U.S. military works to educate soldiers about mental health issues

From The Gazette in Colorado Springs:

In recent years, the military has invested millions of dollars in mental health care, fueling a proliferation of treatment programs while attempting to reshape fundamental attitudes about mental illness.

But the stigma persists among the rank-and-file, keeping many troubled soldiers from taking advantage of help that is readily available, according to two Army generals.

The Army's top psychiatrist, Brig. Gen. Loree K. Sutton, and Fort Carson commander Maj. Gen. Mark A. Graham spoke with reporters, civilian health care providers and others Wednesday as part of an Army-sponsored Warrior Care Summit in Colorado Springs.

A 2007 scandal at Walter Reed Army Medical Center that revealed widespread medical neglect, coupled with a rash of soldier suicides and homicides, has led to major strides in how the military approaches health care.

Sutton described the Walter Reed revelation as a tragic "blessing."

"We're really good at the life-saving, white-knuckled, adrenaline-charged stuff," she said about the military's medical team.

But until recently, the military fell short when it came to taking care of soldiers coming off the battlefield or in need of longtime rehab.

This "cultural transformation," Sutton said, has changed medical protocols to place a greater focus on the "whole" soldier. Mental health, she said, is now taken as seriously as physical health. Her job title might serve as an example. She is the founding director of the Defense Centers of Excellence for Psychological Health and Traumatic Brain Injury, a Defense Department organization charged exclusively with addressing the psychological needs of the military.

The changes aren't just at the top. Platoon leaders and medics, for example, are being trained to recognize signs of stress among their troops and to help those soldiers get help.

Army doctors and counselors have honed their questions to better identify conditions such as post-traumatic stress disorder and traumatic brain injuries. Fort Carson recently opened a center designed solely to help soldiers with traumatic brain injuries.

Yet such efforts are hampered by a tough-guy culture where words such as "stress" and "mental health" make people bristle. Graham said soldiers fear that if they seek psychological help, it might be seen as a sign of weakness and could jeopardize promotions or admission into selective programs.

Graham is a vocal advocate in addressing those stigmas. One of his two sons committed suicide, and the other died in combat in Iraq. And at Fort Carson, 14 soldiers were accused or convicted of homicides from 2005-08, he said.

"We take it very hard when a soldier goes downtown and does something horrific," he said. The question, he said: "How do we see that red flag?"

One of Sutton's strategies is a new $1.8 million public awareness campaign built largely on telling the stories of soldiers who sought help.

Disabled people in Myanmar battle stigma

From IRIN:

YANGON -- Nay Lin Soe, aged 28, campaigns for the rights of the disabled in Myanmar, a marginalized group with few rights and little support.

He contracted polio at the age of three, gets around on crutches, and has devoted his adult life to raising awareness of, and dispelling negative attitudes towards, disability.
"People in Myanmar think about disability in a traditional way," Nay Lin Soe told IRIN. "A family will usually regard a disabled person as a burden. And often a disabled person can feel like a burden because he or she doesn't have a chance to lead a productive life."

Government-funded facilities for the disabled are limited. For a nation of 56 million people, there is just one school for disabled children, one vocational training centre for adults, and one rehabilitation centre - all in the commercial capital Yangon.

The disabled make up around 2.3 percent of the population, or some 1.3 million people, according to government figures.

Stigma and lack of mobility hamper them in their efforts to get a good education and a job. "They are isolated and excluded from society. As children they cannot go to school; as adults they have little or no income because it is almost impossible for them to get employment," said Nay Lin Soe.

The Education Ministry's policy is to provide opportunities for disabled children in ordinary schools, but problems remain.

This month, the Disabled People's Development Organization (DPDO), a local NGO established in 2003, will open its first office in Yangon. It aims to change attitudes towards disability, campaign for equal rights and provide a place where its 120 members can come and share their experiences.

Nay Lin Soe, who is on the executive committee, told IRIN: "Lack of capacity is our biggest problem in promoting disability awareness and helping people living with disabilities."

Nay Lin Soe is also the project manager of a community-based rehabilitation programme run by AAR Japan, one of the few foreign NGOs funding projects for disabled people in Myanmar.

AAR runs a vocational training centre in a suburb of north Yangon, where disabled people from across the country learn tailoring and hairdressing.

Chit Hinn Wai, who had both legs amputated above the knee after falling from a train at the age of 13, is learning hairdressing on a three month residential course. Since her accident five years ago she has lived in a government-run orphanage and this is the first time she has been able to share her experiences with other disabled people.

"I've made new friends and I've learned so much. I hope to use my skills and one day lead an independent life," she said.

AAR also runs community-based rehabilitation programmes in three areas affected by last year's Cyclone Nargis. They offer physiotherapy, free crutches and braces, and aim to make schools more accessible for disabled children.

But the one-year programme is a tiny contribution. "There just isn't enough support, from both inside and outside the country," said Nay Lin Soe. "My hope is that all disabled people in Myanmar can live with dignity."

Research in Ghana shows women who have been raped have 30% risk of developing a mental illness

From AllAfrica.com:

Women who are raped or defiled during their childhood are reported to be at 30% risk of developing mental illness in future, than those who are never raped or defiled.

The Acting Chief Psychiatrist at the Accra Psychiatric Hospital (APH), Dr. Akwasi Osei who disclosed this stressed that cases of rape and defilement should not be trivialised but should be taken seriously.

