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January 26, 2005

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Fed: Medical achievers not given enough recognition

AAP General News (Australia)

01-26-2005

By Kylie Walker

CANBERRA, Jan 26 AAP - Most Australians have never heard of the nation's Nobel prize
winners and many have no idea that medical breakthroughs such as the bionic ear happened
in Australia.

A national survey on attitudes to health and medical research highlighted the need
to laud the nation's considerable scientific achievements, Research Australia's chief
executive Dr Christine Bennett said.

"It would be really nice for our community to know how proud they should be of these
contributions," Dr Bennett said.

"There's always a debate over whether sporting or movie stars should be Australian
of the Year but there is obviously a gap in the knowledge of the community about the amazing
contributions to research of Australians."

About half the 1,000 people surveyed knew Australians discovered that sleeping babies
on their back helped prevent cot death, but just one-quarter knew Australian scientists
had made the crucial link between spina bifida and folate deficiency during pregnancy.

"There's been an incredible contribution from Australia," Dr Bennett said.

"For example, the discovery that lithium should be the mainstay of treatment in bipolar
disease, that there's a bacteria that causes stomach ulcers, ... and the discovery of
penicillin.

"We were pleased to see that 60 per cent of the community knew that the bionic ear
had its origins in Australia."

Australia's Nobel prize winners for physiology and medicine were for the most part
forgotten by the community, the survey found.

Just 22 per cent recognised the name Sir Howard Florey - the scientist who discovered
penicillin - while less than 20 per cent knew of the man hailed as the father of immunology,
Frank Macfarlane Burnet.

Overall, Australia's research community was "incredibly productive" and working to
an extremely high standard, Dr Bennett said.

"In medical literature where one researcher has to cite the work of another, that's
a measure of the impact and relevance and importance of a piece of research," she explained.

"We produce three per cent of those citations with just 1.5 per cent of the world's
research population, so it's double our weight.

Scientists also often worked with limited research funding compared with nations such
as the United States, United Kingdom and Canada, Dr Bennett said.

"This isn't just an issue of government funding, it's an issue of donation and philanthropy
as well as private industry and commercial investment," she said.

"The really successful research nations have very strong contributions from their philanthropic
sectors, whether from individuals giving or corporations giving."

Nearly two-thirds of survey respondents said they donated to medical research organisations,
most to disease specific charities.

Of the 39 per cent who never donated, most said they thought research funding was the
government's responsibility.

© 2005 AAP Information Services Pty Limited (AAP) or its Licensors.

Widow sues over brain sample ; A Freedom woman says she declined to donate her husband's brain, then found out it was removed anyway.

Portland Press Herald (Maine)

01-25-2005

ROCKPORT --

Alice Geary says she could not have been more clear to the man who called the morning after her husband's sudden death. The caller asked whether she would agree to an organ donation. Absolutely not, the 57-year-old Waldo County woman says she responded.

"And that's when he told me it would be good if I would give them a small sample," Geary said Monday in an interview at her lawyer's office. "I said I wasn't interested and hung up."
But a written account of that phone call on April 28, 2000, is just as unequivocal. The consent form - signed by the former state employee who was paid to collect brains for a Maryland research institute - says that Geary did agree to make a donation.

The dispute is at the heart of a lawsuit filed Monday in Waldo County Superior Court.

Geary is the second Maine woman to sue the Stanley Medical Research Institute based in Bethesda, Md.; Dr. E. Fuller Torrey, the lab's founder; Matthew Cyr, the man who filled out the consent form; and Lorie Stevens, Cyr's associate who also signed the document.

Byrne Decker, a Portland lawyer who represents the Stanley Institute, declined to comment on the lawsuit Monday, saying he had not seen it. Lawyers for Cyr and Stevens did not return calls seeking comment.

Efforts to retrieve brains at the state Medical Examiner's Office for the Stanley Institute are now the subject of federal and state investigations. The probes were opened after reports in the Portland Press Herald/Maine Sunday Telegram showed the suspended operation was plagued by numerous ethical problems.

The claims in Geary's lawsuit largely mirror the earlier case, which was settled this month for $52,500.

There is one major difference, though. Geary, who lives in the town of Freedom, alleges she did not give partial consent and did not agree to donate a tissue sample. That was the allegation in the lawsuit filed by Lorraine and Frank Gagnon of Gorham.

