Suicide Prevention and Risk Reduction: What Mental Health Practitioners Need to Know. Thursday, February 22, 2007, 2:00-4:00 p.m.

Perspectives on Suicide Prevention: What School Counselors Need to Know. 2:00-4:00 p.m.

For registration and more information, please visit: http://www.adph.org/alphtn/vcomm.asp?action=conflistone&templatenbr=3&deptid=143&templateid=1252

SAMARITANS SUICIDE PREVENTION CENTER SEEKS VOLUNTEERS FOR CAPITAL REGION CRISIS HOTLINE: Volunteer training class is now forming. Email sams@fcscapitalregion.org or call 518-689-0080 ext.125. Deadline for Registration: February 20, 2007.

AFSP REACHES AGREEMENT WITH GENERAL MOTORS REGARDING SUPER BOWL AD:
Following the Super Bowl, the American Foundation for Suicide Prevention (AFSP) asked General Motors to pull an advertisement and cease any further promotion and marketing of an ad, which featured a GM factory robot who gets laid off, becomes depressed and then makes a suicide attempt.

On Friday, February 9th, AFSP had several constructive conversations with GM Executives, and I am pleased to announce that GM has decided to pull the ad, including plans to air it on upcoming television programs and on the company's website.

GM has indicated that they will be revising the ad, removing the scene with the suicide attempt and any implication of suicide before re-releasing the ad in the future.

AFSP and GM have issued a joint statement about the company's decision and our support of it.

AFSP applauds General Motors for taking these actions. It is difficult to find organizations that listen. GM did by responding to the concerns of those touched by mental illness and suicide.

Thank you to everyone who joined with us in expressing concerns about the ad.

Our collective actions have raised awareness, and will help make our country more sensitive to the issues of mental illness and suicide.

Bob Gebbia
Executive Director
American Foundation for Suicide Prevention

IN THE NEWS:

N.Y. Advocates Pleased with Governor’s Support of MH Programs
Mental Health Weekly, February 12, 2007

New York state mental health advocates say they are pleased with Gov. Eliot Spitzer’s first budget plan since his election as governor, which emphasizes such long time priorities in the advocacy community as new housing beds; an expansion of prison-based mental health services; and a commitment to ‘rightsize’ the state psychiatric hospital system to improve services and reinvest resources into the community.

Advocates have also rallied around the recent nomination of Michael F. Hogan as new commissioner of the state Office of Mental Health (OMH). He previously served as director of the Ohio Department of Mental Health. Hogan also chaired the President’s New Freedom Commission on Mental Health. His confirmation is expected in a few weeks.

The governor’s 2007-2008 budget recommendations includes new funding to expand supported housing and single-room occupancy (SRO) efficiency apartments statewide by 2,000 beds. About $12.9 million will also be provided to expand the state’s supported housing initiative, New York/New York IIII, by 625 supported housing and SRO efficiency apartment beds.

Spitzer also proposes to improve the capacity of the OMH research institutes to enhance children’s mental health treatment and supportive services. He also plans to add supported employment slots for persons with mental illness. The budget proposes to expand home and community-based waiver slots.

The governor’s proposed budget also boosts funding for community mental health services by 2.5 percent in keeping with the three-year cost-of-living adjustment (COLA) approved last year.

“The proposed budget is a love fest between advocates and the new administration,” J. David Seay, executive director of the National Alliance on Mental Illness (NAMINYS), told MHW. The governor put forward a strong mental health budget, he said. “There is nothing contentious in it.”

“The three topics of the day are housing, housing and housing,” said Seay who indicated that advocates are pleased with a strong budget that emphasizes supported housing for individuals with psychiatric disabilities.

Seay added, “We have an administration that really wants to do the right thing. It’s the dawning of a new era. There’s lots of hope.”

“We’re very enthusiastic,” Glenn Liebman, chief executive of the Mental Health Association in New York State, Inc., told MHW. “Some areas [of the budget] are very positive for people with psychiatric disabilities, especially around housing.”

