November 16, 2006

SPITZER-PATERSON ANNOUNCE CREATION OF POLICY ADVISORY
COMMITTEES TO PARTICIPATE AS PART OF TRANSITION TEAM:

MHANYS Note: We are exceptionally excited to see one of our very own, Michael Friedman (Director of The Center for Policy and Advocacy for the MHAs of NYC and Westchester) and our very good friend and colleague, Karen Schimke (President and CEO of the Schuyler Center for Analysis and Advocacy (SCAA)), named to the Spitzer-Paterson Transition Team’s Policy Advisory Committees.

Following below are some of the appointments made to the Spitzer-Paterson Transition Team Policy Advisory Committees. For the entire list of appointments in other areas besides those listed below, go to http://www.transitionny.org/main.cfm?actionID=globalShowStaticContent&screen
Key=cmpLearnTeam&s=transitionny.

Following below are the individuals who have been named to the Health Policy Advisory Committee:

• CO-CHAIR James Tallon, President, United Hospital Fund
• Alan Aviles, President of the Health and Hospital Corporation
• Jo Ivey Boufford, Professor of Public Service, Health Policy and Management, Wagner Graduate School at NYU
• Michael Burgess, Executive Director, New York State Alliance for Retired Americans
• Janice L. Charles, Executive Director, North Country Children's Clinic, Inc
• Jon Cohen, M.D., Senior Vice President, North Shore Long Island Jewish Health System, Inc.
• Kelli Conlin, Executive Director, NARAL Pro Choice New York
• Jo Ann A. Constantino, CEO, The EDDY; Executive Vice President, Northeast Health
• Mike Dowling, CEO, North Shore Long Island Jewish Health System, Inc.
• Michael Friedman, Director, The Center for Policy and Advocacy of The Mental Health Associations of NYC and Westchester
• Kristine M. Gebbie DrPH, RN, Elizabeth Standish Gill Associate Professor of Nursing
• Jay Laudato, Executive Director, Callen-Lorde Community Health Center
• Stan Lundine, Executive Director, Chautauqua County Health Network
• Brian McLane, Executive Director, Burton Blatt Institute
• Gail B. Nayowith, Executive Director, Citizens' Committee for Children of New York, Inc.
• Carol Raphael, President and CEO, Visiting Nurse Service of New York
• John Rugge, M.D., CEO, Hudson Headwaters Health Network
• Paul Samuels, Director and President, Legal Action Center
• Michael Stocker, Former President and CEO, Empire Blue Cross Blue Shield
• William Streck, President and CEO, Bassett Healthcare
• Monica Sweeney, M.D., Vice President of Medical Affairs, Bedford-Stuyvesant Family Health Center
• Greg Tarpinian, Executive Director, Change to Win Federation
• Robert Thompson, CEO, Monroe Plan for Medical Care
• Karen Carpenter-Palumbo, Vice President, American Cancer Society
• Dennis Rivera, President, 1199 SEIU
• Kenneth Rasky, Greater New York Hospital Association

Following below are the individuals who have been named to the Human Services Policy Advisory Committee:

• CO-CHAIR Geoffrey Canada, President and CEO, Harlem Children’s Zone
• CO-CHAIR Karen Schimke, President and CEO, Schuyler Center for Analysis and Advocacy
• Gordon Berlin, President, MDRC
• Rev. Dr. Calvin Butts, Pastor, Abyssinian Baptist Church
• Gladys Carrion, Senior VP for Community Investment, United Way of New York City
• Andrew Celli, Jr., Partner, Emery, Celli, Brinckerhoff & Abady, LLP
• Darwin M. Davis, President and CEO, New York Urban League
• Olivia A. Golden, Senior Fellow, The Urban Institute
• Dr. Marjorie Hill, Executive Director, Gay Men’s Health Crisis
• Joel Kaplan, Executive Director, United Jewish Council of the East Side
• Virgina Kee, Founding Member, Chinese-American Planning Council
• Sarah S. Kovner, Former Special Assistant to US Secretary of Health and Human Services, Donna Shalala
• David Mandel, Chief Executive Officer, Ohel Children's Home and Family Services
• Jim Peluso, Vocational Rehabilitation Specialist, US Department of Veterans Affairs
• William E. Rapfogel, Chief Executive Officer and Executive Director, Metropolitan Council on Jewish Poverty
• Trudi Renwick, Senior Economist, Fiscal Policy Institute
• Joseph L. Rich, Executive Director, Disabled Person's Action Organization of Jefferson County
• Rev. Dr. Marcos Rivera, Senior Pastor, Primitive Christian Church
• Ellen Schall, Dean, Robert F. Wagner Graduate School of Public Service
• Anne N. Shkuda, Associate Director, United Neighborhood Houses of NY
• Msg. Kevin Sullivan, Chief Executive Officer and Executive Director, The Catholic Charities of the Archdiocese of New York
• Alan Van Capelle, Executive Director, Empire State Pride Agenda
• Fred Wulczyn, Research Fellow, Chapin Hall Center for Children, University of Chicago
• Betsy Seidman, Executive Director of Development, York College, CUNY
• Stanley Grayson, President and CEO, M.R. Beal & Company
• Bryna Sanger, Professor of Urban Policy and Management, The New School

