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October
11, 2006 MHANYS ANNUAL AWARDS DINNER AND CONFERENCEOCTOBER 26-27Information and Registration at www.mhanys.orgNMHA:
TALKING TO KIDS ABOUT FEAR AND VIOLENCE: Recent acts of violence in Colorado, Pennsylvania and Wisconsin schools have stunned the nation. Children, in particular, may experience anxiety, fear, and a sense of personal risk. They may also sense anxiety and tension in those around them — friends, family members, loved ones, caregivers and other adults who have a direct impact on the well-being of children. Knowing how to talk with your child about violence will play an important role in easing fear and anxieties about their personal safety in these tenuous times as well as helping them to manage rising concerns. To guide parents through discussions about fear and violence, the National Mental Health Association (NMHA) offers the following suggestions: Encourage children to talk about their concerns and to express their feelings. Some children may be hesitant to initiate such conversation, so you may want to prompt them by asking if they feel safe at school, in their neighborhood, or in public places. When talking with younger children remember to talk on their level. For example, they may not understand the term “violence” but can talk to you about being afraid or a classmate who is mean to them. Encourage them to express their feelings through talking, drawing or playing. Validate the child’s feelings. Do not minimize a child’s concerns. Let him/her know that serious acts of violence are not common, which is why incidents such as these shootings and the Sept. 11 terrorist attacks attract so much media attention. Talk honestly about your own feelings regarding violence. It is important for children to recognize they are not dealing with their fears alone. Don’t be afraid to say “I don’t know.” Part of keeping discussion open is not being afraid to say you don’t know how to answer a child’s question. When such an occasion arises, explain to your child that these acts of violence are rare, and they cause feelings that even adults have trouble dealing with. Temper this by explaining that, even so, adults will always work very hard to keep children safe and secure. Discuss the safety procedures that are in place at your child’s school, in your neighborhood, and in other public places. Arrange a presentation by McGruff the Crime Dog, a member of the local police force, or a neighborhood watch captain. Create safety plans with your child. Help identify which adults (a friendly secretary, trusted neighbor or security guard) your child can talk to if they should feel threatened. Also ensure that your child knows how to reach you (or another family member or friend) in case of crisis. Remind your child that they can talk to you anytime they feel threatened. Recognize behavior that may indicate your child is concerned about their safety. Younger children may react to violence by not wanting to attend school or go out in public. Behavior such as bed-wetting, thumb sucking, baby talk, or a fear of sleeping alone may intensify in some younger children, or reappear in children who had previously outgrown them. Teens and adolescents may minimize their concerns outwardly, but may become argumentative, withdrawn, or allow their school performance to decline. Empower children to take action regarding their safety. Encourage them to report specific incidents (such as bullying, threats or talk of suicide) and to develop problem solving and conflict resolution skills. Encourage older children to actively participate in student-run anti-violence programs Keep the dialogue going and make safety a common topic in family discussions rather than just a response to an immediate crisis. Open dialogue will encourage children to share their concerns. Seek help when necessary. If you are worried about a child’s reaction or have ongoing concerns about his/her behavior or emotions, contact your pediatrician or a mental health professional at school or at your community mental health center. Your local Mental Health Association or the National Mental Health Association’s Information Center can direct you to resources in your community. For more information, contact your local Mental Health Association or the National Mental Health Association at (800) 969-NMHA. NMHA AND NAMI RESPOND TO BRITISH STUDY ON OLDER VS. NEWER ANTIPSYCHOTIC MEDICATIONS: See Washington Post article in the In The News Section below. NAMI Press Release: NAMI
Critiques Latest Schizophrenia Study: ARLINGTON, Va., Oct. 3 /PRNewswire/ -- A British study published in the current issue of the Archives of General Psychiatry, comparing old and new antipsychotic medications, has two major implications for federal and state policies, the National Alliance on Mental Illness (NAMI) today advised. The first involves the nation's science agenda. The second involves individual access to the right medications for treatment under Medicare, Medicaid and the Veterans Administration -- which is expected to fuel ongoing federal and state political battles. In April 2006, Jeffery Lieberman, M.D., Chairman of the Columbia University Department of Psychiatry -- who heads a series of studies on schizophrenia funded by the National Institute of Mental Health (NIMH) which has made findings similar to those of the British study (and who wrote an editorial that accompanied its publication) -- warned: "The most important message of the results is the need for better treatments. Until we have those new treatments, given the substantial limitations of current medications and the diversity of patient response, clinicians need a