Health Association in New York State, Inc.
Friday Fax from Albany
SAVE THE DATE - MHANYS AWARDS DINNER AND CONFERENCE ON OCTOBER 20-21, 2005: On October 20th, MHANYS is holding its awards dinner honoring the great work of our membership and our friends in the mental health community. After the dinner, we will be showing the one hour award winning documentary, Out of the Shadows, featuring the moving story of Millie Smiley. Susan Smiley, Millie’s daughter and the chief architect of this documentary, will be on hand at our viewing. We hope that you will join us for our awards dinner and stay for the documentary The Wall Street Journal says, “Movingly captures a side of schizophrenia that few of us ever see, revealing the humanity behind the disease.”
On the following day, October 21st, we will be holding a one day conference on topics including Medicare Part D, PROS, Juvenile Justice, Childhood Depression and several other relevant topics.
All events will take place at the Marriott Hotel in Albany and all our welcome to attend. Look for more information in the coming weeks.
MHANYS ON THE ROAD FOR MEDICARE PART D: Last week, MHANYS’ staff attended a workshop hosted by the MHA of Greater St. Louis (MO) at which the National Mental Health Association provided attendees with a plethora of information on the implementation of the Medicare prescription drug benefit (Medicare Part D) that will take effect in January as part of the Medicare Modernization Act recently enacted by the President and Congress. This will have a huge impact on individuals with mental health needs throughout the country and here in New York, especially those who are presently enrolled in both Medicaid and Medicare (‘dual eligibles’).
Essentially, those ‘dual eligibles’ will no longer be provided with drug coverage through Medicaid, but Medicare, and will need to enroll in the program and choose the benefit plan that best fits their needs. In an upcoming edition of the Friday Fax from Albany, we will provide much more detail on the Medicare Part D program and what it means for New Yorkers living with mental health needs, as well as details on our efforts to ensure a smooth transition from Medicaid to Medicare for this population of people which will include a website dedicated solely to Medicare Part D in New York State.
In the meantime, following in the In The News section is an article recently published in The New York Times that details some of the difficulties this transition will face.
Privileged to have been invited to participate in this discussion, MHANYS voiced concern over particular legislative proposals that would permit authorities to civilly committed certain sex offenders to a mental health facility, such as a secure psychiatric center, after they have served their sentence in jail or prison. While we believe just as strongly as others that the public must be protected from dangerous individuals who have a high propensity to reoffend, we have deep concerns about the appropriateness of placing such individuals in the mental health system.
Typically, sex offenders are dealt with in the criminal justice system where a variety of treatments and services, both in prisons and on parole after release, have proven somewhat successful in halting such behaviors. The mental health system currently has little experience or capacity to handle such people. Psychiatric centers are facilities dedicated specifically to helping individuals with the most serious psychiatric disabilities recovery from those mental illnesses.
However, according to many of the experts at the roundtable discussion, there is a cadre of offenders who have committed the most heinous of sex crimes for whom treatment is not typically successful and who are likely to reoffend with or without treatment. Understanding that psychiatric centers are specifically designed to be therapeutic environments in which people living with mental illness can find the road to recovery, it appears that this environment would be inappropriate for untreatable sex offenders. Further, it seems that putting such predators in with vulnerable people would invite additional sexually deviant behavior, whereas prisons and jails are typically much more restrictive of behavior that could lead to such acts.
As it appears that the primary intention is to keep high risk sex offenders off the streets, MHANYS believes that keeping them in the criminal justice system longer, rather than placing them in the mental health system at a significantly higher cost, makes more sense.
An article on the Assembly’s roundtable discussion follows in the In The News section.
“SAVING CARRICK”: On July 29th, Dateline NBC will air “Saving Carrick,” which documents 16 months of a Westchester County family’s struggle to get insurance coverage for their daughter’s mental health and addiction needs.
