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Burdens of Schizophrenia, Barriers to Care

Experience Schizophrenia Through a Symptom Simulator -
The Virtual Hallucination Machine

April 19, 2004
11:30 a.m.-1:30 p.m.
711-A Legislative Office Building
Albany, New York
Lunch will be provided

Please RSVP
phone: (518) 434-0439 ext. 21
e-mail mseereiter@mhanys.org
fax: (518) 427-8676

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In the News:

Profits show HMOs can afford Timothy's Law. - Letter to the Editor
Albany Times Union, April 16, 2004

There has indeed been an abundance of recent news coverage of Timothy's Law, which would end the discriminatory insurance coverage limits those with mental illness and chemical dependency face (see "Timothy's Law carries too high a price tag," letter, April 4).

For a year and a half, thousands of family members, consumers, professionals and advocates have publicly called for passage of Timothy's Law. On the other side, one man, Paul Macielak, of the Health Plan Association, publicly opposes Timothy's Law, writing to newspapers across the state.

Mr. Macielak represents the multibillion-dollar health insurance industry here in New York. Some of his members were featured in another recent Times Union article, "Growth of HMOs primarily healthy in 2003" (April 2). Indeed, of the 19 HMOs Mr. Macielak represents statewide, the five serving the Capital Region currently enjoy nearly $300 million in net income. In 2002, all the HMOs in New York enjoyed $1.153 billion in profits.

With more than $1 billion in profits, Mr. Macielak would like your readers to believe that HMOs in New York can't afford the $1.26 per person per month cost increase associated with Timothy's Law. But most of the cost of Timothy's Law won't come out of their profits. While New Yorkers are very willing to pay the cost to end this discrimination, the savings and value of good and equal care will more than offset Mr. Macielak's gloom and doom scenario.

JOSEPH A. GLAZER, Esq.
President/CEO, Mental Health Association in NYS
Albany, NY

 

Mentally ill entitled to health coverage. Letter to the Editor
The Journal News, April 11, 2004

Those of us advocating for "meaningful" change in legislation to address the needs of the mentally ill are not telling stories but sharing our experiences with the hope that we can achieve overdue changes.

New York Health Plan Association head Paul Macielak (March 28 letter) believes changing legislation would not provide anything positive and only make health insurance costlier? There is something wrong with a health-care system that leaves parents with no choices but to relinquish their rights in order for their mentally ill child to receive treatment. He fails to point out those adults who suffer from mental illness burden the system so taxpayers struggle to pay higher taxes along with exorbitant insurance premiums. Present legislation leaves those who suffer from mental illness with treatment that is inadequate. They remain sick, resulting in more and more money needed to address their needs.

Mr. Macielak thinks that the mentally ill should continue to be treated with care that is inadequate so that insurance could become more affordable to "others"? This type of rationale is exactly why no progress has been achieved in health care. Those of us advocating for the mentally ill aren't looking for unlimited coverage. We are looking for "meaningful" coverage because that is what the mentally ill are entitled to. Perhaps if the insurance companies stopped spending millions of dollars on lobbying to prevent change, meaningful legislation could be passed, health insurance premiums could be reduced, and we all could afford health insurance. Wouldn't that be the "perfect" solution in this not-so-perfect world?

Joanne Cottini,
West Harrison

 

A call to help the mentally disabled. By Bill Hughes
The Journal News, April 14, 2004

To his many friends at Pete's Saloon in Elmsford, Dennis Morgan was affectionately known as "Dennis DeCaf," a sort of local misfit and bar mascot who came in four or five times a day to drink decaffeinated coffee.

He had a nervous habit of twirling his mustache, he liked to tell corny jokes and he always had to have at least two packs of Marlboro Lights on hand. He came to the bar for the fellowship he found there and to get a break from caring for his schizophrenic and terminally ill mother.

Everyone who knew Morgan said he was a quirky guy, but nobody knew he was also a clinically diagnosed paranoid schizophrenic who took daily medication for about 20 years to control his illness.

"To us, Dennis was just Dennis," said Pete Riekstins, the owner of the popular working-class bar that became Morgan's second home. "Everybody knew he was a little off-the-wall, but nobody who knew him thought he would ever hurt a flea."

To the Westchester County prosecutor's office, Dennis Morgan was Case 1057-2002, a man charged with arson and assault after he set fire to the apartment he shared with his mother in a 14-unit building on Paulding Avenue in April 2002. The blaze injured two firefighters and endangered many other lives.

After the fire, while his mother was being treated, nurses discovered puncture wounds on her stomach. She told them her son had stabbed her the night before, and he was also charged with felony assault. His lawyer argued that Morgan's mental condition was a mitigating factor and tried to get him treatment and probation. District Attorney Jeanine Pirro insisted he serve at least five years in prison.