broad range of treatment options, not restrictions on choices." Science & Medicine "It is essential that science and access to care not be confused, and that key distinctions, limitations and flaws in the study be overlooked," said NAMI executive director Michael J. Fitzpatrick. "For science and medicine, the study reflects much of NAMI's research agenda and points to the need for the President and Congress to push harder for investment in long-term, independent and comprehensive studies." "There is a need for a more effective, third generation of medications that can ultimately lead to a cure for schizophrenia, one of the most severe mental illnesses," said NAMI medical director Ken Duckworth, M.D. Medicare, Medicaid & Veterans Policy "For Medicare, Medicaid, and the Department of Veterans Affairs, it would be a grave mistake to use the study to restrict access to newer medications, based on general findings that older medications seem to work as well as the newest generation," Duckworth said. "General findings cannot be substituted for specific choices made in treating individuals with schizophrenia. One size does not fit all. It is critical that the study's limitations be recognized." For
one, the British study relies heavily on an older drug, sulpiride
that has never been approved by the Food & Drug Administration
(FDA) and is unavailable in the United States. In addition "It is important to note that the study focuses only on medication," Duckworth said. "This is only one dimension of discussion for policymakers. Treatment of schizophrenia also requires psychosocial interventions, such as supportive counseling, housing and employment." "Finding the right medication may be the cornerstone in building the right foundation for recovery for an individual. If you don't get the medication right, you run up costs elsewhere. That's another reason that unrestricted access to both old and new medications is a critical factor for budget concerns." The Framingham Heart Study "It is important too to understand that one-year studies still do not tell us much about the treatment of any mental illness over time," Duckworth said. "We need a comprehensive study to track the progress of a community of individuals over their life courses, looking at a range of factors and real- world conditions. The Framingham Heart Study is a model that urgently needs to be included in the nation's research agenda on mental illness." Directed by the National Heart, Lung and Blood Institute, the FHS is a landmark study begun in 1948 that continues today. Approximately 12,000 residents of Framingham, Massachusetts originally were enrolled in a study designed to gather medical data, and more recently DNA samples. New generations of participants were added in 1971 and 2002. The study has helped to identify risk factors and related concerns, contributing to improvements in treatment. NMHA:
IN THE NEWS: Nearly
8 Years Later, Guilty Plea in Subway Killing. By Anemona
Hartocollis A schizophrenic man pleaded guilty to manslaughter yesterday, admitting for the first time that he knew what he was doing when he pushed a promising young writer to her death in front of a subway train almost eight years ago. The man, Andrew Goldstein, acknowledged that he knew it was wrong to shove the woman, Kendra Webdale, 32, into the path of an N train at the 23rd Street station in January 1999. The death of Ms. Webdale, a journalist and photographer who had moved to the city from Buffalo, unnerved New Yorkers who had come to think of their city as the safest it had been in years. The public outcry over her death led to a state law, known as Kendra’s Law, that gives families the right to demand court-ordered outpatient psychiatric treatment for their relatives.Until his plea yesterday in State Supreme Court in Manhattan, Mr. Goldstein had claimed that he had pushed Ms. Webdale during a psychotic episode and therefore was not responsible for his actions. “She was leaning against a pole with her back to me near the edge of the platform by the tracks,” Mr. Goldstein said in a written statement submitted yesterday to Justice Carol Berkman. “I looked to see if the train was coming down the tracks. I saw that the subway train was coming into the station. When the train was almost in front of us, I placed my hands on the back of her shoulders and pushed her. My actions caused her to fall onto the tracks.” Mr. Goldstein, 37, pleaded guilty in a deal negotiated by prosecutors with the consent of Ms. Webdale’s family. He was promised 23 years in prison with five years of postrelease supervision — including psychiatric oversight — at his sentencing, set for next Tuesday. The plea came as he was about to be tried for the third time. Mr. Goldstein was convicted of second-degree murder in his second trial, in March 2000, after the first ended in a hung jury. He was serving 25 years to life, the maximum, when his conviction was overturned last December by an appeals court that found he had been denied a fair trial. Ms. Webdale’s sister Kim Emerson said yesterday that her family had agreed to the plea deal because they could not bear the trauma of going through another trial with an uncertain outcome. She said it was both painful and a relief to hear Mr. Goldstein admit his guilt. “I miss my sister,” Ms. Emerson said after the hearing yesterday, during which she sat silently with the other spectators. “It brings back what happened on the platform, and to hear him say that he did push her and it was intentional was really hard to hear.” At the same time, she added, “to hear him express it was difficult, but satisfying.” She said the agreement that Mr. Goldstein would be monitored by