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June
14, 2006
TIMOTHY'S
LAW NIGHT AT THE 'JOE': Join
Timothy's Law supporters for a Tri-City Valley Cats baseball game
at the Joseph L. Bruno Stadium in Troy. Tuesday, June 20th at
7:00 p.m. For tickets, contact Ruth Foster at rfoster@ftnys.org
or 518-432-0333 x15. CALL-IN
TO 'BOOT THE SHU': We also
strongly encourage everyone to call Senate leaders to urge them
to pass the legislation to ban the use of solitary confinement
in prisons and jails for inmates with psychiatric disabilities. Timothy’s
Law Campaign Rensselaer
and Suffolk County Legislatures Calls on State Senate to Pass
Timothy’s Law Resolutions before both the County Legislatures passed unanimously with bi-partisan support. Tom O’Clair, Timothy’s father, was present as the Rensselaer County Legislature lent its support to the initiative. O’Clair commented later that “I’m thrilled to have the support of the Rensselaer County Legislature in our campaign for Timothy’s Law. It’s been a long hard battle and I only hope that the overwhelming bi-partisan support I witnessed tonight is a preview of what’s to come from the State Legislature over the next several days.” Concurrently, Kim Spicciate, a member of the Timothy’s Law Campaign on Long Island, watched as the Suffolk County Legislature acted in concert with Rensselaer legislators. “Not only did the measure pass unanimously, but legislators were actually requesting that their names be listed as co-sponsors of the initiative!” said Spicciate. Bolstered by the expression of support at the local levels, Timothy’s Law supporters will continue their efforts to enact parity legislation in memory of Timothy O’Clair.
MHANYS AND SCAA HOST PRESS CONFERENCE AT WHICH MENTAL HEALTH ADVOCATES WILL BE JOINED BY LEGISLATORS TO PUSH FOR HOUSING WAITING LIST BILL PASSAGE BEFORE END OF SESSION: Media Advisory Follows Mental
Health Housing Waiting List Legislation Pushed By Contact: This legislation would create a housing waiting list for individuals with psychiatric disabilities; a model successfully used to create housing for New Yorkers with mental retardation and developmental disabilities. Further, a housing waiting list will assist the State to be in compliance with the U.S. Supreme Court decisions in Olmstead v. L.C. The Olmstead decision requires that persons with disabilities be housed appropriately in the most integrated setting possible. This legislation would establish a process that is necessary for identifying institutionalized individuals who want to live in the most integrated setting possible. After identifying these needs, advocates, housing agencies, local and state government can work together to meet those needs. Without such a waiting list, there is little way to actually ascertain what the housing needs are for individuals with psychiatric disabilities in any parts of our state. WHO: WHAT: WHEN: WHERE:
IN THE NEWS: Assembly
Pushes for Passage of Mental Health Parity Bill ALBANY ---Assembly leaders have called on the Senate to pass Timothy's Law, a mental-health parity bill approved by the Assembly with bipartisan support earlier this year so a joint conference committee can work out a compromise between each house's legislation. In strongly urging immediate Senate action, Speaker Sheldon Silver and Assemblyman Paul Tonko stressed the need to enact a law this year that would end discrimination against mental health and addiction treatment by insurance companies in New York State. They were joined by Assembly Insurance Committee Chair Alexander "Pete" Grannis and Assemblyman Peter Rivera, chair of the Mental Health, Mental Retardation and Developmental Disabilities Committee, in urging the Senate to meet the Assembly in a conference committee to resolve differences between the respective bills once the Senate had passed its legislation. The bill is known as Timothy's Law, for Timothy O'Clair of Rotterdam who took his own life before his 13th birthday. Tom O'Clair, Timothy's father, and other members of the O'Clair family have participated in many news conferences at the Capitol to explain their painful loss and the suffering they continue to experience because they lacked adequate health-insurance coverage required to provide Timothy with the treatment he desperately needed. "Timothy's Law has been a top priority of the Assembly for several years now. Too many people are suffering because they don't have the health insurance they need. This bill establishes the rights of those who need mental-health care or addiction treatment so that these individuals will no longer be second-class citizens in our health-insurance system," said Silver. "We urge the Senate to recognize the severity of this health-care crisis and quickly pass this critical piece of legislation so we can meet in conference committee and agree on a bill that can become law this year." "Each year, health plans continue to cut back on coverage for mental-health care and addiction treatment. Our parents, children, friends and families cannot continue to stand by and watch insurance coverage for these treatments erode from year to year. Most families can't afford to pay out-of-pocket for expensive care, whether it be outpatient counseling, rehabilitation or inpatient care," said Tonko, the bill's sponsor. Timothy's Law is supported by more than 320 state organizations united under the Timothy's Law Campaign, including Alcohol and Substance Abuse Providers of New York State; Coalition for the Homeless; Coalition of Voluntary Mental Health Agencies; Families Together in New York State; Mental Health Association in New York State; National Alliance on Mental Illness in New York State; New York Association of Psychiatric Rehabilitation Services; New York State Coalition for Children's Mental Health Services; New York State Council for Community Behavioral Healthcare; New York State Psychiatric Association; New York State Psychological Association; New York State Rehabilitation Association; and Schuyler Center for Analysis and Advocacy.
