Agonia: Mental Health Advocates

Mental Illness and Sexual-Abuse/Rape:
A Mental Health Advocate/Consumer
Makes Reckonings on Necessarily Discomforting Realities
And Potential Solutions for "Sexuality-Gone-Crazy"


Today from the Internet I read of:

-- A mental patient, sometimes homeless, frequently arrested for crime-- sexually assaulting a woman praying in a New York City Roman Catholic Church. [See "Former Homeless Man Charged with Attacking Woman inside Church," WSTM.com, http://www.wstm.com/global/story.asp?s=6536308&ClientType=Printable .]

-- Again in New York, a psychologist reports testing that a rapist who posed as a fireman to gain entry to a woman's apartment, then to molest her for 13 hours-- was mentally ill (according to this psychometric testing) albeit not schizophrenic as his defense lawyer holds. [See "Psychologist Says 'Fake Firefighter' Has Mental Problems," 1010 WINS .]

-- A psychologist somewhat defensively pleads for sympathy for Seung-Hui Cho-- who on April 16 because of a sexual fixation from deranged (possibly schizoprenic or bipolar) reaction to being jilted-- slew 32 innocent people at Virginia Tech, on grounds of Cho's mental illness and his adverse position as an Asian in alien American society. [ See "Mental Illness, Racial Identity and the Virginia Tech Shooting," The Seattle Times, Friday, May 18, 2007. ]

-- A Canadian schizophrenic is held accountable for the homophobic murder of two gay men in Nova Scotia, and for another man's murder (gender-orientation unspecified) in Mooers, New York. [ See: "Family of Man in Canadian Gay, US Murders Frustrated by Limited Treatment He Has Received," in 365 Gay, http://www.365gay.com/Newscon07/05/051807canfamily.htm .]

-- And all of this was suggestively-- and bitingly-- corroborated by empirical evidence-- from meticulous case-control study from Sweden using thousands of subject and more-thousands of controls-- that male sexual offenders are 4.8 times more-likely to have schizophrenia and 3.4 times more likely to have bipolar disorder than normals. DAMNING! HORRIBLE TO ME AS A MENTAL HEALTH ADVOCATE/CONSUMER! [ But, see abstract from Entrez PubMed: "Severe Mental Illness and Risk of Sexual Offending in Men: A Case-Control Study Based on Swedish National Registers," Journal of Clinical Psychiatry 68(4):588-596, April, 2007 .]


Important Considerations for All of the Above (Troubling) Data:

This Web-log is a journalistic endeavor: I must at all costs strive to present the facts as facts-- no glossing-over or varnishing-up "saying-it-like-it-is." Many criminal justice workers would feel vindicated by all these reports above-- whereas perhaps many mental health advocates would be deflated, even demoralized from such an array of problematic information. Having worked in forensic-psychiatry, general-psychiatry, and corrections-- I do not think I "straddle the fence" by conceding much truth to the charge that numerous sexual offenders have mental illness, but also weigh "in the mix" mitigating and alternative findings, which in no wise defend/justify a rapist whether-or-not deranged, but add what may be considered as "dimension" to these troubles. To wit, balancing all this "bad news," it is fair to say:

1. The mentally ill do have a tendency to engage in crime at a higher rate than normals-- but this rate is slight-- statistically-significant only by virtue of the Law-of-Large-Numbers/Central-Limit-Theorem. [ See, "Walking Time Bombs: Violence and the Mentally Ill," in Out of the Shadows: Confronting America's Mental Illness Crisis, by E. Fuller Torrey, M.D. (a notable advocate for the mentally ill), John Wiley & Sons, Inc., New York, New York, 1997, pages 43-60.]
2. The mentally ill in jails/prisons do not TEND to be incarcerated for "violent" crimes. [Source: U.S. Bureau of Justice statistics as reported in "Root Causes of Violent Behavior Remain Elusive," Kansas City Star, May 6, 2007, found on Internet at KansasCity.com, http://www.kansascity.com/105/v-print/story/95876.html .]
3. Numerous times mentally ill men are incarcerated for sexual offenses when later found certainly (by DNA testing, etc.) to be INNOCENT. [For a case-report of one such incident recently, read: "Son's Arrest Leads Mother on a 22-Year Journey of Faith," in USA Today, May 13, 2007.]
4. The mentally ill (in the case of women, at least) appear to be significantly MORE LIKELY TO BE VICTIMS of rape/sexual-abuse than normals. [See: "Preventive Health Care for Mentally Ill Women," by Jeanne L. Steiner, D.O. et al., in Psychiatric Services 49:696-698, May 1998, http://psychservices.psychiatryonline.org/cgi/content/full/49/5/696 .]

