Noteworthy News Articles on Mental Health Topics, April 1- , 2008 Among the findings:
A Grim Tradition, and a Long Struggle to End It Erik Eckholm, New York Times- 4/3/2008 ESPAÑOLA, N.M. — Eric Lucero has been addicted to heroin for three decades and says he has known at least 100 people in this pastoral county who died from overdoses, some in his presence. But Mr. Lucero has recently become a popular — and, he would argue, safer — injection buddy. Seven times, he says, he has revived companions by using an anti-overdose drug, Narcan, which the state now hands out to addicts and their relatives as part of its effort to reduce the toll of one of the country’s most pervasive epidemics of narcotics use. Mr. Lucero, 48, said, “People know I’m good at saving them.” Rio Arriba County, just north of Santa Fe, is a Georgia O’Keeffe landscape of juniper-dotted desert and mountain valleys populated mostly by Hispanics who proudly trace their lineage to settlers of the 1600s — and who, a decade ago, discovered that their county had the nation’s highest per capita rate of deaths from overdoses. Hundreds of families are struggling to live with a multigenerational plague of narcotics; Mr. Lucero’s own son is addicted. Federal data released in March showed that the county ranked first in drug fatalities for 2001 to 2005, with a death rate of 42.5 per 100,000, compared with a national average of 7.3. Heroin use in the county jumped in the 1970s, as world production soared and some Vietnam veterans returned as addicts. It zoomed in popularity in the 1980s and ’90s, abetted, surprisingly, by the tradition of close-knit extended families. “We start our addiction getting high with our uncles, then we turn on our own nephews,” said Manuel Anaya, who was an addict for 26 years and now runs a drug counseling program for Hoy, the county’s largest treatment group. Intensified law enforcement and a flurry of new treatment programs have failed to stem the use of narcotics here. So New Mexico has adopted the country’s most sweeping effort at “harm reduction,” a strategy to eradicate disease, suffering and death among addicts that includes exchanging used needles for clean ones and dispensing Narcan. Last year, the state adopted the country’s only law limiting the ability of the police to arrest users who call 911 to save an overdosing companion. There has been no evidence yet of a decline in addictions, perhaps because of a scarcity of treatment facilities. And the seemingly contradictory impulses to stamp out drug use and safeguard addicts can lead to difficult situations for relatives. In Cordova, a valley hamlet with peach and apricot orchards, Dolores S. emerged from her adobe house to greet the state’s needle-exchange van. A nonuser who lives with seven relatives, four of whom are addicts, she said trading hundreds of used syringes each week for fresh ones “makes me uncomfortable.” Her face tightened as she admitted to giving money for heroin to her addicted son, slouched nearby, who is in his 20s. “I’d rather give him money than see him panhandle or steal,” said the woman, who does housework for a living and spoke on the condition that her last name not be used, to protect her family. “A lot of mothers here are in the same situation.” Needle exchanges and Narcan distribution are opposed by federal officials, who say they amount to endorsing addiction. Bertha K. Madras, a deputy director at the White House Office of National Drug Control Policy, has said that Narcan, the trade name for naloxone, should be administered only by medical professionals and that it could make addicts feel safer and less likely to seek care. But Bernard Lieving, director of the harm reduction program at the New Mexico Department of Health, said, “These programs have just the opposite result.” Mr. Lieving said studies elsewhere had shown that needle exchanges greatly increased the chances that users would enter recovery programs. “Unfortunately,” he said, “it’s very difficult to get people into residential treatment immediately, right when they express interest, because there aren’t enough beds in the state.” But field workers provide counseling, acupuncture therapy and social services to addicts who say they are ready, which Mr. Lieving called important first steps. Addicts remain a small minority of the population, and drug use remains largely hidden behind the closed doors of trailers and small metal-roofed homes. But nearly everyone here seems to have friends or relatives who died from drug use or are addicted to cheap Mexican heroin, cocaine, prescription painkillers or, increasingly, combinations of the above, often mixed with heavy alcohol use. Peggy Ulibarri, a state health official who distributes Narcan in Rio Arriba County, said clients had told her of using the antidote hundreds of times. Without Narcan, Ms. Ulibarri and others say, the number of deaths would certainly be higher. Instead, recorded deaths have been steady, around 20 a year in a county of 41,000. Meanwhile, the health department trades about 12,000 clean syringes for used ones in the county each week. Dealers are arrested, but users found with syringes now flash a card showing enrollment in the needle exchange program and are often let go. Proximo Martinez, 35, of Chimayo, counts 38 drug-related deaths in his extended family, including his brother and sister, and is a vocal crusader