SAMARITANS SUICIDE PREVENTION CENTER’S JANUARY 2007 VOLUNTEER TRAINING CLASS IS NOW FORMING: Each day in the Capital Region there are individuals who are feeling lonely, depressed, or suicidal that reach out to the Samaritans Suicide Prevention Center Helpline, to talk to trained community volunteers who provide unconditional and non-judgmental support. A caller may feel overwhelmed with circumstances they feel unable to face alone or he/she may be considering suicide and is looking for support during a difficult time. Whatever the caller's challenge or struggle, one can find a caring, patient, empathetic ear, ready to listen and seek to understand his/her feelings. Are you interested in becoming one of our trained volunteers, who makes a difference?

Skills Needed:
• An interest in making a difference.
• Compassion, empathy, and patience.
• Commitment.
• A desire to meet other great volunteers
If you would like to be part of the January 2007 Volunteer Class, please send us an email at
sams@fcscapitalregion.org or call us at 518-689-0080 ext. 125/126.

IN THE NEWS:

A Casualty Far From the Battlefield - For veterans, coming home from war can be harder than being deployed. By Kate Gurnett
Albany Times Union, November 13, 2006

(MHANYS Note – MHANYS’ own Helena Davis and her work toward helping returning veterans is featured prominently in this article)

Clifton Park-- Last month, Jeanne "Linda" Michel came home from Iraq. Back in the suburbs, she tried to feel normal.

She'd been homesick for months. She couldn't wait to see her kids, ages 11, 5 and 4. Between her husband's deployment and her own, the children had been with just one parent for nearly three years.

She was 33, with a bright smile and stubborn determination. Reuniting should be easy. In another month, she'd be discharged from the Navy after five years of service.

"She had come through a lot and she had always risen to challenges," her husband, Frantz Michel, said last week.

What her family didn't see, and what she herself may not have realized, was the enormity of what she faced.

Like thousands of others returning from Iraq, her mental state was fractured. And it went untreated. Within two weeks, Linda Michel would become a private casualty of war.

Re-entry into the world of peace can be harder than deployment, experts say. Picking up where you left off doesn't just happen.

Husbands and wives report feeling like strangers to each other at first, according to Military OneSource, a support Web site for military families.

"Family roles, rituals, dynamics have changed," said Helena Davis, deputy director of the Mental Health Association in New York State. "And the vet has changed. Bonds have been fractured and need to be re-established."

Linda Michel was no exception. A self-sufficient medic known to help others, she was uncomfortable asking for that help for herself.

But treatment and self-care are critical for returnees, Davis said. Without it, "the anxiety keeps them spiraling down." Some turn to alcohol, drugs or domestic violence. Or, Davis said, "they hurt themselves." August, three veterans in New York's Adirondack region committed suicide within three weeks, Davis told a recent gathering of mental health professionals.

And the third American female to die in Iraq, Army interpreter Spc. Alyssa Peterson, 27, of Flagstaff, Ariz., shot herself with her service weapon. A devout Mormon and Arabic interpreter, Peterson had objected to U.S. techniques after just two days of participating in interrogations.

Women experience stronger forms of post-traumatic stress disorder and have higher PTSD rates, experts say. In response, the Veterans Affairs Department launched a $6 million study of female veterans.

Seeking treatment -- seen by some as a weakness -- may be even tougher for women, who still feel the need to prove themselves to men in military service.

In Iraq, female troops experience attacks, mortar fire and critical injuries such as amputation. And, women soldiers also are more at risk for sexual assaults, up 40 percent in combat zones from last year, Davis said.

Camp Bucca, the U.S.-run military prison where Michel was stationed, was investigated after a female mud-wrestling match was staged there.

Two weeks after she got home to Clifton Park, Linda Michel shot herself to death, stunning her colleagues and family.

Like many women who are assigned to Iraq, Linda Michel wanted to serve.