Options for Intervention:

I feel no sympathy-- in view of my experience and the above information-- in "excusing" anyone who resorts to forcing sex from another person, male-or-female, female-or-male, whether or not such a person has organic brain syndrome, mental retardation, schizophrenia or even bipolar disorder (which happens to be the malady from which I suffer)... nor for any other psychiatrically-definable condition or rationalization. Clearly, for those who cannot abide sexually appropriate limits AND who are mentally-ill-- great in number according to the recent Swedish study-- something robust and effective needs to be done.

Clearly what "needs to be done" is not to put such mentally-ill malefactors into "regular" mental hospitals on any form of involuntary mental health commitment; I am in complete accord with the National Alliance on Mental Illness of New York, the American Civil Liberties and (apparently) Fox Media -- strange "fellows," here!-- on this topic. [See: "Critics Look for Alternative to Sex Offender Civil Commitments," Fox News, http://www.foxnews.com/printer_friendly_story/0,3566,202874,00.html .] The reality is that every state-- and most other venues -- as far as I know, have a lock-up for mentally ill people who run afowl of the law. These are variously called institutions for "forensic psychiatry," "criminal insanity," or "correctional psychiatry." If everything was going as designs would indicate, these places offer best-- and LIFETIME -- confinement possibilities for anyone mentally-ill/mentally-retarded who has been sexually aggressive! That for some PECULIAR reason such people as mentally ill rapists and child molesters sometimes "serve out" or-- much worse-- get parole when in such a habitual and proven state-- is an INDICTMENT OF THE SYSTEM. Clearly, however, placing such people in (state, etc.) mental hospitals-- where the security is inevitably more lax than in a jail/prison-- is BY NO MEANS a solution even if hypothetical lifelong "sentences" can be arranged.

But-- say-- someone in "infinite wisdom" decides to place a mentally ill sexual aggressor in some community or another-- a contingency which also happens more frequently than the public knows. In such an event, there are still contingencies. Just today, it was announced that technology has been developed to put "LifeShirts"-- monitoring devices that assay psychiatric symptomatology-- to mental patients in the community-- intervention which augurs to be effective but expensive. [See: "Wearable Technology Helps Monitor Mental Illness," in ScienceDaily, May 18, 2007, http://www.sciencedaily.com/releases/2007/05/070518160743.htm .] A more-cost-effective-- and proven technology might simply be "radio monitoring" with sensors on the bodies of sex offenders who are mentally ill (or any other type of sex offender.) According to a fiscal analysis done by the State of Iowa not-too-long-ago, this intervention is the second-most-inexpensive form of "high-tech" monitoring of sex offenders, beneath which is the simple "call-in" system, and above which are -- in order of cost-- video display (VB), video display radio frequency (VBR), global positioning satellite (GPS), and "advanced" GPS. [ See: "Iowa Legislative Services Agency: Fiscal Services: Electronic Monitoring of Sex Offenders," Des Moines, Iowa, December 15, 2005.] This last-cited report says that -- at prevailing costs at the time of the white-paper, radio monitoring (RF) would cost $2.87 per diem.

One might question whether I am properly functioning as a "mental health advocate" by enouncing such a "permanent lock-up policy" for sexually aggressive mental patients. But any advocacy I might do is HOLLOW if I should not in each instance promote and abet what I know or believe to be JUST. As my information above indicates, the "harmless" mentally ill are in no wise benefitted by the mayhem and sociopathy of any of those who are aggressive, sexually in this instance. Government is designed to "promote the general welfare" [ see "Preamble," United States Constitution], and one may safely predict that the mentally ill in general-- and all hapless and more-or-less disenfranchised in society-- will be first to be "wounded" by the (crazy-or-not) aggressors. For this reason, here I "hang tough"!!!


---Vernon Lynn Stephens, M.S.S.W.
D.S.M. IV # 350
F31.2
Telephone:1 (502) 561-5419
E-Mail: freethink@bellsouth.net

posted by Louisville Hermitage @ 6:42 PM 2 comments

Out-of-One-Hole-and-into-Another:
A Case-Study of the Current New Jersey Predicament
That Psychiatric Patients Are Bedded in Emergency Rooms


On Tuesday, May 15 of this year the Kaiser Foundation pressed an analysis-- "Mental Health Patients Overwhelming New Jersey EDs, Officials Say," . As the title suggests, this story reports on the phenomenal overuse of emergency-department beds by psychiatric patients in recent times. This article aspires to use the New Jersey experience in mental health over the past decades-- using "case study" methodology on the basis of Internet reports-- to fathom why this misappropriation of services might occur.

