Ex-Priest Convicted in Rape of Boy in Boston
Pam Belluck, New York Times- 2/8/2005

CAMBRIDGE, Mass.-- Paul R. Shanley, a defrocked priest who became a lightning rod for the sexual abuse scandal in the Roman Catholic Church, was convicted on Monday of raping and assaulting a boy when he was a parish priest in suburban Boston in the 1980's. Mr. Shanley, 74, was one of the few priests to face criminal charges in the scandal, and his conviction came in a case in which prosecutors relied almost solely on one accuser, who said he had repressed the memory of the abuse until reading a newspaper article about Mr. Shanley three years ago.
      After deliberating for nearly 15 hours beginning last Thursday, the jury of seven men and five women pronounced Mr. Shanley guilty of two counts of rape and two counts of indecent assault on a child. Judge Stephen A. Neel of Middlesex Superior Court revoked Mr. Shanley's bail and scheduled him to be sentenced on Feb. 15. He could face up to life in prison.
      "It was very difficult," said one juror, Victoria Blier, 53, of Lexington. "There was no DNA, there was no direct corroboration, and that made it very difficult." Ms. Blier, who owns a window treatment business, said the jury was persuaded by the prosecutor's argument that the accuser was credible because he had no selfish reason to pursue the criminal case since he had already received $500,000 in the settlement of a civil lawsuit against the church. "I think the one central idea that seemed to be the most compelling to the most people was that the victim had nothing to gain by pursuing the criminal trial and everything to lose, because it was extremely painful," Ms. Blier said. "We tried to, but no one could come up with a convincing reason for why he would pursue this except for a sincere need for justice. He could walk, he could say, 'Listen, this is going to be too hard on my family,' and, 'Sorry, but I'm not going to pursue this' and no one would fault him."
      As the verdict was read, Mr. Shanley stood straight and betrayed little emotion. His accuser, who spoke publicly about his accusations over the last three years but asked news organizations not to name him during the trial, stood in the first row, rocking back and forth with tears in his eyes and a smile on his face. Now a 27-year-old firefighter, the accuser testified that Mr. Shanley would pull him out of Christian doctrine class beginning when he was 6 years old, and would orally and digitally rape him in the bathroom, the pews, the confessional and the rectory of St. Jean's Parish in Newton.
      Mr. Shanley's lawyer, Frank Mondano, had argued that what Mr. Shanley was accused of was logistically impossible given the layout and crowded nature of the church on Sunday mornings. Mr. Mondano also argued that the accuser had concocted the charges in order to prevail in his civil suit against the church.
      The jury asked only one question of the judge during deliberations, requesting to see a journal that the accuser kept after he says he recovered his memories of abuse. The judge denied the request because although parts of the journal had been read at trial, the journal itself had not been entered into evidence. Mr. Mondano said he would appeal and asserted that the prosecution's case was strikingly weak.
      The prosecutors said Monday that they recognized what a difficult case they had to prove. The case had started with allegations from four accusers, at least three of whom were friends and classmates at St. Jean's. But before the trial started, charges relating to three of the accusers were dropped. Midway through the trial, Judge Neel threw out a fifth charge against Mr. Shanley, involving allegations that he forced the accuser to perform oral sex on him. Then, in instructions to the jury, Judge Neel said there had been no direct evidence to support one of the accuser's central claims, that he had repeatedly been taken out of class. "This was a tough case," Martha Coakley, the Middlesex district attorney, said after the verdict. "We know that there were several roadblocks in this case. They were many and they were obvious." But "we knew that this was the perfect storm of the child abuse situation," Ms. Coakley said. "That was because we had a priest with a sexual predilection for young boys," she said. "He was clearly an authority figure and one who was well-loved. We had a priest who told his victims if he told what happened he would not be believed."
      Ms. Coakley suggested that the main reason the three other accusers dropped out of the criminal prosecution was the information unearthed about them in the civil lawsuit in which all four of them received settlements last year. Indeed, in his questioning, Mr. Mondano brought out the accuser's volatile home life as a child and his subsequent problems with alcohol, steroids and gambling, which he said clouded the accuser's credibility.
      Mr. Mondano also suggested several motives for the accuser's pursuit of the criminal case. Beside shaping his accusations to match those of his friends, Mr. Mondano said, journal writings and one psychological session suggested the accuser might be an attention-seeker, someone who wants "to be a hero," perhaps particularly to law enforcement. Mr. Mondano noted that many of the accuser's friends and family members work in law enforcement, including his wife and a friend, who work for the agency investigating his case, the Newton Police Department.
       Mr. Shanley had become something of a symbol of the clergy scandal, in part because he had a colorful and controversial history as a long-haired priest in the 1970's who ministered to troubled youths and spoke out in support of homosexuality. Church documents showed that archdiocesan officials allowed him to remain a priest even though they knew that he had said he supported sex between men and boys. About two dozen people have accused Mr. Shanley of abuse, with allegations dating to the 1960's. Most of the allegations involved teenagers, not allegations of pedophilia.
      Also in the courtroom was John Harris, 47, who said that he was raped by Mr. Shanley 26 years ago when he was sent to him for counseling because he had discovered he was gay. "Finally it seems like somebody has heard us and it turned out to be a jury," said Mr. Harris, who received a settlement from the Boston Archdiocese in a civil suit.
      One of Mr. Shanley's defenders, Paul Shannon, a longtime friend, said he felt "complete devastation" over the verdict. He called the accusations a "preposterous story" that he said was "mathematically impossible for Shanley to have done." Many of the other priests accused of abuse have not faced criminal charges because the allegations against them occurred too long ago.
      Ann Hagan Webb, an advocate for abuse victims, said she hoped the Shanley verdict would put pressure on legislators to change the law so other priests could be forced to stand trial. "We need to make sure history doesn't repeat itself," Ms. Webb said.

