Noteworthy News Articles on Mental Health Topics, April 13-16, 2008


Abused Became Abusers In Case Of Former Probation Officer
Dave Altimari, Hartford Courant- 4/14/2008

They're the Lost Boys of Eastern Connecticut. Each started on a bumpy path toward adulthood, finding trouble in small doses through petty crimes. Douglas Dougherty was 16 when he stole the purse of a woman who had just bought some lottery tickets in a shopping center in Putnam. The tickets were all losers. Marc Page was 18 when he got caught stealing a couple gallons of gas from the pump at the Hebron Public Works Department garage. Scott Evans was 15 when he was caught drinking in the Big Y parking lot in Danielson.
     As first-time offenders, they got no jail time when they appeared before a judge in Superior Court in Danielson. Each got something that would turn out to be far worse -- a probation officer named Richard Straub. During the late 1980s and early 1990s, Straub was chief of the probation department in Danielson, located in a small brick office building across the street from town hall. But Straub's power far exceeded his title. He ran his office like a fiefdom, fueled by a close connection with prosecutors and judges. As a practical matter, Straub's near complete control of the probation system in eastern Connecticut is chilling for one main reason: He picked the boys who reported to him. Boys such as Dougherty, Page and Evans.
     While the three have never met, each tells a strikingly similar story about life on probation. Tales of locked doors in a windowless office, questions about whether they had ever dreamed of being with a man and, finally, molestation. And always when Straub was done -- a warning. "He said, 'What happens in my office stays in my office,' and if something were to leak out about what had happened he would make sure that I go to jail and do every single day of time that I owed,'' Dougherty said.
     Dougherty, Page and Evans were three of 15 teenage boys that state police have verified were sexually molested by Straub when he was their probation officer from the mid-1980s through 1997. Now, years after the teenagers were abused, they have something else in common: They have become abusers themselves. In fact, of the 15 boys known to have been abused by Straub, eight of them have since been convicted of sexually assaulting someone, in many cases children the same age as they were when they were first abused. Another three have served time for assault. All but one have been to jail at least once, records show. Just over one-quarter of Straub's 157 clients have since been convicted of sexual assault, although authorities say they are not sure exactly how many of them were abused by Straub. Scott Deojay, convicted of the 2005 murder of a Thompson mother who was abducted while she was jogging, was among Straub's victims, his public defender told the judge at sentencing.
     The Straub case, which received significant publicity at the time of his arrest, has quietly evolved into a textbook example of how childhood abuse can have lasting effects on society, often creating a whole new generation of victims. Research generally shows that about one-third of those who are victims of sexual assaults later commit sexual assaults themselves. Still, the numbers of repeat offenders among Straub's victims is higher than normal, several experts said.
     Dr. Leslie Lothstein, director of psychology at the Institute of Living, said the "horrific" nature of the crime likely explains the high recidivism rate, along with the fact that many of the youths already were in trouble, albeit minor trouble. "These are the kinds of kids that needed even more protection. They were vulnerable to begin with. To learn that these kids have become more likely to offend than normal isn't surprising, given what he did to them,'' Lothstein said.

Straub's Power
In his 25 years as a probation officer in Danielson, Richard Straub became well known in the community, making friends with judges, police officers and town officials. State police investigators say he used those contacts to rise to power. Over time, he ascended to run the regional probation department, taking the biggest office way in the back with no windows. He kept a peanut dispensing machine on his desk and routinely asked clients to grab a handful. A Massachusetts native, Straub lived by himself on Soap Street, just a few miles from the courthouse in downtown Danielson, a section of Killingly. It's the heart of Connecticut's quiet corner, where the recent news that a Starbucks might be coming to town made the front page of the local paper.
     These are communities where people tend to live for years, along with their extended families, and where the poverty level is above the state average and teenagers have plenty of chances to get in trouble. In many ways, it was the perfect place for Straub to flex his power and find potential victims. "It was his little kingdom," said former state police Det. David LeBlanc, who led the police investigation of Straub. "Straub basically ran the show up there for many years."
     Everyone who was put on probation by a judge had to be interviewed by Straub or someone from his office, so Straub got to pick his clients. It didn't take long for investigators to develop a profile of probation clients who would become his victims . Most looked younger than they seemed, even though most, at best, were 17-year-olds. Most came from dysfunctional families or broken homes; most were easily manipulated or just plain scared because it was their first time in the judicial system. "He really had the catbird seat when it came to picking his victims because he knew everybody coming through that office,'' former Windham County State's Attorney Mark S. Solak said.
     When he was a prosecutor, Solak filed a complaint against Straub for spending so much time in the previous state's attorney's office that defense attorneys complained it was too cozy a relationship. "He was incredibly clever at picking the right victims not only that he could take advantage of, but also because he knew he could control them and keep them quiet about it," said Solak, who later oversaw the criminal investigation that led to Straub's conviction on more than 200 sexual assault charges and a 15-year prison sentence.
     State Department of Correction officials have transferred Straub to a Florida prison out of concern that a former state probation officer could be a target of violence. Straub did not respond to attempts by The Courant to speak with him. He has never admitted to molesting any of his former clients. Under oath during a federal court proceeding, he refused to answer questions about the molestations.

