Study: Teen Runaways Abused at Home
Dean Schabner, ABC News- 7/11/2002

Teenage runaways face the risk of physical and sexual abuse when they take to the streets, but a new study says that what many of them endured at home may have been worse. "You shouldn't be surprised that runaways come from bad situations, but the levels of how bad the home situations are for a lot of these kids is really shocking," said Kurt Johnson, a research sociologist at the University of Nebraska-Lincoln who is one of a group of sociologists at the school that is conducting the study.
    The Midwest Longitudinal Study of Homeless Adolescents is a three-year, $3 million project to conduct interviews every three months with 455 runaway teenagers from eight Midwestern cities. The project is in its second year, and the researchers recently released their preliminary findings. The runaways are encouraged to stay in touch with the researchers with the promise of $25 per interview, and they are also offered a free meal and referrals for places to stay and sometimes offers of work.
    The goal of the project is to examine not only where runaways come from and why they end up on the street, but also to try to discover what effect trying to survive on their own has on them, and how different they are from teenagers who don't run away. The study's findings aren't news to people who work to help runaways, but they raise questions about what should be done with teenagers who have fled their home, if they were really driven out by repeated abuse. "There are homes that children should not be in," National Runaway Switchboard spokeswoman Cathleen Carolan said.
    In the most recent study by the Department of Justice, published in 1990, estimated there were 446,700 runaways a year in the United States. A new report is due out soon. To be considered runaways, children had to stay away from home at least one night if they were 14 or younger, and two or more nights if they were 15 or older.

Runaways or Throwaways?
In the interviews, the University of Nebraska researchers ask the runaway teenagers about what led them to leave home as well as questions about what they face on the streets, how they feel about their families and whether they see returning home as a viable option. What the researchers found was that in many cases, the youngsters are leaving homes in which they were already being physically abused. "I think approximately 60 percent of these kids aren't running — they're thrown," Johnson said. "They're not running because they want to but because either they're thrown out or they're driven out by abuse."
    Of the teenagers questioned, 74.2 percent said they had been hit with an object, 76.9 percent said they had been slapped, 84.2 percent said they had been pushed or grabbed in anger, 71.0 percent said they had things thrown at them in anger and 72.3 percent said they had been spanked. The levels of more serious forms of abuse were also high — 22.4 percent said they had been threatened either verbally or physically with a weapon, 43.4 percent said they had been beaten with fists, 7.5 percent said they had been wounded with a gun or knife, 19.5 percent said they had been asked to do something sexual and 22.3 percent said they had been forced to engage in a sex act.
    "These rates are several times higher, particularly in the areas of really severe abuse, than we'd seen in a general survey of all teenagers," said University of Nebraska-Lincoln sociology professor Les Whitbeck, one of the directors of the study and co-author with Dan Hoyt of Nowhere to Grow: Homeless and Runaway Adolescents and Their Families, which detailed the results of a previous study.

‘Sad Normalcy to Violence’
The levels of many kinds of abuse the runaways experienced at home are as high or higher than what they reported in their life on the streets. Of the girls 13.8 percent said that during their time away from home they had been sexually assaulted more than once and 15.7 percent said they had been sexually assaulted once, as opposed to the 32.1 percent of girls who said they were sexually assaulted by a primary caregiver. Only 1.5 percent of the boys said they had been sexually assaulted once and 2 percent said they had been sexually assaulted more than once. Asked about their homelife, 10 percent said they were forced to do something sexual.
    Perhaps as disturbing as the amount of violence that the runaway teenagers faced at home is the way that they tend to view that abuse, the researchers said. Just 21.5 percent said they left home because of physical abuse, and the most common answer given — at 31.4 percent — was just that they did not get along with their family. "There's a certain sad normalcy to the violence these kids experience," Whitbeck said. "They're more likely to say 'I don't get along with them' or 'I didn't like the rules' than to say 'I couldn't stand the abuse.' They have a hard time defining abuse. "Then they get out onto the streets, and it's more of the same," he added.

Trying to Avoid Pain
The people who staff the National Runaway Switchboard, a national hotline for teenagers who have already run away or are thinking of running away, or for family or friends of youngsters who seem to be at risk of leaving home, say they hear the same things that the runaways told the Nebraska sociologists. "Our experience, just from the people who call us, is they're running from something," said Carolan, the NRS spokeswoman. "They're trying to get out of pain. They're trying to get away from a situation that's so untenable that anything else seems better."
    And even though the teenagers who call the hotline are looking for help, for many the option of going home is not an appealing one, she said. "A lot of what keeps them out there is the fear," Carolan said. "Whether they're adjusting to life on the streets or not, the fear of going home keeps them out there. "I think there's a pain that's being felt by some kids at home," she said. "Just as drugs become a painkiller for some kids, others just don't know. They don't know what they want, but they know what they don't want — and that's what's happening at home. That's a really scary thing."
    When the NRS conducted its own focus group to try to find out what problems runaways felt they faced at home, she said, most of the youngsters said they had no role models in their families, that the adults in the home were not available to talk with them or advise them and that the adults in their lives were not helping them learn the skills they needed to grow up. "I think it's amazing that they are the ones who identify these things better than the other people in their lives," she said. If a runaway who calls the hotline gives their name and any information about their whereabouts, the organization is obligated to alert authorities with that information, she said.

A Need for Stability
However troubled the homelife that runaways experienced might have been, though, what they find on the streets in most cases does not overcome their problems. Besides the risk of becoming victims of violence that they face on the street, runaways find themselves associating with other people who are not likely to present positive role models, the Midwestern study says. More than 70 percent of the runaways involved in the study said that at least one of their close friends had sold drugs, 45.8 percent said they had at least one close friend who had broken into a home or store and stolen something and 77.1 percent said one of their friends had shoplifted. "What these kids need is contact with stable people, contact with someone who's not a deviant person," Johnson said. Johnson and Whitbeck said that is exactly what many of these youngsters have not gotten, even before they left home.

Looking for Adventure
That is a change from many of the runaway situations in earlier generations, when a larger percentage of teenagers who left home left looking for something, as opposed to trying to get away from an unstable situation, Whitbeck said. "This is a different kind of kid than you'd think about in the '60s or earlier than that," he said. He said in the past it was more common to see runaways who went out on the road seeking something — whether it was a bohemian lifestyle, a chance to make a new life for themselves or just the adventure they thought they could find on their own.
    "I think there's a small percentage of kids who still do that, but there's less and less," Whitbeck said. "There isn't a place for these kids to go now, the way there might have been in the past. There's no street culture like Haight-Ashbury [the San Francisco hippie scene of the 1960s] or cowboy or logging camps. "Now it's a really different thing," he added. "It isn't looking for adventure or looking for a better life — it's looking to escape a bad situation, and unfortunately what's out there isn't any better."

Psychiatrists Testify on Serial Killer
Neely Tucker and Alia Ibrahim, Washington Post- 7/11/2002