Dr. Osei was speaking at a forum in Accra organised by Network for Women's Rights in Ghana (NETRIGHT) on Women's Rights and Mental Health. He spoke on the topic "Women and Mental Health in Ghana."

He noted that women generally have more health problems, worse physical and mental health than men, have less access to health care than men and yet live longer than men.

"Women predominate in some types of mental illnesses including depression of all types, postpartum depression exclusive women's disorder, panic disorders, phobias, suicide attempts, anxiety and generally, neurotic or minor mental illnesses."

For three consecutive years women topped OPD attendance at the APH. Out of a total of 40,654 in 2007, 22,430 were women as against 18,224 men.

In 2006, 23,334 women and 19,628 men out of 42,962 sought psychiatric care. The figure for 2005 was 44,211 with 23,692 women and 20,519 men.

According to the Chief Psychiatrist women are more vulnerable due to biological factors (though not significant), sexual abuse, economic inequities, hormonal factors as in menses, pregnancy, menopause and cultural factors.

"Some causes of mental illness in women in Ghana are marital problems, relationship problems - from boyfriend, childbirth, menopause, rape and defilement and drug abuse from pressure from boyfriend."

Sadly, when a woman gets mentally ill, she is branded a witch and left alone, or sent to prayer camp and forced to confess.

Dr. Osei lamented that even Ghana's psychiatric hospitals not baby-friendly.

"A nursing mother will have the baby separated because there is no facility to keep babies. While Accra Psych Hospital has a VIP ward for men, no such ward for women yet."

Also he said insanitary conditions are normally not good for the fragile women coupled congestion more like concentration camp.

Further, at the community level women with mental illness may suffer eviction by a landlord, have their employment terminated and sometimes drop out of school if schooling.

The current mental health law, NRCD 30 of 1972 offers no protection for people who get mentally ill.

Dr. Osei disclosed that a new law has been drafted to solve these problems. He said it will specifically make provisions for women and children as vulnerable groups, specifically criminalise stigma, discrimination and other human rights abuses and criminalises forced marriage, forced labour and sexual abuse at prayer camps.

"Other provisions in the law decriminalises suicide, ensures mentally ill can maintain their marriage, or at least will not be disadvantaged in marriage on grounds of mental illness and can exercise their franchise to vote if so determined by their attending psychiatrists."

He explained that the draft bill which has been at the Ministry of Health for the past three years will seek to overhaul mental health care, deemphasise institutionalisation and emphasise community care, decentralise mental health care and more importantly curtail abuse of human rights.

In his opinion, what is needed now is to create awareness and increase advocacy on the need to pass the new mental health law.

"Women, as the law stands, stand to benefit even more than men."

Kathy Martinez confirmed as ODEP Assistant Secretary

From JFActivist:

Kathy Martinez was confirmed by the Senate Thursday, June 25 as ODEP (Office of Disability Employment Policy) Assistant Secretary.

Blind since birth, Martinez, who has worked as executive director of the World Institute on Disability (WID) since 2005, has worked in employment, asset building, independent living, international development, and diversity and gender issues in her work at WID.

Here's the post about her nomination in March.

Newark Medical Center to integrate physical, mental health care

From The Star-Ledger in N.J.:

NEWARK, N.J. -- Sameerah Rhodes hasn't visited a doctor's office since 2005. Luis Ortiz (pictured) can't even remember the last time he had a check up.

Both lack medical insurance and the means to travel to a doctor's office. Even if they did, both said they would be reluctant to go: The trip would cost them a full day of therapy at University Behavioral HealthCare in Newark, where both said they receive daily treatment for depression.

"I don't want to miss a day, because it helps a lot," Ortiz said.

But starting this week, neither Ortiz nor Rhodes will have to leave the center in order to get the medical attention they need. Instead, they can head to the new Yaffa Rose Integrated Care Center, located on the ground floor of the University of Medicine and Dentistry of New Jersey's facility.

Funded by an anonymous donor, the center is among the first programs in the country to provide on-site medical care for patients receiving treatment for mental illness, and represents a national push to integrate mental and physical health care.

"Providing this kind of care in a single setting, rather than having a person who has a disabling condition go from place to place to receive care -- that's actually the key," said Phil Libutz, said associate director of the National Alliance on Mental Illness in New Jersey. "It's one of the first programs of its kind. ... certainly a welcome occurrence in New Jersey."

The need to address physical health problems among people with serious mental illness is dire, according to the National Council for Community Behavioral Health Care.

The life expectancy for people with serious mental illness is 25 years lower than it is for the general population -- a fact attributable not to suicide or accident rates, but to preventable illness including cardiovascular disease, diabetes and asthma, the council reports.

Many people with serious mental illness are unable to work and lack medical insurance, said Dr. Winthrop Dillaway, a faculty member at the University of Medicine and Dentistry, who will be the Yaffa Rose Integrated Care Center's full time primary care physician.

Some medications required to treat mental health issues can make patients more prone to physical disorders, such as diabetes or hypertension, Dillaway said.

And many people with serious mental illness are unable to manage their physical health needs, struggling to make and keep doctor's appointments, or keep track of their medical records and prescriptions.