Watching Myself On TV
Marc Page, now 45, is in prison, too, serving a 12-year sentence after he was convicted in 1996 of molesting at least two boys in his parents' Woodstock home. His father died while he was in prison; his mother is ill. Straub became Page's probation officer after Page was arrested in 1982 for stealing gasoline from the Hebron Public Works Department. Page said Straub one day led him into his office, closed the door and started asking questions. After some routine inquiries, he started asking Page whether he was gay and whether he had ever had sex with a man.
     In one episode, Page told state police, Straub pulled out a gun while they were locked in his office and forced Page to give him oral sex at gunpoint. Page never returned to Straub's office after that incident, but the damage had been done. Page said he lost his fiancee when he kept seeing Straub's face every time they tried to have intimate relations. His drinking and marijuana use eventually cost him his job at the Eastern Connecticut Cable Co. He had panic attacks any time he was in a room alone with other men.
     Over the next 10 years his life spiraled out of control. Page took to watching some of his friends' children at his parents' Woodstock home as a way to make money. He also assisted a group called the Young Marines based in Putnam by doing video work for them. It was through that association with that mix of kids in which Page, 15 years after he had been abused by Straub, went from being a victim to being an abuser. Page said he used to give the boys back rubs and baths, until one night, when he was drunk, a bath turned into the molestation of a friend's child. "I don't really remember too much of what happened. I felt like my life was like me watching myself on television -- being on the outside looking in,'' Page said. "I remember taking the boy home. He was utterly destroyed -- not in any outward way, but inwardly I could tell. It was if I had crushed his soul.''
     When Page was arrested on a sexual assault charge, he told his parents about his abuse by Straub. "What I did was reprehensible and I still can't believe I did to someone else what Straub did to me," Page said. "I know that I'm ultimately responsible for heading down this path, but there's no way I become a sexual deviant if it wasn't for Richard Straub."
     Page has become somewhat of a jailhouse lawyer, filing federal lawsuits trying to get his sentence reduced and filing one against the Inmate Legal Assistance program for failing to properly represent him. He is scheduled to be released in September, although he isn't sure what awaits him. "What kind of a future am I going to have? No one wants to hire a sex offender so I won't be able to find a job. All of my friends have long abandoned me,'' Page said.
     His hopelessness is likely reflected in a number of Straub's victims, experts in child sex abuse say. "They learned that society is a total mockery and they were so angry at the betrayal that they acted out. They stopped believing that justice is ever possible," said Joynna Silberg, the executive vice president of the Leadership Council on Child Abuse & Interpersonal Violence, based in Pennsylvania. "This was a person in the position to be a role model to these boys and to see the value of following the law who instead abused them,'' she said.
     Silberg said Straub's victims are different from those in other sexual abuse cases -- such as those involving Catholic priests -- because of the circumstances. "They weren't Catholic do-gooders who believed in a particular priest and were betrayed," Silberg said. "This particular population is already a high-risk group because they have been violators of the law and being abused by a person in position of authority just pushed them over the edge."

A Fluke
Straub might never have been caught if it weren't for a guy nicknamed O.J., a motorcycle chase in Rhode Island and a stolen 9mm gun. In December 1995, Oscar "O.J." McDuffie and Steven Chicoine were caught by Providence police operating a stolen motorcycle. When police questioned the two men separately, Chicoine told the cops, "Why don't you ask Oscar about the gun he took from the faggot,'' according to police reports.
     Providence police called state troopers from Danielson to come and interview McDuffie. He eventually admitted stealing the gun and a clip of bullets from Straub's nightstand about five days earlier and trading it for some crack cocaine. Straub had never reported the gun stolen. The trooper then asked McDuffie about his relationship with Straub and whether it was sexual in nature. McDuffie hung his head and didn't answer. The trooper asked again and McDuffie started to sob openly before muttering, "You don't know how it is. He has all the power.''
     When McDuffie was transported back to Troop D in Danielson, he gave a two-page statement describing in detail how Straub, as his probation officer, started inviting McDuffie back to his Soap Street home to play pool and drink. After a few times, Straub started hugging McDuffie and tried to have oral sex with him. When McDuffie initially refused, Straub took out a gun and put it on the table -- at which point McDuffie agreed, according to McDuffie. "It really was a fluke that Straub was caught at all,'' said Solak, the former Windham County state's attorney. "When we were able to corroborate [McDuffie's] story, I asked the state police to put as many men as possible on the case because it was obvious to us all he wasn't the only victim.''
     Solak said the case was a difficult one from the beginning, both because of the nature of the allegations and the fact that it was difficult to figure out who may have been sexually molested. "Normally, victims come to you to complain about a crime that has been done to them, but in this case it was the exact opposite. We had to go out and find the victims by going through all of the court documents, probation records and prison records,'' Solak said. "I'm sure we didn't get all of the victims because we never got all of the records."
     The Courant obtained from the state judicial department a list of clients assigned to Straub during the last 10 years he ran the probation office in Danielson. There are 157 clients on the list, although investigators always believed there were many more that Straub kept off the books because he was molesting them. Among those 157 clients, 40 have been convicted of sexual assault offenses since Straub became their probation officer. There is no evidence that Straub molested more than the 15 that police have identified or that any of the clients were arrested because of their association with him.
LeBlanc, the former state police detective, said he isn't surprised to hear many of Straub's victims turned to a life of crime. He also has no doubts that there were far more victims than state police were able to identify. "If we had been given more manpower, gotten more cooperation from the probation department and had more time, who knows how many more victims we would have found,'' LeBlanc said.
     Deojay, a 37-year-old Plainfield man serving a life sentence for the brutal murder of Judith Nilan in 2005, may have been one of Straub's victims. Deojay kidnapped Nilan as she jogged near her Thompson home, raped her and beat her to death, dumping her body in an outbuilding on a nearby property. At Deojay's sentencing last March, Public Defender Ramon Canning said Straub had repeatedly raped Deojay over a three-year period, from when he was 16. "The state had a great impact on him because of that probation officer's action," Canning told the judge. "It went on for three years and it lasted in his mind and caused that outpouring of rage." Windham State's Attorney Patricia Froelich called the claim "abuse excuse" and questioned Deojay's motives for claiming to be a victim of Straub's. She said there was no evidence Deojay was ever molested by Straub.

