The Killings Begin
On Jan. 15, 1974, B.T.K. struck Wichita for the first time, although most residents would not learn those initials, or even that a serial killer was on the loose, for several years. The scene was ghastly, unlike anything this city had seen before. Four members of the Otero family -- Joseph, 38, a retired Air Force officer; Julie, 34, who had worked at the Coleman Company about a month before; and two of their children, Josephine, 11, and Joseph II, 9 -- were strangled inside their home in the middle of the day with the cord used in Venetian blinds. Left behind was a uniquely grisly scene, and one whose details would be echoed in the future killings. The phone line had been cut. The Oteros had been bound, and the police noted that the knots were particularly elaborate. The killer had taken at least one souvenir of the day: a watch.
     None of the Oteros had been sexually assaulted, though Josephine's body was found partly clothed, hanging from a sewer pipe in the basement. Not far from the girl, there in the basement, semen was found, as it would be in subsequent killings. Investigators quickly believed they were searching for a sexual deviant, someone who took pleasure in tying people up, watching them gasp for air and die slowly. Some of the victims' faces were left bloated, investigators said, suggesting that the killer would strangle them, let them breathe, then strangle them some more.
     The Otero case would be the first and last known time that B.T.K. would kill a man or a child: the rest of the victims were all women, seemingly picked at random, and in ages ranging from 21 to 62 years old. Nine months later, after the police announced a possible confession in the Otero case, the killer's first letter appeared. It took credit for the Otero deaths, mentioned details that the police said only the killer would have known, and expressed frustration that someone else might be trying to assume credit for the deaths. The letter was riddled with typographical and spelling errors."I can't stop it so the monster goes on, and hurt me as well as society," the letter said. He noted that he would be "waiting in the dark, waiting, waiting," and closed the letter with a postscript: "The code words for me will be ... Bind them, toture them, kill them, B.T.K., you see he at it again. They will be on the next victim." But by then the killer had already struck again. Kathryn Bright, who also worked at Coleman, was stabbed to death inside her house in April. Her phone lines were snipped, and she was bound with a knotted cord.

In the Security Business
Soon after Mr. Rader started a job at ADT, the security company, at the end of 1974, he was widely disliked -- particularly by those beneath him after he became supervisor for the alarm installers. "He was deeply competent, organized, and good at what he did, but he was a taskmaster," said Rick Carr, 68, who sold systems for ADT. "He came in with the attitude: you're here to get the job done, and I'm not here to be someone's pal." In his gray ADT uniform shirt with "Dennis" above the pocket, Mr. Rader worked for 14 years in what others called "the dungeon," the section of the office with no windows, gray walls and a steel door. But his job also sent him out of the office during the day regularly, to sign off on installations.
      At company swimming pool parties at the Carrs' home in Wichita, Martha Carr, Mr. Carr's former wife, said Mr. Rader always arrived cheerily with his wife and children, looked people right in the eye and said all the right things: that the party was lovely, the food was nicely arranged. Paula Rader, meanwhile, was a fabulous cook and a quiet, sweet woman who seemed to have a loving, happy marriage, Ms. Carr said. "She seemed innocent," Ms. Carr said, "not worldly, you know?"
     One regular topic of discussion at ADT, not surprisingly, was B.T.K. "It was the conversation all over town, but this was a security company, and let's face it -- B.T.K. increased our business," said Denise Mattocks, 46, who worked alongside Mr. Rader for years. Ms. Mattocks, who was single at the time, was particularly fearful of B.T.K., she said, and told Mr. Rader so regularly. Like so many in Wichita as the panic grew, she spoke of checking her telephone for a dial tone every time she got home. Mr. Rader, she recalled, said little in response. If anything, his efforts at conversation leaned more to his life at home: his wife, the tomatoes in his garden, his Boy Scout outings.
     Mr. Rader became a Scout leader when his son, Brian, was about 8 and could join Pack 491. Mr. Rader held the boys to strict standards, not letting them slide by, as some fathers did, without perfecting skills for a badge, said George J. Martin, 70, who helped lead the pack. Mr. Rader was particularly capable, Mr. Martin said, when it came to the knots the boys had to learn. "The sheepshank, the bowline, the half hitch, the monkey fist," he remembered, "Dennis knew them all."