Transitoning Youth

Advocates feel strongly about a transition plan at the state level for youth, he said. “There has to be funding in the budget for adolescents transitioning out of the mental health system to the adult system of care,” he said. Many kids 16, 17, and18 fall through the cracks when there is no transition planning, he noted.

“Many kids become forgotten youth; they end up incarcerated, homeless, and in emergency rooms.”

An area of contention in the proposal, however, includes funding recommendation to continue the efforts begun under former Gov. George Pataki’s administration to house sexual offenders in the state’s inpatient mental health system, noted Liebman. The budget proposes about $47 million to house sex offenders in state psychiatric facilities, he added.

“We think there are better ways to spend that money around sexual offenders than housing them in psychiatric facilities,” Liebman said.

“Housing sex offenders in existing psychiatric facilities is a position we’ve opposed for many years. We’re concerned about their safety.”

There is also the perception of mental illness being equated with a sexual offender, he added.

Liebman said advocates are also pleased that the proposal will provide funding for a children and families initiative to provide screening and early detection of mental health needs in children.

We’re off to a good start,” said Harvey Rosenthal, executive director of the New York Association of Psychiatric Rehabilitation Services (NYAPRS), told MHW. “It’s a budget that balances great promise with some notable perils as well.”

Rosenthal said he is pleased the new budget includes a recommendation for a $2 million increase to phase in enhanced services for state prison inmates with mental illness.

“That’s another budget area that is very promising,” he said, especially for advocates who have worked for years to stop inhumane practice state prisoners with severe psychiatric disabilities into solitary confinement, he said.

The state OMH and the Department of Corrections will collaborate on the expansion of appropriate alternative programs designed to transition inmates with mental illness from SHUs (Special Housing Units). Over the next three years $50 million will be provided to reconfigure the Department of Corrections to provide more appropriate prison settings and provide treatment for distressed prisoners, said Rosenthal.

The governor intends to enlist the help of various stakeholders to join him in crafting a ‘right-sizing’ plan for the state hospitals, said Rosenthal. “We greet that with great hope,” he said. “Together we can re-configure the state hospital system in a way that redirects millions of dollars in unneeded institution money into the community and at the same time preserving essential, inpatient capacity at fewer, regionalized centers.”

Rosenthal added, “Right-sizing means reinvestment and reinvestment means recovery.”

Spitzer Plan Aids Mentally Ill Inmates - Governor proposes adding $60 million for improved, more humane services
Albany Times Union, February 10, 2007
By Paul Grondahl

ALBANY -- In response to long-standing calls for better treatment for the most vulnerable segment of the prison population, Gov. Eliot Spitzer proposes to increase state spending by $60 million over three years on services for mentally ill inmates.

The proposal was praised by advocacy groups that say it signals a heightened commitment toward humane care of prisoners with severe psychiatric needs.

"This is a long-awaited, very encouraging initiative," said Harvey Rosenthal, who heads the New York Association for Psychiatric Rehabilitation Services.

"It's very refreshing for the governor to take such a clear position on behalf of inmates with serious mental illness," said Bob Corliss, associate director of NAMI-New York, the National Alliance on Mental Illness.

Spitzer's budget includes $2.3 million this year in Office of Mental Health funding to screen all prisoners for mental illness and enhance treatment. He proposed increasing that allocation to $6 million next year and $9 million in 2009.

In addition, Spitzer is seeking $50 million in capital funds in the Department of Correctional Services budget to overhaul prison design to create more therapeutic spaces to house mentally ill inmates. It would also improve training for correction officers and pay for additional services, such as help in preparing mentally ill inmates for the transition to life after incarceration.

Linda Foglia, a DOCS spokeswoman, declined to comment on Spitzer's budget proposal.

About 8,000 of the state's 63,000 inmates have been diagnosed with serious mental illness, according to studies by the Correctional Association of New York, a watchdog group.

Such inmates are often confined for acting out to special housing units, known as "The Box," sometimes for months or years. Once in The Box, they purposely injure themselves and commit suicide at a rate three times higher than other prisoners in solitary, data has shown.