Study Suggests You Can Die of a Broken Heart
Rob Stein, Washington Post- 2/9/2005

As Valentine's Day approaches, scientists have confirmed the lament of countless love sonnets and romance novels: People really can die of a broken heart, and the researchers now think they know why. A traumatic breakup, the death of a loved one or even the shock of a surprise party can unleash a flood of stress hormones that can stun the heart, causing sudden, life-threatening heart spasms in otherwise healthy people, researchers reported yesterday. The phenomenon can trigger what seems like a classic heart attack and can put victims at risk for potentially severe complications and even death, the researchers found. By giving proper medical care, however, doctors can mend the physical aspect of a "broken heart" and avoid long-term damage. "When you think about people who have died of a 'broken heart,' there are probably several ways that can happen," said Ilan S. Wittstein of the Johns Hopkins School of Medicine in Baltimore, whose findings appear in today's New England Journal of Medicine. "A broken heart can kill you, and this may be one way."
      No one knows how often it happens, but the researchers suspect it is more frequent than most doctors realize -- primarily among older women -- and is usually mistaken for a traditional heart attack. That is what happened to Sylvia Creamer, 73, of Walkersville, Md., who experienced sudden, intense chest pain after giving an emotional talk about her son's battle with mental illness. "I started having this heavy sensation just pushing down on my chest," said Creamer, who was taken to a hospital where doctors began treating her for what they thought was a heart attack. But Creamer's arteries were fine, and Wittstein and his colleagues subsequently determined that she had instead experienced an unusual heart malfunction. She quickly recovered.
      The idea that someone can die from a broken heart has long been the subject of folklore, soap operas and literature. Researchers have known that stress can trigger heart attacks in people prone to them, and a syndrome resembling a heart attack in otherwise healthy people after acute emotional stress has been reported in Japan. But very little was known about the phenomenon in this country, and no one had any idea how it happened.
      The new insight is perhaps the most striking example of the link between mind and body, several experts said. "This is another in a long line of accumulating, well-documented effects of stress on the body," said Herbert Benson, a mind-body researcher at Harvard Medical School. "Stress must be viewed as a disease-causing entity."
     The findings also underscore the growing realization that there are fundamental physiological differences between men and women, including how they respond to stress. "This is why we need to do more research involving women," said cardiologist Deborah Barbour, speaking on behalf of the American Heart Association. "We can't extrapolate a man's response to a woman." It remains unclear why women would be more vulnerable, but it may have something to do with hormones or how their brains are wired to their hearts. "Women react differently to stress, particularly emotional stress. We see that in our daily lives," said Scott W. Sharkey of the Minneapolis Heart Institute, who described 22 similar cases last week in the journal Circulation.
      Accurately diagnosing the phenomenon, known technically as stress cardiomyopathy, should help improve treatment for patients who might otherwise receive drugs or other therapies that could do more harm than good, Sharkey and others said.
      Wittstein and his colleagues studied 19 patients who had what appeared to be traditional heart attacks between 1999 and 2003 after experiencing sudden emotional stress, including news of a death, shock from a surprise party, being present during an armed robbery and being involved in a car accident. All but one were women. Most were in their sixties and seventies, though one was just 27. None had a history of heart problems. When the researchers compared them with people who had classic heart attacks, they found that they had healthy, unclogged arteries but that levels of stress hormones in their blood, such as adrenaline, were two to three times as high as in the heart attack victims -- and seven to 34 times higher than normal. "Our hypothesis is that massive amounts of these stress hormones can go right to the heart and produce a stunning of the heart muscle that causes this temporary dysfunction resembling a heart attack," Wittstein said. "It doesn't kill the heart muscle like a typical heart attack, but it renders it helpless." Tests also found distinctive patterns in the electrical firing and contractions of the hearts of those who experienced the syndrome, which should enable doctors to diagnose the condition quickly, Wittstein said.
      While victims of classic heart attacks often experience long-lasting damage and take weeks or months to recover, these patients showed dramatic improvement within a few days and complete recovery with no lingering damage within two weeks. That was the case for Meg Bale, 70, of Bloomington, Minn., who had an attack after Sen. Paul D. Wellstone (D-Minn.) died in a plane crash in 2002. She began experiencing severe chest pain that shot down her arm after attending an emotional gathering at Wellstone's office, and she ended up being taken to an emergency room. "For me, it was just such a shock. I really thought he was something special -- he had real heart," Bale said. "I felt just awful."

Defense Rests in Teen Zoloft Murder Trial
Bruce Smith, Associated Press- 2/10/2005

CHARLESTON, S.C. -- Defense lawyers who say their teenage client killed his grandparents because his mind was clouded by the antidepressant Zoloft rested their case Thursday without calling the youth to testify. Prosecutors in the case of Christopher Pittman, 15, were expected to call reply witnesses later in the day, and the murder case was likely to go to the jury Friday.
      Pittman was 12 when he shot Joe Pittman, 66, and Joy Pittman, 62, to death with a pump-action shotgun as they slept in their rural Chester County home in November 2001. Prosecutors say was angry at his grandparents for disciplining him. For its final witness Thursday, the defense presented testimony from a psychiatrist and former Food and Drug Administration official that the antidepressant kept Pittman from knowing right from wrong.
      "The whole sequence of actions was rash and frantic and done at a high level of anger -- anger that was chemically induced," said Richard Kapit, who at the FDA once handled applications and safety reviews of antidepressants like Zoloft. Pittman suffered from a substance-induced mood disorder with psychotic features, Kapit testified. The defendant was "very rash, very excited and very angry," Kapit said, adding his actions were "very much a part of manic behavior." Pittman, who is being tried as an adult, faces 30 years to life in prison if convicted.
      A month before the slayings, Christopher was hospitalized in Florida, where his father lives, when he threatened to kill himself. The boy was prescribed the anti-depressant Paxil. Shortly after he moved in with his grandparents in early November 20001, another doctor put him on Zoloft. Prosecutors say Pittman killed the couple, then burned their house and drove about 20 miles in their car before getting bogged down on a road. He initially told police a black man killed his grandparents and kidnapped him. In a statement to police, Pittman said his grandparents deserved to die because they paddled him. Killing someone simply because they punished you, Kapit said, is just another sign Pittman was manic.

