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December 28, 2005
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Analysis: Improving mental health care in teen justice system
Morning Edition (NPR); 12/26/2005; STEVE INSKEEP
Host: STEVE INSKEEP
This is MORNING EDITION from NPR News. I'm Steve Inskeep.
Every year, more than one and one-half million youngsters enter the juvenile justice system. Experts say a large percentage of these teen-agers are mentally ill, but rarely do they receive mental health treatment. Some juvenile courts have been created across the country with the goal of taking young people with severe mental illnesses out of the mainstream justice system and providing them with effective mental health care. Michelle Trudeau reports.
Judge RAY DAVILLA (Co-founder, Santa Clara Juvenile Health Court): OK, we will start at the top.
MICHELLE TRUDEAU reporting:
On a Tuesday morning at the Santa Clara County Courthouse, a small group gathers in Judge Ray Davilla's chambers.
Judge DAVILLA: You want to go first as usual, Sandhya.
Ms. SANDHYA SHANKAR (Mental Health Clinician): Yeah.
TRUDEAU: Judge Davilla, one of the co-founders of the Santa Clara Juvenile Mental Health Court, is meeting today with his special team. Sitting here in a semicircle around the judge's desk are probation officers, mental health experts and both prosecutors and defense lawyers. It's a highly unusual group of collaborators. Sandhya Shankar, the team's mental health clinician, starts the meeting by discussing the case of a girl named Sonya(ph), who was arrested three years ago for maliciously punching another girl in the face.
Ms. SHANKAR: ...female Hispanic teen-ager who has a long history of bipolar disorder, more depressive symptoms and a lot of violence.
TRUDEAU: Sonya had been in and out of juvenile detention until this team intervened. They recognized she had a severe mental illness, bipolar disorder. They took Sonya out of the juvenile justice system and enrolled her into this unique program. It's for the over 200,000 cases like Sonya's that this mental health court was created, says child psychologist David Arredondo, a co-founder of the program. Arredondo says that at least 60 percent of youngsters in the juvenile justice system have some form of mental illness and about 20 percent have what he calls biologically based disorders of the brain, severe mental illnesses such as bipolar disorder, major depression and schizophrenia.
Dr. DAVID ARREDONDO (Child Psychologist): I've seen children who were delusional. I've seen children that were hallucinating in solitary cells, left there for days because there was no mental health services available for them.
TRUDEAU: Even doctors who do work in juvenile detention don't have the time or the expertise to care for these kids, but this program targets them. To be accepted into the program, a juvenile offender must first be diagnosed with a severe mental illness. Also, the teen can't have committed a violent felony. And he or she must admit to the charges, which will remain on the teen-ager's record. This last policy was adopted to avoid being perceived as an `excuse court.' If these three conditions are met, the teen comes out of juvenile detention and is offered encompassing mental health care, including psychotherapy, medications, alcohol and drug counseling and individualized school programs. Participation in the court's program is voluntarily and the family must agree to it as well.
At the meeting this morning, mental health counselor Shankar reports to the team that Sonya is benefiting from the program.
Ms. SHANKAR: She's doing really well in therapy, doing for the most part well in school and has a lot of friends and has not run away and has not done any of those...
TRUDEAU: The team discusses how Sonya, now living at home, is doing: medically, psychologically, socially, academically. Is she living up to the terms of her probation, wearing her electronic monitoring bracelet, going to therapy, doing community service, getting drug tested, abiding by house curfew and taking her medicines? At this point, Shankar tells the team something new about the 16-year-old.
Ms. SHANKAR: I did see her at school Monday. She's pregnant, so she's off medication. She is rapid cycling in school and she was, like, one minute very happy and really high energy and talking louder and talking non-stop to sobbing and crying.
TRUDEAU: Now pregnant, Sonya's doctor has taken her off the medicines that control her bipolar mood swings. But in spite of this medical complication, Sonya's had no violent episodes and hasn't committed any new offenses, very important measures of success.
Judge DAVILLA: All right, this is number three on this afternoon's calendar in the matter of Sonya O., petition number 2680...