Joseph M. Mesa Jr. was sentenced yesterday to two life-without-parole terms for the brutal murders of two of his Gallaudet University classmates, as prosecutors and court-appointed psychiatrists portrayed the 22-year-old from Guam as a serial killer in the making. By the time Mesa wrapped his beefy arm around the neck of fellow freshman Eric Plunkett in fall 2000, he was beginning to live out deadly fantasies he had harbored since adolescence, two court-appointed psychiatrists wrote in evaluations that prosecutors quoted in a sentencing hearing before D.C. Superior Court Judge Robert I. Richter.
    Mitchell Hugonett, a psychiatrist who interviewed Mesa at St. Elizabeths Hospital, compared Mesa's psyche to that of serial killers in an FBI study. He wrote that Mesa "found the murder as gratifying as if it were an end in and of itself." Mesa told the doctors of beating a cat to death with a baseball bat when he was a teenager, then killing its kittens. He related the tale "with a twinkle in his eye," one of the doctors said. "There's a dark side to his being, and I don't see any meaningful prospect of that being erased," Richter said from the bench. "The court finds that this is one of the rare cases where a sentence of life without parole is appropriate and warranted."
    Richter spoke in a packed courtroom on a rainy morning as relatives of the victims clutched pictures of the dead and choked back sobs. The families of Eric Plunkett and Benjamin Varner, who were 19 when killed in their dorm rooms at the renowned school for the deaf and hard of hearing, seemed to sink back in their seats after the judge imposed the harshest sentence allowed by District law. Mesa, wearing a blue prison jumpsuit and watching a sign language interpreter, did not flinch when Richter handed down the sentence. "I'm very, very sorry for what I have done," he told the judge earlier during the hearing. "The victims will be in my memory forever, for they had done good things for me."
    Plunkett's older sister Erin said after the hearing, "This is what we were hoping for." She said the entire family had been on medication to "keep from waking up screaming in the middle of the night." Varner's mother, Diane, said, "The judge read Joseph just right." Mesa was convicted of fatally beating Plunkett, a friend, on Sept. 27, 2000. He was also convicted of fatally stabbing Varner, another friend and freshman, on Feb. 1, 2001. He choked Plunkett in a headlock before dropping him to the floor and kicking him several times in the head. He then fatally beat him with a chair. Five months later, Mesa stabbed Varner at least 16 times, slashes most frequently aimed at the face and throat. He took a few hundred dollars in cash and checks from both victims. Mesa turned himself in to police 10 days after Varner's slaying. He testified at his trial that black-gloved hands told him in sign language to carry out the killings, visions he had seen since age 10. He pleaded not guilty by reason of insanity. Jurors deliberated less than three hours before convicting him of all 15 felony charges.
    Yesterday, Mesa and defense attorney Ferris R. Bond asked Ricter to incarcerate him at an institution where he might receive psychiatric help, and Bond asked the judge not to impose the maximum penalty. Richter sentenced Mesa to life without parole on all six murder charges but said four of the counts would be vacated after his appeals had been exhausted. Prosecutors had stacked multiple counts for each killing in case a charge fell through. Mesa's family members, who had planned to attend the sentencing, were delayed by stormy weather on Guam.
    The details that emerged at the hearing added a layer of complexity to the portrait of Mesa, a short, muscular young man. Family and friends on Guam had described him as a role model for the island's deaf youngsters, a determined student who learned to play football and was resolved to succeed. His high school classmates voted him "Most Likely to Be Rich." James R. Boasberg, a prosecutor Mesa threatened to kill during the trial, said Mesa was an emerging serial killer. "He derived great excitement and pleasure from these killings," Boasberg said.
    Serial killers develop in pre-adolescence, said Robert K. Ressler, a former FBI agent and author of the "Crime Classification Manual," who helped create the agency's behavioral sciences unit to track such killers. They usually limit their destructive fantasies to animals or property for most of their teenage years, before graduating to human targets, he said. "By the ages of 7 or 9, their mind-set is cast in a certain direction," Ressler said, citing his studies. "It sets out a road map to becoming a killer who takes their fantasies into realities." Lauri Rush, director of the mental health center at Gallaudet, said the school is still healing. "Friends of Eric and Ben are struggling with feelings of depression, and friends of Joseph are getting over feelings of betrayal. But we are a strong community, and we are recovering," she said.

Ritalin Roulette
Mark Skertic, Chicago Sun/Times- 7/11/2002

Kids in far west suburban Geneva, Winfield and Sugar Grove are more likely to be on Ritalin and its mind-altering cousins than kids in north suburban Waukegan, Palatine and Winnetka. And children in all six of those towns are more likely to be getting the powerful stimulants than youngsters in Chicago neighborhoods such as Hegewisch and Bridgeport or in near west suburbs such as Cicero and Berwyn. Rich kids are far more likely than poor kids to be on these drugs, boys far more likely than girls and, in an alarming development that seems to prove that the potent medications are overprescribed, a couple of dozen babies and toddlers in the Chicago area are on Ritalin and similar drugs.
    Many doctors and the pharmaceutical industry insist there are clear and widely accepted guidelines for diagnosing whether a child has attention deficit disorder or attention deficit hyperactivity disorder, the afflictions most commonly treated with these medications. But a Sun-Times investigation reveals that who gets them is really more often a game of Ritalin roulette. Who gets these drugs has something to do with who needs them, but it has just as much to do with where you live, how much money your family earns and a host of other social--not medical--factors.
    "The system is very much out of balance," said Dr. Thomas A. Blondis, a pediatrician and University of Chicago researcher who has studied ADHD extensively. "If guidelines were followed, chances are there would be more kids in the inner-city being treated, and fewer kids in the suburbs being treated,'' he said. And even then, the Ritalin map of Chicago might remain completely out of whack. ADHD can't be diagnosed by an indisputable blood test or X-ray. Even following the most rigorous guidelines, a doctor must make a judgment call in diagnosing ADHD. And this leaves the diagnosis--and the decision to prescribe drugs--open to social pressures.
    The Chicago Sun-Times analyzed 641,735 narcotic prescription records collected over 18 months by the Illinois Human Services Department to determine where and how children in the Chicago area are being treated for attention deficit disorder. Among the findings:
* Much of the Ritalin and other forms of methylphenidate hydrochloride prescribed is going to the Chicago area's wealthiest areas. In the 18-month period analyzed, enough Ritalin was prescribed in the 60069 ZIP code, home of northern suburban Lincolnshire, to provide a 20 milligram dose to more than half the children living there. But in the 60155 ZIP code, home to near west suburban Broadview, which has an under-18 population nearly identical to Lincolnshire's, only a fifth as much was prescribed. Lincolnshire's 60069 ZIP code has an average annual adjusted gross household income of $149,000, five times higher than the $33,000 income in Broadview's 60155 ZIP code.
* Doctors wrote 4,145 prescriptions for Ritalin and other forms of methylphenidate for children age 5 and under, even though nobody knows what harmful effects these drugs might have in the long run on a small child's developing brain. There were 3,576 prescriptions written for Adderall and Dexedrine for children that young.
* Ritalin and other forms of methylphenidate remain the most popular drugs for treating ADD and ADHD. They account for about 63 percent of the ADHD drug prescriptions written. Adderall and Dexedrine, both amphetamines, are the second and third most popular drugs for ADHD.
* These drugs are most often given to those under 18. About 63 percent of Ritalin and similar drugs such as Methylin prescribed locally go to this age group.
    What the data cannot show is precisely why drugs to treat ADHD are so much more prevalent in some areas than in others. But the generally accepted view is that the drugs are overprescribed in many privileged communities, but underprescribed in other communities. The parents of children in poorer communities may not have access to good medical care or simply may refuse to use powerful stimulants on their children to alter unruly behavior.
    Scientific studies have found similar trends in other metropolitan areas, said Dr. Andrew R. Adesman, a New York developmental and behavioral pediatrician specializing in the disorder and a board member of the advocacy group Children and Adults With Attention Deficit/Hyperactivity Disorder. In some wealthy suburbs, there is an intense emphasis on academic performance, and "when children don't do well, parents look for explanations, whether it be a learning disability of an attention deficit,'' he said. Access to medical specialists is another hurdle many families face, Adesman said, and there is also a racial factor. Particularly for African Americans, he said, there is "cynicism and skepticism" about using medication to change behavior.

'Everything's different'
Dawn Bortnik of Naperville remembers the internal struggle she went through when a doctor recommended she put her son, Blake, on Ritalin. He was in first grade and had become disruptive in school. His performance was steadily slipping, and he was having trouble making friends. "He wasn't socializing normally,'' his mother said. For weeks and months, she resisted putting him on a drug, but things weren't getting better. His teachers were calling. He just couldn't sit still. "The decision to give your child medication is very difficult,'' she said. "I finally made it a year after it was first discussed.''
    Blake began taking Ritalin in second grade. Now a seventh-grader, he's taking Concerta, a drug that has the same primary ingredient as Ritalin, but in a longer-lasting formulation. On days he forgets to take his Concerta, Blake, 12, said he feels it. "Everything's different,'' he said, looking for the words to describe how his world changes. His mother has another way of knowing when he has skipped a day. "When he forgets to take it, I'm called for one reason or another,'' she said. "There's conflict.''
    Carol Vaclavicek of Geneva, whose 17-year-old son was diagnosed with ADHD when he was 8, said she agonized over whether to try medication, although his doctor recommended it. She finally agreed to try. "It reached a point when it seemed like the damage to his social skills and self-esteem was greater than anything the medication would do,'' she said.

Other parents tell similar stories.
"It's like he's on a train, and the Ritalin helped keep him on the track,'' said Adrienne Nelson of Chicago's South Side, describing her 15-year-old son, Jordan Banks. "He used to tell me he needed help because 'my head is too busy.' '' On days he forgets to take his Concerta, Jordan said, "it gets really jumbled up in there.'' He doesn't know anyone else at school with ADHD, but he said there are definitely some kids who need help controlling their behavior. No matter how hard he tries to focus, he needs help, Jordan said: "If your brain is a computer, it's like a virus attacked the computer. It's like I made a virus that wouldn't let the computer organize stuff.''