Geary says she simply said no.

During Monday's interview at the Rockport law office of Don Briggs, Geary became emotional while she recalled the circumstances of her husband's death and the immediate aftermath.

Raymond Geary was a month shy of his 55th birthday when he took his late-model Buick to the store on the afternoon of April 27, 2000. He was an avid hunter and fisherman, a former city councilor in Belfast and a Little League umpire, his wife said. He worked for a group that cares for the mentally and physically disabled.

Leaving home, Geary told his wife that he would be right back.

Ten minutes later, Geary's Buick was found off the road, resting against a tree, with no evidence the brakes had been applied. The Medical Examiner's Office found that he died of a heart attack.

A post-death report showed that Geary once had a heart problem, but his wife said that in recent years he had been relatively healthy.

That evening, Alice Geary remembers getting a phone call about organ donation. She can't remember the details, including who called and what organs were being sought, but says she turned down the request.

"I couldn't even think about anything like that at the time," Geary said.

It was unclear from the lawsuit whether the first phone call was related to the brain-collection program or whether it was made on behalf of another group seeking organ donations.

A second phone call came the following morning - at 7:45 a.m., according to the consent form. Alice Geary is again hazy about the details of the conversation, which happened more than four years ago, amid considerable trauma.

She doesn't remember the male caller's identity, though the consent form identifies the man as Cyr. She says there was no third- party witness to the call, in contradiction to the consent form, which includes Lorie Stevens' signature. Geary does remember the Stanley Institute being mentioned.

"Nothing was ever said about the brain. The only thing he said was tissue," Geary said.

The consent form, which is among those obtained by the Press Herald/Telegram during its investigation, has no space for the donor family's signature, and the document does not say that the entire brain will be taken. Raymond Geary's name is blacked out for privacy reasons, but the form's case number matches the one referred to in Alice Geary's lawsuit.

The Stanley Institute needs entire brains - both normal and diseased ones - for its research on the roots of schizophrenia and bipolar disorder. The lab recently said that the removal of brains and other organs is routine during autopsies.

In Alice Geary's case, the one-page consent form states that she authorized the removal of tissue from her husband's liver, spleen, pituitary, brain and dura, a membrane that envelops the brain. Parts of organs other than the brain were routinely removed for evaluation by the Stanley Institute.

Only in the last couple of months, Geary said, did she learn that her husband's brain was sent to Maryland. This discovery, she said, followed a phone inquiry by a detective at the Maine Attorney General's Office.

She subsequently requested her husband's autopsy report from the Medical Examiner's Office in Augusta.

The report reads, "The brain is donated to the Stanley Foundation for research purposes as per next-of-kin's request."

On May 1, 2000, Raymond Geary was buried at St. Francis Cemetery in his hometown of Waterville. In the lawsuit, Geary's widow asks that his brain and other body parts be returned so they can also be buried.

Alice Geary is the fourth person in Maine to publicly allege that she was confused, misled or worse during a request for a brain donation. Besides those four, Maine lawyers have said they are planning to file suit on behalf of at least three other people.

Geary said she feels aggrieved by the removal of her late husband's brain.

"I think that it was a horrible, horrible thing to do," she said. "I don't think they had any right to do it."

Staff Writer Kevin Wack can be contacted at 282-8226 or at:

kwack@pressherald.com

Copyright 2004 Blethen Maine Newspapers Inc.

Spellman: `I'm doing OK'.

Chicago Tribune (via Knight-Ridder/Tribune News Service); 1/24/2005

Byline: David Haugh

CHICAGO _ Alonzo Spellman does not want to discuss his NFL comeback attempt, the 16 months he spent in a federal prison for threatening a young family on an airplane in 2002 during a fit of bipolar rage, or finally winning his ongoing battle against mental illness.

He prefers not to talk yet about his renewed commitment to stay on his medication, his daily workouts in a gym close to his Willingboro, N.J., home, or any parallels between him and another former NFL player ravaged by bipolar disorder, ex-Raiders center Barret Robbins.

Indeed, Spellman wants to get the word out around the league that he is recovering. As long as he is not the one spreading it.