She grew up in Montreal, with her parents and five sisters. In the states, she married Frantz Michel, a native of Haiti who grew up in Rockland County and became a State Police investigator. They had three children, two boys and a girl, and lived in a quiet Clifton Park development dotted with kids' bicycles and basketball hoops.

By 2004, Frantz, a lieutenant colonel in the U.S. Army National Guard, was serving in Iraq with the 42nd Infantry Division.

Linda had joined the Navy in 2001.
"It was the best fit for her," Frantz said. It meant they likely wouldn't be deployed together. And her chances of being assigned to a combat zone were slim.

When Linda was called up in 2005, she didn't want a deferment.

"She felt she needed to do it," Frantz said. "So I couldn't stop her."

What she hadn't expected was a shortage of Army personnel that forced Navy and Air Force members into land-based and combat areas.

Linda went to Camp Bucca in southern Iraq, the largest U.S. military prison there and the site of a 2005 riot that saw four prisoners killed by guards.

Inevitably dubbed "Doc" by her patients, she worked hard "doing her part to accomplish a mission many people said the Navy could not do," Rob Hallmark of Virginia Beach, Va., wrote in her on-line memorial guest book. "She was always a bright shining light in such a dark, dark place."

"She was more than 'Just in the Navy' or just a 'Corpsman' or 'Sailor,' she was there for us," added Linda's Camp Bucca roommate, Tammy Cartwright, of Anchorage, Alaska. "She was the one that helped me get out of bed every morning when all I wanted to do was give up and go home."

But in private, Michel faced demons. She saw a Navy doctor and was diagnosed with depression. The doctor prescribed Paxil.

Frantz Michel knew his wife's days were long and grueling. But he didn't know about the Paxil.

Studies have linked Paxil to adverse effects, including suicide, sparking an FDA warning in May.

When Linda came home, the Navy discontinued her medication. Again, Frantz Michel wasn't told.

"I just wish the Navy would have done some more follow-up, instead of just letting her come home," said Frantz, who is on the division staff of the Army National Guard. "If somebody needs Paxil in a combat zone, then that's not the place for them to be. You either send them to a hospital or you send them home and then make sure that the family members know and that they get follow-up care."

Talking his way up the Navy's chain of command, Frantz sought answers. "Why wasn't she sent to a facility to resolve the issues? Not keep her in Iraq and give her some antidepressant medication and then just send her home. So those are the answers that I don't have. Which makes me a little angry because I know what is supposed to occur."

Duty Officer Chris Pratt of the Navy Operational Support Center in Albany could not be reached for comment Friday, a holiday.

Linda Michel's suicide drew pages of on-line condolences, from California to Iraq.

Her death came amid rising demands for counseling from veterans returning from Iraq and Afghanistan. A 2005 Government Accountability Office study called services inadequate.

Lots of resources for vets aren't utilized, Davis said. Often, veterans don't retain what they hear during two-day stateside demobilization sessions. "They don't have the focus. All they want to do is get home."

Health care visits every four to six weeks aren't enough, she said.

Frantz Michel wishes the Navy hadn't cleared his wife for re-entry, or left her alone to withdraw from Paxil.

"You look (back) at things," he said last week. "I just wish that I had more information."

Linda Michel was given a full military funeral Oct. 23 and buried in the Gerald B.H. Solomon Saratoga National Cemetery. Friends donated to a fund for the Michels' three children.

Shortly before she died, Linda attended a Navy weekend drill. Fellow reservist Robert Stanziano saw her there, and waved, but never got a chance to talk.

When she was mobilized "we were extremely proud ... and sent them care packages from time to time," he wrote in her memorial guest book. "We couldn't wait for them to return. Now she is gone and I'll never get the chance to ask her how it was over there.

"She was a great sailor, soldier, hospital corpsman, mom and a great woman of war for our country," he wrote in her memorial guest book. "Shipmate, I never had a chance to say this to you. Well done! Goodbye and farewell shipmate, you will be dearly missed."

PICKING UP THE PIECES

Expert advice for returning vets:

* Go easy on yourself and loved ones who are traumatized.
* Take things one day at a time.
* Remember: Everyone has bad days.
* Make yourself connect with people you care about.
* Keep your life as simple as possible. Rest when you can.
* Stay away from alcohol and caffeine to manage moods.
* Try to eat balanced meals.
* Take time to play with your children.
* Anniversaries, birthdays and holidays will be more difficult than other days. Plan ahead for how you can make them easier. Expect your children to act out. Give them extra support. This will pass.
* If you need support, ask for it. Family members and neighbors can help. You can coach them in what you need.
* We may not share your experience, but we do care.