Powerful drugs
Parents have good reason to be cautious about giving their children the drugs. Ritalin and other methylphenidates work by stimulating the central nervous system. Other popular ADHD drugs such as Adderall would be called speed if sold on the street. They can cause nervous tics, chest pain and rapid heartbeats. The U.S. Drug Enforcement Administration controls the production and distribution of all these drugs because they are powerful and potentially addictive. Ritalin, Adderall and similar drugs are Schedule II narcotics, drugs more tightly controlled than anti-depressants such as Prozac.
    It may seem counterintuitive that drugs that send a jolt to the brain, like speed, can be used to treat kids who already can't sit still--until you understand how these drugs work. They stimulate nerve impulses in the brain. In children who can't control their outbursts, the drugs help them put the brakes on inappropriate behavior. Suddenly, the children focus and are less easily distracted. They can go from being the teacher's biggest problem to being the kids who settle down and get their work done. They typically stop losing things and forgetting to do or turn in assignments.
    Barbara Zerfoss had her son, Danny, evaluated for ADHD at the suggestion of his school. Danny, who is in the third grade, takes Concerta every morning. Sometimes an extra dose of Ritalin helps him get through a particularly busy afternoon. "Our son wasn't getting in trouble in school, and he was never a mean kid who hurt animals or anything,'' said Zerfoss, of west suburban Oak Brook. "But he was just doing some things that were off the wall.'' He was, for example, compulsively chewing his T-shirt. In school, he would constantly adjust his chair. "It was the kind of thing that drives a teacher crazy, but he couldn't help it,'' his mother said. "It's behavior that manifests itself as, 'I'm not going to obey you.' '' Danny, who would like to be an astronaut or scientist some day, said the drug wasn't a big deal. "It helps me concentrate and pay attention a little bit more,'' he said.

How legit is ADHD?
But for thousands of wary parents, the risks of medication outweigh the potential benefits. Chicago police officer Janine Renault said she has seen on the job what psychotropic drugs can do to a child. Too many of these kids, she said, are "labeled as troublemakers, problem kids during their whole time in school.'' Drugs are an easy and dangerous answer to a complex problem, she said. "Ritalin is . . . speed,'' she said. "Why do they prescribe something like that to kids, like it's water?''
    As a young child, Renault's son was underweight and sickly, afflicted with chronic ear infections and asthma. He also couldn't be still. "You could tell him to sit down, he'd get up no matter what,'' she recalled. Renault said her son was in kindergarten when a child psychologist told her that he was an underachiever and had ADHD. Ritalin, the psychologist said, was the best solution. But instead, Renault had her son treated for a biochemical imbalance at the Pfeiffer Treatment Center in Naperville. She said his ADHD disappeared.
    Even experts can't agree on how widespread ADHD is or exactly what causes it. The National Institute of Mental Health and American Association of Psychologists estimate the problem affects 3 percent to 5 percent of children. A recent Mayo Clinic study pegged the level at closer to 7.5 percent.

An old problem
"This isn't new--these kids were always there back then,'' said Thomas Phelan, a clinical psychologist with an office in Glen Ellyn who has made treatment of ADHD a cottage industry. Phelan offers seminars, appears on the lecture circuit and sells his books and tapes, works with names such as Surviving Your Adolescents , on his Web site. "Back then, we had different names for these kids,'' he said. "We'd say they were brats, troublemakers. They're just lazy.'' Phelan is a staunch advocate of medication, saying the benefits clearly outweigh the concerns. "The long-term side effect of ADD is prison,'' Phelan said. "How would you like to be the parent who can say, 'My kid's 23 years old, he's in jail. But thank God he never had to take a pill.' ''

Debating Diagnosis of a Sensory Malady in Children
Sheryl Gay Stolberg, New York Times- 7/11/2002

NORTH POTOMAC, Md. - Ever since his baby days, Alex, now nearly 4, has been a puzzle to his parents. As an infant, he screamed unless he was being rocked or held. He hated the feel of water; baths were a nightmare. By 3, he was covering his ears at loud noises. He loved the feel of the sandbox, but could not stand sock fuzz between his toes. Sleep came only in fits and starts. "He was," Alex's father says, "kind of like a raw nerve."
    In years gone by, Alex might have been written off as fussy or difficult, or labeled hyperactive. Today, however, he has received a diagnosis for his baffling collection of symptoms: sensory integration dysfunction, a condition that is regarded by many occupational therapists as a neurological disorder, but which some medical doctors do not believe exists.
    The term sensory integration refers to the brain's ability to process and make sense of stimuli that come in through the senses: sight, sound smell, taste and especially touch. The issue in the sensory dysfunction debate is whether children like Alex, who seem either overly sensitive or under-sensitive to certain types of stimulation, have a true brain disorder or are just at the end of the curve of what is normal.
    "Kids vary along a spectrum," says Dr Adrian Sandier, a developmental pediatrician who is chairman of the American Academy of Pediatrics' committee on children with disabilities. "It is clear that some children seem to have problems with sensory modulation. Noises bother them; touch bothers them. The hustle and bustle of a kindergarten classroom is too much for them. But I don't think it's proven that such a thing as sensory integration disorder exists:"
    Proof or not, a growing number of parents are being told their children have sensory integration dysfunction -- often abbreviated as S.I. -- and a growing number of children are undergoing occupational therapy for it. Alex is among them. For the last six weeks, he has been making twice-weekly visits to Beverly Catron, a pediatric occupational therapist who works out of her home m this suburb of Washington.
    Many people have some kind of sensory integration problem, Mrs. Catron says. Some get carsick. Some are clumsy. Some get a little too close when they talk to you; they don't recognize their own physical place in space. Some are irritated by the tags in their shirts. These problems cross over into dysfunction, Mrs. Catron and others say, when they interfere with a child's daily life -- his ability to learn, or make friends, or get a good night's sleep. "You and I can shut out extraneous sounds, we shut out extraneous touch, like when we are sitting in a chair," Mrs. Catron said. "We don't process constantly that our bottom is against the chair. But these children do, so they can't concentrate. Some of them withdraw from other kids; they don't want to be touched or they don't want to have all that noise around them. That's one end of the scale. Then there's another end, where kids are moving all the time because they can't get enough movement"
    Alex, Mrs. Catron says, is a little bit of both. He exhibits "tactile defensiveness," shying away from the soft touch of a handshake. But he loves to throw himself on the mats in her basement gym -- evidence, she says, that he is seeking out "deep pressure touch." During a recent therapy session, he twirled endlessly from a trapeze, spinning wildly without getting dizzy. Mrs. Catron encourages him to seek out the kind of movement he seems to need, with the goal of helping him "organize himself" to respond to sensory input. Alex's parents, both clinical psychologists, who agreed to interviews only if they were not identified, said the treatment seemed to be making a difference. Their son is sleeping better, and not crying nearly as much. "He is tremendously less irritable, he's smiling more often," he doesn't have that pained look on his face anymore," Alex's mother said.
    No one knows precisely how many children might be affected with sensory integration dysfunction, in part because medical doctors have not yet accepted it as a standard diagnosis. There is no entry for sensory integration dysfunction, for instance, in the psychiatric diagnostic and statistical manual. The Centers for Disease Control and Prevention does not track it as a disease. Nonetheless, Dr. Sandier, of the American Academy of Pediatrics, said there was evidence suggesting as many as 10 to 12 percent of children may have some type of sensory processing problem. Among children with developmental disabilities, including autism and cerebral palsy, he said, the percentage is as high as 30 percent. Children exposed to drugs in the womb, premature infants and hyperactive children also appear to be disproportionately affected. In some cases, newborns, particularly premature infants, are being treated while they are still in the neonatal intensive care unit; Dr. Sandier said their "tactile defensiveness" can contribute to feeding problems.
    Sensory integration dysfunction was first described in the 1960's by a California occupational therapist, A. Jean Ayres, who theorized that the condition was a cause of learning disabilities. The theory has been controversial from the start, said Larry B. Silver, a child psychiatrist in Rockville, Md., and former acting director of the National Institute of Mental Health who is a leading proponent of the sensory integration dysfunction diagnosis. Yet Dr. Silver says there is growing evidence that "the wiring is laid down differently" in the brains of children who exhibit the symptoms of sensory integration dysfunction. He said pediatricians and schools, particularly in large urban areas, were increasingly recognizing it as a problem.
    This is especially so in Washington and its suburbs, in part because of the presence of two women: Lynn Balzer-Martin, an occupational therapist and early disciple of Dr. Ayres's, and Carol Stock Kranowitz, a retired preschool teacher who counts herself as a protegee of Dr. Balzer-Martin. In 1998, Mrs. Kranowitz published a book, "The Out-0f-Sync Child," about the condition. Now in its 18th printing, the book has sold 200,000 copies, she said. It has become the parents' bible to sensory integration dysfunction and has put Mrs. Kranowitz on the lecture circuit. "I get as many as a dozen out-of-the-blue e-mails a week from parents who have read the book and say, `At last, I have an answer,' " she said.
    Dr. Balzer-Martin, who holds a doctorate in education, has developed a specialty in diagnosing sensory integration dysfunction; it was she who evaluated Alex and gave him his diagnosis before referring him to Mrs. Catron. She has developed screening tests and is conducting annual evaluations at a number of preschools in the Washington area. As word has spread, she said, parents have been pressing pediatricians for a diagnosis of S.I. and are seeking referrals for occupational therapy. Sometimes they turn up in the doctors' offices with Mrs. Kranowitz's book. "There are so many two-parent, highly educated families where people want the best for their kids, and even if the problem isn't a terrible one they are willing to spend time and money to work on it," Dr. Baizer-Martin said. "Parents are not as concerned with an elegant diagnosis as they are with what will help my child."
    .Some critics, however, worry that sensory integration is being overdiagnosed, without good scientific evidence. Dr. Sandier, the developmental pediatrician, said there was a great deal of overlap of what might be called sensory integration dysfunction and other behavioral problems, including attention deficit hyperactivity disorder. Sometimes the two are confused, he said, and "The question is, does the diagnosis of S.I. add anything useful?" Dr. Sandier said there was some evidence that occupational therapy could help premature infants gain weight and decrease tactile defensiveness. For autistic children, he said, the treatments hold promise, but more study is required. There is clear evidence, he said, that occupational therapy does not help with learning disabilities, as some occupational therapists contend. "There is much more S.I. treatment going on at this time than I think is justified by the research data," he said. To which Dr. Silver replied: "There is an awful lot we do in medicine that we don't have hard data for. A pediatric neurologist might say, `This is a sham.' But the important thing for me is, I see the kids improve." Alex's father agrees. "Seeing," he said, "is believing."

