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March 22, 2006
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What can be done?: The solution, advocates say, is not to reinstitutionalize those with mental illness but to make the community safer for them. Strict housing standards would be a start.
Milwaukee Journal Sentinel (Milwaukee, WI); 3/21/2006
Byline: Meg Kissinger
Mar. 21--Last of three parts
Dean Baker, a former Wauwatosa High School basketball and baseball star, disappeared one day shortly after he started hearing voices and thinking wild thoughts.
It didn't matter that his father, Bill, a doctor, had spent years taking care of Milwaukee's most profoundly mentally ill patients. Or, that his brother, Vance, was a leading psychiatrist for the city's homeless.
They had no way to know where Dean was, or if he was safe.
They called the police.
Days passed and, then, weeks.
Months later, police found Dean's car in a parking lot in Chicago. Nervously, the family checked the morgues.
"Then, one day, a few days before Christmas, he calls up, like nothing happened," Bill recalled. "Wants to know if I can pick him up at the bus station. He'd been living on the streets somewhere. That's pretty much how it goes."
The Bakers, as schooled and sophisticated as they are in the ways of mental illness, have learned they are no better able to predict what Dean will do than anyone else. And they know that the dangers of having mental illness lurk more outside mental wards than within.
In the 30 years since a Milwaukee lawsuit turned mental health care on its head -- from placements in locked wards to placements in the community -- the problems of mentally ill people have changed dramatically.
A Journal Sentinel investigation found hundreds of people with mental illness living in squalor, placed their caseworkers in illegal group homes and rooming houses with dozens of building code violations. Some have died, essentially from neglect.
Advocates for people with mental illness say there is a lot that can be done to keep them safer:
-- Establish standards for places that take in people with mental illness. Caseworkers should not be allowed to put their mentally ill clients in homes with building code violations or with landlords who have criminal records. Put clients only in places that have proper licenses or permits.
-- Require annual city building code inspections for buildings that are granted transitional living facility licenses, places that provide more care than a rooming house but less oversight than a state- licensed group home. City inspectors don't annually inspect transitional living facilities. They inspect only the common areas of apartment buildings where many people with chronic mental illness now live.
-- Require city inspectors to report illegal group homes or suspected illegal group homes to the Bureau of Quality Assurance, the state agency licensing group homes, so the bureau can prosecute. The newspaper found that city inspectors do not do so today.
-- Require the state to investigate all charges of illegal activity at group homes brought to its attention, not just at those that are licensed. Advocates say they have reported improper care, only to be told the Bureau of Quality Assurance that it monitors only facilities that are licensed.
-- Case managers should refer any landlords who refuse to rent to people with mental illness to the district attorney's office for prosecution. It is against the law to discriminate.
-- Make available more supervised apartments and group homes. Too many severely mentally ill are living on their own without adequate supervision. Caseworkers with caseloads of 30 to 40 people don't have time to make sure that their clients are safe. With fewer than 100 emergency beds, the county does not provide enough safe places for those who are in danger.
-- Allow people with mental illness to be enrolled in a state program that provides supported housing for adults with developmental disabilities. Someone with a brain injury can qualify for this coverage. But someone whose primary problem is schizophrenia, bipolar disorder or major depression -- all debilitating mental conditions that are recognized as such the Social Security Administration -- is not eligible.
-- Expand Family Care to include people under the age of 60 who have mental illness as their primary diagnosis. The program, which offers long-term care, is currently available in Milwaukee County for people over the age of 60 who are on Medicaid and have substantial functional limitations.
-- Allow doctors to initiate a petition to detain a person who is dangerous. In Wisconsin, only police can initiate such a petition. Many doctors say that this limits the kind of protection they can offer their patients.
-- Prohibit landlords from directly receiving their tenants' Social Security checks. Right now, the federal government allows landlords to take control of their disabled tenants' checks, if the tenant agrees, regardless of the opportunity for exploitation or abuse. Caseworkers say they have seen landlords and relatives keep all of their clients' money, and the clients are too frightened to complain, fearing they will be evicted.
-- Build more low-income housing. The U.S. Department of Housing and Urban Development estimates that Milwaukee needs more than 28,000 additional low- income housing units to fill the need. Mental illness is one of the primary causes of poverty. People on disability -- including the nearly 16,000 in Milwaukee County on disability for psychiatric disorders -- typically spend nearly 90% of their income on housing, according to a 2004 study Technical Assistance Collaborative.