TRUDEAU: Court convenes. Judge Davilla, in his black robes, sits behind a raised bench, the other members of his team seated around the small courtroom. And Sonya, her dark hair pulled back, dressed neatly, her pregnancy not showing, sits very still at a table in front of the judge, next to her mother. As the team each talks about her, she doesn't speak.
Judge DAVILLA: Thank you. The court has read the report. It's an up-and-down report, but we know that that's going to happen, especially since you're not able to take the medications anymore. So we're going to expect a little harder effort on your part to make sure good decisions are made and there's more ups than downs. Comments...
TRUDEAU: For Sonya, this is an important day in court. The judge will decide whether she should be allowed to have her electronic monitoring bracelet removed, a freedom the teen-ager very much wants. Her probation officer and mental health team member Tiffany Newen(ph) weighs in.
Ms. TIFFANY NEWEN (Probation Officer): Considering her overall acceptable behavior in the school and at home, and I just learned from Mom that she's on track to graduate--I'm really glad to hear about that and those are wonderful things that Sonya's been working on, so I would not oppose that.
Judge DAVILLA: All right, I will order that she be taken off the electronic monitoring program today. All right? Keep up the good work.
TRUDEAU: Quietly, Sonya thanks the judge, rises and leaves with her mother and her public defender. They don't want to talk about their case. The next teen-ager's case is called.
Judge DAVILLA: All right, this is number five on this afternoon's calendar in the matter of Timothy...
TRUDEAU: Since the Santa Clara Mental Health Court opened in 2001, over 130 juvenile offenders have been through the program, receiving intensive treatment for their severe mental illnesses. Of these, says Judge Davilla...
Judge DAVILLA: The success rate is very high.
TRUDEAU: Last year, Davilla says, the mental health court reduced its recidivism rate to about 10 percent, significantly lower than the national rate for repeat juvenile offenders. And the Santa Clara Court has been nominated as a model program by the US Justice Department.
Judge DAVILLA: Our kids are out of custody. They're either out without any kind of confinement or they're out on house arrest, but they're home. They're going to their school. They're out, they're functioning. Whereas before the program, odds are those kids would have been at the hall or the ranch.
TRUDEAU: In and out of detention repeatedly. According to Judge Davilla, his mental health court doesn't cost any more than processing kids through the traditional juvenile justice system. No new money was allocated. The judge just redirected existing resources.
Mr. ROBERT SCHWARTZ (Juvenile Law Center): This Santa Clara model seems to be well-designed, cost-effective and targets the right kids.
TRUDEAU: Says Robert Schwartz, director of the Juvenile Law Center in Philadelphia. But getting such a specialty court up and running isn't easy, he adds, and only a handful of mental health courts have emerged around the country. There's a perception, Schwartz says, that opening such a court will require extensive start-up funds that won't be recouped down the line. The Santa Clara Court experience counters this perception, says Schwartz, but, he adds, there's a tougher barrier.
Mr. SCHWARTZ: I think inertia is a very big part of the problem, and many jurisdictions are very, very resistant to assigning new duties to staff and to changing the way they operate. There's a comfort level and the Santa Clara model challenges the comfort level.
TRUDEAU: But it takes strong judicial leadership to create a team of prosecutors, defense lawyers, probation officers and mental health experts, a team that can get these youngsters good mental health care, keep them out of jail and fundamentally change the direction of their lives.
For NPR News, I'm Michelle Trudeau.
INSKEEP: It's MORNING EDITION from NPR News.
Content and Programming copyright ę 2005 National Public Radio, Inc. All rights reserved.
Obituary: ROY BROOKS; Tasteful jazz drummer.
The Independent (London, England); 12/26/2005; Voce, Steve
Byline: Steve Voce
Detroit probably ranks with New Orleans and Chicago as one of the leading sources of jazz musicians. The Jones Family " Hank, Thad and drummer Elvin " head an impressive list of those who came from the city in the Fifties and Sixties. The drummer Roy Brooks was on that list but, unlike the others, he returned to the city (in 1977) and devoted the rest of his life to its music.
Brooks was a tasteful musician who was a disciple of both Elvin Jones and of Miles Davis. He recalled,
Miles told me, 'The drummer is the leader in my band. I just pay him a salary.' That made me think of my role in playing drums. You don't have to be obtrusive, but there's a way in which you project yourself that should guide the band. You're not only the pulse, you're the conductor. You make things breathe and stop and go.