The Letters Stop
By the late 1970's, B.T.K. had killed seven people, the police say, and the eerie, taunting letters kept arriving. One letter was traced to a copier at Wichita State University. And in 1979, after B.T.K. apparently broke into a widow's home and waited -- without success -- for her to come home, he sent a poem to the woman who never arrived: "Oh, Anna, Why Didn't You Appear." In part, the poem read: "Alone again I trod in pass memory of mirrors, and ponder why fornumber eight was not." And then the letters suddenly stopped. The police say B.T.K. killed three more women in 1985, 1986 and 1991 -- including two cases, one from Park City and another from nearby, that were not linked to B.T.K. publicly until last weekend.
      Some people, like Al Thimmesch, a retired Wichita police officer, wonder whether more deaths have yet to be identified as the work of B.T.K. But if the police are right, the serial killings ended on Jan. 19, 1991, with the death of Dolores Davis, whose house is near Park City. In May 1991, Mr. Rader was hired as a Park City compliance officer, a period one resident of this suburb just north of Wichita calls the start of the "reign of terror" for homeowners here. Mr. Rader's critics here say he seemed to sit in his truck, just waiting for something to go wrong with their houses. He took numerous photos of their homes, they said, in search of something awry. Some people even insist that he sometimes let their dogs out himself, then cited the owners.Rhonda Reno said she watched one day as Mr. Rader wandered on the lawn of a neighbor who was ill and unable to mow the grass. Walking the grass with a yardstick, she said, he measured for infractions. "I never trusted him," said Jim Reno, her husband. "There were two people I keep an eye on in this block and one was him."
     Still, others here liked Mr. Rader, and found his outsized enthusiasm for his inspection work charming. He helped an elderly resident trap skunks, and helped his neighbor, a single woman, by mowing her lawn and fixing her leaky faucets, the neighbor said. And even he could bend the rules. Another woman, Virginia Jackson, 53, recalled when her boxer got loose and Mr. Rader chased down the dog and, after a struggle, managed to bring it home. Ms. Jackson never got a ticket. "He was very professional," she said. "He was doing his job."

Breaking His Silence
Last January, The Wichita Eagle published an article about B.T.K. to mark the 30th anniversary of the Otero killings and the start of the panic. By then, the case had been forgotten by many. The article suggested that B.T.K. might have moved away or even died. Two months later, B.T.K. wrote a letter, his first in a quarter century. From there, he embarked on a communication frenzy -- 10 letters or packages mailed to newspapers and media outlets, or simply left in parks. He filled these, too, with trinkets, some apparently from the killings: photographs, a word puzzle, a doll with a plastic bag over its head, a necklace, a computer disk and a victim's driver's license. By last weekend, with help from the disk and DNA evidence, the police took Mr. Rader into custody and announced with great fanfare that B.T.K. had been caught.
       Looking back, some people wonder if the Wichita police could have made an arrest sooner. Mr. LaMunyon, the former police chief, tells those who ask that he does not believe an arrest was possible over all those years; the B.T.K.'s newest mailings, many of which contained a mellower, more conciliatory tone than years before, created a whole new room full of evidence for investigators to go on. Still, he acknowledged that Mr. Rader's name was probably included on two long lists drawn up by the police years ago. The police had gathered the names of Coleman employees at one point because the first two women killed had worked there, as had, it turned out, Mr. Rader. They had also collected the names of white men at Wichita State in the 1970's because they knew that one of B.T.K.'s letters had been copied on campus and that a poem sent by B.T.K. resembled a song taught in a popular professor's folklore seminar at Wichita State. There was another link, too. Although the police had not publicly connected the death of Marine Hedge, the eighth victim, to B.T.K. until last weekend, at the time of her death, Ms. Hedge lived six houses down the street from Mr. Rader's home in Park City.
     "I think the police made a mistake over the years," said Robert Beattie, a Wichita lawyer who is writing a B.T.K. book. "They were looking for a Charles Manson type." Charles Liles, a former Wichita police officer, said the police focused too narrowly on convicted sex offenders rather than someone who might live right among them.
     The Rev. Michael G. Clark, Mr. Rader's pastor, visited him in jail on Wednesday, a glass wall between the pastor and his church council president. Mr. Rader is "doing as well as can be expected," Mr. Clark said. His own disbelief, though, has not worn off. The more he reflects, Mr. Clark said, the more he remembers only ordinary conversations with Mr. Rader, talks about fishing and his mother's health. "That's what I've realized," Mr. Clark said. "There is nothing to remember, nothing that would make it all make sense." Park City, meanwhile, quietly fired Mr. Rader last week, saying only that he had failed to show up for work or to call.