Victim Becomes an Abuser
There is no doubt in Douglas Dougherty's case. Dougherty grew up in a single-family home with his mother in Thompson, not far from Danielson. He was a short, stocky kid when he accepted a dare and stole lottery tickets from a woman leaving a package store. Dougherty pleaded guilty to sixth-degree larceny charges and got one-year probation -- and a place in Straub's world.
     Much like he did with Page, Straub started asking Dougherty standard questions, such as where he lived and if he had a job. But the questions soon became sexually explicit -- Had he ever had oral sex? Had he thought about sleeping with a guy? Did he like to look at porn magazines? Straub once scheduled Dougherty's appointment for 7 p.m., which struck the teenager as an odd time for a meeting. "I didn't want to go to jail so I went,'' he said.
     Dougherty said Straub took him to his office and locked the door behind them. Straub pulled out $100 in $20 bills and handed them to Dougherty, along with his business card that had his home number on the back. "If you get in trouble let me know or if you ever need money,'' Dougherty remembers Straub saying. As he talked, Straub walked around the desk and sat on it right next to Dougherty. He then unzipped his pants and took out his penis and started masturbating. He told Dougherty to touch him. When Dougherty wouldn't, Straub said, "You might want to do what I tell you to do.''
     Straub then told Dougherty to take out his own penis and do the same thing. They both ejaculated into napkins Straub had on his desk. When it was over, Straub grabbed Dougherty by the wrist and looked him straight in the eye. "He said, 'What happens in my office stays in my office,'.'' Dougherty said. "He always said, 'Do what you're told or else I'll send you to jail.' I didn't know what to do; there was no one to talk to. He ran that courthouse.'' The scenario stayed the same for about three months, until it escalated to oral sex.
About a year after the abuse began, Dougherty said he was sitting alone in his second-floor apartment in Putnam watching a pornographic movie when the 11-year-old boy who lived downstairs came to visit. Dougherty let the boy watch the movie with him, and then Dougherty took out his penis and started masturbating. "I asked him if he wanted to touch it," Dougherty said. "I knew it was wrong but I thought it was OK because Straub was doing the same thing to me all of the time."
     Dougherty was convicted of sexual assault in 1991 and served two years in prison. He has been in and out of prison ever since, mostly on burglary charges. But he also was arrested on charges of violating probation because, he said, he feared going back to the Danielson offices and possibly seeing Straub again.
     To this day, Dougherty, now 35, can barely sit alone in a room with another man. He started sweating and fidgeting during a three-hour prison interview with The Courant, at one point asking if the door to the interview room could be kept open.
During his numerous prison stints, Dougherty's mother, his only relative, died. The two had a falling out over his criminal behavior. She kicked him out of the Thompson home he had grown up in. Dougherty is in jail now awaiting trial on robbery charges.
     While there are similarities in many of the stories that Straub's victims tell, the case involving Scott Evans was more personal. Evans said Straub was like his uncle. In fact, Straub had a child with Evans' aunt even though they weren't married. Straub also knew Evans' mother, Lorraine Wright, well and went to the family's house in Dayville frequently -- when Evans was around 10.
     When Evans got in trouble for underage drinking, his mother encouraged him to go see "Richard" and let him help. Straub did help Evans, fixing speeding tickets and keeping him out of jail as the drug arrests started to mount. "A couple of times Straub approached me and said, 'You are going to jail unless I help you and if I do help you than you have to help me,''' Evans said. Before long, Straub was bringing Evans to his house, where he and a friend would get the boy drunk and molest him.
     Lorraine Wright realized something was going on when she overheard a phone conversation between Straub and her son. Straub was calling while on vacation in Germany to tell Evans how much he "missed" having sex with him. "I was just shocked. I kept calling Richard, asking him to help Scott get off drugs and to help find him a job and all that time he was molesting him," Wright said. Evans estimated that, over a two-year period, he was molested by Straub more than 50 times. Straub often gave him money, sometimes as much as $100, after they had sex.
     Evans has been arrested 13 more times since he first caught drinking beer in the Big Y parking lot. Most of the crimes were drug-related or burglaries or larcenies to get money to buy drugs. He is being held on bail awaiting a trial on his latest burglary charges. Wright said she has given up trying to constantly bail Evans out. To this day, she said, she feels sick about turning her youngest son, who is now 37, over to a pedophile. "I know that Scott wouldn't be where he is today without what Richard did to him," Wright said.