The pianist Horace Silver had already had three Detroit musicians in his quintet when one of them, the drummer Louis Hayes, decided to leave. Hayes and the other two Detroiters gave Brooks such a powerful recommendation that Silver telephoned Brooks from New York and hired him without ever having heard him play.
Brooks stayed with Silver for five years, working concurrently with other New York-based leaders. It was during his time with Silver that musicians began to notice the symptoms " erratic and violent outbursts " of the bipolar disorder that was to destroy much of his future life. In 1967 he married his wife Hermine, who didn't encounter his bizarre behaviour until some time later. 'I'd be getting up early because I had a nine-to- five job and he would still be up, walking the floor, talking and talking with nobody around, or he would be on the phone,' she says:
I got up one morning and Thelonious Monk and his Baroness, the woman who supported him for so many years, were there. It was so strange. Roy was in the kitchen making one of his teas with all those herbs. Nobody was talking but Roy. And Monk was, like, with his eyes wide open, saying, 'This man is crazier than me!'
In 1972 Brooks joined the band of the turbulent bassist and composer Charlie Mingus. Mingus and Brooks were dismayed at the way the public was being, as they thought, hoodwinked by the contemporary vogue for avant- garde jazz. In 1965 they decided to do a bit of hoodwinking themselves.
The Mingus band was playing at New York's Village Vanguard when Mingus announced to the audience that he was to present a new avant-garde band put together by Roy Brooks. Brooks and the rhythm section appeared, playing conventionally, before a curtain. From behind the curtain came a fashionable cacophony of screeches and honks. 'We'd told the people we were going to do a thing about Selma in Alabama,' Brooks said. 'The people were listening intently.'
After the set, the curtain went up to reveal three small children with a trumpet and two clarinets. Even after the revelation, some of the audience weren't aware that it had been a hoax.
Brooks toured Europe as a member of Mingus's band in 1972 and stayed with the bassist for more than a year. Before his final return to Detroit he played and recorded with many of the top jazz musicians from Coleman Hawkins to Chet Baker. In 1970 he became a founder member of Max Roach's band M'Boom Repercussion.
He was very active on his return to Detroit, setting up a centre for teaching jazz to young people and running his Aboriginal Percussion Choir. He became deeply involved in education with his organisation Music (Musicians United to Save Indigenous Culture) and played and recorded with Artistic Truth, a group dedicated to 'redeveloping the dying arts of African-American music, dance and poetry'.
Brooks's illness continued to haunt him. His wife tried to help him during the frequent attacks and incarcerations in mental health hospitals. But the drummer increasingly refused the medicine that controlled his aggression but made him lethargic and unable to play well. Eventually, in 1980 his wife left him and took their son Raheem and moved back to New York.
Concerned for his welfare, she kept in touch and visited Brooks whenever she could. In the meantime he first tried to turn part of the house they had bought into a kind of community centre, but soon neglected it so badly that it became a ruin. He still tried to tour, but the musicians that he played with realised he was unstable and both they and the music promoters kept their distance.
During the Nineties, still based in Detroit, he toured with Max Roach's band when he was well enough to and gave concerts in Detroit which incorporated a variety of percussion sounds, including a musical saw, a dribbled basketball and an African talking drum.
In 2000 Brooks was jailed for breaking probation orders and for violent assault. 'I'm not sad,' he said whilst in prison:
I'm somewhere between happy and sad. I'm glad I'm still alive. I think a lot about when I am able to play again. I have a lot of hope. I know I'm in here for a reason.
Roy Brooks, drummer and percussionist: born Detroit 3 September 1938; married (one son); died Detroit 16 November 2005.
COPYRIGHT 2005 Independent Newspapers (UK) Ltd.
Date-Rape Drugs Still Prevalent.