New Jersey is no "backward" state-- unlike the Kentucky from which this piece is being written. The state has a high per-captita income, hosts several major-- and Ivy League-- universities, and is known to have an enlightened populace with governance that is historically known to be solid, even progressive. I read that New Jersey once had twelve public psychiatric hospitals-- six run by the state and six by the county, with 90% of expenditure for hospitalization coming from the state [Source: "Profile of Public Psychiatric Hospitals in New Jersey," SAMHSA: National Mental Health Information Center.] Like every other state-- New Jersey is in the process known as "deinstitutionalization"-- but in this case pursued with prudent deliberation -- the state has been in the process of winnowing down the public psychiatric hospitals, and building up community mental health in its preventative, screening, and treatment aspects beginning under the Governorship of Thomas Kean (Republican) in 1987-1988 [from "Profile...New Jersey," work just cited], yet continuing under all governors-- a timespan marked mostly by Republican governors (and legislature) in the 1990s yet Democratic governors in the 2000s followed this diaspora-from-asylum as well [ see, "Profile...New Jersey," same source. ]

A major state psychiatric hospital, Marlboro, was slated for complete closure; I understand ["Profile...New Jersey," again] that this 780-bed hospital stopped taking patients in June, 1998. This was a key component of a state initiative begun in 1995, under the governance of (Republican and fiscally-conservative) Christine Todd Whitman, wherein-- with the closure and curtailing of state/county psychiatric hospital admissions-- there was increased vigor for deinstitutionalization/community-mental-health, formulated under a doctrine known as "Redirection." And shortly thereafter, Governor Whitman announced that another large state psychiatric hospital-- Greystone-- would be scaled back from 538 beds to 400, and subsequent savings obtained funnelled into community mental health. In making this announcement in her budget speech before the New Jersey Legislature, Governor Whitman said, "For our one family to truly thrive, we must do our best to ensure that everyone lives and works as part of the community, not apart from the community...improving our system of care for people with mental illness. This budget allows us to begin building a smaller facility on the grounds of Greystone Park Hospital. Ultimately, scaling down Greystone will save us money that we can dedicate to more community mental health programs. In the meantime, this budget provides $22 million for those services" [from: "Remarks of Governor Christine Todd Whitman-- Fiscal Year 2002 Budget Address, Tuesday, January 23, 2001," http://www.state.nj.us/budget02/bmsgfy2002.html ]; this appears to have been the heralding of a state thrust known as "Redirection II."

We know that Governor Whitman took a prominent position-- head of the Enviornmental Protection Agency-- in the administration of George W. Bush; this left several "caretaker" governors for an inter-regnum period, three Republicans, one Democrat, until the election of James ("Jim") McGreevey-- a Democrat-- in 2002. McGreevey essentially supported much of mental health funding that the Republicans had inaugurated (as does McGreevey's Democratic sucessor, Jon S. Corzine.) This is true despite budget shortfalls and a recession, at which New Jersey-- industrially a "rust-belt" state-- was in the center, and despite the generally conservative timbre of the times. [See, "Mental Health Advocates Win BIG in Trenton," in Mental Health Notes: The Mental Health Association in Southwestern New Jersey, http://www.raphaelwebscapes.com/mha/newsletterfall03.php ; also "Governor Signs New Jersey Legislature's Recommendations for the FY '04," in The Cutting Edge: A Monthly Mental Health Advocacy Update, 2(7): July/August, 2003, http://www.mhanj.org/Resources/edgev2i7.htm -- this last-mentioned document-- in addition to thanking Governor McGreevey-- gives kudos to 16 state senators (8 Democrats, 8 Republicans) and 15 Assemblypersons (10 Democrats, 5 Republicans)-- the skew 18:13 resulting is at a cumulative binomial probability of but .247-- which mostly demonstrates that this less-than-significant result favors neither Democrats nor Republicans in New Jersey.]

In an unfortunate scandal, McGreevey was forced to resign in 2004, to be replaced by an inter-regnum Governor (Democrat), and then in 2006 came the elected Governor Jon S. Corzine (Democrat), whose austerities -- as well as his progressive tendencies were remarkably consistent with the fiscal politics of all U.S. governors at the time-- of either party. This caused disability-rights advocates some concern, but it is reported by New Jersey Protection & Advocacy,Inc., in a story "FY 2007 State Budget," http://www.njpanda.org/legislative.htm , that as of 2006, "The budget funds numerous recommendations from the Mental Health Task Force. These include: mental health screening centers, self help services, psychiatric services, supprtive housing, and jail diversion programs in Atlantic, Essex, and Union Counties." Corzine's steady-state approach initially-- perhaps not now after the known incident of his driving while intoxicated-- won him the tacit, grudging favor of the (predicably conservative) New Jersey Chamber of Commerce in the first part of 2007. [ See: "FY 2008 Budget Update," New Jersey Chamber of Commerce, http://www.njchamber.com/media/budget08/feb%2022%2007%20budget08.htm .]

Here, New Jersey, is a state that did not resort to drastic budget cuts in mental health, overall, and which with the closure of state hospitals still found that alternative facilities take the brunt of "exiled" chronically mentally ill-- the report here is of the emergency wards of hospitals-- but I have little doubts from hints in the Kaiser Foundation story yesterday that there are problems with mental patients going to jail-- and to the "skids" after shutting down the long-term facilities as well. This Kaiser report voices the speculation of mental health experts in New Jersey that this reverse-of-events there comes about through:

• "lack of psychiatric beds"
• "failure to hold and treat clients in a safe and secure location"
• "planned downsizing of available beds in the state mental hospital system"
• "challenges in moving patients with legal charges or violent histories to appropriate state facilities"

[Same Kaiser story, cited.]