Mentally ill inmates also face exceptionally high rates of recidivism because they commonly are released straight from the solitary confinement of The Box into the community with little preparation.

"The additional funding the governor proposed is certainly a very welcome first step," said Bob Gangi, executive director of the Correctional Association of New York.

Gangi and other advocates called on Spitzer to support a bill that passed both houses of the state Legislature but was vetoed by Gov. George Pataki. That landmark legislation would prohibit placing mentally ill inmates in solitary confinement for any reason.

The advocacy groups have joined an ongoing lawsuit in federal court to ban the practice in New York.

"We are still pushing for that bill to pass both houses again and to be signed this time by the governor in order to provide the proper structure to carry out needed reforms," Corliss said.

Concerns Raised About Treatment Of Mentally Ill Inmates, Civil Confinement
Legislative Gazette, February 12, 2007
By Sari Zeidler

Though mental health advocates expressed support for Gov. Eliot Spitzer’s budget proposal, events in Albany last week made it clear that many appeals for reform have yet to be addressed.

A joint budget hearing on proposed 2007-2008 mental hygiene spending held last Wednesday and the New York Association of Psychiatric Rehabilitation Services’ annual legislative day last Tuesday illustrated a mix of optimism and distress about the mental health system in New York State.

One of the issues of greatest concern voiced at both the legislative day and the budget hearing was the practice of placing prison inmates suffering from mental illness in special housing units. Advocates said the suicide rate in these units is 10 times greater than in the general prison population.

Inmates placed in special housing units are subject to 23 hours of solitary confinement a day, a practice called “inhumane” and “unsafe” by the mental health community.

Spitzer proposed $2 million be earmarked in the 2007-2008 budget for increased mental health services in prisons. Though advocates voiced pleasure with this proposal, they called on senators and Assembly members at the budget hearing not to view the money as a substitute for passing regulatory legislation.

Mental Health Alternatives to Solitary Confinement, a coalition of advocates and mental health professionals, announced the commencement of a “Boot the SHU 100 Hour Campaign” aimed at promoting the passage of legislation that would ban solitary confinement for people with psychiatric disabilities by March 13.

Sen. Michael F. Nozzolio R,C–Seneca Falls, introduced a bill in the Senate on Jan. 3 that would prohibit mentally ill inmates from being placed in special housing units and was cited by the New York Association of Psychiatric Rehabilitation Services for his support on the issue.

Nozzolio said New York State must “stop any practice in our prisons that do not meet the standards of humanity.”

He submitted a similar bill last year that passed in the Senate and Assembly but was subsequently vetoed by former Gov. George E. Pataki.

Concerns over mentally ill individuals being placed in special housing units prompted several individuals at the budget hearing to suggest a collaborative effort be made by the New York State Office of Mental Health, Office of Alcohol and Substance Abuse Services and the Department of Correctional Services, to help develop better strategies for dealing with inmates.

A proposed $46 million to civilly confine sex offenders in psychiatric facilities also had advocates asking the Department of Correctional Services to rethink strategies.

According to Peter M. Rivera, D-Bronx, chairman of the Assembly committee on mental health, approximately 700 inmates are expected to be civilly confined within the next several years. He said a number of beds in Rochester that were supposed to be used for civilly confined individuals were pulled from a facility, and he has been unable to determine the cause.

At the budget hearing, acting Mental Health Commissioner Michael Hogan asked why sexual offenders who are listed among those to be civilly confined are being released from prison now. “Was the sentencing long enough to begin with?”

Glenn Liebman, CEO of the Mental Health Association in New York State, expressed concern for the safety of patients in psychiatric facilities, and Harvey Rosenthal, executive director of the New York Association of Psychiatric Rehabilitation Services, suggested using some of the $46 million to create a state office of sex offender management so that behavior could be studied.

Both ideas were echoed by other speakers at the budget hearing, though Sen. Dale M. Volker R,C-Depew, said “mental health advocates want to brush this thing under the table.”

