Yates Knew Drownings Were Wrong, Expert Says
Carol Christian, Houston Chronicle- 3/9/2002

The prosecution's expert psychiatric witness testified Friday that Andrea Pia Yates knew her actions were wrong when she drowned her five children last year, but he declined to say whether he believed she was legally sane at the time. Dr. Park Dietz, a professor of psychiatry at the University of California at Los Angeles School of Medicine, told jurors he believed "with reasonable medical certainty" that Yates knew at the time that her actions were wrong in the eyes of the law, of society and of God. "I have no opinion on the ultimate issue of sanity," Dietz said. "I have opinions on the defendant's knowledge of wrongfulness at the time of the offense."
    Dietz was called by prosecutors to rebut earlier testimony from defense psychiatrists, including Dr. Phillip Resnick. Resnick, the defense's expert witness, had testified that Yates was unable to tell right from wrong when she drowned her children. Like Dietz, though, Resnick declined to say flatly whether he believed Yates was legally insane at the time.  Dietz questioned Yates in the Harris County Jail for six to eight hours in November, videotaping the entire interview. On the tape, Yates tells Dietz that her 3-year-old son, Paul, came into the bathroom as she was filling the bathtub and asked, "Mommy, are we going to take a bath today?" Paul was the first of the five children to be drowned.
    Yates' response to Dietz's questions on the tape gave jurors their most detailed account yet of the drownings. She cries softly as she tells Dietz that she held Paul in the tub for a couple of minutes before putting his lifeless body on the bed in the master bedroom. Yates then says she went back to the bathroom before 5-year-old John came in and she drowned him. "Luke was nearby," she said of her 2-year-old son, adding that she drowned him while John's body was still in the tub. She then put John's body on the bed, followed by Luke's. Next she drowned 6-month-old Mary, who had been beside her on the floor as she drowned the boys. "I called for Noah (to come) from the kitchen," she tells Dietz on the videotape. She said the 7-year-old came and, seeing his sister in the tub, asked, "Mommy, what's wrong with Mary?" Dietz asked if Noah said anything else. "He said something," she answered, again weeping. "I don't know what. I don't know if he was saying, "I'm sorry,' or what."
    Yates told Dietz and others that she drowned the children to save them from burning in hell, but Dietz said some of her actions were inconsistent with that belief. "As she tells me this, I'm inclined to believe her -- she's trying to be forthcoming," he said. "At the same time, I have to be skeptical. That's my job." Yates didn't do things Dietz said he would have expected a loving mother to do if she believed she was saving her children from hell. "She doesn't tell them they'll be with Jesus or God," Dietz said.
    In her first statement to police a few hours after the drownings, Yates said she was a bad mother and needed to be punished because the children were developing poorly. "It's only the next day that she starts talking about burning in hell," Dietz said. Yates told Dietz she had thought about drowning the children for about a month and had not considered other methods. She said she decided the evening of June 19 that she would do it the next day.
    While there is evidence Yates was "grossly psychotic" for a time after the drownings, Dietz said, there is "not nearly the evidence of gross sickness June 20 as we have for the period beginning June 21." The biggest factor accounting for the change, Dietz said, is that she had killed all her children. "Even at one's own hands, to lose a child is an enormous stressor," he said. "To lose five is a stressor beyond anyone's ability to imagine." Defense lawyers will cross-examine Dietz today in an unusual Saturday court session. Dietz's detractors say he almost always concludes that defendants -- no matter how horrendous their crimes -- were sane at the time. Dietz testified he is charging Harris County $500 an hour, his standard fee for government agencies.
    Jurors were released early Friday, and in a hearing afterward, state District Judge Belinda Hill approved a defense request to suppress a computer-generated animation depicting the sequence of the drownings. Prosecutors said they wanted to show the animation to supplement the upcoming testimony of Dr. Harry Wilson, a pediatric pathologist who will testify about the physical aspects of drowning. Hill left open the possibility that the state could try again to introduce the animation when Wilson takes the stand. Prosecutor Kaylynn Williford said the animation would be used to show the sequence of the drownings, but would "tone down" the violent nature of the children's struggling with their mother. Defense lawyer Wendell Odom argued that the sequence was not in question and that if the video did not accurately depict all aspects of the drowning it should not be used as evidence.

Nebraska Court Rejects Attempt by Lesbians to Adopt
Kevin O'Hanlon, Associated Press- 3/9/2002

LINCOLN, Neb. -- The state Supreme Court rejected an attempt by two lesbians to adopt a child, but avoided deciding if gay couples are prohibited in general from adopting in Nebraska. The court ruled Friday in the case of a Lincoln lesbian who wants her domestic partner to adopt her son. The boy was born in 1997 after his mother became pregnant through artificial insemination. He has lived with his mother and her partner since birth.
    The court ruled that the boy cannot be adopted because the mother has not relinquished her parental rights. ''With the exception of the stepparent adoption, the parent or parents possessing existing parental rights must relinquish the child'' before an adoption can take place, the unsigned opinion said. The mother's partner can't be considered a stepparent because the women cannot legally marry. In a strongly worded dissent, Judge John Gerrard said the ''issue in this case is whether Nebraska law permits an adoption when the adoptive parent is not married to the minor child's biological parent.'' ''I believe that it does,'' he said.
    Deputy Attorney General Steve Grasz said the ruling does not necessarily preclude a gay couple from adopting a child whose parent or parents already have relinquished parental rights. ''That question was left open,'' he said. Amy Miller, a lawyer with the American Civil Liberties Union who argued the case, said the ACLU has not decided whether to ask the court to rehear the case.
    On The Net:
American Civil Liberties Union: http://www.aclu.org/
Nebraska Attorney General: http://www.nol.org/home/ago/
Nebraska Supreme Court: http://court.nol.org/

Yates Children Still Alive When Put on Bed, Pathologist Testifies
Carol Christian, Houston Chronicle- 3/9/2002

Four of Andrea Yates' five children were unconscious but still alive when she pulled them from the bathtub and laid them on a bed, a pediatric pathologist testified Saturday in an unusual weekend session. Dr. Harry Wilson, of Texas Tech University School of Medicine in El Paso, said it would have taken each child about three minutes to lose consciousness but another seven minutes or so for the heart to stop.
    Wilson testified that Yates was "determined, decisive and deceptive," as well as "organized," when she managed to drown five children within an hour. But under cross-examination by defense attorney Wendell Odom, the pathologist acknowledged that he was not trained in psychiatry and had not studied records of Yates' mental illness or her interviews with psychiatrists after she was arrested.
    The prosecution's expert witness, Dr. Park Dietz, affirmed under cross-examination Saturday that he thought Yates knew her alleged conduct was wrong when the children were drowned. He said his role as a forensic psychiatrist was not to offer an opinion on her sanity but to report his findings so the jury could decide. Under Texas law, to be judged legally insane, a defendant must have a severe mental disease or defect that results in not understanding that the offensive conduct is wrong.
    Defense attorney George Parnham asked Dietz about his earlier testimony that the decline in Yates' mental health should be viewed in the context of her living conditions. Yates made two suicide attempts in the summer of 1999, earlier testimony indicated. The first, a sedative overdose, occurred while she and her husband, Russell Yates, were living in a converted bus with four small children, including a newborn. She spent a week in the psychiatric unit at Methodist Hospital and returned to her parents' home in southeast Houston. "When she was feeling depressed and overwhelmed, she asked her husband for help but got medical attention only upon taking an overdose," Dietz testified Thursday.
    Discharged to essentially the same situation, Yates made a second suicide attempt about three weeks later, according to testimony. That led to a 19-day stay at the former Memorial Spring Shadows Glen, during which Russell Yates bought their present home. "She upped the ante," Dietz said in his earlier testimony. "I can't help but notice that she got help the first time with an overdose but not enough help. The second time, it got her a house."
    During cross-examination Saturday, Parnham asked Dietz if he was implying that Yates was controlling. "No, just the opposite -- controlled," Dietz said. "This was her way of escaping an intolerable situation. ... Escape is something she couldn't admit she needed. She doesn't have the skill to say, `I'm out of here. Get me a baby sitter and a new house.' "
    Parnham questioned Dietz about how much he would charge the county when he submits a final bill in April. Dietz, a professor of psychiatry at the University of California at Los Angeles School of Medicine who runs two consulting businesses, said it would be at least $50,000 but "could well go over." Dietz has said he is charging the county $500 an hour. "I don't have a way to tell you the number of hours I've put in, but I will readily volunteer that it's a lot of time," Dietz said. "If you keep me here long enough, I'll make up for my Enron losses." Dietz, a technical adviser to the television drama Law and Order, said Saturday that he had helped with an episode about a woman with postpartum depression who drowned her children and was judged insane. He said he usually testifies for the prosecution and has worked in the cases of would-be presidential assassin John Hinckley, Milwaukee serial killer Jeffrey Dahmer and Theodore Kaczynski, the convicted "Unabomber."