"They're so overwhelmed with their mental illness that it's really hard for them to take care of themselves," Dillaway said.

The Yaffa Rose Integrated Care Center will address many of these issues simply by virtue of its location -- patients won't have to make costly, time-consuming trips to see doctors off-site.

They will also be less likely to turn to emergency rooms for medical treatment, said Avis Scott, the clinician administrator of the Adult Extended Day Program at UBHC, noting some of her patients visit the emergency room up between eight and 12 times a year.

Caroline Ndumele, a nurse in the Adult Extended Day Program at UBHC in Newark, said the new program will also keep her and other staff members from spending long hours hounding other doctors' offices for medical records, or accompanying patients to appointments.

"When it comes to mental health, the best thing we can do is spend time with our clients -- not on the phone, or doing paper work," she said.

Kevin Martone, deputy commissioner of the state Department of Human Services, said while other New Jersey mental health care providers are incorporating physical health care into their services, he is not aware of any other program that has achieved integration to this extent.

One reason, he said, is that primary care doctors are often reluctant to participate, noting many of the patients are under- or uninsured and they are not fully reimbursed for their services.

But thanks to the $200,000 annual contribution from the anonymous donor, the UBHC center in Newark -- a converted laboratory on the ground floor now complete with a fish tank and shelves full of potted plants -- will be open five days a week, said Mark Johnson, chair of the Department of Family Medicine at UMDNJ and one of the programs architects.

The same donor has also committed $200,000 a year to establish a separate program integrating physical and mental health care in partnership with University Behavioral HealthCare programs in Middlesex County, said Shula Minsky, director of quality improvement for UBHC.

Through that program, which started last September, patients at UBHC locations in Piscataway, Monmouth Junction and Edison can get medical treatment from a physician's assistant at the Yaffa Rose Project, a clinic housed within Catholic Charities' St. John's Clinic in New Brunswick. UBHC provides the patients with referrals, with transportation to the clinic when needed, Minsky said.

Although the program is still new, Minsky said her staff is already observing a decrease in emergency room trips among their clients.

At the Newark program, she said, where "there is no transportation involved. ... It makes it that much easier to get to the doctor."

Although these programs were only possible because of the donation, Martone said both programs -- particularly the one in Newark -- represent a broad push among health care reform advocates to develop dedicated funding sources for coordinated care.

"What you're seeing right now in health care reform on the national level really gets at the importance of coordinated care, really pushing systems to do that and to make sure that reimbursements reflects the need," he said. "Health care reform legislation will very likely push reimbursement packages so that these type of settings become viable."

Of the venture in Newark, he added, "We would be very interested in seeing the type of outcomes that come out of this model."

Tango dancer starts dance program for amputees

From the San Francisco Examiner:

Imagine being in Buenos Aires and being unable to dance tango? Argentine tango dancer and teacher Naomi Hotta had just that happen to her, yet this year, she attempting to take that experience and inspire others who might not other wise try tango: amputees.

"In 2004 I tore my ACL and spent the last month in Buenos Aires just sitting around watching other people dance. I was very depressed. I love dancing. It was like my life was over," she said in a recent telephone interview.

Hotta was born in the United States, but has lived in Tokyo where she learned rhythmic gymnastics and flamenco. In 2001, she joined the Los Angeles-based "Salsa Brava Dance Company" that took her around the world and she also won several salsa competitions in Los Angeles. In 2004, she began to learn tango and went to Argentina to train for five months, making the finals of the Second World Tango Competition.

After the injury, she had surgery. Locals know Hotta has been teaching and dancing. Now nearly five years after her injury, Hotta has begun her EMBRACE Project.

"I really wanted to do something in tango more than gathering achievements and performing. Tango is a dance for any age and any nationality," she recalled. "I wanted to spread the joys of tango." Hotta hadn't heard or seen the much-vilified Heather Mills McCartney on "Dancing with the Stars," but people mentioned it to her when she began this project.

How to start was somewhat tricky. "I didn't know anybody. I did research on the Internet. I met Katy Sullivan through someone. Sullivan is a double amputee, but she runs and is an actress. She helped me get in touch with people. Prosthetics companies sent emails to see if anyone was interested." Sullivan, for those who don't know, was in the 2008 movie "The Break Up" and a 2008 episode of the new-defunct series "My Name Is Earl." Hotta then got in contact with the Mutual Amputee Aid Foundation. President and Acting Editor, Phil Tamoush, started spreading the news through his newsletters.

"The first amputee class was on April 4. I had another class in May and this Tuesday will be the third class," she said. In April, she had two amputee participants and 18 tango dancers to help support the project at the Tango Room in Sherman Oaks. On May 23, only one amputee came, but he brought his significant other. Eight people had RSVP-ed. Despite the low turnout, Hotta feels that the interest has been growing. In the photos, provided by Hotta, Brenda Maroney is dancing with Angel Echeverria. Below tango instructor Mitra Martin dances with Richard Wu.

"One of the challenges for me as a teacher is figuring out what is more challenging and what is not. How quickly do I move forward in the class. I found that amputee dance students are very quick at learning. I think it's because of their sense of body awareness. They can easily understand weight-shifting. In a way, the class goes faster than an able-bodied beginner class. Still, the prosthetics and gear are different for each student and we need to figure out what they can do and where we need to make an adjustment."