against drug abuse. Yet he recently collected syringes from the van — sterile needles to protect his brother-in-law and other relatives — as well as kits with a new form of Narcan that is sprayed in the nose rather than injected. Mr. Martinez said he had administered Narcan about 20 times. “But some can’t be revived,” he said. “People have died in my house.” Many in the fight against drugs, including Ben Tafoya, the director of Hoy, believe the heavy use of drugs and alcohol is rooted in a shared sense of loss, starting when the United States refused to recognize many Spanish land grants in the mid-19th century and building more recently as struggling families, accustomed to farming and ranching, became dispirited as they had to sell land. An obvious factor is poverty — more than one in five residents is below the federal poverty line and far more are just above it. Yet many working-class people are users, too. The family role is sometimes a sad reversal of expectations. “Addiction can become a source of bonding between parents and their children,” said Angela Garcia, an anthropologist who was born in Rio Arriba County and studied drug use here. The Rev. Julio Gonzalez, the pastor at the Holy Family Roman Catholic parish in Chimayo since 2001, said he had buried overdose victims “of all ages, including people you’d think were pillars of the community.” “It’s not just the youth, it’s all generations here,” Father Gonzalez said. James Garcia, who is now clean, used and sold heroin and cocaine in Española until 11 months ago and said he had encountered at least a dozen families in which grandparents, parents and children all injected drugs, with some working and others selling drugs or stealing to sustain habits that can cost $40 to $100 or more each day. Lawrence N., an Española man in his early 50s, said he had been addicted to heroin, pills and cocaine since 1970, including during 18 years in prison. The man, who would not allow his surname to be used, is disappointed that his two sons, in their 20s, use heroin, too. “I had them deliver to me in jail,” he said. “Maybe that had something to do with it.” Dr. Fernando Bayardo, director of the Española Hospital emergency room, called overdoses “only a small fraction of the deaths and disease caused by substance abuse,” which include liver disease and blood infections as well as car accidents, marked by omnipresent roadside crosses bedecked with plastic flowers. The county has been spared a major epidemic of AIDS, but testing in drug clinics indicates that a majority of needle users here are infected with hepatitis C. The county built a residence that now houses about 25 patients and has a program to counsel youths at high risk, said Lauren Reichelt, the county’s director of Health and Human Services. But there is no county center for medically supervised detoxification, and the wait list for the one in Albuquerque is long. The most successful treatment, used on 75 patients at the community health clinic, is the opiate replacement bupenorphrine, which can be dispensed at doctors’ offices and is rapidly catching on around the country despite costing up to $450 a month. In the backyard of the house he shares with his elderly, ailing mother, Mr. Lucero, the 30-year addict, raises chickens and pigeons, saying, “This is what keeps me sane.” He survived five overdoses, he said, turning apologetically to his mother. “She would find me in the yard with a needle in my arm, all purple, or lying on the floor in the kitchen.” He has been more careful, or luckier, in the last several years. But just in case, his mother took a quick lesson in Narcan administration the other day. She and her son watch over each other, she said. Every night, before going to bed, she checks to make sure he is breathing. After War, Love Can Be a Battlefield Leslie Kaufman, New York Times- 4/6/2008 FORT LEAVENWORTH, Kan.-- In a measured voice, Maj. Levi Dunton explained to the small circle of Army officers and their spouses what had gone wrong in his marriage since he returned home from Iraq in 2005. He had trouble being involved with his family, he said. He didn’t find joy in being a parent to his two boys, 3 and 5 months. Little things made him angry. Major Dunton said he was not sure whether his year in Iraq, where he was an Apache pilot and commander of 150 soldiers, was responsible for his numb state. Others, he wanted to make clear, had it a lot worse. To the other soldiers, this was a familiar litany of guilt, emotional distance and marital discombobulation; they were silent or simply nodded their heads. Like Major Dunton, they seemed uneasy with all this talk, all this sharing, all this connecting to the wife in front of strangers. Even as he spoke, Major Dunton, who fidgeted and played with his wedding ring, rarely made eye contact with Heather, his wife of 10 years and a former helicopter pilot herself. Ms. Dunton, however, seemed relieved, liberated even, to be given a chance to reach out to her husband. She put her hand around his knee and said she was convinced that the war had wormed its way into their marriage. “He used to tell jokes and funny stories and now he doesn’t do that anymore,” she said later. “I could tell he was different right away, but I thought it would pass.” Not long ago, the Army, too, might have waited for it to pass — particularly for someone as seemingly steady and committed