Sources: Courtesy of Helena Davis, Mental Health Association in New York State

What combat vets want families and friends to know about living with PTSD:

* Give me space when I need to be alone -- don't overwhelm me with questions. I'll come and talk to you when I'm ready.
* Get away from me if I am out of control, threatening or violent.
* Be patient with me, especially when I'm irritable.
* Don't personalize my behavior when I explode or get quiet.
* Learn and rehearse a time-out process.
* Don't patronize me or tell me what to do. Treat me with respect and include me in conversations and decision making.
* Don't pity me.
* Don't say "I understand" when there are some things that you cannot understand.
* Realize that I have unpredictable highs and lows, good and bad days.
* Anticipate my anniversary dates -- recognize that these could be tough times.
* I'd like to share my traumatic experiences with you, but I fear overwhelming you and losing you.
* I want to be close to you and share my feelings, but I'm afraid to -- and sometimes I don't know how to express my emotions.
* I also fear your judgment.
* Know that I still love and care about you, even if I act like a jerk sometimes.
* Don't ask me to go to crowded or noisy places because I'm uncomfortable in those settings.

Sources: Courtesy of Vietnam combat vets and the Oklahoma City VA Medical Center
There is hopeResources for veterans and their families.

BOOKS

"Courage After Fire: Coping Strategies for Returning Soldiers and Their Families," by Keith Armstrong, Suzanne Best and Paula Domenici (2006).

"Surviving Deployment: A Guide for Military Families," by Karen M. Pavlicin (2003).

"Helping Children Cope with the Challenges of War and Terrorism," by Annette M. LaGreca. Available for download at http://www.7-dippity.com/other/UWA_war_book.pdf

WEB SITES

National Center for PTSD at http://www.ncptsd.va.gov

S.A.F.E. Program. Support and Family Education: Mental Health Facts for Families. An 18-session curriculum on PTSD at http://w3.ouhsc.edu/Safeprogram

"When the Letdown Doesn't Let Up" and "How to Get Back to 'Normal' " by the National Mental Health Association at http://www.nmha.org/reunions/infoBacktoNormal.cfm

FOR KIDS

Deployment Kids at http://www.deploymentkids.com Operation Purple. Free summer camps for military kids, through National Military Family Association at http://www. operationpurple.com

"Talk, Listen, Connect: Helping Families During Military Deployment." Sesame Street DVD, free to active duty personnel through Military OneSource -- (800) 342-9647 -- or at http://www.sesameworkshop.org/tlc

Time Again to Choose or Switch Drug Plans. By Robert Pear
The New York Times, November 15, 2006

WASHINGTON, Nov. 14 — Starting Wednesday, Medicare beneficiaries can sign up for prescription drug coverage or switch plans, and many may want to do so because prices have changed, with some of the most popular plans charging much higher premiums for 2007.

In every state but Alaska and Hawaii, more than 50 drug plans are available. Beneficiaries have until Dec. 31 to sign up or change plans, but federal officials said they should act by Dec. 8 to avoid the problems that caused turmoil at pharmacies in January, when many people were unable to get their drugs.

Several recent surveys, including one by J. D. Power & Associates, the market research company, suggest that three-fourths of the people with Medicare drug coverage are satisfied. Michael O. Leavitt, the secretary of health and human services, said: “The program is working. People are happy. ”

The Bush administration says that premiums for Medicare drug coverage will average $24 a month in 2007, about the same as in 2006. But for many beneficiaries, the reality may be substantially different.

Melvin London, an 83-year-old retired filmmaker in New York City, said Tuesday that the new Medicare benefit had saved $245 for him and $685 for his wife. He was annoyed at the prospect of a sharp increase in premiums in 2007. For Mr. London’s plan, known as Humana Enhanced, the monthly premium will be $29.60, up from $9.42.

“I call that bait and switch, when the company charges $9 to get you in and then goes to $29,” Mr. London said. “It took me three months to find a plan that was suitable. Am I now supposed to go through the same process every year to determine which plan is best for me? That’s an unfair burden for beneficiaries.”

Thomas T. Noland Jr., a senior vice president of Humana, said: “We still offer excellent value. We will have the lowest premium in 38 states, the second-lowest in 10 states and the third-lowest in the remaining two states.”

About 4.5 million Medicare beneficiaries receive drug coverage from Humana plans. Humana has been wooing people with free showings of the Humphrey Bogart movie “Casablanca.” Medicare beneficiaries eat popcorn and sip sodas while watching the film, along with a short extolling Humana’s Medicare plans.