Advocates are optimistic about the proposed “rightsizing” of the 16 state adult psychiatric facilities and six children’s facilities.

“Rightsizing means reinvestment, reinvestment means recovery,” said Rosenthal at press conference last Tuesday.

Advocates at the press conference said that money spent on maintenance of psychiatric centers that have many empty beds could be better spent on other programs.

Josh Koerner, co-president of the New York Association of Psychiatric Rehabilitation Services board of directors, suggested reinvesting money into community out-patient facilities, and Antonia Lasicki, executive director of Community Access, said “buildings can be used for a whole variety of new programs,” citing geriatric care facilities as an example.

Also, mental health advocates raised concerns over the proposed removal of anti-depressants from the Medicaid preferred drug list.

This removal would make it more difficult for individuals with Medicaid and Medicare Part D coverage to obtain anti-depressants. Most patients would need to obtain a physician override to afford the anti-depressant drugs, advocates said.

A physician override requires a doctor to make a specific request on behalf of patients stating they need a particular type and brand of drug. If granted, the cost of the medicine is covered by the patient’s Medicaid or Medicare Part D.

Advocates also said they would like to see a cap on Medicare drug co-pays.

Adult Home Residents Want Better Care
Legislative Gazette, February 12, 2007
by John Grybos

Adult home residents are tired of bland, repetitive, tiny meals. They’re tired of sweating through the summer months with no air conditioning, even when the heat becomes life threatening for the elderly. So last Wednesday, a crowd of adult home residents traveled to the capital to speak out about their sub-par living conditions.

“You can’t house a German Shepherd for $35 a day,” said Senator Martin Golden, R,C-Brooklyn, though many homes spend that little on their residents. “We need to do better for you.”

The event was coordinated by the Coalition of Institutionalized Aged & Disabled, a non-profit advocacy group for adult home residents.

Though the group came to Albany with a cohesive and lengthy agenda, the three biggest issues are very basic concerns—food, drugs, and air conditioning.

Adult homes provide housekeeping, meals and personal care to their residents. The Department of Health licenses and regulates the homes. Unlike nursing homes, they are disallowed from providing medical services or hiring anybody to provide medical services.

Highly processed meats make up the bulk of resident’s protein consumption, said Bob Burbank, a long-term-care ombudsman. Hot dogs, Salisbury steaks, fish-sticks and “turkey pressed into a gel” constitute most of their entrees.

If the residents are fed up with or simply don’t want those menu items, the alternative, “regardless of what the menu shows,” is almost always a cheese sandwich made with two slices of bread and a slice of cheese, said Burbank.

And if the resident opts for the skimpy alternative, then their meal is pared down even more, because the vegetable and potato that come with the main meal don’t come with the alternate.

Special diets for diabetics and residents with heart conditions are poorly planned, said Kathleen Newman, a diabetic adult home resident in Woodhaven on Long Island. “Most of the time, the meals are so unappetizing that people feel like they’re being penalized for having a disease.”

Newman has been an adult-home resident for five years, and in all that time has not seen any changes in meals for people who need special diets.

She also complained that the meals are too small, and are served on small plates so that they’ll appear larger.

Residents at the home where Burbank serves as an ombudsman had their eight-ounce glasses of milk taken away and replaced with glasses that are half the size.

Air conditioning is “not a luxury, it’s a medical necessity,” said Norman Bloomfield, an adult-home resident. “Air conditioning can literally save people’s lives.”

Some medications can make it worse for heat-stricken residents, said Bloomfield, psychotropic medications especially will increase the body’s susceptibility to heat.

Adult homes don’t provide easy solutions. Bloomfield’s home charges $55 per person per room every month for the use of air conditioning. With two people to a room, that’s $110 a month, nearly enough money to purchase an air conditioner.

“Every resident should have a right to get an air-conditioned building to live in,” said Sen. James Brennan, D-Brooklyn. A solution should be found “so this suffering can be eliminated completely.”

Paying for medications under Medicare Part D can be burdensome for people whose income is about $164 a month.