Mental
Health Advocates Hope to Move Bill that would End Special Housing
Units in State Prisons.
By Joseph M. Gerace The group Mental Health Alternatives to Solitary Confinement came to Albany for the third time in less than a year to continue pressing the State Senate to pass a bill ending the use of solitary confinement for the mentally ill. The
legislation, introduced by Sen. Michael F. Nozzolio, R,C-Fayette,
would require the state to provide an alternative to in-prison
housing, sometimes known as special housing units, or SHU, and
treatment for prisoners with psychiatric disabilities and mandate
the state to provide The Assembly version of the bill was passed earlier this year while Senate bill S.2207-C marched quickly through the Senate Crime Victims, Crime and Corrections Committee, which Nozzolio heads. The bill is being held up in the Senate Finance Committee chaired by Owen H. Johnson, R,C-Babylon. “In actuality, this measure doesn’t cost taxpayers a dime this year and would only require a relatively small down payment in next year’s budget,” said Harvey Rosenthal, executive director of the New York Association of Psychiatric Rehabilitation Services. Part of a comprehensive mental health prison safety and treatment improvement plan would include a redirection of existing state dollars by converting and maximizing the use of existing facilities and would show savings from decreased use of costly inpatient services and decreased time served by untreated disabled inmates. When asked about the real cost if the bill if it were to become law, Rosenthal said that no hard numbers had yet been established. He contended that it was the responsibility of the Senate Finance Committee to conduct the research. Yet the bill is “stuck in the finance committee because it is too costly, and that is false and unacceptable,” said Rosenthal, “There is no data.” Separate from the cost issue, the advocates spoke about humanitarian concerns related to a person’s confinement in the SHU. “This is a sickening way of treating human beings who are sick, it is incompetent from top to bottom,” said Ray Ortiz, a former inmate who now works for the Urban Justice League and says the existence of special housing units in prison is torture. “If you treat people like animals in a cage,” said Ortiz, “they come out as caged animals.” If the bill were to pass in the Senate, it would have to be signed by Gov. George E. Pataki and then implemented by the Office of Mental Health and Department of Correctional Services after 18 months. “This measure must be passed this year,” said Jack Beck of the Correctional Association of New York State. “In the long run, it will save New York millions of dollars. In the short term, it will save lives.”
The Chief Defenders of New York State, who represent the majority of those unable to afford an attorney in criminal cases statewide, have issued a statement opposing civil confinement legislation. The statement comes as the Assembly and Senate discuss the possibility of reconvening a committee to reach a compromise on their civil confinement bills. The Chief Defenders, part of the New York State Defenders Association, says the bills in the Senate and Assembly that would allow state courts to detain sexually violent predators beyond the terms of their prison sentences are unnecessary. A recent court decision allowed the state to use existing provisions of the Mental Hygiene Law to civilly confine sex offenders determined to be dangerously mentally ill. The Appellate Division case Consilivo v. Harkavay was decided in March and supported Gov. George E. Pataki’s 2005 decision to civilly confine those considered to be dangerous sexual predators prior to the passage of a true civil confinement law, which the governor has called for since 1998. The document released by the Chief Defenders also raises a concern that a civil confinement bill lacks “meaningful standards to guide judges and juries charged with applying the law which would result in arbitrary lifetime confinement of persons with a low risk of re-offending.” A coalition of legal groups, mental health advocates and public advocate groups including the state Bar Association, the Mental Health Association in New York State, the New York State Alliance of Sex Offender Service Providers, the New York Civil Liberties Union and The Innocence project joined with the sentiments of the Chief Defenders.