"I'm not going to go into details,'' Spellman said last weekend. "It's just not good timing for me right now.''

It took the troubled ex-Bears defensive tackle the better part of a week to reach that conclusion.

When Spellman answered the phone around 9 a.m. last Monday, two days after Robbins was shot twice by Miami Beach police in a scuffle that resulted in attempted murder charges against the former player, he sounded eager to discuss the illness they share. He had, after all, recounted the horror of his breakdown on the airplane for the HBO program "Real Sports'' last August.

Initially, the former Bears first-round draft choice in 1992 spoke with enthusiasm about getting a second chance at an NFL career at the age of 33, and with empathy when the topic of Robbins was broached.

"That's bad, man, real bad,'' Spellman said. "But I'm doing OK, doing everything I should. I'll talk about it, but I've got some stuff to do right now. I'll call you back (Monday night).''

He never did. Reached a couple of days later, Spellman asked for a few more days to think about what he wanted to say. Finally, Saturday, Spellman confirmed what his mother, Dorothy Spellman, had recommended all along: No interviews.

"Nobody in my family will be talking about Alonzo,'' Dorothy Spellman said.

But Raj Mackara, Spellman's high school coach at Rancocas Valley High School, knows Spellman has plenty to say. He just wants to say it to an NFL executive, face-to-face, heart-to-heart.

"What he's looking to do is get one NFL person to talk to him in person and see the differences in him, see his body, because there are horror stories out there about Alonzo,'' Mackara said. "People hear that stuff and say, `Who needs this?' ''

Even in a league that routinely forgives aberrant off-the-field behavior for on-the-field production, the question will follow Spellman. Any room that Spellman sits down in with an NFL executive will be cluttered with the baggage of his troubled past.

In Chicago, for example, nobody will soon forget the day in 1998 when Spellman walked shoeless and shirtless out of Good Shepherd Hospital in Barrington 24 hours after Mike Singletary coaxed him out of a friend's home in which he had barricaded himself.

Several other examples of Spellman's behavior range from bizarre to dangerous, from wasting thousands of dollars on his own rap-music company to an arrest for ransacking his brother's house seven days before the plane incident.

Before Spellman became unhinged so badly on the July 23, 2002, flight from Cincinnati to Philadelphia that he threatened to tear off a lavatory door, friends say he did not fully accept he was bipolar. One report at the time said he indulged in amphetamines, cognac and marijuana.

Mackara never knew that Alonzo Spellman.

A pair of size 18 { spikes still sit on a shelf in Mackara's office and serve as a constant reminder of how big Spellman's imprint was at the school. The two had grown so close that Mackara once drove Spellman to Ohio State for the start of football practice.

Regrettably for Mackara, they lost touch after Spellman's first couple of years in the NFL when the pressures on a first-round draft pick falling short of expectations changed his demeanor.

Until recently, the closest Mackara had come to Spellman was last year when the educator took some students for a tour of the same Ft. Dix federal prison in which the school's former star had been incarcerated. This is where Alonzo Spellman ended up, kids. Don't let it happen to you.

Mackara had not thought of that day for a while until his phone rang about a month ago. It was Spellman, asking to come to the school for a visit.

"He showed up right when and where he said he would, and if you know Alonzo, you know that's saying something right there,'' Mackara said. "He had remorse, regret and awareness of all that he had done.''

It felt like old times. They talked about Spellman's desire to help around the school's weight room and maybe even as an assistant coach. They talked about how Spellman was going to counseling and working out enough to make his body "look like he's 28,'' according to Mackara.

They talked about Spellman's temptation to call the New York Giants for a tryout last November after they lost defensive end Michael Strahan for the season.

They also talked about the new medication Spellman swore he would never stop taking again.

"I said to him, `You've said that before, why now?' '' Mackara said. "He said, `I can give you 18 months worth of reasons.' ''

That was the length of the sentence U.S. District Court Judge Stewart Dalzall imposed in February 2003, with credit for time served. A spokesman for the U.S. attorney's office in Philadelphia said Spellman, released in November 2003, remains on probation for another two years and must check in with his probation officer regularly to make sure he continues taking his medication and making progress. Spellman described doing "odd jobs,'' to keep busy and make money while living with his mother and several other family members.