Phillip Shapiro, an adult-home resident and peer adviser, gets complaints from fellow residents of medicine co-pays being $60, $70 or even $80 per month. This can be a serious hit to their living allowance of about $164 a month.

“We have to persuade many people ‘do without this, do without that, but don’t do without your medication’,” Shapiro said.

Part of the problem is that adult homes are privately owned and try to maximize profits while providing minimal services, said Ryan Napoli, a lawyer with MFY legal services, an organization that provides free civil legal service to those in need.

Napoli said the most common cases he deals with are “lock-out” cases, where residents who are considered troublesome are sent to a hospital so the adult home staff won’t have to deal with them anymore. Most of these cases arise because residents stand up for their rights too much, and the adult home decides they are too high-maintenance and look for a way to get rid of them.

Adult homes “over-medicate” and “zombify” their residents, said Napoli. “They infantalize them, they encourage them to kind of be controlled.”

The Death Of Timothy Souders
60 Minutes, February 11, 2007
By Scott Pelley

http://www.cbsnews.com/stories/2007/02/08/60minutes/printable2448074.shtml

(CBS) You wouldn't imagine these days that a mental patient could be chained to a concrete slab by prison guards until he died of thirst, but that’s how Timothy Souders died and he is not the only one.

Souders suffered from manic depression. And like a lot of mental patients in this country, he got into trouble and ended up not in a hospital, but in jail. It was a shoplifting case and he paid with his life.

As correspondent Scott Pelley reports, no one would have been the wiser, but a medical investigator working for a federal judge caught wind of Souders' death and discovered his torturous end was recorded on videotape. The tapes, which are hard to watch, open a horrifying window on mental illness behind bars.

Six months ago, Tim Souders was in solitary at the Southern Michigan Correctional Center. He was 21, serving three to five years. Though an investigation would show he needed urgent psychiatric care, Souders was chained down, hands, feet and waist, up to 17 hours at a time. By prison rules, all of it was recorded on a 24-hour surveillance camera and by the guards themselves.

The tape records a rapid descent: he started apparently healthy, but in four days Souders could barely walk. In the shower, he fell over. The guards brought him back in a wheelchair, but then chained him down again. On Aug. 6th, he was released from restraints and fell for the last time. Souders had died of dehydration and only the surveillance camera took notice.

His short life began in Adrian, Mich. Souders was a kid whose troubles didn’t start until late in his teenage years. It was then, his mother, Theresa Vaughn, told 60 Minutes that he began acting strangely.

"It was January in the wintertime. And you know, he was running around outside with his clothes off, thinking he was a knight, fighting dragons. You know, it's…you lose touch with reality," Vaughn remembers.

"So, he went to the hospital and what did the doctors tell you?" Pelley asks.

"They then diagnosed him with bipolar, and put him on several different medications," Vaughn says.

Still, he was troubled by anxiety and depression, often in and out of the hospital. After one hospital stay, he was caught shoplifting two paintball guns. He grabbed a pocket knife, threatened employees, and then begged a cop to shoot him. Instead, he was stunned with a Taser.

No one was hurt.

"He was trying to get money to pay his rent, so that he would not be evicted from his apartment," says Vaughn. "He had gotten to the point where his thinking wasn't straight, and he was suicidal. And he should've never went to jail."

In jail, Souders tried to kill himself three times. He pled to resisting arrest and assault, for waving the pocketknife, and ended up in a Jackson County prison complex, with 5,000 inmates. It’s a troubled place—prisoners filed suit there in the 1980's and since then, their welfare has been monitored by a federal judge.

When Souders arrived he was part of a national trend: there are 300,000 mental patients behind bars nationwide. That’s because starting in the 1960’s many mental hospitals have been closing. And as patients ended up in jail, prisons became the new asylums.

"They became de facto mental hospitals and the prisons are ill equipped to handle it," says Robert Walsh, a clinical psychologist working inside Michigan prisons for the past 25 years.