In
Diabetes, One More Burden for the Mentally Ill.
By N.R. Kleinfield Dr. John Newcomer is a psychiatrist who generally treats people with severe ailments of the mind and spirit. But before his patients sit down, before he hears about their clammy paranoia or renegade voices, Dr. Newcomer wants to know about their waist size. He steers them to a scale to learn their weight. He orders a blood sugar test. If big numbers come up, he begins a conversation about Type 2 diabetes, a disease associated with obesity that is appearing with alarming frequency among the mentally ill. "Uncontrolled diabetes can ruin a person's life as much as uncontrolled schizophrenia," said Dr. Newcomer, a professor of psychiatry at Washington University School of Medicine in St. Louis. In fact, among the mentally ill, roughly one in every five appear to develop diabetes — about double the rate of the general population. This is a little-recognized surge, but one that is jolting mental health professionals into rethinking how they care for an often neglected population. For decades, psychiatrists have worried primarily about patients' mental states, making sure they did no harm to themselves or others because of unrelenting voices or a smothering depression. Far more of the mentally ill, however, die today from diabetes and complications like heart disease than from suicide. Given that mental health specialists are often the only doctors a mentally ill diabetic ever sees, some have begun to debate the customary limits of psychiatric practice, deciding to pay much more attention to physical ailments. In particular, psychiatrists must confront the fact that diabetes, marked by dangerously high blood sugar, is often aggravated, if not precipitated, by some of the very medicines they prescribe: antipsychotic pills that have been linked to swift weight gain and the illness itself. "It's bad enough that these people have mental illness, and then they take treatments and they bring on diabetes," said Dr. Jeffrey Lieberman, chairman of the psychiatry department at the Columbia University College of Physicians and Surgeons. Treating the diabetic mentally ill can be formidable. The regimen of blood testing, dieting and exercise that controls Type 2 diabetes is often beyond the attentions of the mentally ill. For patients, the task of taming two debilitating illnesses can haunt their lives. Michael Schiraldi, 44, a Manhattan man who has both schizoaffective disease and diabetes, said his mental illness, now stabilized, was the lesser of his concerns. "I can't really control the diabetes," he said. "I might die from it." The doctors who regard diabetes as a galloping threat to the mentally ill acknowledge that many in their profession still dispute, or ignore, its consequences. Dr. Newcomer said colleagues often whine about how hard it is to weigh patients. " 'Oh', they'll say, 'there's no scale' or 'It's in a closet someplace,' " he said. Yet he says he hopes other doctors will eventually share his perspective as diabetes expands among the mentally ill and deepens into an even graver problem. BETRAYALS
OF BODY AND MIND Genes? Her mother had it. Lifestyle? She eats more than she should, exercises less than advisable. Or was it the pills that shushed the TV? The TV no longer speaks to her. She stared levelly at the set in her messy room. It was blessedly quiet. She is 53 and has battled mental illness since childhood. The pills for her illness, diagnosed as schizoaffective disorder, have helped. But she feels they have also made her fat around her abdomen, the kind of fat that can lead to diabetes. So even though Ms. Ernst feels better mentally — she no longer imagines everyone despises her — diabetes has been a crippling insult to her troubled psyche. In the late hours, alone in her room on the Lower East Side of Manhattan, trapped in the undertow of two potent diseases, she runs on empty. "Some nights, the only thing I can do is read my Bible," she said. "I look in there to find answers. They're hard to find." Diabetes on top of mental illness asks a lot of a person, and of society. Mental illness is itself a money sponge, an expense borne largely by tax dollars. But that cost may be dwarfed by the bill to manage the heart attacks and amputations that diabetes bestows. With numerous mental institutions emptied, patients often live in lightly supervised settings. Many occupy adult homes that struggle, for good reasons and bad, at providing basic services and are poorly equipped to treat diabetes. Others live on their own, sometimes in boxes beneath bridges or crumpled in doorways. Imagine taking on diabetes if you live alone and find living itself to be a handful. "I try not to drink sugared sodas, but sometimes I forget," Ms. Ernst said. "I'll buy candy — Mary Janes or banana cookies. I know I'm not fooling anybody — it's my arms and legs they're going to cut off — but sometimes I get the craving for something sweet." She sat at a round table in her room, a cool evening of early spring, cradling a stuffed bunny. She flicked a small smile. "I'm sorry it's not neater," she said, looking around. "I'm trying." Ms. Ernst embodies the difficulty of confronting