No Longer a Victim
State police spent more than two years tracking down victims and building a case against Straub. They charged him with 224 counts of sexual misconduct against 15 teenagers. He also was charged with racketeering for using his position as a probation officer to conduct a continuing pattern of abuse. Just as jury selection was about to begin for his trial in March 1999 he pleaded no contest to 31 charges, including sexual assault and kidnapping. He received a 15-year sentence.
     Some of the victims, like John Hajder, showed up at Straub's sentencing and testified about what he did to them. He did so under the condition that he remain anonymous.
Hajder was 14 when he was arrested on a charge of stealing from a general store in Danielson. During a prison interview, Hajder said he was molested twice by Straub in his office. "I never thought about telling anyone because who would believe a kid like me against the guy who ran the probation department?'' Hajder said.
     The first time, his mother was sitting outside in the waiting room. "I had a funny feeling about Straub when I met him. He would never let me come into the office with John,'' said Eileen Bryan, Hadjer's mother.
When she thinks about what was going on behind those closed doors she said it makes her sick. "I feel like it was almost my fault,'' Bryan said. "He was just a kid doing what a grown man who was an authority figure was telling him to do.''
     Straub kept his promise to keep Hajder out of jail even as drug use led Hajder to commit more petty crimes. One day, as Hajder waited with his then-girlfriend to appear in court in Danielson to take care of a parking ticket, Straub came over and pulled Hajder aside and warned him not to tell "anyone about what happened between me and him." That's when Hajder realized he might not have been Straub's only victim . "I always thought that what happened was my fault somehow and that I was the only victim but when he said that to me it made me realize maybe there were others and that he was afraid I was going to talk,'' Hajder said.
     Hajder contacted the attorney Straub had recommended, Paul Chinigo of Norwich, and told him Straub had molested him. Hajder said Chinigo's first reaction was that he "found that hard to believe." That same night, Hajder told his mother what had happened. She convinced him to call Chinigo back and to go to Troop D in Danielson and file a complaint.
     Hajder was disappointed that Straub never had to admit in open court what he did. Straub avoided looking at him in court. "I was looking for some kind of reaction from him but there was nothing. He didn't look at me, didn't say anything. Nothing,'' Hajder said. Hajder remembers ending his testimony in court by saying: "As of today I am no longer a victim, but a survivor."
     When Straub was led out of court to start serving his sentence, the case for police and court officials was effectively over, even though state police sources readily admit there were probably many more victims who were too ashamed to talk about what happened or were never found.
     Detectives moved on to other cases and judicial officials instituted changes -- such as installing two windows in Straub's office. While he was in prison, Straub was arrested again when police thwarted his attempt to put a contract out to kill Solak in a bizarre plot to gain freedom. Straub tried to hire members of the Latin Kings gang, believing that if the prosecutor were gone he could convince court officials from his old stomping grounds to reduce his sentence, authorities have said. He got four years added to his 15-year sentence.
     Straub's victims were quickly forgotten. "It really surprised me that the state didn't take any responsibility for what happened. I mean, he assaulted me in a state office," Hajder said. "It was like no one cared about us. They got what they were after, which was putting him in prison, and then we got put on the shelf."



Anorexic Denied Coverage Under Health Plan 'Three Day Rule'
Diane Levick, Hartford Courant- 3/14/2008

Young Kathryn Laudadio, already battling anorexia and various mental disorders, now has another demon crushing her — guilt that her parents had to pay thousands for a treatment program last summer because insurance wouldn't cover it. Kathryn, 17, entered the residential program after losing 10 pounds in three weeks and then running 80 minutes on a very hot day until she collapsed. She ended up in Bridgeport Hospital's emergency room with an abnormal heart rhythm. Doctors wanted her in the program for eating disorders, and her insurance covers such treatment under certain conditions.
     The denial — which is still being challenged — is especially aggravating to Kathryn and her mother, Lisa Gfeller, of Fairfield, because they won an independent appeal against Anthem Blue Cross and Blue Shield that was supposed to be binding but hasn't been enforced.
     Insurance fights over the "not medically necessary" refrain are common, but Kathryn's case centers on a different rule. It exposes a troublesome crack in the health care system, involving a state law that can be hard to comply with because of Connecticut's shortage of hospital beds for young mental health patients. The rule in Lisa Gfeller's health plan is patterned on state law. The law says insurance doesn't have to pay for residential treatment of mental illness for children and adolescents unless the treatment starts immediately after a hospitalization of at least three days for the illness. Doctors wanted to hospitalize Kathryn the day she was taken by ambulance to Bridgeport Hospital, but a psychiatric bed couldn't be found.
     That insurance Catch-22 has happened to other patients around the state too, consumer advocates say. The three-day rule prevents some young patients from getting residential treatment, a live-in program that's less intensive than hospitalization. Parents who take on the financial burden themselves may not be able to afford enough treatment, raising the chances of patient relapse.
     The three-day rule cost Kathryn's parents $13,420 that they had expected insurance to pay toward her stay in the Renfrew Center of Philadelphia, a live-in treatment center that specializes in eating disorders. Gfeller had to take out a second mortgage because the 24-day stay cost more than $16,000, and Kathryn's anguish about the expense isn't making her recovery any easier. "That has followed me to this day," said Kathryn, a 5-foot-2, 98-pound high school senior with a coif of dark ringlets. "I feel like I have cost way too much, and it's this horrible guilt."
     Her mother has told her not to worry about family finances, knowing Kathryn has enough to deal with. The teen has been diagnosed with borderline personality disorder, obsessive-compulsive disorder, and bipolar illness, which involves cycling between depressed and manic periods. Two of Kathryn's aunts were bipolar and committed suicide, Gfeller said. Kathryn, in her fifth year of anorexia, has threatened suicide from time to time. She said that last June "my goal was to die by Christmas. I had it all mapped out. I realized the only thing I could do was starve." Kathryn has also mutilated herself, using manicure scissors, a razor, and broken glass on various occasions, once even carving the word "vain" into an arm, Gfeller says.