Massachusetts Seeks Psychiatric Drug Cuts
Liz Kowalczyk, Boston Globe- 7/12/2002

Massachusetts, grappling with soaring Medicaid prescription drug costs, will warn doctors about a practice officials say costs millions and may harm some patients: physicians prescribing multiple psychiatric drugs -- sometimes as many as seven -- to individual patients. Medicaid officials, who are seeking new ways to control drug spending, recently turned their attention to psychiatric medications, which gobble up half the state's $890 million drug budget. They said they were surprised by what they discovered: Nearly 5,000 patients on two or more antidepressants. More than 1,100 on five, six or seven different psychiatric medications. And even one mentally ill man for whom doctors simultaneously prescribed 15 mood stabilizers, antipsychotics, and anti-anxiety drugs.
    Dr. Annette Hanson, the state's Medicaid medical director, said that sometimes psychiatric patients are so ill with numerous overlapping problems that their treatment requires some sort of drug cocktail, just as for AIDS patients. But she said that for various reasons, including the movement toward shorter hospital stays, ''poly-prescribing'' or ''poly-pharmacy'' has gotten out of hand. Dr. Ken Duckworth, deputy commissioner at the state Department of Mental Health, said little scientific evidence exists that multiple drug regimens help patients, and that, in some cases, they may worsen side effects such as weight gain, agitation, and diabetes.
    On Aug. 1, the agencies will warn hundreds of doctors to cut back on unnecessarily prescribing medications for the state's Medicaid psychiatric patients. If doctors don't voluntarily restrict the practice, Hanson said, the state will consider requiring prior approval for psychiatric drugs -- a measure patients' groups strongly oppose.
    The Medicaid program is tracking the prescribing habits of psychiatrists and physicians who treat the mentally ill and will send out two pharmacists to educate the most frequent poly-prescribing offenders. This approach, known as ''counter-detailing,'' is intended to give physicians more objective information than drug company sales people do during ''detailing'' visits, Hanson said. ''We are very concerned about this,'' she said. Medicaid spent $45 million last year on the schizophrenia drug Zyprexa alone - the most money spent on any drug for Medicaid recipients. Officials don't know how much money they will save by reducing multiple prescriptions for individuals but say the figure may be at least $20 million.
    Medicaid is wading into a mysterious but well-established practice in psychiatric medicine. Many psychiatrists see poly-prescribing as part of the art of treating the mentally ill, a sort of improvisational medicine; they know that many expensive new psychiatric drugs -- or combinations of them -- work for some patients, but they don't know exactly how. And they often can't predict which drugs will help which patients. ''Sometimes psychiatrists are like mad scientists, and for some reason these wild combinations work,'' said Toby Fisher, executive director of the Massachusetts Alliance for the Mentally Ill. ''We can't always say why, but we know the person hasn't been in the hospital for a long time.''
    In academic medical centers in particular, physicians increasingly believe that even similar drugs in the same class -- the schizophrenia drugs Clozaril and Risperdal, for example -- work on different neurotransmitters in the brain and may be more effective when combined. That's given doctors license to overlap different medications, a practice growing more common, said Dr. Donald Goff, head of the schizophrenia program at Massachusetts General Hospital.
    Medicaid, the state health insurance program for 900,000 needy residents, tends to cover the state's most mentally ill residents; people with severe depression, anxiety, and schizophrenia often lose their jobs and their private health insurance. ''With a lot of patients, doctors have tried these drug combinations out of desperation because patients are so ill,'' Goff said. ''Everyone is trying to figure out the best way to proceed. Most studies say these medications end up saving money over the long haul by reducing hospital stays. Everyone looks at escalating pharmacy costs but not always at the big picture.''
    Dr. Juan Avila, a psychiatrist at the South End Community Health Center, said one problem is that clinical trials on psychiatric medications are unrealistic. They often study ''a very clean population'' of patients on a single drug for one specific problem like severe anxiety. But in ''reality we deal with individuals with multiple problems and diagnoses, and we have to cope with all of these variables,'' he said. For example, Avila treats a woman who was admitted to the hospital twice for psychosis but who wants to take only herbal remedies. He persuaded her after several months to take low doses of two antipsychotics - Risperdal and Zyprexa - but she won't take a higher dose of one. ''Someone may look at her prescriptions and say, `Why is he giving her two drugs and why low doses? This psychiatrist doesn't know what he's doing.' But you have to look at the individual patient,'' Avila said.
    Goff said Mass. General and other medical centers now are more aggressively evaluating drug combinations. About one-third of schizophrenic patients are on more than one antipsychotic medication, he said, and he believes half are benefiting and half are not.
    Many psychiatrists agree that poly-prescribing has gotten too common. Since managed care took off during the 1990s, insurance companies have enforced shorter hospital stays for psychiatric patients. This is true of patients with all types of health insurance, not just Medicaid. When stays were longer, doctors had time to ''wash'' old drugs out of patients' bodies while they were still in the hospital before trying new medications. Now, with most patients in the hospital a week or less, doctors don't have time to wean patients off old drugs first. And when patients are discharged on new medications, their regular physicians don't want to upset the delicate balance by taking them off of their old drugs. ''In order to get patients out of the hospital, they snow them with medication so they aren't doing whatever they were doing to get into the hospital,'' Hanson said. ''And then when they get out and go back to see their regular psychiatrist, he says, `Dr. So-and-So, a world-famous physician, put him on this. So who I am to take him off?' The communication between inpatient and outpatient isn't great.''
    Psychiatrists often use medications to control symptoms -- not treat causes of illnesses. And the number of drugs for various symptoms from insomnia to anxiety to hallucinations have exploded in the last decade, said Dr. David Osser, past president of the Massachusetts Psychiatric Society and a psychiatrist at the Brockton and Taunton Veterans Administration hospitals. ''If a patient can't sleep, the path of least resistance is to add a sleep medication -- even if they're on four other drugs,'' said Osser, who advised Medicaid on its plan to curb multiple prescribing. ''This is improvisational fly-by-the-seat-of-the-pants medicine. The real question is why are all these people on all these medications?'' Osser recently treated a man with post-traumatic stress disorder who was taking five medications -- an antidepressant, a mood stabilizer, two anti-epileptics, and an antipsychotic. He came in asking for a sixth drug, a tranquilizer. Instead, Osser said he signed up the man for cognitive therapy and eventually weaned him off all his medications.
    Medicaid will phase in a program beginning Aug. 1 to limit the state's drug list to the most effective and lowest-priced drugs for certain diseases. But for Medicaid programs across the country, controlling the cost of psychiatric drugs has been extremely difficult because patients' groups have fought prior approval and other limits. Hanson said she understands patients' concerns, which is why the program is trying an educational approach first.