The Monitor (McAllen, Texas) (via Knight-Ridder/Tribune Business News); 12/26/2005
Byline: Cari Hammerstrom, The Monitor, McAllen, Texas
Dec. 26--EDINBURG -- Sexual assault nurse examiner Janie Cantu-Cabrera vividly remembers when police came to her four to five years ago with two teenaged sisters who had been drugged at a Pharr hotel party and then raped, possibly repeatedly. The younger sister, who was 13 at the time, told the nurse that all she could recall was being trapped inside a bathtub while several faces hovered above her. Standing in the door frame was her older sister, 18, just watching. The older sister, Cantu-Cabrera said, told the nurse that all she could remember from the previous night was seeing her sibling in the shower. Both of the girls reported feeling "funny" in the genital area. "Both had physical findings of sexual assault," Cantu-Cabrera said. These girls were both likely drugged with Rohypnol, she said -- a substance local teens still commonly abuse for recreation because of the euphoric state it can induce, and that predators use to facilitate rapes because of how it lowers victims' inhibitions. According to Juan J. Gonzales, Edinburg Consolidated Independent School District police chief, the prescription sleep aid Ambien is also "very popular" among local youth.
"It's becoming more and more widely known," he said. These kind of reports make it especially important for revelers as they head out to parties this holiday season. Even though statistics from the U.S. Drug Enforcement Administration point to a decrease in the availability of the drug on a national scale, Texas has experienced a spike in poison control calls and treatment admissions for Rohypnol, especially among Hispanic youth living along the border. "It's gotten worse," Cantu-Cabrera said, referring to the recreational use of prescription drugs. Kids as young as 12 years old are now taking Rohypnol, or roche pills as they are commonly called. Pills cost as little as $1. And although the pills are illegal in the United States, they can be bought with ease in Mexico and smuggled across the border.
And earlier this month at a meeting in which sexual assault victims' advocates, law enforcement officials and nursing community members came together to discuss the establishment of a Sexual Assault Response Team, a specialist with the Texas Attorney General's office also mentioned Ambien as a "date-rape drug" growing in popularity. Experts working with sexual assault victims say they have never seen a confirmed case of Ambien used to commit a rape in Hidalgo County; however, some do see the potential for this type of abuse and are concerned about the trend the sexual assault community development specialist, Lisa Zapata-Maling, has recognized elsewhere in the state. "It's going to put someone to sleep," said Vanessa Recio, a pharmacist with Saenz Pharmacy in Mission. Recio said Ambien is widely prescribed, but it is mostly approved for adults. It is classified as a controlled medication, along with Vicodin and other strong medications with potential for abuse.
"You don't see too many adolescents prescribed a sleep aid," she said. "I don't know I've ever dispensed an Ambien to a patient under 30." Ambien causes central nervous system depression and can impair cognitive thinking. It's one of the best drugs on the market to treat insomnia, said Andrea Lerma, a psychiatric clinical specialist at Tropical Texas MHMR, which is the state's local mental health facility. Lerma prescribes Ambien with frequency for patients suffering from major depression, bipolar disorder and other mental health illnesses.
Some people, however, do experience Ambien amnesia when taking the drug, she said. People have been known to get up and cook in the middle of the night or eat a lot. They wake in the morning to find candy wrappers or dirty pots and pans, she said, and they don't remember any of it. Lerma said she can see how Ambien could be used as a "date rape drug." It also has a short half-life, which means it is eliminated from the body very quickly. One reason why Ambien has not yet gained as much popularity in Hidalgo County as roche pills is because of its price. "Ambien is very expensive -- $90 to $100 for a one month supply," Lerma said. "It's expensive over in Mexico, too." Ambien is more difficult to obtain, too, said ECISD Police Chief Gonzales. "If kids are using it (Ambien), they are getting it somewhere else," Cantu-Cabrera said. Kids could be stealing their parents' or grandparents' pills, said Diana Cuellar, prevention educator with Women Together/Mujeres Unidas, a safe house for victims of sexual assault. "Sleep aids in general are being abused," Cuellar said. "C* Prescription sleep aids are very powerful." ------
Cari Hammerstrom covers law enforcement and general assignments for The Monitor. You can reach her at (956) 683-4424.
Copyright (c) 2005, The Monitor, McAllen, Texas
Distributed by Knight Ridder/Tribune Business News.