The $24 premium emphasized by the Bush administration is for basic coverage, the minimum required by law, and many plans provide additional benefits for an extra premium. Moreover, the average includes premiums for drug coverage offered by managed care plans and by free-standing drug plans, which serve people in the traditional Medicare program.

Both types of plans charged about $24 a month, on average, for drug coverage this year. In 2007, the average premium will increase about 10 percent for free-standing drug plans, but will decrease about 35 percent for drug coverage offered by managed care plans.

Most drug plans have a gap in coverage. “Beneficiaries tell us this was a helpful benefit for six or eight months, until they fell into the coverage gap,” said Deane R. Beebe, a spokeswoman for the Medicare Rights Center, a consumer group that counsels people with Medicare.

Some insurers provide coverage for generic drugs in the coverage gap, and a few also provide coverage for brand-name drugs in the gap. But Ms. Beebe said, “In 11 states, we cannot find any free-standing drug plan that provides coverage for brand-name drugs in the gap.”

The Medicare handbook, sent to all beneficiaries, says that a plan offered by Coventry Health Care will pay for generic and brand-name drugs in the coverage gap. But Francis S. Soistman Jr., executive vice president of Coventry, said Tuesday that only five brand-name drugs, out of the many available, were covered in the gap.

Jeff Nelligan, a Medicare spokesman, said, “We corrected the online version of the information.”

Sixteen Democratic senators, led by Byron L. Dorgan of North Dakota, said this week that some insurers were misleading consumers by marketing drug plans under names that included the word “complete.”

“How can a plan be called ‘complete’ when it contains a gap in drug coverage?” they asked in a letter to Mr. Leavitt.

John C. Rother, policy director of AARP, the lobby for older Americans, said the new program had helped many people. His “biggest disappointment,” Mr. Rother said, was that several million low-income people had not applied for the extra help available to them.

Pass Mental Health Parity Legislation. Letter to the Editor
Watertown Daily Times, November 06, 2006

Since I wrote about Timothy's Law, there have been some serious negotiations between the Timothy's Law Coalition and state Assembly and Senate leaders regarding the mental health parity law that is named in honor of Timothy O'Clair.

As a result of those negotiations, the Senate finally passed the bill unanimously. Now due to changes in Timothy's Law, we wait for the Assembly to reconvene and once again pass the mental health parity bill that will free those people with mental health issues from the discriminatory shackles that certain employer health insurance companies have them chained to by not giving them access to the full health care that they need.

After the Assembly has passed Timothy's Law, it will go to Gov. George Pataki to be signed and he has said that he might not sign it. Timothy's Law has to be signed by the governor by Jan. 1. If he does not sign it, we will have to start all over from scratch.

Though most of the original law is still intact, the part about alcohol and substance abuse had to be eliminated. Let's hope it can be added in the future. Right now, it is imperative to get Gov. Pataki to sign Timothy's Law this year thereby putting an end to the discriminatory practices of the health insurance companies that result in the untimely deaths of so many of our peers and consumers.

So let's get cracking, folks. Are we going to let the discrimination continue? Are we going to sit on our posteriors and do nothing while there are children, like Timothy O'Clair, taking their own lives? Or are we going to sit right down and write the governor a letter urging him to sign the mental health parity bill? I hope and pray that the answer to the last question is a resounding yes, yes and once again yes.

June C. Gundersen
Watertown

Troubled Children - What’s Wrong With a Child? Psychiatrists Often Disagree. By Benedict Carey
The New York Times, November 11, 2006

Paul Williams, 13, has had almost as many psychiatric diagnoses as birthdays.

The first psychiatrist he saw, at age 7, decided after a 20-minute visit that the boy was suffering from depression.

A grave looking child, quiet and instinctively suspicious of others, he looked depressed, said his mother, Kasan Williams. Yet it soon became clear that the boy was too restless, too explosive, to be suffering from chronic depression.

Paul was a gifted reader, curious, independent. But in fourth grade, after a screaming match with a school counselor, he walked out of the building and disappeared, riding the F train for most of the night through Brooklyn, alone, while his family searched frantically.

It was the second time in two years that he had disappeared for the night, and his mother was determined to find some answers, some guidance.

What followed was a string of office visits with psychologists, social workers and psychiatrists. Each had an idea about what was wrong, and a specific diagnosis: “Compulsive tendencies,” one said. “Oppositional defiant disorder,” another concluded. Others said “pervasive developmental disorder,” or some combination.

Each diagnosis was accompanied by a different regimen of drug treatments.

By the time the boy turned 11, Ms. Williams said, the medical record had taken still another turn — to bipolar disorder — and with it a whole new set of drug prescriptions.

“Basically, they keep throwing things at us,” she said, “and nothing is really sticking.”