Divorce No Guarantee of Happiness, Study Finds
Karen S. Peterson, Chicago Sun/Times- 7/12/2002

Divorce doesn't necessarily make adults happy, but toughing it out in an unhappy marriage until it turns around just might, a new study by University of Chicago researchers found. They identified happy and unhappy spouses, culled from a national database. Of the unhappy partners who divorced, about half were happy five years later. But unhappy spouses who stuck it out often did better: About two-thirds were happy five years later.
    The study results contradict what seems to be common sense, said David Blankenhorn of the Institute for American Values, a think tank on the family. The institute helped sponsor the research team, who presented their findings Thursday in Arlington, Va., at the ''Smart Marriage'' conference sponsored by the Coalition for Marriage, Families and Couples Education. ''In popular discussion, in scholarly literature, the assumption has always been that if a marriage is unhappy, if you get a divorce, it is likely you will be happier than if you stayed married,'' Blankenhorn said. ''This is the first time this has been tested empirically, and there is no evidence to support this assumption.''
    About 19 percent of those divorced had happily remarried within five years. The most-troubled marriages reported the biggest turnarounds. Of the most discontented, about 80 percent were happy five years later, said Linda Waite, the U. of C. sociologist who headed the research team. Waite, author of The Case for Marriage (Doubleday, $24.95), analyzed data on 5,232 married adults from the National Survey of Families and Households. It included 645 who were unhappy. The adults in the national sample were analyzed through 13 measures of psychological well-being. Within five years, 167 of the unhappy were divorced or separated, and 478 stayed married. On average, divorce didn't reduce symptoms of depression, raise self-esteem or increase a sense of mastery compared with those who stayed married, the study found. Results were controlled for race, age, gender and income.
    Staying married did not tend to trap unhappy spouses in violent relationships. Waite glossed over these findings in a single paragraph of The Case For Marriage, published in 2000. But that brief mention attracted so much attention that she decided to return to the topic and explore it further. With research partner Maggie Gallagher, of the Institute for American Values, she set up a series of focus groups, held in several East Coast cities, with people who said their marriages had gone through difficult times but now were doing well.
    These once-discontented marrieds felt their unions got better for one of three reasons:
*Determination. These spouses worked ''to solve problems, change behavior or improve communication.'' Said Waite: "Either they were going to kill each other or they were going to stay married, but they were not going to get divorced."
*Personal change. Partners found ''alternative ways to improve their own happiness and build a good and happy life despite a mediocre marriage.'' In effect, the unhappy partner changed.
*Mere endurance. Even though these couples didn't work at improving their marriages, the report said, ''With time, job situations improved, children got older or better, or chronic ongoing problems got put into new perspective.''
    Those who worked on their marriages rarely did so with the help of a counselor. But when they did, they typically went to faith-based counselors. Men, particularly, were ''very suspicious of anyone who wanted money to solve personal problems,'' Waite said. Those who stayed married also generally disapproved of divorce, Waite said. They cited concerns about children, religious beliefs and a fear that divorce would bring its own set of problems.

Texas Mental Health Agency Turning Away Patients
Todd Ackerman, Houston Chronicle- 7/12/2002

The agency in charge of Harris County's indigent mental health services, claiming its resources are too strained to meet demand, has adopted a policy of turning away new nonemergency patients. The Mental Health and Mental Retardation Authority of Harris County has not taken appointment requests from would-be, first-time patients wanting outpatient care since July 1 and doesn't expect to change course in the next few weeks, Executive Director Steve Schnee said Friday.
    "It's a tragedy," said Schnee. "It means poor people will have to get sicker before they get treatment, and that a lot of them will end up in jail." Schnee said he could not recall the authority previously turning away such patients in his 10 years on the job. He attributed the decision to underfunding -- the state spends about $12 per resident to treat mental illness in Harris County, compared with the national average of $27 -- local population growth and a 500-bed reduction in private psychiatric care in recent years. Schnee also said three physician vacancies played a role in the authority's inability to meet demand and subsequent decision.
    State Rep. Garnet Coleman, D-Houston, vice chairman of the House committee on public health, said this is the first time he'd ever heard of any county in the state not accepting new nonemergency patients. He called the situation "unacceptable." "This shows where Texas is," said Coleman, who suffers from depression. "We're one of the largest states in the richest country in the world, and this is how we treat people. We're talking about closing down intake for folks who will end up on the street and in harm's way. It's unconscionable."
    MHMRA receives roughly $80 million a year in state and county funds to treat adults "with severe and persistent mental illness and regardless of their ability to pay." Its priority population is people suffering from schizophrenia, manic-depression, major depression and something known as schizo-affective disorder, which combines mood disorders and cognitive impairment. It treated 319 new patients in June, a fraction of the month's 9,279 total patient load. Its contract with the state calls for it to treat 8,830 unduplicated adult patients a month. Only about 10 percent receive a full range of services.
    Schnee said a big reason the MHMRA decided to stop taking new nonemergency patients was because their increasing numbers began delaying the authority's response to referrals from other public institutions -- state hospitals, the criminal justice system, the University of Texas Harris County Psychiatric Center and the NeuroPsychiatric Center, MHMRA's own emergency hospital. Patients released from those institutions continue their treatment through MHMRA's outpatient services.
    At UT-HCPC, whose contract with MHMRA calls for patients to receive treatment in three to five days after their release, new patients' waiting time has increased from 3.5 days at the beginning of June to 9.5 days at the end of June and to nearly 13 days the first week of July, said Schnee. Schnee said that when those averages return to normal, the authority hopes to accept new nonemergency patients. He said filling the physician vacancies, expected soon, should speed the process along.
    Geri Konigsberg, spokeswoman for UT-HCPC, which transferred nearly 200 patients to MHMRA in June, said the decision to turn away new nonemergency patients was ill-advised. "By not accepting new nonemergency patients, MHMRA is contributing to the likelihood of their ending up in crisis," said Konigsberg. "Had they received outpatient treatment in a timely manner, many patients wouldn't need crisis care." Konigsberg said UT-HCPC, whose inpatient, crisis care typically lasts just less than 10 days, had a 10 percent increase in unreferred patients between July 1 and 10, the period of MHMRA's new policy. She called that a significant increase.
    Konigsberg said MHMRA's policy of turning away nonemergency patients is especially troubling because it comes as an increasing number of people are seeking mental health care. She cited population growth, a diminished stigma about the field and recent events such as corporate layoffs or fear of terrorism for the increase. UT-HCPC, which was built to serve 3,000 patients, served 5,700 last year and is on pace to exceed that this year, said Konigsberg. MHMRA received more than 9,000 phone calls at its main access center in June. Schnee said it has little ability to respond to so many calls.

Wayne County Mental Health Choice Supported
Niraj Warikoo, Detroit Free Press- 7/13/02

Wayne County residents with mental health problems might soon have more health care choices. On Friday, a county mental health board moved a step closer to approving contracts for three nonprofit firms to provide a range of services. The plan also awaits approval by the county and state. The board of the Detroit-Wayne County Community Mental Health Agency voted Friday to ask three companies to offer the contracts. The board indicated it probably will approve them Wednesday. The board also earmarked $460 million for mental health services and approved a $5.8-million contract, requested by the state, for Wayne State University to analyze the agency's performance and provide support and training.
    Currently, people seeking county services are restricted by geography and other factors, including the county's discretion. Under the new plan, consumers will be able to seek care from any of the providers. "It's a collaboration that will benefit consumers," agency board member Eddie McDonald said Friday. "They'll have a choice." The board's action came after the state threatened in May to stop funding the agency's programs. The agency had not met a deadline for creating new services, and so the state set a July 15 deadline.
    The mental health agency, which serves 75,000 residents a year, has a $540-million budget that pays for an array of programs, from suicide intervention to addiction treatment to helping those with depression. The three companies that will now send contracts to the agency for approval are Gateway and Comprehensive Behavioral Health Services, both in Detroit, and Carelink in Southgate.
    Hubert Huebl, a doctor who heads the Michigan branch of the National Alliance for the Mentally Ill, welcomed Friday's action. He said that having increased choices and the three companies will provide competition, and that working with Wayne State will improve programs. "As a consumer, you have a golden opportunity," Huebl said. "Why not take advantage of a first-class university?"

Three Million U.S. Teens Think of Suicide
Reuters News Service, 7/14/2002

WASHINGTON - Three million American teens have thought seriously about or even attempted suicide, a government survey released today showed. More than 13 percent of young Americans between 14 and 17 years of age considered suicide in 2000, the report from the U.S. Substance Abuse and Mental Health Services Administration found. Only 36 percent of them had received mental health treatment or counseling, SAMHSA said.
    Depression is the main cause of suicide, SAMHSA administrator Charles Curie said in a statement. "We need to help teens make the link between untreated depression and the risk for suicide, and help them identify serious depression or suicide risk in a friend," Curie said. "We must encourage teens to tell a responsible adult when a friend is at risk for suicide."
    More than a third of the 3 million teens aged 12 to 17 who said they thought about suicide in the past 12 months actually tried it, the survey, the first of its kind ever done by SAMHSA, found. Girls were twice as likely as boys to say they thought about suicide, but race did not seem to make a difference, the report found. Nor did whether the teens lived in the city , suburbs or country. The highest rate was in the western part of the country, where 13.5 percent of children aged 12 to 17 reported having had thoughts of suicide.