Hotta feels through these experiences she learned that it "might be difficult for amputee patients to trust you. For the leader, it is very difficult and scary to improvise. It is something new, creating out of the unknown. A follower told me it was scary because it was hard to trust and it is hard to let go. The leader must be confident" and that's not easy when your able-bodies and less so when you're dancing. Still Hotta feels, "They can do it. It is not super challenging like they imagine it to be."

The Tuesday, 23 June class, is a last-minute thing according to Hotta. One of the students from the first class, Brenda Maroney (pictured in the above photo with Angel), couldn't make the second class, but kept requesting another class.

"If you can walk, you can tango," Hotta stated, "at any level of physical stability. The main thing about tango is to connect with someone and enjoy the music. At whatever level, you can still fully enjoy tango, whether you're dancing with an old grandpa or grandma or a small child."

Hotta concluded by saying that her EMBRACE Project, "takes you back to the essence of tango: to connect and enjoy. I'm hoping we can make a more open and safe tango community where anyone can come out and dance and they can feel they are part of the tango community family."

UIC studies autism, "insistence on sameness" connection

From the Chicago Tribune:

As a kid, Alec Kedziora (pictured) was a picky eater, refusing anything new and subsisting on a self-selected diet heavy on Cheerios, Chex Mix and bacon. He insisted that all doors in the house be kept closed. His morning activities were identical every day and timed perfectly. If he overslept by even a few minutes he was late for school.

Alec was diagnosed with autism when he was 3, and his rigid routine is common among people with the disorder. Though he was an affectionate, sweet kid, if something went awry he often threw a fit and sometimes banged his head against a desk or wall.

Two years ago, as a freshman in high school, things took a turn for the worse. His frustration turned aggressive and he started getting in fights. His parents, Joe and NiCole Kedziora of Orland Park, were horrified. Alec realized he was acting badly and would apologize to his parents. "I was suffering," he said recently. "I was sad about it."

Hoping to provide relief to people like Alec and to solve a piece of the autism puzzle, a team of researchers at the University of Illinois at Chicago is looking at the relationship between the brain chemical serotonin and the trait known in the field as "insistence on sameness."

With the help of a five-year, $9.6 million federal grant, the team is using a combination of genetics, medication and brain scans to explore possible mechanisms behind this craving for routine. Alec was enrolled by his parents.

There's no single pattern to autism spectrum disorders, which affect perhaps 1 in 150 children. Some with autism repeat phrases over and over. Some barely interact with anyone. Others are outgoing, but their lack of social skills can sabotage their efforts to make friends. Up to a quarter have insistence on sameness, said geneticist Ed Cook, director of autism and genetics in UIC's psychiatry department.

The differences make autism a challenging condition to study and to treat.

"Autism is too big as a whole to attack," said John Sweeney, director of UIC's Center for Cognitive Medicine and the group's brain imaging specialist. "We have to go through the brain bit by bit to find out what's working and what's not. Get the bricks sorted out, and then build the house."

Having to take the same route to school each day to keep a kid calm may not seem like a big deal. But not doing it can trigger distress, and that can lead to anxiety or aggression. Cook said he knows parents who can track the severity of their child's symptoms by the amount of trashed drywall in the house.

Treating that rigidity has a huge payoff. "They still have autism, but they feel better," Cook said. "And everybody else feels better."

Each participant in the study gets blood drawn for genetic tests, including an analysis of the genes related to serotonin, a neurotransmitter that is part of the brain's system for modulating mood and emotion. Participants' families are asked to donate blood samples so researchers can look for hereditary links. All the blood Cook collects from participants -- he's hoping for more than 250 -- will be shared with a national autism database for other researchers to use.

Participants with a high level of insistence on sameness are referred to the group's pharmacologist, Tom Owley. The outgoing head of UIC's Neurodevelopmental Psychopharmacology Clinic, Owley conducted a preliminary study two years ago on the antidepressant Lexapro, which affects serotonin levels. Sixty-five percent of participants who took the drug were helped, according to results of a detailed questionnaire completed by their parents.

He's hoping this new study backs up those results and that combining the Lexapro research with the genetics and brain scans will help the team understand why the drug may not help some patients. Eventually, he hopes, the research could lead to medications targeted for people with specific autism symptoms.

This month, researchers in another large federal study reported that an antidepressant similar to Lexapro was no more effective than a placebo in reducing repetitive behavior, which seems to contradict UIC's initial results. Cook said the studies are looking at slightly different things.

The UIC study is focused only on repetitive behaviors that cause the participant distress -- like the breaks in routine that caused Alec to bang his head on a wall or start a fight. The other study measured all repetitive behaviors, whether they were upsetting the subject or not. Cook said he agrees that antidepressants don't appear to help reduce repetitive behaviors that a person is not hoping to shed, such as a compulsion to order things in a particular way.

In the Chicago project, people taking Lexapro undergo brain scans that record activity in key areas as the participants perform different mental exercises, both before they begin the medication and several months later. The results will be contrasted with those from a group of participants with low insistence on sameness.

The researchers eventually will have a data set that overlaps all this information -- the genetics, the medication results, the scans.

So far, 93 people have participated in the study, nine of whom were put on Lexapro. The researchers are looking in particular for more teenagers and young adults.