MHANYS SEEKS DIRECTOR OF CONSUMER AND BUSINESS OUTREACH: Director, Consumer and Business Outreach for private, nonprofit agency.: Full time – 35 hr/wk. Implement, manage, and enhance employment retention for employees living with mental illness; promote employment opportunities for mental health consumers with the New York State business community for competitive, private sector employment. Qualifications: 4-year college degree and experience related to mental health services specific to consumer needs; experience in or knowledge of employee assistance programs; ability to promote business development, design curriculum and deliver trainings. Occasional travel. Starting low to mid thirties & benefits. The Mental Health Association in New York State is an equal opportunity employer. Send or fax resume to: email@example.com, or 194 Washington Ave. #415, Albany, NY 12210. FAX: (518) 427-8676.
THE NEWS: While we will not include the lengthy stories featured this
week in The New York Times on the state’s enforcement issues
regarding fraudulent Medicaid claims, we hope that you will consider reading
each article on The New York Times website at:
Pitch for Drug Plan Meets Skeptics. By Robert Pear
SCARBOROUGH, Me., July 15 - Four months before enrollment begins, the Bush administration has started a cross-country campaign to sell its most significant domestic policy initiative, the new Medicare drug benefit. But it is encountering skepticism from some consumers, whose participation is critical to the program's success.
In a stop here, four top Bush administration officials, including the surgeon general of the United States, said the drug benefit would be a boon to retirees, worth $1,300 a year to a typical recipient and much more to those with low incomes.
But the officials offered none of the details that would have allowed beneficiaries to judge for themselves. Crucial information, like the monthly premiums and the names of covered drugs, will not be available until mid-September.
After hearing federal officials praise the program for about 45 minutes, Joan M. Jenness, 72, of Bridgton, Me., said: "I heard nothing I had not heard before. I still have lots of questions."
Everyone enrolled in Medicare is eligible for prescription drug coverage. But public opinion polls suggest that many people have not heard about the new benefit or do not understand it, and many have not decided whether to sign up for it.
The economics of the new program depend on the assumption that large numbers of relatively healthy people will enroll and pay premiums, to help defray the costs of those with high drug expenses. Insurers say the new program cannot survive if the only people who sign up are heavy users of prescription drugs.
That is why President Bush flew to Minnesota last month to open a national "education and outreach" tour, and why other officials have taken the message to Florida and South Carolina.
This week's bus tour rolled into Maine, New Hampshire, Massachusetts and Rhode Island with a twofold purpose: to educate consumers and to galvanize community groups, which are needed to help people enroll. The campaign is headed for Chicago, Milwaukee, Indianapolis, Cincinnati and Dayton, Ohio, next week.
On Tuesday, more than 30 organizations plan to announce a coordinated national effort, including a television advertising campaign, to disseminate information on the Medicare drug benefit. The organizations include AARP and groups representing doctors, pharmacists, insurance companies and people with chronic diseases.
Federal officials face a huge task in trying to educate the 42 million Medicare enrollees about a drug benefit that differs radically from the traditional fee-for-service program. In this Portland suburb, that challenge was on display.
People who said they were healthy said they saw no immediate need to buy the Medicare drug coverage. People who said they were ill said the benefit seemed meager. And local insurance counselors said they shuddered at the complexity of the program.
Officials arrived in a big blue bus painted with the message that people could sign up for the drug benefit on Nov. 15, for coverage beginning on Jan. 1. Dr. Mark B. McClellan, administrator of the federal Centers for Medicare and Medicaid Services, explained why federal officials were here.
"What matters most," Dr. McClellan said, "is not what happens in Washington, but what happens all over the country as people make decisions about their health care and prescription drug coverage."
In deciding whether to sign up for the drug benefit, people will want to evaluate whether they will be getting their money's worth. That depends, in part, on how much they currently spend on drugs.
Health policy specialists say the new benefit will generally be a good deal for low-income people, who are entitled to extra subsidies, and for people with drug costs exceeding $5,100 a year, since Medicare will pay about 95 percent of the cost of each prescription beyond that point. People who have solid drug coverage from other sources, like a former employer or the veterans' health program, may not see a need to sign up immediately for the Medicare drug benefit.
Maine is a good state in which to sample public sentiment about the benefit. About 18 percent of residents, - 239,000 of 1.3 million, are on Medicare. Concern about drug costs figures prominently in state politics. Because Maine is on the Canadian border, residents have ready access to information on drug prices in Canada.