Massachusetts Murder-Suicide Eyed As Act of Depression
Caroline Louise Cole, Boston Globe- 3/10/2002

HAVERHILL, Mass. - Specialists in suicide prevention are not surprised at reports that Darcy Semler's friends and family didn't recognize as serious the apparent depression preceding her decision to take her infant's life and then her own Thursday morning. ''It is very common for people close to a loved one to ignore or just not recognize the signs of depression or mental illness, which 90 percent of the time are the leading cause of suicide,'' said Janice Ventre, an educator with the Samaritans of the Merrimack Valley, a suicide prevention agency. ''Depression is easy to miss,'' she said, ''because one of the leading indicators -- withdrawal from regular activities -- can take a person at risk away from their support network, the very friends and family that might notice if their mood had changed.''
    Police said Semler, 32, who had recently separated from her husband, suffocated her 18-month-old son, Zachary, and then poisoned herself by ingesting a common household chemical sometime Thursday morning. Mark Semler found the two bodies shortly after 10:30 p.m. in two separate bedrooms of the couple's home after becoming alarmed that his wife had not appeared for a scheduled visit. State Police said the murder-suicide took Mark Semler and family members by surprise. Semler's uncle, Ronald Bonesteel of Riverside, Calif., said he did not believe his niece had a history of mental illness.
    Dr. Kimberly Pearson, a psychiatrist at McLean Hospital in Belmont and an expert in postpartum depression, said the details of Darcy Semler's final days as reported by police fit the description of a woman overwhelmed by the responsibility of caring for an infant while coping with other stresses. Semler's father died in December, and her husband of four years moved out three weeks ago, police said. ''The birth of a child triggers clinical depression in 5 to 10 percent of mothers, and, undiagnosed, can last two weeks to several years,'' she said, adding that untreated depression eventually causes changes in the brain's neurological system so that a victim's thinking is clouded.

Police Learning to Deal With Mentally Ill
Timothy Hughes, Los Angeles Times- 3/10/2002

Clutching her month-old daughter like a rag doll, the distraught woman warned Ventura police that she would slam the infant on the pavement if they didn't back off. Officer Ramiro Capa trained his flashlight on the woman and immediately began talking, trying to win her confidence. After a few tense minutes, the baby was safe in the hands of officers and the woman was on her way to a clinic for treatment. Mission accomplished.
    "You try to build a rapport with the person and find something you have in common," Capa said in describing the delicate negotiations that took place in late January. "You get a little bit nervous because you don't know what this lady may do. She was very unpredictable." Law enforcement and mental health officials credit a new training course for officers such as Capa with helping save the baby's life. Capa and 33 other officers were the first to complete the 40-hour mental health training program at the Ventura County sheriff's academy in Camarillo in December.
    Such training has become increasingly important because police often are confronted with incidents involving the mentally ill, officials said. Last year, Oxnard police fatally shot three disturbed people. During the past decade, county law enforcement officers have been involved in the homicides of at least 17 mentally ill people, according to a new grand jury report. After a review, the grand jury recommended that all local police officers and dispatchers take the new academy training course, modeled after successful programs at other agencies across the country. Such training "will decrease the number of police shootings," the grand jury concluded, and "the lives of citizens and police will, as a consequence, be saved."
    The hope among the program's creators is that officers will learn to exercise restraint whenever possible in dealing with an emotionally or mentally troubled person. It is important to think all the options through, to determine what kind of help a person needs before acting, said Ventura Police Sgt. Mark Stadler, who helped design the county's Crisis Intervention Training program. "This isn't regular police work and we realize the danger involved," Stadler said. At the same time, when dealing with mentally disturbed individuals, "we don't want to corner them where they feel trapped."
    Stadler, who teaches a class on officer-involved shootings at the academy, is no novice when it comes to dealing with such cases. In June, he was summoned to talk to a man threatening to leap from a railroad trestle above the Ventura Freeway. After three hours of negotiations, the man agreed to climb down. Then there was an incident that occurred 14 years ago. Six weeks out of the training academy, the then-Santa Barbara police officer confronted a machete-wielding man who had wounded several people during a rampage. When Stadler encountered the assailant, the man lunged toward him and the officer opened fire. The wounded man staggered toward Stadler and collapsed at his feet. Had he known then what he knows now, Stadler said, he may have tried to handle the situation differently when he arrived on the scene. "I wouldn't have done anything different after he attacked me," Stadler said. "But before, I would have tried to communicate with him and find out what was bothering him and find out what it was that brought him to that point ... I didn't come to this job to take lives."
    Organizers of the new training program hope it will reduce the number of officer-involved shootings. At least 150 police officers and dispatchers are expected to complete the course this year. The training includes courses taught by mental health officials that cover everything from role playing to drugs used by the mentally ill. Every local police agency sent officers to the program in December. The goal of the training coordinators is to have 10% of all officers trained eventually.
    The emphasis of the program is on "increased people skills," said Dr. Michael Ferguson, a psychiatrist who works with inmates and helped craft the course's 100-page training manual. In typical police training, officers are taught the importance of establishing an aggressive and commanding presence in potentially violent situations. "Most of the time that's appropriate," Stadler said. But when dealing with the mentally ill, the emphasis is on "talking softly and listening."
    Having trained officers at the scene will allow more time for a member of the county's busy mental health crisis unit to respond, said Patrick Oviedo, a member of the crisis unit. The program has already helped officers in the field diffuse situations before they spiraled out of control, he said. The trainees "have had a profound effect on the mortality rate," he said.
    Though it is a noble effort, it will take more than just a week of training to fix the problems that led to the spate of officer-involved shootings last year, said attorney Greg Ramirez. He formerly represented the family of Robert Jones, a man with a history of mental problems who was shot by Oxnard police on Aug. 24. Oxnard police said they had no choice but to shoot Jones because he moved toward them with a 13-inch knife. Jones' family has sued the department for negligence. "Training in and of itself does not change people," Ramirez said. "The change in the mental attitude has to start at the top. The leadership sets the standard."
    Since last year's shootings, there has been mounting community pressure for police agencies to better prepare their officers for dealing with the mentally ill. The string of officer-involved shootings began in January 2000 when the Oxnard SWAT team shot and killed a 17-year-old boy holding a female student hostage at Hueneme High School and ended in October with the shooting of a knife-wielding man in Thousand Oaks. The district attorney's office has ruled that police were justified in three of the four fatal shootings involving mentally ill suspects. But investigators have yet to rule on the Jones case.
    With the closing of Camarillo State Hospital in 1997 and continued budget cuts for mental health facilities and programs, the number of confrontations between police and mentally ill people will continue to rise, the grand jury report warned. The problem boils down to the fact that there are numerous mentally ill people on the street with little oversight, said Lou Matthews, a consultant for the police training course and a member of the county chapter of the National Alliance for the Mentally Ill. The new police program is "like putting your finger in the dam," Matthews said. "It's not solving the whole problem."
    Oxnard Police Chief Art Lopez said he is in full support of the specialized training but warned that it won't stand in the way of police protecting themselves and the community. "The mental health system is broken down ... the first responders are going to be the ones thrown into the situation more and more," Lopez said. "We want to be able to bring these situations to a peaceful conclusion where there isn't a use of lethal force," he said. "But the fact is that sometimes [suspects] leave us with no other choice."