Of course, it is an inevitable human tendency to begin a "blame-game" when such a massive social disruption occurs. In one place [ "Hospitals as Scapegoats," Treatment Advocacy Center, March 1, 2007, http://psychlaws.blogspot.com/search/label/hospital%20closures ], an irritated blogger-- apparently of New Jersey-- writes, "New Jersey already closed one hospital and 'reinvested' the money in the community. Yet the psychiatric hospitals are overcrowded because community mental health providers can't-- or won't-- do what is necessary to keep patients out of the hospital. Thus tragedies among this very vulnerable population are inevitable both in and out of hospitals...Community mental health must step up and do more for hospital patients than just take their money."

As we may expect, this is not the view of community mental health workers in New Jersey, for we read in "Grassroots Advocacy Newsletter," of the New Jersey Association of Mental Health Agencies, Winter (meaning this past winter) 2007, "Community mental health workers earn 20 to 30 percent lower salaries with similar jobs. This situation leads to high turnover and vacancy rates, undermining the stability that individuals with mental illness need...Since 1997, the consumer price index has risen 32%. In the same time-frame, the state has only provided a total increase of 15%...Medicaid only reimburses organizations 11-15% of the actual amount these services cost."

There is merit with both positions stated just-above, but my experienced sympathies lie with the community mental health workers, and with community mental health as a concept. The basic problem-- and one that is less-often voiced as "charges" get raised-- that chronic mental illness is a bio-psycho-social phenomenon in each instance of its occurrence, and there is only so much that social intervention can do to mitigate against the "sting" of these terrible disorders-- which to date -- with a "total-systems" approach can be managed-- but only liars and tom-fools boast of a cure. The fact remains that community interventions are the-more and not the-less needed when patients are getting themselves in "pickles" and thus winding up in decidedly non-psychiatric places-- dead or barely alive. If the governors-- I am speaking of magistrates-in-general-- do not take into consideration that the mental patient has such complex malady, then we may anticipate that these prophetics-- taken from the none-too-liberal BusinessWeek Online, in an Internet story posted March 24, 2003, http://www.businessweek.com/bwdaily/dnflash/mar2003/nf20030324_3888_db038.htm -- precisely when New Jersey and practically all other states were slashing mental health due to "the budget crunch":

"About 10% of state health-care spending-- a nationwide total of $ 20 billion-- goes to treatingmental disorders, according to the National Institutes of Health. And since the mentally ill aren't a particularly powerful constituency, cutting funds that are earmarked for them is a politically expedient decision. As well as hurting patients, the cuts could have an unintended negative effect on the states themselves. Many of the mentally ill could end up in jail, on the streets, or in hospital emergency rooms...[S]omeone on a simple charge, say panhandling or stealing a cup of coffee, can cost several thousand dollars-- about as much as what's needed to provide outpatient mental-health care for a year, including counseling and medication...The money needed for their treatment will come out of the budgets of departments of correction and the states' general health-care budgets...Adding the mentally ill to their load will put a bigger strain on those other budgets, which are being trimmed as well...The long-term costs of too little care are more tangible, in part because shortcuts taken now can lead to longer and more intensive treatment later-- and increase the lifetime cost of care for a disabled person."

...There is, in my estimation, great merit in what this writer in BusinessWeek had to say. The problem is-- as the New Jersey case reveals-- money is only partly the solution to this crisis of treatment-malapropism for the mentally ill. Programs and jobs designed at custody-- about at the level that the old state "asylums" used to have-- are just a way to "sweep dust under the carpet," whether-- to Dorothy Dix's rage if she knew-- this occurs (again) with the mass-jailing of mental patients, the cramming of schizophrenics and bipolars into ER beds, or -- as I think will en masse happen in my "gentle" Louisville-- for "consumers" to just die in the gutters, the victim of crime, malnourishment, exposure-to-the-elements, and no medicine. The investment should not be considered a matter of budgeting money but in biopsychosocially-astute programming.

This is not "rocket science." Mental health professionals of all types-- psychiatrists, psychologists, psychiatric nurses, mental health social workers, case-managers, expressive therapists, pastoral counselors, yea even aides-- will all tell with little variance approximately what is requisite for an optimum treatment program in mental health. Inpatient and outpatient treatment are both needed, and both types should consider the whole person-- as a complex cluster of events focalizing around the event of personhood-- to be dealt with biologically, psychologically and socially-- with savoir faire as well as the recognition that sometimes-- maybe 10-20% of the time-- there will be setbacks. Budgeting and programming in mental health-- which like it or not is here to stay-- will be so much "wheel-spinning" until these biopsychosocial realities are accomodated.