"The temptation when you hear about these horrible places that some of these people are living in is to put everyone back in the institutions," said Palmer Bell, Milwaukee office director of Disability Rights Wisconsin, an advocacy group for disabled people. "That would serve one purpose: It gets these people out of our way so that we don't have to think about them. The better solution is to work to make our community better, improve housing, improve funding and make people more receptive to people with mental illness."
Bargain Basement Care
No push for institutions, but at least adequate support
Darold Treffert, a psychiatrist from Winnebago County and a national advocate for better mental health care, said meaningful care will come only with the money to support it.
"Let's remind the budget bean counters that when they close expensive in-patient beds, those dollars must follow the patient into the community," Treffert wrote in an e-mail. "Intensive out-patient care in the community (which may require 24-hour, on-site staff in some residential facilities for some severely mentally ill persons) will be just as expensive in the community as in the hospital. Bargain basement care is just that -- bargain basement."
Added Jon Gudeman, who served as medical director of what was then the Milwaukee County Mental Health Complex during the years of massive downsizing: "Granted, lots of bad things happened in old institutions. No one is arguing that we should go back to that. But there are advantages to caring for people in congregate places. I'm not talking about as high a level of care as in a nursing home. But many people need adequate support, help with their activities of daily living. It never should have happened that these people were released without adequate support."
Gudeman said he fears for those who are in high-crime neighborhoods and broken-down buildings.
"You wouldn't put a heart patient in a room with people who smoke. Or give someone with diabetes a high-sugar diet," said Gudeman. "The same principle applies here. Especially because they need support, structure, case management, medications. This is a population that is not seen, not heard."
Charlie Rush, a nurse with the Milwaukee Center for Independence, said the key to improving the lives of people with mental illness is to treat them with dignity and compassion. On a recent day, he checked up on a woman who has diabetes and schizophrenia. A few years ago, she had tried unsuccessfully to get her dentist to pull her teeth because she thought demons were living in them.
"We all have mental illness," he told her. "You just got caught. Big time."
Janet Van Peursem, a psychiatric caseworker whose agency contracts with Milwaukee County, takes on some of the toughest cases in the county. Typically, her clients abuse drug and alcohol in addition to being mentally ill.
Sometimes, she has found success in enlisting people in neighborhoods to help care for those who are most vulnerable. Joe and Nancy Asad run a grocery store on the block where Van Peursem's client Diane Gronowski lives. Gronowski, 38, who has schizophrenia, had been paying $550 a month to sleep on the couch of a rat-infested house across the street with no heat in the hallways and a broken toilet.
Van Peursem worked out a deal for Gronowski so she could rent a much cleaner room in the back of the Asad grocery store for $300 a month in exchange for stocking the shelves and helping at the coin laundry around the corner, which they also own.
The Asads keep watch over Gronowski and let Van Peursem know if she is getting into trouble. It's a fragile balance, Van Peursem said. But it is the best Gronowski can get in a system that provides around-the-clock supervised care for only a tiny fraction of people with mental illness.
"It's not great, that's for sure," Van Peursem said. "But it's the best we can do."
The Illusion of Freedom
Even Lessard wonders if her case did harm
Dean Baker remembers the day his schizophrenia took hold. He was 27 years old, living in Florida, playing a lot of golf but not making much money as a car battery salesman. The glory days of his sports career at Wauwatosa High School and the University of Wisconsin-La Crosse behind him, he was stressed. He remembers feeling "desperate" and thinking, "I can't think straight anymore."
It was a terrifying feeling, Dean said.
He has learned that, if he wants to stay out of trouble, he needs to take his medication, a combination of anti-psychotic drugs and anti-depressants.
Dean is more fortunate than most people with chronic mental illness. He was able to get subsidized housing, after years on the waiting list. He has managed to stay in touch with his family, and, thanks to his mother and father, he has a tidy apartment on Milwaukee's east side. It's a quick walk to his brother's home and the well-appointed condominium where his parents live, overlooking Lake Michigan, for the six months of the year they are in town. His parents pay for a cleaning crew to come in every few weeks.
But Dean's life is a lonely one, said his brother, Vance. Most days, Dean, 56, sits alone in his room. He used to love to walk and, once, made the trek from Milwaukee to Chicago on foot.
"I don't know how his feet stood it, but he did indeed walk all that way," Vance said.
These days, Dean's outings are decidedly more local -- a few blocks north and west to Ma Fischer's Family Restaurant for a meal, or to the East Library to glance at the stacks of books. He doesn't have any meaningful friendships or hobbies, Vance said. He doesn't read. He doesn't watch TV. He doesn't even follow sports anymore.