Alec, now 17, has been on Lexapro for a year and a half -- he continued to take it even after his time in the study ended. He and his family said the drug made an immediate difference. His family said he's able to vary his routine.

U.S. EEOC sues Kmart for an ADA violation

From DOW JONES NEWSWIRES:

The U.S. Equal Employment Opportunity Commission has sued Kmart Corp. for discrimination, alleging the retailer violated the Americans with Disabilities Act by terminating an employee who has spinal stenosis.

The EEOC alleges that Kmart fired Alonzo McGlone - who suffers from the condition in which one or more areas of the spine narrows, often putting pressure on the spinal cord or nerves - because of his disability. The group also said the Kmart discount store, located in Norfolk, Va., refused to allow McGlone to use an "assistive device" to aid him in standing and walking.

The EEOC said McGlone was qualified for and could perform the duties of his position as a greeter.

Kmart is owned by Sears Holdings Corp. (SHLD).

The lawsuit, filed Tuesday in Virginia, seeks unspecified damages including reinstatement to the job or pay in lieu of employment. It also seeks punitive damages for pain and suffering.

This isn't the first time Kmart has been sued by the EEOC. The company paid $ 60,000 in 2004 to settle a job-discrimination lawsuit filed on behalf of a mentally disabled Kansas man.

Sears Holdings' shares were recently up 2.6% at $64.28.

Blue Cross to require Florida psychiatrists to get prior authorization before treating patients

From The Naples News:

NAPLES, Fla. — Mental-health advocates are taking issue with Blue Cross and Blue Shield of Florida for a new rule taking effect in fall requiring psychiatrists to get prior authorization before treating patients in their offices or other outpatient setting.

Letters were sent out from Blue Cross to psychiatrists and other mental-health providers recently outlining the prior authorization rule, effective Oct. 3. The mental-health professionals who accept Blue Cross insurance must sign a contract amendment by a June 24 deadline.

They must get prior authorization for treating patients for office-based care, inpatient admissions, and for partial psychiatric and substance abuse treatment, according to the Blue Cross notice. Emergency visits are covered but the provider must request authorization.

For established patients, the treatment plan must be submitted and approved as of Oct. 3, and prior authorization must be obtained before seeing a new patient. A treatment plan must be sent in before the ninth visit with the new patients.

The rule is a setback for people with mental illnesses, said Kathryn Leib-Hunter, executive director of the National Alliance on Mental Illness of Collier County.

“It simply means access to care is even more hindered by this new policy,” she said. “Chances are, more emergencies are going to occur that could have been prevented. People will wind up in the (crisis stabilization unit) and (hospital) more so now.”

Blue Cross has the state insurance contract and one in four state employees need mental-heath care, Leib-Hunter said.

What especially bothers her is that Blue Cross officials say the new rule is necessary because of the federal Mental Health Parity Act of 2008 that is intended to end inequity between mental health treatment and medical treatment for plans with 50 or more employees.

A Blue Cross spokesman said the company needs to examine reducing costs because the federal mental health parity law could mean increased costs.

“It is our obligation to our members that we continually monitor the necessity of medical and mental procedures and accompanying costs, and look at identifying ways to reduce excess costs if warranted,” Paul Kluding, said in written statements. “With the potential increase in mental health benefits, this authorization allows us to examine cognitive treatment being given to our members and to re-affirm that our members are receiving the proper mental-health care.”

Marcia Mathes, president of the board of the National Alliance on Mental Illness Florida, said the state chapter doesn’t have any legal standing to halt Blue Cross but it will register complaints with the governor’s office, the state Department of Financial Services and anybody else concerned about the implications of insurer’s intentions.

“It’s pure stigma,” Mathes said. “The whole point of parity is to erase some of the stigma attached to (mental illness). It places an incredible burden on psychiatrists, most of whom are solo practitioners. They don’t have a huge staff.”

She’s heard that the Florida Psychiatric Association is also concerned that psychiatrists will decide to drop Blue Cross.

Kluding, the Blue Cross spokesman, said doctors dropping Blue Cross would be unfortunate. Prior authorization is already necessary for HMO’s for federal employers, he said.

“In fact, the required treatment plan is a short questionnaire completed by the office staff in most cases,” he said. “It only takes a few minutes and contains information that most likely already exists in the patients’ files, such as treatment goals.”

Mathes said the National Alliance on Mental Illness has been active in 37 states that have passed state mental-health parity laws. There’s been no huge increase in costs to the insurer — the average is usually 1 to 3 percent — but employee absenteeism goes down and productivity goes up with access to mental-health treatment, she said.
Dr. Jeffrey Fabacher, a psychiatrist in private practice in Naples, said he wasn’t surprised but disappointed by Blue Cross’ action.

“The whole point of parity is to stop the discrimination because mental illness is no different than medical illness, but clearly they are going to make it more complicated to access care,” Fabacher said.

The insurance industry fought the mental health parity bill but studies showed the cost increase would be around one or two percent and no surge in enrollees seeking treatment, he said.

Some psychiatrists and other providers may drop Blue Cross which will further exacerbate access issues, Fabacher said. He declined to say what he plans to do.

A bigger concern is that the insurer wants to reduce payments to physician assistants and others who work directly under psychiatrists, he said.