At a time when increasing numbers of children are being treated for psychiatric problems, naming those problems remains more an art than a science. Doctors often disagree about what is wrong.

A child’s problems are now routinely given two or more diagnoses at the same time, like attention deficit and bipolar disorders. And parents of disruptive children in particular — those who once might have been called delinquents, or simply “problem children” — say they hear an alphabet soup of labels that seem to change as often as a child’s shoe size.

The confusion is due in part to the patchwork nature of the health care system, experts say. Child psychiatrists are in desperately short supply, and family doctors, pediatricians, psychologists and social workers, each with their own biases, routinely hand out diagnoses.

But there are also deep uncertainties in the field itself. Psychiatrists have no blood tests or brain scans to diagnose mental disorders. They have to make judgments, based on interviews and checklists of symptoms. And unlike most adults, young children are often unable or unwilling to talk about their symptoms, leaving doctors to rely on observation and information from parents and teachers.

Children can develop so fast that what looks like attention deficit disorder in the fall may look like anxiety or nothing at all in the summer. And the field is fiercely divided over some fundamental questions, most notably about bipolar disorder, a disease classically defined by moods that zigzag between periods of exuberance or increased energy and despair. Some experts say that bipolar disorder is being overdiagnosed, but others say it is too often missed.

“Psychiatry has made great strides in helping kids manage mental illness, particularly moderate conditions, but the system of diagnosis is still 200 to 300 years behind other branches of medicine,” said Dr. E. Jane Costello, a professor of psychiatry and behavioral sciences at Duke University. “On an individual level, for many parents and families, the experience can be a disaster; we must say that.”

For these families, Dr. Costello and other experts say, the search for a diagnosis is best seen as a process of trial and error that may not end with a definitive answer.

If a family can find some combination of treatments that help a child improve, she said, “then the diagnosis may not matter much at all.”

A KALEIDOSCOPE OF DIAGNOSES
The most commonly diagnosed mental disorders in younger children include attention deficit hyperactivity disorder, or A.D.H.D., depression and anxiety, and oppositional defiant disorder.

All these labels are based primarily on symptom checklists. According to the American Psychiatric Association’s diagnostic manual, for instance, childhood problems qualify as oppositional defiant disorder if the child exhibits at least four of eight behavior patterns, including “often loses temper,” “often argues with adults,” “is often touchy or easily annoyed by others” and “is often spiteful or vindictive.”

At least six million American children have difficulties that are diagnosed as serious mental disorders, according to government surveys — a number that has tripled since the early 1990s. But there is little convincing evidence that the rates of illness have increased in the past few decades. Rather, many experts say it is the frequency of diagnosis that is going up, in part because doctors are more willing to attribute behavior problems to mental illness, and in part because the public is more aware of childhood mental disorders.

At the playground, in the gym, standing in line at the grocery store, parents swap horror stories about diagnoses, medications or special education classes. Their children are often as fluent in psychiatric jargon as their mothers and fathers are.

“The change in attitude is enormous,” said Christina Hoven, a psychiatric epidemiologist at Columbia University. “Not long ago people did all they could to hide problems like these.” Attention deficit disorder is perhaps the most straightforward diagnosis. Elementary school teachers are often the ones who first mention it as a possibility, and soon parents are answering questions from a standard checklist: Does the child have difficulty sustaining attention, following instructions, listening, organizing tasks? Does he or she fidget, squirm, impulsively interrupt, leave the classroom?

These behaviors are so common, particularly in boys, that critics question whether attention disorder is a label too often given to boys being boys. But most psychiatrists agree that while many youngsters are labeled unnecessarily, most children identified with attention problems could benefit from some form of therapy or extra help.

They are less certain about the children — perhaps a quarter of those seen for mental problems, some experts estimate — who do not fit any one diagnosis, and who often go for years before receiving a satisfactory label, if they receive one at all.

These youngsters collect labels like passport stamps, and an increasing number end up with the label Paul Williams received: bipolar disorder.

AN ILLNESS UNDER DISPUTE
Until recently, psychiatrists considered bipolar disorder to be all but nonexistent in children under 18. Today, it is the fastest growing mood disorder diagnosed in children, featured on the cover of news magazines and on daytime talk shows like “The Oprah Winfrey Show.”

The explosion of interest in bipolar disorder came after the approval of several drugs, called antipsychotics, or major tranquilizers, for the short-term treatment of mania in adults.

Beginning in the 1990s some researchers began to argue that bipolar disorder was underdiagnosed in adults. Soon, several child psychiatrists were arguing that the illness was more common than previously thought in children too.