Three Appeals
Gfeller says she didn't know about the three-day rule until the Renfrew center heard from Anthem the day before Kathryn was to enter the facility. Gfeller checked her in anyway because she believed her daughter's life was at risk and figured she would appeal the denial later. The mother and daughter have been through three levels of insurance appeals over the Renfrew stay in Philadelphia, and over a subsequent "partial hospitalization" at Renfrew's center in Wilton. That was day treatment, with Kathryn returning home for the evening.
     Gfeller is a clerk in the assessor's office in the town of Fairfield, and her insurance is the town's self-funded plan. The plan takes on the financial risk of claims itself and hires Anthem to administer the plan, which includes processing claims and handling appeals. Anthem claimed the Renfrew day treatment in Wilton wasn't medically necessary, but denied the Renfrew Philadelphia program solely on the basis of the three-day rule.
     Gfeller lost two appeals to Anthem, despite help at a hearing from the attorney general's office and the Office of the Healthcare Advocate. Then she appealed to an independent firm in an "external review" available to many consumers through the Connecticut Insurance Department. She won. The independent reviewer, the Maximus Center for Health Dispute Resolution, said the residential and day treatment were both medically necessary, and in a Feb. 1 letter reversed Anthem's denials. Anthem has paid what it owed for the day treatment in Wilton, but nothing for the Philadelphia stay.
     Gfeller says Anthem has been "cowardly" by "hanging their hat on an obsolete and ridiculous rule." Anthem believes the matter of the Philadelphia treatment should never have been accepted for external review, which by law is supposed to handle only questions of medical necessity, said Beth Cook, counsel at the Connecticut Insurance Department. The department agrees with Anthem because the denial wasn't based on medical necessity. Even if it had been, a finding of medical necessity can't override rules and limitations written into an insurance contract, such as the three-day rule, Cook says.

A Rule Under Fire
"There is a terrible shortage of inpatient hospital beds for children and adolescents in the state of Connecticut" that creates back-ups in emergency rooms, says Dr. Harold I. Schwartz, psychiatrist-in-chief at Hartford Hospital's Institute of Living. Cook says she's aware of the shortage, but the statute grants no exemption for that in the three-day rule. And the Insurance Department has no jurisdiction over self-funded health plans. However, Fairfield, which can specify what its self-funded plan can or can't cover, has the power to make an exception to its plan. So the Insurance Department has asked Anthem to see whether Fairfield might do so in the Laudadio matter.
     Anthem issued a statement last week to The Courant explaining how the three-day rule had not been met, and which said the company "is currently working with the Town of Fairfield to review this matter." Attorney General Richard Blumenthal's office has been in talks with Richard Saxl, town attorney of Fairfield. As of Friday, Fairfield hadn't made a decision. Saxl says he's been doing some fact-finding. "In the town of Fairfield, we do things the right way," Saxl said. If we owe [Gfeller] the money, she's absolutely going to get paid." The attorney general's office, interpreting the law on external reviews differently from the Insurance Department, believes the reviewer's decision on the Philadelphia treatment must be enforced and Fairfield must pay up.
     Anthem operates the network of health care providers for Fairfield's plan and had a responsibility to make sure that network would have psychiatric beds available, said Attorney General Richard Blumenthal. Meanwhile, he's supporting repeal of the three-day rule, which he calls "short-sighted and unwise and unfair." He and state Healthcare Advocate Kevin Lembo testified at a public hearing in February in favor of Senate Bill 278, which would ax the rule and revise the pre-conditions for getting residential treatment.
     The bill was never brought to a vote in the insurance and real estate committee. Sen. Joseph J. Crisco, D- Woodbridge, a co-chairman of the panel, says there was testimony that the three-day rule ensured that a patient's condition could be thoroughly and professionally evaluated in a hospital setting. The committee has approved many bills augmenting insurance coverage, and should not be held responsible for the public health issue of hospital bed shortages, Crisco said. "It's unfair to burden the insurance committee with the blame," he said.
     Blumenthal and Lembo's office are still hoping the General Assembly will address the residential treatment issue in its current session. Meanwhile, Kathryn, a drama enthusiast who has written a play about pressures on people, feels she has been relapsing since mid-December. At 98 pounds, which is below the minimum 100 that doctors set for her, she said she feels "like a whale." She thinks she may need residential treatment again and calls the Renfrew experience "amazing" but is anxious about insurance rules and cost.
     After what Kathryn has been through, she offers the insurance industry a piece of her mind. "If someone needs help, give it to them," she says. "Because people don't ask for help if they don't need it. Trust me."