The David Lawrence Center, a private nonprofit mental health center in Golden Gate, anticipates administrative expenses rising and likely having to hire more staff to handle the prior authorizations for outpatient programs, said Sharie Boscaglia, clinical records and support services director.

About 12 percent of all of the center’s active patients have some Blue Cross coverage.
Another concern is how Blue Cross defines what an emergency visit is because many of the center’s patients are walk-ins with urgent issues that need immediate attention, she said.

Patients themselves won’t face an increase in their fees and the center won’t turn anyone away because they have Blue Cross, she said.

“This doesn’t have an impact on fees,” she said. “It comes back to the organization to get the authorization.”

Unspent funds for special education in Pennsylvania questioned

From The Philadelphia Inquirer:

Chester Community Charter School, the state's largest charter, would be among the biggest losers if a Rendell administration proposal to change special-education funding for charter and cyber charter schools becomes law.

The 2,150-student Delaware County charter school received $21,840 last school year for each special-education student from its home district, Chester Upland. That's more than three times the $6,812 subsidy it got for each regular student.

But state calculations show that the charter spent less than a third of the $9.4 million it received for special-education students on special education.

Gov. Rendell is proposing that charter special-education subsidies that aren't spent on special education be returned to the school districts that fund the charters. State Education Department spokesman Michael Race said in an e-mail last week that the problem of charters' not spending all their special-education funding for that purpose is "widespread."

The governor's proposal, he added, is "a simple matter of accountability to taxpayers for their dollars. If money is expended for special education, it should be spent on actual special-education needs. If not, it should be returned."

The governor also wants an 80 percent cut in the per-student amount Chester Community and other charters would get for students with "speech or language" disabilities. State education officials said those students generally do not require as many additional services, and it costs less to help them than those in other special-education categories.

Last, Rendell proposes a new formula for funding special education at Pennsylvania's 11 cyber charters, which provide instruction over the Internet. He wants the per-pupil special-education subsidy set at $13,695 for next year, based on the lowest special-education cost among cyber charters whose students met state standards last school year.

Chester Community Charter's special-education students "receive the extra help that they need in order to succeed," board chairman Spencer B. Seaton said in a letter to The Inquirer. Parents, he added, see the charter as "the only beacon of hope that their children have in order to achieve a safe and successful education."

When Rendell made the charter special-education funding proposal in February, he said charter schools received $78 million in special-education subsidies last year, but spent only $50 million on special-education services.

The state totaled each charter's direct special-education spending from required annual financial reports and added up how much school districts were paying charters for their special-education students. A few schools did not report any special-education expenses.

Because the state analysis had to be ready in time for the governor's February budget proposal, it was incomplete. The Inquirer totaled payments to charters that were not included in the February calculations or whose payments were incomplete in the state tally.

That analysis showed that special-education overfunding was worse than the state reported. Charter schools across Pennsylvania received about $91 million in subsidies, while spending only $50 million. They were able to spend the surplus funds for any purpose they wanted.

This school year, Pennsylvania has 127 charter schools, with 67,000 students.

Special education for charters is funded in a different way than for school districts. School districts pay a sizable portion of special-education expenses on their own. They get a state subsidy, calculated using overall student enrollment and adjusted for wealth. Typically, school districts spend more on special education than they receive in subsidies from the state.

Charters get a per-child payment for their special-education students based on the special-education costs of the districts where the children live.

Rendell's proposal addresses a funding quirk that state officials believe costs local school districts money while benefiting charter schools.

Local school districts by law provide a full array of special-education services, from those for mildly disabled students with reading problems to those for children with severe cognitive problems and autism. The most severely disabled are sent to special schools.

Many charters end up with special-education students who are less severely disabled than those in most school districts.

In those cases, where relatively high-cost school districts are funding typically lower-cost charter school special-education students, the possibility of subsidy windfalls exist.

Lawrence Jones, CEO of the Richard Allen Preparatory Charter School in Philadelphia and president of the Pennsylvania Coalition of Charter Schools, blasted the Rendell plan in a recent interview, saying it was part of an effort "to limit and retard the growth of cyber charter schools and charter schools in Pennsylvania."

Bill Winters, CEO of Chester County's Collegium Charter School, said the state's calculations did not include many indirect special-education expenses.

Last year, state figures showed that Collegium took in about $1 million more for its special-education students than it spent on special education. Winters said that if expenses such as the portion of the school's mortgage that pays for special-education classrooms and the amount of classroom time regular teachers spend implementing special-education plans were included, the school spent more on special education than it brought in this year.

Chester Community Charter School last year had the largest dollar gap between the funding it received for its special-education students and what it spent on special education - about $6.6 million. The school is run by a for-profit management company, Charter School Management Inc.

The relationship between the charter school and its home school district, Chester Upland, illustrates how the funding formula works to the charter's benefit.

Each enrolls about the same percentage of learning-disabled children - 27.6 percent last school year in Chester Community Charter, and 24.7 percent in Chester Upland.

But Chester Upland had more than five times as many severely disabled students; it was in the top 10 percent statewide. This year, 117 students went out of the district for specialized services costing about $3 million.

Chester Community Charter, by contrast, had the second-lowest percentage of severely disabled students in Pennsylvania among charters or districts. No students left the school for specialized services last school year.

The situation is reversed when it comes to mildly disabled students with a speech impairment - difficulty producing speech sounds or problems with voice quality - or a language impairment - a problem using words in proper context.