---Vernon Lynn Stephens, M.S.S.W.
D.S.M. IV # 350
F31.2
Telephone: 1 (502) 561-5419
E-Mail: freethink@bellsouth.net

posted by Louisville Hermitage @ 9:05 PM

A "Blood Test" to Identify Schizophrenia/Bipolar-Disorder:
Psychiatric Recycling, for Good-and-not-so-Good

Just yesterday, Sys-Con Media announced that a company in Britain-- Curidium-- has developed a serum (blood) test for determining: 1. whether a person is schizophrenic or bipolar; 2. whether she/he has one of several sub-types of these disorders. The accuracy of this test is stated to be 94% for selectivity-- the ability of a test to determine "true negatives" from "false negatives" -- meaning that the test robustly will eliminate cases where the patient is assessed not to have a condition although in actuality she/he does have the condition. This is impressive: but the finding that the test is effective in detecting "true positives"--its sensitivity-- only stands at 78%-- which means that over one fifth of the time the test will detect a patient as having a condition when in fact she/he does not.

This is hardly better information-quality than what one would get by using the interview-skills of a psychiatrist or panel of psychiatrists or other mental health professionals-- sans psychological testing-- for the diagnostic work-up alone. The literature on this subject mostly has to do with reliability-- the ability to consistently get the same diagnosis in the same type of situation-- yet another questions focuses on validity-- "the best available approximation to the truth of a given inference, proposition or conclusion" [see "Reliability and Validity: What's the Difference?", http://www.socialresearchmethods.net/tutorial/Colosi/lcolosi2.htm .] But from my trove of information, the file cabinet, I do have an article about the reliability of diagnosis with pschiatrists using case material: here we read that two qualified and fitly skilled doctors agree with a diagnosis of psychosis 49% of the time, with "psychoneurosis" (a diagnosis which has gone by the wayside, but to me signifies something real) at 57%, organic brain syndrome at 72%, mental deficiency at 57%, sociopathy (antisocial personality) at 80%, psychophysiological disorder at 83% and "special symptom reactions" at 91%; indeed the only mostly-unreliable showing was in the area was for the assessment of "personality disorder," which registered at 14% [see Table 12-19 of "Reliability of Psychiatrists' Ratings in Community Case Findings," American Journal of Public Health 57(1):94-106, 1967]-- I have not read statistics that the more-recent assessments for these conditions-- while they do imply something different semantically-- is any more reliable.

Now reliability is not the same as validity-- as I say-- but it would be required for a valid diagnosis. Therefore, reliability is a necessary criterion (always shows) but not a sufficient criterion (one that must show) to demonstrate an underlying cause. One could argue that the doctors of behavioral medicine lack such validity in assessments-- but clearly what a psychiatrist assays is real and therefore does constitute measurement.

On the other hand, there is some possibility that the Curidium folks have on hand a reliable test which measures something different than causality. It is known, for example, that this is not the first effort to make psychiatric diagnosis of the psychoses from blood-work: in the 1950s in Saskatchewan, Canada, Doctors Abram Hoffer and Humphrey Osmond claimed to have found a "mauve factor" -- adrenochrome-- in the blood of schizophrenics-- which if rarefied made the investigators to injected this factor by way of self experiment were said to feel alienated from society, and hallucinatory; subsequent evaluative results were mixed, with most psychiatrists-- the most-respected ones at any rate-- tending to think this hematological finding was an artifact (accident.) But for a contrary opinion, read "Orthomolecular Psychiatry," by Junius Adams, reprinted from Cosmopolitan, at the http://www.schizophrenia.org/ortho.html Website.

I do not wish to be too firm in commiting myself to the position that the Curidium test is also an artifact-- likely it is not-- and the difference between the empirical quality of biochemical studies in psychiatry is several orders-of-magnitude better than was the case in 1967-- when the anecdote was the dominant from of research-exchange-- and certainly that is not the case now. However, I just read an article which reflects the view that genetics and environment and the interplay between the two-- epigenesis-- precipitates (at least) major depression (which could include manic-depression.) See "Molecular Studies of Major Depressive Disorder: The Epigenetic Perspective," a feature review by J. Mill and A. Petronis, in Molecular Psychiatry 1-16, 2007, http://www.nature.com/mp/journal/vaop/ncurrent/pdf/4001992a.pdf . If this theory of epigenesis is the most-correct model of major depression-- if not all serious mental disorder-- then a test which only measures the impact of genetics-- read here the Curidium test-- then we are likely to suspect a problem in construct validity-- which is the concern for answering, "...is there a relationship between how I operationalized my concepts in this study to the actual causal relationship I'm trying to study?" [see again, "Reliability and Validity," article cited above.]