psychiatrists after his release was important to her family. “The certainty that he won’t do this to anybody else has been our goal all along,” she said. Prosecutors said Ms. Webdale’s family planned to make a statement to the judge before Mr. Goldstein’s sentencing. Ms. Webdale was the third of six children, and 20 months younger than Ms. Emerson. Mr. Goldstein’s schizophrenia was diagnosed 10 years before Ms. Webdale was killed. A graduate of the Bronx High School of Science, he was living in Howard Beach, Queens, at the time of his arrest. His lawyers blamed his failure to take antipsychotic medication for Ms. Webdale’s death, and said the state mental health system had repeatedly sent him back to the streets despite a history of violent behavior and his own requests for treatment. The prosecution contended that he had a history of using his sickness as an excuse for bad behavior. In Mr. Goldstein’s first trial, the jury deadlocked over whether he should be found not guilty by reason of insanity. The second jury found that he had known what he was doing, and convicted him of second-degree murder. But the Court of Appeals, the state’s highest court, overturned that conviction, finding that Mr. Goldstein’s constitutional right to confront witnesses against him had been violated. The appeals court said Justice Berkman had erred in allowing a psychiatrist to testify about what other people had said about Mr. Goldstein’s mental condition when those people were not available for cross-examination. “What I’ve learned from this whole experience is that there’s no certainties with the justice system,” Ms. Emerson said. “It would be very difficult emotionally to sit through another trial and possibly future appeals. I know my mother is definitely ready to have this be finished.” As part of his plea, Mr. Goldstein had to answer questions meant to determine whether he was pleading guilty of his own free will, and whether he understood the charge. “On Jan. 3, 1999, did you push a woman you came to know as Kendra Webdale to her death?” Justice Berkman asked him yesterday. Mr. Goldstein answered, “As much as I can understand, I did that.” Justice Berkman said she was not sure what he meant, and Mr. Goldstein’s lawyers whispered to him at the defense table. He then changed his answer to a simple “yes.” The judge asked whether he had intended to cause serious injury. “Yes,” he said. “But not necessarily death.” After another conference with his lawyers, he added, “Yes, yes.” In the nearly eight years since Ms. Webdale was thrown to her death, her mother, Patricia Webdale, has become an advocate for the mentally ill. Ms. Emerson said yesterday that her family had received some consolation from the knowledge that Kendra’s Law had helped other people receive treatment. “It’s a wonderful legacy,” Ms. Emerson said. In
Antipsychotics, Newer Isn't Better - Drug Find Shocks Researchers.
By
Shankar Vedantam Schizophrenia patients do as well, or perhaps even better, on older psychiatric drugs compared with newer and far costlier medications, according to a study published yesterday that overturns conventional wisdom about antipsychotic drugs, which cost the United States $10 billion a year. The results are causing consternation. The researchers who conducted the trial were so certain they would find exactly the opposite that they went back to make sure the research data had not been recorded backward. The study, funded by the British government, is the first to compare treatment results from a broad range of older antipsychotic drugs against results from newer ones. The study was requested by Britain's National Health Service to determine whether the newer drugs -- which can cost 10 times as much as the older ones -- are worth the difference in price. There has been a surge in prescriptions of the newer antipsychotic drugs in recent years, including among children. The study, published in the Archives of General Psychiatry, is likely to add to a growing debate about prescribing patterns of antipsychotic drugs. A U.S. government study last year found that one of the older drugs did as well as newer ones, but at the time, many American psychiatrists warned against concluding that all the older drugs were as good. Yesterday, in an editorial accompanying the British study, the lead researcher in the U.S. trial asked how an entire medical field could have been misled into thinking that the expensive drugs, such as Zyprexa, Risperdal and Seroquel, were much better. "The claims of superiority for the [newer drugs] were greatly exaggerated," wrote Columbia University psychiatrist Jeffrey Lieberman. "This may have been encouraged by an overly expectant community of clinicians and patients eager to believe in the power of new medications. At the same time, the aggressive marketing of these drugs may have contributed to this enhanced perception of their effectiveness in the absence of empirical information." Peter Jones, a psychiatrist at the University of Cambridge in England who led the study, searched yesterday for the right word to describe what had happened to his colleagues. " 'Duped' is not right," he said. "We were beguiled." One drugmaker immediately questioned the findings. Carole Puls, a spokeswoman for Eli Lilly and Co., which makes Zyprexa, said it was problematic to compare large groups of medications because there are differences between the drugs in each class. Individual patients need different medication options, she said. Janssen Pharmaceutica, which makes Risperdal, and AstraZeneca, which makes Seroquel, did not respond to requests for comment. Schizophrenia is a serious mental disorder that is believed to affect about