At Chester Community Charter, about 49 percent of special-education students were speech- or language-disabled last school year, compared with 5 percent at Chester Upland.

A state review of the charter's special-education program last year said that 72 percent of special-education students there received three hours or less a week of special-education services.

Randi J. Vladimer, an attorney for Chester Community Charter School, declined to comment, citing earlier responses from Seaton, the school's chairman. In January, after the publication of an article that raised questions about how the school's money was being spent, Vahan H. Gureghian, the CEO of Charter School Management Inc., sued The Inquirer for defamation, saying that failed business talks between him and Inquirer publisher Brian P. Tierney motivated that and other articles late last year.

Inquirer editor William K. Marimow said Tierney had no involvement in the stories. Scott K. Baker, general counsel for Philadelphia Media Holdings L.L.C., owner of the paper, called the suit baseless and denied that Tierney had been in negotiations regarding a business transaction.

About 18 of Pennsylvania's charter schools - less than 15 percent - spent more on special education last school year than they received from school districts in special education funding.

One of them was Montgomery County's Souderton Charter School Collaborative. The 151-student school spent about $176,000 more on its 24 special education students than it received from their school districts. That's mainly because the school has a paraprofessional in each classroom who works intensively with special-education students and others who need extra help; it has no separate special-education rooms.

"The focus becomes more about individualizing than about special education - individualizing for all children," said Wendy Ormsby, the school's director of organizational development and its founder. Special-education funding cuts would make it harder for the school to carry out its work, she said.

Lisa Kern, the mother of two children at the school, agrees. One son, now in seventh grade, was very withdrawn when he started kindergarten, and in third grade was diagnosed with a learning disability that affected his reading. "Every year, he has made such great strides," she said. "I think it is because of the individual attention he received. . . . He's an outgoing kid now. He's taking a leadership role."

Students who struggle say that they don't feel singled out or stigmatized.

"Everybody here learns at their own pace," said fifth grader Kendalyn Ostrander, who gets extra help in math.

House approves bill to speed health care for veterans

From The New York Times:

The House approved legislation on June 23 that is intended to prevent delays in federal financing for veterans’ health care programs, a problem that has disrupted services provided by the Department of Veterans Affairs for decades, officials say.

The bill, which has been a major lobbying priority of veterans’ organizations in Washington, would allow Congress to appropriate funds for health care programs one year in advance.

Officials say that for 19 of the last 22 years, the department’s budget has been approved late, usually because of fiscal wrangling on Capitol Hill. As a result, veterans’ groups and officials say, the directors of veterans’ health care centers and clinics have often been unable to proceed on time with new services, staff expansions or renovations.

“Our veterans pay the price with fewer doctors, longer waiting times and more restricted access for the six million veterans using V.A. health care,” said Representative Bob Filner, Democrat of California and chairman of the House Committee on Veterans’ Affairs.

Under current rules, if a new budget is not in place by the start of the federal fiscal year on Oct. 1, the Department of Veterans Affairs is required to operate on its previous year’s budget. Often, those budgets have lacked money to pay for even existing programs because of inflation, contractual increases and growing caseloads.

Programs have often been postponed or canceled while hospitals and clinics await their new budgets, officials said.

“If there were scheduled pay raises, we wouldn’t have sufficient funds to maintain the status quo, because the pay raise would have to be paid,” said Bob Perreault, a former director of veterans’ health centers in Atlanta, Philadelphia and Charleston, S.C. “That means we would not buy equipment and not do maintenance projects.”

Veterans’ groups say the problem has become more troubling as caseloads have grown with veterans returning from the wars in Iraq and Afghanistan.

“When you have a flat-line budget, you can’t treat the new people coming into the system, which leads to rationing,” said Peter Dickinson, a consultant to Disabled American Veterans, an advocacy group.

A similar bill sponsored by Senator Daniel K. Akaka, Democrat of Hawaii and the chairman of the Committee on Veterans’ Affairs, has bipartisan support and is expected to pass the full Senate.

President Obama has endorsed the idea of advance appropriations for veterans’ health care. In testimony before the House veterans committee in March, Veterans Affairs Secretary Eric Shinseki said: “The care our veterans receive should never be hindered by budget delays. I share the president’s concern as well as his support for advance appropriations as a way to provide uninterrupted care.”

In addition, the House Appropriations Committee approved a bill that appropriates $48.2 billion for veterans’ medical care in the 2011 fiscal year.

About 1,500 mental health clients in El Paso to be put on waiting lists because of budget problems

From The El Paso Times:

EL PASO -- About 1,500 people with mental health-care needs will soon be placed on a waiting list, administrators of a mental- health center have decided.

The El Paso Mental Health and Mental Retardation Authority's board has voted to cut those people from regular services because of budget problems. Starting Sept. 1, those on the waiting list will not have immediate access to medication and therapy, the agency decided.

Minnesota disabled people left without rides because legislature cancels contract with ride-coordination company

From The Star-Tribune:

About 1 million rides were arranged last year for disabled metro-area residents who needed transportation to their doctor's appointments. They used a ride-coordinating system financed by the state.

But in a surprise move, the Legislature eliminated the roughly $2.5 million funding for the company that coordinates their rides, effective July 1.