FDA Won't Ban Drug For ADHD
Associated Press, 2/11/2005

The Food and Drug Administration said yesterday that it does not plan to follow the lead of Canadian regulators who took a drug for attention-deficit hyperactivity disorder off the market because of reports that it has been linked to 20 sudden deaths and a dozen strokes, including some among children. The FDA said it has evaluated the reports on Adderall XR and does not believe the data warrant similar action in the United States.
      In a statement, Health Canada said it is asking makers of related drugs to provide a thorough review of their worldwide safety data. None of the deaths or strokes associated with Adderall XR were in Canada, department spokesman Ryan Baker said. Of the 20 cases of sudden death linked to the drug, 14 involved children. Two of the 12 reported strokes were in children.
      The drug is made by Shire Pharmaceuticals Group PLC, based in Basingstoke, England, and is sold in Canada and the United States. Shire's chief executive, Matthew Emmens, said in a statement late Wednesday that the company "remains confident in the safety and efficacy" of the drug. Emmens said the FDA reviewed the same data as Health Canada last year and sought an additional warning that the drug should not be prescribed for people with "structural cardiovascular abnormalities." About 700,000 people take Adderall XR in the United States, and 300,000 more use Adderall, Shire spokesman Matthew Cabrey said Wednesday.

Psychiatrist: Father of Armless Baby Didn't Do Enough
Associated Press, 2/11/2005

DALLAS -- The husband of a woman accused of killing her 10-month-old baby by cutting off her arms should have sought medical treatment for his mentally ill wife and done more to protect the infant and her older sisters, according to a psychologist's report obtained by The Dallas Morning News. Dena Schlosser, who turned 36 today, was charged with capital murder in November after she told a 911 operator that she had severed baby Margaret's arms. Police and paramedics found Schlosser in her living room, covered in blood and still holding a knife.
      John Schlosser showed a disturbing lack of emotion following his baby's death and his wife's arrest, psychologist Jana R. Long, who evaluated him to help determine whether his surviving daughters should live with him, said in the report obtained by the Morning News. Nevertheless, a judge ruled today that he can have sole custody of his surviving children. Judge Cynthia Wheless also issued a gag order in the case.
      John Schlosser regained custody of the girls last month under the condition that his sister live with the family. The arrangement was reviewed Friday and the sister, who lives in New York, will leave Feb. 17. She will stay in daily phone contact with the children. "This absence of grief is either an immature denial of normal human emotions that hover under the surface of his controlled veneer or indicates a true lack of emotion," Long wrote in her report, which a judge sealed last month. Long said John Schlosser told her he felt "a little melancholy" about the baby's death but finds comfort that she is "praising God" in heaven. He said he was "almost done being very sad when I buried her."
      Howard Shapiro, John Schlosser's attorney, disputed Long's analysis. "If you think that John Schlosser hasn't grieved, you'd be wrong," Shapiro said in a story in Thursday's online edition of the Morning News. "Maybe he hasn't cried openly on TV. Maybe he hasn't jumped up and down and ripped his clothes off, but he's grieved."
      Long also said the Schlossers inappropriately relied on prayer and conversations with their minister as Dena Schlosser's mental health declined. She said John Schlosser, 35, should have sought ongoing psychiatric treatment for his wife. According to the psychiatric report, the Schlossers prayed instead of following up with doctors after Dena Schlosser attempted suicide shortly after the baby's birth.
      Child Protective Services investigated Dena Schlosser for neglect because she left the baby alone a few days after her suicide attempt. She was found running down the street screaming, saying a spirit was in her apartment. John Schlosser also lacked emotion at that time, the report said, adding "he repeatedly told the caseworker that the situation was in God's hands and everything would work out." CPS closed that case in August.
      The day before the baby's death, the couple argued in the parking lot of their church because Dena Schlosser said she wanted to give their youngest daughter to God, according to the psychiatric report and CPS officials. The couple talked about a Bible passage in which a woman promises her baby to God. John Schlosser said the conversation was not unusual because his wife is "very religious but often misinterprets scriptures." The couple prayed about it and consulted their minister, who told Dena Schlosser she was misinterpreting the Bible, the report said. John Schlosser said he thought the problem was solved. Doyle Davidson, the couple's minister, said he never talked with them about Dena Schlosser's interpretation of the Bible.
      Long also noted that the couple's 6-year-old daughter told CPS caseworkers that her father spanked her mother with a wooden spoon for not listening to him when they argued in the parking lot. Long said John Schlosser could benefit from parenting education, though he scored within normal limits on a parenting test. But she expressed concern that his lack of understanding of mental illness and his wife's condition "will negatively impact his daughters."