one in 100 adults. It is characterized by psychotic symptoms such as hallucinations and delusions and negative symptoms such as social withdrawal. Especially over the past decade, older antipsychotics such as Haldol have been widely criticized for triggering uncontrolled body movements, even as the new "atypical" antipsychotics were hailed for causing fewer side effects. Recently, however, concern has grown that antipsychotics in general, and some of the newer drugs in particular, may be causing metabolic side effects. The new study randomly assigned 227 schizophrenia patients to two groups -- one received a newer antipsychotic, the other an older drug. The patients were evaluated for more than a year by experts who did not know which drug was being taken. While the researchers had expected a difference of five points on a quality-of-life scale -- showing the newer drugs were better -- the study found that patients' quality of life was slightly better when they took the older drugs. Jones said a conservative interpretation of the data suggested that there is no difference, "so the notion you would pay 10 times as much would be difficult to justify." "Why were we so convinced?" he asked, referring to the widespread opinion among psychiatrists that the new drugs were worth the great difference in cost. "I think pharmaceutical companies did a great job in selling their products. That is certainly one issue. "It became almost a moral issue on whether you would prescribe these dirty old drugs," he added. "It became the 'my son' phenomenon. What would you prescribe for your son?" In retrospect, Jones and others said, there were hints going back many years. In 2003, Robert Rosenheck, a psychiatrist at the Department of Veterans Affairs, found there was no difference between Haldol and Zyprexa -- after patients taking Haldol were treated to prevent the movement side effects. Last year, the U.S. government trial found that an older drug called perphenazine did about as well as the newer medications. Still, the belief in the newer drugs was so ingrained that many psychiatrists insisted that the results could not be extrapolated to other old drugs, said Rosenheck, who helped conduct that study. Darrel Regier, who directs research at the American Psychiatric Association, cautioned against drawing broad conclusions after the new study and said that "a thoughtful and prolonged process " is needed before treatment guidelines are changed. Not all the drugs used in the British study were available in the United States, he said, and with many of the newer medications reaching the end of their patent lives, he predicted that questions of cost would fade away. Jones and Rosenheck said the problem with many drug company studies that seemed to show that new drugs are better is that they focused on short-term results -- a symptom or side effect -- rather than the big picture: how patients fare long-term. "The story of these newer antipsychotic drugs is a story that reveals an institutional gap," Rosenheck said. "It should not have needed 10 years to get three government studies." Jones said the studies also illustrate the importance of trusting data, rather than judgment. He drew an analogy with his hobby of walking. "Sometimes the compass tells you go straight in front of you, but you somehow know it is wrong and that north is behind you," he said. "I have learned to follow the compass."
N.Y.
Advocates Encouraged by Senate Passage of MH Parity Following several years of intense advocacy, New York mental health advocates may be getting one step closer to achieving parity in insurance coverage for mental illnesses, after last month’s unanimous Senate passage of the parity bill known as Timothy’s Law. The New York bill reflects an agreement with the state Assembly that was reached at the end of the regular legislative session in June. The Assembly has pledged its commitment to pass the legislation when it returns after the fall elections. If Gov. George Pataki signs the bill, New York would join about 37 states with some form of mental health parity, according to advocates. Advocates say their only disappointment is that the legislation does not expand coverage for chemical dependency treatment; however, they vow to continue the fight for that in the future. On the federal side, discussion of the need for comprehensive mental health parity is heating up again, as some leading supporters in Congress filed a petition last week to demand a vote on their mental health/substance-use parity bill (see story on page 4). The New York legislation is named for 12-year-old Timothy O’Clair, who committed suicide in 2001, seven weeks before his 13th birthday. The legislation requires that adults and children with biologically based mental illnesses — including schizophrenia/psychotic disorders, major depression, bipolar disorder, panic disorder, obsessive-compulsive disorder and other conditions — receive the same health care coverage benefits as those provided for any other physical ailments. Insurance companies would be required to cover 30 inpatient days of treatment and 20 outpatient days of treatment for all mental illnesses per year. The parity bill would also require the state insurance department and the state Office of Mental Health (OMH) to conduct a two-year study to determine the effectiveness and impact of mental health parity legislation in New York and other states. The legislation would require insurance coverage for children under age 18 with attention-deficit disorder, disruptive behavior disorders or pervasive development disorders where there are serious suicidal symptoms or other life-threatening self-destructive behavior; significant