Auerbach said. ''People are working very hard to address the immediate crisis, but the problems are intensifying. We're going to try to come up with some short-term steps to improve the current system.''
    The meeting, cosponsored by Mayor Thomas M. Menino, state public health commissioner Howard Koh, and state mental health commissioner Marylou Sudders, also will seek ways to improve care for mentally ill adults, which has been among the services affected by hospital budget cuts. A survey released by the city yesterday found that 11 percent of adult residents said they or their family members needed mental health services but did not get them. Meanwhile, state statistics show that 263 adults are unnecessarily hospitalized, waiting for appropriate placements in group homes or residential facilities that are not available. ''My hope is that by bringing together key leaders and brainstorming outside the box, we can find some things we can do differently,'' said Sudders.
    The crisis for children largely stems from a shortage of community based care and early intervention that could reduce the number of acutely ill children being admitted to hospitals. The problems have been exacerbated by the closing of some facilities. Among the proposals Sudders and others plan to consider are:
*Requiring all state-licensed therapists and psychiatrists to accept Medicaid patients.
*Requiring insurers to pay for home-based services to increase their availability.
*Streamlining licensing of new facilities.
*Getting hospitals to pledge not to shut psychiatric wards.
    Menino said he planned to press state and federal leaders to use budget surplus money to address health problems that ''cut across all lines in the city.'' ''We've all been hiding behind the door on this issue,'' Menino said. ''It's time to get together, get everyone on the same page, and address the issue, especially among our young children.''  A motivating factor for state officials participating in the meeting is the threat of lawsuits over inadequate adult and children's care in the form of ''demand letters'' that lawyers for the mentally ill sent to state officials during the winter.
    Some doctors said the state's $10 million effort over the last year to expand residential programs and add home-based services for children had helped a bit - largely by delaying the expected winter-early spring crisis by a few months. But not all of the new beds are available because facilities cannot hire enough qualified staff. ''There was considerably less stacking up of kids this winter because of all the things that have been done, but it has reached a saturation point,'' said Dr. Joseph Gold, director of community child psychiatry for Partners HealthCare, who added that children's units at McLean and Franciscan hospitals are completely full. ''Kids are getting turned away left and right,'' said Lisa Lambert, assistant director of the Parent/ Professional Advocacy League.
    At Westwood-Pembroke Health Systems, the state's largest inpatient provider with 89 beds for children, administrators had to turn down 350 requests for admission since March 1, because beds were full. Some of those 350 children probably ended up at other psychiatric hospitals, but others probably were sent home or ''boarded'' in hospital emergency rooms and pediatric wards while awaiting an open bed. Statewide, 19 children with public insurance were boarding at hospitals on Friday, slightly fewer than a year ago at this time. ''Since last year, the situation hasn't gotten better and may have gotten slightly worse,'' said Westwood-Pembroke chief executive Kenneth Davis. ''It's a terrible situation for the kids in the hospital who are ready to leave, and a terrible situation for the children in need of acute treatment.''
    Even for those who know how to work the system, it's difficult to find a bed. Mary Rowland, the paid Berkshire County advocate for the National Alliance for the Mentally Ill, lobbied for five days before finding a hospital bed for her 14-year-old son, Josh, who was hallucinating and cycling rapidly from mania to depression. ''When I can't get service, it worries me, because I know how many people get discouraged easily,'' she said. Meanwhile, 96 children statewide who are ready to leave the hospital are being held because there is no suitable placement for them, according to state officials. That number is down slightly from the high of 103 in January.
    Among those is a young woman from Southeastern Massachusetts who has been waiting in a locked ward at Arbour-Fuller Hospital in South Attleboro since last May for a residential bed. Doctors say she no longer needs hospital care for her mental retardation, autism, and behavioral problems. ''It's hurtful for her that she has been in a hospital and not off grounds for more than a year,'' said Angela Martin of the Cooperative for Human Services, who along with the young woman's mother is serving as a guardian. ''She constantly asks to go home.''