to his wife as Major Dunton. But that was before this war, with its 15-month deployments, before 2004 when divorce rates spiked among the officer corps and before recruitment and retention became a military preoccupation. These days the Army is fighting a problem as complex and unpredictable as any war: disintegrating marriages. And so, the Duntons, like 18 other couples, gathered for a weekend retreat in late March, part of an Army pilot program to address marital stress after soldiers return from long tours in Iraq. The retreat is part of a new front in the Army’s “Strong Bonds” programs, which are for families and couples and run by its chaplains. Many of the earlier programs dealt with fundamentals such as “how not to marry a jerk” and how to have open communication. What was missing, said Col. Glen Bloomstrom, the command chaplain at Fort Leavenworth who championed the retreat, was a way to address the stress that war places on marriages — where stress often first manifests itself and where it can take the greatest toll. Most couples at the retreat — in all but one, the men were the soldiers — had been married 10 years or more, which means they had tied the knot in peacetime. Back then, the worst thing that could happen, many wives explained, was a posting to South Korea, where spouses are not included. Now, these couples must handle the separation that comes not only from long periods away, but also from spouses trying to connect with their partners’ combat experiences — something the men do not easily know how to share. Or want to share. To build the bridge from love to war and back, Chaplain Bloomstrom turned to Sue Johnson, director of the Ottawa Couple and Family Institute and a developer of Emotionally Focused Couples Therapy, one of the few marriage therapies with empirical data showing that it helps. Ms. Johnson, the daughter of a British Navy commando, teaches couples to address the emotions that underpin their fights, which is usually the need for more love and reassurance of love. In her new book, “Hold Me Tight” (Little, Brown), Ms. Johnson writes of the work Israeli researchers have done with soldiers who were prisoners of war and experienced torture and solitary confinement. Those fastest to recover were in secure, happy marriages. The men told of coping by writing letters in their minds to their partners about returning home. To develop those kinds of bonds, she counsels “nonjudgmental” conversations in which spouses can frankly discuss fears and needs. She even reads a few sample dialogues out loud where men say things like “I am afraid.” It can be a mushy message for a group of seen-it-all veterans. When Kathryn Rheem, a therapist assisting Ms. Johnson, talked about the “echoes of war” — the pain and isolation of returning from war, afraid to tell partners what really happened for fear of losing love — a soldier interrupted to say, “Ma’am, aren’t you overhyping this thing?” But the wives protested. Amy, the wife of a Special Forces veteran who asked that her last named be withheld to protect the privacy of her marriage, was weeping. “I am listening and thinking there is five years of my marriage I need to catch up on,” she said. With her blond hair cut into a stylish chin-length bob, and wide blue eyes, she looked too young to be war weary, and she admitted that military culture had been a shock. She had asked her husband about Iraq but he protested that she should know he could not give details. “They are very private,” she said of her husband and his Special Forces buddies, adding that the wives “only know what’s going on if they get together and have a couple of beers, and we eavesdrop.” The soldier, Ms. Rheem said, is trained to endure extremes. When it comes to problems in the marriage, “He is saying, ‘We are not really at the worst-case scenario,’ ” Ms. Rheem said. “For the spouse, it is like: ‘Yes, we are. To you, it is a small thing, because it is not life, or death, or bleeding. But if we don’t talk about these things now, it may feel like we are bleeding. I’m bleeding.’” This split perspective within marriages — and soldiers’ understandable wariness of being labeled as troubled — makes this retreat a delicate effort. To entice volunteers, the Army called the sessions not counseling or therapy, but “marriage education.” The retreat was held at the nearby Great Wolf Lodge, which had family luxuries like an indoor water park. The Army also paid for baby-sitting for most of the two days and part of Saturday night as well. Some couples joked that they had signed up just for that. The soldiers also know the retreat has the blessing of Fort Leavenworth’s commanding officer, Lt. Gen. William B. Caldwell IV, just back from Iraq to his own wife and three small children. A decade ago, the three-star general went through a divorce, and thereafter, he said, he gave soldiers in his command planning marriage the book “The Five Love Languages,” a best seller on discovering the way to give your mate what he or she needs. A kind of precautionary measure, like the retreat. The soldiers at this retreat are much more stable than any newlywed. They are career military; they have been promoted to officer training at Fort Leavenworth, a prestigious midcareer posting, and none are in the category of soldier likely to commit suicide, disappear or beat their wife. Or even to divorce, for that matter. But these