"My understanding is that this was an individual who committed several serious criminal acts, who stabbed his own mother with a knife and lit fire to a building that could have resulted in the deaths of several people," Pirro said. "My primary charge as district attorney is to secure the safety of the public and to see to it that dangerous people are put in jail where they belong."

Depending on whom you talk to, Morgan was either a likable eccentric with no criminal history who lost control over his mental illness during one tragic, 24-hour period, or a threat to society who belonged locked up in prison for several years.

But no matter whom you talk to, these facts are indisputable: Morgan is now dead, an apparent prison suicide. He might be alive today if he had options available to a growing number of mentally ill defendants across the country, but not in Westchester.

A life out of control
Morgan's court-appointed attorney, Robin Bauer, said his case is a prime example of the need for a mental-health court in Westchester County.

"In my 23 years as an attorney, this case was the greatest failure of the system as a whole that I've ever seen," Bauer said. "This man just slipped through the cracks and had such a sad, horrible ending to his life. The most disturbing thing is that it could have easily been avoided."

As a teenager, Morgan wanted to be a professional golfer, and after he graduated from Woodlands High School in Greenburgh in 1971, he worked for a few years at the Sleepy Hollow Country Club.

But when he was about 30, his mental illness got the best of him, and he attempted suicide by jumping out a window. Bones in both his legs were shattered, along with his dreams of becoming a golf pro.

His injuries and illness transformed him into a ward of the state, permanently disabled by his combined mental and physical conditions. Had he tried suicide 10 years earlier, Morgan might have been institutionalized, but his episode occurred in an era when New York state was emptying its mental hospitals.

So he was placed in subsidized housing with his schizophrenic mother and put on daily medication.

"He managed to hold it together for 20 years, taking care of a sick mother and taking care of himself by taking his medication," Bauer said.

In the months leading up to the fire, bad news fell on Morgan like a dark, steady rain. First, his only sister died of a heart attack, but his brother-in-law didn't tell Morgan and his mother about it until two months after she was buried.

Around that time, he learned that his mother was terminally ill. Morgan had two brothers, one a former Greenburgh police officer who apparently wanted nothing to do with his family and moved to the West Coast, and another confined to a mental institution.

In an effort to pull his dissolving world together, Morgan petitioned officials to release his brother from the institution so he could care for him. Shortly before the day he set the fire, Morgan was informed that his brother would not be released.

Several people familiar with his case believe that Morgan stabbed his mother and lit the fire in an abysmally failed attempt at mercy killing and suicide.

After Morgan was arrested in April 2002, Bauer began working with the District Attorney's Office to get him a probationary sentence. Bauer persuaded a group home in Port Chester to accept Morgan as a resident, should he get probation, a difficult feat for a person accused of arson. She went back and forth with Pirro's office for nearly a year, and finally she was told that the only plea offer on the table involved a minimum five-year prison term.

'Complicated things, I can't comprehend'
When Bauer brought the bad news from the prosecutor's office to Morgan, he became angry and confused. He couldn't handle the uncertainty of his situation or the idea of standing trial; he just wanted the whole thing to be over.

"I tried to convince him he should either hold out for a better deal or go to trial, but he said he couldn't take not knowing what was going to happen to him anymore, and he wanted to take the plea," Bauer said.

Morgan wrote to the judge telling him he was firing Bauer and pleading guilty. He wanted to serve the five years and be done with it. At the hearing during which Morgan entered his guilty plea, Bauer was tentatively re-hired by Morgan, and she gave an impassioned plea to the judge asking for leniency.

During the hearing, at which he waived his right of appeal, Morgan responded to several questions with the answers of a man who was clearly confused about what was happening to him. At one point, in response to a question from Assistant District Attorney Susan Ferlauto about whether he had any problem understanding the English language, Morgan replied, "I have neurological problems. Complicated things, I can't comprehend. And I have short-term memory loss."

Laurence Baker, a practicing psychologist for more than 50 years, reviewed the transcript and concluded that Morgan should have been evaluated for competency.

"Here you've got a guy who's on medication and known to be suicidal. How could he be competent?" Baker said. "There's a real question of whether people on medication are really mentally competent, especially when they're waiving their right to an appeal. Medications can help seriously ill people negotiate the world comfortably, but it doesn't make them necessarily normal."

A call for reform
Baker said the courts should appoint neutral parties, not hired by either the defense or the prosecution, to evaluate the mental status of defendants like Morgan. He also said he intended to recommend that the Westchester County Psychiatric Association, of which he is a board member, begin advocating for the establishment of a mental-health court for the county.