New Study Tries to Find Best Mix of Treatment for Alcoholism
Lauran Neergard, Associated Press, 4/10/2001>

WASHINGTON -- Marvin President tried to quit drinking for more than 10 years. Even a hospital detoxification program after he sustained serious liver damage didn't leave the South Carolina man sober for long. Half of alcoholics who undergo treatment relapse at least once; many relapse repeatedly. Now the federal government is fighting that statistic in a nationwide study to see whether novel combinations of therapies will better treat patients like President -- essentially hitting alcoholism with a one-two punch. Does a standard medication or an experimental pill work better, or do they work best together? What about medication plus different types of psychotherapy?
    The National Institutes of Health is hunting for 1,375 volunteers to test the different treatment combinations, for free, at 11 universities around the country. None of these are in Michigan. Researchers hope to uncover combinations that particularly suit certain alcoholics' vulnerabilities so they get better help. "The goal is to cure," said Dr. Enoch Gordis, director of the NIH's National Institute on Alcohol Abuse and Alcoholism. "We can't do that yet.... But every day a patient is abstinent and sober is a big step."
    Health officials estimate about 8 million people in the United States are alcoholics -- they have strong cravings to drink, experience withdrawal and need increasing amounts of alcohol to feel satisfied. Another 6 million abuse alcohol but aren't deemed physically dependent on it. Alcoholism is not a character weakness, but a disease that needs treatment by a doctor, specialists say. The NIH study will test combinations of:
*Acamprosate, an experimental pill said to ease withdrawal symptoms by normalizing abnormalities in two brain chemical systems.
*Naltrexone, a drug that works on different brain circuitry, blocking chemicals that make alcoholics feel good after a drink.
*Intensive cognitive and behavioral therapy, teaching patients to manage cravings and unlearn habits that promote drinking.
    For information on volunteering for the study, call 866-807-8839, 8 a.m.-6 p.m. weekdays.

Study Says Insomnia is Curable Without Medicine
Rose Palazzolo, ABC News- 4/10/2001

A new study says that when people with sleep maintenance insomnia (or people who wake up during the night) are given more knowledge about effective sleep habits they are able to sleep more. "Typically, if you have more than 30 minutes of awake time in the middle of the night then you are classified as having sleep maintenance insomnia," according to Dr. Jack Edinger, lead author of the study lead author of the study published in this week's Journal of the American Medical Association. "By using typical cognitive behavioral therapy we were able to get most of the patients below the 30 minute time."  Cognitive behavioral therapy is a psychotherapeutic technique that combines changing an individual's beliefs and attitudes about sleep and then teaching that person how to use new habits to improve his sleep. "We found that when people had faith in themselves, in their ability to sleep they actually slept more," Edinger said.

Mind Over Insomnia
In the study, researchers at Duke University Medical Center and the Veterans Affairs Medical Center, both in Durham, North Carolina, divided a group of 75 men and women with insomnia into three groups. Each group received either cognitive behavioral therapy, relaxation training or placebo therapy for six weeks. Those receiving cognitive therapy saw significant reduction in their wake time after sleep onset. The sleep improvement for the cognitive therapy group lasted through six months of follow-up observations.
    The study tried to correct misconceptions people have about their own sleep needs and habits. Patients were given information packets about sleeping techniques. Any unique problems a participant had with sleeping, such as failing to be able to relax or being distracted by television, were addressed individually. Some of the common misconceptions about sleep that lead to insomnia is the myth that everyone needs eight hours of sleep a day to function, that once you get older you can sleep all you want and that sleeping late in the morning can help you catch up on what you lost at night. "Those things are dysfunctional and can sustain sleep trauma," Edinger said. "For one thing you put stress on yourself by making these kinds of rules and stress keeps people up at night."