Walsh is an insider. He was a deputy warden and director of psychological services at the prison where Souders died. He retired six years before Souders arrived.

"Given what you see in the Souders videotape, what should have been happening?" Pelley asks.

"What should have been happening was right away, mental health staff should have been consulted and reported to the scene, and they should have intervened. Given that he wasn't assaultive against anybody," says Walsh.

But there was no mental health staff to consult—the psychiatrist was on a seven-week leave.

"Then he should have been replaced. It's too critical a situation," Walsh remarks.

This situation started when Souders took a shower without permission. That landed him in solitary. When he broke a stool and used his sink to flood his cell, the chains came out—what the prison calls "top of bed" restraints.

"Approximately 15 minutes ago, the prisoner began flooding his cell. His water is being shut off even as we speak. And we’re going to place the prisoner in top-of-bed restraints," an officer could be heard on the videotape.

Walsh did an extensive study of Michigan prisons and found that the staff often tries to punish psychotic inmates into better behavior.

Incredibly, he found in a number of cases, the staff insists inmates are not mentally ill, despite profound insanity.

"One man, he enucleated his eyes, cut 'em out, because he felt they were offending God. These were men that were, claimed to be manipulative, malingerers and non-mentally ill," says Walsh.

"Wait a minute. Did I just understand you to say that the department of corrections declared those men not mentally ill?" Pelley asks.

"The staff did. That's correct. The psychiatric and psychological staff considered, considered them to be malingerers and manipulators that went to extremes," Walsh says.

"Now can that be? You have a man who gouges his eyes out?" Pelley asks.

"Exactly," Walsh says.

"And he's not mentally ill?" Pelley asks.

"Or a man that disembowels himself," says Walsh. "Yes. Yeah. He's manipulating."

After his arrest, a state psychologist said Souders was trying to manipulate the staff when he stabbed himself seven times in the stomach in a suicide attempt. Months later, in solitary, there was no psychiatric intervention, even when Souders was raving.

A social worker wanted him transferred to a hospital, but the paperwork never got done. The guards resorted again to chains, which the federal judge overseeing the prison criticized as “punitive restraints.”

"We do not actually use punitive restraints. We use restraints," says Patricia Caruso, the director of Michigan's prison system. "Punitive implies restraints for punishment. Restraints are never used for punishment. Restraints are used for protection. They are used for the protection of the prisoner of harming himself, or for the protection of others who are being harmed by the prisoner."

But Tim Souders wasn’t harming anyone and a prison report shows it was his attempt to break the stool and flood his cell that led to the authorization to put him in top-of-bed restraints.

"It depends on you how long you’re in these, okay? Can’t flood your cell, can’t do that type of stuff. We put you in restraints to kind of control your behavior," an officer told Tim.

"We've seen cases where people have been in restraints on and off, day after day after day. And I have not found a mental health expert who has told me that that's a good idea," Pelley tells Caruso.

"It is on and off. People are removed from restraints. Even prior to that, people [are] removed from restraints at a maximum of every two hours. And would get up and walk around," she replies.

Two hours? 60 Minutes checked the surveillance tape. Souders was up some of the time, but 60 Minutes found he was restrained for stretches of 12 hours, 16 hours, and 17 hours.

Tim Souders had bed sores and on the third day in restraints, he resisted for the first and only time, complaining bitterly about the hours in chains.

"I'm tired of this. Eighteen hours is not justified," Souders could be heard saying on the videotape.

Recently, Michigan's corrections director Patricia Caruso suggested limiting the total time in restraints to six hours.

"Federal judge describe that as trading six hours of evil for unlimited evil. Evil is evil, he’s saying. You're smiling," Pelley remarks.

"No. I'm…I don't—," says Caruso.

"Surely you take that seriously," Pelley asks.

"I absolutely take that seriously. Prison is a difficult environment. I have correctional officers, who become accustomed to having urine and feces thrown on them by prisoners, who have prisoners who are so injurious that they will open their bodies to remove organs from others. And so we have to rely on our responsibility to keep people safe," says Caruso.