"The negative symptoms of my brother's illness really keep him from enjoying much of anything," Vance said. "This is freedom, sitting alone? How free is he really?"
Society pretends that people with chronic mental illness are treated better now, outside institutions, when that is not necessarily true, Vance said.
"There is this illusion that we have given all these people their freedom," he said. "The truth is, they are shackled their mental illness."
Bill Baker said he has wondered "hundreds of times" over the years if his son Dean is getting better care in the new system than those patients he used to care for as an internist at what was then known as the Asylum for the Chronic Insane.
"I don't think his life is any better than it would have been in there," Bill Baker said.
And what about the woman whose case changed it all? Alberta Lessard is 85 and still living on her own in an apartment in West Allis. She has a few health problems that come with age. But she still cherishes her freedom. She has no regrets about suing the county.
"It wasn't right the way they just locked up people like animals," she said.
Still, Lessard laments that things have not improved more for people with mental illness. Over the years, Lessard has sought to get treatment several times at the county's mental health hospital, only to be turned away.
"In some ways, my case made things worse," Lessard said. "There are lots of people out on the street who have to get arrested just to get some help. That's not any too nice."
Copyright (c) 2006, Milwaukee Journal Sentinel
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COPYRIGHT 2006 The Milwaukee Journal Sentinel
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Teen alleges sexual abuse by DYFS worker
The Record (Bergen County, NJ); 3/21/2006; KIBRET MARKOS, STAFF WRITER
An 18-year-old Fairview man filed notice Monday that he intends to sue the state Division of Youth and Family Services, alleging that a former caseworker molested him when he was a minor.
Martin O'Neill said he was 17 and undergoing supervision for substance abuse when the 34-year-old family specialist made advances, beginning a months-long relationship that eventually led to intercourse.
"He was under their supervision because he was vulnerable," his lawyer, Rosemarie Arnold, said Monday. "Instead, they used their position to hurt him and take advantage of him."
Officials with DYFS and the Bergen County Prosecutor's Office confirmed that they were investigating the accusations against former caseworker Bobbi Triolo of New Hampton, N.Y., but no criminal or administrative charges have been brought.
"We have looked into those allegations and, based on what we know so far, we don't plan to file charges in the near future," Bergen County Prosecutor John Molinelli said.
He declined further comment, saying the matter was pending.
DYFS spokesman Andy Williams said Triolo's case is being investigated administratively by the Public Defender's Office, which handles cases involving DYFS workers. Tom Rosenthal, the office's spokesman, declined comment.
Triolo has retained River Edge lawyer Paul Brickfield, who also declined comment Monday.
Williams said Triolo began as a "family service specialist" at DYFS in January 2005 and resigned in January 2006.
In an interview at Arnold's Fort Lee office, O'Neill said he began drinking at 12 and soon became an alcoholic. He was in several substance-abuse programs and psychiatric hospitals, where he was diagnosed with bipolar disorder, he said.
Unable to cope with him, his mother called DYFS two years ago. A case was opened, she said.
When he was 17, O'Neill beat up his brother, prompting his mother to file assault charges. He was later placed on one year of probation, which he is still serving.
O'Neill said Triolo was assigned his case in February 2005. The two became close, he said, after he left a therapy program and went back home to live with his mother. He said she took him out to lunch in September at a River Edge diner and began fondling him there.
"After that there was a lot of hugging and kissing," O'Neill said.
Because she'd bought him clothing and took him to a concert of his favorite band, he said, "I didn't want to tell anybody about our relationship."
On the eve of his graduation from an alcohol-recovery program, O'Neill relapsed and told his parents that a caseworker with a local youth agency bought him the liquor. Arnold said the local caseworker then told investigators that O'Neill told her he had an affair with Triolo.
His mother, Maria Stoker, then called DYFS. O'Neill has since been questioned twice by the prosecutor's investigators, Arnold said.
Molinelli said his office has "conducted some interviews," but he declined to elaborate.
Explaining why she filed a notice of claim when no criminal charges had been brought, Arnold said: "They [DYFS and Triolo] had a civil responsibility to my clients, whether or not criminal charges are filed."
Under state law, plaintiffs must file a notice and wait six months if they plan to sue a public entity.
A message left with the local caseworker's supervisor at Maxim Health Care in Hackensack was not immediately returned Monday.
Copyright © 2006 Bergen Record Corp. All rights reserved.
This material is published under license from the publisher through ProQuest Information and Learning Company, Ann Arbor, Michigan. All inquiries regarding rights should be directed to ProQuest Information and Learning Company.
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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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