Elderly and Adults Had Positive Results
Edinger recommends that people avoid napping, schedule a standard wake-up time no matter what time you go to bed and to go to another room if you can't sleep at night. Restricting your actual time in bed helps. The strategies worked well for both the elderly and the younger patients, he said. The most common way to treat insomnia, especially sleep maintenance insomnia is with drugs. The elderly are even more likely to be prescribed drugs and are usually the patients studied for insomnia treatment. But this study looked at men and women ranging in age from 40 to 80 years old. "This study shows quite clearly that a cognitive behavioral insomnia therapy can be effective for people who have difficulty staying asleep at night," Edinger said. "Many patients were able to reach fairly normal levels of sleep with this treatment and without the use of sleeping pills."

An Early Start to Try to Stop Domestic Abuse
Marcella Bombardieri, Boston Globe- 4/11/2001

Kevin DesRuisseaux grew up watching bats swinging, knives waving, and irons sailing across the room as men abused women in his family. He saw aunts pushed and shoved, hurt so badly they landed in the hospital. ''My dad was never that type of person, but he'd say, `You're too young to understand. Wait till you get older,''' said DesRuisseaux, 20, of Lynn, explaining that his father was not violent. ''But when you get older, it's too late.''
    That's one motivating factor behind ''Peace in the World Begins at Home,'' a project that sends young volunteers to schools to teach students as young as 12 that an argument between a man and a woman does not have to end with a fist. The program was born out of a growing belief that the message must be delivered to the youngest possible audience, since children often grow up with warped notions of how men and women get along.
    Massachusetts has taken a strong lead: It is the only state that funds a grant program aimed at preventing teenage dating violence through school programs, said Carole Sousa, a Department of Education consultant. This year, the state is funneling $950,000 to 62 school districts, up from $250,000 when the grant started six years ago. And more privately run workshops and drama projects have cropped up.
    One of the private efforts is Peace at Home Begins at Home, which started in 1995 as a collaboration between City Year, the national community service program, and Peace at Home, a Boston-based human rights organization fighting domestic violence. DesRuisseaux and seven other City Year team members, trained for three months by Peace at Home, will go into at least 15 schools this year to lead five-hour workshops.
    Specialists in the issue are impressed that the program is staffed by young people. ''The whole concept of peer-led and delivered programs is our best hope around prevention,'' said Marianne Winters, associate director for membership and education for Jane Doe Inc., a group that works to combat violence against women. ''It creates a group of role models who are also living social change.'' Another element that adds depth is the reality that so many City Year volunteers have seen domestic violence firsthand. ''I tell kids, `I've been where you guys are. I've seen things. I'm older than you, but I'm not much older. I'm speaking to you as real as I can,''' DesRuisseaux said.
    Statistics, Peace at Home organizers say, show that domestic violence is not an academic issue for a startling percentage of teenagers. A 1999 state survey found that 18 percent of high school females and 7 percent of males answered yes when asked, ''Have you ever been physically hurt by a date?'' The beginnings of negative behavior patterns often go unrecognized in young people, said David Adams, director of Emerge, a batterers' treatment program based in Cambridge. Many teenagers believe, Adams said, ''that possessiveness or coerciveness are good things because `I wouldn't be so jealous if I didn't care.'''
    And City Year volunteers have found plenty of confusion among students they've met in the past few months. With most groups, several students agree that ''If a girl is wearing a short skirt, she's asking for trouble,'' or ''If a wife cheats on her husband, he has a right to hit her,'' said team member Erica Dacey, 18, of Belmont. DesRuisseaux remembers a class with one boy who argued that all men hit women. But the boy came to him at the end and said, ''Now I know what to do when my dad hits my mom.''
    Peace at Home gets overwhelmingly positive feedback from students, and schools often report a surge in teenagers turning to nurses or guidance counselors, said Amir Femi, director of the youth program at Peace at Home.  Seventh-graders at the Academy of the Pacific Rim, a charter school in Hyde Park, peppered the volunteers with questions and shouted suggestions last week. ''It's good to teach us this, so when we're older we'll know how to avoid stuff like this,'' said 13-year-old Courtney Israel.