Book Review of "Electroboy: A Memoir of Mania" by Andy Behrman
Rick Martin, New York Times Book Review- 3/10/2002

If Mark Kostabi, the artist famous for getting other people to come up with and execute his "ideas," winds up being a footnote in the history of 20th-century art, Andy Behrman would be a footnote to the footnote. In 1993, he was convicted of defrauding Kostabi, and did some soft time for his crimes. Now, the "Easel Weasel," as The New York Post called Behrman, tells us in "Electroboy" that the real culprit was mental illness. The noonday demon made him do it. "More than two million Americans suffer from manic depression, usually beginning in adolescence and early adulthood; millions more go undiagnosed," Behrman writes in his book's preface, the required bit of sociopsychology that precedes any memoir of dysfunction.
    Bad news for those of us who share Behrman's obsessive-compulsive mania for to-do lists, khakis and loafers or organizing our girl friends' closets. But these were the milder manifestations of what Behrman calls the "crazies." In the manic-depressive-bisexual-art-publicist-memoir genre, "Electroboy" is certainly a standout. The real weirdness starts when he pulls off his braces with a pair of pliers in his parents' comfortable home in suburban New Jersey. "I was presented with a rather enviable deal: the Deluxe Male Progeny package," he says of his cozy youth. "There was never a doubt in my mind that I was a special child. I had a heightened sense of self-importance -- I felt larger than life, too creative, too smart." Unlike his wits, that assurance did not seem to desert him in the years to come.
    Skipping past high school and college -- I will, he doesn't -- brings us to New York, circa 1984. Behrman's descent is rapid, from trying to squeeze money from his friends' parents for a film he'll never make to cruising Times Square, the old Times Square, for transgressive kicks. At the New York office of an Italian designer, he claims to have procured male prostitutes for the visiting Italian brass. Before long he finds himself working at a gay strip club and contracting with customers for private sessions. Then his sister draws him into another kind of rough trade: publicity. She has a fledgling firm and together they go to work representing, among others, a drug-addicted diet doctor and Cornelia Guest. The partnership dissolves in a squalid furor of sibling rivalry: he physically assaults her; she leaks an item to Page Six that suggests he was stealing company money. Charming.
    Now we get to Kostabi. "He's like an unsigned painting" is the clever summation Behrman gives of this Warhol wannabe. The descriptions of Kostabi World, the artist's headquarters are vivid and funny. The staff is "an assorted fun pack of people." The receptionist has a "double isle accent" -- British and Long Island. Behrman's tireless energy and smarts are a hit. He's a P.R. machine. Soon, he's dealing art as well as pitching, and jetting back from Tokyo with thousands of dollars in cash hidden in his shoes. But too much is never enough. His appetite for drugs and sex, in various combinations of gender and substance, is a bottomless pit. No amount of couch time or prescribed mood-altering cocktails slows his enthusiasm for cocaine, vodka and Diet Coke. "Like talking to a piece of Danish Modern furniture," he says of his sessions with one shrink.. He's too messed up for them. "I imagine that there's pus within the depths of my brain -- just waiting to explode." It's around this period that one of the Kostab World artists-for-hire approaches him with the scheme. She'll forge Kostabi's signature on the kind of paintings she's already producing and Behrman will sell them as originals, pocketing. the money instead of just his 10-percent commission. He is caught and thrown in a minimum-security prison in midtown Manhattan, where the chief inconvenience for Behrman seems to be that they only have Diet Pepsi.
    "I have manic depression, or bipolar disorder," he says after finally receiving a diagnosis he trusts. This inaugurates the self-awareness phase of the book. "I am like a butterfly trapped beneath a glass dome." "It feels like someone is pouring cement into my skull." And: "I'm obsessed with masturbating." In Behrman World, there's no such thing as too much information.
    The last resort is electroshock therapy. You have to admire a guy who, strapped to the table and about to get 200 volts shot through him, asks, "Got an Amstel Light?" But then, he is, by his own admission, crazy. "Come, Electroboy," a Jamaican nurse says after the first of his many shock treatments, giving the book its catchy title.
    Behrman's writing has a certain ... manic energy. Diary entries fly out of his head in long unbroken paragraphs. His stream of consciousness has the raw appeal of the unfiltered, unedited monologue. But what, if anything, has he learned from all the pain and suffering? "I have a mental illness" is the recovery mantra that accompanies his 22 pills a day. Well, yes. We've established that. It must be terrible. But what can we learn? What it's like to be crazy? Or just what it's like for this particular person? Is there any larger meaning here for the noncrazy reader - or is this memoir, like so many, just another installment of "Jerry Springer"?
    Behrman, the congenital voyeur and onanist, is so mesmerized by peering into his autobiography that he's incapable of looking outside himself. Even in prison, surrounded by inmates from the other side of the Upper West Side, it does not occur to him that without his cozy parental cushion and social connections he'd be living in a cardboard box or not living at all by now. Using the real name of a theater critic who invited him back to his office to perform perverse acts on copies of his reviews would seem to undermine Behrman's assurance at the outset that "certain names and identifying details have been changed to protect the privacy of individuals whose paths crossed mine at a time in their lives from which they have since moved on." The man in question is now dead - doesn't that count as moving on? But these quibbles may be incidental to the purpose of this book: authorship as therapy. The writing cure. Publicity.

Beautiful Minds Can Be Reclaimed
Courtenay M. Harding, New York Times- 3/10/2002

BOSTON--The film "A Beautiful Mind," about the Nobel Prize-winning mathematician John F. Nash Jr., portrays his recovery from schizophrenia as hard-won, awe-inspiring and unusual. What most Americans and even many psychiatrists do not realize is that many people with schizophrenia -- perhaps more than half -- do significantly improve or recover. That is, they can function socially, work, relate well to others and live in the larger community. Many can be symptom-free without medication.
    They improve without fanfare and frequently without much help from the mental health system. Many recover because of sheer persistence at fighting to get better, combined with family or community support. Though some shake off the illness in two to five years, others improve much more slowly. Yet people have recovered even after 30 or 40 years with schizophrenia. The question is, why haven't we set up systems of care that encourage many more people with schizophrenia to reclaim their lives?
    We have known what to do and how to do it since the mid-1950's. George Brooks, clinical director of a Vermont hospital, was using Thorazine, then a new drug, to treat patients formerly dismissed as hopeless. He found that for many, the medication was not enough to allow them to leave the hospital. Collaborating with patients, he developed a comprehensive and flexible program of psychosocial rehabilitation. The hospital staff helped patients develop social and work skills, cope with daily living and regain confidence. After a few months in this program, many of the patients who hadn't responded to medication alone were well enough to go back to their communities. The hospital also built a community system to help patients after they were discharged.
    These results were lasting. In the 1980's, when the patients who had been through this program in the 50's were contacted for a University of Vermont study, 62 percent to 68 percent were found to be significantly improved from their original condition or to have completely recovered. The most amazing finding was that 45 percent of all those in Dr. Brooks' program no longer had signs or symptoms of any mental illness three decades later.
    Today, most of the 2.5 million Americans with schizophrenia do not get the kind of care that worked so well in Vermont. Instead, they are treated in community mental health centers that provide medication -- which works to reduce painful symptoms in about 60 percent of cases -- and little else. There is rarely enough money for truly effective rehabilitation programs that help people manage their lives. Unfortunately, psychiatrists and others who care for the mentally ill are often trained from textbooks written at the turn of the last century -- the most notable by two European doctors: Emil Kraepelin in Germany and Eugen Bleuler in Switzerland. These books state flatly that improvement and recovery are not to be expected.
    Kraepelin worked in back wards that simply warehoused patients, including some in the final stages of syphilis' who were wrongly diagnosed with schizophrenia. Bleuler, initially more optimistic, revised his prognoses downward after studying only hospitalized patients -- samples of convenience -- rather than including patients who were ultimately discharged.
    The American Psychiatric Association's newest Diagnostic and Statistical Manual -- D.S.M.-IV, published in 1994 -- repeats this old pessimism. Reinforcing this gloomy view are the crowded day rooms and shelters and large public mental health caseloads. Also working against effective treatment are destructive social forces like prejudice, discrimination and poverty, as well as overzealous cost containment in public and private insurance coverage. Public dialogue is mostly about ensuring that people take their medication, with little said about providing ways to return to productive lives. We promote a self-fulfilling prophecy of a downward course and then throw up our hands and blame the ill person, or the illness itself, as not remediable.
    In addition to the Vermont study, nine other contemporary research studies from across the world have all found that over decades, the number of those improving and even recovering from schizophrenia gets larger and larger. These long-term, in-depth studies followed people for decades, whether or not they remained in treatment, and found that 48 percent to 68 percent showed significant improvement or had recovered. Earlier research had been short-term and had looked only at patients in treatment.
    Although there are many pathways to recovery, several factors stand out. They include a home, a job, friends and integration in the community. They also include hope, relearned optimism and self-sufficiency. Treatment based on the hope of recovery has had periodic support. In 1981 a report of the American Medical Association, the American Psychiatric Association, the American Academy of Neurology and the Justice Department said, "The fallacies of total insanity, hopelessness and incurability should be attacked and the prospects of recovery and improvement though modem concepts of treatment and rehabilitation emphasized." In 1984, the National Institute of Mental Health recommended community support programs that try to bolster patients' sense of personal dignity and encourage self-determination, peer support and the involvement of families and communities. Now there are renewed calls for recovery-oriented treatment. They should be heeded. We need major shifts in actual practice.
    Can all patients make the improvement of a John Nash? No. Schizophrenia is not one disease with one cause and one treatment. But we, as a society, should recognize a moral imperative to listen to what science has told us since 1955 and what patients told us long before. Many mentally ill people have the capacity to' lead productive lives in full citizenship. We should have the courage to provide that opportunity for them.