But Michigan prisons have not been safe for mentally ill prisoners who have died needlessly. At least one starved to death, and others died of dehydration like Souders. Jeffrey Clark, a paranoid schizophrenic serving time for robbery, died of thirst in solitary. His sister, Bonita Clark-Murphy, pored over investigative reports of his death.

"There are reports that he had his mouth up against the plexiglas window, begging and pleading for water and air, and for someone again, to turn a deaf ear and a blind eye to that, that's why I say Jeffrey was tortured," she says.

Clark-Murphy filed suit against the state; she claims the warden told the family that her brother died of an infection.

"We buried Jeff, not even knowing what happened," says Clark Murphy.

"It seems that the prison officials expected to tell you that this was natural causes, and that you'd just leave it alone," Pelley asks.

"Absolutely. And they were so wrong," she replies.

Jeffrey Clark was locked in solitary in the heat of the summer with his water turned off. And four years later, the heat index in solitary was over 100. Souder's was also water turned off.

"That is steam, I’m afraid," one officer said. "Oh yeah, because it’s so hot in here," another officer remarked.

He became delusional, refusing water when offered. But not even that was a medical emergency to the staff. "Souders has refused. Officer asked him if he needed water. He replied, ‘No,’" an officer could be heard on the tape.

After Souders' death, federal Judge Richard Enslen, who oversees the prison, wrote that inmates are exposed to an "unauthorized death penalty at the hands of a callous and dysfunctional health care system that regularly fails to treat life- threatening illness."

"I understand that it's easy to take individual cases and to sensationalize them, and you know, relentlessly replay the facts of an individual case. But I also think it's unfair," argues Caruso.

"But director, fair to say, people starve to death and die of thirst in your prisons?" Pelley asks.

"Any death, any incident like that in our custody is a tragedy. I will not deny that. It is not…that certainly isn't something that, you know, we set out…I mean, we have people come to us dying," she replies.

"They don't come to you dying of thirst and dying of starvation. How can that happen under your custody?" Pelley asks.

"I'm not gonna address cases that are under litigation. I cannot do that," the prison system director replies.

The Souders case is under litigation. His mother, Theresa Vaughn, is suing. She says the prison never told her how her son died. She found out in the "Detroit Free Press."

Vaughn has seen the videotapes of her son's last days and says they give her nightmares. "I cannot believe anyone would treat another human being that way at all. That they can watch over a four day period, slowly declining, slowly dying before their eyes," she says.

Asked if she things the guards meant to kill her son, Vaughn tells Pelley, "I don't believe anybody meant to kill Tim. I don't believe that they meant to hurt Tim. But they did. They did hurt him. And he did die. He's not comin' home. He's not comin' back. And he is gone. And he was only 21 years old."

After Souders died, a prison nurse was fired for failing to recognize his condition was becoming critical. In November, Judge Enslen used the word "torture" to describe those restraints and banned them. The state is appealing his decision.

In part because of the death of Timothy Souders, a federal judge in the case of Hadix v. Caruso ordered wide-ranging reforms in the prison mental health care, including an end to the in-cell use of mechanical restraints in most circumstances. Hadix is a federal civil rights class action involving the medical care, mental health care, fire safety and protection from excessive heat at three prisons in Jackson, Mich., the Egeler Correctional Facility, the Southern Michigan Correctional Facility (JMF), and the Parnall Correctional Facility. These three prisons contain thousands of prisoners, including a concentrated population of medically fragile prisoners at JMF. For more on this case, visit The ACLU National Prison Project.

Survey Puts New Focus on Binge Eating as a Diagnosis
The New York Times, February 13, 2007
By Nicholas Bakalar

Binge eating is not yet officially classified as a psychiatric disorder. But it may be more common than the two eating disorders now recognized, anorexia nervosa and bulimia.

The first nationally representative study of eating disorders in the United States, a nationwide survey of more than 2,900 men and women, was published by Harvard researchers in the Feb. 1 issue of the journal Biological Psychiatry. It found a prevalence in the general population of 0.6 percent for anorexia, 1 percent for bulimia and 2.8 percent for binge-eating disorder.