Defendant's Darker Side Emerging in Serial Killer Case
Lois Romano, Washington Post- 3/6/2005

WICHITA -- The signs that he was tightly wound were there for many to see. He signaled his powerful need for control again and again, but even the people who say he bullied them had no inkling that he could be the man police are now calling a serial killer. Dennis L. Rader, the government inspector charged with killing 10 people between 1974 and 1991, may have been a Boy Scout volunteer and active church leader. But he was also known as an arrogant and harassing neighbor who bullied single women on his street, and an unforgiving supervisor who made life miserable for at least one subordinate -- another single woman. "He nitpicked people to death. He was a total control freak," said Dee Stuart, a mayoral candidate in nearby Park City, where Rader lived.
      Stuart said a friend of hers, whom she declined to identify, worked with Rader, a Park City compliance officer, and "filed grievance after grievance" against him. "She suffered through a constant barrage of belittling attacks from him," Stuart said. "No one was as smart as Dennis Rader." Accounts such as Stuart's stand in sharp contrast to the descriptions of Rader that emerged soon after he was arrested on Feb. 25. Rader has been depicted as a selfless, churchgoing family man, so well-liked that those who knew him were flabbergasted by the news that he is an accused serial killer. Rader, however, exhibited some classic antisocial traits -- superiority, narcissism and anger -- and was seen by some as a man imprisoned in a life he believed was beneath him, associating with people he believed were not up to his intellect.
     His job was to enforce city codes -- animal laws, trash regulations, property maintenance -- and Rader took it too far, some said. "He was mean-spirited and a coward," said James Reno, a neighbor who did battle with Rader for years over his treatment of neighbors. Reno said he called City Hall to complain about Rader several times and was always told "we'll look into it." "He never messed with me," Reno said. "He always picked on the single women on the street who he could bully."

Few Close Friends
Over the past 25 years, Rader raised two children, held steady jobs, volunteered in his son's Boy Scout troop, earned a college degree in criminal justice and became the president of his church's governing council. But no one here could name close personal friends -- people he might have socialized with outside work. And none has surfaced to defend him.
      Rader's pastor, Michael Clark of Christ Lutheran Church, said in an interview that he views the man he visited in prison last week as his parishioner -- not a killer. "Let me make it very clear that I'm not challenging law enforcement. It's very possible[it is he. If that's a fact, we'll accept it and move on," Clark said. "All I am saying is I don't know the man they call BTK. I know Dennis Rader. . . . I could ask him to do anything at this church. He would light the candles, work the sound system, usher." Paul Carlstedt, who worshiped with Rader for 30 years, said the arrest is "beyond comprehension for me. None of us will ever be the same again. I've thought back and asked myself, 'Is there something he did, some word, some deed that could shed light?' I can't find one thing. ". . . We prayed here for the capture of BTK. We didn't know he was among us."
     Carlstedt said that he always viewed Rader as someone who could be counted on. "Here's the kind of guy he is: Last week, he couldn't make the Wednesday service because his mother was ill, so he and his wife Paula brought by the salad and the spaghetti sauce because he said he would." Bob Smyser, who has known Rader for 35 years through the church, said that "every time I came up to the church to do stuff -- wash windows, fall cleaning, Dennis was there. I mean, how do you judge relations in your life after this? How do you deal with everybody?"
     Neither Carlstedt nor Smyser socialized with Rader outside church. Both knew little about his personal life. Rader's brother, Jeff, did not return a reporter's telephone call seeking comment. At Rader's home, the shades were drawn, and no one answered a knock on the door. Police investigators and psychologists had long concluded that the killer thrived on attention and the knowledge that he continued to elude law enforcement. If Rader is BTK, he became so cocky that he once killed a woman who lived on his street and on another occasion called 911 to report a slaying he had committed.