Health Experts Worry on Czech Drinking
Associated Press, 2/12/2005

PRAGUE, Czech Republic -- Drinking is a national pastime in this beer-loving country, and health experts worry they have trouble on their hands: A growing number of underaged youths, some as young as 10, are hitting the bottle regularly. Igor is thirsty, but not for soda. He's after suds -- beer suds -- even though he's only 16, two years under the legal drinking age. ``I never had a problem to get a drink in Prague. I was never asked how old I am,'' said Igor, a student in a small northern Czech town who declined to give his last name. Getting served is easy, he said. ``We know where to go to get what we want.''
      Young people routinely are served alcohol in cafes, pubs and restaurants across Europe, but Czech officials are raising the alarm over the scope of the problem here, where children increasingly are requiring the kind of medical treatment sought by older alcoholics. ``We are swamped,'' said Dr. Darina Stancikova, a psychiatrist who a year ago opened the nation's first detox center for children, at Prague's Sisters of Mercy of St. Karel Boromejsky Hospital. Children ``start drinking earlier than ever before -- and they drink much more than ever,'' Stancikova said.
      Since the center opened last March, more than 160 adolescents have been hospitalized. The youngest of them, a 10-year-old boy, had drunk himself unconscious and had to be treated in the intensive-care unit. Dozens of others have received treatment on an outpatient basis. Those who check into the center typically undergo three weeks of individual and group therapy designed to teach them how to turn down a drink -- not easy for some people in the Czech Republic, which boasts the world's highest per-capita beer consumption, at nearly 42 gallons a year.
      That readiness to drink trickles down to children, said Dr. Marian Koranda, who helped Stancikova found the center. Parents ``don't explain to children how dangerous drinking is,'' he said, citing the example of a 15-year-old male patient who was drinking up to 15 beers a day on a regular basis. ``His mother told us she never noticed he was drunk,'' Koranda said.
      Although many bartenders don't hesitate to serve underage patrons, young Czechs say the few who do are easily foiled. ``I always go to pubs with older friends so I have somebody else to buy me a drink,'' said Anna de Abreu e Lima, a 16-year-old high school student in Prague.
      In a 2002 study of underage drinking in 35 countries, 21 percent of 13-year-old Czech boys interviewed said they drank beer at least once a week, putting this country at the top of list. Czech girls of the same age ranked third, behind Russia and Italy. A recently released study of students ages 15-16 found that 68 percent of young Czechs admitted being drunk at least once during the preceding year, above the 53 percent average for all 35 countries surveyed.
      ``The data are horrific,'' said Dr. Karel Nespor, who heads the addiction treatment department at Prague's Bohunice Hospital. ``It's crucial that the politicians do something about the problem of youth drinking,'' said Nespor, who fears unchecked underage drinking will lower the country's birth rate and undermine the quality of its work force. ``It's important for our future.''
      Czech lawmakers don't seem to be in any rush. Legislation to toughen fines for selling alcohol to minors and strip violators of liquor licenses has been debated for nearly three years in parliament, with a vote nowhere in sight. ``There's no political will to do something,'' said Ladislav Czemy, a psychologist who has studied the drinking phenomenon.
      There also are no plans to raise taxes on alcohol and make liquor more expensive, which many experts think would help reduce youthful drinking. Beer is cheap in the Czech Republic. A pint costs the equivalent of 45 to 55 cents in many pubs, and half that in supermarkets. The country is one of just 16 around the globe where nonalcoholic drinks are more expensive than beer, the World Health Organization says. ``We prefer preventive measures to raising taxes,'' said Marek Zeman, a spokesman for the Finance Ministry.
     Josef Janecek, a lawmaker and physician, recently pushed a ban on tobacco advertising through parliament but sees no hope of similar restrictions on booze. ``The alcohol producers' lobby is extremely powerful. It's a big business,'' he said. Meanwhile, therapists like Stancikova are fighting the problem one young drinker at a time -- in hopes of sparing them a lifetime of alcoholism. ``It's absolutely necessary to have a positive attitude to our clients and rejoice in every positive step they take,'' she said. ``At least we hope to divert them from the road to addiction.''

Therapists Question Canada's Action on Hyperactivity Drug
Benedict Carey, New York Times- 2/12/2005

Psychiatrists said yesterday that they were as confused as they were concerned by the news that Canadian regulators had suspended the use of a commonly prescribed hyperactivity drug amid reports of deaths linked to its use. "The news just threw a curveball into our efforts to advise doctors on how to treat attention deficit disorders in kids," said Dr. Oscar Bukstein, an associate professor of psychiatry at the University of Pittsburgh School of Medicine. "I think everyone in the field is going to be more fastidious in how they screen children for potential heart or other problems" before prescribing drugs, said Dr. Bukstein, who is helping the American Academy of Child and Adolescent Psychiatry write treatment guidelines for the attention disorder.
      Canadian health officials said on Wednesday that they were suspending the sale of Adderall XR indefinitely because the drug was linked to 20 deaths, 12 of those children. Adderall XR and its short-acting cousin, Adderall, are amphetamines, which are known to cause side effects like sleeping problems, appetite loss and irritability as well as slight increases in blood pressure and heart rate. The drugs are not recommended for some people with heart conditions. More than 700,000 Americans take some form of Adderall, which is made by Shire Pharmaceuticals Group of Britain. Experts said yesterday that they still did not have enough information about the 20 deaths to determine whether they resulted from the drug or from other causes.
      Amphetamines have proven safe over the last 50 years when prescribed to children in appropriate doses, doctors said, and studies of the drugs in children and adults alike have not found significant health risks in healthy people. The Canadian decision "is a reminder that these are powerful drugs and we need to be very vigilant in prescribing them," said Dr. Thomas Newton, a psychiatrist at the Neuropsychiatric Institute at the University of California, Los Angeles. "But we have absolutely no idea what happened in these deaths and no idea what to look for" -- and no reason to alarm patients.
      Psychiatrists estimate that 2 percent to 5 percent of school-age children, mostly boys, have attention or hyperactivity problems serious enough to interfere with their classroom and social lives. A variety of medications help these children calm down and focus, researchers say, by activating areas of the brain involved in concentration. They include amphetamines like Adderall and Dexedrine and stimulants like Ritalin and Concerta, a long-acting form of Ritalin. Strattera, another drug, acts something like an antidepressant. Of these drugs, the amphetamines are by far the most potent, and for some people, the most effective, experts said.
      Yet while a drug's potency is often directly related to its risk of side effects, studies have not found significant differences between amphetamines and the other drugs used to treat attention and hyperactivity problems, said Dr. Joseph Biederman, chief of pediatric psychopharmacology at Massachusetts General Hospital. Dr. Biederman estimates that 30 percent to 40 percent of his patients cannot manage their attention problems well without amphetamines; Ritalin and Strattera are not strong enough for them, he said. "This is not like high blood pressure, where we have many drugs to treat the condition," he said. "We only have three different kinds of drugs, and to lose one of them would cause an enormous amount of suffering."
      The use of medications to treat hyperactivity and the number of children taking them have increased sharply in the last decade or so in the United States. Prescriptions of the drugs more than doubled during the 1990's, experts said, and doctors now recommend that children take their medication daily, instead of only on school days, as they once advised. Depending on the dosages, longer-acting drugs like Adderall XR and Concerta may also expose children to more of the stimulants than they would get by taking two separate doses of shorter-acting pills, said Dr. William Pelham, director of the Center for Children and Families at the State University of New York at Buffalo. Dr. Pelham estimates that the increased use of long-acting formulations, combined with the advice to use them every day, has more than doubled the amount of medication that many children are exposed to, which should raise concerns about overtreatment.
      Some doctors said they expected the news of Canada's withdrawal of Adderall XR to change some parents' and patients' behavior, if not their own. "It may be that people are simply not going to want to deal with amphetamines as the first, front-line drugs; they'll want Ritalin instead," Dr. Bukstein of Pittsburgh said. "We do not have enough information to justify that decision, but it may not matter what we say."