the two diseases with all their complexities. She takes clozapine for her mind because she can't manage without it. She has diabetes and can't defeat her weight. "Disgusting, that clozapine," she said. "Makes you eat everything under the sun." She takes a lineup of other drugs, too, not all positive for her weight. She had hit 250, fought her way to 198, and is now at 221. She lives at Gouverneur Court, a residence run by a nonprofit organization, where about 15 of the 66 mentally ill residents have diabetes. "Some say they don't have it, but they do," said Abby Stuthers, the nurse who works there. "Or they say they have a little diabetes." Ms. Ernst freely recounts her callused life. Her marriage exploded. Once she was smacked in the face with a glass ashtray. She opened her mouth — every tooth was missing. Now diabetes. Her blood sugar has been O.K., but her vision has worsened. And she is inconsistent, prey to the fury of her demons. Susanne Rendeiro, a family nurse practitioner who serves as her primary care physician, said Ms. Ernst misses half her appointments. Recently, in reviewing her drugs, Ms. Rendeiro asked about her blood pressure pills. Puzzled, Ms. Ernst said she was not on blood pressure pills. Mrs. Rendeiro said she had supposedly been taking them for two years. "I want to be the best I can be," Ms. Ernst said. "Nobody changes overnight." TREATMENT
AND CRUEL IRONIES The spread of diabetes, however, is making the physical conditions impossible to ignore. "Psychiatrists are literally watching patients balloon up before their eyes," said Dr. Gail Daumit, an assistant professor of medicine at Johns Hopkins Medical Institutions. This has been especially true since the advent of so-called atypical antipsychotic drugs in the early 1990's. Studies indicate that these drugs can alter glucose metabolism and stimulate weight gain, particularly in people predisposed to diabetes. "Sort of a cruel irony in this," said Dr. Lieberman of Columbia, "is that all of the drugs do it to some degree, but the ones that have the most effect cause the most weight gain and metabolic side effects. There's increasing discomfort that these are driving up deaths and lowering quality of life." Some cases have been striking: a patient packing on 50 pounds in mere months, for example. Diabetes arrived as quickly, and sometimes subsided if the drugs were halted. In certain instances, there was no weight gain, but still diabetes came, often in patients who were already heavy. Studies have indicated that dozens of these patients died from diabetes-related complications. The Food and Drug Administration requires atypical antipsychotics to bear warning labels about diabetes risk, though drug makers say patients taking them who develop diabetes were destined to get it anyway. Robin Stigliano's psychiatrist has her taking Haldol by injection as well as one of the drugs most closely associated with weight gain, Zyprexa. They have helped her schizophrenia, but Ms. Stigliano, 37, who lives in a Brooklyn adult home, has seen her weight soar to 241 pounds from 150. And when she gets her Haldol infusion every three weeks, all she wants to do is sleep. "It's my favorite activity," she said. Without the drugs, psychiatrists believe, many high-functioning patients would find themselves in institutions or jail. "These drugs are enormously beneficial," said Dr. P. Murali Doraiswamy, head of biological psychiatry at Duke University. "But they have an Achilles heel." A few years ago, Dr. Doraiswamy reported a case of a mentally ill person who got diabetes and was prescribed insulin. The impact of having two serious conditions overwhelmed him. He wound up trying to kill himself by insulin overdose. Some researchers think it is possible the rash of diabetes stems in part from mental illness itself. Studies associate the onset of diabetes with depression. The mentally ill are also at high risk because they tend to eat poorly, get little exercise and have limited access to health care. In a 2003 survey, the city's health department found that about 17 percent of adults who reported symptoms of a mental illness, or 52,000, have diagnosed diabetes. Elsewhere, rates are as great or greater. Even these estimates may be low, experts said, because the mentally ill see doctors sporadically and their illnesses may be underdiagnosed. The rates of diabetes and obesity are nudging Dr. Doraiswamy and others in his field — in modest ways thus far — toward prevention, toward screening people for diabetes before choosing drugs and connecting better with primary care doctors. "This wouldn't be a big problem if most mentally ill patients had a primary care provider, but they don't," said Dr. Newcomer at Washington University. "And it's never been part of the game plan for the psychiatrist to write the prescription for your blood pressure medicine or your diabetes medicine." He feels change is imperative. "The days when I don't do windows can't go on," he said. Dr. Kenneth Duckworth, medical director for the National Alliance on Mental Illness, agreed. "I think the field has been passive," he said. "We viewed it that we do symptoms and you run your life." Stimulating change