Killer Seeks Attention
He first communicated through the media after the Otero killings; his writings contained poor grammar and spelling. "Its hard to control myself," he wrote. "You probably call me 'psychotic with sexual perversion hang-up.' When this monster enter my brain I will never know. . . . I can't stop it so the monster goes on."
      BTK struck another time in 1977, and in 1985, 1986 and 1991. In one of his last communications, he sent a note to the Wichita Eagle-Beacon newspaper in early 1978; that note was not publicized. Soon the angry killer sent this screed to a television station: "How many people do I have to kill before I get my name in the paper or some national attention? How about some name for me, its time: 7 down and many more to go. I like the following . . . The B.T.K. STRANGLER, THE WICHITA HANGMAN . . . THE GAROTE PHANTOM, THE ASPHYXIATOR."
     For his last surreptitious communication, in February, BTK tried something new: He sent a Wichita television station a necklace, the cover of "Rules of Prey" -- a 1989 novel about a serial killer named "maddog" -- and a purple computer disk. The disk was immediately traced to Christ Lutheran Church. If Rader is ultimately convicted of the BTK slayings, then he may have been undone by the very sanctuary that gave him decades of cover: his church. Clark said it was apparently clear to investigators that the disk had been used in the church's computer. Clark recalled recently showing Rader how to print an agenda for the church council meeting. Rader's was among the names of people with access to the computer that Clark provided to police.
     Little has emerged about Rader's wife, Paula, and his children. Paula Rader was a founding member of the church and sings in the choir. Rader's daughter, Kerri, is married and earned a degree in education from Kansas State University. His son, Brian, is in the Navy undergoing submarine training. Neither went to Wichita last week to see Rader, and Paula Rader has left town, Clark said. Police have denied reports that Rader's daughter, who lives in Michigan, turned him in. But she reportedly gave her blood for a DNA test after Rader was arrested, and it matched DNA that was found at some of the crime scenes.
     On the modest street of A-frame homes where the family lived, some neighbors said they despised Rader. He would harangue them for tall grass, loose dogs, branches piled in a driveway and once because a woman mistakenly brought her trash cans out front on the wrong day. Two neighbors said that he was particularly hard on a woman dying of cancer, an arthritis sufferer. He repeatedly wrote her warnings and costly citations for not keeping her lawn properly cut. "He knew my mother couldn't get around, and he would come down the street and measure her grass, and if it was a little bit over he'd write her a warning or a citation," said Joshua Thomas, who moved into the house after his mother died.

Neighbors' Perspective
"What little power he had, he abused. He was a very petty man," Reno, another neighbor, said. "It's kind of curious that dogs that were in back yards suddenly came loose when he was around, and then there he was to write the ticket." Margaret Farmer said her daughter's garage burned down a few years ago, and within a day Rader was demanding she pay to have the debris hauled off. "I don't know anyone on the street that didn't despise him," she said. "He acted like his word was the only law. Everyone else was supposed to do exactly as he said and when he said."
      Stuart, the Park City mayoral candidate, said last week that her friend who had the run-ins with Rader was on the verge of quitting when Rader was arrested. Citing the ongoing investigation, Park City Mayor Emil Berquist declined in an interview to name the woman or discuss complaints that may have been filed against Rader. Meanwhile, Rader, who turns 60 this week, sits in a county jail in lieu of $10 million bond. On Saturday, the Wichita Eagle reported that Rader had confessed to the killings. On Wednesday, the City Council voted to fire him for not showing up to work.
     Raeder received a visit from his pastor, Michael Clark of Christ Lutheran Church, after leaving a voice mail for Clark. Clark reported that Rader seems to be "holding up pretty well" considering the circumstances. "I told Dennis that I will not abandon him," Clark said. "I told him that I will stand by his side as long as he wants me to. And people just don't want to hear that right now. We are no different than Dennis in our journey in life. Regardless of who we are, we are all sinners and we will all be judged."