days, the Army is covering all its bases. Divorce rates for its personnel have been on the rise since 2003, the first year of war, when they were 2.9 percent. In 2004, divorce rates in the Army soared to 3.9 percent, propelled by a sharp rise in divorce among the usually much more stable officers corps. That rate has dropped, according to Army demographics, to 1.9 percent for officers and 3.5 percent for the entire Army in fiscal year 2007 — which represents roughly 8,700 divorces in total. Female soldiers are the exception; they divorce at a rate of about 9 percent. Yet even with divorce rates stabilizing, the Army says it remains worried about the effects of combat on its core soldiers, the ones who are supposed to be lifers. Internal studies show that couples are deeply stressed by the war and contemplating divorce at a much higher rate. After the first day of the retreat, a group of wives gathered in the hotel hallway, sitting on the carpet, pouring red wine into plastic glasses, and children wandered back and forth smelling of chlorine. They discussed other echoes of war that stress their marriages: civilian friends and family who cannot understand their husbands’ choice to re-enlist and shower them with unwanted pity; husbands who leave when children are born and show up a year later only to disappear again; and watching other military couples divorce at what seems like an astonishing clip. The men, they noted, almost all remarry right away — usually to someone younger. It is why, they said, this retreat was needed. This stuff doesn’t get aired enough with the men. During the retreat, it was easy to see why. While some soldiers seemed truly engaged in the process, others seemed only to endure it. For a few others, it seemed like the Army had finally asked too much. Not only must they go to war, but now, after everything, they are expected to emote. Maj. Guy Wetzel returned home last November from a 15-month deployment in Baghdad as a brigade intelligence officer, and things at home have not been going smoothly, they said. “He always wants to raise his voice and thinks I will listen more,” said Melissa Wetzel, his wife. “And for me, I don’t. I am like: ‘Speak to me like a human, not like you are telling your soldier what to do. I am your spouse, not someone working under you.’ ” “And my question is,” Maj. Wetzel said, visibly bristling, “Why do I have to lower my type of understanding down to where you are? Why can’t you come to my type of understanding?” As the sessions continued, the couple painfully confessed that the war had intruded on their bedroom as well. He cannot sleep without noise, so at night they separate, they later elaborated. She stays in the bedroom and he lulls himself to sleep in front of the television in another room. Ms. Johnson said couples can change their behavior. She told a story of a man at a party who saw his wife flirting with someone else and blew up. Instead, she suggested, the man could have told his wife what he was really thinking, which is that he wished she would relate to him that way. Major Wetzel was indignant. “Why is it the soldier who always has to give?” he asked. “Oh, no,” Ms. Johnson assured him, “Everyone should have to give.” Afterward, the Wetzels said the retreat had helped, because it created time for them to talk. But when asked what was next, the soldier did not talk about counseling. “What we need is a way to get this out to the troops,” Major Wetzel said. “In terms of combat stress, they are the ones who really need it.”
Alison Leigh Cowan, New York Times- 4/08/2008 NORWALK, Conn. — When Matthew Morelli, a 38-year-old police officer, was found slumped in a secluded parking lot with an AK-47 rifle on March 21, state and local authorities spent two days looking for a suspect, with helicopters and police dogs scouring the neighborhood, where witnesses reported hearing multiple shots. The culprit turned out to be a stealthy if surprisingly familiar cop killer: suicide. “We’re all numb,” said William Curwen, the president of Norwalk’s police union, speaking for many at Officer Morelli’s wake almost a week later. Within one recent week, a 35-year-old New York State trooper fatally shot himself with his service pistol after learning that he might be disciplined for minor misconduct, and a New York City police officer was found dead in her home in Upper Manhattan, propped up in bed with the Glock pistol that delivered the fatal shot in one hand, a beer can in the other. And the Los Angeles Police Department, which has counted one or two suicides annually in recent years, presented a report last month calling for online prevention programs for all employees, additional training for supervisors, and psychologists at roll calls to discuss the topic with officers. While line-of-duty deaths grab the public’s attention, experts say that law enforcement officers more often — perhaps two or three times more often — die by their own hands. Comparing suicide rates within law enforcement with those in the general population is difficult because statistics are kept by different agencies and it is hard to account for demographics. Also, the general population does not undergo the extensive psychological and physical screening most officers undergo when they are hired, making comparisons questionable. But many who have studied the phenomenon agree that the stress of the job and