In addition, Maine has been a leader in devising state programs to reduce drug costs. It defended one such program all the way to the United States Supreme Court.
The event here was held at the Southern Maine Agency on Aging, a nonprofit organization that offers counseling and other services. Federal officials are counting on such agencies to help beneficiaries select drug plans.
As he welcomed visiting officials on Wednesday, Laurence W. Gross, executive director of the agency, described the drug benefit as "one of the most important changes in Medicare in 35 years."
But Mr. Gross has yet to persuade his mother, Lisette V. DeBruycker. "I'm betwixt and between," said Ms. DeBruycker, 81. "I don't take any medications aside from an occasional aspirin. What will the new program do for me?"
Richard E. Robbins, 72, said he would probably sign up, although he uses only a few hundred dollars' worth of drugs in a year. "It's a no-brainer," he said. "The drug coverage is a safety net. We never know from day to day what our needs will be."
Many Democrats adamantly opposed the drug bill when Republicans pushed it through Congress in 2003. Democrats denounced the measure as a giveaway to drug companies and insurers. But Gov. John Baldacci of Maine, a Democrat, is working with the Bush administration to help people enroll.
"This is not the drug benefit we would have designed," said Jude E. Walsh, the governor's top adviser on pharmacy programs. "But we have no choice. It's coming whether we want it or not. We are trying to make it work for vulnerable people in the state of Maine."
The officials who barnstormed through New England called themselves "the four docs." Besides Dr. McClellan, those visiting were Surgeon General Richard H. Carmona; Julie L. Gerberding, director of the Centers for Disease Control and Prevention; and Elias A. Zerhouni, director of the National Institutes of Health.
In establishing the drug benefit, Congress and Mr. Bush are trying to inject market forces into the traditional Medicare program.
Under the law, Medicare will subsidize drug coverage offered by private insurers if it is at least as generous as a standard benefit defined by Congress. Private plans can charge different premiums and co-payments and will cover different drugs, creating a potentially confusing situation for beneficiaries.
Carmela Decker, 74, of Portland, asked, "Wouldn't it have been easier if Medicare had just established a prescription plan and said, 'We will pay 80 percent of the cost'?" Medicare typically pays doctors 80 percent of the approved amount for treating Medicare patients.
Mr. Bush and Congressional Republicans wanted to create a market in which insurers would compete for Medicare business by offering better benefits at lower prices. Maine officials said they expected 10 or 12 drug plans to be offered here.
Estimates of enrollment nationwide are uncertain. In the Federal Register of Jan. 28, the Bush administration predicted that 39 million people would receive drug coverage in 2006 through a Medicare plan or an employer-sponsored health plan subsidized by Medicare. In June, Michael O. Leavitt, the secretary of health and human services, predicted that 28 million to 30 million people would receive such coverage.
Carol S. Rancourt, coordinator of health insurance counseling at the Southern Maine Agency on Aging, said, "My biggest fear is that people will be confused by the large number of options, will be shocked into inertia and will just do nothing."
Many people are automatically enrolled in Medicare when they turn 65, Ms. Rancourt said. But, she added, most beneficiaries must "make an affirmative choice to enroll in the drug benefit."
policies fuel debate in NYC. By Bill Hughes
NEW YORK — The imagery of "gulags and modern leper colonies" contrasted with confining "dogs that we know are going to bite people" were invoked yesterday at a round-table meeting called by state legislators to discuss expanding criminal penalties and civil commitment for sex offenders.
A panel of 15 speakers from an assortment of groups representing prosecutors and defense lawyers, along with advocates for victims' rights, legal ethics and mental-health treatment, met in lower Manhattan to discuss a controversial bill pending in the Assembly.
The bill, which passed in the Senate in April, would amend the state's existing mental hygiene law in ways critics called too broad but supporters insisted are necessary to allow the state to keep inmates in jail or on lifetime parole if they are deemed likely to repeat their offenses.