Texas Mental Health Program Helps Some, Denies Others
Associated Press, 3/7/2005

A 16-year battle with schizophrenia and major depression left Michael Newman afraid to go to parties or the movies, and voices often told him to hurt himself. But he's getting better now, and he credits his recovery to a new system for treating Texans with mental illnesses: Resiliency and Disease Management.
      The system categorizes clients and dictates the kind of treatment they receive at state-financed community mental health centers. It is meant to give the most severely mentally ill people meaningful care that allows them to become healthy and self-sufficient. "For the first time in over 16 years, I feel kind of sane, so to speak," said Newman, 32. "I feel like I can interact with people."
     But there is a cost. Thousands of people are being turned away from the centers because they don't meet the more stringent eligibility criteria. Since Sept. 1, about 17,000 of the approximately 130,000 people who were receiving care at the centers have been deemed ineligible for services. Statistics from some centers show large numbers of potential clients also are being turned away. Experts say many of those people are ending up in emergency rooms because they have nowhere else to go.
     "It has not been an easy road," said Rose Childs, deputy director for mental health services at the Mental Health and Mental Retardation Authority of Harris County, which rejects about 15 percent of its potential clients every month. "I think it's going to be a continual struggle to balance the money and services. "The issue is how to do it without hurting clients."
     A recent report by the Mental Health Association in Texas said mental illness costs the state up to $16.6 billion per year in workforce reduction and lost income. The group is urging lawmakers to restore $50 million in mental health funding cuts made in 2003 when the state faced a $10 billion budget shortfall. According to the report, Texas ranked 49th in the nation in spending for mental health services in 2002.
     Even before the 2003 cuts, community mental health centers said they had nowhere near enough money to help everyone seeking their services. As a result, the centers gave most people minimal services that often had little effect. "The old saying was that everybody got to lick the pill once," said Joe Vesowate, assistant commissioner of the state's Mental Health and Substance Abuse Services Division. With no additional money in sight, Resiliency and Disease management was born. The idea is to give fewer people more intense and focused services, Vesowate said.
     According to a recent Department of State Health Services report, people treated through the system improve. The number of adults who functioned better under the program increased almost 8 percent, the report said. The number of adults who had better results with the criminal justice system, including decreased recidivism, was up more than 9 percent. El Paso mental health officials say the number of their clients hospitalized each month has dropped from 100 to 60, and they say that's probably because they gave people the right services.
     But it's hard for people who've been dropped from the program to understand why they're being denied help. Larry Tierney, 55, has had to find new ways to handle his schizophrenia and depression since he was dropped from a Travis County treatment program in December. Tierney estimates that he's been to the Austin State Hospital 18 times, but he hasn't been back in three years — a feat he attributes to the treatment program. But the new rules say his lack of a recent crisis makes him ineligible for the intensive services. For now, Tierney is stable. He gets about two hours of help a month and tapes notes to the walls of his Austin efficiency apartment to help himself cope. "Ways to comfort myself — Journal, worry stone, reading, watercolor, talk to a friend ..." reads one note. Another, written in big block letters, bears a deceptively simple reminder. "Don't think negative thoughts. Love, Larry."
     On the Net:
Department of State Health Services, www.dshs.state.tx.us/
Mental Health Association in Texas, www.mhatexas.org/