N.J. Drug Treatment Center Called Into Question
Associated Press, 7/14/2002 18:36

HACKENSACK, N.J. -- New Jersey judges and probation officers send drug addicts to Reflections Recovery Center. Parents entrust their children to the 4-year-old treatment center. But an investigation by The Record of Hackensack found licensing problems, little supervision of Reflections clients and a founder with multiple drug and theft convictions of his own.
    The Record interviewed dozens of former Reflections clients, their parents, drug treatment experts and state regulators. It found the drug treatment center profited from clients' failures, expelling them for minor infractions and demanding a $2,200 ''readmission fee'' before allowing them to return. The center operated without a license for 2½ years. It is now licensed for outpatient care, but The Record said it has up to 80 live-in patients in unlicensed rooming houses in Hackensack, Maywood and Paramus.
    But in a state where the majority of the 140,000 seeking drug or alcohol treatment each year cannot get into a program, officials are reluctant to close down any avenue for treatment. ''Maybe they're not running the program exactly the way it ought to be run, but you have to use what's available,'' said John Bell, a Morris County probation supervisor. ''You take what you can get.''
    Reflections' founder, Dean Molin, defended it as ''the cheapest rehab in the state of New Jersey, probably pumping out some of the best-quality recovery in the state of New Jersey.'' He said 95 percent of Reflections' 150 graduates have stayed drug-free, compared with the average national success rate of 40 to 60 percent. The center issues no reports that would verify Molin's claim.
    Reflections has no board of directors. Molin's mother, Harriet, is listed as the owner, and his psychologist uncle is the clinical director. Molin himself has been convicted of car theft, cocaine possession and stealing money and jewelry. When he opened Reflections, he was on probation for being an accessory to grand larceny in Nevada.
    The Record reported that supervision at Reflections is loose, with clients living unsupervised in four homes scattered around the county and placed in charge of distributing medication to other drug addicts. ''You live in a house with a bunch of other people, but none of them are counselors or anything like that,'' said one former client, who asked to be identified only by her initials, K.L. Many clients reported having no ''blackout period'' upon their arrival at Reflections. Most licensed halfway houses put new clients under tight supervision for two to six weeks, forbidding them to work, restricting contact with friends and requiring frequent counseling sessions. One Reflections client, Edward Aikens, was found dead in a Paterson Public Library restroom two weeks after checking into the center. The medical examiner told Aikens' family he injected heroin after drinking and taking prescription drugs.
    Because the state allows Reflections to classify itself as outpatient, officials have little control over center. Reflections also receives no state money. Finances and clients' progress at state-funded centers are inspected quarterly, and licensed inpatient programs must provide constant supervision and high ratios of certified staff.
    James O'Brien, director of Addiction Treatment Providers of New Jersey, which represents 60 state rehab operators, said the state may feel it has few options in dealing with Reflections. ''The wall they run up against is, if they yank the outpatient license, where are these people going to go?'' O'Brien asked. ''Where are those 80 people going to go when all the other centers are filled?''

Alcoholics Say Many Employers Too Lush with Tolerance
Diane Stafford, Kansas City Star- 7/15/2002

KANSAS CITY, Mo. -- Her former boss uses words such as "skilled," "excellent with people" and "talented" to describe Desiree Pfeffer-Van Pullis. But because of a problem with alcohol, Pfeffer-Van Pullis no longer works at the Center for Management Assistance in Kansas City. She wasn't doing what was expected of her at the center, which provides management consulting to non-profits. "I knew I was drunk and had no right to be on the road," Pfeffer-Van Pullis said of a night in April 2001 when she was stopped and ticketed for driving under the influence. She later lost her driver's license. She also lost her job. "My boss said I was discrediting myself and the non-profit consulting company where I worked," Pfeffer-Van Pullis said. "I have a master's degree in management information systems, but in one year the world changed for me. It's incredibly humbling." Only this month, she said, she got her driver's license back and obtained part-time, temporary work. And in some ways she considers herself luckier than many other workers whose work-related problems with alcohol continue for years. She said her turning point was fairly quick and definitive.
    Other people interviewed, most of whom described themselves as alcoholics, all sounded a similar theme: They wished their employers had confronted them sooner about their drinking problems. In hindsight, most said they wished their bosses had enforced consequences for their failures to perform as soon as their alcohol abuse became apparent -- not after watching them unravel for months or, in some cases, for years. That common wish sometimes put them at odds with the human resource practices at their companies.
    Usually, alcoholics who were interviewed said, their managers slowly built personnel files, charting their unexcused absences, missed deadlines and subpar performances -- and then eventually fired them "for cause" without ever mentioning their obvious drinking problems. Some even characterized their former bosses as "enablers" who looked the other way or covered for them when they were drinking.
    It is possible to pass off their comments as failure to take personal responsibility. But in a time when individual rights of privacy and fear of corporate liability for discrimination influence many human resource policies and practices, the drinkers' desire for a more paternal workplace is worth noting.
    Judy Kay, a counseling supervisor, has counseled many alcoholics who didn't admit the extent of their drinking problems until they lost their jobs. "People will deny their addictions as long as they're still working," Kay said. "The job gives them the illusion of stability and control. But when that goes and they're sitting at home, many reconsider." For that reason, Kay supports management education about the benefits of early intervention. "When there's drinking, there's not just lower productivity and increased accidents and absences, there are real personal problems," Kay said. "Most people truly would rather have their bosses intervene and show they care about them as people rather than handling their personnel cases exactly according to procedure." Managerial intervention is far preferable to obfuscating or ignoring drinking problems, several recovering alcoholics said.

'You guys need to quit this'
John (who attends Alcoholics Anonymous meetings and uses only his first name in public) said one of his former bosses at a warehouse and distribution center protected him and three or four of his colleagues who for years drank heavily at lunchtime. "He hid us out when his managers would come around," John recalled. "He'd send us to the other end of the dock so the managers couldn't smell our breath. The only thing he'd say was: 'You guys need to quit this. Someday you're going to get in trouble.'"
    Eventually, John got in trouble. He was injured, possibly because of impaired attentiveness. After he had surgery, he decided to control his drinking. John said he heard repeatedly from fellow AA members that "their employers weren't saying anything about their drinking" and that their bosses used other performance issues to fire them. "That's unfortunate, because those people are getting sicker and the company is losing a lot of money," John said. "I know I cost my company a lot of money and lost productivity because of my behavior. It's like we were all blind to the effect on our co-workers and our employers, and nobody was talking about it."
    Judy and Bob Kelly, who have devoted more than a decade to teaching and counseling others about alcohol abuse and awareness, agreed that they might have stopped their years of drinking earlier if their bosses had confronted them. "I never once had a supervisor confront me about my drinking, not ever," Bob Kelly said, recalling a checkered work history while he was drinking. "Each time I was let go, they just said my performance wasn't what it should be, that I wasn't meeting their expectations." Realistically, he admitted, confrontations might not have made a difference: "Until I was ready to quit drinking, I might have just ignored them ... but you never know."

Fewer three-martini lunches
There are several reasons that drinking problems may not seem to be at the forefront of workplace attention:
    * The reason most often stated is thrown out somewhat facetiously by drinkers and non-drinkers alike: "Who the heck takes a three-martini lunch anymore?" It is possible that alcohol-lubricated lunches are less common these days. Downsized work forces in a tight economy are more likely to eat lunch at their desks or gobble fast food, partly because of time and partly because of budget restrictions. Furthermore, staff cuts have eliminated many of the poorest-performing workers, no matter what the reason for their poor evaluations. The workers who remain may be more likely to be the clean and sober ones. (Of course, counselors note, many alcoholics refrain from drinking until after work, but still imbibe enough that it impairs their next-day performance.)
    * Because the Americans With Disabilities Act is interpreted to protect alcoholics from workplace discrimination, many managers are afraid to mention drinking as a problem. But there are fine points to that protection that must be understood. "People need to understand that the (Americans With Disabilities Act) protects a recovering alcoholic," explained Cherlyn Johnson, a chapter president of the Human Resource Management Association. "Alcoholism itself is not a protected class." If the law is interpreted incorrectly or disregarded, employers might expose themselves to lawsuits if they discipline, fire or refuse to hire an alcoholic. The law protects an alcoholic from being disciplined more harshly than a non-drinker for the same conduct. A recovering alcoholic cannot be discriminated against in hiring or promotion decisions based on past drinking, Johnson said, but the law doesn't protect someone who falls off the wagon and suffers performance problems as a result. "That's why it's all about documenting performance problems," she explained. "I'd never say, 'I smell alcohol,' because what if it's mouthwash? "An employer has to document behavior, and if you're not performing as needed for the job, then we can ask, 'What can we do to help you?' or 'Is there something that's preventing you from doing your job?'" The alcoholic must be able to perform the essential functions of the job, with or without accommodation (such as time off to attend Alcoholics Anonymous meetings). Those who can't fulfill the requirements of the job are subject to the same disciplinary procedures as non-drinkers.   
    * In recent years Employee Assistance Programs -- offering confidential counseling and treatment for such problems as alcoholism -- have become an established corporate benefit. Although the programs aren't as common in small and midsize organizations as they are in big companies, there is broader work-force awareness that help is available to substance abusers, through both private and government-sponsored counselors. Whether drinkers take advantage of such services, though, is almost completely up to them.
    * Mandatory or random drug-screening programs have mushroomed in the workplace -- making it easier to definitely identify workers with substance abuse problems. But such screening is more likely to occur before a worker is hired or be administered randomly or after an accident occurs in manufacturing and transportation environments. Many white-collar workers never are exposed to such testing.
    In the white-collar workplace, though, health and wellness education -- often paired with health insurance programs -- has grown, especially at large companies. And at all companies the push to do more with less and the heightened emphasis on safety are prompting more co-workers to speak up when alcohol-impaired colleagues fail to pull weight or endanger others. The bottom line is that no employer is required to accept alcoholism as an excuse for inadequate job performance. The law says employers have the right to hold drinkers to the same performance standards as non-drinkers. Many alcoholics say they want that message to be delivered as soon as possible.