Social Isolation, Guns and a 'Culture of Suicide'
Fox Butterfield, New York Times- 2/13/2005

STEVENSVILLE, Mont. - Patrick Spaulding, 17, was the star of his basketball team, an honor student and one of the most popular boys in his class at Stevensville High School here in western Montana. Bill Tipps, 83, was devoted to his wife of 62 years, Louise, who had developed diabetes and who he feared would need to have her leg amputated. Ron Malensek, 42, owned several small businesses, collected guns and called his wife "Princess." All three died of a single gunshot wound to the head in this valley below the snow-covered Bitterroot Mountains. All three pulled the trigger themselves.
      Death by gunfire is typically thought of as an urban plague, fueled by crime, poverty and drugs. But rural America also has such an affliction. "Americans in small towns and rural areas are just as likely to die from gunfire as Americans in major cities," said Charles Branas, an assistant professor of epidemiology at the University of Pennsylvania School of Medicine. "The difference is in who does the shooting."
      No matter the method, suicides occur at a higher rate in rural areas than in cities or suburbs, with the rate rising steadily the more rural the community. With homicides, the trend works in reverse, with higher rates in more urban areas. Researchers have long known the statistics, but new research illuminates the substantial role of firearms in suicide. When Professor Branas examined data from the federal Centers for Disease Control and Prevention, he found that the risk of dying by gunshot was the same in rural and urban areas from 1989 to 1999, findings that were published in The American Journal of Public Health. He has also concluded that in the most rural counties, the incidence of suicide with guns is greater than the incidence of murder with guns in major cities.
      Many of the cases in Stevensville and in other rural areas have common threads, professors and epidemiologists say. People who see themselves as rugged frontiersmen are often reluctant to reach out for help, particularly for mental health treatment. If they do, they may see a physician instead of a psychiatrist or another trained mental health expert.
      Suicide risk factors like depression, economic worries and alcohol use are, of course, prevalent in urban areas, said Dr. Alex Crosby, an epidemiologist in the National Center for Injury Prevention and Control at the Centers for Disease Control. But they are heightened in rural areas by social isolation, lack of mental health care and the easy availability of guns. "People say, 'How could people living in such beautiful places commit suicide?' " said Nels Sanddal, a psychologist in Bozeman, Mont., and president of the Critical Illness and Trauma Foundation, which works to prevent suicides. "We have a culture of suicide."

Surprise Over Statistics
As far back as 1890, soon after Montana became a state, statistics from the Census Bureau showed that it had the highest suicide rate in the nation, Mr. Sanddal said. "When you have seen other people exercise it as an option in a difficult situation, it becomes easier for you to exercise it as an option," he said. "So now suicide is condoned or tolerated in Montana, even if people don't talk about it."
      Stevensville is in Ravalli County, which has a suicide rate more than twice the national average. Since 1990, the county has had 103 suicides, more than three quarters of which involved a firearm. By comparison, there have been just 13 homicides in the county, whose population has swelled 44 percent in that time, to 36,000 people. The youngest to commit suicide in the county was 13 and the oldest was 92. Reflecting a national pattern, suicides rise sharply with age among men in the county.
      The editor of The Ravalli Republic, the local daily newspaper, said that it is against the paper's policy to report on suicides and that he was unaware of a sizable number of incidents in the county. When asked about the high suicide figures, Sheriff Chris Hoffman said, "This shocks me," even though he is also the coroner and signs all death certificates. Since the 1890's, Sheriff Hoffman's family has raised cattle in the Bitterroot area, which Lewis and Clark traversed in 1805 and described as the most difficult part of their journey. "People here are not aware of all the suicides," he said. "It's not something people here talk about." Professor Branas said he encountered similar surprise when he conducted field studies in rural counties in Iowa, Ohio and Pennsylvania.
      Most families of those who committed suicide around Stevensville in the last year declined to be interviewed. But relatives and friends of several people who died in previous years agreed, often reluctantly, to talk. Mary Lee Rush, whose son committed suicide at 29 and who lives in Grantsdale, an unincorporated town in Ravalli County, said: "People here are very rural. They do for themselves. They won't go for help." Suicide, she said, "is an acceptable way of dying if you feel desolate or you can't handle things anymore."