"He's looking to re-establish himself as a solid member of this community,'' Mackara said. "All he wants is a chance to walk into a training camp next (summer) and prove he can still play.''

Those chances are remote.

Asked about Spellman's chances to make a 53-man roster next summer, one NFL personnel director all but ruled it out. He never used the words bipolar disorder either.

"He's old and he hasn't played in four years (since 2001) with the (Detroit) Lions,'' the executive said. "That would be a bigger concern than the health stuff.''

Earlier this month, the Bears got a surprise call seeking information about Spellman from H.R. Silvagni, the general manager of the Cincinnati Marshals of the National Indoor Football League. Players in the NIFL make $200 per game, but the league believes it also offers an avenue to the NFL, albeit a circuitous one.

Silvagni had heard from some friends that Spellman had committed to recovery and an NFL comeback. So he tracked down Spellman's home phone number in New Jersey and reached out.

"I left a message: `Alonzo, I know things have been rough for you but I'd really like to give you a chance here in Cincinnati if you want to start somewhere,' '' Silvagni said. "I never heard back.''

(c) 2005, Chicago Tribune.

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COPYRIGHT 2005 Chicago Tribune

Mental health systems in disrepair.

Houston Chronicle (Houston, Texas) (via Knight-Ridder/Tribune Business News); 1/23/2005

Jan. 23--Call him the money man.

He's schizophrenic, obsessive-compulsive and so ill he can't remember things from one day to the next. Until he was moved to a nursing home recently, he spent years entering downtown skyscrapers and holding forth on Hitler, Mussolini and the Beatles.

Security guards asked him to leave, but he couldn't, he had to get to the end of his spiel. Inevitably the police came, charged him with misdemeanor trespassing and put him in jail. From jail he went to a state mental hospital, and from there he recycled back to jail, the county psychiatric hospital and the streets.

He has cost taxpayers at least $2 million over the last 30 years, says a mental health expert who has followed his case, and even at that price tag he didn't get what he needed -- long-term outpatient services or a spot in a supervised residential facility. He represents a state mental health system that's been broken for years.

Millions of dollars in tax money -- the exact amount is untallied, but an informal survey of area mental health providers shows that it easily tops $70 million -- goes to the treatment of mental illness in Harris County every year. While 25,000 received services from the public mental health system in 2003, almost three times as many did not.

Texas House Bill 2292, which became law in September, was supposed to fix things.

To streamline services, agencies for mental health and substance abuse were combined and eligibility requirements tightened. To save money, most mental health benefits were cut from Medicaid, the state-federal health insurance program for the poor, leaving nearly 128,000 Texas Medicaid recipients with mental illnesses without a way to pay for care.

To improve patient care, the law also implemented the concept of disease management. Instead of treating everyone with a mental illness with medication and little else, staffers at the Mental Health and Mental Retardation Authority of Harris County and other community mental health centers across the state now assign clients to one of four levels, with Level IV clients receiving the broadest range of services.

Legislators said the sickest people in the state would receive effective, even improved, treatment.

It didn't turn out that way, say those who work most closely with the mentally ill.

"Are we comfortable letting people die on the streets? Are we comfortable having a level of health care that may approach Third World status for some portion of our society?" asks Steve Schnee, executive director of the Mental Health and Mental Retardation Authority of Harris County.

Tom Mitchell, who has worked with the indigent mentally ill for 28 years, describes the four months since the law has been in effect "as the worst I've ever seen. The population is growing, and we're cutting services."

MHMRA, the region's largest provider of mental health services for the uninsured and underinsured, simply can't keep up with client demand. People not in crisis wait up to 3 1/2 months for an appointment. The day of the visit, they wait hours to see a doctor, who typically has a caseload of more than 600 patients.

According to a 2004 report by the Mental Health Needs Council, a local advocacy group, 84,000 Harris County residents who are severely ill with depression, bipolar disorder or schizophrenia depend on the public mental health system. Twenty percent of county residents in jail or prison and one-third of the county's homeless population are severely mentally ill.

Since September, mental health services in Harris County have undergone changes. Here's a look at what's happened and what the outlook is for the future.

Only people with schizophrenia, bipolar disorder and major depression now are eligible for more than crisis care at MHMRA. People in acute psychiatric crisis are eligible for treatment, regardless of their diagnoses, but under the new law they may be forced out of the system once they are stabilized.