Runaway Cases Are Tough for Parents and Police
Amalie Nash, Ann Arbor News- 3/10/2002

Shaunda Green was 12 years old when she began running away from home - staying out for a day or two at a time. At age 13, she left for good. That was more than 18 years ago. Shaunda's father, Jessie Claybron, said when he woke up one morning in his Ypsilanti home, she was simply gone. Her mother, Beverly Wiley, said she scoured the places where Shaunda usually went when she took off, but this time she wasn't at any of them. Shaunda was reported as a runaway and her picture was posted on the Web site of the National Center for Missing and Exploited Children. The site also includes an age-progression photo to show what she might look like today. "When she left, I thought it would be what usually happened -- she'd take off and then come back or we'd be notified where she was," Claybron said. "I just kept thinking she'd show up."
    Nationwide, 651,209 juveniles were reported missing in 2001 - almost 2,000 a day. The FBI estimates that 85 to 90 percent of missing people are under the age of 17. Most runaways are 14-16 years old. In Washtenaw County, the Sheriff's Department handled 405 runaway reports in 2001, down from 470 the year before. Runaways can be difficult cases for police agencies, because once officers track down the teens and bring them back to their parents, many take off again, said Washtenaw County Sheriff's Detective Sgt. Patrick Bell. "Runaways can become a chronic problem," Bell said. "We'll have one or more just about every day, and 99 percent of the time, parents call and say they returned or they get picked up."  The National Center for Missing and Exploited Children has 2,601 missing children pictured on its Web site and has handled 80,310 missing cases since 1984, spokeswoman Oname Thompson said.
    Quinn LaPeer, a juvenile case worker for the sheriff's department, sees many of the same teens over and over. Her job involves helping families get to the root of the problem and referring them to agencies that can help. "The vast majority probably aren't gone much longer than a day or the next day," LaPeer said. "We find that certainly a lot of them are also truant in school and have some family conflicts. A lot of parents are frustrated and at the end of their rope."
    Wiley, Shaunda's mother, said she once tried to get her daughter into a juvenile program because she was skipping school, but that didn't work. She couldn't be kept at the detention center since she hadn't committed a crime, Wiley was told. "I was doing everything I could think of as a parent," she said. Shaunda's case continues to be investigated by the Washtenaw County Sheriff's Department. Tests were performed on the remains of a female found several years ago in St. Louis but were not conclusive. Her Social Security number has not been used since her disappearance. "The not knowing part is the hardest," Wiley said.
    To view the Washtenaw County Sheriff's Department missing cases, go to www.co.washtenaw.mi.us/DEPTS/SHERIFF/whatwedo/shfmissing.htm   To view cases on the National Center for Missing and Exploited Children web site, go to: www.missingkids.com

Ordering Prescription Drugs Online From Canada Is Cheaper
Bill Redeker, ABC News- 3/10/2002

D E N V E R, Colo.— Colorado businessman Don Bozarth got the idea while trying to take care of his mother-in-law. "I discovered pharmaceutical prices had doubled in the past 10 years," he said. "And as you know, most seniors who are on Medicare have no prescription coverage." So he looked around for less expensive prescription drugs. He found them in Canada. "Everyone's seen the articles about seniors getting on buses and going to Canada but I believed there must be an easier way," said Bozarth. After carefully studying the law, he discovered it was possible to place orders over the Internet — as long as there was a prescription and a doctor in Canada willing to review it and write the same prescription. Thus "www.canadianmedsusa.com" was born.
    Carollee Hatch, 74, who is battling breast cancer, was one of the first customers. "In Canada, my tamoxifen would be $13.95, plus the $20 co-pay. Here in the United States I was paying $187! It's a tremendous savings," she said. Hatch also buys her husband Claude's medicines through the company and says she is saving enough money to take a vacation this summer.
    Sister Mary Kay Kottenstette, a 64-year-old nun and part-time Spanish teacher, is also sold on the plan. She is taking three medications to treat high cholesterol, gout and thyroid problems. "I have no health insurance, I only make $15,000 a year and I can't spend it all on medicines," she said. "Last year, I spent $1,068 on these three drugs; Lipitor, allopurinol and Synthroid. This year I'll be spending about $640. The savings are absolutely amazing!"
    The Food and Drug Administration says that technically the practice violates federal laws. But a spokesman says the FDA looks the other way and does not enforce them. "We don't want to punish seniors," he said. The FDA also says it cannot guarantee the purity of the drugs from Canada. But the truth is, in most cases, the drugs are identical.
    When pressed on how she felt about the legality of all of this, Kottenstette was blunt. "You know what? When the laws are unjust, I really don't care," she said. "There are so many people without health insurance, without the means to take care of themselves, and it just isn't just." Bozarth says demand is picking up and he plans to expand his service. He is careful to point out that all his company is allowed to do is assist those who have questions and need help placing their orders. "The prescription drugs are mailed directly to the patients from a pharmacy in Winnipeg, Manitoba," he says. "I make a small percentage from the price of the prescription." What's to keep the rest of us from ordering our prescriptions from Canada? "Absolutely nothing," he says. "In fact if the trend continues, perhaps it will force the drug companies to do something about their high prices."

Louisiana Tries Out Sentencing Policy for Nonviolent Offenders
Dan Harris, ABC News- 3/10/2002

N E W O R L E A N S— In the 1980s and 1990s, with Louisiana experiencing a surge in crime, state Sen. John Hainkel helped write and pass tough new sentencing laws. Now, he makes a startling admission: It "didn't work at all." Too many nonviolent drug criminals got put away, he said. The prison population doubled. The cost tripled. And the crime rate barely dropped. He said Louisiana simply cannot afford the system he helped design.
    "I am a fiscal conservative — a strict fiscal conservative," said Hainkel, the Republican state senate president. "And it made no sense whatsoever, from either a financial viewpoint or a moral viewpoint, to put people in jail that didn't need to be in jail." So Hainkel recently helped pass a new law that drastically reduced sentences for nonviolent offenders. Hainkel's change of heart comes as a recent ABCNEWS poll shows Americans favor less strict punishment for nonviolent offenders. Eighty-nine percent said they preferred sentencing first-time drug offenders to treatment rather than jail, and 76 percent said they opposed requiring life in prison for third-time nonviolent offenders under "three-strikes" laws. See poll.
    The new Louisiana law went beyond lighter sentencing of nonviolent offenders, and included a provision to take 2,000 inmates sentenced under the old laws and set them free. Eligible inmates can apply to a panel that decides whether to pass on their names to the pardon and parole boards.
    Southern Simms, who got a 16-year sentence after his first arrest for selling a small amount of crack, made the cut. "Mr. Simms, the board has recommended favorable on your application," the panel told Simms at a recent hearing. Simms later said he would use his second chance to avoid trouble — and jail. "After I do what I got to do in prison, I can't come back," he said. "I ain't coming back."
    Hainkel said inevitably some released inmates will commit more crimes. But he'd rather take that risk than stick with a system that has failed, he said. "It's difficult," Hainkel said. "But it's better to admit that what you did was not a proper solution than to keep defending it when you know it's wrong." His new plan is to spend more on education, so that fewer people commit crimes in the first place. This time, he said, he hopes he's right.

Men Seek to End Violence Through Counseling
Associated Press, 3/11/2002

TRAVERSE CITY, Mich.-- A counseling program here is seeking to end violence against women by getting men to work through their anger. The Men Exploring Non-violent Solutions Program is organized through the Woman's Resource Center. Most attendees are there because a judge ordered the sessions after a criminal conviction. Some attend to learn how to prevent violence. They range from white-collar professionals to construction workers, but they are all trying to end the cycle of domestic violence.
    Debi Cain, executive director of the Michigan Domestic Violence Prevention and Treatment Board in Lansing, said judges across the state have been encouraged in recent years to make such counseling mandatory for men who have been convicted of domestic violence. Whether this sort of treatment is successful in stopping further abuse is unknown, the Traverse City Record Eagle reported Sunday. There are no studies to show if men who complete the program continue to batter women. "We have a long way to go in trying to figure out what works and what doesn't work in this arena," Cain said. "There's not a lot of definitive research that clearly demonstrates whether these programs make a lot of difference in the long term."
    The uncertainty in part is because the programs vary across the state. There are statewide standards for intervention programs, but they are not enforced. Some programs last 26 weeks or a year, while others consist of a weekend seminar. Compounding matters is the inconsistent reporting of domestic violence among police agencies from jurisdiction to jurisdiction.
    Cain also said some men are receptive to the treatment, but others are less likely to change. She compared the counseling to programs for alcoholics. "We read all the time about people who have been in and out of those programs (for alcohol abuse), and then they continue to drink and drive," she said. "Some may eventually come to a realization that they want to change their behavior."
    Until more is known about how to treat someone prone to domestic assault, Cain said experts in the field rely on the current model a combination of treatment like the Traverse City program and cooperation between police, prosecutors and judges. Barbara Graves, one of the counselors in Traverse City, explained the goal of the program is to teach men to resolve disputes without resorting to violence or intimidation.
    "Now that I've done the program and have been in counseling, I'm doing the reverse of this," one man said. He said his relationship with his wife has improved. Now when he feels anger toward his wife, he takes a deep breath and a "time-out," one of the strategies taught in the program to stop abusive behavior. Recently, during an argument he'd had with his wife over Christmas, he did calm down, he said, and reasoned with his wife. "I chose to talk to her just like I'm talking to you. ... Once you do it once and don't lose control, and use the tools that you get out of this group, it makes it easier." Some of the other men agreed. "You start feeling better about yourself," one said.
    Still, Graves and other counselors agree the added attention paid to domestic violence in recent years is an important step toward addressing a problem they say takes an incalculable toll on society. "The people involved in this work are here because they believe in it, because this is hard work," said Charlie Phelps, a retired 26-year veteran of the Traverse City Police Department who has been a counselor in the men's program for two years.