A Young Life Ended
Patrick Spaulding, a 6-foot-4-inch senior, was the leading scorer on his high school basketball team and had set a school record with 28 rebounds in a single game. "He lived for basketball," said his mother, Paulette Spaulding, who lives in the family house with her husband about five miles outside Stevensville. Patrick was consistently on the honor roll. On a Friday night in January 1997, Patrick went out and drank a few beers, his friends said, and on the way home apparently fell asleep at the wheel, entangling his pickup truck in barbed wire. A sheriff's deputy gave Patrick a citation for illegal possession of alcohol. "Under school rules, that would have meant he would be suspended from the team for the rest of the season," his mother said. "He was such a perfectionist, always harder on himself than on anyone else, he felt he had let his family and teammates down." He did not discuss the situation with his parents. The next morning, the day of a big game, alone in his bedroom, Patrick shot himself. "Teenagers don't live for tomorrow, they live for today," Mrs. Spaulding said.
      At Stevensville High School, the guidance counselor, Linda Mullan, was concerned about how other students would respond to Patrick's death and was worried about the possibility of copycats. Many students own guns and hunt, often starting in junior high school. "Guns and hunting are a rite of passage in Montana," Ms. Mullan said. Two seniors in the same class as Patrick were so distraught by his death that they turned down appointments to the Air Force Academy, preferring to concentrate on trying to heal the wounds of grief among their classmates and prevent any further tragedy, Ms. Mullan said.
      A few families of those who have taken their own lives have begun organizing themselves to better understand what happened. Pat Kendall, whose son, Josh, shot himself in the Blue Mountains in 2000, when he was 23, has opened a resource center with a lending library in a small house in Missoula, at the northern end of the valley. She has also helped get the Missoula County Health Department to start a suicide prevention program, the first of its kind in the area.
      What Mrs. Kendall has come to believe is that her son probably had bipolar disorder. When he finally went to a doctor, not long before he killed himself, the doctor, who was not a trained psychiatrist, prescribed the antidepressant Prozac. But Prozac can make mood swings worse for some people with bipolar disorder. Mrs. Kendall believes that in a region with few mental health resources, Josh's problem was mistaken for depression.

'A Mercy Killing'
Bill Tipps and his wife, Louise, moved to Stevensville from a suburb of Las Vegas to be close to their adult son, Dennis Tipps, who was the high school football coach and onetime police chief. Dennis Tipps found a site for a home for his parents nearby in an area of small farms and new houses. One of his sons, Dennis Jr., a contractor, built them a simple ranch-style home. But Bill Tipps grew depressed. "My dad hated the cold and the winter," Dennis Tipps said. He was also becoming increasingly concerned about the health of his wife, who was 80. She had undergone several heart surgeries, and the local doctor said her toes might have to be amputated because of diabetes.
      Dennis Tipps now surmises that when the doctor pointed with a sweeping gesture to Louise Tipps's foot, and then her knee and hip, Bill Tipps assumed the doctor was suggesting that his wife's leg would also have to be taken off. His father hated doctors and would not seek their advice, Dennis Tipps said. So his father never clarified his wife's prognosis or sought help for his apparent depression. His father "never displayed his emotions," Dennis Tipps said. "He kept everything inside, and he was very stubborn. He wouldn't change his mind."
      One morning in September 1999, at 8:05 a.m., Bill Tipps called his son at his home. "I just shot and killed your mother so they can't take her leg off," said the elder Mr. Tipps, who was 83. "Now I'm going to shoot myself." Dennis Tipps jumped in his truck, and as he approached his parents' house, he heard what he thought was his engine backfiring. It was his father shooting himself. "In my dad's mind, this was a mercy killing," Dennis Tipps said. "He would never leave her side. He thought he was doing the right thing, but he overreacted."

'He Just Quit'
Debbie Miller describes the gentle side of her husband, Ron Malensek. "He called me Princess and treated me like a princess," she said. But Mr. Malensek had been diagnosed with depression as a child, she said. In early 2000, he called all his friends, told them goodbye and then tried to commit suicide by overdosing on pills. He survived, and she urged him to see a doctor, who prescribed Prozac. In the summer of 2003, Mr. Malensek stopped taking the medication.
      Mr. Malensek had always worked seven days a week at various jobs: he had owned two bars, a gas station and a bingo parlor, and then had a business installing rain gutters. That summer, he started neglecting customers who called for estimates, Ms. Miller said. He became angry and could not sleep, and he had no energy, she said. It was as if "he just quit," said Ms. Miller, a speech therapist at Stevensville High School.
      On Aug. 5 last year, they went to a favorite bar, the Rustic Hut, in the town of Florence. It was the anniversary of his father's death. When Ms. Miller left to go home, her husband stayed at the bar. Then he walked out back, retrieved a handgun that he had stashed there earlier, and shot himself.
      After his death, Ms. Miller discovered that he had not shared other pressures with her. "It turned out there were a lot of financial issues I didn't know about," she said. Bill collectors bombarded her and repossessed his pickup truck. She had to sell his business. She also learned that he was a "gun freak," she said. "I'm still finding guns he had stashed all over the house." Ms. Miller does not know the statistics about rural suicides, but she knows enough. Her father and her first husband also killed themselves.

County Tax Would Help Keep Mentally Ill Out of Jail
Lisa Kilionsky, Ann Arbor News- 2/13/2005

Washtenaw County, through its jail millage request, is asking voters to make the largest mental-health spending decision in county history. The proposal's plan to improve services and treatment for mentally ill offenders would cost $84 million over 20 years -- more than 25 percent of the $314 million that would be generated by the levy.
      The proposal would provide more assessment, more treatment, more beds outside the jail and more support to help mentally ill inmates once they've left jail than the county has ever offered.
"It is unprecedented," said Donna Sabourin, executive director of the county's Community Support and Treatment Services, formerly known as Community Mental Health. Sabourin said her counterparts in other counties are "amazed and impressed. ... Washtenaw County is way ahead of the curve on this." The concept is known as mental health diversion -- keeping mentally ill people who are not violent offenders and whose crimes often result from untreated mental illness from being incarcerated.
      Many county groups serving mentally ill people, including the Washtenaw County chapter of the National Alliance for the Mentally Ill and the St. Joseph Mercy Health System, have endorsed the proposal, but critics of the millage ask whether the money would be put in the right places and what would happen after the levy ends in 20 years. "We should not be passing bond issues of this magnitude that are basically operating costs unless we have some plan of what we'll do when the bond issue is finished," said Rosemary Sarri, professor emeritus from the University of Michigan and an active researcher with U-M's Institute for Social Research. "I think the mistake that was made was to put all of this into one issue." Sarri said she favors the mental health aspects of the proposal, "but the solution isn't just to build jail beds. We need to think about how this will be paid for afterwards, since it's mostly operating costs."