easy access to weapons can contribute to a higher risk for suicide. “We’re losing a police officer every 19 or 20 hours of self-inflicted wounds,” said Robert E. Douglas Jr., a former Baltimore police officer and chaplain who runs the National Police Suicide Foundation in Maryland. “It is a big wow. It’s so sad because what you see in Connecticut goes on all the time.” Mr. Douglas estimates that 400 to 450 officers kill themselves each year, compared with 150 to 200 who die in the line of duty. In Norwalk, at least five officers besides Officer Morelli have committed suicide since 1974; four officers have been killed in the line of duty since the department was established in 1913, the most recent ones in 1982 and 1971. Some law enforcement agencies have beefed up prevention programs after seeing troubling spikes in suicides within their ranks. The California Highway Patrol expanded peer counseling and suicide-related training after losing 10 of its roughly 7,900 officers to suicide in 2005 and 2006; last year, said Capt. Susan Coutts of the employee assistance unit, “we had one.” The Maryland State Police saw a cluster of suicides, including two from the same barracks, in the 1990s, and initiated programs to identify officers at high risk, along with mandatory psychological consultations and firearms reorientation for officers involved in fatal shootings. “I know we didn’t have a suicide for years after that,” said David B. Mitchell, who was Maryland’s State Police superintendent from 1995 to 2003 and now is Delaware’s secretary of safety and homeland security, But some law enforcement leaders would rather not acknowledge the problem, given the emotional and financial implications that can hang in the balance. Officers who fall in the line of duty have their names etched on a prominent wall at the National Law Enforcement Officers Memorial Fund in Washington and posted on Internet sites. Their funerals are better attended, and their survivors are typically eligible for some $300,000 from the federal government alone, as well as college scholarships. “When you’re killed in the line of duty, you get a huge send-off,” said Mr. Mitchell, who also served as police chief in Prince George’s County, Md. “It’s a hero’s send-off, and that doesn’t happen if you kill yourself. There’s a stigma attached to it.” Mr. Mitchell said that he has “seen a number of staged murders that were actually suicides,” similar to the scene where Officer Morelli was found. Suzie Sawyer, a co-founder of Concerns of Police Survivors, a nonprofit group that represents families of officers who die in the line of duty, said it can be difficult even to count suicides because “police agencies will try to say it’s an accidental discharge, because it’s pretty hard to admit that your good buddy is trying to end his life.” More than 32,000 Americans each year take their lives, or about 11 per 100,000 people in the general population, according to the Centers for Disease Control and Prevention. Several academic studies have estimated the number of law enforcement officers who commit suicide at about 18 per 100,000, though Mr. Douglas’s count, compiled from news accounts and personal contact with police departments, would put the rate at two or three times that. Wayne R. Keeney, a defense lawyer in Connecticut who spent nine years on the New York City police force in the 1970s, has little doubt that officers are at risk of suicide because of their exposure to danger and stress, a reluctance to seek psychological help, and the cold fact that, unlike many civilians, they “usually have a gun sitting around.” He said that for years after shooting a suspect who was fleeing the scene of a crime, he had nightmares in which he dreamed his gun’s trigger was jammed and the weapon failed to fire. But Mr. Keeney said the counseling he received afterward consisted of fellow officers taking him out to get drunk. Mr. Mitchell said he also suffered nightmares, lost weight and was left by his girlfriend in 1973, after he was in a shootout in which a fellow officer died. “We buried him on a Saturday morning,” Mr. Mitchell said. “I went to work that night.” He said he did not seek counseling for several years, fearful that reaching out would wreck his career. “Today we’re a lot more sophisticated,” he said. “We put people on administrative leave.” Lt. Paul Resnick, a spokesman for the 175-member Norwalk Police Department, said few would argue that police work, with a roster of grim tasks that include chasing suspects, racing to bloody crime and accident scenes and following up on child abuse cases, can take a toll. “People call you when they’re under the most stressful circumstances, when their lives are out of control and you’re trying to deal with that, with limited resources,” he said. “To somehow think you can turn the switch off at the end of the day is not realistic.” There is no indication, however, that work-related stress led to Officer Morelli’s death; he had not been involved in any shootings during nearly 12 years on the force, and he had compiled a strong record of commendations from the community. He had, however, gone through a divorce and custody battle. Born in Stamford and raised in nearby Weston, Officer Morelli became a Marine after high school and was decorated for his service in Operation Desert Storm. He joined the Norwalk Police Department in 1996 and