Much of the debate at yesterday's meeting centered on who would get to make the decisions, how to predict the future and whether it makes sense to require rigorous enforcement of laws and penalties that are already on the books but are routinely nullified by plea bargains.
Officials present included Westchester County Chief Assistant District Attorney Richard Weill and Assemblyman Gary Pretlow, D-Mount Vernon. The Assembly came under fire by local officials for not passing the bill before the end of its session last month.
That session ended days before the attack on Concetta Russo-Carriero of White Plains, who was fatally stabbed by a homeless convicted rapist who served more than two decades in prison before his release in 2003.
Under pressure to hold a special session to consider the bill, the chairmen of the Assembly's committees on codes, correction and mental health convened yesterday's meeting and have promised to conduct a hearing in the fall before deciding whether to pass it.
Under the proposed legislation, several sex crimes would be raised to the level of Class A felonies, which would enable prosecutors to seek a sentence of life without parole. Advocates, including Weill, mentioned the statistically rare and extreme cases such as Russo-Carriero's slaying as proof of the need for the change in the law. But critics called the bill a "wish list for prosecutors," with some terms broadly defined and others not defined at all.
"To do this under civil commitment seems to me to be a bait and switch," said Michelle Maxian of the Legal Aid Society in New York. "(Prosecutors) can go ahead and bargain down an A-felony to whatever they like, knowing they can turn it into a life sentence down the line."
Other critics complained the legislation would cast too wide a net and result in the commitment of up to 1,000 inmates a year at a high cost to taxpayers.
Weill, who appeared on behalf of the New York State District Attorney's Association, said there are approximately 550,000 convicted sex offenders in the country, roughly 3,000 of whom have been subjected to civil commitment.
"When you consider that we're talking about the upper echelon of the most dangerous offenders, that's not a whole lot," Weill said.
new director excited by challenge - Stephen Butler hopes to boost agency's
position in community, add services. By Frank Brieaddy
Faced with declining revenues, the Mental Health Association of Onondaga County is poised for a reassessment of its mission and has appointed a new executive director who says he relishes the challenge.
"I am a very passionate believer in strategic planning," said Stephen N. Butler, a native of Central New York who returned from employment in New York City to get his master's degree in public administration from Syracuse University's Maxwell School of Citizenship and Public Affairs and decided to stay.
"Our search committee reviewed more than 30 applications for this position," said MHA board President Gregg Phillips. "Among the highly qualified finalists, Steve stood out in the minds of every member of the committee as the person we wanted as executive director."
Butler is a graduate of the Baldwinsville school system and has a bachelor's degree in theater from State University College at Oswego. He developed an interest in performing arts as therapy for mental health patients. It led to a 20-year career in nonprofits.
Most recently he was executive director of Creative Alternatives of New York, a nonprofit associated with the Department of Psychiatry at Mount Sinai Medical Center in New York City. The nonprofit involved about 1,000 groups of mental health patients a year in theater-as-therapy projects.
While working on his master's degree, Butler, 47, served as interim director of the Appleseed Trust, which provides business training for novice entrepreneurs.
The Mental Health Association's budget dropped in the past year from $395,000 to about $300,000, mostly as a result of cuts in government grants, Butler said.
One of his primary goals, he said, is to help the agency focus its role within the community with a strategic plan that will involve input from mental health professionals, organizations in the field and consumers.
"I think the MHA can play a critical role in bringing people together," he said.
He also hopes to increase services for children and raising funds for the nonprofit.
Butler said he's interested in local efforts to use performing arts as mental health therapy, but it isn't high on his current to-do list.
The Mental Health Association has a full-time staff of three. Phillips declined to reveal Butler's salary.
His immediate predecessor, Leo Friel, held the position for almost six months at a salary of $35,000 a year.
"It just wasn't a good mix," Phillips said of Friel's departure.
Alfred Fusco, who ran the nonprofit for 24 years before Friel, returned as interim director for six months until Butler was appointed.
Founded in 1962, the MHA offers many programs and services generally grouped in the categories of advocacy, education, and information and referral.
Programs include anger management; anorexia-bulimia support; Children 1st! for separating and divorcing parents; Community Companions, which pairs clients with a friend; and STRIVE, a support group for parents.