GROTON, Conn. -- Researchers are racing to develop a potentially lucrative drug that would make smoking as treatable as erectile dysfunction, high cholesterol and acid reflux disease. Major pharmaceutical companies and small startups see the potential for billions of dollars in sales for a vaccine or a nicotine-free pill that could end addiction at the chemical level for America's 50 million smokers. ``It's the biggest addiction market there is,'' said Dr. Herbert D. Kleber, a psychiatry professor and addiction researcher at Columbia University. ``Is it realistic to be able to help addicts stop smoking and remain off with a pill? I think the answer is yes and we're working on a number of them.''
      While nicotine patches, gums, lozenges and sprays help wean smokers off cigarettes by slowly reducing their dependence on nicotine, researchers are tailoring drugs to mimic or block nicotine's chemical reactions with the body. In Connecticut, researchers at Pfizer Inc. identified a brain receptor that nicotine binds to and designed a drug, varenicline, that latches to the same site. Varenicline is in Phase III testing, normally the last step before a company applies for approval from the Food and Drug Administration. Researchers hope that the drug will attach to nicotine receptors in the brain, preventing overpowering cravings from setting in when someone stops smoking. If varenicline's claims hold up, the drug could generate more than $500 million a year in sales, said David Moskowitz, an analyst with Friedman, Billings, Ramsey & Co. ``It's an unmet medical need,'' said Dr. Karen Reeves, executive director of clinical development for Pfizer. ``The morbidity and mortality rate is so high, and doctors and smokers really have not had enough in their armamentarium to help smokers stop smoking.''
     The French pharmaceutical company Sanofi-Aventis said it will ask for FDA approval this year for the drug rimonabant, which it would market under the name Acomplia as a way to help stop smoking and overeating. Acomplia targets circuitry in the brain that encourages smokers to keep lighting up. If the body's chemical reward system is blocked, smoking might not be as pleasurable or as addictive. Researchers have high hopes for the drug, saying it might also treat alcohol and drug abuse. That combination could translate into billions in yearly sales, Moskowitz said.
     Then there's NicVax, a drug that Florida-based Nabi Pharmaceuticals claims could be used as a nicotine vaccine. NicVax triggers the production of antibodies that bind to nicotine molecules, preventing them from reacting with receptors in the brain. NicVax, which was developed primarily with grants from the National Institute on Drug Abuse, has shown promise in early trials and could begin Phase III testing late this year, the company said. A similar drug, called Ta-Nic, is in early testing by the Xenova Group in England. ``Everyone has been looking for the magic bullet,'' said Thomas Glynn, director of cancer science and trends for the American Cancer Society. Whether one will be found remains uncertain, he said. It's more likely, doctors agree, that scientists will develop a number of successful drugs that will prove effective, but no single pill will ``cure'' smoking.
     Doctors with high hopes have been let down before. In 1997, the FDA approved bupropion, commonly sold under the name Zyban, as an anti-smoking drug. The drug, which was originally marketed as an antidepressant, has proven successful for some smokers but was never the industry blockbuster some expected. Dr. Cheryl Oncken, associate professor of medicine at the University of Connecticut Health Center, said the new drugs being developed represent the next generation of medicine. Oncken will present a research study this weekend on varenicline, which in an earlier Pfizer study was shown to help nearly half of smokers quit within seven weeks -- compared to about 33 percent with bupropion. Investors are proceeding cautiously. Scott Henry, a Pfizer analyst at Oppenheimer & Co., said it's too early to tell whether there is a smoking wonder drug in development. He said varenicline has shown promise, but like all drugs being tested, there are many unanswered questions. ``Is it truly a revolutionary new treatment, or is just another bell and whistle?'' he said.