Identifying the need
County mental health officials estimate that 25 percent of jail inmates have some sort of mental illness, primarily depression, bipolar disorder and schizophrenia. That percentage represents only those who are being seen by a psychiatrist or are on prescribed medication. "Certainly there are additional people in jail showing depression, anxiety. If it's being managed through counseling, those people aren't counted," Sabourin said. "There's a significant gap in our society as a whole and in our community in having a full range of mental health services available for all citizens. ... There is no identifiable funding stream to serve the population we have targeted."
      Screening for mental illness among jail inmates is limited to a brief interview by corrections officers, with more comprehensive assessments done only for those already on psychotropic medicine or those being treated through county services. Yet county psychologist Daniel Ing, who works with and assesses jail inmates, said he sees a need to assess everyone, something that would happen if the millage passes. "People are committing the petty crime side of things and they're suffering from illness," Ing said. "We have people who come here (to the jail) who need treatment but don't have it and go back into the community untreated, and then end up back here."
      Ing, who also has worked in county mental health outside the jail, said inmates are far more motivated to adhere to a treatment program than mentally ill clients who are struggling with basic food and shelter issues. "Having the stability the jail provides in relation to everyday needs, then people are able to look at issues they are dealing with," he said. And, he said, providing an entire assessment for everyone who becomes incarcerated would help the community as well as the inmates. "Taxpayers would benefit just as a whole with fewer individuals going around untreated," Ing said.
      Diane Davidson said she believes her 27-year-old son could have avoided going to prison if the provisions in the Feb. 22 millage request were in effect during the past decade. She said her son, John, who suffers from mental illness and substance abuse, underwent years of repeated arrests and jail time. When first arrested, he wasn't in the mental health system, so he didn't get a mental assessment and the pattern continued. "It was a vicious revolving door," Davidson said, adding that her son was imprisoned for three years after repeated stints in the Washtenaw County Jail and then a Charlevoix County facility before he was caught stealing a car. "I'm convinced that if we'd had mental health assessment capability in jail here, his earlier experiences in jail before he ended up north could have been avoided. We'd have had a more intensive treatment program for him," said Davidson, the executive director of the Washtenaw Housing Alliance, which has endorsed the jail proposal.
      Davidson, who has participated in the county's mental health diversion subcommittee, has for years spoken openly about her son's illness and convictions. She said the mental health initiatives under the millage would provide better care for mentally ill people. "Over the long haul, the recidivism rate would go down, and we'll do a better job across the board," she said.
      Gloria VanAlstine, a Scio Township mother of a son with mental illness and substance abuse problems, also sees hope in the proposal. She said the new, 96-bed jail pod that would house inmates with medical and special needs, as well as general population inmates, would have greatly helped her son. "When he ended up in jail due to stealing to get these drugs, what he really needed was drug rehabilitation," VanAlstine said. "One of the problems is that once someone like my son has been in jail, then it's not as easy to get into drug rehabilitation because he basically detoxed in jail."

Outlining the costs
While the three-quarter mill property tax levy would be in effect, cost projections show that the mental health part of the $314 million plan would steadily increase, due to inflation and rising numbers of people using the services. During most of those years, mental health diversion would cost at least half as much as the overall, additional jail operating expense. For example, in 2015, additional jail operating costs covered by the millage would be an estimated $9.4 million and mental health diversion would be $4.8 million. By 2024, additional operating costs would be $13.4 million and mental health diversion would be $7.2 million.
      The mental health money would be spent in several ways. For starters, there would be more training for law enforcement officers in recognizing and working with mentally ill people. The county also would provide better assessment of the mental status of an inmate; build three new six-bed crisis residential facilities, one of which would help those with both mental illness and substance abuse problems; and put in place long-term referral and treatment services tailored to those diverted from the jail.
      The price tag would be steep. The crisis residential services alone, for the 24 people who could be housed at one time, would cost $7,200 a day, or $2 million a year. Each client would use those services for very short-term periods, from eight to 30 days, Sabourin said. Yet the cost is half what it would be to hospitalize such mentally ill offenders, she said. The long-term treatment services in the plan would cost $10,507 a year for each client, for an estimated $1 million a year for nearly 100 clients. Yet that cost is less than half of what incarceration costs a year, Sabourin said. Staffing is another issue. Nearly 60 new employees would be needed, either through direct county hires or contracted services, to make the millage proposal work, Sabourin said.
      The critics of the costs include those who want the county to consider the front end first -- providing social and mental services that would prevent people, including those with mental illnesses, from going to jail in the first place. "We recognize the community needs jails but so much research shows that if you invest in kids early on there is less juvenile delinquency, less crime, less jail service to teenagers and young adults," said Susan Miller, a community member and co-chair of the Zero to Five Action Group, which focuses on early childhood issues. The group has made that recommendation to the county. "Wouldn't it be wonderful if the community would look at both ends," Miller said. "Yes, we need improvements in the jail ... but we'd like to talk about social and emotional health for kids."
      The movement to deinstitutionalize mentally ill people began in the late 1970s, Sabourin said, and accelerated in Michigan in the 1990s, during former Gov. John Engler's administration. "Over the years there had been a whole series of hospital closures. ... There had been promises made that the money would follow people into the community (through community mental health boards). But there was a strong sense (under Engler) that fewer funds were transferred during his administration than previously," Sabourin said. Over time, the percentage of mentally ill jail inmates rose. Sabourin said there is a direct correlation between the hospital closures and the larger mentally ill jail population today. "If the (state) money had followed people as we'd understood it would when we started this, and had been maintained instead of being decreased, putting more people at risk, we wouldn't see as high a number of mentally ill inmates," Sabourin said.
      The National Institute of Corrections estimates that the trend to deinstitutionalize reduced the number of mentally ill patients in state hospitals from nearly 600,000 nationwide in 1959 to about 70,000 in the late 1990s. And, by 1998, an estimated 283,000 mentally ill adults were in prison and jail nationwide; another 547,800 were on probation. Locally, no historical records exist of mental illness and inmates at the jail, sheriff's Cmdr. Dave Egeler said.
      But mental health advocates and correctional facility leaders have been working -- on a limited basis -- to keep those who are mentally ill, but not violent offenders, out of the jail. In 2001, a jail diversion agreement was worked out among the county's criminal justice, public safety and mental health systems. Sabourin said it came about after the state Department of Community Health issued a policy statement setting expectations for community mental health to negotiate such agreements in each county. However, there was no money attached to the policy.