Butler said he would like to eventually expend the agency's support group offerings.
For more information on these and other services, the MHA can be reached at (607) 445-5606 or at http://www.mha-oc.org.
health courts merit widespread support. Letter to the Editor
The June 19 editorial, "When the accused are ill," spoke directly and succinctly to the travails faced by people with a serious mental illness who wind up in the criminal justice system. Specifically, you cite the need for reform in how the judicial system deals with cases in which a defendant invokes an insanity defense, and the usefulness of mental health courts for those people whose criminal responsibility is mitigated by their psychiatric disorder.
Many in the legal and mental health community believe the current standard for being able to invoke a full mental health defense -- that the defendant "knows" an action is right or wrong -- is woefully inadequate and downright unfair.
The Wilhelm case in Rensselaer County, which you cite, is a classic case in which compelling psychiatric testimony was insufficient to convince a jury that the defendant should have been found "not responsible" and committed to long-term hospitalization. The Yates case in Texas and the tragic case involving Ralph Tortorici in Albany County in 1996 are also testament to a flawed standard for criminal responsibility.
The American Bar Association has taken a position that the standard employed in most states is too narrow. In its place, the bar association has adopted a model statute, which proposes an alternative approach that would hinge on whether a person lacked substantial capacity to "appreciate" the wrongfulness of his action, or was incapable because of illness to conforming conduct to the law.
NAMI-NYS joins the Times Union in urging the state Legislature to revisit this area of the law and to look at the American Bar Association's Model Standard for guidance and direction in fashioning a more just statute.
NAMI-NYS is familiar with each mental health court in this state, and there is no question but such courts are able to intervene in a constructive way in the lives of many people. As such, we are enthusiastic about the interest shown by both Albany County and Schenectady County in considering such courts. While NAMI has been out front in supporting the development of such courts, these courts can only be as effective as mental health resources permit in any jurisdiction. And there is virtually nowhere in this state where the range of mental health resources comes close to meeting the demand for ordinary services, let alone the kinds of services needed by a criminal justice population.
Perhaps as more counties establish mental health courts, we will be able to galvanize the support of judges, district attorneys, public defenders and others to strengthen our advocacy efforts to create the array of services so vitally needed.
oppose Timothy's legislation. By Cara Matthews
Anger is a very powerful emotion, and it's one that fuels Tom O'Clair's daily activities.
Four years ago, the 45-year-old Schenectady resident's youngest son, Timothy, took his own life.
The suicide came after a 4 1/2-year battle to get 12-year-old Timothy the intensive mental health care he needed. The maximum of 20 outpatient therapy sessions a year would be used up before June each year, O'Clair said. The family went so far as to put Timothy in foster care to get Medicaid coverage so he could be hospitalized. He had attention deficit hyperactivity disorder and oppositional defiant disorder in addition to depression.
"It was a very drastic move and the hardest decision we ever had to make, short of choosing a casket," said O'Clair, a New York State Thruway Authority worker.
In 2003, O'Clair and his wife, Donna, loaned Timothy's name to a state bill that would bar insurers from limiting coverage of mental health and substance abuse problems. The legislative session has closed each year without Timothy's Law's passage. This year, lawmakers could not agree on whether to exempt companies with 50 or fewer employees.
"Every year, I feel we're getting close, but it is taking much longer than it should," said O'Clair, whose other sons are 19 and 21.
Thirty-five states have passed parity legislation, although they vary greatly in the level of equality they provide, the National Mental Health Association said. Treating mental illness early and adequately ultimately can reduce costs, said Michael Seereiter, public policy director for the Mental Health Association of New York State. Recovery rates are better than many physical ailments, he said.
Arguments against Timothy's Law include: Premiums would rise; use of benefits would surge; competitiveness would be hampered.
Parity would be the latest in a long string of mandates imposed on business, said Elliott Shaw, director of government affairs for the Business Council of New York State Inc. That would further drive up costs at a time when insurance expenses are skyrocketing. It would cripple companies — especially small ones — financially or force them to pass on costs to employees. The council supports the small-business exemption.