Yates Case Exposes Holes in Insanity-Plea Laws
Leigh Hopper, Houston Chronicle- 3/11/2002

Experts on mental illness say that regardless of her trial's outcome, Andrea Pia Yates will be imprisoned in a personal hell for the rest of her life. Psychologist Xavier Amador, an expert on schizophrenia and related mental disorders, has treated five women hospitalized after killing their babies in the grip of psychosis. Three of those women were successfully treated with medication, but none of their stories had happy endings. "Once they came under control, they were devastated, and we were dealing with a whole new set of problems. Trauma, depression, suicide attempts," said Amador, an associate professor of psychology at Columbia University in New York. "The two that never recovered, they never fully understood what had happened."
    Because of their experience in treating the deeply disturbed, many psychiatrists and psychologists around the country are riveted by Yates' capital murder trial. The Clear Lake homemaker confessed to drowning her five children June 20 and has pleaded not guilty by reason of insanity. If convicted, she faces life in prison or the death penalty. Testimony is to resume today.
    Could the Yates tragedy have been averted? Many mental health experts believe so. And, they say, the case emphasizes the law's inability to address serious mental illness. Jurors must reconcile the complexities of a sick mind with the demands of a black-or-white question: Did Yates, at the time of the drownings, know her conduct was wrong? "She may have known it was illegal. She had severe mental illness. All those things are true," said J. Ray Hays, a psychologist at the University of Texas-Harris County Psychiatric Center who also has a law degree. "The two sides are talking about two different issues. The jury is going to have to sort that out."
    Yates had been treated for schizophrenia and post-partum depression with psychotic features. She was hospitalized several times and responded well to antipsychotic medications. The weak links, observers say, may have been a doctor's decision to discontinue her medication and her family's failure to understand the severity of her situation.
    Schizophrenia can be difficult to diagnose at first but falls into a predictable pattern after a patient has had it a while. Onset typically occurs between the late teens and mid-30s. It is characterized by a chronic deterioration in daily life functions, accompanied by delusional ideas and hearing voices. "It does need constant treatment, just like diabetes does," said Dr. Glen Gabbard, the clinic director at Baylor College of Medicine's psychiatry department.
    People with psychosis -- characterized by hallucinations and hearing voices -- can function in some aspects of life, giving them the appearance of normality. But the person may hear voices telling them to do dangerous things. "That doesn't necessarily mean that person won't be careful crossing the street," said Dr. Stuart Yudofsky, the chairman of psychiatry at Baylor. "If that person is careful crossing the street, it doesn't mean that person is not psychotic in some other realm."
    Experts say severe mental illness is usually apparent. Some people question how Yates' family allowed her to be alone with her children after she stopped bathing and washing her hair. Problems with Yates' treatment may also have been compounded by other features of her disease -- a tendency to be nearly mute with family members and clinicians, and a lack of awareness that she was ill.
    Now that the Yates case is being tried, many mental health experts say the state's legal definition of insanity -- not knowing right from wrong -- is too narrow to cover people such as Yates. The prosecution's expert witness, psychiatrist Dr. Park Dietz, testified last week that Yates was mentally ill but knew drowning her children was wrong. A second component to the insanity defense in Texas before 1984 allowed the defense for those who knew they were committing a crime but were unable to stop themselves because of mental illness. Texas and some other states removed that component after John Hinckley Jr. was acquitted by reason of insanity after his 1981 assassination attempt on President Reagan.
    "What's harsh about (the current) standard is it's very much based on knowledge (of right versus wrong), but it doesn't have any consideration of the mental state that might affect knowledge," said Jennifer Bard, an assistant professor at UTMB's institute for medical humanities. Yudofsky gives this example: If a driver had a heart attack and ran over and killed several pedestrians, he would be unlikely to face the death penalty. "I don't believe the law sufficiently recognizes that (mental illness) can be on very similar grounds with a heart attack," he said. "That person acted in this way as a result of a dysfunctional organ."
    Amador maintains that the question of knowing right from wrong is so broad and open to interpretation that it is "essentially useless." "Frankly, I don't think (Yates) should ever have gone to trial," said Amador, who was a consultant on the Unabomber case and has served as an expert defense witness at other trials. "This is someone who deserves our compassion, needs to be in treatment and will certainly be in her own personal hell for the rest of her life."
    Yates knew that what she did would be perceived as wrong -- that's why she waited until her husband left for work and why she called police afterward, Amador said. But she believed that drowning her children was the right thing to do, he said. Yates told psychiatrists afterward that she had done a poor job of raising her children and that killing them was the only way to save them from Satan. "Clearly her delusions made her feel incredibly guilty, made her believe she was inherently tainting her children," he said. "That's not the kind of thing you could easily talk about if it were true, much less (if you thought) your husband ... would take you to a psychiatrist. "Andrea Yates (had) bigger fish to fry than seeing a psychiatrist," Amador said. "She was grappling with heaven and hell."

Covering Up of Priests' Cases Can Take Bigger Toll
Daniel J. Wakin, New York Times- 3/11/2002

In 1993, lawyers for Sharon See and Brian Freibott, then both 28, served papers on the Rev. Raymond Pcolka that accused him of abusing them as children in Stratford, Conn. But before the lawsuit was filed, See's lawyer said, a lawyer for the Diocese of Bridgeport called with a message: The priest was a good man. Don't sue. We'll handle it. It was a "bolt out of the blue," recalled See's lawyer, Cindy L. Robinson.
    See and Freibott were not dissuaded from filing their lawsuit, and during the next eight years, the church tried to keep the case from public view. The diocese moved to keep the evidence secret, and filed a barrage of legal motions: Too much time had passed since the incidents; the church was shielded by the First Amendment protection of religious freedom; the diocese was not liable because a priest abusing a child was not working on the diocese's behalf.
    Legal experts say the tough legal approach, with an emphasis on secrecy, has been adopted by other Catholic dioceses. Over the past two decades, plaintiffs lawyers say, dioceses have reached more than 1,000 settlements in cases involving sexual abuse by priests, many of them sealed. That approach, which is commonly used by many corporations and institutions in their legal battles, has come back to haunt the church as diocese after diocese has acknowledged that priests were accused of abuse. In recent months, dioceses from Boston to Philadelphia to Los Angeles have disclosed names of priests accused of sexual abuse, many of whom were subjects of secret court settlements.
    "In terms of avoiding the scandal and eliminating the legal liability, this is exactly the wrong thing to have done," said Peter Schuck, a professor at Yale Law School and author of Agent Orange on Trial. Schuck said the settlements' scope and recently unsealed documents that show the church knew about longstanding allegations of abuse raised the question of whether the church could be held liable as an institution and be forced to pay punitive damages. "It's not simply a case of an organization whose agents have erred," he said. "It's an organization that knew about the improprieties and actively concealed it."
    Last week, Bishop Anthony J. O'Connell of Palm Beach, Fla., resigned. O'Connell acknowledged that he had inappropriate contact with a teen-ager 27 years ago while he was a rector at a seminary in Hannibal, Mo. The victim reached a secret settlement with the diocese of Jefferson City in 1996 for $125,000. Church officials say it is quite possible that because of the secrecy, the Vatican did not know about the lawsuit or the settlement, either at the time or later, when the bishop received the Palm Beach appointment. O'Connell said that he never mentioned it before taking on the Palm Beach diocese in 1999, succeeding a bishop who resigned over allegations of sexual involvement with boys.
    Lawyers for several dioceses defended confidentiality of court papers and settlements, saying it was often necessary to protect the privacy of the priests and victims. Every move to seal documents, they said, is approved by a judge. And plaintiffs agreed to all of the secret settlements. "The idea is to protect the confidentiality of information that is not really necessary for the plaintiffs and not really appropriate for public disclosure," said Michael Dolan, the Bridgeport diocese's general counsel. Lawyers who specialize in civil litigation say the church has acted no differently than other large institutions or industries facing legal attack. But another consequence of such secrecy was that when a pedophile priest was transferred from one parish to another, the new parish was unaware of the priest's history.
    In Connecticut, the church was forced to make limited disclosures to settle the lawsuit begun by See and Freibott in 1993. The case concluded in March 2001 after settlements covering 26 plaintiffs and six priests, with both sides agreeing to keep silent about the terms. The diocese publicly acknowledged the abuse, condemned it, apologized and said offending priests were removed from their duties. Personnel records and transcripts of what the diocesean officials said in their depositions remained under seal.
    Robinson said that several months after the lawyer for the diocese said it had no evidence of abuse by Pcolka, another plaintiff's lawyer, Henry Lyons, contacted her and said he talked to the diocese about settling other sex-abuse complaints against the same priest. Dolan, the diocese's general counsel, said he did not remember making a call about an unsullied record but that whether the suit had been filed was irrelevant. "You always say, in any case, is there something that we should be talking about, is there a way to resolve this before gearing up for a full-fledged trial," Dolan said. "There is no harm in sitting down to resolve differences." As the case progressed, the diocese successfully argued that six plaintiffs had no right to sue because they were over 35 when they went to court. That is the cutoff age under Connecticut law for people to sue over claims that they had been sexually abused as children.