Lifetime rates of the disorders, the researchers found, are higher in younger age groups, suggesting that the problem is increasingly common. Eating disorders are about twice as common among women as men, the study reports.

Experts not involved in the study called it significant. “This is probably the best study yet conducted of the frequencies of eating disorders in American households,” said Dr. B. Timothy Walsh, director of the eating disorders research unit of the New York State Psychiatric Institute at Columbia University Medical Center.

“It confirms that anorexia nervosa and bulimia are uncommon but serious illnesses, especially among women,” Dr. Walsh said. “It also finds that many more individuals, especially those with significant obesity, are troubled by binge eating, and underscores the need to better understand this problem.”

The survey, partly financed by two pharmaceutical companies, was carried out from 2001 to 2003 among adults 18 and older, and the diagnoses were established using face-to-face interviews.

While all three eating disorders appear in the American Psychiatric Association’s diagnostic bible, the Diagnostic and Statistical Manual of Mental Disorders, or D.S.M.-IV, binge eating disorder is not considered a definitive diagnosis like anorexia and bulimia. Rather, it is one of a number of categories requiring further study.

Some suspect that establishing binge eating disorder as a psychiatric diagnosis is merely an attempt by psychiatrists or drug companies to “medicalize” what would otherwise be considered simply ordinary, if unfortunate, human behavior. Cynthia M. Bulik, director of the eating disorders program at the University of North Carolina, Chapel Hill, does not see it this way.

“It’s patients who want this in the D.S.M. so they can get treatment,” Dr. Bulik said. “I’ve gotten e-mails from people saying, ‘Thanks for putting a name on this binge-eating disorder.’

“The disorder has no diagnostic label that will get them insurance payments,” she continued. “They have a nasty syndrome with serious health implications, knowing that there is evidence-based treatment available and not being able to get it because it’s not officially recognized as a diagnosis.”

The diagnosis of binge eating disorder requires that a person eat an excessively large amount of food in a two-hour period at least twice a week for six months, feel a lack of control over the episodes, and experience marked distress regarding the practice.

Marlene B. Schwartz, the director of research and school programs at the Rudd Center for Food Policy and Obesity at Yale, who had no role in the study, said binge-eating disorders were “not a matter of just eating too much every now and then.”

“The diagnosis requires the feeling that you can’t stop,” Dr. Schwartz said. “And it’s that loss of control that makes it a psychiatric disorder different from someone just overindulging every now and then.”

Dr. James I. Hudson, the lead author of the new study, said binge eating was associated with obesity, particularly severe obesity. “This brings in a lot of medical consequences and suggests it’s a major health problem,” he said. “This information will help us make decisions on public health policy.” Dr. Hudson is director of the psychiatric epidemiology research program at McLean Hospital in Belmont, Mass., and a professor of psychiatry at Harvard.

A diagnosis of anorexia requires a refusal to maintain at least 85 percent of normal weight and a distinctly distorted view of one’s weight or body shape. Bulimia is characterized by recurrent episodes of binge eating at least twice a week for three months and then compensating for the behavior, usually by self-induced vomiting or abuse of laxatives and other medicines.

Eating disorders, the researchers found, are commonly accompanied by other psychiatric illnesses. In the survey, more than half of the people with bulimia had major depression, 50 percent had phobias and more than one-third had a substance abuse disorder. Over all, more than 94 percent of people with bulimia, 56 percent of those with anorexia and 79 percent of those with binge-eating disorder had at least one other psychiatric diagnosis.

Dr. Hudson said the most significant limitation of the study was its basis on self-reports, explaining that people tend to underreport their problems with eating disorders. So the true prevalence, he said, is probably higher than reported.

“Obesity is an endpoint, and there are many pathways in,” Dr. Bulik said. “One of the things I look for is modifiable behavioral factors. This study shows now that binge eating disorder is relatively prevalent. For a certain percentage of the population, this is a modifiable behavior.”