Theoretically, people with other serious mental illnesses -- anxiety and panic disorders, obsessive-compulsive disorder and nonsuicidal depression -- will be referred elsewhere, but they have few other places to go. The other main public provider, the Harris County Hospital District, has little capacity to absorb the overflow.

So far, about 125 clients who don't meet the new eligibility standards have been or soon will be purged by MHMRA, and 120 people, or 15 percent, are turned away each month, says Rose Childs of MHMRA.

At any one time, MHMRA juggles 8,830 clients, Childs says. That's one-tenth of those who need public treatment.

Texas already ranked near the bottom in per capita state spending for mental health care -- 48th in 2002, according to a study by the National Association of State Mental Health Program Directors Research Institute. And spending has dropped since then. The local MHMRA has lost $8 million in state funding for mental health services since 2003; of its $129.1 million budget for this fiscal year, $35.1 million is for adult outpatient mental health programs.

"With all these budget cuts, I'm afraid one day I might not be sick enough to qualify for help," says Bobby Harper, who has spent much of his life homeless, severely depressed and occasionally suicidal.

MHMRA of Harris County juggles funding issues and the delivery of care. Some lawmakers and other experts want community mental health agencies across the state to choose between the two.

State Rep. John Davis, R-Houston, filed a bill earlier this month to regionalize state-funded programs for mental health, mental retardation, substance abuse, aging and services for the disabled. Among other things, it would prohibit agencies from both overseeing funds and providing services.

The local Mental Health Needs Council and other groups focusing on the system's shortcomings agree. They'd also like to see much greater coordination between the Harris County Hospital District, MHMRA and the county public health department. The newly formed Harris County Public Health Care System Council is supposed to oversee that coordination.

Harris County faces special challenges, including the fact that rural areas in Texas have historically received more money per capita for mental health services than the state's urban areas. Couple that with urban areas' attraction for people who need such services, and the problems become clear, said Harris County Judge Robert Eckels. The county's geographic sprawl complicates the problem by making it difficult for many people to reach clinics where services are available.

Several other urban counties have begun to address the challenges, but change has been slow to arrive in Harris County.

"There are people who think we (in Harris County) have the worst mental health system in Texas," says Lois Moore, administrator of the University of Texas-Harris County Psychiatric Center, which provides short-term inpatient treatment. "It's very dysfunctional."

Once, MHMRA operated seven outpatient clinics; it's down to four. The places almost smell of budget cuts that have been going on for years.

Outside the northwest clinic, clients smoke and keep wary eyes on a man who is shouting -- to himself.

Inside, patients recline in well-worn chairs and wait. For hours, they wait.

Irene Castorino, a middle-age woman, skipped breakfast to make it to the clinic for her 9 a.m. appointment. Then she sat in the dusty waiting area until her name was called at 2:15 p.m.

She waited more than five hours for a five-minute meeting with a social worker. Had to, she says. She needs medication for her depression, but she can't see the doctor who will write a prescription until she gets past the gatekeeper.

"You have to put up with it," Castorino says. "If you don't come and keep your appointment, they drop you."

Castorino has been an MHMRA client since 1995. "The waits are so much longer now," she says. "Also, I used to come to group therapy. They stopped that."

Specific budget cuts are decided locally. But the major changes have been dictated in Austin.

Davis described the legislation as an attempt to bring mental health care into the modern age.

He and other proponents note that the old system was cobbled together before the explosion of information about brain-based diseases. Now that society knows more about mental illness, they say, treatment needs to change, too.

Combining effective, new drugs with meaningful therapy will help more people manage their mental illnesses, Davis said.

Most experts like the idea of disease management.

"In theory, it makes a lot of sense," said Betsy Schwartz, executive director of the Mental Health Association of Greater Houston. "But it's mandated without any new funding in a system already totally underfunded."

MHMRA, for example, has about $35 million a year to spend on outpatient adult mental health services.

That's not nearly enough, says Schwartz, who estimates roughly 35,000 mentally ill adults would seek services if the system were accessible.

Thousands of others are so sick they may not know they need treatment.

"It costs $10,000 a year, minimum, to give an adult the care he or she needs in an outpatient clinic," Schwartz says.