is not easy. Psychiatrists have a problem simply getting patients to stay on their drugs. Resources are inadequate. "Psychiatry is historically a couch and the chair," Dr. Duckworth said. "How do you get movement into the equation?" He said that he weighed his patients, checked sugars. But few psychiatrists are set up to do this. Treating diabetes, they say, was not what they were trained to do. And where, they ask, do they find time in 15-minute appointments? "Most psychiatrists barely look at their patients," said Dr. Donna Ames Wirshing, a staff psychiatrist at the West Los Angeles Veterans Administration Medical Center. She recently asked 30 how many weighed their patients; 3 hands went up. Dr. Wirshing and her husband, Dr. William Wirshing, are experimenting with the use of nutrition and exercise coaches for mentally ill patients. Couches could be replaced with exercise bikes. Or, as Dr. David Hellerstein, associate professor of clinical psychiatry at Columbia's College of Physicians and Surgeons, noted, "Instead of having the patient lie down and you say, 'So tell me why you fight with your brother,' you could say to the patient, 'Let's take a walk around the block while you tell me about why you fight with your brother.' " For the most part, however, psychiatrists confront the knotty questions without ready answers. If some 10 percent of schizophrenics kill themselves, and clozapine is the only antipsychotic medication demonstrated to significantly reduce suicide, but it has grave side effects, like its association with diabetes, is it miracle or monster? Or both? "When I chat with patients, about clozapine, I say, 'This may give you your mind back, but it may hurt your body,' " Dr. Duckworth said. "I think of it as psychiatric chemotherapy. Your hair won't fall out, but you may get diabetes." How do patients respond? "Some say, 'If this will give me my mind, I'll take anything,' " he said. "Some say, 'There's nothing wrong with me, why are we even having this conversation?' About 60 percent of schizophrenics don't recognize that they have it. There are very few easy answers in my line of work." HOUSING
THE ILL AND DIABETIC So the men and women eat, sleep, smoke, watch TV, sleep — then do it all over again. Unsurprisingly, those who live there say, dozens of the 200 residents struggle with diabetes. These often-troubled homes where so many of the mentally ill are housed, frequently grumbling about inadequate attention to their needs and their dignity, can be hideously difficult places for someone at high risk for diabetes. And that is basically everyone who lives there. Leslie Hinden, a chatty man of 51, sat listlessly in the lounge, near the junk food dispensers. He'd be buying sweets but was broke from binging. He has had schizoaffective disease — characterized by symptoms of schizophrenia and depression — for most of his life. Sometimes he hears Indian war whoops in his head. About 17 years ago, he picked up diabetes, too. His blood sugar was 289 that morning, he said. A normal fasting blood sugar reading is below 126 milligrams per deciliter. "I cheated," he said. "Last night I ate two eclairs. Had a Coke. A lot of times I don't cheat and it goes up to 300. I don't know what to do." Why the binge last night? "I don't know," he said. "I felt scared." A recent State Department of Health sampling of 19 homes found that nearly a quarter of residents had diabetes. The homes say they do what they can. Some have diabetes sections in the dining halls, where occupants get a sugar-free dessert. "I'm not a doctor, but we're very helpful," said Mordechai Deutscher, the case manager at Surf Manor, who said he did not think the home had many diabetics. "The people here are doing very well." Even mental health advocates have not given diabetes much attention. The Commission on Quality of Care and Advocacy for Persons with Disabilities, a state watchdog agency, said it has never examined diabetes prevalence or care. At Surf Manor, Mr. Hinden, like the other diabetic residents, cannot have a blood sugar meter or give himself insulin. Needles are considered perilous. He depends on the staff. But no one prescribes motivation or understanding. And where diabetes requires vigilant self-management, illnesses like schizophrenia often mean memory problems and lack of drive. "I'll be honest with you, I don't understand diabetes," Mr. Hinden said. "I don't understand it at all." Joseph Franklin, 47, sat down, all 300-plus pounds of him. He said he has been taking diabetes drugs for seven years. "It's just in case," he said. He said he was bipolar: "I couldn't see people with shoes on. If I saw someone with shoes on, it could do something to my forehead." He spread out some greeting cards he had made. He leaned close. "Listen, I don't want everyone to hear this," he said, "but it's very possible that, unless the doctor made a mistake, I do have diabetes." A stoic man of great girth named Lee Symons, 57, nodded. He had it, too. He hears guitars and banjos thrumming in his head. Was he trying to diet? "No one told me to," he murmured. What about the diabetes? "As long as it doesn't hurt, I don't mind it," he said. "It's just diabetes."