The council and other opponents cite an Employer Alliance for Affordable Health Care study that predicted a 3 percent increase in premiums a year.
But the Mental Health Association and other advocacy groups point to a 2002 PricewaterhouseCoopers actuarial study that estimated the cost of additional coverage at $1.26 a month per member. As with coverage for physical ailments, patients would not get unnecessary care, Seereiter said.
Large companies have an advantage over their smaller counterparts because they can self-insure and thus not be bound by mandates, Shaw said.
In a March 3 memorandum to the state Legislature, the National Federation of Independent Business said the increase in premiums could prompt employers to drop coverage altogether. The group represents 20,000 small-business owners in the state.
"New York's employers have seen double-digit increases in each of the past six years, and a large percentage of those increases were fueled by legislatively enacted state health insurance mandates," the memo said.
Proponents of the law say employers will benefit by having more productive workers. Tom O'Clair, who bears a tattoo with Timothy's face on his left bicep, said he lost 800 hours of work in the more than four years of caring for Timothy.
The family had financial difficulties because out-of-pocket expenses were so high, he said.
"At times we had to make a decision, 'Do we get groceries this week or get Timothy to the doctor?' "
O'Clair said advocates are "fighting money with morality," and the large number of suicides in New York — about 1,300 a year — is reason enough for the law.
Although disappointed by this year's failure, O'Clair said he would continue the campaign in the name of Timothy, a high-energy boy whose interests ranged from Little League and soccer to playing instruments and bowling. He hanged himself in his bedroom.
"He was the class clown," his dad said. "Everybody loved him."
stigma of suicide. By Cara Matthews
She remembered the special afternoon vividly — the escape into a sun room at a chilly barbecue last year, the eye contact and smiles between mother and daughter when they were spotted by a camera-wielding host.
When the friend recently dropped off the framed snapshot to Joan White, her irreplaceable loss came flooding back.
"I cried so hard Saturday night. I said, 'My God, you're going to hurt yourself,' " the West Nyack woman said as she rubbed a muscle she had strained from sobbing.
On Nov. 22, after telling her dad she was returning movies, 36-year-old Stephanie White jumped off the Tappan Zee Bridge and died in her 200-foot fall.
Stephanie's final decision, reached after 12 years of crippling mental illness, placed her among legions of New Yorkers who decide each year that death is the best option. What has been called a silent epidemic is the leading cause of violent death in the state and nationwide. There were 1,292 completed suicides in New York three years ago, which exceeded the number of homicide victims by 32 percent, according to "Saving Lives in New York: Suicide Prevention and Public Health."
Joan White said it's upsetting her daughter was in such pain. Bipolar and obsessive-compulsive disorders robbed her of the life she wanted. In the end, Stephanie — a scholar who had to cut short her doctoral work in Victorian literature — was on six medications and suffered from side effects. Difficulty finding work had lowered her self-esteem.
White said she would like to see more support groups and help for people who are at risk of taking their own lives because of mental illness.
"It's nothing to be ashamed about. That's No. 1," she said.
Suicide is a major public-health challenge that hasn't gotten the national priority and attention it merits, state Mental Health Commissioner Sharon Carpinello said.
"Saving Lives," which the Office of Mental Health released in May, underscores New York's commitment to treating suicide as a societal problem that can be prevented, rather than an ambiguous and "largely unpredictable end-state of a severe psychological disorder."
"Silence and suicide go hand-in-hand. It's time to stand up and destigmatize the idea of mental illness and reach out," Carpinello said.
The profile of a typical suicide victim in the state is a middle-aged white man living in a rural upstate community and who has access to a gun. One in 25 people who take their own lives in the nation is a New Yorker. The suicide rate in the state peaked in 1994, then declined until stabilizing in 1999 at 6.7 deaths per 100,000 people, the recently released report stated.
"Saving Lives" came a year after the agency launched its SPEAK — Suicide Prevention Education Awareness Kits — campaign. More than 18,000 packets have been distributed so far.