Currently, there are only three such courts in the state. They provide treatment alternatives to incarceration for mentally ill defendants — in Brooklyn, the Bronx and Rochester. Lucille Jackson, clinical director for Brooklyn's court, the only one that takes felony cases, said Morgan's situation was common among people who crack under the stress of chronic mental illness.

"We've had a lot of success with people like Dennis Morgan because they're not criminals in the traditional sense; they're people who are sick and who have had a psychotic breakdown," Jackson said. "While that breakdown may have caused them to commit a criminal act, structuring a treatment program designed to prevent this sort of thing from happening again makes a lot more sense than throwing them into a prison where their conditions will very likely deteriorate."

Judge Matthew D'Emic, who presides over the court, said many people have radically different reactions to mental illness than they do to physical suffering.

"For whatever reason, when most people learn that someone is physically ill, they automatically respond with compassion. But when they learn that someone is mentally ill, their first response is fear," D'Emic said. "I believe the court system has to take this fear for public safety from where it's been to where it's never been."

Another systemic failure, Baker said, was Morgan's placement into the general population when he was shipped to the Clinton Correctional Facility in Dannemora, N.Y., in August of last year, despite his mental illness and two known previous suicide attempts.

Three months later, his mother died, and in what may have been the final stroke of bureaucratic bungling for Morgan, her cremated remains were sent to the prison. A few days later, on Dec. 8, he was found alone in his cell at 5:40 a.m., bleeding from a cutting wound to his throat. According to a statement released by the prison, a guard had seen him alive 40 minutes earlier. At 7:45 a.m., Dennis Morgan was pronounced dead. He was 51 years old.

A prison chaplain contacted Rob "Sparky" Georganakis, one of the regulars at Pete's Saloon, since he was the only contact they had for Morgan. Subsequently, Georganakis was told that prison officials had contacted Morgan's brother, who apparently gave the state permission to bury him in a potter's field upstate.

State Department of Correctional Services spokesman James Flateau said the urn bearing Morgan's mother's ashes was placed on top of his coffin and buried in the same unmarked grave.

 

Mental health court offers options for many defendants. By Bill Hughes
The Journal News, April 14, 2004

BROOKLYN — In Judge Matthew D'Emic's court, it is not unusual to see magic tricks performed by schizophrenics and artwork displayed by manic depressives, or to hear gospel tunes belted out by criminal defendants with bipolar disorders.

In fact, the judge encourages it.

D'Emic presides over Part MD-1 of the state Supreme Court, otherwise known as mental health court in downtown Brooklyn. It is the only court in the state where felony defendants who suffer from serious mental illness but are not legally incompetent can opt into a special program and receive treatment for their illness instead of incarceration.

"Years ago, the solution to the drug problem was 'Lock 'em up and throw away the key,' " D'Emic said. "Well, we realized that wasn't working. Drug courts were created with treatment alternatives and, lo and behold, they worked. Likewise with domestic violence. It used to be 'This is a personal thing. To take a walk around the block and cool off.' And a week later, the police would be back. Then we started domestic violence courts and, guess what? They're working, too. This was a natural evolution of those success stories."

Brooklyn's court is one of 37 federally funded programs nationwide set up since 2002 to provide mentally ill defendants with comprehensive screening and treatment programs that address problems ranging from medication and therapy needs to job training and housing for defendants who qualify.

Most mentally ill criminal defendants are represented by court-appointed lawyers who can apply to have a client's case heard in D'Emic's court. The Brooklyn District Attorney's Office can review and oppose the applications. Once a defendant is accepted, he or she must enter a guilty plea and submit to an evaluation by a team of psychologists and social workers.

A treatment program is tailored to each defendant, and can include components such as mandatory medication or drug treatment, curfews and an array of therapeutic programs, along with regular visits to D'Emic's courtroom for updates.

A visit to D'Emic's courtroom can be therapeutic in itself, unlike the usually stress-charged atmosphere of a normal criminal courtroom. D'Emic and his staff are intimately acquainted with each defendant's personal and criminal history.

The judge reviews each defendant's progress report and speaks directly to them in a kind, fatherly tone, inquiring about their lives and their treatment, and encouraging them to display whatever talents or hobbies they may have.

"It's been amazing to watch how this man has literally transformed people's lives by simply conveying to them that he genuinely cares about them and wants them to succeed in their treatment," said Karen Kleinberg, D'Emic's law secretary.

The court opened in October 2002 and has only recently begun "graduating" defendants who have completed 18- to 24-month sentences. Upon successful completion of the program, the district attorney formally drops the charges.

"So far, we've got empirical evidence that this is working, since only 12 percent of our people violate their probation, while it's closer to 50 percent for the general courts," D'Emic said.