Treatment for Young Drug Addicts
Alexa Pozniak, ABC News- 3/11/2002

As a little girl growing up in a small town, Melanie had a picture-perfect life. She was a well-rounded child who attended Catholic school, went to summer camp, and had what she calls an "amazing" family. By the age of 18, Melanie was a recovering drug addict who had been using both street and prescription drugs for more than five years. "I first started using drugs when I was about 13," recalls Melanie, who asked that her real name not be used. "I was hanging out with my friends, getting messed up on weekends, then once a week, then twice, and then every day. I experimented with acid, cocaine, prescription painkillers, and then I was introduced to opiates in my last year of high school."
    Experts believe drugs fill a need for children and adolescents, like Melanie, as well as adults. "They take the drugs because it serves some sort of emotional purpose for them, it provides an escape route," explains Dr. John Shaw, director of child and adolescent psychiatry at the University of Miami.
    Melanie admits the addiction quickly grabbed hold of her and as she built up a tolerance the amount of drugs she took escalated. After a successful recovery, Melanie now wants to warn parents that drugs are "out there," and kids have access to them from a variety of sources. "It's sad to say, but kids can get drugs anywhere they want, especially in high school," she warns. "You can get them in school, from the street, or even from someone's mother."
    Fortunately, Melanie eventually realized she had a problem and sought the help of a local treatment program when quitting on her own proved to be too difficult. "Drugs were ruining my life. I lost a lot of friends, my relationship with my parents was ridiculous. Everything seems to crumble and you don't seem to realize it. I did not want to wake up in the morning and get sick anymore," she says. "I found out about a clinic from kids on the street. At first, it wasn't about stopping, it was about not getting sick."
    The treatment program that Melanie sought out is run by Lisa Marsch, an assistant professor of psychiatry at the University of Vermont College of Medicine in Burlington, who has been researching the recent surge in teen drug use. Currently, Marsch is leading a study funded by the National Institute on Drug Abuse to develop an effective treatment program for young addicts. "In the last decade, there's been more than a 100 percent increase in the number of kids who use heroin, and yet we know virtually nothing about how to treat them," says Marsch.
    Marsch's 28-day program is set up so that kids are given a combination of medical detox, which includes medication, and lots of intensive counseling. "The kids we're typically seeing have started drug use around age 10," says Marsch. "First they tried cigarettes, and then marijuana. After that usually comes OxyContin and heroin. Generally they've used for several years before seeking treatment." One unique aspect of the program, which Marsch says is so far yielding "very promising" treatment data, is that every child involved has sought treatment on their own. "This is surprising because they're still young, they haven't experienced all of the negative effects of drug abuse," says Marsch. "But they don't want to be drug users."
    Although she had been a drug user for many years, Melanie admits her parents never knew about it. "Unfortunately you learn to be a good liar, so my parents had no idea I was using drugs because they trusted me way too much. I told them the day before I entered treatment and they were totally shocked," she says, adding that her parents were very supportive throughout her treatment. Melanie warns other parents to keep a close eye on their children. "Kids aren't stupid — parents think their children are a lot more innocent and ignorant than they really are."
    "The most important thing is for parents to be involved and provide positive examples at home," explains Judy Foley, director of the Massachusetts Prevention Center in Boston. Says Foley: "That's the first environment the child is raised in." Parents need to set norms in home and give their kids behaviors appropriate consequences and rewards.
    Heavy parental involvement is precisely the approach being taken in another study being conducted at the University of Vermont College of Medicine, this time by Alan Budney, associate professor of psychiatry/psychology. Budney tries to address the needs of the majority of young drug users who, unlike Melanie, are neither ready nor willing to admit they have a problem which must be treated. That's one major difference between child and adult drug users: "Only the minority of the actual kids admit they need help. A lot of them say 'I'm only here because 'my parents' made me.' Whereas many more adults admit they have a problem."
    Budney's treatment style, which is still in the experimental stage, focuses on teaching the parents of young drug abusers parenting styles they can use to motivate their children. "We use a combination of incentives and consequences," he explains. "Incentives meaning things like urine testing. If it's clean, they can earn points, and then buy things with those points. We've used this with adults and it's worked pretty well." The idea is to have kids spend the points on things that will provide them with alternatives to using drugs. The incentives include passes to clubs, sporting events, and movies, and gift certificates for music stores and McDonalds. He also teaches parents about making clear to their children the consequences for using drugs, such as the loss of driving privileges, access to friends and activities. Shaw also points out that it's important for doctors to look beyond the drugs, and to treat the child. "It's not just drug abuse, there is usually some underlying psychiatric condition, maybe depression or anti-social behavior that you have to treat, as well," he says.
    As Melanie looks back, she wishes she received more education about drugs. "I can't emphasize enough how much these kids have no idea what they're getting themselves into. If I had known what heroin does to people, I probably wouldn't be sitting here talking to you. " She wants kids to know that there is help out there, and all they have to do is ask. "Kids need to know that they can go anywhere for help, guidance counselors, teachers, friends. The information and help is out there, everywhere. Even though it's intimidating to go up to someone and ask for help, it's important."

Analysis: Women Report Gambling Problems as Often as Men
Associated Press, 3/12/2002

HARTFORD, Conn. -- Women now report gambling problems nearly as often as men, according to new figures released Monday. ''Women as problem gamblers have really zoomed up in the statistics in the last five to 10 years,'' said Marvin A. Steinberg, executive director of the Connecticut Council on Problem Gambling. Steinberg said that women made about 47 percent of about 1,100 calls that came in to the council's 24-hour hot line in 2000. In 1994, women accounted for 27 percent of the calls. ''Women have increasingly gambled,'' said Steinberg. ''When it becomes more accessible and socially acceptable, women do it more and we find out that women are as vulnerable as men are.''
    The gambling statistics released Monday also support the theory that people who have gambling problems have other problems as well. ''Gambling has deep repercussions in people's lives,'' Steinberg said. Callers to the council's phone line reported significant emotional problems, such as depression and thoughts of suicide. About 40 percent of problem gamblers reported that alcohol abuse was a problem in their family when they were growing up.
    Although male problem gamblers tend to be younger than female problem gamblers, they had substantially larger lifetime losses due to gambling, the new statistics show. Males had an average lifetime loss of $73,980, compared with $54,278 for women. But both men and women reported that their current gambling debt was the same, about $21,000. Nearly a third of problem gamblers earned less than $25,000, and 61 percent had trouble paying bills because of their habit, according to the figures. Slot machines were cited as the primary problem for problem gamblers. The council's help line is funded by contributions from the state's two casinos and the lottery.