It has been a chicken-and-egg question for decades: Does the misery of poverty breed mental illness, or does the burden of mental illness cast people down into poverty? The two clearly tend to go together, but which causes which? This week, a Massachusetts researcher published possibly the broadest study yet on the question, examining tens of thousands of hospital records statewide to see whether patients who were hospitalized for mental illness then ''drifted down" to less affluent ZIP codes.
      The study, which followed patients from 1994 through 2000, turned up surprisingly little such downward drift, said the researcher, Christopher G. Hudson, a professor at Salem State College and expert in mental health policy. So, he said, ''the news here is that there is now increasingly strong evidence that socioeconomic status is indeed a very important dimension of mental illness, though obviously not the only dimension."
     The study also highlighted the striking contrast between the state's richer and poorer communities when it comes to the rate of mental illness. It documented a rate of about 4 percent of the population with mental illness serious enough to lead to repeat hospitalizations in the richest communities, compared to about 12 percent or 13 percent in the poorest -- and those are very conservative figures, Hudson said.
     Hudson acknowledged that the study, which focused on 34,000 patients who had been hospitalized at least twice, had some methodological issues. In particular, ZIP code is far from a foolproof way to determine a person's economic level. And he did not conduct diagnostic interviews with any patients. David Duncan, a mental-health epidemiologist based in Kentucky, noted another possible flaw: When downward economic drift occurs among the mentally ill, it is believed to happen mainly before they are ever hospitalized. So, a study following them only after a first hospitalization might come too late to catch their drift, he said.
     The study used powerful statistical tools to test five hypotheses about the link between mental illness and poverty, including the ''downward drift" idea. The theory that stressful economic conditions bring on mental illness was the only one that really fit the data, Hudson writes in the current issue of The American Journal of Orthopsychiatry, published by the American Psychological Association.
     That comes as no surprise to Deborah Belle, a psychology professor at Boston University who studies poverty-related stress. ''There are so many plausible causal links between poverty and mental illness, particularly depression, which I know best," she said. Among them: Poor people are likelier to face threatening, humiliating and entrapping life events, she said. Poverty can undermine their self-image and social connections, and leave them feeling deprived of control over the most basic aspects of their lives. Hudson said that his findings jibed with his own experience as a community organizer and social worker among the demoralized poor in Chicago and on two Indian reservations. Their circumstances, he said, were like ''straightjackets, especially suited to induce mental breakdown."
     Ever since a seminal study was conducted in 1930s Chicago, researchers have documented the tendency for poverty and mental illness to go hand in hand. But they continue to dispute which causes which, and the answer may vary depending on the mental illness. Schizophrenia, which is often highly debilitating, may be more likely than other diseases to cause downward drift, for example. Depression and anxiety disorders may be likelier than other diseases to be exacerbated by poverty. Hudson's study found that, for all types of mental illness, the data best fit the model of poverty as a cause rather than a result, but he did see some downward drift for schizophrenics, he said.
     Asked whether his study translated into policy advice, he said that it showed how important it was for states to allocate mental health funding to towns based not simply on population -- as happens in many places -- but on the level of illness. It also suggests the need for more mental-health outreach in poor communities, and for programs linking mental health services with help obtaining jobs, housing and education, he said.
     Hudson does not deny that biology and heredity play a role in mental illness; even the richest towns have a baseline level of mental illness that likely reflects that biological factor, he said. Other environmental factors like troubled families and life trauma are also linked to mental illness. ''We know that economic circumstances, the lack of supports, and the stresses that people are subject to sometimes overtax their cognitive and emotional and mental abilities." And broadly speaking, he said, his study suggests that ''poverty is at least as important as innate or biological factors."

NEW YORK -- The irony has not escaped Lorraine Bracco. For five seasons as psychiatrist Dr. Jennifer Melfi on HBO's ``The Sopranos,'' the actress has battled mob boss Tony Soprano's mental demons. But for a year and a half in real life, Bracco was fighting clinical depression with medication and therapy. ``If you break your leg, you have it fixed,'' Bracco, 50, recently told The Associated Press. ``If you have a toothache, you go to the dentist. When it comes to mental health, people tend to think they can just get over it.''
      Bracco's ready to talk about her fight with depression in hopes of knocking out stigmas about antidepressants and their effects. The mother of two went to drug manufacturer Pfizer in hopes of getting the word out, which she'll do with a series of commercials and a Web site -- www.depressionhelp.com -- that goes live on Tuesday. ``I don't blame anything or anyone,'' said Bracco. ``I think it was lack of education about medication. I thought if I need medication, I must be really sick.''
     Bracco acknowledges she wasn't feeling too keen after battling for custody of daughter Stella with ex-husband and actor Harvey Keitel, dealing with Stella's juvenile rheumatoid arthritis and declaring bankruptcy after splitting with actor Edward James Olmos. ``I just had a lot of really big things that kept pounding me and I would let all these things rule my life instead of my dreams and wishes,'' said Bracco. ``I was doing everything. I was being a good mommy. The laundry was done. They had food. They were driven to school and extracurricular activities, but I was joyless in it. It just became a chore for me.''
     Looking back, Bracco said she was dealing with depression for over a decade. It wasn't until 1997, after she'd been cast in ``The Sopranos,'' that she followed the suggestion of a friend to seek professional help. ``I was very afraid to go on any kind of medication because I was afraid it was going to dull me, which is not true,'' said Bracco. ``I think a lot of people think you'll become a zombie.'' But antidepressants didn't hinder Bracco's performance in ``Sopranos,'' and she eventually escaped the depression. ``I was on the medication for a year and a half and went into the doctor's office and said, `I don't really need this anymore,''' said Bracco. ``I haven't been taking it for five years, six years.''
     If the story ended here, it'd be a happy ending for Bracco. She bought a house in the Hamptons. Stella's in college. Bracco goes back to shooting the sixth season of ``Sopranos'' in April. And she's been dating 30-year-old former Syracuse University basketball player Jason Cipolla for almost three years. ``A good relationship doesn't hurt anybody,'' said Bracco. ``Let's be fair, younger or older. That's been very nice for me.''
     On the Net:
http://www.depressionhelp.com
http://www.pfizer.com