Some experts who made those arguments had ties to manufacturers of antipsychotic drugs, financial interests disclosed in professional journals. But the message struck a chord, particularly with doctors and parents trying to manage difficult children.

Parents whose children have been given the label tend to adopt the psychiatric jargon, using terms like “cycling” and “mania” to describe their children’s behavior. Dozens of them have published books, CDs, or manuals on how to cope with children who have bipolar disorder.

A recent Yale University analysis of 1.7 million private insurance claims found that diagnosis rates for bipolar disorder more than doubled among boys ages 7 to 12 from 1995 to 2000, and experts say the rates have only gone up since then.

Katherine Finn, a 14-year-old who lives in Grand Rapids, Mich., said she was grateful for the growing awareness of the disease. Possessed by feelings of worthlessness as early as the fourth grade, Katherine said that by the sixth grade she “threw my sanity out the window.”

She became impulsive, loud, and abrasive, she said, adding, “I would blurt things out in class, I would moo like a cow, act like a little kid, just say the most random stuff.”

A psychiatrist promptly diagnosed the problem as bipolar disorder, after learning that there was a history of the disease on her mother’s side of the family. Katherine began taking drugs that blunted the extremes in her mood, and she now is doing well at a new school.

“It hit me like a Mack truck when I heard the diagnosis, but I knew right away it was correct,” said her mother, Kristen Finn, who is writing a book about her experience.

Still, many psychiatrists believe that, although childhood bipolar disorder may be real in families like the Finns, it is being wildly overdiagnosed. One of the largest continuing surveys of mental illness in children, tracking 4,500 children ages 9 to 13, found no cases of full-blown bipolar disorder and only a few children with the mild flights of excessive energy that could be considered nascent bipolar disorder — a small fraction of the 1 percent or so some psychiatrists say may suffer from the disease.

Moreover, the symptoms diagnosed as bipolar disorder in children often bear little resemblance to those in adults. Instead, the children’s moods seem to flip on and off like a stoplight throughout the day, and their upswings often look to some psychiatrists more like extreme agitation than euphoria.

“The question with these kids is whether what we’re seeing is a form of mania, or whether it’s extreme anger due to something else,” said Dr. Gregory Fritz, medical director of the Bradley Hospital, a psychiatric clinic for children in Providence, R.I.

Dr. Ellen Leibenluft, a research psychiatrist at the National Institute of Mental Health, argues that children who are receiving a diagnosis of bipolar disorder fall into two broad groups. The children in one group, a minority, have mood cycles similar to those of adults with bipolar disorder, complete with grandiose moods, and a high likelihood of having a family history of the illness. Those in the other group have severe problems regulating their moods and little family history, and may have some other psychiatric disorder instead.

“It is a mistake to lump them all together and assume they are all the same,” Dr. Leibenluft said. “It may be that the disorder has different dimensions and looks different in different kids.”

For parents with a child who is frantic and possibly dangerous, these distinctions may be academic. The medications may blunt their child’s extreme behavior, which may be all the confirmation they need.

For others, though, the uncertainties about childhood bipolar disorder loom larger. They wonder whether mania really explains what their child is going through, and if not, what it is that is being treated.

Evelyn Chase of Richmond, Va., said that a neurologist drove home his diagnosis of bipolar disorder in her 10-year-old son by pulling out “a copy of Time magazine and slamming the article in front of me.”

Ms. Chase said her son seemed to react most strongly to abrupt changes in the environment and to certain dyes and chemicals. “I used the bipolar diagnosis for school and getting services, but I don’t think it covers his behaviors,” she said.

For Paul Williams, the diagnosis simply feels like a temporary stop. In his short life, Paul has taken antidepressants like Prozac, antipsychotic drugs used to treat schizophrenia, sleeping pills and so-called mood stabilizers for bipolar disorder, in so many combinations that he has become nonchalant about them.

“Sometimes they help, sometimes they don’t,” he said. “Sometimes they make me feel like another person, like not normal.”

In recent months, his mother said, Paul seems to have improved: he visibly tries to control himself when he is upset and usually succeeds. He is an eager Mets fan who loves reading Harry Potter and the Goosebumps series. He gets out and plays baseball and football, like any 13-year-old boy.

But he has grown tired of telling his story to doctors, and neither he nor his mother expect that bipolar disorder will be the last diagnosis they hear.

IN SEARCH OF CLARITY
The specialists who manage children’s psychiatric disorders are trying to bring more standards and clarity to the field. Harvard researchers are completing the most comprehensive nationwide survey of mental illness in minors and hope to publish a report next year. And a recent issue of the journal Child and Adolescent Psychology was entirely devoted to the subject of basing diagnoses in hard evidence.