The long-term results
What would county residents get for their investment? Local mental health community advocates say this proposal might be the best hope mentally ill people have had in years to counter the long-term effects of the hospital closings in the early 1990s. Both the National Alliance for the Mentally Ill of Washtenaw County and the Shelter Association of Washtenaw County have endorsed the proposal.
      Ellen Schulmeister, executive director of the Delonis Center, Ann Arbor's homeless shelter, sees the proposal for mental health diversion as another example of how the community has come together to help disadvantaged populations. "If people are appropriately assessed and given treatment, then maybe fewer would be here, down the road," she said, referring to the homeless shelter. "I see it as an appropriate tool that may help prevent homelessness and keep people out of jail. ... In the long run, it could save the community money."
      The local NAMI also supports the millage, particularly the mental health aspects. "It's good because it's not just about adding jail space. There's lots of programs that will benefit these people without them just being incarcerated," said Chuck Hughes, president of NAMI of Washtenaw County. "We feel a lot of people are being incarcerated who have mental illness problems. This way they can receive the treatment they need and should get," Hughes said. "It's too bad we don't have the resources to do it without a millage."

Tax Money Would Expand Education for Police
Amalie Nash, Ann Arbor News- 2/13/2005

Ann Arbor Officer Rob Schneider was sent to a city home last week to check on a woman with a mental illness who hadn't been taking her medication for two weeks. After determining she wasn't a danger to herself or others, Schneider gave her family members some options, such as petitioning to have her evaluated at a hospital. Later in the day, Schneider was sent to speak to a man who said he was in pain and was considering suicide. Schneider and other officers talked the man into voluntarily agreeing to a psychiatric evaluation at the University of Michigan Medical Center.
      Being on the front line in cases involving people with mental illnesses has become commonplace for police officers. They're called daily to situations where people are contemplating suicide, have become violent or simply need help. Until recently, Schneider said, he had little training on how to handle those situations. That changed when Schneider volunteered for a pilot program aimed at helping police learn more about mental illnesses and how to effectively prevent situations from becoming violent. "It was very valuable," Schneider said. "It teaches you that you definitely don't want to beat around the bush - you should tell the person why you're there, ask what medication they're on, and what it's for. If you can talk and develop a rapport, the contact is easier for us and them."
      The 40-hour crisis relief training began with Ann Arbor Police in 2000 and included a second session last year with officers from other agencies. The program has operated on a shoestring budget and grants from Pfizer and Eli Lilly. But the jail millage request on the Feb. 22 ballot includes $50,000 a year for the training. The goal is to train at least 50 officers a year. Once a large contingent of officers has been trained, the next goal is to offer in-depth training on specific topics, said Donna Sabourin, executive director of the county's Community Support and Treatment Services, formerly known as Community Mental Health.
      The training started in Ann Arbor in part because of an incident at Trailblazers, now known as Fresh Start, said Don Leach, a former deputy police chief and now pastoral associate at Our Lady of Good Counsel in Plymouth. In that incident, officers responding to a call at the facility, which had drop-in services for mentally ill people, agitated the situation more than they helped, Leach said. That led to discussions between Trailblazers staff members and police, and eventually expanded into the Crisis Relief Task Force.
      Leach has been involved in the training since his retirement and speaks openly about battling clinical depression while he worked at the police department. "There's a lot of stigma that people with mental illness are violent and prone to anger, but quite often it's the person right next to you," Leach said. "I think people have been surprised that I talk about it, but if you don't talk, people won't learn. "If officers don't approach the situation as if it's going to get violent, the vast majority will be resolved more effectively," he said.
      Several people -- including police officers, people with mental illnesses and officials at mental health agencies -- got together to help design the training, Ann Arbor Detective Lt. Khurum Sheikh said. The training covers the different types of mental illnesses, recognizing them, and the medications and resources available to people with mental illnesses, their families and police. Officers also learn to intervene before the situation turns dangerous, Sheikh said.
      Schneider said the most valuable aspect was learning about the available resources. He is a downtown beat officer who regularly interacts with homeless and mentally ill people. He said he often relies on Project Outreach, also known as PORT. The joint project of Washtenaw County and Ann Arbor provides mental health and supportive services for the county's homeless, mentally ill population.
      Ann Arbor has about 40 officers trained in crisis relief, and dispatchers try to send those officers to what they refer to as "emotionally disturbed person" calls. Sheikh said callers also can request that an officer with the training be sent. "The nature of the police business is that we deal with people in distress a high percentage of the time," Ann Arbor Police Chief Daniel Oates said. "We regularly come into contact with people who are mentally ill. Some of the most dramatic and tragic situations that occur between police and citizens involve the mentally ill. Every scrap of training that we can get is just really valuable."