So here we have it, in a nutshell and "to the rub": the rate at which this test actually discriminates between schizophrenics and manic-depressives is hardly better than conventional-- all-too-conventional-- psychiatry, and as well we may readily anticipate that for the time being at any rate this test will be quite expensive!!! The main use of the test properly should fall under the balliwick of "research," i.e. to open up new pathways for treatment-- based on genomics. There the concern for expense is less than would be the case in work-a-day mental health, where medical economics has always been a factor-- always working counter to poor saps like me-- on psych disability, etc.

And it would be different if there were not medications already on-line for the treatment of the kind of malady I and other mental health consumers have. Mental illness is a highly treatable condition! But in the same way that one can cut butter with a table knife or a laser, one can be treated nowadays with viable and cheaper psychotropics or by the new medicine -- expensive as well as modern-- which no doubt will derive from work like that being done at the Curidium entrepreneurship. The "old stuff" -- like ECT and phenobarbital-- still have a niche in psychiatry, and may be applied in (economically and clinically) fitting cases.

There is one more factor I'd like to put in here, before I put "this one to-bed." The expensive stuff of today gets cheaper, and then dirt-cheap, as time goes on. Patents on medications, for example, strictly speaking run out in seven years: to wit, the expensive name-brand of risperadone-- check it out-- will expire in just a couple of weeks-- opening the door for some generic-drug manufacturer to begin distribution of a risperadone-clone for orders-of-magnitude less than the hundreds for which this medication now sells. [See "...RISPERDAL ," DrugPatent Watch.com , from my search dated May 7, 2007.

Consequently, if I live that long, within the next ten years, I expect some lab techy person to swab-me-well to get saliva/blood/any-tissue for my DNA, and then to get a "real fix" on my genomic information for clinical purposes. Then, just later, will come real genetically-engineered drugs to treat my condition-- but admittedly this may take some time. But that time IS a-coming! The Curidium news seems to be on the avant-garde of this coming tsunami-like front!

---Vernon Lynn Stephens, M.S.S.W.
D.S.M. IV # 350
F31.2
Telephone: 1(502) 561-5419
E-Mail: freethink@bellsouth.net

posted by Louisville Hermitage @ 11:46 PM 0 comments

Shortcheated:
The Tax Relief and Health Care Act of 2006 (H.R. 6111, Congress 109)
And the Deficit Reduction Act of 2005 (S. 1932, Congress 108)
Work to Slash Medicare and Medicaid to Mental Health Consumers (and Others!)

In December, 2006, I happened to read a feature "Psychiatrists Face 7% Pay Cut Unless Congress Steps In," in Clinical Psychiatry News, December, 2006, pages 1 and 59. This is a scary headline to a mental health consumer like me, and while I do not profess to be expert in the outs-and-ins of federal budgetary policy-- about which in reference to the Medcare/Medicaid budget this article pertained, but what the article assuredly said was that Congress had recently moved to -- in time-- pare back funding for these healthcare services, with greater impact on psychiatry than other health disciplines.

Having many "irons in the fire," I did not try to cross-validate this claim until quite recently-- albeit if the charge were true that these slashes would occur in times to come-- just as numerous "Baby Boomers" will be both reaching retirement-age and be-times ( commensurate with advancing age) going onto disability-- this would be a scathing indictment of the (Ancien- Regime- , G.O.P.-led) representatives we had and (in minority) remain in Congress. But as per usual when I try to balance-off reports in the media against one another, I did of late make a concerted effort to verify the substance of the charges in the Clinical Psychiatry News to which I have alluded. To my consternation, with only minor qualification, I found the implication for Medicare/Medicaid/SCHIP programs -- which includes a lot of good people who DID often-as-not work hard for a toe-hold in this Cowboy Country-- and so will the coming horde of "Baby-Boomers" who have in longtitudinal time been "booped-out" of society from crowded-kindergarten, jammed-job-market, yea now unto shortcheated-retirement.

Here are my particulars: the Congressional Budget Office report, "Cost Estimate December 28, 2006 H.R. 6111 Tax Relief and Health Care Act of 2006...," http://www.cbo.gov/ftpdoc.cfm?index=7714&type=0&sequence=0 , plainly indicates that the effect on premiums-- the amount paid-out for Medicare A (hospitalization) and B (doctor's visits and 'therapy') will be a net reduction of $ 1.7 billion between 2007-2016-- although it must be admitted that integrity of Medicare fiscally will be maintained in F.Y. 2007. All the while-- as one upon a microsecond's reflection will assess-- the costs of medicine-- including mental health will go up in an inflationary spiral far in excess of the rest of the economy. This presents a real dilemma for doctors, who do like to get paid, and many of whom also -- as keepers of a kind of public trust-- like to do Medicare work (and Medicaid and SCHIP work, as well.) To get a clear grasp of this predicament-- I know of no better graphic on the "Web" than the AMA's one-page PDF document entitled, "Future Bleak for Seniors, Baby Boomers. Medicare to Cut Payments as Boomers Enter the Program," http://www.ama-assn.org/ama1/pub/upload/mm/399/nac_costs.pdf , dated February, 2007. Here we see the dollar-value of two variables-- "practice costs" (to the medical professionals) and "Medicare costs," in a time-series projection between 2001 and 2015, with the first variable mentioned making a wide "V" with the second-- really scary stuff for the average sap-- probably you, Reader, and certainly me (one who worked a career and then got inadvertantly saddled with disability, Medicare, and such issues as my unchosen lot-in-life.)