Virginia Tech Massacre Has Altered Campus Mental Health Systems
Associated Press, 4/14/2008

The rampage carried out nearly a year ago by a Virginia Tech student who slipped through the mental health system has changed how American colleges reach out to troubled students. Administrators are pushing students harder to get help, looking more aggressively for signs of trouble and urging faculty to speak up when they have concerns. Counselors say the changes are sending even more students their way, which is both welcome and a challenge, given that many still lack the resources to handle their growing workloads.
     Behind those changes, colleges have edged away in the last year from decades-old practices that made student privacy paramount. Now, they are more likely to err on the side of sharing information -- with the police, for instance, and parents -- if there is any possible threat to community safety. But even some who say the changes are appropriate worry it could discourage students from seeking treatment. Concerns also linger that the response to shooters like Seung-hui Cho at Virginia Tech and Steven Kazmierczak, who killed five others at Northern Illinois University, has focused excessively on boosting the capacity of campus police to respond to rare events. Such reforms may be worthwhile, but they don't address how to prevent such a tragedy in the first place.
     It was last April 16, just after 7 a.m., that Cho killed two students in a Virginia Tech dormitory, the start of a shooting spree that continued in a classroom building and eventually claimed 33 lives, including his own. Cho's behavior and writing had alarmed professors and administrators, as well as the campus police, and he had been put through a commitment hearing where he was found to be potentially dangerous. But when an off-campus psychiatrist sent him back to the school for outpatient treatment, there was no follow-up to ensure that he got it.
     People who work every day in the campus mental health field -- counselors, lawyers, advocates and students at colleges around the country -- say they have seen three major types of change since the Cho shootings: Faculty are speaking up more about students who worry them. That's accelerating a trend of more demand for mental health services that was already under way before the Virginia Tech shootings. Professors "have a really heightened level of fear and concern from the behavior that goes on around them," said Ben Locke, assistant director of the counseling center at Penn State University.
     David Wallace, director of counseling at the University of Central Florida, said teachers are paying closer attention to violent material in writing assignments -- warning bells that had worried Cho's professors. "Now people are wondering, 'Is this something that could be more ominous?' " he said. "Are we talking about the Stephen Kings of the future or about somebody who's seriously thinking about doing something harmful?"
     The downside is officials may be hypersensitive to any eccentricity. Says Susan Davis, an attorney who works in student affairs at the University of Virginia: "There's no question there's some hysteria and there's some things we don't need to see."
     Changes are being made to privacy policies. In Virginia, a measure signed into law Wednesday by Gov. Tim Kaine requires colleges to bring parents into the loop when dependent students may be a danger to themselves or others.
     Even before Virginia Tech, Cornell University had begun treating students as dependents of their parents unless told otherwise -- an aggressive legal strategy that gives the school more leeway to contact parents with concerns without students' permission.
     In Washington, meanwhile, federal officials are trying to clarify privacy guidelines so faculty won't hesitate to report potential threats. "Nobody's throwing privacy out the window, but we are coming out of an era when individual rights were paramount on college campuses," said Brett Sokolow, who advises colleges on risk management. "What colleges are struggling with now is a better balance of those individual rights and community protections."
     The big change since the Virginia Tech shootings, legal experts say, is colleges have shed some of their fear of violating the federal Family Educational Rights and Privacy Act. Many faculty hadn't realized that the law applies only to educational records, not observations of classroom behavior, or that it contains numerous exceptions.
     The stigma of mental illness, in some cases, has grown. "In general, the attention to campus mental health was desperately needed," said Alison Malmon, founder of the national Active Minds group. But some of the debate, she added, "has turned in a direction that does not necessary support students." All the talk of "threat assessments" and better-trained campus SWAT teams, she said, has distracted the public from the fact that the mentally ill rarely commit violence -- especially against others. "I know that, for many students, it made them feel more stigmatized," Malmon said. "It made them more likely to keep their mental health history silent."
     Sokolow, the risk consultant for colleges, estimated in the aftermath of the Virginia Tech and NIU shootings, the schools he works with spent $25 on police and communications for every $1 on mental health. Only recently has he seen a shift. "Campuses come to me, they want me to help them start behavioral intervention systems," Sokolow said. "Then they go to the president to get the money and, oh, well, the money went into the door locks." Phone messaging systems and security are nice, he said, but "there is nothing about text-messaging that is going to prevent violence."