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COPYRIGHT 2005 The Monitor
Mental health clinics may close Fresno Co. agency wrestles with ways to deal with a $15 million budget shortfall.(LOCAL NEWS)
The Fresno Bee (Fresno, CA); 12/25/2005; Ginis, Kerri
Starr McDonald heads to a neighborhood clinic in Reedley once a week for group therapy and individual counseling.
The 37-year-old suffers from bipolar disorder and said the services at the Reedley clinic, run through Fresno County's Behavioral Health Department, help her stay healthy.
"I like it here because I have somebody to talk to," McDonald said Thursday during a break from her group therapy. "My therapy means a lot to me."
But McDonald and the roughly 225 other clients who go to the Reedley clinic each year might soon have to look elsewhere for mental health services. The county is proposing to close a downtown Fresno clinic and seven rural clinics, including the one in Reedley.
The department is facing a $15 million deficit and needs to save money by the end of this fiscal year in July. Director Giang Nguyen has come up with options for reducing costs such as consolidating rural clinics, contracting with private companies to manage outpatient services, reducing mental health services in the jail or eliminating peer support programs. The proposal is being reviewed by the county's mental health board, which will recommend to the Board of Supervisors what services to cut.
County supervisors have the final say -- a decision that some fear will have a detrimental effect on the lives of the county's neediest residents.
"Some of these cuts are very drastic," said Curtis Thornton, a mental health board member. "This is going to hurt a lot of people."
Thornton has a family member with a mental illness and said he knows first-hand the importance of these mental health services. He said he wants the county to put some of its general fund dollars -- which pay for services such as road repairs and public safety -- toward existing mental health programs.
Over the past six years, the county has given more than $45 million from the general fund to help pay for mental health services. That money could have gone to hire more sheriff's deputies or build more parks.
Supervisor Henry Perea said the board will have to decide whether it wants to take money from other departments to avoid making cuts in the Behavioral Health Department.
"We're talking about taking away or eliminating services to the most vulnerable in our community," he said. "Some of these cuts are just way too drastic."
The Behavioral Health Department has struggled financially for years. But a healthy reserve kept the budget intact and even allowed some expansion -- including the addition of clinics in rural communities. But that reserve has run out, leaving the department without the resources it needs to operate existing services. That has forced Nguyen to look at ways to reduce costs, such as eliminating programs that the county isn't mandated to provide.
"I've lost sleep over how we're going to balance the budget," said Nguyen, who took over as head of the department in June and contends that the budget problems were the result of mistakes made by prior administrators. "Certainly we have to make some cuts, and certainly we have to make some drastic changes."
One of the options is to close seven rural clinics in the Pinedale neighborhood, west Fresno, Firebaugh, Mendota, Huron, Reedley and Sanger and a clinic in downtown Fresno.
The plan is to keep three regional sites open in Kerman, Coalinga and Selma. The county would still try to do house calls and offer services at schools and community centers in the other rural communities, but would no longer have fully staffed clinics.
If the Reedley clinic closes, Brett Cline said he doesn't know how he will get to the Selma clinic, which is 15 miles from his home. Cline, 47, doesn't have a car and walks to the Reedley clinic once a week for group therapy. The staff helps him manage his medication for schizophrenia.
"I'd have to either give up my treatment or try to find a ride," he said. "I really don't know what I will do."
McDonald also doesn't have a car. She said she hopes the county realizes how hard it will be on residents if they close the rural clinics. Said McDonald: "We need to have this because we don't have any other options."
The reporter can be reached at email@example.com or (559) 441-6317.
COPYRIGHT 2005 The Fresno Bee. All rights reserved. Reproduced with the permission of the Dialog Corporation by Gale Group.
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The Warning Signs Of An Impending Bipolar Disorder Manic Episode
Bipolar disorder - as the name implies - involves two distinct set of symptoms. One set throws the individual down into the depths of a massive depression. The other places the individual who suffers with bipolar disorder at the top of a peak manic episode.
Most everyone can eventually recognize the warning signs of an impending depressive episode related to bipolar disorder. More likely than not, individuals with bipolar disorder try very hard to avoid it.
However, for many individuals with bipolar disorder, it's more difficult to recognize the signs of an impending manic episode. After all, a manic episode of bipolar disorder can be mistaken in some cases - especially in the very early formation -- for the lifting of the corresponding mood swing of the depression.
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