This is not the only "woe" to note: this sharp and untimely reduction in Medicare just at the time a lot of folks may be anticipated to need services, and the additional problem of medical-cost-inflation-- is to be compounded with a prior bill called the "Deficit Reduction Act" (S. 1932, Congress 108), which mandated cuts of - $ 22 Billion for Medicare for the period between 2006-2015 and - $ 26 Billion for Medicare/SCHIP programs for the same period [see Congressional Budget Office, "Cost Estimate: S. 1932: Deficit Reduction Act of 2005," page 2, January 27, 2006, http://www.cbo.gov/ftpdocs/70xx/doc7028/s1932conf.pdf .] While this bill barely passed Congress-- surviving only by the one gainful vote of Vice-President Dick Cheney-- with most Congresspersons voting along "party lines" -- so given a Republican Congress, the bill passed from legislature on December 21, 2005, and was signed into law by President George W. Bush on February 8, 2006. In his comments on the passage of the bill-- at which signing Kentucky Senator Mitch McConnell was in attendance, President Bush said, "This important piece of legislation restrains federal spending-- and it will leave more money in the pockets of those who know how to use it best, the American people...The Deficit Reduction Act is estimated to reduce the growth in Medicare spending by more than $6 Billion over the next five years. " Somewhat paradoxically, or even inconsistently, the President adds, "With this bill, we're showing that we can keep the promise of Medicare and be good stewards of the taxpayer's money at the same time."

OK. I worked virtually a career before losing my mind at the loss of my wife: I paid all the taxes of a working-man then, and now I still pay federal taxes-- e.g. on my telephone bill, and gasoline, and the myriad other ways the feds have of getting money out of folks who draw a disability check. It is not the case that I ever fretted more over the pittance I would save in paying-out a few-less dollars to care for the sick, the injured, or dependent children: I have always thought that kind of "tax" to be completely acceptable, provided the service were not "second-class" by comparison with the "worried well." NOW, I want my taxes and my government to live up to this very same expectation I had of government for deserving others when I managed a career. For, to paraphrase Ronald Reagan, who said that "all work enobles," I rejoin that "humanity enobles," and those who profess such a right/value-to-human-life had better show me how there is quality-of-life-after-birth!

The President's Press Secretary issued a "Fact Sheet.." upon the signing of the "Tax Relief and Health Care Act of 2006," upon President Bush's signing of the bill on December 20, last year [see http://www.whitehouse.gov/news/releases/2006/12/print/20061220.html .] This played much "the same music" as was enounced at the signing of the "Deficit Reduction Act of 2005," as we read, "This Act will extend tax relief for millions of American families and small businesses, and add momentum to our growing economy. It will maintain key tax reforms, expand our commitment to small business." On the crucial matter of healthcare, this notice touts a provision of the bill which would facilitate "Health Savings Accounts" hypothetically for lower-income Americans-- although I have heard through N.P.R. and other sources that these accounts are an arcane source of benefit-- for the few-- historically the haven of the wealthy-- and not readily used by the "nitty-gritty poor." Nothing is said in defense of the cuts that the Congressional Budget office reported -- as well as the December issue of Clinical Psychiatry News just cited-- that substantial cuts in Medicare/Medicaid/SCHIP will occur as a result of this bill.

HEY! I do vote, and so do most of the people who read this blog. You Congresspeople who did this number on those who depend on Medicare, etc., ultimately the great majority in this nation, will hold YOU accountable-- just as I was held accountable when I was a social worker by Nixon's -- and then Reagan's lackies-- and just as I must not as a disability recipient waste the taxpayer's money now-- I SHALL REMEMBER ALL THIS WHEN I GET TO THE POLLS, AT THE PROPER TIME, IN THAT COMING "JUDGMENT DAY" FOR THE MALEFACTORS BEHIND THIS FISCAL MYOPIA, AND LACK OF SOCIAL CONSCIENCE!

---Vernon Lynn Stephens, M.S.S.W.
D.S.M. IV # 350
F31.2
...with 20+ involuntary mental hospitalizations behind me!
...with death-in-the-gutter without medical treatment ahead of me!