Illinois Mental Health Cuts Labeled Dire
Richard Wronski, Chicago Tribune- 3/12/2002

Mental health care providers say they will appeal to lawmakers Tuesday to save programs from being sacrificed in Gov. George Ryan's plan to slash spending. They say the proposed cuts will wipe out many resources for the mentally ill, including innovative programs that treat people in their communities rather than requiring them to be institutionalized. Advocates are scheduled to testify Tuesday before a House appropriations committee in Chicago.
    "We hope to inform the legislature that the state will suffer deeply if the budget is cut as proposed," said Pam Fisher, a coordinator for the Grow in Illinois treatment program. "In times of economic hardship, the mental health needs get greater and greater," she said. "Making a short-term cut now will have long-term, devastating effect on the people of Illinois." Some of the programs hardest hit are those that gather people with mental illness in small groups for such activities as therapy, recreation and checking that patients have been taking their medicine.
    Officials at agencies across the Chicago area say their programs will be pounded by the funding reductions proposed by the state Department of Human Services. The department has been told to cut 5.5 percent of its spending across the board and has targeted dozens of programs for even deeper cuts or elimination. "The targeted cuts are stunning," said Dennis Smith, executive director of the McHenry County mental health board. "They will make it impossible for us to do our jobs." If approved by the state legislature, the cuts would take effect July 1, the start of the new fiscal year.
    Grow in Illinois, one of the organizations targeted for cuts, recently was notified that its 2003 funding would be slashed from $1.6 million to $366,000. The group says it will have to close 100 community support groups at 11 locations across the state, including in Chicago, Joliet and Des Plaines. "It's devastated us," said Fisher, residential program coordinator for the Champaign-based organization. "We've been entirely funded by the state since the early 1980s. This has shut us down."
    Another organization, Family Alliance, would lose $146,000, which is used to pay for a day-treatment program serving 200 mentally ill senior citizens in McHenry County. "These people have no alternative but institutionalization," said executive director Carol Louise. "That will cost the state a lot of money."
    In all, the Department of Human Services is cutting $12 million in community services across the board and $7.6 million in targeted programs. The department could provide no comprehensive list of affected programs, but a spokesman said the across-the-board cuts would hit all 200 agencies the state contracts with for adult mental health programs. Of those, 29 agencies were targeted for deeper reductions, including 17 that would see all their mental health funding eliminated, according to department spokesman Tom Green. "The department has to make the cuts to reach its budget goal for fiscal year 2003," Green said. "The [budget] blueprint is still up for negotiation, and we will look at alternatives and continue to discuss them with community-based providers and officials in the [department's] office of mental health."
    Mental health providers say they were blindsided by the proposed cuts--especially the targeted cuts--and were given little or no time to adjust. "No one told us these were coming," Smith said. "We could have made changes in our budget. There could have been some planning done." Mental health officials say the proposed reductions run counter to the state's goal--expressed by Ryan on Feb. 20 in his budget address--of developing more community-based mental health services in place of treatment at state institutions. Green said the cuts were not determined by geography or the performance of the programs. "They were made to protect essential services and to ensure that we maintain comprehensive community mental health centers," he said. Preference was given to Medicaid-eligible agencies and programs, in which 50 percent of funding comes from the federal government.
    Mental health advocates expressed some relief that Ryan decided to scale back his plan to downsize the Elgin Mental Health Center. But others said the cuts in the overall human services budget would more than cancel any gain from the revised plans for Elgin. In his budget address last month, Ryan announced that he would reduce the number of psychiatric beds in one of Elgin's divisions to 105 from 180, backing away from his initial threat in December to cut the number of beds to 50.
    Downsizing the Elgin Mental Health Center, which serves a six-county area, would save the state about $4.9 million a year, according to the Department of Human Services. To make up for the reduction in patient beds at Elgin, key mental health agencies in northwest suburban Cook, Lake, DuPage, McHenry, Kane and Kendall Counties would be allocated a share of $7.2 million. That money would go to community-based programs and local hospitals that would absorb most of the patients who would have gone to Elgin. But some providers say the money is not enough to offset the Elgin reductions, especially in light of the across-the-board cuts. "It's like putting money in one pocket, but taking it out of another," said Dave Schanding, director of behavioral health services for the Lake County Health Department.
    Mental health providers add that many community facilities and programs already are understaffed, underfunded and operating at full capacity. Suzanne Andriukaitis, executive director of the National Alliance for the Mentally Ill of Greater Chicago, said trimming mental health programs in general puts more demand on other public services, such as police, hospital emergency rooms and prisons. "Pinching pennies in the mental health system creates a gargantuan backlash in other systems," she said.

Testimony Completed in Deaths of Children
Carol Christian, Houston Chronicle- 3/12/2002

After hearing from 38 witnesses and seeing some 300 exhibits over the past three weeks, jurors are expected to begin deliberating today whether Andrea Pia Yates is guilty of capital murder. Closing arguments are scheduled to start this morning after state District Judge Belinda Hill reads her instructions to the jury.
    Defense lawyers will tell the jury that Yates' psychosis was so severe when she drowned her five children June 20 it prevented her from knowing her conduct was wrong -- meaning she was legally insane under Texas law. Prosecutors will counter that, although the 37-year-old Clear Lake homemaker was mentally ill, she clearly knew her actions were wrong. And with more than three weeks of testimony and legal arguments complete, jurors will then be asked to decide whether to convict Yates or find her not guilty by reason of insanity.
    Jurors spent part of their last day of testimony Monday watching more video of Yates being interviewed in November by Dr. Park Dietz, the prosecution's expert witness on insanity. The video accompanied testimony from Dr. Lucy Puryear, a psychiatrist in private practice and the former director of the Baylor Psychiatry Clinic at Baylor College of Medicine. Puryear was called as a rebuttal witness for the defense. Puryear testified earlier that Yates has a "baseline psychiatric disorder, probably schizophrenia" and a major depressive disorder, both exacerbated by childbirth.
    In her interview with Dietz, Yates says she wasn't thinking much of anything when she drowned her children -- something Puryear testified Yates had told her "over and over." The video shown Monday began where one shown with Dietz's testimony last week left off. At the end of the tape accompanying Dietz's testimony, Yates said Noah had said something like "I'm sorry" as he struggled with her during his drowning. In answer to Dietz's questions, Yates said she was not crying or thinking about Satan as she drowned the children, but was thinking only about what she was doing. But when Dietz asked her whether she was thinking about heaven, Yates said she was and that she was praying her four boys would go there. When Dietz asked about Mary, Yates responded, "She was the most innocent of all of them."
In analyzing the Dietz video, Puryear said Yates was incapable of sorting rational from irrational thought or right from wrong at the time of the drownings. Puryear, who specializes in the treatment of women's childbirth-related psychiatric problems, also testified there was ample evidence of psychosis in Yates' medical record before and after June 20. The evidence would indicate she was not connected to reality when she drowned her children, Puryear said.
Prosecutor Joe Owmby sought to show inconsistencies in Puryear's testimony during his cross-examination, but Puryear stuck to her testimony that Yates was incapable of knowing her conduct was wrong that day. Owmby began a series of questions that Puryear said were confusing and indicated Owmby didn't understand the issue. He cited three hypothetical examples of delusional men, including one who believed the United States is the great Satan, before adding a fourth hypothetical case of a woman who thinks she's a bad mother and doesn't spend enough time with her children.
    "You don't understand mental illness," Puryear finally said in frustration. "To a psychotic person, psychosis is as real as the jury is in the courtroom, I'm in the chair and you are asking me questions," she said. "It's crazy to everyone else." "It's not crazy that the United States is the great Satan?" Owmby asked. "You're asking me questions that don't make sense," Puryear said.
    Another psychiatrist testified Monday that she never asked Yates whether she thought killing her children was wrong, contradicting earlier testimony from a sheriff's deputy. Dr. Melissa Ferguson, the medical director of psychiatric services at the Harris County Jail, interviewed Yates the day after she drowned her children. Deputy Michael Stephens, of the Harris County Sheriff's Department, testified Saturday he was standing guard outside the tiny interview room and heard Ferguson ask Yates about drowning the children. He said Yates told Ferguson that she knew her actions were wrong. But Ferguson said Monday she had asked Yates no such question because it would have gone to the issue of legal sanity and she had not been appointed to evaluate that.