Carpinello singled out some successful early intervention programs. Locally, Columbia University's TeenScreen offers voluntary mental-health checkups at 350 sites. None are in the tri-county region. Recent research has shown that talking about the topic with kids does not cause more suicides, as many had believed.
On a national level, legislation named for Garrett Lee Smith, who took his own life, provided $82 million for youth suicide prevention, she said. He was the son of Sen. Gordon Smith, R-Ore. President Bush's New Freedom Commission on Mental Health reported in 2003 that just managing mental illness no longer was enough; recovery is possible. A National Strategy for Suicide Prevention came out in 2001.
Rhona Seligman, 47, of Irvington, whose husband, Marc, killed himself by jumping off the Tappan Zee this month, said anyone who has a friend or family member who's even a little depressed should take it very seriously. Marc Seligman had visited a psychotherapist a few times before his death, she said, but there apparently was no indication he was suicidal. The 45-year-old chiropractor had a lot of stress and frustration in his career. His brother killed himself at age 17, so it's possible genetics or other factors were at play, she said.
"He was young and vibrant and had a great, outgoing personality. Over the years, things just wore him down, I guess. Life," she said.
Her husband was a great dad and assured their 9-year-old daughter in a note that what he did was not her fault, she said.
The process of accepting mental illness as a valid ailment is not unlike the evolution of AIDS, said Tom O'Clair of Schenectady, whose son, Timothy, took his own life in March 2001. That disease no longer is shrouded in mystery and, as a result, there is less fear of those who are afflicted with it.
"Mental illness is one of the ones that's taking the longest to get that stigma removed or eliminated," O'Clair said.
Gail Brajevich of Lake Carmel said a teenage relative has tried more than once to take his own life. She might have lost him if she hadn't been open about his bipolar disorder and asked others to look out for him. She often stays up nights to make sure he doesn't harm himself, she said.
"It takes a whole community to raise a child like him," said Brajevich, 56, who has received help from Putnam Family Support and Advocacy and other groups.
Brajevich said the teen has been in treatment since first grade. "It makes him ashamed. He doesn't like to discuss it or talk about it," she said.
The late Ed Gallagher of New Rochelle, who became a quadriplegic after purposely rolling off the edge of the Kensico Dam in 1985 in a suicide attempt, turned his personal experience into a life of advocacy for suicide prevention.
He tried to kill himself because he had been ashamed he was gay. But Gallagher, who was 48 when he died of a heart condition in May, spoke to kids, professionals and civic groups; wrote three books; and ran www.alivetothrive.org. The Web site gives information about prevention, emotional and sexual health and other issues.
Lisa Tarricone said she and Gallagher met at the Burke Rehabilitation Hospital in White Plains, where she was recovering from a hiking accident. Gallagher, who was recovering from his fall off the dam, was charismatic and skilled at drawing people out, and it was therapeutic for him to counsel others, said Tarricone, who used to co-present with him.
"He had a great time doing it. Eddie enjoyed life. He loved public speaking. He loved giving back," said Tarricone, a paraplegic who works for Westchester Independent Living Center.
Nancy Tadler Winchell of Mahopac reluctantly joined those who have lost loved ones to suicide when her 16-year-old niece took her life Dec. 16, 2001.
Her suicide note said she wanted to end the pain, said Winchell, who is married with three girls, ages 5, 8 and 16, and a son, 13.
Winchell, 47, said she realized then just how many people in her past had killed themselves or tried to. She unconsciously started evaluating family, friends and strangers and did bed-checks of her kids for months, she said.
The stigma of suicide hit when a family member asked what cover story they would use to explain her niece's death. People should be as comfortable discussing mental illness as they are broken legs, she said.
"I just think that we have to find a way to break through so that everyone is comfortable to talk about it. That's why I do what I do," said Winchell, an accountant.
Soon after, she learned of the American Foundation for Suicide Prevention and its "Out of the Darkness" walks. The first year she did it was 2002, along with her sister — her niece's mother — and sister-in-law.
"You went from where you're isolating yourself from going out ... to being somewhere you felt completely at home," she said.
Winchell will be among some 2,150 people who will do the 20-mile, sundown-to-sunrise walk in Chicago this weekend.