Telephone: 1 (502)561-5419
E-Mail: freethink@bellsouth.net

posted by Louisville Hermitage @ 10:51 AM 0 comments

"Don't Expect to Live Long if You're a Nut":
A Sad Comment by a Mental Health Consumer
On the Finding of Foreshortened Life-Expectancy for Psychiatric Patients


A media report that was uttered on or about May 3, 2007 [see "Mental Illness Linked to Shortened Life Span," by Katie Allison Granju, http://www.wbir.com/printfullstory.aspx?storyid=44809 ], presents survey result to the effect that the average life-expectancy of a mental health consumer is about 25 years less than other Americans. This compares with the already-sad finding of the early 1990s when it was found in a survey that mental health consumers live on the average 10-15 years less than Americans as a whole.

This article suggests that modern "atypical antipsychotics" are substantially to blame for these short life-expectancies, as these medications cause weight-gain in excess of the traditional antipsychotics and thus contribute to the development of diabetes, hypertension (high blood pressure), other cardiovascular problems, and all else-- which is a lot-- that is associated with obesity.

OK. I buy that thesis, in part. But every death, like every life, is the summed result of all inputs and outputs, the warp-and-woof of experience in the totality of being. In statistical terms, it is appropriate to speak of "subcomponential analysis" in such contingencies, and of course-- while we can parse off part of the variance related to short lifetimes in mental patients as due in some way to meds, it is likewise true that many other variables "feed" into the thanatological picture. This report is honest enough to cite the fact that mental patients are more-likely to succumb to "other" medical diseases and accidents which lead to death. But I do feel that we need to consider the overall curtailing of (community-based- and hospital- ) mental-health services as being in the "mix" here, too.

In the 1990s-- due to the impulse of the Reagan Administration but carried unto its zenith in the Clinton Administration-- community mental health for the indigent (and most who become mentally ill will become quite indigent!) reached a kind of low "hill-top" from which it has nothing but descend. Once-available community services from (visiting) case-managers was the rule, not the exception, and -- here in Louisville, at least-- the norm was for a psychotherapist to see a "client" (we are not called "patients" by this crew, although I am not offended in the least by being "patient"!) around once per fortnight. One could see a psychiatrist once per month, more-often if necessary. One went to a state hospital when it came time for inpatient mental health care, and the absolute rule there was that no patient (we were called "patient" at Central State--"our" hospital) would go out of the hospital without a proper "placement" (meaning shelter with the opportunity to obtain food, and care.)

Nowadays, things are much-different. Managed-care and the federal passage of the Deficit Reduction Act-- by a Republican Congress and White House with a decidedly arch-conservative slant-- one goes no more to a state hospital, but -- if service along these lines is compelled-- to the local "general" hospital, which inevitably cares not a whit if you become homeless as a result of mental hospitalization (having been cunningly evicted by shyster landlords to our general hospital and subsequently made homeless, I know well whereof I speak.) Consequently homelessness-- and the very exposure to the elements when the mental patient is left out-of-doors to his own device and judgment-- all contribute to the kind of mortality-- not painless death!-- that we could expect under such conditions.

It matters not to me whether the state government or the county government (as it was in certain venues previously) or the federal government "picks up the tab" for the care of the mentally ill-- this can all be explained as an obligation parens patriae [Latin: "the King/State is the father-of-us-all"; by inference, "when the normal social system breaks down, the state needs to intervene"] obligation of governance under wise common law. But in fine, we live in the Untied Snakes of America, a country which would much rather wage war in Iraq than take care of the dying-in-the-street at home.

And mental patients are dying-in-the-street. Here, in Metro-Louisville, Kentucky, we read in the newspaper quite often of folks who are just described as "homeless" dying of exposure to the elements; what often-as-not goes unsaid is that this person was a mental health consumer or marginalized "should-be" mental patient-- who died without insight or judgment as to how to care for herself/himself "out there." This is especially true in the winter: but one can die of the merciless heat in Kentucky summer as well, or from exposure-without-shelter to our well-known "cold Kentucky rain" of any season. Our politicians in Washington, in Frankfort, in City Hall just have "other fish to fry," and -- while we have 'paper' rights of which we are informed if when absolutely needed we can get into a psychiatric hospital-- it is also quite true that many of us are -- as the saying does go in mental health-- "dying-with-our-rights-on."

Any politician who sponsored or voted for the Deficit Reduction Act-- and I think this had great appeal to the Kentucky Congressional contingent-- does not rate her/his job as a result of this great "penny-wise-and-treasury-note-foolish" decision. The damage that has been done to the mentally ill-- and to the ill -- as a result of this shortsightedness does make us live shorter lives-- but that is not all: without our medication, and without continuing psychosocial care, the cohort of the chronically mentally ill gets into all kinds of mischief-- and we spread diseases like hepatitis, HIV, tuberculosis-- and even LICE --at rates which, if known, would shock and alarm this REDNECK NATION!

...I do NOT rest my case!


---Vernon Lynn Stephens, M.S.S.W.
D.S.M. IV # 350
F31.2
Telephone: 1 (502) 561-5419
E-Mail: freethink@bellsouth.net

posted by Louisville Hermitage @ 9:24 AM 0 comments