was a patrolman and a member of the department’s scuba team. His personnel file contained letters of thanks from people he helped. After his death, residents of a local homeless shelter presented the police with $10 they collected to show their appreciation for his kindness. His neighbors in Oxford, Conn., described someone who was helpful, courteous and enjoyed raising alpacas and other animals on a small farm behind his house. But court records showed that Officer Morelli was locked in an international battle with his ex-wife, Tamra Bartholomaeus, over their daughter, Sydney Anne, who is 6. Ms. Bartholomaeus and Officer Morelli were married in 2001, and broke up in early 2005. She took Sydney to Australia in December 2005 for what Officer Morelli had been told was a “brief vacation,” he said in court papers, but she called three weeks later and said that she was not “going to return to Connecticut, and that she and the minor child would live in Australia permanently.” In the court papers, Officer Morelli also accused Ms. Bartholomaeus of running up $11,000 in debts before leaving town, on credit cards he said he was not aware she had. He asked the court to order Ms. Bartholomaeus back to Connecticut and sought sole custody of the child. But the couple’s divorce settlement, finalized in February 2006, allowed Ms. Bartholomaeus to remain in Australia, with Sydney. It ordered weekly telephone calls between Officer Morelli and his daughter, and called for her to spend two weeks each year with him in Connecticut, and for him to visit Australia two weeks a year as well. According to the court papers, Officer Morelli also agreed to make his daughter the beneficiary of a $100,000 life insurance policy, at least until she graduated from high school, and to name her the beneficiary of a $58,000 contractual benefit from the City of Norwalk that is “collectible only upon the event of the husband’s death while on duty.” City officials in Norwalk, including Mayor Richard A. Moccia, declined to discuss what Officer Morelli’s family would receive. The Norwalk police chief, Harry W. Rilling, made a point instead of praising the officer for the years he served. “Every day, he put on the uniform,” Chief Rilling said. On March 28, some 700 officers put on their dress uniforms and white gloves to accompany Officer Morelli’s body to a church cemetery, in the city he served. Virginia To Modernize State Mental Health Services Anita Kumar, Washington Post- 8/10/2008 RICHMOND -- Virginia Gov. Timothy M. Kaine signed bills Wednesday that will make it easier for Virginians to receive treatment as part of the first significant overhaul of the state's mental health system in three decades. Some of the proposals had been sought for years but did not get approval until a Virginia Tech student from Fairfax County with a history of mental health problems fatally shot 32 students and teachers before killing himself on campus a year ago next Wednesday. Kaine (D) told a packed room of legislators, mental health advocates and state employees that the changes will "benefit generations of Virginians to come." "It has been a difficult year, but it has been a year where people haven't [shrunk] from trying to learn and improve," he said. "The Tech tragedy reminded us . . . we have a significant need to improve mental health services." The changes will bring Virginia in line with nearly every other state in several key ways, including lowering the standard under which a mentally ill person can be forced into treatment. "It's the most sweeping overhaul in 30 years," Del. Robert B. Bell (R-Charlottesville) said. "We talk a lot about things being a big deal. This one actually is." The 26 bills expand the criteria under which a mentally ill person can be barred from buying guns, require mental health officials to more closely monitor people in community-based treatment and allow the sharing of information among providers and court officials to keep better track of people in treatment. "It's a terrible shame that it took something as terrible as Virginia Tech and the incident there to bring to light so many inadequacies in the mental health system," said Andrew Goddard of Richmond, whose son Colin was shot four times and survived. "I'm sure many people were crying out about these for a long time. It didn't get the spotlight that it deserved." Kaine signed the bills surrounded by Attorney General Robert F. McDonnell (R) and 10 legislators who helped write the legislation. They applauded after he finished. "It was a very good day," said Sen. Janet D. Howell (D-Fairfax), who has worked on some of the proposals for years. "We now have a solid legal framework to deal with persons with mental illness. We did not have one before." The Virginia Tech killer, Seung Hui Cho, had been ruled a danger to himself in 2005 and was ordered to receive mental health treatment but never did. "It takes care of the mental health problems that allowed Cho to work his way through this labyrinth of what existed in the way of mental health services and get in a position of creating havoc," said Del. C. Charles Caputo (D-Fairfax), whose district is home to the families of two Virginia Tech victims. "The risk of that happening again as a result of this legislation is extremely minimized."Last month, the General Assembly passed a two-year, $77 billion spending plan that included an increase of $42 million for more caseworkers, psychiatrists and other staff to treat and monitor the mentally ill. "Now the real job begins," said Del. Phillip A. Hamilton (R-Newport News), vice chairman of the House Appropriations Committee. "While we have done some significant public policy changes, the real challenge in the out years is to make sure we provide the funding to put services where folks need them most. . . . It's going to be tough, but it's about establishing priorities." Legislators called the funding increase significant, particularly at a time when Virginia faces a shortfall of more than $1 billion in the next two years. Some mental health advocates said the state needs to spend even more. Mira Signer, executive director of the National Alliance for the Mentally Ill of Virginia, had asked for an additional $25 million over two years. "We are very grateful and thankful that more funding is being allocated," Signer said. "It's a huge step in the right direction, but we did call attention to the need for more funding because Virginia has traditionally lagged behind in community-based care." Kaine said he will ask his staff to evaluate what recommendations from the Virginia Tech Review Panel report have not been implemented and possibly suggest them to the legislature next year. "We recognize while we have done good, this is not the end of what we need to do. We have more work to do," Kaine said. Many victims' families remain disappointed that the General Assembly failed to pass a bill that would have required all firearms sellers to conduct background checks on buyers at gun shows. Caputo, who introduced a bill to make that change this year, plans to do so again next year. "It's not just one thing: mental health," he said. "We have to fix this horrendous gun situation."
When did you get the condition under control? What are the most important things you do every day to manage your mental illness? What's your average day like? What is your goal with "Madness?" What are the biggest misconceptions about people with mental illness?
Melissa Healy, Los Angeles Times- 4/13/2008 As symptoms of depression go, there is none much clearer than having thoughts of suicide. But a spate of recent announcements from federal health officials suggests a surprising new interpretation of suicidal fantasies and the depression they are thought to signal: Sometimes, sadness, anxiety and self-destructive thoughts are not symptoms but side effects -- of medicine. In this year alone, federal regulators have warned that a surprising array of drugs could play a role in spurring thoughts of self-destruction. Medicines that treat epilepsy, asthma and influenza are now under suspicion, as is one that helps smokers kick the tobacco habit. The FDA stresses that it has established no direct causal link between these medications and suicidal thoughts in patients taking them. But in all the cases, regulators acknowledge they had one of two indicators of potential trouble. In some cases, a review of a drug's early clinical trials turned up increased rates of suicidal thinking among subjects taking the medicine. In others, the tip-off came when the FDA observed an uptick of reports that patients taking a medication for some other condition developed symptoms of depression. As a result, FDA officials and medical researchers now are scouring their data for clear signs that these drugs increase the risk of dangerous psychiatric symptoms. Moving forward, the agency will require developers of many new drugs to test for psychiatric side effects that could tip the balance between a new medicine's risks and benefits. "We're trying to develop systematic strategies for looking . . . in a more rigorous way" for links between drugs and unintended psychiatric effects, said Dr. Thomas Laughren, director of the FDA's division of psychiatry products. "The difficulty is that we have such a primitive understanding of human behavior on a biological level . . . it is hard to predict which compounds are going to have psychiatric effects." FDA warnings The recent rash of advisories comes just four years after the FDA first suggested a connection. Prompted by reports that suggested children taking antidepressants were more likely, not less, to commit suicide, the agency in 2004 warned that antidepressants might actually increase the risk of suicidal fantasies and behaviors among children. That link is now in doubt, after recent studies showed a rise in youth suicide even as antidepressant use in that population has plummeted. But the experience of coping with the anguished families of young suicide victims who took antidepressants has had a lasting effect on mental health professionals, researchers and federal regulators. If early-warning systems detect even a hint of psychiatric danger with a medication's use, government officials are inclined to alert first, study later. "When they see a signal, even if they don't understand the genesis of that signal, that's a reasonable time to warn," said Dr. Robert Ward, a member of the FDA's pediatric advisory committee and professor of pediatric medicine and pharmacology at the University of Utah. As it moves forward, the FDA hopes to detect such signals -- and warn patients and physicians -- before a drug enters wide use. One of the first drugs that will require testing for psychiatric side effects before it can be FDA-approved in