A Complex Path to Recovery
Jo Collins Mathis, Ann Arbor News- 4/14/2008

For most of her adult life, Donna Friedman has struggled with anorexia. When she was a 19-year-old college sophomore, it nearly killed her. "At the time, there was little known about eating disorders,'' said Friedman, 43, a busy mother of four who sits on several Ann Arbor area boards. "Back in the '80s, people knew nothing. Fortunately, we've come a long way in understanding and treating this illness.''
      Still, it's a daily struggle for Friedman, whose therapist calls her a "functioning anorexic.'' That means she's able to maintain her weight and go about her life as a wife and mother, but still has eating disordered patterns.
      Four months ago, after going through a particularly difficult stretch of too much exercise and too little food, Friedman picked up a copy of Aimee Liu's book, "Gaining: The Truth about Life after Eating Disorders.'' She read that true recovery requires learning how genetics, personality, relationships and anxiety affect eating disorders. By the end of the book, she was sobbing. "Aimee understood the complexity and courage it takes to fully recover,'' Friedman said. "What she wrote was so striking and right on. As someone who dealt with this for 26 years, she got it.''
     After e-mailing the author, Friedman received an inspiring response she takes with her everywhere. In fact, those words made such a difference in her life, she decided other people - especially the young women who struggle most with eating disorders - needed to hear what Liu has to say.
     That's why Friedman and her husband, Randy, an Ann Arbor school board member, are co-sponsoring Liu's free lecture Tuesday at the University of Michigan's Michigan League. "This woman is amazing,'' said Friedman. "If she can just talk to these 19-year-olds! If at 19 I had gone down a different path, I would have had a different result.'' The event is also sponsored by the University of Michigan University Health Service, CARE, a U-M student organization for body image and healthy eating awareness, and the Center for Eating Disorders, a nonprofit treatment and support organization in Ann Arbor since 1983.
     Many people struggle with subclinical eating issues including obsessive dieting, poor body image, and binge eating, said Judith Banker, founder and executive director of the Center for Eating Disorders. She hopes that those at risk for developing full-blown eating disorders will attend Liu's talk, and says her book is one of the best written on the topic because it's useful for professionals, people with eating disorders and their loved ones, and the general public.
      Friedman wants younger women to realize all the help that's available today, and take advantage of it. "These girls have to realize what they're doing today can affect the rest of their lives,'' she said. "If you don't do the work, you'll be living with this at 43 ... . When you're 19, you feel invisible and what you're doing in that moment doesn't impact you're future. It does.''
     Though her best friends know about her struggle, until now she has not spoken publicly about it. She said she's not embarrassed to come forward. "It's an illness I was born with and fought to overcome,'' she said. "I didn't ask for it. It can hit anybody.'' "For people who've not gone down this road, it's way more complicated than they realize. My mom has worried about me for 25 years.''

Sexual Assault Victims Hire Ex-Top State Prosecutor
Dave Altimari, Hartford Courant- 4/15/2008

Some of the men sexually abused as teens by probation officer Richard Straub have hired a former chief state's attorney in what they hope will be a first step toward getting long-delayed justice. Christopher Morano, the state's top prosecutor from 2002 to 2006, said part of his efforts will focus on determining whether state authorities were aware of Straub's abuse of at least 15 boys during the 1980s and 1990s. "The sexual abuse my clients suffered so many years ago is unconscionable. It had severe effects on them then and continues to do so today," Morano said. "Accordingly, my office is putting together an investigative team to discover who did what, who knew what and when."
     The Courant this past weekend reported that eight of Straub's victims were convicted of sexual assault in the years after they were abused and that Straub named many of them as creditors when he filed for bankruptcy. Morano was hired by William Bernard and John Hajder. Bernard and Hajder are not among the victims who were convicted of sexual assault.
     Many of the men were originally arrested for petty crimes as teens. Straub, who is serving a 15-year sentence, forced many of them to have sex with him in his state office under the threat that he would revoke their probation.
     Some of Straub's victims received about $4,300 each from the bankruptcy court. Half of that amount went to attorney and trustee fees. Straub's attorneys split $20,000 and the state received about $98,000. Hajder received $32,000 as part of a separate settlement.
     Just over one-quarter of Straub's 157 clients have since been convicted of sexual assault, although authorities say they are not sure how many of them were abused by Straub. Some of Straub's victims say they are convinced that there were probation department employees and court personnel in Danielson who knew what Straub was doing. Bernard said he hopes Morano will be able to hold state officials responsible. "How could they not know? There were several times when someone tried to get in while he was molesting me and they'd be knocking on the door," Bernard said. "What he did to me changed my life forever."
     Former state police Det. David LeBlanc, who was the lead investigator in the Straub case, told The Courant "there's no question Straub's supervisors were made aware that there was a problem years before it ever got to us." LeBlanc said even when officials were made aware that state police were investigating Straub, the adult probation department's cooperation was lacking. The judicial department, which at the time ran the probation department, investigated the handling of the Straub case and found no wrongdoing. That report also exonerated Straub's direct supervisors. After Straub's arrest, the department developed new procedures designed to prevent a similar occurrence, said William Carbone, executive director of the state's court support-services division.
     Morano would not discuss what legal action he might take, but state Attorney General Richard Blumenthal, who would have to defend the state, said that the victims have several options. "This case is not decades old," Blumenthal said. "These are real people who potentially deserve a remedy. What these boys needed was more than money; they needed help. I'm certainly ready and willing to help and hopefully they will get more effective legal assistance this time."
     Among the possibilities are filing for assistance from the state-funded Victim's Compensation Fund or filing a federal civil rights lawsuit against specific state employees who may have known what Straub was doing or suing the state. In order to sue the state, the victims might need a special act from the legislature because the statute of limitations has expired. A special act would give the victims a chance to file a claim with the state claim's commissioner's office, which would decide if they had a legal case to take the state to court.
     Straub will be far better off financially than his victims when he is released from a Florida prison in 2011, according to Department of Correction records. Straub was transferred to a Florida prison a few years ago for his own safety. He still owns his home and has more than $50,000 in his pension, according to court records. He continues to receive a pension of about $4,000 per month from the state.