Robert Corliss works for the state chapter of the National Alliance for the Mentally Ill, which advocates for such courts to be established in all New York counties and across the country. Corliss said frequent opposition to alternative sentencing projects arises from law enforcement agencies and politicians who don't want to be seen as coddling criminals.

"Some DAs tend to take a hard line. As a class, they tend to feel that's their job, and it's up to the defense attorney to fight for their clients to get something different," Corliss said. "They tend to think, 'As far as I'm concerned, I'm just here for public safety, and if I can get a person out of the community for five years or 10 years, I don't care if it's in prison, where he doesn't belong.' "

Westchester County District Attorney Jeanine Pirro wrote in her recently published memoir that she opposes insanity defenses in criminal trials, but said recently that she would work with state officials if the Office of Court Administration were to establish a mental health court in the county. Pirro added that her primary concern was keeping dangerous individuals off the streets and that she would rather see more drug courts established throughout the county before mental health courts, because drug problems are more pervasive.

D'Emic said he, too, was concerned with public safety.

"Don't get me wrong. I'm perfectly willing to lock up people who are a danger to society and to themselves," D'Emic said. "I'm just a firm believer that it's not the only thing we as a society can do to protect our citizens. There are other ways to address this problem and we need to explore them all."

At a recent meeting with The Journal News Editorial Board, New York state Chief Judge Judith Kaye and Administrative Judge Jonathan Lippman said they both supported the expansion of mental health courts throughout the state.

"If it's a matter of getting them help and getting them resources before something terrible happens, let's do that rather than having the same person come in again and again with a mental health problem where it's not identified as such," Lippman said. "They come back and forth, back and forth, and no one really understands it's a mental health problem. Then, down the line, something terrible happens. With early screening, getting them into a part which is knowledgeable about this sort of problem and then getting them some help can have that person where they're no longer in the justice system."

 

State prisons need oversight.
Poughkeepsie Journal, April 12, 2004

State lawmakers should be furious that the Department of Correctional Services has cut off their oversight on the prison system -- but, instead, there's an astounding lack of response.

The Correctional Association of New York, the Legislature's prison watchdog group, is outraged, and justly so. Correctional Services Commissioner Glenn Goord has put so many restrictions on the nonprofit organization that doing its job has become incredibly difficult.

Little wonder, then, that the Correctional Association is taking legal action against the state Department of Correctional Services. The group has filed a motion seeking a preliminary injunction against Goord, in federal court in Manhattan.

However, it's state lawmakers, not lawyers in court, who should be the loudest in demanding a return of independent oversight of the state's prisons.

It was the Legislature that established the Correctional Association in 1846. Ever since, association staff members have visited state prisons, reporting on what they saw and heard and offering policy recommendations to lawmakers.

That oversight is needed more than ever 158 years later. Today's state correctional system is responsible for 65,000 inmates at any given time in 70 facilities across the state.

The Correctional Association, among other groups, has called attention to some serious matters in these prisons, particularly in regard to mentally ill inmates.

An association report says some of these prisoners have been put in isolation units to punish them for infractions -- for as much as 23 to 24 hours a day. In ''The Box,'' they reportedly are often denied meals, taunted, called by racial epithets and neglected of medical attention.

The Poughkeepsie Journal has reported that more than half of prison suicides occur in solitary confinement -- even though less than 10 percent is ever put into these units.

Instead of directly answering contentions like these, the Department of Correctional Services has accused its principal author, Jennifer Wynn, of an ''improper personal relationship'' with an inmate. She allegedly gave the prisoner a couple of gifts. Goord has banned Wynn from all but designated visitor areas. Whether or not Wynn did something wrong, it has nothing to do with prison conditions and should be investigated separately.

The department has also restricted the ability of Wynn's colleagues to interview inmates and corrections officers, or to observe conditions in The Box.

This is not a reasonable response. It's an affront to the Legislature -- which ought to be insisting on answers.

The Department of Corrections has made some important strides in recent years. For instance, it has:

- Cut the number of AIDS deaths by 94 percent - from 258 in 1995 to 15 in 2002.

- Effectively kept illegal drugs out. Nearly 93,000 convicts were examined last year, but less than 4 percent tested positive for drug use.

But oversight is still important. The courts will eventually rule on the lawsuit against the Department of Correctional Services. State lawmakers shouldn't wait. They should demand an immediate restoration of unfettered access by their independent Correctional Association.

On the Web

- Read the Correctional Association's report at: www.corrassoc.org/lockdown-new-york.htm

- Read the Department of Correctional Services' response at www.docs.state.ny.us/PressRel/gangi2.html

- Read the Journal's study of prison suicides at www.poughkeepsiejournal.com/projects/suicide

 

Until next time, we remain,
Working to ensure available and accessible
mental health services for all New Yorkers