"It costs $55,000 a year not to treat that client. They cycle into crisis, and crisis care is prohibitively expensive. We pay now or pay later."

When Sandra Robles first called for help, she was so depressed she couldn't leave her bare west Houston apartment.

She lost her job as a nursery-school teacher when she took time off to help Steven, her adult schizophrenic son. At her next job, in a nursing home, a colostomy bag exploded in her face and caused an eye infection so severe she couldn't work.

Panicked about her bills, her son, her vision and her sanity, Robles called the Mobile Crisis Outreach Team, a free emergency service that is part of MHMRA. MCOT made several home visits, providing counseling and medication. Robles' employer also came through, giving her the temporary assistance she needed to pay bills and buy groceries.

Crisis averted, it seemed, for the licensed vocational nurse who feared she'd be living on the street. Her apartment was just a little box, she sobbed at one point, but it was all she had.

Two weeks ago, just as Robles planned to return to work, everything unraveled again.

Her doctor told her she wasn't ready -- one eye was getting worse. A few days after she asked her employers to extend her medical leave, she was fired. That meant she lost the financial help. Then her mother died.

Thank goodness, Robles said, she had the anti-depressants from MCOT. Otherwise, she said, she'd be suicidal.

The MCOT services, designed to be temporary, actually came to an end before the latest series of crises. The MCOT counselor directed her to MHMRA's eligibility center, where the staff told her she qualified for services but would have to start paying $89 a month.

Robles didn't have the money and gave up on any hope of treatment. The MCOT staff stepped in again, assuring her that MHMRA would help her, even if she couldn't pay.

And that's what happened. Now Robles is trying to figure out how to come up with rent and put food in the refrigerator when she has no money coming in.

"I'm not going to cry -- I can't cry anymore," she said. "I'm going to fight."

When Robles is not worrying about basic survival, she frets about her son. She wants to help him, she says, but sometimes the schizophrenia is a destructive force bigger and more powerful than either of them. Even when he gets free care, she says, he sometimes refuses it.

She's no longer surprised by that, she says. He's very ill. And sometimes they both question the value of 15 minutes of talk therapy here and there.

Tom Mitchell, the MCOT director, worries about the folks he and his team members lose while transferring them from their jurisdiction to the eligibility center and outpatient clinics. He feels particularly bad for the clients who are bounced because they don't have one of the big three diagnoses.

That, says Dr. Avrim Fishkind, is his biggest beef with the legislation: "It's almost a 'who should live and who should die' kind of decision."

Fishkind is medical director of MHMRA's NeuroPsychiatric Center, which provides assessment and treatment for people in psychiatric crises. Because of their emergency status, doctors can treat them without worrying about an approved diagnosis.

"But then what?" Fishkind asked. "There are dozens of psychiatric illnesses with the risk of violence and suicide as great or greater than major depression, schizophrenia or bipolar disorder. Think what would happen if doctors at Ben Taub (General Hospital) or the hospital district were told they could only treat cancer, diabetes and heart disease. That's how limiting (House Bill) 2292 is."

Joe Lovelace, executive director of the National Alliance for the Mentally Ill in Texas, acknowledges that some people will lose services, but he says the limits are necessary to ensure that those with the greatest needs get help.

"It's a rational rationing," said Lovelace, who got involved in mental health issues after his son was diagnosed with schizophrenia in 1988.

The legislation was an appropriate if difficult step to take, says Robert Black, a spokesman for Gov. Rick Perry. "2292 merged 11 state agencies into four, eliminated a lot of duplication and saved taxpayers dollars. With a $10 billion shortfall, legislators had to make some hard decisions."

For clients who get the ax, the Harris County Hospital District is the logical fallback. But it was stretched beyond capacity even before House Bill 2292 took effect.

Already Ben Taub and other emergency centers in the Texas Medical Center, including the NeuroPsychiatric Center, periodically go on diversion, too crowded to accept even the most critically ill patients.

"We will do everything we can, but we are not staffed and funded to provide adequate mental health care to everybody in Harris County," said Dr. John Burruss, chief of psychiatric services.

Those who call for outpatient treatment aren't denied outright. The waiting time is about three months. People wait, and often they cycle into crisis.