The Manhattan-based foundation was established in 1987 to promote research on suicide. Its mission has grown, said Robert Gebbia, executive director. The group has been working, particularly in the past 18 months, to form local affiliates to provide education and promote awareness of suicide. One target area is the northern suburbs. This is the second year the group is sponsoring a community walk in New Rochelle. It is planned for Oct. 2.
"I think we're just starting to see a real change. It's an enormous problem. It affects so many people. There are more than 1 million attempts each year in this country," Gebbia said.
Mary Jean Coleman, executive director of the Samaritans Suicide Prevention Center, said losing her brother to suicide 25 years ago drives her work. Her group takes between 8,000 and 10,000 calls a year in the Albany region.
"We have such hope for the future. Twenty-five years ago, there was such shame and stigma and silence," said Coleman, a New York State Suicide Prevention Council member and contributor to "Saving Lives."
Joan White, who works at a local college, continues writing daily "letters" to Stephanie, who was a companion as well as a daughter. Stephanie's two Siamese cats, who used to crowd around when the two drank afternoon tea, roam the quiet home.
White believes her family did everything they could to help Stephanie, the youngest of three girls, but she didn't want to go on living as she was. When the medicines worked, she was OK. Side effects included sleep disturbances, psychotic episodes and trembling. She had dealt with mental illness for years before graduate school, but she had her first major depression there. After that, her inner light never rekindled, her mom said. She emphasized the importance of doctors and families closely monitoring patients on medications.
After leaving graduate school, Stephanie taught as an adjunct professor at two colleges in Rockland for several years. She found it stressful and considered veterinary medicine or library science, but permanent employment remained elusive. At one point, she volunteered at a health center but lost the job to an aide, Joan White said.
White keeps an unwashed sweat shirt of Stephanie's and is compiling dozens of her daughter's poems and stories into a volume. The two used to harmonize "Blue Skies." Now, every beautiful day reminds her of Stephanie.
"Sometimes, I look outside and I say, 'My God, you're all around today,' " Joan White said.
needed on mental health costs. Letter to the Editor
As long as the effort to end insurance discrimination against people living with mental health and addiction needs has been afoot, insurance companies have been arguing that passing such legislation would raise health insurance costs to where no one could afford it.
Even in the face of studies on parity laws in other states that have shown the increase to amount to 1 percent to 2 percent, insurance companies have maintained their position.
Now there is evidence by the Bush administration's Department of Health and Human Services that finds the cost of providing the 8-plus million federal employees, retirees and their families with complete parity-based mental health and addiction coverage at an additional 1 percent.
As the title of your article ("Costly limits for mental health persist," July 4) suggests, the real costs are those realized by families like Michael's who either pay exorbitant co-pays or even higher out-of-pocket prices for mental health and addiction services. Financial costs are nothing compared to what families pay when a loved one is in crisis, when parents are forced to relinquish custody of their children to access services, or the impact that suicide, like Timothy O'Clair's, has on a family.
The debate over how much Timothy's Law will raise insurance costs is over. Now it's time to pass this legislation to eliminate these unbearable costs on families.
health care parity needed now. Letter to the Editor
Timothy's Law, an attempt to force health insurers to provide the same level of coverage for mental disorders as for physical ones, failed to pass the state Legislature once again. The Capital District Branch of the American Psychiatric Association commends the Times Union for its July 4 front-page coverage of this issue.
The article points out the 20-visit limit for treatment of mental disorders and the financial burden on the patient and their families imposed by a 70 percent co-pay after the first five visits. These practices fail to consider chronic mental illnesses such as bipolar disorder, major depression and schizophrenia.
Many mental disorders resemble chronic conditions like diabetes or hypertension in that symptoms require monitoring to keep patients in remission and good health. But this can only be done when the resources are provided for appropriate treatment.
No one would consider treating only one of three blocked coronary arteries, because we know that it is more cost-effective to treat thoroughly as soon as possible. Patients with leukemia are not left to struggle with their illness after a set number of visits or penalized for relapses.
The same attitude must be applied to mental disorders rather than punishing people who have the misfortune of becoming ill.