Who Are We? Coming of Age on Antidepressants
Richard Friedman, M.D., New York Times- 4/15/2008

“I’ve grown up on medication,” my patient Julie told me recently. “I don’t have a sense of who I really am without it.” At 31, she had been on one antidepressant or another nearly continuously since she was 14. There was little question that she had very serious depression and had survived several suicide attempts. In fact, she credited the medication with saving her life. But now she was raising an equally fundamental question: how the drugs might have affected her psychological development and core identity.
     It was not an issue I had seriously considered before. Most of my patients, who are adults, developed their psychiatric problems after they had a pretty clear idea of who they were as individuals. During treatment, most of them could tell me whether they were back to their normal baseline. Julie could certainly remember what depression felt like, but she could not recall feeling well except during her long treatment with antidepressant medications. And since she had not grown up before getting depressed, she could not gauge the hypothetical effects of antidepressants on her emotional and psychological development.
     Her experience is far from unique. Since their emergence in the late 1980s, serotonin reuptake inhibitors like Prozac and Zoloft have become some of the most widely prescribed drugs in the world, for depressed teenagers as well as adults. Because depression is often a chronic, recurring illness, there are certain to be many young people, like Julie, who are coming of age on these newer antidepressants.
     We know a lot about the course of untreated depression, probably more than we do about very long-term antidepressant use in this population. We know, for example, that depression in young people is a very serious problem; suicide is the third-leading cause of death in adolescents, not to mention the untold suffering and impaired functioning this disease exacts. By contrast, the risk of antidepressant treatment is small. A 2004 review by the Food and Drug Administration, analyzing clinical trials of the drugs, did show an elevated risk of suicidal thinking and nonlethal suicide attempts in young people taking antidepressants — 3.5 percent, compared with 1.7 percent of those taking a placebo. But since the lifetime risk of actual suicide in depressed people ranges from 2.2 to 12 percent, risk from treatment is dwarfed by the risks of the disease itself.
     Still, what do we know about the effects of, say, 15 to 20 years of antidepressant drug treatment that begins in adolescence or childhood? Not enough. The reason has to do with the way drugs are tested and approved. To get F.D.A. approval, a drug has to beat a placebo in two randomized clinical trials that typically involve a few hundred subjects who are treated for relatively short periods, usually 4 to 12 weeks.
     So drugs are approved based on short-term studies for what turns out to be long-term — often lifelong — use in the world of clinical practice. The longest maintenance study to date of one of the newer antidepressants, Effexor, lasted only two years and showed the drug to be superior to a placebo in preventing relapses of depression.
     What do I say to a depressed patient who is doing well after five years on such a drug but can’t stop without a depressive relapse and who wants reassurance that the drug has no long-term adverse effects? I usually say that we have no evidence that the drug poses a risk with long-term use; and since the risk of untreated depression is much greater than the hypothetical risk of the drug, it makes sense to stay on it.
     This large gap in our clinical knowledge is compounded by the public’s growing and well-founded skepticism about research sponsored by drug makers. A study in the January 2008 issue of The New England Journal of Medicine, involving 74 clinical trials with 12 antidepressants, found that 97 percent of positive studies were published, versus 12 percent of negative studies. Clearly, physicians and the public need much better data on the safety and efficacy of drugs after they hit the market, which at present consists mainly of anecdotes and case reports.
     Congress recently reauthorized the Prescription Drug User Fee Act, which will expand the F.D.A.’s post-marketing drug surveillance, though I think it did not go far enough in mandating the use of powerful epidemiological strategies to monitor drugs over the long term.
     Beyond these concerns, there are other important issues to consider in long-term use of antidepressants, especially in young people. One patient, a woman in her mid-20s, told me that she felt pressured by her boyfriend to have sex more often than she wanted. “I’ve always had a low sex drive,” she said. For the past eight years she had been taking Zoloft, which like all the antidepressants in its class is known to lower libido and to interfere with sexual performance. She had understandably mistaken the side effect of the drug for her “normal” sexual desire and was shocked when I explained it: “And I thought it was just me!”
     This just underscores how tricky it can be to use psychotropic drugs during adolescence — when the brain is still developing, when one’s identity is still work in progress. The drugs save lives, and we often have no choice but to use them — even if we have questions about their long-term use. But the questions are big ones, and we owe it to our patients to try to answer them.
     Richard A. Friedman is a professor of psychiatry at Weill Cornell Medical College.


FDA Review Finds Generic Wellbutrin Safe, Effective
Associated Press, 4/16/2008

WASHINGTON -- Federal regulators said Wednesday Teva Pharmaceutical's generic version of a popular antidepressant is safe and effective, despite a spate of recent consumer complaints. The Food and Drug Administration agreed to review Teva's version of Wellbutrin after dozens of patients reported their depression came back after they switched from the original drug, made by GlaxoSmithKline PLC. Some patients said they also experienced headaches, anxiety and other side effects.
      In a report posted online, the FDA concluded the reoccurance of depression and other side effects are typical of patients taking antidepressants. Regulators pointed out that a study of another antidepressant showed 20 percent of patients relapsed into depression at least once after six months on the drug. The FDA detected slight differences between Teva's formulation and the original, but said they were small enough to be inconsequential.