Russell Yates on Trial with Public's Commentary
Mike Snyder, Houston Chronicle- 3/12/2002

In a sense, Russell Yates' trial began long before his wife's. The 37-year-old NASA computer engineer has been the focus of intense sympathy and condemnation since stepping onto his front lawn June 21 to speak about the drownings of his five children the day before. Driven by a mixture of fascination and revulsion, Americans followed the relentless news coverage laying bare the intimate details of the Yates family's traditional religious lifestyle and of Andrea Yates' history of mental illness. On talk radio, in letters to the editor and in countless private conversations, hundreds of people who had never met Russell Yates spoke passionately about what he should and shouldn't have done. He should never have left the children alone with a mother suffering from such serious mental illness, some said. He should not have continued having children with Andrea, given her history of severe postpartum depression. He should have helped more with the children. He was too controlling.
    Some have even suggested that the wrong parent was being prosecuted. "If the state of Texas allows Russell Yates to go unpunished for his part in the drowning deaths of his children, it will be a shame," Jody King of Cleveland wrote in a letter published in the Chronicle on Feb. 21. Andrea Yates' best friend, Debbie Holmes, testified that Russell Yates had ignored her pleas to take his wife to see a doctor in the weeks preceding her first hospitalization last year. "Rusty only cares about Rusty," Holmes told Time magazine.
    In part because of a gag order imposed by state District Judge Belinda Hill on June 26, Yates has had few opportunities to defend himself publicly. He has said his wife was adept at hiding her dark moods and sometimes resisted taking her medication. He testified he did not believe she was a danger to their children.
    In the midst of the criticism, he found an unlikely supporter. Deborah Bell, president of the National Organization for Women's Texas chapter and founder of the Andrea Pia Yates Support Coalition, exchanged e-mails with Yates and spoke with him and other family members for hours during the trial. Bell, a self-described radical feminist and "pagan atheist," has little in common with Yates, a Christian who embraces traditional views about the roles of husbands and wives. Despite their differences, however, Bell found herself warming to Yates. She argued that much of the criticism of him has been based on snap judgments made in response to fragments of a complex story. "The first thing people did was jump on the husband," Bell said. "He made some poor judgments. Who among us has not? Luckily for most of us, our poor judgments don't have such devastating consequences."
    Bell said Yates may have been reluctant to face the full extent of his wife's illness and to respond appropriately, but she said that's true of many people with mentally ill family members. "Rusty was in huge denial," she said. "He did not know what had hit him. He did not know what he was dealing with. But that is not why those children died. Those children died because their mother was sick."
    Other feminists have been less forgiving. "The least, it seems, is that he could have been more vigilant as far as trying to get some equal responsibility or some sharing of all of this, or even been more vigilant as far as her mental health," said Iris Sizemore, who has led a weekly feminist group in Houston for more than 20 years.
    Cynthia Freeland, a University of Houston philosophy professor, said the case may resonate more with women because "they have either had young children themselves or been baby sitters or big sisters taking care of young children. "I think more women than men tend to have a clear idea of how very stressful and difficult it can be to be shut in a home with two small children, let alone five," Freeland said. But Freeland said a male student in her feminist philosophy class made it clear men shared many of the same concerns. In an e-mail to Freeland that she shared with the Chronicle, the student said he and his three grown sons were aghast at Yates' "failure to take charge of the circumstances in his home." "Ask men, fathers, what they think of Russell Yates," the student wrote. "Gender will disappear from the essay. The man is deviant."

Acquittal Not Equal to Free for the Insane
Alan Bernstein & Leigh Hopper, Houston Chronicle- 3/12/2002

Andrea Yates would not have been freed even if she had been acquitted. Though murky in places, state law would have allowed the courts to control the rest of her life. The law also barred any mention to jurors of what Yates' future would have been like had she been acquitted. But, depending on how she responded to medication and other treatment, Yates could have been committed to state mental health institutions for the rest of her life. Or she could have gained her liberty as a cured woman in a matter of weeks. Had the jury acquitted her, Yates' fate would have rested with Judge Belinda Hill or her successors on the 230th state district court bench. Decisions on her fate would have relied on medical evidence, ignoring the severity of her actions and the length of any prison sentence she would have received, experts say.
    Yates likely would have been sent to the state's only high-security facility for the mentally ill -- the North Texas State Hospital branch in Vernon, near the Oklahoma border. That is where psychiatrists and other employees of the state Mental Health and Mental Retardation Department evaluate those acquitted of violent crimes by reason of insanity. Most of the hospital's 350 or so patients are there not because they have been acquitted of a crime, but because of a mental illness that makes them dangerous to themselves or others. As of last month, a spokesman said, the hospital had 67 female patients, three of whom were acquitted of criminal charges.
    Surrounded by a 14-foot fence and shadowed by guard towers, the Vernon campus of one-story brick buildings is a place where many patients attend group therapy, wear their own clothing and accept visitors. It is a place for treatment rather than punishment -- a hospital rather than a prison. By law, the facility's mission is to treat patients for only as long as it is necessary. "You get there, and you are all handcuffed. Then you walk in the door and the handcuffs come off," hospital spokesman Gerald McLain said.
    Taken literally, state law says anyone acquitted of a violent crime by reason of insanity must be sent to Vernon for evaluation -- regardless of whether they remain mentally ill. But the most common interpretation of the law calls for the judge or jury to first decide whether the patient's current condition requires commitment to a state mental health facility, according to MHMR lawyer Kent Johnson. "It's a couple of the most confusing statutes you would ever want to read," he said.
    Under the interpretation requiring the judge to take initial action, Hill would have had 30 days to conduct a hearing on Yates' mental condition. The law would have allowed Hill to keep Yates in jail until the hearing even though she no longer faced criminal charges. Yates and her lawyers would have decided whether the commitment decision would have been made by Hill or a jury -- a different jury from the one that tried her. The judge or jury would have had to consider at least two professional evaluations of Yates' mental health before deciding.
    Mental illness alone is not sufficient reason for involuntary commitment. The patient also must be a danger to herself or others or unable to function on her own, according to Johnson and other experts. If Yates' condition didn't meet the test for involuntary commitment, experts say she could no longer have been held against her will, but that the court could have continued to monitor her case. If she had been committed, her case would have come back to court after 90 days for the judge to decide whether to recommit her for as much as a year. At the expiration of each commitment, the judge would again have had the option of recommitting her for as much as another year. If and when Yates no longer met the requirements for commitment, the judge still could have placed conditions on her freedom, such as a requirement that she continue to receive psychiatric care.
    Patients at Vernon have specific rights. State law requires that they be transferred to a "non-security" state mental health facility within 60 days unless a review board of five experts decides they are "manifestly dangerous." Houston psychiatrist Fred Fason, who has testified in local cases involving insanity pleas but did not appear in the Yates case, said he believes Yates would no longer have been considered dangerous after her initial two-month evaluation period.
    The average stay at Vernon is 101 days. After leaving Vernon, most patients from Harris County are sent to the similar-size Rusk State Hospital in Cherokee County in East Texas, where the average stay is 56 days. A sign on the Rusk grounds recently detailed the staff's credo, with phrases such as "Our patients are the reason we are here" and "Make sure they are satisfied." Some former criminal defendants from Harris County have remained at Rusk for several years or up until their death, according to Fason. But in one local case, a man acquitted of a 1991 killing by reason of insanity was treated by state mental health institutions, released and later arrested in another killing in 1995. He was again acquitted by reason of insanity and recommitted to Rusk.
    The treatment at Rusk has been a source of friction between local judges and MHMRA. "People go up there, they are sent back quickly to Harris County (with treatment experts) saying they are well, they come into court, and they don't appear to be well to the common citizen," state District Judge Ted Poe said. "And so we go through the whole procedure again to send them back." Poe said many patients improve quickly with medication provided by state institutions but deteriorate just as quickly after their release because they fail to continue the medications. "I don't know that the system has figured out the answers," he said. But Johnson, the MHMRA lawyer, said the courts and mental health professionals often see cases differently because their work is different. Law enforcement sees a defendant who should be in prison, he said, and mental health workers see a patient needing medical attention. "I don't think you are ever going to see total agreement," Johnson said.
    The high-security evaluation program for those acquitted of violent crimes by reason of insanity was transferred from Rusk to Vernon in 1986. Built in 1969 to house the state's oldest mental patients, the Vernon facility is the newest of the state's nine such hospitals. It employs 1,100 people in a city of 11,660. Its 60-acre campus is surrounded by an apartment complex, a community college, churches and farms.
    Some points on the treatment of those acquitted by insanity remain fuzzy. If a judge releases a patient from a state institution and requires them to seek psychiatric care while free, could the judge also order the patient to stay away from certain places or people? The law "doesn't say yea or nay," Johnson said. "It is just silent."
    Some people also were concerned that a freed Yates could have become pregnant again. And although the state couldn't have prevented her from having more children, experts say, it would have had a say in who would have raised them. "That's what (Children's Protective Services) is for," said J. Ray Hays, a psychologist and lawyer with the University of Texas-Harris County Psychiatric Center. "You would not let her parent again." Judy Hay, a spokeswoman for Harris County CPS, said state law allows the agency to take a newborn into custody before it leaves the hospital. Afterwards, CPS must go before a family law judge and prove that it acted to protect the child. "The judge might say, `Why not let Mom take the baby home?,' " Hay said. "Then we'd have to show a reasonable person would agree there was enough risk in the home (that) the child had to come into custody." CPS would still have had the authority to evaluate the case even if Yates had been acquitted, Hay said. She said the majority of CPS clients have never been prosecuted.