Hispanic students are much more likely than black or white students to report attempted suicide, according to a new report on youth risk behaviors released last week by the Centers for Disease Control and Prevention (CDC). The national report, Youth Risk Behavior Surveillance, United States, 2005, monitors priority health risk behaviors that contribute to the leading causes of death, disability and social problems among youth and adults. YRBS provided data representative of 9th through 12th grade students in public and private schools throughout the country. Nearly 14,000 U.S. high school students participated in the 2005 National YRBS. The report found that fewer U.S. high school students are engaging in health risk behaviors compared to their counterparts from 15 years ago. Despite an overall decrease in health risk behaviors among high school students since 1991, racial and ethnic differences continue to be evident, the report noted. 'The reasons for these racial and ethnic differences are complex. More research is needed to assess the impact of education, socio-economic status, environment, and cultural factors that may contribute to health risk behaviors among high school students,' said Howell Wechsler, Ed.D., MPH. In the United States, 71 percent of all deaths among persons aged 10-24 years result from four causes: motor vehicle crashes (31 percent), other unintentional injuries (14 percent) homicide (15 percent) and suicide (11 percent). Nationwide 8.4 percent of students actually attempted suicide one or more times during the 12 months preceding the survey. Overall, the prevalence of having actually attempted suicide was higher among female (10.8 percent) than male (6 percent) students; higher among white female (9.3 percent), black female (9.8 percent) and Hispanic female (14.9 percent) than white male (5.2 percent) black male (5.2 percent) and Hispanic male (7.8 percent) students. Overall, the prevalence of having actually attempted suicide was higher among Hispanic (11.3 percent) than white (7.3 percent) and black (7.6 percent) students; higher among Hispanic female (14.9 percent) than white female (9.3 percent) and black female (9.8 percent) students. The study found the prevalence of attempted suicide was higher among Hispanic male (7.8 percent) than white male (5.2 percent) students. According to the study, the prevalence of having actually attempted suicide was higher among 9th grade (10.4 percent) than 11th grade (7.8 percent) and 12th grade (5.4 percent) students. It was higher among 9th grade female (14.1 percent) than 10th grade female (10. 8 percent) and 12th grade female (6.5 percent) students. Among male students, the study found the prevalence of attempted suicide was higher among 10th grade male (7.6 percent) than 11th grade male (4.5 percent) and 12th grade male (4.3 percent) students. SAD,
HOPELESS Overall, the prevalence of having felt sad or hopeless almost every day for more than two weeks was higher among female (36.7 percent) than male (20.4 percent) students; higher among white female (33.4 percent), black female (36.9 percent) and Hispanic female (46.7 percent) students than white male (18.l4 percent), black male (19.5 percent) and Hispanic male (26 percent) students, respectively, according to the report. During the 12 months preceding the survey, 13 percent of students nationwide had made a plan about how they would attempt suicide. Overall, the prevalence of having made a suicide plan was higher among female (16.2 percent) than male (9.9 percent) and higher among white female (15.4 percent) black female (13.5 percent) and Hispanic female (18.5 percent) students than white male (9.7 percent), black male (5.5 percent), and Hispanic male (10.7 percent) students. For a copy of the full report visit, www.cdc.gov. |
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