the U.S. is rimonabant, an anti-obesity drug already used in some 20 other countries. After early clinical trials suggested patients taking the drug had increased rates of depression and anxiety, an FDA advisory panel voted last June to recommend a delay in market approval pending further study. The FDA has asked rimonabant's maker, the French pharmaceutical firm Sanofi-Aventis, to use a new yardstick to detect and measure suicidal side effects. Scientists have long known that many drugs used to treat symptoms below the neck enter the brain also and that the receptors and chemicals on which they work in organs such as the heart, blood vessels or liver are present in the brain as well, although they may have different functions there. That these drugs might have an incidental effect on mood, then, "shouldn't be terribly surprising," Laughren said. Abnormal behavior Still, some of the bizarre reports prompting advisories were wholly unexpected. In Japan, where antiviral medicines such as Tamiflu and Relenza are widely used to shorten the duration and ease the symptoms of influenza, last year's flu season raised serious alarms. In the span of several months, two 14-year-old patients taking Tamiflu -- a boy and a girl -- fell to their deaths from high-rise apartment buildings in suspected suicides, and two 12-year-olds on the medication were injured after falling from buildings. Delirium, hallucinations and psychotic behavior caused one child taking the drug to bolt into traffic to his death. In all, an FDA advisory panel was told last November, there have been 25 deaths and 365 cases of abnormal behavior in children and young adults under 21 who took Tamiflu since it was approved for use in 1999. Although regulators underscored that hallucinations and bizarre behavior can be a consequence of the high fevers and brain inflammation that can come with influenza, they acknowledged they could not, without further scrutiny, rule out a link to Tamiflu. "It came as a surprise to everyone," Ward said. "First the antidepressants raised people's concerns, and then they started to find these unusual suicidal behaviors with Tamiflu. It caused people to ask, 'Whoa, what is happening here?' " Last month, the FDA notified physicians of the Japanese incidents (while also noting that "the contribution of Tamiflu to these events has not been established") and urged close monitoring of young patients with influenza, who might be taking an antiviral medication. In early April, GlaxoSmithKline, maker of the antiviral medication Relenza, voluntarily issued a similar notification to physicians. On March 27, the FDA went on to announce it was investigating a "possible association between the use of Singulair," a pill used to treat asthma and allergies, and changes in mood and behavior, including suicidal thinking and suicide attempts. That warning came after the FDA's adverse-event monitoring system saw an uptick in reports about patients taking Singulair experiencing symptoms of depression, including thoughts of self-destruction. Although this monitoring system relies on voluntary reports from patients and physicians and does not establish causal connections between a drug and a reported "event," it is a key early detector of untoward side effects once a drug enters wide use. Reports to the FDA also prompted a warning to healthcare professionals on Feb. 1 about Chantix, an anti-smoking drug approved in May 2006. As the medication gained a foothold among U.S. smokers wishing to quit, patients began telling physicians and the FDA of peculiar behavior, agitation, depressed mood and suicidal thoughts and actions. By January, the FDA had concluded "it appears increasingly likely that there may be an association between Chantix and serious neuropsychiatric symptoms" and urged physicians to weigh that possibility when prescribing the drug, and to carefully monitor patients who take it. One recent warning emerged not from spontaneous reports by patients and doctors, but from an internal FDA effort. Last year, after studies had shown an increase in suicidal thoughts and behavior among people taking certain drugs for epilepsy, the FDA conducted a broad review of clinical trials conducted on 11 anti-convulsive drugs. The result was a Jan. 31 alert informing physicians of an established link between the 11 drugs and suicidal thinking and actions. As a group, patients taking any of the 11 medications were twice as likely to experience suicidal thoughts and actions as those who took a dummy pill. The heightened risk of self-destructive symptoms was evident as early as one week into treatment and continued throughout the 24 weeks of study. Mind-body connection Though such reports of psychiatric side effects defy prediction, researchers said that growing understanding of the connection between mind and body should lead the way to better guesses at which drugs may unexpectedly darken a patient's mood, and why. "With every passing day, we've learned so much that there's a strong connection" between physical and mental health, said Dr. Husseini Manji, director of the Anxiety and Mood Disorders Program at the National Institute of Mental Health. "When you're depressed, a lot of things in your body don't work well. But conversely, both medical illnesses and certain medications can markedly make you depressed."
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