Texas Psychiatric Center Goes on "Drive-By"
Todd Ackerman, Houston Chronicle- 7/16/2002

The Harris County agency that oversees indigent mental health care, already turning away new nonemergency patients, has now had to reject its sickest patients. The agency's Neuropsychiatric Center went on drive-by status -- when law enforcement and emergency medical services are instructed to take acute patients elsewhere -- much of Sunday and Monday, and the agency's executive director said Monday he doesn't expect the situation at the emergency hospital to improve soon.
    "I'm deeply concerned about what is happening to public and private mental health care in Harris County," said Steve Schnee, head of the Mental Health and Mental Retardation Authority of Harris County. "It's a sad reflection at a time when we can do so much for people with psychiatric disturbances." Schnee said the problem is the large number of indigent patients awaiting transfer to the University of Texas Harris County Psychiatric Center, the primary inpatient site for patients who are a threat to themselves or others. The authority, which contracts with UT-HCPC for 143 beds, was using 170 of the hospital's beds Sunday. Schnee said that, if anything, he expects the crunch will only get worse because a change in Texas' reimbursement policy for state hospitals beginning in September won't cover increasing charges, leaving fewer beds available for transfer from the MHMRA.
    The Neuropsychiatric Center's drive-by status will leave many dangerously ill patients at home or on the street, experts said. But they can be taken to UT-HCPC or Ben Taub Hospital's emergency psychiatric clinic, where doctors assess the patients and look for a bed for them if none is available on site.
    The MHMRA receives about $80 million in state and county funding to treat adults "with severe and persistent mental illness, regardless of their ability to pay." It provides outpatient care and assesses people suffering from schizophrenia, manic-depression, major depression and schizo-affective disorder, which combines mood disorders and cognitive impairment. Those requiring inpatient care are transferred to UT-HCPC or other institutions.
    With its resources strained by a growing population of patients and a shrinking system to serve them, the MHMRA began turning away new nonemergency patients July 1, the first time Schnee could remember the agency taking such a step. He said he doesn't foresee a change of plans in the near future. The Neuropsychiatric Center receives roughly 1,000 to 1,250 patient visits a month, evaluating or stabilizing most within 23 hours. It includes an eight-bed unit -- closed for most of 2002 because of funding problems, it reopened in June -- where acute patients can be treated for three to five days. Plans call for expanding the unit to 16 beds.
    On Monday, Schnee said the center was housing 17 acute involuntary patients awaiting transfer to UT-HCPC and 10 voluntary acute patients awaiting transfer to somewhere in the system. He said that is the reason the center went on drive-by, which he described as "a new phenomenon." Meanwhile, UT-HCPC is struggling to accommodate a growing number of walk-in patients. Center spokeswoman Geri Konigsberg said 86 percent of such patients were admitted for inpatient care in June, compared with percentages ranging from the low to mid-70s in most of 2001 and early 2002.

Massachusetts Man Shot Said to Have Mental Illness
Emily Ramshaw, Boston Globe- 7/17/2002

CAMBRIDGE - A gruff but likable war veteran, Daniel Furtado was a common face in his East Cambridge neighborhood, whether he was helping his neighbors shovel snow, feeding stray cats, or gardening in his yard. But Furtado, 59, also had a history of mental illness. According to those who knew him, he had recently stopped taking his medication and started having violent outbursts, prompting his wife to move in with their daughter in Medford on the Fourth of July.
    On Monday afternoon Furtado was shot and killed in his home by police after he allegedly threatened them with a hatchet, according to the Middlesex district attorney's office. Neither the prosecutor's office nor the Cambridge Police Department would comment yesterday on the matter, the second time in two weeks that Boston-area police have shot and killed a mentally ill suspect in the line of duty. Cambridge police were called to Furtado's home on Porter Street at 11 a.m. after neighbors complained he had gone through their backyards cutting cable and telephone lines. A neighbor said several police officers and at least two psychiatrists attempted to coax Furtado, a retired security guard, out of his home in a three-hour standoff before resorting to tear gas. Finally, police shot an explosive to divert Furtado's attention, then broke down the door, neighbors said. Porter Street residents said they heard a total of four shots and saw Furtado being carried out on a stretcher, his face covered with a sheet. Authorities said police opened fire after Furtado allegedly charged them, swinging a hatchet.
    ''He was a real nice guy, a real quiet guy,'' said neighbor Ray Durette. ''His wife left him on July 4, and he's been on the war path ever since. It's just too bad.'' Neighbors said police have been called to the Furtado home more than a dozen times in the past 10 years. About 15 years ago, neighbors said, Furtado leaped from roof to roof on the street's three-story homes. On other occasions, he was taken away by ambulance. On Monday morning, neighbors counted up to 30 police officers, three ambulances, several paramedics, and a fire engine at Furtado's house.
    Furtado is the eighth civilian killed by police in the Boston area in the past 20 months. On July 2, a mentally ill Dorchester woman was shot and killed by Boston police officers after she lunged at them with the knife she had just used to slit the throats of her two children, police said. On Sunday night, police subdued a mentally ill Dorchester man, who was trying to flood his apartment, by shooting him with beanbags. Four officers had to be treated at the hospital following the incident, and the man was also hospitalized. Seth Horwitz, spokesman for the district attorney's office, said the Furtado case is still under investigation to determine whether proper police action was taken. Cambridge police had no comment on the shooting. Furtado's family also had no comment.
    Jack McDevitt, associate dean at Northeastern University's College of Criminal Justice, said police officers are taught the ''use of force continuum,'' which recommends working with suspects starting with voice commands, then moving toward physical restraint, and ultimately the use of firearms if officers are in a life-threatening situation. The problem with the continuum, McDevitt said, is that not all police incidents progress the same way. ''If someone is coming at you with a knife, you don't have time to talk them out of it,'' he said. ''Police are taught to do everything they can not to have to shoot, but once they decide, they don't shoot to wound. They have to aim for the place most likely to stop the person from advancing.''
    McDevitt said the average police officer in Boston will never fire a gun in the line of duty in his or her entire career. ''Obviously, in the rare chance it happens, an officer will be nervous,'' he said. ''All you can do is hope that the training you've had kicks in and helps you decide whether it is an appropriate situation in which to use force.''

Seattle Man's Competency Trial Begins
Tracy Johnson, Seattle Post-Intelligencer- 7/17/2002

Roy Webbe takes several medications, a blend of pills crushed into his food to stifle the voices and the things he sees that aren't really there. Everyone agrees the man is mentally ill. But now a jury must decide whether that means he can't be tried for aggravated murder, the state's most serious crime. King County prosecutors contend the 34-year-old transient is mentally competent to stand trial, a legal standard they say doesn't take much. It would simply mean he understands the charge against him and can help his lawyers with his defense. But Webbe's attorneys contend the man suffers not only from severe mental illness, but also brain damage -- the result of three childhood head injuries and a mother who drank 180-proof moonshine during pregnancy.
    An unusual trial to establish whether Webbe is competent began yesterday in King County Superior Court. Webbe is charged with the April 2000 slaying of Deborah Funk, 40, a mother of three who prosecutors say was sexually assaulted and stabbed to death in her Federal Way apartment. Prosecutors say Webbe, a convicted sex offender, broke into Funk's apartment and attacked her with a steak knife from the kitchen, then cooked himself a meal of bacon and eggs. He also is charged with attacking another woman in her nearby apartment one day earlier. He has pleaded not guilty. If jurors find Webbe competent, he could face trial within weeks. But if they find that he's not, prosecutors must dismiss the charges. The state would then begin efforts to have him committed as someone who is dangerously mentally ill, and prosecutors could refile the charges if Webbe was later found competent.
    The competency trial is nearly unheard of in King County, where attorneys usually try to convince a judge, not a jury, that defendants are not competent. Deputy prosecutor Kristin Richardson said she could recall just one other such trial, though in that case the defendant was trying to convince a jury of the opposite: that he was competent. He lost.
    Yesterday, deputy prosecutor Don Raz told jurors that Webbe is clearly competent -- and that two doctors at Western State Hospital, a state mental facility that has treated him for more than a year, agree. "He understands the nature of the charges against him," Raz said. "You don't have to be free of drugs and free of mental illness ... to be competent." Raz said the medications have brought Webbe's mental problems under control. The man -- wary of tampering -- still carefully examines his juice bottles for pinpricks, but recently was able to answer psychiatrists' questions about the charges and possible defenses, Raz said. He also told jurors Webbe began refusing to attend "competency classes" at the hospital because he was afraid the treatment would help him end up in prison.
    But Webbe's attorney, Mark Prothero, said Webbe had many reasons for not going to the classes, mainly that "he could not even function in a group setting." The man has been diagnosed with a severe form of bipolar disorder and paranoid schizophrenia. Prothero said doctors have tried different medications -- once trying to wean Webbe from one before realizing that was a mistake -- and have been "tinkering, wondering ... what combination is going to work to get this fellow competent?" The lawyer said Webbe's childhood helped shape some of his afflictions, including the time his mother abandoned him in a shack without food or heat until neighbors finally noticed. He was about 5.
    Webbe sat quietly during yesterday's hearing, drinking water from a paper cup. He occasionally stroked his frayed goatee or fidgeted. Funk's family has watched for more than two years while Webbe's mental heath has been debated. They are waiting for his trial on the murder charge, hoping it will end with Webbe being locked away for life. "We were given a permanent life sentence," said Funk's mother, Shirley Tuthill, beginning to cry. "It's been very difficult."