Given the controversies, one of the articles concludes, “we acknowledge that tackling the issue may be tantamount to taking on a 900-pound gorilla while still wrestling with a very large alligator.”

Dr. Darrel Regier of the American Psychiatric Association, who is coordinating work on the next edition of the association’s diagnostic manual for mental disorders, due out in 2011, said that researchers would focus on drawing distinctions among several childhood disorders, including bipolar disorder and attention deficit disorder.

“We wouldn’t disagree that criteria for these disorders currently overlap to some degree,” Dr. Regier wrote in an e-mail message, “and that a significant amount of research is under way to disentangle the disorders in order to support more specific treatment indications.”

Until that happens, parents with very difficult children are left to read the often conflicting signals given by doctors and other mental health professionals. If they are lucky, they may find a specialist who listens carefully and has the sensitivity to understand their child and their family.

In dozens of interviews, parents of troubled children said that they had searched for months and sometimes years to find the right therapist.

“The point is that not everything is A.D.H.D., not everything is bipolar, and it doesn’t happen like you see in the movies,” said Dr. Carolyn King, who treats children in community clinics around Detroit, and has a private practice in the nearby suburb of Grosse Pointe Farms.

“Kids often have very subtle symptoms they can mask for short periods of time,” Dr. King said, “and the most important thing is to observe them closely, and get a complete history, starting from birth and straight through every single developmental milestone.”

She added, “A speech delay can look like anxiety,” an obsessive private ritual like mania.

Or struggling children, in the end, may look only like themselves, with a unique combination of behaviors that defy any single label. Camille Evans, a mother in Brooklyn whose son’s illness was tagged with a half-dozen different diagnoses in the last several years, said she concluded, after seeing several psychiatrists, that the boy’s silences and learning difficulties were best understood as a mild form of autism.

“That’s the diagnosis that I think fits him best, and I’ve just about heard them all,” Ms. Evans said.

The label is not perfect, she said, but it is more specific than “developmental delay” — one diagnosis they heard — and does not prime him for aggressive treatment with drugs like attention deficit disorder or bipolar disorder would. He has not responded well to the drugs he has tried.

“Most important for me,” Ms. Evans said, “the diagnosis gives him access to other things, like speech therapy, occupational therapy and attention from a neurologist. And for now it seems to be moving him in the right direction.”

Insurers Blamed for Crisis in Health Care. "The paper pusher . . . is making all the money," says former banker. By James T. Mulder
Syracuse Post-Standard, November 12, 2006

William Mooney used to think chronic financial problems plaguing New York's hospitals were symptoms of bad management and inefficiency.

"When you put doctors who really don't know a lot about business together with mismanaged hospitals, what do you think you're going to get? A mess on your hands," said Mooney, president of the Westchester County Association, a business/public policy group based in White Plains.

The former banker, however, changed his mind after he and other business people from his association spent a year studying the health-care crisis in his county, where in recent years two hospitals have closed and another has flirted with bankruptcy. The biggest problem, they concluded, is too many health-care dollars are going to fatten the profits of health insurers and the salaries of insurance company CEOs.

"The hospitalsand the doctors are not making any money to speak of, but the person in the middle, who is the paper pusher, is making all the money," said Mooney, who's coming to Syracuse Monday to address local hospital trustees and business people.

Mooney has been traveling around the state trying to rally support for reforms he believes will help correct the health-care crisis. He wants the state to set up a health-care reinvestment fund. A portion of insurance company profits would go into this fund to help hospitals and doctors pay for electronic medical records and make other improvements.

He also wants to restore the state Insurance Department's authority to regulate health insurance rate increases. Insurers in New York have been free to boost rates without regulatory review since 2000, when a state law requiring state Insurance Department approval of rate increases expired.

"With my car insurance, the premiums are regulated. My property and casualty premiums are regulated but my health insurance premiums are not," Mooney said. "That made no sense to us."

Mooney said he typically opposes price controls, but believes they are necessary in health care, where the traditional laws of supply and demand don't work.

Leslie Moran, senior vice president of the New York Health Plan Association, an insurance trade group, said Mooney's proposals would increase health insurance costs.

"Everyone agrees there is some need to look at the New York health-care market and ways to reform it and make it work better for everyone, but you can't just tinker around with one player and one piece of that," she said.

The reinvestment fund would be a new tax on insurers that would increase premiums, she said. The state's health insurers already pay $1.5 billion a year in surcharges and assessments that are used to pay for hospital charity care and graduate medical education, she said.