"They end up in the ER, they end up in jail, they end up dead," Burruss said.

Bobby Harper had been homeless for much of his adult life when he moved to Houston in 1997. He would get a job, rent an apartment, buy a few appliances. Then he'd get fired.

Harper's fortunes changed when he met his wife-to-be, Deborah, in a church singles group. She suffered from severe depression, she told him, and she recognized his untreated symptoms. If he didn't take care of his own mental illness, they were finished.

Last year, at age 35, Harper sought help from the Safe Havens Transitional Living Center, an MHMRA facility for homeless, mentally ill men. He is stable now. He and Deborah are married, living in their own apartment and expecting a child. He would like to say all is well, love conquers all, but in their case, it hasn't.

Deborah can't work because of multiple health problems. She receives Social Security payments of $564 a month. He wants to work, but if he earns as much as $825 a month, Deborah loses her benefits. He can earn enough to jeopardize her income but not enough to pay for their living expenses, their health problems and a high-risk pregnancy.

"I'd feel better working," Harper said. "But the system penalizes me if I do."

Harper knows most people can't relate to him or his story. He's short, stout, and can't take care of himself very well. When he and his wife first learned she was pregnant, they were thrilled but also frightened. They didn't plan the pregnancy and they knew they couldn't afford to raise a child.

In the past few weeks, they've contacted an adoption agency.

"We're going to give up the baby," Harper said.

He knows most people don't understand chronic depression.

"You're depressed?" people ask him. "So am I."

He said, "I'm not talking about getting sad or a bad day. I'm talking about waking up and not wanting to live."

Harper is not an expert on House Bill 2292, but he knows it means even more budget cuts in the future, and the prospect terrifies him.

"I just can't be homeless again," he said.

By Claudia Feldman and Jeannie Kever

COMING UP

Mental health is back on the Legislature's agenda. Some of the topics:

--Regionalization: Rep. John Davis, R-Houston, has filed House Bill 470 to regionalize state-funded programs for mental health, mental retardation, substance abuse, aging and services for the disabled. Among other things, it would prohibit agencies from both overseeing services and providing them, as MHMRA of Harris County now does.

--Medicaid, CHIP: Debate on restoring some mental health benefits to Medicaid and the Children's Health Insurance Program will be fierce.

--Money, money, money: Most mental health advocates will ask for more money, amid tough competition. Public schools, higher education and other human-service programs slashed during the last session also want more.

DOLING OUT TREATMENT

Under disease-management protocols, people are assigned to one of four levels and offered services ranging from help in managing medication to psychotherapy, jobs and housing.

--Level I: Medication, routine case management and life-skills training.

--Level II: The above services, along with counseling and limited amounts of psychotherapy. 380 slots.

--Level III: The above services, along with psychosocial rehabilitative services, supported employment and services by a registered nurse. 1,350 slots.

--Level IV: The above services, with 24-hour staff availability and housing services. 270 slots.

PAYING FOR TREATMENT

One complaint about Harris County's public mental health system is that it's fragmented. No one oversees all funding or even claims to know how much money is spent. Among the pieces:

--MHMRA: The Mental Health and Mental Retardation Authority of Harris County's budget is $129.1 million, including $35.1 million for adult outpatient mental health programs and $13.8 million for emergency mental health services. The budget is down $14.8 million from two years ago.

--County funding: Harris County's budget includes $27.1 million for MHMRA, along with almost $5 million for mental health services in the juvenile probation department.

--Hospital district: The Harris County Hospital District spent $5.4 million on mental health services in 2004. About 80 percent went to inpatient treatment.

--Veterans Affairs: The department spends more than $17.5 million annually on mental health care in the 28-county Southeast Texas region.

PER CAPITA

--Low rank: Even before the 2003 state budget cuts, Texas per capita spending on mental health care -- about $40 in 2002 -- was less than half the national average of $87.Texas ranked 48th among states, above only New Mexico and Arkansas, according to the National Association of State Mental Health Program Directors Research Institute.

--Near the bottom: Harris County received $36.5 million, or $9.72 per capita, for state-funded community mental health programs in 2004, ranking 39th out of 40 programs. The West Texas MHMR Center in Big Spring ranked No. 1, with a per-capita payment of $27.13.

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