Mandated Insurance Coverage a 'Great Leap Forward' for Mental Health
Angela Galloway, Seattle Post-Intelligencer- 3/10/2005

Under new consumer protections signed into law yesterday, 1.6 million Washingtonians will be guaranteed coverage for psychiatric treatment. For many patients, the law means insurers will no longer be allowed to refuse to pay for office visits because the doctor is a psychiatrist instead of an internist, or charge more for prescriptions that treat depression than for medicines that treat heartburn. "This truly represents a great leap forward," said Gov. Christine Gregoire, who signed the bill into law. "When we fail to treat mental illnesses in the same way we treat illnesses of the body, it costs everybody." Patient advocates and hospitals have been fighting for the law for nearly a decade.
      In Washington, some insurance policies don't cover mental health treatment. Others provide coverage, but with weaker terms than for medical or surgical coverage. For example, some limit the length of hospital stays they will reimburse if the admission is for psychiatric treatment. Some businesses said they couldn't afford to give their workers health coverage unless they drew that distinction. But insurers will now be required to provide so-called mental health parity, according to the measure Gregoire signed. Although employers are not required to provide their workers with insurance benefits, many state programs and larger companies that do so will have to include mental health treatment.
     Sally Stultz of Spokane Valley said her 17-year-old son is diagnosed with brain damage and bipolar disorder. She said her family's insurer quickly cut off coverage after her son's condition took a dangerous turn more than a year ago. He was skipping school, running away and even shoplifting. "He was, frankly, headed toward life on the streets," she said. "He was careening out of control. I maxed out my mental health insurance on him in one month's (hospital) stay because I was just desperate to find something to help. "Had he had the kind of coverage he needed early on, he probably would have been in a whole lot better shape today," she said, adding that such coverage also would have saved taxpayers in educational and social services her son now receives.
     Some businesses have predicted this measure will force them to drop coverage for their employees. And over the years, supporters of the measure have made substantial concessions. Policies bought by individuals or through employers with 50 or fewer workers will be exempt from House Bill 1154, which will be phased in between 2006 and 2010. "That's a problem," Stultz said. "There are going to be a lot of people who lose out. And, of course, there's all the downstream effects (of inadequate mental health care)."
     Backers of the bill say untreated mental illness leads to reduced productivity for some workers -- and prison sentences for others. As part of his condition, Stultz's son suffers from memory problems that contribute to him making the same mistakes repeatedly, Stultz said. "Early on, if a lot of folks got what they needed, they might not end up critical and in the jails," she said. "It's inhumane, as far as I'm concerned. These folks, they don't need prison; they need help. "I feel like it's a measure of society -- how much a society is willing to take care of its own."
     Many large employers are exempt because they use so-called "self-insured plans," in which the employers cover the cost of care. More than one-fifth of Washington policies are such plans, which are not regulated by the state. The two sides of the debate disagree over how much it will cost. Backers of the measure claim it will boost insurance costs by a net of 0.44 percent after employers offset some of their expenses through rate increases and benefit reductions. Opponents say it will increase costs by 2 percent to 5 percent. And state budget officials estimate it will increase taxpayer-supported health costs by nearly $9 million a year when fully implemented. The Insurance Commissioner's Office estimates 1.6 million Washingtonians are covered by policies that will be subject to the new rule. "It won't solve everything," Stultz said, "but I know it would have made a difference for my son."
     Here are highlights of the new law regarding mental health coverage:

• The law will apply to some government employees, patients in the state's Basic Health Plan for the working poor and about 1.6 million Washingtonians who work for companies with 50 or more employees, with the exception of companies that are self-insured. Policies sold to small businesses and individuals are exempted.

• Beginning in January 2006, policies that cover medical and surgical services must cover mental health services and prescriptions as well. Co-payments and premiums for mental health may not be higher than for other services.

• Beginning in July 2010, policies cannot impose different limits for mental health services, such as caps on the number of office visits.