Pain Killer Abuse is Spiraling, U.S. Says
Jeremy Manier, Chicago Tribune- 4/11/2001

Abuse of prescription pain relievers nearly tripled in recent years, sparked in part by a new painkiller making inroads in Illinois, federal officials said Tuesday. In just the last month, officials in Lake County have linked two overdose deaths to OxyContin, a prescription drug that has become widely abused in several Eastern states since its introduction in 1996. In late March a federal grand jury indicted a Downstate physician on charges of illegally obtaining OxyContin, in Illinois' first known case involving physician abuse of the drug, state regulators said.
    An estimated 4 million Americans abuse prescription drugs, according to researchers gathered by the National Institute on Drug Abuse in Washington on Tuesday to launch a public health initiative against misuse of prescription drugs, including OxyContin. Surveys indicate the abuse is worst among whites who live in suburban or rural areas, with recent increases among adolescents and the elderly. Some patients and doctors who advocate aggressive pain treatment fear that the minority of people who abuse prescription drugs might make some doctors reluctant to give out painkilling medication at all, even to patients who truly need it.
    One goal of the new federal effort is to educate medical professionals, many of whom do not even know how to recognize when a patient is addicted, said institute Director Alan I. Leshner. Abuse of OxyContin is new enough in states such as Illinois that preventive action now may keep it from taking root, he said. "Because this is an emerging problem as opposed to a full-bore catastrophe, you are in a position to get ahead of its spread," Leshner said in an interview Tuesday.
    Most experts said OxyContin, a drug whose sales exceed Viagra's, can be of great help to patients with chronic pain if used properly. But it has cut an unexpected path of addiction in some regions, where it is known by the street name "Oxy." Police in Kentucky recently arrested more than 200 alleged Oxy dealers--the state's largest-ever drug bust.
    Dr. Laura Parise, an addiction specialist at Highland Park Hospital, said she has seen more abuse of OxyContin in the last year, including by a 17-year-old who said her high school friends crush the pill and snort it. One of Parise's patients, a manufacturer's representative named Jim, said he started abusing OxyContin after getting a prescription for chronic pain from an old car accident injury. "I took it because I wanted to be able to do more," Jim said. "After a while I didn't want to get out of my chair."

Prone to abuse
The main ingredient in OxyContin is oxycodone, a morphinelike drug long used in other pain relievers. Experts said OxyContin can be especially prone to abuse because it contains a large dose, which normally is released from the pill over many hours. But crushing or chewing the pill can release the medication all at once. Some abusers of prescription drugs begin as normal patients who lapse into addiction because of poor monitoring by a doctor or an underlying psychiatric condition that makes them susceptible, experts said. Others are addicts who seek out painkillers like OxyContin or Vicodin for the heroin-like high they can get from snorting or injecting crushed pills. Such users often get the drugs through unscrupulous doctors or by forging prescriptions.  Forgery of OxyContin prescriptions became so widespread in Maine and Virginia that the drug's manufacturer, Purdue Pharma, announced plans last month to distribute tamper-proof prescription pads to doctors in those states.
    One advertising executive from the North Shore said he supplied his Vicodin habit by "doctor-shopping"--alternating among three or four doctors who never gave him enough pills at one time to raise suspicion. His prescriptions called for him to take seven pills each week. By the end of his 3 1/2-year bout with the drug, he was taking 12 to 14 pills a day. "I was as addicted as any street user," said the executive, who asked not to be identified. "The preoccupation of getting pills was an obsession you can't believe. Even if I had 300, I was still worried I would run out." The executive said he occasionally got Vicodin pills through a dentist who would supply them for $4 each--many times the drug's retail value.