Maine Hospitals to Bar Psychiatric Patients From Smoking
Associated Press, 7/18/2002

PORTLAND, Maine -- Thanks to the repeal of a state law, Maine hospitals are moving to prohibit psychiatric patients from smoking. Maine Medical Center implemented a smoking ban in its psychiatric unit this month, a move that the hospital's interim chief of psychiatry said will help doctors take care of the patient's overall health. ''Our first concern is about health and about patients, and it's high time we made the statement that smoking is not OK in a health care environment,'' Dr. Girard Robinson said.
    But some advocates for people with mental illness oppose the change, saying nicotine and the act of puffing away can have a calming effect. That's a big reason, they say, why smoking rates are estimated to be as high as 90 percent among the mentally ill. Some patients will find it impossible to fight nicotine cravings as they struggle with their mental illness, advocates say. Hospitals are ''going to find people walking out against medical advice, or they'll find people not calling at all,'' said Janine Elkanich, program director of the Portland Coalition, a social club for people with mental illnesses.
    Before its repeal last year, a 1989 law that banned smoking in hospitals and made exceptions for psychiatric patients was crafted under the impression that tobacco would help the group during hospitalization. Medical experts can give no clear explanation for why smoking is so common among the mentally ill, except that it has mood-stabilizing properties and that tobacco is viewed as a form of self-medication.
    On the sixth floor of Maine Medical Center, in a tiny room on the psychiatric ward, a small knot of patients used to light up four times a day. While medical patients and employees had to leave hospital grounds for a smoke, the patients of P-6 were allowed two cigarettes each for every 15 minute break. Now, smokers on this 26-bed unit get no such breaks.
    Hospitals that have gone smoke-free also include St. Mary's Hospital in Lewiston and Southern Maine Medical Center in Biddeford. Spring Harbor Hospital in South Portland plans to be smoke-free by the end of the year. And the two state-run mental health hospitals, Augusta Mental Health Institute and Bangor Mental Health Institute, are examining the possibility of having similar policies.

Outreach Worker to Help Victims of Priest Abuse in Maine
Associated Press, 7/18/2002

PORTLAND, Maine -- The Roman Catholic Diocese of Portland has hired an outreach professional to fill a newly created position helping victims of sexual abuse by priests. The woman, whose name is expected to be released next week, also will work with parishes that have lost a priest, Sue Bernard, a spokeswoman for the diocese, said Wednesday.
    ''We will be reaching out to parishes who are in any kind of crisis,'' she said. The outreach worker will help parishes where priests have died as well as parishes where priests have been removed because of allegations of inappropriate conduct. ''Anybody who loses their priest goes through a lot of adjustment and mourning, so to speak, so this person will be reaching out to parishes who are in any kind of crisis,'' Bernard said.
    The worker also will coordinate any future meetings between survivors of sexual abuse and the bishop. Sister Rita-Mae Bissonnette, one of two chancellors of the diocese, helped coordinate one such ''listening session'' June 20 in Augusta. Cynthia Desrosiers, who recently stepped down as coordinator of the state's Survivors Network of those Abused by Priests, said Wednesday that the church has agreed to a second meeting. That meeting will be held Aug. 15 in southern Maine, and will include Bissonnette, Bishop Joseph Gerry and Auxiliary Bishop Michael Cote. ''It's just like the last time,'' Bernard said. ''It's a pastoral meeting so that these people, victim-survivors, can explain to the bishops how they feel, what they went through.''
    Michael Sweatt, the Maine spokesman for Voice of the Faithful, a Catholic organization promoting reform from within, said the second meeting should be helpful. Sweatt also said he knew that the church had planned to hire an outreach worker, but did not realize one had been chosen. Sweatt said a charter drafted by the nation's bishops in Dallas said that dioceses across the country should provide outreach to survivors and parishes. ''So it's certainly in the direction and in the spirit of the charter,'' he said. ''That's a positive sign for me. I would just question that we make sure that we have the right person with the right qualifications not just another person hand-picked by the diocese. Hopefully there was some insight and guidance by lay people.''

Anti-Anxiety Drug Ruled a Factor in Air Crash
Mike Chambers, Associated Press- 7/18/2002

JUNEAU, Alaska -- The pilot of a sightseeing plane that crashed near Haines last year, killing all aboard, was taking an anti-anxiety drug that should have disqualified him from flying, a report by the National Transportation Safety Board said. Pilot Chad Beer, 26, of Juneau had been prescribed the drug Paroxetine by a doctor three months before the July 2001 crash that also killed five passengers, the NTSB said in a report released Monday. Beer was prescribed the drug, which is marketed under the name Paxil, to combat anxiety over flying in bad weather and giving presentations to tourists during flights.
    The drug is not approved by the Federal Aviation Administration. Beer and his doctor did not divulge his use of the medication to his employer, L.A.B. Flying Service of Haines, said NTSB crash investigator Clint Johnson. Medical records show the physician informed Beer he should not fly if the drug impaired him at all. The physician, who was not identified in the report, also allegedly told Beer that he would make the information available to his employer if asked. A final report listing the cause of the crash is to be released.
    Beer was flying a Cherokee Six plane on a 90-minute sightseeing tour of Glacier Bay National Park when he hit a mountain at about 5,500 feet in bad weather. Beer was flying with another L.A.B plane at the time of the crash. The pilot of the second plane, who was not identified, said he advised Beer against flying through a pass near Davidson Glacier due to low clouds, rain and fog. Beer's last radio transmission said that he was confident the weather would improve on the other side of the pass. The pilot of the second aircraft took an alternate route and returned to Skagway.

Rehab Director Suspended Over Sex Abuse Allegation
Denise Lavoie, Associated Press- 7/18/2002

BOSTON -- The director of a rehabilitation center for priests accused of molesting children has himself been suspended over sexual abuse allegations dating to the 1970s. The Rev. Robert Beale was placed on administrative leave Wednesday by the Archdiocese of Boston after church officials reviewed an allegation that Beale molested a minor while a parish priest. Donna Morrissey, a spokeswoman for the archdiocese, would not release details but said church officials found the allegation credible. She said the rehabilitation center, Our Lady's Hall, currently has no patients. Beale did not return calls for comment Thursday. ''If this father is someone who was a child molester himself, then you have to wonder how much supervision he was giving his colleagues at the time,'' said Philip Saviano, the New England director of the Survivors Network of Those Abused by Priests.
    Our Lady's Hall, a stately brick mansion in the well-to-do Boston suburb of Milton, made headlines in March when the Rev. Ronald Paquin was accused in a lawsuit of repeatedly molesting a teen-age boy there in the 1990s. Paquin had been sent to the center by the archdiocese for allegedly molesting children. The alleged victim, who was 14 and 15 at the time, told The Boston Globe he visited Paquin's bedroom at the center several dozen times and spent the night there at least twice. He said the other priests never questioned his presence. Paquin is now awaiting trial on three unrelated counts of child rape.
    Another priest at Our Lady's Hall, the Rev. Edward T. Kelley, was reclassified earlier this year from counselor to client after the church received allegations that he, too, had molested children. Kelley has since left the center. Milton Police Chief Kevin Mearn said people living near the home had though it was a retreat for alcoholic priests and were upset to learn in 1997 that it housed priests accused of sexually abusing children. ''We were notified by a resident who had young children and lived in very close proximity to Our Lady's Hall,'' Mearn said. ''I think a lot of people thought it was a retirement home for priests.'' Mearn said Thursday that he met with church officials, who told him they would stop sending accused sexual offenders to stay there.
    Beale had worked at Our Lady's Hall for two decades. Beale is the 18th priest in the archdiocese suspended since January, when the clergy sexual abuse scandal that has engulfed the nation's Roman Catholic Church erupted in Boston. Since then, at least 250 priests nationwide have either been dismissed or resigned.