That means metro counties have just weeks to try to cobble together a new system to move thousands of disabled people to often-critical doctor's appointments.

"I can't understand how they expected us to pull this together so quickly," said Monty Martin, human services director for Ramsey County, which averages 20,000 rides a month. "For Ramsey County alone, it would involve hiring 10 staff, introducing a sophisticated phone system we currently don't have, as well as a new computer system allowing us to connect with all the transportation providers."

Other counties are equally unprepared.

"We were contacted by the Minnesota Department of Human Services about five weeks ago, asking what telephone number they should give clients to call," said Jerry Soma, who oversees human services in Anoka County.

"My response was, 'We don't have one!'"

In a swift move of solidarity, nine of the 11 counties that had used the service have proposed temporarily paying for it themselves until they can figure out another plan. County boards in Ramsey, Hennepin, Anoka and other counties will consider the proposal June 23.

At issue is the Minnesota Non Emergency Transportation program serving the 11-county metro area. It is available to about 220,000 people with physical and mental disabilities enrolled in Medical Assistance. The centralized system was introduced in 2005 to make their ride coordination more efficient, user-friendly and inexpensive, human services officials said. This news comes on the heels of reports that the dial-a-ride program for seniors also is in disarray.

Sen. Kathy Sheran, DFL-Mankato, chief author of the measure to end the funding, said the program's funding was cut to help balance the human services budget and to free up money for rate increases for outstate transportation service.

"It was a nice service but not an essential service in this time of budget deficits," she said.

Sheran said there also were concerns about the quality of some of the providers and possible conflicts of interest with the company operating the program. The program is operated by Medical Transportation Management, a Missouri company that runs similar programs around the country.

But county officials, and those with the Minnesota Department of Human Services, disagree. They note that the company has staff that speak several languages, has a software system that ensures the correct mileage is billed, and offers other features that make it the most efficient way to administer the roughly 85,000 rides each month.

"It was an efficient way to arrange transportation and it worked well," said Brian Osberg, assistant commissioner with Human Services. "It doesn't make sense to have counties come up with their own plans when we can do it through one arrangement."

The Human Services Department, in fact, had proposed expanding the service to outstate Minnesota during the past legislative session, Osberg said. And Gov. Tim Pawlenty singled out the transportation cuts as an area of "significant concern" when he signed the human services bill in May.

Elizabeth Demski, an office specialist at the Minnesota State Council on Disability, said people like her rely on the service. Demski, who suffers from epilepsy, diabetes and leukemia, said she must see medical specialists scattered across the metro area. Having one place to call to coordinate the often-complicated routes is very helpful, she said.

"Just to see my internist is three buses," Demski said. "That's more than an hour of travel time if I hit everything right. What I like about this service is they pick me up at my door and drop me off at the door of my doctor's office."

That said, the state disability council has received complaints about how some clients are treated by drivers as well as some delays, said Joan Willshire, executive director of the council. But that's a different issue than cutting funding with little advance notice.

"There was no planning whatsoever," she said.

The cost of running the program was $5 million a year, shared equally by the state and federal government, according to the human services department. Counties are prepared to pick up the cost for the remainder of 2009, until they can figure out how -- or whether -- to create their own program.

For Hennepin County, the estimated $947,000 cost to continue using the service for the next six months may actually be cheaper than hiring and training 17 staff members to run the program and getting the needed computer software, said Bill Brumfield, county human services director.

The county would get reimbursed half of the cost from Washington, he said.

"This is a big deal,'' Brumfield said. "If you're sick and need to get back and forth the doctor, this is how you'd do it."

Michigan State receives $2.1 million for autism research

From The AP:

EAST LANSING, Mich. - Michigan State University has received a three-year, $2.1 million federal grant to help coordinate a large epidemiological study of autism.

The school says its Biomedical Research Informatics Core will collect data from about 3,000 families.

Principal researcher Phil Reed says the university is working with the U.S. Centers for Disease Control and Prevention on "the largest study ever conducted designed to help identify factors that may put children at risk" for autism.

The work at Michigan State is part of a 10-year study to try to find what might put children at risk for autism and related disorders.

The study sites are in California, Colorado, Maryland, North Carolina, Pennsylvania and the CDC in Atlanta.

Thai blindness group demands apology for government official's comment that blind people are "legally incompetent"

From The Nation in Thailand:

Representatives of the blind on June 21 demanded an apology from Interior Minister Chaovarat Chanweerakul for his comment that blind people were legally incompetent.

Thailand Association of the Blind president, Senator Montien Boonton, and Law lecturer from Thammasat University Wiriya Namsiripongpan held a press conference about the minister's comment.

Chaowarat said in an an interview with Matichon newspapers on June 11 that giving Bt2,000 to the blind was not a vote buying action because blind persons were legally incompetent and not eligible to vote.

Monthien said such a comment reflected a negative viewpoint against the blind and a lack of maturity, especially from a man who was former social development and human security minister.

He explained the blind were not legally incompetent because the civil law's article 28 stipulated that legal incompetence required a court order, therefore blind people were not incompetent.

Besides, there was no law indicating the blind had no right to vote as casting ballots was a Thai citizen's duty, he said.

Monthien said that, knowing the government had such an immature person in its ranks, he as a senator could no longer trust this person to be among decision makers on the country's budget.