psychotic symptoms; or behavior caused by emotional disturbances that place the child at risk of causing personal injury or significant property damage. “I support parity,” Sharon E. Carpinello, RN, Ph.D., Commissioner of OMH, told MHW. “I am especially concerned about children. Children should not suffer because of disparities in health insurance coverage.” Mental health advocates remain optimistic that Pataki will sign the bill into law once the state Assembly approves it. “We’re on the cusp of having it done,” Shelly Nortz, deputy executive director for policy with the Coalition for the Homeless in New York, told MHW. “It’s a long-fought battle. It’s a good package; it’s not everything we want — it does not include unlimited coverage for addiction.” Nortz added, “A compromise in negotiations greatly disappointed all parties in our campaign.” The legislation will help reduce Medicaid costs and increase worker productivity rates dramatically, said Nortz. “That’s why large corporations offer a parity benefit to their employees,” she said. “It helps the bottom line. They do it automatically.” Timothy O’Clair’s father, Tom O’Clair, said he is encouraged by the Senate passage. “The Senate passing the bill unanimously was a huge relief,” O’Clair told MHW. “I’m thrilled, because [the Senate] has been a stumbling block for so many years in moving us forward,” he said. “It’s a pared-down version; however, it is still a huge stepping stone toward moving it forward.” O’Clair said he is confident that the Assembly will pass the bill and that Pataki will subsequently sign it. “I have been given the promise of the Assembly Speaker [Sheldon Silver]. That holds a lot of weight with me.” O’Clair added, “I would hate to think that a governor who has built his reputation on child treatment issues would not want to sign it.” “All eyes are looking to New York for what the governor will do,” Harvey Rosenthal, executive director of the New York Association of Psychiatric Rehabilitation Services, told MHW. “We have another month before we find out.” Push for chemical dependency treatment The Assembly’s version of Timothy’s Law originally included substance abuse coverage; however, in negotiations with the Senate, lawmakers dropped that provision, Michael Polenberg, director of policy and advocacy for the Coalition of Voluntary Mental Health Agencies in New York, told MHW. “It’s been a long battle,” Polenberg said. “We also view it as incomplete; it excludes coverage for substance abuse treatment, which we think is important. We’re going to work in the year ahead for people battling addiction disorders.” Phillip A. Saperia, executive director of the Coalition of Voluntary Mental Health Agencies in New York, told MHW that he was also disappointed over the lack of coverage for addiction and substance use. “Chemical dependency should be covered in full as every other physical illness is covered,” said Saperia. “We will be in Albany this year for addiction issues.” Saperia added, “It is an incredibly wonderful first step. We have this legislation. Let’s move on to the next step and make sure we cover people with chemical dependency as well.” Keeping
Offenders in Mental Facilities Debated. By Mark Johnson ALBANY — The state's top court will consider this month whether state officials can force convicted sex offenders to be confined as patients in psychiatric facilities after their prison sentences end. In September 2005, Gov. George Pataki ordered state authorities to use existing mental health law to begin evaluating every sexually violent convict before their release from prison to determine whether their confinement should continue in mental institutions. Initially, 12 men were deemed to be continuing threats and were transferred to institutions. That number has since grown to 118, according to a report in Monday's New York Post. Advocacy groups for the mentally ill opposed the so-called civil commitment program, saying that the vast majority of sex offenders have not been diagnosed with a mental illness. Mental Hygiene Legal Service sued the state on behalf of the men, arguing they were denied due process because the state violated rules for transferring prison inmates to psychiatric facilities. A state Supreme Court judge agreed, ordering the inmates freed unless two independent physicians, appointed by the court, both determined that confinement was still needed. But a midlevel appeals court reversed that decision, ruling that because the sex offenders had been released from prison, the lower court judge erroneously applied provisions in the state's Correction Law, which governs psychiatric confinement of prison inmates. The court said the judge should have used the Mental Health Law, which deals with the hospitalization of people in general. Pataki has pushed for a law allowing the civil confinement of sex offenders at risk of committing more crimes when their sentences end but has been unable to get the Democrat-led Assembly to act on his proposal. Pataki's plan included a proposal to convert part of the Rochester Psychiatric Center, 111 Elmwood Ave., to a 55-bed facility for sex offenders who finish their prison sentences but are deemed by the state as too dangerous to release. But in May, local officials declared that the conversion was unlikely to happen. "It's dead," state Sen. Joseph Robach, R-Greece, said at the time. "The mayor, myself and others in the neighborhood have been heard loud and clear (by) the administration of the governor, and I've been told by them that Rochester will not be a site." The sides will make oral arguments in the case Wednesday. |
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