More taking painkillers
The 1990s saw a huge spike in the use of prescription drugs for non-medical reasons, according to household surveys by the federal Substance Abuse and Mental Health Services Administration. People who used painkillers for the first time jumped from 564,000 in 1990 to more than 1.5 million in 1998, the agency estimates. During the same period the estimate for young people between the ages of 12 and 17 jumped more than fivefold, to 718,000 in the most recent survey. The figures indicate an especially sharp rise among adolescent girls, said Howard Chilcoat, a professor in the department of mental hygiene at Johns Hopkins University. "That's certainly a concern," Chilcoat said. "The earlier you start, the higher your risk for developing other problems later on."
    Chilcoat's analysis of the household surveys also shows that prescription drug problems are at least three times more common among whites than blacks. Six percent of young white respondents reported non-medical use of such drugs, compared with 2 percent of African-Americans and 3 percent of Hispanics. One reason for the gap may be less access to health care and prescriptions among minorities, Chilcoat said. The recovering advertising executive, who said he makes more than $600,000 a year, is typical of the patient population Parise sees at Highland Park Hospital.
    Parise, who is medical director of Evanston Northwestern Healthcare's center for drug addiction, said she sees addicted nurses, housewives, cardiologists, and attorneys.  Officials said it's difficult to say why OxyContin has struck the East especially hard. One factor may be that trade in the drug has tended to thrive in rural areas away from established routes for drugs such as cocaine and heroin. Authorities in Maine traced widespread abuse there to just one doctor giving his patients more of the drug than their symptoms justified.

Effective treatment
Although many doctors have called for more aggressive treatment of pain in recent years, experts said that is not a reason for the recent jump in prescription drug abuse. In fact, denying pain sufferers effective treatment can foster drug abuse if those people turn to other ways of relieving their symptoms, said Dr. Richard L. Brown of the University of Wisconsin Medical School. Brown said doctors need better education on what constitutes addiction. For example, many doctors believe--wrongly--that physical dependence on a drug means a patient is addicted. But dependence flows almost inevitably from treatment with some painkillers, Brown said. It can be treated simply by taking a patient off the drug gradually, which can prevent withdrawal symptoms. The hallmarks of addiction--loss of control and negative consequences in one's life because of the drug--should never arise in the proper treatment of chronic pain, Brown said. "The research shows that about 80 percent of physicians would not consider opioids for severe, chronic back pain," Brown said. "That's not good care. Many patients who get labeled as drug seekers and addicts may have real pain that's undertreated."

Tension Surrounds Maxey Training School Trial
Irvin L. Jackson, The Detroit News- 4/11/2001

HOWELL, MI -- Tense exchanges, accusations and an admission of lying marked the first day of the trial of a W.J. Maxey Training School employee. James Cotter, who was suspended as a youth social worker at the Green Oak Township facility, is charged with first-degree criminal sexual conduct involving a 15-year-old male inmate in August, 1998.
    Livingston Circuit Court Judge Daniel Burress Tuesday cut into both the defense and prosecution's cases with rulings. One issue involved a tissue that the victim supposedly gave police that had Cotter's semen on it. But State Police Detective Tom Cremonte admitted there was no tissue, that he had lied to Cotter to get him to take a lie detector test. Cotter, who has a bachelor's degree in psychology and 25 years experience working with juveniles, failed the test not knowing he had been lied to. The defense convinced Burress to throw that out as evidence. A grainy, hour-long video tape of the questioning was shown to the judge, but not the jury. On the tape, recorded in an interrogation room at the State Police Brighton Post, Cotter verbally sparred with Cremonte.  "Guilty people get attorneys. Innocent people are not worried about their rights," Cremonte told Cotter to get him to agree to a polygraph.
    The only witness to take the stand Tuesday was Cotter's accuser, now 18. The teen, who has been released after serving time at Maxey for molesting his 6-year-old cousin five years ago, testified that Cotter flirted with him in a bathroom during the midnight shift. He also told the jury that he performed a sex act to make life easier for him at the facility. "I was going to use him to basically get out of there," he testified. The teen, who now lives in Lansing, also said that his years in the Michigan juvenile system have been marked by repeated sexual activity with other male inmates.  Cotter, 49, of South Lyon, is free on bond. He was arrested last March after the teen told a group counselor at Maxey that a group of facility employees had inappropriate sexual contact with him. Only Cotter was charged. The trial is expected to continue today.